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Papers by Iain Williamson

Journal of Advanced Nursing, 2016

Aim. To extend our understanding of how healthcare assistants construct and manage demanding situ... more Aim. To extend our understanding of how healthcare assistants construct and manage demanding situations in a secure mental health setting and to explore the effects on their health and wellbeing, in order to provide recommendations for enhanced support. Background. Contemporary literature acknowledges high rates of occupational stress and burnout among healthcare assistants, suggesting the context in which they work places them at elevated risk of physical harm and psychological distress. Yet, there is a deficit of qualitative research exploring the experiences of healthcare assistants in adolescent inpatient facilities. Design. An exploratory multi-method qualitative approach was used to collect data about the challenges faced by healthcare assistants working on secure adolescent mental health wards in an independent hospital during 2014. Method. Fifteen sets of data were collected. Ten participants completed diary entries and five participants were also interviewed allowing for triangulation. Data were analysed using Interpretive Phenomenological Analysis. Findings. The findings illustrated how inpatient mental health care is a unique and distinctive area of nursing, where disturbing behaviour is often normalised and detached from the outside world. Healthcare assistants often experienced tension between their personal moral code which orientate them towards empathy and support, and the emotional detachment and control expected by the organisation, contributing to burnout and moral distress. Conclusions. This study yielded insights into mental health nursing and specifically the phenomenon of moral distress. Given the ever-increasing demand for healthcare professionals, the effects of moral distress on both the lives of healthcare assistants and patient care, merits further study.-Due to the effect of moral distress on healthcare assistants and patient care, this phenomenon needs to be addressed more fully in terms of both research and intervention.

Although diary methods have a long tradition of use within psychology and appear to have consider... more Although diary methods have a long tradition of use within psychology and appear to have considerable potential in researching health-related processes and experiences, the use of unstructured diary methods to generate detailed phenomenological accounts within contemporary health psychology has thus far been limited. In this poster presentation, we describe a recently completed British study in which a sample of first-time mothers used voice-recording technology to make daily diary entries about their infant feeding experiences. We present a consideration of the benefits and challenges of this approach to data collection. In particular, we focus on ethical and epistemological issues, drawing on the accounts of both participants and members of the research team. We also explore the most suitable ways of analysing data derived from diaries and consider the practical advantages and limitations of using audio-diaries. Finally, some of the implications for developing the use of audio-dia...

Psychology & Health, 2013

Many women report difficulties with breastfeeding and do not maintain the practice for as long as... more Many women report difficulties with breastfeeding and do not maintain the practice for as long as intended. Although psychologists and other researchers have explored some of the difficulties they experience, fuller exploration of the relational contexts in which breastfeeding takes place is warranted to enable more in-depth analysis of the challenges these pose for breastfeeding women. The present paper is based on qualitative data collected from 22 first-time breastfeeding mothers through two phases of interviews and audio-diaries which explored how the participants experienced their relationships with significant others and the wider social context of breastfeeding in the first five weeks postpartum. Using a thematic analysis informed by symbolic interactionism, we develop the overarching theme of 'Practising socially sensitive lactation' which captures how participants felt the need to manage tensions between breastfeeding and their perceptions of the needs, expectations and comfort of others. We argue that breastfeeding remains a problematic social act, despite its agreed importance for child health. Whilst acknowledging the limitations of our sample and analytic approach, we suggest ways in which perinatal and public health interventions can take more effective account of the social challenges of breastfeeding in order to facilitate the health and psychological well-being of mothers and their infants.

Maternal & Child Nutrition, 2011

Breastfeeding is a practice which is promoted and scrutinized in the UK and internationally. In t... more Breastfeeding is a practice which is promoted and scrutinized in the UK and internationally. In this paper, we use interpretative phenomenological analysis to explore the experiences of eight British first-time mothers who struggled with breastfeeding in the early post-partum period. Participants kept audio-diary accounts of their infant feeding experiences across a 7-day period immediately following the birth of their infant and took part in related semi-structured interviews a few days after completion of the diary.The overarching theme identified was of a tension between the participants' lived, embodied experience of struggling to breastfeed and the cultural construction of breastfeeding as 'natural' and trouble-free. Participants reported particular difficulties interpreting the pain they experienced during feeds and their emerging maternal identities were threatened, often fluctuating considerably from feed to feed. We discuss some of the implications for breastfeeding promotion and argue for greater awareness and understanding of breastfeeding difficulties so that breastfeeding women are less likely to interpret these as a personal shortcoming in a manner which disempowers them. We also advocate the need to address proximal and distal influences around the breastfeeding dyad and, in particular, to consider the broader cultural context in the UK where breastfeeding is routinely promoted yet often constructed as a shameful act if performed in the public arena.

