This study has identified the knowledge, skills and attitudes required by qualified nurses who care for children in Accident and Emergency (A and E) following trauma. These requirements were then compared with the current attributes of such nurses. The researchm ethodologyw as carriedo ut in three phasesa fter an extensives urveyo f the relevant literature. The identification of the level of knowledge, skill and attitudes required for best practice was achieved by the first phase: a Delphi study, being a structured approach to collecting the opinions of a panel of qualifieda nd experiencedc hildren's nurses.T he actualk nowledge,s kills and attitudes that nurses have and apply in practice were identified by the second and third phases of the research.R egisteredn ursesc aring for children in three A and E units were surveyedb y questionnairew hilst further dataw as obtainedb y nine sessionso f participant observationi n three A and E units. Ile three sets of results have been compared and contrasted with each other and with the review of the literature and this triangulation approach has led to a number of key findings. The care needs of traurnatised children are different from those of adults; at present the majority of children are not cared for by nurses with the necessary competence or within an appropriate environment. Children need holistic care, not just the treatment of their medical injury. ibis study has uncovered a specific education and training challenge, because most of the registered nurses in this survey who do care for traumatiscd children think they arc competent in that specific and distinct role, although the observations showed that this is not always the case. Such nurses should be trained in both paediatric and A and E nursing skills. Tl-ýs can and should be achievedb y personaliseda nd flexible courses. The recommendationsa rising from the key outcomesh ave been made separatelyto educationa nd training providers, to the nurses themselves and finally to the health care policy makers and managers who control the clinical environment for the A and E nursing of children's care. 11c recommendations to the education and training providers arc specific to the content of the curricula for training nurses who care for children and to the structure of the corresponding courses. Adult-trained nurses, however expert in that context, are recommended to seek the advice of their child-traincd colleaguesw ho care for children. Managersa rc recommendedt o benchmark the physical environment, culture and practices of their A and E Units against those in the Children's hospital. Iley are also recommended to work with education and training providers to support three different models of continuous professional development; models which reflect the different backgrounds and initial levels of compctcncc of nurses who care for children. The researchers uggeststh at, if theser ecommendationsa re actedu pon, then nursesc aring for children wiH be better educated and in turn the practices of caring for traumatiscd chUdrcn in A and E wiU also improve, and wiU better meet the needs of both the children and their families.

Background: In modern neurological physiotherapy practice, a patient’s neuroplasticity is harnessed, teaching them to develop motor control at ‘impairment’ level. Consequently, the patient relearns ‘normal’ movement, which in turn enables them to gain more efficient function and independence that has significant impact on their ‘life’. However, there are no outcome measures that capture the patient’s quality of movement, or the specific effects of physiotherapy intervention. Such an outcome measure, the Leeds Movement Performance Index, was developed to fill this gap. It was hypothesised to be a valid, reliable and clinically useful tool. Methods: A multi-centre, three-part, mixed-methods study was undertaken with three groups of neurological physiotherapists (n=34) and patients with neurological diagnoses (n=42). A range of quantitative and qualitative methods were used: Consensus methods to develop the new outcome measure; psychometric tests to examine reliability and validity against existing outcome measures in the field; focus groups, face-to-face interviews and reflective writing to further explore clinical utility. Results: The Leeds Movement Performance Index was shown to be a tool with strong measurement properties i.e.: internal consistency (Chronbach’s, overall scale=0.862), inter-rater reliability (ICC=0.959); test-re-test reliability (rho=0.792); and criterion validity compared with the Berg Balance Scale (rho=0.468, SD±2). Thematic analysis demonstrated robust content validity and clinical utility. Furthermore, it un-expectedly revealed that the Leeds Movement Performance Index also supported fundamental aspects of neurological physiotherapy clinical practice, including assessment, analysis and clinical reasoning, and potential usefulness as an education aid. Conclusion: The Leeds Movement Performance Index makes an important and novel contribution to the field of neurological physiotherapy, both clinically and within research practice. It is the first outcome measure to conceptually map the nature and definition of quality of movement for patients with motor impairment, and it captures the impact of neurological physiotherapy intervention more responsively compared with other outcome measures routinely used within the field.

