• Subjective experiences of participatory arts engagement of healthy older people and explorations of creative ageing

      Bradfield, E.; University of Derby (Elsevier BV, 2021-08-04)
      The aim of this article was to report findings from a qualitative focus group study conducted to understand the subjective experiences of community-dwelling healthy older people engaging in a range of participatory arts activities. The article also uses the participants' voices to consider nuances and interconnections of themes to unpack the complexities of ‘participatory arts’ engagement and support a conceptualisation of ‘creative ageing’. This study involved qualitative focus group interviews. Focus group interviews were conducted with five groups of healthy older people (aged ≥50 years) living in the community (i.e. not in residential care settings). Participants were recruited through self-selected sampling, and on the basis of self-reporting, no diagnosis of ill-health. Focus group interviews were digitally recorded and analysed using thematic analysis. Themes developed from a systematic review of participatory arts for promoting well-being in later life conducted previously by the author were used as the stimulus for conversation in the focus groups. Interviews were not transcribed, rather pseudonymised quotations are used to support the themes. The study also explored barriers to participation, although these findings are not reported here. Subjective experiences of participatory arts engagement of healthy older people focused on everyday creativity and reflections on the term ‘participation’, which challenge the traditional focus of arts and health research on the effects of active engagement. Healthy older people experienced a sense of achievement and ‘flow’ through creative engagement, which led to opportunities for social interaction and developing a sense of purpose. Through transitions of ageing, older people found creative ways of rediscovering their identity in later life, which supported resilience and highlighted a connection between body, mind and soul. Findings suggest that participation in everyday creative experiences can lead to a sense of achievement and purpose, which provides support and structure in the construction of changing identity in later life. Participatory arts engagement is particularly instrumental during transitions of ageing. This study provides a conceptualisation of ‘creative ageing’ which challenges traditional ideas of ‘participatory arts’ and audience engagement by focusing on subjectivities of the participant voice. The framework moves debate beyond a focus on the efficacy of arts engagement to consider the relevance of subjective experiences of everyday creativity in later life.
    • A feasibility study of a novel work-focused relational group CBT treatment programme for moderate to severe recurrent depression

      Walker, Nicola; Vernon-Smith, Madeleine; Townend, Michael; Teesside University; Leeds and York Partnership NHS Foundation Trust; University of Derby (Emerald, 2021-09-02)
      No current psychotherapeutic intervention is designed to enhance job retention in employees with moderate-severe recurrent depression. We hypothesized that interdisciplinary, work-focused psychotherapy would have the triple benefits of alleviating depression, improving interpersonal difficulties, and enhancing job retention. To test the feasibility of a new Work-focused Relational Group-CBT Treatment Programme for moderate-severe depression. The new programme was based on a theoretical integration of occupational stress, psychological, social/interpersonal, and bio-medical theories and consisted of (i) 1:1 psychotherapist sessions; (ii) a work-focused, twelve-week group CBT programme; and (iii) optional 1:1 sessions with an occupational therapist. Depression, coping/self-efficacy, health-related quality of life (HRQoL), interpersonal difficulty, and work/social functioning outcomes were assessed before and after group therapy using validated instruments. Intervention delivery, therapeutic alliance, client satisfaction, and programme cost were assessed. While there was no statistically significant change in HAM-D depression scores after therapy (n=5; p=0.313), there was a significant decrease in BDI-II depression scores after therapy (n=8; -20.0 median change, p=0.016; 6/8 responses, 7/8 minimal clinically important differences, 2 remissions). There were significant reductions in clinically relevant psychological distress, coping self-efficacy, HRQoL, and interpersonal difficulties after therapy. All clients in work at the start of therapy remained in work at the end of therapy. The intervention was safe, had 100% retention, and clients were satisfied with their treatment. The Work-focused Relational Group-CBT Treatment Programme showed promising immediate positive outcomes in terms of depressive symptoms, interpersonal difficulties, and job retention that warrant further exploration in a longer-term definitive study.
    • A non-injected opioid analgesia protocol for acute pain crisis in adolescents and adults with sickle cell disease

