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ABSTRACT: Background Alleviating the economic and human impacts of falls and fear of falling are critical health and social care issues. Despite some proven effectiveness of a number of falls prevention intervention programmes, uptake remains low and attrition high. There is a need for greater understanding of social, cultural and individual, life course positioning of falling, actual or perceived. Objective To address the question: what is the evidence of the experience of having a fall across the life course? Method A qualitative evidence synthesis with key electronic databases searched from 1990-2011 using terms related to the experience of falls and falling. Selected papers presented data from the perspective of the person who had fallen. Synthesis included collaborative coding of ‘incidents’ related to falling, theoretical sampling of studies to challenge emerging theories, and constant comparison of categories to generate explanations. Results The initial focus was to access and assess the evidence for the experiences of a fall across the life course but the authors’ systematic search revealed that the vast majority of the published literature focuses on the experience of a fall in later life. Only 2 of the 16 studies included, provided perspectives of falling from a life stage other than that of older adults. However older adults’ perceptions of their falls experiences are likely to be influenced by lifelong attitudes and beliefs about falling and older age. Synthesis identified that a falls incident or fear of falling induces explicit or implicit ‘Fear’. Consequences are related to notions of ‘Control’ and ‘Social standing’. Recovery work involves ‘Adaptation’, ‘Implications’ ‘Social standing’ and ‘Control’. ‘Explanation’ is sought. Conclusions How and why people make sense of falling across the life course should have positive impacts on developing falls intervention programmes that people will want to engage with and adhere to.
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ABSTRACT: Action learning sets (ALS) are used widely for organisational and workforce development, including in nursing (Anderson and Thorpe, 2004; Pounder, 2009; Young et al., 2010). In the United Kingdom, a multi-faceted educational Pilot programme for new nurses and midwives was implemented to accelerate their clinical practice and leadership development (NHS Education Scotland, 2010). Action Learning Sets were provided for peer support and personal development. The Realistic Evaluation study reported in this paper explored issues of context, mechanism and outcome (Pawson and Tilley, 1997) influencing the action learning experiences of: programme participants (recently qualified nurses and midwives, from different practice settings); and programme supporters. A range of data were collected via: online questionnaires from 66 participants and 29 supporters; three focus groups, each comprising between eight and 10 programme participants; and one focus group with three action learning facilitators. The qualitative data pertaining to the ALS are presented in this paper. Thematic data analysis of context, mechanism and outcome configurations, generated five themes: creating and sustaining a collective learning environment; challenging constructively; collective support; the role of feedback; and effectiveness of ALS. Study outcomes suggest nursing and midwifery action learning should (a) be facilitated positively to improve participants' experience; (b) be renamed to avoid learning methodology confusion; and (c) be outcome focused to evidence impact on practice.
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