This thesis uses a grounded theory methodology to reveal the processes by which cognitive heuristics are used by senior managers to make decisions in a large UK local authority. The thesis is based on primary data, organisational documentation and an extensive and critical review of the pertinent literature. Primary data was generated over four years and involved detailed observation of 156 senior managers making a total of 513 decisions, together with formal interviews and informal discussions with these managers. The organisation under study provided an ideal context for this research since it offered a rich insight into management decision-making practices in diverse contexts such as social work and highways, and with varying degrees of urgency ranging from procurement decisions lasting several months to instant decisions concerning child protection. Furthermore, UK local government has been subject to drastic change in recent years, such as the introduction of private sector management practices and increased competition. This has been exacerbated by an austerity programme which means that local authorities, in common with much of the world, have to do a lot more with a lot less. The turbulent context of local government is, in Yin’s (2009) terms, an ‘exemplifying’ case study, and hence the issues raised in this study resonate far beyond the scope of this thesis. This thesis makes a number of significant contributions to knowledge. Firstly, original flow charts are developed that allow the underlying processes of heuristic decision-making to be identified, and these reveal that, whereas the academic literature treats heuristics as discrete entities, there is actually considerable interplay between them. Further, a new definition of the moral heuristic is developed, which allows researchers to view this heuristic at a higher, more conceptual level than has hitherto been possible. The thesis also extends the work of Daniel Kahneman and demonstrates that the role of the unconscious in decision-making is more complex than previously thought. For instance, intuitive heuristics can be used consciously and choice-based heuristics can be used unconsciously. It is also argued that the underlying processes of ‘classical’ theory are better explained by the degree of consciousness involved when making a decision, and not by the commonly accepted normative/behavioural distinction made by Herbert Simon and others. As such, this thesis represents an important contribution to the decision-making literature.

Having dominated policy agenda in developed economies for well over three decades, corporate governance is now getting to the top of the policy agenda in developing countries (Abor and Adjasi, 2007). However, the issues of corporate governance have focused on the major shareholders and institutional shareholders of the organization while little or no attention has been paid to public sector and the private enterprises in developing countries. This has been ignored by the literature. This study investigates the ethical dimensions of corporate governance practice in Ghanaian public sector and private enterprises. It aims to understand the phenomena of governance practices in this context and examine its implications for good corporate governance systems in Ghana. Using grounded theory methodology, data was collected from 28 semi structured interviews with board of directors and senior officials, and group discussion of 9 participants, mainly directors and officials involved with Ghanaian corporate governance system. The interviews were informed by the survey of governance practice. Through the constant comparative method of open coding of interviews, categories emerged which were subsumed into main categories during the axial coding. The paradigm model was used to establish the relationship among the categories. This formed the basis for the selective coding which identified the core category and its relationships with the sub-categories, verified to develop the substantive theory of corporate governance systems. The study explored the relationship between culture relativism and universalism and the formal theory in terms of stakeholder theory and shareholder theory. The substantive theory identifies that corporate governance practice in the public sector and private enterprises is influenced by traditional cultural values which has implications for ethical business environment. This study is the first attempt to combine corporate governance, grounded theory and national level culture in public sector and business enterprises, and to offer relevant recommendations for policy-makers. The substantive theory demonstrate that corporate governance systems are socially constructed and as such understanding the behaviour of board of directors is vital for understanding how corporate governance is practiced. The study contributes to better understanding of governance practice in the public sector organisations and the informal sector

The poor outcomes of young people leaving foster care are well documented and demand a focus on placement permanency and interventions that encourage stability (Rubin et al, 2007). The need for better support for foster carers is widely acknowledged (Warman, Pallet & Scott, 2006; Morgan & Baron, 2011). To provide effective support an understanding of foster carers support needs is required. A qualitative approach explored the support needs of foster carers who look after young people perceived to have emotional and behavioural difficulties. Semi- structured interviews were undertaken with 17 foster carers employed by a local authority or an Independent Fostering Agency. A grounded theory methodology within a social constructionist framework was used to develop a new theoretical understanding from the data. A central storyline of ‘keeping your head above water’ emerged and appeared to encapsulate daily struggles and ways of managing. Categories which contributed to this were ‘becoming isolated’ from other professionals, ‘role ambiguity’ regarding the multiple meanings attached to being a foster carer, ‘making sense of emotional and behavioural difficulties’ highlighting a need to understand the children cared for, ‘a focus on behaviours’ illuminating approaches to parenting and ‘unmet emotional needs’ which is a possible consequence of focussing on children’s behaviours. The emergent theory may hold potential for developing psychological formulations, interventions and training programmes for foster carers. Suggestions for future support are put forward based on the new theoretical framework. Applications of the findings to Counselling Psychology are discussed in detail.

