This work was designed to explore the effect of cetirizine on mediator release secondary to intradermal bradykinin challenge in normal human skin. On intradermal injection, bradykinin produces a dose-dependant weal and flare response similar visually to that produced by histamine, suggesting that histamine release is involved in mediating the cutaneous response. This is further supported by the fact that premedication with cetirizine significantly inhibits both the bradykinin and histamine weal and flare. However microdialysis demonstrated that there is insignificant histamine release following bradykinin, and SLDI showed that the weal and flares produced by both histamine and bradykinin are different in nature, suggesting that other mediators, such as prostanoids or NO are involved. Although both prostanoid synthesis and NO release were observed following bradykinin, cetirizine failed to have any effect on the levels measured, suggesting that these are not the major mediators responsible for the bradykinin response. Cetirizine was shown to be able to inhibit the cutaneous responses induced by a number of agonists, namely bradykinin, histamine, and methacholine. All of these act via a specific GPCR, and each one having an alpha subunit of the Gq/11 variety. Therefore it is postulated that the bradykinin-induced weal and flare is mediated by activation of B2-kinin receptors located on sensory neurones, resulting in the release of neuropeptides, and that inhibition of this response is achieved by a direct inhibition of Gq/11 G-proteins, their regulatory proteins or modulation of a common second messenger system.

No description available.

This is a study about participation of mental health service users in the clinical practice decisions of mental health student nurses undertaking their nurse training. The research was undertaken with students, recruited from a higher education institution, in collaboration with mental health service users, recruited from mental health service user organisations, and was conducted over a period of eighteen months. Mental health service users have long been calling for greater involvement in the clinical decisions which affect their lives. Involvement in this context means decisions made collaboratively with service users where there is determined effort, on the part of the nurse, to share decisional power. Concern has also been expressed that current theory used to inform practice is derived predominantly from professional academics rather then those who use services. In order to address these issues, a co-operative inquiry design was adopted which engaged all participants as co-researchers, as well as co-subjects, and involved repeated cycles of action and reflection, using recorded group meetings as the means to collect the data. The aims of the study were to identify strategies for increasing user participation in decisions, to develop a model of good practice and to explore the value of co-operative inquiry as a vehicle for bringing about increased participation. The outcomes of the inquiry have been to identify, from a service user perspective, professional values, behaviours and actions and cultural aspects within organisations which inhibit or enable the sharing of power and participation in decisions. In addition the inquiry has developed the ‘time for change’ model which it is proposed could be used to evaluate aspects of participation within the clinical practice and education environment. The inquiry concludes by demonstrating the potential benefits and challenges of conducting meaningful participatory research. It also reflects on the value of the co-operative inquiry process as a vehicle for developing the students’ practice and moral development, which, it is argued, has wider utility in higher education and the practice learning environment. Finally the inquiry emphasises the need for an organisational culture in which the practice of participation can evolve and be nurtured, in order to overcome the systematic exclusion, or what has been termed ‘institutional userism’, which was a common experience for the inquiry participants.

This thesis describes a three-stage project using a qualitative case study approach. It explores in what way the features of Army life affect the daily lives of Army parents, how aspects of Army life influence the decision-making of mothers, and what support Army mothers expect when their child is unwell after their primary health care centre has closed (called the out-of-hours period). The study was conducted within an Army garrison in England. It occurred during an intense period of overseas operational deployment that left mothers as temporary lone parents for many months. Out-of-hours service provision had changed from an Army clinic within walking distance to an NHS provider located over thirty miles away. Phase One, using focus groups with 24 parents, identified how Army life affected parents and what their expectations were for health care provision in the out-of-hours period. During Phase Two, seven of these parents were interviewed to explore the themes identified in the previous stage in greater depth. Phase Three involved interviews with a further seven mothers who had accessed the out-of-hours clinic when their child had been unwell, to investigate the decision-making process that led to a consultation with a health professional. This study provides a rich and detailed description of how disruption, mobility and enforced separation affect parents living with young children within a garrison in England and the coping strategies that mothers used. It is distinctive as it theorises that emotional vulnerability caused by anxiety and fear during military enforced separation challenges a mother’s fundamental sense of belonging. An algorithm developed from the findings demonstrates that a partner’s presence influences whether the mother calls health care services as a first or last resort. Thus, it makes an important contribution to the development of both civilian and military knowledge regarding a mother’s decision-making behaviour and her expectations for care when her child is unwell, particularly when a lone parent

