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This paper is based on a research study which explores Social Workers' feelings about professionals touching children during statutory child protection visits to clients' homes in one part of a southern English county. The study focussed on Social Worker visits to children aged between two and ten years who were subject to child protection plans following Section 47 enquiries of the Children Act 1989. A convenience sample of ten completed questionnaires recorded the types of touch, which were reported during the last visit made by the social worker. Semi-structured interviews followed with a further ten Social Workers. Analysis of the data revealed that most of the Social Workers in the study did touch children in a range of ways and for a variety of reasons during visits. 'Touch' was a term which some found uncomfortable and this paper considers whether terminology obstructs open reflection on the topic. Practitioners were keen to discuss the subject more amongst their peers in order to share best practice. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to evaluate the Supported Discharge Service as a case study of integrated care. The paper will critically evaluate integrated care with regard to patient outcomes, patient satisfaction and cost and productivity.Design/methodology/approach A retrospective mixed methods case study design was adopted utilising patient satisfaction questionnaires, therapy outcome measure and a performance dashboard to measure improvements in patient satisfaction, patient outcomes and cost and productivity.Findings Measured improvements were observed in the integrated discharge process and analysis of the findings demonstrated a statistically significant improvement in patient outcomes, high levels of patient satisfaction and improved productivity subsequently leading to financial savings.Research limitations/implications Due to convenience sampling, the small sample size and a short time frame when analysing patient outcomes, the generalisability of results is limited. Despite this, with integrated care being polymorphous the findings can be utilised to develop theoretical principles to make assertions about integration (Wikfeldt, 1993).Originality/value This paper draws on the importance of integration as the principal driver of reform within the healthcare system. Even though on a small scale, the case study provides evidence to support the use of integration to improve patient outcomes, patient satisfaction and financial savings. [ABSTRACT FROM AUTHOR]

Aims This paper is a report of a study, which seeks to determine if self-reported estimates of RNs' self-rated confidence in responding to alcohol use in patients is a psychometrically sound measure. Background Alcohol-related harm is a global public health problem. Nurses are the largest group of health professionals worldwide, with evidence showing that despite being well placed to respond, they are not engaging in this important role. Design Instrument development. Method The study was a survey set in a large teaching hospital in England, UK. The Clinical Confidence Questionnaire was made available to a convenience sample of 200 RNs in 2007, with a response rate of 22%. Rasch analysis was used to develop a scale for future learning based on the conjoint estimates of registered hospital nurses abilities to meet needs of patients requiring nursing care of different complexities related to alcohol use in patients. Results Outcomes verify that registered hospital nurses' self-rated clinical confidence measures for their own nursing abilities in responding to alcohol use in patients can be reliably estimated and a hierarchical scale of learning can be generated to inform curricula content and learning processes. Conclusion Current health policy in the UK identifies nurses as having a role in responding to alcohol-related harm. More focus should, therefore, be placed on ensuring that they are prepared to fully engage with patients in assessing and responding to alcohol use through specific education, training and skill development. The self-rated clinical confidence tool offers evidence as an acceptable method of measurement in this area. [ABSTRACT FROM AUTHOR]

A small, self-selected convenience sample of male and female contraceptive users in the United Kingdom (n = 34) were interviewed between 2006 and 2008 concerning their feelings about the body and their contraceptive attitudes and experiences. The interviewees were a sub-sample of respondents (n = 188) who completed a paper-based questionnaire on similar topics, who were recruited through a poster placed in a family planning clinic, web-based advertisements on workplace and university websites, and through direct approaches to social groups. The bodily metaphors used when discussing contraception were analyzed using an interpretative phenomenological analytical approach facilitated by Atlas.ti software. The dominant bodily metaphor was mechanistic (i.e.,“body as machine”). A subordinate but influential bodily metaphor was the “natural” body, which had connotations of connection to nature and a quasi-sacred bodily order. Interviewees drew upon this “natural” metaphorical image in the context of discussing their anxieties about hormonal contraception. Drawing upon a “natural,” non-mechanistic body image in the context of contraceptive decision-making contributed to reluctance to use a hormonal form of contraception. This research suggests that clinicians could improve communication and advice about contraception by recognizing that some users may draw upon non-mechanistic body imagery. [ABSTRACT FROM PUBLISHER]

