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Reflective supervision (RS) is a crucial component of social work practice but little is known about how RS works within the UK context and what the outcomes of RS are for social workers and their service users. A rapid literature review comprised searching four databases for academic and grey literature on the topic of social work RS. The Mixed Methods Appraisal Tool and the University College London's literature assessment method were employed in an expedited quality appraisal for all included papers. Twenty-seven papers were included. Findings suggest that a supportive, available manager or a peer-group enables reflective practice. Regularity of supervisory sessions and acknowledgement of a social worker's autonomy are seen as enablers of reflexivity. In contrast, task-oriented approach that is overly focused on accountability and hindered by the sparsity of resources proves problematic for both social workers and service users. Whilst theoretical papers were available, RS was not defined in a uniform fashion and there was limited evidence pertaining to supervisory practice. More research focusing on what works and what improvements are needed in RS, including adopting a participatory approach would help to bridge this gap and further inform policy and practice. [ABSTRACT FROM AUTHOR]

Aim: We aim to explore healthful leadership practices in nursing and midwifery evident within the COVID‐19 pandemic in the United Kingdom, the contextual facilitators, barriers and outcomes. Background: Globally, the health and care sectors are under pressure and despite nurses and other professionals, demonstrating resilience and resourcefulness in the COVID‐19 pandemic; this has negatively impacted on their health and wellbeing and on patient care. Evaluation: Two searches were conducted in July 2021 and December 2021. Inclusion/exclusion criteria were identified to refine the search, including papers written since the beginning of the pandemic in 2020. A total of 38 papers were included principally from the United States and United Kingdom. Ten were research papers; the others were commentaries, opinion pieces and editorials. MS Teams literature repository was created. A unique critical appraisal tool was devised to capture contexts, mechanisms and outcomes whilst reflecting more standardized tools, that is, the Critical Appraisal Skills Programme and the Authority, Accuracy, Coverage, Objectivity and Date tool for reviewing grey literature to refine the search further. Key issues: Six tentative theories of healthful leadership emerged from the literature around leadership strategies, which are relational, being visible and present; being open and engaging; caring for self and others; embodying values; being prepared and preparing others; and using available information and support. Contextual factors that enable healthful leadership practices are in the main, created by leaders' values, attributes and style. The literature suggests that leaders who embody values of compassion, empathy, courage and authenticity create conditions for positive and healthful relations between leaders and others. Nurse and midwives' voices are however absent from the literature in this review. Conclusion: Current available literature would suggest healthful leadership practices are not prioritized by nurse leaders. Perspectives of nurses' and midwives' about the impact of such practices on their wellbeing is also missing. Tentative theories are offered as a means of identifying healthful leadership strategies, the context that enable these and potential outcomes for nurses and midwives. These will be explored in phase two of this study. Implications for Nursing Management: Nurse leaders must be adequately prepared to create working environments that support nurses' and midwives' wellbeing, so that they may be able to provide high‐quality care. Ensuring a supportive organizational culture, which embodies the values of healthfulness, may help to mitigate the impact of the COVID‐19 pandemic on nurses' and midwives' wellbeing in the immediate aftermath and going forward. [ABSTRACT FROM AUTHOR]

Since at least 2012, UK housing providers (and policy makers) have introduced policies aimed at developing autonomy and independence among service users, through an agenda sometimes referred to as 'responsibilisation'. This paper considers the role that technologies play in this agenda, through an analysis of how wellbeing and independence are facilitated amongst older social housing tenants. Based on case studies of four supported housing schemes in England, the research considers the capacity to exercise agency amongst older persons, through their willingness and ability to accept technological interventions, and the role of support networks to facilitate independent living. Using the concept of modalities of agency, the research examines the impact of implementing 'low-level' assistive technologies in the home, based on the perspectives of residents and staff. The interventions studied were designed to improve social relationships, promote self-sufficiency and support self-managed care (based on the principle that the most effective projects facilitate individual agency). The research findings identified that residents responded differentially to technology, based on their levels of capability, motivation, reluctance and resistance. Whilst the study demonstrated that small technological innovations could have disproportionately positive impacts in improving wellbeing, the research demonstrates the complex nature of agency and limits of responsibility. The paper argues that responsibilisation is part of a wider neoliberal project, where choice and agency are manufactured to create an idealised notion of the autonomous actor (in this case through technology-enabled care). The article argues that a collaborative approach to service provision in which responsibility is shared, via co-managed care, is a more effective means of enhancing agency, than one which advocates a withdrawal of support (in the guise of autonomy). [ABSTRACT FROM AUTHOR]

Previous research has indicated that healthcare support for sexuality after spinal cord injury appears to be neglected or inadequately provided. The perspectives of people living with spinal cord injuries regarding what is lacking and what support they would like to be provided, and why, has yet to be explored. This paper uses critical theory to explore how societal constructs of sexuality and disability shape how sexuality is supported after a spinal cord injury. To do this, we conducted in-depth semi-structured interviews with 11 people with a spinal cord injury from Australia, the United Kingdom, and the United States. We drew from the works of various critical disability theorists to analyze what discourses underpinned the experiences people with spinal cord injuries had when receiving sexuality support. Analysis suggested that the following discourses were apparent: (1) broken bodies require repair, (2) sex is penetration, ejaculation then reproduction, and (3) sexual autonomy is required. Findings indicated healthcare professionals need to recognize people with spinal cord injuries as sexual beings with a diverse range of desires, lives, relations, and bodies. Provision of individualized comprehensive high-quality sexuality support is therefore warranted. To achieve this, healthcare professionals should aim to be aware of, and mitigate, ableist and normative assumptions. [ABSTRACT FROM AUTHOR]

This article covers the ethical issues that arise when human organs are bought or sold, and whether there is a place for the sale of kidneys [ABSTRACT FROM AUTHOR]

