This case study explored the factors that influence the experience of night-time postural management equipment by children with cerebral palsy in the South-West of England. The aims were to explore the views of children on using a sleep system, the role of their parents and therapist in its use and the quality of sleep experienced before and during use of a sleep system. Further objectives were the identification of factors that affect the use of sleep systems and the production of findings to guide therapists' clinical practice. Seven subunits made up the whole case, with each one consisting of a child, aged 18 months to nine years who had just been prescribed a sleep system, the child's therapist and parents. All participants, excepting children under three years old, were interviewed. Talking Mats, an innovative communication tool, was used to enable children with little or no verbal communication to give their views. Children as young as three years old were able to express their views on sleeping in a sleep system and to provide reasons for waking in the night. The findings included sleep difficulties in six out of seven children, two of whom improved with the use of a sleep system. Six children were thought to experience regular pain or discomfort, two of whom were more comfortable when sleeping in their sleep system. Factors were identified that influenced whether a child and family were able to continue using a sleep system at night including the finding that some of the therapists who were prescribing sleep systems did not have the necessary knowledge and experience. It was concluded that when children are given the appropriate tools they can have a voice and be able to practice making decisions about their healthcare. It is suggested that when considering prescription of a sleep system, use of the ICF framework model would assist clinicians in focussing on those factors that predict the child and family are most likely to continue to use it. Therapy services should consider the role of a specialist clinician to lead local postural management services and to put in place training and competency measures for generalist therapists to ensure that they have the necessary knowledge and experience.

For midwifery practitioners, the concept of excellence is central to the ethos of quality midwifery care (DH 2009, NMC 2009) and although midwives are being asked to aspire to ‘a standard of excellence’ (DH 2009), the meaning of ‘excellence’ for both women and midwifery practitioners has not been defined. The focus of this study is to understand excellence at a personal level, what makes some midwives ‘stand out’ and what it means to ‘be’ an excellent midwife, from the service users perspective.

This work grew out of a need to try to understand my often experienced sense of being misunderstood, misrepresented and marginalised. A prerequisite to helping others in mental health nursing is arguably some requirement to understand one’s self. But who is the self? In this thesis I use an autoethnographic approach to examine how the self, multiple selves and identity formation is socially constructed. Social constructionism contends that categories of knowledge and reality are actively created by social relationships and interactions. As an autobiographical genre of writing, this evocative autoethnography has been written in the first person displaying my multiple layers, connecting my selves to the cultures I inhabit. As a reflexive methodology it offers the researcher a means of critically exploring the social forces and discursive practices that have shaped his own cultures. In addition I discuss the contrast between traditional guidelines and protocol driven ethics with more progressive relational ethics. Central to relational ethics is the question ‘What should I do now?’ rather than the statement ‘This is what you should do now.’ I continue by arguing that we use stories as ‘equipment for living’, as tools to understand, negotiate and make sense of the many different situations we encounter. In recent years, as part of the ‘narrative turn’ in the social sciences, a growing number of scholars have suggested that we live in a world shaped by these stories. I discuss connections between the cultures people occupy and how an individual’s reflexivity can keep them stuck or liberated and emancipated with regard to their personal narratives. Whilst the text is not intentionally instructional, storytelling can be instructive. By showing my vulnerabilities the work is a prism for the reader to reflect on their narratives and the cultures they inhabit.

Breech birth has become a rare phenomenon in England over the last two decades. 3-4% of all babies present bottom or feet first at full term (37-42 weeks gestation) and despite conflicting research about the safest mode of delivery for breech presentation, the vast majority of breech babies will be delivered by planned caesarean section. The small number of qualitative research studies suggest that the experience of breech has complex meanings for childbearing women. This research intended to explore these elements further and to better understand this experience within a social, cultural and gendered context.

This study explores the introduction of an approach called Pre-Therapy to staff working with people with dementia. Pre-Therapy contributes to the existing range of therapeutic approaches which aim to engage with the subjective experience of the world of people with dementia who have severe difficulty communicating. Pre-Therapy aims to facilitate engagement and create relationships with people who are traditionally seen as beyond contact or out of reach. The approach involves using contact reflections. The worker reflects back to the person their words, facial expressions, actions and surroundings. Until now, the application of Pre-Therapy to dementia care has not been explored in depth. An Action Research process examined the research question - What happens when staff learn and use Pre-Therapy contact reflections with people with dementia? The question involved three aspects: the response of people with dementia to contact work, the use of contact work by staff, and the learning process undergone by staff. Underpinned by values of inclusion, participation, democracy and collaboration, the study demonstrates joint inquiry and cyclical exploration. The research process involved self-participation, participation with health care staff and engagement with an expert community (The International Pre-Therapy Network). The entire research process spanned five years. Eleven staff in three residential settings participated as colearners for 18 months of the process. Located in the real world context, the study accommodated organisational flux, service instability and changes of personnel in a climate of modernization and reorganisation. Data were generated through observation, which included 14 hours of video recordings of interactions, and ongoing dialogue with health care staff and the expert community. The analytic process accompanied the research activity, using comparative analysis and Schatzman's Dimensional Analysis. Findings indicate that Pre-Therapy Contact Work has the potential to add to existing approaches in dementia care, facilitating greater self-expression of the experience of the subjective world of the person with dementia and promoting greater communication with workers. However, minor adaptations of the approach are indicated. Despite the apparent simplicity, contact work challenged staff. Barriers to learning and using contact work arose from intrapersonal, interpersonal and contextual factors. Factors which mediated the learning and use of contact work led to the emergence of a theoretical model of the emotional management of interactions. Resting on theories of constructed role identities, the model contains two contrasting positions: the emotional custodian and the emotional container. The thesis proposes that the model may be part of an underlying social process around maintaining emotional social order in interactions with people with dementia. In turn, this may help understand difficulties workers face when engaging in the emotional world of people with dementia and enacting values of being person-centred which are inherent in the policy and literature.

Previously documented evidence suggests that motherhood is potentially an important time for change in drug-using behaviour. My research interest for this longitudinal phenomenological study stemmed from practice observations where methadone-treated women struggled to prove their trustworthiness as mothers. They consistently reported frustration in the face of continued professional suspicion of their identity as drugusers. The essence of the phenomenon is therefore described as an existential tension experienced by breastfeeding mothers in methadone maintenance treatment during the first 12 weeks of motherhood. The aim of this thesis is to reveal the previously hidden inter-subjective and social realms of their lived worlds.

Caesarean birth accounts for a quarter of all births in England and is the most commonly performed operation. Despite this, little is known of how individual women experience planned Caesarean birth. Reviews of the literature reveal that rising rates of Caesarean birth are preceived to be problematic by women ,clinicians and policy makers but women's experiences are either absent from this debate or perceived as universally realised. This qualitative study involved listening to the stories of eight women to reveal how planned Carsarean birth was experienced, understood and constructed.

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).