Search

The JCCP has presented its response to the Government's first public consultation document with the aim of informing and determining the standard, type and content of the new practitioner licence [ABSTRACT FROM AUTHOR]

Focuses on the author's remark about the magisterial work of the books in English legal profession by Professor Rick Abel in Great Britain. Impressiveness of the scope, the depth and breadth of the source material; Coverage deals in the decade from Lord Mackay's "Green Papers" to Lord Irvine's "Access to Justice Act 1999"; Accounts the story of the battle over the several books written by Prof. Abel.

This paper presents the case study of a British doctor who posted videos on social media platforms denying the existence of COVID-19. The case examines the approach taken by the UK's medical regulator in dealing with doctors who espouse conspiratorial views at odds with accepted medical opinion. In such cases, there may be a conflict between the safety of patients and the public (which is the principal function of medical regulators) and the doctor's freedom of expression (whether under the First Amendment, Article 10 of the European Convention on Human Rights, or another international human rights instrument). During this protracted three-and-a-half-year case, the UK's Medical Practitioners' Tribunal, High Court and--latterly--Court of Appeal have each made it clear that doctors remain free to express views contrary to medical orthodoxy except where they lack any supporting evidentiary basis. In September 2023, an order was made revoking the doctor's licence. Rather than accept the Tribunal's guidance following his initial suspension, he chose to continue promoting his conspiratorial views in a public forum. [ABSTRACT FROM AUTHOR]

The use of remote measurement technologies (RMTs) across mobile health (mHealth) studies is becoming popular, given their potential for providing rich data on symptom change and indicators of future state in recurrent conditions such as major depressive disorder (MDD). Understanding recruitment into RMT research is fundamental for improving historically small sample sizes, reducing loss of statistical power, and ultimately producing results worthy of clinical implementation. There is a need for the standardisation of best practices for successful recruitment into RMT research. The current paper reviews lessons learned from recruitment into the Remote Assessment of Disease and Relapse- Major Depressive Disorder (RADAR-MDD) study, a large-scale, multi-site prospective cohort study using RMT to explore the clinical course of people with depression across the UK, the Netherlands, and Spain. More specifically, the paper reflects on key experiences from the UK site and consolidates these into four key recruitment strategies, alongside a review of barriers to recruitment. Finally, the strategies and barriers outlined are combined into a model of lessons learned. This work provides a foundation for future RMT study design, recruitment and evaluation. [ABSTRACT FROM AUTHOR]

In this paper, I explore whether and how New Public Management (NPM) inhibits the long-term sustainability of co-production between non-profit practitioners and service users in the United Kingdom. I show how the key elements of NPM (contracts and competitive tendering, performance measurement, a pressure for non-profits to become more 'business-like', and the framing of citizens as 'customers') provide distinct barriers for non-profits to engage in co-production over the longer term, inhibiting the long-term creation of value for citizens. Through an analysis of seven case study organisations, this paper contributes to building theory about the sustainability of co-production, the factors that shape enduring co-production, and the compatibility/incompatibility of NPM tools with co-production. [ABSTRACT FROM AUTHOR]

The article focuses on the launching of new version of Standard for professional engineering competence called UK-SPEC from Engineering Council UK in Great Britain. It states that the Standard integrates the three categories of registration into a format that will emphasize the progression for those who will enroll in the profession such as Engineering Technician and Chartered Engineer. Professor Fidler notes that the new standard intended to clarify and reinforce the original standard.

Purpose: The fund management sector plays an important role in society. The sector exists in close proximity to the accounting profession and the concerns of the paper reflect themes discussed by accounting scholars, particularly financialization, inequality and life within elite professional service organizations. Design/methodology/approach: This is an interpretive study of the fund management field based in the UK. It is based on 32 semi-structured interviews with individuals with personal experience of the field, combined with reflections from the researcher's own experience as a practitioner within the field. Findings: The paper describes the backgrounds and motivations of individuals entering the field, the recruitment processes through which they are admitted, and the different strategies used to gain admission to the field. It explores the habitus of successful professionals in the field and the effects of this habitus. Social implications: An important social implication of the paper is the problematization of the fund management industry's dislocation from broader society. Originality/value: By identifying the different strategies employed by applicants from different backgrounds, it highlights the role of reflexive agency and the complicity between agent and field. Recognizing that professional fund management is organized as a game, it suggests that individuals are so committed to the game they know they are playing that they fail to realize that they are also drawn into a different game, namely the absorbing game of being a fund manager. [ABSTRACT FROM AUTHOR]

This work explores international research into library and information studies (LIS) education as part of the diversity, equity, inclusion and access (DEIA) agenda and identifies options for LIS education reform in addressing racial inequity in the library profession in the UK. The paper sets out the UK legal, higher education and LIS education contexts, focussing on the role of the professional association, accreditation and the curriculum, and the library and information workforce, and highlights current practices in DEIA in the UK. Using a methodology drawn from bibliometric approaches, a set of academic and professional articles related to DEIA and the LIS curriculum are analysed and nine interpretative repertoires are then identified and discussed. Four core mature repertoires concentrate on the professional association, the university, LIS faculty and the curriculum. These core clusters are surrounded by emerging repertoires which are more recent and more critical. Each repertoire is discussed, referring to key sources and authors to present a picture of trends and complexity in recent (2000–2022) literature on the topic. The aim of this work is to provide a detailed view of existing practice in LIS education relating to DEIA. LIS schools are a vital part of the professional pathway: without a qualification there is no profession, and university students are more-often-than-not drawn from the more privileged and wealthier sectors of society. It is recommended that LIS schools recruit students and faculty who reflect communities and develop the abilities of students to serve the communities they may or may not reflect. These are categorized into clusters, in an attempt to inform LIS education reform in the UK. [ABSTRACT FROM AUTHOR]

An editorial is presented on disseminating work funded under the UK research councils' Diet Research and Industry Club (DRINC). Topics include ensuring the transfer of knowledge between the science base and industry through the support of effective networking between the academic groups and companies involved in DRINC; and working in food businesses having the opportunity to forge research collaborations with leading UK academics in the field of food, nutrition and health.

