Scoping drug and alcohol consumption in young people on the Isle of Sheppey

Executive Summary: Scoping Drug and Alcohol Consumption in Young People on the Isle of Sheppey. Introduction: In 2008 the Sheppey Health and Wellbeing Group (SHWG) raised awareness of the need for a project on the Isle of Sheppey with a focus upon drug and alcohol abuse. The SHWG is a network of over 20 local community groups and partners involved in various local public health initiatives. The group had been concerned for some time by regular reports of drugs and alcohol abuse in Sheerness, often leading to fights and other anti-social behaviour. The University of Greenwich was identified as a suitable partner to gather data about local needs. The members of the SHWG agreed that Sheppey Matters was best placed to work with the University on this project, funding was obtained from the HEFCE funded SECC initiative and a community researcher was employed to bridge the gap between the University of Greenwich and the Isle of Sheppey. The project was overseen by a steering group of individuals from the Isle of Sheppey and University of Greenwich. The members who were Sheppey–based were as followed: Councillor Kenneth Pugh- Chair (Member Sheerness District), Mike Brown (Chair of the Sheppey Health and Wellbeing Group), Nigel Martin (Manager- Sheppey Matters) and Kelly Barshell (Community Researcher). The following individuals from the University of Greenwich were on the Committee; Professor Elizabeth Meerabeau (Dean of School, Health and Social Care), Professor Elizabeth West (Director of Research, School of Health and Social Care), Professor Roslyn Corney (Psychology and Counselling) and Dr John Foster- (Principal Research Fellow in Mental Health Nursing and Substance Use.) In addition to collecting data about local needs the project team have to date developed two pilot projects; firstly a survey of drug and alcohol use in young people attending Sheppey Academy aged 14-18 and secondly a residents survey investigating the impact of drug and alcohol use in young people on the island. The aim is to leave a legacy of research skills that would, in the long run, benefit the island’s young people. Local volunteers were recruited to assist the community researcher who commenced employment in March 2010. These volunteers have received training/supervision from researchers from the University and were able to attend 2 one day public health workshops. Health professionals and workers from the third sector attended the public health workshops on social marketing and community engagement that contributed to the legacy of the project. Methodology: This has primarily been a scoping exercise to explore drug and alcohol use in young people, though substance use data relating to adult populations has also been collected. The five main modes of data collection were as follows: • Publically available health and crime and datasets, such as hospital admission data. Similar locally focused crime-related data has proved far harder to obtain. • Survey of young people from Sheppey Academy • Residents survey conducted via the internet • Focus Groups of Young People • Stakeholder interviews with a member of the local primary care trust, street wardens, senior member of staff from Sheppey Academy, workers from local voluntary and statutory sector local drug and alcohol treatment services and commissioner of drug and alcohol services. Ethical approval was granted for the study by the University of Greenwich Research Ethics Committee in April 2010. Key Findings: Publicly Available Data • Notwithstanding some data collection anomalies alcohol-related hospital admissions for the Isle of Sheppey are disproportionate compared to the rest of Swale and Kent. • This is particularly marked for women. • No data has so far been located that would allow us to conclusively attribute anti-social behaviour to alcohol or drug use. • Hard data about drugs use and criminality on the island has been very difficult to locate. Survey of Young People: • 400 students from Sheppey Academy aged 13-19 (14.8, 0.9, Mean, SD) (males 168 (42%), females 232 (58%) replied to a survey on drug and alcohol use. • The vast majority were occasional alcohol users who other than being sick caused or encountered very few problems when drinking. • The police were active on the island and it was common for young people to have contact with them. • Less than five percent had any form of medical treatment as a result of their drinking. • Only 13% of the sample had ever used an illicit drug. • Cannabis was the most frequent illicit drug taken and this was only on an occasional basis Residents Survey conducted via the internet: • 109 responses were received and other than Leysdown all areas of the island provided responses consistent with their population levels. • The majority of respondent were 20-30 and 65+ • There was drug and alcohol related anti-social behaviour and drug dealing but it was at the same level of concern as “rubbish or litter” and “people not treating other people with respect and consideration.” Focus Groups of Young People: • Two mixed gender focus groups. Group a) students aged 16-17 from Sheppey Academy. Group b) aged 15-16 and recruited through the Sheppey Healthy Living Centre. • The participants confirmed the findings of the young people’s survey. • A number had alcohol confiscated by the anti-social behaviour vehicle but would have also welcomed having their parents informed • Alcohol was easy to obtain chiefly from off-licenses rather than pubs or supermarkets. • Alcohol was frequently obtained through parents, older siblings and older friends • Alcohol and Drug Education classes delivered in their schools were regarded as having minimal impact. A number could not remember whether they received them or not. • The main reason the participants drank was boredom • Drug use in the focus group participants was minimal and infrequent. • The participants would have welcomed greater activities such as sports or a night clubs. • One of the main problems impacting upon them was poor public