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Given that the number of children and young people needing care keeps rising and fewer people are becoming foster carers, efforts to support carers and workers in foster caring are essential. This paper considers the experiences of carers and foster care agency workers involved in Australia's piloting of the Mockingbird Family. With a view understanding experience, data were collected via focus groups with carers and agency workers (n = 20) involved in piloting, implementation and evaluation. Deductive analysis applied the theory of experience to generate understanding of experience, as both intrinsic and extrinsic dimensions to capture strengths in the Mockingbird Family's foster caring networks. These dimensions of experience included collective passions of carers and workers; experiential change over time; collective experiences as a moving force; and experiences as transformational. Understanding of experience associated with the perceived strengths of the Mockingbird Family, including strategies to promote strong professional relationships between carers and workers, is an important element in strengthening environments of children and young people in care. Safe and stable environments are crucial for wellbeing. [ABSTRACT FROM AUTHOR]

The Kenyan Ministry of Health (MOH) and a consortium of nutritionists, researchers and communication, and design specialists developed a novel approach to create an evidence‐based recipe book promoting complementary feeding (CF) in Kenya. The ADAPT approach includes five steps: applied research (A), dialogue with stakeholders (D), adapted behaviour change communication (BCC) theories (A), purpose‐driven visual communication (P), and tailoring to priority audiences (T). Through this approach, the recipe book addresses key knowledge gaps using behaviour change theories and visual communication best practice to increase accessibility, acceptability, retention and motivation for behaviour change. The book addresses barriers to CF identified through formative applied research. Dialogue with stakeholders helped ensure cultural appropriateness and the book's alignment with MOH recommendations and key messages. The book uses behaviour change theories to approach the reader in a respectful way that motivates behaviour change. The use of consistent, purpose‐driven visuals helps ensure key messages are easily understood and accessible to all caregivers regardless of literacy level. The book's tone and content are tailored to its audiences’ attributes, needs and preferences. This five‐step process inspired the development of ADAPT, a novel approach that integrates behaviour change and visual communication for greater impact. This paper outlines how the consortium used the ADAPT approach to develop an evidence‐based book that thoughtfully and holistically addresses a wide range of barriers, provides practical solutions and increases self‐efficacy around CF. It offers a blueprint for public health practitioners from any field who are interested in using visual behaviour change communication to promote healthy behaviour. [ABSTRACT FROM AUTHOR]

Objectives: This paper considers home from the perspective of people living with dementia supporting ongoing discourse around ageing in place and the significance of creating more inclusive communities. Methods: Forty‐six home tour interviews led by people living with dementia were conducted in England and Scotland to better understand the connectivity between home and neighbourhood for people living with dementia. These interviews used a range of participatory and creative approaches including video, photographic images and in situ interviews. Data were analysed via reflexive thematic analysis. Results: Three themes were identified in data analysis. 1. Connected home and neighbourhood, where participants revealed the dynamic relationship between home and neighbourhood; 2. Practices of home, where participants discussed the everyday nature of their homes and routines; and 3. Displaying home and family, which reflected participant's biographical homes in the context of living with dementia. Discussion: The findings show that home holds multiple meanings for people living with dementia. For example, home is understood as a part of the neighbourhood and an extension of the home space into gardens and backyards, thus extending existing discourses that solely focus on the inside of people's homes. For people living with dementia, homes are also sites of negotiation and renegotiation where new meanings are created to reflect the changing nature and context of the home. There is not one fixed solution to these issues. Support and understanding for people living with dementia will need to evolve to adapt to the shifting dynamics and multiple meanings of home. Key points: Neighbourhoods begin within homes and are interconnected. This relationship has important implications for the discourse of ageing in place.'Home' for people living with dementia holds the same meanings for those without dementia, but with some notable differences. It is important to recognise the shifting dynamics of home and to recognise the complexity of home in the context of dementia. There is not a fixed solution to the challenges of ageing at home with dementia, but support and understanding need to evolve alongside people with lived experience.Homes are a site of renegotiation where new meanings are created to reflect the changing nature of home and the lived experience of home for those with dementia.The study has provided findings through innovation in the research design. The employment of creative methods enabled people living with dementia to participate in sharing their own narratives of home.The work provides evidence where there is a current gap in understanding 'what matters' about home for people living with dementia. [ABSTRACT FROM AUTHOR]

This article is based on a larger research project, which investigates the effectiveness of a culturally appropriate model, namely ūloa, when working with Tongan people. Ūloa is a communal method of fishing in Tonga, which includes all members of the community. A previous paper described the three phases of ūloa: presenting the concept to health providers and community groups; phase two amended the model based on phase one. This paper reports on phase three and findings related to the increased awareness of ūloa model within the mental health services and to raise awareness of how to work with Pacific people and adjust the health service to suit the needs of this population to test its effectiveness. Using reflexive thematic analysis, results highlighted a number of patterns both across the groups, described as napanapangamālie (harmony, balance), ngāue fakataha (working together/oneness), and toutai (fisher). These findings continue to support that the conventional biomedical approach employed in the mental health services overlooks elements of Tongan constructions of mental illness and the intersections between Tongan and biopsychosocial themes. Care that is based only on the 'medicine' rather than bringing the spiritual aspect into care planning (fake leaves) will not serve the needs of the Tongan community. [ABSTRACT FROM AUTHOR]

Parental attachment refers to the protective and comforting role of parents toward their children. This role has been violated in cases of maltreatment. Understanding the attachment of parents who endanger their children can illuminate the psychological processes behind the harmful behaviour of parents. This paper proposes assessing parental attachment with the Adult Attachment Interview (AAI), classified according to the Dynamic‐Maturational Model of Attachment and Adaptation (DMM). We discuss meta‐analyses of the 'gold standard' Berkeley method for extracting AAI information. AAIs of maltreating adults classified with the Berkeley method have an improbably high rate of secure attachment, making it inadequate for family forensic applications. In contrast, the DMM uses a theory‐based, developmental expansion of Ainsworth's infant categories to describe a wide array of dimensionally related protective strategies for coping with danger across the lifespan. DMM‐AAIs, classified by trained, reliable professionals and integrated with data from other sources to create an individualised family formulation, meet evidentiary requirements. We call for a programme of research of court‐involved families comparing DMM‐AAI formulations to outcomes of usual methods for determining family services. 'This paper proposes assessing parental attachment with the Adult Attachment Interview, classified according to the Dynamic‐Maturational Model of Attachment and Adaptation (DMM)' Key Practitioner Messages: Childhood exposure to danger is crucial to understanding maltreating parents' behaviour.Adult Attachment Interviews, classified with the DMM method by authorised experts, can reveal motivating psychological processes that are not apparent in parental behaviour.Information about parents' attachment, together with other information, can help child protection personnel gauge the risk that parents pose to their children and organise personalised treatment plans to reduce that risk.ABCD Berkeley AAI classifications are not suitable for forensic use. [ABSTRACT FROM AUTHOR]

