Laura Serrant

Silence of a scream: application of the Silences Framework to provision of nurse-led interventions for ex-offenders:

The Silences Framework and its underpinning concept of ‘Screaming Silences’ was originally presented with the invitation for further peer review and utilisation in other contexts in order to test its usefulness and enable critique by a wider audience. This paper reports the use of the framework in a study researching nurse-led interventions for released ex-offenders. Screaming Silences were situated in how an issue, as experienced by ex-offenders, screams out to them in relation to their health and its impact on their reality while remaining silent in the consciousness of society and the application of practice. In addressing these Screaming Silences, we associated the Silences Framework within marginal discourses as they are less prioritised by policy and frequently positioned as far removed from what society considers as normal. Screaming Silences were situated in the subjective experiences of ex-offenders known as the ‘listener’ and the social and personal context in which these experiences occurred. We affirmed that the framework is ideally suited for researching issues which are under-researched, silent from policy discourse and excluded from practice, as it is oriented towards exploring individual experiences by valuing individual interpretations of events.

Speech and language therapists’ perspectives of therapeutic alliance construction and maintenance in aphasia rehabilitation post stroke.

Abstract Background Therapeutic alliance refers to the interactional and relational processes operating during therapeutic interventions. It has been shown to be a strong determinant of treatment efficacy in psychotherapy, and evidence is emerging from a range of healthcare and medical disciplines to suggest that the construct of therapeutic alliance may in fact be a variable component of treatment outcome, engagement and satisfaction. Although this construct appears to be highly relevant to aphasia rehabilitation, no research to date has attempted to explore this phenomenon and thus consider its potential utility as a mechanism for change. Aims To explore speech and language therapists’ perceptions and experiences of developing and maintaining therapeutic alliances in aphasia rehabilitation post‐stroke. Methods & Procedures Twenty‐two, in‐depth, semi‐structured interviews were conducted with speech and language therapists working with people with aphasia post‐stroke. Qualitative data were analysed using inductive thematic analysis. Outcomes & Results Analysis resulted in the emergence of three overarching themes: laying the groundwork; augmenting cohesion; and contextual shapers. Recognizing personhood, developing shared expectations of therapy and establishing therapeutic ownership were central to laying the groundwork for therapeutic delivery. Augmenting cohesion was perceived to be dependent on the therapists’ responsiveness and ability to resolve both conflict and resistance, as part of an ongoing active process. These processes were further moulded by contextual shapers such as the patients family, relational continuity and organizational drivers. Conclusions & Implications The findings suggest that therapists used multiple, complex, relational strategies to establish and manage alliances with people with aphasia, which were reliant on a fluid interplay of verbal and non‐verbal skills. The data highlight the need for further training to support therapists to forge purposive alliances. Training should develop: therapeutic reflexivity; inclusivity in goal setting, relational strategies; and motivational enhancement techniques. The conceptualization of therapeutic alliance, however, is only provisional. Further research is essential to elucidate the experiences and perceptions of alliance development for people with aphasia undergoing rehabilitation.

People with aphasia’s perception of the therapeutic alliance in aphasia rehabilitation post stroke: a thematic analysis

ABSTRACT Background: The therapeutic alliance has been found to be a critical component of treatment delivery in mental health interventions. This construct may have the potential to inform both treatment efficacy and adherence in aphasia rehabilitation. However, little is known about how people with aphasia perceive therapeutic alliance construction in the context of aphasia rehabilitation. Aims: This study aimed to investigate people with aphasias’ subjective experiences and reflections of constructing and maintaining therapeutic alliances in aphasia rehabilitation. Methods & procedures: In-depth interviews were conducted with eighteen people with aphasia who had received aphasia rehabilitation following a stroke. Interviews were subject to thematic analysis. Outcomes & results: Data analysis revealed five core themes: (1) readiness to contribute to the alliance; (2) proximity with the therapist; (3) perceived attunement with the therapist; (4) receiving information; and (5) collaborative engagement. The therapist’s perceived ability to read and respond effectively to individuals’ relational and situational needs contributed to the success of the alliance. Conclusions: These findings offer novel insights into current practice, highlighting considerable variation in alliance formation across the profession, with ineffectual alliances obstructing engagement and eroding hope and effective alliances promoting adherence and instilling hope. Further research is recommended to understand which aspects of the therapeutic alliance are essential for optimising therapeutic efficacy.

