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As phenomenology rests on, and is informed by, a long and deep philosophical heritage, this chapter outlines some distinctions about phenomenology setting it conceptually apart from other qualitative methods. The chapter offers some ways of defining what a phenomenological approach is and what this means in the pursuit of enquiry. We illustrate how the philosophical considerations of a phenomenological approach are translated into specific methods and procedures for carrying out research in the human sciences and we specifically make a case for descriptive phenomenological enquiry. A key area for the purpose of this chapter is how Husserl offers us firstly a way to use ‘the life-world’ as a source of knowledge, and secondly an emphasis that is not focused on articulating theory but is instead a beneficial way of describing the whatness or quiddity of a phenomenon as it appears, deepening understanding the phenomenon and its essential features. The chapter also points to new directions in phenomenology and provides examples and illustration from published phenomenological research studies.

Psychosocial interventions (PSI) have been recognised as an important and valuable treatment for individuals with a serious mental health problem and their families. Over the past decade, PSI has gained national recognition through training courses such as the Thorn programme. However, despite NHS provider organisations investing time and money in the training of mental health practitioners in Thorn‐based PSI, implementing this training in practice has been inconsistent and difficult. Current literature focuses mainly on the efficacy of Thorn‐trained practitioners and on their attempts at transferring skills into practice. The aim of this study was to assess the effectiveness of a cross‐educational practice meeting in assisting Thorn graduates to implement PSI into clinical practice. Fifteen participants from a specialist mental health trust (including eight Thorn graduates) who participated in this type of meeting were interviewed. Six core themes were identified: framework for implementation; organisational drivers; Thorn graduates' position; service achievements; reforms to the process and threats to implementation. These themes indicate that a cross‐educational practice meeting can be a valuable framework for assisting Thorn graduates in implementing a range of PSI in clinical practice. This type of meeting can also make an impact on the culture of an organisation through facilitating change towards evidence‐based psychosocial practice.

Background Fatigue is one of the most commonly reported and debilitating symptoms of multiple sclerosis (MS); approximately two-thirds of people with MS consider it to be one of their three most troubling symptoms. It may limit or prevent participation in everyday activities, work, leisure, and social pursuits, reduce psychological well-being and is one of the key precipitants of early retirement. Energy effectiveness approaches have been shown to be effective in reducing MS-fatigue, increasing self-efficacy and improving quality of life. Cognitive behavioural approaches have been found to be effective for managing fatigue in other conditions, such as chronic fatigue syndrome, and more recently, in MS. The aim of this pragmatic trial is to evaluate the clinical and cost-effectiveness of a recently developed group-based fatigue management intervention (that blends cognitive behavioural and energy effectiveness approaches) compared with current local practice. Methods/Design This is a multi-centre parallel arm block-randomised controlled trial (RCT) of a six session group-based fatigue management intervention, delivered by health professionals, compared with current local practice. 180 consenting adults with a confirmed diagnosis of MS and significant fatigue levels, recruited via secondary/primary care or newsletters/websites, will be randomised to receive the fatigue management intervention or current local practice. An economic evaluation will be undertaken alongside the trial. Primary outcomes are fatigue severity, self-efficacy and disease-specific quality of life. Secondary outcomes include fatigue impact, general quality of life, mood, activity patterns, and cost-effectiveness. Outcomes in those receiving the fatigue management intervention will be measured 1 week prior to, and 1, 4, and 12 months after the intervention (and at equivalent times in those receiving current local practice). A qualitative component will examine what aspects of the fatigue management intervention participants found helpful/unhelpful and barriers to change. Discussion This trial is the fourth stage of a research programme that has followed the Medical Research Council guidance for developing and evaluating complex interventions. What makes the intervention unique is that it blends cognitive behavioural and energy effectiveness approaches. A potential strength of the intervention is that it could be integrated into existing service delivery models as it has been designed to be delivered by staff already working with people with MS. Service users will be involved throughout this research. Trial registration Current Controlled Trials ISRCTN76517470

