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The dynamic support database (DSD) clinical support tool structures the risk of admission rating for individuals with intellectual disabilities. This study aims to investigate inter-rater reliability between multi-disciplinary health care professionals within the North West of England.

A small-scale quantitative study investigated reliability between raters on the DSD clinical support tool. A data set of 60 rating tools for 30 individuals was used. Descriptive statistics and Kappa coefficient explored agreement.

The DSD clinical support tool was found to have strong inter-rater reliability between individual items and the differences between individual scores were spread suggesting variance found could not be attributed to specific questions. Strong inter-rater reliability was found in the overall ratings.

Results suggest the DSD clinical support tool provides stratification for risk of admission ratings independent of who completes it. Future studies could investigate inter-rater reliability between organisations, i.e. health and social care professionals, and use a larger data sample to ensure generalisability. Replication of the study within child and adolescent services using the children’s DSD clinical support tool is also recommended.

The DSD clinical support tool has been implemented within the child and adult intellectual disability services across the North West. As more teams across England consider its implementation, the study provides reassurance that coding agreement is high, allowing for stratification for risk of admission independent of the rater.

The purpose of this paper is to evaluate whether two regional intellectual disability (ID) assessment and treatment (A&T) units in England were meeting the recommended length of stay stipulated by the Learning Disability Professional Senate, in line with the Transforming Care (TC) agenda. A secondary purpose of the study was to evaluate the reasons for admissions and delayed discharges in order to inform how to reduce these.

A retrospective evaluation of 85 admissions across two A&T units was conducted over a three-year period (2013–2016) following publication of the TC agenda.

There were 85 admissions compared to 71 discharges. Of the 85 admissions, 11 were readmissions. The most common factors thought necessary to prevent admission were early support for care providers or alternative service provision. There were barriers to discharge in over half of admissions; the main reason was a lack of suitable service provision.

The study suggests that providing specific support or training to care providers could prevent (re)admission and ensure shorter admissions. Further research to establish reasons for the reported lack of suitable providers would be beneficial.

This study provides current admission and discharge rates for regional A&T units, as recommended by the TC national guidance. It also provides potential reasons underlying preventable admissions and delayed discharges and therefore indicates what might be necessary to prevent admissions and reduce the length of inpatient stays for people with ID and/or autism.

This paper aims to examine the prevalence and reasons for delayed discharge from two regional assessment and treatment units (ATUs) for people with learning disabilities, in line with the transforming care agenda.

This is a retrospective evaluation of 44 admissions and discharges from two ATUs from February 2019 to March 2022.

Of 44 admissions who were discharged during the included period, 20 experienced delays in their discharge. Delayed discharges occurred despite the two ATUs meeting standards for length of assessment and treatment as specified by the Learning Disability Professional Senate. The most prevalent reasons for discharge delays were identification of a new placement, recruitment of care staff and building work.

This paper offers an in-depth evaluation of recent delayed discharges from two regional ATUs, highlighting the most common reasons for delays and offering suggestion for reducing delays in future.

The purpose of this clinical audit was to review the adherence to the 2017 care and treatment review policy across two NHS assessment and treatment units. Care and treatment reviews should be offered to people with an intellectual disability and/or autism who are at risk of admission into a mental health hospital.

Admission and discharge data was collected across two assessment and treatment units between January 2019 and December 2022. Adherence to the care and treatment review policy was also reviewed as was length of inpatient stay. A retrospective evaluation was conducted. Triangulation of data was collected via the trusts’ electronic patient record system and NHS analytics team. Descriptive statistics, Mann–Whitney U test and a one-way ANOVA with post hoc tests were used in the analysis.

An increase in behaviours of challenge and deterioration of mental health were the main reasons for admission. Forty-nine percent (30) of those admitted to the assessment and treatment units accessed a care and treatment review. Care and treatment reviews were more frequently provided for individuals experiencing longer inpatient stays.

There is limited evidence relating to outcomes and impact of care and treatment reviews. Further research is required to explore effectiveness of care and treatment reviews to understand benefits and appropriately prioritise resource.

The purpose of this paper is to explore the clinical perspective of the practicality, utility and face-validity of the dynamic support database (DSD) Red, Amber, Green (RAG) rating support tool within adult learning disabilities services in a North West NHS Foundation Trust. The aim of the current project is to evaluate the practicality, utility and face-validity of the DSD RAG rating support tool, as reported by clinicians who have been employing it.

