This thesis explores the impact of simulation upon learning for undergraduate nursing students. A brief history of the evolution of pre-registration nurse education and the development of simulation for nursing provide background and context to the study. The conceptual frameworks used for this study draw upon the work of Benner and Sutphen (2007) and Engeström (1994). Benner and Sutphen’s work highlights the complex nature of situated knowledge in practice disciplines such as nursing. They suggest that knowledge must be constantly integrated within the curriculum through pedagogies of interpretation, formation, contextualisation and performance. These pedagogies present a framework, which enhances the understanding of the impact of simulation upon student learning. Engeström’s work on activity theory, recognises the links between learning and the environment of work and highlights the possibilities for learning to inspire change, innovation and the creation of new ideas. His notion of expansive learning offers nurse education a way of reconceptualising the learning that occurs during simulation. Together these frameworks present an opportunity for nurse education to articulate and theorise the learning inherent in simulation activities. Conducted as a small-scale narrative case study, this study tells the unique stories of a small number of undergraduate nursing students, nurse mentors and nurse educators and explores their experiences of learning through simulation. The nurse educators viewed simulation as a means of helping students to learn to be nurses, whilst, the nurse mentors suggested that simulation helped them to determine nursing potential. The students’ narratives revealed that they approached simulation learning in different ways resulting in a range of outcomes: those who were successfully becoming nurses, those who were struggling or working hard to become nurses and those who were not becoming nurses. A theoretical analysis of learning through simulation offers a means of conceptualizing and establishing different perspectives for understanding the learning described by the participants and offers new possibilities towards an expansive approach to learning nursing. The study concludes by examining what this interpretation of learning might mean for nurse education, nursing research and nursing practice.

This portfolio presents a schema of publication outputs developed from different stages of a journey of research framed by supporting commentary. Collectively these provide a portfolio of study that explores the learning potential of simulation in undergraduate nurse education. A brief history and overview provides context and background into the positioning of simulation within undergraduate nurse education that influenced the design and implementation of this research enquiry. Exploration of the literature base revealed a lack of consensus and understanding of simulation at that time. A concept analysis to search for common use and meaning of simulation as a learning strategy provided initial clarity, a foundation for further research and the first publication within this portfolio. This further informed the research aims and subsequent publications which focus on fundamental aspects of simulation which offer different perspectives for exploring and understanding this educational choice. A qualitative methodology was adopted as the optimum research design to establish a theoretical analysis of how simulation contributes to learning from the perspectives of undergraduate adult nursing students. An adapted form of classic grounded theory (Glaser, 1978) maintaining close association with the original approach (Glaser and Strauss, 1967) enabled data to be collected contemporaneously with student performance and reflection. Deep understanding developed from the multiple methods of dynamic data collection and analysis that captured the interactions of individual as they engaged in the simulation experience. Data was analysed through multiple lenses, including context and through the lens of both the researcher and learner. Findings suggest that immersive simulation engages and enables students to actively participate in professional context resulting in reflection and a motivation to learn. Simulation in this study has been found to enable curiosity and intellect engendered through activity which is enhanced through social collaboration and assists in embedding and contextualising theory. Ultimately students need to make identity shifts and evidence from this study would indicate that simulation enables students to think like a nurse as they make connections between theory and practice illuminated through activity and working together. The collective publications, findings and supporting commentary within this portfolio, serve to strengthen the existing evidence base for educators to consider when designing and developing simulation-based learning opportunities.