      Telfer, Paul; Bestwick, Jonathan; Elander, James; Osias, Arlene; Khalid, Nosheen; Skene, Imogen; Nzouakou, Ruben; Challands, Joanne; Barroso, Filipa; Kaya, Banu; et al. (Sage, 2021-08-02)
      Initial management of the acute pain crisis (APC) of sickle cell disease (SCD) is often unsatisfactory, and might be improved by developing a standardised analgesia protocol. Here, we report the first stages in developing a standard oral protocol for adolescents and adults. Initially, we performed a dose finding study to determine the maximal tolerated dose of sublingual fentanyl (MTD SLF) given on arrival in the acute care facility, when combined with repeated doses of oral oxycodone. We used a dose escalation algorithm with two dosing ranges based on patient’s weight (<50 kg or >50 kg). We also made a preliminary evaluation of the safety and efficacy of the protocol. The study took place in a large tertiary centre in London, UK. Ninety patients in the age range 14–60 years were pre-consented and 31 treatment episodes were evaluated. The first 21 episodes constituted the dose escalation study, establishing the MTD SLF at 600 mcg (>50 kg) or 400 mcg (<50 kg). Further evaluation of the protocol indicated no evidence of severe opioid toxicity, nor increased incidence of acute chest syndrome (ACS). Between 0 and 6 hours, the overall gradient of reduction of visual analogue pain score (visual analogue scale (VAS)) was 0.32 centimetres (cm) per hour (95% confidence interval (CI) = 0.20 to 0.44, p < 0.001). For episodes on MTD SLF, there was median (interquartile range (IQR)) reduction in VAS score of 2.8 cm (0–4.2) and 59% had at least a 2.6-cm reduction. These results are supportive of further evaluation of this protocol for acute analgesia of APC in a hospital setting and potentially for supervised home management.
    • Multiple emotions, multiple selves: compassion focused therapy chairwork

      Bell, Tobyn; Montague, Jane; Elander, James; Gilbert, Paul; University of Derby (Cambridge University Press (CUP), 2021-07-19)
      Compassion focused therapy (CFT) is rooted in an evolutionary view of the human mind as formed of a multitude of contrasting, and often conflicting, motivations, emotions and competencies. A core aim of the therapy is to help clients understand the nature of their mind in a way that is de-pathologizing and de-shaming. The approach is also focused on the cultivation of compassion to work with these difficult aspects of mind. CFT includes the ‘multiple-selves’ intervention which involves the differentiation of threat-based emotion and an exploration of their conflict. Compassion is then applied to the client’s affective world to aid regulation and integration. This paper focuses on clients’ experiences of a chairwork version of multiple-selves, wherein clients personify their emotions in separate chairs. Nine participants with depression were interviewed directly following the intervention and the resulting data were analysed using interpretative phenomenological analysis. Three interconnecting themes were identified: appreciating emotional complexity; the role of chairwork process; and compassionate integration. The results highlight the importance of emotional differentiation in understanding internal multiplicity and conflict in depression, and the role of compassion in creating a sense of personal coherence. The embodied and enactive nature of chairwork was found to be of benefit in identifying and separating emotion, and in developing new forms of self-relating. The paper discusses the clinical implications of such findings for the treatment of depression.
    • ‘It’s quite a taboo subject’: an investigation of mother’s experiences of breastfeeding beyond infancy and the challenges they face

      Jackson, Jessica; Hallam, Jenny; University of Derby (Taylor and Francis, 2021-06-10)
      Current recommendations state that women should breastfeed their child up to 2 years and beyond. However, the UK has one of the lowest breastfeeding rates in the world. This could in part be explained by the stigma mothers face when breastfeeding an older child. This research aims to provide a detailed understanding of what motivates women to continue breastfeeding beyond infancy and the barriers they face to (i) add to existing research literature which has examined this area and (ii) support and normalize this practice. Semi-structured interviews were conducted between April and June 2018 with 24 women who had breastfed at least one child past 12 months. A theory-driven thematic analysis identified themes that ran through the interviews centering on the benefits of continued breastfeeding, the stigma mothers faced when breastfeeding past infancy and the challenges of returning to work. The women felt that continued breastfeeding enabled them to play a central role in their child’s health and develop an attachment led parental style but faced social and cultural stigma due to a lack of public awareness of current breastfeeding recommendations. Interventions which raise awareness of breastfeeding beyond infancy are needed to normalize this practice in the UK.
    • Exploring factors having an impact on attitudes and motivations towards volunteering in the undergraduate nursing student population − A comparative study of the UK and Ghana

