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Anxiety after birth: an existential phenomenological enquiry into mothers’ lived experiences
Get PDFThe concept of anxiety after birth has attracted increasing interest from perinatal researchers in recent years, however there are no studies which examine the phenomenon from an existential phenomenological standpoint. The aim of this study therefore was to explore women’s lived experiences of maternal anxiety from a new perspective. Eight mothers were interviewed to obtain detailed experiential accounts which were analysed using Van Manen’s hermeneutic phenomenological approach. Three emergent themes were identified: 1. Being taken over; 2. Being with uncertainty; 3. Being with others. These themes illustrate the ontological nature of maternal anxiety in it’s embodied, ambiguous and interpersonal dimensions. Existential insights into the relational, transitional, and temporal nature of postnatal anxiety are presented. The discussion recognises key implications for therapeutic practice, noting that therapy can play a vital role in assisting mothers to explore their maternal identity, choices, uncertainties and anxious feelings. The study reveals that in addition to the considerable distress that anxiety after birth can bring, it also serves a protective function when understood from an existential context. By listening to the testimonies of mothers we can offer alternatives to a medicalised view of anxiety and shine light on what it is through how it is experienced
Strength and power assessment in rehabilitation: profiling the athlete’s return to sport journey following ACL reconstruction
Get PDFResidual deficits in athletic performance are common despite rehabilitation guidelines following anterior cruciate ligament (ACL) reconstruction including criterion-based progressions to protect healing structures, ensure safe restoration of fundamental physical capacities, and guide appropriate return to sports (RTS) activities. The aim of the proposed research was to examine strength and power in the rehabilitation pathway of soccer players following ACL reconstruction. This enabled us to explore interrelationships between physical capacities, movement strategies, and subsequent injury risk. These data were also compared with pre-injury values and matched controls to more fully examine the overall level of physical preparedness following ACL reconstruction, and to examine the validity of alternative approaches to determine RTS status such as composite physical capacity profiling. To address our aims, a systematic review was completed to examine the physical ability of athletic populations in the later stages of rehabilitation in comparison to healthy controls. The results showed deficits in knee peak extension and flexion in adult males at more than 6 months post ACL reconstruction, which were influenced by graft type, and can be mitigated by targeted rehabilitation programs. Insufficient evidence was available to examine rate of force development and reactive strength. The relationships between fundamental physical capacities and biomechanical variables during dynamic movement tasks were then explored through a narrative review using a structured search criteria. Quadriceps strength and rate of torque development explained a moderate portion of the variance in aberrant kinetic and kinematic strategies commonly detected in ACL reconstructed cohorts in the later stages of rehabilitation, prior to RTS. Increasing our understanding of these inter-connected aspects is required to improve rehabilitation outcomes and to reduce the risk of secondary injury following RTS. The findings from our comprehensive review of the available literature led us to explore the recovery pattern of strength and power qualities during rehabilitation and at the time of RTS relative to pre-injury baseline data and those of healthy matched controls. We also examined the effect of these physical qualities has on performance and task execution during tasks which may be associated with subsequent re-injury risk. In addition to the systematic review, three experimental studies were designed each with specific aims.
The aim of study 1 was to examine changes in strength and power characteristics at the time of RTS relative to pre-injury baseline data and healthy matched controls. The main finding was that strength and power in professional soccer players at RTS following ACL reconstruction were often reduced compared to preinjury values and controls. Compared to pre-injury, ACL normalised quadriceps peak torque of the involved limb, SLCMJ height and Reactive Strength Index modified (RSImod) were reduced following ACL reconstruction, even after the completion of rehabilitation. No significant reductions in bilateral CMJ height, RSImod and relative peak power were indicated at RTS in the ACL group when compared to pre-injury values, but deficits were present relative to controls. The uninvolved limb significantly improved quadriceps and hamstring strength from pre-injury to RTS. No significant differences from baseline were shown in SLCMJ height, power and reactive strength of the uninvolved limb following ACL reconstruction.
