There has been a recent increase in the use of graphic symbols in school settings (Abbott and Lucey, 2003). However, the use of graphic symbols in schools remains, to date, an under-researched area. In order to address this and develop understanding of practitioners’ experiences of using graphic symbols in school settings, exploratory research was conducted investigating the experiences of a range of practitioners using symbols in Foundation Stage school settings. A qualitative research design was used drawing upon an interpretive phenomenological philosophical framework. The research sample consisted of three groups of practitioners; teachers, early years practitioners (teaching assistants, learning support assistants and nursery nurses) and speech and language therapists. Data were collected through semi-structured interviews which were conducted face-to-face by the researcher. In the interviews participants were encouraged to explore their experiences of using graphic symbols and their associated beliefs and attitudes about this topic. Interview data was analysed using thematic analysis which was facilitated by the use of qualitative data management software QSR NVivo2. Prolonged engagement with the data led to the development of a theoretical framework based on a set of themes and subthemes. Four major themes were identified: practitioners’ beliefs about which children to use symbols with; practitioners’ thoughts about children’s understanding of symbols; practitioners’ accounts of the ways symbols are used; and, practitioners’ experiences of the implementation of symbols. Interpretations of the data were extended further to develop two original theoretical constructs; ‘models of reasoning’ and ‘perceptions of professional roles’. These constructs were developed to provide an over-arching framework depicting the researcher’s interpretations of the data set as a whole. The findings suggest that practitioners go through a process of reasoning and decision making surrounding the use of symbols. Practitioners in this study also appeared to be influenced by their perceptions of their own professional role and those of others in their decisions surrounding the implementation of symbols. The theoretical model may provide some explanation for the ways in which individual practitioners interact and work alongside practitioners from the same and different professional groups. The findings of the research were related to existing literature in the fields of symbolic development, symbols and literacy, and, collaborative working. The findings led to the development of five suggestions for future research.

Yes / If global palliative care is to successfully address challenges of unequal access, continuity of care, and health services reductionism, new practice models to address these issues need to be identified, debated and tested. This paper offers one such practice model based on a public health approach to palliative care that has so far shown promising evidence of effectiveness. Methods: We describe how four essential elements within a public health model can work together to address quality and continuity of care as well as addressing the numerous barriers of access. These elements are: (I) specialist, and (II) generalist palliative care services working with (III) communities and neighbourhoods, working in their turn with their (IV) key civic institutions. Results: The positive and negative impact and advantages of each of these elements is described and discussed. Conclusions: A solely clinical model of palliative care is inadequate to addressing the multiple comorbidities and access issues characteristic of modern palliative care. A public health approach based on a close partnership between clinical services and communities/civic institutions is the optimal practice model.