(Re)examining the relationship between children's subjective wellbeing and their perceptions of participation rights

In recent years wellbeing has been linked increasingly with children’s rights, often characterised as central to their realisation. Indeed it has been suggested that the two concepts are so intertwined that their pairing has become something of a mantra in the literature on childhood. This paper seeks to explore the nature of the relationship between wellbeing and participation rights, using a recently developed ‘rights-based’ measure of children’s participation in school and community, the Children’s Participation Rights Questionnaire (CPRQ), and an established measure of subjective wellbeing – KIDSCREEN-10. The data for the study came from the Kids’ Life and Times (KLT) which is an annual online survey of Primary 7 children carried out in Northern Ireland. In 2013 approximately 3,800 children (51% girls; 49% boys) from 212 schools participated in KLT. The findings showed a statistically significant positive correlation between children’s overall scores on the KIDSCREEN-10 subjective wellbeing measure and their perceptions that their participation rights are respected in school and community settings. Further, the results indicated that it is the social relations/autonomy questions on KIDSCREEN-10 which are most strongly related to children’s perceptions that their participation rights are respected. Exploration of the findings by gender showed that there were no significant differences in overall wellbeing; however girls had higher scores than boys on the social relations/autonomy domain of KIDSCREEN-10. Girls were also more positive than boys about their participation in school and community. In light of the findings from this study, it is suggested that what lies at the heart of the relationship between child wellbeing and children’s participation rights is the social/relational aspects of both participation and wellbeing.

How can we use systematic reviews to inform clinical practice?

Aims/purpose: Systematic reviews provide the highest quality evidence and inform clinical practice. For patient benefit, it is imperative that nurses keep abreast of evidence-based practice. This presentation highlights where to find systematic reviews and how the information presented can be used to inform care.
Presentation description: Clinical research is increasing at an incredible rate. In the clinical trials database alone, more than 2000 new studies are registered/month and this does not include qualitative studies that do not require registration. Keeping abreast of current evidence can not only be a time consuming process, but can be problematic when studies produce conflicting results. Systematic reviews can be useful for summarizing the increasing amount of knowledge that is gained from scientific papers. In addition, combining individual studies in a meta-analysis increases statistical power, resulting in more precise effect estimates. This presentation draws upon a few systematic reviews relevant to ICU nursing practice, highlights their findings and demonstrates how the information can be used to inform translation of evidence into practice. Additionally, although these reviews include steps to minimize bias, nurses should be aware of some of the biases that may reduce confidence in the findings.
Conclusion: Systematic reviews can be useful tools for informing evidence based practice, although careful interpretation is necessary for understanding their relevance to local practice.

IMPLEMENTING BACK PAIN TREATMENT PATHWAYS IN CLINICAL PRACTICE: QUALITATATIVE ANALYSIS OF STAKEHOLDER PERCEPTIONS

Background
Evidence-based practice advocates utilising best current research evidence, while reflecting patient preference and clinical expertise in decision making. Successfully incorporating this evidence into practice is a complex process. Based on recommendations of existing guidelines and systematic evidence reviews conducted using the GRADE approach, treatment pathways for common spinal pain disorders were developed.

Aims
The aim of this study was to identify important potential facilitators to the integration of these pathways into routine clinical practice.

Methods
A 22 person stakeholder group consisting of patient representatives, clinicians, researchers and members of relevant clinical interest groups took part in a series of moderated focus groups, followed up with individual, semi-structured interviews. Data were analysed using content analysis.

Results
Participants identified a number of issues which were categorized into broad themes. Common facilitators to implementation included continual education and synthesis of research evidence which is reflective of everyday practice; as well as the use of clear, unambiguous messages in recommendations. Meeting additional training needs in new or extended areas of practice was also recognized as an important factor. Different stakeholders identified specific areas which could be associated with successful uptake. Patients frequently defined early involvement in a shared decision making process as important. Clinicians identified case based examples and information on important prognostic indicators as useful tools to aiding decisions.

Conclusion
A number of potential implementation strategies were identified. Further work will examine the impact of these and other important factors on the integration of evidence-based treatment recommendations into clinical practice.

Bereavement: A D.I.S.C. analysis

Theories of bereavement abound. The endeavour to understand this complex process has moved from intra-psychic explanations and stage theories to cognitive rationalizations and, most recently, process orientated explorations of bereavement. What has been missing in most of the literature to date is a detailed analysis of the context within which bereavement behaviours occur. This paper outlines a contingency analysis that includes consideration for the context of Death itself, Individual factors of the bereaved, Social factors, and influences of Cultural norms and systems (D.I.S.C.). The paper concludes by proposing that a comprehensive D.I.S.C. analysis might lead to whole person evidence-based practice in helping those who are experiencing bereavement.

