The arrival of the modern matron into the NHS acute setting in 2001 was in response to increased public and political concern regarding standards of nursing care and the quality of patient care. As a politically motivated initiative, the modern matron role and its relationship with the concept of the traditional matron has been extensively debated. The aims of this study were to explore: 1. How far the modern matron represents continuity between the traditional matrons of the mid 20th century and the present day. 2. What socio-political forces led to the development and establishment of the modern matron? 3. From the perspective of health professionals, what impact has the modern matron had on the quality of patient care? Adopting a case study design underpinned by realistic evaluation, the study involved interviewing patients and a carer, a focus group and interviews with staff and national policy leads. Documentary analysis was undertaken on a set of traditional matron archives. A number of key themes emerged from the research, including: the importance of uniform and visibility, patient expectations, the impact of policy processes and the political rationale for national policy change. Conflict between ensuring nursing quality and operational demands, which acts as a barrier to the modern matron role, was also found. Long-held assumptions about the functions and the positioning of the traditional matron are explored, with continuity and divergence between the traditional and modern matron roles revealed. Using a realistic evaluation approach, the findings were framed whilst considering the structural and generative elements, which resulted in social interplay or visible phenomena and provided an explanation for the predicament of the modern matron. The key conclusions were that national policy decisions appeared to be diluted once locally implemented. Modern matrons in part did positively impact on care quality. The introduction of modern matrons and the quality agenda may have been the start of a national discussion about how to continually improve patient care in an arena where intermittent care quality challenges which give concern. The effect of previous national policies that impacted on senior nurses may have diverted them away from their core purpose – patient care. The modern matron guidance may have been limited before publication by the inference within it about limiting the authority of the new post-holders. There was limited evidence of the modern matrons’ visibility to patients and this was reflected by the traditional matron’s accounts. The expectation of modern matrons’ physical presence may have been drawn from assumptions embedded in nostalgia and media portrayal of the traditional matron. The thesis concludes with implications for strategic nurse leaders and national policy leads to consider how the organisational arrangements for secondary care can best support and secure the ultimate aim of consistent provision of good quality nursing care.

The lived experiences of the family of a Traumatic Brain Injury (TBI) survivor is an under represented, yet growing field of qualitative psychological research. This thesis used a case study approach with a family in which one member sustained TBI thirteen years previously. Using conversational unstructured interview techniques, I participated with the family in eliciting public narratives around their experiences since the accident. These public stories were also thickened by individual interviews, which both supported and contradicted the public narratives. In the analysis I found two major narrative lines, the first of which was the baby-narrative which held that the injured person must not be injured any further in word or deed and must be protected at all time. The second dominant narrative was the fighting-narrative, which was characterised by language and actions around fighting/battling on behalf of the injured person against uncaring ‘others’. Several important suppressed or counter narratives emerged during the individual interviews, which could not be spoken about publically. I conclude that the power of the two dominant narratives is fuelled by constant rehearsal and enactment, which actually freezes the family and does not allow it to move forward. Suppressed stories are discussed as a possible avenue for therapeutic growth and for the evolution of the family story as they age.

A heterogeneous research partnership (HRP) is one in which industry, academia and government collaborate to conduct research, typically of national importance. Whilst most HRPs complete their planned duration and deliver their agreed tasks, it is not uncommon for participants to be left feeling somewhat dissatisfied, suggesting that the requirements which are being met are incomplete. There is an opportunity to improve the success of HRPs by establishing principles and practices for the application of systems engineering in their development. The thesis reviews literature drawn from a broad body of work covering three main areas: the context of HRPs themselves, systems engineering and related disciplines, and research methodology. The research adopts an interpretive approach, initially applying Soft Systems Methodology in a pilot case study and subsequently conducting a qualitative analysis of sixteen HRP case studies in order to develop and refine generic models which are relevant to HRPs. Drawing from the commentary of interviewees, published sources and other evidence, major themes across the case studies are integrated in order to develop ten principles and ten practices for the application of systems engineering to HRPs. The importance of consistency between the research context, systems approach and research methodology is emphasised, and the thesis highlights a significant philosophical challenge facing system of systems research as the discipline seeks to use a range of hard and soft systems approaches which are fundamentally rooted in different paradigms.

