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PubMed2006

Vision to reality: using patients' voices to develop and improve services.

The NHS is being transformed into a patient-led service requiring radical new ways of gathering patients' views. Sunderland Teaching Primary Care Trust (TPCT) demonstrated its commitment to this change by introducing an action research project in parallel to the introduction of a new nurse-led urgent care team (UCT). The project used a qualitative methodology to collect views from initial UCT service users, patients with chronic obstructive pulmonary disease (COPD). Views were analysed using a thematic framework analysis. A multi-disciplinary action research group considered emerging themes and literature finding solutions and taking action to deliver service improvements. The research provides evidence of the quality of the new service and highlighted a service gap for housebound patients with chronic disease. This needs to be used positively to make improvements for patients in line with the NHS Improvement Plan and long-term conditions agenda.

Community Health Nursing↗
PubMedDate not supplied

Work-based learning: challenges and opportunities.

This article discusses some of the challenges and opportunities arising from the development and implementation of an innovative work-based open and distance learning programme available exclusively to healthcare assistants working in general health and mental health practice. The programme is based on a partnership between the sponsoring organisation and the Open University. The focus is on the development of standards of proficiency, service user involvement, partnership working, skills development and the pedagogic implications of a work-based learning format.

Adult↗
PubMed2004

A community based programme to improve access to dental services for drug users.

In 1999 South Lancashire Health Authority published their Oral Health Improvement Plan in which they specifically identified drug users as a target group. In this paper the authors outline the development of a project, which aimed to improve access to dental services for this group. Essential to the relative success of the project was the inclusion of drug users and service providers at the outset. In addition perceived barriers, which exist between drug users and the profession have started to be broken down.

Community Dentistry↗
PubMed2000

Comprehensive integrated primary mental health care for South Africa. Pipedream or possibility?

While the vision for restructuring health care in South Africa is based on a comprehensive primary health care system, care at the primary level remains largely biomedical in orientation. Given this, I argue that whilst adding mental health care to primary level care may increase accessibility of psychiatric care. it will not, however, provide for comprehensive integrated primary mental health care as planned. This would require a paradigm shift towards a comprehensive discourse of care which includes mental health care. While efforts towards reorienting health care personnel in South Africa towards the primary health care approach have been initiated, an examination of the primary health care system in one sub-district in South Africa, reveals that the delivery of biomedical care is sustained by a number of factors within the primary health care system as well as within the macro-context. A shift in the paradigm of care provided would therefore require the transformation of the system on many fronts. Of central importance would be the restructuring of the primary health care system to be supportive of emotional labour, health promotion, empowerment of service users and of care which takes the subjectivity of the illness experience for the patient into account.

Culture↗
PubMed2002

Using network variation in practice: identification of support network type.

This paper evaluates the use of a support network measurement instrument (PANT) in social work practice, focusing primarily on a study of the introduction and use of the instrument with social work teams. The paper describes practitioners' responses during the training period and during the initial phases of using the instrument in practice. The findings show how growth in familiarity with the new tool and support from managers overcame early resistance and contributed to both practitioners' confidence and understanding of the situations of older people. It allowed them to tailor interventions appropriately. It also contributed to understanding of differences between teams in the area and made it possible to create area profiles of older service users, their carers and their needs. The importance of network type for prediction of outcomes is stressed.

Aged↗
PubMed2006

Do people with diabetes who need to talk want to talk?

AIM: Our objective was to determine whether people with diabetes who ask for psychological support are those who are experiencing clinically significant levels of psychological distress. METHOD: Three hundred people with diabetes were asked to complete psychometrically validated questionnaires that assessed subjective need and objective psychological distress. RESULTS: High levels of psychological distress were reported: 25% reported depressive symptomatology, 41% reported clinically significant levels of anxiety and 51% reported some binge eating behaviour. Participants also indicated a desire to talk to diabetes professionals about various problem areas in diabetes. Those reporting psychological distress, especially depression, were most likely to indicate a desire to talk to someone about living with diabetes. CONCLUSIONS: Those who want to talk are those who need to talk. Future service development issues should acknowledge the needs and expressed wishes of service users.

