In Social Work Practice, Social Justice is the Rock Learning About Social Justice During Field Education

In Social Work Practice, Social Justice is the Rock: Learning About Social Justice During Field Education. Social justice is a core principle of social work and a social justice framework underpins the knowledge and teaching in social work education programs in Australia. Field education offers students the opportunity to discover the complexities of social work practice. While field education is an integral component of social work education, there is insufficient research on the inclusion of social justice principles within field education. This under-researched area is the focus of the dissertation. Students’ understandings of social justice and observations of learning about social justice during field education were explored. This qualitative study involved in-depth interviews of 32 social work students, new graduates, field educators, managers and academics with an interest in social justice on placement. Using a critical theory perspective, these interviews were thematically analysed. Field education was viewed as central to students developing practice with a social justice focus. Students and new graduates understood social justice to include concepts of equality and fairness and, for some the structural factors that maintain injustice. Significant influences were experiences of injustice, ideas from their families and inspirational educators. Students and new graduates learnt about social justice from those using the service and linking these reflections to campus learning. Students struggled to apply theory to practice and in particular concepts of social justice. Field educators, managers and academics described how they assisted students to link their experiences to theoretical models. They expected students to be ready to take a social justice focus within the practice context but noted the significant impact an organisation’s stance on social justice in social work practice had on student learning. This study affirms the central importance of field education for learning about social justice and exposes tensions between field education and campus learning. Keywords: social work field education, social justice, social work education, social work, social justice education

The prevention and resolution of disputes over property rights in twelfth and early thirteenth century Scotland

The accepted view of dispute resolution during the twelfth and early thirteenth century is to either dismiss the possibility altogether due to a scarcity of documents or to look backward from the later thirteenth century and beyond, measuring the records of the twelfth century and early thirteenth against the more prolific and more detailed records of later periods. This has led to the widely accepted conclusion that either the means of resolving disputes in the earlier period were less sophisticated, less developed versions of later legal systems, or that the earlier period was in a legal dark age where the light of reason and systematic approaches to law had not yet developed. The evidence discussed here shows, however, that there were systematic approaches to both preventing disputes and resolving those that did occur. The documents are not in the format that came to be accepted in later periods, nor are they worded as later legal documents would be. But that there were legal decisions being made according to norms, customs and rules that were consistently applied is clear. Using complexity theory as a means of analysis allows us to see the patterns and the systematic approaches, not in a system wide context, but at the level of decision making, where these rules, norms and customs were applied to the facts by one or more decision makers in order to achieve a just result. This approach affirms the underlying concept of justice that drives any legal system, whether a more modern, well documented legal structure or one where the records are not so abundant

STOPP/START criteria for potentially inappropriate prescribing in older people: version 2

Purpose: screening tool of older people’s prescriptions (STOPP) and screening tool to alert to right treatment (START) criteria were first published in 2008. Due to an expanding therapeutics evidence base, updating of the criteria was required. Methods: we reviewed the 2008 STOPP/START criteria to add new evidence-based criteria and remove any obsolete criteria. A thorough literature review was performed to reassess the evidence base of the 2008 criteria and the proposed new criteria. Nineteen experts from 13 European countries reviewed a new draft of STOPP & START criteria including proposed new criteria. These experts were also asked to propose additional criteria they considered important to include in the revised STOPP & START criteria and to highlight any criteria from the 2008 list they considered less important or lacking an evidence base. The revised list of criteria was then validated using the Delphi consensus methodology. Results: the expert panel agreed a final list of 114 criteria after two Delphi validation rounds, i.e. 80 STOPP criteria and 34 START criteria. This represents an overall 31% increase in STOPP/START criteria compared with version 1. Several new STOPP categories were created in version 2, namely antiplatelet/anticoagulant drugs, drugs affecting, or affected by, renal function and drugs that increase anticholinergic burden; new START categories include urogenital system drugs, analgesics and vaccines. Conclusion: STOPP/START version 2 criteria have been expanded and updated for the purpose of minimizing inappropriate prescribing in older people. These criteria are based on an up-to-date literature review and consensus validation among a European panel of experts

Towards fast algorithms for the preference consistency problem based on hierarchical models

