An examination of how the ‘Household Model' of care can contribute to positive ageing for residents in the ‘Fourth Age’

Background: Promoting a good quality of life for the oldest members of society has become a top priority as evidenced in UK policy. The ‘household’ model is a departure from traditional approaches to care provision since it offers person-centred support - combining health and social care - to older people in specially-designed, small, homelike environments. Having gained increasing popularity in care homes across developed countries, the impact of this model of service delivery on residents’ quality of life and its contribution to positive ageing is of increasing interest. Belong is a not-for-profit, UK care organisation currently operating several villages under the household model. The villages comprise independent living apartments (bought or rented) and residential/nursing care households offering 24 hours personalised, on-site care for residents. In each village there is a range of facilities open to the public (including a Bistro, hairdressers and gym facilities) and a domiciliary community service. Methods: In this paper we present new data generated from qualitative interviews with a sample of household residents in the ‘Fourth Age’ and relatives across two villages in the North West of England, UK. Results: We examine how the household model as operated at Belong facilitates the maintenance of autonomy and independence - which underpins positive ageing and quality of life in the fourth age - among residents. Conclusion: We show how the household model contributes to positive ageing and quality of life as defined by residents

Investigating UK renal psychosocial service provision

Background: Internationally, emerging evidence of psychosocial problems in patients with end-stage renal disease has led to increasing calls for collaborative renal care models that include psychosocial services. In the UK, there is a dearth of empirical studies and clear policies to guide the implementation of these services. Methods: This thesis used a critical realist, mixed-methods approach to examine processes and outcomes of psychosocial service delivery, specifically focusing on the renal social worker role. First, an audit of the UK renal psychosocial workforce was completed. Then, a cross-sectional survey (n=869) captured and compared distress, psychosocial issues and need for services of in-centre haemodialysis patients across seven units. Focus groups (n=4) and in-depth interviews (n=6) with health professionals added a deeper understanding of processes of service delivery. In addition, diaries (n=15), questionnaires completed before and after social worker involvement (n=161), and a focus group brought insight into the renal social worker role. Results: Findings highlighted variation in psychosocial staffing patterns, with recommended benchmarks significantly exceeded. Overall, almost 50% of patients experienced distress. Multivariable logistic regression analysis showed that patients in units with better psychosocial staffing ratios [odds ratio (OR) 0.33 (95% CI 0.14-0.77); p= .01] and specifically better renal social work ratios [OR 0.15 (95% CI 0.05-0.45; p= .001) were less likely to experience distress, even after controlling for demographic variables. Nurses were found to play an important part in the process of psychosocial service delivery, yet experienced barriers in their ability to fulfil this role. Differences were found in funding arrangements and in the degree to which services were proactive and process oriented. The role of renal social worker was found to be poorly defined; and problems with their integration into renal teams and threats for the future of the role from Local Authorities were exposed. Discussion: The novel findings implicate a need for an increase in the renal psychosocial workforce. To ensure equitable access across the country, renal policy documents should make dedicated psychosocial care an unambiguous requirement and offer clear standards of practice and staffing recommendations. Renal units should explore processes, such as psychosocial education for clinical staff and distress screening, that can be put in place to ensure that a focus on psychosocial wellbeing is a standard part of renal care. To guide practice and further research, this thesis proposes a stepped-care model, putting renal social work at the heart of psychosocial service provision

Exploring the role of the UK renal social worker: the nexus between health and social care for renal patients

Introduction Patients living with progressive chronic kidney disease may face a variety of ongoing physical, emotional, financial and/or social challenges along the disease pathway. In most UK renal units, psychosocial support has traditionally been provided by a renal social worker. However, in recent years, the numbers of renal social workers have been declining. The specialised role is poorly understood and there is no UK research about the profession. To inform future research and guide workforce planning, this study presents the first-ever exploration of the UK renal social worker role. It aimed to map the profession’s activities and reasons for involvement in patient care, as well as providing an initial evaluation of that involvement on patient wellbeing. Methods and analysis This mixed-method study recruited adult renal social workers (n = 14), who completed diaries over a 4-month period, participated in a focus group, and provided secondary data (caseload data and audit files where available) to give insight into their role. The evaluation of social work involvement on patient wellbeing used a pre-post intervention design. It measured distress, anxiety and depression levels as captured by the Distress Thermometer and Emotional Thermometers. A total of 161 patients completed the pre-involvement questionnaire, and 87 (55%) returned the post-involvement questionnaire. Results and conclusion The renal social worker role is creative, broad and fluid, with variations in roles linked to differences in employment and funding arrangements, configurations of the wider multidisciplinary renal team, level of standardisation of psychosocial care, availability of community services, and staff-to-patient ratios. Renal social work is different from statutory social work, and renal social workers are generally able to offer continuous rather than episodic care and support patients that would not meet strict local authority eligibility criteria. The findings showed that this support leads to significantly reduced distress and anxiety