This portfolio presents a schema of publication outputs developed from different stages of a journey of research framed by supporting commentary. Collectively these provide a portfolio of study that explores the learning potential of simulation in undergraduate nurse education. A brief history and overview provides context and background into the positioning of simulation within undergraduate nurse education that influenced the design and implementation of this research enquiry. Exploration of the literature base revealed a lack of consensus and understanding of simulation at that time. A concept analysis to search for common use and meaning of simulation as a learning strategy provided initial clarity, a foundation for further research and the first publication within this portfolio. This further informed the research aims and subsequent publications which focus on fundamental aspects of simulation which offer different perspectives for exploring and understanding this educational choice. A qualitative methodology was adopted as the optimum research design to establish a theoretical analysis of how simulation contributes to learning from the perspectives of undergraduate adult nursing students. An adapted form of classic grounded theory (Glaser, 1978) maintaining close association with the original approach (Glaser and Strauss, 1967) enabled data to be collected contemporaneously with student performance and reflection. Deep understanding developed from the multiple methods of dynamic data collection and analysis that captured the interactions of individual as they engaged in the simulation experience. Data was analysed through multiple lenses, including context and through the lens of both the researcher and learner. Findings suggest that immersive simulation engages and enables students to actively participate in professional context resulting in reflection and a motivation to learn. Simulation in this study has been found to enable curiosity and intellect engendered through activity which is enhanced through social collaboration and assists in embedding and contextualising theory. Ultimately students need to make identity shifts and evidence from this study would indicate that simulation enables students to think like a nurse as they make connections between theory and practice illuminated through activity and working together. The collective publications, findings and supporting commentary within this portfolio, serve to strengthen the existing evidence base for educators to consider when designing and developing simulation-based learning opportunities.

For over 30 years, the assessment of the clinical competence of student nurses has been the subject of much theoretical debate, yet the definition of criteria based on observable indicators of competence remains problematic. In practice, however, different assessors will judge and agree, relatively quickly, whether a student is competent or not; whether they have got ‘it’. Articulating what ‘it’ is, is difficult; although ‘it’ appears to be collectively, yet tacitly, understood. These judgements provide the key to the definition of competence. This research solves the dilemma of revealing and investigating these tacit understandings through the video analysis of students in simulated practice. The findings of four initial exploratory studies confirmed that competence is an example of tacitly understood behaviour and identified the limitations of traditional research methods in this context. The practical challenges of analysing video were highlighted, leading to the development of Video-View-Point to solve these problems and to reveal the tacitly understood behaviours. This innovative hybrid research method combines analysis of multiple ‘Think Aloud’ commentaries with the ability to ‘point’ at the subject of interest. The analysis is presented as a time-stamped multimedia dialectic, a visually simple yet sophisticated collage of data which reveals relevant behaviours, including those which are tacitly understood. A bespoke software tool (BigSister) was designed to facilitate the data collection, and was tested against the most similar commercially available technology, an eye tracker. The test of Video-View-Point successfully revealed four tacitly understood indicators of competence: communication, processing clinical information, being in the right place, and being proactive. Video-View-Point offers huge potential for behavioural analysis in other domains.

