Engagement and observation: a review of local policies in England and Wales

© 2020, Emerald Publishing Limited. Purpose: The purpose of this paper is to report on the content of local policies on engagement and observation written by National Health Service (NHS) organisations in England and Wales. Design/methodology/approach: Engagement and observation policies were obtained from all (n = 61) NHS mental health trusts in England and health boards in Wales via a Freedom of Information Act 2000 request. Data were analysed using content analysis. Findings: All organisations had a specific policy referring to either “observation and engagement” or “observation”. The policies varied considerably in quality, length, breadth and depth of the information provided. Significant variations existed in the terminology used to describe the different types of enhanced observation. Inconsistencies were also noted between organisations regarding: which members of the clinical team could initiate, increase, decrease and terminate observation; who could undertake the intervention (for example students); and the reasons for using it. Finally, despite rhetoric to the contrary, the emphasis of policies was on observation and not engagement. Research limitations/implications: This research has demonstrated the value of examining local policies for identifying inconsistencies in guidance given to practitioners on the implementation of engagement and observation. Further research should be undertaken to explore the impact of local policies on practice. Practical implications: Local policies remain variable in content and quality and do not reflect contemporary research. There is a need to produce evidence-based national standards that organisations are required to comply with. Originality/value: To the best of the author’s knowledge, this is the first research in 20 years examining the local policy framework for the implementation of engagement and observation

Sentosa : a feminist ethnography of a psychiatric hospital in Sarawak, East Malaysia

This doctoral thesis is a feminist ethnographic study of psychiatric patients in the State of Sarawak, East Malaysia. The study took place at a psychiatric hospital located in the capital city of Kuching, commencing in 1997. Although Hospital Sentosa is a small institution it is the only psychiatric institution in the State and therefore constitutes an important mental health resource in this region. This ethnographic study primarily concentrates on the lives of women patients in keeping with my chosen methodological approach and seeks to explore the 'culture' of the hospital setting through facets such as daily interactions, activities and relationships. The feminist approach has not however precluded the accounts of male patients whose experiences are utilised in a comparative exercise with those of women counterparts. In addition the views of staff of both sexes and all ranks are considered in relation to their attitudes towards the care of psychiatric patients and the broader area of work-related concerns including collegial support and occupational hazards. In keeping with an ethnographic approach themes developed in the thesis are drawn through an analysis of findings as noted by observation methods as well as through interviews with participants. Furthermore a self-reflexive approach has been an important aspect of analysis commensurate with feminist methodology, in which my role as a researcher is considered in relation to issues of culture, gender and class as well as some of the difficulties of research in a post-colonial and unfamiliar cultural context. Although some avenues of inquiry in the study have not easily lent themselves to an analysis of gender, this thesis primarily argues that the hospital reproduces oppressive policies and practices that impact with greater severity on women patients. Oppressive practices in relation to gender and ethnicity at the hospital are viewed against a backdrop of contemporary psychiatric care as enacted on wards. It is argued that these practices can be viewed in turn as being, for the most part, historically premised upon imported British models of care replicated through colonialism in Malaya and by extension at a later period in the multicultural State of Sarawak

Missed opportunities: Module design to meet the learning and access needs of practitioners - A work based learning pilot in the rehabilitation setting

It is with great pleasure that this report is presented as a result of an exciting project that truly exemplified partnership working. For a Higher Education Institution to come together with an NHS organisation to negotiate and tailor an education initiative in direct response to the needs of both the organisation and its staff is a very positive direction of travel. The project has been possible through the enthusiasm and commitment of its partners, their contribution of resources including time and funding, and the support of others who have played a part in enabling it to happen. The willingness of the students taking part in the pilot module should be recognised as much of what we have learnt from the process and the evaluation of it, will more directly benefit future students rather than the participating students themselves. As with any pilot, there are risks and where challenges have not been foreseen they have been addressed along the way, flexibly and promptly. Whilst a relatively small project, it has generated much interest from others interested in work based learning approaches and potential students from across the health care professions wanting to take part in future courses. On behalf of the Project Team, I hope you find the report useful and encourage you to make contact if you require further information, wish to explore work based learning opportunities (uni-discipline or multi-professional) here at the University or would like to discuss research or evaluation

A study of the nutritional experiences of older people in hospital

Knowing what it feels like for older patient's eating in hospital is central to nurses giving quality nutritional care. The aim of this study was to gain insight into the phenomena of nutritional care from the patients' perspective, by exploring older people's experiences and feelings in relation to the provision of food in hospital. A descriptive study design was employed to enable patient's own words to offer insight into their experiences. Data were collected from individual interviews with fifteen patients, and analysed according to the principles of phenomenology. Four key themes emerged from the data: Making choices, anticipation, eating behaviour, and appreciation. The findings are based on informant's descriptions of the specific themes, and their general feeling of each theme being experienced either positively or negatively, and indicate patients' experience of eating was an 'evolving process', termed the 'eating process continuum', that began even before patients received their food. This process was affected by issues such as the variety of foods offered, the content of the meals and the nursing care given at mealtimes. The results of this study will inform nursing practice by describing the participants' experiences from their own viewpoint, and may assist nurses to identify patients at potential risk of nutritional deficiency using the 'eating process continuum' as a framework

A phenomenological analysis of women's choices, expectations and experiences when intending to give birth in a birth centre