This study explores perceptions of child abuse and child protection matters involving staff working in the out‐of‐school‐hours care (OSHC) sector. Quantitative and qualitative data were collected through an online survey, focus group and interviews with staff and managers employed by one organisation that provided OSHC services in Sydney, Australia. This paper reports on their perceptions about implementing mandatory reporting requirements associated with the concepts of 'significant harm' and 'reportable conduct'. The aim of this paper is to engage OSHC stakeholders, including government, in reviewing child protection policies and practices to support educators in their work with children. Key findings indicate the inadequacy of available training, and the importance of relationships and communication between stakeholders, especially OSHC and school staff. This requires systemic change including raising the status of OSHC and the critical role that these educators have in supporting children's development, learning and wellbeing during the early years of school. Key Practitioner Messages: It is important that leadership supports educators to engage in respectful partnerships with families and schools to ensure child protection, and thereby child wellbeing and learning outcomesTraining in supporting children's safety and wellbeing in OSHC is critical.There is a need for a systems approach to OSHC services which places children's development, learning and wellbeing at the forefront of professional practice. 'Explores perceptions of child abuse and child protection matters involving staff working in the out‐of‐school‐hours care (OSHC) sector' [ABSTRACT FROM AUTHOR]

The aim of this paper is to address risks young people in the late 20th and 21st century are exposed to with regard to political participation. Based on qualitative data and ordinary language interviews with 27 Norwegian pupils in upper secondary school, we address how the construction of the political space is understood by young people themselves. By analysing how young people define political interest and engagement, the findings indicate that a gap exists in the perception of 'own' and 'institutionalised' political participation. This paper concludes that exploring the understanding of politics among the young may reduce vulnerability of this particular group in their democratic participation as well as facilitate their political empowerment. [ABSTRACT FROM AUTHOR]

Abstract: Background: Internationally, pharmaceutical policy has heightened expectations for community pharmacies to act as healthcare professionals, increasing the need to understand the health professional–retailer nexus. Literature suggests that pharmacy involves a dichotomy of roles including both retailing and healthcare provision, yet it is unknown whether pharmacists themselves perceive a tension between these roles and how such a tension might be managed. Aim: To explore whether there is tension between being retailers and healthcare providers in community pharmacy and to understand how any such tension is perceived and managed. Methods: Ten in‐depth semi‐structured interviews were conducted with pharmacist owners and managers of community pharmacies in New Zealand. General inductive thematic analysis was undertaken to gain insight from the data. Results: Pharmacists experienced tension between being healthcare providers and being retailers. In total, eight themes were derived from this study. Four themes emerged to describe the tension: (i) balancing roles; (ii) tension – what tension?; (iii) we give a lot for free; and (iv) too much bureaucracy and paperwork. Four themes for managing tension were identified: (i) imparting of owner beliefs; (ii) use of incentives; (iii) effective business management skills; and (iv) being entrepreneurial. Conclusion: This paper is expected to assist in helping policy‐makers and practitioners be aware of the role of tensions when policies are implemented to move pharmacists from a retailer role to healthcare provider. This paper aids in policy development and should inform professional practice and forthcoming business management training programs for community pharmacy. [ABSTRACT FROM AUTHOR]

Public policies encourage the service system to work in new ways to promote health and increase social equality. This paper presents four categories that show the character of the low-threshold services in Norwegian family centres from the professionals' and parents' perspectives, focusing on accessibility and participation: easy access, low level of bureaucracy, collaborative competences and inclusive arena. This paper is based on an inductive study in three municipalities that have chosen to establish family centres as interdisciplinary co-located services that aim to offer low-threshold services for children and their families. Data were generated through a fieldwork, and participatory observation and interviews were the main source of data. The methodological framework for the analysis was grounded theory, in which the data generation and analysis interchanged throughout the study, and theoretical sampling set the focus for the fieldwork. Exploring the actor's perspective highlighted both strengths and challenges with the low-threshold services in the family centres. The four elements presented emphasize that the value of these low-threshold services are not found in one single hallmark; rather, the value depends on an interaction between different elements that must be addressed when establishing, evaluating and developing low-threshold services in family centres. [ABSTRACT FROM AUTHOR]

This paper reports on data from a qualitative case study of child protection social work in one local authority. Ethnographic methods were used and constructionist grounded theory employed to collect and analyse 329 pages of historical documents about the local authority child protection service, 246.5 hours of observations of social work practice and 19 interviews of social workers and their team managers. By interpreting the experiences of the social workers through the conceptual debates about the changes in the field of social administration, the social workers could be seen to want to perform a traditional form of social work but were required to perform a contemporary form of social administration. The aims and purposes of this form of practice could be considered to be distinct from those of social work as understood by the social workers, and as such, the social workers experienced the practice environment as constraining and often felt disillusioned. This paper conceptualizes these forms of practice, contributing to the debates about what practice is and how we are to analyse and categorize it for the purposes of influencing the institutions that create and maintain contemporary practice. [ABSTRACT FROM AUTHOR]

The environments in which nursing work is undertaken can be highly stressful and complex with resultant harmful outcomes for the health of both nurses and patients reported. Undergraduate nursing students are particularly challenged when on clinical placement through having only partially developed work capabilities, with wide claims that these nurses remain underprepared for work even upon graduation. Over time undergraduate nursing education has arguably not prioritized developing resilience and other non‐technical skills required to respond effectively to these challenges. This paper reports findings from a qualitative study of student nurses who received training and coaching in emotional intelligence, a well‐established correlate of resilience, just prior to undertaking a mental health or medical/surgical clinical placement. Of that cohort, 12 agreed to qualitative semi‐structured interviews that sought to better understand how these students used the knowledge and capabilities from the training within clinical placement contexts. Four themes emerged from the thematic analysis of the interviews: (1) greater experiences of resilience; (2) responding positively to mental health consumers; (3) experiences of greater empathy and compassion; and (4) experiences of improved non‐technical work skills. Implications from these findings suggest that student and patient experiences of nursing placement, and mental health nursing placements in particular, would be enhanced by pre‐placement emotional intelligence training and coaching. Such training will support nursing graduates to be work‐ready upon entering the workforce. [ABSTRACT FROM AUTHOR]

This novel paper critically addresses a currently popular sex education resource which compares sexual consent to tea drinking. Drawing from a study which considered the meaning of consent through focus groups and interviews with young people and professionals, we argue that the central 'risk avoidance' message of such resources individualises the potential risks of non‐consensual sex and ignores the gendered social structures which shape interpersonal relationships. We suggest that simplifying and extrapolating sexual consent from broader cultural understandings is problematic. Conversations with young people are important, but they need to address the complexity of sexual consent, coercion and gendered sexual norms. [ABSTRACT FROM AUTHOR]

