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This thesis discusses the Canadian nursing sisters who served in the Second World War, as part of the general mobilization of the Canadian Army Medical Corps. It concentrates on a cohort of nurses from Winnipeg who were part of a medical unit known as No.5 Canadian General Hospital (No. 5 CGH). The analysis considers the mobilization of No.5 CGH, examining factors such as personal and professional connections, patriotism, and economic need in describing the recruitment of nurses. The discussion then follows the Winnipeg nursing sisters into various theatres of war, comparing their living and working conditions in England, Sicily and Italy. The study also discusses the nurses’ rapid demobilization after the war, looking at their adjustment to civilian life, their postwar work as nurses, and overall legacy.

Introduktion: Kommunikation inom vården innefattar ofta en överföring av patientrelaterad information. Utbyte och överföring av information sker flera gånger på ett dygn vilket ska säkerställa att sjuksköterskan ständigt besitter adekvat information för att kunna ge korrekt vård. Bristande kommunikation kan leda till en ökad morbiditet och mortalitet inom hälso- och sjukvården. Syfte: Syftet var att beskriva sjuksköterskors uppfattningar om kommunikation med andra sjuksköterskor och läkare på kirurgiska vårdavdelningar samt att jämföra dessa resultat. Syftet var även att jämföra sjuksköterskors uppfattningar utifrån deras utbildningsnivå samt antalet yrkesverksamma år. Metod: En empirisk tvärsnittsstudie med en deskriptiv och jämförande design med en kvantitativ ansats. Data samlades in genom en enkät bestående av en sektion med frågor rörande demografiska data samt en sektion med frågor från ICU Nurse Questionnaire short version sektion 1. Huvudresultat: Resultatet som framkom i studien kan ge en indikation om hur sjuksköterskor uppfattade kommunikationen på de utvalda kirurgiska vårdavdelningarna. Dock gick det bara att påvisa statistisk signifikans gällande en faktor, öppenhet i kommunikation. Där framkom att sjuksköterskor upplevde en öppnare atmosfär i kommunikationen med andra sjuksköterskor än de upplevde med läkare. Inga övriga statistiskt signifikanta skillnader kunde påvisas. Slutsats: Endast ett statistiskt signifikant resultat kunde ses, nämligen att sjuksköterskor uppfattade öppenhet i kommunikationen med sjuksköterskor högre än med läkare. Spridningen i resultatet visade att det finns utrymme för förbättring. I en mer utförlig studie med en större undersökningsgrupp är det möjligt att resultaten uppvisat fler signifikanta fynd. / Introduction: Communication within healthcare often involves a transfer of patient related information. Transfer and exchange of information happens several times per day to make sure that the nurse always has adequate information to be able to provide the correct care for patients. Lack in communication may lead to an increase in morbidity and mortality within the healthcare system. Aim: The aim of this study was to describe nurse’s perceptions of communication with other nurses and physicians in surgical wards and to compare these findings. The aim was also to compare nurses perceptions based on their level of education and number of working years. Method: An empirical cross-sectional study with a descriptive and comparative design with a quantitative approach. Data was collected through a survey consisting of one part with questions about demographic data and one part with questions from ICU Nurse Questionnaire short version section 1. Main findings: The findings in the study can indicate how nurses perceived communication in the chosen surgical wards. There was only one factor that showed statistical significance, communication openness. There was shown that nurses perceive a more open atmosphere in communication with other nurses than they perceive with physicians. No other statistical significant differences could be found. Conclusion: Only one statistically significant finding was made, that nurses perceive communication openness with nurses higher than that with physicians. The spread in the findings showed that there is room for improvement. In a more thorough study with a larger study population it is possible that more statistical significant findings could have been identified.

Health policy reforms have dominated health systems in African countries for over three decades. However, the impacts of these policies on nurses’ work, as well as the extent to which the nurses are involved in the policy decisions, have not been well documented. As the largest group of health professionals in the workforce, nurses’ services are necessary to achieve population health outcomes. Thus, nurses’ work concerns related to the reform of national policies should be identified and addressed. This study was carried out to examine how the national policy reforms have impacted on nurses’ work in Kenyan district health care systems and how nurses have been involved in policy processes in the health care system. Critical theory and feminist critical policy analysis perspectives guided the study. The study was implemented in two phases. The first phase involved qualitative interviews with 32 decision makers and nurses in the public health care system. The second phase involved a comparative quantitative survey of nurses and nurse managers in two districts. A sample of 169 nurses was interviewed in two district hospitals to generate data for this second phase of the study. This thesis contains three manuscripts. The first manuscript presents a qualitative analysis of the impact of policies on nurses’ work (Chapter 2). The second manuscript presents qualitative results of how nurses were involved in policy processes at various levels of the health care system (Chapter 3). The third manuscript presents results of a quantitative survey of frontline nurses’ experiences with the policy reforms, comparing two districts (Chapter 4). An integrative discussion of key findings from all these manuscripts forms the last chapter of the thesis. The findings revealed that policies meant to enhance access to services like decentralization and primary health care were more enabling to nurses’ work while those aimed at enhancing efficiency like structural adjustment programs were more constraining. The constraints included poor work environments, unchanging work conditions, increased responsibilities and dilemmas in providing care. These constraints were experienced more by nurses in the district that was poorly resourced and had poor health indicators than the district that had better resources and better health indicators. The results suggest that inadequate involvement of nurses in policy processes is a reason why their work concerns have not been addressed. There are recommendations to improve nurses’ work in the context of policy reform and to improve nurses’ abilities to participate in policy processes.

