Do grandparents matter? : The impact of Grandparenting on the wellbeing of children

This timely and important report shows the immense value of grandparents in 21st century family life. It reveals a unique relationship that exists between the older generation and the youngest: a relationship of love and trust that enables the children to use their grandparents as confidantes and counsellors as well as playmates and cookery instructors. The report shows that children value the non-critical support, emotional advice and guidance that grandparents offer and enjoy the quality time their grandparents give them. It also found that the relationship has benefits for grandparents adding to their raison d’être and contributing to their health and longevity. The report also notes the change in the nature of family relationships in Britain throughout the 20th century, from the extended family to the nuclear family to the current variety of relationships, formal and informal, in which both the elderly and the young suffer neglect. With today’s increased incidence of divorce and family breakdown, grandparents can sometimes provide the only stable family relationship in a child’s life, and yet grandparents often lose contact with their grandchildren during or after a divorce or relationship breakup and have no legal rights through the Family Court to continue offering loving care and support to their grandchildren. The report concludes that there is need for much greater understanding of the role and function of grandparents in family life today.Final Published versio

The effects of integrated care: a systematic review of UK and international evidence

BACKGROUND: Healthcare systems around the world have been responding to the demand for better integrated models of service delivery. However, there is a need for further clarity regarding the effects of these new models of integration, and exploration regarding whether models introduced in other care systems may achieve similar outcomes in a UK national health service context. METHODS: The study aimed to carry out a systematic review of the effects of integration or co-ordination between healthcare services, or between health and social care on service delivery outcomes including effectiveness, efficiency and quality of care. Electronic databases including MEDLINE; Embase; PsycINFO; CINAHL; Science and Social Science Citation Indices; and the Cochrane Library were searched for relevant literature published between 2006 to March 2017. Online sources were searched for UK grey literature, and citation searching, and manual reference list screening were also carried out. Quantitative primary studies and systematic reviews, reporting actual or perceived effects on service delivery following the introduction of models of integration or co-ordination, in healthcare or health and social care settings in developed countries were eligible for inclusion. Strength of evidence for each outcome reported was analysed and synthesised using a four point comparative rating system of stronger, weaker, inconsistent or limited evidence. RESULTS: One hundred sixty seven studies were eligible for inclusion. Analysis indicated evidence of perceived improved quality of care, evidence of increased patient satisfaction, and evidence of improved access to care. Evidence was rated as either inconsistent or limited regarding all other outcomes reported, including system-wide impacts on primary care, secondary care, and health care costs. There were limited differences between outcomes reported by UK and international studies, and overall the literature had a limited consideration of effects on service users. CONCLUSIONS: Models of integrated care may enhance patient satisfaction, increase perceived quality of care, and enable access to services, although the evidence for other outcomes including service costs remains unclear. Indications of improved access may have important implications for services struggling to cope with increasing demand. TRIAL REGISTRATION: Prospero registration number: 42016037725

Evaluation of services for children with complex needs : mapping service provision in one NHS Trust

Aim: The aim of this paper is to identify and descriptively map the key characteristics of themodel of service delivery in operation, and to explore the user, carer and professional experience of service provision. This included an exploration of congruity and mismatch between the different stakeholder groups. Background: In the United Kingdom (UK), 15% of the children under five years of age and 20% of the 5 to 15-year age group are reported to have a complex long-term condition, with the likelihood of having a condition increasing according to socio-economic circumstances. An increasing number of young people with complex needs are now surviving into late adolescence and early adulthood. However, service provision for children with complex needs is an area that, nationally, has been underdeveloped. Methods: An exploratory single-site case study was undertaken across one Primary Care Trust in the UK. Documentary and policy review were undertaken along with in-depth qualitative exploration. Eighteen in-depth interviews were undertaken with relevant stakeholders and professionals across the multidisciplinary teams. Families with children between 12 months and 16 years of age who have continuing complex care needs were invited to take part in an interview to give their views about the care they receive. Interviews focused on the family experience and understanding of the child’s condition, transition between secondary and primary care, effectiveness of admission and discharge planning and the overall contribution of different professionals. Professionals were also asked about their experiences of delivering care. Findings: This study highlighted issues of communication between professionals and with parents and children as a major factor in determining the quality of service provision. Key aspects relating to the model of service provision, namely, paucity of communication, interagency collaboration and the parent as health worker, are highlighted. Conclusions: Parents experienced both health and social service communication challenges when seeking care for their child. These challenges can be located within a general systems theory and hierarchy approaches to understand the complexity of service provision.Peer reviewe

