The Faculty of Health and Social Care has a long history at University of Chester, being established in the early 1990s as the School of Nursing and Midwifery. A wide variety of programmes are delivered by the Faculty including foundation degrees, undergraduate degrees and postgraduate degrees. All branches (adult, mental health, learning disability and child) of pre-registration nursing can be undertaken, as well as pre-qualification courses in Midwifery and Social Work. Social Work programmes are available at both undergraduate and masters levels. The Faculty also offers a wide ranging and exciting portfolio of post-qualifying programmes with an inter-professional focus. Within the Faculty, research is viewed as integral to the working life of staff, in partnership with local and regional providers of care. The Faculty has a research office which coordinates the activity of the Faculty. The strategic focus is on further development in community/primary care, users and carers support and inter-professional learning. There are opportunities to register for a PhD, with supervision from recognised experts in their field. Individual Professors, Readers and Teaching Fellows lead their own research developments in subjects closely related to practice-based care. These include clinical interventions in eating disorders, supporting individuals with learning disabilities in the penal system, interventions in forensic mental health, supporting carers and users of services, safety factors for single practitioners in the community and pedagogical research.

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  • A phenomenological exploration of nursing students’ experience of raising a care concern in clinical practice

    Cooper, Elizabeth (University of ChesterUniversity of Chester, 2020-01)
    UK pre-registration healthcare students are expected to raise a care concern about unsafe situations whilst in clinical practice. The UK’s NHS is in the midst of a change to an open, honest and transparent culture which responds to a professional’s concern about patient care, to improve safety and prevent harm. Central to this change is improving the experience of registered healthcare professionals whose decision to raise a care concern is influenced by the organisational culture; this can create a difficult moral choice. The experience of nursing students who decide to raise a care concern has received little attention, and this study sought to explore this under-researched area. A literature review was undertaken which identified that the experience of nursing students who had raised a care concern had not been previously examined. To guide this study, Clarke Moustakas’ (1994) transcendental phenomenological methodology was used to explore nursing students’ lived experience of raising a care concern. Ten nursing students with experience of raising a care concern in clinical practice voluntarily participated in the study. Open interviews conducted between December 2016 and October 2017 were audio recorded and transcribed, exposing individual narratives of raising a care concern in clinical practice. The transcripts were analysed to produce a composite description which summarises nursing students’ lived experience, reflecting four themes or essences: 1) patient centred concern; 2) deciding how to act; 3) having emotional strength; and 4) feedback and support. These typify what it is like for nursing students to raise a care concern whilst in clinical practice. The findings were critically examined and suggest that compassion may motivate nursing students to act when faced with an unsafe situation, seeking to stop patient harm and suffering. Recognising this moral motivation, students described the relevance of emotional strength when dealing with the emotionally complex experience of facing difficult situations, with feedback and support providing comfort plus moral and emotional satisfaction. This study also explores the implications for professional practice, specifically the impact upon future teaching and learning approaches to facilitate nursing students’ ability to detect and act upon unsafe situations; providing listening opportunities to support students in clinical practice; and valuing nursing students who raise a care concern as role models and local clinical leaders. Recommendations include a new national campaign to improve the likelihood of nursing students raising care concerns and updating UK professional guidance.
  • Predictors of mortality and survival in type 1 diabetes: a retrospective cohort study of type 1 diabetes mellitus (T1D) in the Wirral Peninsula

