1,123 research outputs found
An end-of-life care nurse service for people with COPD and heart failure: stakeholders' experiences
Background:
End-of-life care (EOLC) has historically been associated with cancer care. However, demographic changes indicate that future provision must also cater for other long term conditions (LTC). An EOLC-LTC service, delivered by palliative care nurses, is currently being piloted in one area in the East Midlands with patients with cardiac and respiratory disease. In order to inform future commissioning, it is important to gain the views and experiences of those involved with the service.
Aims:
This study aimed to explore patients, and their partners, views and experiences of the EOLC-LTC service.
Methods:
Semi-structured interviews were used as part of a case study design, involving six cases. Each case consisted of the patient, their nominated family member/carer and key healthcare professionals involved in their care as identified by the patient. This paper reports on the findings from the interviews conducted with the six patients and their family member/carers. Data were analysed thematically.
Results:
From the interviews, the following themes were identified: experiences managing a long term cardio-respiratory condition, the nurse service, building a close/therapeutic relationship and fragmentation and integration.
Conclusions:
This study has shown that the EOLC-LTC service is welcomed and highly regarded by patients and their family members/carers. Further studies are required to explore the views and experiences of other key stakeholders and to evaluate how well the pilot operates within the wider care pathway
Decision making in mental health team meetings
Background: Single point of access meetings represent a critical juncture in the lives of mental health clients. The decision-making process undertaken by mental health professionals during this time is therefore crucial.
Method: Glaserian grounded theory, with observations and interviews through theoretical sampling, was used to investigate the decision making of attendees.
Findings: A basic social process named handling role boundaries emerged, consisting of four phases: recognising, positioning, weighing up and balancing.
Conclusion: Handling role boundaries is an innovative, sociological theory that allows conceptual understanding to show how personality traits contribute to the discussions and decisions, as well as professional roles. These need to be managed effectively to make decisions in a limited time frame. Handling role boundaries explains how this is done in a local mental health trust
An end-of-life care nurse service for people with COPD and heart failure: stakeholders' experiences
Background:
End-of-life care (EOLC) has historically been associated with cancer care. However, demographic changes indicate that future provision must also cater for other long term conditions (LTC). An EOLC-LTC service, delivered by palliative care nurses, is currently being piloted in one area in the East Midlands with patients with cardiac and respiratory disease. In order to inform future commissioning, it is important to gain the views and experiences of those involved with the service.
Aims:
This study aimed to explore patients, and their partners, views and experiences of the EOLC-LTC service.
Methods:
Semi-structured interviews were used as part of a case study design, involving six cases. Each case consisted of the patient, their nominated family member/carer and key healthcare professionals involved in their care as identified by the patient. This paper reports on the findings from the interviews conducted with the six patients and their family member/carers. Data were analysed thematically.
Results:
From the interviews, the following themes were identified: experiences managing a long term cardio-respiratory condition, the nurse service, building a close/therapeutic relationship and fragmentation and integration.
