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This paper presents a case study of a participant’s experience of exploring and connecting to the New Cut docks, in Bristol, UK, which had been excavated by Irish immigrant labourers between 1804 to 1809. This particular site was sought out by the British born, second generation Irish participant to “find the orphaned, Irish parts of me”, in order to explore the potential for healing self-determined aspects of personal identity suppression and denial of unwanted traits, through direct connection to their ancestors. Using this case as an example of the phenomenon of archaeotherapy, which encourages direct site visitation, exploration and communion, the chosen site has the potential to offer connectedness, understanding, and health and healing, in ways that promote well-being and belonging in diasporic communities. It is further suggested that heritage sites offer a unique ability to support participants, mirroring personal heritage in a manner that invites storytelling, yarning, and meaning making. This unique ability, where the site and participant are in embedded communication, suggests the site has agency and is an active therapeutic facilitator in its own way, inviting challenging and sense-making narratives that support a positive outcome. This research has direct ramifications for UK based “social prescribing” projects that are currently being delivered by well-being, archaeology, heritage and ecotherapy organisations. Non-clinical approaches to well- being and mental health outreach in a variety of settings, including organisations who work with displaced communities and with politics of identity, will also benefit from the findings of this study.

Total hip arthroplasties (THAs) are usually performed in older patients. Despite a growing number of THAs in younger adults, it is unclear whether they have similar priorities in recovery compared with their older counterparts. The purpose of this systematic review was to explore younger patients' priorities when undergoing a THA. Multiple databases were searched in September 2021 prioritizing qualitative data. This review was reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Of 14,495 articles screened, nine remained for analysis. Four common themes were discovered: improving function and mobility; pain; relationships; and patient expectations and education. However, there was insufficient information to clarify whether these themes could be attributed directly to younger adults undergoing a THA. The absence of research on THA patients younger than 50 years results in the loss of the voices of these patients. Further research is essential to ensure their needs are identified, addressed, and met.

Background/Aims Following several major reports of poor quality care in the NHS, including the Francis report, a multi-centre study was undertaken by to improve patient-centred care by implementing near-real time patient feedback. This article follows on from this and explores the experiences of staff from one hospital involved in the multi-centre study, including the learning from the intervention and how it affected their practice. Methods Semi-structured interviews were conducted with eight individuals who were involved in the original study, including five clinical staff members and three volunteers. Responses were transcribed and analysed thematically. Results The interviews highlighted four inter-related themes: the importance of communication; normalising feedback; confidence to talk to patients; and seeing from the patient perspective. Participants described how near real-time feedback enhanced communication, giving them confidence to interact with patients. Staff responded to negative patient feedback by making improvements to patient experiences. However, the initiative was not sustained following the conclusion of the study. Conclusions Near-real time patient feedback can be effective in improving staff patient communication and creating a more positive experience for both patients and staff. However, this study highlights the need to examine the sustainability of improvement initiatives, as well as their initial effectiveness.

Background: In the UK, there are huge inequities in maternal and neonatal mortality, yet there appears to be very little training to address this for midwives. This quality improvement project aimed to address this by providing training on implicit bias, stereotyping and clinical assessment of babies from black, Asian and minority ethnic families. Methods: A training package was created and delivered to 67 midwives and students on placement at the Yeovil District NHS Foundation Trust on implicit bias, structural racism and clinical assessment of babies from black, Asian and minority ethnic groups. Pre- and post-training surveys were completed and descriptive statistical analysis alongside thematic analysis was used to analyse the findings. Results: It was evident that midwives benefited from the training, as pre-session surveys noted that many midwives were unaware of the factors influencing the care of women and babies from black, Asian and minority ethnic families. After the training, they identified a wish to change their practice to be more inclusive. Conclusions: The training package was well evaluated; however, more training and research is needed to improve the safety of mothers and babies from black, Asian and minority ethnic families.

This is the second paper in the series; in the last paper we presented an overview of health inequity and health access in the UK, explored the difference between inequality and inequity and presented key national and international policies working to address health inequity. This paper builds upon this by considering three particular communities: people who are homeless and individuals from LGBTQ+ and Ethnic Minority communities as well as how practice nurses can have a key role in addressing poor health outcomes for individuals within these communities.

Practice nurses are ideally placed within local communities to have a significant impact on addressing health inequities. However, to achieve this they need to understand the many factors that lead to certain groups having poorer health outcomes. Advances in longevity do not automatically match advances in health and wellbeing across all social groups. In the UK, someone living in a deprived area of England is more likely to die eight and a half years younger than someone living in a more affluent area. The COVID-19 pandemic has highlighted health inequities faced by ethnic minority groups in particular. This article, the first of two, will define the terminology used, explore access to health services in the UK and present the evidence driving healthcare policy

