Although social work as an international profession has begun to take spirituality seriously as part of its professional discourse and commitment to best practice, in the UK there has been considerable reluctance to regard it positively. This thesis argues for a comprehensive understanding of spirituality that relates to deep, human themes including meaning and purpose, mystery and awe, concepts which are by no means limited to, or restricted by, religious perspectives. Spirituality, it is argued, is ‘what we do to give expression to our chosen world-view’, and as such is an all-encompassing concept that helps us understand and appreciate the positive and negative aspects of humanity. The author builds upon and develops existing theoretical perspectives to demonstrate the relevance of spirituality to the professional social work discourse. A ‘co-creative’ /action research methodology was adopted to enable key ‘players’ in social work education and practice (students, academics, practitioners, service users and carers) to ‘co-create’ and own a theoretical framework that would enable spirituality fulfil a key role in the social work curriculum. The author’s new strap-line for social work -celebrating diversity with social justice - argues for an understanding of spirituality that is all-encompassing in its scope, and recognises the ways in which spirituality can be both a positive and negative influence at a wider level in society. His discussion of the key concept of authentic and inauthentic spirituality demonstrates its relevance to the core social work values of anti-discriminatory and anti-oppressive practice. The discussion of workplace well-being in the thesis is a further distinctive development of the author’s understanding of spirituality and the contribution it can make to social work theory and practice.

Introduction: Parkinson’s disease (PD) is a progressive neurological condition. As the condition progresses people with PD (PwP) need more support with their care needs to remain at home. Due to the complex symptoms of PD, carer strain has been identified as a possible consequence for carers of PwP. PD is recognised as a risk factor for care home placement. It has been reported that carer strain can lead to PwP being placed within a care home setting; however there is scant literature at present to substantiate this claim or to understand the extent of this issue. The aim of this study was to determine the level of carer strain and to understand its influence on care home placement for people with moderate to advanced PD. Methods: This is a convergent mixed methods study, following a critical realist approach. Participants were recruited from a representative PD Specialist Service in the North East of England. A battery of quantitative data were collected from people with moderate to advanced PD by a research nurse. Quantitative data, following an adapted stress-appraisal model, were collected on carer profile, tasks performed and variables causing carer strain. Study participants were followed for the study period of 24 months. Semi-structured, in-depth interviews were conducted with carers of PwP who went into a care home during the study period, to develop a deeper understanding of the carer role and the factors influencing care home placement. The quantitative data were analysed using multivariable linear regression modelling and qualitative data were analysed using thematic analysis. Quantitative and qualitative results were then integrated to provide a more complete understanding of the issues. Findings: Quantitative data were collected from 115 patient carer dyads. The mean age of the carers was 70.7, the median time spent caregiving was 5 years and half of all carers spent at least 16 hours per day acting as a carer. A predictive model of carer strain was identified, which was supported and further explained by qualitative data. Variables that caused the greatest levels of strain included neuropsychiatric symptoms displayed by the PwP, along with difficulties with eating tasks, hygiene and mobility. Carers who had poor sleep, their own health issues and were involved in personal care and mealtime support were also most at risk of carer strain. Carer strain was also found to be significant in 69% of carers. Interviews were conducted with 10 carers of PwP who went into a care home placement. They all described the strain of caring and the need to reach a crisis point before PwP were placed into care. All 10 PwP went into a care home placement following a crisis point that involved an emergency respite placement or prolonged hospital stay. Predictors to care home placement were identified, including worsening memory, increased daytime sleepiness and functional disability for the PwP. Carers described distressing delsions and using dysfunctional coping to try and manage the situation. Conclusions: Informal carers for PwP are older and are providing more support than previously appreciated. It is vital that health and social care professionals are aware that carer strain is a serious issue for many carers and there are a number of variables inparticular that can lead to the greatest levels of carer strain. Improving communication with carers will enable staff to fully understand symptoms displayed by the PwP, but also to ensure that carers feel involved and supported within their role. To try and maintain PwP within their own homes issues of carer strain need to be addressed in clinical practice and carers supported more within their role. Ultimately some PwP will still need to go into a care home and both carers and PwP need to be supported through this process, to avoid distressing crisis events and to make this difficult, but necessary, decision as smooth as possible.

