Risks to home care workers: Professional perspectives

Care at home is fundamental to community care policy, but the simultaneous growth of health and safety regulation has implications for home care services because of the duty of employers towards home care workers. This grounded theory study set in Northern Ireland used data from 19 focus groups and nine semi-structured interviews with a range of health and social services professionals and managers to explore perspectives on planning long term care for older people. Home care workers faced a wide range of hazards in the homes of clients, who themselves were faced with adapting their living habits due to their changing health and care needs and 'risks.' Creative approaches were used to ensure the health and safety of home care workers and simultaneously to meet the choices of clients. Staff experienced feelings of conflict when they judged it necessary to impose their way of providing home care and thus impose their values on clients to create a safe working environment. There was variation between and within organizations in terms of the staff focus on client needs or on their employer responsibility towards home care workers. The planning of home care services must take account of both the choices of clients and the hazards facing home care staff.

Professional perspectives on decision making about the long-term care of older people

With the increasing pressure on social and health care resources, professionals have to be more explicit in their decision making regarding the long-term care of older people. This grounded theory study used 19 focus groups and nine semi-structured interviews (99 staff in total) to explore professional perspectives on this decision making. Focus group participants and interviewees comprised care managers, social workers, consultant geriatricians, general medical practitioners, community nurses, home care managers, occupational therapists and hospital discharge support staff. The emerging themes spanned context, clients, families and services. Decisions were often prompted by a crisis, hindering professionals seeking to make a measured assessment. Fear of burglary and assault, and the willingness and availability of family to help were major factors in decisions about living at home. Service availability in terms of public funding for community care, the availability of home care workers and workload pressures on primary care services influenced decision 'thresholds' regarding admission to institutional care. Assessment tools designed to assist decision making about the long-term care of older people need to take into account the critical aspects of individual fears and motivation, family support and the availability of publicly funded services as well as functional and medical needs.

Beyond the shadow space: architecture as a professional and creative process; during and post-conflict.

Introduction

Much has been written about the impact of conflict on the physical nature of cities; most obviously perhaps the damage, destruction, defensive construction and spatial reconfigurations that evolve in times of conflict. Set within the context of Belfast, Northern Ireland, this paper will focus on three areas. First, a closer reading of the long-term physical impact of conflict, in particular, the spatial forms and practices that persist conceptually and culturally, and/or resist re-conceptualisation. Secondly, the effect of conflict on the nature of architectural practice itself, considering whether issues such as appointment and procurement impacted on architectural expectation and the context of operation. Thirdly, the effect of conflict on people, in particular in relation to creativity and hence the psyche of practice itself. This section will also identify the conditions that undermine or support design quality and creativity not only within times of conflict but also as society evolves out of the shadow space. 1
Twelve years on from the Peace Agreement,2 it may seem remarkable from an external perspective that Northern Ireland still needs to be reflecting on its troubled past. But the immediate post-conflict phase offered the communities of Northern Ireland place and time to experience ‘normal life’, begin to reconcile themselves to the hurt they experienced and start to reconfigure their relationships to one another. Indeed, it has often been expressed that probing the issues too much, at too early a phase, might in fact ‘Open old wounds without resolving anything’ and/or ‘Destabilise the already fragile political system.’3 This tendency not to deliberate or be too probing is therefore understandable and might be the reason why, for example, Northern Ireland's first Architecture and Built Environment policy, published in June, 2006, contains only one routine reference to ‘the Troubles’.

Clearly, however, there is a time in the development of a healthy, functioning society, when in order effectively to plan its future, it must also carry out a closer reading and deeper understanding of its past. As Maya Angelou puts it, ‘History, despite its wrenching pain/ Cannot be unlived, and if faced/ With courage, need not be lived again.’4

Increasingly, those within the creative arts sector and the built environment professions are showing interest in carrying out that closer reading, teasing out issues around conflict. This was led in part by the recent publication of the Troubles Archive by the Arts Council of Northern Ireland.5 Those involved in the academic or professional development of future generations of architects are also concerned about the relevance of a post-conflict condition. As a profession, if architects purport to be concerned with context, then the almost tangible socio-political circumstances and legacy of Northern Ireland does inevitably require direct eye contact. This paper therefore aims to bring the relationship between conflict and architectural practice in Northern Ireland into sharp focus, not to constrain or dull creative practice but to heighten its potential.

ABA-Based Programs for Children Diagnosed With Autism Spectrum Disorder: Parental and Professional Experiences at School and at Home

Having a child diagnosed with Autism Spectrum Disorder (ASD) poses a range of challenges to families, many of which can be addressed through appropriate intervention. A study of parental (n = 95) and professional (n = 67) experiences was carried out in relation to two settings: (a) schools that provided intensive interventions based on the science of Applied Behavior Analysis (ABA), and (b) non-intensive ABA-based home programs. Results show that parents whose children attend ABA-based schools were generally more satisfied with their child's educational provision, monitoring procedures, and level of staff training, than parents who were not offered ABA-based education in schools. © 2012 Copyright Taylor and Francis Group, LLC.

Healthcare professional experiences and attitudes on unlicensed/off-label paediatric prescribing and paediatric clinical trials.

Objectives: To investigate the knowledge and views of a range of healthcare professionals (consultant paediatricians, general practitioners (GPs), community pharmacists and paediatric nurses) regarding the use of unlicensed/off-label medicines in children and the participation of children in clinical trials.

Methods: A regional study in which a survey instrument with 39 items was issued to 500 randomly selected GPs, all community pharmacists (n?=?512), 50 hospital consultants and 150 paediatric nurses in Northern Ireland.

Results: Approximately half (46.5%) of the 1,212 healthcare professionals approached responded to the questionnaire. The majority of respondents indicated their familiarity with the term unlicensed (82.9%) or off-label (58.6%) prescribing with the most frequently quoted reason for such prescribing being younger age (33.6%). Apart from community pharmacists, most respondents reported having gained their knowledge through personal experience. Even though a large percentage of respondents expressed concerns about the safety (77.8%) or efficacy (87.9%) of unlicensed/off-label prescribing in children, only 30.7% reported informing parents/guardians of these concerns on the use of such medicines in children. In addition, only 56% of respondents believed that unlicensed/off-label medicines should undergo clinical trials in children. Overall, 28.4% of respondents (20.1% of GPs, 41.4% of community pharmacists, 27.7% of paediatric nurses and 94% of consultant paediatricians) indicated their willingness to be actively involved in, and recruit their patients for paediatric clinical research.

Conclusion: The use of unlicensed and off-label medicines remains a major issue in paediatric medicine. Until such times as more licensed medicines are available for children, clear guidance should be developed to allow consistency in practice across the spectrum of healthcare professionals who are involved with such medicines in their routine practice.