Thesis and Research Data Repository Leeds Beckett University
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Understanding the care and support needs of nursing home residents with dementia and comorbid cancer
No full textBackground
Due to an ageing population, and the increasing prevalence of older adults living with comorbidities, a growing proportion of people are living with dementia and comorbid cancer (DCC) in nursing homes (NH). People with DCC are diagnosed at a later stage, receive less treatment, and have poorer survival. Very few studies, and none in the United Kingdom, have examined the care and support needs of people with DCC living in nursing homes (NH).
Aims
The aims of this thesis are: (1) what are the care and support needs of people with DCC living in NHs; (2) what are the barriers and facilitators to high-quality, person-centred care (PCC) for this resident group?; and (3) what are the target areas and outcomes for a future intervention to support and improve PCC for this group.
Methods
Across five NHs I conducted: (1) interviews with 14 staff members and healthcare professionals, and 5 family caregivers; and (2) ethnographic observations (a) following the care experiences of 7 residents with DCC (approx. 90-hours over 10-months), and (b) broader NH observations (approx. 170-hours over 10-months). This research draws on aspects of the Cumulative Complexity Model (CCM) with an in-depth exploration of the Burden of Treatment (BOT) and Illness (BOI) placed on family caregivers, NH staff and residents with DCC.
Results
Four main themes were identified: (1) Complexity of decision-making– a collaboration of views from a resident’s care triad was crucial to determine the most appropriate care outcome for a resident; (2) Obstacles to accessing oncology services– generally, gaining an early cancer diagnosis is deemed both desirable and best practice in terms of its management. For most residents with severe dementia, physical and well-being factors showed receiving a diagnosis or treatment was not the most appropriate care route for this population; (3) Balancing delivery of dementia and cancer care – due to staffs’ incomplete knowledge about a resident’s cancer and how to manage this, their condition was often overlooked in care documentation and practice. Thus, a resident’s cancer was overshadowed by their dementia; (4) Consequences of dementia-orientated care for residents with cancer – if dementia-related care needs were prioritised, there was a higher risk of cancer symptoms being overlooked, inefficiently managed, or misattributed to a resident’s dementia.
Conclusion
Care and support inequalities are an identified risk for people with DCC in NHs for whom attending hospital to gain a formal cancer diagnosis is not feasible or in their best interests. This includes the risk of diagnostic overshadowing and heightened cancer-related symptoms that could lead to an emergency presentation. Recommendations for practice have included establishing ceilings of care with a resident’s care triad, outlining the logistics of accessing oncology services at the point of referral for residents that require hospital support, implementing areas in care plans to include a suspected diagnosis of cancer and related needs, utilise pain assessment tools to support cancer pain management, establish communication pathways with specialist palliative care teams and identify gaps in knowledge for nursing home staff to provide appropriate symptom management.</p
Modern Slavery Survivor Pathways: A Critique of UK Policy, Legislation and Practice
No full textThis thesis examines the Modern Slavery survivor pathway from intervention to recovery and assesses the support systems available to survivors throughout this process. It also explores links to other traumatic crimes and investigates how the role of “witness” in the criminal justice system impacts survivors’ experiences. The work showcases findings from interviews with frontline practitioners alongside analysis of Government publications and independent reports.
This research builds on existing literature and draws on a range of sources to develop a broad and detailed picture of the survivor support system in the UK. Against this backdrop, the thesis offers a unique perspective based on the experiences of frontline practitioners within the survivor support system and provides a holistic contribution to the current body of work in this field.
This thesis posits that the current Modern Slavery legal framework is failing survivors of this horrific crime. The UK Government is falling short of its commitment to protect and support survivors and much of the financial cost of support is subsidised through the voluntary sector’s own fundraising efforts. Combined with a greater Governmental focus on immigration enforcement, many survivors end up homeless or in immigration detention. Poor monitoring and communication practices mean that many survivor outcomes are not known at all.
