Background: Person-centered ness within care relationships has received considerable attention in nursing literature, research and healthcare policy since the turn of the century. Concept analyses and conceptual frameworks have been developed and it is considered by some a core value that when enacted forms an essential attribute of effective workplace cultures. However, there has been no exploration of person-centeredness within clinical nurse leadership relationships. In an era of competing needs and dwindling resources traditional hierarchical and autocratic styles of leadership have been shown to be inadequate, but continue to persist, especially in healthcare settings. Whilst a relational approach to leadership is being propagated and showing positive outcomes, the majority of models referred to were developed outside a healthcare context. This study set out to explore and develop the concept of person-centred leadership within a nursing context. Aims and research questions: Having negotiated conducting a three year study with stakeholders, we set out to find answers to the questions: "What is person-centred leadership? How can it be developed?" The primary aim was to explore person-centred leadership as it was developed in collaboration with a nurse leadership team of a ward in a Dutch urban general hospital. Approach and methods: A critical participatory action research methodology was chosen to enable research done with rather than on leader participants and other stakeholders. The initial orientation phase explored care and leadership relationships using patient and staff narratives alongside participant observation. Narratives were critically and creatively analysed with participants and after combining with other data sets, the whole team reviewed results and identified issues for action. Four action spirals structured the rest of the fieldwork. A critical and creative reflective inquiry method was designed to facilitate leader exploration of the lived leadership experience. A new nursing system based on primary nursing was implemented. Participant leader facilitated storytelling sessions with staff were set up and self-reflective inquiries were conducted. Collected data was thematically analysed post fieldwork and member-checked.

Medical students are able to take a year out to intercalate and study another subject during their medical degree. They may choose one that is informed by subjects that have different epistemological traditions to medicine, such as the social sciences. The aim of this study was to explore medical students' experience of intercalation in international health (an exemplar of a degree that includes social science components) and of their return to medical training. It is important to understand this multi-epistemic journey, as integrating social science teaching into the medical curriculum is currently advocated as one of the means with which to produce doctors who can practice with a global remit. The study adopted a constructivist perspective and a longitudinal design. Data were gathered via informal interviews (conversations) with and emails from six medical students in one university in the UK over a three year period during and after intercalation in international health, and from two students during their first year as junior doctors. The methodology adapted Douglas Moustakas' heuristic enquiry (Moustakas 1990) and incorporated narrative methods to preserve the student voice during data analysis and interpretation. The main findings were that following an intensive exposure to other disciplines' ways of knowing these medical students had some problems of reintegration and that the term "hippy doctor" was used to describe this experience. Whilst they sometimes struggled to bring together different ways of knowing and apply these to clinical medicine, these students also provided accounts that showed that such multi-epistemic experiences appear to make a valuable contribution to students' overall education and identity formation. The findings suggest that medical educators would benefit from paying attention to students' experience of crossing epistemological boundaries and to the potential of this hybrid space to support their development as doctors.

No description available.

The overall argument in this thesis is that the ethico-political aspiration to . professionalism eludes any particular instantiation but that narrative practices , of improvisation serve to realise such aspirations even while questioning the givens of received instantiations of professionalism and policy- led interventions. As such they are also serviceable as resources for research and professional education. The purpose of the research was to examine professionalism in the context of education for workforce development in the National Health Service (NHS) to develop the role of the Advanced Practitioner (AP) through a work-based Masters degree programme in partnership with the researcher's employing University. The research engaged critically with debates within the literature concerning professionalism and identified methodological debates and approaches to the examination of the achievement of professionalism in the current context of public sector reform. It established that received notions of professionalism linked to definitions of profession and professsionalization ,are inadequate to conceptualise the ethico-political task of achieving professionalism in this context. It aimed to provide empirical evidence and theoretical argument to show how professionalism can be conceived and realised under these conditions. The methodology adopted hermeneutic and ., narrative methods of enquiry for analysis of accounts of students and lecturers participating in the delivery of the AP masters programme. The r findings of the research built upon identification of improvisation as a core sensitising concept which was then further detailed as narrative practices of achievement. Analysis of these accounts identified two broad approaches to the achievement of professionalism characterised by different stances in respect of how the ethico-political enterprise is conceived in practice: for 'modernisation' , improvisation is an unfortunate fall-back position in the project of seeking occupation of a strategic position; alternatively, 'improvisation' provides the possibilities for achieving professionalism notwithstanding received notions of professions, professionalization and modernisation in the current context of workforce development and neoliberal reform of public services.

