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Purpose: The dermatology service on the islands of Orkney, with a population of approximately 22,500, was taken over by National Health Service (NHS) Tayside in August 2018. This paper aims to provide an overview of the planning and review of a highly efficient and effective dermatology service for a rural island population. Design/methodology/approach: The service includes visiting dermatology consultants, enhanced electronic referral vetting, skin surgery services, a General Practice (GP) with extended role (GPwER) in dermatology, specialist virtual clinics, urgent advice for inpatients at the local district general hospital and remote systemic therapy monitoring. A new phototherapy service has been set up in an island GP practice. Findings: Local GPs and consultant dermatologists find the enhanced vetting service useable, efficient and educational. Between August 2018 and November 2022, there have been 1,749 referrals. Of these referrals, 60% were seen in clinic or a GPwER surgery, with 40% managed remotely by providing advice back to the referring GP. The number of consultations performed by the GPwER has grown over the past 3 years, and in the last year, it accounted for more than 50% of patient appointments. The waiting time has been significantly reduced using this model. Originality/value: This remote service uses an integrated approach of teledermatology (TD) whilst offering continual in-person services using local capabilities including a GPwER and island general surgeons. New treatment facilities are provided to the island population. Continual educational feedback to the primary care referrer is provided, and it enhances relationships that greatly aid the high-quality dermatology service provided. [ABSTRACT FROM AUTHOR]

Part 2 of this article continues its investigation into the relationships between Scots and Italy, as seen through books of friendship, by considering additional socioprofessional categories beyond the academic and military worlds. Among the political activists considered is David Graham of Fintry, a Marian and member of the Catholic party, whose album is studied in great depth. It is a key document for our further knowledge of his activities as a courier and intelligencer for Scottish Catholic interests in Europe and adds to the scholarly understanding of his political involvement in the Counter-Reformation. More broadly speaking, friendship albums shed light on Scottish activists' politico-religious networking processes and their connections with middle-ranking and regional intermediaries, at times in key locations or seats of power. As with the military officers studied in Part 1, it transpires from these contacts that there were lighter moments for artistic and cultural activities or edification. In correlation, the few ecclesiastical contributions studied in this paper cast light on a fluid matrix of information and networks and highlight their potential influences, both negative and positive. Indeed, there were risks involved in being in contact with dubious characters, whereas tapping into a rich circle of contacts with courtiers could present opportunities and patronage. For Scottish scientists, the genre of alba amicorum is particularly important, not so much to highlight their side activities as to lay the foundations for their subsequent careers and establish the potential links and backgrounds that underscore their subsequent scientific tasks, achievements, and modus operandi in their professional roles. [ABSTRACT FROM AUTHOR]

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]

Aims and objectives: To explore the role that Donor Transplant Co‐ordinators have played and the future potential of Specialist Nurses for Organ Donation (SN‐ODs), within organ donation strategies in the UK and other countries. Background: Organ donation and transplantation rates vary extensively around the world. However, there is a universal shortage of deceased donors, prompting different approaches to increase transplantation rates. Within the UK, the Clinical Lead for Organ Donation and Specialist Nurse in Organ Donation undertake a key role in the implementation of the Organ Donation Strategy. The Human Transplantation (Wales) Act 2015 is a recent development which facilities a deemed (presumed) consent approach to organ donation, the Specialist Nurse in Organ Donation undertakes a major role identifying the potential donor in this situation by confirming the deemed consent status of the donor and supporting bereaved relatives. UK governments in England and Scotland are currently seeking legislative changes to an opt‐out system of organ donation, in line with the Wales change. Design: This discursive paper explores the role from Donor Transplant Co‐ordinator to Specialist Nurse in Organ Donation (SN‐OD) within organ donation policy in different settings, but with a specific focus on the UK. The paper clarifies the current and future potential of nurses working with bereaved families when requesting authorisation for donation. Implications for nursing: The current scope and future potential of Donor Transplant Co‐ordinator and Specialist Nurse in Organ Donation roles need better recognition. Little empirical data exist about the key role that these nurses play in the organ donation process, especially in relation to gaining authorisation to proceed to donation. Conclusion: There is a need to clarify the role of the Specialist Nurse in Organ Donation and their impact on improving rates of organ donation. [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]

Purpose – The purpose of this paper is to explore the leadership implications of a mutual health service in National Health Service (NHS) Scotland. Design/methodology/approach – Analysis of extant government policy and suggestions of leadership considerations for practice. Findings – Moving towards a mutual health system will require new ways of thinking about health care and existing leadership practices in NHS Scotland. The leadership implications at the strategic, operational and tactical levels of delivery in NHS Scotland will need to be thought through. At present, it is not clear how this will be done, either from the available health-related literature or from policy. “Mutuality” will require a complex and multi-layered effort to embed it within the culture of the organisation, which will require inspirational leadership and sustained management from the government, the NHS and the wider public to make the change happen. Research limitations/implications – This paper suggests that more leadership research is still required to understand fully – and implement – a mutual health service in Scotland. A theoretical framework and/or empirical reference points have yet to be developed. Practical implications – This paper highlights the practical implications in operationalising government policy. Originality/value – Little – if any – has been written about the leadership implications of a mutual and public health service. [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]

