The aims of this study were to explore the preconceptions of pre-registration undergraduate and Diploma of Higher Education in Nursing (Dip.H.E.) (Adult) students have in relation to their programme and the nursing profession, and students' perceptions as their programmes progress. In addition the study aimed to explore how pre-registration undergraduate and Dip.H.E. (Adult) students perceive their preparation for the qualified role, and compare pre-registration undergraduate and diploma nursing students' actual performance in the clinical area near to qualification. The study used grounded theory methodology (Glaser and Strauss 1967). Undergraduate (n=20) and Dip.H.E. (n=22) nursing (Adult) students from two institutions in Scotland were used. Findings from the focus groups indicated that both groups were apprehensive about their first clinical placement, especially in relation to their own self-confidence and the uncertainty about their role within those placements. All students wanted to have the qualities of a 'good nurse' and expected to learn these qualities from clinical staff. Diploma level education was perceived as giving students better practical skills, while degree level education was perceived as giving students better theoretical skills. At the mid-point of the programmes, diploma participants were more confident in their practical ability, while undergraduate participants were more confident in their theoretical ability. The clinical learning environment had a major effect, both positive and negative, on both sets of students' practical abilities. Students had experienced good and bad mentors, which had affected the integration of theory and practice, had 'shaped' their learning experience, and had resulted in different degrees of supervision and feedback. Overall, both groups of participants expressed their anxiety about their lack of practical skills, and their opportunities to link theory to practice.

An innovative and complex action research study was carried out in a teaching hospital ward in order to implement the nursing process and to contribute to theory regarding the factors that facilitate or hinder this implementation. The findings from the baseline phase showed a very poor implementation of the nursing process on the ward. Nevertheless, the culture of the organisation was favourable towards the nursing process implementation. The five months implementation of change phase was led by a steering group composed of two nursing managers, two staff nurses and the researcher. They decided on the interventions needed which consisted in the clarification of nursing competencies and the nursing philosophy of the ward; the design and implementation of nursing documentation, and an education course on the nursing process. A formative evaluation took place immediately after phase 2 and identified improvements in the use of the nursing process on the ward. The findings from the study showed that action research was a useful and appropriate approach for implementing the nursing process. The flexible and context-based nature of this approach, the fact of providing a facilitator of change and finally the participative nature influenced positively the implementation of the nursing process. Among the factors that facilitated the implementation were the education programme on the nursing process with special attention to increasing knowledge, changing attitudes and developing skills; and to introduce nursing documentation facilitating the development of nurses skills, specially communication and problem-solving. Among the barriers found was the use of a medical model of care; nurses lack of preparation to lead their own changes and the lack of co-ordination with doctors and auxiliaries as well as excessive dedication to bureaucratic maters. Important recommendations have been made for nursing practice, education and research.

This research is a detailed study of the phenomenon of teenage parenthood at the beginning of the twenty first century. The study draws on a contextualised analysis of the lives and experiences of eight teenage mother and father couples as they make the transition to parenthood. The aim of the research is to analyse the experience of teenage motherhood and fatherhood in Britain today and to understand young, contemporary, mothering and fathering ‘practices’. The study is based on qualitative research methods and has adopted a longitudinal approach to the collection of data. The research strategy used is the case study. Data collection proceeded over a period of nineteen months. Sixteen young mothers and fathers were interviewed up to four times over this period. This study found that young people attach great value to family life and family relationships and that they have high ideals and aspirations for the future of their own ‘new’ families. It is this belief in the idea of family that guides a young pregnant woman’s decision about continuing with her unplanned pregnancy, and the young man’s commitment to support his pregnant partner and unborn baby. This thesis also found that for the young mothers in this study, motherhood represents a positive choice. Pregnancy occurs at a time of vulnerability, yet these young women chose to continue their unplanned pregnancies and become mothers. The uniqueness of young motherhood is the multiple transitions that young women have to undergo simultaneously. Nonetheless, with the right support young mothers do mother successfully. The study reveals that the young fathers had a strong desire to support their partners and be ‘good’ fathers to their children. Fatherhood is meaningful and important as an ideal, and represents a marker of responsibility and a transition to adulthood. Young fatherhood is challenging, yet it is also a generative experience. It is the young men’s strengths and resourcefulness, generated in response to their difficult situations that stand out in the findings in this study. The study found that young people are doing and living family in a variety of ways. Some are living with their families and caring for their children in this context. Others were embarking on independent lives. Yet the striking feature of the ways in which they ‘lived’ family was the extent of the family support networks which they sought out, depended upon, and valued highly.

