Abstract The purpose of this research is to describe and comprehend the planning and realization of the Finnish Nurse Education from 1945 to 1957. The historical perspective of Nurse Education is examined from the Health Administration perspective, which utilizes the Intellectual and Administrative history research tradition. The phenomenon of education is studied holistically at macro and micro levels. At macro level the organizing of State Administration and the work of the leading nurses in development analysis is based on various documentation. At micro level the analysis concentrates on research knowledge based on memories of the contemporaries, i.e. experiences and conceptions of teachers and students of Nurse Education. The source materials are interpreted qualitatively. This approach structures the change in foundation and contents of education as well as the general nation-wide educational principles and the sympathies and frailties of human nature of the leading nurses that influenced the education. The research results present the changes in Nurse Education structure and content from 1945 to 1957, and the occurred change. The projecting of Nurse Education was effected by administrative and educational instructions. It was greatly influenced by the so-called Nurse Elite, which adopted an international perspective to nurse education supported by the Rockefeller foundation. The goal-oriented realization of education resulted in increase in theoretical education, concentration on social evaluation and holistic approach in teaching. Practical realizations intensified student guidance and systematic teaching, and also student independence and vocational education were intensified. The results structure research knowledge of Nurse Education, and present the identity of the current Nurse Education and the foundation for further development. / Tiivistelmä Tutkimuksen tarkoituksena on kuvailla ja ymmärtää sairaanhoitajien koulutuksen suunnittelua ja toteutusta Suomessa vuosina 1945 - 1957. Sairaanhoitajien koulutuksen historiankuvaa tarkastellaan terveyshallintotieteen näkökulmasta, jossa hyödynnetään aate- ja tapahtumahistoriallista tutkimusperinnettä. Koulutusta kokonaisuutena tutkitaan makro- ja mikrotasoilla. Makrotasolla analysoidaan erilaisten dokumenttien avulla valtionhallinnon organisointia sekä kehittämistoimintaa johtaneiden sairaanhoitajien työtä. Mikrotasolla analysoidaan aikalaisten muistitiedon avulla tuotettua tietoa eli opettajien ja sairaanhoitajaopiskelijoiden kokemuksia ja käsityksiä koulutuksesta. Lähdeaineiston tulkinnan perustana on aineistojen kvalitatiivinen lukutapa. Lukutapa auttaa ymmärtämään koulutuksen rakenteen ja sisällön muutoksen lisäksi myös koulukseen vaikuttaneiden kasvatusaatteiden ja sairaanhoitajien inhimillisen toiminnan merkitystä. Tutkimustuloksissa kuvaillaan sairaanhoitajien koulutuksen suunnittelua ja toteutusta vuosina 1945 - 1957 sekä siinä tapahtunutta muutosta. Suunnitteluun vaikuttivat sekä valtiohallinnolliset että kasvatusaatteelliset ohjeet. Sairaanhoitajien koulutuksen suunnittelua ohjasi erityisesti niin kutsuttu sairaanhoitajaeliitti, joka omaksui suunnitteluun Rockefeller-säätiön tukemana kansainvälisen ajattelun. Koulutuksen tavoitteellinen toteutus edisti sairaanhoidon opetusta siten, että teoriaopetus lisääntyi, yhteiskunnallinen painotus korostui ja opetuskokonaisuudet kehittyivät. Käytännöllisessä toteutuksessa tehostettiin opiskelijoiden ohjausta ja käytännön järjestelyjä sekä vahvistettiin opiskelijoiden itsenäisyyttä ja syvennettiin ammattikasvatusaatetta. Tutkimustulokset auttavat jäsentämään sairaanhoitajien koulutuksen tietoperustaa. Ne auttavat myös ymmärtämään nykyisen sairaanhoitajakoulutuksen identiteettiä ja ovat perusta sen edelleen kehittämiselle.

