Introduction and Background Talent management (TM) is described as an organisational process led by senior leaders that encompasses core components including; defining, attracting, developing and retaining talented employees to best meet strategic business objectives. In the pressing contemporary context of global financial and workforce challenges, including national nursing shortages and an aging population with increasingly complex health and social care needs, it is essential to ensure that nursing can compete with other industries to attract, develop and retain the full potential of the current and future nursing workforce. A review of the literature revealed TM as an emerging concept, a subject more commonly associated with business and Human Resource Management literatures rather than healthcare and nursing. Whilst there are numerous definitions of TM, two primary organisational approaches to TM were identified, inclusive and exclusive. This research addresses the lack of empirical studies relating to TM in nursing in the NHS. Aims The research primarily aimed to engage clinical nurses in an exploratory case study of one large acute NHS trust, to gain new insights and knowledge into how TM is emerging as a concept within nursing. I aimed to explore nurses’ perceptions, lived experiences and possibilities of Talent Management. The secondary aim was to contribute to the development of TM in nursing within one acute NHS trust and to the emerging debates on TM in nursing in national and international contexts. Objectives • To identify how participants define talent in nursing • To identify what participants see as the challenges of talent management and how talented nurses can be effectively attracted, developed and retained • To identify areas for further research and contribute to the emerging debates on TM in nursing. Methodology A qualitative case study employed focus groups, one to one interviews, documentary sources and wider consultation involving 229 staff nurses. A thematic analysis of qualitative data was utilised and findings triangulated with other data sources, including a wider consultation. Findings Three common themes were identified; Nursing as talent, ward leadership and culture and career development. The findings were examined within the context of nursing as a gendered occupation. They identified a challenge for nurse participants in describing talent in nursing; nurses did not spontaneously describe what they did as talent. The image of nursing and public and media perceptions were identified as a concern when aiming to attract, develop and retain future and existing talented nurses. There was felt to be a lack of recognition and reward for nursing talent, a lack of clear career pathways and the impact of the local manager on talent development was influential. Talent in nursing could sometimes be viewed as negative, seen as a ‘disruption’ if individuals did not conform to existing expectations influenced by the leadership and local culture within a ward or department. In addition there was a need for greater recognition of Black and Minority Ethnic (BME) nurse development. The need for an inclusive approach to TM in nursing, creating an environment where all nurses felt engaged and valued with opportunities for education and development was identified. Conclusions This study contributes new knowledge identifying what participants regard as important in the development of TM as an emerging concept in nursing. Nurses were proud of their roles but felt undervalued and had no readily accessible point of reference for aspirational standards of excellence or talent in nursing. The majority aspired to clinical careers but career pathways in nursing were regarded as invisible. Nurses wanted to be recognised for their contribution, skills and talents and valued and engaged in the workplace. Recommendations include; a need for greater clarity in nursing career pathways, careers guidance for nurses, including the development of clinical career ladders for staff nurses, a need to improve managers’ skills as talent developers and explore inclusive approaches to TM. There is a need for Directors of Nursing to make TM important at all levels within an organization. To meet the healthcare needs of the population developing talent in nursing also needs to be considered wider than the boundaries of individual wards and specialities. Further research is recommended including; evaluation of approaches to TM, strategies for nurse retention, nursing career pathways and exploration of means to identify and recognise excellence in nursing.

