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Schizophrenia is a global concern, and, this paper, describes the caring roles of health professionals who are mothers of adult children with schizophrenia. A thematic analysis of data from a doctoral study identified a blending of expertise into an informed care model. Caring roles included: constant carer; coordinator carer; watchful bystander carer; and life coach carer. Previous research has not explored these dual roles. This paper elucidates their responsive approaches and contributions to mothering and caregiving roles. Informed by a fusion of professional and mothering knowledges, their insights into mental health care have been forged by their experiences and is an untapped resource. [ABSTRACT FROM AUTHOR]

This paper explores the ways in which practitioners in children and family social work teams make sense of information in their work. By examining observations and recordings from an ethnographic study, the paper focuses on how informal discussions within the office space inform and affect social workers' analysis (or sense-making). Three elements of sense-making activity are illustrated with vignettes and extracts from field notes: methodical doubt, proximity/reflexivity and security. These three distinct features of practice are then discussed and the significance of the findings considered in relation to contemporary practice. The paper highlights the importance of informal interaction and discussion in the social work office as part of the process of social workers' sense-making. It indicates that feelings of trust and security may be linked to intellectual curiosity and an ability to work with uncertainty in sense-making. Ethnography can provide a means of illuminating this complex and inaccessible element of practice and the findings add to the body of knowledge. Practitioners and organisations may wish to reflect on the findings and consider how they contribute to, and are affected by, such cultures and practices. Copyright © 2017 John Wiley & Sons, Ltd. Key Practitioner Messages Curiosity and methodical doubt are central elements in effective social work sense-making., Social workers can use informal discussions effectively to support open-minded and rigorous sense-making., Choice and proximity of colleagues can promote shared sense-making., The nature of office spaces may influence the sense of self-security that underpins effective sense-making. [ABSTRACT FROM AUTHOR]

Scotland is faced with pernicious health inequalities, which stem from inequalities in living conditions and the societal structures that create them. While action is needed to address the wider structural causes of health inequalities, the role of general practitioners (GPs) merits attention due to health care's potential to mitigate or exacerbate health inequalities. Minimal research, however, has explored how GPs understand the fundamental causes of health inequalities nor how they conceptualise their role in mitigating these. This paper aims to fill this gap using in-depth qualitative interviews with 24 GPs working in some of Scotland's most socio-economically disadvantaged, urban areas. Using Raphael's SDH discourse framework, this paper found clear linkages between GPs' perceptions of their patients, how they defined the 'problem' of health inequalities, and what they thought could be done to tackle them in disadvantaged areas. In general, there was convergence on how interviewees viewed their role in mitigating health inequalities through their work with individual patients. However, greater variation was found when describing the boundaries of their role and how far these extended beyond individual encounters. Specifically, only those GPs fluent in discussing structural causes of health inequalities discussed obligations to change local systems via strengthening community linkages and to influence higher level policies related to the SDH. This suggests that while there is a degree of what Metzl and Hansen deem 'structural competency' amongst some GPs working in disadvantaged areas, the scope remains to deepen this competency more broadly. [ABSTRACT FROM AUTHOR]

Each year, parental imprisonment affects approximately 27,000 children and young people in Scotland. Research that focuses on the views and experiences of the children and young people affected by parental imprisonment has highlighted the dominance of stigma, secrecy and shame in the lives of such children. This paper reports the findings of a small-scale qualitative study which sought the accounts of six young people aged between 13 and 26 whose biological father was, or had been, imprisoned. The paper explores the impact of stigma on day-to-day experiences in childhood and on the emotional and social well-being of young people. Young people described this in terms of growing up too fast and revealed ways in which they managed these adversities. Overwhelmingly the young people displayed considerable resilience in the face of extreme challenges and were able to identify positive outcomes of parental imprisonment such as personal growth. In order to promote resilience, we identify a need for public education to challenge social stigma; training for families in selective disclosure and supportive relationships for children. [ABSTRACT FROM AUTHOR]