      Dyson, Sue E.; Korsah, K.A.; Liu, L.Q.; O’Driscoll, M.; van den Akker, O.B.A; University of Derby; University of Ghana; Middlesex University (Elsevier, 2021-04-10)
      This study explores attitudes and motivations towards volunteering in nursing students in Ghana compared with nursing students in the United Kingdom (UK). Ghana traditionally follows a western model of nurse education, with students studying programmes commensurate in theory and practice, making Ghana a suitable location for a comparative study. We explored similarities and differences in attitudes and motivation towards volunteering to challenge and inform our common place practice towards nursing pedagogy. Ghanaian students displayed positive attitudes towards volunteering, although these did not translate into increased motivation to volunteer while at university. Students reported financial constraints as reasons for not volunteering as did UK students, although Ghanaian students used available resources for daily living expenses, whereas UK students prioritised available resources to pay down student debt. Structured volunteering was absent from both Ghanaian and UK nursing programmes, despite its potential to increase the variety of social groups or situations to which students are exposed, to increase self-confidence and to encourage greater reflection on practice through doing. Structural challenges within countries may provide a better explanation of variation in student motivation towards volunteering, than cross-cultural variation in attitudes towards volunteering between countries.
    • Singing

      Irons, J. Yoon; Hancox, Grenville; University of Derby; Canterbury Christ Church University (Emerald Publishing Limited, 2021-03-18)
      We are 'hard-wired' to sing - singing has defined our evolution. Through singing we express our feelings, communicate and connect with others. We are all singers: singing is part of us and defines cultures worldwide. Singing also, importantly, makes us feel better: it is, undoubtedly, good for us. This book provides an important overview of current research showing the benefits of singing on our health and wellbeing. Case studies illustrate its power - for example, how singing helps hospitalised children and a man living with Parkinson's. The book also discusses potential barriers for singing and useful strategies needed to overcome them. An example of a community singing group is also demonstrated, alongside practical advice on facilitating community singing groups for health and wellbeing. The book will be valuable to professionals working in health and social care settings, to practitioners and educators interested in engaging in singing for health promotion, and individuals looking to find out more about the benefits and practicalities of singing.
    • How Many Maneuvers Should We Do for Maximal Inspiratory and Expiratory Muscle Pressure Testing in Children: A Retrospective Review in Children with Cystic Fibrosis

      Boonjindasup, Wicharn; Chang, Anne B.; Marchant, Julie M.; Irons, J. Yoon; McElrea, Margaret S.; Charles Darwin University, Darwin, NT, Australia; Queensland University of Technology, Brisbane, QLD, Australia; Chulalongkorn University, Bangkok, Thailand; Cough, Asthma & Airways Research Group, Centre for Children’s Health Research, Level 7, 62 Graham Street, South Brisbane, QLD, 4101, Australia; Queensland Children’s Hospital, Brisbane, QLD, Australia; et al. (Springer Science and Business Media LLC, 2021-02-15)
      Objectives Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) could be useful clinical parameters in monitoring many conditions including cystic fibrosis (CF). However, current protocols for undertaking the measurements lack standardization including the number of repeated attempts to achieve best values. We aimed to (a) determine the optimum number of attempts to achieve best MIP/MEP values, and (b) evaluate if the number of attempts is consistent across two different test days. Methods We analyzed data of a previous randomized controlled trial involving the effect of singing on respiratory muscle strength in 35 children with CF. On two different days (T1, T2) children performed MIP/MEP with at least ten attempts each to achieve < 10% repeatability. Results All children achieved repeatable MIP/MEP values within 10–11 attempts with 24 (68.6%) and 26 (74.3%) of these achieving best values of MIP and MEP, respectively, at attempts 6–11. Median values of the pressures by three, five, eight and all attempts significantly increased with more attempts (all p < 0.05). At T2, 56% required fewer attempts to achieve best values, but 32% required more attempts, indicating that the number of attempts required was inconsistent between test days. Conclusion It is likely that at least ten attempts (best two within < 10% variability) is required to achieve best and reliable MIP/MEP in children with CF. A larger sample size in children with CF and various conditions is required to consolidate these findings.
    • Metabolic syndrome among type 2 diabetic patients in Sub-Saharan African countries: A systematic review and meta-analysis.

