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Aims: The aim of this research was to engage with the experiences of professionals, parents, and young people in order to develop an understanding of the current diagnosis and management of ADHD. This research will be of interest to Counselling Psychologists working with the child and adolescent population and the clinical area of ADHD. Method: Nine semi- structured interviews were conducted with two young people, three parents, and four professionals. The interviews were transcribed and analysed using the principles’ of grounded theory methods. A constructivist version of grounded theory was implemented, as outlined by Charmaz (2006) and a social constructionist epistemology was adopted. Analysis: A central story line of ‘investing in ADHD’ emerged. This involved the investment of resources in the ‘simple truth’ of ADHD as existing within the child’s brain. A number of categories emerged which contributed to this position, including the ‘battlegrounds’ which were fraught with struggles to gain control of children’s difficult to manage behaviours and ‘knowledge and understanding’ which highlighted the need to understand the nature of the perceived problems. In addition, ‘social expectations’ and ‘personal conflicts’ depicted the social and personal factors which served to construct the perceived problems. Conclusion: The investment in the ‘simple truth’ of ADHD appeared to hold the most meaning for those involved in the study. These findings offer utility for Counselling Psychologists wishing to engage clients in psychological formulation and management approaches which aim to address the underlying factors which influence ADHD.

The thesis has been prepared in a paper-based format and includes three papers: Paper 1, a systematic review; Paper 2, an empirical study; and Paper 3, a critical appraisal and reflection on the work. Paper 1 has been prepared for submission to Neuro-Oncology. The paper presents a systematic review of 21 studies concerning the relationships of demographic, clinical and mental health factors on health-related quality of life (HRQoL) and psychological functioning in adults with primary malignant brain tumours. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) principles. Methodological qualities of studies included were appraised using a checklist based on the Newcastle-Ottawa Scale (Wells et al, n.d.).Findings were synthesised narratively adhering to published guidelines (Popay et al, 2006). The review identified evidence for factors relating to HRQoL and psychological functioning, offered several considerations for clinical practice, and outlined recommendations for improving the methodological rigour of future research. Paper 2 has been prepared for submission to Psycho-Oncology and presents the findings of a qualitative study of patients’ psychological adjustment to glioblastoma, the most aggressive and most common form of brain tumour in adults. Semi-structured interviews were conducted with 10 participants 3.3-5.1 months post-diagnosis. Data were analysed using a constructivist grounded theory methodology (Charmaz, 2014). Analysis yielded three theoretical categories describing processes of maintaining continuity with the past, reframing the present and changing to accommodate an uncertain future. The implications of these findings on current supportive interventions are discussed. Paper 3 is not intended for publication. It offers a critical appraisal of the individual papers and the research process overall, considering their strengths and limitations. The paper also discusses issues of reflexivity encountered during the empirical study, and considers the implications of this research for the author’s professional development as a clinical psychologist.

Pharmaceutical drugs are one of the most socially important health care products. They are part of many individuals' everyday lives, from the eradicating of diseases at birth to treating patients at the end of life. However, for many patients access is prevented due to expensive cost. This study explored cost-related non-adherence (CRN) and researched if reimportation of pharmaceutical drugs from other countries could increase patient drug adherence. The perceptions of 10 patients and 10 providers in Maine were assessed. Maine is the only state that allowed its citizens to purchase prescription drugs from abroad. The research questions addressed (a) how reimportation drugs could contribute to drug adherence, (b) the perceptions of patients, and (c) the perceptions of key providers of reimportation. This study was guided by a theoretical framework utilizing Kurt Lewin's theory of organizational change. Participants answered 15 open-ended questions. The study utilized a qualitative grounded theory approach; data were analyzed inductively. The research demonstrated that patients and health care providers had positive perceptions for a reimportation policy. Future research of other regions for this topic should prevail. Member checking was used to validate the emerging theories of increased long term drug adherence incentivized by affordable drug cost, which contributes to perception of competence, better management of current disease, and decreased safety concerns. Positive social change implications can be achieved through savings to the health-care industry by creating a pathway to affordable drugs that will bring more drugs to market and create a competitive structure that can drive down pricing.