Advancing nursing practice : the emergence of the role of Advanced Practice Nurse in Saudi Arabia

BACKGROUND The roots of advanced practice nursing (APN) can be traced back to the 1890s, but the nurse practitioner (NP) emerged in Western countries during the 1960s in response to the unmet healthcare needs of populations in rural areas. These early NPs utilized the medical model of care to assess, diagnose and treat. Nursing has since grown as a profession, with its own unique and distinguishable, holistic, science-based knowledge, which is complementary within the multidisciplinary team. Today, APNs demonstrate nursing expertise in clinical practice, education, research and leadership, and are no longer perceived as “physician replacements” or assistants. Saudi Arabia has yet to define, legislate or regulate APN. AIMS This article aims to disseminate information from a Saudi APN thought leadership meeting, to chronicle the history of APN within Saudi Arabia, while identifying strategies for moving forward. CONCLUSION It is important to build an APN model based on Saudi healthcare culture and patient population needs, while recognizing global historical underpinnings. Ensuring that nursing continues to distinguish itself from other healthcare professions, while securing a seat at the multidisciplinary healthcare table will be instrumental in advancing the practice of nursing.

THE SILENCES FRAMEWORK: METODOLOGIA PARA PESQUISAS DE TEMAS SENSÍVEIS E PERSPECTIVAS MARGINALIZADAS NA SAÚDE

© 2017, Universidade Federal de Santa Catarina. All Rights Reserved. Objective: to describe the experience of applying of The Silences Framework to underpin health research investigating Tuberculosis/ HIV/AIDS coinfection. Method: the Silences Framework originally developed following a study exploring the decisions and silences surrounding black Caribbean men living in England, discussing the themes ‘sexual health’ and ‘ethnicity’. Following this study, a conceptual theory for research on sensitive issues and health care of marginalized populations was developed called ‘Screaming Silences’, which forms the foundation of The Silences Framework. ‘Screaming Silences’ define research areas and experiences that are poorly studied, little understood or silenced. Results: the Silences Framework supports researchers in revealing “silences” in the subjects they study - as such, results may reflect how beliefs, values, and experiences of some groups influence their health. This framework provides the application of four complementary stages: working the silences, hearing silences, voicing silences and working with the silences. The analysis occurs cyclically and can be repeated as long as the silences inherent in a study are not revealed. Conclusion: this article presents The Silences Framework and the application of the notion of “sounds of silence”, mapping an antiessentialist theoretical framework for its use in sensitive research in health and nursing areas, being a reference for other researchers in studies involving marginalized populations.

Screaming silences: lessons from the application of a new research framework

BACKGROUND The Silences Framework ( Serrant-Green 2011 ) originated from research exploring ethnicity, gender and sexual health decision-making, and provides a useful tool for researching underrepresented groups and topics. AIM To present the lessons learned from the application of the Silences Framework in the context of a qualitative study exploring the experiences of people under the age of 60 recovering from a fragility hip fracture. DISCUSSION The authors explore current conceptions of marginalisation in healthcare with reference to nursing research and provide practical tips for others interested in applying and further testing the framework. CONCLUSION The framework is likely to be attractive to nurses as it is underpinned by core nursing values, such as advocacy-based action. It places participant and public voices at the centre of the research and resembles the familiar nursing process. The structure and flexibility it offers also makes it relevant for new and experienced researchers in a variety of contexts. IMPLICATIONS FOR PRACTICE Critical analysis of the initial application of the Silences Framework in a different setting to the one in which it was developed indicates it offers a beneficial addition to the research toolkit. Its limited use to date means its relevance for nursing and potential for further development have not yet been fully established. It should be tested more widely and in other contexts.