Quality assurance (QA) is an important process in ensuring that systematic reviews and other evidence syntheses are supported by a high‐quality search. This paper describes how the National Institute for Health and Care Excellence (NICE) in the UK established a development pathway to ensure its information specialists had the skills, knowledge and confidence to undertake search QA. The key component of the pathway is that it blends technical knowledge with interpersonal skills. The pathway develops technical skills in the early steps before using peer support activities to build confidence while undertaking a range of searches. QA is effective when the search lead communicates the contextual information that has influenced search development. QA is treated as a collaboration to get the right search for the review. The key requirements for search QA, alongside technical knowledge, are communication, collaboration and negotiation skills. [ABSTRACT FROM AUTHOR]

Deborah Robertson provides an overview of recently published articles that may be of interest to non-medical prescribers. Should you wish to look at any of the papers in more detail, a full reference is provided [ABSTRACT FROM AUTHOR]

This article reports and reflects on an element of a recent survey of UK public health professionals, specifically in relation to the Public Health Knowledge and Skills Framework (PHSKF) and the ethical requirements that underpin public health practice. Only 38.4% of respondents reported accessing the PHKSF and a mere 13.7% reported accessing the accompanying background paper on ethical public health practice. Given that ethical practice underpins the PHSKF, it is concerning that so few respondents are familiar with the PHSKF and one of the source documents. While issuing frameworks and guidance is one way to support public health practice, there is a further need for greater integration of skills and knowledge around ethical public health practice within education and training initiatives. [ABSTRACT FROM AUTHOR]

Introduction: Non-medical prescribing has the potential to deliver innovative healthcare within limited finances. However, uptake has been slow, and a proportion of non-medical prescribers do not use the qualification. This systematic review aimed to describe the facilitators and barriers to non-medical prescribing in the United Kingdom. Methods: The systematic review and thematic analysis included qualitative and mixed methods papers reporting facilitators and barriers to independent non-medical prescribing in the United Kingdom. The following databases were searched to identify relevant papers: AMED, ASSIA, BNI, CINAHL, EMBASE, ERIC, MEDLINE, Open Grey, Open access theses and dissertations, and Web of Science. Papers published between 2006 and March 2017 were included. Studies were quality assessed using a validated tool (QATSDD), then underwent thematic analysis. The protocol was registered with PROSPERO (CRD42015019786). Results: Of 3991 potentially relevant identified studies, 42 were eligible for inclusion. The studies were generally of moderate quality (83%), and most (71%) were published 2007–2012. The nursing profession dominated the studies (30/42). Thematic analysis identified three overarching themes: non-medical prescriber, human factors, and organisational aspects. Each theme consisted of several sub-themes; the four most highly mentioned were ‘medical professionals’, ‘area of competence’, ‘impact on time’ and ‘service’. Sub-themes were frequently interdependent on each other, having the potential to act as a barrier or facilitator depending on circumstances. Discussion: Addressing the identified themes and subthemes enables strategies to be developed to support and optimise non-medical prescribing. Further research is required to identify if similar themes are encountered by other non-medical prescribing groups than nurses and pharmacists. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to review safeguarding adult reviews (SARs) pertaining to individuals with acquired brain injury (ABI) since 2014. This extended literature review also explores the lessons and recommendations from these reviews in relation to social work practice within the UK. Design/methodology/approach: The literature review reported and discussed findings across reviews and then used a thematic analysis to synthesise the findings and recommendations from the SARs reviews. Findings: This paper identified four main themes: a lack of awareness of the needs of those with ABI and their families and around the symptoms and nuances of brain injury, particularly executive impairment and mental capacity, among social workers; poor interdisciplinarity led to a lack of shared communication and decision-making with professionals with such knowledge; a poor understanding of aspects of the mental capacity legislation, particularly surrounding unwise decisions, led to inappropriate or absent mental capacity assessments; and a lack of professional curiosity led to a lack of action where intervention or assessment was required. Research limitations/implications: This review identifies significant shortcomings in social work practice, education and training within the UK with regards to ABI. Practical implications: This paper provides recommendations to current social work practice and highlights the need for significant improvements in pre-qualification and post-qualification training and supervision of social workers. Originality/value: To the best of the authors' knowledge, while there have been extensive reviews conducted on SARs, this is the only review that has focused solely on ABI. [ABSTRACT FROM AUTHOR]

Article 12(c) of the Nutrition and Health Claims Regulation (NHCR) prohibits authorised health claims in consumer‐facing commercial communications which make reference to the recommendations of individual doctors or health professionals. However, this has been controversial amongst dietitians and nutritionists who work in commercial settings. Given the lack of empirical data, a survey was conducted amongst UK‐based nutrition professionals to assess their knowledge of, and attitudes to, Article 12(c). The findings revealed confusion about the scope of the regulation and how it applies to working practices, with a considerable proportion of respondents being unable to recognise examples of commercial communications or health claims, indicating a need for additional training. There was also a broad interpretation of what nutrition professionals could, and could not, say about a hypothetical food product. This paper explores current guidance in Great Britain and debates the proportionality and fairness of Article 12(c), which, at present, does not regulate authorised health claims made by influencers or celebrities in commercial communications to consumers. It could be argued that consumers are better protected by the articulation of health claims by nutrition professionals who are guided by codes of practice rather than by unqualified, unregulated individuals. Hence, it is essential to level the regulatory playing field either by revising the NHCR to amend Article 12(c) or by updating the guidance to apply an interpretation of the Article's intention which enables a broader role for nutrition professionals in commercial communications. Such action would also be consistent with the UK's better regulation agenda to ensure evidence‐based, proportionate regulation for industry. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: People diagnosed with a personality disorder might be more likely to have physical health problems and be admitted to the hospital. Treatment in hospitals might be complicated by mental health crises or self‐injury, and barriers to NHS care may increase the risk of developing further illness with serious consequences.Literature on "personality disorder" and the general hospital has to date primarily focused on emergency departments. Research on how general hospital inpatient wards respond to people diagnosed with a "personality disorder" has been long overdue. Thirteen clinicians working in mental health liaison in the general hospital were interviewed as part of a sequence of research studies. What this paper adds to existing knowledge: This study identified unjust and avoidable differences in the care and treatment received by people diagnosed with a "personality disorder" in general hospitals. People with a "personality disorder" diagnosis were discriminated against and over‐ and under‐medicated.Mental health liaison clinicians reported limited understanding and skills among general hospital clinicians. People working in general hospitals were fearful of the "personality disorder" diagnosis. Poor care was accepted because general hospital clinicians did not consider themselves to be "mental health trained." What are the implications for practice?: Clinicians working in mental health liaison need credible knowledge of mental and physical health and medicines.Capability, influence, and high‐level interpersonal skills are needed to successfully work across mental health services and the general hospital.More advanced and consultant‐level nursing roles in more mental health liaison teams are needed to strengthen this specialist workforce. Introduction: Literature on "personality disorder" and the general hospital has to date primarily focused on emergency departments. Research on how general hospital inpatient wards respond to people diagnosed with a "personality disorder" has been long overdue. Aim: Qualitative telephone interviews were undertaken to explore the views and perspectives of clinicians working in mental health liaison in this final strand of a mixed methods explanatory sequential study. Method: Participants were recruited via social media and professional networks by snowball sampling. Data were analysed using a framework approach. Results: Four themes were identified: knowledge, understanding, skills, and discriminatory practice; alliances, diplomacy, care, and treatment of people diagnosed with a "personality disorder"; achieving parity of esteem in a disparate healthcare system; and organizational stress, mismatched expectations, and service led decision‐making. Discussion: There were unjust and avoidable differences in the care and treatment received by people diagnosed with a "personality disorder" in the general hospital. People were discriminated against and routinely over‐ and under‐medicated. Implications for practice: Clinicians working in mental health liaison need capacity for partnership working, clinical capability spanning mental and physical health, credibility and influence and high‐level interpersonal skills to address the entrenched discrimination of people diagnosed with a "personality disorder." [ABSTRACT FROM AUTHOR]

