Thesis--Columbia University. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 157-165).

Thesis (M.A.(Applied))--Victoria University of Wellington, 2009. / Includes bibliographical references.

Thesis (M.S.)--University of Nevada, Reno, 2008. / "May 2008." Includes bibliographical references (leaves 132-153). Online version available on the World Wide Web.

Thesis (Ph.D.) -- University of Rhode Island, 2008. / Typescript. Includes bibliographical references (leaves 118-129).

Thesis (M. Nurs.)--University of Hong Kong, 2003. / Includes bibliographical references (leaves 150-173). Also available in print.

Thesis--Columbia University. / Includes bibliographical references (leaves 157-165).

Thesis (M. S.)--Florida State University, 2005. / Advisor: Jeanne Flannery, Florida State University, School of Nursing. Title and description from dissertation home page (viewed Feb. 7, 2006). Document formatted into pages; contains vii, 90 pages. Includes bibliographical references.

No description available.

The adoption of a " nursing " model in practice and education is discussed in relation to the socio-cultural and organisational factors which have shaped the traditional care giver role. Issues arising out of this change in the "practitioner" role are identified. The changing roles of the nurse and the teacher are described and discussed. The move toward an autonomous role for the clinical nurse is seen to require a change in the nurseteacher relationship. Learning contracts are perceived to be a vehicle for implementing the new roles of the nuise and the teacher. The writer in the role of an observer-who-participates negotiates learning contracts with nurses working in four wards of four hospitals in one Health Authority. The clinical areas are described as one community hospital, one long-stay geriatric unit, one psychiatric rehabilitation unit and one psycho-geriatric assessment unit. Thus, community, general and psychiatric nursing are included in this study of the management of knowledge and change in nursing practice. A variety of data collecting techniques are employed to give an illuminative evaluation of the outcomes of the learning contracts and the effect formal and non-formal education have on the implementation of the nursing process. The formal approach to education takes the form of the Diploma in Nursing (London University, Old and New Regulations) and the Joint Board of Clinical Nursing Studies Course in Care of the Elderly (940/941). The non-formal inputs are the clinically based learning contracts negotiated with the nurses in the four clinical areas.The data are presented as comparative case studies which record the organisational policies adopted by the Health Authority and the outcomes of the learning contracts in the four clinical areas. From the case studies two "themes" emerge: that of role conflict and the problems of assessing thedegree of change achieved. A theoretical framework of "codes and control" is developed from that originally presented by Bernstein (1975) for general education and adapted to health care organisations by Beattie and Durguerian (1980). This framework is used to interpret the changing roles of the nurse and the teacher, and the division of labour between the professional nurse and the woman in her own home. It is argued that the implementation of the "practitioner" role demands a redistribution of power and control in favour of the patient and the nurse vis-a-vis the manager, the teacher and the doctor. Further, in addition to the teacher's and the clinical nurse's dependence on the manager for the resources required to implement the desired change in practice, nurse-practitioners are dependent on the knowledge held by doctors, clinical psychologists and occupational therapists to implement the nursing process. In the presence of an inadequate basic education programme and a limited access to continuing education, the data suggest that the literature on the nursing process and the key documents distributed by the R.C.N. (1981) and the U.K.C.C. (1982) are making demands upon the clinical nurse with which she is unable and sometimes unwilling, to comply. It is argued that a "codes and control" framework identifies the complexities of the change toward the "practitioner" role and thereby, clarifies the existing role. In this way concepts of care held by the nursing staff are identified which in turn, can be utilised in model building to promote a "grounded" theory of nursing in the cultural and organisational context of nursing in the United Kingdom. Thus the use of learning contracts which identify the nurse's need for continuing education, in conjunction with an action research mode utilising case studies, can assist in the development of a theory for nursing practice and education. In this way the theory for nursing has its basis in clinical practice, is refined through research, and is returned to practice through the education programme. It is therefore argued that learning contracts have a useful role to play in bridging the gap between theory and practice in the school of nursing and institutions of higher education. The data recorded in the case studies suggest that in the absence of a redistribution of power and control and/or supportive education programmes during and after the period of transition between the old and new roles, the implementation of the nursing process will merely continue the existing Nightingale strategies. The formalisation of the present problem-solving approach to care in the form of care plans will not necessarily promote the "practitioner" role desired by the profession. Instead the clinical role will continue to be defined by physicians and management will consolidate its position in the hierarchy of the bureaucratic organisation of the National Health Service. This will not be challenged by nurses in that it will continue the existing strategy of "reifying" the presence of the "professional" nurse and an particular, her position in institutions of higher education. Such a strategy although satisfying in terms of status will lead to the clinical nurse being asked to implement a role with which she is unable to comply. This in turn will lead to role conflict and a greater division between the "theory" of the school and the "reality" of the ward.