The landscape for social work is continually changing and working with asylum seekers remains a highly charged and contested area of practice. This paper compares the role of social workers working with asylum seekers in statutory and voluntary-sector settings in the UK. Institutional practices suggest a divide between statutory settings and charitable organisations. However, based on empirical qualitative research and in-depth interviews with thirty-four social workers in Scotland and the south-east of England that explored dominant discourses influencing their practice, we suggest considerable similarities in the different sectors. Austerity measures for local authorities (LA) and voluntary agencies have resulted in the closure of specialist teams and reduced funding for social workers. Findings highlight politicised dominant narratives when working with asylum seekers and we argue for alternatives that promote a more nuanced perspective of entitlement and human rights. [ABSTRACT FROM AUTHOR]

By providing a place in which children can be accessed, the school has long been a site for population-level health initiatives. Recent policy shifts towards health-promoting schools have however re-cast the school from passive host to active collaborator in public health. This paper examines secondary school teachers' views of their roles as partners in Scotland's human papilloma virus vaccination programme. Focus groups were held in seven schools across Scotland. Confusion was evident in relation to this role, with competing understandings of young women's sexuality, concerns about parental perceptions and uncertainty about professional responsibilities. Many teachers sought to distance themselves from the vaccination programme. Evidence was found of a ‘sedimentation of discourses’, as mass models of state-sanctioned health intervention persist alongside contemporary discourses of individual choice. [ABSTRACT FROM PUBLISHER]

Rationale, aims and objectives Internationally, health technology assessments ( HTAs) are ubiquitous drivers to health policy. Within Scotland, the Scottish Medicines Consortium undertakes the medicine review process. Input from clinical experts, involved in frontline care, is an integral component of the assessment process. This paper explores the relationship between the clinical experts and the HTA agency within Scotland to better understand what motivates expert clinicians to devote their time to the medicine review process with no remuneration. Methods Twenty-seven clinical experts from 16 different clinical specialties took part in one-to-one interviews at their place of work between October 2011 and March 2012. Data analysis was inductive and comprised the organization of data into a framework and a subsequent thematic analysis. Results Three distinct themes were identified: (1) recruitment, which identified two types of explanations for the experts' appointment: external justification (nominated by another) and internal justification (being recognized as an expert); (2) flexibility of the procedures, with experts able to determine their own response style and negotiate timelines; (3) health care systems, demonstrating that their affiliation to the health system underpinned the relationship and their motivation to be clinical experts. Conclusions The findings of this study provide insight into the elements important to clinicians who voluntarily contribute to HTA processes. Examination of these elements in the context of the organizational citizenship behavior literature provides a foundation on which to improve understanding of this relationship and sustain and improve clinical expert participation in an increasingly intensified clinical environment and within cash-limited HTA systems. [ABSTRACT FROM AUTHOR]

law j., mccann d. & o'may f. (2011) Managing change in the care of children with complex needs: healthcare providers' perspectives. Journal of Advanced Nursing 67(12), 2551-2560. Abstract Aim. This paper is a report of a descriptive qualitative study of the role and activities of nursing and allied health professionals caring for children with complex needs in a community setting. Background. Health care is changing in terms of service provision and delivery, with an increased focus on person-centred care, prevention and community-based services. The role of nursing and allied health professionals is central to these changes but is not well described in terms of capacity, or the knowledge and skills required to meet increasing demand. Method. Within four Health Boards, semi-structured telephone interviews were conducted in 2007 with three nursing and four allied health managers, followed by four focus groups with 15 nursing and 11 allied health practitioners; in addition, three nurses and one speech therapist were interviewed by telephone. Results. Respondents identified challenges related to communication and information systems, equity of service provision, family-centred care and partnership working. Generic and specialized knowledge and skills are needed, although providing the right skills in the right place can often prove problematic with potential implications for service provision. Conclusion. Findings support the adoption of integrated partnership working, going beyond the identification of key professionals, to developing a set of criteria against which future service provision could be judged. Research priorities were identified; comparative evaluation of services, better understanding of the transition process and a clearer sense of the individual's response to the increasing customization of services. [ABSTRACT FROM AUTHOR]