      Shiferaw, Wondimeneh Shibabaw; Akalu, Tadesse Yirga; Gedefaw, Mihretie; Anthony, Denis; Kassie, Ayelign Mengesha; Misganaw Kebede, Worku; Mulugeta, Henok; Dessie, Getenet; Aynalem, Yared Asmare; Debre Berhan University, Ethiopia; et al. (Elseveir, 2020-07-23)
      PubMed, Web of Science, African Journals Online, Google Scholar, Scopus, and Wiley Online Library databases from inception to April 27, 2020 were searched to identify relevant studies. The I2 statistic was used to check heterogeneity across the included studies. DerSimonian and Laird random-effects model was applied to estimate pooled effect size, and 95% confidence interval across studies. A funnel plot and Egger's regression test were used to determine the presence of publication bias. Sensitivity analysis was deployed to determine the effect of a single study on the overall estimation. All statistical analyses were done using STATA™ Version 14 software.
    • Which exercise and behavioural interventions show most promise for treating fatigue in multiple sclerosis? A network meta-analysis

      Harrison, Anthony M; Safari, Reza; Mercer, Tom; Picariello, Federica; van der Linden, Marietta L; White, Claire; Moss-Morris, Rona; Norton, Sam; University of Derby (SAGE Publications, 2021-04-20)
      Fatigue is a common, debilitating symptom of multiple sclerosis (MS) without a current standardised treatment. The aim of this systematic review with network meta-analyses was to estimate the relative effectiveness of both fatigue-targeted and non-targeted exercise, behavioural and combined (behavioural and exercise) interventions. Nine electronic databases up to August 2018 were searched, and 113 trials (n = 6909) were included: 34 were fatigue-targeted and 79 non-fatigue-targeted trials. Intervention characteristics were extracted using the Template for Intervention Description and Replication guidelines. Certainty of evidence was assessed using GRADE. Pairwise meta-analyses showed that exercise interventions demonstrated moderate to large effects across subtypes regardless of treatment target, with the largest effect for balance exercise (SMD = 0.84). Cognitive behavioural therapies (CBTs) showed moderate to large effects (SMD = 0.60), with fatigue-targeted treatments showing larger effects than those targeting distress. Network meta-analysis showed that balance exercise performed significantly better compared to other exercise and behavioural intervention subtypes, except CBT. CBT was estimated to be superior to energy conservation and other behavioural interventions. Combined exercise also had a moderate to large effect. Treatment recommendations for balance and combined exercise are tentative as the certainty of the evidence was moderate. The certainty of the evidence for CBT was high.
    • Physical activity: understanding and addressing inequalities

      Jackson, Jessica; Roscoe, Clare M. P.; Mourton, Niamh; University of Derby (Public Health England, 2021-02-22)
      This guidance can be used by local level practitioners and commissioners to begin tackling inequalities in physical activity across and within protected characteristic groups. It presents the findings of a review, analysis and research aimed at understanding the enablers, barriers and opportunities for increasing physical activity across inequality groups. Three major themes are identified as considerations for action by practitioners and commissioners: enablers, barriers, and identifying opportunity community consultation, engagement, and partnership adopting a holistic approach for protected characteristics and intersectionality The document concludes with a full set of recommendations for commissioners and practitioners to consider when designing services and interventions locally.
    • A systematic review of evidence about the role of alexithymia in chronic back pain

      Elander, James; Kapadi, Romaana; Bateman, Antony H.; University of Derby; Royal Derby Spinal Centre, University Hospitals of Derby and Burton NHS Foundation Trust (British Psychological Society, 2021-02-01)
      Individuals with alexithymia struggle to make sense of their emotions. Alexithymia has been associated with a range of physical illnesses, but may influence different illnesses differently, so to understand the role of alexithymia in illness it is important to focus on specific conditions. This article reviews evidence from ten reports published between 2000 and 2018 of studies with samples of adults with chronic back pain that used the Toronto Alexithymia Scale (TAS). The studies were conducted in Germany, Israel, Italy, Russia, Turkey and the USA. Eight studies involved clinical samples and two involved public transit workers. Studies that compared participants with high and low alexithymia consistently found associations with measures of pain. The findings show that more severe alexithymia plays a role in the experience of chronic back pain, and support the incorporation of alexithymia-related elements in interventions to help people with chronic back pain improve their emotional regulation and reduce their pain-related distress.
    • Coping with joint pain in haemophilia

