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Engaging in 'reflexive practice' throughout the research process (Benson and O'Reilly, 2022) and a 'reflexivity of discomfort' (Hamdan, 2009) through an intersectional lens, this article presents a reflective account of accessing and conducting observations and interviews at a South Asian women's organisation, in North England, to explore Pakistani and Bangladeshi Muslim (PBM) lone motherhood. It critically explores how researchers' own subjectivities and intersecting identities – in this case, my intersecting identities and positionalities as a young British Pakistani Muslim women, researcher and volunteer – impact interactions in different circumstances with different groups of participants and the importance of having continuous critical self-awareness. Moving beyond simplistic insider–outsider debates, the paper contributes towards further developing reflexivity debates taking an 'intersectional reflexivity' approach. It argues for thinking about the research process and engagements in the field as socially constructed, changing, adapting and negotiated overtime and to utilise intersectionality to unpick broader categories. Finally, it encourages researchers to adopt reflexivity in their research practices. [ABSTRACT FROM AUTHOR]

Fieldwork encounters are not only contingent to biographical subjectivities, but are mediated by a confluence of identity, place and embodiment. This paper offers reflexive accounts of researchers with various socio-cultural and disciplinary backgrounds, who collaborated as a team to examine the varied funerary experiences and needs of established minorities and recent migrants in England and Wales. Focusing on the researchers' varied personal experiences with death and bereavement and on their performances of minority and majority ethnic and migrant identities, the paper highlights the mediated and embodied nature of fieldwork. It argues that reflection on the various aspects of intersectional researcher identity is necessary for a rigorous fieldwork practice that takes transparency and politics into account. This facilitates a deeper understanding of the positionality of both researchers and interlocutors, and the situated co-production of knowledge. In doing so, the paper illustrates that conducting research with a diverse team of researchers contributes to better understanding the complexity and multifacetedness of social phenomena. [ABSTRACT FROM AUTHOR]

This paper considers the importance of material objects for looked after and adopted children integrated as part of life story work practices. Conducting life story work is believed to be good practice within direct work with looked after children in England and there are a range of diverse practices, including life story books, later life letters and memory boxes. Through a creative design project developing a playful memory product for looked after children, we have had the opportunity to capture sector perspectives on life story work approaches and these are interspersed throughout this commentary. Combining multi-disciplinary theoretical perspectives and these sector insights, we explore how special material objects are important for children's identity and continuity of sense of self. The paper highlights the importance of children telling their own stories of these objects, giving them agency and control over their life story narratives. In a context of austerity, life story work may not be prioritised by social workers who have many other competing demands and limited resources. We emphasise the need for professionals to recognise the value children give to objects and to provide them with opportunities to both keep these safe during placement moves and to tell their own story through their objects alongside more traditional, formal life story work. The recommendations have implications for children in out of home care in many country contexts, not just England where the research has been conducted. [ABSTRACT FROM AUTHOR]

This paper draws on two experiences of undertaking comparative research in England, Sweden and Italy, and offers a discussion of the kinds of dilemmas raised in relation to language and meaning surfaced by these. Its primary focus is to examine the reflexive construction of meaning, both in relation generally to the workings of an international research team and, more specifically, how such construction of meaning impacts on the process of qualitative interviewing across linguistic and cultural boundaries. The article argues that a culture of reflexive research practice is helpful for approaching national differences, to facilitate understanding in internationally mixed research teams and to support and empower participants in research, in second languages and differing cultures. Overall, the paper attempts to advance some tentative ideas that other international researchers may be able to consider and deploy in relation to their own research ambitions. [ABSTRACT FROM AUTHOR]

This article uses Feminist New Materialist theoretical perspectives on time and temporality to critically explore the social work practice of life story work, designed to help children who are or have been in public care, or are adopted, assemble a coherent narrative of their care journey, adverse experiences and identity. Interview data presented here was produced with 17 participants (foster carers, adoptive parents and social work professionals in care or adoption teams) who were part of a project which sought to understand how aspects of life story work could be transformed into everyday care conversations between children and the adults who care for them (see www.difficultconversations.info). Our analysis highlights the way participants understood and constructed temporal elements of children's experiences and identities: their pasts, presents and futures, in the context of having conversations about care with them. Through the discussion, we indicate a need to loosen the configuration of children's life stories and identities as 'pre-care' and 'post-care', and instead move toward an acceptance of children's multiple selves and multiple important others as existing across time. [ABSTRACT FROM AUTHOR]

