The pre-registration preparation of health care professionals for work in the operating department is in a transformative period. Now firmly entrenched in higher education, the professions are pursuing a policy of graduate entry based on a discourse underpinned by human capital theory. The impact of the introduction of graduate entry to nursing and Operating Department Practice (ODP) is explored in the context of the role of these professional groups in the operating department. A purposive sample of ODPs and theatre nurses participated in a survey, which was followed up with semi-structured interviews with a purposive sample of ODPs and theatre nurses, from each of the salary Bands 5 – 8. The findings from the study provide an original contribution to the field of education in three areas. First is a reconceptualisation of human capital theory which acknowledges both organisational and individual factors as determinants of participation in further education and training. Human capital theory is repositioned as a multidimensional model which maintains and builds on Becker’s (1993) original conceptualisation. Second is an insight into professionalisation at an individual practitioner level, which is linked to the red queen hypothesis to explain individual actions and reactions to the introduction of graduate entry. Third, a recommendation for review of the pre-registration training for ODPs and nurses is made, based on how the practitioners in this study developed their body of professional knowledge and contextualised clinical experience.

This project was conducted under the assumption that examples of troublesome knowledge exist in mental health nursing education curricula. The purpose of the project was to identify specific mental health content that nursing students and faculty identified as being troublesome and organized them using the definitions established by Perkins (1999) and Meyer & Land (2003). A sequential mixed methods research design was used to investigate nursing students and faculty member perspectives on troublesome mental health nursing content. Data were collected using surveys and focus groups and analyzed using a combination of quantitative and qualitative methods. From the project data, troublesome mental health nursing content was organized into five themes including the spectrum of mental illness, therapeutic relationships and boundaries, praxis, professionalism in nursing, and brain chemistry changes and management. Troublesome mental health nursing content was also organized according to troublesome form, revealing that students focused more on alien/foreign content and faculty focused more on tacit content. The student and faculty perspectives on troublesome mental health nursing knowledge are different. However, specific mental health nursing content was identified by all participants as being troublesome. This overlap consisted of troublesome knowledge for students with unresolved troublesome knowledge for faculty. To explain the learning examples collected during this project, a learning pathway was created, providing a visualization of the student's movement through the liminal spaces associated with learning troublesome mental health nursing knowledge.

This is an exploratory study of the factors that enhance or inhibit empowerment development during the clinical placement of final-year undergraduate nursing students in Ireland. Empowerment is a topical concept used not only in health care but also in business and education. However, few studies have looked at the impact of clinical placements on the empowerment of undergraduate nursing students. A qualitative design was employed using Layder’s adaptive and social domain theories (2005; 2006). Focus group interviews were conducted with 43 (n=43) undergraduate nursing students in one college providing nursing education in Ireland. Interview data was analysed and findings suggest that preceptors are pivotal to nursing student empowerment. When preceptors were empowered in the clinical learning environment they radiated positive influences and positively influenced nursing student empowerment. In addition the concepts of inclusion, belonging, trust and respect were also factors in creating a supportive culture to nurture nursing students’ empowerment. Conversely disempowerment occurred in ward areas that reflected a hierarchical culture that lacked respect and where nursing student socialisation was inhibited by feelings of powerlessness. Cultural influences, socialisation processes and positive preceptorship within the clinical learning environment combined with feelings of power/powerlessness impacted empowerment of nursing students in this study. Not all participants in this study had similar experiences, demonstrating that organisational and hospital culture had a considerable influence on the extent of empowerment and disempowerment experienced by the participants.

