Following the expansion of the European Union (EU) in 2004, migration from the new Accession 8 EU Member States to the United Kingdom (UK) has been identified as one of the most significant international migratory movements to the UK in recent times. The largest member of these states is Poland and the UK has been the most common destination for Polish migrants post 2004. Arguably, there is limited literature that focuses solely on women; indeed, women migrants were invisible until the 1970s. In relation to A8 migration, gender and gender roles are an under-researched area. The aim of this thesis is to fill this gap and offer new insights with regard to the influence of the migratory experience on Polish women’s lives and the way they negotiate their gender roles through migration. This thesis contributes new and unique evidence to the debates surrounding migration, gender, Polish women and comparative social policy, in particular with regard to the role of networks in migration; enduring and new push and pull factors; the icon of ‘Matka Polka’ and work-life balance. Through the use of 32 qualitative in-depth semi-structured interviews with Polish migrant women resident in two countries – the UK and Poland, this thesis considers the factors that motivate the initial and any subsequent ‘return’ international migratory movements undertaken by Polish women between the UK and Poland. Additionally, the ways in which Polish migrant women (re)negotiate their gender roles in regard to paid work and informal familial care across time and space are explored. It is concluded that motivations for migration as well as motives to remain in the host country are often related to economic factors and the availability of migrant networks. It is shown that the migratory process may indeed influence women’s perception of gender roles which seem to be re-evaluated post migration.

It is commonly stated proprioception or the perception of one’s own limb position, movement and effort is reduced following an anterior cruciate ligament (ACL) injury. Therefore, this thesis begins with an analysis of all current literature on this topic in the form of a meta-analysis. It became clear that the methods used to measure knee proprioception were very inconsistent and did not appear to provide normative levels of knee proprioception making it very difficult to syntheses results. This led to the thesis main objectives. The first study provided a reliable and valid method of knee joint position sense (JPS), the static component of proprioception, based on previous JPS protocols. This method was then used in the remaining studies to consider normative values of a UK population, the effect of ACL injury in both non-athletic and elite athletic populations, the effect of knee injuries (not including ligament damage) and the effect of fatigue on knee JPS. The most appropriate clinical method of measuring knee JPS using image capture as covered in this thesis was in a sitting position, from full extension in to 60-90 degrees of flexion and from 90 degrees of flexion in to 30-60 degrees of extension. Age, mass, height, BMI, activity level, knee condition (other than ligament injury) or fatigue did not appear to significantly affect knee JPS in an uninjured population. However, both non-athletic and elite athletic populations with previous ACL injury demonstrated significantly worse knee JPS when compared to controls. In conclusion, it would appear the only knee condition that reduces joint position sense ability is ACL injury. Although, it may also be possible the method is not sensitive enough to measure subtle changes in JPS in other populations due to large measurement error values. In the future it may not be necessary to place importance on knee joint position sense as it either may not be impacted by any injury other than ACL damage, or the methods used to collect JPS are not sufficient in measuring changes during rehabilitation. Additionally, it is important researchers consider the relationship between knee JPS and functional movements.

Title: Nursing Observation and Assessment of patients in the Acute Medical Unit Objectives: To generate knowledge and understanding of the observation and assessment of patients in the acute medical unit, where patient acuity and activity is unpredictable and length of stay for patients is brief. Background: Time and temporality pose challenges for the nursing observation and assessment of patients because unlike other hospital wards, the acute medical unit is a dedicated acute short-stay facility, admitting patients with highly complex medical illness on a 24-hour basis. Over the past fifteen years, political drivers for improved efficiency of hospital beds, combined with recent austerity measures, have resulted in shorter length of stay in hospital for patients. The implications of these for nursing practice and the observation of patients have not previously been investigated. Method: An ethnographic approach was applied to explore the nursing observation and assessment of patients admitted to an acute medical unit. Data were collected from seven nurse participants using participant observation and qualitative interviews over a six-month period. A thematic analysis was undertaken. Results: The brevity of nurse-patient relationships combined with a problematic ward layout resulted in adaptations to practice to ensure safe monitoring of patients, including frequent visual and verbal assessments of patients. Nurses observed for facial colour, expression, appearance and verbal response. Nurses employed explicit, tacit and intuitive knowledge to interpret observations of patients and safely managed highly complex care despite the challenge of limited time. Nurses demonstrated expertise despite having limited experience. Recommendations: Layout of the acute medical unit must consider ease of visibility for patient observation and impact upon nursing workload. Recognition of nurses' ability to safely observe patients is essential, rather than relying upon the use of paper-based observation tools. Acute medical nursing must be recognised as a distinct specialism, with appropriate standardisation.

