RSS 1.0Theses
This collection contains the Doctoral and Masters by Research theses produced within the department.
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Recent Submissions
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What Aspects of Professional Socialisation Impact on UK Adult Student Nurses’ Future Career Aspirations? A Visual Methods StudyThere have been calls to strengthen the evidence base regarding how effective pre-registration nursing education is impacting upon improved healthcare outcomes. Whilst educating more student nurses is welcomed to meet the demands of the whole health and social care economy, there is deep concern that there is a lack of evidence to ensure that students are going into areas of clinical practice in which they are needed the most. The aim of this study was to critically investigate what aspects of professional socialisation impact on UK adult student nurses’ future career aspirations. Visual methods were selected as the methodological lens of enquiry, utilising photo elicitation to discover the characteristics and attributes that UK student nurses socially construct about registered nurses from their most and least desired areas of clinical practice post registration. The methods included eight semi-structured interviews from a third-year nursing student cohort from a university situated in the Northwest of the United Kingdom. Thematical analysis was employed to inform the findings of the study. A global theme of self-actualisation was established from student nurses describing their ‘ideal registered nurse’. This study presents new knowledge on the characteristics and attributes that student nurses perceive about registered nurses from different areas of adult clinical practice, which are socially constructed through themes of professional socialisation, professional evolution, care environments and mastery of skills and attributes. These findings suggest there is a dichotomy between socially constructed views held by student nurses and the reality of the registered nurse working in the least desirable area of clinical practice. The findings echo previous recommendations for approved educational institutions and practice learning partners to collaborate to ensure students experience a diverse range of clinical practice with greater preparation for learning opportunities with good role modelling. The findings also make new recommendations for nursing education and further research into the early evaluation of the effectiveness of the new NMC (2018;2023) standards. A student nurse career aspiration disk has also been created to support discussions with personal academic tutors and academic assessors.
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An ethnographic study of Acquired Brain Injury survivors: Meaningful occupation and recovery in the acute settingEvidence suggests early activity-dependent experiences post brain injury can support neuroplastic regeneration and reorganisation of the brain for improved functional recovery. It is imperative that this early phase of recovery includes opportunities for meaningful occupation in a motivating environment. Hospitals embody a complex system of cultural symbols and actions yet this cultural influence on Acquired Brain Injury (ABI) recovery has been poorly researched in general acute UK hospitals. The aim of this study was to explore how hospital culture influenced the experience of meaningful occupation and recovery for ABI survivors. As an interpretivist study, symbolic interactionism provided the theoretical framework for an ethnographic methodology. Methods of data collection included 144 hours of participant observation on the wards of a general hospital in Northwest England and twenty-three semi-structured interviews. Participants were purposively selected adults admitted following an ABI, and their significant others. Data were analysed using Reflexive Thematic Analysis. Three themes were constructed from the data: Occupation disconnect ‘too much and too boring’; A way of ‘being’ in hospital; Acceptance ‘that’s how it is’. An overarching theme also captured an umbrella concept: Hospital is the wrong place for recovery. Hospital culture has encompassing tendencies, a characteristic of total institutions, stifling person-centred care and limiting opportunities for ABI survivors to experience meaningful occupations resulting in occupational injustice and adaptive coping strategies that are not beneficial for recovery. This is of great concern during a critical period of neuroplastic brain recovery. Recommendations for policy and practice include expedited discharge from the acute hospital because current cultural processes do not facilitate recovery. Furthermore, this study recommends enhanced training for healthcare staff to optimise acute ABI recovery through embedding person-centred care and opportunities to engage in occupation for health and activity-dependent neuroplasticity. Practical changes on the wards are recommended such as providing clocks, televisions and changing intrusive call bell systems. Greater attention is needed to facilitate circadian rhythm to improve sleep as an occupation integral to brain injury recovery.
