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Background: Many countries have identified a lack of leadership skills among nurse leaders. To develop these skills, Basel University Hospital in Switzerland adapted and implemented the RCN Clinical Leadership Programme (CLP). Aim To evaluate the impact of the CLP on the development of leadership competencies of nurse leaders. A specific focus was on the development of a vision and its effect on practice development (PO). Methods: The study was a mixed-methods design with a sequential explanatory approach. In a one-group pre-test-post-test quasi-experimental design, a convenience sample of 14 ward leaders was assessed three times using the Leadership Practices Inventory (LPI). Individual interviews (n=6) and focus groups (n=4) were then undertaken with a selection of ward leaders and their teams. Descriptive, inferential and content analysis techniques were employed as appropriate. Results 420 LPI-Observer-, and 42 LPI-Self-assessment questionnaires were distributed and the response rate was 406 (96%) and 42 (100%) respectively. Nurse leaders demonstrated significant improvement in two subscales: 'inspiring a shared vision' (self p=0.011; observer p= 0.015) and 'challenging the process' (self p= 0.004; observer p= 0.047). Interviews also evidenced growth and development of the leaders which enabled them to build trust and interact in a more facilitative way with their teams. Leaders described the development of a vision as a creative, joyful, timeconsuming and nonlinear process. They applied different approaches and experienced enabling and hindering factors. Having a vision helped leaders and teams to become inspired and committed to a shared goal. Moreover, the vision was a strong driving force for PO and thus established a culture that favoured quality and safety improvement. Conclusion: This study demonstrated improvement in leadership practices of nurse leaders following the CLP. Moreover, it identified factors that are crucial to vision development, which should be considered when planning educational programmes

Aim: The research study sought to examine qualified registered nurses' attitudes towards and understanding of nursing theories, models and care planning in Scotland. Problems have been identified with the attitudes towards and understanding of nursing theories and models as well as the implementation of care planning. This is perceived as affecting the way care is carried out. Method: Qualified registered nurses' attitudes towards, understanding and knowledge of nursing theories, models and care planning in two regions of Scotland were explored. Data were collected through a questionnaire. Findings: The data suggest that there are five factor analysis themes (Enabling Theory; Caring Practice; Negative Doing; the Encompassing Nature of Nursing and Apprenticeship) concerning with nursing theories, models and care planning. These had some similarities and some differences with Benner and Wrubel's (1987) and Glen's (1998) ideas about these areas of nursing. There was a significant level of dissatisfaction with the education around care planning with more than half the respondents indicating that they had received no such training. The qualitative findings provided a more detailed picture of the quantitative results and showed that there are five groups of nurses where caring practice is involved. There was also uncertainty and confusion about whether or not nursing is an art or a science and a lack of knowledge about the issues surrounding models, theories and care planning. There is a negative attitude to care planning that specifically relates to the doing of care planning. Conclusions: There is a need to encourage the development of education about nursing theories, models and care planning for all nurses in all clinical areas because, despite the lack of credible evidence for them, there is an expectation by senior nurses that they should be used in practice.

This thesis describes learning, organisafiond change and personal development in a context of Action Learning whilst establishing consultative approaches in diabetes nursing. The main contention of the thesis is that many people with diabetes have complex needs and these needs are often not met by conventional care delivery approaches. However, using established research methods with a foundation of Action Learning I desigrfed, tested, implemented and evaluated a new paradigm of diabetes care delivery. This paradigm is an Innovative model of diabetes care delivery which is patient centred, orientated and driven, and which uses motivational interviewing philosophy as its guide. It brings the patient and health care provider into a close working partnership that Is attractive and mutually beneficial.

The doctor-nurse relationship can impact on the nurses' decision-making capacity, yet very little is known about this relationship in the field of dermatology. This thesis provides an insight into the doctor-nurse relationship in the highly specialised area of dermatology, exploring how doctors and nurses make decisions about patient care, specifically, who made the decisions, and when and where the decisions were made.

A central concern of this research has been to understand more about how and why organisations change. My initial research question posed was: What is 'strategy', how does it emerge in health care organisations and how can I influence its development? This is explored within the context of my field of practice as a Director of Nursing in a National Health Service (NHS) Trust. I have approached this enquiry through using a methodology known as emergent exploration of experience (Stacey et al., 2003). This methodology is informed by insights from Complexity Science and the theories of complex responsive processes of relating. What emerged through the enquiry were a number of key areas of concern related to national healthcare strategy and the management of risk within my NHS trust. The findings from this research radically challenge the way we are practising together in my organisation in moving from the position of locating accountability for mistakes with either the individual or the system. Instead it is suggested that, as part of our ongoing process of interaction, we co-create what others are describing as a 'system' through our participation with each other. Accepting the notion of co-creation requires us to examine very carefully the influence of our own participation in the dangerous situations that arise in our everyday work, and to acknowledge our own accountability for what emerges. I am proposing that this makes a new contribution to knowledge in this field for two reasons. First, because it explores for what I believe to be the first time the validity of the theory of complex responsive processes in the discourse of risk management in health care. I am proposing that this theory has a legitimate contribution to make in this field of practice, that is worthy of further enquiry and research. Second, in making this shift to a perspective that understands accountability for error as something that we co-create in groups, my thesis poses a radical challenge to many of the activities that are traditionally undertaken when mistakes occur in organisations. Specifically, I have questioned the usefulness of approaches that seek remedies through focusing on individuals outside the context of the group and those that focus on re-engineering what other authors refer to as the 'whole system'. I offer an alternative through describing examples in my narrative of a different approach grounded in the research methodology of emergent exploration of experience. This focuses on the micro-interactions between participants in groups as a way of understanding the transformation of practice .I am arguing that such transformation may not always be an improvement, because we cannot always accurately predict the outcomes of our actions in advance. This perspective therefore also challenges the assumption made by some authors in this field, who believe it is possible to 'human-proof' systems and thus guarantee ‘zero defects'. In seeking an answer to my research question I have therefore moved from understanding strategy as a vision for the future that can be planned and implemented by a few powerful individuals whom others follow to a different understanding. I now see strategy as an emergent phenomenon arising from micro-interactions between people in the present – hence we co-construct our future as the actions we take in the present. From this perspective I have argued we all have the potential to influence what is emerging through our actions, for which we are constantly held to account, through both our inner dialogue with ourselves and our conversations with each other.

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