    Akata, Eloho (University of ChesterUniversity of Chester, 2019-05)
    Background: The prevalence of T1D is rising, despite improvements in the management of this condition. It presents a risk of premature and excess mortality, which impacts survival and life expectancy. Aim: The study aim was to assess mortality, identify predicting risk factors for mortality and survival in T1D in the Wirral. A systematic review was done to establish present current evidence of all-cause and cause-specific mortality amongst T1D patients. Methods: A retrospective cohort study design, 1786 patients diagnosed with T1D extracted from the Wirral Diabetes Register (WDR). The follow-up period was between 1st of January, 2000 to 31st December, 2012. The primary outcome measured was all-cause mortality. Results: 1458 participants with T1D meet the inclusion criteria, after a follow-up period of 12 years, 113(7.75%) deaths were recorded. While the incidence rate was steady over the study period, the prevalence rate continued to increase over the study period. Significant predictors of mortality in this cohort were age of diagnosis, duration of diabetes, HbA1c,systolic blood pressure (SBP), diastolic blood pressure (DBP), and triglyceride levels. The predicting risk gender, age at diagnosis, duration of T1D, BMI, serum creatinine levels, SBP, total cholesterol, LDL, HDL, TC\HDL, and LDL\HDL showed a linear increase in mortality risk. IMD and DBP followed a U-shaped relationship with relative and absolute mortality, while HbA1c levels reveal a sinusoidal pattern with the highest risk of mortality at the levels ≤ 5.9% (41 mmol/mol). The risk of mortality for the predicting risk factors for this study ranged between 5% and 9%. Maximal risk of mortality of 9% was recorded in the predicting risks of smoking, BMI, SBP, and DBP. The risk of mortality of 8% was recorded for IMD, serum creatinine, total cholesterol, TG, LDL\HDL ratio, and TSH. The risk of mortality of 7% was recorded for the predicting variables of HbA1c, HDL, LDL, and TC\HDL ratio. The minimum risk of mortality of 5% was recorded for the predictor variable of the duration of diabetes. The significant predictors of mortality were the age at diagnosis, duration of diagnosis, systolic and diastolic blood pressure, HbA1c. The burden of mortality rest disproportionately with females who had higher relative risk of mortality of 4 times that of their male counterparts, however, the burden of premature mortality as recorded by the years of potential life lost was slightly higher in males (1797[53.6%]) as compare to females (1553[46.4%]). Of the 113 deaths recorded for the cohort that indicated a proportion of 7.75% of the total T1D patients, records for only 37 participants were retrieved. The principal cause of death in this cohort was malignancy-related 8 deaths (21.6%), this was followed by cardiovascular disease and sepsis, each having 6 deaths (16.2%) respectively. Cerebrovascular disease accounted for 5 deaths (13.5%). Death from diabetes complications (hypoglycaemia) was recorded in 1 patient (2.7%). There were marked reductions in life expectancy for this cohort. Life expectancy at 40 years for females was to an average age mortality of 66.2 years as compared to males 78.3 years. There has been improved survival for T1D in this cohort, 77.185 years [95% CI: 75.191 – 79.179] in males and 76.011 years [95% CI: 73.169 – 78.000] in females. The systematic review highlighted increased mortality in those with T1D as compared to the general population, females showed greater risk of vascular complications as compared to the males with T1D. 35 studies were included. Results showed all-cause mortality RR 3.73 (95% CI 3.19, 4.36) compared to general population, with gender specific mortality RR 1.17 (95% CI 1.06, 1.29). For cause specific mortality risk (overall and gender specific): cardiovascular v disease RR 3.48 (95% CI 3.14, 3.86) and RR 1.41 (95% CI 0.92, 2.17); renal disease RR 1.06 (95% CI 0.89, 1.26) and RR 0.63 (95% CI 0.38, 1.04); neoplasms RR 1.03 (95% CI 0.92, 1.16) and RR 1.18 (95% CI 0.75, 1.86); cerebrovascular disease according to gender RR 0.99 (95% CI 0.66, 1.48), and accidents and suicides according to gender RR 2.30 (95% CI 1.31, 4.06). Conclusion In conclusion, the study highlighted significant mortality risk in females as compared to their male counterparts; there has been progress in the survival of patients with T1D. However, life expectancy remains reduced as compared to those without the condition. Prevalence of T1D continues to increase, and the complex interplay of the predictor variables support the need for an individualised approach to care.
  • Queering Blackpool: An Ethnographic Study