This paper outlines the protocol for a study that is being carried out at multiple centres across the UK in the next three years. It is a Research for Patient Benefit (RfPB) study funded by the National Institute for Healthcare Research (NIHR). The aim is to assess the effectiveness of treating hypertrophic burns scars with pulsed dye laser (PDL) at an early stage of scar formation. The objective is to improve Quality of Life for the patient by improving both the appearance and quality of burn scarring, as well as reducing its psychological impact. This is a parallel-arm randomised, controlled trial to compare PDL and standard care against standard care alone. The difference is measured between baseline and six-month follow-up. Recruits are within three months of healing from a burn injury; with wounds showing a defined potential for hypertrophic scarring. A total of 120 patients are recruited in a multi-centre study; with randomisation in a 1:1 allocation to each arm. The treatment arm receives 3 PDL treatments at six-week intervals in addition to standard care, whereas the control arm receives standard care alone. The primary outcome is the patient-rated part of the Patient and Observer Scar Scale (POSAS). Psychological and psycho-social impact is evaluated using the CARe burn scale (UWE, Bristol) and Quality Adjusted Life Years (QALY) is determined using the Short-Form Health Survey (SF-12). The study evaluates both the cost-effectiveness through an economic analysis and the patient-reported experience of the treatment by phone interviews.

Vulnerability linked to offenders tends to focus on victims and society. Understanding prisoner vulnerability, is important to better address the negative impact of prison life. This paper reviews the evidence on vulnerability reported by male prisoners. 3038 citations were filtered using the Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. Data were analysed using thematic analysis, highlighting four areas of vulnerability: uncertainty, environmental vulnerability, fear of harm and loss of human connection. The paper notes that basic principles for treatment of prisoners are not met in many areas, indicating a need to shift conceptualisations of vulnerability.

Objectives This is a protocol for a Cochrane Review (intervention). The objectives are as follows: 1. To assess the clinical outcomes of psychological and educational interventions in children and adults with eczema 2. To summarise the availability and principal findings of relevant economic evaluations

This paper discusses the synthesised findings from two interdisciplinary, feminist studies conducted under the auspices of the non-corporate nexus, the Women’s Academic Network at Bournemouth University, UK, of which the main author is a co-convenor and co-founder. These qualitative studies focus on academic women’s experiences of managing careers in the work culture of corporate Institutions of Higher Education (HEI) in a modern UK university. The background to this work draws from a body of international research into the slower career progression rates of women academics in comparison to male counterparts and gendered barriers the former encounter. While there has encouragement within Higher Education bodies across the EU to balance out the current gendered inequities within academia, our findings indicate that these are woven into the institutional fabric of enacted daily academic practices serving to disadvantage women scholars.

Editorial

Efforts to widen participation into higher education (HE) are having an impact with increasing numbers of diverse students accessing HE. Outreach is a key strategy within widening participation (WP), yet there has been little peer reviewed, published evidence regarding how outreach is identified, situated and understood. This paper addresses this gap, presenting a systematic review of published research examining how the impact of WP outreach is identified and understood in UK research. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist was used to frame the review and empirical studies focusing upon outreach (2005–15) were included. Papers excluded were focused on international, part-time students or those not focused upon WP outreach. Twenty-six papers were identified for inclusion and these were analysed thematically. The analysis identified themes of person-centred impact, raising aspirations, and social capital, addressing ‘how and why’ questions rather than the ‘what works’ question judged by the impact of outreach on student numbers. Doing so can enable improvements in the design of outreach activities addressing individual experiences alongside structural barriers. Ultimately, this analysis suggests there is insufficient systematic evidence regarding the impact of outreach on the underlying structural factors shaping access to higher education.

Background: There are significant numbers of people experiencing homelessness both in the UK and internationally. People who are homeless are much more likely to die prematurely and, therefore, need strong access to ongoing health and social care support if we hope to address the health disparity they face. Objectives: The aim of the research was to explore how people who are homeless identify and locate appropriate health and social care services. Design: A mixed methods research study was applied on people who are currently homeless or had previously experienced homelessness. Settings: The research study was based in an urban area in the southwest of England. The area was chosen as it was identified to be in the top 24 local authorities for the number of homeless individuals. Participants: A hundred individuals participated in the survey, of those 32% were living on the streets whilst 68% were living in temporary accommodation such as a charity home, shelter or a hotel paid for by the local authority. In addition, 16 participated in either a focus group or one‐to‐one interview Methods: The quantitative component consisted of a paper‐based questionnaire whilst the qualitative aspect was focus groups/one‐to‐one interviews. The COREQ criteria were used in the report of the qualitative aspects of the study. Results: Quantitative data identified poor health in 90% of the sample. Access to both healthcare and wider wellbeing services (housing and food) was problematic and support for this was largely through third sector charity organisations. Qualitative data identified numerous systemic, individual and cultural obstacles, leaving difficulty for people in terms of knowing who to contact and how to access services, largely relying on word of mouth of other people who are homeless. Conclusions: In order to address health inequities experienced by people who are homeless, there is a need to review how information regarding local health and wider wellbeing servic

