Holding practices are employed to help a child or young person stay still during the administration of treatments, prevent treatment interference or to undertake an examination which can sometimes be invasive. The aim of this thesis was to explore holding practices from the perspective of nurses and healthcare professionals. This included identifying and examining holding techniques currently in use to help a child or young person stay still. An exploratory sequential mixed methods design was followed. Studies 1, 2 and 3 examined assumptions and practices of holding to develop theories about „what is happening on the ground‟ following Grounded Theory methodology for practicing nurses and other allied health professionals (1), undergraduate nursing students, university lecturers and clinical mentors (2) and university lecturers from other institutions (3). A core category of „indifference‟ emerged. Studies 4 and 5 explored technique preference to establish theories about what is known about the techniques in use. Descriptive statistics was used to analyse the data. The practice of therapeutic holding is often covert and not considered to be part of the treatment per se, which has led to concealment and a reticence to discuss practices openly. Studies 1, 2 and 3 identified that there is variance in the experiences and practices of the participants. The prominent themes that emerged were a lack of clarity, lack of policy, lack of training, and that parents are often expected to hold their child. There appears to be a strong element of denial that there is a problem and little evidence that nationally this is seen as an issue. Studies 4 and 5 showed that healthcare staff „prefer‟ techniques they are familiar with, in particular „cuddling‟ and „wrapping‟ of young children and found it more difficult to judge techniques for young people. It appears that therapeutic holding practices have moved from being viewed as „uncontested‟ to „indifferent‟. These findings have serious implications for current practice and the future training of healthcare professionals.

This study begins with a premise that ‘caring’ is no longer as evident in nursing practice, which in turn has repercussions for understanding nursing as a ‘vocation’. The study, therefore, sets out to problematise both ‘caring’ and ‘vocation’ and in so doing identifies that whilst both are elusive ‘caring’ is particularly difficult to ‘pin down’ - in terms of abstracting a definitive definition, and importantly, how it is articulated in practice. By situating the study within social constructionism (Berger and Luckmann, 1991) and communities of practice (Lave and Wenger, 1991) and by additionally drawing on narrative inquiry, the study pays attention to the stories of six final year student nurses. By closely reading these accounts, through a number of theoretical frames, including Sheldon Stryker (1980), it becomes possible to glimpse some of the interactions and oscillations where an individual’s nursing ideals situates them in what MacLure describes as a ‘moral universe (2003: 9). It is by disentangling this ‘universe’ that I am able to catch some of the meanings that circulate around ‘care’ and which reverberate with the notion of nursing as a ‘vocation’. Further disentanglements, especially those relating to discourses and discursive power occur when Foucault is brought into the picture. Whilst this study is unable to provide a definitive account of what it means to care or provide guidelines for nursing as a vocation it does nevertheless raise a number of pressing and critical questions; questions that highlight the political, social, emotional and ethical work that student nurses have to undertake where hopes, beliefs and ideals in relation to ‘care’ have to find ‘some sort of place’. Moreover, by working with Judith Butler’s theoretical ideas relating to ‘performance’ I am obliged to (re)turn again to the data so as to radically (re)consider the means by which the participants are con(script)ed to perform care in some ways and not others. The study also illustrates the reflexive journey that I have undertaken, where my own ideological longings in relation to ‘care’ have been sorely tampered. It is argued that such tampering is a necessary irritant and component within the context of the university classroom where it obliges both me and the students to work together so that we can, together, (re)think and (re)configure what it means to ‘care’.

Aim. To explore the impact of an online learning versus a blended learning approach on undergraduate nursing students with regards to their motivation and attitudes in relation to clinical supervision and their knowledge and satisfaction with the teaching modality. Background. Traditional teaching methods in higher education have achieved much success and have a proven track record of graduate attainment. Contemporary online and blended learning teaching methods have less supporting evidence of success due to their emergent state of development. Design. An experimental study using a randomised control design Methods. This study was conducted from 1 st June 2013 - 1 st July 2013, with 125 undergraduate nursing students, intervention group (n=63), control group (n=62). Data was collected using a modified version of the Manchester Clinical Supervision Scale-36, a Multiple Choice Questionnaire and a training evaluation. The intervention group received clinical supervision training via a blended learning approach and the control group received online only clinical supervision training. Data was analysed using t-tests and multiple linear regressions. Thematic analysis was conducted on data retrieved from open ended questions included in the training evaluation. Results. The intervention and control groups reported statistically significant results with regards to knowledge (p=0.015) and satisfaction (p=0.001). No statistical difference was reported with regards to attitude and motivation towards clinical supervision. The training evaluation regression model reported a statistical significance, with a positive Beta value (0.339), which indicated a higher level of satisfaction related to teaching delivery (in a positive direction). The thematic analysis reported five themes which were all recognised as impacting on the students' level of satisfaction with the clinical supervision training. Conclusion. The evidence from this study suggests that blended learning does have added value when compared to full online learning in terms of student satisfaction and knowledge when teaching clinical supervision skills.