In contrast to the conventional focus on recruits and members, this paper examines identity construction in professional organisations. It explores authenticity work – identification activity directed at external audiences to assert distinctiveness. The focus is on commemorative celebrations of the Institute of Chartered Accountants of Scotland (ICAS) and the Institute of Chartered Accountants in England and Wales (ICAEW) during the twentieth century. Evidence from archival and published documents demonstrates that the chartered bodies in Britain were anxious to assert their uniqueness in an increasingly congested professional field. The analysis shows that ICAS made authenticity claims based on its unique position as the first accountancy body in the modern world and emphasised its status as the originator of the institutions of the accountancy profession. The ICAEW, by contrast, initially stressed its alignment to progress and modernity and later emphasised its standing as the leading professional body located at the centre of economic and political power. It is suggested that comprehending the authenticity claims of these organisations is potentially significant to understanding the fragmentation of the chartered accountancy profession in Britain. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to share the findings of a realist evaluation study that set out to identify how to strengthen nursing, midwifery and allied health professions (NMAHP) leadership across all health-care contexts in the UK conducted between 2018 and 2019. The collaborative research team were from the Universities of Bangor, Ulster, the University of the West of Scotland and Canterbury Christ Church University. Design/methodology/approach: Realist evaluation and appreciative inquiry were used across three phases of the study. Phase 1 analysed the literature to generate tentative programme theories about what works, tested out in Phase 2 through a national social media Twitter chat and sense-making workshops to help refine the theories in Phase 3. Cross-cutting themes were synthesised into a leadership framework identifying the strategies that work for practitioners in a range of settings and professions based on the context, mechanism and output configuration of realist evaluation. Stakeholders contributed to the ongoing interrogation, analysis and synthesis of project outcomes. Findings: Five guiding lights of leadership, a metaphor for principles, were generated that enable and strengthen leadership across a range of contexts. – "The Light Between Us as interactions in our relationships", "Seeing People's Inner Light", "Kindling the Spark of light and keeping it glowing", "Lighting up the known and the yet to be known" and "Constellations of connected stars". Research limitations/implications: This study has illuminated the a-theoretical nature of the relationships between contexts, mechanisms and outcomes in the existing leadership literature. There is more scope to develop the tentative programme theories developed in this study with NMAHP leaders in a variety of different contexts. The outcomes of leadership research mostly focussed on staff outcomes and intermediate outcomes that are then linked to ultimate outcomes in both staff and patients (supplemental). More consideration needs to be given to the impact of leadership on patients, carers and their families. Practical implications: The study has developed additional important resources to enable NMAHP leaders to demonstrate their leadership impact in a range of contexts through the leadership impact self-assessment framework which can be used for 360 feedback in the workplace using the appreciative assessment and reflection tool. Social implications: Whilst policymakers note the increasing importance of leadership in facilitating the culture change needed to support health and care systems to adopt sustainable change at pace, there is still a prevailing focus on traditional approaches to individual leadership development as opposed to collective leadership across teams, services and systems. If this paper fails to understand how to transform leadership policy and education, then it will be impossible to support the workforce to adapt and flex to the increasingly complex contexts they are working in. This will serve to undermine system integration for health and social care if the capacity and capability for transformation are not attended to. Whilst there are ambitious global plans (WHO, 2015) to enable integrated services to be driven by citizen needs, there is still a considerable void in understanding how to authentically engage with people to ensure the transformation is driven by their needs as opposed to what the authors think they need. There is, therefore, a need for systems leaders with the full skillset required to enable integrated services across place-based systems, particularly clinicians who are able to break down barriers and silo working across boundaries through the credibility, leadership and facilitation expertise they provide. Originality/value: The realist evaluation with additional synthesis from key stakeholders has provided new knowledge about the principles of effective NMAHP leadership in health and social care, presented in such a way that facilitates the use of the five guiding lights to inform further practice, education, research and policy development. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to demonstrate how action research-based interventions can effect change in a complex and challenging professional service environment (Lewis and Brown, 2012). This paper presents a successful way to do this. First, by eliciting factors for change driven by deregulation in the United Kingdom's (UK) legal service sector (Falconer, 2005). Second, by designing and implementing context-sensitive change in a selected legal service firm. Design/methodology/approach: This research adopts a participatory action research methodology involving the use of systems thinking (namely the PrOH modelling methodology) to design suitable interventions and catalyse change. Findings: This study has generated new knowledge on three fronts–to the legal service operations, to methodology and to the intellectual framework used for abductive reasoning (Checkland and Poulter, 2006). Lessons are transferable to wider professional service operations research. Findings indicate, despite traditional challenges of delivering typical professional services, there is potential for rationalising processes and service delivery commodification, mainly in the low volume, high variety legal service typology (Silvestro et al., 1992). Research limitations/implications: This research uses data from an in-depth study of a single organisation. Practical implications: This research helped legal service professionals to improve overall efficiency and effectiveness and create new management tools. Social implications: This research could help improve legal service operations and make them more accessible. Originality/value: This research applies a novel, systems thinking based methodology for the first time in a complex professional service operations environment leading to three-fold contributions in the areas of practice, theory and methodology. The paper uses a change management framework (the Change Kaleidoscope), a soft systems methodology (PrOH modelling) and applies these to legal services. [ABSTRACT FROM AUTHOR]

