14 research outputs found
Gendered and Social Hierarchies in Problem Representation and Policy Processes: ‘Domestic Violence’ in Finland and Scotland
This article identifies and critiques presumptions about gender and violence that continue to frame and inform the processes of policy formation and implementation on domestic violence. It also deconstructs the agendered nature of policy as gendered, multilevel individual and collective action. Drawing on comparative illustrative material from Finland and Scotland, we discuss how national policies and discourses emphasize physical forms of violence, place the onus on the agency of women, and encourage a narrow conceptualization of violence in relationships. The two countries do this in somewhat comparable, though different ways operating within distinct national gender contexts.The complex interweaving of masculinities, violence, and cultures, although recognized in many debates, is seemingly marginalized from dominant discourses, policy, and legal processes. Despite growth in critical studies on men, there is little attempt made to problematize the gendered nature of violence. Rather, policy and service outcomes reflect processes through which individualized and masculine discourses frame ideas, discourses, and policy work. Women experiencing violence are constructed as victims and potential survivors of violence, although the social and gendered hierarchies evident in policies and services result in longer-term inequities and suffering for women and their dependents
Outreach programmes for health improvement of Traveller Communities: a synthesis of evidence
A randomised controlled trial to evaluate the impact of a human rights based approach to dementia care in inpatient ward and care home settings
BackgroundAlthough it is widely recognised that adopting a person-centred approach is beneficial in the care of people living with dementia, a gap remains between the rhetoric and the reality of quality care. Some widely adopted care practices can result in the personhood of this group being threatened and their human rights being undermined.ObjectivesTo evaluate the impact of applying a human rights based approach in dementia inpatient wards and care homes on the quality of care delivered and the well-being of the person living with dementia.DesignA cluster randomised design was employed to compare the impact of implementing a human rights based approach intervention (i.e. training, applying the ‘Getting It Right’ assessment tool and receiving booster sessions) at 10 intervention sites with 10 control sites.SettingEight NHS dementia inpatient wards and 12 care homes in the north-west of England.ParticipantsPeople living with dementia who were residing on dementia inpatient wards or in care homes, and staff working at these sites. The aim was to recruit 280 people living with dementia.InterventionsA sample of staff (an average of 8.9 per site) at each of the sites was trained in a human rights based approach to care, including the application of the ‘Getting It Right’ assessment tool. The tool was then introduced at the site and monthly booster sessions were delivered.Main outcome measuresThe primary outcome measure used in the research was the Quality of Life in Alzheimer’s Disease scale to assess the subjective well-being of the person with dementia. Secondary outcome measures included measures of the quality of care provided (dementia care mapping) and direct measures of the effectiveness of the training in increasing knowledge of and attitudes towards human rights. The study also included an economic evaluation utilising the EuroQol-5 Dimensions, three-level version, and the Adult Social Care Outcomes Toolkit measure.ResultsThe study recruited 439 people living with dementia: 213 to the intervention arm and 226 to the control arm. Primary outcome data were analysed using a linear mixed model. There were no significant differences found in the reported quality of life of residents between the control and intervention groups after the intervention [F(1,16.51) = 3.63;p = 0.074]. The mean difference between the groups was 1.48 (95% confidence interval –7.86 to 10.82).ConclusionsDespite the fact that the training increased staff knowledge of and positive attitudes towards human rights, and although there were some changes in staff decision-making strategies in clinical situations, there was no change in the quality of care provided or in the reported well-being of people living with dementia in these settings. This led to questions about the efficacy of training in bringing about cultural change and improving care practices.LimitationsThere was limited uptake of the training and booster sessions that were integral to the intervention.Future workFuture work could usefully focus on understanding the difficulty in translating change in attitude and knowledge into behaviour.Trial registrationCurrent Controlled Trials ISRCTN94553028.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 6, No. 13. See the NIHR Journals Library website for further project information.</jats:sec
Involving patient in the early stages of health technology assessment (HTA): a study protocol
Social policy for people with dementia in England: promoting human rights?
This paper discusses whether current UK social policy promotes the human rights of people with dementia living in England. The author focuses on the role of recent legal reforms and key developments in social care policy – notably the Mental Capacity Act 2005 and the 2009 National Dementia Strategy – in facilitating their human rights to liberty and self-determination, particularly a right to choose to live at home. The extent to which the National Dementia Strategy provides access to services and support which provide an alternative to institutional care is critiqued. Whilst recent legislative change has endorsed the rights of people with dementia to liberty and self-determination, it is suggested there is a lack of commitment in government policy more generally to providing access to social care to enable people with dementia to exercise these human rights