Nursing
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/7188
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Item THE ROLE OF A FACILITATOR IN ENABLING REGISTERED NURSES TO TRANSLATE REFLECTIVE APPRAISAL INTO WORK-BASED LEARNING AND AN EVALUATION OF THE OUTCOMES OF THIS LEARNING(Queen Margaret University, Edinburgh, 2019) Williams, Caroline VivienThis research set out to develop a detailed understanding of the role of the facilitator in enabling registered nurses to translate reflective appraisal into work-based learning (WBL). In doing so the research identified contextual issues that impact on WBL, facilitative processes that enable WBL, and outcomes from WBL. A person-centred, action-oriented, participative methodology was developed specifically for this study. It combined a conceptual framework for facilitation (Critical Companionship) with constructs for a critical enquiry. The methodology was operationalised through two year-long action cycles. In each cycle a facilitator/researcher worked in a 1:1 relationship with five registered nurses to facilitate their learning. Each 1:1 session was audio recorded, and a reflective process review was completed. Three times in each action cycle the participants and facilitator/researcher met up as a group to undertake data analysis using a creative reflective approach. The outputs from this were themed by the facilitator/researcher, and the resultant themes and sub-themes were illustrated with extracts from the 1:1 sessions. A reflective synthesis of each theme enabled the development of a model for a Professional Learning Partnership. A Professional Learning Partnership contains a facilitation triad that requires a trusting partnership; activities to maintain stability; and activities to stimulate growth. The facilitation takes place during a professional conversation in a safe space in work. The contextual factors that impact on the learner are their commitment, how safe they feel in work; and how able they are to act. The outcomes for the learners are changes to self, a changed way of being, and professional growth. These lead on to changes to individual practice. This research has added a new methodology to the field of person-centred healthcare research, and a model for a Professional Learning Partnership that contributes to understanding how a facilitator can enable nurses to learn through their work. Key Words: Facilitation; Work-based learning; Professional learning; Person-centred research; Action-oriented methodology;Item Postgraduate nursing education in Nigeria: understanding registered and graduated students’ experiences in their journeys to programme completion or withdrawal(Queen Margaret University, Edinburgh, 2018) Onwe, Simon NwigbojiBackground: Nigerian nursing education has developed from initially limited numbers of missionary schools to a more substantial expansion of urban, hospital-based institutions since 1945. Postcolonial emancipation sparked the University of Ibadan into opening the first Department of Nursing in Nigeria in 1965. This triggered the creation of further university-based undergraduate programmes across Nigeria, though many hospital-based schools offering diploma level training have also been retained. The first postgraduate nursing programme commenced in 1988 at the Obafemi Awolowo University, followed by the University of Ibadan and the University of Nigeria, Nsukka. These three universities are still the main postgraduate nursing education providers in Nigeria today. The Nigerian Government and professional stakeholders including the Nigerian Nursing and Midwifery Council are concerned by the low graduation rate of nursing students in relation to the standard programme duration of one year for masters’ and three years for PhD programmes (10%), and their relatively high rate of attrition (20%). Objectives; The study seeks to understand the experiences of postgraduate nursing students in Nigeria. Research method: The research participants included registered and graduated postgraduate nursing students, lecturers, and the staff of nursing education coordinating bodies. They were recruited to this study purposively and by snowballing. The research employed a qualitative inquiry method using face-to-face interviews, the methodology being informed by a critical realist worldview with regard to agency and structure. Result: The key findings revealed that the students’ experiences of delay in completing their programme were influenced by student factors (allocation of time between full-time work and full-time study, and sponsorship); lecturer factors (workload and workforce development); policy issues (programme structure and implementation); and social structures and mechanisms in Nigeria. Recommendation: The researcher recommends further studies on the impact of gender on nursing education, the relationship between postgraduate nursing students’ experience and their expectations, and the effect of international partnerships on postgraduate nursing education in Nigeria. He further recommends a review of the postgraduate nursing curriculum. Conclusion: Findings from such studies would further help to improve the students’ experiences.Item Virtuous, invisible and unconcerned: nurses, nursing and the media(Queen Margaret University, Edinburgh, 2017) Balaam, MartinaThis study, underpinned by a hermeneutic methodological strategy, investigates how British nurses make sense of representations of nurses in the popular media, and their perceptions of the potential implications of media representations for nursing as a profession and their own sense of self. The study was designed because of a number of factors: the popularity of hospital dramas and the increasing prevalence of hospital based 'fly on the wall' television programmes, a plethora of press coverage about the poor quality of nursing care, concerns from the nursing profession that the media representation of nurses have a detrimental effect on the nursing profession and nurses' sense of self, and a scarcity of research which has explored nurses' perceptions of