Myths and Realities of Inter-professional Working

Introduction: Childhood cancers are rare and community based health care professionals have limited experience in caring for these children and often even less experience in providing their palliative care. It is well recognised that the provision of palliative care falls beyond the remit of any one profession, thus inter professional working is the standard model. This qualitative study aims to examine the experiences of the range of health care professionals involved in providing palliative care at home for children with cancer, focusing on how knowledge is exchanged; the level of communication and support both interprofessionally and at the community/specialist interface. It also aims to examine interprofessional collaboration in palliative care; identifying healthcare professional's perceptions of problems involved, interprofessional boundaries, specific areas of the organisation or provision of care that could be enhanced through changes in practice, support issues and the educational needs of health professionals. Methods The study involves three types of data collection; in-depth interviews, facilitated case discussion (FCD) and field notes from up to 20 cases (a "case" refers to the provision of palliative care to one child). Cases are selected from children who were treated at one regional childhood caner centre. For each case the community based health care professionals (for example the GP, community nurse or health visitor) involved in the care of the child at home are invited to participate in a one-to-one tape recorded in-depth interview followed by a group discussion in the form of a FCD. Field notes are completed following each interview. Data analysis follows a grounded theory approach. The term "social worlds theory" (SWT) his used to define a type of social organisation with no fixed or formal boundaries (such as membership boundaries), for example the range of health professionals that work together to provide palliative care. The boundaries of SW's are determined by the interaction and communication between recognised organisations, such as community nursing teams and general practitioners. SWT examines encounters between different professional groups and can be used to extend knowledge in both the organisation (for example general practice) and the content of what is being provisioned (for example, palliative care). The use of SWT in the analysis of the data is through examining the ethos of the different professions and the associated individual approaches to palliative care, exploring how this determines their roles in the provision of palliative care. Results 10 cases have so far been completed: 47 1:1 interviews (with a range of between 2-7 health care professionals being involved in each case): ( 9 x GP, 19 x CCN, 4 x DN, 3 x HV, 1 x HV assistant 7 x paediatric palliative care nurses, 1 x home support worker, 1 x OT, 1 x physiotherapist, 1 x community paediatrician) and 5 x FCD. The range of participants in the FCDs reflected that of the individual interview sampler. Data obtained to date gives clear insight into the personal experience of the individual health care professional in providing palliative care. Two themes emerging from the data will be focused upon: the continuity of care provision throughout treatment and palliation and the emotional burden experiences by the health care professional. Conclusions SWT can provide a useful framework in examining the social worlds of a disparate group of health care professionals working together for the first and maybe, the only time. A wide variation in the continuity of care provision has been found not only between professions, but also within professions. The emotional burden is evident across the professions.

'Producing the Scene': the Evolution of the Director in British Theatre 1900-50

The role of the director as the individual who harnesses and controls resources to shape the theatrical product to a personal artistic vision, begins to emerge in British theatre in the early years of the twentieth century. What distinguishes the role from that of the actor-manager who had led the profession since the seventeenth century, is that it separates off from the leading actor in performance. The power and authority of the director (or producer as he or she tended to be known initially) is exercised in the pre-performance stage. In the first half of the century there were still old-style actor-managers—Donald Wolfit is a prime example—and many of the new directors had begun their careers as actors and some continued to act their in their own productions. But the perception of the function of the director began to change radically. In part this was linked to the early attempts to create a new model of producing company or ‘repertory’ theatre which required a different set of administrative as well as artistic skills to tackle the challenge of a short-run system of multiple play production. This became especially important in the developing network of regional repertory theatres which were established as autonomous, locally-specific institutions predicated on policies opposed to the dominant commercial ethos. The best-known of the early directors, most notably H.Granville Barker, confined their radical experiments to short-lived metropolitan experiments, or, as in the case of Terence Gray and J.B.Fagan, operated within the influential Oxbridge nexus. Others such as H.K.Ayliff, Herbert Prentice, William Armstrong and William Bridges-Adams remain comparatively obscure because of their long-term ‘provincial’ connections or, as in the case of Nugent Monck and Edy Craig because their creativity was largely channelled through amateur actors. This chapter will explore the evolving role of the director as both a necessary functionary and an artistic innovator within the changing structures of British theatre.