Sex, PrEP and the moral backlash : A High Court decision on the funding of a drug that prevents HIV shows 1980s prejudice lingers on

The news last week that the National AIDS Trust had won its High Court challenge for Pre-exposure Prophylaxis (PrEP) to be provided by NHS England has made the headlines

Embedding learning from adverse incidents: a UK based regional case study

Purpose: This paper reports on a regionally based UK study uncovering what has worked well in learning from adverse incidents in hospitals. It reviews the incident investigation methodology used, identifying strengths or weaknesses and explores the use of a database as a tool to embed learning Design/methodology/approach: Documentary examination was conducted of all adverse incidents reported between 1st June 2011 and 30th June 2012 by three UK National Health Service hospitals. One Root Cause Analysis report per adverse incident for each individual hospital was sent an advisory group for review. Using terms of reference supplied, the advisory group feedback was analysed using an inductive thematic approach. The emergent themes led to the generation of questions which informed seven in-depth semi-structured interviews Findings: ‘Time’ and ‘Work Pressures’ were identified as barriers to using adverse incident investigations as tools for quality enhancement. Methodologically, a weakness in approach was that no criteria influenced the techniques which were used in investigating adverse incidents. Regarding the sharing of learning, the use of a database as a tool to embed learning across the region was not supported Research limitations/implications: Practical implications: Softer intelligence from adverse incident investigations could be usefully shared between hospitals through a regional forum Social implications: Originality/value: The use of a database as a tool to facilitate the sharing of learning from adverse incidents across the health economy is not supporte

Screaming silences: lessons from the application of a new research framework

This paper presents the lessons learned from the application of a new research framework, The Silences Framework (Serrant-Green, 2011) in the context of a qualitative study exploring the fragility hip fracture recovery experiences of people under 60. Originating from research exploring ethnicity, gender and sexual health decisionmaking, this new framework provides a useful research tool for researching underrepresented groups and topics. It is likely to be attractive to nurses as it is underpinned by core nursing values such as advocacy based action, places participant and public voices at the centre of the research and resembles the familiar nursing process. The structure and flexibility it offers also make it relevant for new and experienced researchers in a variety of contexts. Current conceptions of marginalisation in healthcare are explored with reference to nursing research and practical tips are provided for others interested in applying and further testing this new research framework

Black Caribbean men, sexual health decisions and silences

Sexual health behaviour and the choices people make are influenced by whole range of factors including social grouping, education, peer pressure and access to services/information. Report on the health of the public in Britain have shown that sexual ill health is unequally distributed across society (Department of Health 2001; Royal College of Nursing 2001). people from socially disadvantaged and marginalised groups experience the highest levels of sexually related illness. Quantitative studies form the main pool of information available in relation to sexual health and risk. They have demonstrated that in some areas of the country the infection rates for STI's are up to twelve times higher in men from black Caribbean communities (Fenton, Johnson et al. 1997; Lacey, Merrick et al. 1997; Low, Daker-White et al. 1997). At present there is very little published qualitative information on the factors affecting sexual health decisions, especially in relation to black Caribbean communities. The research study focuses on black Caribbean men. A qualitative approach is used to identify and explore the key factors influencing the health decisions and risk activities of black Caribbean men in relation to sexual health. Social construction theory provides the theoretical underpinning for this study alongside aspects of feminism, criticalist and ethnicities based approaches. The stereotype of black Caribbean men as sexually insatiable and irresponsible emerged as a key feature of the social scripts associated with their sexual behaviour. The themes 'The nature of the stereotype', 'Living with the stereotype' and 'Hearing the silences' discussed in the data chapters explore the impact of the stereotype on the sexual health decisions of black Caribbean men. The experiences highlighted through the themes expose the importance of the political, social and personal context associated with specific sexual scripts on the sexual health decisions of black Caribbean men. Of key importance in these socially determined scripts are the screaming silences contained within them. The findings are reviewed in the light of current sexual health policies to consider how sexual health services and professionals can best provide for the sexual health needs of black Caribbean men. The thesis adds to current knowledge in sexual health and ethnicities in concluding that the sexual health decisions of black Caribbean men take pace in the context of the real or imagined expectations that society has of them. Individuals sexual decisions therefore occur in light of shared and personal appraisal of socially determined relevant issues. This forms the context in which sexual scripts are given meaning and sexual decisions take place. The study compliments the established pool of quantitative data available linking issues of sexual health and ethnicity in Britain. The findings presented within the thesis reveal a range of issues to initiate further qualitative research in the area and provides a lead for British based thinking on adult sexual health decisions and ethnicity