For over 30 years, the assessment of the clinical competence of student nurses has been the subject of much theoretical debate, yet the definition of criteria based on observable indicators of competence remains problematic. In practice, however, different assessors will judge and agree, relatively quickly, whether a student is competent or not; whether they have got ‘it’. Articulating what ‘it’ is, is difficult; although ‘it’ appears to be collectively, yet tacitly, understood. These judgements provide the key to the definition of competence. This research solves the dilemma of revealing and investigating these tacit understandings through the video analysis of students in simulated practice. The findings of four initial exploratory studies confirmed that competence is an example of tacitly understood behaviour and identified the limitations of traditional research methods in this context. The practical challenges of analysing video were highlighted, leading to the development of Video-View-Point to solve these problems and to reveal the tacitly understood behaviours. This innovative hybrid research method combines analysis of multiple ‘Think Aloud’ commentaries with the ability to ‘point’ at the subject of interest. The analysis is presented as a time-stamped multimedia dialectic, a visually simple yet sophisticated collage of data which reveals relevant behaviours, including those which are tacitly understood. A bespoke software tool (BigSister) was designed to facilitate the data collection, and was tested against the most similar commercially available technology, an eye tracker. The test of Video-View-Point successfully revealed four tacitly understood indicators of competence: communication, processing clinical information, being in the right place, and being proactive. Video-View-Point offers huge potential for behavioural analysis in other domains.

This research is an exploration of nurse education leadership, as identified and experienced by nurse teachers working in a Higher Education (HE) environment. In total 18 nurse teachers were interviewed who formed a whole population sample. The author is identified as a coworker and part of the community being researched. Semi-structured interviews and field notes were used to triangulate the data and thematic analysis was used to analyse the data. From the findings, the interviewees can be seen to have a strong professional focus and look to their own health and nursing structures to provide leadership. The acceptance of the authority of these institutions and people can be broadly located in a bureaucratic model. Their expectations of people they identified as leaders conforms to a transformational model of leadership, as they identified that leaders were people who had vision, values and influence and of particular importance was the identification of how these individuals made them feel valued. They identified themselves as problematic within the HE environment in which they work and identify being excluded from the collegiate structures and working practices of the university. The findings illuminate problems in the identification and role of nurse education leadership and their position within the university, which this author suggests are areas that need further exploration and have policy implications.

<p> The AACN has asked academic leaders to align the performance of their organizations to the prescribed standards within the <i>Essentials of Baccalaureate Education for Professional Nursing Practice</i> document and has provided indicators of quality suggestions for program enhancement as a means of promoting continuous performance improvement. However, the AACN has not prescribed a strategy that specifies the manner in which colleges should achieve these benchmarked standards, which has created uncertainty among administrators about whether the indicators of quality lead to improvements that are actually indicative of improved performance.</p><p> This dissertation used multiple linear regression research design to determine whether predictive relationships exist between the American Association of Colleges of Nursing (AACN) indicators of quality and the Baldrige core values and concepts of performance improvement within Commission on Collegiate Nursing Education accredited baccalaureate colleges of nursing.</p><p> The purpose of this study was to determine whether the behaviors associated with specific AACN indicators of quality reflect behaviors that the Baldrige core values and concepts have already proven to be successful in achieving continuous performance improvement. The results revealed nine AACN indicators of quality behaviors most likely to enhance performance improvement outcomes within baccalaureate colleges of nursing. They include; (1) Resources are budgeted for research, development, business operations, public relations, marketing, and human resources; (2) Establishing and upholding policies that reflect faculty and leadership development resources; (3) Student experiences include service learning opportunities; (4) Practice partnerships include collaborative practice initiatives; (5) Collecting data and making program changes that focus on the level of graduate satisfaction with their preparation for the profession; (6) Faculty have input into the governance of the college/school; (7) The majority of faculty have a presence in state, regional, national, and international professional activities; (8) Opportunities for baccalaureate graduate's employment with practice partnerships; and (9) Formal mentoring program for clinical preceptors.</p><p> The results underline the fact that continuous performance improvement within baccalaureate colleges of nursing is a deliberate and dynamic analysis-driven endeavor dependent on an organization's ability, willingness, and initiative to continually strive to narrow the chasm between actual and potential performance results.</p>

