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Accessible Summary: What is known on the subject: Mental health wards can feel unsafe. We know that patients and staff have different ideas about what makes a hospital ward safe or unsafe.Patients are often the first to know when the atmosphere on a ward becomes tense, but often, no one asks them for their views.Patients and staff are experts and should be included in discussions about how to make wards safer. What this paper adds to existing knowledge: We got together with some service users and staff, and made an app that helps patients to tell staff when they are not feeling safe on a mental health ward. We tried it out on six wards and we asked patients and staff what they thought.The app was easy to use and most people liked the look of it.Patients said staff did not talk with them enough and so they liked using the app. However, some staff said they could tell how patients were feeling without an app and so they did not need it. Ward managers told us that staff were often very busy and did not always have time to use the app. What are the implications for practice: This app could help staff know straightaway when patients do not feel safe on the ward, so that they can act quickly to calm things down.To make the most of the app, staff need to get used to it and bring it into ward routines. Introduction: Safety improvement on mental health wards is of international concern. It should incorporate patient perspectives. Aim: Implementation and evaluation of 'WardSonar', a digital safety‐monitoring tool for adult acute mental health wards, developed with stakeholders to communicate patients' real‐time safety perceptions to staff. Method: Six acute adult mental health wards in England implemented the tool in 2022. Evaluation over 10 weeks involved qualitative interviews (34 patients, 33 staff), 39 focused ethnographic observations, and analysis of pen portraits. Results: Implementation and evaluation of the WardSonar tool was feasible despite challenging conditions. Most patients valued the opportunity to communicate their immediate safety concerns, stating that staff had a poor understanding of them. Some staff said the WardSonar tool could help enhanced ward safety but recognised a need to incorporate its use into daily routines. Others said they did not need the tool to understand patients' safety concerns. Discussion: Foreseeable challenges, including staff ambivalence and practical issues, appeared intensified by the post‐COVID‐19 context. Implications for Practice: The WardSonar tool could improve ward safety, especially from patients' perspectives. Future implementation could support staff to use the real‐time data to inform proactive safety interventions. [ABSTRACT FROM AUTHOR]

In this paper, Curating Spaces of Hope is offered as a new paradigm for postsecular partnership for uncertain times. The need for a new paradigm is set out intially using literatures from faith based organisations. The case is made that the understanding of faith or the 'F' is inadequate, and that in order to make sense of the role it plays in social policy, a fresh framing is needed. For this, literatures from political philosophy, sociology or religion and social policy are engaged. These set out the space for mapping different worldviews, as part of the diversifying beleif landscape in the UK, and the policy context into which they are speaking. The paper then turns to empircal data to make the case for the new paradigm of postsecualr partnership, Curating Spaces of Hope. This case is made in three phases. First auto-ethnographic data is used as the basis for a social movement in the north west of England which takes place over 3 years. This is used as the premise for ethnographic research which maps postsecular contexts and informs the production of Curating Spaces of Hope. The paper then turns to the COVID-19 pandemic, as a lens through which to view current contexts of uncertainty. Three case studies are then offered which point to early applications of Curating Spaces of Hope and opportunities for building postsecular partnerships in the north west England. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to explore the concept and practice, of dignity as understood and experienced by older adults and district nursing staff. The paper adds a new, nuanced, understanding of safeguarding possibilities in the context of district nursing care delivered in the home. Design/methodology/approach: The research used an ethnographic methodology involving observations of care between community district nursing clinicians and patients (n = 62) and semi-structured interviews with nursing staff (n = 11) and older adult recipients of district nursing care (n = 11) in England. Findings: Abuse is less likely to occur when clinicians are maintaining the dignity of their patients. The themes of time and space are used to demonstrate some fundamental ways in which dignity manifests. The absence of dignity offers opportunities for abuse and neglect to thrive; therefore, both time and space are essential safeguarding considerations. Dignity is influenced by time and how it is experienced temporally, but nurses are not allocated time to "do dignity", an arguably essential component of the caregiving role, yet one that can become marginalised. The home-clinic exists as a clinical space requiring careful management to ensure it is also an environment of dignity that can safeguard older adults. Practical implications: District nurses have both a proactive and reactive role in ensuring their patients remain safeguarded. By ensuring care is delivered with dignity and taking appropriate action if they suspect abuse or neglect, district nurses can safeguard their patients. Originality/value: This paper begins to address an omission in existing empirical research regarding the role of district nursing teams in delivering dignified care and how this can safeguard older adults. [ABSTRACT FROM AUTHOR]

Context: The future comes into the present and acts upon the now. Understanding how engagement with the future shapes today and how actions taken in the now affect a time yet to come is important in understanding and improving brain injury rehabilitative practice. Objective: This paper examines the way in which futures of different types of braininjured residents residing in long-term neurological care settings are imagined by health and care professionals and the role a 'rehabilitative imaginary' has in how residents' futures are imagined or go unimagined. Methods: Over 500 hours of ethnographic observations and 49 interviews with staff members in two neurological rehabilitation and long-term settings in England were analysed using situational analysis, drawing out key rehabilitative narratives presented here. Findings: Residents were primarily categorised by their abilities to rehabilitate successfully (or not) and their futures imagined (or not) in line with their rehabilitative journey. Key residents who successfully rehabilitated and fulfilled a rehabilitative ideal were held up as 'poster boys' (or girls), providing a positive advertisement for the organisation, engendered dedication to the specialism of neurological rehabilitation and reinforced rehabilitation-as-process. Limitations: Data was collected in two English care settings. Applicability to international care settings is unknown. Extraneous factors restricting health care professionals' future imaginings were not explicitly studied. Implications: The paper concludes by considering the implications of rehabilitative imaginary-fuelled narratives in these settings. It argues that predominant rehabilitative narratives bracket out how and if the futures of those unable to rehabilitate successfully are imagined by health care professionals and questions whether non-imagining leads to inaction around those not rehabilitating. Potential organisational and structural reasons for constrained health care professionals' imaginings is discussed, and broader applicability of the reification of particular patient types in other areas of health care is considered. [ABSTRACT FROM AUTHOR]

In England the macro context of adoption practice is characterised by radical change across administrative, political and organisational systems. The adoption regionalisation programme is underpinned by a policy commitment to speed up 'matching' processes. The Adoption and Children (Coronavirus) (Amendment) Regulations 2020 states that adoptions should 'proceed swiftly' and some agencies are pioneering online and virtual introductions between children and prospective adopters. This paper offers a timely contribution to practice debates and scholarship in this area. Drawing on a collaborative doctoral study, 'everyday' practices are considered through an emergent theoretical framework, the 'liminal hotspot'. The analysis hones in on the transformative practices generated in the early matching stages and the role of the social worker in their mediation and management. This paper supports findings from other studies that suggest that when matches are rushed necessary processing of complex dynamics is by-passed, creating unnecessary vulnerabilities in the fabric of new families. [ABSTRACT FROM AUTHOR]

