Professional Doctorate theses
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Item 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.Item A qualitative study exploring healthcare students’ understanding of their moral compass and its influence on practice.(Queen Margaret University, Edinburgh, 2019) Edwards-Horton, SusanAims: To explore healthcare students’ understanding of their moral compass. Background: Francis (2010; 2013) highlighted failings within health and social care delivery, identifying themes of poor care, compassion, dignity and respect as issues. Stimulated by these reports a critical literature review revealed spirituality to be important in developing good healthcare practice. A proof of concept (pilot study) sought to understand healthcare students’ understanding of religion/spirituality. The moral compass emerged as an important theme that required deeper understanding. Methodology: I took a critical, social constructionist perspective incorporating a theological axiology, as I sought to understand healthcare students’ moral compass. The research was exploratory and descriptive using qualitative and inductive approaches. Methods: Sampling and recruitment was purposive (N=12), using students within a higher education institution in Lothian. Three data collection methods were used (interpretation of picture cards, identification on journey lines key points where healthcare students felt their moral compass was developed or challenged, and one-one, face-face semi-structured audio-taped interviews) and data was triangulated to increase rigour and trustworthiness within the study. Analysis: Data analysis used an iterative process of thematic analysis, with a critical exegetical/hermeneutical interpretation. I used the theological/anthropological lens of St Augustine’s Two Cities, ‘The City of God’ (spiritual) and the ‘City of Man’ (secular) as a reference to interpretation. Interpretation: Early religious education appeared to influence how an individual’s moral compass developed. Having a faith, seemed to guide an individual in the choices they made, developed self-esteem and the way they interacted with others. Elements such as forgiveness and trust were important in relationships. Feelings of guilt and shame were evident with wrong-doing but the level of wrong-doing appeared to be calibrated depending on the situation. Conclusion: It would appear that what a person does in this life can influence how they will enter the next-life. A great deal of information was generated concerning forgiveness, trust, guilt and shame which need to be addressed for proper moral development. Participants calibrated these factors depending on their situation and it is proposed that the moral compass can be fluid.Item People with serious mental illness living in supported accommodation: a meta-analytic and secondary data analysis study(Queen Margaret University, Edinburgh, 2019) Harrison, MichelePeople with serious mental illness experience significant difficulties related to social, occupational and cognitive functioning. A key form of intervention for these individuals is supported accommodation, with the aim of providing opportunities to live in the community, develop independence and increase social integration. Supported accommodation ranges from help being available 24 hours a day, to having support provided at home one to two times a week. There has been increasing interest in understanding if this type of intervention not only supports clinical outcomes – that is, symptoms and levels of risk – but also outcomes important to people’s recovery, including wellbeing, satisfaction with life, living conditions and social functioning. The aim of the research was to investigate supported accommodation for people with serious mental illness. The first objective was to consider outcomes for individuals, including quality of life issues such as wellbeing, satisfaction with living conditions and social functioning. The second objective was to understand what personal and environmental factors determined the placement of individuals in different types of supported accommodation. This study followed two stages. First, a systematic review and meta-analysis of outcomes for people with serious mental illness living in three types of supported accommodation was conducted to address the first research objective. This identified that outcomes related to wellbeing, satisfaction with living conditions and social functioning improved for people as they moved into accommodation with less support. The second stage used secondary data analysis of two national datasets: the Scottish Morbidity Record – Scottish Mental Health and Inpatient Day Case Section (SMR04); and the Scottish Government Social Care Survey (SGSCS). This phase primarily addressed the second research objective. Logistic regression modelling identified the contextual factors that predict being placed in supported housing and floating outreach accommodation from high support accommodation. For placement in supported housing compared to high support accommodation, predictors were age, a diagnosis of schizophrenia, length of stay and a formal admission to hospital. For placement in floating outreach compared to high support, formal admission to hospital was a predictor. There was limited data available which would address outcomes associated with different placement types. However, predictors of people’s needs were identified. A diagnosis of schizophrenia predicted having a healthcare need; length of stay predicted having a social, educational and recreational need; and individuals were more likely to have needs identified if support was provided by the local authority. The results suggested that people with serious mental illness achieved greater wellbeing, satisfaction with living conditions and social functioning in less restrictive accommodation. Predictors of accommodation placement were prolonged involvement with mental health services, a diagnosis of schizophrenia and extended lengths of stay in high support. Irrespective of placement type, social, educational, recreational and healthcare needs are important for this client group. The study highlights that service user perspectives on outcomes in mental health services are not routinely