• MA: Critical and creative writing: writing dissertation

      Rees, Emma L E; Lamont, Joanna (University of ChesterUniversity of Chester, 2007-09)
      This dissertation contains an extract from a proposed novel for young adults called "Winter in Curio Crescent: The Hellhound and the Hypnotist" and a critical piece on "A reflection on the inherent didacticism in children's literature of the nineteenth century".
    • MA: Critical and creative writing: Writing dissertation

      Chantler, Ashley; Winchcombe, Matthew (University of ChesterEnglish department, 2007-09)
      This dissertation contains an extract from a proposed novel set in Gdansk between 1935-1937.
    • Male-only preserves: Homosocial environments in the nineteenth century

      Edwards, Carol (University of Chester, 2013)
      This dissertation explores those areas of nineteenth-century life from which women were excluded. Links are made throughout to literary texts as illustrations of how male-only groups were depicted in literature and how homosociality was represented. As well as describing the national picture, examples of male-only environments in Cheshire, which are still in existence in the twenty-first century, are used. The Introduction describes the background to the project and considers the development of male-only environments in the light of nineteenth-century attitudes to the respective roles of men and women. It reviews expectations with regard to men’s behaviour that were current at the beginning of the nineteenth century, and considers the changes in those attitudes that took place during Queen Victoria’s reign. The first chapter deals with public schools and the consequences for young boys of growing up in a female-free environment, paying particular regard to the aspirations of their parents, the pupils’ everyday lives and their relationships. Chapter 2 deals with adult male associations and societies: gentlemen’s clubs, Freemasonry, and examples of other local groups that survive today. It looks at their rules and rituals, specifically with regard to their attitude to the presence of women. The final chapter is concerned with intense male relationships and nineteenth-century public opinion about them; particular attention is given in this section to literary examples of close friendships between men and to the role of bachelors. Finally, the Conclusion reflects on the complexity of the subject matter and highlights the different perceptions, historical and contemporary, of the changes that took place during the nineteenth century; and considers how much, or little, has changed since then.
    • Malnutrition, enteral nutrition and the use of the percutaneous endoscopic gastrostomy

      Fallows, Stephen; Wolfendale, Christine; Eckersley, Deborah (University of Chester, 2014)
      The number of adult patients in the community receiving enteral feeding via a percutaneous endoscopic gastrostomy (PEG) is increasing. Identified problems in relation to PEG were highlighted by a community multidisciplinary team including delayed referrals and discharges. The study aimed to explore retrospectively outcomes in relation to PEG insertion following the implementation of a pilot community PEG placement care pathway. The number of adult patients in the community receiving enteral feeding via a percutaneous endoscopic gastrostomy (PEG) is increasing. Identified problems in relation to PEG were highlighted by a community multidisciplinary team including delayed referrals and discharges. The study aimed to explore retrospectively outcomes in relation to PEG insertion following the implementation of a pilot community PEG placement care pathway.The number of adult patients in the community receiving enteral feeding via a percutaneous endoscopic gastrostomy (PEG) is increasing. Identified problems in relation to PEG were highlighted by a community multidisciplinary team including delayed referrals and discharges. The study aimed to explore retrospectively outcomes in relation to PEG insertion following the implementation of a pilot community PEG placement care pathway. Data were analysed for a sample of participants over 18 years of age in three communities, served by a district general hospital in the North West of England. Group 1; ten participants managed on the community PEG placement care pathway and Group 2; ten participants who were not managed on community PEG placement care pathway with a similar primary diagnosis to Group 1. PEG insertion required to maintain nutritional status, hydration and/or medication administration for greater than fourteen days. Group 1 data for referral to treatment (RTT) waiting time was compared with the National Health Service (NHS) RTT waiting times for gastroenterology. Group 1 data for length of stay (LOS) following PEG insertion was compared to Group 2 data by conducting an Independent t‐test to analyse LOS between the two groups. A measure of central tendency obtained for LOS for Group 1 and Group 2 data was used in the calculation to estimate treatment cost. Group 1 data to estimate treatment cost was compared to Group 2 data by conducting an Independent t‐test to analyse treatment cost between the two groups. Data collection was obtained to establish if the hospital’s PEG information booklet was provided prior to PEG insertion. 6/10 participants in Group 1 had a RTT waiting time of 1 to 58 days. Median LOS for Group 1 was 4 days; Median LOS for Group 2 was 10 days. Group 1 had an estimated treatment cost of £1114.15 per patient; Group 2 had an estimated treatment cost of £2314.15 per patient. 7/10 Group 1 participants were provided with the hospital’s PEG information booklet at least one week prior to PEG insertion. A reduction in LOS, a RTT waiting time within 18 weeks and a lower estimated mean treatment cost were noted for Group 1 participants. Expansion of the exploratory study is required so the objectives generated can be challenged further.
    • Malnutrition; Can the Leeds screening tool identify haemodialysis patients at risk?

