Declining resources are a global phenomenon. One of the consequences has been the reorganization of health care provision in different countries. Doctor shortages and scarcity of resources particularly in developing countries like Cameroon have resulted in nurses providing frontline care to patients and taking on roles traditionally performed by doctors in developed economies, such as diagnosing and prescribing. However, little is known about the exact role of nurses, the process of providing care, how key stakeholders influence the nurse’s role and the consequences of this role of nurses on the various parties concerned in the context of Cameroon. An empirical study was conducted with (n= 42) key stakeholders; (government representatives, doctors, nursing managers, nurses and patients). Semi-structured taped-recorded interviews were carried out on a one-to-one basis to explore the perceptions of multiple key stakeholders of the role of nurses in diagnosing and prescribing. Interviews were transcribed and data analysed using framework analysis. Nurses are the first point of contact for patients in Cameroon in all health care settings and most have a far greater role in diagnosing and prescribing than their counterparts in developed economies. However their involvement was found to vary significantly depending on a number of factors, including: the organisational context, the type of facility (whether public / private or mission owned), individual nurse characteristics, doctors’ attitudes and practices, resources and experience of nursing managers, level of income and characteristics of patients. Most patients (including women) prefer to consult with doctors and in their absence, male nurses rather than female nurses. Some nurses, patients and doctors felt that a preoccupation with diagnosing and prescribing left nurses with little time for compassion and caring. In addition, the key stakeholders felt that some nurses were overstepping their professional boundaries, or had inadequate knowledge and were acting in a manner detrimental to patient care. Extended roles for nurses have the potential to enhance accessibility to care, to enhance the status and job satisfaction of nursing staff and maximise the use of scarce resources. Despite the benefits, there is growing concern that nurses do not have the advanced level of training and behaviour necessary to take on this expanded role and that some are neglecting the traditional caring side of their profession in pursuit of a more medical oriented disease-focused approach.

Breastfeeding benefits the mother as well as the baby. Breast milk is a complete food for newborn human infants, adequately supplying all nutritional needs for at least the first 4- 6 months of life (Kramer & Kakuma, 2002). In 1993, the Commonwealth of Australia recommended the following goals for promoting breastfeeding by the year 2000 and beyond (Nutbeam, Wise, Bauman, Harris & Leader, 1993): For infants to the age of three months, 60% should be fully breastfed or 80% should be partially breastfed. For infants to the age of six months, 50% should be fully breastfed or 80% should be partially breastfed. However, according to the most recent national survey, these targets have not been met (Donath, 2000). In effect, breastfeeding figures have not changed in the last ten to fifteen years (Mortensen, 2001). Research indicates that the largest decrease in breastfeeding occurs between two weeks and six weeks after birth (Binns & Scotts, 2002; Stamp & Crowther, 1995; Mogan 1986), with women giving Insufficient Milk Supply (IMS) as the major reason for stopping. Despite research in the field of physiology, biochemistry, psychology and socioeconomics, this phenomenon of IMS remains an 'enigma' (Hill, 1991, p. 312). However, failure to thrive in infancy can be seen in babies who do not achieve an adequate weight gain within the normal time span. According to lactation consultants at the Royal Women’s Hospital Breastfeeding Assessment Service in Melbourne, some babies who are breastfed present with inadequate weight gain due to IMS. Women with low breastmilk supply who wish to persist with breastfeeding often look for some means to increase their milk supply. There are very few alternative treatment to assist them. For over a thousand years mothers in China have used acupuncture to increase their supply of breast milk. Within the last decade, several authors have published results of studies on the effect of Traditional Chinese Acupuncture (TCA) on lactation (Wu, 2002; Huang & Huang, 1994; Tureanu, 1994; Dong, 1988; Kang, 1990). These study all indicated improvement in lactation after TCA therapy. However, all these studies have been uncontrolled clinical trials. This research is a first single blind controlled clinical trial to investigate the effectiveness of Traditional Chinese Acupuncture for the treatment of IMS. The aim of the study is to find out whether a course of Traditional Chinese Acupuncture treatment would help mothers diagnosed with insufficient breast milk supply produce more milk. This clinical trial was conducted by a qualified Traditional Chinese Medicine practitioner. The researcher gained a Bachelor of Medicine degree in TCM after completing the five years program at the Beijing College of TCM in China. The researcher has been in clinical practice for more than 15 years. This is a pilot study. The final number of subjects in the study was 27,: 9 in the Traditional Chinese Acupuncture (TCA) Group; 6 in the Sham Acupuncture (SA) Group and 12 in the Non-Treatment Control Group. The major finding of the study was that - 'Other things being equal, infants whose mothers received TCA weighed 160.13 grams more on average than those whose mothers received SA. This effect is marginally significant (p less than 0.1)'. The finding generally confirms that the Traditional Chinese Acupuncture intervention to the mother is effective in increasing infant weight gain.

