This thesis examines how political devolution in the UK impacted upon nursing workforce policy and planning by investigating the following research questions:  What has been the impact of devolution on nursing workforce policy and planning across the four countries of the UK (1997-2009)?  How and why have the approaches to nursing workforce policy and planning changed across the four countries of the UK (1997-2009)? The research methodology used was a mixed methods approach which included semi-structured interviews with 30 stakeholders from the fields of nursing, healthcare policy or workforce planning across the UK. A purposive sampling strategy was adopted and the distribution of interviewees was England (11), Scotland (7), Wales (6) and Northern Ireland (6). A realist review approach to inquiry was taken which involved establishing what works for who, in what circumstances and why? The qualitative data from the interviews was supplemented by analysis of quantitative data on nursing workforce trends and information from the analysis of health policies from the four countries. The key findings include: changing patterns of power and influence in the devolved administrations; continued cycles of ‘boom and bust’ in nursing workforce supply; variable growth in the nursing workforce across the UK; the unwillingness of England to ‘let go’ and the perception by interviewees that some national nursing policies were unimportant. The conclusions were that although devolution enabled greater freedoms in terms of policy and workforce flexibility, just under half of the interviewees reported that devolution had a positive impact upon nursing. There was reluctance from senior nursing leaders to share and learn from good practice across countries and despite the rhetoric from numerous reports around the need to improve nursing workforce planning, there was little evidence of lessons being learned which would have improved the effectiveness of planning the future nursing workforce.

Background: In general, the shortage of organs and tissues for donation reflects not only the rise in the number of patients in need of transplants, but also the failure to acquire sufficient donors. A variety of factors is responsible for this shortage, including poor public awareness and insufficient knowledge, religious perceptions of potential donors and families, and the failure of healthcare staff to identify potential donors. Because of their close relationships with potential donors and families, nurses are vitally important in the donation process. The hospital nursing population in Israel is composed of people from a mixture of religious groups, creating a complex environment which may influence the nurse's behaviour. There is thus a clear need to examine what factors affect the professional behaviour of nurses in the organ donation process. Aims: The overall aim of this research was develop a sensitive psychometric scale to identify key points in nurses' perceptions of professional duty toward organ donation in the context of religion. Methods: The research was divided into four stages using a number of methods. First, a qualitative study with seven homogenous focus groups of hospital nurses grouped by religion was done. The findings were used for the second stage, whose aim was to develop a sensitive psychometric scale of the coverage, relevance and readability of the initial items and a pilot study examining each item. Next, a large-scale field test was conducted and the data were then analysed using principal component analysis. In the third stage, reliability and validity of the newly developed Care & Donate scale were evaluated. Finally, in stage four, the relationship between the Care & Donate scale and key questions in each category was demonstrated. Results: The first stage found thirteen central themes, reduced into four categories, reflecting the nurses' perceptions towards organ donation. The next stage produced an initial conceptual framework for developing a psychometric scale. In the field test stage, a principal component analysis produced a robust conceptual framework composed of 23 items in three subscales. Conclusion: This research is the first to develop a reliable, valid, sensitive measure of nurses’ attitudes towards organ donation in north of Israel: the Care & Donate scale. The scale should provide the basis for an intervention program for nurses and help evaluate the effectiveness of such programs. Analysis of the Care & Donate scale also provided evidence that the scale is related to scales developed outside of Israel, possibly leading to its use in other countries.

Ensuring the provision of equitable, high quality care is becoming progressively more challenging in a context of an ageing population, increased prevalence of long term conditions and a prolonged period of public spending austerity. In response to these challenges, commissioners and providers have explored and piloted a range of innovative approaches to service delivery, including those that involve the utilisation of information technologies. One such modality – teleconsultation – is the utilisation of video to facilitate real-time, remote consultation between healthcare practitioners and patients. Though teleconsultation has been used as an approach to care since the 1970s, it has grown in prevalence of late, due to reduced costs, improved connectivity and greater social acceptance of video-mediated interaction. Teleconsultation is used within the acute sector (e.g. to expedite specialist stroke or burns care) and to support people living with long term conditions within the community. However, despite evidence of feasibility, clinical benefit and patient acceptance, there is little understanding of how the use of video impacts on the role of those nurses who are involved in teleconsultation.

