There are currently numerous concerns about the quality of pre-registration nurse training in the United Kingdom, particularly regarding the fifty per cent of that training spent in practice placement settings. If pre-registration nurse training is to be as effective as possible, it is essential to create practice placement learning environments where all student nurses are empowered to be caring, confident, competent and resilient, where students feel able to survive and thrive and, hence, where they can maximise their learning experiences. When undertaking nurse training in the United Kingdom every applicant has to decide which field of nursing they wish to enter – adult, mental health, child, or learning disability – the majority choosing adult nursing. The aim of this study was to gain a deeper understanding of the practice placement learning experiences’ of those students who had chosen the adult nursing field, with a view to improving those experiences. This qualitative study drew on interpretive description, narrative inquiry and used Framework as the basis for the data analysis and interpretation. The findings of this study suggest that in order to ensure that student nurses have the best possible practice placement learning experiences attention needs to be paid to the following areas: • The preparation of individual student nurses for their practice placements. • The selection and preparation of individual mentors for their mentorship role. • The design and development of humanistic and transformative pre-registration nursing and mentorship preparation curricula. • The development of effective practice placement learning environments, including consideration of how both students and mentors are supported and valued in those practice placement settings. This study proposes that if the practice placement learning experiences of student nurses are to be improved, changes are required at the professional and regulatory levels within nursing, at the practice placement-university level of nurse training and at the individual student nurse-mentor level. Such changes, however, must be underpinned by evidence and not based solely on expert opinion, political ideology, or economic expediency, as has so often been the case in the past.

The employment of registered general nurses (RGNs) is underpinned by management’s need for economic utility in that the cost of salaries must be reconciled with the need to meet the demands inherent in service provision. Using grounded theory, interviews captured the experience of physically disabled RGNs, who use the phrase ‘physically disabled’ to describe themselves. Their collective experience was then compared with nondisabled RGNs working in the clinical areas of general medical wards, general surgical wards, and day case units, situated in three district general hospitals. Data collection was by partial participant observation, and interviews. The data revealed that both nurseinterviewee groups share an understanding of the meaning of health and illness. Both the physically disabled and non-disabled RGNs manipulate working time to take unauthorised breaks in order to ‘accommodate tiredness’ and ‘stamina lack’. ‘Accommodating need’ is the identified basic social process (BSP) and ‘pacing’ is the identified core category. RGNs distinguish between using a ‘public’ voice and a ‘private’ voice. In respect of a physically disabled RGN ‘doing nursing’, the data uncovered stigma relating to a spoiled identity. Theoretical sampling interviews with senior nurse managers, occupational health doctors, and trade union officials (termed ‘elite groups’), reflected the data findings of both the physically disabled, and non-disabled RGNs, in identifying the factors limiting the employability of physically disabled RGNs. Moreover, data from the elite group interviews revealed the importance of economic utility, in that management has to take account of diminishing returns. This is the crux of the employment issue. ‘Maintaining organisational pace’ is the generated grounded theory, and was confirmed by aligning data to the established literature on Labour Process Theory (LPT) in a supplementary theoretical sensitivity validation process.

Previous studies have shown that student nurses find the analysis of ethical dilemmas difficult (McAlpine 1996). This may well be due to the nature of such situations, which are frequently complex and prone to ambiguity. This leads to uncertainties as to which course of action is the correct one for those involved. The purpose of this study was firstly to explore the perceptions of a group of student nurses in relation to ethical dilemmas, which arose in practice both before and after exposure to the clinical environment, and secondly to evaluate the usefulness of modules dedicated to ethics, which the students undertook as part of the Project 2000 curriculum. The focus of the evaluative process was the development ot moral responsibility and ethical decision - making skills. 210 students representing two consecutive cohorts on the Project 2000 pathway took part in the study. An evaluative case study design was used to examine the responses of students using two instruments, a questionnaire and an in-depth interview. The results from the questionnaire data indicated that student views had altered significantly after exposure to practice and theoretical input regarding the decisions taken in response to the ethical scenarios presented. Statistical analysis was conducted involving the variables student response and age, and student response and gender, but the results were not statistically significant. Data generated from the interviews were divided into four major themes. The complexity of ethical issues for the health care team; the consequences ethical decision-making could have for society; the development of students' confidence when faced with ethical dilemmas, and finally how their theoretical input had prepared them for their forthcoming role as qualified nurses. The results from the interview data suggest that nurses realised the importance of the decisions that are taken in practice and how these will influence the direction of health care in the future. The results also demonstrated the importance nurses placed on a theoretical basis in ethical decision-making as this provided a framework that could be used throughout a nurse's career allowing him or her to enhance their professional status. The study results indicate that if nurses are to fulfil their role as professionals then the acknowledgement of moral responsibility and development of ethical decision-making skills are essential. In today's health service nurses will be involved with the moral decisions taken by colleagues, patients and their relatives. It is important that nurses cannot only respond to the moral aspects of individual patient situations but also have an in-depth understanding of the ethical frameworks which direct decision -making.