BackgroundEvidence for an effect of work stressors on common mental disorders (CMD) has increased over the past decade. However, studies have not considered whether the effects of work stressors on CMD remain after taking co-occurring non-work stressors into account.MethodData were from the 2007 Adult Psychiatric Morbidity Survey, a national population survey of participants ⩾16 years living in private households in England. This paper analyses data from employed working age participants (N=3383: 1804 males; 1579 females). ICD-10 diagnoses for depressive episode, generalized anxiety disorder, obsessive compulsive disorder, agoraphobia, social phobia, panic or mixed anxiety and depression in the past week were derived using a structured diagnostic interview. Questionnaires assessed self-reported work stressors and non-work stressors.ResultsThe effects of work stressors on CMD were not explained by co-existing non-work stressors. We found independent effects of work and non-work stressors on CMD. Job stress, whether conceptualized as job strain or effort–reward imbalance, together with lower levels of social support at work, recent stressful life events, domestic violence, caring responsibilities, lower levels of non-work social support, debt and poor housing quality were all independently associated with CMD. Social support at home and debt did not influence the effect of work stressors on CMD.ConclusionsNon-work stressors do not appear to make people more susceptible to work stressors; both contribute to CMD. Tackling workplace stress is likely to benefit employee psychological health even if the employee's home life is stressful but interventions incorporating non-work stressors may also be effective. [ABSTRACT FROM PUBLISHER]

Aims: The aim of this study was to investigate nursing students' clinical decision‐making by using high‐fidelity simulation of a deteriorated patient scenario. Design: A convergent parallel mixed methods research design was used consisting of quantitative and qualitative data collection. Methods: Twenty‐three students completed the Health Science Reasoning Test before and after the simulation between October 2015 and June 2016. They were presented with a simulated scenario and asked to 'think aloud' during and after the simulation. The students were audio‐video recorded and observations were collected by the researcher. Results: There was a significant moderate increase in the 'deduction' and 'analysis' sub‐scale scores and overall test score, suggestive of improved analytical decision‐making processes through the simulation experience. Think‐aloud and observation data identified that students predominantly applied 'forward' reasoning during the simulated 'patient's' deterioration, focusing mainly on cue acquisition. 'Backward' reasoning with a focus on cue interpretation was most prominent in the debriefing data, in line with the survey outcomes. Accurate cue interpretation of critical, key cues appeared more useful than the total number of cues in solving the main clinical case problem. Conclusion: Students learn different clinical decision‐making skills during the simulation compared to what they learn from debriefing. Using observation and think‐aloud methods have significant benefits for researchers seeking to optimize the evaluation of the clinical decision‐making process. [ABSTRACT FROM AUTHOR]

Introduction: The social-emotional impacts of Developmental Coordination Disorder (DCD) for children and young people (CYP) are often the most disabling. Occupational therapists (OTs) have a central role in facilitating holistic service provision for this population. There is a need to understand OTs' perceptions regarding provision of support for the social-emotional needs of CYP with DCD. Method: A focus group (n = 9) explored issues pertaining to OT support for the social-emotional needs of this population. Qualitative data were analysed through collaborative coding, organization and reorganization following the classic analysis strategy. Results: Findings suggest that social-emotional support is not explicitly addressed in service provision for CYP with DCD. It appears that OTs know what needs to happen to improve social-emotional outcomes, and have made some progress, but more remains to be done. Holistic service provision depends upon varied factors, many of which are outside individual therapists' control. Conclusion: In England, OTs working with CYP with DCD may be providing services in settings not geared to supporting social-emotional needs. This raises concerns as to whether practitioners are enabled to stay true to holistic principles, as well as concerns related to delivering evidence-based practice in light of growing evidence regarding this population's social-emotional risks. [ABSTRACT FROM AUTHOR]

