Safeguarding and promoting children in maternity services- implications for policy and practice

The article debates the issues involved in safeguarding and protecting children in maternity services and offers implications for professional practice. Midwives and other staff who work as members of the maternity team have a safeguarding role to play in the identification of babies and children who have been abused, or at risk of abuse, and in subsequent intervention and protection services. The study highlights how domestic violence increases during pregnancy and the postpartum period, and is significantly related to all types of child maltreatment up to the child's fifth year, and children under one being at the highest risk of injury, or death. Close inter-agency liaison is required with midwives who are accountable and not afraid to challeneg hiostorical working practices.

Conference Reflections. Some Practice and Practical Implications of Banning the Physical Punishment of Children through Legislation.

This brief paper represents the reflections of a participant at the recent conference ‘The Physical Punishment of Children’ organised jointly by Child Care in Practice and The Office of Law Reform. The participant’s reflections are related to his roles both as a Family Therapist and as a Guardian Ad Litem. The writer largely accepts the academic and moral arguments in respect of making the physical punishment of children a legal offence, so eloquently put by the main speakers. He wishes, however, to draw out some of the practical and practice implications which need to be considered alongside the implementation of such legislative change.

Innovative Approaches to Involving Service Users in Palliative Care Social Work Education

Service user involvement in social work education is now a firmly established concept in UnitedKingdom.As a result, it is common practice for service users to occupy central roles the education and training of social work students and staff in both qualifying and postqualifying programmes. This paper describes an initiative, undertaken inNorthern Ireland, which compares two methods of user involvement employed with undergraduate and postqualifying social work students. In both situations the students firstly observed discussedDVDexcerpts of narratives from people affected by cancer and secondly observed live facilitated interview with a 25-year-old male service user who shared his experiences being diagnosedwith cancer at a young age.Understanding the social work role in palliative care is crucial as all social workers, regardless of practice context, will have some degree involvement in helping individuals and families to address end-of-life care issues. paper compares the findings of evaluations from two student groups which may help inform social work educators about the effectiveness of different teaching methods used achieve meaningful and effective user involvement with seldom heard groups.

A national survey of the mangement of delirium in UK intensive care units

Background: Delirium is an acute organ dysfunction common amongst patients treated in intensive care units. The associated morbidity and mortality are known to be substantial. Previous surveys have described which screening tools are used to diagnose delirium and which medications are used to treat delirium, but these data are not available for the United Kingdom. Aim: This survey aimed to describe the UK management of delirium by consultant intensivists. Additionally, knowledge and attitudes towards management of delirium were sought. The results will inform future research in this area. Methods: A national postal survey of members of the UK Intensive Care Society was performed. A concise two page questionnaire survey was sent, with a second round of surveys sent to non-respondents after 6 weeks. The questionnaire was in tick-box format. Results: Six hundred and eighty-one replies were received from 1308 questionnaires sent, giving a response rate of 52%. Twenty-five percent of respondents routinely screen for delirium, but of these only 55% use a screening tool validated for use in intensive care. The majority (80%) of those using a validated instrument used the Confusion Assessment Method for the Intensive Care Unit. Hyperactive delirium is treated pharmacologically by 95%; hypoactive delirium is treated pharmacologically by 25%, with haloperidol the most common agent used in both. Over 80% of respondents agreed that delirium prolongs mechanical ventilation and hospital stay and requires active treatment. Conclusions: This UK survey demonstrates screening for delirium is sporadic. Pharmacological treatment is usually with haloperidol in spite of the limited evidence to support this practice. Hypoactive delirium is infrequently treated pharmacologically.

Cardiac rehabilitation uptake following myocardial infarction: cross-sectional study in primary care

Background Policies suggest that primary care should be more involved in delivering cardiac rehabilitation. However, there is a lack of information about what is known in primary care regarding patients' invitation or attendance. Aim To determine, within primary care, how many patients are invited to and attend rehabilitation after myocardial infarction (MI), examine sociodemographic factors related to invitation, and compare quality of life between those who do and do not attend. Design of study Review of primary care paper and computer records; cross-sectional questionnaire. Setting Northern Ireland general practices (38); stratified sample, based on practice size and health board area. Method Patients, identified from primary care records, 12-16?weeks after a confirmed diagnosis of MI, were posted questionnaires, including a validated MacNew post-MI quality-of-life questionnaire. Practices returned anonymised data for non-responders. Results Information about rehabilitation was available for 332 of the 432 patients identified (76.9%): 162 (37.5%) returned questionnaires. Of the total sample, 54.4% (235/432) were invited and 37.0% (160/432) attended; of those invited, 68.1% (160/235) attended. Invited patients were younger than those not invited (mean age 63?years [standard deviation SD 16] versus 68.5?years [SD 16]); mean difference 5.5?years (95% confidence interval [CI] = 1.7 to 9.3). Among questionnaire responders, those who attended were younger and reported better emotional, physical, and social functioning than non-attenders (P = 0.01; mean differences 0.44 (95% CI = 0.11 to 0.77), 0.48 (95% CI = 0.10 to 0.85) and 0.54 (95% CI = 0.15 to 0.94) respectively). Conclusion Innovative strategies are needed to improve cardiac rehabilitation uptake, integration of hospital and primary care services, and healthcare professionals' awareness of patients' potential for health gain after MI.