A mixed-methods design was utilised by asking clinicians to complete a questionnaire in relation to the DSD Support Tool. Questionnaires were distributed across three community learning disability teams within the North West. A total of 50 clinicians completed the questionnaire which included rated responses for quantitative analysis and free-text comments for qualitative analysis.

Positive ratings given by clinicians suggested good practicality, utility and face-validity in relation to the tool. Analysis of the free-text comments suggested that the tool supported clinical judgement in a standardised way and helped discussions with commissioners. Feedback also provided insights into how the DSD support tool could be improved.

Further investigation would be required to yield higher numbers of participation across NHS Trusts to add reliability to the present findings.

The DSD support tool has been used within the NHS Foundation Trust for the last 12 months however the practicality, utility and face-validity of the tool had not been explored from the clinician perspective.

This study aims to understand the experiences of professional paid carers providing community support to people with intellectual disability “at risk of admission”. This study explores factors that were helpful or lacking in terms of the support the carers received from NHS health services during this time.

This study conducted semi-structured interview with eight participants. Thematic analysis was used to analyse the data.

Three main themes and ten subthemes were identified. The first main theme was “support systems” that were available or lacking for the client and their carers. The second main theme was “training and supervision” available to the carers and their team when the individual they supported needed additional support. The third theme was “change” clients encountered which included changes in the environment as well as changes because of COVID-19 pandemic.

To the best of the authors’ knowledge, this is the first study on experiences of carers during specifically high stress periods, such as when the clients they are supporting are at risk of hospital admission.

This paper aims to understand the lived experience of people with intellectual disability of their anxiety and of being co-design partners in developing a multi-component approach to the management of anxiety.

The development of an anxiety manual and programme was part of a service development which allowed existing and established psychological therapies to be adapted for people with intellectual disability. A qualitative approach was used to better understand the views of people who experienced anxiety on a daily basis. The feedback generated was used to make modifications to the manuals and the anxiety management programme.

The study has demonstrated the value of involving people with intellectual disability in the co-production of an anxiety management programme. Additional findings identified the real-life challenges and experiences of the impact anxiety has on people’s lives.

To our knowledge, this is the first study to involve people with intellectual disability in developing an anxiety management programme as co-production partners. This paper underlines the value of understanding and involving people as co-production partners in developing clinical interventions.

Proposes to treat social law contracts by covering the two most important aspects of the contract of employment, and also the collective agreement. Covers the contract of employment in full with all the integral laws explained as required, including its characteristics, written particulars, sources or regulations, with regard to employers, are also covered. Lengthy coverage of the collective agreement is also included, showing legal as well as moral (!) requirements, also included are cases in law that are covered in depth.

Recent advancements in the field of organizational psychology have transformed the employees’ perceptions related to the reactions of the employment relationship. The main aim of the study is to explore the consequences of psychological contracts among the nursing staff and how to provide better patient care and quality service in the health-care system as nurses play a pivotal role in the context of Pakistan. Significantly, this study attempts to bridge the research gap by exploring consequences of psychological contracts. Drawing on the social exchange theory, this study examined the psychological contracts of nurses and their reactions to the perceived violation.

This research adopted a qualitative method and was based on an exploratory approach. Data were collected through in-depth semi-structured interviews from 21 nurses working in public, private and charity hospitals in Karachi, Pakistan. The thematic content analysis is employed for the analysis of data by using NVivo software.

The study identified the relational and transactional elements related to the psychological contract of nurses who predominantly consisted of supervisor support, autonomy, tangible/intangible rewards and trust. The intrinsic motivation which relates to their devotion to work was found as an additional element to balance their psychological contract. This research also establishes that the psychological contract of nurses is being violated in their work settings.

By highlighting the importance of psychological contract breach, the findings demonstrate that health-care institutions should take measures to cope with psychological contract breach issues at the workplace.

This study contributes to the body of knowledge by exploring psychological contract breach. Substantially, there are rare studies conducted on psychological contract breach among nurses in developing country context (Pakistan). However, this study adds to the previous studies related to the psychological contract of nurses in the context of Pakistan by using social exchange theories. Finally, this study enables the management of healthcare to balance the psychological contract issues effectively.