Caroline Norrie

Doing it differently? A review of literature on teaching reflective practice across health and social care professions

Reflective approaches have been increasingly adopted in health and social care education. However, how reflective practice is taught in and between professional courses differs extensively. This review of literature identified and categorised literature available on teaching reflective practice in health and social care and compared this with what was available interprofessionally and multiprofessionally. Limited examples comparing how reflective practice is taught in different professions were found. This lack of empirical data has implications for both the teaching and researching of professional practice.

Models of adult safeguarding in England: A review of the literature

Summary This article presents the findings of a narrative synthesis of literature published between January 2000 and September 2013 exploring the organisation of adult safeguarding services in England. The review sought to identify the characteristics of safeguarding practice, which may be important for local authorities to consider when choosing between models of organisation. Findings The findings suggest that the development of adult safeguarding policy and practice has prompted local authorities to develop specialist safeguarding roles. The implications of specialism have not been extensively explored. However, several important characteristics of safeguarding practice are identifiable from the literature including specialism within the organisation of adult safeguarding; decision-making and thresholds for safeguarding response; and multi-agency working. Applications The review found limited evidence relating to the organisation of adult safeguarding, which suggests that further empirical research is needed. The critical features of safeguarding practice identified here comprise a useful starting point from which to explore the implications of different ‘models’ of safeguarding organisation.

Taking the long view: Exploring the development of interprofessional education

Interprofessional education (IPE) in health and social care has been well documented regarding student outcomes. Less has been written from the perspective of those who actually developed IPE. This study explores IPE within the context of a university partnership working with service providers in Southwest London (UK). We focused on the experiences and perspectives of 19 key players who were interviewed about the inception, implementation and development of IPE over 15 years. Our aim was to understand their views of IPE and its evolution over time. Interviewees provided different understandings of IPE, as well as contrasting views regarding its purpose and optimum delivery. Problems such as lack of central planning and the logistics of implementation were also discussed. Paradoxically, however, the participants highlighted positive outcomes and conveyed optimistic messages for the future. Despite various challenges and setbacks, a strong belief in the importance of IPE and a commitment to carrying it through were strong motivators contributing to finding solutions, as were building trust and positive relationships across professional and disciplinary boundaries.

Addressing incontinence for people with dementia living at home: a documentary analysis of local English community nursing service continence policies and clinical guidance.

AIM AND OBJECTIVES To establish whether the problems and issues experienced by people with dementia living at home and their carers were addressed in the clinical guidance for continence management for community nursing services in England. BACKGROUND Internationally, the numbers of people with dementia are rising. Managing incontinence is a significant issue as the presence of incontinence is one of the triggers for people with dementia to move their residence to a care home. People with dementia living at home and their family carers report difficulties in accessing knowledgeable professionals and acceptable continence products. DESIGN A review by documentary analysis of clinical policies and guidance from a sample of community nursing services in all Strategic Health Authority regions of England. METHODS A sample of clinical policy and guidance documents for continence assessment and management from up to four community nursing services in each of the ten Strategic Health Authority regions in England was sought. Documentary analysis was undertaken on the relevance of the documents identified for people with dementia living at home. FINDINGS Ninety-eight documents from 38 local community nursing services spread across ten Strategic Health Authority areas were obtained and analysed. Only in the documents of three services were nurses offered detailed guidance about the management of incontinence for people with dementia at home. In the documentation of only one service were people with dementia identified as a special case which warranted the provision of additional continence products. CONCLUSION Clinical guidance on continence assessment and management for community nurses in many parts of England does not address the specific needs of people with dementia living at home or their carers. RELEVANCE FOR CLINICAL PRACTICE Nurses working in community settings and those providing clinical leadership in continence care should review their clinical guidance and policies to ensure relevance for people with dementia living at home and their family carers.

The potential uses and abuses of a power of entry for social workers in England: a re-analysis of responses to a government consultation

Purpose Whether social workers should have a power of entry in cases where individuals seem to be hindering safeguarding enquiries for community-dwelling adults at risk is a topical question in England. The purpose of this paper is to present the findings of a re-examination of relevant sections of the 2012 Government Safeguarding Power of Entry Consultation. Design/methodology/approach Re-analysis of responses to question three of the 2012 Government’s Safeguarding Power of Entry Consultation was undertaken in late 2015-early 2016. The consultation submissions were located and searched for information on views of the prevalence of the situations where access to an adult at risk (with decision-making capacity) is being hindered by a third party and the nature of examples where a new power of entry might be considered appropriate by consultation respondents. Findings The majority of respondents to the consultation generally reported that situations when a new power of entry would be required were not encountered regularly; however a minority of respondents stated these situations occurred more frequently. Examples of situations where third parties appeared to be hindering access were given across the different categories of adults at risk and types of abuse and current practices were described. Respondents observed that the risks of excessive or inappropriate use of any new powers needed to be considered carefully. Originality/value This re-analysis sheds light on the prevalence and circumstances of the problems encountered about access to adults at risk. The legal framework of adult safeguarding continues to be of interest to policy makers, researchers and practitioners.