In study 2 we investigated if greater physical capacity results in different SLDJ mechanics in adult male soccer players following ACL reconstruction. Moderate to large significant differences between the ACL reconstructed and uninjured limb in SLDJ performance (d = 0.92 – 1.05), kinetic (d = 0.62 – 0.71) and kinematic variables (d = 0.56) were evident. Stronger athletes jumped higher (p = 0.002; d = 0.85), produced greater concentric (p = 0.001; d = 0.85) and eccentric power (p = 0.002; d = 0.84). Similar findings were present for RSI, but the effects were larger (d = 1.52 – 3.84). Weaker players, and those who had lower RSI, displayed landing mechanics indicative of a “stiff” knee movement strategy and this may be indicative of heightened injury risk.
The final experiment chapter (study 3) examined the utility of the Total Score of Athleticism (TSA), a composite score including strength, power, and reactive strength assessments to aid RTS decision making, moving beyond the current practice of limb symmetry thresholds and their inherent limitations. A large difference was evident between ACL reconstructed and uninjured players in TSA score (d = 0.84). For every additional increase of one unit in the TSA, the odds of belonging to the ACL reconstructed group decreased by 74% (95%CI 0.19, 0.56). A case series also showed there was a higher frequency of low TSA scores in players who sustained a second injury following RTS. These preliminary findings indicate the TSA may be a useful RTS readiness tool and can be used to set benchmarks, and rehabilitation goals for restoration of physical performance.
This thesis provides an original and significant contribution to the existing research. The cumulative findings suggest that: i) strength, power and reactive strength are reduced in elite male professional soccer players at the later stages of rehabilitation and at the time of RTS; ii) these have detrimental effects on kinetic and kinematic variables in dynamic tasks, with weaker players who also have a lower RSI displaying aberrant strategies commonly associated with increased re-injury risk; iii) when assessing recovery of physical capacities, clinicians and coaches should consider both absolute scores on each limb and not just symmetry values. In situations where baseline pre-injury data are not available, comparisons to uninjured matched controls should be made to ensure minimum standards are met; and iv) a TSA can be used to aid RTS decision making due to its ability to differentiate between injured and un-injured athletes, and preliminary evidence suggesting TSA scores are likely to be lower in players who sustain a re-injury after RTS. Further research could prospectively monitor rebounding tasks (e.g., SLDJ) performance and biomechanics, with the implementation of wearable technology (e.g. IMU system) and include these data along with the existing tests which comprised the TSA in the current thesis. Also, a broader range of physical capacities (e.g. aerobic fitness, speed, change of direction, etc.) could be added to our TSA to ensure the all relevant physical performance characteristics are assessed. Using this broader test battery and subsequent TSA composite profile, prospective analysis of secondary injuries following return to sport is warranted to more clearly elucidate its ability to identify associations with re-injury risk
Counselling Psychologists’ experience of working with religious clients, what has helped and/or hindered their work, and what might benefit it: an exploration in the context of the historical relationship between religious faith and psychotherapy
Get PDFThe experiences of Counselling Psychologists when working with religious clients, in the historical context of the relationship between psychotherapy and religious faith, were explored using Narrative Inquiry as the research methodology. The participants were nine qualified and practicing Counselling Psychologists of different ages and genders, from different cultural backgrounds, holding a range of different positions on religious faith, with one being a committed Christian, one loosely a non-conformist Christian, one a traditional Muslim, one belonging to a philosophical branch of Islam, one not religious but currently reflecting on religious faith, two agnostic, one spiritual but not religious, and one not religious but a Humanist; they were trained in five different training institutions in the South-East of England, qualifying between 2004 and 2021.
The findings established what had helped and/or hindered the participants’ work with religious clients, and what might benefit it, as well gained some insight into their perception of the similarities and differences between religious faith and spirituality, and the relationship between religious faith and mental health. Whilst the Counselling Psychologists worked well with religious clients, helped by their integrative approach to counselling and psychotherapy, together with their own life experiences, and studies, and in a few cases, religious faith Chaplains, they were hindered primarily by a lack of specific training in working with religious clients. They considered the work of Counselling Psychologists would benefit by the inclusion of a mandatory core module in initial training, as well as CPD activities, that covered working with this client group, and was taught by believing religious lecturers.
This research was limited to Counselling Psychologists and further similar research needs to be carried out with different groups of professionals working in the psychotherapeutic communities. It would also be beneficial for research to be carried out within the different faith traditions to gain their perspective
Peer mentors as a transitional and emerging position in alcohol and drug services
Get PDFBackground and rationale: The thesis explores the role of peer mentors (PMs) and how it is perceived and shaped by PMs themselves and the people they work with in alcohol and drug services in London. The literature review, carried out as part of this thesis, found critical gaps in the published literature, particularly regarding the lack of relevant studies in the United Kingdom. This thesis contributes to understanding how individuals define and carry out the PM role, the transitional nature of the role, and the pathways PMs have taken. It explores how concepts of identity, liminality, and organisational socialisation are useful in describing the pathway from a service user to PM.