Background: In primary analyses, dialectical behavior therapy (DBT) was associated with greater reduction in self‐harm during treatment than individual/group supportive therapy (IGST). The objective of this paper was to examine predictors and moderators of treatment outcomes for suicidal adolescents who participated in a randomized controlled trial evaluating DBT and IGST. Methods: Adolescents (N = 173) were included in the intent‐to‐treat sample and randomized to receive 6 months of DBT or IGST. Potential baseline predictors and moderators were identified within four categories: demographics, severity markers, parental psychopathology, and psychosocial variables. Primary outcomes were suicide attempts (SA) and nonsuicidal self‐injury evaluated at baseline, midtreatment (3 months), and end of treatment (6 months) via the Suicide Attempt and Self‐Injury Interview (Psychological Assessment, 18, 2006, 303). For each moderator or predictor, a generalized linear mixed model was conducted to examine main and interactive effects of treatment and the candidate variable on outcomes. Results: Adolescents with higher family conflict, more extensive self‐harm histories, and more externalizing problems produced on average more reduction on SH frequency from baseline to post‐treatment. Adolescents meeting BPD diagnosis were more likely to have high SH frequency at post‐treatment. Analyses indicated significant moderation effects for emotion dysregulation on NSSI and SH. DBT was associated with better rates of improvement compared to IGST for adolescents with higher baseline emotion dysregulation and those whose parents reported greater psychopathology and emotion dysregulation. A significant moderation effect for ethnicity on SA over the treatment period was observed, where DBT produced better rate of improvement compared to IGST for Hispanic/Latino individuals. Conclusions: These findings may help to inform salient treatment targets and guide treatment planning. Adolescents that have high levels of family conflict, externalizing problems, and increased level of severity markers demonstrated the most change in self‐harm behaviors over the course of treatment and benefitted from both treatment interventions. Those with higher levels of emotion dysregulation and parent psychopathology may benefit more from the DBT. [ABSTRACT FROM AUTHOR]

Parkinson's disease ( PD) presents as an illness which predominantly affects older men. However older men's lived experiences of PD, including how they are influenced by age and gender relations has seen little empirical study. Drawing on Watson's male body schema, this paper explores how men engage with masculinities and ageing in order to make sense and meaning from PD. Data is presented from 30 narrative and semi structured interviews with 15 men of various ages who were living with PD. Findings suggest that PD threatens a visceral embodiment located in the body's basic movements and intimate functions; a pragmatic embodiment expressed through men's everyday occupations and an experiential embodiment concerned with emotions and sensations felt within and through the body. In addition, each dimension of men's embodiment also intersected with the ageing process, a process also shaped in turn by broader social and cultural concerns regarding the positions and possibilities of men's lives as they move through the life course. This paper concludes by discussing the implications of gender and ageing in understanding men's experiences of PD [ABSTRACT FROM AUTHOR]

Social workers working to protect children face the prospect of making very finely balanced judgements, often on the basis of incomplete information. Based on doctoral research into sense‐making by social workers, this paper explores aspects of the tipping point, i.e. where the categorization of a child's situation changes, potentially leading to a very different response to their needs. Those aspects include identifying the triggers for, and consequences of, the tipping point, and being aware that the tipping point being reached may have to do with changes in the internal world of the worker as well as changes in the circumstances of the family. This paper stresses the need for a more nuanced understanding of the tipping point, and emphasizes the need to take account of the processes of decision‐making, and of looking at both inter‐ and intra‐personal components of those processes. Further, it is argued that a cautious attitude requires to be taken towards technical–rational solutions and that there is a real need to place professional judgement and consideration of the tacit dimension at the heart of the child protection process. [ABSTRACT FROM AUTHOR]

This paper draws on a British Academy (BA) funded study exploring social workers' conceptions of family using a vignette and focus groups. The policy context is discussed and the data from the BA study are then compared and contrasted with families' accounts of their own situations using the data from a separate qualitative study about child protection social work. The paper discusses the themes emerging and argues for a renewed focus on theorizing family in children's social work and the implications for practice. [ABSTRACT FROM AUTHOR]

Although a widely accepted term in child welfare discourses, there remains a vagueness as to what Family Support as a named orientation in children and family services actually entails. This lack of clarity is, at times, used to detract from its usefulness within the policy and practice arena. Using the accumulated wisdom of a select group of accomplished managers, academics and policy makers in social work and social care, this paper retrospectively reviews the evolution of Family Support within the Irish context and distils the core characteristics of Family Support practice and service delivery. An unstructured narrative inducing interview was conducted with 14 veterans of Family Support and child welfare. Participants who are based in the USA, the UK and Ireland each had between 30 and 60 years' experience working in this field. Salient factors were identified by participants as having contributed to the growth of Family Support. Specific and distinct characteristics of Family Support practice and services were also categorized by these veterans, providing voice and meaning to Family Support as a specific approach. This paper addresses the debate on Family Support with its place as an accepted and valued orientation within the child welfare arena acknowledged. [ABSTRACT FROM AUTHOR]

This paper presents data from a qualitative case study of a family support service, support care. As a time‐limited service that aims to enable positive change within families and involves children and parents spending time apart, aspects of time feature prominently in understandings and experiences of the service. This paper uses the concept of time as a lens to explore some of the organizing principles and underlying assumptions of this service. Eighty‐two qualitative interviews and 22 participant observation sessions were undertaken with stakeholders engaged in support care. This paper examines the variety of ways in which time was understood and experienced over the course of the research. This includes a conceptualization of time as a resource, together with the hopes, expectations and concerns attached to the time provision. It is argued that the service‐specific questions regarding how much time to afford families, and the purpose of support have wider relevance within social work policy and practice. This includes debates about how best to respond to families with support needs, including those with enduring needs, how to manage tensions in respect of balancing need while seeking to avoid dependency and the sometimes competing nature of support and protection objectives. [ABSTRACT FROM AUTHOR]

This paper reports part of the findings from a 2014 audit of shelters for street children conducted in four provinces of South Africa. The paper focuses on the assessment of the types, structure and implementation of the programmes, as well as on the adequacy of resources necessary for implementing the programmes. The overall picture that emerged from the assessment was that all shelters draw on a comprehensive and enabling legislative and policy framework to offer some elements of developmental, therapeutic and recreational programmes at the early intervention level. Overall, however, the implementation of the programmes does not effectively take into consideration the varied and interconnected factors that, within and across multiple social systems, impel children to the streets. It was thus apparent that the programmes do not adequately address the risks and opportunities of street children in South Africa, specifically within the eco‐developmental framework. Recommendations are offered for social work policy and practice to further enhance the quality and impact of programmes offered in the shelters. [ABSTRACT FROM AUTHOR]

