This scientific phenomenological study aims to explore and better understand the lived experience of learning through reflective processes, the nature, meaning and purpose of reflective learning, what is learned and the triggers and processes that enable meaningful reflective activity. Ten final year nursing students who felt that they had experienced learning through reflective processes were invited to describe their lived experiences of the phenomenon during taped phenomenological interviews. The rich and contextualised data was analysed using the four steps for descriptive phenomenological analysis proposed by Giorgi (1985). The findings essentially differentiate between authentic reflective learning which enables the emergence of 'own knowing', and the academically driven activities often perceived as 'doing reflection'. Authentic and significant personal 'own knowing' is derived from reflective activity prompted by unpredictable, arbitrary occurrences experienced in everyday encounters in the professional and personal worlds of the participants, which stimulate meaningful existential questions that, in turn, demand attention and drive the commitment to ongoing reflection. Engagement with authentic reflective activity is often triggered by an insistent and personal 'felt' sense of a need to understand and know 'something more for the self, and this activity demands far more privacy than the contemporary literature acknowledges. On the cusp of registered practice, the participants described how the maturation of reflective activity had enabled them to engage with the struggle to locate themselves personally and professionally in the context of care, to establish and refine personal and professional values and beliefs and to consider the realities of their nursing practice. Reflection enabled the participants to recognise and affirm that they had become nurses and could fulfil the role to their own and others expectations. Their reflective knowing and understanding was active and embodied in the way they lived their nursing practice. Analysis of the lived experience of learning through reflective processes has raised a number of issues for nurse education, in particular how student nurses may be supported in coming to know themselves and to become reflective, the importance of supportive mentorship and the significance of role modelling in professional development, the psychological safety of the 'practicum' and the need for privacy for authentic reflective learning.

Over the last twenty years there has been an increasing international research interest in women's experience of postnatal perineal trauma and its impact on their physical, psychological and sexual health. To date, however, no research on perineal morbidity and general health has been undertaken in Malta. Using a longitudinal descriptive correlational design, a homogenous systematic sample of 144 Maltese postnatal mothers was recruited with the aim of exploring the relationship between perineal trauma and general health following normal delivery. Self-administered questionnaires within 48 hour s of delivery and again at 10 days, 6 weeks and 13 weeks sought to assess perineal pain, urinary and faecal continence, resumption of sexual intercourse and dyspareunia. The General Health Questionnaire-12 (Goldberg and Williams, 1998) assessed mothers' psychosocial health. Open-ended questions explored further their experience of perineal trauma and general health. The retention rate at the end of time 4 was 86.1%. Following descriptive and inferential statistical analysis, the key findings revealed a constant decline in perineal trauma and an inconsistent but significant rise in general health over time. Mothers sutured by senior hospital officers reported higher scores of well-being, and resumed sexual intercourse earlier than those sutured by registrars and senior registrars. Significant negative correlations persisted between postnatal total perineal trauma and resumption of sexual intercourse at 13 weeks but not at 6 weeks.Qualitative data generated three main themes: experiencing total perineal trauma, resuming sexual intercourse and maintaining general health. Mothers identified tiredness, exhaustion and emotional pain as other burdens alongside a painful perineum. 'Being not ready yet', 'fear of falling pregnant again' and 'caring for the baby and family' were reasons preventing postpartum sexual intercourse. Tedeschi, Park and Calhoun's (1998) post-traumatic growth theory provided an overarching theoretical framework.

