Informed use of patients' records on trusted health care services

Health care is an information-intensive business. Sharing information in health care processes is a smart use of data enabling informed decision-making whilst ensuring. the privacy and security of patient information. To achieve this, we propose data encryption techniques embedded Information Accountability Framework (IAF) that establishes transitions of the technological concept, thus enabling understanding of shared responsibility, accessibility, and efficient cost effective informed decisions between health care professionals and patients. The IAF results reveal possibilities of efficient informed medical decision making and minimisation of medical errors. Of achieving this will require significant cultural changes and research synergies to ensure the sustainability, acceptability and durability of the IAF

(Re)-regulating care : employing foreign carers for older persons in Taiwan

The purpose of this research was to develop a theoretical understanding of the social phenomenon of the employment of foreign carers for older Taiwanese in households. Foreign carers were introduced into Taiwan in 1992 to address the care needs of the older population. By 2012, over 200,000 foreign caregivers from Indonesia, Philippines, and Vietnam were providing care in households in Taiwan. There has been little research on the interactions between and experiences of family employers, foreign carers and older persons receiving care. The theoretical framework brought together symbolic interactionist concepts and the social constructionism of Berger and Luckmann. Data collection and analysis were informed by Charmaz‘s formulation of grounded theory. Two focus groups and 54 in-depth interviews with a total of 57 Indonesian and Vietnamese foreign carers, Taiwanese family employers and older persons receiving care were undertaken. The analytical findings of the research reflect the ways in which the foreign carer, older persons receiving care and family employer participants were socially situated within the research context and how their respective social realities were shaped differently by changing social structures and cultural values within a globalising context. (Re)-regulating care was generated as the core category, forming a coherent and overarching framework that integrated the three analytical dimensions of the reality of the social change, resituating roles and struggling for control. The reality of social change refers to the employment of foreign carers as a manifestation of the reshaping of the social worlds of the three groups of participants. Resituating roles reflects the processes that underpin the hierarchical positioning of participants, the resultant asymmetrical power relations and associated interactions. Struggling for control, depicts how each group employed strategies to create space and identities that would sustain a sense of self and autonomy. In the current situation of economic and social change in Taiwan the three participant groups shared a desire for control. The autonomy of the women employers was negotiated through employment of foreign carers; for the foreign carers, a pragmatic decision to work abroad became a means for personal empowerment; and the older persons receiving care regained some authority through relationships with carers.

Mediating conflict and control : practice challenges for nurses working in palliative care

A work-based professional development program was offered to a group of registered nurses working in palliative care. The goal of the program was to improve skills in psychosocial care (Yates et al., 1996). Participants were encouraged to reflect critically on their practice experience within a group setting. The focus of the group discussion and reflection were shared practice incidents. Each participant was given the opportunity to identify and describe an incident from their professional practice that presented a challenging issue within palliative nursing. This paper explores the themes of conflict and control, evident within the collection of fifteen practice incidents and discusses the nurses role as mediator. The concepts of patient advocacy and professional autonomy are challenged through the nurses experience of providing care within a hierarchical and bureaucratic health service. The outcome of reflection for the organization is most effective when shared experience and collective action (rather than individual practice) are the focus.

Approaches to reducing the most important patient errors in primary health care : patient and professional perspectives

We have previously reported a preliminary taxonomy of patient error. However, approaches to managing patients' contribution to error have received little attention in the literature. This paper aims to assess how patients and primary care professionals perceive the relative importance of different patient errors as a threat to patient safety. It also attempts to suggest what these groups believe may be done to reduce the errors, and how. It addresses these aims through original research that extends the nominal group analysis used to generate the error taxonomy. Interviews were conducted with 11 purposively selected groups of patients and primary care professionals in Auckland, New Zealand, during late 2007. The total number of participants was 83, including 64 patients. Each group ranked the importance of possible patient errors identified through the nominal group exercise. Approaches to managing the most important errors were then discussed. There was considerable variation among the groups in the importance rankings of the errors. Our general inductive analysis of participants' suggestions revealed the content of four inter-related actions to manage patient error: Grow relationships; Enable patients and professionals to recognise and manage patient error; be Responsive to their shared capacity for change; and Motivate them to act together for patient safety. Cultivation of this GERM of safe care was suggested to benefit from 'individualised community care'. In this approach, primary care professionals individualise, in community spaces, population health messages about patient safety events. This approach may help to reduce patient error and the tension between personal and population health-care.