Young people experiencing first‐episode psychosis taking antipsychotic medications often develop comorbidities such as obesity and cardiometabolic abnormalities at an earlier age than young people in the general population. Therefore, it is important to explore the healthcare needs and experiences of this group of consumers. This paper reports research conducted to obtain an informed understanding of young people's health literacy, physical healthcare needs, and interest and knowledge about their physical health. Grounded theory methodology was used to guide the research. Semistructured interviews were conducted with 24 young consumers aged between 18 and 35 years who were case managed by one metropolitan community mental health service. The results describe the journey of young people from the time of diagnosis, to when they developed an awareness of the need to improve their physical health and the impact of physical health issues on their overall health and well‐being. Six categories emerged from the data: (i) initial responses when diagnosed with first‐episode psychosis; (ii) focus of care on treating first‐episode psychosis; (iii) lack of education on antipsychotic medications; (iv) adverse effects from taking antipsychotic medication; (v) increased awareness of the need for good physical health; and 6) importance of social support in the community. The findings highlight the importance for health professionals improving young people's health literacy and addressing physical health and well‐being as part of first‐episode psychosis programmes. Young people require improved health education on the importance of maintaining healthy lifestyle in relation to their overall health and well‐being. [ABSTRACT FROM AUTHOR]

With growing concerns about the efficacy and costs of intrusive child protection interventions and increasing recognition of citizen rights to participation in governance, jurisdictions are looking to collaborative alternatives that divert families from the courts and out‐of‐home care. In Queensland (Australia), "intervention with parental agreement" (IPA) is one such response. Under IPA, the statutory child protection authority can work collaboratively with families, without a court order, to respond to children assessed as "in need of protection." In this paper, we use procedural justice theory as a lens to explore how IPA policy is enacted in practice. Procedural justice relates to the quality of treatment a person receives and the fairness of the process than an authority uses during decision‐making (Tyler,). It is associated with voluntary cooperation and compliance; key practice concerns when working to address child maltreatment via parental agreement rather than court ordered intervention. We report on a qualitative study that utilized semistructured, in‐depth interviews to capture the perceptions of 30 practitioners regarding the factors that shape the extent to which they enact IPA policy in a procedurally fair manner. Strategies for enhancing procedurally just enactment of IPA policy in practice are discussed. [ABSTRACT FROM AUTHOR]

Practitioners' preconceived ideas about service users can lead to prejudice and labelling, and ultimately may result in biased services. This paper reports on a UK‐based qualitative research study exploring the views and experiences of practitioners working with adult victims and perpetrators of domestic violence. It examines whether or not practitioners believe that childhood experiences of witnessing domestic violence indicate the likelihood of domestic violence in adulthood. It further explores practitioners' perceptions of factors contributing to the experiences of domestic violence amongst their service users. Twelve semi‐structured interviews were conducted with practitioners working in the domestic violence field, and thematic analysis was used to analyse their responses. The data did not indicate a general consensus on the matter of children becoming victims or perpetrators based on their childhood experiences of domestic violence. Participants' responses indicated that they thought the issue was more complex. Common themes that participants consider important to children's development of healthy/unhealthy relationships in this context were identified in the data. These included: an awareness of service users' individuality; the importance of meaningful support networks; and an understanding of the risk amongst their service users to normalise abusive behaviour. '[Explores] the views and experiences of practitioners working with adult victims and perpetrators of domestic violence' Key Practitioner Messages: Not all children witnessing domestic violence will inevitably become victims or perpetrators of abuse in adulthood.Perpetrating domestic violence in adulthood is often associated with a combination of various factors and circumstances, and can rarely be attributed to just one past experience.Assessments and holistic and judgement‐free services provided by practitioners are vital for children to develop positive and healthy future relationships. [ABSTRACT FROM AUTHOR]

Background: This paper explored the health beliefs and behaviours of families towards the health needs of children with intellectual and developmental disabilities (IDD) in Accra, Ghana. The aim was to inform health promotion strategies for the children and their families. Method: Twenty‐two parents of children with IDD participated in this study. Semi‐structured interviews were the primary means of data collection. The interviews were analysed using constant comparison. Results: The signs that alerted the parents that the children might be ill included high temperature, vomiting and excessive sleep. The parents explained that some children expressed feelings of ill‐health through verbal or non‐verbal communication. Most of the parents self‐prescribed medication for the children or waited for symptoms to persist for a while before accessing health care because they experienced difficulties managing the behavioural challenges associated with the IDD of the children in public and attitudinal barriers when accessing health care. The parents did not often patronise health facilities in their neighbourhoods due to private health insurance requirements for accessing care at designated facilities, poor confidence in neighbourhood facilities and long‐term established relationships with facilities elsewhere. Further, many parents did not patronise religious interventions for the children. However, some parents explained that in addition to seeking medical care to address the physical symptoms of the children's disabilities and/or illnesses, they sought religious interventions because they believed that there could be a spiritual dimension to the situation. Conclusion: The findings highlight key areas to address in health promotion for children with IDD and their families in Accra, Ghana. [ABSTRACT FROM AUTHOR]

Background: For parents who experience stillbirth, knowing the cause of their baby's death is important. A post mortem examination is the gold standard investigation, but little is known about what may influence parents' decisions to accept or decline. Aim: We aimed to identify factors influencing maternal decision‐making about post mortem examination after late stillbirth. Methods: In the New Zealand Multicentre Stillbirth Study, 169 women with singleton pregnancies, no known abnormality at recruitment, and late stillbirth (≥28weeks gestation), from seven health regions were interviewed within six weeks of birth. The purpose of this paper was to explore factors related to post mortem examination decision‐making and the reasons for declining. We asked women if they would make the same decision again. Results: Maternal decision to decline a post mortem (70/169, 41.4%) was more common among women of Māori (adjusted odds ratio (aOR) 4.99 95% confidence interval (CI) 1.70–14.64) and Pacific (aOR 3.94 95% CI 1.47–10.54) ethnicity compared to European, and parity two or more (aOR 2.95 95% CI 1.14–7.62) compared to primiparous. The main reason for declining was that women 'did not want baby to be cut'. Ten percent (7/70) who declined said they would not make this decision again. No woman who consented regretted her decision. Conclusion: Ethnic differences observed in women's post mortem decision‐making should be further explored in future studies. Providing information of the effect of post mortem on the baby's body and the possible emotional benefits of a post mortem may assist women faced with this decision in the future. [ABSTRACT FROM AUTHOR]

