The premise for this research initially stemmed from a perceived crisis facing the provision of the nuclear medicine service within the United Kingdom, the possible impact posed by the shortage of nuclear medicine clinicians and the untapped potential of a body of non-medical healthcare practitioners working within the nuclear medicine sector to whom recognised additional roles, such as reporting of images, may sensibly be delegated. Yet, despite the support by various professional bodies and colleges, uptake is not widespread and appears to be ill provided for in terms of educational programmes. From an educational perspective, with ever advancing technology and the ubiquity of web based resources, eLearning within healthcare is still in its infancy. Certainly its ability and flexibility to reach geographically diverse populations of learners, is undisputed, yet whilst advantageous to the professional leaner in accessing material away from a restricted campus based environment, its efficacy to teach a skill, or competence, and indeed to translate this to clinical practice remains largely unproven. With both these issue in mind, the project question was posed as to whether it was possible to establish the efficacy and credibility of an eLearning resource to prepare and support the training of non-medical healthcare practitioners working within the field of nuclear medicine in reporting of bone scans.

The present research aims to explore falls and injury prevention interventions for older people, with focused investigations of different but complementary aspects of fall and injury prevention. The research was carried out using quantitative and qualitative methodologies: a Cochrane Overview of Reviews of falls prevention interventions; a focused quantitative assessment of shock absorbing flooring in a hospital setting for those with different risks of fracture, as a sub-analysis of a pilot cluster-randomised controlled trial (The HIP-HOP Flooring study); and a qualitative examination of the relationship between falls and injury prevention interventions and the resulting psychosocial effects for care home residents and staff. The Overview identified two Cochrane systematic reviews which included rate of falls and number of fallers as outcomes. Intervention comparisons were assessed to determine whether the quality of evidence was of a high enough standard for the Overview authors to have confidence in the estimate of effect. Comparisons within two (of a possible nine) single intervention categories, exercise and medication, as well as comparisons in the multiple and multifactorial interventions categories reached this standard and reduced the rate of falls or the number of fallers. Focusing on a specific fall and injury prevention intervention, the assessment of the effect of shock absorbent flooring for hospital patients according to their fracture risk was part of a larger pilot cluster randomised trial. As a pilot, the study informed the methodology and organisation required for a full trial. Tentative findings indicate that more people fell on the shock absorbing flooring than on the control flooring, but sustained less injuries. Additionally, more falls and injuries were sustained by people with an intermediate fracture risk, although again this finding was a little tenuous due to missing data. The interview study presents the experiential aspects of using interventions for fall and injury prevention for care staff and residents in a care home setting. Through this exploration, the study revealed some of the dynamics of the relationship that the carers have with residents concerning the interventions themselves. This also uncovered a much deeper, complex process that the residents were undergoing through the changes that have taken place in their lives, as they move from independent adults in their own homes to semi-dependent adults in a care home. The overall discussion reviews the findings of the studies and highlights that there is still much research to be done around fall and injury prevention interventions in order to not only evaluate the effectiveness and efficacy of interventions, but also to assess the usefulness of the interventions and acceptability on a practical level.

Mental health needs are more prevalent in people with learning disabilities than in the general population, with practically all categories of mental illness represented. The literature, however, indicates that the views of people with learning disabilities who have experienced concomitant mental health needs have received little exploration. The primary aim of this research project was to investigate the experience of mental health needs from the individual perspectives of adults with learning disabilities. A major focus of the study involved adapting the psycho-social conception of subjectivity and methodological framework, which has been developed by Hollway and Jefferson (2000), and employing this as a means of enabling the participation of people with learning disabilities in knowledge production relating to their care and support needs. Data production was based on case studies of seven service users who have presented mental health issues. Methods for data production included ‘free-association narrative interviews’, an examination of relevant case records, as well as information provided by key care/support staff. Data analysis involved working with the whole of the material gained during fieldwork, and paying attention to links and inconsistencies within that whole. The participants’ free associations were afforded precedence over narrative coherence. Interpretation was theoretically informed, and researcher reflexivity was interwoven throughout the process. The main conclusions drawn from this research project are:- 1) The ‘free association narrative interview’ method provided an innovative and effective means of addressing the power asymmetry between the researcher and research participants; 2) Information elicited from the research participants reflected the various traumatic/life events in their individual biographies; as well as the growing recognition of the (previously unacknowledged) emotional needs of people with learning disabilities; 3) Experiential data elicited from the research participants have contributed to the (proposed) development of a theoretical model regarding psycho-social subjectivity within the field of Learning Disabilities; 4) Some findings from this project resonate with findings from previous studies; and have potential implications for policy makers, service providers and service users.

