Emotional encounters in health care: an investigation into the experiences of health visitors when working across cultures

Background: A substantial body of research evidence suggests that inequalities in health linked to ethnicity exist. People from minority ethnic groups suffer discrimination and have poorer access to health care services, however, the influence of health professionals in relation to these health inequalities is under researched. Health professionals are expected to deliver a high standard of culturally appropriate health care to a diverse, changing and complex population. Educational packages in the area of cultural care have flourished, but there is a paucity of research that seeks to explore the experience of health professionals themselves. This research explores the opportunities and barriers experienced by health visitors in the North East of England when working with clients who are from another culture. The findings from the study are developed into a substantial theory which conceptualises this work. Methodology: Grounded Theory methodology was used and 21 semi-structured interviews were conducted with practicing health visitors in the North East of England between May 2008 and September 2009. All participants described themselves as white. Findings and conceptual theory: When health visitors talk about their work with people from cultures they identify as different to their own, there are three areas which are important to them. These are, first, in 4 relation to relationship building; second, a metaphorical ‘cross cultural terrain’; and finally, and most importantly, in managing emotions. The complex ways in which these three areas intersect with each other is what shapes professional engagement across cultures. The theory ‘emotional encounters through cross cultural terrain: shaping relational journeys through culture’ was developed to conceptualise this work. Conclusion: Emotions have the power to shape professional practice in health care, influencing (dis)engagement with clients across cultures. The ways in which this happens have implications for practice, theory and education

Emotional Encounters in Health Care: An investigation into the experiences of health visitors when working across cultures

Background: A substantial body of research evidence suggests that inequalities in health linked to ethnicity exist. Health professionals are expected to deliver a high standard of culturally appropriate care and yet problems persist. This research explores the opportunities and barriers experienced by health visitors in the North East of England when working with clients who are from another culture. Methodology: Grounded Theory methodology was used and 21 semi-structured interviews were conducted with practicing health visitors between May 2008 and September 2009. All participants described themselves as white. Findings: When health visitors talk about their work iwth people from cultures they identify as different to their own, there are three areas which are important to them. First, in relation to relationship building; second, a metaphorical 'cross cultural terrain'; and finally, and most importantly, in managing emotions. The complex ways in which these three areas intersect with each other is what shapes professional engagement across cultures. Conclusion: Emotions have the power to shape professional practice in health care, influencing (dis)engagement with clients across cultures. The ways in which this happens has implications for practice, theory and education

Benefits of GP care in outreach settings for people experiencing homelessness:A qualitative study

BACKGROUND: Although people experiencing homelessness (PEH) have the worst health outcomes in society, they have a low uptake of primary care services. GP outreach has developed as a way of increasing their access into primary care but little is known about the experience of patients receiving care in this way. AIM: To explore PEHs’ experiences of GP care in community outreach settings in UK; and to seek staff/volunteers’ views on the strengths and weaknesses of GP community outreach services. DESIGN AND SETTING: A multi-method qualitative study with PEH and staff/volunteers working in three different community outreach settings in the UK. METHOD: Individual semi-structured interviews were carried out with 22 PEH and two focus groups with key staff/volunteers. Data were analysed thematically using framework analysis. RESULTS: GP outreach services better enabled PEH to access medical care and staff/volunteers valued GP support to promote, and facilitate access to, healthcare services. In particular, the findings illuminate the high value that PEH placed on the organisational environment of the GP outreach service. Valued aspects of GP outreach were identified as comfortable, safe, and engendering a sense of belonging; convenient, opportunistic, and a one-stop shop; and being heard, having more time, and breaking down barriers. CONCLUSION: The organisational environment is important in enabling PEH to engage with GP services. The physical and organisational environment of the outreach settings were the most important factors; they created a space where professional barriers between the GP and patients were flattened, so facilitating a therapeutic relationship

Home level bureaucracy:Moving beyond the ‘street’ to uncover the ways that place shapes the ways that community public health nurses implement domestic abuse policy

Street‐level bureaucracy is an increasingly useful way to understand how strategic policy is implemented in day‐to‐day practice. This approach has uncovered the ways that individual health and social care practitioners work within institutional constraints to influence policy implementation at the micro‐level. Nonetheless, despite the diversity of settings where these street‐level bureaucrats (SLBs) work, little attention has been focused on the impact of place on policy delivery. This paper draws on empirical research to examine the ways that delivering government domestic abuse policy in the intimate space of the family home shapes the delivery of strategic policy in the everyday. Drawing on qualitative research with Health Visitors (HVs) in the UK in 2016, the study findings illuminate the ways that the material, socio‐spatial and idealised boundaries of the family home shape the implementation of policy. Key themes in the HV's narratives emerged as they described themselves as both a danger and in danger in the family home. In challenging the ontological security of the home (Giddens 1990) – privacy, security and control are key concepts here – HVs described how they shape their actions to achieve policy outcomes while simultaneously managing threats to the home, to professional identity and to self

Psychometric Properties of a New Scale for Measuring Depression in People With a Learning Disability: The Glasgow Depression Scale for People With a Learning Disability (GDS-LD)

Objectives The aim of this study was to evaluate the effectiveness of an information leaflet regarding psychological therapy, which aims to increase patients' knowledge of what is expected of them and the therapist in treatment, and reduce anxiety and confusion. The leaflet is routinely sent to all new patients referred to the Psychology Department. Design A structured questionnaire was designed specifically for this survey and was distributed by post. Setting The study was undertaken in a Clinical Psychology Outpatient Department in Central Scotland. Participants 210 patients who had no previous experience of psychological treatment took part in the study. They were referred to the Clinical Psychology Department over a four month period (April 1999 - July 1999). Results 40% (n=84) of participants replied. Responses to the questionnaire indicated that the information leaflet had succeeded to an acceptable extent in achieving it's aims and that the majority of patients found it useful. Conclusion The information leaflet could be considered to be beneficial to patients waiting for psychological treatment. However, several areas of possible improvement were identified which may increase it's usefulness in the future

‘A bridge to normal’:A qualitative study of Indonesian women’s attendance in a phase two cardiac rehabilitation programme

Background:Cardiac rehabilitation is effective in reducing mortality and morbidity, in improving life expectancy and quality of life for people with cardiovascular disease. Despite these recognised benefits, women’s attendance rates in cardiac rehabilitation programmes remain suboptimal.Aims:This paper details the study that explored factors that influence women’s attendance of a phase two cardiac rehabilitation programme in IndonesiaMethods:An exploratory qualitative research design was used in the study. Semi-structured interviews were used as the main method of data collection. Data were collected from June to September 2016. Twenty-three women aged between 30 and 66 years were interviewed. Transcribed interview data were analysed using a qualitative framework analysis.Results:Three major themes were inferred from the analysis: (a) a bridge to normal; (b) connecting with others; and (c) contextual factors. The first theme is illustrated by two subthemes: ‘making my heart work again’ and ‘performing social roles’. The second theme was illustrated by the following subthemes: ‘exchanging knowledge and experience’ and ‘developing a give-and-take relationship’. The third theme was illustrated by three subthemes: ‘recommendations from the staff’, ‘family support’ and ‘availability of health insurance’.Conclusion:Women’s attendance in cardiac rehabilitation in Indonesia is mainly influenced by their expectations and desire to be able to resume their previous social roles in the family and society. The findings of this study can assist healthcare professionals to understand better the needs of women and the fit between women’s needs and existing cardiac rehabilitation programmes. Such understanding could provide direction for more effective approaches to the cardiac rehabilitation programmes that are currently offered in Indonesia