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Background: This study looked to investigate the sometimes conscious and sometimes intuitive decision-making processes of Intensive Interaction practitioners. More specifically, this study set out to develop a rich description of how practitioners make judgements when developing a dynamic repertoire of Intensive Interaction strategies with people with severe or profound learning difficulties and/or autism, how this decision-making process is enacted in practice and what issues inform such decisions. Materials and Methods: This research followed a "Template Analysis" qualitative methodology, informed by semi-structured interviews with 13 experienced Intensive Interaction Practitioners (who had completed the Intensive Interaction Coordinators course as administered by the Intensive Interaction Institute). The participants included the following: speech and language therapists, parents, teachers, residential care staff and managers, and a clinical psychologist. Results: The findings of this study indicate why and how certain decisions are made by experienced practitioners before, during and after engagement in Intensive Interaction. Such decision-making is indicated as sometimes being intuitive in nature, sometimes more conscious, sometimes moving between the two cognitive states as differing issues arise. Practitioner decision-making was focused on a number of issues, including specific learning or care "agendas"; practitioner confidence and knowledge; environmental considerations; individual learner characteristics and behaviour; learner attention, "attunement" and arousal levels; building a shared "repertoire"; and issues of available time. Conclusions: The issue of how novice Intensive Interaction practitioners may best be supported to more quickly and confidently develop improved Intensive Interaction practices is discussed, proposing the development of a cyclical process of experiential learning and supported reflection.

Background: There is increasing worldwide interest in person‐centred care in haemodialysis and home haemodialysis (HHD). Intradialytic fluid management is a vital component of haemodialysis, and often a shared decision, yet patients' perspectives and experience of related decisions are largely unexplored. Objectives: To explore the perspectives of patients receiving home or incentre haemodialysis (IHD), in relation to intradialytic fluid management. Design: A multicentre cross‐sectional survey. Participants: Eight hundred and thirty‐nine patients receiving IHD and 99 patients receiving HHD, across six English renal units. Measurements: Self‐reported measures of understanding, experiences and control of fluid management, and willingness to achieve target weight. An objective test of patients' ability to relate common signs and symptoms to fluid overload or excessive ultrafiltration. Results: Patients receiving HHD had greater knowledge than those receiving IHD (66.1% vs. 42.3%, p < 0.001) about causes of common signs and symptoms which remained when controlling for age, education and years since beginning haemodialysis. Patients receiving HHD felt more in control of and had greater self‐reported adherence to fluid management (p < 0.01), yet knowledge gaps existed in both cohorts. Conclusions: Greater patient knowledge and its practice in HHD may contribute to improved fluid balance and outcomes. Whilst patient selection may contribute towards these differences, the training patients receive when opting for HHD and subsequent experience are likely to be key contributing factors. Integrating aspects of education on fluid management from HHD training programmes should be considered in IHD, and further targeted, robust education remains an unmet need. [ABSTRACT FROM AUTHOR]