Secure children's homes are locked institutions that deprive children of their liberty. The government are investing significantly in these homes, yet there remains a lack of clarity about their nature and purpose. Drawing on data generated through a substantial ethnography in one secure children's home in England, this paper uses Goffman's (1961) theorising as a conceptual lens to view the institution. It concludes that ambiguity and confusion about what these institutions are, and what they seek to achieve, impacts negatively on the experience of everyday life within. Clarity is needed urgently to improve experiences and to enable the assessment of outcomes. [ABSTRACT FROM AUTHOR]

In recent years, Meals on Wheels (MoW) services have been in a state of decline as austerity policies have become entrenched. However, this decline is occurring with little knowledge of the impact withdrawal of MoW services has on the health and well‐being of those who use them. The pandemic has raised awareness of precarity and vulnerability in relation to food that affects many people in the UK and other Westernised countries and this provides further context for the analysis presented. This paper presents findings of a mixed methods ethnographic study drawing on qualitative interviews and visual methods underpinned by social practice theory to explore the household food practices of older people receiving MoW services. Interviews were conducted with 14 older people receiving MoW, eight MoW staff delivering MoW services in the east of England and one expert. The Covid‐19 pandemic interrupted the study, and once the first lockdown began visits to the homes of older people were terminated and the remaining interviews were undertaken by telephone. The study found that a number of threats accumulated to change food practices and moved people towards vulnerability to food insecurity. Threats included difficulty accessing food and cooking due to sensory and physical challenges. The MoW service increased participants' coping capacity. As well as benefiting from the food provided, the relational aspect of the service was important. Brief encounters between MoW staff built caring relationships that developed over time to ensure older people felt valued and cared for. The study demonstrates how MoW services make a positive contribution to food practices, supporting vulnerable adults to continue living well in their own homes and protecting them from food insecurity and ill‐being. Local authorities looking to make cost savings through ending MoW services should consider the impact this would have on the well‐being of older residents. [ABSTRACT FROM AUTHOR]

Background: Speech and language therapists and nurses need to work together to keep patients with swallowing difficulties safe throughout their acute stroke admission. Speech and language therapists make recommendations for safe swallowing following assessment and nurses put recommendations into practice and monitor how patients cope. There has been little research into the everyday realities of ongoing swallow safety management by these two disciplines. Patient safety research in other fields of healthcare indicates that safety can be enhanced through understanding the cultural context in which risk decisions are made. Aims: To generate new understanding for how speech and language therapists (SLTs) and nurses share information for ongoing management of swallows safety on stroke units. Methods & Procedures: An ethnographic methodology involving 40 weeks of fieldwork on three stroke wards in England between 2015 and 2017. Fieldwork observation (357 h) and interviews with 43 members of SLT and nursing staff. Observational and interview data were analysed iteratively using techniques from the constant comparative method to create a thematically organized explanation. Outcomes & Results: An explanation for how disciplinary differences in time and space influenced how SLT and nursing staff shared information for ongoing management of swallow safety, based around three themes: (1) SLTs and nurses were aligned in concern for swallow safety across all information‐sharing routes; however, (2) ambiguity was introduced by the need for the information contained in swallowing recommendations to travel across time, creating dilemmas for nurses. Patients could improve or deteriorate after recommendations were made and nurses had competing demands on their time. Ambiguity had consequences for (3) critical incident reporting and relationships. SLTs experienced dilemmas over how to act when recommendations were not followed. Conclusions & Implications: This study provides new understanding for patient safety dilemmas associated with the enactment and oversight of swallowing recommendations in context, on stroke wards. Findings can support SLTs and nurses to explore together how information for ongoing dysphagia management can be safely implemented within ward realities and kept up to date. This could include considering nursing capacity to act when SLTs are not there, mealtime staffing and SLT 7‐day working. Together they can review their understanding of risk and preferred local and formal routes for learning from it. What this paper adds: What is already known on the subject: It is known that information to keep swallowing safe is shared through swallowing recommendations, which are understood to involve a balance of risks between optimizing the safety of the swallow mechanism and maintaining physiological and emotional health. There is increasing appreciation from patient safety research, of the importance of understanding the context in which hospital staff make decisions about risk and patient safety. What this paper adds to existing knowledge: The paper provides new empirical understanding for the complexities of risk management associated with SLT and nursing interactions and roles with respect to ongoing swallow safety. What are the potential or actual clinical implications of this work?: Findings can underpin SLT and nurse discussion about how swallow safety could be improved in their own settings. [ABSTRACT FROM AUTHOR]

This paper presents one aspect of a sociocultural micro-ethnographic study examining how 11- and 12-year-old children formulate meanings when working with an artist in a contemporary art gallery. My primary focus is an examination of methodological contributions emerging from an imaginative coding and analysis of children's art. Ninety-nine artworks were created in collaboration with the artist and were organised and interpreted using a constructionist interviewing coding scheme. This unorthodox approach to visual analysis unearthed information that oral accounts cannot provide alone revealing meanings which would otherwise remain dormant. By intuitively applying the coding framework I expose how participants' meanings are negotiated by appropriating and re-organising cultural concepts into personalised narratives. As such, artworks reveal participants' desires, interpretations and intentions, operating as agentic cultural producers as well as unconsciously reproducing visual epistemologies ubiquitous in Western cultures. [ABSTRACT FROM AUTHOR]

Aims: This paper focuses on the reasons for the under-representation of British South Asians in substance use services. Based on a small-scale evaluation of a substance use service that delivers targeted outreach support within two predominantly Pakistani and Bangladeshi communities in the north west of England, this paper contributes to the debate around how substance use services can best engage with young British Pakistani and Bangladeshi substance users. Methods: Semi-structured interviews (with six staff members, 18 young Pakistani and Bangladeshi service users, and 18 stakeholders and partner agencies), a detailed ethnographic observation of the service, and an analysis of routinely collected quantitative monitoring data. Findings: The paper highlights the importance of what Fountain terms low threshold/open access services. Alongside this, the paper argues that the building of trust and confidence in a substance use service is a key when it comes to engaging with young Pakistani and Bangladeshi substance users. Yet this necessary process takes time: something that is at odds with the current trend towards short-term funding regimes and 'quick wins'. Conclusions: The paper concludes by advocating the need for, not only a diverse range of engagement strategies, but also a longer term approach when it comes to developing and delivering substance use services aimed at successfully engaging with this particular group of substance users. [ABSTRACT FROM AUTHOR]