Abstract The purpose of this study was to develop a descriptive model of envy in nursing practice and nurse education environments. The context of nursing and the concept of envy were described in the first phase of the study. The aim of the second and third phases was to describe envy and its conceptual meaning in the nursing practice and educational communities. Data were collected by a questionnaire presented to 78 (N = 120) employees in one central hospital in 1994 and to 94 (N = 110) student nurses in one polytechnic of health and welfare in 1996 in Finland. The data were analysed using cross-tabulations and factor analysis. The construct validities of the questionnaires were good, but their construct reliabilities were only acceptable and partly even poor. The aim of the fourth phase of the study was to describe different opinions of envy. Data were collected from 64 (N = 100) student nurses in 1998. The aim of the fifth phase of the study was to describe envy and its conceptual meaning in nursing practice and nurse education environments. The material was collected by interviewing four lecturers from two polytechnics of health and welfare in 1998. A phenomenographic approach was used to analyse these materials. In the sixth phase of the study, the concept of envy, the positions of employees/students/lecturers and the relations between them, the managers and the other community members, the objects of envy and the methods of coping with envy and were shown. According to the model of envy, the position of an individual was defined by his/her experience of him/herself and his/her role in the community. The role was related to his/her tasks, individual actions and socioemotional factors. Envy was considered to pertain to the relations between individuals and groups, managers and objects of envy, such as professional knowledge, individual abilities and the individual's position of the community. The informants coped by themselves, co-operated in their tasks and worked with a task orientation. They shared a subjective feeling of busyness. The connections between the concepts were not tested. The concepts were assumed to be related to each other. The model of envy is hence hypothetical. This study produced new knowledge of envy in nursing practice and nurse education environments. The results can be used in nurse management and to improve curricula and collaboration. The methodological solutions can be used in other kinds of nursing research. / Tiivistelmä Tässä tutkimuksessa tarkoituksena oli kehittää malli kateudesta, joka kuvaa terveysalan käytännössä ja koulutuksessa ilmenevää kateutta. Tutkimuksen ensimmäisen vaiheen tehtävänä oli kuvata terveysalan kontekstia ja kateuden käsitettä. Toisen ja kolmannen vaiheen tehtävänä oli kuvata terveysalan käytännössä ja koulutuksessa ilmenevään kateuteen liittyviä tunnuspiirteitä. Aineistot kerättiin 1994 yhdessä keskussairaalassa työskennelleiltä 78 henkilöltä (N = 120) ja 94:ltä (N = 110) sosiaali- ja terveysalan opiskelijalta yhdessä ammattikorkeakoulussa kyselylomakkeella 1996. Aineistot analysoitiin käyttäen ristiintaulukointia ja faktorianalyysia. Kyselylomakkeiden rakennevaliditeetti oli hyvä. Sisäinen johdonmukaisuus oli hyvä ja osin kyseenalainen. Tutkimuksen neljännen vaiheen tehtävänä oli kuvata kateuteen liittyviä erilaisia käsityksiä. Aineisto kerättiin 64:ltä (N = 100) terveysalan opiskelijalta 1998. Tutkimuksen viidennen vaiheen (1998) tehtävänä oli kuvata terveysalan käytännössä ja koulutuksessa ilmenevään kateuteen liittyviä käsitteitä. Siksi haastateltiin neljä terveysalan opettajaa, jotka toimivat kahdessa eri sosiaali- ja terveysalan ammattikorkeakoulussa. Aineistot analysoitiin käyttäen fenomenografista lähestymistapaa. Kuudennessa vaiheessa kuvattiin terveysalalla ilmenevä kateuden käsite, työntekijän/opiskelijan/opettajan asema, suhde samassa yhteisössä toimijaan, johtajuuteen ja toiseen yhteisöön, kateuden kohteet ja kateudesta selviytymisen keinot sekä niihin liittyvät käsitteet, joiden avulla kehitettiin malli kateudesta. Kehitetyn kateuden mallin mukaan ihmisen asemaa kuvaa käsitys itsestä ja omasta roolista yhteisössä. Käsitykseen itsestä liittyy ammatillinen tyytyväisyys tai tyytymättömyys. Rooli on tehtäväkeskeinen, yksilöllinen ja sosioemotionaalinen. Kateus liittyy ihmisten keskinäisiin ja eri ryhmien välisiin suhteisiin sekä johtajuuteen ja kateuden kohteisiin (ammatilliseen osaamiseen, henkilökohtaisiin taitoihin ja ominaisuuksiin sekä asemaan yhteisössä). Terveysalan käytännössä ja koulutuksessa toimivat selviytyvät yksin, tekevät tehtävän mukaista yhteistyötä ja työskentelevät tehtäväkeskeisesti. Toimijoita yhdistää kiireen kokemus. Mallissa ei testattu muodostettujen käsitteiden välisiä suhteita, mutta oletetaan, että käsitteet liittyvät toisiinsa. Tuotettu malli kateudesta on hypoteettinen. Tutkimus tuottaa uutta tietoa terveysalan käytännössä ja koulutuksessa ilmenevästä kateudesta. Tuloksia voidaan käyttää terveysalan johtamisessa ja kehitettäessä opetusmenetelmiä ja yhteistoiminnallisuutta. Tutkimuksen menetelmällisiä ratkaisuja voidaan soveltaa myös muissa hoitotieteellisissä tutkimuksissa.