Background: Total Hip Arthroplasty (THA) is one of the most commonly performed operations in orthopaedics. It is an operation usually performed in older patients, however the need for THA in younger patients is increasing. There is a lack of literature examining whether current recovery pathways address the specific needs of younger patients. Public and Patient Involvement (PPI) is a core aspect of good research practice and is recommended throughout the research process, including the formulation and refinement of pertinent research questions. Therefore, the explicit aim of this PPI study was to collect qualitative data from patients on the feasibility and requirement for further research into the experience of younger hip arthroplasty patients. Methods: Qualitative data was collected via an online questionnaire that was advertised on social media, requesting the input of anybody who had experienced a lower limb musculoskeletal injury or condition before the age of 50. The survey asked the respondents to describe their experiences and reflect on their priorities and goals throughout their recovery. Results: There were 71 respondents, of which 90% were female, with an average age of 43. Qualitative responses identified many concerns that were issues that could be translated across all patient ages. However, other priorities were raised that are not always recognised as important when measuring successful outcomes after a THA. Furthermore, many respondents described not feeling listened to by clinicians or treatment options not being sufficiently addressed and explored. Multiple respondents reported being told they were too young to have anything serious or that nothing could be done until they were older. Conclusions: The responses to the survey indicate that current care pathways are not fulfilling the needs and priorities in younger patients. Further research is required to explore these priorities and goals in more depth in order to understand how healthcare prof

This article chronicles the present situation of coronavirus disease 2019 (COVID‐19) on individuals with intellectual and developmental disabilities (IDD) in Nigeria. A systematic search was conducted on three bibliographic databases: MEDLINE Complete, Web of Science and Scopus, and supplemented with grey literature searches to assess studies on the effect of COVID‐19 on these individuals in Nigeria with data on this group from December 2019 to July 2020. There were no studies found concerning individuals with IDD in Nigeria. This article argues for an urgent call to action by Nigerian policymakers to make data available to help understand the impact of COVID‐19 and to develop and implement appropriate interventions. This article provides steps to support and care for these individuals in Nigeria. Forecasting models are recommended which offer better approaches in yielding accurate predictions and provide valuable decisions in the event of future threats and infectious disease outbreak in Nigeria.

Background: People who are homeless experience poorer health outcomes and challenges accessing healthcare contribute to the experienced health inequality. There has been an expansion in using technology to promote health and wellbeing and technology has the potential to enable people who are socially excluded, including those who are homeless, to be able to access health services. However, little research has been undertaken to explore how technology is used to promote health and wellbeing for those who are homeless. This review aims to address the questions: ‘what mobile health (mHealth) related technology is used by homeless populations’ and ‘what is the health impact of mobile technology for homeless populations’? Methods: An integrative review methodology was employed. A systematic search of electronic databases was carried out between 4 January 2021 and 30 April 2021, searching for papers published between 2015 and 2021, which yielded 2113 hits, relevant papers were selected using specified inclusion and exclusion criteria reported using the Preferred Reporting Items for Systematic reviews and Meta-Analysis. The quality assessment of each paper included in the review was undertaken using the Mixed Methods Appraisal Tool. Results: Seventeen papers were selected for review and thematic analysis identified four themes: technology ownership, barriers to use, connectivity and health benefits. Conclusion: It is evident that technology has the potential to support the health and wellbeing of individuals who are homeless; however, there are challenges regarding connectivity to the internet, as well as issues of trust in who has access to personal data and how they are used. Further research is needed to explore the use of health technology with people who are homeless to address these challenges.

The caste system is social stratification system that has been used over the last three millennia. This review aims to investigate caste-based inequity in healthcare utilisation in South Asia, particularly focusing those at the bottom of the caste hierarchy, commonly known as Dalit communities. A systematic methodology was followed; key databases (including CINAHL, Medline, SocINDEX, PubMed, Nepjol, JSTOR and ASSIA) were searched for relevant articles published before 2019 October, using comprehensive search strategy in accordance with the PRISMA guidance. In total 15,109 papers were found, and from these, nine selected papers were included in the review. The papers focused on studies in both India (n=7) and Nepal (n=2) and utilised a range of methods including qualitative (n=2), quantitative (n=3) and mixed methods (n=4) approaches. The review identified four main themes: stigma, poverty, cultures and beliefs and healthcare. Caste-based inequity impacts upon all aspects of an individual’s well-being including violence and everyday life risks. Caste also impacts upon individuals’ opportunities to access education, employment and healthcare. Dalits appear to experience this more significantly due to both poverty and their caste status which increases their vulnerability to health risks.

Background; Gypsy Roma Travellers are Europe’s largest ethnic minority group. Yet they remain one of the most stigmatised communities who have significant health inequalities. Whilst nurses have a role in promoting health access, there have been minimal studies exploring health care professionals’ attitudes towards these communities and no studies exploring nursing students’ perceptions. Objectives; To explore nursing students understanding, knowledge and perceptions of working with Gypsy Roma Travellers Participants; 23 nursing students from across four European countries (UK, Spain, Belgium, Turkey) participated in the study. The students ages ranged between 19-32 year old, there was a mix of students between year one to year three of their programme and both male (n=3) and female students (n=19). Methods; This qualitative research utilised focus groups and one to one interviews based at the four different universities, all following a pre-agreed interview schedule. Focus groups and interviews were conducted by the research team in the students’ first language and later translated into English for analysis using thematic analysis. The COREQ criteria were used in the reporting of the study. Results; Four themes were identified which included: Exposure to Gypsy Roma Traveller Communities, Perceptions of Gypsy Roma Traveller cultures, Unhealthy lifestyles and culture and Nursing Gypsy Roma Travellers. Conclusions; Although personal and professional contact with Gypsy Roma Travellers was limited, most of the students’ perceptions of these communities were negative. Nurse educational programmes need to embed transformational learning opportunities enabling student nurses to critically reflect upon values and beliefs of Gypsy Roma Travellers developed both before and during their nursing preparatory programme if they are to work effectively in a respectful, culturally sensitive way. There is also generally, a lack of research focussing upon healthcare professionals’ att

