Claire Goodman | University of Hertfordshire (original) (raw)
Papers by Claire Goodman
British Journal of General Practice, 2011
Background Case management is widely promoted as a means of ensuring continuity of care, improvin... more Background Case management is widely promoted as a means of ensuring continuity of care, improving patient outcomes, and achieving efficient management of resources. Community matrons have been introduced recently as specialists in the case management of patients with multiple complex problems. Aim To understand how nurse case managers are seen by GPs and NHS managers.
Age and ageing, Jan 5, 2018
care home residents have high healthcare needs not fully met by prevailing healthcare models. Thi... more care home residents have high healthcare needs not fully met by prevailing healthcare models. This study explored how healthcare configuration influences resource use. a realist evaluation using qualitative and quantitative data from case studies of three UK health and social care economies selected for differing patterns of healthcare delivery to care homes. Four homes per area (12 in total) were recruited. A total of 239 residents were followed for 12 months to record resource-use. Overall, 181 participants completed 116 interviews and 13 focus groups including residents, relatives, care home staff, community nurses, allied health professionals and General Practitioners. context-mechanism-outcome configurations were identified explaining what supported effective working between healthcare services and care home staff: (i) investment in care home-specific work that legitimises and values work with care homes; (ii) relational working which over time builds trust between practitioner...
Objectives: Globally, populations are rapidly ageing and countries have developed health promotio... more Objectives: Globally, populations are rapidly ageing and countries have developed health promotion and wellbeing strategies to address increasing demand for health care and old-age support. The older population is not homogeneous however, and includes a large group in transition between being active and healthy to being frail, i.e. with early frailty. This review explores the extent to which policy in England has addressed this group with a view to supporting independence and preventing further progression towards frailty. Methods: A narrative review was conducted of 157 health and social care policy documents current in 2014–2017 at three levels of the health and social care system in England. Findings: We report the policy problem analysis, the shifts over time in language from health promotion to illness prevention, the shift in target populations to mid-life and those most at risk of adverse outcomes through frailty, and changes to delivery mechanisms to incentivize attention to the frailest rather than those with early frailty. We found that older people in general were not identified as a specific population in many of these policies. While this may reflect a welcome lack of age discrimination, it could equally represent omission through ageism. Only at local level did we identify some limited attention to preventative actions with people with early frailty. Conclusion: The lack of policy attention to older people with early frailty is a missed opportunity to address some of the demands on health and social care services. Addressing the individual and societal consequences of adverse experiences of those with the greatest frailty should not distract from a more distinct public health perspective which argues for a refocusing upstream to health promotion and illness prevention for those with early frailty.
BMC Health Services Research, 2011
Background: In the UK there are almost three times as many beds in care homes as in National Heal... more Background: In the UK there are almost three times as many beds in care homes as in National Health Service (NHS) hospitals. Care homes rely on primary health care for access to medical care and specialist services. Repeated policy documents and government reviews register concern about how health care works with independent providers, and the need to increase the equity, continuity and quality of medical care for care homes. Despite multiple initiatives, it is not known if some approaches to service delivery are more effective in promoting integrated working between the NHS and care homes. This study aims to evaluate the different integrated approaches to health care services supporting older people in care homes, and identify barriers and facilitators to integrated working. Methods: A systematic review was conducted using Medline (PubMed), CINAHL, BNI, EMBASE, PsycInfo, DH Data, Kings Fund, Web of Science (WoS incl. SCI, SSCI, HCI) and the Cochrane Library incl. DARE. Studies were included if they evaluated the effectiveness of integrated working between primary health care professionals and care homes, or identified barriers and facilitators to integrated working. Studies were quality assessed; data was extracted on health, service use, cost and process related outcomes. A modified narrative synthesis approach was used to compare and contrast integration using the principles of framework analysis. Results: Seventeen studies were included; 10 quantitative studies, two process evaluations, one mixed methods study and four qualitative. The majority were carried out in nursing homes. They were characterised by heterogeneity of topic, interventions, methodology and outcomes. Most quantitative studies reported limited effects of the intervention; there was insufficient information to evaluate cost. Facilitators to integrated working included care home managers' support and protected time for staff training. Studies with the potential for integrated working were longer in duration.