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Utilising a community cultural wealth model to explore African heritage social work student stories from placement: A critical ethnographic studyPost-graduate qualifying social work education programs in England generally recruit higher numbers of minoritised ethnic students than other post-graduate programmes. However, longstanding inequalities in outcomes and progression for ethnically minoritised social work students persist. Unpaid work placements constitute a key component of qualifying social work programmes but can pose additional barriers for ethnically minoritised students. Nonetheless, most successfully complete their placements and their programmes. This study utilised critical ethnography to identify the strengths and strategies employed by seven African heritage M.A. social work students as they navigated placements arranged by a higher education institution (HEI) in north-west England. Discourse in social work education regarding unequal outcomes for minoritised ethnic students is dominated by deficit thinking, whereby the assets of marginalised students are frequently overlooked, and interventions focus on 'fixing' students, ignoring HEI practice. This study challenged such discourse by illuminating the assets that seven African heritage students, four of whom were classified as ‘home’ students and three as ‘international’, brought to their practice placements. Arts-based engagement ethnography was utilised to gather stories from the participants, employing creative techniques, generating artefacts that informed individual interviews and a focus group. Participants' voices were privileged throughout, and rich, nuanced detail obtained. The impact of intersecting factors, including gender, religion, and immigration status, was apparent throughout the study. The data chronicled participants’ counter storytelling narratives, uncovering the multiple strategies they applied to 'fit' into their placements. Furthermore, elevated levels of individual agency were evidenced, utilised by participants to secure essential learning. The study illustrated the critical role dispersed families and kin, alongside religious faith, and values, contributed to sustaining participants' endeavours. However, the data also highlighted students' efforts as predominantly unnoticed, therefore unsupported by their HEI and placements. Analysis of their stories, utilising a community cultural wealth model, evidenced extensive cultural knowledge, skills, and resources. Aspirational, familial, linguistic, navigational, social, resistant, and spiritual capital were present in abundance: their interconnected nature evident. Actions to empower students to use their cultural assets were identified, with the significance of supporting social, linguistic, and spiritual capital emphasised. The study contributed new knowledge taking a strength-based perspective to identify the cultural assets a group of African heritage social work students brought to their practice placements in England. The applicability and value in using community cultural wealth models in practice settings, to identify students’ assets, was established. The findings have implications for HEIs and placement agencies, with potential to improve support and outcomes for African heritage social work students on placement.
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Curated Immersion: An Exploration of Participatory Arts Practice in Healthcare ContextsResearch into the nature of participatory arts practice in health is scarce. Literature discussing this practice lists successful components but there are few conceptualisations of the practice that draw these components together. Assemblages available are specific to health contexts or art-forms and therefore this research investigates the common componential nature of participatory arts practice in health (PAPH) and aims to map a casual network of this practice. Artist ‘case studies’ are formed from data gathered through social-science methodologies (observations and semi-structured interviews). These case studies are coded and then displayed as data matrices, used to collate common components across the diversity of practices. Causation networks then plot the causal relationships of these components and a map is created to visualise the collective whole. This map is then analogised as a terrarium, an emblem of the whole practice, describing both the constituent parts of PAPH and its assembly. The findings reveal that, despite the diversity of PAPH, common components - and their assembly - exist. This research suggests that PAPH consists of a carefully curated and attentively adapted space in which an immersive, co-created, participatory experience is nurtured.
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Optimising sexual health and wellbeing services for raciosexual minorities in England using constructivist grounded theoryBackground Racism, stigma, and discrimination can result in poor experiences, marginalisation, misinformation, and thus detrimental health outcomes for racially and sexually minoritised (Lesbian, Gay, Bisexual, Trans and Queer+ Black Persons of Colour (LGBTQ+ BPoC) identifying) individuals. By considering what culturally safe, sensitive, and inclusive services can look like, we can begin to advocate for better, more appropriate health service development. This study aims to examine the experiences of racially and sexually minoritised individuals in accessing sexual health services to develop a theoretical explanation of how to optimise sexual health and well-being services for raciosexual minorities in England. Design Charmaz's constructivist grounded theory was used to develop a theoretical explanation of how to optimise sexual health and well-being services for raciosexual minorities in England. Fourteen in depth interviews were used to collect data. Broun and Clarke's thematic analysis was used to analyse the data. Results From five fundamental themes, three key factors emerged from the data i) access to credible sexual health information, ii) culturally competent lived experience leadership, and iii) culturally safe environments and conditions. Findings highlight disparities with regards to access, outcomes, and experiences of care for raciosexual minority individuals in England. Factors such as the absence of lived experience practitioners, a lack of sensitivity and privacy, and a lack of diverse prevention options were said to compromise the accessibility and usability of existing sexual health services. Similarly, factors such as practitioner competency, trauma-informed approaches, access to practical information, were all said to optimise this experience, leading to greater openness and likelihood of service user engagement (see Figure 25). Conclusion In line with the recommendations made by the participants of this study, culturally safely, sensitivity, and inclusivity remain key drivers toward the design of more optimal sexual health provision in England. This will be achieved through an improved access to credible sexual health information, an increase in lived experience practitioners, provision of cultural competency training across the workforce, and the curation of culturally safe clinical environments and conditions. While it will require significant changes, where intersectionality is honoured, a shift will be observed toward a more optimal sexual health service delivery model. In turn, improved access, experiences, and overall health and wellbeing outcomes will be noted for raciosexual minorities in England.
