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Service Development (service + development)
Kinds of Service Development Selected AbstractsA Resource-Process Framework of New Service DevelopmentPRODUCTION AND OPERATIONS MANAGEMENT, Issue 2 2007Craig M. Froehle Motivated by the increasing attention given to the operational importance of developing new services, this paper offers a theoretical framework that integrates both process- and resource-oriented perspectives of new service development (NSD) by defining and organizing 45 practice constructs for NSD-related practices and activities that occur in contemporary service firms. We employ a rigorous procedure whereby both quantitative and qualitative data were gathered through multiple rounds of interviews and card-sorting exercises with senior service managers. This iterative refinement process helps ensure that the construct domains and definitions are consistent and that they are applicable across multiple service sectors. A primary contribution of this research is to provide precise operational definitions of theoretically important NSD practice constructs. Importantly, this study expands on the NSD literature by including both resource- and process-centric perspectives within a single framework. A second contribution is to illustrate a general methodology for developing clear, concise, and consistent construct definitions that may be generally useful for production and operations management scholars interested in new construct development for emerging areas. Empirical results suggest that the resource-process framework can help guide and organize future research on, and provide insight into, a more comprehensive view of new service development. [source] Network Parenting in International Service DevelopmentBRITISH JOURNAL OF MANAGEMENT, Issue 1 2004Michael Lewis This paper explores theoretical and practical aspects (i.e. resources allocated, activities undertaken, actors/decisions involved) of corporate ,parenting' in the development of international service networks. A review of the relevant corporate strategy, supply-chain, networks and services management literature underpins a preliminary content (capability; market orientation) and process (top-down; bottom-up) typology of network parenting. This provides the structure for discussion of two telecommunications-sector case studies. Analysis of the data acknowledges the influence of generic network mechanisms (e.g. weak and strong social ties) but the parenting typology also highlights other mechanisms, the effectiveness of which appears contingent on specific parenting roles. The paper details these roles (labelled: governing; training; curating; facilitating) and makes some preliminary comments on the role trajectories (e.g. governing , training) observed. The paper concludes with a discussion of possible directions for future work. [source] The challenge of uncorrected refractive error: driving the agenda of the Durban Declaration on refractive error and service developmentCLINICAL AND EXPERIMENTAL OPTOMETRY, Issue 3 2010Kovin S Naidoo BSc BOptom MPH OD The purpose of this article is to highlight the challenge of uncorrected refractive error globally, as well as to discuss recent advocacy successes and innovative programs designed to address the need for broader refractive error service development, particularly in developing countries. The World Health Organization's VISION 2020: The Right to Sight program first posed the challenge to national governments to give priority to strategies and resources targeted towards avoidable causes of blindness and visual impairment, so that these unnecessary forms of blindness or visual impairment can be eliminated globally by the year 2020. The blindness prevention community is challenged to increase in scale its initiatives, which support the attainment of VISION 2020: The Right to Sight goals primarily and the United Nation's Millennium Development Goals indirectly. The Durban Declaration on Refractive Error and Service Development was the outcome of a meeting of eye-care professionals, researchers, governments, civil society and industry in March 2007 and still stands as a guiding document to the blindness prevention community for the elimination of avoidable blindness due to uncorrected refractive error. [source] The voice of detainees in a high security setting on services for people with personality disorderCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 4 2002Sue Ryan Background British government Home and Health Departments have been consulting widely about service development for people with ,dangerous severe personality disorder' (DSPD). There has, however, been no consultation with service users, nor is there any user view literature in this area. Methods All people detained in one high security hospital under the legal classification of psychopathic disorder were eligible but those on the admission or intensive care wards were not approached. Views of service were elicited using a purpose designed semi-structured interview. The principal researcher was independent of all clinical teams. Confidentiality about patients' views was assured. Aims To establish views on services from one subgroup of people nominated by the government department as having ,DSPD'. Results Sixty-one of 89 agreed to interview. With security a given, about half expressed a preference for a high security hospital setting, 20% prison and 25% elsewhere, generally medium secure hospitals. Participants most valued caring, understanding and ,experience' among staff. An ideal service was considered to be one within small, domestic living units, providing group and individual therapies. Some found living with people with mental illness difficult, but some specified not wanting segregated units. Views were affected by gender and comorbidity. Conclusions As the sample were all in hospital, the emphasis on treatment may reflect a placement bias. All but five participants, however, had had experience of both health and criminal justice services, so were well placed to talk with authority about preferences. Copyright © 2002 Whurr Publishers Ltd. [source] Community forensic psychiatry: restoring some sanity to forensic psychiatric rehabilitationACTA PSYCHIATRICA SCANDINAVICA, Issue 2002J. Skipworth Objective:, To review clinical and legal paradigms of community forensic mental health care, with specific focus on New Zealand, and to develop a clinically based set of guiding principles for service development in this area. Method:, The general principles of rehabilitating mentally disordered offenders, and assertive community care programmes were