The career progression of teachers of black, Asian and minority ethnic heritage is a matter of much debate and research. Over the past decade, a body of research has confirmed that race discrimination/race inequality is a factor in the progression of teachers of black, Asian and minority ethnic heritage in England. Although it has been argued that 'Britain is not a racist nation', it nonetheless has, as described by Phillips in 2016, a '...deep sensitivity to...ethnic and cultural difference'. According to Miller, this sensitivity remains at the heart of a 'deep-rooted and continuing struggle among black, Asian and minority ethnic teachers and academics for equality and mutual recognition'. Drawing on Miller's 2016 typology of educational institutions: engaged, experimenting, initiated and uninitiated, this paper presents evidence from three English headteachers of Multi-Academy Trusts who devise, implement and embed positive actions in the recruitment, development, retention and progression of staff of black, Asian and minority ethnic heritage. The objective of this study was to examine the work of school leaders/institutions in taking steps to improve black, Asian and minority ethnic teacher progression in England, by identifying and highlighting 'what works', and how. Furthermore, by treating each school/leader as a unique 'case', this paper shows their motivation (personal and professional), experiences of 'race', school contexts and the type/s of leadership required and used in these institutional contexts to change attitudes, cultures and behaviours. [ABSTRACT FROM AUTHOR]

The National Health Service (NHS) cardiac rehabilitation patient care pathway has remained largely unchanged for many years despite, on average, half of all eligible patients declining to engage. To investigate reasons for non-engagement, we explored the experiences of ten cardiac patients who participated in cardiac rehabilitation, dropped out, or declined, as well as experiences of seven people deemed significant others by participants. Our ethnographic study involved participant observations, repeat in-depth semi-structured interviews, and reflexive journaling. Reflexive thematic analysis was conducted, focusing on participants' lived experiences. Utilising Bourdieusian concepts of habitus, capital, and field, this article highlights how personal biography, material conditions, and dispositional inclinations combine to make cardiac health care decision-making individual and complex. Despite this, health professionals were not always attuned to specific circumstances arising from differences in patients' experiences and lifeworlds. By considering service improvement recommendations that acknowledge socio-cultural influences, cardiac rehabilitation can work towards providing patients and their significant others with more appropriate, personalised, and person-centred support. [ABSTRACT FROM AUTHOR]

Palliative care exists in a variety of settings and palliative care teams form many guises within this. A Palliative Medicine Outpatient Clinic (PMOC) exists to meet the flexible provision of the needs and preferences of individuals within whatever care setting they reside. This explorative study used a qualitative methodology, capturing patients’ actual experience of care in preference to their satisfaction, as this is a more accurate measure of how and what patients judge as important in their healthcare. The overall themes in this paper point to the ‘value’ that patients perceived from attending the PMOC and how important the clinics were to clinicians that provided the care. The clinic facilitates much more than symptom control and here lies the challenge in how we convert the very positive experience of individuals into a language of outcome measures that captures the ‘essence’ of our work in this fiscally driven health economy. [ABSTRACT FROM AUTHOR]

Aim: The aim of this cross-sectional survey was to determine the views of infection prevention and control practitioners (IPCPs) on publishing research. Methods: A convenience sample was obtained by approaching delegates at the 2015 Infection Prevention Society conference and data were captured via a hand-held electronic device. Findings: Of the 79 respondents, most (83%) read the Journal of Infection Prevention (JIP) and found it useful for informing their practice (72%). However, most (91%) had never published in JIP, and less than half (40%) published elsewhere. The main barrier to publication was not having work suitable for publication (38%). Support (37%), training in writing for publication (10%) and time (9%) were considered to be important facilitators in encouraging respondents to publish. Discussion: Strategies that support IPCPs in developing their writing skills may encourage more IPCPs to disseminate evidence to support best practice by publishing their work in peer-reviewed journals. [ABSTRACT FROM AUTHOR]

Background: During the past two decades, psychology has become a favorite school subject in many countries. This situation has led to studies on students' attitudes and perceptions of psychology as a secondary school subject. Objective: The purpose of this study was to compare motives for choosing psychology as a school subject among secondary school students (15–19 years of age) from England and Slovakia. Method: In this study, we administered an online questionnaire to gather data about motivation toward studying psychology among secondary students in England (n = 150) and Slovakia (n = 210). Results: For both groups, the most frequent motives and beliefs influencing the choice of psychology were self-understanding and understanding behaviors of others. However, significant cross-cultural differences in other motives emerged (e.g., the perception of difficulty of psychology as a school subject). Conclusion: Students, regardless the cultural context, choose psychology mostly to understand how the human mind works and to understand human behavior to help people. Teaching Implications: Pre-tertiary psychology teachers therefore need to accept a challenge to fulfill students' expectations and to raise awareness of pre-tertiary students' perceptions and beliefs about psychology among decision makers on national and international levels. [ABSTRACT FROM AUTHOR]

