Using the hub and spoke student placement model in learning disability settings

The 'hub and spoke' model of placement learning began as an ad hoc arrangement. Now it has become de facto policy as student learners on placement are increasingly located across a range of different environments to take advantage of the various experiential opportunities that present. Most commentaries have focused on the experiences of those staff and students engaged on adult nursing programmes. Here we have adopted a small scale case study approach to get some insights into how the hub and spoke model actually feels for those people who engage with it in a joint learning disability and social work programme - students and placement providers

Intellectual disability, hate crime and other social constructions : A view from South Yorkshire

The category of hate crime is a recent legislative response to the increasing levels of anti-social, criminal and discriminatory behaviours and practices that target a wide spectrum of individuals on the basis of their identification within certain minority sociological subcultures. People with intellectual disability are often targeted for this kind of behaviour. Here we report on an evaluation of one English city's efforts to instigate a street-based scheme to offer some security and protection to its intellectually disabled citizens. The physical location of the premises and the engagement of the staff employed therein has some bearing on their potential to be effective in offering shelter and support to distressed individuals. But even where premises are well situated with positive staffing the absence of local records to list the uptake of the scheme leaves room for doubt about its overall effectiveness. We make some recommendations for practice and suggest directions for further research key words: hate crime intellectual disability safe places social inclusio

Multiple stakeholder perspectives of factors influencing differential outcomes for ethnic minority students on health and social care placements: a qualitative exploration

Abstract: Background: Despite considerable efforts there continues to be a degree awarding gap within the United Kingdom (UK) between the proportion of White British students receiving higher classifications, compared to ethnic minority UK-domiciled students. Practice placement elements constitute approximately 50% of most health and social care programmes, yet surprisingly little research exists related to the factors which may contribute to ethnic minority student placement outcomes or experiences. This study bridges this evidence gap by exploring factors influencing differential placement outcomes of ethnic minority students from the perspectives of key stakeholders. Methods: The study followed a descriptive qualitative research design and was multi-disciplinary, with participants drawn from across nursing, midwifery, social work and the allied health professions. Participants from four stakeholder categories (ethnic minority students, academic staff, placement educators and student union advisors) were invited to join separate focus groups. Focus groups were recorded and transcribed and analysed thematically. Results: Ten separate focus groups [n = 66] yielded three primary themes: 1) recognition, which highlighted stakeholder perceptions of the issues [sub-themes: acknowledging concerns; cultural norms; challenging environments]; 2) the lived experience, which primarily captured ethnic minority student perspectives [sub-themes: problematising language and stereotyping, and being treated differently]; 3) surviving not thriving, which outlines the consequences of the lived experience [sub-themes: withdrawing mentally, feeling like an alien]. Conclusion: This study presents a rich exploration of the factors affecting differential outcomes of ethnic minority students on practice placements through the lens of four different stakeholder groups. To our knowledge this is the first study in which this comprehensive approach has been taken to enable multiple viewpoints to be accessed across a wide range of health and social care professions. The issues and challenges raised appear to be common to most if not all of these disciplines. This study highlights the urgent need to value and support our ethnic minority students to remove the barriers they face in their practice learning settings. This is a monumental challenge and requires both individuals and organisations to step up and take collective responsibility

Reliable quantification of the potential for equations based on spot urine samples to estimate population salt intake: protocol for a systematic review and meta-analysis