reviewed and applied to the law and policy in a New Zealand forensic mental health setting. Results: There is a need to develop comprehensive community treatment programmes for mentally disordered offenders. The limited available research supports assertive community treatment models, with specialist forensic input. Ten clinically based principles of care provision important to forensic mental health assertive community treatment were developed. Conclusion:, Deinstitutionalization in forensic psychiatry lags behind the rest of psychiatry, but can only occur with well-supported systems in place to assess and manage risk in the community setting. The development of community-based forensic rehabilitation services in conjunction with general mental health is indicated. [source] The promise of early interventionEARLY INTERVENTION IN PSYCHIATRY, Issue 4 2007Jean Addington Abstract The focus of this review is the research and clinical work in early psychosis and early intervention which over the past 10,15 years has had a tremendous impact on the field of schizophrenia. Unparalleled progress has been made in programme and service development with a wide range of reported research results, outcome studies, treatment approaches and new initiatives. Traditional areas are being explored in the first episode that can add to our knowledge of schizophrenia. New areas that have a specific relevance for early intervention such as the duration of untreated psychosis and pathways to care are being widely studied. Despite the criticism of the lack of randomized controlled trials, there is a wealth of positive outcome from both effectiveness studies and limited controlled trials. However, there are still many unanswered issues which are in developing stages or which require further investigation. [source] The Mexican migration to the United States and substance use in northern MexicoADDICTION, Issue 4 2009Guilherme Borges ABSTRACT Aims To examine the impact of migration to the United States on substance use and substance use disorders in three urban areas of northern Mexico. Design Cross-sectional survey of immigration-related experiences and life-time and past-year alcohol and drug use, in a representative sample of respondents aged 12,65 years. Setting Interviews were conducted in the cities of Tijuana, Ciudad Juarez and Monterrey during 2005. Respondents were classified into three groups: (i) ,return migrants', (ii) ,relatives of migrants' and (iii) ,others in the general population'. Findings A total of 1630 completed interviews were obtained for a response rate of 70.5%. ,Return migrants' were more likely to have used alcohol, marijuana or cocaine at least once in their life-time and in the last 12 months, more likely to develop a substance use disorder and more likely to have a 12-month substance use disorder compared with ,others in the general population'. Among ,return migrants', longer length of time in the United States and type of work performed as an immigrant were related to higher prevalence of substance use. Among ,relatives of migrants', migration experiences were not associated with increased prevalence of substance use compared with ,others in the general population'. Conclusion This study found a link between migration to the United States and the transformation of substance use norms and pathology in Mexico. Future research on pre-migration involvement in substance use and data on the timing of events among return migrants is needed. Public health measures are likely to require cross-border coordination of research and service development. [source] Young adults' (16,25 years) suggestions for providing developmentally appropriate diabetes services: a qualitative studyHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 5 2005Gail Dovey-Pearce BA (Hons) D Clin Psychol Abstract Managing the multiple demands of a chronic condition whilst negotiating the developmental tasks of adolescence and young adulthood is a process that is neither well described nor understood, particularly in relation to providing developmentally appropriate health care for young people. The importance of this issue is starting to be reflected within the literature, and although research into models of service delivery is emerging, a lack of user involvement in service development is apparent. This qualitative, user involvement study aimed to describe and understand the considered opinions of 19 young adults with diabetes who were receiving secondary care services about the provision of diabetes services for young people. The findings, gathered using semistructured interview and focus group methods, have potentially wide-reaching implications across primary and secondary health care, and across agencies providing services to children and young people, in terms of facilitating a person's transition through adolescence and into young adult life. Participants suggested key issues to address when developing services for young people, including staff consistency, civility, clinic structures which help a person navigate the health care system, provision of age-specific information, and support in relation to a range of health, emotional, social and developmental needs. Health care professionals can help young people to meet the expectations upon them as autonomous service users by modelling appropriate relationships, helping them to acquire skills and knowledge, and overcome barriers to them becoming active participants in their health care and achieving social participation in a fuller sense. It is somewhat arbitrary to delineate between adolescence and young adulthood in terms of age alone, but in this paper, ,adolescence' refers to the period between 11 and 15 years of age, and ,young adulthood' between 16 and 25 years of age. The phrase ,young people' will also be used to refer to people between 11 and 25 years. [source] Involving mental health service users in quality assuranceHEALTH EXPECTATIONS, Issue 2 2006Jenny Weinstein BPhil BA(Hons) Msc Abstract Objective, This study compares the process and outcomes of two approaches to engaging mental health (MH) service users in the quality assurance (QA) process. Background, QA plays a significant role in health and care services, including those delivered in the voluntary sector. The importance of actively, rather than passively, involving service users in evaluation and service development has been increasingly recognized during the last decade. Design, This retrospective small-scale study uses document analysis to compare two QA reviews of a MH Day Centre, one that took place in 1998 as a traditional inspection-type event and one that took place in 