There are in excess of one million people across the UK people living with atrial fibrillation (AF), a long term condition that can lead to stroke and other complications, costing the NHS over £2,200 million per year. However little is known about the experience of living with AF and what patients' perceptions are of the support they receive from health professionals. In order to ensure that patients have the best possible experience of care, healthcare professionals need to have an understanding of how patients view their condition and the type of support they would like to receive from the professionals involved in their care. Although there has been a significant amount of work investigating social support for people with health conditions, there has been little work exploring support provided by healthcare professionals, defined in this study as professional support. This study aimed to investigate and assess the professional support needs of people with AF to develop knowledge and understanding in this field. A theoretical framework for professional support was developed based on the tri-dimensional model of social support and was used to direct the research. Using an exploratory sequential design, a two phase mixed methods study was undertaken. Initially, qualitative interviews were undertaken with patients recruited from outpatient arrhythmia clinics at one National Health Service (NHS) hospital and identified from the perspective of the patient how, when and where healthcare professionals did/did not provide support. Key components of emotional, informational and tangible professional support were identified from thematic analysis of the interview data and used to inform the development of a quantitative questionnaire. Physical activity, exercise and the impact of AF on activity levels were identified by participants as important and so were also included. The quantitative online questionnaire was completed by patient members of the Atrial Fibrillation Association (AFA). To examine relationships between variables, statistical analyses were performed using Fisher's exact test and indicated that people with AF had a range of emotional, informational and tangible professional support needs. Different subgroups of people with AF had different professional support needs: People with more severe symptoms needed more emotional support as well as more tangible support and people with paroxysmal AF needed more informational support. People undergoing ablation as treatment for their AF had specific informational and emotional needs for support. AF played a significant part in the lives of people with AF by modifying activities of daily living and shaping physical activity behaviour and choice of activities. People with AF therefore needed professional support in maintaining and/or increasing their levels of activity. Considering the specificity of professional support, GPs, cardiologists and arrhythmia nurse specialists were identified as most supportive, with GPs and cardiologists also considered as the least helpful at providing support, indicating a variation in professional support. The findings from this study contribute to the limited body of knowledge describing the experience of living with AF and provide healthcare professionals with a unique understanding of how best to provide professional support. The tri-dimensional model provides detailed knowledge of the components of informational, emotional and tangible support that people with AF would like to receive from the healthcare professionals involved in their care. The findings indicate there are differing support needs for different subsets of people with AF demonstrating a need for individualised professional support. The theoretical framework for professional support used in this study provides a model that could be used in future research studies to identify the types of professional support required by patients and to identify subgroups of patients who may require additional professional support. By accurately identifying the needs of patients, this will ensure that healthcare professionals are able to deliver effective patient centred services, leading to an improved patient experience and the delivery of high quality patient care.

This qualitative study described the development and implementation of a professional support program for beginning teachers in a school division for the 1997-98 school year. The community members including mentor teachers, principals, and central office staff, supported specific needs in a structured program to assist beginning teachers to learn how to teach. The study involved 25 beginning teachers with no years of experience who were paired with mentor teachers from their elementary schools. The study focused on the experiences and perceptions of the beginning teachers and mentors in the program building process. Phase one description includes components of program planning and development including design, collaboration, and resources. Identified beginning teacher needs, professional support community needed to provide support for the beginning teachers, program contents, and a timeline of activities, complete the description. The description of phase two of program delivery includes specific activities for beginning teacher meetings, recommendations for school-based activities between beginning teachers and mentor teachers, mentor teacher meetings, and connections to school principals. Methodology included a combination of questionnaires, participant observation and field notes from program planning meetings, beginning teachers meetings, and mentor teacher meetings, research journal, and collection of documents. Text was created from these methods looking at larger themes and issues that emerged to allow for an understanding of beginning teachers and what is involved in their necessary support. This study suggests that there are several key program essentials for providing support for the beginning teachers. Program essentials include: (1) building program awareness;(2) establishing goals; (3) determining beginning teachers' needs; (4) having a broad-based program participation; (5) preparing participants for their support roles; (6) identifying benefits to program participants; and (7) providing a program structure. A program structure includes: (1) a kick-off of the program and orientation for beginning teachers; (2) a recommended school-based activity schedule of times and topics for a collaborative relationship between beginning teachers and mentor teachers; (3) beginning teacher meetings held three times during the year for beginning teachers to meet together; (4) and mentor teacher meetings for mentor teachers to meet together. Time is an important issue for beginning teacher support with time needed to plan and develop the program and to build trust among program participants. While mentor teachers find the process of supporting beginners satisfying, they also appreciate receiving tangible benefits such as stipends, release time to work with beginning teachers, and program training. These rewards provide verification of the school division's valuing of the enterprise. An ongoing program evaluation system contributed to program planning decision making and assessment of program effectiveness. With a support program designed to meet individualized needs, beginning teachers feel supported and appreciated in their first year of teaching. In addition, a school division gains an understanding of what is needed to build support and community building for the beginning teachers and how to assist the mentor teachers as they support the beginning teachers. / Ed. D.

