The research study aspired to ascertain what, if any key factors can be identified by the Senior Nurses in Wales to improve the quality and safety of the service delivered by the nursing service. Numerous reports with recommendations for improvement have been published following significant service failures in the nursing service. Despite these reports, failures continue. This thesis details the methodology and findings of a research study undertaken with Senior Nurses in Wales, to ascertain their views on what factors are needed to have a successful nursing service. It explores what needs to be in place in the nursing service to prevent failure and deliver high quality, safe care to patients. A mixed-method research approach was used which comprised three stages. Stage one analysed secondary qualitative data in the form of case study inquiry reports into service failures. The second stage comprised semi-structured elite interviews with nine Senior Nurses in Wales. The final stage, which was used to prioritise and validate the results from stage two, was a questionnaire sent to 65 Senior Nurses in Wales, with 41 returned. From the analysis of the above research, a Senior Nurses’ Framework covering 6 main themes and containing 35 key factors was developed, which if implemented could potentially lead to a successful nursing service. In addition the thesis explores why Senior Nurses find it difficult to implement such actions, their lack of empowerment and how it is important for their voices to be heard if failure is to be prevented in the future.

The purpose of this study is to explore how students' nurse identity has developed over the years and the particular role that disciplinary power has had in shaping it. The research focus was the School of Nursing in Jersey from 1924-2015. The study site included the wider social space where nurse education occurred at the School of Nursing; that is the classroom, the practice area and the nurses' home. The study attempts to fill a gap in local nursing history by creating a unique record while also considering the wider social influences on how students develop a nurse identity. The primary data comprises interviews with fifteen (n=15) participants who provide an historical account of their experiences as students. Interview transcripts and diary narratives with a further four (n=4) former nursing students from the earlier period are also included. These are supplemented with documentary archive material in the form of hospital student nurse records, newspaper archives, Societe Jersiaise archives, personal correspondence and photographs. Foucault's (1979) concept of panopticism was used to explore how the functioning of disciplinary power promoted the notion of docility and shaped the developing nurse identity of students. The Foucauldian framework provided a sociological analysis of disciplinary power and how the unconscious conditioning of students created the "docile body". The main themes identified relate to freedom (or not) of choice in choosing a career, shifting modes of control, control through the use of time, knowing your place, sister's "gaze" as a panoptical figure, living and working by the rules, fear of punishment, the gendered nature of nursing as an occupation, medical dominance, and the support from fellow students. The technologies of surveillance, normalising judgement and examination were employed to understand how, as student nurses, the participants internalised the values, beliefs and behaviours experienced in the School of Nursing. Tracing these technologies of discipline from the beginnings of the School of Nursing to its present day amounts to what in Foucauldian terms is a history of the objectification of the present. Findings indicate that discipline was a means of constructing experience and served to shape the identity of the participants as student nurses. It was easier to recognise Foucault's (1979, 1995) concept of panopticism in the traditional nurses' accounts; how this applied to the contemporary setting was less obvious but nonetheless apparent. While there has been more discreet monitoring of students in recent years, the methods of surveillance remain rooted in Foucault's (1979, 1995) representation of panopticism and the construction of the "docile body". Control was exerted over their lives in the classroom and on the wards. As students the participants began to regulate their own behaviour and discipline themselves. The historical perceptions of what it means to be a "good nurse" impacted on their developing identity across the years. The unconscious conditioning of the students served to create the "docile body" of the student nurse and this impacted on the development of an identity. Having identified the importance of the influence of disciplinary power, further research exploring this among student nurses in the contemporary university setting could make a positive contribution to understanding how this moulds a nurse identity.

The current position of the World Health Organisation (WHO, 2014) is that there is a threat of a global “obesity epidemic” (Boero, 2007, p.1); and existing studies in the UK report that a 5th of pregnant women are overweight. This has created increased scrutiny of fatness and weight, especially in pregnant women. The concern about obesity and pregnancy outcomes also contributes to the National Institute for Health Care Excellence (NICE, 2010), recommending that the antenatal care delivered to overweight pregnant women should be within the guidelines of a high-risk pathway of antenatal care. This has increased the medicalisation of the care for overweight pregnant women. The aim of this study is to explore the experiences of overweight pregnant women in relation to their heightened medicalised antenatal care. Using a social constructionist approach and a Foucauldian interpretive lens, semi-structured face-to-face interviews were used to collect data from 12 women who were between 16 and 30 weeks pregnant, 6 midwives who provide antenatal care for them, and 3 obstetricians to whom women are referred. The data were analysed using thematic analysis. The findings show that pregnant women do not identify with being ‘obese’ and perceive themselves as being overweight but healthy. Key themes that emerged from the data describing women’s perception of heightened antenatal care are: their understanding of risk and risk perception, the power of science and how it constructs their maternal health and the power of obstetricians justifying medical interventions in pregnancy and childbirth. This study creates and contributes to the awareness of how overweight pregnant women who are healthy experience antenatal care. It explores the need of overweight pregnant women, and identifies changes that need to be made to positively enhance how these women experience pregnancy and childbirth. These findings need to be considered by policy makers, individuals in practice and those with a role in educating health care practitioners so that overweight pregnant women are provided the appropriate antenatal care.