      Woodall, Alison; Morris, Mike; Bowra, Kim (University of ChesterLeeds Teaching Hospitals, 2014-11)
      There is global recognition of the need for early identification of those at risk of malnutrition. Nutritional screening has been advocated for systematically detecting and managing those at nutritional risk, triggering a dietetic referral where indicated. Dietetic assessment aims to minimise progression to overt malnutrition and ultimately, curtail the associated clinical and financial consequences. Patients receiving haemodialysis treatment are at increased risk of malnutrition. Generic nutritional screening tools are inherently limited in this population due to the observed variances in fluid status. There is currently no validated nutritional screening tool that is effective in this population. The present study aimed to test the effectiveness of the Leeds Nutritional Screening Tool (developed through pilot studies) in 140 representative haemodialysis patients. By means of a clinical audit, the clinical support worker tested the Leeds tool and the dietitian provided the criterion measure. A distinct feature was the inclusion of patients that were unable to fully complete answers, due to dementia, learning difficulties and a language barrier. Risk of malnutrition was evident in 49% of the Leeds sample. The Leeds tool showed good diagnostic accuracy (95%) with sensitivity and specificity comparable with other National Health Service tests. In turn, these results suggest that patients would be appropriately signposted for dietetic assessment, without wasting finite resources. Component analysis showed that the tool was well-balanced with a combination of objective and subjective measures and that it could be simplified by removal of a question on appetite, without affecting performance. Reliability testing was achieved by patient self-completion and by a nurse, both of whom produced consistent results with the clinical support worker. The tool was evaluated to have good practical acceptability amongst users. This research suggests that the Leeds tool can identify patients at risk of malnutrition, fulfilling the requirements needed to consider local implementation, alongside appropriate staff education. This research provide a sound framework for the development and testing of nutritional screening tools, in a field of variable study quality. It is hoped that the results will contribute to the wider audience, with further research needed to assess tool transferability amongst dialysis units.
    • Management development: A case study of Liverpool City Council

      Khan, Hussein (University of ChesterLiverpool City Council, 2007-05)
      Following a change in political and organisational leadership in 1999 Liverpool City Council has undergone a myriad of changes in order to improve service delivery and whilst reducing costs and bureaucracy. A key factor to achieving these aims was the recognition that for many years there had been a lack of investment in management development within the council and that service improvements were dependant on the skills and knowledge of managers at all levels and staff throughout the organisation. As part of a strategy known as the Liverpool Way the council aimed to achieve its 'Vision and Values' objectives by radically changing the culture and the behaviours of its employees through education, and to create a learning environment through which service improvements would continue to grow. Key to this strategy has been the development of front line managers through the Leadership Academy, middle managers through the Diploma in Management Studies (DMS) and senior managers through the Masters in Business Management (MBA) programme. This study determines through a mixed phenomenological/positivist approach, uses epistemology, qualitative and quantitative research to identify whether the development programmes are having a greater effect than other contributing factors on influencing managers performance and attitudes whilst testing the data against established theory. The study illustrates the investigation and analysis of the data, discusses the findings and uses the results as a basis to identify possible recommendations for the future.
    • A managers view of critical success factors necessary for the successful implementation of ERP

