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School nurses in the UK have a unique position to recognise and respond to suspected abuse and neglect through their universal contact with the school population (HM Government, 2018) although a dearth of in-depth research exists to understand their role. The aim of this research study is to understand how school nurses identify and work with school children aged 5-19 years at risk of child abuse and neglect. Three research objectives informed the study; (1) to explore the processes through which school nurses identify school children aged 5-19 years at risk of child abuse and neglect (2) to explore how school nurses make assessments of school children aged 5-19 years at risk of child abuse and neglect, and the types of school nursing interventions offered to them, and (3) to explore the experiences of school nurses in identifying and working with school children aged 5-19 years at risk of child abuse and neglect: including the perceived challenges and opportunities of their role. A mixed-methods approach was taken to the study, underpinned by the epistemological stance of pragmatism (Creswell and Plano Clark, 2007; Teddlie and Tashakkori, 2009). A sequential design was conducted in two stages; Stage One explored the context of school nursing caseloads and appointments with children and young people using secondary data from electronic diaries and caseloads, and Stage Two explored in-depth the experiences of school nurses through semi-structured interviews, informed by a constructivist Grounded Theory approach (Charmaz, 2014). A process model of risk assessment in school nursing practice, developed from the findings of this study, is presented in three key stages; 'becoming aware of safeguarding concerns', 'detective work' and 'managing risk'. Key concepts of risk, trust and communication are explored, which form the foundations of a school nursing safety net of care for vulnerable children and young people who may otherwise fall through the gaps of current service provision. Much greater clarity is needed at a local and national level as to the remit of school nurses in safeguarding and child protection. School nurses are expected to operate at any given point along the spectrum of preventative to reactive care; they must not only be regarded as an expanding catch-all service in this way, but rather a speciality with focus.

Examining the relationship among government performance, service satisfaction and trust in government advocated by the New Public Management, this research contributes to a better understanding of the performance-trust hypothesis and its assumptions. This study evaluates the satisfaction link of the performance-trust hypothesis, investigating influences on service satisfaction and how these translate into trust. In particular, two implicit assumptions of the performance-trust hypothesis are explored. First, citizen experience with public services is examined as a measure of specific support for government. Second, the role of citizen interactions with the bureaucracy is assessed, specifically identifying the influence of citizen attitudes toward public administrators on general trust in government. The performance-trust hypothesis poses that improved government performance leads to more satisfied citizens, thus resulting in higher levels of citizen trust in government. Although empirical research has supported the link between satisfaction with public services and trust in government, the implicit assumption that satisfaction is a function of specific support for government, impacted by citizen experiences with government services, requires further evaluation. Examining the relationship between using a particular government service and evaluations of the effectiveness of that service, these findings show that service users have significantly different evaluations of government services than non-service users. Personally experiencing the service delivery of a particular government program results in higher levels of service satisfaction compared to levels among those who have not personally used the program. A second implicit assumption of the performance-trust hypothesis is that evaluations of public administrators based on citizen interactions during service delivery influence trust in government. Although the performance-trust hypothesis assumes that citizen evaluations of bureaucrats are based on specific support for government, only one component is emphasized, output-based trust—or perceptions of bureaucratic competence—while the second dimension, process-based trust—or perceptions of the caring of public administrators—is overlooked. These findings indicate that attitudes toward bureaucrats do influence trust in government broadly. However, it is not only competence that influences trusting attitudes, as expected by the performance-trust hypothesis, but also caring. In fact, process-based trust may have a greater impact on citizen trust in government than output-based trust.

This study tested the relationship between change in NDI scores after 3 weeks of strengthening exercise and response to strengthening exercise at the final assessment. A change in the NDI of 7 points after 3 weeks correctly classified 93.2% of participants that would display a positive change at the final assessment. This minor thesis was written by a post-graduate student as part of the requirements of the Master of Health Science (Osteopathy) program.