• Academic induction: Perceptions of newly appointed university lecturers in nurse education: An interpretive phenomenological inquiry

      Ashford, Ruth; Mansfield, Madeleine; Carr, Helen (University of Chester, 2019-01-11)
      Aims: Empirical evidence demonstrates successful expert nurses appointed as nurse lecturers in higher education find themselves as ‘newcomers’ to the role and organisation. New nurse lecturers often find their transition to higher education confusing and challenging. Using the conceptual framework of communities of practice, this study aims to provide original research into what induction means for new nurse lecturers, and gain an in-depth understanding of their perceptions and experiences of their induction into working in a multi-sited university. Method: A qualitative research methodology was employed, using the theoretical approach of Interpretive Phenomenological Analysis (IPA) developed by Smith, Flowers, and Larkin (2009). Eight lecturers, with between one to three years’ experience as nurse lecturers, were recruited from one university in the North West of England. Purposive sampling was utilised and data was obtained through one-toone semi-structured interviews. Verbatim transcripts were analysed following the principles of IPA. Findings: Three super-ordinate themes emerged (partial transition, dual communities of practice, introduction), along with six sub-ordinate themes (expectations of the nurse educator role, career change, contextual influences, location and culture of sites, tick box exercise, and the limited role of the mentor). New nurse lecturers found transition stressful: key aspects included the culture shock and the career change of adopting their new academic identity. Changing identity from a nurse to an educator, working across the boundaries of both practice and academia, was a struggle, particularly in participants with visiting lecturer experience who had mistakenly perceived this would prepare them for the role. Early role preparation was essential to understanding the different cultures and processes within the university. Formal mentoring supported development of self-confidence, but its value was undermined due to the mentors’ workload and lack of understanding of their role, which affected relationship building. Supportive heads of department, and informal mentoring and peer support, were essential in developing new academic identities. Conclusion: This study contributes to practice through the development of an induction framework for new nurse educators. This framework acknowledges the relevance of maintaining a dual community of practice for new nurse educators, in supporting their new identity and their dual continuing professional development. Practical outcomes include: development of an informational resource for new lecturers (including visiting lecturers); development of a community of learning with facilitated workshops and online information resources; development of mentor training and resources for mentors; and mentors being thoughtfully designated by heads of department, with hours attached to their workload for mentoring. A long term online community of practice is needed for new staff to keep in touch and share information. Heads of department need to take ownership of inductions to ensure that their staff feel welcomed and supported in their new environment, with regular evaluation taking place.
    • Constructing and delivering services of support: An Evaluation of the Northwest Post-placement Adoption Support Service.

      Harlow, Elizabeth; Mitchell, Andrew E. P.; Doherty, Pauline; Moran, Paul; University of Chester (University of Chester, 2015-04)
      The aims of the Post-placement adoption support services (PPASSs) were to enhance the lives of 40 adopted children by: improving their school attainment; improving their relationships with teachers, peers and family members; building their confidence and well-being; and reducing behavioural difficulties.
    • Constructions of meaning and personal identity in the decision-making of community safety professionals