This thesis presents a holistic description of perioperative nurses' experiences and perceptions of continuing professional education (CPE), from their decisions to study and experiences as students, to the outcomes realised from formal post-registration university courses. Some studies have explored CPE holistically; however these did not include perioperative nurses, whose views may differ from colleagues working in other specialities due to the patriarchal nature of the theatre environment. A descriptive qualitative approach was adopted and 23 unstructured interviews were conducted with 23 perioperative nurses who had recent experience of CPE. Audio-taped interviews were transcribed fully into the Ethnograph, and the data coded and analysed using both Seidel's (1998) and Dey's (1993) models for data analysis. Four themes emerged: 1) 'Background', including managers' attitudes and cultural discourses 2) 'Going In', relating to motivations and deterrents in accessing CPE 3) 'Process', including participants' experiences as students and 4) 'Going Out', describing the personal, professional and practice outcomes which resulted. Findings relating to motivations, barriers and outcomes reflected those of previous studies. Local cultures within theatres appeared to promote practical skills above academic qualifications, with managers controlling access to CPE, and horizontal violence experienced by nurses who traversed dominant cultural discourses. Participants perceived the possession of student cards as symbolic of a raised social status. Formal study did not impact directly on practice, however the development of increased confidence appeared to facilitate participants' collaboration with, and questioning of, medical colleagues and was attributed to indirectly enhancing patient care. The extent to which participants revealed their CPE lay on a continuum from telling all colleagues they were studying (public study) through to telling no one (secret study). Participants indicated the extent to which CPE was revealed, or kept secret, was crucial, based on the prevailing cultural discourse, their own academic confidence, and potential ramifications should they be unsuccessful. This study is the first to attribute significance to the concept of 'secret study'. This work contributes to the knowledge relating to CPE: It confirms the transferability of existing literature relating to motivations, barriers and outcomes of formal study to the perioperative setting, and advances knowledge with regard to participants' perceptions of their student status, and the development of inter-professional relationships following CPE. Further research is required to explore the concept of secret study, and to indicate whether the findings are transferable to areas outside of the perioperative setting. The findings are of significance to nurses working in practice, and educators involved in designing and delivering post-registration formal courses to perioperative nurses.

No description available.

The aim of this study was to examine whether newly qualified healthcare staff can be supported in their journey to become a practitioner using an interprofessional framework to mentoring. The study involved the mentoring of newly qualified doctors (pre-registration house officers - PRHOs) by senior nurses for the first six months of their clinical practice. The setting for this study were the wards within four NHS Trusts across the South West of England where all the participating newly-qualified staff were practising. An ethnographic approach, which allows the use of both qualitative and quantitative methods of data collection, was adopted for this study. Data collection involved predominately qualitative methods (one-on-one interviews). Quantitative methods (questionnaires) were, however, also employed. The total number of participants in this study included 69 mentors (senior nurses), 64 mentees (PRHOs), four project leaders, four clinical tutors and three post-graduate managers, of which four clinical tutors, four project leaders, two postgraduate managers, 12 mentees and 12 mentors were interviewed. The objectives, pursuant to the aim, were to: • Examine the experiences of interprofessional mentoring for mentors, PRHOs and those involved in implementing the scheme; • Identify factors that support or hinder interprofessional mentoring among nurses and doctors; • Identify any benefits for the learning path of nurses and doctors; • Explore perceived benefits for healthcare delivery. The mentoring period for this study was six months and data collection occurred at the beginning and at the end of this period. All those involved Interprofessional mentoring Abstract completed a pre- and post- questionnaire. Additionally, some of the mentors, junior doctors, clinical tutors and project leaders from each of the four participating Trusts were interviewed prior to the commencement of mentoring and after six months. The data was thematically analysed using a personcentred approach. The findings from this study show that mentoring usmg an interprofessional method is a viable approach to supporting professionals, particularly during the early stages of their professional lives and in the current health service climate. Interprofessional mentoring was perceived as a means for supporting the personal and professional development of newcomers as well as the professional development of the mentors. Professionally it involved learning clinical skills through observation, increasing knowledge about the roles and responsibilities of other professional groups and their contribution to healthcare, and developing working relationships with other professionals. In terms of personal development, it helped develop increased confidence and thereby an ability to cope with stress, enhanced interpersonal skills, and improved communication skills. These benefits ultimately influenced the care received by patients, and provided improved staff job satisfaction and a more effective use of resources. The main recommendations for interprofessional mentoring and the research process based on the findings of this study are as follows: • The use of various means, e.g., shared learning, should be employed in the preparation of students during their training for collaborative work • Training for medical staff should give attention to mentoring • Interprofessional mentoring can be applied to any grade. For example, consultants or senior registrars can easily support the educational needs of senior nurses, such as nurse consultants or nurse practitioners, in the same clinical speciality. • Clear guidelines for mentors, mentees and all hospital staff about the aims and objectives of interprofessional mentoring programmes. • The process must receive the full support and backing of management and senior staff. Interprofessional mentoring Abstract• Time should be allocated for training mentors and for meetings between mentor and mentee. • The incorporation of interprofessional mentoring as one of the support systems within the hospital would be advantageous. This would necessitate the inclusion of interprofessional mentoring in hospital policy. This study demonstrates that junior doctors can be mentored and receive support from senior nurses in the early days of their practice. Furthermore, this study provides an example of how interprofessional initiatives can be implemented on general acute wards.

