Nursing documentation is the key to nursing care in hospitals. According to Pirie (2011) and Wang et al. (2011), nursing documentation that contains evidence regarding the comprehensive level of nursing care has a strong correlation with nurses’ professional practice. Nurses in Malaysia are trained to abide by the Code of Professional Practice (1998); therefore, the purpose of this study is to explore how nurses demonstrate the elements of professionalism within their documentation from a Malaysian context. Despite the significance of nursing documentation in nursing practice, no study has been conducted and published on this crucial aspect of nursing practice in Malaysia. Hence, there is a need to explore how nurses demonstrate the elements of professionalism within their documentation. This study utilises a mixed methods approach (triangulation - convergence model design) in exploring how nurses in Malaysia demonstrate the elements of professionalism within their nursing documentation. This mixed approach enables greater understanding of nurses’ views on their documentation and its influence on the way the documentation is prepared. A quantitative approach is employed to analyse retrospective nursing documentation, where a total of 655 case notes were selected from the five participating hospitals in Malaysia. An innovative data extraction tool based on the Registered Nurses’ Association of Ontario (RNAO, 2007) model of Professionalism in Nursing was used in the analysis. The RNAO (2007), proposed eight attributes of professionalism in nursing: i) accountability, ii) advocacy, iii) innovation and visionary, iv) ethics and values, v) autonomy, vi) knowledge, vii) spirit of inquiry and, viii) collegiality and collaboration. The presence of all these attributes was assessed in the 655 selected case notes. Simultaneously, a total of 40 semi-structured interviews were conducted with nurses involved in completing the 655 reviewed case notes. In this context, thematic analysis (Braun & Clarke, 2006) was used to identify categories and themes in nurses’ accounts of their documentation, in relation to the elements of professionalism in nursing. In summary, the quantitative findings reveal that there is evidence of the elements of professionalism exhibited in the nursing documentation among the selected case notes. However, the qualitative findings prove that the nurses could not demonstrate their comprehension of the elements of professionalism in their documentation. Several factors and influences were identified, which could be detrimental to nurses’ understanding of the elements of professionalism in nursing documentation, such as the working culture and common cultural values, educational backgrounds, different workplace settings and recognition of the profession. Additionally, the findings of this study point towards the creation of an alternative approach to explore and understand the elements of professionalism in nursing within the scope of this study. The findings of this study suggest that there is room for further, extensive development of nursing documentation and future studies in many other health settings in Malaysia. The findings of this study could inform responsible authorities in health care and nursing educators to focus or to re-emphasise the importance of ensuring the good quality of nursing documentation in Malaysia. Furthermore, the findings could be used as a baseline to guide the relevant nursing authorities and personnel in Malaysia when dealing with complicated documentation issues and to improve the standard of the nursing documentation from a professional perspective in relation to the nursing practice.

Reflection and reflective practice has become a key issue for curriculum development within nurse education, particularly mental health nursing. The Nursing and Midwifery Council have linked the demonstration of reflective skills to clinical competence to gain entrance onto the professional register. However, despite a significant volume of literature on reflection there is a paucity of research evidence regarding how nurse educators teach mental health nursing students to reflect and become effective reflective practitioners and, little research exploring experiences of staff and students engaged in reflection for teaching and learning purposes. A person-centred enquiry was undertaken to explore staff and student perceptions and understanding of reflection in the context of the undergraduate pre- and post-registration mental health nursing diploma programme, utilising a framework involving four focus groups and conducted in the university setting. Findings indicated that participants’ definitions were congruent with the literature on reflection. However, it was evident that students were uncertain as to how to reflect on their practice and this was attributed (by students) to a lack of appropriate teaching, whilst staff felt that they lacked the appropriate context within which to teach skills of reflection. A new model and extended description of effective reflection is offered together with some non-prescriptive recommendations aimed at enhancing teaching practice.

INTRODUCTION: Clinical guidelines, as products of research, are increasingly used to raise the quality of care delivery in acute hospital NHS Trusts. However, their use is impeded by many organizational and individual barriers and understanding of psychological barriers is underexplored. This study aimed to explore ‘intention’ as a psychological explanation of health professionals’ research utilisation behaviour using an extended Theory of Planned Behaviour (TPB) social cognitive model. METHODOLOGY: The ‘care round checklist’ was identified, in collaboration with practice partners, as a suitable guideline behaviour to evaluate. A theory-driven questionnaire was developed and utilized to measure nurses’ and Health Care Assistants’ (HCAs’) intentions. Inferential statistical tests were used to establish differences in nurses’ and HCAs’ intentional behaviour and the predictive value of the TPB model. RESULTS 270 questionnaires were returned from 24 wards. The TPB model explained a modest level of intention; 20% of nurses’ and 24% of HCAs’ care round intentions. Nurses’ attitudes and perceived control best predicted intentions, whilst HCAs’ intentions were predicted by attitude and practice habit. CONCLUSION AND RECOMMENDATIONS: The TPB model lacked sophistication to sufficiently explain intentional guideline behaviour, within a complex guideline behaviour, though role differences were significant. Further variables could add to the predictive value of intention. Future work should acknowledge limitations in the TPB model in explaining intention. Clinically, role differences should be recognized in the future implementation of care rounds.