Accessible summary What is known on the subject? Solution Focused Brief Therapy (SFBT) is an effective model of brief psychotherapy., Evidence suggests that nurses can be trained to deliver SFBT with only a few days training., It has been argued that SFBT reflects the core values of nursing practice, but no empirical research has been undertaken to validate this assertion., What does this paper add to existing knowledge? This is the first time the impact of such training on nurses' sense of professional and personal identity has been explored., Drawing upon data derived from twenty interviews, this paper explores the key themes reported by nurses in relation to their personal experience of training in SFBT., This paper extends our understanding of the lived experience of mental health nurses and facilitates discussion on the preparation and practice of their role., What are the implications for practice? Training in SFBT can provide a framework for nurses to empower their clients/patients to take control of their own recovery in a shared and trusting relationship., Training in SFBT can enhance nurses' sense of trust in their clients., Training in solution-focused interactions may provide a framework for many nurses to provide the type of collaborative, patient-led care they aspire to., Abstract Introduction SFBT is a psychotherapeutic model that aims to 'build solutions' rather than 'solve problems'. It has evolved into a structured communication framework utilized across a range of disciplines, focusing on the future, as opposed to the past, and on participant's strengths and abilities, as opposed to their problems and deficits. There have been no studies exploring the experience of training in SFBT from the perspective of the nurses being trained. Aim This study sought to explore the experience of nurses who had completed a six-month training course in SFBT. Methods Using a qualitative methodology, 20 nurses who had undertaken SFBT training were interviewed at various locations across Scotland. Results Five main themes emerged from analysis of the 20 interviews. Many of the participants reported increased trust in their clients and enhanced role satisfaction. Implications for Practice Training in SFBT provides nurses with an alternative model of practice to the dominant 'medical' and 'psychological' models of contemporary practice. The experiences of the participants in this study suggest that SFBT can be a useful intervention in nursing practice and that nurses can easily incorporate SFBT into their practice. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to examine the persistent challenges in implementing care management within the context of integration. In addition the appropriateness of the care management model will be considered within the current, personalization focused, health and social care policy landscape. The paper draws upon a recent evaluation of a care management and assessment pilot project within a health and social care partnership in Scotland. Design/methodology/approach – A multi-method approach was adopted, including interviews, vignettes and focus groups, in order to capture data around expectations in relation to the pilot as well as exploring processes and outcomes for those involved. Findings – This paper argues that whilst progress has been made with regard to care management, specific and persistent challenges remain. Professional and organizational boundaries, communication and information sharing remain key challenges. Policy imperatives have shifted the emphasis in community care services towards self-care, co-production and personalization contributing to a lack of clarity over the place of care management within the broader integration agenda. Research limitations/implications – This research was undertaken in one partnership locality in Scotland and as such the findings are related to that particular area. However, the key messages arising from this paper resonate with the broader academic literature on care management and as such are likely to be of interest to a broader audience. Originality/value – This paper brings together integrated working, care management and the developing policy framework of self-care to consider the challenges for care management in this context. [ABSTRACT FROM AUTHOR]

The professional status of UK healthcare chaplains remains partial, with voluntary accreditation effective in achieving around 50% registration. This study set out to elicit reasons for this by surveying healthcare chaplains working in Scotland. An online survey was created to gather demographic details and chaplains' opinions on the importance of five key elements of professional status: A body of knowledge that underpins practice; A code of professional ethics; An occupational organization controlling the profession; Substantial intellectual and practical training; and Provision of a specialized skill or service. Most respondents (38/43) agreed that chaplains should belong to a professional body in order to maintain standards, ensure accountability and formalize professional development. They said that registration reinforced their professional status, added credibility and a clear governance structure to protect the public. However, a minority felt disconnected from the professionalization agenda. This paper discusses the reasons for this. Further UK and international studies into the professional status of chaplains are planned. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various articles within the issue on topics including health and social care for older people, the Practitioner-Research: Older People (PROP) project related to social care for older people in Scotland and social policy in Scotland.

Abstract: Health and social care integration has been a long‐term goal for successive governments in Scotland, culminating in the implementation of the recent Public Bodies (Joint Working) Scotland Act 2014. This laid down the foundations for the delegation of health and social care functions and resources to newly formed Integrated Joint Boards. It put in place demands for new ways of working and partnership planning. In this article, we explore the early implementation of this Act and how health and social care professionals and the third sector have begun to renegotiate their roles. The paper draws on new empirical data collated through focus groups and interviews with over 70 professionals from across Scotland. The data are explored through the following key themes: changing cultures, structural imbalance, governance and partnership and the role of individuals or “boundary spanners” in implementing change. We also draw on evidence from other international systems of care, which have implemented integration policies, documenting what works and what does not. We argue that under the current framework much of the potential for integration is not being fulfilled and that the evidence suggests that at this early stage of roll‐out, the structural and cultural policy changes that are required to enable this policy shift have not yet emerged. Rather, integration has been left to individual innovators or “boundary spanners” and these are acting as key drivers of change. Where change is occurring, this is happening despite the system. As it is currently structured, we argue that too much power is in the hands of health and despite the rhetoric of partnership working, there are real structural imbalances that need to be reconciled. [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]

