Peer learning has been successfully introduced into professional education within the practice setting (Secomb 2008). This thesis provides a chronological narrative presentation of a qualitative case study that evaluated an interprofessional peer learning programme designed to consolidate communication skills and develop interprofessional understanding among physiotherapy and nursing students. The peer learning programme was implemented with two different groups of students over two four week periods when nursing and physiotherapy students overlapped during routine placements. It enabled students placed within the same hospital but in different clinical environments to work together in both a tutorial setting and on patient centred tasks. This included verbal peer review of interpersonal communication skills in both tutorial and practice settings. The theoretical framework for the research was provided by cooperative learning, with a conceptual framework provided by social interdependence theory. Ethical approval for the study was obtained from the University and NHS Research Ethics Committees. The peer learning programmes were implemented and evaluated between May and December 2007. Data collection included validated UWE Interprofessional Questionnaires before and after the programme, concurrent reflective diaries and semi-structured interviews following completion of the peer learning programme by students. Semi-structured interviews with clinicians involved in facilitating the programme along with RIPLS questionnaires were also gathered. The interviews and reflective diaries were analysed using an inductive thematic analysis (Coffey and Atkinson 1996), single case study sheets were used to summarise data and a cross case analysis matrix (Stake 2006) was adopted. Data analysis identified the focus on interpersonal and interprofessional communication skills was relevant for students at all levels; it complemented placement learning and enabled students to cooperate in practice and develop greater insight into each other’s role. Interprofessional peer observation and review within both tutorial and practice settings were found to be appropriate educational strategies. All agreed it was not threatening; it was valuable in gaining insight into another profession and for consolidating own professional knowledge. Students valued undertaking patient centred tasks together although an appropriate level of challenge and mentor support was required. The case study also discusses the use of the cooperative learning framework adopted to minimise known challenges associated with peer learning (Secomb 2008, Ladyshewsky 2000). A case is made for principles associated with cooperative learning to be more widely applied to practice

The aim of this anthropologically informed qualitative study was to explore the primary cultural issues in mental health student nurses’ clinical placements and to explore how these issues in placements were dealt with, from the perspectives of years two and three mental health student nurses and their undergraduate university nursing educators. ‘Critical incident’ (Fitzgerald, 2000) focused ethnographic interviews (Spradley, 1979) were undertaken with a self-selected and purposive sample of 36 second and third year mental health nursing branch students, and 7 undergraduate mental health nursing branch educators across four nursing education centres in northern England. Member checking at descriptive and analytical levels was carried out, and these checks allowed for further exploration with the research participants to take place. Thematic analysis revealed that the primary issue to emerge from participants’ ‘critical incident’ accounts of cultural issues in clinical placements were problems with differentiating psychopathology from culturally validated phenomena. This issue relates to the clinical anthropological concept of the ‘normative uncertainty’ evaluation dilemma (Good and Good, 1986), and was particularly associated with concerns around assessing the clinical significance of service users’ religious beliefs, experiences, or practices. The clinical implications presented by this dilemma seemed to be exacerbated by a shortfall in culture specific knowledge, structural organisational issues, and the professional ideological orientation of the placement setting. Whilst the participants mentioned some strategies for dealing with the ‘normative uncertainty’ evaluation dilemma, one of the key lessons to be drawn from the ‘critical incident’ data is that student nurses and their colleagues in clinical placement should be encouraged to view the experiences of their service users in context. In the absence of previous empirical research on the ‘multicultural clinical interactions’ (Fitzgerald, 1992) of mental health student nurses, this explorative study clarifies the importance of cultural issues and the theoretical base of clinical anthropology and cultural psychiatry to mental health nursing.

The thesis considers the views and experiences of nurse leaders and policy-makers on the use of EU accession as a policy window to advance a professional agenda in Romania and Croatia. The research question and objectives are designed to identify the policy context prior EU accession, the processes and mechanisms employed to achieve compliance with Directive 2005/36/EC, the nursing policy agendas and achieved legislative and professional outcomes. They are analytically located within the process of Europeanisation, EU accession policy, leadership, engagement and advocacy literature. The comparative findings are interpreted within this theoretical framework. The study adopted a qualitative approach using an ethnographic multi-method design involving interviews and documentary analysis of key EU accession primary source reports. My own positional was written into the account in a reflexive manner. The findings indicate that the nursing leadership used EU accession as a policy window to advance a professional agenda but the extent to which this opportunity was exploited differed in the case studies. Findings indicate the importance of regime specific conditions creating a set of constraints which differed in both cases. The Croatian case shows what could have been achieved through the use of TAIEX capacity building engaging stakeholders in agenda-setting. The Romanian nurse leadership failed to take advantage of the policy window prior to EU accession but the continued advocacy hold the Romanian government post-EU accession to account for its policy decisions. Although the new generation of nurses in Romania and Croatia comply with Directive 2005/36/EC, the nursing workforce which graduated prior to EU accession does not benefit from mutual recognition. It is concluded that the EU mechanisms to process compliance – peer review and capacity building – are not robust enough to strengthen free movement based on mutual recognition. The research findings contribute towards our understanding of the role of nursing in policy-making and the dynamics that drive policies outcomes. The research adds new knowledge to our understanding of the researched area and helps to position nursing within a broader context of EU enlargement.