Developing a Healthcare Research Proposal : An Interactive Student Guide

This book is written with the intention of being an introductory research workbook for healthcare professionals who are novices to research. Its primary aim is to demystify the research process. Research needs to be every healthcare professional’s business if we are to practice evidence-based care. Most chapters contain patient scenarios or activities for you to undertake, which serve to contextualise the topic under discussion. It is envisaged that this will assist the reader in gaining greater understanding of the research process. The book takes the reader through the different stages of the research process. It begins with an overview of research, the different types and the underpinning philosophy of each. Subsequent chapters explain the research process moving through the research problem to writing a research report. The book concludes with a chapter exploring the current state of research and the implications for healthcare professionals

Developing a healthcare research proposal: an interactive student guide

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Information in radiotherapy for men with localised prostate cancer : An integrative review

© 2019 John Wiley & Sons Ltd.INTRODUCTION: Men with prostate cancer may receive radiotherapy as part of their management. They encounter a range of information related to radiotherapy, and a crucial role for therapeutic radiographers and other healthcare practitioners is ensuring patients receive appropriate information related to their treatment. This integrative review aims to identify, synthesise and analyse literature reporting experiences of men with localised prostate cancer related to information in radiotherapy. METHODS: A systematic literature search encompassing database and hand searches was carried out between February and March 2017 with date limits of 2000-2017 applied. Initially, 4,954 articles were identified. Systematic screening and detailed examination identified that 33 met the inclusion criteria. Data were synthesised and analysed thematically. RESULTS: Few studies explicitly addressed the issue of information in radiotherapy for men with localised prostate cancer. Themes that emerged and were explored are information needs, information regarding adverse effects, information and time, information preferences, satisfaction with information related to radiotherapy and patient experience related to radiotherapy information. CONCLUSION: This review suggests that although several aspects related to information for men with localised prostate cancer have been documented, few were explored in detail with respect to radiotherapy indicating that further research in this area is warranted.Peer reviewe

The use of cognitive continuum theory and patient scenarios to explore nurse prescribers' pharmacological knowledge and decision­-making

Background: Nurses have been involved in prescribing in England since 1996, and to date over 41,000 nurses are registered with the Nursing and Midwifery Council as prescribers. The majority of evaluative research on nurse prescribing is descriptive and relies on self-report and assessment of patient satisfaction. Objectives: To explore and test nurse prescribers’ pharmacological knowledge and decision-making. Design: An exploratory approach to test the usefulness of patient scenarios in addressing the reasons why nurses decide whether or not to prescribe was utilised. Semi-structured interviews with nurse prescribers using patient scenarios were used as proxy methods of assessment of how nurses made their prescribing decisions. Setting: Two primary care trusts in the southeast of England were the settings for this study. Participants: Purposive sampling to ensure there was a mixed group of prescribers was used to enable detailed exploration of the research objectives and to obtain in-depth understanding of the complex activities involved in nurse prescribing. Methods: Interviews and case scenarios. The use of cognitive continuum theory guided the analysis. Results: The majority of participants were unable to identify the issues involved in all the scenarios; they also failed to provide an acceptable solution to the problem, suggesting that they would refer the patient to the general practitioner. A similar number described themselves as ‘very confident’ while seven participants felt that they were ‘not confident’ in dealing with medication issues, four of whom were practising prescribing. Conclusions: The effects of social and institutional factors are important in the decision-making process. The lack of appropriate pharmacological knowledge coupled with lack of confidence in prescribing was demonstrated. The scenarios used in this study indicate that nurses are perhaps knowledgeable in their small area of practise but flounder outside this. Further research could be conducted with a larger sample and with more scenarios to explore the decisionmaking and the pharmacological knowledge base of nurse prescribers, particularly in the light of government policy to extend prescribing rights to non-medical prescribers, including pharmacists

Children with Complex Long Term Conditions : The Family Perspective on Services

Non peer reviewe

A qualitative study of the impact of the implementation of advanced access in primary healthcare on the working lives of general practice staff

Peer reviewe