The aim of this study was to examine patients’ experiences of day surgery from a sociological perspective. Although there has been massive expansion in day surgery provision, both internationally and in the United Kingdom, there has been surprisingly little sociological research concerning this development. Within the space of three hours a patient is admitted to hospital, undergoes a general anaesthetic, followed by a significant surgical intervention and is then discharged home where responsibility for their care, which was previously performed by health service professionals, is now undertaken by the patient and their families. A study was devised to gain an understanding of the patients’ experiences within a sociological framework of analysis. One-hundred and forty-five patients and their relatives, from two different day surgery units within the United Kingdom, were recruited to the study. A qualitative framework, utilizing the grounded theory approach, enabled the researcher to gain deep insights into the patient experience. Fieldwork comprised semi-structured interviews and observation, as well as extensive use of field notes and memos. During a two-year span in the field, patients were interviewed on three occasions. The first interview took place in the pre-operative assessment clinic, where fitness for day surgery was assessed. The second and third interviews were carried out by telephone, at forty-eight hours and four weeks post-operatively. Data was simultaneously analyzed alongside data collection. Line by line analysis of the transcribed interview was undertaken whereby keywords and phrases were identified. Codes were then clustered into groups from which emerged core concepts. The core concepts which emerged from this study were: Time, the ambiguities of the Sick Role, Control, the importance of therapeutic relationships and formal communication. Recommendations include improved educational preparation for day surgery patients and their families as well as for the day surgery and community staff who are called upon to support the patient following discharge.

Objective: Physical activity has been shown to improve sleep, fatigue and mood among breast cancer patients during treatment. However, few studies have focused on assessing the effect of activity on these symptoms after treatment is complete. Using a correlational design, this study aimed to explore associations between physical activity, sleep, fatigue and mood in women who had completed treatment for breast cancer and to evaluate the reliability and validity of the short-version International Physical Activity Questionnaire. Methods: Twenty-eight women (aged 43 to 75 years) with stage I and II breast cancer were recruited at 6-months post-diagnosis and after completion of active treatment. Respondents completed measures of activity, sleep, fatigue, depression and anxiety. Six participants also undertook actigraphic monitoring to obtain objective activity levels. Results: Descriptive analyses suggest the sample was relatively active with 50% of participants engaging in moderate-intensity activities. Despite this, however, only 18% were sufficiently active to meet national guidelines. No significant relationships were found between total physical activity, sleep, fatigue or depression, whereas, anxiety and activity were significantly correlated. Reliability of the IPAQ was low, however, comparison with objective actigraphy data suggests high criterion validity. Conclusion: These findings have implications for designing interventions to reduce anxiety among breast cancer patients returning to physical activity after treatment. However, the choice of assessment instrument may have a significant impact on research results.

The specific objectives of the study were to: 1. Investigate women's perceptions and experiences of postnatal care; 2. Examine the current pattern of postnatal care provision in terms of clinical outcomes (maternal and neonatal) and maternal satisfaction; 3. Evaluate the new model in terms of clinical outcomes (maternal and neonatal) and maternal satisfaction; 4. Compare the outcomes of both models; and 5. Evaluate midwives' perceptions of both models of care. There were no difference between the two Phases in terms of clinical outcomes (maternal and neonatal) midwifery and maternal satisfaction. In both stages of the study, the average day of postnatal discharge was day three, the mean number of postnatal visits was 4.2, and the average number of midwives to visit a woman was two. Women were very satisfied with the community postnatal care provided by midwives, although concerns were expressed about hospital postnatal care. All women agreed that community postnatal care was an important service and would choose to have the midwife visit her in their own home rather than attend health or drop in centres. Midwives applied aspects of the new template of postnatal visiting and were more likely to visit low risk women three times following introduction of the ne template. There was not change in community of carer. Findings of focus group discussions highlighted that women were not prepared for motherhood and the postnatal period. Women stated that the educational support antenatally and in the postnatal ward did not meet their expectations and needs.