Methodology and Methods: The thesis employed a qualitative interpretivist methodological approach to gain a deeper and more nuanced understanding of the participants’ experiences of either working as PMs or as service providers and managers in the organisation in which PMs’ positions exist. The sample was a convenience one, recruiting those with lived experiences of alcohol dependency and staff working in alcohol and drug services. The data collection method primarily consisted of semi-structured interviews, participant observations, and data from a service mapping exercise. Thematic analysis was used to analyse the data collected, to code, and identify emergent themes. The theoretical framework drew on social-ecological framework theory, combined with Schlossberg’s transitional theory in examining the PM pathway, and concepts of self, identity, organisational socialisation, and liminality to understand the changes individuals underwent in transitioning from a service user to a PM.
Findings: This study showed that the role of PMs was regarded as valuable both for the individuals concerned and for the organisations they worked for. The role was defined by two common denominators: possessing lived experiences and maintaining abstinence; however, it was a role which lacked clear definition, and which varied between organisations. There are several pathways service users may take into and through the PM role, each with the potential to positively enhance or hinder individual progression. The PM role can be seen as a ‘transitional’ pathway when individuals are adjusting to new roles and opportunities. Given the transitional nature of the PM role, individuals can experience a liminal state which can impact (positively or negatively) on their personal and social identity and their future pathways depending on the socialisation processes offered by their host organisation.
Conclusions: This thesis contributes to new knowledge by offering insights into the benefits and potential risks associated with the role of PMs in alcohol and drug services. PM's positions are not only valued by the alcohol and drug services, but it aids their recovery journey, leading to positive self-identities and social integration within broader societal and organisational settings. This research identifies specific recommendations for further exploration, including the transitional nature of the PM role, the integration of these individuals into the organisation, the role of organisational socialisation in this process, and the development and implementation of a competency framework for the PM role
Spatio-temporal modelling of breast cancer incidence between 2000 and 2021 at sub-national levels in Iran: Bayesian disease mapping
Get PDFWhile in Iran trends in breast cancer incidence are generally monitored at the national level, little is known about sub-national variation in these trends. This project aims to assess levels and trends (2000-2021) of relative risk of breast cancer incidence and mortality at sub-national levels in Iran and their relation to key socioeconomic dimensions, to understand the full extent of geographical and social inequalities in the country associated with breast cancer morbidity and mortality. Data from the national cancer registry system of the Iranian Ministry of Health have been used, which is gathered on cancer incidence at provincial and district levels by age and sex. Census and Household Expenditure and Income Survey (HEIS) datasets have been then used to extract related covariates. The relative risk of breast cancer incidence was estimated in women aged 30+ years for all 316 districts in Iran from 2000 to 2010 using a Bayesian spatio-temporal model. Then, I’ve propagated uncertainty from the spatio-temporal model into the prediction model for the years from 2011 to 2021. The national relative risk of breast cancer incidence in Iran increased from 0.21 (95% credible interval (CrI): 0.19, 0.22) in 2000 to 0.66 (0.63, 0.68) in 2010 and 1.23 (1.18, 1.28) in 2021. The relative risk of breast cancer incidence was highest in Yazd (1.96 [1.63, 2.33]), Shiraz (1.90 [1.72, 2.09]) and Shemiranat (1.90 [1.12, 2.91]) in 2010 and Tehran (3.99 [3.86, 4.33]), Bushehr (3.89 [3.07, 4.77]) and Abadan (3.67 [2.99, 4.39]) in 2021. In contrast, Savojbolagh, Saravan and Nikshahr were found to have the lowest relative risks in both 2010 (0.11 [0.05, 0.20], 0.17 [0.08, 0.30] and 0.20 [0.09, 0.36], respectively) and 2021 (0.19 [0.10, 0.33], 0.34 [0.18, 0.54] and 0.35 [0.17, 0.62], respectively). The relative risk of breast cancer incidence was 60% higher across districts in the highest YOS quintile (average years of schooling: 3.9) than those in the lowest YOS quintile (average years of schooling: 2.2; relative index of inequality: 1.6). Results show that the relative risk of breast cancer incidence has increased over time (2000-2021) at national and sub-national levels in Iran. Breast cancer is one of the few diseases with a positive education gradient, with higher relative risk of breast cancer incidence among higher- compared to lower-educated women, probably due to better awareness of diagnostic approaches and access to those. While social inequalities are a major barrier to reducing the prevalence and incidence of breast cancer, it is important to track the progress made at the district level based on the characteristics of specific policies aimed at reducing health inequalities. A scaling-up in the quality of healthcare services, national and sub-national policies addressing prevention and treatment, and more specialised training programs in women's health are needed
Therapists’ experiences of helplessness; an interpretative phenomenological exploration of the experiences of Egyptian cognitive behavioral practitioners
Get PDFCourtesy of their line of work, therapists are frequently brought face to face with the helplessness of clients as well as their own. The main aims of this research are:
• To explore therapists’ own definitions of helplessness.