A shared reading intervention with parents to enhance young children’s early literacy skills

Parental reading to children from an early age has been shown to enhance children’s emergent literacy skills. A pragmatic randomized controlled trial (RCT) was used to investigate the effects of two forms of shared reading interventions on children’s language and literacy skills. Parents of 80 preparatory year children from outer suburban schools of an Australian metropolitan city were trained to use shared reading strategies in an eight-week home intervention. Families were assigned to one of three groups: Dialogic Reading (DR), Dialogic Reading with the addition of Print Referencing (DR + PR), or an attention-matched control group. The sample comprised 42 boys and 38 girls ranging in age from 4.9 years to 6.3 years (M = 5.5, SD = 0.3). Data were collected at pre, post, and at three months follow-up. Measures assessed children’s oral language (receptive and expressive vocabulary), phonological awareness (rhyme, word completion), alphabet knowledge, and concepts about print. Analyses of change from pre to post showed significant effects for the DR and DR + PR groups compared to the control group on three of the six measures: expressive language, rhyme, and concepts about print. At 3-month follow-up assessment, the two intervention groups maintained significantly better performance on the measure of concepts of print only. At both time points, there were no group differences between the DR and DR+PR conditions. These findings illustrate the potential of a brief home focused intervention on promoting children’s emergent literacy.

Shared caregiving responsibilities of adult siblings with elderly parents

This paper uses a nonstructural, ordered discrete choice model to measure the effects of various parent and child characteristics upon the independent caregiving decisions of the adult children of elderly parents sampled in the 1982 and 1984 National Long Term Care Survey (NLTCS). While significant effects are noted, emphasis is placed on test statistics constructed to measure the independence of caregiving decisions. The test statistic results are conclusive: The caregiving decisions of adult children are dependent across time and family members. Structural models taking dependencies among family members into account note effects similar to those in the nonstructural model.

Storytelling; safeguarding; treatment; and responsibility; attributes of recovery in psychiatric intensive care units

Background and aim In recent years policy in Australia has endorsed recovery-oriented mental health services underpinned by the needs, rights and values of people with lived experience of mental illness. This paper critically reviews the idea of recovery understood by nurses at the frontline of services for people experiencing acute psychiatric distress. Method Data gathered from focus groups held with nurses from two hospitals were used to ascertain their use of terminology, understanding of attributes and current practices that support recovery for people experiencing acute psychiatric distress. A review of literature further examined current nurse based evidence and nurse knowledge of recovery approaches specific to psychiatric intensive care settings. Results Four defining attributes of recovery based on nurses’ perspectives are shared to identify and describe strategies that may help underpin recovery specific to psychiatric intensive care settings. Conclusion The four attributes described in this paper provide a pragmatic framework with which nurses can reinforce their clinical decision-making and negotiate the dynamic and often incongruous challenges they experience to embed recovery-oriented culture in acute psychiatric settings.

Visual narratives and counter-narratives in aged care : Centring the participant as photographer in social science research

