Using cognitive behaviour therapy to explore resilience in the life-stories of 16 UK centenarians.

AIM: In 2010, we interviewed 16 UK centenarians about their lives and later published a paper on the socio-emotional aspects of positive ageing. We were struck by their ability to 'move on' from difficult situations which we recognized conceptually as 'resilience'. In the effort to understand aspects of resilience as portrayed in their stories, we re-examined their data. METHODOLOGY: In the original study, we used participatory action research (PAR) for its storytelling and group process components. Here, we re-examine data from the centenarians' life stories using a cognitive behavioural therapy (CBT) lens. DESIGN: We focused on the notion of resilience in the centenarians' stories guided by CBT insights to analyse and develop psychosocial interpretations. RESULTS: Resilience comprised the ability to frame difficult life events in positive terms, accept what cannot be changed, manage worry and anxiety effectively, develop psychological flexibility in the face of change and continually seek opportunities for growth and development. We suggest that these resilient behaviours may have contributed to positive ageing.

Cutaneous Adverse Drug Reactions in Dogs Treated with Antiepileptic Drugs.

Epilepsy is one of the most common neurologic disorders in dogs and life-long treatment with antiepileptic drugs (AED) is frequently required. Adverse events of AED targeting the skin are only rarely reported in veterinary medicine and the true incidence and spectrum of cutaneous reactions in epileptic dogs remains unknown. In this study, we hypothesized that cutaneous reactions commonly occur in epileptic dogs and are related to AED treatment. A retrospective case review of 185 dogs treated for epilepsy identified 20.0% with simultaneous appearance of dermatologic signs. In a subsequent prospective case investigation (n = 137), we identified newly appearing or distinct worsening of skin lesions following initiation of AED therapy in 10.9% of dogs treated for epilepsy (95% CI 6.8-17.7%). Cutaneous lesions were classified as probably drug-induced in 40.0% of these cases. Patch testing and intradermal testing were further investigated as potential diagnostic methods to confirm AED hypersensitivity. They were of high specificity but sensitivity and positive predictive value appeared inappropriate to recommend their routine use in clinical practice.

Staphylococcus aureus proteins Sbi and Efb recruit human plasmin to degrade complement C3 and C3b.

Upon host infection, the human pathogenic microbe Staphylococcus aureus (S. aureus) immediately faces innate immune reactions such as the activated complement system. Here, a novel innate immune evasion strategy of S. aureus is described. The staphylococcal proteins surface immunoglobulin-binding protein (Sbi) and extracellular fibrinogen-binding protein (Efb) bind C3/C3b simultaneously with plasminogen. Bound plasminogen is converted by bacterial activator staphylokinase or by host-specific urokinase-type plasminogen activator to plasmin, which in turn leads to degradation of complement C3 and C3b. Efb and to a lesser extend Sbi enhance plasmin cleavage of C3/C3b, an effect which is explained by a conformational change in C3/C3b induced by Sbi and Efb. Furthermore, bound plasmin also degrades C3a, which exerts anaphylatoxic and antimicrobial activities. Thus, S. aureus Sbi and Efb comprise platforms to recruit plasmin(ogen) together with C3 and its activation product C3b for efficient degradation of these complement components in the local microbial environment and to protect S. aureus from host innate immune reactions.

What does it feel like to be 100? Socio-emotional aspects of well-being in the stories of 16 Centenarians living in the United Kingdom.

OBJECTIVES: The purpose of this article was to describe socio-emotional themes in the stories of 16 Centenarians living in the United Kingdom. METHODOLOGY: Sixteen Centenarians were recruited and interviewed face-to-face by members of the research team. Participants were invited to tell the story of their lives in line with the principles of participatory action research (Koch and Kralik, 2006). The resultant story was returned to the Centenarian and their significant others for their validation and ownership. Stories were further analysed alongside verbatim interview transcripts. The first author wrote her psycho-social interpretation of the socio-emotional content in each person s life. These psycho-social interpretations were combined to provide commonalities in experience. FINDINGS: These six common experiences or themes were: Engagement in the world, Happiness and describing a good life, Stoicism, Sources of support, Sources of frustration and Talking about death. All participants had strong interests. They reported their lives as having been 'good' or 'happy'. They were resilient in the face of stress. Their frustrations pertained to visual or mobility impairments. While they were accepting the death of spouses, siblings and significant others, they were silent about the proximity of their own. In this article, we consider these themes in the light of previous empirical findings and theories. CONCLUSION: Centenarians indicated that life had been worth living and that it felt good to be 100 years of age. We explore the limitations of this study and discuss implications of the findings for those involved with the oldest old.

