ABSTRACT
As policymakers consider how best to respond to increased labour market volatility in post-Covid-19 economies, there is concern that vulnerable groups such as lone parents may be left behind, and consensus that we need to develop more responsive and person-centred approaches to employability. Drawing on Cottam's (2011, 2018) work on ‘relational welfare', and the principles of the capabilities approach that underly it, this article discusses the experiences of unemployed lone parents and stakeholders involved in an innovative employability initiative operating across five localities in Scotland. We argue that relational approaches are valuable in supporting such vulnerable jobseekers to achieve outcomes that they have reason to value in terms of employability, learning, wellbeing and relationships (with balancing work and family relationships of particular importance for lone parents). We also discuss facilitators of, and challenges for, relational approaches to employability before identifying lessons for future policy. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
ABSTRACT
Introduction: Effective multidisciplinary team working enhances patient care and staff performance and reduces length of stay. In stroke services, this has recently been strained by challenges of staff shortages, team exhaustion and COVID-19, in addition to SSNAP data reporting responsibilities. Consequently, psychological distress has heightened in these healthcare workers. Understanding staff experiences in stroke team environments is crucial to staff retention, wellbeing, and reshaping effective multidisciplinary processes. Method(s): Clinical staff in emergency, hyperacute, and acute stroke units at our hospital were invited in May 2022 to complete an online questionnaire based on validated measures of teamwork, stress, and burnout. Result(s): Twenty-seven respondents represented across therapy, medical (29.6%), and nursing (29.6%) teams. Teamworking was rated as positive by most staff (63%), relating this to open communication and diverse, specialised stroke knowledge. Over 75% of the sample experienced moderate to high burnout, with prevalent experiences of emotional exhaustion. External pressures to meet SSNAP requirements was a time resource barrier that lowered sense of both personal achievement and input into directing work duties. Stress was in the severe-dangerous range for 37% of respondents. Key themes identified for improvement were opportunities for education and service development, and efficiency of knowledge sharing. Conclusion(s): Our multidisciplinary stroke teams reported high levels of stress and burnout, associated with challenging staff to patient ratios, and feeling professional autonomy is compromised to meet stroke service standards. Positive experiences of teamworking were viewed as partially protective against further distress escalations. Results highlight the critical need for novel implementations focusing on team support and development.
ABSTRACT
Introduction: EMGT is an effective, evidence based intervention for improving mobility outcomes in people with stroke. It enables highly repetitive stepping practice, in patients who are unable to stand/step. Despite being recommended in national guidance, adoption within the UK is extremely limited. We report preliminary data from its implementation in an NHS stroke service. Method(s): We initiated use of EMGT in our Acute Stroke Unit in November 2021 - implementation has been phased, and use was limited at times due to the COVID-19 pandemic. Patient demographics, clinical outcome measures and discharge information are recorded pre- and post-treatment. Result(s): To date, 38 patients have used EMGT, accumulating 232 sessions of walking. 74% of patients were male. . Mean age was 73.5 years (range 51 - 91). 19 patients used EMGT for >=3 sessions;of those, 14 completed > 6 sessions. Median Functional Ambulatory Category (FAC) at baseline was 0 (range 0-1), rising post treatment to 2 (range 0-4). Mean modified Rivermead Mobility Index rose from 13.5 to 24.3. 57% of patients who used EMGT as part of their rehabilitation programme were able to mobilise at least 10 metres post intervention. Initially, only 1 patient could manage a step transfer and following treatment this increased to 8. Conclusion(s): Early results indicate that EMGT is feasible in an acute NHS setting, alongside conventional care. It enables early and highly intensive mobilisation, resulting in improved function. Further work is required to develop clinical protocols, establishing recommended dose, time after stroke for EMGT initiation, and recommended duration of treatment.
ABSTRACT
Background: COVID-19 has caused significant upheaval in medical education. Ageism has profound adverse effects on the healthcare of older people and on the recruitment of geriatricians. It is unclear what effect the pandemic, with its focus on older vulnerable adults, may have had on students' attitudes to this population. We have used mixed methods to explore whether the COVID-19 pandemic has had a positive, negative or no change on medical students' attitudes towards older people. Methods: 2020 marked the final year of Bristol Medical School's MB16 curriculum, which was replaced with MB21. Whilst MB16 included just 4 weeks, MB21 involves an 18-week attachment in geriatrics. Two groups of students (5th year MB16, 4th year MB21) undergoing these different curricula were invited to participate in an online questionnaire study after their geriatrics attachments, collecting demographic and attitudinal information. We examined descriptive data and undertook multivariable logistic regression analysis to look at predictors of a positive attitude change. 12 students volunteered to participate in qualitative focus groups, of which anonymised transcripts were analysed using a framework approach. Results: 284 students responded to our survey: 115 MB16 and 169 MB21 (43% and 79% response rate respectively). One third answered that the COVID-19 pandemic had made them feel more positively towards older adults. In univariable analysis the only predictors were curriculum type, student age and survey timing. MB21 students were over twice as likely to report a positive change in attitude towards older people than MB16 students after adjustment for age and timing (OR 2.40, 95%CI 1.24-4.63, p=0.009). The main qualitative themes are that young people felt a duty to protect vulnerable older people during the pandemic. They also spoke of an increased awareness of aging and life for older people, particularly the experience of loneliness during coronavirus lockdowns. Conclusions: The most notable difference between MB16 and MB21 is an expansion in time dedicated to geriatric medicine during 4th year. Our work joins the growing body of evidence showing that quality undergraduate education in geriatric medicine can positively influence medical students' attitudes towards older adults, even during a global pandemic.