Objective: Systematic reviews of mistletoe therapy (MT) trials in cancer show promising results in improvement of patients' quality of life during chemotherapy and reduction of fatigue. However, patients' experiences of side effects and the acceptability, tolerability, and perceived benefits of MT have not been systematically reviewed. The aim of this study was to systematically review and synthesise the results of qualitative studies of cancer patients' experiences of using MT. Design: A systematic search was conducted in MEDLINE, Embase, PsychLIT, CINAHL, and AMED to identify qualitative studies of MT. Articles were screened independently by two reviewers and critically appraised using the Critical Appraisal Skills Programme tool. A thematic synthesis of the findings was carried out. Results: One hundred and seventy-three papers were identified; 156 were excluded at initial screening. Seventeen papers were read in full, 14 of which were excluded. Three articles about patients' experiences of MT alongside conventional treatment were included in the synthesis, either as a monotherapy (two articles) or as part of a package of anthroposophic treatment (one article). Patients reported demonstrable changes to their physical, emotional, and psychosocial well-being following MT, as well as a reduction in chemotherapy side effects. Self-reported side effects from MT were few, and the studies suggest good adherence to the therapy. Self-injection gave patients a sense of empowerment through involvement in their own treatment. Conclusions: A systematic search revealed a small number of qualitative studies of MT in cancer. These were effectively combined to provide a detailed overview of patients' experiences in order to complement the developing evidence base from trials. Given the variation in context of MT delivery across the articles, it is not possible to ascribe changes in patients' quality of life specifically to MT. The results of this review will help in the design of outcome measures that more fully capture patients' experiences. It is essential to embed qualitative research of patients' experiences of MT and other CAM therapies within future trials. [ABSTRACT FROM AUTHOR]

Background: Adults with intellectual disabilities have historically been hindered, rather than supported, in their desire to form loving relationships. This paper sought to explore with them what kinds of support they wanted in the 21st Century. Method: Semi‐structured in‐depth interviews were conducted with 40 adults with intellectual disabilities in the United Kingdom. Results: Participants placed a high value on having a partner and being supported to maintain and develop a loving relationship. The factors which constrained them in achieving this included a lack of social opportunities, barriers created by social care services and limits on them exercising autonomy. Facilitating factors included access to specialist dating agencies, strong family and staff support and opportunities to learn about relationships. Conclusions: The importance of a loving relationship as a source of pleasure and meaning in the lives of adults with intellectual disabilities who are often disadvantaged in many other spheres of life is emphasised. [ABSTRACT FROM AUTHOR]

Introduction: The UK low‐risk drinking guidelines were revised in 2016. Drinkers were primarily informed about the guidelines via news media, but little is known about this coverage. This study investigated the scale and content of print and online textual news media coverage of drinking guidelines in England from February 2014 to October 2017. Methods: We searched the Nexis database and two leading broadcasters' websites (BBC and Sky) for articles mentioning the guidelines. We randomly selected 500 articles to code for reporting date, accuracy, tone, context and purpose of mentioning the guidelines, and among these, thematically analysed 200 randomly selected articles. Results: Articles mentioned the guidelines regularly. Reporting peaked when the guidelines revision was announced (7.4% of articles). The most common type of mention was within health‐ or alcohol‐related articles and neutral in tone (70.8%). The second most common was in articles discussing the guidelines' strengths and weaknesses, which were typically negative (14.8%). Critics discredited the guidelines' scientific basis by highlighting conflicting evidence and arguing that guideline developers acted politically. They also questioned the ethics of limiting personal autonomy to improve public health. Criticisms were partially facilitated by announcing the guidelines alongside a 'no safe level of drinking' message, and wider discourse misrepresenting the guidelines as rules, and highlighting apparent inconsistencies with standalone scientific papers and international guidelines. Discussion and Conclusions: News media generally covered drinking guidelines in a neutral and accurate manner, but in‐depth coverage was often negative and sought to discredit the guidelines using scientific and ethical arguments. [ABSTRACT FROM AUTHOR]

This article outlines why people should not be allowed to sell their kidneys, and the reasons that people sell them [ABSTRACT FROM AUTHOR]

Background: There are no universally agreed rules of healthcare ethics. Ethical decisions and standards tend to be linked to professional codes of practice when dealing with complex issues. Objectives: This paper aims to explore the ethical complexities on who should decide to give infants born on the borderline of viability lifesaving treatment, parents or the healthcare professionals. Method: The paper is a discussion using the principles of ethics, professional codes of practice from the UK, Nursing Midwifery Council and UK legal case law and statute. Healthcare professionals' experiences that influence parental decision are also considered. Findings & Discussion: There are considerable barriers to an effective discussion taking place in an environment where clinical decisions have to be made quickly once the baby is born. This is compounded by the need and respect for parental autonomy and the difficulties they face when making a best interest's decision knowing that this could cause more harm than good for their infant child and balancing any decision they make with quality of life. Conclusion: On deciding whether to give lifesaving treatment born at the borderline of viability, it should be a joint decision between the parents and the neonatal team. [ABSTRACT FROM AUTHOR]

This study offers a detailed and original assessment of the practices of prescription veterinary medicine use on UK dairy farms. The emergence of antimicrobial resistance as a global threat has necessitated an increasing focus on medicine use in agriculture. While an abundance of studies have recently emerged to demonstrate and evaluate strategies for medicine reduction, this paper seeks to understand the context and the on-farm culture within which treatment practices occur on a sample of UK dairy farms. Arguing that the experiential knowledge, on-farm culture and informal information flows are as important as 'science' in the practice of treatment decision making and drawing on extensive participant observation fieldwork combined with semi-structured interviews, this paper identifies and discusses three key themes that develop and, in places, challenge our current understanding of farmer treatment practices. These areas - treatment knowledge and understanding, a duty of care and autonomy of treatment practice - are seen to have complex effects on the use of veterinary medicines in dairy cattle and, as such, highlight critical areas for further research and opportunities for policy interventions aimed at improving responsible medicine use. • Farmers construct their own narratives of disease and treatment, based on experiential and experimental knowledges. • Uncertainty remains a key element of treatment decision-making, which can manifest as risk-averse behaviour. • Farmers are strongly motivated to treat by a sense of duty to the wellbeing of the animals for which they are responsible. • A perceived lack of autonomy with regard to treatment decisions directly affected dairy farmers' medicine use behaviours. [ABSTRACT FROM AUTHOR]