      Proctor, Tony; Turton, James W. (University of Chester, 2010-09)
      Organisations look to enterprise resource planning (ERP) as a significant strategic tool of competition. ERP plays an important role in today's enterprise management and is beginning to be the backbone of organisations. Although ERP has been recognised as a useful tool, in practice, there are many difficulties in compelling people to implement it effectively. In this case, how to help ERP's future effective implementation has already attracted the attention of several researchers. The goal of this research was to increase the knowledge base regarding Enterprise Resource Planning (ERP) Software implementation in the public sector. To this end, factors regarding benefits sought through ERP system implementation and critical factors surrounding successful ERP implementation were identified. In addition, the perception of project team members' satisfaction with modules implemented and their concerns about implementing ERP software were identified in this study. The results of this study provided recommendations for public sector organisations in order to increase their opportunity for successful ERP system implementation. However, there is no reason why this information cannot be considered to be useful to private sector organisations when considering ERP implementation projects. The literature review and results of this study suggested that the benefits sought during ERP system implementation included increased standardisation, better reporting, and reduced operational costs were recognised as goals of ERP software implementation, with the overarching goal to improve efficiency. Factors that were important to successful ERP system implementations were top management support, knowledgeable and experienced project managers and knowledgeable and committed team members. The study included recommendations for organisations to fully research ERP functionality prior to implementation, to implement strong change management, use other means of measuring return on investment, ensure employee buy-in and top management involvement and to avoid scope creep at all cost. In addition, a key element is to undertake some form of benchmarking exercise of existing systems prior to commencement as a measure of success of implementation of all or various elements of ERP.
    • Manchester Healthy Living Programme: A case study

      Fallows, Stephen; Ellison, Andrew (University of Chester, 2007-12)
      This paper reviews: health promotion initiatives; the evidence highlighting the need for such initiatives; and evaluates one health promotion initiative, the 'Manchester Healthy Living Programme'. This paper is separated in to two separate sections. Study 1. Evaluation of the Manchester Healthy Living Project. The evaluation involved a self-assessment questionnaire during the 10-week healthy living course. The questionnaire assessed the participants' knowledge, attitudes, and behaviour before and after the project. The 15 questions related to diet, exercise and lifestyle. 9 adults and 10 young people participated (n=19). The findings showed that all participants increased their self-assessed scores after the project when compared to before. The biggest increase was seen in the questions relating to knowledge. The findings lead onto the second study, which investigated the effectiveness of health initiatives in changing behaviour. Study 2. Health Promotion Initiatives and Behaviour Change. The second study addressed the findings from the Healthy Living Programme and reviewed evidence from similar health promotion initiatives, which assessed the effectiveness of health promotion. The findings showed that the methods for evaluation such as, interviews and long-term follow up studies show the greatest behaviour change, and that health promotion is more effective in relation to behaviour change when carried out on a one-one basis.
    • Marketing of UK universities overseas: An evaluation study of Chester University, University of Huddersfield and Staffordshire University

      Webb, Paul; Kavididevi, Kumar R. (University of Chester, 2009-11)
      The study focuses its attention on the various marketing and international marketing strategies used by UK Universities to determine the elements that can be considered by UK Universities in future while designing their marketing and international marketing strategies. Qualitative research methods have been adopted and the case studies of Chester University, University of Huddersfield and Staffordshire University have been considered to gain understanding of the perceptions of the universities’ officials. The themes emerging from the case study of the Universities & from the views of officials are used to derive a model using questionnaires and semi structure interviews as the research instruments. The research aim and question that is to be explained in the study is: How UK Universities are Marketing Overseas. The study illustrates the investigation and the data analysis. The study also tests the data against the relevant theory and discusses the findings and finally gives the possible recommendations. These recommendations can be used to further develop the marketing mix model for UK Universities or other similar models & these models can be used in future by UK Universities to plan their marketing and international marketing strategies.
    • Materialising meaning: Samuel Taylor Coleridge and George Eliot

      Davis, Jenny L. (University of Chester, 2012)
      George Eliot’s response to Romantic ideology is critically established. While most scholarship recognises the influence of William Wordsworth on her prose fiction, the affinities between Eliot’s prose and the poetry of Samuel Taylor Coleridge remain relatively unexplored. A wealth of criticism has established Coleridge’s importance to nineteenth-century philosophical and religious thought, as well as to aesthetic discourse; critical discussion of his poetic influence is usually linked with contemporary and later poets. He is, however, often invoked as a major influence on Eliot’s intellectual development. Evidence of Coleridge’s direct influence on Eliot’s fiction is difficult to substantiate; this study offers readings that diverge from previous analyses by foregrounding Eliot’s engagement with Coleridge’s language. Focus on the language used by Coleridge and Eliot reveals thematic and linguistic similarities, as well as convergences in their use of metaphor and symbolism. Where divergences exist, they are examined with the objective of establishing a development or progression in the way ideas and concepts are expressed in Eliot’s fiction. The nature of this progression is analysed in terms of Eliot’s increased preoccupation with materiality.
    • Mathematical analysis of some virus models