2000 as a collaborative process with a user-led QA agenda. Setting and participants, The project was undertaken with staff, volunteers and service users in a voluntary sector MH Day Centre. Intervention, The study compares the management, style, evaluation tools and service user responses for the two reviews; it considers staff perspectives and discusses the implications of a collaborative, user-led QA process for service development. Results, The first traditional top,down inspection-type QA event had less ownership from service users and staff and served the main purpose of demonstrating that services met organizational standards. The second review, undertaken collaboratively with a user-led agenda focused on different priorities, evolving a new approach to seeking users' views and achieving a higher response rate. Conclusions, Because both users and staff had participated in most aspects of the second review they were more willing to work together and action plan to improve the service. It is suggested that the process contributed to an evolving ethos of more effective quality improvement and user involvement within the organization. [source] Needs assessment in dementiaINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 4 2005A. M. Meaney Abstract Background Resource allocation and service development traditionally focuses on diagnostic categories and consequent perceived need. Identification of the actual level of need in the elderly with dementia, and the degree to which it is unmet is necessary to plan services both individually and as a group. The aim of this study was to characterise the needs of a sample of community dwelling elderly patients with dementia who were referred to an old age psychiatry service in Ireland between July 2002 and July 2003. Methodology Eighty-two consecutively referred community dwelling patients with ICD-10 diagnosis of dementia were assessed on The Care Needs Assessment Pack for Dementia (CareNap-D). Data on needs across seven domains (health and mobility, self-care and toileting, social interaction, thinking and memory, behaviour and mental state, housecare, community living) is presented (Reynolds T et al., 1998). Results Subjects had a mean of 33 (range: 13,56) identified needs. Approximately 1/3 of these were unmet with a mean of 13 (range: 0,37) and a mean of 20 (range: 4,39) were met. High levels of unmet need was identified in the domains of behaviour and mental state (84% of those with agitation) and of social interaction (79% of those with ,partaking in activities' need). The specific item of repetitive questioning occurred in 68 individuals and was unmet in 88% of these cases. Increasing age, lower MMSE score, and living alone were associated with greater total levels of unmet need. Conclusion This data underlines the degree of unmet need in the community dwelling elderly with dementia and the importance of developing a spectrum of services on the basis of the actual needs identified. Copyright © 2005 John Wiley & Sons, Ltd. [source] A national survey of pharmacist transcribing of discharge prescriptionsINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 2 2003Mrs Rachel J. Hobson teacher-practitioner pharmacist Objective To provide quantitative data on pharmacist discharge prescription transcription service (PDPTS) provision in UK hospitals. Method Postal questionnaire survey of clinical pharmacy managers. Setting Selection criteria included one hospital in each acute trust in the UK. Key findings The response rate was 66% (135/206). In mid-2001, a PDPTS was provided by 49 hospital pharmacy departments (36%). PDPTS was the most common prescribing activity undertaken by pharmacists, followed by a prescription amendment policy (29%), prescribing in pre-admission clinics (18%) and re-writing drug charts (15%). 59 departments (44%) did not undertake any prescribing activity. Of the 86 non-transcribing hospitals, 69% undertook no prescribing activity (range = 0 to 3 prescribing activities). Transcribing hospitals offered a wider range of prescribing activities (range = 1 to 8 prescribing activities). A weak relationship was found between the number of pharmacists employed per hospital and the number of prescribing activities undertaken (correlation coefficient = 0.208, P = 0.018). The most frequently used PDPTS model (78%) involved pharmacists transcribing the discharge prescriptions for their own wards. The number of pharmacists transcribing discharge prescriptions per hospital ranged from 1 to 89 (mean = 8, mode = 2, median = 5, 25% percentile = 2, 75% percentile = 10). The majority of pharmacists (52%) reported writing less than five prescriptions per day; 35% were writing 5,10 prescriptions per day. The most common training requirement for pharmacists to start transcribing was an in-house training programme (55%). The majority of departments (80%) did not re-assess the ability of their pharmacists to transcribe. Conclusion Hospital pharmacy departments in the UK have started to take on prescribing roles, especially transcribing discharge prescriptions. However, it would appear that the majority of the PDPTS schemes are not being run extensively throughout the hospitals. It is of concern that the principles of clinical governance are not being met in terms of training and re-assessment of the pharmacists who are undertaking this service. The reasons why the service has developed in some hospitals and not others are not known. In order to extend this service, funding, resources and skill-mix maximisation need to be considered. This will enable patients to gain the maximum benefit from this service development. [source] A concept analysis of renal supportive care: the changing world of nephrologyJOURNAL OF ADVANCED NURSING, Issue 6 2007Helen Noble Abstract Title.,A concept analysis of renal supportive care: the changing world of nephrology Aim., This paper is a report of a concept analysis of renal supportive care. Background., Approximately 1·5 million people worldwide are kept alive by renal dialysis. As services are required to support patients who decide not to start or to withdraw from dialysis, the term renal supportive care is emerging. Being similar to the terms palliative care, end-of-life care, terminal care and conservative management, there is a need for conceptual clarity. Method., Rodgers' evolutionary method was used as the organizing framework for this concept analysis. Data were collected from a review of CINAHL, Medline, PsycINFO, British Nursing Index, International Bibliography of the Social Sciences and ASSIA (1806,2006) using, ,renal' and ,supportive care' as keywords. All articles with an abstract