Background: Despite strong evidence supporting the expansion of midwife‐led unit provision, as a result of optimal maternal and perinatal outcomes, cost‐effectiveness, and positive service user and staff experiences, scaling‐up has been slow. Systemic barriers associated with gender, professional, economic, cultural, and social factors continue to constrain the expansion of midwifery as a public health intervention globally. This article aimed to explore relationships and trust as key components of a well‐functioning freestanding midwifery unit (FMU). Method(s): A critical realist ethnographic study of an FMU located in East London, England, was conducted over a period of 15 months. Recruitment of the 82 participants was purposive. Data collection included participant observation and semi‐structured interviews, and data were analyzed thematically along with relevant local guidelines and documents. Results: Twelve themes emerged. Relationships and Trust were identified as a core theme. The other 11 themes were grouped into six families, three of which: Ownership, Autonomy, and Continuous Learning; Team Spirit, Interdependency, and Power Relations; and Salutogenesis will be covered in this paper. The remaining three families: Friendly Environment; Having Time and Mindfulness; and Social Capital, will be covered in a separate paper. Conclusions: A relationship‐based model of care was crucial for both the functioning of the FMU and service users' satisfaction and may offer a compelling response to high levels of stress and burnout among midwives. [ABSTRACT FROM AUTHOR]

Social media applications are used daily by billions to communicate. Adolescents living in state care are no different, yet the potential implications of their social media use are. Despite the global use of social media and evidence highlighting their role in social capital cultivation, how adolescents living in state care make use of social media remains unknown, with discussions tending to focus exclusively on risk. Using data from a four-year Digital Life Story Work (DLSW) research programme, this paper explores adolescents' and social care professionals' (n =45) perspectives on the everyday use of social media by adolescents living in state care. Using an ethnographic multi-method approach, extracts of conversations from the four English residential homes engaged in the DLSW programme were thematically analysed. Three major themes emerged; contacts as currency, promoting and protecting the self and transitions. Analysis illustrates how adolescents living in state care use social media as active digital agents and the need to reframe this usage to enable benefits to be enacted. The paper concludes that urgent research is needed to enable practitioners and policy makers to show a deeper appreciation of the potentials of social media, enabling a more balanced approach to succeed in practice. [ABSTRACT FROM AUTHOR]

Purpose - Service users very often interpret and respond to their experiences of death, dying and bereavement through a religious or spiritual lens. However, recent trends in religion and belief have influenced how professionals respond to indicators such as faith. Since the post-war years in Britain and due to the transfer of services from church to state, as well as the change in the religious landscape, language has largely secularized. When people start addressing religion and belief again, they lack the appropriate literacy to do so, this is termed religious literacy by Dinham (2015). The purpose of this paper is to explore how professionals in end of life (EOL) care respond to service user's religious and spiritual indicators, through the lens of religious literacy. Design/methodology/approach - The paper draws from an ethnographic study undertaken across hospices in England, UK. In this study, healthcare professionals (HCPs) were observed for one calendar year. Findings - Results show that lack of religious literacy on the part of HCPs may lead to subtle and unintentional microaggression. Three types of indications of microinvalidation have been noted: verbal, non-verbal and environmental. Originality/value - This paper innovates in offering a first-hand phenomenological interpretation of observations in the field. The research data capture visually the impact of lack of religious literacy, an achievement which adds to the dialogue about service user rights in EOL care. [ABSTRACT FROM AUTHOR]

The past two decades have seen an increasing role for the UK community and voluntary sector (CVS) in health promotion in disadvantaged areas, largely based on assumptions on the part of funders that CVS providers are better able to engage ‘hard-to-reach’ population groups in services than statutory providers. However, there is limited empirical research exploring CVS provider practices in this field. Using ethnographic data, this paper examines the experiences of a network of CVS providers seeking to engage residents in health-promoting community services in a disadvantaged region in the North of England. The paper shows how CVS providers engaged in apparently contradictory practices, fluctuating between an empathically informed response to complex resident circumstances and (in the context of meeting externally set targets) behavioural lifestyle approaches to health promotion. Drawing on concepts from figurational sociology, the paper explains how lifestyle drift occurs in health promotion as a result of the complex web of relations (with funders, commissioners and residents) in which CVS providers are embedded. Despite the fact that research has revealed the impact of targets on the work of the CVS before, this paper demonstrates more specifically the way in which monitoring processes within CVS contracts can draw providers into the neoliberal lifestyle discourse so prevalent in health promotion. [ABSTRACT FROM PUBLISHER]

The welfare of the child in the context of private family law proceedings is of significant international interest. This paper presents findings from an ethnographic study of private law proceedings in England, which explored legal professionals' experiences of and practice within space and place. Data are derived from interviews with professionals, and observations from the waiting areas, canteens, interview rooms and offices of lawyers who represent parents in private family law proceedings. The paper focuses on winners and losers in the area of private family law, and the 'trophy', the child, who appears to be lost in the battleground of legal proceedings, but remains the ultimate prize. The concept of space is explored before moving to reflect upon the data from the interviews. The themes that emerge from the data are the relationships between the public space of the court and the vulnerability of the parties as they attempt with greater or less ease, to navigate the complexities of this formal and procedurally driven space. This paper explores the idea of the child as the ultimate 'trophy' within private law proceedings to consider its significance for family justice practice in England, and to elicit a greater understanding of the importance of space and place in private law proceedings that have remained largely unexplored. [ABSTRACT FROM AUTHOR]

The paper explores the implications of being a social worker seconded to a Mental Health Trust based on narrative interviews with mental health social workers. As part of a wider study, thirteen mental health social workers from across England were interviewed individually about their experiences of being seconded to a Mental Health Trust. Building on the work of Andrew Pithouse, the findings reveal the (in)visibility of mental health social work. The social workers were isolated within Health Trusts with minimal links to their local authority employers. They struggled to articulate and define social work. Instead, social work was depicted as being indefinable, involving working in liminal spaces and as filling the gaps left by other professions. Furthermore, the social workers were unable to make social work visible, as social work is not 'seen' by the other members of the team. Finally, the social workers were unable to make social visible through supervision if they did not have a social work manager. The paper ends with an unexpected outcome of the research: the notion of the research interview as surrogate supervision. [ABSTRACT FROM AUTHOR]

Aim The aim of this paper is to explore what might be gained from collecting and analysing visual data, such as photographs, scans, drawings, video and screen recordings, in clinical educational research. Its focus is on visual research that looks at teaching and learning 'as it naturally occurs' in the work place, in simulation centres and other sites, and also involves the collection and analysis of visual learning materials circulating in these sites. Background With the ubiquity of digital recording devices, video data and visual learning materials are now relatively cheap to collect. Compared to other domains of education research visual materials are not widely used in clinical education research. The paper sets out to identify and reflect on the possibilities for visual research using examples from an ethnographic study on surgical and inter-professional learning in the operating theatres of a London hospital. Main contribution The paper shows how visual research enables recognition, analysis and critical evaluation of (1) the hidden curriculum, such as the meanings implied by embodied, visible actions of clinicians; (2) the ways in which clinical teachers design multimodal learning environments using a range of modes of communication available to them, combining, for instance, gesture and speech; (3) the informal assessment of clinical skills, and the intricate relation between trainee performance and supervisor feedback; (4) the potentialities and limitations of different visual learning materials, such as textbooks and videos, for representing medical knowledge. Discussion and conclusion The paper concludes with theoretical and methodological reflections on what can be made visible, and therefore available for analysis, explanation and evaluation if visual materials are used for clinical education research, and what remains unaccounted for if written language remains the dominant mode in the research cycle. Opportunities for quantitative analysis and ethical implications are also discussed. [ABSTRACT FROM AUTHOR]