The literature suggests many positive benefits of Group Clinical Supervision (GCS) with pre-registration students facilitated by lecturer supervisors. It helps students hone their reflective and critical decision-making skills, and engagement demonstrates working with peers is strongly linked with developing self-awareness and empathic understanding of others. It normalises shared practice experiences and is experienced as supportive and restorative. However, positive findings of GCS are enhanced when the learning environment feels safe and sensitively facilitated and reduced when this is diminished. In addition, several issues are identified as problematic, intriguing or unexplored. These include; methodological approaches, group and supervisory relationships, perceived coercion versus engagement, perceived value of challenge, lack of clarity around the operationalisation of functional and reflective models, differing experiences of men and women. It is argued that the analytic method known as conversation analysis (CA) addresses some of the methodological concerns in the literature and uncovers how social action in GCS is played out through talk-interaction. Nine two-hour sessions of GCS were filmed with a convenience sample recruited from one post graduate entry cohort, of pre-registration student nurses over a twelve-month period, encompassing sessions including four different lecturer supervisors. Talk was selected, transcribed and analysed to reveal how participants orient to each other’s conduct. Three clear themes emerged from the findings; power, challenge and empathy. Power; supervisors were apt to remind student participants of inferential frameworks and the multiplicity of roles influencing their relationships. As these reminders were embedded within the talk-interaction, there was frequently an accountability for participants to respond in an expected way potentially compounding disempowerment and oppression already experienced as a subordinate group in the practice setting. A Foucauldian perspective recognised concern raised in the data about surveillance through the supervision process and through filming itself. Challenge, is conceptualised as a facet of reflective learning. However, the findings in this study note that aspects of challenge and confronting were conducted in a tentative way, and participants were wary of making what is private, public. Mezirow’s theory of perspective transformation and Freire’s work on emancipatory education are used to theorise how a more critical approach to reflection can be developed empowering nurse’s own emancipation. Further findings underpinned by Rogers’ core conditions for a conducive learning environment suggests that whilst supervisors play a critical role in facilitation of GCS, it is the unmediated empathy of peers that provides the restorative support so valued by student participants. The experience of men in this study did not emerge as of local procedural relevance in the CA however, it is posited this may have been associated with the membership bias of the researcher as a woman and suggests this topic needs focused attention in future research. This study responds to the call for renewed expansion in clinical supervision research agendas. The value in employing a new way of exploring the experiences of participants in GCS has led to providing a more detailed picture of interactional practice and added new dimensions to understanding. The potential for using a similar methodology in other facilitated small group settings where person centred approaches are central to their process, has been presented. The impact of co-constructed narratives towards either increasing or distancing shared empathy may be illuminating in a range of settings where such relationships are critical.

This thesis measures and explores the perceived work related stress (WRS), job performance, social support and intention to stay among immigrant nurses in a multicultural nursing workforce in a diverse cultural setting at Sultan Bin Abdul-Aziz Humanitarian City (SBAHC), Riyadh region. The present research addresses gaps in the empirical literature by investigating the key work stressors experienced by immigrant nurses working in the Kingdom of Saudi Arabia (KSA) and by establishing nurses’ referent levels of work stress, social support, job performance and intention to stay in their current job. In addition, the research explores the complex relationships between work stress, social support, intention to stay and job performance. The job demand control-support (JDC-S) theory (Johnson and Hall 1988) provides the theoretical background for the thesis. This theory proposes that strain (i.e., work stress) occurs when demands (i.e., work stressors) exceed coping resources (e.g. social support). This research utilizes the case study mixed methodology approach incorporating a quantitative questionnaire survey and qualitative semi structured interviews. The eligible participants comprised 321 nurses 246 (76%) of whom returned their completed questionnaires. For the qualitative component of the study, a purposive sampling strategy was used; 20 nurses were interviewed using a semi-structured interview technique. The quantitative data revealed that nurses’ perception of WRS was occasional. The most common stressful event was Treatment” and “Death and Dying”. The reported mean for the overall job performance scale was high. The highest reported mean of the job performance subscale was for “Professional Development” and “Critical Care”, and the lowest mean was for “Leadership”. Moreover, male nurses reported higher level of stress than female nurses; the higher the number of patients, the higher the reported mean of stress by nurses. The reported mean of the Intention to Stay Scale [McCain Behavioural Commitment Scale (MBCS)] was moderate indicating that most nurses reported that they have a neutral perception of willingness to stay in their current placement. The qualitative phase indicated that the nurses within this environment were experiencing high levels of WRS and struggling to achieve cultural competence; consequently, they were having difficulties in meeting the patient’s cultural and spiritual needs as well as maintaining a high standard of care. Importantly, there was inadequate support by the organisation or supervisor to manage WRS. Nurses perceived their job performance as high, and they intended to stay at work due to the financial benefits they get compared to their home country. Immigrant nurses felt discriminated due to the pay difference. In conclusion, the present research further contributes to our understanding of WRS, social support, job performance and intention to stay among immigrant nurses in KSA. The present study demonstrates that immigrant nurses in KSA are stressed; there was a significant difference between the qualitative and quantitative results.