This research seeks to explore the nature and value of peer learning for a group of pre-registration nursing students and specifically aims to examine a group of student nurses in order to inquire whether they learn from each other and if so, how, when and where this takes place. Secondly, the work aims to discover more about the process used by those nurses while engaging in peer learning and to unearth their perceptions of and value systems ascribed to this type of learning. In this context the students engage in peer learning as they learn from and through each others’ experience. This research is set against the backdrop of recent changes within nurse education in the United Kingdom. In 1999, the Peach report made several main recommendations regarding the future of pre-registration nurse education, including the integration of knowledge and skills through balanced time in theory and practice together with the fostering of interpersonal and practice skills through experiential and problem-based learning (UKCC 1999). In this case the fellow learners are a group of pre registration student nurses enrolled on a programme leading to registration as Adult Branch nurses with a Diploma level academic qualification. The curriculum (based on the Fitness for Practice recommendations within the Peach report) convenes the group (known as a base group) together throughout the course at regular intervals, and utilizes a strategy of problem based learning as part of a range of teaching and learning strategies in order to help the students to acquire the knowledge required by a qualified nurse. It is important to differentiate peer learning from other mechanisms which involve students in learning from each other. For example, peer teaching or peer tutoring is a far more formal and instrumental strategy whereby advanced students or those further on in progression, take on a limited instructional role (Boud, Cohen and Sampson 2001). In other words, the more senior students are used to formally teach various aspects of the curriculum to more junior students.

Written by a full-time clinician, this thesis explores an example of ‘Big IT’ in healthcare, the National Programme for IT in the United Kingdom National Health Service. It is unique in exploring the interaction between people and information technology in the healthcare workplace, from an engaged standpoint within one of the National Programme’s implementation sites, in order to provide a critical and a socio-technical appreciation.

This thesis is about nursing work and the ways in which nurses in a general hospital accomplished occupational jurisdiction. It is based on ethnographic data generated on a surgical ward and a medical ward in a single NHS trust hospital. The study is set in the context of recent developments in nursing and medical education (DHSS, 1987; GMC, 1993; UKCC, 1987) and health policy (DH, 1989) which have created the impetus for shifts in the division of labour in health care, reviving deep-rooted historical tensions between professional and service versions of nursing. Drawing on the work of Hughes (1984), Abbott (1988) and Strauss and colleagues (Strauss et al, 1963; Strauss et al, 1964; Strauss, 1978) the aim of this project was to move on from the policy debates and develop a less essentialist account of the nursing role through an exploration of the ways in which nurses managed the parameters of their work in the course of their everyday activities. Hughes concept of 'dirty work' is employed as a sensitising device. The work of hospital-based general nurses is explored through the analysis of five key nursing boundaries: nurse-doctor, nurse-support worker, nurse-patient/relative, nurse-nurse, and nurse-management. The professional and sociological literature suggested that as a result of recent policy developments, there would be an increased need for negotiation of nurses' inter-occupational boundaries with medicine and support workers and that this was likely to be subject to some tension. But field observations revealed that nurses accomplished these inter-occupational boundaries with minimal negotiation and little explicit conflict. Conversely, there were policy-related tensions at the three other key nursing boundaries - at nurses' infra-occupational boundary, at the boundary between nurses and patients and their relatives, and at the boundary between ward-based nurses and nursing and general management - which were largely unanticipated.

