Professional Doctorate theses
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Item TREE-BUILDING RELATIONSHIPS: INVESTIGATING THE EFFECTS OF ARBORICULTURAL KNOWLEDGE ON UK ARCHITECTS’ DESIGN PRACTICE.(Queen Margaret University, Edinburgh, 2024-12-11) Winn, GaryDespite an exiguous amount of published literature investigating the effects of arboricultural knowledge on UK architects’ design practice, factors influencing the practice of UK architects to incorporate trees within their designs have not been fully considered. The research presents a contribution towards this issue through an interpretative, qualitative study comprising a design workshop. It investigated the incorporation of arboricultural topics within UK architectural practice and resulting features of success. A purposive sample group participated in workshops considering application of arboricultural knowledge to design practice. Members of the sample group are defined as stakeholders: those with a professional interest in the study with potential to be affected by any outcomes. The study adopts Action Research (AR) utilising phases of planning, action, and reflection. Following a pilot study comprising three AR cycles, cycle 4 constitutes the intervention explored herein. The intervention adapted a tree-building system promoting possibilities for trees and buildings to coexist in close proximity. The system supported an evolution of current practice, enabling stakeholder utilisation within various areas of professional practice. General System Theory (GST) provided a strategy for exploring issues relating to the association between arboriculture and architecture. Findings produced three primary themes: 1. Engagement, freedom and enablement; impact on practice as a result of arboricultural understanding 2. Outcomes following acquisition of arboricultural hard skills; abilities and understanding 3. Shift of attitude towards a change of practice; relationships and education. Thus, acquired arboricultural knowledge and a holistic approach to design solutions has benefits including enabling better understanding of treebuilding relationships and deeper engagement with site contexts. Additionally, application of acquired arboricultural hard skills revealed changing attitudes towards tree-building relationships, with conflict emerging as a contributing mechanism. Stakeholders confirmed positive responses to receiving arboricultural knowledge, contextualising trees and practice within a variety of situations, including well-being and sustainability. Findings also identified a gap in professional training and current practice.Item A RETROSPECTIVE CLINICAL AUDIT OF THE CLINICAL APPLICATION OF THE RAYPILOT REAL TIME MOTION MANAGEMENT SYSTEM AND THE FEASABILITY OF ITS USE FOR FURTHER DOSE ESCALATED STEREOTACTIC BODY RADIOTHERAPY FOR PROSTATE CANCER.(Queen Margaret University, Edinburgh, 2024-03-13) Adamson, SusanBackground and purpose Prostate cancer is one of the most prevalent malignancies within oncology cases. Intrafraction motion is an important consideration in the clinical delivery of radiotherapy and indeed, long-term outcome and toxicity for patients. The purpose of this retrospective clinical audit was to review the efficacy of the RayPilot® real time motion management system and the impact that this has on planning target margins in prostate stereotactic body radiotherapy to assess if the RayPilot® system could be used clinically to allow for further dose escalation and fractionation reduction. Materials and methods Intrafraction motion was measured and recorded using the RayPilot® real time motion management system in seven patients. The RayPilot® system collated intrafraction data thirty times per second during treatment delivery for each patient. The collected data was then used to replan the patient in the Eclipse treatment planning software using reduced planning target margins to assess if this was a feasible method of dose escalation by reducing treatment fractionation. Results The RayPilot® recorded data resulted in 54175 intrafraction motion measurements in total. Mean displacement (following removal of outliers >0.3cm) was 0.1cm (SD± 0.1cm), 0.1cm (SD± 0.1cm) and 0.1cm (SD± 0.1cm) in the lateral, longitudinal and vertical directions respectively. The Van Herk Margin recipe was used to calculate the required clinical margins using the intrafraction motion data resulting in lateral, longitudinal and vertical margins of 0.7cm, 0.7cm and 0.7cm respectively. These margins allowed for dose escalation of 2400cGy in three fractions with no detrimental effects or increase in patient toxicity using dose volume histogram analysis. Conclusion RayPilot® is an efficient method of monitoring and recording prostate intrafraction motion and allowed for a reduction in target volume margins resulting in dose escalation in prostate stereotactic body radiotherapy. However, further analysis and research must be carried out to assess the feasibility of it being used as a stand-alone monitoring modality.Item The Lived Experience of a Single Cohort of NHS Scotland Podiatrists Undertaking Supervision. Supervisor and Supervisee Perspectives.