Service user and carer involvement in health and social care education in the UK has gained momentum over the last two decades, largely driven by consumerist and democratic ideologies. This is reinforced by the health and social care regulatory bodies such as the Nursing and Midwifery Council (NMC) and the Health and Care Professions Council (HCPC). This thesis presents a series of eight peer reviewed papers that have focussed on the agency of service user and carer involvement in health and social care education. The accompanying commentary draws the papers together and locates them within an overarching theoretical framework, ‘The Ladder of involvement’. This portfolio of evidence demonstrates a coherent approach that draws on underlying philosophies and theoretical underpinnings and displays contribution to knowledge in five distinct sections: Contribution to the literature with new findings, location of the findings within the current literature, location of the findings within the theoretical framework, contribution to the refinement and development of theory and contribution to dialogue and debate. The key message from the studies undertaken as part of this portfolio of evidence is that service user and care involvement in health and social care education enhances student learning and influences their future practice. However, there must be a well-developed infrastructure within higher education institutions that recognises the complexities of user involvement for the key stakeholders. There is a pressing need for additional research to further substantiate the benefit of user involvement for all parties concerned, in order for user involvement to take its place as a core component of health and social care education.

This research is concerned with patient dignity in nursing. It proposes the introduction of the concept of Perceptual Adjustment Level (PAL) in order to resolve the problem of the definition of patient dignity and its maintenance within nursing care. The aims of the study are to identify how patients and nurses perceive patient dignity, to investigate the extent to which patient dignity is maintained and to identify nursing care activities in maintaining patient dignity. The implications of the findings of this study for nursing education and the development of policy on clinical practice are also examined. The literature review revealed a paucity of research on patient dignity. There was no clear definition of dignity that could be understood by both nurses and patients during their day to day interaction. Little was known of the maintenance of patient dignity and its influencing factors. A qualitative methodology utilising a phenomenological approach was used. A total of 102 patients and 94 nurses from medical and surgical wards in three hospitals within the United Kingdom were interviewed using semi-structured interview techniques. Although neither patients nor nurses specifically defined patient dignity, they came up with similar categories in terms of how they perceived patient dignity: privacy, respect, communication, the need for information, involvement in care, independence, patients' choice, form of address, decency and confidentiality. Control was only mentioned by patients. Although there was congruence between how the patients and nurses described patient dignity, it emerged that nurses tended to operate on different levels from how patients perceived the maintenance of their dignity. While nurses utilised primarily their own perception of dignity to maintain patient dignity, it was discovered that hospitalised patients went through a process of adjustment of their notion of dignity and came to a level they could accept. As a result a new concept termed Perceptual Adjustment Level (PAL) is proposed. Patients felt dignified if events matched with this level. This research has, therefore, proposed a tentative definition of patient dignity as the fulfilment of patients' expectations or needs in terms of values within each patient's perceptual adjustment level taking into account the hospital environment. The need for assessing patients to discover their perceptual adjustment level has been highlighted. A number of patients were satisfied with how their dignity was maintained but a significant number were not. Ways of improving the maintenance of patient dignity have also been proposed. In order to maintain patient dignity, nurses should consider six questions: "what?" signifies the needs of dignity which should be met. "Why?" highlights the importance of full explanations of the purpose of tasks carried out on patients, and whether it matters to the patient. "Who?" relates to who is going to perform the task on her or him? "Where?" considers whether privacy will be ensured when the tasks will be done and "how?" sensitively the tasks will be done? It is also important to make the patient aware "when?" tasks will be carried out. The main factors that influenced the maintenance of patient dignity are revealed and implications for nursing practice, management, education and research are discussed.

No description available.

This thesis explores how patients and practice nurses negotiate and manage decisionmaking involving risks associated with type 2 diabetes. The location of the study was general practice as this reflects the significant shift of diabetes management for people with type 2 diabetes over the last decade. Purpose of the study To improve understanding of what is effective when communicating about risks to people with diabetes and how people with diabetes use information on risk to make decisions about how they manage their diabetes. Overview of study design A qualitative approach, based on case studies involving a patient with diabetes and a practice nurse who was their main diabetes care provider, was undertaken in three local general practices. Grounded theory methodology was used to investigate the perspectives of healthcare professionals and patients managing risk of diabetes complications. Data collection involved audio recording or observing a consultation between a person with diabetes and their practice nurse, followed by individual interviews with each. The follow-up interviews were lightly structured around a topic list, which was adapted to pick up issues identified from the consultation. Subsequent interviews were informed by theoretical sampling consistent with the grounded theory method. Data was analysed through cycles of data collection, coding and constant comparative analysis with the development of categories and the final core category: ‘Responding according to risk perception’. Findings: What this study contributes to understanding risk communication and how risk is managed: • Patients live with uncertainty which impacts on their behaviour and how they manage risk; • Diabetes creates a social risk for patients which has to be managed in their daily lives; • Practice nurses balance the tensions of formal and informal risk management in order to meet professional and organisational requirements as well as the expectations of patients; • Effective risk communication may be enhanced by the quality of the nurse-patient relationship, the use of visual metaphors and anecdotes involving ‘similar’ others.

