This research study employed Q-methodology (Q) to explore the factors influencing e-learning adoption in a nurse education context, and Bourdieu’s Theory of Practice (TOP) to analyse these findings using a case study of one school of nursing in the UK. E-learning adoption has been limited in nurse education despite a wide body of literature promoting its use for improved learning outcomes. Most research studies to date have used surveys to explore the overarching factors influencing academics to adopt e-learning across higher education more generally, but these findings have not identified the underlying issues influencing their responses to these factors, nor do they allow a deep analysis of discipline-specific factors. This study identified four groups (Factors) of academics each responding differently towards e-learning in their teaching. The first group represented the ‘e-advocates’ who saw technology as having the potential to improve nurse education by giving more control to learners and preparing future nurses for their evolving role in health care. The second group represented the ‘humanists’ who although sharing similar pedagogical beliefs as the first group had not been motivated to engage with technology because of the value they placed on human interaction. The third group was described as the ‘sceptics’ who had had previous negative experiences with e-learning and were unconvinced about technology’s ability to improve learning outcomes. Finally, the fourth factor, the ‘pragmatics,’ although ostensibly positive in their views towards e-learning, held different pedagogical beliefs from the three other groups and felt it was their responsibility to cover certain content in a face-to-face setting. The unique combination of Q and Bourdieu’s TOP enabled a deeper analysis of the four groups’ views and the socio-cultural context shaping them, thus providing new insights into academics’ responses to e-learning. Moving beyond the binary labels commonly attributed to those considered either ‘early adopters’ or ‘laggards,’ the findings make a contribution to the e-learning adoption literature by revealing a wider breadth of views and responses towards technology. Moreover, this study showed that internal beliefs determined the extent to which external factors were perceived as influential. This serves to explain why some individuals overcome certain barriers to e-learning adoption whilst others succumb to them. The findings from this study will inform policy-makers, e-learning strategists and professional development staff on how to more effectively present and promote e-learning.

Case studies of five Dutch undergraduate students form the initial focus of this longitudinal study. An ethno-methodological approach was utilised to provide insight into how student nurses made sense of their social and personal reality and dealt with situations and challenges encountered during the four-year programme leading to registration as a degreenurse. The case studies are further examined within a meta-case study -this being the auto-ethnographic context of the researcher's role as a nurse, an educator and a researcher.The study highlights the interface between sociology and education, and between power and authority, discussing the student journey in terms of Parsonian and confluent educational frameworks. The research findings also highlight student awareness in dealing with the challenges of practice and indicate that students are proactive, and use preconceived strategies to negotiate their way through their placements successfully. Specifically a student, who dropped out of the programme, is the subject of a 'deviant' case study; her experience provides an interesting backdrop to the students who completed the programme. The researcher analyses and discusses the concept of 'deviance', questioning the appropriateness of this terminology. The study provides some insights into the original research questions regarding student motivation on entering nursing; the developmentof a 'caring philosophy, the internalisation of professional values and the ability to integrate theory and practice. In addition the richness of the researcher/student interaction adds an extra dimension to the existing body of knowledge. This narrative account invites the reader to follow the researcher's thoughts and decision-making whilst it simultaneously challenges the reader to confront their personalhistory and beliefs.