Sense-making is an important practice accomplishment in child protection. This is because the judgement and decisions which follow can have life changing consequences for children and families. A contemporary social constructionist perspective identifies critical-reflexivity as a concept drawing attention to the influence discourse, knowledge, language and culture can have on human sense-making processes. In all social settings, these often taken-for-granted phenomena can shape human sense-making, action and agency. Empirical studies exploring practitioners’ sense-making and reflexive practice(s) in social work settings remain underrepresented within the literature. Therefore, informed by Margaret Archer’s theory of reflexivity, this study examines sense-making in child protection and the reflexive practice(s) of social workers situated in a statutory setting. The research questions guiding the study are: ‘How do social workers ‘make sense’ in child protection?’ And: ‘Is sense-making in child protection informed by reflexivity?’ Utilising methods commonly applied in ethnography the study combined participant observation with in-depth interviews. Interviews included participant reflections on case studies. A thematic analysis was utilised to interpret the study data. Key themes drawn from the study data included how sense-making in child protection was influenced by: (1) prescriptive policy and practice frameworks (2) practitioners’ biographical backgrounds, perspectives, approaches, values, beliefs and concerns and (3) their differing ‘modes’ of personal reflexivity. The study findings highlight how sense-making in child protection and the practice of personal reflexivity is a multi-faceted activity embedded within a range of formal and informal reasoning processes. Practitioners’ differing reflexive modes are identified as causally influenced by their personal biographies, knowledge, experiences, values, beliefs, concerns and their professional practice contexts, approaches and relationships. Highlighting how social workers think, talk about, experience and assign meaning to their day-to-day practice realities this study contributes knowledge to understanding sense-making, personal reflexivity and the development of ‘practice-depth’ in child protection.

No description available.

Health behaviours learned in adolescence set precedence for healthy habits that extend throughout the lifespan. During adolescence transitions take place that lay the foundations for health and wellbeing in adulthood. This study is underpinned by two frameworks: Antonovsky’s theory of salutogenesis and Bronfenbrenner’s ecological systems theory. Research evidence within the salutogenic paradigm suggests that both the strength of an individual’s Sense of Coherence (SOC) and the Sense of Family Coherence (SOFC) are linked to positive health outcomes. This study aimed to explore how family life is associated with the development of SOC in adolescents. To achieve this a fully integrated longitudinal mixed method research design was employed. Data were collected through mixed method surveys in three waves and semi-structured family interviews using genograms and ecomaps as data collecting tools. The sample was purposively selected from one school and consisted of Swedish-speaking Finns: 65 adolescents, 89 parents and 56 families. Longitudinal data were generated from 18 families. The data were analysed using descriptive statistics, content analysis and thematic analysis. The study findings add to the body of knowledge of the sparsely researched area of a collective SOC. Developmental processes of SOC were found to take place in several environments of development simultaneously, with each of these environments providing diverse contexts for complex non-linear and overlapping processes influencing social, physical and mental dimensions of wellbeing. It was however not the contexts of development that were the most crucial factors influencing SOC but rather the processes that took place within these contexts. The findings suggest a reciprocal relationship between SOFC and SOC, with a strong SOFC promoting the development of a strong SOC in adolescents. Individuals with strong SOC scores and families with strong SOFC scores voiced an understanding of beliefs, facts and values deemed important for health and wellbeing. They also demonstrated insight into what actions are needed and should therefore be taken when aiming to promote the health and wellbeing of adolescents. This study recommends that a salutogenic discourse of health should be implemented when planning and implementing policies and strategies aimed at promoting the health and wellbeing of adolescents and their families, leading to improved health and wellbeing.

This thesis presents a study concerning the narrative identity (and associated ‘identity work’) of four leaders working within Sure Start Children’s Centres, these being integrated, multi-professional services established in England for children aged 0-5 years and their families. Specifically, it asks questions regarding the relationship between narrative identity and professional practices for these individuals, and examines ways in which they establish, maintain and deploy their narrative identities. To investigate this topic, a narrative and hermeneutic theoretical lens is presented that draws upon and adapts the work of Paul Ricoeur (1981, 1983/1990, 1990/1994, 2005). The resulting study uses a methodology that is consistent with this framework, and employs innovative visual and participative elements in detailed work over time with participants. Findings of the study are presented in four themes that emphasise the dynamic, connected, diverse and social character of narrative identity for participants. Here, narrative identity is discussed as something established over time, through successive ‘cycles’ of talk and action. Further, the study establishes the ways in which particular patterns and structures within narrative identity facilitate or constrain this development. Participants’ narrative identity is discussed as existing within an ecosystem of narratives, each having a range of functions which complement relatively stable narrative identity. Finally, these narrative identities are presented as social projects, which involve others in the processes that come to define and legitimise them. The thesis therefore emphasises the complex relationship between narrative identity and professional experience and practice for participants in the study. As a result, professional narrative identity is understood as a practical and philosophical project, and the thesis opens up lines of enquiry for further study within the early years sector and beyond.