      Ellis, Roger; Hogard, Elaine; Wheeler, Timothy J.; Bendall, Mark; Warren, Jeremy J. (University of Chester, 2010-09)
      This thesis takes an interdisciplinary approach to the study of the impact that constructions of meaning and personal identity have upon the processes of professional decision-making, in the delivery of community safety services. The research draws upon the previous work undertaken in the fields of psychology, sociology, social anthropology, criminology and community safety. The research was composed of five separate studies. Study one was a Delphi exercise to determine consensus of meaning for different community terms in common usage for policy makers, practitioners and academics. The research was able to define consensual meanings for ten of the thirteen terms presented, including crime prevention, crime reduction and community safety. Consensus was not achieved for the terms community engagement, respect and quality of life and suggestions are made which may account for this result. Study two utilised repertory grids to investigate the ways that community safety professionals might construe the decisions that they have to make as part of their duties. Studies three and four utilised bespoke ISA/lpseus instruments, whose structures were informed by the results from Study Two. These instruments were used to further explore the construals and worldviews of a variety of community safety professionals through six process postulates. It was found that whilst an individual's initial job role or gender did not have significant impact upon their professional decision-making, the training that they had received in community safety and the time that they had spent working in the field did have a significant impact upon their professional decision-making. It was also found that the groups of community safety professionals differed in their attitudes towards those members of society who are the target of community safety activity. Study five involved the generation and piloting of a survey instrument whose various sections were designed to validate the findings generated from the previous studies, as well as providing further data on the decision-making processes of those working within community safety. The final chapter presents the Warren Person Process Priority (WaPPP) layered model of decision-making that was derived from the data collected to inform the current thesis. The outer Person layer is defined by the four-way typology derived from the Procedural / Free-form and Cautious / Adventurous bi-polar constructs of identity types that were identified from the ISA/lpseus studies. The middle layer of the model describes a number of different decision-making processes that professionals may follow when making a judgement or coming to a conclusion. The order of the processes was given by the results of the survey pilot. The central portion of the model presents a number of factors that may impact upon professional decision-making, determined from the ethnographic work that informed the ISA/lpseus studies. The order of these factors was determined from the preparatory data collection instrument that was used with the ISA/lpseus studies and confirmed by the results of the survey pilot. Suggestions are made for further research that may expand upon the results presented in this thesis. These include a larger version of the Delphi, with an international panel of experts; correlation of the ISA/lpseus instruments with other validated instruments for the measurement of personality, identity and decision-making and an expansion of the survey pilot.
    • Digital Mental Health in the Wild: An Adapted Grounded Theory Study

      Mitchell, Andrew; Bergin, Aislinn D. (University of Chester, 2017-12)
      This study explores Digital Mental Health (DMH), referring to the use of digital technologies in mental health, from the perspective of users and system builders – individuals ‘in the wild’. Using an adapted constructive Grounded Theory Methodology (Charmaz, 2014), it qualitatively explores DMH and how it is applied to everyday life. Interviews with users, developers and academics were supported by data collected from extant documents and observations. Findings addressed the complexity of development and use, where differences in priority between the technical and clinical paradigms in development challenged the usability and usefulness for consumers of DMH. Changes implemented within, and the transience of, DMH resources were constructed by users as potentially distressing and difficult for system builders to mitigate. DMH is a new and emerging way to self-manage mental health. However, whilst it provides options, it does not inform as to how to choose and, whilst it supports change, it is not in itself motivating. In understanding the role of DMH it is essential to consider it alongside existing mental health prevention and management. DMH is constructed not as use of a single resource, but rather a toolkit for self-management where resources are used in different ways and at different times. Some will be integral whilst others may be used more occasionally. Many of the participants identified the difficulties and challenges of managing their mental health with only traditional tools and interventions available, and how DMH offered additional ways of doing so. DMH offers users autonomy and a way to explore their experiences in a simulated environment, contributing to its purpose as a supplement to existing mental health provision. Understanding how DMH can supplement the existing treatment and management of mental health is essential. One key area is addressing the opportunities provided by the simulative functions of new technologies and how mobile technologies have enabled these to become part of the everyday lives of so many people. Finally, the concept of Technology-asAdvocate was constructed to identify the ways that technology can help individuals to help themselves. This study recommends that DMH stakeholders invest and conduct further research that bring together clinical, technical and user paradigms to better understand how changes to devices and resources impact users. It positions DMH within the initial stages of help-seeking and addresses its role as one of many tools in the individual’s self-care. It proposes that technology be viewed as supporting self-advocacy and theorises that future technologies, such as personal assistants, be designed to advocate rather than to dictate. It is vital that policymakers recognise the impact of changes for users who find resources that support them in their mental health and apply them within their everyday life.
    • The effects of induced negative mood state on recalled autobiographical content and memory