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The policy and prevalence of dyslexia in WalesAbstract available in hard copy
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Managers' Perspectives of an Effective Health and Social Care Worker in the Independent Sector: An Ethnographic StudyAim: This thesis presents an ethnographic investigation into the perceptions of managers in the independent health and social care sector regarding the characteristics of effective health and social care workers. The study investigates the managerial perspective of the values, skills, knowledge, and functional behaviours regarded essential for providing high-quality care services to adults who may be at risk. Using an ethnographic methodology, the study seeks to glean rich and nuanced insights from managers who play a central role in moulding and supervising the Health and Social Care workforce. Background: Health and social care workers require a variety of skills and knowledge for them to be perceived as effective by their managers. The skill and behavioural requirements range from the practicalities of supporting people with their daily living tasks, including clinical support, to high levels of emotional intelligence to support the sociological, psychological, and emotional wellbeing of people who access health and social care services. Health and social care frontline workers require a sophisticated level of emotional intelligence with positive, personal attributes such as patience, kindness, empathy, and compassion. Methodological approach: An interpretive, ethnographic design was adopted for the study incorporating symbolic interactionism with social constructionism as a lens with which to analyse the outcomes from the research question. Individual, semistructured ethnographic interviews were conducted with ten managers (n=10), and 18 two focus groups were held in which participants were asked to identify the characteristics that, in their opinion, constitute an effective frontline worker. The leadership focus groups included eleven managers in total (n=5 + n=6) therefore twenty-one participants in total (n=21) plus field notes thus achieving triangulation. The data was analysed using Ricoeur’s thematic analysis framework. Findings: Communities of practice are naturally inherent in well performing teams. On a service level this is brought about through the behaviours of effective frontline workers, creating cultures of effective communication and continual, shared learning to enhance the lives of their service users. One may suggest a culture of experiential learning begins through the metamorphic, liminal experience of integrating staff members into the organisational culture. Liminality is present in the experience of individual workers, teams and the ‘living organisation’. It is a catalyst, in which processes happen spontaneously, leading to consideration of 21st century healthcare and compassion in caring; essential for the transformative, person-centred healthcare required in contemporary practice. Recommendations: Recommendations included the development of a professional identity through communities of practice, an educational push towards enhancing staff self-actualisation, and the cultivation of organisational culture, all of which would lead to compassionate care with a focus on facilitating service user safety and happiness.
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Exploring engagement: A Constructivist grounded theory study of pregnant woman’s engagement with antenatal care health services in rural IndiaBackground: Safe motherhood, a woman experiencing a healthy pregnancy experience, with a positive outcome and healthy living of women and newborns are an integral concern for global public health (WHO, 2016). The estimated global maternal mortality rate is 211 deaths per 100 000 live births and approximately 810 mothers died each day worldwide in 2017 from preventable maternal complications (WHO et al., 2019). Only 52% of women reported to have attended at least four ANC visits as per NFHS 4 (2015-16), along with 17% of Indian women who never contacted health facilities for visits (NFHS4a, 2017). Methodology: The research study has adopted Kathy Charmaz’s Constructivist Grounded Theory methodology. Methods: In-depth semi-structured interviews were conducted with eight initial purposive samples of pregnant women. The data was simultaneously analysed to gather preliminarily concepts which further guided the theoretical sampling of sixteen pregnant women and eight healthcare workers. All 32 interviews were audio-recorded with the permission and consent of the participant. The three stages of coding in Constructivist Grounded Theory methodology, Initial coding, Focused coding, and Theoretical coding were followed for data analysis. Findings: The core category consists of interrelated sub-categories; perceived Benefits and importance of Antenatal care health services; pregnant women and Health worker interaction and structural factors as a barrier to antenatal care. Pregnant women especially for a full and partial ANC, perceived ANC as an opportunity to gain assurance about their well-being. Family presence is crucial in women's ANC decision-making. A positive relationship with healthcare providers significantly influences ANC engagement. ASHA community health workers act as a crucial bridge between the community and the health system is one of the important social processes which encourage women. Women preferred the Ultrasound over complete ANC services and recognized it as a core component to reassure both the baby and the woman. Family members especially elder female strongly influenced women’s decision-making. Health worker-pregnant women interaction is pivotal, fostering trust and encouraging ANC acceptance. Conclusion: The study reveals varying perceptions of ANC among full, partial, and non-attenders, shaped by diverse factors influencing their engagement. A prevalent theme is the predominant view of ANC as curative rather than preventive care, reflecting a significant social process. Pregnancy is often seen as a normal, healthy event, affecting decision-making. Lack of autonomy emerged as a significant predictor for ANC utilization, highlighting the need for women-cantered care.