This study investigated two cases in Scotland and Japan regarding government nursing workforce policies related to recently qualified nurses (RQNs) and the responses of clinical practice to these policies. Comparisons of findings and results between Scotland and Japan were made. Mixed methods were used including questionnaires (adapted POWCS and PES-NWI) and semi-structured interviews. In Scotland, five NHS managers, seven ward managers, and nine RQNs participated for the semi-structured interviews. A total of 119 Scottish RNs participated for the questionnaires. In Japan, seven nurse managers, six ward managers, and six RQNs participated for the semi-structured interviews. A total of 83 Japanese RNs responded to the questionnaires. In Scotland, three government initiatives related to RQNs for the last 5 years were identified; ‘One Year Job Guarantee’, ‘Flying Start’(FS), and ‘Early Clinical Career Fellowships’(ECCFs). Several responses in clinical practice to these initiatives were identified from the interviews and questionnaires. Firstly, FS and ECCFs were understood as ‘good support’ by managers and RQNs. However, RQNs did not find FS helpful for supporting their transition process. Lack of engagement and poor understanding among RNs was found to be an issue as well as a lack of evaluation and tracking system for FS and ECCFs on completion of the programmes In Japan, two major legislative changes related to RQNs for the last 5 years were identified; change in the Medical Care Fee Schedule for Remuneration and change in ‘Public Health Nurses, Midwives, and Nurses Act’ and ‘Nurse Provision Act’. An Increased number of RNs in the study hospitals was reported as an outcome for the Medical Care Fee Schedule for Remuneration. The increased annual inflow of RQNs caused issues such as increased workload for experienced nurses as well as a lack of the ability of experienced nurses as clinical educators for RQNs. Lack of funding and resources were found to be key issues for maintaining nurse staffing levels as well as the lack of a monitoring system for Japanese nursing workforce such as registration system. Findings from this study suggested several factors for better policy development and implementation related to RQNs in Scotland and Japan; 1) there is a need to establish an evaluation or monitoring system for government initiatives in both countries, 2) the importance of developing and implementing nursing workforce policies without large fluctuations in nursing workforce was highlighted, 3) the Japanese government needs to develop more integrated nursing workforce policies, 4) the importance of having engagement from RNs with policies related to clinical practice was reported, 5) finally, this study suggests that Scottish and Japanese governments need to keep the attempts to sustain the changes by previous policies. The findings added to the current knowledge by providing the insight of each country related to recently qualified nursing workforce policy from two single case studies.

This is a study of all ranks of nurses working on a cancer ward in a London teaching hospital. Other than the sisters, who had specialist oncology training, the nurses were not self-selected, but simply were assigned to this particular ward. Nursing, as a job, is stressful (Menzies 1959). Nursing cancer patients is believed to be particularly stressful; nurses on cancer wards have been shown to manifest extreme signs of stress which affect their perceptions of their work and the quality of care patients receive as well as their own health. Using a symbolic interactionist approach, the purpose of this study was to explore the issues of stress and support from the perspective of nurses themselves. An important aspect of the study was the use of repeated interviews which revealed changes in nurses' experiences and ward practices over time. Nurses did not identify illness category as a cause of stress nor did they view additional psycho-social support as necessary. Their accounts of how they experienced nursing cancer patients provides insights into their ideology of nursing. They spoke repeatedly of this being a "good ward" where they could practice "good nursing." This thesis explores how these nurses made sense of their work and felt enabled to nurse cancer patients without experiencing emotional distress. A theoretical explanation is proposed in terms of the interaction between the context of nurses' work (including the way in which it is structured and managed) and their ideology which was based on the concept of caring.

