Evaluation of a Brief Intervention to Assist Health Visitors and Community Practitioners to Engage with Fathers as Part of the Healthy Child Initiative

Aims: To improve engagement of Health Visitors and Community Practitioners delivering the Healthy Child Programme with fathers. To evaluate a one-day, father-focused workshop with a supporting handbook for Practitioners. To identify institutional and organisational barriers to engagement with fathers. Background: The UK government policy encourages health professionals to engage with fathers. This derives from robust evidence that fathers’ early involvement with their children impacts positively on emotional, behavioural and educational development. Yet, there is little evidence that the importance of engaging fathers is reflected in Health Visitor training or that primary-care services are wholly embracing father-inclusive practice. The Fatherhood Institute (FI), a UK charity, has developed a workshop for Practitioners delivering the Healthy Child Programme. Method: A ‘before and after’ evaluation study, comprising a survey followed by telephone interviews, evaluated the impact of the FI workshop on Health Visitors’ and Community Practitioners’ knowledge, attitudes and behaviour in practice. A total of 134 Health Visitors and Community Practitioners from eight NHS Trusts in England attended the workshop from November 2011 to January 2014 at 12 sites. A specially constructed survey, incorporating a validated questionnaire, was administered before the workshop, immediately afterwards and three months later. Telephone interviews further explored participants’ responses. Findings: Analysis of the questionnaire data showed that the workshop and handbook improved participants’ knowledge, attitudes and behaviour in practice. This was sustained over a three-month period. In telephone interviews, most participants said that the workshop had raised their awareness of engaging fathers and offered them helpful strategies. However, they also spoke of barriers to engagement with fathers. NHS Trusts need to review the training and education of Health Visitors and Community Practitioners and take a more strategic approach towards father-inclusive practice and extend services to meet the needs of fathers.

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.

Pediatric Oncology Palliative Care: Experiences of General Practitioners and Bereaved Parents

Objective: This qualitative study set in the West Midlands region of the United Kingdom, aimed to examine the role of the general practitioner (GP) in children's oncology palliative care from the perspective of GPs who had cared for a child with cancer receiving palliative care at home and bereaved parents. Methods: One-to-one semi-structured interviews were undertaken with 18 GPs and 11 bereaved parents following the death. A grounded theory data analysis was undertaken; identifying generated themes through chronological comparative data analysis. Results: Similarity in GP and parent viewpoints was found, the GPs role seen as one of providing medication and support. Time pressures GPs faced influenced their level of engagement with the family during palliative and bereavement care and their ability to address their identified learning deficits. Lack of familiarity with the family, coupled with an acknowledgment that it was a rare and could be a frightening experience, also influenced their level of interaction. There was no consistency in GP practice nor evidence of practice being guided by local or national policies. Parents lack of clarity of their GPs role resulted in missed opportunities for support. Conclusions: Time pressures influence GP working practices. Enhanced communication and collaboration between the GP and regional childhood cancer centre may help address identified GP challenges, such as learning deficits, and promote more time-efficient working practices through role clarity. Parents need greater awareness of their GP's wide-ranging role; one that transcends palliative care incorporating bereavement support and on-going medical care for family members

Evolution of an Interactive Online Magazine for Students, Academics and Expert Practitioners to Engage Students in ESD

Urgency to embed awareness of sustainability principles and practice across society, and need for digital literacy and advocacy for sustainability are reshaping ESD. These, together with developments in learning and teaching, demand new tools to support implementation of project-based learning and more interactive approaches. This investigation explores the evolution of susthingsout.com, an online magazine for students, academics and expert practitioners, developed by the University of Worcester. This comprises two parts; the first, a private site specifically for students involved in sustainability learning on-campus; the second, an open-access site developed to deliver sustainability information and good practice across campus, community and not-for-profit and commercial organisations. This paper involves only the private site i.e. the equivalent of an in-house VLE specifically designed to support the teaching of sustainability to multi-disciplinary first and second year undergraduate students. It reports on the progress of the VLE, following three years of use and initial improvements, in terms of the student support and engagement, as well as considering the practical issues affecting these. The results fall into four categories of pedagogical, operational, cultural and external factors, which are synthesised to capture and share emerging knowledge of good practice offering insights to other developers of online sustainability materials.

Talking everyday science to very young children: a study involving parents and practitioners within an early childhood centre

The acquisition of everyday scientific concepts by 3-6 year old children attending early childhood institutions has been widely studied. In contrast, research on science learning processes among younger children is less extensive. This paper reports on findings from an exploratory empirical study undertaken in a ‘stay and play’ service used by parents with children aged 0-3 and located within an East London early childhood centre. The research team collaborated with practitioners to deliver a programme of activities aimed at encouraging parents’ confidence in their own ability to support emergent scientific thinking among their young children. The programme generated children’s engagement and interest. Parents and practitioners reported increased confidence in their ability to promote young children’s natural curiosity at home and in early childhood provision. The authors see no reason for positing qualitative differences between the way children acquire scientific and other concepts in their earliest years.

Good looks and good practice: the attitudes of career practitioners to attractiveness and appearance

Empirical evidence attests the impact that career image has on objective career success, yet little is known of how career practitioners conceptualise and operationalise this information. This article presents the quantitative findings of an online survey of career practitioners (n=399, 74% female, 89% white, 75% from the UK) exploring their attitudes and practices towards issues of appearance and attractiveness. Career practitioners who participated in this survey acknowledged that beauty, self-presentation and interpersonal skills influence career success, and 96% of them considered conversations about career image as part of their professional remit. The career practitioners felt relatively comfortable and well informed in their discussions in this arena, but would welcome further guidance and training to inform their practice. Ethical and practical implications for the profession are considered.