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A Hermeneutic Study of a Paraprofessional Mental Health Initiative involving Medical Teams and Male Professional FootballersThe spotlight has only recently focussed on mental health in professional football. High-profile suicides alarmed the football community and players continue to take their own lives. Consequently, mental health disorders in professional football have become a topic of increasing interest in research, due to the serious consequences for quality of life, and the likelihood of the player’s predisposition to inflict serious self-harm. Aims Given the increased interest in and importance of mental health issues, mental health education and guidance for football medical teams is essential. The research aim was to investigate the role of the medical team in managing the mental health issues faced by male professional football players and establish whether a paraprofessional Solution Focussed Brief Therapy (SFBT) initiative could enhance that role. A total of thirty-four participants, working in Premier League and Championship level professional football, took part in this two-phased study. Nineteen were contracted players, thirteen were members of medical teams and two were PFA representatives. A Heideggerian hermeneutic approach was adopted and data was collected through fifteen in-depth interviews and four focus groups. In Phase 1, the problem of mental health disorders and mental healthcare in professional football was explored. In Phase 2, a pilot study investigated the feasibility of a SFBT intervention, delivered through a smartphone APP. Results All of the nineteen players declared mental health issues. De-selection, not injury, was the main reported issue. The majority of players and medics agreed that disclosing mental health problems could lead to de-selection from the team, for some further punishment, due to the value placed on maintaining a ‘mental toughness’. Therefore, if a sports psychologist was present at the club, the player may not seek help as it was dependent on trust in the individual. None of the players made use of the PFA counselling hotline, at any time, for mental health support. The majority of players would speak to a member of the medical team if confidentiality was guaranteed. None of the medical team members had any mental health education, and yet engaged in unofficial paraprofessional mental healthcare. All medical team members thought paraprofessional mental health education would be of benefit. The SFBT APP intervention was unanimously well received as a paraprofessional mental healthcare aid. Conclusions The SFBT intervention indicated it was clearly possible to develop a paraprofessional mental healthcare supporting role for players. Mental health issues of professional footballers could be managed more effectively if the appropriate education and SFBT intervention, from inside the medical team, was in place. This could potentially save lives. Recommendations for future strategies and further research have been detailed.
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An exploration of the social and cultural functions of drinking alcohol within the home for professional middle-aged women: implications for public healthEvidence suggests that middle-aged women in the UK are drinking more alcohol today than in previous generations, particularly those in professional roles. Similarly, the place of drinking is changing, too, with recent data suggesting that women within this age group are drinking more at home. From a public health perspective, liver disease is now the second leading cause of death in working-age people, and 5%-11% of breast cancer diagnoses in women are attributed to alcohol consumption. Research which seeks to understand why women within this demographic are drinking more at home remains limited. Alcohol research has, to date, focused primarily on younger people. The qualitative study, situated within the interpretivist paradigm, sought to understand whether social and cultural changes have impacted middle-aged professional women’s consumption of alcohol in the home. Unstructured interviews were undertaken with ten middle-aged professional women. Interviews were recorded, transcribed, and analysed using thematic narrative analysis. Bourdieu’s theory of practice was used as a conceptual framework, and narratives further analysed through a Bourdieusian lens. Findings indicate that alcohol is used as a means of relaxation, reward, and coping with pressure and stress, particularly for those with caring roles across ascendant and descendant generations. Increased availability, accessibility, and reduced cost have resulted in alcohol being part of the weekly supermarket shop. A positive portrayal of alcohol through both television and social media was found to increase consumption. Scepticism was displayed towards the government’s low-risk drinking guidelines. Furthermore, a lack of concern was noted regarding the potential detrimental impacts of alcohol consumption on health. Viewed through a Bourdieusian lens, findings indicate that habitus became a structure that generated dispositions toward an expectation of drinking at home and a normalisation of that behaviour for the women. Accumulation of capital enabled the women to become “connoisseurs” within the social field of home drinking, differentiating their taste in what they viewed as socially acceptable alcohol consumption, notably wine. Within the field of home drinking, women who consumed alcohol felt at ease as they were conforming to the game's rules—conversely, those who tried to reduce their drinking experienced feelings of unease. This research provides new insights into middle-age professional women who drink alcohol at home. Findings suggest that social and cultural changes have contributed to increased drinking at home for this population cohort. Recommendations for further research opportunities are made, and implications for public health policy and practice discussed. Highlighted is the need for future partnership approaches to tackle this increasing public health concern.
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An ethnographic investigation into multidisciplinary team collaboration - the role of psychological safety in a high-secure forensic in-patient hospital in GermanyBackground: Multidisciplinary team (MDT) collaboration in high-secure forensic in-patient hospitals is, although essential to the work, hardly studied. The culture of MDT collaboration differs due to their composition and the environment. Psychological safety (PS), that is the interpersonal feeling that the environment is safe enough to engage in MDT collaboration, without fear for personal consequences, could support staff to construct and better accumulate knowledge about patients between the different professions. Aim: To explore factors of influence on the culture of MDT collaboration and PS in the constantly changing MDT in day-to-day life. To understand how interactions with the environment and people in the environment become meaningful and are enhanced or create barriers which prevent staff from engaging in MDT collaboration. To study the role of PS and which factors, if any, influence it and how they interact with each other. Methodology/methods: A symbolic interactionist ethnographic methodology was used, with an emic approach to data collection and an eclectic approach to data analysis. Ten observations of weekly treatment meetings and 13 interviews (with a psychiatrist, a psychotherapist, a social worker, a teacher, five nurses, two ward mangers, two occupational therapists) were conducted and analysed through thematic analysis (TA). Reflexivity was used to constantly feedback on the role and presence of the researcher in the study. Findings: Four central themes were discovered: a shared approach to care; support and informal relationships; leadership and power and hierarchy; and PS, influenced by all and influencing all. The themes are visualised in a model of the social construction of MDT collaboration and PS. They are distinct and interrelated and discovered on four levels of social interaction in the hospital. The absence of a shared model of care, the supportive relationships, leadership, and the personal interpretation of the interactions between staff exerted the most influence on MDT collaboration and on PS. The absence of a multidisciplinary shared model of care kept the features of the total institution (TI) and the totality of the medical model in place. The traditional inequality and power issues between the professions responsible for the treatment and their knowledge, and the supporting staff created barriers to effective MDT collaboration and PS. The locally constructed meeting chaired by the nursing staff, the relationships, support, sub-teams, and inclusive leadership and behaviour enhanced both MDT collaboration and PS as a team emergent state (TES). These factors promote a culture of equality, belonging and perceived value. However, without a shared model of care, the relationships and perceived equality and support in sub-teams promoted dependencies on the knowledge and the support of others and revealed detrimental effects of high PS in sub-teams on MDT collaboration. Implications: MDT collaboration is complex and requires an unequivocal, carefully designed setting informed by a shared model of care with meaningful roles for all professions, inclusive leadership, and supportive informal relationships. Findings include the need to: diminish the deeply embedded unequal culture of collaboration informed by the TI and the medical model; diminish the dependencies on knowledge and support of others; promote an innovative culture of safe MDT collaboration with no fear for personal consequences for its members. Further recommendations for practice, education, and further research have been made.