      Hayes, Peter; Boulton, Mike; Mitchell, Andrew E. P. (University of Chester, 2012-04)
      Autobiographical memory has been theorized to serve as an adaptive function in coping with negative mood state. To gain a better understanding of whether autobiographical memory changes with negative mood state, a number of experiments examined the relative accessibility of cognitive content and ability to recall specific event memories in those who had a previous history of depression or showed some aspects of current depressive symptoms. Five separate studies involved 288 participants and examined the effects of negative mood components on autobiographical recall. Studies 1 – 4 examined the autobiographical content by cueing content using a cue word technique to evoke autobiographical memories by means of a modified version of the Autobiographical Memory Test (AMT; Williams & Broadbent, 1986). Negative mood state was induced by Velten mood induction technique, and self-reported mood was measured using University of Wales Institute of Science and Technology Mood Adjective Checklist (UWIST-MACL; Matthews, Jones & Chamberlain, 1990) before and after mood induction. The ability to recall specific event memories was measured in Study 5 by the Sentence Completion for Events from the Past Test (SCEPT; Raes, Hermans, Williams, & Eelen, 2007). The results indicate that negative mood does influence autobiographical recall in terms of content and memory. These results indicate that autobiographical memory is a phenomenon that is in part dependent on negative mood state and in part dependent on current depressive symptoms and history of depression. Increased rumination was particularly responsive to induced negative mood state in those with current depressive symptoms. Reduced levels of activity, alertness, loss of interest and diminished pleasure are aspects of negative mood that seem to be particularly important components of mood state at the time of recall. To gain further insights into mood state effects in autobiographical recall, future directions in mood research should focus on and differentiate between the separate mood state components that are more important in bringing about changes in recalled content, especially in those with either a history of depression or showing current depressive symptoms.
    • An ethnographic study that explores the policy and cultural influences on the continuing professional development of nurses and their utilisation of computer technology in a community hospital in Uganda

      Gidman, Janice; Wilson, Frances R. (University of Chester, 2019-03-19)
      Through ethnographic fieldwork conducted in a hospital in rural Uganda, the study explores how continuing professional development (CPD) of nurses is supported through utilisation of information and communications technology (ICT), and how policy and culture can influence this process. The existing research literature raised three questions: what facilitates and restricts learning and using computer technology? What are the nurses’ views and experiences of using ICT? Is nurses’ professional development and how they utilise ICT influenced by policy and culture? The literature, drawn from international sources, is reviewed in chronological order to reflect the development of ICT and its use in health services and CPD. Policies and theories are analysed to gauge their relevance to the research aims and questions. These include Walt’s policy analysis theory; Hofstede et al.’s dimensions of national culture; Rogers’ diffusion of technology theory; Davies’ technology acceptance model; and theories of culture. These theories are synthesised into a model of influence. Early in the research, a macro study of Uganda was undertaken covering the political, economic, sociocultural, technological, legal and environmental (PESTLE) impacts on the ICT infrastructure, health and nursing. Spradley’s (1979, 1980) developmental research sequence (DRS) formed the methodological framework, providing a systematic and comprehensive approach to data collection and analysis. Its twelve steps were applied to participant observation and ethnographic interviews, offering a progressive approach to data analysis through domain, taxonomic and componential analysis. Spradley’s DRS enabled dimensions of contrast to be identified and the discovery of unique cultural themes. Four field visits took place between 2009 and 2012, each lasting two weeks. Participant observation was undertaken on each visit, and interviews and focus groups on the third and fourth visits, facilitating exploration of ICT developments, computer skills training, education and CPD. Informants expressed their views about cultural influences on technology development, and their knowledge of policies and how they impacted on ICT adoption and nurses’ computer skills development. The study makes a unique contribution to knowledge by analysing the influences of culture and policy on nurses’ CPD and utilisation of computer skills. Major findings include the significance of cultural themes amongst factors influencing ICT adoption, CPD and development of nurses’ computer skills. Knowledge of the local culture, as well as the underpinning theories, contributes to the successful construction of teaching strategies for this professional group. The impact of policies has been influential in building the national and local ICT infrastructure, but CPD and nurses’ computer skills have developed in the research location due to local capacity building rather than the direct impact of policies.
    • Evaluation of Hungarian social work and social policy students' work placements in Cheshire