    Owens, Allan; Moran, Paul; Eadon-Sinkinson, Helen (University of ChesterUniversity of Chester, 2019-11)
    This research explores the notion of identity in relation to drag queens in the seaside town of Blackpool in the North West of England. What I describe is how this complex form of identity is composed not only from the appropriation and cultural manipulation of gendered tropes, in terms of behaviours, dress, and attitudes; but how identity is also composed from the socio-cultural place of Blackpool within the Northwest of England; and from specific genres of entertainment as they manifest in this sea-side town, which suffers from a high level of deprivation. The research employs qualitative data collection methods to build an understanding of how identity is created whilst exploring the ethnographic structure and representation of the town of Blackpool which is reflected in the analysis of the film through an autoethnographic lens. It becomes autoethnographic as it is my personal reaction to the research. I wanted to analyse my findings in terms of a qualitative visual ethnography and critical reportage, which takes the form of a short film which was an appropriate way to present the visual and socio-cultural representations of the data. Blackpool’s identity has been shaped by its raucous history. Early examples of dancing, drunken behaviour and prostitution at the Raikes Garden in the 1870s are documented by Walton (1998) as well as fairground style attractions and a rising number of cheap drinking establishments to cater for the influx of holidaymakers; all of which were difficult to police. Advertising the resort’s entertainment attracted more working-class visitors creating a more downmarket holiday resort which continues to this day. The working-class history of the town gives the resort a particular kind of focus. It also means that the town is vulnerable; it is vulnerable to economic market change, problems of poverty, and unemployment. Therefore, this thesis seeks to discuss the question: how is Blackpool’s social history reflected in both the town and drag performance spaces? This thesis uses the theory of Bakhtin’s Carnival (1984) to highlight certain aspects of the film in order to present the research through an appropriate theoretical lens as well as appropriate supporting literature throughout. I felt it appropriate to use Bakhtin, since even at the level of a superficial joke, Bakhtin’s work is located in celebration, freedom, holiday and the superficial preoccupations of historic and contemporary Blackpool. More significantly perhaps Bakhtin was interested in how the world, in these contexts, can be turned upside down, and what it means for order and identity to be essentially forms of performativity, a theme central to my own work around identity and place with respect to Blackpool. Due to the nature and disclosure of some participants I decided to present the data through the form of a film. Through the initial interview process, it became apparent that some identities needed to be hidden as a means of protecting both the participants and their families as sensitive details were 11 discussed, however their stories still needed to be told. To both explore and mitigate the problems that I have mentioned, visual ethnography seemed to offer both a solution and an interesting way to convey meaning that would otherwise be lost in text. By presenting the data in this way I am creating characters. This becomes unavoidable, rather like the drag queen performers who create characters, therefore I am paralleling that. By creating the characters that are heard and deliberately filming various aspects of Blackpool, I was able to join both person and place to create a visual means that represents the journey and exploration that I went through as a researcher and which further presents the data, as self and other, in the most appropriate way. When I use the word ‘trans,’ I am referring to transvestites, transsexuals and transgender people. Throughout this written part of this thesis, I will refer to the visual aspect as ‘the film.’
  • ‘Being different’: realities of life experiences as constructed by persons with albinism in Nigeria

    Mabhala, Andi; Keeling, June; Buck, Gill; Keen, Adam; Olagunju, Adeolu (University of ChesterUniversity of Chester, 2019-08)
    In Nigeria, persons with albinism (PWA) continue to face a higher burden of health and social challenges in the society compared with the general population. PWA experience multi-faceted social injustices such as stigma, discrimination and exclusion from education, employment and social participation. These injustices are driven by the Nigerian society because of sociocultural perceptions and stereotypes associated with albinism which can be attributable to the lack of adequate understanding of the condition. This research aimed to understand how the realities of being a PWA in Nigeria could be conceptualised based on their life experiences to develop a substantive theory of their social wellbeing status. By adopting constructivist grounded theory methodology, forty-two in-depth interviews were conducted amongst eleven PWA. Analysis identified three categories each of which embodies the multiple realities of disadvantages and exclusion experienced within the home, schooling, working and social environments at different stages of life. The concept of ‘Being different’ emerged from these categories to offer a theoretical explanation of what it means to be a PWA in Nigeria. The realities of ‘being different’ constitute processual social injustices for PWA because of how the Nigerian society is socio-culturally and institutionally configured to magnify the limitations of albinism above the rights and social liberties of the individual. This research identified albinism as a disability and concluded that PWA are owed a moral and ethical obligation by the Nigerian society for them to be able to access the liberties and support necessary to secure their health and social wellbeing. The sustainable fulfilment of this moral and ethical obligation necessitates an inter-institutional collaboration and vigilance that should address the layers of injustices meted to PWA. This study adds an original contribution to knowledge by offering a theoretical concept to qualify the social status of PWA in Nigeria, and thus, could be useful to inform appropriate health and social care interventions.
  • Utilising a Bourdieusian lens to explore emerging health visitor practice education experiences within the context of the Health Visitor Implementation Plan