Control strategies against the parasitic nematode Teladorsagia circumcincta are problematic under current sheep management systems. Infection with the parasite, particularly in young lambs, results in significant production losses therefore sustainable worm control is being sought. It has been established that variation in resistance to T. circumcincta is under genetic control and the development of resistance is an acquired characteristic and has an immunological basis. This project investigated the immunological response to infection, of lambs with predicted resistance or susceptibility to T. circumcincta. Specifically, the study aimed to identify immune response-associated genes that were differentially-expressed in resistant and susceptible lambs and attempted to identify mutations in these genes. This study was part of a long term project that aims to identify genetic marker/s to aid in marker-assisted selection (MAS) for resistance to T. circumcincta. Real time reverse transcription-quantitative polymerase chain reaction (real time RTqPCR) was performed on abomasal mucosa and lymph nodes from 55 lambs used in a previous experiment. The lambs had been either trickle-infected with 2,300 infective larvae every two days over three months (infected resistant/susceptible, n=45) or sham-dosed (non-infected control, n=10). Lambs were ranked in relation to faecal egg count (FEC) and adult worm count (AWC) at post mortem; zero or low FEC (resistant) to high FEC (susceptible). Histopathology showed only mild pathological changes in the abomasal mucosa of resistant lambs but heavy lymphocytic inflammatory infiltration in the mucosa and submucosa of infected susceptible animals. Measurements of a range of cytokine transcripts and cell markers associated with the four major CD4+ T cell subsets identified IL6, IL21, and IL23A as significantly increased by at least two-fold in abomasal lymph nodes and abomasal mucosa of susceptible lambs in comparison to resistant animals. Highly significant (P<0.02) positive correlations were found between IL6 (ρ=0.35), IL21 (ρ=0.54) and IL23A (ρ=0.38) transcript levels and AWC. Similarly, there were highly significant (P<0.01) positive correlations between FEC and IL6 (ρ=0.41), IL21 (ρ=0.65) and IL23A (ρ=0.31). In contrast, significant negative correlation (P<0.04) between IL23A with IgA antibody levels (ρ=-0.31) was found. There was also a significant positive correlation (P<0.03) of TGFB1 levels with AWC (ρ=0.42) and FEC (ρ=0.32) in the abomasal mucosa. These data suggests that susceptibility to T. circumcincta is linked to the activation of the inflammatory TH17 T cell subset and that this chronic inflammatory response was inappropriate to clear worm infection. High resolution melt analysis failed to identify single nucleotide polymorphisms in the coding regions of IL21 and IL21R. This is the first report of the involvement of TH17 response in GI worm infection in sheep. Similar gene expression studies involving the known upstream and downstream players of the TH17 response could be done.

I september 2015 anslöt sig Ryssland som en militär part till kriget i Syrien genom att börja bomba oppositionella styrkor. I samband med detta hamnade Ryssland och USA ännu en gång på motsatta sidor av en militär konflikt, Ryssland stödjer den syriska regimen, samtidigt som USA tillsammans med flera andra länder, däribland Qatar, stödjer oppositionen. Vi har valt att avgränsa oss till fem specifika händelser under den pågående Syrienkonflikten och tre mediers rapportering av dessa. Medierna som kommer att undersökas är USA- baserade CNN, Ryssland-baserade RT (f.d. Russia Today) och Qatar-baserade Al-Jazeera. Att undersöka dessa tre konkurrenter är intressant då dessa är bland de största medierna i världen och når därmed miljontals människor med sin information. Dessutom står länderna där medierna är baserade i på olika sidor av den väpnade konflikten. Syftet är att undersöka om rapporteringen har varit allsidig eller tendentiös. Dessutom ska uppsatsen undersöka om rapporteringen är opartisk eller propagandistisk. Artiklarna analyseras med hjälp av en av oss konstruerad undersökningsmodell, som tar avstamp i Lundgren, Ney &amp; Thuréns massmedieretoriska analysmodell, och som kompletterats med kritiska frågor hämtade från Hermans och Chomskys teorier om kritik av internationell krigsrapportering samt kriterier hämtade från den svenske statsvetaren Jörgen Westerståhls forskning om objektivitet och opartiskhet i medierapporteringen. Resultatet av undersökningen visar att RTs och CNNs rapportering till stor del var tendentiös, och innehöll det som Herman &amp; Chomsky kallar för propaganda på nästan alla punkter, samtidigt som de uppfyllde väldigt få av Westerståhls punkter för opartiskhet. Vanligast var att båda medierna hade en stor obalans i användningen av vilken part som får komma till tals. Den tendentiösa rapporteringen kan förklaras genom bristen på förstahandskällor, en stor mängd tendentiösa källor - men även hur CNN och RT finansieras. CNNs kommersiella syften, samt det faktum att RT finansieras av den ryska staten, kan vara faktorer som påverkar rapporteringen. Men Al-Jazeeras rapportering såg dock annorlunda ut. I undersökningen hittades inte en enda artikel där någon propagandapunkt uppnåddes, samtidigt som punkterna för opartisk rapportering till största del uppfylldes. Dessutom visades en helt annan allsidighet i rapporteringen från kanalen.

