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Background: The aim of this study was to develop an understanding of how the experience of living with an Implantable Cardioverter Defibrillator (ICD) influenced patients and their partners’ educational needs and concerns. An ICD is a device that is designed to treat patients who have life-threatening arrhythmias. The quality of life (QoL) of the ICD recipient is not only influenced by the disease itself but by adjustment to an altered life situation. Providing patient education can be an effective intervention to improve patient adjustment to the device. However, there is little qualitative research on the educational needs and concerns of these patients. It is therefore argued that qualitative research focussing on the lived experiences of patients is needed to identify appropriate educational interventions to facilitate this adjustment. Methodology: The constant comparative method of constructivist grounded theory was employed for data collection and analysis. Semi-structured face-toface interviews were carried out with fourteen ICD patients and four partners. Findings: A grounded theory model was developed which described how patient’s experiences of getting back to normal following the insertion of an ICD influenced their educational needs and concerns and ultimately led to their acceptance of the ICD. The model had two key components, getting back to normal and being informed. How the patients and carers experienced getting back to normal consisted of adapting lifestyle, focusing on the positive, effect on the family and living with the uncertainty regarding experiencing an ICD shock. Their experience of the ICD influenced their educational needs in that the information needed to be tailored to their individual experiences. Discussion: This study found a strong need to feel informed, which is a major part of Mishels theory of uncertainty. The model is also compared to the crisis theory and the common-sense model of illness representations. The chapter ends with a conclusion and recommendations for future research.

Informal learning is a major factor influencing the professional development and practices of health professionals (Eraut, 1994). This thesis is an in-depth exploration of how this process occurs in pharmacy and involves a detailed study of practising pharmacists. The learning approach of these individuals is explored in relation to the variety of working situations in which they practise and the prevailing climate in relation to professional learning and development within the National Health Service (NHS). This study therefore adds to an understanding of the way in which informal learning shapes the practice of pharmacists and as such it has considerable implications for both future policy and practice. In the past there has been very little detailed research investigation into informal learning in pharmacy, although studies by Wilson, Schlapp & Davidson (2003) and Swallow et al (2006) have demonstrated the importance of this aspect of professional development. This study addresses that deficit, utilising semi structured interviews and focus groups to explore in some depth the nature of pharmacists’ informal learning and their perceptions of the effectiveness of current CPD practices in supporting such learning. The study reveals that pharmacists use a range of informal learning methods to develop in their careers post-qualification, including experiential learning and reflective practice. Many also continue to take further formal courses and qualifications. Practitioners perceive knowledge to be of particularly high value, and place less emphasis and value on the learning of skills, attitudes and behaviours, despite their comprising a vital part of practice. The role of helpful others (Eraut et al., 2004) plays a critical part in the professional learning and development of many pharmacists. They appear to value this support highly and in some cases rely on it due to the isolated nature of their practice situation. Paradoxically, whilst pharmacists acknowledge the need to provide evidence of their ongoing professional development, they often do not complete CPD records in practice. One of the main criticisms offered, in relation to the CPD system, was the perceived limitations of the RPSGB Plan & Record forms, and this was also used as a justification for not completing their records. Greater flexibility in the system was seen as vital for the full benefits and strengths of the CPD system to be realised. The change management process through which the RPSGB introduced CPD is critically examined and the literature on educational change processes utilised, to suggest ways in which the implementation process of CPD may have created the resistance evident in the pharmacists’ narratives. This thesis raises questions about the value that pharmacists and the pharmacy profession place on various types of learning. The importance of informal learning in the development of pharmacists is emphasised. The thesis also explores the apparent need for pharmacists to have access to appropriate helpful others and the need to ensure that the method used to record CPD is flexible and fit for purpose.