As detailed by a number of scholars (Emmison & Smith, 2000, 2012; Harrison, 1996, 2002, 2004), photographs and the process of photographing can provide fertile ground for sociological investigation. Examining the production of photography can tell us much about inclusion/omission and power/knowledge in a variety of social settings. Recently, some researchers have begun to utilise the participatory action research methodology, PhotoVoice, where people take and share photographs as a means of communicating and advocating on a specific topic. While medical sociologists have used PhotoVoice to communicate the impacts of disease in vulnerable populations (eg Burles, 2010), little social research has been done that combines PhotoVoice and older persons. This is interesting given the world’s population is ageing and the general lack of research that examines what daily life is like for older people living in aged care (Timonen & O’Dwyer, 2009). In response, a recent project tracked 10 participants who recently transitioned into living in residential aged care (RAC). The project combined the use of PhotoVoice methodology with repeated in-depth interviews. Residents were asked to orally and visually describe the positives and negative aspects of their daily lives. In the first instance, they shared the use of a RAC owned camera and later had the opportunity to access a camera for their sole use. Photographic analysis emphasised the value of centring the participant as an autonomous photographer in social research. In the photographs captured on a shared use camera, the photographs tended to depict predominately positive life stories (e.g. weekly morning tea outings, social activities). In comparison, the photographs captured on the sole use camera also described intimate but everyday activities, spaces, objects and people that frequented in their daily lives. Shifting the responsibility of the camera and photography solely to the participants resulted in the residents disrupting conventions of ‘suitable’ subject matter to photograph (Harrison, 2004) and in doing so, provided a much richer insight into what daily life is like in aged care.

Reflexivity and self-care for creative facilitators: Stepping outside the circle

Those who work with others to explore new and creative ways of thinking about community and organizational participation, ways of engaging with others, individual well-being and creative solutions to problems, have a significant role in a cohesive society. Creative forms of learning can stimulate reflexive practices of self-care and lead to enhanced relationships and practices both personally and professionally. We argue that those who facilitate such practices for others do not always practice their own self-care, which potentially leads to burnout and disillusionment. This research sought to explore understandings and practices of self-care with such facilitators in order to develop resources or techniques to support more sustainable professional identities. A key finding is that reflexive processes are most effective and transforming when shared as a social practice.

Carer perspectives of factors affecting placement trajectories of children in out-of-home care

Carers are at the frontline working with children in the care of the child protection system. This paper reports carer's views about key factors influencing the placement trajectories of children and young people living in out-of-home care in Queensland, Australia. The study sample included 21 foster and kinship carers with a minimum two-year experience in the carer role. Study data were from semi-structured telephone interviews in which carers shared their experiences of the factors impacting upon placement stability and placement movement. Carers' responses were analysed thematically. Data analysis yielded an overarching theme regarding placement trajectory: Carer engagement, and its three sub-themes; with the child; with the child protection system; and, with the caring role. Findings suggested that carer engagement and ‘fit’ are complex constructs that play critical influential roles in placement outcomes (stability or movement) for individual children in out-of-home care. It is argued that practice needs to be better grounded in these relational dynamics, and better aligned concerning the power differentials that exist.

Cloud Computing - health care's silver lining.

Cloud computing is the technology prescription that will help the UK’s National Health Service (NHS) beat the budget constraints imposed as a consequence of the credit crunch. The internet based shared data and services resource will revolutionise the management of medical records and patient information while saving the NHS millions of pounds.

The information needs and information-seeking behaviours of home-care workers and clients receiving home care

Cooper, J. & Urquhart, C. (2005). The information needs and information-seeking behaviours of home-care workers and clients receiving home care. Health Information and Libraries Journal, 22(2), 107-116. Sponsorship: AHRC