Nursing competence is a necessity as it affects public health, safety and welfare; however there are very few reliable and valid tools that measure nursing competence. The Nurse Competence Scale has been used in many different countries outside of the United States and is based on Benner’s Novice to Expert theory. The purpose of this study was to examine the content validity of the Nurse Competence Scale using a mixed methods approach. Descriptive statistics were used to report results of the frequency of use scale and the critical to practice scale. Nursing faculty indicate Prioritizing My Activities Flexibility According to Changing Situations in the Managing Situations category of the Nurse Competence Scale as most frequently used. Nursing faculty rated Acting Appropriate in Life Threatening Situations as most critical to practice. Based on the results from this study, there is evidence to support the content validity of the Nurse Competence Scale in the United States. Results may be used to assess students prior to National Council Licensure Examination and may further the discussion on how nursing competence is measured globally. Additional research is need on the use of the NCS in the United States.

Magister Curationis / Background: A preceptor is defined as a specialized tutor who gives practical training to the student in the practice settings. Preceptors are frequently used to orientate nursing students to prepare them for their duties as professional nurses. In the Western Cape Province professional nurses attend a training programme to prepare them for the role of preceptor. Following the training it is unclear how the trained nurse preceptors' perceive their preparation for the role. The perceptions of preceptors may also influence their commitment to their role. Aims and Objectives: The purpose of this study was to explore the interrelationships among preceptors' perceptions of benefits and rewards of, support for and commitment to the role. A conceptual framework guided the study which replicated previous studies that explored nurse preceptors' perceptions. Research Methodology: A descriptive, correlational design was used in this study to address the research questions. A quantitative approach was used to establish the perceptions of nurse preceptors' benefits, support and commitment to the role. The convenience sample was drawn from the preceptors (n=60) who completed the preceptor training programme at the University of the Western Cape. Instrumentation for the study included the following scales: Preceptor's Perceptions of Benefits and Rewards Scale, the Preceptor's Perceptions of Support Scale and the Commitment to the Preceptor Role Scale. Data analysis was performed through SPSS 20.0 to produce both descriptive and inferential statistics and to establish the relationships between the variables. Results and Recommendations: Statistical significance was examined and correlation between variables were analysed. The findings indicated that nurse preceptors were committed to their role: the workload of nurse preceptors needs to be refined and in-service training should be given to the nursing staff in relation to the goals of the nurse preceptor in the clinical and education units. The findings of this study will add to what is known about preceptors' perceptions and may assist in guiding the evaluation of the preceptorship programme. In addition, the results may inform nurse managers about the perceived benefits, rewards and support required by preceptors, thus adding to the body of knowledge about clinical teaching and learning. Ethical Considerations: Ethical clearance was sought from the Ethics Committee of the University of the Western Cape and informed consent was obtained from the participants. iv

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No / This paper presents the findings of the third stage of a research study, the overall aim of which was to evaluate the educational preparation for cancer and palliative care nursing for children and adolescents in England. The specific aim of this stage was to define the attributes of `threshold' and `higher level' practice in nursing in order to inform the outcomes of future educational programmes. The research design involved children, their parents and their nurses at two different stages in the study. The first stage was the construction of the research instruments, in this case video and audio recordings of episodes of care in which the children participated. The second stage was the review of the recordings by the children, their parents and other stakeholders involved in their care. Service users were also involved in the management of the project. The study findings suggested that although there was considerable agreement between service users and other stakeholders about the characteristics of adequate or threshold practice, for both cancer and palliative care, there was less agreement about what constituted higher level or expert practice — other than `more of the same but better'. The key areas of importance for future professional development courses were agreed as partnership working, clinical skills, multidisciplinary working and the personal attributes of the nurse.