This project evaluates the effectiveness and impact of a feeding assistance programme ‘Making Meal Times Better for those with a Dementia’ (MMB) supported by five sixty minute health professional led support forums as compared to a three hour MMB standalone version and control conditions for health care assistants (HCAs) working with residents with a dementia and oral feeding difficulties. Outcomes were evaluated for 90 participating health care assistants and 451 observed meal times across three nursing homes. Measures of staff knowledge, competency, attitudes and daily care practices were measured using self completion questionnaires alongside observations of the quality of and adequacy of mealtime feeding assistance pre- and five months post intervention, using purposive sampling. HCAs who participated in support forums maintained significantly better knowledge and competency scores five months following training compared to those who received the stand-alone three hour MMB training programme and control conditions. Observations of mealtimes revealed that the nursing home exposed to greatest duration of training demonstrated most improvement in the provision of quality feeding assistance: actively identifying and providing targeted feeding assistance to those residents deemed at risk of malnutrition and relocating more residents into the communal dining room. Beneficial changes were accompanied by a significant reduction in social stimulation. Control conditions demonstrated several changes in feeding behaviours which may be attributed to attempts to increase oral intake without sufficient training. Training increased the food consumption of those residents at risk of malnutrition but did not increase food consumption overall or the high levels of stress and guilt experienced by HCAs. Lack of social cueing and less than five minutes of feeding assistance were correlated with increased risk of malnutrition across nursing homes. A paucity of HCA documentation of oral intake in medical records suggests an organisational barrier to the translation of HCA knowledge to the wider healthcare team.

Since the mandatory twelve week minimum placement was introduced in 2010 by the regulatory body for nursing in the UK, there is little documented as to its effectiveness from the students’ perspective. The aim of this study was to explore the lived experiences of ten student nurses as they completed a longer than usual practice placement as the last component of their undergraduate pre-registration nursing education. Previously students had been allocated to practice for periods of five or six weeks and this was the first time they had experienced a longer placement. Using a descriptive phenomenological approach, a purposive sample of ten student nurses were interviewed within one week of completing their final three months in practice in July 2013. Data were analysed using Giorgi’s (2009) modified Husserlian approach to descriptive phenomenology. Findings revealed the four invariant constituents of: belongingness and fitting in; taking charge of own learning; making sense of the complexities of nursing; and becoming a nurse. Discussion exposed not only challenges to current thinking from the collective views of ten students in the south of England, but revealed a process of transformative learning that the students journeyed to prepare themselves for registration as a professional nurse. Fuelled by their mentors facilitating and encouraging autonomous practice, students began to experience a sense of awakening to the responsibilities and accountability that they faced as a registered nurse. New insights from this research suggest that more could be done to enhance the final practice placement experience for students on the point of transition. It is seen as a dress rehearsal for the real world of work as a registered nurse and mentors should supervise at arm’s length and encourage students to work things out for themselves, take risks and make decisions. Nurse educators should recognise that during the extended last placement students re- contextualise their knowledge as they begin to make sense of the complexities of nursing practice. Conclusions from this study support the notion that a longer final practice placement helps students to prepare for their impending transition to registered practice. It recognises the key role of the mentor in supporting all four invariant constituents and the process that these students undertook to gain the confidence and competence to practise as a qualified nurse. This new knowledge is of interest to a wider audience concerned with the preparation of undergraduate pre-registration nursing students both in the UK and abroad.