Background: Whilst the terms vulnerability and resilience are commonly used within professional nursing discourses, they are often poorly understood. Vulnerability is often framed negatively and linked to being at risk of harm, whilst resilience is often perceived as the ability to withstand challenges. Aim: The aim of this paper is to explore resilience and vulnerability; re-positioning them within the context of contemporary professional nursing practice. Design: Discussion paper. Method: Drawing upon historical and contemporary international literature, both concepts are de-constructed and then re-constructed, examining them from the position of patient care as well as from the perspective of nurses and the nursing profession. Conclusion: Resilience and vulnerability have an interdependent relationship as resilience comes into play in situations of vulnerability. Yet, contrary to the popular discourse they are multi-faceted, complex phenomena based on factors such as individual circumstances, supports and resources.

General Practice Nurse (GPN) practice is becoming increasingly diverse, due to a changing patient base and political climate which impacts upon their role. Over the last decade there has been an increase in the number of foreign born individuals living in the UK, the number of individuals identifying as Lesbian, Gay, Bisexual or Transgender (LGBQT) as well as the number of people living with a long term health condition or disability. Yet all of these groups also experience greater health inequalities, despite increasing political drives in the UK and internationally to address this. General Practice Nurses are ideally placed to address health inequalities by facilitating health access for diverse groups however in order to do this they have to recognise and respond to the cultural values of the patient they are working with.

There is a focus on increasing the numbers of students with disabilities to apply to and study in Higher Education (HE). Despite sector-wide criteria regarding what comprises a disability, there are still students who do not disclose a disability at the application stage. This study sought to explore perceptions of students across one UK university regarding their views and experiences of a range of disabilities and reasons why a disability may not be disclosed on application to HE. The findings suggest a lack of understanding regarding what constitutes a disability, and concerns that disclosure will negatively impact upon the application decision and disadvantage the student. This paper highlights the disconnect between the support that universities can provide to students with a disability and the perceptions that some students have about the disadvantages that disclosure can bring. The findings support initiatives at policy and practice level across the sector to recognise and address perceptions and experiences of risk and stigma that applicants may have but at the same time highlight that more needs to be done to reduce the anxieties and lack of clarity that some students experience.

Introduction: Across Europe large numbers of Gypsy Roma Traveller communities, experience significant health inequities such as higher morbidity, mortality and infant mortality. This health inequity is perpetuated by wider determinants such as lower social status, lower educational attainment and sub-standard accommodation. This is not dissimilar to other indigenous peoples, even though many Gypsy Roma Traveller communities are not identified as indigenous. Methods: This paper presents contemporary literature and research alongside the internationally agreed principles of indigenous peoples; examining similarities between Gypsy Roma Traveller communities and other indigenous peoples. Results: We argue that Gypsy Roma Traveller communities could be recognised as indigenous in terms of the internationally agreed principles of indigeneity as well as shared experiences of health inequity, colonisation and cultural genocide. Doing so would enable a more robust public health strategy and development of public health guidelines that take into account their cultural views and practices. Conclusion: Recognising Gypsy Roma Traveller communities in this way is important, especially concerning public health, as formal recognition of indigeneity provides certain rights and protection that can be used to develop appropriate public health strategies. Included within this are more nuanced approaches to promoting health, which focus on strengths and assets rather than deficit constructs that can perpetuate problematizing of these communities.

Introduction: Given the emerging evidence internationally of poor care within the healthcare sector, a recent report in the United Kingdom recommended the need for education to produce nurses who are prepared both intellectually and with compassion. Aim: This paper aims to understand the beliefs and values of caring, held by student nurses from entry to completion of their education programme. Methods: Using a prospective qualitative longtitudinal approach, two cohorts of nursing students (February 2013 and 2014) each following a different undergraduate curriculum (the February 2013, based on a philosophy of person-centred care and the February 2014, based on the philosophy of humanisation) were followed throughout their programme leading to Registration. Data were collected from February 2013 to February 2017 using individual interviews at commencement and completion of their programme with focus groups after their first placement and at the end of years one and two. Using purposive sampling, from February 2013, 12 commenced the study and five finished. From February 2014, 24 started, with nine completing. Findings: Data were analysed using thematic analysis with four themes emerging: i) Articulating the terms caring and dignity ii) Recognising the need for individualisation iii) Learning nursing and iv) Personal journey. Conclusion: Reporting on the final phase of this 5-phase study and on the brink of qualifying, both cohorts of students recognised the impact of their different curriculum and their exposure to the same educators who had embraced the humanisation philosophy. They each acknowledged just how they had changed as individuals and how determined they were to influence the quality of care.