This paper explores public health policy implementation through partnership working at the local level by examining how local actors from public health, and the wider workforce make sense of and work on social inequalities in health. An ethnographic case study was used to examine policy implementation in one local strategic partnership in north-west England during a period of significant resource constraint. Semi-structured interviews were the primary method of data generation. Sensitising concepts from figurational sociology were used to develop a theoretical account of how local policy implementation directed at narrowing social inequalities in health tended to give rise to relatively fragmented and short-term services, projects and practices, which focused on lifestyle factors and behaviour change. Theorising partnership work as figurations goes some way to explaining the apparent paradox among participants who expressed a relatively detached appreciation of wider social influences, alongside emotional involvement in their work. This process of individualisation explains how local professionals tended to conceptualise health inequality and the social determinants of health as personal troubles. Individualisation meant that the social reality of working in partnerships on difficult issues was simplified. Thus, any scope for working on the social determinants of health tended to be overlooked. The extent to which this was intentional or a matter of struggling to see opportunities, or a mixture of the two, was difficult to discern. Although the policy landscape has changed, the findings give some insight into understanding how local collaborative processes reproduce local public health work underpinned by lifestyle choices. [ABSTRACT FROM AUTHOR]

This paper discusses the strengths of using ethnographic research methods in cross-national comparative research. It focuses particularly on the potential of applying such methods to the study of migrants and minority ethnic youth in education, where large-scale quantitative studies or single-sited ethnographies are currently dominant. By linking findings and methodological reflections from a research study into the schooling experiences and life projects of migrants and minority ethnic youth in England and Spain, the paper shows how cross-national comparative ethnographies enable researchers to (1) contextualise and compare topics identified by research participants in the course of the fieldwork, (2) analyse topics, which only appear in one research setting and (3) explore and challenge how concepts and categories are employed by research participants in different settings. This, it is argued, makes such research methods particularly well placed to identify issues, which young people themselves find important to their schooling, and explore how these interlink with local practice. [ABSTRACT FROM PUBLISHER]

Abstract: Continence is a key moment of care that can tell us about the wider care of people living with dementia within acute hospital wards. The spotlight is currently on the quality of hospital care of older people across the UK, yet concerns persist about their poor treatment, neglect, abuse, and discrimination within this setting. Thus, within hospitals, the care of people living with dementia is both a welfare issue and a human rights issue. The challenge of continence care for people living with dementia can be seen as the ‘canary in the coal mine’ for the unravelling of dignity within the acute setting. This paper draws on an ethnographic study within five hospitals in England and Wales, selected to represent a range of hospital types, geographies and socio‐economic catchments. Observational fieldwork was carried out over 154 days in acute hospitals known to admit large numbers of people living with dementia. This paper starts to fill the gap between theory and data by providing an in‐depth ethnographic analysis examining the ways in which treatment as a person is negotiated, achieved or threatened. We examine how the twin assaults on agency of a diagnosis of dementia and of incontinence threaten personhood. The acute threats to this patient group may then act to magnify perils to treatment as a person. Our findings suggest that personal dignity and the social construction of moral personhood are both threatened and maintained in such a setting. We show how empirical ethnographic data can lend weight to, and add detail to, theoretical accounts of moral personhood and dignity. [ABSTRACT FROM AUTHOR]

This paper examines how some elderly Chinese tenants in a cluster of housing schemes in the north of England differed in their perception, consciousness and management of time. It examines how there was too much or too little time for some of these tenants and how time played a part in their personal and social identification arising from their experiences of migration. Lefebvre's concept of rhythmanalysis is intended to be a transdisciplinary theory that could be used to theorise ‘everyday life’. The writer superimposes this concept on the activity and disengagement theories of ageing to add meaning to the ethnographic data gathered and argues that ageing is not a simple matter of activity or disengagement. These Chinese elders coped with change through a flexible and ongoing process of adapting to different rhythms of life. This paper aims to contribute to the empirical understanding of ageing for a minority in Britain and to present a novel theoretical perspective on research approaches to ageing. [ABSTRACT FROM PUBLISHER]

Although breastfeeding is known to improve health, economic and environmental outcomes, breastfeeding initiation and continuation rates are low in the United Kingdom. The global WHO/UNICEF Baby Friendly Hospital Initiative (BFHI) aims to reverse declining rates of breastfeeding by shifting the culture of infant feeding care provision throughout hospital maternity settings. In the United Kingdom, the global BFHI has been adapted by UNICEF UK reflecting a paradigm shift towards the experiences of women and families using maternity services. This research used a critical ethnographic approach to explore the influence of the national UNICEF UK Baby Friendly Initiative (BFI) standards on the culture of one typical maternity service in England, over a period of 8 weeks, across four phases of data collection between 2011 and 2017. Twenty‐one staff and 26 service users were recruited and engaged in moderate‐level participant observation and/or guided interviews and conversations. Basic, organising and a final global theme emerged through thematic network analysis, describing the influence of the BFI on providing, receiving and leading infant feeding care in a hospital maternity setting. Using Antonovsky's sense of coherence construct, the findings discussed in this paper highlight how the BFI offers 'informational' (comprehensible), 'practical' (manageable) and 'emotional' (meaningful) support for both staff and service users, strengthened by effective, local leadership and a team approach. This is juxtaposed against the tensions and demands of the busy hospital maternity setting. It is recommended that ongoing infant feeding policy, practice and leadership balance relational and rational approaches for positive infant feeding care and experiences to flourish. [ABSTRACT FROM AUTHOR]

This paper reports on data from a qualitative case study of child protection social work in one local authority. Ethnographic methods were used and constructionist grounded theory employed to collect and analyse 329 pages of historical documents about the local authority child protection service, 246.5 hours of observations of social work practice and 19 interviews of social workers and their team managers. By interpreting the experiences of the social workers through the conceptual debates about the changes in the field of social administration, the social workers could be seen to want to perform a traditional form of social work but were required to perform a contemporary form of social administration. The aims and purposes of this form of practice could be considered to be distinct from those of social work as understood by the social workers, and as such, the social workers experienced the practice environment as constraining and often felt disillusioned. This paper conceptualizes these forms of practice, contributing to the debates about what practice is and how we are to analyse and categorize it for the purposes of influencing the institutions that create and maintain contemporary practice. [ABSTRACT FROM AUTHOR]

