The chronic pain associated with rheumatoid arthritis (RA) is identified by patients as a priority for treatment and is said to shape their illness experience. However, review of the literature reveals that little is known about patients' perspectives on pain in RA, with even less being known about how rheumatologists, the clinical experts in patient care, perceive this phenomenon. Increasing knowledge and understanding of patients' and rheumatologists' perspectives on pain can be used to try to influence their action/inactions as well as helping to identify patients' specific concerns and unmet needs. The aims of this study were: To describe patients' and rheumatologists' perspectives on the meaning of pain in RA; To explore how these pain meanings are constructed; and To consider the implications of these constructions for pain management. This interpretive, qualitative study used semi-structured interviews to generate accounts related to respondents' perspectives on pain in RA. Purposive sampling was used to select a heterogeneous group of patients with RA (n=29) and rheumatologists (n=16). Thematic analysis was used inductively to generate findings using a cumulative, constant comparative technique (Strauss and Corbin, 1998). Both patients and rheumatologists presented multiple pain meanings but generally viewed pain as an expected symptom of the disease, both being resigned to the belief that most patients would have some degree of daily pain. Additionally, both groups considered the pain experience to have a pervasive, negative impact on life, potentially threatening the patient's concept of 'self'. In contrast, patients' and rheumatologists' pain meanings regarding clinical topics were not similar. Patients' views of medical responsibility were narrowly difined, rooted in western biomedical conceptions of pain and were influenced by experiences of clinical interactions. Accordingly, patients viewed the rheumatologist to be responsible only for 'legitimate' pain i.e. pain associated with the body and disease processes. Rheumatologists, on the other hand, presented a more comprehensive understanding of pain by incorporating psychological and social theories along with an associated 'ideal' model of care (reflecting a biopsychosocial approach). Consequently, they identified eclectic roles/responsibilities for themselves in patient management. However, rheumatologists viewed this 'ideal' as difficult to attain in the context of their experiences of clinical work where multiple constraints were perceived to exist, such as difficulties in deciphering pain, the perception of limited resources (e.g. time) and organisational barriers. In light of this, their role was often reduced to focusing simply on disease management, thus displacing the 'ideals' of patient-centred care and perpetuating the dominant biomedical discourse of pain in the clinical context. This thesis adds to the body of knowledge about patients' perspectives on pain when they live with a chronically painful condition and patient barriers to reporting pain. New findings are presented regarding the medical experts' conceptions of pain; in particular, those related to complex clinical work. The findings also identify areas of unmet need regarding patients' knowledge of pain, pain management and of the roles and responsibilities of healthcare professionals. Suggestions are made for further work in the areas of investigating patient barriers to reporting pain; exploring patient perspectives on self-management and using alternative research methods to complement and develop the findings from this study.

The thesis contextualises creative dance as art in a community setting. The participants were teenage members of a community-run creative dance company. The aim was to explore any links young people make between their creative dance experience in a community class and their feelings of social well-being. The literature gives a brief historical overview of dance as a performing art and of the nature of aesthetics and creativity. It considers the art of dance as a form of communication, and the conditions for creativity to flourish. It looks at Bourdieu‘s (2005) theory of ‗habitus‘ and ‗field‘ in understanding the social experience which the dancers derived through creative dance. Consideration is given to theories and accounts of adolescent development and how community interaction can affect the dancers‘ feelings of social wellbeing. The methodological approach is hermeneutic phenomenology, with influences from ethnomethodology and social constructionism. The ontological principle is that personal meaning is socially constructed. Epistemologically the study is informed by the belief that knowledge is generated through the creative dance experience. The main data collection method was semi-structured interviews with the dancers (n=10), supported by observation of dance classes (n=7; filmed: n=4), group discussions (n=3) and graffiti walls (n=8, completed by the dancers). The data were organised and analysed thematically using a method of presentation inspired by Bourdieu‘s concept of a ‗social trajectory‘ - a lifetime journey of social encounters – offering headings under which the data were loosely organised. Selected observations are presented on DVD. The responses suggested a dance ‗journey‘ from preparation to performance, which allowed further organisation of data. The emergent themes included the dancers‘ motivation for dancing, their feelings about the creative process, experiences of social interaction and of taking control of one‘s own identity, through all the stages of experimenting with movement, refining the dances and performing. The main findings are: the dancers attached importance to company membership because it offered a means to clarifying self-identity through physical and artistic endeavour; the creative dance context gave them freedom to explore their movement capabilities and to interact socially, and thus gave them a means of negotiating their ‗habitus‘, i.e. adopting and adjusting social norms and values on their own terms. Performing was a celebration of achievement and confirmation of identity as a dancer. The study contributes to the understanding of how adolescents make sense of their identity in their social context through their creative dance experience and how that influences their feelings of social wellbeing.

