My research explored student experiences of becoming midwives. It focused specifically on understanding their lived world experiences. The research is located in a hermeneutic framework as described by van Manen (1990). I chose to undertake a longitudinal study as the length of the students’ course of study was three years. My study recruited two cohorts of student midwives from two universities in the North West of England (n=90). Each university had a different recruitment target for their midwifery programme of study; University A (n=60), University B (n=30). I prepared a PowerPoint presentation and an information leaflet which supported the recruitment strategy (Appendix B). My approach proved successful as the study originally consisted of a purposive sample of student midwives (n=22); University A (n=10) which equated to 20% of the cohort and University B (n=12) equated to 33% of the cohort. Four students from University B dropped out of the research following the first focus group, thereby reducing the total sample to 18. This reduced the sample size of university B (n=8) which equated to 27% of the cohort. My use of narrative inquiry within focus groups enabled a hermeneutic cyclical process of gathering and interpreting the student holistic experiences in a constructivist paradigm (Clandinin and Connelly, 2000). I also used reflective diaries which enabled the students to reflect on their personal experiences. This added richness to the empirical data (Berg, 2009). The interviews were recorded and transcribed verbatim. Thematic analysis was undertaken using the principles of van Manen (1990). I gained ethical approval from LJMU and the two universities where the students were studying. The aims of my research directed the focus of the study. Discovering their interpretations of their experiences of becoming midwives brought an understanding of the influences the working environment had on the process. The findings of my study brought new knowledge in respect of the education of student midwives. It also highlighted some of the restrictions imposed on their training within a medical model of care in an NHS Trust. The research also highlighted some of the challenges experienced by the students as they progressed through their training. The findings suggested there were many tension experienced by the students. The broad themes were related to: the students’ understandings of their learning and development, the ideology of the role of the midwife and the role of the midwife within the philosophy of the medical model of care in NHS Trusts. This brings new knowledge in respect of the education of student midwives.

Only 20% of patients at diagnosis of gastrointestinal cancer will be suitable for potentially curative surgical resection, and then only 5 -10% of these will survive to 5 years. Most individuals die within twelve months. Whilst the relief of physical symptoms is essential and contributes to improving quality of life, such patients are also likely to have psychosocial needs. Psychological adaptation has been found to be positively influenced by the coping resources available to individuals e.g. physical and emotional well being, their values and beliefs, support from family and their social network. Carers' levels of psychological distress, when cure is no longer an option, can be extremely high. Evaluation and research of the organization of generic palliative care in specialist gastrointestinal cancer is limited. Method An exploratory case study design using contextual triangulation was used. 34 patients receiving generic palliative care for gastrointestinal cancer, 30 main carers and 28 bereaved carers were interviewed and completed measures of psychological wellbeing. Patients also completed the Concerns Checklist. Findings Whilst the main message in the literature had suggested that psychological distress manifested as depression was underestimated in patients with cancer, this study did not support these conclusions. There were however, high levels of anxiety, concerns and adjustment disorder in patients. Fisher's exact test was highly significant (p= 0.002) for anxiety and poor disclosure in patients. Contributing factors to this are explored. Patient anxiety was significantly correlated with total concerns (r =0.419 p= .017) In carers Fisher's exact test was significant for psychological distress and information (p = .029) with a trend for younger female carers and bereaved carers to be more anxious than older carers. There was a clear association between insensitive disclosure, unmet information needs, poor coordination of care and increased psychological distress in carers, with unresolved consequences when bereaved. Implications Results demonstrate the need to proactively manage those affected by these cancers of limited prognosis. Individual assessment of patient and carers at an early stage of their referral to a specialist gastrointestinal cancer centre, with particular attention to psychosocial needs, use of sensitive disclosure, tailored information and coordination of care may promote positive appraisal of coping resources, improve adjustment and increase psychological well-being. Conclusion This study has illustrated the wide diversity amongst those affected by incurable gastrointestinal cancer. The perceptions and concerns of 92 people have been listened to, and their levels of psychological well-being measured. It offers new insight in a number of areas and in particular the association of health service care and how this increases or decreases access to coping! improving levels of psychological well being. The current case study using triangulation was able to reveal individual meaning as well as collaborative interpretation of the con~tituents and processes of living, dying, or caring for someone with incurable gastrointestinal cancer. The breadth of such an approach has not been found previously in a British study in gastrointestinal cancer, and this exploratory and explanatory approach provides evidence and a strong new insight into the effects of incurable gastrointestinal cancer upon those affected. Such results hold potential for practical application and key quality issues which address how a specialist gastrointestinal cancer service should develop its standards of care and audit practice. By entering the participant's world, although very briefly, this study has explored the perceptions and concerns of those affected by incurable gastrointestinal cancer, and links with coping and psychological well-being. There is a need to pursue this work with on going study, whilst publishing and promoting evidence of the positive outcomes for all parties involved.