Context: Competency‐based medical education has spurred the implementation of longitudinal workplace‐based assessment (WBA) programmes to track learners' development of competencies. These hinge on the appropriate use of assessment instruments by assessors. This study aimed to validate our assessment programme and specifically to explore whether assessors' beliefs and behaviours rendered the detection of progress possible. Methods: We implemented a longitudinal WBA programme in the third year of a primarily rotation‐based clerkship. The programme used the professionalism mini‐evaluation exercise (P‐MEX) to detect progress in generic competencies. We used mixed methods: a retrospective psychometric examination of student assessment data in one academic year, and a prospective focus group and interview study of assessors' beliefs and reported behaviours related to the assessment. Results: We analysed 1662 assessment forms for 186 students. We conducted interviews and focus groups with 21 assessors from different professions and disciplines. Scores were excellent from the outset (3.5–3.7/4), with no meaningful increase across blocks (average overall scores: 3.6 in block 1 versus 3.7 in blocks 2 and 3; F = 8.310, d.f. 2, p < 0.001). The main source of variance was the forms (47%) and only 1% of variance was attributable to students, which led to low generalisability across forms (Eρ2 = 0.18). Assessors reported using multiple observations to produce their assessments and were reluctant to harm students by consigning anything negative to writing. They justified the use of a consistent benchmark across time by citing the basic nature of the form or a belief that the 'competencies' assessed were in fact fixed attributes that were unlikely to change. Conclusions: Assessors may purposefully deviate from instructions in order to meet their ethical standards of good assessment. Furthermore, generic competencies may be viewed as intrinsic and fixed rather than as learnable. Implementing a longitudinal WBA programme is complex and requires careful consideration of assessors' beliefs and values. Are assessment practices ethical? This paper shows that longitudinal assessment of competencies may be complicated by assessors' beliefs [ABSTRACT FROM AUTHOR]

Abstract: Improving infant and young child feeding practices is critical for improving growth and reducing child mortality and morbidity. This paper aims to compare predictors of minimum dietary diversity, an important indicator of adequate complementary feeding practices, in Bangladesh in 2011 and 2014. The 2011 and 2014 Bangladesh Demographic and Health Survey were used to examine predictors of minimum dietary diversity among 6–23 months. An additional analysis was conducted for the 18–23‐month group, because a significant increase in meeting minimum dietary diversity recommendations was seen in this age group only. Factors found to be associated with practices were compared across time points. In 2011, minimum dietary diversity was 23.8% and increased to 28.8% in 2014. Among children 18–23 months, in 2011, minimum dietary diversity was 32.5% and increased to 42.8% in 2014. Among all children, wealth, education, exposure to media, and antenatal care were significant predictors of dietary diversity. In the 18–23‐month age group, significant predictors in 2011 were wealth and decision making. In 2014, significant predictors were education and exposure to media. Demographic trends indicated a significant increase in education and exposure to media between 2011 and 2014. As these were significant for minimum dietary diversity in 2014 overall and for 18–23 months, they might be important targets of future interventions, specifically utilizing media channels and tailoring special strategies for women with low education and limited exposure to media. [ABSTRACT FROM AUTHOR]

Grandparents whose grandchildren are exposed to domestic violence are faced with some unique challenges in their grandparenting, which have thus far been little discussed in research. This paper discusses the narratives of 10 Swedish grandparents whose grandchildren have been exposed to violence towards their mother. The aim was to explore grandparents' narrations of their responses in the face of violence, and their understanding of the role they play in their grandchildren's social networks. Two significant responses are discussed: ‘being there’ and ‘acknowledging the independence and self‐determination of the adult children’. Grandparents experienced these responses as contradictory and felt powerless when it came to their possibilities to protect their grandchildren. The paper suggests that grandparents could be a resource for domestic violence services, and social work practice needs to assess the roles of grandparents of children exposed to domestic violence. Social workers should consider the challenges these grandparents are facing and what support they may need in order to support their grandchildren. [ABSTRACT FROM AUTHOR]

Little is known about how children themselves understand their moves to and between foster homes. The data presented in this paper come from a study that sought children's views on becoming and being a foster child. A key finding of that study was how children's accounts of being fostered illustrated a high level of anxiety and concern about their moving to live with a foster family. This paper firstly explores the key issues about looked‐after children's moves. It then describes the research study undertaken, before exploring the data generated from children's accounts of their moves to a new foster home. Lastly, there is a discussion of the implications for social work practice in this area. [ABSTRACT FROM AUTHOR]

Interviews with survivors of intimate partner violence were conducted to gain information on the transition from violent relationships to new non‐violent relationships. A subset of this data was re‐analysed using Social Relational Theory to gain further insight into the roles of children and important others who were identified as impacting this transition for mothers who had exited violent relationships. This paper reviews two major themes discovered during the SRT analysis that were inherent in the women's experiences: (i) agency of children, family, peers and community and (ii) power. In addition, this paper suggests implications for research, intervention and psychotherapeutic practice. [ABSTRACT FROM AUTHOR]

Generations of parents lost to AIDS and other causes have created a vacuum of care for the orphaned children they leave behind. This crisis has resulted in rapid changes in caregiving and family life, with extended family members, having to care for orphaned children. As a result of high numbers of vulnerable orphaned children residing with kinship carers, and the fundamental importance of the relationship between carers and orphaned children, we need to understand more about these relationships. This paper explores the nature of orphaned children-kinship carer relationships in Botswana. Interview guides were used to collect data from 15 caregivers and 15 orphaned children. The results indicate that the nature of relationships between orphaned children and caregivers is influenced by the way the parties communicate, how adolescents behave and the competing responsibilities of caregivers. Lastly, the paper recommends how positive relationships can be developed and nurtured between orphaned children and their caregivers in an African setting. [ABSTRACT FROM AUTHOR]

Abstract: This paper explores the contribution of social identity change to international students' health and well‐being. International students typically face a range of challenges from the time they leave their home country, including the need to adapt both to a new culture and norms and to a new educational landscape. Previous research informed by the Social Identity Model of Identity Change (SIMIC) suggests that during such life transitions, an individual's group memberships and associated social identities can provide a buffer against the threats to well‐being that such transitions present. To examine the relevance of SIMIC for the transitions that international students' experience, semistructured interviews were conducted with 15 international students attending an Australian university. Thematic analysis provided support for the relevance of SIMIC's social identity gain and social identity maintenance pathways in the transition and revealed a number of associated factors that acted as either facilitators (e.g., a host family that supported community integration) or barriers (e.g., experiencing culture shock) to social identity change. These findings present the first qualitative support for SIMIC within an international student population and help to flesh out the specific ways in which social identity processes contribute to both positive and negative health and well‐being outcomes. [ABSTRACT FROM AUTHOR]