Chronic low back pain (CLBP) is a widespread and disabling condition affecting many thousands of people in the UK, causing distress in many areas of their lives. Most people with CLBP do not have access to specialist advice and resort to managing it themselves. The government drive to encourage people to manage their own long-term conditions has led to some work on the use of self-help techniques with CLBP. However little research has been done with CLBP populations who are not seeking specialist advice. This study actively sought people from this population group. Focusing - a self-help technique based on the client-centred psychological approach - was introduced to two people who had long-term CLBP. In addition two people who had been using Focusing in their lives for some time and have long-term CLBP (but have not applied Focusing to that problem) were also recruited. Focusing was taught either face-to-face or by telephone for six weekly hour-long sessions; the experienced Focusers spent an hour each week for six weeks Focusing with their pain. Using a mixed methods approach the four participants were interviewed a number of times, namely before, immediately after and three to six months following the Focusing sessions. They also completed the WHOQOL-PainUK questionnaire, the short-form McGill Pain Questionnaire and a global QOL measure at these three times. During the Focusing sessions they completed the SF-MPQ and the global QOL weekly. Within the concurrent nested design the qualitative aspect formed the theoretical driver for the study; the quantitative element providing a smaller amount of data. This enabled the findings to be framed in a way which makes them accessible to the wide range of healthcare professionals involved in the management of CLBP; an approach described as one of 'utility'. The management of potential incongruencies in using a mixed method approach was a continuous theme throughout the study and a model - the context of stability model - was devised to enable a harmonisation of these in the study design.During the study three of the four participants reported a change in the meaning of their pain, and improvement in the perception of their pain and its impact. After using Focusing with their CLBP participants reported that the pain no longer controlled what they did, they were able to feel more 'themselves' and value themselves and Focusing had given them a supported place to talk about their pain. Focusing appears to have an impact for these people in enabling the acceptance of CLBP and an improvement in overall quality of life was found. The physical, psychological and independence quality of life domains in particular showed sustained improvement. No negative side effects were noted by any of the participants. Further study is needed to demonstrate whether the use of Focusing with CLBP confers longer term benefits and is suitable for a wider range of people.

Compassion and empathy are essential characteristics of healthcare providers, yet the public sees provider compassion as lacking. Physician empathy also decreases during medical training. While the traditional scientific model of objective principles predominates the medical field, more recent moves in research-informed theatre have allowed qualitative researcher/educators to use drama to make their research more significant and relevant to healthcare settings. Theatre can significantly contribute to medical education by allowing students to reflect on their own emotions and the use of an imaginative perspective to develop insight into how best to convey compassion and empathy to patients. This study explored the emotional impact of a phenomenology-based play on medical students, healthcare professionals, and the public including carers of people with dementia with a specific focus on empathy and understanding of the patient/caregiver/ physician triad. Three phases were involved in the completion of this project: 1) a phenomenological study was completed with 10 people caring for a person with dementia; 2) these findings and basic theatrical principles were used to develop a theatrical playscript about the experiences of family carers of persons with dementia; 3) the playscript was produced before an audience of healthcare professionals including physicians and medical students, informal carers and community members. The emotional impact of the play was evaluated through a reflective writing exercise. Ofthe 400 people attending the play, 255 completed the evaluation. Evaluation data was analyzed using a content analysis methodology. There was strong evidence that lifeworld phenomenology-based theatre was a stimulus for empathic understanding. Four types of empathy were identified: 1) cognitive empathyunderstanding another's thoughts/feelings; 2) affective empathy-feeling another's emotion; 3) shared empathy-finding commonalities in previous experiences/feelings; and 4) projected/imagined shared empathy-imagining having same experience/feelings in the future. Medical students spend little time understanding and processing their own emotions around patient care. Lifeworld phenomenology-based theatre is a safe and effective tool to enhance empathy and help students understand patient emotions as well as their own.

