Multiprofessional Views on Older Patients' Participation in Care Planning Meetings in a Hospital Context

Care planning meetings (CPMs; sometimes referred to as family meetings) for older patients involve group decision-making between the multidisciplinary team, the older person and their family. However, service user participation is challenged by the inequity of knowledge and power between participants, together with organisational and resource pressures for timely discharge. The effective use and perhaps, potential misuse of communication strategies within CPMs is of ethical concern to all participants. Habermas' essential critique of participatory communication provides insight as to how older people's involvement can be either enabled or blocked by healthcare professionals (HCPs) depending on their use of communication strategies. Seven discipline-specific mini-focus groups provided an opportunity for HCPs to reflect on the participation of patients over 65 and their families in CPMs. Findings explore HCPs' understanding of older patients involvement based on key dimensions of communicative participation, namely, mutuality, inclusiveness, patient centredness and clear outcomes. Whilst the benefits of collaborative decision-making were confirmed, legitimate concerns as to the quality of participatory practices, limited attention to group work processes and the exclusion of older patients with cognitive impairment were identified. © 2013 Copyright British Association of Social Workers.

Service user involvement in drug treatment programs: Barriers to implementation and potential benefits for client recovery

Service user forums have the potential for improving awareness of services, empowering service users and strengthening community partnerships within an inclusive treatment and rehabilitation framework. The research aimed to investigate perspectives about service user involvement in order to inform the development of effective service user forum(s) in west Ireland. A total of 30 interviews with key service providers and 12 interviews with service users were conducted, with interview questions focusing on: (1) awareness of the Service User Support Team and (2) barriers to service user involvement and the development of service user forums in the region. An integrated data collection and thematic analysis was undertaken. Current levels of service user involvement were low, restricted by one-way communication and appeared grounded in user-provider power differentials and stigma relating to drug dependency. Service providers queried the actual terms of reference, capacity and training that would be needed for service user forums to advocate and lobby for service users. The use of existing support groups, creation of internet user forums and rotation of rural meetings were recommended to promote engagement among service users. The research underscores the need for transparency, resources and a framework for good practice that reflects a participatory approach


Read More: http://informahealthcare.com/doi/abs/10.3109/09687637.2012.671860

Service user involvement in teaching about conflict - an exploration of the issues

Service user involvement is now a well embedded feature of social work
education in the United Kingdom. Whilst many education institutions have
fully embraced the involvement of service users in teaching, there is still
work to be done in more fully engaging with service users who are seldom
heard. This article highlights the opportunities and challenges associated
with innovative work being piloted in Northern Ireland where victims and
survivors of political conflict are routinely involved in teaching social work
students about the impact of conflict on their lives.

Service-user involvement in nurse education: partnership or tokenism?

Following on from the Francis Report (2013) the need for a framework of service user involvement is required not just in the Health Service but also in Higher Education. There are wide variances globally on the levels of service user interaction and involvement in healthcare education. Health policy internationally has indicated a move towards developing partnerships with service users but to date this still remains elusive with the majority of user involvement consultative in approach. This paper aims to discuss the Health policy background and the current approaches taken in the involvement of service users in healthcare education.

Service user perspectives on palliative care education for health and social care professionals supporting people with learning disabilities

Background and objectives
Evidence from European and American studies indicates limited referrals of people with learning (intellectual) disabilities to palliative care services. Although professionals’ perceptions of their training needs in this area have been studied, the perceptions of people with learning disabilities and family carers are not known. This study aimed to elicit the views of people with learning disabilities, and their family carers concerning palliative care, to inform healthcare professional education and training.

Methods
A qualitative, exploratory design was used. A total of 17 people with learning disabilities were recruited to two focus groups which took place within an advocacy network. Additionally, three family carers of someone with a learning disability, requiring palliative care, and two family carers who had been bereaved recently were also interviewed.

Results
Combined data identified the perceived learning needs for healthcare professionals. Three subthemes emerged: ‘information and preparation’, ‘provision of care’ and ‘family-centred care’.

Conclusions
This study shows that people with learning disabilities can have conversations about death and dying, and their preferred end-of-life care, but require information that they can understand. They also need to have people around familiar to them and with them. Healthcare professionals require skills and knowledge to effectively provide palliative care for people with learning disabilities and should also work in partnership with their family carers who have expertise from their long-term caring role. These findings have implications for educators and clinicians.

