Narratives of recovery after floods: Mental health, institutions, and intervention.

There is increasing evidence that flood events affect the mental health of those experiencing them, with recognition that the period of recovery after the event is particularly important to outcomes. Previous research on flooding has argued that there is a recovery gap that occurs during the long process of recovery at the point when the support provision from public authorities and agencies diminishes, and less well-defined interactions with private actors, such as insurers, begin. This concept highlights the importance of the support and intervention from authorities and other institutions for recovery processes. To date, little research has focused specifically on these relationships and their consequences for people's mental wellbeing through recovery. This study examines the processes of individuals' recovery from flood events, focusing on the role of interaction with agencies in the trajectories of mental health journeys. The analysis applies a narrative approach to in-depth repeated interviews carried out over a fifteen-month period with nine individuals whose homes were inundated by floods in 2013/14 in Somerset, UK. The results suggest strong evidence for institutional support having an important role in how individuals experience their post-flood mental health recovery journeys. The data reveal strategies to maintain psychological and emotional resilience at distinct periods during recovery, and show that both institutional actions and the perceived absence of support in specific circumstances affect the mental health burden of flood events.

Increasing radiology capacity within the lung cancer pathway: centralised work-based support for trainee chest X-ray reporting radiographers.

INTRODUCTION: Diagnostic capacity and time to diagnosis are frequently identified as a barrier to improving cancer patient outcomes. Maximising the contribution of the medical imaging workforce, including reporting radiographers, is one way to improve service delivery. METHODS: An efficient and effective centralised model of workplace training support was designed for a cohort of trainee chest X-ray (CXR) reporting radiographers. A comprehensive schedule of tutorials was planned and aligned with the curriculum of a post-graduate certificate in CXR reporting. Trainees were supported via a hub and spoke model (centralised training model), with the majority of education provided by a core group of experienced CXR reporting radiographers. Trainee and departmental feedback on the model was obtained using an online survey. RESULTS: Fourteen trainees were recruited from eight National Health Service Trusts across London. Significant efficiencies of scale were possible with centralised support (48 h) compared to traditional workplace support (348 h). Trainee and manager feedback overall was positive. Trainees and managers both reported good trainee support, translation of learning to practice and increased confidence. Logistics, including trainee travel and release, were identified as areas for improvement. CONCLUSION: Centralised workplace training support is an effective and efficient method to create sustainable diagnostic capacity and support improvements in the lung cancer pathway.

Experiences of patients with traumatic brain injury and their carers during transition from in-patient rehabilitation to the community: a qualitative study.

PURPOSE: To explore the experiences of individuals who have had a severe traumatic brain injury (TBI) and their carers in the first month post-discharge from in-patient rehabilitation into living in the community. METHOD: Using a qualitative approach underpinned by critical realism, we explored the narratives of 10 patients and nine carers using semi-structured interviews approximately one month post-discharge. Thematic analysis was carried out independently by two researchers. RESULTS: Firstly, perceptions of support were mixed but many patients and carers felt unsupported in the inpatient phase, during transitions between units and when preparing for discharge. Secondly, they struggled to accept a new reality of changed abilities, loss of roles and loss of autonomy. Thirdly, early experiences post-discharge exacerbated fears for the future. CONCLUSIONS: Most patients and carers struggled to identify a cohesive plan that supported their transition to living in the community. Access to services required much persistence on the part of carers and tended to be short-term, and therefore did not meet their long-term needs. We propose the need for a case manager to be involved at an early stage of their rehabilitation and act as a key point for information and access to on-going rehabilitation and other support services. Implications for Rehabilitation Traumatic Brain Injury (TBI) is a major cause of long-term disability. It can affect all areas of daily life and significantly reduce quality of life for both patient and carer. Professionals appear to underestimate the change in abilities and impact on daily life once patients return home. Community services maintain a short-term focus, whereas patients and carers want to look further ahead - this dissonance adds to anxiety. The study's findings on service fragmentation indicate an urgent need for better integration within health services and across health, social care and voluntary sectors. A link person/case manager who oversees the patient journey from admission onwards would help improve integrated care and ensure the patient, and carer, are at the center of service provision.

