Haydock, Deborah (University of Chester, 2019-05-14)
The Health Visitor Implementation Plan (HVIP) (DH, 2011a) changed the recruitment criteria for health visiting and the way health visitor (HV) practice placements were supported. Several universities offered accelerated '2+1' programmes, where a graduate with a health related degree obtained accreditation of prior learning and completed pre-registration nurse training in two rather than three years. This was then followed by a one-year post-registration Health Visitor programme. This widening of recruitment afforded a unique opportunity to explore the experiences of 2+1 HV students, practice teachers (PTs) and mentors, and emerging practice education models within the context of the HVIP. Findings are considered through the lens of Bourdieu’s theory of practice.
The study adopted an interpretive phenomenological design to gain a deeper understanding of the experiences of students, PTs and mentors. In-depth semistructured conversational interviews were undertaken with four HV 2+1 students, two PTs and two mentors. Interviews were recorded, transcribed and analysed using Interpretative Phenomenological Analysis.
Findings viewed through a Bourdieusian lens indicate that policy change in the form of the HVIP affected the structure of the social field, resulting in a period of transition when some participants had difficulty adapting to the changed social context. Long arm models of practice education added to the complexity of the PT role, including the additional responsibility of overseeing numerous students and mentors. Mentors reported feeling under pressure, exacerbated by working in inexperienced teams; and frustration that their contribution to the HVIP was disregarded, compounded by a lack of opportunity for professional progression. Students undertaking different routes into nursing are affected by extrinsic views and this affects evolving habitus and enculturation. When students’ prior experience is valued, this strengthens the students’ perception of their ‘field’ position. Placement changes, particularly during consolidation, can be detrimental as they affect habitus formation and student learning and impact upon assessment processes.
The research offers new insights into health visiting practice education and the impact of policy change on practice settings. The findings have implications outside health visiting in the current context of changes to nurse education and the introduction of the new NMC (2018b) standards for student supervision and assessment. New knowledge is offered with regards to the significance of transition periods, changing roles, and the potential impact upon the provision of student practice placements and those who support them. Recommendations are made for further areas of research, practice placement providers and HEIs.
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.
Hellenbach, Michael (University of Liverpool (University of Chester), 2011-09)
This PhD study examines how people who are intellectually impaired are processed within the criminal justice system. In this context it analyses the understanding of intellectual disabilities, criminal justice decision-making processes, and the constructon of crime and punishment by professionals involved in criminal justice. Despite significant changes in mental health legislation and greater awareness by professionals of issues around intellectually disabled offenders, previous research has demonstrated that this population remains disadvantaged when coming into contact with the criminal justice system. The study focuses on how the criminal justice system maintains its traditional way of operating when engaging with people who are impaired in their intellectual capacities and who, therefore, often have difficulties in processing information and understanding complex situations. The study draws on qualitative data generated through thirty five unstructured interviews with custody sergeants, forensic examiners, prosecutors, magistrates, judges and probation officers from three regions in the North West of England: Cheshire, Merseyside and Greater Manchester. Through those interviews, the provision of support to alleged offenders is examined and the process of legal representation evaluated. By analysing decision-making processes around vulnerable defendants, two conflicting views that influence cimrinal justice professionals in their strategic behaviour were identified: protecting offenders' rights and protecting the public from criminal behaviour. It is argued that the criminal justice system draws its normative and enforcement powers from a 'discourse of truth' that concentrates on capacity and intent. Defendants who are classified as vulnerable because of impaired intellectual functioning whereby capacity to reason and intellectual disability are functionally separated. This way, an alleged offender's vulnerability becomes a manageable object within the criminal justice system and is integrated into a person's risk management. The disjointed discourse around intellectual disabilities increases the risk that people with an impaired level of intellectual functioning become drawn into the mainstream criminal justice system and, therefore, further compromises the empowerment and social inclusion of this population.