Teaching has been reported to be one of the most stressful professions in the UK (HSE, 2000). There is vast international literature that has documented for many years the negative implications that stress and burnout can have on educators’ health and well being and the wider systems and individuals’ connected to their work. The research also clearly documents that the development of school support systems can mediate the negative effects of stress for educators (Zellars & Perrewe, 2001). Given that teachers are one of the UK’s largest groups of public sector employees (Bowers, 2001) and that the education system is once more in a period of rapid change, it makes this piece of research timely in the current context of education policy and practice. This study calls for policy makers to recognise that stress in the education system is becoming an increasingly worrying trend and one that with the right kind of support systems in place could be alleviated in the future. Focus of thesis Two papers form this thesis. A flexible design consistent with an interpretive approach and a social constructionist philosophy has been adopted. Epistemology Social Constructionism Theoretical Perspective Interpretivism Paper One Paper Two Methodology Methodology Illuminative enquiry Action Research Methods Methods Semi-structured interviews Focus group Focus group Open questionnaires The purpose of paper one was to generate new understandings and gain insights into participants’ experiences regarding school staff stress, school support systems and the implications of this. The findings from the first paper informed my second paper. In paper two I worked with school staff to develop and evaluate a support-based intervention in order to address the gaps in support that staff identified in the first paper. This thesis was conducted in a large secondary community college, with a specialist subject status. This was located in a unitary authority in the South West of England. All participants that took part in this research were employed as teachers, support staff and/or members of middle or senior management team at the school. Paper one findings The findings in this study showed school systems to be complex environments, affected greatly by a range of internal and external factors. Participants’ experiences indicated that stress and burnout are a function of the quality of work life in the education system for many, with negative implications associated with those closely connected to them and the education system. This paper contributes to the existing body of knowledge in this area by drawing participants from across the school meso system, as opposed from one part of the system, ensuring that all those working at different levels within the school were represented. A key issue uncovered by this study and adding to the existing literature in the field is the hierarchical nature of schooling. This hierarchy served to maintain the causes of stress experienced by my participants. These causes were systemic in nature as the issues raised were common across my participants and originated from the way the school system was organised and operated. The implication of this is that the focus of support needs to be aimed at adapting the school environment to reduce the main areas of stress faced by teachers and support staff and helping teachers to deal more positively with the stress factors within the environments and systems in which they work. The evidence also showed that my participants had a limited knowledge of the wider roles of the EPS and this may be significant area for the local authority in which this research was conducted to focus on in the future. This paper’s contribution is timely given the current context of education policy and practice Paper two findings The focus of this paper was developing and evaluating, in collaboration with participants, a staff support-based intervention. The staff’s support intervention of choice was a series of short training workshops focused on developing a better understanding of stress, promoting EHWB, assertiveness and methods of support. There were four stages to the creation of the intervention: Development of the intervention (through a focus group and the collaboration of school staff); Recruitment of participants (conducted through the senior management team through emails and staff reminders); Implementation of the intervention (five one hour, after-school workshops, using a range of teaching strategies, including practical skills; Outcomes (gained through an open pre and post training questionnaire which considered the practical strategies the participants had adopted from the workshop and applied to their practice). Despite working with staff including teachers, non teachers and senior staff to design the intervention, attendance at the after-school training workshops was poor, with only five members of the school’s support and special needs team attending. There were no teachers or members of the senior management team present. However those staff that did attend the training intervention provided positive feedback and found it useful in their practice. The questionnaires suggested that the training increased staff’s knowledge of how to manage their