Not only is it tacitly understood that walking is good for health and well-being but there is also now robust evidence to support this link. There is also growing evidence that regular short walks can be a protective factor for a range of long-term health conditions. Walking in the countryside can bring additional benefits, but access to the countryside brings complexities, especially for people with poorer material resources and from different ethnic communities. Reasons for people taking up walking as a physical activity are reasonably well understood, but factors linked to sustained walking, and therefore sustained benefit, are not. Based on an ethnographic study of a Walking for Health group in Lincolnshire, UK, this paper considers the motivations and rewards of group walks for older people. Nineteen members of the walking group, almost all with long-term conditions, took part in tape-recorded interviews about the personal benefits of walking. The paper provides insights into the links between walking as a sustainable activity and health, and why a combination of personal adaptive capacities, design elements of the walks and relational achievements of the walking group are important to this understanding. The paper concludes with some observations about the need to reframe conventional thinking about adherence to physical activity programmes. [ABSTRACT FROM AUTHOR]

This empirically informed ‘opinion paper’ reflects upon the use of observant participant as a qualitative research method during an applied, multilocal, ethnographic study of street-based injecting drug use (conducted throughout the south of England during 2006–2011). Throughout these studies, participant observation took place with frontline service personnel and observant participation occurred with people who inject drugs. As participant observation typically involves the acquisition of a new role in an unfamiliar setting for a given person, observant participation prioritises existing roles in order to conduct research within familiar/unfamiliar settings. In this study, the method of observant participation is compared and contrasted with participant observation as both methods were conducted in the aforementioned ethnographic study of street-based injecting drug use. This experience-based comparison is followed by a discussion that offers a theoretically informed explanation for the various success and outcomes attached to the study (and, specifically, to those obtained from the applied use of observant participation with people who inject drugs). The paper concludes that observant participation may be best used as a ‘synergising’ component within a wider qualitative research toolkit especially when dedicated to inquiries of sensitive issues or ‘hard-to-reach’ populations (such as those affected by drug dependence). In addition, the synergistic effect of observant participation may contribute towards a combined understanding of social problems that is perhaps greater than the sum of findings obtained from separate, disconnected methods of social research. [ABSTRACT FROM PUBLISHER]

The social positioning and treatment of persons with dementia reflects dominant biomedical discourses of progressive and inevitable loss of insight, capacity, and personality. Proponents of person-centred care, by contrast, suggest that such loss can be mitigated within environments that preserve rather than undermine personhood. In formal organisational settings, person-centred approaches place particular responsibility on 'empowered' direct-care staff to translate these principles into practice. These staff provide the majority of hands-on care, but with limited training, recognition, or remuneration. Working within a Foucauldian understanding of power, this paper examines the complex ways that dementia care staff engage with their own 'dis/empowerment' in everyday practice. The findings, which are drawn from ethnographic studies of three National Health Service ( NHS) wards and one private care home in England, are presented as a narrative exploration of carers' general experience of powerlessness, their inversion of this marginalised subject positioning, and the related possibilities for action. The paper concludes with a discussion of how Foucault's understanding of power may help define and enhance efforts to empower direct-care staff to provide person-centred care in formal dementia care settings. [ABSTRACT FROM AUTHOR]

ABSTRACT As there are a number of high-profile public inquiries into child death tragedies, 'information sharing' has now become a moral and political imperative across England and Wales for improving the welfare and protection of children. This paper discusses multi-agency information practices, at the stage of referral, which were observed and documented in the day-to-day practice of child protection work. Drawing on transcribed, professional narrative accounts, a 'jigsaw' metaphor is used to describe the process of piecing information together to ascertain a 'full' picture of children and families lives. However, these accounts highlight that there is something of a mismatch between the jigsaw, as articulated in the conceptual abstract accounts, and jigsaw practices operating on the ground. It is argued that abstracting professional information practices from situated contexts creates impoverished understandings of these practices. Thus, reported findings in this paper highlight the inherent complexities of jigsaw practices in the 'everyday' of child protection work, which challenges objectivist assumptions about a stability of meaning, and further highlight that the 'endpoint' of reaching a 'full' picture of a child's life is not fixed, nor does it have the same meaning for all professionals, but rather it is a complex process involving sense-making, translation in context and organizational relevance. [ABSTRACT FROM AUTHOR]

This paper explores the interpretative practices of the police when carrying out stops and searches. Drawing on ethnographic research carried out in England and Wales, a conceptual framework is developed to understand how officers become suspicious and decide to initiate encounters. It is argued that officers use tacit knowledge to make sense of new situations and determine what action to take, and base their suspicions on signals they come across on patrol. In examining these social processes, the paper shows that categories and stereotypes are central to decision-making which result in a police focus on the socially marginal. Looking beyond the immediate influences on officer action, the paper also explores the role played by the law in regulating police practice. [ABSTRACT FROM PUBLISHER]

Cemeteries garner considerable academic attention as anthropologists, landscapers, archaeologists, sociologists, geographers and historians examine their layout, purpose and use. Emerging from these studies is a body of literature that considers cemetery and burial ground design, memorialisation, mourning behaviour and ‘dark tourism’. Beyond interdisciplinary journals such as Mortality and edited multi-disciplinary books however, the insight generated in this literature can be fragmented through publication in discipline specific periodicals. As a result cemeteries are often analysed and presented as places that contain, for example, design or tourism and heritage or emotion and mourning. Framed by concerns over the sustainability of cemeteries nationwide, this paper considers the contemporary English cemetery as a simultaneous space of emotion, commerce and community. Using data from an ethnographic case study of a cemetery in East London, it illustrates the contestation that can result from these concurrent contrasting interpretations. The paper concludes that care needs to be taken when implementing initiatives and policy to balance the varying demands and expectations of a cemetery's purpose and use. [ABSTRACT FROM AUTHOR]

This paper aims to increase our understanding about how student nurses' experiences of supernumerary status are embedded in the hidden curriculum in clinical practice and contribute to the theory-practice gap in nursing. Current literature suggests that the hidden curriculum exists in many professional curricula and that it functions to socialise students into professional behaviours and practice. However, in nursing, there is a gap in our understanding of how these socialisation processes have been influenced by supernumerary status and what forms the hidden curriculum might take currently in clinical practice. An ethnographic case study design. Data were collected in four sites using fieldwork in clinical practice as well as interviews with students, mentors and key stakeholders, an online survey of student bodies and curriculum analysis in four universities. The findings in this paper are drawn from the qualitative fieldwork and interviews and were analysed thematically. The findings suggest that supernumerary status is an important aspect of the hidden curriculum in clinical learning for nursing students; that students are expected by trained staff to work while they learn and that on registration, they are expected to be competent to work immediately as registered nurses. These expectations are at odds with those of academic nurses and contribute to a theory-practice gap for student nurses. These expectations form part of the hidden curriculum that shapes the clinical context, and students have to learn to negotiate their status as supernumerary students in practice to meet these expectations. Consequently, students have to learn in a disintegrated learning context where opposing values of learning exist. To reintegrate student nurses' learning, educators in universities and clinical practice have to understand how the hidden curriculum and expectations around supernumerary status among trained staff affect learning for students. [ABSTRACT FROM AUTHOR]