Autologous blood cell transplantation (ABCT) has been successfully used to treat a variety of haematological cancers and some solid tumours. The number of patients who are long term survivors and free of disease following this treatment is growing rapidly. To enable nurses and health care workers to provide optimal supportive care for these patients, an understanding of how the transplant has affected their quality of life (QOL) is essential. In the last two decades numerous studies have focused on QOL issues in this patient group. However, the majority of these studies tend to approach QOL from a bio-physiological perspective, generating knowledge about the treatment and its side effects. Little is known about the patients' experiences and how they interpret their QOL in the years following their transplants. The purpose of this study was to explore QOL issues from the perspectives of 12 patients who had undergone an ABCT. Heideggerian phenomenology (interpretive phenomenology) was chosen as the theoretical framework for the study, as it allows for the transparent world of people's everyday lived experiences to be illuminated, and so reveal how they interpret their QOL. The aims of this study was to gain a deeper understanding of QOL issues through the participants interpretations of their experiences, and to uncover themes and different patterns of meaning which embody the participants' QOL. Data was collected through in-depth, unstructured interviews with each participant. Thematic analysis, exemplars and paradigm cases were utilised to present the participants' interpretations of their QOL. The findings showed that the participants' QOL was influenced by their interpretations of embodiment, being in time, being in society and re-appraisal of life. The findings also revealed that QOL following an ABCT is a highly individualised, dynamic experience that depends on the challenges the participants confront in their everyday lives. As the participants re-interpreted their lives following their transplants, their perspectives on their QOL changed. For some this was a positive experience, but for others their QOL diminished. The implication of this study is that nurses must be committed to providing individualised, patient focused care following an ABCT. The findings of this study offer a deeper understanding of patients' everyday lived experiences and their QOL following an ABCT, and will enable nurses and other health professionals to develop supportive care infrastructure to assist patients during their recoveries, thus improving their QOL.