The changing demographic UK population in terms of cultural, racial and ethnic mix demands mental health nurses to be educated in ways that will enable them to provide care that is both efficient and culturally appropriate to the diverse population they will serve. However, reported studies indicate that professional nurses, particularly mental health nurses, are not ready to meet the challenges posed by an increasingly culturally diverse society. These have raised questions about the undergraduate nursing education's readiness to develop a mental health work force that is capable of delivering effective mental health services to a multicultural population. The aim of the study was to explore and gain an understanding of cultural competence education from the perspectives of the key participants involved in the undergraduate mental health nursing education within the UK context, and to use the findings to develop a conceptual framework of developing cultural competence. Qualitative grounded theory approach was the method of inquiry used to collect and analyse interview data from the experiences and views of senior lecturers, third year mental health student nurses, clinical sign-off mentors and student mentors within the universities that offer pre-registration mental health nurse training in the West Midlands Region. Analysis of the research findings resulted in an emergent conceptual framework that explains how cultural competence is developed in the undergraduate mental health nursing curriculum in terms of content, processes, strategies, actions and approaches that are considered effective. The findings of this study revealed a degree of consistency between the views of the current study participants and what the literature describes as frameworks for developing cultural competence. The main theoretical constructs emerging from the study fit into a cultural competence frameworks encompassing awareness, knowledge and skills. Whilst some of the themes and theoretical constructs emerging from the results of the interview data were generally consistent with those indicated in the cultural competence literature, there were some other themes that emerged from the study participants on what was required within the curriculum in order to educate student nurses in ways that will enable them to work effectively and culturally appropriately with clients from diverse cultural backgrounds. The additional bridging theoretical construct included ‘conscious of the dynamics and discourse of intercultural education’ which was a result of the differing ideological views about current curricula and how issues of cultural competence could best be addressed within the curricula. The strategies of ‘engagement of local experts to assist in teaching cultural competence specific areas’ and ‘creating educational activities that challenge stereotypes, prejudice, discrimination and religious intolerance’ also expands the current literature by providing evidence to support some of the conceptualisations regarding some of the educational intervention strategies to cultural competence. This study is significant as it represents the first attempt to develop a conceptual framework of developing cultural competence within the UK context based on the perspectives of those directly experiencing the undergraduate mental health nursing education, using qualitative grounded theory approaches. Exploring and developing the conceptual framework from the perspectives of the neglected silent voices of the key participants who are directly involved in the undergraduate nurse training within the UK context, contributes to the existing research in this area and provides a view not currently presented in the nursing literature.

In this thesis, I investigate permanence through exploring tattoo consumption in terms of the social-historical context of being tattooed. The analysis is based on four years of data collection adopting a grounded theory approach. I present an analysis of how permanence occurs in terms of tattoo consumption, with particular interest in the physical permanence in relation to identity creation. This is set within the framework of Consumer Culture Theory (CCT). The reason for this is twofold, firstly to illustrate the ability of using tattooing as an instrument to investigate permanence within CCT. Secondly, to show the lack of use of the socio-historical perspective within such an investigation, and to show that the use of such data is a valid strategy and which adds depth and context to such an investigation. Furthermore, I suggest that tattoo consumption has become a site of embodied expression that is bounded by physicality, and permanence. I present a typology of tattooed consumers based on levels of commitment and explore in depth two main categories, physicality, and, permanence. I find that the physical permanence is shown through the commitment to tattoo usage. Its permanent nature determines the tattoo as an act of consumption that is dualistic in nature; both accepted, and yet equally rejected, which is seen within the consumers‘ negotiation of its use, in terms of mimicry and placement. Being tattooed represents a form of consumption that contravenes certain rules and norms of society, and yet at the same time is the basis for community membership and adherence to a set of sub-cultural norms and values.

