Now treatment of paediatric malignancies is capable of extending the life of children with cancer, there is an increase move toward investigating the quality of life and needs experienced by children and young people diagnosed with cancer. Although earlier investigations examined differences in adjustment among children with cancer and their healthy counterparts, the results of these studies were inconclusive, and there is a considerable lack of studies of the psychological wellbeing of children in the Middle East. In this thesis, two central themes are examined: first, the psychological status of children and young people with cancer in Jordan as indicated by their quality of life and symptoms of anxiety and depression; second, patterns of communication of cancer diagnosis in families caring for children with cancer, to develop a better understanding of Jordanian children's experience with cancer. Fifty eight children and young people and their mothers attending the paediatric oncology services in Jordan participated in this study. In an attempt to explore their psychological wellbeing in greater detail, the study involved another group of fifty six children and young people with chronic illness and a control group of sixty four healthy peers. Three assessment tools were translated into Arabic, piloted and tested for reliability and validity at a number of schools all over Jordan. Then, the tools were administered to the three groups. Participating children and young people were asked to complete self-reported depression and anxiety scales, as well as an instrument to measure the quality of life. Thirty seven mothers of children and young people with cancer completed a self-report measure of stress, anxiety and depression. Mothers were also asked during the interview about the amount of information they shared with their children and their satisfaction with the way the cancer diagnosis was communicated to their children. The results showed that children and young people with cancer function at a very similar level to children and young people without cancer. There were no significant differences on the measure of depression, between the scores of children and young people with cancer, chronic illness and the healthy group. On the quality of life measure, the healthy group scored significantly higher than the children and young people in the other two groups. At the same time, the healthy group scored significantly higher on the anxiety measure. It is suggested that children and young people with cancer are able to cope with their illness because they utilise defensiveness as an adaptive mechanism, since higher scores for defensiveness were associated with lower scores for child-reported depression and anxiety in this group and a significant difference in the level of defensiveness exists between the three groups. This supports previous findings. In addition to these results, this thesis shows that exploring children's and young people's psychological distress in a culture where this is not recognised provides the researcher with a number of concerns. The influence of Arab culture and religion on Jordanian children and young people, the communication patterns of cancer diagnosis, the wisdom of their elders, and the importance of their family result in reluctance to show emotion or to question decisions made on their behalf. The results of quantitative findings and contextual information from the interviews in this thesis go some way to demonstrate the impact that cancer can have on both the patient and family in the Jordanian culture. The child's quality of life can be compromised by the illness. Moreover, communication of the diagnosis of illness has a detrimental effect on both child's and mother's psychological wellbeing.

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This thesis explores the level of awareness women in Sunderland have of help-seeking intervention and what is known about the agencies that respond to domestic violence, regardless of personal experiences. It examines the extent of how understandings of domestic violence impact on potential help-seeking and the barriers that contribute to the difficulty of help-seeking. Previous research has largely focussed on survivors of domestic violence who have had contact with formal agencies. Feminist theory informed this thesis and standpoint epistemology was used as a framework for the procedures that were applied in the research. A mixed method approach was utilised in the form of an on-line survey, which recruited participants, and informed the interview schedule in the qualitative phase. The qualitative phase included 20 semi-structured interviews with women of varied ages, which was analysed using thematic analysis. Through reflexive practice of the fieldwork process there emerged, as a result of consciousness raising, what I have coined, an ‘ontological transition’. Significantly, ontological transitions vary between respondent pending upon their knowledge and/or personal experiences of domestic violence. However, crucially the analysis of the respondent interviews highlights that one characteristic is the impact of shame. It was found that the experience of shame is not confined to a particular social positioning or related to faith or ethnicity. Through talking about their experiences of shame respondents were able to consider a different relationship. Some respondents were able to reject shame as they recognised that their experience is not personal but a collective of experiences in some way. This realisation and their transformation through taking part in the interview is part of the ontological transition and will be discussed further in the body of the thesis. Importantly, this thesis illustrates the significant difference in knowledge of 3 identified respondent group types, which emerged during analysis of the qualitative data. Through reflection on the written documents and thematic maps it enabled the development and management of the key themes and new ideas (appendix 18). It was through this process that a relationship between experiences of domestic violence, and knowledge emerged as the data was refined. This was the recognition of 3 identified groups of knowledge about domestic violence, which, after further analysis, were named the experiential, institutional and notional groups (see appendix 18). The groups are informed through their social, personal or professional experiences, and this shapes their potential for future help-seeking (chapters four and five). This gives the opportunity to offer an understanding of how domestic violence and help-seeking are understood by women regardless of their experience of domestic violence. Current theoretical and policy explanations of domestic violence and help-seeking are predominantly based on the collective experiences of survivors. They do not take into account the understandings and experiences of other women regardless of their experiences of domestic violence and, how this shapes their potential for help-seeking. I argue help-seeking is complex and the decision to seek help is a consequence that starts with recognising that what is being experienced is domestic violence. Additionally, I argue that the help-seeking is hampered through non-recognition of behaviour as domestic violence and ideologies of gendered roles and expectations, male entitlement, ownership, love and acts of altruism by women that normalise and minimise abusive behaviours in the heterosexual relationship.