‘Making it real’: evaluating the impact of service user and carer involvement in social work education

Service user and carer involvement (SUCI) in social work education in England is required by the profession’s regulator, the Health and Care Professions Council. However, a recent study of 83 HEIs in England reported that despite considerable progress in SUCI, there is no evidence that the learning derived from it is being transferred to social work practice. In this article we describe a study that examines the question: ‘What impact does SUCI have on the skills, knowledge and values of student social workers at the point of qualification and beyond?’ Students at universities in England and Northern Ireland completed online questionnaires and participated in focus groups, spanning a period immediately pre-qualification and between six to nine months post-qualification. From our findings, we identify four categories that influence the impact of service user involvement on students’ learning: student factors; service user and carer factors; programme factors; and practice factors; each comprises of a number of sub-categories. We propose that the model developed can be used by social work educators, service user and carer contributors and practitioners to maximise the impact of SUCI. We argue that our findings also have implications for employment-based learning routes and post-qualifying education.

An Evaluation of the Drug and Alcohol Service User Network in NI

Objectives:
The process evaluation will consider the views of the appointed SUN workers and representatives from selected service user groups as regards the setting up and maintenance of the SUN network. This component of the evaluation will also examine the perceptions of stakeholders from a number of relevant organisations.

The outcome evaluation will assess the effectiveness of the SUN project in achieving the intended outcomes as outlined in the original Action Plans.
The following outcomes will be evaluated:
To ascertain the level to which the SUN has provided support, information and advice to existing service user groups.
To examine the SUN co-ordination of Trust and regional networks of service user groups.
To consider how the SUN assists organisations to establish and maintain service user groups.
To examine the level of current and future membership of service users on relevant groups, with a particular focus on engagement of hard to reach populations.
To gauge service user perceptions of the Service User Network.
To examine the levels of training provided and consider the efficacy of training.

The Human in the Loop: User Participation in Self-Adaptive Software

Self-adaptive software provides a profound solution for adapting applications to changing contexts in dynamic and heterogeneous environments. Having emerged from Autonomic Computing, it incorporates fully autonomous decision making based on predefined structural and behavioural models. The most common approach for architectural runtime adaptation is the MAPE-K adaptation loop implementing an external adaptation manager without manual user control. However, it has turned out that adaptation behaviour lacks acceptance if it does not correspond to a user’s expectations – particularly for Ubiquitous Computing scenarios with user interaction. Adaptations can be irritating and distracting if they are not appropriate for a certain situation. In general, uncertainty during development and at run-time causes problems with users being outside the adaptation loop. In a literature study, we analyse publications about self-adaptive software research. The results show a discrepancy between the motivated application domains, the maturity of examples, and the quality of evaluations on the one hand and the provided solutions on the other hand. Only few publications analysed the impact of their work on the user, but many employ user-oriented examples for motivation and demonstration. To incorporate the user within the adaptation loop and to deal with uncertainty, our proposed solutions enable user participation for interactive selfadaptive software while at the same time maintaining the benefits of intelligent autonomous behaviour. We define three dimensions of user participation, namely temporal, behavioural, and structural user participation. This dissertation contributes solutions for user participation in the temporal and behavioural dimension. The temporal dimension addresses the moment of adaptation which is classically determined by the self-adaptive system. We provide mechanisms allowing users to influence or to define the moment of adaptation. With our solution, users can have full control over the moment of adaptation or the self-adaptive software considers the user’s situation more appropriately. The behavioural dimension addresses the actual adaptation logic and the resulting run-time behaviour. Application behaviour is established during development and does not necessarily match the run-time expectations. Our contributions are three distinct solutions which allow users to make changes to the application’s runtime behaviour: dynamic utility functions, fuzzy-based reasoning, and learning-based reasoning. The foundation of our work is a notification and feedback solution that improves intelligibility and controllability of self-adaptive applications by implementing a bi-directional communication between self-adaptive software and the user. The different mechanisms from the temporal and behavioural participation dimension require the notification and feedback solution to inform users on adaptation actions and to provide a mechanism to influence adaptations. Case studies show the feasibility of the developed solutions. Moreover, an extensive user study with 62 participants was conducted to evaluate the impact of notifications before and after adaptations. Although the study revealed that there is no preference for a particular notification design, participants clearly appreciated intelligibility and controllability over autonomous adaptations.

