Key Indicators of Personal Social Services for Northern Ireland 2001

Social Services expenditure and provision in NI

Transforming personal experience and emotions through education to cultural diversity: an interplay between unicity and genericity

When subjects studied at school are close to societal discourses and to the students' social identities, when they have high emotional resonance, is it possible to enable the students to distance themselves from their emotions and personal experience, and to conceptualise them? Examining the relation between emotion and learning through the lens of socio-cultural psychology, the aim of our study was to shed light on "secondarisation" processes, that is, processes that transform personal experience and emotions into conceptualised forms of thinking. We analysed 85 video-recorded lessons in education for cultural diversity involving 12 teachers (of primary and secondary schools). Having identified episodes in which emotions were put into words or personal experience was reported, we analysed the use of pronouns (taken as indicators of secondarisation processes) and found a recurrent pattern: "the unicity-genericity routine". We illustrate the functioning of this routine with various excerpts taken from lessons in education for diversity taught in the classes of two teachers in primary school. The results show that the interplay between unicity and genericity works as a discursive resource for the development of secondarisation processes.

Communication skills training in oncology: a position paper based on a consensus meeting among European experts in 2009.

BACKGROUND: Communication in cancer care has become a major topic of interest. Since there is evidence that ineffective communication affects both patients and oncology clinicians (physicians and nurses), so-called communication skills trainings (CSTs) have been developed over the last decade. While these trainings have been demonstrated to be effective, there is an important heterogeneity with regard to implementation and with regard to evidence of different aspects of CST. METHODS: In order to review and discuss the scientific literature on CST in oncology and to formulate recommendations, the Swiss Cancer League has organised a consensus meeting with European opinion leaders and experts in the field of CST, as well as oncology clinicians, representatives of oncology societies and patient organisations. On the basis of a systematic review and a meta-analysis, recommendations have been developed and agreed upon. RESULTS: Recommendations address (i) the setting, objectives and participants of CST, (ii) its content and pedagogic tools, (iii) organisational aspects, (iv) outcome and (v) future directions and research. CONCLUSION: This consensus meeting, on the basis of European expert opinions and a systematic review and meta-analysis, defines key elements for the current provision and future development and evaluation of CST in oncology.

Mandatory communication skills training for oncologists: enforcement does not substantially impact satisfaction.

PURPOSE: Even though there is evidence that both patients and oncology clinicians are affected by the quality of communication and that communication skills can be effectively trained, so-called Communication Skills Trainings (CSTs) remain heterogeneously implemented. METHODS: A systematic evaluation of the level of satisfaction of oncologists with the Swiss CST before (2000-2005) and after (2006-2012) it became mandatory. RESULTS: Levels of satisfaction with the CST were high, and satisfaction of physicians participating on a voluntary or mandatory basis did not significantly differ for the majority of the items. CONCLUSIONS: The evaluation of physicians' satisfaction over the years and after introduction of mandatory training supports recommendations for generalized implementation of CST and mandatory training for medical oncologists.

TV or not TV? Subtitling and English skills

We study the influence of television translation techniques on the quality of the English spoken across the EU and OCDE. We identify a large positive effect for subtitled original version as opposed to dubbed television, which loosely corresponds to between four and twenty years of compulsory English education at school. We also show that the importance of subtitled television is robust to a wide array of specifications.We then find that subtitling and better English skills have an influence on high-tech exports, international student mobility, and other economic and social outcomes.

L' Impacte de la mort en estudiants d'infermeria durant el seu primer període de pràctiques