• To explore therapists’ experiences of helplessness in their personal and professional lives.
• To explore how therapists experience any potential connection between the two sets of experiences.
Interpretative Phenomenological analysis is used as the guiding methodology. 8 participants were recruited and interviewed. The interviewees were Egyptian, cognitive behavioral practitioners. The findings indicate that helplessness is experienced when participants encounter inability, uncertainty, and self-doubt/incompetence in both their personal and professional lives. The participants also evidenced helplessness in reaction to certain emotional experiences, including grief and anxiety and employed distinct strategies in response to helplessness. Amongst these strategies, are giving-up, dissociation, pursuing further knowledge, doing, and planning. 7 domains of connection between personal and professional helplessness were identified. These areas of connection could be framed as follows:
1. Relationship with helplessness
2. Tools and techniques
3. Current helplessness
4. Similar instances
5. Similar strategies
6. Choice of profession
7. Empathy
These findings have important implications that could help inform our understanding of therapists’ helplessness, as well as guide therapist training efforts
Corporate Governance für KMU – Eine empirische Analyse und Konzeptualisierung für den Schweizer Markt
Get PDFAlthough corporate governance (CG) is relevant to small and medium-sized enterprises (SMEs) as well, little is known about the application of CG principles in SMEs.
This work analyses the implementation of CG in Swiss SMEs and contrasts it with theoretical principles in order to identify potential for improvement and to derive a conceptual framework for effective implementation and handling of CG.
To cover the topic of CG holistically and gain a new and clear perspective on its complexities, the theoretical basics were divided into three dimensions: structural, content-related and prescriptive. All essential CG elements were introduced and discussed from the perspective of effectiveness.
For expert interviews, an interview guideline was derived from these basics to realistically capture the implementation status in a wide range of SMEs. A two-stage sampling process with predefined criteria and a theoretical sampling phase was implemented to obtain a comprehensive picture of the existing heterogeneity of SMEs.
Content-structuring qualitative content analysis was then conducted on the data by using a deductively derived and inductively supplemented category system.
To identify characteristic features of the implementation of these CG systems, both different subgroups of SMEs were analysed, and a typology was developed. This analysis led to the conclusion that the design of the CG structures in the companies investigated could be divided into three types: 'CG specialists', 'CG optimizers' and 'CG beginners'. The implementation of CG in these companies was influenced by the following factors: 'interest', 'knowledge' and 'external influences'.
As a result, a conceptual framework could be developed by considering potential for improvement in the general meetings of shareholders, staffing and development of the board of directors, internal control, risk management, and compliance.
For research, further insights could be gained both for SMEs and their handling of CG by being close to the object of investigation.
However, to be able to develop research tools and CG recommendations that are capable of meeting the needs of SMEs, the complexity of their characteristics must be addressed by a more differentiated structuring rather than solely via the number of employees
Nachhaltigkeit Im Alpinen Tourismus – Datengestützte Theoriebildung Für Die Praxis
Get PDFThis thesis deals with the possibilities of sustainable development in alpine tourism. The aim of the work is to develop concrete approaches for the practice of tourism professionals.
When searching through the literature, it was found that predominantly people unfamiliar with tourism deal with and evaluate aspects of sustainability in alpine tourism. On the part of tourism experts, the topic is treated inadequately, at least in the literature. In order to close this gap, the options for action on the part of the provider were therefore worked out in this work. As a result, the work is primarily aimed at everyone working in tourism.