were considered. The World Wide Web was also searched in English utilizing the phrase ,renal supportive care'. Results., Five attributes of renal supportive care were identified: available from diagnosis to death with an emphasis on honesty regarding prognosis and impact of disease; interdisciplinary approach to care; restorative care; family and carer support and effective, lucid communication to ensure informed choice and clear lines of decision-making. Conclusion., Renal supportive care is a dynamic and emerging concept relevant, but not limited to, the end phase of life. It suggests a central philosophy underpinning renal service development that allows patients, carers and the multidisciplinary team time to work together to realize complex goals. It has relevance for the renal community and is likely to be integrated increasingly into everyday nephrology practice. [source] Primary mental health workers in child and adolescent mental health servicesJOURNAL OF ADVANCED NURSING, Issue 1 2004Wendy Macdonald BSc PhD Background., The interface between primary care and specialist services is increasingly seen as crucial in the effective management of child and adolescent mental health (CAMH) problems. In the United Kingdom, a new role of primary mental health worker (PMHW), has been established in order to achieve effective collaboration across the interface through the provision of clinical care in primary care settings and by improving the skills and confidence of primary care staff. However, little is known about the development of this innovative role in service contexts. Issues raised during the early stages of implementation may have important implications for the preparation and development of professionals who undertake the role. Aims., The aim of this paper is to report on a study that examined key issues in implementation of the PMHW role in six health authorities in England. Methods., Case study evaluation was conducted, using thematic analysis of 75 qualitative interviews with key stakeholders from different professions (e.g. PMHWs, general practitioners, health visitors, psychiatrists and service managers) and representing different sectors (primary care, specialist services and community child health services). Findings., The study identified three models of organization (outreach, primary care-based and teams). Each was associated with different advantages and disadvantages in its effects on referral rates to specialist services and the development of effective working relationships with primary care providers. Problems associated with accommodation and effective integration of PMHWs with specialist services, and tensions caused by the two different roles that PMHWs could undertake (direct clinical care vs. consultation-liaison) were common across all sites. Conclusions., The PMHW role is an important development that may go some way towards realizing the potential of primary care services in CAMH. The implementation of new roles and models of working in primary care is complex, but may be facilitated by effective planning with primary care providers, clear goals for staff, and a long-term perspective on service development. [source] Cytotoxic chemotherapy for incurable colorectal cancer: living with a PICC-lineJOURNAL OF CLINICAL NURSING, Issue 18 2008Doreen Molloy Aims., (i) To determine which aspects of living with a peripherally inserted central catheter (PICC) line cause Modified de Gramont (MdG) patients most difficulty. (ii) To explore MdG patients' views of the PICC-line experience. (iii) To determine if patients view PICC-lines as a benefit or a burden when receiving ambulatory MdG chemotherapy. Design., A two-stage, descriptive study. Methods., Phase 1 comprised semi-structured interviews. Phase 2 surveyed the MdG population. Phase 1 interview data informed the Phase 2 questionnaire. The setting was a West of Scotland Cancer Care Centre and the sample was: Phase 1, a convenience sample of 10 MdG patients; Phase 2, 62 consecutive patients. Results., A response rate of 93·9% for Phase 2. The majority of PICC-line patients held favourable views towards having a PICC-line and adapted well with minimal disruption to daily life. Concerns were evident regarding coping at home with a PICC-line, chemotherapy spillage, dealing with complex information and the responsibility of patients/carers regarding PICC-line management. Patients preferred ambulatory chemotherapy to in-patient treatment. Conclusions., PICC-lines should be considered for more chemotherapy patients but service development is necessary to ensure individual needs are addressed. Relevance to clinical practice., Contributes to the PICC-line literature by providing a national patient perspective on a range of daily living activities (DLAs). PICC-line patients prefer out-patient ambulatory chemotherapy rather than in-patient treatment. The longer a patient has a PICC-line, the more able they are to manage activities such as dressing. Concerns remain over chemotherapy spillage, partner/carer responsibility for PICC-line maintenance and the proper balance between required information and what the patient wants to know. [source] Concordance with community mental health appointments: service users' reasons for discontinuationJOURNAL OF CLINICAL NURSING, Issue 7 2004Tony Hostick MSc Background., Quality issues are being given renewed emphasis through clinical governance and a drive to ensure service users' views underpin health service development. Aims., To establish service users' reasons for discontinuation of community based mental health appointments in one National Health Service Trust. Method., A two-phase survey of all non-completers over a year. Phase one using a structured postal questionnaire. Phase two using structured interviews with respondents to phase one by post, telephone and face to face. Results., A total of 243 discharges because of non-completion were identified by local services over the 12 months of the study and followed up by initial questionnaire. This represents 8.19% of all discharges (2967) within the same period. Forty-four users were engaged and followed up within phase two of the survey. Data were subject to both quantitative and qualitative analysis. Conclusions., Analysis of responses suggests that the main reasons for non-completion are because of dissatisfaction although the reasons are varied and the interplay between variables is complex. Whilst this user group are not apparently suffering from ,severe mental illness', there is clear, expressed need for a service. Relevance to clinical practice., Whoever provides such a service should be responsive to expressed