Author: Alistair Ritch

Thesis Title: Sick, Aged And Infirm’ - Adults In The New Birmingham Workhouse, 1852 – 1912

Awarding Institution: University of Birmingham

Year of Completion: 2010

ABSTRACT

This study has explored the role of a large urban workhouse and its separate infirmary in Birmingham in the provision of indoor medical care for adult paupers between 1852 and 1912. Due to the difficulty in distinguishing between the medical and social care of older people, it has examined the provision for all older inmates. Birmingham guardians were forward thinking in appointing resident medical officers and paid nurses earlier than other unions, but retrograde by continuing to apply the workhouse test to sick patients longer than others. Workhouse medical officers in Birmingham worked long hours, provided care for many more patients than doctors in voluntary hospitals, and stayed in post for an average of four and a half years. Nevertheless, some strove to provide high standards of treatment. Patient narratives have been identified, showing that positive experiences of medical care did occur. Despite being the largest group of adult inmates, older people were relatively neglected compared with able-bodied inmates until the later part of the nineteenth century, when better standards of living were introduced. The development of the infirmary into an acute hospital created conflict between the two institutions and resulted in the workhouse’s role being limited to the care of patients with chronic conditions.

Author: Carolyn Wallace

Thesis Title: An Exploration of Health and Social Care Service Integration in a Deprived South Wales Area

Awarding Institution: Coventry University

Year of Completion: 2010

ABSTRACT

Frailty poses a complex challenge for some people through their experience of ageing. In Wales, devolution requires organisations to use a whole systems approach with a model of partnership to deliver public services. An integrated care approach is offered to meet the service user focus or ‘value demand’ which impacts on clinical, professional, organisational and policy levels within the system. Therefore, the aim of this study was to explore whether there was a difference between integrated health and social care day services and non-integrated health and social care day services. In doing so, answering the questions, how were these services different, what were the differences as perceived by the participants, why were they different, what could be learned from this study and how could health and social care services integrate in practice?

The study utilized Gadamer’s interpretative hermeneutics with a single intrinsic case study design. Using this approach ensured that the unique voice of the individual lived experience was heard and interpreted within the whole system of the study. The participants were service users, carers and staff in a day hospital, an outpatient clinic, day centre, reablement team and a joint day care facility. The methods included a survey questionnaire (SP12v2 and London Handicap Scale), in-depth interviews, observations, historical and service documents, and reflective diary. Data collection occurred January 2005 to December 2006. Quantitative and qualitative data were analysed separately. The qualitative data was analysed using Gadamer’s five stage approach developed by Fleming et al (2003) and NVivo 7.0. The embedded quantitative data was analysed using SPSS version 13.0. Triangulation was achieved through the use of a meta matrix which merged the qualitative and quantitative data.

The difference between integrated and non-integrated services is expressed through the four themes, ‘the study participants’, ‘commissioning and decommissioning integrated services’, ‘the journey within day services’, ‘navigating services and orchestrating care’. The four themes were developed through a strategy used for interpreting the findings, which was to follow the study questions, propositions and ‘emic’ questions. The differences between integrated and non-integrated services were in the meaning of their purpose, culture, level of integration, team orientation of practice and the model of service user/carer relationship observed within the services. The thesis identified challenges in respect of integrated working such as concept confusion, negative experiences of care for frail or older people, a vertical gap in knowledge transfer between strategic organisation, the operational services and service users. Mapping each service level of integration and team orientation to the model of service user and carer relationship, found that the level of team orientation and integration does not appear to be proportionate to the service user and carer relationship.

The thesis concludes that in order to attempt to answer the question as to whether these day centres can integrate in the practice, all levels of the system should focus on the service user/carer relationship. We need to understand service user diagnosis, how its characteristics and effect are interpreted by the service users, carer, professional and wider society in relation to independence and autonomy. It argues that knowledge emerges at this micro level (service user and carer relationship) and how we engage with this relationship and manage the knowledge we gain from it (both vertically and horizontally), will lead us to understand how we can ensure the integration occurs and that services in the future are person focussed.

Author: Meriel Norris

Thesis Title: Curing the blood and balancing life: Understanding, impact and health seeking behaviour following stroke in Central Aceh, Indonesia.

Awarding Institution: Brunel University

Year of Completion:2010

ABSTRACT

Previous studies have highlighted the importance of understanding the subjective illness experience. Stroke, as the second highest cause of death and highest cause of adult morbidity internationally, is no exception. However, the research to date has significant gaps. Lay understandings of stroke in low and middle income countries remain poorly understood, and very few studies have explored the links between experience and the context in which they occur. These gaps in knowledge have resulted in insufficient attention being paid to the relevance of local contexts in the implementation of international and regional recommendations for stroke.

The study presented in this thesis explores the experience of stroke in Central Aceh, Indonesia. It drew on phenomenology and ethnography and used a range of qualitative methods. People with stroke and their carers were involved in the examination of stroke understandings, its causation and mechanism, the impact of stroke on their lives, and actions taken to remediate the symptoms. This information was complemented with an in-depth study of healers, within the context of the health systems through which they operate. Further information on current social, religious and cultural practices was gathered through participant observation.

The study revealed that lay understandings occurred within a range of explanatory models. Also highlighted was the complex relationship between the understanding of the condition, the impact on the family, and the health seeking behaviour. All were influenced by the specific context and an attempt to regain a homeostatic balance in life; within the person, with others, and with the supernatural.

The results of this study demand critical interrogation of the international guidelines both for stroke and for policies to promote access to health personnel at the primary care level.

Author: Barbara Dieris

Thesis Title: Speech and Silence: Family Negotiations of Eldercare

Awarding Institution: University of Muenster

Year of Completion:2010

ABSTRACT

As political and social conditions only provide rough norms that family-members are expected to care for their elderly, families have to negotiate on their own how to arrange the care-giving concretely (i.e. who cares when and in which way). In my doctoral thesis, I researched on the familial interactive processes that channel care-decisions.

In order to reconstruct a model of these psychosocial processes I adopted a Grounded-Theory-Approach (Glaser/Strauss/Corbin). In an inter-disciplinary qualitative study, I analysed narratives of family members (i.e. interviews) as well as ‘fictional’ narrations (i.e. novels and plays). The fictional narrations were added due to the research-topic, which focused at least in part on implicit and/or delicate interactive processes that might be hard to refer to in an interview situation. Specific regard was also paid to subjective, self-reflective aspects of research.

The core-category of the model differentiates strategies of speech and silence that can be used by family members for and during care-negotiation. Further components of the model refer to protagonists, care-concepts, events/stages and (provisional) care-realities as preconditions and/or consequences of ‘speech and silence’. This modelling clearly sticks to the context of distinct narrative perspectives – due to the data sources and my research action. Therefore, I also tried to consider aspects of these narrative perspectives in the model.

The thesis is published in German. [Sprechen und Schweigen. Aushandlungsstrategien des ‘Sich Kuemmerns’ um alte Familienmitglieder. Verlag Dr. Kovac. Hamburg. 2009.]