This thesis explores the entry into, and early experience, of nursing in higher education, between 1918 and 1960. Because nursing education originated in the monotechnic environment of the hospital, it did not easily translate into the domain of the university. Accordingly, the status of nursing as a profession was compromised. Thus the professional status of nursing as a discipline of study is ambiguous and `in-between'. This historical survey from 1918 to 1960, has been undertaken using a three strand approach, reading documents, viewing film and conducting oral histories. The scope of the study will trace three different courses which were instituted at university colleges around the country; the Diplomas in Nursing; the sister tutor; and health visitor courses. The study will also consider the special probationer schemes, that is nurse training schemes in hospitals in the late nineteenth and early twentieth centuries, for middle and occasionally upper-class, educated women; training for which these women would pay. These schemes are included by way of an introduction, in order to gauge some of the early ambiguities relating to the professional status of the nurse. This study was undertaken in order to demonstrate that although the professional status of nursing and its place in higher education were, and probably still are ambiguous, significant attempts were made in the early twentieth century to establish nursing as a discipline of study within the academy, when women's place in general within that sector was an anomaly.

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This collaborative action research study addressed the perceived practical skill deficits in newly qualified nurses during role transition into practice. It extended over three cycles. Participants were newly qualified and experienced staff nurses in an acute NHS Hospital. A qualitative exploratory study during the first cycle found that much of what beginning staff nurses needed to know was embedded in routinised contextual activity and was not readily accessible to them. Managing and co-ordinating the work in the complexity of the clinical context is a composite skill, and a major component of clinical nursing practice. Because it is quickly internalised, it is constantly unrecognised and undervalued. A key issue was to access this knowledge and make it available to newly qualified nurses. A Critical Pathway was developed to provide the structure and preceptor support for the learning experience. This is a means of explicating and conceptualising the staff nurse role and provides an overview of components whilst suggesting a time and action framework to be progressively developed in goal directed activities. It was incorporated into a Competency-Based Preceptor Programme along with learning contracts for specific practical skills; both were designed to be adapted to the context-specific needs of each clinical area. This interactive tool was tested for adaptability and effectiveness in intervention studies in the second and third action research cycles. Qualitative and quantitative methods were used. The data confirmed its adaptability and the positive impact on preceptee competence and performance. Literature from across disciplines supported and illuminated interpretation of the study data with evidence of the infinitely complex nature and contextual dependence of practical knowledge and skills; some of which is explicit but some is submerged in the tacit dimensions of personal knowledge and performance. Practical thinking and action incorporate cognitive, perceptual and embodied characteristics and features of the task environment and are dependent on acquisition and exploitation of context-specific knowledge. The embodied and perceptual nature of nursing skills is integral to clinical nursing practice; and the evidence is that this embodied intelligence can only be demonstrated and learned in contextual activity mediated by an experienced colleague. This awareness has the potential to inform practical education and support the rationale for a more rigorous approach to practice-based education and experience.

This longitudinal study investigated the ways in which participants reflected about their practice as they progressed through a three year programme as students in adult nurSing and in the first years following graduation. The method was qualitative, with data gained from written critical incidents based on practice experiences, classroom discussions and interviews. A mixed methodology was used, combining the constant comparative method outlined in Grounded Theory and Narrative Analysis. The aim was to unravel the complexities of reflection; what participants reflected about, how and why, as they progressed through important stages of professional development. Analysis of content data revealed the range of issues perceived as most important for practice and the multifaceted skills, knowledge and attitudes required to deal with them. Strong themes emerging from the data related to the complexity of learning what it means to be a professional and, in consequence, what they learn about themselves. Categories exemplifying the use of forms of knowledge and influencing processes such as cognition, memory and language were also uncovered. These categories showed the diversity and complexity of reflecti ve skills and the common use participants made of 'storytelling' . Because of this, a decision was made to reveal the function reflection served through undertaking narrative analysis using Gee's model of analysis. 'Horizons of meanings' were identified leading to the conclusion that reflection was a means of: exploring possible self images; constructing and conveying a personal value system; understanding the meaning of the professional context and fitting the learning jigsaw together. The research process is delineated as a journey of discovery requiring the adoption of theoretical pluralism to discover meaning and a logical reconstruction of reflection. A reconsideration of reflection as an integrative model of personal progress has been advocated and implications this has for nursing practice, management and education outlined.