      Bailey, Jacqueline; Robinson, Georgina; Elander, James; London Metropolitan University; University of Surrey (British Psychological Society, 2005-05-01)
      Some Rolling Stones fans might think that joint bleeds in haemophilia are now more a case of ‘Its all over now’ than ‘Let it bleed’, for just as Mick Jagger’s song writing skills have changed since the 1960s and 70s, so has haemophilia care - treatment has improved dramatically over the last 30 years. Prophylactic clotting factor concentrates are now commonly used to prevent bleeding episodes among patients with severe haemophilia. Many patients, however, and especially those aged over 40, still live with chronic pain caused by arthritic complications of repeated bleeds into joints, leading to disability and reduced quality of life, and this aspect of the condition has not been widely recognised by health psychologists. Haemophilia patients' experiences of pain were the subject of a recent health psychology work placement and are the focus of an ongoing research project, collaborations with the UK Haemophilia Society, and this article summarises some aspects of that work.
    • Respect, trust, and the management of sickle cell disease pain in hospital: comparative analysis of concern-raising behaviors, preliminary model, and agenda for international collaborative research to inform practice

      Elander, James; Beach, Mary Catherine; Haywood, Carlton; University of Derby; John Hopkins University, Baltimore, MD, USA (Taylor and Francis, 2011-07-28)
      Qualitative interview studies suggest that adult patients’ experiences of hospital treatment for sickle cell disease (SCD) pain reflect an absence of respect by providers for patients, and an absence or breakdown of trust. Systematic comparisons between treatment settings could help identify contextual influences on respect and trust. Quantitative comparison of concern-raising behaviors (pain treatment outcomes indicating breakdowns of trust) among adult SCD patients in Baltimore, Maryland, U.S.A., and London, U.K., followed by analysis of potential explanations for differences, including socio-cultural and behavioral factors, with a preliminary model of the processes leading to concern-raising behaviors. Rates of concern-raising behaviors were significantly higher in Baltimore than London. The model identifies respect and trust as key factors which could be targeted in efforts to improve the quality of SCD pain management in hospital. An agenda for international, interdisciplinary research to improve the treatment of SCD pain in hospital should include: comparative analyses between countries and treatment settings of factors that could influence respect and trust; research to test hypotheses derived from models about the roles of respect and trust in the treatment of pain; studies of the impact of healthcare structures and policy on patients’ experiences of care; research focusing on developmental and interpersonal processes related to respect and trust; applications of attribution and other social psychology theories; and development and evaluation of interventions to improve the hospital treatment of SCD pain by increasing respect and trust.
    • "I don’t want to hold your hand": Can Covid-19 public health messages delivered through songs?

      Sheffield, David; Irons, J Yoon; University of Derby (The British Psychological Society, 2020-10-28)
      In response to the outbreak of Covid-19, governments around the world have published their guidelines including rigorous hand washing, respiratory etiquette, social distancing and restrictions in movements and gatherings (European Centre for Disease Prevention and Control, 2020). Songs have been used to share key advice since the start of the outbreak in many countries (Hui, 2020). In the UK, the first advice proffered concerned rigorous hand washing.
    • An integrative systematic review of creative arts interventions for older informal caregivers of people with neurological conditions.

      Irons, J Yoon; Garip, Gulcan; Cross, Ainslea J; Sheffield, David; Bird, Jamie; University of Derby (PloS, 2020-12-07)
      We aimed to assess and synthesise the current state of quantitative and qualitative research concerning creative arts interventions for older informal caregivers of people with neurological conditions. A systematic search was employed to identify studies that examined creative arts interventions for older informal caregivers, which were synthesised in this integrative review. We searched the following databases: MEDLINE, PubMed, EBSCO, CINAHL, EMBASE, PsycINFO, Cochrane Library, Scopus, Web of Science, and Google Scholar. We also backwards searched references of all relevant studies and inspected trials registers. Of the 516 studies identified, 17 were included: one was quantitative, nine were qualitative and seven used mixed methods. All included quantitative studies were pilot or feasibility studies employing pre- and post-test design with small sample sizes. Studies varied in relation to the type of creative intervention and evaluation methods, which precluded meta-analysis. Large effect sizes were detected in wellbeing measures following singing and art interventions. The qualitative synthesis highlighted that interventions created space for caregivers to make sense of, accept and adapt to their identity as a caregiver. Personal developments, such as learning new skills, were viewed positively by caregivers as well as welcoming the opportunity to gain cognitive and behavioural skills, and having opportunities to unload emotions in a safe space were important to caregivers. Group creative interventions were particularly helpful in creating social connections with their care-recipients and other caregivers. The current review revealed all creative interventions focused on caregivers of people living with dementia; subsequently, this identified gaps in the evidence of creative interventions for informal caregivers of other neurological conditions. There are encouraging preliminary data on music and art interventions, however, little data exists on other art forms, e.g., drama, dance. Creative interventions may appeal to many caregivers, offering a range of psycho-social benefits. The findings of the current review open the way for future research to develop appropriate and creative arts programmes and to test their efficacy with robust tools.
    • Florence Nightingale (1820–1910) – what does history say about her feminism?