Storytelling reveals the active, positive lives of centenarians.

AIM: To present alternative stories of ageing that countered the prevailing negative stereotypes of older people by interviewing centenarians about their lives. METHOD: Sixteen healthy U.K. centenarian volunteers were interviewed in their place of residence. A story draft was produced using the interview recording and verbatim transcript. The four researchers collaborated to generate a consensus storyline which was returned to the centenarian and their significant other for their corrections, additions, validation and consent to publish using their own names. FINDINGS: Centenarians elected to talk about living as independently as possible, their continuing growth and development and their ongoing close relationships. Difficulties and loss were considered to be 'part of life' indicated by comments such as: 'accept whatever life brings', 'just plod on', 'do what you can to make things better and then move on'. CONCLUSION: The centenarians present a positive picture of ageing, which counteracts negative stereotypes. Aspects of successful ageing relate to lifestyle and environment. Centenarians have felt 'personalised' through attention gained as part of the storytelling process, therefore older people may feel valued through listening and responding in this way.

The process of practice redesign in delirium care for hospitalised older people: a participatory action research study.

BACKGROUND: In 2007 three researchers completed a 6-month study in one 32-bed acute care medical ward in a large hospital in New South Wales, Australia. The problem drawn to the attention of researchers was that approximately 60% of older people were delirious on arrival or develop incident delirium during their hospital stay. Lack of recognition, underreporting and inadequate care responses to delirium in hospitalised older people signalled a major practice problem. AIM: To collaboratively explore ways in which clinical practice could be improved. METHOD: We selected Participatory Action Research (PAR) as the methodology to involve health practitioners in practice redesign. PAR is a process in which 'we', researchers and participants, systematically work together in cycles of 'looking, thinking and acting'. Delirium and the high percentage of older people who succumb to this condition was the main practice problem requiring a response. Eight volunteer clinicians and three researchers met weekly as a group for 13 sessions over 6 months. Clinicians set the agenda for redesign of practice. Raising awareness about delirium and its prevention were the selected action strategies. A delirium alert protocol was developed for implementation by the clinicians and later evaluation as a separate study. FINDINGS: There was evidence that practice had changed. Physical and chemical restraints had not been used for 3 months subsequent to the study's completion. The nurse manager reported that early detection strategies had prevented episodes of acute hyperactive delirium. Whilst there continued to be older people admitted with a diagnosis of delirium, there were fewer incidences of delirium developing on the ward and there was less disruption to other patients, especially at night. The strategy of raising the awareness of delirium in older people was successful. We are confident that working collaboratively with practitioners is the way to bring evidence to practice in delirium care for older people in acute care settings.

Delirium and older people: what are the constraints to best practice in acute care?

An Australian research team conducted a six-month acute care pilot study in a medical ward of a large hospital in New South Wales. Aim. To explore ways health practitioners might redesign their practice to include prevention, early detection and management of delirium in older people based on the best current practice. Method and design. Participatory action research (PAR) was selected as the best approach for involving ward staff to make sustainable clinical practice decisions. The PAR group comprised research academics and eight clinicians from the ward. Thirteen PAR sessions were held over 5 months. Clinicians described care of patients with delirium. Stories were analysed to identify constraints to best practice. Following PAR group debate about concerns and issues, there were actions toward improved practice taken by clinicians. Relevance to clinical practice. The following constraints to best practice were identified: delayed transfer of patients from the Emergency Department; routine ward activities were not conducive to provision of rest and sleep; assisting with the patient's orientation was not possible as relatives were not able to accompany and/or stay with the older patient. Underreporting of delirium and attributing confusion to dementia was viewed as an education deficit across disciplines. A wide range of assessment skills was identified as prerequisites for working in this acute care ward, with older people and delirium. Clinicians perceived that management driven by length of a patient's stay was incongruent with best practice delirium care which required more time for older patients to recover from delirium. Two significant actions towards practice improvement were undertaken by this PAR group: (i) development of a draft delirium alert prevention protocol and (ii) a separate section of the ward became a dedicated space for the care of patients with delirium. A larger study is being planned across a variety of settings.

