Search

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]

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]

Scientific-bureaucratic medicine (SBM) has been the dominant discourse on evidence-based medicine in the English National Health System (NHS). It has being claimed that SBM has led to new forms of medical professionalism with an emphasis on organisational values and the control of autonomy. This paper explores the medical professions' response to SBM, where SBM is manifested in the form of National Institute of Health and Clinical Excellence (NICE) guidelines. Seventy-four face-to-face informal interviews were carried out with clinicians and managers between 2007 and 2009. Three major themes emerged from the analysis each of which was linked to doctors' receptiveness to NICE guidelines implementation. The first emphasised organisational values, which accounted for conditional acceptance of NICE guidelines. The second was proactive professionalism or entrepreneurial professionalism, which was linked to the rejection of NICE guidelines and the emergence of alternative forms of introducing new ideas for the expansion of their clinical practice. The third was related to the prominence of clinical autonomy linked with doctors' resistance to the use of NICE guidelines. It is argued that this evidence does not reflect a significant emergence of new forms of professionalism but the development of multiple occupational identities. [ABSTRACT FROM AUTHOR]

This paper reports on an evaluation of a domestic violence intervention in the maternity and sexual health services of a UK hospital. The intervention encompassed guidelines, staff training, inclusion of routine enquiry for domestic violence with all patients, and referral of women disclosing violence to an on-site advocacy service. An "assumption querying" approach was applied to evaluate the intervention. Programmatic assumptions were identified and tested using interviews with service providers and patients, review of patient records, and pre- and post-training questionnaires. Domestic violence training resulted in changes in health professionals' knowledge and practice in the short-term, but universal routine enquiry was not achieved even in a context of organisational support, guidelines, training and advocacy. Potential and actual harm occurred, including breaches of confidentiality and failure to document evidence, limiting women's ability to access civil and legal remedies. Advocacy support led to positive outcomes for many women, as long as support to maintain positive changes, whether women stayed with or left the violent partner, continued to be given. Maternity and sexual health services were found to be opportune points of intervention for domestic violence services that combine routine enquiry by clinicians, support after disclosure and attention to harm reduction. Cet article décrit l'évaluation d'une intervention en matière de violence domestique dans les services de santé génésique et de maternité d'un hôpital britannique. L'intervention comportait des directives, la formation du personnel, une enquête systématique auprès de toutes les patientes sur la violence domestique et l'aiguillage des femmes révélant des violences vers un service de sensibilisation sur place. L'intervention a été évaluée avec une approche de « questionnement des postulats ». On a identifié et testé les postulats des programmes par des entretiens avec les prestataires de services et les patientes, l'examen des dossiers des patientes et des questionnaires avant et après la formation. La formation sur la violence domestique a changé à court terme les connaissances et la pratique des professionnels de santé, mais n'a pas réussi à les inciter à questionner systématiquement toutes les patientes, même dans un contexte de soutien organisationnel, de directives, de formation et de sensibilisation. On a constaté des préjudices potentiels et réels, notamment des violations de la confidentialité et l'incapacité à réunir des preuves, limitant ainsi la possibilité des femmes d'avoir accès à des réparations civiles et juridiques. Le soutien à la sensibilisation a eu des résultats positifs pour beaucoup de femmes, tant que le soutien s'est poursuivi pour maintenir des changements positifs, que les femmes restent ou non avec le partenaire violent. Les services de santé génésique et de maternité se sont révélés des points précieux d'intervention pour les services de violence domestique car ils associent l'enquête systématique des cliniciens, le soutien après la révélation et l'attention à la réduction des risques. Este artículo resume la evaluación de una intervención relacionada con la violencia doméstica en los servicios de salud materna y sexual de un hospital del Reino Unido. La intervención comprendió guías, capacitación del personal, indagación rutinaria de todas las pacientes respecto a la violencia doméstica y referencia de las que denunciaron violencia a un servicio de promoción y defensa in situ. Se aplicó un enfoque de "investigación de suposiciones" para evaluar la intervención. Las suposiciones programáticas fueron identificadas y probadas utilizando entrevistas con profesionales de la salud y pacientes, revisión de los expedientes médicos y cuestionarios pre- y post-capacitación. La capacitación en violencia doméstica produjo cambios en los conocimientos y las prácticas de los profesionales de la salud a corto plazo, pero no se logró establecer una rutina de indagación universal, ni tan siquiera en un contexto con apoyo organizacional, guías, capacitación y promoción y defensa. Ocurrieron daños posibles y reales, como violación de confidencialidad e incumplimiento de documentar la evidencia; éste último limitó la capacidad de las mujeres para acceder remedios civiles y jurídicos. El apoyo de promoción y defensa llevó a resultados positivos para muchas mujeres, siempre y cuando se les continuara brindando apoyo para mantener cambios positivos, independientemente de que la mujer permaneciera con su pareja violenta o la dejara. Se concluyó que los servicios de salud materna y sexual son puntos oportunos de intervención para los servicios contra la violencia doméstica, que combinan la indagación rutinaria por parte del personal de salud, apoyo después de confirmada la violencia y atención a la reducción de daños. [ABSTRACT FROM AUTHOR]

Background: The prevalence of hearing loss is considerably higher in individuals in residential care than in people within the community-dwelling population, and yet hearing aids and hearing services are relatively underused. Care staff have a key role in supporting access to services. Objectives: This study identifies staff perspectives on hearing loss and their views about potential hearing service improvements. Study design: A four-stage mixed methods study was used, made up of qualitative interviews, observation, a survey and a stakeholder involvement meeting. Results: The qualitative stages indicated that staff were concerned about their levels of interaction with residents. Staff considered maximizing communication as part of their professional role. The quantitative survey indicated that these views were widely held by staff, and the stakeholder stage identified the need for social support and dedicated staff training opportunities. Conclusion: Care home staff regard communication as a shared issue. Future interventions could enhance access to hearing services and provide care home staff with training in hearing loss and hearing aid management. [ABSTRACT FROM AUTHOR]