Resilience, respite and general practice:taking a mindful approach to culture change

Demand for primary care services is high, with more patients and fewer practitioners leading to concerns that primary care physicians are struggling to cope with patient demand (1). General practice workload is seen as a potential risk to patients, simply because GPs are overworked (2). It may be time to be concerned about the long-term future of the family doctor—and to think personally, as well as professionally. These pressures clearly have an effect on those who currently practice in primary care. It is not just patients that are at risk; high levels of stress caused by unmanageable workloads are affecting practitioners too (3). The phenomenon of ‘burnout’ has been widely studied in medicine, linking chronic job-related stress and exhaustion, depersonalization and frustration (4,5). High levels of burnout have been found amongst family doctors across Europe, with up to two-thirds of doctors surveyed experiencing feelings contributing to burnout including being emotionally drained and unable to deal with problems calmly (6). Similar patterns have been observed in the USA (7) and Canada (8) and repeated across further studies....

Murder by the book:using crime fiction as a bibliotherapeutic resource

Crime is a popular genre of fiction, widely read but sometimes seen as ‘throwaway’. Disregarding this type of fiction because it is seen as low quality does not take into account its value to readers. Reading has been established as a means of improving mental health and well-being—often known as bibliotherapy. This often focuses on fiction considered to have literary merit rather than genre fiction like crime. However, in framing therapeutic reading in this way, the impact of texts considered to have low cultural value such as crime has been concealed. Examining readers’ responses as a starting point identifies some reasons why crime fiction fulfils a need. Readers in an empirical study spoke about the strong narrative as a distraction, the predictability as a comfort and the safe distance from events as a reassurance that left them feeling that reading crime fiction was a refuge from the world. In exploring readers’ responses in relation to the academic literature, the paper argues that there is a need to think differently about how readers engage with texts and how they experience reading as therapeutic, with a role for fiction like crime

Contextual barriers to implementation in primary care:an ethnographic study of a program to improve chronic kidney disease care

Background. Context is important in implementation—we know that what works in one setting may not work in the same way elsewhere. Primary care has been described as a unique context both in relation to the care delivered and efforts to carry out research and implementation of new evidence. Objective. To explore some of the distinctive features of the primary care environment that may influence implementation. Methods. We conducted an ethnographic study involving observations, interviews and documentary analysis of the ENABLE-CKD project, which involved general practices implementing a chronic kidney disease care bundle and offering self-management support tools to patients. Analysis was based on the constant comparative method. Results. Four elements of the primary care environment emerged as important influences on the extent to which implementation was successful. First, the nature of delivering care in this setting meant that prioritizing one condition over others was problematic. Second, the lack of alignment with financial and other incentives affected engagement. Third, the project team lacked mechanisms through which engagement could be mandated. Fourth, working relationships within practices impacted on engagement. Conclusions. Those seeking to implement interventions in primary care need to consider the particular context if they are to secure successful implementation. We suggest that there are particular kinds of interventions, which may be best suited to the primary care context

A qualitative study of views and experiences of performance management for healthcare-associated infections

Background Centrally-led performance management regimes using standard-setting, monitoring and incentives have become a prominent feature of infection prevention and control (IPC) in health systems. Aim We aimed to characterise views and experiences of regulation and performance management relating to IPC in English hospitals. Methods We analysed two qualitative datasets containing 139 interviews with healthcare workers and managers. Data directly relevant to performance management and IPC were extracted. Data analysis was based on the constant comparative method. Findings Participants reported that performance management regimes had mobilised action around specific infections. The benefits of establishing organisational structures of accountability were seen in empirical evidence of decreasing infection rates. Performance management was not, however, experienced as wholly benign, and setting targets in one area was seen to involve risks of ‘tunnel vision’ and the marginalisation of other potentially important issues. Financial sanctions were viewed particularly negatively; performance management was associated with risks of creating a culture of fearfulness, suppressing learning and disrupting inter-professional relationships. Conclusions Centrally-led performance management may have some important roles in infection prevention and control, but identifying where it is appropriate and determining its limits is critical. Persisting with harsh regimes may affect relationships and increase resistance to continued improvement efforts, but leaving all improvement to local teams may also be a flawed strategy

