This paper arises from the conceptual framework underpinning a research study focusing on black Caribbean men’s sexual decisions and health behaviour. In investigating these issues the notion of ‘screaming silences’ was developed to unite the theoretical and philosophical approaches that underpinned the research, the experiences of the researcher and participants involved. While ‘screaming silences’ was initially applied to a sexual health and ethnicity context it provides a useful basis for a theoretical framework for researching sensitive issues or the health care needs of marginalised populations. ‘Screaming silences’ (or ‘silences’) define areas of research and experience which are little researched, understood or silenced. ‘Silences’ reflect the unsaid or unshared aspects of how beliefs, values and experiences of (or about) some groups affect their health and life chances. They exposed issues which shape, influence and inform both individual and group understandings of health and health behaviour. This paper presents the notion of ‘screaming silences’ with reference to the original study and maps out a four-stage framework for its utilisation in ethnicities based and sensitive research. It is presented here for use by other researchers as a vehicle for exposing additional perspectives in studies involving sensitive subjects or marginalised populations.

Mental health in elite sport is receiving more publicity due to an increase in male athletes sharing their personal experiences. Sports injury is recognised as the major risk factor for psychological distress amongst male athletes, although anecdotally this may be that athletes are more likely to discuss their emotional wellbeing when related to the injury they are experiencing. Stress can be amplified within elite sport and the pressure they experience in relation to competition and performance can be exacerbated by adverse life events. This ongoing stress does not end when their sporting career does, it can follow them into retirement. The physical and psychological demands placed upon them by the sporting environment may predispose athletes to developing depression. As an athlete’s symptoms of mental illness intensify, their performance can be negatively affected leaving them vulnerable and exposed to further symptoms of common mental disorders. The pressure of performance can also expose male athletes to overtraining syndrome which can be difficult to distinguish from depression. Male athletes are more vulnerable to eating disorders compared with males in the general population and they do have anxieties, particularly around their bodies, but find it difficult to disclose their concerns. In addition to this, male athletes are more likely to use substances, including opioids to improve both sport and non-sport performance.Despite the prevalence of common mental disorders in male athletes, stigma still exists, and although some athletes discuss their issues publicly after their career has ended, the majority of athletes prefer to remain silent. There remains a view that athletes who seek help for psychological problems may be seen as weak. Although there is an improvement in help-seeking attitudes within elite sport, further research and education is needed to encourage men to talk about their mental health, share their experiences and to enjoy a greater sense of emotional wellbeing.

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 Alliances in aphasia rehabilitation 2 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.

BACKGROUNDThe 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.AIMSThis 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.CONCLUSIONIt 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.

BackgroundTherapeutic 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.AimsTo explore speech and language therapists’ perceptions and experiences of developing and maintaining therapeutic alliances in aphasia rehabilitation post‐stroke.Methods & ProceduresTwenty‐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 & ResultsAnalysis 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 patient's family, relational continuity and organizational drivers.Conclusions & ImplicationsThe 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.