Colonial refractions: the 'Gypsy camp' as a spatio-racial political technology

Camps for civilians first appeared in the colonies. Largely drawing on the literature on colonialism and race, this article conceptualizes the 'Gypsy camp' in Western European cities as a spatio-racial political technology. We first discuss the shift, starting with decolonization, from colonial to metropolitan technologies of the governance of social heterogeneity. We then relate this broad historical framing to the ideas and ideologies that since the 1960s have been underpinning the planning and governance of the ‘Gypsy camp' in both the UK and Italy. We document the 1970s emergence of a new and distinctive type of camp that was predicated upon a racially connoted tension between policies criminalizing sedentarization and ideologies of cultural protection. Given that the imposition of the ‘Gypsy camp' was essentially uncontested, we argue that the conditions of possibility for it to emerge and become institutionalized were both a spatio-racial similarity with typically colonial technologies of governance, and the fact that it was largely perceived as a self-evident necessity for the governance and control of one specific population. We conclude by calling for more analyses on this and other forms of urban confinement in both the Global North and South, in order to account for the increasingly disquieting mushrooming of confining and controlling governance devices, practices and ideologies

Implementing person-centred key performance indicators to strengthen leadership in community nursing: a feasibility study

From Crossref via Jisc Publications RouterBrendan McCormack - ORCID 0000-0001-8525-8905 https://orcid.org/0000-0001-8525-8905Replaced AM with VoR 2020-09-04Aims To explore the utility and feasibility of implementing eight person‐centred nursing key performance indicators in supporting community nurses to lead the development of person‐centred practice.Background Policy advocates person‐centred healthcare, but few quality indicators exist that explicitly focus on evaluating person‐centred practice in community nursing. Current quality measurement frameworks in the community focus on incidences of poor or missed opportunities for care, with few mechanisms to measure how clients perceive the care they receive.Methods An evaluation approach derived from work of the Medical Research Council was used and the study was underpinned by the Person‐Centred Practice Framework. Participatory methods were used, consistent with person‐centred research.Results Data were thematically analysed, revealing five themes: giving voice to experience, talking the language of person‐centredness, leading for cultural change, proud to be a nurse and facilitating engagement.Conclusions The findings suggest that implementing the 8 person‐centred nursing KPIs and the measurement framework is feasible and offers a means of evidencing person‐centredness in community nursing.Implications for Nursing Management Person‐centred KPI data, used alongside existing quality indicators will enable nurse managers to evidence a high standard of care delivery and assist in the development of person‐centred practice.28pubpub

Profound CD4+/CCR5+ T cell expansion is induced by CD8+ lymphocyte depletion but does not account for accelerated SIV pathogenesis

Depletion of CD8+ lymphocytes during acute simian immunodeficiency virus (SIV) infection of rhesus macaques (RMs) results in irreversible prolongation of peak-level viral replication and rapid disease progression, consistent with a major role for CD8+ lymphocytes in determining postacute-phase viral replication set points. However, we report that CD8+ lymphocyte depletion is also associated with a dramatic induction of proliferation among CD4+ effector memory T (TEM) cells and, to a lesser extent, transitional memory T (TTrM) cells, raising the question of whether an increased availability of optimal (activated/proliferating), CD4+/CCR5+ SIV “target” cells contributes to this accelerated pathogenesis. In keeping with this, depletion of CD8+ lymphocytes in SIV− RMs led to a sustained increase in the number of potential CD4+ SIV targets, whereas such depletion in acute SIV infection led to increased target cell consumption. However, we found that the excess CD4+ TEM cell proliferation of CD8+ lymphocyte–depleted, acutely SIV-infected RMs was completely inhibited by interleukin (IL)-15 neutralization, and that this inhibition did not abrogate the rapidly progressive infection in these RMs. Moreover, although administration of IL-15 during acute infection induced robust CD4+ TEM and TTrM cell proliferation, it did not recapitulate the viral dynamics of CD8+ lymphocyte depletion. These data suggest that CD8+ lymphocyte function has a larger impact on the outcome of acute SIV infection than the number and/or activation status of target cells available for infection and viral production

Europe’s perennial "outsiders": a processual approach to Roma stigmatization and ghettoization