Adolescent↗
PubMed2003

Primary care. Home truths.

Charging social services for delays in patients being discharged from hospital is unlikely to result in improved care for older people. A new kind of community support worker dedicated to care of the elderly is needed. These workers could provide sustained support and prevent avoidable admissions to residential care. Care packages should take more account of what service users want. Government focus needs to shift from the management of beds to community resources.

Aged↗
PubMed2006

Traversing the network: a user-led Care Pathway approach to the management of Parkinson's disease in the community.

This article reports on a pilot study to develop and implement a Care Pathway framework for people with Parkinson's disease (PD) and their carers, to facilitate more comprehensive and integrated health and social care, with a streamlining of the transfer of core information around the system. The pathway is user-led, conceptualising the user/carer as the 'communications centre', resourced and supported in the management of their situation by the professionals to achieve their own integrated package of care. The Care Pathway tools, comprising of a local information pack, a Problems/Needs form, a Clinic Summary and a service record sheet, were designed by a working party consisting of service providers, a service user and carer and the researchers. The use of the framework was evaluated by following the progress of a convenience sample of 22 people with PD over a 12-month period. Beginning and end-point data on patient characteristics, social circumstances, severity of illness, and recent/current use of services were collected. The separate tools and the contribution of the framework to the management of the illness were evaluated through semi-structured interviews with participants and their carers and focused interviews with the participating neurologist and specialist nurse, conducted at the end of the 12-month period. Participants' situations showed very little change overall. The people with PD and their carers were generally enthusiastic about the Care Pathway, particularly the problems/needs form which they felt facilitated their active engagement in their own care. Very few service record forms had been used. The neurologist and specialist nurse were equally enthusiastic, and envisaged that full use of the framework with all service providers participating would greatly improve the overall care of their patients. In conclusion the Care Pathway framework is feasible within normal clinic procedures and improves patients' care. However, its effectiveness in contributing to the better management of the illness overall requires further testing.

Aged↗
PubMed2002

The voice of detainees in a high security setting on services for people with personality disorder.

BACKGROUND: British government Home and Health Departments have been consulting widely about service development for people with ' dangerous severe personality disorder' (DSPD). There has, however, been no consultation with service users, nor is there any user view literature in this area. METHODS: All people detained in one high security hospital under the legal classification of psychopathic disorder were eligible but those on the admission or intensive care wards were not approached. Views of service were elicited using a purpose designed semi-structured interview. The principal researcher was independent of all clinical teams. Confidentiality about patients' views was assured. AIMS: To establish views on services from one subgroup of people nominated by the government department as having 'DSPD'. RESULTS: Sixty-one of 89 agreed to interview. With security a given, about half expressed a preference for a high security hospital setting, 20% prison and 25% elsewhere, generally medium secure hospitals. Participants most valued caring, understanding and 'experience' among staff. An ideal service was considered to be one within small, domestic living units, providing group and individual therapies. Some found living with people with mental illness difficult, but some specified not wanting segregated units. Views were affected by gender and comorbidity. CONCLUSIONS: As the sample were all in hospital, the emphasis on treatment may reflect a placement bias. All but five participants, however, had had experience of both health and criminal justice services, so were well placed to talk with authority about preferences.

Antisocial Personality Disorder↗
PubMed1999

Patient satisfaction with HIV service provision in NPMS hospitals: the development of a standard satisfaction questionnaire. NPMS Steering Group.