No description available.

This thesis explores the impact of simulation upon learning for undergraduate nursing students. A brief history of the evolution of pre-registration nurse education and the development of simulation for nursing provide background and context to the study. The conceptual frameworks used for this study draw upon the work of Benner and Sutphen (2007) and Engeström (1994). Benner and Sutphen’s work highlights the complex nature of situated knowledge in practice disciplines such as nursing. They suggest that knowledge must be constantly integrated within the curriculum through pedagogies of interpretation, formation, contextualisation and performance. These pedagogies present a framework, which enhances the understanding of the impact of simulation upon student learning. Engeström’s work on activity theory, recognises the links between learning and the environment of work and highlights the possibilities for learning to inspire change, innovation and the creation of new ideas. His notion of expansive learning offers nurse education a way of reconceptualising the learning that occurs during simulation. Together these frameworks present an opportunity for nurse education to articulate and theorise the learning inherent in simulation activities. Conducted as a small-scale narrative case study, this study tells the unique stories of a small number of undergraduate nursing students, nurse mentors and nurse educators and explores their experiences of learning through simulation. The nurse educators viewed simulation as a means of helping students to learn to be nurses, whilst, the nurse mentors suggested that simulation helped them to determine nursing potential. The students’ narratives revealed that they approached simulation learning in different ways resulting in a range of outcomes: those who were successfully becoming nurses, those who were struggling or working hard to become nurses and those who were not becoming nurses. A theoretical analysis of learning through simulation offers a means of conceptualizing and establishing different perspectives for understanding the learning described by the participants and offers new possibilities towards an expansive approach to learning nursing. The study concludes by examining what this interpretation of learning might mean for nurse education, nursing research and nursing practice.

Reflective journal writing has frequently been used in nursing and other health care fields as an educational strategy to promote reflection and learning. Although reflective journal writing is recognised as a valuable tool to promote students' learning, very little research has been undertaken to evaluate its use. The overall aim of this study is to examine the use of reflective journals in the promotion of reflection and learning in post-registration nursing students. In order to achieve that aim a qualitative descriptive case study design was utilised to examine four objectives. The first was to analyse reflective journals completed by students during a period of learning in order to determine the extent and level of reflection achieved. The second, to examine the use of reflective journals as an educational strategy for facilitating learning in the practice setting. Thirdly, there was the intention to examine the nature and content of guidelines given to students with regard to the use of a reflective journal, and fourthly, to examine the support given to students by preceptors in relation to completing a reflective journal during their practice experience. A purposive homogenous sample of eighty one part-time post-registration nursing students undertaking one of four modules, either as part of the Diploma in Professional Studies in Palliative Care Nursing or the Diploma in Breast Care Nursing during one semester constituted the total sample. Forty- two students agreed to participate in the research. Data were collected from reflective journals completed during one module and by interviews with fifteen students, two teachers and three preceptors. Forty-two journals were analysed to determine the extent and level of reflection using a model devised by Boud et al. [1985] and adapted by Wong et al. [1995]. A model devised by Mezirow [1990] was used to identify the non-reflectors, reflectors, and critical reflectors. The findings suggest that student writing can be used as evidence for the presence or absence of reflective thinking. Allocating students to the three categories of non-reflector, reflector and critical reflector was possible. However, identifying textual elements within the journals and allocating them to the finer levels of reflection was more difficult and less reliable. Evidence suggests overall that journals are a useful tool for promoting reflection and learning. However, some students appear to benefit more from journals than others. Approximately two thirds of the respondents were able to demonstrate varying levels of reflection and were classified as either reflectors or critical reflectors. The remaining one third of the respondents were unable to demonstrate any levels of reflection. Overall respondents expressed positive views, regarding the use of reflective journals. However, a small number found writing challenging and some questioned their use. Some respondents preferred to talk about their reflections rather than write them in a journal. The importance of receiving clear guidance on the purpose of journal writing from teachers, and the need for non-judgemental feedback were highlighted as important factors in promoting the effective use of journals. Some concern was expressed regarding the disclosure of confidential information, and also who would have access to journals when used for assessment purposes. The issue of the time required for reflection and writing a journal was a major concern for some respondents. Students valued the role of preceptors in supporting their journal writing during the practice experience. Preceptors considered that the preparation they received for their role was adequate. However, they did request debriefing sessions following their support of students who had experienced difficult situations. This study has presented further evidence that overall, reflective journals may be used as a tool to promote reflection and learning in post-registration nursing students.