    Gidman, Jan; Taylor, Lou; 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.
  • 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.
  • 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.
  • Stigma: Personality disorder and homicide in the U.K. red-top tabloid press, 2001-2012

    Lovell, Andy; McIntosh-Scott, Annette; Bowen, Matt (University of Chester, 2018-08-28)
    There is evidence of stigma towards people with personality disorder from within healthcare systems, but relatively little known about other aspects of stigmatisation. This study explored the image within the red-top tabloids of people with personality disorder who have committed homicide and how this may have contributed to the processes of stigmatisation. The analysis was underpinned by a symbolic interactionist perspective on individuals and society and was informed by the modified labelling model. The role the press plays in the processes of stigmatisation is elaborated through exploration of the theoretical models and empirical evidence. The data set for the thesis was articles published by the red-top tabloids between the years 2001 and 2012 (inclusively) that made reference to personality disorder. The data set was analysed using three methods: content analysis, corpus linguistics and frame analysis. The three methods were used in a mixed methods approach with a sequential design so that the results from one stage of the analysis fed into the next stage. The content analysis of the data set identified that of the 552 articles published about people with personality disorder, 42% met the criteria for being homicide themed. Analysis identified that there was a significant reduction in the proportion of homicide themed newspaper articles in the period 2007-2012 compared to 2001-2006 ((1, n=552) = 7.38, p < .05), however, the effect size was small (φ = .12). Corpus linguistics analysis was used on articles that were homicide themed and identified 22 words that were stigmatising in their use, and were used proportionally more frequently than a comparator data set. These words were categorised as either epithets (e.g. psycho, monster), qualities (e.g. evil) or contributing to the process of labelling (e.g. branded). Comparison between 2001-2006 and 2007-2012 identified a proportional increase in the use of stigmatising descriptors, but to a level that was not considered to be significant ((1, n=114110) = 1.53, p > .05). Frame analysis of the homicide data set identified a dominant news frame in the articles, referred to as lock them up and throw away the key. This news frame was structured on a model that the problem was a failure to protect us, the public, from the risk presented by them, dangerous people with personality disorder who commit homicide. The results of the study are discussed in relation to the model elaborated in the study of the role the red-top tabloids may play in the processes of stigmatisation. Implications for practice include using personality disorder in press guidance, and training for clinicians about attitudes towards people with personality disorder to include reviewing the impact of the press.
  • 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 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.
  • 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.
  • 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.
  • Understanding the diffusion of the idea of contact with nature to enhance health: An Eliasian case study

    Thurston, Miranda; Greening, Kim (University of Chester, 2015-12)
    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.
  • 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.
  • 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.
  • 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.
  • 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.
  • Visual perceptions of ageing: A multi method and longitudinal study exploring attitudes of undergraduate nurses towards older people

    Mason-Whitehead, Elizabeth; McIntosh-Scott, Annette; Ridgway, Victoria (University of Chester, 2015-12)
    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.
  • Understanding the Processes Involved in Implementing an Improving Access to Psychological Therapies Service: An Exploratory Study that Investigates Practitioner and Client Experience Regarding its Effect on Patient Pathways, Service Design and Overall Outcomes

    Pietroni, Patrick; Thomas, Mike; Steen, Scott (University of Chester, 2015-12-31)
    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.

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