Background/Aims: This article will present how an interdisciplinary team working within a day hospital in an acute NHS Foundation Trust embraced the opportunities of practice development to work ‘better together’ to meet the complex needs of individuals using the service. Methods: By working closely with key stakeholders, the team developed an integrated service intersecting both primary and secondary care boundaries. Results: The principles of practice development, including shared vision and focus, ensured changes made to the service were patient centred. These changes included a 360-degree assessment by professional staff with extended skills beyond their own professional role, and a virtual ward round, where individual patients are reviewed by an interdisciplinary team in the community with a focus on avoiding hospital admission, with quicker access to the day hospital. The team worked closely with their local university towards achieving practice development unit status, demonstrating a rigorous approach to the development of services provided by the day hospital. Conclusions: The article highlights both the value of practice development and significantly the value of an interdisciplinary team working within a day hospital setting.

Ancient sites such as Stonehenge, UK, and Santiago de Compostela, Spain, have long been directly associated with healing and the promotion of well-being. It is a dimension of heritage that continues into the present day. This chapter contextualizes public perceptions and aspirational public policies in relation to heritage and well-being by reviewing the development of interest in therapeutic places, and summarizing the achievements of projects that promoted physical and mental well-being through access to heritage landscapes, encounters with museum collections, participation in archaeological fieldwork, and journeys around ancient monuments. Three dimensions are common to many successful projects: the idea of journeying; structured engagements between people and places; and the opportunities offered for human interaction and making sense of empirical experiences.

Aim: The aim of this paper is to explore the impact of culture on health, healthcare provision and its contribution towards health inequity experienced by some marginalised communities. Background: Health inequity is a global issue, which occurs across and within countries, and is the greatest barrier to worldwide health and the development of the human race. In response to this challenge, there is an international commitment to ensure universal health coverage based on the fundamental principle that individuals should be able to access healthcare services they need. Despite this, there is clear evidence that indigenous and other cultural minorities such as New Zealand Māori and Gypsy Roma Travellers still experience far poorer health outcomes when compared to the majority population. Furthermore, when they do access health care, their experiences are often not positive and this in turn results in reluctance to access preventative health care, instead accessing health services much later, reducing treatment options and compounding higher mortality rates. What is often not explored or examined is the impact of the different cultural beliefs of individuals in these communities and the nurses caring for them. Design: This is a position paper drawing upon research experience with New Zealand Māori and Gypsy Roma Travellers. We critically review the experiences of health inequity of marginalised communities. It does so by examining how these communities may have a different world view to the nurses caring for them and it is this lack of understanding and valuing of alternative worldviews that contributes to the poorer health outcomes both communities face. Conclusion and relevance to clinical practice: As nurses work with many different individuals and groups we have to find ways of ensuring a more embracing, culturally responsive health care environment which respects and values the beliefs of others.

Purpose Due to an international ageing population, global health organisations have recognised challenges arising from fragmented interaction between health and social sectors in end of life care. This paper shall explore existing literature on integrative palliative care services for older people. Design An integrative review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA), papers included in the review focussed upon integrated care within palliative care systems (Jan 2007-17); papers were excluded when focussed on individuals younger than 65, not written in English and not being focused on integrated palliative care. Findings- Nine studies fitted the inclusion criteria and three themes were identified: Person-centred care, coordination of care, and education and training. The review identifies that integrated palliative care requires coordinated techniques that focus upon quality of life, individual needs and awareness of vulnerability rather than fixation on inevitable mortality. Research Implications- The emerging presence of the need for integrated palliative care requires further research in order to develop coherent models of integrated palliative care which can be incorporated into practice. Originality/Value- This review identified themes relevant to emerging issues in the global health sector of end of life care. The literature suggests that the optimised use of an integrated care approach to a palliative model of care is required and in need of further investigation.

Background The significance of sanitation to safeguard human health is irrefutable and has important public health dimensions. Access to sanitation has been essential for human dignity, health and well-being. Despite 15 years of conjunctive efforts under the global action plans like Millennium Development Goals (MDGs), 2.3 billion people have no access to improved sanitation facilities (flush latrine or pit latrine) and nearly 892 million of the total world’s population is still practicing open defecation. Methods The study provides a systematic review of the published literature related to implications of open defecation that goes beyond the scope of addressing health outcomes by also investigating social outcomes associated with open defecation. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) was used to frame the review, empirical studies focusing upon open defecation in women aged 13–50 in low and middle income countries were included in the review. Research papers included in the review were assessed for quality using appropriate critical appraisal tools. In total 9 articles were included in the review; 5 of these related to health effects and 4 related to social effects of open defecation. Results The review identified 4 overarching themes; Health Impacts of open defecation, Increased risk of sexual exploitation, Threat to women’s privacy and dignity and Psychosocial stressors linked to open defecation, which clearly present a serious situation of poor sanitation in rural communities of Lower-Middle Income Countries (LMICs). The findings of the review identified that open defecation promotes poor health in women with long-term negative effects on their psychosocial well-being, however it is a poorly researched topic. Conclusion The health and social needs of women and girls remain largely unmet and often side-lined in circumstances where toilets in homes are not available. Further research is critically required to comprehend th

Studies and reports on uptake of health services in Nepal and other low-income countries often focus on limitations due to physical factors, such as travel distance to health facility, or lack of medical facilities or electricity at the health care centre or focus on resources, such as lack of service providers, or lack of appropriately trained staff. In this editorial article, we highlight the importance of discrimination as a reason for people not seeking available health care. Discrimination is particularly a barrier to service usage among the most deprived people in society, such as the Dalit community in Nepal and South Asia more generally. We discuss the caste-based discrimination in Nepal and its effects on health outcomes of those groups who experience such discrimination.

