Patient-Reported Outcome Measures (PROMs) are increasingly used in health services research and clinical practice for the quantification of patient experiences, including quality of life, mood (e.g. depression), and satisfaction with services. Such PROMs usually take the form of questionnaires. The underlying measurement model is derived from psychometric theory, specifically Classical Test Theory (CTT). This model requires statistical analysis of questionnaire data to establish the quality of data so collected, with emphasis on the reliability (reproducibility) and validity (domain-specific measurement) of the data.

The re-conceptualisation of stroke unit provision towards acute and hyperacute care has been a relatively recent development in the United Kingdom. This hermeneutic phenomenological study aimed to explore how the acute stroke unit (ASU) experience, as the phenomenon of interest, was meaningfully lived from a human lifeworld perspective. Eight participants: four stroke survivors and four healthcare practitioners: took part in semi-structured interviews, and if they agreed, an optional creative element. Interviews were recorded then transcribed. Detailed hermeneutic analysis drawing on interpretative phenomenological analysis (IPA) was undertaken firstly on each person’s account, and then across the collective from each perspective. An additional close textual reading was developed for one stroke survivor and one healthcare practitioner. A particular feature of the analysis was its influence in generating an innovative graphic interpretation of the research findings. The stroke survivors experienced the ASU as a lived space in two differentiated forms. The ASU holding space, through the spatial practices of nurses, and others, including similar others (patients), was understood to provide them with protection and safe haven; holding them intimately but also at a distance, so that they could think, make sense, plan and work towards transition. The transitional space of the ASU was experienced by three of them in more disparate ways, and represented how they transitioned their self (for protection, necessity and for recovery) in response to the stroke, the hospital space and the spatial practices of the ASU. The healthcare practitioners experienced the ASU as a space that they produced and appropriated for themselves and others. This was intertwined with their work as existential project; through their relationships with others, and their contribution to patients’ transitional work, they were understood to experience authenticity and belonging. This project was always in the making, and was undertaken amidst the day-to-day pressures on the unit. As a result, three of the health practitioners looked to make sense, navigate, and survive the vulnerability they experienced in relation to their meaningful work, as part of their ASU experience. Further synthesis of these two horizonal1 perspectives elucidated 3 key areas of new insight and understanding: the spatiality of the lived experience of the acute stroke unit, suffering and thriving as a human being, and the intertwining of multiple selves in time and place. The implications of this new knowledge for clinical practice, education, and research are further discussed in this thesis.

This thesis examines how women with a diagnosis of borderline personality disorder (BPD) negotiate their identity in relation to risk, also referred to as their ‘risk identity’. This is defined as, ‘…the view people have of themselves and project to others in their talk and actions in relation to risk and risk taking’. The theoretical perspective which underpins the study is informed by ontological realism, epistemological discursive/linguistic social constructionism, and an ideological critical liberatory position primarily derived from the work of Foucault (1978; 1991a; 1991b; 1998; 2002; 2008a; 2008b; 2009). This perspective informed the decision to adopt email interviews as a method for generating appropriate texts for analysis. Eight women diagnosed with BPD were interviewed over a period of ten months. Adopting a critical emancipatory methodology which incorporated feminist principles of research, Lather’s (1991) adaptation of Van Maanen’s (1988 cited in Lather 1991) ‘four tales’ was employed to view and analyse the texts from four theoretical perspectives; a ‘Realist Tale’, a ‘Critical Tale’, a ‘Deconstructivist Tale’, and a ‘Reflexive Tale’. By ‘layering’ these tales, the findings revealed sets of tensions discernable within the context of interactions with staff, the nature of services, and the wider material and discursive resources at play which inform how risk identities are negotiated. Converging Western discourses of the subject, binary gender discourse, neoliberal discourse, ‘psy’ discourses, and discourses around motherhood were found to be key discursive resources through which risk identity is produced, resisted and projected. In addition these to broad discursive findings, the study also contributes to the existing empirical literature that focuses on the lived experience of those with a BPD diagnosis. A conclusion is drawn that women with a BPD diagnosis not only receive a label which discursively excludes them from being able to be viewed as a ‘good subject of psychiatry’ (and hence leads to them being viewed as dangerous and risky), but that their difficulties and need for relational approaches to manage risk and promote recovery run counter to the way that mental health services are structured in the current neoliberal era.

Introduction The centrality of the patient to health care has been increasingly recognised both politically and professionally. Patient-centred care has become synonymous with high-quality care and a number of studies have reinforced patient's desire for, and the positive impact of the approach. Although the concept emerged over 30 years ago, it is still not clear what it is, upon what theories it is based, or how to measure it. Whilst the concept has been explored within medicine, nursing and other allied health professions, within physiotherapy there has only been minimal discussion. The aim of this research was to explore the meaning of patient-centred care in relation to low back pain, from the perspective of musculoskeletal physiotherapists. Methods Purposive sampling was initially used to select participants. Subsequently theoretical sampling was adopted whereby analysis of the data informed the sample selection. Nine musculoskeletal physiotherapists agreed to participate in the study. They ranged in experience from five to 25 years. Individual semi- structured interviews were adopted as the method of data collection. The interviews were audio taped and then transcribed verbatim. Analysis broadly followed the Grounded Theory approach outlined by Strauss and Corbin (1990). It consisted of a process of open, axial and selective coding. Constant comparative analysis resulted in the identification with a core category and three inter-related sub-categories and the development of a substantive theory of patient-centred care.

This study explored the ways experienced mental health nurses working within a local acute mental health NHS Foundation and Teaching Hospital Trust felt about being unobtrusively observed in their everyday clinical practice. Participants were recruited from eight local units: four Community Mental Health Teams (CMHT), one Crisis Resolution Home Treatment Team (CRHT), one inpatient ward, one in-patient rehabilitation unit and an Assertive Outreach Team (AOT).