The study informing this paper set out to reframe evaluation as a collaborative, participatory, dialogical process with a focus on learning rather than accountability. Evaluation, much like reflective practice, has been shaped in terms of individual activity and deficit-based discourses. Using an ‘insider’ approach, an innovative methodology was developed and implemented in a voluntary youth organisation in the UK. Data gathered via semi-structured interviews before and after the implementation were analysed using an inductive thematic analysis approach. The findings suggest that collective spaces for reflection and dialogue are disappearing and yet practitioners highly valued this for its re-energising and restorative properties. Evidence is presented to suggest that narratives, in this case co-constructed stories, enabled collective critical reflection and the development of a shared understanding of practice which in turn supported and strengthened professional autonomy. This paper offers a significant contribution to knowledge in regard to the design and use of participatory evaluation. It is argued that the appreciative, collaborative and reflective aspects of the methodology enabled the learning and development functions to be realised. Evaluation based on collective, reflective dialogue has the potential to provide an evidence base of good practice, enhance staff well-being and improve practice outcomes. [ABSTRACT FROM PUBLISHER]

Accessible summary Self-Directed Support is the latest system of social care giving vulnerable people in the UK a budget instead of a service provided by local authorities., There is a lack of evidence to demonstrate how people with intellectual disabilities access information and make choices about Self- Directed Support., Self- Directed Support is not yet available to all individuals with an intellectual disability., There is a need for further education and training for professionals and support staff to ensure that people who have intellectual disabilities are assisted to make informed choices about care provision., Summary A systematic literature review was conducted between September 2010 and April 2011 and published earlier in this journal, paper 1. The findings indicated that few studies of Self- Directed Support focused specifically on people with intellectual disabilities. The range of individuals' ability and distinction between adults with or without legal capacity have not been addressed. It is clear that Self- Directed Support is not, as yet, a viable option for all individuals with an intellectual disability. However, some who have accessed it reported an improvement in their quality of life. For Self- Directed Support to succeed for people with a wide range of intellectual disabilities, the level of awareness of its existence, and the potential barriers in relation to uptake, must be identified and addressed. This paper suggests possible strategies to maximise access to Self- Directed Support and identifies areas in which further research is required. [ABSTRACT FROM AUTHOR]

Reports in the British media over the last 4 years have highlighted the schisms and contestations that have accompanied the reports of gender selective abortions amongst British Asian families. The position that sex-selection may be within the terms of the 1967 Abortion Act has particularly sparked controversy amongst abortion campaigners and politicians but equally among medical practitioners and the British Pregnancy Advisory Service who have hitherto tended to stay clear of such debates. In what ways has the controversy around gender-based abortion led to new framings of the entitlement to service provision and new ways of thinking about evidence in the context of reproductive rights? We reflect on these issues drawing on critiques of what constitutes best evidence, contested notions of reproductive rights and reproductive governance, comparative work in India and China as well as our involvement with different groups of campaigners including British South Asian NGOs. The aim of the paper is to situate the medical and legal provision of abortion services in Britain within current discursive practices around gender equality, ethnicity, reproductive autonomy, probable and plausible evidence, and policies of health reform. [ABSTRACT FROM AUTHOR]

In the UK, Valuing People ( Department of Health, 2001, 2010b) has shaped services for people with learning difficulties for the past decade. Promoting choices and independence are two of the four key principles that underpin this White Paper and its subsequent delivery plans. This paper assesses the impact that these changes had on the availability of mundane choices. It draws on empirical evidence from interviews with adults with learning difficulties. First impressions of the findings indicate that individuals are indeed able to make an increased range of decisions. At closer inspection, it does however become apparent that not all of these decisions are based on an infinite spectrum of options. Under the guise of choice-based policy rhetoric, some people with learning difficulties are at times presented with a pre-arranged ‘menu of choices’. For instance, a person may be free to choose activities at their day centre, but they may have limited control when deciding whether to attend the service in the first place. The wider implications that tokenistic choice-making processes have for the development of personal autonomy are highlighted. It is argued that a lack of control in respect to mundane choices is disempowering and leads to learned passivity. [ABSTRACT FROM AUTHOR]

Purpose – There are major pressures on social care funding for people with learning disabilities. It is unsustainable to continue working in the same way. The need to promote independence and prevent the need for social care for people with a learning disability is urgent. The purpose of this paper is to highlight key issues, stimulate debate and strengthen the evidence base. Design/methodology/approach – The paper takes evidence from research, literature reviews, statistics and policy debates. It illustrates key points with case studies. The argument for change has been developed in discussion with key stakeholders including the chief executive of a leading self-advocacy organisation. Findings – Demand is increasing whilst funding is reducing. Policy, practice and evidence on prevention of the need for social care for people with a learning disability are underdeveloped. Nevertheless, there are many examples of good practice, and of emerging opportunities for local partnerships to work together to build a new approach. Research limitations/implications – Research on the benefits and costs of prevention of social care for people with a learning disability is underdeveloped. There is a need to extend the evidence base on the range of interventions and their effectiveness. Originality/value – The paper argues for a step change in culture, practice and the focus of research. [ABSTRACT FROM AUTHOR]

The history and professionalisation of midwifery has travelled through turbulent times to arrive at an opportunity for transformation in the contemporary UK maternity system. This professionalisation, the midwifery profession and professional autonomy are explored in this article from a sociological perspective, to answer the question of whether a midwife can achieve professional autonomy within the UK system. This is a two-part article. Part one has a strong focus on the historical context of midwifery, government policy and guidelines, risk, litigation and increasing managerialisation to frame the discussion in part two. The second part provides a discussion of autonomy, choice, managerialisation and reflexive practice, to create a conceptual framework utilising the concept New Professional Midwifery. This is to centralise a core belief in midwifery autonomy and women's choice facilitation. This paper is part one of two. [ABSTRACT FROM AUTHOR]

There are many challenges in providing palliative and end-of-life care to people with dementia; some of which may be reduced through advance care planning (ACP) to support the person with the diagnosis to have a greater influence on their care at end-of-life. Advance care planning has been defined as a process of discussing and recording wishes, values, and preferences for future care and treatment held between an individual, family members and their care provider(s) that takes effect when the person loses capacity. This paper considers some of the barriers and enablers to lead to better support of ACP in families affected by dementia. [ABSTRACT FROM AUTHOR]