This paper draws on the theoretical work of Norbert Elias and Loïc Wacquant in seeking to understand the stigmatized and marginalized position of the Roma population within Europe. The paper argues that the persistent persecution of Roma, reflected in social policy, cannot be understood without reference to long-term social processes, which shape the nature of the asymmetric power relations between Roma and non-Roma. Elias's theory of established-outsider relations is applied at the intra-state European level in arguing that Roma constitute a cross-border "outsider" group; with their intense stigmatization explained and perpetuated by a common set of collective fantasies which are maintained through complex group processes of disidentification, and which result in Roma being seen as of lesser human worth. Wacquant's theoretical concept of the "ghetto" is then drawn upon to show how the manifestations of stigmatization for the stigmatized are at once psychological, social and spatial. The paper suggests that the synthesis of the two theorists' relational, theoretical concepts allows for an approach that can expose the way in which power is exercised within and through group relations. Such an approach emphasizes the centrality of the interdependence between Roma and non-Roma, and the fluctuating power balance that characterises that relationship across time and space. The paper concludes that, while existing research focused on policy and outcomes is useful in understanding the negative contemporary experiences of Roma populations, they need to be understood in the context of wider social processes and historical continuities in seeking to elucidate how these processes shape policies and contribute to social and spatial marginalization

Documentation in the neonatal unit: The support given to parents and their participation in their baby’s care.

Aims: To explore how often the participation of parents in their infants’ care and professionals’ support for parents was documented in the clinical records and to determine how such participation and support were documented. Background: Comprehensive documentation can facilitate collaboration between parents and health care professionals, supporting family-centered care, yet little is known about how this is reflected in practice. Design: A prospective, mixed methods approach was used to analyse the clinical records of newborns. Methods: The study was carried out in a large tertiary Neonatal Unit in the United Kingdom, from 2013-2014. We analysed the clinical records of 24 critically ill newborns using content analysis and thematic analysis, enabling us to determine the frequency of documented support and participation as well as how these were documented. Results: We identified four categories of support in the clinical records: emotional, spiritual, social and practical support. We also identified instances where parents were encouraged to participate in their infant’s care. Frequency differences in the documentation of support between infants facing a redirection of care decision and infants receiving active treatment were found. Two organisational themes were identified: task focused documentation and minimal documentation of parental role. These were grouped together under the global theme professional accountability. The perspectives and experiences of parents were minimally documented throughou

Motivational engagement in first-time hearing aid users: a feasibility study

Objective: To assess (1) the feasibility of incorporating the Ida Institute’s Motivation Tools into a UK audiology service, (2) the potential benefits of motivational engagement in first-time hearing aid users, and (3) predictors of hearing aid and general health outcome measures. Design: A feasibility study using a single-centre, prospective, quasi-randomized controlled design with two arms. The Ida Institute’s Motivation Tools formed the basis for motivational engagement. Study sample: First-time hearing aid users were recruited at the initial hearing assessment appointment. The intervention arm underwent motivational engagement (M+, n = 32), and a control arm (M-, n = 36) received standard care only. Results: The M+ group showed greater self-efficacy, reduced anxiety, and greater engagement with the audiologist at assessment and fitting appointments. However, there were no significant between-group differences 10-weeks post-fitting. Hearing-related communication scores predicted anxiety, and social isolation scores predicted depression for the M+ group. Readiness to address hearing difficulties predicted hearing aid outcomes for the M- group. Hearing sensitivity was not a predictor of outcomes. Conclusions: There were some positive results from motivational engagement early in the patient journey. Future research should consider using qualitative methods to explore whether there are longer-term benefits of motivational engagement in hearing aid users

Boundaries Around the 'Well-Informed' Patient: The Contribution of Schutz to Inform Nurses' Interactions

Aim. The aim of this paper is to explore the operation of two different types of knowledge in health care and the position of the nurse to assist in the confluence of knowledge to develop the well-informed patient. Background. If patients are to be active participants in their care they require useful information. Interactions in contemporary health care mostly involve 'medico-scientific' knowledge, that refers to the 'science' of patients' conditions, as opposed to 'everyday' knowledge, which refers to information that can assist patients in lifestyle matters relating to their condition. Theoretical perspective. This paper draws on the work of the 'well-informed citizen' as proposed by Schutz in the analysis of two patient case studies of practices in the acute care setting of the hospital. Method. Data collection was undertaken through fieldwork, incorporating participant observation and discussions with patients in general medical/surgical areas. Results. Two patient case studies representative of the findings are analysed. Analysis identifies the predominant use of 'medico-scientific' knowledge to the detriment of 'everyday' knowledge during interactions between patients and all health professionals. Conclusions. There is predisposition in the acute context to interact in 'medico-scientific' knowledge as opposed to 'everyday' knowledge that does not facilitate a comprehensive understanding by patients of how they can best manage their lifestyle. Relevance to clinical practice. Using the notion of Schutz's 'well-informed' citizen this study identifies strategies for nursing staff to capture and explore the development of 'everyday' knowledge that can assist patients to become more informed and improve their health management