need and a non-medical approach seems to be favoured. If these needs are appropriately met then users are more likely to be engaged and satisfaction is likely to be improved. Although this in itself does not necessarily mean improved clinical outcomes, users are more likely to stay in touch until an agreed discharge. Practical problems of applied health service research are discussed and recommendations are made for a review of referral systems, service delivery and organization with suggestions for further research. [source] Acute Pain Teams in England: current provision and their role in postoperative pain managementJOURNAL OF CLINICAL NURSING, Issue 3 2003Ann Mcdonnell BSc Summary ,,This survey describes the current provision of multidisciplinary Acute Pain Teams (APTs) in acute English hospitals performing adult in-patient surgery (excluding maternity). Associations between the presence of an APT and a number of organizational and clinical initiatives for the management of postoperative pain are also explored. ,,Postal questionnaires were sent to the Clinical Director of Anaesthetics or head of the APT at every acute English hospital providing separate anaesthetic services. ,,After written and telephone reminders, the response rate was 86% (n = 226). ,,Eighty-four per cent (n = 190) of respondents had an APT in their hospital. The presence of an APT was associated (P,0.05) with higher estimates of patient controlled analgesia and epidural use, regular in-service training for nurses and junior doctors, written guidelines/protocols for management of postoperative pain, routine use of postoperative pain measurement systems and audit/research in relation to postoperative pain issues. ,,Acute Pain Teams, in which nurses play a major role, have a pivotal influence not only in relation to postoperative analgesia but also in wider service development. Since 1995, the number of hospitals offering in-patient surgery that are covered by an APT has risen. However, despite repeated endorsements from professional bodies, some acute hospitals still have no APT and recent evidence indicates that some APTs face financial problems and provide a ,token' service only. Recent policy recommendations may have little impact on the current situation. [source] Educational and health service needs of Australian general practitioners in managing hepatitis CJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 4 2006Leena Gupta Abstract Background:, There has been interest in recent years in the role of primary care practitioners in managing hepatitis C, but there has been minimal research to identify educational and health service needs. A national survey of Australian general practitioners (GPs) was therefore conducted to assess their needs and identify areas for service development. Methods:, A self-administered questionnaire was developed that included questions to assess caseload, confidence in patient management, educational needs and approaches to management and prevention. Questionnaires were sent to a random sample of Australian GPs. Returned questionnaires were coded, frequencies tabulated and significant associations identified. Results:, A 70% response rate was achieved from 658 eligible GPs. A total of 76% of respondents had managed one patient in the previous year with hepatitis C. While 69% reported feeling more confident about their management of hepatitis C than 5 years previously, 55% identified a high level of need for hospital-based clinics. Financial benefits for case conferences and chronic case management were not considered useful by most GPs. Topics identified for further skills development included therapeutics and diagnostic testing. Only 39% were highly likely to discuss psychosocial issues as part of initial patient management and 37% reported finding it difficult to play a central role in the medical and psychosocial care of patients with hepatitis C. Conclusion:, These results have significant implications for policy and service development, as well as identifying areas where GPs need support. The findings invite further discussion between health authorities about the source and magnitude of funding for hospital-based services and further consideration of how to provide services to address patients' psychosocial needs. [source] Non,housestaff medicine services in academic centers: Models and challengesJOURNAL OF HOSPITAL MEDICINE, Issue 3 2008Niraj L. Sehgal MD Abstract Non,housestaff medicine services are growing rapidly in academic medical centers (AMCs), partly driven by efforts to comply with resident duty hour restrictions. Hospitalists have emerged as a solution to providing these services given their commitment to delivering efficient and high-quality care and the field's rapid growth. However, limited evidence is available on designing these services, including the similarities and differences of existing ones. We describe non,housestaff medicine services at 5 AMCs in order to share our experiences and outline important considerations in service development. We discuss common challenges in building and sustaining these models along with local institutional factors that affect decision making. Keys to success include ensuring an equitable system for scheduling and staffing, fostering opportunities for scholarly activities and academic promotion (defining the "academic hospitalist"), and providing compensation that supports recruitment and retention of hospitalists. With further work hour restrictions expected in the future and increased requests for surgical comanagement, the relationship between AMCs and hospitalists will continue to evolve. To succeed in developing hospitalist faculty who follow long careers in hospital medicine, academic leadership must carefully plan for and evaluate the methods of providing these clinical services while expanding on our academic mission. Journal of Hospital Medicine 2008;3:247,255. © 2008 Society of Hospital Medicine. [source] Adults with intellectual disabilities: prevalence, incidence and remission of aggressive behaviour and related factorsJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 3 2009S.