The central contention of this thesis is that story as an aid to learning, particularly student nurses' own stories of practice, is not being used to its full potential in nurse education. The dominant tendencies in nurse education are briefly outlined; the first, a ‘top- down’, managerialist approach, which is theory-focused, and where ‘reflection-on-action’ from an essentially theoretical perspective, with assessment strategies related to extrinsic criteria, is predominant; and the second, a ‘bottom-up’ approach, focused on practice itself as a resource for learning, with ‘reflection-in-action’ (moment-to-moment decision-making) as its major pedagogic strategy. This thesis argues that these approaches are too often treated in isolation from one another, but that for nurse education to be effective, professional practice must unite the two, and that story is an imaginative and stimulating method by which this can be achieved. The thesis outlines the ways in which story has been explored in the literature, but the emphasis is on the ‘humanness’ of stories and the varied and diverse roles they could play in the development of nurse education. This discussion of the unique contribution that story can make to nurse education is placed in the context of two major theories of learning: constructivist and social constructivist, with particular emphasis on the seminal work of Schon. The research methodology adopted is that of narrative, and data were provided by student nurses’ written stories and learning accounts of practice, and notes taken during focus groups. The data were supplemented by the use of my own stories of experience of clinical practice. In all, 55 students’ written stories and learning accounts were collected, and then analysed using a three stage approach: first, reading the stories and learning accounts; second, a two- part analysis using content analysis and analysis of form; and third, a structured presentation of findings. Therefore, whilst accepting that direct learning from story is difficult to demonstrate, the evidence presented in this thesis illustrates the different ways in which stories can be an aid to student learning from practice, particularly by encouraging students to differentiate and structure clinical experiences that might otherwise remain undifferentiated and unstructured, and acknowledge and identify the tacit nature of their learning in practice and develop strategies for making it explicit. The evidence presented in this thesis supports the contention that inclusion in the curriculum of students’ stories of clinical practice can contribute towards the transformation of nurse education.

Since the late 1990s, the UK Government has a policy to support Widening Participation (WP) measures in UK universities. These measures aimed to increase the demographic and socio-economic profile of the undergraduate student population across all UK universities. The target for these measures includes a focus on mature applicants, women entrants, and ethnic minority representation. Latest data (2010/2011) from the Higher Education Statistics Agency (HESA) indicates whilst by far the largest proportion of full-time entrants to undergraduate places are the ‘traditional’ 19 year entrant with A level qualifications (288,590). By comparison a further 77,155 entrants are mature, those aged over 21, who have gained a variety of accepted entry qualifications. One such recognised qualification is that of an Access to Higher Education Diploma. The Access programme is usually undertaken by mature students, with no previous qualifications, who after successful completion of a one-year full-time course are then able to apply for an undergraduate course. It is estimated that one in four mature entrants will enter a university course with an Access qualification (HEFCE, 2006). Against a backdrop of a changing and more diverse student population, a discourse has emerged around the retention of HE students. Current data suggests that one in every twelve undergraduates will leave their university programme in the first year of study (Thomas, 2012a). The attrition of students who have entered university is not only an economic cost to the institution and the individual but is considered a wider social cost. Within the body of work on student retention there is an emerging focus on pre-registration nursing programmes, which were traditionally delivered in nursing schools attached to hospitals but since the 1990s are now delivered in HE institutions. Historically there have been concerns about the levels of student attrition from all nursing programmes and this has continued to the present day with individual Schools of Nursing and the Department of Health trying to address the issues around retaining pre-registration nursing students. Concerns around student retention have given rise to a prolific and substantive body of work around HE student retention both in the UK and wider afield, with much of this work underpinned by the seminal work of Tinto (2002, 1993). Studies on student retention agree that understanding and addressing the issues of student retention is complex, with multiple reasons why students leave early. The largest proportion of research undertaken on UK pre-registration nursing programmes have focussed on the reasons why students leave pre-registration nursing programmes rather than what makes them stay. The research questions asked in this thesis are not around student retention, although this phenomenon provides a backdrop to the study, but around learner persistence by mature Access entrants on UK pre-registration nursing programme. This research raises important questions about what is enabling mature entrants to persist on their programme, since data indicates that mature entrants account for 46% of all nursing students who enter pre-registration nursing programmes in the UK. This study is located in one large UK School of Nursing that attracts over 19% of their student cohort as mature Access entrants. This study follows nine individuals through their second year of a three-year programme to understand their transition, through this mid-point year, as an understanding of the transitions for these mature entrants is currently lacking in the literature. The nine participants were recruited via an electronic survey and were interviewed on three occasions throughout their 2nd year of a DipHE/BSc pre-registration nursing course in order to gain an understanding of their lived experiences as mature Access entrants. Data analysis in this study utilised Glaser and Strauss (1967) classic grounded theory (CGT) methodology. The findings from this CGT study indicate two phases in the participants’ journey enabling them to successfully complete their pre-registration nursing programme: Phase One - pre entry to university and participant journey towards their current course and Phase Two – continued journeys in the first 2 years of nurse training with 5 main categories metaphorically described as: ‘Home Territory’, ‘No Man’s Land’, ‘I Can See Land, ‘Lost Bearings’ and ‘Wearing the Uniform’. These metaphor categories describe a journey that is undertaken from when participants left school and made their early career decisions, through to participants exploring opportunities of further study and gaining an Access qualification to participants been accepted onto a DipHE/BSc pre-registration nursing programme. The study findings indicate that despite the known transition hurdles that result in some student nurses leaving their course early, the nine participants in this study were able to persist successfully on their programme. The study findings suggest that there are significant factors that have enabled these nine mature Access entrants to have a ‘persistent’ approach. These are the ‘learner profile’, ‘On-programme’ and ‘Environmental’ factors and are presented as a framework for a grounded theory of mature learner persistence directly taken from the lived experiences of the nine individuals in this study. These significant factors for a theory of learner persistence include an overarching ‘profile of the learner’ that enters a pre-registration programme and includes their entry qualification, age, career aspiration, and previous experience of nursing. Whist ‘on-programme’ factors aid learners’ ability to overcome the transitions into university and the clinical practice requirements of the programme. The skills and experiences gained through obtaining an Access qualification and the preparation for higher-level study is a significant factor in enabling the study participants to overcome the difficulties that they experienced over their first two years of their DipHE/BSc programme. An additional factor for their persistence was a strong career motivation, a desire to become a nurse. This career motivation underpinned the reasons why participants choose an Access programme, provided a route into university and enabled them to focus on their DipHE/BSc pre-registration nursing programme. UK Schools of Nursing who offer pre-registration programmes are required to attract and retain the very best student nurses. This presented theory of mature student learner persistence raises important questions about the policy for selection, recruitment, and retention by all HE providers and policy makers of nurse education. The findings demonstrate how different factors enable learners to persist and recommends that these should be incorporated into the recruitment stage and furthermore how to support learners during the 3-years of a pre-registration nursing programme.