transport- especially buses to the more remote parts of the island which are infrequent and stop at 7.30pm. Stakeholder Interviews: • Anti-social behaviour is not spread evenly across the island, but is concentrated around beaches and parks as follows: Warden:- area near Donkey Hill, Queenborough; Stanley Avenue, Rushenden: Manor Road, Halfway Area around car park. Minster: Lapwing Close, Harps Estate, Noreen Avenue, Bunnybank, The Glen, Redrow Estate, Appleford Drive, The Broadway, The Leas, Queens Road and behind the supermarket car park and finally Sheerness: Vincent Court, Edenbridge Drive, Beach Front, Beachfield Park, Barton Points, Marine Town, the canal, the town centre, St. Georges Avenue, the railway station and various alleyways in and around the Alma Road area. • Anti-social behaviour worsens in the summer months • Drug and alcohol use in young people on the island is largely seen as being consistent with the rest of Kent and the rest of England, though there are a small number who are encountering significant alcohol and drug–related problems. • Alcohol and drug use on the island has to be seen within the context of deprivation, isolation and perceived lack of opportunity • The main drug of choice for young people on the island is alcohol • In relation to illicit drugs in young people, cannabis use is the most prevalent followed by Ecstasy and legal highs such as mephedrone* • Problematic illicit drug use requiring treatment intervention tends to be uncommon and spread across a number of generations. • There is a perception that drug problems and drug dealing have reduced since the closure of a nightclub in Sheerness in 2004. Role of Volunteers/Public Health Workshops: One of the first tasks of the community researcher was to recruit volunteers to assist in delivering the proposed pilot studies. Prior to the advertisement being placed the project was publicised in the local press and radio. Potential volunteers were subject to a criminal records check, a process that took approximately three months so volunteers were not able to take an active role in the project until May/June 2010. Originally five volunteers were recruited, two found employment in the interim, one did not attend any meetings after initially expressing an interest and two took an active role in the study. In July 2010 a Social Marketing workshop, facilitated by two external consultants, was held at University of Greenwich Medway Campus. It was attended by thirty people including the two volunteers. The majority of the participants were professionals/volunteers with an interest in drug/alcohol use/young people who lived or worked on the island. Thus although the numbers were small a great deal of goodwill was developed that could be utilised to drive the project forward. Another workshop was held concerning enhancing community engagement in December 2010. It was a one day workshop held on two days attended by voluntary and statutory workers from the island and mainland Swale. Six individuals attended on day 1 and eight on day 2. This coincided with very cold weather so attendance was disappointing, however the courses were both positively evaluated by the participants. Establishing a legacy for the project: The project team are taking a number of steps to ensure a permanent legacy for the project. • A DVD aimed at the public health community has been made using a production company employed by Sheppey Matters celebrating the project and summarising the main findings. Key personnel from both Sheppey Matters and the University of Greenwich have been filmed in addition to young people on the island. The final result is also available in a series of pod/video casts that will be uploaded on to the web sites of Centre for Nursing and Health Care Research – University of Greenwich http://www.gre.ac.uk/schools/health/research/cnhr and Sheerness Healthy Living Centre. http://www.sheppeyhlc.org.uk • On May 27th a dissemination event for the project was held to celebrate the work and establish local goodwill to push it forward. Key local stakeholders were invited to hear the main findings being presented with ideas about providing permanent initiatives to improve health of both young people and adults on the island. • The legacy is concerned with taking steps to reduce overall drug and alcohol use on the island. The first of these concerns drug and alcohol education for young people. The focus groups confirmed that alcohol/drug education was not highly regarded by the young people. There is now a large evidence base that finds that if drug/alcohol education is to have a positive impact it has to be appropriate for age of the audience and re-inforced throughout the school career. The University of Greenwich will work to secure funding for a worker to deliver the education in an evidence based way using established templates and train teachers/youth workers etc to continue this work once the project has ended. As part of the project the work will be evaluated. • The SOS bus is a public health initiative that has been funded in part by Medway PCT and evaluated by a team from the University of Greenwich. It delivers public health interventions such as screening for diabetes and providing advice re sexual health etc and the intention now is for this bus to be used in a similar way on Sheppey. If funding can be found for this it will be particularly important in reaching the more remote parts of the island. • Data from the study has shown that many young people come into frequent contact with the police and in some cases a greater police presence would be welcomed. It is also important to note that the culture surrounding young people’s drug and alcohol use is constantly evolving-social networking packages such as facebook and twitter may produce fresh challenges for the police. The research team are now working with Councillor Kenneth Pugh to negotiate a formal advisory role with the police on the island. Note: * Mephedrone was legal at the time of the interviews. It has since been banned-see http://news.bbc.co.uk/1/hi/uk/8623958.stm). November 201

