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The use of Instagram by adolescents to access deliberate self-harm content is a growing concern among scholars, mental health professionals and families, with many adolescents (10–19-year-olds) imitating offline what they have seen online. This scoping review aims to investigate the extent to which Instagram use impacts the mental health of its adolescent users, identifying if there is a relationship between time spent on Instagram and engagement in deliberate self-harm. The databases, Pubmed, Web of Science, Google scholar, APA PsycInfo, CINAHL and Child Development and Adolescent Studies were explored and after applying the inclusion/exclusion criteria 15 papers were included in this review. Thematic analysis indicated that there was a relationship between time spent on Instagram and deliberate self-harm; de-sensitisation of deliberate self-harm resulting in normalisation; social contagion and that Instagram provided a sense of belonging to its users who engaged in deliberate self-harm. Implications of this research is that it is quickly outdated as new social media platforms are developed and that the reliance on self-reports does not have high validity or reliability.

Focussing on end-of-life care for people who use, or have used, substances, this book explores their social and health care needs and the multiple disadvantages they have often experienced, discussing the complexities around access to care.

Background Secondary traumatic stress (STS) has been defined as the stress resulting from helping or wanting to help a traumatised or suffering person. The hyperacute nature of stroke specialist nurses’ work places them at risk of developing STS. Aims To explore the factors that are influential in stroke specialist nurses' experience of STS development within hyperacute practice. Methods This study is qualitative with a narrative design. Data were collected from a purposive sample of stroke specialist nurses (20 female and 2 male) working in hyperacute services during the years 2016 and 2017. Data were analysed using Polkinghorne’s approach. Results This research identified four themes: exposure to acute suffering and death- young presentations; moral distress; interactions with relatives and problematic healthcare systems. Conclusion The findings from this study suggest that stroke specialist nurses are exposed to multiple triggers which are commensurate with the potential for STS development. The findings contribute a new understanding of the emotional burden of hyperacute specialist stroke nursing that has implications for patient safety and satisfaction, services provision and staff well-being.

Background Secondary traumatic stress (STS) has been defined as the stress resulting from helping or wanting to help a traumatised or suffering person. The hyperacute nature of stroke specialist nurses’ work places them at risk of developing STS. Aims To explore the factors that are influential in stroke specialist nurses' experience of STS development within hyperacute practice. Methods This study is qualitative with a narrative design. Data were collected from a purposive sample of stroke specialist nurses (20 female and 2 male) working in hyperacute services during the years 2016 and 2017. Data were analysed using Polkinghorne’s approach. Results This research identified four themes: exposure to acute suffering and death- young presentations; moral distress; interactions with relatives and problematic healthcare systems. Conclusion The findings from this study suggest that stroke specialist nurses are exposed to multiple triggers which are commensurate with the potential for STS development. The findings contribute a new understanding of the emotional burden of hyperacute specialist stroke nursing that has implications for patient safety and satisfaction, services provision and staff well-being.

This discussion article examines narrative positioning related to pain management for people who use substances at the end of life. We explore how dominant narrative genres associated with biomedicine, such as 'restitution' and narratives common within the context of drug services such as 'recovery' can hinder effective pain management within this population. We argue that these discourses can marginalise the ethical self-identity of patients who use substances at the end of life. It can also trouble health and social care professionals in supporting patients and generating counter-narratives that challenge those often associated with substance use. Stigma is a common experience for this population with stereotyping as 'junkies' and associated with criminality. They are positioned as drug-seeking, and this requires more surveillance at the end of life when opioid therapy is potentially more available and authorised. This can make it challenging to generate 'companion' stories that are positive and maintain moral adequacy. Dominant biomedical narrative genres often prevent the recognition of the fractured stories that people using substances can often present with. This can lead to narrative silencing and to the under treatment of pain. The person's self-identity is invested in narratives of recovery, and opioid use symbolises their addicted past because for practitioners, this population is at clinical risk with the potential for drug seeking behaviours. Whilst not requiring formal ethical review this discussion paper was constructed in accordance with good scientific practice with the work of other researchers respected and cited appropriately.

