The Influence of Child Protection Orientation on Child Welfare Practice

This article reports the findings of the second part of a two-part research project examining the potential for social workers to make changes in their work with families and children. While social workers in the United Kingdom have been encouraged to shift from a child protection to a child welfare orientation in their practice, such changes have been hampered by professional and organisational concern to manage risk. The research explores the influence of a child protection orientation on practice in child welfare cases. The findings, from two file analyses and interviews with twenty-six social workers, indicate that such an influence is indeed apparent. This is evidenced in two ways; firstly patterns of practice in child welfare cases are similar to those in child protection cases. Secondly, while the majority of social workers express an attitudinal desire to move towards a child welfare orientation, they still prioritise the management of risk in their practice. It is argued that social workers need permission from their employing organisations to make changes in their practice. This, in turn, requires such organisations to state clear goals in line with a child welfare orientation and develop holistic strategies to achieve these.

The State, Compartmentalization and the Turn to Local Community: A Critique of the Political Thought of Alasdair MacIntyre

Alasdair MacIntyre condemns modern politics, specifically liberalism and the institutions of the liberal state, as irredeemably fallen. His core argument is that the liberal state encourages a disempowering ‘compartmentalization’ of people’s everyday roles and activities that undermines the intersubjective conditions of human flourishing. MacIntyre’s alternative is an Aristotelian politics centred on the notion of “practice.” Defined by justice and solidarity, this politics can only be realized, he claims, within local communities which oppose and resist the dictates of the administrative state and capitalist market. Here it is argued that MacIntyre’s notion of “practice” represents a compelling ethical-political ideal. However, the belief that this ideal is best realized within local communities is rejected. In privileging local community, MacIntyre relies on a reductive view of modern states and overlooks the institutional conditions of a just polity. Against this, it is argued that a politics of human flourishing cannot succeed without an emancipatory transformation of large-scale, trans-communal institutions, in particular the state.

'Work and Emancipatory Practice: Towards a Recovery of Human Beings' Productive Capacities,'

This article argues that productive work represents a mode of human flourishing unfortunately neglected in much current political theorizing. Focusing on Habermasian critical theory, I contend that Habermas’s dualist theory of society, on account of the communicative versus instrumental reason binary which underpins it, excludes work and the economy from ethical reflection. To avoid this uncritical turn, we need a concept of work that retains a core emancipatory referent. This, I claim, is provided by Alasdair MacIntyre’s notion of ‘practice’. The notion of ‘practice’ is significant in suggesting an alternative conception of human productivity that is neither purely instrumental nor purely communicative, but rather both simultaneously, a form of activity which issues in material products and yet presumes a community of workers engaged in intersubjective self-transformation. However, we can endorse MacIntyre’s notion of ‘practice’ only if we reject his totalizing anti-modernism and insist on the emancipatory potentialities of modern institutions.

The use and limitation of realistic evaluation as a tool for evidence-based practice: a critical realist perspective

In this paper, we assess realistic evaluation’s articulation with evidence-based practice (EBP) from the perspective of critical realism. We argue that the adoption by realistic evaluation of a realist causal ontology means that it is better placed to explain complex healthcare interventions than the traditional method used by EBP, the randomized controlled trial (RCT). However, we do not conclude from this that the use of RCTs is without merit, arguing that it is possible to use both methods in combination under the rubric of realist theory. More negatively, we contend that the rejection of critical theory and utopianism by realistic evaluation in favour of the pragmatism of piecemeal social engineering means that it is vulnerable to accusations that it promotes technocratic interpretations of human problems. We conclude that, insofar as realistic evaluation adheres to the ontology of critical realism, it provides a sound contribution to EBP, but insofar as it rejects the critical turn of Bhaskar’s realism, it replicates the technocratic tendencies inherent in EBP.

The spirit of palliative practice:A qualitative inquiry into the spiritual journey of palliative care physicians

Objective: Much is known about the important role of spirituality in the delivery of multidimensional care for patients at the end of life. Establishing a strong physician-patient relationship in a palliative context requires physicians to have the self-awareness essential to establishing shared meaning and relationships with their patients. However, little is known about this phenomenon and therefore, this study seeks a greater understanding of physician spirituality and how caring for the terminally ill influences this inner aspect. Method: A qualitative descriptive study was used involving face-to-face interviews with six practicing palliative care physicians. Results: Conceptualized as a separate entity from religion, spirituality was described by participants as a notion relating to meaning, personal discovery, self-reflection, support, connectedness, and guidance. Spirituality and the delivery of care for the terminally ill appeared to be interrelated in a dynamic relationship where a physician's spiritual growth occurred as a result of patient interaction and that spiritual growth, in turn, was essential for providing compassionate care for the palliative patient. Spirituality also served as an influential force for physicians to engage in self-care practices. Significance of results: With spirituality as a pervasive force not only in the lives of palliative care patients, but also in those of healthcare providers, it may prove to be beneficial to use this information to guide future practice in training and education for palliative physicians in both the spiritual care of patients and in practitioner self care. Copyright © Cambridge University Press 2010.

