• Assessment of higher level practice in nursing: an exploration of the support required by practice assessors

      Stoneley, Helen; Wesson, Wendy (University of DerbyUniversity of DerbyN/A, 2012-11-01)
      Nurse education is continually adapting to meet the requirements of employers to develop increasingly autonomous practitioners who can provide evidence-based, high quality care. The work-based project examines the support available to mentors, known as practice teachers, in their role as assessors of nursing students in higher level practice. A qualitative study: the project employs a grounded theory approach to the analysis of data elicited from practice teachers and academics. Semi-structured interviews and focus groups alongside regular reviews of the literature are utilised to elicit data, and via an inductive process, categories emerging from the analysis are constructed to present new insights and understanding of the subject under scrutiny. Whilst it is clear that a degree of support is available to practice teachers in response to a rudimentary understanding of their role in higher level practice, it is also clear that this support is limited by a number of factors. The product of practice assessment for the employer is a newly-qualified practitioner who is able to carry out a role based on a specified set of competencies. For the educator, whether within the higher education institution or in practice, the process of education is ongoing; producing a practitioner with the capability to utilise higher level practice in ever-changing contexts and situations. Support for the practice teacher can only be enhanced if recognition of the role is promoted. This requires a shared understanding of the importance of developing both competence and capability for higher level practice. Only then will the vital contribution made by the practice teacher in the student’s development be understood by those supporting them. Converging rather than competing philosophies of training for competence and educating for capability are necessary to maintain the status and commitment of the practice teacher and consequently the rigour required of assessment in practice.
    • Being Sikh

      Gill, Santokh Singh (University of Derby, 2005)
    • A case study to evaluate the introduction of Objective Structured Clinical Examination (OSCE) within a School of Pharmacy

      Townend, Michael; Ellis, Lorraine; O'Hare, Roisin (University of DerbySchool of Health ScienceFaculty of Education, Health and ScienceUniversity of Derby, 2014)
      Healthcare education is continually evolving to reflect therapeutic advances in patient management. Society demands assurances regarding the ongoing competence of HCPs including pharmacists. The use of OSCEs to evaluate competence of medical staff as well as nurses is well documented in the literature however evidence of its use with undergraduate pharmacy students is still sparse.
    • Communities that care: an insight into male career patterns in a small neighbourhood

      Hooley, Tristram; Hope, Antony Steven (University of Derby, 2014-07-09)
      This study will offer an insight into the complex living of a group of mid-thirties males in a small neighbourhood and describe their personal career journeys. In particular, the study will highlight the complex influence of social capital, the men’s personal development through the ‘opportunity structure’ (K. Roberts, 1977) and how chance along with place of residence impact on career advancement. There have been numerous studies that have sought to discover why people make stereotypical career choices. More specifically, how male stereotyping can influence career choice and shape identity. However, many studies fail to tackle the influence of neighbourhood and family bonding which engulfs the male individual to create a very close knit masculine gang of individuals. By taking the epistemological position of interpretivism and using a narrative interview approach, along with a life history tradition, this research addresses these shortcomings. Additionally, Bourdieu’s (1985) concept of social field is employed within this study to represent the various social arenas in which young people spend their time. This notion of fields, along with the concepts of ‘habitus’ and ‘capital’ (Bourdieu, 1985, 1986) are seen to create an effective framework for understanding the social worlds of young people and the community in which they belong. The data is drawn from 10 in-depth interviews with men in their mid-thirties, who were born and raised in an inner city neighbourhood. Despite poverty, deprivation and social exclusion, these 10 men now have a career but choose not to leave the neighbourhood of their birth. They have each turned their life around by being confident, persistent, and determined to succeed, thereby empowering other individuals and their community, to build their own ladders out of poverty and towards a brighter future. However, this is a close knit network of friends and family that according to the headteacher in the local secondary school are ‘unwilling to move the boundaries of opportunity and rely too much on the ways of the past’. Each interviewee has a story to tell and these stories are interwoven and analysed through common themes explored in depth in the thesis. These stories map out a career trajectory that is based on rites of passage into adulthood and an adult sense of masculinity. Throughout the interviews evidence is provided to support the argument that ‘opportunity structure’ (K. Roberts, 1977) plays an important role in the career path of young people. Furthermore, it is argued that career choice is a developmental process with many twists and turns along the way. However, it is further argued that an identity based on age, location, ethnicity, along with common interests and a shared purpose, creates a closed shop ethos, where education and employment are shaped by elders within the family and close friends. In fact, because everyone knows everyone else, a strong common bond between family and friends is displayed, this creates strong loyalties which are manifested in the behaviour of each individual. This situation creates a large gang of individuals whose organisation has a hierarchical structure, starting from new entrants or recruits, through to elders at the top. Membership through birth is non-negotiable and to refuse to be part of this wider family could result in psychological and physiological consequences for the individual.
    • Constructing professional identity: the role of postgraduate professional development in asserting the identity of the career practitioner

