This research study employed Q-methodology (Q) to explore the factors influencing e-learning adoption in a nurse education context, and Bourdieu’s Theory of Practice (TOP) to analyse these findings using a case study of one school of nursing in the UK. E-learning adoption has been limited in nurse education despite a wide body of literature promoting its use for improved learning outcomes. Most research studies to date have used surveys to explore the overarching factors influencing academics to adopt e-learning across higher education more generally, but these findings have not identified the underlying issues influencing their responses to these factors, nor do they allow a deep analysis of discipline-specific factors. This study identified four groups (Factors) of academics each responding differently towards e-learning in their teaching. The first group represented the ‘e-advocates’ who saw technology as having the potential to improve nurse education by giving more control to learners and preparing future nurses for their evolving role in health care. The second group represented the ‘humanists’ who although sharing similar pedagogical beliefs as the first group had not been motivated to engage with technology because of the value they placed on human interaction. The third group was described as the ‘sceptics’ who had had previous negative experiences with e-learning and were unconvinced about technology’s ability to improve learning outcomes. Finally, the fourth factor, the ‘pragmatics,’ although ostensibly positive in their views towards e-learning, held different pedagogical beliefs from the three other groups and felt it was their responsibility to cover certain content in a face-to-face setting. The unique combination of Q and Bourdieu’s TOP enabled a deeper analysis of the four groups’ views and the socio-cultural context shaping them, thus providing new insights into academics’ responses to e-learning. Moving beyond the binary labels commonly attributed to those considered either ‘early adopters’ or ‘laggards,’ the findings make a contribution to the e-learning adoption literature by revealing a wider breadth of views and responses towards technology. Moreover, this study showed that internal beliefs determined the extent to which external factors were perceived as influential. This serves to explain why some individuals overcome certain barriers to e-learning adoption whilst others succumb to them. The findings from this study will inform policy-makers, e-learning strategists and professional development staff on how to more effectively present and promote e-learning.

There are many situations in healthcare delivery in the UK where nurses are the dominant workforce or have expert practitioners working directly with clients, yet rarely, apparently, are they involved in national healthcare policy development nor do they have significant input into how they are expected to practise. Given the large number of nurses compared to other healthcare professions and the long history of the profession it is not immediately clear why this should be the case. However the impression is that this situation is somehow embedded in our culture and history. One clue here is the widely held perception that nursing is women’s work which in turn reveals an apparent parallel between the historical treatment of women in society and the status of nursing. The lack of value ascribed to the skills of the woman nurse can, I believe, be found in our Christian heritage In this work I have explored this phenomenon by examining the development of nursing through history to try and identify and expose the barriers to nursing being able to lead in public healthcare policy determination. I have used an historiographical approach to review the literature using, where possible, contemporaneous accounts. Through this approach I have highlighted the historical, impact of Christianity on the status and value of women in society overlaid with the struggle nursing has had with the enduring legend of Florence Nightingale. This exposure of nursing’s history and the roots of the embedded attitudes of and towards nurses offers the expectation of its use by nurse educators to better prepare future practitioners to take on the challenge of influencing national healthcare policy in Britain.

In 1991, the United Kingdom (UK) government introduced reforms of the National Health Service (NHS), the most recent in a series of successive rationalisations aimed at increasing accountability and containing the service's costs. These rationalisations featured the strengthening of managerial control over the traditional professions, among them medicine and nursing, a system of contracting between purchasers and providers of healthcare and an unprecedented emphasis on the control and measurement of inputs particularly in terms of workers' activities. This thesis grew out of concerns arising from the author's involvement in a study conducted by the Royal College of Nursing (RCN) into nursing morale and managerial strategy in the wake of these reforms. The study took place in initially four and later three first wave NHS Trusts working in the community sector and ran over three years. Influenced by postmodern philosophy, deconstructive literary theory and discourse analysis, this work places the language and argumentation of managers and many of nursing's leaders within a philosophical context of modernity. Modernity, in this context, is characterised by an appeal to impersonal criteria and procedures, a search for objective, context-free knowledge, and a turning away from the authority of tradition and revelation toward an autonomous use of reason and particular forms of rationality. Postmodern writers argue that reason and rationality have come to be defined in terms that support the values and interests of particular groups and through their globalising claims marginalise other groups and delegitimise their claims to knowledge. In this study managers tended to characterise, at least sections of, their nursing workforce as irrational, fearful and traditional. Nurses described themselves in terms of moral agency and self-sacrifice in the face of exploitation by their managers. This philosophical critique, effected through literary approaches, is offered as a theoretical framework within which to mount offensives on totalising regimes.

