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This thesis is a case study of coordination policies and practices in child protection services. The study is an exploratory, descriptive account of the processes and outputs of interagency coordination rather than a hypothesis-testing study or an evaluation of the outcomes of coordination. It is based on empirical research undertaken in two research sites in the north of England. The principal data sources used in the research were: an analysis of the social services departmental case records relating to a sample of 48 children on child protection registers for physical or sexual abuse; interviews with 90 professionals (social workers, teachers, community nurses, police officers, doctors and others), drawn from a sub-sample of the 48 cases; a questionnaire issued to those interviewed and selected others, completed by 81 respondents; and analysis of central government guidance, local interagency procedures and other documents. In Chapter One of the thesis, selected topics in the literature on interagency coordination and the policy background to the study are reviewed. The research methods used and the characteristics of the case sample and the interview and questionnaire respondents are presented in Chapter Two. The principal research findings are presented in Chapters Three to Eleven covering three main topics: i) interagency coordination in the key phases of a case career (namely referral, initial investigation, medical assessment, case conferences, child protection plans and intervention, monitoring and review) ii) an examination of local interagency procedures and the role of Area Child Protection Committees and iii) the perceptions and experiences of respondents concerning interagency work. The thesis concludes that there is a high degree of routinised coordination with a relatively clear division of labour in child protection services; that coordination involves principally the exchange of information, arranging for the sequential and separate performance of key tasks and some limited shared decision-making but that there is little joint hands-on collaboration; that interagency activity peaks in the early phases of the construction of a case and diminishes thereafter; that the implementation of policy guidance may be seen as relatively successful and that there is some support for the idea that interagency coordination strategies tend towards conservatism.

This thesis examines how Eva Lückes, matron of The London Hospital between 1880-1919, influenced a generation of nurse leaders. The nursing historiography suggests that the nascent profession was trying to establish itself as an élite service. This study's initial aim was to determine whether Lückes was a 'maker of matrons' and whether she had selected her protégées solely from the higher-classes. The empirical primary sources for this study, which is in part a prosopography, was gathered from the archives of The London Hospital, the Royal College of Nursing, the British Library, and a range of local archives across the country. This established that 474 women could be identified who became matrons, having trained or worked under Lückes. Their social class was determined using genealogical techniques, which found that Lückes did not select these future matrons by social class alone; the primary sources showed that Lückes selected 'suitable' women with education and the right 'tone', and used character training to mould her version of the new Nightingale 'model' nurse. The research revealed that Lückes selected 'special' nurses for managerial training during their probationary period, or their early careers. Lückes was mentored by her friend Florence Nightingale, and in turn, acted as mentor and patron to her nurses. The study reveals Lückes's not inconsiderable vicarious influence, through her nurse leaders on civilian and military nursing. It uncovered the part she played in the professionalisation of Poor Law infirmaries and voluntary hospitals, and in the development of the Queen Alexandra's Imperial Military Nursing Service. Lückes accessed patronage and beneficial networks - often from the social élite and a 'web' of London Hospital supporters, in order to disseminate a reformed nursing diaspora both at home and overseas. The thesis considers Lückes's role in the professionalisation of nursing against the impact of industrialisation, and developments in hospital, and nursing provision. Where appropriate to this study, ongoing debates about Lückes's disciplinarian management style, her treatment of nurses during the 1890 Metropolitan Hospitals Enquiry, her determined opposition to centralised nurse registration including a mandatory three-year training programme are considered, and whether these issues impinged on the careers of the nursing leaders. The study is set against the context of increasing education, careers for women and their changing role in society. It is framed largely by general nursing and cultural history, but gender, social and women's history also inform the thesis.

