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Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-05-11T20:30:17Z No. of bitstreams: 1 AliceLima.pdf: 3882529 bytes, checksum: 66b4f51e02caa1f3ede5d2a067357808 (MD5) / Made available in DSpace on 2017-05-11T20:30:17Z (GMT). No. of bitstreams: 1 AliceLima.pdf: 3882529 bytes, checksum: 66b4f51e02caa1f3ede5d2a067357808 (MD5) Previous issue date: 2016-03-30 / The Nursing Assistance Systematization is able to offer support for the development of interdisciplinary and humanized care methodologies, providing nurses greater autonomy and security in assistance providing. The objective was to analyze the applicability of the interventions proposed by the Nursing Interventions Classification - NIC indicated for the diagnosis of Ineffective Breathing Patterns in a Pediatric Intensive Care Unit - PICU. This is a descriptive, exploratory study, conducted in the PICU of a highly complex teaching hospital in São Luis-MA. Nine PICU nurses participated. Data collection was carried out between July to September 2015, which had the instruments to characterize the participants and description of activities for Ineffective Breathing Patterns ND. The study followed the ethical principles set out in Resolution CNS / MS 466/12, with consideration and approval of the CEP, identified as opinion nth 1,047,920 and CAAE: 42619815.8.0000.5086. After the description of the activities, the researcher compared the activities of the NIC, carrying the cross mapping. Eight nurses experts conducted the review and refinement of the data. The comparison of the activities pointed out that from 61 activities reported by nurses, 54 were selected as activities of the NIC. From interventions two were described as priority, seven described as suggested, five optional and eight not suggested for diagnosis. The most frequently reported by nurses were: remove secretions stimulating coughing or breathing in; perform endotraquel or nasotracheal aspiration, as appropriate; monitoring frequency, pace, depth and effort in breathing and realization of auscultation. In the evaluation of expert nurses it was suggested that some activities remain under the language of the PICU nurses; some were reorganized with additions of terms and change of verbs; others remain with the description of the NIC. The study identified the use of standardized language in the PICU environment and the possibility of this taxonomy be used and prove adequate to performed this site; besides observing the gaps to expand and improve the care provided for the diagnosis Ineffective Breathing Patterns. / A Sistematização da Assistência de Enfermagem (SAE) é capaz de oferecer subsídios para o desenvolvimento de metodologias interdisciplinares e humanizadas do cuidado, proporcionando ao enfermeiro maior autonomia e segurança na prestação da assistência. Objetivou-se analisar a aplicabilidade das intervenções propostas pela Nursing Interventions Classification - NIC indicadas para o diagnóstico de enfermagem Padrão Respiratório Ineficaz em Unidade de Terapia Intensiva Pediátrica – UTIP. Trata-se de um estudo descritivo, exploratório, realizado na UTIP de um hospital de ensino de alta complexidade no município de São LuisMA. Nove enfermeiros da UTIP participaram da pesquisa. A coleta de dados foi realizada no período de julho a setembro de 2015, que contou com os instrumentos de caracterização dos participantes e a descrição das atividades para o DE Padrão Respiratório Ineficaz. A pesquisa seguiu os princípios éticos estabelecidos na Resolução CNS/MS nº466/12, com apreciação e aprovação do CEP, identificado conforme parecer nª 1.047.920 e CAAE: 42619815.8.0000.5086. Após a descrição das atividades realizadas, a pesquisadora comparou as atividades da NIC, realizando o mapeamento cruzado. Oito enfermeiros experts realizaram a revisão e o refinamento dos dados. A comparação das atividades apontou que das 61 relatadas pelos enfermeiros, 54 foram selecionadas por pertencerem às atividades da NIC. Das intervenções, foram descritas duas prioritárias, sete sugeridas, cinco optativas e oito não sugeridas para o diagnóstico. As mais relatadas pelos enfermeiros foram: monitorar frequência, ritmo, profundidade e esforço na respiração; remover secreção estimulando a tosse ou aspirando; realizar aspiração endotraqueal ou nasotraqueal, conforme apropriado e monitorar a eficácia da terapia de oxigênio (p. ex: oximetria de pulso, gasometria arterial), conforme apropriado. Na avaliação dos enfermeiros experts foi sugerido que algumas atividades permanecessem de acordo com a linguagem dos enfermeiros da UTIP; algumas fossem reorganizadas com acréscimos de termos e mudança de verbos; outras permanecessem com a descrição da NIC. O estudo possibilitou identificar a utilização da linguagem padronizada no ambiente da UTIP e a possibilidade dessa taxonomia ser utilizada e se mostrar adequada à realizada deste local; além de observar as lacunas existentes para ampliar e aprimorar os cuidados realizados para o diagnóstico Padrão Respiratório Ineficaz.