Paramedics frequently encounter patients requiring palliative and end of life care. This is anticipated to increase with an ageing UK population, a strengthening preference for care and death to occur in the home, alongside pressurized community services. Nationally education is lacking and despite localized efforts of improvement, widespread change within ambulance services to advance the quality of care for this patient group has been slow to emerge. This paper describes two UK ambulance service improvement programmes that have sought to address this need. South Western Ambulance Service NHS Foundation Trust and London Ambulance Service NHS Trust collaborated with a nationally renowned charity, Macmillan Cancer Support, to create innovative programmes of change. Both services targeted data exploration, valued inter-professional learning and effectively engaged local stakeholders. Experience demonstrates the need for collaboration with specialist palliative care and dependence on community services to access support and alternatives to hospital conveyance. This paper considers the future for end of life care leadership in UK ambulance services and the development of specialist paramedic roles. While the future of an alliance of paramedicine and palliative care is yet to be fully realized, our work exhibits the significant progress made by UK ambulance services. [ABSTRACT FROM AUTHOR]

The Psychology of Women and Equalities Section (POWES) of the British Psychological Society (BPS) accounts for much of the feminist action in British psychology and beyond. In this qualitative study, we use discursively informed thematic analysis to examine a set of eleven in-depth interviews to explore the everyday experiences of feminists within academic spaces in and around the discipline of psychology in the United Kingdom. Three research questions addressing the boundary between activism and academia; the provision of support; and differing approaches to knowledge production were investigated. Our findings highlight the role of POWES as a feminist community as well as the conceptual importance of notions of home, work, and fun. Moreover, the paper examines the ways traditional conceptions of scientific rigour continue to haunt feminist spaces, as does the invisibility of emotional labour. Overall, our findings indicate that the place of feminist academic communities remains vital to sustain critical thought and action: having an intellectual "home" is pivotal to the survival of feminist psychology as well as feminists in psychology. [ABSTRACT FROM AUTHOR]

Background Few pediatric cases of coronavirus disease 2019 (COVID-19) have been reported and we know little about the epidemiology in children, although more is known about other coronaviruses. We aimed to understand the infection rate, clinical presentation, clinical outcomes, and transmission dynamics for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in order to inform clinical and public health measures. Methods We undertook a rapid systematic review and narrative synthesis of all literature relating to SARS-CoV-2 in pediatric populations. The search terms also included SARS-CoV and MERS-CoV. We searched 3 databases and the COVID-19 resource centers of 11 major journals and publishers. English abstracts of Chinese-language papers were included. Data were extracted and narrative syntheses conducted. Results Twenty-four studies relating to COVID-19 were included in the review. Children appear to be less affected by COVID-19 than adults by observed rate of cases in large epidemiological studies. Limited data on attack rate indicate that children are just as susceptible to infection. Data on clinical outcomes are scarce but include several reports of asymptomatic infection and a milder course of disease in young children, although radiological abnormalities are noted. Severe cases are not reported in detail and there are few data relating to transmission. Conclusions Children appear to have a low observed case rate of COVID-19 but may have rates similar to adults of infection with SARS-CoV-2. This discrepancy may be because children are asymptomatic or too mildly infected to draw medical attention and be tested and counted in observed cases of COVID-19. [ABSTRACT FROM AUTHOR]

The article emphasizes the need for health visitors in Great Britain to establish clear and accurate record-keeping procedures to support the effective delivery of care and defend against litigation. Topics discussed include reasons behind the difficulties and inconsistencies in relation to record-keeping, digital record-keeping, and the need to have a contingency when information technology systems fail.

Background: Discourse assessment and treatment in aphasia rehabilitation is a priority focus for a range of stakeholder groups. However, a significant majority of speech and language therapists (SLTs) infrequently conduct discourse analysis, and do not feel competent in doing so. Known barriers identified in other countries, specifically a lack of time, training, expertise and resources, affect use of discourse analysis in clinical practice. Aims: To investigate UK SLTs' reported practices and views of discourse analysis, barriers and facilitators, and clinical feasibility in aphasia rehabilitation. Methods & Procedures: An online survey of 52 questions adapted from existing research and incorporating behaviour change literature was created for the study and piloted. UK SLTs working in aphasia rehabilitation for at least 6 months were invited to participate. Potential participants were contacted through national and local clinical excellence networks, a National Health Service (NHS) bespoke e‐mail list, and national magazine advertisement, and the study was also advertised on social media (Twitter). Therapists read an online participant information sheet and submitted individual electronic consent online; then progressed to the Qualtrics survey. Descriptive, correlational and inferential statistical analyses were conducted, and content analysis was carried out on the questions requiring text. Outcomes & Results: A total of 211 valid responses were received from primarily female SLTs, aged 20–40 years, working full‐time in the NHS in England, in community, inpatient and acute/subacute multidisciplinary settings. A total of 30% SLTs collected discourse analysis often, were mostly very experienced, and working part‐time in community settings. Years of experience was predictive of use. Discourse was most often collected using standardized picture descriptions and recounts during initial assessment. Samples were infrequently recorded, and typically transcribed in real‐time. Most SLTs (53–95%) reported making clinical judgements or manually counted words, sentences, communication of ideas and errors, and were confident in doing so. Barriers included time constraints; lack of expertise, confidence, training, resources and equipment; and patient severity. Discourse 'super‐users' were distinguished by significantly higher professional motivation for discourse and workplace opportunity than other SLTs, and 'non‐users' were distinguished by significantly less knowledge and skills in discourse analysis than other SLTs. SLTs reported a desire and need for training, new/assistive tools and time to do more discourse analysis in practice. Conclusions & Implications: Clinicians were highly engaged and relatively active in at least some aspects of discourse analysis practice. Interventions that target individual clinicians as well as organizations and systems are needed to improve the uptake of discourse analysis in practice. What this paper addsWhat is already known on the subject?Discourse in aphasia rehabilitation is a priority in clinical practice and research. However, the majority of clinicians infrequently collect and analyse discourse. Research in Australia and the United States indicated that lack of time, assessment resources and relevant knowledge and skills are the main barriers to use.What this paper adds to existing knowledgeCompared with existing research, UK SLTs were more likely to see discourse analysis as part of their role and experienced fewer barriers, and more SLTs did it at least sometimes in clinic. However, practices were limited by lack of training, giving rise to challenges in selecting and interpreting findings for clients. More use was predicted by more experience and commitment to discourse analysis, particularly where workplaces supported this approach. Less use was associated with less knowledge and skills in discourse analysis. Practice and decision‐making were influenced by client factors and constrained to a lesser degree by logistical challenges.What are the potential or actual clinical implications of this study?Education and training in discourse analyses and in specific procedures are needed to improve individual clinicians' knowledge, skills and confidence in using discourse analysis for clients' rehabilitation. Equally, organizational and systems changes are needed to promote, support and reinforce discourse analysis in the workplace. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to improve the efficacy of professional support services and teaching processes within a leading UK university so that they align better to changing academic requirements and external market forces, using a novel systems thinking methodology. A case study is given from a school in a leading UK university. Design/methodology/approach: The case uses a novel process modelling methodology known as the process-orientated holonic modelling methodology. Abducted rationalisation is used to reflect upon the 4V's theoretical concept of operational characteristics (volume, variety, variation over time and visibility). The paper also briefly describes the unique systems thinking principles behind the methodology and its use of abductive rationalisation. Findings: The methodology and models show that it is advantageous to simultaneously review strategic processes and operational processes because this enables roles, processes and tasks to be more purposefully redefined and more closely meet endogenous organisational requirements and exogenous market forces. Originality/value: This work will interest organisational analysts wishing to use a novel approach to improve strategy and operational processes in higher education and universities. The practical implications of the study are discussed using the 4V's theoretical concept: volume of throughput, variety of offerings, variation over time and visibility of processes to students. The international context and implications are outlined. [ABSTRACT FROM AUTHOR]