This thesis discusses the Canadian nursing sisters who served in the Second World War, as part of the general mobilization of the Canadian Army Medical Corps. It concentrates on a cohort of nurses from Winnipeg who were part of a medical unit known as No.5 Canadian General Hospital (No. 5 CGH). The analysis considers the mobilization of No.5 CGH, examining factors such as personal and professional connections, patriotism, and economic need in describing the recruitment of nurses. The discussion then follows the Winnipeg nursing sisters into various theatres of war, comparing their living and working conditions in England, Sicily and Italy. The study also discusses the nurses’ rapid demobilization after the war, looking at their adjustment to civilian life, their postwar work as nurses, and overall legacy.

Introduction: It is a well known fact that children suffer from pain due to treatment and procedures in health care and historically, their procedural pain due to medical treatment has been undertreated and under-recognized. Children’s understanding of pain and their ability to express their feelings depend on their stage of development and the nature and diversity of their prior pain experiences. The goal of pain management is to reduce pain, distress and anxiety, and the nurse is the key person to help and support the child in pain. Nurses’ professional competence form the foundation for pain management procedures, and there is a need to investigate whether the care and procedures nurses perform for children in pain lead to desired outcomes. Aim: The overall purpose was to describe nurses’ competence in pain management in children. The specific aims were to - identify and describe knowledge about and attitudes to pain and pain management - identify factors influencing pain management in children and - describe nurses’ experiences of caring for children in pain. Methods and material: Forty-two nurses participated in a survey on knowledge about and attitudes to pain management in children, and 21 nurses were interviewed about their experiences fromcaring for children in pain. All the data were analyzed using approved methods of analysis. Results: The results showed that the nurses had good knowledge about and positive attitudes to pain management in children. Collaboration with physicians was considered important in providing children with sufficient pain relief. Parents were regarded as a resource, and the nurses described communication with parents as important. The nurses’ own experience led to a better understanding of the children’s situation. The nurses stated that pain is a subjective experience and that if a child says he or she is in pain they should be believed. Pain was seen as a complex phenomenon, and the nurses had difficulty distinguishing between pain of different origins. In predictable situations, when the child had a clear medical diagnosis with physical pain and the child’s pain followed an expected pattern, the nurses trusted their knowledge and knew how to act. On the other hand, in unpredictable situations, when the child did not respond to the treatment despite all efforts, this created feelings of insufficiency, fear and abandonment, and even distrust. Conclusions: The conclusions of this thesis are that pain management in children is a challenge for clinical nurses in unpredictable situations. Professional competence in nursing deals with both personal abilities and the organization. Reflective practices and dialogues with colleagues would improve nurses’ work satisfaction, and guidelines and better routines would improve nurses’ pain management when caring for children.

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The aim of this study is to assess the pre-registration preparation of nurses as a means for producing women and men capable of doing new things, not simply repeating what other generations had done. The issues which are examined are:-(1) The purposes of nurse education (11) The extant forms of knowledge (111) The nature of teacher/student relationships in the process of learning. The study was carried out in three stages:- (1) Analysis of the literature from 1947 to 1963 by abstracting and utilising grounded theory approaches to identify the essential issues.(11) Opinion survey of student nurses utilising content and structural analysis of the audio-taped recordings of interviews to develop a theory of nurse education in the 1980's,(ill) Experimental testing of one operational hypothesis describing the effect of teacher behaviours on the student nurse’s clinical decision making. It is concluded that the pre-registration preparation of nurses is not an educational experience on the grounds that the extant forms of knowledge and the prevalent teacher/student relationships are inconsistent with the production of a critical, reflective and self-reliant practitioner. Because of this, the recommendations of UKCC Project 2000 must be carefully planned and closely monitored if the problems of the theory/practice gap are to be minimised rather than exacerbated.

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A nurse-manager relationship plays a key role in a nurse’s practice environment. A nurse’s trust in one’s manager is the foundation for a supportive nurse-manager relationship and has crucial bearing upon the professional and personal lives of the nurse. However due to health care restructuring, nurses expressed little trust towards their leaders. To develop and implement strategies to help build healthy nurse-manager relationships, research is needed to more fully understand the factors that establish and enhance a nurse’s trust in one’s manager. This study tested a theoretical model that examined potential individual, managerial, relational and environmental attributes that impact a nurse’s degree of managerial trust. Employing a cross-sectional, descriptive design, a self-administered survey was completed by a random sample of 342 Registered Nurses employed in Ontario emergency departments. Structural equation modeling techniques tested and refined the hypothesized model. Final analysis showed adequate fit of data to theoretical model (χ 2 = 78.86, df = 20, SRMR = .02, CFI = .98, RMSEA = .09). In the final model, a manager’s perceived ability, benevolence, integrity and procedural justice had a strong, direct impact on managerial trust. Trust in one’s manager was indirectly influenced by procedural justice and ability as well as a manager’s facilitation of team work, communication accuracy, emotional availability and interaction frequency. Attributes of the individual RN, specifically job tenure and propensity to trust as well as self-determination, access to support and resources and span of control did not affect trust in one’s manager. Study findings suggest that creation and preservation of a nurse’s managerial trust is a complex process affected by manager’s competence and character as well as a fair decision-making process. Education programs that contribute to a manager’s ability, benevolence, integrity and procedural justice may help build and sustain nurses’ trust and healthy nurse-manager relationships.