Background An initial review of the literature pertaining to the emotional health of women in their transition to motherhood was undertaken. It became clear that this is an emotional time for women where they are particularly at risk of becoming distressed (Drift 2004) and if women are emotionally distressed at this time it may have long term implications for mother (Drift 2004), baby (Miller et al 1993, Lemaitre-Sillere 1998, McMahon et a1200l) and family (Burke 2003, Tammentie et al 2004a, Tammentie et al 2004b). This understanding led to an exploration of who might provide for the emotional health needs ofwomen at this time. Midwives were identified as key professionals because of their regular contact with women through pregnancy, labour, birth and early childcare. The literature review indicated that midwives were providing for the emotional needs of women but there was no indication of how, despite the recent studies conducted into the emotion work of midwives by Hunter and her colleagues (Hunter 2001,2005,2006, Hunter and Deery 2009). Design This study has been conducted using the Husserlian philo.sophical approach with Giorgi's psychological method (Giorgi 1985). Eight community midwives were recruited following a presentation at their community midwifery team meeting at a local NHS Trust and subsequent 'snowballing'. Unstructured interviews were conducted with them in 2004 in order to explore their experiences ofproviding emotional support to women who were becoming mothers. Findings A general structure was developed along with four constituents: these were 'tipping the balance to showing emotionally supportive care', 'showing emotionally supportive care', 'struggles in showing emotionally supportive care' and 'emotional experiences'. The descriptions of experiences shared by the midwives led to an understanding that emotional support is a special type of care. This occurs in an intimate relationship supported by a 'circle of care'. The midwives use their communication skills with the aim of facilitating comfort and ameliorating emotional distress. To give this care, midwives needed to go through a process of 'tipping the balance' but even after this was enacted, they still struggled in providing this care. They appeared to particularly struggle with maintaining their 'with woman' ideology within their current professional culture. Recommendations There is a need for midwifery to consider how midwives might manage their 'with woman' care within health and social care services. For the midwives in this study, having the autonomy to manage their own diaries and caseloads along with good working relationships with their colleagues was facilitative. This was a small study in one geographical area but it clearly indicates the need for further research in this area.