The high neophyte nurses’ turnover rate has been recognized as one of the most important issues in Taiwan’s nursing profession. Although Taiwanese nursing researchers have started to investigate the reasons why neophyte nurses’ leave their jobs, most of the studies use quantitative research methodologies. Consequently, we still know very little about how neophyte nurses experience their first year after graduating. Therefore, in order to comprehensively understand more about the phenomenon of neophyte nurses’ experiences following graduation, the research question was posed to guide the study: How do neophyte nurses experience their first year after graduating in Taiwan? The aim of the study was to explore the first year experiences of Taiwanese neophyte nurses. The study was undertaken using a hermeneutic phenomenological approach. The participants were recruited from two sources: a nursing junior college and a healthcare institute in central Taiwan. One hundred and forty-three neophyte nurses from a local junior nursing college and one hundred and thirty-six neophyte nurses from a healthcare institute were the potential participants. Thirty-one neophyte nurses participated in this study. Data were collected via in-depth interviews and analyzed using phenomenological methods. The findings of the study uncovered the phenomenon of how neophyte nurses experience their first year of practice in Taiwan. Three themes emerged from the analysis process, which are: hesitation, a hard beginning, and achievement. Prior to entering work and during their first year of practice, the neophyte nurses felt hesitant. This period of hesitation has not yet been fully discovered either in Taiwanese literature or in that of the English-speaking countries. This is relevant to our understanding of the experiences of the neophyte nurses. When the participants started nursing, they experienced a hard beginning period. They learnt through tears, felt frustrated but also gained others’ support. Then, they recognized that, in order to master the nurse role, they had to go through the transition period. It is important that keep practising nursing in the same unit and not to frequently change their posts during the transition period because entering any new post may need another period of time to adapt to their new role. By gaining positive feedback from the patients and their families, they finally felt a sense of achievement from nursing work. The findings not only bridge the gap in the knowledge of how neophyte nurses experience their first year of practice, but also provide valuable insights for future neophyte nurses, and nurse administrators, preceptors and nurse educators who may wish to guide neophyte nurses. They will also help policy-makers to understand what efforts could be made to facilitate the neophyte nurses’ transition from student to nurse and to reduce the number of neophyte nurses who leave the profession at an early stage.

The Organizational Safety Space Model (OSSM) was developed as a tool to investigate the factors which influence the safety of industrial operations. It is applied in this study to investigate the safety of medication administration in adult critical care settings, including Intensive Care Units and High Dependency Units. In this study, semi-structured interviews were conducted with 33 adult critical care nurses. The participants’ views on the safety of medication administration were analyzed using OSSM. The data suggested that the safety of medication administration is subject to complex influences of many organizational factors. Socio-cultural factors, including lack of questioning culture, the perceived hierarchy of professions and the nature of nursing education, were identified as influential safety factors. Furthermore, organizational complexity and structures created tension between organizational, ethical and structural priorities on one side, and the requirements of safe management of medication in critical care a setting on the other, inevitably leading to tradeoffs among these organizational priorities. Some organizational factors are difficult to classify according to the OSSM and the model is not fully operational in identifying factors related to the safety of medication administration. While the OSSM’ theoretical framework helped to focus on the underpinning safety factors in the organization of medication administration, it remains unproven as an operational tool to understand the full complexities and interplays between the organization structures, professional differences and socio-cultural impacts on the safety of medication administration in adult critical care setting.