Over the past twenty years advanced nursing roles have become increasingly prevalent in the United Kingdom. A scoping review identified that the traditional scope and boundaries of professional nursing have been reshaped by health service policy and managerial reforms, resulting in advanced nurses focusing less on tasks which were traditionally the domain of nursing, and more on traditionally medical tasks. The research aims were to explore the development and practice of advanced nursing roles in Wales, and analyse ways in which policies and initiatives have influenced the advanced nursing roles. A qualitative approach guided by the principles of Charmaz's (2006) constructivist grounded theory methodology, was used to provide an understanding of advanced nursing roles and the factors influencing them. Semi-structured individual interviews were conducted with forty-five participants: advanced nurses, doctors and managers from two health boards in Wales. All participants had first-hand experience of the advanced roles, and some control over the advanced nursing roles. Documentary analysis was also utilised to contextualise what was said during interviews in order to ascertain the official account of advanced practice and compare this with nurses' reports of current practice. The grounded theory principles of theoretical sampling, coding, constructing categories and developing theoretical concepts, were adopted to produce a theoretical framework explaining the relationships between the emerging categories. The three main categories: working autonomously, reshaping role boundaries and status distinctions, and working relationships, revealed the major paradoxes of advanced practice that emerged from the data. The first paradox concerns advanced nurses' perceptions of their autonomy in making clinical decisions, which was in contrast with their descriptions of direct control by the medical profession and managers, as well as their descriptions of being controlled by protocols and guidelines. The second paradox describes advanced nurses' growing identification with the medical profession as they demarcated boundaries to distinguish advanced practice from other nursing roles, which was in contrast with their desire to be professionally identified as nurses. The third paradox highlights the medicalised task-oriented nature of advanced practice, which prevented many advanced nurses from following patients through and getting to know their patients, versus an idealised view of nursing as delivering personalised, holistic care. The main categories and paradoxes raise questions as to whether advanced nursing roles are advancing nursing, meeting service imperatives, or fulfilling a new doctor's handmaiden role.

This study aimed at describing how the nursing profession in Malta changed between 1964 and 1996 emerging as a profession a result of circumstances and changes within and without. Change appears to have been imposed from outside the profession but Maltese nurses did not react to changes whether it was to their benefit or not. Meanwhile, the cumulative effect of various factors such as demographical changes, educational status and political decisions initiated the process of professionalisation of nursing in Malta. Source materials included archival sources and oral history interviews with twenty four interviewees consisting of nurses and other persons who were influential during the time, including politicians. These were analysed in order to produce a narrative of professionalisation of nursing in Malta. This is the first indepth study on the subject. The chosen period under study begins in 1964, the year Malta gained independence and ends in 1996, the year when the post of Nursing Director was established, thus allowing nurses a relative autonomy. Nurses were initially led by the Sisters of Charity who supervised them. Changes in the demographics of nursing, the type of preparation needed for it and the management system together with political decisions that often followed similar ones taken abroad, affected Maltese nurses. The official opening of the St Luke's School for Nurses and the introduction of nurse education at tertiary level were significant markers in the process of professionalisation. The thesis presents an insight into how Maltese nurses did not show much eagerness to reach professionalisation but were still propelled towards it by changes occurring extrinsically and then intrinsically. This is perhaps unique since nurses in other countries had nurse leaders who actively worked to reach professionalisation.

The study is an oral history of the work of district nurses in the Outer Hebrides of Scotland from 1940-1974. The main themes that emerged from the study were, the wide scope of the nurses' practice, their significant relationships, and the unique nature of their role. Within the themes were concepts of self sacrifice, resilience and autonomy. The challenges the nurses faced in their daily lives from their surrounding environment and the urgent needs of patients were physically and mentally taxing. There was evidence of their resilience and strength of character when they did not flinch in difficult situations. Yet they described being 'happy at work' and relied on their faith. The study suggests that the service these women provided could be regarded as 'heroic'. The thesis offers an insight into the daily lives of district nurses in a remote part of Scotland which has never been studied before. Most nurses were trained Queen's Nurses which was evidently influential and to some a prestigious qualification.