The changing demographic UK population in terms of cultural, racial and ethnic mix demands mental health nurses to be educated in ways that will enable them to provide care that is both efficient and culturally appropriate to the diverse population they will serve. However, reported studies indicate that professional nurses, particularly mental health nurses, are not ready to meet the challenges posed by an increasingly culturally diverse society. These have raised questions about the undergraduate nursing education's readiness to develop a mental health work force that is capable of delivering effective mental health services to a multicultural population. The aim of the study was to explore and gain an understanding of cultural competence education from the perspectives of the key participants involved in the undergraduate mental health nursing education within the UK context, and to use the findings to develop a conceptual framework of developing cultural competence. Qualitative grounded theory approach was the method of inquiry used to collect and analyse interview data from the experiences and views of senior lecturers, third year mental health student nurses, clinical sign-off mentors and student mentors within the universities that offer pre-registration mental health nurse training in the West Midlands Region. Analysis of the research findings resulted in an emergent conceptual framework that explains how cultural competence is developed in the undergraduate mental health nursing curriculum in terms of content, processes, strategies, actions and approaches that are considered effective. The findings of this study revealed a degree of consistency between the views of the current study participants and what the literature describes as frameworks for developing cultural competence. The main theoretical constructs emerging from the study fit into a cultural competence frameworks encompassing awareness, knowledge and skills. Whilst some of the themes and theoretical constructs emerging from the results of the interview data were generally consistent with those indicated in the cultural competence literature, there were some other themes that emerged from the study participants on what was required within the curriculum in order to educate student nurses in ways that will enable them to work effectively and culturally appropriately with clients from diverse cultural backgrounds. The additional bridging theoretical construct included ‘conscious of the dynamics and discourse of intercultural education’ which was a result of the differing ideological views about current curricula and how issues of cultural competence could best be addressed within the curricula. The strategies of ‘engagement of local experts to assist in teaching cultural competence specific areas’ and ‘creating educational activities that challenge stereotypes, prejudice, discrimination and religious intolerance’ also expands the current literature by providing evidence to support some of the conceptualisations regarding some of the educational intervention strategies to cultural competence. This study is significant as it represents the first attempt to develop a conceptual framework of developing cultural competence within the UK context based on the perspectives of those directly experiencing the undergraduate mental health nursing education, using qualitative grounded theory approaches. Exploring and developing the conceptual framework from the perspectives of the neglected silent voices of the key participants who are directly involved in the undergraduate nurse training within the UK context, contributes to the existing research in this area and provides a view not currently presented in the nursing literature.

