Advances in health care have led to an increasing emphasis on family involvement in the day-to-day care of children with chronic renal disease, but if families do not become competent in this it can negatively influence the child's management. Research into the psychosocial implications of childhood chronic disease has been prolific in recent years, although relatively few studies have investigated the way that families learn about chronic disease management. However, a body of work is emerging in the human sciences around the premise that social engagement in communities of practice is a fundamental process by which people learn. Building on these lines of research this study, therefore, aimed to explore the way that children with chronic renal disease and their families learned to manage the condition, and to determine the impact of relationships between families and professionals on the learning process. Using grounded theory within a symbolic interactionist approach, data were collected and analysed in two phases (retrospective and prospective). Phase one aimed to uncover the issues that eight children and/or their parents identified as important in learning about the condition since diagnosis in the preceding four years. In phase two, a longitudinal approach (building on phase one analysis) involving six families and key professionals, allowed detailed exploration, over eighteen months, of learning events that arose following referral to a Children's Kidney Unit. A focus on learning by families as social participation in care was identified in the study. A novel, substantive theory, the social theory of learning in childhood chronic renal disease is proposed comprising three categories: the processes of assessing; interacting and synthesising. Assessing is the process by which families and professionals learn through assessing the disease course as well as each others' ability and social positioning. Interacting is the process whereby families and professionals learn through sharing knowledge, earning and maintaining trust and engaging jointly in decision making. Synthesising is the process whereby families' and professionals' learn through a new, shared understanding based on knowledge of each others' communities of practice, cultures and patterns of learning. The theory conceptualises family learning as: a two way process of interaction in developing an ongoing practice between family members and professionals; the influence of interpersonal as well as intrapersonal learning; and not only acquisition of skills but also the formation of identities in the context where the skills are learned. Three patterns of learning also emerged from the data (parallel, integrated and synthesised). These help to explain some of the differences and similarities between families' learning as they move through the chronic disease journey. This study develops and modifies Wenger's (1998) social theory of learning and Gibson's concept of participatory competence (1995) and contributes an innovative perspective to the growing body of knowledge around childhood chronic disease. Testing and further development of the theory and its use in child health is indicated.

Background: It has been suggested that compassion is aspirational, rather than a reflection of the reality of contemporary nursing practice. This notion is reflected through reported negative experiences of nursing care, encountered by individuals across a range of age groups and care contexts. In response, a political and professional reaffirmation has ensued to declare that compassion remains a core philosophy of nursing, although this provides limited articulation of what compassion entails. Furthermore, there is limited empirical research to explore compassion exclusively through the perceptions of individuals who have experienced nursing care, highlighting a gap in existing knowledge. Aim: The aim of the research was to address this gap in knowledge and develop a more comprehensive understanding of compassion in nursing. Specifically, the research aimed to explore compassion, exclusively, through the perceptions of individuals who had personal experience of nursing care. Methodology and Methods: A constructivist grounded theory methodology was implemented, influenced by the theoretical perspectives of symbolic interactionism and social constructionism. The target sample population comprised a group of individuals who were in an established role to contribute to teaching and learning strategies to undergraduate health students within the university setting. Applying a theoretical sampling strategy, data was collected via eleven individual interviews, a focus group discussion with three participants and three additional individual interviews. Data was analysed using initial, focused and advanced coding techniques, supported by constant comparative analysis. Findings: Five data categories were generated from analysis. This comprised the four major categories of Self-Propensity for Compassion, Attributes for Compassion, Socialising for Compassion, Conditions for Compassion and the core category of Humanising for Compassion. Advancing reflexivity to consider these data categories at a more conceptual level identified that compassion was fundamentally characterised by experiences of humanising approaches to nursing care, which were dependent upon the equilibrium of five interrelated elements of compassion. These elements comprised Character for Compassion, Competence for Compassion, Motivation for Compassion, Connecting for Compassion and Action for Compassion. The five elements of compassion were subject to further influence by three overarching principal dimensions of compassion, which comprised Compassionate Self, Compassionate Interactions with Others and Compassionate Situational Contexts. In order to reflect participant perceptions of the complex nature of compassion, a grounded theory was constructed and assimilated into The Model of Compassion for Humanising Nursing Care. The new theoretical insight gained from this model provides a more comprehensive understanding of what compassion in nursing involves, offering an original contribution to the existing knowledge base and a foundation from which to address emerging implications for practice and opportunities for future research.

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).

Remission is synonymous within cancer care and with other physical disorders, but less known and utilised in relation to people with a diagnosis of schizophrenia. Following work by Andreasen et al (2005) the idea of remission in schizophrenia became more widely utilised as symptomatic remission and was employed as an outcome measure primarily addressing medication efficacy. Whilst remission may or may not be a useful concept, the language, perception and social construction of remission for people with a diagnosis of schizophrenia is also of high importance. To date, there has not been any published material with respect to consultation with service users who have a diagnosis of schizophrenia regarding their personal interpretations and possible concern of the concept of remission. This study explores and conceptualises the possible introduction of the concept of remission into the process of recovery for people with a diagnosis of schizophrenia. Therefore raising the question; “Is remission a useful concept to facilitate transition back into primary care for people with a diagnosis of schizophrenia?”

