This study investigates all graduate entry to nursing in England, focusing on the perceptions and experiences of nursing students and health professional educators at one English university. It presents a history of nurse education, debates the cases for and against the move to an all graduate entry, and introduces a conceptual framework based on the influences on, and expected outcomes of, the undergraduate nursing student. The study adopts a single-embedded case study design. Data was collected between October 2012 and September 2014 using questionnaires and focus groups. Statistical analysis and thematic analysis (using the framework devised by Braun and Clarke, 2006) were undertaken on the quantitative and qualitative data respectively. The undergraduate student nurses reflected a positive attitude towards nursing, seeing a therapeutic relationship and the values underpinning ‘compassion in practice’ as fundamental to the role of Registered Nurse (RN). They also demonstrated motivations that reflected these principles and, to some extent, recognised them in themselves. The importance of developing and demonstrating graduate attributes was acknowledged, but these were not seen to be as significant as the fundamental principles of what it means to be a nurse. The majority of health professional educators supported the move to an all graduate entry to nursing, with nurse educators being more in favour that their Allied Health Professional colleagues. There was also clear recognition that the role of the RN had changed and that RNs needed graduate attributes in order to manage the complexities of twenty-first century healthcare. Participants in this study saw the move to all graduate entry as welcome and necessary, although this view was not universal. Reasons students gave for pursuing a career in nursing reflected those identified in earlier studies. The students’ experiences in clinical practice were affected by the standards of care they observed, the quality of mentorship and by issues related to ‘belongingness’. The study highlights and contributes to the on-going debate surrounding the development of nursing as a profession, confirming that the ideals of altruism have not been lost in the development of academic processes and identity.

This qualitative study explores spiritual issues in relation to coping with loss in situations of chronic and terminal illness. An Heideggerian hermeneutic phenomenological approach was chosen as the most appropriate methodology for exploring nurses’ lived experience of utilising spirituality as a means of helping patients cope with loss. My prior knowledge both brought me to the subject of study and influenced my interpretation of data. To ensure transparency of method this prior knowledge is outlined in my fore-structure of understanding. A purposive sample of 12 registered nurses, 5 from hospice, 4 from community practice and 3 from a nursing home setting participated in semi-structured interviews. A stepped process of analysis of interview texts produced overarching themes which are illustrated with excerpts that collectively produce a ‘thick enough description’ intended to facilitate understanding of my interpretation of data by those who chose to read this study. Findings were illuminated by drawing on existing theoretical knowledge and concepts. My research diary and notes at interview constituted a research journal that recorded how my knowledge and understanding developed through my reflection on, and reflexive response to interview data. In this way my research journal was used to illuminate the research process. There are an increasing number of studies that consider spirituality in healthcare and how patients’ spiritual needs can be recognised and fulfilled. However, this study provides a different perspective, in particular, examples of how nurses’ development as persons may render them not only a spiritual resource in themselves, but also, contribute to how they become proficient in spiritual care in situations of loss. There were four overriding ways in which the development of this aptitude was evident. Firstly, belief provided them with a means of coming to an understanding of why things happen and so helped them accommodate repeated exposure to patients’ grief. Secondly, being a spiritual carer involved establishing a relationship with patients through ‘connected’ communication. Thirdly, becoming proficient in spiritual care was reflected by an increasing maturity in engaging with patients’ real life and death issues, which was sustained by taking ‘time out’ to reconnect with the self. Finally, belonging to a team whose culture reflected a spirit of reciprocal support was crucial when patient care was emotionally demanding.