The findings emphasise the importance of holistic care pathways with a consistent, benchmark standard of support across all services, including advocacy for each individual. The thesis further argues that the UK Government needs to extend its anti-slavery efforts towards long-term support and understanding of survivor needs, which should include a focus on survivor narratives and input. This would not only improve recovery outcomes but would advance the criminal justice process in this area through witness retention and stronger evidence.</p
Achieving supply chain resilience within the offsite construction sector: A review of success factors
No full textThe modern construction supply chains (SCs) are extended over hundreds and thousands of miles, making them overexposed to various risks with distinct levels of probabilities and magnitudes. The modern trend of offsite construction has been highlighted as the panacea for some of the illnesses currently faced by industry, including the environmental emergency, fragmentation of the industry, high uncertainty within construction markets, and the continuous need for uplifting performance of the built assets. Focusing on the offsite construction industry (OC), this paper aims to review the available literature in order to investigate how supply chain resilience (SCR) is an essential concept to adopt by the entities operating within the sector, highlighting the different factors affecting this adoption. The results revealed 96 critical factors that affect the degree of adoption and successful application of SCR for entities operating within the OC sector. On the one hand, these factors are categorised under six constructs of SCR failure: Environmental, Financial, Procedural, Project Organizational factors, Supplier/customer and Technological. On the other hand, 12 constructs of SCR success factors: Adaptability, Anticipation, Capacity, Collaboration, Dispersion, Efficiency, Financial, Flexibility, Market position, Recovery, Security, Visibility. This paper is beneficial in introducing prior knowledge on SCs to the OC sector by identifying and promoting success and failure factors in a collective manner. This knowledge provides guidance to industry practitioners on how to assess the levels of their criticality, seek improvements, and identify the most suitable ways to properly integrate them into supply chain processes in the OC industry.</p
A Systematic Review of Responsible Sourcing Literature Across the Architecture, Engineering and Construction (AEC) Sector of the UK
No full textThe UK’s strategy for sustainable construction has raised concerns over the plethora of negative environmental impacts related to the architecture, engineering, and construction (AEC) sector. The introduction of policy documents (including the Construction Playbook) provides challenging targets for the AEC sector in relation to climate change, carbon impact and social value. Thus, construction and its associated processes, in order to respond, must transform to meet with expectations. Several tools are proposed in support of this change, which include green supply chain management (GSCM) and responsible sourcing (RS). The aim of this study is to provide a systematic review of literature and research with a focus on the UK’s AEC sector to identify the benefits and barriers to these practices and highlight opportunities for uptake. The PRISMA review process was used to identify, screen, and select (n=50) articles included in the review. Comprehensive document analysis reveals the most frequently reported benefits relating to the uptake of responsible sourcing were: (i) stakeholder value (44%); (ii) improved supply chain performance (42%) and (iii) competitive advantage (34%); whereas the most frequently reported barriers were: (i) cost (46%); (ii) lack of awareness (28%); and (iii) industry constraints (22%). To surmise, responsible sourcing clearly aligns with UK policies and AEC sector targets. However, the barriers remain an issue that must be addressed to effectively convert construction towards a sustainable future. It is, therefore, recommended that further investigation into the adoption of sustainable behaviours is undertaken. It is also recommended that support be provided by frameworks and public spending to allow tangible case studies proving the relevance and effectiveness of RS and GSCM.</p
How Does UK Corporate Management Select and Measure Innovation in the Construction Industry?
No full textSpeed and quality of innovation has become crucial to surviving in highly competitive markets. Indeed, some argue that innovation should be embedded within corporate culture, rather than being delivered within a process of ad-hoc events. Furthermore, the organization’s ability to innovate is increasingly recognized as a key factor for sustainability, competitiveness, economic success, well-being, and the development of society. However, without the ability to observe, measure and reflect on the management of innovation, the ability to implement good corporate strategy is limited. The work reported will gain direct insight to the practices and methods used to capture and measure corporate innovation operations in UK construction, with the aim of developing a framework that captures and defines a practical process for measuring and valuing innovation. A systematic review of literature has been undertaken to identify the key attributes of corporate innovation that may be measured, interviews will be undertaken to identify literature outside of the academic field that might inform the work. It is expected that case studies will follow to collect rich strategic data that provides a unique and valuable contribution to knowledge. Following a study and analysis of the data, methods will be presented for better understanding of those metrics and measures used when assessing the value of innovation at a corporate level. This stage also includes a review of the literature and initial interviews in the field of innovation operation measurements outside of academia. Early results suggest innovation is far too important to be managed without accurate measurements. Metrics drive behaviour and “what gets measured gets done.” Innovation indicators should be selected, and their metrics should be designed and used to manage company’s evolution, to achieve better alignment with business strategies and nourish a culture of entrepreneurship that results in improved corporate success.</p
Improving decision-making in smaller local authorities to facilitate Net Zero Delivery - Practitioner insights
No full textLocal authorities in the UK face significant challenges to meet Net Zero targets since they are endeavouring to take on a diversity of roles including being investors in Renewable Energy (RE). They must work within defined legal, constitutional and democratic decision-making structures but without a unifying Central Government regulatory or policy mandate. Much of the research and evidence presented in the literature draws upon the experiences of larger urban local authorities in the single (Unitary) or upper tier of the two-tier structure where most investment will be needed to tackle Net Zero. This paper tries to provide a smaller local authority perspective to Net Zero, with specific attention on RE investment decision-making, drawing on 25 semi?structured interviews with local authority staff involved in Net Zero policy and delivery across the East of England. The research reveals insights highlighting the impact on how RE decisions are made because of political decision-takers' understanding of the Climate Change and Net Zero, different staffing levels and functional approaches to managing Net Zero activity, and complex and time-consuming decision-making processes recognizing the importance of upholding democratic principles of transparency and accountability. Some councils in the study area have managed to streamline their decision-making processes by creating more effective and coherent investment and delivery mechanisms. Recommendations are made in the paper to help smaller local authorities improve their effectiveness at investment decision-making as part of RE delivery with wider implications for central government Net Zero policy and delivery at local level.</p
