Vanessa Heaslip

Service user involvement in preregistration general nurse education: a systematic review.

AIMS AND OBJECTIVES A systematic review of published studies on service user involvement in undergraduate, preregistration general nursing education (excluding mental health-specific programmes). The objective is to examine how students are exposed to engagement with service users. BACKGROUND The requirement of service user involvement in all nurse education is policy expectation of health professional education providers, in response to the increased public and political expectations. Previous literature reviews have focused solely on mental health. DESIGN Systematic review using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines; timeframe 1997-2014; published in English. METHODS Search of CINAHL, Cochrane Review, Education Research Complete, Internurse, MEDLINE, PsychINFO, Scopus, SocINDEX and Web of Science yielded 229 citations; 11 studies met the review eligibility criteria. RESULTS Seven studies used qualitative methodology, two quantitative and two mixed methods. Studies from the United Kingdom dominated (n = 9), the remainder from South Africa and Turkey. The results are described using four themes: benefits and limitations of service user involvement; nursing student selection; education delivery; practice-based learning and assessment. Most studies were small scale; nine had less than 30 participants. Overall the evidence suggests that student, lecturers and service users valued service user involvement in nurse education, to provide an authentic insight into the illness experience. Logistical considerations around support and student cohort size emerged. CONCLUSIONS This is the first systematic review to focus on service user involvement in general nurse education. It reveals that service user involvement commenced later and is more limited in general programmes as compared to equivalent mental health education provision. Most of the evidence focuses on perceptions of the value of involvement. Further research is required to more clearly establish impact on learning and clinical practice. RELEVANCE TO CLINICAL PRACTICE Service user involvement in nurse education is valued by stakeholders but preparation and support for those involved, including mentors is underestimated.

Legionella pneumophila found in windscreen washer fluid without added screenwash.

A paper by Wallensten et al. [1] identified an epidemiological association between Legionnaires’ disease cases and the absence of screenwash in windscreen washer fluid and a follow up pilot study had identified Legionella species in one vehicle. The research extrapolated that as many as 20 % of sporadic community acquired cases may be attributed to this exposure and prevention by the use of screenwash could be readily achieved and could theoretically prevent 50 United Kingdom (UK) cases each year. However, Legionella pneumophila has never been grown from windscreen washer fluid and it is not known whether or not screenwash inhibits or prevents growth of Legionella. We undertook an open cross-sectional study aiming to investigate whether L. pneumophila can be detected in vehicle windscreen washer fluid reservoirs and to establish whether or not the addition of screenwash can inhibit the growth of L. pneumophila and at what concentration. 30 vehicles were sampled, six of which had no screenwash added and 24 used screenwash. L. pneumophila serogroup 1 was not detected in any of the cars with screenwash but was found in one of the other vehicles. The level of contamination was 6,000 colony forming units per litre (cfu/l). The positive vehicle was unusual in that it had never had screenwash added to it. Subsequently, a laboratory-based experimental study was also undertaken to see if screenwash had a bactericidal effect on Legionella. Standard screenwash was found to be effective against Legionella at very low concentrations (10 ppm). This is the first time that L. pneumophila has been identified in windscreen washer fluid and the first time that screenwash has been shown to be effective against its growth.

A women’s worker in court: A more appropriate service for women defendants with mental health issues?

Aims: Court liaison services aim to reduce mental illness in prison through early treatment and/or diversion into care of defendants negotiating their court proceedings. However, liaison services may inadvertently contribute to gender inequalities in mental health in the prison system because women often do not access liaison services. This is attributed to services failing to recognize that women have different needs from men. To address this, it is essential that the needs of women in contact with the criminal justice system (CJS) are clearly articulated. However, there is a dearth of research that considers women’s needs at this stage of their journey through the CJS. This paper aims to identify these needs before women enter prison. It does so through an analysis of a pilot Women’s Support Service based at a magistrates’ court, a response to concerns that women were not accessing the local liaison service. Methods: Proformas were completed by a women’s specialist worker for 86 women defendants assessed over four months. Information was collected on characteristics including education, domestic violence, accommodation, physical and mental health. This specialist worker recorded the range of needs identified by defendants at assessment and the services to which women were referred. Results: Access to the Women’s Support Service is high, with only 11.3% of women refusing to use the service. Women attending have high levels of physical and mental health issues. Their mental health issues have not being addressed prior to accessing the service. Women often come from single households and environments high in domestic abuse. Women have multiple needs related to benefits, finance, housing, domestic abuse, education and career guidance. These are more frequent than those that explicitly link to mental health. The women’s worker providing the service referred women to 68 services from a wide variety of statutory and voluntary organizations. Conclusions: The Women’s Support Service is accessed by a higher number of women, many more than access the local liaison service. It is suggested that this is due to their multiple and gender-specific needs being adequately addressed by the former service and the organizations to which they are referred. Mental health needs may also be secondary to other more basic needs, which makes the generic service provided by the Women’s Support Service more appropriate than a liaison service that deals with mental health support alone.