Aim The aim of this study is to test the relationship between personality, job stress, burnout, satisfaction and resilience in Taiwanese cancer nurses. Background The retention of nurses is a global issue which is closely related to patients’ safety and the quality of nursing care. Job stress, burnout and satisfaction influence nurses’ intentions to leave their jobs. Job stressors, levels of stress and burnout, coping strategies selection, and influential factors of job satisfaction such as leadership type have been broadly investigated. Personality is the deciding factor in how people perceive the environment and events, and it affects an individual’s stress and behaviour in an organization. Resilience has been noted as a mediator of stress. Nurses possessing certain personality characteristics may adapt to their jobs better than others by showing less stress and burnout, and higher job satisfaction. The difficulties of nursing care vary across different specialised contexts; therefore, further research should emphasise specific nursing specialists such as cancer nurses. Design Mixed research methods with questionnaire survey and in-depth interview was used. Methods The NEO Five Factor Inventory-3 (Coast and McCare, 1992), the Nurse Stress Checklist ; (Benoliel, 1990; translated into Chinese by Tsai, 1993), the MBI-Human Services Survey (Maslach et al., 2001), the Nurse’s Job Satisfaction Scale (Lin et al., 2007b) and the Brief Resilience Scale (Smith et al., 2008) were selected as the measurement tools in this research. An interview guideline was developed based on the components of selected questionnaires to check the validity of the questionnaires and to investigate significant relationships in the statistical results. T-test, Pearson’s correlation, ANOVA (analysis of variance) and structural equation modelling (SEM) were used to test the relationships between variables; content analysis was used to analyse interviews. Results Cancer nurses’ personality successfully predicted their resilience, stress, burnout, job satisfaction and intention to stay. Personality especially explained resilience, stress and burnout. Nurses’ resilience acted as a negative mediator to burnout, while stress mediated burnout positively. Conclusion A personality test could be used in recruiting nurses, making nursing career plan and proposing effective interventions to increase nurses’ resilience and diminish nurses’ stress and burnout. Further studies in other nursing professionals are needed.

Nurses in Palestine work in a significantly challenging environment within and outside their workplaces. Mental health services in Palestine are underdeveloped and under-resourced. For example, the total number of community mental health nurses (CMHNs) in the West Bank is seventeen, clearly insufficient in a total population of approximately 3 million. This thesis is concerned with the resilience of nurses who work in community mental health workplaces in Palestine. This research explored sources of resilience and daily challenges that Palestinian CMHNs face within and outside their demanding workplaces. The up to date understanding of resilience is drawn from the social ecological perspective. Within Arabic culture, resilience has traditionally been conceptualised as a prerequisite to understanding and achieving ‘Sumud’, meaning that the individual has to be resilient in order to remain steadfast in the face of daily challenges and not to leave their place or position. An interpretive qualitative design was chosen to explore resilience and the daily challenges. Fifteen face-to-face interviews were completed with participants. Thirty-two hours of observations of the day-to-day working environment and workplace routines were conducted in two communities’ mental health centres. Written documents relating to practical job-related policies were also collected from various workplaces. Thematic analysis was used across all data sources resulting in four main themes, which describe the challenges faced by CMHNs and their sources of resilience. These themes consist of the context of unrest, societal challenges, lack of resources and organisational challenges. These sources are Sumud and Islamic cultures, supportive relationships, making use of the available resources, and personal capacity. The study concludes with a better understanding of resilience in nursing which draws on wider cultural contexts and responses. The outcome of this thesis will be used to develop the resilience of CMHNs in Palestine.

The study examines nursing assessment in the context of questioning how nurses' encounters with patients become occasions for nursing. The focus of the study is on those occasions which constitute nursing assessment, in recognition that these occasions cannot be detached from other aspects of nurses' conduct. To undertake this examination of nursing assessment, I have drawn on the work of Michel Foucault, with an approach to field research and the analysis of discourse which has developed from contemporary writings on communication, anthropology, ethnomethodology and ethnography. With its focus on examining how power effects are constituted within an acute medical ward, the position developed in the thesis seeks to integrate critical thinking in ethnography with a post-structuralist problematising of 'detachment' as an everyday feature of social conduct. There are three parts to the study. The first part entails a textual analysis of how nursing assessment has been written in the literature. Nursing assessment has been conceptualised as a component of the nursing process; as a technical and cognitive activity. Representing nursing assessment in this way raises issues of knowledge and power. Writing nursing in terms of information processing, problem-solving 'models' is however less a representation of nursing reality and more a discursive practice, one with its own domain and locus of action. The nursing process detaches nursing assessment as a technology, separable from the organisation of patient care and autonomous from the social, but one designed to reconstitute the social through making nursing thinkable in a particular epistemic space. The second part of the study, a detailed examination of the care of old people in an acute medical ward, suggests the particular development of nursing assessment as a cognitive and technical activity overlooks the heterogenous conditions in which nursing is practised, in which it is being written and in which the conditions of detachment that the nursing process, once in process, helps produce and reproduce. These include involving an instrumentalrationalist approach to research on health services, a managerialist climate which seeks to make nursing 'visible' in relation to cost and time; the professionalisation of nursing, which impacts on nurses as a call for nurses to make nursing 'professional', rational and distinct from other practices; and, instituted through fashionable talk of customer care and the care of the subject, a heightening of persons as individuated, accountable, knowing subjects. The analysis shows how the disposal of elderly persons is effected by nurses through a 'constituting of classes' and explicates the motility of these classes in response to the aforementioned pressures. The final part of the thesis develops these themes. The nursing process appears to give the burden of knowing to the nurse as expert, always saving itself from appearing to be a congenitally failing technology through appeals for more and better training. Far from this being so, I illustrate how the burden of knowing falls upon the person; how as patient, persons must detach themselves from their everyday experience and seek modes of conduct appropriate to their disposal. By writing nurses as rational, scientific and professional practitioners, I suggest how the nursing process has been developed as a control technology which both disciplines patients to help accomplish their disposal and manage nurses through the institution of new forms of accountability and self-discipline.

