This thesis is concerned with the information needs of informal carers, or, as they are now increasingly referred to, carers Within this thesis, the appellation carer is defined in terms chosen by carers themselves. In their words, • A carer is someone whose life is restricted by the need to assist another person to live independently at home. Information is similarly defined by reference to the perspective of the carers, whose information needs form the topic of this research. For the purposes of this thesis, therefore, information is defined as follows • information is all knowledge, ideas, facts and data which are communicated in any format either formally or informally, and which, for whatever reason, are needful for carers to know. Information has been identified as a key requirement by most of the surveys undertaken of carers since 1988. Most surveys of carers and their needs have noted the absence or deficiency of this critical resource; yet relevant information is prolific, and accessible through a multiplicity of mechanisms and formats. This thesis set out to answer four important questions: • Why, when information appears to be so widely accessible, do carers continue to assert that lack of information remains one of their key problems? • What is the role of workers and other professionals in information provision to carers? • What changes to current information provision and dissemination would remove the obstacles to carers obtaining the information they need? • Is there a role for the public library service in either creating or overseeing the provision of an information strategy for carers? These questions were examined within a Leicester-based study of a group of carers of older people, and carers who were themselves older people, during the period 1994-1996. The study followed a qualitative methodology and used a number of methods. The chief of these entailed the researcher, in her professional role as Community Care Librarian, acting as a critical friend, that is one, who through understanding the context of the presenting situation, is able to offer a helpful critique, a valued judgement and an honest response. This approach elicited a wealth of qualitative data through telephone contact with carers on a regular and frequent basis during a period of fifteen months. The study also included a sample of workers and potential information providers, already having professional responsibilities in the households of the participating carers and who were involved through a series of focused semi-structured interviews. The workers represented a range of health, social services and voluntary sector teams and organisations. The data obtained from this study was particularly rich and subtle, providing unexpected insights into considerably more than information provision, as well as confirmation of certain conjectured findings. For example, the results indicate that the carers in the study were proactive information seekers, rather than passive recipients of information despite having poor formal and informal information networks. As a result, they were almost entirely dependent upon the professional workers as sources of information. Because of restrictive multi-disciplinary and inter-agency working and a lack of systematic and effective information support, workers were unable to fulfill all the carers' expectations in this regard. The study would indicate a crucial role for an agency able to devise an effective information strategy, suitable to meet not only the needs of carers, but also of others similarly disadvantaged in information provision. Such an agency could itself act as an holistic information provider, or else take responsibility for overseeing such a service. In the perception of the study participants the public library service, in theory uniquely placed to fulfill such a role, held a low profile as an information provider. If such an opinion were to be confirmed amongst the general population, it would seem that this role could not automatically be assigned to public libraries. However, the availability of insufficient evidence to either corroborate or refute such an opinion resulted in this particular research question remaining unanswered.

<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>

This thesis is a story of how I came to construct and illuminate a reflexive narrative as a journey of self-inquiry and transformation towards personal realisation. It shares a view of reflection as lived in being and becoming a reflective nurse educator in higher education. My narrative draws upon, autoethnography, critical social theory and hermeneutic perspectives. Johns (2010) six dialogical movements have been used to give structure to my narrative. Nineteen reflections generate the reflexive narrative in a hermeneutic spiral, as each text informs the other along the journey. Insights become clearer through guidance, dialogue, and engagement with the literature. Early reflections show anxiety, emotional distress and entanglement as I tried to solve student problems. Maternalism influenced my approach to being with distressed and struggling students. Gradually these feelings give way to being available, becoming student kind as an enabling relationship with students. Becoming student kind is framed through my adaptation of the Being Available Template (Johns 2013). It is realised through; listening, presence, caring, empathy, compassion and emotional intelligence. Poise, a self-management practice ensures that personal concerns and tensions do not hinder my relationships with students. Mindfulness expressed as spirituality sustains this process. This path to becoming student kind creates a learning space for student growth and development. In so doing, students are enabled to enter into a nurse patient relationship through being available. I express my empowerment through a dialogical voice, transforming my practice with individual students, in the classroom and beyond. Understanding the tensions within the complexity of university culture influencing nurse education, informs collaboration with colleagues towards a shared vision of nurse education. I turn to reflect on a journey of constructing a reflexive narrative. Five stepping stones for dialogue in advancing guided reflection as a foundation for nurse education are offered. My inquiry weaves a story of reflection as testimony to a fusion of practice and theory. I reveal practice wisdom, informing my day to day work in being available becoming student kind in relationships with students. I explore the contribution to knowledge, my practice and future research, considering the strengths and challenges therein.