Domestic abuse is a public health issue with long term health and social consequences for its victims. The prevalence of domestic abuse among women seeking healthcare is higher than in the general UK population and often begins or worsens in pregnancy. Health visitors, because of their role with pregnant women and mothers are in a key position to offer both supportive interventions and to play a preventative role in domestic abuse. The aim of this research is to improve understanding of issues health visitors face when working with Pakistani mothers living with domestic abuse. The study is set in the north of Britain in an area that has experienced chain migration and settlement from the Mirpur and Faisalabad regions of Pakistan since the 1970s. Taking a qualitative approach and informed by a critical realist perspective, first-hand accounts from health visitors working in the area are used. The findings of the study confirm that domestic abuse perpetrated against some Pakistani mothers is a complex aspect of health visiting practice compounded by deep rooted cultural and social practices within many Pakistani families. The key challenge health visitors face appears to be non-disclosure of abuse by many Pakistani women and the main approach taken by health visitors in this situation is predominantly one of harm minimisation. Inconsistencies in practice were however noted. Three overarching themes were found from the analysis of the data which depict the challenges health visitors face and the endeavours they take to keep women safe. The theme of Presence depicts a range of actions linked to ‘seeing’ or ‘being with’ women and includes carrying out repeated enquiry into abuse. Role Strain describes how the health visitors express difficulty in fulfilling the various demands and expectations of the role. The term Covert Actions encompasses a range of seemingly hidden or concealed activities undertaken by health visitors in an endeavour to maintain Presence. The study provides useful insight into the forms of evidence many health visitors deem can legitimately inform their clinical interventions when working with this population group and succeeds in extending current understanding of the types of knowledge health visitors draw from to inform their decisions in this specific area of practice. It also provides awareness of the wider challenges health visitors can encounter when working more generally among collectivist and honour-based communities and raises questions about some of the philosophical assumptions usually associated with Western models of healthcare. Implications for practice are that mainstream domestic abuse interventions should be used with sensitivity to the different cultural contexts in which many Pakistani mothers live, and attempts should be made to develop appropriate interventions that derive from those contexts. This includes holistic assessment tools that are flexible enough to allow clinical judgements to be informed by the more subjective elements of evidence gathering and which take into consideration the impact of the multiple oppressions some women encounter. Recommendations for service providers are that they should take a broader view of domestic violence that recognises ‘difference’ and therefore enables health visiting interventions to be flexible and responsive to differing need. This includes considering more community-based interventions among certain population groups.

Service user and carer involvement in health and social care education in the UK has gained momentum over the last two decades, largely driven by consumerist and democratic ideologies. This is reinforced by the health and social care regulatory bodies such as the Nursing and Midwifery Council (NMC) and the Health and Care Professions Council (HCPC). This thesis presents a series of eight peer reviewed papers that have focussed on the agency of service user and carer involvement in health and social care education. The accompanying commentary draws the papers together and locates them within an overarching theoretical framework, ‘The Ladder of involvement’. This portfolio of evidence demonstrates a coherent approach that draws on underlying philosophies and theoretical underpinnings and displays contribution to knowledge in five distinct sections: Contribution to the literature with new findings, location of the findings within the current literature, location of the findings within the theoretical framework, contribution to the refinement and development of theory and contribution to dialogue and debate. The key message from the studies undertaken as part of this portfolio of evidence is that service user and care involvement in health and social care education enhances student learning and influences their future practice. However, there must be a well-developed infrastructure within higher education institutions that recognises the complexities of user involvement for the key stakeholders. There is a pressing need for additional research to further substantiate the benefit of user involvement for all parties concerned, in order for user involvement to take its place as a core component of health and social care education.