The present thesis surveys different philosophical approaches to the nature of delusions: specifically, their ontology. However, since none of the various theories of the nature of delusions succeeds, I argue that there must be something problematic about the form of the analyses commonly offered. My general conclusion is that one cannot characterize delusions without taking away what it is distinctive about them.

My thesis reads Ernst Bloch’s materialist ontology with the aim of producing a utopian perspective on language’s materiality. As my Introduction outlines, set against the backdrop of a contemporary renewal in speculative philosophy, the present context is marked by a twofold limitation: (1) the perdurant marginalisation of Bloch’s form of utopian speculation, serving to couch contemporary materialism in thoroughly un-prospective tendencies; and (2), a relative failure of contemporary speculative philosophy to reflect on language, a failure attributable to the long drawn-out dominance of post-structuralism’s linguistic form of relativism. To overcome these limitations I dedicate Chapter I of my thesis to expounding the core categories of Bloch’s materialism, casting a light on what I call its fundamental compositional structure: Incompleteness → Process → (possibility of an) Outfall, i.e. completion or arrival. In light of this, I argue that, placed within the horizon of Bloch’s materialism, incompleteness, process, and futural-directedness ought to be taken as cornerstones of language’s materiality. So as to better position what this means, in Chapter II a reading of the metaphysical Sens of Bloch’s materialism is given. There I consider Bloch’s materialism as a novel form of analogic metaphysics. Insofar as at the core of Bloch’s materialism there lies a metaphysical conception whereby being as such (e.g. Aristotle’s ontōs on) names an ultimate desire and not—pace the classical metaphysical tradition—an already existent beingness—a metaphysical conception Bloch proleptically terms the “ontology of not-yet being“—so then the essential dynamic of this materialism hinges on an incomplete analogy, for all things relate to that which is not-yet in existence; this not-yetness is the sustaining meaning of what is. In the final chapter I concretise my findings by turning to the question of language proper, reading “anacoluthon” as a speculative materialist figure of language which expressive this utopian analogic metaphysics. Anacoluthon denotes an interruption in syntactical flow (Greek: an-akóluthos, “not following“; German: Satzbruch, “sentence fracture/rupture“) and marginally features in Bloch’s corpus. But precisely because of its marginal status the figure possesses a real force in understanding language’s utopian materiality. Indeed, I read anacoluthia as expressive of the Blochian ontological composition. Anacoluthic discontinuities of speech are read as linguistic expressions of ontological incompleteness, ontological novelty, and ontological directedness to what is not yet. They linguistically express both the non-existence of ontological totality, but also, crucially, a real and open intending towards it: a utopian, creative, linguistically-based transgressiveness expressive of the world’s ontology.

Aim. This study aimed to explore factors influencing health practitioners’ work performance. This knowledge will facilitate development of appropriate support and education for health practitioners in delivering quality healthcare. Design and participants. A mixed method exploratory descriptive study using cross-sectional methodology was used to gather relevant data and obtain an overview from 60 health workers and 40 health managers in health facilities operated by the Ministry of Health (MOH) in Jazan region, Saudi Arabia. Survey questionnaire followed by selected unstructured interviews to gather data were used. Descriptive statistics, particularly the percentage and weighted mean (Wm) were used. Findings: Results showed that a typical health practitioner in Jazan, KSA has a mean age of 31.17 (health workers) and 28 (health managers). Majority are female (68.33% health workers; 85% health managers) and from other Asian countries. Most have Diploma in Nursing/Midwifery (46.67% health workers; 55% health managers) as educational qualification. Many of them are charge nurses (41.67%). The average number of years they have worked is 6.92 years for the health worker and 12.63 years for the health managers. The health workers showed agreement on the utilization of performance appraisal in their unit (Wm=3.66); however, they were uncertain on their appraisal regarding remuneration, benefits, and recognition (Wm=3.30) as well as uncertain on staffing and work schedules (Wm=3.01) and staff development (Wm=2.39). Factors affecting their work performance were generally intermediate in nature (Wm=2.39), but shortage of staff specifically was a major factor (Wm=3.27). They perceived the strategies to improve and maintain excellent performance as moderately needed (Wm=2.23). Health managers were often involved in management tasks (Wm=2.89) and they assessed their skills as “Good” (Wm=3.63). Conclusion. Many of the health practitioners in Jazan are predominantly younger, female expatriates. They encounter issues in their job and in management that may affect their work performance. Addressing these issues is necessary to assist their development and support work performance. The strategic plan developed from these results will support the education and training of these health practitioners and will be implemented and evaluated.