The principle of autonomy is at the heart of the right of a competent individual to make an advance directive that refuses life-sustaining medical treatment, and to have that directive complied with by medical professionals. That right is protected by both the common law and, to an extent, by legislation that has been enacted in the United Kingdom and many jurisdictions in Australia. The courts have a critical role in protecting that autonomy, both in those jurisdictions in which the common law continues to operate and in those jurisdictions which are now governed by statute, and in which judicial determinations will need to be made about legislative provisions. The problem explored in this paper is that while the judiciary espouses the importance of autonomy in its judgments, that rhetoric is frequently not reflected in the decisions that are reached. In the United Kingdom and Australia, there is a relatively small number of decisions that consider the validity and applicability of advance directives that refuse life-sustaining medical treatment. This paper critically evaluates all of the publicly available decisions and concludes that there is cause for concern. In some cases, there has been an unprincipled evolution of common law principles, while in others there has been inappropriate adjudication through operational irregularities or failure to apply correct legal principles. Further, some decisions appear to be based on a strained interpretation of the facts of the case. The apparent reluctance of some members of the judiciary to give effect to advance directives that refuse treatment is also evidenced by the language used in the judgments. While the focus of this paper is on common law decisions, reference will also be made to legislation and the extent to which it has addressed some of the problems identified in this paper. [ABSTRACT FROM AUTHOR]

The law of informed consent to medical treatment has recently been extensively overhauled in England. The 2015 Montgomery judgment has done away with the long-held position that the information to be disclosed by doctors when obtaining valid consent from patients should be determined on the basis of what a reasonable body of medical opinion agree ought to be disclosed in the circumstances. The UK Supreme Court concluded that the information that is material to a patient's decision should instead be judged by reference to a new two-limbed test founded on the notions of the 'reasonable person' and the 'particular patient'. The rationale outlined in Montgomery for this new test of materiality, and academic comment on the ruling's significance, has focused on the central ethical importance that the law now (rightfully) accords to respect for patient autonomy in the process of obtaining consent from patients. In this paper, we dispute the claim that the new test of materiality articulated in Montgomery equates with respect for autonomy being given primacy in re-shaping the development of the law in this area. We also defend this position, arguing that our revised interpretation of Montgomery's significance does not equate with a failure by the courts to give due legal consideration to what is owed to patients as autonomous decision-makers in the consent process. Instead, Montgomery correctly implies that doctors are ethically (and legally) obliged to attend to a number of relevant ethical considerations in framing decisions about consent to treatment, which include subtle interpretations of the values of autonomy and well-being. Doctors should give appropriate consideration to how these values are fleshed out and balanced in context in order to specify precisely what information ought to be disclosed to a patient as a requirement of obtaining consent, and as a core component of shared decision-making within medical encounters more generally. [ABSTRACT FROM AUTHOR]

Aim: Corporate parenting in the UK may not be well-operationalised, with a potential role for educational psychologists (EPs) in promoting effective practice. This paper explores care leavers' needs and priorities from the perspective of self-determination theory (SDT), which relates the individual's motivation to the human need for competence, relatedness and autonomy. Method: Ten young people aged 16-19 from two UK local authorities were interviewed about their priorities in preparing for adulthood. Interview findings were then deductively analysed using a SDT framework. Findings: Interviews highlighted the young people's preference for graduated transition to adulthood. Analysis showed relatedness to be the most salient SDT domain, foregrounding the importance of consistent, authentic and personalised relationships. Consistent relationships motivated care leavers to engage with support and to pursue post-16 goals with enhanced self-determination. Conversely, gaps in young people's support networks undermined service engagement, potentially impeding a supported and successful transition to adulthood. Limitations: The study was small-scale and the age range, demographics and quality of leaving care support may not have been representative of a wider population. Conclusions: SDT is potentially useful for highlighting care leavers' needs and priorities when preparing for adulthood, with clear implications for corporate parenting, particularly within the relatedness domain. A possible role for EPs is proposed, which could strengthen service delivery through both systemic and individual work. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic and the lockdown measures imposed as a result affected the lives of people in all parts of society across the world. In 2020, during the first UK national lockdown, older adults (aged 70 years and over) were told to 'shield' within their homes, as they were regarded as being at higher risk of serious COVID-19 infection compared to other age groups. This paper explores older adults' experiences of COVID-19 lockdown measures whilst living in housing with care schemes for older people. The purpose is to examine the impact of the lockdown measures on scheme life including social connections amongst residents and their general everyday wellbeing during this time. We present qualitative findings based on interviews with 72 residents who took part in longitudinal and cross-sectional interviews across 26 housing with care schemes. Data were analysed using a thematic framework approach to examine specifically their experiences of living in housing with care schemes during the 2020 UK lockdown. The paper highlights that COVID-19 restrictions had a detrimental impact on the social connections and interactions of older residents living in housing with care schemes, as well as on their feelings of autonomy and independence. Despite this, residents adapted and coped with self-isolation restrictions and sought out positive ways to maintain social contact with others inside and outside to the scheme. We further highlight the tensions that providers of housing for older adults faced in promoting residents' autonomy and connectedness whilst also trying to provide a safe living environment and protect residents from risk of COVID-19 infection. Our findings apply not only to a pandemic situation but to the broader understanding of how housing with care for older adults must navigate between autonomy and support. • COVID-19 lockdowns challenged the independence and autonomy of older residents of housing with care in the UK. • Older adults in housing with care exercised autonomy through employing practices to maintain social connections. • Housing staff bolstered residents' autonomy, facilitated social interactions, and supported residents' wellbeing. • Housing staff faced challenges in maintaining the independent ethos of housing schemes whilst also protecting residents. [ABSTRACT FROM AUTHOR]

Purpose This commentary takes the article, “Participation of adults with learning disabilities in the 2015 United Kingdom General Election”, as a jumping-off point for considering a tension between the aim of full and equal equality for all people with disabilities as set out in the Convention on the Rights of Persons with Disabilities and more traditional beliefs, that on occasion, it is necessary to deny legal autonomy of men and women with intellectual disabilities in order to protect them. The paper aims to discuss these issues.Design/methodology/approach This issue is explored by reviewing the multiple and often conflicting ways in which disability and intellectual disability are conceptualised.Findings Given the multiple and contradictory ways in which both disability and intellectual disability are understood, any discussion of the rights of persons with disabilities is going to be highly problematic.Originality/value Equal recognition before the law and the presumption that all persons with intellectual disabilities can – with support – make autonomous decisions could be treated as an empirical question. [ABSTRACT FROM AUTHOR]