Over the last 20 years, research has questioned how well equipped newly qualified social workers are in relation to child care and protection. Recent inquiries have highlighted that some social workers have not recognised their responsibilities towards children and young people when they encounter them in the course of their duties. In England, Lord Laming's (2009) report The Protection of Children in England, following the death of Peter Connelly in Haringey, recommended a specialist child protection route as part of the social work degree and re-opened the debate about the benefits of specialism versus genericism. In Scotland, when faced with similar challenges, Key Capabilities in Child Care and Protection were introduced to ensure that all social workers at the point of qualifying can evidence their knowledge and skills in relation to child care and protection. This paper describes their development. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper suggests that there is an imbalance between the ideal and the actual palliative care provision for some older people living and dying in care homes in Scotland. Successive studies demonstrate that care home residents are increasingly frail and disabled. Many experience challenging physical and psychosocial symptoms which could benefit from a palliative approach to alleviate suffering and promote comfort. However, palliative needs for people with non-malignant conditions, such as dementia, can be complex, and not easily identified or managed. A range of challenging factors currently impact palliative care provision for care home residents in Scotland including: the insufficiency of robust NHS healthcare support, the skill mix of the care home workforce, and the promotion of palliative tools as the primary means of improving the quality of palliative care in nonspecialist settings. Issues highlighted in this paper give cause for concern on a number of levels, particularly as the demand for palliative care in care homes is likely to increase in the near future. Therefore, sustained collaborative effort from leaders in the health, social and care home sectors is recommended if practical solutions are to be found for this vulnerable population. [ABSTRACT FROM AUTHOR]

Debates surrounding the ostensibly ‘transformative’ potential of personalisation for social work services, and service users, have variously illustrated the risks and opportunities this presents, although the implications for criminal justice social work services have received comparatively limited attention. By extending the concept of ‘service user’ to include not only offenders, but wider stakeholders (victims and communities), this paper considers the practical application of theories of personalisation and co-production by reviewing proposed and extant strategies for maximising stakeholder involvement in criminal justice services. It is argued that, in progressing beyond the more individualistic interpretations of this somewhat controversial reform agenda—in prioritising not only the individual, their rights, strengths and subjective identities, but locating the individual in situ, in the concrete realities and textures of their lives and communities—the strength of the personalisation agenda rests in its potential to develop and strengthen the collective organisation of service users, service providers and communities in a co-productive endeavour. It is argued that both this reading and the principles underpinning it resonate more widely with the empirical and theoretical literature on just and effective penal practices and, in so doing, this paper exposes the complexities that lie behind the apparent simplicity of this argument. [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]

Background Childsmile is Scotland's national child oral health improvement programme. To support the delivery of prevention in general dental practice in keeping with clinical guidelines, Childsmile sought accreditation for extended duty training for dental nurses to deliver clinical preventive care. This approach, has allowed extended duty dental nurses (EDDNs) to take on roles traditionally undertaken by general dental practitioners (GDPs). While skill-mix approaches have been found to work well in general medicine, they have not been formally evaluated in dentistry. Understanding the factors which influence nurses' ability to fully deliver their extended roles is necessary to ensure nurses' potential is reached and that children receive preventive care in line with clinical guidance in a cost-effective way. This paper investigates the supplementation of GDPs' roles by EDDNs, in general dental practice across Scotland. Methods A cross-sectional postal survey aiming to reach all EDDNs practising in general dental practice in Scotland was undertaken. The survey measured nurses': role satisfaction, perceived utility of training, frequency, and potential behavioural mediators of, preventive delivery. Frequencies, correlations and multi-variable linear regression were used to analyse the data. Results Seventy-three percent of practices responded with 174 eligible nurses returning questionnaires. Respondents reported a very high level of role satisfaction and the majority found their training helpful in preparing them for their extended role. While, a high level of preventive delivery was reported, fluoride vanish (FV) was delivered less frequently than dietary advice (DA), or oral hygiene advice (OHA). Delivering FV more frequently was associated with higher role satisfaction (p < 0.001). Those nurses who had been practising longer reported delivering FV less frequently than those more recently qualified (p < 0.001). Perceived difficulty of delivering preventive care (skills) and motivation to do so were most strongly associated with frequency of delivery (p < 0.001 for delivery of FV, DA and OHA). Conclusions This study has provided insight into EDDNs' experiences and demonstrates that with appropriate training and support, EDDNs can supplement GDPs' roles in general dental practice in Scotland. However, some barriers to delivery were identified with delivery of FV showing scope for improvement. [ABSTRACT FROM AUTHOR]