Codesigning a Measure of Person-Centred Coordinated Care to Capture the Experience of the Patient: The Development of the P3CEQ

Background: Person-centred coordinated care (P3C) is a priority for stakeholders (ie, patients, carers, professionals, policy makers). As a part of the development of an evaluation framework for P3C, we set out to identify patient-reported experience measures (PREMs) suitable for routine measurement and feedback during the development of services. Methods: A rapid review of the literature was undertaken to identity existing PREMs suitable for the probing person-centred and/or coordinated care. Of 74 measures identified, 7 met our inclusion criteria. We critically examined these against core domains and subdomains of P3C. Measures were then presented to stakeholders in codesign workshops to explore acceptability, utility, and their strengths/weaknesses. Results: The Long-Term Condition 6 questionnaire was preferred for its short length, utility, and tone. However, it lacked key questions in each core domain, and in response to requests from our codesign group, new questions were added to cover consideration as a whole person, coordination, care plans, carer involvement, and a single coordinator. Cognitive interviews, on-going codesign, and mapping to core P3C domains resulted in the refinement of the questionnaire to 11 items with 1 trigger question. The 11-item modified version was renamed the P3C Experiences Questionnaire. Conclusions: Due to a dearth of brief measures available to capture people’s experience of P3C for routine practice, an existing measure was modified using an iterative process of adaption and validation through codesign workshops. Next steps include psychometric validation and modification for people with dementia and learning difficulties.</p

Multidisciplinary cancer care in Spain, or when the function creates the organ: qualitative interview study

Background The Spanish National Health System recognised multidisciplinary care as a health priority in 2006, when a national strategy for promoting quality in cancer care was first published. This institutional effort is being implemented on a co-operative basis within the context of Spain's decentralised health care system, so a high degree of variability is to be expected. This study was aimed to explore the views of professionals working with multidisciplinary cancer teams and identify which barriers to effective team work should be considered to ensure implementation of health policy. Methods Qualitative interview study with semi-structured, one-to-one interviews. Data were examined inductively, using content analysis to generate categories and an explanatory framework. 39 professionals performing their tasks, wholly or in part, in different multidisciplinary cancer teams were interviewed. The breakdown of participants' medical specialisations was as follows: medical oncologists (n = 10); radiation oncologists (n = 8); surgeons (n = 7); pathologists or radiologists (n = 6); oncology nurses (n = 5); and others (n = 3). Results Teams could be classified into three models of professional co-operation in multidisciplinary cancer care, namely, advisory committee, formal co-adaptation and integrated care process. The following barriers to implementation were posed: existence of different gateways for the same patient profile; variability in development and use of clinical protocols and guidelines; role of the hospital executive board; outcomes assessment; and the recording and documenting of clinical decisions in a multidisciplinary team setting. All these play a key role in the development of cancer teams and their ability to improve quality of care. Conclusion Cancer team development results from an specific adaptation to the hospital environment. Nevertheless, health policy plays an important role in promoting an organisational approach that changes the way in which professionals develop their clinical practice

Multidisciplinary cancer care in Spain, or when the function creates the organ: qualitative interview study

Background The Spanish National Health System recognised multidisciplinary care as a health priority in 2006, when a national strategy for promoting quality in cancer care was first published. This institutional effort is being implemented on a co-operative basis within the context of Spain's decentralised health care system, so a high degree of variability is to be expected. This study was aimed to explore the views of professionals working with multidisciplinary cancer teams and identify which barriers to effective team work should be considered to ensure implementation of health policy. Methods Qualitative interview study with semi-structured, one-to-one interviews. Data were examined inductively, using content analysis to generate categories and an explanatory framework. 39 professionals performing their tasks, wholly or in part, in different multidisciplinary cancer teams were interviewed. The breakdown of participants' medical specialisations was as follows: medical oncologists (n = 10); radiation oncologists (n = 8); surgeons (n = 7); pathologists or radiologists (n = 6); oncology nurses (n = 5); and others (n = 3). Results Teams could be classified into three models of professional co-operation in multidisciplinary cancer care, namely, advisory committee, formal co-adaptation and integrated care process. The following barriers to implementation were posed: existence of different gateways for the same patient profile; variability in development and use of clinical protocols and guidelines; role of the hospital executive board; outcomes assessment; and the recording and documenting of clinical decisions in a multidisciplinary team setting. All these play a key role in the development of cancer teams and their ability to improve quality of care. Conclusion Cancer team development results from an specific adaptation to the hospital environment. Nevertheless, health policy plays an important role in promoting an organisational approach that changes the way in which professionals develop their clinical practice