      Kavallaris, Nikos I.; Yan, Yubin; Gildea, Joe; Roberts, Jason A.; Useni, Paul F. (University of Chester, 2014-09)
      The Mathematical Analysis of some virus models such as SIR epidemic model, HIV infection model and Ebola virus model are hereby presented. The stability of both the SIR and HIV infection models were investigated using linearization method. The SIR model has an endemic infection when the equilibrium is unstable i.e R0 > 1, and attain a disease-free equilibrium with regards to the existing population when the equilibrium is asymptotically stable i.e R0 = ra+ < 1. The analysis shows that the threshold behavior is directly related to the relative removal rate and that an epidemic will reach its maximum when S = with a condition that I(t) = 0. Also, there is an oscillatory behavior of susceptible and that of infective at the zero point and highest point respectively. Then the homosexual population and T-cell infection models consisting of supply rate solution and that of clonal production solution were discussed. In particular the stability of T-cell infection model was also investigated for HIV virus and it was proven that the unique critical point is globally asymptotically stable.In the last chapter of this thesis, the formulation of EVD model and its numerical solution using Euler's method is also presented. Finally, the conclusion and future work suggestions are stated.
    • Mathematical Modelling and it's Applications in Biology, Ecology and Population Study

      Forrest-Owen, Owain (University of Chester, 2016-09-12)
      This thesis explores the topic of mathematical modelling involving the simulation of population growth associated with mathematical biology and more specifically ecology. Chapter 1 studies how populations are modelled by looking at single equation models as well as systems of equation models of continuous and discrete nature. We also consider interacting populations including predator-prey, competition and mutualism and symbiosis relationships. In Chapters 2 and 3, we review stability properties for both continuous and discrete cases including differential and difference equations respectively. For each case, we examine linear examples involving equilibrium solutions and stability theory, and non-linear examples by implementing eigenvalue, linearisation and Lyapunov methods. Chapter 4 is a study of the research paper - A Model of a Three Species Ecosystem with Mutualism Between The Predators by K. S. Reddy and N. C. Pattabhiramacharyulu [32]. Here, we study the basic definitions and assumptions of the model, examine different cases for equilibrium solutions, prove global stability of the system and implement numerical examples for the model before reviewing existence and uniqueness and permanence properties. In Chapter 5, we construct a discrete scheme of the model from Chapter 4. We do this in two ways, by using Euler's method to create one autonomous time-invariant form of the system, and utilising the method of piecewise constant arguments implemented in [6] to establish another autonomous time-invariant form of the system. For both discretisations, we study equilibrium solutions, stability, numerical examples and existence and uniqueness, and permanence properties. Finally, we conclude the findings of the thesis, summarising what we have discovered, stating new questions that arise from the investigation and examine how this work could be taken further and built upon in future.
    • Mathematical modelling of mutualism in population ecology

      Kavallaris, Nikos I.; Roberts, Jason A.; Rowntree, Andrew (University of Chester, 2014-09)
      This research dissertation focuses on the symbiotic interaction of mutualism, we give explanations as to what it is before mathematically modelling population dynamics of two species displaying mutualistic behaviour. Throughout the course of this dissertation, we shall be re-examining the work done in the book by Kot [16] and the paper by Joharjee and Roberts [32], whilst providing further explanations of the mathematics involved and the steps taken. We begin by constructing a model for mutualism before attempting to improve the model in order to make it more realistic. We go on to add delays to our improved model and determine the stability of its equilibrium points. We formulate models via piecewise constant arguments and via a simple Euler scheme before determining stability for both systems. A graphical comparison will then be made to explain the differences in behaviour between the two discretised systems.
    • ‘The matrix of all problems’: Stephen King’s marriage of fundamentalism and the monstrous-feminine as social critique