      Watt, Vanessa; Hogard, Elaine; Ellis, Roger; Erdos, Marta; University of Chester ; Univesity of Pecs (Erdos) (University of Chester, 2007-10)
      This report evalutes a scheme whereby six social work or social policy students from the University of Pecs spent a nine month work placement in Cheshire County Council's community service department.
    • Evaluation of village and community halls energy consumption in Cheshire and Warrington

      Hellenbach, Michael; Hunt, Tamara; Alexander, Roy; Hogard, Elaine; Ellis, Roger; University of Chester (University of Chester, 2007-03)
      This report discusses public buildings and environmental education, particulary in relation to energy use and efficiency, attitudes to renewable energy, and institutional problems. A number of recommendations are made.
    • From Ascertainment to Assessment: The Development of a Social Work Role in Local Authorities, 1950-1993

      Burt, Michael (University of Chester, 2015)
      The social work literature of the last two decades has drawn attention to the increasing importance of the assessment role of social workers. However, there has been limited historical analysis of the development of the assessment function in social work. This study examines the way in which the assessment role of social workers in England and Wales developed between 1950 and 1993. Historical narrative has been used to develop the themes of this study, addressing the significance of interrelated events and the range of political, economic and social influences on the changes which took place. It uses archival sources as primary material, including the archive of Lancashire County Council which is employed as a case study. This study traces the stages of development of social policy for the assessment function of social workers in local authorities. It draws attention to the diverse approaches of separate occupational groups of social workers to making enquiries and investigations about the circumstances of people who experienced social problems in the 1950s. Principles of social assessment which emerged during the 1960s are explored, together with their wider application to all client groups during the 1970s and the development of assessment as a priority activity within the newly established Social Services Departments (SSDs). The importance of the development of criteria and models of assessment in the late 1970s and 1980s and their inclusion as part of the social work process in planning documents produced by SSDs in the 1980s is discussed. The significance of the children’s and adults’ legislation and accompanying documentation at the end of the 1980s and beginning of the 1990s in giving local authorities a lead role in the co-ordination of assessments is addressed. Although conventional interpretations of the history of social work have suggested that a high point in the development of social work was reached in the early 1970s, archival material points to the function of social assessment being at a particularly early stage of its development. As a consequence of the changes which took place, the thesis argues that assessment was a unifying influence on social work as a single occupational group and emerging profession.
    • The Global Mental Health Assessment Tool Primary Care and General Health Setting Version (GMHAT/PC): A validity and feasibility study – Spanish version