Lay perceptions of health, housing and community on the Kent Coast, England

Lay perceptions of health inequalities are becoming increasingly important in developing local housing strategies and many coastal areas have attracted recent attention because of high levels of deprivation. This paper draws from the findings of 14 socioeconomically and geographically representative focus groups as part of the wider French British Interreg IIIA project examining health inequalities and health behaviours in South East England and Northern France. Kent coastal areas were identified as being of particular and unique interest, leading to a wider literature review of socio-economic and health inequalities more generally in coastal towns and the effect of geography on health. Participants in the focus groups particularly suggested that the loss of traditional industries – notably the holiday trade (tourism), but also other local employment – had led to new low-income, deprived communities, including immigrant communities, whose needs often went unmet. Participants identified the changing nature of coastal or seaside housing from guest house to residential living accommodation and the relationship to the benefit system as being of particular concern, affecting both physical and mental health and the wider environment. However, participants also described successful local community-led regeneration solutions which could run alongside new local authority responsibilities to tackle health inequalities. The focus group findings suggest that lay perceptions are in many ways close to recent governmental research findings which identify the coastal regions as unique environments, some with similar levels of deprivation to inner urban and rural areas and lacking sufficient public investment. The results of this study suggest that the public have additional concerns around housing allocation policies creating marginal coastal communities and how these needs might be addressed. New strategies need to involve the communities affected. Although this can prove challenging, there is a new range of legislative provisions to tackle complex and multifaceted housing, social, economic and environmental conditions faced by those suffering some of the most acute health inequalities

Innovations in pay and grading in NHS trusts

This report examines innovations in pay and grading in 10 NHS trusts in England using data collected from March 2000 to January 2001, ie prior to the implementation of Agenda for Change. These 10 trusts, which varied in size, function, and location, were selected primarily to illustrate a variety of different approaches to pay and grading. The research utilised a qualitative methodology, with interviews of managers on a one to one basis, group interviews with lay union representatives, focus groups with staff and the inspection of documents. This study focused on four questions: • Did local pay resolve the problems associated with Whitley? • What were the consequences of local pay? • Were the trusts’ pay systems introduced in line with 'new pay' ideas and current trends in reward management? • What factors were critical to the success of developing and implementing local pay systems in NHS trusts