<p> <b>Background:</b> Advanced nursing education needs to be pursued along the continuum of the nursing career path. This education process is indispensable to the role of the nurse as educator, manager, nurse leader, and researcher who will effect policy changes and assume leadership roles as revolutionary thinkers in addition to implementing paradigmatic shifts. </p><p> <b>Purpose:</b> This grounded theory study sought to unearth the critical factors that motivate nurses to advance academically. The study aimed to gain an understanding of the social processes associated with the decision of diploma and associate degree nurses to advance their nursing education. </p><p> <b>Philosophical Underpinnings:</b> A qualitative methodology in the tradition of grounded theory using the constructivist and interpretivist approach was used to conduct the study. </p><p> <b>Method:</b> Data were collected from two groups of participants using a face-to-face semistructured interview. The first group was diploma and associate degree nurses, and the second group was a focus group comprising of baccalaureate, masters, or doctoral degree nurses who have progressed academically from diploma or associate degree level. </p><p> <b>Results:</b> Emerging from the thick rich data that were collected from the research participants were the following core categories that ground the theory: rewarding, motivating, and supporting for diploma and associate degree nurses to advance academically. </p><p> <b>Conclusions:</b> The study concluded by elucidating that professional advancement was the social process that grounds. Hence, the emergent theory was; <i>The Theory of Professional Advancement.</i></p>

This study was undertaken using Foucault’s genealogical approach to explore an aspect in the governmentality of the nursing profession from the 1950s to the present. It uses developments in the education of nurses in South Australia as a case in point, but includes, at all stages, a concomitant analysis of global trends in the profession and education of nurses. Hence, data were collected from historical documents such as government reports, professional nursing journals, nursing text books and curriculum documents across the period for analysis, from South Australia and Flinders University as a particular case. I thought of these texts as data and examples of the production of discourses about nursing education and practice influenced by the Foucauldian method of process of The Archaeology of Knowledge (1972). These discourses produced in both social and professional spheres mirror the sociological knowledge development of the professionalisation agenda that has enveloped the process of professional legitimacy since the Second World War. The interactions are described intertextuality, with each chapter in this thesis presenting the interconnectedness of a variety of discourses. The Foucauldian perspective achieved the purpose of seeking how nursing was shaped by the society and influenced society to form what constituted a nursing professional, to the present time. ‘Uncertainty’ in the nursing profession was the key concept found in the investigation. Nursing attempted to reduce uncertainty by regulating nursing education, and by setting boundaries for the practice of professional nursing. This governmentality generation process reflects other forms of surveillance developed during the late 20th century, and was used to establish the subjectivity of nurses in terms of ‘who’ has the right to define nursing and its knowledge systems. The role of the nurse and the requirements for a nurse were emphasised as personal characteristics rather than as professional behaviour when nurse ‘training’ occurred solely in the hospitals. Who defined the role of nurse and who could be a nurse was decided by medical officers and administrators rather than nurses themselves. As the description of the role of the nurse was expanded to the social sphere, the debates about the appropriate place for nursing students’ training was influential in bringing about change. Establishing nursing education in the tertiary sector facilitated the professionalisation of nursing. I explored curriculum development as an example of the internal governmentality of nursing. The historical analysis of curriculum development processes at an Australian university and its antecedent organisations, showed how nursing educators think about nursing and the role of nurse and how they reflect these requirements in the teaching of nursing students. The way of thinking about nursing and the professional nurse role was also actively observed in the discourses arguing for the use of the thinking tools of nursing such as the nursing process, other problem-solving approaches and latterly for the use of clinical reasoning. This study uncovered the process of handling uncertainty internal and external to nursing through processes of professional education. Uncertainty control was an essential in nursing education and thinking tools were key in the process for nursing educators to re-set the parameters of nursing. Professional education aims to develop both the individual nurse and the profession, as a whole, which may lead to conflicts of interest. Therefore, it is important for nurse educators to be aware of these potential conflicts of interests in their governmental strategies. It is also necessary to develop an interactive and corroborative curriculum that includes the many stakeholders interested in the development of the nursing profession.

