The study aimed to develop, monitor and explore the process and outcomes of guided reflection and its impact on enabling practitioners to achieve desirable and effective caring practice. A secondary focus of the study was to monitor and explore the process and outcomes of guided reflection as a form of critical action research which may generate theoretical insights regarding its use in clinical supervisory practices. The process referred to as 'guided reflection' was developed and used to guide this study. Guided reflection represents a form of social action research which was framed within an ontology and process of critical and reflexive phenomenology of experience between practitioners and their supervisors over a period of four years. Whilst each guided reflection relationship was written as a critical narrative to illuminate the reflexive development of effective practice, these narratives became a secondary level of analysis to construct meta-narratives of the nature of effective work and dynamics of guided reflection. Various frameworks were developed and tested within a reflexive process that was appropriately informed and juxtaposed with extant theory to adequately interpret and present the process and ou.tc omes of the study. The method and process of guided reflection generated two major empirical and theoretical insights. • 'The 'Being available' framework to know effective caring practice, presented as one major exemplar of 'Pru'. • Meta-reflection of methods and process of guided reflection. Three frameworks in particular are significant: . • 'Being available' as a parallel framework for effective supervision practice. This parallel framework supports the coherence between developmental and research processes. • The Model for Structured Reflection as an heuristic device for knowing reflection. • 'Framing perspectives' as a series of integrated lenses to focus on discrete layers of learning within reflection. The insights gained through the study have considerable significance for informing and guiding the future development of reflective practice within nursing curriculum, clinical supervision within practice, and the future development of nursing knowledge. The development of nursing knowledge is of particular significance in understanding the meaning and nuances of holistic nursing as a lived reality and have significantly contributed to the reflexive development of the Burford NDU Model: Caring in Practice. The study has become a springboard for research to gain further insight into the factors that facilitate or constrain the efficacy of guided reflection in enabling practitioners to know and realise desirable practice within everyday practice.

The purpose of this research was to ascertain how primary nursing care is perceived by both the elderly infirm living in the community and their district nurses. How the perceptions of needs for care were translated into action and the sort of expectations they had and results they achieved. The research also examined whether or not differences in nursing care patterns occurred between those nurses working within a primary health care team and those aligned to a number of single-handed general practices. The main research instrument was in the form of interview schedules. These contained structured and open ended questions as well as Likert assessment scales, and were administered by the researcher to patients, nurses and general practitioners at various stages of care. Over a period of 18 months a total of two-hundred patients and their district nurses and general practitioners from one health district participated. The results were analysed with the help of a computerised statistical package for social science. The findings indicate that district nurses' perception of patient needs is illness focused and, as such, prescribe and give nursing care on the basis of the medical model. The patients' perceive their state of health mainly in terms of discomfort and disability and their effects. As their problems manifest themselves to a great extent in multiple health as well as social issues as a legacy of past life events, a shift from the medical towards the social model of care seems, therefore, of prime importance. There is little doubt that where district nurses become involved with the elderly infirm person she becomes the focal health care professional support. It seems that this emphasis on the district nurse becoming the key member of the primary health care team produces a whole new set of values. This approach has implications not only for post basic nurse training but also demands a change of attitude towards organisational support. As the role of the district nurses as a fully participant health care team member in Attachment schemes has not been established conclusively in this research it is important to consider professional support by strengthening the peer reference group. These findings and their limitations are discussed and areas of further research identified.

Primary nursing is a system of delivering nursing care when one nurse is responsible and accountable for the assessment of the patient's needs as well as the planning, implementing and evaluating of the nursing care throughout the patient's hospitalization. These activities are done in collaboration with the patient and other members of the health team. This system is a relatively recent development in the field of nursing. There has been little research done to either describe or evaluate primary nursing, particularly in the area of psychiatry. This study was an attempt to include both patients and nurses in such an evaluation. A validated and reliable questionnaire was developed by the author to obtain data related to patients' and nurses’ perceptions of the occurrence, importance and satisfaction of specific primary nursing behaviours. The questionnaire was administered to twenty-nine patients and their primary nurses during the last week of the patient's hospitalization. Nurses and patients reported that primary nursing behaviours related to discharge had a low occurrence rate. However, they attributed a high degree of importance to these same behaviours. Both groups reported a low occurrence and importance score for primary nursing behaviours related to family involvement with the primary nurse and the patient's treatment program. Both nurses and patients agreed on the occurrence and importance of most of the primary nursing behaviours. There was less agreement in the area of satisfaction. / Applied Science, Faculty of / Nursing, School of / Graduate