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This thesis describes a project using a qualitative study approach. It explores the utilization of the pre-registration period as preparation for clinical nurse leadership relevant to work in contemporary health care. The empirical focus of this study was to fundamentally address only the perceptions of senior student nurses about to qualify, of their own leadership development during their programme. Using focus groups with a total of 35 third year pre-registration students about to qualify as nurses provided a rich and detailed description of what inhibited and enhanced the development of their leadership skills. Alongside this, the students' perceptions of qualities and competencies required specifically for contemporary nurse leader roles were identified. No substantive studies exist in the United Kingdom exploring the experiences and perceptions of student nurses regarding nurse leadership during their training. It is distinctive as it challenges the state of nurse leadership in healthcare and the expected developmental needs for it. Students recognised the need to be prepared for leadership during their pre-registration programme and questioned the use of the standard theoretical approach for its development. They asked instead for skills to deal with difficult conversations, unexpected power struggles, challenging and dealing with inappropriate behaviour and introducing evidence into practice in areas of resistance. The study makes an important contribution to education as the findings can inform leadership development throughout the pre-registration nursing programmes within England. It also raises the question as to whether nursing needs more leaders, or just for nurses to take the professional responsibility for their own practice.

Using Casebook Ethnography, nine registered Adult Nurses were observed and interviewed to explore the ways in which they undertook their daily work and the place of reflection in that. The participants were employed in one of two units; a surgical breast care and an acute palliative care unit, both of which were in a large National Health Service trust hospital in central England. Data collection was illuminated by the researcher’s reflective journal. The data collected, rather than simply describing reflective practice, led to wider and more broadly focussed findings which, when analysed, generated one central theme - Communication, Interaction and Discourse and three linked associate themes - Being and Caring, Practical Action, and Knowing. These themes were considered in the light of the key literature around nursing practice and reflection. The findings point to a new understanding of contemporary nursing practice, which illustrates ‘what our kind does’, amongst the groups of participants in order to deliver patient-focussed care. This practice was directed towards working with colleagues who shared the same values and understandings, and who used these shared beliefs to adapt their practice to achieve individualised and exquisite care. As they communicated and interacted with one another, the participants went about their work with attention to empathy and caring, articulated as a common humanity with their patients. They prioritised action where patient need was clear, and used a form of knowledge that was negotiated and validated within a community of practice. As they maintained a dialogue in their teams, the participants developed a sense of their professional identity and of who qualified as ‘our kind’. The implications of this study are that a fuller understanding of how nurses work in contemporary practice will inform the preparation and continuing professional development of nurses and the ways in which effective clinical leadership may be implemented.

The aim of this study was to examine how caregivers manage their day-to-day living and health care needs, care for themselves and their sick children with HIV and AIDS in rural Malawi. The study used a longitudinal descriptive qualitative research design, using the “lens” of a narrative analysis theoretical framework to explore the experiences of caregivers looking after a child living with HIV and AIDS in rural Malawi. In-depth Interviews (IDIs) with women caregivers (n=20) recruited from Mponela Rural Hospital catchment area were conducted and all twenty women caregivers participated in in-depth interviews. Direct Observations (DOs) of the environment where interviews were conducted and at a local rural hospital were used to explore the primary care and support available for these women caregivers and their children. Data were analysed manually using the thematic analysis of the narrative accounts , combined with a detailed narrative analysis of one carers experiences to better understand how women constructed their stories in their own particular cultural context. A summary of the narrative analysis accounts of the rest of the 19 participants has been done to exemplify the main key issues each one of them had told in her story of caring for a child living with HIV and AIDS.

This thesis presents work conducted for a structured doctorate consisting of four main components. The first element is a case study investigating the current practice of mentorship in a clinical setting in Jeddah, Saudi Arabia. The qualitative case study was conducted in a government nursing college and its associated government hospital. Data were collected through individual interviews (2) with nursing coordinators; semi-structured focus groups (8) with mentees (n=3), mentors and clinical educators (n=3), lecturers (n=1) and head nurses (n=1); and finally, documentary analysis. The findings show that neither mentors nor mentees were happy with the current arrangements. Mentees believed that mentorship did not benefit them, and mentors seemed to resent the request to devote time to mentees. Both parties need to approach the other with more empathy, appreciating their difficulties and respecting their individual choices and wishes. Mentors also pointed to a lack of coordination between university and hospital, and both mentors and mentees felt that the mentorship process lacked clarity. Devising and putting into practice a new policy could lead to important positive changes in mentors’ and mentees’ experiences and relationships. The second element of the structured doctorate, undertaken after the case study, is the best evidence literature review. The aim of the review was to examine published studies on mentorship in nursing from the perspectives of both mentors and mentees in order to obtain a holistic view of mentorship experiences. A critical evaluation of these published studies is presented, reviewing the definitions of mentorship in the literature and highlighting the sparse literature on nursing mentorship in Saudi Arabia. Next is a critical overview of the nursing mentorship experiences in Islamic countries. Mentors’ and mentees’ views on mentorship are discussed. The final section summarizes the findings and attempts to use them to answer the literature review questions whilst highlighting the gaps in the literature. The third element is the main study, which emerged from the literature and builds on the case study. It aimed to investigate the factors contributing to positive mentorship experiences in nursing in Jeddah by exploring mentors’ and mentees’ positive experiences. The qualitative study was conducted from the theoretical perspective of appreciative inquiry (AI). Data were collected in semi-structured focus groups (total of six) with mentees (n=3) and mentors (n=3) at three settings. The key contributing factors to positive mentorship experiences and the main themes from data analysis are communication; involvement; encouragement; reciprocity; students’ sense of fear; mentors’ role, including its characteristics, preparation for it and feedback; and organisational-level processes and resources, such as time availability, workload, allocation and college-university collaboration. It is recommended that a consensus definition of mentorship be issued to avoid conflict in roles and expectations, that systems be developed to give mentors time to spend with mentees and that mentors attend a mentorship training programme to gain understanding of the process and be prepared for their role. The fourth element is the dissemination artefact and plan, which communicate the findings to develop education, policy, practice and research. A briefing for stakeholders contains an overview of the study and key findings. An outline of a mentorship training programme and a draft handbook for local use in Saudi Arabia are proposed. The dissemination plan explains how the researcher plans to disseminate the artefact.

