Making adult safeguarding personal

Purpose To ascertain what efforts Adult Safeguarding Leads (ASLs), generic advocates, and Independent Mental Capacity Advocates (IMCAs) are making to involve service users in decisions about protective measures, and to investigate whether the Adult Safeguarding Service is delivering outcomes, which are valued by its users. Design/methodology/approach semi-structured interviews with a sample of key stakeholders. Findings Findings: ASLs are making efforts to involve service users in the complex and demanding process of safeguarding. These efforts, however, are shaped by their understandings of the difference between ‘residential’ and ‘community’ settings. Research limitations/implications The study is based in a single county council, albeit in a large county, and involves a limited number of service users Practical implications Clarification is needed of what it may mean to adopt a person-centred approach to adult safeguarding, and the responsibilities of ASLs when individuals with capacity to make decisions about this aspect of their lives are unwilling to engage with the safeguarding process. Originality/value The findings improve our understanding of how ASLs understand their responsibilities towards the users of their services and endeavour to involve them in the adult safeguarding process. Based on this understanding, those with responsibility for managing Adult Safeguarding services should be better able to support improvements in professional practice.SJ’s contribution was funded by The Health Foundation. Support for MR, AJH and ICHC was provided initially by the NIHR CLAHRC for Cambridgeshire & Peterborough), and subsequently by The Health Foundation (MR) and the NIHR CLAHRC East of England (AJH and ICHC). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.This is the accepted manuscript. The final version is available at http://www.emeraldinsight.com/doi/abs/10.1108/JAP-11-2014-0031

The incidence of healthcare use, ill health and mortality in adults with intellectual disabilities and mealtime support needs

This is the final published version. It first appeared at http://onlinelibrary.wiley.com/doi/10.1111/jir.12167/full.Background\ud Adults with intellectual disabilities (ID) experience a wide range of eating, drinking and/or swallowing (EDS) problems, for which they receive diverse mealtime support interventions. Previous research has estimated that dysphagia (difficulty swallowing) affects 8% of all adults with ID and that 15% require some form of mealtime support. People with ID (whether they require mealtime support or not) also experience a greater burden of ill-health and die younger than their peers in the general population with no ID.\ud \ud Methods\ud Using an exploratory, population-based cohort study design, we set out to explore health-related outcomes in adults with ID who receive mealtime support for any eating, drinking or swallowing problem, by establishing the annual incidence of healthcare use, EDS-related ill-health, and all-cause mortality. This study was conducted in two counties in the East of England.\ud \ud Results\ud In 2009, 142 adults with mild to profound ID and a need for any type of mealtime support were recruited for a baseline survey. At follow-up one year later, 127 individuals were alive; eight had died; and seven could not be contacted. Almost all participants had one or more GP consultations each year (85-95%) and, in the first year, 20% reportedly had one or more emergency hospitalisations. Although their annual number of GP visits was broadly comparable to that of the general population, one-fifth of this population?s primary healthcare use was directly attributable to EDS-related ill-health. Respiratory infections were the most common cause of morbidity, and the immediate cause of all eight deaths, while concerns about nutrition and dehydration were surprisingly minor. Our participants had a high annual incidence of death (5%) and, with a standardised mortality ratio of 267, their observed mortality was more than twice that expected in the general population of adults with ID (not selected because of mealtime support for EDS problems).\ud \ud Conclusions\ud All Annual Health Checks now offered to adults with ID should include questions about respiratory infections and EDS functioning, in order to focus attention on EDS problems in this population. This has the potential to reduce life-threatening illness