Labai svarbu, kad neįgalūs žmonės neliktų intensyvios visuomenės kaitos nuošalyje. Menas yra pati universaliausia kalba, kai žmonės gali vieni kitus suprasti jausmais, o kūryba, skatina žmogaus saviraišką, ugdo asmenybę, padeda adaptuotis ir integruotis į visuomenę. Meninis neįgaliųjų ugdymas yra neatsiejama mokymo dalis ir labai svarbi veikla, kuri kartu atlieka ir terapinį pobūdį. Mokslininkai vieningai pripažįsta dailės reikšmę: dėl jos tobulėja ir lavėja mokinių meninis suvokimas, skonis, jausmai, intuicija, vaizduotė – būtinos jauno žmogaus „kultūrinimo“ ir kūrybiškumo sąlygos. Šiame darbe aprašyto tyrimo tikslas – atskleisti meninės saviraiškos poveikį sutrikusio intelekto mokinių kalbos ir komunikacijos įgūdžių lavinimui. Siekiant patikrinti tyrimo hipotezę pasirinkti mokslinės literatūros analizės, fenomenografinis ir turinio (content) analizės metodai. Požiūriai į sutrikusio intelekto asmenų raidą išsiskiria, yra įvairių mitų ir faktų, tačiau neabejotina, kad tokių vaikų kalba ir komunikacija turi ypatumų. Šiame darbe aptariamas meninės raiškos poveikis neįgalaus asmens raidai, meninės raiškos ypatumai ir poreikiai, galimybės plėtojant sutrikusio intelekto vaikų kalbos ir komunikacijos įgūdžius. Meninė sutrikusio intelekto asmenų raiška skatina jų sėkmingą ir visapusišką socializaciją. Atlikus tyrimą paaiškėjo, kad visų tiriamųjų verbalinės raiškos pokytis įvyko. Nepriklausomai nuo tiriamųjų individualių gebėjimų, atsiskleidė šių sutrikusio intelekto mokinių... [toliau žr. visą tekstą] / It is very important that disabled people wouldn‘t stay out of the way when intensive society is changing. An art is the most universal language, which helps people to understand each other by feelings and creation stimulates man‘s self-expression, trains personality, helps to specialize and integrate into society. An artistic training of disabled is concurrent and very important activity, which at the same time does a kind of therapeutical impact. Scholars unanimously assert a significance of art: it improves and trains pupils' artistic consciousness, taste, feelings, intuition and imagination which are important conditions to young man's civilisation and creativity. A point of research given in this paper is to show, how artistic expression trains skills of language and communication of disabled pupils'. In order to check a hypothesis of research, there were taken phenomenographical method, scientific literature and content's analysis. Views to development of persons with dysfunctional intelligence are different, there are some myths and facts, but it is certain that communication of those pupils‘ has some peculiarities. In this paper is discussed an impact of artistic axpression to development of disabled, peculiarites and needs of artistic expression and facilities by which are being developed skills of language and communication of pupils‘ with dysfunctional intelligence. The artistic expression stimulates successful and universal socialization of people with... [to full text]

This thesis focuses on social work and art therapy, specifically the possibility of the applicability and usefulness of the specific therapeutic art techniques in social work. In the first step my thesis introduces theoretic solutions of both mentioned disciplines. After that it looks for places of applicability of therapeutic art techniques in social work by a practical form. The final part describes specific of benefit of the mentioned techniques for social work, as well as in specific methods of social work - social work with an individual, a group, a family and a child client.

The Diploma Thesis "Utilization of art therapy methods and techniques in social services for mentally disabled people" deals with topic of art therapy and its elements which are used while working with mentally disabled people. The thesis defines the term art therapy and describes art therapy methods and techniques which are used in social services for mentally disabled people. Object of the thesis is to ascertain to what extent art therapy methods and techniques are utilized while working with mentally disabled people and whether these methods and techniques help to develop mentally disabled people. The theoretical part of the thesis defines the term art therapy and its position in a system of coordinated rehabilitation. It also describes the history of art therapy, its forms and possibilities of utilization of colors in art therapy. The other part of the theoretical part defines mental retardation and its classification and social services for mentally retarded people are described here as well. In the end, the theoretical part is devoted to art therapy methods and techniques. The practical part of the thesis deals with two researches. The quantitative one which was performed with mentally retarded people ascertains whether mentally retarded people like using art therapy methods and techniques...

