Aim and background: this study investigates faculty members’ perceptions of the impact of Impact of the leadership styles of nursing deans on the job satisfaction of faculty members working in nursing education in Oman. Nursing education in Oman currently is going through a major transformation, with the appointment of new deans, the introduction of an accreditation process, and the upgrading of the nursing diploma to a Bachelor’s degree program in all governmental nursing institutions. These reform require significant development work in a short period of time; various taskforces have been established with specific tasks such as curriculum restructure, improving the range and number of research activities, the merging of institutes, introducing new policies, and establishing a quality assurance approach. This reform programme demands effective leadership to lead faculty, build the vision and respond to a range of external demands. In Oman, there is a lack of research on the role of leadership in higher education and its importance to staff professional development and job satisfaction, which in turn reflects on the level of organizational performance. The significance of this study is that it explores the perceptions of both teaching staff and their deans in a comparable set of organizations to determine which leadership styles have the greatest potential to improve their organizations. This was an insider research project with the researcher being a nursing dean; however certain measures were taken to ensure validity and reliability of the study. Method and conclusion: The study involved 147 lecturers and 7 leaders from various nursing institutes in Oman. Data were collected through semi-structured interviews and questionnaires: the Minnesota Satisfaction Questionnaire (Weiss 1967) and the Multifactor Leadership Questionnaire (Avolio & Bass 2004). Qualitative data were analysed for recurring themes and coded accordingly. Coding categories were constructed from the concepts and themes that emerged during the interview process and from the review of the literature. The overall findings indicate that most faculty members are satisfied with the leadership style of their deans. The transformational leadership style emerged as the preferred style to ensure faculty satisfaction and maintain productivity levels in demanding times; however, the deans also used a transactional leadership style for specific tasks. Implications: Management roles in health care education are very demanding, thorough preparation is required for the dean’s role and its associated tasks in order to develop and sustain a transformational style. Work-related leadership training and skill-development workshops, mentoring, and survival skills workshops could provide new deans with much needed support. The research on transformational leadership provides a good starting point; however, we need to think of the next step. It is very clear that deans of nursing institutes need to adopt transformational-transactional leadership styles to overcome continuous challenges, satisfy the nursing faculty and boost organizational productivity. Hence, the role of the nursing dean in Oman has to be built on transformational leadership, with a focus on collaboration by adopting a distributive stance (distributed leadership) that focuses on learning.

This thesis explores the impact of simulation upon learning for undergraduate nursing students. A brief history of the evolution of pre-registration nurse education and the development of simulation for nursing provide background and context to the study. The conceptual frameworks used for this study draw upon the work of Benner and Sutphen (2007) and Engeström (1994). Benner and Sutphen’s work highlights the complex nature of situated knowledge in practice disciplines such as nursing. They suggest that knowledge must be constantly integrated within the curriculum through pedagogies of interpretation, formation, contextualisation and performance. These pedagogies present a framework, which enhances the understanding of the impact of simulation upon student learning. Engeström’s work on activity theory, recognises the links between learning and the environment of work and highlights the possibilities for learning to inspire change, innovation and the creation of new ideas. His notion of expansive learning offers nurse education a way of reconceptualising the learning that occurs during simulation. Together these frameworks present an opportunity for nurse education to articulate and theorise the learning inherent in simulation activities. Conducted as a small-scale narrative case study, this study tells the unique stories of a small number of undergraduate nursing students, nurse mentors and nurse educators and explores their experiences of learning through simulation. The nurse educators viewed simulation as a means of helping students to learn to be nurses, whilst, the nurse mentors suggested that simulation helped them to determine nursing potential. The students’ narratives revealed that they approached simulation learning in different ways resulting in a range of outcomes: those who were successfully becoming nurses, those who were struggling or working hard to become nurses and those who were not becoming nurses. A theoretical analysis of learning through simulation offers a means of conceptualizing and establishing different perspectives for understanding the learning described by the participants and offers new possibilities towards an expansive approach to learning nursing. The study concludes by examining what this interpretation of learning might mean for nurse education, nursing research and nursing practice.