La mort i el procés de morir són fets quotidians en les persones grans i, conseqüentment, en els centres sociosanitaris, on bona part de les persones usuàries són d’edat avançada. Tot i que es tracta d’un fenomen natural que s’inclou dins del cicle vital de les persones, en la nostra societat la mort encara provoca rebuig, por, ansietat, tristesa i inquietud. En aquest marc, les estudiants1 d’infermeria són un col·lectiu que poden patir especialment l’impacte de la mort. Primer, perquè com a membres de la societat tenen interioritzat el codi social preestablert envers aquest tema i, segon, perquè durant la seva formació estan en contacte amb persones que estan al final de la vida i poden presenciar vivències de mort. En el primer període de pràctiques dels estudis d’infermeria, les estudiants han de fer front a diverses situacions del dia a dia fins aleshores desconegudes. Els conflictes interpersonals amb l'equip de treball i la inseguretat sobre les habilitats i les competències professionals són alguns dels aspectes que acostumen a viure amb més tensió. Tot i això, el que més impacte els provoca és la cura de les persones al final de la vida. Davant d'una situació de tensió, la persona viu un component estressor, que suposa el punt d’inflexió. A partir d’aquí s’activen els components adaptatius, que és el que emocionalment fa que la persona pugui fer front a aquesta situació estressant. A més, hi ha un component de suport, que són les ajudes que té. Segons com es treballi el component adaptatiu farà que la persona reaccioni en un futur de forma més automàtica i inconscient o, al contrari, que la persona respongui de forma més conscient i intencionada. El present treball està concebut per comprendre quins elements psicosocials – components estressors i components de suport– poden afectar a les estudiants que presencien la vivència de la mort de malalts geriàtrics terminals en el primer període de pràctiques en un centre sociosanitari. S’ha dissenyat un estudi descriptiu transversal quantitatiu, de caràcter exploratori, per tal de descriure la freqüència i algunes característiques psicosocials al voltant de la mort en estudiants d'infermeria en el seu primer període de pràctiques, tant a nivell personal com a nivell professional. La mostra de l'estudi són 65 estudiants, la majoria són dones d'entre els 18 i els 29 anys –més d’un 90%–. Els resultats indiquen que un 80% dels futurs professionals estudiats han patit la mort d’alguna persona significativa al llarg de la seva vida; d'aquests, gairebé un de cada quatre presenta dol complicat. Quant a la vivència de mort en les pràctiques, el 83% l'ha experimentat. Tot i aquest elevat percentatge, no totes les experiències tenen una connotació negativa. En prop de la meitat dels casos, les morts són percebudes com una experiència enriquidora i natural. Els components estressors més impactants que les estudiants han viscut durant les pràctiques per la mort d’alguna persona malalta són: la reacció de la família del finat, el patiment que es genera al seu voltant, algun signe o símptoma físic experimentat pel malalt al final del procés, i la pròpia reacció emocional. Els components de suport expressats són: saber gestionar les pròpies emocions, tenir més formació sobre relació d’ ajuda i empatia, tenir més formació en control de símptomes i comunicació, per atendre usuaris –tant malalts com familiars- i que algú els informés i orientés en el procés. Altres resultats a tenir en compte són que la població estudiada té més preocupació o inquietud per la mort i el procés de morir de la persona estimada i menys per la pròpia mort. A més, tot i que la meitat no hagués escollit geriatria com opció a les primeres pràctiques clíniques, gairebé tot el grup estudiat ho recomanaria després d'haver viscut l'experiència. Les implicacions pràctiques d'aquest estudi porten a pensar que es pot reorientar la informació i preparació que es dóna a les estudiants d’infermeria abans del primer contacte amb la realitat dels centres sociosanitaris, així com també el paper de formació i suport que pot fer tant la persona tutora de pràctiques com les infermeres de referència dels diferents centres. En conclusió, caldria dissenyar estratègies formatives i de suport entorn a la preparació psicològica personal de l’estudiant; entorn a l’acompanyament, les cures pal·liatives i el dol; i valorar la seva eficiència en el futur.

Anticipatory pleasure skills training: a new intervention to reduce anhedonia in schizophrenia.

PURPOSE: Anhedonia is a challenging symptom of schizophrenia and remains largely recalcitrant to current pharmacological treatments. The goal of this exploratory pilot study was to assess if a cognitive-sensory intervention could improve anticipatory pleasure. DESIGN AND METHODS: Five participants meeting the Diagnostic and Statistical Manual of Mental Disorders (4th edition, Text Revision) criteria for schizophrenia, presenting severe anhedonia and stabilized on atypical antipsychotic medication, received between 10 hours and 25 hours of training. FINDINGS: Results show that the patients improved on the anticipatory scale of the Temporal Experience of Pleasure Scale. Daily activities of the patients were also increased. PRACTICE IMPLICATIONS: These preliminary data need to be interpreted with caution given the small sample of the study, but they offer promising paths to develop new interventions to alleviate anhedonia in schizophrenia.

Knowledge hierarchy and professional knowledge

The aim of this article is to substantiate, in the sociological point of view, the distinction between the social and cognitive processes that produce knowledge in knowledge abstract systems - KAS - to generate cultural inequality and the micro processes of knowledge usage, which build local and cultural knowledge from common sense. It is circumscribed to this aim a problematization of knowledge usage developed by middle class salaried professional groups, rich in cultural capital but without equivalent symbolical capital, in a capitalist society at risk. In order to achieve this goal, the classical contributions of Pierre Bourdieu, Boaventura Sousa Santos, Donald Schön and Basil Bernstein (among others) are taken as a basis regarding the limitation of critical and reflexive thinking and the virtues of professional knowledge to support an epistemology of professional practice.