The purpose of this study is to explore how students' nurse identity has developed over the years and the particular role that disciplinary power has had in shaping it. The research focus was the School of Nursing in Jersey from 1924-2015. The study site included the wider social space where nurse education occurred at the School of Nursing; that is the classroom, the practice area and the nurses' home. The study attempts to fill a gap in local nursing history by creating a unique record while also considering the wider social influences on how students develop a nurse identity. The primary data comprises interviews with fifteen (n=15) participants who provide an historical account of their experiences as students. Interview transcripts and diary narratives with a further four (n=4) former nursing students from the earlier period are also included. These are supplemented with documentary archive material in the form of hospital student nurse records, newspaper archives, Societe Jersiaise archives, personal correspondence and photographs. Foucault's (1979) concept of panopticism was used to explore how the functioning of disciplinary power promoted the notion of docility and shaped the developing nurse identity of students. The Foucauldian framework provided a sociological analysis of disciplinary power and how the unconscious conditioning of students created the "docile body". The main themes identified relate to freedom (or not) of choice in choosing a career, shifting modes of control, control through the use of time, knowing your place, sister's "gaze" as a panoptical figure, living and working by the rules, fear of punishment, the gendered nature of nursing as an occupation, medical dominance, and the support from fellow students. The technologies of surveillance, normalising judgement and examination were employed to understand how, as student nurses, the participants internalised the values, beliefs and behaviours experienced in the School of Nursing. Tracing these technologies of discipline from the beginnings of the School of Nursing to its present day amounts to what in Foucauldian terms is a history of the objectification of the present. Findings indicate that discipline was a means of constructing experience and served to shape the identity of the participants as student nurses. It was easier to recognise Foucault's (1979, 1995) concept of panopticism in the traditional nurses' accounts; how this applied to the contemporary setting was less obvious but nonetheless apparent. While there has been more discreet monitoring of students in recent years, the methods of surveillance remain rooted in Foucault's (1979, 1995) representation of panopticism and the construction of the "docile body". Control was exerted over their lives in the classroom and on the wards. As students the participants began to regulate their own behaviour and discipline themselves. The historical perceptions of what it means to be a "good nurse" impacted on their developing identity across the years. The unconscious conditioning of the students served to create the "docile body" of the student nurse and this impacted on the development of an identity. Having identified the importance of the influence of disciplinary power, further research exploring this among student nurses in the contemporary university setting could make a positive contribution to understanding how this moulds a nurse identity.

Background: Choice has become the defining characteristic of service users’ relationship with the National Health Service (NHS) in the UK. Decades of market-orientated policy have encouraged greater customer focus, and the NHS is now subject to the same consumer drivers that can be identified elsewhere in society. Aim: The aim of this study is to understand whether the introduction to the NHS of market reforms designed to encourage and improve choice and experience have influenced the way in which service users access care and interact with service providers when receiving it. Method: This study utilises an ethnographic approach to data collection combined with the structure, theoretical under-pinning and replication logic afforded by comparative case study. Both approaches allow for the inclusion of qualitative and quantitative data and use multiple data collection instruments in a triangulating fashion. Two minor injury units (MIUs) were selected as research sites/cases since they serve a large community with multiple and diverse needs and provide a crucial stepping-stone between primary and secondary care services. Results: Although very few service users at either case identified themselves as ‘customers’ or ‘consumers’ of healthcare per se, there was general consensus that high standards of customer service were both important and desirable in a healthcare context. Similarly, regardless of whether service providers believed that service users should be viewed as ‘customers’ or ‘consumers’ of healthcare, they consistently demonstrated modes of behaviour that treated them as such. Conclusions: Through careful analysis of the data, it is possible to identify five different healthcare consumer typologies: passive, reluctant, assertive, pragmatic and knowledgeable. The broad range of views and positions demonstrated by these typologies in relation to healthcare consumption seem to be the result of social values and practises that have developed in response to consumer culture and society as well as previous experience of healthcare services.

