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It seems probable that some form of medically-assisted dying will become legal in England and Wales in the foreseeable future. Assisted dying Bills are at various stages of preparation in surrounding jurisdictions (Scotland, Republic of Ireland, Isle of Man, Jersey), and activists campaign unceasingly for a change in the law in England and Wales. There is generally uncritical supportive media coverage, and individual autonomy is seen as the unassailable trump card: 'my life, my death'. However, devising a law which is 'fit for purpose' is not an easy matter. The challenge is to achieve an appropriate balance between compassion and patient autonomy on the one hand, and respect for human life generally and medical autonomy on the other. More people should benefit from a change in the law than be harmed. In relation to medically-assisted dying, this may not be possible. Protecting the vulnerable is a key issue. Likewise, not impacting negatively on societal attitudes towards the disabled and frail elderly, particularly those with dementia. This paper compares three existing models of physician-assisted suicide: Switzerland, Oregon (USA), and Victoria (Australia). Vulnerability and autonomy are discussed, and concern expressed about the biased nature of much of the advocacy for assisted dying, tantamount to disinformation. A 'hidden' danger of assisted dying is noted, namely, increased suffering as more patients decline referral to palliative-hospice care because they fear they will be 'drugged to death'. Finally, suggestions are made for a possible 'least worse' way forward. One solution would seem to be for physician-assisted suicide to be the responsibility of a stand-alone Department for Assisted Dying overseen by lawyers or judges and operated by technicians. Doctors would be required only to confirm a patient's medical eligibility. Palliative-hospice care should definitely not be involved, and healthcare professionals must have an inviolable right to opt out of involvement. There is also an urgent need to improve the provision of care for all terminally ill patients. [ABSTRACT FROM AUTHOR]

Background/Aims In addition to the high rate of attrition among registered midwives, student midwives are increasingly likely to choose to leave their programme, decreasing the projected number of midwives who would join the NHS. The aim of this study was to understand how students experience clinical practice and if these experiences affect their decision to enter the professional register. Methods Seven student midwives who had experienced clinical placement as part of their pre-registration training were invited to attend semi-structured interviews. Data were analysed following an interpretive phenomonology approach, where descriptive, linguistic and conceptual comments on the transcripts were used to identify emergent themes. Results The 79 identified themes were categorised into five sub-themes within two super-ordinate themes: 'kindness and compassion grows future midwives and strength' and 'resolve through COVID-19 and beyond'. The overarching theme from the participants' interviews was 'I can be a good midwife when I qualify'. Conclusions Students want to feel like they will be good midwives, which will be achieved with positive attitudes and behaviours towards them from senior staff during clinical placements. Staff involved with the care of women and newborns should ensure they show students civility and patience while teaching and supporting them. Understanding the level of knowledge that students possess can make it simpler for staff to recognise what each student may or may not have been exposed to. [ABSTRACT FROM AUTHOR]

Background Healthcare organisations have legal and ethical duties to reduce inequalities in access to healthcare services and related outcomes. However, lesbian, gay, bisexual and/or transgender (LGBT+) people continue to experience and anticipate discrimination in health and social care. Skilled communication is vital for quality person-centred care, but there is inconsistent provision of evidence-based clinician education on health needs and experiences of LGBT+ people to support this. This study aimed to identify key stakeholders' experiences, preferences and best practices for communication regarding sexual orientation, gender identity and gender history in order to reduce inequalities in healthcare. Methods Semistructured qualitative interviews with LGBT+ patients with serious illness, significant others and clinicians, recruited via UK-wide LGBT+ groups, two hospitals and one hospice in England. We analysed the interview data using reflexive thematic analysis. Results 74 stakeholders participated: 34 LGBT+ patients with serious illness, 13 significant others and 27 multiprofessional clinicians. Participants described key communication strategies to promote inclusive practice across three domains: (1) 'Creating positive first impressions and building rapport' were central to relationship building and enacted through routine use of inclusive language, avoiding potentially negative non-verbal signals and echoing terminology used by patients and caregivers; (2) 'Enhancing care by actively exploring and explaining the relevance of sexual orientation and gender identity', participants described the benefits of clinicians initiating these discussions, pursuing topics guided by the patient's response or expressed preferences for disclosure. Active involvement of significant others was encouraged to demonstrate recognition of the relationship; these individual level actions are underpinned by a foundation of (3) 'visible and consistent LGBT+ inclusiveness in care systems'. Although participants expressed hesitance talking about LGBT+ identities with individuals from some sociocultural and religious backgrounds, there was widespread support for institutions to adopt a standardised, LGBT+ inclusive, visibly supportive approach. Conclusions Person-centred care can be enhanced by incorporating discussions about sexual orientation and gender identity into routine clinical practice. Inclusive language and sensitive exploration of relationships and identities are core activities. Institutions need to support clinicians through provision of adequate training, resources, inclusive monitoring systems, policies and structures. Ten inclusive communication recommendations are made based on the data. [ABSTRACT FROM AUTHOR]