A healthy settings framework: an evaluation and comparison of midwives' responses to addressing domestic violence

Objectives: to compare and contrast how midwives working in either hospital- or community-based settings address domestic violence by evaluating their views on: prevalence of domestic violence; their role in addressing domestic violence; the acceptability of routine enquiry; and barriers encountered in asking clients questions about violence and abuse in pregnancy. Design: a postal survey questionnaire. Setting: Northern Ireland. Study population: 983 hospital and community midwives. Findings: overall, 488 midwives returned a completed questionnaire; a 57% response rate. Comparisons were made using descriptive, inferential statistics and cross-tabulation. Although there were significant differences between hospital- and community-based midwives in relation to domestic violence, both groups of midwives tended to underestimate its prevalence. Key conclusions: the findings suggest that midwives per se identify and respond to a fraction of the cases of domestic abuse in pregnancy, due to lack of confidence, education and training. This reinforces the need for both hospital and community midwives to gain further confidence and an understanding of the many psychosocial factors that surround domestic violence. Implications for practice: healthy settings theory can be used effectively to identify good practice with women who experience domestic violence. Effective investment for health care requires the gaps between hospital- and community-based practice to be bridged, and for work to be integrated.

Social work in the UK: a testing ground for trialists

This article examines the history of social work research within the UK from a perspective of evidence-based practice, as originally advocated in the 1990s. It reviews the progress made to date in relation to the use of experimental studies in the field of children and families, and the reasons why this remains limited. It sets this in the broader context of evidence-based practice and the education and training of qualifying and post-qualifying social workers, including postgraduate training.

Research priorities of adult intensive care nurses in 20 European countries: a Delphi study.

Aims: This paper is a report of a three round Delphi study of intensive care nursing research priorities in Europe (October 2006–April 2009).

Background: Internationally, priorities for research in intensive care nursing have received some attention focusing on healthcare interventions and patient needs. Studies as early as the 1980s identified priorities in the United States, United Kingdom, Hong Kong and Australia. Research priorities of intensive care nurses across the European Union are unknown.

Methods: The participants, invited in 2006, included 110 intensive care nurses, managers, educators and researchers from 20 European Critical Care Nursing Associations. Delphi round one was an emailed questionnaire inviting participants to list important areas for research. The list was content analysed and developed into an online questionnaire for rounds two and three. In round two, participants ranked the topics on a scale of 1–6 (not important to extremely important). Mean scores of round two were added to the questionnaire of round three and participants ranked the topics again.

Results: There were 52 research topics in 12 domains. There was a dominance of priorities in five main areas: patient safety; impact of evidence based practice on outcomes; impact of workforce on outcomes; well being of patients and relatives; and impact of end-of-life care on staff and practice.

Conclusions: The results reflect worldwide healthcare concerns and objectives and highlight topics that nurses view as fundamental to the care of critically ill patients. These topics provide a platform for future research efforts to improve clinical practice and care of patients in intensive care.

Systemic Family Therapy for Families who have Experienced Trauma: A Randomised Controlled Trial

This paper describes a randomised controlled trial (RCT) investigation of the added value of systemic family therapy (SFT) over individually focused cognitive behavioural therapy (CBT) for families in which one or more members has suffered trauma and been referred to a community-based psychotherapy centre. The results illustrate how an apparently robust design can be confounded by high attrition rates, low average number of therapeutic sessions and poor protocol adherence. The paper highlights a number of general and specific lessons regarding the resources and processes involved that can act as a model for those planning to undertake studies of this type and scope. A key message is that the challenges of conducting RCTs in ‘real world’ settings should not be underestimated. The wider implications in relation to the place of RCTs within the creation of the evidence base for complex psycho-social interventions is discussed and the current movement towards a phased mixed-methods approach, including the appropriate use of RCTs, which some might argue is a return to the original vision of evidence-based practice (EBP), is affirmed.

Do conflict management systems matter?