This is achieved by the fact that the surveys have already been carried out with a corresponding focus. In order to achieve this, the actual situation on the market was first surveyed. Concrete examples of sustainable tourism from practice were also analysed. In addition to the relevant literature, legal regulations and statistics were analysed. Interviews were also carried out with decision makers and people directly connected to the tourist system. In addition to the employees and the guests, also indirectly affected profiteers and suffering people were interviewed in order to capture as many perspectives as possible. With the ground theory, a qualitative method was chosen with which the collected data was analysed, concepts created and reassembled in a new way.
It transpired that the topic of sustainability has been anchored directly and indirectly in many parts of alpine tourism for a long time. In addition to the core competence of a company, its partnerships and the willingness of the individual participants are of great importance for sustainable development. A major challenge in the tourism market is the difficult assessment of the sustainability of an offer. This fact makes a comparison difficult for both guests and tourism professionals. In this context, interesting and above all relevant findings were discovered, which are particularly relevant for the decision makers of tourism companies and which represent helpful approaches
Strategisches Management zweckbasierter Organisationen: Strategie und Umsetzung in öffentlichen und Nonprofit-Organisationen neu fokussiert
Get PDFThe current management literature assumes that nonprofit and public organizations can freely choose their fields of action in the strategy process. However, the practical reality looks different. In this thesis, the difference between scientific literature and practical experience was explored. In addition, it was investigated what the scientifically founded models and instruments of strategic management for nonprofits and public organizations in Switzerland must incorporate in order to yield a high benefit to practice.
A literature analysis showed that the legal framework for the strategic management of nonprofit and public organizations in countries with the common law legal system differs from those countries with a civil law legal system. In civil law countries, nonprofit and public organizations are based on a purpose that can hardly - if at all - be changed in the strategy process. Based on this insight, the new name Purpose-Based Organizations was developed for these organizations.
In order to be able to develop an optimal strategic management model with associated instruments for purpose-based organizations, qualitative interviews were conducted. On the one hand, the importance and application of strategic management was to be explored; on the other hand, the needs with regard to strategic management were to be assessed, as well. Furthermore, this qualitative survey was used to test a new methodological approach: In addition to the face-to-face interviews for data collection, qualitative data on the same topics were collected in writing via the Internet. No difference in the quality of the results between written and oral data collection could be established.
This empirical study showed that the theories and instruments of the scientific literature hardly play a role in practice. They are perceived as too complex and time-consuming. A model for the strategic management of purpose-based organizations must therefore be simple and easy to apply. Such a model of strategic management with associated instruments was subsequently developed. This work could not answer all open questions: There continues to be a great need for a simple instrument to a review both the impact and the success of the work of purpose-based organizations
Employer Branding - Konzeption einer lebensphasenorientierten Employer Value Proposition für öffentlich-rechtliche Kreditinstitute auf Basis einer empirischen Untersuchung ausgewählter Kreditinstitute
Get PDFThis thesis examines the extent to which employer branding measures are already being implemented in public credit institutions for a successful employer positioning. The necessity of creating a successful employer positioning due to the importance of labor market policy and employer strategic relevance of innovative personnel marketing concepts is derived from a critical review of the literature. Basically, companies have recognized the added value of employer branding and are implementing appropriate measures in practice. However, there are two different opinions about employer branding: For some it is "lip service", for others it is a valuable opportunity to ensure the quality and quantity of staff and to promote a positive image internally and a strong employer brand externally.
The focus is achieved by closing the gap in scientific knowledge with regard to a successful employer positioning of companies of public-law credit institutions in Germany and employees and employers experiencing a successful life phase-oriented employer value proposition. Based on a qualitative method, interviews are carried out on the basis of a small selection of companies. A multi-stage analysis is carried out for a holistic approach to the investigation: students and employees for the perspective of the market participants and HR managers for the perspective of the company.
In addition, life phases and generations, lifelong learning and leadership in the context of an employer brand are critically discussed within the scientific literature and included in the focus of the work.
The aim of the work is to model an innovative concept for employer positioning for recruiting and retaining employees. In doing so, phases of life and the specific values of the generations should be taken into account in working life. These components could occupy a relevant position in the employer positioning and will therefore determine a substantial part in the research work