Pain in care home residents with dementia: an exploration of frequency, prescribing and relatives' perspectives

Objectives: This study aims to determine pain frequency amongst care home residents with dementia, to investigate variables associated with pain, to explore analgesic use among residents and to seek residents' relatives' views on provision of care and management of pain by the care home. Methods: Structured face-to-face interviews were conducted with residents, nursing staff and relatives from nine dementia care homes in Northern Ireland, between May 2010 and March 2012. Demographic information was collected from participants, neuropsychiatric tests were used to assess residents' cognitive functioning, medication use was determined from care home records and residents' pain was assessed using a verbal descriptor scale. Relatives' views were sought on care provision and management of pain. Results: Forty-two residents, 16 nurses/care assistants and 35 relatives participated; the participation rate of residents was low (27.6%). Most residents were suffering moderate-severe dementia, and some residents (26.2%) were unable to provide a self-report of pain. A significantly higher proportion of relatives (57.1%) deemed residents to be experiencing pain at the time of the interview, compared with residents (23.8%, p = 0.005) and nurses/care assistants (42.9%, p = 0.035). Most residents (88.1%) were prescribed with analgesia; non-opioid analgesics were most commonly prescribed. High proportions of residents were prescribed with psychoactive medications. Antipsychotic drug use was associated with presence of pain (p = 0.046). Conclusions: This study has reinforced the challenge of assessing and managing pain in this resident population and highlighted issues to be addressed by long-term care providers and clinicians. Participation of people with dementia, and their families, in healthcare research needs to be improved.

Realising Justice for victims before the International Criminal Court

The International Criminal Court (ICC) has been celebrated for its innovative victim provisions, which enable victims to participate in proceedings, avail of protection measures and assistance, and to claim reparations. The impetus for incorporating victim provisions within the ICC, came from victims’ dissatisfaction with the ad hoc tribunals in providing them with more meaningful and tangible justice.1 The International Criminal Tribunals for the former Yugoslavia and Rwanda (ICTY/R) only included victim protection measures, with no provisions for victims to participate in proceedings nor to claim reparations at them. Developments in domestic and international law, in particular human rights such as the 1985 UN Declaration on Justice for Victims and the UN Guidelines on Remedy and Reparations, and transitional justice mechanisms, such as truth commissions and reparations bodies, have helped to expand the notion of justice for international crimes to be more attuned to victims as key stakeholders in dealing with such crimes.

With the first convictions secured at the ICC and the victim participation and reparation regime taking form, it is worth evaluating the extent to which these innovative provisions have translated into justice for victims. The first part of this paper outlines what justice for victims of international crimes entails, drawing from victimology and human rights. The second section surveys the extent to which the ICC has incorporated justice for victims, in procedural and substantive terms, before concluding in looking beyond the Court to how state parties can complement the ICC in achieving justice for victims. This paper argues that while much progress has been made to institutionalise justice for victims within the Court, there is much more progress needed to evolve and develop justice for victims within the ICC to avoid dissatisfaction of past tribunals.

Πολιτικες ασύλου της ΕΕ- A critical review of the European policies of asylum: The re-positioning of asylum seekers from refugees/victims in need of protection to criminals (illegal immigrants)

This publication traces how asylum seekers are repositioned in the existing European asylum legislation from asylum seekers as victims in need of protection, to criminals . It is argued that this is due to the European legislation concerning the area of freedom, security and justice. The latest asylum legislation seems to undermine the refugee status which -as it is widely known- is safeguarded by the 1951 Geneva Convention relating to the Status of Refugees and its relevant 1967 Protocol. Additionally, in this paper the role of social workers and other social scientists to protect the rights of asylum seekers and question the existing legislation is presented.

When terror hits home: Identity Fused Americans who saw Boston bombing victims as “family” provided aid

When tragedy strikes a group, only some group members characteristically rush to the aid of the victims. What motivates the altruism of these exceptional individuals? Here, we provide one set of answers based on data collected before and shortly after the 15 April 2013, Boston Marathon bombings. The results of three studies indicated that Americans who were strongly “fused” with their country were especially inclined to provide various forms of support to the bombing victims. Moreover, the degree to which participants reported perceiving fellow Americans as psychological kin statistically mediated links between fusion and pro-group outcomes. Together, these findings shed new light on relationships between personal and group identity, cognitive representations of group members, and personally costly, pro-group actions.

Elaborating Justice for Victims at the International Criminal Court: Beyond Rhetoric and the Hague

Justice for victims has often been invoked as the raison d’être of international criminal justice, by punishing perpetrators of international crimes. This article attempts to provide a more holistic account of justice for victims by examining victims’ needs, interests, and rights. The International Criminal Court itself includes participation, protection and reparation for victims, indicating they are important stakeholders. This article also suggests that victims are integral to the purpose of the ICC in ending impunity by ensuring transparency of proceedings. However, there are limits to the resources and capacity of the ICC, which can only investigate and prosecute selected crimes. To overcome this justice gap, this article directs the debate towards a victim-orientated agenda to complementarity, where state parties and the Assembly of State Parties should play a greater role in implementing justice for victims domestically. This victim-orientated complementarity approach can be achieved through new ASP guidelines on complementarity, expanding universal jurisdiction, or seeking enforcement and cooperation through regional and international bodies and courts, such asUniversal Periodic Review or the African Court’s International Criminal Law Section. In the end, ifwe are serious about delivering justice for victims we need to move beyond the rhetoric, with realistic expectations of what the ICC can achieve, and concentrate our attention to what states should bedoing to end impunity.