identified in national datasets. For future research, it is recommended that personal and environmental factors are explored within supported accommodation environments to understand how these affect the recovery of people with serious mental illness, and to assess outcomes associated with different supported accommodation types.Item ADVANCING NURSING PRACTICE IN THE FIELD OF HEPATOLOGY THROUGH A PROSPECTIVE OBSERVATIONAL RESEARCH STUDY IMPLEMENTING INNOVATIVE SCREENING FOR LIVER DISEASE IN A COMMUNITY ALCOHOL SERVICE WITH A PORTABLE FIBROSCAN® DEVICE(Queen Margaret University, Edinburgh, 2019) Matthews, KarenBackground Alcohol related liver disease, including cirrhosis, is a major cause of death in the UK (Williams et al 2014). Liver disease is silent and usually presents late. FibroScan® is a non-invasive tool for measuring liver stiffness; an indicator for fibrosis/cirrhosis. Socially deprived patients with alcohol related liver disease are a “hard to engage” population (Watt 2013) therefore, simple screening methods may help early identification of liver disease. Aims 1. Monitor uptake of FibroScan® in individuals accessing one community alcohol support service in a deprived area. 2. Determine prevalence of undiagnosed fibrosis/cirrhosis in study sample. 3. Monitor engagement following referral to specialist liver services. Method A prospective observational study recruited self-identified harmful drinkers between November 2014 and April 2015 for a liver FibroScan®. Participants with a FibroScan® reading of ≥7.1kPa were referred to a nurse-led liver clinic for further investigations, results of which determined referral to a liver specialist in secondary care. Participants referred were monitored for engagement over 6 months. Descriptive statistics were used to determine prevalence of undiagnosed cirrhosis and to determine engagement. Results Seventy-nine consented individuals participated, an uptake of 67% of those informed of the study (n=118). Of the 79 scans performed, three were unreliable leaving 76 participants. After scanning, 20/76 (26%) had a FibroScan® reading ≥7.1kPa requiring referral on to the nurse led clinic. All 20 (100%) engaged in further assessment. Of those, 12 required onward referral to specialist services. Subsequent compliance with specialist services in this sample (n=12) was ≥ 90%. Conclusion This nurse-led intervention advances nursing practice in the field of Hepatology. It demonstrates high uptake and subsequent engagement in liver services, giving potential for early intervention and improved health outcomes in a previously considered hard to engage population (Watt 2013). Keywords: Alcoholic, FibroScan®, liver cirrhosis, nursing assessment, transient elastography, screening.Item ACQUISITION OF COMPLEX THERAPEUTIC PROCEDURES IN PRE-REGISTRATION PHYSIOTHERAPY EDUCATION USING MOTOR LEARNING PRINCIPLES(Queen Margaret University, Edinburgh, 2019) Sattelmayer, Karl MartinThis thesis focuses on the acquisition of complex procedures in physiotherapy education using two motor learning principles and reports on five separate key studies: Chapter II: A study about the definition of procedural skills in physiotherapy education using a systematic review design and a text mining approach. Chapter III: A systematic review about the effectiveness of different attentional foci on the acquisition of complex motor skills. Chapter IV: A critical analysis of mental practice interventions in health professions education: A condensed review. Chapter V: The development and validation of a mental practice script for a transfer procedure for people with hemiparesis after stroke. Chapter VI: A randomised controlled trial evaluating the effectiveness and feasibility of two motor learning principles on the acquisition of complex procedures in physiotherapy education Chapter II: Randomised controlled trials and systematic review reporting about procedural skills were systematically searched. A qualitative analysis identified several relevant sub-concepts of procedural skills such as “execution of a motor task” or “decision-making”. A quantitative analysis was performed to identify term occurrences and to create a network of associations between the used terms. Based on both analyses a novel definition of “procedural skills in physiotherapy education” was proposed and operationalised. Chapter III: Studies comparing the effectiveness of an external focus of attention versus an internal focus of attention on the acquisition of complex motor skills were systematically searched in Medline, Embase, ERIC and SPORTDiscus. Findings of a meta-analysis were in favour of external focus of attention (SMD: -0.54; 95% CI between -0.86 and -0.22). Meta-regression identified “task complexity” as potential relevant predictor variable. Chapter IV: This study analysed how mental practice interventions designed for health professions were defined, structured and adhered to proposed best practice variables of mental practice. Chapter V: A mental practice script for a transfer procedure for people with hemiparesis was developed and validated in this study. Experienced physiotherapists were interviewed how they perform the procedure. Analysis of the interviews resulted in the development of a preliminary script, which was piloted to validate the manuscript. Chapter VI: The effectiveness and feasibility of two motor learning principles (mental practice and focus of attention) was evaluated on two different task procedures in pre-registration physiotherapy education. The difference between mental practice and no mental practice was not statistically significant. Findings of the comparison of the attentional focus differed between task procedures. An internal focus of attention was more effective for the acquisition of a transfer task procedure. For the second task procedure in vestibular rehabilitation the performance between the internal and external focus of attention groups was similar. Conclusions: This was the first study, to the authors knowledge, that investigated the acquisition of complex motor task skills in pre-registration physiotherapy students. The results presented in this thesis will help inform educators and researchers regarding the use of mental practice and different attentional foci to