The aim of this study was to investigate the relationship between the perceived stress in qualified nursing staff and the satisfaction of students with the clinical learning environment. The study consisted of three distinct phases. The initial phase was based on informal interviews with students (N=54) and qualified staff (N=23). Data collected from these interviews was used to develop and design three tools. The latter formed the basis of the second phase of the study - a quantitative survey. Respondents in this phase were pre registration students (N=162) from one school of nursing, and qualified staff (N = 105) from two district hospitals in the south of England. The final phase of the study was carried out using a grounded theory approach. Findings from phase two provided the focus areas for this phase of the study. A total of 13 qualified staff and 18 students were interviewed. Collection of data for the three phases spanned a two and a half year period. The overall findings, based on the results from all three phases of the study, suggest that satisfaction for students and stress in qualified staff is derived from the atmosphere in, and the organisation of, the working enyironment.These two aspects were unified by the style of leadership employed in the clinical learning areas. A participative leadership style, which employed an individualised approach to patient care, increased the satisfaction of students and qualified staff, and was associated with reduced staff turnover, sickness and absenteeism. Good social support and social integration strategies existed for nursing staff working in this area. Conversely there was much dissatisfaction of qualified staff and students in areas where authoritarian leadership styles were employed. There was an increase in staff turnover,sickness and absentee rates. Consequently a large percentage of bank/agency staff were employed. Recommendations include the need for training in participative leadership styles for all clinical managers, and the assurance of individualised patient care in clinical areas where students are allocated. Alongside this there is a need to monitor student satisfaction and qualified staff stress and job satisfaction on a regular basis.

A novel osteopathic treatment has been discovered during the clinical practice of the author which alleviates many of the symptoms of chronic fatigue syndrome (CFS) known in the UK as CFS/ME. The efficacy of this manual approach was tested using two separate clinical trials. The first examined the change in the symptoms following a year of treatment. The second repeated the first study and examined the possible mechanisms of the improvement. The studies were designed to develop a greater understanding of the disorder, for which there is much scientific uncertainty regarding the cause, diagnosis and treatment. Phase 1 of the research trials included self report questionnaires to examine overall symptom change. With post-exercise fatigue being a major symptom of CFS/ME, the treatment protocol was best evaluated by determining its effects on muscle function which was analysed utilising isometric testing of the knee extensor muscles measuring the impulse torque. The second trial, which included the same self report questionnaires assessing symptom relief as in the initial trial, was divided into two parallel phases. Phase 2 primarily took the form of brain analysis using magnetic resonance imaging (MRI) to confirm if brain abnormalities seen in previous research were found in sufferers of CFS/ME. No cerebral abnormality was detected in the patient group. Central lymph scans were also carried out showing a possible trend of enlargement in CFS/ME sufferers. In the other part, phase 3, isometric tests were repeated with more accurate equipment than in phase 1. Integrated EMG and median frequency of the power spectrum were measured using surface electromyography (sEMG). Overall this study has provided strong evidence that an important component of CFS/ME involves a disturbance of lymphatic drainage of the brain and muscles. The novel osteopathic treatment developed by the author has been statistically validated in both phases of the study, emphasising the need to focus future research on the biomechanical aspectso f this disorder.

This Reflective Topical Autobiography (RTA) aimed to reflect on and recount my own actual life stories and the life lessons learned, in order to identify patterns, trends and insights from my life and to offer these insights to others. My objectives were to promote personal empowerment as a tool for fulfilling individual potential, and to heal and be healed, by taking personal responsibility and making choices that enhance the individual and thus the collective consciousness.The research questions I posed to myself to assist in reflecting on and recounting my life stories were: What are the key stories of my life? What life lessons have I learned from my experiences? What are the patterns, trends and insights from my life? How can I offer these insights to other people? The RTA activities included writing personal stories, reflecting on my life patterns, trends and insights, and using photographs and a DVD production, to illustrate the main ideas and events.The research process allowed me to move from being reactive to reflective and to answer the research questions. Some of my life lessons learned from my experiences are that: one person can make a difference; lack of money is not lack of personal power; and nothing is impossible. My life patterns and trends include having a high-energy lifestyle, living without fear, learning to deal with disappointments, keeping life records, taking responsibility for action, and creating a morphic field. This RTA also offers insights to other people, with whom they resonate.It became apparent to me, in the process of documenting my personal journey in this RTA, that by suspending judgement and keeping an open mind and open heart, I am able to attune to what I call ‘Divine Intelligence’. It is a deep cellular knowing, that we are all connected. In 32 years of my own development, I have witnessed quantum leaps in the disciplines of science, spirit, ancient wisdom and health, which are acknowledged in the academies of the world. There is a new way of seeing and thinking, which is about a future based on these holistic principles of interconnectedness. It is the contention of this RTA that thoughts and intentions are the tools for personal and global change.