Exploring the intersections of creative and academic life among Australian academic creative writing practitioners

Variations in chemoprophylaxis for meningococcal disease: a retrospective case note review, analysis of routine prescribing data and questionnaire of general practitioners

BACKGROUND: Invasive meningococcal disease is a significant cause of mortality and morbidity in the UK. Administration of chemoprophylaxis to close contacts reduces the risk of a secondary case. However, unnecessary chemoprophylaxis may be associated with adverse reactions, increased antibiotic resistance and removal of organisms, such as Neisseria lactamica, which help to protect against meningococcal disease. Limited evidence exists to suggest that overuse of chemoprophylaxis may occur. This study aimed to evaluate prescribing of chemoprophylaxis for contacts of meningococcal disease by general practitioners and hospital staff. METHODS: Retrospective case note review of cases of meningococcal disease was conducted in one health district from 1st September 1997 to 31st August 1999. Routine hospital and general practitioner prescribing data was searched for chemoprophylactic prescriptions of rifampicin and ciprofloxacin. A questionnaire of general practitioners was undertaken to obtain more detailed information. RESULTS: Prescribing by hospital doctors was in line with recommendations by the Consultant for Communicable Disease Control. General practitioners prescribed 118% more chemoprophylaxis than was recommended. Size of practice and training status did not affect the level of additional prescribing, but there were significant differences by geographical area. The highest levels of prescribing occurred in areas with high disease rates and associated publicity. However, some true close contacts did not appear to receive prophylaxis. CONCLUSIONS: Receipt of chemoprophylaxis is affected by a series of patient, doctor and community interactions. High publicity appears to increase demand for prophylaxis. Some true contacts do not receive appropriate chemoprophylaxis and are left at an unnecessarily increased risk

How does employer support and educational background effect an Ergonomics Practitioner’s awareness of the relationship between ergonomics and psychosocial hazard control?

There is a growning need to address psychological health and safety in the workplace. Ergonomics tends to be widely recognized for its physical applications, such as ¨office¨ and ¨manual materials handling¨ however the other domains of specialization of ergonomics (cognitive and organizational) appear to be less well known. This study evaluates the level of understanding that professionals who practice ergonomics have of the relation between ergonomics and the control of psychosocial hazards in the workplace. A survey was distributed to ergonomics practitioners and asked them about their awareness of the relation between ergonomics and workplace psychosocial hazard control. Ergonomists and human factors specialists demonstrated a greater awareness of this relationship than other allied occupational groups that also practice ergonomics, however they indicated that there may be difficulties in the “real world” applying these areas of knowledge into practice. Participants who demonstrated a high level of awareness of the relation between ergonomics and psychosocial hazard control demonstrated stronger organizational commitment than participants with a low awareness. Ergonomics practitioners who reported having employer support for professional development also demonstrated a higher degree of awareness of the relation between ergonomics and psychosocial hazard control, as did the professionals who had been practicing in the field the longest. This research provides some insight for professional associations for Ergonomists, employers of Ergonomists, and human resource professionals about how ergonomics practitioners perceive the ergonomics field and the profession as well as their employing organization.

Place, policy and practitioners: on rehabilitation, independence and the therapeutic landscape in the changing geography of care provision to older people in the United Kingdom

A growing body of literature in geography and other social sciences considers the role of place in the provision of healthcare. Authors have focused on various aspects of place and care, with particular interests emerging around the role of the psychological, social and cultural aspects of place in care provision. As healthcare stretches increasingly beyond the traditional four walls of the hospital, so questions of the role of place in practices of care become ever more pertinent. In this paper, we examine the relationship between place and practice in the care and rehabilitation of older people across a range of settings, using qualitative material obtained from interviews and focus groups with nursing, care and rehabilitation staff working in hospitals, clients’ homes and other sites. By analysing their testimony on the characteristics of different settings, the aspects of place which facilitate or inhibit rehabilitation and the ways in which place mediates and is mediated by social interaction, we consider how various dimensions of place relate to the power-inscribed relationships between service users, informal carers and professionals as they negotiate the goals of the rehabilitation process. We seek to demonstrate how the physical, psychological and social meanings of place and the social processes engendered by the rehabilitation encounter interact to produce landscapes that are more or less therapeutic, considering in particular the structuring role of state policy and formal healthcare provision in this dynamic.

A Letter of Consequence: Referral Letters from General Practitioners to Secondary Mental Health Services

The referral letter is a key instrument in moving patients from primary to secondary care services. Consequently, the circumstances in which a referral should be made and its contents have been the subject of clinical guidelines. This article is based on a project that demonstrated that physicians do not adhere to clinical guidelines when referring patients to secondary mental health services. This research supports earlier findings into noncompliance with guidelines by general practitioners (GPs). The authors briefly note possible reasons, which have been the subject of some debate. They also present a content analysis of referral letters to demonstrate the important ways in which they differ from guideline criteria. However, their central argument is that the role of the referral letter in relation to the GP’s repertoire of treatments has not been understood fully. Such understanding implies the need for a reexamination of the support available for GPs.