This narrative inquiry traces and recounts an epiphaffic experience of a registered nurse on entering gerontic nursing, and her subsequent three-decade journey through the complexities and mazes of this nurse specialty. Such inquiry seeks to enable a better understanding of the realities of ageing and caring for older adults by opening up thinking and beliefs underpinning gerontic nursing work. Modern aged healthcare involves complex gerontic nursing actions, requiring highly skilled nursing personnel, but on the whole, gerontic nursing is dimly perceived and misunderstood by professional colleagues and the general public. Much of this misunderstanding is a legacy of an outdated ideology of gerontic nursing; yet these public beliefs, attitudes and interpretations are extremely powerful in determining aged care policy. As the population ages and more elderly people access healthcare services, society will be faced with an array of complex political and socioeconomic factors. This thesis aims to untangle such choices by pursuing the questions of: How have the constructs of ageing impacted on gerontic nursing practice and education?, What type of gerontic nurse will be required to provide future elderly care? and How will these people be educationally prepared for their new roles? Many of the constructs explored are dialectical in nature; that is, they have developed by inner conflict, the scheme of which is thesis and antithesis, or an original tendency and its opposing tendency. Such dialectical thinking has underpinned much of this thesis and in many instances, particularly in chapter 7, has taken the next step to the unification of these opposing tendencies; that is, synthesis, to create new understanding or meaning. Issues explored relate to: the ontology of ageing; the meaning of life; gerontophobia; Australia's changing population profile; changing aged healthcare systems; gerontic nursing cultural dilemmas; workforce planning; elder health in the future and gerontic nursing practice and education shifts. In a theoretical and methodological context, increasing difficulty with conventional epistemologies and the science founded on them is leading nurse theorists ever nearer to a postmodernist position. Narrative becomes a means through which gerontic nursing can accumulate and express cultural knowledge and critique procedure. The thesis exemplifies narrative's profound potential for underpinning the reconceptualisation of gerontic nursing practice and education. It is narrative's capacity to foreground the relationship between daily practice and knowledge that makes it a critical tool for the future of gerontic nursing inquiry. Narrative facilitates the paradigm, or more ontological shift from the dominant medical model of aged healthcare and 'tender loving care' rhetoric, to a therapeutic, caring-healing approach which has been in the margins in gerontic nursing practice. In the context of gerontic nurse education, narrative pedagogy offers new ways of thinking even in the midst of oppressive practices. Many issues remain unresolved about how gerontic nurses can be educated for future gerontic nursing practice. It would seem that aged care in Australia is a site of such organisational and cultural change, it threatens to undermine knowledge, care and understanding and shift care to untrained staff. The thesis illustrates how such approaches cloak much of gerontic nursing practice and devalue the intimate work of caring intelligently, emotionally and physically for frail older adults. However, while such tensions abound in gerontic nursing practice, the 2l~ century offers skilled gerontic nurses the opportunity to become key components in the refigured and redesigned aged healthcare delivery system. Research indicates that because few know enough about the sum of the future to impede well-constructed attempts at engaging in any new model design, taking any action is infinitely better than none. It is on this premise that Chapter seven posits a new model design for residential long-term aged care for older adults, believing that by imagining a different future, it can then be created and become a reality.

This study was conducted in the context of the regulation of professional nursing and midwifery practice in the Australian health care system. In this environment, professional regulatory authorities established by State and Territory legislation in all jurisdictions, regulate and control the work of health professionals. In Queensland, registered nurses, enrolled nurses and midwives are regulated by the Queensland Nursing Council, the statutory body created by the Nursing Act 1992 (Qld). Part of the regulatory role of this and other authorities is to discipline professionals whose conduct or behaviour falls short of appropriate and acceptable standards of practice. All regulated health professionals, including nurses and midwives, are potentially subject to professional disciplinary action if a complaint is lodged in relation to their conduct. This being an important issue in the management and delivery of health care, and an increased trend among health care consumers, the dearth of existing research into the disciplinary process is a major concern. This exploratory study examined the disciplinary role of the Queensland Nursing Council in adhering to its legislative mandate to ensure safe and competent nursing practice. The study focused on the extent to which structural (legislation and policy), professional, and process factors impacted on the outcomes of disciplinary Tribunals and Committees in cases of incompetent or unsafe practice and sexual misconduct. The study was situated within the interpretive paradigm using a case study approach. Specifically, it investigated cases of sexual misconduct by nurses and unsafe or incompetent practice by midwives. The study was guided by Donabedian's conceptual framework of structure-process-outcome. This framework was seen to be most suited to the aims of the study and provided a template for in-depth analysis of the data emerging from the two cases. The findings of this study provided insight into the factors underpinning the decisions of the disciplinary bodies in making determinations and formulating outcomes. There was found to be a lack of consistency and predictability in both the legislative frameworks and the interpretation of terms and concepts used to identify conduct warranting a disciplinary response from regulatory authorities. Although the processes of disciplinary proceedings are prescribed by both legislation and policy, their practical application was characterised by considerable challenges, which resulted in varying outcomes. The thesis reports this information so that it can be used as an initial basis to build a body of knowledge from practical experience with disciplinary proceedings that will inform future processes. Subsequent case studies in other contexts and systems will increase the level of knowledge available to nurses, other health care providers, health care institutions and regulatory authorities. The initial base of evidence suggests implications for practice, education and further research which are outlined in the final chapter of the thesis.

