My work is about an inner struggle, which stems from the shifting nature of my own identity being constantly displaced and re-imagined. My paintings and performances are propositions for a utopic world. They offer a place for identity to rest and are defined through ritualistic movements, which are inescapably mine. While I work in several mediums including paintings, performance, installation and sculpture, this thesis paper is an exploration of the work I have produced specifically over the last six months

The aim of this project was to use patient scenarios (clinical/case vignettes) to explore three aspects of General Practitioners' (GPs') clinical decision-making: how difficult decisions are perceived to be, the time taken to make decisions, and the appropriateness of decisions relative to evidence-based clinical guideline recommendations. A systematic review synthesised the results of published scenario studies. A secondary analysis of scenario studies which investigated antibiotic prescribing for upper respiratory tract infection (URTI) and x-ray referral for low back pain was performed. Relationships between the three aspects of decision-making were investigated, and scenario and GP characteristics associated with these aspects were identified. An online scenario study further refined these relationships for two specific URTI types: sore throat and otitis media. Cognitive processes involved in clinical decision-making were investigated in a Think-Aloud interview study, where GPs verbalised their thoughts while making prescribing decisions for URTI scenarios. There was some evidence that inappropriate antibiotic prescribing for URTI was associated with greater decision difficulty and longer decision time. Decisions made using a more effortful cognitive process may therefore be less likely to be appropriate. Illness durations of four or more days and, in otitis media, unilateral ear examination findings were related to inappropriate prescribing. Based on these results, suggestions have been made for informing the design of interventions to support GPs in making appropriate decisions. A secondary aim was to provide an overview of the methodology and reporting of scenario studies. The systematic review indicated a lack of consistency in methodologies, while reporting is often inadequate. Formats less similar to real consultations (e.g. written scenarios) are commonly used: the results of studies using these formats may be less likely to reflect real practice decision-making than studies using more realistic formats (e.g. videos). Based on these findings, methodological recommendations for scenario studies have been developed.

Background: Current demographic trends giving rise to an ageing population worldwide, and changes in disease patterns, are increasing demands for palliative and end of life care. Nurses play a fundamental role in the care of patients with chronic and life-threatening illnesses, making it critical that nurses entering the profession should be competent and confident to provide palliative care. However, some preregistration nursing curricula, particularly those in resource-poor settings, do not include any palliative care content. Existing research identifies a lack of palliative care competencies among practising nurses, both newly graduated and student nurses. Aim: The aim of this study was to develop, pilot and evaluate the impact of a palliative care course on Cameroonian preregistration nursing students’ palliative care knowledge and self-perceived competence and confidence in palliative care provision, using Kirkpatrick’s (1967) framework for training programme evaluation. Design: This study is situated within the World Health Organisation’s public health model for palliative care as an overarching theoretical framework. It employed a longitudinal quasi-experimental pretest/posttest design, using both quantitative and qualitative methods. It was conducted in 3 phases. In the first phase, a 30 hours classroom based palliative care course, underpinned by experiential learning theory, was developed. In the second phase, the course was delivered to second and third year nursing students in one University in Cameroon, by nurse educators, a chaplain and palliative care trained nurses in Cameroon. In the third phase, an evaluation of the impact of the course on students’ palliative care knowledge, self-perceived competence and confidence in palliative care, and transfer of learning to practice was conducted. Course evaluation data was collected via a pretest/posttest survey, 3 focus groups and 10 individual critical incident interviews. Both descriptive and inferential statistics were used to analyse the quantitative data. The qualitative data was analysed thematically using the framework approach. Findings: This study revealed a deficiency in the palliative care content of the pilot University’s preregistration nurse training curriculum, and very poor palliative care knowledge and self-perceived competence and confidence in palliative care provision, among preregistration nursing students of this University. A 30 hour classroom based palliative care course, delivered by nurse educators, palliative care nurses and a chaplain in Cameroon was found to statistically significantly improve students’ overall palliative care knowledge. In this study students’ also had improvements in their self-perceived competence and confidence in palliative care provision, though this was not statistically significant. Student nurses in receipt of palliative care education were able to transfer their learning to practice. They reported recognizing patients with palliative care needs, providing patients with physical, psychosocial and spiritual support and communicating patient information to the wider care team. Notwithstanding this positive finding, some factors, related to the student themselves, the qualified nurses, the practice setting or the patient and family, were found to negatively impact on the learning transfer process. The students generally felt that the course was an ‘eye opener’ and met with their expectations. They perceived the major strength of the course was the use of interactive and stimulating educational strategies, but felt that the absence of a supervised clinical practice component with dying patients was a major weakness of this course. Conclusion: There is a need for a curriculum revision to include palliative care content in the preregistration nurse training curricula of the pilot University. This seems to reflect a general need by all preregistration nursing students in this country. This study’s findings reveal the need to advocate for palliative care education and practice policies, and for adequately preparing clinical placement sites for nursing students’ palliative care learning and transfer of learning in Cameroon, and possibly other resource poor settings.