Advanced clinical practice (ACP) roles evolved to fill gaps in healthcare provision and improve consistency in standards of care. Historically, variance in service specific requirements, combined with inconsistent approaches to role governance and education, resulted in a multitude of ACP roles and remits. Definitions of roles and titles vary, but there is agreement on academic level and role competency assessment. Irrespective of these definitions, staff and services need support to operationalise guidance. In Scotland, development of advanced practice roles is supported through regional NHS Advanced Practice Academies. One Scottish Board has initiated a local board level advanced care academy to fulfil the three key components of advanced practitioner development: master's level theoretical knowledge, effective supervision and robust clinical competency assessment in practice. This development model, known as the 'triangle of capability', has allowed rapid progress with the advanced practice agenda, which is a central component of sustainable healthcare provision. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine the elements of the intensive care environment and consider the impact on nurses' involvement in decision-making when weaning from mechanical ventilation. Background Optimal management of difficult to wean patients requires the dynamic collaboration of all clinicians and the contribution of their knowledge and skills. The introduction of weaning protocols has increased nurses' input in decision-making, but there are various elements of the decision environment that impact on their involvement, which have been given little consideration. Design Ethnography was used as the research design for this study. Methods Fieldwork took place in two tertiary hospitals in Greece and Scotland for five months each to unveil clinicians' behaviour and interactions during the weaning practice. Observation was based on the weaning process of 10 Scottish and 9 Greek long-term ventilated patients. Semi-structured interviews followed with nurses ( n = 33) and doctors ( n = 9) in both settings to understand nurses' perceived involvement in weaning decision-making. Thematic analysis of interviews and field notes followed using the Qualitative Data Analysis software NVivo. Clinicians' participation was voluntary. Results The main themes identified were the (1) organisation of the units (time and structure of the ward rounds, staff levels and staff allocation system), (2) the inter- professional relationships, (3) the ownership and accountability in weaning decision-making and (4) the role of the weaning protocols. These elements described the culture of the ICUs and defined nurses' role in weaning decision-making. Conclusions Clinical decision-making is a multi-dynamic process specifically in complex clinical situations such as weaning from mechanical ventilation. This paper suggests that weaning practice should be considered in relation to the elements of the clinical environment to provide an individualised and patient-centred weaning approach. Relevance to clinical practice Methods to enhance nurses' role in teamwork and collaborative decision-making are suggested. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to explore the detection and prevention of elder financial abuse through the lens of a "professional bystander intervention model". The authors were interested in the decision cues that raise suspicions of financial abuse, how such abuse comes to the attention of professionals who do not have a statutory responsibility for safeguarding older adults, and the barriers to intervention. Design/methodology/approach – In-depth interviews were conducted using the critical incident technique. Thematic analysis was carried out on transcribed interviews. In total, 20 banking and 20 health professionals were recruited. Participants were asked to discuss real cases which they had dealt with personally. Findings – The cases described indicated that a variety of cues were used in coming to a decision that financial abuse was very likely taking place. Common to these cases was a discrepancy between what is normal and expected and what is abnormal or unexpected. There was a marked difference in the type of abuse noticed by banking and health professionals, drawing attention to the ways in which context influences the likelihood that financial abuse will be detected. The study revealed that even if professionals suspect abuse, there are barriers which prevent them acting. Originality/value – The originality of this study lies in its use of the bystander intervention model to study the decision-making processes of professionals who are not explicitly charged with adult safeguarding. The study was also unique because real cases were under consideration. Hence, what the professionals actually do, rather than what they might do, was under investigation. [ABSTRACT FROM AUTHOR]

What we know already. There are significant changes in the way that health and social care is being understood and delivered in Scotland. Chaplains are already proficient at promoting the spiritual health and wellbeing of individuals however their impact on organisational spirituality and compassionate communities is fragmented. What this paper adds. This article describes three key elements of health and social care; patient centred care; preventative care and an asset based approach and then proceeds to show how healthcare chaplains contribute to this agenda. Why this is important. Greater awareness is required amongst those working in primary health and social care of the potential of spiritual care to support health and well-being within communities. Greater awareness is required within the chaplaincy community of the issues facing those working in primary health and social care, the common challenges and the areas of shared interest How this impacts on Chaplaincy. Chaplains have key learning needs: to be aware of current health and social care policies and to be innovative in promoting the spiritual health and wellbeing of individuals, organisations and communities. [ABSTRACT FROM AUTHOR]

What we know already. Listening is an essential part of caring practice. Being listened to and telling our story is in itself therapeutic and life affirming. Listening is time consuming and whilst acknowledged as central to care in practice is hard to accomplish given the pressures on health and social care staff in terms of targets, paperwork and protocols. What this paper adds. The sociological background to listening and its practice in contemporary health services. Why this is important. Community Chaplaincy listening is based on the assumption of careful, agenda free listening. How this impacts on Chaplaincy. Chaplains are primarily the bearers and witnesses of stories of suffering and triumph. Understanding the link between wellbeing and the act of listening gives theoretical substance to the core work of chaplaincy. [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]

Medical Education 2011: 45: 995-1005 Context A particularly onerous aspect of the transition from medical student to practising doctor concerns the necessity to be able to rapidly identify acutely unwell patients and initiate appropriate resuscitation. These are skills in which many graduates feel poorly prepared and are considered by some to be best learned on the job. This constructivist study investigated the factors that influence the behaviour of junior doctors in this context and initiated the development of a framework that promotes understanding of this important area. Methods Focus groups involving 36 clinicians with a variety of clinical experience were conducted and analysed using a qualitative, grounded theory approach. The complex relationships between emergent themes guided the development of a framework that was refined and validated by further interviews with participants. Results Six main themes, grouped under three broad headings, emerged from the data: 'transferring knowledge into practice' and 'decision making and uncertainty' (cognitive challenges); 'acts and omissions' and 'identity and expectations' (roles and responsibilities), and, finally, 'the medical hierarchy' and 'performing under stress' (environmental factors). The framework presented within this paper illustrates the complex relationships between these factors. Conclusions Although the potential of metacognitive strategies to reduce medical error is acknowledged, the framework promotes looking beyond the individual to consider the contributions to patient safety of identity issues, role uncertainty and the hierarchical clinical environment. A more distributed approach to situation awareness may help junior doctors to better tolerate complexity and uncertainty. The efficacy of simulation as an educational strategy may be improved by finding ways to recreate the hierarchical and stressful environment in which junior doctors practise. Junior doctors should be aware of the impact of affect and emotion on behaviour, and clinical supervisors should strive to ensure that roles and responsibilities are explicitly discussed. [ABSTRACT FROM AUTHOR]