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The aims of this study were to explore the preconceptions of pre-registration undergraduate and Diploma of Higher Education in Nursing (Dip.H.E.) (Adult) students have in relation to their programme and the nursing profession, and students' perceptions as their programmes progress. In addition the study aimed to explore how pre-registration undergraduate and Dip.H.E. (Adult) students perceive their preparation for the qualified role, and compare pre-registration undergraduate and diploma nursing students' actual performance in the clinical area near to qualification. The study used grounded theory methodology (Glaser and Strauss 1967). Undergraduate (n=20) and Dip.H.E. (n=22) nursing (Adult) students from two institutions in Scotland were used. Findings from the focus groups indicated that both groups were apprehensive about their first clinical placement, especially in relation to their own self-confidence and the uncertainty about their role within those placements. All students wanted to have the qualities of a 'good nurse' and expected to learn these qualities from clinical staff. Diploma level education was perceived as giving students better practical skills, while degree level education was perceived as giving students better theoretical skills. At the mid-point of the programmes, diploma participants were more confident in their practical ability, while undergraduate participants were more confident in their theoretical ability. The clinical learning environment had a major effect, both positive and negative, on both sets of students' practical abilities. Students had experienced good and bad mentors, which had affected the integration of theory and practice, had 'shaped' their learning experience, and had resulted in different degrees of supervision and feedback. Overall, both groups of participants expressed their anxiety about their lack of practical skills, and their opportunities to link theory to practice.

The lecturer practitioner role in nursing is widely seen as offering hope for the future of nurse education, by overcoming the 'theory-practice gap', and establishing and maintaining effective links at many different levels between education and practice. It is clear, however, that there are a number of issues of concern about the role. These can be summarised as: lack of role clarity about overcoming the theory-practice gap; varying conceptions of the role and unclear job descriptions; and role conflicts and overload, from the conflicting demands of service and education settings Despite current political support for strengthening the links between higher education institutions and practice settings, a new governmental emphasis on the support of students in practice, and a growing in-depth evaluative literature about the role, there is no research examining its systematic development, or measuring and addressing aspects of lecturer practitioners' occupational stress and burnout. Initial project planning work found that lecturer practitioners perceived themselves as 'adding value' to education provision, with personal and professional gains for postholders. However, their key concerns were: absence of role clarity; absence of effective joint review/appraisal;a bsenceo f formal support In, order to develop and address aspects of lecturer practitioners' work roles and their employment position, this action research project was established. Using a spiral methodological framework, and a multi-methods approach to data collection to triangulate the findings, new knowledge about lecturer practitioner roles was uncovered, and employment practices were developed as a result. The project established three new mechanisms, and these outcomes can be summarised as: joint appraisal policies and materials; orientation/induction policies and materials; group support network. In addition, previously validated measures of occupational stress and burnout were used to meas. ure those conceptsi n this group of lecturer practitioners, and the impact of the project. They were found to be generally no more stressed or burnt out than comparable workers, and the project was unable to demonstrate statistically significant differences in beforeand after-scores. Synthesis of quantitative and qualitative findings indicates that these LPs were 'thriving rather than just surviving'.

Nursing and nurse education within Britain are influenced by the legacy of the development of hospital based adult general nursing in the 19th Century. Discourses that emerged at that time identify nurses as ‘good women’: respectable, hardworking, loyal and obedient. Currently, nurse education is criticised for being less able to produce nurses who are fit to undertake their role than in the past. Taking the concept that discourse exerts a powerful influence on the way people behave, this thesis asserts that the 19th Century legacy is important and seeks to establish the discourses that shaped nurse education. The period 1945 -1955 is chosen as sufficiently distanced from early developments, but recent enough to be in living memory and prior to the relocation of British nursing from a hospital base into Higher Education. Six overlapping discourses are identified though the literature. An interpretative approach is then taken to data collected in three stages: a life story 1932 -1973, semi-structured interviews with nurses who commenced their training 1945 -55 and documentary analysis of nursing journals for the same period. The ‘good nurse’ is explored through discourses around the ‘right kind of girl’, the tension between vocation and profession and the transition from woman to nurse. Despite significant change of direction in educational theory and policy in the period 1945 -55 the thesis suggests that the power of the discourse meant that little changed in the practice of nursing or the conduct of nurse education. Furthermore, it is argued that whilst discourses have changed and contemporary nursing is establishing its place in Higher Education as an applied academic discipline, the current discourses embracing caring, reflection and emotional labour are equally gendered and controlling. Now, as then, this discourse is not imposed by outside forces, but is generated and controlled from within the profession. It therefore concludes that the pervasive influence of discourses surrounding the ‘good nurse’ and related discourses about control and care must be given full recognition when attempting to change nursing or to influence its policy and educational developments.