Appalling deficiencies in care as demonstrated in the Francis Report (2013) illustrate how nursing needs to understand, perform and ensure high quality nursing services. This strive for excellence includes better knowledge and education of students and registrants, both academically and by mentorship, coaching and supervision. However, ‘better’ educated is difficult to define. For Aristotle “the most finished form of knowledge is wisdom” or phronesis (Aristotle 1986 pg. 211), therefore the pursuit of wise nurses is a laudable endeavour. A paucity of empirical research exists around the identification of wise nurses, although previous theorists have critiqued nursing in relation to phronesis which has led to many contradictions and blurring of concepts. In an attempt at clarification this thesis enlisted retired adult nurses with the benefit of hindsight from a full career within nursing to recall former colleagues considered wise. By using constructivist grounded theory and in-depth interviewing I elicited data from which my theory, the 3 pillars of virtue, for wise nurses emerged (intellectual, personal and professional virtue). This holistic model suggests that nursing applicants should demonstrate foundation virtues then strive for ‘professional phronemos’ (on the journey to professional wisdom) over their career with the ultimate goal of reaching wise nurse status. I postulate that it takes many years to achieve excellence in all 3 virtues, hence wise nurses were shown to be rare and from the older generation. Their extensive expertise was recognised by participants as ‘something special inside’, ‘stunning’, ‘gifted’, ‘some indefinable essence’. This research offers pertinent recommendations to the field since wise nurses were identified as natural leaders, guardians of the profession, enablers and role-models for facilitating professional phronemos in others. The recent UK recession has diminished the numbers of senior nurses and thereby many wise professionals. We need to encourage mature nurses to remain in order to role-model, mentor and nurture others to become wise nurses of the future. My results also advocate ‘gatekeeping’ the profession; broadening our professional knowledge beyond competency frameworks and guidelines; facilitation of professional phronemos in all nurses; and consideration of ‘legacy mentors’ from amongst recently retired nurses.

Objective: This study aims to examine the relationship between nurse managers' leadership style and nurses' organizational commitment in Saudi Arabia. Background: The contribution that nurses make to healthcare systems is fundamental to meeting the goals of the organization in providing safe and high quality health care services. Quality of care can thus be jeopardized by a shortage of nurses: a problem of increasing concern in Saudi Arabia. Design and methods: The study used a quantitative methodological approach: the Multifactor Leadership Questionnaire (1995) was used to measure nursing leadership styles, and the Organizational Commitment Questionnaire (Mowday et al., 1979) was used to assess organizational commitment. Data was collected in a one-stage cluster random sample of 219 nurses and nurse manager from two medical cities in Riyadh, Saudi Arabia. Results: Transformational and transactional leadership were the two most dominant leadership styles as perceived by nursing managers and their staff in the sample. Both nurse managers and staff nurses considered the transformational leadership style to be the most frequent followed by the transactional leadership style. However, differences between the perceptions of nurse managers and their staff as to their leadership style were apparent. Nurse managers' self-rating scores were higher than their nursing staff rating scores on all five transformational, and two transactional, leadership styles. Overall, the level of organizational commitment was higher in nurse managers than nursing staff. In both, nurse managers and nursing staff, there was a positive relationship between transformational and transactionalleadership styles and the commitment to stay. Transactional leadership displayed a strong positive relationship with organizational commitment. However, after controlling for the influence of manager/staff statues, nationality, and hospitals, transformational leadership styles was the strongest contributor to the organizational commitment. Perceptions of both, transformational and transactional leadership styles, increased with age for nurse managers and nursing staff; however, there was no concrete relationship between the length of experience and the perception of leadership style. Conclusion: Transformational leadership enhances organizational commitment, which can result in enhanced staff retention. If the nursing workforce is well managed and the retention of nurses is enhanced, better health outcomes for patients could be the result. An understanding of the relationship between leadership and organizational commitment, which is a predictor of nursing retention, is of paramount importance. Introducing the Full Range of Leadership model to the Saudi nursing system will help to prepare Saudi nurses for positions as nurse managers and leaders. This will not only develop and strengthen the health care system in Saudi Arabia but will also contribute to the "Saudization" programme.

