This thesis reports the findings of a study, which considered the impact of widening participation on the role( s) of a group of nurse teachers based at a School of Nursing. A single case study approach and semi-structured interviews were used to explore the perceptions of the nurse teachers. Subsequent thematic analysis enaJ:>led the identification of three key findings; the contribution of widening participation to the changing profile of pre-registration nursing students at the School of Nursing; the impact of widening participation on the nurse teachers teaching, clinical and personal tutor roles and the nurse teachers' acceptance that, currently, widening participation has a contribution to make to the School of Nursing. Some secondary themes emerged within the key findings and suggest that nursing was perceived as being devalued by the influx of students from alternative entry routes. Additionally, the findings highlighted that nurse teachers' considered increased student numbers had a negative impact on many aspects of their roles, and relationships, with students and clinical placement staff. Finally, it was identified that the nurse teachers felt unappreciated by senior managers at the School of Nursing who, they perceived, had little insight into, or understanding of, the pressures and demand made on them. Integral to the study was the role of the 'insider' researcher. The study acknowledges the challenges faced by the researcher and the strategies incorporated to ensure a candid representation of the findings. The study concludes by offering some suggestions and recommendations for future practice and research.

Explanations hitherto forwarded for the underrepresentation of Asian people in health care professions such as nursing, have placed undue emphasis upon cultural factors as the main barrier affecting recruitment. In particular, the physical aspects of caring, the requirement to work irregular hours and the unsuitability of the uniform are thought to deter Asian young people from considering careers in nursing. These views are based largely on anecdotal evidence; there has been little attempt to examine how attitudes of Asian people towards nursing and other health care professions are mediated by factors such as gender, generation, ethnicity, religion and class background. In addition, there has been a failure to examine how wider structural factors, such as careers guidance and institutional recruitment strategies, affect career choices of Asian people. This study examines perceptions of nursing, radiography and physiotherapy amongst a cross-section of Asian young people and parents in a northern town of England. It also examines careers advice in relation to these careers. The study highlights considerable variations in attitudes towards these three professions along class, gender and religious lines. It shows that Asian students' views towards these professions are not wholly dissimilar to those of their white counterparts. It identifies, however, that Asian students could be further discouraged from considering these health care professions due to limited opportunities for work experience, few Asian role models and low levels of awareness about entry requirements.

New graduates’ transition into the workplace is a critical period and workplace learning during this period is under- researched, particularly for people coming into newly emerging professions such as Patient Educators. The aim of this thesis was to explore Patient Educator Interns’ (PEIs) experience of learning during internship. In this case study from the Kingdom of Saudi Arabia, semi-structured interviews were conducted with 10 PEIs. Following a narrative analysis, case summaries were developed, compared and interpreted. The study’s findings showed that being from a newly emerging profession can exacerbate the transition shock experienced by new graduates, as PEIs experienced additional challenges resulting from being new as a profession in the work force. The sociocultural element of transition shock was significant among those study participants who found it hard to settle in a workplace when they did not feel that they were formally recognised. The intellectual element of transition shock was evident in the rigid understanding which PEIs held about the role of patient educators. Finally, the concept of epistemological transition shock was introduced in this thesis to describe the challenge which PEIs experienced as a result of the shift from the formal learning given in educational institutions to learning which takes place in a working environment through engaging and participating in practice. This new understanding has implications for new graduates’ making the transition to practice in a range of professions. PEIs learning experiences were seen to be influenced by three factors; PEIs’ understanding of their role, PEIs’ relationships to others, and PEIs’ understandings of learning. These factors were distilled into two issues; professional identity and personal epistemologies. These issues should be taken into account when developing educational policy, particularly,when introducing a new professional discipline, and when enhancing learning in the workplace.

This Doctoral of Philosophy program aimed to evaluate an initiative to foster knowledge translation through a national, interactive, and distant continuing education program based on an evidence based medicine point-of-care information service. It further explored the quality of the contents used in ECCE as compared to its market competitors (i.e. other evidence-based practice point-ofcare services). Our randomised controlled trial of nearly 200 physicians revealed little evidence for a difference in the health care knowledge of physicians who were exposed to versus those who were not exposed to contents derived from a point-of-care service. These results suggest that changes in behaviours, a direct consequence of changes in knowledge, may be difficult to obtain or might not be attainable at all, at least when a single continuing medical education program is implemented for short time period. In terms of determining the best available online resources among the 18 authoritative point-of-care services for guidance in clinical decision making that were assessed, only a minority satisfied the quality criteria (coverage of medical conditions, editorial quality, evidence-based methodology, and speed of updating), with none excelling in all. Publishers should continue to invest in the development of such products and improve their efficient use in continuing educational programs. These results might influence how international research and editorial groups that advocate evidence-based decision-making and evidence syntheses think about dissemination.