This study aimed to evaluate stroke rehabilitation services including the quality of services and the opinions of multiple stakeholders involved in stroke rehabilitation. Several methodologies were employed including a literature review, content analysis of national documents, case note audit and questionnaires of patients, staff and commissioners. The content analysis identified 214 separate recommendations from 15 documents. Of these 21 were relevant to every patient receiving stroke rehabilitation; 13 related to the overall service provision and 8 related to specific aspects of patient care. These recommendations were converted to standards and used to audit the 10 stroke rehabilitation services in Greater Manchester using 100 individual patient records. 146 patients completed a satisfaction questionnaire, 46 staff and 6 commissioners completed questionnaires. Results demonstrated variable compliance to national recommendations with primary stroke centres showing greater adherence than district stroke centres, indicating a two-tier service. All services offered a weekly multidisciplinary team meeting, 93% of patients spent most of their time in hospital on a specialist stroke ward and 96% commenced rehabilitation as soon as they were medically stable. However, only 22% of patients received 45 minutes of therapy per day and 4% received a discharge plan when leaving hospital. Staffing levels did not impact on adherence to national recommendations, however the most long-standing and prominent recommendations achieved greatest compliance. Patients felt that they were treated with dignity, with older patients being more satisfied with stroke rehabilitation services than younger patients. However, patients did not feel that they received enough therapy or information relating to their goals within rehabilitation. Staff felt patients should receive more therapy than they currently do; patients should receive more than 3 hours a day despite currently receiving less than 60 minutes a day. The amount of therapy offered varied across disciplines with speech and language therapists providing less therapy than occupational therapists, physiotherapists and nursing staff. Staff felt the primary factor limiting the amount of therapy was staffing levels. Commissioners' primary priority was to improve the outcomes for stroke patients, however different monitoring mechanisms between localities leads to the potential for different priorities and accountability. This study is the first to systematically compile and evaluate national recommendations within stroke rehabilitation services and to include commissioners in the evaluation of stakeholders’ opinions.

Objectives: The primary aim of this UK-based study was to identify core clinical competencies (skills, knowledge, attitudes, and behaviours) for primary-care-based extended-scope physiotherapists (ESPs) working in the field of adult musculoskeletal (MSK) medicine. Although the musculoskeletal (MSK) ESP role in the UK has been in existence for over 10 years, there is no competency and curriculum framework supporting these posts. This study used a consensus-building methodology with a multidisciplinary panel of MSK experts to identify core clinical competencies for MSK ESP practice. Methods: Purposive sampling was used to recruit MSK ESPs and MSK medical experts from six specialist fields within medicine: rheumatology, neurology, neurosurgery, general practice, orthopaedic surgery, and rehabilitation medicine. Seventy-two experts volunteered to take part in a three-round online Delphi survey and fifty-six experts completed all three rounds. Qualitative data from the first and second questionnaire rounds were analysed using content analysis, and descriptive statistics facilitated the presentation of quantitative data. Principal findings: The expert Delphi panellists identified 104 core clinical competencies for primary-care-based MSK ESP practice and they reached a consensus view on 85 competency items. Importance and Relevance: This is the first study to have identified core clinical competencies for primary-care-based MSK ESPs. Although further work is required to validate the results of this Delphi survey, they represent a contribution to knowledge in the field of MSK ESP practice and they should assist the professional body and the health care regulator with their development of a nationally agreed competency and curriculum framework for MSK ESP practice.

Introduction: Over the last decade there has been a significant increase in the use of computerised clinical decision support systems (CCDSS) in health care. While significant research has been carried out to demonstrate the impact of CCDSS, the role of CCDSSs in Emergency Departments (EDs) remains under-investigated. The aim of this study was to investigate if the introduction of a CCDSS at ED triage, improved the quality and safety of decisions at triage and improved overall departmental safety. Methods: This study adopted an interrupted time series design, with 8 time points. A random sample of triage records (n=400) from the year before the introduction of eTriage (four time points) were compared to the same number of records from the year after its introduction. Data was extracted from ED clinical records to establish the accuracy of triage prioritisation as an indicator of safety and the management of pain as an indicator of quality. A smaller subset of cases (n=44) over the same time period were analysed to assess any differences in the clinical management of patients presenting with neutropenic sepsis, a further indicator of safety. Logistic regression analysis was undertaken to expose the underlying decision-making trend over the whole study period. Results: This study demonstrates a statistically significant improvement in triage prioritisation (p<0.001), pain scoring (p<0.001) and pain management (p<0.001). Logistic regression demonstrated improvements in decision-making above what have been expected if eTriage had not been introduced. For patients presenting with neutropenic sepsis there was no statistically significant difference in their clinical management. Conclusion: This study clearly demonstrated the positive impact that a CCDSS can have on the quality and safety for ED patients and provides a unique contribution of the current ED CCDSS knowledge base. The ever-increasing demand for emergency care and the difficulties in recruiting an experienced workforce is a fertile environment for clinicians to harness the potential that technological solutions can offer.