Critical care nursing is a clinical specialist nursing practice discipline. The critical care nurse provides a constant presence in the care of a critically ill patient. She/he creates a thread of continuity in care through the myriad of other health care professionals and activities that form part of a patient’s stay in the critical care environment (World Federation of Critical Care Nurses [WFCCN], 2007). During conversations with people who have had intimate experience of the critical care environment, they have offered anecdotes that describe their interaction with critical care nurses who they perceive to be different from and better than other critical care nurses they encountered. Despite having met common professional requirements to be registered as a clinical specialist nurse, these distinctive, unique abilities that seem to be influential in meeting the complex needs and expectations of critically ill patients, their significant others as well as nursing and medical colleagues, are not displayed by all critical care nurses. While students of accredited postgraduate nursing programmes are required to advance their nursing knowledge and skill competence, many students do not seem to develop other, perhaps more tacit, qualities that utilisers characterise in their anecdotes of ‘different and better’ nursing practice. The overarching research question guiding this study was how can ‘different and better’ critical care nursing practice as recognised by a utiliser be explained? The purpose of this study was to develop an understanding of the qualities that those people who use critical care nursing practice recognise as ‘different and better’ to the norm of nursing practice they encounter in this discipline. The participant sample included patients’ significant others, nursing colleagues and medical colleagues of critical care nurses, collectively identified as utilisers. The stated aim of this work was to construct a grounded theory to elucidate an understanding of the qualities that a utiliser of critical care nursing recognises as ‘different and better’ critical care nursing practice in order to enhance the teaching and learning encounters between nurse educators and postgraduate students in learning programmes aiming to develop clinical specialist nurses. The method processes of grounded theory are designed to reveal and confirm concepts from within the data as well as the connections between these concepts, supporting the researcher in crafting a substantive theory that is definitively grounded in the participants’ views and stories (Streubert & Carpenter, 2011: 123, 128-129). Two data collection tools were employed in this study, namely in-depth unstructured individual interviews and naïve sketch. Constant comparative analysis, memo-writing, theoretical sampling, theoretical sensitivity and theoretical saturation as fundamental methods of data generation in grounded theory were applied. The study unfolded through three broad parts, namely: Forming & shaping this grounded theory through exploration and co-creation; Assimilating & situating this grounded theory through understanding and enfolding; Reflecting on this grounded theory through contemplating and reconnecting. The outcome of the first part of the study was my initial proposition of a grounded theory co-created in the interactions between the participants and myself. This was then challenged, developed and assimilated through a focussed literature review through the second part of the study. Through these two parts of this study, an inductively derived explanation was formed and shaped to produce an assimilated and situated substantive grounded theory named Being at Ease. This grounded theory articulates how ‘better and different’ nursing is recognised from the point of view of those who use the nursing ability of critical care nurses through the core concern ‘being at ease’ and its four categories ‘knowing self’, ‘skilled being’, connecting with intention’ and’ anchoring’. The final part of this study unfolded in my reflections on what this grounded theory had revealed about nurses and elements of nursing practice that are important to a utiliser in recognising ‘different and better’ critical care nursing. I suggest that as nurses we need to develop a language that enables us to reveal with clarity these intangible and tacit elements recognised within the being and doing of ‘different and better’ nursing. I reflected on the pivotal space of influence a teacher has with a student, and on how the elements essential in being and doing ‘different and better’ nursing need to be evident in her/his own ways of being a teacher of nursing. Teaching and learning encounters may be enhanced through drawing what this theory has shown as necessary elements that shape ‘different and better’ nurses through the moments of influence a teacher has in each encounter with a student.