Aims and objectives. To examine how the role of the Emergency Nurse Practitioner has evolved in Scotland. Background. In 2001, Cooper and colleagues published a report on their survey (carried out in 1998) which described the extent and nature of Emergency Nurse Practitioner services in Scotland. They described a nascent nursing role and service that existed in almost half of Emergency Departments and that concentrated its activity on the management of minor distal limb trauma and wound management. Since that date, several relevant and important political, professional and local issues have combined to accelerate the development of this role. Design. Longitudinal survey of Scottish Emergency Departments ( n = 97 in 1998, n = 93 in 2009). Method. Census survey of all Scottish Emergency Departments identified by NHS National Services Scotland's Information and Statistics Division Accident and Emergency Waiting Times dataset 2006-07. Results. Emergency Nurse Practitioners are now practising in the majority (89%) of Emergency Departments and Minor Injury Units compared with 47% in 1998. Most departments (78%) use Emergency Nurse Practitioners in dual roles, and most departments (67%) differentiate their Emergency Nurse Practitioners from other nursing staff by use of a title. Wide variations in pay, role and scope of practice still exist. Conclusions. The role of the Emergency Nurse Practitioner has increasingly become part of mainstream health care delivery in Emergency Departments across Scotland and can now be considered to be common place. This study demonstrates that 'Advanced Nursing Practitioners' and 'Nurse Practitioners' cannot necessarily be considered to be synonymous, and nursing roles that are allowed to evolve naturally adopt a non-uniform level of practice. Relevance to clinical practice. This paper is of interest to Nurse Practitioners and workforce planners. [ABSTRACT FROM AUTHOR]

This paper describes a national birth cohort study of influences on health, development and ageing processes throughout life, so far to age 65 years. It began as an early post-war study of maternity in England, Wales and Scotland two years before the NHS began, and continued as a follow-up study of a large sample (5362) of those births. The study has influenced scientific and policy thinking by showing the relationships of children's physical and mental development and home background with many aspects of health and life chances throughout their life, including the processes of physical and mental ageing. Health visitors and research nurses have been closely involved in the study's work throughout. Four comparable cohort follow-up studies have since been started in Britain, and a sixth is soon to begin. These national cohort studies provide the opportunity to compare development and health in succeeding generations. Health visitors and nurses have also been involved in these subsequent studies. [ABSTRACT FROM AUTHOR]

Purpose - National guidance in Scotland says that spirituality is part of healthcare. This paper aims to review some of the evidence that this is a relevant but neglected topic across the lifespan for people with a learning disability (PLD) and their families, rarely addressed by healthcare professionals.Design/methodology/approach - The author visited local faith-based groups for PLD and sought views from service managers, parents, faith-based professionals and service users about their experience of fostering the spiritual lives of PLD. The author asked: whether this is a legitimate topic for healthcare professionals to enquire about during clinical contacts; what they knew about related training issues; and whether accessible information and communication passports might be helpful.Findings - There was qualified support for the first and third questions and little awareness of any training for health staff on spiritual matters.Practical implications - Other strategic priorities with in the LD service precluded the first step of auditing what Community learning disability team staff currently do in relation to the spiritual needs of their clients.Social implications - However, by allowing more obvious pressing concerns to predominate, especially in the context of cutbacks, we may be overlooking a potential source of distress as well as an opportunity to promote an avenue to meaningful relationships.Originality/value - The author poses questions for future research and practice, giving examples from clinical experience. [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 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]

Background: A Pharmacy Longitudinal Clerkship (PLC) was designed to develop student pharmacists' (SPs) competence in a general practice setting. Aim: The aim was to carry out a theoretically underpinned qualitative evaluation of stakeholder perceptions of influences of behavioural determinants on SP development for clinical practice in general practice. Method: General practice-based PLCs were delivered in 2019/20 and 2020/21 for two cohorts of SPs in NHS Highland, Scotland. Qualitative semi-structured interviews were used to explore stakeholder perceptions of influences of behavioural determinants on SP development. Informed written consent was obtained. An interview schedule was developed and piloted using the Theoretical Domains Framework (TDF). Interviews were recorded, transcribed verbatim and analysed using thematic methodology. Ethics approval was granted. Results: Seven SPs and five general practitioner (GP) tutors were interviewed. Key themes were identified mapped to TDF domains and included: knowledge—utilisation and practical application of knowledge; skills—triangulation of skills under clinical supervision; beliefs about capabilities—confidence building with clinical and patient contact; professional role and identity—elucidation of professional roles within general practice. Conclusion: This evaluation shows benefits of embedding SPs within clinical teams and immersing them in a clinical environment over a prolonged period in a general practice Pharmacy Longitudinal Clerkship. It is expected this will translate into a more confident transition to postgraduate professional clinical practice. Funding should be sought to test alternative PLC arrangements including: multiple full-time longitudinal placement blocks; or ultimately a year-long longitudinal clerkship programme with an IPE element. [ABSTRACT FROM AUTHOR]