This study aims to design a practice-based, culturally sensitive model of health education for hospital nurses. The theoretical and literature background to the meaning of practice-based, culturally sensitive models indicates that designing such models requires consideration of theoretical assumptions and evidence-based findings related to both health education practice and cultural sensitivity. Hence, the study has to use the study findings to create the final model design. The study objectives that needed to be answered using mixed methods include:1) Identify which health education skills are most valued by hospital nurses in Saudi Arabia; 2) Explore the self-perceived competence levels of Saudi hospital nurses when delivering health education; 3) Identify which aspects of health education knowledge are most valued by hospital nurses in Saudi Arabia; 4) Identify any organisational barriers that might impact on the delivery of health education in Saudi Arabian hospitals; 5) Identify any strategies that might impact on improving the delivery of culturally sensitive health education in Saudi hospitals. The results have found several important skills and subjects of knowledge related to health education, low confidence levels for the majority of measured skills among nurses, the presence of culture, nursing, the workplace and educational barriers to health education practice, and also recommended several culturally sensitive strategies able to help to deal with Saudi cultural norms and values. Therefore, from the discussion of theoretical assumptions, literature and evidence-based findings of the study results, the final model is created and indicates that practice-based, culturally sensitive health education requires several interventions at two levels. The model consists of two dimensions including internal and external dimensions. The internal dimension reflects actions inside hospitals, which include continuous education, barrier removal and motivational interventions. Actions outside hospitals include updating nursing policies, cooperation with community organisations and use of the media.

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Whilst the Government has made explicit its stance towards identifying and taking into account the views of children and young people as service users it appears, within some hospital settings, that few openings are available to many children and young people, particularly those with learning or physical disabilities and acute illnesses. This qualitative study used an ethnographic approach to explore 46 children and young people's experiences of being in hospital. Data were collected within the hospital setting through unstructured participatory observation and semi-structured interviews alongside a variety of methods and activity based techniques. The data were collected and analysed concurrently in order to explore emerging themes in the analysis. The children and young people were diverse in terms of age ranges, experience of being in hospital and illness, with some being acutely ill and others having long term chronic illness. The findings revealed that children and young people experienced disruption due to being in hospital. This was experienced as a complex variety of factors, situations and people impacting upon their experiences. Interwoven within this disruption were feelings of powerlessness and uncertainty. Children and young people described experiencing disruption, uncertainty and powerlessness in terms of being in hospital, being ill and undergoing treatment and experiences of care and caring. In order to reduce these experiences children and young people undertook a range of strategies and actions in an attempt to restore equilibrium including "influencing", "accepting", "acting" and "positivity". Within this study I bring together for the first time the ways in which being in hospital creates disruption for children and young people and their agency and capacity in mediating their resultant experiences of powerlessness and uncertainty. I also provide an explanation for the ways in which children and young people experience disruption and restore equilibrium by drawing on Bronfenbrenner's work. The findings have implications for children's nursing in terms of quality and delivery of care for children and young people in hospital.

Change is a common feature of nursing, influenced by prevailing governments as part of their political agendas. These changes have impacted both on the context within which nursing takes place as well as on the actual role of the nurse. For change agents who are implementing these changes, it is imperative that they are aware of how nurses respond to change in order that they can plan the most effective strategies. This thesis investigated how nurses understand their own practice changes, the process that they undergo, how resistance to change manifests and if nursing rituals have an impact on the process. Finally the thesis made recommendations based on the findings to facilitate effective practice change and development. The study was conducted in two parts. In-depth interviews with eight nurses from one acute NHS Trust made up the first part of the study. A further two interviews were conducted with eleven mental health nurses from an early intervention team in one NHS Mental Health Partnership Trust, and this constituted the second part of the study. Constructivist grounded theory was the research method employed in the design of the study. An underpinning theoretical framework of structural anthropology with specific reference to the work of Levi-Strauss was used to present the final grounded theory. The study found that nurses understood the process of practice change as a spiral with the most significant aspects of practice change at the bottom. These were the day-to-day changes that may or may not lead to permanent change. At the top of the hierarchy and of least significance were the changes imposed by their employing organisations or nationally. The overall personal process of practice change and development was identified from the study as a process that centres on the experiences that participants have in their workplace, a process of sense making, learning and intuition. A Practice Change Model in the form of a continuum was developed that described how nurses respond to practice change and development. The significance of this study is that the thesis was able to identify strategies for promoting effective practice change and development, aimed at nurses in practice, change agents at an organisational and national level, and the clinical link role within higher education.