Parliamentary arguments on powers of access - the Care Bill debates

Purpose Opinion is divided on whether a new power of entry should be introduced for social workers in cases where individuals seem to be hindering safeguarding enquiries for community-dwelling adults at risk in England who have decision-making capacity. The purpose of this paper is to investigate the prevalence and circumstances of situations where access to an adult at risk is denied or difficult and what helps those in practice. The study consists of a literature review, a survey of adult safeguarding managers and interviews with social care staff in three case studies of local authorities. As part of the contextual literature review, during 2014 the authors located parliamentary debates on the subject and this paper reports on their analysis. Design/methodology/approach Following approaches were used in historical research, documentary analysis was carried out on transcripts of parliamentary debates available online from Hansard, supplemented by other materials that were referenced in speeches and set in the theoretical context of the representations of social problems. Findings The authors describe the content of debates on the risks and benefits of a new right to access for social workers and the role of parliamentary champions who determinedly pursued this policy, putting forward three unsuccessful amendments in efforts to insert such a new power into the Care Act 2014. Research limitations/implications There are limits to a focus on parliamentary reports and the limits of Hansard reporting are small but need to be acknowledged. However, adult safeguarding research has surprisingly not undertaken substantial analyses of political rhetoric despite the public theatre of the debate and the importance of legislative initiatives and monitoring. Originality/value This paper adds to the history of adult safeguarding in England. It also offers insight into politicians’ views on what is known/unknown about the prevalence and circumstances of the problems with gaining access to adults with capacity where there are safeguarding concerns and politicians’ views on the merits or hazards of a power of access.

Investigating models of adult safeguarding in England - a mixed-methods approach

Purpose – The purpose of this paper is to describe the methodology being used in a study exploring the organisation of adult safeguarding. Design/methodology/approach – A mixed-methods study is presented which describes how the research team is seeking to identify models of adult safeguarding and then compare them using a quasi-experimental study design. Findings – Close examination of this study’s methodology highlights the potential value of mixed-method research approaches. Research limitations/implications – Anticipated study challenges include difficulties with gaining agreement from study sites and recruitment of people who have been the subject of a safeguarding referral. Originality/value – This will be the first study in England to identify and compare different models of adult safeguarding in depth. Outlining and discussing current methodology is likely to be of interest to practitioners, managers and other researchers and policy makers.

Developing an adult safeguarding outcome measure in England

Purpose – There are currently no national adult safeguarding outcome measures that focus on people who have been through an adult safeguarding investigation in England. There is a need for local authorities (LAs) and their partners to be able to measure whether the services provided to adults at risk of abuse and neglect are effective. The paper aims to discuss these issues. Design/methodology/approach – This paper describes the cognitive testing phase of a study to develop and implement a standardised adult at risk outcome measure in adult safeguarding for use by LAs in England. An outcome measure (a set of seven survey questions administered in a face to face interview) was cognitively tested in three LAs with adults at risk (or their carers/advocates) for whom an investigation of abuse had been concluded (n=40), with the aim of assessing whether it was commonly understood. A set of guidance notes was designed and LA staff (n=12) who assisted with the survey were interviewed about its usability and the ...

Social workers' power of entry in adult safeguarding concerns: Debates over autonomy, privacy and protection

The purpose of this paper is to explore debates about the powers social workers may need to undertake safeguarding enquiries where access to the adult is denied.,The paper takes as a starting point a scoping review of the literature undertaken as part of a study exploring social work responses to situations where they are prevented from speaking to an adult at risk by a third party.,A power of entry might be one solution to situations where social workers are prevented from accessing an adult at risk. The paper focuses on the Scottish approach to legal powers in adult safeguarding, established by the Adult Support and Protection Act (Scotland) 2007 and draws out messages for adult safeguarding in England and elsewhere. The literature review identified that debates over the Scottish approach are underpinned by differing conceptualisations of vulnerability, autonomy and privacy, and the paper relates these conceptualisations to different theoretical stances.,The paper concludes that the literature suggests that a more socially mediated rather than an essentialist understanding of the concepts of vulnerability, autonomy and privacy allows for more nuanced approaches to social work practice in respect of using powers of entry and intervention with adults at risk who have capacity to make decisions.,This paper provides a novel perspective on debates over how to overcome challenges to accessing adults at risk in adult safeguarding through an exploration of understandings of vulnerability, privacy and autonomy.

Gambling and adult safeguarding: Connections and evidence

Purpose Opportunities to gamble have boomed in the UK in recent years, since the passing of the Gambling Act 2005. The implications of this for adults with care and support needs and for safeguarding services have not been greatly investigated. The purpose of this paper is to address the interface of how gambling affects adults with care and support needs in England and adult safeguarding. Design/methodology/approach This paper reports on the scoping review which focussed on adults with care and support needs and gambling-related harm. It also included literature on perpetrators who exploit adults with care and support needs to fund their own or others’ gambling. The overall aims of this scoping review were to explore what is known about gambling-related harm affecting adults with care and support needs, the gaps in the evidence base, and specifically to refine the interview questions for the wider study. Findings There is some evidence that adults with care and support needs experience or are at risk of gambling-related harm. There is, however, lack of data from safeguarding services about this affecting adults at risk and safeguarding practice and systems. A public health approach to gambling is advocated by some, as well as effective regulation and support for people who have problems with their own or others’ gambling. Originality/value Industry operators, practitioners, and policymakers are increasingly paying attention to gambling-related harm but there is a lack of focus on adults with care and support needs or implications for adult safeguarding.