The structure of the United Kingdom population is changing with the percentage of people aged 65 and over increasing from 15% in 1985 to 17% in 2010 (Office of National Statistics 2012). During this time older people have been encouraged to remain living in their own homes (National Consultative Ethics Committee for Health and Life Sciences 1998). There is a growing body of evidence regarding older people and their homes concentrated primarily on the interpretative paradigm. In view of the existing evidence base the question posed was: ‘How do the discursive practices of older people living in their own homes reflect societal discourses?’ The aim of the research was to investigate the meaning of the home space and how older peoples’ discursive practices reflect societal discourses. In order to meet this aim the paradigm of post-modernism was selected along with the methodology of discourse analysis using Michel Foucault’s ideas. Narrative accounts were generated from a sample of 12 older people on two separate occasions on a one-to-one basis. The data was transcribed verbatim and a thematic analysis was used to condense the data and to allow for a Foucauldian discourse analysis of the topics identified by the participants. Five dominant discourses were identified as follows: Discourse of Risk – this was related to danger and trauma such as falls but the underlying risk was that of losing the home; Discourse of the Failing Body - explained how the participants were managing the physical demands of home-keeping with bodily changes threatening self-sufficiency; Discourse of Cognition – ageing as cognitively ‘challenged’ and again could be a threat to self-sufficiency; Discourse of Connections – the importance of contact and socialisation with others, animals and artefacts; Discourse of Consumption – highlighted the acquisition of equipment, adaptations and services to look after the self and the home and demonstrate ability. The meta-discourse of ageing as inevitable decline that circulates in society was being adhered to. However, one of the main findings was that the older people managed ageing in the home via managing risk. There was a constant underlying fear of losing their home and the participants consequently adopted the subject position of vulnerability. Foucault discusses the pervasiveness of power but stresses that where there is power there is resistance. In order to resist power, however, individuals need to gain critical consciousness. Challenging the status quo is essential if the dominant discourses regarding ageing are to be changed. Discursive trends towards ageing do appear to be emerging, but these are being heavily influenced by neoliberal policies and challenges from other modes of thinking are limited. Older people themselves can and do resist these dominant discourses and this requires continued encouragement and facilitation by professionals, voluntary organisations and the media.

No description available.

The prevention and appropriate professional response to children at risk of or experiencing child abuse and neglect has been identified as a national priority within the United Kingdom. Nurses (adult field) are likely to come into contact with children during their professional career and need to have the skills to detect and refer children who they suspect are suffering or at risk of suffering significant harm. However, there remains a dearth of evidence examining how nursing students (adult field) are prepared and supported and what their experiences are when they encounter child abuse or neglect in the clinical area. Therefore, the intentions of this study were: Research aim: To explore the experiences of student nurses (adult field) when they encounter what they perceive to be child abuse or neglect during their first community placement. Research questions: · How do student nurses (adult field) interpret, respond and learn from their experiences of encountering perceived child abuse or neglect during their first community placement? · How well are student nurses (adult field) prepared for encountering abuse and neglect? · How can they be better supported? Hermeneutic phenomenology was employed to guide the research design and processes, including data collection and analysis. The data were collected using narrative-style in-depth interviews from a purposeful self-selected sample of nine first-year nursing students (adult field) who perceived they had encountered child abuse or neglect during a community placement. Ethical approval was gained from the University ethics committee. Mezirow’s theory of transformational learning was used as a framework for analysis. Three overarching themes were identified: 1) Encountering disorienting events, 2) Reflecting on responses, assumptions and pre-conceptions and finally 3) An expanded worldview. The first theme reflected the student nurses’ initial thoughts as they encountered actual or perceived situations involving child abuse or neglect as well as deprivation. The second theme encompassed the student nurses’ initial feelings and responses to the experiences they encountered. This included feelings such as shock, anger, frustration and fear. Finally, the third theme outlined how the students reflect upon their practice experience, developing professional and personal insights. This is conceptualised as a transformational learning episode. The students’ journeys were idiosyncratic with variations in educational growth and transformation. The findings of this study suggest that student nurses (adult field) who encountered perceived child abuse or neglect during their first community placement felt unprepared for these encounters and would have welcomed the opportunity to reflect on their experiences when they returned to university. This has implications for the BSc Nursing studies (adult field) in considering the preparation and support of student nurses before, during and after their first community placement.

Risky sexual behaviours are prevalent among low Socio Economic Status (SES) female teenagers, and earlier sexual initiation is associated with unplanned pregnancies and sexually transmitted infections. Large systematic reviews have found an extensive list of predictors of risky sexual behaviours, but it is not clear which of these are highly important to low SES female teenagers and if sexual health intervention programs are currently meeting teenagers’ sexual health needs. This thesis sets out specifically to address this issue, by investigating the predictors and developing a brief online sexual health intervention program for low SES female teenagers. Two research questions were explored using a mixed-methods approach across five studies. The research aimed to gain sexual health professionals and teenagers qualitative views on the predictors of risky sexual behaviours, and then confirm these predictors quantitatively with a large number of female teenagers. Teenagers views of existing online sexual health intervention programs were then explored leading to the development of a brief online self-affirmation and sexual health intervention program. Self-esteem was found to be an important predictor of risky sexual behaviours both by sexual health professionals and low SES female teenagers. It was also clear that teenagers did not currently have access to reliable sexual health information. Therefore, a brief online self-affirmation intervention, aimed at increasing self-esteem, paired with reliable sexual health information was developed. It was found that the self-affirmation intervention significantly increased self-esteem for the self-affirmed group compared to the non-affirmed group. In addition, the self-affirmed group had significantly higher intentions to have safe sex post intervention and at a one week follow up, compared to the non-affirmed group. Therefore, low-cost brief online self-esteem and sexual health interventions can be effective in increasing intentions to have safe sex for low SES female teenagers. The theoretical and practical implications of these results are discussed together with suggestions for future research.