An increasing number of people with chronic illness use complementary and alternative medicine (CAM) (Metz, 2000) and rarely disclose such use to treating biomedical physicians [B/M] (Adler & Fosket, 1999). Although the incidence of CAM use amongst people with chronic illness has been investigated (Nader et al., 2000; Sharon & Mark, 2006; Yang et al., 2002) research specifically examining that section of people who require ongoing biomedical treatment from a very early age until death has never before been conducted. This thesis examined the patterns of self-prescribed and CAM practitioner prescribed CAM use, reasons for CAM use and disclosure of CAM use to treating physicians, among people with a lifelong medical condition, thalassaemia major (TM). To examine the reasons for use and disclosure of CAM in this population, 21 people (eight males, 13 females) aged between 24 and 43 years volunteered for the three-phase study, which forms the thesis. The participants were English speakers whose physical and cognitive capacities did not prevent participation in the study. Interviews were conducted in the participants’ homes and followed standard consent procedures. All phases were conducted face-to-face. In Phase 1, using an in-depth unstructured questionnaire and two structured questions, participants were asked about their medical history, CAM use and whether they disclosed such use to their biomedical physician/s. In addition, the participants were asked to nominate any CAM practices they had heard of, that people might use. A written list was devised as the participants mentioned CAM therapies/treatments. The participants were then asked which of these CAM therapies/treatments they had used. In Phase 1, all of the participants reported having multiple co-morbidities and at least one major surgical procedure. Twelve of the participants reported using CAM when asked a dichotomous choice question. All participants were found to be CAM users when CAM was estimated according to the substances and therapies that participants reported using. Phase 1 showed that CAM estimates varied according to which CAM definition was applied to analyse the data. In Phase 1 there was only one participant out of 21 (4.76%) who reported CAM disclosure and disclosure was ongoing in that case. The reasons for CAM use and disclosure were elicited using in-depth conversational interviews, which constituted Phases 2 and 3 respectively. The operational definition of CAM devised for this thesis was based on the intent of CAM use and not prescribed by a biomedical physician. Based on the operational definition of CAM proposed for thesis there were 21 CAM users. Examination of the reasons the participants gave for CAM use confirmed there were 21 CAM users. Phase 2 showed the participants wanted safe and effective treatment to manage and cure the primary illness and co-morbidities. Phase 2 also indicated that CAM was used, at times in lieu of biomedicine, to prevent illnesses and to enhance quality of life (QoL) and to increase life expectancy. Phase 2 showed biomedical failure and adverse outcomes from biomedicine motivated CAM use. These reasons shaped perceptions of dissatisfaction with biomedical treatment and the prescribers of such treatment. Phase 3, addressed CAM disclosure, showed most of the participants considered they had disclosed their CAM use when they asked their treating biomedical physician about CAM. Phase 3 demonstrated most participants attempted to disclose CAM use and whilst they felt it was important for the treating physician to know about such use, they abandoned disclosure because of dissatisfaction with biomedical practitioners’ responses to their attempts to disclose. Other reasons for non-disclosure or aborted disclosure included a desire to maintain privacy and a belief that CAM was harmless. Phases 2 and 3 showed core reasons for CAM use and CAM non-disclosure were dissatisfaction and a loss of confidence in biomedicine. The one person who did disclose CAM use stated disclosure symbolised their dissatisfaction with biomedicine. This thesis showed people with a serious life-long illness used CAM because biomedicine was often ineffective, frequently palliative and sometimes considered deleterious to health. These aspects of biomedical care instigated dissatisfaction and a loss of confidence in biomedicine treatment and practitioners. The negative perceptions held by the participants of biomedical treatment and biomedical physicians were the primary motivators for CAM use and disclosure. All participants were found to be CAM users and this might have serious implications for their on-going biomedical treatment because some CAM products have a pharmacological effect that might interact with prescribed biomedicine medication. The findings suggest CAM was beneficial in an environment in which biomedicine could only offer palliative care, but this finding requires further research. This thesis showed that CAM use and disclosure are complex issues, deserving indepth examination in people with a range of medical conditions, as well as in the general population.

The purpose of this evaluative case study was to evaluate the effectiveness of a 48 hour Medical Unit in relation to Patient Satisfaction, Patient Care, Nursing Staff Job satisfaction and the Average Length of Stay for patients' Pre and Post a Rapid Assessment Medical Unit's (RAMU) inception. The study used a combination of Patient Satisfaction Survey's, Interviews, and data of the average length of stay of patients pre and post RAMU. This report aims to provide a comprehensive description of the research process and the results obtained from the collection of data throughout this research project. An evaluative case study using Yin (2003), as a framework of this study was deemed appropriate, as no research to date had been conducted on 48 hours Medical Wards, because of their uniqueness. A case study allowed for "multiple sources of evidence gathering", thus ensuring that the findings to this study are more likely to be accurate if based on several different sources of information. Despite the study's limitations, the results to this study were surprisingly supportive and positive of those patients who had participated in this research project. Nursing Staff on both wards that participate in the interviews had a positive attitude in relation to how well RAMU is functioning. The findings indicate there are a few minor changes that are required and further research is recommended, however the hospital and staff have managed to find a formula that works extremely well in providing patient satisfaction, patient care and job satisfaction in a short period of time.

Previously documented evidence suggests that motherhood is potentially an important time for change in drug-using behaviour. My research interest for this longitudinal phenomenological study stemmed from practice observations where methadone-treated women struggled to prove their trustworthiness as mothers. They consistently reported frustration in the face of continued professional suspicion of their identity as drugusers. The essence of the phenomenon is therefore described as an existential tension experienced by breastfeeding mothers in methadone maintenance treatment during the first 12 weeks of motherhood. The aim of this thesis is to reveal the previously hidden inter-subjective and social realms of their lived worlds.

