The achievement of autonomous practice has been a clearly and consistently stated aim in nursing for many years. It is one which has driven significant changes in the education and preparation of student nurses, and one which continues to shape developments in clinical practice. This near universal, and perhaps uncritical, pursuit and endorsement of autonomy as a desirable attainment for nurses has its roots in commonly held beliefs about the status and influence enjoyed by more 'traditional' professions. Yet little is understood about the relationship between autonomy and nursing in the acute sector of the National Health Service (NHS). One of the key aims of this research is to explore whether nurses perceive themselves to be autonomous, and to identify conditions within nurses' work environment which either constrain or facilitate the development of autonomy. A second aim is to elucidate the relationship between the concepts of autonomy and influence. Having influence over managerial and resource decisions made within the hospital may be more important than having autonomy vis-a-vis nurses' ability to control their practice. Empirical measures of autonomy and influence were developed from data collected from 825 nurses working in 119 acute hospital wards in 7 RHAs, related to nurses' perceptions of the ward organisational environment. Three influence scales were developed associated with distinct managerial functions: influence over ward management, influence over the timing of ward and patient events, and influence over ward human and financial resources; and an autonomy scale. These scales were analysed in conjunction with scales measuring nurses' perceptions of other features of the ward organisational environment, and objective ward data about organisational practice, staffing characteristics and clinical specialty. Nurses' perceptions of autonomy were enhanced where care organisation was characterised by a high degree of individual nurse responsibility, and where the ward ethos of care was innovative. Social aspects of the ward environment and staffing resources were also important: nurses' perceived themselves to be more autonomous when they had a cohesive working relationship with ward nursing colleagues, and when there was a high degree of collaboration with medical staff. In addition, a high nurse/bed ratio and ward staff stability enhanced perceived autonomy. Perceptions of influence were particularly associated with a high ward grade mix, and individual nurses' clinical grades however. In general, nurses perceived themselves to be autonomous in their clinical practice, but to lack influence over managerial and resource decisions affecting the care they provide. This suggests that nurses have a narrow conceptualisation of autonomy, i.e. clinical autonomy, which is derived from the work organisation process at the micro, ward level. This type of autonomy is limited in scope and value however, because it makes little difference to nurses' ability to influence higher level hospital management decisions. The researcher argues that influence represents a missing, more enigmatic aspect of autonomy, and that consideration of both are vital to developing an understanding of nurses' position within acute NHS Trust hospitals, and to enhance nursing's professional development.

This phenomenological study firstly examines the concept of the 'therapeutic community' as it appears within contemporary British psychiatry. It argues that certain confusions and contradictions which are exhibited within this area of practice arise as an inevitable consequence of the medicalistic and psychologistic epistemologies upon which these communities are predicated. Secondly, it proposes a number of informing sources whereby the practices of a therapeutic community might be more soundly guided. Amongst these are the ethical writings of Aristotle, and the discussions of 'dwelling' which are to be found within recent European philosophical writings. In particular, certain writings of Heidegger, Levinas and Bachelard are seen to be important. Informed by these sources, it is argued, we may find ourselves in a position to embody theorizing in a manner which more befits the subject matter of the therapeutic community. In the third part, an illustration is offered, of one therapeutic community household within which these questions of 'dwelling' were raised, and whose therapeutic gesture was understood in terms of the hospitality of dwelling, rather than the application of psychological method. Discussion is devoted to the founding of this household, the embeddedness of its conversations within the fabric of the ordinary, and the issues which were raised in the course of its finding its own way. In the final chapter of this thesis, attention is paid to the matter of the evaluation of such therapeutic households, and to their relevance to the current social policy of psychiatric 'care in the community'.

