This thesis examined the meanings of student nurses' Locus of Control, satisfaction, a utonomy and professional accountability. The thesis a Iso assessed whether perceptions of these concepts change during the time on a nursing course. The participants were 170 nursing (non graduate and graduate) students from 4 different groups studying for Diploma in Nursing. In Phase 1, all participants completed LOC and Satisfaction Questionnaires. In Phase 2, 11 participants from graduate group were interviewed at the beginning and the end of their course, 2 years later. The qualitative data were analysed usmg Interpretative Phenomenological Analysis. Findings from Phase 1 demonstrated that students in this sample were more 'externally' rated when compared with other student populations (LOC mean 13.2 SD 3.85) but became more 'internally' rated towards the end of the course. Satisfaction data showed that the students were more satisfied at the beginning of the course and became progressively less satisfied the longer they were 0 n the course. This was demonstrated by a significant negative correlation between External Locus of Control and satisfaction. The findings revealed gender difference in LOC scores, with males scoring lower on the LOC scale, thus being more 'internally' rated than females. Findings from Phase 2 showed that the LOC mean for the interviewed group was higher a t the beginning 0 f the course, decreasing at the end of the course, thus demonstrating the shift towards internality. The qualitative data reflected this shift particularly in the statements from the second interviews. The analysis of the LOC concept showed marked differences between statements of 'internally' and 'externally' rated students. These differences were observed in relation to all studied concepts. Those rated 'internal', were more focused and more definite in their explanations and also linked control to independent decision-making. Different explanations of control were offered from seeing it as 'power' and 'knowledge' to perceiving it as an 'ability to determine the outcomes of events'. Some 'externally' rated students commented on the 'hierarchy in nursing' and some saw themselves at the bottom of this hierarchy. This research also found that autonomy and professional accountability were perceived as one and the same by many students. Autonomy was strongly linked with control and expressed in similar terms and all the students in the interview sample considered it important to have personal and professional autonomy

The main aim of this research study was to explore midwives' views and experiences of their support needs in clinical practice and then to identify how they would wish to receive such support. There was much literature to support the existence of stress and burnout in midwifery but no research that addressed ways of alleviating this. Further aims were to redress that imbalance by planning and facilitating a model of clinical supervision devised by the participating midwives. The study took an action research approach that involved working with a group of eight National Health Service (NHS) community midwives in a collaborative, non-hierarchical and democratic way in order to achieve change. This accorded with a woman-centred approach to working with clients that was being encouraged within midwifery. The midwives were typical of many community-based midwives in the United Kingdom (UK) who were working in increasingly stressful, complex and changing environments. Wider organisational and cultural issues are considered that affect working relationships. The nature of the way the midwives worked when they were offered and received support, and how they reacted and coped when their work team and work situation was threatened, was also explored. Each midwife was interviewed twice; before and after the experience of clinical supervision. They also participated in two focus groups before clinical supervision. In- depth individual interviews lasted up to two hours, as did the focus groups. The interviews and the focus groups were taped, transcribed and then analysed using a relational voice-centred methodology. The main findings were that recent and ongoing change plus the organisational demands placed on the midwives by the NHS and their managers were detrimental to working relationships with their colleagues and clients. This also inhibited the process of change. A discourse of denigration became apparent within the interviews and the midwives behaviour and coping strategies revealed some well developed defence mechanisms, as well as an apparent lack of understanding on their part and that of their midwifery managers in relation to emotion work. Resistance to change was a key defence mechanism used by the midwives. Strong messages emerge about certain 'performances' being available to midwives and the use of defence mechanisms as a way of 'getting the work done'. There are also messages about the cultural legacy of midwifery and how this can inhibit autonomous behaviour by midwives. Developing and increasing self awareness is still not viewed as being intrinsic to the work of the midwife and midwives are being asked to undertake a level of work that they have not been adequately prepared for. Neither do there appear to be effective role models for midwives. The bureaucratic pressures of working in a large maternity unit are also addressed where the system is seen as more important than the midwives.

The computer is becoming a routine tool in the nursing workplace. This offers nurses the opportunity to use the Internet to access evidence based information to support care giving, information to support their patients manage their health, and a range of systems for efficient record keeping and quality enhancement. To achieve this nurses need a variety of skills and knowledge, including information governance. A mixed methods longitudinal study was undertaken with a cohort of student nurses to explore how ready, willing and able they were to engage with the nursing informatics agenda, and the factors that affected this. The students in this research were found to have quite poor computer skills at the start of the course. There was low use of applications, and the use was unsophisticated. Students were unaware of the skills required and were unable to assess their own skill levels. The students considered that computers were important for nurses and were a good information source for patients, and expressed a willingness to engage with them during their course. The support received in practice varied between, and within, organisations. The most frequent scenario was that the qualified nurses supporting students had poor skills, low awareness of nursing informatics and did not encourage the students to use computers. Nursing informatics needs to be explicitly and consistently included in preregistration nursing courses. This needs to be supported by academic staff with nursing informatics expertise in order to provide support for integrating nursing informatics into both theory and practice elements of the student's education. A model for nursing informatics in pre-registration education is proposed. The aim being to break out of a vicious circle of poor awareness of nursing informatics in the university based elements of the course, and a lack of interest in practice leading to students being unaware of the scope of nursing informatics, and socialised into a nursing model that does not value nursing informatics. This can be achieved by creating an upwards spiral, building on the students willingness to engage, ensuring that they develop nursing informatics expertise and are ready to use it in practice thus providing positive role models for future students.