Teaching has been reported to be one of the most stressful professions in the UK (HSE, 2000). There is vast international literature that has documented for many years the negative implications that stress and burnout can have on educators’ health and well being and the wider systems and individuals’ connected to their work. The research also clearly documents that the development of school support systems can mediate the negative effects of stress for educators (Zellars & Perrewe, 2001). Given that teachers are one of the UK’s largest groups of public sector employees (Bowers, 2001) and that the education system is once more in a period of rapid change, it makes this piece of research timely in the current context of education policy and practice. This study calls for policy makers to recognise that stress in the education system is becoming an increasingly worrying trend and one that with the right kind of support systems in place could be alleviated in the future. Focus of thesis Two papers form this thesis. A flexible design consistent with an interpretive approach and a social constructionist philosophy has been adopted. Epistemology Social Constructionism Theoretical Perspective Interpretivism Paper One Paper Two Methodology Methodology Illuminative enquiry Action Research Methods Methods Semi-structured interviews Focus group Focus group Open questionnaires The purpose of paper one was to generate new understandings and gain insights into participants’ experiences regarding school staff stress, school support systems and the implications of this. The findings from the first paper informed my second paper. In paper two I worked with school staff to develop and evaluate a support-based intervention in order to address the gaps in support that staff identified in the first paper. This thesis was conducted in a large secondary community college, with a specialist subject status. This was located in a unitary authority in the South West of England. All participants that took part in this research were employed as teachers, support staff and/or members of middle or senior management team at the school. Paper one findings The findings in this study showed school systems to be complex environments, affected greatly by a range of internal and external factors. Participants’ experiences indicated that stress and burnout are a function of the quality of work life in the education system for many, with negative implications associated with those closely connected to them and the education system. This paper contributes to the existing body of knowledge in this area by drawing participants from across the school meso system, as opposed from one part of the system, ensuring that all those working at different levels within the school were represented. A key issue uncovered by this study and adding to the existing literature in the field is the hierarchical nature of schooling. This hierarchy served to maintain the causes of stress experienced by my participants. These causes were systemic in nature as the issues raised were common across my participants and originated from the way the school system was organised and operated. The implication of this is that the focus of support needs to be aimed at adapting the school environment to reduce the main areas of stress faced by teachers and support staff and helping teachers to deal more positively with the stress factors within the environments and systems in which they work. The evidence also showed that my participants had a limited knowledge of the wider roles of the EPS and this may be significant area for the local authority in which this research was conducted to focus on in the future. This paper’s contribution is timely given the current context of education policy and practice Paper two findings The focus of this paper was developing and evaluating, in collaboration with participants, a staff support-based intervention. The staff’s support intervention of choice was a series of short training workshops focused on developing a better understanding of stress, promoting EHWB, assertiveness and methods of support. There were four stages to the creation of the intervention: Development of the intervention (through a focus group and the collaboration of school staff); Recruitment of participants (conducted through the senior management team through emails and staff reminders); Implementation of the intervention (five one hour, after-school workshops, using a range of teaching strategies, including practical skills; Outcomes (gained through an open pre and post training questionnaire which considered the practical strategies the participants had adopted from the workshop and applied to their practice). Despite working with staff including teachers, non teachers and senior staff to design the intervention, attendance at the after-school training workshops was poor, with only five members of the school’s support and special needs team attending. There were no teachers or members of the senior management team present. However those staff that did attend the training intervention provided positive feedback and found it useful in their practice. The questionnaires suggested that the training increased staff’s knowledge of how to manage their stress and to promote their well-being. Staff also stated that they were able to apply the practical strategies provided directly to their practice. One of the main purposes of paper two was to begin the process of change in participants’ perceptions and practice. As a direct result of conducting this piece of research the school of focus have set up a staff well-being forum, open to all staff, to meet on a termly basis to discuss matters relating to staff EHWB and support. The school are also considering setting up staff consultation groups for the teaching assistants in the future, in addition to creating a staff well being notice board, a suggestion box, having a staff well being awareness day, creating a staff well being policy and also providing yearly drop in sessions for staff on stress management. The role of the EP EPs are well placed to offer their services to schools in supporting them with examining professional support systems. EPs are experienced researchers and could conduct small pieces of individual school-based research looking at those areas of the workplace where stress is experienced the most and be able to identify gaps in staff support systems. EPs are equipped with the training and experience to provide bespoke packages of support for individual schools that may include staff training aimed at prioritising staff support and EHWB both in policy and practice. It seems then that EPs are well placed to work in collaboration with schools to develop their staff support systems in this area of staff development and school improvement.

The aims of this thesis were to explore nurses' experiences of stress in the ICU (I), to analyze experiences of moral concerns in intensive care nursing from the perspective of relational ethics (II), to describe the synthesis of the concept of moral stress and to identify preconditions for moral stress (III) and to analyse and describe lived experiences of support in situations characterized by critical care situations and moral stress in intensive care (IV).The design was exploratory and descriptive. Material in studies I, II and IV consisted of interviews with intensive care nurses (10 head nurses and 26 staff nurses) employed in general, thoracic and neonatal intensive care units in five hospitals located in different parts of Sweden. The material in study III data from two studies of professional issues in nursing were used for the analysis: one concerned psychiatric nursing and the other was the previously referred study I.In study I qualitative content analysis and descriptive interpretation was used in the analysis. The main theme 'stress induced by dissonant imperatives' formulated in the analysis. Dissonant imperatives are composed of the four sub-themes: 1) controlled by the working situation - needing to be in control, 2) constrained by prioritisation - wanting to do more, 3) lacking authority to act - knowing that something should be done, and 4) professional distance - interpersonal involvement. In study II qualitative content analysis and descriptive interpretation were used in the analysis. A main theme was formulated, 'caring about-caring for: tensions between moral obligations and work responsibilities in intensive care nursing'. Five sub-themes were formulated 1) believing in a good death, 2) knowing the course of events, 3) feelings of distress, 4) reasoning about the physicians and 5) expressing moral awareness. In the study III a hypothetical-deductive method was used. The findings indicate that moral stress is independent of context-given specific pre-conditions: 1) nurses are morally sensitive to the patient's vulnerability, 2) nurses experience external factors preventing them from doing the best for the patient, and 3) nurses feel that they have no control over the situation. In the study IV an interpretive method was used. The first level of analysis of data identified contextual factors, such as type and purpose of support and working conditions. Thereafter five tentative interpretations were revealed: 1) receiving organised support is a matter of self-determination, 2) whether to participate or to be off duty is experienced mutually as exclusive, 3) dealing with moral stress is experienced as a private matter, 4) colleagues managing moral stress serve as models in stress support, and 5) not being able to deal with moral stress urges one to seek outside support. A comparison of these interpretations identified three major themes: availability, accessibility and receptivity of support. The main interpretation of data was: "lived experience of moral stress support involves an interconnectedness between structural and existential factors".A comprehensive understanding was formulated using the four studies (I, II, III and IV). Moral stress was found to be influential on the caring competence. Conflicts between different competences were found leading to a shift in focus away from the patients leading to a possible decrease in the caring competence. Moreover, the subtle resistance among nurses toward participation in organized moral stress support may obstruct the development of nurses' caring competence. Accordingly, imbalance, due to moral stress, between different competences hinders the development of collectively shared caring competence.