Background: The role of community matron (CM) was introduced to provide a single point of access to patients living with co-morbid long-term conditions who had, or were at risk of, frequent emergency admissions to hospital. CMs utilised case management as a means of managing this growing population of patients with fragile health. Since its inception, many changes in service delivery have impacted on the role. Aim: The aim was to undertake a mixed methodology study of the factors that have affected embedding of the community matron role in 3 geographical areas. Methodology: A pragmatic mixed methods approach (QUAL quan) was utilised. Settings and participants: The studies were based in health services within 2 cities and a rural area in central England. Participants for the qualitative components of the study were purposefully sampled. The sample comprised professionals: community matrons (n=21), managers (n=4), former commissioners (n=2) and GPs (n=3); and patients (n=10) and their family carers (n=5). Quantitative data for 212 people with long-term conditions were derived from the anonymised Patients at Risk of Rehospitalisation database (PARR data) held by area 1. Methods: Qualitative data were collected from participants using semi-structured interviews and audio diaries. For the quantitative component using PARR, some patient journeys within area 1 were explored. In addition, a sample of patients who were case managed by a CM (n=106) were matched with a set of patients who were not (n=106) and the data was examined. Findings: Participants were largely positive about the role of CM. However, difficulties with role setup had led to numerous changes which affected how the role has embedded. Additionally, this impacted understanding of the role by health care professionals, and caused practical and emotional difficulties for some CMs as they perceived the role to be eroded. The quantitative findings showed that CMs did not make a significant difference to hospital bed days used by patients on their caseload. Evaluating the role and finding an effective means of showing the work undertaken by CMs, which is often invisible, proved difficult. Conclusion: Embedding of the CM role has been affected by numerous changes in service delivery. Invisibility of community nursing rather than autonomy of the community matron role seems to be a key factor in the challenges of embedding the role. The significance of these findings is that using a mixed method approach and Liaschenko and Fisher’s adapted model may help CMs to improve the visibility of their role, and so helping the role to be less prone to the challenges of service redesign.

This thesis follows the research portfolio format and is carried out in part fulfilment of the academic component of the Doctorate in Clinical Psychology at the University of Edinburgh. An abstract provides an overview of the entire portfolio thesis. Chapter One contains a systematic review of published research investigating the experience of living with incurable forms of haematological malignancy. Chapter Two is an empirical study exploring adults’ experiences of living with follicular lymphoma while being maintained under the ‘watch and wait’ protocol. Both chapters are prepared for submission to the European Journal of Cancer Care, and follow their author guidelines.

Despite a general consensus concerning the relevance of supply partnerships to agility, the literature reveals disagreements and contradictions regarding their characteristics and, in particular, their duration. This is, whether partnerships in an agile strategy should be long-term (strategic partnerships) or short-term (agile partnerships). The research joins this debate by investigating the types and characteristics of supply partnerships to achieve agility. The underlying premise of the work is that the type of supply partnership is contingent on the degree of turbulence an agile strategy is designed to face. The research was carried out in the fashion industry, given the relevance of agility in this industry. Specifically, the research focused the supply partnerships developed by the footwear companies in the Macerata-Fermo district, the largest footwear district in Italy. The focus on district companies allow the comparison of several companies sharing a very similar business context, allowing a better control of external variables and increasing the internal validity of the study. The field research consisted of a preliminary survey on agility drivers and agile capabilities in the Macerata-Fermo footwear district, followed by an in-depth investigation on supply partnerships using multiple embedded cases studies. Overall six medium-large footwear companies have been analysed in their supply relationships with respect to five key supply categories. For each supply category, the buyer view of the focal firms has been complemented with a view from the supplier side. In total the fieldwork is built upon 30 interviews with 22 informants from 18 companies for a total of more than 23 hours of interviews. In all cases, except two, the key informant was owner, CEO or general manager of the company, eventually supported by another company manager. In two cases, the interviews data have been strengthened by a longitudinal analysis of purchase orders over eight years. The fieldwork highlights that agility drivers and agile capabilities impact on the footwear companies’ decision of developing agile supply partnerships. Specifically footwear companies that are under the pressure of high-turbulence agility drivers (here represented by a high collection renewal rate) and that have developed strong agile capabilities (here represented by a local supply network and a purchase orders postponement) choose agile supply partnerships with respect to supply categories that are sensitive to the fashion trends and therefore difficult to be sourced in a stable way – season after season – from the same suppliers. The main contribution to theory is related to the characteristics of supply partnerships in an agile strategy and specifically to the apparent paradox of “high-involvement & short- term” relationships (i.e. agile supply partnerships). In spite of the presence of time compression diseconomies in building up partnership and of the loss of relational (non- redeployable) benefits in closing down partnerships, scenarios of high-turbulence can give companies an incentive to look for short-term partnerships. Such finding can support a wider claim that different levels of turbulence call for different agility strategies requiring different capabilities and practices. The main contribution to practice is related to the way agile partnerships are selected, started and ended. Given that many industries are facing an increase in market turbulence, it appears that many companies – even outside the fashion industry – might have to learn how to balance high-involvement supply relationships with respect to a shorter time horizon.