In this paper, we construct and compare algorithmic approaches to solve the Preference Consistency Problem for preference statements based on hierarchical models. Instances of this problem contain a set of preference statements that are direct comparisons (strict and non-strict) between some alternatives, and a set of evaluation functions by which all alternatives can be rated. An instance is consistent based on hierarchical preference models, if there exists an hierarchical model on the evaluation functions that induces an order relation on the alternatives by which all relations given by the preference statements are satisfied. Deciding if an instance is consistent is known to be NP-complete for hierarchical models. We develop three approaches to solve this decision problem. The first involves a Mixed Integer Linear Programming (MILP) formulation, the other two are recursive algorithms that are based on properties of the problem by which the search space can be pruned. Our experiments on synthetic data show that the recursive algorithms are faster than solving the MILP formulation and that the ratio between the running times increases extremely quickly

Computation and complexity of preference inference based on hierarchical models

Preference Inference involves inferring additional user preferences from elicited or observed preferences, based on assumptions regarding the form of the user's preference relation. In this paper we consider a situation in which alternatives have an associated vector of costs, each component corresponding to a different criterion, and are compared using a kind of lexicographic order, similar to the way alternatives are compared in a Hierarchical Constraint Logic Programming model. It is assumed that the user has some (unknown) importance ordering on criteria, and that to compare two alternatives, firstly, the combined cost of each alternative with respect to the most important criteria are compared; only if these combined costs are equal, are the next most important criteria considered. The preference inference problem then consists of determining whether a preference statement can be inferred from a set of input preferences. We show that this problem is coNP-complete, even if one restricts the cardinality of the equal-importance sets to have at most two elements, and one only considers non-strict preferences. However, it is polynomial if it is assumed that the user's ordering of criteria is a total ordering; it is also polynomial if the sets of equally important criteria are all equivalence classes of a given fixed equivalence relation. We give an efficient polynomial algorithm for these cases, which also throws light on the structure of the inference

Preference inference based on hierarchical and simple lexicographic models

Preference Inference involves inferring additional user preferences from elicited or observed preferences, based on assumptions regarding the form of the user’s preference relation. In this paper we consider a situation in which alternatives have an associated vector of costs, each component corresponding to a different criterion, and are compared using a kind of lexicographic order, similarly to the way alternatives are compared in a Hierarchical Constraint Logic Programming model. It is assumed that the user has some (unknown) importance ordering on criteria, and that to compare two alternatives, firstly, the combined cost of each alternative with respect to the most important criteria are compared; only if these combined costs are equal, are the next most important criteria considered. The preference inference problem then consists of determining whether a preference statement can be inferred from a set of input preferences. We show that this problem is coNP-complete, even if one restricts the cardinality of the equal-importance sets to have at most two elements, and one only considers non- strict preferences. However, it is polynomial if it is assumed that the user’s ordering of criteria is a total ordering (which we call a simple lexicographic model); it is also polynomial if the sets of equally important criteria are all equivalence classes of a given fixed equivalence relation. We give an efficient polynomial algorithm for these cases, which also throws light on the structure of the inference. We give a complete proof theory for the simple lexicographic model case, and analyse variations of preference inference

Palliative care for Parkinson's disease: Patient and carer's perspectives explored through qualitative interview

Background: Palliative care is recommended for non-malignant illnesses, including Parkinson’s disease. However, past research with healthcare workers highlights unmet palliative needs in this population and referral rates to Specialist Palliative Care are low. Some healthcare workers perceive a ‘fear’ in their patients about introducing palliative care. However, less is known about the views of people with Parkinson’s disease and their carers about palliative care. Aim: (1) To explore the palliative care and related issues most affecting people with Parkinson’s disease and their families and (2) to examine perceptions about/understanding of palliative care. Design: This was a qualitative study; semi-structured interviews were conducted, transcribed and analysed using thematic analysis. Setting/participants: A total of 31 people participated, both people with Parkinson’s disease (n = 19) and carers (n = 12), across three Movement Disorder Clinics in the Republic of Ireland. Results: People with Parkinson’s disease and their carers were unfamiliar with the term palliative care. When informed of the role of palliative care, most felt that they would benefit from this input. People with Parkinson’s disease and carers experienced a high illness burden and wanted extra support. Crises requiring Specialist Palliative Care involvement may occur at diagnosis and later, with advancing illness. Participants wanted more information about palliative care and especially further supports to address their psychosocial needs. Conclusion: A holistic palliative care approach could address the complex physical and psychosocial symptoms experienced by people with Parkinson’s disease and their carers, and people with Parkinson’s disease and their carers are open to palliative care. Further research needs to explore how palliative care can be introduced into the routine care for people with Parkinson’s disease

Study protocol for evaluating the implementation and effectiveness of an emergency department longitudinal patient monitoring system using a mixed-methods approach