The research enquiry using a sample of 20 NHS organisations with similar revenue and population characteristic profiles sets out to identify the information needs of the NHS General Managers and in doing so highlight the information that they need to meet their organisations' key success factors. The research identifies through the enquiry process the General Managers' information needs and describes the categories of those needs, the pressures and influences of the General Managers' working environment on those needs and the links to the influences that have been reflected in their information needs. In particular the external influence of the Department of Health and the business environment has not only changed the General Managers' information needs but affected the balance of power between the stakeholders, which in turn has affected those information needs. These organisational and environmental changes, health policies, stakeholder demands, and changes in the balance of power between the stakeholders has resulted in a change in the way in which the General Managers work with information, which has in turn increased the need for more accurate, timely and complex information. The research analyses the General Managers' understanding of their roles in the General Manager/patient/doctor relationship and analyses the potential areas of conflict arising when the patients' interests clash with the market-led (business) interests of the healthcare organisations and the diverse needs of the Provider, Purchaser and Regional Executive General Managers. These problems together with the effects of organisational resistance, organisational culture clash and system requirements and its effect on the information needs of the General Managers were examined for associated links with the difficulties that the General Managers experience in defining their information requirements. The research provides an understanding of the links between a market-led healthcare environment, the General Managers' information needs, and their attitude towards information as well as an understanding as to whether the patient, a key stakeholder, has benefited in the healthcare empowerment stakes as a result of the re-delineation of the General Managers' information needs and the impact upon their decision making. The information needs identified as a result of the research have shown them to have become business orientated with financial targets as a key measure and clinical performance (outcomes) increasingly being seen as the other key factor as an indication of success for the organisation. The hypothesis (Null Hypothesis) of the research asserts that it is not possible to link a market-led healthcare environment, the General Managers' information needs, their attitudes and behaviour towards information, and patient empowerment in such a way as to develop a model of information needs that is common across the Purchaser, Provider and the NHS Executive organisations. However, the research has developed as a first step, a series of outline models of information needs that will lead to a more complex and common model of information needs across the General Managers' organisational groups that will allow, when assessed against key success factors, a judgmental view of the ability of both the General Managers and their organisations to deliver their aims and objectives.

This study explores the care provided for physically disabled people who are admitted to acute hospital wards for the treatment of short -term illness. Two groups of 75 disabled and 75 non - disabled patients were recruited for the study on a matched pair basis, and a survey of 205 nurses was undertaken. The study involved an assessment of how well disabled patients could manage eight activities of daily life at home and in hospital. The experiences of disabled and non -disabled patients in acute hospital wards were compared by assessing patient satisfaction with six different aspects of care. The views of nurses about caring for disabled patients in acute hospital wards, their experience and training in the care of disabled patients are also explored. The study demonstrates no difference in the levels of satis- faction with care experienced by disabled and non- disabled patients. Patient satisfaction with all aspects of care was found to be associated with satisfaction with the communication of information, a factor shown to be equally important for both disabled and non -disabled patients. It was hoped that the theory of social roles would provide a theoretical framework for understanding the position of the disabled patient on an acute hospital ward. However, in the event, role theory proved not to be entirely adequate for this purpose. An alternative model is developed which takes into account the attitudes and experiences of nurses as well as the experiences of disabled patients on acute hospital wards. This is used to suggest ways in which improvements could be made in the care of disabled patients.

This thesis reports the results of a pluralistic evaluation of rota bed systems providing respite care to carers of the dependent elderly. Using a multi-method triangulated design the study examines: the sources and determinants of carers' stresses and rewards; the subjective views of the main stakeholder groups as to the benefits and problems of the rota bed system; the rota bed experience as indicated by the environment and regime of care and the activity levels of rota bed users at two contrasting continuing care hospital wards. Using data from a national sample survey of members of the Association of Carers, convincing empirical support is provided for the transactional approach to the understanding of carer stress. In addition the results extend the conceptualisation of caring to include sources of satisfaction. The benefits and problems of the rota bed system are explicated and, on the basis of these suggestions are made as to how both respite care and related services to carers might be improved. Within the context of recent policy initiatives consideration is given to the nature of professional responses to carers and their dependants with particular reference to the role of the nursing profession.