Background: Saudi Arabia has always been dependent on non-Saudi nurses. However, the recruitment of these nurses has been challenged by the consequences of the first Gulf War of 1991 and the political unrest in the Middle East ever since. Moreover, the annual supply of Saudi nursing graduates has been insufficient in meeting the demands of the expanding healthcare services. Indeed, Saudi nurses make less than 30% of the total nursing workforce Kingdom wide. The Saudi literature links the shortage in Saudi nurses to socio-cultural factors found to influence the prevailing negative images and perceived low status of nursing. Hence, I have developed a personal interest to explore the impact of prevalent images and perceived status of nursing on the Saudi nurses’ perceptions of nursing as an occupational choice. The reviewed literature guided the development of a framework for my study using six concepts. Aim: To gain an understanding of the social, cultural, economic and political influences on Saudi nurses’ perceptions of nursing and their impact on recruitment of nursing students and retention of graduates. Method: Sixty eight semi-structured interviews were conducted in Jeddah, Saudi Arabia with a sample of student nurses (n = 38), staff nurses (n = 21) and senior nurses (n = 9) from government and private sectors. A purposive sampling approach increased the likelihood that the variability within nursing was represented in the data. A focus on the inclusion of Saudi male nurses is unusual; it allowed this study to explore gender issues in more depth. The interview guides covered selected concepts derived from the literature. These include: nursing images; status of nursing; perceptions of nursing as an occupational choice; nursing education; gendered-nature of nursing and nursing support systems. Interviews were conducted and transcribed in Arabic and participants were interviewed once. A socio-demographic checklist was filled at the end of each interview. Findings: Findings were presented using three explanatory themes. First, perceptions of nursing suggesting that, against a background of negative gender-related perceptions of nursing, there is an increasing recognition of nursing as a secure occupational choice in a shifting labour market. Second, challenges facing professionalism suggesting that participants acknowledged the importance of achieving a recognised professional status for nursing. Third, dealing with personal struggle suggesting that participants have been experiencing a personal struggle as they were learning to cope with the prevalent negative perceptions of nursing at social and professional levels. Conclusions: Findings from the study provide evidence of a personal struggle female and male participants have been experiencing in their attempts to transcend through shifting gender, social, cultural, economic and global boundaries. A struggle they had to deal with in order to achieve social and professional recognition. Overlooking causes of struggle might risk Saudi nurses’ recruitment into and retention within nursing. A new model for the Saudisation of nursing workforce has been proposed. Policy makers are requested to divert their strategies from focusing only on graduates from the nursing programmes to targeting Saudi school children. They are expected to design and implement Saudisation strategies that aim at changing the prevailing gender-related perceptions of nursing as an occupation among prospect candidates; and building on the nurses’ efforts to achieve professional recognition and integrate success in their career with their personal life.

In the context of one Intensive Care Unit (ICU) and one High Dependency Unit (HDU), this thesis explores and analyses the nursing contribution to the development of critical care. This comprises over more than half a century, focussing on nurses' relationship with, and perceptions of one 'technology', weaning from mechanical ventilation, as part of everyday nursing practice in the new millennium. My findings suggest that nurses take a task-focussed approach to weaning, treating it as a `medical' technology transferred to them from doctors, rather than seeing its potential to become a ‘nursing technology' in which the nurse is enabled to transform weaning into a way of implementing care in order to improve patient outcomes. Analysis demonstrates when nurses work in this way weaning is delayed and as a result patients will be exposed to greater morbidity and mortality. Theoretically, my argument builds in particular on Sandelowski's (1996, 1997,1998,2000,2000a, 2000b) work on the nursing – technology relation in which she describes how technology has shaped nursing practice and was shaped by nursing practice. I build on Sandelowski's ideas to develop two concepts that are central to my argument: technology transferred and technology transformed. I have used an ethnographic approach to study nurses using technology in the work place. The empirical data were obtained through fieldwork on one critical care unit in a large teaching hospital in the Midlands over a six-month period. The methods include participant observation, interviews with twelve nurses and the collection of over two–hundred and fifty hours of field notes. My study of the nursing role in critical care contributes new knowledge to two fields: first, the history of intensive care as a specialism within the wider development of the National Health Service (NHS). My work adds to this literature by making visible the nursing contribution to that development and, in the process, raising a question about the extent to which previous histories may have been misleading: these (see for example Lassen 1953, Hamilton 1963, Ibsen 1966, Hilberman 1975, Pontoppidan, Wilson, Rie & Schneider 1977, Cule 1989, Crocket and Mercer 1995, Gilbertson 1995, Le Fanu 1999, Kesecioglu 2000) have tended to assume that its development was a result of new medical technology. Second, is the literature on 'technology' as it relates, to nursing. I believe that my definition of a 'nursing technology' makes it possible for the first time to put structures in place which will transform nurses' contribution to patient care, improving patient outcomes. I conclude that rather than extending and expanding their roles through the transfer of technology, nurses transform those technologies that preserve the nursing role and can contribute to positive outcomes for patients. Only in this way will the nursing contribution to the development of critical care be recognised and valued.