Dementia may make adults more susceptible to abuse and neglect and such mistreatment is recognised as a human rights violation. This article focusses on how the rights of people living with dementia might be protected through the use of supported decision-making within safeguarding work. The article begins by reviewing the aims and scope of adult safeguarding services. It then describes how the concept of 'legal capacity' is set out in the UN Convention on the Rights of Persons with Disabilities (CRPD) and how this differs from the concept of 'mental capacity' in the Mental Capacity Act 2005. Focussing on practice in England, it is argued that tensions between the CRPD and domestic law exist, but these can be brought into closer alignment by finding ways to maximise supported decision-making within existing legal and policy frameworks. The article concludes with suggested practice strategies which involve: (i) providing clear and accessible information about safeguarding; (ii) thinking about the location of safeguarding meetings; (iii) building relationships with people living with dementia; (iv) using flexible timescales; (v) tailoring information to meet the needs of people living with dementia and (v) respecting the person's will and preferences in emergency situations. [ABSTRACT FROM AUTHOR]

Background: Multidisciplinary team collaboration has been identified as a key factor in optimising intrapartum care. The way future doctors feel about their undergraduate placements with midwives is worth considering, given that this might influence their behaviour in the long term. This study aimed to investigate the experience of medical students working with midwives on NHS labour wards. Methods: Qualitative thematic analysis was done on transcripts of in-depth interviews with 10 medical students from across England. These students had clinical experiences with midwives or were seeking to work with midwives, and had experiences of training during or after 2010. Results: Midwives were described as 'gatekeepers', with the power either to open or close the labour room door to medical students. Participants described mixed feelings about midwives; some reportedly provided pivotal learning experiences, particularly regarding physiological labour and birth. Others were perceived as unsupportive. The dynamic with midwives was often linked to wider multidisciplinary team culture. Conclusions: Despite national calls to improve multidisciplinary team relations and undergraduate experiences, this sample of medical students shows that some still perceive tension with midwives. This may affect future obstetricians' exposure to physiological birth at an impressionable time and also influence their multidisciplinary team behaviour. Research into midwives' perspective is needed, given that collaboration is a key factor in providing safer, more personalised care. [ABSTRACT FROM AUTHOR]

Background: Emergency Care and Treatment Plans are recommended for all primary care patients in the United Kingdom who are expected to experience deterioration of their health. The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) was developed to integrate resuscitation decisions with discussions about wider goals of care. It summarises treatment recommendations discussed and agreed between patients and their clinicians for a future emergency situation and was designed to meet the needs of different care settings. Our aim is to explore GPs' experiences of using ReSPECT and how it transfers across the primary care and secondary care interface. Methods: We conducted five focus groups with GPs in areas being served by hospitals in England that have implemented ReSPECT. Participants were asked about their experience of ReSPECT, how they initiate ReSPECT-type conversations, and their experiences of ReSPECT-type recommendations being communicated across primary and secondary care. Focus groups were transcribed and analysed using Thematic Analysis. Results: GPs conceptualise ReSPECT as an end of life planning document, which is best completed in primary care. As an end of life care document, completing ReSPECT is an emotional process and conversations are shaped by what a 'good death' is thought to be. ReSPECT recommendations are not always communicated or transferable across care settings. A focus on the patient's preferences around death, and GPs' lack of specialist knowledge, could be a barrier to completion of ReSPECT that is transferable to acute settings. Conclusion: Conceptualising ReSPECT as an end of life care document suggests a difference in how general practitioners understand ReSPECT from its designers. This impacts on the transferability of ReSPECT recommendations to the hospital setting. [ABSTRACT FROM AUTHOR]

This paper explores the methodological aspects of a user‐led study investigating mental health service user experiences of targeted violence and abuse (often called 'hate crime'). 'Keeping Control' was a 16‐month qualitative study, undertaken in the context of adult safeguarding reforms in England. By collecting data on service user concepts and experiences, the research sought to address a gap in research and practice knowledge relating to targeted violence, abuse and hostility against people with mental health problems. In this paper, we discuss the significance of the design and methodology used for this study, with a particular focus on the interviews with service users. The research was both user‐led and carried out in collaboration with practitioners and academics, a form of research co‐production. Our aim is to inform researchers, practitioners and policymakers about the value of user leadership in co‐productive research with practitioners, particularly for a highly sensitive and potentially distressing topic. [ABSTRACT FROM AUTHOR]

Over recent decades, there has been a lot of academic and political focus on anti-social behaviour, but less attention on the everyday moral judgements that can inform what we perceive to be anti-social. This is despite politicians' claims that anti-social behaviour reflects a moral decline. This article draws on a focus group study from the North West of England and on ideas from criminology and philosophy. People's assessments of anti-social behaviour are found to be informed by judgements of morality, most often in terms of 'doing what's right', having respect, and abiding by the Golden Rule, to 'do to others what you would have them do to you'. Understandings of anti-social behaviour are stretched so far by the public that they can range from littering through to tax avoidance, but what these behaviours have in common is their perceived breaching of our day-to-day moral standards. Implications are discussed. [ABSTRACT FROM AUTHOR]