Background: Our study aimed to evaluate to what extent Zero2 Expo's 'Birthing a Better Future', a co‐created multimedia exhibition, was effective in raising awareness on the importance of the first 1001 days of life and explore what refinements would help to optimize the impact of future exhibitions. Methods: We conducted a mixed‐methods evaluation of the exhibition delivered in the John Radcliffe Hospital, Oxford. Through convenience sampling, 14 participants were selected to participate in 12 structured interviews and 19 participants completed a questionnaire. Interviews were thematically analysed alongside quantitative analysis of questionnaire responses through Likert scales. Results: The majority (78.6%, n = 11/14) of participants who completed the questionnaire either agreed or strongly agreed that the exhibition raised their awareness about the first 1001 days of life. This was supported by the analysis of interviews. The use of art was found to provoke an emotional engagement from participants. Participants felt that the length of the written pieces and location of the exhibition were important factors for designers to consider in future exhibitions. Conclusion: This study demonstrated that multimedia exhibitions, combining science with art, may be an effective way to raise awareness of public health messages. Engaging with key stakeholders will be an essential step in order to improve future public health exhibitions. Public Contribution: When designing the study, the public reviewed the study tools, which were refined based on their feedback. At every phase of the study, members of the public who are artists co‐created the exhibition content. [ABSTRACT FROM AUTHOR]

This study aimed to implement and evaluate a work‐based personal resilience enhancement intervention for forensic nurses. A mixed methods design consisting of surveys, interviews, and a case study approach, whereby the experiences of a group of nurses were studied in relation to their experiences of an intervention programme to enhance personal resilience, was utilized. Nurses working on forensic inpatient wards were invited to participate. Senior nurses were recruited as mentors. Data were collected via pre‐ and post‐programme surveys to evaluate nurses' levels of resilience. Post‐programme interviews were undertaken with nurses and mentors to explore their experiences of the programme. Descriptive statistics of survey data examined changes in nurses' resilience levels pre‐ and post‐intervention. Free‐text survey data and interview data were analysed thematically. The SQUIRE 2.0 checklist was adhered to. Twenty‐nine nurses participated. Levels of personal resilience (M = 4.12, SD = 0.60) were significantly higher post‐programme than pre‐programme (M = 3.42, SD = 0.70), (t49 = 3.80, P = 0.000, 95% CI = 0.32, 1.07). Nurses felt the programme had a marked impact on their personal resilience, self‐awareness, confidence, and professional relationships. The benefits of the programme demonstrate the advantages of providing a nurturing environment for nurses to consolidate their resilience levels. Findings demonstrated that resilience enhancement programmes can increase nurses' levels of resilience and confidence and improve inter‐professional relationships. Our findings are important for clinicians, nurse managers, and policymakers considering strategies for improving the workplace environment for nurses. The long‐term impact of resilience programmes may improve nurse retention and recruitment. [ABSTRACT FROM AUTHOR]

Introduction: Health care organisation cultures and working environments are highly complex, dynamic and constantly evolving settings. They significantly influence both the delivery and outcomes of care. Aim: Phase 1 quantitative findings are presented from a larger three phase feasibility study designed to develop and test a Cultural Health Check toolkit to support health care workers, patients and organisations in the provision of safe, compassionate and dignified care. Methodology: A mixed methods approach was applied. The Cultural Health Check Healthcare Workers Questionnaire was distributed across two National Health Service Hospitals in England, UK. Both hospitals allocated two wards comprising of older people and surgical specialities. Findings: The newly devised Cultural Health Check Staff Rating Scale Version 1 questionnaire was distributed to 223 health care workers. Ninety eight responses were returned giving a response rate of 44%. The Cultural Health Check Staff Rating Scale Version 1 has a significant Cronbach alpha of .775; this reliability scaling is reflected in all 16 items in the scale. Exploratory factor analysis identified two significant factors “Professional Practice and Support” and “Workforce and Service Delivery.” These factors according to health care workers significantly impact on the organisation culture and quality of care delivered by staff. Conclusion: The Cultural Health Check Staff Rating Scale Version 1 questionnaire is a newly validated measurement tool that could be used and applied to gauge health care workers perceptions of an organisations level of compassion. Historically we have focused on identifying how caring and compassionate nurses, doctors and related allied health professionals are. This turns the attention on employers of nurses and other related organisations. Implications for nursing management: The questionnaire can be used to gauge the level of compassion with a health care organisation culture and working environment. Nurse managers and leaders should focus attention regarding how these two factors are supported and resourced in the future. [ABSTRACT FROM AUTHOR]