Caring for a relative or friend with Multiple Sclerosis (MS) may negatively impact the quality of life (QoL) of carers. However, in the existing literature, there are no adequate scales available to measure MS carers’ QoL due to the lack of satisfactory conceptualisation and operationalisation of QoL in MS caregiving. This has limited the ability to have a consistent body of evidence to guide further MS carer QoL research and practice. Therefore, this research aimed to systematically investigate the factors that enhance or compromise the lives of MS carers by utilising the theoretical construct of QoL. In so doing, the research sought to develop and validate an MS-specific QoL measure for informal carers (MSQoL-C). A sequential mixed-methods approach was utilised to explore QoL among MS carers and to inform the development of the MSQoL-C. First, a meta-synthesis of 17 qualitative studies on MS informal caregiving was conducted (Study 1) to improve the conceptual understanding of the experiences of MS carers. The synthesis resulted in 9 inter-linking themes: Changes and losses; MS and patient-related challenges; caregiving demands; burden of care; future concerns; external stressors; support; coping and motivating factors. This synthesis presented a model for MS caregiving and a preliminary list of operationalisations of QoL that needed further exploration. Second, in order to explore the QoL of MS carers and investigate the factors that enhance or compromise their QoL, a photovoice study (Study 2) was conducted with 12 MS carers. Study 2 established that MS carers often experience MS caregiving-related challenges, personal losses and changes, negative emotions, an urge to escape and a unique sense of anxiousness over the unpredictability of their MS carer role. However there were also some positive elements that emerged, such as the happy moments and the supporting role of loved ones, that helped ameliorate these negative events and enhance QoL. Study 3 was an online interview study conducted with six MS carers in order to triangulate the findings from Studies 1 and 2, and to derive a more comprehensive understanding of the QoL issues in MS caregiving. Interview data were analysed using Interpretative Phenomenological Analysis and findings yielded three super-ordinate themes: Difficulties of MS caregiving, Satisfaction/Dissatisfaction with life and Consequences of MS caregiving. Study 3 provided further support that QoL of MS carers is substantially compromised and that they experience a number of unique MS-specific obstacles within their caregiving role. Finally, the findings from these three studies informed the development of the MSQoL-C, and a pilot study (Study 4) was conducted to test its psychometric properties. The MSQoL-C was found to have good congruent validity, internal consistency and test-retest reliability. It is envisaged that the MSQoL-C will provide an understanding of the factors that impact upon MS carers’ QoL, and will be useful to implement and evaluate therapeutic interventions.

Background: Many problems of incivility/uncivil behaviour have been faced by nursing education globally from disrespectful to violent behaviour. However, most research on this subject has been carried out in Western countries with regard to psychological viewpoints (e.g. physical and emotional disadvantages). Indonesia is an excellent case study as a developing country with over 700 ethnicities and diverse socio-economic backgrounds and six official religions; these conditions can shape behaviours in nursing education. Purpose: To develop a model to provide an educational framework of the techniques and strategies of teaching and learning for managing civility in nursing education that is congruent to Indonesian culture based on nursing students and academic staff’s perceptions. Method: Multiple-case study research design. Respondents (students and lecturers) were purposely sampled from two nursing faculties (private and public) in West Indonesia. University IRB and settings approval were obtained. Data collection was by survey, observations and semi-structured interviews from September 2012 to April 2013. Findings: Uncivil behaviour in nursing education is a vital problem that needs to be prevented. It is affected by individuals’ cultural backgrounds and professionalism in context, including religious beliefs and values. New understandings for managing uncivil behaviour in this context were identified. Improved understanding of individuals’ backgrounds can manage uncivil behaviour in nursing education. Strategies for addressing uncivil behaviour in nursing education include effective communication and relationship, self-awareness, role modelling and effective rule implementation. Limitations: Despite the high participation rate and the demographic homogeneity of the sample (although only one Hindu was recruited), the two nursing faculties are located in West Indonesia, which limits generalisation for nursing education in Indonesia as a whole. Future research could explore incivility from nurses’ perspectives.