The increase in the number of children living with complex, long term nursing needs has led to an expansion of services. The growth in community children’s nursing has been influenced by local politics and the needs of individual children, rather than by research investigating children’s perspectives (Whiting 2005). At the same time, policy and professional agendas have included a willingness to listen to children as service users (Department of Health 2001a, Coad and Shaw 2008). The aim of this study was to address the lack of an evidence base for community children’s nursing by exploring children’s experiences of receiving nursing care in community settings. A mosaic of qualitative methodologies, within the philosophical framework of Clark’s (2004) Mosaic approach, was used to investigate the experience of children, aged 5-12. The study engaged a core group of seven children in participatory activities spread over one year. A larger, non-core group of fourteen children was also observed receiving nursing care. The children’s perspectives were placed in context using data from observation of six nurses’ working days, and individual and group interviews with community children’s nurses. Four themes emerged. Firstly, the dominant theme for children was how they portrayed themselves as children, like other children. Secondly, findings show, for the first time, that children have negative as well as positive regard for nurses. Children’s regard for nurses seemed to be influenced by children’s understanding of their illness and their involvement in receiving care. Thirdly, children and nurses focused on highly visible clinical interventions, not on the work of nurses which helped children to access social or educational opportunities. Finally, some of the children wanted to receive care from a nurse of the same sex as themselves. These findings have significant implications for quality measurement, the management of relationships between children and nurses, and the organisation of children’s nursing.

This study aimed to explore the influences of Supervisors of Midwives in the context of Lifelong Learning (continuing professional development) (CPO) of practising midwives. This study was designed using a mixed method approach incorporating both qualitative and quantitative approaches to data collection to enable validation of results and to gain a variety of information to illuminate the experiences of participants in this area of study. Questionnaires and focus groups were utilised in order to obtain the data. The participants in this study comprised: • the total population of midwives and Supervisors of Midwives in three NHS Trusts • the total population of LSA Midwifery Officers in England • the total population of Lead Midwives for Education in England. This study has provided a variety of evidence specifically on the developmental role of the Supervisor of Midwives which has not been explored previously. There is an increasing emphasis on informal learning to meet CPO and these need to be given a higher priority for achievement within the work environment and supervisory framework. Collaboration between supervisors, managers and educationalists requires review to ensure midwives are afforded the opportunities to meet their needs. The process of education contracting between NHS service providers and education providers is not understood by supervisors unless they hold the dual role of manager and this needs addressing if midwives are to have equal opportunity In accessing resources. The dual role of manager and supervisor also needs further research as an emergence of the 'policing' role has been raised by some midwives in this study. Conclusions - Supervisors of Midwives are in a unique position to influence midwives CPO but the lack of a coherent approach with managers and educationalists prevents this being effective. Supervisors of Midwives need to have more influence in enabling midwives to access the available resources to achieve their CPO needs. Informal learning opportunities need to be valued and developed to facilitate midwives lifelong learning to improve practice and good outcomes for women and their families.