In the United Kingdom there are increased pressures to extend the role of nurses as a result of policy reform, rising demands for health care, a shortage of doctors and financial constraints within the National Health Service (Faithfull and Hunt, 2005). As nurses are called upon in times of ‘crisis’ to fill the skills gap, the development of nurse-led services and the consequent shifting of professional boundaries between health care groups have led to certain challenges and tensions within the discourse of modernisation in delivering compassionate, safe and effective care for people in the 21st century (Maben and Griffiths, 2008). This thesis focuses on the nursing biographies of ten sexual health nurses (nine female and one male) in the North West of England. They describe how they came to be nurses and their experience of their on-going clinical practice as their roles and responsibilities change as a result of reorganisation. Using narrative interviewing as a means for data collection, the theoretical and interpretative framing of this study is based on Gee’s (2011) theory of ‘Big D’ Discourse and Holland, Lachicotte, Skinner and Cain’s (1998) theory of Figured Worlds, emphasising the role of narrative in identity construction and the ways in which individuals draw on the figured nature and cultural models of the nursing world. I argue that while a recurrent narrative theme describes childhood and adolescent experiences of ‘always wanting to be a nurse,’ the majority of the respondents appear to have had limited choices, given their academic achievement, family backgrounds and influences and socio-economic status. The single male nurse in the sample offers an account of his career which puts the women’s stories into relief, drawing attention to particular aspects of gender discourses and caring. For women, nursing was in fact, ‘a respectable career for a working class girl,’ and it also fitted in with being a mother. A discourse of caring is also prominent in their accounts and this underpins much of what they say about becoming a nurse and their experience of role change. I argue that whilst their strong values of caring and compassion are sometimes seen at odds with their new role, in some accounts the discourse of caring is clearly incorporated into their developing clinical skills and knowledge. I report that not all the nurses ‘embrace’ role change; their stories present anxieties, conflicts and resistance around new responsibilities, power imbalances within the doctor-nurse relationship and the disruption of their figured world of nursing, which raises issues of perceived inequality of pay and some ambivalences concerning their new role.

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Difficulties in attracting and retaining health workers in disadvantaged areas are the main causes of inequitable distribution of health workers. This study aims to explore the dynamics of labour market of nurse workforce to improve the national nurse workforce planning in Thailand. Discrete Choice Experiment (DCE) analysis shows that the participants prefer jobs offered in rural areas, offering higher income, civil service scheme health benefit, provision of private accommodation at the workplace, short time to wait for promotion, supportive management, and fewer working hours/week respectively. The result also shows that a participant is ready to sacrifice 8413 THB/month in exchange for a civil service post. In addition, the availability of civil service post with "moderate" monthly income (25,000 THB), in a rural health facility near their family's place could increase rural job uptake by 85%. Factors significantly influencing job satisfaction are income, management, workload, and gender. Male nurses tend to have a higher level of job satisfaction than female nurses. Factors significantly affecting intention to move are job satisfaction, health benefit, and workload. A factor significantly determining movement is distance from home. The theoretical workforce mobility model developed from job search theory was tested by Structural Equation Modelling shows that job preference is a source of job satisfaction. It does not have significant direct effect on intention to move or movement. Thus job preference implication on retention strategy is questionable. Job satisfaction significantly influences intention to move rather than movement. It is only intention to move which is an independent predictor for the movement. The analysis of job history shows that the participants seem to move within the same sector, between the similar types of workplace. If the movement between sectors is the main concern, the movement from private sector to public sector is the dominant pattern. Nurses working in Bangkok tend to move out to other big cities or rural areas. The career pathway of nurses working in the public sector start in provincial hospitals, then moves to district hospital, and ends at community health centres. The majority of direction of movement direction is towards their families. Most of the planning assumptions adopted in the current National Nurse Workforce Plan in Thailand are in line with the current health labour situation, such as selective recruitment policy and financial incentives. Additional suggestion is that the Thai government should add job satisfaction, motivation strategy at institutional level using the same guideline and indicators identified in this study.

