No description available.

No description available.

No description available.

Pharmacy, particularly in the community setting, has been subject to significant changes over the last three decades. Running concurrently to these changes has been the development of the field of pharmacogenetics, or ‘personalised medicine’, which is likely to have significant impacts on hospital and community pharmacy practice. Despite this, little sociological research has been undertaken to map the contemporary pharmacy landscape into which pharmacogenetics may be integrated and the effects that pharmacogenetics may have on pharmacy. Through 38 semi-structured interviews with diverse practitioners, this thesis addresses these gaps in the academic literature by positing a novel sociological model through which contemporary pharmacy practice may be analysed and examining the potential impacts of pharmacogenetics on it. It is argued that a dual approach to the management of medicines intersects both community and hospital pharmacy. Within this dual medicines management model, codified, organisational interests in medicines management are practised alongside a more negotiated approach which is enacted through what has been called here the ‘pharmacy gaze’. The pharmacy gaze characterises the ways in which medicines and the patient bodies to which they are administered are co-constructed by pharmacists through discourses of risk and toxicity. Pharmacogenetics, it is argued, represents a way in which the pharmacy gaze, and patient bodies within it, may be increasingly molecularised and risk and toxicity increasingly managed at the genetic level within pharmacy practice. Within this, a number of ‘pharmacogenetic futures’ involving pharmacy testing, patient counselling and practitioner education are presented although these are argued to be highly speculative and to present a number of macro- and micro-level challenges for policy makers and pharmacists. The thesis concludes by making a number of recommendations as to how some of these challenges may be addressed.

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My research is concerned with the development of social work students’ personal and professional identities in the light of policy changes introduced into social work education. Since April 2005, social work students have had to register with the General Social Care Council and ‘sign up to’ the Codes of Practice. The Codes specify that social workers must not ‘behave in a way, in work or outside work, which would call into question [their] suitability to work in social care services’. The research is of particular interest because the participants were among the first social work students to be registered; I hope that it will contribute to academic and professional debates. The study is informed by a poststructuralist approach to identity and discourse. I argue that social work education and professional registration are part of a regulatory discourse. The research questions explore some of the discursive resources that social work students draw on to construct their personal and professional identities. I begin by locating the study within contemporary debates in higher and professional education, and then review the literature about social work registration and its implications for students and social work education. These policy and educational developments are considered through the lens of poststructuralist concepts: discourse, power and subject positions; governmentality and resistance. Finally, my literature review explores some concepts of identity and professional identity. The empirical data is derived from seven semi-structured interviews with social work students. The transcripts were interrogated using a form of discourse analysis developed from the work of Potter and Wetherell (1987). The research findings suggest that this group of students see professional registration as an integral part of social work education and becoming qualified. Their talk indicates that registration brings students’ private lives into a more public domain than previously. However, the data suggests that social work education itself challenges and de-stabilises identity as students negotiate the boundary between being ‘unqualified’ and ‘professional’. So while registration does impact on how students behave and how they see themselves, this must be placed in the broader context of learning to be a professional social worker. The study concludes by considering the practical implications for social work education.

This thesis describes a study of power and power relations, which is developed through an exploration of the literature and professional discourse in an abductive research strategy The focus is provided by services for people with learning disabilities within one English County and the relationships that are produced within the processes that surround care planning. The study sets out to describe and to provide evidence for the proposition that welfare professionals and the organisations in which they are embedded set out to manufacture trust. This trust has a particular quality as it is impersonal and therefore does not require knowledge of any individual involved. At the same time this trust serves as a commodity within the competitive environment of welfare and it is contested - hence the politics of trust. The study defines trust as the reduction of complexity and the management of expectations. It uses a framework developed from the work of Michel Foucault and his followers’ relating to the relationship between power and discourse and the concept of governmentality. The study describes the local relations of power within which both organisations and the people to whom they provide services become fixed. At the same time it links a developing discourse of citizenship concerning people with learning disabilities with a discourse of trust that is articulated by professionals within organisations. However, organisations tend to promote sets of relationships between the individual and the community, which produce differing forms of citizenship dependent upon the discursive structure of the organisation. The existence of differing discursive structures between organisations is linked with Foucault’s description of the ‘orders of discourse’ that is then used to produce an organisational typology of three broad forms into which the range of organisations involved in the study are be placed. These are described as New Wave, Pragmatists and the Old Radicals and as each provides a different set of outcomes for service users they actively challenge the basis of the trust claimed by the other with the first category, New Wave, proving hegemonic. This implies that an understanding of the discursive structure of an organisation is essential to the understanding of power relations within a particular field of operations such as social welfare.

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No description available.

Chronic disease is the major challenge facing global health care. In tandem there has been the emergence of active and informed patients in western society, with the contemporary patient increasingly involved in decisions about their treatment and care. However, while it is acknowledged that the vast majority of chronic disease management is via self-care and effective self-management has a potentially significant effect on reducing resource demand, there has been comparatively little research on the concept of the expert self-managing patient within chronic disease. The aims of this study were therefore to: " Investigate how patient expertise is viewed, interpreted, defined and experienced by patients and clinicians. " Understand how patient expertise is promoted and enabled through the self-management process. " Discover how patient expertise is enhanced or impeded by other mechanisms. Adopting a grounded theory approach underpinned by critical realism, the study commenced with three focus groups with patients and seven focus groups conducted with nurses and physiotherapists. Using the emergent themes as a starting point for constant comparative analysis, concurrent data collection via semi-structured interviews and observation was conducted. This included interviews with twenty two patients, twelve clinicians including doctors, nurses and physiotherapists and two Expert Patients Programme lay tutors. Observation was undertaken with ten consultant and nurse-led clinics, a six week Expert Patients Programme and an eight week Back Fitness Course. A storyline is described that illustrates the journey of the expert patient and the thesis explores the barriers and enablers on this journey. A typology of the expert patient is developed in which it is shown that expert patients fall into four quadrants with overt acceptors as the idealized patient within medical consultations. The findings suggest that many expert patients learned characteristics of being succinct and non-emotional when communicating with clinicians, but at the cost of not being able to articulate the emotional consequences of living with chronic disease. Variance from this idealized type leads to conflict which is explored through theories of the medical division of labour. It is concluded that the typology of the expert patient should be widely discussed and acknowledged as a framework for professional and lay practice. In particular, there should be explicit recognition of the emotional needs of people with chronic illness. Recommendations for policy and practice are generated that include acknowledgement of the expert patient beyond the medically idealised type. It is suggested that within the Expert Patients Programme there should be a move away from the current rigid content and delivery style and a greater focus on the subjective experience of chronic illness. Lay tutors would benefit from developing skills to support the psychological needs of participants. Furthermore, it is suggested that the behaviours and working environment that characterised nurse specialists should be used as a template for good practice to enable clinicians to meet the needs of expert patients. Finally, recommendations are made for inter-professional education. It is suggested that the skills of a variety of expert patients beyond the idealized overt-acceptor type are utilised in order to expose clinicians to a fuller range of patient narratives surrounding the experience of chronic disease.