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Registered Nurses’ experiences of working within professional and contractual boundaries: A Grounded Theory studyAligned to the Nursing and Midwifery Council’s (NMC) The Code (2018a) and other supporting regulatory documents, Registered Nurses (RNs) are accountable to the healthcare organisation through an employment contract and must work within the remit of professional standards and organisational policies. Falling below explicit professional and organisational standards has the potential for repercussions for the RN, the public and the organisation. This research explores RNs’ experiences of meeting the needs of the patient whilst fulfilling the requirements of The Code (NMC, 2018a) in conjunction with operational policies in a small District General Hospital within the British Isles. As far as can be ascertained, this study is the first to focus on the topic of interest. To explore this subject area and to have generated a substantive theory of Professional Liminality, a qualitative constructivist grounded theory approach situated in the interpretive research paradigm was espoused. Participants were purposefully and theoretically sampled to take part in this study. 12 face-to-face individual semi-structured interviews were conducted with experienced RNs. The interview guide evolved and lengthened over the data collection process in keeping with a grounded theory approach pertaining to emerging theoretical interests from the participants’ answers. The grounded theory principles of data collection techniques, constant comparative method of analysis to code data, construction of categories and the development of theoretical themes were adopted to produce a theory explaining the relationships between the emerging themes. Analysis of the findings uncovered three themes: Governance, Professional discrepancies, and Professional disquiet. These themes highlighted a dichotomy between professional and organisational expectations, significantly affecting RNs’ daily clinical practice, and are contextualised in the theoretical framework of professional liminality, representing the complexity of the findings. A new model, Rules versus Roles (RvR), is proposed as an approach to address and resolve the precarious professional liminal positions in which RNs find themselves. Whilst The Code (NMC, 2018a) and operational policy are both vital; they coexist paradoxically. This research indicates that they would benefit from complementing each other to affect an evolving and dynamic contemporary healthcare organisation.
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Quality of life and social support in rare genetic skin conditions: A mixed methods studyAim The aim of this study was to explore the relationship between quality of life (QOL) and social support in adults living with rare genetic skin conditions, specifically Epidermolysis Bullosa (EB) Ehlers-Danlos Syndrome (EDS) and related conditions. Background Measuring QOL has become an increasingly important method of evaluating the effectiveness of health and social care interventions. Living with the effects of a rare genetic condition has a profound impact on QOL for the individual and families. Design Methodological triangulation was adopted, in a sequential mixed methods exploratory design. Three stages were included: a literature review, online survey (n=31), and semi structured interviews (n=8). Outcomes The literature review concluded that professionals should adopt a biopsychosocial approach to the management of rare diseases. The online survey found a positive correlation between QOL and social support. The role of the family was a prominent theme. Most participants indicated that emotional support was provided by family carers, and tangible (practical) support was the highest rated support need. Conclusion This study demonstrated was that health and social care practitioners, policy makers and commissioners have to make room for QOL perspectives that come from the patient. These are wounded storytellers whose narratives are subjective but are spoken through illness. Their collective experiences can influence the direction of their diagnostic journey and must be front and center of any rare disease implementation plans in a post COVID era.
