Paul Newton

Back to basics: Re-examining the role of patient empowerment in diabetes

The concept of patient empowerment is currently popular in research and at policy level. As early as 2001, the UK Government proposed a diabetes health strategy, wishing to “ensure that people with diabetes are empowered to enhance their personal control over the day to day management of their diabetes in a way that enables them to experience the best possible quality of life” [1] (p. 21). It went on to say that “users of the NHS should have choice, voice and control over their lives, build confidence and be active partners in their care”. This strategy is reflected in the abundance of papers within the area. A search conducted in July 2010 on Scopus, yielded 17,102 publications, which included ‘empowerment’ in the title, abstract or keywords. Of these, at least 353 were about empowerment in diabetes. There can be no doubt then, that empowerment is a popular topic yet, it is surprising to discover a lack of concordance about the meaning and scope of the term. The UK Government strategy highlighted above, is a case in point. The need to empower diabetes patients is explicitly stated but the means to achieve empowerment in practice is not. This observation reflects a generalised lack of clarity around what ‘empowerment’ actually means.

A national survey of dental technicians: career development, professional status and job satisfaction

Objective To investigate the career development, perception of status within the dental team, and level of job satisfaction of dental technicians in the United Kingdom.Design Cross-sectional postal questionnaire survey of 1,650 dental technicians registered with the Dental Technicians Association. Replies were received from 996 (60%).Results Eighty two per cent respondents had a qualification in dental technology and 21% also had an advanced level qualification. Almost two thirds of the respondents had undertaken no verifiable continuing professional development in the previous year. Only 27% of respondents expected to develop their career over the next five years. Less than 50% of the respondents felt adequately valued as individuals and as a professional group in the dental team. Job satisfaction was significantly related to age, attendance at one or more courses in the last year, working shorter hours, feeling valued in the dental team, and future career plans.Conclusions Plans for the registration and role expansion of dental technicians provide opportunities for career development which have yet to be realised. The low levels of continuing professional development currently undertaken indicate the need for a review of the provision and funding of training at a strategic level. Whilst levels of job satisfaction are satisfactory, many dental technicians feel insufficiently valued in the dental team.

The context of empowerment and self-care within the field of diabetes

There is a growing emphasis within the diabetes literature on the importance of empowerment as a way of encouraging people to take control of and responsibility for the successful management of their disease. Patients are actively encouraged to become active participants in their care, and there is an expectation that health-care professionals will facilitate this process. This article uses Bourdieu’s concept of field, as a bounded social space in which actors conduct their lives day-to-day, to explore the context within which issues of empowerment are addressed and negotiated. The practice of empowerment within the biologically defined and biomedically ‘policed’ field of diabetes is explored using empirical data from a study of diabetes health-care professionals’ understanding and practices around empowerment. It is concluded that rather than promoting active self-management and empowerment, the nature of the field of diabetes, and in particular its privileging of the biomedical, can mitigate against people with diabetes negotiating the field effectively and taking control of the disease and its management.

Linking social work agency perspectives on interprofessional education into a school of nursing and midwifery

Recent policy documents have highlighted the importance of developing interprofessional education to support interprofessional practice. In particular improving communication between health and social care agencies has been highlighted as an educational and practice priority. This study set out to explore the interprofessional training needs of social work practitioners with social work agencies in North East London to ensure that the interprofessional courses were relevant to social work. Findings from 15 qualitative interviews with key health and social care professionals in eight London boroughs will be presented. The findings suggest that there is great diversity in the budgets, resources and approaches taken to post qualifying training across the boroughs and between agencies and that training needs analysis for experienced practitioners is at an early stage of development workforce planning to the commissioning of education. Social work services identified bespoke training and the accreditation of their existing programmes as important. Responding to rapid organizational change and immediate training needs was a key priority in the services interviewed. However, limited funding to release social workers to take up interprofessional post-qualifying training remains a constraint for training officers, and how training was planned and organized by both practitioners and providers was considered important.

Recruitment and retention of dental nurses and dental hygienists in general practice.

Purpose of study To explore the recruitment and retention of dental nurses and dental hygienists working in general dental practice in West Kent, and to identify training needs. Basic procedure Questionnaire survey of 195 general dental practices in West Kent. Main findings Problems with turnover of staff were reported by 19% of practices. Some 49% of practices reported difficulties in recruiting dental nurses, 6% had experienced difficulties recruiting dental hygienists, and 15% had difficulties recruiting both nurses and hygienists. The median length of service for both dental nurses and dental hygienists was five years. Approximately 39% of practices had advertised single posts three or more times. Difficulties in recruiting were related more strongly to ensuring the right person for the job, than to a shortage of applicants. Principal conclusions Difficulties in the recruitment and retention of dental nurses and dental hygienists were reported by dental practices in West Kent. These are likely to be exacerbated by the requirement that all dental nurses be registered with the General Dental Council.