Medication monitoring is used in primary care to guide treatment and protect the patient from adverse drug events (ADEs). Early detection of ADEs may prevent their development and avoid serious or permanent effects to patient health. Published guidelines for the conduct of medication monitoring in UK primary care recommend monitoring in patients with long-term prescription of certain cardiovascular medications, including angiontensin-converting enzyme inhibitors (ACEI), loop diuretics and amiodarone. Although much evidence exists on the practice of monitoring of these medications in primary care, few studies have considered the effect of carrying out monitoring at different frequencies during long-term therapy on the risk of ADEs. Similarly, evidence of the economic effect of regular monitoring of these medications is sparse. As a consequence, policy-makers rely primarily on evidence from expert opinion as a basis for recommendations and compliance to guidelines in practice is poor. This programme of research aimed to gain an understanding of the nature of monitoring of ACEI, loop diuretics and amiodarone in primary care in England, and investigate the effectiveness and cost-effectiveness of monitoring in accordance with current guidelines. Using electronic health records from the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES), a cohort study was carried out in order to quantify the effect of monitoring the study medications at different frequencies during the course of long-term therapy. Weights based on propensity scores were used to control for confounding arising from non-random assignment into alternative monitoring regimens in retrospectively observed data. The time-to-event analysis found that conducting thyroid function tests (TFT) in amiodarone therapy below the recommended interval of once in 6 months was associated with more than a two-fold increase in the hazard rate of hypothyroidism (HR 2.79; 95% CI 1.42,5.47), thyrotoxicity (HR 2.57; 1.40,4.74) and major adverse cardiovascular events (HR 2.13; 1.31,3.45), when comparing against a group of patients monitored according to guidelines. Conversely, conducting urea & electrolyte monitoring in ACEI therapy below recommended frequency was associated with a reduced rate of hyperkalaemia treated in primary care (HR 0.57; 0.42,0.77) and hospital admission (HR 0.13;0.02,0.95). In addition, monitoring urea & electrolytes during loop diuretic therapy below recommended frequency was associated with a lower hazard rate of hypokalaemia or hyponatraemia treated in primary care (HR 0.17; 0.06,0.45). These findings support current recommendations on frequency of regular monitoring in the case of amiodarone TFT monitoring, but not in the case of ACEI or loop diuretics. The results of the time-to-event analysis of amiodarone monitoring were used to populate a decision-analytic model designed in order to estimate the cost-effectiveness of different strategies of monitoring medication, compared to recommended practice. This analysis demonstrated that conducting TFT at recommended frequency yielded modest cost savings per patient (£129, compared to less frequent monitoring and £192 compared to more frequent monitoring option) and utility gains per patient (0.0245 quality-adjusted life-years (QALYs) compared to less frequent monitoring and 0.0543 QALYs compared to more frequent monitoring option). The probabilistic model estimated that the recommended frequency strategy had a 97% probability of being a cost saving option compared to the two alternatives. These findings support the current policy of encouraging 6-monthly monitoring of TFT in amiodarone therapy. This programme of research has demonstrated that medication monitoring is potentially effective and cost-effective in amiodarone therapy, but did not find regular monitoring of ACEI or loop diuretic therapy to be effective. Observational research using routinely collected electronic health records can be used to gauge both the clinical and cost-effectiveness of medication monitoring in order to guide practice in this area and improve the safety of medications in primary care.