representations of nurses in the popular media. Twenty-five nurses from a broad spectrum of nursing areas were recruited to the study. Eighteen participated in focus groups and a further seven nurses were interviewed individually. A thematic analysis of participants' descriptions, perceptions of, and emotional response to the representation of nurses in the media, revealed that nurses hold diverse, contradictory and ambivalent views of media representations. Whilst the way nurses describe representations in the media is consistent with previous research, which argues that nurses are represented by a number of stereotypes, there are novel and significant findings presented in this thesis, which may have implications for the nursing profession. The study reveals that some nurses hold a virtuous understanding of the profession and secondly, that some nurses hold a stereotypical understanding of nurses. Despite participants dismissing the media as 'just entertainment', having no consequence to the status of the profession or their sense of self, they nonetheless expressed concern at the 'negative' way they were represented in the media. Consequently, there is a need for nurses to challenge both existing media representations and the way they talk about nurses and the profession.Item Whispers and song: a phenomenological inquiry to discover nurses' lived experience of person-centred dementia care(Queen Margaret University, Edinburgh, 2016) Wareing-Jones, SianPerson-centred is now a widely used term to describe much dementia care in the UK and Jersey. This existential hermeneutic phenomenological research seeks to discover the lived experience of person-centred dementia care for nurses in Jersey and through this, the essences and meanings of person-centred care. It is grounded in Merleau-Ponty’s ideas of embodiment for being in the world and Buber’s primacy of relationships and includes complimentary ideas within Lévinas, Gendlin and Vanier’s philosophies. Its methodology is inspired predominantly by van Manen, it is hermeneutic in its interpretive and poetic stance and is existential in its focus on nurse’s lived experiences. Eight nurses, working in care homes and specialist dementia care units, took part in semi-structured interviews which were recorded and transcribed. Deep immersion into these texts followed using the six existentials of corporeality, relationality, temporality, spatiality, materiality and mood, proposed by van Manen and Todres, as lenses to get closer to the participants’ lived experiences, essences and meaning of person-centred dementia care. This research has been amongst the first to use six existentials for data analysis; it demonstrates the accessibility of this methodology for counsellors from its parallels with therapy; it demonstrates the potential of poetry and metaphor images to uncover the essences and meanings of phenomena; and its enhanced focus on the experience of person-centred care reveals considerable rhetoric in the use of the term in mission statements and care philosophies. This research shows that the term, and the models and frameworks associated with it, are not well understood, indicating the need to embrace a new understanding of person-centred care from the macro context to individual practitioners; the need for more effective training, education and practice development together with new support structures for nurses and better communication throughout the services. It also proposes a new vision focussed more on ‘caring’ than ‘care’ and for a uniting Jersey Dementia Strategy to help refine and define systems, policy, practice and care.Item Trends, motivations and experiences of Czech migrant nurses: a mixed methods study(Queen Margaret University, Edinburgh, 2016) Di Cara, VeronikaThe migration of nurses is currently an important political theme, and it is only expected to intensify in the future, because of the current demographic trends. Considering the facilitating policies and the differences between salaries, the intra-European migration of nurses is rather small, but its monitoring is not very exact. The migration of Czech general care nurses remains under-researched. I used mixed research with explorative sequential design in this study. In the initial embedded qualitative strand, I interviewed informants with expert knowledge on the migration of Czech nurses. The second quantitative strand consisted of a survey of self-selected Czech migrating nurses using an electronic questionnaire. The last strand used a focus group technique with Czech nursing migrants to clarify some of the previously researched topics. Some findings from this study are similar to the previously conducted research, and some differ substantially. Almost all of the respondents and participants felt that their professional skills improved because of their migration. More than half eventually returned to the Czech Republic, often they provided direct care in the Czech Republic, and mostly they reported not being able to utilize all of the new knowledge gained abroad. The main destination country was Saudi Arabia, therefore the respondents often cooperated with a recruiting agency. Their families were typically not involved in the decision to migrate and the migrants only rarely sent remittances home. Instead, they invested their earnings in real estate. Consistent with the literature, the professional communication in a foreign language and the different nursing practices of the destination country were rated as difficult. Findings from all three strands suggested that the nurses were transformed by the migration. It is generally understood that nurses are vital for providing health care services, thus we should offer them motivating working conditions to prevent more extensive migration and use the potential of brain circulation.Item Working in a storied way.The development and evaluation of a narrative based approach to practice development in an older adult residential care setting.