Exploring staff experiences of therapeutic relationships and team formulation in inpatient forensic mental health services

Forensic Mental Health (FMH) services represent a complex service area with competing political, legal and health care demands. Members of staff working within these services must navigate the competing demands of care and control and have an important influence on how FMH services function and the quality of care that is provided. A systematic search strategy was developed and PsycINFO, Medline, CINAHL, Web of Science, EMBASE and grey literature were searched. A qualitative meta-ethnography of papers from the United Kingdom explored how power, control and risk management influence staff experiences of the therapeutic relationship (TR) in inpatient FMH services. Three third-order themes emerged from this synthesis: 1) Staff team cohesion; 2) Dialectic between care and control; and 3) Structural systems. The findings highlight the dynamic process in which staff hold dual-roles between care and control and the importance of staff team cohesion, safety and containment when fostering TRs. Semi-structured interviews were conducted with 12 staff members from multi-disciplinary teams in an inpatient FMH service in the UK. A thematic analysis was conducted, yielding three themes: 1) Processes and parallel processes; 2) Mechanisms for change; and 3) Barriers to successful intervention. A process model is presented, which highlights six stages involved in team formulation interventions and is discussed in relation to the themes. This model adds to the limited existing literature and provides facilitators with a flexible framework of key factors to consider during team formulation interventions. A critical appraisal summarises the findings of the review and research paper and reviews the process of carrying out research in FMH settings. Ethical issues of indirect working are also discussed

Comparative Findings from the IEA Civic Study and Their Impact on the Improvement of Civic Education in Australia

The IEA Civic Education Study occurred in a context of little formal civics curricula in Australian schools. The paper compares some Australian data with that from England and the USA. Comparative Civic Knowledge data emphasise the finding that students do learn civics in school and that the kind of delivery does affect student learning outcomes. The comparative data on Civic Engagement indicate that more positive civic attitudes about engagement co-exist with greater civic knowledge. They also indicate that formal provision of civic education makes a difference to civic attitudes. Teacher data demonstrated the need for more training in civics, especially in the contested nature of the field. Teachers did not show an appreciation that encouraging decision-making in schools might increase student engagement in democracy more generally. The paper argues that pedagogic and administrative strategies to address decision-making and other civic competencies are crucial to the engagement of students in schools and to their future engagement in the wider society

The Case for Urgency: Advocating for Indigenous voice in education

In 2004 the Australian Council for Educational Research (ACER) published an Australian Education Review (AER) on Indigenous Education: The Case for Change: A review of contemporary research on Indigenous education outcomes, AER 47 (Mellor & Corrigan, 2004). In the 13 years since its publication, the state of Indigenous education outcomes has remained substantially unaltered. All the social indicators demonstrate that Australia’s First Nations people continue to be the most socio-economically disadvantaged population cohort in Australian society. This is after decades of continued policy efforts by successive Commonwealth, state and territory governments to ameliorate Indigenous education disadvantage. We still struggle with understanding how best to get Indigenous children to go to school, keep them in school, help them finish school and then go on to future education or employment. Despite the seemingly elementary nature of the problem, policy practitioners will be all too familiar with the complex nature of Indigenous education in Australia. Consequently, addressing Indigenous educational disadvantage attracts a multitude of solutions that manifest themselves as ever-changing policy approaches, often underpinned by ideology. The authors of this review paper argue that no one solution will remedy Indigenous social or educational disadvantage, but neither will policies premised on ideological views.https://research.acer.edu.au/aer/1027/thumbnail.jp

Factors affecting decision making in children with complex care needs:a consensus approach to develop best practice in a UK children’s hospital

BACKGROUND: Children with complex care needs are a growing proportion of the sick children seen in all healthcare settings in the UK. Complex care needs place demands on parents and professionals who often require many different healthcare teams to work together. Care can be both materially and logistically difficult to manage, causing friction with parents. These difficulties may be reduced if common best practice standards and approaches can be developed in this area. OBJECTIVE: To develop a consensus approach to the management of complexity among healthcare professionals, we used a modified Delphi process. The process consisted of a meeting of clinical leaders to develop candidate statements, followed by two survey rounds open to all professionals in a UK children’s hospital to measure and establish consensus recommendations. RESULTS: Ninety-nine professionals completed both rounds of the survey, 69 statements were agreed. These pertained to seven thematic areas: standardised approaches to communicating with families; processes for interprofessional communication; processes for shared decision-making in the child’s best interests; role of the multidisciplinary team; managing professional–parental disagreement and conflict; the role of clinical psychologists; and staff support. Overall, the level of consensus was high, ranging from agreement to strong agreement. CONCLUSIONS: These statements provide a consensus basis that can inform standardised approaches to the management of complexity. Such approaches may decrease friction between parents, children and healthcare professionals