      Ackers, Jenny L. (University of Chester, 2013-09)
      The place of women in society has long been decried by their place in religion – at least according to horror novelist Stephen King. Indeed, the release of first novel Carrie (1974) was the beginnings of an avid interest in both religion and gender stereotyping, the latter of which the author has been accused of utilising for horrific effect. Yet, this unison of themes is more complex than this. Certainly, these thematic concerns become the means with which King interrogates religious extremism and the conditions which cultivate such devotion; the novel succeeded in exposing the cataclysmic aftermath of a childhood so governed and restricted by militant Puritanism as to metamorphose Carrie White from a wholesome, all-American teen into an ardent evangelist responsible for a town massacre and the murder of her mother. However, utilisation of the fundamentalist agenda within this novel and later releases becomes the means with which King critiques both the archaic notions of the sin of femininity upheld within Christianity, and crucially, how and why such conceptions still pervade modern-day culture. In particular, King turns ‘his women’ monstrous because of their adherence to roles placed upon them by the conservative – even oppressive – conception of gender found within fundamentalist discourse; monstrous when they succeed in following such ideals – and monstrous when they do not – King also suggests that the origins and perpetuation of the image of the monstrous-feminine are far more sewn into the fabric of US society than its citizens would care to admit. This study will thus focus upon the methods of control found within fundamentalist ideology and how they presume to demarcate boundaries which dictate appropriate behaviour for women. Analyses of the monstrous-feminine within later novels will also demonstrate King’s motivation for marrying religion and the woman-as-horror scenario, and will be highlighted as not simply a mechanism within King’s oft-used toolbox of terror, but as the mechanism with which he turns the spotlight on both fundamentalism - and an avidly patriarchal society still struggling to maintain a hold over women.
    • Measuring anxiety in left and right handers via the BIS/BAS scale: Is there a difference when the scales are reversed?

      Rodway, Paul; Davis, Felicity (University of Chester, 2016)
      A considerable amount of research suggests that left-handers experience more behavioural inhibition and anxiety than right-handers. This is due to the assumption that left-handers operate with a right hemispheric dominance, where behavioural inhibition is believed to be processed. The current study examined the relationship between handedness, behavioural approach and inhibition, where it was hypothesised that left-handers would achieve a higher score of behavioural inhibition than right-handers. Additionally, the effects of inverting the scale of measurement were examined, as previous investigations suggest that left-handers prefer items to the leftward spatial area, whereas right-handers prefer items to the rightward spatial area. Participants (N=213) completed two self-report questionnaires online, Carver and White’s (1994) BIS/BAS scale and the Edinburgh Handedness Inventory (Oldfield, 1971). Participants were presented with either the normal version of the BIS/BAS scale, or the inverted version. No significant effects of handedness were obtained, thus suggesting that being left-handed does not increase anxiety. Additionally, there were no significant effects of inverting the BIS/BAS scale. The lack of significant results are discussed in relation to the importance of measuring handedness as a continuous variable rather than as a dichotomous variable.
    • Meat abstention, heamoglobin levels and tiredness in a university population

