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Older people residing in nursing homes have complex needs requiring the input of nurses skilled in managing multi-morbidities and psychosocial issues. However, in England, nursing homes have proven to be unappealing work settings for potential staff, while nurses who do work in these settings are often afforded low status. Such contradictions pervade current understanding of the nature of work in nursing homes. To-date, few studies have investigated the views and experiences of nursing home nurses themselves regarding the contradictions that arise from role and status issues. This study explores English nursing home nurses’ views regarding status and role. The aims of the study were constructed as follows:  To explore the experiences and views of nursing home nurses working with older people regarding their status and role. -To generate an understanding of how and why these experiences and views occur. -To explore whether emerging insights regarding nursing home nursing can inform workforce development processes. The methodology utilised was hermeneutic phenomenology, based upon the philosophies of Gadamer and Iser. Thirteen nurses from seven nursing homes were each interviewed five times using an episodic interview technique. Data analysis methods were adapted from Van Manen’s hermeneutic phenomenological approach, and Iser’s literary reception theory methods. Four categories emerged from the data - nursing ‘residents’ rather than ‘patients’, business role, stigma, and isolation and exclusion. From these categories, three themes were ascertained - uncertainty about role identity, unpreparedness for the demands of the role, and low occupational status. Participants feel uncertain, unprepared and stigmatised because they are positioned at the intersection of health and social care – a location where health and social care funding issues cross, and healthcare and social care work overlaps. Understanding generated from this study can inform workforce development processes.

This thesis explores the experiences of older people participating in drama workshops, based on the physical theatre actor training practices of Philippe Gaulier and Monika Pagneux. It examines older people's perceptions of the impacts of their drama experiences on their creativity, health and wellbeing. The study addresses a lack of research on the creative and cultural value of older people's theatre-making. The findings also make a significant contribution to the limited research on the impact of drama on older people's health and wellbeing. Four groups of older people (42 participants) in North East England participated in physical theatre, drama workshops, over one year. The workshops were designed to, give participants a practical introduction to key elements of Gaulier and Pagneux's work: Le Jeu (play), complicité (collaboration and rapport) and disponibilité (openness). These tenets underpin an approach to theatre-making that Pagneux describes as 'lifeful'. Participants' responses were collected through questionnaires, focus groups and journals. The data were analysed within a heuristic and hermeneutic phenomenological framework. Key themes identified from the data were grouped under the headings: The Physical Self; The Mental, Psychological and Emotional Self; The Individual and the Group. The findings indicate that participants particularly enjoyed the collaborative and improvisatory nature of the workshops, learning and developing new theatre-making skills. They found the work to be integrating and holistic, encouraging them to take risks and step out of their comfort zones through creative movement and play. Several participants described the workshops as enabling them to express parts of themselves that, as older people, might often be hidden from public view. This was a freeing and liberating experience. Additionally, many participants also reported improved posture, balance and range of movement, as well as enhanced mood, confidence and cognitive stimulation. This research contributes original knowledge as to how physical, playful and improvisatory approaches to theatre making, based on Le Jeu, complicité and disponibilité, can support older people to stay active, engaged and 'lifeful', regardless of any physical or mental limitations they might experience. These approaches build older people's skills in creative expression which can also engender experiences of empowerment and agency, thereby challenging individual and societal perceptions of ageism.

The current literature highlights that professional healthcare staff admit to regularly telling lies in practice, to people with dementia. This, despite the Nursing and Midwifery Council and the General Medical Council being explicit in their codes of conduct that nurses and doctors must not tell lies to patients. Both codes also highlight the duty of beneficence and non maleficence, and it is known, that sometimes, telling the truth to people with dementia can cause great distress. The purpose of this study was to use ethnography to undertake a critical analysis of the concept of lying in clinical practice in the context of people with dementia. The aims of the study were as follows: • To develop a taxonomy of lies • To use the taxonomy to develop a model which could be used in practice, to explore the impact of lie telling Current literature has used either phenomenology or grounded theory to ask staff their perceptions of what they say when they tell lies. Uniquely, the methodology used for this study was ethnography, with the researcher acting as a complete participant observer, observing lies told in practice to people with dementia by staff (nurses, doctors, allied health professionals and healthcare assistants). By using ethnography, this study has recorded previously unidentified phenomenon and brought new knowledge and insight to the topic area. Data was collected from two wards for people with moderate to severe dementia over a period of 45 shifts, equating to approximately 338 hours. The data was analysed using thematic content analysis. Six categories of lies emerged from the data which formed the taxonomy: familiarity, banter, props, going along with, avoidance and delaying and blatant. The taxonomy was then used to develop the Lie ARM (Affective Reflection Model) to enable healthcare professionals to reflect on the practice of telling lies and consider the effectiveness of them. Findings from the study can be used to challenge current policies around lie telling; specifically, that whilst truth should always be the starting point, telling lies to patients with dementia can be a kind and effective intervention to support their personhood and reduce distress.

Background: People with severe dementia are frequently cared for by registered mental health nurses due to their often complex cognitive or psychological care needs. This may present challenges in practice due to the inter relatedness of physical and mental health that accompanies dementia, not least the presentation of delirium superimposed on dementia (DSD). This study aimed to explore and describe the experiences of mental health nurses who provide care for people with DSD. This will support better understanding of what influences or impacts their work. Methodology and Methods: Using Activity Theory to guide the study throughout, a mixed methods exploratory sequential design was constructed. Semi structured interviews were undertaken to collect qualitative data, before a quantitative exploration through questionnaire development and completion. Data analysis was undertaken utilising framework analysis in the qualitative phase, and descriptive statistics in the quantitative phase. Integration of data was undertaken, and findings presented in an activity system graphic. Participants were registered mental health nurses working in 24-hour care settings for people with dementia. Findings: Five key themes emerged from the data: 1. For RNMHs to use tools (such as scores or guidelines), they need to see them as useful and contextually relevant. Whilst they are aware of tools, they may choose not to use them if they do not see the value in them. 2. Knowing the person for whom they provide care is central and personal. The RNMHs favour aesthetic ways of knowing and use this to guide their care provision. 3. Hierarchy within the multidisciplinary team remains, however this is not seen as a negative. The RNMHs feel supported and secure within their wider MDT. 4. Burdens of care felt by the RNMHs is driven by the care environment and care context. 6. There remains a disconnection of mental and physical health in both care environments and how the RNMHs see their role.