The history of nurse education is one of conflicting claims regarding what it is a nurse needs to know. Perceived deficiencies in standards of nursing care whether in the past or present, have often been attributed by medical doctors, those responsible for policy at governmental level, the media and the general public, as resulting from either a deficiency or perhaps, too great a proportion of, 'theoretical', 'practical' and, 'moral and spiritual' knowledge in nurse training curricula. This thesis is concerned with tracing the history of the debate through examining the evolution of nurse education policies and the discussions which have shaped them. The analysis is carried out within a framework constructed using all three 'types' of knowledge, which are later analysed to determine what they might mean particularly in respect of nursing practice. As part of the assessment of the merit of the arguments regarding the weight to be given to these forms of knowledge in nurse education, the issue of what a contemporary nurse might be and therefore need to know is also addressed. Finally, and despite an initial tacit acceptance of the existence of these distinct 'types' of knowledge, this thesis raises questions about whether knowledge can be divided in this way. It argues that to do so is, at best, unhelpful and constraining in the designing of curricula for the education of nurses - indeed at worst, it is divisive of the profession and its educators and may have negative implications for the welfare of patients.

The General Medical Council (GMC) is the UK's independent regulator of doctors, ensuring that proper standards in the practice of medicine are maintained to safeguard the public. The GMC sets and accredits the undergraduate medical curriculum in the UK as detailed in the Tomorrow's Doctors documentation. This specifies the standards of professional behaviour to be delivered as part of the undergraduate medical curriculum. Tomorrow's Doctors (GMC, 2009) places emphasis on the use of formative and summative feedback, with students' knowledge, skills and professional behaviours being assessed as part of their learning experience. Peer assessment has emerged as an effective mechanism for delivering feedback on professional behaviours (Schonrock-Adema et aI, 2007). However, clear guidance from the GMC on how to incorporate peer feedback on professional behaviours in the undergraduate medical curriculum is absent. This thesis will examine different ways that peer feedback on professional behaviours can be incorporated within the existing curriculum at the University of Liverpool with reference to the latest GMC guidance and the views of staff and students. The research used a social constructionist approach informed by action research theory (Carr and Kemmis, 1997). This sociological approach aimed to produce recommendations for curriculum change that were relevant and achievable. The interpretation and analysis of data is presented to highlight how peer feedback on professional behaviours is and can be incorporated into the undergraduate medical curriculum at Liverpool, other medical schools regulated by the GMC, and related medical and health care courses. The study population consisted of two undergraduate medical student cohort groups in their second year of study (2007/8, 2009/10), contemporary Problem Based Learning (PBL) and communication skills tutors. A mixed methods research methodology was employed using qualitative and quantitative methods in the form of interviews, online surveys and Problem Based Learning (PBL) evaluation data to elucidate the mechanisms that exist in relation to peer feedback on professional behaviours. The thesis demonstrates what students and staff think of peer feedback generally, and how this would fit into the delivery of PBL with reference to current GMC guidance. Recommendations are made for how peer feedback could fit into the Liverpool - and other - undergraduate medical curriculums. By examining the same material from different viewpoints, the research has produced a set of methodological triangulated qualitative data to provide detailed information about the peer feedback of professional behaviours. Tutors and students expressed some concerns about the delivery and use of peer feedback on professional behaviour but did appreciate the value of these comments for reflective learning. The results suggest a formative model of peer feedback on professional behaviours supported by training for students and tutors would be the most effective way to implement this aspect of curriculum change. This model should link to the communication elements of the MBChB course explicitly referring to outcomes of GMC guidance.

The aim of this research was to explore professionalism in medical educators, mostly from a primary care background, in a mixed method research design. Previous research on profesSionalism has focused on medical students and doctors. However medical educators are responsible for teaching professionalism to medical students. Professionalism is a complex and developed state, which must be explored in context to a specifiC role. This study was an exploratory sequential mixed method research design, with two distinct phases. The first was a qualitative phase involving exploration into the concept of professionalism within the doctors' role of a medical educator. This exploration inCluded a literature review and open-ended survey on professionalism, which led to the development of a model of professionalism for medical educators. The second phase involved the design and piloting of a tool, the Professional Reflective Enrichment Tool (PRET), that could be used to enhance professionalism in medical educators, using the model developed in phase one to structure the tool's development. The model of professionalism offered a unique insight into the medical educator's role. In this research, a resource to encourage reflection was used to enhance aspects of professionalism. Reflection was encouraged by developing a series of scenarios, based on the model, designed to pose professional dilemmas. Formative feedback was provided based on this reflection. The PRET was piloted using both assessors and users. A high multi-rater reliability was found. The pilot testing used 53 medical educators, 75% of whom were from primary care. A three-stage model of reflective thinking was developed using existing, tested models of reflection to structure formative feedback to the PRET. Qualitative data comments indicated that the PRET did promote a state of reflection and that the formative feedback was useful. This research offers a unique resource to encourage reflective thought and professional development in medical educators. By providing a structure to this thought the educator is able to apply the resource to their own practice, in personal reflection and implicit or explicit teaching methods.