The current position of the World Health Organisation (WHO, 2014) is that there is a threat of a global “obesity epidemic” (Boero, 2007, p.1); and existing studies in the UK report that a 5th of pregnant women are overweight. This has created increased scrutiny of fatness and weight, especially in pregnant women. The concern about obesity and pregnancy outcomes also contributes to the National Institute for Health Care Excellence (NICE, 2010), recommending that the antenatal care delivered to overweight pregnant women should be within the guidelines of a high-risk pathway of antenatal care. This has increased the medicalisation of the care for overweight pregnant women. The aim of this study is to explore the experiences of overweight pregnant women in relation to their heightened medicalised antenatal care. Using a social constructionist approach and a Foucauldian interpretive lens, semi-structured face-to-face interviews were used to collect data from 12 women who were between 16 and 30 weeks pregnant, 6 midwives who provide antenatal care for them, and 3 obstetricians to whom women are referred. The data were analysed using thematic analysis. The findings show that pregnant women do not identify with being ‘obese’ and perceive themselves as being overweight but healthy. Key themes that emerged from the data describing women’s perception of heightened antenatal care are: their understanding of risk and risk perception, the power of science and how it constructs their maternal health and the power of obstetricians justifying medical interventions in pregnancy and childbirth. This study creates and contributes to the awareness of how overweight pregnant women who are healthy experience antenatal care. It explores the need of overweight pregnant women, and identifies changes that need to be made to positively enhance how these women experience pregnancy and childbirth. These findings need to be considered by policy makers, individuals in practice and those with a role in educating health care practitioners so that overweight pregnant women are provided the appropriate antenatal care.

Submitted by KARLA ALVARENGA NASCIMENTO null (karlanascimentovet@yahoo.com.br) on 2017-03-21T13:16:57Z No. of bitstreams: 1 Dissertação Karla.pdf: 1655729 bytes, checksum: 6cdf4bfec3aad9e315d583cdf42d5d1a (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2017-03-21T21:32:38Z (GMT) No. of bitstreams: 1 nascimento_ka_me_jabo.pdf: 1655729 bytes, checksum: 6cdf4bfec3aad9e315d583cdf42d5d1a (MD5) / Made available in DSpace on 2017-03-21T21:32:38Z (GMT). No. of bitstreams: 1 nascimento_ka_me_jabo.pdf: 1655729 bytes, checksum: 6cdf4bfec3aad9e315d583cdf42d5d1a (MD5) Previous issue date: 2017-02-09 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Os pestivírus possuem importância significativa na suinocultura, sendo que os suínos podem ser infectados pelo Vírus da Diarreia Viral Bovina (BVDV) em condições naturais. O presente estudo teve como objetivo induzir a infecção experimental do BVDV-1 em leitões desmamados e avaliar a excreção e possível transmissão do vírus pelas vias lâmina d’água e naso-nasal. Foram conduzidos dois experimentos e uma repetição para cada via de transmissão avaliada. No total foram selecionados 24 leitões, sendo utilizados seis por experimento, divididos em grupos controle (n=2), sentinela (n=2) e infectado (n=2), utilizando isoladores, projetados para estabelecer o contato entre os animais apenas pela via de transmissão em estudo. O grupo infectado recebeu um inóculo contendo BVDV-1, estirpe Singer, enquanto que os grupos controle e sentinela foram inoculados com meio E-MEM. Os animais permaneceram nos isoladores por 25 dias, período em que foram coletadas amostras de suabe nasal diariamente e sangue a cada sete dias. Ao final, os animais foram eutanasiados e necropsiados, sendo realizada coleta de fragmentos de órgãos para histopatologia, imunohistoquímica e RT-PCR. Quando avaliada a via de transmissão lâmina d’água, apenas um animal infectado apresentou excreção de material genômico a partir do 6o dia pós-infecção (dpi), e um animal sentinela apresentou excreção no 20o dpi. Nestes animais, a soroconversão ocorreu no 25o dia