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Gavin J Andrews

Publications and source records attributed to Gavin J Andrews.

33 records · Page 2Linked to original sources
PubMed2005

Space, place, and the evidence base: Part II--Rereading nursing environment through geographical research.

This, the second and final article in the short health geography series, articulates how, moving beyond the models and assumptions associated with the metaparadigm of Nursing Environment, as a focused subdisciplinary approach, health geography might provide unique insights into nursing. A case study of a fictional yet somewhat typical children's hospital is presented and demonstrates some wide-ranging geographical issues and research questions (and hence potential geographical data) pertaining to nursing and the allied health professions. Indeed, this broad-brush approach is purposeful to make as many connections as possible to readers with varied theoretical, methodological, empirical, and practice expertise. In addition to the case study, to indicate further how geographical inquiry might locate quite comfortably in nursing research, the article also makes some initial and tentative connections between geography and an established nursing framework for the uptake of research evidence for practice. Although it is acknowledged that geographical inquiry should certainly never have the first call on researching the relationships between nurses and their environments, it is argued that its conceptual focus on space and place provides dedicated and detailed attention and a sound basis for a reformed, "spatialized" route to a more comprehensive understanding. Moreover, it is argued that it also demonstrates great versatility in terms of the scales and the subject matter with which it might engage. Some important issues certainly remain with respect to what might be the correct form of engagement between geographical and nursing research, but arguably, as a reformed disciplinary approach, health geography has the potential to provide a wealth of focused evidence for nursing practice.

Child↗
PubMed2004

Sharing the spirit of the policy agenda? Private complementary therapists' attitudes towards practising in the British NHS.

During recent years, complementary medicine (CM) has grown as a significant provider of health care in the UK, the majority of this provision being allocated through the small private business sector to privately paying clients. Given the substantial demand for CM, the government acknowledges its structural integration with orthodox medicine (OM) to be a logical progression. However, although the time frame, evidence bases and regulatory structures are as yet undetermined, key to the current emphasis on integration is an underlying assumption that private sector providers would be willing participants, potentially alongside nurses. In this context, using a combined questionnaire (n=426) and interview (n=49) survey, this paper makes an initial exploration and considers the current connections that private therapists have with OM and their attitudes towards collaborating with and working within the NHS. The majority of therapists claimed not to have existing business connections with NHS providers, though many stated that they had established some form of informal arrangements. In general, therapists were happy that they had experienced increasingly positive reactions from orthodox clinicians towards their therapies. The overwhelming majority of therapists were positive about the proposition of working within OM but did have certain reservations. Given the range and intensity of opinion found in this initial investigation, the paper concludes by signposting some substantive avenues of focused research inquiry on the structural integration of CM and OM.

Adult↗
PubMed2004

The geography of complementary medicine: perspectives and prospects.

While complementary and alternative medicine (CAM) research has benefited from a range of social scientific perspectives, geographical contributions have been only slowly forthcoming. In this context, this paper illuminates the possibilities for CAM researchers to develop dedicated geographical perspectives. Some fundamental changes in the empirical and theoretical foci of medical/health geography are outlined, from a concern with mapping services and diseases in macro-space to investigating the dynamic between health and place. Highlighted are some important relational dynamics among CAM providers, patients/consumers and places of treatment and some general issues that could benefit from a geographical analysis. The concurrent research agenda is located across the sub-disciplinary strata of human geography.

Complementary Therapies↗
PubMed2004

Complementary medicine and older people: past research and future directions.

Due to the natural aging processes, older people are particularly susceptible to a range of chronic health conditions. However, despite that research has indicated that chronic health conditions and disability act as reliable predictors of complementary/alternative medicine (CAM) use, despite research evidence that older people are significant consumers of CAM, and regardless of the potential for CAM to enhance successful aging, reduce frailty, and increase independence and quality of life in older persons, older people's use of CAM therapies remains under-researched. This paper reviews what existing research literature is there on CAM use in older age; considers rates of and potential for use, features of and barriers to use, and economic, effectiveness and safety issues. From these beginnings, outlined is a wide-ranging research agenda on CAM and older people.

Aged↗
PubMed2004

The urban geography of SARS: paradoxes and dilemmas in Toronto's health care.