Technologies such as geographical information systems (GIS) have emerged during the past two decades as part of the Information Revolution and include functions such as data storage, management, integration, analysis and presentation. GIS have wide and diverse applications in disciplines such as engineering, business/marketing, urban planning and environmental management but remain underused in public health. The thesis reports the findings of a mixed methods study examining the views and perceptions of public health practitioners on the value of GIS mapping in decision-making. A case study design was chosen; the case issue (childhood lead [Pb] exposure) represents an example of the "case" which is defined as 'decision- making in public health'. The exploratory phase of the study combined heterogeneous data to produce a visualisation of lead contamination in Newcastle. The value of GIS in public health was explored in an interview phase. Twenty-two semi-structured interviews were conducted with decision-makers involved either directly or indirectly in public health practice. Interview recordings were transcribed and coded thematically for analysis. Decision-makers tended to be positive about the use of GIS in public health and many volunteered potential opportunities to apply GIS mapping techniques further. Four discourses were highlighted through analyses, namely: data origins (Ontological Discourse), status (Power Discourse), application (Functionality Discourse) and reciprocity (Collaboration Discourse). The power of maps to integrate multiple, disparate datasets was found to be important and respondents felt, overall, that GIS mapping was a democratic means of communication. Complexity frameworks are drawn upon to make sense of the research findings and to illuminate the need for non-reductionist models of decision-making in the public health context. The lessons learnt through this study can be translated to other fields, thereby sharing skills, knowledge and experience to promote collaboration and integrated thinking across the public health landscape.

This thesis explores the impact of changes in health policy introduced by Conservative administrations in the period 1987 to 1995 on the definition, management and control of professional work within general medical practice. The research underpinning this work combined secondary analysis, large-scale primary fieldwork and qualitative research with clinicians and managers. The first stage of primary fieldwork was conducted during the period September 1994 to June 1995 and consisted of a postal survey of 750 practices across England and Wales. This was followed up with a second phase of research involving depth interviews with managers and clinicians, delivered in the period July to November 1995. This pluralist methodology sought to connect micro and macro levels of analysis in exploring the relationship between the state, professions and managers in primary care. The research explores the extent to which a number of professional freedoms have been challenged by policy change including political, economic and technical autonomy and the extent to which this had changed the position and rewards of managers in general practice. Employing a multi-dimensional approach to the analysis of power this thesis suggests that prevailing theories of a decline in professional power, based primarily on economic relations at the macro level cannot account for the complexity of relations found in UK general practice. Further, studies focusing at the collective level of bargaining between the state and the medical profession in the UK have over-estimated the impact of policy change due to a neglect of study at the micro level. Rather this study has revealed a complex picture of both continuity and change in which general practitioners have lost, retained and in some cases extended their power as a result of policy initiatives. Whilst professional freedoms have remained relatively intact, the impact of policy change on the occupation of Practice Management has been more significant, with prevailing discourses of `managerialism' creating gendered struggles over the definition and meaning of management in primary care. This work therefore calls for a multi-dimensional account of social life which can explain the complex interaction of differing sites of power, within which a wide range of power resources are deployed. Further this work would endorse a dynamic concept of power in which 'patterns of interaction' (Bradley 1999) are fluid and changeable rather than fixed and self-sustaining systems. It is argued here that constraints on social action are created by the history of past agency, embedded in institutions and social practices that both shape, and are shaped by the agency of individuals.

Healthcare assistants (HCAs) have been a longstanding feature of the Irish health service workforce albeit under different guises such as nursing auxiliary or nursing aide. However, concerns have been growing about this workforce since scandals in the UK (Winterbourne View and Mid-Staffordshire) and Ireland (Aras Attracta) reported appalling standards of care being administered by unregulated care assistant staff members to vulnerable adults in residential settings. Whilst recognising these concerns and acknowledging that the role continues to evolve and grow in significance from a policy perspective no proposal has being posited for the professional regulation for this occupational group. The purpose of this study is to explore the changing role of Healthcare Assistants in Ireland and to consider the potential need for professional regulation in the public interest. This thesis makes use of two central theories proposed to explain the pattern and motivation of professional regulation in healthcare, public interest theory and public choice theory. An explorative in-depth case study approach combining a number of different data-gathering methods, including focus groups with HCAs, semi-structured interviews with senior managers and other key stakeholders and document analysis, was adopted. The findings reveal the existence of a three tiered HCA workforce – qualified, part qualified and unqualified that is a source of confusion at the interface between HCAs and registered nurses for delegated tasks and subsequently viewed as a risk to patient safety. This study makes a valuable contribution to a neglected area of knowledge by presenting for the first time the views of HCAs and senior managers regarding professional regulation for the evolving HCA workforce in Ireland. The study also makes a valuable contribution to practice by developing a series of recommendations regarding regulation and governance of the HCA workforce.

