Women, Addictions, Mental Health, Dishonesty, and Crime Stigma: Solutions to Reduce the Social Harms of Stigma.

British drug policies could underserve women with treatment needs, and this paper provides evidence that communication through the words and actions of professionals across drug and alcohol services, health and mental health, social work and the criminal justice sector can leave women feeling stigmatised and failed. Women live with the stigma of 'the lying addict'; however, documents and courtroom statements provided by professionals can misrepresent women's experiences, which exacerbates social harm. Data are drawn from feminist participatory action research, where female lived experience experts worked alongside academics to implement a qualitative study using interviews and focus groups with women using treatment services (n = 28) and an online world café with professionals working with these women (n = 9) and further professionals providing support at lived experience data collection events (n = 5). This data set is cross-referenced with one-to-one and small-group interviews with professionals in the field (n = 17) conducted by a third-sector partner. Findings establish that stigma negatively impacts the identification of treatment needs and access to timely and appropriate service delivery. Social harms to women with addictions could be significantly reduced with timely, authentic, honest, gender-informed and trauma-informed practices for girls and women using drugs and alcohol to self-medicate from traumatic experiences.

Exploring pregnant women's experiences of stopping smoking with an incentive scheme with 'enhanced' support: a qualitative study.

AIM: This study aims to understand pregnant women's experiences of smoking cessation with an incentive scheme in a deprived UK city. This is important because smoking cessation with pregnant women is one of the most crucial public health initiatives to promote, and is particularly challenging in deprived areas. While financial incentive schemes are controversial, there is a need to better understand pregnant women's experiences. The scheme combined quasi-financial incentives (shopping vouchers) for validated quits (carbon monoxide (CO) validated at < 10 ppm), enhanced support from smoking cessation advisors, the opportunity to identify a 'Significant Other Supporter' and nicotine replacement therapy. METHODS: With the focus on understanding pregnant women's experiences, a qualitative design was adopted. Semi-structured interviews were completed with 12 pregnant women from the scheme, and the three advisors. All interviews were transcribed, and thematic analysis conducted. RESULTS: Pregnant women reported various challenges to quitting, including long-established routines, and stress. Participants were aware of stigma around incentives but were all very positive about the scheme. The relationship with advisors was described as fundamental. The women valued their advice and support, while uptake of the 'Significant Other Supporter' appeared low. Participants viewed the CO monitoring as 'an incentive', while the vouchers were framed as a 'bonus'. Advisors perceived the vouchers as helping engage pregnant women and maintain quit status, and women appreciated the vouchers both as financial assistance and recognition of their accomplishments. CONCLUSION: This study highlights the great value women placed on the support, advice and monitoring from specialist advisors. The distinction between vouchers as a welcomed bonus, rather than 'the incentive' to engage, is important. How smoking cessation and schemes to promote this are communicated to pregnant women and health professionals is important, particularly given the stigma and controversy involved.

Homelessness, hospital discharge and challenges in the context of limited resources: A qualitative study of stakeholders' views on how to improve practice in a deprived setting.

Hospital discharge for people experiencing homelessness is a perennial challenge. The Homeless Reduction Act 2017 (HRA) places new responsibilities on hospitals, but it remains unknown whether this has affected discharge practices. This qualitative study explores stakeholders' views on the challenges around hospital discharge for people experiencing homelessness, in the context of a deprived English city. Semi-structured interviews were conducted with 27 stakeholders. Participants were purposively recruited from local authority, third sector and the National Health Service. Interviews were transcribed and thematic analysis conducted. Analysis generated three main themes. First, a need for better planning and communication with the third sector, particularly around medication, prescriptions and information sharing. Second, the need to improve awareness and 'upskill' hospital staff to work more effectively with people experiencing homelessness, including understanding their needs, the wider support available and HRA requirements. Third, there were calls for (re)investment in a different approach to better support this population, based on outreach and flexibility. The need for improved partnership working and investment was emphasised. Whilst recognising the challenges faced by hospitals, especially within the context of funding cuts, this study highlights the need to recognise the third sector's contribution in supporting people experiencing homelessness in the community. Developing site-specific checklists for practice before discharge (and as early as possible) may help to ensure appropriate measures are in place. Improving legal literacy in the context of what an appropriate discharge is for people experiencing homelessness may help develop staff confidence to challenge the focus on 'quick' discharges.