User participation in the performance assessment of school buildings : a study of six primary schools in the Bellarine Peninsula region

Young children spend a significant portion of their lives at primary school. This research traces the development of school facilities in Victoria and examines the performance of six primary schools from the users' perspective. Performance assessments were carried out using participatory evaluation methods that included Touring Interviews with small groups of students aged from six to twelve years. The study found that participatory evaluation methods with both student and staff users generate significant information to improve school facilities. User comments were analysed with respect to 14 aspects of building quality and serviceability including character, thermal environment, privacy and flexibility. The study concludes that school buildings do not meet a number of key user requirements. Children expressed dissatisfaction with furniture and equipment in their classrooms and the playground, and to a lesser extent with student toilets, security of their school bags and personal privacy. Staff were dissatisfied with the provision of withdrawal areas and specialist spaces. Department of School Education facilities guidelines do not address the concerns of school users or meet user needs.

Understanding user participation in Australian Government tourism Facebook page

With Facebook being the largest social network site (SNS), can government use Facebook (FB) to increase citizen participation in delivering and promoting their services? This paper presents the case of government use of social media for tourism to provide a general understanding online government and user participation in the Tourism government FB page. This is a case study research into the government FB page of Tourism Australia. FB page wall posts and comments are analysed quantitatively using content analysis to determine what type of online participation is visible in these sites and what the agencies are trying to achieve. Further, the paper employed a spectrum of online engagement matrix to identify the type of engagement being attained by the page. Findings show that the page has successfully served as a platform for its audience to share their Australian experience and it is being used for the purpose of announcing, informing and involving type of online engagement. This is an example of a crowdsourcing endeavour where tourism experiences and stories and pictures are being sourced from public. The research contributes to gaining a better understanding of government FB phenomenon, in particular for Australian context.

Integrating service user and practitioner expertise within a web-based system for collaborative mental-health risk and safety management

Objectives: To develop a decision support system (DSS), myGRaCE, that integrates service user (SU) and practitioner expertise about mental health and associated risks of suicide, self-harm, harm to others, self-neglect, and vulnerability. The intention is to help SUs assess and manage their own mental health collaboratively with practitioners. Methods: An iterative process involving interviews, focus groups, and agile software development with 115 SUs, to elicit and implement myGRaCE requirements. Results: Findings highlight shared understanding of mental health risk between SUs and practitioners that can be integrated within a single model. However, important differences were revealed in SUs' preferred process of assessing risks and safety, which are reflected in the distinctive interface, navigation, tool functionality and language developed for myGRaCE. A challenge was how to provide flexible access without overwhelming and confusing users. Conclusion: The methods show that practitioner expertise can be reformulated in a format that simultaneously captures SU expertise, to provide a tool highly valued by SUs. A stepped process adds necessary structure to the assessment, each step with its own feedback and guidance. Practice Implications: The GRiST web-based DSS (www.egrist.org) links and integrates myGRaCE self-assessments with GRiST practitioner assessments for supporting collaborative and self-managed healthcare.

Care planning for aggression management in a specialist secure mental health service: user involvement

This paper describes an audit of prevention and management of violence and aggression care plans and incident reporting forms which aimed to: (i) report the compliance rate of completion of care plans; (ii) identify the extent to which patients contribute to and agree with their care plan; (iii) describe de-escalation methods documented in care plans; and (iv) ascertain the extent to which the de-escalation methods described in the care plan are recorded as having been attempted in the event of an incident. Care plans and incident report forms were examined for all patients in men's and women's mental health care pathways who were involved in aggressive incidents between May and October 2012. In total, 539 incidents were examined, involving 147 patients and 121 care plans. There was no care plan in place at the time of 151 incidents giving a compliance rate of 72%. It was documented that 40% of patients had contributed to their care plans. Thematic analysis of de-escalation methods documented in the care plans revealed five de-escalation themes: staff interventions, interactions, space/quiet, activities and patient strategies/skills. A sixth category, coercive strategies, was also documented. Evidence of adherence to de-escalation elements of the care plan was documented in 58% of incidents. The reasons for the low compliance rate and very low documentation of patient involvement need further investigation. The inclusion of coercive strategies within de-escalation documentation suggests that some staff fundamentally misunderstand de-escalation.