Managing the self: living with an indwelling urinary catheter.

AIMS: This paper reports the findings of a study that aimed to understand the perspectives of community dwelling adults' who lived with a permanently indwelling urinary catheter. The objectives of the research were to: reveal the participants' perspective of living in the community with a permanent indwelling urinary catheter, raise awareness of the experiences of catheterized men and women and to inform community nursing practice. BACKGROUND: Catheter care is a common nursing intervention. Clinical Nurse Consultants (CNCs) with a focus on continence drove this inquiry because it was believed that Community Nurses may underestimate the impact that a permanently indwelling catheter may have on peoples' lives. DESIGN: Structured interviews were undertaken with twelve men and nine women (n = 21), aged between 24 and 82 years and who had a permanently indwelling catheter (either urethral or supra pubic) for longer than six months. Analysis of the interview transcripts was a collaboration between the researchers and clinicians. RESULTS: The most significant finding was that participants wanted to learn urinary catheter self-care as this allowed them to take control and gave relevance to their daily life. Data revealed a learning pattern consisting of seven interrelated themes as people have learned to self-manage: (i) resisting the intrusion of a catheter, (ii) reckoning with the need for a catheter, (iii) being vigilant for signs of problems, (iv) reconciling between the needs of self and others, (v) reclaiming life, (vi) managing self-care, and (vii) taking control. CONCLUSIONS: We do not suggest that people undergo a straightforward path toward catheter self-care, rather, that the seven interactive themes we have identified may be useful for observation in nursing practice whilst sensitizing nurses to clients' experiences of living with a catheter. RELEVANCE TO CLINICAL PRACTICE: Promoting self-care of a catheter is not simply about educating clients about their condition or giving them relevant information. It is intrinsically a learning process, observing responses to every day events, such as the identification of the different sounds and sensations that may alert the individual to a full catheter bag, urine that has stopped flowing or signs of impending infection.

Researching with centenarians.

Aims and objectives. The objectives were shaped by ways in which to best engage the readers' curiosity about being 100 years old. Background. In the effort to reverse negative stereotyping associated with older people, the aim was to produce a book of individual stories for public readership that had the power to combat ageism and to present alternative constructions. Methods. Twenty-four centenarians were interviewed. Each person was asked to retell, using their own words, something about themselves and the social context that had shaped their lives. Centenarians could select whatever was foremost in their minds; an aspect of their lives that they wanted to share. We asked a few standard questions: What is it like to have lived one hundred years? What, in your opinion, has contributed to longevity? What matters today? A conversational approach to interviewing was adopted with the use of prompts to encourage story telling. Results. Centenarians privileged talking about their early years, childhood, going to school and first employment. Although most people could relate to a country upbringing and fewer years at school, subsequent life experiences and opportunities were diverse. Advice to others who desired a long life was keeping active, leading a simple life, eating well, working hard, maintaining an interest in events and surroundings, helping others and being moderate in all things. Maintaining a sense of humour was thought to be important. Loss of eyesight, mostly in the last few years, had been a profound disruption in the lives, creating new dependencies. Extensive family cohesion and frequent contact with others who cared was a profound feature. There appears to be a matter of fact appraisal of difficulties, losses and sadness but these were considered to be part of life and not particularly extraordinary. It seemed that these people had made a successful transition to living beyond 100 years old by leaving stress behind and moving on. Embedded in the stories of centenarians was a sense of self that was strong and resilient. Conclusions. The book containing 24 separate stories was published by Penguin. Sharing the stories of centenarians provided an opportunity to engage with the public readership and help shape wider social perceptions of older people as worth listening to. Relevance to clinical practice. In this paper, alternatives to dominant stories about ageing are presented and challenge the negative stereotyping of older people and its associated notions of decline, dementia, decay and death. Its relevance to clinical practice is precisely to show that older people are worth listening to. Moreover their ordinary lives make interesting, popular readership. Although the stories were primed to reach a wide public audience, we argue that its health promotion message and our creative effort to combat negative stereotypes can filter to healthcare delivery.

The experience of fatigue for adults living with HIV.