apresentando título de anticorpos igual a 20. Um animal infectado não apresentou soroconversão durante o período amostrado, porém houve excreção a partir do 5o dpi. Na repetição do experimento, apenas um animal infectado soroconverteu ao 25o dia, com título de anticorpos de 20, cuja excreção do material genômico foi detectada ao 21o dpi. Nos animais sentinelas, apenas um apresentou excreção no 13o dpi. Em relação ao experimento naso-nasal, os animais infectados apresentaram excreção de material genético a partir do 17o dpi, porém a soroconversão não foi observada em todos os animais. Na repetição do experimento naso-nasal a soroconversão foi detectada em apenas um dos leitões infectados no último dia de experimento, com título de anticorpos de 20. A excreção do material genômico ocorreu nos dois animais infectados, sendo que um animal apresentou excreção a partir do dia 10 e o outro a partir do 18o dpi. Em relação à macroscopia e microscopia, os animais de todos os experimentos não apresentaram lesões significativas. O presente estudo demonstra que os suínos são susceptíveis ao BVDV, possibilitando a excreção e servir como fonte de infecção. Evidenciou-se que a lâmina d’agua pode veicular o BVDV de um suíno infectado para outro, ressaltando a importância e o risco de transmissão. A possibilidade de transmissão do BVDV pela via naso-nasal em leitões não foi provada dentro do período avaliado. / Pestiviruses have significant importance in swine breeding, and pigs can be infected by Bovine Viral Diarrhea Virus (BVDV) under natural conditions. The present study aimed to induce the experimental infection of BVDV-1 in weaned piglets and to evaluate the excretion and possible transmission of the virus through the water and naso-nasal routes. Two experiments and one replicate were conducted for each evaluated route of transmission. In total, 24 piglets were selected, and six were used per experiment, divided into control (n = 2), sentinel (n = 2) and infected (n = 2) groups using isolators, designed to establish contact between animals only by Route of study. The infected group received an inoculum containing BVDV-1, Singer strain, while the control and sentinel groups were inoculated with E-MEM medium. The animals remained in the isolators for 25 days, during which samples of nasal swab and blood were collected every seven days. At the end, the animals were euthanized and necropsied, and organ fragments were collected for histopathology, immunohistochemistry and RT-PCR. When the water-borne transmission pathway was evaluated, only one infected animal showed excretion of genomic material from day 6 post-infection (dpi), and one sentinel animal showed excretion at the 20th dpi. In these animals, seroconversion occurred on day 25 with an antibody titer equal to 20. An infected animal did not present seroconversion during the sampled period, but there was excretion from the 5th dpi. In the repeat of the experiment, only one infected animal was seroconverted at day 25, with antibody titer of 20, whose excretion of the genomic material was detected at 21o dpi. In sentinel animals, only one had excretion at the 13th dpi. In relation to the naso-nasal experiment, the infected animals presented excretion of genetic material from the 17th dpi, but seroconversion was not observed in all the animals. In the repetition of the nasonasal experiment, seroconversion was detected in only one of the infected piglets on the last day of the experiment, with an antibody titre of 20. Excretion of the genomic material occurred in the two infected animals, and one animal had excretion from the Day 10 and the other from the 18th dpi. Regarding macroscopy and microscopy, the animals of all experiments did not present significant lesions. The present study demonstrates that pigs are susceptible to BVDV, allowing excretion and serve as a source of infection. It has been shown that the water table can transport BVDV from one infected pig to another, emphasizing the importance and risk of transmission. The possibility of BVDV transmission by the nasal nasal route in piglets has not been proven within the evaluated period. / FAPESP: 2014/13590-3 / FAPESP: 2015/07098-1