Outreach and Early Warning Systems (EWS) for the prevention of intensive care admission and death of critically ill adult patients on general hospital wards

BACKGROUND: Despite the fact that outreach and early warning systems (EWS) are an integral part of a hospital wide systems approach to improve the early identification and management of deteriorating patients on general hospital wards, the widespread implementation of these interventions in practice is not based on robust research evidence. OBJECTIVES: The primary objective was to determine the impact of critical care outreach services on hospital mortality rates. Secondary objectives included determining the effect of outreach services on intensive care unit (ICU) admission patterns, length of hospital stay and adverse events. SEARCH STRATEGY: The review authors searched the following electronic databases: EPOC Specialised Register, The Cochrane Central Register of Controlled Trials (CENTRAL) and other Cochrane databases (all on The Cochrane Library 2006, Issue 3), MEDLINE (1996-June week 3 2006), EMBASE (1974-week 26 2006), CINAHL (1982-July week 5 2006), First Search (1992-2005) and CAB Health (1990-July 2006); also reference lists of relevant articles, conference abstracts, and made contact with experts and critical care organisations for further information. SELECTION CRITERIA: Randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series designs (ITS) which measured hospital mortality, unanticipated ICU admissions, ICU readmissions, length of hospital stay and adverse events following implementation of outreach and EWS in a general hospital ward to identify deteriorating adult patients versus general hospital ward setting without outreach and EWS were included in the review. DATA COLLECTION AND ANALYSIS: Three review authors independently extracted data and two review authors assessed the methodological quality of the included studies. Meta-analysis was not possible due to heterogeneity. Summary statistics and descriptive summaries of primary and secondary outcomes are presented for each study. MAIN RESULTS: Two cluster-randomised control trials were included: one randomised at hospital level (23 hospitals in Australia) and one at ward level (16 wards in the UK). The primary outcome in the Australian trial (a composite score comprising incidence of unexpected cardiac arrests, unexpected deaths and unplanned ICU admissions) showed no statistical significant difference between control and medical emergency team (MET) hospitals (adjusted P value 0.640; adjusted odds ratio (OR) 0.98; 95% confidence interval (CI) 0.83 to 1.16). The UK-based trial found that outreach reduced in-hospital mortality (adjusted OR 0.52; 95% CI 0.32 to 0.85) compared with the control group. AUTHORS' CONCLUSIONS: The evidence from this review highlights the diversity and poor methodological quality of most studies investigating outreach. The results of the two included studies showed either no evidence of the effectiveness of outreach or a reduction in overall mortality in patients receiving outreach. The lack of evidence on outreach requires further multi-site RCT's to determine potential effectiveness.

Evaluating the Effectiveness of Social Work Education: Preparing Students for Practice Learning

Evaluating the effectiveness of social work education has become a topic of major interest in the UK in the wake of a succession of child-care tragedies that have undermined confidence in the profession. However, many key aspects of social work education remain under-researched and/or contested and our knowledge of how students acquire and develop professional expertise remains limited. This paper reports on the first part of a longitudinal study aimed at developing evidence-based knowledge in this area by considering student perceptions at different stages of their social work education at Queen’s University Belfast. Focusing on the strengths and limitations of preparatory teaching, and their first experience of practice learning, this article considers the impact of demographic factors, including age, gender and experience, on how students experience the learning process. The findings indicate a significant level of disjunction between academic and practice learning and suggest that better integration between these two domains of learning is needed if social work students are to be more effectively prepared for the challenges they are likely to encounter in practice.

The effects of sudden paternal death on young people and their family relationships: some implications for practice

The importance for children and young people to be able to communicate openly about the death of a parent is evident from the literature. This small-scale investigation uses a case-study approach to illustrate the impact on siblings of the sudden death of a father. The abundance of comments from the young people in the study such as “talking is the only thing that helps” and “everybody has to get it out” emphasise the important role of communication within the family. Children tend to take their emotional cues from other family members and, paradoxically, restrict communication of their own grief in an attempt to protect others. Even if painful in the short term, certain lines of communication may need to be established if family members are to be able to support each other in dealing with the distressing experience of the death in a healthy manner. The study suggests that those who work with young people in such circumstances should take cognisance of these issues.

Ascertaining the perspectives of young children in care: case studies using reality boxes

This article describes the use of an innovative method, reality boxes, to elicit the perspectives of children, ages four to seven years, in state care. Using examples from a broader research project based on children in Northern Ireland, which was concerned with their participation rights, the article considers how the children used the boxes to express their views. Informed by a child rights-based approach, the article highlights the processes and practices involved and concludes by stressing the potential importance of this method, used in the context of this framework, in social work practice with young children.

The policy context of leaving care services: A case study of Northern Ireland

The transition of foster youth from state care to independent living has received increased research, practice, and policy attention in the United States and in many other countries. Most contributions to this literature have focused on documenting poor outcomes across various dimensions of need in the young people's lives whereas little attention has been given to the policy context in which the responses to those needs are being developed. In this article, we argue that there is a pressing need for better understanding of how the policy context can both promote and impede the development of appropriate services. To illustrate our argument, we use Northern Ireland as a policy case study both because of recent initiatives underway there in regard to youth transitions from state care and because of the heightened political sensibilities associated with it as a society. We draw attention to the socio-political historical context, a number of intersecting social policies, and the place of social work as a key occupation involved in delivering service improvements. We conclude by suggesting that this case study not only highlights the need to address similar aspects of the policy on youth transition frorn state care in the United States but also demonstrates the benefits of reflecting on policy development and implementation elsewhere in the world.