Suchergebnisse

While ethics has been addressed in the health care literature, relatively little attention has been paid to the subject in the field of social care. This book redresses the balance by examining theory, research, policy and practice in both fields. The importance of this approach is reflected in the growing emphasis on ethical issues in research and practice and, in Britain, on government policy aimed at improving partnership working across the two sectors

Choice, as an aspect of existence, may be taken for granted or it may not exist at all. Choice may be complex, simple, false, or not apparent. Choices can be quantitatively and qualitatively different. There are ironies of choice in that profusion of choice can mean confusion of choice. Equally, and perversely, those who have choices can also enjoy the privilege of not choosing – itself a choice. Design is a site of choice-making – not only within the nuances of design processes but also for the role it plays in identity formation, social being, politics, and global interactions. This paper aims to address the significance of choice not only for focussed design and technology education but also for the general education of all students in their preparations to become fulfilled and engaged global citizens. The paper: a) explores choice from philosophical, social, political and consumerist perspectives; b) presents the student as both person and player in, and on, the world; c) offers two illustrations of curricula considered supportive of choice education for design and citizenship literacy; and, d) discusses 'pedagogies of choice' which can contribute to the growth of 'altered consciousness' through design education.

Markella Boudioni,1 Susan McLaren,2 Graham Lister2 1NIHR Imperial Biomedical Research Centre & Patient Experience Research Centre, Imperial College London, 2Institute for Leadership and Service Improvement, Faculty of Health and Social Care, London South Bank University, London, UK Background: Comparison of patient empowerment (PE) policies in European countries can provide evidence for improvement and reform across different health systems. It may also influence patient and public involvement, patient experience, preference, and adherence.Objective: The objective of this study was to compare PE within national policies, systems, and structures in England and Greece for achieving integrated people-centered health services.Methods: We performed a critical search and review of policy and legislation papers in English and Greek languages. This included 1) general health policy and systems papers, 2) PE, patient and/or public involvement or patients' rights policy and legislation (1990–2015), and 3) comparative or discussion papers for England and/or Greece.Results: A total of 102 papers on PE policies, systems, and structures were identified initially; 80 papers were included, in which 46 were policy, legislative, and discussion papers about England, 21 were policy, legislation, and discussion papers about Greece, and 13 were comparative or discussion papers including both the countries. In England, National Health Service policies emphasized patient-centered services, involvement, and empowerment, with recent focus on patients' rights; while in Greece, they emphasized patients' rights and quality of services, with recent mentions on empowerment. The health ombudsman is a very important organization across countries; however, it may be more powerful in Greece, because of the nonexistence of local mediating bodies. Micro-structures at trusts/hospitals are comparable, but legislation gives more power to the local structures in Greece.Conclusion: PE policies and systems have been developed and expressed differently in these countries. However, PE similarities, comparable dimensions and mechanisms, were identified. For both the countries, comparative research and these findings could be beneficial in building connections and relationships, contributing to wider European and international developments on PE, involvement, and patients' rights and further impact on patient preferences and adherence. Keywords: patient empowerment, patient involvement, patients' rights, England, Greece, national health policies

Background: The relationship between continuity of care and user characteristics or outcomes has rarely been explored. The ECHO study operationalized and tested a multi-axial definition of continuity of care, producing a seven-factor model used here. Aims: To assess the relationship between user characteristics and established components of continuity of care, and the impact of continuity on clinical and social functioning. Methods: The sample comprised 180 community mental health team users with psychotic disorders who were interviewed at three annual time-points, to assess their experiences of continuity of care and clinical and social functioning. Scores on seven continuity factors were tested for association with user-level variables. Results: Improvement in quality of life was associated with better Experience & Relationship continuity scores (better user-rated continuity and therapeutic relationship) and with lower Meeting Needs continuity factor scores. Higher Meeting Needs scores were associated with a decrease in symptoms. Conclusion: Continuity is a dynamic process, influenced significantly by care structures and organizational change.

Introduction: Continuity of care has been demonstrated to be important for service users and carer groups have voiced major concerns over disruptions of care. We aimed to assess the experienced continuity of care in carers of patients with both psychotic and non-psychotic disorders and explore its association with carer characteristics and psychological well-being. Methods: Friends and relatives caring for two groups of service users in the care of community mental health teams (CMHTs), 69 with psychotic and 38 with non-psychotic disorders, were assessed annually at three and two time points, respectively. CONTINUES, a measure specifically designed to assess continuity of care for carers themselves, was utilized along with assessments of psychological well-being and caregiving. Results: One hundred and seven carers participated. They reported moderately low continuity of care. Only 22 had had a carer's assessment and just under a third recorded psychological distress on the GHQ. For those caring for people with psychotic disorders, reported continuity was higher if the carer was male, employed, lived with the user and had had a carer's assessment; for those caring for people with non-psychotic disorders, it was higher if the carer was from the service user's immediate family, lived with them and had had a carer's assessment. Conclusion: The vast majority of the carers had not had a carer's assessment provided by the CMHT despite this being a clear national priority and being an intervention with obvious potential to increase carers' reported low levels of continuity of care. Improving continuity of contact with carers may have an important part to play in the overall improvement of care in this patient group and deserves greater attention.