Medical residents' feedback on needs and acquired skills following a short course on cross-cultural competence

Objectives The purpose of this study is to assess short and long term changes in knowledge, attitudes, and skills among medical residents following a short course on cultural competency and to explore their perspectives on the experience. Methods Eighteen medical residents went through a short training programme comprised of two seminars lasting 30' and 60' respectively over two days. Three months later, we conducted three focus groups, with 17 residents to explore their thoughts, perspectives and feedback about the course. To measure changes over time, we carried out a quantitative sequential survey before the seminars, three days after, and three months later using the Multicultural Assessment Questionnaire. Results Residents expressed a wide variety of perspectives on the main themes related to the content of the training - culture, trialogue, stereotypes, status, epidemiology, history and geopolitics - and related to its organization - relevance, volume, timing, target audience, training tools, and working material. Using the MAQ, we observed a higher global performance score (n=16) at three days (median=38) compared to results before the training (median=33) revealing a median difference of 5.5 points (z=2.4, p=0.015). This difference was still present at three months (∆=4.5, z=2.4, p=0.018), mainly due to knowledge acquisition (∆=3) rather than attitudes (∆=0) or skills (∆=1). Conclusions Cross-cultural competence training not only brings awareness of multicultural issues but also helps participants understand their own cultures, perception of others and preconceived ideas. Physicians' education should however also focus on improving implementation of acquired knowledge in cross-cultural competence.

Communication skills training in oncology: it works!

While the previous chapter by L. Fallowfield and V. Jenkins focuses on different communication skills training (CST) concepts currently being utilized, this chapter reviews and comments the scientific evidence of the impact of CST on improving communication skills. The aim of this chapter is not to provide a complete review of the evidence-this has already been done in systematic reviews-but to discuss the scientific evidence and reflect on the available results and relevant topics for further investigations.

Working alliance in communication skills training for oncology clinicians: A controlled trial.

OBJECTIVE: The aim of this study was to evaluate the impact of communication skills training (CST) on working alliance and to identify specific communicational elements related to working alliance. METHODS: Pre- and post-training simulated patient interviews (6-month interval) of oncology physicians and nurses (N=56) who benefited from CST were compared to two simulated patient interviews with a 6-month interval of oncology physicians and nurses (N=57) who did not benefit from CST. The patient-clinician interaction was analyzed by means of the Roter Interaction Analysis System (RIAS). Alliance was measured by the Working Alliance Inventory - Short Revised Form. RESULTS: While working alliance did not improve with CST, generalized linear mixed effect models demonstrated that the quality of verbal communication was related to alliance. Positive talk and psychosocial counseling fostered alliance whereas negative talk, biomedical information and patient's questions diminished alliance. CONCLUSION: Patient-clinician alliance is related to specific verbal communication behaviors. PRACTICE IMPLICATIONS: Working alliance is a key element of patient-physician communication which deserves further investigation as a new marker and efficacy criterion of CST outcome.

Ammatti-identiteetin rakentuminen sairaanhoitajilla

Ammatti-identiteetti luo pohjan henkilön ammattitaidolle, oman, henkilökohtaisen ammatillisen osaamisen arvostamiselle sekä koko ammattikuvalle, sille millaisena työntekijänä jokainen itsensä näkee. Vahva ammatti-identiteetti aikaansaa positiivisen takaisinkytkennän, kun hyvin tehdyn työn seurauksena saadaan kannustavaa palautetta, mikä kasvattaa itsetuntoa, joka puolestaan luo positiivinen omakuvan, jonka seurauksena syntyy vahva ammatti-identiteetti. Tämän tutkimuksen tarkoituksena on selvittää millä tavoin ammatti-identiteetti rakentuu ja muotoutuu, ja millaisia ovat sitä muovaavat tekijät. Samalla pyritään selvittämään millainen merkitys ammatti-identiteetillä on työn suorittamiseen, työssä viihtymiseen sekä omaan näkemykseen itsestään tietyn alan ammattilaisena. Tutkimuksen kontekstina on terveydenhoitoala, ja empiriassa tutkitaan sairaanhoitajien ammatti-identiteettiä. Tutkimuksen perusteella näyttää siltä, että sairaanhoitajat arvostavat ammattiaan ja ammattitaitoaan huolimatta yhteiskunnallisesta aliarvostuksesta. Tämä tukee käsitystä sairaanhoitajien vahvasta ammatti-identiteetistä. Tutkimuksen tulokset osoittavat, että sairaanhoitajan ammatti-identiteetti on moniulotteinen ilmiö. Ammatti-identiteetti ei ole irrallinen henkilön persoonallisesta identiteetistä, vaan ne tukevat toinen toistaan.

¿Pueden contribuir los métodos visuales a avanzar hacia una investigación inclusiva? Un estudio sobre inclusión sociolaboral con personas con Trastorno Mental Grave (TMG) = Can visual methods help to go forward inclusive research? A study about social and labor inclusion with people with Severe Mental Illness (SMI)

En este artículo se pretende mostrar cómo la utilización de métodos visuales en la investigación contribuye a potenciar la participación activa de las personas con TMG. Se utiliza como ejemplo un estudio de caso de corte cualitativo que incorpora tres actividades de componente visual (el dibujo “el río de la vida”, las fotografías y el dibujo de proyección de futuro) para favorecer la reflexión narrada que, sobre sus experiencias y vivencias, desarrollan cinco personas con TMG. El uso de las fotografías y dibujos en este estudio permite afirmar que estas estrategias se han mostrado válidas para acceder, en la medida que los participantes han querido, a esferas de vida personales en trayectorias vitales determinadas por la enfermedad mental