Since 1997, the Criminal Cases Review Commission of England, Wales and Northern Ireland has served as a state-funded post-conviction body to consider claims of wrongful conviction for those who have exhausted their rights to appeal. A meticulous organisation that has over its lifetime referred over 700 cases back to the Court of Appeal, resulting in over 60% of those applicants having their convictions quashed, it is nonetheless restricted in its response to cases by its own legislation. This shapes its decision-making in reviewing cases, causing it to be somewhat deferential to the original jury, to the principle of finality and, most importantly, to the Court of Appeal, the only institution that can overturn a wrongful conviction. In mandating such deference, the legislation causes the Commission to have one eye on the Court's evolving jurisprudence but leaves room for institutional and individual discretion, evidenced in some variability in responses across the Commission. While considerable variability would be difficult to defend, some inconsistency raises the prospects for a shift towards a less deferential referral culture. This article draws on original research by the author to consider the impact of institutional deference on the work of the Criminal Cases Review Commission and argues for a slightly bolder approach in its work. [ABSTRACT FROM AUTHOR]

Background: Respectful care is central to ethical codes of practice and optimal patient care, but little is known about the influences on and challenges in communicating respect. Research question: What are the intra- and inter-personal influences on nurses' communication of respect? Research design and participants: Semi-structured interviews with 12 hospital-based UK registered nurses were analysed using interpretative phenomenological analysis to explore their experiences of communicating respect to patients and associated influences. Ethical considerations: The study was approved by the Institutional ethics board and National Health Service Trust. Findings: Three interconnected superordinate themes were identified: 'private self: personal attitudes', 'outward self: showing respect' and 'reputational self: being perceived as respectful'. Respectful communication involved a complex set of influences, including attitudes of respect towards patients, needs and goals, beliefs around the nature of respectful communication, skills and influencing sociocultural factors. A tension between the outward self as intended and perceived presented challenges for nurses' reputational self as respectful, with negative implications for patient care. Discussion: The study offers an in-depth understanding of intra- and inter-personal influences on communicating respect, and sheds light on challenges involved, helping provide practical insights to support respectful care. Conclusion: Findings stress the need for improved conceptualisations of respect in healthcare settings to formally recognise the complex attitudinal and socially constructed nature of respect and for appropriate professional training to improve its communication. [ABSTRACT FROM AUTHOR]

Background: There is growing awareness that patient care suffers when nurses are not respected. Therefore, to improve outcomes for patients, it is crucial that nurses operate in a moral work environment that involves both recognition respect, a form of respect that ought to be accorded to every single person, and appraisal respect, a recognition of the relative and contingent value of respect modulated by the relationships of the healthcare professionals in a determined context. Research question/aim: The purpose of this study was to develop better understandings of perceptions of nursing's professional respect in community and hospital settings in England. Research design: The research design was qualitative. Focus groups were chosen as the most appropriate method for eliciting discussion about nursing's professional respect. Participants and research context: A total of 62 nurses who had been qualified for at least a year and were working in two localities in England participated in this study. Methods: Data were collected using 11 focus group sessions. The data were analysed by means of an inductive content analysis, extracting meaning units from the information retrieved and classifying the arising phenomena into conceptually meaningful categories and themes. Ethical considerations: To conduct the research, permission was obtained from the selected universities. Results: Recognition respect of human beings was perceived as ingrained in the innermost part of nurses. Regarding appraisal respect, a great importance was placed on: the interactions among healthcare professionals, the time to build trust in these relationships, the influences of the workplace characteristics and nurses' professional autonomy and decision-making. Conclusion: Recognition respect of persons was embedded in the inmost part of nurses as individuals. Concerning appraisal respect, it was thought to be deeply enshrined in the inter- and intra-healthcare professional interactions. The forging of trusting relationships over time was deemed to be strongly associated with good quality interactions with other healthcare professionals. [ABSTRACT FROM AUTHOR]

This article critically considers the question of whether an increase in legal recognition of patient autonomy culminating in the decision of the Supreme Court in Montgomery v Lanarkshire Health Board in 2015 has led to the death of deference to doctors, not only within the courts and healthcare regulatory arenas in England and Wales but also in the consulting room and the health care system more broadly. We argue that deference has not been eradicated, but that the types of deference paid to doctors and to the medical profession have changed. In addition, whilst traditionally deference was extended towards the medical profession, increasing instances of deference being shown to other parties in the healthcare setting can be identified, allowing wider debate or recognition of the complexity of understandings, interests and aims of all those involved. Finally, we note instances in which deference to the medical profession has become more hidden. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Investigate patient perspectives on barriers and enablers to the use and effectiveness of de‐escalation techniques for aggression in mental health settings. Background: De‐escalation techniques are the recommended first‐line intervention for the management of aggression in mental health settings internationally, yet use of higher risk restrictive practices persists. This indicates de‐escalation techniques are not used at optimum frequency and/or there are important factors limiting their use and effect. Design: Descriptive qualitative research using semi‐structured interviews and Framework Analysis. Methods: Inpatient interviews (N = 26) exploring staff, patient and environmental factors influencing the use and effectiveness of staff de‐escalation were conducted mid‐2014. Three service user researchers led analysis. Results: Data were synthesized in three deductive themes relating to staff, patient and environmental influences on the use and effectiveness of de‐escalation techniques. The dominant view was that restrictive practices, rather than de‐escalation techniques, are used in response to escalating patient behaviour. Under‐use of de‐escalation techniques was attributed to: lack of staff reflection on culture and practice and a need to retain control/dominance over patients. Ward rules, patient factors and a lack of staff respect for patients diluted their effectiveness. Participants identified a systematic process of de‐escalation, rule subversion, reduced social distance and staff authenticity as enablers of effective de‐escalation. Conclusion: This study investigated patient perspectives on staff, patient and environmental influences on the use and effectiveness of de‐escalation techniques. Our framework of barriers and enablers provides indicators of organizational/behaviour change targets for interventions seeking to reduce violence and restrictive practices through enhanced de‐escalation techniques. [ABSTRACT FROM AUTHOR]