      Sharma, V. K.; Tejada, Paola A. (University of Chester, 2017)
      BACKGROUND: There is an urgent need to provide training and tools to frontline health workers in order for them to properly diagnose and treat mental illnesses in Latin-American communities, since the vast majority of people with a mental illness suffer in silence. A computer-assisted interview, the Global Mental Health Assessment Tool (GMHAT/PC) has been developed to assist general practitioners and other health professionals to make a quick, convenient, yet reasonably comprehensive and standardised mental health assessment. GMHAT/PC has been translated into various languages including German, Dutch, Chinese, Hindi and Arabic. This is the first study, of a GMHAT/PC Spanish version carried out in Latin America, to establish its validity in that culture and feasibility to be used in the health care setting. If proven a valid tool through this study, the GMHAT/PC Spanish version will be an important aid towards improving the mental health of Spanish-speaking communities within the Latin-American region. AIM: The study aims at assessing both the validity of a GMHAT/PC Spanish version, and the feasibility of utilising a computer assisted diagnostic interview by GPs. DESIGN: 1) Validation study was planned to establish whether the GMHAT/PC based diagnosis compares well with the consultants ICD-10 based diagnosis (Gold Standard) 2) Feasibility study was carried out to examine whether GMHAT/PC can be used in routine clinical care in a general health setting. MATERIALS AND METHODS: In the first study (validation), participants varied from those who were in remission i.e. without much psychopathology to those had symptoms of a severe mental illness. They were recruited from in-patient (82%) and out-patient (18%) mental health settings in Colombia. The participants were expected to have a wide range of psychiatric diagnoses (anxiety disorders, depression, psychosis, bipolar affective disorder, organic mental disorders, and other diagnoses). All consecutive patients were interviewed by GPs using GMHAT/PC and psychiatrists made an independent diagnosis applying ICD-10 criteria. The second study (feasibility) was carried out on patients hospitalised at medical, surgical and women’s wards during a period of one month in each service. The diagnosis of a medical illness was made by specialists in each service. A trained GP carried out psychiatric assessment of all participants using GMHAT/PC. RESULTS: First study (validity): two hundred ninety-nine patients (n=299) participated, 54.18% males and 45.81% females in the age range of 14-78. All patients were interviewed independently by seven psychiatrists with over five years of clinical experience. The mean duration of GMHAT/PC interview was 12.5 minutes. Most patients were pleased that they were asked about every aspect of their mental health. Psychiatrists made a single diagnosis in 183 (61%) cases, multiple (two) diagnosis in 112 (37%) cases and multiple (three) diagnosis in another four cases. GMHAT/PC in almost all cases gave additional multiple diagnoses.The results show an acceptable-to-good level of agreement between the GPs’ (GMHAT/PC) diagnoses and the psychiatrists’ (clinical) diagnoses of any mental illness, Kappa 0.58- 95% C.I (0.46, 0.72). There is a good level of sensitivity (81%) and specificity (92%), with GPs correctly identifying 242 out of the 250 participants diagnosed with a mental illness, and 27 out of 35 of those who do not present any whatsoever. The agreement (kappa value) between GMHAT/PC diagnosis and psychiatrists ICD-10 based diagnosis of specific disorders were as follows: Organic disorders-0.87; Psychosis- 0.56; Depression-0.53; Mania-0.6, Alcohol and drug misuse- 0.62, Learning disorder- 0.4; Personality Disorder- 0.39 and Anxiety disorders- 0.14. The sensitivity of different disorders ranged from 63% (Mania) to 100% (Anxiety) and specificity from 71% (Anxiety) to 100% (organic). The second study (feasibility): out of 455 medically-ill patients, 4.8% had a mental illness identified by GMHAT/PC interview. Anxiety, depression and organic disorders were the most frequently identified mental disorders in internal medicine and surgery. Cancer had a significantly higher prevalence of comorbid mental illness. CONCLUSION: GMHAT/PC -Spanish version used by GPs in this study detected mental disorders accurately and it was feasible to use GMHAT/PC in Colombia and Latin-American health settings. The findings of this study will have a big impact upon mental health service provision in Spanish-speaking nations within the Latin-American region as the Spanish version for GMHAT/PC will assist primary care physicians and other health workers in detecting and managing mental health disorders in the communities. There is no other comparable easy-to-use comprehensive mental health diagnostic tool available in Spanish.
    • A grounded theory study to explore how clinical nurses undertaking research as master's students accommodate and adjust to the experience

      Thomas, Mike; Keen, Adam (University of Chester, 2016-02)
      Taught master's degree programmes represent a popular mechanism for part-time students to access postgraduate level education. A common feature of such programmes is the inclusion of some form of independent research project. Whilst such projects are recognised as being demanding for the students involved, there is a scarcity of research literature that explores their experiences. In this study I have now explored how clinical nurses, as an example of a particular professional group, accommodated and adjusted to the experience of undertaking part-time master's research. My intent was to contribute to the body of knowledge relating to the support of part-time students undertaking master's research.
    • The health consultation experience for people with learning disabilities: A constructivist grounded theory study based on symbolic interactionism