Conclusions:
This study has shown that the EOLC-LTC service is welcomed and highly regarded by patients and their family members/carers. Further studies are required to explore the views and experiences of other key stakeholders and to evaluate how well the pilot operates within the wider care pathway
Cracking the code: a personal journey of learning Glaserian grounded theory
My PhD study which began in 2009 focused on the decision-making behaviors of mental health professionals, as they attended a âSingle Point of Accessâ meeting. These meetings are set in community mental health services and involve professionals from an array of professional backgrounds discussing client cases, based on received letters from general practitioners. The general practitioners write these letters seeking advice and direction as to which mental health services the client should be sent to, in response to their needs. On occasions, some general practitioner letters are addressed to a specific person attending the meeting; at other times, they are addressed generally to the whole team. The Single Point of Access meetings house community mental health team members and representatives from more specialized services. The business and interactions of this collection of multidisciplinary professionals provided a useful opportunity to apply a classical grounded theory approach. With Single Point of Access meetings being relatively new at the time of study, discovering, describing, and conceptualizing the decision-making process inherent in these meetings were exciting prospects. After 4 years of study, I produced a grounded theory from my data collection and analysis, which was named âHandling Role Boundaries,â highlighting how these professionals manage and work with multiple roles to bring out the strength of the team and expedite the decision-making process. This case study conveys my personal journey from copious data to Handling Role Boundaries. I present the journey as a learning process, denoted in an âABCDâ format
"Gateway to the gatekeepers", single point of access meetings: evaluating the client case referral procedure within an NHS Trust
This ESRC funded CASE studentship PhD project provides a comprehensive investigation into the referral allocation process within an NHS Trustâs adult mental health facilities, known as Single Point of Access (SPA) meetings. These meetings provide a multidisciplinary environment in which mental health practitioners consider client referrals in the form of letters from, primarily, General Practitioners (GPs) and direct them to appropriate services and interventions. Participants in these meetings can be seen as gatekeepers authorising access to other mental health services. The study was formally identified by NHS Research Ethics procedures as a service evaluation. From an academic perspective it is sociological research heavily informed by Glaserian Grounded Theory (GT) methodology. This approach has uncovered an internal Basic Social Process (BSP) underpinning SPA meetings. It has been named âHandling Role Boundariesâ, and it describes how SPA meeting attendees endeavour to work together as they make crucial decisions about clients. Initial research plans included the collection and evaluation of quantitative data which would assess the relative validity of SPA meeting decisions. Unfortunately the quality of available data proved insufficient for this purpose. This provided brief insight into tensions between administrative systems and the real life mechanisms of SPA meetings. Overall, the unfulfilled evaluative purposes of the study provided an opportunity to focus more on clarifying the BSP underpinning SPA meetings. Also explored is how this BSP has wider implications for an understanding of how âmental health difficultiesâ are framed and provided for. The thesis concludes that Handling Role Boundaries is a highly innovative theory offering major contributions to understanding one social space of mental health professionals. Furthermore, it offers plentiful scope for further research and will be appropriate for many avenues of dissemination
"Gateway to the gatekeepers", single point of access meetings: evaluating the client case referral procedure within an NHS Trust
This ESRC funded CASE studentship PhD project provides a comprehensive investigation into the referral allocation process within an NHS Trustâs adult mental health facilities, known as Single Point of Access (SPA) meetings. These meetings provide a multidisciplinary environment in which mental health practitioners consider client referrals in the form of letters from, primarily, General Practitioners (GPs) and direct them to appropriate services and interventions. Participants in these meetings can be seen as gatekeepers authorising access to other mental health services. The study was formally identified by NHS Research Ethics procedures as a service evaluation. From an academic perspective it is sociological research heavily informed by Glaserian Grounded Theory (GT) methodology. This approach has uncovered an internal Basic Social Process (BSP) underpinning SPA meetings. It has been named âHandling Role Boundariesâ, and it describes how SPA meeting attendees endeavour to work together as they make crucial decisions about clients. Initial research plans included the collection and evaluation of quantitative data which would assess the relative validity of SPA meeting decisions. Unfortunately the quality of available data proved insufficient for this purpose. This provided brief insight into tensions between administrative systems and the real life mechanisms of SPA meetings. Overall, the unfulfilled evaluative purposes of the study provided an opportunity to focus more on clarifying the BSP underpinning SPA meetings. Also explored is how this BSP has wider implications for an understanding of how âmental health difficultiesâ are framed and provided for. The thesis concludes that Handling Role Boundaries is a highly innovative theory offering major contributions to understanding one social space of mental health professionals. Furthermore, it offers plentiful scope for further research and will be appropriate for many avenues of dissemination