No description available.

This study investigates the links between the leadership of school principals and school culture in international schools in South East Asia. Two main research questions shaped the study: i) To what extent, if at all, do the principals exhibit behaviours of transformational leadership? ii) How does the selected transformational principal’s leadership style and behaviour affect the culture of the schools? The study, employing mixed methods, was split into two distinct phases. Phase 1 examined the leadership styles of the principals of the selected schools using the Multifactor Leadership Questionnaire (Bass, 1998) and Phase 2 was an in-depth study of the three principals selected and their schools exploring in detail how their differing leadership values and behaviour influenced school culture. Qualitative data collected in phase 2 was through interviews, observation and the gathering of data from artefacts. The major findings of the study were: 1. Both phases of the study show that the three principals show particular behaviours of transformational leadership with different levels of display. The findings also show that the leader with the highest levels of transformational leadership is leading the school with the highest outcome scores from phase 1. 2. Although the project was designed to investigate principal transformational leadership, the three principals showed usage of various leadership styles and behaviours whilst performing their duties. 3. Context, power, trust and change are important considerations in the three principals’ leadership behaviour investigated in the project. 2 4. The principals’ perceptions of their leadership style and behaviour differed from the way that the leadership teams and other teachers saw them. 5. All three schools have different cultures. These cultures have been characterised as being ‘not rock the boat’ with School E, ‘slow and steady’ with School L and ‘the extra mile’ with School J. 6. There is a relationship between the transformational leadership behaviours of the principals and the culture existing in the three schools.

The historical origins of Restorative Practices (RPs) can be traced back to the Māori communities in New Zealand (Wearmouth & Berryman, 2012). In the 1980s and 1990s RPs were applied in the criminal justice sector and a decade later in the educational sector (McCluskey, Lloyd, Stead, Kane, Riddell & Weedon, 2008b). According to a large-scale survey of English schools in 2009, some 69% reported to sometimes employ RPs (Kane, Lloyd, McCluskey, Maguire, Riddell, Stead & Weedon, 2009). The benefits of using RPs in schools are that it allows the focus to be shifted from punitive approaches to providing children with learning opportunities when conflict has occurred (Hopkins, 2003). The evidence base in the United Kingdom (UK) consists largely of evaluation studies for example a study was commissioned by The Scottish Executive Education Department (SEED) to measure the impact of RPs across 3 local authorities (Kane et al., 2009). The findings suggested that in 14 out of 18 schools, RPs had led to significant changes in practice, including increased positivity and reflectiveness in pupils and staff. Few research studies conducted in the UK have explored the perceptions of either the victim or ‘identified wrong-doers’ involved in RPs in school settings. Therefore the current study aimed to gain an insight into the perceptions of young people ‘identified as wrong-doers’ by school staff and who had been involved in some form of Restorative Interventions (RIs) such as a Restorative Conference (RC) or a Restorative Mediation (RM). A qualitative study was designed using Interpretative Phenomenological Analysis (IPA). 7 participants were recruited (5 males, 2 females aged between 11 and 16) from a Secondary school. Data was collected through semi-structured interviews which were conducted between one and six weeks after the mediation or conference had taken place. The data was analysed and five master themes were created: the emotional component of being involved in the RI process; the experience of RIs as learning opportunities; the interactions between individuals before and during the RIs; the experience of feeling vulnerable and difficulties with recognising, processing and expressing thoughts and feelings. Some of these master themes directly related to the RP process and others related to the general experience of being an ‘identified wrong-doer’. Methodological issues and implications are considered. For instance, in terms of the research setting, the current study gives an indication of the elements of the RIs the participants valued (for example sharing stories) and found challenging (such as expressing their emotions). One of the implications for Educational Psychologists (EPs) could be supporting schools to employ RPs effectively to create an inclusive school environment.