Objective To explore the experience of training and performing self-needling from both the practitioners' and patients' perspective. Methods A qualitative study was conducted using focus groups and interviews, nested within our multi-site randomised controlled trial, Acupuncture for Cancer-Related Fatigue in Patients with Breast Cancer. Patients allocated to self-needling across two UK study sites and all therapists who were involved in the trial were invited to participate. The interviews/focus groups were then transcribed verbatim and analysed thematically by the process of content analysis. Results Of the 67 eligible patients, 8 (12%) contributed to the focus groups and 15 practitioners (100%), contributed to the study by either attending a focus group or being interviewed. Themes identified for patients included: the allocation to self-needling, teaching techniques and practical considerations and whether they would self-needle again. Themes identified for practitioners included: views on self-needling, teaching self-needling and future implications of self-needling. Conclusions Self-needling was found to be acceptable to, and manageable by, patients, and enthusiastically adopted by most practitioners. Methods of teaching self-needling need to be developed and evaluated with guidelines recommended for best practice. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the experiences and perceived impact of the COVID-19 lockdowns among early adolescents in the northwest of England, as well as explore the self-care and coping strategies that helped the young people continue to thrive. Fourteen adolescents, 9 boys and 5 girls, were recruited from four secondary schools in North West England. Remote online interviews were conducted. Inductive reflexive thematic analysis was used to analyse the interview data and four themes were identified: (1) change: 'life feels weird'; (2) embracing lockdown; (3) feelings of loss; and (4) stress, worry and challenge. Processes identified will be able to help inform policy and practice for supporting adolescents in the future, including the promotion of positive coping strategies and the provision of resources for young people, schools and families. [ABSTRACT FROM AUTHOR]

Background: Palliative care for people with dementia dying in care homes is an important aspect of long-term care. Whilst there is consensus about the principles of palliative care, less is known about how care home staff negotiate and influence decisions around end of life and how organisational context shapes that process. Aim: To explore the views and experiences of care home staff and palliative care specialists on end of life care in care homes and understand how care home settings affected palliative care provision in England and Australia. Design/participants: Eight focus groups in Australia and England with care home staff and palliative care specialists (n = 49). Reflexive thematic analysis was undertaken. Findings: Australian participants reported collaboration between care home staff, visiting professions and family members though case conferences. English participants discussed resident-focussed involvement from specialists that was less formally organised. Negotiating roles and responsibilities in end of life care; the importance of relationships to overcome deficiencies in formal processes; and the legitimacy and authority of advance care planning at times of crisis were recurring themes. The organisation and embedding of end of life care in processes and practices of care homes differed; this closely linked to care home procedures in Australia but was less apparent in England. Conclusion: In both countries, partnership working was recognised and valued as key to effective palliative care. Work that enables care home staff to identify challenges with visiting professionals, such as agreeing priorities for care and negotiating their shared responsibilities, may lead to context-sensitive, sustainable solutions. [ABSTRACT FROM AUTHOR]

Background: People residing in UK homeless hostels experience extremely high rates of multi-morbidity, frailty and age-related conditions at a young age. However, they seldom receive palliative care with the burden of support falling to hostel staff. Aim: To evaluate a model embedding palliative specialists, trained as 'homelessness champions', into hostels for two half-days a month to provide support to staff and residents and facilitate a multidisciplinary approach to care. Design: An exploratory qualitative design. Setting/participants: Four homeless hostels in London, UK, including nine hostel managers/support staff and seven palliative care specialists (five nurses and two social workers). Results: Benefits to introducing the model included: developing partnership working between hostel staff and palliative care specialists, developing a holistic palliative ethos within the hostels and improving how hostel staff seek support and connect with local external services. Challenges to implementation included limited time and resources, and barriers related to primary care. Conclusion: This is the first evaluation of embedding palliative care specialists within homeless hostels. Inequity in health and social care access was highlighted with evidence of benefit of this additional support for both hostel staff and residents. Considering COVID-19, future research should explore remote ways of working including providing in-reach support to homelessness services from a range of services and organisations. [ABSTRACT FROM AUTHOR]

