Annetta Smith

Service provision for people with dementia in rural Scotland: Difficulties and innovations

The provision of health and social care services to people with dementia and their carers living in remote and rural areas has been neglected globally. Meeting the needs of people with dementia poses many challenges for service providers. Such challenges may be compounded by the difficulties of providing and accessing services in rural areas.This article explores the views of Scottish service providers drawn from the voluntary, statutory and private sectors. Our findings highlight the difficulties relating to dementia and rurality faced by service providers in Scotland. We also consider innovative measures reported by service providers. Such measures indicate that not only can the distinct challenges of dementia service provision be overcome, but also challenges posed by providing services to people with dementia and their carers in rural and remote areas.These findings extend the literature on rural dementia service provision.The article concludes with a consideration of the practice and policy implications of providing dementia services in remote and rural Scotland.

Doing action research in organizations: Using communicative spaces to facilitate (transformative) professional learning

This paper considers the nature of professional learning arising through the processes of carrying out action research in professional organizations. It suggests that communicative space opened up outside of the professional context can lead to unanticipated professional learning. Such learning could be considered transformative in the way it leads professionals to reframe their understanding of the dilemma arising from doing action research. To illustrate this, two cases are presented to show the pivotal role university tutors can play not only in the way they create and maintain communicative space but also in the way they purposefully employ strategies to interrupt and challenge viewpoints, assumptions and practices held by professionals doing action research, enabling professional learning to become transformative.

Conceptualising psychological distress in families in palliative care: Findings from a systematic review

Background: Adult palliative care patients and their family members experience significant psychological distress and morbidity. Psychosocial interventions adopting a systemic approach may provide a cogent model to improve the psychosocial care of families in palliative care. To facilitate design of these interventions, the construct of psychological distress in families in palliative care should be empirically derived. Aim: To ascertain how psychological distress is conceptualised in families receiving palliative care. Design: A systematic review of the literature; this was followed by a thematic analysis and narrative synthesis. Data sources: Using pre-defined search terms, four electronic databases (MEDLINE, CINAHL, PsycINFO and Behavioural Sciences collections) were searched with no date restrictions imposed. Pre-determined inclusion and exclusion criteria were then applied. Results: A total of 32 papers were included in the review. Two findings emerged from data synthesis. First, distress is conceptualised as a multi-dimensional construct but little consensus exists as to how to capture and measure distress. Second, distress in the families within these studies can be conceptualised using a tiered approach, moving from individual non-interactive depictions of distress through gradations of interaction to convey a systemic account of distress within the family system. Thus, distress shifts from a unitary to a systemic construct. Conclusion: Currently, there is a paucity of research examining distress informed by family systems theories. This review proposes that distress in families in palliative care can be conceptualised and illustrated within a tiered model of distress. Further research is merited to advance current explanatory frameworks and theoretical models of distress.

Does time matter? An investigation of knowledge and attitudes following blood transfusion training

The Scottish National Blood Transfusion service have developed an educational programme aimed at ensuring a high standard of care for blood transfusions to minimise risk to patients and healthcare practitioners. This paper investigates whether knowledge and understanding of, and attitudes towards, safe practice declined over time following completion of module 1 of the programme. An online survey was administered to a range of healthcare practitioners who had completed the module. The survey tool tested knowledge and ascertained views on blood transfusion practice and perceptions of the modules importance. Comparisons were made between participants 6-8 weeks, 12-14 months and 22-24 months since module completion. In-depth interviews were conducted with a sub-sample of survey respondents to explore attitudes in more detail. Findings indicate evidence of a slight though statistically significant reduction in the degree of emphasis respondents placed on the importance of understanding aspects of transfusions as time lapsed, but no difference was found in knowledge between those who took the course more recently and those who were up to two years post-module. The studys findings indicate that recognition of the importance of safe practice declines over time and thus also suggests that frequent refresher courses are important to maintain safe practice.

Exploration of the effects of peer teaching of research on students in an undergraduate nursing programme

The use of peer teaching has been recognised as a valuable teaching and learning strategy in higher education. It has been used in nursing as an adjunct to lectures and to support learning in clinical practice. Despite a developing literature there is limited understanding of its use for teaching about research. This educational project aimed to increase understanding of the effects of peer teaching of research in an undergraduate nursing programme. A convenience sample of 151 third year student ‘learners’ were recruited from three campuses across a School of Nursing, Midwifery and Health in Scotland. Students were asked to complete a questionnaire evaluating nine peer teaching sessions delivered by seven separate peer ‘tutor’ presenters, i.e. honours students (two students repeated their presentations). Five peer ‘tutors’ participated in a focus group to discuss their experience of teaching and personal learning. Results indicated that the student learners’ understanding of research and its relevance to clinical practice had been enhanced. These findings resonated with the peer ‘tutors’ intentions of helping other students to make that connection through the presentation of their work. In conclusion, peer teaching of research helped undergraduate nursing students learn about research and it assisted the peer ‘tutors’ to consolidate their learning, develop teaching skills and confidence.