Health assistant in nursing: a Victorian health service pilot

Objective: Develop and evaluate pilot of a new role to support nursing care delivery in hospital settings. Design: A naturalistic, three-stage pre-post, multimethod pilot design used data collected from hospital administrative datasets, and surveys and focus groups with staff participants. Setting: Three wards at three hospital sites of a large tertiary health service in Victoria, Australia. Subjects: Staff performing the new role and registered nurses working on participating wards. Intervention: Pilot of a new Health Assistant in Nursing (HAN) role. Main outcome measures: Staff outcomes were work satisfaction and workload of registered nurses; quality outcomes included reported patient falls and medication errors; organisational outcomes included service costs and sick leave. Results: Work satisfaction and workload of registered nurses remained stable after introducing the new role. The frequency of reported patient falls reduced in two of the three wards. Costing outcomes suggested potential for cost benefits attributed to reduced falls in acute wards. Conclusions: This pilot identified the new HAN role has capacity to contribute to improved patient quality and safety outcomes without compromising nurse job satisfaction and workload. Potential cost benefits of thenew role warrant further consideration in the acute care sector. Abbreviations: CPO – Constant Patient Observer; CSN – Clinical Support Nurse; HAN – Health Assistant in Nursing. NWSQ – Nursing Workplace Satisfactio

Investigating the widely held belief that men and women with learning disabilities receive poor quality healthcare when admitted to hospital: a single-site study of 30-day readmission rates.

BACKGROUND: This study aims to use 30-day readmission rates to investigate the presumption that men and women with learning disabilities (LDs, known internationally as intellectual disabilities) receive poorer quality hospital care than their non-disabled peers. METHOD: A 12-month retrospective audit was conducted using Hospital Episode Statistics (HES) at a single acute hospital in the East of England. This identified all in-patient admissions; admissions where the person concerned was recognised as having a LD; and all emergency readmissions within 30 days of discharge. Additionally, the healthcare records of all patients identified as having a LD and readmitted within 30 days as a medical emergency were examined in order to determine whether or not these readmissions were potentially preventable. RESULTS: Over the study period, a total of 66 870 adults were admitted as in-patients, among whom 7408 were readmitted as medical emergencies within 30 days of discharge: a readmission rate of 11%. Of these 66 870 patients, 256 were identified as having a LD, with 32 of them experiencing at least one emergency readmission within 30 days: a readmission rate of 13%. When examined, the healthcare records pertaining to these 32 patients who had a total of 39 unique 30-day readmissions revealed that 69% (n = 26) of these readmissions were potentially preventable. CONCLUSION: Although overall readmission rates were similar for patients with LDs and those from the general population, patients with LDs had a much higher rate of potentially preventable readmissions when compared to a general population estimate from van Walraven et al. This suggests that there is still work to be done to ensure that this patient population receives hospital care that is both safe and of high quality.This research was funded by a grant from the Addenbrooke's Charitable Trust (CK), while the preparation of this paper was funded by the Health Foundation (AH, MR) and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East of England (AH, MR, AW) at Cambridgeshire and Peterborough NHS Foundation Trust.This is the author accepted manuscript. The final version is available from Wiley via http://dx.doi.org/10.1111/jir.1219

Nursing strategies for engaging families of older immigrants hospitalized for end-of-life care: an Australian study

BACKGROUND: Engaging with families of older non-English-speaking background (NESB) immigrants hospitalized for end-of-life (EOL) care can be challenging, especially when their cultures, lifeways, and family decision-making processes are unfamiliar to the nurses caring for them. Despite the recognized importance of family engagement when providing EOL care, the issue of ethnic minority family engagement has received little attention in the field. AIM: To explore and describe the strategies nurses use to facilitate engagement with families of older immigrant NESB patients hospitalized for EOL care. METHODS: A qualitative descriptive approach was used. Data were collected via in-depth interviews conducted with 22 registered nurses recruited from 4 Australian health services. FINDINGS: Using thematic analysis processes, 5 key strategies were identified: listening and understanding families, encouraging family members to speak first, dealing with angst, redressing naive views about the dying process, and managing intergenerational differences. Underpinning these strategies was a profound "will to engage" with the families and their cultural worldviews. CONCLUSION: Further cross-cultural comparative research is required to inform evidence-based policies, practice, and education on this issue

'What vision?': experiences of Team members in a community service for adults with intellectual disabilities.

