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The study presents the thesis that nursing with its wide range of work in spheres of the management, teaching and prac¬ tice of nursing care relies for its maintenance and extension upon the stable contributions of auxiliary workers. Auxiliaries in the U.K. context are nursing workers without recognised qualification to nurse and who may have little or no formal training for their work. A secondary theme is argued that auxiliaries are inherently disadvantaged in the professional nursing structures. The disadvantage is due to a reified image of nursing which is unrelated to patients' needs and unrelated to the daily practice of nursing care. The reification of nursing and the resulting disadvantage to unqualified nursing workers render them less effective than their quantity and human potential should allow. Through the means of two national reviews of policies related to auxiliaries in general and psychiatric divisions of the N.H.3., a wide variety of patterns of employment, instruction, and use were found; nursing managers also revealed a range of problems met in the employment of less-than-fully qualified workers in nursing systems. With this problem-oriented perspec¬ tive, the characteristics and work of auxiliaries in one English health district characterised by relatively low reliance upon these workers, are described. The health district, one of three districts serving as case studies for^he government health department—funded research, was examined by means of postal questionnaires, personal interviews, work diaries and observation of nursing activities. The study, endeavouring to contribute to the discussion of work levels in health care, and within this in nursing care of patients, provides base-line information upon which experimental research may be undertaken.

This study attempts to identify the interplay between the statutory qualifying associations in nursing, the service within which they operate and the climate of opinion in the profession they serve. Using a case study approach one such organisation is chosen as the vehicle far the exploration of the factors influencing the powers and responsibilities of a qualifying association and the significance of its relationship with the central government departments.

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Background. Although research has been carried out within higher education circles little is known about any educational benefits that may result from primary care professionals engaging in networked learning and what strategies may be used to overcome barriers to effective learning. Aim. This research was undertaken to identify specific educational strategies which may inform educators wishing to support continuing professional development for healthcare professionals within communication and information technology. Method. A model of networked learning was developed from the literature and using the experience of working models elsewhere. The model was implemented and evaluated over two case studies, and further refined in a third. The evaluation methodology used action research collecting data from surveys, interviews, observer participation, electronic text generated bye-mail discussions, and project documents. Results. Healthcare professionals were able to usefully communicate over a prolonged period with colleagues about clinical and professional matters, developing a number of process skills; using e-mail, web and on-line database searching. Compared to face -to-face small group learning, the added benefit of using e-mail discussions supported by web based learning resources was being able to use the method at a place, pace and time of their own choosing whilst still remaining committed to a shared educational experience. GPs were able to use the educational material to put to-wards a portfolio (personal learning plan) for accreditation for PGEA. Specific roles for an on-line facilitator in addition to small group learning skills were identified. However networked learning is acknowledged to have many obstacles, eg access, using software, lack of support which will need to be overcome. Managing a learning environment for CPO for healthcare professionals involves an integration of the teaching and learning strategy of the host organisation with a networked learning environment. Conclusion. A networked learning environment has the potential of supporting continuing professional development and its assessment with portfolios. For individual participants much depends on there own learning style, what they feel is relevant to learn at the time and their own preferences for a learning format. Much needs to be done to provide the necessary supporting infrastructure and integration of provision across traditional divides within healthcare education. This research describes a number of recommendations, which can inform action by educational stakeholders interested in healthcare education.