Aim To study the conceptualization of mentors‘ behaviour and develop and validate a scale based on that to assess students‘ expectation and measure mentors‘ actual performance. Background In the field of clinical nursing education in China, mentors are struggling with student mentoring as no national guidelines exist and proper training is unavailable and nursing students are suffering from a low quality of learning and negative experiences. Design A mixed methods exploratory sequential design. Methods At the development and validation stage eleven steps were taken; mixed methodology was used, including focus group and cross-sectional survey with a large sample from China (n=669); in data analysis both classical test theory (exploratory and confirmatory factor analysis) and item response theory (Mokken scale analysis) were conducted. Results Mentorship in nursing was conceptualized as a model with three correlated factors, i.e. professional development, facilitating learning and psychosocial support, which was guided by the theoretical framework generated through 46 studies and supported by exploratory factor analysis, confirmatory factor analysis and Mokken scale analysis. Conclusion This new scale based on this conceptulization is reliable, valid and scalable, which is supported by a wide range of psychometrics. It has shown good content validity according to review by nine mentor experts from the UK, stability over time, homogeneity in content, differentiability between extreme groups and hierarchical properties of mentors‘ behaviour in importance and reliability and moderate precision of ordering students‘ expectation. Therefore the mentorship in clinical nursing education is conceptualized as a three–correlated factor model and it is hierarchical in importance. This scale could find utility in nurinsg education in China.

This thesis aims to: investigate the motivations of why many individuals with developmental dyslexia are successful despite experiencing traumatic schooling. It details seven studies that investigate the emotional coping amongst individuals with developmental dyslexia, investigating successful post-school careers as ‘post-traumatic growth’, an outcome from school-based trauma. The first two studies with school-aged dyslexics were quantitative and whilst helpful in understanding different coping strategies utilised, it was perceived to lack depth in understanding the emotional side of the dyslexia experience, and any long-term emotional ramifications from school-based trauma. A third study sought to understand the discrimination, stigma, and the dangers of self-disclosure of dyslexia, experienced by adult dyslexics. Two investigations of self-harm and possible post-traumatic stress disorder followed to better understand how adults with dyslexia emotional cope with learned helplessness experienced at school. Lastly, two studies investigating post-school workplace success, firstly to understand concepts of ‘success’ amongst adults with dyslexia, and secondly to understand how school-based trauma could be used positively. This thesis offers original contributions to literature through the use of standardised measures to measure emotional coping in school-aged dyslexic samples (especially depression); comparing the sources and manifestations of stress between school-aged dyslexics and their siblings; the types of self-harm used by dyslexic adults and where the source of their helplessness/depression begun; and how the concept of ‘post-traumatic stress disorder’ could be correlated to the reactions that many dyslexic adults experience now as parents returning to school. Original contributions were also made regarding adult dyslexics in regard to self-perceptions of success and understanding the role that school plays in motivating them to post-school success in the workplace, argued to be a form of ‘post-traumatic growth’. Lastly, the author proposes the use of ‘bi-abilities’ to better understand the experience of dyslexia, rejecting both the medical and social models of disability, as dyslexics reject a disability identity.