-A. Cooper Abstract Introduction Aggressive behaviours can be disabling for adults with intellectual disabilities (ID), with negative consequences for the adult, their family and paid carers. It is surprising how little research has been conducted into the epidemiology of these needs, given the impact they can have. This study investigates point prevalence, 2-year incidence and 2-year remission rates for aggressive behaviour (physically aggressive, destructive and verbally aggressive), and it investigates which factors are independently associated with aggressive behaviour. Methods All adults with ID , within a geographically defined area of Scotland, UK , were recruited to a longitudinal cohort. At baseline, assessments were undertaken of demography, lifestyle, supports, development, problem behaviours, disabilities and physical and mental health. These were repeated for a 2-year period. Results At baseline, the participation rate was 1023 (65.5%). After 2 years, the cohort retention was 651 adults. The point prevalence of Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation (DC-LD) aggressive behaviour was 9.8% (95% confidence interval = 8.0,11.8%), 2-year incidence was 1.8%, and 2-year remission rate from all types of aggressive behaviour meeting DC-LD criteria was 27.7%. The factors independently associated with aggressive behaviours were lower ability, female gender, not living with a family carer, not having Down syndrome, having attention-deficit hyperactivity disorder and having urinary incontinence. Incidence of aggressive behaviour meeting DC-LD criteria in adult life is similar to that for each of psychotic, anxiety and organic disorders. Conclusions Aggressive behaviour is common among adults with ID, but contrary to previous suggestions, more than a quarter remit within the short to medium term. This is important knowledge for professionals as well as the person and her/his family and paid carers. There is much yet to learn about the mechanisms underpinning aetiology and maintenance of aggressive behaviour in this population, and exploratory epidemiological investigations such as this have a role to play in progressing research towards further hypothesis testing and trials to influence clinical practice, service development and policy. [source] Looking at the future and seeing the past: the challenge of the middle years of parenting a child with intellectual disabilitiesJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 6 2005S. Todd Abstract Background This paper seeks to understand and conceptualize the experience of mothers of adolescents with intellectual disabilities (IDs) at a time in their lives which others have characterized as ,mid-life' or the ,middle years of parenting'. The concerns of the paper are the lifecourse concerns in mothers' own lives and with biographical elements of becoming and being such a parent. Methods Qualitative interviews were conducted with mothers of adolescents with IDs. The average age of mothers was 48 years. Typically parents were interviewed on two to three occasions. Results The data suggest that despite the difficulties they faced, these parents had constructed a ,life-as-ordinary' in the early phase of their parental careers. They saw themselves as ,ordinary mothers'. However, the social content and events of the middle years of parenting prompt a realization that their lives and, for some, their sense of ,self', are undergoing considerable change. Mothers are forced to look over their lives to find the meaning and significance of these events. For some, there is biographical reinforcement. For others, there is only disruption. Discussion The overall picture of these years is one of considerable changes and challenges, and underlines the need for a focus on the lifecourse concerns of parents as well as their children. The implications of the data for further research and service development are discussed in the context of identity theory. [source] Frail older people's experiences and use of health and social care servicesJOURNAL OF NURSING MANAGEMENT, Issue 2 2007MARKUS THEMESSL-HUBER PhD Aims, To highlight older people's experiences and expectations of services and the consequences for service provision, service development and research. Rationale, A large amount of resources have been invested in providing services for frail older people who experienced multiple hospital admissions. However, their own views are under-reported. Method, Semi-structured interviews with frail older people were conducted in four Scottish Health Board areas to explore the context of emergency admissions and the use of extramural services. Outcomes, Frail older people are high users of services but claim that services are not responsive to their main concerns: meeting individual needs, maximizing independence and helping to live fulfilled lives. Services not catering for these needs are often cancelled or left in abeyance. Conclusion, The same people who are targeted by care services are reluctant to engage with them. Care providers need to adopt older people's priorities to provide them with responsive patient-centred care. [source] An appraisal of the use of secondment within a large teaching hospitalJOURNAL OF NURSING MANAGEMENT, Issue 6 2001BA(HONS), J. Hamilton RGN, M MED SCI Introduction, This study was undertaken in a large teaching hospital in Sheffield. It explores the use of secondment as a vehicle for practice, service and career development. Aim, To provide us with an understanding of the ways in which we utilize secondment opportunities, with a view to developing good practice guidelines that will help both the individual and the organization to maximize the potential in each secondment post. Method, A survey of nursing staff who had been on secondment during the previous year. Questionnaires were used to gather data from the senior nurse in each specialty directorate to develop an organizational (seconder) perspective and 20 secondees to provide an individual (secondee) perspective. Results, Nurses tended to be seconded from clinical roles into specialist clinical roles or non-clinical roles, predominantly in areas of research, audit, practice development and teaching. Seconded posts were new roles for individuals and the majority were relocated to new work environments. Secondment was overwhelmingly seen as an opportunity, allowing individuals to develop new skills and knowledge, progress their career and gain a broader strategic perspective. However, there were a number of barriers to progress: lack of role definition for the organization and the individual; uncertainty about the future; falsely raised hopes that secondments would be extended; uncertainty about status; and difficulties adjusting to a new environment and culture within unrealistically short timeframes. Conclusions, Secondment use has become widespread throughout the National Health Service (NHS) and is a very positive and popular vehicle for staff and service development. The potential benefits are high but must be offset against the risks. This paper introduces an organizational risk assessment matrix which can be used to inform the development of effective