Carolyn Wallace

Caring for frail patients: best practice.

Frailty has become synonymous with vulnerability and is a state caused by many factors, including disability, recurrent infection and multiple co-morbidities. The Gwent frailty service recognises the importance of an interdisciplinary approach to care, including timely recognition of frailty in patients and referral to the most appropriate services to optimise management and treatment.

Interventions to improve the self-management support health professionals provide for people with progressive neurological conditions: protocol for a realist synthesis

Introduction Supporting self-management among people with long-term conditions is recognised as an important component of healthcare. Progressive neurological conditions (PNCs), for example, Parkinsons disease and multiple sclerosis are associated with problems such as fatigue and cognitive impairment which may make self-management more challenging. Health professionals may need to develop specific skills in order to provide effective self-management support for these patients. The review aims to develop explanatory theories about how health professional-targeted interventions to improve self-management support provision for people with PNCs operate in different circumstances. Methods and analysis A realist synthesis of the evidence is proposed. There are 2 priority questions for the review to address. These relate to the role of a shared concept of self-management support within the healthcare team, and the need to tailor the support provided to the requirements of people with PNCs. Key stakeholders will be involved throughout the process. The initial search strategy uses terms relating to (1) self-management, (2) health professionals and (3) PNCs. Searching, data extraction and synthesis will occur in parallel. Studies will be prioritised for inclusion based on anticipated contribution to generating explanatory theories. Key informant interviews are planned to direct supplementary searches and help further refine the theories developed. Results will be expressed in the form of context–mechanism–outcome configurations. Ethics and dissemination Publication guidelines on realist synthesis will be followed. The results will be published in a peer-reviewed journal and made available to organisations involved in the provision of health professional training.

Occupational health for humanitarian aid workers in an Ebola outbreak

The recent Ebola outbreak has caused worldwide consternation due to the spread of the disease and the high fatality rate, especially within the health care profession. Unfortunately this exacerbated the already limited health care infrastructure within Guinea, Liberia and Sierra Leone. Recruitment and the ability to respond by humanitarian aid organisations were impaired due to lack of willing delegates, facilities and equipment. This investigative qualitative study of International Federation of the Red Cross and Red Crescent staff was conducted in three West African countries to assess the current staff health situation and make recommendations for improvement to issues and needs that may impact staff capacity to deliver services during deployment. A field visit was conducted in September 2014 during which a diary of interviews, notes and logged events was taken. The information will be used to inform a modified Delphi study for the development of minimum standards for occupational health for humanitarian aid workers. A total of 24 delegates were interviewed in Conakry (Guinea), Freetown and Kenema (Sierra Leone) and Monrovia (Liberia). The issues raised during the interviews covered pre-deployment, deployment, post-deployment and various issues related to work and life as a delegate in an Ebola operation. Pre-deployment issues raised were: addressing the concerns expressed by family, friends and employer, the importance of medical clearance and receiving health briefing prior to deployment and appropriate special training. Deployment raised different issues regarding ability to maintain personal health, location and acceptability of accommodation, new ways of living and working, including development of standard operating procedures to ensure quality of care and safety, security and travel restrictions and communication with family, friends and colleagues. Post-deployment concerns included media-related issues impacting on family, alienation instead of admiration, quarantine and ability to go home, and coming to terms with their experiences. The Ebola outbreak posed a huge challenge to the deploying humanitarian organisations in terms of recruiting, preparing, deploying, post-deployment and supporting their delegates through this process. The lessons learnt from this study and recommendations made to improve the future health and safety of humanitarian aid workers will inform the development of minimum standards for occupational health for these professions.

“Happily independent” – configuring the Gwent frailty support and wellbeing worker

Purpose – This article aims to report on the configuration of the integrated Support and Wellbeing Worker (SWB) role in an innovative Gwent Frailty programme from 2009 until 2011.Design/methodology/approach – The health and social care Gwent Frailty programme used a configuration approach by adopting “frailty” as its unifying theme across the seven agencies involved. In order to configure this role, the Frailty Workforce Group (FWG) identified three tasks; staff engagement, identifying the SWB worker training needs, and scoping the employment options for the new role.Findings – For others facing the same challenges there are three key principles. The first is that having a unifying concept underpinned by the commissioned “Happily independent” study legitimately enabled the FWG to deliver on its three tasks identified by the Frailty Board. The second was that time spent on early staff and trade union engagement gave positive messages about their value within the role configuration. Finally, that developing...

Shifting mindsets: a realist synthesis of evidence from self-management support training

Accompanying the growing expectation of patient self‐management is the need to ensure health care professionals (HCPs) have the required attitudes and skills to provide effective self‐management support (SMS). Results from existing training interventions for HCPs in SMS have been mixed and the evidence base is weaker for certain settings, including supporting people with progressive neurological conditions (PNCs). We set out to understand how training operates, and to identify barriers and facilitators to training designed to support shifts in attitudes amongst HCPs.

Developing and Translating a New Model for Teaching Empowerment Into Routine Chronic Care Management: An International Patient-Centered Project

Background: Health professional education has been criticized for not integrating patient expertise into professional curricula to develop professional skills in patient empowerment. Objective: To develop and translate a new expert patient-centered model for teaching empowerment into professional education about routine chronic care management. Methods: Eight Finnish patients (known as expert patients), 31 students, and 11 lecturers from 4 European countries participated in a new pilot intensive educational module. Thirteen focus groups, artefacts, and an online student evaluation were analyzed using a thematic analysis and triangulated using a meta-matrix. Results: A patient-centered pedagogical model is presented, which describes 3 phases of empowerment: (1) preliminary work, (2) the elements of empowerment, and (3) the expected outcomes. These 3 phases were bound by 2 cross-cutting themes “time” and “enabling resources.” Conclusion: Patient expertise was embedded into the new module curriculum. Using an example of care planning, and Pentland and Feldman’s theory of routine organization, the results are translated into a patient-centered educational model for teaching empowerment to health profession students.

Reporting adverse events in a large community-based public health trial (building blocks): what gets reported and how does it vary?

Background Adverse event (AE) reporting is an integral part of safety monitoring for clinical trials and standard definitions for medical AEs exist under GCP. However, public health trials in community settings present challenges for consistent safety monitoring. For studies of complex behaviour change interventions, what should be recorded may not be self-evident. Building Blocks is such a trial and is evaluating the effectiveness of a home visiting intervention (Family Nurse Partnership programme). This presentation aims to assess variability in safety reporting, and explore factors associated with nature, level and quality of reporting.