Carers and Co-Production: Enabling Expertise through Experience?

Purpose To provide a brief overview of the literature to date which has focussed on co-production within mental healthcare in the UK, including service user and carer involvement and collaboration. Design The paper presents key outcomes from studies which have explicitly attempted to introduce co-produced care in addition to specific tools designed to encourage co-production within mental health services. The paper debates the cultural and ideological shift required for staff, service users and family members to undertake co-produced care and outlines challenges ahead with respect to service redesign and new roles in practice. Findings Informal carers (family and friends) are recognised as a fundamental resource for mental health service provision, as well as a rich source of expertise through experience, yet their views are rarely solicited by mental health professionals or taken into account during decision-making. This issue is considered alongside new policy recommendations which advocate the development of co-produced services and care. Research Limitations Despite the launch of a number of initiatives designed to build on peer experience and support, there has been a lack of attention on the differing dynamic which remains evident between healthcare professionals and people using mental health services. Co-production sheds a light on the blurring of roles, trust and shared endeavour (Slay and Stephens, 2013) but, despite an increase in peer recovery workers across England, there has been little research or service development designed to focus explicitly on this particular dynamic. Practical Implications Despite these challenges, coproduction in mental healthcare represents a real opportunity for the skills and experience of family members to be taken into account and could provide a mechanism to achieve the ‘triangle of care’ with input, recognition and respect given to all (service users, carers, professionals) whose lives are touched by mental distress. However, lack of attention in relation to carer perspectives, expertise and potential involvement could undermine the potential for coproduction to act as a vehicle to encourage person-centred care which accounts for social in addition to clinical factors. Social Implications The families of people with severe and enduring mental illness (SMI) assume a major responsibility for the provision of care and support to their relatives over extended time periods (Rose et al, 2004). Involving carers in discussions about care planning could help to provide a wider picture about the impact of mental health difficulties, beyond symptom reduction. The ‘co-production of care’ reflects a desire to work meaningfully and fully with service users and carers. However, to date, little work has been undertaken in order to coproduce services through the ‘triangle of care’ with carers bringing their own skills, resources and expertise. Originality/Value This paper debates the current involvement of carers across mental healthcare and debates whether co-production could be a vehicle to utilise carer expertise, enhance quality and satisfaction with mental healthcare. The critique of current work highlights the danger of increasing expectations on service providers to undertake work aligned to key initiatives (shared decision-making, person-centred care, co-production), that have common underpinning principles but, in the absence of practical guidance, could be addressed in isolation rather than as an integrated approach within a ‘triangle of care’.

Understanding the Patient Experience Through the Power of Film: a Mixed Method Qualitative Research Project

Film is a highly attractive teaching instrument for the study of different terminal diseases, exploring bioethics (Beauchamp and Childress, 2009) and is a preferred medium over traditional lectures (Edmunds, 2013) to provide realistic examples for adult learners. It can tap into ethical issues; facilitate decision-making; and examine underlying issues such as euthanasia; assisted suicide; and professional responsibility. Contrast this with standard means of teaching, such as scenarios- although a useful pedagogic tool, these are limited because students must imagine the clinical scenario. Film can fill that imaginative gap (Volandes, 2007). It can be utilised as an active teaching strategy for a variety of topics in nursing (Edmunds, 2013) providing a unique way to promote active learning in nursing education (Herrman, 2006). The objectives of the study, aim to help pre registration student nurses from each year of study to engage with their role as health care professionals; provide open discussion and debate on how they view the personal experience of illness/disease/disability/death and to reflect on their role and provision of patient care. It is delivered in 3 tiers to provide a range of data for thematic analysis; 1) Film screening followed by a ‘5 minute reaction’ discussion and post screening questionnaire; 2) Pre screening guided activities for reflection and discussion; 3) Focus groups. This project meets identified aims from the UK Professional Standards Framework (UKPSF) by fostering creative and innovative approaches to teaching and learning; facilitating and supporting the design and delivery of continuing education development programmes and activities; and demonstrates professionalism that staff and institutions bring to teaching. Preliminary feedback and themes will be presented.