There is widespread concern over the high levels of reported work-related stress, job dissatisfaction and psychological distress associated with teaching and the effects of stress on teacher's sense of well-being and their willingness to stay in the profession (Borg, 1990; MSLAT, 1996; Troman, 1998; Schonfeld, 1990; Wilson, 2002). Much of the traditional research on teacher stress has been carried out by external 'experts' using quantitative survey type approaches to analyze occupational stress levels resulting in restrictive data analysis unrepresentative of the true picture of stress in the teaching profession. Researchers have advocated a more holistic approach incorporating mixed methods combining both qualitative and quantitative methods in order to gain subjective teacher reports of stress and coping mechanisms resulting in a fuller picture on teacher stress with future recommendations grounded in research. Recently, the reflective practice movement in healthcare (eg:-Boswell, 2007) has suggested using a more integrative approach to advance practitioner knowledge and empower them to improve practice through reflection to create an understanding ofthe issues within a local context. My research was particularly interested in the issues relating to teacher stress including the way teacher stress was being measured and the effectiveness of qualitative over quantitative methods, the inclusion and exclusion practices of disruptive students and the use of practitioner research to encourage teacher collaboration as a way of dealing with teacher stress. Practitioner-Research methodology has been successfully adopted in Nursing and Health-Care and has recently been used in Education with mixed findings some successfully advocating p-r while other research was hampered by bureaucracy and top-down managerial agendas. In relation to this a single UK Secondary school was researched as a case study by the investigator who taught Sixth formers A'level Psychology at the school. The research was conducted in phases using a qualitative multimethod approach incorporating triangulation to include staff, students and researcher reflections about practice in order to encourage staff collaboration, empowerment and meta-cognition. A reflexive stance was thus adopted to underpin the research methodology. Semi-structured qualitative interviews were conducted on 20 teachers (varying levels, ages and mixed gender) to assess the proposed research objectives. Classroom observations and student interviews were carried out for a year 10 class to complete the data collection. The findings revealed how students felt caught up in a selffulfilling prophecy with teachers seeing them negatively, leading to a spiral of failure and lack of motivation and the teacher interviews with both newly qualified and experienced teachers, uncovered how different coping strategies were used to deal with disruption, classroom and task management in general. The most important findings came from middle managers who claimed there was poor communication between senior tiers and lower teaching tiers with a strong sense of bureaucracy ruling their decisions. In order to bridge this gap, the practice development phase of the research tried to establish collaborative meetings in order to encourage teachers from all levels to self-reflect, deal with problematic issues and action research solutions of teaching practices. The Senior Management Team (SMT, including the Head) did not encourage staff or the researcher to proceed further with the final phase and the research was abruptly halted. Despite this, I believe that practitioner-research is a viable methodology in education research as it gives 'ownership of knowledge' to the practitioner using a self-reflexive stance to increasing their evidence-based practice resulting in a growth in meta-cognition to make improvements in practice. I feel, we need to increase insider research and use Action Research spirals and collegial collaboration as a wayforward.

Background: Breastfeeding is recognised as the optimal feeding method, conferring short and long term benefits to infants and their mothers. In the UK some women do not initiate breastfeeding. Many commence formula milk feeding at birth or after a brief period of breastfeeding. Often women have decided how to feed their infants before conception or even during adolescence, prior to when infant feeding education has traditionally been provided. Negative attitudes to breastfeeding amongst some social groups, and lack of familiarity with the practice appear to contributing factors. This research has explored infant feeding awareness of children in primary schools as a first step towards informing appropriate health education interventions. Methods: Fifty six children aged 5/6, 7/8 and 10/11 years were recruited to the study from 3 schools in rural and urban areas of Southern England. Children were shown a series of drawings, and read a story about a hungry baby. They were asked to finish the story, showing how they thought the baby was fed, using the ‘draw, write and tell’ method, developed as an adaptation of ‘draw and write’. The children produced one or more pictures, often with text, and were offered the opportunity to talk about their work; the data were united in a ‘commentary’. Codes emerged, which were combined into categories. Mapping and charting techniques were used to identify five key areas for discussion. Results: The development, and flexibility, in children’s ideas regarding infant feeding was noted. Whilst breastfeeding was identified by some children, breastfeeding terminology and imagery were problematic for many. The prevalence of feeding bottles and references to formula milk were striking, with children identifying these as equivalent to breastfeeding. Solid foods were frequently referred to by children, and seemed to be identified with formula milk feeding rather than breastfeeding. Conclusions: For the first time this study identified primary school children’s awareness of different feeding methods and the inter-relationships between these methods. It appeared difficult for children to view breastfeeding as normal, perhaps because it is rarely seen or discussed, and formula milk feeding is so prevalent. The children were interested in the subject and it is anticipated that infant feeding education with these age groups would be beneficial. Introducing children to breastfeeding needs to be achieved with care and sensitivity, using language and imagery with which they are confident. In addition, the efficacy of ‘draw, write and tell’ and the challenges of using this method are discussed.