BACKGROUND: Severe acute respiratory syndrome (SARS) has impacted heavily on both Canada's society and its health care system. Quite unexpectedly, hospitals and health care workers became facilitators of disease diffusion. This experience has demonstrated the need for a comprehensive disease control strategy. AIMS: The aims are threefold. First, to examine the subtle and changing spatial characteristics of SARS during the short but critical period of its rapid spread in the Greater Toronto Area. Second, to make salient three paradoxes, and their associated dilemmas, faced by nurses and other health care professionals challenged with caring for the sick and containing the rapid spread of the disease. Third, to propose some ways of approaching these dilemmas, as well as some broader preventative and mitigating strategies. METHODS: The crosscutting concepts of 'clinical uncertainty' and 'flow of human contacts' are used to explain disease transmission characteristics and urban spatial diffusion and to guide the particular strategies developed. Evidence for the paper comes from public health records, governmental and non-governmental health statements and the initial epidemiological research on SARS. Direct insights are also gained from recent first-hand experiences of Toronto's health care system during the crisis. DISCUSSION: The concepts of clinical uncertainty and the flow of human contacts provide in-depth insights that complement the findings of large-scale epidemiological studies, and help operationalize their general calls for enhanced control measures. The comprehensive disease control strategy proposed includes the creation of a hospital infrastructure specific to the containment of biological threats; an advisory coalition of disease control specialists; the development of a biological threat-and-containment simulation laboratory and three specific programmes in patient safety, risk assessment and community mobilization. CONCLUSION: It is argued that containment alone, while a necessary and urgent priority, cannot be seen as an end in itself and might better be understood as one possible trajectory within a comprehensive problem-solving strategy. The experiences in Toronto may offer insights to other cities and countries that currently lack such strategies and hence may be vulnerable to similar outbreaks of dangerous infectious diseases.

Canada↗
PubMed2003

Life in a secure unit: the rehabilitation of young people through the use of sport.

Sport is used widely in the rehabilitation of British young people who are resident in secure facilities following criminal sentencing, during remand or for welfare reasons. The research uses a quasi-longitudinal observational study in a secure unit, located in Southern England, and questions the suitability of sporting activities used as a primary vehicle for, and mechanism of, rehabilitation. Through the analysis of experiences at the unit, the paper supports the use of those sporting activities which de-emphasise regulations and winning, and argues for an emphasis on choice for participants, the tailoring of programmes to suit individual needs, and on positive feedback. Sport evidently has an important role in youth rehabilitation. However, it should be used selectively because, if unsuitable activities and programmes are used, they may have a detrimental effect on participants. The paper demonstrates the usefulness of qualitative research methods in rehabilitation studies.

Adolescent↗
PubMed2003

Placing the consumption of private complementary medicine: everyday geographies of older peoples' use.

Using a combined questionnaire and interview survey of older users of complementary medicine, an interpretative framework is developed to examine their consumer behaviour. Collectively, three inter-related levels of interpretation provide a detailed description of complementary medicine as a consumer experience very much associated with particular places and settings. First, structural features of two local private sectors are investigated, including the different organisational modes and local cultures of provision. Second, experiential features are investigated, including how treatment impacts on older users' use of space and on their personal mobility. Third, conceptual features are investigated, including how older users articulate the belief systems associated with complementary medicine. Overlying these levels are a wide-variety of therapeutic settings that make up the total therapeutic experience. These range in scale from the micro-level of clinics and users' homes to the macro-level of towns. The paper unravels the complex, individualized, dispersed and everyday consumer geographies associated with these emerging forms of health care, highlights the intimate dynamics that exist between places and care and showcases how these may be effectively mapped by using qualitative methods and a critical theoretical framework.

Aged↗
PubMed2003

Receiving money for medicine: some tensions and resolutions for community-based private complementary therapists.

During recent years, private complementary medicine has grown as a significant provider of healthcare in the UK and much of this provision is through small private businesses financed by out-of-pocket payments made by privately paying clients. Using a combined questionnaire (n = 426) and interview survey (n = 49), the present paper considers the potential tensions and dilemmas which therapists face and the resolutions which they come to in being carers, but in market terms, also profit makers. Therapists generally identified with being carers first and business people second, and this was reflected in their caring decisions. Indeed, under circumstances where the roles potentially conflicted (e.g. when clients could no longer afford to pay for their treatments), most therapists claimed that they continued to provide care, either by providing their services free-of-charge, at a reduced rate, by deferring payment or by accepting alternative forms of compensation. There is a relative lack of dedicated research literature on complementary therapists, their attitudes and actions, and this paper provides some important data on their specific management and caring decisions. At the same time, the evidence also provides some initial food-for-thought and indicates some potential research directions for exploring ethical issues in the private practice of complementary medicine.

Adult↗
PubMed2003

Nurses who left the British NHS for private complementary medical practice: why did they leave? Would they return?

BACKGROUND: Although the successful retention of National Health Service (NHS) nursing staff is a policy concern, evidence suggests that substantial numbers of registered nurses continue to leave the profession, and some to own and run small caring-related business. At the same time, private complementary medicine has undergone a rapid expansion in recent years, and initial impressionistic evidence suggests that many therapists are former nurses. AIMS: The paper investigates the motivations and experiences of nurses who have either left nursing altogether, or substantially reduced their involvement, and who now practise complementary medicine in the private sector. It also investigates the issue of whether they would consider returning to practise complementary medicine within the NHS. METHODS: A combined questionnaire (n = 63) and semi-structured interview (n = 11) survey was used to collect detailed attitudinal data from respondents. The analytical approach to the interview data used a form of constant comparative analysis which was derived from the principles of grounded theory. In particular, the interviews were developed and refined from each other as they progressed. RESULTS: The majority of therapists operate independently, either from their own homes or from small rented premises. They were originally motivated by a disillusionment with the health service and particular aspects of their former jobs. However, equally they were attracted by the therapies themselves, the conceptual paradigms which underpin them and the different experiences of practice. Despite stating a disillusionment with the NHS, most respondents expressed a cautious willingness to potentially re-enter the NHS to practise complementary medicine. CONCLUSIONS: Many practising complementary therapists are registered nurses who may be willing to re-enter the formal health service. It is therefore argued that a greater synergy between orthodox and complementary medicine may be one way of addressing shortages of nursing labour, and in particular this form of drop-out, whilst meeting evolving consumer health care demands.