Rodgers’ evolutionary model of concept analysis was used to develop definitions of children’s nursing and their special needs, from which the inherent qualities of children’s nurses were extrapolated and tested in a variety of ways. Firstly selectors of children’s nursing students evaluated the suitability of six hypothetical candidates, in a self administered postal questionnaire. There was some agreement on the identified pre-requisite qualities. Secondly a content analysis of 25 job descriptions for newly qualified children’s nurses, using NUD*IST was undertaken, to determine English NHS Trusts’ expectations. Across the sample there was agreement on the role of the children’s nurse, confirming the definition derived from the concept analysis. There was less agreement between trusts in the manner in which these expectations were expressed. New regulations for nurse education were introduced during the time of this study and the government published new standards for children’s health services. Therefore a final concept analysis of children’s nursing at the start of the 21st century was undertaken. A number of implications for children’s nursing selection and further development of the identified qualities of potential students were identified. The definition of children’s nursing should continue to be debated as the role develops and becomes increasingly expressed in terms of competencies.

No description available.

This case study research involves a unique cohort of seven third year pre-registration student nurses (PRSNs) towards the end of their nursing programme with a North West Higher Educational Institution (HEI). The aim of the research was to provide the reader with a deeper understanding of the experiences, motivation and challenges of the PRSNs when completing the theoretical component of their nursing programme within the current socio-political and professional nurse education reforms. A Case study approach to gather and interpret the PRSNs perceptions of their nursing programme was necessary. Data was collected through use of focus groups, PRSNs Personal reflections and academic grades. Thematic network analysis and descriptive analysis were used to interpret the data followed by Triangulation of the findings. The key findings suggest that a definitive demarcation between the engagement of PRSNs to the theory and practical components of the nursing programme. Other key findings included which impacted on the PRSNs learning and motivation were, the actions of others, the increase in academic level and the use of formative assessment. The main external challenge to be recognised was the need for some of the PRSNs to undertake additional paid work distracting them from their studies. The nursing programme is currently ‘fit for prurpose’ with PRSNs meeting all the necessary requirements to apply for registration status. However, amendments to the programme would improve the PRSNs expereince. Therefore the recommendations would be as follows, to increase student engagement and maintain flexibility within programme development, change the delivery model, amalgamate academic and professional regulations and change the current grading system. It should be recognised that pre -registration programmes throughout the country incorporate similar standards and therefore generality of the study can be applied. Future research to enhance student re-motivation, to decrease the theory practice gap, change assessment marking practices and raise public awareness of degree awards for nurses will prove beneficial.