This study evaluated the impact of counsellor training on emotional intelligence (EI) in 45 undergraduates and 58 postgraduates. Significant improvements were recorded by students on completion of both programmes, suggesting that these were attributable to training which enhanced intra- and interpersonal aspects of emotional functioning. As a group, postgraduates were older than undergraduates, and at the outset of the study, EISAQ scores were comparable; however, at follow-up, undergraduates recorded significantly higher EISAQ scores. Students’ EI was not significantly related to their age, and these findings indicate the potential for effective EI-skills training which is unrelated to quantity of life experiences. It is hoped that this study contributes to a growing quantitative evidence base from which the counselling profession can evaluate its training profile. [ABSTRACT FROM PUBLISHER]

Background: Local and national financial incentives were introduced in England between 2008 and 2015 to encourage screening and brief alcohol intervention delivery in primary care. We used routine Read Code data and interviews with General Practitioners (GPs) to assess their impact. Methods: A sequential explanatory mixed-methods study was conducted in 16 general practices representing 106,700 patients and 99 GPs across two areas in Northern England. Data were extracted on screening and brief alcohol intervention delivery for 2010-11 and rates were calculated by practice incentive status. Semi-structured interviews with 14 GPs explored which factors influence intervention delivery and recording in routine consultations. Results: Screening and brief alcohol intervention rates were higher in financially incentivised compared to non-incentivised practices. However absolute rates were low across all practices. Rates of short screening test administration ranged from 0.05% (95% CI: 0.03-0.08) in non-incentivised practices to 3.92% (95% CI: 3.70-4.14) in nationally incentivised practices. For the full AUDIT, rates were also highest in nationally incentivised practices (3.68%, 95% CI: 3.47-3.90) and lowest in non-incentivised practices (0.17%, 95% CI: 0.13-0.22). Delivery of alcohol interventions was highest in practices signed up to the national incentive scheme (9.23%, 95% CI: 8.91-9.57) and lowest in non-incentivised practices (4.73%, 95% CI: 4.50-4.96). GP Interviews highlighted a range of influences on alcohol intervention delivery and subsequent recording including: the hierarchy of different financial incentive schemes; mixed belief in the efficacy of alcohol interventions; the difficulty of codifying complex conditions; and GPs' beliefs about patient-centred practice. Conclusions: Financial incentives have had some success in encouraging screening and brief alcohol interventions in England, but levels of recorded activity remain low. To improve performance, future policies must prioritise alcohol prevention work within the quality and outcomes framework, and address the values, attitudes and beliefs that shape how GPs' provide care. [ABSTRACT FROM AUTHOR]

Objectives.This study aimed to investigate the associations between migration status and health-related outcomes and to examine whether and how the effect of migration status changes when it is disaggregated by length of residence, first language, reason for migration and combined with ethnicity. Design.A total of 1698 adults were interviewed from 1076 randomly selected households in two South London boroughs. We described the socio-demographic and socio-economic differences between migrants and non-migrants and compared the prevalence of health-related outcomes by migration status, length of residence, first language, reason for migration and migration status within ethnic groups. Unadjusted models and models adjusted for socio-demographic and socio-economic indicators are presented. Results.Migrants were disadvantaged in terms of socio-economic status but few differences were found between migrant and non-migrants regarding health or health service use indicators; migration status was associated with decreased hazardous alcohol use, functional limitations due to poor mental health and not being registered with a general practitioner. Important differences emerged when migration status was disaggregated by length of residence in the UK, first language, reason for migration and intersected with ethnicity. The association between migration status and functional limitations due to poor mental health was only seen in White migrants, migrants whose first language was not English and migrants who had moved to the UK for work or a better life or for asylum or political reasons. There was no association between migration status and self-rated health overall, but Black African migrants had decreased odds for reporting poor health compared to their non-migrant counterparts [odds ratio = 0.15 (0.05–0.48),p< 0.01]. Conclusions.Disaggregating migration status by length of residence, first language and reason for migration as well as intersecting it with ethnicity leads to better understanding of the effect migration status has on health and health service use. [ABSTRACT FROM PUBLISHER]