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Although she is part of the Traveller community, for many years dementia nurse specialist Cheryl Scarrott chose not to share this information publicly. [ABSTRACT FROM AUTHOR]

At the beginning of the 2013/2014 season in England and Wales, 90 head coaches of the 92 men's national professional football league clubs and 20 of the 22 men's professional rugby union clubs had tenure as a professional elite player in their respective sports. Moreover, Rynne [(2014). ‘Fast track’ and ‘traditional path’ coaches: Affordances, agency and social capital.Sport, Education and Society,19, 299–313] has claimed that many former elite athletes are ‘fast-tracked’ through formal accreditation structures into these high-performance coaching roles. The reasons why former elite athletes dominate head coaching roles in professional sports clubs and why a ‘fast-track’ pathway from elite athlete to high-performance coach is supported remain unclear. Thereby the present study sought to address this issue by investigating the basis for ‘fast-tracked’ head coaching appointments. Eight male directors of men's professional football and rugby union clubs in England were interviewed to examine how particular coaching skills and sources of knowledge were valorised. Drawing upon Bourdieu's conceptual framework, the results suggested that head coaching appointments were often based upon the perceived ability of head coaches gaining player ‘respect’. Experiences gained during earlier athletic careers were assumed to provide head coaches with the ability to develop practical sense and an elite sporting habitus commensurate with the requirements of the field of elite sports coaching. This included leadership and practical coaching skills to develop technical and tactical astuteness, from which, ‘respect’ could be quickly gained and maintained. The development of coaching skills was rarely associated with only formal coaching qualifications. The ‘fast-tracking’ of former athletes for high-performance coaching roles was promoted by directors to ensure the perpetuation of specific playing and coaching philosophies. Consequently, this may exclude groups from coaching roles in elite men's sport. The paper concludes by outlining how these findings might imply a disjuncture between the skills promoted during formal coaching qualifications and the expectations club directors have of elite coaches in these sports. [ABSTRACT FROM PUBLISHER]

Health and social care settings worldwide need to sustainably improve the quality of relationships across communities or 'whole systems'. This research informs the development of a relational framework based on stakeholder perspectives. It is grounded in an action research project with practitioners, and draws on a previous literature review, to present the underpinning elements of quality relationships as statements, organised under the headings of integrity, respect, fairness, compassion and trust. Using Q methodology, 27 participants, comprising a range of stakeholders (staff, residents, family and service providers), rank-ordered 48 statements based on perceptions of the importance of differing aspects of relationships. By-person factor analysis was used to create five factors or viewpoints by comparing and contrasting using the composite rankings alongside interview data collected for each participant. The first view 'Altogether now' prioritises compassionate engagement. Second, 'Respect is a two-way street' emphasises the need for reciprocal respect and recognition of history. The factor labelled 'Free spirits' posits the dominant view of freedom. The fourth view 'Families ... strengths and challenges' focuses on the necessary and complex involvement of families and finally, 'Helping hands' emphasises the role of relationships in increasing previously low expectations of social integration for previously isolated residents. The different views that exist on the composition of quality relationships can be used to help extra care communities to understand and utilise relationships as a powerful and effective resource. [ABSTRACT FROM AUTHOR]

Defining 'effectiveness' in the context of community mental health teams ( CMHTs) has become increasingly difficult under the current pattern of provision required in National Health Service mental health services in England. The aim of this study was to establish the characteristics of multi-professional team working effectiveness in adult CMHTs to develop a new measure of CMHT effectiveness. The study was conducted between May and November 2010 and comprised two stages. Stage 1 used a formative evaluative approach based on the Productivity Measurement and Enhancement System to develop the scale with multiple stakeholder groups over a series of qualitative workshops held in various locations across England. Stage 2 analysed responses from a cross-sectional survey of 1500 members in 135 CMHTs from 11 Mental Health Trusts in England to determine the scale's psychometric properties. Based on an analysis of its structural validity and reliability, the resultant 20-item scale demonstrated good psychometric properties and captured one overall latent factor of CMHT effectiveness comprising seven dimensions: improved service user well-being, creative problem-solving, continuous care, inter-team working, respect between professionals, engagement with carers and therapeutic relationships with service users. The scale will be of significant value to CMHTs and healthcare commissioners both nationally and internationally for monitoring, evaluating and improving team functioning in practice. [ABSTRACT FROM AUTHOR]