Background: Obesity, smoking and sedentary lifestyles have led to a high prevalence of cardiovascular disease (CVD) in Jordan. This study aimed to examine the views of Registered Nurses (RNs), doctors and patients regarding the RNs’ role legitimacy in health promotion relating to CVD and develop an explanatory model relating to the RNs’ role legitimacy in Jordan. Methods: A correlational cross-sectional survey was conducted using cluster random sampling at the sector level with proportional quota sampling within individual study sites. A sample (n=1726) of RNs (n=676), doctors (n=458) and patients (n=592) were recruited from community and hospital settings in Amman. Data were collected using structured self-administered questionnaires. Findings: The RNs reported positive views regarding their role in health promotion relating to CVD and achieved high knowledge scores related to CVD. The doctors and patients, however, reported negative views regarding the RNs’ role. The RNs’ perceptions of general health promotion and their role in general health promotion together with personal health behaviours, were associated with their perceived role legitimacy in health promotion relating to CVD. Lack of time and perceived role together with limited health promotion training and communication problems with patients were constraints to the RNs’ role. Conclusion: The role legitimacy of the RNs in health promotion relating to CVD is limited in Jordan. It is important for professional bodies and healthcare employers to agree the RNs role in health promotion relating to CVD. Further examination of the barriers inhibiting the RNs role legitimacy in health promotion relating to CVD is crucial.

This study, which was undertaken in Scotland, is concerned with hospital nurses' perceptions of how they manage their health promotion responsibilities. The work was undertaken from the qualitative paradigm, employing strategies of grounded theory to generate and handle data arising from fifty loosely structured, in-depth interviews with nurses practising in hospital settings. The findings of the study include discussions of the nurses' descriptions of the natural context of their work - Ward Life; their experience of incorporating health promotion in their practice - Negotiating Identity; the knowledge they hold concerning how to undertake these aspects of practice - Nurses Knowing; the relationships which they perceive as pivotal to this practice - Forming a Relationship and their critical reserve regarding the whole enterprise - Being Sceptical. The theoretical framework generated suggested an ongoing negotiation of role and professional identity influenced by perspectives external to the practice knowledge of the nurses. The identity that emerged through the mediation of these influences has been labelled as the nurses representing themselves as health promoters. Embedded in the nurses' accounts are hidden aspects of their knowledge: knowledge that is often unspoken and is derived through their experience of working with patients. It is claimed that this knowledge has the potential to reconstruct the nurses' professional identity to that of health-promoting nurses, an identity that is congruent with the nurses' 'close to the patient' and context-dependent experience of practice.

Aim: To evaluate the use of Concept Maps as an educational intervention in the development of Critical Thinking abilities during Practice Learning Placements over the course of one year with one cohort of final year pre-registration nursing students. The Research Hypothesis: The research hypothesis is that a positive relationship will be demonstrated between the use of Concept Maps and the development of Critical Thinking abilities. Methods: A quasi-experimental non-equivalent groups design was used with one experimental and one control group of final year undergraduate student nurses on the adult branch of a BSc (Honours) nursing programme over the course of one year. Data were collected in three phases at various points identified below

Nursing has experienced transformational change over the last twenty years. One major difference is the shift in nurse preparation from the apprenticeship system to higher education. In response, practice has extended, expanded and in some instances blurred with other healthcare professions, while the focus has moved from cure to prevention and from acute to chronic care. The extent and pace of change has resulted in claims that nursing has 'lost its way'. At the same time, no consensual definition of nursing exists. When considered together, the question of what it means to be a nurse arises; an area that has received little attention. Consequently, the aim of this study was to understand what it means to be a qualified adult nurse working in Scotland at the beginning of the twenty first century. The philosophic hermeneutic of Hans-Georg Gadamer, whose main concern was the possibility of understanding, guided the study. In addition, a Gadamerian-based research method developed by Fleming and her colleagues was applied to enable the development of understanding in accordance with Gadamer's philosophy. A purposive sample of eleven nurses who attended a Mentorship or MSc Advanc@d Nursing-programme at a SGOttish-Universityparticipated in the study. Analysis of their conversations using Gadamer's hermeneutic circle led to the emergence of three overarching themes and an understanding, which suggests that what it means to be a nurse is to 'make a difference' to the lives of others, while having a 'nursing identity' and 'playing the game'. The findings offer a fresh perspective from which to consider how one defines nursing whilst encouraging nurses to think about the impact of their actions and approach to practice. Recommendations for policy, practice and education are given and include the need to address the culture in nursing, as it has a significant impact on what it means to be a nurse and the ability to make a difference.