In public health working in a less medical and more preventative way by focussing on the wider determinants of health, inter-sectoral collaboration, and evidence based practice have been advocated as ways to raise the health status of the population. In recent years, the idea of contact with nature to enhance health has come to the fore as one way to tackle current public health challenges: for example, diabetes, overweight and obesity, chronic liver disease, hypertension and mental health problems. Yet little is known about how this idea has diffused through the interdependent figurations of researchers, policy makers and into use through the actions of people in local organisations. The processes connecting these interdependent figurations are complex and, in the case of contact with nature, are not well understood. This is the research problem this thesis seeks to address, that is to say, the evidence into action process of an idea. The theoretical perspective of Norbert Elias is used throughout the thesis to analyse the diffusion process of the idea. Elias’s work is concerned with long term processes in human history; in adherence with his approach to sociological inquiry a historical context going back more than three generations provides the backdrop for the empirical work. An examination of the context illuminated the significance of the decade of the 1970s onwards to the present use of the idea of contact with nature in public health; notably the shift in discourse about hazards, risk and threats from nature to one of health enhancement. Norbert Elias’s own thinking and discourse about contact with nature to enhance health is used as a touchstone for the analysis. The empirical data in the thesis is generated through mixed methods, principally bibliometrics and content analysis, to reveal the diffusion and development of the idea over time and to show the way that the idea is framed when used by researchers, policy makers and by people within organisations. An Eliasian approach to case study methodology is utilised. Sub-study 1 revealed that empirical research literature about the idea emerged in the 1970s and that the number of publications per annum increased year on year until 2005. The empirical research was generated by researchers located across several continents and from different disciplines. Early researchers into the idea investigated the psychological benefits whilst latterly epidemiological studies have come to the fore. Sub-study 2 showed that the idea was taken up widely by policy makers in four government departments in England from 2000, with a peak in 2011. There were more references to the idea in the policy documents of the Department for Environment, Food and Rural Affairs than other government departments; the references of this department took an ecosystem services stance. Sub-study 3 showed that during July to October 2013 and within Greater Manchester, 36 organisations were providing and/or promoting activities which involved the idea of contact with nature on their websites. Of these 36 organisations, 16 (44%) were conservation/wildlife based agencies whose use of the idea included the pursuit of their own agendas and purposes. ix An analysis of the results, using the theoretical perspective of Norbert Elias, shows the involvement of many figurations of interdependent individuals, and the long term, largely unplanned, and non-linear character of the diffusion process. The empirical findings reflect the transdisciplinary nature of the research, inter-sectoral collaboration across government departments within policy, and the adoption of the idea outside of the traditional health service. People and thinking from the environment sector have greatly influenced the diffusion and development of the idea, and their involvement has widened the scope and form of public health action.
Flynn, Sandra D. (University of Liverpool (University of Chester), 2013-05)
“Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn life around,” (Leo F Buscaglia 1924-1998). Caring is a universal phenomenon (Leininger, 1988a, 1991) that influences the way we think, feel and act and is the focus of debate worldwide. Studied since the days of Florence Nightingale and reflected in the literature are numerous theoretical opinions in the search for a comprehensive understanding of caring in the health experience of human beings (Newman et al., 1991). This ethnographic thesis has a caring science perspective (caring in orthopaedics) with the aim of acquiring a greater understanding of perceptions of caring in an orthopaedic clinical setting from both patient and health care professional perspectives. There is a wealth of literature relating to caring which attempts to define and interpret its meaning from several theoretical perspectives. In respect of institutional or professional caring, nursing has historically been synonymous with the notion of care and caring, modest research has been attributed to caring amongst other health care professionals in the wider context. The study used a sequential exploratory mixed methods design and was underpinned by Watson’s Theory of Transpersonal Care in order to discover and illuminate the essential caring behaviours valued by both care givers and care recipients. A total of 30 patients and 53 health care professionals consisting of doctors, nurses, physiotherapists and occupational therapists participated in the study through a three stage approach consisting of questionnaires, observation and semi-structured interviews. The findings revealed both similarities and differences between patients and health care professionals relating to the importance of positive caring behaviours revealed during caring interactions. The questionnaires disclosed that patients statistically rated caring behaviours demonstrated by health care professionals lower than the professionals rated themselves. The data analysis from the participant observation and semi-structured interviews established that although all of the caring caratives according to Watson’s Theory of Care were evident in caring interactions they varied as to the number of times they were exhibited by the respected health care professional groups. Overall patient perception of caring focused upon behaviours related to the caring carative ‘assurance of human presence’ whilst health care professionals considered caring behaviours relating to the caring carative ‘respectful deference’ as the most important. This thesis highlights the need of the patient to feel ‘cared for’ and ‘cared about’ and in today’s modern health care system caring should not be monopolised by one profession but instead the caring concept embraced and the caring dais shared by other professions.
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.
This study aims to critically analyse and explore how social workers (operating in the adult social work practice domain) draw on wider social (and social work) discourses in accounting for the work that they do. Utilising purposeful samples of students and qualified social work practitioners, this exploratory study of discourses analyses the implications this has on the construction of the social work identity, role and practice (action). Driven by a series of research questions, the objectives of this research were: 1) To critically analyse and explore the discourses on which students and social work practitioners draw on in their accounts of social work practice; 2) To identify and critically analyse the subject positions and discursive practices (collective ways of speaking) of social workers in respect of these discourses; 3) To critically analyse how and in what way social workers at different stages of the career trajectory draw differently upon these discourses; 4) To critically analyse and evaluate the implications for practice and service users of the respondents’ subject positioning and the discursive practices that they employ; 5) Develop a critically reflexive method (model) for social work education and research in order to make recommendations for research, education and critical social work practice (in the context of self-awareness). As this study involves several people in the exploration of adult social work (Community Care policy context), it will contribute to knowledge of the meaning given to contemporary social work. It does so by expanding the concept of discourse analysis to the wider social context in which the overall narrative (story) is ‘told’. This research aims to understand how respondents draw on discourses in particular ways and includes an analysis of the contradictions and gaps within the overall narrative of social work. Stemming from wider pre-determined narratives that are available in social work cultures, this study not only analyses the words themselves by utilising discourse analytic tools, but demonstrates new ways in which to apply critical discourse analysis in the exploration of accounts of social work. In this examination, this research critically analyses and evaluates the implications these discourses can have on identity construction (personal and professional self), as well as on those social work intends to benefit (service users).
