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.

Ageism and negative attitudes are reported to be institutionally embedded in healthcare. The unprecedented increase in the older population together with social perceptions of later life presents all those involved in the delivery of healthcare with considerable challenges. It was therefore timely to examine attitudes and perceptions of healthcare professionals towards older people. This study presents a critical visual exploration of the perceptions of ageing of undergraduate nursing students at a University in the North of England, based on the findings of a three year longitudinal study. The research employed a pragmatic standpoint where mixed methodology was adopted to explore perceptions and included the use of an attitude towards older people scale (KOP) (Kogan, 1961), visual methods (participants were asked to draw a person aged 75), a Thurstone scale and photo elicitation. The research design and construct was influenced by the epistemology of constructionism and discourse analysis. The research was conducted alongside an undergraduate nursing programme, and followed the natural journey of 310 students from one intake and involved three waves of data collection. The study established that the majority of participants had moderately positive attitudes towards older people the beginning of the programme and that these had improved for a significant number by the end of the study programme. From the quantitative data it was determined that age, gender, educational qualifications, practice learning, branch of nursing and contact with older people influenced the participants’ overall attitude score. The use of visual methods provided a narrative of the participants’ perceptions of later life and appearance dominated the imagery via the physical depiction of ageing and the ascetics of clothing and grooming. The influence of role models was seen to impact upon the production of the image via the depiction of grandparents and people they knew and the drawings identified some older people being active. The visual findings established that the undergraduate nurses in the study viewed older people from a socially constructed phenomenon and used symbols (hairstyle, clothing, mobility aids) to depict old age. The nursing programme was found to positively alter perceptions. The research findings have led to recommendations based on three prominent themes; 1) implications for nurse education and practice, 2) gerontology education and research and 3) future use of the research methods.

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.

Change is a common feature of nursing, influenced by prevailing governments as part of their political agendas. These changes have impacted both on the context within which nursing takes place as well as on the actual role of the nurse. For change agents who are implementing these changes, it is imperative that they are aware of how nurses respond to change in order that they can plan the most effective strategies. This thesis investigated how nurses understand their own practice changes, the process that they undergo, how resistance to change manifests and if nursing rituals have an impact on the process. Finally the thesis made recommendations based on the findings to facilitate effective practice change and development. The study was conducted in two parts. In-depth interviews with eight nurses from one acute NHS Trust made up the first part of the study. A further two interviews were conducted with eleven mental health nurses from an early intervention team in one NHS Mental Health Partnership Trust, and this constituted the second part of the study. Constructivist grounded theory was the research method employed in the design of the study. An underpinning theoretical framework of structural anthropology with specific reference to the work of Levi-Strauss was used to present the final grounded theory. The study found that nurses understood the process of practice change as a spiral with the most significant aspects of practice change at the bottom. These were the day-to-day changes that may or may not lead to permanent change. At the top of the hierarchy and of least significance were the changes imposed by their employing organisations or nationally. The overall personal process of practice change and development was identified from the study as a process that centres on the experiences that participants have in their workplace, a process of sense making, learning and intuition. A Practice Change Model in the form of a continuum was developed that described how nurses respond to practice change and development. The significance of this study is that the thesis was able to identify strategies for promoting effective practice change and development, aimed at nurses in practice, change agents at an organisational and national level, and the clinical link role within higher education.

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.