Alcohol use in later life has received little attention. Among older people psychosocial factors including bereavement, retirement, boredom, loneliness, and depression are associated with higher rates of alcohol use. The loss of a home has been compared to bereavement; therefore, where older people live has an impact on the quality of their lives (Tinker, 1997). This thesis focuses on alcohol use of older people who live in sheltered accommodation in Newcastle upon Tyne. No published work has been conducted on this population to date and therefore it is not known whether or why they drink at different levels to the general population of older people because of their loss of their home. The population for this research was people living in sheltered accommodation in one city in the North East of England. Sheltered accommodation is housing designed to help older people live independently, where there is support available onsite. Alcohol use in residents of sheltered accommodation was assessed in two studies. The aim of Study 1 was to investigate the levels at which the sheltered housing population are consuming alcohol. The study comprised of a postal survey using the alcohol disorders identification test survey tool (AUDIT) (Babour, Higgins-Biddle, Sanders et al, 2001). The AUDIT score is a method of measuring a person’s risk from alcohol related harm which goes beyond purely measuring consumption as it also measures the frequency of use and the effect of alcohol use. Data were analysed using SPSS. Findings showed that 3 men in the research population scored higher than the women and that the younger age group (< 70) had higher scores than the other two age groups (71-80 and >80). The aim of Study 2 was to investigate the factors determining decisions to drink in later life. Study 2 comprised 16 in-depth interviews using a life course approach. Data were analysed using a framework approach with a biographic narrative overlay. Findings showed that there were a number of factors influencing the decision to drink to harmful and or hazardous levels including mental health, domestic violence, social contact, family and work. Case studies were developed and presented based on these findings. This research found that older people’s lives do not simplify as they age and therefore the reasons for using alcohol are complicated and individualised. They are influenced by early life experiences, traumatic or life changing events as well as the strength of the person’s locus of control. Further work is needed to establish support needs for drinkers in later life, both to reduce drinking levels and to reduce harms from current levels of drinking. Older people are the group who are most likely to lack knowledge of what these units and limits are (McInnes & Powell, 1994). An older person specific unit guide should be developed and implemented. There needs to be improved multidisciplinary staff training to facilitate an increase in the identification of those older people who consume over the advised alcohol limits. Policy should consider the move away from a one size fits all model of alcohol management to a more individualised approach to support the adjustment of later life events.

Positive Behaviour Support (PBS) has evolved over the past two decades and in 2014 it received UK government endorsement as the chosen health and social care practice model Positive and Proactive Care: reducing the need for restrictive interventions coincided with this evolutionary development. In the UK, the Winterbourne View Care Home case was the main reason for improving the support of people with living with autism. From a pragmatic perspective the majority of autism practitioners undertake only what lies within their immediate scope of practice. Without established practice standards, organisational policy and practice has the potential to be misinterpreted and wrongly applied. Understanding these key pragmatic attributes of effective care for practitioners is crucial in protecting vulnerable people; this study investigates the rhetoric and reality of what has been lost in translation at organisationally macro, meso and micro levels. PBS enables the recognition that in order to ensure quality of life and restrictive practice reduction, a focus on leadership and management is critical. The ‘Holistic Positive Behaviour Support Practice Framework for Autism Practitioners’ focuses on promoting tangibly effective PBS and autism practice through leadership training. An ecological systems theory perspective is considered and synthesised within situational analysis as a methodology. A mixed methods approach is adopted in a single social care organisation in the UK that provides autism services. Semi-structured interviews were undertaken with 8 leaders and managers to extrapolate policy and practice interpretations. 48 autism practitioners engaged in focus groups and the completion of questionnaires. Leaders and practitioners were re-tested to capture the impact of the PBS framework. Practitioners completed pen portraits to provide information on the qualitative impact of the PBS Framework in practice. Discourse analysis and reflexivity were considered to be essential approaches to extrapolate findings and complement the situational analysis. 79% of practitioners considered organisational policy to have improved, alongside levels of incident recording improved by 96%. The qualitative outcomes captured holistic improvements to quality of life for people with autism and relevant wider societal outcomes in statutory regulation and compliance.

The government’s pursuit of ‘evidence-based’ practices within the National Probation Service (NPS) emphasises evaluating offending behaviour programmes. These evaluations produce mixed findings largely because methodological limitations facilitate inconclusive results. My study did not seek to overcome these shortcomings; indeed, I question whether it is possible to definitively answer ‘what works’ in perpetrator programmes. I provide an alternative way of undertaking research into the ‘treatment’ of intimately violent offenders using a Foucauldian form of discourse analysis. My research draws on in-depth interviews, questionnaires, programme observations, and programme manual and case file analysis undertaken in one NPS area. In analysing the data, I outlined the institutional domains of the assessment, case management and programme. I considered the official and unofficial rhetoric about the ‘treatment’ of (male intimately violent) offenders, and how practitioners and intimately violent men in my study used this. Two key discourses were delineated. One is risk discourse about dealing with offenders by assessing, managing and reducing risks of re-offending; the other is rehabilitation discourse about working with offenders to change attitudes and behaviours to end crime. My study argues that risk discourse was prominently talked about throughout the different institutional domains. Albeit a fading discourse, rehabilitation was used more within the programme domain. I conclude that individuals’ use of these discourses varies within and throughout domains, because of investments. Practitioners in the domain of case management draw on official rhetoric to talk about managing offenders’ risks because this implies they are ‘doing their job’. Violent men used this rhetoric to talk about reducing their own risks of violence since this indicates compliance with their court orders. These findings question the legitimacy of the NPS to protect women from men’s violence and evaluative research that relies on men’s linear stories of violence.