Doctors' Views on How to Improve Communication and Quality of Care for Patients Experiencing End-of-Life: A Qualitative Descriptive Study.

(1) Background: There remains a lack of sufficient progress in enhancing quality of care for patients experiencing end-of-life. This study aimed to better understand the views of doctors on how to improve end-of-life healthcare, in light of existing challenges and processes. (2) Methods: This qualitative descriptive study used semi-structured individual interviews. Through purposive sampling, sixteen doctors from primary care (three general practices) or acute care (one National Health Service hospital trust) participated. Interviews were audio-recorded, transcribed and thematic analysis conducted. (3) Results: Two main themes were identified: First, planning for patient-centred care-conversations about end-of-life care should take place earlier to allow for care that is planned and personalised. The need for more training and improvements to documenting patient wishes were highlighted. Second, delivering on patients' wishes: improvements to the healthcare system-the importance of a record of patient wishes that can be shared across the system was identified. Improved utilisation of available resources is also needed to better deliver quality patient-centred care. (4) Conclusion: More effective communication and coordination across acute and primary care settings is needed. The importance of patient wishes and advance care planning was emphasised. More guidance at a strategic level may help provide clarity about expectations, roles and responsibilities.

Clinically indicated replacement of peripheral vascular catheters: is it safe for patients?

Replacing peripheral vascular catheters when clinically indicated rather than routinely has multiple benefits for patients and practitioners. Managing vascular catheters based on clinical indication provides early opportunities for intervention, or catheter removal or replacement. Where clinically indicated, peripheral vascular catheters can be used for a long time, and this is aided by decision-making tools such as the visual infusion phlebitis score and care bundles. Fewer cannulations result in less pain, better patient comfort and a lower risk of infection. For each cannulation avoided, about 20 minutes can be saved for other care activities. Replacing peripheral vascular catheters according to clinical indication can improve patient safety and optimise resource use.

Moving beyond panaceas in fisheries governance.

In fisheries management-as in environmental governance more generally-regulatory arrangements that are thought to be helpful in some contexts frequently become panaceas or, in other words, simple formulaic policy prescriptions believed to solve a given problem in a wide range of contexts, regardless of their actual consequences. When this happens, management is likely to fail, and negative side effects are common. We focus on the case of individual transferable quotas to explore the panacea mindset, a set of factors that promote the spread and persistence of panaceas. These include conceptual narratives that make easy answers like panaceas seem plausible, power disconnects that create vested interests in panaceas, and heuristics and biases that prevent people from accurately assessing panaceas. Analysts have suggested many approaches to avoiding panaceas, but most fail to conquer the underlying panacea mindset. Here, we suggest the codevelopment of an institutional diagnostics toolkit to distill the vast amount of information on fisheries governance into an easily accessible, open, on-line database of checklists, case studies, and related resources. Toolkits like this could be used in many governance settings to challenge users' understandings of a policy's impacts and help them develop solutions better tailored to their particular context. They would not replace the more comprehensive approaches found in the literature but would rather be an intermediate step away from the problem of panaceas.

Palliative care in general practice: GP integration in caring for patients with advanced cancer.

BACKGROUND: Patients with advanced cancer often desire home-based care, placing general practitioners (GPs) at the centre of complex clinical situations. The objective of this article was to determine GPs' needs when providing home-based palliative care in collaboration with existing palliative care services. METHODS: A survey of GPs was conducted to determine knowledge, skills and confidence in providing community-based palliative care. RESULTS: Of the 56 respondents, 82% reported that they were involved in palliative management of at least one cancer patient in the previous year. A significant number of GPs (31%) lacked confidence in providing this care because of patient complexity, inadequate training and insufficient resources. Other barriers included poor communication from specialists and treating teams. Factors facilitating provision of home-based palliative care were community palliative care services and links to hospital-based palliative care teams. DISCUSSION: This survey highlights the importance of support and resources to empower GPs to confidently provide home-based palliative care for patients with advanced cancer.