The Wonderful Wizard of Decarbonisation - Lived–Experiences on the Green Brick Road
No full textNet zero carbon initiatives and decarbonisation are gaining popularity as approaches that hold a promise to mobilise government, business, and civic action towards addressing concerns over the climate emergency. The UK Government has set challenging targets in terms of carbon reduction and is pursuing wide–scale net zero interventions through local industrial strategies supported by the national and international funding programmes. SMEs are increasingly becoming a focus of funded business support towards decarbonisation. So how are the SMEs responding to decarbonisation interventions? What are the intended and un–intended consequences of decarbonisation in a small or medium size business context? This study sets out to ascertain, through a phenomenological lens, how SMEs are discovering what net zero carbon ambitions look like within their businesses, how they are approaching decarbonisation and what are the impacts of the decarbonisation initiatives undertaken. Six SMEs from a variety of sectors in the East Midlands (UK), in receipt of support from an on–going ERDF funded project, were interviewed for this study. Participants were asked to share experiences in terms of their initial perspective on what net zero business would look like and to consider the support they received. The decarbonisation journeys and the outcomes were explored with the emphasis on the practices and participants, and the planned and achieved carbon reduction outcomes. The decarbonisation journey through the project is examined in three phases: before, during and after the journey. The role of the external assistance in the journey to net zero was also explored as part of the study. Interpretative analysis of all the interview transcripts revealed three overarching themes: (i) Technology is a significant enabler of decarbonisation; (ii) Data is essential to enable positive change to happen; and (iii) Business support is important for the uptake of the decarbonisation initiatives. Therefore, based on this information, the study surmises that companies need external guidance to make the decarbonisation actions possible, which includes provision of data and a sounding board for ideas, plus extra funding and assistance are needed to achieve the targets set by the UK Government.</p
Agricultural Construction in Ireland: Issues and Strategies Concerning Substandard Farm Building Developments
No full textThe construction industry in Ireland is heavily regulated, and typically abides by a rigorous planning process with strict rules and regulations. However, one area that has been subject to much scrutiny and confusion is agricultural construction, which has been described as a law unto itself. It fails to meet construction standards set by most other sectors, and this is evident throughout the country. Therefore, the purpose of this study is to investigate Irish planning and construction procedures within an agricultural context. It aims to unearth reasons why, despite recurrent, and sometimes fatal accidents, the agricultural construction industry is permitted to continue using alternative, more lenient regulations, compared to other building sectors throughout Ireland. A mixed methods research approach is adopted, incorporating both qualitative and quantitative analysis. Following a descriptive literature review, four individual interviews with participants from diverse agricultural backgrounds are undertaken, followed by a confirmatory questionnaire survey. This approach is implemented due to limited previous research on the topic and allows for greater scope during data collection. The results indicate that themes such as a lack of funding, cultural issues, inexperienced personnel, and weak existing legislation are recurrent issues evident throughout the study. Strategies to counteract the identified issues include more government funding such as grant aided schemes for farmers, stricter planning procedures to adhere to, and more formal training for planning inspectors and officials. Ultimately, the key contribution of this study illustrates that the current system is no longer fit for purpose, and identifies key issues and weaknesses, as well as outlining various strategies to develop and improve planning and construction processes, for agricultural construction developments in Ireland</p
The Rise of the Micro-Influencer as a New Form of Marketing in Neoliberal Times
No full textIn late modern times, a social media ‘influencer’ is considered an individual who has a large follower count with the ability to convince their followers that they should purchase the products that they received for free. Marketers state, according to Dean Hund (2019: 80), that ‘the minimum number of followers across their combined social networks is 50,000 before we consider them’. This implies that social media profiles are only of any value to brands when they have a large follower count. But what if this is no longer the case? Brands have now evolved so that even online presences with small followings, or nano-influencers, are being utilised with the purpose of influencing others to buy into their personal and cultural interests. Berne-Manero and Marzo-Navarro (2020: 14) found that nano-influencers ‘tend to have between 1,000 and 10,000 followers on each platform’ and ‘often have a small audience but high engagement in relativity’. This essay will explore the rise of the nano-influencer using both sociological theories and concepts to explain how the commodification of relationships is being utilised by brands to maximise profits.</p
Does Class and Place Still Matter in the UK? COVID-19 Suggests Yes
No full textCovid-19, a virus first discovered in China in early 2020, was declared by the World Health Organisation (WHO) as a pandemic on 11th March 2020. By the end of March 2022, some 186,000 people have died from Covid-19 in the UK (GOV.UK, 2022). In many ways, Covid-19 can be seen as late-modern risk in Beck’s (1992) terms. After numerous waves of infections, several mutations of the virus, and having to live through various lockdowns, it appeared that no one was immune to the risks posed by Covid-19 as we learnt to live within what was coined “the new normal”. However, this contribution aims to argue differently and explores Covid-19 in the UK arguing that, although everyone was at risk from Covid-19, these risks were unequally distributed and were largely dependent on social class and place, which helped to further reinforce existing structural inequalities. The limitations of Beck’s theory of risk society will be explored to look at how certain groups had an unequal impact on the level of risk faced during Covid-19. The impact of austerity in the UK over the past eleven years will also be explored to examine how its effects have helped to worsen the impact of Covid-19 for some groups.</p