Background: It is reported that hospitalised adults require daily oral care to prevent respiratory infections and maintain oral health but patient oral health declines in hospital. Enhancing knowledge and attitudes has not proven effective for changing behaviours or improving oral health. Reports suggest that some nurses find providing oral care unpleasant, therefore, emotions may influence care provision. Aim: To understand how nurses’ and student nurses’ emotional experiences and reactions influence the provision of oral care for hospitalised adult patients. Methods: The initial study explored emotional experiences, reactions and oral care practices. Eight focus groups and ten one-to-one semi-structured interviews with 48 subjects were used to collect data. These were analysed with Grounded Theory. A second study developed and tested methods to measure student nurses’ emotions towards oral care. This used a self-report questionnaire, interviews and Stroop tests. In the final study, 248 student nurses completed a revised self-report questionnaire, a disgust sensitivity questionnaire and two oral care attitude measures; 41 participants additionally completed emotional Stroop tests, implicit association tests and interviews. Qualitative data were analysed with thematic analysis. Χ2 tests, correlations, and Principal Component Analysis were used to analyse quantitative data. Results: Nurses and student nurses experience emotions towards the social, moral and physical aspects of providing oral care; emotions vary with different situations. Unclean mouths are associated with unpleasantness. Failure to provide oral care evokes moral disgust and anxiety. Providing oral care can evoke anxiety and disgust in unpleasant situations, this leads to student nurses reporting altering oral care procedures. Conclusions: Nurses’ and student nurses’ emotions of disgust and anxiety influence oral care. Although these emotions can motivate nurses to provide care, anxiety and disgust can lead to the selection of procedures that avoid aspects of oral care thus reducing the quality of care provided. Nurses’ oral care training programmes need to address these emotions to improve the quality of oral care for patients in hospitals.

The aim of this study was to investigate the effects of the diagnostic label ‘antisocial personality disorder’ on health care staff’s causal attributions of challenging behaviour, their emotional responses to that challenging behaviour, their optimism about treatment and behavioural change and their propensity to help. Of additional interest was how three aspects of burnout might impact on the above variables. This study employed a between subjects questionnaire methodology. There were 62 participants that comprised of healthcare staff working in low and medium secure mental health settings. Participants were given a case vignette describing a challenging behaviour. In one group, the character in the case vignette was described as having a diagnosis of ‘antisocial personality disorder’, in another group he was described as having a diagnosis of ‘schizophrenia’ and in the third group no diagnosis was provided. Participants then rated the causal attributions, emotional responses, optimism and helping behaviour. All ratings were taken on seven point bipolar scales. Finally they completed the Maslach Burnout Inventory (1996). Participants who were given the vignette with the ASPD diagnosis gave higher ratings for causal attributions of control. The no label group responded with the highest ratings of anger. On the sample as a whole, attributions of controllability and internality were correlated. Controllability was correlated with emotional responding and helping behaviour. Optimism was correlated with helping behaviour. Emotional exhaustion was associated with attributions of controllability and internality. Depersonalisation was also associated with attributions of controllability. Diminished personal accomplishment was associated with optimism. The label antisocial personality disorder may influence how staff make causal attributions of control. This may have implications for how staff respond to such patients. Attributions of control were associated with more anger, less sympathy and less helping behaviour. In addition staff that are experiencing high levels of stress may also have been more vulnerable to making attributions of control. This study found that qualified nursing staff were more likely to experience stress. These findings are discussed in relation to current literature and the clinical implications are described particularly in relation to the formulation of interventions for healthcare staff.