International Journal of Older People Nursing
Recently completed work examining the use of emergency ambulance services in the East of England ... more Recently completed work examining the use of emergency ambulance services in the East of England indicates that at least 15% of call-outs to patients aged 75+ are to OPWD and close to 60% of call-outs to OPWD resident in care homes do not result in an unscheduled hospital admission. Currently East of England Ambulance Service (EEAS) alongside Cambridge Community Services (CCS), are piloting an innovative paramedic and therapy led service (AGIS), which aims to deliver holistic, person-centred assessment and intervention for older people with urgent care needs, wrapping care around the person in the most appropriate setting. Our research programme "Research into Older people with Dementia and their use of Emergency ambulance Services" (RODES), developed in close collaboration with EEAS Elderly Care Lead, takes a four-pronged approach including evidence review, audit of routinely collected data, qualitative interviews using critical incident technique and a case study of the ...
Emergency Medicine Journal, 2015
Does dementia matter: Is dementia an important factor in 999 callouts to older people? NIHR CLAHR... more Does dementia matter: Is dementia an important factor in 999 callouts to older people? NIHR CLAHRC East of England Policy Context : Prime Minister's challenge on dementia 2012 ,The NHS Five Year Forward View, NHS England Urgent and Emergency Care Review… Service context: major pressures on emergency services, constant innovation, multiple pilots, risk of reinvention, need for evidence base…..
Literature search, all published and grey (primary care) and e-scoping. Review and analysis of ma... more Literature search, all published and grey (primary care) and e-scoping. Review and analysis of material focusing on nursing enterprise in non-acute care sector and international settings, female and social entrepreneurship. Expert seminar presentations Development of search strategy including e-scoping, review and analysis of material focusing on nursing enterprise in non-acute care sector and international settings, female entrepreneurship and policy development General application of entrepreneurship theory and practice to both the research and the report, and broader contextualisation of this in relation to the recent developments in health care
BMJ Open, 2015
Faecal incontinence (FI) is the involuntary loss of liquid or solid stool that is a social or hyg... more Faecal incontinence (FI) is the involuntary loss of liquid or solid stool that is a social or hygienic problem. The prevalence of FI in residents of care homes is high, but it is not an inevitable consequence of old age or dementia. There is good evidence on risk factors, but few studies provide evidence about effective interventions. There is a need to understand how, why, and in what circumstances particular programmes to reduce and manage FI are effective (or not) for people with dementia. The purpose of this review is to identify which (elements of the) interventions could potentially be effective, and examine the barriers and facilitators to the acceptability, uptake and implementation of interventions designed to address FI in people with dementia who are resident in care homes. A realist synthesis approach to review the evidence will be used which will include studies on continence, person-centred care, implementation research in care homes, workforce and research on care home culture. An iterative four-stage approach is planned. Phase 1: development of an initial programme theory or theories that will be 'tested' through a first scoping of the literature and consultation with five stakeholder groups (care home providers, user representatives, academics and practice educators, clinicians with a special interest in FI and continence specialists). Phase 2: a systematic search and analysis of published and unpublished evidence to test and develop the programme theories identified in phase 1. Phase 3: validation of programme theory/ies with a purposive sample of participants from phase 1. The overall protocol does not require ethical review. The University research ethics committee will review interviews conducted as part of phase 1 and 3. The final fourth phase will synthesise and develop recommendations for practice and develop testable hypotheses for further research.
International journal of nursing studies
The older person with dementia has a limited life expectancy and the dying trajectory can be prot... more The older person with dementia has a limited life expectancy and the dying trajectory can be protracted and unpredictable. For good end-of-life care, early communication, exploration of residents' wishes, and identification of someone who can represent them, are important. In care homes the timing of these discussions, and who is involved is variable. Person-centred approaches to dementia care assume that people with dementia can actively participate in decisions about their lives. Less well understood is how this can inform end-of-life care decision making and complement information provided in advance care plans completed prior to, or at the point of admission to a care home. To explore how older people with dementia discuss their priorities and preferences for end-of-life care. An exploratory, qualitative study that used guided conversations with 18 people with dementia, living in six care homes. Participants were asked about their life in the care home, their health, thought...