Complementary and alternative medicine (CAM) degrees in Australian and British universities have come under attack from sceptics who argue that such courses teach only 'pseudoscience'. Moreover, CAM academics have themselves been publicly labelled 'quacks'. Comparatively little is known about this group of health professionals who span the two worlds of CAM practice and academia. How do they navigate between these domains, and how are their collective and individual professional identities constructed? Drawing on 47 semi-structured interviews, this paper explores the professional identities of academics working in three university-based CAM disciplines in Australia and the UK: osteopathy, chiropractic and Chinese medicine. By analysing these individuals' accounts, and building on prior research on health professions in the academy, the paper contributes to understanding how contests about professionalism and professional knowledge take place against the academic-practice divide. By focussing on a domain where knowledge claims are conspicuously contested, it highlights the salience of navigating 'epistemic stress' for both group and individual professional identity. [ABSTRACT FROM AUTHOR]

Background: Cardiopulmonary resuscitation (CPR) is internationally defined as chest compressions and rescue breaths, and is a subset of resuscitation. First used for out‐of‐hospital cardiac arrest, CPR is now frequently used for in‐hospital cardiac arrest (IHCA) with different causes and outcomes. Aims: This paper aims to describe clinical understanding of the role of in‐hospital CPR and perceived outcomes for IHCA. Methods: An online survey of a secondary care staff involved in resuscitation was conducted, focussing on definitions of CPR, features of do‐not‐attempt‐CPR conversations with patients and clinical case scenarios. Data were analysed using a simple descriptive approach. Results: Of 652 responses, 500 were complete and used for analysis. Two hundred eleven respondents were senior medical staff covering acute medical disciplines. Ninety‐one percent of respondents agreed or strongly agreed that defibrillation is part of CPR, and 96% believed CPR for IHCA included defibrillation. Responses to clinical scenarios were dissonant, with nearly half of respondents demonstrating a pattern of underestimating survival and subsequently showing a desire to offer CPR in similar scenarios with poor outcomes. This was unaffected by seniority and level of resuscitation training. Conclusions: The common use of CPR in hospital reflects the broader definition of resuscitation. Recapturing the CPR definition for clinicians and patients as only chest compressions and rescue breaths may allow clinicians to better discuss individualised resuscitation care to aide meaningful shared decision‐making around patient deterioration. This may involve reframing current in‐hospital algorithms and uncoupling CPR from wider resuscitative measures. [ABSTRACT FROM AUTHOR]

What is the impact of digital technology on professional work? This paper addresses this question by developing a theory on professional jurisdictional control, which we define as a profession's power to maintain or shift from existing jurisdictional settlements in the face of external disturbances. Digital technology is a disturbance, and who ends up undertaking digital tasks depends on the nature of professional jurisdictional control. With protective jurisdictional control, the profession engages in full or subordinate jurisdiction, delegating new tasks to subordinate semiprofessionals. By contrast, with connective jurisdictional control, the profession prefers settlements by division of labor or advisory links, enabling equal-status professions to work together. Using a large and representative database of online job postings, we find evidence for this hypothesis. Empirically, we deploy three ways to gauge the nature of professional jurisdictional control: first, by comparing traditional law firms and alternative business structure firms in the UK; second, by contrasting the US (with protective jurisdictional control) and the UK; and third, by examining the legal sector (in which the legal profession dominates) and non-legal sectors. We also find that protective (connective) jurisdictional control is associated with lower (higher) pay premia for digital skills, consistent with theory. Our findings highlight the mediating role of professional jurisdictional control to inform the future of work debate. [ABSTRACT FROM AUTHOR]

This paper focuses on recent developments in UK health research policy, which place new pressures on researchers to address issues of accountability and impact through the implementation of patient and public involvement (PPI). We draw on an in-depth interview study with 20 professional researchers, and we analyse their experiences of competing for research funding, focusing on PPI as a process of professional research governance. We unearth dominant professional narratives of scepticism and alternative identifications in their enactment of PPI policy. We argue that such narratives and identifications evidence a resistance to ways in which patient involvement has been institutionalised and to the resulting subject-positions researchers are summoned to take up. We show that the new subjectivities emerging in this landscape of research governance as increasingly disempowered, contradictory and fraught with unresolved tensions over the ethical dimensions of the researchers' own professional identities. [ABSTRACT FROM AUTHOR]

Social work writing, often referred to as 'recording' or 'paperwork', is frequently the target of criticism in reviews and public media reporting in the UK. However, despite the many criticisms made and its significance in social work practice, little empirical research has been carried out on professional social work writing. This paper draws on findings from an ESRC-funded study in the UK to offer a baseline characterization of the nature and function of writing in contemporary social work. Drawing on text and ethnographic data, the paper foregrounds three key dimensions: the number of written texts, key textual functionalities and genres; the specific ways in which 'text work' constitutes everyday social work professional practice, using case studies from the domains of adults, children and mental health; and the concerns of social workers about the amount of time they are required to spend on writing. The baseline characterization provides empirical evidence for claims made about the increased bureaucratization of social work practice, signalling contemporary social work as a 'writing-intensive' profession which is at odds with social workers' professional 'imaginary'. The paper concludes by outlining the educational and policy implications of the baseline characterization and calls for debate about the nature of contemporary social work practice. [ABSTRACT FROM AUTHOR]