Qualified nurses require equitable access to continuing professional education (CPE) that is responsive to the needs of learners, employers and most importantly clients. There is scant attention paid to the CPE custom of community nurses, with research in the experience of island-based nurses mainly limited to the Mediterranean and under-developed islands, or of nurses working in the Scottish Isles. The community nurses in question are employed by a charity working outside the National Health Service (NHS), based on an island with a unique model of healthcare that is more medicalised and institutionalised than the United Kingdom NHS. Semi-structured, one-to-one interviews were conducted with sixteen community nurses, and two focus groups undertaken, one with nurse managers and the other with qualified nurses. Interview data were analysed using Interpretative Phenomenological Analysis, a method new to education research, and not yet recorded in relation to nurse education. Findings indicated an ageing workforce, with ageism hindering access to CPE. Geographical isolation coupled with a lack of access to tertiary education dictated CPE to fulfil professional development. Charitable status and limited CPE funding resulted in a third of nurses applying for sponsorship via local or national agencies, this was not found elsewhere in the current literature. This research contributes to the knowledge relating to nurse CPE, confirming the transferability of existing literature relating to geographical remoteness, barriers and outcomes of formal study to community nurses. It advances the current knowledge base with regard to small island infrastructure effecting access to CPE, funding formal education for nurses working outside the NHS, and silo working within the community setting. Further research is required to explore the experience of community nurses under the age of 30 years not represented within this study, who will be the future workforce when older nurses retire. These findings are of particular significance to the Jersey Health and Social Services Department who are currently redesigning the future health and social care system on the island based on a community model, nurse educators, the charity and its qualified nurse employees, and finally the island population.

Thesis (Ph. D.)--University of Missouri-Columbia, 1997. / Typescript. Vita. Includes bibliographical references (leaves 79-82). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 1997. / Typescript. Vita. Includes bibliographical references (leaves 79-82). Also available on the Internet.

The main aim of this study was to explore student nurses and lecturers’ perceptions of directed study time (DST) within an undergraduate nursing curriculum. Previous research pertaining to the phenomenon has predominantly focused on how students approached learning, and the pedagogical preferences of lecturers and students. A wealth of quantitative literature demonstrates attempts to measure students’ preparation for self directed learning (SDL). Whilst a substantial amount of research has identified that students are unprepared to study independently and direct their own learning; no research has explored the underlying reasons behind this, nor has any research explored the perceptions of DST within undergraduate nursing curricula. A hermeneutic phenomenological approach was used to understand and interpret the participants’ perceptions of DST. The research was undertaken in two phases. In Phase One three focus group interviews were undertaken with student nurses on an undergraduate adult branch nursing course at an English university. In Phase Two, individual semi-structured interviews were carried out with nurse academics from the same university. Template Analysis was used to analyse the data and to determine key themes. Significant findings revealed that both groups perceived DST to be owned by student nurses, who controlled DST. The identities of the groups was not reflective of their roles and resulted in a lack of belonging to the university; this led to limited levels of engagement by both parties with academic activities. Many student nurses did not engage with SDL during DST and the majority of lecturers did not value academia. The culture was influenced by the ‘hidden curriculum’ within which nurse lecturers lacked authority and relied on traditional pedagogical methods to regain a sense of control. The participants also described how some students’ mentors did not value academia and did not always recognise the importance of linking theory to practice. The implications of this research study emphasise the need for a multi-faceted approach to promote the value and importance of academia within the nursing profession.

This thesis examines the experience of gay male student nurses during their university course, which leads to registration as a nurse with the Nursing and Midwifery Council. Using in-depth qualitative interviews I focus on the student’s choice of nursing as a career and their performance of sexuality within the differing spaces of their clinical placements and the university. This thesis explores how these gay student nurses negotiate their gender, masculinity and gay sexuality within the professional boundaries of nursing. Furthermore, it identifies how these students negotiate issues of caring and the formation of therapeutic relationships with their patients, as men and gay men. The theoretical framing of the thesis draws upon Goffman's theories of presentation and performance of the self and Rubin’s 'charmed circle'. Alongside analysis of interview material, I explore the space of the hospital from a personal perspective and interrogate its gendered and desexualized organization through the lens of human geography. Moving between these two analytical frameworks, I examine and draw together the experiences of these students and examine their negotiation of the nursing role as gay men. I argue that the experience of these students and the negotiation of their sexuality as student nurses is fraught and precarious due to the complexities and boundaries of professional nursing roles in contemporary healthcare. Within the conclusion I address the implications of my research for gay nurses, patients, educators and for those who recruit nursing students.