Advance care planning: between tools and relational end-of-life care?

The way in which end-of-life care is delivered in the UK has changed dramatically over the last few years. Owing to the changes in systems and care practice promoted in the End of Life Care Strategy more people have access to higher quality care, including advance care planning and symptom management. Drawing on the ‘best practice’ at the time, the Strategy recommended the use of several tools to facilitate identifying dying patients, communicating and planning future care, and coordinating otherwise disparate services. These changes have not gone unnoticed: in 2010, the UK was considered as the best place to die by the Economist Intelligence Unit, and recent UK data released as part of Dying Matters Awareness week suggest people are more comfortable talking about death and dying now than they were 10 years ago. Yet, end-of-life care has been described as ‘failing’, in a 2015 Parliamentary and Health Service Ombudsman's report, particularly in terms of discussing dying and documenting patient preferences

The grammar of administrative justice values

The debate concerning administrative justice in the UK often involves reliance upon a certain set of values. Examples of such values include openness, confidentiality, timeliness, transparency, secrecy, fairness, efficiency, accountability, user-friendliness, consistency, participation, rationality and equal treatment. These values are often deployed, both in academic and policy contexts, without much precision. This produces confusion which can hamper debate. This article therefore argues there is a need to reflect on how these oft-used values are deployed, and consider the particular concerns which underlie them. In this sense, this article suggests there is a need to refine the grammar of administrative justice. This argument is demonstrated through an extended analysis of the value of ‘user-friendliness’: a site of emerging disagreement in recent years. It proposes that an important distinction must be drawn between two understandings of the value: the ‘accessibility’ and ‘consumerist’ understandings. This article concludes by suggesting that, going forward, it is important to consider whether the use of abstractions is helpful at all in administrative law and justice debates

To flag or not to flag : identification of children and young people with learning disabilities in English hospitals

Background Children and young people with learning disabilities experience poor health outcomes and lengthier hospital admissions than those without learning disabilities. No consistently applied, systematic approach exists across the NHS to identify and record this population. This paper describes practices in English hospitals to identify children and young people with learning disabilities. Method Interviews: 65 NHS staff. Questionnaire: 2,261 NHS staff. Conducted across 24 NHS hospitals in England. Results No standardized approach exists to identify children or young people with a learning disability or for this information to be consistently recorded, communicated to relevant parties within a hospital, Trust or across NHS services. Staff reported a reliance on parents to inform them about their child's needs but concerns about “flagging” patients might be a significant barrier. Discussion Without an integrated systematic way across the NHS to identify children with learning disabilities, their individual needs will not be identified.</p

The ombudsman, tribunals and administrative justice section: a 2020 vision for the ombudsman sector

This article analyses the growing role for ombudsman schemes in the UK administrative justice system following the Government reforms post 2010. It argues that the ombudsman institution is perhaps the one example of an administrative justice body that looks set to emerge stronger over the period. But the ombudsman sector needs to guard against complacency, as the demands, expectations and publicity placed upon it are all likely to increase

The views of patients, mentors and adult field nursing students on patients' participation in student nurse assessment in practice

© 2015 Elsevier Ltd. In recent years, changes to undergraduate nursing curricula in the United Kingdom have been coupled with increasing expectations that service users be involved in assessment of student nurses. These factors lead to the development of a tool to facilitate gathering of feedback from patients/carers on the competency of adult field student nurses in practice.This study evaluated experiences of those involved in the process of using the feedback tool.Using an exploratory qualitative research design, four patients, four mentors and five pre-registration adult field nursing students were interviewed. Thematic analysis of the data identified three interconnecting themes; value of the patient's voice, caring and protection, and authenticity of feedback. A sub-theme of timing of giving feedback was also identified.Patients felt they should be involved in giving feedback, were comfortable in doing so, and felt best placed to judge students' performance in several aspects of care. Students and mentors shared these opinions. Additionally they felt service user feedback potentially helped improve students' competence and confidence, and facilitated mentors in their assessment of students' professional values, communication and interpersonal skills. However, mentors were more reticent about the possibility of receiving feedback from service users on their own practice

Current perceptions of statutory supervision of midwifery: time for change

Statutory supervision of midwifery has been in place in the UK for 113 years. Recently, however, the Nursing and Midwifery Council (NMC, 2015) have voted to accept the recommendations of the King’s fund review (2015) into midwifery regulation, which will see the end of the statutory supervision of midwifery as we know it. Much of the literature on this subject extols the virtues of statutory supervision. The aim of this study is to explore current perceptions of statutory supervision among a sample of midwifery practitioners to establish whether their views and opinions of statutory supervision supports or undermines the provision of care. The data represents a complex picture of supervision. Concerns and challenges arise for all those involved with statutory supervision, which at times does not appear to support the provision of quality care

Communication between healthcare professionals and relatives of patients approaching the end-of-life : a systematic review of qualitative evidence

Background: Effective communication between healthcare professionals and relatives of patients approaching the end-of-life is vital to ensure patients have a ‘good death’. To improve communication, it is important to first identify how this is currently being accomplished. Aim: To review qualitative evidence concerning characteristics of communication about prognosis and end-of-life care between healthcare professionals and relatives of patients approaching the end-of-life. Design: Qualitative systematic review (PROSPERO registration CRD42017065560) using thematic synthesis. Peer-reviewed, English language articles exploring the content of conversations and how participants communicated were included. No date restrictions were applied. Quality of included studies was appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Data sources: An electronic database search of CINAHL, MEDLINE, PsycINFO and EMBASE was performed. Results: Thirty-one papers were included. Seven themes were identified: highlighting deterioration; involvement in decision-making, post-decision interactional work, tailoring, honesty and clarity, specific techniques for information delivery and roles of different healthcare professionals. Varied levels of family involvement in decision-making were reported. Healthcare professionals used strategies to aid understanding and collaborative decision-making, such as highlighting the patient’s deterioration, referring to patient wishes and tailoring information delivery. Doctors were regarded as responsible for discussing prognosis and decision-making, and nurses for providing individualized care. Conclusion: Findings suggest training could provide healthcare professionals with these strategies to improve communication. Interventions such as question prompt lists could help relatives overcome barriers to involvement in decision-making. Further research is needed to understand communication with relatives in different settings and with different healthcare professionals