Objective: To investigate acceptability, barriers to adherence with the interventions, and which outcome measures best reflect the participants' rehabilitation goals in a pilot and feasibility randomised controlled trial evaluating early patient-directed rehabilitation and standard rehabilitation, including sling immobilisation for four weeks, following surgical repair of the rotator cuff of the shoulder. Design: Nested qualitative study. Setting: Five English National Health Service Hospitals. Subjects: Nineteen patient participants who had undergone surgical repair of the rotator cuff and 10 healthcare practitioners involved in the trial. Method: Individual semi-structured interviews. Data were analysed thematically. Results: Four themes: (1) Preconceptions of early mobilisation; many participants were motivated to enter the trial for the opportunity of removing their sling and getting moving early. (2) Sling use and movement restrictions; for some, sling use for four weeks was unacceptable and contributed to their pain, rather than relieving it. (3) Tensions associated with early mobilisation; clinical tensions regarding early mobilisation and the perceived risk to the surgical repair were apparent. (4) Processes of running the trial; participants found the trial processes to be largely appropriate and acceptable, but withholding the results of the post-operative research ultrasound scan was contentious. Conclusion: Trial processes were largely acceptable, except for withholding results of the ultrasound scan. For some participants, use of the shoulder sling for a prolonged period after surgery was a reported barrier to standard rehabilitation whereas the concept of early mobilisation contributed tension for some healthcare practitioners due to concern about the effect on the surgical repair. [ABSTRACT FROM AUTHOR]

There is a growing recognition of the importance of the social work contribution within community mental health services. However, although many texts describe what the mental health social work contribution should be, little empirical evidence exists about their role in practice and the difference it might make to service users. This qualitative study sought to articulate this contribution through the voices of social workers and their multidisciplinary colleagues via focus group discussions across four English Mental Health Trusts. These considered the impact of the social worker on the service user. Thematic analysis resulted in the identification of three over-arching themes: social workers own perceptions of their contribution situated within the social model; the high value their colleagues placed on social work support and leadership in a range of situations and the concerns for service users if social workers were withdrawn from teams. Key findings were that social workers are the only professional group to lead on the social model; that this model enhances the whole teams' practice and is required if service users are to be offered support that promotes long-term recovery and that without social workers, the community mental health team offer would be more transactional, less timely, with the potential for the loss of the service users' voice. If social work is to make a full contribution to community mental health team practice, it must be clearly understood and provided with the support to enable social workers to operate to their full potential. [ABSTRACT FROM AUTHOR]

The first section of the paper criticizes the concept of inconsistency between status ranks as an explanation of variations in attitudes and behaviour between different groups. The second section argues that the concept of relative deprivation may, if appropriately qualified, prove more useful and suggests a possible application of it to the topic of attitudes towards immigrants. The third section presents some findings from a sample survey carried out in England and Wales in 1962 which furnish a limited test of two proposed hypotheses. [ABSTRACT FROM AUTHOR]

Psychological problems are common among people with inflammatory bowel disease (IBD) following stoma surgery. However, the ways in which stoma-related psychological needs are identified and addressed in health care settings remain unexplored. In this study, we investigated the perspectives of young people with a stoma and health care professionals about access to psychological support. Semi-structured interviews were conducted with young people with an IBD stoma (18–29 years, n = 13) and health care professionals (n = 15), including colorectal surgeons, gastroenterologists, specialist nurses in IBD and stoma care, and general practitioners in England. Data collection and analysis were informed by constructivist grounded theory. Three analytic categories were developed: "initiating support-seeking," "affirming psychological needs," and "mobilizing psychological support," which capture young peoples' trajectory to access psychological support. Based on the findings, we highlight the need for both patients and health care professionals to assign greater priority to the identification of psychological symptoms post-stoma surgery. More effective care pathways, which include responsive psychological services, would enhance access to psychological support for young people with a stoma. [ABSTRACT FROM AUTHOR]

We explored the potential of asthma apps to support self-management and identified preferred features that enable users to live with asthma. We recruited patients from five UK practices and social media; observed their usage of our app, administered a questionnaire and interviewed a purposive sample of patients and professionals to explore preferred features. Thematic analysis of interview was synthesised with quantitative data. A total of 111 patients used our app for 3 months. We interviewed 15 patients and 16 professionals. Participants were interested in a broad range of self-management support strategies, including action plans, monitoring with feedback, allergy/weather warnings and tailor-made running coaching. Professionals wanted to integrate patients' logs with practice records, though were concerned about data overload and risk of patient dependency. We propose a paradigm shift - from apps developed to provide features that are easy to implement technologically, to an approach in which apps are designed to deliver theoretically grounded preferred components. [ABSTRACT FROM AUTHOR]

Deep vein thromboses (DVTs) are common sequelae of injecting drugs into the groin. We explored meanings and experiences of DVTs in a group of 19 patients from the North East of England with a DVT and in treatment for opioid use. We report three themes: (a) DVT meaning making, (b) embodied experience, and (c) Stigma. Patients attributed DVTs to groin injecting, though thought other factors were also partially responsible. Medication performed both treatment and preventive functions. The most pertinent worry was amputation. Patients recognized stopping injecting as important, but it did not necessarily occur. Stigma resulted in delayed admission to hospital and feelings of isolation; support groups might alleviate the latter. Although groin injecting was undertaken partly to avoid the censure of being a drug user, ironically, a DVT led to long-standing stigmata that were discrediting signs of that exact status. [ABSTRACT FROM AUTHOR]