Nurses and doctors work together in hospitals as they provide care to patients. Nursing knowledge and practice are affected by relationships between nurses and doctors. This study sought to shed light on relationships between nurses and doctors using a broad comparative approach. Relationships between nurses and doctors in Britain and America were examined in order to shed light on the nature of the relationship between nursing and medicine in Britain and America between 1860 and 1914 and to elucidate factors which contributed to the development of this relationship. Examination of the historical roots of the relationship between nursing and medicine may help nurses to develop a deeper understanding of the situation of nursing within healthcare and the ways in which historical factors, such as societal practices and assumptions regarding class, gender, hospitals, and work have affected nursing theory, practice, and status. Studying these issues in two countries may facilitate exposure of factors which might be overlooked in a study of one country alone. This study focuses on hospitals in London and Philadelphia, which were both major centres for development in nursing and medicine during the study time period. The time period for this thesis is 1860 to 1914. It begins with the opening of the Nightingale School at St. Thomas’s Hospital in London in 1860 which served as a model for other hospital training schools for nurses in London and Philadelphia. The bulk of the material for the study comes from the 1880s to the early years of the twentieth century as multiple formal hospital nurse training schools developed in important hospitals in both cities. Various factors were identified which contributed to the context in which nursing developed in London and Philadelphia during the study time period. This study examines conceptualisations of nursing and nursing work in relation to medicine and doctors’ work particularly through Nightingale’s writings and the elaboration of her ideas by her friend Eva Luckes, matron of the London Hospital as well as material in nursing textbooks. The study also looks at relationships between nurses and medical staff as they worked on hospital wards, particularly the effect of the presence of many medical students on the wards of London hospitals and their absence in Philadelphia. The importance of strong nurse leaders within hospitals in regard to separation of hospital nursing and medical services is examined. Harmony and discord between nurses and doctors is examined in order to understand factors which contributed to tensions between doctors and nurses. The case of the development of physiotherapy reveals important aspects of relationships between nursing and medicine in society.

The thesis examines the position of nurses during the Second Anglo-Boer War (1899 – 1902) and considers how their work helped to raise the profile of nursing. The experience of the war demonstrated the superiority of the work undertaken by trained nurses as compared with that of ‘amateurs’. At the commencement of war a small cohort of army nurses worked alongside large numbers of trained male orderlies, however these numbers proved insufficient during the period of the war and additional, entirely untrained orderlies (often convalescent soldiers) were relied upon to deliver nursing care. Against a backdrop of long term antipathy toward nurses at the seat of war, the work of both army and civilian nurses in military hospitals suggested that the clinical proficiency of trained nurses had a significant impact on military effectiveness. The thesis will develop arguments based on the personal testimonies of nurses who served during the Anglo-Boer War, relating to clinical nursing and nurses perceptions of professionalism during the period. Personal testimony will be used primarily to examine the working lives and experiences of serving nurses, as many historians simply state that the excellent work of the nurses forced changes, yet make no allusion to what this specifically entailed. Faced with the exigencies of war, including limited medical supplies and military bureaucracy (termed by nurses and doctors alike as ‘red tape’) that hindered nurses’ abilities to provide high levels of care, nurses demonstrated their developing clinical confidence. Despite accusations that nurses were ‘frivolling’ in South Africa, raising concerns over the control and organisation of nurses in future military campaigns, the social exploits of nurses on active service was not entirely detrimental to contemporary views of their professional status. Nurses were able to demonstrate their abilities to survive the hardships of war, including nursing close to the ‘front lines’ of war and the arduous conditions inherent in living under canvas on the South African veldt. Not only were nurses proving their abilities to endure hardship normally associated with masculine work, but they were also establishing their clinical capabilities. This was especially so during the serious typhoid epidemics when nurses were able to draw upon their expert knowledge to provide careful nursing care based on extensive experience. Nurses, who had undergone recognised training in Britain, demonstrated their professional competence and proved that nursing was a learned skill, not merely an innate womanly trait. The war also represented an opportunity to evidence their fitness for citizenship by using their skilled training for the benefit of the Empire. The subsequent reform of the Army Nursing Service, resulting in the establishment of the Queen Alexandra’s Imperial Military Nursing Service in 1902, suggests permanent recognition of the essential role of nurses in times of both war and peace.