This study critically explores how Bourdieu’s (1985; 1989) concept of social space impacts on the experiences of medical and nursing students in the primary care setting when non-formal work based learning (WBL) is used as a model for interprofessional education (IPE) (Moore, 2012). Current ways in which professionals conduct their relationships with each other are also examined and factors that impede collaboration are also explored using Bourdieu’s theory of social life (1979; 1985; 1989; 1992; 1996; Bourdieu & Wacquant, 1992) as a theoretical lens. Bourdieu (1979) uses the concept of social space as a means of exploring power and hierarchical relationships arguing that social space influences relationships so that whilst groups of people can be located in the same physical space, they can remain socially distant (Bourdieu & Wacquant, 1992). In the United Kingdom (UK) different professions are now located together, within GP (General Practitioner) Practices, in the belief that it will enhance CP (DH, 2005; Hudson, 2007). However, there are a number of factors influencing how doctors and nurses work together and these include the powerful position of the doctor in relation to the nurse (for example: Coombs & Ersser, 2004; Davis, 2003; Fagin & Gaerlick, 2004, Malloy et al 2009, Vogwill & Reeves 2008). Therefore, students placed in this environment are likely to be immersed into practices where power relationships occur and supervised by those who are involved in them. As such it is likely that they learn the implicit, hierarchically influenced, rules of engagement that are practiced by their qualified counterparts (Collin et al., 2011). The study drew on critical ethnographic principles and took place in a city in the north of England. Participants were selected purposively and were comprised of the staff from three GP Practices, as well as medical and nursing students who were on or had recently completed a clinical placement at one of the three Practices. Data were collected predominantly through uni-professional focus groups alongside a selection of observations. Field notes were made at the time of the observations and a reflexive diary kept throughout. I transcribed the focus groups verbatim and uploaded them into NVIVO8 with analysis undertaken using template analysis (King, 2004). Whilst CP is now accepted as a fundamental part of contemporary health care (Barr et al., 2005; Dickinson & Sullivan, 2014) there is little clarity regarding either its meaning (Haddara & Lingard, 2013; Lingard et al., 2012) or of how it should be achieved (King et al., 2013) and could be the reason that measurements of its effectiveness are limited (Barr et al., 2005; Zwarenstein & Reeves, 2006). Exploration of CP within an emancipatory discourse ii however suggests a multitude of interplaying influences on how professions engage (Ansari et al. 2001; Haddara & Lingard, 2013). Indeed, findings from this study showed that whilst staff groups perceived CP to be positive, there remained a complex interplay of factors that impacted on how it occurred. In particular the dominant position of the doctor remained problematic influencing how, when and if it occurred. Physical space, elusiveness, communication methods, titles, language and tasks performed were all found to be significant in relation to the level and type of capital held and therefore the social space between professions. However, these were frequently masked by the physical space and distance between the staff groups. Bourdieu (1985; 1986) argues that the habitus of the individual is also influential in relation to social relationships as it is an inherent element of who a person is: influencing how they think as well as what they say and how they say it. The individuals’ habitus will ultimately manifest itself as a set of ‘tastes’ which shape their identity (Bourdieu, 1979) and how they engage with their environment (Bourdieu & Wacquant, 1992). The socialization of students into uni-professional practices resulted in their becoming indoctrinated into the epistemological norms of the profession to which they aspired: adopting similar tastes to their qualified counterparts. In this way the official criteria of WBL became lost in the unofficial criteria of social compliance to the hierarchical position held by their qualified counterparts (Billet, 2001a). The conclusions from this study argue that collaboration is complex and that greater recognition is required of those factors that impact on it: and in particular the power imbalance between doctors and nurses. Equally, current assumptions regarding students’ learning in this setting need also to recognize the complexities of CP, rather than simply relying on the experiences into which they are immersed to enable them to attain the goals of IPE and become ‘collaborative practice ready’ (WHO, 2010) at the point of qualification.