Challenges and opportunities for ex-offender support through community nursing

This study was a qualitative case study underpinned by “The Silences Framework” aimed at mapping the ex-offender health pathway towards identifying “touch points” in the community for the delivery of a nurse-led intervention. Participants meeting the study inclusion criteria were quantitatively ranked based on poor health. Participants scoring the lowest and endorsing their ranking through a confirmation of a health condition were selected as cases and interviewed over 6 months. Individuals in the professional networks of offenders contextualized emergent themes. The study indicated that pre-release, offenders were not prepared in prison for the continuity in access to healthcare in the community. On release, reintegration preparation did not routinely enquire whether offenders were still registered with a general practitioner or had the agency to register self in the community. Participants identified the site of post-release supervision as the “touch point” where a nurse-led intervention could be delivered.

Which aspects of the therapeutic alliance are valued by people with aphasia in speech and language therapy? A Q-methodology study

Background: The therapeutic alliance refers to the interactional and relational processes at play during therapeutic interventions (Green, 2006). In psychotherapy, the therapeutic alliance has been...

THE SILENCES FRAMEWORK: METHOD FOR RESEARCH OF SENSITIVE THEMES AND MARGINALIZED HEALTH PERSPECTIVES

© 2017, Universidade Federal de Santa Catarina. All Rights Reserved. Objective: to describe the experience of applying of The Silences Framework to underpin health research investigating Tuberculosis/ HIV/AIDS coinfection. Method: the Silences Framework originally developed following a study exploring the decisions and silences surrounding black Caribbean men living in England, discussing the themes ‘sexual health’ and ‘ethnicity’. Following this study, a conceptual theory for research on sensitive issues and health care of marginalized populations was developed called ‘Screaming Silences’, which forms the foundation of The Silences Framework. ‘Screaming Silences’ define research areas and experiences that are poorly studied, little understood or silenced. Results: the Silences Framework supports researchers in revealing “silences” in the subjects they study - as such, results may reflect how beliefs, values, and experiences of some groups influence their health. This framework provides the application of four complementary stages: working the silences, hearing silences, voicing silences and working with the silences. The analysis occurs cyclically and can be repeated as long as the silences inherent in a study are not revealed. Conclusion: this article presents The Silences Framework and the application of the notion of “sounds of silence”, mapping an antiessentialist theoretical framework for its use in sensitive research in health and nursing areas, being a reference for other researchers in studies involving marginalized populations.

The Silences Framework: A Method for researching sensitive themes and marginalized health perspectives (English version)

© 2017, Universidade Federal de Santa Catarina. All Rights Reserved. Objective: to describe the experience of applying of The Silences Framework to underpin health research investigating Tuberculosis/ HIV/AIDS coinfection. Method: the Silences Framework originally developed following a study exploring the decisions and silences surrounding black Caribbean men living in England, discussing the themes ‘sexual health’ and ‘ethnicity’. Following this study, a conceptual theory for research on sensitive issues and health care of marginalized populations was developed called ‘Screaming Silences’, which forms the foundation of The Silences Framework. ‘Screaming Silences’ define research areas and experiences that are poorly studied, little understood or silenced. Results: the Silences Framework supports researchers in revealing “silences” in the subjects they study - as such, results may reflect how beliefs, values, and experiences of some groups influence their health. This framework provides the application of four complementary stages: working the silences, hearing silences, voicing silences and working with the silences. The analysis occurs cyclically and can be repeated as long as the silences inherent in a study are not revealed. Conclusion: this article presents The Silences Framework and the application of the notion of “sounds of silence”, mapping an antiessentialist theoretical framework for its use in sensitive research in health and nursing areas, being a reference for other researchers in studies involving marginalized populations.