Women with Tourette's syndrome (TS) continue to be under-researched, despite female sex being associated with increased tic-related impairment in adulthood. Existing literature indicates that individuals with TS are more likely than the general population to report self-stigma, but little is known about the subjective identities of women with TS and how this relates to psychological wellbeing. Semi-structured interviews were conducted via Zoom with a purposive sample of 11 females. All were diagnosed with TS and aged 18–28. Data was transcribed verbatim and thematic analysis applied. Five themes were established: "I'm not normal", "I just want to be me", I'm a "people pleaser", seeing oneself as an "outsider", and "it's just part of me...it's not going anywhere". Difficulties with self-acceptance and the autonomy to be one's true self were noted and appeared to be intensified by stereotypical gender roles and attempts to conceal tics. Findings also suggested that personal growth and feelings of mastery can be achieved through embracing TS as part of one's identity, or recognising it as just one aspect of the self. Psychological support focused on accepting and living with tics rather than reducing them may benefit this population and is currently difficult to access. Consideration should also be given to improving the availability of support groups where women with TS can meet others like themselves. [ABSTRACT FROM AUTHOR]

The present paper outlines a perspective on Milgram's obedience experiments informed by rhetorical psychology. This perspective is demonstrated through a qualitative analysis of audio recordings and transcripts from two of Milgram's experimental conditions: 'voice-feedback' and 'women as subjects'. Analysis draws attention to the way in which participants could draw the experimenter into a process of negotiation over the continuation of the experimental session, something which could lead to quite radical departures from the standardized experimental procedure, and points to the ineffectiveness of Milgram's fourth prod (You have no other choice, you must go on). These observations are discussed in terms of their implications for theory and research on dis/obedience, with a specific focus on the concepts of choice and agency and the nature and meaning of dis/obedience. [ABSTRACT FROM AUTHOR]

There are growing numbers of people using personalised support and it has been argued that this system of social welfare requires a very different workforce, with a re-evaluation of the role of social work. This paper reports empirical research that explores the perceptions of sixty-six disabled people, carers and elders of the role social workers should perform in a personalised world. The study used a grounded theory approach, obtaining data from a thread posted on eighteen internet forums. This novel methodology allowed access to ‘hard to reach’ groups and encouraged participation by individuals whose contributions may be inhibited by more traditional research methods. The analysis revealed that notions of power and autonomy were fundamental in understanding respondents' views of social work with concerns raised about the power of social workers and statutory organisations. These findings have implications for the recommendations made by the Social Work Task Force in 2009 for the reform of social work that argues for social work to have a greater professional status and potentially more power in the support relationship. [ABSTRACT FROM PUBLISHER]

The introduction of policies to transform adult social care, combined with scrutiny of social workers' roles and functions, has created considerable uncertainty about the future of social work with adults. This paper explores the implications of these policy changes, arguing that a number of dilemmas for practitioners—the balance between a preventative focus and tight budgets, autonomy and protection, safeguarding and capacity—will exist in the changed policy framework. In addition, it suggests that the various core functions of social work—assessment, advocacy and brokerage, safeguarding and capacity—also contain elements of conflict and incompatibility. As a result, the future of social work in this policy area runs a strong risk of becoming both fragmented and isolated. This could be reflected in the education requirements for social workers where, both historically and as a result of recent bitter experiences, the key priorities clearly relate to child protection rather than adult social care. To counter this, the paper suggests a number of core areas of practice that are common across social work, and that therefore continue to argue for the maintenance of a generic qualification. In addition, it specifies particular aspects of practice with adults that should continue to be highlighted. [ABSTRACT FROM PUBLISHER]

This paper examines the establishment and appropriation of a hitherto overlooked space: the modern cubicle. The principal aim of the paper is to develop a political understanding of cubicle space in terms of the everyday practice of liberalism, and in particular Victorian liberalism. The key function it played in this respect was to afford subjects the freedom to operate on themselves in private and effect a moral and physical individuation of the self; part of its novelty as a site of power was the relative intensity with which it bound together various ethical norms, the body and the senses. But the modern cubicle illuminates much else besides. It allows for an exploration of the various cultural values - class, nature, gender, economy, amongst others - that liberalism sought to secure in material terms, and the equally varied spatial, technological and administrative tactics through which it operated. The cubicle, however, was always something of a fragile and indeterminate amalgam of human and non-human agency: civilised indulgence might develop into deviance; and technological fluency deteriorate into breakdown. To this extent, the cubicle also illuminates some of the reciprocities of rule and resistance, power and pleasure that characterise modern liberalism. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to reflect on progress and lessons in improving the social work system in England in the interests of children and families.Design/methodology/approach Based on an interview with the author by Michael Little (one of the Guest Editors of this edition).Findings Social work is best placed to lead the child protection system given its ability to manage risks in a challenging social and political environment. However, there is a need to address common concerns about the system, for instance to give social workers more autonomy, and to improve the quality in the workforce, especially at the senior level. The best authorities are practice focused, led by practitioners who are part of a stable team, and do well at a systems level.Originality/value Offers the perspective of the Chief Social Worker for Children in England on the process of reforming the social work system for children and families. [ABSTRACT FROM AUTHOR]

Objectives To investigate autonomous working among singly and dually qualified dental hygienists and therapists in UK primary care. Earlier studies and policy papers suggest that greater autonomy for these groups may be a desirable workforce planning goal.Methods UK-wide postal surveys of hygienists, hygienist-therapists and therapists. Respondents were asked whether they undertook 15 clinical activities on their own initiative, how comfortable they would feel undertaking such clinical activities if referral from a dentist were not required, and how they perceived dentists' reactions.Results Overall response rate was 65% (n = 150 hygienists, 183 hygienist-therapists and 152 therapists). Over 80% of hygienists and hygienist-therapists reported undertaking BPEs, history-taking, pocket charting, mucosal examinations and recall interval planning autonomously. Similarly high proportions of hygienist-therapists and therapists reported giving local analgesia and choosing restorative materials autonomously. However, fewer than 50% of all three groups said they undertook dental charting, fissure sealing, resin restorations, taking radiographs, and tooth whitening autonomously. While confidence in undertaking such activities without a dentist's referral was generally high, it was lower in respect to mucosal examinations, identifying suspicious lesions, interpreting radiographs, tooth whitening, and (except for singly qualified dental therapists) diagnosing caries.Conclusions Results suggest high levels of experience and confidence in their ability to work autonomously across a wide range of investigative activities, treatment decision-making and treatment planning. The exceptions to this pattern are appropriate to the different clinical remit of these groups. [ABSTRACT FROM AUTHOR]