The aim of this study was to explore the factors that influenced women to choose care in a birth centre in the South Wales Valleys, and to ascertain their expectations and experiences of care in the antenatal period and during labour. The possibility of complications arising during normal pregnancy is a well-known phenomenon, leading to a woman‘s care being transferred from a midwife to an obstetrician. For women intending to give birth in the birth centre, this also meant having care transferred to the District General Hospital eight miles distant. Experiences of those women who had care transferred were of a particular interest. Even though transfer is a common occurrence, little research exploring the effects of this from the woman‘s perspective has been carried out. The study was qualitative, using thematic analysis based on Gadamerian phenomenological principles. Semi-structured interviews were carried out with a purposeful sample of twenty women who described their antenatal experiences. Five of the women were later transferred from midwifery-led to obstetric-led care in the obstetric unit, with three of the transfers occurring during labour. A second interview was held with these five women to explore their experiences further. Key findings indicate that women choose the birth centre for its friendly, welcoming environment and woman-centred midwifery care. The influence and importance of family around the time of birth was a notable feature. Women transferred in labour subsequently experienced a different model of care, which for one woman meant that she remained empowered to make choices and decisions about her labour, whilst two other women felt some aspects of care to be mechanistic and impersonal. Recommendations from the study include further, larger scale research into women‘s experiences of transfer. Areas where specific guidance and education may be beneficial are suggested, to give a better understanding of those aspects of transfer that might affect women

A Description of a Public Health Role for Health Visitors

The term "public health nursing" was introduced to the UK before a definition was generally agreed. Consequently, there was confusion over the use of the term "public health" in relation to nursing as a whole and health visiting in particular. SNMAC (1995) believed that health visitors had a particular public health role because of their orientation to health promotion in relation to individual and community need. However, it was not clear whether community-focused health promotion activity could legitimately be described as a current public health role of health visitors. Taking "public health" to mean a population perspective, the purpose of the study was to develop an understanding of health visitors' public health role by examining the practices and processes of community-based health visitors. In addition, the relevance of a community-focused health visiting role was established in relation to current practice and policy in public health, primary care, health promotion and social services. Data were collected from health visitors who worked with community-focused remits in Scotland and England using face-to-face, semi-structured interviews within an ethnographic framework. Transcriptions of interviews were analysed by an inductive process of identifying themes, patterns, concepts, contrasts and irregularities. Reliability and validity were sought through a reflexive process whereby the researcher maintained awareness of her involvement with the data. A model of a health visiting role was proposed that emphasised a population or community approach, and employed a range of methods of working drawn from generic health visiting, public health and community work

Nurses in the information age : ready, willing and able? : the role of pre-registration education in preparing nurses for working in an evolving workplace

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

What are mothers' and healthcare professionals' experiences of infant feeding within the current policy context and culture of healthcare in England?

Background: Increasing breastfeeding rates is a longstanding goal of health policy in England. Rationale for this is premised upon the health benefits to both mother and child conferred by exclusive breastfeeding.Current UK Infant Feeding Policy (IFP) derives from international guidelines incorporating the Baby Friendly Initiative (BFI) that promote exclusive breastfeeding. Such ‘evidence informed policy formation’ is emblematic of the current context of health policymaking. However, the impact of current IFP upon women and healthcare professionals is under researched.Aim: This study explores the impact of IFP upon Women, Midwives and Heads of Midwifery services in England and considers the implications for maternity services.Methodology: A qualitative design used semi-structured interviews to determine the experiences and views of IFP with eight Heads of Midwifery and eight Midwives. Six women underwent three interviews exploring their infant feeding journeys at: 8 months pregnant, 1 month and 6 months’ post-partum. Data were analysed using Colaizzi’s phenomenological method.Findings: Three key themes arose contributing towards understanding the context of IFP: Being with IFP, Discourses of Self-Determination and The Emotion work of Compliance.For Midwives: The socio-political context of health and health-care system policy is multifarious but contains identifiable spheres relating to current IFP. Midwives do not appear to actively engage in the political process of this type of policy generation. For Mothers: Infant feeding remains emotionally fraught territory. Three key themes arose from the first interview: Adopting a Stance, Formulating a Vision and Processing the Dialogues of Infant Feeding. The second interview engendered three more key themes termed: Being with the Reality of Infant Feeding, Regaining Selfhood and Seeking Companions.Discussion and Conclusion: Foucault’s analyses of power and governmentality were used to explore the ‘Art of Midwifery’ vs the ‘Art of Governance’. Lack of holism and neoliberal agendas dominating current IFP may be detrimental to maternity service provision as they compromise decisional autonomy for women and clinical autonomy for midwives

Talking about mental health nursing: a qualitative analysis of nurses’ and service users’ accounts.

This study explores talk about mental health nursing, in a policy and practice climate that promotes service user involvement in nursing processes. The intention of this study was to gain multiple perspectives about mental health nursing and service user involvement through in-depth research interviews and focus groups with mental health nurses, nursing students and mental health service users. Analysis centred on the meaning making of participants’ talk and how mental health nursing identities are accounted for and constructed.The opportunities for authentic service user involvement in nursing processes within mental health systems that include detention and a focus on compliance are under-explored. Historically mental health services have been linked with power and control, as treatments and interventions have often been coercive and at times involve forced assessment and treatment under mental health legislation. Challenges to power, control and coercion can be found in practices that promote service user involvement. However, a power imbalance in relationships between mental health service users and mental health practitioners is evident, with service users having partial agency and often limited involvement regarding their care and treatment.This study found that nurses and mental health service users talked about how nursing work was often task-focused, and made reference to nurses spending limited therapeutic time directly with service users, who then spoke of their dissatisfaction regarding engagements with nursing staff. Nursing students voiced limited knowledge and exposure to examples of how nurses engage in service user involvement activities in practice indicating they had little experience of this. Instead students said they felt compelled to go along with practices that appeared to work in opposition to involvement. Displays of understanding in participants’ talk about mental health nursing work indicated the existence of powerful professional cultures that included distance and separateness from service users and perpetuated limited involvement. It is important that mental health nurses consider imbalanced power relationships that exist in mental health environments and challenge cultures that discourage nurses from working more collaboratively with service users