(Queen Margaret University, Edinburgh, 2023) McIntyre, JosephIntroduction: The landscape for the allied health professions (AHPs) in the Scottish health and social care sector is evolving and arguably becoming more complex. Increasing demands, service pressures and patient complexity, are all influencing factors. Clinical supervision (termed supervision throughout this thesis) is a phenomenon which is widely utilised in the AHP setting to support staff in all aspects of practice. The researcher is embedded within the profession of podiatry, a profession which is somewhat new to the practice of supervision in the Scottish health and social care sector. The profession of podiatry, like the other AHPs, is experiencing rapid change. Podiatrists are inputting into more complex areas of care which historically they were not involved with. The researcher embarked on a journey to support podiatry staff in a local team with this rapid change and evolving landscape. The researcher sought to support podiatry staff by introducing an evidenced based model of supervision which was co-constructed between the researcher and the podiatry team involved in this research. The aim of this research was to explore the lived experiences of the podiatry staff within this team who were enacting this new model of supervision. Methodology: An interpretive hermeneutic phenomenological stance underpinned this research. Word clouds and participant led one-to-one interviews were used to explore (n=12) NHS podiatry participants’ lived experiences with the local model of supervision, (n=6) were supervisors and (n=6) were supervisees. Data was analysed by the researcher (JM) using methods which respected the hermeneutical philosophy of Hans-Georg Gadamer, and his concept of the fusion of horizons. Findings which emerged from the data analysis were co-constructed by the researcher and participants in the fusion of horizons. Findings: Four key phenomenological meanings emerged from the data which highlighted trust as a key essence of the phenomenon of supervision. The four key meanings represent different facets of trust which emerged in relation to participants’ experiences of the local supervision model. These included: ‘trust in the process and its impact and outcomes’; ‘trust in self’; ‘trust in one another’; and ‘trust in the organisation (and one’s position within)’. Conclusion: The findings of this research have added to what is already known about the concept of trust in relation to the phenomenon of supervision in the AHP setting. The findings also begin to build an evidence base in relation to supervision in the context of the profession of podiatry. To date, this is an area with little research, and thus this research begins to address this gap.Item A quantitative research study exploring translation, content validation, and crosscultural adaptation of the Arabic version of General Risk-taking Propensity Scale (GRiPS) with school-aged adolescents in Sur City in Oman(Queen Margaret University, Edinburgh, 2022) Al-Alawi, Muna Salim KhamisBackground and purposes: Epidemiology and prevention interventions programmes for risk-taking behaviours have been the target themes of many studies. In Arabic-speaking countries, including Oman, where this study is based, the prevalence of engagement in various risk-taking behaviours are worrying, particularly amongst school-aged adolescents. The General Risk-Taking Propensity Scale (GRiPS) is a valid and reliable scale in English for measuring general risk attitudes. There is no reliable and valid version of the GRiPS in Arabic. The purpose of this study was to describe the systematic instrument translation, content validation and cross-cultural adaptation processes of the GRiPS scale into Arabic version. Methods: in this study, a quantitative, and methodological methods using forward-backward translation and content validation indexing based approaches. Two panels (7 bilingual professional experts from education and health fields, and 24 school-aged adolescents panel) participated in the validation of this translation. Two phases were conducted: the translation process, and the content validation processes. The Item-Content Validity Index (I-CVI) and modified Kappa statistics were calculated. The translation, content validation, and cross-cultural adaptation processes resulted in the final Arabic version of the GRiPS scale. Results: The translated Arabic version of the GRiPS Scale is reliable and valid to be used to school-aged adolescents in Oman, including all Arabic-speaking adolescents in the world (reliability scored 0.80, and overall scale scored 0.90). Only two items (4 and 7) scored lower than 0.80 in readability and simplicity scores. There were minor gender differences between girls and boys. Conclusion: The study provided the first reliable and valid Arabic version of the GRiPS scale. Using appropriate translation, content validation, cross-cultural adaptation guidelines for adolescents and their parents in Oman is highly recommended in future studies.Item Closing the stable door after the horse has bolted: exploring Charcot foot health literacy among individuals with diabetic peripheral neuropathy in Scotland(Queen Margaret University, Edinburgh, 2022) Bullen, BenjaminCharcot foot is a potentially devastating complication of diabetic peripheral neuropathy (DPN). The frequently asymptomatic nature of this condition may lead to delayed