Abstract: For patients living with chronic illnesses, self‐care has been linked with positive outcomes such as decreased hospitalisation, longer lifespan, and improved quality of life. However, despite calls for more and better self‐care interventions, behaviour change trials have repeatedly fallen short on demonstrating effectiveness. The literature on heart failure (HF) stands as a case in point, and a growing body of HF studies advocate realist approaches to self‐care research and policymaking. We label this trend the ‘realist turn’ in HF self‐care. Realist evaluation and realist interventions emphasise that the relationship between self‐care interventions and positive health outcomes is not fixed, but contingent on social context. This paper argues socio‐materiality offers a productive framework to expand on the idea of social context in realist accounts of HF self‐care. This study draws on 10 interviews as well as researcher reflections from a larger study exploring health care teams for patients with advanced HF. Leveraging insights from actor‐network theory (ANT), this study provides two rich narratives about the contextual factors that influence HF self‐care. These descriptions portray not self‐care contexts but self‐care assemblages, which we discuss in light of socio‐materiality. [ABSTRACT FROM AUTHOR]

Abstract: Despite large amounts of care for chronic conditions being provided within the family, information regarding the extent to which siblings contribute to informal care practices in families where a child has a chronic condition is limited. This article draws on multiple perspective data from 24 families that had a child with epilepsy. In doing so, the article illustrates siblings' significant contribution to caring for their brother or sister and further develops the alert assistant concept. Two additional distinct caring roles that the siblings took on are also outlined – the substitute parent and parenting assistant roles. The relationship between siblings' socio‐demographic characteristics and their caring responsibilities is also explored. The paper's findings are that siblings who were older, female and those in families with a higher child to parent ratio took on more caring responsibilities. Consequently, this article contributes to the currently limited literature on siblings who care for a chronically ill brother or sister by increasing understandings of different caring roles and experiences of chronic illness in families. [ABSTRACT FROM AUTHOR]

Political rhetoric and media reports following the August 2011 London riots in the UK drew attention to poor parenting to explain the cause of the riots, thus, a parent-blaming discourse emerged. This article presents findings from a PhD thesis about how London parents and families constructed the riots and relevant clinical implications. A separate paper focuses on the method and findings from the PhD thesis with an aim to include parent and family perspectives on the riots in the academic literature. A Foucauldian-informed thematic analysis indicated that social exclusion, gentrification, criminality, parenting, morality and neighbourhood were relevant to the 2011 London riots from interviews with parents and families. This article aims to support clinical work with parents and families, especially as clinicians were positioned as useful in supporting such groups, through the Troubled Families Programme following the London riots. Clinical implications were developed from themes about socio-political issues and parent-blaming discourses and the notion of positioning, as influenced by the Foucauldian-informed analysis adopted. Practitioner points Consider the relevance of socio-political issues and parent-blaming discourses to the August 2011 London riots., Use 'social context' questions to explore socio-political issues when conducting therapy., Use 'parenting expectations' questions to explore possible parent-blaming discourses when conducting therapy., Consider the ways in which clients may be positioned within their relationships. [ABSTRACT FROM AUTHOR]

In this paper, midwives' experiences of working with vulnerable pregnant women who were subject to child protection orders in New South Wales, Australia, and faced the possible removal of their baby at birth, known as 'assumption of care', are described. A qualitative descriptive approach was used to explore the experiences of ten midwives who had been involved in some 91 episodes of assumption of care. In-depth interviews were undertaken and thematic analysis was used to analyse the data-set. Four themes were elicited that demonstrated how midwives worked with vulnerable women and Community Services during the antenatal period. These were labelled: Reporting - Taking the first step; The woman-midwife relationship remains a priority; Jumping through the 'community service' hoops; and Crunch time: The decision... sometimes justifiable sometimes not? Even though the three-way relationship between the woman-midwife-Community Services could be confrontational, it was essential that midwives worked in a positive way with Community Services to improve outcomes for the woman and her unborn child. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Messages Working effectively with Community Services is essential. Sharing information and developing multidisciplinary approaches and pathways will produce the best outcomes for vulnerable newborns and their mothers whilst at the same time supporting health and community workers to work in a cohesive manner to provide quality care., Midwives need to be supported to stay 'woman centred'. Keeping the woman engaged in the system will help ensure the health of the foetus (baby)., Further research is needed to explore the perspectives of all those involved in assumption of care. [ABSTRACT FROM AUTHOR]

This paper presents the findings of a scoping study into looked after children and care leavers who are parents in Wales. Eight parents engaged in a qualitative interview. Thirty-one pregnancies were discussed during the interviews: 16 live births, two ongoing pregnancies, one stillbirth, one termination and 11 miscarriages. At the point of interview, two parents continued to care for their children, but six had experienced the permanent removal of their child/ren as a result of social services intervention. Twelve of the 16 children discussed in the interviews were 'looked after' or adopted. Despite its small-scale nature, the study highlights important considerations before, during and after participants became parents. Broadly categorized, these relate to the influence of parents' childhood experiences on their capacity to be parents, the availability and adequacy of support during parenting and the ensuing impact of parenting 'success' or 'failure'. For parents who had experienced the loss of a child, some were resigned to having no further children, some continued to hope for a family in the future, while others had experienced cycles of repeated pregnancies and compulsory removals. The findings are considered in the context of related literature and suggest that increased attention is required in this under-researched but highly emotive area. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to critically examine family stigma as one form of the stigma of mental illness in child and youth mental health. Presented are the outcomes of a thematic content analysis of in-depth, semi-structured interviews conducted with seven ( n = 7) young siblings, ages 13 to 21 years old, with a brother or sister identified as having a mental-health issue. The focus of the interviews was on the ways the siblings experienced their other sibling's mental health and how those experiences shaped their sense of self and family. From the analysis, young siblings had predominately negative experiences, struggled with making sense of their brother or sister and the family as 'flawed' against the mental illness as 'bad' and experienced considerable family stress and overt family stigma. Current practice theories fail to consider the complexity of these factors and, in doing so, fail to adequately explain the nature and extent to which stigmatization occurs for immediate family members. The importance of peer support and understanding stigma in social work practice with children and their families is discussed. [ABSTRACT FROM AUTHOR]

In an interview study of decision-making about statins, many participants said they took pills regularly, yet described themselves as 'not really pill-takers'. This paper explores this paradox and its implications. The practice of pill-taking itself can constitute a challenge to the presentation of moral adequacy, beyond the potential for rendering stigmatised illnesses visible. Meeting this challenge involves a complex process of calibrating often-conflicting moral imperatives: to be concerned, but not too concerned, over one's health; to be informed, but not over-informed; and deferential but not over-deferential to medical expertise. This calibration reflects a broader tension between rival tropes: embracing medical progress and resisting medicalisation. Participants who take statins present them as unquestionably necessary; 'needing' pills, as opposed to choosing to take them, serves as a defence against the devalued identity of being a pill-taker. However, needing to take statins offers an additional threat to identity, because taking statins is widely perceived to be an alternative strategy to 'choosing a healthy lifestyle'. This perception underpins a responsibilising health promotion discourse that shapes and complicates the work participants do to avoid presenting themselves as 'pill-takers'. The salience of this discourse should be acknowledged where discussions of medicalisation use statins as an example. [ABSTRACT FROM AUTHOR]