      Poultney, Val; Davies, David; Neary, Siobhan (University of DerbyInternational Centre for Guidance Studies (iCeGS), 2014-08-15)
      The professional identity of career practitioners in the UK has become increasingly challenged in recent decades due to the influence of government policy and the dominance of work-based qualifications. Privatisation, multi-professional working and workforce realignment have all contributed to a reshaping of the career guidance professional. This research examines the views of a group of practitioners all undertaking continuing professional development (CPD) in the form of a postgraduate award. The participants were all UK based practitioners working in a career related role; all were either currently on programme, had completed or stepped off with an interim award within a masters programme. The research explored practitioners’ views at a time of significant upheaval, of themselves as professionals, their professional identity and the extent to which postgraduate CPD contributed to this. The research utilised a case study approach employing document analysis, questionnaire, in-depth interviews and narrative biographies. These tools were specifically selected to enable sequential analysis of data allowing findings from each stage to be rigorously tested out by the next research tool. Applications from potential students were initially analysed helping to establish motivation for undertaking a programme of this type, an on-line survey explored practitioners views of themselves as professionals, motivation for postgraduate study and potential outcomes for themselves, their organisation and their profession. In-depth interviews and narrative biographies provided a voice allowing participants to explore their personal journey with their studies and how this engagement contributed to the establishment, maintenance or enhancement of their practitioner professional identity. Continuing professional development was classified as consisting of three types, operational, experiential and formal. Findings suggested participants predominantly valued formal CPD with operational being perceived as only meeting employer contractual compliance. Postgraduate level CPD contributed to professional identity through engagement with reflection, theory, policy and academic study. Ethics and client focus were central to the professional identity of the career practitioner. Postgraduate study was perceived to empower practitioners and to contribute to the professionalisation of the sector and give parity with other public sector professions. The research contributes to both the limited body of knowledge addressing professional identity within the career guidance context and discourse addressing professionalisation of new professions. It offers a shared professional perspective that can inform the evolving policy debate aiming to professionalise the career and allied workforces. The research offers a unique insight into a profession in transition and the voice of practitioners who have experienced successive waves of government policy, which has been often internalised as de-professionalisation.
    • Disciplinary understandings of anorexia nervosa

      Rehavia-Hanauer, Dafna (University of Derby, 2011)
    • Do haemodynamic responses to mental stress tests predict future blood pressure one year later? Prospective studies in the United Kingdom and Thailand