The Mental Capacity Act (2005) (MCA) is part of the legislative framework of the NHS. Small scale studies in a range of health settings have shown that the understanding and use of the MCA (2005) varies considerably in different services and across staff of differing occupations and grades. The experiences of individual staff in using the MCA has received little attention. This grounded theory study aimed to explain how staff working with people with a learning disability (PWLD) make sense of and use the MCA, whilst also exploring the factors that influence applying the MCA in clinical practice. This study involved 11 healthcare staff from a specialist learning disability service that had used the MCA in the six months prior to their participation in the research. Staff interviews provided narratives about how they had used the MCA. A theoretical framework was developed from the analysis which underpinned three core conceptual categories. The first core category was that of ‘professional risk’ in which staff have awareness of a series of risks that pertain to themselves or the service user that could have negative professional or legal consequences. The second core category described ‘emotional risk’, which affected both the staff and service user. Staff appeared to experience those risks as feelings in the form of anxiety or concern. Both ‘professional risk’ and ‘emotional risk’ bring about ‘strategies’ which mediate the risk; allowing staff to justify and document their position, creating what feels like safe practice for both the staff and service user. Factors which facilitate the use of the Act are concerned not only with these risks but the significance of the decision that the service user has to make. The findings suggest that there is much uncertainty in the process of using the Act, some of which is due to the subjective nature of evidence gathering. The study suggests that peer support offers a range of factors important to education and development of experience in using the Act, along with helping staff cope with the outcome of decision making. The findings have clinical implications for those involved in managing difficult assessments and decision making, including how to gain an appropriate balance between risk and human rights against a backdrop of adversity that can be present for people with a learning disability. Further implications clinically and for future research, along with limitations of the study are also discussed.

The postnatal period is an important and extremely vulnerable time for new mothers and their infants. Research has outlined the considerable extent of maternal physiological and psychological morbidity following childbirth. The underreporting and undiagnosed aspect of this morbidity has also been highlighted. Newborn infants are totally dependent on their needs being met and are also at risk of newborn conditions particularly if they are undiagnosed, for example neonatal jaundice. There is however, mounting evidence regarding the lack of postnatal support from health professionals, with women continuing to report their dissatisfaction with postnatal care. Research into postnatal care is pre-dominantly quantitative and clinically focused. Few empirical studies have examined the meaning women give to their postnatal care experiences. This research aims to generate a deeper understanding of the meanings, and lived experiences of postnatal care. In addition, it aims to reveal future possibilities to enhance women’s postnatal care experiences. Initially, an in-depth examination of relevant literature is undertaken followed by a presentation of the process and findings from a qualitative meta-synthesis. An in-depth exploration of Martin Heidegger’s biography and explication of his philosophy is then outlined. This research is a Heideggerian hermeneutical phenomenological study of Irish women’s aspirations for, and experiences of, postnatal care. Purposive sampling is utilised in this research, which was undertaken in two phases. Phase one involved group interviews over three different time periods (between 28-38 weeks gestation, 2-8 weeks and 3-4 months postnatally), with a cohort of primigravid women and a cohort of multigravid women. The second phase involved recruiting two further cohorts of primigravid and multigravid women who participated in individual in-depth interviews over the same longitudinal period. In total nineteen women completed the study. Thirty-three interviews were held in total. The data analysis is guided by Crist and Tanner’s (2003) interpretative hermeneutic framework. The women’s aspirations/expectations for their postnatal care are represented through three interpretive themes: ‘Presencing’, ‘Breastfeeding help and support’ and ‘Dispirited perception of postnatal care’. In addition, five main themes emerged from the data and capture the meanings the women gave to their lived experiences of postnatal care: ‘Becoming Family’, ‘Seen or not seen’, ‘Saying what matters’, ‘Checked in but not always checked out’ and ‘The struggle of postnatal fatigue’. The original insights from this research clearly illuminate the vulnerability women face in the days following birth. A further in-depth interpretation and synthesis of the findings was undertaken. This philosophical-based discussion drew from the work of Heidegger (1962) and Arendt (1998). Engaging with these theoretical perspectives contributed to a new understanding about why some women within a similar context, have positive experiences of postnatal care while others do not. As such, the very nature that midwives and other postnatal carers are human beings has an influence on a woman’s experience of her care. These carers, in their exposition of ‘being’ have the ability to demonstrate ‘inauthentic’ or ‘authentic’ caring practices. It is those who choose to be ‘the sparkling gems’ that are the postnatal carers who make a difference and stand out from the others. For the women in this study, their postnatal care experiences mattered. While some new mothers reported positive and meaningful experiences others revealed experiences which impacted unnecessarily. The relevance of these findings, recommendations and suggestions for future research are offered.