Childbirth can be associated with short and long-term psychological morbidity including depression, anxiety and trauma symptoms. Some previous studies have used psychological interventions to reduce postpartum distress but have primarily focussed on attempting to relieve symptoms of depression with little recognition of trauma symptoms. Furthermore, the intervention used in these studies has generally been poorly documented. The first aim of the present study was to develop a counselling framework, suitable for use by midwives, to address psychological trauma following childbirth. Multiple methods were used to develop the intervention including focus groups with women and midwives. Both the women and midwives gave unequivocal support for postpartum debriefing. Themes that emerged from the focus groups with women included the need for opportunities to talk about their birth experience, an explanation of events, an exploration of alternative courses of action that may have resulted in a different birth experience, talking about their feelings such as loss, fear, anger and self-blame, discussing social support, and discussing possible future childbearing. There was a high level of agreement between the women's and midwives' views. These themes were synthesized with contemporary literature describing counselling interventions to assist in reconciling a distressing birth experience and a model for understanding women's distressing birth experiences to develop a counselling framework. The counselling intervention was then tested using a randomised controlled study involving 400 women recruited from antenatal clinics of three public hospitals. When interviewed within seventy-two hours of birth, 103 women reported a distressing birth experience and were then randomised into either the treatment or control group. Women in the intervention group had the opportunity to debrief at the initial postpartum interview (< 72 hours postpartum) and at four to six weeks postpartum. The prevalence of posttraumatic stress disorder was quite high; 9.6% of participants meeting the diagnostic criteria for acute PTSD at four to six weeks postpartum. Fewer participants (3.5%) met the diagnostic criteria for chronic PTSD at three months postpartum. As with previous research relating to childbearing women, few demographic factors or antenatal psychological factors were associated with the development of a PTSD symptom profile following childbirth. The development of PTSD symptom profile was strongly associated with obstetric intervention and a perception of poor care in labour. This finding is also consistent with previous research. Emotional distress was reduced for women in the intervention group in relation to the number of PTSD symptoms [t (101) = 2.144, p = .035], depression [c2 (1) = 9.188, p = .002], stress [c2 (1) = 4.478, p = .029] and feelings of self-blame [t (101) = -12.424, p <.001]. Confidence about a future pregnancy was higher for these women [t (101) = -9.096, p <.001]. Although there was not a statistically significant difference in the number of women with a PTSD symptom profile at three months postpartum, fewer women in the intervention group (n=3) than in the control group (n=9) met PTSD criteria. Likewise, there were fewer women in the intervention group (n=1) with anxiety levels above mild than in the control group (n=6). Importantly, this study found that offering women who have had a traumatic birth the opportunity for counselling using the framework documented in this dissertation was not harmful. This finding is in contrast to previous findings of other studies. The intervention was well received by participants. All the women in the intervention group found the counselling sessions helped them come to terms with their birth experience. Maternity service providers need to be cognizant of the prevalence of this debilitating condition and be able to identify women at risk for early intervention and referral to a mental health practitioner if appropriate. This research offers further support for the compelling need to implement changes to the provision of maternity services that reduce rates of obstetric intervention and humanise service delivery as a means of primary prevention of birth-related PTSD.