The primary aim of this longitudinal study was to evaluate the effect of an educational programme upon the attitudes of nursing students toward working with ill older people, with two main objectives: 1. To explore the contextual conditions necessary for the programme mechanisms to work, and 2. To investigate how these contextual conditions may influence the success of the programme mechanisms in changing attitudes. Critical realism provided the theoretical framework, which guided the study design, from inception through to data analysis. Katz’ (1960) functional approach to attitude change was used to develop the educational programme. The study was quasi-experimental, using an interrupted time-series design. The attitudes of two groups of nursing students were measured over a period of 20 months, prior to and after the educational programme. A questionnaire-based tool was used to measure attitudes, selected because of its acknowledgement of the importance of contextual factors when measuring the attitudes of nursing students toward the field of older person care. One group attended the educational programme, the other did not. The attitudes of the second group were measured at identical points, to provide data for comparison. The findings showed that the programme had no effect on the attitudes of nursing students toward working with ill older people, either immediately, or over time. Both existing and new mechanisms were identified, that appear to adversely affect the context in which nursing students learn about the practise of nursing, and make it difficult for students to experience the care of ill older people in a positive way. Detailed analysis showed that elements related to the clinical learning environment have a strong impact on students’ attitudes towards the care of ill older people; very often, this impact is negative. The reality of clinical practice, it appears, is highly influential on students’ attitudes toward working with this group. The critical realist conception of a stratified clinical learning environment was developed in this study, informed by the work of Brown (2009). Mechanisms related to the structures and people in the clinical learning environment were identified which if addressed locally, may be pivotal in improving the contexts in which nursing students learn about the nursing care of ill older people. The original contribution that this study makes relates to how nurse educators can begin to improve the attitudes of nursing students toward the nursing care of ill older people, by improving the contexts in which they learn, with reference to their mechanisms. In line with this study’s findings, developmental work should begin within the psychological stratum, with concurrent action in both the socio-cultural and curricular strata of the clinical learning environment, in order to provide more immediate improvements in students’ placement experiences. A number of recommendations were made that would begin this developmental process, and may result in negating the need for attitude change programmes, with the ultimate intention of improving the quality of care for ill older people.

This thesis investigates how individual student nurses construct a body of knowledge that is appropriate and able to support or underpin their practical experiences in the early part of their undergraduate pre-registration nursing programme. It is an exploration of how contemporary nursing students link theory, that is fit for purpose, with the art and skills that are pre-requisite for competent nursing practice. The study is written from the perspective of a senior academic and perceived gatekeeper of professional nursing standards, and uses personal and professional writing to illustrate the ontological stance adopted. Working with the core concepts introduced by Bernstein (1975), Von Glasersfeld (1989), Mezirow et al (2000) inter alia, an emergent research methodology is employed. A questionnaire is used to confirm that the Higher Education Institution where the research was conducted was typical in the UK at the time; web logs (blogs) are used to explore the individual experiences of ten student nurses; and this is supplemented by interviews, naturally occurring and other data to illuminate, extend and contextualise the findings. The findings underpin the construction of a recursive model that links heads, hands and hearts with a central focus on viable knowledge, this being the knowledge that guides practice. The contribution of this study to practice relates to the recognition that knowledge must be presented and transmitted in a viable fashion with practice being maintained as pivotal to the educational process, and the recommendations of the study for curriculum design and delivery reflect this. The research concludes that viable knowledge that is dependent upon the centrality of practice in nurse education should become the defining attribute of the nurse of the future.

Background Clinical placements are essential to nursing education, allowing students to gain live experience and knowledge of nursing in clinical environments prior to entering the healthcare workforce. Healthcare has increasingly integrated information and communication technology (ICT) into clinical environments, therefore ICT is also significant in nursing students’ clinical placements. However, research has revealed that despite its benefits, nurses and nursing students are unable to use ICT effectively for their practice and their learning. This may reflect one aspect of the challenges faced by nursing students as they learn during clinical placements. Therefore this research aims to analyse the dynamics of undergraduate nursing students’ learning and use of ICT during clinical placements. By doing so, this research seeks to develop theoretical models that can be used to improve clinical nursing education amidst the current technology era. - Research design This study was conducted in Seoul, South Korea. A qualitative-dominant mixed method strategy was adopted. Quantitative data was collected through the development of a modified Information Technology Attitude Scales for Health (ITASH), which was then administered to 508 nursing students from six different universities from October 2012 to December 2012. Constructivist grounded theory (CGT) guided qualitative data collection, which was achieved through sequence of four rounds of intensive individual and group interviews with 16 nursing students, 4 qualified nurses, and 2 university lecturers from April 2013 to June 2015 (a total of 23 individual interviews and 6 group interviews). The exploratory and confirmatory factor analyses of quantitative data analysis were supported by SPSS and LISREL, while the constant comparison approach of qualitative data was supported by Nvivo 10. - Findings The findings revealed: 1) nursing students’ learning dynamics through the qualitative research process based on CGT methodology, and 2) nursing students’ use of ICT during clinical placements based on the learning dynamics via both qualitative and quantitative research processes. In the learning dynamics, this study identified the nursing students’ cognitive learning and knowledge building process, and then the factors and dynamics influencing that process in the clinical environment. This was compared with classroom and simulation environments. Based on these dynamics, the factors and dynamics influencing the use of ICT for learning in the clinical environment was identified. An integration of the findings with supporting literature resulted in two theoretical models, the knowledge building dynamic (KBD) model and the contextual knowledge building dynamic (CKBD) model. These models assist in understanding the cognitive processes involved in an individual’s learning process, the influence of context and resulting dynamics on these processes, and subsequently, learning with ICT. - Conclusion This research expands on current nursing education literature by exploring the cognitive aspects of learning, specifically within the clinical environment. These are shaped by contextual factors such as socio-cultural factors, and their influence on students’ learning and use of clinical ICT. The theoretical models are relevant for several applications in educational assessment and design, policy, and in learning itself with the goal of improving the quality of patient care.