Caesarean birth accounts for a quarter of all births in England and is the most commonly performed operation. Despite this, little is known of how individual women experience planned Caesarean birth. Reviews of the literature reveal that rising rates of Caesarean birth are preceived to be problematic by women ,clinicians and policy makers but women's experiences are either absent from this debate or perceived as universally realised. This qualitative study involved listening to the stories of eight women to reveal how planned Carsarean birth was experienced, understood and constructed.

This study explored the ways experienced mental health nurses working within a local acute mental health NHS Foundation and Teaching Hospital Trust felt about being unobtrusively observed in their everyday clinical practice. Participants were recruited from eight local units: four Community Mental Health Teams (CMHT), one Crisis Resolution Home Treatment Team (CRHT), one inpatient ward, one in-patient rehabilitation unit and an Assertive Outreach Team (AOT).

<p dir="ltr">Nurse managers recognize clinical judgment as a core competency of practice readiness (Boyer et al., 2019; Harrisona et al., 2020). Reflection is vital for novice nurses’ clinical judgment development (Tanner, 2006), enhancing their ability to deliver safe care. Despite its importance, nurse educators lack the ability to measure reflection in simulation debriefings. To address this gap, the Student-Centered Reflection Scale (SCRS) was created to assess reflection during simulation debriefings. This study aimed to conduct item testing and evaluate the psychometric properties of the SCRS to measure the presence of reflection during simulation debriefings.</p><p dir="ltr">Four sequential psychometric studies conducted initial item testing and evaluated the SCRS’s reliability and validity. The first two studies, a content validity study with 11 experts and pretesting study with 16 undergraduate nursing students, provided feedback for item revision and evidence of validity. Then an exploratory factor analysis (EFA) and item analysis study, involving 92 undergraduate nursing students from a Midwest public baccalaureate nursing school, was completed. Finally, a confirmatory factor analysis (CFA) and convergent validity study were completed using the SCRS and Groningen Reflective Ability Scale (GRAS; Aukes et al., 2007) in a convenience sample of 218 nonoverlapping undergraduate nursing students from the same educational institution.</p><p dir="ltr">The EFA revealed 20 items with four factors or subscales: (a) comparison of previous knowledge (four items); (b) analysis of biases, beliefs, and consideration of moral and ethical criteria (five items); (c) analyzing the scenario (eight items); and (d) challenging assumptions and considering a change in practice (three items). These subscales explained 82.78% of the variance and demonstrated acceptable item loadings ranging from .50–.83 and inter-item reliability ranging from .219–.664. The CFA demonstrated acceptable global fit (RMSEA = .071, CFI = .914, TLI = .900) and component fit. The SCRS also demonstrated reliability (α = .92) and convergent validity (<i>r </i>= .496) with the GRAS.</p><p dir="ltr">In conclusion, the SCRS demonstrated adequate reliability and validity with this sample. The SCRS is a resource for educators to evaluate and foster reflective skills in undergraduate nursing students during simulation debriefings, thereby promoting nursing students’ overall practice preparedness.<br></p>

Students diagnosed with long-term mental health conditions have been the focus of policy development for over a decade. Student mental health is on the increase and universities are legally obliged to make reasonable adjustments for disabled students. Therefore it is crucial that nursing and midwifery education provides an inclusive learning environment, while maintaining fitness to practice standards. The focus of this study was to explore how discourses of mental health, reasonable adjustments and fitness standards influence nursing and midwifery education for students with a mental health condition. Principles of Wodak’s (2001) critical discourse analysis approach, which gives prominence to dominant discourses, their justifications and persuasive nature was utilised. Ten key written texts and 23 semi-structured interviews with students, lecturers and clinical mentors were conducted to acquire the constructions of mental health, reasonable adjustments and fitness requirements. The findings show that the dominant discourses attributed to students experiencing mental ill health were around medicine, difference and blame, all of which reinforced mental health stigma. In addition, mental health discourses within both verbal and written texts were not underpinned by disability discourses, allowing the exclusion of students who disclose mental ill health from accessing reasonable adjustments. In conclusion, students considered to have a mental health label faced discriminatory barriers and legislative and regulatory requirements of equality were not implemented.