Visual methods are a popular way of engaging children and young people in research. Their growth comes out of a desire to make research practice more appropriate and meaningful to them. The auteur approach emphasises the need to explore with young participants why they produce the images they do, so that adult researchers do not impose their own readings. This article, while recognising the value of such visual techniques, argues that their benefit is not that they are more age appropriate, or that they are more authentic. Instead it lies in their capacity to display the social influences on how participants, of any age, represent themselves. The article does so through discussion of an Economic and Social Research Council research project, which made use of visual and other creative methods, undertaken in the UK with disabled young people. The research involved narrative and photo elicitation interviews, the production of photo journals, and creative practice workshops aimed at making representational artefacts. Through analysing the photography, the journals and interviews the article examines what it was research participants sought to capture and also what influenced the types of photographs they gathered and the type of person they wanted to represent. We argue that they aimed to counter negative representations of disability by presenting themselves as happy, active and independent, in doing so they drew from broader visual iconography that values certain kinds of disabled subject, while disvaluing others. [ABSTRACT FROM AUTHOR]

Background: Patients with advanced chronic obstructive pulmonary disease have difficulty reporting their holistic support needs to health care professionals, undermining delivery of person-centred care. We lack tools that directly support patients with this. Aim: To develop an evidence-based, designed-for-purpose, tool to enable patients to directly identify and express support needs to health care professionals. Design: Two-stage qualitative study. Stage 1: domains of support need were identified through a systematic review, analysis of an established qualitative dataset and patient/carer focus groups. Stage 2: draft tool developed using the identified domains of need and then refined through feedback from patients, carers and health care professionals, ensuring acceptability and suitability. Setting/participants: Stage 1 patients/carers recruited via four primary care practices and two patient support groups (East of England). Stage 2 health care professionals recruited via the Clinical Research Network and local community trust and patients/carers through two further practices and two additional support groups (East of England). In total, 57 patients, carers and health care professionals participated. Results: A comprehensive set of evidence-based support domains (for example: overcoming boredom or loneliness, knowing what to expect in the future) was identified and formulated into questions. The resulting tool asks patients to consider whether they need more support in 15 broad areas. Patients, carers and clinical stakeholders broadly endorsed the tool's content and wording. Conclusion: The Support Needs Approach for Patients (SNAP) tool is a concise evidence-based tool designed to help patients with advanced chronic obstructive pulmonary disease identify and express their support needs to enable delivery of person-centred care. [ABSTRACT FROM AUTHOR]

Objective: To ask those most affected by continuing professional development for senior doctors - patients, other professional groups and doctors themselves - what it needs to encompass.Design: The nominal group technique.Participants: Six groups of between seven and nine members (n = 49). Separate groups were held for nurses and therapists (n = 9), patient representatives (n = 8), medical directors (n = 8), consultants (n = 8) and medical trainees (n = 7). An additional group consisted of 'Darzi Fellows' (n = 9), trainee doctors who were undertaking a leadership fellowship.Setting: Groups were held at the Royal Society of Medicine in London.Main Outcome Measures: Priorities for the content of continuing professional development for senior hospital doctors, ranked in order of importance. Themes derived from analysis of group discussions.Results: We present the ranked priorities of different groups for what should be included in continuing professional development for senior hospital doctors. Analysis of group discussions identified the following three themes: developing and supporting the system of care; changes in the way medicine is practised; and personal wellbeing and caring for colleagues.Conclusions: The implication of our findings for providers of continuing professional development is to consider the balance of content. Doctors and other healthcare professionals need to keep up with scientific advances and technical developments. But in addition, they need to be adept at working with the system changes required for translation of research into practice, the development of new ways of working, and for the organisational changes that underpin continual quality and safety improvement. [ABSTRACT FROM AUTHOR]

Background.: Following a life-changing event, such as a serious illness, people can experience a disruption of meaning and identity, making it difficult to move forward. The "What Now?" Workbook was developed to enable exploration of the personal meanings of specific occupations to facilitate future planning. Purpose.: The aim of this study was to investigate the utility—usability and usefulness—of the workbook in practice. Method.: Five occupational therapists trialled the workbook at a specialist cancer centre in England. Qualitative data were gathered via a focus group, an interview, and questionnaires. The data were subject to a realist thematic analysis. Findings.: The findings showed the workbook to have actual and potential utility for service users in this setting, as perceived by their occupational therapists, by helping them to explore occupations, their loss, meanings, and future possibilities as part of an occupational therapy intervention. Implications.: The workbook appears to offer a structured yet flexible way to explore personal meanings of occupations, enabling service users to gain insights and move forward following a life-changing illness. [ABSTRACT FROM AUTHOR]