This research identifies, through an extensive series of exploratory and explanatory case studies, the mathematical difficulties that might be encountered by dyslexic engineering students. It details support mechanisms that may be put in place to help these students reach their full potential and makes suggestions for the introduction of measures at institutional level to ensure compliance with current legislation. This is an area, identified from the literature search, that has not, until now, been the focus of any substantial research activity and thus the findings form an original and significant contribution to knowledge in this field. The findings are not only intrinsically interesting but will also be of use to practitioners of mathematics, support staff, staff developers and policy makers in higher education. A literature review gives historical background on the development of education in general, and mathematics in particular, in the UK. The main theories and problems associated with developmental dyslexia are also given. Surveys were undertaken to determine the extent of mathematics learning support in UK universities and also to determine the extent of the provision of mathematics support to dyslexic students. Using case study research and by providing one-to-one mathematics support, the difficulties encountered by dyslexic students were investigated. Related work is an exploratory study into the use of different media combinations in Computer Assisted Assessment. Additionally, an in-depth case study of the Mathematics Learning Support Centre at Loughborough University has been undertaken and is reported in detail with recommendations for changes suggested. The results of this research show that mathematics learning support is widespread and often essential to bridge the gap between school mathematics and university level mathematics but specialist mathematical support for dyslexic students is rarely available. It is determined that dyslexic students can be impeded in their learning and understanding of mathematics as a direct result of their dyslexia. Recommendations for further study in some areas and future lines of inquiry in others are suggested.

This study presents a normative framework of the RFID implementation process in the UK public sector. It was motivated by the lack of socio-technical studies on the RFID implementation process in the UK public sector and the need for existing and potential RFID project managers to have an implementation model which could guide their effort in implementing any RFID initiatives in the sector. The study has been conducted through a combination of case study research and grounded theory research approach. Primary data have been collected from the in-depth interviews conducted with the RFID project managers from seven public sector organisations, i.e., five libraries and two hospitals. The analyses of the data were in two main stages. The first stage involved the analysis of the RFID implementation process in each of the organisations and the second stage involved a cross analysis of the RFID implementation process across the entire organisations. Potential contribution towards the existing body of knowledge on RFID implementation was in the form of a normative framework of RFID implementation process in the public sector. This framework describes the main and sub activities in the implementation process, and illustrates the dissimilarities and similarities between the implementation processes. Consequently, the implications of the study to the existing and potential RFID project managers in the public sector and also to the study of information system and RFID implementation are discussed.

The research applies the contextual context, content, and process (CCP) framework to explore the contextual and processual factors that are associated with implementing interorganisational collaborative arrangements in the public sector. Collaborative arrangements in the public sector are found to be complex, difficult to implement, and liable to failure when not fully explored and recognised. Background theory reveals the absence of a multilevel lens that can embrace the multifaceted nature of interorganisational collaborations, the multiple contextual levels, the process stages and micro-actions, and the interplay between the process and the context. By identifying the need to explore contextual and processual factors, the background theory informs the focal theory which proposes an extended CCP framework as a useful multilevel lens to elucidate the research problem. The framework is developed and validated through multidisciplinary literature synthesisation, the pilot stage, and the main fieldwork which applies qualitative methods based on multiple case studies from the public sector in Oman as data sources’ techniques. The originality of this study stemming from developing and validating a novel multilevel contextual framework. The emerged multifaceted CCP framework, used to explore contextual and processual factors when implementing collaborative arrangements in the public sector, is found to be an applicable, feasible, and useful analysis tool. It can help public policy-makers, public management, academics, change agents, and collaborating organisations in identifying the inhibitive, supportive prerequisites, and in general influencing contextual factors. It helps also in elucidating and minimising uncertainty about the nature and micro-actions of the processual stages.