Maternal & Child Nutrition, 2013

There is now a body of research evaluating breastfeeding interventions and exploring mothers' and... more There is now a body of research evaluating breastfeeding interventions and exploring mothers' and health professionals' views on effective and ineffective breastfeeding support. However, this literature leaves relatively unexplored a number of questions about how breastfeeding women experience and make sense of their relationships with those trained to provide breastfeeding support. The present study collected qualitative data from 22 breastfeeding first-time mothers in the United Kingdom on their experiences of, and orientation towards, relationships with maternity care professionals and other breastfeeding advisors. The data were obtained from interviews and audio-diaries at two time points during the first 5 weeks post-partum. We discuss a key theme within the data of 'Making use of expertise' and three subthemes that capture the way in which the women's orientation towards those assumed to have breastfeeding expertise varied according to whether the women (1) adopted a position of consulting experts vs. one of deferring to feeding authorities; (2) experienced difficulty interpreting their own and their baby's bodies; and (3) experienced the expertise of health workers as empowering or disempowering. Although sometimes mothers felt empowered by aligning themselves with the scientific approach and 'normalising gaze' of health care professionals, at other times this gaze could be experienced as objectifying and diminishing. The merits and limitations of a person-centred approach to breastfeeding support are discussed in relation to using breastfeeding expertise in an empowering rather than disempowering way.

Journal of Advanced Nursing, 2012

Aim. This paper is a report of a descriptive study of early infant feeding experiences focusing o... more Aim. This paper is a report of a descriptive study of early infant feeding experiences focusing on accounts of women who expressed milk extensively in the first few weeks postpartum. Background. Relatively little is known about the reasons for expressing milk following healthy term births. Evidence indicates it is an increasingly common practice during early infant feeding in Westernised countries. A more comprehensive understanding of this practice will help midwives and nurses assist mothers negotiate early feeding challenges. Method. Audio-diary and semi-structured interview data from seven British women who extensively expressed milk in the first month postpartum were analysed. These data were drawn from a larger qualitative longitudinal study which took place in 2006-2007. Themes, discursive constructions and discourses are identified through the use of a feminist informed analysis. Findings. The practice of expressing was employed as a solution to managing the competing demands and dilemmas of early breastfeeding and ensuring the continued provision of breast milk thereby deflecting potential 2 accusations of poor mothering. In addition, the practice may afford a degree of freedom to new mothers. Conclusions. The need to maintain the 'good maternal body' can account for the motivation to express milk, although there may be reasons to be cautious about promoting expression as a solution to breastfeeding difficulties. Education for health professionals which emphasises the complexities and contradictions of mothering and which challenges prescriptive notions of 'good mothering' could better support new mothers in their feeding 'choices'.

Qualitative Research Journal, 2015

Purpose – Audio-diary methods are under-utilised in contemporary qualitative research. The purpos... more Purpose – Audio-diary methods are under-utilised in contemporary qualitative research. The purpose of this paper is to discuss participants and researchers’ experiences of using audio-diaries alongside semi-structured interviews to explore breastfeeding experiences in a short-term longitudinal study with 22 first-time mothers. Design/methodology/approach – The authors provide a qualitative content analysis of the participants’ feedback about their experiences of the audio-diary method and supplement this with the perspectives of the research team based on fieldwork notes, memos and team discussions. The authors pay particular attention to the ways in which the data attained from diaries compared with those from the interviews. Findings – The diaries produced were highly heterogeneous in terms of data length and quality. Participants’ experiences with the method were varied. Some found the process therapeutic and useful for reflecting upon the development of breastfeeding skills whil...

Journal of Health Psychology, 2020

This study examined mothers’ ( n = 9) mealtime experiences when caring for their son or daughter ... more This study examined mothers’ ( n = 9) mealtime experiences when caring for their son or daughter with anorexia nervosa through semi-structured interviews. Interpretative Phenomenological Analysis identified three themes: (1) managing mealtime combat through accommodation and acceptance; (2) feeling isolated, inauthentic and ill-equipped and (3) a need for understanding and to be understood. The overarching concepts of ‘combat’ and ‘distortion’ also underpin the analysis, uniquely outlining how mothers come to understand this daily situation. Mealtime-related interventions need to be developed which prioritise promoting skills and confidence in managing mealtimes and helping carers to address the emotional challenges of these occasions.

Social science & medicine (1982), 2009

Recent feminist analyses, particularly from those working within a poststructuralist framework, h... more Recent feminist analyses, particularly from those working within a poststructuralist framework, have highlighted a number of historically located and contradictory socio-cultural constructions and practices which women are faced with when negotiating infant feeding, especially breastfeeding, within contemporary western contexts. However, there has been little explicit analysis of the practice of expressing breast milk. The aim of this article is to explore the embodied practice of expressing breast milk. This is done by analysing, from a feminist poststructuralist perspective, discourse surrounding expressing breast milk in sixteen first time mothers' accounts of early infant feeding. Participants were recruited from a hospital in the South Midlands of England. The data are drawn from the first phase of a larger longitudinal study, during which mothers kept an audio diary about their breastfeeding experiences for seven days following discharge from hospital, and then took part i...

This study explored experiences and representations of breastfeeding reported by British Muslim w... more This study explored experiences and representations of breastfeeding reported by British Muslim women. Six mothers who breastfed their infants for at least 3 months were interviewed on two occasions, namely during the breastfeeding period and again once the provision of breast milk to the infant had ceased. Accounts were analysed using a social constructivist version of interpretative phenomenological analysis. Participants utilised interwoven constructions of breastfeeding which fused Islamic and biomedical understandings. Breastfeeding was simultaneously viewed as beneficial to the child's health and as a deeply spiritual act through which the mother's attributes as a 'good Muslim' nourished the child and promoted his or her moral development. Making reference to sacred texts such as the Qur'an and Hadith, the women believed that they would be rewarded for breastfeeding by Allah, and that some past sins would be forgiven. Helping breastfeeding mothers was viewed as a collective responsibility involving family and community members.