Objective: A growing proportion of older people live in care homes and are at high risk of preventable harm. This study describes a participatory qualitative evaluation of a complex safety improvement intervention, comprising training, performance measurement and culture-change elements, on the safety of care provided for residents.Design: A participatory qualitative study.Setting: Ninety care homes in one geographical locality in southern England.Participants: A purposeful sample of care home managers, front-line staff, residents, quality improvement facilitators and trainers, local government and health service commissioners, and an embedded researcher.Main Outcome Measures: Changes in care home culture and work processes, assessed using documentary analysis, interviews, observations and surveys and analysed using a framework-based thematic approach.Results: Participation in the programme appears to have led to changes in the value that staff place on resident safety and to changes in their working practices, in particular in relation to their desire to proactively manage resident risk and their willingness to use data to examine established practice. The results suggest that there is a high level of commitment among care home staff to address the problem of preventable harm. Mobilisation of this commitment appears to benefit from external facilitation and the introduction of new methods and tools.Conclusions: An evidence-based approach to reducing preventable harm in care homes, comprising an intervention with both technical and social components, can lead to changes in staff priorities and practices which have the potential to improve outcomes for people who live in care homes. [ABSTRACT FROM AUTHOR]

Objective: To identify why the National Clinical Guideline recommendation of 45 minutes of each appropriate therapy daily is not met in many English stroke units. Design: Mixed-methods case-study evaluation, including modified process mapping, non-participant observations of service organisation and therapy delivery, documentary analysis and semi-structured interviews. Setting: Eight stroke units in four English regions. Subjects: Seventy-seven patients with stroke, 53 carers and 197 stroke unit staff were observed; 49 patients, 50 carers and 131 staff participants were interviewed. Results: Over 1000 hours of non-participant observations and 433 patient-specific therapy observations were undertaken. The most significant factor influencing amount and frequency of therapy provided was the time therapists routinely spent, individually and collectively, in information exchange. Patient factors, including fatigue and tolerance influenced therapists' decisions about frequency and intensity, typically resulting in adaptation of therapy rather than no provision. Limited use of individual patient therapy timetables was evident. Therapist staffing levels were associated with differences in therapy provision but were not the main determinant of intensity and frequency. Few therapists demonstrated understanding of the evidence underpinning recommendations for increased therapy frequency and intensity. Units delivering more therapy had undertaken patient-focused reorganisation of therapists' working practices, enabling them to provide therapy consistent with guideline recommendations. Conclusion: Time spent in information exchange impacted on therapy provision in stroke units. Reorganisation of therapists' work improved alignment with guidelines. [ABSTRACT FROM AUTHOR]

Background: The role of non-medical prescribers working in palliative care has been expanding in recent years and prescribers report improvements in patient care, patient safety, better use of health professionals' skills and more flexible team working. Despite this, there is a lack of empirical evidence to demonstrate its clinical and economic impact, limiting our understanding of the future role of non-medical prescribers within a healthcare system serving an increasing number of people with palliative care needs. Aim: We developed a unique methodology to establish the level of non-medical prescribers' activity in palliative care across England and consider the likely overall contribution these prescribers are making at a national level in this context in relation to medical prescribing. Setting/participants: All prescriptions for 10 core palliative care drugs prescribed by general practitioners, nurses and pharmacists in England and dispensed in the community between April 2011 and April 2015 were extracted from the Prescribing Analysis Cost Tool system. Design: The data were broken down by prescriber and basic descriptive analysis of prescription frequencies by opioid, non-opioids and total prescriptions by year were undertaken. To evaluate the yearly growth of non-medical prescribers, the total number of prescriptions was compared by year for each prescribing group. Results: Non-medical prescribers issued prescriptions rose by 28% per year compared to 9% in those issued by medical prescribers. Despite this, the annual growth in non-medical prescribers prescriptions was less than 1% a year in relation to total community palliative care prescribing activity in England. Impact on medical prescribing is therefore minimal. [ABSTRACT FROM AUTHOR]

In England, school leadership preparation has shifted from the National College and local authorities to teaching schools, their alliances and multi-academy trusts. Against this changing educational landscape, we investigate opportunities presented to men and women in secondary school leadership teams (SLTs). Drawing on interview data from a British Educational Leadership, Management and Administration Society funded investigation, we report on leadership preparation and development opportunities, aspiration to headship, headteachers’ support of ‘in house’, regional and national preparation programmes, coaching and mentoring involvement as well as access to formal and informal networks. Our analysis of SLTs as sites of potential for headship demonstrated some variability in women’s and men’s reported experiences. Accredited courses, higher degrees and workplace-based preparation provided access to leadership preparation and development opportunities; access was not transferrable from school to school. We identified a fragmented system and suggest policy and cultural changes to allow SLTs to offer inclusive and sustainable opportunities for succession planning. [ABSTRACT FROM AUTHOR]