International Journal of Geriatric Psychiatry
The goals of this study are to describe end-of-life care costs of older people with dementia (OPW... more The goals of this study are to describe end-of-life care costs of older people with dementia (OPWD) residents in care homes (CHs) with no on-site nursing and evaluate the economic case for an intervention designed to improve end-of-life care for OPWD in CHs. Phase 1 tracked for a year, from March 2009, health services received by 133 OPWD in six residential CHs in the East of England. CH and resident characteristics were obtained through standardised assessment tools, interviews with CH managers and publicly available information from the independent regulator of social care services in England. Phase 2 used a modified Appreciative Inquiry intervention that ran for 6 months from January 2011, in three of the six CHs. Wilcoxon matched-pairs sign-rank tests were conducted to compare total cost and cost components during Phases 1 and 2 for those residents who had participated in both. Costs for each resident in Phase 1 were about £2800 per month, including service, accommodation and me...
Primary Health Care Research & Development
To understand the effects of Nurse Case Managers (NCMs) working in primary care in the English Na... more To understand the effects of Nurse Case Managers (NCMs) working in primary care in the English National Health Service (NHS) from multiple perspectives and how this new role impacts on social workers, this paper reports and discusses findings from a multi-level study of the role of NCMs working in primary care in the English NHS. Case management as understood by the NHS is equivalent to key-worker type care management as understood by social workers. However, English health and social services are separately organised with different organisational principles; health services are free at the time of need, whereas social services are means-tested and access is restricted. The study included reviews of evaluations and policy, a national survey of nurse case management in Primary Care Trusts (PCTs) and case studies in three purposively selected PCTs. The views and experiences of patients were collected through face-to-face and telephone interviews with 51 older people and their carers, ...
BMC Health Services Research
Most services provided by health and social care organisations for older people living at home re... more Most services provided by health and social care organisations for older people living at home rely on interprofessional working (IPW). Although there is research investigating what supports and inhibits how professionals work together, less is known about how different service models deliver care to older people and how effectiveness is measured. The aim of this study was to describe how IPW for older people living at home is delivered, enacted and evaluated in England. An online survey of health and social care managers across England directly involved in providing services to older people, and a review of local strategies for older people services produced by primary care organisations and local government adult services organisations in England. The online survey achieved a 31% response rate and search strategies identified 50 local strategies that addressed IPW for older people living at home across health and social care organisations. IPW definitions varied, but there was an ...
Health & Social Care in the Community
Health and social care policy in the UK advocates inter-professional working (IPW) to support old... more Health and social care policy in the UK advocates inter-professional working (IPW) to support older people with complex and multiple needs. Whilst there is a growing understanding of what supports IPW, there is a lack of evidence linking IPW to explicit outcomes for older people living in the community. This review aimed to identify the models of IPW that provide the strongest evidence base for practice with community dwelling older people. We searched electronic databases from 1 January 1990-31 March 2008. In December 2010 we updated the findings from relevant systematic reviews identified since 2008. We selected papers describing interventions that involved IPW for community dwelling older people and randomised controlled trials (RCT) reporting user-relevant outcomes. Included studies were classified by IPW models (Case Management, Collaboration and Integrated Team) and assessed for risk of bias. We conducted a narrative synthesis of the evidence according to the type of care (int...
Palliative medicine, 2015
British journal of community nursing, 2012
British journal of community nursing, 2002
This article describes the evaluation of a scheme to improve communication between primary care n... more This article describes the evaluation of a scheme to improve communication between primary care nurses and newly established primary care groups. Findings suggest that the successes of the scheme were in part attributable to the appointment of experienced practitioners to a facilitator/link nurse role and the sustained support of the scheme by the NHS community trust. The article concludes by suggesting that, in a time of constant change within primary care, innovations such as these contribute to the development of practitioner participation in the organization and delivery of primary care services.
Health & Social Care in the Community, 2015
What is known about this topic • Worldwide, there are high numbers of family members caring for p... more What is known about this topic • Worldwide, there are high numbers of family members caring for people with dementia. Caring for a person with dementia may have significant impacts on the health and well-being of family carers. The reviews of community-based support for carers of people with dementia included 155 studies but, in general, evidence that interventions reduced caregiver depression or burden was weak, although psychosocial and educational interventions may reduce depression in carers. Community support for carers of people with dementia, such as that provided by Admiral Nurses, is valued by family carers, but the impact of such initiatives is not clearly established.