Background Teachers are a key part of the wider public health workforce in England. We conducted a survey to find out how they are trained for this role during their initial teacher education (ITE). Methods Between 2011 and 2012, we sent an online questionnaire to 220 ITE course managers and conducted semi-structured interviews with a purposive sample of 19 course managers to explore issues in more depth. Results The response rate to the questionnaire was 34% (n = 74). Although most of the course managers felt inclusion of health and well-being training in ITE was important, provision across courses was variable. Topics which are public health priorities [e.g. sex and relationships education (SRE) and drugs, alcohol and tobacco] were covered by fewer courses than other topics (e.g. child protection, emotional health and anti-bullying). Perceived barriers to training included lack of time and a belief that health and well-being were low priorities in educational policy. Conclusions Not all of tomorrow's teachers are being adequately prepared for their role in helping to address public health priorities. Educational policy does not appear to be supporting the priorities of public health policy, and this is a key barrier to health promotion training in ITE. [ABSTRACT FROM AUTHOR]

The introduction of cash-for-care schemes such as individual or personal budgets in England has been seen as central to the personalisation agenda for reforming the delivery of adult social care. However, despite there being 5.2 million carers in England and Wales, the initiative concentrates predominantly on the needs of the service user. The implementation of individual budgets (IBs) was piloted within 13 local authorities during 2005–2007 and the Department of Health commissioned an independent evaluation of this pilot (IBSEN). The focus was only on the service user in the evaluation and therefore a separate but linked study was set up to evaluate the impact and outcomes of IBs on carers. Carers of service users who had consented to take part in the main IBSEN study were identified and invited to participate in a follow-up study aimed at exploring how IBs impacted on carers and the caring role. The study found that the receipt of the budget was significantly associated with positive impacts on carers' reported quality of life and, when other factors were taken into account, with social care outcomes. These outcome gains were achieved despite no higher costs being incurred to the public purse, thus suggesting that IBs for service users are cost-effective for carers. [ABSTRACT FROM PUBLISHER]

Acne vulgaris is a skin disease affecting many young people and, if it continues into their twenties, can be a substantial barrier to social relationships. Although there is evidence that sufferers are adversely psychologically affected, what is less apparent from research to date is whether this is because of negative self-beliefs or the discriminatory attitudes of others. This study set out to explore how far young people with moderate acne are viewed less favourably compared to their clear-skinned peers. The design was quasi-experimental. The faces of two male and two female 21-year-old volunteers with clear skin were photographed and then photographed again after having had facial signs of moderate acne simulated by a professional make-up artist. Photographs of a male and female face were given to 143 participants who were divided randomly into two conditions: “Clear” and “acne”. The former were shown the unblemished faces and the latter were given the faces with acne. The participants were asked to estimate the age of the person in the photograph and then rate the volunteer on a scale of 16 personality items. It was found that the participants in the “clear” condition estimated the volunteers as two years older and more mature than in the “acne” condition. In terms of personality, the photographs in the “clear” condition were given higher scores for potential friendship, attractiveness and overall positive personality features than the photographs in the “acne” condition. The conclusion is that moderate acne vulgaris could be a potential barrier to social relationships for young people not simply because of their social anxiety but because they may well be meeting with prejudice. It is suggested that attitudes might be changed by more accurate information about the condition. [ABSTRACT FROM PUBLISHER]