support the teaching approach for acquisition of complex skills in physiotherapy education.Item An Investigation Into The Relationship Between Psychosocial Factors And Employment Outcomes In A Population Of People With Complex Mental Health Problems Receiving Individual Placement And Support(Queen Margaret University, Edinburgh, 2018) Prior, SusanWork is one of the most valued roles in society, offering the opportunity to create selfidentity and improve financial and social status. However, people with complex mental health problems (CMHP) are often excluded from this human right. Individual placement and support (IPS) is an effective intervention, supporting just over half of people with CMHP achieve their employment goals. Recently attention has been drawn to the efficiency of services identifying that a positive outcome is most likely to be achieved within a nine-month time frame. Identifying factors which predict success in attaining employment has been the focus of research. Findings are complex and contradictory. Psychosocial factors influence the successful attainment of employment, but are often poorly defined and overlapping, lacking a theoretical conceptualisation and accurate measurement. The research questions to be addressed by this study are: • Can psychosocial variables predict who will obtain employment or education? • Can psychosocial variables predict who will obtain employment or education within nine months, and who will take an extended period of time? A prospective cohort study utilising a secondary dataset from an established IPS service was conducted. Multiple logistic regression allowed construction of models which examine the effects of psychosocial predictors on the probability of the outcomes. Interpretation of the analysis was shared and discussed with clinicians, who are experts in their field, to ensure that findings can be considered from both a statistical significance and clinical significance position. An analysis was performed on data relating to 202 participants of an IPS service. Ability to adapt routines was a significant predictor of both goal attainment and requirement of extended intervention. This study provides evidence that while having strong work-related values are important predictors the translation of these values into lifestyle, expressed through habits and routines, provide stronger predictors of the likelihood of success in IPS.Item Exploring clinical research nurses’ experiences of working with clinical nurses(Queen Margaret University, Edinburgh, 2018) Hill, GordonIntroduction Over the last 10-15 years the role of the clinical research nurse (CRN) has evolved, with many CRNs now participating in the design, planning, analysis and dissemination of research. However, from the literature it is evidenced that despite this, CRNs have difficulties in developing a positive working relationship with clinical (ward-based) nurses. Additionally, previous literature identified that liminality, isolation, perceptions of CRNs and issues related to the transition from a clinical nurse to a CRN appeared to be important. However, the experiences of CRN’s have never been fully explored in this context. Research Question How do CRNs make sense of their relationship with clinical nurses? Methodology A qualitative approach, using interpretative phenomenological analysis, was utilised for this research. This approach allowed an exploration of the lived experience of the CRNs interactions with clinical nurses and generated real-life information on their relationships. Methods Semi-structured interviews were conducted with ten CRNs. The rich data gathered from these informed a deeper understanding of the relationships between CRNs and clinical nurses. Analysis The interviews were transcribed by the researcher and analysed individually. Once this process was completed, the findings were combined to develop over-arching super-ordinate themes. This followed the process suggested by Smith, Flowers and Larkin (2009). Findings New understanding emerged from this study, including perceptions of harm, particular issues relating to CRNs from clinical research facilities, negative impacts of poor relationships with clinical nurse specialists and how relationships with doctors can impact on how CRNs are perceived. Additionally, theoretical constructs including duality, dramaturgy and injurious misconception were also identified and explored. Conclusion The study indicated that CRNs value their relationship with clinical nurses. This relationship assists in conducting successful clinical research and confirming the importance of the CRN role. However, there appear to be some difficulties that should be addressed, to further enhance this relationship for the benefit of patients, CRNs and the clinical nurses.Item An exploration of intersectoral partnerships for people with multiple and complex needs: a realist informed qualitative study(Queen Margaret University, Edinburgh, 2019) Irvine Fitzpatrick, LindaThe well-being of people with complex and multiple needs is impacted upon by the interplay of life experiences, social determinants, contextual factors, and health conditions. People with multiple and complex needs are considered to include but not be limited to People with severe and enduring mental health problems People who are in contact with the criminal justice system People with substance misuse problems People whose life opportunities are limited due to income People who have experienced significant trauma Despite policy imperatives, there remains a lack of systematic knowledge and practice relating to what works, for which people, and under which set of circumstances. Evaluating the evidence base for interventions for people with complex and multiple needs is complicated by several factors. Historically (and currently), interventions tend to be focused on a diagnosis, behaviours, or for a particular age range. Too often, professional services look at behaviour and conditions without exploring the wider set of relationships and opportunities and life disruptions that people might have experienced or are experiencing. Within the Lothian area, a number of intersectoral partnerships (ISPs) have been developed, focused on improving health, well-being, and opportunities for