This professional doctorate thesis consists of a primary research grounded theory study exploring how first year student nurses learn in practice on their first placement. The study is complemented by a mixed methodology practice development project (PDP) that examines the specific aspect of student placement support using online communication methods. The thesis is interwoven by six personal narratives explaining both the reflexivity and reflectivity at key decision points. The aim of the primary research was to develop a theory of practice learning of first year students on their first clinical placement. An initial literature review identified a lack of recent research on how student nurses learn in practice settings. It revealed theories and research related to work based learning in other contexts that could be pertinent to student nurses’ learning on their first placement. Twenty one first year student nurses volunteered for the primary research study and were interviewed twice during their first placement (January – November 2013). Data collection and analysis used the constant comparative method and theoretical sampling of emerging categories. Participant interviews illuminated the organic and inconsistent nature of students’ practice learning. The theory which emerged from the data showed that first year student nurses were “learning to be a professional” from their first placement experience. Recognition and negotiation of practice learning in the highly politicised clinical setting was influenced by both the social context of the placement and the individual influence of the student. The primary research recommended the need for a greater awareness of practice pedagogy and support systems for students’ practice learning. The PDP found that online asynchronous groups could provide students with peer and academic support A grounded theory study exploring first year student nurses’ learning in practice 4 and included the dissemination of the project findings with recommendations for further implementation identified.

Nursing education has undergone radical change during the last decade. All nursing programmes are now based in Institutions of Higher Education. While many aspects of the implications of these changes have been investigated, little research has been published concerning the approaches to learning adopted by student nurses. The Approaches and Study Skills Inventory for Students (ASSIST) is a tool designed to investigate preferences for different approaches to learning. It was administered to 296 students undertaking the Diploma of Higher Education in Nursing programme of De Montfort University, Leicester. The responses provided by the students were analysed using the constructs of the original authors (deep, surface and strategic approaches). The data was then subjected to factor analysis. There was found to be a high level of consistency between the original constructs and the factors extracted, and it was thus concluded that the inventory was probably a valid tool for use with the sample population. The approaches to learning favoured by various subgroups of the population were examined. Thus comparison could be drawn between male and female students, between younger and more mature students, between students with different previous academic qualifications, and between students undertaking different nursing branch programmes. It was found that deep approaches to learning were most favoured overall, and that there was no change in approach as the students progressed through the course. Older students showed an increased preference for deep approaches when compared to younger students, and male students showed similar preference when compared to female students. It was also found that students undertaking the adult nursing branch programme were more likely than other students to favour surface approaches to learning. Some of the implications for nursing education are discussed.

Seventy five nursing staff working in a high-security psychiatric service for women completed the Maslach Burnout Inventory and a measure of emotional reactions in response to one of three vignettes depicting a commonly experienced violent siutation: an attack by a patient on a patient, on a member of staff and an episode of self-harm. An attack on a member of staff was associated with more negative feelings but less Depersonalisation than an attack on a patient, and with more negative feelings than self-harm. However, staff felt more Personal Accomplishment in the case of an attack on a member of staff than in the case of self-harm. Male staff experienced more Depersonalisation than female staff in association with an attack on a patient. Overall, the longer that staff had worked at Ashworth Hospital and in particular in the Women's Services, the greater their negative feelings and Emotional Exhaustion. Length of service with the women patients was associated with reduced Personal Accomplishment in relation to self-harm. The results are discussed in terms of the communicative function of violence, in particular self-harm which appears to elicit particularly strong feelings of helplessness and incompetence in staff. The use of unconscious and cognitive coping strategies are considered along with role-conflict for forensic nurses and the organisational context of Ashworth Hospital.

Objectives: The aim of this study was to explore the underlying factors that may influence dimensions of safety climate in nursing practice. A mixed methods study was used to explore safety climate in nurses working in operating theatres, critical care units and ward areas. A cross-sectional survey was undertaken using the Safety Climate Questionnaire (SCQ) to undertake a Confirmatory Factor Analysis (CFA) and to compare safety climate. Focus group discussions and thematic analysis were undertaken to explore the meaning of safety climate in nursing practice. Results: The nine factor structure of the SCQ was used as the a priori model for the basis of a CFA of the SCQ. The results indicated that there was a good model fit on some criteria (χ2 = 1683.699, df 824, p < 0.01; χ2/ df = 2.04; RMSEA = 0.058) but a less acceptable fit on Comparative Fit Index (CFI) = 0.804. There was a statistically significant difference in the safety climate dimension of Management Commitment (F [4,266] = 4.66, p = 0.001) where the operating theatre group reported lower safety climate compared with ward areas and the operating theatre focus group also reported negative perceptions about management. Although there was significant variation in safety climate scores for the dimension of Communication across clinical specialism (F [4,266] = 2.62, p = 0.035) none of the pair-wise comparisons achieved statistical significance. The three themes identified in the thematic analysis were Human Factors, Clinical Management and Protecting Patients. The system and the human side of caring was identified as a meta-theme. There were areas of overlap and some differences between the dimensions of the SCQ and the findings of the thematic analysis. Conclusions: The results suggest that the SCQ has some utility but requires further exploration for use in nursing practice. There were differences between different clinical areas for Management Commitment and Communication. The measurement of safety climate is complex and the findings of the thematic analysis indicate that safety in nursing practice has a complex relationship between safety systems and the social and interpersonal aspects of clinical practice.