The quality of diabetes care in the community: practice, policy and culture

Aim: Diabetes is an important barometer of health system performance. This chronic condition is a source of significant morbidity, premature mortality and a major contributor to health care costs. There is an increasing focus internationally, and more recently nationally, on system, practice and professional-level initiatives to promote the quality of care. The aim of this thesis was to investigate the ‘quality chasm’ around the organisation and delivery of diabetes care in general practice, to explore GPs’ attitudes to engaging in quality improvement activities and to examine efforts to improve the quality of diabetes care in Ireland from practice to policy. Methods: Quantitative and qualitative methods were used. As part of a mixed methods sequential design, a postal survey of 600 GPs was conducted to assess the organization of care. This was followed by an in-depth qualitative study using semi-structured interviews with a purposive sample of 31 GPs from urban and rural areas. The qualitative methodology was also used to examine GPs’ attitudes to engaging in quality improvement. Data were analysed using a Framework approach. A 2nd observation study was used to assess the quality of care in 63 practices with a special interest in diabetes. Data on 3010 adults with Type 2 diabetes from 3 primary care initiatives were analysed and the results were benchmarked against national guidelines and standards of care in the UK. The final study was an instrumental case study of policy formulation. Semi-structured interviews were conducted with 15 members of the Expert Advisory Group (EAG) for Diabetes. Thematic analysis was applied to the data using 3 theories of the policy process as analytical tools. Results: The survey response rate was 44% (n=262). Results suggested care delivery was largely unstructured; 45% of GPs had a diabetes register (n=157), 53% reported using guidelines (n=140), 30% had formal call recall system (n=78) and 24% had none of these organizational features (n=62). Only 10% of GPs had a formal shared protocol with the local hospital specialist diabetes team (n=26). The lack of coordination between settings was identified as a major barrier to providing optimal care leading to waiting times, overburdened hospitals and avoidable duplication. The lack of remuneration for chronic disease management had a ripple effect also creating costs for patients and apathy among GPs. There was also a sense of inertia around quality improvement activities particularly at a national level. This attitude was strongly influenced by previous experiences of change in the health system. In contrast GP’s spoke positively about change at a local level which was facilitated by a practice ethos, leadership and special interest in diabetes. The 2nd quantitative study found that practices with a special interest in diabetes achieved a standard of care comparable to the UK in terms of the recording of clinical processes of care and the achievement of clinical targets; 35% of patients reached the HbA1c target of <6.5% compared to 26% in England and Wales. With regard to diabetes policy formulation, the evolving process of action and inaction was best described by the Multiple Streams Theory. Within the EAG, the formulation of recommendations was facilitated by overarching agreement on the “obvious” priorities while the details of proposals were influenced by personal preferences and local capacity. In contrast the national decision-making process was protracted and ambiguous. The lack of impetus from senior management coupled with the lack of power conferred on the EAG impeded progress. Conclusions: The findings highlight the inconsistency of diabetes care in Ireland. The main barriers to optimal diabetes management center on the organization and coordination of care at the systems level with consequences for practice, providers and patients. Quality improvement initiatives need to stimulate a sense of ownership and interest among frontline service providers to address the local sense of inertia to national change. To date quality improvement in diabetes care has been largely dependent the “special interest” of professionals. The challenge for the Irish health system is to embed this activity as part of routine practice, professional responsibility and the underlying health care culture.

A strategy to advance the evidence base in palliative medicine: formation of a palliative care research cooperative group.

BACKGROUND: Palliative medicine has made rapid progress in establishing its scientific and clinical legitimacy, yet the evidence base to support clinical practice remains deficient in both the quantity and quality of published studies. Historically, the conduct of research in palliative care populations has been impeded by multiple barriers including health care system fragmentation, small number and size of potential sites for recruitment, vulnerability of the population, perceptions of inappropriateness, ethical concerns, and gate-keeping. METHODS: A group of experienced investigators with backgrounds in palliative care research convened to consider developing a research cooperative group as a mechanism for generating high-quality evidence on prioritized, clinically relevant topics in palliative care. RESULTS: The resulting Palliative Care Research Cooperative (PCRC) agreed on a set of core principles: active, interdisciplinary membership; commitment to shared research purposes; heterogeneity of participating sites; development of research capacity in participating sites; standardization of methodologies, such as consenting and data collection/management; agile response to research requests from government, industry, and investigators; focus on translation; education and training of future palliative care researchers; actionable results that can inform clinical practice and policy. Consensus was achieved on a first collaborative study, a randomized clinical trial of statin discontinuation versus continuation in patients with a prognosis of less than 6 months who are taking statins for primary or secondary prevention. This article describes the formation of the PCRC, highlighting processes and decisions taken to optimize the cooperative group's success.

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.