Lean Thinking (Lean) is a management philosophy originating from the Toyota automobile manufacturing company in Japan. Lean has been widely adopted in the United Kingdom (UK) National Health Service (NHS) as a panacea for addressing challenges that threaten its sustainability. Attempts to evaluate the outcomes of Lean implementation, in order to assess its claims to improve efficiency, quality and safety, have proved challenging owing to ambiguity surrounding the definition of Lean, differences in approaches to, and the poor quality of literature reporting, implementation. Lean continues to be adopted in healthcare regardless however, and a body of literature considering the consequences of Lean more broadly, is suggestive of implementation holding other, far-reaching implications. In attempting to transform healthcare culture and the way in which work is physically and socially structured, managed, organised and delivered, Lean can be understood as a socio-cultural intervention, holding the potential to transform the socio-cultural milieu of healthcare practice. There is, however, a dearth of research considering the nature of this transformation, the interaction between Lean and the socio-cultural context of practice, healthcare professionals’ experiences, understandings and interpretations of implementation, and the implications that it holds for them. This is especially true in the context of Lean applied to nursing. Theoretically, owing to its managerialist associations, Lean presents challenges to essential facets of nursing as a profession, its socio-cultural foundations and identity. Other ‘empowering’ characteristics of Lean philosophy however, are congruent with increasing autonomy and control over practice, associated with nursing’s professional agenda. Lean implementation can therefore be conceived of as representing both a challenge to, and as proffering opportunities for, the nursing profession. Underpinned by feminist philosophy and employing an ethnographic methodology, the thesis explores the lived reality of Lean implementation for nurses working in three settings at an NHS Hospitals Trust, and its meaning for nursing’s professional project, identity and mandate. The lived reality of Lean is conceptualised as a game played between the Trust and nurses, for power and control over nursing practice. The organisational rationale for, and mechanisms of, exercising power under the guise of Lean are explored, together with the nursing response, incorporating strategies to preserve the socio-cultural status quo and protect nursing knowledge, autonomy and practice. The notions of ‘power’ and ‘holistic, person-centred theory’ are employed as conceptual vehicles, through which the lived reality of Lean and its meaning for nursing, are critically explored and understood. The traditional ‘powerless’ depiction and ‘project’ of nursing, are challenged in light of empirical findings. The positioning of Lean as a contemporary scapegoat for a theory-practice nexus, and the role of antagonising factors intrinsic to nursing itself, are considered. The utility and feasibility of the nursing project and identity, predicated on a holistic, person-centred model, is also questioned. In this context, the notion of ‘organisational collaboration work’ is introduced, and advanced as a recommendation of the thesis, as a potential means of extending nursing’s mandate, to better meet the needs of organisations, patients and nurses in contemporary healthcare.

With the advances in technology and computers, e-portfolios replaced paper based portfolios in many higher education institutions and professions, including nursing (Skiba, 2005; Garrett and Jackson, 2006). They both have some overlapping benefits but the most important benefit of eportfolios over the paper based version lies in its potential for meaningful interaction and network structure (Butler, 2006). The existing literature, therefore, suggests that e-portfolios may have some added pedagogical value. Understanding this added value through research can provide valuable data for academic, clinical and administrative staff on how to implement and use e-portfolios effectively to support students’ learning. According to the literature review, there was a lack of a detailed and comprehensive study on benefits and challenges of using e-portfolios for nursing students. Hence, this study explored the pedagogical value of eportfolios and the contextual challenges that influenced its effectiveness as a learning tool from the perspective of the key stakeholders: students, tutors, and curriculum planners. The study used qualitative instrumental case study to collect data through initial and follow up interviews, online observation and document analysis. The data were collected for a period of 21 months. The participants in this study included 14 students, 11 tutors, and 6 curriculum planners. The study employed critical realism as philosophical approach and Activity Theory as a methodological and analytical framework. This study contributes to the literature through being the first longitudinal empirical inquiry in nursing education that adopted Activity Theory to explore the pedagogical value of e-portfolios and the contradictions that may influence their perceived value from student and tutor perspectives. The findings of this study show that the e-portfolio allowed for a more student-centred approach to learning through providing these four affordances: (1) Fostering communication and interaction between the students and their peers and tutors. The findings indicated that the e-portfolio allowed for a flexible, instantaneous and ongoing online communication that helped the students to stay connected, seek feedback and support share their work, experiences, and any personal information with their tutors and raise their awareness of any issue they thought would have an impact on their learning and progress, at any time and from anywhere using their mobile devices. It also allowed them to create and participate in different online learning communities with their peers to exchange experiences and ideas, learn from and support each other. (2) Supporting formative assessment through facilitating formative feedback and self-assessment. The eportfolio offered the tutors unlimited and flexible access to any work shared by their students, and this enabled them to formatively assess their students’ performance and progress towards achieving the desired learning outcomes, spot more quickly those who were struggling and in need for remediation, and provide them with immediate and