AIMS: The aim of this study was to go beyond objective clinical assessment and explore the experience of fatigue and self-care strategies with adults who live with HIV. RATIONALE: This study responded to a perceived lack of available evidence to inform the practice of service providers about ways fatigue impacts on the lives of people with HIV. Prior understandings of fatigue are derived from survey or instrument-based tools or studies that do not consider the complexities of the personal experience that in-depth interviews can elicit. The focus remains generally on description, measurement or management from a biomedical perspective. METHODS: A qualitative study using participatory action research methods was conducted during 2003 with 15 adults diagnosed with HIV who perceived fatigue was a problem in their lives. Data were collected by individual interviews, researcher's notes and two participatory action research groups. RESULTS: Thematic analysis of data demonstrated that fatigue remains silent and invisible to participant's families, friends and employers. Fatigue experienced by people living with HIV generally also met with a lack of acknowledgement and understanding from health professionals. People developed self-care strategies over many years of trial and error. RELEVANCE TO CLINICAL PRACTICE: People living with a HIV seek to be acknowledged that fatigue is a legitimate concern, not only by health care professionals, but also people with whom they live. It is imperative that nurses who work with people living with HIV-related fatigue consider the wider social aspects of the person's life as well as physical symptoms. Most importantly, there then needs to be a process of engagement and active listening to the individual's account of their experience of fatigue. Advocating that fatigue is a legitimate complaint to the person living with HIV as well as the wider public and professional community is imperative.

Acceptance and denial: implications for people adapting to chronic illness: literature review.

AIM: This paper reports an exploration of the terms acceptance and denial by exploring the literature, with the aim of understanding the implications of using these concepts to categorize people's responses to living with chronic illness. BACKGROUND: People learning to live with a chronic illness or condition may be judged and labelled by others as being in denial, particularly when they do not adhere to prescribed treatment regimes. METHOD: A literature search for the period between 1989 and 2003 was conducted using the electronic databases Medline, CINAHL, PSYCArticles, Health Source Nursing/Academic Edition, Academic Search Elite and Sociological Abstracts. Key terms used were 'acceptance and denial' and variations of such themes as 'chronic illness', 'disability', 'adjustment', 'illness discourse', 'medical discourse', 'illness experience', 'labelling', 'self' and 'identity'. DISCUSSION: The theoretical background of the common constructs 'acceptance and denial' are discussed using the psychoanalytic theories of Freud and Kubler-Ross's work on death and dying. Healthcare professionals and lay people commonly refer to the terms acceptance and denial when describing a person's response to chronic illness. Those whose understanding of the illness experience relies on the acceptance-denial framework may not listen when people with chronic illness attempt to tell their own unique story of how they have experienced life with illness. Instead, their listening antennae may be focused on fitting aspects of the experience with stages of adjustment. When others use labels of acceptance and denial, people who are learning to live with a chronic illness may internalize these labels as reflections of the self. This may be most likely when the person using the label is perceived to have authority, such as a healthcare professional. The internalization of negative information associated with these labels may obstruct the reshaping of self-identity that is fundamental when making a transition to living well with chronic illness. CONCLUSION: Healthcare professionals are urged to challenge the stage model of adjustment as a way of understanding the response to illness and to listen instead to the stories people tell. They are encouraged to privilege the person's experience as the basis for developing a sensitive, client-focussed response that takes into account the wider social context of people's lives as well as the medical aspects.

Lovestruck: women, romantic love and intimate partner violence.

Intimate Partner Violence remains a significant problem globally despite health promotion aimed at raising awareness. In particular, there is a current trend for many young women to view some abusive/violent behaviours as acceptable in their relationships. Intimate Partner Violence has serious implications for its short and long term impacts on the health of women and children. Health workers may find working with women a challenging and sometimes frustrating experience. A way forward is to develop clearer understandings of the complexities of Intimate Partner Violence and to better understand women's investments in romantic relationships. In this paper a secondary analysis of data from a narrative study of women's recovery from IPV relationships is presented in order to illustrate discourses that inform underpinnings of romantic relationships. Transcriptions of audio-taped interviews were analysed using a feminist post-structural approach in order to make visible the ways in which the women negotiated their identities in the discourses of femininity. A critical review of current literature was also undertaken to develop the construct of romantic love. Women revealed that cues for Intimate Partner Violence were present early in the relationship but were not recognised at the time. Two positions within the discourse of romantic love were identified that underpinned their desires to establish and invest in the relationship despite the presence of cues for Intimate Partner Violence. These were 'Desperate for a man' and interpreting jealousy as a sign of love. Romantic love may be desirable for the sharing of warmth, safety and protection, and yet can mask behaviours that are cues for domestic violence. Understanding the complex nature of the ways that women's desires are located in the discourse of romantic love has implications for all nurses working to prevent and reduce the incidence of Intimate Partner Violence.