This qualitative study explores the experiences and learning of five new teachers with less than three years in the classroom as they engaged in a study group. This research highlights the ways that participation in a study group enhanced teacher efficacy and supported their retention.The research reveals that power and authority over classroom decisions, lack of support from administration and frustration with autonomy of curriculum issues hindered the development of a positive teacher efficacy. When framed in a more positive light within a study group setting the changes to teacher efficacy enabled the study groupparticipants to be more proactive for their own personal and professional needs.Implications for supporting new teachers through opportunities to participate in a studygroup format are discussed. The result of this work is a contribution to the effects ofteacher efficacy and the power of collaboration in a study group setting for new teachers.

The study was developed after research with older women suffering urinary symptoms showed that many had tolerated social, psychological and hygiene effects on their lives for some time. There is evidence that some symptoms in later life may originate from pregnancy and childbirth. However, whist there is evidence that pelvic floor muscle exercises can be effective in the short term, there is a paucity of research on the reasons why women tolerate symptoms in the postnatal period rather than seek help. It was also unclear what significance the interactions with health professionals had in aiding or suppressing help-seeking. The aim of this qualitative study was to use grounded theory methodology to describe women’s experiences and knowledge of urinary symptoms in the postnatal period and the perceptions of health professionals. Fifteen women were interviewed in the postnatal period, and one woman was interviewed twice. From the interviews and observations of antenatal clinics and postnatal groups three categories emerged; messages women receive, seeking and understanding information and responding to the messages. Views and knowledge of health professionals were obtained through two focus groups of five. From the analysis of the findings the following five categories emerged; clarifying pathways of care, clarifying education, improving communication, understanding actions and serious issues. The core category arising from this; overcoming barriers to facilitate empowerment, revealed barriers that women and health professionals must overcome in order to approach the issue of urinary incontinence collaboratively. This study identified that there can be problems with communication at all levels between women and health professionals, resulting in poor communication regarding urinary symptoms and accessing treatment. Furthermore, superficial education regarding pelvic floor muscle exercises and dysfunction, both in the antenatal and postnatal periods, coupled with difficulties with disclosure on a sensitive subject could be disempowering for women and health professionals. In particular, women found the possibility of an examination so soon after delivery worrying. Normalisation was a negative but powerful influence on women, encouraged by friends and family. It is suggested that, by developing interventions that enable women and health professionals to overcome the barriers of communication and knowledge exchange, women could be empowered in relation to their physical health after childbirth to manage their urinary symptoms. Empowerment for women, therefore, with regard to postnatal urinary symptoms means being able to believe that looking after the pelvic floor is normal rather than accepting urinary symptoms after childbirth as inevitable.