Introduction: Peripheral arterial disease (PAD) is a strong prognostic indicator of poor long-term survival (Norgren et al., 2007). A symptom of PAD is intermittent claudication which affects 5% of the adult population aged over 55 years (Fowkes et al., 2013). Intermittent claudication (IC) occurs during ambulation when the peripheral circulation is inadequate to meet the metabolic requirement of the active leg muscle, resulting in severe pain (Gardner et al., 2008). Consequently, patients suffering from IC find that the ambulatory dysfunction limits daily physical activity and negatively affects health-related quality of life. Current recommended first-line treatment for IC is for the patient to undertake a supervised exercise programme (NICE, 2012), supervised exercise is designed to improve symptoms by improving rate of formation of new blood vessels and establishing collateral flow. However, there are limitations with supervised exercise. These limitations include: difficulties with accessing exercise programmes (Stewart et al., 2008, Shalhoub et al., 2009, Harwood et al., 2016), poor completion rates/high dropout rates (Kruidenier et al., 2009, Treat-Jacobson et al., 2009, Nicolai et al., 2010), high number of patients unsuitable to participate due to concomitant disease (Suzuki and Iso, 2015, Kruidenier et al., 2009), and lack of patient motivation/willingness to undertake exercise therapy (Muller-Buhl et al., 2012, Stewart et al., 2008). Due to these limitations there is a need to investigate alternative treatments to help improve patients’ symptoms of intermittent claudication. One potential option is cycloidal vibration therapy (CVT). CVT has been shown to increase blood flow (Maloney-Hinds et al., 2009, Button et al., 2007): it is hypothesised that improvement in blood flow would positively impact on patients’ symptoms of IC. This prospective feasibility study explored whether there is an association between CVT and patients’ symptoms of experiencing IC, measuring changes in pain free walking time and maximum walking time. Focusing on evaluating the research protocol and assessing the feasibility of undertaking a large study in this area and providing detailed information about the variability of the primary outcome measures to facilitate the design of future randomised controlled trial. Methods: A feasibility study was designed and undertaken. National Health Service (NHS) research and ethical approval was obtained. Patients reporting intermittent claudication were identified from vascular out-patients clinics within Mid Yorkshire NHS Trust. They were screened to ensure they met the inclusion/exclusion criteria for this study, and if suitable were approached to be included within the study. The patients were than consented and recruited into the study based on sample of convenience. CVT if provided through a portable machine called Vibropulse (Vibrant Medical) which is designed to be used by the patient at home. The device is a rectangular soft pillow style pad, approximately the size of the lower leg, which is connected to a transformer powered via mains electricity. The machine is fully portable and comes within its own carrying case. The CVT was self-applied at home for 30 minutes twice a day over a 12-week period. Participants were reviewed at weeks 4, 8 and 12, then again at weeks 24 and 36 to assess whether any changes were sustained. Primary outcomes were: change from baseline of both pain free walking time and maximum walking time. Secondary outcome measures were: ankle brachial pressure index (ABPI), limb systolic pressure, mental health component summary score and physical component summary score of the SF-36 quality of life questionnaire, treatment compliance and patients’ ease of use of product assessed via a simple questionnaire. Results: Thirty-four participants with IC were recruited, of which 30 (88%) were male and four (12%) were female. Mean age of all participants was 68 years (IQR 60-75 years). After 12 weeks, 29 participants improved their pain free walking time, with an average improvement of 215% from baseline, (range of -8% to 1005%). Comparison of differences in time to event (event being pain onset) showed a statistically significant difference, between comparison time points at baseline and week 12 (2(1)=25.6; p < 0.001). Furthermore, at week 12, 23 participants recorded improvement in their maximum walking time, with an average improvement of 161%. Comparison of differences in time to event (event being termination of walking due to pain) showed that there was a statistically significant difference between comparison time points at baseline and week 12 (2(1)=15.36; p < 0.001). Analysis of the results showed that improvements in participants’ pain free walking time and maximum walking time were most pronounced within the first eight weeks of CVT treatment. Additionally, the long-term follow-up results showed that the improvements seen in pain free walking time and maximum walking time within the treatment phase were sustained once the CVT therapy had been discontinued. Assessment of changes in participants’ lower limb perfusion showed evidence of a statistically significant difference between ABPI at baseline and at the end of week 12 (t29=-2.008, p=0.046). Furthermore, statistically significant changes were seen in the treated leg when comparing systolic leg pressure at baseline and week 12 (t31=-2.273, p=0.03). However, in the untreated leg there was no evidence of a statistically significant difference (t31=-0.597, p=0.555). The results showed a positive improvement in participants’ quality of life, with their overall physical functioning scores improvement from 35.34 (SD 8.93) at baseline increasing at the end of active therapy to 44.52 (SD 9.11). During the follow-up period there was a decline in scores; however, at week 36 the physical functioning scores were 39.55 (SD 12.37), which is an increase from the starting baseline. Conclusion: Following 12 weeks of CVT there was statistically significant improvement in pain free walking time and maximum walking time in participants experiencing IC, with improvements being most pronounced within the first eight weeks of treatment. On average, participants’ pain free walking time increased by 215% from baseline, this level of improvement is comparable to improvements seen from other treatment options such as supervised exercise (Stewart et al., 2002). This improved walking ability resulted in improved quality of life, measured by physical functioning scores. Additionally, participants’ lower limb perfusion had increased, both ABPI and systolic leg pressure showed statistical evidence of improvements, and these changes in lower limb perfusion were not seen in the untreated limb. This is the first study investigating the feasibility of using CVT as a treatment for IC and has provided novel information relating to duration/positioning of treatment, sample size, number of potential eligible participants and potential association between CVT and improved symptoms. Additionally, it has established that CVT treatment is highly acceptable, as indicated by no participant drop out in the treatment phase, and may potentially offer an alternative treatment option for patients experiencing IC. Furthermore, this study has assessed the variability of the primary outcome measure which provides vital information needed to calculate sample sizes for any future studies. In conclusion, this study has established the feasibility of using CVT to improve patients’ symptoms of IC and provides essential information which will contribute to the design of any future investigations.