Patient reported outcome measures for measuring dignity in palliative and end of life care : a scoping review
BACKGROUND: Patient reported outcome measures are frequently used standard questionnaires or tools designed to collect information from patients regarding their health status and care. Their use enables accurate and relevant insight into changes in health, quality of life, and symptom severity to be acquired. The purpose of this scoping review was to identify PROMs that had been subject to rigorous development and were suitable for use in palliative and end of life care for clinical practice and/or research purposes. The review had a specific focus on measures which could be used to assess perceptions of dignity in these contexts. METHODS: A scoping review of English-language papers published between 2005 and 2015. Searches were devised in conjunction with an information science specialist and were undertaken in Medline; PsycINFO; EMBASE; CINAHL; Social Science Citation Index; ASSIA; CENTRAL; CDSR; DARE; HTA; Oxford PROM Bibliography; PROQOLID, using dignity related terms such as personhood; dignity or dignified; patient-centred care; which were linked (via the Boolean operator "AND") to care-related terms such as terminal care; hospice care; palliative care; end of life. Papers were assessed against inclusion criteria and appraised for quality. RESULTS: The search strategy produced an initial 7845 articles. After three rounds of eligibility assessment, eight articles discussing eight patients reported outcome measures were found to meet the inclusion criteria and were included in the final review. These underwent a thorough critical appraisal process. All seven studies were empirical research focused on the development and testing of a PROM. CONCLUSIONS: The eight patient reported outcome measures had all undergone some psychometric testing, and covered dignity aspects suggesting that they could be considered for use for research purposes to assess dignity. There were also indications that some could be implemented into a clinical setting. However, each measure had limitations and scope for further development
Graphic Interlude
This graphic interlude features a selection of photographs which can illustrate the adage âBrevity is the soul of witâ. True to the spirit of the adage, the viewer is invited to interpret the pictures which are presented without commentary.Cet interlude iconographique comporte une sĂ©lection de photographies illustrant Ă leur maniĂšre lâaphorisme: âBrevity is the soul of witâ. Pour rester dans lâesprit de cet aphorisme, les images sont livrĂ©es telles quelles Ă lâapprĂ©ciation du spectateur, sans commentaire
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Goal-directed versus outcome-based financial incentives for weight loss among low-income patients with obesity: rationale and design of the Financial Incentives foR Weight Reduction (FIReWoRk) randomised controlled trial.
IntroductionObesity is a major public health challenge and exacerbates economic disparities through employment discrimination and increased personal health expenditures. Financial incentives for weight management may intensify individuals' utilisation of evidence-based behavioural strategies while addressing obesity-related economic disparities in low-income populations. Trials have focused on testing incentives contingent on achieving weight loss outcomes. However, based on social cognitive and self-determination theories, providing incentives for achieving intermediate behavioural goals may be more sustainable than incentivising outcomes if they enhance an individual's skills and self-efficacy for maintaining long-term weight loss. The objective of this paper is to describe the rationale and design of the Financial Incentives foR Weight Reduction study, a randomised controlled trial to test the comparative effectiveness and cost-effectiveness of two financial incentive strategies for weight loss (goal directed vs outcome based) among low-income adults with obesity, as well as compared with the provision of health behaviour change resources alone.Methods and analysisWe are recruiting 795 adults, aged 18-70âyears with a body mass index â„30âkg/m2, from three primary care clinics serving residents of socioeconomically disadvantaged neighbourhoods in New York City and Los Angeles. All participants receive a 1-year commercial weight loss programme membership, self-monitoring tools (bathroom scale, food journal and Fitbit Alta HR), health education and monthly check-in visits. In addition to these resources, those in the two intervention groups can earn up to $750 over 6 months for: (1) participating in an intensive weight management programme, self-monitoring weight and diet and meeting physical activity guidelines (goal-directed arm); or (2) a â„1.5%âto â„5%âreduction in baseline weight (outcome-based arm). To maximise incentive efficacy, we incorporate concepts from behavioural economics, including immediacy of payments and framing feedback to elicit regret aversion. We will use generalised mixed effect models for repeated measures to examine intervention effects on weight at 6, 9 and 12 months.Ethics and disseminationHuman research protection committees at New York University School of Medicine, University of California Los Angeles (UCLA) David Geffen School of Medicine and Olive-View-UCLA Medical Center granted ethics approval. We will disseminate the results of this research via peer-reviewed publications, conference presentations and meetings with stakeholders.Trial registration numberNCT03157713
Promoting Bicycle Commuter Safety, Research Report 11-08
We present an overview of the risks associated with cycling to emphasize the need for safety. We focus on the application of frameworks from social psychology to education, one of the 5 Esâengineering, education, enforcement, encouragement, and evaluation. We use the structure of the 5 Es to organize information with particular attention to engineering and education in the literature review. Engineering is essential because the infrastructure is vital to protecting cyclists. Education is emphasized since the central focus of the report is safety
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