In this study, the professionalisation of nursing in Switzerland is being investigated with the help of the theoretical approaches of the sociology of professions. These approaches - demand approach and supply approach - represent two opposing lines of argumentation. In the demand approach, the status of being a profession (monopolised autonomy by state licence, social standing) is ascribed to successful political strategies of the professional group. In the supply approach, the professions are seen as institutions which can only be explained in their relationship to the state. Thus, in one line of thought, the constitution of the professions is viewed as a process parallel to the modernisation of the state. Another line of thought understands the professions also as bearers of uncertainty of both individuals and collectives. In the course of global neo-liberal politics, the ethic aspect of this approach has been condensed into the soul of the professions - as an antagonist to the soullessness of state and market. Since the 1950s, leading nurses in teaching and practice in Switzerland have been active to create a new position for professional nursing. Their main concern is to develop autonomous, specific concepts in addition to the traditionally dominant concepts of medicine. As a result, a professional project evolved which aims to gain a state monopoly for professional nursing. The study shows that the demand approach can only explain single aspects and short historic phases in the development of the profession. In each development phase, state and market have created the prevailing conditions of nursing like, so to speak, a mould. This becomes manifest in each phase depending on the federal structures of the state. This corresponds to the supply approach of the sociology of the professions. Nursing has not reached the goal of state licensure. However, if the profession thanks to its professional soul independently stands up for its patients, it fulfils the role typical of professions in this theoretic approach. This soul was present in the nursing profession from its very beginning.

Nurse education has altered considerably in the past 30 years. The combined demands of a growing population with diverse health needs and an expansion of career opportunities for those traditionally recruited to nursing have made it increasingly difficult to recruit and retain a viable workforce. At the same time pressure to establish nursing as a profession has influenced how the nursing curriculum has been delivered. Schools of nursing are now established in universities and away from clinical control. However, the retention of student nurses has remained an issue for many universities and studies have identified that students are particularly at risk of leaving around the time of their first practice placement. Whilst underlying factors associated with either the student or the practice environment have been identified which may be predictors for attrition at this time, no studies have given detailed consideration to the way students cope with the process of transition from the academic setting to the practice setting. This thesis aims to research and understand how first year student nurses manage the transition into their first practice placement and studies this process through the lens of human, social and identity capital theory. Questionnaires were used to collect the initial data from an entire cohort of first year student nurses. These data were then explored in depth via face to face semi-structured interviews with 20 of these students. The findings show that the transition process is highly complex and stressful for the student. It has been made more difficult by the separation of academic and practice settings. As a result students are expected to adapt rapidly to a strong occupational culture as they enter the practice setting. In order to do this they rely heavily upon building human, social and identity capital. The students who struggle and falter at this time appear to be those who lack the skills or support they require build capital successfully. These findings have significant implications for nurse educators who must consider how a student’s abilities to build and exploit capital can be encouraged within the nursing curriculum.

Aim and research questions: The aim of the study described in this thesis was to explore the personal and professional experience of consultant cardiologists, oncologists and old age psychiatrists and the consequent impact on referral practices to specialist palliative care services. The research questions attempted to develop an understanding of the relationship between their perceptions of and attitudes to palliative care and consequent decision making. Methods: The chosen methodological approach was interpretative phenomenological analysis (IPA) which supported exploration of the consultants experience together with facilitating their understanding of their idiographic experience. Ten minimally structured individual interviews were conducted with four cardiologists, four oncologists and four old age psychiatrists. Consistent with the philosophical approach of IPA their individual experiences were analysed - descriptively, conceptually and linguistically. The experiences of each consultant group were then combined to elicit their shared experience before being compared across group. The work was interpreted by detailed discussion which considered the structural context, the influence of the macro, meso and micro levels of health care and the political, historical and clinical aspects of palliative care on their experience. Deepr exploration was undertaken by considering the phenomenological concept of the life-world, 'habitus' and the philosophical and theoretical contexts of knowing and clinical thinking. The use of language and specifically metaphor supported increased understanding. Findings: The consultants' experiences (both personal and professional) reflected the primacy of their clinical expertise and their uncertainty as to whether a palliative care referral was always in the best interests of the patient group. The requirement for prognostication, identifying the transitions from active to palliative care was especially problematic for heart failure and dementia patients due to the uncertain disease trajectory. Many of the consultants identified the personal cost and clinical dilemmas of determining the end of life. Their stories, in particular identified the difficulties in establishing and communicating an end of life prognosis reflecting their unique personal and professional responsibility as medical consultants which contradicts the perceived contemporary dominance of multi professional working.