This paper summarizes, elaborates upon, and contrasts the findings of two research projects that explored how general practitioners and nurses coped with the dual challenge of personal and work demands following the earthquakes in Canterbury, New Zealand, in 2010 and 2011. Qualitative data from two separate studies - the first with general practitioners and the second with nurses - are compared to identify the challenges faced during and following the earthquakes. Semi-structured interviews took place with eight general practitioners two years after the start of the earthquake sequence and 11 nurses a year later to enable exploration of the longer-term aspects of the recovery process. The interview transcripts were analyzed and coded using a constructivist grounded theory approach. The analysis identified that the earthquakes had a significant impact on nurses and general practitioners both in terms of their professional and personal lives. The nurses and general practitioners commented on the emotional impact and their support needs, as well as some of the longer-term recovery issues. [ABSTRACT FROM AUTHOR]

Poor outcomes for young people in and leaving care have been well documented and research has indicated that the expectations of professionals working with children and young people looked after is a significant influence, particularly in relation to education. An evaluation of an independent children's residential school in Scotland provided a rare opportunity to analyse and compare the views of different kinds of staff about desirable outcomes and how successful outcomes could be achieved. Care workers, teachers and specialist support staff shared some views, but also held contrasting expectations, which appeared to be linked to differing emphases in their models for working with young people. This paper offers tentative explanations for such differences and concludes with suggestions on how to help align service staffs' expectations of young people leaving their care. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim The aim of this study was to explore the potential use of visual diarizing to enable intensive care unit (ICU) survivors to create their story of recovery. Background An ICU experience can have deleterious psychological and physical effects on survivors leading to reductions in quality of life which for some may be of significant duration. Although there has been exploration of many interventions to support recovery in this group, service provision for survivors remains inconsistent and inadequate. Design and participants A qualitative interpretive biographical exploration of the ICU experience and recovery phase of ICU survivors using visual diarizing as method. This paper is a component of a larger study and presents an analyses of one participant's visual diary in detail. Methods Data collection was twofold. The participant was supplied with visual diary materials at 2 months post-hospital discharge and depicted his story in words and pictures for a 3-month period, after which he was interviewed. The interview enabled the participant and researcher to interpret the visual diary and create a biographical account of his ICU stay and recovery journey. Findings The analysis of one participant's visual diary yielded a wealth of information about his recovery trajectory articulated through the images he chose to symbolize his story. The participant confirmed feelings of persecution whilst in ICU and was unprepared for the physical and psychological disability which ensued following his discharge from hospital. However, his story was one of hope for the future and a determination that good would come out of his experience. He considered using the visual diary enhanced his recovery. Conclusions The participant perceived that visual diarizing enhanced his recovery trajectory by enabling him to recreate his story using visual imagery in a prospective diary. Relevance to clinical practice Prospective visual diarizing with ICU survivors may have potential as an aid to recovery. [ABSTRACT FROM AUTHOR]

Objectives This research explored what happens when psychological input is offered in the inpatient setting and examined service users' and staff members' understanding and portrayal of these experiences. Design Narrative analysis, an interview design, was used to examine experiences of inpatient psychological interventions in National Health Service inpatient mental health settings. Methods Ten participants (four service users and six staff members; five males and five females; seven White British, one White Irish, one Black African, and one Black Caribbean) were recruited via clinical psychologists from an inpatient psychology department and participated in 18- to 90-min interviews. Results Evidence suggested that direct, indirect, and strategic psychological interventions were used in the inpatient setting, with formulation and the therapeutic relationship conceptualized as common features. Connections between inpatient psychology and change, evidenced in the stories, suggested that interventions can help people make sense of a crisis, improve relationships, and contribute to meaningful recovery. Evidence of barriers suggests that psychological input in this setting might not always be compatible with everyone's needs. Conclusions This paper explored service users' and staff members' experiences of psychological input in the inpatient setting. The analysis revealed that psychological provision in the inpatient mental health setting is varied and encompasses direct and indirect input, valued by service users and clinicians. It also identified that psychological input in the acute inpatient mental health setting is perceived as meaningful and can lead to changes at an interpersonal and intrapersonal level. There is a sense that providing psychological thinking in the inpatient setting can be challenging due to environmental constraints and individual factors. This highlights the need for further research focused on the costs and clinical effectiveness of providing psychological thinking within the acute inpatient mental health setting. Practitioner points Staff members and service users made connections between psychological input and change, suggesting that interventions can improve relationships, help people make sense of a crisis, and contribute to meaningful recovery., There are significant barriers to and challenges of providing psychological input in this setting: Some participants suggested that this approach might not suit everyone. [ABSTRACT FROM AUTHOR]

Little is known about how mental health services consider the parenting role and the well‐being of children when assessing parents with acute mental illness. This paper investigated how crisis mental health services addressed child well‐being in the Wellington region, New Zealand. This mixed‐method case study included: (i) an audit of the electronic clinical records of all adults presenting to the crisis assessment team; (ii) interviews with 22 key informants; and (iii) a documentary review. We found that data about children were not systematically collected. Less than half of (49 of the 104) the records of patients who were parents included information on their child's well‐being; only six (6%) contained a specified plan for action. The focus for services was the adult patient. Key informants were unclear about their role. They identified inadequate training and institutional support, inflexible funding models and limited availability or inappropriateness of referral services as problems. They saw a need for children to become more visible, for collaborative working to improve the use of existing services and for new funding models, resources and roles. Existing national policy documents contained little guidance and no practice guidelines were in use. These were lost opportunities to improve support for the parenting role and promote child well‐being. [ABSTRACT FROM AUTHOR]

The life expectancy of people living with mental illness is significantly shorter than that of the rest of the population. Despite the profound impact of physical health issues on both quality of life and life expectancy, the perspectives of mental health consumers have yet to be thoroughly explored. Furthermore, research has focused far more on describing barriers than on identifying solutions. This paper reports on findings from a qualitative exploratory research study, with the aim to examine the potential role of a specialist nurse with advanced physical health-care skills. Focus groups were conducted with 31 consumers. Data were analysed thematically. The concept of a role like this was supported; however, participants stressed: (i) the importance of integration between health professionals and various components of the health-care system; and (ii) the need for culture change for nurses to work from a less medically-dominated approach. Previous research literature suggests that a nursing position dedicated to physical health care and coordination might produce positive outcomes for mental health consumers. The findings from the current research project emphasize the need for consumers to be identified as key stakeholders in a solution-focused approach to improved physical health care for mental health consumers. [ABSTRACT FROM AUTHOR]