No / This study aims to review the biosciences component of preregistration nursing programmes in higher education institutions across the UK through the experiences and perceptions of lecturers involved in nursing education. Studies suggest that some qualified nurses lack confidence in explaining the bio-scientific rationale for their clinical practice. Biosciences can be difficult to understand and integrate into clinical decision-making and require protected time within preregistration nurse education. In the absence of explicit national guidelines, it is unclear as to the depth and extent biosciences are taught across different institutions and the level achieved at the point of registration. A survey approach was adopted to generate quantitative and qualitative feedback. Data were collected using a semi-structured questionnaire seeking the experiences and views of lecturers involved in teaching biosciences to nursing students across the UK. Data received from 10 institutions were analysed using descriptive statistics and thematic analysis. Lecturers reported that the hours of taught biosciences ranged from 20-113 hours, principally within the first year. This represents between 0.4-2.4% of time within a preregistration nursing programme (4600 hours). Large group lectures predominate, supplemented by smaller group or practical work, and online materials. The biosciences are assessed specifically in half the institutions surveyed and as part of integrated assessments in the rest. In relation to student feedback, all respondents stated that students consistently requested more time and greater priority for biosciences in their programme. This survey suggests that the number of hours spent teaching biosciences is minimal and varies widely between higher education institutions. All respondents expressed concern about the challenges of teaching difficult bio-scientific concepts to large groups in such a limited time and called for greater clarity in national guidelines to ensure that all nurses are adequately educated and assessed in bioscience subjects. Failure to understand the biosciences underpinning care has implications for safe and competent nursing.

Bakgrund: Sjuksköterskestudenter kan genomföra verksamhetsförlagd utbildning inom utbildningsvårdavdelningar. En modell benämns Utvecklande och Lärande Vårdenhet (ULVE), där studenter handleds och vårdar i par. Det finns studier som visar att modellen stödjer studenters lärande, men det finns få studier om hur patienter upplever det att vårdas av studenter i par. Därför är det intressant att undersöka hur patienterna ser på att det är två studenter som vårdar dem och hur de upplever den vård de får. Syfte: Syftet med studien är att beskriva patienters erfarenheter av att vårdas av sjuksköterskestudenter som handleds och vårdar i par. Metod: Studien är genomförd med en reflekterande livsvärldsansats grundad i fenomenologisk kunskapsteori. Fenomenet i studien är ”Att vårdas av sjuksköterskestudenter som vårdar och handleds i par”. Data har samlats in via intervjuer av sjutton patienter som vårdats inom ULVE. Resultat: Att vårdas av studenter som handleds i par innebär att bli involverad i studenternas lärande och att mötas av ansvarstagande och en vilja att vårda och lära.  Patienterna känner trygghet och är positivt inställda till att vårdas av studentpar. Tilltro till att vården ges med stöd av handledning bidrar även till trygghet i vårdsituationen. Resultatet beskrivs vidare med innebördselementen: Involverad i lärande och vårdande, Att vara i centrum för vård, Tilltro och tillit till vårdens kvalitet och Att få något utöver det ”vanliga”. Konklusion: Studien visar att patienter som vårdas av studenter som handleds och vårdar i par sätts i centrum, blir tagna på allvar och lyssnade till som människor. Det visar sig i respektfulla möten som präglas av omtänksamhet, engagemang, närvaro och där behov tillgodoses. Studien stödjer att studenter ger god vård när de handleds och vårdar  i par. / Background: Nursing students can complete clinical training in educational hospital wards. A model called Developing and Learning Care Unit (ULVE), where students care and supports in pair. Studies show that the model supports student learning, but there are few studies about how patients perceive to be cared for by students in pairs. It would be of interest to examine what patient’s experience are, what they think about being cared of students who work in pairs and if they believe that they receive good care.  Aim: The aim of this study is to describe how patients’ experience being cared for by student nurses who are caring and supervised in pairs.     