This thesis engages with travel writing at two levels: pedagogically and practically. It discusses at length, the unique configuration of travel writing’s literary currencies and conventions. Primary linguistic data were collected from travel texts collated within a portfolio of the researcher’s own negotiated and sustained practice as a travel writer. Within this portfolio the researcher engaged with a variety of travel text types, including a travel blog, prose and a poem. A close reading of these portfolio texts is presented, along with the introduction of the Aim, Design, Assessment (ADA) apparatus – a tool developed to aid the analysis and understanding of travel writing for both writers and commissioning editors. The findings present the following conclusions; Travel writing’s pedagogy does inform the practice, by way of its generic currencies and their inclusion within a travel writer’s professional practice. Secondly, that the ADA apparatus is a tool that the practitioner has applied here with measurable success in changing and developing both her writing and her attention to language. Within its conclusions, the thesis reflects on the researcher’s ResM Travel Writing degree and provides suggestions of how the genre can be taught academically. It documents a set of practices that the researcher evolved to professionalise her own travel writing. This positions the work within the discipline of applied research, where the science of academic research disclosures can be recycled into the pedagogic education and professional practice of travel writing. Examining travel writing from an interdisciplinary perspective (Tourism Knowledge, Design & Literary Studies) it also contributes to the volume of new tourism knowledge and introduces travel writing’s role as a toureme conduit.

No description available.

This is an exploratory study about understandings of dyslexia in primary schools in Kuwait. The study aims to find out how dyslexia is conceptualised in the Kuwaiti educational system and explore the implications of these understandings in terms of the identification of and support provided for children with dyslexia. The study investigates current practices in Kuwait to reflect the perceptions of the various people involved in this system, namely school staff (teachers, headteachers and school psychologists), students, and parents. It applies a variety of methods to explore participants’ perceptions and school practices. Furthermore, the study attempts to identify the influences of such understandings in developing ‘dyslexia-friendly’ practice and the barriers holding it back. The findings have posed some challenges for implementing inclusion for children with dyslexia in Kuwait. These challenges are mainly related to the educational context in Kuwait generally and the different actors involved in supporting dyslexic children, such as teachers, parents and schools. The study revealed an absence of those children from government and school policies. Participants had different understandings and interpretations about dyslexia. Their responses highlighted the complexity surrounding dyslexia as a concept and the lack of awareness on the part of people involved in the Kuwaiti educational system about children with dyslexia. The findings also displayed limitations stemming from the policy and cultural contexts, which impact the timing of identification. There is no clear policy targeted towards the early identification of children with learning difficulties/dyslexia; as a result of this an early intervention strategy is yet to be created for primary education. The findings further underlined the inclusive schools’ poor performance in accommodating children with dyslexia. On the other hand, Model schools are actually ‘segregated schools’ which kept children with learning difficulties generally and dyslexia in particular in specialised schools. The dilemma is hence represented between insufficient provision in the inclusive schools and the stigma of studying in a special school for learning difficulties, which in turn is aggravated by poor societal awareness. Participants had differing personal concepts of inclusion, which highlights the uncertainty about the implication of inclusion and the capability of the schools in the current provision to meet the needs of children with dyslexia. The study thus implies that there is an urgent and real need to implement a holistic framework for children with dyslexia using knowledge of the local context in Kuwait as well as benefiting from the international literature, research, and experiences in this respect. Such international experiences should not neglect the Kuwaiti context, however. In other words, it should benefit from international success with regards to dyslexia, but implement changes in the context of the country to successfully adopt culturally appropriate dyslexia-friendly practices.