(Queen Margaret University, Edinburgh, 2015) Buckley, CatherineThis thesis presents the development, implementation and evaluation of a methodological framework for a narrative based approach to practice development and person-centred care in residential aged care settings. The study is underpinned by practice development, person-centred care and narrative methodologies. Narrative focuses on a way of being, paying attention to past present and future, and also as a way of doing, as the means through which action is understood and made meaningful. Carried out between 2010 and 2014 and underpinned by theories of narrative inquiry, person-centred care, practice development and action research, this study is guided by the philosophical perspectives of Heidegger (1962). Forty six interviews, collected as part of a national research programme, (Person-Centred Care Practice Development Programme 2007-2010), were analysed for key themes by myself, four focus groups of 12 clinical nurse managers and two independent experts. Themes were also derived from a focus group of eight residents who explored person-centredness and narrative. Combined, this analyses led to a single set of themes that were used to develop a Framework of Narrative Practice. This framework consists of four pillars, prerequisites, care processes, care environment and narrative aspects of care. The framework further includes three narrative operational elements, narrative knowing, narrative being and narrative doing. Working with the four foundational pillars and the three narrative elements enabled staff to 'work in a storied way' and provide person-centred outcomes and a narrative informed philosophy of care for older adults. Using an action research approach with work-based learning groups, the framework was implemented in two residential care settings that were comprised of 37 residents and 38 staff. Three action cycles (1) narrative practice and culture identification, (2) developing narrative practice and (3) working in a storied way emerged during the implementation. Using these action cycles, staff developed action plans to address areas where changes could improve practice and quality of life for the residents. These plans included communication/intercommunication, homely environment, having more going on with and for the residents and meals and mealtimes. By taking account of their biography, the framework confirmed the identity of older people. Three key areas emerged, however, that warranted further conceptualisation. These were, how staff and residents responded to change (narrative being), development of shared understandings (narrative knowing) and intentional action (narrative doing).Item How do the characteristics of context influence the work of facilitators when implementing a standardised educational intervention targeting nursing home staff to reduce restraint in dementia care?(Queen Margaret University, Edinburgh, 2015) Mekki, ToneThis research is part of a larger study - a sequential mixed method education intervention targeting staff in 24 Nursing Homes (NHs) in Norway to reduce use of restraint and psychotropic drugs. Building on a previous successful intervention, we used the Promoting Action on Research Implementation in Health Services (PARIHS) prospectively to combine cluster randomized controlled trial, participatory action research (PAR) and ethnography to design and evaluate the effectiveness of 2 day staff education and 1 hour monthly coaching during 6 months in two rounds (12 x 2 NHs). In my research that is the primary focus of this thesis, four teams of eight facilitators facilitated the intervention and simultaneously participated in PAR to co-construct knowledge of hindering and promoting implementation factors. A 'Creative Hermeneutic Knowledge Co- Production' (CrHeKCoP) model blending paradigmatic and epistemological assumptions from critical and participatory worldviews was created and used in spirals of 10 mini-cycles of actions to co-construct knowledge of the implementation process.Item Devolution and nursing workforce policy and planning in the four countries of the United Kingdom 1997-2009(Queen Margaret University, 2013) Milne, PaulineThis thesis examines how political devolution in the UK impacted upon nursing workforce policy and planning by investigating the following research questions: What has been the impact of devolution on nursing workforce policy and planning across the four countries of the UK (1997-2009)? How and why have the approaches to nursing workforce policy and planning changed across the four countries of the UK (1997-2009)? The research methodology used was a mixed methods approach which included semi-structured interviews with 30 stakeholders from the fields of nursing, healthcare policy or workforce planning across the UK. A purposive sampling strategy was adopted and the distribution of interviewees was England (11), Scotland (7), Wales (6) and Northern Ireland (6). A realist review approach to inquiry was taken which involved establishing what works for who, in what circumstances and why? The qualitative data from the interviews was supplemented by analysis of quantitative data on nursing workforce trends and information from the analysis of health policies from the four countries. The key findings include: changing patterns of power and influence in the devolved administrations; continued cycles of ‘boom and bust’ in nursing workforce supply; variable growth in the nursing workforce across the UK; the unwillingness of England to ‘let go’ and the perception by interviewees that some national nursing policies were unimportant. The conclusions were that although devolution enabled greater freedoms in terms of policy and workforce flexibility, just under half of the interviewees reported that devolution had a positive impact upon nursing. There was reluctance from senior nursing leaders to share and learn from good practice across countries and despite the rhetoric from numerous reports around the need to improve nursing workforce planning, there was little evidence of lessons being learned which would have improved the effectiveness of planning the future nursing workforce.