This thesis explores the impact of the phenomenon of transnational medical and nursing education on the lifeworlds of a small group of Bahraini female medicine and nursing graduates in Bahrain as they ‘became’ Irish qualified doctors and nurses ‘at home’ in the Middle East. A regional hub of transnational medical and nursing education was created in the tiny Kingdom of Bahrain ten years’ ago when a leading Irish medical university, pursuing a strategy of internationalization, opened a branch campus on the island. Students in Bahrain are conferred with the same degrees as those awarded in Ireland, but little is known about local student experiences of transnational medical and nursing education in this particular socio-cultural context. Bahraini female medical and nursing students occupy and embody a unique local cultural sphere grounded in Arab Islamic values and patriarchal norms, yet have to imagine themselves in different ways informed by the global discourse of transnational education. The purpose of this study was to investigate how these students gave meaning to and made sense of their lived experiences as they navigated complex issues of gender, power relations and socio-cultural values during their lengthy socialization into the professional persona of a western educated doctor or nurse. The study design was qualitative and employed Interpretative Phenomenological Analysis (IPA) as its methodological framework. Data were collected from two focus group discussions and nine individual in-depth interviews, according to conventions of qualitative research and principles of IPA. Findings were interpreted through the lens of postmodern feminism. The importance of reflexivity in IPA and postmodern feminist thought was highlighted as the voices of participants were clearly heard from the position of their own lifeworlds, filtered through the researcher’s own positioning within the research process. A deep and contexualised investigation into Bahraini female student experiences was undertaken, moving forward the discourse of transnational medical and nursing education. As these young women became empowered learners, they articulated self-determination, self-efficacy and personal agency within their uniquely constructed Transnational Community of Practice (TCP), through which they redefined cultural boundaries and developed coping strategies in order to succeed in an emotionally charged and challenging transnational space. The study demonstrates that gendered ways of knowing and the tensions of negotiating differing cultural contexts are often ignored and invisible components of a hidden curriculum which shape student personal, academic and professional achievement. This study revealed new conceptualisations for Bahraini female engagement within the discourse of transnational medical and nursing education in the Middle East, from which a particular Bahraini female discursive positioning and standpoint emerged, grounded in a distinct Arab Islamic feminist reflexivity. The impact of their educational experiences was transformational in character as the graduates became agents of change, shifting the balance of local gendered power relations and extending their influence into wider Bahraini society. This study concludes by calling for new metaphors in transnational medical and nursing education which take into account local student voices and move beyond the realm of western cultural norms in order to enhance student empowerment, engagement and success in specific contexts.

Recent scandals, such as the abuse at Winterbourne View, continue to draw public attention to the issue of the abuse of people with learning disabilities (Department of Health, 2012). Existing research into this area is often too simplistic, focusing on characteristics of the victim, perpetrator and settings in which the abuse takes place. Nurses in learning disabilities services have been suggested to occupy multiple roles (Golding, 2001); however, there appears to be a lack of consideration given to the impact this has on staff management of boundaries. Interpretative Phenomenological Analysis was used to explore the experiences of five nurses working in residential services for people with learning disabilities. Three superordinate themes were identified: (i) investment and enmeshment of one’s self in the role, (ii) unique setting and population and (iii) staff understanding and management of boundary crossings. Findings indicated that multiple roles, for these participants were irrelevant, and instead concerns around balancing client needs within service limitations and pressures were more salient. Additionally, participants appeared to lack a clear conceptualisation of boundaries instead focusing more on their relationships with service users and their understanding of what it means to provide good care, likening these to personal relationships. In addition, guidance and supervision was insufficient in meeting staff needs leaving service users vulnerable to abuse. Service level changes including supervision facilitated by an outside agent, and experiential training to challenge axiomatic thinking may support staff in managing the pressures and complexity of their roles.