Background: The provision of high quality medical and surgical care is predicated by high quality education and training. This enables staff to respond more effectively and flexibly and is crucial when considering the various factors impacting upon the delivery of patient care. The development and training of all healthcare students and staff is an important factor in ensuring patient safety and self satisfaction, and relies on understanding the needs of learners as well as the way in which they learn. This fundamental training and education is no less pertinent in the perioperative environment, where high impact interventions are performed by Operating Department Practitioners (ODPs), and where patient safety and the quality of care must be paramount. This is due to the often difficult and potentially dangerous surgical and anaesthetic interventions on elective, unscheduled or critically ill patients. Aim: The aim of this programme of research was to investigate the effectiveness of ‘traditional’ lecture/placement provision in ODP education, resulting in the implementation and evaluation of a revised curriculum that integrates simulation based teaching and learning for this group of allied health professionals at the University of Portsmouth. Methods: This programme of research used a mixed methods QUAL + quant approach on multiple purposive and convenient samples of ODP students and placement education managers. Drawing on phenomenographic methodology, the interpretivist studies used semi-structured interviews and focus groups to investigate the understanding and perceptions of learning from those with relevant lived experiences. Furthermore, a positivist study was conducted to analyse and further understand the effectiveness of different teaching methods. The results from these studies informed a revision of the traditional ODP curriculum, based upon a nursing conceptual framework that included the integration of simulation-based learning. Results: A total of five studies were conducted, beginning with individual semi-structured interviews with 12, second year ODP students investigating perceived enablers and barriers to traditional learning using lectures in University and placement learning in the hospital environment. Study Two continued with a positivist study on a cohort of first year ODP students, which investigated the effectiveness of three types of teaching. The results of these first two studies informed a revision of the traditional ODP curriculum to integrate simulation-based learning. The revised curriculum was subsequently evaluated using focus group interviews and follow up interviews, with 30 first year ODP students. Finally, a focus group interview with 12 clinical educators that are responsible for the clinical placement learning for ODPs was conducted to gather their perceptions of the revised curriculum, and the clinical performance of the students. This led to the development of a conceptual framework to inform the integration of simulation-based learning into future ODP courses. Conclusions: The results of this research demonstrate that simulation-based learning for this professional group of ODP learners showed an encouraging trend in its effectiveness compared to other teaching methods. The revised curriculum encouraged higher order learning and mitigated to some extent the challenges faced by the NHS and placement educators. In addition, revising the ODP curriculum was evaluated positively by participants and clinical educators and tackled challenges such as inequity of learning opportunity and exposure to a diverse range of patient groups, that learners often face when undertaking learning on clinical placement. The conceptual framework designed to inform the curriculum identified specific areas for consideration when integrating simulation-based education into the ODP curriculum. However, further development and comparison of the conceptual framework reported here and a larger cross-university sample is needed to confirm its reliability and validity.

The 'holistic discourse' is a central identification mark of acupuncture and homeopathy practice. The term holism reflects much of the critique of biomedicine as reductionist, dualistic and oppressive, and, as such, has been used to distance these therapies from conventional medicine. However, in recent years, acupuncturists and homeopaths in the UK have become increasingly engaged in professionalisation, including the formalisation of their education. These efforts to move closer to the mainstream call into question the role of holism in the representation of acupuncture and homeopathy practice. The overarching aim of this research study is to explore the way that Non Medically Qualified (NMQ) acupuncturists and homeopaths in England, as part of their efforts to professionalise and formalise their educational structures, negotiate holistic concepts that are embedded in their theory, practice and discourses. The thesis firstly considers the meanings that the two practitioner groups attach to the rather fluid concept of 'holism'. It then moves on to examine how the holistic discourse is negotiated during the process of formalising education including the teaching of courses in Higher Education Institutions (HEIs). The thesis is the product of an in-depth, qualitative inquiry. Several data sets were used in this research: (1) Twenty-five in-depth interviews with acupuncturists and homeopaths in London and the South of England, including practitioners who are school principals and lecturers; (2) Participant observation of teaching a research methods unit in a BSc (Hons) Acupuncture in a private school for Chinese medicine; (3) A review of practitioners' professional websites, of professional bodies' educational and practice documents, and of 27 acupuncture and homeopathy course syllabi; and (4) Two non-participant observations of a day in an acupuncture practice and a day in a homeopathy practice. The findings from this research study show that NMQ acupuncturists and homeopaths still make frequent use of the term 'holism' as part of the representation of their practice. Nevertheless, their holistic discourse appears to be mostly focused on individuals and their immediate environment, a discourse which can be described as 'wider self' holism, with little awareness of the relationships of patients with their broad environment, these relationships being described as 'wider world' holism. Crucially, the holistic discourse which is interwoven in acupuncture and homeopathy's philosophy, theory and practice, is a dynamic discourse, influenced by political and societal factors surrounding these therapies, as well as by the dynamics within the therapies themselves. This research study demonstrates the way practitioners 'narrow’ and 'expand’ their holistic narratives and practices according to the challenges that they face during the process of professionalising and formalising their education, as well as in relation to their consumers' expectations. This research study suggests that the way by which practitioners often negotiate the tension that exists between increasing formalisation and the unique nature of their expert knowledge, can be described as 'pragmatic holism’ through which practitioners try and make gains from the formalisation process, without losing their holistic approach and appeal. Furthermore, the entrance of HEIs to the teaching of acupuncture and homeopathy courses seems to have accentuated some of the tensions that are part of the formalisation process, but it may also offer opportunities to increase practitioners' critical reflectivity in relation to their holistic discourses and practices and to expand their wider world holistic awareness.