This paper presents a cross-cultural examination of the trans-contextual model in University education setting. The purpose of the study was to test the effect of students' perceived autonomy support and in-lecture learning motivation on motivation, intention, and behaviour with respect to after-lecture learning via the mediation of the social cognitive variables: attitude, subjective norm, and perceived behavioural control. University students from UK, China, and Pakistan completed the questionnaires of the study variables. Results revealed that in-lecture perceived autonomy support and autonomous motivation were positively associated with autonomous motivation and intention to engage in after-lecture learning activities via the mediation of the social cognitive variables in all samples. After controlling for the effect of past behaviour, relations between intention and behaviour were only observed in the Chinese sample. In conclusion, the trans-contextual model can be applied to University education, but cultural differences appear to moderate the predictive power of the model, particularly for the intention-behaviour relationship. [ABSTRACT FROM AUTHOR]

This paper starts by introducing a tripartite conception of responsibility for health consisting of a moral agent having moral responsibilities and being held responsible, that is blamed, for failing to meet them and proceeds to a brief discussion of the nature of the blame, noting difficulties in agency and obligation when the concept is applied to health-threatening behaviours. Insights about the obligations that we hold people to and the extent of their moral agency are revealed by interrogating our blaming behavior, and to facilitate this, my own blaming attitudes and actions are analysed in respect of an imagined adult son who seeks thrills by jumping from a pier into the sea, an activity common around coastlines and intended to be analogous in varying degrees to a range of health-threatening behaviours. I consider my responses to this imagined act in relation to some features of moralism, the excess of morality, concluding that blame can be justified when it is proportionate and within interpersonal relationships. There is evidence that some nurses hold negative blaming attitudes towards groups of patients considered to have caused or contributed to their illness, but this is not justified, not only because of impaired agency, but also because if there is responsibility for health, associated obligations are owed to those who share our lives, and it is those people who are entitled to hold individuals responsible. Nurses who hold negative blaming attitudes towards groups of patients are invited to identify the status of moral agency, the precise natures of their (failed) obligations, and of the patient-nurse relationship. It is concluded that reflection on these matters and the difference between justified blame and moralism demonstrates that blaming behaviour in the context of professional health care is built on nothing stronger than prejudice. [ABSTRACT FROM AUTHOR]

This paper seeks to determine the value of theoretical ideal-types of medical control. Whilst ideal types (such as the iron cage and gaze) need revision in their application to medical settings, they remain useful in describing and explaining patterns of control and autonomy in the medical profession. The apparent transition from the cage to the gaze has often been over-stated since both types are found in many contemporary health reforms. Indeed, forms of neo-bureaucracy have emerged alongside surveillance of the gaze. These types are contextualised and elaborated in terms of two empirical examples: the management of medical performance and financial incentives for senior hospital doctors in England. Findings point towards the reformulation of medical control, an on-going re-stratification of the medical profession, and the internalisation of managerial discourses. The cumulative effect involves the medical profession's ability to re-cast and enhance its position (vis-à-vis managerial interests). [ABSTRACT FROM AUTHOR]

The aim of this paper is to re‐examine nursing work from a Marxist perspective by means of a critique of two key concepts within nursing: autonomy and caring. Although Marx wrote over 150 years ago, many see continuing relevance to his theories. His concepts of capital, ideology and class antagonism are employed in this paper. Nursing's historical insertion into the developing hospital system is seen in terms of a loss of autonomy covered over by the development of cults of loyalty toward those institutions, while the concept of emotional labour is used to re‐examine nursing's high valuing of "caring" and to understand it as potentially exploitative of nurses. Raising awareness of this alternative way of understanding nursing work can become a first step toward change. [ABSTRACT FROM AUTHOR]

Purpose: Musculoskeletal disorders (MSDs) are associated with high rates of work disability in the UK. This review synthesized qualitative evidence concerning the employment experiences of people with MSDs to explore the factors shaping their employment trajectories post-onset and the resources they draw on to remain in work. Material and methods: Systematic database searches identified 16 qualitative studies of the employment consequences of having a chronic MSD in the UK. Meta-ethnographic methods were utilized to synthesize this body of evidence. This included a translation of concepts across studies to produce a line of argument synthesis. Results: The lack of certainty associated with often fluctuating and invisible MSD symptoms leads to employees struggling to maintain a stable work identity. Work retention is aided by having: a clear diagnosis, occupational tasks commensurate with altered abilities, and employers and colleagues who understand the nature of the condition. The ability to negotiate and implement workplace adjustments aids work retention but is dependent upon having good quality employee–employer relationships and the degree of autonomy available to the employee. Conclusion: Individuals with MSDs must draw on a range of personal, social, organizational and institutional resources to remain in or return to work post-onset. The fluctuating and invisible nature of chronic musculoskeletal disorders (MSDs) creates uncertainty for individuals about their ability to remain working or return-to-work. Individuals with MSDs must draw on a range of personal, social, organizational, and institutional resources to remain in work following onset. Work retention is aided by having a clear diagnosis; occupational tasks commensurate with altered abilities; and understanding employers and coworkers. Organizational flexibility and the ability to act autonomously by changing occupations or self-implementing or requesting work adjustments are particularly important for work retention. [ABSTRACT FROM AUTHOR]

Aim: To critically evaluate the concepts of harm and re‐traumatization in the research process and to explore the ethical implications of conducting research on distressing topics using our research on the experiences of nurses working during the COVID‐19 pandemic as an exemplar. Design: Longitudinal qualitative interview study. Methods: Using qualitative narrative interviews, we explored the impacts of the COVID‐19 pandemic on nurses' psychological well‐being in the UK. Results: To reduce the potential for harm to both research participants and researchers, the members of the research team were keen to establish ways to reduce the power differential between the researcher and participants. We found that our collaborative and team‐based approach, with participant autonomy and researcher reflexivity embedded into the research framework, enabled the sensitive generation of data. Conclusion: Reduction of potential harm for both participants and researchers in the generation of at times highly distressing data with a traumatized population was achieved through a respectful, honest and empathetic approach within a team that met frequently for reflection. Impact: The research participants were not harmed by our research, instead they expressed gratitude at being given space and time to tell their stories in a supportive environment. Our work advances nursing knowledge through accentuating the value of giving autonomy to research participants to control their stories whilst working within a supportive research team with emphasis placed on reflexivity and debriefing. Patient and Public Contribution: Nurses working clinically during COVID‐19 were involved in the development of this study. Nurse participants were given autonomy over how and when they participated in the research process. [ABSTRACT FROM AUTHOR]