To date there has been minimal published investigation into the experiences of Speech and Language Therapists in providing end of life dysphagia (swallowing) care to adults with head and neck cancer. In addition, the question of how Speech & Language Therapists are prepared to carry out this role and what they consider to be necessary in order to do this effectively has not been fully considered. This study aimed to make a contribution towards addressing this issue by adopting a qualitative approach, interviewing practising SLTs and providing an opportunity for them to discuss their experiences of working in this field. The research area aligned with a phenomenological methodology which was felt to be the most suitable approach to facilitate a detailed and rich description of their experiences. The intention was that the findings may inform future practice and professional education. Eleven participants consisting of two pilot participants, a focus group of three participants and six individual, main participants from across four health boards in Scotland took part in semi-structured interviews. Interview topics were identified from a broad initial literature search. An Interpretative Phenomenological Analysis approach was taken. The study revealed a wealth of rich data and four super-ordinate themes: ‘A risk worth taking’ ‘Under your skin’, ‘Communication isn’t always wonderful’ and ‘Trained and equipped’. The findings suggest that there is a considerable emotional impact on SLTs engaged in this type of work and that multi-disciplinary communication is not always effective. Finally, the findings suggest that there is currently a gap in professional training and support.

In the United Kingdom current maternity policy advocates the importance of flexible individualised services that fit with the needs of women. Choice of services for women as consumers is paramount in a system that aims to promote safe, high quality care. As women make choices, they navigate a complex journey; learning from women’s experiences is fundamental to understanding this journey and influencing future policy and practice. Literature on what influences decision-making demonstrates a paucity of information and a limitation of women’s voices. Following an Interpretive Phenomenological approach grounded in a feminist perspective to promote women’s voices, a group of 25 antenatal and postnatal women were asked about their experiences, perceptions and choices in the context of their maternity care. This study explored how they may be socially influenced and pressured to conform to authority in birthplace choices. It illuminates how emancipation and conformity are linked to consider whether emancipation reduces pressure to conform and what the implications of this might mean in a wider sociological context of birth experience. Based on Interpretative Phenomenological Analysis, a unique, seven stage iterative framework of analysis was developed. Self and aspects of self emerged as the most significant theme for decision-making existing within a frame of constant interplay of external influences such as environment, knowledge and professionals. As different pregnancy identities emerged, it was evident that this interplay has positive and negative effects as women experience decision-making. Conformity and emancipation are profoundly linked to decision-making; self is complex but critical to this process. For women to be self-determined and assured in their birthplace choices there is urgent need to reconsider interactions at every level. This approach must address the complexities of self so women and midwives remain equal partners. The implications of this reach beyond the discipline of maternity care.

This thesis documents a study which set out to explore the links between culture, dementia and long-term residential care in Scotland. A key aim of the work was to gain insights into manifestations of individual formative culture as part of selfhood in people with dementia in care homes, and how service providers take account of this in constituting „person-centred‟ care processes (which are claimed by virtually every such provider in Scotland). Another aim was to explore the contexts influencing care processes at individual care home/theoretical/government policy levels. Lastly, as a study with a „critical‟ bent, it set out to provide suggestions for future research based on the conclusions reached. In doing this, it involved six care homes, three of which were in large urban centres and three of which were in a remote island group. Sixteen social care workers and nurses took part, as did eleven care home residents with significant dementia. An ethnographic approach to data gathering and analysis, combined with a poststructural discourse analysis in interpreting initial findings, represented the research methods used. It was found that culture as an aspect of selfhood is a much more reducible phenomenon than is represented by traditional metanarratives of diversity, and failure to take account of this can have substantial implications for „person-centred care‟(especially for people who are progressively losing the ability to adapt to new sociocultural environments because of cognitive impairment). Failure to acknowledge these very individual formative sociocultural contexts in people with dementia who are in long-term care, may lead to a failure to acknowledge personhood. Conclusions revolve around the assertion that accepted discourses of cultural diversity, combined with other socially-located discourses linked to the residential care home sector, combine to produce environments in which „knowing the person‟ (and knowing the sociocultural contexts which help define that person), often do not feature highly in so-called „person-centred‟ approaches.

The introduction of the National Health Act in Britain, 1946-1948, brought a renewed public interest in nurses and nursing and references to their status or lack of it became frequent in professional and national publications. In 1950 the World Health Organisation expressed its concern for the status of nursing at international level. It seemed therefore of interest and possible usefulness to investigate the social standing of professional nursing as an occupation for women in England in 1948-9, since in the American literature the status or prestige of an occupation was considered relevant to vocational choice. Social status and prestige have been considered in the light of current psychological and sociological literature and in relation to social mobility. Earlier studies of occupational status and of nursing recruitment in England have been reviewed. Teaching has been shown as a control occupation and the historical development of nursing and teaching considered. Present day nursing has been assessed for prestige as one of five occupations by means of a paired comparisons technique. 217 respondents completed this questionnaire and some interesting profiles of occupational stereotypes were obtained in addition to a rank order for the five occupations. Difficulties encountered in the use of the first questionnaire suggested that It infringed a social taboo for some people. A wider survey was therefore made with a different questionnaire by which 1552 subjects compared nursing with teaching end secretarial work only, The results of this second survey allow comparison of various disadvantages within the three occupations and show differences of opinion between the public and practising members. The various findings are discussed and conclusions drawn relating to a social taboo, some social stereotypes and the popularity of nursing in this country.

