This thesis is the first research of its kind to examine the career journeys of leading African, African-Caribbean and Asian, male and female, nurses' careers in England, and adds substantially to our extremely limited knowledge concerning the black professional class in Britain. It examines the barriers, the career opportunities, personal motivations and cultural capital that the respondents drew upon to negotiate and deal with racialised social and professional structures from the entry gate into nursing to their current appointments as senior managers in nursing, nurse management, research or nurse education. This study has considerable policy relevance in view of the National Health Service (NHS) commitment to recruit qualified nurses from overseas to combat the nursing labour market shortages. The research was conducted in three phases over a period of six years using an oral biography / life history approach to obtain narratives from eighty-eight black respondents working and domiciled in England. It revealed that the group of black nurses who had reached senior levels had became highly qualified and had contributed to service, policy, education and research development at the local level. There is also substantial evidence of their contribution to nursing at national and international levels. The findings also reveal that respondents experienced self-reported unequal treatment at the entry gate and throughout their career. The staying power and career journeys of these respondents show that the intersection between social structures of class, 'race' / ethnicity and gender, and personal agency is important in shaping careers and is influenced by social, professional, political shifts and constraints, suggesting that how individuals negotiate and deal with racialised barriers is linked to both their 'stocks' of cultural capital and their personal motivations and determinations. This structure-agency relationship counters much of the research on 'race' and occupation which has looked primarily at racialised structural barriers to advancement.

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No description available.

The following doctoral thesis provides an ethnographic account of sudden deathwork performed by emergency personnel. The study centres on three accident and emergency departments in the North East of England. Sudden death practices and perceptions are revealed using thick description from focus groups, narratives and informant accounts. Three emergency disciplines: accident and emergency nurses, police traffic officers and paramedics provide the backdrop to describing three sudden death trajectories, which take the dead body from a state of collapse to a mortuary. Particular attention is paid to the significance of status passage as a temporal dimension of deathwork with due consideration being given to the concept of body handling as 'dirty work'. A feminist concept of embodiment challenges the dominant discourse of the death processing industry in relation to beneficence and non- maleficence for those who are left behind to grieve. The theatrical representation of the body to relatives is discussed within a dramaturgical frame, questioning what is appropriate and achievable within the boundaries of an emergency care environment. An exploration of the roles of emergency personnel illuminates problems of dealing with a phenomenon, which annihilates the possibility of a sense of order and emotionally incapacitates emergency personnel. The procedural base to sudden death is presented through accounts of emergency personnel contact with human suffering and emotional pain with the intention to build a substantive theory of a sudden death milieu. Finally, Schutzian relevances highlight key concepts of significance within the data demonstrating how, despite an evidence-base to practice, some myths are highly influential in shaping the behaviours of emergency personnel throughout the sudden death event. It is hoped that insight gained may provide a catalyst to inform change where needed, in service provision and enhance interprofessional working relationships.

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Primary care professionals work in settings which have traditionally been very hierarchical, and medical practitioners have occupied the dominant places in that hierarchy, possessing structural power through their affiliation with the social institution of medicine, and their control of funding. Counselling in primary care has been described as a fast evolving profession and Counselling Psychologists are filling many of these newly created posts, cautionary notes concerning the impact of the NHS reforms of recent years on the discipline have been raised. This study was designed to raise awareness of some key factors impacting on the process of communication in multidisciplinary working in primary care relevant to counselling psychologists, and to explore multidisciplinary working in health care from a psychological discourse analysis perspective. Three different workshops were run comprised of multidisciplinary groups brought together for the purpose of the study. Each team were trained in the Community Oriented Primary Care (COP) model and then audio- and videotaped constructing a COPC programme to address depression in older people. Analysis of the group transcripts was carried out exploring power relations, competing agendas and ideological patterns. Conclusions are that 1. COPC may have had limited application due to difficulties implementing the nonhierarchical multidisciplinary working aspect of the model. 2. Counselling Psychology has much to contribute to multidisciplinary working and could foster true innovation in primary care through broadening the clinical perspective. 3. Counselling Psychologists need to be aware of the power of medical discourse in the environments in which they work, and the resistance of primary care to change which can emerge through the promotion of the medical agenda and the language used in multidisciplinaryworking in medical settings.

The policy decisions of the 1990's were designed to maximise the potential for older people to remain in their homes for as long as possible and to prevent unnecessary admission to hospital. The NHS and Care in the Community Act (1990) created the role of care management within Social Work (in Scotland) which made it necessary for district nurses to artificially separate the health and social care needs of older people. Whilst health care remained free at the point of delivery, social care was chargeable so the decisions taken by district nurses had implications for the care older people subsequently received. This study was set in an NHS Trust in Scotland and considered how district nurses constructed health and social need when assessing the care needs of older people. Following a pilot study, the main study was undertaken in two phases. The first phase profiled caseload data from 23 district nurses which was used to inform the researcher of current trends in decision making and to purposefully select nurses to interview. A Grounded theory approach was used to undertake 16 in depth interviews until a saturation point was reached and no new data emerged. Following detailed analysis based upon the method described by Strauss and Corbin (1990), core categories of context, gerontological knowledge and personal values emerged to inform the theory of how district nurses construct need. The contribution to new knowledge in this area includes an addition to the theoretical understanding of care delivery. The study has identified the key role played by the assessment of risk and the appraisal of family support. Gerontological knowledge and personal values have been shown to be central to both the assessment of risk, and the appraisal of family support. The study has also identified strategies used by district nurses to manage their workload, some based upon a rational response to the management of work and others. including the avoidance of less popular patients and carers, which are open to question The only area of district nursing care where the delivery of both health and social care is uncontested, is where patients are terminally ill

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The increasing involvement of mothers in paid employment has brought attention to child care both as a critical social issue and as a pressing need for families. Nevertheless, child care in Canada continues to be framed as a private issue to be resolved by individual families. In the absence of policies and programs that ensure widespread access to affordable, high-quality care, women who combine motherhood with paid employment face considerable challenges in making decisions about child care. This study examines the processes by which women make child care decisions and sheds light on both how and why they make such decisions. The emphasis is on the meanings that women themselves give to motherhood, paid work, and child care and on how they resolve the competing interests that inevitably underlie work and family decisions. By drawing on women's accounts of their own lives, the research elucidates the multiple and interrelated factors that enter into women's decisions and thus offers insights into the reasoning behind complex patterns of decision making. In-depth interviews were conducted with 25 women who were intending to return to work or school following the birth of their first child. Women were interviewed at three points in time, encompassing a period from late pregnancy to several months after returning to work. The study furthers our understanding of the public and private dimensions of child care by revealing the dilemmas faced by women who frame their child care concerns in deeply moral terms, yet are called on to meet their child care needs within a public market oriented child care system. In particular, women's accounts of their experiences demonstrate the ways in which the intertwined and deeply privatised notions of 'dependent child' and 'good mother' underlie women's decisions about child care. Moreover, the research leaves no doubt that women's experiences of making child care decisions do not accord with the prevailing neo-classical economics version of rational and self-interested decision making. By examining women's decisions over time, the study illuminates the sequence of decision making about child care and adds to our understanding of what is entailed in looking for and deciding about child care. The study concludes with a discussion of implications of the findings for policy development and future research.

No description available.