A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing. Johannesburg, 2017 / Background and objectives: The purpose of the study was to explore and describe the economic and social wellbeing and aspirations of professional nurses in selected provinces of South Africa. The objectives of the study were: to explore the existing evidence on the nature and meaning of aspirations and their impact on wellbeing, to formulate an aspiration questionnaire based on existing evidence, to explore and describe the economic and social wellbeing and aspirations of professional nurses in selected provinces of South Africa, to determine if there is any difference between the economic and social wellbeing and the aspirations of professional nurses in urban and rural provinces and to formulate recommendations for addressing the economic and social wellbeing and aspirations of professional nurses in South Africa. Method: An exploratory, sequential mixed method design was used. The study was conducted in four phases (scoping review, Delphi study, a survey and formulation of recommendations with the assistance of experts through a focus group and follow up verification. The results of qualitative phase were used to build onto the quantitative phase. One thousand, one hundred and thirty-eight (1138) professional nurses participated in the study. The data from all phases of the research was integrated prior to the formulation of recommendations which were organized according to the Walt & Gilson framework (1994) in order to answer the research question. Results: Important lessons were learned in terms of professional nurses’ aspirations for job satisfaction, possessions, financial success, self-acceptance income and status and power. The quantitative data revealed that professional nurses as a group are mainly mature (the majority >40 years old) unmarried females, working irregular hours, highly indebted and who carry the financial and social burden of caring for extended families. They value education, both for themselves and their children, but are part of the ‘missing middle’ as far as accommodation is concerned as they earn too much to qualify for grants and too little to qualify for housing mortgages. Overall, professional nurses’ have aspirations that are not met which impacts on their economic and social wellbeing. There is no significant difference between the economic and social wellbeing of urban and rural participants. Conclusion: Recommendations aimed at addressing the aspirations, economic and social wellbeing of professional nurses in South Africa were formulated. However, it is clear that an inter-sectoral and inter-departmental approach is required to address the aspirations, economic and social wellbeing of nurses if a positive impact is to be made. Keywords: professional nurses, aspirations, economic wellbeing, social wellbeing, wellbeing. / LG2018

Background: Children make up more than 50% of the population affected by humanitarian crisis. Although it has been shown that a stable, nurturing and safe home environment can help mitigate the negative effects of ambient violence and instability, with deteriorating family relationships and poor psychosocial wellbeing of caregivers in humanitarian crisis, children may face an additional source of harm from within their home. This scoping review was conducted to a) examine the extent to which caregiver psychosocial wellbeing and family violence affect the wellbeing of children and b) understand if interventions and programming can improve wellbeing of children through changes in caregiver psychosocial wellbeing or family violence. Methodology: Using the Arksey and O’Malley framework, we searched three electronic databases and various grey literature sources for literature that discussed the associations between caregiver psychosocial wellbeing and/or family violence, and the wellbeing of children. A quantitative and thematic analysis was conducted to examine the extent, range and scope of literature. Results: The findings from 22 identified observational studies indicated that caregiver psychosocial wellbeing and family violence are both associated with various dimensions of child wellbeing. Although the three interventional studies suggest that targeting caregiver wellbeing and family violence may be promising, the search revealed very limited evidence in the form of evaluated programs that reliably measure caregiver and family dimensions, while also measuring child outcomes. Conclusion: Focusing on improving the wellbeing of caregivers and reducing family violence may provide an important venue through which we can improve the lives of children. However, further research must be conducted to expand our understanding of the relationships between relevant factors, and to create robust program evaluations to determine the efficacy and value of interventions. Such research can contribute to the evidence base that is crucial to helping us protect and promote the wellbeing of children in these challenging contexts. / Thesis / Master of Science (MSc)

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Yes / ESRC funded project Powering Productivity (ES/S015124/1)