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A grounded theory exploration into situational adaptation strategies developed by Paramedics when dealing with mass casualty incidentsThe Manchester (U.K.) Arena bombing took place on the 22nd May 2017 at 22:31, when a suicide bomber detonated an improvised explosive device in the foyer of the Manchester Arena, as the crowd was leaving an event. The attack claimed the lives of 22 people, and a further 116 people required medical treatment, mostly for ballistic injuries. A key objective for Ambulance Service Commanders was to establish a casualty management system consisting of clinical triage, treatment, and transport of patients from a Casualty Collection Point into the hospital network. To achieve this, two Hazardous Area Response Teams were deployed alongside Consultant and Advanced Paramedics. The purpose of which was to provide point of injury care within the vicinity of the blast area. Whereas previous studies have identified how individuals react to the biopsychosocial response to traumatic incidents post the event, understanding how Ambulance Service personnel adapt to situations while deploying to, or during mass casualty incidents, remains an area that has received limited research in relation to defining empirical evidence. This study aimed to identify a process that either supported or inhibited Paramedics in achieving situational adaptability when dealing with a mass casualty situation. Constructivist Grounded Theory was used as the chosen methodology, with fifteen Paramedics volunteering to participate in the research. Analysis identified eleven theoretical categories, which were then divided into four theoretical themes. Combined, these formed the basis for four major theoretical propositions: ‘Training & Education’, appropriate application of ‘Incident Management Frameworks’, established ‘Peer Support Networks’, and individual reaction to ‘Stress stimuli’. This study makes a novel contribution to the phenomenon of situational adaptively. The significance of the resulting theory is that situational adaptability can be enabled through the application of effective decision making strategies, being able to draw on previous experiences, along with effective scene management. This along with communication strategies, support from peers, the incident commander, and multi-agency partners. Key identified inhibitors are presented as situational stressors, perceptions of threat, risk appetite, and environmental stimuli. Consequently, it is now possible to provide four recommendations for Paramedics preparing to respond to mass casualty incidents.
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A modified grounded theory study exploring the impact of military service in Northern Ireland on mental wellbeingMilitary service in Operation Banner during the Northern Ireland Troubles posed significant challenges for individual soldiers. The purpose of this study is to explore the impact of service in Operation Banner on the mental wellbeing of veterans who served in this conflict, and factors that have hindered or facilitated acquiring help in those who have experienced mental distress. This is a qualitative study that has utilised a modified grounded theory methodology and adopted a symbolic interactionism theoretical framework. Data were collected in semi-structured interviews with 16 veterans, recruited via advertising in newsletters distributed by veterans’ organisations to their members, advertising via posters and local radio and through snowballing. Data analysis was by open and focussed coding, supported by computer assisted qualitative data analysis software. The study confirms that for the majority, military service did not result in long-term mental distress and participants gained useful career and life skills. Yet, for some mental distress has persisted. Since leaving Operation Banner, the ability of veterans to cope with the past and meet present or future challenges has been through a combination of innate skills, resilience, individual initiative, outside support, and making use of opportunity. For some, though, coping has been hindered by internal barriers such as self-isolation, emotional suppression, legacies of military culture and veterans’ perceptions of indifference or even hostility by society and politicians. These barriers have led to some veterans to being predominantly oriented towards the past and unable or unwilling to seek help, a situation made worse by threats of prosecuting veterans, which have reinforced memories of the past. This study theorises, therefore, that there is no single way to help these veterans without understanding each veteran’s perception of themselves. When this self-identity is predominantly past-oriented, internal barriers negate the relevance of external help. When the veteran’s self tends towards future-orientation, external barriers to accessing help are more relevant. Understanding this individuality of self-perception may help to address factors that are maintaining past-orientation. Yet, for those who seek a resilient future, providing the right services, at the right time and in the right format is critical. This study helps to fill the relative gap in qualitative studies on UK veterans and those from Operation Banner in particular. Recommendations are made for the support of Operation Banner veterans and for future research.