      Chapman, Hazel M. (University of Chester, 2014-06-09)
      Aims. The aim of this study was to explore the effects of the health consultation experience for people with learning disabilities, particularly in terms of their self-concept Background. Annual health checks have been introduced as a reasonable adjustment for health providers to make in meeting the needs of people with learning disabilities, who experience significantly poorer health outcomes than the general population. Evaluation of the health consultation from the service user perspective can inform this service provision. Design. A constructivist grounded theory approach, based on symbolic interactionism, was used to explore the meaning of the health consultation experience for the person with learning disabilities, and its effects on their sense of self. Methods. Purposive and snowballing sampling was used to recruit 25 participants with learning disabilities through a GP practice, self-advocacy groups and a health facilitator. Nine individual interviews, three interviews with two participants, three focus groups (n=7, n=5 and n=3), and an audio-recorded health check consultation were carried out (with two participants interviewed twice and four attending two focus groups), as well as a member check used to assess the resonance of the findings. Data collection was undertaken in different primary care trusts across the north west of England. Data were subjected to constant comparative analysis, using a symbolic interactionist approach, to explore all aspects of the health consultation experience and its effects on the self. Findings. Current expectations, attitudes and feelings about health consultations were strongly influenced by previous experience. Participants negotiated their own reality within the consultation, which affected their self-concept and engagement with their health care. Respectful and secure health professional – service user relationships, developed over time, were central to an effective consultation. Perspectives on the consultation, and engagement within it, were co-constructed with a companion, who could help to promote the personhood of the service user with support from the health professional. Anxiety, embarrassment and felt stigma were identified as significant barriers to communication and engagement within the consultation. Conclusions. People with learning disabilities have similar health consultation needs and expectations to other people, but may have more difficulties in engaging with the process and building trusting relationships with the health professional, due to previous negative experiences, anticipated stigma and loss of self within health settings leading to a fear of disclosure. This, combined with difficulties in communication and cognitive processing, results in less satisfactory outcomes persisting over time. The effects of triadic consultations are generally positive, particularly where relatives or health facilitators are involved. However, continuity of companion as well as health professional is needed, and more service user engagement should be supported. Fundamental attitude change by health professionals, supported by specific educational initiatives to enhance their understanding of the service user perspective, is needed to reduce health inequalities. Participatory research by people with learning disabilities should inform future health care practice.
    • Internal representation in nurse education: Imagery and identity

      Hogard, Elaine; Ellis, Roger; Smith, Dave; Wheeler, Timothy J.; Parry, Clare E. (University of Chester, 2010-10)
      The main aim of this thesis was to examine internal representation in the context of nurse education using two main output variables - namely imagery and identity. The initial basic argument for the thesis was that procedures to facilitate the acquisition of psychomotor skills that have been developed in sports science could fruitfully be applied to the development of skills in other areas, such as nurse education. Study one approached this through the use of an imagery training programme - PETTIER (Holmes & Collins, 2001) on an undergraduate nursing curriculum. PETTIER served as the independent variable with the dependent variable - performance - being measured through Obje&tive Structured Clinical Examinations (OSCEs). Unexpected results revealed no significant differences between the control and experimental groups, with the control group actually performing better overall. Given this, the explicit choice was made to pursue investigation into the other plausible factors affecting behaviour, in order to explicate and underpin the results obtained. Study two investigated students' perceptions of and preparation for the OSCEs using a skills training questionnaire. Results revealed common concerns, specifically related to skills practice. Furthermore these concerned the amount of practice time provided; the practice environment; and the amount of support and training during teaching. In light of these findings, study three pursued a contrasting and comparative investigation from the professionals' perspective on the curriculum. This specifically examined perceptions of the assessment structure and expectations within the curriculum; the content of the curriculum; levels of support and provision for training; and the application of theory and practice. This aimed to identify any coherent or conflicting views between the students' receiving the curriculum and the staff delivering the curriculum. Results revealed coherency in the professional view that theory and practice were equally as important for nurse education. However, students commonly perceived practice as the most important aspect. Also, some students often struggled to apply theory to practice and vice versa. In light of this it became apparent that students may in fact identify differently with the content of the curriculum. Therefore, appraisal of the content may have different significance for students and affect behaviour differently both internally and/or externally. Study four investigated this using Identity Structure Analysis (ISA)/lpseus (Weinreich & Saunderson, 2003).This explored how students applied themselves to the various aspects of nursing in the contexts of healthcare and broader affiliations, and how these fitted into students' broader sense of identity. It also looked at typologies within nursing and whether identity fitted into three distinct categories depending on construals. Study five followed this up using two individual case studies. The purpose of this was to encapsulate meaning behind individual construals and typologies and explicate the findings of ISA/lpseus and the implications for nurse education. Results found that construals are grounded in experiences which can affect development, behaviour and identity towards nursing and the broader affiliations in individuals' lives. In conclusion identity in nursing should be investigated further in order to provide stronger evidence in regards to typologies and how these may be influencing students' behaviour and development in nurse education. Such research could have important implications for the future of nurse education and be a positive step towards future curriculum revisions.
    • Narratives of personalisation in mental health: a collective case study

