The aim of this study was to investigate the perceptions held by health care professionals, of multi -disciplinary education. In addition, possible areas for the development of a multi-disciplinary approach were identified. The research focused on the views of nurses, physiotherapists, radiographers, speech therapists and occupational therapists. The study adopted a case study methodology, incorporating a mixed-method approach in terms of data collection. A questionnaire was used to review the perceptions of multi-disciplinary education amongst health care professionals, and interviews were then conducted with a sample of the respondents to explore their views further. From the outset, the research process assumed a multi-disciplinary perspective. During the study it became clear that organisational and professional factors were important influences on how health care professionals perceived multidisciplinary education. The research appeared to indicate that the idea of "multidisciplinary education" is a problematic concept and that multi-disciplinary education is acceptable, where it is appropriate. Most of the professions involved recognised the benefits of the process, but were anxious to protect the integrity of each individual profession, in the long term. Moreover, they maintained that the medical profession needs to be included in the process. The organisational findings were, primarily, that multi-disciplinary education might benefit from a cross-agency approach. Perhaps significantly, it was suggested that multi-disciplinary education should be introduced at the pre-registration stage. It was apparent that teamwork does not always occur in practice and that this was an area that could be a focus for multidisciplinary education. The research concluded that there should be joint ownership of any multi-disciplinary education programme across professions and organisations.

A hypothetical journey from the moment a soldier was wounded to his discharge from the field hospital was detailed in order to provide an idea of the organisation of military health services, evacuation strategy and roles of health care personnel during the Spanish Civil War. It was observed that despite both Nationalists and Republicans formally banning female nurses as part of the military units stationed on the front lines, nurses working at the auto-chirs, advanced surgical units and some field hospitals often found themselves only metres from the firing lines. Both men and women volunteered to nurse the war casualties from the start. It was soon observed, however, that untrained nursing staff could often cause more harm than benefit to patients, hence training courses for both nurses and orderlies were organised by a variety of organisations and political groups all over Spain. Due to the circumstances of war, nursing experienced a clear practical development expanding its professional boundaries from core to complex procedures which, until the outbreak of war, had been the sole responsibility of another professional group known as practicante. Nursing's unchallenged evolutionary process during the Spanish Civil War was explained by a number of factors including not only the war situation itself but the large number of nurses available, their determination, adaptability and capacity to evolve in order to meet the new health care needs of the population. The impact of key individuals such as Mercedes Mil, Inspector General of all Female Hospital Personnel, in the Nationalist side, and the nurses of the International Brigades, in the Republican side, on Spanish nursing was also significant. The evidence confirmed the hypothesis that the Civil War exerted a positive impact on Spanish nursing.

This study was undertaken with people who have a learning disability and dementia and their carers. The overall aim of this research was to gain insight into the perspective of the person with a learning disability who had developed dementia, alongside that of their carer, with the anticipation that this would influence the development of practice and service delivery accordingly. People with a learning disability are two to three times more likely to develop dementia than the general population, but historically, dementia care policy has rarely made specific reference to this group of people. In order to ensure that the needs of people with a learning disability and dementia are met, their voices need to be heard regarding their views and perceptions on what their needs are and what health and social care support services are required in order to meet those needs. Very few studies relating to this group of people can be found, one of the main reasons appearing to be the ethical and methodological challenges involved in carrying out research with people who have a learning disability. This qualitative study involved 11 people who had a learning disability and dementia, along side a nominated carer participant for each person. Semi-structured interviews were used and the transcriptions were analysed using Interpretative Phenomenological Analysis, whereby themes were identified. The findings illustrated that services experienced difficulties in providing person centred care, particularly the poor communication between service providers working with each individual, and the general lack of person centred approaches to care. The data indicated that people with a learning disability and dementia wanted improved communication between service providers; improved understanding of dementia by those with the illness, and by family, paid and professional carers; to stay as well as possible; continue living in their home; and to have good access to a range of activities, services and support as deemed necessary. In conclusion, this research goes someway to exploring and overcoming the barriers to including people with a learning disability and dementia in research studies. It found ways of listening to and interpreting the views of people with a learning disability and dementia about their lives and circumstances and has made it possible to produce recommendations in relation to practice and policy development. These include ways of ensuring person centred approaches to care, and suggestions on the effective implementation of policy documents key to this group of people.

This thesis examines the experience of gay male student nurses during their university course, which leads to registration as a nurse with the Nursing and Midwifery Council. Using in-depth qualitative interviews I focus on the student’s choice of nursing as a career and their performance of sexuality within the differing spaces of their clinical placements and the university. This thesis explores how these gay student nurses negotiate their gender, masculinity and gay sexuality within the professional boundaries of nursing. Furthermore, it identifies how these students negotiate issues of caring and the formation of therapeutic relationships with their patients, as men and gay men. The theoretical framing of the thesis draws upon Goffman's theories of presentation and performance of the self and Rubin’s 'charmed circle'. Alongside analysis of interview material, I explore the space of the hospital from a personal perspective and interrogate its gendered and desexualized organization through the lens of human geography. Moving between these two analytical frameworks, I examine and draw together the experiences of these students and examine their negotiation of the nursing role as gay men. I argue that the experience of these students and the negotiation of their sexuality as student nurses is fraught and precarious due to the complexities and boundaries of professional nursing roles in contemporary healthcare. Within the conclusion I address the implications of my research for gay nurses, patients, educators and for those who recruit nursing students.