Most nursing history has focused on the politics, identity and development of the profession. This study focuses on practice. It examines the surge of interest in complementary and alternative medicine {CAM) in British nursing during the second half of the twentieth century and explores how and why some nurses used CAM in their practice. It examines the therapies that nurses employed and how these practitioners were supported. The merit of this research lies in exposing evidence of a more clearly designed organisation of CAM in nursing than has been suggested previously and places it within a discrete timeframe, one already recognised as a period of reform in medicine. In using the methodology of oral histories, archives and nursing journals, the research is rooted in nursing history, importantly demonstrating that CAM practice in nursing was not only part of a shift in consciousness away from a medical model, but was an extension of the patient-centred nature of nursing culture in the late twentieth century. In presenting a movement that challenged the dominance of biomedicine, this thesis demonstrates the emergence of a changing model of healthcare and contributes an important perspective to the modern history of medicine and healing.

In the nursing literature to date there have been no reported applications of `cognitive simulation' nor of intelligent Computer Assisted Learning. In Chapter 1 of this thesis a critical review of existing nurse education by computer is used to establish a framework within which to explore the possibility of simulation of thinking processes of nurses on computer. One conclusion from this review which is offered concerns the importance of firstly undertaking reliable study of nursing cognition. The crucial issue is that an understanding must be gained of how expert nurses mentally represent their patients in order that a valid model might be constructed on computer. The construction of a valid computer based cognitive model proves to be an undertaking which occupies the remainder of this thesis. The approach has been to gradually raise the specificity of analysis of the knowledge base of expert and proficient nurses while seeking concurrently to evaluate validity of the findings. Reported in Chapter 2, therefore, are the several experimental stages of a knowledge acquisition project which begins the process of constructing this knowledge base. Discussed firstly is the choice of the skill domain to be studied - pressure sore risk assessment. Subsequently, the method of eliciting from nurses top-level and micro-level descriptors of patients is set out. This account of knowledge acquisition ends with scrutiny of the performance of nurse subjects who performed a comprehensive simulated patient assessment task in order that two groups might be established - one Expert and one Proficient with respect to the nursing task. In Chapter 3, an extensive analysis of the data provided by the simulated assessment experiment is undertaken. This analysis, as the most central phase of the project, proceeds by degrees. Hence, the aim is to `explain' progressively more of the measured cognitive behaviour of the Expert nurses while incorporating the most powerful explanations into a developing cognitive model. More specifically, explanations are sought of the role of `higher' cognition, of whether attribute importance is a feature of cognition, of the point at which a decision can be made, and of the process of deciding between competing patient judgements. Interesting findings included several reliable differences which were found to exist between the cognition of subjects deemed to be proficient and those taken as expert. In the final part of this thesis, Chapter 4, a more formal evaluation of the computer based cognitive model which was constructed and predictions made by it was undertaken. The first phase involved analysis in terms of process and product of decision making of the cognitive model in comparison to two alternative models; one derived from Discriminant Function Analysis and the other from Automated Rule Induction. The cognitive model was found to most closely approximate to the process of decision making of the human subjects and also to perform most accurately with a test set of unseen patients. The second phase reports some experimental support for the prediction made by the model that nurses represent their patients around action-related `care concepts' rather than in terms of diagnostic categories based on superficial features. The thesis concludes by offering some general conclusions and recommendations for further research.

There has been a concerted effort to enable a managed response to the delivery of mental health care. This has been made through various Government in initiatives such as'general management and clinical audit. Methods have developed,such as a care pathway to control the way care is delivered along planned treatment trajectories. In this qualitative study the researcher explored h ow respondent so n a psychiatric ward and community team developed a care pathway for people suffering from schizophrenia, including the process of admission and discharge from hospital. Findings from this study showed that respondents argued for the individuality of the patient in shaping the way care should be delivered. Individual clinician-patient relationships and the unpredictable nature of schizophrenia were also important factors. Other respondents pointed out that some aspects of the systems of care could and should be standardised such as the procedures for finding accommodation upon discharge. The difficulty in describing the process of care influenced perceptions of evidenced-based are. On the whole, respondents were in agreement with the necessity to use evidence to drive the delivery of care. The purpose of a care pathway is to work in a coordinated way and this is reliant on knowing how interventions are known to work. Findings from this study demonstrated that clinicians were not always aware of how or why they carried out psychiatric interventions. Over the span of time covered by the study, while the care pathway was being developed and implemented, various external factors had a significant influence. Particularly influential was the rapid turnover of staff on the study ward and the impact this had on motivation for developing and implementing the care pathway. Important too were the approaches taken by the researcher and how the respondents perceived this. These finding are relevant for other health service areas that employ large numbers of temporary staff and staff groups that feel disenfranchised by managerial approaches. Using a care pathway to deliver care has implications for the training of all discipline members and for the way they work together. Ultimately, the acceptance of a care pathway for psychiatric services will be influenced by the way in which they are perceived by clinicians and managers, each of whom have different interests to be served.