      Sheffield, David; Baker, Ian S.; Maratos, Frances A.; Yuenyongchaiwat, Kornanong (University of Derby, 2013-08-21)
      This thesis explored whether haemodynamic responses to psychological stress test predict future blood pressure (BP) levels: the Reactivity Hypothesis. The research included a systematic review and two prospective cohort studies in the UK and Thai samples. In addition, the Blunted Reactivity Hypothesis, which posits that cardiovascular reactivity is inversely related to symptoms of anxiety and depression, was examined in cross-sectional analyses. A systematic review with meta-analysis and meta-regression with 41 prospective cohort studies (from 1950 to 2012) examined whether cardiovascular responses to psychological stress tests predict future BP levels, hypertension status, preclinical coronary heart disease (CHD) and cardiac events. Three possible moderators were included in analyses: type of task (active versus passive coping), age group (children versus adults), and duration of follow-up (short versus long-term follow-up). The review found that systolic BP reactions to psychological stress tests predict future systolic BP levels and that there was better prediction in child samples with shorter follow-up periods. Similarly, diastolic BP reactions to psychological stress predicted future diastolic BP levels. Cardiovascular reactions to psychological stress tests did not predict hypertension, preclinical CHD, or cardiac events. Cross-sectional analysis of two studies conducted in the UK and Thailand provided some evidence that anxiety and depressive symptoms were negatively associated with cardiovascular reactivity: these findings supported the Blunted Cardiovascular Hypothesis. However, these relationships were observed in the UK sample, but not in the Thai sample. Further, Thai participants responded to psychological stress task with large cardiovascular reactions, of a similar magnitude to the UK participants and observed in previous studies of Europeans and North Americans. Finally, prospective analyses revealed that systolic BP responses to mental arithmetic predict future systolic BP levels after one year of follow-up in both UK and Thai individuals, after controlling for baseline cardiovascular activity and traditional risk factors. In contrast, haemodynamic responses did not predict future BP. These results provide support for the “Reactivity Hypothesis” although the effect sizes were relatively small. However, responses to only one of the three stressors, mental arithmetic, predicted future BP implicating beta-adrenergically mediated cardiovascular responses. However, there was no physiologic evidence (i.e., cardiac output responses) that suggested beta-adrenergic mechanisms. Accordingly, future studies should examine alternate mechanisms (e.g., platelet aggregation and endothelial function) and cardiovascular responses in larger samples with a longer follow-up to further clarify the predictive value of reactivity in the development of hypertension, along with potential mechanisms.
    • The effects of anxiety on visual attention for emotive stimuli in primary school children

      Maratos, Frances A.; Lipka, Sigrid; Kelly, Lauren (University of Derby, 2014-02-24)
      Anxiety can be advantageous in terms of survival and well-being, yet atypically high levels may be maladaptive and result in the clinical diagnosis of an anxiety disorder. Several risk factors have been implicated in the manifestation of clinical anxiety, including cognitive biases. In recent years, a plethora of research has emerged demonstrating that anxious adults exhibit biases of attention for threatening stimuli, especially that which is biologically relevant (e.g., facial expressions). Specific components of attentional bias have also been identified, namely facilitated engagement, impaired disengagement, and avoidance. However, the majority of studies have focused on the spatial domain of attention. Furthermore, the area is under-researched in children, despite research demonstrating that symptoms relating to clinical and non-clinical anxiety follow a stable course from childhood through to adolescence and adulthood. Consequently, the aim of this thesis was to investigate how anxiety affects children’s visual attention for emotive, particularly angry, faces. In order to provide a more comprehensive understanding, the current research involved examining the role of temporal and spatial attention utilising rapid serial visual presentation with the attentional blink, and the visual probe paradigm, respectively. The main hypothesis was that high state and/or trait anxiety would be associated with an attentional bias for angry, relative to positive or neutral faces in both the temporal and spatial domains. In relation to the temporal domain, key findings demonstrated that high levels of trait anxiety were associated with facilitated engagement towards both angry and neutral faces. It was further found that all children rapidly disengaged attention away from angry faces. Findings related to the processing of angry faces accorded with the main hypothesis stated in this thesis, as well as research and theory in the area. The finding that anxious children preferentially processed neutral faces in an attentional blink investigation was unexpected. This was argued to potentially reflect this stimulus type being interpreted as threatening. Key findings regarding the spatial domain were that high trait anxious children displayed an early covert bias of attention away from happy faces and a later, overt bias of attention away from angry faces. The finding that high trait anxiety was linked to an attentional bias away from happy faces in a visual probe task was also unexpected. This was argued to potentially reflect smiling faces being interpreted as signifying social dominance, thus resulting in the viewer experiencing feelings of subordination and becoming avoidant and/or submissive. To conclude, this thesis has enhanced current knowledge of attentional bias in both the temporal and spatial domains for emotive stimuli in anxious children. It has demonstrated that higher levels of trait anxiety moderate children’s allocation of attentional resources to different stimulus types, whether these are threatening, positive, or neutral. This has important implications for evaluating past research in adults and children, and for further developing theoretical models of attentional bias and anxiety. It also offers important clinical implications, since attending towards or away from specific stimuli may affect the development and maintenance of anxiety disorders. Recently, a treatment that aims to modify attentional bias in anxious individuals has begun to be developed. In light of the present findings, it may be necessary to review this treatment so that anxious children are re-trained in the specific biases of attention demonstrated here.