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    ABSTRACT: OBJECTIVES: To compare self-reported experiences of and attitudes towards sexual professional boundaries (SPB) in a cohort of undergraduate and graduate physiotherapists domiciled in the UK and Australia. DESIGN: A cross sectional survey design was utilised to capture data from two UK cohorts. SETTING: Data was collected from a University in the Midlands region of England. PARTICIPANTS: Fifty one final year undergraduate students and 17 graduate students took part in this study. This was compared to published data from Australian undergraduates (n=67) and Australian graduates (n=939). OUTCOME MEASURES: A questionnaire consisting of 3 distinct sections was distributed. Section 1 established demographic information, section 2 considered personal experience of the SPB, and section 3 considered attitudes to 6 vignettes describing a variety of scenarios examining the SPB. RESULTS: Graduate students in both cohorts demonstrated a greater awareness of professionals crossing the SPB. Self reported sexual attraction towards a patient was significantly higher in graduate students (50%) compared to undergraduates (9%). Six percent and 4% of UK and Australian graduates reporting they had dated a patient. However, a much higher percentage (53% and 17% respectively) reported knowing a colleague who had dated a patient. A significant difference between graduates and undergraduate in their attitudes towards selected vignettes describing SPB crossings was also identified. CONCLUSIONS: The current results provide evidence of inappropriate sexual behaviour occurring within the UK. Both graduates and undergraduates require training pertinent to the topic of SPB. Further research is required to enhance our understanding of this topic area.
    Physiotherapy 01/2013; 99(4). DOI:10.1016/j.physio.2012.12.005
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    Journal of Advanced Nursing 12/2012; 68(12):2595-6. DOI:10.1111/j.1365-2648.2012.06102.x
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    ABSTRACT: In the past decade there has been both an increase in the number of children who receive nursing care in their communities rather than in hospitals, and an increasing willingness to listen to children. This qualitative study used Clark's Mosaic approach to elicit children's views of community children's nursing. Twenty-one children took part in total, with seven children making up a core group who participated in a number of activities for over a year. A non-core group of 14 children were observed receiving care from six community children's nurses. The children had diverse medical conditions, were aged from 11 months to 17 years old and came from diverse social, ethnic and cultural backgrounds. Some children expressed a positive regard for nurses and nursing. Some children a negative regard, others were ambiguous. From these data it is proposed that there is a continuum of regard for nurses. How children regarded nurses did not seem to be related to the nurse's actions, but to the child's understanding of their illness and their involvement in care. Further study is required to clarify the concept and should focus on what effect children's regard for nurses and nursing has on health outcomes.
    Journal of Child Health Care 03/2012; 16(1):91-104. DOI:10.1177/1367493511426279
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    ABSTRACT: This paper explores how emergency nurses manage the emotional impact of death and dying in emergency work and presents a model for developing expertise in end-of-life care delivery. Care of the dying, the deceased and the bereaved is largely conducted by nurses and nowhere is this more demanding than at the front door of the hospital, the Emergency Department. Whilst some nurses find end-of-life care a rewarding aspect of their role, others avoid opportunities to develop a relationship with the dying and bereaved because of the intense and exhausting nature of the associated emotional labour. Qualitative study using unstructured observations of practice and semistructured interviews. Observation was conducted in a large Emergency Department over 12 months. We also conducted 28 in-depth interviews with emergency staff, patients with terminal illnesses and their relatives. Emergency nurses develop expertise in end-of-life care giving by progressing through three stages of development: (1) investment of the self in the nurse-patient relationship, (2) management of emotional labour and (3) development of emotional intelligence. Barriers that prevent the transition to expertise contribute to occupational stress and can lead to burnout and withdrawal from practice. Despite the emotional impact of emergency deaths, nurses who invest their therapeutic self into the nurse-patient relationship are able to manage the emotional labour of caring for the dying and their relatives through the development of emotional intelligence. They find reward in end-of-life care that ultimately creates a more positive experience for patients and their relatives. The emergency nurse caring for the dying patient is placed in a unique and privileged position to make a considerable impact on the care of the patient and the experience for their family. This model can build awareness in managing the emotive aspects involved in care delivery and develop fundamental skills of nursing patients near the end of life.
    Journal of Clinical Nursing 12/2011; 20(23-24):3364-72. DOI:10.1111/j.1365-2702.2011.03860.x
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    ABSTRACT: Recent policy pronouncements emphasise the importance of engaging fathers with preventive primary care services. However, in England, there is a paucity of literature which examines African and African-Caribbean fathers' experiences of service provision. This paper reports a study that investigated African and African-Caribbean fathers' beliefs about fatherhood, health and preventive primary care services, with the aim of addressing the deficit in the literature. Nine focus groups involving 46 African and African-Caribbean fathers, recruited using purposive sampling, were undertaken between October 2008-January 2009. Fatherhood was seen as a core aspect of the participants' identities. The fathers enacted these identities in a number of ways, such as caring for and protecting children, which were influenced by spirituality, relationships with women, paid work and racism. The fathers had concerns about their bodies, medical conditions, physical activity and forms of consumption. However, their primary focus was on maintaining and improving the well-being of their children. This resulted in them neglecting their own health needs as they had to meet the obligations of family life and paid work. The fathers reported limited contact with preventive primary care services and were unaware of their purpose, function and availability. They identified ethnicity as a positive asset, and felt their families and communities had particular strengths. However they acknowledged that structural constraints, including racism, influenced their perceptions of and access to local health services. The engagement of African and African-Caribbean fathers needs to be addressed more specifically in policy as part of a broader programme of action to tackle health inequalities. In addition, child health services could build on fathers' commitment to children's well-being through practice that addresses fathers' as well as mothers' needs in families.
