Suchergebnisse

Background: Legislation places an onus on local authorities to be aware of care needs in their locality and to prevent and reduce care and support needs. The existing literature overlooksostensibly 'healthy' and/or non-users of specific services, non-health services and informal assistance and therefore inadequately explains what happens before or instead of individuals seeking services. We sought to address these gaps by exploring older adults' accounts of seeking assistance in later life. Methods: We conducted semi-structured qualitative interviews with 40 adults aged 68-95. We invited participants to discuss any type of support, intervention, or service provision, whether medical, social, family-provided, paid or unpaid. Findings: This paper reports older people's accounts of how they evaluated their need for assistance. We found that the people in our sample engaged in a recursive process, evaluatingtheir needs on an issue-by-issue basis. Participants' progression through this process hinged on four factors: their acknowledgement of decline; the perceived impact of decline on their usual activities and independence; their preparedness to be a recipient of assistance; and, the opportunity to assert their need. In lieu of seeking assistance, participants engaged in self-management, but also received unsolicited or emergency assistance. Conclusions: Older people's adaptations to change and attempts to meet their needs without assistance mean that they do not present to services, limiting the local authority's knowledge of their needs and ability to plan appropriate services. Our findings offer four stages for policymakers, service providers and carers to target to address the uptake of assistance.

Marttila A, Whitehead M, Canvin K, Burström B. Controlled and dependent: experiences of living on social assistance in Sweden
Int J Soc Welfare 2010: 19: 142–151 © 2009 The Author(s), Journal compilation © 2009 Blackwell Publishing Ltd and the International Journal of Social Welfare.This study explored experiences of people receiving social assistance in 21st‐century Sweden, based on 33 in‐depth interviews conducted in 2005 and 2006. Two overarching themes emerged from the accounts, encompassing both a material and a psychosocial dimension of living on social assistance. Recipients reported that social assistance was generally sufficient for their basic material needs but allowed for no extras. It was possible to live on social assistance for a short time, but became difficult in the longer term. Perceptions of powerlessness, hopelessness and dependency were common and had the most damaging consequences for the recipients' perceived wellbeing. Some recipients believed that society at large had negative perceptions of people living on social assistance; it was something to be ashamed of but, at the same time, it was the recipients' only possible source of income. Findings of this study are partly similar to previous studies conducted in Sweden, suggesting that improvement in services should take into account the experiences of social assistance recipients.

This opinion piece emerged from a collaboration of mental health researchers working on the National Institute of Health Research 3-schools mental health programme in underserved communities. The aim is to encourage debate and reflection on the challenges encountered with university research ethics committees when undertaking qualitative research with vulnerable young people. We explore the tension between principles of safeguarding and protection of research participants, on the one hand, and the potential for this oversight to become obstructive and thus to effectively stifle the voices and experiences of an already marginalised population, on the other hand.

Background: Leverage is a particular type of treatment pressure that is used within community mental health services to increase patients' adherence to treatment. Because leverage involves practitioners making proposals that attempt to influence patients' behaviours and choices, the use of leverage raises ethical issues. Aim: To provide guidance that can assist practitioners in making judgements about whether it is ethically acceptable to use leverage in a particular clinical context. Method: Methods of ethical analysis. Results: Four ethical duties relevant to making such judgements are outlined. These four duties are (1) benefitting the individual patient, (2) benefitting other individuals, (3) treating patients fairly and (4) respecting patients' autonomy. The practical requirements that follow from each of these duties are considered in detail. It is argued that practitioners should determine whether the use of leverage will mean that care is provided in ways that are consistent with the requirements of these four duties, regardless of whether the patient accepts or rejects the terms of the proposal made. Conclusion: Particular attention must be paid to determine how the requirements of the four duties should be applied in each specific treatment scenario, and in making careful judgements when these duties pull in opposing directions.

AbstractRestrictive practices are often used harmfully with children in institutional settings. Interventions to reduce their use do not appear to have been mapped systematically. Using environmental scanning, we conducted a broad‐scope mapping review of English language academic databases, websites and social media, using systematic methods. Included records (N = 121) were mostly from the United States and contained details of 82 different interventions. Children's participation was limited. Reporting quality was inconsistent, which undermined claims of effectiveness. Overall, despite a multitude of interventions, evidence is limited. Leaders should consider the evidence, including children's perspectives, before introducing poorly understood interventions into children's settings.