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An analysis of the acceptability, feasibility, and utility of the Global Mental Health Assessment Tool for Primary Care (GMHAT/PC) in a UK primary healthcare setting: a practice-based mixed methods studyIntroduction: Published evidence shows that at least one in four people at any one time have mental health symptoms, most commonly of anxiety and depression. This is set against a background where the evidence demonstrates that primary care in general is poorly equipped to identify, diagnose and manage mental health disorders. The effect of these disorders affects the individual’s physical and social wellbeing and has an impact at all levels of Society. This study investigates the acceptability and feasibility of the Global Mental Health Assessment Tool for primary care (GMHAT/PC), and the impact of using it on the confidence and self-rated competence of healthcare workers. The Global Mental Health Assessment Tool for primary care (GMHAT/PC) is a computerised semi-structured interview tool to support a healthcare worker in the assessment of patients presenting with mental health symptoms. While single diagnosis tools are now more widely used in UK general practice, semi-structured mental health interview tools are not. GMHAT/PC was developed in the UK using resources from both community mental health services and primary care. Used in clinical practice, GMHAT/PC guides a healthcare worker through a comprehensive mental health assessment and its greater use has the potential to increase their diagnostic accuracy. With diagnostic accuracy comes more appropriate patient management. Method: The study deploys mixed methods research strategies in a UK general medical practice setting. Fifty-five healthcare workers were trained in the use of GMHAT/PC. They provided pre- and post-training self-ratings and participated in semi-structured interviews to provide views of the feasibility of the tool and its impact on their confidence and self-rated competence in mental health assessments. After training, the healthcare workers interviewed 198 patients with mental health symptoms using GMHAT/PC. The patients completed a questionnaire exploring their views of the time taken for the interview, whether it addressed their symptoms and whether they found it acceptable. Seventeen patients were also interviewed to further explore their opinions. Results: Ninety-nine per cent (99%) of the patient participants found the use of GMHAT/PC in their clinical assessment either “somewhat acceptable” or “very acceptable” (2 (1) = 6.636, N = 198, p = .010). Most healthcare workers identified time as a barrier to GMHAT/PC’s feasibility but viewed its use as feasible, provided that additional time was available for the assessment, such as extra appointment time, arranging an appointment at the end of a consulting session, or delegating the assessment to another healthcare worker with less time pressures. There was a statistically significant improvement in the self-rated competence (T = 253, z = 4.221, p < .001) and confidence (T = 378, z = 4.560, p < .001) of healthcare workers still in undergraduate training. For healthcare workers working under the supervision of a fully qualified general practitioner, statistically significant improvements were also seen in self-rated competence (T = 73, z = 2.801, p = .005) and confidence (T = 150, z = 3.491, p < .001). There was no statistically significant change in the confidence and self-rated competence of fully certified practitioners. Conclusion: The results show that the use of GMHAT/PC is highly acceptable to patients. Its use is feasible provided additional time is made available for the interview. There were improvements in the confidence and self-rated competence of undergraduate healthcare workers and those working under supervision. This research is important because it shows how the use of a tool such as GMHAT/PC could support healthcare workers in their practice, facilitating more accurate diagnoses and hopefully reducing the burden of mental health disorders for the individual and their societal settings. Future research should assess the value of semi-structured interview tools, such as GMHAT/PC, in developing trainee healthcare workers’ skills in mental health assessments, most particularly for common mental health disorders which cause significant disability for a large proportion of Society. Healthcare workers were concerned about the additional consultation time required for the GMHAT/PC interview. Future research could assess the impact of a semi-structured mental health interview on the patient’s subsequent consulting patterns.
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Flexible shared parental leave: Shaping infant-feeding decisions in the UK - A longitudinal explanatory sequential internet-mediated mixed methods studyInfant feeding is an enduring public health issue. The changes made to parental leave entitlement which came into effect in April 2015 in the United Kingdom (UK) have the potential to impact infant-feeding decisions. The introduction of flexible shared parental leave (SPL) remodelled maternity and paternity (or adoption) entitlement, enabling parents to share up to 50 weeks’ leave. The discourse has not yet considered this policy shift fully, nor has research comprehensively examined whether it will influence parental feeding decisions. The research design was informed by a narrative literature review followed and a systematic review of the literature, which indicated that few studies consider both infant feeding and parental leave. The systematic review found that focus of the discourses tended towards breastfeeding and maternity leave. In light of the interdisciplinary nature of the topic, a longitudinal explanatory sequential mixed methods design was selected to comprehensively address all strands of the research questions. The research was framed by a theoretical framework meta-model derived from Belsky's (1984) process model of the determinants of parenting, set within Bronfenbrenner's (1977, 1979) ecology of human development (later termed the bioecological systems model (2005)) and informed by a pragmatist lens. A sample of parents of infants born in April 2015 (the first eligible for shared parental leave) were surveyed via online questionnaire. At three points over the course of 12 months, the parents were asked to detail how their infants were fed and about leave decisions. Following on from this, a subset of parents were interviewed to illuminate the decision-making process further. The study aimed to baseline behaviour at the point of policy implementation and record attitudes towards shared leave. The outcome of the research is an initial evidence base documenting infant feeding patterns in the UK in 2015, in the context of a potential future shift stemming from the introduction of shared parental leave. In line with expected projections (BIS, 2013), take-up of shared parental leave was low within the sample of parents who took part. Of interest, the small number that did opt for shared parental leave reflected the wider sample tendency towards breastfeeding at 24-hours, yet mixed feeding to 6 months. Nevertheless, the parents that took part did not shy away from revisiting feeding decisions made in light of day-to-day practicalities, any issues they faced and the development of their infant. The study provides insight into the approach of parents opting for mixed feeding i.e., selecting the feeding mode(s) and/or substance(s) or mode(s)/substance(s) seen as most appropriate at the time. It is atypical (contrasted with conventional definitions applied within the research discourse) in disaggregating breastfeeding and breast milk feeding. Finally, the research further evidences the complexity of the narrative in parental decision-making. In view of the findings, further research is needed to document shared parental leave take-up and how parents are choosing to apportion it. A reconsideration of infant feeding definitions by the relevant agencies, to further the granularity of research data in relation to breastfeeding, breast milk feeding and mixed feeding (mixed mode, mixed substance or mixed method - mode and substance - feeding) would be welcome to improve research outcomes. Moreover, as a result of the discontinuation of the quinquennial Infant Feeding Survey series, there is a need for systematic, low cost research at regular intervals to supplement the modest infant feeding data collected via the Personal Child Health Record programme. Without this research, the significance of the impact of the parental leave policy reform in the UK on infant-feeding decisions may be overlooked.