The End-of-Life Care Strategy (DH 2008), Quality Standards for End-of-Life Care for Adults (NICE 2013) and One Chance to Get it Right (LACDP 2014), expect nurses to provide compassionate care with sensitive communication to the dying and their relatives. However, More Care Less Pathway reported examples of less than optimum care and communication (DH 2013). There has been a call for basic knowledge of end-of-life care to be in pre-registration nurses’ programmes, but there are currently no curricula guidelines (DH 2008, 2013). Therefore, this study aimed to explore undergraduate pre-registration nurses’ perceptions of how learning end-of-life-care could be enhanced in the Higher Education Institute (HEI) and Clinical Learning Environments (CLE). A review into the effect of pre-registration nurses’ education on end-of-life-care revealed eleven quasi-experimental studies. These suggest that following education programmes, knowledge and attitude towards end-of-life-care appeared to improve. However, only one study occurred in England. A meta-ethnography into pre-registration nurses’ experiences of providing end-of-life-care revealed its emotional impact, including grief, anxiety and fear. This was influenced by ward culture, type of death, performing last offices, difficult communication with patients and relatives and support from friends and nurses. However, these studies did not explore pre-registration nurses’ perceptions of factors that enhance how they learn to provide end-of-life-care. A qualitative investigation was undertaken using focus group methodology. Twelve final year BSc Nursing (Adult) pre-registration students participated in three focus group interviews. Transcripts were analysed following techniques recommended by Strauss and Corbin (1998), including constant comparison, open, axial, selective and process coding. Five key elements that enhanced pre-registration nurses learning were elucidated: translation of knowledge between the HEI, CLE and P-RNs; role modelling; P-RNs motivation to learn, being able to manage the emotional labour of EOLC and the creation of a safe learning environment. It is recommended that future research should be directed towards a longitudinal study following pre-registration nurses learning during the programme, at six months and 12 months after qualification to reveal how knowledge is translated into end-of-life-care.

The purpose of this Constructivist Grounded Theory investigation is to discover the impact that spirituality education delivered throughout the pre-registration nursing programme has on the clinical practice of the study participants. Although a number of previous studies have looked at pre-registration spirituality education, to date, the transferability and sustainability of such education in clinical practice is unknown, so this is the unique purpose of this investigation. Furthermore, a qualitative approach was used to gain insight from the subjective stance of participants into their on-going understanding and experience of spirituality and spiritual care. The study involved thirteen adult branch participants who all happened to be female, and enrolled on a pre-registration nursing programme at the same university in the West Midlands, United Kingdom (UK). This investigation was in two phases. Phase 1 took place during the participants’ final year as student nurses, to enquire about their understanding of education about spirituality and spiritual care. Additionally, it was necessary to know about their practical application of such knowledge, and understanding in the clinical areas then, and Phase 2 six to eight months after qualification. So each individual in-depth interview was digitally recorded and transcribed before analysis in the cyclical tradition of grounded theory. From Phase 1 three main categories were developed: Perceptions of spirituality, accruing spirituality education, and opportunities to provide spiritual care. Finally the core category of ‘Enablement’ was constructed. The above main categories were explored further in Phase 2 to confirm any changes and developments in participants’ perceptions, knowledge, understanding, skills, and practice concerning spirituality and spiritual care. The main categories developed during Phase 2 were: essence of spiritual care, knowledge and skills for spiritual care, and delivering spiritual care. The analysis in Phase 2 revealed the core category of ‘Efficacy’. Consequently, the core categories from both Phase 1 and Phase 2 were combined to construct the theory, ‘Continuing with Enablement for Efficacy’. This theory explains how the participants resolved their main concerns of: transient recognition of some aspects of spiritual care, dominance of physical care, low priority of spiritual care in most clinical areas, and insufficient knowledge about spirituality and spiritual care. So the findings from this investigation support growing concerns in the literature for more spirituality education in nurse programmes, to enable them to feel more prepared and competent to consistently address the spiritual needs of patients in all clinical areas.

No description available.