Introduction/Background: Suicide in older people is a historically neglected research area. Local audits had suggested that Cornwall had a higher than average suicide rate, and people aged 75 years and over appeared to be at particularly high risk. Heterogeneity between studies and variations in presenting suicide statistics can make comparison of rates difficult. Aims: The study aimed to explore in depth the epidemiology of suicide in elderly people in Cornwall, to develop an understanding of the risk factors (including sources of stress), suicide methods, locations, and warnings, and consequently to identify potential preventive strategies. Methods: A mixed methods approach was taken, combining quantitative epidemiological study of suicide using Office for National Statistics (ONS) Public Health Mortality Files with qualitative retrospective case study analysis using coroner’s records and local audit database. All completed suicides (and some systematically selected open verdicts) in people aged 75 years and over occurring in Cornwall between 2006 and 2010 were included. A questionnaire survey of rural community dwelling people aged 75 years and over (n = 49) in a part of Cornwall was also carried out to identify the main sources of stress associated with ageing in the local area. Results: Some discrepancies in the number of open verdicts reported by the coroner and ONS were noted. Although suicide in the over 75 age group was responsible for only 0.3 % of all-cause mortality in males and 0.1 % in females, the overall suicide rate in this age group in Cornwall was significantly higher than the average for the UK, with a Standardised Mortality Ratio of 172 (95 % CI 123 to 236). Males aged between 75 and 84 years had the highest suicide rate in Cornwall (mean of 25.8 deaths per 100,000 population, 95 % CI 1.1 to 50.5). Jumping from a height and suffocation were the most frequently used methods, accounting for 8 and 7 of the 34 deaths respectively. 28 of the 34 suicides took place at home. Depressive illness, physical illness and bereavement were the most commonly identified risk factors. Concerns revealed in survey responses were closely related to suicide risk factors, including fear of losing independence, bereavement, physical illness, isolation, and fear of becoming a burden. Warnings included previous self-harm or attempted suicide, suicide ideation or plans, behavioural changes and researching euthanasia. Discussion: As persons aged 75 and over are at significantly higher risk of suicide in Cornwall than other regions, there is a need to reduce the number of suicides in this group. Possible preventive measures include reducing access to means (in particular for jumping incidents), earlier detection of depression in the physically ill, bereavement counselling, more social groups and support groups in rural areas, helping people to retain their independence, and a change in societal attitudes towards elderly people. There may also be a need to improve the accuracy of suicide statistics. Conclusion: Health services, councils, voluntary groups and the community as a whole should work together to prevent suicide in older people. Future controlled studies should assess the effectiveness of interventions and focus more on differences between subgroups of elderly people.

This research aims to inform the relevance of Organisational Learning (OL) to policing management practice by investigating its impact and prevalence in UK policing. In the prescriptive literature, OL is propounded as an important aspect of effective organisations that needs to be leveraged. The field of OL is found to be diverse, lacking empirical work, and in need of suitable research techniques. To focus the research, a specific example of OL is proposed in performance management (PM) practice. The PM literature shows the theoretical foundations for practice are underdeveloped. This research addresses this by combining these two fields. As a result, practical data is made available to support an examination of OL and a theoretical basis for PM is developed. In the absence of a suitable model to structure data collection, a new OL model of PM is derived from the literature. A Critical Realist position is adopted which aims to identify the nature of the phenomena underlying OL. Three case studies with UK Police Forces, which involved fifty-two interviewees, were undertaken during 2008. A pilot case study was undertaken in Scotland, with the follow-up case studies in England and Northern Ireland. The data from interviews is analysed in NVivo using a range of coding techniques. Using the results from these case studies, the provisional OL Model of PM is tested and developed further. PM practice is found to involve the creation of knowledge and the creation of action and the relationship to organisational purpose is highlighted. Six elements of the OL process are defined as Attention, Analysis, Advising, Adjusting, Affecting and Achieving. Dimensions influencing PM practice in the cases are identified. The outcomes of the research indicate relevance to policing management practice, as well as to the wider fields of PM practice and OL theory.