people with multiple and complex needs. The partnerships are intersectoral in that they include statutory, private, and voluntary partners working together to provide innovative interventions and services for people with multiple and complex needs. Lothian’s ISPs provide support to individuals, in response to specific needs, and may be defined by geographical locations or in respect to service requirements. However, common features of good practice are obscured by differing models for provision, apparently dissimilar client groups, and a diversity of providers and contributors. Key success features and elements of effective practice require investigation and synthesis. The current research used qualitative and realist methods to propose a “programme theory” of effective intersectoral partnership based on ISPs within Lothian. Qualitative data were gathered from 18 key informants from 6 Lothian-based ISPs. A clearer, more rigorous, and systematic understanding of ISPs for people with complex and multiple needs has been developed, with recommendations for how programmes might be developed in other areas or otherwise expanded. The Incite model is the summary descriptor of the refined programme theory. The model contains the programme theory of context, mechanisms, and outcomes which should be considered in the development of an intersectoral partnership. How the Incite model may be operationalised is discussed in the thesis, as well as implications for policy, practice and research.Item Transformation and study change among hospitality and tourism students(2018) Jost, MartinOver four decades of transformative-learning (TL) research, theorists have steadily called for the design of a quantitative instrument capturing the central tenants of individual transformation. The aim of this study is to introduce the Triggering Incident Student Survey (TISS) as a means to explore incidents experienced by learners that trigger reflective processes during a semester of study. The TISS was designed in the spirit of a post-positivist paradigm to evaluate central variables of TL, namely, triggers, emotions, forms of reflection, dialogue with important social actors and elicit demographic information on age, level of study, gender and cultural background. Data were gathered from 333 individuals on two occasions. With the data, and consistent with ideas in the TL literature, structural relationships were estimated to see if emotions mediated the influence of triggers on reflective ability or acted to disrupt that influence entirely. Further, again in line with the literature, structural models were established to test if dialogue with social actors facilitate transformation and if affection and cognition displayed reciprocal relations that is, there existed feedback between the constructs. This study has special relevance in hospitality education with its mix of practical, theoretical and internship elements and is unique in that no evidence exists as to what transforms individual learners within and outside of the classroom in the discipline of hospitality. Given the calls in the TL literature for quantitative studies and the criticisms of those that exist, the current study fills a substantial gap in the literature. Data were gathered reliably and validly. Using the data it has been shown that among those studying hospitality, failures and personal dilemmas have effects on thinking processes, either directly or via positive and negative emotions. Differences between central variables were additionally dependent to varying degree on age, status, gender and culture and evidence was provided that learners seek varying interactions with students, friends and family during transformational processes. TISS findings also suggested that the relationships between positive emotions and cognitive reflection are reciprocal and mutually reinforcing. A substantial contribution in this research arises from the testing of a quantitative instrument that overcomes criticisms in the literature of other surveys. Another substantial outcome is the setting of a robust analytical framework that can be exploited by TL theorists, practitioners and future researchers to further examine the central variables in studies of transformation in other disciplines, other educational contexts and other types of studentsItem Visual support systems: a qualitative evaluation of the support provided to parents of children with Autism(2018) Borg, Rachel MalliaSince the 1990s, parent-professional partnership working has seen a shift from a professionally driven model, where professionals had a power-over relationship with parents, to an empowerment model, which allows power to be created and developed through relationships. This move has enabled families of children with Autism Spectrum Disorder (ASD) to have their priorities attended to when planning goals and intervention around Visual Support Systems (VSSs). However, there is debate as to whether a collective empowerment model of service delivery is being used effectively when planning and implementing goals around VSSs. There is also lack of information on the perceived benefits of using VSSs with children with ASD. This study aimed to explore the parental perspective and negotiation of responsibility with professionals when planning goals and service provision around VSSs and to elicit parents’ views on the changes they perceived in their children and their own abilities following the support received. Adopting a qualitative, case study methodological strategy, a total of ten participants participated in either a focus group or semi-structured interview. Thematic analysis was used to analyse data. Three major themes emerged from the data: parent-professional partnership, perceived changes in abilities and skills, and experiences of using VSSs. Sub-themes are also presented, including shared planning and decision-making, enablers and barriers of using VSSs, and professionals’ qualities. Implications for practice suggest: the need for regular discussions with parents in relation to VSSs; further examination of service delivery; the need for professionals to draw on parent-professional partnership literature; the implementation of strategies to encourage parental engagement and prevent possible barriers.