This paper develops a theoretical approach to children's rights in youth justice, located within a wider rights-based theory of criminal justice which emphasises the centrality of citizens' autonomy. Understanding what is special about children's rights in the youth justice system requires an understanding of how children's autonomy differs from that of adults. One difference is that within the legal system children are not considered to be fully autonomous rights-holders, because childhood is a time for gathering and developing the assets necessary for full autonomy. These assets should be protected by a category of 'foundational' rights. It is argued that an essential component of a rights-based penal system for children is that it should not irreparably or permanently harm the child's foundational rights. The concept of foundational rights can then underpin and strengthen international children's rights standards, including those relating to the minimum age of criminal responsibility, differential sentencing for children and adults and a rights-based system of resettlement provision. [ABSTRACT FROM AUTHOR]

Driving cessation for many older people is associated with a poorer quality of life and can lead to health problems such as depression. This paper aims to reveal the process of giving-up driving, examining in particular triggers for giving-up driving, how information on alternative modes of transport is sought and how new transport and travel behaviour is integrated into older people's lives. It examines the challenges faced and how these are overcome and what impact the process has on self-reported quality of life, as articulated by the participants themselves. To this end, twenty-one individuals from three locations in the United Kingdom (UK) were followed over a period of 10 months, through five waves of data collection. Each participant took part in three interviews, a focus group and completed a diary of travel behaviour. Findings suggest that although a similar pattern was found between the trigger and life post-car, not all older people go through the stages of giving-up driving in the same way. Instead, a range of responses are seen, from contemplation of gradually reducing driving, through to stopping abruptly, with the route taken having consequences for the eventual outcome for any individual. Triggers for contemplating driving cessation could be varied and often involved health and social factors. Importantly, people who engaged in pre-planning reported a relatively higher quality of life beyond the car, whilst for those who were more reactive and engaged in little or no pre-planning a poorer quality of life resulted. In addition (and in conjunction with planning), other factors, such as flexibility in travel destinations, the role of family and friends, and wider support networks are also seen as important. With such evidence of the importance of pre-planning it is suggested that more could be done to support giving-up driving and encouraging contemplation at a younger age to mitigate the negative effects experienced by some. [ABSTRACT FROM AUTHOR]

This paper uses critical discursive psychology to examine expressions of dissatisfaction and complaint by people with learning disabilities. UK government policies stress that people with learning disabilities should have more control over their lives. Expressing dissatisfaction about services is an important aspect of this process. However, given that such individuals are often treated as incompetent, and given the delicate nature of complaining about services one might rely on for day-to-day support, this can be difficult to do. In building complaints, speakers drew on repertoires about competence and incompetence, the right to free choice as a principle, and tempered dissatisfaction to make contrasts between good and bad supporters and practice. While the complaints show many of the general features of complaints identified in previous work in the general population, they were crafted to the particular institutional context of social care, and attended both explicitly and implicitly to the particular issues of competence, power, and authority found in those services. Speakers positioned themselves as competent, and service workers as more or less competent in their roles. Issues of power in social care services were observed explicitly in the accounts, whereby people described staff as controlling and it being difficult to voice dissatisfaction. They were also implicit in the way speakers drew on the others with institutional authority for corroboration and comparison. [ABSTRACT FROM AUTHOR]

Providing patients with information is fundamental to respecting autonomy. However, there may be circumstances when information may be withheld to prevent serious harm to the patient, a concept referred to as therapeutic privilege. This paper provides an analysis of the ethical, legal and professional considerations which impact on a decision to withhold information that, in normal circumstances, would be given to the patient. It considers the status of the therapeutic privilege in English case law and concludes that, while reference is made to circumstances when information (primarily in relation to risk disclosure) may be withheld, further clarification is required on the status of therapeutic privilege. I suggest there has been shift in English law relating to the standard of information disclosure towards one set by the test of the reasonable, prudent patient. It is this shift that necessitates the existence of a therapeutic privilege which enables doctors to withhold information that would usually be given to the patient in order to prevent serious harm. I then explore the professional guidance in relation to information disclosure and how this relates to the legal position. There are strong ethical arguments in favour of disclosure of information to patients. In light of these, further clarification is required to identify and define the grounds on which this exception exists, the information that could lawfully be withheld and how this exception extends to rest of the health care team, particularly nurses. As such, explicit ethical and legal scrutiny of therapeutic privilege is needed in order to consider how this concept might be articulated, constrained and regulated. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to gain insight into the prevalence of entrepreneurial activity amongst older people, and whether such activity may be an option for them to extend their working lives. Design/methodology/approach – Research was conducted amongst the Policy Voice database of respondents at the Institute of Directors, members who have volunteered their time to answer research questions on a variety of public policy issues. Undertaken electronically, a series of questions were asked of respondents relating to their age and business activities. Amplification by verbatim comments was requested, which gave qualitative context to the quantitative answers received. Over 1,200 responses to the survey were received. Findings – Starting, running or continuing in individual business or entrepreneurial activity would appear to be surprisingly commonplace amongst the research sample, suggesting that there might be more older entrepreneurs amongst the population as a whole than might have previously been supposed. For those with the requisite skills and personal attributes, entrepreneurship in later life would appear to be a valid option for extending working lives. Research limitations/implications – Research responses were from a membership base biased towards A, B, and C1 socio-economic groups. Originality/value – There have been very limited studies of entrepreneurial and business activity amongst older people. [ABSTRACT FROM AUTHOR]

Scientific-bureaucratic medicine (SBM) has been the dominant discourse on evidence-based medicine in the English National Health System (NHS). It has being claimed that SBM has led to new forms of medical professionalism with an emphasis on organisational values and the control of autonomy. This paper explores the medical professions' response to SBM, where SBM is manifested in the form of National Institute of Health and Clinical Excellence (NICE) guidelines. Seventy-four face-to-face informal interviews were carried out with clinicians and managers between 2007 and 2009. Three major themes emerged from the analysis each of which was linked to doctors' receptiveness to NICE guidelines implementation. The first emphasised organisational values, which accounted for conditional acceptance of NICE guidelines. The second was proactive professionalism or entrepreneurial professionalism, which was linked to the rejection of NICE guidelines and the emergence of alternative forms of introducing new ideas for the expansion of their clinical practice. The third was related to the prominence of clinical autonomy linked with doctors' resistance to the use of NICE guidelines. It is argued that this evidence does not reflect a significant emergence of new forms of professionalism but the development of multiple occupational identities. [ABSTRACT FROM AUTHOR]