      Fallows, Stephen; Pugh, Isobel (University of Chester, 2006-09-30)
      Rationale: Tiredness is related to reduced quality of life and productivity. Iron Deficiency Anaemia (IDA) causes tiredness, and is the leading nutritional deficiency in the developed world. Numerous studies have compared iron status of vegetarians to omnivores; however, few studies have examined other patterns of meat consumption. This study compares three female populations: those that eat white meat>2x/wk but consume beef, lamb and their products 2x/wk (Red Meat Eaters, or RME), and vegetarians (VEG). Methods: 50 RMA, 47 VEG and 47 RME were compared. Capillary haemoglobin (Hb) levels were monitored using a Reflotron haemoglobin analyser and compared for significant differences using oneway ANOVA. Participants were also asked to recall if they felt tired at certain times of day, hours sleep needed per night, and difficulty sleeping per week, by questionnaire. Frequency of regular daily episodes of tiredness was compared to Kahneman and Krueger's Day Reconstruction Method (DRM). Non-parametric data was analysed using Kruskal-Wallis and Mann-Whitney U tests. Testing for correlation between frequency of tiredness and Hb levels was conducted using Spearman's Rho. Results: Mean Hb was 13.7g/dl for VEG, 13.6g/dl for RME and 13.2g/dl for RMA: this result was non-significant (p = 0.140; p>0.05). Difficulty sleeping and hours' sleep needed were similar between groups (/7-0.969 and p=0.549 respectively; p>0.05). There was no significant correlation between Hb and number of reported incidences of tiredness (r=0.023; ;p=0.830; p>0.05); however, variability in healthy Hb levels may have confounded these results, and reduced the ability of the study to detect significant effects. Conversely, 7 RMA, 4 RME and 3 VEG fell below one recognised Hb cut off point for IDA (12g/dl); further, 4 RMA were the only individuals to fall below the second recognised cut off point of llg/dl. VEG also reported significantly less episodes of tiredness per day than RMA (p=0.0l6; p<0.05). An interesting finding was the large population of RMA within the university. Conclusion: This study has important implications for individuals interested in improving their quality of life, and institutions and organisations interested in improving productivity.
    • Mindful Individualism and Communitarian Engaged Buddhisms: A comparative analysis, with special reference to Thich Nhat Hanh.

      Dossett, Wendy; Ward, Laura (University of Chester, 2017-09)
      This dissertation argues that the contemporary Western mindfulness movement has taken two forms: 'mindful individualism' and 'communitarian engaged Buddhisms.' Mindful individualism adopts a personal, individual and 'self-help' view of mindfulness, and is largely commodified, secularised and disconnected from the Buddhist roots of mindfulness in order to further other agendas. Communitarian engaged Buddhisms maintains many connections to the history and teachings of Buddhism and tends to use mindfulness in conjunction with other Buddhist concepts, such as interconnectedness, with an overall emphasis on compassionate action and social justice. I provide a comparative analysis of mindful individualism and community-focused engaged Buddhism, while demonstrating that Thich Nhat Hanh, a significant figure in the contemporary mindfulness movement, is depicted as a paradoxical figure within the movement. While he maintains his reputation as the archetypal engaged Buddhist, peace activist and global spiritual leader, Hanh's bestselling books teach the benefits of mindfulness in a range of contexts, and have been especially popular among a secular Anglo-American audience. Hanh has therefore also been viewed as the archetypal 'packager' of mindfulness, which in contrast to the community-focused nature of engaged Buddhism, has been criticised as being individualistic, secularised, and disconnected from its Buddhist roots, since flourishing in Euro-America. This dissertation explores the ways in which mindfulness has been applied to a variety of secular contexts, including mindfulness as a therapeutic technique, corporate mindfulness, mindful eating and more. I use these examples to demonstrate that contemporary mindfulness has become largely individualistic, secular and focused on personal happiness, whilst in contrast, those involved in engaged Buddhism remain focused on the aspect of community and reducing the suffering of those around them. I argue that Thich Nhat Hanh's teachings function within both sides of this dichotomy, promoting a mindfulness which 'begins with the individual' and is accessible for a non-Buddhist readership, while actively engaging with and encouraging his concept of engaged Buddhism. This dissertation uses Hanh as a lens to explore and analyse the theoretical 'paradox' problem in Western Buddhism.
    • The mission practices of new church congregations in Manchester city centre

      Graham, Elaine L.; Edson, John B. (University of Chester, 2013-10)
      Religious practices, which are increasingly being perceived as the bearers of the religious tradition, reflect and then shape the theology of the tradition of which they are a part. This thesis examines the mission practices of two different, yet growing, church congregations in Manchester city centre by asking what can be learnt from their practices in mission. Throughout the thesis different missiological themes and mission practices emerge from the two congregations as a response to the same postmodern, urban space of Manchester city centre. This difference, in themes and practices, is particularly notable regarding bounded and centred practices and the prioritisation of poiesis, theoria and praxis. In King’s Church, the first congregation researched, the notion of boundedness is identified as the most significant factor in their identity. This is reflected in their mission practices, which are shaped by their bounded ecclesiology, eschatology and pneumatology. It is from this boundedness that an eschatological ecclesiology becomes apparent and boundary crossing mission practices develop. This eschatological ecclesiology prioritises theoria, and hence their mission practices prioritise theoria above praxis and poiesis. In contrast, centred mission practices are identified in the second congregation, Sanctus1. Their synthetic approach to the city centre is dialogical and hence the ecclesiology and mission practices that develop are shaped by both the culture of the city centre and their religious tradition. Alongside the centeredness of their mission practices, a prioritisation of poiesis can be discerned as mission is approached in an innovative and oblique way.
    • A modular approach to diabetes structured education: Effects on patient knowledge, self-efficacy, self-management and patient experience in diabetic kidney disease