Injuries are among the leading causes of death and disability in the world and a major public health concern. Young persons with learning disabilities have a higher rate and different pattern of injuries when compared with young persons without learning disabilities, but little is known regarding adults. The aim of this study was to determine the incidence and types of injuries experienced by a community-based cohort of adults with learning disabilities (n = 511). Face-to-face interviews were conducted with participants and their carers two years after they had first been recruited into a longitudinal study. The measures were based on those previously used with a large population-based sample (n = 6,104) in the Scottish Health Survey (2003). Results were compared between the adults with learning disabilities and the general population. Incidence of at least one injury that required medical or nursing attention or treatment in a 12-month period was 20.5% (105), of which 12.1% (62) was due to falls. The standardised incident injury ratio for adults with learning disabilities aged 18 - 64 years, compared with the regional general population aged 18 – 64 years, is 1.63 (95% confidence interval (CI) = 1.55 – 1.71). The types and causes of injuries experienced differed from those found in the general population. Incident injury was predicted by having epilepsy (odds ratio (OR) 1.809), and not having autism (OR 0.153). Incident fall injury was predicted by urinary incontinence (OR 1.976), whilst Down syndrome reduced risk (OR 0.416). Carers of adults with learning disabilities (n = 446) were less likely to experience at least one injury in a 12-month period overall, but they were significantly more likely to experience harmful injury from another person (p = 0.048), and less likely to experience injury through the use of a tool, implement or equipment (p = 0.045), when compared with the regional general population. These findings are first steps towards understanding the considerable burden of injuries, accidents and falls in the learning disabilities population, and towards informing interventions to prevent injuries and falls in adults with learning disabilities in the future. The types and causes of injury experienced by carers of adults with learning disabilities are also reported for the first time.

Recognition and education: It is important to ensure the inclusion within palliative care of chronic, progressive incurable diseases and for this additional workload to be adequately staffed and funded. There is a need to promote a clear, simple and friendly definition of Palliative Care for health care workers, patients and their carers. Education of the service providers, patients and the public to increase awareness of the palliative care needs of patients with non-cancer diseases will promote recognition and acceptance of this concept. Patient’s choice: There is a recognition among the GPs and distinct nurses for patients to be given the choice of place of care and death, and for patients and their carers to be involved in partnership in care decisions with healthcare professionals from the initial stages. This could be increased and improved if the generalist palliative care providers listened to and understood the needs of patients and their carers and promoted patient centred planning for all future strategies in palliative care. Co-ordination and communication: There is a need for improved communication and co-ordinated working between primary healthcare, social work community care, specialist palliative care teams, the voluntary sector and the acute setting. Joint working and multi-agency working groups and managed clinical networks could contribute to this. Services: Finite resources have led to service remodelling and redesign in both voluntary and statutory sectors. There were substantial changes in service provision during the study period. Over the three-year period of the study a greater number of services for patients with non-cancer were discontinued. There is a lack of specialist palliative care services in the acute sector. There is also a need for improved services including availability of hospice beds, palliative care services in care-homes and in particular social work services appear to be under provided. Health care professionals: The percentage of GPs and district nurses who had used current specialist palliative care services for their patients with cancer was more than double that of those who had used similar services for their patients with non-cancer diseases. GPs and district nurses also placed more importance on future palliative care services for their patients with cancer in comparison to similar services for their non-cancer patients. Compared to the GPs, the nurses had more contact with patients with non-cancer diseases and perhaps because of this had a greater recognition of the need for palliative care services for non-cancer patients. Service users: Patients with neurodegenerative diseases were younger compared to those with cancer. A higher percentage of patients with neurodegenerative diseases needed help with their daily activities compared to patients with cancer. There was a longer time interval between first appearance of symptoms and confirmation of diagnosis for patients with neurodegenerative diseases compared to patients with cancer. Lack of information was an issue highlighted by both groups of patients. The health status and care of the patients with neurodegenerative diseases was found to be inferior to patients with cancer. Resources: Funding was an issue identified by all service providers. Despite the desire to help with non-cancer diseases, providers of specialist palliative care and primary healthcare have their finite resources for palliative care fully utilised with cancer patients at present. The service providers agreed that they would increase their present workload, but were restricted by lack of resources. Research: There is a lack of evidence on the needs of non-cancer patients, on the best ways of meeting these needs and on the effectiveness and acceptability of services. This is necessary to provide the evidence to justify the resources (human and financial) that need to be allocated to make palliative care services to all on the basis of need and not on diagnosis