The First Year Experience of Occupational Therapy Students at an Australian Regional University: Promoting Student Retention and Developing a Regional and Remote Workforce

Abstract Objective: Student retention at regional universities is important in addressing regional and remote workforce shortages. Students attending regional universities are more likely to work in regional areas. First year experience at university plays a key role in student retention. This study aimed to explore factors influencing the first year experience of occupational therapy students at a regional Australian university. Design: Surveys were administered to 58 second year occupational therapy students in the first week of second year. Data were analysed using descriptive statistics, inferential statistics (Pearson χ2; Spearman rho) and summarising descriptive responses. Setting: An Australian regional university. Participants: Second year undergraduate occupational therapy students. Main outcome measures: Factors influencing students’ decisions to study and continue studying occupational therapy; factors enhancing first year experience of university. Results: Fifty-four students completed the survey (93.1%). A quarter (25.9%) of students considered leaving the course during the first year. The primary influence for continuing was the teaching and learning experience. Most valued supports were orientation week (36.7%) and the first year coordinator (36.7%). Conclusion: The importance of the first year experience in retaining occupational therapy students is highlighted. Engagement with other students and staff and academic support are important factors in facilitating student retention. It is important to understand the unique factors influencing students’ decisions, particularly those from regional and remote areas, to enter and continue in tertiary education to assist in implementing supports and strategies to improve student retention.

An Enterprise Opportunity for Entrepreneurial Students: Student Enterprise Development and Experience Assessed through the Student Voice

Purpose: This research investigates the effectiveness of an experiential learning approach, available to students in all disciplines that combined a hands-on entrepreneurial and enterprise experience with professional consultant mentoring by using a competition to win business start-up funding. Design/methodology/approach: Students at a UK university had the chance to enter a competition in which they developed an entrepreneurial idea and then designed and presented a business plan to win business start-up capital. Students who were entrepreneurially motivated, but who lacked capital to start up their business, were targeted, as these students have been argued to benefit the most from a combination of business plan training and entrepreneurial development. Feedback and data was obtained from the students at each stage of the process and was thematically analysed to assess the development of students’ entrepreneurial skills and knowledge through the experience. Findings: The research found that the benefits gained from this approach included both enterprising and entrepreneurial skills, with the greatest impact being on student confidence and belief in their ability to start a business. The practical skills had a ‘demystifying’ effect on students that made them feel like entrepreneurship and enterprise start-up were attainable. Research limitations/implications: The research focused on students at one UK University and centered on entrepreneurship in a retail business. The competition thus appealed mainly to students who were interested in retail start-up, thus leaving out some enterprising students whose feedback may have been different. In addition, while entrepreneurial skills are assessed in the data, the students who would be interested in the competition would be assumed to be proactive, and this skill was not able to be analyzed. This research is a single case, and thus could be enhanced by more cases and looking at other enterprise start-up means beyond retail. Originality/value: This research makes a case that, in light of literature critical of the use of business plan training in entrepreneurship education, certain students are appropriate candidates for this approach. Specific skills and knowledge can be developed in university students using a live enterprise experience, supported by entrepreneurial mentoring. By making the event extracurricular, the study sought to capture the feedback of students who self-selected into the program, who can benefit most from combined entrepreneurial and business-plan development experience.

Caring for Children Dying from Cancer at Home: a Qualitative Study of the Experience of Primary Care Practitioners

Background. The rarity of childhood cancers makes providing palliative care in the community an unusual event for primary care practitioners. Providing this care requires effective interprofessional collaboration with the team that forms to provide the care often working together for the first and only time. Objective. To explore the experiences of primary care practitioners following their involvement in the palliative care of a child with cancer at home. Methods. The study design was a community-based qualitative study. The study location was the West Midlands region. Purposeful sample of GPs and community nurses involved in providing palliative care to 12 children. One-to-one in-depth interviews with 47 primary care professionals (10 GPs and 37 community nurses) and 5 facilitated case discussions were undertaken. Field notes were documented and grounded theory data analysis undertaken: chronological comparative data analysis identifying generated themes. Results. GPs had minimal input into the preceding care of children undergoing treatment for cancer but sought to re-establish their role at the child’s transition to palliative care. GPs felt they had a role to play and could add value to this phase of care, highlighted their continuing role with the child’s family and acknowledged that they had gained from the experience of contributing. However, lack of specialist knowledge and uncertainty about their role within the team made this more challenging. In contrast, community nurses were routinely involved in both active treatment and palliation care phases. There was little evidence of collaboration between the specialist and primary care professionals involved. There was considerable variation in out of hours provision across cases. Conclusions. Engaging primary care practitioners needs to be more actively anticipated and negotiated at the transition to palliation. Variation in out of hours care is another cause for concern. Enhancing inter-professional collaboration and planning during both active and palliative care phases may help. Keywords. Cancer, family medicine, palliative care, paediatric.

