BACKGROUND: Mental health problems are of serious concern across Europe. A major barrier to the realisation of good mental health and well-being is stigma and discrimination. To date there is limited knowledge or understanding of mental health nurses' attitudes towards mental illness and individuals experiencing mental health problems. No previous study has been conducted in Malta that addresses this aim, and prior to this study the attitudes of nurses and midwives towards mental illness were unknown. This study is the first of its kind to sample the nursing and midwifery population of an entire country. This study is also the first to attempt to compare the attitudes of nurses according to the years within a mental health setting as well as a comparison between attitudes and the different mental health settings. To the researcher’s knowledge this study is also the first to include a midwifery population within the comparisons. OBJECTIVES: To identify the attitudes of Maltese nurses and midwives towards mental illness and also the investigation of factors that contribute to the formation of attitudes towards mental illness. DESIGN: A nation-wide cross sectional questionnaire survey. SETTINGS: All Maltese state-owned hospitals, departments, units and clinics employing nurses and midwives. PARTICIPANTS: A total of 1483 nurses and midwives participated in this study, representing all the various nursing and midwifery grades and work settings. METHODS: Data were collected using The Community Attitudes towards the Mentally Ill (CAMI) scale, which is a 40-item self-report questionnaire. Data were analysed using quantitative methods using SPSS ver.21. RESULTS: Maltese nurses and midwives hold a positive attitude towards mental illness. Positive attitudes are also seen for each of the 3 subscales of the CAMI tool, namely Fear and Exclusion, Social Control and Goodwill. This study concurs with existing literature and also identifies the importance of education in the formation of attitudes. Results show that Registered Mental Health nurses hold the highest attitudinal score. Apart from education and professional grade, age, years in service and working specifically within the mental health field also seem to infer on the attitudes of Maltese nurses and midwives towards mental illness. CONCLUSIONS: Understanding the variables influencing nurses’ and midwives’ attitudes towards mental illness is critical to deliver effective care. Although Education has been identified as the most influential variable in this study, influencing variables only account for 6.9% of the total variation in the responses. This implies that other predictors exist that affect attitudes, thus further research is warranted.

Parenting a son or daughter who has an intellectual disability is typically framed as being very stressful and has been reported to lead to poorer physical health, mental wellbeing and earlier mortality than for parents of typically developing children. While the stress that comes with parenting a child who has intellectual disabilities is undeniable, some parents also report that their child has brought about a positive change in their lives. The aim of this study therefore, was to explore whether there was a relationship between parents who identify positive aspects of parenting their child with itellectual disabilities and their slef-reported health and mental wellbeing. A two-phase sequential mixed methods study was undertaken between September 2013 and September 2015 and a reflexive approach was used by the researcher throughout. The study was underpinned by the theoretical paradigm of critical realism and the philosophical worldview of pragmatism. In phase I, seventeen face-to-face semi-structured interviews were undertaken to elicit how and in what way parents described a positive aspect of parenting their son or daughter. Seven key themes were identified which served as the basis for locating an existing scale which represented the positive aspects. The scale chosen was the posttraumatic growth inventory underpinned by one of the shattered assumptions theories of posttraumatic growth. Phase II explored the relationship between posttraumatic growth, health and mental wellbeing through an online survey of these parents (N=576). Posttraumatic growth was found to be a significant predictor of mental wellbeing, but not of general health. Potential explanations were explored. A lack of clarity between the theoretical underpinning of the construct and the terms used to describe, measure and report positive aspects, posttraumatic growth and/or benefit finding were identified and require further investigation. The study offers new knowledge in relation to the experience and impact of parenting a son or daughter who has intellectual disabilities and the potential for utility in professional practice is explored.

Patients often exhibit premonitory abnormalities in vital signs before an adverse clinical outcome. Patient survival may depend on the decisions of nurses to call for assistance. There is a paucity of published early warning scores (EWS) literature for general ward use from South Africa. In a public hospital in South Africa, the study aimed to develop, validate and test the impact of implementation of a modified early warning scoring (MEWS) system vital signs chart and training programme designed to improve hospital nurses’ performance in early identification of postoperative clinical and physiological deterioration in adult patients.

Civil unrest has become a feature of South African society and has resulted in varying degrees of social disruption. Health services, particularly those located in residential areas, have been affected. As nurses constitute the largest group of health care professionals in South Africa, and often live in the communities in which they work, they serve as useful indicators both of community dynamics and the health services. This study describes the effect of civil unrest on nursing personnel and determines the short term and long term effects on health and nursing services. A self-administered questionnaire was distributed to all community based nurses working in two major health services in the Cape Peninsula in 1986. In addition, routinely available health data directly related to nursing services were collected on a monthly basis for the period 1984-1988 (inclusive). For purpose of analysis the Cape Peninsula was classified into areas of high, medium and low impact violence evident in 1986. The nursing questionnaire had a response rate of 76.9%. Problems associated with civil violence that were identified were the need for nurses to ensure the safety of their own children; transportation to and from work; identification as nurses; security; curtailment of nursing services (particularly home visits); disruption of ancillary services; employer attitudes; political and police activity. Health data relating directly to nursing services revealed disrupted antenatal dinics, an increase in the number of women booking antenatally following a time of disrupted booking clinics, an increase in deliveries associated with interrupted family planning clinics, a decrease in treatment of ophthalmia neonatorum and umbilical sepsis associated with curtailed home visits. The study indicated that nurses wer:a not adequately equipped to cope with the changing demands mad1:1 upon them during periods of political instability; that civil unrest negatively affects nursing personnel and nursing services; and further, that disruption of a service impacted other services. It is recommended that in areas of violence it is essential to have a single management team co-ordinating all health services; education and in-service training must address the needs of nurses.and health care in situations of civil violence; nurses must strive to be accepted as universal carers and be committed to justice and peace; and the professional association must be proactive in providing guidelines to nurses who are affected by civil unrest.

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.

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.

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.