To evaluate the usability and acceptability of the Mental Capacity Assessment Support Toolkit (MCAST) in healthcare settings and whether its use was associated with increased legal compliance and assessor confidence. A mixed methods convergence triangulation model was used. Multidisciplinary professionals used the MCAST during mental capacity assessments for UK hospital patients with diagnoses of stroke or acute or chronic cognitive impairment. Changes in legal compliance were investigated by comparing scores on case note audits before and after implementation of the MCAST. Changes in assessor confidence and professionals' perceptions of the MCAST's usability and acceptability were explored using surveys. Patients' and family members' views on acceptability were determined using semi-structured interviews. Data were integrated using triangulation. Twenty-one professionals, 17 patients and two family members participated. Use of the MCAST was associated with significant increases in legal compliance and assessor confidence. Most professionals found the MCAST easy to use and beneficial to their practice and patients. Patients and family members found the MCAST materials acceptable. The MCAST is the first toolkit to support the needs of individuals with communication disabilities during mental capacity assessments. It enables assessors to deliver high quality, legally compliant and confident practice. Mental capacity assessment practice needs to be improved to maximise patient autonomy, safety and well-being. The MCAST is a paper-based toolkit designed to facilitate and improve mental capacity practice in England and Wales. This study suggests the MCAST would be easy and acceptable to use in healthcare settings and could lead to improvements in assessment quality and assessor confidence. [ABSTRACT FROM AUTHOR]

This paper studies the impact on universities of operating in a new public management (NPM) world by examining UK experiences, in general, and the specific cases of two UK universities. As institutions with high levels of human capital and articulate professionals, universities offer a complex setting in which to study the tensions between professions and managerialism. This study identifies the importance of accounting and calculative practices in the contemporary university and distinct professional reactions fostered by intense NPM experiences prompted by the 2010 UK Government's austerity program. [ABSTRACT FROM AUTHOR]

Physical inactivity has been identified as a leading risk factor for premature mortality globally, and adolescents, in particular, have low physical activity levels. Schools have been identified as a setting to tackle physical inactivity. Economic evidence of school-based physical activity programmes is limited, and the costs of these programmes are not always collected in full. This paper describes a micro-costing and cost-consequence analysis of the ‘Girls Active’ secondary school-based programme as part of a cluster randomised controlled trial (RCT). Micro-costing and cost-consequence analyses were conducted using bespoke cost diaries and questionnaires to collect programme delivery information. Outcomes for the cost-consequence analysis included health-related quality of life measured by the Child Health Utility-9D (CHU-9D), primary care General Practitioner (GP) and school-based (school nurse and school counsellor) service use as part of a cluster RCT of the ‘Girls Active’ programme. Overall, 1,752 secondary pupils were recruited and a complete case sample of 997 participants (Intervention n = 570, Control n = 427) was used for the cost-consequence analysis. The micro-costing analysis demonstrated that, depending upon how the programme was delivered, ‘Girls Active’ costs ranged from £1,054 (£2 per pupil, per school year) to £3,489 (£7 per pupil, per school year). The least costly option was to absorb ‘Girls Active’ strictly within curriculum hours. The analysis demonstrated no effect for the programme for the three main outcomes of interest (health-related quality of life, physical activity and service use).Micro-costing analyses demonstrated the costs of delivering the ‘Girls Active’ programme, addressing a gap in the United Kingdom (UK) literature regarding economic evidence from school-based physical activity programmes. This paper provides recommendations for those gathering cost and service use data in school settings to supplement validated and objective measures, furthering economic research in this field. Trial registration: -ISRCTN, . [ABSTRACT FROM AUTHOR]

Introduction: Non-medical prescribing was introduced into the United Kingdom (UK) to improve patient care, through extending healthcare professionals’ roles. More recent government health service policy focuses on the increased demand and the need for efficiency. This systematic policy review aimed to describe any changes in government policy position and the role that non-medical prescribing plays in healthcare provision. Method: The systematic policy review included policy and consultation documents that describe independent non-medical prescribing. A pre-defined protocol was registered with PROSPERO (CRD42015019786). Professional body websites, other relevant websites and the following databases were searched to identify relevant documents: HMIC, Lexis Nexis, UK Government Web Archive, UKOP, UK Parliamentary Papers and Web of Science. Documents published between 2006 and February 2018 were included. Results and discussion: Following exclusions, 45 documents were selected for review; 23 relating to policy or strategy and 22 to consultations. Of the former, 13/23 were published 2006–2010 and the remainder since 2013. Two main themes were identified: chronological aspects and healthcare provision. In the former, a publication gap for policy documents resulted from a change in government and associated major healthcare service reorganisation. In the later, the role of non-medical prescribing was found to have evolved to support efficient service delivery, and cost reduction. For many professions, prescribing appears embedded into practice; however, the pharmacy profession continues to produce policy documents, suggesting that prescribing is not yet perceived as normal practice. Conclusion: Prescribing appears to be more easily adopted into practice where it can form part of the overall care of the patient. Where new roles are required to be established, then prescribing takes longer to be universally adopted. While this review concerns policy and practice in the UK, the aspect of role adoption has wider potential implications. [ABSTRACT FROM AUTHOR]

In the United Kingdom there are guidelines and policies to facilitate boundaries within professional interactions which recognise power differences between those employed in services and those referred to them. However, perhaps we must acknowledge that these boundaries may have indirectly resulted in an unbridgeable division between professionals and those that use services in current professional policies. This paper considers what it means to be a Clinical Psychologist and user of services or carer with the complexity that surrounds this dual position. Through incorporating personal reflections, it seeks to highlight how hard it can be to break down 'them and us' barriers despite the best intentions of the profession and policy makers. The suggestion is that to be truly equal and inclusive we must shift from relating differently to service users, professionals and professionals who may use services by acknowledging our personal positions; otherwise breaking down barriers will remain an ideal rather than a reality. When it comes to our overall well-being breaking down these barriers could shift us from direct or oblique misunderstandings, judgements and stigma towards understanding, tolerance and acceptance within and between all of us. [ABSTRACT FROM AUTHOR]

Introduction: In response to growing demands on health and social care services there is an emphasis on communities addressing the needs of local populations to improve lives and reduce inequalities. Occupational therapists are responding to these demands by expanding their scope of practice into innovative settings, such as working with refugees, the homeless and residents of nursing homes, and within sport and leisure environments. The benefits of sport are widely acknowledged, and this paper argues that occupational therapists could play a pivotal role in enabling people to participate. Method: This qualitative study drew on a phenomenological approach and used interviews and thematic analysis to explore five occupational therapists' experiences of enabling people to participate in sport. Findings: Findings revealed that participants demonstrated the uniqueness of occupational therapy when enabling people to participate in sport and practised according to their professional philosophy. There were opportunities to reach wider communities and promote the value of occupational therapy by collaborating with organisations, but there were also challenges when working outside of traditional settings. Conclusion: The study emphasises the unique skills occupational therapists can bring to this setting. It highlights opportunities to expand their practice, to forge new partnerships in sports and leisure environments, and to address the national inactivity crisis. [ABSTRACT FROM AUTHOR]