      Lovell, Andy; Coyle, David S. (University of Chester, 2016-11)
      This work describes the impact of personalisation on users and professional workers identities in four mental health care settings. The development and context of personalisation is identified and set within an emergent narrative of consumer choice and austerity. International personalisation research is compared and a discussion of UK mental health literature is presented. The social constructions of key participants are analysed through their narrative accounts as they undertook identity work while being involved with individual budget pilots, either as users, carers, brokers or mental health professionals. The work employs Stake’s collective case study as the method of combining semi-structured interview data taken from participants in four personalisation studies designed and led by this author between 2008-2011. Narrative social constructionist methods, positioning theory and story-line are used in the analysis to produce a framework of participants’ orientation to personalisation. The importance of nuance as opposed to binary construction towards personalisation is highlighted, as are the positioning actions of independent brokers for the success of personalisation. The importance of co-production and challenging professional asymmetry in health and social mental health care services is clearly made as are the implications for practice. The value of the proposed framework and possible future research are discussed.
    • 'Paperwork': Its implications for community mental health nurses' practice

      Deacon, Maureen; University of Chester (University of Chester, 2011-09)
      This study aims to examine the real life documentary practices of community mental health nurses to enable a better understanding of the impact of paperwork on their nursing practice.
    • The perceptions and experiences of e-learning within undergraduate healthcare education: A case study

      Brownsell, Michael D. (University of Chester, 2016-03)
      Introduction: The use of e-learning in healthcare education is being increasingly advocated and used, but can prove challenging. The need to explore educator’s experience and student perspectives in relation to this area of pedagogy was identified as a relevant area of study Study Aim: To explore and critically analyse the perspectives and experiences of healthcare educators and students regarding e-learning. Design: A mixed methods exploratory case study of one HEI’s use of e-learning. Methods: Quantitative descriptive data was collected through educator and student questionnaires from 34 academics and 127 students across four university departments delivering undergraduate healthcare related programmes. A sample of 12 module web spaces and associated documentation was reviewed. The data sets were considered in relation to the thematic analysis of 16 semi-structured educator interviews and 6 healthcare student focus groups. Results: Educator and student needs are interwoven during undergraduate healthcare provision. Differing educational philosophies, practices and culture across the cases created opportunities and challenges with e-learning. Two differing, yet potentially complimentary definitions of e-learning existed within and across the four departments which produced either congruence or conflict toward the varied e-learning approaches. Student respondents selectively engaged in what was primarily educator controlled e-learning. Conclusions: The findings highlighted the need for agreement and understanding of philosophical and pedagogical underpinnings which define and shape e-learning by educators and students, along with an awareness of differing professional cultures across which e-learning is required to operate. Originality / Value: The findings of this study offer a deeper understanding of the effect on educator and student engagement in e-learning of differing higher education and professional practice education cultures. A model is offered as a response to particular issues faced by the study respondents; whilst non-generalisable the model may serve as an enlightening guide for educators who are introducing or applying constructivist e-learning practices within undergraduate healthcare provision and benefit the student experience.
    • Personal grooming (beyond hygiene): a grounded theory study.