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No description available.

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By the next decade, 5.1 percent of the British population will be over the age of eighty years. Women will make up over half of this figure. Finding ways of helping elderly women to maintain good health and therefore well-being, will become even more critical. Exercise is increasingly being recognised as a possible way of promoting health for elderly women, as evidence is emerging of the physical and psychological benefits that accrue from exercise. However, the empirical research evidence on exercise has derived mainly from young and middle-aged males, which means little is known about the specific benefits of exercise for the elderly and there are few tools to measure accurately exercise behaviour in this population. In the few exercise studies which have been conducted with the elderly, methodological flaws have often left the results unclear. Exercise up-take and adherence amongst elderly women is also low and psychological models have so far failed to adequately explain the reasons for this. To achieve the aim of this thesis to contribute to knowledge on the relationship between physical activity and well-being in elderly women, three studies are conducted. In study one, a postal questionnaire for measuring exercise behaviour, beliefs and attitudes in this population was first developed (the London Health and Fitness Questionnaire; LHFQ) with 248 elderly women. Second in study two, a randomised controlled trial of 100 post-menopausal women assigned to either a six month brisk walking programme or homeopathic dose of exercise was conducted. Baseline and six month measures of stamina, leg strength, exercise attitudes (using the LHFQ) and subjective health status (using the Nottingham Health Profile; NHP) were taken. Finally, study three is exploratory, and examines the influences on elderly women's participation in domestic and sporting physical activity, in a sample of 820 retirees from a major national retail company. The LHFQ and the NHP were used to obtain data. In study one, the reliability and validity of the LHFQ proved acceptable. Re-test reliability was best for number of hours spent on carrying out errands and recreational exercise, but lowest for reports on past exercise experience and identifying barriers to exercise. The LHFQ appears to have satisfactory face, content and construct validity. In study two, repeated measures ANOVAs were used to detect any changes between and within the brisk walking and placebo exercise groups over the six month period. Mean scores on the NBP indicated that the brisk walking programme had a more beneficial impact on health status, with significant improvement in perceived physical mobility. Significant positive changes were also noted for brisk walkers on two exercisea ttitudes tatementsS. taminaa nd leg strengths ignificantlyi mprovedf or both groups over time. A number of threats to the internal validity of the study findings emerged and these are discussed at length. In study three, multiple regression analyses indicated that although different factors influence domestic and sporting activity, good-health status and age (being younger) are core variables influencing both these activities. In addition, positive exercise beliefs and attitudes, and past exercise experience were shown to influence exercise behaviour.

This thesis is about the pregnancy and childbirth experiences of two different groups of Asian women in Britain. It sets out to address the issues surrounding pregnancy and childbirth from the women's point of view. This is an attempt to redress the balance in the previous research on Asian women which has often portrayed them as a homogeneous group with 'problems'. An overview of the literature focuses on how Asian communities and, in particular, Asian women are portrayed. In order to provide a context for the issues which emerge in this research, attention is paid, first, to how Asian communities and, in particular Asian women, are viewed by mainstream society and, second, to cultural attitudes towards the sexual politics of reproduction. The main theme of the research is the degree of control the women were able to exercise given the constraints of western medicalised childbirth practices in Britain, traditional childbirth practices and the role played by the women's relatives during pregnancy and childbirth. The study draws on in-depth interviews (during and after pregnancy) with two samples of Asian women- the first Gujarati, the second Bangladeshi. In addition, two Gujarati case studies and two Bangladeshi case studies provide further insights into the lives of these two groups of women. The women's perceptions of their experiences of pregnancy and childbirth are emphasised by the use of the actual quotes which give some indication of the way these women conceptualised the issues which confronted them. The final chapter of the thesis concludes with a discusses of the position of Asian women within the current childbirth debate and makes suggestions for improving the delivery of maternity services to the Gujarati and Bangladeshi women in particular and to Asian women in general.