Adolescents with Type 1 Diabetes: transition between diabetes services.

AIM: The research aimed to develop a sustainable and coordinated approach to facilitating the transition between diabetes services for adolescents. The objectives were to: (1) involve key diabetes health delivery stakeholders in expressing their concerns and issues about current service delivery and ways to improve same, and (2) reveal from the perspective of the adolescents living with Type 1 Diabetes their experiences surrounding the process of transition. BACKGROUND: This paper presents research that sought to identify the major concerns and issues that stakeholders had about transition and to reveal the experience of transition for the adolescent with Type 1 Diabetes. Key representatives from seven public diabetes services in Adelaide, South Australia worked collaboratively to answer the objectives of this inquiry. Approach. Interview data were generated and analysed using a response focus framework provided by fourth generation evaluation research. In this study, the focus was on common concerns, claims and issues raised by health care professionals (n = 21) and adolescents (n = 10) aged between 15 and 18 years about transferring from children's to adult diabetes services. FINDINGS: Data revealed education and dietetic advice was reactive rather than proactive and that the paediatric model of care is philosophically and practically different to the adult model of diabetes care. Three phases of transition were identified: preparation, formal transition and evaluation. Our findings indicated that these stages of transition were not being fully implemented in health units. CONCLUSION: The project findings have set the scene to establish a multidisciplinary working party to work collaboratively across agencies to develop effective transition pathways. RELEVANCE TO CLINICAL PRACTICE: The role of diabetes nurse educators and dietitians in South Australia is under-used throughout the transition process. Diabetes nurse educators are in an ideal position to prepare, coordinate and evaluate transitional processes.

Issues in data generation using email group conversations for nursing research.

AIM: The purpose of this paper is to provide an overview of the issues we have confronted when generating and analysing dialogue data by using electronic mail. BACKGROUND: The decision to use email for our research arose from our developing understanding of some of the consequences of illness that people living with chronic illness confront in their lives. As researchers, we recognized the potential of the Internet for computer-mediated communication using email for communication between researchers and research participants. DISCUSSION: We consider the functional aspects of generating data by email, such as the software needed, and then explore the issues encountered during the research process including ethical considerations, fluctuating participation, participants' familiarity with using email, facilitating lurkers towards participation, establishing group norms, and the role of the facilitator. CONCLUSION: As a collaborative inquiry, email conversation allowed us to spend time with participants over 2 years to explore chronic illness experience. However the scope and viability of computer-mediated communication as a qualitative method of research remains relatively unexplored, hence this paper.

The ethics of research using electronic mail discussion groups.

AIM: The aim of this paper is to identify and discuss the ethical considerations that have confronted and challenged the research team when researchers facilitate conversations using private electronic mail discussion lists. BACKGROUND: The use of electronic mail group conversations, as a collaborative data generation method, remains underdeveloped in nursing. Ethical challenges associated with this approach to data generation have only begun to be considered. As receipt of ethics approval for a study titled; 'Describing transition with people who live with chronic illness' we have been challenged by many ethical dilemmas, hence we believe it is timely to share the issues that have confronted the research team. These discussions are essential so we can understand the possibilities for research interaction, communication, and collaboration made possible by advanced information technologies. DISCUSSION: Our experiences in this study have increased our awareness for ongoing ethical discussions about privacy, confidentiality, consent, accountability and openness underpinning research with human participants when generating data using an electronic mail discussion group. We describe how we work at upholding these ethical principles focusing on informed consent, participant confidentiality and privacy, the participants as threats to themselves and one another, public-private confusion, employees with access, hackers and threats from the researchers. CONCLUSION: A variety of complex issues arise during cyberspace research that can make the application of traditional ethical standards troublesome. Communication in cyberspace alters the temporal, spatial and sensory components of human interaction, thereby challenging traditional ethical definitions and calling to question some basic assumptions about identity and ones right to keep aspects of it confidential. Nurse researchers are bound by human research ethics protocols; however, the nature of research by electronic mail generates moral issues as well as ethical concerns. Vigilance by researchers is required to ensure that data are viewed within the scope of the enabling ethics approval.