<p>Nursing is one of the most important professions in the United States but it has historically endured high levels of shortage and turnover (Apker, Propp, & Ford, 2009; Fox & Abrahamson, 2009). A nurse’s organizational climate and culture have been shown to impact a number of job outcomes including intention to leave the organization (Aiken & Patrician, 2000), and therefore is of interest to both scholars and practitioners alike. One way to understand the context in which nurses work is through organizational identification because people make sense of their own identities in part through the organizations to which they belong (Kuhn & Nelson, 2002). However, because individuals have various identities which can reinforce but at times conflict with each other (Scott et al., 1999) and the strength of these identities can dictate outcomes such as performance (Trybou, Gemmel, Pauwels, Henninck, & Clays, 2013), it is necessary to explore how nurses connect to different identities and social collectives (e.g., team, organization, and occupation/profession) within their work. Further, these connections with the multiplicities of identifications may help explain the decisions that guide nurses’ career trajectories as well as how the perceived identity of a nurse guides individuals to choose a career in nursing. This project seeks to understand how nurses talk about their jobs and how communicating with other nurses influences their career trajectory and decision to stay in or leave their organization or the nursing profession altogether. </p><p>This project draws upon both social identity theory and self-categorization theory to help explain how nurses communicate and situate themselves among others in their workplaces. Social identity theory and self-categorization theory are suited for this study’s social constructionist approach and the topic of this research because they explain how the strength and multiplicities of identification within an organization are constructed and shaped by communication with others. Data collection methods for this study consist of in-depth interviews with nurses of specific licensures, posts collected online from a nurse discussion forum, and a questionnaire of nurse forum participants. This study applies a mixed methods approach consisting of qualitative and quantitative analyses. In doing so, this project contributes in several ways including extending our understanding of (1) the connections between the multiplicities of identification; (2) how nurses construct meaning in their jobs to guide career decisions; (3) the nature of nurses’ interactions in online spaces; (4) nurse career decisions; and (5) nurses’ perceptions of the nursing profession before entering the profession.</p>

<div> <div> <div> <div> <div> <p>This study follows a resource-recovery-adaptation approach, where nurses’ personal and external resources, a potential recovery mechanism, and a positive outcome are operationalized from an existing dataset obtained from a multi-state sample of registered nurses in the United States. Data was collected in two Press Ganey surveys, the Employee Survey and the Resilience Survey, in 2018. The surveys were administered in over one thousand healthcare organizations, including acute care hospitals, medical practice groups, outpatient surgery centers, children's hospitals, home health organizations as well as other ancillary services (Press Ganey Associates, 2018). The surveys contained items measuring nurses’ perceptions of their organizations (i.e., community commitment, diversity and inclusion, employee care, compensation, and service and quality), their direct work environments (i.e., leadership, teamwork, staffing level, and job resources), and their work (i.e., job stress, job satisfaction, commitment to the nursing profession, and work-life balance), as well as nurses’ demographic characteristics (i.e., age, sex, race, tenure, shift, and full-time/part-time status).</p></div></div></div> </div> </div>

<p>Seligman (2011) introduced well-being theory as a multidimensional model to increase and measure well-being. The PERMA model of well-being theory defines well-being in terms of five constructs: Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment. Together, these five constructs are the foundation of individual and community well-being. The end goal of well-being theory is flourishing, which is defined as optimal well-being, where one is in the upper range of all five PERMA elements. The purpose of this study was to test whether all five PERMA elements of well-being could be derived from items in the <i>2018 Purdue Student Experience at a Research University</i> (SERU) survey, thus providing support for the multidimensional model in context of undergraduate students at a research-intensive university. Using confirmatory factor analysis, all five PERMA constructs were supported with use of 32 items and demonstrated good model fit statistics. A second order PERMA well-being construct was built and demonstrated adequate model fit with RMSEA = 0.04. In the full PERMA model, all 32 items were significant at <i>p</i> < .05. In the full PERMA model, all five constructs were significant at <i>p</i> < .001. Accomplishment had the highest factor loading (0.76) and Meaning had the lowest factor loading (0.25). Results from this study provide initial support for use of well-being theory in context of undergraduate students.</p>

<p dir="ltr">This study investigates healthcare decision-making dynamics among adults diagnosed with autism spectrum disorder (ASD) without intellectual disability (ID), focusing on the influence of the egocentric norm concept and comparing it to neurotypical (NT) individuals. Employing a quasi-experimental design and meticulously developed vignettes, the research gathers quantitative and qualitative data from Prolific survey responses, exploring nuances in decision processes. The findings reveal substantial disparities in response patterns between individuals with ASD without ID and NT counterparts, emphasizing the significance of the egocentric norm. Factor analysis and structural equation modeling support the validity of the questions and highlight egocentric norms’ impactful role in health-related decisions.</p><p dir="ltr">Qualitatively, themes within both groups illuminate unique decision-making processes, including enduring support from significant others, autonomy trends, and reliance on digital resources. The study contributes nuanced insights for healthcare practitioners, policymakers, and educators, emphasizing the need for tailored interventions that resonate with the distinctive decision-making dynamics of individuals with ASD without ID. While acknowledging limitations related to sample characteristics and reliance on self-reported data, the study provides an in-depth understanding of the interplay between the egocentric norm, Reasoned Action Approach (RAA) concepts, and other influential factors in healthcare decision-making.</p>

The thesis proposes and defends a maxim which can serve as a foundation and guideline for professional ethics in nursing, the maxim that nurses should act so far as possible to promote patient's self-determination. The thesis is informed by philosophical ethics and by knowledge of professional nursing practice.