recognition, diagnosis and pressure relief, associated with a characteristic ‘rocker bottom’ foot deformity. Deformity may, in turn, precipitate diabetic foot ulceration (DFU), infection and, ultimately, lower extremity amputation (LEA). Podiatric diabetes self-management education and support (DSMES) strategies have historically focused on DFU and LEA prevention, reserving Charcot foot information for those with ‘Active’ disease. The World Health Organisation defined health literacy (HL) as those personal traits and social support mechanisms required to understand and apply health information and access appropriate services. Specific traits and social support required to recognise and respond to early Charcot ‘danger signs’ were defined as ‘Charcot foot health literacy’ (CFHL). A resultant ‘Charcot foot health literacy conundrum’ was proposed, as individuals with DPN, ‘At-risk’ of Charcot foot, were not informed of their risk status nor did they receive targeted education or support. The research hypothesis was that individuals with Charcot foot experience, classified as ‘In Remission,’ developed specific CFHL traits through exposure to podiatric DSMES and reflection on past experience. This pragmatic, mixed methods research compared general, multidimensional HL and ‘Knowledge,’ ‘Understanding’ and ‘Contextualisation’ CFHL skills between people with and without Charcot foot experience, with the Health Literacy Questionnaire and a novel CCHAIR Study Qualitative Questionnaire, respectively. Study findings confirmed ‘At-risk’ individuals lacked Charcot foot knowledge. All participants more readily associated this condition with late-stage complications, rather than early inflammatory signs. Charcot foot experience was associated with active self-management and those ‘In Remission’ remained engaged with specialist podiatry and/or multidisciplinary services. Future DSMES approaches should target all individuals with DPN, focusing on prompt self-recognition of, and self-referral in the event of, Charcot foot ‘danger signs.’Item A Prospective Observational Study on Factors that Influence Survival or Non-survival for the Patient Suffering Out-of-hospital Cardiac Arrest within Abu Dhabi Emergency Medical Services(Queen Margaret University, Edinburgh, 2021) Alhmoudi, AssimIntroduction: Out-of-hospital cardiac arrest (OHCA) is a global health concern and one of the leading causes of death. Each year, three thousand patients in Scotland suffer OHCA while only 6% survive to hospital discharge. Only one out of ten OHCA cases in England survive OHCA every year. In total, 37,054 OHCA were reported from 28 European countries in 2017, with only 8% surviving. Death and disabilities from OHCA can be avoided (Graham et al. 2015). Immediate comprehensive strategies to improve patient’s survival is critical to saving lives. In the United Arab Emirates, strategies to improve OHCA survival do not exist in the capital city of Abu Dhabi. The OHCA survival rate within pre-hospital care has yet to be investigated. Lack of OHCA status knowledge impacts examining the survival rate adversely and may prevent any potential improvement in Abu Dhabi. Factors such as unique demographics, cultural aspects, patient characteristics, and policies may influence patient survival; however, the apparent lack of research in the Abu Dhabi context is a significant concern. Thus, the purpose of this thesis is to identify the survival rate and factors that may influence survival or non-survival for an OHCA by Abu Dhabi emergency medical services (EMS). Method: A descriptive cross-sectional approach based on a quantitative prospective data set was undertaken. A cardiac-arrest registry was created to record OHCA data prospectively in 2019 and was utilised for this thesis project. Result: Three hundred and thirty patients with OHCA (79 females, 250 males, 1 unknown) were included in this research between January and December 2019. Most patients recorded for this study were witnessed (72%), male (75%), of younger age 56.93 ± 18.67 years. Most OHCAs happened at patients' homes (60%) to individuals who have a history of cardiovascular diseases (76%). The EMS arrival at the patient’s side was 10.15 ± 4.92 minutes and the average time from patient collapse to EMS arrival was 14.7 minutes. The majority of resuscitation was initiated by the EMS staff (82.4%). First ECG rhythm and pre-hospital return of spontaneous circulation (ROSC) were predictors of survival status, while no significant prediction was determined for age, response time, and bystander CPR (X2 (5) = 31.61, p< 0.000, Nagelkerke R2 = 0.58). The current study found that Abu Dhabi EMS interventions (epinephrine injection, advanced airway management, and mechanical CPR device) do not yet significantly affect patient survival (X2 (3) = 8.50, p= 0.04, Nagelkerke R2 = 0.18). This study defines one key factor that influences survival for OHCA treated by Abu Dhabi EMS, being that the patient was more likely to survive if basic life support is started within seven minutes or less from when the patient collapsed (p = 0.02). Pre-hospital ROSC was observed in only 56 individuals with OHCA (17%). Of 330 patients, only 16 with OHCA (5%) (6 females, 10 males) survived to discharge from the hospital. Conclusion: A critical factor to