The purpose of this thesis is to clarify different aspects of the nursing curriculum from lecturers' and students' points of view in Iran. The evaluation employed a triangulation technique in order to assess the strengths and weaknesses of the nursing programme and to provide explanations for its successes and failures. In addition, it attempts to find whether there was any relationship between the characteristics of the respondents and their evaluation of the curriculum. The thesis begins with an introduction to the research. The general policy of The Ministry of Health in nursing education and also the main problems which the students and the teaching staff are confronted with, and the deficiencies of facilities are clarified as background to the research. After describing the main features of the nursing curriculum, some critical issues in nursing education are reviewed. At first, investigations on the nursing curriculum in general are analysed and then nursing research on a particular course of a component of the nursing curriculum is described. The conceptual framework of the research explores different concepts of curriculum and its evaluation. Methodological issues and the findings of the research are also presented in detail. In order to make inferences about the characteristics of the lecturer and student populations from the characteristics of the samples drawn from these populations, inferential statistics are applied. The most important findings of this study fall into three categories: The different components of the curriculum from viewpoints of the lecturers and students were: - Goal: ambiguous from the respondents' viewpoints; - Content: acceptable from the respondents' viewpoints: - Methodology: controversial. Lecturers were critical of the teaching methods. On the other hand, they were acceptable to the students; - Evaluation: controversial. Assessment approaches of the individuals were acceptable to the lecturers but not acceptable to the students; There was no common viewpoint among the respondents about the nursing components of the curriculum. None of the respondents' characteristics had a statistical significant relationship with their perceptions about evaluation of the nursing curriculum.

This thesis is a comparative and historical study of nursing in Britain and the USA from 1860 to 1970. The framework for the enquiry is drawn from the sociology of occupations and professions and the material is oriented specifically to the suggestion that occupational groups 'professionalise' and that professionalisation is a quest for power. There are four parts. Part one reviews the literature on professions which was available in the early 1970s, noting the strong consensus of what are called 'sceptical theorists' around the theme of professional power. It also examines a more substantive literature on nursing, for its bearing on this theme, and outlines a research design. The design involves the specification of areas of power and of indicators of the amount of power held. It sugges ways in which empirical materials might be, collected, largely from secondary sources. Part two presents data on control gained by nurses in both countries in relation to two areas of entry and training. Reasons are given why the research design needed to be modified to produce a much more exploratory and interpretative account than had been envisaged. Differences in the matrix of institutions surrounding the regulation of nursing and the ways they function in the two settings are covered, still in the context of asking questions about the locus of power. The weaknesses of this style of analysis prompt an approach in part 3 which departs further from the original specifications. Nursing is seen as engaged less in a direct quest for control and more in a struggle for meaning. Three chapters deal in turn with concepts of the nurse and her work, aspects of the formulation and presentation of nursing knowledge and some of the strategies and struggles in which nurses have collectively engaged. A deliberate effort is made to build on and use the crosscultural, comparative opportunities presented by these data. The concluding section assesses the relevance of these analyses for the sociology of occupations and professions, suggesting that although the sceptical theorists of the early 1970s performed an important service in highlighting the normative nature of the concept of profession, they did not suggest altogether satisfactory ways of coming to terms with it. Two appendices are included, one providing additional statistical material for chapters 3 and 4, the other discussing issues of theory and method which arise in an historical and sociological project such as this.

Postoperative pain is still poorly managed among surgical patients despite evidence-based approaches to its treatment being well established. Prompted by the persistence of this problem, many researchers have studied factors influencing postoperative pain management. Empirical clinical research has dominated this area and has presented a set of factors which, albeit important, have not taken into account the influence of contextual factors on the individual’s practices in pain management. This study is designed to examine the role of context on the practices and interactions of professionals and patients during postoperative pain management. Informed by the insights of post-structuralism, it uses nonparticipant observation, informal and semi-structured interviews with participants of both genders (29 staff nurses, 13 surgeons, 38 patients, and 20 patients’ family members), and a document review to construct a case study of four surgical patients’ wards in two Jordanian hospitals. Also included is a descriptive analysis of pain and distress scores, and a thematic analysis of the raw data The findings reveal both a significant problem with pain among Jordanian surgical patients, and limited engagement by nurses in postoperative pain management. It is found that a series of socio-cultural and organizational factors limit participants’ practices in respect of pain management. Influential socio-cultural factors include: sexual surveillance, an inferior public view of nurses, patriarchal ideas, and use of personal influence (wasta). Organisational factors include: hierarchical observations, fear of punishment, the subordination of nursing staff, perceptions of low staffing and high workload, and social hierarchies, such as rank. In combination these contextual factors operate as a set of disciplinary and power mechanisms that limit the ability of nurses to become involved in patients’ pain management; impede nursing professionalism by restricting autonomy and self-regulation; reduce some of the patients’ willingness to communicate pain and lead to a reluctance to be cared for by professionals of a different gender. It is concluded that in this area organisational policies are subservient to nurses’ culturally constructed approaches to pain management. As such, socio-cultural factors appeared to have a greater effect than organizational factors. Recommendations are made to address the situation and provide for appropriate pain relief after surgery.