The importance of spirituality in relation to mental well-being and physical health is currently well regarded in the academic literature. Therefore spiritual care is now considered an important aspect of holistic healing practices. However, research is showing that most health care providers do not feel competent or confident in this area of care. In this thesis I explore how spiritual care is understood and experienced by practitioners in aged and palliative care in a regional area on the coast of New South Wales. The 26 participants, whose insights and experiences are depicted in this thesis, were very happy to be involved in this qualitative research project, because they felt that they now had the opportunity to explore spirituality and spiritual care.The participants in this research describe spiritual care as involving doing in the form of religious practices, such as praying or bible readings and non-religious activities that were seen as spiritual such as talking about dying, touching people or reminiscing. Additionally, they also commented about spiritual care as a special way of being with clients, which involved qualities and attitudes that were clearly felt or recognized by the participants as special. Not necessarily labeled as spiritual care, this special way of being was described as not being separate, but being an integral part of the daily acts of caring such as feeding a patient or preparing them for a bath. Participants found it often difficult to elaborate on what made such an interaction spiritual or how to describe the quality of these interactions as there seemed to be no familiar language to share the experiences of spirituality and spiritual care. Additionally, participants commented quite regularly that, although spiritual care was seen as important, there were many factors that inhibited these practices. In reflecting on these issues I put forward that, although the practitioners in this research are familiar with spiritual care, the most important contribution to encouraging health care providers to feel more confident is to continue conversations about spiritual care to increase competency in a non-denominational spiritual discourse in aged and palliative care.

This Reflective Topical Autobiography (RTA) aimed to reflect on and recount my own actual life stories and the life lessons learned, in order to identify patterns, trends and insights from my life and to offer these insights to others. My objectives were to promote personal empowerment as a tool for fulfilling individual potential, and to heal and be healed, by taking personal responsibility and making choices that enhance the individual and thus the collective consciousness.The research questions I posed to myself to assist in reflecting on and recounting my life stories were: What are the key stories of my life? What life lessons have I learned from my experiences? What are the patterns, trends and insights from my life? How can I offer these insights to other people? The RTA activities included writing personal stories, reflecting on my life patterns, trends and insights, and using photographs and a DVD production, to illustrate the main ideas and events.The research process allowed me to move from being reactive to reflective and to answer the research questions. Some of my life lessons learned from my experiences are that: one person can make a difference; lack of money is not lack of personal power; and nothing is impossible. My life patterns and trends include having a high-energy lifestyle, living without fear, learning to deal with disappointments, keeping life records, taking responsibility for action, and creating a morphic field. This RTA also offers insights to other people, with whom they resonate.It became apparent to me, in the process of documenting my personal journey in this RTA, that by suspending judgement and keeping an open mind and open heart, I am able to attune to what I call ‘Divine Intelligence’. It is a deep cellular knowing, that we are all connected. In 32 years of my own development, I have witnessed quantum leaps in the disciplines of science, spirit, ancient wisdom and health, which are acknowledged in the academies of the world. There is a new way of seeing and thinking, which is about a future based on these holistic principles of interconnectedness. It is the contention of this RTA that thoughts and intentions are the tools for personal and global change.

Thesis (M.H.A.)--University of Michigan, 1961.

Thesis (Ph. D.)--UCLA, 2007. / Vita. Includes bibliographical references (leaves 227-256).

Thesis (D.P.H.)--University of Michigan, 1994.

Thesis (M. P. A.)--Texas State University-San Marcos, 2007. / "Summer 2007." Includes bibliographical references (leaves 53-56).

Thesis (M.P.H.)--University of Michigan, 1946.