BACKGROUND: In the UK, the closure of 'long-stay' hospitals was accompanied by the development of community teams (CTs) to support people with intellectual disabilities (IDs) to live in community settings. The self-reported experiences of staff working in such teams have been neglected. METHODS: Focusing on a single county-wide service, comprising five multi-disciplinary and inter-agency CTs, we measured perceptions among the health care and care management Team members of (1) their personal well-being; (2) the functioning of their team; and (3) the organisation's commitment to quality, and culture. RESULTS: Almost three-quarters of the questionnaires were returned (73/101; 72%). The scores of health care practitioners and care managers were very similar: (1) the MBI scores of more than half the respondents were 'of concern'; (2) similarly, almost four in ten respondents' scores on the Vision scale of the TCI were 'of concern'; (3) the perceived commitment to quality (QIIS-II Part 2) was uncertain; and (4) the organisational culture (QIIS-II, Part 1) was viewed as primarily hierarchical. DISCUSSION: The perceived absence of a vision for the service, combined with a dominant culture viewed by its members as strongly focussed on bureaucracy and process, potentially compromises the ability of these CTs to respond proactively to the needs of people with IDs. Given the changes in legislation, policy and practice that have taken place since CTs were established, it would be timely to revisit their role and purpose.We are grateful to all our participants in the IDP, without whom the study could not have taken place, to Professor Eivor Oborn (Warwick Business School) for her insights in the development of the study. Funding was provided by the NIHR’s Collaboration for Health Research & Care (CLAHRC) for Cambridgeshire & Peterborough. The preparation of the paper was funded by the NIHR’s CLAHRC East of England (ICHC, KAW, AJH, AL, EJ, APW). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.This is the author accepted manuscript. The final version is available from Wiley via https://doi.org/10.1111/jir.1231

Clinical services for adults with an intellectual disability and epilepsy: A comparison of management alternatives

Background Intellectual disability (ID) is relatively common in people with epilepsy, with prevalence estimated to be around 25%. Surprisingly, given this relatively high frequency, along with higher rates of refractory epilepsy than in those without ID, little is known about outcomes of different management approaches/clinical services treating epilepsy in adults with ID—we investigate this area. Materials & methods We undertook a naturalistic observational cohort study measuring outcomes in n = 91 adults with ID over a 7-month period (recruited within the period March 2008 to April 2010). Participants were receiving treatment for refractory epilepsy (primarily) in one of two clinical service settings: community ID teams (CIDTs) or hospital Neurology services. Results The pattern of comorbidities appeared important in predicting clinical service, with Neurologists managing the epilepsy of relatively more of those with neurological comorbidities whilst CIDTs managed the epilepsy of relatively more of those with psychiatric comorbidities. Epilepsy-related outcomes, as measured by the Glasgow Epilepsy Outcome Scale 35 (GEOS-35) and the Epilepsy and Learning Disabilities Quality of Life Scale (ELDQoL) did not differ significantly between Neurology services and CIDTs. Discussion In the context of this study, the absence of evidence for differences in epilepsy-related outcomes amongst adults with ID and refractory epilepsy between mainstream neurology and specialist ID clinical services is considered. Determining the selection of the service managing the epilepsy of adults with an ID on the basis of the skill sets also required to treat associated comorbidities may hence be a reasonable heuristic.This paper presents independent research funded by the National Institute for Health Research (NIHR - www.nihr.ac.uk) under its Research for Patient Benefit (RfPB - https://www.nihr.ac.uk/funding-and-support/funding-for-research-studies/funding-programmes/research-for-patient-benefit/) Programme (Grant PB-PG-0706-10051; PI Dr H Ring). During the time that this research was carried out, AP Wagner, TJ Croudace, M Redley and H Ring also received support from the NIHR CLAHRC for Cambridgeshire and Peterborough (http://clahrc-cp.nihr.ac.uk/). In preparing this manuscript AP Wagner and H Ring received support from the NIHR Collaboration for Leadership in Applied Health Research and Care East of England at the Cambridgeshire and Peterborough NHS Foundation Trust (http://www.clahrc-eoe.nihr.ac.uk/). SR White was supported by the Medical Research Council (Unit Programme no. U105292687 - http://www.mrc.ac.uk/)

