京都大学 / 新制・論文博士 / 博士(医学) / 乙第13606号 / 論医博第2316号 / 新制||医||1073(附属図書館) / 旭川医科大学医学部医学科 / (主査)教授 黒田 知宏, 教授 古川 壽亮, 教授 山崎 渉 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

The aim of the study is to identify and map the process of transformation of the practice of a mental health nurse from everyday practice to desirable practice (that is, the realisation of mental health Recovery) through self-inquiry into a series of narratives derived from that practice. Recovery is desirable in terms of clinical governance and is also desirable practice for mental health nurses as a standard to which they should practice. A series of reflexive narratives signposted the transformative journey and also captured the lived experience of transformation. Experiences from practice were captured as spontaneous stories. Guided reflection obtained insights from these stories, and the insights derived from the stories were subsequently reflexively deepened by inquiring into them. In time the cues in the model of guided reflection became internalized to the extent that practitioner narratives arose that already embedded insights. Self-inquiry into these practitioner narratives indicated the nature and the felt affect of constraints met within practice. The affect of these constraints upon the individual practitioner and upon the ability of the individual practitioner to achieve desirable practice is indicated by self-inquiry into them. The result of the study was the realisation that transformation is unable to take place without the individual practitioner being fully aware of who one is, in order that s/he may effect transformation and change. Whilst self-inquiry into the narratives indicated the constraints upon the individual practitioner, the psychological unpreparedness also indicated by that self-inquiry indicated why that the tension between the reality of practice and desirable practice could not be adequately explored. The thesis takes the form of a narrative about writing narratives. The narratives illustrate the norms and values that affect individual practice both vertically (that is, from the organisation and the government), and horizontally (that is, from colleagues and managers), and how an individual practitioner experiences these as obstructive to delivering the service they desire. There have been no narratives written by practitioners about the journey to realise Recovery in their practice; and the structure of the narratives as performances is unique to this subject of thesis by a mental health nurse.

This qualitative study was aimed at exploring and describing the theoretical and practical experiences of second-year critical care nursing students. Purposive sampling was done, and unstructured interviews and narrative descriptions were used as data collection tools. An adaptation of Johns's Framework, the Guideline for the Facilitation of Reflection as Teaching Strategy, was used during interviews to guide participants in reflecting on theory-practice integration. Multiple strategies were used to ensure the trustworthiness of the study. Concerning patient data, communication, and the administration of life-saving medications, theory-practice integration did occur. Regarding treatment and the outcome of nursing interventions, it seemed that knowledge deficiencies and a lack of exposure to practical situations contributed to the inability to apply theory to practice. This apparent inability evoked negative feelings, such as guilt. Discrepancies between practice and theory taught led to confusion. Guided reflection assisted students in gaining a new perspective on nursing and theory-practice integration. / Health Studies / M.A. (Health Studies)

This qualitative study was aimed at exploring and describing the theoretical and practical experiences of second-year critical care nursing students. Purposive sampling was done, and unstructured interviews and narrative descriptions were used as data collection tools. An adaptation of Johns's Framework, the Guideline for the Facilitation of Reflection as Teaching Strategy, was used during interviews to guide participants in reflecting on theory-practice integration. Multiple strategies were used to ensure the trustworthiness of the study. Concerning patient data, communication, and the administration of life-saving medications, theory-practice integration did occur. Regarding treatment and the outcome of nursing interventions, it seemed that knowledge deficiencies and a lack of exposure to practical situations contributed to the inability to apply theory to practice. This apparent inability evoked negative feelings, such as guilt. Discrepancies between practice and theory taught led to confusion. Guided reflection assisted students in gaining a new perspective on nursing and theory-practice integration. / Health Studies / M.A. (Health Studies)