This study is concerned with an evaluation of a nursing education programme designed to provide practical experience of child health education in two primary schools local to a university in Western Uganda. The purpose of the programme evaluated in this study, was both to provide health promotion and education experience to students in a real-life situation while being supervised by a member of the academic staff and to offer ‘real’ health care in relation to preventable diseases. This programme represents a paradigm-shift where students can practice health care within a project developed and run by their university for the local people. The programme focused on health promotion, illness prevention, and early intervention with the aim that, pupils would pass on their learning to children and through them to the wider family and community. This is suggested to take place through a ‘Reciprocal Ripple Effect Model’ and role modelling guided by ‘Ubuntu’ philosophy with its focus on community members helping each other. This qualitative study aimed to evaluate the project through an exploration of participants’ experiences. Data were collected using participant observation, document analysis, focus group discussions, semi-structured and email interviews from a total of 71 participants. Participants included children, parents, academic staff, nursing students and local administrators. The data were analysed using content analysis. The study provides new insights into community-based nursing education programmes. It found key themes that reflected a positive experience of the programme from all participants. Through collectiveness, participants valued ‘being involved and participating', 'sharing information', and the wider communication that the initiative enable for all actors. Students valued 'acting as role models' and the project was associated in the participants' experience with 'developing and growing confidence'. The one key theme which most clearly reflects the child and parents' experience was 'transforming one's life', indicating the way in which the project helped make members of the university's local community feel valued. The university had ceased to be an institution of privileged outsiders and had become integrated and valued with their community. This study provides support for the use of the 'Reciprocal Ripple Effect Model' guided by 'Ubuntu' philosophy in resource-limited environments in empowering the community to make decisions and embrace informed responsibility for their health. Also in enhancing the learning and intervention performed by student nurses and in a manner that was culturally acceptable and sustainable in a resource-limited environment.

This research is part of a larger study - a sequential mixed method education intervention targeting staff in 24 Nursing Homes (NHs) in Norway to reduce use of restraint and psychotropic drugs. Building on a previous successful intervention, we used the Promoting Action on Research Implementation in Health Services (PARIHS) prospectively to combine cluster randomized controlled trial, participatory action research (PAR) and ethnography to design and evaluate the effectiveness of 2 day staff education and 1 hour monthly coaching during 6 months in two rounds (12 x 2 NHs). In my research that is the primary focus of this thesis, four teams of eight facilitators facilitated the intervention and simultaneously participated in PAR to co-construct knowledge of hindering and promoting implementation factors. A ‘Creative Hermeneutic Knowledge Co- Production’ (CrHeKCoP) model blending paradigmatic and epistemological assumptions from critical and participatory worldviews was created and used in spirals of 10 mini-cycles of actions to co-construct knowledge of the implementation process.

Since the late eighties healthcare policy has seen a shift from a paternalistic model of care to that of an inclusive partnership approach which encourages engagement, responsibility and self-management of long term conditions. This paradigm shift has given credence to the notion of the “expert patient” (EP); an individual with a long-term condition whose knowledge and skills are valued and utilised in partnership with healthcare professionals. However, there is debate as to the definition of the EP, and an assumption that all patients would want to adopt this role and a partnership model of care. There is also scepticism about the motivation behind the introduction of the EP and the perceived benefits of EP Programmes. This study aimed to explore how young “expert patients” living with cystic fibrosis (CF) and the healthcare professionals (HCPs) with whom they interact perceive partnership and negotiate care. Adopting a qualitative methodological strategy, informed by Interpretivism and Symbolic Interactionism, thirty three consultations were observed between eight patients, two accompanied by a carer and twelve healthcare professionals (HCPs). Following the observed sessions the eight patients, two carers and eleven HCPs were interviewed. Data were analysed thematically using the five stages of “Framework” a matrix-based analysis approach. Three major themes emerged from the data: experiences of partnership, attributes of the expert patient and constructions of illness. Multiple sub themes are also presented, including the power of the nurses, normalcy, the expert patient as navigator and the ceremonial order of the clinic. Implications for practice suggest the need for ground rules outlining both parties’ roles and responsibilities in partnership, a remodelling of the clinic format to ensure patient- centredness and a consideration of the role of decision tools and Telehealth in any new proposed model.