Journal of health services research & policy
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J Health Serv Res Policy · Jan 2011
Respecting patient autonomy: understanding the impact on NHS hospital in-patients of legislation and guidance relating to patient capacity and consent.
to determine the extent and nature of the decisions individuals are asked to make as in-patients, and whether doctors, nurses, other health care practitioners, and housekeepers engaged in routine (non-emergency) medical assessments, investigations and treatments, or acts of personal care observe the Reference Guide to Consent for Examination or Treatment, the principles of the Mental Capacity Act (England and Wales) 2005, and the guidance from the Dignity in Care Campaign. ⋯ patients were asked to make many varied decisions and the approaches taken by hospital staff differed depending on the nature of the decision and/or act in question. In contrast to personal care decisions, when health care practitioners approached patients in order to undertake routine acts of medical care, they generally did so in a manner that did not acknowledge that the patient had a right to exercise a choice. This is contrary to current law, policy and guidance. It seems to be rooted in the practical demands of running a hospital ward and uncertainties as to the purpose of securing patient consent before undertaking routine acts of medical care.
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J Health Serv Res Policy · Jan 2011
Storylines of self-management: narratives of people with diabetes from a multiethnic inner city population.
to analyse the narratives of people with diabetes to inform the design of culturally congruent self-management education programmes. ⋯ living with diabetes involves both medically recommended behaviours and complex biographical work to make sense of and cope with illness. Self-management education programmes should take closer account of over-arching storylines that pattern experience of chronic illness and recognize that some elements of self-management knowledge cannot be pre-specified in a structured curriculum.
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J Health Serv Res Policy · Jan 2011
Senior-friendly emergency department care: an environmental assessment.
to assess the environment of an emergency department (ED) and its impact on care of adults aged 75 and over, using a 'senior-friendly' conceptual framework that included the physical environment, social climate, hospital policies and procedures, and wider health care system. ⋯ the ED is an important part of seniors' health care. Changes to policy and practices, and enhanced education must occur to better meet the complex health care needs of seniors. This assessment provides a method that can be replicated elsewhere to generate site-specific recommendations and initiate capacity development processes to enhance senior-friendly care.
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J Health Serv Res Policy · Oct 2010
'Not quite Jericho, but more doors than there used to be'. Staff views of the impact of 'modernization' on boundaries around adult critical care services in England.
To explore staff perceptions of the impact of 'modernization' on the organization, delivery and culture of adult critical care services in England. 'Modernization' policies aimed to alter the boundaries around critical care and create a comprehensive, seamless service. ⋯ Policies to remove boundaries around adult critical care are perceived to have had a dramatic impact on the organization of the service. Considerable progress was reported towards developing comprehensive critical care services both within and between hospitals.