more personalized feedback specifically tailored to their needs. Moreover, the reflective nature of the e-portfolio and its structure encouraged continuous self-assessment through prompting the students to iteratively look back and reflect on their collection of evidence and experiences. This iterative process allowed them to develop a better understanding of their own strengths and weaknesses and engage in selfdevelopment, make connections between their seemingly disparate learning experiences, hence, see a comprehensive picture of their learning. (3) Scaffolding the reflective process. The findings indicated that e-portfolio, through its inbuilt structured reflective templates, acted as a scaffold for the students who were struggling with writing reflection. These templates were perceived to have made their attempts at reflection easier and stimulated them to think deeper about their experiences. Improvement in their reflective writing was noted by some tutors and students after using the templates for a considerable amount of time. (4) Allowing for multiple modes of presentation and self-expression. The multimedia capabilities of the e-portfolio allowed the students to present evidence of their learning and express their thoughts and feelings in variety of modes such as videos, images, audios, and texts. Creating and combining multimedia evidence and materials enabled for presenting a more realistic and authentic view of their experiences and integrating information from different sources to show the multifaceted nature of these experiences. Interestingly, being able to present learning and achievements in multiple modes encouraged the students to view the e-portfolio as a potential tool to apply for jobs after graduation. With regard to the challenges and contradictions, mainly secondary contradictions emerged in the context in which the e-portfolio was used. The majority of these contradictions, for example, technical issues, the tutors’ perceived complexity and inefficiency of the e-portfolio system, the students’ underdeveloped digital literacy, and the limited access to computers on placements, have had a short term or less harmful effect on the use and the perceived value of the eportfolio. But, contradictions such as the mismatch that existed between the students’ expectations and the tutors’ perception of the frequency and adequacy of feedback that needed to be given in the e-portfolio appears to have had a more detrimental effect on the students’ motivation to use the e-portfolio.

Ethnography; Compassion; Compassionate care; Nursing A series of healthcare scandals over the last 15 years in the United Kingdom (UK) National Health Service (NHS) generated a vigorous public and professional debate. Within this debate, care failures were framed as a ‘lack of compassion’ and, specifically, a lack of compassion in contemporary nursing. The healthcare policy response was to rapidly implement a values-based strategy that aimed to ‘embed the principles of compassion and caring’ (DoH, 2014) in healthcare staff. The strategy progressed, despite evidence suggesting that healthcare professionals valued compassionate care (Maben et al., 2007b, Newton et al., 2009, Glazer and Beehr, 2002). Significant changes were made to nursing recruitment, regulation and education, with the explicit intention of prioritising compassion. The research response to the NHS care standards debate has also focused predominantly on the values of NHS staff, and has inadequately represented the contextual contingencies of practice. This study aimed to develop an empirically informed descriptive and explanatory understanding of compassion in a healthcare setting. The objectives were to examine the key elements of the phenomenon and how participants constructed and enacted compassion. The study was a constructionist ethnographic design set in one NHS hospital ward. Participants included various staff groups, patients and relatives. Fieldwork lasted one year and included over 150 hours of participant observation, 70 informal interviews and 30 recorded interviews. Analysis involved thick description of ward life, and thematic, key-event and deviant-case analysis. Theories of compassion, psychological research and a sociological perspective were employed as analytic lenses. Themes included contextualised compassion, compromised compassion, receiving compassion, and the role of threat and safety. I found compassion in the ward setting was constrained by a tangle of micro- and macro-level contingencies which shape the experience of giving, and receiving, compassionate care. The contingencies of the clinical context were frustrating to staff and patients and led to an inconsistent quality of care. All actors contributed to the dynamics of compassion on the ward. I found that staff valued compassion as an aspect of their care, and for some it was part of their identity and gave meaning to their work. Patients also valued compassionate care, felt comforted by it, and responded positively, which in turn was uplifting for staff. Unexpectedly, some patients struggled to recognise, trust or feel relieved from compassionate care. I found that a sense of threat dominated the ward culture, which was evident in the language and practices of staff, and could inhibit their capacity to engage compassionately with others. However, when the organisation provided positive practical support, compassionate care often flourished. This study contributes the notion of ‘constrained compassion’ as a descriptive and explanatory framework for understanding the phenomenon in the ward setting, and evidences that threat and safety, compromise and cost are inherent in its enactment. It demonstrates that theoretically-informed compassion research can be beneficial, and highlights the value of cross-disciplinary approaches to compassion scholarship. The study also demonstrates the strengths and limitations of process- and values-based theories of compassion and argues that conceptualising compassion as a context-dependent process can broaden the possibilities of future nursing research. In terms of policy, this study argues that healthcare strategies must take a broader, research-based approach. Furthermore, it recommends the urgent acknowledgement and investigation of the contextual barriers to care. Embedding positive, practical and pastoral staff support within organisations should be a priority. Rather than aiming for ‘compassionate staff,’ healthcare organisations may benefit from making multidisciplinary efforts towards developing compassionate healthcare environments.