In a previous publication we described the implementation and early evaluation of general practice paediatric scholarships in Scotland. We suggested that it was too early to be able to determine whether this significant investment will produce a return for Scotland in terms of enhanced roles in providing, leading or developing children's services in primary care or at the primary care/secondary care interface. This paper presents the results of a survey of the impact of the scholarship for the first six cohorts of the scholarship (119 General Practitioners). The response rate was 76%. Of the 90 respondents, almost half (44) have developed roles or areas of special paediatric interest either within or out with the practice, or in three cases both within and out with the practice. A total of 37 (43%) of those that continue to work within general practice reported that they have developed areas of special interest of benefit to the practice. Qualitative analysis of free text questions suggested that scholars had benefited from their experience in terms of increased confidence in dealing with child health problems, developing links with secondary care colleagues, and personal gain with respect to role development. [ABSTRACT FROM AUTHOR]

Introduction: Health professional identity transitions involve a dynamic period of liminality prompting a time of considerable uncertainty and self‐doubt. For postgraduate trainees in the United Kingdom, the transition to medical registrar can be a significant deterrent to recruitment and retention. Narrative analysis offers insight into identity work during transitions with potential to inform strategies for developing professional identities. This study aimed to use narrative analysis to explore trainees' experiences and their sense of agency during the liminal phase of this transition. Methods: Following ethical approval, internal medicine (IM) trainees in their second year of IM training were interviewed. Transcripts were audio recorded, transcribed verbatim and analysed to identify narratives describing liminality during the transition to the role of medical registrar, including examples of rejecting and claiming identity grants. Narrative analysis, as described by Riessman and influenced by James Gee's units of discourse, was undertaken, with an agentive lens applied to the data. Results: Between January 2021 and February 2022, 19 IM trainees were interviewed. Given the in‐depth analysis, four narratives were purposively selected to present, including trainees rejecting and claiming the medical registrar role. Trainees tended to describe negative experiences, but those with a higher sense of agency demonstrated positive reflection and identity construction through narrative. There was often identity dissonance between how trainees defined their stage in the transition to medical registrar and how their narrative illustrated their identity work. Conclusion: This study exemplifies narrative analysis' linguistic and agentive lenses in exploring the experience of the liminal identity transitional period. The findings reflect the identity dissonance experienced by trainees during this time and sheds light on their sense of agency throughout. It heralds a need to acknowledge the significant liminality experienced during transitions throughout medical training and to empower a sense of agency to support identity work. The authors' narrative analysis reveals identity dissonance experienced by trainees, as they transition to medical registrar, in ways that herald need to empower a sense of agency to support identity work. [ABSTRACT FROM AUTHOR]

In the UK, transformation of the nursing workforce, including development of the role of the advanced nurse practitioner within general practice, is essential to meet healthcare demands. This article presents the results of a small, qualitative study conducted among students at one university in Scotland, describing their experiences of participation in advanced practice education. Data were collected through semi-structured interviews to generate in-depth descriptions and to identify the facilitators and barriers to learning. The study identified that a shared responsibility for patient care creates opportunities for learning. The facilitators to learning were identified as foundation level education in history taking and clinical examination, finance, having a supportive network and mentorship. Barriers included pressure of work and a lack of clarity about roles and training needs. Given the key role that these nurses will have in future healthcare models, there is a requirement for a national education standard. It is recommended that the Nursing and Midwifery Council leads on defining advanced nurse practitioner in general practice programme learning outcomes. The overall aim of such courses is to enhance the experience for future nurses to encourage recruitment and transform the nursing workforce. [ABSTRACT FROM AUTHOR]