The reporting behaviours of student nurses who have experienced verbal abuse

Background: There is evidence that student nurses are vulnerable to experiencing verbal abuse from a variety of sources and under-reporting of verbal abuse is prevalent throughout the nursing profession. The objective of the study is to explore the reporting behaviours of student nurses who have experienced verbal abuse. Method: For this study a definition of verbal abuse was adopted from current Department of Health (England) guidelines. Questionnaires were distributed in 2005 to a convenience sample of 156 third year nursing students from one pre-registration nursing programme in England. A total of 114 questionnaires were returned, giving an overall response rate of 73.0%. Results: Fifty one students (44.7% of responses) reported verbal abuse; all of these completed the section exploring reporting behaviours. The incidents involved patients in thirty three cases (64.7%); eight cases (15.7%) involved visitors or relatives and ten cases (19.6%) involved other healthcare workers. Thirty two students (62.7%) stated that they did report the incident of verbal abuse they experienced and nineteen (37.3%) of respondents reported that they did not. Only four incidents developed from an oral report to being formally documented. There was a statistically significant association (P = 0.003) between the focus of verbal abuse (patient/visitor or colleague) and the respondents reporting practices with respondents experiencing verbal abuse from colleagues less likely to report incidents. Most frequent feelings following experiences of verbal abuse from colleagues were feelings of embarrassment and hurt/shock. Most frequent consequences of experiencing verbal abuse from patients or relatives were feeling embarrassed and feeling sorry for the abuser. When comparing non reporters with reporters, the most frequent feelings of non reporters were embarrassment and hurt and reporters, embarrassment and feeling sorry for the abuser. When considering levels of support after the incident the mean rating score of respondents who reported the incident was 5.40 (standard deviation 2.89) and of those that did not, 4.36 (standard deviation 2.87) which was not statistically significant (p = 0.220). Conclusions: 1. Not documenting experiences of verbal abuse formally in writing is a prevalent phenomenon within the sample studied and reporting practices are inconsistent. 2. Both Higher Education Institutions and health care providers should consider emphasising formal reporting and documenting of incidents of verbal abuse during student nurse training and access to formal supportive services should be promoted. 3. Effective incident reporting processes and analysis of these reports can lead to an increased awareness of how to avoid negative interactions in the workplace and how to deal with incidents effectively

The exposure to verbal abuse of student nurses gaining placement experience

Clinical placement experience has a key role to play in the socialisation and preparation of future members of the nursing profession. Aggression experienced by healthcare workers is currently receiving considerable attention and student nurses have been identified as a group vulnerable to experiencing workplace abuse (Little 1999). The primary aim of the study is to gain a greater understanding of the nature, severity, frequency and sources of verbal abuse experienced by student nurses in health care settings in the south east of England, using as a definition, “the use of inappropriate words… causing distress” (Department of Health 2003). A convenience sample of 156 third year student nurses of all four branches of one preregistration nursing programme in the south east of England was studied with questionnaires distributed retrospectively; 11 4 student nurses returned the questionnaires equating to a response rate of 73%. Results 46% of respondents reported experiencing verbal abuse, 39% had witnessed other students experiencing verbal abuse and 61% reported that they were aware of other students experiencing verbal abuse. Students reported experiencing threats to kill, racial abuse, sexually orientated verbal abuse and bullying while gaining placement experience. Student nurses are a high risk group for experiencing verbal abuse whilst gaining placement experience.In the literature, mental health and learningdisability settings are viewed as high risk areasfor experiencing aggression (Beech and Leather 2003); this study suggests that student nurses experience verbal abuse in a variety of settings and verbal abuse may be more prevalent on general medical and surgical wards than previously expected

Conceptualising learning through simulation: An expansive approach forprofessional and personal learning

This paper explores different ways of conceptualising the learning that occurs as student nurses engage in simulation experiences. The conceptual frameworks discussed in this paper draw upon the work of Benner and Sutphen (2007) and Engeström (1994). Benner and Sutphen's work highlights the complex nature of situated knowledge in practice disciplines such as nursing. They suggest that knowledge must be constantly integrated within the curriculum through pedagogies of interpretation, formation, contextualisation and performance. These pedagogies present a framework, which may enhance our understanding of the impact of simulation upon student learning. Engeström's work on activity theory, recognises the links between learning and the environment of work and highlights the possibilities for learning to inspire change, innovation and the creation of new ideas. His notion of expansive learning offers nurse education a means of reconceptualising the learning that occurs during simulation. Together these frameworks present an opportunity for nurse education to articulate and theorise the learning inherent in simulation activities. © 2013 Elsevier Ltd