Aim: To evaluate Advanced Nurse Practitioner (ANP) role implementation in primary care across Scotland in contributing to primary care transformation, and establish what works, for whom, why and in what context. Design: A realist evaluation using multiple case studies. Methods: Two phases, conducted March 2017 to May 2018: (1) multiple case studies of ANP implementation in 15 health boards across Scotland, deductive thematic analysis of interviews, documentary analysis; (2) in‐depth case studies of five health boards, framework analysis of interviews and focus groups. Results: Sixty‐eight informants were interviewed, and 72 documents were reviewed across both phases. ANP roles involved substitution for elements of the GP role for minor illness and injuries, across all ages. In rural areas ANPs undertook multiple nursing roles, were more autonomous and managed greater complexity. Mechanisms that facilitated implementation included: the national ANP definition; GP, primary care team and public engagement; funding for ANP education; and experienced GP supervisors. Contexts that affected mechanisms were national and local leadership; remote, rural and island communities; and workload challenges. Small‐scale evaluations indicated that ANPs: make appropriate decisions; improve patient access and experience. Conclusions: At the time of the evaluation, the implementation of ANP roles in primary care in Scotland was in early stages. Capacity to train ANPs in a service already under pressure was challenging. Shifting elements of GPs workload to ANPs freed up GPs but did little to transform primary care. Local evaluations provided some evidence that ANPs were delivering high‐quality primary care services and enhanced primary care services to nursing homes or home visits. Impact ANP roles can be implemented with greater success and have more potential to transform primary care when the mechanisms include leadership at all levels, ANP roles that value advanced nursing knowledge, and appropriate education programmes delivered in the context of multidisciplinary collaboration. [ABSTRACT FROM AUTHOR]

As the number of people living longer with life‐limiting conditions grows, so too does the number of caregivers and the complexity of the caring role. To understand more about the role and how caregivers can be supported, local and national registers have been created that collect data on caregivers. Our objective was to undertake comparative analysis of female and male adult caregiver assessments from a caregiver database created from a carers support service running in Glasgow, Scotland. Assessments were carried out over a 12‐month period (01/04/17–29/03/18). We aimed to identify the prevalence of negative consequences of caring through descriptive statistical, comparative analysis. Seven hundred and eighty‐three assessments were eligible for inclusion. In our dataset, 69% were female (n = 552), and 29% were male (n = 231). Female caregivers were more likely to be of working age but unemployed (p = 0.03) and experiencing mental ill‐health (p = 0.011). Male caregivers were more likely to be retired (p < 0.001), caring for a parent (p = 0.017) and living with heart disease (p = 0.0004), addiction issues (p = 0.013) or diabetes (p = 0.042) than female caregivers. For caregivers using this support service, female and male caregivers experienced, recognised or reported negative impacts from caring on their personal identity, social life, ability to self‐care and relationships similarly. Furthermore, a caregiver whose relationships had been negatively impacted was 13.8 times more likely (p > 0.00) to report a reduction in psychological well‐being. Sex disaggregated data are an important consideration for caregiver research due to socio‐political influences that impact caring roles and expectations. Disaggregating data by sex allow researchers to understand how the caring role differs between subsets and allow for the development of more targeted, sensitive support. [ABSTRACT FROM AUTHOR]

In 2004 the then Scottish Executive launched the 21st Century Social Work Review. The review report, Changing Lives, addressed perceived shortcomings in statutory social work services, claiming to offer a fundamental review of the profession. This paper argues that, rather than offering any significantly new principles or policies, the drift of the Changing Lives process was chiefly to refurnish the discourse in which statutory social work is conducted. Specifically it shifts that discourse away from a long-standing Scottish concern to promote social welfare on a community basis towards an individualised conception of well-being. Central to that process is the Review's advocacy of personalisation of services. It is argued therefore that Changing Lives is best understood as an exercise in the ‘problematics of government’—a reassertion of control by reshaping expectations, rather than a substantive reform of services. [ABSTRACT FROM AUTHOR]

Objective: To investigate the extent of consensus between faculty and students in order to benchmark appropriate sanctions for first-time offences with no mitigating factors in the area of Academic Probity by quota sampling in one cohort of medical, nursing and dental students in a Scottish university. Methods: This study reports administration of a web-based preliminary inventory derived from the international research literature to a target population of health professions staff and students. This study was conducted at Scottish University College of Medicine, Dentistry, Nursing and Midwifery. Subjects: 57 faculty and 689 students in the College in first quarter of 2009 participated in this study. Results: 50%% of medical students, 26%% of dental students, 22%% of nursing students and 27%% of midwifery students responded; 22%% of faculty responded. Administration of a preliminary 41-item inventory to 57 faculty and 689 students from a Scottish College of Medicine, Dentistry, Nursing and Midwifery has allowed us to preliminarily rank the sanctions that are broadly agreed between the two cohorts as well as to identify a small cluster of behaviours which are viewed less severely by students than by faculty. Conclusions: These data will give guidance to undergraduate Fitness to Practice committees but also guidance to curriculum planners about the areas in which students may need more teaching. The results informed the reduction of the inventory and its refinement in to a 30-item e-learning tool that is being field tested for generalisability within and beyond the UK. The researchers have also been invited to adapt the proposed teaching and learning tools beyond the health professions. [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]

The article discusses the 15th International Philosophy of Nursing (IPONS) Conference held on 25–28 August 2011, at the West Park Centre in Dundee, Scotland. Several speakers at the conference included professor Sam Porter, Queen's University, Belfast, Peter Allmark, of Sheffield Hallam University and Robert Newsom from Guildford Technical Community College in North Carolina. Several papers presented at the conference focused on the theme of 'Healthcare and the Politics of Austerity.'