The most influential current idea in the theory of conflict management concerns the design features and supposed superior outcomes of conflict management systems combining interest-based and rights-based practices for resolving conflict in organizations. Yet much of the literature in the area is highly prescriptive and draws heavily either on exemplary case studies or descriptive data. Using focus groups of HR practitioners and experts in conflict resolution to develop a questionnaire covering the main conflict management practices associated with the theory of conflict management systems, the study analyzes data from a survey of firms in the Republic of Ireland to examine quantitatively the effects of conflict management systems on organizational outcomes. While proactive line management and supervisory engagement in conflict resolution as a key dimension of conflict management systems is found to be positively associated with a range of organizational outcomes, no evidence is found for the kind of system effects proposed in the theoretical and prescriptive literature. © 2012 Wiley Periodicals, Inc.

Playful structure: a novel image of early years pedagogy for primary school classrooms

Playful structure is a new pedagogic image representing a more balanced and integrated perspective on early years pedagogy, aiming to blend apparent dichotomies and contradictions and to sustain and evolve play-based practice beyond Year 1. Playful structure invites teachers and children to initiate and maintain a degree of playfulness in the child’s whole learning experience, even when the learning intentions demand a supportive structure. Thus, playfulness becomes characteristic of the interaction between adult and the child and not just characteristic of child-initiated versus adult-initiated activities, or of play-time versus task-time. The paper is based on intensive observations and interviews with teachers in Northern Ireland who participated in a play-based and informal curriculum. This paper explains how playful structure rests on complementary processes of infusion of structure into play-based activities and infusion of playfulness into more structured activities, illustrated by cameos. ‘Infusion’ suggests the subtle blending process that allows apparent dichotomies and contradictions to be resolved in practice.

Social work research: the state we’re in

This paper presents an argument in favour of a particular research strategy as the basis for evidence-based practice in social care. It presents some grounds for optimism and reviews the difficulties that need to be overcome if this model of evidence-based practice is to prevail over other, more laissez-faire, versions.

“They might as well be walking around the inside of a biscuit tin”: Barriers to Employment and Reintegration for ‘Politically Motivated’ Former Prisoners in Northern Ireland

The prisoner provisions under the Northern Ireland Peace Agreement clearly emphasised the importance of the reintegration and civic inclusion of ‘politically motivated’ former prisoners; however, numerous barriers to full reintegration remain. Even though these prisoners were released as part of a peace process, based on principles of conflict transformation and reconciliation, there were still The prisoner provisions under the Northern Ireland Peace Agreement emphasised the importance of the reintegration and civic inclusion of ‘politically motivated’ former prisoners; however, numerous barriers to full reintegration remain. Notwithstanding the fact that these prisoners were released as part of a peace process, based on principles of conflict transformation and reconciliation, there were still numerous conditions placed upon them as part of their release process and they continued to hold a ‘criminal’ record upon release. As with ‘ordinary’ ex-prisoners, these ‘politically motivated’ former prisoners have subsequently faced numerous obstacles in their attempts to reintegrate back into society, particularly in the area of employment. Recognising that they needed to deal with the consequences of imprisonment, ‘politically motivated’ former prisoners formed numerous self-help organisations to assist in the reintegration process and have mobilised to lobby for protection against the discrimination and unequal treatment experienced by ex-prisoners seeking employment. This article explores the remaining barriers to employment for ‘politically motivated’ former prisoners and the consequences of these barriers. The article moves to assess how prisoner groups have subsequently used a ‘rights based’ discourse to engage local government in their struggle to overcome existing obstacles before finally concluding that any piecemeal attempt to remove barriers to full reintegration will only impede the longer term conflict transformation process in Northern Ireland.

Comparing long-term placements for young children in care: The care pathways and outcomes study - Northern Ireland

When deciding on a long-term placement for a young child in care, a key challenge is to identify one that will enable children to achieve their full potential and enhance their health and wellbeing in the longer term. However, there is a dearth of research evidence that compares how children fare in the longer term across placement options.

The Care Pathways and Outcomes study is one of a small number of studies internationally that takes this form of longitudinal comparative approach. Since 2000, it has been tracking the placement profile for a population of children who were under the age of five and in care in Northern Ireland on a particular census day, and gathering comparative data on how the children and their parents/carers have been coping across the different types of placements provided.

This book reports on the most recent phase of the study, which involved interviews with a sub-group of the children (aged 9 to 14) and their parents/carers in adoption, foster care, kinship care, on residence order, and living with birth parents. Similarities and differences were explored between placement types, in terms of children’s attachment, self-concept, education, health and behaviour, their carers’ stress, social support, family communication, and contact with birth families.

This contemporary study contributes to evidence-based practice and provides a research base for decision-making throughout the UK.