The aim of this thesis is to explore the experiences of siblings within their family, who are living with a child with a life limiting chronic illness. Siblings have been identified as being a marginalized group because there is limited recognition of their sibling voice within the literature and in family centered care practices. Family centred care is an important aspect of children’s nursing in terms of inclusivity and maintaining dignity and respect of the whole family and needs to include the sibling. Therefore specific insight into their worlds is presented to inform care because siblings do need help when journeying along the cystic fibrosis trajectory with a brother/sister. A qualitative methodological narrative inquiry has been elicited to engage siblings within the context of their family with the use of a bricolage of creative participatory methods (n=10 children in middle childhood living with a brother/sister with cystic fibrosis). Narrative interviews, observations and the use of visual media have provided the platform for the siblings expression of their performed voice that was encapsulated in the collection of over 200,000 words of data, along with pictures, poems, songs and artifacts. Goffman’s theoretical framework of dramaturgy was used as the exploratory ‘lens’ in which to view the sibling’s front stage, back stage and centre stage stances. Microsoft word was used to conduct a thematic analysis of the data collected (observations, interviews and visual media), which provided an insight into sibling position, space, roles encompassed in their overall self-presentation in their familial/cultural milieu. Data analysis is presented as a three-act play called “The segments of the sibling mosaic” where the siblings are performing on the stage set of family life within their home. Through interactive performances siblings act out scenes of multiple presentations of self to reveal the contradiction between their ideology and reality of their lives as a consequence of the opposing force of cystic fibrosis. Through the use of Goffman’s framework I suggest that the children’s expression of voice goes beyond the use of the spoken word, as siblings gave voice through their constructed and co-constructed performances. I also suggest that siblings are skilful in their interactions as they are able to fluctuate easily between their dramaturgic front stage and back stage stances. I argue that siblings are placed in a decentralized position in family life and I introduce three prominent positions/spaces where these children stage themselves, which are “in the wings”, “left of centre” and in the “off stage place sets”. I highlight how siblings demonstrate diplomacy and wisdom in their communicative interactions of being good so as to remain protective, loyal and maintain family equilibrium. I argue that siblings should not be labeled or referred to as being well or healthy in the absence of physiological illness, because they provide an insight into their emotional self where a need for help is identified. Bringing siblings to centre stage and using creativity in this study has identified one way of helping them to share their experiences and enabling their voice to be heard to inform future aspects of care. However, further research is suggested.

Spirometry (lung function assessment) is an essential tool for the chronic disease management of chronic obstructive pulmonary disease (COPD). Chronic disease monitoring for COPD was introduced in 2004 and included spirometry for target achievement and financial remuneration within the Quality and Outcomes Framework of the General Medical Services Contract. However, practice nurses have anecdotally struggled to gain competence and expertise with the spirometric procedure and interpretation post 2004, despite the successful achievement of financial targets within the general practice setting. A sequential exploratory mixed methods study (Tashakkori and Teddlie, 2003) was undertaken within a University Health Board in Wales to determine what, if any, barriers exist for practice nurses undertaking spirometry assessment and interpretation for the chronic disease management of COPD. Quantitative data were collected via an online questionnaire. Qualitative interviews were conducted and analysed using an analysis framework method (Ritchie et al, 2003). The methodological framework of the feminist transformative lens (Caracelli and Greene, 1997) was utilised to gain an understanding of the barriers practice nurses faced in the gaining of competence with spirometry assessment and interpretation within the wider professional context. The quantitative results confirmed the anecdotal reports of difficulty with spirometry and demonstrated that lack of training was the greatest reason for lack of confidence in spirometric interpretation, followed by lack of clinical time and lack of general practitioner (GP) support. The qualitative results demonstrated that practice nurses are commonly working as disenfranchised isolated practitioners within general practice teams, and are commonly undertaking a procedure in which they are not highly confident. Recommendations for development of future clinical practice are: mandatory training with assessment of competency to improve skills with spirometry, in addition to supervisory support and training of GP colleagues. Other recommendations include: a greater focus on inter-professional team working to reduce professional isolation and disenfranchisement of practice nurses, and for practice nurses to actively contribute to local and national initiatives to improve spirometry services in the long term.