The government's regulations on mandatory vaccination in care homes have been approved and will take effect in all care homes in England on 11 November. The policy focuses on staff employed in homes, but has a wider scope. [ABSTRACT FROM AUTHOR]

Sam Foster, Chief Nurse, Oxford University Hospitals, considers the recommendations of the new Messenger report that explores ways to develop leadership and management in health and social care [ABSTRACT FROM AUTHOR]

Background: Last offices are the procedures carried out shortly after a person dies. The National End of Life Care Programme UK guidelines recognise the potential impact of last offices on nurses and advocate the involvement of significant others, but offer no guidance on how to facilitate this. Aim: To explore nurses' experiences of carrying out last offices, in hospice inpatient and community settings, and their views on involving the person's significant others in the process. Methods: Semi-structured interviews with 10 nurses/health-care assistants (held in June to August 2012). Interviews were analysed using interpretative, thematic analysis. Results: Four main themes emerged from the data. Last offices were described as: a range of care activities, a learning and coping challenge, a time of transition, and a demonstration of respect and support. Conclusion: Last offices are a range of care activities, shaped by the environment, time and help available. Further research into the potential benefits and harms of involving significant others is required. [ABSTRACT FROM AUTHOR]

Background: Pre-dialysis education that leads to decisions on treatment has traditionally been ad hoc, with programmes lacking a theoretical or evidence basis. A multidisciplinary and service user participatory action research study developed and delivered a self-efficacy, theory based pre-dialysis education intervention. A core principle of action research methodology is critical reflection. Aims and objectives: The aim of this article is critically to explore a novice's experience of facilitating collaborative participatory action research and the contribution this made to pre-dialysis education. Using the reflective practice framework developed by Rolfe et al. (2001), the article will examine the facilitation challenges encountered, using three questions: 1. What was the issue? 2. So what did I learn? 3. Now what do I need to do to make things better? Conclusion and implications for practice: Effective facilitation requires reflective practice that adds clarity when dealing with facilitation challenges Participatory action research provided a clear framework within which to facilitate the review of pre-dialysis education. Its hands-on, action based nature was shown to have appeal for collaborators and has linked theory to practice and ultimately improved practice Working in partnership with a multidisciplinary and service user group has enabled changes to be embedded into practice [ABSTRACT FROM AUTHOR]

In the context of calls for the social work profession to show leadership, this article reports a single site qualitative study in a specialist palliative care setting in England, which explored suggested similarities between social work practice and a recently developed model of ‘servant and partner’ leadership. The research showed that social workers demonstrated integrity in their dealings with both service users and colleagues, in that they were both respectful and holistic. It indicated that social workers used insights gained by engaging at depth with service users to influence decision making within the multidisciplinary team of which they were members. By drawing on sophisticated and adaptive communication skills and genuinely valuing others' contributions, they enhanced the ability of the team to achieve proportionate responses to sensitive and complex situations. The article suggests that social workers in this setting exercised leadership, in the sense of influencing the practice of others at the level of individual cases and more generally, and that this was achieved by practices that were based in established theoretical models of social work. [ABSTRACT FROM AUTHOR]

Purpose - Involving communities, citizens and service users in the design and delivery of public services has long been a key aim of government policy and arguably has it never been more important than within times of austerity. Yet, whilst acknowledging the importance of engagement, many health and social care organisations struggle with this in practice. This paper sets out some guiding principles for engagement. Design/methodology/approach - This paper draws on conversations at a series of events in 2013 which brought together researchers, those charged with delivering on government policy at the local level and active citizens, to debate and explore evidence and practice on how to involve and mobilise citizens in local decision making in a time of austerity. Learning is distilled from these events to provide a useful guide for working effectively with communities. Findings - As with any issue as complex as this, there is no magic bullet, quick fix, simple check-list or solve-all tool. Like doing anything worthwhile, working with communities is difficult, takes time and is at its core about building relationships. However, this does not mean that every attempt to design involvement processes needs to start entirely from scratch. There is a wealth and diversity of experience in designing and developing involvement mechanisms to draw upon. Originality/value - This paper will provide a helpful guide to those who are about to embark on a programme of engagement or who are presently involved in engagement activities with communities, citizens and service users. [ABSTRACT FROM AUTHOR]

