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A mixed methods literature review was conducted to investigate the association between ward environment and patient outcome. Eleven articles were retrieved that met the inclusion criteria. The data were synthesized and critiqued according to methodological features, with limitations evaluated. Results were presented according to how ward environment and patient outcome has been measured and how the association between the two has been explored. Clinical implications were considered as was the complexity of measuring patient outcomes. Recommendations for improving the environments of wards was also discussed. The research explored staff responses to a formulation based upon a psychodynamic ward observation study for the initial evaluation of the psychodynamic method of observation. Data from staff discussions of the formulation during two away days was analysed using thematic analysis (Braun & Clarke, 2006). Six main themes were created to describe the different responses staff had. Staff engaged selectively with ideas in the formulation. Some responses appeared to confirm parts of the formulation, whereas other responses were considered potentially valuable for re-formulation. It was hypothesised that findings showed some preliminary evidence of the validity of the psychodynamic observation method. This was discussed with reference to the psychotherapy literature. A critical appraisal is included which describes the researcher’s reflections throughout the research, particularly influences on the process of analysis of data.

This study investigated two cases in Scotland and Japan regarding government nursing workforce policies related to recently qualified nurses (RQNs) and the responses of clinical practice to these policies. Comparisons of findings and results between Scotland and Japan were made. Mixed methods were used including questionnaires (adapted POWCS and PES-NWI) and semi-structured interviews. In Scotland, five NHS managers, seven ward managers, and nine RQNs participated for the semi-structured interviews. A total of 119 Scottish RNs participated for the questionnaires. In Japan, seven nurse managers, six ward managers, and six RQNs participated for the semi-structured interviews. A total of 83 Japanese RNs responded to the questionnaires. In Scotland, three government initiatives related to RQNs for the last 5 years were identified; ‘One Year Job Guarantee’, ‘Flying Start’(FS), and ‘Early Clinical Career Fellowships’(ECCFs). Several responses in clinical practice to these initiatives were identified from the interviews and questionnaires. Firstly, FS and ECCFs were understood as ‘good support’ by managers and RQNs. However, RQNs did not find FS helpful for supporting their transition process. Lack of engagement and poor understanding among RNs was found to be an issue as well as a lack of evaluation and tracking system for FS and ECCFs on completion of the programmes In Japan, two major legislative changes related to RQNs for the last 5 years were identified; change in the Medical Care Fee Schedule for Remuneration and change in ‘Public Health Nurses, Midwives, and Nurses Act’ and ‘Nurse Provision Act’. An Increased number of RNs in the study hospitals was reported as an outcome for the Medical Care Fee Schedule for Remuneration. The increased annual inflow of RQNs caused issues such as increased workload for experienced nurses as well as a lack of the ability of experienced nurses as clinical educators for RQNs. Lack of funding and resources were found to be key issues for maintaining nurse staffing levels as well as the lack of a monitoring system for Japanese nursing workforce such as registration system. Findings from this study suggested several factors for better policy development and implementation related to RQNs in Scotland and Japan; 1) there is a need to establish an evaluation or monitoring system for government initiatives in both countries, 2) the importance of developing and implementing nursing workforce policies without large fluctuations in nursing workforce was highlighted, 3) the Japanese government needs to develop more integrated nursing workforce policies, 4) the importance of having engagement from RNs with policies related to clinical practice was reported, 5) finally, this study suggests that Scottish and Japanese governments need to keep the attempts to sustain the changes by previous policies. The findings added to the current knowledge by providing the insight of each country related to recently qualified nursing workforce policy from two single case studies.

A longitudinal constructivist grounded theory study was undertaken in Scotland with the aim of exploring the on-going perceptions and experiences of HCAs and PNs withinGeneral Practice following the introduction of the HCA role. Data collection and constant comparative analysis took place within two contrasting regions in Scotland over a two year period with each participant. An emergent theory oF HCA role growth and identity was identified.

Recent UK health policies have identified nurses as key contributors to public health strategies to reduce health inequalities, on the assumption that all nurses understand and wish to contribute to the public health agenda. Following the policy shift, public health content within pre-registration nursing curricula increased. Public health nurse educators come from varying backgrounds, and some had limited formal public health training or involvement in or understanding of policy required to contribute effectively to it. However, their knowledge of this subject, their understanding and interpretation of how it could be taught, was not fully understood. This research aimed to understand how public health nurse educators' (PHNEs) professional knowledge could be conceptualised and to develop a substantive theory of their knowledge of teaching public health, using a qualitative data analysis approach. Semi-structured interviews (n=26) were conducted with higher education institution-based PHNEs. The research concluded that PHNEs are embodying knowledge in teaching through critical pedagogy, which involves them engaging in transformative, interpretive and integrative processes to refashion public health concepts; this requires PHNEs who possess a vision of what to teach, know how to teach, and are able to learn from experience. Their vision of public health is influenced by social justice principles in that health inequalities, socioeconomic determinants of health, epidemiology, and policy and politics are seen as essential areas of the public health curriculum. They have developed appropriate critical pedagogical practices to make these concepts intelligible to students, and teaching strategies which put greater emphasis on students' engagement with them, allowing students to recognise the connectedness of public health with their lives. They believe in forms of teaching that achieve social transformation at individual, behavioural and societal levels, while also enabling learners to recognise their capacity to effect change and to reflect upon their own and others' experiences in their teaching practice.