A considerable number of students undertaking pre-registration nurse education in the UK are international students from Zimbabwe. The aim of this study is to listen to their narratives in order both to understand their experiences and to make suggestions for improving their educational management. The context from which the Zimbabwean students have migrated is discussed, outlining the current Zimbabwean educational and health care systems; prevailing social mores, religion and kinship ties; and the more recent sharp economic downturn in the Zimbabwean economy and the effects of the prevalence of HI VIA IDS in Southern Africa. Nine pre-registration nursing students from Zimbabwe attending one UK university, and one further respondent who had qualified as a nurse and was practising in the same locality were recruited to take part in life-history interviews. The interviews covered experiences in Zimbabwe leading to migration to the UK; accounts of arriving in the UK and challenges experienced in starting the course, working in health care settings as placements, and becoming reconciled to life in the UK. Factors prompting migration to the UK are reported to include the emphasis on education as a means of social mobility; the economic crisis, and the disruption of family ties by the HIV epidemic. Educational courses for nursing are the means to prevent their aspirations for professional occupation floundering on current economic and political instability in Zimbabwe, rather than a positive career choice. The reliance of the NHS on internationally-recruited students to cover shortfalls in labour in the UK contributes to this process. Experiences upon arrival in the UK include problems with visas, immigration officials and banking facilities. Zimbabwean students find it challenging to adapt to self-directed learning styles, to combine studying in a context without their familiar domestic help, and under financial pressure to remit monies home. They also report experiences of racism both in the college and in placement settings. Despite these challenges the next step seems more likely to be to work in nursing in the UK and to bring family to join them when financially possible. These life-histories have implications for the educational management of Zimbabwean nursing students at the level of the University, the University International Office, the School of Nursing and Midwifery, the individual nurse tutor, and the local NHS placement settings. They also have implications for the future prospects of Zimbabwe after the Mugabe regime.

In 2007 the Nursing and Midwifery Council (NMC) endorsed the use of simulation to replace up to three hundred hours of practice learning in the pre-registration nursing programme (NMC, 2007a). This decision was the impetus for this study as it raised questions regarding whether simulation could replace practice and whether simulated learning transferred to the practice setting. For the first time, the NMC proposal to replace practice hours with simulation has been critically analysed and the implications of this decision explored. A literature review demonstrated a lack of robust evidence to support the use of simulation in this way. This informed the development of this study’s research question and aims. A qualitative collective case study was chosen as the optimum research design to facilitate in-depth exploration of the use of simulation at a selected university in the North West of England. The in-depth qualitative case study incorporated multiple models of simulation, student cohorts, nurse educators and key informants which provided the most comprehensive analysis of viewpoints in any published research in the UK to date. Deeper understanding of the case arose from the use of multiple data collection methods: documentary analysis, participant observation and interviews which enabled findings to be triangulated and corroborated. Most importantly, because the simulation models used were comparable to those used by other education providers in the UK; there is a possibility of the transferability of findings which could be used to inform the development of simulation in the under-graduate nursing curriculum. This thesis develops an argument that there were three key assumptions made by the NMC when they endorsed the replacement of practice hours with simulation. The first is that there is a shared understanding in nursing regarding what simulation is. Secondly; that simulation is delivered in a ‘safe environment’ and finally that competence demonstrated in simulation transfers seamlessly to practice. This thesis has presented new knowledge and developed an argument for caution regarding the use of simulation in pre-registration nurse education. These findings challenge the assumptions made by the NMC and highlight issues for further consideration and exploration namely: the ambiguity regarding the concept of simulation, student safety during simulation, student perceptions of authenticity and finally the transfer of simulated learning to practice.

