Communication partner training for student health and social care professionals engaging with people with stroke acquired communication difficulties: A realist review. [version 1; peer review: 1 approved, 2 approved with reservations]

Background: Stroke acquired communication impairments impede effective communication. Consequently, in stroke care, communicative interactions can be challenging for both patients and staff and can predispose patients to increased risk of preventable adverse events. Communication partner training (CPT) can mitigate such negative outcomes by optimising communicative interactions. Providing CPT to student health and social care professionals (SH&SCPs) has the potential to enhance their clinical expertise and experiences and enhance the future clinical care of patients with stroke acquired communication impairments. This research aims to expand our understanding of how CPT is operationalised for SH&SCPs in higher education institutions and determine: what works; for whom; in what contexts; how and why? Methods: This review is phase 1 of a research project employing a realist approach with public and patient involvement (PPI). It incorporates five iterative steps: 1.) Clarifying the scope; 2.) Searching for evidence; 3.) Selecting and appraising evidence; 4.) Data extraction; 5.) Synthesising data and developing a middle range theory explaining how CPT is expected to work for SH&SCPs. An advisory group, including PPI advisors, content experts, SH&SCPs and realist experts has been set up to consult throughout the review and collaboratively agree the middle range theory. Discussion: While there is an evolving evidence base for CPT, including stroke specific CPT for SH&SCPs, it is acknowledged that there are challenges to its implementation in complex real-world settings. In combining empirical evidence with theoretical understanding, realist review permits synthesis of data from diverse sources and goes beyond determining efficacy to explore generative causation and solutions for real world practice. A middle range realist programme theory that coherently explains how CPT is expected to work when teaching SH&SCPs to communicate with people with stroke acquired communication impairments will provide educators with new insights into CPT development and implementation in their higher education institutions

‘Language has been granted too much power’. 1,p.1 Challenging the power of words with time and flexibility in the precommencement stage of research involving those with cognitive impairment

Meaningful and inclusive involvement of all people affected by research in the design, management and dissemination of that research requires skills, time, flexibility and resources. There continue to be research practices that create implicit and explicit exclusion of some members of the public who may be ‘seldom heard’ or ‘frequently ignored’. Our focus is particularly on the involvement of people living with cognitive impairment, including people with one of the many forms of dementia and people with learning disabilities. We reflect especially on issues relating to the precommencement stage of research. We suggest that despite pockets of creative good practice, research culture remains a distinct habitus that continues to privilege cognition and articulacy in numerous ways. We argue that in perpetuating this system, some researchers and the institutions that govern research are committing a form of bureaucratic violence. We call for a reimagining of the models of research governance, funding and processes to incorporate the time and flexibility that are essential for meaningful involved research, particularly at the precommencement stage. Only then will academic health and social science research that is truly collaborative, engaged, accessible and inclusive be commonplace

Moving regional health services planning and management to a population-based approach: Implementation of the Regional Operating Model (ROM) in Victoria, Australia

Various jurisdictions are moving towards population-based approaches to plan and manage healthcare services. The evidence on the implementation of these models remains limited. The aim of this study is to evaluate the effect of a regional operating model (ROM) on internal functioning and stakeholder engagement of a regional office. Semi-structured interviews and focus groups with staff members and stakeholders of the North West Metropolitan Regional office in Victoria, Australia, were conducted. Overall, the ROM was perceived as relevant to staff and stakeholders. However, creating shared objectives and priorities across a range of organisations remained a challenge. Area-based planning and management is seen as simplifying management of contracts however, reservations were expressed about moving from specialist to more generalist approaches. A clearer articulation of the knowledge, skills and competencies required by staff would further support the implementation of the model. The ROM provides a platform for public services and stakeholders to discuss, negotiate and deliver on shared outcomes at the regional level. It provides an integrated managerial platform to improve service delivery and avoid narrow programmatic approaches

Developing outcome, process and balancing measures for an emergency department longitudinal patient monitoring system using a modified Delphi

Early warning score systems have been widely recommended for use to detect clinical deterioration in patients. The Irish National Emergency Medicine Programme has developed and piloted an emergency department specific early warning score system. The objective of this study was to develop a consensus among frontline healthcare staff, quality and safety staff and health systems researchers regarding evaluation measures for an early warning score system in the Emergency Department

Ireland's contradictory welfare reality, globalisation and a diversity of migration experiences : the case of County Clare