Developing the DESCARTE Model The Design of Case Study Research in Health Care

Case study is a long-established research tradition which predates the recent surge in mixed-methods research. Although a myriad of nuanced definitions of case study exist, seminal case study authors agree that the use of multiple data sources typify this research approach. The expansive case study literature demonstrates a lack of clarity and guidance in designing and reporting this approach to research. Informed by two reviews of the current health care literature, we posit that methodological description in case studies principally focuses on description of case study typology, which impedes the construction of methodologically clear and rigorous case studies. We draw from the case study and mixed-methods literature to develop the DESCARTE model as an innovative approach to the design, conduct, and reporting of case studies in health care. We examine how case study fits within the overall enterprise of qualitatively driven mixed-methods research, and the potential strengths of the model are considered.

Everybody Knows Everybody Else's Business—Privacy in Rural Communities

Patients have a right to privacy in a health care setting. This involves conversational discretion, security of medical records and physical privacy of remaining unnoticed or unidentified when using health care services other than by those who need to know or whom the patient wishes to know. However, the privacy of cancer patients who live in rural areas is more difficult to protect due to the characteristics of rural communities. The purpose of this article is to reflect on concerns relating to the lack of privacy experienced by cancer patients and health care professionals in the rural health care setting. In addition, this article suggests future research directions to provide much needed evidence for educating health care providers and guiding health care policies that can lead to better protection of privacy among cancer patients living in rural communities.

Seeking, accepting and declining help for emotional distress in cancer: A systematic review and thematic synthesis of qualitative evidence

Many individuals affected by cancer who experience emotional distress report not wanting help. This review aims to understand why individuals affected by cancer seek, accept or decline help for emotional distress and what influences these actions. A systematic review and thematic synthesis of the qualitative literature was conducted. Using pre-defined search terms, four electronic databases were searched from January 2000 to May 2016. Pre-determined inclusion and exclusion criteria were then applied. Identified papers were quality appraised. In total, 32 papers were included in the synthesis. Four themes emerged from data synthesis: attaining normality-the normality paradox; being emotionally literate; perceptions of help; needs-support gap. Attaining normality is ideographic, context dependent and temporally situated; some individuals maintain normality by not seeking/declining help whereas others seek/accept help to achieve a new normality. Thus, attaining normality paradoxically functions to explain both why individuals sought/accepted help or did not seek/declined help. Data indicate that a context dependent, systems thinking approach is merited to enhance psychosocial care. In particular, clinicians must actively explore the personal context of an individuals distress to ensure that help desired and help offered are mutually understood. Further research must address the limitations of the current evidence base to advance theoretical understanding.

The impact of a support centre for people with sensory impairment living in rural Scotland

UNLABELLED Aim The overall aim of this study was to evaluate whether attendance at a Sensory Support Centre for people with a sensory impairment living in the Western Isles of Scotland had an impact on their lives. BACKGROUND Demographic forecasts show that the prevalence of sensory impairment in the population will increase, as a significant proportion of sensory loss is age related. People with sensory impairments are more likely to experience social exclusion, and are more at risk of injury and physical and mental illness. Therefore, strategies to improve service access and provision for people with sensory impairments are important to reduce the disability associated with sight and/or hearing loss. METHODS All clients who accessed the service during a six-month period were invited to complete a postal questionnaire about their service experience. Semi-structured individual interviews with clients (n=12) described their experience of living with a sensory impairment and the impact (if any) that access to the Sensory Centre had on their lives. Individual interviews were also conducted with healthcare and social-care professionals (n=7) to ascertain their level of service awareness. Findings Clients who experienced sensory impairment described how the impairment negatively impacted on their activities of living, safety and independence. Following Sensory Centre assessment and support, some clients were able to identify ways in which interventions had reduced their sense of social isolation, impacted positively on self-confidence and sense of self-esteem and safety. Importantly, interventions had supported greater functional independence in their own homes. CONCLUSION This study provides evidence that access to sensory services are important to people with sensory impairments living in remote areas, and should be considered when planning healthcare services, as they are one way of ameliorating health inequalities in this population group.

“I know exactly what I'm going into”: recommendations for pre-nursing experience from an evaluation of a pre-nursing scholarship in rural Scotland.

To develop a model of pre‐nursing experience from evaluation of a pre‐nursing scholarship for school pupils in Scotland.