The paper deals with the issue of practical knowledge for enabling participation. Participation as a strategy for change is widespread in community, health and human service contexts. Research to date has focused on the mechanisms of beneficiaries' participation (e.g. identity, empowerment, activity, gender, space). However, participation as an engagement strategy is action oriented and requires high levels of interaction between those creating the conditions for participation and those participating. These conditions need to be continuously adjusted and outcomes are often unpredictable. This process of 'working with' is often dealt with as a technical issue and captured in metaphorical language. Less emphasis has been given to the type of knowledge modalities that might be necessary in order to enable participation. Drawing on an ethnographic case study of participation in a youth inclusion programme the paper explores the role of stories as potential indicators of practical knowledge. The paper argues that enabling young people's participation requires intuition and imagination, patience and perseverance, and judgement for acting under uncertainty. It concludes that stories only partially fulfil their potential as indicators of such knowledge modalities. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Smoking in high‐income countries is now concentrated in poor communities whose relatively high smoking prevalence is explained by greater uptake but above all by lower quit rates. Whilst a number of barriers to smoking cessation have been identified, this is the first paper to situate cessation itself as a classed and cultural practice. Drawing on ethnographic research carried out in a working‐class community in the North of England between 2012 and 2015, I theorise smoking cessation as a symbolic practice in relation to the affective experience of class and social mobility. I show that ambivalence about upward mobility as separation and loss translated into ambivalence about smoking cessation. The reason for this was that the social gradient in smoking operated dynamically at the level of the individual life course, i.e. smoking cessation followed upward mobility. A serious health problem was an appropriate reason to quit but older women continued to smoke despite serious health problems. This was linked to historical gender roles leading to women placing a low priority on their own health as well as the intergenerational reproduction of smoking through close affective links with smoking parents. [ABSTRACT FROM AUTHOR]

This paper focuses on the diversity in patients' experience of biomedicine and contrasts it with the normative view characteristic of health professionals. Ethnographic fieldwork among Polish migrant women in London, Barcelona and Berlin included interviews about their experiences with local healthcare and health professionals. Themes drawn from the narratives are differences between the cities in terms of communication between patients and health professionals, respect for patients' choices and dignity, attitudes to pregnancy and birth (different levels of medicalization), and paediatric care. It is argued that patients continuously negotiate among their own views and expectations based on previous experiences and knowledge from personal communication; internet forums and publications; and the offer of medical services in the countries of their settlement. Patients experience pluralism of therapeutic traditions within and outside bio-medicine. In turn, representatives of bio-medicine are rarely aware of other medical practices and beliefs and this leads to various misunderstandings. By highlighting the pluralism of medical practices in European countries and the increasing mobility of patients, this case study has useful implications for medical anthropologists and health professionals in a broader Western context, such as raising sensitivity to different communication strategies and a diversity of curing traditions and expectations. [ABSTRACT FROM AUTHOR]

Research into child and family social work has largely stopped short of getting close enough to practice to produce understandings of what goes on between social workers and service users. This is despite the known problems in social worker engagement with children in cases where they have died. This paper outlines and analyses the methods used in a study of social work encounters with children and families on home visits where there were child protection concerns. It illustrates how mobile methods of walking and driving interviews were conducted with social workers on the way to and from home visits, and how the ethnography involved participant observation and audio-recordings of the interactions between social workers, children and parents in the home, revealing the talk, actions and experiences that occurred. Social workers often moved around the home, especially to interview children on their own in their bedrooms, and the paper shows how ways were found to stay close enough to observe these sensitive encounters within families' most intimate spaces, while ensuring the research remained ethical. Ethnographic and mobile methods produce vital data that advance new understandings of everyday social work practices and service users' experiences and of dynamics that are similar to breakdowns in practice that have occurred in child death cases. [ABSTRACT FROM AUTHOR]

This paper describes some of the findings of a qualitative study into the health and illness beliefs of Greek Cypriots living in London. Data were collected through group and individual in-depth interviews and were analysed using the grounded theory approach of constant comparison and saturation. Two of the six themes which were identified are discussed in this paper. The findings provide the reader with important insights into Greek Cypriots' beliefs of health and illness. The paper argues that the understanding of such beliefs from a cultural perspective is vitally important for all those involved in the provision of health care to this group. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to investigate the content, purpose and effectiveness of the handover of information between care home staff beginning and completing a shift. Design/methodology/approach: This was an exploratory study drawing on ethnographic methods. A total of 27 interviews with a range of care home staff, including managers, registered nurses, senior care workers and care workers were undertaken in five care homes selected to give a good contrast in terms of size, ownership, shift patterns and type of handover. Findings: Most handovers were short – lasting 15 min or so – and were held in the office or secluded area in which staff could talk privately. They lasted longer in one home in which the incoming and outgoing shifts physically visited each resident's room and the communal spaces. Staff felt that handovers were important for the efficient running of the home as well as to alert everyone to changes in a resident's health or important events, such as a hospital appointment. In one home, handheld devices enabled staff to follow a resident's care plan and update what was happening in real time. Research limitations/implications: This was a small scale study based on data from a limited number of care homes. Practical implications: The increasing popularity of 12 h shifts means that many homes only hold two short handovers early in the morning and in the evening when the night staff arrive. There appears to be a trend to reduce the number of staff paid to attend handover. Despite this, handovers remain an important component of the routine of a care home. The information contained in handover relates to the running of the care home, as well as residents' wellbeing, suggesting that, while their content overlaps with written records in the home, they are not superfluous. Originality/value: Although the literature on handovers in hospitals is extensive, this appears to be the first published study of handover practices in care homes. [ABSTRACT FROM AUTHOR]

Increased emphasis on the child's voice and point of view in care and treatment has led to an expansion in the development of methods to access and identify their perspectives. Drawing on our experiences in a study of children with leukemia in hospital, this article explains the challenges and opportunities that arise in the use of five commonly used methods in a study of hospitalized children's experiences with health care professionals, including the "Draw and Write" technique, a sticker activity, a paper–person exercise, informal interviews, and participant observation. Each of these methods was examined with regard to ease of use, data generation, and utility of data for accessing children's perspectives and development of initial clinical guidance. [ABSTRACT FROM AUTHOR]

This paper examines a sample of ninety-three child welfare workers' perceptions of emotional relations in risk assessment situations.Workers from England, Norway and California (USA) are interviewed about risk factors in a vignette. Seventy-three per cent of the total workers identify the emotional issues described in the vignette as a risk factor, but a lower percentage of the American workers do so. Nearly all of these workers identify the mother's lack of meeting her daughter's emotional needs as a risk factor; however, the analysis shows that only approximately one-third of these workers elaborate on the possibleconsequencesandreasons for this lack of attachment. Evenfewersuggest services that can improvethe situation.Thefindings suggest thatemotional issues havea relatively low importance in a risk assessment situation but that there are differences by country. Although the sample is small, it is likely that systemic factors in the child welfare system and the risk assessment approach explain some of these differences. [ABSTRACT FROM AUTHOR]