emerge from this study is that scientific research is now recognised by the Abu Dhabi EMS for the first time since its inception in 2001. The findings shed light on current Abu Dhabi EMS abilities concerning critical patients' care. My original contribution to knowledge is identifying opportunities for a patient's survival following OHCA and suggesting high-priority actions in Abu Dhabi pre-hospital care.Item The transition to retirement: A narrative inquiry(Queen Margaret University, Edinburgh, 2020) Renton, LindaThe aim of the study was “To explore how people experience the transition to retirement” and the research question was “How do people experience the transition to retirement”. The literature review aimed to identify and critically explore relevant research, in relation to peoples’ experiences of the transition to retirement and ten studies were included. The following five themes were generated and discussed: paradoxical issues, change, occupation, ways of transitioning to retirement and challenges in the transition to retirement. Links were made to occupational adaptation theory. Many of the studies were dated and the gap for further research exploring experiences of the transition to retirement was identified. The methodology and methods were theoretically underpinned by an ontology of relativism, epistemologies of interpretivism, social constructionism and constructivism and a methodology of narrative inquiry. A convenience sample of seven recently retired individuals and financial advisors (providers of pre-retirement courses) was interviewed, using narrative interviewing, and the interviews were analysed using narrative analysis. The findings showed that four overall themes emerged from fourteen shared plots. These were “planning retirement”, “how and when I transitioned to retirement”, “experiencing early retirement” and “what I do in early retirement”. The findings demonstrated that there was agreement with previous studies regarding staying healthy, freedom, occupational balance and engaging occupations. New findings emerged in relation to positive experiences, loss, freedom, family relationships and caring in the transition to retirement. The findings were related to, and interpreted using, occupational adaptation theory and the concepts of occupational identity and engaging occupations. This offered insight into potential occupational challenges, as well as ways of acknowledging, facing, changing or selecting occupations, in the transition to retirement. In conclusion, occupational adaptation theory, along with an understanding of engaging occupations and occupational identity, was found to facilitate and underpin the occupational transition to retirement. This new knowledge can be applied to practice with individuals, groups or communities preparing for, or transitioning into, retirement, when anticipated changes in occupations could be identified and explored. The implications of this work are that by using the theory of occupational adaptation, occupational identity and engaging occupations, potential occupational challenges in the transition to retirement can be identified and resolved.Item An exploration of nurse preceptors’ perspectives of a pre-registration nursing clinical preceptorship programme in an acute hospital context in Egypt: A constructivist grounded theory approach(Queen Margaret University, Edinburgh, 2020) Helaly, OmniaBackground: The proposed reforms of Egyptian nursing education are based on competencies to achieve well-educated nurse graduates. There is a shortage of clinical faculty and increasing demands for nurse preceptors to act as clinical instructors. There is no national framework to prepare nurse preceptors or clinical instructors, nor a clear framework for implementation of an evidence-based competency-based pre-licensure internship. Research is needed to explore factors influencing the preparation of preceptors and preceptorship programme priorities in the nursing context in Egypt. Aim: To explore preceptors’ perspective of their previous preceptorship experiences and the factors that influence their professional role and development while introducing competency-based internship in an acute critical care hospital in Egypt. Purpose: To develop a contextual preceptorship model to help prepare professional nurse preceptors as clinical leaders within their organizations. Methodology: A qualitative inquiry approach was used with two phases of spiral Constructivist Grounded Theory to develop the proposed theoretical themes. The first study phase engaged semi-structured interviews and comparative analysis of data to construct initial codes. The second phase shared theoretical sampling with participant focus groups. Further data verified initial codes and analysis continued until theoretical themes emerged. Results: The concepts of self-awareness and self-esteem become first steps in an over-arching theme of developing preceptors as lifelong learners. These concepts emerged from the core themes of, ‘Education misalignment issues’, ‘Preceptor selection criteria’ and ‘Developing preceptors as lifelong learners. Discussion: The study analyzed findings with comparison to relevant research literature. A contextualized developmental model of competency-based preceptorship programme