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This thesis is about policy instruments for the regulation of international labour mobility. It focuses on the use of government-to-government agreements on the cross-border movement of nurses, negotiated between source and destination countries. This research is a qualitative case study of agreements signed in the early 2000s between the UK and Spain, South Africa, the Philippines and India. It aims to understand the role of these agreements in British policy as perceived by actors in the destination country. It addresses three questions: 1) What types of agreements did the British government negotiate? 2) Why did the British government negotiate these agreements? and 3) What functions did these agreements perform? Employing the notion of ‘policy tools’ as an organising concept, this thesis’s analytical framework draws on political sociology and the conception of policy instruments as being composed and brought into existence by actors and their power relations in multilevel policy contexts. This study is based on documentary analysis and elite interviews with experts in international organisations, officials in the Department of Health (England), recruitment officers in the source countries, and professional nursing organisations and trade unions in the UK. This thesis argues that government-to-government agreements between the UK and supply countries emerged from a discourse on the ethical recruitment of health workers which was framed in the language of human rights. One of the roles of these agreements was to contain contradictory and conflicting interests between and within institutional actors involved in the international recruitment of nurses on both sides of the migration process. More broadly, the research addresses and advances the discussion of the policy instrumentation approach, and contributes to the understanding of the choice of policy tools and their performance in an ambivalent policy context.

This thesis is about patient/nurse interaction in a community practice. My aim is to advance sociologically informed understandings about patient/nurse interaction. The key areas of inquiry in my grounded theory study are: The meanings and understandings expressed in patient/nurse interaction. The influence of socio-cultural characteristics in patient/nurse interaction. My study was conducted in a community practice setting using the traditional discovery methodology of Glaser and Strauss (1967). The community practice setting is four health centres with social and geographical differences. The participants in the study are patients attending those health centres and practice nurses who work there. Research methods are observations, informal interviews and semi-structured interviews. Constant comparative analysis supports my research process. My substantive theory is constructed from the generation of two categories: Investment and Experience. The category of Investment relates to the social assets and resources brought to patient/nurse interaction. The category of Experience relates to the historically crafted meanings and understandings that individuals bring to patient/nurse interaction. Together, these categories contribute to understandings of patient/nurse interaction in a community practice setting. I argue in this thesis that the meanings and understandings that patients and nurses bring to interaction provide the social dimension that is quintessential and foundational in their relationship. I also argue that the social construction of reality of being a patient or a nurse is related to the socio-cultural characteristics that they bring to their performance in patient/nurse interaction. I show that performance as a patient or a nurse is initiated and achieved via processes of acting and reacting to each other in relation to socio-cultural characteristics. I demonstrate that the meanings and understandings patients and nurses generate from experiences beyond and including their situated need/care interaction are pivotal in the negotiation of their relationship. Empowerment plays a central role in processes of negotiation and is connected to the social construction of reality in patient/nurse interaction. My substantive theory contributes to understanding of patient/nurse interaction and raises the visibility of negotiation, empowerment, and the influential role of socio-cultural characteristics. The implications of my substantive theory relate to the involvement and participation of stakeholders in health care practice and delivery. In nurse education, the standards of proficiency for eligibility to register with the NMC should be revised to include the social dimension of patient/nurse interaction as a domain of practice. I conclude by arguing that sociologically informed understandings need to be expanded and applied in health care and nursing with contemporary social policy and current priorities for health in mind.

The employment of registered general nurses (RGNs) is underpinned by management’s need for economic utility in that the cost of salaries must be reconciled with the need to meet the demands inherent in service provision. Using grounded theory, interviews captured the experience of physically disabled RGNs, who use the phrase ‘physically disabled’ to describe themselves. Their collective experience was then compared with nondisabled RGNs working in the clinical areas of general medical wards, general surgical wards, and day case units, situated in three district general hospitals. Data collection was by partial participant observation, and interviews. The data revealed that both nurseinterviewee groups share an understanding of the meaning of health and illness. Both the physically disabled and non-disabled RGNs manipulate working time to take unauthorised breaks in order to ‘accommodate tiredness’ and ‘stamina lack’. ‘Accommodating need’ is the identified basic social process (BSP) and ‘pacing’ is the identified core category. RGNs distinguish between using a ‘public’ voice and a ‘private’ voice. In respect of a physically disabled RGN ‘doing nursing’, the data uncovered stigma relating to a spoiled identity. Theoretical sampling interviews with senior nurse managers, occupational health doctors, and trade union officials (termed ‘elite groups’), reflected the data findings of both the physically disabled, and non-disabled RGNs, in identifying the factors limiting the employability of physically disabled RGNs. Moreover, data from the elite group interviews revealed the importance of economic utility, in that management has to take account of diminishing returns. This is the crux of the employment issue. ‘Maintaining organisational pace’ is the generated grounded theory, and was confirmed by aligning data to the established literature on Labour Process Theory (LPT) in a supplementary theoretical sensitivity validation process.