The aim of this research was to examine nurses' and health care assistants' perspectives of infection control practice on one hospital ward and use this as the basis for the development, implementation and evaluation of an education and support programme for improving practice on the ward. In Phase I of the study, nurses and health care assistants were interviewed using a semistructured interview schedule to explore their views and anxieties about infection control practice and identify their priorities for practice development. Qualitative and quantitative analysis of these data revealed that respondents' concerns related primarily to the use of Contact Precautions for patients with Clostridium difficile associated diarrhoea (CDAD) and Methicillin resistant Staphylococcus aureus (MRS A). Structured observations of practice were employed to confirm the prevalence of the issues raised in relation to this and provide an understanding of their context. The findings of Phase I informed the design of an intervention to improve practice. This involved the development of a practice guideline on Contact Precautions and the availability of practical instruction and support during its implementation. In Phase II of the study, participant observations of practice were conducted to gain an understanding of nurses' and health care assistants' behaviour and in particular, their responses to the supportive intervention. Their perceptions of its impact on their practice were ascertained in Phase III using semi-structured interviews. Qualitative analysis of these data revealed that participants experienced great difficulty understanding and implementing infection control recommendations. Factors that may help explain this include nurses' and health care assistants' knowledge and skills in infection control, their personal belief systems and self-preservation instincts. In addition, the recommendation to use Contact Precautions for patients with infectious conditions such as CDAD and MRS A may itself counteract attempts to promote the routine use of infection control precautions in clinical practice. It is suggested that in relation to infection control, there may be a need to radically re-think the ways in which health care workers are educated and supported in practice. Moreover, it is argued that until the ambivalent evidence base relating to the use of Contact Precautions is resolved, messages about infection control are likely to generate confusion amongst health care workers.

No description available.

Patients with rheumatoid arthritis (RA) frequently present with pain under their feet. Forefoot bursae can give rise to such symptoms, but are rarely investigated. The aim of this thesis was to use musculoskeletal ultrasound (MSUS) performed by a podiatrist to evaluate the prevalence and natural history of bursae in the forefoot in RA patients. Once reliability of technique was established, a longitudinal study design was used in which a sample of RA patients (N=149) and a comparator group (N=50) of healthy individuals were assessed at baseline. A Diasus MSUS system was used to image the forefeet of all participants to determine prevalence of bursae. 120 patients (98 female, 22 male) with RA (24 seronegative, 93 seropositive, 3 unknown) completed the study at twelve months: mean age 60.7 (SD 12.1) years and disease duration 12.99 (10.4) years. Results confirmed a high prevalence of forefoot bursae (92.6% of patients; mean per individual =3.54, range 0-9) and that these were often missed by clinical examination. Findings that there could be an association between patient reported foot impact scales of impairment/footwear (LFISIF) and activity participation restriction/limitation (LFISAP) and presence of bursae (LFISIF β=0.377, p=0.033; LFISAP β=0.762, p=0.013) independent of disease activity were unique. On examination of prospective data after one year, 25.8% of participants had increases in bursae and 23.3% decreases. There was a significant correlation between changes in bursae with changes in LFISIF (PCC=0.216, p=0.018) and LFISAP (PCC=0.193, p=0.036) and a significant negative correlation with changes in duration of RA (PCC=-0.269, p=0.003). The findings imply that MSUS detectable bursae in the forefeet are highly prevalent, clinically under-reported and change over time. The findings suggest that bursae within the foot in RA deserve increased clinical attention and that further work is required to confirm associations with patient reported foot impact outcome measures.

A major challenge of the 21st century for the health-care professionals is to provide care for the ever-expanding population of people with renal-failure. Patient numbers are rising and specialist nurses, who are the pivotal factor in haemodialysis units, are becoming increasingly scarce. In this context it has become essential to understand the dynamics and functioning of haemodialysis units. The aim of this research project is to increase understanding of the lives of patients and carers by uncovering the culture of haemodialysis units. Ethnography, from the naturalistic paradigm, is a holistic study of culture, developed out of classical philosophy. This study examines the entire social world of the dialysis unit. It describes the ethnographic journey made over twenty-four months' research in two different dialysis units. The participants were amongst patients and carers from these two units. The fieldwork, which facilitated data collection, was based on a participatory process of observation, interviews and participant feedback. These data were analysed into domains and themes using Spradley's Research development sequence (1980) and the reflexive process. Through the theme-based analysis used during the research and writing of this ethnographic study an emergent theory of partnership in care became apparent. Such a theory contributes to our understanding of the culture of the dialysis unit. Uncovering the culture of dialysis units will not prevent the increase in numbers of people needing Renal Replacement Therapy. It does, however, shed light on the condition of living with renal failure and the nature of partnerships developed in the haemodialysis unit. It is these partnerships between people, machines and the environment that sets the dialysis unit apart in the hospital, giving it its own particular culture. Partnership means shared care where patients and carers work towards mutual goals. The realisation of these common goals leads towards the overall objective of better treatment outcomes.