This research aims to explore Egyptian undergraduate nursing students’ perceptions of working with mentally ill patients and to explore factors that influence student nurses’ perceptions of mental health nursing. The study took place at the school of nursing in Cairo University. The research approach for the study is qualitative and descriptive since it aims to explore opinions and perceptions of participants and describe meanings about researched topic (Creswell 2014, Willing 2013, Hancock et al 2009). The method for data collection used in the study was focus group discussion: 8 focus groups were conducted that included 32 participants, all of them female students. A pilot focus group took place at the faculty of nursing in Modern University for Technology and Information (MTI) where fourth year students were asked to participate. The remaining focus groups were held at the school of nursing in Cairo University. Participants were chosen from fourth and fifth year students of the undergraduate programme. The participants had accumulated knowledge as students and they were about to graduate and to start their nursing career. Data analysis stage of the study employed thematic analysis to develop codes and themes that constitute the results of the research. Results of the study revealed that stigma associated with mental health nursing (MHN) is one of the main factors that keep students away from this specialty. Students expressed their fear and lack of a sense of safety within mental health facilities. The main stereotype as expressed by participants was that patients are violent and potentially aggressive. Other factors contributed to a negative view about MHN such as lack of positive role models, insufficient clinical training and the need for clinical supervision within mental health clinical placement. Few participants expressed an opposite opinion and were motivated to work in MHN but were not sure how to start this career. The gender issue appeared to be influencing perception of MHN since many considered MHN as a male job.

This study, underpinned by a hermeneutic methodological strategy, investigates how British nurses make sense of representations of nurses in the popular media, and their perceptions of the potential implications of media representations for nursing as a profession and their own sense of self. The study was designed because of a number of factors: the popularity of hospital dramas and the increasing prevalence of hospital based ‘fly on the wall’ television programmes, a plethora of press coverage about the poor quality of nursing care, concerns from the nursing profession that the media representation of nurses have a detrimental effect on the nursing profession and nurses’ sense of self, and a scarcity of research which has explored nurses’ perceptions of representations of nurses in the popular media. Twenty-five nurses from a broad spectrum of nursing areas were recruited to the study. Eighteen participated in focus groups and a further seven nurses were interviewed individually. A thematic analysis of participants’ descriptions, perceptions of, and emotional response to the representation of nurses in the media, revealed that nurses hold diverse, contradictory and ambivalent views of media representations. Whilst the way nurses describe representations in the media is consistent with previous research, which argues that nurses are represented by a number of stereotypes, there are novel and significant findings presented in this thesis, which may have implications for the nursing profession. The study reveals that some nurses hold a virtuous understanding of the profession and secondly, that some nurses hold a stereotypical understanding of nurses. Despite participants dismissing the media as ‘just entertainment’, having no consequence to the status of the profession or their sense of self, they nonetheless expressed concern at the ‘negative’ way they were represented in the media. Consequently, there is a need for nurses to challenge both existing media representations and the way they talk about nurses and the profession.

The main purpose of this study was to investigate the home care patients’ satisfaction received from the nursing staff in the public home care program in Cyprus. Patients’ satisfaction has become an important part in evaluating the quality of health care services. Patients are the ones who can identify better than anyone else the aspects of nursing care which need improvement. Home care services are quite new and still developing in Cyprus while the need for these services is increasing rapidly. This study, utilized the QPP survey questionnaire, in depth semi-structured interviews and observations. The questionnaire was delivered to the home care patients who received long term care during the period of February 2011 to May 2011. A purposive sample was used for the interviews of the patients, the nursing staff and the management staff of the home care program and for the observations of the home care visits. The results of this study showed that the home care patients of the public home care program in Cyprus are very satisfied from the services they receive from the home care nursing staff. The quality of care, QPP index was found of the highest score in all items of the questionnaire. This study revealed high standards in the elements relating to the humane approach, the medical competence, the information and advising provided to the patients. At the same time, this study identified a deficiency in the abilities of the nursing staff to provide psychological support in difficult cases and the patients’ inadequate control of their medical care according to their desires rather than by the procedures of their home care nurse. It also identified the need of the home care patients for help in the activities of daily living (ADLs). Additionally, this study surfaced the aspects of the nursing care which the home care patients consider more important and highlighted the characteristics of an ideal home care nurse through the patients’ eyes; placing the humane approach as the most important aspect, followed by the psychological support provided and then by the nursing knowledge. A deviation was identified between the nursing and management views, with the later placing the nursing knowledge as first, followed by leadership skills and then by the humane approach. This study, also identified those problematic areas of the program which negatively influence the nursing services; these were the absence of a team of health professionals in the program, the limited operating hours, the non-implementation of the concept of prescribing nurses, the non- eligibility of the nurses to refer the patients to other health professionals, inadequate technology, insufficient financial support of the program, and the cumbersome procedures of the public sector. Home care patients’ satisfaction from the nursing staff is very high; yet there are some areas which need improvement. Recommendations emanated from the project include the enhancement of the nursing undergraduate and post graduate education in home care nursing, with courses and workshops on the psychology of home care patients, on gerontology, on leadership and communication skills. Recommendations also include individual and organizational development interventions for providing more support to the home care nurses, higher quality of care to the home care patients within a client-centred environment and feedback strategies.