Method: The study was conducted with a reflective lifeworld approach based on phenomenological epistemology. The phenomenon of the study is ”to be cared for by  student nurses caring and supports in pairs”. Data was collected through interviews of seventeen patients cared for  within ULVE.       Results: The care of students who are supported in pairs means to become involved in student learning and to meet the responsibility and a desire to nurture and learn. Patients feel secure and are positive to be looked after by student nurses in pair.  Confidence in the healthcare provided under the supervision also contributes to security in the care situation. The result is further described with four meaningful elements: Being involved  in learning and caring, being the center of care,  confidence and trust in the quality of care and  getting something out of the ”ordinary”. Conclusion: The study showed that patients cared by pairs of students is taken seriously and humanly during supervision of nursing clinician and it focuses in a patient centered care. This method of pair nursing students care shows respect, thoughtfulness, engagement and presence to patients where needs are fulfilled.

This study focused on Registered Nurses (RNs) working in Acute Trust surgical wards in the context of their role development, role expansion and role extension. The study originated from concerns raised by RNs undertaking the surgical pathway of the BSc Hons in clinical nursing practice, who alerted me to their dissatisfaction with their working conditions and their role. This revelation was made at a time when modernization was cascading into Acute Trusts as a result of the NHS plan (DOH 2000); simultaneously the European Working Time Directive (EWTD) was being implemented, sequentially reducing Junior Doctor’s hours of work. NHS modernization and the EWTD were the two initiatives which led the researcher to the assumption that RNs working in surgical wards were the labour force who would be absorbing the additional workload brought about by these changes, because RNs are the only health professionals in acute surgical wards with twenty-four hour contact with, and responsibility for, ward-based surgical patient care. The study was conducted in one clinical directorate of an Acute Trust hospital, comprising six in-patient surgical wards and five specialist nursing services. The methodology was ethnography, where the researcher worked as an RN for fifteen months, collecting data through Spradley’s (1980) descriptive, selective and focused phases of fieldwork. Data was analysed using what Miles and Huberman (1994) refer to as a set of ‘choreographed / custom built’ techniques. The descriptive phase of fieldwork revealed an apparent ‘staffing illusion’ on the surgical wards and RNs were found to be under tremendous pressure to manage ‘patient throughput’, and an ever increasingly dependent case mix of surgical patients, within the existing, or if possible diminishing Senior / experienced RN labour force due to the emergent evidence of a ‘cycle of staff change’ with non-clinical managers backfilling Senior RN posts with Junior RNs. For Senior RNs this backdrop meant additional support and supervision demands on their role. To get through the workload many RNs held ‘dual roles’ to enable maintenance of the surgical services within the directorate. The selective phase of fieldwork re-focused the ethnographic lens on the RNs in the context of their role development, role expansion and role extension, from which six perspectives were found: 1) role development from Junior to Senior RN, 2) role expansion dependent on shift of the day, day of the week – the co-ordinator role, 3) role extension confusion and boundary disputes, 4) hidden [role expansion and extension] talents of surgical nurses, 5) role contraction – a feeling Nursing is going backwards, and finally, 6) ‘if only I could’ – role expansion aspirations of surgical RNs. The third phase of fieldwork, described by Spradley (1980) as the focused phase, was spent validating the findings and conducting the ethnographic interviews. The findings are interpreted locally [from the perspective of RN’s working within Rodin] as ‘working to full capacity’ through ‘doing more for more with less’, as a result of the RN with the surgical directorate being sandwiched between two agendas, that of Junior Doctors EWTD and NHS modernisation. Braverman’s skill substitution / degradation of skilled work thesis is then used as an interpretative framework to conclude the thesis, the outcome of which reports a ‘triple substitution’ agenda.