European Journal of Emergency Medicine, 2015
British Journal of General Practice, 2011
Background Case management is widely promoted as a means of ensuring continuity of care, improvin... more Background Case management is widely promoted as a means of ensuring continuity of care, improving patient outcomes, and achieving efficient management of resources. Community matrons have been introduced recently as specialists in the case management of patients with multiple complex problems. Aim To understand how nurse case managers are seen by GPs and NHS managers.
Age and ageing, Jan 5, 2018
care home residents have high healthcare needs not fully met by prevailing healthcare models. Thi... more care home residents have high healthcare needs not fully met by prevailing healthcare models. This study explored how healthcare configuration influences resource use. a realist evaluation using qualitative and quantitative data from case studies of three UK health and social care economies selected for differing patterns of healthcare delivery to care homes. Four homes per area (12 in total) were recruited. A total of 239 residents were followed for 12 months to record resource-use. Overall, 181 participants completed 116 interviews and 13 focus groups including residents, relatives, care home staff, community nurses, allied health professionals and General Practitioners. context-mechanism-outcome configurations were identified explaining what supported effective working between healthcare services and care home staff: (i) investment in care home-specific work that legitimises and values work with care homes; (ii) relational working which over time builds trust between practitioner...
Objectives: Globally, populations are rapidly ageing and countries have developed health promotio... more Objectives: Globally, populations are rapidly ageing and countries have developed health promotion and wellbeing strategies to address increasing demand for health care and old-age support. The older population is not homogeneous however, and includes a large group in transition between being active and healthy to being frail, i.e. with early frailty. This review explores the extent to which policy in England has addressed this group with a view to supporting independence and preventing further progression towards frailty. Methods: A narrative review was conducted of 157 health and social care policy documents current in 2014–2017 at three levels of the health and social care system in England. Findings: We report the policy problem analysis, the shifts over time in language from health promotion to illness prevention, the shift in target populations to mid-life and those most at risk of adverse outcomes through frailty, and changes to delivery mechanisms to incentivize attention to the frailest rather than those with early frailty. We found that older people in general were not identified as a specific population in many of these policies. While this may reflect a welcome lack of age discrimination, it could equally represent omission through ageism. Only at local level did we identify some limited attention to preventative actions with people with early frailty. Conclusion: The lack of policy attention to older people with early frailty is a missed opportunity to address some of the demands on health and social care services. Addressing the individual and societal consequences of adverse experiences of those with the greatest frailty should not distract from a more distinct public health perspective which argues for a refocusing upstream to health promotion and illness prevention for those with early frailty.
BMC Health Services Research, 2011
Background: In the UK there are almost three times as many beds in care homes as in National Heal... more Background: In the UK there are almost three times as many beds in care homes as in National Health Service (NHS) hospitals. Care homes rely on primary health care for access to medical care and specialist services. Repeated policy documents and government reviews register concern about how health care works with independent providers, and the need to increase the equity, continuity and quality of medical care for care homes. Despite multiple initiatives, it is not known if some approaches to service delivery are more effective in promoting integrated working between the NHS and care homes. This study aims to evaluate the different integrated approaches to health care services supporting older people in care homes, and identify barriers and facilitators to integrated working. Methods: A systematic review was conducted using Medline (PubMed), CINAHL, BNI, EMBASE, PsycInfo, DH Data, Kings Fund, Web of Science (WoS incl. SCI, SSCI, HCI) and the Cochrane Library incl. DARE. Studies were included if they evaluated the effectiveness of integrated working between primary health care professionals and care homes, or identified barriers and facilitators to integrated working. Studies were quality assessed; data was extracted on health, service use, cost and process related outcomes. A modified narrative synthesis approach was used to compare and contrast integration using the principles of framework analysis. Results: Seventeen studies were included; 10 quantitative studies, two process evaluations, one mixed methods study and four qualitative. The majority were carried out in nursing homes. They were characterised by heterogeneity of topic, interventions, methodology and outcomes. Most quantitative studies reported limited effects of the intervention; there was insufficient information to evaluate cost. Facilitators to integrated working included care home managers' support and protected time for staff training. Studies with the potential for integrated working were longer in duration.
