Chronic Open Angle Glaucoma (COAG) refers to a chronic progressive condition that is characterised by damage to the optic nerve, resulting in peripheral visual loss that can progress to involve the fovea and central vision; subsequently causing blindness. COAG is reported to have a poor level of adherence to treatment due to its asymptomatic nature. In this study, a Glaucoma Expert Patient Programme (GEPP) demonstrated new ways of improving patients' experience and adherence to COAG treatment. The research has employed an Information-Motivation-8ehavioural Skills Model to understand the association between knowledge, motivation and behavioural skills in an attempt to improve adherence amongst recently diagnosed patients. Patient participation was at the heart of every component of the study. In this research, four Expert Patients were trained and supported to deliver an educational programme (termed the GEPP) to 25 recently diagnosed patients with COAG (Intervention Group) and then a comparison was made to 25 participants (Control Group) that were also recently diagnosed with COAG but did not receive the educational programme. Three pre and post educational programme validated questionnaires were used to measure patients' knowledge, satisfaction and adherence at baseline and then discern changes at 1 month and 6 months follow up to the GEPP intervention. Staff (N = 10), Expert Patient (N = 4), Intervention Group (N=10) and Control Group (N=10) semi-structured interviews were also conducted to obtain deeper insight into their experiences of engaging in the programme. Data analysis indicated IMPROVING AWARENESS was the main theme that emerged supported by three subthemes: knowledge, satisfaction and adherence. This research has taken the Patient-Patient relationship to a higher level. It is viewed that the Expert Patients' experience is crucial and valuable to improving the experience, knowledge and adherence of newly diagnosed patients with COAG. The GEPP delineated in this study provided insight regarding individuals' life experiences of living with and managing chronic complex glaucoma. Implications for practice relate to the development of tailored educational programmes. This research contributed new knowledge to improving the adherence practices of glaucoma patients. It also demonstrated the value of Expert Patients' experience and their contribution to assisting newly diagnosed patients in self-managing their COAG.

Background: Pressure ulcers (PrUs) have a significant impact on health system expenditure and patient’s quality of life. It is a global problem. Many studies were undertaken in regard to PrU prevention and management. In Oman, no studies have been conducted to investigate nurses’ knowledge on prevention and management of PrUs. The purpose of this descriptive sequential explanatory mixed-method study was to explore the nurses’ level of knowledge in relation to prevention and management of PrUs in Oman. Methods: A mixed method design was used and the study was conducted over two Phases. In Phase I, a questionnaire was developed to explore nurses’ knowledge on PrU, policy, and resources. The main section of the questionnaire was the Pieper-Zulkowski Pressure Ulcer knowledge test (PZ-PUKT) which tests the knowledge on PrU. Another two sections were developed including questions about wound policy and resources available for PrU prevention and management in Oman. The questionnaire was distributed to nurses who were working in surgical, medical, orthopaedic, CCU, and ICU wards/units in seven hospitals. In Phase II study, semi-structured qualitative interviews were conducted with 16 of the questionnaire respondents. Interviews took approximately 30 minutes, were recorded and transcribed verbatim. Qualitative data were analysed using the Knowledge, Attitudes and Practice (KAP) model as the a priori framework. Results: In Phase I, 478 questionnaires were analysed. The knowledge test results showed the overall mean percent score for correctly answered questions was 51% suggesting a low level of knowledge. There was a significant relationship between nurses’ knowledge and age (P=0.001) and between knowledge and years of experience (P=0.001) with knowledge increasing with age and years of experience. In Phase II, four themes were identified from the interviews: knowledge, attitude, and practice (framework themes) and perception of role. Findings indicated positive and negative attitudes towards the care of PrUs. Some nurses stated feeling rewarded when they see wounds improving while others said they could not work with patients independently because they lacked the knowledge and the skills needed. There was variation in the management of PrU between hospitals. Both studies indicated that the wound management policy did not include enough information to guide nurses. Conclusion: Overall the nurses’ level of knowledge on PrU was relatively low. Most nurses were not familiar with wound management policy or different PrU prevention and management strategies. Nurses are aware of the risk of PrUs and try their best to manage them with the available resources however more training is required.

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.