Women's experiences of fatigue in chronic illness.

AIM: The aim of this paper is to add a qualitative dimension to the body of knowledge about fatigue by revealing the meaning given by women living with chronic illness to the experience of fatigue. BACKGROUND: Fatigue is a common symptom experienced by people who live with chronic illness. It pervades every aspect of life and may be experienced in physical, psychological, emotional or social dimensions. Management of fatigue relies heavily on the individual's ability to employ self-care actions. The invisibility of fatigue is recognized as one of the most frustrating aspects, which can lead to lack of understanding and misunderstanding by others. METHOD: We report the findings of data from research in progress (2003-2005). Data were generated via email group conversations between us and 30 women who live with long-term illness. FINDINGS: A recurring conversational thread has been women's experiences of fatigue when living with long-term illness. Although fatigue has been reported to be a major obstacle to maintaining usual daily activities and quality of life, few studies have explored this common symptom from the perspective of people themselves. Common themes found in the experience of fatigue as described by women are the meaning of fatigue, awareness as self-care, fatigue as invisible to others, seeking medical validation and accountability for self-care. CONCLUSION: It is vital for healthcare workers to give opportunities for women to talk about fatigue, validate their experiences and provide support with self-care. Healthcare workers are encouraged to challenge their own meanings and expectations surrounding a person's report of fatigue so that opportunities for therapeutic intervention can be facilitated.

A Delphi study of district nursing research priorities in Australia.

This study, using a Delphi approach, sought the opinion of a self-selected panel of 320 district nurses regarding research priorities for district nursing in Australia. Over three rounds of questionnaires, the 419 research clinical problem areas requiring research as suggested by the panel were each rated in importance by the panel and then ranked through analysis from high to low average rating scores, thereby, whittling down the list to the top 15% (68) research questions and to a final list of the top 10 research priorities overall. Research questions focusing on discharge planning are dominant in these top 10 priorities, with documentation issues the second most common focus. Other foci in the top 10 priorities are staffing, aged care, palliative care, and assessment. The organization-specific top 10 research priorities focus on wound care, funding, education, and communication issues. Additionally, the top 68 priorities, which are either finitely practice-based or contextual-issues research questions, were categorized into 20 themes. The results will hopefully lead to scarce human and financial resources being directed to practice-relevant research programs that will facilitate improved health for district nursing (primarily home-nursing) clients in Australia and elsewhere.

Core elements of programmatic research in nursing: a case study.

In this invited paper Tina Koch and Debbie Kralik present the establishment of a research program outside the precincts of a university and we ask Gary Rolfe to provide a commentary from the perspective of an academic. We argue that a dedicated research unit, with a clearly articulated philosophy and in response to research questions from clients, community and practitioners, provides the focus to drive the program. Although we have infrastructure from the RDNS Foundation, obtaining external funding to support our program is a central activity. Discernable outcomes of our collaborative inquiries are described as participants with whom we research narrate aspects of their experience, leading to enhancement of self agency and quality of life. We illustrate the reform potential as groups of research participants develop sustainable people networks. Most importantly, theoretical development is ongoing describing transition (ways in which people are able to take a chronic illness into their lives and move on) and better understanding on ways in which health care professionals can facilitate transition. Evidence based news letters are written in collaboration with practitioners, however we ponder about ways to further our research findings in practice. Gary Rolfe speculates about intermural or extramural research programs. He frames his response using Brand's criteria to research program decisions. In order of importance he asks: (1) will it be fun? (2) will we learn anything from it? (3) will it make the world a better place? (4) will it earn enough money to pay for the first three? Gary argues that one of the luxuries of working within the university sector as an academic is that he can occasionally ignore question four.

'Moving on': the transition to living well with chronic illness.

This paper describes the process of 'moving on' when living with a chronic illness or condition. The findings of this study emerged from daily email conversations between six women who live with long term illness and the three researchers during a three month period in 2003. In collaboration with the women, researchers have drawn out seven interrelated themes which are seen to constitute the process of 'moving on'. The concept of readiness to change is discussed as fundamental to the relationship between potential learning as a result of living with illness and 'moving on'. We conclude that health workers are in a strong position to facilitate the learning that will assist people to 'move on' and incorporate illness as an ordinary part of life.