In this thesis I explore the development of professional identity in general practice (GP) training from a number of complimentary angles. The first of three studies is a scoping review of the literature on professional identity in postgraduate medical training. The second is an analysis of cross-sectional interviews with GP trainees shortly after beginning GP training. The third is a longitudinal case study of a single GP trainee over a two year period. The second and third studies use experience centred narrative analysis with a sociocultural framework, with a strong orientation towards lived experience. GP trainees navigate a rocky road through a shifting cultural landscape. They are positioned as outsiders within hospital, and construct an alternative community of practice outside the boundaries of their daily work. GP training offers a special case within medical training. Educators should support GP trainees during time spent training in hospital, ensuring they follow a curriculum orientated towards the community.

Professional development is an essential part of undergraduate medical training. Since the GMC’s (2003) document ‘Tomorrows Doctors’ underlined the need to provide support for medical students to monitor their progress as independent learners, reflective practice has become a significant aspect of medical student’s education and professional training. One method of supporting reflective practice amongst such students is the use of online discussion forums. However, the use of students as peer facilitators for online discussions in a medical education context is not well researched. Using such a student-centred approach, this two year multi-case study examined the use of Student Peer Facilitators for online group reflective discussion amongst third year medical students. A range of data collection methods was employed throughout the two years of the study. In the first year volunteer medical students were trained as Facilitators using generic group facilitation techniques (n=76). In the second year e-moderating strategies were incorporated into the training and preparation of Facilitators (n=79). To obtain medical students’ perceptions of this approach, quantitative and qualitative data was gathered through questionnaires, in-depth interviews and focus groups. Data was coded and organised according to the study’s research aims with interpretation of findings arranged by analytical themes, emerging theories and the study’s conceptual framework. The text output from sample online discussions (n=40) from both years of the study were also selected to explore the influence the Facilitators on the interaction amongst the sample groups. Primary methods included analyses of Cognitive, Social and Tutor presence levels in the online discussions as defined by the Community of Inquiry model devised by Garrison and Anderson (2000). Findings from the study suggest that as a pedagogical strategy, Student Peer Facilitators can assist in the development of reflective practice in online group discussion; the sharing of good practice; and creating a context to foster group collaboration and communities of inquiry. Introducing practical experience of e-moderating skills into the training of Facilitators showed marked enhancements in the online discourse within the three elements of the Community of Inquiry model. This was particularly visible within the Cognitive Presence levels analysed. By modelling these vital skills, it was possible for Facilitators to encourage other group members to emulate good practice in the online discussions. Other positive aspects of the amended training showed an increase in contributions from male participants to the discussions. Although students in this study noted several benefits in introducing the Student Peer Facilitators, various challenges were also observed including a perceived lack of ‘presence’ by Tutors; the social dynamics and learning culture peculiar to medical students, and building and sustaining an online learning community in a widely dispersed educational context. In this respect findings demonstrated the importance of embedding appropriate training and preparation into the introduction and delivery of Student Peer Facilitators to enhance the development of reflective discourse amongst online groups of learners.

In 2014, the NHS Five Year Forward View (FYFV) set out new models of care and care strategies. Amongst them was the introduction of the role of Assistant Practitioner (AP). The AP role was positioned at Band 4 (of 9) on the NHS Careers Framework, gained through the successful completion of a foundation degree (fd). Those already in employment accessed the fd through day release to university and work-place clinical skills development. A qualified AP would work under the supervision of a registered nurse. This thesis examines and centralises the experiences of ten Black British and Black Caribbean women’s experiences of the fd programme and its impact on their personal and professional identities. It (re)tells, (re)captures and (re)presents their accounts of getting in, moving on and getting through Higher Education. This study disrupts the silence of Black women in the NHS. Black Feminist Methodological Stance is put to work to centre and privilege Black women who transitioned through the research process unearthing, examining and unapologetically speaking their ‘truths’. The analysis is intentionally theoretically provocative, it uses performative autoethnograpy to present the voices of the women through characters in fictional settings. The characters use the works of predominantly Black philosophers to critically reflect on their experiences of education. Their exposures to philosophies and their sharing of life leads them to Black feminist epistemologies. This study demands engagement, it challenges all who access it, to come and reside in our spaces… to feel the discomforts… to rethink the stereotypes… to speak of the biases… then to co-align with us… it questions… challenges… and seeks honest approaches to fairness in nursing education and professions; two areas, where for seven decades Black women have been professionally subordinated and exploited. This thesis demonstrates the courage of the author to engage in research which breaks the silence of Black women in NHS and makes the theorised assertion of our ‘right to write’ as Black women about Black women. The presentation of the data as performance autoethnography, renders this work accessible to the contributors, as well as significant and important for academic scholarship. This study strives for engagement, it resists recommendations which, historically are ineffective liberatory tools of the master’s house, in that they fail to make a difference to the Black women’s assigned subordinated space. Finally, this work challenges Black women in the NHS to become active agents of their professional emancipation.