Background Tools that proactively identify factors that contribute to accidents have been developed within high-risk industries. Although patients provide feedback on their experience of care in hospitals, there is no existing measure which asks patients to comment on the factors that contribute to patient safety incidents. The aim of the current study was to determine those contributory factors from the Yorkshire Contributory Factors Framework (YCFF) that patients are able to identify in a hospital setting and to use this information to develop a patient measure of safety (PMOS). Methods Thirty-three qualitative interviews with a representative sample of patients from six units in a teaching hospital in the north of England were carried out. Patients were asked either to describe their most recent/current hospital experience (unstructured) or were asked to describe their experience in relation to specific contributory factors (structured). Responses were coded using the YCFF. Face validity of the PMOS was tested with 12 patients and 12 health professionals, using a 'think aloud' approach, and appropriate revisions made. The research was supported by two patient representatives. Results Patients were able to comment on/ identify 13 of the 20 contributory factors contained within the YCFF domains. They identified contributory factors relating to communication and individual factors more frequently, and contributory factors relating to team factors, and support from central functions less frequently. In addition, they identified one theme not included in the YCFF: dignity and respect. The draft PMOS showed acceptable face validity. Discussion Patients are able to identify factors which contribute to the safety of their care. The PMOS provides a way of systematically assessing these and has the potential to help health professionals and healthcare organisations understand and identify, safety concerns from the patients' perspective, and, in doing so, make appropriate service improvements. [ABSTRACT FROM AUTHOR]

The Nursing and Midwifery Council (2008) define the standards of conduct, ethics and performance for nurses and midwives of nursing currently practicing in the UK. The Code places emphasis on the core nursing principles of kindness, respect, dignity and support for patients and relatives while under nursing care. A prospective study was conducted using a validated questionnaire to assess adherence to these core nursing principles on the basis of parental assessment in an orthopaedic paediatric inpatient unit at University Hospital Coventry and Warwickshire (UHCW). Core nursing standards were highest in respect to 'kindness' and 'respect' shown for patients (96% and 98% positive scores) and lowest for 'support' offered to their parents (89% positive scores). Lower 'support' scores possibly relate to information provision or emotional support. Improvement may be achieved via provision of additional time to identify parental concerns, which may be non-medical. The results demonstrate that parents perceive core nursing principles to be strongly adhered to on the orthopaedic paediatric unit at UHCW. [ABSTRACT FROM AUTHOR]

During a ‘Well London’ study, residents were asked about their neighbourhood and its environment. Above all other complaints, ‘dog poo’ was mentioned as a key concern. Despite low rates of infection and disease among the human population resulting from contact with canine faecal matter, the concerns of the public continue to rate it as a serious public health issue. Most public health studies, therefore, seek to identify processes of transmission and disease pathology as a method of addressing the problem. This study approaches the issue through a contextualised analysis of residents’ complaints, using anthropological theory to examine the symbolic representation of ‘dog poo’. Analysis of the interviews shows that these specific complaints were located among less easily defined or articulated experiences of social and environmental neglect, where neighbours were estranged from one another and local authorities seen as negligent. This approach has important implications for public health, as it provides not only a strong indicator of the level of dissatisfaction within some of London's more disadvantaged neighbourhoods, but also identifies a need for policies that are grounded in cross-disciplinary research into the relationship between health, ‘wellbeing’ and experiences of marginalisation among urban populations. [ABSTRACT FROM PUBLISHER]

In 1581 the archbishop of York, Edwin Sandys, resided overnight at a Doncaster inn whilst making a visitation of his archdiocese. This seemingly innocuous visit triggered a series of events that cast light on early modern ideas regarding respectability, reputation and wider views of Protestantism. The trigger for all of this occurred when Sandys was found in bed with the innkeeper's wife. He claimed this was all part of an elaborate plan to blacken his name by associating it with sexual scandal and that moreover this was an attack on the reformed Church. The observer to the events at the inn and the accused in the subsequent legal proceedings was a local gentleman, Sir Robert Stapleton, who was accused of blackmailing and slandering the archbishop. This article will not seek to condemn or exonerate either Sandys or Stapleton, but rather to examine the motives and actions of all involved. The nature and fragility of reputation in early modern England in relation to both sexual behaviour and religion will be discussed and the importance of preserving one's good name will be seen to be paramount to both men. In addition the interaction of regional and national tensions will become evident as a minor incident turned into a cause célèbre. [ABSTRACT FROM AUTHOR]

Background: This article explores in a primary care setting how clinical learning occurs across a range of professional groups and levels of learner experience, both undergraduate and postgraduate. Aim: To explore how clinical learning occurs in a primary care workplace from a socio-cultural perspective. Method: A single case study approach using interview data from 33 participants and strengthened through direct and indirect observations and documentary evidence. Results: Clinical learning occurs through engagement and opportunity. Engagement in learning appeared to be developed through four elements: recognition, respect, relevance and emotion. Opportunity includes the availability of patient encounters (made meaningful through the immediacy of hearing patient narratives de novo and the authenticity arising from the social context of illness) and the ability to learn with peers and professional colleagues. Conclusion: These findings support and develop existing literature on learning in other clinical settings. They are consistent with socio-cultural theories of learning, but develop this literature within the context of clinical education. Engagement and learning occurred in transient learners in the absence of prolonged participation, belonging or a clear trajectory of learning. The study offers evidence from multiple learner perspectives as to how the learning environment might be enhanced in all educational settings. [ABSTRACT FROM AUTHOR]