Patient participation is a central theme in health care policy in the United Kingdom (U.K.). Indeed, there is a trend in health care policy and practice towards encouraging patients to participate actively in their care, treatment and the services they use (Department of Health, 1989, 2003; 2004; 2005; 2006; 2008; 2009; 2010; 2011; 2012). Despite the current popularity surrounding such an approach to care, the concept remains elusive. Patient participation in nursing care specifically has not been examined adequately and remains one of the least understood ideas in clinical practice. The contribution that nurses make to this important activity has also not been explored. Furthermore, only a few studies have examined the nature of patient participation in nursing care from the frame of reference of the acute surgical patient (Henderson, 1997; Sahlston et al., 2008 and Larsson et al., 2011). Most studies have targeted clinically distinct patient groups and discrete aspects of patient participation within the context of chronic illness or medical and primary care practice. They are therefore limited by their precision and narrow focus (Cassileth et al., 1980; Haug & Levin, 1981; Vertinsky et al., 1984; Caress et al., 2005; Entwhistle et al., 2004; Collins et al., 2007; S. Parsons et al., 2010). Most have also drawn on positivist epistemologies and derived data from self-completed fixed choice questionnaires. An empirically grounded theory that explains the process of patient participation in surgical nursing care within the empirical world has yet to be published. The purpose of this grounded theory study was to explore the nature of patient participation in nursing care within the context of the acute surgical care setting. Ultimately the aim was to generate a substantive theory that could account for, and explain, the process by which patients’ participate in their surgical nursing care. A qualitative, inductive design, based on the classic grounded theory approach to data collection and data analysis (Glaser & Strauss, 1967; Glaser, 1978) was employed to examine the complex nature or natural history of patient participation within the context of contemporary surgical nursing practice. The informants of the research were patients and nurses on three acute surgical wards in an NHS Trust Hospital. Data were collected through 61 unstructured, audiotaped interviews (47 patients and 14 nurses) and 72 hours of participant observation. The interview and observational data were analysed using the constant comparative method of analysis (Glaser & Strauss, 1967; Glaser, 1978). The analytic process generated a substantive theory, labelled Engaging in Nursing Care. The theory explains how patient participation in nursing care within the acute surgical setting is established, developed, maintained or inhibited. It reveals an evolutionary context-sensitive process, which describes the complex and challenging nature of patient participation in nursing care as experienced by patients and nurses in the pre and post-operative period. Three dynamic phases: Establishing Readiness, Shaping Work and Incurring Rewards and Costs describe how patients engage in their nursing care prior to and after surgery. The phase Establishing Readiness describes the structural, organisational and environmental antecedents of patient participation within the context of the surgical care setting. Shaping Work describes the range and variation in participatory behaviour and the levels at which patients participate in their own nursing care throughout their surgical experience. The phase Incurring Rewards and Costs explains the varied effects of patient participation in surgical nursing care on the individual patient, the nurse and surgical ward performance and resources. A number of recommendations are made to enable nurses, educationalists, health care managers and policy makers to develop substantiated strategies and initiatives for the effective implementation of patient participation in modern surgical nursing practice.

This article reports the findings of a grounded theory study of the processes involved in adherence and treatment seeking delay for febrile neutropenia in chemotherapy patients. Interviews were conducted with 12 patients. Six theoretical constructs were generated, namely ‘Recall of Treatment Advice’, ‘Impact of Emotions’, ‘Influence of Social Networks’, ‘Symptom Monitoring Behaviour’, ‘Symptom Interpretation’, and ‘Preparation and Journey Time’. A model was developed to reflect the complex interplay between these theoretical constructs. Data extracts are presented to illustrate the grounding of the model in patients’ accounts, and the model is discussed with reference to previous theory and research.

Background: Primary care providers, family physicians and nurse practitioners provide most mental health services in Canada. However, primary care providers lack knowledge, skills, and time to provide these services. Access to onsite mental health consultation or collaborative mental health care, affords primary care providers support to offer patients increased access to mental health services. Researchers suggest that interprofessional collaborative relationships are foundational to the success of collaborative mental health care. However, there is little understanding of how to build these relationships. Purpose: The purpose of this grounded theory study was to develop an understanding of how primary care and mental health care providers collaborate to deliver mental health care in primary care settings. Methods: Counsellors, family physicians, psychiatrists, nurse practitioners, and program leaders were recruited (N=40). Data were collected using individual (19) and focus group (7) semi-structured interviews. Interviews were audio recorded, transcribed and open coded. After open coding the first seven interviews, memos were written on each participant and focus group. These memos were sorted, compared to previous memos and then used to create a coding table. This iterative process of open coding, memo writing and then adding emergent codes to the coding table was repeated for all transcripts. Similar codes were grouped then collapsed to create the preliminary categories. Preliminary categories were sent to the participants after the primary care provider interviews and again after the provider focus groups to create the final categories. The final categories were compared to examine their relationships to one another. Findings: The main finding of this study is a theoretical rendering of the participants’ experiences and ascribed meaning of interprofessional collaboration to deliver mental health services in primary care. Specifically, a collaborative relationship building model with four developmental stages: 1) Primary Care Providers Need for Collaboration, 2) Initiating Co-location, 3) Fitting-in, and 4) Growing Reciprocity is offered. Conclusions: The findings underscore that collaborative care requires an understood need for collaboration, organizational support, contextually effective modes of communication, and a perception that collaboration improves patient care. Further research may explore the applicability of this model to other health care contexts. / February 2017