This study is a result of one not-for-profit organization’s aim to develop and evaluate a new approach to intermediate care (IC) by drawing together three separate enterprises; a not-for-profit charitable organization, a primary health care trust and local referring hospitals and social care providers in order to design a new service. This research describes and examines the factors that influenced the success (or not) of this IC service during its first two years of functioning. Using a single descriptive case study a detailed account of the innovation journey that a multidisciplinary team (MDT) underwent as they developed and implemented their own unique model of person-centred intermediate care (PCIC) within a community based nursing home facility is provided. The study describes the workings of the unit and details the service users’ outcomes and their perceptions of the care that they received on this unit. Through the use of a mixed methods, concurrent triangulation, design quantitative data (i.e. assessments of functional ability and length of stay (n= 94)) and qualitative data (i.e. semi-structured interviews-staff (n=12), service users (n=94)) were collected in order to generate thick description which allowed for an in-depth explanation of how a new event (PCIC in a nursing home) was integrated into the culture of the facility. This design allowed the data, once analysed, to be discussed from different viewpoints in order to simultaneously address the confirmatory and exploratory aims of the study. The results of this research provide the field of IC and the practice community with a detailed account of the successes and challenges that one MDT’s experiences during their innovation journey whilst crafting and successfully implementing PCIC within a community based nursing home facility. This study also exposed the staff’s use of emotional labour in order to successfully deliver their model of PCIC.

This thesis examines the uneven development of trade union activity among hospital nurses in Britain between 1910-1976, within a 'situated' materialistic perspective on union growth. It is argued that both professionalism and unionism developed as a result of the decay of traditional nursing ideology in its home base of the voluntary hospital, and the failure of its proponents to win total hegemony in areas where nursing reform spread, notably the asylums, workhouse infirmaries and private nursing. In explaining these developments due emphasis is given to both material changes in the labour process and the influence of 'subjective' predispositions that are the result of prior and continuing orientations, and of the extent to which wider economic and political conditions are favourable. Thus, the expansion of the medical division of labour in the 'acute-oriented' voluntary hospitals, involving the delegation of more tasks to subordinates, encouraged the development of professionalism; while in private nursing the attempt to realise the value of nursing as a commodity was the key material influence. However, in both instances the social background of recruits was also influential in determining that 'professional strategies of occupational closure would be the favoured 'solutions' to problems caused by material changes. Thepartial success of professionalism in achieving the 1919 Nurses Registration Act was influenced by the temporarily favourable political and economic situation. Trade unionism arose out of the contradictions with traditional nursing ideology and the failure of professionalism to solve them fully. These contradictions were most intense in those sectors where work was of lower status, like the asylums and workhouse infirmaries, and where the social background of recruits would also incline them to be more inclined towards trade unionism. Changes in the tempo of popular struggle are also shown to have had an important influence on the development of trade unionism. Successive chapters follow the unfolding of these contradictions, ideological responses and wider influences through to the 1970's, where it is argued that, despite continuing differences, there has been some convergence between the apparently competing strategies of professionalism and unionionism. The relative importance of the purported'proletarianisation' of the nursing labour force, is also assessed.

The aim of this study was to examine patients’ experiences of day surgery from a sociological perspective. Although there has been massive expansion in day surgery provision, both internationally and in the United Kingdom, there has been surprisingly little sociological research concerning this development. Within the space of three hours a patient is admitted to hospital, undergoes a general anaesthetic, followed by a significant surgical intervention and is then discharged home where responsibility for their care, which was previously performed by health service professionals, is now undertaken by the patient and their families. A study was devised to gain an understanding of the patients’ experiences within a sociological framework of analysis. One-hundred and forty-five patients and their relatives, from two different day surgery units within the United Kingdom, were recruited to the study. A qualitative framework, utilizing the grounded theory approach, enabled the researcher to gain deep insights into the patient experience. Fieldwork comprised semi-structured interviews and observation, as well as extensive use of field notes and memos. During a two-year span in the field, patients were interviewed on three occasions. The first interview took place in the pre-operative assessment clinic, where fitness for day surgery was assessed. The second and third interviews were carried out by telephone, at forty-eight hours and four weeks post-operatively. Data was simultaneously analyzed alongside data collection. Line by line analysis of the transcribed interview was undertaken whereby keywords and phrases were identified. Codes were then clustered into groups from which emerged core concepts. The core concepts which emerged from this study were: Time, the ambiguities of the Sick Role, Control, the importance of therapeutic relationships and formal communication. Recommendations include improved educational preparation for day surgery patients and their families as well as for the day surgery and community staff who are called upon to support the patient following discharge.