Wellbeing in the aftermath of floods.

The interactions between flood events, their aftermath, and recovery leading to health and wellbeing outcomes for individuals are complex, and the pathways and mechanisms through which wellbeing is affected are often hidden and remain under-researched. This study analyses the diverse processes that explain changes in wellbeing for those experiencing flooding. It identifies key pathways to wellbeing outcomes that concern perceptions of lack of agency, dislocation from home, and disrupted futures inducing negative impacts, with offsetting positive effects through community networks and interactions. The mixed method study is based on data from repeated qualitative semi-structured interviews (n=60) and a structured survey (n=1000) with individuals that experienced flooding directly during winter 2013/14 in two UK regions. The results show for the first time the diversity and intersection of pathways to wellbeing outcomes in the aftermath of floods. The findings suggest that enhanced public health planning and interventions could focus on the precise practices and mechanisms that intersect to produce anxiety, stress, and their amelioration at individual and community levels.

An exploration of role model influence on adult nursing students' professional development: A phenomenological research study.

Patients' expectations of being cared for by a nurse who is caring, competent, and professional are particularly pertinent in current health and social care practice. The current drive for NHS values-based recruitment serves to strengthen this. How nursing students' development of professionalism is shaped is not fully known, though it is acknowledged that their practice experience strongly shapes behaviour. This study (in 2013-14) explored twelve adult nursing students' lived experiences of role modelling through an interpretive phenomenological analysis approach, aiming to understand the impact on their development as professional practitioners. Clinical nurses influenced student development consistently. Some students reported that their experiences allowed them to learn how not to behave in practice; a productive learning experience despite content. Students also felt senior staff influence on their development to be strong, citing 'leading by example.' The impact of patients on student professional development was also a key finding. Through analysing information gained, identifying and educating practice-based mentors who are ready, willing, and able to role model professional attributes appear crucial to developing professionalism in nursing students. Those involved in nurse education, whether service providers or universities, may wish to acknowledge the influence of clinical nurse behaviour observed by students both independent of and in direct relation to care delivery and the impact on student nurse professional development. A corollary relates to how students should be guided and briefed/debriefed to work with a staff to ensure their exposure to a variety of practice behaviours.

Ways forward for aquatic conservation: Applications of environmental psychology to support management objectives.

The success or failure of environmental management goals can be partially attributed to the support for such goals from the public. Despite this, environmental management is still dominated by a natural science approach with little input from disciplines that are concerned with the relationship between humans and the natural environment such as environmental psychology. Within the marine and freshwater environments, this is particularly concerning given the cultural and aesthetic significance of these environments to the public, coupled with the services delivered by freshwater and marine ecosystems, and the vulnerability of aquatic ecosystems to human-driven environmental perturbations. This paper documents nine case studies which use environmental psychology methods to support a range of aquatic management goals. Examples include understanding the drivers of public attitudes towards ecologically important but uncharismatic river species, impacts of marine litter on human well-being, efficacy of small-scale governance of tropical marine fisheries and the role of media in shaping attitudes towards. These case studies illustrate how environmental psychology and natural sciences can be used together to apply an interdisciplinary approach to the management of aquatic environments. Such an approach that actively takes into account the range of issues surrounding aquatic environment management is more likely to result in successful outcomes, from both human and environmental perspectives. Furthermore, the results illustrate that better understanding the societal importance of aquatic ecosystems can reduce conflict between social needs and ecological objectives, and help improve the governance of aquatic ecosystems. Thus, this paper concludes that an effective relationship between academics and practitioners requires fully utilising the skills, knowledge and experience from both sectors.

Foot pain in rheumatoid arthritis prevalence, risk factors and management: an epidemiological study.