Pharmaceutical drugs are one of the most socially important health care products. They are part of many individualsâ?? everyday lives, from the eradicating of diseases at birth to treating patients at the end of life. However, for many patients access is prevented due to expensive cost. This study explored cost-related non-adherence (CRN) and researched if reimportation of pharmaceutical drugs from other countries could increase patient drug adherence. The perceptions of 10 patients and 10 providers in Maine were assessed. Maine is the only state that allowed its citizens to purchase prescription drugs from abroad. The research questions addressed (a) how reimportation drugs could contribute to drug adherence, (b) the perceptions of patients, and (c) the perceptions of key providers of reimportation. This study was guided by a theoretical framework utilizing Kurt Lewinâ??s theory of organizational change. Participants answered 15 open-ended questions. The study utilized a qualitative grounded theory approach; data were analyzed inductively. The research demonstrated that patients and health care providers had positive perceptions for a reimportation policy. Future research of other regions for this topic should prevail. Member checking was used to validate the emerging theories of increased long term drug adherence incentivized by affordable drug cost, which contributes to perception of competence, better management of current disease, and decreased safety concerns. Positive social change implications can be achieved through savings to the health-care industry by creating a pathway to affordable drugs that will bring more drugs to market and create a competitive structure that can drive down pricing.

This research project conducted an in-depth, qualitative assessment of vocational education and training (VET) teachers’ perceptions of pedagogic innovation, with an emphasis on obstacles and supporting factors. The main research question was: “How do teachers’ roles and perspectives shape innovation processes in VET and what does this imply for the development of teaching and learning practices?” Three clusters of subsidiary questions were derived around thematic foci: ‘perceptions and concepts’, ‘documentation of practice’, and ‘dynamics, limitations, and lessons for innovation’. Based on analytical strategies derived from grounded theory, two phases of interviews – the first with ten experts and the second with 62 VET practitioners at 20 colleges – were conducted in England, Germany, and Austria, with a focus on full-time VET (Further Education Colleges, Berufskollegs, and Berufsbildende Mittlere und Höhere Schulen) in the 16-19 age range. Classroom observation preceded semi-structured, 30 to 60 minute interviews with teachers. The study builds on previous research and existing frameworks such as Lipsky’s concept of ‘street-level bureaucracy’ and Flyvbjerg’s ‘critical cases’. However, it fills a gap in the literature by focusing on practitioner perceptions, motivations, professionalism, autonomy, work contexts, and own learning in relation to pedagogic innovation, whilst tracing relevant connections to educational policy, college management, and societal influences. Teachers are shown in multiple roles as inventors, designers, and implementers of innovation, facing nine categories of obstacles. Those include limited time and budgets, bureaucracy and lack of autonomy, problems with project planning and execution, and issues related to lack of support. In addition, this study provides a comparative investigation of practitioners’ interpretations of key terms (‘pedagogy’, ‘didactics’, ‘innovation’), revealing differences between England on the one hand, and Germany and Austria on the other, based on different degrees of autonomy and innovative focus. Based on such findings, the study details recommendations for college leaders and policy makers for facilitating pedagogic innovation, placing each in their respective national contexts.

Indiana University-Purdue University Indianapolis (IUPUI) / This qualitative study was successful in utilization of grounded theory methodology to ascertain nurses’ decision-making processes following their awareness of having made a medical error, as well as how and/or if they corrected and reported the error. Significant literature documents the existence of medical errors; however, this unique study interviewed thirty nurses from adult intensive care units seeking to discover through a detailed interview process their individual stories and experiences, which were then analyzed for common themes. Common themes led to the development of a theoretical model of thought processes regarding error reporting when nurses made an error. Within this theoretical model are multiple processes that outline a shared, time-orientated sequence of events nurses encounter before, during, and after an error. One common theme was the error occurred during a busy day when they had been doing something unfamiliar. Each nurse expressed personal anguish at the realization she had made an error, she sought to understand why the error happened and what corrective action was needed. Whether the error was reported on or told about depended on each unit’s expectation and what needed to be done to protect the patient. If there was no perceived patient harm, errors were not reported. Even for reported errors, no one followed-up with the nurses in this study. Nurses were left on their own to reflect on what had happened and to consider what could be done to prevent error recurrence. The overall impact of the process of and the recovery from the error led to learning from the error that persisted throughout her nursing career. Findings from this study illuminate the unique viewpoint of licensed nurses’ experiences with errors and have the potential to influence how the prevention of, notification about and resolution of errors are dealt with in the clinical setting. Further research is needed to answer multiple questions that will contribute to nursing knowledge about error reporting activities and the means to continue to improve error-reporting rates