Rationale for the study Sample Clauses

Rationale for the study. Experiencing physical or sexual abuse during childhood is a major stressor and a risk factor for psychosis; however, the reason why some individuals who are exposed to this abuse develop psychosis while others exposed to the same abuse do not is still unclear (▇▇▇▇▇▇ ▇ ▇▇▇▇▇▇▇▇, 2015). Evidence from the general population shows that exposure to childhood abuse affects the functioning of the endocrine and central nervous systems with long-lasting consequences (▇▇▇▇▇▇▇▇ 2004; ▇▇▇▇▇▇ et al. 2009). In particular, these experiences have been linked with alterations the HPA axis and its reactivity, and abnormalities of brain structure resulting in aberrant neuroendocrine and behavioural responses (▇▇▇▇▇▇▇ et al. 2006; ▇▇▇▇ et al. 2010). Furthermore, physical or sexual abuse has the most severe consequences in term of physical and mental health with its effects minimally influenced by the co-occurrence of other minor types of abuse and by the co-occurrence of other socio-economic factors (▇▇▇▇▇▇ et al., 2010). Nonetheless, the impact of trauma on HPA axis activity and brain structure mimics and sometimes overlaps with the biological abnormalities present in individuals with psychotic disorders, the pathway that leads from childhood abuse to the onset of psychosis has still not been defined. 1.6.1 This thesis The aim of this project is to delineate the biological mechanisms through which physical and sexual abuse increase the risk of psychosis. The objectives are to investigate the presence of a pattern of abnormalities in brain structure and in the activity of the Hypothalamic Pituitary Adrenal HPA axis in people at their first episode of psychosis and healthy controls, with and without a personal history of childhood abuse. In particular, I use structural MRI (sMRI) to evaluate structural differences in the brain and salivary cortisol levels at multiple time-points during the day as measures of HPA axis activity, between those who were exposed to childhood abuse and those who were not. Neuroimaging and biological findings are then integrated to define a biological process that may contribute to the onset of psychosis in subjects who suffered childhood physical or sexual abuse. Having a sample that includes healthy individuals with and without history of physical and sexual abuse provides an unparalleled opportunity to understand the mechanisms through which abuse may exert its influence; indeed, studying people exposed to severe childhood adversities but who do ...

Rationale for the study. Compassionate care is a national priority in the NHS and there are exhortations for this to be implemented in the clinical settings (DOH, 2008; DOH, 2012a, DOH, 2013, ▇▇▇▇▇▇▇, 2013). However, most of the literature on compassionate care is anecdotal and the limited number of existing studies are mostly conducted in acute care settings (▇▇▇▇▇▇ and ▇▇▇▇▇▇▇, 2004; ▇▇▇▇▇▇▇▇, 2006; ▇▇▇▇▇ and ▇▇▇▇▇▇, 2010; ▇▇▇▇▇, 2009; ▇▇▇▇, 2011; ▇▇▇▇, 2011; ▇▇▇ ▇▇▇ ▇▇▇▇▇▇, 2011). There is a paucity of research on compassionate care in acute mental health care settings and existing studies in mental health care have explored compassionate care from the perspectives of staff and students and have not included service users and carers. Additionally, a number of the service users in acute mental health care settings are involuntary and have not consented to admission and treatment (▇▇▇▇▇▇▇▇▇ et al, 2015; ▇▇▇▇▇ et al, 2015), therefore it was believed that the delivery of compassionate care within acute mental health care settings could be different from acute care settings. Furthermore, the level of challenges encountered by staff working in acute mental health care settings such as high levels of aggression due to the severe and enduring nature of service users’ mental health conditions are different to the challenges that staff experience in acute care settings and could impact on the delivery of compassionate care (▇▇▇▇▇▇▇▇▇ et al, 2015; ▇▇▇▇▇ et al, 2015). Despite the severity of service users’ conditions and associated aggression towards staff, there is an expectation that staff have a duty of care to deliver compassionate care to service users, particularly if compassionate care is a national priority in the NHS and one of the fundamental values of the vision and strategy for nursing and midwifery underpinning the practice of nurses, midwives and care workers across the NHS, Public Health and Social Care (DOH, 2008; DOH, 2012a, DOH, 2013, ▇▇▇▇▇▇▇, 2013). If service users in acute mental health care settings are to be shown compassion and nurses and healthcare assistants are to deliver compassionate care, then it is vital to examine what the concept means in acute mental health care settings to enable its delivery. It was against this backdrop that the study was conducted. The delivery of compassionate care includes both the recipient and provider of care. Therefore, in order to gain an understanding of the meaning of compassionate care in acute mental health care settings, it...

Rationale for the study g., importance for the conduct of the research study, what gaps in the literature will you address.