It is thought that dyslexia and learning difficulties affect approximately 10% of the U.K. nursing population. There is a global shortage of nurses which makes a policy of widening participation a prudent recruitment strategy, meaning that this percentage is unlikely to drop even though nursing is now an all degree entry profession. Nurse mentors are central to the practice learning of student nurses and this equates to 50% of the course requirements. Nurse mentors receive training around disability which incorporates learning difficulties but this tends to be factual. Little is known about how nurse mentors support and work with students who may have a learning difficulty in the clinical setting. The aim of the study was therefore to explore mentors’ experiences with students who have, or may have, a specific learning difficulty such as dyslexia. Using an adapted constructivist grounded theory methodology, 24 nurse mentors were recruited allowing the formulation of a substantive theory to explain mentors’ experiences with these students. This is encapsulated by the phrase ‘To mentors, dyslexia is just spelling’. Three sub-categories are presented to establish the context in which the theory is set, and these are: ‘The practice environment’, ‘The mentor/student relationship’ and ‘Dyslexia and learning difficulties’. Extant literature is used as a resource to further explore issues arising within these categories. Researcher reflexivity contributed significantly to the research process, providing insight into the researcher’s thinking and the process of theory production. The research offers contributions to Higher Educational Institutions, NHS Trusts, all levels of the nursing workforce, and to students who have, or may have a learning difficulty. Recommendations for practice centre on promoting knowledge and understanding of dyslexia and learning difficulties in the practice environment so that cultures supportive of students with these difficulties are encouraged.

The concept of specialist nursing and advanced nursing practice has been extensively debated in the literature internationally but to date no consensus exists on the preparation, titling and regulation of these nurses worldwide. The introduction of specialist nurses in Malta in 2003, now titled ‘practice nurses’, was seen as an evolution in nursing practice and launched in response to gaps in services and developments in health policy. This was perceived as a much needed career advancement option for nurses; an alternative to traditional administrative/educational roles; and a drive towards improving patient access and quality care. However there was still a paucity of information and evaluation of the nurses’ role in Malta. The aim of this study was to explore the perceptions of the roles, development and preparation of specialist nurses in Malta, an island with its own historical, political and social context. Using a qualitative case study design, a deep understanding of the complex issues surrounding specialist nurses was gained from multiple data sets using purposive sampling techniques. Data included a survey of the total specialist nurse population (N=27), in-depth interviews with a group of specialist nurses (N=9) and four focus groups with key professionals and policy stakeholders (total N=28). Data were collected between 2013 and 2015 and analysed using thematic analysis. The main themes that emerged from the findings including concepts of advanced nursing practice, role boundaries, preparation, regulation and autonomy to practice. In spite of the very positive views on the roles and practice of these specialist nurses, a number of barriers to their future development were exposed. Barriers comprised the lack of understanding and support for their role and the paucity of evaluation research on their role. Additional areas affecting their advancement included the organisational and political systems that were seen to affect leadership, and power in nursing to achieve the ultimate aim of consistent provision of good quality nursing care. The study provides the first research- based insights into the role and development of specialist nurses in Malta, and concludes by highlighting the need for a legally accepted set of definitions, preparation and evaluation of the specialist nurse role from a national policy perspective.

In spite of national and international policy encouraging assistant nurses to become Registered Nurses (RNs), the work role transition they experience has attracted little attention from researchers. The present study addressed this gap, adopting a mixed methods, cross-sectional, sequential approach. Qualitative approaches were needed to develop core understandings of work role transitions and quantitative approaches for statistical measures to outline changes over time and influences on transitions. The dominant approach was qualitative, sequencing the qualitative to follow the quantitative data collection. The components were analysed separately up to the point of interface and the core qualitative component provided the mechanism for reporting the results. Three cohorts of student nurses at two universities, from academic years 1, 2 and 3, and with prior Health Care Assistant (HCA) experience, were surveyed then interviewed at the beginning and end of their academic years. It was found that students, clinicians and policy makers assume and expect that prior HCA experience facilitates students’ pathway to RN. Findings indicate that the former role and workplace experience do not automatically facilitate change and transition. A model of transition is presented from assistant worker to professional qualification. Students disconnected from their former work role, re-visioning old values and perceptions and finding that the student/RN role required different ways of thinking and working. They moved from a skills task focus to a whole-task approach. Students experienced role change shock as they found that prior experience did not automatically equip them for their placements and could constrain as much as facilitate their transitions. They entered a betwixt and between stage of uncertainty and discomfort while learning to act out the student role to the satisfaction of audiences of practitioners, educationalists and patients. Students changed and developed, clinically, professionally, academically and personally, becoming a “reconstituted” person before inclusion in the profession. The combination of transitions and dramaturgical, theoretical and analytical approaches explains the pattern and experiences of transition. The journey of transition cannot be reversed because, once educated to be a nurse, the traits deemed desirable by the profession are made to “stick” and exert their influence long after initial education. The support worker becomes professionally qualified – the transition from HCA to student and neophyte RN is completed.