This paper reports on the background, context, design, and findings of a collaborative research project designed to develop a future roadmap for strengthening an Australian research-rich and self-improving education system. Building on the BERA-RSA Inquiry into the role of research in the teaching profession in the UK (Furlong, 2013), the Australian Teacher Education Association (ATEA), Australian Association for Research in Education (AARE) and Australian Council of Deans of Education (ACDE) initiated a national study across education systems and jurisdictions to identify ideas, issues, challenges and opportunities to strengthen teacher education and education policy development through research. The mixed-method study, inclusive of focus groups and an on-line survey collected data from pre-service teachers, teachers, academics and leaders across schools, universities and education departments. A set of recommendations highlight the need for research literacies to be embedded at all stages of a teachers' career and that the profession would benefit from professional learning strategies where teachers are positioned as both critical and discerning consumers and active producers of research. The importance of teachers being able to respond to data within their own set of contextual factors was a key message. [ABSTRACT FROM AUTHOR]

Over the last 10 years there have been increasing concerns raised about a potential skills gap in the field of radiation protection (RP). Noting these concerns in 2019, the Society for Radiological Protection, the UK's Chartered Professional Body, launched a study to determine the RP demand in the UK going forward along with the capacity of the profession. The initial results show that over 50% of the SRP membership retires in the next 10−15 years, coupled with an increase in RP demand across the nuclear fuel cycle, medical sector and advancement of new technologies or applications requiring RP advice. This provides strong evidence supporting the concerns of a future skills gap. This paper presents a framework highlighting three core objectives that need to be met to resolve the skills gap. A review of the existing initiatives being undertaken by the Society of Radiological Protection to meet these objectives is included, identifying both areas of good practice and areas for further work and development. A key theme in tackling this challenge has been identified as the need to foster greater collaboration between RP professionals, and organizations both within the UK and abroad, such as IRPA, national societies, employers, academia and industry. This brings a unique opportunity to direct efforts and resources toward a common goal, allowing the sharing of good practice, whilst reducing the strain and burden on any one organization. Another key output of the review was the need to embrace new and innovative solutions to developing our profession and importantly inspiring and communicating into the future of the profession. [ABSTRACT FROM AUTHOR]

Purpose: High-fidelity simulation has well-established educational value. However, its use in psychiatry remains underexplored. This study explores medical students' experiences of high-fidelity simulation teaching during their psychiatry placements. A session was delivered on "psychiatric emergencies", set in a simulated emergency department, with equal emphasis on the management of physical and psychiatric aspects of patient care. This paper aims to report on student attitudes to high-fidelity simulation teaching in psychiatry, as well as student attitudes to "integrated" teaching (i.e. covering both physical and psychiatric knowledge). Design/methodology/approach: Semi-structured focus groups were conducted with medical students at a UK university. This exploratory approach generated rich qualitative data. Thematic analysis was used. Findings: High-fidelity simulation teaching in psychiatry is well regarded by medical students, and helps students recognise that psychiatric problems can present in any clinical setting. This study has demonstrated that students value this type of "integrated" teaching, and there is potential for this approach to be more widely adopted in undergraduate health-care professional education. High-fidelity simulation could also be considered for incorporation in undergraduate examinations. Originality/value: To the best of their knowledge, the authors are the first to conduct an in-depth exploration of attitudes to simulation teaching specifically in psychiatry. The authors are also the first to directly explore student attitudes to "integrated" teaching of psychiatry and physical health topics. The results will support the effective planning and delivery of simulation teaching in psychiatry, the planning of undergraduate summative assessments and will likely be of interest to health-care professionals, educational leads, simulation practitioners and students. [ABSTRACT FROM AUTHOR]

This paper offers a commentary regarding the centrality of critical reflection in social work before discussing a research project drawing on a sample of ten social work students as they approached the end of their social work training in one English university. The original intention of the research was to focus solely on students' perceptions of critical reflection, but when using a more reflexive approach, we identified that participants utilised the focus groups as an opportunity to discuss their practice learning experiences per se before considering and discussing critical reflection. Most students were placed in child protection social work teams and discussed how they felt unprepared for such a fast-paced and stressful environment. Participants felt that the expectations some practitioners had of students were unrealistic, and not always commensurate with the Professional Capabilities Framework. Students highlighted the use of practice scenarios in developing their knowledge and skills particularly when considering their application of critical reflection. This study highlights the significance of adequate preparation for practice and argues for a more focussed agenda for future research exploring the culture of learning, including those factors that inhibit students sharing their concerns as well as the training needs of educators. [ABSTRACT FROM AUTHOR]

The study informing this paper set out to reframe evaluation as a collaborative, participatory, dialogical process with a focus on learning rather than accountability. Evaluation, much like reflective practice, has been shaped in terms of individual activity and deficit-based discourses. Using an ‘insider’ approach, an innovative methodology was developed and implemented in a voluntary youth organisation in the UK. Data gathered via semi-structured interviews before and after the implementation were analysed using an inductive thematic analysis approach. The findings suggest that collective spaces for reflection and dialogue are disappearing and yet practitioners highly valued this for its re-energising and restorative properties. Evidence is presented to suggest that narratives, in this case co-constructed stories, enabled collective critical reflection and the development of a shared understanding of practice which in turn supported and strengthened professional autonomy. This paper offers a significant contribution to knowledge in regard to the design and use of participatory evaluation. It is argued that the appreciative, collaborative and reflective aspects of the methodology enabled the learning and development functions to be realised. Evaluation based on collective, reflective dialogue has the potential to provide an evidence base of good practice, enhance staff well-being and improve practice outcomes. [ABSTRACT FROM PUBLISHER]

