Search

In this paper, we examine the use of creative methods for understanding the experience of young adults aged between 16 and 30 years over a year following a cancer diagnosis. Exploring the renegotiation of identity, the narrative, longitudinal research design of the study demonstrated the unfolding process of the narrative work between participants and researcher. We used a combination of visual, spoken and reflexive psychosocial approaches to understand emergent narratives, many of which do not always find symbolisation in language. Our methodological approach focused on the difficult and sometimes 'unspeakable' nature of the young adults' narratives, demonstrating the importance of different modes of communication in articulating complicated relations with uncertain futures. In this respect the links between narrative, social action and the imagining of possible futures are precarious. In this paper, we explore how untellable issues were explored, and the challenges of doing so.

Introduction: The inherited hemoglobin disorders constitute a major public health problem. Facilitators (experienced hemoglobin counselors) were trained to deliver knowledge and skills to "frontline" practitioners to enable them to support parents during antenatal screening via a cascade (train-the-trainer) model. Objectives of evaluation were to explore the extent that the cascade model was perceived to be embedded in practice, identify enablers and barriers to effective cascading, assess the feasibility of incorporating e-learning into the model, and obtain the facilitators' perceptions of the change process. Methods: Focus groups and interviews were undertaken with 50 facilitators. Data were analyzed thematically. Results: Cascading was influenced by contextual factors operating in the work environment, especially workload, existing roles and responsibilities and adequate preparation. Facilitators' confidence and perceptions of success varied for individuals in the same workplace exposed to the same opportunities to receive and deliver training. Cascading could by enhanced by carefully selecting potential facilitators, training needs assessment to identify the knowledge and skills required by individuals, and follow-up to offer ongoing support. Discussion: Evaluation demonstrated the importance of contextual and individual factors to successful cascading and the feasibility of combining it with e-learning. Future evaluations should consider the perspectives of all stakeholders, namely managers, recipients of cascading and clients, and cost-effectiveness. (Contains 1 table.)

This article examines major theoretical approaches to the study of death and dying. It presents theories or models that have informed developments in this area and influenced the way care is shaped and delivered towards the end of life. Theories of death and dying are important as the concept of 'a good death', and how it can be achieved, is promoted in UK government policy. Two central aspects are discussed: the first focuses on dying trajectories and explores these in patients with cancer, heart failure, chronic obstructive pulmonary disease and old age; the second is concerned with how people have been observed to cope with dying and how they deal with this knowledge. In particular, the article examines the following issues: awareness of dying; coping with dying in stages and intervals or using a task-based approach; hope when coping with dying; and the readiness-to-die theory. The article also explains that little is known about patients with stage 5 chronic kidney disease, their trajectories to death and how they cope with the knowledge that they are dying. [ABSTRACT FROM AUTHOR]