Aim of the thesis: To report on a study to describe and explain the contribution of registered nurses’ and care assistants’ to hospitalised patients’ mobility rehabilitation. Background: Studies internationally have shown that older adults often experience a decrease in their ability to mobilise during and after hospitalisation. Rehabilitation nursing interventions could be important in maximising the functional abilities of this population. Methods: A grounded theory approach structured data collection and analysis. Data were derived from three hospital settings (general rehabilitation, spinal injuries and stroke rehabilitation) and included 39 staff interviews and 61 hours of observation. Findings: Mobility rehabilitation is an ‘embedded activity’ and is achieved indirectly when nurses and care assistants transfer patients safely from one place to another. These events are described as ‘A to B transfers’. Practitioners perceive distinct differences in the process and purpose of ‘A to B’ transfers in comparison to ‘therapeutic handling’ activities undertaken by physiotherapists and occupational therapists. The core category for the grounded theory (Care to keep safe: Safe to care) is used to explain the findings. Conclusion: Theoretically, the nursing team could implement more structured intentional strategies’ to promote patients’ mobility rehabilitation. However, teamworking arrangements and work environments do not facilitate this.

The study evaluated the survival of 364 glioblastoma multiforme (GBM) patients who received different modalities of treatment in two Canadian tertiary care centres. Retrospective and prospective databases were utilized to do a retrospective population based cohort study. The thesis question was among treated GBM patients in Edmonton and Halifax; does the survival rate differ with introduction of concomitant temozolomide and radiation therapy (RT) versus non concomitant treatment? Our results indicate that concomitant temozolomide with radiation therapy and surgery was associated with longer survival in comparison to radiation therapy with surgery. We also found that age; surgical resection and shorter time to radiation therapy are important factors for longer survival. / Clinical epidemiology

MicroRNAs (miRNAs) play a vital role in differentiation, proliferation and tumorigenesis by binding to messenger RNAs (mRNA) and inhibiting translation. To initiate an investigation into the identification of miRNAs in the domestic dog, an emerging model for human disease, a comparison of the human and canine genetic databases was conducted. The bioinformatics work revealed significant conservation of miRNA genes between the two species. Proof of principle experiments, including serial dilutions and sequencing, were performed to verify that primers made to amplify human mature miRNAs can be used to amplify canine miRNAs, providing that the mature sequences are conserved. TaqMan® Real-time RT-PCR, a sensitive and specific method, was used to isolate the first miRNA mature products from canine tissues. The expression levels of miR-17-3p, miR-17-5p, miR-18, miR-19a, miR-19b, miR-20, and miR-92 were evaluated in five canine tissues (heart, lung, brain, kidney, and liver). Because miRNAs have been found to act as both tumor suppressors and oncogenes in several different cancers, expression patterns of ten miRNAs (miR-15a, miR-16, miR-17-5p, miR-21, miR-29b, miR-125b, miR-145, miR-155, miR-181b, let-7f) known to be associated with human breast cancer were compared between malignant canine mammary tumors (n=6) and normal canine mammary tissue (n=10). Resulting data revealed miR-29b and miR-21 to have a statistically significant (p<0.05) up-regulation in cancerous samples. Overall expression patterns showed nine of the ten miRNAs follow the same pattern of expression in the domestic dog as the human, while the miR-145 expression does not show a difference between the normal and cancerous samples.

The North American elk or wapiti is an indigenous species to Canada. Understanding of the reproductive physiology of elk is limited, as little research has been conducted in this field as compared to domestic farmed species. In order to make available the tools to study reproductive physiology of the elk this thesis describes the cloning and expression of elk pituitary glycoprotein hormone cDNAs. The common gonadotropin a-subunit, and FSH, LH and TSH b-subunit elk cDNAs were amplified by reverse transcription and polymerase chain reaction (RT-PCR). There was a high degree of nucleotide similarity between the elk a and b subunits when compared with reported sequences from other species. The cDNAs for the pituitary glycoprotein hormone genes were used as probes to investigate seasonal expression in the female elk pituitary gland. Steady state levels of the common a-subunit mRNA was observed regardless of the reproductive season, but a significant increase in expression occurred during the breeding season. The FSH and LH b-subunit genes were expressed at low levels in pituitary glands of animals during presumed anestrous and pregnancy, but levels considerably increased during estrus. In contrast, levels of TSH b-subunit mRNA were similar regardless of the reproductive status. The FSH cDNAs were also transfected into a Chinese hamster ovary (CHO) mammalian expression system, aimed at the production of recombinant elk FSH. Transfected CHO cell lines were screened for expression of a- and FSH b-subunit mRNA by Northern blot. Activity of FSH was equivalent to ~100 mIU/ml of recombinant human FSH (Gonal-FTM), identified by FSH receptor signaling in an in vitro cell based assay. In conclusion, this work represents an advance towards understanding the molecular basis of seasonal reproduction in elk. This information and the availability of elk recombinant FSH will be useful for the application of advanced reproductive technologies required for the rapid expansion of healthy, disease resistant, and genetically superior animals, which are important for domestic production and wildlife management.