The aims of this research study were threefold. Firstly, to explore the impact of the strategic arrangements and mechanisms to implement and support practice based learning. Secondly, to investigate the selection processes, preparation, support and evaluation of mentors. Thirdly, to explore the impact of mentorship from the viewpoint of mentors, students, managers and educational links within the clinical learning environment. The study design incorporated both quantitative and qualitative approaches involving a three phased approach engaging three regional sites. The first phase involved a quantitative approach using a survey. Phase one data arose from senior staff in Higher Education Institutions (n = 10) and the National Health Service (n = 22). The results from the survey, which focused on the strategic implementation of practice based learning and the preparation of mentors in Scotland, were used to inform phases two and three of the study. Phases two and three of the research study used a modified grounded theory approach. A range of data collection methods were used to gain information from mentors, Link Lecturers, Practice Education Facilitators, managers and students. Data collection and analysis for phases two and three occurred simultaneously and incorporated the constant comparative method of analysis. Phase two provided data from interviews with mentors across the three regional sites giving a total of 30 with ten participants in each site. Focus groups were conducted with Link Lecturers (n=17); Practice Education Facilitators (n=13); ward managers (n=21) and third year student nurses in the adult branch of the undergraduate programme (n=34). Three major categories were developed ‘Becoming a mentor to facilitate learning in practice' ‘Operationalising the facilitation of learning in practice', and ‘Quality infrastructure optimising learning in practice. From these major categories a core category emerged. The core category ‘Strategic Engagement for a Quality Learning Experience in Practice' captured the process that mentors, Link Lecturers, Practice Education Facilitators, managers and students perceived as their experience related to the clinical learning environment. A tentative theory emerged which addresses the gap between strategy and operationalisation in order to enhance the learning experience in practice. The emerging tentative theory is closing the strategic and operational gap: strategic engagement for a quality learning experience in practice. A model is provided to illustrate how to manage the interface in order to provide quality learning in practice. The study provided useful insight into learning in practice and the roles of staff within the clinical learning environment with how learning maybe more effectively managed and strengthened.

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.

Reflective journal writing has frequently been used in nursing and other health care fields as an educational strategy to promote reflection and learning. Although reflective journal writing is recognised as a valuable tool to promote students' learning, very little research has been undertaken to evaluate its use. The overall aim of this study is to examine the use of reflective journals in the promotion of reflection and learning in post-registration nursing students. In order to achieve that aim a qualitative descriptive case study design was utilised to examine four objectives. The first was to analyse reflective journals completed by students during a period of learning in order to determine the extent and level of reflection achieved. The second, to examine the use of reflective journals as an educational strategy for facilitating learning in the practice setting. Thirdly, there was the intention to examine the nature and content of guidelines given to students with regard to the use of a reflective journal, and fourthly, to examine the support given to students by preceptors in relation to completing a reflective journal during their practice experience. A purposive homogenous sample of eighty one part-time post-registration nursing students undertaking one of four modules, either as part of the Diploma in Professional Studies in Palliative Care Nursing or the Diploma in Breast Care Nursing during one semester constituted the total sample. Forty- two students agreed to participate in the research. Data were collected from reflective journals completed during one module and by interviews with fifteen students, two teachers and three preceptors. Forty-two journals were analysed to determine the extent and level of reflection using a model devised by Boud et al. [1985] and adapted by Wong et al. [1995]. A model devised by Mezirow [1990] was used to identify the non-reflectors, reflectors, and critical reflectors. The findings suggest that student writing can be used as evidence for the presence or absence of reflective thinking. Allocating students to the three categories of non-reflector, reflector and critical reflector was possible. However, identifying textual elements within the journals and allocating them to the finer levels of reflection was more difficult and less reliable. Evidence suggests overall that journals are a useful tool for promoting reflection and learning. However, some students appear to benefit more from journals than others. Approximately two thirds of the respondents were able to demonstrate varying levels of reflection and were classified as either reflectors or critical reflectors. The remaining one third of the respondents were unable to demonstrate any levels of reflection. Overall respondents expressed positive views, regarding the use of reflective journals. However, a small number found writing challenging and some questioned their use. Some respondents preferred to talk about their reflections rather than write them in a journal. The importance of receiving clear guidance on the purpose of journal writing from teachers, and the need for non-judgemental feedback were highlighted as important factors in promoting the effective use of journals. Some concern was expressed regarding the disclosure of confidential information, and also who would have access to journals when used for assessment purposes. The issue of the time required for reflection and writing a journal was a major concern for some respondents. Students valued the role of preceptors in supporting their journal writing during the practice experience. Preceptors considered that the preparation they received for their role was adequate. However, they did request debriefing sessions following their support of students who had experienced difficult situations. This study has presented further evidence that overall, reflective journals may be used as a tool to promote reflection and learning in post-registration nursing students.

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.

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.

The study is about the experience of Arab University students whose main subjects are taught in English. It investigates and discusses many English language problems in the Kingdom of Saudi Arabia in teaching, learning and studying medicine, pure science and technical English. In general, Arab learners of the English language encounter problems in the four skills of the English language, in speaking, writing, reading and listening. They also show weaknesses in many aspects of the English language such as vocabulary, grammar, pronunciation, spelling, morphology and syntax. The question is how these language difficulties affect their studies in medicine. The initial hypothesis was that all depended on the students’ facility in English, but this turned out not to be the case. The research started with the analysis of students’ written replies to questions. This was followed by the development of a questionnaire distributed to 736 medical students. This explored various factors in relation to their success in exams to find out which factors might be significant. There were few correlations between success in medical exams and previous encounters with the English language. The one correlation between the test results and the questionnaire findings was not the uses of and familiarity with English but the parents’ background. The research therefore went on to explore, through interviews, and analysis of written statements, the students’ attitudes towards the teaching of medicine in relation to the use of the English language. It was found that the hypothesis of the importance of English as a prerequisite for success was not borne out. What was discovered was the students’ pragmatic attitude towards their study and that what they thought they needed as medical practitioners depended on a kind of secondary technical vocabulary. The research discusses some of the effects of learning and teaching theories and their relationship to the process of the education system. Whilst social constructivism is held to be the ideal one to apply to the learning process, this research demonstrated that behaviorism and rote learning still dominated the experience of the students in their learning of medicine. Despite their continued commitment to the ideals of learning English, the students took a pragmatic approach to their studies, which consisted of a mixture of Arabic and English medical vocabulary.