is proposed as based on four key phases ‘Discovery’, ‘Selection’, ‘Socialization’ and ‘Development’. Conclusion: A critical component of the conceptual model is improving self-esteem through promoting self-awareness. The proposed program can help academic and hospital leaders to sustain the competency-based internship, orientation and preceptorship to improve the quality of nursing care.Item AN EXPLORATION OF MIDWIFERY PRACTICE VIEWED THROUGH A SOCIAL CONSTRUCTIONISM LENS IN ORDER TO GAIN AN UNDERSTANDING OF HOW MIDWIVES PROVIDE CARE TO PREGNANT WOMEN WHO ARE OBESE(Queen Margaret University, Edinburgh, 2020) Greig, YvonneTo enter pregnancy whilst obese carries risk for both mother and baby but obesity rates continue to rise. Community midwives are now the lead carers for all pregnant women and will inevitably encounter women whose health is at risk due to being obese. This qualitative study has explored how midwives construct their practice when delivering care and advice to women who live with a raised BMI≥30kg/m² and what it means for them to do so. Thirteen in-depth interviews were conducted with practicing community midwives in South East Scotland. Participants were invited to complete reflective diaries. Interviews took place between January and May 2018. Interviews were audio recorded and then transcribed verbatim. Data were analysed thematically using a stepwise approach, the software package NVivo 10 was used to assist in this process. Three main themes emerged – ‘The situational context of practice’, ‘Constructing relationships and partnerships with women’ and ‘Midwives as public health agents’. Findings suggest that both the situational context and the role of community midwives is complex. Midwives appear to construct a unique approach to antenatal care as they provide care to women structures that do not appear to be flexible. They appear to ‘move’ between the paradigms of traditional midwifery practice and that of obstetric medicine and simultaneously promote normality and manage risk, in so doing they construct a unique pattern of practice. The public health agenda competes for time during appointments with midwives being expected to deliver voluminous information to women leaving little time to develop woman-focused care. Midwives rely on clinical protocols to open dialogue pertaining to obesity and its risks. Midwives could develop more personalised care schedules in partnership with women, ensuring that the woman’s voice is heard and that her needs are met. Practice may be strengthened by equipping midwives with enhanced consultation skills, enabling them to raise sensitive issues. Exploring alternative ways to address public health components may also facilitate better use of time, allowing midwives to ensure the antenatal appointment is woman-focused. Keywords – Midwives, pregnancy, obesity, public healthItem Doing Mad Studies: A Participatory Action Research Project to explore the experiences and impacts of being part of a Mad People’s History and Identity course and the relationship between critical education, activism and emancipation(Queen Margaret University, Edinburgh, 2019) Ballantyne, ElaineMad People’s History and Identity (MPHI) is a Mad Studies course delivered at Queen Margaret University (QMU). The course is a partnership including academics at QMU, Consultancy and Advocacy Promotion Service (CAPS), NHS Lothian and people with lived experience of mental health issues. LeFrançois (2016, p. v) provides a coherent definition of Mad Studies stating that “mad activist scholarship, a form of knowledge production or collective intellectual contribution that is embedded in Mad community interventions and actions.” MPHI is an exercise in critical pedagogy to facilitate “conscientisation” through the exploration of individual and collective experiences of madness, psychiatrisation and oppression. It aims to engage students in challenging dominant discourses, creating counter-knowledge and activist resistance to the Epistemic Injustice and oppression experienced by the mad community. This PAR research proposed to explore the experiences and impacts of being part of the course. Its main focus was on the exploration of the relationship between participation on the course and activism. Congruent with the philosophy of the course, this research was committed to privileging the experiences, knowledge and histories of the user/survivor/mad MPHI students. A PAR group of four students, two partners from CAPS and the author co-produced this research. Data collection involved the peer interviews of nine MPHI students. The actions of the research were the generation of a Photovoice exhibition and the production of a film. The research revealed that participation in the course had facilitated change in both mad and intersectional identities. It had given voice to experiences of distress, psychiatrisation and oppression. The collective experience had fostered support, solidarity and increased social capital. This included accessing new communities, occupations and engagement with social movements. The course had raised consciousness of personal and collective oppression resulting in agency and engagement with advocacy and activism. Key words: Mad People’s History, Mad Studies, Participatory Action Research, Activism.