No

No / The Silences Framework as a tool for exploring marginalised perspectives The Silences Framework was devised for use as a vehicle for exposing additional viewpoints in studies revolving around sensitive subjects and marginalised perspectives. Cyril’s presentation conveys the use of The Silences Framework in the provision of a nurse-led intervention for custodial community based ex-offenders. ‘Screaming Silences’ as exposed were located in the subjective experiences of ex-offenders known as the ‘listener’ and the social and personal context in which their experiences occurred. Crucially, The Silences Framework as used sought to acknowledge and redress the balance of power relating to ‘what and whose’ experience count in a research study. Epistemologically, the generation of knowledge using the framework necessitated an anti-essentialist perspective which was interpretive in nature. Thus, the intent was to arrive at what constitutes as truth from the lived experiences of the individuals researched. It is hoped that this presentation will facilitate understanding by unravelling the process of using The Silences Framework to underpin applied research and concurrently contribute to the wider use of the framework in research with other marginalised groups.

No

No / The current context of offender health in England and Wales indicates that the health needs of ex-offenders are significantly greater than those of the general population with a lack of equity existing between need and supply. The study presented herein is aimed at mapping the ex-offender health pathway towards identifying “touch points” in the community for the delivery of nurse-led interventions. The study was underpinned by the “Silences Framework” which enabled the study to gain theoretically by situating power with ex-offenders. A total of 26 respondents were ranked on the basis of poor health with those scoring the lowest and confirming their ranking through a confirmation of a health condition selected as cases and interviewed over the course of 6 months. These interview narratives were validated by interviewing individuals in the professional networks of ex-offenders and were analysed using the inductive qualitative thematic approach. The study uncovered that ex-offenders were not prepared in prison for the continuity in access to health care in the community on release. Ex-offender’s on-release preparation did not enquire as a matter of procedure on whether an offender was registered with a General Practitioner (GP) or had the agency to register self with a practice on release. Postrelease, the study uncovered a disparity between services, which address the physical health needs of ex-offenders and those which address their mental and substance misuse health needs. Finally, the study identified the site of postrelease supervision as the “touch point,” where a nurse-led intervention could be delivered.

No

Yes / This study was a qualitative case study underpinned by “The Silences Framework” aimed at mapping the ex-offender health pathway towards identifying “touch points” in the community for the delivery of a nurse-led intervention. Participants meeting the study inclusion criteria were quantitatively ranked based on poor health. Participants scoring the lowest and endorsing their ranking through a confirmation of a health condition were selected as cases and interviewed over 6 months. Individuals in the professional networks of offenders contextualized emergent themes. The study indicated that pre-release, offenders were not prepared in prison for the continuity in access to healthcare in the community. On release, reintegration preparation did not routinely enquire whether offenders were still registered with a general practitioner or had the agency to register self in the community. Participants identified the site of post-release supervision as the “touch point” where a nurse-led intervention could be delivered.

No / The Silences Framework and its underpinning concept of ‘Screaming Silences’ was originally presented with the invitation for further peer review and utilisation in other contexts in order to test its usefulness and enable critique by a wider audience. This paper reports the use of the framework in a study researching nurse-led interventions for released ex-offenders. Screaming Silences were situated in how an issue, as experienced by ex-offenders, screams out to them in relation to their health and its impact on their reality while remaining silent in the consciousness of society and the application of practice. In addressing these Screaming Silences, we associated the Silences Framework within marginal discourses as they are less prioritised by policy and frequently positioned as far removed from what society considers as normal. Screaming Silences were situated in the subjective experiences of ex-offenders known as the ‘listener’ and the social and personal context in which these experiences occurred. We affirmed that the framework is ideally suited for researching issues which are under-researched, silent from policy discourse and excluded from practice, as it is oriented towards exploring individual experiences by valuing individual interpretations of events.

Isolated hip fracture following a minor fall is a serious injury, normally requiring urgent surgical treatment and a complex recovery journey. Although commonly associated with the elderly, incidence and impact in adults under 60 years of age may be underestimated. The extensive literature almost exclusively focuses on the elderly, surgical interventions and relatively short-term outcomes. Young adults are also missing from the dominant societal discourse and healthcare policy on fragility hip fracture. They therefore represent a silent sub-subset of the fragility hip fracture population, whose recovery experiences and needs, particularly in the longer term, remain largely unknown. A critical interpretivist approach and The Silences Framework (Serrant-Green, 2011), were used to ‘give voice’ to young adults with isolated hip fracture. Thirty participants, between one and ten years post injury, completed an in-depth, minimally structured interview in which they told their story of recovery. An inductive, thematic analysis was undertaken integrating Braun and Clarke (2006) and the four phase cyclical analysis of The Silences Framework (Serrant-Green, 2011). One cross-cutting theme: Communication emerged, together with four other main themes: Experience of care, Impact on self, Impact on others and Moving forward. 11 The findings indicated wide variation in the quality of care, often influenced by social and professional norms regarding hip fracture patient characteristics such as age and mode of injury. Multi-faceted, often long term, physical, social and psychological impact on participants, their family and wider social networks was also found. This included Post Traumatic Stress Disorder type symptoms and impact on work, finances and relationships. The study highlighted some limitations of the current hip fracture care pathway for supporting the specific recovery needs of young adults. It also identified some limited effectiveness of commonly used patient reported outcome measures for hip fracture in this young client group. Exploring the recovery experiences of this under-represented group confirmed, but also altered the silences initially identified. Furthermore, it uncovered new silences which informed recommendations for future research; healthcare practice and policy. This study offers the first long term exploration of the impact of isolated hip fracture following a minor fall in young adults from their perspective. In doing so, it has also demonstrated the appropriateness of The Silences Framework (Serrant-Green, 2011) for guiding a person-centred, experience-based, acute orthopaedic/rehabilitation study undertaken by a student researcher.

The current context of offender health in England and Wales indicates that offenders re-enter their communities with limited pre-release preparation for the continuity of access to healthcare and an increased risk of release with a health condition and very little support to cope in the community. This study was aimed at mapping the ex-offender health pathway towards identifying ‘touch points’ in the community for the delivery of a nurse led intervention. The study was a qualitative case study underpinned by ‘The Silences Framework’ which enabled it to gain theoretically by situating power with offenders, thus, aiding their ‘Silences’ to be heard, explored and brought to light. Participants meeting the study inclusion criteria were quantitatively ranked on the basis of poor health with those scoring the lowest and confirming their ranking through a confirmation of a health condition selected as cases and interviewed over the course of six months. These interview narratives were confirmed by interviewing individuals in the professional networks of offenders. The study identified the site of post-release supervision as the ‘touch point’ where a nurse led intervention could be delivered. With regards to the delivery of the health intervention, the study indicated that the nurse led intervention be provided as an advisory and signposting service structured on a drop-in and appointment basis. Furthermore, the study indicated that pre-release, offenders were not prepared in prison for the continuity in access to healthcare in the community on release. On-release, offenders’ on-release preparation did not enquire as a matter of procedure on whether offenders were registered with a GP or had the agency to register self with a GP practice in the community. Post release, the study uncovered a disparity between services which address the physical health needs of offenders and those which address their mental and substance misuse health needs.