Diabetic Retinopathy Screening: A Systematic Review on Patients’ Non-Attendance

Diabetic Retinopathy is a microvascular complication of diabetes, that can go undetected and unnoticed until irreversible damage and even blindness has occurred. Effective screening for diabetic retinopathy has been proven to reduce the risk of sight loss. The National Health Service (NHS) which provides healthcare for all UK citizens, implemented systematic retinal screening for diabetic retinopathy in England in 2003, with the aim of identifying and treating all patients with sight threatening retinopathy. Crucial to this is patients partaking in the programme. Therefore, increasing screening uptake has been a major focus of the programme. This review explores the views of people living with diabetes who do not attend retinal screening, their characteristics, concerns, experiences of retinal screening and their understanding of the risks of diabetic retinopathy. All studies that satisfied the study inclusion criteria on ‘patients’ non-attendance at retinal screening’, between 2003 to 2017 were included after extensive database search. A total of 16 studies were included in the review. Findings showed that socio-economic deprivation was a major risk factor for non-attendance, about 11.5–13.4% of the screened population had sight threatening retinopathy (STDR), repeated nonattendance was linked to sight threatening diabetic retinopathy, and that certain factors, could be barriers or incentives for screening uptake. Some of those factors are modifiable whilst others are not.

‘Where the biological predominates’: Habitus, reflexivity and capital accrual within the field of batten disease

Much of the empirical work within the sociological study of chronic disabling conditions developed, explicitly or implicitly, as a challenge to the dominance of biomedicine. Alongside the work of disability theorists in reincorporating the body into the study of disability (see for example, Lock et al, 2005; Thomas, 2004; Williams, 1999), this chapter addresses the need to re-evaluate the, often negatively portrayed, contribution of biology and biomedicine to the study of chronic disabling conditions. We draw on Bourdieu’s concepts of field and habitus to chart the overwhelming impact of the biological on the lifeworld of those living with rare, chronically disabling degenerative conditions and their families. The theoretical framework provided by Bourdieu is used to present data from a recent empirical study to advance the view that for those living with such conditions, the biological can causally ’swamp’ the psychological and the social in an extended and pervasive assault on the lifeworld.

Factors influencing uptake of measles, mumps and rubella (MMR) immunization in site‐dwelling Gypsy, Roma and Traveller (G&T) communities: a qualitative study of G&T parents' beliefs and experiences

BACKGROUND Increasing immunization in the Gypsy, Roma and Traveller (G&T) community is a key priority for improving health outcomes in this community. This study aimed to explore G&T parents: (1) beliefs about childhood immunization; (2) beliefs about the risks of immunization and non-immunization; (3) perceived obstacles to, and facilitators of, immunization and (4) views on increasing immunization levels. METHOD A cross-sectional, qualitative study was conducted comprising of five focus groups with 16 site-dwelling G&T women with pre-school aged children. Data were transcribed verbatim and analysed thematically. RESULTS Five main themes were identified: Lay understandings of causation and risk; Timing of immunization; Children being perceived as vulnerable; The fit between lifestyle and healthcare provision; The impact of living with a high burden of disease. CONCLUSION Understanding of the risks and benefits of measles, mumps and rubella immunization did not differ significantly from the wider population or those promoted by the health service. The majority of barriers stemmed from living with the effects of long-standing health inequalities, which posed further barriers to accessing immunization, and shaped beliefs about immunization. Factors facilitating uptake occurred where access to immunization services was made flexible, e.g. immunization on traveller sites.

Patient-centred assessment and management of pain for older adults with dementia in care home and acute settings

Evidence suggests that there is a greater prevalence of pain, particularly chronic pain, in the older than in the younger population. This review looks at how dementia affects older peoples ability to report pain, and indicates that pain is poorly assessed and managed in people living with dementia, in particular in care and acute settings. The review also reports findings from two recent studies looking at ways of improving the assessment and management of pain in acute settings. Multi-dimensional, patient-centred approaches to assessing and managing pain in those living with dementia are required, and future research should focus on innovative and practical approaches that can be applied in care home and acute settings.

A Qualitative Exploratory Study of Informal Carers’ Experiences of Identifying and Managing Oral Pain and Discomfort in Community-Dwelling Older People Living with Dementia

Increased prevalence of dementia and poor oral health in older people is associated with more people living with dementia who experience oral pain and discomfort. However, little is known about how informal carers manage oral pain for people living with dementia in the community. This study aimed to explore informal carers’ experiences of identifying and managing oral pain and discomfort in people living with dementia, and barriers and enablers they encountered. Focus groups with informal carers of people living with dementia were conducted, transcribed verbatim, and analysed using thematic analysis. Carers’ accounts suggested that day-to-day contact was required to identify oral pain and discomfort, and a symptomology of the signs and symptoms was developed. Carers’ accounts also highlighted issues in maintaining oral health, difficulties in accessing the mouth, managing dentures, competing demands, and difficulties in accessing treatment due to health service-, behavioural- and treatment- related barriers. Enablers included informal carers’ pivotal role in the identifying and managing oral pain and discomfort in people living with dementia. The study concludes that carers want more partnership work with dental professionals, and clearer care pathways are required to meet the oral health needs of people living with dementia who experience oral pain.