This research seeks to explore the nature and value of peer learning for a group of pre-registration nursing students and specifically aims to examine a group of student nurses in order to inquire whether they learn from each other and if so, how, when and where this takes place. Secondly, the work aims to discover more about the process used by those nurses while engaging in peer learning and to unearth their perceptions of and value systems ascribed to this type of learning. In this context the students engage in peer learning as they learn from and through each others’ experience. This research is set against the backdrop of recent changes within nurse education in the United Kingdom. In 1999, the Peach report made several main recommendations regarding the future of pre-registration nurse education, including the integration of knowledge and skills through balanced time in theory and practice together with the fostering of interpersonal and practice skills through experiential and problem-based learning (UKCC 1999). In this case the fellow learners are a group of pre registration student nurses enrolled on a programme leading to registration as Adult Branch nurses with a Diploma level academic qualification. The curriculum (based on the Fitness for Practice recommendations within the Peach report) convenes the group (known as a base group) together throughout the course at regular intervals, and utilizes a strategy of problem based learning as part of a range of teaching and learning strategies in order to help the students to acquire the knowledge required by a qualified nurse. It is important to differentiate peer learning from other mechanisms which involve students in learning from each other. For example, peer teaching or peer tutoring is a far more formal and instrumental strategy whereby advanced students or those further on in progression, take on a limited instructional role (Boud, Cohen and Sampson 2001). In other words, the more senior students are used to formally teach various aspects of the curriculum to more junior students.

The preparation of newly qualified nurses has raised many professional debates and yet the ‘end product’ of nurse education, the qualified nurse continues to demonstrate knowledge and skill deficits in areas considered essential to patient care. Technological advances in an ever-changing and complex clinical environment mean that certain acute clinical skills have become routine for the qualified nurse and yet few educational institutions and NHS Trusts in the UK have seen the need to address this within the pre-registration nursing curricula. This study, questions whether the pre-registration nursing curricula is failing newly qualified nurses by not adequately preparing them to cope with the complexities of practical skills within the clinical environment. This skill deficit is rectified on qualifying when nurses rapidly equip themselves with skills that are considered essential for practice. Using a constructivist paradigm and a mixed methods research approach, the opinion of key stakeholders in pre-registration nurse education was sought. Focus groups and surveys were conducted with skills teachers to ascertain essential skills. Constructive alignment theory (Biggs 1999) was tested with two student cohorts from a pre-registration nursing programme (n=58). Comparisons were made between an experimental group who acquired certain skills during their pre-registration programme and a control group who had not acquired those additional skills. The programme was evaluated using Stake’s (1967) countenance model of evaluation. Data were analysed using SPSS, constant comparative analysis and triangulation. The findings confirmed that nurses should acquire the skills investigated in this study, but differences of opinion were found as to when this was acceptable. Favourable results for the experimental group were demonstrated indicating the need to provide nurses with the additional skills prior to qualifying. The study also identified other like-minded UK nurse educators who had been innovative with their skills’ curricula. Nursing curricula can be successfully underpinned by an educational theory such as constructive alignment providing added value to the learner and enablingnurses to enter the profession fit for practice and purpose. To further enhance the quality and standard of provision, the following are recommended: strengthening the collaborative relationships between the key stakeholders for nurse education, as well as promoting interprofessional learning and skills development. This will help improve the international credibility for the UK skills curricula.