Background: The Saudi government is currently pursuing the development of a qualified and appropriate Saudi nursing workforce through higher education preparation programmes. The addition of Bachelor of Science in Nursing (BSN programmes at new universities throughout the country was part of this strategy. However, it has been speculated that the rapid expansion of the new universities has resulted in inadequate educational and training facilities. However, the products of the new implemented universities not yet robustly investigated. The existing literature suggests that Saudi nurses graduating from both old and new universities are insufficiently prepared for clinical practice, while a number of international studies have argued that graduates’ competence can be influenced by high school background, along with education and training facilities. The characteristics of established and new universities differ in terms of the training facilities offered, and the type of students admitted. Aim: The aim of this research project is to assess the preparedness of Saudi nursing graduates for practice, following the expansion of nursing education in the Saudi higher education sector, with a particular focus on competence and knowledge. This was achieved by pursuing the following objectives: (1) assessing how nursing graduates from Saudi Arabian Universities performed in the knowledge test, and how they self-rated themselves in a self assessment of competence at the point of graduation. (2) Investigating and comparing the differences between graduates from established and new Saudi Arabian Universities in terms of performance on a knowledge test and self-assessment of competence. (3) Comparing the differences between graduates from established and new Saudi Arabian Universities in terms of knowledge test performance and self-assessment competence when background is controlled. Result: The initial results showed that the total mean score for all participants on their selfassessment of competence was 3 out of 4, whereas the total mean score on the knowledge test was just 26.6%. There were no statistically significant differences between the graduates of established universities and new universities in relation to their total mean self-assessment of competence scores. The total mean score for the self-assessment of competence for established universities was (Mean = 3.0) and for the new universities (Mean = 3.0), p = .405. Graduates of the established universities achieved higher knowledge test scores (Mean = 28%) compared with the graduates of new universities (Mean = 25 %.), p value = 008.

The thesis examines why first year nursing students leave their programme of study and the factors that influence whether they stay or leave. A descriptive, exploratory study design was undertaken using two survey instruments, the College Students Expectations Questionnaire and the College Student Experiences Questionnaire. Data about the expectations and experiences of one cohort of nursing students were collected at the beginning and compared with experiences the end of their first year of study. Additional data obtained from institutional records. There was a preponderance of first generation university students who entered the university through completion of an Access to Health Studies course. This group entertained similar high expectations of academic achievement to the school leavers. These expectations were not that was not matched by their experiences in the main. The most successful students being those in the 30 to 39 age group. Overall, students’ degree classifications did not match their expected performance. The findings show that most students who left the programme intended to return but did not do so. Identifying predictors of success for nursing students remains a key issue for the nursing profession. The findings indicate that although student attrition is multi-factorial, focussing on the predictors of success can overshadow the need to identify and support students who possess the potential for success if additional support is provided. The findings also underline the importance of helping students connect with their learning environment during the first year and to develop self efficacy skills early.

In the last decade over a thousand Indian physiotherapists have travelled to work or study overseas. Published literature investigates the global mobility of doctors and nurses but there is no literature that considers the global migration of physiotherapists from developing countries. The purpose of this study was to understand the motivations and aspirations underpinning the Indian physiotherapists' global mobility. Nineteen Indian physiotherapists were interviewed in English individually or in focus groups. The data was collected and analysed using constructivist grounded theory methods. The findings suggest that Indian physiotherapists travelled overseas for professional development, they sought knowledge, skills and experience that they perceived were not available in India. Many sought experience of autonomous physiotherapy practice. They aspired to a better life, through better professional practice, increased respect and pay. Indian societal values amplified the importance of pay and respect for male physiotherapists, whereas females prioritised professional development. All aspired to professional autonomy and planned to return to India once their travel objectives were met. Behind the motivations for travel was a discourse of challenge and turmoil for physiotherapy in India, where they have no legal professional recognition. The grounded theory constructed posits that the Indian physiotherapists' global mobility is a journey of professional identity transformation that consists of four stages 'forming', 'storming', 'transforming' and 'returning'. Identity formation occurs through professional socialisation during their degree training. 'Storming' occurs as they transition into work and experience a disjuncture between their nascent physiotherapy identity and the workplace role expectations. This leads to frustration as they aspire to autonomous practice and an autonomous professional identity; they hear that physiotherapy is different overseas. Transformation occurs through overseas professional development and experience of autonomous practice. Successful return to India is dependent upon returnees transferring and integrating their new professional identity back to the Indian physiotherapy context.