The English Improving Access to Psychological Therapies (IAPT) programme is a government-funded initiative that aims to provide timely and equitable access to evidence-based psychotherapeutic interventions, within a primary care setting. Despite the many achievements of the programme, there are several issues regarding research to clinical gaps, as well as a high rate of variation between sites concerning outcomes and attrition. This thesis explores the implementation process of the IAPT delivery model to understand which factors are influential in the successful uptake and integration of evidence-based psychotherapeutic interventions. The aims of this thesis are: To explore, identify and analyse the implementation process involved in establishing and delivering an IAPT service. To uncover the factors that either facilitate or impede its development to provide a more in-depth and detailed account of the implementation and operation of services. To develop an understanding regarding the applicability of evidence-based practice and the IAPT delivery model in a clinical setting, for the provision of psychological therapies. I conducted a series of semi-structured interviews with practitioners delivering and implementing services, across seven sites, and clients, across three sites. The design and analysis followed an Interpretative Phenomenological Analysis, focusing on personal meaning and sense-making processes. The objective of the interview was to understand the implementation process regarding the IAPT delivery model, exploring how this influences personal experiences and client engagement. Additionally, participant narrative was set in context using open-access data collected and published by the programme. The analysis generated three master themes for practitioners delivering and implementing services including: ‘A Call to Action’ describing how participants regarded this process as a genuine opportunity to make a real impact in mental healthcare; ‘Contextual Influences on Service Operation’ which explores the activities in becoming a locally determined, adaptable and relevant service; and a ‘Focus on Relationships’ outlining the relational and collaborative work involved during implementation. For the client group, three master themes were generated including: ‘A Personal Journey: From Discovery to Advocacy’ illustrating the changing experiences involved during service access and engagement; ‘Perception of Self’ which portrays how individuals made sense of their engagement by judging what it meant to them; 5 and ‘Outside Factors’ which explores the role of others and the physical journey made in getting to services. The analysis suggested that both groups made sense of their experiences in complex and varied ways. Heavily influencing the implementation of the IAPT delivery model is the over-arching need to boost throughput and quantity, possibly at a cost of quality. Additionally, it is argued that the use of routine outcome monitoring in services is useful for reflecting on the implementation process and engaging clients. The key to successful implementation appears to be about achieving integration, requiring a whole-systems based approach that considers the mediating pathways into and out of services. In light of the findings and literature, the thesis proposes several recommendations for future practice and further research.
This thesis explores women’s disclosure of domestic violence, and is based on the findings of two research studies. The first study explored prevalence rates of domestic violence reported by women following childbirth. The subsequent narrative study explored women’s experiences of disclosure and their interactions with statutory agencies. The research was influenced by a feminist epistemology, recognizing the marginalisation of the women’s experiences from a subjugated relationship, addressing the power relationship between the researcher and participants and because of the significant disparity between gendered lives. The study was conducted in two parts. A survey of five hundred women in the immediate postnatal period within a large NHS Hospital participated in the first part of the study. The second study involved narrative interviews with fifteen women living within their own community who talked about their experiences of domestic violence and issues surrounding disclosure. Women’s stories about disclosure including the responses they received were influenced by cultural narratives. The theories of social power have been utilized as an explanatory framework and provide the theoretical basis of the analysis. The study found low levels of disclosure at two specific points along the pregnancy/childbirth continuum; during booking in clinic and in the immediate postnatal period. Furthermore, the findings revealed three specific tactics used by perpetrators to engage women in the early relational stage with the intentionality of exerting control and subjugation. These have been termed feeling special, feeling vulnerable and commitment. Whilst women talked of coercion and subjugation by their partners, they also talked of how their interactions with statutory agencies limited their agency. The significance of this study is that the thesis was able to challenge contemporary policies developed by statutory agencies in the provision of support to women who experience domestic violence. The thesis develops some understanding of the nature and role of cultural narratives and patterns of disclosure before suggesting new directions to further advance the findings presented. Finally, the thesis proposes recommendations to improve training for statutory agencies in providing a response to women disclosing domestic violence, suggesting a new direction in thinking about the facilitation of this training.
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.
The export option will allow you to export the current search results of the entered query to a file. Different
formats are available for download. To export the items, click on the button corresponding with the preferred download format.
By default, clicking on the export buttons will result in a download of the allowed maximum amount of items.
To select a subset of the search results, click "Selective Export" button and make a selection of the items you want to export.
The amount of items that can be exported at once is similarly restricted as the full export.
After making a selection, click one of the export format buttons. The amount of items that will be exported is indicated in the bubble next to export format.