Influenza Hospitalisations in England during the 2022/23 Season: do different data sources drive divergence in modelled waves? A comparison of surveillance and administrative data

Accurate and representative data is vital for precisely reporting the impact of influenza in healthcare systems. Northern hemisphere winter 2022/23 experienced the most substantial influenza wave since the COVID-19 pandemic began in 2020. Simultaneously, new data streams become available within health services because of the pandemic. Comparing these data, surveillance and administrative, supports the accurate monitoring of population level disease trends. We analysed admissions rates per capita from four different collection mechanisms covering National Health Service hospital Trusts in England over the winter 2022/23 wave. We adjust for difference in reporting and extracted key epidemic characteristics including the maximum admission rate, peak timing, cumulative season admissions and growth rates by fitting generalised additive models at national and regional levels. By modelling the admission rates per capita across surveillance and administrative data systems we show that different data measuring the epidemic produce different estimates of key quantities. Nationally and in most regions the data correspond well for the maximum admission rate, date of peak and growth rate, however, in subnational analysis discrepancies in estimates arose, particularly for the cumulative admission rate. This research shows that the choice of data used to measure seasonal influenza epidemics can influence analysis substantially at sub-national levels. For the admission rate per capita there is comparability in the sentinel surveillance approach (which has other important functions), rapid situational reports, operational databases and time lagged administrative data giving assurance in their combined value. Utilising multiple sources of data aids understanding of the impact of seasonal influenza epidemics in the population

Teaching medical students about nutrition: from basic principles to practical strategies

Poor nutrition is widely recognised as one of the key modifiable risks to health and life, with doctors in an ideal position to recognise when suboptimal nutrition is impacting on their patients’ health and provide them with advice and support to create sustainable and achievable diet and lifestyle modifications. However, it has been acknowledged that nutrition training within medical schools is extremely varied, and in many cases inadequate. The Association for Nutrition UK Undergraduate Curriculum in Nutrition for Medical Doctors provides medical schools with guidance on what should be included in the training of all medical students. This paper discusses three key ways in which medical schools can support the implementation of nutrition into their teaching; incorporating nutrition within the core medical curriculum teaching, the use of subject specific experts to support and deliver nutrition training, and the inclusion of nutrition within formal assessment so as to reinforce and cement learnings into practical, applicable actions and advice

Adherence to Mediterranean diet ; not olive oil consumption alone predicts hypercholesterolemia in elderly : the MEDIS study

Background/Aims: This analysis aimed to compare the role of olive oil consumption with that of Mediterranean diet on their diagnostic value for the presence of hypercholesterolemia. Methods: Mediterranean islands study (MEDIS) recruited 2749 older (over 65 years of age) individuals between 2005-2015. Recruitment occurred from 21 Mediterranean islands and the rural Mani region (Peloponnesus) of Greece. Dietary habits, energy intake, physical activity status, sociodemographic characteristics (altitude in residing area, lifestyle parameters) and clinical profile aspects (including blood lipids) were measured. The level of adherence to Mediterranean diet was assessed using the a-priori index MedDietScore and olive oil consumption was assessed with a validated FFQ. The diagnostic value of the food data was assessed using the AUC for the presence of hypercholesterolemia. The p value for the comparison of AUC with 0.5 was performed with Likelihood Ratio test. [Excerpt]peer-reviewe

Residential altitude and fish consumption : effect on systolic blood pressure in elderly : MEDIS study cross-sectional results

Background/Aims: Frequent consumption of fish is associated with decreased SBP levels. Both aging and living at high altitude are associated with significant increases in Systolic Blood Pressure (SBP) levels. The aim of this analysis was to examine the potential interaction between fish consumption and high altitude on SBP in elderly cohort. Methods: Mediterranean islands study (MEDIS) recruited 2749 older (aged 65+ years) individuals from 2005-2015. Participants were selected from 21 Mediterranean islands and the rural Mani region (Peloponnesus) of Greece. Dietary habits, energy intake, physical activity status, socio-demographic characteristics and clinical profile aspects (blood pressure) were measured. The altitude of the area was also recorded. [excerpt]peer-reviewe