Family presence during resuscitation: A randomised controlled trial of the impact of family presence

Introduction: This study was undertaken to determine effects on relatives of family presence in an emergency resuscitation room during resuscitation. Methods: This study was undertaken using a randomised controlled trial using survey methodology. The setting of the study was the emergency department of a major tertiary referral teaching hospital in Queensland. Participants were relatives over 18 years of age, related to patients meeting the inclusion criteria. Relatives were randomly assigned to the experimental or control group. The control group followed the established procedure of placement in the relatives' waiting room, while the experimental group was given the option to be present during the resuscitation with a supportive officer for assistance. Results: An association was found between those who were present (and their relative survived) and their belief that their presence was beneficial to the patient. Demographic data identified characteristics of the relatives. Conclusions: This work has identified that relatives find it beneficial to be present in the resuscitation room. Their presence helped with communication between staff and family, and helped relatives to cope with the situation

An exploration of the use of infant observation methods to research the identities of severely learning disabled adolescents and to enhance relationship-based practice for professional social work practice

This paper considers how infant observation methods may be adapted to explore and research the identities of severely learning disabled adolescents, a group of young people whose experiences are poorly represented in the literature. Through focusing on emotion and relationship, this ‘practice-near’ research method also offers a way for social workers to develop their reflective capacity in relation to the often hidden, uncomfortable emotions aroused by experiencing impairment and difference, but without the defences usually involved in assuming the professional role. The importance of taking time to get on a disabled child’s ‘wavelength’ is illustrated through extracts from the research which show how a young person’s agency and identity can be appreciated. The method also has the potential to develop social workers’ awareness of the powerful undercurrent of emotions apparent at times within families of severely disabled young people and tentative suggestions are made about the projective processes and hidden hostilities at work within one of the families observed as part of the research project. Professionals may be able to use this knowledge to become resilient and reflective practitioners and the observation method itself has something to offer by way of a containing experience for families

Development of a Management Algorithm for Post-operative Pain (MAPP) after total knee and total hip replacement: study rationale and design.

BACKGROUND: Evidence from clinical practice and the extant literature suggests that post-operative pain assessment and treatment is often suboptimal. Poor pain management is likely to persist until pain management practices become consistent with guidelines developed from the best available scientific evidence. This work will address the priority in healthcare of improving the quality of pain management by standardising evidence-based care processes through the incorporation of an algorithm derived from best evidence into clinical practice. In this paper, the methodology for the creation and implementation of such an algorithm that will focus, in the first instance, on patients who have undergone total hip or knee replacement is described. METHODS: In partnership with clinicians, and based on best available evidence, the aim of the Management Algorithm for Post-operative Pain (MAPP) project is to develop, implement, and evaluate an algorithm designed to support pain management decision-making for patients after orthopaedic surgery. The algorithm will provide guidance for the prescription and administration of multimodal analgesics in the post-operative period, and the treatment of breakthrough pain. The MAPP project is a multisite study with one coordinating hospital and two supporting (rollout) hospitals. The design of this project is a pre-implementation-post-implementation evaluation and will be conducted over three phases. The Promoting Action on Research Implementation in Health Services (PARiHS) framework will be used to guide implementation. Outcome measurements will be taken 10 weeks post-implementation of the MAPP. The primary outcomes are: proportion of patients prescribed multimodal analgesics in accordance with the MAPP; and proportion of patients with moderate to severe pain intensity at rest. These data will be compared to the pre-implementation analgesic prescribing practices and pain outcome measures. A secondary outcome, the efficacy of the MAPP, will be measured by comparing pain intensity scores of patients where the MAPP guidelines were or were not followed. DISCUSSION: The outcomes of this study have relevance for nursing and medical professionals as well as informing health service evaluation. In establishing a framework for the sustainable implementation and evaluation of a standardised approach to post-operative pain management, the findings have implications for clinicians and patients within multiple surgical contexts