Objective To investigate trainee doctors' and trainers' perceptions of the validity of the Annual Review of Competence Progression (ARCP) using Messick's conceptualisation of construct validity. Design Qualitative semi-structured focus groups and interviews with trainees and trainers. Setting Postgraduate medical training in London, Kent Surrey and Sussex, Yorkshire and Humber, and Wales in November/December 2015. Part of a larger study about the fairness of postgraduate medical training. Participants Ninety-six trainees and 41 trainers, comprising UK and international medical graduates from Foundation, General Practice, Medicine, Obstetrics and Gynaecology, Psychiatry, Radiology, and Surgery, at all levels of training. Main outcome measures Trainee and trainer perceptions of the validity of the ARCP as an assessment tool. Results Participants recognised the need for assessment, but were generally dissatisfied with ARCPs, especially UK graduate trainees. Participants criticised the perceived tick-box nature of ARCPs as measuring clerical rather than clinical ability, and which they found detrimental to learning. Trainees described being able to populate their e-portfolios with just positive feedback; they also experienced difficulty getting assessments signed off by supervisors. ARCPs were perceived as poor at identifying struggling trainees and/or as discouraging excellence by focussing on minimal competency. Positive experiences of ARCPs arose when trainees could discuss their progress with interested supervisors. Conclusions Trainee and trainer criticisms of ARCPs can be conceptualised as evidence that ARCPs lack validity as an assessment tool. Ongoing reforms to workplace-based assessments could address negative perceptions of the 'tick-box' elements, encourage constructive input from seniors and allow trainees to demonstrate excellence as well as minimal competency, while keeping patients safe. [ABSTRACT FROM AUTHOR]

Introduction: We conducted a survey amongst families of children with cerebral palsy to ascertain the ownership and therapeutic use and potential of commercial games consoles to improve motor function. Method: Three hundred families in South East England were identified through clinical records, and were requested to complete an anonymised questionnaire. Results: A total of 61 families (20% response) returned a completed questionnaire with 41 (68%) identified males and 19 (32%) identified females with cerebral palsy, with a mean age of 11 years 5 months (SD 3Y 7M). The large majority of families, 59 (97%), owned a commercial console and the child used this for 50-300 minutes a week. Returns by severity of motor impairment were: Gross Motor Function Classification System I (22%), II (32%), III (13%), IV (15%), V (18%). Consoles were used regularly for play across all Gross Motor Function Classification System categories. Conclusion: The potential of games consoles, as home-based virtual reality therapy, in improving the motor function of children with cerebral palsy should be appropriately tested in a randomised controlled trial. Wide ownership, and the relative ease with which children engage in the use of commercially-based virtual reality therapy systems, suggests potential as a means of augmenting therapy protocols, taking advantage of interest and participation patterns of families. [ABSTRACT FROM AUTHOR]

Muslim public opinion polls are mostly taken at face value as the direct and unbiased voice of British Muslims, but, as this article argues, most of the public opinion polls are commissioned by the media and suffer from similar framing effects to those seen in the general media coverage of Muslims. At a time of national crisis, following the London terrorist attacks in 2005, it has become especially clear that the media have been following their pre-existing narrative on Muslims rather than responding to public interest. We analyse all public opinion polls conducted in the 18 months following the 7 July attacks and all their broadsheet newspaper coverage to show that the media-framing effects influence both the creation of Muslim opinion polls and their reporting. [ABSTRACT FROM AUTHOR]

This article aims to explore how visual methods can be employed in social work research as a means of understanding the impact of space and environment in child protection practice. It will draw from the findings of a comparative ethnography, which, alongside the traditional methods of data collection, also involved the use of photography to capture the nature of two very different agencies situated in England and Belgium. The aim of using images was primarily to contextualise the everyday details of both settings and provide the reader with a visual dimension of what both agencies have embodied for the researcher, the participants and the service users. The findings demonstrate just how important the organisational setting can be in developing, or impairing, the way in which relationships are built between professionals and the families they work with. [ABSTRACT FROM PUBLISHER]

The literature on integrated care is limited with respect to practical learning and experience. Although some attention has been paid to organizational processes and structures, not enough is paid to people, relationships, and the importance of these in bringing about integration. Little is known, for example, about provider engagement in the organizational change process, how to obtain and maintain it, and how it is demonstrated in the delivery of integrated care. Based on qualitative data from the evaluation of a large-scale integrated care initiative in London, United Kingdom, we explored the role of provider engagement in effective integration of services. Using thematic analysis, we identified an evolving engagement narrative with three distinct phases: enthusiasm, antipathy, and ambivalence, and argue that health care managers need to be aware of the impact of professional engagement to succeed in advancing the integrated care agenda. [ABSTRACT FROM PUBLISHER]

The article presents information on a study conducted on the professional identity of child protection social workers in Great Britain. Sociologist Eliot Freidson recognized that the professional's attitude and commitment to their career became that of their own identity because they represent their profession through who they are and the activities they perform. The study involved interviewing of eight child protection social workers.