      Woodall, Aly; Joseph, Frank; Mellor, Duane; Gallagher, Susan (University of Chester, 2014-12)
      Diabetic kidney disease (DKD) is a serious chronic complication of diabetes, associated with increased risk of cardiovascular disease, end stage kidney disease and mortality. Intensive management, incorporating dietary and lifestyle changes with pharmacological agents, has been shown to reduce associated risks of DKD. This requires multiple self-management (SM) actions to optimise risk factors including diabetes, hypertension and hyperlipidaemia. Diabetes structured education (DSE) is integral to diabetes management and research shows DSE is beneficial to knowledge, SM activities, and diabetes control (Dekain et al., 2009; Speight et al., 2010). However, little evidence exists in DSE focused on DKD, despite the increased risk of mortality associated with the condition and NICE guidelines (NICE, 2008; NICE, 2003) encouraging education to optimise management of diabetes and kidney disease. The aim of the research is to determine whether complication-specific DSE for DKD has an impact on SM, self-efficacy (SE), and knowledge related to DKD, and to identify what effect education has on participants. A mixed method approach, combining quantitative questionnaires and semi-structured qualitative interviews was utilised. A standalone education module specifically for adults with DKD was provided for participants, tailored to the needs of this distinct group. A single education module demonstrated positive changes in SM activities, specifically seeking information, asking questions regarding biomedical results and following suggestions to alter dietary and exercise habits. Improvements were also seen in knowledge related to DKD. Significant positive correlations were demonstrated between SM and SE outcomes related to seeking support and discussing worries with family and friends. Qualitative results identified that social support can have a negative or positive impact on participants depending on the nature of the support. It was also found that participants felt healthcare professionals did not inform them of their biomedical results. An education module specifically for DKD allows the information to be tailored to meet the needs of participants to a greater extend, which is in keeping with NICE guidelines (NICE, 2003). A single education session had a positive impact on participants demonstrated by improvements in DKD knowledge, SE and increased engagement in SM activities. Healthcare professionals can improve partnership with patients through the sharing of, and the significance of, biomedical information. This could have a benefit in reducing the health burden of DKD considering its morbidity and mortality risk.
    • Money in therapy: Private practitioners’ experiences and perceptions of charging for counselling - a qualitative study

      Doherty, Susan (University of Chester, 2012-11)
      This is a small-scale qualitative research study of 32 participants, drawn from private counselling practitioners who charge a fee for counselling/psychotherapy. It examines their experiences and perceptions around the fee transaction in the therapy room, in an attempt to explore whether a taboo remains in this area. The symbolic nature of money, the fee and its manifestations in the behaviours of counsellors and clients are examined, together with the roles value and self-worth play in the therapeutic journey of the client. Likewise, the counselling practitioner’s journey within the sphere of private practice is scrutinised in the light of his/her professional journey towards establishing an ethical counselling business. The findings that emerge are: (1) Counsellors face tensions by charging a fee; (2) Charging a fee signifies a contracted professional business service; (3) Charging a fee can be therapeutic; (4) The fee transaction has an impact on the therapeutic relationship; (5) Money in therapy is symbolic; (6) The counsellor undergoes a personal journey to feel comfortable charging fees. Recommendations from this study include adequate preparation of practitioners for private practice, through business training on counselling courses and specific personal development of practitioners to address their own issues around money. It is also recommended that knowledge and expertise is shared across related professions, e.g. money coaches and debt counsellors. Those mental health problems associated with debt such as, depression, relationship problems and potential suicides should be addressed openly by therapists in an attempt to reduce the financial ignorance which may be perpetuated by “money blindness” of therapists and clients alike, in an attempt to reduce the stigma of the financial conversation in today’s society.