No abstract is available for this article.

Human Henge is run by the Restoration Trust in partnership with Richmond Fellowship, English Heritage, the National Trust and Bournemouth University and supported by Avon and Wiltshire Mental Health Partnership NHS Trust. It was funded by the Heritage Lottery Fund, Wiltshire County Council and English Heritage. The aim of the project was to enhance mental wellbeing of participants through activity and exploration in the prehistoric landscape. This was achieved through a facilitated programme of participant-led activities coupled with experts, carers, support workers, and contributors from a range of cultures who together explored prehistoric landscapes in the Stonehenge and Avebury World Heritage Site. This report builds upon the first report shared in June 2017 (Darvill & Heaslip 2017). The research question that framed the project was: “Does a creative exploration of historic landscape achieve sustained, measurable mental health and wellbeing outcomes for people with mental health conditions?” Answering this was achieved through two parallel investigations. First, a study of available literature and published case studies was collated and published as a chapter in the volume A handbook of well-being edited by Kate Galvin (Darvill et al. 2018). Second, the focus of this report, was an evaluation of the impact of the Human Henge project on the mental well-being of its participants.

Challenges for students who are ‘first in family’ to attend university have been discussed within widening participation discourse. However, in the UK, ‘first in family’ or first-generation students have frequently been conflated with those experiencing poverty or from lower socio-economic groups. This research integrated survey data with assessment data from final-year design and engineering students in a UK university to examine students’ attainment, the influences on why students decide to attend university, and students’ experiences during their degree programmes. Analysis of the data showed variations in the reasons for first- and second-generation students wanting to go to university, particularly a significant difference in the influence of parents. First-generation students described significantly less parental influence on the decision to attend university than second- or subsequent-generation students. Smaller differences in students’ experiences and attainment in university were also noted. While first-generation students reported differences in study habits, their attainment was, on average, marginally higher than that of their peers. Building on others’ theoretical work, which suggests the importance of social capital within higher education, this research highlights the difference in social influences both on university application and expectations of university for those with and without a family history of tertiary education. Further research is needed to explore, in larger samples, whether the social influences on an individual’s perception of higher education are in turn shaped by whether or not their parents attended university, and further, what impact this may have, not only on degree outcomes but on the broader benefits typically associated with graduate experience.

As the Office for Fair Access and the Higher Education Funding Council for England priorities now extend across widened access to success, both the aspirations of young people from widening participation (WP) backgrounds and their existing or developing resilience as students are of concern to Higher Education institutions. In this paper, these positive psychology concepts of aspiration and resilience are used in two different studies each seeking to move away from the prevalent discourse of deficit. This paper thus offers the joint perspective of two researchers exploring the phenomena of a) aspiration in students from low participation neighbourhoods and b) resilience in students from low-income backgrounds. Interpretative Phenomenological Analysis (IPA) is utilised by both to offer a credible, insightful research approach which may enable educators, researchers and policy-makers to appreciate the nature and significance of WP students’ experiences in a previously unseen way, thus enabling effective interventions and methods of support. Through in-depth exploration of the cognitions and emotions of young people from WP backgrounds, the researchers discuss how listening to individual stories can provide rich data that may enhance future support for students. Important methodological challenges and the implications of applying IPA to both studies are debated; including use of language to convey meaning, the role of researcher reflexivity and the difficulties in achieving a truly interpretative account of the phenomenon. Whilst often a challenging methodology, IPA can provide rich, contextualised accounts which contribute to the limited extant qualitative literature on WP student aspiration and resilience.

Background: Widening participation into higher education is espoused within educational policy in the UK, and internationally, as a mechanism to promote equality and social mobility. As nurse education is located within higher education it has a responsibility to promote widening participation within pre-registration educational programmes. It could also be argued that the profession has a responsibility to promote equality to ensure its’ workforce is as diverse as possible in order to best address the health needs of diverse populations. Objectives: To undertake an integrative review on published papers exploring Widening Participation in undergraduate, pre-registration nurse education in the UK Design: A six step integrative review methodology was utilised, reviewing papers 2013-2016; published in English. Data sources: Search of CINAHL, Education Source, MEDLINE, PsychINFO, SocINDEX, Science Direct, Business Scource Complete, ERIC, British Library ETOS, Teacher Reference Centre, Informit Health Collection and Informit Humanities and Social Science Collection which highlighted 449 citations; from these 14 papers met the review inclusion criteria. Review methods: Both empirical studies and editorials focusing upon widening participation in pre-registration nurse education in the UK (2013-2016) were included. Papers excluded were non UK papers or papers not focussed upon widening participation in pre-registration nursing education. Research papers included in the review were assessed for quality using appropriate critical appraisal tools Results: 14 papers were included in the review; these were analysed thematically identifying four themes; knowledge and identification of WP, pedagogy and WP, attrition and retention and career prospects. Conclusions: Whilst widening participation is a key issue for both nurse education and the wider profession there is a lack of conceptualisation and focus regarding mechanisms to both encourage and support a wider diversity of entr

Community nurses face many challenges when trying to practice evidence-based, person-centred care. Ongoing concerns regarding the impact of the 2013 Francis Report (Ford and Lintern, 2017) suggest that individualised and holistic care is an impossible dream, one made harder when the client appears uncooperative. This paper presents a case study that sets out how some of these challenges were met in a potentially difficult situation experienced by a student nurse and her mentor in practice, in which the student was supported to further examine and explore issues that may have influenced the situation. In this instance, the solution came with the recognition that the client had expertise and knowledge that needed to be taken into account, alongside that of the nurses looking after him. His care became a partnership, not an imposition of expertise; a principle which is transferable to many other situations. Underpinning it was the recognition of our shared humanity, wherein lies the essence of truly holistic care, and student nurses learning this, through the guidance and support of their mentor..