Background: Early detection of patient deterioration is a key element of patient safety as it allows timely clinical intervention and potential rescue, thus reducing the risks of serious patient safety incidents. Longitudinal patient monitoring systems have been widely recommended for use to detect clinical deterioration. However, there is conflicting evidence on whether they improve patient outcomes. This may in part be related to variation in the rigour with which they are implemented and evaluated. This study aims to evaluate the implementation and effectiveness of a longitudinal patient monitoring system designed for adult patients in the unique environment of the Emergency Department (ED). Methods: A novel participatory action research (PAR) approach is taken where socio-technical systems (STS) theory and analysis informs the implementation through the improvement methodology of ‘Plan Do Study Act’ (PDSA) cycles. We hypothesise that conducting an STS analysis of the ED before beginning the PDSA cycles will provide for a much richer understanding of the current situation and possible challenges to implementing the ED-specific longitudinal patient monitoring system. This methodology will enable both a process and an outcome evaluation of implementing the ED-specific longitudinal patient monitoring system. Process evaluations can help distinguish between interventions that have inherent faults and those that are badly executed. Discussion: Over 1.2 million patients attend EDs annually in Ireland; the successful implementation of an ED-specific longitudinal patient monitoring system has the potential to affect the care of a significant number of such patients. To the best of our knowledge, this is the first study combining PAR, STS and multiple PDSA cycles to evaluate the implementation of an ED-specific longitudinal patient monitoring system and to determine (through process and outcome evaluation) whether this system can significantly improve patient outcomes by early detection and appropriate intervention for patients at risk of clinical deterioration

Prescriber implementation of STOPP/START recommendations for hospitalised older adults: a comparison of a pharmacist approach and a physician approach

Background: Two randomised controlled trials (RCTs) conducted simultaneously in the same Irish university teaching hospital have shown that provision of Screening Tool of Older Persons’ Prescriptions (STOPP)/Screening Tool to Alert doctors to Right Treatment (START) recommendations to attending prescribers by a physician or a pharmacist can reduce in-hospital adverse drug reactions (ADRs) in older adults (≥ 65 years). The aims of this study were to compare the prescriber implementation rates of STOPP/START recommendations between the physician approach and the pharmacist approach in these two RCTs and to provide a narrative summary of the comparable clinical outcomes. Methods: Data were extracted from the two RCT published papers and their associated computerised databases to calculate the percentage prescriber implementation rates for the STOPP/START recommendations. The Chi-square test was used to quantify the differences in prescriber implementation rates, with differences considered statistically significant where p < 0.05. Results: Prescriber implementation rates of the STOPP and START recommendations made by the physician were 81.2% and 87.4% respectively, significantly higher than those made by the pharmacist (39.2% and 29.5% respectively), p < 0.0001. A greater absolute risk reduction in patients with ADRs was shown with the physician’s intervention compared to the pharmacist’s intervention (9.3% vs 6.8%). Conclusion: This study shows that the methods of communication and the medium through which the STOPP/START recommendations are delivered significantly affect their implementation. Non-implementation of some pharmacist-delivered recommendations may be contributing to preventable ADRs in older adults. Thus, future research should aim to identify the factors influencing prescriber implementation of pharmacist recommendations in order to inform the design of more effective pharmacist interventions in optimising older patients’ pharmacotherapy

Fibrotic interstitial lung disease - palliative care needs:a World-Café qualitative study

Objectives: The importance of palliative care in those with advanced fibrotic interstitial lung diseases (F-ILD) is recognised, but the palliative care requirements of patients and caregivers affected by F-ILD regardless of disease course are not established. We set out to explore this and identify optimal solutions in meeting the needs of a F-ILD population in Ireland. Methods: Implementing a World-Café qualitative research approach, we captured insights evolving, iteratively in interactive small group discussions in response to six predefined topics on palliative care and planning for the future. Thirty-nine stakeholders participated in the World-Café including 12 patients, 13 caregivers, 9 healthcare professionals, 4 industry representatives and 1 representative of the clergy. Results: Palliative care emerged as fundamental to the care and treatment of F-ILDs, regardless of disease progression. Unmet palliative care needs were identified as psychological and social support, disease education, inclusion of caregivers and practical/legal advice for disease progression and end-of-life planning. Participants identified diagnosis as a particularly distressing time for patients and families. They called for the introduction of palliative care discussions at this early-stage alongside improvements in integrated care, specifically increasing the involvement of primary care practitioners in referrals to palliative services. Conclusion: Patients and caregivers need discussions on palliative care associated with F-ILD to be included at the point of diagnosis. This approach may address persisting inadequacies in service provision previously identified over the course of the last decade in the UK, Ireland and European F-ILD patient charters.</p