This research set-out to: a) investigate attitudes of disabled people (adults) toward other disabled people; and, b) attitudes of disabled people toward different impairment groups. Comparative data from a non-disabled sample was also collected. Two new attitude rating scales were developed for this research: the General Attitude Scale Toward Disabled People (GASTDP) and the Attitude Toward Impairment Scale (A TIS). Both scales achieved acceptable levels of internal and external reliability. Positive attitudes toward disabled people were found from both the disabled (M = 41.08; n = 193) and non-disabled samples (M = 39.29; n = 120). However, a hierarchy of impairment also appears to exist, with the disabled sample producing a rank ordering of most accepted to least of Deaf, Arthritis, Epilepsy, Cerebral Palsy, HIV/AIDS, Down's Syndrome and Schizophrenia. The nondisabled sample rank ordering was the same for five of the seven impairment groups, with only Cerebral Palsy and HIV / AIDS being placed in reverse order. The GASTDP contains two sub-scales (Subtle and Blatant Prejudice subscales). Statistically significant results between the two sub-scales were found for both the disabled and non-disabled samples, suggesting people tend to hold subtle forms of prejudice toward disabled people. The discussion therefore utilises the term aversive disablism, based on aversive racism. This theory argues that whilst people may be reluctant to express negative attitudes toward disabled people, they may also support policies that are disablist, i.e. segregated housing. The contact hypothesis, whereby contact with members of a minority group influence attitudes, was not supported by the data. This thesis recommends further research into subtle forms of prejudice toward disabled people from an in-group perspective and attitudes toward different impairment groups.

Background: New nursing roles and advances in care and treatments have resulted in nurses facing increasingly complex ethical dilemmas in practice; nurses are therefore required to engage effectively in ethical decision-making. Prior to commencing this empirical study a literature review was undertaken, the databases CINAHL, Science Direct, Medline, Web of Science and British Nursing Index were searched. Peer reviewed papers were systematically reviewed. Emerging themes were moral distress, codes of ethics, conflict within ethical decision-making and policy. The literature included international studies and indicated that ethical decision making is a concern amongst nurses globally. Aim: To identify how nurses contribute to the resolution of ethical dilemmas in practice. Method: An Interpretive Qualitative study was undertaken, between March and December 2012, using a flexible approach to analysis. The National Research Ethics Committee provided Ethical approval. Eleven registered nurses were interviewed using semi-structured interview, focusing on how participants addressed ethical dilemmas in practice. In-depth thematic and content analysis of the data was undertaken. The relatively small, single site sample may not account for the affects of organisational culture on the results. Results: Four major themes emerged: ‘Best for the patient’, ‘Accountability’, ‘collaboration’ and ‘policy’. In addition professional relationships were identified as key to resolving ethical dilemmas. Moral distress was evident in the data as identified in the literature, and reflects the emotional labour nurses’ experience. Discussion: Support is required for nurses to acquire the skills to develop and maintain professional relationships for addressing ethical dilemmas in practice. Nurses require strategies to address the negative impact of moral distress. Conclusion: Nurses’ professional relationships are central to nurses’ contributions to the resolution of ethical dilemmas. Recommendations: Research is required to explore this phenomenon in other geographical areas and professional settings. Nurses need to engage with political and organisational macro and micro decision making. Further research is required to establish how nurses can manage moral residue and minimise the negative impact of moral distress.