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The aim of this study was to model the process of development for an Online Learning Resource (OLR) by Health Care Professionals (HCPs) to meet lymphoedema-related educational needs, within an asset-based management context. Previous research has shown that HCPs have unmet educational needs in relation to lymphoedema but details on their specific nature or context were lacking. Against this background, the study was conducted in two distinct but complementary phases. In Phase 1, a national survey was conducted of HCPs predominantly in community, oncology and palliative care services, followed by focus group discussions with a sample of respondents. In Phase 2, lymphoedema specialists (LSs) used an action research approach to design and implement an OLR to meet the needs identified in Phase 1. Study findings were analysed using descriptive statistics (Phase 1), and framework, thematic and dialectic analysis to explore their potential to inform future service development and education theory. Unmet educational need was found to be specific to health care setting and professional group. These resulted in HCPs feeling poorly-equipped to diagnose and manage lymphoedema. Of concern, when identified, lymphoedema was sometimes buried for fear of overwhelming stretched services. An OLR was identified as a means of addressing the unmet educational needs. This was successfully developed and implemented with minimal additional resources. The process model created has the potential to inform contemporary leadership theory in asset-based management contexts. This doctoral research makes a timely contribution to leadership theory since the resource constraints underpinning much of the contribution has salience to current public services. The process model created has the potential to inform contemporary leadership theory in asset-based management contexts. Further study of a leadership style which incorporates cognisance of Cognitive Load Theory and Self-Determination Theory is suggested. In addition, the detailed reporting of process and how this facilitated learning for participants contributes to workplace education theory.

This research project sets out to explore, analyse and theorise the way district nurses and social care workers construe their identity, and their relationships within the changing context of collaborative projects. Unlike previous research in this field, this project offers an alternative, relational view of exploring professional identities and inter-professional relationships. The research adopted a constructivist phenomenological approach drawing upon the theories of personal construct psychology (Kelly, 1955) and existential phenomenology (Merleau Ponty, 1962), as elaborated by Butt (2004, 1998). The project consists of three studies. The first empirical work is a preliminary study using individual interviews of students undertaking degree courses in community nursing or social work. This study is concerned with examining the students' concepts of what it means to belong to a particular occupational group and the influences that shape their ideas. Using focus groups and individual interviews, the second study explores how district nurses and social care workers negotiate their identity as a result of national changes and service developments. The final study explores interprofessional relationships of individual district nurses and social care workers, using reflective interview techniques (Hargreave, 1979, Salmon, 2003). In keeping with phenomenological methodology, data was analysed using template analysis (King, 2004). A number of emerging constructs were identified that highlight the personal, historical and contextual influences upon professional role construction and inter-professional relationships, notably: visibility and recognition, role flexibility and rigidity. In particular the findings illustrate how professional identity is constructed, challenged, and reconstructed, through on-going interaction. To facilitate role re-construction and sociality, the reflective interview techniques were adapted and extended to encourage practitioners to reflect upon their every-day practice and relationships when working in a multi-disciplinary setting.

Nursing and nurse education within Britain are influenced by the legacy of the development of hospital based adult general nursing in the 19th Century. Discourses that emerged at that time identify nurses as ‘good women’: respectable, hardworking, loyal and obedient. Currently, nurse education is criticised for being less able to produce nurses who are fit to undertake their role than in the past. Taking the concept that discourse exerts a powerful influence on the way people behave, this thesis asserts that the 19th Century legacy is important and seeks to establish the discourses that shaped nurse education. The period 1945 -1955 is chosen as sufficiently distanced from early developments, but recent enough to be in living memory and prior to the relocation of British nursing from a hospital base into Higher Education. Six overlapping discourses are identified though the literature. An interpretative approach is then taken to data collected in three stages: a life story 1932 -1973, semi-structured interviews with nurses who commenced their training 1945 -55 and documentary analysis of nursing journals for the same period. The ‘good nurse’ is explored through discourses around the ‘right kind of girl’, the tension between vocation and profession and the transition from woman to nurse. Despite significant change of direction in educational theory and policy in the period 1945 -55 the thesis suggests that the power of the discourse meant that little changed in the practice of nursing or the conduct of nurse education. Furthermore, it is argued that whilst discourses have changed and contemporary nursing is establishing its place in Higher Education as an applied academic discipline, the current discourses embracing caring, reflection and emotional labour are equally gendered and controlling. Now, as then, this discourse is not imposed by outside forces, but is generated and controlled from within the profession. It therefore concludes that the pervasive influence of discourses surrounding the ‘good nurse’ and related discourses about control and care must be given full recognition when attempting to change nursing or to influence its policy and educational developments.