The aim of nursing practice is to provide evidence-based care that ensures quality outcomes for patients, families, healthcare providers and the health care system. This may only occur with increased exposure to nursing research. Nursing education institutions should therefore ensure that students are prepared to provide evidence-based care by participating in and conducting research. The purpose of the study is to explore and describe the challenges faced by nurse educators in teaching research methodology and supervising undergraduate nursing students at a university in order to make recommendations to support nurse educators in teaching research and supervising research projects. Qualitative, explorative, contextual and descriptive research was conducted to explore and describe the challenges experienced by nurse educators. Data were collected through a focus group discussion. Nine nurse educators participated in the research study. Participants acknowledged that they faced challenges in teaching research methodology and supervising research projects. The challenges described pertained to human resources; research experience, competencies and guidelines; physical resources; and a lack of support from their institution’s management. Based on the challenges, recommendations were made to address the lack of specific competencies, research guidelines, student/educator ratios, physical resources and technology issues / Health Studies / M.A. (Health Studies)

This research is concerned with the assessment of student nurses' practice, implementation of which has been considered problematic since the move of initial training into higher education. It examines clinical nurses' accounts of assessment, and rejects an approach based on identification of competencies as too rationalistic for a situated practice. Insights from, in particular, Foucault, Deleuze, and Derrida were used to analyse practitioners' alternative discourse of practice, and the processes of self-constitution and decision-making. Eighteen practitioners from different settings were interviewed in depth about how they determine acceptable performance. Three participants were interviewed twice to develop ideas arising from the first round of conversations. Practitioners' accounts challenged the conventional understanding of assessment, and the construction of practice implicit in current policy. The analysis suggests a more fluid, un-predetermined understanding, characterised by hesitation and uncertainty, though without losing a concern with safe practice. Several implications for policy and practice are presented. These require a shift of authority towards practitioners' situated judgements and away from predetermined outcomes, both in respect of programme planning and policy guidelines on the specification of standards. A new alliance is proposed to encourage a more authentic engagement with the process from both clinical and educational practitioners.

Text in Afrikaans / The purpose of this research was to draw up guidelines for nursing tutors on the facilitation of critical reflective learning in student nurses within the context of nursing education. The research question was stated as follows: What guidelines does the nursing tutor need to facilitate critical reflective learning in student nurses? The research design was qualitative, contextual, explorative and descriptive of nature. Ten nursing tutors were selected for participation on the basis of their expertise and experience. Data collection was in the form of written narratives. The data was analysed according to the eight-step method of Tesch (1990) in Cresswell (1994:155). An independent coder was involved in the judgement and interpretation of data. The research guidelines were derived from the research findings. These guidelines are applicable directly to nursing education and indirectly to the nursing practice, therefore it contributes to the scientific body of nursing knowledge. / Die doel van hierdie navorsing was die beskrywing van riglyne vir verpleegdosente om krities reflektiewe leer by verpleegstudente te fasiliteer binne 'n verpleegonderwys konteks. Die navorsingsvraag is soos volg gestel: Walter riglyne benodig die verpleegdosent om krities reflektiewe leer by verpleegstudente te fasiliteer? Die navorsingsontwerp was kwalitatief, kontekstueel, verkennend en beskrywend van aard. Tien verpleegdosente is geselekteer vir deelname op grond van hulle kundigheid en ervaring. Geskrewe narratiewe is gebruik om data in te sa mel. Die data is geanaliseer volgensdieagt-stap metodevan Tesch (1990) in Cresswell (1994:155). 'n Onafhanklike kodeerder was betrokke by die beoordeling en interpretasie van data. Die navorsingsriglyne is afgelei vanuit die navorsingsbevindinge en lewer 'n bydrae tot die wetenskaplike verpleegkennisbasis deurdat dit direkte toepassing vind in verpleegonderwys en indirek in die verpleegpraktyk. / Health Studies / M.A. (Verpleegonderwys)