Wind Power Planning: Problems and Perceptions in Practice and Procedure

Despite the fact that the UK has highest potential in the EU to generate renewable energy from wind, it lags behind its European partners. The departure point for this study is provided by the fact that the land use planning system has been perceived by some to create difficulties in pursuit of the achievement of National Action Plan targets. In the course of a review of literature, legislation, policy and case files a number of issues emerge relating not only to operational practice but structural concerns regarding knowledge, legitimacy and ethics. These are scrutinised in an empirical investigation which provides insights into the ontologies behind how knowledge is used and abused. Concerns are highlighted regarding the tactical manipulation of knowledges and the difficulties associated with objectifying evidence so that it can be understood, validated and authenticated. The paper concludes by reflecting on the implications for the regulatory framework, the legitimisation of decisions and the ethics of the profession and how these, in turn, are conditioned by the production, use and transparency of planning knowledge.

City visioning and the turn to community:The case of Derry/Londonderry

In the 1980s, urban re-imaging and place marketing were vital elements in the strategies of post-industrial cities aiming to redefine their role, make themselves more competitive and attract global investment and tourists. By the early 1990s, the questionable effects of trickle-down economics on deprived housing estates and the rediscovery of the 'community' as a social partner shifted both the substance and process of vision exercises. This paper examines the experience of building an input into a city vision that aimed to address social and ethno-religious segregation in Derry/Londonderry. Designing a consensus statement for a city that cannot agree its name, was wrecked by bloody violence and has its hinterland fractured by a contested international border, is a difficult and delicate process. The city had a population of 105 800 people in 1998, but is divided by the river Foyle between the mainly Catholic Cityside (to the north and west) and the mainly Protestant Waterside (to the south and east). The analysis connects with the literature on urban policy that emphasises the importance of argumentation and democratic debate in strategic planning and local regeneration (Forester, 1989; Healey, 1996). The paper concludes by arguing that strategies for 'listening' would help to shape a vision that could mobilise community interests around some common urban regional issues and help to promote social and ethno-religious polarisation as mainstream policy concerns.

Psychosocial aspects in cardiac rehabilitation: From theory to practice. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology

A large body of empirical research shows that psychosocial risk factors (PSRFs) such as low socio-economic status, social isolation, stress, type-D personality, depression and anxiety increase the risk of incident coronary heart disease (CHD) and also contribute to poorer health-related quality of life (HRQoL) and prognosis in patients with established CHD. PSRFs may also act as barriers to lifestyle changes and treatment adherence and may moderate the effects of cardiac rehabilitation (CR). Furthermore, there appears to be a bidirectional interaction between PSRFs and the cardiovascular system. Stress, anxiety and depression affect the cardiovascular system through immune, neuroendocrine and behavioural pathways. In turn, CHD and its associated treatments may lead to distress in patients, including anxiety and depression. In clinical practice, PSRFs can be assessed with single-item screening questions, standardised questionnaires, or structured clinical interviews. Psychotherapy and medication can be considered to alleviate any PSRF-related symptoms and to enhance HRQoL, but the evidence for a definite beneficial effect on cardiac endpoints is inconclusive. A multimodal behavioural intervention, integrating counselling for PSRFs and coping with illness should be included within comprehensive CR. Patients with clinically significant symptoms of distress should be referred for psychological counselling or psychologically focused interventions and/or psychopharmacological treatment. To conclude, the success of CR may critically depend on the interdependence of the body and mind and this interaction needs to be reflected through the assessment and management of PSRFs in line with robust scientific evidence, by trained staff, integrated within the core CR team.

Using protocols in ICU practice. Engaging the staff.

Aims/Purpose: Protocols are evidenced-based structured guides for directing care to achieve improvements. But translating that evidence into practice is a major challenge. It is not acceptable to simply introduce the protocol and expect it to be adopted and lead to change in practice. Implementation requires effective leadership and management. This presentation describes a strategy for implementation that should promote successful adoption and lead to practice change.
Presentation description: There are many social and behavioural change models to assist and guide practice change. Choosing a model to guide implementation is important for providing a framework for action. The change process requires careful thought, from the protocol itself to the policies and politics within the ICU. In this presentation, I discuss a useful pragmatic guide called the 6SQUID (6 Steps in QUality Intervention Development). This was initially designed for public health interventions, but the model has wider applicability and has similarities with other change process models. Steps requiring consideration include examining the purpose and the need for change; the staff that will be affected and the impact on their workload; and the evidence base supporting the protocol. Subsequent steps in the process that the ICU manager should consider are the change mechanism (widespread multi-disciplinary consultation; adapting the protocol to the local ICU); and identifying how to deliver the change mechanism (educational workshops and preparing staff for the changes are imperative). Recognising the barriers to implementation and change and addressing these locally is also important. Once the protocol has been implemented, there is generally a learning curve before it becomes embedded in practice. Audit and feedback on adherence are useful strategies to monitor and sustain the changes.
Conclusion: Managing change successfully will promote a positive experience for staff. In turn, this will encourage a culture of enthusiasm for translating evidence into practice.