This research study explored the meanings former patients attributed to being on long-term mechanical ventilation in a critical care unit (CCU). An interpretive phenomenological-ontological perspective informed by the philosophical tenets of Heidegger (1927/1962) was used to examine the lived experience of a group of people who had previously been hospitalised in one of three critical care units in southeast Queensland, Australia, during which time they were on a mechanical ventilator for a period of seven days or more. Data were collected using 14 unstructured audio-taped interviews from participants, who had indicated that they were willing and able to recall aspects of their critical care experience. The data were analysed using the method developed by van Manen (1990). A total of nine people participated in the study, of which six were male and three female. Their ages ranged from 21 to 69 years. Thematic analysis of the data revealed four themes: Being thrown into an uneveryday world; Existing in an uneveryday world; Reclaiming the everyday world; and Reframing the experience. Throughout the description of these themes, excerpts from the interviews with the participants are provided to demonstrate, and bring to light the meaning and interpretations constructed. From this thematic analysis, a phenomenological description drawing on Heidegger's tenets of Being was constructed. Titled Being at its most elusive, this description showed that participants experienced momentary lapses of: situation, engagement, concern and care, temporality, and the ability to self-interpret. These findings highlight and affirm the relevance of Heidegger's ontological tenets to reveal Being. The findings of this study served as a basis for a number of recommendations relating to nursing practice, education and research. Recommendations relating to practice include: constructing a more patient-friendly critical care environment, increased involvement of patients and their families in decision making and patient care activities; ensuring adequate critical care nursing staff levels; ensuring and maintaining appropriate skill level of critical care nurses; enhancing methods of communication with patients; planning for effective patient discharge and adoption of a designated nurse position for discharge planning; providing opportunities for follow up contact of patients once they are discharged from CCU; and promoting the establishment of follow up services for former CCU patients, and their families. Recommendations relating to critical care education include: incorporating more in-depth information of the psychological and social aspects of patient and family care into care planning; incorporating communication and counselling education and training to assist nurses caring for mechanically ventilated patients, and their families; further education regarding the role and responsibilities of patient discharge planning from CCU; incorporating more advanced research skills training and utilisation of research findings into practice; and the provision of appropriate and ongoing training and education in areas such as manual handling and communication skills for all health care staff involved in the direct care of CCU patients. This study also recommended that further research be undertaken to: examine and compare different sedative and analgesic protocols and their effects on the incidence of nightmares and hallucinations reported by CCU patients; replicate this study in a group of patients from different cultural or ethnic backgrounds; evaluate the efficacy of current methods for communicating with intubated and mechanically ventilated patients in the CCU; develop, test and evaluate the efficacy of new methods for communicating with intubated and mechanically ventilated patients in the CCU; examine CCU patients' perceived level of control and power; explore the extent and type of involvement patients would like to have in their care whilst in the CCU; investigate the extent and type of problems experienced by CCU patients after discharge; explore the usefulness and appropriateness of personal diaries for individual patients as an aid to assist in understanding and resolving their CCU experience; and examine the value of follow up contacts by CCU staff to former patients and their families. In summary, the findings from this study add substantial knowledge to critical care nurses' understanding and knowledge about what it means to be on long-term mechanical ventilation in a critical care unit. Findings will help inform future critical care nursing practice and education, and the provision of holistic and evidenced-based care.

In 1978, Primary Health Care (PHC) was formally recognised, in the Declaration of Alma-Ata, as the key to achieving the World Health Organisation's goal of 'Health For All by the Year 2000' (HFA). PHC was seen as the solution to the inadequate illness management systems that had developed throughout the world. It was hoped that PHC would address some of the major inequalities in health observed both within and between countries by its balanced system of treatment and disease prevention. The WHO envisaged that PHC would take place as close as possible to where people live and work and be the first element of a continuing health care process. Additionally, health service collaboration and multi-professional partnerships were expected to replace professional boundaries and competition. Shortly after the Declaration of Alma-Ata, the World Health Organisation, supported by national and international nursing bodies, proposed that nurses would be the driving force behind the HFA movement as active partners in inter-professional teams, leaders in health care and resources to people rather than resources to other health professionals. In the ensuing years, although community health nurses were acknowledged by the government and the nursing profession as key players in PHC in Australia, practice nurses (nurses who are employed in general medical practices) were not identified within this group. Hence, it appeared as though these practice nurses were 'invisible', not considered important to PHC in Australia, or simply overlooked as a major influence on population health. The purpose of this study was to describe the current role of these nurses and to identify and analyse the factors that influenced their scope of practice and hence their contribution to PHC. The research was conducted as a case study of practice nurses in one Division of General Practice in southeast Queensland. The study was influenced by the constructivist paradigm of inquiry and utilised a complementary sequence of quantitative methods followed by qualitative investigation. The first stage of the study comprised a telephone followed by mail survey of general practitioners and practice nurses employed within the Division. This was followed by a second stage, which involved group and individual interviews of key informants and was supported by document review and observation. The study revealed that the practice nurse role is essentially one of assistant to the general practitioner wherein the nurse undertakes basic assessment procedures to aid the medical diagnosis, carries out delegated therapeutic procedures, and contributes to the administrative functioning of the practice. Autonomous nursing initiatives, which appear to be largely opportunistic and incidental to delegated activities, include physical and emotional support of patients, clarification and reinforcement of medical instructions, and the provision of health education. The practice nurse's role, and hence contribution to PHC, was found to be constrained by a number of factors. These factors include the current funding arrangements for general practice, the view that practice nurses are an option rather than a necessity, the general practitioners' control of the practice setting, the appropriation of nursing work to medical receptionists, the lack of professional development opportunities, and the practice nurses' passive acceptance of their circumstances. However, both general practitioners and practice nurses appreciate the value of nursing services in general practice and GPs would sanction the employment of more nurses, if given financial incentives, especially for the purpose of preventive care. The majority of practice nurses believe their role should be expanded to include autonomous functioning while most of the GPs were amenable to some extension of nursing practice but reticent or opposed to any independent interventions. There appears a need in Queensland for courses to prepare practice nurses for advanced practice if they want to expand their role in PHC beyond that of assistants to GPs. It would also seem to be in the nurses' interests to initiate a professional association of practice nurses as a vehicle to explore other issues relevant to their professional development. In addition, if PNs want to expand their role they will need to demonstrate improved patient outcomes and cost effectiveness.