International Journal of Older People Nursing
Recently completed work examining the use of emergency ambulance services in the East of England ... more Recently completed work examining the use of emergency ambulance services in the East of England indicates that at least 15% of call-outs to patients aged 75+ are to OPWD and close to 60% of call-outs to OPWD resident in care homes do not result in an unscheduled hospital admission. Currently East of England Ambulance Service (EEAS) alongside Cambridge Community Services (CCS), are piloting an innovative paramedic and therapy led service (AGIS), which aims to deliver holistic, person-centred assessment and intervention for older people with urgent care needs, wrapping care around the person in the most appropriate setting. Our research programme "Research into Older people with Dementia and their use of Emergency ambulance Services" (RODES), developed in close collaboration with EEAS Elderly Care Lead, takes a four-pronged approach including evidence review, audit of routinely collected data, qualitative interviews using critical incident technique and a case study of the ...
Emergency Medicine Journal, 2015
Does dementia matter: Is dementia an important factor in 999 callouts to older people? NIHR CLAHR... more Does dementia matter: Is dementia an important factor in 999 callouts to older people? NIHR CLAHRC East of England Policy Context : Prime Minister's challenge on dementia 2012 ,The NHS Five Year Forward View, NHS England Urgent and Emergency Care Review… Service context: major pressures on emergency services, constant innovation, multiple pilots, risk of reinvention, need for evidence base…..
Literature search, all published and grey (primary care) and e-scoping. Review and analysis of ma... more Literature search, all published and grey (primary care) and e-scoping. Review and analysis of material focusing on nursing enterprise in non-acute care sector and international settings, female and social entrepreneurship. Expert seminar presentations Development of search strategy including e-scoping, review and analysis of material focusing on nursing enterprise in non-acute care sector and international settings, female entrepreneurship and policy development General application of entrepreneurship theory and practice to both the research and the report, and broader contextualisation of this in relation to the recent developments in health care
BMJ Open, 2015
Faecal incontinence (FI) is the involuntary loss of liquid or solid stool that is a social or hyg... more Faecal incontinence (FI) is the involuntary loss of liquid or solid stool that is a social or hygienic problem. The prevalence of FI in residents of care homes is high, but it is not an inevitable consequence of old age or dementia. There is good evidence on risk factors, but few studies provide evidence about effective interventions. There is a need to understand how, why, and in what circumstances particular programmes to reduce and manage FI are effective (or not) for people with dementia. The purpose of this review is to identify which (elements of the) interventions could potentially be effective, and examine the barriers and facilitators to the acceptability, uptake and implementation of interventions designed to address FI in people with dementia who are resident in care homes. A realist synthesis approach to review the evidence will be used which will include studies on continence, person-centred care, implementation research in care homes, workforce and research on care home culture. An iterative four-stage approach is planned. Phase 1: development of an initial programme theory or theories that will be 'tested' through a first scoping of the literature and consultation with five stakeholder groups (care home providers, user representatives, academics and practice educators, clinicians with a special interest in FI and continence specialists). Phase 2: a systematic search and analysis of published and unpublished evidence to test and develop the programme theories identified in phase 1. Phase 3: validation of programme theory/ies with a purposive sample of participants from phase 1. The overall protocol does not require ethical review. The University research ethics committee will review interviews conducted as part of phase 1 and 3. The final fourth phase will synthesise and develop recommendations for practice and develop testable hypotheses for further research.
International journal of nursing studies
The older person with dementia has a limited life expectancy and the dying trajectory can be prot... more The older person with dementia has a limited life expectancy and the dying trajectory can be protracted and unpredictable. For good end-of-life care, early communication, exploration of residents' wishes, and identification of someone who can represent them, are important. In care homes the timing of these discussions, and who is involved is variable. Person-centred approaches to dementia care assume that people with dementia can actively participate in decisions about their lives. Less well understood is how this can inform end-of-life care decision making and complement information provided in advance care plans completed prior to, or at the point of admission to a care home. To explore how older people with dementia discuss their priorities and preferences for end-of-life care. An exploratory, qualitative study that used guided conversations with 18 people with dementia, living in six care homes. Participants were asked about their life in the care home, their health, thought...
