Understanding research, consent and ethics: a participatory research methodology in a medium secure unit for men with a learning disability

People with learning disability have historically been the subjects or recipients of research, rather than participants or contributors. Whilst there is considerable literature on issues of informed consent, little is known about what people with learning disability understand about research, participation in research or how to facilitate understanding. Ways of facilitating consent have been offered by a number of studies (Fisher, 2003, Murphy and Clare, 1995, DeRenzo et al 1998) but these studies have not researched the effectiveness of such methods from the perspective of the participants. Understanding what is meant by research is fundamental to involving people with learning disabilities in research and to developing and maintaining informed consent (Gilbert, 2004). This study set out to discover how men with a learning disability living in a Medium Secure Unit understand research, consent and ethics and what enables them to learn about these concepts. Seven men and ten staff were invited to become co-researchers with two researchers from Northumbria University, over 20 months. Lessons learned from this study about research can now be used to educate other adults with learning disability concerning research, how it can be helpful, and how it can make a difference in the lives of people with learning disability

Discourse and forensic learning disability nursing practice : ideology, paradox and truth

Overview Central to successful therapeutic relationships in working with people with a learning disability is the language used by nurses; the discourses which they create and perpetuate; and resultant implications for practice. These are key issues in the current investigation. Employing retrospective data obtained during an action research programme carried out in a medium security forensic unit (MSU), it analyse types of discourse employed by the men who reside there and the staff. Part of the analysis shows having a learning disability as viewed through the eyes of the men themselves in a study extending over twenty months. Literary analyses on method, representations of learning disabilities, security and discipline, and forensic practice were carried out concurrently. Aims These are to (1) develop a critical and a post-modern approach to investigating given 'truths' about; the positives of learning disability; men with learning disability who offend; and the nature of forensic nursing: (2) develop a socio-political overview by applying critical discourse analysis to examine micro discourses and macro models associated with learning disabilities, related national and local policies, and models of nursing and disability: (3) combine the products of (1) and (2) to illustrate discourse, repertoires, paradoxes and practical ideologies justifying treatment in the MSU, revealing ideologies and beliefs regarding learning disabilities in this setting. Theory and method Foucault shows how linguistic constructions, written protocols and customary oral dialogue are used to create and sustain dominant views of 'reality' — and may also be used to challenge these. Retrospective data regarding six men living in the MSU and their staff [total N=17] were obtained using diaries, observational notes, semi-structured interviews, focus groups and evaluations originally collected as part of an action research project. National and local policies were also interrogated. Data were then reanalysed using critical discourse-analytic techniques. Outcomes Findings suggest that the men are viewed paradoxically. On one hand, they are seen negatively as different, dangerous, lacking ability: and staff as custodians restricting their rights. Paradoxically, affirmative discourse is also abundant — the men are talented and pleasant companions. Repertoires illustrate warm therapeutic relationships existing between the men and staff, demonstrating 'good nurse' characteristics expressed within a complex and restrictive environment, with humour playing an important part. These paradoxical repertoires reveal practical ideologies which defend forensic practice and justify treatment. Results have implications for the men (their views are acknowledged and disseminated); for practice through enhancing the evidence base; for nurse education through reflection on ideologies and justifications on which forensic practice is based

Discourse and forensic learning disability nursing practice : ideology, paradox and truth

