Paediatric 'care closer to home':stake-holder views and barriers to implementation

In this study we explore the views of NHS stakeholders on providing paediatric ‘care closer to home’ (CCTH), in community-based outpatient clinics delivered by consultants. Design: Semi-structured interviews and thematic framework analysis. Setting: UK specialist children's hospital and surrounding primary care trusts. Participants: 37 NHS stakeholders including healthcare professionals, managers, commissioners and executive team members. Results: Participants acknowledged that outreach clinics would involve a change in traditional ways of working and that the physical setting of the clinic would influence aspects of professional practice. Different models of CCTH were discussed, as were alternatives for improving access to specialist care. Participants supported CCTH as a good principle for paediatric outpatient services; however the challenges of setting up and maintaining community clinics meant they questioned how far it could be achieved in practice. Conclusions: The place of service delivery is both an issue of physical location and professional identity. Policy initiatives which ignore assumptions about place, power and identity are likely to meet with limited success.

A qualitative study of English community pharmacists’ experiences of providing lifestyle advice to patients with cardiovascular disease

Background - Cardiovascular disease (CVD) progression is modifiable through lifestyle behaviors. Community pharmacists are ideally placed to facilitate self-management of cardiovascular health however research shows varied pharmacist engagement in providing lifestyle advice. Objective - This study explored community pharmacists' experiences and perceptions of providing lifestyle advice to patients with CVD. Methods - Semi-structured interviews were conducted with fifteen pharmacists (1 supermarket; 7 multiple; 7 independent) recruited through multiple methods from community pharmacies across the Midlands, England. A thematic analysis was conducted using a Framework approach. Results - Pharmacists categorized patients according to their perceptions of the patients' ability to benefit from advice. Many barriers to providing lifestyle advice were identified. Confidence to provide lifestyle advice varied, with pharmacists most comfortable providing lifestyle advice in conjunction with conversations about medicines. Some pharmacists felt lifestyle advice was an integral part of their role whilst others questioned whether pharmacists should give lifestyle advice at all, particularly when receiving no remuneration for doing so. Conclusion - Pharmacists viewed providing lifestyle advice as important but identified many barriers to doing so. Lifestyle advice provision was influenced by pharmacists' perceptions of patients. Professional identity and associated role conflict appeared to underpin many of the barriers to pharmacists providing lifestyle advice. Pharmacists may benefit from enhanced training to: increase their confidence to provide lifestyle advice; integrate lifestyle advice with regular pharmaceutical practice and challenge their perceptions of some patients' receptiveness to lifestyle advice and behavior change. Changes to the way UK pharmacists are remunerated may increase the provision of lifestyle advice.

Undergraduate peer mentoring:an investigation into processes, activities and outcomes

Peer mentoring of undergraduates is increasingly being used in higher education to reduce first year attrition by aiding transition to university. The authors propose that peer mentoring may also be a means of transmitting the values and ethics which reflect academic and personal integrity and underpin graduate and professional identity. In a qualitative study, they examined students' expectations and subsequent experience of a psychology undergraduate pilot mentoring scheme, together with the process and content. Mentors and mentees felt that mentors had a unique part to play in aiding transition to university. Mentors' advice reflected implicit academic values rather than strategic short cuts and mentoring cued reflection on their own development. The implications for encouraging student participation in mentoring schemes are discussed.

Professional football in apartheid South Africa:leisure, consumption and identity in the national football league, 1959-1977

A growing body of academic and popular literature considers the history of South African football. These and existing publications pay little or no attention to the emergence of white professional football in apartheid South Africa. The National Football League (NFL) challenged the amateur game and introduced professional football to the country. During its 17-year existence, the NFL grew each season with large attendances until its demise in 1977. In addition, the NFL imported a range of international players, invited foreign teams and actively engaged in the political debates in South African sport at the time. The NFL was instrumental in popularising the game across the country for all South Africans. The NFL became the most popular sports entertainment of choice for South Africans during this period. Finally, the NFL actively engaged in a campaign of destroying rival non-racial anti-apartheid leagues while simultaneously co-opting less progressive organisations. © 2013 Taylor and Francis.

The construction and negotiation of identity and face in post observation feedback

Identity influences the practice of English language teachers and supervisors, their professional development and their ability to incorporate innovation and change. Talk during post observation feedback meetings provides participants with opportunities to articulate, construct, verify, contest and negotiate identities, processes which often engender issues of face. This study examines the construction and negotiation of identity and face in post observation feedback meetings between in-service English language teachers and supervisors at a tertiary institution in the United Arab Emirates. Within a linguistic ethnography framework, this study combined linguistic microanalysis of audio recorded feedback meetings with ethnographic data gathered from participant researcher knowledge, pre-analysis interviews and post-analysis participant interpretation interviews. Through a detailed, empirical description of situated ‘real life’ institutional talk, this study shows that supervisors construct identities involving authority, power, expertise, knowledge and experience while teachers index identities involving experience, knowledge and reflection. As well as these positive valued identities, other negative, disvalued identities are constructed. Identities are shown to be discursively claimed, verified, contested and negotiated through linguistic actions. This study also shows a link between identity and face. Analysis demonstrates that identity claims verified by an interactional partner can lead to face maintenance or support. However, a contested identity claim can lead to face threat which is usually managed by facework. Face, like identity, is found to be interactionally achieved and endogenous to situated discourse. Teachers and supervisors frequently risk face threat to protect their own identities, to contest their interactional partner’s identities or to achieve the feedback meeting goal i.e. improved teaching. Both identity and face are found to be consequential to feedback talk and therefore influence teacher development, teacher/supervisor relationships and the acceptance of feedback. Analysis highlights the evaluative and conforming nature of feedback in this context which may be hindering opportunities for teacher development.