Occupational therapy (OT) pre-registration education in the United Kingdom (UK) stands at the intersection of the fields of higher education (HE) and professional practice. It is subject to various government agendas including an ongoing commitment to widening participation in HE and to diversifying the health and social care workforce to reflect modern cultural diversity. Both have contributed to a changing profile in the OT student population and in 2005, 67 percent of the intake was mature (College of Occupational Therapists, 2007b), and increasing numbers are entering with ‘non-traditional’ academic backgrounds, an umbrella term which subsumes a variety of entry qualifications. The early weeks of study in HE can prove challenging to students as they settle into the new learning environment and begin to comprehend the expectations held of them (Yorke, 2005). It has been suggested that those from non-traditional academic backgrounds may find this transition, particularly the need to take a high level of responsibility for their own learning, difficult as a result of the skills, experiences and expectations accumulated throughout their pre-entry education (Sambell and Hubbard, 2004). While small-scale studies suggest that OT students from such backgrounds are as academically successful as traditional school-leavers at graduation (Howard and Jerosch-Herold, 2000), there is little evidence offering insight into how they actually experience and negotiate the demands of their programme. Recognising that learning and teaching are embedded within the milieu in which they occur, this longitudinal research adopted a case study methodology to capture complexity and understand the issue within its natural context (Yin, 2003). In an instrumental single-case design (Stake, 1995), a neither unique nor extreme undergraduate OT programme became a vehicle for exploring the educational experiences of students with non-traditional academic backgrounds. Thirteen volunteer participants were drawn from a single cohort in one of the UK’s research intensive universities. Data were collected via initial focus groups exploring pre-entry educational experiences and expectations of studying in HE, reflective diaries recording educational experiences that participants considered significant or meaningful, and one-to-one semi-structured interviews conducted towards the end of participants’ first and third years of study which focused on exploring their learning experiences. Supplementary and contextual data were provided by analysis of institutional, school and departmental documents to provide insight into the culture and practices of the learning context and a progression routes study which considered the entry qualifications, progression and exit awards of four cohorts of OT students from a range of educational backgrounds. The nature of students’ entry qualifications or academic background were found to have no statistically significant impact on whether they passed at Level 4, 5 or 6, or achieved a ‘good’ (upper second or first class) honours degree, although male students and those from amongst the lower socio-economic groups had significantly poorer academic outcomes at all levels of analysis. Theoretical thematic analysis (Braun and Clarke, 2006) of qualitative data underpinned by Bourdieu’s (1990b) theory of practice highlighted that students’ educational experiences were much less influenced by the nature of their academic backgrounds than by the congruence of individual dispositions or habitus, born out of social provenance, with the dominant culture of the particular field of HE they had entered. Emerging codes converged to represent themes suggesting clusters of shared experience amongst some participants, while examination of each individual dataset revealed varying positional tendencies and trajectories within the field. This research highlights the important roles played by academic, linguistic, social and practice-oriented capital in the way that students developed a feel for and learned to play ‘the game’ and present knowledge and understanding in the form ‘legitimated’ by the field. Juxtaposing the nature and expectations of the new field in relation to those previously occupied by individual participants and the established habitus each brought with them helped to illuminate the situation and adds a new dimension to understanding individual experiences of learning in HE.