Central to successful therapeutic relationships in working with people with a learning disability is the language used by nurses; the discourses which they create and perpetuate; and resultant implications for practice. These are key issues in the current investigation. Employing retrospective data obtained during an action research programme carried out in a medium security forensic unit (MSU), it analyse types of discourse employed by the men who reside there and the staff. Part of the analysis shows having a learning disability as viewed through the eyes of the men themselves in a study extending over twenty months. Literary analyses on method, representations of learning disabilities, security and discipline, and forensic practice were carried out concurrently. Aims These are to (1) develop a critical and a post-modern approach to investigating given 'truths' about; the positives of learning disability; men with learning disability who offend; and the nature of forensic nursing: (2) develop a socio-political overview by applying critical discourse analysis to examine micro discourses and macro models associated with learning disabilities, related national and local policies, and models of nursing and disability: (3) combine the products of (1) and (2) to illustrate discourse, repertoires, paradoxes and practical ideologies justifying treatment in the MSU, revealing ideologies and beliefs regarding learning disabilities in this setting. Theory and method Foucault shows how linguistic constructions, written protocols and customary oral dialogue are used to create and sustain dominant views of 'reality' — and may also be used to challenge these. Retrospective data regarding six men living in the MSU and their staff [total N=17] were obtained using diaries, observational notes, semi-structured interviews, focus groups and evaluations originally collected as part of an action research project. National and local policies were also interrogated. Data were then reanalysed using critical discourse-analytic techniques. Outcomes Findings suggest that the men are viewed paradoxically. On one hand, they are seen negatively as different, dangerous, lacking ability: and staff as custodians restricting their rights. Paradoxically, affirmative discourse is also abundant — the men are talented and pleasant companions. Repertoires illustrate warm therapeutic relationships existing between the men and staff, demonstrating 'good nurse' characteristics expressed within a complex and restrictive environment, with humour playing an important part. These paradoxical repertoires reveal practical ideologies which defend forensic practice and justify treatment. Results have implications for the men (their views are acknowledged and disseminated); for practice through enhancing the evidence base; for nurse education through reflection on ideologies and justifications on which forensic practice is based.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The ability to reject invalid logical inferences predicts proof comprehension and mathematics performance

In this paper we report a study designed to investigate the impact of logical reasoning ability on proof comprehension. Undergraduates beginning their study of proof-based mathematics were asked to complete a conditional reasoning task that involved deciding whether a stated conclusion follows necessarily from a statement of the form “if p then q”; they were then asked to read a previously unseen proof and to complete an associated comprehension test. To investigate the broader impact of their conditional reasoning skills, we also constructed a composite measure of the participants’ performance in their mathematics courses. Analyses revealed that the ability to reject invalid denial-of-the-antecedent and affirmation-of-theconsequent inferences predicted both proof comprehension and course performance, but the ability to endorse valid modus tollens inferences did not. This result adds to a growing body of research indicating that success in advanced mathematics does not require a normatively correct material interpretation of conditional statements

Poverty stigma, mental health, and well-being : a rapid review and synthesis of quantitative and qualitative research

Poverty is associated with higher rates of mental illness and lower levels of well-being. Poverty affects mental health and well-being through a range of mechanisms, one of which may be experiences of stigma associated with living in poverty or accessing services designed to assist individuals on low incomes (including social security). The aim of this study was to synthesise published research on the relationship between individuals' experiences of poverty stigma and aspects of mental health and well-being. A rapid review was undertaken of quantitative and qualitative research published between January 2005 and February 2021. In total, 22 (5 quantitative and 17 qualitative or mixed methods) studies met the inclusion criteria, the findings of which were extracted and analysed using thematic synthesis. Experiences of poverty stigma were found to be associated with four broad aspects of mental health and well-being: negative self-evaluations, diminished social well-being, negative affect, and mental ill-health. Several forms of poverty stigma, including self, received, perceived, anticipated, and endorsed stigma were implicated in these associations. Poverty stigma may contribute to inequalities in mental illness and well-being, although further quantitative and longitudinal research is required to test its impact on mental health

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio

De-escalation: the evidence, policy and practice

Purpose – The management of violence and aggression is an important aspect of any service in the NHS and has been rightly tackled as a whole organisational approach. De-escalation is one such aspect of the organisation approach relating foremost to the safety of people and as such is a central part of relational security, personal safety and the therapeutic relationship. Design/methodology/approach – The paper explores the evidence and policies around de-escalation. Findings – The paper recommends that a randomised-controlled trial be designed, comparing different de-escalation techniques to establish an evidence base for this routine practice. Research limitations/implications – The paper is limited to discussing de-escalation as an approach and the policy that directs it, and does not consider individual theories on aggression and management. It makes recommendations for policy, research and practice. Practical implications – There is a lack of high-quality evidence around de-escalation policy and principles which staff may believe is evidence-based practice because training is often mandatory. This obviously impacts upon the patient experience and aspects of safety. The paper is valuable to practitioners working in secure environments, or with offenders that may require management of violence and aggression. Originality/value – There are many policies and guidelines from the government and from professional bodies that seems to have tailored off since 2005 (Muralidharan and Fenton, 2006; UKCC, 2002). Forensic staff are constrained by such guidance which is further complicated by debates concerning care/coercion and forensic environments, some of which is alluded to here