Background: Methods based on spot urine samples (a single sample at one time-point) have been identified as a possiblealternative approach to 24-hour urine samples for determining mean population salt intake.Objective: The aim of this study is to identify a reliable method for estimating mean population salt intake from spot urinesamples. This will be done by comparing the performance of existing equations against one other and against estimates derivedfrom 24-hour urine samples. The effects of factors such as ethnicity, sex, age, body mass index, antihypertensive drug use, healthstatus, and timing of spot urine collection will be explored. The capacity of spot urine samples to measure change in salt intakeover time will also be determined. Finally, we aim to develop a novel equation (or equations) that performs better than existingequations to estimate mean population salt intake.Methods: A systematic review and meta-analysis of individual participant data will be conducted. A search has been conductedto identify human studies that report salt (or sodium) excretion based upon 24-hour urine samples and spot urine samples. Therewere no restrictions on language, study sample size, or characteristics of the study population. MEDLINE via OvidSP (1946-present),Premedline via OvidSP, EMBASE, Global Health via OvidSP (1910-present), and the Cochrane Library were searched, and tworeviewers identified eligible studies. The authors of these studies will be invited to contribute data according to a standard format.Individual participant records will be compiled and a series of analyses will be completed to: (1) compare existing equations forestimating 24-hour salt intake from spot urine samples with 24-hour urine samples, and assess the degree of bias according tokey demographic and clinical characteristics; (2) assess the reliability of using spot urine samples to measure population changesin salt intake overtime; and (3) develop a novel equation that performs better than existing equations to estimate mean populationsalt intake.Results: The search strategy identified 538 records; 100 records were obtained for review in full text and 73 have been confirmedas eligible. In addition, 68 abstracts were identified, some of which may contain data eligible for inclusion. Individual participantdata will be requested from the authors of eligible studies.Conclusions: Many equations for estimating salt intake from spot urine samples have been developed and validated, althoughmost have been studied in very specific settings. This meta-analysis of individual participant data will enable a much broaderunderstanding of the capacity for spot urine samples to estimate population salt intake

Recognising and respecting patients’ cultural diversity

Aim: To explore nursing students’ experiences of caring for patients from different and often unfamiliar cultural backgrounds. Method: Focus group discussions were conducted with nursing students from mental health, learning disability and adult nursing in one university, to obtain qualitative information about areas of difficulty in providing culturally competent care. Findings: Nursing students expressed difficulties and challenges meeting the cultural needs of patients, with particular focus on issues related to language, food and gender. Conclusion: Nursing students need to prepare for work in a culturally diverse healthcare setting and should receive education and training in this area to ensure ongoing personal and professional development.</p

Treatment of clients in the NHS: a case study

The families of people with learning disability frequently report that their relatives receive poor care when they attend hospital as in-patients. For some individuals the consequences have been fatal. Despite official responses there is growing evidence to suggest that this situation remains unchanged and may even be worsening. Here we present a case study. The narrative is related principally by two close relatives and with additional contributions from caregivers who worked regularly with the gentleman whose experiences form the basis for this account. From this we must conclude that current provision is inadequate. Hospital staff of all grades and backgrounds clearly need more training and education in caring for people with learning disability who present as patients. This is urgent because the learning disability population is growing and ageing and will necessarily be more frequently in contact with secondary care. </p

Contemporary issues in the training of UK health and social care professionals — Looking after people with a learning disability

The health and social care of people labelled with ‘learning disability’ has historically been a disputed territory for those individuals working within the nursing and allied health professions. In recent times this situation has seen public debate as instances of poor care and avoidable deaths have received a high profile in the popular and professional presses. Here we report on a local initiative where students can study for a joint honours award which allows them to practise as a generic social worker and a learning disability nurse. We believe that the inter-professional perspective improves their ability to manage the increasingly complex aspects of health and social care that this client group demands. Furthermore, we suggest that if a similar model were to be applied at a foundation module level to the training of ALL health and social care professionals, then the results would be a win/win situation for all parties. This would also go some way to meeting the recommendations of Sir Jonathan Michael's report, Health Care for All (DH, 2008

The anatomy lesson of Dr Nicolaes Tulp: what can it teach us today?

We report on the use of a high fidelity patient simulator (SimMan) within a clinical lab setting to teach learning disability nursing students about epilepsy management. We had previously prepped the students with verbal discussions on epilepsy management and, when the simulator began to undergo a seizure, small groups of students managed the unfolding scenario. We received written feedback from the students on the experience, and with reference to this and to the wider literature we consider the benefits of this approach to patient care. We surmise that lessons learned here will be applicable to trainee professionals from other parts of the register and in other fields allied to healthcare. We anticipate that this will improve care for people with intellectual disability in line with recommendations in Health Care for All (2008)