Métodos mistos: abra-se a novas oportunidades

Tradicionalmente, como pesquisadores iniciantes, aprendendo sobre metodologia de pesquisa, os estudantes se focam em aprimorar seu entendimento e proficiência no uso de métodos únicos ou mistos (geralmente quantitativos ou qualitativos) como um pré-requisito para a prática eficaz. Somos apresentados a esses dois paradigmas como se fossem abordagens opostas. De fato, somos incentivados a visualizá-los como opostos polares resultantes de divergentes suposições antecedentes. A pesquisa quantitativa reconhece a existência de uma realidade única fora do controle dos indivíduos e se concentra em reunir “fatos”, para que as “asserções verdadeiras” possam ser estabelecidas. Os pesquisadores qualitativos sustentam que verdade e significado não existem em algum mundo externo, mas são construídos através das interações das pessoas com o mundo – portanto, buscam explorar como o mundo é entendido..

Fragility hip fracture in the under 60s: a qualitative study of recovery experiences and the implications for nursing

Background: Hip fracture is a common, serious, complex injury and an important cause of morbidity, mortality and rising healthcare costs. Incidence and impact in the under 60s has been under researched. The aim of this study was therefore to explore the recovery experiences of young adults with an isolated hip fracture following a minor fall to inform future care delivery. Methods and Findings The Silences Framework was used to guide a critical interpretivist study. Thirty in-depth, minimally structured, story-telling interviews were conducted with participants between one and 10 years post injury. One cross-cutting theme, ‘Communication’ and four main themes: ‘Experience of care’, ’Impact on self’, ‘Impact on others’ and ‘Moving forward’ were identified. The findings indicated multi-faceted, often long term, physical, social and psychological impact on participants, their family and wider social networks. This included Post Traumatic Stress Disorder type symptoms and impact on work, finances and relationships. Inadequacies in the current care pathway and limited relevance of the commonly used patient reported hip fracture outcome measures used for young adults were also identified. Conclusion: The dominant discourse on fragility hip fracture almost exclusively focuses on the elderly and short-term outcomes. This was the first study investigating the long-term impact of fragility hip fracture in young adults from their perspective and the first application of a new research framework in an acute care setting. It found the needs of younger hip fracture patients are not adequately recognised or addressed. Increased awareness and improvements in healthcare provision are needed to minimise the long-term personal and societal impact of fragility fracture in the under 60s

Women’s experiences of gynaecological consultations – uncovering its technological toolboxes: challenges in a Brazilian context

Historically, the medical definition of women as an object of biomedical knowledge has restricted the way by which gynecology is understood. In Brazil’s Unified Health System (Sistema Unificado de Saúde – SUS, in Portuguese), it is the responsibility of gynaecological care services to identify, diagnose and treat reproductive related conditions. However, gynaecological consultations are based predominantly on a medicalised model of diagnosis, treatment and disease management which often fails to address the wider determinants of women’s reproductive health and its impact on their general health and life chances. This paper is focused on the way the Brazilian health system has responded to women’s health needs in gynaecological consultations, given its central role in maintaining and promoting women’s health. it explores variations between “what should be” and “what is” offered to Brazilian women in gynaecological consultations. The authors argue that while gynaecological consultations in Brazil (and elsewhere) are currently restricted to programmatic targets, complaints and symptoms associated with sexual and reproductive functions; consultations could be used to respond to women’s needs, using a broader life course approach if a combination of health technologies ‘toolboxes’ are employed. Implementation of care services utilising a ‘toolbox’ approach provides an opportunity to truly follow the principle of ‘integrality’, one of the doctrinal principles of the Brazilian health system, which furthermore could have application in women’s health care services elsewhere