Children taken into care and custody are arguably the most vulnerable and problematic groups within the wider debate and responses developing to the ‘troubled families’ agenda in England. They represent what the state most wants to avoid when it intervenes in the life of a family. This paper is based on an analysis of the service involvement and needs of the 196 children taken into care or custody over a 3‐year period (2008–2011) in one city local authority in England. The research was undertaken to inform the response to prevention of entry into care and custody which was the original focus of the most intensive part of the troubled families programme in the city. Interviews with 10 senior professionals from a range of agencies involved in setting up this local programme, explored the way the emerging troubled families agenda was shaping ideas about the understanding of and response to the needs of these children and their families. Key findings of the study illustrate the range and complexity of need as well as the sequence and amount of agency involvement. Professionals were often critical of the thinking behind the troubled families agenda, but were positive and creative about new ways of working with these families. [ABSTRACT FROM AUTHOR]

Context This paper describes the transition processes experienced by Year 3 medical students during their longitudinal integrated clerkship ( LIC). The authors conceptualise the stages that encompass the transition through a LIC. Objectives The purpose of this study was to understand the perspectives of 12 Northern Ontario School of Medicine ( NOSM) Year 3 medical students about their transition process. Methods Data were collected longitudinally through three conversational interviews with each of these students, occurring before, during and after the clerkship. The authors used a guided walk methodology to explore students' everyday lives and elicit insights about the transition process, prompted by the locations and clinical settings in which the clerkship occurred. Results Participants identified three interconnected stages in the transition process: (i) shifting from classroom to clinical learning; (ii) dealing with disorientation and restoring balance, and (iii) seeing oneself as a physician. Interview data provided evidence for the adaptive strategies the participants developed in response to these stages. Conclusions Based on these findings, the transition process during a LIC can be characterised as one of entering the unfamiliar, with few forewarnings about the changes, of experiencing moments of confusion and burnout, and of eventual gains in confidence and competence in the clinical roles of a physician. Recommendations are made regarding future research opportunities to further scholarship on transitions. [ABSTRACT FROM AUTHOR]

The paper analyses children's experiences of (in)security in cases of post-separation stalking and asks how children can be safeguarded under such circumstances. Children are at particular risk when the family is stalked by the biological father or stepfather. This qualitative study draws on data collected from 13 children using three different methods: therapeutically-oriented group sessions, interviews with the children and a series of ten mother and child therapy sessions. Supplementing these data are insights gained from interviews with 18 women/mothers, the main targets of the stalking. The analysis of the narratives distinguishes three overlapping forms of security - eroded, lost and reconstructed - in which the degree of trust and extent of knowledge are the main elements. Children feel insecurity to different degrees and experiences of (in)security may vary even from child to child in the same family. The findings highlight the crucial importance of considering a child's relationship to his or her mother, siblings and trusted adults when intervening in stalking. Loved ones, day care and school staff, and social welfare workers have a significant role to play in reconstructing and strengthening children's security. The study suggests that this can be done through 'safety talk' with a mother and her children. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Messages In cases of post-separation stalking of the family, children's security can appear in three forms: eroded, lost and reconstructed., Feelings of insecurity vary and can appear to differing degrees within the same family., It is important in safeguarding children to lighten the burden that they take upon themselves of reconstructing security for themselves and their loved ones., Practitioners can play a significant role by providing space for and facilitating 'safety talk' between children and their mothers. [ABSTRACT FROM AUTHOR]

The management of consumer-related risk is paramount in a secure forensic mental health facility. However, the consequent risk aversion presents a major barrier to consumers forming sexual relationships in a manner that is open and accepted. Investigation of the views of nurses working in forensic mental health settings on this topic is limited, and even more so for consumers of services. This qualitative exploratory study was undertaken to elicit the views of consumers and nurses about forming sexual relationships within this long-term and secure setting. Individual in-depth interviews were conducted with 12 nurses and 10 consumers. The benefits of, and barriers to, sexual relationships was identified as a major theme, and these findings are the focus of this paper. Nurse responses included the subthemes 'supportive factors' and 'potential dangers', reflecting their qualified support. Consumer responses included the subthemes 'therapeutic', 'feeling normal', 'restrictions and barriers', and 'lack of support and secrecy'. The importance of sexual relationships was clearly articulated, as was the difficulties in forming and maintaining them within the forensic setting. More open discussion about this commonly-avoided issue and the education of nurses and other health professionals is required. [ABSTRACT FROM AUTHOR]

Little is known about the impact of living with pulmonary hypertension. This paper reports data exploring the experience of living with pulmonary hypertension. Qualitative, semistructured, one-to-one interviews were conducted in participants' homes to understand their experiences of living with pulmonary hypertension. Thematic analysis was used to identify codes and generate themes from the interview data. The identification of initial codes was conducted independently by the first author, and checked by the second. Thirty patients recruited through the pulmonary hypertension descriptions of living with pulmonary hypertension are presented under five themes that center on the invisibility of pulmonary hypertension, and its complex treatment are presented: (i) living with a hidden illness; (ii) being on a symptomology rollercoaster; (iii) expectations from treatments; (iv) treatment burden; and (v) awareness of financial burden of treatments. Key findings included daily challenges of living with a rare condition that is largely 'hidden' and its related complex treatment regimes. People with pulmonary hypertension would benefit if more healthcare professionals, as well as family and friends, would validate their condition and provide them with appropriate support. [ABSTRACT FROM AUTHOR]

Background Exercise has traditionally been an important part of the treatment of ankylosing spondylitis (AS) in order to maintain spinal mobility. Additionally, anti-tumour necrosis factor-alpha (TNFα) medication has been proven highly effective in treating the condition. Over recent years, a few papers have shown the synergistic effect of combining anti-TNFα medication with rehabilitation. There is minimal evidence on the perceptions of AS patients on how the medication has affected their exercise behaviour. The aim of the present study was to explore the effects of anti-TNFα medication on exercise behaviour in patients with AS. Method A qualitative approach was adopted to provide a holistic understanding of participants' exercise behaviour while on anti-TNFα medication. Semi-structured interviews were undertaken and transcribed verbatim. Data were analysed using thematic network analysis. Ethical approval and informed consent were obtained. Results Twenty participants (age range 26-74, disease duration 3-36 years) who had been on the medication for over a year described how their exercise behaviour had improved since being on the medication. They highlighted their motivation and incentives to continue with an exercise programme. The participants had reinstated previous sporting activities, started new ones and regularly undertook physiotherapy exercises. Conclusion The present study provides evidence of the long-term effects of anti-TNFα medication on the exercise behaviour of AS patients. It shows that AS patients are able to sustain a regular exercise programme over a number of years, provides insight into what motivates them to exercise and reveals the incentives that have influenced their choice of activity. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]