Triggers of self-conscious emotions in the sexually transmitted infection testing process

<p>Abstract</p> <p>Background</p> <p>Self-conscious emotions (shame, guilt and embarrassment) are part of many individuals' experiences of seeking STI testing. These emotions can have negative impacts on individuals' interpretations of the STI testing process, their willingness to seek treatment and their willingness to inform sexual partners in light of positive STI diagnoses. Because of these impacts, researchers have called for more work to be completed on the connections between shame, guilt, embarrassment and STI testing. We examine the specific events in the STI testing process that trigger self-conscious emotions in young adults who seek STI testing; and to understand what it is about these events that triggers these emotions.</p> <p>Semi-structured interviews with 30 adults (21 women, 9 men) in the Republic of Ireland.</p> <p>Findings</p> <p>Seven specific triggers of self-conscious emotions were identified. These were: having unprotected sex, associated with the initial reason for seeking STI testing; talking to partners and peers about the intention to seek STI testing; the experience of accessing STI testing facilities and sitting in clinic waiting rooms; negative interactions with healthcare professionals; receiving a positive diagnosis of an STI; having to notify sexual partners in light of a positive STI diagnosis; and accessing healthcare settings for treatment for an STI. Self-conscious emotions were triggered in each case by a perceived threat to respondents' social identities.</p> <p>Conclusion</p> <p>There are multiple triggers of self-conscious emotions in the STI testing process, ranging from the initial decision to seek testing, right through to the experience of accessing treatment. The role of self-conscious emotions needs to be considered in each component of service design from health promotion approaches, through facility layout to the training of all professionals involved in the STI testing process.</p

Establishing a method to support academic and professional competence throughout an undergraduate radiography programme

Purpose: Radiography degree programmes are coming under increasing pressurefrom the community to ensure that graduates have not only the necessary academic developmentbut also the practice-based skills. This study aims to establish a method of monitoringstudents’ progress towards, and ability to meet, academic and professional competencesthroughout a radiography programme.Methods: Questionnaires were designed for students and academic staff to determine thestages and standards of progress of competence development, and to inform the review processof the current assessment tools throughout the programme. A literature search identifiedthe appropriate pedagogy as a basis for devising the method. Another questionnaire was distributedto overseas radiography institutions to gain insights into other assessment practicesto validate the framework.Results and discussion: It was established that years of study rather than semester periodswere appropriate to allow students to meet the standards. Discrepancies were noted in theexpectations between academic staff (higher expectations) and students (more realistic) interms of the pace of development expected. As students progress at different rates, and donot experience the same clinical exposure, their ability to meet expectations may differand so both sets of expectations were combined as a range of criteria. A multi-dimensionalassessment approach should be adequate to gauge students’ progress but time and resourceeffectiveness has not yet been addressed. The portfolio was identified as the pedagogy capableof integrating all the competence assessment tools, linked by reflective writing, to gatherindividual outcomes into a whole, and form a holistic framework.Outcome: The portfolio framework will initially run as a voluntary activity and standards ofprogress corresponding to the students’ stages will be delivered to participants in advance.Participants will be required to select materials and reflect on these, as evidence of development.Faculty members will provide support and feedback to students and oversee the wholeprocess

The sensorium at work: the sensory phenomenology of the working body

The sociology of the body and the sociology of work and occupations have both neglected to some extent the study of the ‘working body’ in paid employment, particularly with regard to empirical research into the sensory aspects of working practices. This gap is perhaps surprising given how strongly the sensory dimension features in much of working life. This article is very much a first step in calling for a more phenomenological, embodied and ‘fleshy’ perspective on the body in employment, and examines some of the theoretical and conceptual resources available to researchers wishing to focus on the lived working-body experiences of the sensorium. We also consider some possible representational forms for a more evocative, phenomenologically-inspired portrayal of sensory, lived-working-body experiences, and offer suggestions for future avenues of research