Residential outdoor education has had a significant formal and informal presence within the education system of the United Kingdom since the 1950s. However, there is little empirical research into the experiences of participants, particularly from a long-term perspective. The present study investigates the meanings, values, and impacts that participants attribute to a five-day residential experience at Ardentinny Outdoor Education Centre, near Dunoon, Scotland. Participants attended the Centre as school pupils between 13 and 16 years of age. Ardentinny Outdoor Education Centre operated as an educational facility under the auspices of the local authority between 1973 and 1996. Participants were contacted between 2007 and 2008, hence a minimum of 11 years after the Centre closed. Semi-structured questionnaires (n = 110) and interviews (n = 14) were used to generate data regarding participants’ experiences. These were analysed using a hermeneutic approach. Supplementary data were generated from archival documents and interviews (n = 29) with various stakeholders in Ardentinny Outdoor Education Centre, ranging from local authority education officers to Centre managers and instructional staff. These supplementary data contribute towards a nuanced interpretive account of participants’ experiences that has both breadth and depth. The data suggest that participants’ experiences at Ardentinny Outdoor Education Centre represented highly significant events in their school career. Principal findings relate to themes of achievement, independence and responsibility, and the development of more adult relationships. Seventy-two percent of questionnaire respondents claimed that their experience at Ardentinny Outdoor Education Centre continued to influence their adult lives. This influence was manifested in a variety of ways ranging from a love of the outdoor environment, to choices regarding use of leisure time, to employment choices. Bourdieu’s (1977, 1990b) theory of social practice, particularly the concepts of field and habitus, provides a framework to interpret participants’ expressions of the nature of their experiences and the impact those experiences did or did not have on their lives. From this perspective Ardentinny Outdoor Education Centre presented participants with a safe and authentic experience that differed sufficiently from their previous life experiences to allow for the opportunity to develop new understandings of self and the social world. These new understandings were expressed in different ways and at different times over participants’ subsequent life course.

The purposes of this secondary study were to explore the case detection phenomena of elder abuse by determining the congruence between nurses' assessments of abuse and elders' self-reports of abuse; to identify factors that may account for differences between abusive situations and nonabusive situations; then to describe differences between abused elders correctly identified and abused elders incorrectly identified by nurses. Both quantitative and qualitative data were used. The theory of attribution directed this research. The conceptual framework consisted of four concepts: structural factors, relationship factors, elder factors, and caregiver factors. A descriptive-comparison design was used to address the research questions. The sample included 48 elder-caregiver dyads, of whom 24 were self-reported abused elders and 24 self-reported nonabused elders. Descriptive analysis was used, including chi-square and t-tests. Results indicated that the nurses' assessments of elder abuse and elders' self reports of abuse were congruent in only one-fifth (N = 5) of the abused cases (N = 24). The findings confirmed allegations that nurses have difficulty identifying elder abuse unless outright battering is observed. Five variables were significant between abused and nonabused elders, and 10 variables were significant between abused elders correctly identified by nurses and abused elders incorrectly identified by nurses.

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No description available.

The documentation of Recreation Therapy and Leisure Opportunities in Long-term Care The Recreation Therapy discipline at Sunnybrook Health Sciences Centre (SHSC) has undergone a series of research initiatives to ensure a patient focused philosophy is integrated into their practice. The purpose of the study is the development of documentation procedures that will enable the recreation therapy practitioners to engage in authentic and professional documentation of the residents??? experiences in recreation therapy and leisure opportunities based on a patient focused philosophy. This research project followed an action research methodology and was guided by a hermeneutic framework adapted from Karkainen and Eriksson (2004). The recreation therapists at SHSC were involved in all aspects of the project as co-research participants. This project employed a variety data collection techniques including focus groups, a hermeneutic dialogue, self-reflective activities and active application sessions. The information collected through the various data collection phases in this project led to the creation of a new documentation framework and associated sample documentation, which allow for a more patient focused documentation process. A series of quality indicators were also developed in this project to help authentically express the experiences in leisure and recreation of the residents living at SHSC. This research project has added to the growing base of knowledge focused on the integration of a patient focused care philosophy into the recreation therapy practice at SHSC.

Abstract It is estimated that by 2038 over a million Canadians will be diagnosed with some form of dementia with nearly 443.000 living in long-term care facilities. Non-professional health care workers such as health care aides provide most of the direct care to these residents. The interaction skills of health care aides have a significant impact on the function, communication skills and wellbeing of residents with dementia. The purpose of this study using Strauss and Corbin’s mode of grounded theory was to develop a mid-range theory to describe and explain how health care aides perceive and understand residents with dementia and how this perception impacts the way they interact with these residents. The sample for this study was made up of 24 health care aides who worked with residents with dementia in personal care homes in Winnipeg. Data from audiotaped individual and group interviews were analyzed using grounded theory methodology: open, axial and selective coding. The central category was “The Resident being perceived as a Respected Person”. The resulting theory shows that when health care aides perceive the resident as a respected person with whom they have a relationship and as a care recipient with challenging behaviors, the health care aides use communication enhancement strategies and modify their caregiving to meet the resident’s unique physical and emotional needs and challenging behaviors. The interactions of these health care aides in this study were consistent with the principles of person-centered care and the literature about communication and dementia. The facilitators of this perception of the resident were primarily the personal characteristics of the health care aide and the inhibitors were the time constraints, workload, and lack of support of peers and supervisors. This theory has implications for the training and supervision of health care aides and the organizational structures in which they work. Key words: Health care aides; dementia; communication; long term care; personhood / May 2017

To study potential hyperactivity and hyperconnectivity based on the latent resource hypothesis, this study assessed functional connectivity in survivors of childhood brain tumors compared to their healthy peers during an attention task using psychophysiological interaction (PPI) analyses and evaluated for a relationship with performance. Twenty-three survivors and 23 healthy controls completed a letter n-back task in the scanner. An empirically-based seed was placed in the parietal lobe, a theoretical seed was placed in the hippocampus, and a control seed was placed in the occipital lobe. Differences in both performance and functional connectivity networks from each seed emerged between groups, with some findings supporting the latent resource hypothesis and other networks showing compensatory function in survivors. Attention networks, phonological networks, and executive function networks were all found to differ between controls and survivors.