Who are we protecting? - Exploring counsellors’ understanding and experience of boundaries.

The concept of boundary is a term often used within counselling and psychotherapy literature. However, there is a paucity of research exploring how useful and meaningful boundaries are for therapy practice. This study explored how counsellors understand and experience boundaries within their counselling practice. Seven participants, who were all qualified and practising counsellors, were interviewed about their understanding and experience of boundaries. These interviews were transcribed and then analysed using interpretative phenomenological analysis (IPA). Analysis identified one significant overarching theme entitled “Protection and Safety” which distinguished between the protection of self and other. This paper focuses solely on the Protection of Self theme because of the theme’s rich and vivid data and the theme’s overarching dominance across the accounts. Two subthemes were identified: Establishing the Self and Defending the Self. Findings indicate that there was a lack of awareness around boundaries, with some participants describing defensive responses to some boundary issues. However, participants also described using boundaries to restrict, limit and defend themselves when working with clients, and they identified this as necessary for their own safety and security. This study recommends that therapists should engage reflexively with boundaries, towards developing a more relational and/or client-focused approach

Using a modified Delphi methodology to gain consensus on the use of dressings in chronic wounds management

Objective: Managing chronic wounds is associated with a burden to patients, caregivers, health services and society and there is a lack of clarity regarding the role of dressings in improving outcomes. This study aimed to provide understanding on a range of topics, including: the definition of chronicity in wounds, the burden of illness, clinical outcomes of reducing healing time and the impact of early interventions on clinical and economic outcomes and the role of matrix metalloproteinases (MMPs) in wound healing. Method: A systematic review of the literature was carried out on the role of dressings in diabetic foot ulcer (DFU), and venous leg ulcer (VLU) management strategies, their effectiveness, associated resource use/cost, and quality of life (QoL) impact on patients. From this evidence-base statements were written regarding chronicity in wounds, burden of illness, healing time, and the role of MMPs, early interventions and dressings. A modified Delphi methodology involving two iterations of email questionnaires followed by a face-to-face meeting was used to validate the statements, in order to arrive at a consensus for each. Clinical experts were selected, representing nurses, surgeons, podiatrists, academics, and policy experts. Results: In the first round, 38/47 statements reached or exceeded the consensus threshold of 80% and none were rejected. According to the protocol, any statement not confirmed or rejected had to be modified using the comments from participants and resubmitted. In the second round, 5/9 remaining statements were confirmed and none rejected, leaving 4 to discuss at the meeting. All final statements were confirmed with at least 80% consensus. Conclusion: This modified Delphi panel sought to gain clarity from clinical experts surrounding the use of dressings in the management of chronic wounds. A full consensus statement was developed to help clinicians and policy makers improve the management of patients with these conditions

Evaluating qualitative research

A chapter that discusses quality criteria in qualitative research

Responding well to Spiritual Abuse: practice implications for counselling and psychotherapy

This paper presents the findings of a survey exploring people’s understandings and experiences of Spiritual Abuse (SA) in a Christian faith context. The online survey was completed by 1591 individuals from the UK, 1002 of whom identified as having experienced SA. Inclusion criteria were: membership of the Christian faith, being or having been, a Church attender or member of a Christian organisation and to have heard of the term SA. Participants detailed the features of an effective response to disclosures of SA and many of these are directly relevant to counselling and psychotherapy practice. Additionally, the research findings echo repeated calls in previous research for the necessity to include discussions of religion and faith in initial training and continuing professional development for counsellors and psychotherapists. Finally, the paper suggests a next step would be the establishment of a network of counsellors with training and knowledge about SA

'Loss of self': a psychosocial study of the quality of life of adults with diabetic foot ulceration.

At present, recognition of the importance of psychosocial factors in the care of individuals with diabetes is still in its infancy. Understanding of the specific psychosocial factors relating to diabetic foot ulceration is embryonic. The study reported in this paper begins to raise awareness of psychosocial quality of life issues for patients living with diabetic foot ulceration, as narrated by the patients themselves. Findings revealed a range of restrictions on daily life that profoundly affected the individual's sense of self. These findings have implications for patients' adherence to treatment. Implications of these findings for health promotion are also reported

'Loss of self': A psychosocial study of the quality of life of adults with diabetic ulceration

At present, recognition of the importance of psychological factors in the care of individuals with diabetes is still in its infancy. Understanding of the specific psychological factors relating diabetic foot ulceration is embryonic. The study reported in this paper begins to raise awareness of psychosocial quality of life issues for patients living with diabetic foot ulceration, as narrated by the patients themselves. Findings revealed a range of restrictions on daily life that profoundly affected the individual's sense of self. These findings have implications for patients' adherence to treatment. Implications of these findings for health promotion are also reported. copyright © 1992-Feb 2001 by SMTL

Validation of COPDPredict™: Unique Combination of Remote Monitoring and Exacerbation Prediction to Support Preventative Management of COPD Exacerbations

Neil Patel,1,2 Kathryn Kinmond,1,3 Pauline Jones,1 Pamela Birks,1 Monica A Spiteri1 1Directorate of Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK; 2Directorate of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital, Birmingham, UK; 3Department of Health & Social care, Staffordshire University, Stoke-on-Trent, Staffordshire, UKCorrespondence: Neil PatelDirectorate of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital, Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UKTel +44 7852 318157Email [email protected]: COPDPredict™ is a novel digital application dedicated to providing early warning of imminent COPD (chronic obstructive pulmonary disease) exacerbations for prompt intervention. Exacerbation prediction algorithms are based on a decision tree model constructed from percentage thresholds for disease state changes in patient-reported wellbeing, forced expiratory volume in one second (FEV1) and C-reactive protein (CRP) levels. Our study determined the validity of COPDPredict™ to identify exacerbations and provide timely notifications to patients and clinicians compared to clinician-defined episodes.Methods: In a 6-month prospective observational study, 90 patients with COPD and frequent exacerbations registered wellbeing self-assessments daily using COPDPredict™ App and measured FEV1 using connected spirometers. CRP was measured using finger-prick testing.Results: Wellbeing self-assessment submissions showed 98% compliance. Ten patients did not experience exacerbations and treatment was unchanged. A total of 112 clinician-defined exacerbations were identified in the remaining 80 patients: 52 experienced 1 exacerbation; 28 had 2.2± 0.4 episodes. Sixty-two patients self-managed using prescribed rescue medication. In 14 patients, exacerbations were more severe but responded to timely escalated treatment at home. Four patients attended the emergency room; with 2 hospitalised for < 72 hours. Compared to the 6 months pre-COPDPredict™, hospitalisations were reduced by 98% (90 vs 2, p< 0.001). COPDPredict™ identified COPD-related exacerbations at 7, 3 days (median, IQR) prior to clinician-defined episodes, sending appropriate alerts to patients and clinicians. Cross-tabulation demonstrated sensitivity of 97.9% (95% CI 95.7– 99.2), specificity of 84.0% (95% CI 82.6– 85.3), positive and negative predictive value of 38.4% (95% CI 36.4– 40.4) and 99.8% (95% CI 99.5– 99.9), respectively.Conclusion: High sensitivity indicates that if there is an exacerbation, COPDPredict™ informs patients and clinicians accurately. The high negative predictive value implies that when an exacerbation is not indicated by COPDPredict™, risk of an exacerbation is low. Thus, COPDPredict™ provides safe, personalised, preventative care for patients with COPD.Keywords: COPD acute events, preventative care, digital enabled-healthcare, automated health-status algorithms, diagnostic accuracy, reduced hospitalisation