This conceptual paper explores the notion of professional curiosity within child protection practice considering the barriers that can inhibit social workers invoking curiosity. The authors contend that definitions of professional curiosity are lacking in clarity and transparency; at the time of writing, we are not aware of any other endeavours to create a definitional reference point or analysis of this concept. Furthermore, invoking professional curiosity is challenging when the social work task is pressurised, stressful and operates within a system that is stretched to breaking point. Drawing on messages from Serious Case Reviews in the UK which identify social work failings in context of a lack of professional curiosity, this paper initially focuses on constructing some definitional reference point, moving on to explore factors that may inhibit curiosity in practice. We cement connections between the emotional dimension of child protection practice, organisational context and the wider neo-liberal political climate, constructing these as potential barriers to invoking curiosity. We contend the interplay of such complicated relational dynamics has the potential to distort professional judgement, including enacting curiosity. Finally, we consider realistic mechanisms by which social workers could be supported to generate creativity and curiosity in their practice. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to investigate governance in service triads, specifically studying significant steering and connecting coordination failures, to reveal typically hidden characteristics and consequences. Design/methodology/approach: This study focuses on coordination functions and activities between a buyer (a government department), a customer (a military service) and two service providers. Rich data on these normally confidential service ties are drawn from an official report into the causes of a fatal accident involving a UK reconnaissance aircraft and specifically from the evidence presented regarding the earlier development of its complex safety case. The authors also analysed a range of additional secondary data sources. Findings: The authors examine the sources, drivers and manifestation of coordination failures. The authors uncover a series of coordination failures driven from the bridge position, revealing that while bounded rationality and opportunism influenced steering coordination failures, connecting coordination failures were associated with knowledge asymmetry, dyadic inertia and unethical practices. Practical implications: Organisations and governments delivering complex projects and knowledge-intensive professional services should guard against outsourcing the "coordination" activity to a third party, thereby relinquishing the bridge position. Handing over the bridge position to an integrator would leave the client vulnerable to coordination dysfunctions such as bounded rationality, opportunism, knowledge asymmetry, dyadic inertia and unethical practices. Originality/value: The study links the previously separate research streams of service triads and inter-organizational coordination. While extant research pays attention to mainly positive control functions, this study focuses on all three actors in two (failed) service triads – and highlights the impact of coordination activities and failures. [ABSTRACT FROM AUTHOR]

ABSTRACT UK voluntary and community sector organizations (VCOs) play a key role in caring for homeless people. However, there are widespread concerns about the impact of increasing government contracting on the quality of their services. This paper examines understandings of homelessness and identities as homelessness professionals, as expressed by VCO professionals. By so doing, it considers how 'partnership working' enables or undermines their capacities to care. The paper uses 24 in-depth interviews and four focus groups with London-based homelessness professionals. Professionals expressed deep tensions in their experience of their role. On one hand, they reported a deep ethical commitment to care and to develop quality supporting relationships to respond to their clients' complex needs. On the other, their capacity to care was undermined by their dependence on statutory resources and the controls this involved over the way VCOs delivered care. Professionals had to adjust to statutory monitoring frameworks and hard performance targets, which detached them from the human and intimate encounter with their clients and constrained their person-centred caring interventions. The findings highlight the contradictory nature of contemporary systems of 'joined up' welfare that neglect the very human and complex nature of the issues that they were originally created to address. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The status of funeral directors, including whether or not the industry can be considered a legitimate ‘profession’, has long been a topic of interest in this journal. Contributing to this ongoing debate, this paper considers opportunities and barriers to professional development in the UK funeral industry. In so doing, the paper makes particular reference to ‘communities of practice’ (CP), a model of situated learning. Previous research in comparable sectors has indicated that CP enhances individual and organisational performance through emphasising commitment to sharing and developing best practice within an area of common interest. Drawing on interviews with and presentations given by funeral directors/arrangers, the paper examines perceptions of performance, alongside issues of mistrust and resistance to change. Data will show that participants conveyed a situation of competing forces in terms of a hierarchical structure within the industry that perpetuates a lack of incentive to invest in education and training. At the same time, a new generation of staff is developing an alternative vision of funeral directing, which includes wider public recognition of their skills. In view of the industry’s long-standing drive for professional standing, the paper identifies the potential of CP as a means of negotiating such competing forces to provide a medium through which issues associated with regulation can be addressed. [ABSTRACT FROM PUBLISHER]

Healthcare-associated infections are a significant reason for readmission to hospital post-discharge to the community. In this paper, the authors describe some of the key findings from a programme of work conducted in a home care agency (community care organisation) in the US. A survey was conducted to explore home care nurses' knowledge, attitudes and beliefs around infection control (n=415); 400 nurse-patient visits were observed, and 50 nurses were interviewed about their infection control practices. Nurses reported high compliance with infection control practices. However, the overall average adherence rate to observed hand hygiene practices was 45.6%. Interview data provided valuable insights into specific challenges faced by nurses in a home care setting. This study provides insights that can be used to enhance infection control practice in community care in the UK. [ABSTRACT FROM AUTHOR]

The history and professionalisation of midwifery has travelled through turbulent times to arrive at an opportunity for transformation in the contemporary UK maternity system. This professionalisation, the midwifery profession and professional autonomy are explored in this article from a sociological perspective, to answer the question of whether a midwife can achieve professional autonomy within the UK system. This is a two-part article. Part one has a strong focus on the historical context of midwifery, government policy and guidelines, risk, litigation and increasing managerialisation to frame the discussion in part two. The second part provides a discussion of autonomy, choice, managerialisation and reflexive practice, to create a conceptual framework utilising the concept New Professional Midwifery. This is to centralise a core belief in midwifery autonomy and women's choice facilitation. This paper is part one of two. [ABSTRACT FROM AUTHOR]

In England and Wales, decision-making in cases of uncertain mental capacity is regulated by the Mental Capacity Act 2005. The Act provides a legal framework for decision-making for adults (16 and over) who are shown to lack capacity and where best interest decisions need to be made on their behalf. Frail older people with cognitive impairments represent a growing demographic sector across England and Wales for whom the protective principles of the Act have great relevance, as they become increasingly dependent on the care of others. However, while the Act articulates core principles, applying the Act in everyday healthcare contexts raises challenges for care providers in terms of interpretation and application. This paper presents a review of the published evidence documenting the use of the Act in healthcare practice, with particular reference to frail older people. Our aim was to identify, review and critically evaluate published empirical studies concerned with the implementation and application of the Act in healthcare settings. A systematic approach was undertaken with pre-determined exclusion and inclusion criteria applied across five electronic bibliographic databases combined with a manual search of specific journals. This review reports on 38 empirical sources which met the inclusion criteria published between 2005 and 2013. From the 38 sources, three descriptive themes were identified: knowledge and understanding, implementation and tensions in applying the Act, and alternative perspectives of the Act. There is a need for improved knowledge and conceptualisation to enable successful incorporation of the Act into everyday care provision. Inconsistencies in the application of the Act are apparent across a variety of care settings. This review suggest staff need more opportunities to engage, learn and implement the Act, in order for it to have greater resonance to their individual practice and ultimately benefit patient care. [ABSTRACT FROM AUTHOR]