Background: Historically, nursing has struggled to introduce researchbased interventions into routine clinical practice. Reasons for this difficulty range from poor communication between clinically and academically based nurses to limitations within organisations that obstruct the implementation of new ideas. Aims: To identify the barriers to research utilisation and the preferred methods of research dissemination amongst breast care nurses (BCNs), to develop a dissemination intervention for BCNs and to evaluate a dissemination intervention for BCNs. Method: The study was conducted in three stages. In Stage 1, a national survey was conducted using the Barriers to Research Utilisation Scale (Funk et al. 1991), questions about dissemination preferences and a demographic questionnaire. In Stage 2, the Conceptual Framework for Selecting a Targeted Experimental Dissemination Method based on social interactionalist theory was developed. In Stage 3, a pre-test/post-test randomised controlled design was used to evaluate the dissemination method developed in Stage 2; the unit of randomisation and analysis were hospital clusters of BCNs. Sample: 263 BCNs from 13 regions within the U.K. comprised the sample in Stage 1. In Stage 3, the sample consisted of 92 BCNs from 62 hospitals in the north of England. Analysis: In Stage 1 analysis was undertaken using descriptive and nonparametric statistics. In Stage 3, analysis consisted of descriptive statistics 19 and clustered regression techniques with estimation of robust standard errors: clustered logistic regression for knowledge items, clustered linear regression for knowledge scores, ologit for attitude and reported practice items and clustered multiple regression for paired and multiple variable analyses. Findings: The results from the Barriers Scale revealed ‘statistical analyses not understandable’, ‘insufficient time on the job to implement new ideas’, ‘facilities inadequate for implementation’, ‘research not reported clearly and readably’ and ‘no time to read research’ as the greatest barriers to research utilisation. Free text responses revealed additional problems with communication and conditions within provider organisations and identified facilitators for research utilisation and dissemination. These data led to the selection and production of a targeted information booklet, entitled Exercise and Breast Cancer: A Booklet for Breast Care Nurses, specifically designed to be accessible, time efficient, understandable and relevant to the target audience. In evaluation, the booklet was shown to overcome the perceived barriers of the sample associated with accessing and understanding research. A statistically significant increase in knowledge and changes of reported practice and attitudes were found. Robust variables affecting knowledge acquisition were identified as the promotion of health, promotion of exercise and understanding of how exercise can reduce cancer-related fatigue. Implications: This study has demonstrated that printed materials can be used as an effective dissemination method provided that they are developed in line with the needs, values and context of a target audience. The 20 Conceptual Framework can be followed to develop similar booklets on different topics and could provide a purposeful contribution to the promotion of evidence-based practice for all nurses.

No description available.

This is the thesis (critical appraisal) component of a PhD by Published Works. The overall submission was a portfolio of ten published papers supported by a critical appraisal focusing on two key areas: an exploration of the roles that Health Information Professionals (HIPs) can play within evidence based practice (EBP) and an exploration of the effectiveness and impact of the traditional supportive role played by HIPs within EBP. The published papers are listed and referenced within this document but not contained within it. The majority are available elsewhere within the University of Salford Institutional Repository. Drawing on a model developed from the library literature, the thesis highlights a wide range of supportive and active roles that HIPs can potentially play within EBP. This model is informed and illuminated by the studies within the portfolio that demonstrate how the author has fulfilled a wide range of these roles in practice, and identified a new role within systematic reviews in health and social care. This demonstrates that HIPs can transfer their skills outside their traditional library and information practice domain, thus extending their role and offering a range of professional opportunities. Using a varied range of research methodologies, the thesis also explores the effectiveness and impact of the contribution made by HIPs when using traditional skills to support EBP. Two models are used to illustrate the outcomes to which HIPs contribute. These include improving search skills and providing evidence which can, over the longer term, contribute to policy making and patient care. At present the weight of the evidence presented to support these links is weak. Methodological issues and future research that needs to be addressed to improve the strength of the evidence base are therefore highlighted and discussed.

This grounded theory study explored the nature of contemporary military nursing, in particular, the juxtaposition of personal, professional and organisational dogmas to identify the actual or potential affect on the operational nursing role. With increased deployment into low spectrum conflicts there is a need for a deeper understanding of this altered world to prepare military nurses, in particular, for their role. No research to date has explored this field. The sample comprised 24 military nurses drawn from the Royal Navy (RN), Army and Royal Air Force (RAF), with a counter-group of 4 military chaplains from the RN and Army. Data collection involved in-depth interviews and a focus group. Three core categories key to the central ideology 'Caring for War: Transition to Warrior' emerged from constant comparative analysis: (1) The spectrum of modem conflict (2) The profession of arms and the profession of caring (3) Caring warriors. Data analysis culminated in a substantive theory capturing the essence of the harmonious relationship of nurse and warrior. The combination of training and socialisation with the Social Defence Mechanism enacted by military nurses and to a degree, chaplains, resulted in the employment of coping strategies in response to operational challenges. Value identification was articulated as It's Who We Are, a sense of being called to serve. Further research is needed to explore the culture of contemporary military nursing, as conflict is a catalyst to social and role development.