Lived experience of vulnerability from a Gypsy Roma Traveller perspective

AIMS AND OBJECTIVES To describe the lived experience of vulnerability of individuals within a Gypsy Roma Travelling community. BACKGROUND People experience vulnerability whenever their health or usual functioning is compromised. This may increase when they enter unfamiliar surroundings, situations or relationships. Ones experience of vulnerability can also be heightened through interactions between the individual and the society within which they live. Gypsy Roma Travellers are often identified as vulnerable owing to increased morbidity and mortality as well as their marginalised status within society. Yet little is known of the experiences of vulnerability by the individuals themselves. Without their stories and experiences, health professionals cannot effectively develop services that meet their needs. DESIGN This descriptive phenomenological study sought to explore the lived experience of vulnerability in a Gypsy Roma Travelling community. METHODS Seventeen Gypsy Roma Travellers were interviewed in 2013-2014 about their experiences of feeling vulnerable. This paper reports on the findings from the depth phase in which 13 individuals were interviewed. The interviews were conducted and analysed using Giorgis descriptive phenomenological approach. FINDINGS Six constituents of the phenomenon of vulnerability were identified as feeling: defined and homogenised as a group; pressurised to conform to live in a particular way; split in ones identity; a loss of ones heritage; discriminated, persecuted and threatened; and powerlessness. RELEVANCE TO CLINICAL PRACTICE There is a wealth of evidence that Gypsy Roma Travellers experience high levels of morbidity and mortality, which has led to them being identified by health professionals and policy makers as a vulnerable community. Exploring their lived experience of vulnerability presents a different perspective regarding this concept and can help explain why they may experience poorer levels of physical and mental health.

First- and second-generation design and engineering students: experience, attainment and factors influencing them to attend university

ABSTRACT Challenges for students who are ‘first-in-family’ to attend university have been discussed within widening participation discourse. However, in the UK, ‘first-in-family’ or first-generation students have frequently been conflated with those experiencing poverty or from lower socio-economic groups. This research integrated survey data with assessment data from final-year design and engineering students in a UK university to examine students’ attainment, the influences on why students decide to attend university and students’ experiences during their degree programmes. Analysis of the data showed variations in the reasons for first- and second-generation students wanting to go to university, particularly a significant difference in the influence of parents. First-generation students described significantly less parental influence on the decision to attend university than second- or subsequent-generation students. Smaller differences in students’ experiences and attainment in university were also noted. Whilst first-generation students reported differences in study habits, their attainment was, on average, marginally higher than that of their peers. Building on others’ theoretical work, which suggests the importance of social capital within higher education (HE), this research highlights the difference in social influences on both university application and expectations of university for those with and without a family history of tertiary education. Further research is needed to explore, in larger samples, whether the social influences on individuals’ perception of HE are in turn shaped by whether or not their parents attended university, and further, what impact this may have, not only on degree outcomes but also on the broader benefits typically associated with graduate experience.

Troubling ideas for widening participation: how higher education institutions in England engage with research in their access agreements

This article explores how higher education institutions in England engage with research in their access agreements. Through an analysis of access agreements from 2014-15 to 2016-17, a picture of how research is understood, undertaken and documented emerges. A lexical analysis of the texts was used to establish the different ways research is being referred to or funded as part of the access agreement process. The analysis shows a productive relationship between national policy and institutional activity. But there appears to be a lack of infrastructure at an institutional and sector level to join up sustained and rigorous research with widening participation activity and policy. This means that, even after ten years of access agreements, widening participation is not fully embedded into the academic practice of higher education. We argue that research undertaken as part of the access agreement process can provide much needed evidence of impact and situate activity within an institution-wide context. However, we also suggest that widening participation research has the potential to offer productive troubling ideas to dominant rhetoric and, in so doing, shape new ways of thinking about, and doing, widening participation within institutions and across the sector.

Mental health and the criminal justice system: The role of interagency training to promote practitioner understanding of the diversion agenda

Historically there has been a significant under-recognition of mental health problems among people in the criminal justice system, and little research exploring the issues encountered by those with mental health problems who come into contact with the criminal justice system. Recent policy has highlighted the importance of early identification of mental health needs in criminal cases, and the role of diversion of offenders into appropriate mental health services. However research suggests that currently the provision of mental health services for offenders is patchy, and it has been suggested that improved interagency communication and training is required to improve the diversion of offenders with mental health problems into more appropriate mental health provision. The aim of this paper is to consider the current position of those with mental health conditions within the criminal justice system in England, and discuss how joint interagency training can improve understanding of the diversion agenda for the range of practitioners that come into contact with offenders with mental health problems. The perspectives of a range of practitioners who attended a joint interagency training day will be discussed, and recommendations for future training will be offered.