Objective: Physical activity has been shown to improve sleep, fatigue and mood among breast cancer patients during treatment. However, few studies have focused on assessing the effect of activity on these symptoms after treatment is complete. Using a correlational design, this study aimed to explore associations between physical activity, sleep, fatigue and mood in women who had completed treatment for breast cancer and to evaluate the reliability and validity of the short-version International Physical Activity Questionnaire. Methods: Twenty-eight women (aged 43 to 75 years) with stage I and II breast cancer were recruited at 6-months post-diagnosis and after completion of active treatment. Respondents completed measures of activity, sleep, fatigue, depression and anxiety. Six participants also undertook actigraphic monitoring to obtain objective activity levels. Results: Descriptive analyses suggest the sample was relatively active with 50% of participants engaging in moderate-intensity activities. Despite this, however, only 18% were sufficiently active to meet national guidelines. No significant relationships were found between total physical activity, sleep, fatigue or depression, whereas, anxiety and activity were significantly correlated. Reliability of the IPAQ was low, however, comparison with objective actigraphy data suggests high criterion validity. Conclusion: These findings have implications for designing interventions to reduce anxiety among breast cancer patients returning to physical activity after treatment. However, the choice of assessment instrument may have a significant impact on research results.

The specific objectives of the study were to: 1. Investigate women's perceptions and experiences of postnatal care; 2. Examine the current pattern of postnatal care provision in terms of clinical outcomes (maternal and neonatal) and maternal satisfaction; 3. Evaluate the new model in terms of clinical outcomes (maternal and neonatal) and maternal satisfaction; 4. Compare the outcomes of both models; and 5. Evaluate midwives' perceptions of both models of care. There were no difference between the two Phases in terms of clinical outcomes (maternal and neonatal) midwifery and maternal satisfaction. In both stages of the study, the average day of postnatal discharge was day three, the mean number of postnatal visits was 4.2, and the average number of midwives to visit a woman was two. Women were very satisfied with the community postnatal care provided by midwives, although concerns were expressed about hospital postnatal care. All women agreed that community postnatal care was an important service and would choose to have the midwife visit her in their own home rather than attend health or drop in centres. Midwives applied aspects of the new template of postnatal visiting and were more likely to visit low risk women three times following introduction of the ne template. There was not change in community of carer. Findings of focus group discussions highlighted that women were not prepared for motherhood and the postnatal period. Women stated that the educational support antenatally and in the postnatal ward did not meet their expectations and needs.

This research seeks to explore the nature and value of peer learning for a group of pre-registration nursing students and specifically aims to examine a group of student nurses in order to inquire whether they learn from each other and if so, how, when and where this takes place. Secondly, the work aims to discover more about the process used by those nurses while engaging in peer learning and to unearth their perceptions of and value systems ascribed to this type of learning. In this context the students engage in peer learning as they learn from and through each others’ experience. This research is set against the backdrop of recent changes within nurse education in the United Kingdom. In 1999, the Peach report made several main recommendations regarding the future of pre-registration nurse education, including the integration of knowledge and skills through balanced time in theory and practice together with the fostering of interpersonal and practice skills through experiential and problem-based learning (UKCC 1999). In this case the fellow learners are a group of pre registration student nurses enrolled on a programme leading to registration as Adult Branch nurses with a Diploma level academic qualification. The curriculum (based on the Fitness for Practice recommendations within the Peach report) convenes the group (known as a base group) together throughout the course at regular intervals, and utilizes a strategy of problem based learning as part of a range of teaching and learning strategies in order to help the students to acquire the knowledge required by a qualified nurse. It is important to differentiate peer learning from other mechanisms which involve students in learning from each other. For example, peer teaching or peer tutoring is a far more formal and instrumental strategy whereby advanced students or those further on in progression, take on a limited instructional role (Boud, Cohen and Sampson 2001). In other words, the more senior students are used to formally teach various aspects of the curriculum to more junior students.