A self-completion satisfaction questionnaire evaluating the standard of care of HIV outpatient services was developed as part of the National Prospective Monitoring System on the Use, Cost and Outcome of HIV Service Provision in English Hospitals (NPMS). The questionnaire was designed in conjunction with service users and health care professionals, and piloted in three London and three non-London HIV clinics. In addition to testing alternative methods of administering the questionnaire, the pilot provided satisfaction scores on a variety of aspects of service provision for participating clinics. The questionnaire was completed by 548 respondents and was most effectively collected using a sealed box in the clinic waiting area. Mean satisfaction scores for the attitude and skills of staff members was 4.7 (95% CI 4.6-4.7) but satisfaction scores were significantly lower for the clinic environment with a mean of 4.1 (95% CI 4.1-4.2). Satisfaction scores did not differ significantly by gender, age, sexual orientation, ethnic group, employment status or severity of symptoms. London respondents were more satisfied with the clinic environment and seeing preferred members of staff than their non-London counterparts, however there were no other differences between clinics. The questionnaire functioned well in practice and provided meaningful and useful information for individual clinics as well as at aggregate level.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Broadening the partnerships: experiences of working across community agencies.

The creation of inter-agency partnerships to deliver mental health services that meet the health and social care needs of service users is now a central strand of UK national policy and a considerable body of literature has developed around the concept of partnership. The date, however, the focus has been on partnerships between the specialist health and social services, or between these services and primary care. In the course of a study aimed at identifying the mental health training needs of a broader range of community agency staff, it became apparent that partnership working was problematic for the majority of agencies. Focus group discussions were carried out with staff from 21 agencies working across five practice contexts. On the basis of the data obtained we describe the extent of inter-agency working and the barriers to its development. The implications for meeting clients' mental health needs are then considered and means suggested for broadening inter-agency working to include a wider range of relevant agencies.

Community Mental Health Services↗
PubMed2005

The challenges associated with providing community care for people with complex needs in rural areas: a qualitative investigation.

The aim of the present study was to explore the experiences of recipients and providers of community care in rural areas in Northern Ireland. Additionally, the authors sought to examine the impact of location, housing and environmental factors on the delivery of community care to older people with complex needs. Individual, semistructured interviews were held with service users (n = 17) and family carers (n = 14). Individual and focus group interviews were conducted with care assistants, health and social care professionals, and senior managers from a large health and social care trust and health and social services board in Northern Ireland. The importance of enabling older people to remain in their own homes and communities was emphasised by all participants. The main challenges associated with care provision in rural areas included: difficulties recruiting care assistants; lack of choice of care assistants; isolation; travel and distance between clients and their care assistants; and poor housing conditions. There was a general consensus among participants that the effectiveness of rural community care was perceived to be reliant upon the goodwill of the community. Additionally, changing demographic trends and the predicted shortfall in the number of formal and informal carers were considered key issues for service planners. A number of creative strategies could be used to address many of the limitations associated with rural isolation. These should involve capitalising on available community networks. However, planners should also acknowledge that additional resources are required to maintain older people in rural communities.

Community Health Services↗
PubMed2001

Experiencing personality disorder: a participative research.

As Personality Disorder continues to be a subject of intense public and professional debate, this study has explored by means of an in-depth interview the views of fifty people to whom this diagnosis has been attributed, to include: demographic data, type of personality disorder and other diagnoses; its meaning for them; how they found out about the diagnosis; its impact; related life events, and value of different types of support. The interviewers were also people with the same diagnosis, who have been trained specifically for this purpose. The findings highlight the mainly negative impact of the label, and the gap between the users' perception of the problems they face in the context of having this diagnosis, and professional perspectives. The likely implications of the findings for the validity and usefulness of the diagnosis are outlined. The methodological innovation of engaging service users with personality disorder is looked at in terms of usefulness and feasibility.

Adolescent↗
PubMed2006

Addressing diversity in mental health care: a review of guidance documents.

Discriminated against and marginalised groups of people within our communities continue to be over represented within mental health services and frequently their particular needs are not met. Challenging discrimination and working towards more equitable services are a vital part of anyone's role working within mental health services. This paper provides a review of guidance documents on diversity issues with a particular focus on ethnicity, gender, sexuality, learning disability, spirituality, homelessness and age. The review concludes with a summary of the range of approaches that are currently being advocated for translating guidelines and recommendations into improved and equitable mental health services that meet the needs of service users from a wide range of diverse groups.