secondment ventures. [source] Out-of-area placements in Scotland and people with learning disabilities: a preliminary population studyJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 4 2008M. BROWN bsc (hons) msc pgce phd rgn rnld People with learning disabilities have a different pattern of disease from the general population and high health needs that are frequently unidentified and unmet. Many require responses from general and specialist health services. A picture is emerging of some people with learning disabilities, often with complex care needs, moving from their home area on what is being termed, out-of-area placements, to receive specialist care. However, within the learning disability population, limited research has been undertaken and the impact on health services is unknown. Data were collected from health and social care providers to identify people with learning disabilities moving in and out of services across Scotland. Further data about the consequences and impact of out-of-area placements were gathered in one geographical area using focus group methodology. The results suggest that people with learning disabilities are moving in, out and across Scotland, often as a result of breakdown of local care arrangements or because of lack of specialist resources. Planning, service development and effective communication need to be in place to address the needs of this increasing and ageing population. [source] Developing services for the carers of young adults with early-onset psychosis , listening to their experiences and needsJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 5 2005J. SIN msc bsc (hons)-thorn bn bgs rmn The care-giving experience of carers of young adults with early onset psychosis is relatively unexplored. New carers are less likely to be engaged with local services for carers and families, than those more established in their caring role. Understanding the experience of these carers provides some valuable insight into the value of caring and in guiding service development. This paper reports on a study designed to explore carers' experiences of caring for a young adult diagnosed with a first psychotic episode and their needs in relation to the development of an early intervention for psychosis service. A phenomenological approach was used. Eleven carers were given a semi-structured interview in their own homes. All of the carers in the study had a son with early onset psychosis. The outcome revealed that all carers were providing a comprehensive range of practical, emotional and financial support for their son including initiating and sustaining engagement between them and local mental health services. Many carers were felt to be invisible and silent partners in care and felt under-valued by mental health services. [source] The development of a user-led clinical service for newly diagnosed rheumatoid arthritis patients.MUSCULOSKELETAL CARE, Issue 4 2004An action research study Abstract Objective: To identify the clinical services required to meet the perceived needs of patients within the first 6,12 months following a diagnosis of rheumatoid arthritis in an orthopaedic NHS trust. Methods: An action research methodology was utilized. Twenty three newly diagnosed patients were asked to complete a questionnaire focusing on their needs at the time of diagnosis. The content included reactions to diagnosis, physical and psychological implications and clinical services that were required. A sub-sample of patients (n = 6) participated in an interview to explore these issues in more depth. A questionnaire was also distributed to 14 members of the multidisciplinary team (MDT) to ascertain their views on the purpose, content, and provision of a clinical service for newly diagnosed patients. Results: Eighteen patients agreed to take part (M:F, 9:9, age range 23,74 years, mean age 52.3 years, mean disease duration from diagnosis 16 weeks). Data from the questionnaires and interviews led to the following themes being identified: pre-diagnosis anxiety and fear, the impact of the diagnosis, physical and psychological implications of the diagnosis, and issues related to control perceptions. There was concordance between the MDT and the patients regarding impact of the disease and the need for information. Areas of the service that were identified independently by patients related to the importance of the period of time pre-diagnosis while awaiting the hospital appointment, and employment issues. Conclusions: This study has identified the impact of RA in the early stages of pre- and post- diagnosis on physical, psychological and social functioning and has consequently informed service development. Copyright © 2004 Whurr Publishers Ltd. [source] Feasibility and Acceptability of Providing Nurse Counsellor Genetics Clinics in Primary CareNURSING & HEALTH SCIENCES, Issue 2 2006Greta Westwood Increasing referrals to specialist genetics services have precipitated a review of models of service delivery in the United Kingdom. Little is known about whether a change in clinic location is feasible or acceptable for the patients seen. We consider the feasibility of genetics service development and delivery in primary care and develop a questionnaire to evaluate acceptability and cost to patients. Between July 2003 and May 2004, 64 primary care appointments with a genetics nurse counsellor were offered to patients referred and registered with selected general practices. 45 (79%) patients attended their appointment and 34 (77%) returned their follow-up questionnaire. Total mean satisfaction score was high and patients were most satisfied with the information and affective domains of the appointment. 