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Objectives: The objectives of this study were to benchmark roles that veterinary librarians at universities and colleges play in systematic reviews (SRs) and scoping reviews that are conducted by faculty and students at their institutions, to benchmark the level of training that veterinary librarians have in conducting SRs, to identify barriers to their participation in SRs, and to identify other types of literature reviews that veterinary librarians participate in. Methods: Sixty veterinary librarians in universities and colleges in Canada, the United States, England, Scotland, Ireland, Australia, and New Zealand were surveyed online about their roles and training in conducting SRs, barriers to participation in SRs, and participation in other types of literature reviews. Results: Veterinary librarians' highest participation was at an advising level in traditional librarian roles as question formulator, database selector, search strategy developer, and reference manager. Most respondents reported pretty good to extensive training in traditional roles and no or some training in less traditional roles. Sixty percent of respondents received few or no requests to participate in SRs, and only half of respondents had participated in SRs as a review team member. Sixty percent of respondents stated that their libraries had no policies regarding librarian roles and participation in SRs. Conclusions: The surveyed veterinary librarians participated in SRs to a lesser degree than human health sciences librarians, experienced low demand from veterinary faculty and students to participate in SRs, and participated as review team members at significantly lower rates than human health sciences librarians. The main barriers to participation in SRs were lack of library policies, insufficient training, and lack of time. [ABSTRACT FROM AUTHOR]

Aims: A recent systematic review highlighted the lack of robust studies on prescribers' perspectives of direct‐acting oral anticoagulants (DOACs) for nonvalvular atrial fibrillation. The aim was to determine prescribers' views and experiences of prescribing DOACs. Methods: A cross‐sectional survey of prescribers in a remote and rural area of Scotland. Survey items were: demographics; prescribing of DOACs; views of potential influences on DOAC prescribing; knowledge of prescribing guidelines; and experiences. Items on potential influences were based on the Theoretical Domains Framework. Data were analysed using descriptive and inferential statistics, and content analysis of responses to open questions. Principal component analysis was performed on the items of potential influences. Results: In total, 154 responses were received, 120 (77.9%) from doctors, 18 (11.7%) from nurse prescribers and 10 (6.4%) from pharmacist prescribers (6 missing). Principal component analysis of the Theoretical Domains Framework items of potential influences gave 4 components. Component scores for (i) role of professionals, their knowledge and skills and (ii) influences on prescribing were positive. Those for (iii) consequences of prescribing and (iv) monitoring for safety and effectiveness were more neutral. There were low levels of agreement for statements relating to DOACs being more effective, safer and cost‐effective than warfarin. There were similar responses around the complexity of bleeding management and detection of over and under‐anticoagulation. Conclusion: This study has identified several key issues of DOAC prescribing (e.g. bleeding management) hence further emphasis is required in continuing professional development and during guideline implementation and evaluation. [ABSTRACT FROM AUTHOR]

Aim: This service aimed to improve patient access to treatment for urinary tract infections (UTI), impetigo and exacerbation of chronic obstructive pulmonary disease (COPD) and relieve pressure on general practice and out of hours services. Background: In 2016, a service (Pharmacy First) was introduced in Forth Valley for the management of UTI, impetigo and exacerbation of COPD using patient group directions in community pharmacies. Trained pharmacists supplied a limited range of prescription medicines. Pathways for GP referral were defined. After 5 months of implementation, the service was evaluated. Methods: A quantitative evaluation was undertaken. Feedback was sought from patients, GPs, pharmacists and GP reception staff, using structured questionnaires. Pharmacy records were used to assess referrals and pharmacy data summarised the number and type of consultations. Basic cost data was obtained from the Health Board. Findings: In all, 75 pharmacies (of 76), and all 55 GP practices in the area, participated in the service. Over a 5-month period, 1189 cases were managed, the majority being for UTI (75.4%) followed by impetigo (15.2%), then COPD (9.3%). Of all cases, 77.9% were prescribed medication by the pharmacist, 9.1% were given advice only and 16.7% were referred to the GP. Independent clinical assessment of a random sample of 30 GP referrals considered all to be 'appropriate'. Feedback was received from 69 pharmacists, 34 GPs, 54 reception staff and 73 patients. Patients were very satisfied with the service, most frequently citing the 'quick and efficient' access to treatment, and a 'professional service'. Two thirds of GPs (67%) and 59% of reception staff found the service useful, mainly because it reduced pressure on GP appointments. A further cost benefit evaluation would allow objective assessment of the value of this service. [ABSTRACT FROM AUTHOR]