      Hogan, Susan; University of Derby (Informa UK Limited, 2020-11-28)
      Is Florence Nightingale becoming unfashionable? The UK’s largest union UNISON voted to drop the use of Nightingale’s image for their union as she was considered to be unrepresentative of modern nursing. One of those backing the motion is on record as saying, ‘All over Eastern Europe, statues of Lenin are being taken off their pedestals, dismantled and pulled off to be cut up.… It is in the same vein that we must enter the new Millennium, start to exorcise the myth of Florence Nightingale’. This paper will discuss modern attitudes to Nightingale in terms of her feminism (not a term she used of herself) and survey scholarly articles that address Nightingale in relation to the position of women. It ends with reflections on the iconography of notable women.
    • Patient-reported outcome measures: Clinical applications in the field of chronic pain self-management

      Elander, James; Elisabeth, Spitz; University of Derby; University of Lorraine, Metz, France (Routledge, Taylor and Francis Group, 2017-05-16)
      Chronic pain is a major influence on patient-reported quality of life. This chapter examines ways that information from patient-reported outcome measures (PROMs) can be translated into clinical practice to improve the management and self-management of chronic pain among people with rheumatic disorders and haemophilia. This includes: 1) evidence about how PROMs can be used to improve routine clinical practice and self-management programmes in rheumatic disorders and haemophilia; 2) evidence about a DVD intervention with patient perspectives about living and coping with chronic joint pain, which improved patient-reported readiness to self-manage pain; 3) evidence about pain acceptance and pain coping as influences on patient-reported quality of life among people with haemophilia; and 4) recommendations for clinical and treatment interventions to improve patient-reported outcomes for people with haemophilia-related joint pain.
    • Development and evaluation of student transition writing mentoring

      Elander, James; Westrup, Rebecca; Caldwell, Teresa; Foxcroft, Angela; Norton, Lin; Crooks, Sarah; Wardley, Karen; University of Derby; Liverpool Hope University (Oxford Centre for Staff and Learning Development, 2011-09-01)
      Flying Start, an inter-institutional NTFS project, developed and evaluated programmes in which university students mentored A-level and other pre-university students in academic writing. Feedback showed that the pre-university mentees found the mentors easy to talk to and believed the programme would help them write better at university. Focus groups revealed that mentees would have liked better preparation for the programmes; that interpersonal mentor-mentee interactions affected both sets of students’ experiences; and that mentees valued working with mentors on the aspects of writing that were programme targets. Before-and-after measures showed limited changes in approaches to learning, no changes in understanding of the core criteria for university writing, but small improvements in quality of writing. The evaluation provides the basis for recommendations about wider use of pre-university interventions in academic writing, and about ways the approach could be adapted for different settings.
    • What changes in the transition to learning at university?

      Elander, James; Foster, Ed; Norton, Lin; Foxcroft, Angela; University of Derby; Nottingham Trent University; Liverpool Hope University (Oxford Centre for Staff and Learning Development, 2010-09-01)
      This paper reviews evidence about factors affecting student transitions to learning at university. We first review theoretical models of student transitions, and consider their different emphases and end-points. We then examine evidence about academic factors (eg approaches to learning and beliefs about knowledge), social factors (eg engagement and integration) and pedagogic factors (eg teaching methods) as potential influences on student learning transitions. We then attempt a synthesis of the findings and theory, and propose a transitions model in which quality of learning is the key central factor.