This thesis reports a mixed-method investigation into the relationship between training experiences and commitment in students training for a caring profession such as nursing. There are recruitment and retention difficulties in healthcare care professions (Storey, Cheater, Ford and Leese, 2009) and on nursing courses (Waters, 2006). While extensive research has examined the retention of student nurses, little is known about the antecedents, experience and impact of work commitment in student nurses. The findings of such research have the potential to inform interventions and enhance support structures to improve retention in students training for the caring professions. This programme of research initially aimed to explore the experiences of students training for caring professions, with particular focus placed on nursing students, together with how these experiences relate to commitment. Lecturers and students participated in semi-structured interviews in study 1 and 2 respectively. Issues were identified relating to support, such as peer support and staff-student relationships during placement, as being important to understanding the development and maintenance of commitment in students. Quantitative work in study 3 demonstrated that affective commitment was positively related with wellbeing and help-seeking behaviours, and negatively with turnover intentions. Perceived support was positively related to satisfaction with experiences of training, affective commitment, and help-seeking behaviours. In a longitudinal study (study 4) affective commitment and work-related anxiety-contentment were found to decrease, and turnover intentions increase, between time 1 and time 2, before and after a work placement. Further, satisfaction with placement experiences appeared to causally influence affective commitment. However, study 4 provided only limited support to the findings of study 3, partly due to its limited sample. The findings of this programme of research suggest that placement experiences have important implications for the development and maintenance of student commitment to nursing. An intervention following placement could assist in re-establishing student commitment to nursing if required. It is argued more broadly that it would be of benefit for nursing educators to manage student commitment in order to enhance retention, wellbeing and satisfaction amongst students. These findings also have the potential to enhance insight into the nature and impact of commitment in students training for other caring professions.

For women with anorexia nervosa, control and routine are important in managing distress and maintaining a sense of self in challenging situations. The transition to motherhood is characterised by change and uncertainty. Women may struggle to integrate the demands of anorexia alongside the challenges of motherhood. The aim of this thesis was to review the literature regarding the experiences of pregnancy and motherhood for women with eating disorders and develop a grounded theory of the transition to motherhood for women with anorexia nervosa. The literature regarding experiences of pregnancy and motherhood with an eating disorder was reviewed. The findings suggested a trend for remission of eating disorder symptoms in pregnancy followed by relapse during the postpartum period. Women with eating disorders were most likely to experience depression and anxiety during the later stages of pregnancy and postpartum. The review highlighted how eating disorders impacted on women's ability to embrace motherhood and bond with their children. There was a paucity of research exploring the lived experience of motherhood for women with specific eating difficulties, most notably anorexia. A grounded theory was informed by the experiences of eight mothers with anorexia. A core process of breaking the cycle highlighted how women were attempting to make lasting positive changes. They achieved this by protecting their children from anorexia, exploring new perspectives, setting a good example to their children and battling temptation to succumb to anorexia. This study provides a unique insight into the experiences of mothers with anorexia. In the final chapter the research process is reflected upon. It is hoped that these findings will influence clinical practice and help professionals to better understand women's experiences.

Background: In the UK, South Asian and Black Caribbean communities are more at risk of developing vascular dementia and experience a higher rate of young onset dementia (under age 65 years), compared with the majority ethnic population (Seabrooke & Milne, 2004). Despite this, Black and Minority Ethnic (BME) persons with dementia are underrepresented in health services, receive diagnoses later in disease progression and are less likely to access anti-dementia medication or partake in research trials (Cooper, Tandy, Balamurali et al., 2009). An emerging theme in culture and dementia research is the impact of religion on dementia in terms of perceiving the illness, accepting the illness, coping with the illness and accessing services (Milne & Chryssanthopoulou, 2005). Religious beliefs and practices offer one explanation for BME underrepresentation in mainstream health and social care services (MHSCS). MHSCS appear ill-equipped to respond to the religious needs of ethnic minority individuals (Bowes & Wilkinson, 2003). Aim: To conduct an investigation of the influence of religion on access to - and experiences of - dementia care services, for South Asians from the Sikh, Hindu and Muslim communities in the West Midlands. Method: An exploratory, qualitative study employing Critical Realist Grounded Theory methodology (Strauss & Corbin, 1990) utilising a multimethods approach of semi-structured interviews and observations informing a three-phase data collection and data analysis model with five service user and service provider cohorts. Results: A two-stage model: “Existing Service Provision” and “Service Improvements” demonstrates religious beliefs influence low knowledge of dementia, stigma of mental illness, isolation and family duty of care. This led to ill-informed care choices and carer burden. Persons with dementia were also under-identified within their religious communities. Regular outreach in to South Asian religious communities is vital to educate and identify underrepresented persons, allow informed dementia care choices and relieve carer burden. Scripture-influenced dementia training is required to dispel stigma and improve care options. Investment in face to- face communication with translators and a shift away from paper resources is required. Conclusion: The full potential of religious communities in dementia care provision is yet to be realised. Utilising this resource as a symbiotic channel – firstly, to identify persons with dementia and educate the congregation about dementia - and secondly, to utilise the existing congregation to meet the psycho-social needs of the person with dementia, offers a holistic care package, leading to informed care choices.