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BACKGROUND This action research study focused on crafting the practice learning element of a pre­registration nursing curriculum in implementing a portfolio as a tool to support learning and development within a person-centred context. METHODOLOGY An emancipatory action research methodology was used over three annual cycles with one cohort of pre-registration nursing students, academics and practice partners. The research questions were: 1. How can the portfolio be enhanced to be an effective tool that enables students to learn and develop in practice? 2. How can the portfolio be enhanced to support the development of person-centred nurses? Data collection occurred annually using the Caring Dimension Inventory (CDI-35), the Portfolios in Nursing Education (PNE) questionnaire and focus groups. Descriptive and comparative statistics were calculated on quantitative data and qualitative data were prepared into verbatim reports as preparatory steps for critical creative hermeneutics analysis. RESULTS Sixty five actions were implemented to improve the portfolio as a successful learning tool. These related to sign-posting learning, supporting the identification of learning needs, accessing learning opportunities, and engaging students in authentic critical reflection. Improving the nature and consistency of support was a strong feature of these actions. Perceptions of caring attributes were sustained and developed further by the point of registration. DISCUSSION In unfolding solutions to improving the portfolio and support in its use, the findings revealed conditions for this to take place within a person-centred context. These were central to creating a culture that enabled transformative learning for human flourishing. Students self-actualised in terms of their concepts of caring and person-centredness in achieving the standards for registration. Authentic collaboration between stakeholders in the curricular approach were core to the success of the project. Theorisation of findings led to a conceptual Framework for Practice Learning (FPL), enabling findings to be applied in curricula in pursuit of person-centredness.

This study is an exploration of student education and training choice-making in the Allied Health Professions (AHPs). Rejecting the dominant and ‘official’ government discourse, educational choice-making in the AHPs is constructed as a form of social practice, derived from individual agency, but also the effects of institutional and social structures. Engaging with the work of Pierre Bourdieu, in particular the application of his conceptual tools of habitus, capital and field, I have ‘borrowed’ from his unique methodological approach to engage a number of inter-related stages of exploration in a specific and unique case. At the macro level, I conduct a critical discourse analysis of a relevant policy text. This is followed by a meso-level examination of field-specific capital, as the basis for determining the position of each programme within the AHP education and training field. Finally, a micro-level analysis, using both questionnaire and semi-structured interview data is used to identify and explore how students’ personal stories reveal the way that the habitus guides and shapes individual accounts and experiences of choice-making within Watson et al.’s (2009) diagrammatic construction of a social field. Choice-making in the AHP education and training field was found to be a complex mix of institutional structures, processes and individual position-taking. In this milieu, economic and political motives underpinning a revised policy discourse do not necessarily support greater democratisation of participation. The effect of capital revealed the possibility for distinction, hierarchy and status as a reflection of the position of each programme and the value placed upon them. Finally, the habitus, rather than generating static replies, was found to be capable of multiple and contingent responses. Along with other structural influences, social class, despite the emergence of its own fluidity, was nevertheless a major factor in shaping experiences and practical responses to AHP choice-making.

This thesis explores the experiences of a group of newly qualified Mental Health Nurses (NQN) who were educated using a new Problem-based Learning (PBL) curriculum. It begins by outlining the literature and other drivers that shaped the design and delivery of this programme. Drawing on an initial evaluation of the programme together with a consideration of the literature a number of foreshadowed questions were identified that informed the constructivist grounded theory approach that the study adopted. Data were collected from former students and their supervisors using telephone interviews and analysed using constant comparison. The resultant theory describes a temporal model of the students’ experiences and identifies three basic processes that shaped their learning. These were: Struggling; Resolving; Performing. The findings support the use of PBL in developing the necessary skills and knowledge needed for Mental Health Nurses. The quality of the theory is appraised using relevant criteria. The thesis concludes by comparing the theory with the literature and considers the implications of the study for education and future research.

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There is a gap in the knowledge about the research culture of nurses and Allied Health Professionals (AHPs) in the UK, and the influence of a dedicated research strategy and funding. It is important to understand the culture in order to effectively promote evidence- based patient care. The primary aim of this research was to explore the influence of research focused exposure on the research culture of nurses and AHPs in the UK and identify if there was a difference in the research culture between a research focused and non-research focused clinical area (City and Riverside Hospitals). This is a unique and novel study that explored and compared the research culture stance of both AHPs and nurses. A mixed methods design was used in this study. Tools used included the ‘Research Capacity and Culture Tool’ as an online survey, three focus group discussions and 5 semi-structured interviews with senior managers. Focus groups included research naive groups from both hospitals and a research active group from City Hospital. There were 224 responses received from 941 surveys with a 24% response rate. Descriptive statistics of the survey results indicated that there was a difference (p=0.001) in the mean score of the research culture between City Hospital (5.35) and Riverside Hospital (3.90), but not between nurses and AHPs (p= 0.12). Qualitative data findings from the framework analysis were congruent and supported the survey results. The results provided empirical evidence to support a whole level approach in order to improve the research culture. The findings showed that there may not be any difference in the research culture between professional groups. Importantly, new evidence is presented to suggest that there were crucial communication issues which were hampering the research culture and there was a lack of support at the middle management level which needed to be tackled to improve the research culture of nurses and AHPs. The study highlighted the need to include communication within the Cooke’s Framework if evidence based practice is to influence the quality of patient care.