After completing a three year midwifery degree course at university newly qualified midwives are expected to function fully as autonomous and accountable practitioners. This interpretive phenomenological investigation explored the lived experiences of twelve participants throughout their first twelve months post registration. Data were collected using semi-structured interviews at three points in time: the point of registration, four and twelve months post registration. Analysis and interpretation of these data were achieved using van Manen's methodological structure combined with an interpretive phenomenological approach. The findings revealed two final interpretive themes that described the meaning of 'becoming a midwife'. These were 'Fairy tale midwifery: fact or fiction' and 'Submissive empowerment: between a rock and a hard place'. The first incorporated the two super-ordinate themes false promises and reality shock; the second incorporated four super-ordinate themes beyond competence, part of the club, self doubt and struggling. This study has contributed to existing knowledge by way of highlighting the 'crisis of reality shock' that these newly qualified midwives experience surrounding the change of responsibility upon qualification. When participants experience the 'real' world as a newly qualified midwife, they may have to undertake work that previously they did not want to do and could opt out of as a student. The newly qualified midwives did not perceive themselves to have autonomy and by virtue, responsibility. Lack of autonomy and the ability to undertake decisions can lead to high levels of anxiety in the newly qualified midwife. Despite this, they prefer to work on the delivery suite where they have instant access to support and advice compared to being on their own in what they perceive to be a chaotic community setting. It may be that transition is an emotional challenge and like birth, the reality is that preparation might help, but that the 'reality' can only be experienced.

This study was set up to test the effectiveness of relaxation techniques to reduce hot flushes and to find out more about the experience of menopause after breast cancer. A randomised, controlled trial was conducted on 150 women to investigate whether relaxation training reduces hot flushes in women with breast cancer. A diary was devised and tested in order to gather accurate data on hot flushes. A purposeful sample of eight women were selected for interview and information was gathered about the experience of hot flushes in the context of breast cancer through the interviews and diaries. From the interviews it was found that there was much uncertainty about menopausal difficulties after breast cancer. The women faced profound changes in their bodies, which could bring feelings of being out of control. Ultimately they found that menopause was secondary in relation to having cancer and that they were expected to adapt, although menopausal difficulties could remain for many years. Menopausal difficulties after breast cancer were found to be a major problem for many women, causing severe disruption to life. Hot flushes were experienced by 68% of women and continued for more than five years in 34% of women. Women in this sample experienced a median of five flushes per day. Sleep disruption was a major problem with 72% of women having disturbed sleep. There was a diurnal pattern to flushes, with more occurring in the morning and the evening. This pattern was more marked in women taking tamoxifen. Relaxation was found to be an effective intervention, which significantly reduced the incidence of hot flushes by 22% (p<0.001), the severity of flushes (p<0.01) and the distress caused by flushes (p=0.01). The actual reduction in flushing was relatively small, being the equivalent of one flush per day. It was therefore recommended that relaxation be incorporated into a programme of self-management measures to relieve hot flushes, which can be adopted by women who have had breast cancer.