Dominant discourses regarding concerns with anti-social behaviour in England and Victoria, Australia, reveal counterposed perspectives; the former positioning anti-social behaviour as an issue of law and order and an extension of concerns with crime and victimization, and the latter emphasizing concerns with the vulnerability of the perpetrator. These opposing perspectives inevitably give rise to markedly different policies and interventions. In England, an emphasis on the needs of the victim prioritizes the prevention of particular behaviours, whilst interventions in Victoria seek to address the needs of the perpetrator that are seen to contribute to or result from anti-social behaviour. To illustrate this contrast, the paper highlights the particular effects of these contradictory discourses on young people, and in doing so suggests a need to be wary of the impact of resultant approaches on those who may be most susceptible to committing anti-social behaviour, or to having their behaviour labelled as such. [ABSTRACT FROM PUBLISHER]

Manchester's older residents together with statutory, voluntary and independent agencies are leading the development of partnership work and supporting varied initiatives to improve elders' quality of life in Manchester. They aim to tackle the city's health and other inequalities and address specific challenges of growing older in deprived urban areas. Manchester Valuing Older People last year published its ageing strategy and the city has now joined the global network of age-friendly cities. This paper describes progress and some of the current issues and opportunities. [ABSTRACT FROM AUTHOR]

This article asks whether a school improvement programme in three provinces in Canada could have any implications for schools in England. Based on experience in a failing school that 'turned around', a key feature of the programme was its emphasis on developing respectful social relationships at the same time as strengthening the teaching of curriculum subjects. We summarise the key features of the programme. Next, we discuss questions arising from projects in schools in very diverse provinces in Canada. Finally, we discuss the potential implications for the development of more positive relationships, and improvements in educational progress, in schools in England. [ABSTRACT FROM AUTHOR]

The article discusses the role of assistive technology in attaining dignity, equality and respect in older people care in Norfolk, England. It is considered that the technology is an essential vehicle for change and a catalyst to encourage staff to be creative and innovative in approaches. It is emphasized that the telecommunication care has a vital role to play in encouraging person-centered care which is based on the principles of dignity, equality and respect. It is concluded that the technology makes any one to think about new skills, new competencies and new job roles where the most important criteria will be a good imagination, ability to think creatively and potential to innovate.

The issue of what in fact constitutes politeness remains a source of considerable debate amongst researchers. There is mounting evidence that although there may be common underlying elements, politeness is conceptualised differently across cultures. A comparison of the notions of politeness in English and teinei, reigi tadashii and keii hyoogen in Japanese indicates that these respective terms encompass somewhat different conceptual ranges. Politeness in English refers to showing consideration for others and demonstrating a polished self-presentation. In Japanese, on the other hand, it encompasses showing respect (with a strong nuance of vertical respect involved) and consideration towards the position and quality of character of others, and modesty about oneself. While politeness in both English and Japanese involves showing one thinks well of others (other-oriented politeness) and showing one does not think too highly of oneself (self-oriented politeness), differences in the underlying conceptualisation of politeness give rise to different ways of expressing politeness. It is thus difficult to maintain the assumption that politeness can be defined in the same way across different cultures, although this does not necessarily preclude the identification of common elements of politeness across cultures. [ABSTRACT FROM AUTHOR]

The article analyses recent legal challenges of the prohibition of assisted suicide in England and Wales to review where we are in the debate for reform, and where we can go. The article, principally, advocates for an evidence-based new governmental inquiry. Aside the fact that this is widely-supported by various interested parties, this argument stems from the approach recently attempted by claimants in English courts in challenging the prohibition of assisted suicide, and that is, an evidence-based approach to judicial review. As this article discusses, the review of 'the available evidence' is unlikely to be done by English courts, but what this new legal strategy does is to send a strong message to Parliament and the government that there is a need to identify and examine the evidence. The findings of a fresh governmental inquiry, will allow Parliament to engage in a careful, informed review of the law and practice on assisted suicide and decide whether there is another way to protect the vulnerable, while respecting individual choice. The benefits of this inquiry go beyond England and Wales; an English (or indeed UK-wide) inquiry will inform discussions currently taking place elsewhere, and vice versa., (© The Author(s) 2021. Published by Oxford University Press.)

Purpose: The purpose of this paper is to demonstrate that the eventual legalisation of assisted dying in England and Wales should extend to persons deprived of liberty, as well., Design/methodology/approach: Using a relational view of dignity strengthens the argument that the need to protect the dignity of persons deprived of liberty requires the extension of the legalisation of assisted dying to persons deprived of liberty once generally achieved in England and Wales., Findings: Three aspects make dignity a relational concept - dignity being attributed by society, dignity working as a restraint on others and dignity requiring specific behaviours. All these elements support the claim that assisted dying should be available to persons deprived of liberty, once legalised in England and Wales., Originality/value: Both the legalisation of assisted dying for persons deprived of liberty and the concept of relational dignity have to date found little attention. With a legalisation of assisted dying being debated in England and Wales, it is pertinent to discuss its application to persons deprived of liberty, who would undoubtedly not automatically benefit from a future Assisted Dying Act., (© Emerald Publishing Limited.)

