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The main aim of this thesis was to examine internal representation in the context of nurse education using two main output variables - namely imagery and identity. The initial basic argument for the thesis was that procedures to facilitate the acquisition of psychomotor skills that have been developed in sports science could fruitfully be applied to the development of skills in other areas, such as nurse education. Study one approached this through the use of an imagery training programme - PETTIER (Holmes & Collins, 2001) on an undergraduate nursing curriculum. PETTIER served as the independent variable with the dependent variable - performance - being measured through Obje&tive Structured Clinical Examinations (OSCEs). Unexpected results revealed no significant differences between the control and experimental groups, with the control group actually performing better overall. Given this, the explicit choice was made to pursue investigation into the other plausible factors affecting behaviour, in order to explicate and underpin the results obtained. Study two investigated students' perceptions of and preparation for the OSCEs using a skills training questionnaire. Results revealed common concerns, specifically related to skills practice. Furthermore these concerned the amount of practice time provided; the practice environment; and the amount of support and training during teaching. In light of these findings, study three pursued a contrasting and comparative investigation from the professionals' perspective on the curriculum. This specifically examined perceptions of the assessment structure and expectations within the curriculum; the content of the curriculum; levels of support and provision for training; and the application of theory and practice. This aimed to identify any coherent or conflicting views between the students' receiving the curriculum and the staff delivering the curriculum. Results revealed coherency in the professional view that theory and practice were equally as important for nurse education. However, students commonly perceived practice as the most important aspect. Also, some students often struggled to apply theory to practice and vice versa. In light of this it became apparent that students may in fact identify differently with the content of the curriculum. Therefore, appraisal of the content may have different significance for students and affect behaviour differently both internally and/or externally. Study four investigated this using Identity Structure Analysis (ISA)/lpseus (Weinreich & Saunderson, 2003).This explored how students applied themselves to the various aspects of nursing in the contexts of healthcare and broader affiliations, and how these fitted into students' broader sense of identity. It also looked at typologies within nursing and whether identity fitted into three distinct categories depending on construals. Study five followed this up using two individual case studies. The purpose of this was to encapsulate meaning behind individual construals and typologies and explicate the findings of ISA/lpseus and the implications for nurse education. Results found that construals are grounded in experiences which can affect development, behaviour and identity towards nursing and the broader affiliations in individuals' lives. In conclusion identity in nursing should be investigated further in order to provide stronger evidence in regards to typologies and how these may be influencing students' behaviour and development in nurse education. Such research could have important implications for the future of nurse education and be a positive step towards future curriculum revisions.

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Asthma is a chronic disease that affects 8.4 million children in the United States (American Lung Association [ALA], 2007). Adolescents with asthma need tailored management of their care with attention given to particular developmental concerns. Standards of care, such as the National Heart, Lung, Blood Institute [NHLBI] 2007 asthma guidelines (NHLBI, 2007), exist to guide patient care and in this case, also address specific adolescent needs. Advanced practice nurses should incorporate "national standards of care as a framework for managing patient care" (American Association of Nurse Practitioners [AANP], 2007, p. 2). There is a lack of research about nurse practitioner use of standards of care, especially in caring for adolescents with asthma.The purpose of this practice inquiry was to explore patterns of practice and perceptions of practice by the nurse practitioners who care for adolescents with asthma, and to evaluate the current patterns of practice in comparison with national standards for providing care to adolescents with asthma at the Larry Combest Community Health Wellness Center [LCCHWC]. The design for this practice inquiry was descriptive retrospective, using mixed methods for process evaluation of a program through description of nurse practitioner practice at an academic nurse-managed primary care clinic.The nurse practitioners addressed all components of the process of care recommended by the AANP (2007), which includes assessment, diagnosis, development and implementation of a treatment plan, and evaluation of the patient status. However, despite comments about the importance of using evidence based practice in the form of guidelines, results from health records review indicate that nurse practitioners have not fully integrated the NHLBI 2007 asthma guidelines into providing care to adolescents with asthma. This study establishes a baseline measure of adoption of the NHLBI 2007 asthma guidelines by nurse practitioners at this clinic site. The results of this study may ultimately contribute to nurse practitioners' awareness of use of standards of care and improved quality of care for adolescents with asthma.

Triage, which means "to sort", determine the priority of the patients need of care. The aim of the present study was to describe nurses’ perception of triage at a pediatric emergency department. A questionnaire with open- and closed-ended questions were distributed to all 25 nurses that worked at a pediatric emergency department. The answer frequency was 48 % (n=12). Open-ended questions were analyzed by qualitative content analysis and the closed-ended questions with descriptive statistics after which statistical correlations and differences were calculated. The nurses’ perception of triage was that this first assessment and prioritization of the patients’ need of care increased safety and control and that to refer patients to another level of care may reduce the waiting time however, were time consuming for the nurse. The perception of interception factors for referring patients to another level of care were lack of availability and negative reactions from parents and patients. To perform triage and at the same time be responsible for other patients was perceived as a difficult. As a support in the performance of triage a triage-system, easy to interpret, was needed. Any significant differences or association could not be detected regarding level of education or work experiences. The nurses perceived that a correct triage gave the patient correct care at right level. / Utifrån triagebedömning, där triage betyder "att sortera", prioriteras patientens behov av vård. Syftet med denna studie var att beskriva sjuksköterskors uppfattning om triagebedömning på en barnakutmottagning. En frågenkät med öppna och slutna frågor delades ut till samtliga 25 tjänstgörande sjuksköterskor vid barnakutmottagningen. Svarsfrekvensen var 48 % (n=12). De öppna frågorna analyserades med kvalitativ innehållsanalys och de slutna frågorna bearbetades med deskriptiv statistik därefter beräknades statistiska samband och skillnader. Sjuksköterskors uppfattning om triage var att denna första bedömning och prioritering av patientens vårdbehov gav en ökad säkerhet och kontroll samt att hänvisning av patienter till annan vårdnivå kunde minska väntetider men krävde stor tidsåtgång. Brist på tillgänglighet till primärvården och negativa reaktioner från föräldrar och patienter uppfattades som en hindrande faktor vid hänvisning. Sjuksköterskorna uppfattade att det var en svår arbetsuppgift att utföra triagebedömning samtidigt som man ansvarade för andra patienter. Som stöd i triagebedömningen önskades triagemallar som var lätta att tyda. Inga signifikanta skillnader eller samband kunde identifieras vad gäller graden av utbildning eller antal yrkesverksamma år. Sjuksköterskorna uppfattade att rätt utförd triage gav patienten rätt vård på rätt vårdnivå.