Early intervention on frailty can help prevent or delay functional decline and onset of dependency. Community nurses encounter patients with frailty routinely and have opportunities to influence frailty trajectories for individuals and their carers. This study aimed to understand nurses' perceptions of frailty in a community setting and their needs for education on its assessment and management. Using an exploratory qualitative design we conducted focus groups in one Health Board in Scotland. Thematic content analysis of data was facilitated by NVivo© software. A total of 18 nurses described the meaning of frailty as vulnerability, loss and complex comorbidity and identified processes of caring for people with frailty. They identified existing educational needs necessary to support their current efforts to build capability through existing adversities. Our study indicates that current practice is largely reactive, influenced by professional judgement and intuition, with little systematic frailty-specific screening and assessment. [ABSTRACT FROM AUTHOR]

School nurses are the only health professionals with a remit specifically to address the health needs of school-aged children and young people in the UK. However, evidence within one Scottish city suggests that the health needs of vulnerable school-aged children are not always identified or met by the school nurse. Using a qualitative approach, a purposive sample of six school nurses was selected to explore their perceptions of their role in child protection and to identify training needs. Data collection comprised semi- structured interviews and the data were analysed thematically. The school nurses in this study perceived that there was confusion and lack of clarity in relation to their role and involvement in child protection. Report writing, child trafficking, and legal issues were identified as training needs. [ABSTRACT FROM AUTHOR]

Background: As UK healthcare moves towards the ideals of prevention and enablement, health promotion is more commonly cited as an area of practice. In comparison with its allied health profession peers, physiotherapy and occupational therapy, the speech and language therapy profession has little evidence to demonstrate that it has explored what its members understand health promotion to mean or how they describe their current and future practice in relation to it. Aims: To explore how speech and language therapists define health promotion and how they describe their current and future practice in relation to it. Methods & Procedures: Individual, semi-structured interviews were conducted with 15 community-based speech and language therapists. Interviews were transcribed verbatim and analysed using inductive coding. Outcomes & Results: Participants viewed health promotion as a complex entity representing the processes of education and enablement in relation to responsibility for speech, language and communication skills. Participants viewed health promotion as a means of maximizing the scarce resource they represented. The vast majority of activities described as being illustrative of health promotion in a speech and language therapy context were examples of educational interventions, e.g. training, information provision. Participants believed that the speech and language therapist's role will continue to develop in relation to health promotion and that this will have implications for future workforce preparation. Conclusions & Implications: Participants viewed health promotion as both an educational, enabling process and as a strategy that maximizes the potential of speech and language therapy resources. Further research is indicated to develop professional consensus regarding the meaning of health promotion and to support a cohesive approach to workforce development in this area. [ABSTRACT FROM AUTHOR]

Accessible summary [ABSTRACT FROM AUTHOR]

Background: Medication, particularly analgesia, is an important component of palliative care. However, timely access to medication, particularly opioids, can become problematic for patients receiving palliative care in the community setting. In Scotland in 2009, NHS Greater Glasgow & Clyde Health Board (NHS GG&C), in partnership with Macmillan Cancer Support, established a programme to improve the local provision of pharmaceutical palliative care services with the appointment of Macmillan Pharmacist Facilitators. Researchers at the University of Strathclyde were commissioned to support the development and evaluation of this new service. We report the findings of this initial investigation into the provision of current palliative care services and outline an evidence-based action plan to support service improvement. Methods and results: Qualitative data were gathered using focus group interviews. Three key themes were identified: medication supply, communication, and education and training. Conclusions: The study findings have been used to develop an evidence-based action plan for the Macmillan Pharmacist Facilitators. This program of work is due for completion by December 2012. [ABSTRACT FROM AUTHOR]

The article presents a study on community nursing in Scotland and generalist working. Changes to the role of community nurse from specialist disciplines to a generalist community health nurse model were reportedly proposed in Scotland. The study explored the role of a community health nurse as opposed to the roles of a specialist. It has been concluded that discourses on job empowerment, satisfaction and consultation is important to be utilized for discussions on future role changes.