AIM: To present a new etemic model of vulnerability. BACKGROUND: Despite vulnerability being identified as a core consequence of health and health experiences there has been little research exploring the meaning of vulnerability as a concept. Yet being vulnerable is known to have dire physical/mental health consequences. It is therefore a fundamental issue for nurses to address. To date, the meaning of the term vulnerability has been influenced by the work of Spiers (2000, 2005). Spiers identified two aspects of vulnerability; the etic (external judgment of another persons' vulnerability and the emic (internal lived experience of vulnerability). This approach has led to a plethora of research which has explored the etic (external judgment) of vulnerability and rendered the internal lived (or emic) experience invisible. Consequences of this, for marginalised communities such as Gypsy Roma Travellers include a lack of culturally sensitive services compounding health inequalities. DESIGN: Position paper. METHOD: Drawing upon a qualitative phenomenological research study exploring the lived experience of vulnerability from a Gypsy Roma Travelling community (published previously), this paper presents a new model of vulnerability. This etemic model of vulnerability values both external and internal dimensions of vulnerability and argues for a fusion of these two opposing perspectives. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: If nurses and other health and social care professionals wish to develop practice that is successful in engaging with Gypsy Roma Travellers then there is a need to both understand and respect their community. This can be achieved through an etemic approach to understanding their vulnerability achieved by eliciting lived experience alongside the appreciation of epidemiological studies. Doing so would enable the development and delivery of culturally sensitive services facilitating health access to this community. Only then, will their poor health

Three empirical papers critically assess the impact and potential of foregrounding life story and digitally mediated narrative in three widening participation (WP) projects carried out in the North-East, South-West and south coast of England. The projects share a critical perspective on deficit discourses in WP theory and practice. The projects draw upon life stories of under-represented students as a way of attending to the politics of representation and the need to diversify WP discourses, utilising digital technologies and participatory methods to foreground power and positioning, representation and ethics in WP work. The papers argue that attending to social justice issues methodologically has broader significance for educational research.

Purpose - This paper explores the dark side of the relationship between gender, mobility, migration and tourism. Specifically the paper looks at one form of human trafficking, the global sex industry and the relationship between sex trafficking and sex tourism. More particularly, the paper examines the global sex industry (Goh 2009; Sassen 2000, 2001); the impact of migration and human rights aspects (Voronova and Radjenovic 2016) of sex trafficking and sex tourism as well as the emotional dimensions of trauma, violence and vulnerability (Author B). Design - The paper is an interdisciplinary discussion paper combining socio-economic perspectives (Goh 2009; Author A), human rights perspectives (Cheah 2006), migration perspectives (Voronova and Radjenovic 2016) tourism perspectives (Carolin et al 2015) and health perspectives (Cary et al. 2016, Matos et al. 2013, Reid and Jones 2011). The contribution of these intersecting perspectives to an understanding of sex trafficking and sex tourism is explored. Findings - The paper highlights the moral and ethical responsibility of the tourist industry to counteract sex trafficking and sex tourism, an issue which tourism studies have failed to fully engage with. In presenting the human costs of trafficking from a gender perspective, the paper considers the ways in which the tourism industries, in some countries are attempting to respond. Originality/Value – In theorising the relationship between gender, migration, sex trafficking and tourism from an interdisciplinary perspective, exploring the societal and individual impact, this paper provides a framework for further empirical research or policy changes with regards to the intersection of sex trafficking and tourism.

Research and clinical practice education are often conceptualised as related but opposing areas of professional development. While nurse education and training highlights the importance of evidence based practice, often in reality the career trajectories and leadership development of nurses working as researchers or practitioners exist as parallel entities. In many countries this is further complicated by the fact that becoming a nurse researcher, educationalist or clinical practitioner requires an individual to select disparate career pathways. However the professional regulatory bodies for nursing stipulate that utilising evidence to inform education, policy and practice of healthcare is an essential part of nurses’ fitness to practice (Nursing Midwifery Council 2014). In addition, in the UK as elsewhere, national strategic priorities for nurses highlight nurses’ responsibility to evidence the work they do and the impact it has on patient care (NHS England 2016; Nursing Council New Zealand 2016). The authors here therefore assert, that far from being disparate requirements nurse educators have a responsibility to ensure that research and practice are unified and that nurses at the point of qualification and beyond are research ready and research able respectively. This paper explores the critical relationship between research readiness and fitness to practice in a nursing context and argues that failure to ensure that education programmes equip nurses with the skills to use, understand, create and apply research evidence fail to adequately prepare them for practice in the 21st century. NHS England, 2016. Leading Change; adding value a framework for nursing midwives and care staff. London: NHS. Nursing Council for New Zealand. 2016. Competencies for registered nurses. Nursing Council for New Zealand: Wellington. Nursing Midwifery Council, 2014. Standards for competence for registered nurses. London: Nursing Midwifery Council.