This research aims to understand how the experience of placement influences nursing students’ self-concept and their achievement goals. The relevant literature suggests that the current shortage of nurses is a consequence of low professional self-concept, which is also related to how nursing students’ achievement goals alter before and after clinical learning settings. Research to date has yet to examine how the experience of placement influences nursing students’ self-concept and their achievement goals. Applying quantitative data analysis, this thesis addresses how first-time nursing placement influences nursing self-concept and achievement goals as well as the relation between achievement goals and students relationship with staff. 276 Taiwanese nursing students completed two questionnaires, Achievement Goal Questionnaire (AGQ) and Nurses’ Self-Concept Questionnaire (NSCQ) at 3 different time points over a period of 7 months. The results suggest as follows. First, students had higher self-concept of staff relations after placements, though no other self-concepts increased. Because of this result, the current thesis will specifically discuss nursing students’ confidence development on staff relations. Second, mastery approach goal reduced after placements and performance goal remained stable. Third, a moderate positive correlation between mastery approach goal and staff relation was found in the group who stayed in classroom, while such correlation was very weak in the group who attended placements during this research. Given the literature has demonstrated anxiety and fear of failure are students’ common challenges during placements, this research supports that the participants’ anxiety and feeling of incompetence diminished their desire to mastery nursing. Additionally, the findings appear coherent in terms of students’ progress during the placement. The nature of clinical placements is performance oriented; however, in the current experiment, students’ confidence in nursing skills and knowledge did not change. This result indicated students’ perceived competence did not alter because of the placement; their performance goals therefore remained unchanged. Furthermore, the incline of the confidence in staff relations after placement suggests nursing students understood they needed to bond with staff before learning to be a nurse. Such result is in line with the literature that novice is aware of the importance of being accepted by the team because being accepted is a prerequisite for learning. Despite empirical studies noted that mastery goal has positive correlation with interpersonal relation but the third finding pinpointed that in addition to mastery goal whether or not the individual has found sense of belonging in the group should be taken into account when examining how achievement goals influence interpersonal behaviours.

Background: Nurse rounding has been widely practiced in the UK since 2012, transferred from the US as a nursing intervention which positively impacts on patient outcomes. Current evidence highlighted a dominance of quantitative studies tentatively linking rounding to impact measures of reduced falls, pressure sore incidence and reduced use of call bells. Outcome measures fail to elicit an understanding of what rounding means from the perspective of the patient or the nurse, moreover applied research evidence in the UK was limited. This study was designed to understand how the practice of rounding impacts on patient experience and nursing care in the NHS. Method: Ethnographic methodology was used to see, listen and talk about rounding with nurses and patients. Data collection involved participant observations (38), nurse (34) and patient (34) interviews alongside the analysis of documentary data across two NHS in-patient wards. Findings: Findings exposed a culture of rounding practice different from the process described in the literature, encapsulated within four themes: Presence, Actioning Care, Playing the Routine, and Engagement. Reduced falls rates and pressure ulcer prevalence were flawed outcomes of rounding practice, rounding had both social and clinical outcomes depending on the person delivering the round, and patients valued the regular presence of the rounder particularly the nurse in charge. The rounding model generated defined the outcomes of nursing rounding. Conclusion: The new knowledge identified rounding practice in its current form was in danger of becoming a tick box exercise with limited impact on patient experience and patient safety. However, recommendations identify opportunities exist for nursing to develop rounding as a mode of care delivery or as a way of offering social presence and engagement to patients. The constituents and constructs of the rounding process need to be further understood to find the true value of the practice to nursing.