stress and to promote their well-being. Staff also stated that they were able to apply the practical strategies provided directly to their practice. One of the main purposes of paper two was to begin the process of change in participants’ perceptions and practice. As a direct result of conducting this piece of research the school of focus have set up a staff well-being forum, open to all staff, to meet on a termly basis to discuss matters relating to staff EHWB and support. The school are also considering setting up staff consultation groups for the teaching assistants in the future, in addition to creating a staff well being notice board, a suggestion box, having a staff well being awareness day, creating a staff well being policy and also providing yearly drop in sessions for staff on stress management. The role of the EP EPs are well placed to offer their services to schools in supporting them with examining professional support systems. EPs are experienced researchers and could conduct small pieces of individual school-based research looking at those areas of the workplace where stress is experienced the most and be able to identify gaps in staff support systems. EPs are equipped with the training and experience to provide bespoke packages of support for individual schools that may include staff training aimed at prioritising staff support and EHWB both in policy and practice. It seems then that EPs are well placed to work in collaboration with schools to develop their staff support systems in this area of staff development and school improvement.

Self-efficacy is an individual’s judgment of the relative probability of her or his likely success in attaining desired outcomes (Bandura, 1977). For teachers, efficacy beliefs serve as an assessment of their own abilities to promote student learning. Efficacy beliefs are content-specific and are believed to form early in teachers’ professional careers. While studies on teachers’ sense of efficacy have examined content areas such as math and science (Mulholland & Wallace, 2001; Riggs & Enochs, 1990), very little research has been conducted to explore the perceived efficacy beliefs of beginning foreign language (FL) teachers. Using a mixed methods approach, this investigation explored factors influencing the teaching efficacy beliefs of FL teachers in a major urban school district in north Texas, as well as the potential relationship between their perceptions of efficacy and professional support. Quantitative data included surveys of FL teachers’ efficacy beliefs and perceptions of support. Qualitative data was comprised of case studies, including interviews, observations, and documents collected from four novice FL teachers, all of whom entered the classroom via alternative routes to certification. Cross-case analyses suggest that FL teachers often felt their content area was devalued by administrators, colleagues, and students as a result of its status as a non-tested content area. The efficacy beliefs of the novice FL teachers were influenced in part by contextual factors of their respective schools, including professional isolation as a result of being the only FL teacher on campus, support of colleagues, and the availability of time and resources. Because the four case study participants lacked the benefit of traditional university-based certification, they demonstrated tendencies to rely on their “selected memories,” making sense of their role(s) as teacher via the perspective acquired when they were students. Findings of the study suggest that FL teachers often experience “Stepchild Syndrome,” marked by professional isolation, a lack of relevant professional development opportunities, and a shortage of pertinent resources for FL teaching. The speculative nature of alternatively certified FL teachers’ efficacy beliefs is also examined. The study draws implications for supporting beginning FL teachers, particularly those who enter the profession through alternative routes. / text

Bakgrund: Kvinnlig könsstympning är en sed som utförs i flera länder i Afrika, längs ekvatorn och delar av Mellanöstern. Invandringen till Sverige från områden där kvinnlig könsstympning utförs ökar. Det innebär att svenska barnmorskor kommer att möta könsstympade kvinnor allt oftare. Riktlinjer och mer och bättre utbildning har efterfrågats för att kunna bemöta kvinnan på ett professionellt sätt. Syfte: Att belysa barnmorskors erfarenheter av möten med kvinnor på ungdomsmottagning som kommer från områden där kvinnlig könsstympning är vanligt förekommande. Metod: Studien genomfördes med kvalitativ metod och en induktiv ansats. Åtta semistrukturerade intervjuer utfördes med barnmorskor på ungdomsmottagningar. Materialet analyserades med konventionell innehållsanalys enligt Hsieh och Shannon. Resultat: Ämnet visade sig beröra barnmorskorna känslomässigt och en oförståelse för traditionen beskrevs. Barnmorskorna framhöll vikten av att inte acceptera traditionen, men underströk betydelsen av att respektera kvinnan och hennes kulturella arv. Ett varsam och lyhört förhållningssätt i mötet betonades, där ett felaktigt förhållningssätt antogs kunna leda till att kvinnan kände sig kränkt.  