The Role of Art in Computer Game Design

Computer games are significant since they embody our youngsters’ engagement with contemporary culture, including both play and education. These games rely heavily on visuals, systems of sign and expression based on concepts and principles of Art and Architecture. We are researching a new genre of computer games, ‘Educational Immersive Environments’ (EIEs) to provide educational materials suitable for the school classroom. Close collaboration with subject teachers is necessary, but we feel a specific need to engage with the practicing artist, the art theoretician and historian. Our EIEs are loaded with multimedia (but especially visual) signs which act to direct the learner and provide the ‘game-play’ experience forming semiotic systems. We suggest the hypothesis that computer games are a space of deconstruction and reconstruction (DeRe): When players enter the game their physical world and their culture is torn apart; they move in a semiotic system which serves to reconstruct an alternate reality where disbelief is suspended. The semiotic system draws heavily on visuals which direct the players’ interactions and produce motivating gameplay. These can establish a reconstructed culture and emerging game narrative. We have recently tested our hypothesis and have used this in developing design principles for computer game designers. Yet there are outstanding issues concerning the nature of the visuals used in computer games, and so questions for contemporary artists. Currently, the computer game industry employs artists in a ‘classical’ role in production of concept sketches, storyboards and 3D content. But this is based on a specification from the client which restricts the artist in intellectual freedom. Our DeRe hypothesis places the artist at the generative centre, to inform the game designer how art may inform our DeRe semiotic spaces. This must of course begin with the artists’ understanding of DeRe in this time when our ‘identities are becoming increasingly fractured, networked, virtualized and distributed’ We hope to persuade artists to engage with the medium of computer game technology to explore these issues. In particular, we pose several questions to the artist: (i) How can particular ‘periods’ in art history be used to inform the design of computer games? (ii) How can specific artistic elements or devices be used to design ‘signs’ to guide the player through the game? (iii) How can visual material be integrated with other semiotic strata such as text and audio?

Understanding the Patient Experience Through the Power of Film: a Mixed Method Qualitative Research Study

Background For decades film has proved to be a powerful form of communication. Whether produced as entertainment, art or documentary, films have the capacity to inform and move us. Films are a highly attractive teaching instrument and an appropriate teaching method in health education. It is a valuable tool for studying situations most transcendental to human beings such as pain, disease and death. Objectives The objectives were to determine how this helps students engage with their role as health care professionals; to determine how they view the personal experience of illness, disease, disability or death; and to determine how this may impact upon their provision of patient care. Design, Setting and Participants The project was underpinned by the film selection determined by considerate review, intensive scrutiny, contemplation and discourse by the research team. 7 films were selected, ranging from animation; foreign, documentary, biopic and Hollywood drama. Each film was shown discretely, in an acoustic lecture theatre projected onto a large screen to pre-registration student nurses (adult, child and mental health) across each year of study from different cohorts (n = 49). Method A mixed qualitative method approach consisted of audio-recorded 5-minute reactions post film screening; coded questionnaires; and focus group. Findings were drawn from the impact of the films through thematic analysis of data sets and subjective text condensation categorised as: new insights looking through patient eyes; evoking emotion in student nurses; spiritual care; going to the moves to learn about the patient experience; self discovery through films; using films to link theory to practice. Results Deeper learning through film as a powerful medium was identified in meeting the objectives of the study. Integration of film into pre registration curriculum, pedagogy, teaching and learning is recommended. Conclusion The teaching potential of film stems from the visual process linked to human emotion and experience. Its impact has the power to not only help in learning the values that underpin nursing, but also for respecting the patient experience of disease, disability, death and its reality.

Growing Well-beings: the Positive Experience of Care Farms

Objectives: Care farms enable people who are in some way vulnerable to engage with agricultural places and farming activities. This study investigates how this impacts on the health and well-being of service users and explores associated processes and outcomes. Design: A mixed methods design was adopted that allowed for the integration of quantitative measurements of change with qualitative descriptions of this change. A pragmatic approach provided sufficient flexibility to support the investigation of complex contexts. Methods: A total of 216 service users completed an initial questionnaire, and 137 (63%) of this number provided comparative data in a follow-up questionnaire. Questionnaires contained multiple choice and open-ended questions alongside standardized health and well-being measures requiring Likert-format responses. Semi-structured interviews with 33 service users allowed personal experiences to be detailed. Results: Statistical analysis of well-being measure scores identified significant positive relationships with the length of time people had been attending the care farm. Questionnaire and interview data presented health benefits as being enabled by the farm environment, the positive experience as supporting personal development, and associated social interactions as becoming increasingly influential as time progressed. Conclusions: The health and well-being outcomes that result from participating at a care farm influence multiple elements of the human condition and apply amongst vulnerable people with a wide range of personal needs. Care farms have access to a potentially unique range of resources that can support many service users in becoming happier and healthier individuals.