Culture is a complex concept, but it is central to the task of curriculum design and development. The Ministry of Health (MoH) in the Sultanate of Oman plays a major role in healthcare education because it is the main employer and producer of healthcare professionals in the country. The MoH claims that its educational programmes are designed to meet the healthcare needs of the country at international standards, with ample consideration to the culture. As nursing is the major profession that the MoH invests in, produces, and employs, the purpose of this study is to explore the MoH’s approaches to designing, developing, and implementing the current basic (general) nursing curricula and its cultural congruency in the context of Oman. A qualitative case study design is used to answer the research questions. Educational policy documents, semi-structured qualitative individual interviews and focus groups have been used to collect data from the MoH’s nursing education decision makers, educators, students and service users (public) over a period of six months. Data was analysed using RichieRitchie and Spencer’s five-stage analytical framework to identify the themes from the data collected from the documents and the interviews. A purposeful sampling was used to select study participants from the MoH nursing education decision makers, educators, students and service users. Findings of the study reveal that the MoH’s current approach to nursing curriculum fails short of what Denis Lawton considers a culturally competent curriculum. The study proposes a framework, adapted from Lawton’s cultural analysis model, aimed at developing culturally congruent nursing education in Oman.

Background: At the inception of this research the academic level of pre-registration nurses education in England was receiving significant attention in the public and professional press. This was as a result of the decision to increase the minimum academic entry level from a Diploma in Higher Education to a Degree which created a contested climate amongst practitioners, educationalists and current students. A complex background turbulence was present surrounding nurse education, which incorporated both pro and anti-intellectualist positions with frequent contradictions made by those who are attempting to stand within both camps. Within this unsettled environment, the Division of Nursing at the University of Nottingham implemented a Graduate Entry Nursing (GEN) programme. This thesis took advantage of the unique opportunity to explore the experiences of the first cohort of students on this programme in practice. Aim: To explore the way in which GEN students present and position themselves in practice in response to perceived stereotypes, media representations and the agenda of practice and education institutions. Method: The study adopted a longitudinal case study design conducted over a 2 year period. It encompassed data arising from GEN students (n=8), mentors (n=12) and clinical assessment documentation which was generated through diaries, interviews and focus groups. A time-series analysis was conducted on the student data which identified how salient issues related to the research aim were expressed amongst participants over time. Data arising from other sources was utilised to offer alternative perspectives. These findings were compared to a series of analytical suppositions arising from the existing literature to offer insight into how the data confirmed, contradicted or expanded current knowledge (Yin 1994). Findings: The findings demonstrated the interplay of performance strategies adopted by GEN students to challenge or pre-empt the impact of actual or perceived negative stereotypes held by mentors and other established practitioners. The students’ desire to appear to comply with the expectations of others arose from an awareness of their dependency on the established practitioner's perception of them as competent. This involved presenting a level of confidence which portrayed competence whilst not appearing arrogant or threatening to those assessing their practice. Numerous inconsistencies were present within the accounts of students and mentors which demonstrated the discrepancy between the publically endorsed position and the privately held adverse stance. Discussion It is proposed that the GEN students take the stance of the expert performer as a result of the life experience and resilience they have developed prior to commencing their nurse education. The mentor is conceptualised as the sceptical audience who is in the process of adapting to the implications of change arising from their response to a different type of nursing program and student entering the profession. The inconsistencies within the participants’ accounts are viewed as unmeant gestures (Goffman1959) and offer insight into the private view of self which challenges the stability of their performance. However, whilst this remains within the private domain and GEN students continue to portray sincerity within their performances, it is proposed that a predominately amicable relational encounter is facilitated despite the continued presence of stereotypes and perceived threat amongst mentors. Conclusion: The transient performance mode adopted by