    Health & Social Care in the Community 11/2011; 20(2):216-23. DOI:10.1111/j.1365-2524.2011.01037.x
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    ABSTRACT: In an ageing society, like the UK, where long-term illness dominates healthcare, there has been a change in the way that the end-of-life is approached and experienced. Advancing technology, inadequate knowledge and inconsistency in palliative care services have complicated the ability to recognise imminent dying and many people access emergency services at the end-of-life. Drawing on ethnographic research exploring end-of-life care in one large Emergency Department (ED), the authors examine the spaces of dying and death, which are created in a place designed to save life, and not necessarily to provide supportive and palliative care. Despite the high need for attention in an emergency crisis, this study shows that the approach taken to care for someone at the end-of-life, and consequently the space in which they are cared for, often falls short of the expectations of the dying patient and their relatives. It is argued that the dying body is seen as dirty and polluted in the sterile, controlled, clinical environment and is therefore 'matter out of place'. Attempts are made to conceal or remove the dying patient, the bereaved relatives and the deceased body protecting the natural order of the ED. Consequently, the individual supportive and palliative care needs of the dying are often overlooked. This paper highlights the needs of patients as death nears in the ED and argues that the critical decisions made in the ED have a significant impact on the quality of care experienced by patients, who spend the last few hours of their life there.
    Social Science [?] Medicine 09/2011; 73(9):1371-7. DOI:10.1016/j.socscimed.2011.07.036
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    ABSTRACT: The growing evidence suggests that physiological mobilisation techniques influence the passive properties of the muscle-tendon unit (MTU). Techniques that combine a transverse directed force to the physiological technique attempt greater influence on biomechanical properties. No research has investigated the biomechanical effects of a technique with addition of a transverse directed force. This pilot study aimed to explore preliminary data of effectiveness of two techniques on longitudinal load (extensibility and passive resistance) in the hamstring MTU. A counterbalanced quasi-experimental same subject design using fifteen healthy subjects compared two conditions: physiological technique and a technique with addition of a transverse directed force. Passive resistance (torque, Nm) and extensibility (knee extension range of movement) of the hamstring MTU were recorded during and following both conditions. Paired t tests explored within and across condition comparisons, with Bonferroni adjustment to account for multiple analyses. Passive resistance demonstrated a significant reduction for the technique with addition of a transverse directed force (t = 4.26, p < 0.05) that may have contributed to the significant increase in extensibility (t = 8.48, p < 0.05). The data suggest that longitudinal load through the hamstring MTU during a physiological mobilisation can be increased by the application of a transverse directed force. This merits further research.
    Manual therapy 11/2010; 16(2):161-6. DOI:10.1016/j.math.2010.10.001
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    ABSTRACT: To assess the clinical outcomes of types of exercise in the management of subacromial impingement syndrome. Systematic review of randomized controlled trials. Studies were identified from databases searched to May 2009: MEDLINE, EMBASE, CINAHL, Sports Discus, PEDro, AMED, Cochrane Library, National Research Register, Index Chiropractic Literature. Two reviewers selected studies meeting inclusion criteria. The methodological quality of the included studies was independently assessed by two reviewers using the PEDro quality assessment tool. Eight studies with sample sizes ranging from 14 to 125 were included in the systematic review and appraised for content. Four papers achieved a score of 6 or above indicating good quality, with the remaining four achieving 4 or lower, indicating poor quality. Synthesis showed only limited evidence to support the use of exercise in the treatment of subacromial impingement syndrome. There is a need for further well-defined clinical trials on specific exercise interventions for the treatment of shoulder dysfunction including subacromial impingement syndrome.
    Clinical Rehabilitation 02/2010; 24(2):99-109. DOI:10.1177/0269215509342336
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    Journal of Clinical Nursing 11/2009; 18(22):3210-2. DOI:10.1111/j.1365-2702.2009.02922.x
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    ABSTRACT: This paper is based upon research undertaken in the Birmingham City Archives in which the development of nurse training and education is traced from its beginnings in 1869 to the creation of a central school for the Teaching Hospitals in 1957. The results from this research are discussed in the context of national developments in training and as such developments in Birmingham can be seen as typical of many towns and cities in provincial England, during the period under study.
    International history of nursing journal: IHNJ 02/2003; 7(3):56-65.
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