48% of patients seen by the genetics nurse counselor remained in primary care. Patients were satisfied with the travel time and distance to clinic and patient clinic costs were limited. This study shows that patients do attend genetics nurse counselor clinics in primary care, and are satisfied with the new location. A large cluster randomized controlled trial is now being conducted to obtain a controlled comparison of acceptability to patients of attending clinics in primary vs. secondary care settings. [source] Developing and setting up a patient and relatives intensive care support groupNURSING IN CRITICAL CARE, Issue 1 2009Maureen Peskett Abstract Aim:, The purpose of this article was to highlight the need to provide support for patients and relatives following critical illness and discharge from hospital and how this can be improved through the establishment of user support groups. Background:, Critical illness predisposes patients to extended physical and psychological ill health with the potential for a reduced quality of life. The authors' personal experience, patient feedback and current literature suggested that there was a need for further support during their recovery. Methods:, Building on an existing formal follow-up service, Intensive Care Unit (ICU) Support Team for Ex-Patients established a patient-centred forum, where patients and relatives could share experiences with others who had also been through critical illness by holding drop-in sessions. Feedback from those attending these flexible and informal sessions indicates that support was needed and that patients and families have found benefit in sharing experiences with others who can empathise, having been through critical illness themselves. Conclusions:, Our experience has shown there is a need that can be met simply with minimal investment of time and funding but that addresses a gap in patient support that otherwise goes unmet. Although this was a service development in one local area, it could be adapted to ICU patients and relatives more widely. [source] A Resource-Process Framework of New Service DevelopmentPRODUCTION AND OPERATIONS MANAGEMENT, Issue 2 2007Craig M. Froehle Motivated by the increasing attention given to the operational importance of developing new services, this paper offers a theoretical framework that integrates both process- and resource-oriented perspectives of new service development (NSD) by defining and organizing 45 practice constructs for NSD-related practices and activities that occur in contemporary service firms. We employ a rigorous procedure whereby both quantitative and qualitative data were gathered through multiple rounds of interviews and card-sorting exercises with senior service managers. This iterative refinement process helps ensure that the construct domains and definitions are consistent and that they are applicable across multiple service sectors. A primary contribution of this research is to provide precise operational definitions of theoretically important NSD practice constructs. Importantly, this study expands on the NSD literature by including both resource- and process-centric perspectives within a single framework. A second contribution is to illustrate a general methodology for developing clear, concise, and consistent construct definitions that may be generally useful for production and operations management scholars interested in new construct development for emerging areas. Empirical results suggest that the resource-process framework can help guide and organize future research on, and provide insight into, a more comprehensive view of new service development. [source] Practitioner Review: How can epidemiology help us plan and deliver effective child and adolescent mental health services?THE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 9 2008Tamsin Ford This review focuses on ways in which epidemiological research can inform mental health service development and clinical practice. Data from epidemiological studies can provide cross-sectional and secular estimates of the prevalence of psychopathology to support rational service development. Epidemiological surveys have difficulties in finding large enough samples of children with rare disorders, although these disorders are often severely debilitating and require extensive service input. Systematic surveillance provides a rigorous method for studying rare disorders and events. Only a minority of children with impairing psychopathology reach mental health services, although a larger proportion have mental health related contacts with other services. The gap in provision is such that an expansion of mental health services is unlikely to reach all children who could benefit, suggesting that mental health professionals need to develop innovative strategies to increase the number of children seen and the effectiveness of interventions that they receive. Training and supervision of non-mental-health professionals working with children in the identification and management of mental health problems is also extremely important. Most studies suggest that the children with the severest problems are getting to specialist mental health services, and service contact is more likely if important adults can perceive the child's difficulty or find it to be burdensome. The latter suggests that education of key adults would improve detection if services had the capacity to cope. Studies consistently suggest that the region in which the child lives affects the likelihood of service contact, but studies of other characteristics predicting service contact are so contradictory that studies should only be (cautiously) applied to similar populations to assess which types of children may currently be falling through gaps in service provision. Academics are beginning to explore the use of structured measures developed for epidemiological studies in clinical assessment and outcome monitoring. [source] Life-Cycle Flexibility: How to Measure and Improve the Innovative Capability in Turbulent Environments,THE JOURNAL OF PRODUCT INNOVATION MANAGEMENT, Issue 5 2006Tommaso Buganza Managing innovation in rapidly moving environments, such as Interned-based services, is a major challenge for the consolidated theories on product and service development. The innovation management literature identifies flexibility as the right way for coping with these challenges. By increasing the development process flexibility, it is possible to reduce the development time as well as the time and cost needed for last-minute concept changes. But this is not enough. The product or service must also be flexible after it has been released: A life-cycle flexibility (LCF) must be pursued. Focused on the Italian on-line discount brokers industry, this article is a result of a two-staged research process that started with a qualitative explorative phase (i.e., case-study methodology) and ended with a quantitative explorative one (i.e., questionnaire methodology). It identifies three different LCF dimensions,frequency of adaptation, rapidity of adaptation, and quality of adaptation,and it defines a metric for each of them. Subsequently, it identifies five managerial and organizational practices that increase at least one of the three LCF dimensions: (1) to manage the back-end technological competences; (2) to share the front-end technological competences with external suppliers; (3) to utilize open and standard technologies; (4) to have a low formalization of the new service development (NSD) procedures; and (5) to have high formalization of the NSD organization. [source] | ||||||||||||||||||||||||||||||||||||||||