Sex trafficking and sex tourism in a globalised world

Purpose This paper aims to explore the dark side of the relationship between gender, mobility, migration and tourism. Specifically, the paper looks at one form of human trafficking, the global sex industry and the relationship between sex trafficking and sex tourism. More particularly, the paper examines the global sex industry (Goh, 2009; Sasse, 2000, 2001) and the impact of migration and human rights aspects (Voronova and Radjenovic, 2016) of sex trafficking and sex tourism, as well as the emotional dimensions of trauma, violence and vulnerability (Heaslip, 2016). Design/methodology/approach The paper is an interdisciplinary discussion paper combining socio-economic perspectives (Goh, 2009; Brooks and Devasayaham, 2011), human rights perspectives (Cheah, 2006), migration perspectives (Voronova and Radjenovic, 2016), tourism perspectives (Carolin et al., 2015) and health perspectives (Cary et al., 2016; Matos et al., 2013; Reid and Jones, 2011). The contribution of these intersecting perspectives to an understanding of sex trafficking and sex tourism is explored. Findings The paper highlights the moral and ethical responsibility of the tourist industry to counteract sex trafficking and sex tourism, an issue which tourism studies have failed to fully engage with. In presenting the human costs of trafficking from a gender perspective, the paper considers the ways in which the tourism industries, in some countries, are attempting to respond. Research limitations/implications The originality of the research is the focus on the dark side of the relationship between gender, mobility and tourism through sex trafficking and sex tourism drawing on an interdisciplinary perspective. Social implications The paper looks at the individual and social implications of sex trafficking and sex tourism for different countries and states and for the individuals concerned. In addition, it looks at the ways in which the tourism industry is responding to sex trafficking and sex tourism and the social impact of this. Originality/value In theorising the relationship between gender, migration, sex trafficking and tourism from an interdisciplinary perspective, exploring the societal and individual impact, this paper provides a framework for further empirical research or policy changes with regard to the intersection of sex trafficking and tourism.

Improving equity and cultural responsiveness with marginalised communities: Understanding competing worldviews

AIM To explore the impact of culture on health, healthcare provision and its contribution towards health inequity experienced by some marginalised communities. BACKGROUND Health inequity is a global issue, which occurs across and within countries, and is the greatest barrier to worldwide health and the development of the human race. In response to this challenge, there is an international commitment to ensure universal health coverage based on the fundamental principle that individuals should be able to access healthcare services they need. Despite this, there is clear evidence that indigenous and other cultural minorities such as New Zealand Māori and Gypsy Roma Travellers still experience far poorer health outcomes when compared to the majority population. Furthermore, when they do access health care, their experiences are often not positive and this in turn results in reluctance to access preventative health care, instead accessing health services much later, reducing treatment options and compounding higher mortality rates. What is often not explored or examined is the impact of the different cultural beliefs of individuals in these communities and the nurses caring for them. DESIGN This is a position paper drawing upon research experience with New Zealand Māori and Gypsy Roma Travellers. We critically review the experiences of health inequity of marginalised communities. It does so by examining how these communities may have a different world view to the nurses caring for them, and it is this lack of understanding and valuing of alternative worldviews that contributes to the poorer health outcomes both communities face. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE As nurses work with many different individuals and groups, we have to find ways of ensuring a more embracing, culturally responsive healthcare environment which respects and values the beliefs of others.

Interpretative Phenomenological Analysis: A means of exploring aspiration and resilience amongst Widening Participation students

As the Office for Fair Access and the Higher Education Funding Council for England priorities now extend across widened access to success, both the aspirations of young people from widening participation (WP) backgrounds and their existing or developing resilience as students are of concern to Higher Education institutions. In this paper, these positive psychology concepts of aspiration and resilience are used in two different studies each seeking to move away from the prevalent discourse of deficit. This paper thus offers the joint perspective of two researchers exploring the phenomena of a) aspiration in students from low participation neighbourhoods and b) resilience in students from low-income backgrounds. Interpretative Phenomenological Analysis (IPA) is utilised by both to offer a credible, insightful research approach which may enable educators, researchers and policy-makers to appreciate the nature and significance of WP students’ experiences in a previously unseen way, thus enabling effective interventions and methods of support. Through in-depth exploration of the cognitions and emotions of young people from WP backgrounds, the researchers discuss how listening to individual stories can provide rich data that may enhance future support for students. Important methodological challenges and the implications of applying IPA to both studies are debated; including use of language to convey meaning, the role of researcher reflexivity and the difficulties in achieving a truly interpretative account of the phenomenon. Whilst often a challenging methodology, IPA can provide rich, contextualised accounts which contribute to the limited extant qualitative literature on WP student aspiration and resilience.