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Employment support needs of personnel undergoing a medical discharge: a phenomenological and IPA study based on the experiences of British Army Veterans and StakeholdersWounded, injured and sick (WIS) military personnel from operations in Iraq and Afghanistan 2003-14 initially lacked comprehensive holistic recovery support. An Army Recovery Capability (ARC) evolved to improve such support. Future employment is an important factor in recovery and transition. This study examines the employment support needs of Army WIS likely to be medically discharged. Until this study, little research specifically considered such needs. The study examines military to civilian Transition in its widest sense. Holistic Transition involves coming to terms with ‘the new me’, including a civilian identity in a timeframe preceding and extending beyond military discharge. The voice of individual WIS personnel has been lacking in reviewing recovery and transition. Using Interpretive Phenomenological Analysis (IPA), data from twelve medically discharged veterans was triangulated against data from five specialist employment consultants and six military and charity stakeholders. The main findings are that the employment needs of the WIS are not fully defined, identified, assessed or reviewed by the chain of command. Methods of effectiveness (MOEs) are lacking in the MOD, hampering the Army’s capability to manage change and assess the effectiveness of its processes and programmes. A lack of resources, unsynchronised policy, poor communications, and a gap between intent and delivery causes variation in support from the chain of command; whilst compensating charity resources mask inefficiencies in the MOD. Recommendations include a major review of the ARC and the medical discharge process; treating employment support as a subset of a broader Transition; the development of MOEs; greater compliance with policy and improved assurance; further research to examine individual WIS needs and outcomes and the use of identity process theory to enhance understanding of the challenges of change facing service leavers crossing the military-civilian divide. A life-course view is recommended to improve military reintegration and the optimisation of available resources.
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Social Care Workers’ Experiences of Assessing Parents with Learning Disabilities: An Interpretative Phenomenological Analysis Study Based in the Northwest of England.Aims: Qualitative research has identified a number of issues when working with parents with learning disabilities. Pre-conceived ideas, professional discrimination and a high percentage of children living away from the family home have featured heavily in the literature. However, less is known about the assessment process, and how practitioners adapt their skills to assess this parental group. The current study therefore aimed to gain an in-depth understanding of the assessment process, utilising a qualitative approach. The study focused upon the experiences of social care assessors from children’s and adult services, and sought to explore the following: the approach social care workers adopt when assessing parents with learning disabilities; if appropriate knowledge is embedded into practice to assess competently; experiences of the application of the PAMS 4.0; multi-disciplinary approach to assessment, and how this exhibits in practice. Method: Semi-structured interviews were carried out with fourteen frontline social care practitioners from children’s and adult services who had direct experience of assessing parents with learning disabilities. The transcripts of the interviews were analysed using Interpretative Phenomenological Analysis (IPA). Results: The analysis produced four master themes. These were; inadequate knowledge to understand complexities; hierarchy; reasonable adjustments; assessing parental ability. An analysis of these master themes and the related super-ordinate themes is presented. Discussion: The results are considered in light of the experiences of the participants, and how this impacts on the assessment of parents with learning disabilities. The study finds that whilst there is evidence the participants hold pre-conceived ideas, a lack of relevant skills and knowledge as well as an unstructured implementation of the Parenting Assessment Manual 4.0, are both contributing factors. Furthermore, problematic multi-agency working and managerial influences impact on the overall outcomes for parents with learning disabilities and their families.
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Exploring the staff development needs of junior academic middle managers in a Faculty of Health and Social Care during organisational change: A Bourdieusian perspective.The aim of this study was to gain an in-depth understanding of the personal and professional staff development needs of junior academic middle managers in a Faculty of Health and Social Care during a period of change. The research was undertaken in the North West of England in a post-1992 University, following a reorganisation of the Faculty of Health and Social Care and introduction of new roles. The study adopted an action research methodology and a co-operative inquiry method, which consisted of a co-operative inquiry group of junior academic middle managers who were also co-researchers. The nature of co-operative inquiry is for co -researchers to engage in repeated cycles of reflection and action that generate changes to their professional practice. The study was conducted over a period of one year and during this time multiple data collection methods were utilised to triangulate the evidence. The research findings identified that multiple identities caused conflict between professional and academic roles, negatively impacting on junior academic middle managers during periods of change. During transition, some participants reported difficulty in adapting to complex political reforms, which caused dissonance between their actual and perceived roles in the field. The junior academic middle managers reported that the safe and trusting environment of the co-operative inquiry group enhanced their confidence and enabled them to learn in action and acquire a reflexive approach when undertaking their roles in the newly structured organisation. The study contributes to the existing literature regarding role identity of professional academics in higher education and offers new insights into transition during complex organisational change.