This discussion article examines narrative positioning related to pain management for people who use substances at the end of life. We explore how dominant narrative genres associated with biomedicine, such as 'restitution' and narratives common within the context of drug services such as 'recovery' can hinder effective pain management within this population. We argue that these discourses can marginalise the ethical self-identity of patients who use substances at the end of life. It can also trouble health and social care professionals in supporting patients and generating counter-narratives that challenge those often associated with substance use. Stigma is a common experience for this population with stereotyping as 'junkies' and associated with criminality. They are positioned as drug-seeking, and this requires more surveillance at the end of life when opioid therapy is potentially more available and authorised. This can make it challenging to generate 'companion' stories that are positive and maintain moral adequacy. Dominant biomedical narrative genres often prevent the recognition of the fractured stories that people using substances can often present with. This can lead to narrative silencing and to the under treatment of pain. The person's self-identity is invested in narratives of recovery, and opioid use symbolises their addicted past because for practitioners, this population is at clinical risk with the potential for drug seeking behaviours. Whilst not requiring formal ethical review this discussion paper was constructed in accordance with good scientific practice with the work of other researchers respected and cited appropriately.

People who use alcohol and other drugs(hereafter ‘substances’) and who are over the age of 40 are now more likely to die of a non-drug related cause than people who use substances under the age of 40. This population will therefore potentially need greater access to palliative and end-of-life care services. Initially, the purpose of this rapid evidence assessment (REA), conducted August 2016- August 2017, was to explore the peer-reviewed evidence base in relation to end-of-life care for people with problematic substance use. The following databases were searched using date parameters of 1st January 2004-1st August 2016: Amed, Psycharticles, Ovid, Ageinfo, Medline, Ebscohost, ASSIA, Social Care Online, Web of Knowledge, Web of Science, SSCI, Samsha, NIAAA. Data were extracted using a pre-defined protocol incorporating inclusion and exclusion criteria. Given the dearth of evidence emerging on interventions and practice responses to problematic substance use, the inclusion criteria were broadened to include any peer-reviewed literature focussing on substance use specifically and end of life care. There were 60 papers that met the inclusion criteria. These were quality assessed and rated low, moderate or high quality. Using a textual thematic approach to categorise findings, papers fell into three broad groups i) pain and symptom management, ii) homeless and marginalised groups, and iii) alcohol-related papers. In general, this small and diverse literature lacked depth and quality. The papers suggest there are clear challenges for health and social care professionals in meeting the end-of-life needs of people who use substances. Addressing issues like safe prescribing for pain management becomes more challenging in the presence of substance use and requires flexible service provision from both alcohol/drug services and end of life care providers. Work is needed to develop models of good practice in working with co-existing substance use and end of life conditions as wel

A lot of later life care is centred on the family. A member of a family, usually an adult daughter or son, informally care for an older parent. Families often include people who are not biological kin but who hold a similar status – ‘fictive kin’. For example, a long-term neighbour or friend from school might be known as an Aunty or Uncle. Often the biological child or ‘fictive kin’ is the ‘go-between’ between older parent(s) and formal care services. They perform an essential role in maintaining the dignity and independence of the older person(s) and facilitate access into and out of care services. However, over the last few decades there has been a change in the shape of families. This change is linked to long-term decline in fertility rate, the rise in the age of mortality, economics, increase in divorce rate and stepfamilies. Not only are families smaller than they once were but there is an increase in number of people ageing without children. By 2030 it is estimated there will be over a million people aged 65 or over who are childless McNeil (McNeil and Hunter, 2014). The childless are a much under researched group and as a result they are often absent from both policy and practice information. Research shows that older childless people are not disadvantaged when they are well but should they need help they are more quickly taken into formal care settings than people with family (Albertini and Mencarini, 2014). Moreover, as men tend have smaller social networks and more likely to be estranged from adult children than women, they more likely to be placed in residential care than equivalent women (Arber et al., 2003).