A review of normative literature, in the field of Electronic Learning (e-learning) implementation, indicates that traditional approaches to e-learning implementation in higher education have failed to result in cost effective, integrated and sustainable learning environment. In addressing this issue, a new movement called Open Source (OS) has emerged and addresses most of traditional e-learning application by resulting in the development of reusable and manageable platforms. The use of Open Source E-Leaming Applications (OSELA) in Higher Education Institutes (HEI) is a new research area with many research issues needing to be investigated. At this end, OSELA adoption has not efficiently studied with HEI and researchers needing to understand and analyze OSELA adoption. This work examines the introduction of Open Source E-Learning Applications in Higher Education Institutes and proposes a novel model for its adoption. The model is based on a comprehensive set of factors that influence the introduction of OSELA in HEI.The work is based on a qualitative case study approach to examine the concepts of the proposed model for the adoption of OSELA. In doing so, three case studies were conducted in Medical Higher Education Institutions. The case studies were presented and analyzed. However, some modifications were made to the conceptual model as some complementary factors emerged during the empirical research. The main factors that influence the adoption of OSELA are: (a) costs; (b) benefits; (c) barriers; (d) external pressures; (e) support; (f) level of IT sophistication; (g) limitations of existing IT infrastructure, (h) internal pressure and, (i) an evaluation framework that supports higher education institutes to assess OSELA.The proposed model makes novel contribution and can be used as a decision-making tool to support management when taking decisions regarding the adoption of OSELA. Additionally, it can be used by researchers to analyse and understand the adoption of Open Source Software for E-learning.

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The knowledge needed for nursing practice has long been a contested and divisive issue among nursing scholars and nurse practitioners. Professional knowledge in nursing is recognised as complex and multifaceted, drawing on many different sources. Throughout the history of modern nursing, as the profession attempted to establish itself as a discipline in its own right, various movements in the development of nursing knowledge may be identified. From an earlier era of grand theories to evidence-based practice in more recent times, the nature, origins and scope of nursing knowledge remains a source of on-going debate and discussion. Reflective practice has proved to be a very popular model of professional knowledge in nursing since it first appeared in the literature in the 1980s. Its appeal for nursing may be understood in its valuing of practice knowledge and the possibility of generating knowledge from practice. However, despite the appeal of reflection as an epistemology of practice in nursing education, the term is understood in many different and sometimes contradictory ways. This aim of this study is to examine the textual construction of reflective practice as a model of professional knowledge in nursing education. Since knowledge in many disciplines is textually mediated, a consideration of the language in which knowledge claims are made seems apposite when a concept is contested. Deconstruction consists in a close reading of texts, not with the aim of understanding the meaning of a text but with the aim of understanding how meaning is constructed, in particular, the resources of language that are used and the effects thereby created. This deconstructive reading reveals a concept that never fully coincides with itself. Reflective practice as a model of professional knowledge in nursing education is never punctually present in the texts that strive to construct its identity. The identity of reflective practice appears deeply saturated by its so-called binary opposite. Such a reading does not claim to be the "truth" of reflective practice. It does, however, permit the concept to be considered and understood in a different way and that, I should contend, is what reflective practice is all about.

Objectives: Patient involvement in primary care research is often hindered by confidentiality concerns regarding the use of their identifiable medical records. Consequently there is no universal 'pre-consent' process in England, whereby patients provide prior informed consent for their identifiable data to be accessed for different research purposes. This mixed-methods two-phase study investigated patients' opinions about this proposed 'pre-consent' process and the effectiveness of different invitation methods. Methods: Phase 1 used cognitive and semi-structured interview methods to optimise recruitment documents for, and ascertain participants' attitudes towards, providing an informed consent decision for the 'pre-consent' process. Phase 2 tested the feasibility of different recruitment documents ('standard' and 'modified') and invitation methods (postal, consultation and new) to determine the most effective in terms of allowing patients the opportunity to provide an informed consent decision. Results: Phase 1: Readability of the 'standard' recruitment documents impacted on participants' abilities to provide consent decisions, consequently a 'modified' version was created using participant feedback. Opinions about the 'pre-consent' process were chiefly affected by an individual's personal attitudes; key findings were 'data security' concerns and 'public benefit' motives. Phase 2: Recruitment documents affected response rates, with patients that received 'standard' documents 43% less likely to re~pond than those receiving the 'modified' documents. Postal, consultation and new invitation methods biased the types of patients invited, the number and types of patients responding, and the consent levels provided. Of the 2550 patients invited to participate in the 'pre-consent' process, only 30% (n=767/2550) responded, undermining the feasibility of this process. Discussion: The 'pre-consent' process seems currently unfeasible. However, engaging with the public to identify the most effective recruitment documents, invitation methods and consent options could streamline research in primary care. These approaches, employed on a study-by-study basis, would ensure primary care research remains cost-effective and representative of the general population.

Nurse education has altered considerably in the past 30 years. The combined demands of a growing population with diverse health needs and an expansion of career opportunities for those traditionally recruited to nursing have made it increasingly difficult to recruit and retain a viable workforce. At the same time pressure to establish nursing as a profession has influenced how the nursing curriculum has been delivered. Schools of nursing are now established in universities and away from clinical control. However, the retention of student nurses has remained an issue for many universities and studies have identified that students are particularly at risk of leaving around the time of their first practice placement. Whilst underlying factors associated with either the student or the practice environment have been identified which may be predictors for attrition at this time, no studies have given detailed consideration to the way students cope with the process of transition from the academic setting to the practice setting. This thesis aims to research and understand how first year student nurses manage the transition into their first practice placement and studies this process through the lens of human, social and identity capital theory. Questionnaires were used to collect the initial data from an entire cohort of first year student nurses. These data were then explored in depth via face to face semi-structured interviews with 20 of these students. The findings show that the transition process is highly complex and stressful for the student. It has been made more difficult by the separation of academic and practice settings. As a result students are expected to adapt rapidly to a strong occupational culture as they enter the practice setting. In order to do this they rely heavily upon building human, social and identity capital. The students who struggle and falter at this time appear to be those who lack the skills or support they require build capital successfully. These findings have significant implications for nurse educators who must consider how a student’s abilities to build and exploit capital can be encouraged within the nursing curriculum.