Aim To reflect on the use of photo elicitation as a data collection method when conducting research with primary school age children (nine to 11 years). Background There is recognition that children feel an affinity with the visual medium; as a result, visual methods can be useful when conducting research with children. Photo elicitation is one such method, but there has been little discussion of its use with primary school children within a health context. This paper considers the main issues that researchers should consider. Data sources This paper draws on a research study conducted by the author that used an ethnographic approach and photo elicitation to identify the assets underpinning children’s wellbeing. Review methods A reflective discussion is used to highlight issues relating to the use of photo elicitation to collect data from primary school children. Discussion Photo elicitation is not without its challenges: it creates additional ethical considerations, and can be more time-consuming and expensive. However, children value the opportunity to be involved in research and have their opinions sought, and photo elicitation provides a method of collecting data that is appropriate for children’s developmental and cognitive maturational stages. Conclusion Photo elicitation can be a positive experience for children, and one that is not only fun and engaging, but that is also empowering and valuing of their contributions. Implications for research/practice Research that uses photo elicitation needs to be carefully planned to ensure that the study is supported appropriately. The visual process can offer a unique insight into children’s lives that allows health professionals to deepen their understanding of children’s experiences. [ABSTRACT FROM AUTHOR]

All secondary schools in England have been required to teach Relationships and Sex Education (RSE) since 2019, which has raised particular challenges for – and confrontations with – religious minorities. This paper draws on ethnographic research to centre analysis on the fraught moral binds felt by Jewish parents and educators as they struggle to decide when and how to equip children with knowledge while needing to conform to institutional positions on what protection means. Bodily knowledge is redacted across religious/state models of education, which propagates the maintenance of social boundaries and definitions of sexual transgression, but do not stop the quests and questions that adolescents harbour during puberty and development. The paper draws attention to the use of bracketed words in feminist scholarship to convey how terms are projected as having universal meanings or connotations, which are, in reality, socially situated or at least used in socially sanctioned ways. [ABSTRACT FROM AUTHOR]

Care-home residents with dementia can experience behavioural and psychological symptoms such as aggression, agitation, anxiety, wandering, calling out and sexual disinhibition. Care-home staff have a duty to keep residents safe. However, residents with dementia can pose particular challenges in this area. In this paper, we draw on a study which explored how care-home staff manage dementia-related behaviours. In-depth ethnographic case studies at four separate care homes were conducted in England. These involved interviews with 40 care-home staff and 384 hours of participant observation. Our analysis showed that some residents with dementia experience behaviours which can either create risks for, or negatively impact on, themselves and/or other residents or staff members. It emerged that the consequences of the behaviours, rather than the behaviours themselves, created difficulties for staff. To cope with the risk and impact of behaviours, staff employed multiple strategies such as surveillance, resident placement, restrictions and forced care. Using the data, we explore how actions taken by staff to manage the risk and impact of behaviours in these communal settings relate to residents’ human rights. Our findings have particular relevance for care-home staff who need support and guidance in this area, for service development worldwide and for the global ageing population whose valued human rights may become under threat, if they require long-term care. [ABSTRACT FROM AUTHOR]

Older people living in long-term facilities (nursing and residential homes providing 24-hour care) spend the majority of their time inactive, despite the known health and wellbeing benefits of physical activity and reduced time spent sedentary. In order to successfully embed interventions that aim to increase physical activity or reduce sedentary behaviour, it is necessary to understand the features of the care environment that influence residents’ routine patterns of movement. Drawing on an organisational perspective, this paper explores the structures and mechanisms that shaped different care practices concerning residents’ movement in two contrasting care homes in the north of England. This study adopted an ethnographic approach, using a combination of qualitative observations, informal conversations and interviews. A grounded theory approach to data analysis was adopted. The findings illustrate the importance of translating espoused values of care into tangible and acceptable care practices, systems of management, staff training and development, and the use of care planning in residents’ routine patterns of movement. Understanding how organisational factors shape routine movement among care home residents will help inform the development of embedded and sustainable interventions that enhance physical activity and reduce sedentary behaviour. This study is part of a wider programme of research developing and testing a complex intervention, embedded within routine care, to reduce sedentary behaviour among care home residents. [ABSTRACT FROM AUTHOR]

Objectives:The burden of informal caregivers might show itself in different ways in different cultures. Understanding these differences is important for developing culture-specific measures aimed at alleviating caregiver burden. Hitherto, no findings regarding such cultural differences between different European countries were available. In this paper, differences between English, Finnish and Greek informal caregivers of people with dementia are investigated. Methods:A secondary analysis was performed with data from 36 English, 42 Finnish and 46 Greek caregivers obtained with the short form of the Burden Scale for Family Caregivers (BSFC-s). The probabilities of endorsing the BSFC-s items were investigated by computing a logit model with items and countries as categorical factors. Statistically significant deviation of data from this model was taken as evidence for country-specific response patterns. Results:The two-factorial logit model explains the responses to the items quite well (McFadden's pseudo-R-square: 0.77). There are, however, also statistically significant deviations (p< 0.05). English caregivers have a stronger tendency to endorse items addressing impairments in individual well-being; Finnish caregivers have a stronger tendency to endorse items addressing the conflict between the demands resulting from care and demands resulting from the remaining social life and Greek caregivers have a stronger tendency to endorse items addressing impairments in physical health. Conclusion:Caregiver burden shows itself differently in English, Finnish and Greek caregivers. Accordingly, measures for alleviating caregiver burden in these three countries should address different aspects of the caregivers’ lives. [ABSTRACT FROM AUTHOR]

High quality primary care is a foundational element of effective health services. Internationally, primary care physicians (general practitioners (GPs), family doctors) are experiencing significant workload pressures. How non-patient-facing work contributes to these pressures and what constitutes this work is poorly understood and often unrecognised and undervalued by patients, policy makers, and even clinicians engaged in it. This paper examines non-patient-facing work ethnographically, informed by practice theory, the Listening Guide, and empirical ethics. Ethnographic observations (104 h), in-depth interviews (n = 16; 8 with GPs and 8 with other primary care staff) and reflexive workshops were conducted in two general practices in England. Our analysis shows that 'hidden work' was integral to direct patient care, involving diverse clinical practices such as: interpreting test results; crafting referrals; and accepting interruptions from clinical colleagues. We suggest the term 'hidden care work' more accurately reflects the care-ful nature of this work, which was laden with ambiguity and clinical uncertainty. Completing hidden care work outside of expected working hours was normalised, creating feelings of inefficiency, and exacerbating workload pressure. Pushing tasks forward into an imagined future (when conditions might allow its completion) commonly led to overspill into GPs' own time. GPs experienced tension between their desire to provide safe, continuous, 'caring' care and the desire to work a manageable day, in a context of increasing demand and burgeoning complexity. • The non-patient-facing work of general practitioners is often invisible or hidden. • Hidden work is associated with complexity and uncertainty. • Behind-the-scenes work is care work, just as direct work with patients is care work. • Doctors face tensions between completing tasks and working a manageable day. • Combining practice theory with the Listening Guide embraces multi-vocality. [ABSTRACT FROM AUTHOR]