Critical Review of the LiteratureCan Borderline Personality Disorder be treated effectively in forensic settings? A systematic reviewBorderline Personality Disorder (BPD) is a common diagnosis in forensic settings. Certain features of BPD, such as impulsivity and emotional dysregulation, can create a vulnerability to impulsive acts. The condition is also associated with poor mental and physical health, making the treatment of BPD and its clinical features an important goal in forensic settings. This paper reviews evidence for the effectiveness of treating BPD and its symptoms using psychological approaches in forensic settings. A systematic search found 2913 papers, of which 13 met the inclusion criteria. The papers reported nine separate studies (six controlled) that implemented four distinct interventions, often adapted for particular forensic settings. Improvements in overall BPD symptomatology and specific BPD symptoms were reported for all types of intervention, although few differences in outcome between intervention and control groups were found. There were also reported improvements in BPD-related behaviours, but data on offending behaviour were absent. Heterogeneity in study quality and design makes it challenging to draw any firm conclusions about the effectiveness of any one form of treatment over another, nor about which treatment may best suit a particular setting. Further randomised controlled trials are needed to answer these questions. Service Improvement ProjectEvaluation of a brief educational intervention for clinical staff aimed at promoting trauma-informed approaches to careThere is growing evidence that trauma plays an important role in the aetiology of severe and enduring mental health problems. Yet staff can be reluctant to ask patients about trauma for reasons such as anxiety about harming patients and limited access to training. Where services have adopted trauma-informed approaches (TIAs) to mental health care (i.e., considering the ways in which trauma affects individuals when planning and delivering services), improved clinical outcomes have been observed. With this in mind, a new educational video was developed for mental health staff at an NHS trust. The video was intended to be (a) brief (10 minutes); (b) contemporary and engaging; and (c) accessible using computers, smartphones and tablets. Forty-one multidisciplinary staff viewed the video. Quantitative and qualitative evaluation indicated improvements in self-reported knowledge and confidence with regard to trauma, and a decrease in worries with regard to asking patients about such experiences. Participants found the video to be enjoyable, understandable and informative. Importantly, many indicated that it spurred them to further action, such as further training and asking patients about possible trauma. These findings indicate that a video of this type can offer an important ‘taster’ of trauma-related learning, constituting an important step towards embedding trauma-informed ways of working at a service. Main Research ProjectThe Role of Intrusive Imagery in Hoarding DisorderThe cardinal feature of Hoarding Disorder (HD) is persistent difficulty discarding possessions, with the resulting clutter compromising the intended use of living areas. Within the dominant cognitive-behavioural model of hoarding (Frost & Hartl, 1996), hoarding behaviours are positively and negatively reinforced in the context of certain object-related beliefs. Available treatments for HD have so far yielded modest outcomes, indicating a need for new approaches. Intrusive imagery has so far been neglected in HD research, despite the frequency of trauma in the histories of people with the condition. To address this, 27 individuals who met the DSM-5 criteria for HD and 28 community controls (CCs) were interviewed about their everyday experiences of mental imagery. Participants were also asked about the images they experienced during two recent real-life examples of actual or attempted discard of (1) an object of low subjective value; and (2) an object of high subjective value. Everyday imagery in the HD group commonly reflected themes of illness, death and reminiscence. Imagery in HD participants tended to carry negative emotional valence in comparison with CCs, and was associated with greater interference in everyday life and attempts to avoid the imagery. HD participants reported more negative experiences of intrusive imagery in comparison with CCs during recent episodes of discarding objects of low subjective value. However, HD participants experienced positive imagery when discarding, or trying to discard, high value objects. These findings indicate that although people with HD frequently report traumatic histories, this is not reflected in the everyday imagery that they experience. There is some evidence to suggest that the negative and positive memories experienced in relation to low and high value objects may aid our understanding of discarding and saving behaviour in HD. The theoretical and clinical implications of these findings are further discussed.

AIM The purpose of this study was to explore and describe factors that contribute to the non-initiation of Antiretroviral Therapy (ART) amongst Pre-Antiretroviral Therapy eligible patients and to make recommendations for health care workers to enhance early initiation of pre-ART-eligible patients for primary health care facilities in Swaziland. METHOD A qualitative design was applied in rural primary health care (PHC) facilities in the Hhohho region of Swaziland. The target population for this study included nurses who have successfully completed the National Nurse Led Antiretroviral Therapy Initiation in Swaziland (NARTIS) training, and who actively initiated ART to eligible patients in rural PHC facilities. Data was collected through semi-structured interviews and field notes. Purposive, convenient sampling was applied. Eleven respondents were interviewed for the study, and data was collected until data saturation was reached. Data from transcripts and field notes was analysed and categorised with thematic analysis through Tesch’s open coding process. RESULTS The study identified the following three predominant themes: 1) systematic enablers of prompt ART initiation, 2) barriers to prompt ART initiation, 3) sources of support. Categories included public health care (PHC) factors, community level factors, the interdependence of the health care system, patient centred barriers, individual patient agency, and NARTIS nurse support. CONCLUSION The recommendations for health care workers that emerged from the study included continued HIV treatment scale-up and decentralisation to grass roots levels, aggressive treatment prioritisation among pre-ART patients, building the capacity of the local health care system and continued research initiatives. It is hoped that recommendations emerging from the findings of this study will have positive implications for programming and practice regarding the initiation of ART for eligible pre-ART patients in Swaziland. / Health Studies / M. PH.