Introduction: The recruitment and retention of Registered Nurses (RNs) in Guernsey and Alderney has been a continual challenge over the years. Whilst measures have been put in place to address the problem, these solutions have had little sustained impact on the problem. The current vacancy rate is double that being experienced by National Health Service (NHS) Trusts outside of the London area. This study proposed to explore the recruitment and retention problem in a more holistic way by capturing the experiences of RNs who are working within the Islands. Study aim: To explore the professional and personal challenges facing generalist RNs working and living in two small island communities. Methodology: An experience-centred narrative research methodology was used to explore the experiences of 20 newly appointed RNs and 15 long-serving RNs. The data consisted of 35 ‘stories’ which were captured through the use of semi-structured interviews, written accounts and visual media. The data was analysed using a critical hermeneutic approach. Results: Sixteen themes were identified and aligned with the conceptual framework underpinning the study. The stories of the participants were used to develop a model to demonstrate the acculturation process they were experiencing. Conclusions: It was recognised that all new recruits undergo a process of acculturation when they take up employment in the Islands. The study demonstrated that the process of acculturation was a continual journey and that the longer-serving participants were also undergoing a process of adjustment to the on-going cultural changes taking place in the organisation. The research highlighted that this acculturation process was influenced by multiple inter-connected factors which contributed to the challenges perceived by the participants. Whilst these factors had some commonality with those identified in the literature, the specific nature of the issues raised by the participants in this study were context dependent.

There are national and international expectations for nurses to be role models in health promoting behaviour despite little existing research exploring or defining the concept within nursing theory. This study aimed to i) promote theoretical clarity for the concept of the nurses being role models in health promoting behaviour and ii) investigate student nurses, nurse educators and registered nurses’ experiences and perceptions of the concept. A hybrid, concept analysis and development framework was developed for this study which involved a theoretical, fieldwork and final analytical phase. The theoretical phase of the study firstly involved analysis of multi-disciplinary literature to determine uses of the term ‘role model’ and secondly, analysis of nursing literature to identify antecedents, attributes and consequences to the concept of nurses as role models in health promoting behaviour. The fieldwork phase involved a qualitative study of six focus groups and one interview, which included participants from a range of NHS Trusts and independent organisations across London and South East England. Student nurses, nurse educators and registered nurses’ (RNs) were recruited to capture opinions and experiences about being healthy role models from across the profession and to explore their understanding of what the concept actually means. Thematic analysis of qualitative data contributed to further identification of antecedents, attributes and consequences and identification of model, contrary, borderline and related cases. The final analytical phase involved integrating findings from fieldwork and theoretical phases and considering: i) the relevance of the concept, ii) if the selection of the concept seems justified, and iii) to what extent the theoretical and empirical analysis support the presence and frequency of the concept within the population under study The adapted hybrid framework developed for this study went beyond analysis of literature to provide the following definition: Being a role model in health promoting behaviour involves being an exemplar, portraying a healthy image (being fit and healthy), and championing health and wellness. Personal attributes of a role model in health promoting behaviour include being: caring, 8 non-judgemental, trustworthy, inspiring and motivating, self-caring, knowledgeable and self- confident, innovative, professional and having a deep sense of self. Thematic analysis of qualitative data provided insight into factors perceived to affect the ability or desire to act as healthy role models. Thus qualitative data highlighted perceived personal, educational, societal and organisational complexities surrounding the requirement to be role models. Many participants in this study were unaware of the NMC requirement to be role models in health promoting behaviour and did not understand what is meant by the concept. Although most participants perceived being a healthy role model as important to their role as a nurse many considered that working as a nurse did not support their own health and considered working environments unhealthy. Some participants disagreed with the requirement to be a healthy role model and many felt undervalued by their organisations, which they considered a barrier to being a healthy role model. If nurses continue to be expected to act as healthy role models, understanding of the complexities identified in this study can help inform nurses, nurse educators, health care organisations and policy makers to support the profession to meet that expectation.