Konklusion: Möten med könsstympade kvinnor på ungdomsmottagningarna förekom sällan. Barnmorskorna upplevde därför att deras kunskaper var bristfälliga. I dagsläget ansågs inte behovet av riktlinjer vara stort, men en gemensam uppfattning fanns att behovet inom en nära framtid kommer att öka. / Background: Genital mutilation of woman is a custom practiced in several African countries, along the equator and parts of the Middle-East. Immigration from areas where this custom is common is on the rise. Midwives in Sweden are increasingly visited by women who have been victims of genital mutilation.  Guidelines and more and better education have been requested in order to approach the women in a professional way. Purpose: To highlight midwives experiences of meetings at the youth health center with women who come from areas where the practice of genital mutilation is common.  Method: A qualitative approach was chosen. Eight interviews were conducted with midwives at youth health center. Content analysis according to Hsieh and Shannon were used to analyze the material.  Results: The topic affected midwives emotionally. Midwives stressed the importance of not accepting the tradition, but felt it to be important to respect the woman and her cultural heritage. It is considered important to be gentle and responsive during the meeting and to show a good attitude towards the woman where an incorrect approach is perceived to lead to the woman feeling offended. Conclusion: Meetings with genitally mutilated women at youth health center were something that rarely occurred. Midwives knowledge of the subject was incomplete due to the lack of experience. In the current situation guidelines are not needed, but the common perception was that they will be in the future.

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Becoming a mother is a challenging time and for some women the lifestyle adjustment can be very stressful. In combination with the changes in family structure mothers are increasingly seeking professional support and assistance in the care of their infants and children. Child and family health services in NSW offer varying levels of professional support and education, including 24-hour residential care. The purpose of this study is to explore and describe the mothers' perceptions and experiences of residential admission to a Child and Family Health Unit - Karitane. This study is descriptive in nature. Sixteen English speaking mothers admitted to Karitane in 1998 took part in the study. Focus groups were the main source of data for the study. The focus groups were undirected, conversations recorded and written notes taken. Additional data were collected by a questionnaire to determine the demographic characteristics of the mothers. The mothers' indicators of depression were scored using the Edinburgh Postnatal Depression Scale (EPDS). Each mother completed the EPDS during the admission period and at the time of the focus and respective comparison was made. Data analysis revealed that the mothers' EDPS scores had decreased significantly at the time of the focus group meeting. The key concepts that emerged in the mothers' descriptions of their experiences were the importance of the development of the professional relationship, equity and access to parenting services, particularly for the partner, and the need for services to promote and provide realistic parenting education with an early intervention focus. The implications of the findings lend support to health care professionals in lobbying government for the necessary funds, in providing increased access to quality parenting services. / Master of Nursing (Hons)

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abstract: This mixed methods participatory action research study explored how an instructional coach influenced a state mandated curriculum adoption at a Title 1 urban middle school. The purpose of this study was to identify ways in which an instructional coach supported a veteran staff during the adoption of new curriculum standards. The instructional coach/action researcher employed a three pronged coaching approach that incorporated individual and team coaching sessions and increased networking to encourage and support the development of social capital. This study was informed using Vygotsky's Social Learning Theory, Wenger's Communities of Practice, Coleman's Social Capital Theory, and Hall and Horde's Concerns-Based Adoption Model. The study is heavily weighted in favor of qualitative data which includes participant reflections, coach individual session and team session reflections, field-notes, team meeting videos, and exit interviews. Several themes emerged supporting the use of a differentiated coaching approach, the promotion of social capital, and the identification of initiative overload as a barrier to curriculum adoption. The quantitative data analysis, pre and post study Stages of Concern Questionnaires, produced evidence that participants experienced minor shifts in their concerns relating to the adoption of Common Core State Standards. Results were used to inform coaching decisions based on individual participant needs as well as to augment the qualitative findings. Ideas for further research are discussed. / Dissertation/Thesis / Ed.D. Educational Leadership and Policy Studies 2014