Before the availability of antibiotics minor infections could become life threatening. Nurses working in voluntary and public hospitals in Britain were exposed to such risks. This thesis uses both oral testimonies and published sources in order to examine their practices concerning the management of infection risks. The detail of nursing work in this period has been generally hidden in nursing histories of the 1930s and 1940s which have addressed mainly political, recruitment, educational, registration and status issues. Whilst these histories may comment about menial duties, and the culture and discipline in clinical areas, they lack detailed exploration of the day-to-day work of the nurse. This novel study contributes to redressing the balance by examining nursing practice between the discovery of penicillin in 1929 and its widespread availability in Britain in 1948. Data analysis, including the oral testimonies of nineteen former nurses who worked between 1929 and 1948, suggests that nursing practice during this period placed enormous emphasis on cleanliness and hygiene. It is argued that this was linked to sanitarianism which influenced nursing practice before its replacement by germ theory. Probationer nurses learnt their skills in managing infection risks to themselves and their patients in a disciplined and safe way. This was achieved through the exercise of strict routines and a hierarchy of tasks that provided a graduated exposure to the patient and infection risks. This thesis draws on debates in the literature about purity, vocation and status to explore, and add weight to this argument. The analysis also identifies that the introduction of sulphonamide drugs and antibiotics altered nursing practices in the management of both infection risks and patients with infection. Whilst the full effects of these changes are not examined in this thesis, it is argued that the significant impact of these drugs was such that the emphasis on cleaning and hygiene became diminished in importance and nursing had to redefine its role. It suggests that more prominence needs to be given to changes in clinical practice in the history of nursing. This study breaks new ground by suggesting the rigorous training of nurses in cleaning and hygiene tasks was needed in order to manage the infection risks faced by nurses before the availability of antibiotics.

This thesis presents a qualitative multiple case study which examines the early implementation of the community matron policy in three primary care trusts in England. The community matron was a new role in nursing, introduced by the Department of Health in 2004, as part of its strategy for the management of long term conditions (DH, 2005e). There was a paucity of research literature underpinning the policy and the implementation of the community matron role in England. A descriptive multiple case study was used as it generates a richness of data using multiple data collection methods, ideally positioned to investigate phenomena in context and contemporaneously. In addition to documentary material, 49 participants were recruited across the three case study sites, from community matrons, active case managers, health and social care colleagues and patients. A total of 30 interviews, 33 observations and one focus group were undertaken between 2006 and 2008. Framework Analysis was used to interpret the data and critical sensemaking was applied as a heuristic to gain insight into the findings.This study explored the early role implementation from the perspective of the community matron. It found that the community matron role had been adopted with regard to the national model but there was variation in its implementation between case study sites, seen in service structures, eligibility criteria and caseload management. Practitioners had exercised professional discretion to flex local service models to fit their ways of practice and professional decision making, although this may not have been conscious behaviour. They also expanded the role to include psychosocial support, beyond the nationally defined functions. Advanced practice was integral to the role; whilst there appeared to be a medical influence on this aspect of role development; practitioners had adopted traditionally medical tasks and incorporated them into nursing practice, making such roles their own. Community matrons described experiencing resistance to the role initially from some district nurses and GPs, outlining how they adopted strategies to address these and promote acceptance of the role. As such, individual community matrons were the key change agents. They experienced dissonance between organisational values and professional values, which they addressed by reinterpreting collective targets such as reducing hospital admissions into individual patient outcomes related to improved quality of life. Critical sensemaking gives a unique perspective on the implementation of national policy, through the lens of the community matron, highlighting the experience of nursing role development at an individual and team level, and the ways in which variation can occur. Further research is needed into nursing policy implementation to better understand the processes at play nationally and organisationally. Critical sensemaking might be used to inform how implementation can be effective and sustainable.

This thesis is an attempt to theorise the therapeutic subjectivity of the 'young sexual abuser'. It falls into two parts. In the first, I make the case for an 'analytic bridging' between Foucauldian and other more broadly sociological perspectives in theorising sexual and therapeutic subjectivities. Specifically, I extend the Foucauldian idea of governmental practices into the therapeutic hour - that is, into the space and tie of therapeutic interaction. At the same tie, I also draw on more sociological readings about the self in interaction, sexuality and gendered embodient - themes which are revisited throughout the thesis when looking at chidhood, therapeutic practices and sexual risk. The second part of the thesis presents an empirical analysis of popular, practice and research accounts of 'problematic' young people and young sexual abusers; interview data with both 'young sexual abusers' and practitioners; and video-recordigs of a therapeutic programme for sexually abusive boys. Through ths analysis, I argue that the therapeutic subjectivity of the young sexual abuser is actually made up of three emergent subjectivities: the risky self, the victi-victiser and the controlled self. The thesis as a whole contributes to debates withn the sociology of chidhood, includig the relationship between gender, generation and sexual risk; to debates about the relationship between social theory and analysis of practice; and to debates about subjectification practices in late modernity, particularly with the gendered therapeutic project of sexual control.