Aims. To investigate how one aspect of anticipatory care is understood and delivered in practice. 'Anticipatory care' in this context can be understood as proactive care, which is oriented towards prevention of adverse events. Background. Scotland has identified the intention to move away from a preoccupation with acute care and invest in health improvement and anticipatory care. Community nurses are the key, yet little is known about how they understand and deliver anticipatory care. Methods. A qualitative case study design using individual in-depth interviews (n = 10), observation (n = 9) and focus groups (n = 5) was selected. Five focus group interviews were carried out with district nurses, practice nurses and health visitors. Subsequently, nine observation events took place, each focused on a single nurse/client encounter. Data were collected during 2008 and 2009 in one Community Health Partnership in Scotland. Findings. Two approaches to anticipatory care emerged; these were influenced by participants' roles and responsibilities. Approach 1 derives from Government policy agenda and is focused on protocol-focused management of long-term illness. Approach 2 is synonymous with long-standing nursing activity focused on holistic care of individual patients. Both approaches are proactive in nature. Conclusions. There is scope to develop a more conceptually complex model of anticipatory care, building on this initial exploration, within which all aims, roles, practices and methods of evaluation can be located and clearly visible. This offers the potential to enable practitioners to interpret and apply policy - otherwise change may be limited and result in service gaps. [ABSTRACT FROM AUTHOR]

Community nurses have a central role in the provision of palliative and end-of- life care; helping people to die with dignity is an important component of this care. To conserve dignity, care should comprise a broad range of actions addressing the distress that might impact on the patient's sense of dignity. These care actions need to be defined. This study aims to suggest care actions that conserve dignity at the end of life based on evidence from local experience and community nursing practice. Data were collected by focus group interviews and analysed by framework analysis using the Chochinov model of dignity as a predefined framework. Suggestions on care actions were given in relation to all themes. As part of a multi-phase project developing and testing a dignity care pathway, this study might help community nurses to conserve dying patients' dignity. [ABSTRACT FROM AUTHOR]

Background Looked after young people (LAYP) have poorer sexual health outcomes than their peers. However, research seldom examines the health needs of, or intervenes with, this group. The aim of the current study was to identify LAYP's perceived sexual health needs and explore sources of sexual health information, knowledge levels, concerns and service preferences. Methods Looked after young people within Fife, Scotland, were recruited through their workers and carers to participate in qualitative semi-structured interviews. Those aged 12–19 years were targeted for recruitment. National Health Services ethics approval was granted. Thematic analysis was conducted using NVivo. Results Interviews were conducted with 10 LAYP. Key themes included gaps in knowledge, and gaps between knowledge and behaviour. Being ‘looked after’ may have negative consequences on knowledge, sources of support and safer sex. A flexible, one-to-one service, aimed at several lifestyle issues, not solely sexual health, was preferred by respondents. Conclusion Looked after young people require support to bridge the gap between knowledge and behaviour and several theories relevant to the findings have been identified. Participants desired more support around a range of health issues, which may come from school, workers and carers, as well as health professionals. Further research examining effective interventions with this group is crucial to improve outcomes. [ABSTRACT FROM PUBLISHER]

Approximately 42 million people worldwide are displaced due to persecution, war or natural disaster (UNHCR, 2008). Many seek refuge in countries far from their own. Where host countries supply refugee mental health services, these services rely heavily on the work of interpreters. Despite interpreters being exposed to significant client distress, little attention has been paid to the impact of mental health interpreting on the well-being of interpreters themselves. This study set out to build on limited previous work in this area.A total of 157 interpreters contracted by Glasgow Translating and Interpreting Service, UK, were surveyed in April 2007. Responses were analysed using grounded theory analyses. Of the 18 interpreters who responded, 56% reported having been emotionally affected by mental health interpreting, 67% reported that they sometimes found it hard to put clients out of their minds and 33% reported that interpreting for clients with mental health difficulties had had an impact on their personal life. Respondents experienced a range of emotions in relation to their work, including anger, sadness, hopelessness and powerlessness, and 28% reported sometimes having difficulty moving onto their next job due to distress associated with a previous client. These findings are discussed in relation to good practice guidelines. [ABSTRACT FROM AUTHOR]