Adult↗
PubMed2003

Locating a geography of nursing: space, place and the progress of geographical thought.

Although traditionally, nursing research has paid little attention to geographical approaches, recent years have witnessed some initial research interest in the dynamic between nursing, space and place. Such research potentially represents the foundations of what may be termed a 'geography of nursing'. Although, to date, some novel and valuable perspectives have been gained into the spatial features of nursing, no consideration has been given to the theoretical development of, and basis for, a geography of nursing. Furthermore, no consideration has been given to philosophical heritage; the treatment of space and place in human geography and the insights that this may provide for the new field of research. In this context, this paper provides an historical review of geographical research and traces the evolution of how space and place have been conceptualized and operationalized by it. The paper outlines the emergence of a health geography subdiscipline and its own changing and diverse perspectives. In the final section, the central themes of the current geography of nursing are considered and, reflecting back on the theoretical concerns of contemporary human geography, the paper outlines some philosophies and theories on which future geography of nursing could be based. From a disciplinary perspective, one potential role of the geography of nursing is argued to be the maintenance of the relationship between health geography and mainstream health service and medical concerns, but in a place-sensitive, patient-sensitive and qualitative form.

Demography↗
PubMed2002

Changing local geographies of private residential care for older people 1983-1999: lessons for social policy in England and Wales.

The population structures of many developed countries are changing and shifts towards much older age distributions are common. One way of meeting the resulting increasing demand for long-term care is through small business private sector provision allocated through market systems. However, the private residential care sector in England and Wales demonstrates some of the potential problems of leaving long-term care to the market. During the 1980s, the private residential sector for older persons enjoyed substantial state financed support. Since the 1990 National Health Service and Care in the Community Act introduced markets in social care in 1993, homes have had to compete amongst each other for a much smaller number of clients funded by limited local authority budgets. This impacted on their business and caring operations. Based on a three-stage quasi-longitudinal survey of over 100 residential care homes in one county, this paper considers changes in the overall size and structure of a local sector, discusses the specific management strategies that have been adopted by proprietors and the development of a purchasing and providing market culture. The paper also highlights the importance of interdisciplinary perspectives on the topic by illustrating how changes in social policy can influence local and national geographies of long-term care provision and how, in turn, an understanding of these geographies can inform the sensitive implementation of future social policy initiatives.

Aged↗
PubMed2002

Liminality and breastfeeding: women negotiating space and two bodies.

It is almost universally accepted that breastfeeding infants is nutritionally superior to bottle-feeding. However, despite this medical advice, in many countries breastfeeding rates remain low and in the UK, rates are relatively static. The literature on breastfeeding has discussed international rates and the broad socio-economic factors influencing these rates. Through an observational study of a group of breastfeeding and non-breastfeeding women in the United Kingdom, this research utilises contemporary theoretical perspectives on the body, space and rites of passage, and investigates the reasons why some breastfeeding mothers may be in a liminal period, and the breastfeeding event itself, at times, a liminal and marginalised act. The paper argues that, for the group studied, breastfeeding is sometimes discouraged by its medicalisation, and that breastmilk and breastfeeding are often considered by mothers to be embarrassing. Many of the women studied regarded certain public and private places to be unacceptable places to breastfeed and claimed to modify their behaviour accordingly. The paper demonstrates the value of conducting locally based qualitative research into breastfeeding experiences, and of using theoretical perspectives from post-medical geography to interpret women's experiences.

Attitude to Health↗
PubMed2002

Towards a more place-sensitive nursing research: an invitation to medical and health geography.

During recent years, nursing research has adopted and integrated perspectives and theoretical frameworks from a range of social science disciplines. I argue however, that a lack of attention has been paid in past research to the subdiscipline of medical geography. Although this may, in part, be attributed to a divergence between research priorities and foci, traditional 'scientific' geographical approaches may still be relevant to a wide range of nursing research. Furthermore, a recasting, redirecting and broadening of medical geography in the 1990s, towards what is termed health geography, has enhanced the discipline and provided a more cultural and expansive recognition of health, and a more comprehensive understanding of the dynamic relationship between people, health and place. Given the increasing range of places where health-care is provided and received, and some recent linkages made between nursing and place by nurse-theorists, these newer perspectives and concepts may be particularly useful for interpreting nurses' and patients' relationships both within and with a variety of healthcare settings and living spaces. Indeed, although a more place-sensitive nursing research is potentially a trans-disciplinary academic endeavor, a range of geographical approaches would be central to such a project.

Epidemiologic Methods↗