Meaningful and Effective? Considering Victims’ Interests Through Participation at the International Criminal Court

This article explores the role of victims in the criminal proceedings of the International Criminal Court and the extent to which their interests have impacted upon the ICC judges’ decision making in light of human rights law and victimological theorisation. The article begins by first outlining how victims’ interests can be considered in international criminal proceedings, before contrasting this role with the purpose of international criminal justice. The second part of the article examines victim participation within the ICC and how this has affected judicial decision making to assess its effectiveness. The contest between the rights of victims and the role of Prosecutor in determining the selection of charges and perpetrators is also examined in an effort to add to the current debate on victim participation at the ICC. The author finds that at the ICC, despite innovative victim provisions, victims’ interests have little impact on outcomes of the Court. The author argues that in order to ensure the Court is more responsive to victims understanding of justice it should give greater weight to their interests, which in turn is likely to improve their satisfaction with the ICC, as well as public confidence and legitimacy of the work of the Court.

The community trigger for anti-social behaviour: protecting victims or raising unrealistic expectations?

In October 2014, a statutory remedy for victims of anti-social behaviour became available called the community trigger. It affords complainants a right to request a review of their case if they consider that the response from local agencies has been inadequate. The Government has hailed the reform as “putting victims first”. This article first explores the context behind this reform. This includes a number of high profile cases involving the deaths of complainants after systematic failures led to prolonged exposure to anti-social behaviour. The article then examines the provisions and how they are likely to operate in practice. It argues that whilst much will depend upon implementation, the community trigger has the potential to improve the level of service offered to vulnerable complainants without necessarily impacting adversely on the rights of alleged perpetrators. As such, the community trigger may provide a model from which other areas of the criminal justice system may draw.

The inclusion and juridification of victims on the Island of Ireland

Concern for crime victims has been a growing political issue in improving the legitimacy and success of the criminal justice system through the rhetoric of rights. Since the 1970s there have been numerous reforms and policy documents produced to enhance victims’ satisfaction in the criminal justice system. Both the Republic of Ireland and Northern Ireland have seen a sea-change in more recent years from a focus on services for victims to a greater emphasis on procedural rights. The purpose of this chapter is to chart these reforms against the backdrop of wider political and regional changes emanating from the European Union and the European Court of Human Rights, and to critically examine whether the position of crime victims has actually ameliorated.

While separated into two legal jurisdictions, the Republic of Ireland and Northern Ireland as common law countries have both grappled with similar challenges in improving crime victim satisfaction in adversarial criminal proceedings. This chapter begins by discussing the historical and theoretical concern for crime victims in the criminal justice system, and how this has changed in recent years. The rest of the chapter is split into two parts focusing on the Republic of Ireland and Northern Ireland. Both parts examine the provisions of services to victims, and the move towards more procedural rights for victims in terms of information, participation, protection and compensation. The chapter concludes by finding that despite being different legal jurisdictions, the Republic of Ireland and Northern Ireland have introduced many similar reforms for crime victims in recent years.

Reparations for ‘guilty victims’: Navigating Complex Identities of Victim-Perpetrators in Reparation Mechanisms

Reparations are often declared victim-centred, but in transitional societies defining who is a victim and eligible for reparations can be a politically charged and controversial process. Added to this, the messy reality of conflict means that perpetrators and victims do not always fall in two separate categories. Instead in certain circumstances perpetrators can be victimised and victims can be responsible for victimising others. This article explores complex victims, who are responsible for victimising others, but have themselves been unlawfully victimised. Looking in particular at the 1993 Shankill bombing in Northern Ireland, as well as Colombia and Peru, such complex victims are often seen as ‘guilty’ or ‘bad’ victims undeserving of reparations. This article argues that complex victims need to be included in reparation mechanisms to ensure accountability and to prevent their exclusion becoming a source of victimisation and future violence. It considers alternative avenues of human rights courts, development aid, services and community reparations to navigate complex identities of victim-perpetrators. In concluding the author finds that complex identities can be accommodated in transitional societies reparation programmes through nuanced rules of eligibility and forms of reparations.

Developing an information booklet to meet the needs of intensive care patients and relatives

Changes in the economic climate and the delivery of health care require that pre-operative information programmes are effective and efficiently implemented. In order to be effective the pre-operative programme must meet the information needs of intensive care unit (ICU) patients and their relatives. Efficiency can be achieved through a structured pre-operative programme which provides a framework for teaching. The need to develop an ICU information booklet in a large teaching hospital in Northern Ireland has become essential to provide relevant information and improve the quality of service for patients and relatives, as set out in the White Paper, ‘Working for Patients’, (DoH, 1989). The first step in establishing a patient education programme was to ascertain patients' and relatives' informational needs. A ‘needs assessment’ identified the pre-operative information needs of ICU patients and their relatives (McGaughey, 1994) and the findings were used to plan and publish an information booklet. The ICU booklet provides a structure for pre-operative visits to ensure that patients and relatives information needs are met.

A Pension for Injured Victims of the Troubles: Reparations or Reifying Victim Hierarchy?

Reparations have been often used victim-centred measures to redress both private harm and gross violations of human rights. However, with the increasing occurrence of internal armed conflict and political violence, identities of victims and perpetrators in protracted conflicts can become blurred for some individuals. In countries like Peru and Northern Ireland that have suffered protracted violence, victimhood has been contested around which individuals are seen as innocent and deserving to exclude any members of non-state armed groups from claiming reparations. This article explores the issue of a proposed bill on a pension for injured victims of the Troubles in Northern Ireland. It identifies that there is no consistent state practice or human rights jurisprudence in this area, but instead offers a more complex approach through four models that can grapple with the seeming diametrically opposed victimhood and responsibility, by including victimised-perpetrators in reparations programmes such as that proposed for a pension of seriously injured victims in Northern Ireland.