Nursing theorists have reviewed the contexts and continua into which advanced nursing practice roles in emergency care have evolved and developed, yet little empirical evidence has been gleaned directly from advanced nurse practitioners’ (ANP) perceptions. The nature and scope of this study is to explore ANPs’ (Emergency) perceptions of their role, positionality and professional identity from an Irish perspective. A qualitative narrative approach was used to gain insight into ten ANPs’ perceptions. The ANPs nursed in seven different emergency departments representing both urban and rural regions. Content analysis was applied to the narrative interviews to code and categorise the data and Bourdieu’s theoretical framework was applied to this analysis. This enabled the recognition and analysis of social and health contextual factors that related to professional advanced nursing practice in Ireland. Five key themes emerged: participants’ career pathways; personal and professional transitions; role dimensions and core concepts; position within the organisation; and emergent professional identity. Each theme contained a number of categories which included: starting points and management roles; structural changes; transitions and educational challenges; multidimensional nature of practice; ANPs’ communities of practice; and status and recognition. Discussion of these findings focused on: ‘Habitus - the transition from nurse to ANP’; ‘Field - reconstructing advanced practitioner positionality’; and ‘Capital - structure and agency that influence ANPs’ professional identity’. This study identified an in-depth understanding of ANPs’ experience of personal and professional transitional processes; heightened awareness of autonomy and accountability in decision making; waiting times, throughput numbers, X-ray and medication prescribing, and referral pathways as stressors; practice-based tensions regarding recognition at ADON level and communities of practice relations; and expressions of high job satisfaction in their provision of safe, timely, expert patient care. This provided a greater understanding of the ANPs’ (Emergency) role, position within the organisation and emergent professional identity. These are all unique important elements that were narrated in this study by the participants. The concepts of ANPs’ positionality and professional identity enable their role-fulfilment. The consequence of this is that ANPs’ roles reflect the attributes of advanced practice. This is seen to confirm and add to the current contemporary body of knowledge on the national and international stage. Recommendations for the domains of nursing, education, management and future research were drawn including: increasing awareness of ANPs’ (Emergency) role and scope of practice amongst healthcare personnel; forging links between nursing academics and ANP clinicians to create appropriate course curricula for ANPs’ continuing professional development; and the processes of reviewing future planning of nursing roles to include ANPs at strategic levels. Bourdieu’s model provided an important theoretical framework which exposed the interrelations and interconnectedness of ANPs’ habitus, field and capital. This played a major part in identifying and exploring ANPs’ unique perceptions, thus contributing to the body of knowledge for the domains of nursing, education, management and research. To conclude, this study has revealed that ANPs’ (Emergency) perceptions of their role, position within the organisation and emergent professional identity are multidimensional, complex and unique within the field of healthcare practice in Ireland.

Background: Health professional roles are being adapted in response to increased demand and declining medical workforces, both in England and internationally. This is exemplified by advanced nurse practitioners (ANP) in primary care. However, evidence suggests ANP practice may lack acceptability and understanding, leading to underutilisation. Professional identity (how colleagues are perceived by themselves and others) may influence how professionals work together to utilise such roles. Previous research has explored ANP professional identity during transition and in isolation from workplace cultures. Less is known about relationships between professional identity and established ANP practice within primary healthcare teams, or how ANP practice is affected by workplace cultures. Wider societal level influences have not been fully explored. This study aimed to explore the relationship between professional identity and ANP practice in a context where ANP practice was established. Methods: The study consisted of a qualitative cross-sectional study which explored professional identity of ANPs on a sample of general practice websites. Then the relationship between professional identity and ANP practice was explored, in-depth, in an ethnographic study of two general practices in England. Findings: ANPs lacked visibility on general practice websites. Both studies found ANPs were framed within a traditional nursing identity. This impacted on ANP practice and has implications for how professionals and the wider public understand ANP roles. Individual characteristics and interactional relationships were central to acceptance and utilisation of ANPs within the workplace, but were limited by broader societal level understanding of professional identities. ANPs negotiated their place within the workforce by utilising established understanding of professional identity. Intra-professional tensions were identified between ANPs and nursing. Conclusions: Professional identity is a useful framework within which to develop contextual understanding of ANP practice. Primary healthcare team members utilised shared understanding of professional identity to shape ANP roles, which both supported and inhibited ANP utilisation.