Objective To measure agreement between dental therapists and the Scottish gold-standard dentist undertaking National Dental Inspection Programme ( NDIP) examinations. Methods A study of interexaminer agreement between 19 dental therapists and the national gold-standard dentist was carried out. Pre-calibration training used the caries diagnostic criteria and examination techniques agreed by the British Association for the Study of Community Dentistry ( BASCD). Twenty-three 5-year-old children (Primary 1) and 17 11-year-old children (Primary 7) children were examined. Agreement was assessed using kappa statistics on d3mft and D3 MFT for P1 and P7 children, sensitivity and specificity values, and kappa statistics on d3t/D3T and ft/ FT. Calibration data on P1 and P7 children from 2009-2012 involving dentists as examiners were used for comparison. Economic evaluation was undertaken using a cost minimization analysis approach. Results The mean kappa score was 0.84 ( SD 0.07) ranging from 0.69 to 0.94. All dental therapists scored good or very good agreement with the gold-standard dentist. This compares with historic NDIP calibration data with dentists, against the same gold-standard dentist, where the mean kappa value was 0.68 ( SD 0.22) with a range of 0.35-1.00. The mean sensitivity score was 0.98 ( SD 0.04) (range 0.88-1.0) and mean specificity score was 0.90 ( SD 0.06) (range 0.78-0.96). Health economic analysis estimated that salary costs would be 33.6% lower if dental therapists were substituted for dentists in the year 2013, with an estimated saving of approximately £103 646 per annum on the national budget. Conclusion We conclude that dental therapists show a high level of interexaminer agreement, and with the appropriate annual training and calibration, they could undertake dental examinations as part of the NDIP programme. [ABSTRACT FROM AUTHOR]

Mental distress is prevalent across all social work contexts, yet social work's relationship with mental health is insufficiently articulated and the contributions practitioners make to this area of practice are under-recognised. This action research study sought to explore and address these concerns from academic, educational and practice perspectives. It was conducted in two parts: beginning with social work students at a Scottish university, followed by social workers in three practice settings. This pa per reports on part one, which examined students' prepared ness for working with mental distress in their final year placements. Using semi-structured questionnaires, a focus group and follow-up interviews, the study set out to enhance understanding of the social work role, identify gaps in educational provision and develop 'Learning Insights' to address them. Whilst the results here suggest that many students felt unprepared for the complexity of roles and tasks in working with mental distress, some reported successful engagement in powerful and transformative interventions by the use of relationship-based methods. The findings attest to a largely unsung but distinct professional contribution social work makes to the amelioration of mental distress--one that is relational, that transcends technical-rational concerns and is encapsulated in the concept of connection. [ABSTRACT FROM AUTHOR]

The article discusses parental views on the proposed Children (Equal Protection from Assault) Bill in Scotland that has no justifiable assault defence in 2019. Topics covered include the reduction of violence toward children by a smacking ban, parents' use of smacking as a result of frustration or anger, and the view that parental rights are paramount as children are not fully developed adults. Also noted is the need for health visitors to be able to recognise children at risk of violence.

Context Despite persistent health inequalities and intergenerational deprivation, the Scottish government aspires for Scotland to be the best country for children to grow up in. Getting It Right for Every Child (GIRFEC) is a landmark children's policy framework to improve children's well-being via early intervention, universal service provision, and multiagency coordination across organizational boundaries. Placing the child and family 'at the center,' this approach marks a shift from welfare to well-being, yet there is still a general lack of consensus over how well-being is defined and measured. As an umbrella policy framework with broad reach, GIRFEC represents the current and future direction of children's/family policy in Scotland, yet large-scale practice change is required for successful implementation. Methods This article explores the origins and emergence of GIRFEC and presents a critical analysis of its incremental design, development, and implementation. Findings There is considerable scope for interpretation within the GIRFEC legislation and guidance, most notably around assessment of well-being and the role and remit of those charged with implementation. Tensions have arisen around issues such as professional roles; intrusion, data sharing, and confidentiality; and the balance between supporting well-being and protecting children. Despite the policy's intentions for integration, the service landscape for children and families still remains relatively fragmented. Conclusions Although the policy has groundbreaking potential, inherent tensions must be resolved and the processes of change carefully managed in order for GIRFEC to be effective. It remains to be seen whether GIRFEC can fulfil the Scottish government's aspirations to reduce inequalities and improve lifelong outcomes for Scotland's children and young people. In terms of both a national children's well-being framework within a universal public service context and a distinct style of policymaking and implementation, the Scottish experience represents a unique case study of whole-country, transformational change and is of relevance to other jurisdictions. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate the experiences of patients with intellectual disabilities, family and paid carers regarding the role of liaison nurses and the delivery of compassionate, person-centred care. From this to propose a model of person-centred care embedded in these experiences. Background People with intellectual disabilities have a high number of comorbidities, requiring multidisciplinary care, and are at high risk of morbidity and preventable mortality. Provision of compassionate, person-centred care is essential to prevent complications and avoid death. Design A qualitative design was adopted with Interpretative Phenomenological Analysis for data analysis. Methods Semistructured interviews and focus groups were conducted. Data were analysed with a focus on compassionate, person-centred care elements and components. Themes were modelled to develop a clinically meaningful model for practice. Results Themes identified vulnerability, presence and the human interface; information balance; critical points and broken trust; roles and responsibilities; managing multiple transitions; 'flagging up' and communication. Conclusions The findings provide the first 'anatomy' of compassionate, person-centred care and provide a model for operationalising this approach in practice. The applicability of the model will have to be evaluated further with this and other vulnerable groups. Relevance to clinical practice This is the first study to provide a definition of compassionate, person-centred care and proposes a model to support its application into clinical practice for this and other vulnerable groups. [ABSTRACT FROM AUTHOR]