Gordon Grant

Older Carers, Interdependence and the Care of Mentally Handicapped Adults

Elderly people are often seen as the recipients of informal care. In the study reported here, there are clear indications that carers of mentally handicapped people are predominantly female and often beyond retirement age. For some the task is burdensome, but for many it provides a reciprocity both of care and of companionship. Older carers are observed to receive more professional aid than younger carers. But as demographic trends make this caring relationship more common it will be necessary for formal support systems to become more integrated and comprehensive.

Assessing nurses' work environment: old dilemmas, new solutions

Objectives to develop conceptually meaningful and statistically robust indicators of nurses work environment and workplace change. Design following a review of the literature, a census survey of nurses working in onehealth authority in North Wales ( n =1760) was undertaken. After preliminary statistical analysis and a content analysis of qualitative data, a second census survey was completed. Data were subjected to factor analysis using principal components analysis with varimax rotation. Results two scales, the Assessment of Work Environment Schedule (AWES) and the Perception of Workplace Change Schedule (POWCS) were developed. Factor analysis indicated the existence of six sub-scales on AWES and three on POWCS, each of which was conceptually meaningful and statistically robust. It is argued that the indices can be used to assess aspects of nurses work environment and to assess the degree of workplace change, providing target areas for intervention and evaluation.

Action Research—a Necessary Complement to Traditional Health Science?

There is continuing interest in action research in health care. This is despite action researchers facing major problems getting support for their projects from mainstream sources of R&D funds partly because its validity is disputed and partly because it is difficult to predict or evaluate and is therefore seen as risky. In contrast traditional health science dominates and relies on compliance with strictly defined scientific method and rules of accountability. Critics of scientific health care have highlighted many problems including a perpetual quality gap between what is publicly expected and what is deliverable in the face of rising costs and the cultural variability of scientific medicine. Political demand to close the quality gap led to what can be seen as an elitist reform of policy on UK health research by concentrating more resources on better fewer centres and this may also have reduced support for action research. However, incompetent, unethical or criminal clinical practice in the UK has shifted policy towards greater patient and public involvement in health care and research. This highlights complementarity between health science and action research because action research can, as UK health policy requires, involve patients and public in priority setting, defining research outcomes, selecting research methodology, patient recruitment, and interpretation of findings and dissemination of results. However action research will remain marginalised unless either scientific research is transformed generally into a more reflective cycle or there is increased representation of action research enthusiasts within the establishment of health R&D or current peer review and public accountability arrangements are modified. None of these seem likely at this time. The case for complementarity is illustrated with two case studies.

Supporting family carers: a facilitative model for community nursing practice

It is the purpose of this chapter to outline an assessment and intervention model that can be used to support and complement the family care provided to frail individuals living in the community. Although the approach is a generic one, intended for use by any formal service provider, particular attention is given to the role of community nurses in creating a more equitable and appropriate partnership with family carers. The chapter begins with a brief overview of the demographic and policy contexts that have shaped the emergence of community care, and describes the way in which family carers are usually perceived by service agencies. Alternative models are then presented, and it is argued that professionals in general, and nurses in particular, must have a fuller understanding of the dynamic nature of family care if more tailored support is to be provided to reinforce effective family care. The need to link assessment and subsequent intervention to the relevant stage of care-giving is highlighted, and a number of assessment instruments developed by the authors are considered, their theoretical bases being briefly outlined.

Researching Valuing People

Prior to the launch of Valuing People, Gordon Grant and Paul Ramcharan were appointed by the Department of Health as co‐ordinators of the learning disability research initiative People with Learning Disabilities: Services, Inclusion and Partnership, which was intended to inform the implementation and outcome of the White Paper Valuing People during its crucial early years. In this paper they describe the genesis of the research initiative, the research commissioning process and intentions for a research communication strategy.

Do Families and Care Managers Have a Similar View of Family Coping

This article seeks an answer to the question, `Do families and care managers have a similar view of family coping? Using a coping inventory influenced by the transactional stress-coping model, family carers and their care managers were interviewed separately about successful family coping. The findings support the view that families report more successful coping strategies than seem to be acknowledged by care managers. Some tentative explanations for these differences are offered, including ways in which caring and coping are socially constructed by each group as well as by structural factors in the work environment.

The Roles and Tasks of Care Management Practitioners in Wales — Revisited

BASED ON TWO POSTAL surveys in 1995 and 1997 of care management practitioners in Wales, this paper examines practitioners perceptions of change in work roles and tasks over time. Assessment tasks are taking up increasing amounts of care management practitioner time leading to a corresponding decrease in the time set aside for arranging services and for direct work with clients. The results are claims of de‐skilling and the likelihood of a more administrative style of working.