Discusses the classical theory of deference and a theory of natural aristocracy in eighteenth-century in England. Interpretation of the theory of deference; Role of deference in the oligarchical society; Deference in the relationship among patron and clients; Examination of the Whig parliamentary reform to explain deference at the expense of influence.

The article discusses the results of the study concerning the relationship of skill and adjustment of West Indian African American workers in England. Individual reports of the volunteers from the Welfare Officer of the Ministry of Labor for 3 to 4 years are evaluated. It reveals that the adjustment of the workers is associated with skill and status in the industry, thus, older workers are likely to make better adjustment and earn the respect of his fellow than younger ones. Desire for social recognition, security, satisfaction and respect are important factors that determine their adjustment in which a less-skilled man sense inferiority because of his poorer skill.

The article offers health-related news briefs in Great Britain as of May 2019. Without radical action, nurse and general practitioner (GP) shortages will double and nearly treble, respectively in five years time. Northern Health Trust office staff are now obliged to vacuum, dust and keep their workplaces clean. Public Health Wales has two new directorates and has placed research at the forefront of health strategy.

The retention and display of the remains of Charles Byrne, an Irishman with acromegaly, by the Hunterian Museum of the Royal College of Surgeons has been contentious for some years, and the moral case for his release for burial has been repeatedly made. This article makes the legal case through five arguments. The first three concern common law rights and duties; Byrne's right to burial, the duty of the State to ensure his burial where others do not, and the right of his friends to assume that duty. The fourth concerns Byrne's common law right to direct his disposal, and, related to this, not to be retained and displayed. The fifth, which underpins the rest, is that Byrne is not, and has never been property, and it is in fact intuitively and legally arguable that he, like other corpses, remains a person. The article finally outlines three options available to those wishing to ensure Byrne finally has the burial at sea that he sought to ensure in 1783., (© The Author(s) 2021. Published by Oxford University Press.)

The World Health Organisation (WHO) Global Age-Friendly Cities (AFC) Guide classifies key characteristics of an AFC according to eight domains. Whilst much age-friendly practice and research have focused on domains of the physical environment, those related to the social environment have received less attention. Using a Photovoice methodology within a Community-Based Participatory Research approach, our study draws on photographs, interviews and focus groups among 26 older Liverpool residents (60+ years) to explore how the city promotes respect and social inclusion (a core WHO AFC domain). Being involved in this photovoice study allowed older adults across four contrasting neighbourhoods to communicate their perspectives directly to Liverpool's policymakers, service providers and third sector organisations. This paper provides novel insights into how: (i) respect and social inclusion are shaped by aspects of both physical and social environment, and (ii) the accessibility, affordability and sociability of physical spaces and wider social processes (e.g., neighbourhood fragmentation) contributed to or hindered participants' health, wellbeing, intergenerational relationships and feelings of inclusion and connection. Our findings suggest that respect and social inclusion are relevant across all eight domains of the WHO AFC Guide. It is core to an AFC and should be reflected in both city-based policies and evaluations.

In 2017 and 2018, the English courts were asked to decide whether continued life-sustaining treatment was in the best interests of three infants: Charlie Gard, Alfie Evans and Isaiah Haastrup. Each infant had sustained catastrophic, irrecoverable brain damage. Dignity played an important role in the best interests assessments reached by the Family division of the High Court in each case. Multiple conceptions of dignity circulate, with potentially conflicting implications for infants such as Charlie, Alfie and Isaiah. The judgements do not explicate the conceptions of dignity upon which they rely. This article reconstructs the conceptions of dignity invoked in these judgements, finding that a broadly Kantian, agential conception dominates, under which human dignity requires the prospect of agency. This conception is situated within the broader body of thought on dignity, and the potentially adverse implications of applying the reconstructed conception in best interests assessments for infants with severely restricted consciousness are discussed., (© 2020 John Wiley & Sons Ltd.)

In contemporary neo-liberal societies, forms of responsible individualism and approaches to everyday foodways that reify healthy home-cooked food prepared from scratch, eaten together around a table are imbued with high cultural capital. What are the implications of this for criminalised individuals incarcerated in a prison system in England and Wales, that works with extremely low budgets, makes heavy use of pre-packaged convenience food and serves food to prisoners in their cells? Indeed, findings from Her Majesty's Inspectorate for Prison Report on food (2016:13), claims that 'the quantity and quality of the food provided [in prison] is insufficient, and the conditions in which it is served and eaten undermine respect for prisoners' dignity', which they argue has implications in terms of increasing the marginalisation and alienation of the prison population from the 'free community'. In this paper I draw on data from 39 in depth interviews at a resettlement scheme in England, conducted with 18 prisoners released on temporary licence from the resettlement wing of a closed and segregated Category C male prison. The enhanced status of prisoners and the benefits of being on the resettlement wing affords opportunities in relation to everyday foodways not available to regular prisoners. Their narrative accounts of prison foodways exemplify some of the HMIP findings and demonstrate how an enhanced prisoner status can counter notions of food as threat and poison, through systems of bartering, solidarity and recompense., (Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.)