Mental health is a fundamental aspect of wellbeing; yet 1 in 4 people experience a mental health issue at some point in their life. Despite this, there is evidence that people living with mental illness can become isolated due to stigma. Historical sites such as Stone Henge are known to have been associated with healing in the past and there is an increasing interest in the impact of history and heritage in supporting and restoring mental wellbeing. This presentation reports upon a collaborative project funded by Heritage Lottery in which 24 people living with mental illness were involved in an innovative, creative ‘Human Henge’ programme over a period of 10 weeks at Stone Henge and the surrounding landscape. This paper presents initial findings from the mixed method evaluation that ran alongside the programme, examining the impact of Human Henge upon individual’s metal health. Data was collected via surveys (incorporating the Warwick Edinburgh Mental Wellbeing Scale) as well as qualitative methods (focus groups and personal reflections). The presentation will explore both quantitative and qualitative findings to date focussed upon four themes (Feeling Special, Challenging myself, Being Human, Impact upon mental health & wellbeing and Fear for the future).

Within the United Kingdom (UK) there is an increasing focus on Values Based Recruitment (VBR) of staff working in the National Health Service (NHS) in response to public inquiries criticising the lack of person-centred care. All NHS employees are recruited on the basis of a prescribed set of values. This is extended to the recruitment of student healthcare professionals, yet there is little research of how to implement this. Involving Service Users in healthcare educational practice is gaining momentum internationally, yet involvement of service users in VBR of ‘would be’ healthcare professionals remains at an embryonic phase. Adult nurses represent the largest healthcare workforce in the UK, yet involvement of service users in their recruitment has received scant attention. This paper is an evaluation of the inclusion of service users in a VBR of 640 adult student nurses.

Background: To gain additional insight on health outcomes, this presentation explores health systems in three industrialized, high income countries located on three different continents, United Kingdom (UK), Israel, and United States (US). The UK, Israel and the US differ in size, population structure, and have very different health care systems. The purpose of this presentation is to describe the healthcare systems of the countries, discuss health outcomes in vulnerable populations, and propose a more proactive approach to health care delivery. Methods. Utilizing three factors of the Behavior Model of Utilization (health system environments, characteristics of the population, and health outcomes), this presentation examines healthcare accessibility for each of the countries. Results. Health systems and populations in the three countries differed dramatically, but many similarities surfaced. Most importantly, all countries' health systems had issues addressing the health needs of socioeconomically low income individuals, immigrants, and minorities which was reflected in unmet needs and inadequate health promoting behaviors. Conclusions. Philosophies of "health is a right" or "health is a benefit to be purchased" have not altered the level of health outcomes or nature of gaps in providing care to several vulnerable population groups. High income countries must take an active approach to address gaps in health care delivery. Relevance to clinical practice. Nurses comprise the largest health-care workforce in the world and must take the lead in reaching out to engage high risk population groups worldwide to provide them information on the use of health care systems and the importance of preventive care with the goal of reducing poor health outcomes and decreasing health disparities.

This article explores how higher education institutions in England engage with research in their access agreements. Through an analysis of access agreements from 2014-15 to 2016-17, a picture of how research is understood, undertaken and documented emerges. A lexical analysis of the texts was used to establish the different ways research is being referred to or funded as part of the access agreement process. The analysis shows a productive relationship between national policy and institutional activity. But there appears to be a lack of infrastructure at an institutional and sector level to join up sustained and rigorous research with widening participation activity and policy. This means that, even after ten years of access agreements, widening participation is not fully embedded into the academic practice of higher education. We argue that research undertaken as part of the access agreement process can provide much needed evidence of impact and situate activity within an institution-wide context. However, we also suggest that widening participation research has the potential to offer productive troubling ideas to dominant rhetoric and, in so doing, shape new ways of thinking about, and doing, widening participation within institutions and across the sector.

In a climate of intense international scrutiny of healthcare and nursing in particular, there is an urgent need to identify, foster and support a caring disposition in student nurses worldwide. Yet relatively little is known about how core nursing values are shaped during education programmes and this warrants further investigation. This longitudinal study commencing in February 2013 examines the impact of an innovative nursing curriculum based on a humanising framework (Todres et al. 2009) and seeks to establish to what extent professional and core values are shaped over the duration of a three year nursing programme. This paper reports on Phase One which explores student nurses' personal values and beliefs around caring and nursing at the start of their programme. Undergraduate pre-registration nursing students from two discrete programmes (Advanced Diploma and BSc (Honours) Nursing with professional registration) were recruited to this study. Utilising individual semi-structured interviews, data collection commenced with February 2013 cohort (n = 12) and was repeated with February 2014 (n = 24) cohort. Findings from Phase One show that neophyte student nurses are enthusiastic about wanting to care and aspire to making a difference to patients and their families. This research promises to offer contributions to the debate around what caring means and in particular how it is understood by student nurses. Findings will benefit educators and students which will ultimately impact positively on those in receipt of healthcare.