Since the introduction of the Internet, there has been an increase in the adoption of this technology for educational purposes. This development and widespread availability of Internet technologies, alterations in the needs of clinical practice and the characteristics of students, have all inspired changes in nursing education (Mallow & Gilje, 1999). In response, nursing education has embraced the opportunity this communication medium offers to the diverse groups of students in nursing. These students may be studying at a distance, or due to other constraints such as time or professional commitments, studying in flexible ways where students may or may not be in the classroom. In other instances, Internet technologies are being used with the aim of enriching learning in nursing. However, despite widespread development and implementation of these innovations, the effects on nursing education have not been extensively researched (Cheek, Gilham & Mills, 1998; Gillham, 2002; Mallow & Gilje, 1999) and little is known about how the Internet contributes to teaching and learning, what learning outcomes are, or what support is required by teachers and students (Billings, 2000). At this time of rapid development of Internet-based and Internet-supported courses in the Australian nursing education system, there is a need to ensure such courses are educationally effective, clinically relevant, and that resources are appropriately assigned. This exploratory study aimed to contribute to effective discipline-specific use of internet learning environments through increased understanding of students’ and academics’ experiences of teaching practices and learning processes. There were two phases to this mixed-method study, a survey of course coordinators, and secondly, interviews with eleven students and sixteen academics. The survey of diverse schools of nursing across Australia provided foundational information about the ways the Internet was integrated into nursing education, and the preparation and supports that were offered to students for Internet-based or Internet-supported learning. Guided by a constructivist theoretical framework, and analysed thematically, the key findings of this study were drawn from the academics’ and students’ experiences in a variety of nursing courses in universities located across Australia. The Internet was employed in these courses in a variety of ways. At the time of data collection for both the survey and the interviews, more courses were Internet-supported than Internet-based. A variety of Internet information and communication features were used in courses. The survey findings provided both a context for the interview findings, and a degree of confirmation of these findings. The context reported was diverse, consistent with an emergent educational environment that has few precedents to guide its implementation. The academics’ experiences revealed that teaching in online environments was vastly different to face-to-face teaching and required different practices of teaching and learning that took into consideration the separation of teachers from learners, and learners from each other. While often enthusiastic about the new environment, many teachers needed specific preparation, support, and adequate resources to teach in this new environment. Similarly, students experienced a dislocation from the learning environments to which they were accustomed. Significant shifts were apparent in the students’ constructions of both individual and collaborative learning that were contingent upon the separation of teachers and learners, and the necessity of communicating in a written medium. Both teachers and learners revealed how, consequent upon their dislocation, they were relocating to a new interpretation of time, place and relationships in Internet learning environments, and were reconstructing teaching and learning. The reconstructions of learning included ways of relating that built learning communities predicated on a shift in focus from teaching to learning. These included both a shift in individual student’s learning, and a constructed understanding that arose variously from shaping a fundamental comprehension or challenging thinking, to expand comprehension in the group. Through new understandings and practices, the participants were beginning to construct a place for students and teachers to realise the possibilities for enriched learning that online communities can provide. The findings of this study are discussed in terms of the possibilities for teaching and learning in nursing education, and recommendations are made.