The power of one-to-one tuition in Higher Music Education is evidenced by its continuing place at the heart of conservatoire education. The need to examine this student–teacher relationship more closely has been emphasised in the last decades by increasing understanding of processes of student learning in Higher Education as a whole, and in particular the impact which student–teacher relations have on learning. Literature on PhD supervision, for example, has highlighted the depth of applied craft skills made possible in one-to-one interaction, and has also drawn attention to a range of potential difficulties encountered in the supervisory relationship. This paper draws on findings from a study at a conservatoire in the UK, which explored student and teacher perceptions of one-to-one tuition. It analyses student and teacher perspectives on the relationship and considers the match between their perceptions within student–teacher pairs. Findings demonstrate diverse characterisation of the relationship, and varied approaches to extending a social relationship beyond the confines of the lesson. Comparison of student–teacher pairs indicates that the students tended to mirror their teachers' opinions about appropriate social interaction. This was one example of the dynamics of power operating within the one-to-one relationship, although these were rarely discussed explicitly. Such dynamics of power made it difficult in some instances for students to articulate difficulties with learning and to change teacher. There was also evidence of a possible connection between dynamics of power in the relationship and students' reluctance to develop artistic and professional self-direction. The implications of these findings are considered in terms of conceptualising one-to-one tuition, and the need to review the professional framework of its delivery in Higher Music Education. [ABSTRACT FROM PUBLISHER]

This paper considers the ideals and activism of the fin de siècle feminist organisation, the Women's Emancipation Union (WEU). Active between 1891 and 1899, the WEU held a prophetic vision of the future and an appraisal of women's subjection more comprehensive than any contemporary feminist group. Members were the first to link the possession by women of their bodily autonomy directly to the acquisition of the parliamentary vote, and thus redefined the terms upon which citizenship was constructed. One member raised the matter of armed insurrection in support of the women's franchise, an issue which would have serious implications for the future of suffragist campaigns. The political roots of WEU members lay chiefly within the utopian-socialist and Radical-liberal traditions, but it was an organisation which resisted party-political allegiance to become anchored in the Progressive movement. Adopting what has been defined as the ‘muckraking’ tradition associated with Progressive authorship, the WEU suffragists constructed a rhetoric of resistance to women's subjection from social, sexual, economic and political standpoints. Many points they raised, including for a woman's right to consent to maternity to be enshrined in law, were to become the bedrock of the philosophy of the militant suffragette movement. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a study to evaluate the impact and success of the United Kingdom centralized Research Management and Governance model. BACKGROUND: Research is crucial to the generation of new knowledge and for the development of nursing services. However, poor research conduct has prompted a growing international impetus to govern and monitor research activity. In 2004, a centralized Research Management and Governance Model aimed at fostering a quality research culture through streamlining bureaucratic management processes was implemented across 14 primary care provider organizations in the United Kingdom. METHODS: A questionnaire survey was undertaken in 2004 to explore researchers' experiences (n = 76) of the model across the 14 organizations, and semi-structured interviews were conducted with five research and development managers. The interview transcripts were independently thematically analysed. FINDINGS: Governance processes were seen as useful or very useful by 36.8% (n = 28) of researchers viewed, and 47.3% (n = 36) thought they were a hindrance or not useful. Managers suggested that the model supported the research infrastructure and had reduced paperwork. The benefits of centralization were balanced against managers' perceptions of reduced autonomy and control. CONCLUSIONS: Centralizing research governance is an effective way of maximizing research resources, but researchers still may not value the process. Partnership working can streamline research governance mechanisms, but needs to be adequately resourced and transparent. This model could be of benefit to international colleagues who are charged with the management of research. [ABSTRACT FROM AUTHOR]

This paper problematizes the widespread use of self-determination theory, with its dichotomized conceptualization of intrinsic and extrinsic motivation, as an adequate means of understanding higher education student motivation. We draw on theories of situated motivation and extend them to encompass areas of students' lives beyond the academic environment, to analyze data from interviews with first year students. Our findings suggest that students' motivation for academic work may be reinforced or obstructed by other motivations in their everyday lives, such as forming friendships and developing as a person. These various motivations are shaped by students' social contexts, including social networks and material factors such as accommodation. Students experienced particular problems with motivation for independent study, which was most often understood as working alone. We reconceptualize student motivation as social and relational and we explore the ramifications of this for learning and teaching. [ABSTRACT FROM AUTHOR]

The present paper uses life course theory to explore the move toward 'independent living' required of young people leaving care in England and Wales. Informal interview contact with 14 young people who had recently left care was maintained over a period of 12-18 months. Biographical stories constructed from field research are used to consider the social and developmental processes of the life course. The contextual analysis formalized within life course theory focused on the social timing and social construction of independence, revealing the way in which important 'invisibilities' may have social and developmental consequences for care leavers. [ABSTRACT FROM AUTHOR]

The paper offers empirical insight into how traditional thinking can continue to dominate contemporary change initiatives, and suggests that the propensity to repackage and sell 'old' management theory as new techniques reflects the persistence of fundamental, insoluble dilemmas in the nature of organizing. Empirical evidence is drawn from a detailed qualitative study of two case study sites at the Royal Mail, the UK postal service. The analysis shows how the two different change initiatives of Total Productive Maintenance (TPM) and Technical Centers of Excellence (TECEN) are in competition through their methods and discourse, and how this reflects underlying and competing differences in ideologies of management. It vividly demonstrates how contemporary management thinking can involve repackaging old ideas in new rhetoric and a tendency for faddism. In organizations such as Royal Mail the consequence is that far from proving to be the solution to organizational problems, the techniques perpetuate a traditional management dualism in strategies of labor management between control and autonomy. [ABSTRACT FROM AUTHOR]

* Although autonomy and independence are widely held to be important goals of care for older people, these terms lack precise definition and operationalization in the literature. * This paper reports on observational data gathered as part of an evaluation of educational programmes in the nursing care of older people. * Strategies which appear both to promote and inhibit autonomy and independence of older patients in a range of care settings are described. * Recommendations are made for further research to explore the extent to which autonomy and independence are appropriate goals of care for older people with cognitive impairment. [ABSTRACT FROM AUTHOR]