Food allergies in children, teenagers and adults are managed by eliminating the allergenic food from the diet. Healthcare professionals and policy makers have developed guidelines for the dietary management of food allergies, but as yet there has been no assessment of how individuals with food allergies are able to adapt their behaviour to them. In order to be able to improve the diet and nutrition of children, teenagers and adults with food allergies, and thereby to increase their quality of life, it needs to be understood which processes influence food choices and management of food and eating in this population, and how their actual diet is affected by the chronic condition. This research consisted of four stages, the first three addressing food choice behaviour among age groups of children, teenagers and adults; the fourth stage evaluating the impact of food allergies on nutrient intakes of this population. A mixed-method approach has guided this research. The findings indicate that food choice behaviour is mostly affected by food allergies in adults. This is probably because personal cognitive factors play a more dominant role during food choice decisions than during childhood and adolescence, where social influences are more prevalent. Adults reported a lack of satisfaction and joy from food, had difficulties sharing meals, and felt the need to organise their eating. Teenagers struggled to widen their palate, felt secure under parental protection, and expressed the wish to eat similar foods to their friends. Children showed highest engagement with foods if the mother displayed an authoritative parenting style. Although they appeared least affected by the allergic condition in the way they were choosing food, children have been shown to be the age group making most nutritional compromises. Protein, vitamin B12, potassium, calcium, phosphorus, and iodine intakes were lower than among healthy age-matched children. This research has provided a cross-sectional survey of food choice behaviour and dietary intake among food-allergic children, teenagers and adults with many implications for practice and future research. It is recommended that dietary management of food allergies should place emphasis on dietary variety and enjoyment aspects of eating as well as the importance of social relationships that are built around food. Additionally, regular evaluations of dietary intake should be conducted, in particular for children with a cow’s milk allergy or individuals with multiple food allergies.

Background: The importance of accessible information within modern learning disability services and the wider society cannot be underestimated. This research aimed to explore both the production and implementation of accessible information for adults with learning disabilities. A novel approach to the accessible information ‘process’ was adopted; resulting in a movement away from specific resource focused research to a process focused approach. The research was conducted in three stages: a comprehensive review of the literature; a qualitative scoping exercise which investigated the firsthand experience of producing and implementing accessible information; and a qualitative investigation of the dynamic behaviours involved in the implementation of health related accessible information at a clinical level. Methodology: The purpose of the first stage was to comprehensively review and critically appraise the literature relating to accessible information, learning disabilities and symbolic development. This was achieved through a detailed search of electronic databases and hand-searches of the grey literature. For the scoping exercise, eighteen participants were recruited from four distinct sampling groups: adults with learning disabilities; staff from a specialist learning disability service; mainstream NHS and local authority staff; and speech and language therapists. Each participant took part in either a semi- structured focus group or interview. Eight participants (four community learning disability nurses and four of their learning disabled clients) took part in a non- participatory observational study. Conversational analysis was used to explore the sequence of both the vocal and non-vocal behaviours. Findings: The literature review revealed that there was a dearth of high quality primary research that has investigated accessible information within the field of learning disabilities. Of the seven relevant primary research studies, two quantitative studies measured the effectiveness of specific accessible resources through pre and post comprehension scores. Three mixed method studies, which were generally poorly reported, described a qualitative process of developing and/or appraising a specific accessible resource or guidelines as well as a quantitative element to investigate its effectiveness. Two qualitative studies attempted to answer broader questions relating to the human dimensions and experiences of accessible information. One explored the use of accessible information with a wider population and the other explored issues relating to the implementation of a specific accessible resource. These findings highlighted the largely resource-focused research and failed to report on accessible information as a process which involves the implementation of such resources. A Framework approach to thematic analysis was used to analyse the data collected from the scoping exercise which led to three main classifications: the ideology of accessible information, accessible information practice and the outcomes of accessible information. Firsthand experience varied across the stakeholders, highlighting differences in the operationalisation of national policies and legislation. The notion of accessible information being relevant to more than just people with learning disabilities was introduced. The data supported the approach of accessible information as a process, although the practice of implementing accessible resources appeared less advanced. Three main clusters of episodes were identified through the conversational analysis of the non-participatory observations. Cluster one related to providing the accessible health information; cluster two to topic development; and cluster three to consent. The findings revealed numerous intricacies in the vocal and non-vocal exchange. The use of an accessible resource appeared to promote joint attention; communicative style appeared influenced by the primary and secondary reported outcomes of the resource; practical considerations of the topic development were evident; and contradictory goals in the decision making process were highlighted. The notion of the implementation of accessible information as a dynamic process was confirmed. Conclusions: The combination of the chosen methodology and subsequent findings generated a novel approach to accessible information within the field of learning disability. In conceptualising accessible information as a process, with a particular focus on the implementation phase, the findings illustrated that it was the implementation phase that allowed for personalisation in providing and developing the information, which was dependent on the intersubjectivity of the communication partner and the person with learning disabilities. This in turn supported the accessibility of the information. These findings would not have been apparent without the movement away from specific resource focused research to a process focused approach.

