The paper introduces a new approach to reflecting and acting called participatory and appreciative action and reflection (PAAR). It explores its potential to enable individuals and groups to move forward, to improve their working practices and lives in particular communities and contexts. The paper situates PAAR in the historical context of participatory and action research and reflective learning. It suggests that using PAAR requires four strategic 'turns'. By turn we mean a change in direction from one way of thinking and practising to another. The four turns are: (i) away from a preoccupation with changing behaviours in order to solve problems, with 'fixing' things and an engagement in deficit-based discourses, towards the development of appreciative insight, understanding the root causes of success and sustaining strengths-based discourses in order to amplify those things that will help build a better future from the positive present; (ii) away from self-learning (individualism and isolation) and towards collective learning through interconnectedness, appreciative knowledge sharing and the use of new forms of communications technology which enable simultaneous action in dispersed geopolitical spaces; (iii) away from one way of knowing and one perspective on truth to an acceptance of more pluralistic view of ways of knowing, of understanding human experience and putting this knowing to good use; (iv) away from reflective cycles and spirals and towards the use of a reflective learning (r-learning) framework comprising four mutually supportive processes. They are those of developing an appreciative 'gaze', of reframing lived experience, of building practical wisdom and of achieving and moving forward.

Much of the current literature relating to international students at university level tends to highlight their experiences from a deficit perspective and in some cases even problematises the experience for the student and university. Other studies tend to focus on recruitment and motivation rather than the lived experiences of the student, thereby providing little assistance to guide the student, academic and host university in their preparation for, and working with, the international student. International students choose to study in the United Kingdom for a variety of positive reasons. However, these factors have the potential to become stressors as the student makes the transition to studying in a foreign country. Rather than viewing these stressors from a negative perspective, this literature review identifies how, with planning, support and understanding, universities can provide and develop a positive experience for all concerned.

This paper evaluates the use of storyboarding within a classroom setting as a means of addressing end of life issues and engaging second year student nurses in creative, critical thinking and deeper reflection on practice. Storyboarding is a process that was developed to encourage learners to use the creative right brain and the critical left brain to formulate ideas in front of a group and then to look at those ideas critically (Lottier, 1986). The session was evaluated using a questionnaire and group discussion to elicit perceived learning from students. The activity was to create the storyboards in small groups, then review the content generated by discussion with the whole group. Main themes identified by the students included breaking bad news, dealing with cardiac arrest situation, coping with families following bereavement and the dying patient. Evaluation of the teaching session suggested that students found storyboarding helped to identify cultural aspects and feelings related to the dying patient. Students valued sharing with each other and the opportunity to have their experiences heard. It was noted that although this method provided as valuable learning experience for the student it is staff and time intensive and attention is required to establish a climate of trust and safety. The risk of exposing unexpected emotions within individual students appears no greater than with other approaches to teaching about loss, death and dying.

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This article reports the initial findings from the evaluation of four creative arts projects involving groups of older people living in a rural community. The purpose of the projects was to reduce social isolation among participants through providing direct access to arts and social activities. The view was that these activities would improve life skills and independence, increase levels of activity and improve the health, wellbeing and quality of life of participants. Evaluation of these projects demonstrated increased levels of self-worth and self-esteem among participants. Many of the older people involved agreed that they had made new friends while having the opportunity to try out a new activity.

A lifestyle survey of older adults living in Gloucestershire was carried out by Birmingham City University (formerly The University of Central England) and Age Concern Gloucestershire last year. Participants were asked to identify three main areas of concern for their retirement and while fears about health topped the list, fear of social isolation was cited by 11 per cent of participants, forced through events such as lack of mobility, loss of their partner and closure of community facilities such as post offices. Public involvement and inclusion schemes, such as befriending, may provide some solutions to this problem, but healthcare professionals need to be aware of these issues and to work towards community-focused solutions to avoid greater demands on health and social care resources.

With growing numbers of people dying with, and from, dementia there is a need for professionals and health-care organisations to review the access to and provision of palliative care. This literature review has identified several key themes in relation to the person dying with dementia including: diagnosis of the dying phase, appropriate timing of referral to specialist palliative care services; ethical decisions in relation to medication and nutrition; the environment; undertreatment especially, for pain relief; over and burdensome treatment interventions; carer involvement; collaborative working and advance decision making.

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