Aims: The overall aim of this programme of research is to evaluate aspects of an innovative approach to the education and training for a sample of student and registered mental health nurses (MHNs) in preparation for their medicines management (MM) role. In addition papers are included that make a contribution toward what is known about this fundamentally important responsibility for the MHN. Background: Medicines management is an established role for the registered MHN. Medicines prescribed for people diagnosed with a mental illness can be therapeutic but this is complicated by potential short and long-term side effects, which can produce extreme discomfort, and even can be life limiting. In these circumstances it is of paramount importance that the nurse needs to have the requisite knowledge and skill to assist the patient gain the maximum therapeutic benefit whilst minimising any potential harm including medicine administration errors. There is however a paucity of evidence concerning the preparation of mental health nurses (MHNs) to undertake medicines management in their undergraduate and early career as a registered practitioner. There is also a significant criticism in the research literature about MHNs suggesting they lack the appropriate underpinning knowledge and skills to perform MM that is safe and inclusive of the patient prescribed psychotropic medication. Methods: This thesis analyses several publications over a defined period 2009-2014 and describes a coherent programme of research including: The evaluation of a collaborative four-stepped approach between an NHS Trust and a University. Aspects of the approach evaluated included: a Psychopharmacology Workbook; An Objective Structured Clinical Examination; a Competence Assessment Framework for Administering Medicines. All these components had the intention of building the requisite knowledge and skill base to teach both student and registered nurses competently to undertake MM. The consideration of conceptual approaches that the MHN may adopt toward their MM work and relationship with the patient. Analysis of the contribution of the submitted publications to the evidence base of MHN education and training for MM. Findings: The programme of research indicated that MHNs do not have sufficient education and training to undertake MM. In addition, although they value education and training toward MM, student nurses think they learn better when the content they receive is clinically focused. A dedicated diet of education and training for MM, in the framework of a stepped approach was perceived both by student and registered MHNs positively. The sample of nurses reported it enhanced their knowledge and skill base to practice MM safely and competently. However, the MHNs had criticisms in that they considered that there was a lack of clinical validity and overuse of simulated assessments as a learning mode. A number of related findings emerged from the programme of research: (1) the prevention errors in medicines administration needs to involve an organisational ‘systems’ approach; (2) establishing a conceptual approach to medicines management training can enhance the subsequent relationship the MHN has with patients who are prescribed psychotropic medication; (3) the MHN role when managing medicines has to include physical health assessments, and education and training initiatives needs to reflect this. Conclusions: Using a ‘stepped approach’ to prepare mental health nurses in the undergraduate and early career following registration for their MM role is generally well received by nursing students and practitioners who felt it would enhance their competency. The findings indicate that this novel approach to training has the potential to contribute to safer clinical practice. Prospective studies are now needed to find out if this approach in the early stages of the mental health nurse career does indeed produce improved outcomes in terms of therapeutic gain and reduced risks for the patient who is prescribed psychotropic medication. The potential of the stepped approach as a model needs to encompass all four stages. Thus further work to develop and implement the latter two stages and evaluate their impact is needed.

Current pre-registration nursing programmes in the United Kingdom (UK) require students to spend 50% of their programme time in practice, with this practice learning and assessment supported through the process of mentoring. Concerns have been expressed both locally and reflected in the wider literature regarding mentoring, with a specific concern that mentors fail, or may be reticent, to judge student performance as unsatisfactory. However to date few empirical studies have examined how mentors reach an assessment decision. Thus this study set out to examine the concerns expressed using judgement and decision making theoretical frameworks, and investigate how mentors form judgements and reach a decision regarding an assessment of student competence in practice. An embedded mixed methods design was employed for the study. In the first phase student practice assessment documents (PADs) relating to a whole cohort of students (n =41) completing a three year undergraduate pre-registration nursing programme were collected following the final exam board. Documentary analysis of the mentor decisions (n =330) was undertaken to examine mentors’ use and conduct of assessment interview processes, with data contributing to a sampling frame used to identify final placement mentors (sign-off mentors) to invite for interview. In phase two, mentor comments in student PADs were thematically analysed using Braun & Clarke’s (2006) six phase process. Stimulated recall interviews were conducted with the selected sign-off mentors (n = 17) and data analysed thematically. Assessment strategies and documentation were shown to have limited effect on mentor judgements and decisions. Instead mentors formed impressions regarding a student and their practice, which led the management of the assessment process, and formed the basis of formative judgements and the summative decision. Key to any judgement was an evaluation of the student’s ability to function as a reliable member of the team. Mentor judgements were informed by mentor expectations of a student appropriate to the practice area and stage of the student’s programme. Judgements were accumulated over the placement and combined to inform the final decision taken, in a manner that can best be understood and conceptualised with reference to Brunswik’s lens model of social judgement (1952). Recommendations are made for supporting and developing mentor decision making within current assessment systems, and for further work on assessment tools and strategies. Finally recommendations are proposed for research to test the criteria and decision making model developed as well as further understand mentor decision making in the difficult areas identified.