      Mason, Tom; Gidman, Janice; Mason-Whitehead, Elizabeth; Boulton, Michael J.; Woodhouse, Jan (University of Chester, 2015-10)
      Background: We are very individualistic in how we present ourselves to the world. Whilst we are healthy and self-caring we have control over the way we undertake self-groom. Once we need care the situation may change. In the setting of health and social care the emphasis has been on hygiene; aspects of personal grooming [PG] may be overlooked. Few studies exist in the health and social care literature that explore this crucial daily activity of living. Aim: This study aims to address the imbalance on what is known of PG. It seeks to thoroughly explore the concept of PG, identifying the normative activities involved, and the age-related behaviours that occur across the lifespan. Methods: Utilising a grounded theory [GT] methodology, an eclectic data collection approach was taken. Consequently a pilot group, four focus groups (child-focused; males 18-45; females 18-45; over-46), and a visual methodology formed the first phase of the study. The second phase consisted of a formal concept analysis, drawing on literature and data from the focus groups. The final phase of the study involved one-to-one semi-structured interviews with retired persons. A total of 26 participants took part in the study and both genders were represented. Analysis was undertaken using the range of coding consistent with a GT approach and the notion of constant comparison. Findings: New knowledge on PG emerged; an academic definition of PG; PG was found to have ‘four elements’: hygiene, appearance management behaviours, body modification and enhancement. There was a ‘spectrum’ of grooming recognised, which ranged from the wild, un-groomed state to that of being over-groomed. The term ‘allo-grooming’, which means grooming of another, was used to explore the part families play in social learning about PG. A timeline of PG behaviours was created to illustrate how PG changes over the lifespan. Additionally, information on grooming activities, other than those of hygiene, was recorded. Implications: PG is complex and the ‘one-size-fits-all’ approach of concentrating on hygiene may not meet the needs of service users. Some body areas, for example, are not included in the published documents that help to guide care services. There appears to a gap in educational programmes of health and social care workers, in respect to PG. Recommendations for practice, policy, education and further research are proposed.
    • Realities from practice: What it means to midwives and student midwives to care for women with BMIs ≥30kg/m2 during the childbirth continuum

      Steen, Mary; Thomas, Mike; Roberts, Taniya (University of Chester, 2016-12)
      Women with raised BMIs ≥30kg/m2 have now become the ‘norm’ in maternity practice due to the recent obesity epidemic. To date only very limited research evidence exists highlighting midwives’ experiences of caring for this group of women. This thesis aims to provide original research on what it means to midwives and student midwives on the point of qualification to care for this client group throughout the childbirth continuum.
    • Recovery budget in a mental health service: Evaluating recovery budgets for people accessing an early intervention service and the impact of working with self directed services on the team members within a north west of England NHS trust

      Coyle, David L.; University of Chester (University of Chester, 2009-07)
      This report follows a 12 month pilot of implementing Individual Recovery Budgets within an early intervention service across Mersey Care NHS Trust.
    • Retrospective cohort study of type 2 diabetes mellitus (T2DM) in the Wirral peninsula: complexity science

      Nwaneri, Chukwuemeka (University of Chester, 2014)
      T2DM continues to be a public health burden with its increasing incidence, prevalence, and mortality risks. The aim of this thesis was to examine a population-based cohort of 22,000 people with T2DM diagnosed between 1 January 2000 and 31 December 2010 within the Wirral Peninsula, UK with the aim of: Assessing factors relating to all-cause, cardivascular-, malignancy-, and non-cardiovascular mortality; evaluating the role of glycaemic control, socioeconomic status, smoking, dyslipidaemia, blood pressure, obesity, and nephropathy, as predicting risk factors for mortality; assessing the influence of age at diagnosis, duration of diabetes, year of diagnosis and gender on mortality; examining the life expectancy and mortality patterns and measuring the years of life lost as a result of a diagnosis of T2DM; applying Complexity Science to the dynamic interplay of the various factors in T2DM that lead to unpredictability in health outcomes.