This study sets out to interpret pupils’ and teachers’ perceptions about learning in visual arts in the context of the third year visual art class of one of the three specialist arts schools in Greece. The rationale for the research was to understand how pupils and teachers in this type of specialist arts school perceived the learning process, which could have some transfer value to other contexts of learning in the visual art subject. The research may contribute to the body of knowledge and the practice of art education in Greece, and possibly inform future curriculum development in the subject. In Greece, since 1985, the development of art education and pupils’ aesthetic understanding has been one of the five fundamental aims for secondary and primary education. To improve art education at the primary and secondary level, the Greek Ministry of National Education and Religious Affairs has undertaken several initiatives. One such initiative has been the development of specialist arts schools. These alternative specialist schools exist in several European countries. In 2003 the Greek Ministry of Education announced the establishment of the first arts school of the country. The year the research was conducted 2008-2009, three arts schools were operated in Greece. The research endeavoured to understand issues related to the learning process in one of the new specialist arts schools, as perceived by third year pupils (aged fourteen and fifteen years old) and their visual art teachers. The research used the interpretive research paradigm, as it is the most suitable method to explore the socio-cultural reality in which the pupils and teachers are situated. Qualitative data were collected using semi-structured interviews, observations, and focus groups. The analysis of findings revealed a learning experience very closely related with the philosophy and the content of the Greece’s national curriculum of visual art. However, according to the findings of this study further attention needs to be given to the issue of developing imaginative thinking, within the framework of the art curriculum. The study proposes an alternative version of the art curriculum, with a view to facilitating imaginative thinking, in the art curriculum of specialist arts schools in Greece as well as the teaching of art in normal secondary schools. It is hoped that the results of the study will offer ground for discussions and oppositions in the area of art education in Greece, in which area not much research has been undertaken. The study’s proposal for the revisions to the existing art curriculum for the specialist arts schools, as they are resulted from evidences embedded in pupils and teachers views, stress on the significance and the originality of the findings and for this reason it is hoped to concern the writing aspect of Greece’s future curriculum writers. This will add to the development of art education in Greece and further will foster relationships between the members of the particular school where the research was carried out.

The aim of this research programme was to explore ehealth technology in pharmacy practice in Scotland and, by doing so, contribute original knowledge to this area. Strategists worldwide believe technology has the potential to promote quality, safety and efficiency in healthcare. This has been reflected in national ehealth policies designed to support collaborative working between medical and non-medical healthcare practitioners and, more recently, the whole health and social care team. A meta-narrative systematic review was conducted to explore and contextualise research related to healthcare professionals’ views of the adoption of ehealth technologies to support shared care. Findings indicate the importance of organisational development and training for core and optional ehealth services with pharmacists particularly under-represented in ehealth research. Socio-technical systems theory and the computer supported cooperative working framework were adopted to explore healthcare practitioners’ perceptions of ehealth in relation to integrated care. Findings from the review indicate ehealth research continues to focus on doctors and nurses. No ehealth application was perceived to be an unqualified success with the socio-technical gap still evident. Multiple case studies were conducted to develop explanatory theory around the digital literacy experiences, education and training related needs of pharmacy staff in the NHS Grampian area. Digital literacy levels were self-reported as basic with mixed views on the need for formal education and training. Findings indicate organisational and social factors may act as restraining forces against implementation of technology in pharmacy and associated digital literacy training. A final theory testing, systematic review was conducted into digital literacy training experiences of pharmacy staff applying Kirkpatrick’s four level model. It found a lack of evidence of specific, measurable digital literacy levels but indications that suggest digital literacy should be included in pharmacy education at all levels and career stages. This research provides novel insight into ehealth and digital literacy in pharmacy practice. Combined ehealth, education and pharmacy research has been demonstrated to be an under-researched area therefore these findings contribute original knowledge.