This study investigates the conceptions of information literacy held by student nurses on a BSc Nursing Studies course and asks whether the information skills sessions taught are successful from the students’ viewpoint. Additionally, it compares attitudes to, and use of information literacy within the artificial environment of the university and the ‘real world’ of the nurse as perceived by participants on their clinical and community placements. The inquiry introduces the concept of information literacy and charts its development before discussing it in relation to the changing context of nurse education and evidence-based practice. The research adopts the interpretive paradigm with phenomenography as its methodology. It uses focus groups and twenty-one individual interviews to obtain rich data from a purposive sample of students across the three years of the course. Such data were analysed to produce categories of description representing the collective experience of information literacy across the sample. The thesis questions whether learning to nurse effectively is best achieved through training along traditional lines, education, or a combination of both. For the latter it is imperative to find an appropriate balance between academic and clinical skills. The findings reveal a tension between the academic and clinical aspects of learning to be a nurse which some students struggle to resolve. The study concludes that while information literacy is perceived as part of a nurse’s professional role in supporting evidence-based practice, participant observations suggest that its use is context dependent and variable. The thesis recognizes that the adoption of evidence-based practice may depend on the presence or absence of particular personal and organisational barriers. Suggestions for further research include the relationship between academic and clinical learning, the importance and influence of informal learning, and the nature of the transition from student nurse to autonomous practitioner.

This study investigates the perceptions of key stakeholders in midwifery education concerning the involvement of service users in student assessment. It identifies the key stakeholders in specific interest groups, as expert professional and expert lay people, parents, student midwives, qualified midwives who mentor students in clinical practice and the heads of midwifery education in University Departments. The work starts from the premise that assessment is an underestimated means of enhancing students' learning and the development of competence to practise as a registered midwife. The inquiry opens by examining the professional context in which maternity services are provided. It identifies the relationships that midwives form with the women and their families for whom they care. These considerations are followed by an interrogation of the literature that reveals a rich variety of interlocking concepts that are apposite considerations in terms of the assessment of student midwives and the involvement of women in it. This finely links the problem to previous research and provides a sound rationale for the conduct of the study. Interpretivism is advanced as a suitable philosophical framework for the prosecution of the study that offers a methodological rationale for a pragmatic, mixed methods investigation. The study design presents a raison d'dtre for a phased approach to the work and data are accrued variously from qualitative and quantitative sources. Although the focus of the work concerned the role of users of maternity services in student assessment and found considerable support for their involvement, what emerged has wider consequences for teaching and learning, the overall student experience and also for women as health service consumers. Having examined the principle dynamics that influence student learning in clinical placements, the study concludes that there is a superficial disharmony between learning and assessment yet it claims the two are mutually complimentary. The inclusion of women in teaching and learning is seen as a potent means to add an extra element to the definition of competence and to add to the authenticity of its assessment.

Background: The rationale for this study was developed from the personal and professional experience of the researcher living in a Muslim community in Nigeria where HIV/STIs are major health and social care problems. Most literature reviews on HIV/STIs and polygamy in Nigeria and in sub-Saharan Africa, have focused mainly on case studies and surveys. Aim: This study explores the experience and impact of HIV/STIs on Muslim women living in polygamous marriages in Nigeria. The objectives of this study are to explore their perceptions, knowledge and awareness of HIV/STIs, examine the effect of polygamy and identify factors to empower Muslim women to protect themselves. Method: The study adopts a qualitative approach, consisting of one-to-one in-depth interviews, within a feminist framework, with 20 women living in polygamous marriages in Nigeria. The qualitative approach was valuable because the words of the women who live in polygamous relationships cannot be quantified. A narrative, descriptive approach to the one-to-one in-depth interviews helped the researcher to listen and to describe their perspective; this was necessary because it is about their lived experience in polygamy. Using feminism, as the theoretical framework, offers an understanding of how polygamous women can be understood in relation to the dominant ideologies existing within a particular socio structure and it provides the lens to review the situation and suggest the necessary changes. The extract from the interview transcript was used to illustrate how the polygamous women’s accounts were explored in their own vernacular ways of speaking. Through the use of thematic analysis ten themes emerged. Findings: Ten themes were initially identified and four concepts finally emerged after coding and recoding of the similarities. These are the four concepts that emerged. They are; Education, Testing, Condom usage and an Economic empowerment (ETCE) approach. This means that there is a need for education, especially sex education as well as economic empowerment. The women’s accounts in this study area highlight the problems that polygamous women frequently experience such that, they cannot negotiate their sexual needs and cannot refuse their husbands taking on additional wives, within this kind of marriage system. The knowledge systems of polygamous women were evaluated and positioned in terms of women’s subjectivity and experiential knowledge. This study reveals that polygamy creates asymmetrical positioning, such asymmetrical positioning creates unequal power positions, not only among spouses, but among the co-wives within the polygamous marriage. The ways in which these social relations are negotiated and experienced are shaped by religion and traditions. This study also reveals that power and gender issues are critical factors in disempowering polygamous women, as they appear to be voiceless on issues that affect them in their polygamous marriage. Therefore, this means that there is a need for sexual education and for an improvement in the socio-economic status of women. Conclusions: Power and gender issues are critical factors in subordinating and disempowering polygamous women in their community; they are voiceless on their reproductive rights and limited in their option to control the spread of HIV/STIs. This study therefore, calls upon policy makers in Nigeria to consider these four concepts of Education, Testing, Condom Use and Economic empowerment (ETCE), as identified in the study, to help enhance the issue of economic empowerment of the polygamous women. Also this is to say that a window of opportunity exists; planners should develop partnerships with religious and community leaders to change the detrimental behaviours of polygamous men and women on issues of prevention and the control of HIV/STIs.

No description available.