students to navigate the mentor relationship and assessment structures within nurse education is clearly demonstrated in these findings. It remains unknown whether the acceptance of the temporary need to perform as will result in eventual conformity, or if the reflection and resilience documented throughout this study will provide the GEN students with the means of exercising their criticality publically within their future roles and achieve job satisfaction they privately desire. The wider implications of this thesis relate to understanding the rules of the game that students engage in in order to successfully navigate their nurse education in both practice and higher education institutions. This will require a convergence of agendas between education and practice as opposed to the current situation in which both institutions perpetrate their competing interests and the student is required to respond through adopting a variety of incongruent performances.

The aim of this research was to understand the relationship between and the characteristics of computing competence and confidence in student nurses. The absence of a dominant paradigm for ICT, computers and computing influenced the choice of two sequential exploratory quantitative and explanatory qualitative studies. Data for the first study were collected through survey using a postal questionnaire, from a volunteer sample of student nurses. The results from a Principal Components Analysis influenced the second study. This was a recording of simultaneous concurrent think-aloud commentary and the behaviours of volunteer student nurses working in small groups on a computing activity. Protocol Analysis was used to examine a computing task outcomes and concurrent think-aloud comments. The results and findings showed a complex relationship between competence and confidence in this context. Students wanted a combination of teaching and social learning approaches. In both studies confidence had a high representation. This was evident where collaboration and social learning in small groups influenced confidence and competence. Research originality and its contribution to nursing lie first in the use of an innovative combination of methods. Secondly, the grouping and exploration of a range of subtle and seemingly unremarkable phenomena gave unique insight into how student nurses develop computing competence and confidence, not examined elsewhere. Both studies revealed differing levels of ability within and across the academic year groups. The findings show that attention to the social and psychological aspects of learning is crucial for skill and confidence development. Students would benefit from a bespoke range of approaches to suit their individual needs. This requires a balanced response between ongoing assessment of individual needs and proactive teaching and learning provision. Transferable to a wider setting, this research adds to the current understanding of ICT and computer related teaching and learning in nurse education.

The present thesis report research on the role of leadership style related to the quality of nurses' working lives in Taiwanese hospitals. It begins by focusing on the mental health of nursing work forces and questions the applicability of leadership styles employed in different ownership of health care organisations. There is very little literature on this issue and knowledge of how such hospitals function is not clear. The thesis addresses the influences of nursing leadership style at both the individual and organisational levels examining the perception of nurses and developing a research model using Structural Equation Model (SEM). Both the leader's perspective and subordinate's viewpoint were measured. Two studies were conducted which illustrated the perception of leadership style in Taiwanese healthcare settings. The first study was designed as the qualitative study which used in depth interviews with 21 representatives to explore the current organisation status of hospitals and attitudes towards and interpretation of leadership. Study Two was a quantitative study which was informed by the results of Study One and 651 employees participated in a questionnaire survey. This thesis proposed a model of the relationships among the key variables. Analysis of the data based on this model revealed that transformational leadership style contributed significantly to supervisor support. Supervisor support was an important mediator variable that explained the relationship between transformational leadership and job satisfaction and organisational commitment. In addition, the effects of transformational leadership style on the general health well-being of nurses were buffered by job satisfaction and organisational commitment. Organisational commitment was the strongest factor related to the general health well-being of Taiwanese nurses than job satisfaction. The study highlighted the influences of certain aspects of leadership such as mental health outcomes. Leadership is a complex process and may diffuse throughout an organisation. This thesis makes a useful contribution to the literature on the mental health well-being of nurses and provides a comprehensive background of a Taiwanese approach to nursing leadership research.