This portfolio thesis is divided into three parts; a systematic literature review, an empirical paper, and a set of appendices. The thesis as a whole seeks to understand positive experiences of professional caregivers, in order to provide a more holistic understanding of caregiving in residential dementia care settings. Part one is a systematic literature review which explores and reviews the literature relating to positive and negative aspects of caregiving experienced by professional caregivers in residential dementia care settings. Factors associated with positive and negative experiences of caregiving are also examined. Fourteen papers were identified and reviewed using a narrative synthesis approach; three themes and six subthemes were identified. The findings are considered and discussed in the context of previous literature relating to caregiving in addition to clinical and research implications. Part two is an empirical paper exploring hope in professional caregivers in residential dementia care settings. The investigation includes the experience of hope, facilitators/barriers of hope and the role of hope in caregiving. Using a constructivist Grounded Theory approach a focus group consisting of six participants was conducted, and purposive theoretical sampling was used to conduct nine individual interviews. Data were analysed using constructivist Grounded Theory and nine categories emerged which were organised into three theoretical concepts. The emergent theory is discussed in the context of previous literature relating to hope and caregiving in addition to clinical and research implications. Part three is a set of appendices for both the systematic literature review and empirical paper, and includes an epistemological statement and reflective statement.

This thesis portfolio is comprised of three parts: Part One – Systematic Literature Review The systematic literature review explored adoptees’ experiences of reunions with birth relatives in adulthood. Thirteen studies were identified to be reviewed through a systematic search of electronic databases. A narrative synthesis of the findings related to the types of relationships developed, impact of the reunion and factors that facilitated or hindered this process is provided. A review of methodological quality of the research is also offered. Important clinical implications, including a role for clinical psychologists, and recommendations for future research are identified. Part Two – Empirical Paper The empirical paper explored social workers’ experiences of deciding how to place siblings for adoption using Interpretative Phenomenological Analysis (IPA). Four superordinate and twelve subordinate themes were identified, which describe participants’ experiences of making decisions, and the role of their experiences and beliefs in the decision-making process. The findings are discussed in relation to theory and a decision-making model. Clinical implications and suggestions for future research are discussed. Part Three – Appendices The appendices provide supporting documentation that are important for the systematic literature review and empirical paper, plus a reflective statement and an epistemological statement.

This portfolio thesis has three parts. Part one is a systematic literature review in which an analysis is conducted on existing research exploring asylum seekers’ and refugees’ beliefs and experiences of interventions for trauma-related distress. A systematic database search identified 18 studies to be reviewed. Narrative Synthesis is used to analyse the findings, and methodological quality is evaluated. The clinical implications for service design and directions for future research are also discussed. Part two is an empirical paper which uses Interpretative Phenomenological Analysis to explore interpreters’ experiences of working in mental health settings and how compassion may be experienced in their role. The findings are discussed in relation to psychological frameworks of compassion, and implications for practice and training, as well as recommendations for future research, are considered. Part three comprises the appendices supporting the systematic literature review and the empirical paper. A reflective statement considering the process of the research, as well an epistemological statement, are also included.