International Journal of Geriatric Psychiatry
The goals of this study are to describe end-of-life care costs of older people with dementia (OPW... more The goals of this study are to describe end-of-life care costs of older people with dementia (OPWD) residents in care homes (CHs) with no on-site nursing and evaluate the economic case for an intervention designed to improve end-of-life care for OPWD in CHs. Phase 1 tracked for a year, from March 2009, health services received by 133 OPWD in six residential CHs in the East of England. CH and resident characteristics were obtained through standardised assessment tools, interviews with CH managers and publicly available information from the independent regulator of social care services in England. Phase 2 used a modified Appreciative Inquiry intervention that ran for 6 months from January 2011, in three of the six CHs. Wilcoxon matched-pairs sign-rank tests were conducted to compare total cost and cost components during Phases 1 and 2 for those residents who had participated in both. Costs for each resident in Phase 1 were about £2800 per month, including service, accommodation and me...
Primary Health Care Research & Development
To understand the effects of Nurse Case Managers (NCMs) working in primary care in the English Na... more To understand the effects of Nurse Case Managers (NCMs) working in primary care in the English National Health Service (NHS) from multiple perspectives and how this new role impacts on social workers, this paper reports and discusses findings from a multi-level study of the role of NCMs working in primary care in the English NHS. Case management as understood by the NHS is equivalent to key-worker type care management as understood by social workers. However, English health and social services are separately organised with different organisational principles; health services are free at the time of need, whereas social services are means-tested and access is restricted. The study included reviews of evaluations and policy, a national survey of nurse case management in Primary Care Trusts (PCTs) and case studies in three purposively selected PCTs. The views and experiences of patients were collected through face-to-face and telephone interviews with 51 older people and their carers, ...
BMC Health Services Research
Most services provided by health and social care organisations for older people living at home re... more Most services provided by health and social care organisations for older people living at home rely on interprofessional working (IPW). Although there is research investigating what supports and inhibits how professionals work together, less is known about how different service models deliver care to older people and how effectiveness is measured. The aim of this study was to describe how IPW for older people living at home is delivered, enacted and evaluated in England. An online survey of health and social care managers across England directly involved in providing services to older people, and a review of local strategies for older people services produced by primary care organisations and local government adult services organisations in England. The online survey achieved a 31% response rate and search strategies identified 50 local strategies that addressed IPW for older people living at home across health and social care organisations. IPW definitions varied, but there was an ...
Health & Social Care in the Community
Health and social care policy in the UK advocates inter-professional working (IPW) to support old... more Health and social care policy in the UK advocates inter-professional working (IPW) to support older people with complex and multiple needs. Whilst there is a growing understanding of what supports IPW, there is a lack of evidence linking IPW to explicit outcomes for older people living in the community. This review aimed to identify the models of IPW that provide the strongest evidence base for practice with community dwelling older people. We searched electronic databases from 1 January 1990-31 March 2008. In December 2010 we updated the findings from relevant systematic reviews identified since 2008. We selected papers describing interventions that involved IPW for community dwelling older people and randomised controlled trials (RCT) reporting user-relevant outcomes. Included studies were classified by IPW models (Case Management, Collaboration and Integrated Team) and assessed for risk of bias. We conducted a narrative synthesis of the evidence according to the type of care (int...
Palliative medicine, 2015
British journal of community nursing, 2012
British journal of community nursing, 2002
This article describes the evaluation of a scheme to improve communication between primary care n... more This article describes the evaluation of a scheme to improve communication between primary care nurses and newly established primary care groups. Findings suggest that the successes of the scheme were in part attributable to the appointment of experienced practitioners to a facilitator/link nurse role and the sustained support of the scheme by the NHS community trust. The article concludes by suggesting that, in a time of constant change within primary care, innovations such as these contribute to the development of practitioner participation in the organization and delivery of primary care services.
Health & Social Care in the Community, 2015
What is known about this topic • Worldwide, there are high numbers of family members caring for p... more What is known about this topic • Worldwide, there are high numbers of family members caring for people with dementia. Caring for a person with dementia may have significant impacts on the health and well-being of family carers. The reviews of community-based support for carers of people with dementia included 155 studies but, in general, evidence that interventions reduced caregiver depression or burden was weak, although psychosocial and educational interventions may reduce depression in carers. Community support for carers of people with dementia, such as that provided by Admiral Nurses, is valued by family carers, but the impact of such initiatives is not clearly established.
European Journal of Emergency Medicine, 2015