Aim: To investigate the determinants of physical activity participation among primary schoolchildren in the Portsmouth area. Introduction: There is a strong body of empirical evidence to suggest a causal relationship between physical activity and health. Although many of the health-related diseases manifest themselves in adulthood, precursors or risk factors for many of these healthrelated diseases appear to be established in early childhood. Studies among children and adolescents suggest that they do not engage in physical activity of the type, duration, intensity and frequency to gain health benefits. Therefore, an understanding of the factors that influence children's physical activity would help us to comprehend how children might be encouraged to increase their participation. Very few studies have described the factors that influence physical activity participation among British primary schoolchildren; this provided the avenue of investigation for the present study. Subjects, Materials & Methods: Participants were 10-11 year-old primary schoolchildren (n=270) and their parents from three schools in the Portsmouth area. A multi-method approach was taken, combining subjective and objective methodologies, to meet the aims and objectives of the study. Three questionnaires, a self-administered report form and heart rate (HR) monitoring were chosen to obtain data about the dependent variable, physical activity participation, and twenty-five independent variables, including home media usage, school environment, socio-economic class and other parental factors. Prior to the main study a pilot study was conducted to evaluate and amend the three questionnaires. Data collection took place during one academic year. Stepwise multiple regression analysis was used to develop a 'best-fit' model identifying potential determinants of physical activity partlclpatlon among British primary schoolchildren. Results: In total 92.1% of children completed the questionnaires and self-administered report, 72.2% of children taking part in the HR monitoring provided usable data, and 54.1% of children's parents completed the parental questionnaire. The children's physical activity checklist revealed that, on average, children participated in 5.2 hours of physical activity per week (encompassing light, moderate and vigorous physical activities), or 44 minutes per day during the study period, significantly less than the stated physical activity recommendations (Health Education Authority, 1998). HR monitoring of children's physical activity participation during school break-times showed that, on average, children accumulated 15 minutes of moderate-ta-vigorous physical activity (MVPA) per day, during their school break-times. Multiple stepwise regression models were able to account for 45.3-50.0% of variance in children's physical activity behaviour. 'Community sports partiCipation', 'extracurricular sports participation' and 'having a favourite sports personality' were consistent positive correlates of physical activity among all children. Multiple regression analysis also demonstrated that the determinants of phyalcal activity participation were gender-specific. Conclusion & Recommendations: The present study provides important guidance for physical activity interventions and suggests that efforts should be concentrated on working with schools and local communities to develop opportunities for children to engage in a wide range of sport and physical activities with particular emphasis on those which are likely to encourage lifelong physical activity habits. Future studies, should build on the knowledge presented here by expanding the number and type of physical activity correlates investigated.

No description available.

This qualitative study explores the two year journey from healthcare assistant to assistant practitioner within an acute health care setting. With a paradigm shift in the NHS to organisational and workplace learning and the local introduction of the Assistant Practitioner role to support the nursing workforce there was a broad need to understand the context of the lived experiences of those who work and learn. Hermeneutic phenomenology was chosen as the most appropriate methodology for exploring the lived experience. A purposive sample of eight trainee assistant practitioners, four matrons, seven mentors and the practice development nurse participated in conversational interviews at intermittent points in the journey. A stepped process of analysis of interview text produced three over-arching super-ordinate themes which indicated that the transition to assistant practitioner is non-linear and complex necessitating a change in knowledge and behaviour and the workplace culture must enable learning and role development. These themes are illustrated with excerpts from the participants experience to collectively produce a description intended to facilitate understanding of my interpretation of data. Findings were illuminated by drawing on existing theoretical knowledge and concepts and imbued by reflections from the researcher's diary to elucidate the research process. This study has determined many different aspects of the experience of learning in the workplace. This experience has informed an emerging framework of the attributes, enabling factors and expected consequences for describing an effective journey. It identifies the common characteristics through which an effective journey is evident - the learner engages in mindful transformative learning experiences and manages the transition process through adjusting, adapting and accommodating to the new role, the learner and their mentor use the workplace as the main resource for learning and the workplace culture accommodates and learns from the development and implementation of new roles.

Little has been written about nursing in the period 1870-1960 within the geographical boundaries and surrounding areas of Halifax and Huddersfield. This thesis aims to explore the development of nursing within these towns. The focus is on general nurses in hospital and community roles. Rosenberg’s eight areas of importance were used allowing the construction of an historical analysis of both nursing and nurses locally. Archival sources were found in twenty-five main archives and twelve of these were investigated further. Primary documents belonging to local retired nurses such as personal documents, photographs and memorabilia were included. In total 1493 individual items were subjected to documentary analysis. The second stage of data collection involved conducting oral history interviews to capture memories and experiences of local retired nurses. A total of 373 named nurses were identified, sixty-eight contacted, forty-four agreed to participate and twenty-one were interviewed. A life story approach recorded their personal lives and nursing careers. This approach required the ethical issues of biographical research methods and interviewing to be addressed. Interviews were recorded on audio tape and transcribed ready to be deposited in the University of Huddersfield archives. Data was subjected to analysis using NVivo computer software and Rosenberg’s eight areas of importance used as a priori themes. Nursing in these two provincial towns changed during the ninety years under study often in response to local or national issues such as professional registration. Nurse education occurred in all but the early years and developed alongside the increasing specialization of nurses and as each nursing branch emerged. Nurses in West Yorkshire were subject to particular local issues such as its geography, environment and industrial heritage. The merits of this research are it provides a unique account of the local development of nursing adding to the professions history and presenting implications for present day practice.