Background The unpredictable, variable nature of Multiple Sclerosis (MS), and the possibility of increasing disability, means that a diagnosis can have substantial psychological consequences. Objectives To assess the effectiveness of psychological interventions for people with MS. Search methods We searched the Cochrane MS Group Specialised Register (December 2004), Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2004 ), MEDLINE (January 1966 to December 2004), PsychINFO (January 1887 to December 2004), CINAHL (January 1982 to December 2004) and 14 others. We searched reference lists of articles, wrote to corresponding authors of the 13 papers identified by June 2004, and searched for trials in progress using 3 research registers. Selection criteria Randomised controlled trials of interventions described as wholly or mostly based on psychological theory and practice, in people with MS. Primary outcome measures were disease specific and general quality of life, psychiatric symptoms, psychological functioning, disability, and cognitive outcomes. Secondary outcome measures were number of relapses, pain, fatigue, health care utilisation, changes in medication, and adherence to other therapies. Data collection and analysis Pertinent studies were identified from abstracts by one author. Full papers were independently compared to selection criteria by four authors. Key details were extracted from relevant papers using a standard format, and studies scored on three dimensions of quality. The review is organised into four mini-reviews (MR) dependent on the intervention's target population; people with cognitive impairments (MR1), people with moderate to severe disability (MR2), people with MS (no other criteria) (MR3), and people with depression (MR4). Main results Overall 16 studies were identified and included. MR1: three trials (n=145). Some evidence of effectiveness of cognitive rehabilitation on cognitive outcomes, although this was difficult to interpret because of the large number of outcome measures used. MR2: three trials (n=80). One small trial suggesting psychotherapy may help with depression. MR3: seven studies (n=688). Some evidence that cognitive behavioural therapy may help people adjust to, and cope with, having MS (three trials). The other trials were diverse in nature and some difficult to interpret because of multiple outcome measures. MR4: three trials (n=93). Two small studies of cognitive behavioural therapy showed significant improvements in depression. Authors' conclusions The diversity of psychological interventions identified indicates the many ways in which they can potentially help people with MS. No definite conclusions can be made from this review. However there is reasonable evidence that cognitive behavioural approaches are beneficial in the treatment of depression, and in helping people adjust to, and cope with, having MS.

[Extract] This chapter provides an overview of the differentiation between the ‘nontaught’ and ‘taught’ doctorates, and examines why and how different doctoral approaches in nursing have evolved. The major forms of doctoral education examined are: professional doctoral programmes (mainly taught), doctorates by published work, and doctorates by portfolio; doctoral study via distance education is also explored. Within our discussion we draw out benefits and challenges of these diverse doctoral approaches in nursing, all of which are equally robust and aim to contribute to knowledge for practice. For the purpose of the chapter doctorates may be termed ‘non-traditional doctorates’; however, we acknowledge that it is difficult to define what is traditional and non-traditional1 in a global context. We suggest that because many different doctoral education systems have emerged over time in many countries with distinct postgraduate systems, no single definition is satisfactory, and mutually exclusive criteria to categorize doctorates are difficult to identify. While many countries have examples of ‘traditional’ PhDs by thesis, diverse new approaches to doctoral education are emerging worldwide, some based on the US Doctorate of Nursing Science (DNS) model, with others emerging within specific contexts such as practice and/or higher education policy, and are subsequently mixed in their structure and delivery. Therefore, we explore new forms of doctoral education as well as concepts that underpin current understandings of the non-taught (thesis-based PhD) and taught doctorates (professional doctorates such as DNS), and illustrate their key tenets.

This article reports 1 theme from an ethnographic study that aimed to describe the experiences, expectations, and beliefs of mothers and health care professionals concerning supplementation in a UK maternity unit. Observation was conducted on the postnatal ward and the newborn infant unit, and 30 mothers, 17 midwives, 4 neonatal nurses, 3 health care assistants, 3 senior house officers, and 3 senior pediatricians gave in-depth interviews during a 9-month period in 2002. One of the major themes that emerged was the cup-versus-bottle debate. There were 3 categories strongly linked to this theme: difficulties returning to the breast, ease of use, and necessary skills and knowledge. It appears there is an urgent need to determine which is the best method of giving supplementary feeds, so that full, accurate information can be given to mothers, appropriate policies be devised, and the necessary resources and staff training be provided. Journal of Human Lactation. 21(2):151-162.