Access to clinical supervision is an enduring enigma to many nurses and other healthcare professionals. The aim of this action research study was to bring about the potential for a change in the practice of clinical supervision (CS) by developing a solution to the problem of access. This was achieved in collaboration with community nurses and a range of other staff from one NHS Primary Care Trust. The solution proposed was the development of a new mode of delivery: online clinical supervision. Holter and Schwartz-Barcott’s (1993) Technical Collaborative Approach was used to identify potential user (Supervisee, Supervisors and Management) requirements for an online environment for CS. The research was conducted in three stages. The first stage ‘Conceptualisation’ involved the identification and exploration of the problem as well as the initial steps in discovering how the problem could be addressed. Central to this was the engagement with the stakeholders. The second stage ‘Designing the Solution’ was a synthesis of activities undertaken by focus groups in order to determine what a potential online environment might look and feel like, as well as how it might function. Analysis was through a continuous, iterative, cyclical process of member checking. Schach’s (1999) Life Cycle Model (adapted) and Lengel’s (2001) Website Design Principles were used as a theoretical frame to guide the solicitation of the required design and build criteria. The final stage was ‘Evaluation’, participants evaluated the design and build criteria they had developed using a SWOT analysis, and finally the experience of undertaking action research was captured through a self completion questionnaire. In conclusion, this research has identified what an online environment for CS could look like, as well as how it might function, thus opening up the possibility of improving access to CS. The research also highlighted a potential tension between the users’ desire for privacy and the employers’ desire for access to information. Future negotiations are required to determine how this tension could be managed. The likely impact of this development, if implemented, will be more community nurses and others undertaking CS at a time and place that is convenient to them, potentially making CS available (via a user-centred design) 24 hours-a-day, seven days-a-week a reality.

Over the past few decades, Task-Based Language Teaching (TBLT) has come into existence as a further development of the communicative approach. There have been some theoretical arguments over the merits of TBLT, and TBLT has taken a variety of different forms. However, a number of empirical studies confirm the feasibility of TBLT under appropriate conditions, and demonstrate its pedagogic effectiveness in ESP settings. To date, there has been no application of TBLT in professional communication courses in English for health science students in Thailand. This thesis investigated the potential of TBLT in this setting, to address a number of known problems with the development of spoken English within ESP in Thai higher education. This study was designed as a teaching intervention, conducted with a group of health science students. An action research design was followed, and both qualitative and quantitative data were obtained in the current study concerning the instructional process, ongoing student learning, and final learning outcomes. Thirty-one second year nursing students from School of Nursing, University of Northern Thailand (a pseudonym), participated in this study. All students attended a 12-week TBLT in Professional English course designed and taught by the researcher, and the central feature of the course was the requirement for students to perform oral role-play tasks over twelve weeks. Data were collected via (1) pre-and post-listening comprehension tests, (2) pre-and post-role play tasks, (3) longitudinal student case studies (4) repeated in-sessional questionnaires, (5) a post-sessional questionnaire, (6) an in-sessional group interview, and (7) teacher journal. The results from the pre- and post-listening comprehension tests and pre-and post-role play tasks showed that the students significantly increased their listening comprehension scores and used more communication skills in the interaction between nurses and patient in the post-role play. The case study results also indicate that individual students increased their use of communication skills, grammatical structures and lexical variety over time, as well as being more confident and adventurous with spoken language use. The positive outcomes of professional TBLT were supported by the findings of the in-sessional questionnaire, post-sessional questionnaire, in-sessional group interviews and teacher journal, which demonstrated very positive opinions towards the implementation of professional TBLT. Implications are drawn and recommendations made for further research and development to promote the fuller application of TBLT in ESP settings.

No description available.

No description available.

Dementia affects over 750,000 people in the UK (Alzheimer’s society, 2003). Clinicians and healthcare managers report dissatisfaction with current healthcare options available for people with dementia (Stubbings & Sharp, 1999). Multisensory Environments (MSEs) utilising advanced sensory stimulating equipment targeting the senses, have been successfully used in dementia care, severe learning disabilities and palliative care (Baker et al, 1997). Despite this, no controlled studies have been conducted to explore the efficacy of this intervention on functional performance. This study explores to what extent, if any, MSEs influence function, mood and behaviour of people with moderate / severe dementia compared with a control activity (gardening). In addition, sensory needs were identified using the Adult Sensory Profile to explore whether sensory preferences are associated with improved performance. Participants were selected from people with a diagnosis of moderate / severe dementia. They were randomly allocated to one of two groups (MSE or gardening). Following baseline assessment, each participant attended their allocated intervention 3 times a week for 4 weeks. Assessment was carried out before and after each session using the Assessment of Motor and Process Skills (function) and the Neurobehavioural Rating Scale (mood and behaviour). Results revealed a significant main effect of intervention in both function and mood and behaviour. Sessional analysis revealed significant improvement in motor performance for the MSE group. Overall, both activities were found to improve function and mood and behaviour. Participants who attended the MSE group and improved significantly in function fell within the low registration quadrant of the sensory profile. This suggests that the MSE is more suitable for those who require increased sensory stimulation. This study supports the use of sensory activity for people with moderate / severe dementia and recommends the use of the PAL and Adult Sensory Profile to plan and facilitate activity.