“Would you decide to keep the power?”: reflexivity on the interviewer–interpreter–interviewee triad in interviews with female punjabi rheumatoid arthritis patients

This article presents methodological reflections on the different streams of knowledge that are drawn upon during interpreted interviews and the shifts of power between (1) the interviewer, (2) the interpreter/co-researcher, and (3) the interviewee. Interpreters are increasingly seen as active agents in the interview process, and they act as cultural brokers.Interpretation by a nurse researcher introduces further challenges and benefits to the interview dynamic, which was explored through reflexive discussions with an independentresearcher. These challenges include conducting interviews in a clinical setting, where the health professional–patient relationship remains active. A modified discourse analysis was used to examine the subject positioning in the interview situation and the power negotiationsthat ensued. The main conclusion that can be drawn from these reflexive accounts is that the use of different streams of knowledge (experiential, clinical, cultural, and academic)enhanced the interview interaction, and power relations were successfully negotiated to facilitate rapport and data collection. Reflexivity provides an important tool for identifying,and learning from, the challenges and benefits of working with an interpreter, who is also a co-researcher with multiple professional roles

Developing and integrating cultural competence into nursing education curricula : a qualitative grounded theory approach

The changing demographic UK population in terms of cultural, racial and ethnic mix demands mental health nurses to be educated in ways that will enable them to provide care that is both efficient and culturally appropriate to the diverse population they will serve. However, reported studies indicate that professional nurses, particularly mental health nurses, are not ready to meet the challenges posed by an increasingly culturally diverse society. These have raised questions about the undergraduate nursing education's readiness to develop a mental health work force that is capable of delivering effective mental health services to a multicultural population. The aim of the study was to explore and gain an understanding of cultural competence education from the perspectives of the key participants involved in the undergraduate mental health nursing education within the UK context, and to use the findings to develop a conceptual framework of developing cultural competence. Qualitative grounded theory approach was the method of inquiry used to collect and analyse interview data from the experiences and views of senior lecturers, third year mental health student nurses, clinical sign-off mentors and student mentors within the universities that offer pre-registration mental health nurse training in the West Midlands Region. Analysis of the research findings resulted in an emergent conceptual framework that explains how cultural competence is developed in the undergraduate mental health nursing curriculum in terms of content, processes, strategies, actions and approaches that are considered effective. The findings of this study revealed a degree of consistency between the views of the current study participants and what the literature describes as frameworks for developing cultural competence. The main theoretical constructs emerging from the study fit into a cultural competence frameworks encompassing awareness, knowledge and skills. Whilst some of the themes and theoretical constructs emerging from the results of the interview data were generally consistent with those indicated in the cultural competence literature, there were some other themes that emerged from the study participants on what was required within the curriculum in order to educate student nurses in ways that will enable them to work effectively and culturally appropriately with clients from diverse cultural backgrounds. The additional bridging theoretical construct included ‘conscious of the dynamics and discourse of intercultural education’ which was a result of the differing ideological views about current curricula and how issues of cultural competence could best be addressed within the curricula. The strategies of ‘engagement of local experts to assist in teaching cultural competence specific areas’ and ‘creating educational activities that challenge stereotypes, prejudice, discrimination and religious intolerance’ also expands the current literature by providing evidence to support some of the conceptualisations regarding some of the educational intervention strategies to cultural competence. This study is significant as it represents the first attempt to develop a conceptual framework of developing cultural competence within the UK context based on the perspectives of those directly experiencing the undergraduate mental health nursing education, using qualitative grounded theory approaches. Exploring and developing the conceptual framework from the perspectives of the neglected silent voices of the key participants who are directly involved in the undergraduate nurse training within the UK context, contributes to the existing research in this area and provides a view not currently presented in the nursing literature.EThOS - Electronic Theses Online ServiceGBUnited Kingdo