Search

This thesis explores the perceptions of students undertaking a Diploma of Higher Education in Nursing, in relation of the care practices that they encounter during their practice placement allocations. Specifically, the factors and processes, by means of which students deem the quality of care provision to be satisfactory, or otherwise, are analysed. A central concern in the thesis is identification and exploration of the changes and constancies in the students' perceptions over time. Findings indicate that the students' conception of care, as related to nursing work, contains some important variations from the concept as used by policy-makers in nursing. In relation to their moral reasoning, the students' accounts indicate processes that are more subtle and complex than some of the influential theorists (Kohlberg, Gilligan) suggest. Students do not appear to adopt a perspective based on justice or care per se, although elements of these principles are present within their accounts. Rather, the students' moral reasoning processes become increasingly focused, over time, upon providing care in context and this emerges as the core category, and basic social process, within the study. The students, in progression through their programme, gain access over time to a 'wider picture' than is available to them during their initial practice placements. Increased experience and concomitant acquisition of confidence enable students to place the provision of patient/client care in the context of the substantive circumstances pertaining to the individual. Development of the ability to view care in context appears to be accompanied by a reduction in reliance upon abstract moral principles as a guide to behaviour. Direct involvement in patient/client care and the ability to access the 'wider picture' increases the moral complexity of decision-making for students. This is viewed by the students as being a prerequisite for good nursing practice. The factors which facilitate and inhibit provision of care in context are discussed and some implications of the study's findings for nurse educators and service providers are suggested.

Abstract Background Compassionate caring and dignity are key priorities in current policy and research agendas and are central to the quality of experience for patients, families and staff. Developing relationships has been identified as a key component in enabling excellence in caring to be realised in practice. However there is little evidence that identifies the processes involved in delivering compassionate relationship-centred care. This study sought to address this gap in the knowledge base. Aims and research questions The study's aim was to examine and evaluate processes that enhance compassionate relationship-centred care within an older people care setting in an acute hospital. Key objectives were: to develop an understanding of the concept of compassionate relationship-centred care within the practice setting through exploring the views, perceptions and experiences of staff, patients and their families; to develop, implement and evaluate strategies that promote this concept; to examine the processes that need to be put in place to enable sustainability of these strategies; and to identify the lessons learnt to inform practice, education, policy and research. This study was part of a larger programme of work that aimed to integrate compassionate care across practice and education. Approach and methods My role as a senior nurse and practitioner researcher meant that I was in a unique position to be able to capture not just theoretical views of compassion but how this was enacted in practice. To do this the study used the approach of appreciative inquiry. A range of methods was used: participant observation, stories using emotional touchpoints, photo-elicitation, and group discussions to explore beliefs and values. Data were continually fedback to staff participants to involve them in analysis. An iterative and inductive process of immersion crystallization was used to analyse data. Findings A key finding was the development of a practice model to support practitioners to deliver compassionate relationship-centred care. This model suggests that, in order to deliver such care, people need to engage in the process of appreciative caring conversations in order to understand a) who people are and what matters to them; and b) how people feel about their experience. This in turn enables a process of working together to shape the way things are done. The findings support the notion that during these caring conversations the practitioner needs to connect emotionally, be curious, collaborative, able to compromise, considerate of others perspectives, courageous and actively celebrate when practices have worked well in order to promote compassionate relationship-centred care. This framework comprises the 7 ‘C's of caring conversations and makes a unique contribution to the body of knowledge in providing practical guidance as to the ‘how' of compassionate relationship-centred care. Key outcomes of implementing this model were that people felt comfortable to express emotions, developed stronger relationships, were more consistent in delivering compassionate care practice across the team, and had a sense of learned hopefulness in the face of complex and competing demands. Conclusions and implications Implementation of activities in practice to support this way of working revealed that these processes are complex, often requiring the practitioner to takes risks and therefore the provision of appropriate support, facilitation and strong leadership are important factors in helping to sustain such practices. The outcomes of this research build upon the existing knowledge base by providing a practice model that specifies how to deliver compassionate relationship-centred care, and they demonstrate the impact of using appreciative approaches to facilitate improvement within health care contexts.

Anxiety in young people with Asperger's syndrome (AS) is of serious concern. With a greater prevalence of girls with AS than previously considered, there is a paucity of research into experiences of anxiety in this population. Girls with AS and their parents may seek help through professional Western Herbal Medicine (WHM), the practice of which has little research evidence. The aim of this study is to explore experiences of girls in Scotland with AS and anxiety during a course of WHM treatment, described by the girls, their mothers and the herbalists. A Hermeneutical or Interpretive Phenomenological longitudinal case-study approach included a purposive sample of 3 girls, their mothers and 3 Western Medical Herbalists (WMH) (n=9). Innovative methods developed to address specific needs of the girls comprised of licensed computer interview software ‘In My Shoes' and an online diary facility. Individual interviews took place with all participants, second interviews held with girls and mothers, were transcribed verbatim and thematic analysis carried out. The study was endorsed by Edinburgh Napier University Faculty of Health, Life and Social Sciences Research Ethic and Governance Committee and the National Autistic Society. Informed consent was given by all participants. Where can we be what we are? was identified as a theme within a narrative of marginalisation in which individuals whose needs are marginalised turn to a treatment marginalised within the prevailing biomedical health care model. Anxiety manifests in girls with AS in a number of ways including chronic insomnia, emotional outbursts and school refusal. The WHM treatment had beneficial effects. However, access to, and compliance with, the treatment, may be inequitable. There is an urgent need for greater support for girls with AS and families, with an evidence base underpinning appropriate intervention. Diagnosis needs to be accompanied by acceptance in society and the availability of future opportunities. Further qualitative research in this area would increase insight and understanding and provide support for the development of larger scale studies. The creation of ‘best practice' guidelines in WHM for the treatment of girls with AS is recommended as is a pragmatic clinical trial of WHM for girls with AS and anxiety. key terms: Girls, Asperger's, anxiety, Western Herbal Medicine, hermeneutic interpretive phenomenology, methods, In My Shoes