Foot involvement is a major feature of rheumatoid arthritis (RA). Most epidemiological studies of the RA foot report radiological changes and results of clinical examination. This study aimed to determine the prevalence of foot symptoms, frequency of foot assessment and access to foot care from the perspective of people with RA. A questionnaire was sent to 1,040 people with RA throughout the UK enquiring about foot symptoms, their anatomical distribution (via validated mannequins) availability of podiatry services and perceived usefulness of interventions for alleviating foot symptoms. Altogether 585 useable replies were received; 93.5% of respondents reported having experienced foot pain, and 35.4% reported current foot pain as the presenting symptom. Most (68.2%) reported moderate or severe foot pain daily. Pain was most prevalent in the forefoot and/or ankle. The main predictive factors for reporting current foot pain were longer disease duration (mean 13 vs 10.3 years, p = 0.009), higher BMI (25.6 vs 24.1 p = 0.001) and the prevalent foot symptoms foot stiffness and numbness (both p < 0.0001). Age, gender and current treatment were not significantly associated. Most (82%) had discussed foot symptoms with their rheumatologist, and only 64% had seen a podiatrist. Reported current adherence to prescribed orthoses was 55.8% and to prescribed shoes was 29.5%. Foot symptoms are ubiquitous in RA and frequently severe. Most patients had discussed their symptoms with their rheumatologist, and only 64% had specifically seen a podiatrist. Despite the remarkable progress in development of new treatment modalities for RA, foot pain remains a common and disabling symptom. Our findings support the need for wider access to specific foot care services and evidence-based, patient-centred interventions.

A clinical study and the national service framework for diabetes.

Clinical assessment and management for anyone who has diabetes may be influenced by the development of the National Service Framework (NSF) for Diabetes. Through a case study, this article explains how the NSF for Diabetes and other recent NHS documentation has influenced our approach to managing a type 2 diabetic patient whose feet are categorised as 'high risk'. Some of the potential shortfalls of the NSF for Diabetes are also discussed in this context.

The role of outcome measures in assessing change in the at-risk rheumatoid foot.

In common with other outcome measures, those for the at-risk rheumatoid foot need to be sensitive, specific and patient focussed, although currently these combined features are not available within one measure. There is also the issue of cross-validation with other commonly used measures to be considered. Both government policy and clinical need predicate development of suitable measures for the rheumatoid foot. In the first part of this paper, general issues relating to outcome measures and some government policy are considered and in the second, outcome measures relating to the at-risk rheumatoid foot are introduced alongside a discussion on the implications for practitioners.

Introduction to some common cutaneous foot conditions and their management.

Problems that happen to the body through injury or disease can also happen to the owner's feet, and there are additional complications associated with the feet. Feet are a long way from the core, are in contact with an unclean environment (the ground), can be abused through poor-fitting footwear and are subjected to more general wear and tear than many other parts of the body. There are a large number of conditions affecting the feet, many associated with medical disorders such as diabetes, rheumatoid arthritis or peripheral vascular disease. The symptom of pain often triggers help being sought, but change in the appearance of the skin is a very important indicator of the state of superficial and deeper tissues. Health-care professionals may be called upon to comment on these conditions and treat and/or refer accordingly, so a multidisciplinary approach is required. Clinical skill is required to identify the conditions which are treatable, or those which should be referred for treatment by someone in another specialism. This paper provides information for clinicians and interested others in the form of an introduction to some common cutaneous foot conditions through outline case examples and their treatment.

The impact of diabetes on wound management.

Kate Springett discusses the management of chronic diabetic wounds in the lower leg and foot. The aim of the article is to enhance the practitioner's understanding of the pathogenesis of these wounds and to aid clinical assessment and management while working within local wound management guidelines.

Skin changes in the "at risk" foot and their treatment.

The skin provides a "mirror" of the patient's general health, and any changes from normal for that person may be generalized or located to specific body sites. In the foot, poor quality skin may develop associated with a number of medical disorders such as diabetes or rheumatoid arthritis, and peripheral states such as peripheral vascular disease. In these instances the foot is "at risk" of developing ulcers following even minor trauma. To manage epidermal and dermal changes efficiently, it helps to have a good understanding of the skin structure and function as well as knowledge of the more common conditions affecting the poorly viable foot. Skin physical characteristics change in the "at risk" foot and skin conditions and lesions, e.g. anhydrosis, fissures, ulceration, can develop readily and left untreated, there is increased morbidity and risk of mortality. Even apparently minor skin conditions in the foot are therefore worthy of attention and appropriate treatment as introduced in this paper, as all those involved in health care have a responsibility and role in foot health education.