This thesis examines the experience of gay male student nurses during their university course, which leads to registration as a nurse with the Nursing and Midwifery Council. Using in-depth qualitative interviews I focus on the student’s choice of nursing as a career and their performance of sexuality within the differing spaces of their clinical placements and the university. This thesis explores how these gay student nurses negotiate their gender, masculinity and gay sexuality within the professional boundaries of nursing. Furthermore, it identifies how these students negotiate issues of caring and the formation of therapeutic relationships with their patients, as men and gay men. The theoretical framing of the thesis draws upon Goffman's theories of presentation and performance of the self and Rubin’s 'charmed circle'. Alongside analysis of interview material, I explore the space of the hospital from a personal perspective and interrogate its gendered and desexualized organization through the lens of human geography. Moving between these two analytical frameworks, I examine and draw together the experiences of these students and examine their negotiation of the nursing role as gay men. I argue that the experience of these students and the negotiation of their sexuality as student nurses is fraught and precarious due to the complexities and boundaries of professional nursing roles in contemporary healthcare. Within the conclusion I address the implications of my research for gay nurses, patients, educators and for those who recruit nursing students.

The significant influence that practice learning plays within undergraduate nurse education cannot be overstated. By practice learning, I mean work-based learning immersed in the activities of nursing practice, typically involving learning undertaken in placements at hospitals and other clinical worksites. Practice learning is intended to achieve standards defined by professional regulatory bodies, and aims to enhance learners' capability and employability. Learning here refers to processes through which student nurses develop capabilities to practice effectively, critically, confidently and professionally in health care settings. Practice is a key concept in this thesis, much contested in debates about professional learning in practice which I will examine in detail in chapter 2. In terms of current policy regarding practice learning, I would, however, suggest that what we have at the moment is an inherited legacy which to date has not been robustly scrutinised. Based on my experiences as a nursing educator I came to believe that it was timely for a re-examination of policies, practices and philosophies underpinning the duration and structure of the current practice learning model. Taken together, the above experiences led me to focus this thesis on the following research question: How might practice learning experiences be better designed to promote nursing capability? This thesis brings together six published papers reporting studies that I conducted to explore this question, as well as chapters explaining the background literature, theory and methodology guiding these studies. My overarching aim is to contribute to the improved practice learning experiences of undergraduate student nurses, retaining them on programmes and easing their transition into the role of newly qualified practitioners (NQP). Chapter 1 charts the history of nursing educational developments. The aim is to demonstrate the influence of government and professional policy over nursing’s development from an apprentice-style model to the current-day academic model. In charting these developments alongside reviewing the contemporary research literature, what is obvious is that the issues of support, retention, models of practice learning and curricula to prepare nurses are perennial challenges. However, as a practice-based discipline, the focus of preparation has always remained grounded in practice. Chapter 2 sets forth the theoretical constructs of this thesis. During the course of conducting the studies reported in the publications of this thesis, I became frustrated with the relative lack of emphasis on contemporary learning theory in nursing education, and the paucity of supporting evidence for the ‘reflective’ theory that seems to be dominant in nursing. The discussion presented in this chapter aims to provide an overview of the major traditions of constructivism and reflective practice, as well as their historical theoretical foundations, which have been widely adopted in nurse education. I discuss the strengths and limitations of these theories as they apply to undergraduate nurses’ practice learning and capability development. These are then contrasted via the means of a critical discussion with more novel alternative models. These include situated learning theory and legitimate peripheral participation, and practice-based learning theory as advocated by contemporary writers such as Schatzki (2002). These theories changed my thinking about practice learning and informed my efforts to develop a more cogent understanding of learning through, for and at work for undergraduate nurse education. In setting out Chapter 3, I am presenting a brief overview of these publications for a nursing education audience. Firstly, I have included information that is generally considered important to this audience, such as details about the journal’s standing and article citations, the databases searched, and the percentage of my own contributions. Secondly, I report the studies from an evidence-based perspective of prediction and control aligned with the contexts of the commissioning process and the conduct of each project. By this I mean that I treat the findings in these papers as valid and credible within the stated limitations Chapter 4 presents the six publications in their entirety for the reader Chapter 5 explains the research methodology adopted in the papers presented for this thesis, and offers my critical reflections on these methodologies. I outline the philosophy that underpins the approach taken with the research studies, discussing the interpretive stance that was taken to research and the consequent choice of qualitative approaches. The chapter also discusses the strengths and limitations of the methods employed in each of my papers along with the means used to analyse the data, and the ethical considerations that an interpretive researcher must consider. In retrospect, given where my theoretical orientation has moved (as explained in chapter 2), I now look rather more critically on the premises of these studies, their categories of definition, multiple causes and uncertainties at play. In my reflections on the research approach, I explain some of these issues. In concluding this thesis, Chapter 6 details my recommendations and some future implications for policy and practice. It also explains my plans for carrying forward different methodological and theoretical approaches in my future research work examining nurses' practice learning.