Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University

The study reported in this thesis is concerned with the education of basic general nurses whilst they are working in the clinical setting. Set against a system where the position of the student is essentially that of an apprentice, previous studies have demonstrated that theory is often divorced from practice and any teaching which does take place is frequently sparse and erratic. In an attempt to alleviate this situation, this study examines the circumstances surrounding the introduction of a scheme of self-directed learning (in the form of learning packages) into two orthopaedic wards in a District General Hospital. Using a case study approach to educational research, the techniques of illuminative evaluation are used to monitor the project in all its phases (planning, production and implementation). Throughout the study the effects of this educational innovation are viewed from three main perspectives: i) the student and pupil nurses ii) the permanent, qualified staff on the wards; iii) the nurse teachers. Findings from the study demonstrate that although the planning and production of learning packages which are appropriate for use in clinical areas is both time-consuming and initially expensive, their use in promoting learning and in helping students (and pupils) from a wide range of educational abilities to apply theory to practice is effective. Since the learning package was introduced, i) the students' motivation to learn increased, their study habits improved and they became generally more questioning; ii) the quality of teaching by both the qualified ward staff and the nurse teachers improved in a variety of ways. The total effect was therefore one of a generally enhanced teaching/learning milieu within the clinical areas concerned. There was some definite evidence to suggest that this change of circumstances had a beneficial effect on patient care. The need for a "partnership approach" to nurse education between the nurse teachers and the clinical staff was highlighted by the findings from every stage of the study, as was the changing role of the teacher who employs methods of self-directed/ distance learning. In the last chapter of the thesis certain conclusions are drawn from these findings and they are examined alongside those from other studies which have investigated the teaching and learning of nurses in the clinical areas. The external validity (generalizability) of small, predominantly qualitative studies of this nature is also discussed. Finally several recommendations are made and suggestions are put forward for further research in similar areas.

This thesis is an examination of the practice of physiotherapy, an exploration of the context within which the profession of physiotherapy developed and an identification of the theoretical frameworks within which it is practised. The experiences of physiotherapists and nurses working in particular settings at a specific point in the development of the profession provided a starting point for the study. Physiotherapy, a profession openly dependent for a significant part of its history on medicine for its practice and knowledge base, is contextualised with reference to the development of a medical hegemony, the changing role of women in society, and the development of specialisms within physiotherapy. A methodological framework was developed through the use of a naturalistic design which places the researcher within the study and legitimises personal perspectives. Knowledge of the field prior to the study, fieldwork observations, and findings from two sets of interviews generated the data which provided the framework for an exploration of the theoretical base for the practice of physiotherapy. The thesis concludes by examining the components of context and theory which are fundamental to the practice of theory, and places them within a new framework. This new framework or paradigm is based on a re-evaluation of the concept of holism and goes back to the origins of this model which developed amidst the chaos of post-Boer was South Africa. The meaning of holism has been changed to make it nearer the concept of summative dualism which fits well with key concepts of balance, harmony and homeostasis. True holism is about movement and change and this is proposed as an appropriate model on which to base a paradigm for physiotherapy.

The prevalence of obesity is increasing and due to its associated co-morbidities (WHO, 2011) obese people are at greater risk of being hospitalised. While it is evident that student nurses will increasingly be caring for obese patients, there has been a scarcity of studies exploring student nurses' conceptualisation of obesity and participation in obese patients' care. The aims of this study were to explore student nurses' care of obese patients and the meaning they assigned to obesity. I utilised an ethnographic approach that included 305 hours of participant observation of student nurses (n=11), qualified nurses (n=11), nurse managers (n=3) and health care assistants (n=10) in three hospital settings in Wales (orthopaedic, gynaecological-surgical, and respiratory). Data also included semi-structured interviews with student nurses (n=7), documentary analysis and the technique of drawing pictures. The thematic analysis generated three themes: 'student nurses' encounters with obese patients', 'constructing the meaning of obesity: the culture and context of care', and 'the consequences of student nurses' involvement with obese patients' care'. Student nurses found the intensity and frequency of their involvement with obese patients' care challenging, particularly in the areas of interaction, food and nutrition, physical care and moving and handling. Integral to their conceptualisation of obesity were student nurses' cultural norms and values, their limited knowledge regarding obese patients' care, professional socialisation, organisational constraints, and patients' contribution to their care. Student nurses felt disempowered because of the emotional and physical labour they experienced when caring for obese patients. In turn, they participated in the exercise of power over obese patients with both intended and unintended consequences. Equally important was the 'covert liking' (Johnson, 1997) that some students felt towards obese patients who engaged in empowering acts of care to compensate for others' controlling behaviours. The findings provided insights into the student experience of caring for obese patients and raised issues related to the role of culture and context of care in student nurses' conceptualisation of obesity. Drawing on Foucault's (1976) notion of power facilitated understanding of the significance of obesity-related discourses and associated power inequalities in clinical practice. Changes in nurse education and practice are proposed to ensure that nurses are adequately prepared to care for obese patients.

D.Cur. ( Psychiatric Nursing Science) / The aim of this study was to develop a selection model for prospective candidates in advanced psychiatric nursing, based on a whole person approach. In her interaction with patients, the nurse is confronted by the unusual realities of death, birth, pain and suffering of her patients, and the concomitant dependency and intimacy needs of these patients. This reality activates intense and complex feelings in the nurse's internal world, against which she develops a system of defense mechanisms which enable her to control her feelings and effect distance between her and her patient. These defense mechanisms protect her in general nursing practice, but become stumbling blocks for those nurses who wish to specialize in psychiatric nursing. It is contingent upon her as an advanced practitioner in psychiatric nursing to expose herself by casting off these defense mechanisms, building up intimate relationships with her patients, and to be open in terms of her own feelings. This process is intensely painful, anxiety provoking and stressful, and all are not equal to this task. The research question which arises is: To what extent can candidates who are not equal to the task of a course in, and the practice of, advanced psychiatric nursing, be protected by an effective selection procedure? A theory generational approach was used in the design and description of a selection model for prospective candidates in advanced psychiatric nursing. The methodology of Chinn & Jacobs (1987) was combined with that of Dickofj, James & Wiedenbach (1968) in this process. The 5 steps in this combined approach included: * The identification, definition and classification of concepts central to the model. Concepts were identified by utilizing four different methods: A literature survey of the characteristics of the mature person (ideal candidate). A survey of existing selection methods and techniques.

Transition of the newly qualified nurses from an educational focus to professional practitioner has long been identified as a conflicted time of critical personal and professional adjustment and staggering reality shock. This study explored the experiences of newly qualified R425 professional nurses during their first year of practice in the Eastern Cape Province at three selected hospitals. The study followed a qualitative, exploratory, descriptive design using a phenomenological approach. The sample included newly qualified professional nurses in their first year of employment. Convenience sampling was used to select the participants. Data collection was conducted by means of semi-structured interviews from ten (n=10) participants. Each interview took about 45 minutes. Ethical codes of research were followed. Data was coded manually and analyzed using content analysis Four themes and seven subthemes emerged from the data collected The findings revealed positive experiences such as sense of belonging and feelings of independence; negative experiences such as feelings of rejection, as well as management challenges The study identified challenges which impacted on the performance of new nurses, namely shortage of human and material resources and inadequate support in the working environment Recommendation: Introducing mandatory education by service institutions on transition as well as extended, sequential and structured orientation and mentoring programs for newly qualified professional nurses as this will assist them in their career development Managers to use different strategies in enhancing quality environments in order to reduce frustration for these newly qualified nurses.