This article discusses the early findings of an on-going ethnographic study which is exploring the implementation of Community Treatment Orders (CTOs) in English mental health services, a process in which social work practitioners are closely involved. CTOs are present in a number of countries, and most recently in 2008 were enacted in England and Wales with the policy purposes of reducing ‘revolving door’ admissions, increasing the ability of clinicians to manage risk and encouraging recovery. They work by imposing conditions on how mental health service users live in the community as well as providing a mechanism for them to be recalled for treatment in hospital if they fail to meet those conditions. Perhaps unsurprisingly, their introduction has brought with it debate on the ethical implications of extending compulsory treatment into the community. The majority of research on CTOs has tended to ask the question, ‘Do they work?’ In this article I argue that ethnography may help to address a more ethically engaged and pertinent question for social work practice, namely, ‘Who might CTOs work for, in what circumstances and why?’ Immersion in service settings over an extended period enabled the incorporation of contextual factors and causal mechanisms into the analysis, which in turn has led to a consideration of the nature of CTO outcomes. This approach draws upon ideas about the role of qualitative research in exploring causality, and consideration is given to how the research may fit within some form of a realist framework. [ABSTRACT FROM AUTHOR]

The article offers information on lectures and presentations related to infection prevention delivered by several professors at the 2013 Infection Prevention conference. Topics of the lectures include hand hygiene education by Hugo Sax, challenges of multidrug-resistant Gram-negative bacteria by Peter Wilson and copper surfaces introduction in healthcare by Tom Elliot. The conference also featured presentations by professors Barry Cookson, Tricia Hart and Dale Fisher.

The current study aimed to explore the personal meaning of eating difficulties. Eight women with a variety of eating issues were interviewed. These conversations were then analysed using Interpretative Phenomenological Analysis to construct a framework for understanding the personal world of the interviewees. Three overarching themes identified in participants’ accounts of their experiences are reported here: the experience of the eating difficulties as functional; negative effects of having eating difficulties; ambivalence towards the eating difficulties. These themes add to our knowledge of the potential role of personal experiences in the aetiology and maintenance of eating difficulties. [ABSTRACT FROM PUBLISHER]

Qualitative research indicates that dance is an immensely popular recreational activity with young people, yet in many European schools it is often regarded as that aspect of the PE curriculum most suited to young children and high-school girls. This prac-tice however is not based on empirical information; details relating to adolescent atti-tudes to dance for instance and how these may vary with age and gender are sparse. Opinions were sought, therefore, from a total of 1668 11--16-year-old boys and girls, from 19 schools throughout England, using a questionnaire which included four Likert-type dance attitude scales. Analyses showed little change in attitudes between the ages of 11 and 16 and no interaction of age with gender. Girls displayed more positive atti-tudes than boys on two of the scales, but the reverse was the case on the third scale and no gender differences were evident on the fourth. The virtual absence of change in age-related scale scores highlights the need for both increased dance provision in schools and more focused teaching, while the specific nature of the gender-related attitude differences offers curriculum development opportunities. The absence of interaction between age and gender suggests cultural rather than school influences on attitudes. [ABSTRACT FROM AUTHOR]

The article presents young people's reasons for leaving or remaining in a rural area in Great Britain, the Scottish Borders. Young people's views about migration and attachment demonstrate a contradictory and more complex pattern than that of detached late-modern migrants and traditional backwater stay-at-homes. These stereotypes have some resonance in local culture, for example in disdain for rootless "incomers" lacking real sympathy with the community and in the common accusation of the parochial narrow mindedness of locals who have never been elsewhere. However, such stereotypes emerge from complex social class antagonisms and cross-cutting ties to locality. Many young people's ties contradict the classifications these stereotypes imply. There are young out-migrants who are the children of rootless in-migrants, but also, nevertheless, have lasting attachments to the locality of their childhood. Then there are young "stayers" who are the children of born and bred locals but yet feel serious disaffection from their locality. These attached migrants and detached stayers may not represent settled orientations to their locality of childhood, but they, nevertheless, contradict both certain local stereotypes and Baumanesque "late modernist" sociological theorizing.