Attitude of Health Personnel↗
PubMed2003

Exploring sexual and relationship possibilities for people with psychosis--a review of the literature.

This review examines the literature on sex and relationship issues in the context of serious and persistent mental health problems. It identifies gaps in the research and highlights key issues needing further investigation. The available published documents have been identified, which contain information, ideas, data and evidence on the topic. A critical analysis of the subject, through the examination of the various documents, is provided. The main themes that emerged included HIV/AIDS, medication and sexual dysfunction, sexuality needs, intimate relationships, family planning, policies and sex education. Several subthemes are discussed and include needs assessment, stigma and loneliness. The key findings highlight the lack of systematic studies in the UK, especially regarding the subjective views of patients in determining need and the subsequent development of appropriate plans of care. The author argues that future mental health research needs to go beyond investigating perceived 'risky' behaviours and should include potential therapeutic responses in all areas of sexuality. Further recommendations are made in terms of nurse education particularly the inclusion of psychosexual aspects in future pre- and postregistration curricula. This paper may be of interest to service users, mental health practitioners working alongside people with serious and persistent mental health problems as well as educators, researchers and policy makers.

Family Planning Services↗
PubMed2006

The national suicide prevention strategy for England: the reality of a national strategy for the nursing profession.

Suicide is recognized as a global phenomenon and many countries now have national suicide prevention strategies. International guidance on suicide prevention and accepted epidemiological and treatment-based research underpins healthcare policy relating to suicide reduction. There has been an established comprehensive strategy in England since 2002. However, the rate of suicide continues to be a concern and nurses hold a key role in the implementation of national, regional and local policy into practice. The aim of this paper is to consider the current implications of the national suicide prevention strategy in England for nursing. This discussion paper draws upon both empirical evidence-based literature, governmental guidance and policy-related documentation. The national suicide prevention strategy for England currently continues to have a multifaceted impact on the nursing profession. This ranges from clinical practice issues such as risk assessment through to broader public health responsibilities. If nurses and allied health professionals are to be effective in their role within suicide prevention, they will need to be supported in building awareness of the wider context of the national policy. In particular, this will mean working effectively and collaboratively with the voluntary sector, service users and other non-medical agencies.

Cooperative Behavior↗
PubMed2006

Sexual health education for people with mental health problems: what can we learn from the literature?

Research into sexual risk behaviour among people with 'severe' mental health problems suggested that they are likely to engage in high-risk sexual behaviour, for a number of reasons, putting them at risk of sexually transmitted diseases. The aim of this review is to describe approaches, content and outcomes of sexual health education programmes, developed and implemented for people with mental health problems. A literature review from 1980 to 2005 was carried out using the electronic databases CINAHL, PsycINFO, British Nursing Index, Pubmed and Medline, and the Cochrane library was also searched. The literature search was confined to papers written in English. The keywords 'sexuality', 'sexual health education', 'sexual health promotion', 'HIV', 'sexually transmitted disease' were combined with 'mental illness', 'chronic mental illness''severe mental illness''persistent mental illness''psychiatry', 'mental disorder', 'education interventions' and 'evaluation'. A vast amount of literature was recovered on sexual risk behaviour in people with severe mental health problems, and sexual dysfunction as a result of prescribed medication. As the focus of the review was on sexual health education, this literature was omitted. Although the literature on sexual health education for people experiencing mental health problems was sparse, 14 studies were located that either described or evaluated sexual health education programmes. Most sex education programmes focused on topics such as HIV and other sexually transmitted diseases, negotiating safe sex and skill development in condom use. Findings suggested that the people who attended benefited from sexual health education programmes, facilitated in a sensitive and supportive manner. Education tended to produce a reduction in sexual risk behaviour as opposed to complete cessation. Nevertheless, it is appropriate to consider integrating such education with service provision. The results of the review provide guidance to service providers and mental health nurses wishing to develop and evaluate sexual health education programmes for service users. Areas for future research are also identified.

Attitude to Health↗