Since the late 1990s, the UK Government has a policy to support Widening Participation (WP) measures in UK universities. These measures aimed to increase the demographic and socio-economic profile of the undergraduate student population across all UK universities. The target for these measures includes a focus on mature applicants, women entrants, and ethnic minority representation. Latest data (2010/2011) from the Higher Education Statistics Agency (HESA) indicates whilst by far the largest proportion of full-time entrants to undergraduate places are the ‘traditional’ 19 year entrant with A level qualifications (288,590). By comparison a further 77,155 entrants are mature, those aged over 21, who have gained a variety of accepted entry qualifications. One such recognised qualification is that of an Access to Higher Education Diploma. The Access programme is usually undertaken by mature students, with no previous qualifications, who after successful completion of a one-year full-time course are then able to apply for an undergraduate course. It is estimated that one in four mature entrants will enter a university course with an Access qualification (HEFCE, 2006). Against a backdrop of a changing and more diverse student population, a discourse has emerged around the retention of HE students. Current data suggests that one in every twelve undergraduates will leave their university programme in the first year of study (Thomas, 2012a). The attrition of students who have entered university is not only an economic cost to the institution and the individual but is considered a wider social cost. Within the body of work on student retention there is an emerging focus on pre-registration nursing programmes, which were traditionally delivered in nursing schools attached to hospitals but since the 1990s are now delivered in HE institutions. Historically there have been concerns about the levels of student attrition from all nursing programmes and this has continued to the present day with individual Schools of Nursing and the Department of Health trying to address the issues around retaining pre-registration nursing students. Concerns around student retention have given rise to a prolific and substantive body of work around HE student retention both in the UK and wider afield, with much of this work underpinned by the seminal work of Tinto (2002, 1993). Studies on student retention agree that understanding and addressing the issues of student retention is complex, with multiple reasons why students leave early. The largest proportion of research undertaken on UK pre-registration nursing programmes have focussed on the reasons why students leave pre-registration nursing programmes rather than what makes them stay. The research questions asked in this thesis are not around student retention, although this phenomenon provides a backdrop to the study, but around learner persistence by mature Access entrants on UK pre-registration nursing programme. This research raises important questions about what is enabling mature entrants to persist on their programme, since data indicates that mature entrants account for 46% of all nursing students who enter pre-registration nursing programmes in the UK. This study is located in one large UK School of Nursing that attracts over 19% of their student cohort as mature Access entrants. This study follows nine individuals through their second year of a three-year programme to understand their transition, through this mid-point year, as an understanding of the transitions for these mature entrants is currently lacking in the literature. The nine participants were recruited via an electronic survey and were interviewed on three occasions throughout their 2nd year of a DipHE/BSc pre-registration nursing course in order to gain an understanding of their lived experiences as mature Access entrants. Data analysis in this study utilised Glaser and Strauss (1967) classic grounded theory (CGT) methodology. The findings from this CGT study indicate two phases in the participants’ journey enabling them to successfully complete their pre-registration nursing programme: Phase One - pre entry to university and participant journey towards their current course and Phase Two – continued journeys in the first 2 years of nurse training with 5 main categories metaphorically described as: ‘Home Territory’, ‘No Man’s Land’, ‘I Can See Land, ‘Lost Bearings’ and ‘Wearing the Uniform’. These metaphor categories describe a journey that is undertaken from when participants left school and made their early career decisions, through to participants exploring opportunities of further study and gaining an Access qualification to participants been accepted onto a DipHE/BSc pre-registration nursing programme. The study findings indicate that despite the known transition hurdles that result in some student nurses leaving their course early, the nine participants in this study were able to persist successfully on their programme. The study findings suggest that there are significant factors that have enabled these nine mature Access entrants to have a ‘persistent’ approach. These are the ‘learner profile’, ‘On-programme’ and ‘Environmental’ factors and are presented as a framework for a grounded theory of mature learner persistence directly taken from the lived experiences of the nine individuals in this study. These significant factors for a theory of learner persistence include an overarching ‘profile of the learner’ that enters a pre-registration programme and includes their entry qualification, age, career aspiration, and previous experience of nursing. Whist ‘on-programme’ factors aid learners’ ability to overcome the transitions into university and the clinical practice requirements of the programme. The skills and experiences gained through obtaining an Access qualification and the preparation for higher-level study is a significant factor in enabling the study participants to overcome the difficulties that they experienced over their first two years of their DipHE/BSc programme. An additional factor for their persistence was a strong career motivation, a desire to become a nurse. This career motivation underpinned the reasons why participants choose an Access programme, provided a route into university and enabled them to focus on their DipHE/BSc pre-registration nursing programme. UK Schools of Nursing who offer pre-registration programmes are required to attract and retain the very best student nurses. This presented theory of mature student learner persistence raises important questions about the policy for selection, recruitment, and retention by all HE providers and policy makers of nurse education. The findings demonstrate how different factors enable learners to persist and recommends that these should be incorporated into the recruitment stage and furthermore how to support learners during the 3-years of a pre-registration nursing programme.