A point of connection?:Wellbeing, the veteran identity and older adults

Maintaining good wellbeing in older age is seen to have a positive effect on health, including cognitive and physiological functioning. This paper explores experiences of wellbeing in a particular older adult community: those who have served in the military. It aims to identify the specific challenges that ex-service personnel may have, reporting findings from a qualitative study focused on how older veterans told stories of military service and what these stories revealed about wellbeing. We used a qualitative approach; data are drawn from 30 individual interviews, and from engagement with veterans in workshops. Analysis was conducted using a data-driven constant comparison approach. Three themes are presented: how loneliness affects older adult veterans; how they draw on fictive kinship; and the role of military visual culture. Although participants had diverse experiences of military service, they felt that being a veteran connected them to a community that went beyond association with specific experiences. Using narratives of military experience to connect, both in telling stories and by stories being listened to, was vital. As veterans, older adults were able to access each other as a resource for listening and sharing. However, it was also exclusionary: civilians, because they lacked military service experience, could not empathise and be used as a resource

The daily digital practice as a form of self-care:Using photography for everyday well-being

Interest in the connection between involvement in digital communities and well-being has increased as these communities become more commonplace. Specific models of interaction that affect well-being have emerged; here, we examine one of those models, termed ‘digital daily practice’. Digital daily practices involve a commitment to doing one thing – exercise, photography and writing – every day and sharing it online. Participants in these practices agree that they provide an unexpected benefit of improving well-being. This article makes an in-depth examination of one digital daily practice, photo-a-day, using a practice theory framework to understand the affordances it offers for well-being. We engage with the literature on well-being and self-care, critiquing its presentation of well-being as an individual trait. We present data from an ethnographic study including interviews and observations to highlight how photo-a-day as a practice functions as self-care and how communities are formed around it. Photo-a-day is not a simple and uncomplicated practice; rather it is the complex affordances and variance within the practice that relate it to well-being. We conclude that this practice has multi-faceted benefits for improving well-being

Design for Mobile Mental Health:Exploring the Informed Participation Approach

Mobile applications (apps) have the potential to improve mental health services. However, there is limited evidence of efficacy or responsiveness to user needs for existing apps. A lack of design methods has contributed to this issue. Developers view mental health apps as stand-alone products and dismiss the complex context of use. Participatory design, particularly an informed participation approach, has potential to improve the design of mental health apps. In this study, we worked with young mobile users and mental health practitioners to examine the informed participation approach for designing apps. Using auto-ethnography and a set of design workshops, the project focused on eliciting design requirements as a factor for successful implementation. We compared resultant ideas and designs with existing apps. Many user requirements revealed were absent in existing apps, suggesting potential advantages to informed participation. The observation of the process, however, showed challenges in engagement that need to be overcome

Take a photo a day and call me in the morning:Exploring photography projects and well-being

The practice of taking a photo every day and sharing it online has increased in popularity across social media and image-sharing websites. This paper explores the potential well-being benefits of participating in this practice, examining the different social and creative ways in which participants use it. We interviewed sixteen people who currently participate in photo-a-day projects, and identified with the concept that participation in these projects had positive wellbeing benefits. Data were analysed using a grounded and iterative approach. Analysis focused on how participants derived well-being benefits in photo-a-day projects. Photo-a-day projects enabled participants to look differently at the world. There was something satisfying to participants about noticing the world around them more, perhaps giving a sense of being more alive because they were more aware. The negative impacts on well-being mainly centred around the rules and constraints of the projects, including feeling obliged to respond to comments. Nevertheless, photoa-day projects gave a sense of agency and choice, focused around a pleasant goal. Sharing photos could enhance social connections and lead to new relationships. The structure of taking one photo every day encouraged reminiscence, looking back on positive experiences and negative experiences overcome