Traditional approaches to welfare state literature have tended to be dominated by a concentration on welfare regimes and a subsequent focus on fitting countries into classifications. This thesis seeks to go beyond these debates by concentrating the analysis of empirical investigation on changes within welfare states, with a view to contributing to a further understanding of the changes taking place within welfare states. It is in this context that the work focuses on the impact of globalisation, noting that even the globalisation literature has devoted little attention to the internal dimensions of the globalisation process within states. Arguably, the biggest globalisation impact is the movement of people across state borders and the resultant challenges of integrating race, ethnicity and migration into our understanding of welfare states. The thesis therefore aims to map welfare state responses to immigration and outcomes for immigrants, and posits Ireland as an exemplar case of globalisation. In doing so, it highlights that three general types of incorporation of immigrants (differential exclusion, assimilation and multiculturalism) can be found throughout Europe, resulting in an assortment of immigration policies encompassing restrictive and expansive tendencies and varying types of inclusion and exclusion of migrants and their families. In the Irish case, the research finds that the state has created a hybrid model giving different rights and entitlements to immigrants depending on their status. The empirical research is underpinned by an emancipatory methodological approach and draws on the testimonies of immigrants and local service providers. Drawing from these conceptual and empirical sources, the thesis explores the practical implications of, and possibilities for, immigration into the Irish state

A design-led framework for engaged research: Using a design approach to understand and place the public at the core of health and social care

This paper offers a multi-perspective approach on the role of engaged research in health and social care. Each of the authors focuses on their individual experiences of this domain, from the perspective of an academic partner of the Health Research Board’s PPI Ignite programme, a CEO of an umbrella organisation for health research charities and a researcher in design innovation, focusing on health research. The paper outlines the values which underpin public and patient involvement, as well as examples of its application as engaged research. It details how organisations like Health Research Charities Ireland support and enable engaged research within health and social research and policy. This paper offers a framework for facilitating dialogue and response across all stakeholders in the engaged research process, illustrating the importance of engaged research and how we can further our understanding and application of it within health and social care policy by adopting a design-led approach. We argue that a design-led approach can both facilitate engaged research as well as support policymakers in the design of new policies and practices

Defining and Supporting Public Engagement at University College Dublin: Summary Report

Public engagement is recognised as a pathway to impact and currently there is an increased focus from policy and funding agencies on how universities engage with diverse audiences beyond the institution. There are already a wide range of creative and innovative public engagement activities underway across UCD. These include a spectrum of forms of engagement from informing and inspiring audiences through lectures or articles, to co-producing and co-designing research with members of the public (including patients and other stakeholders). A Public Engagement (PE) Working Group was recently established to further develop a culture of public engagement in UCD. The PE Working Group established that a definition of public engagement in UCD should be developed. This was done through a number of collaborative workshops with UCD staff (academic and administrative) and a workshop with members of the public held during the UCD Festival on the June 6th 2018. Without any information available on the public engagement activities that are underway across the university, the PE Working Group undertook a census of public engagement activity in UCD. A total of 322 submissions were received in the census. Based on the census and workshops, the PE Working Group outline key proposals to develop a more supported, cohesive and encultured approach to Public Engagement in our university.University College Dubli

New Ways of Working? A Rapid Exploration of Emerging Evidence Regarding the Care of Older People during COVID19

Health and social care staff have had to quickly adapt, respond and improve teamwork, as a response to the COVID-19 pandemic. Our objective was to rapidly summarize the emerging evidence of new ways of working in the care of older people during this period. We conducted an exploration of the emerging evidence within the timeframe of 1 March 2020 to 11 May 2020. To capture a broad perspective, we undertook thematic analysis of Twitter data which was extracted through a broad search for new ways of working in health and social care. For a more in-depth focus on the health and social care of older people, we undertook a systematic scoping of newspapers using the Nexis UK database. We undertook a validation workshop with members of the interprofessional working group of the Irish National Integrated Care Programme for Older People, and with researchers. A total of 317 tweets were extracted related to six new ways of working. There was evidence of using telehealth to provide ongoing care to patients; interprofessional work; team meetings using online platforms; trust and collaboration within teams; as well as teams feeling empowered to change at a local level. 34 newspaper articles were extracted related to new ways of working in the care of older people, originating in England (n = 17), Wales (n = 6), Scotland (n = 6), Ireland (n = 4) and Germany (n = 1). Four main themes were captured that focused on role expansion, innovations in communication, environmental restructuring and enablement. The results of this exploration of emerging evidence show that health and social care teams can transform very rapidly. Much of the change was based on goodwill as a response to the pandemic. Further analysis of empirical evidence of changing practices should include the perspectives of older people and should capture the resources needed to sustain innovations, as well as evaluate gaps in service provision.Health Research BoardIrish Health Service Executiv

Getting to know you: a local study of the needs of migrants, refugees and asylum seekers in County Clare

This report includes a desk study on the policy and legal context of immigration into Ireland, and presents the findings of a field research project on the needs of refugees, asylum seekers and migrants in County Clare. In 2007, Ennis CDP and the HSE West commissioned the University of Limerick Centre for Peace and Reconciliation to conduct this research for a inter-agency group assembled by the Health Service Executive (West) in County Clare