The role of Nurse Consultant was developed as part of government strategy to reform the National Health Service. This thesis is an evaluation of my practice in this ‘new’ role. The evaluation was undertaken in three phases. In the first phase, from an extensive qualitative data base collected from my day-to-day practice, I analysed and constructed four short stories of my practice. Told in poetic form, these short stories evocatively portray the difficulties faced in caring for people at the end of life in an acute hospital and illuminate key themes that shaped my experience in this ‘new role’. These were finding my place and being put in my place, the emotion inherent in my day-to-day practice, developing and enhancing palliative care practice, and brokering professional presence and hybridity. In the second phase, I analysed and evaluated the short stories to identify the values that influenced my nursing leadership and patient care. From these a theory of my practice was constituted. This theory was critically examined in the third phase of analysis. The theory emphasises the importance of leadership as a relational practice, through which patient care is enhanced. This practice is influenced by professional power interrelations, the meanings of palliative care within the acute Trust and the cultural divide between organisations, particularly between nursing and education and acute care and palliative care. The thesis concludes with reflections on the research process and the tension I experienced in researching my own practice in a culture where ‘evidence-based practice’ is the norm and empirical evidence is most valued. My understanding and theory of leadership portrayed in this thesis stems from a different tradition. Grounded in observation and reflection on practice, it provides a perspective on the role currently absent from the literature, especially in the field of palliative care.

Nurse education has moved from apprenticeship models to advanced competency-based curricular in higher education. The bachelor’s degree is already becoming the entry level into professional practice. Postgraduate programmes have been developed and there is growing autonomous regulation. Nursing in Cameroon has equally been going through its own evolution from the colonial era to present day Cameroon. However, the absence of empirical data makes it difficult to ascertain the nature of this evolution. The aim of this study was to critically analyse the basis of/and ideological positions of key stakeholders in relation to nurse education in Cameroon. Charmaz’s (2006) constructivist interpretation of grounded theory was used to analyse data from official texts and in-depth interviews of nurses involved with education policy. Data sources were initially selected using purposive sampling and subsequently through theoretical sampling. The results showed that nurse education in Cameroon has been influenced by a series of interacting factors. These included categories that occurred at particular points in time though their influence persist: multiple births and formation; reactive growth and development; liberalisation and nurse education expansion; turf wars and intra-professional conflicts. These were found to interact with fluid categories that represent dynamic current movements whose direction are unclear: change mode; moving nursing to higher education; harmonisation of nursing programmes; and professionalizing nursing. A grounded interpretation of these categories and their relationships led to the development of a theory on seizing the opportunity of the moment. The theory proposes a harmonisation project to move nurse education from a scenario where nursing has no control over the education system to one where nursing seizes control of the nurse education process. The argument is made that turf wars and intra-professional conflicts have the potential to pull nursing education from the unanticipated opportunities suddenly generated by government’s policy of liberalization. The current conjunction of the desire for change among nurses and the unplanned inclusion of nurse education in higher education provide the unique opportunity for harmonization if harnessed to advance nurse education and professionalise nursing. The study concludes that nurse leaders must create a platform that unites nurses towards the adoption and implementation of the harmonisation project or risk another generation of erratic growth and development.

Background Greater longevity means that many more women with learning disabilities (LD) are becoming eligible to participate in the NHS Breast Cancer Screening Programme (NHSBCSP). The NHSBCSP is used to detect early signs of breast cancer and is open to all women over fifty years of age. Participation by women with LD is lower than that of the general population and little is known about their experience of mammography or what influences their decision whether or not to participate in the programme. This study explored these gaps. Aim To explore factors influencing whether or not women with LD participate in breast screening and their experience of having mammography. Methods An ethnographic approach was adopted using purposive sampling. One-to-one semi-structured interviews were conducted with 12 women with LD, 10 allied-professionals and 13 carers (10 paid-carers, 3 family-carers). These were supported by periods of focused observation of behaviour related to breast awareness and breast screening. Field-notes were used to support data collection. Data was subjected to thematic analysis, using a blended framework based on McCarthy (1999), Smith (1999) and Smith and Osborn (2003). Findings Findings revealed that the women's experience of breast screening was negative, and that this dissuaded them from returning. Factors influencing attendance at breast screening were inextricably linked to the women's level of LD, the level of support they received and the philosophy of care observed in the work place of the paid-carers. These factors were identified as influencing each stage of the breast screening process. Conclusions Findings revealed that whilst the women's experiences of breast screening were negative, each woman's journey was unique and depended upon the support provided and their level of LD. For this reason, despite equality of access to breast screening, there was inequality in preparation and delivery of the service.

No description available.