Social prescribing link workers are recently introduced roles in English primary care. One of their intended functions is to support patients with conditions influenced by the wider, social determinants of health. Their main purpose is to connect people to community resources to meet their nonmedical needs. However, our research reveals that link workers provide not only connections but also what we have described as "holding" for individuals with complex needs, who lack informal networks of support or who are waiting to access services. We explore the concept of holding, its meaning and significance in this context, and consider its consequences. As part of a realist evaluation, we observed seven link workers in GP practices in England during focussed ethnographies over a 3‐week period. We took field notes and interviewed 61 patients and 93 healthcare and voluntary sector professionals. Nine to twelve months later, we carried out follow‐up interviews with forty‐one patients, seven link workers, and a link worker manager. We identified four functions of holding: supporting patients waiting for services, sustaining patients as they prepare for change, reducing the emotional burden of primary healthcare professionals, and bearing witness to patients' distress. Holding appears to be a vital but often overlooked aspect of social prescribing. Patients benefit from having a reliable and consistent person to support their emotional needs. However, similar to the impact of holding on other primary care professionals, there are unintended consequences: some link workers exceed their capacity, become overburdened, experience burnout, and leave their job. Recognizing the importance of holding and understanding its role in link workers' primary care responsibilities are critical. If holding work is accepted as a role for link workers, providing training and support to them should be prioritised to ensure successful implementation and positive outcomes for patients, link workers, and primary healthcare staff. [ABSTRACT FROM AUTHOR]

In England, health inequalities policy shifted during the Labour term (1997–2010) from initially strong commitments to tackling the ‘upstream’ social determinants of health to a technically-driven emphasis on lifestyle risk factors and healthcare access. This multi-sited study, based in and around Westminster (2006–2007), extends our understanding of how political context influences policy-making by drawing from anthropological studies of policy. Qualitative material from central government is put into conversation with theory concerning policy as zones of practices. The paper explores the bristly process through which public health, healthcare and corporate interests vied to shape the political agenda for health inequalities; the selective use of evidence by civil servants in accordance with their perceptions of what politicians conceive to be electorally palatable; the silencing of critique of the dominant narrative about evidence-based policy; and how technical aids developed a life of their own – as a result of which, health inequalities policy ended up being depoliticised. [ABSTRACT FROM PUBLISHER]

This paper explores the effects of kin, social network and the neighbourhood on an individual's well-being. The material is drawn from a community-based qualitative study that explored the attitudes and experiences of African-Caribbean adolescents and their families in the north of England towards healthy lifestyles. A convenience sample of 10 African-Caribbean households units comprising 24 adolescents (12-18 years of age) and 18 adults (22-60 years of age) participated in the study with interviews conducted in their homes. The paper focuses on the adult participants' perception of the role of social support networks and neighbourhood effects on well-being. An in-depth interview schedule was used to explore participants' perceptions on barriers to health and healthy lifestyles; and factors facilitating and inhibiting good health and healthy lifestyles. Data were subjected to thematic analysis with the aid of a Qualitative Data Analysis software package. Emerging categories were discussed with participants by conducting post interview visits and at community events. Findings indicated that participants believed that being a member of a kin network enhanced one's well-being, with such networks described as capable of providing protective support for one's health and well-being. In addition, they preferred to live in neighbourhoods with a high concentration of people of the same ethnicity, despite the effects of neighbourhood deprivation such as poor housing and lack of services. However, participants believed that ethnic segregation leads to marginalisation and further deprivation. These findings suggest that there is a need to explore further the influence of social networks and neighbourhoods on the full spectrum of an individual's well-being. The study concludes by suggesting that in considering new paradigms for the promotion of well-being, health and social care practitioners need to incorporate ways to promote social support and consider relevant psychosocial and neighbourhood factors in designing models of community well-being. [ABSTRACT FROM AUTHOR]

Fisher R. International Journal of Nursing Practice 2010; : 579-585 Prescribing by community nurses is established practice in the UK National Health Service. Although much has been written about the technical aspects of prescribing, little published work addresses the ways in which prescribing might affect relationships. Part of a PhD project set in southern England, this ethnographic project used semistructured interviews with a purposive sample of district nurses ( n = 17), staff nurses ( n = 4), pharmacists ( n = 2) and a general practitioner to investigate the real world of nurse prescribing. Using theories of domination, power and legitimacy from Weber and Foucault, this paper sets out to demonstrate that despite government efforts to encourage collaborative working, power relationships still play an important part in some areas of practice. Analysis, building from Morrell's notion of naïve functionalism, reveals strategies used by actors in community practice to manage such relationships. [ABSTRACT FROM AUTHOR]

Consumption practices of children in contemporary Western societies are implicated in the reconstruction of childhood, according to both popular debate and to those academic perspectives stressing the individualisation of identities within the life course of late modern consumer societies. Yet, little is known about the meanings children themselves give to their own consumption. Drawing from an ethnographic study of children aged 6-11 years and their families, the paper presents girls' constructions of fashion in relation to their own bodies and to those of others. It is shown that although girls may both desire and actually 'dress up' in fashionable clothing, they present a range of contingent and contradictory meanings for doing so. For some girls, 'dressing up' in certain clothes may be a way of 'ageing up' toward feminine adulthood, albeit in restricted contexts and after negotiations between themselves and their parents as to what can be worn and where. Nonetheless, girls in the study also showed anxieties and disapproval of 'showing the body' through 'revealing' clothing. The article concludes by considering the implication of these findings for debates about gendered childhoods, and intergenerational relations in late modern consumer society. [ABSTRACT FROM AUTHOR]

As identity and agency are central to the well-being of people with dementia, this paper explores whether their dialogue conveys a gendered sense of identity and agency. The author discusses whether they demonstrate not just a subjective sense of being but also an understanding of their relational selves. Findings are presented from a qualitative study in the North of England which examined the everyday decisions made by married couples when one partner had dementia. Ethnographic methods were used, including participant observation and interviews. While dialogical analysis usually centres on the subjective self, it was also used to examine intersubjectivity. Comparisons are made between the dialogue of women and men in order to draw conclusions about the gendered nature of identity and agency. The study found that the women and men defined themselves according to their social and gender identities. The literature had suggested that agency might be a gendered concept and the study confirmed that men were somewhat individualistic and rational in their concerns, whereas women were more relational and even spiritual. Yet, women and men demonstrated emotional reflexivity. As national and international health policy prioritises living well with dementia, more systematic attention should be given to the role of gender in influencing well-being in dementia. Health and social care staff should recognise and facilitate the gender identity and related social roles of people with dementia (e.g. parent, carer and worker) in order to enhance their quality of life. [ABSTRACT FROM AUTHOR]