Opportunities and challenges for improving antimicrobial stewardship in low and middle income countries ; lessons learnt from the maternal sepsis intervention in Western Uganda

This paper presents findings from an action-research intervention designed to identify ways of improving antimicrobial stewardship in a Ugandan Regional Referral Hospital. Building on an existing health partnership and extensive action-research on maternal health, it focused on maternal sepsis. Sepsis is one of the main causes of maternal mortality in Uganda and Surgical Site Infection, a major contributing factor. Post-natal wards also consume the largest volume of antibiotics. The findings from the Maternal Sepsis Intervention demonstrate the potential for remarkable changes in health worker behaviour through multi-disciplinary engagement. Nurses and midwives create the connective tissue linking pharmacy, laboratory scientists and junior doctors to support an evidence-based response to prescribing. These multi-disciplinary ‘huddles’ form a necessary, but insufficient, grounding for active clinical pharmacy. The impact on antimicrobial stewardship and maternal mortality and morbidity is ultimately limited by very poor and inconsistent access to antibiotics and supplies. Insufficient and predictable stock-outs undermine behaviour change frustrating health workers’ ability to exercise their knowledge and skill for the benefit of their patients. This escalates healthcare costs and contributes to Anti-Microbial Resistance

SPARC 2019 Fake news & home truths : Salford postgraduate annual research conference book of abstracts

Welcome to the Book of Abstracts for the 2019 SPARC conference. This year we not only celebrate the work of our PGRs but also our first ever Doctoral School Best Supervisor awards, which makes this year’s conference extra special. Once again we have received a tremendous contribution from our postgraduate research community; with over 90 presenters, the conference truly showcases a vibrant, innovative and collaborative PGR community at Salford. These abstracts provide a taster of the inspiring, relevant and impactful research in progress, and provide delegates with a reference point for networking and initiating critical debate. Find an abstract that interests you, and say “Hello” to the author. Who knows what might result from your conversation? With such wide-ranging topics being showcased, we encourage you to take up this great opportunity to engage with researchers working in different subject areas from your own. To meet global challenges, high impact research needs interdisciplinary collaboration. This is recognised and rewarded by all major research funders. Engaging with the work of others and forging collaborations across subject areas is an essential skill for the next generation of researchers. Even better, our free ice cream van means that you can have those conversations while enjoying a refreshing ice lolly

The UK renal psychosocial workforce : a mapping exercise

This is the first detailed workforce report in the UK that describes the provision of psychosocial care to kidney patients across 84 renal units. It presents an overview of the renal psychosocial workforce (in July 2017) and compares this to results of an earlier snapshot report written in 2002. Psychosocial care is support for psychological or social problems usually provided by professionals such as psychologists, social workers, counsellors, youth workers and welfare advisors. Studies show that kidney patients face many problems, for which these professionals provide much needed help. The current report shows the following findings: • Renal units employ different combinations of psychosocialstaff. For example, In some units a social worker andpsychologist work together, whereas in other units thiswould be a counsellor and a psychologist. • There are inequalities and large variations in the number of psychosocial staff available to help patients within units. 12 units (14%) have no psychosocial staff dedicated to kidney patients, 34 units (40%) have one or two dedicated staff, and 38 units (46%) provide three or more psychosocial staff to care for their patients. • The number of psychologists (in adult services) hasincreased over the past 15 years but the number of socialworkers has decreased. Overall, these adult psychosocialservices have increased with 25%, but this is not as muchas the increase in number of patients of about 50%. • In paediatric services, psychology and social work services overall have decreased with 21% compared to 2002. • None of the 84 units employ the recommended number ofsocial workers (proposed in 2002). • Only 4 units (5%) employ the recommended number ofpsychologists (proposed in 2002). These results suggest that there are not enoughpsychosocial staff to provide care to all renal patients.The provision of renal psychosocial care is patchy andappears to be inadequate. Further research into thepsychosocial needs of kidney patients is necessary, todevelop innovative solutions to provide equitable care andevidence based psychosocial clinical guidelines