Ensayos de biotransformación de apocarotenoides

A consistent pattern that emerged across the majority of the sample was the cluster of factors underpinning the students’ motivation to pursue a career in nursing. This centred on the opportunity to positively influence others and provide high quality, individualised care. This commitment was stated at the onset of the course and remained consistent

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throughout, despite students’ observation of numerous examples where this was not modelled in practice. It was evident that a reassessment of the role occurred for the some of the students in the first thirteen months of the programme, whereby nurses were identified as more distant from patients and focused more highly on administrative tasks than they expected.

There’s a sense that the patient’s interrupting the paper work... It’s a shame, I saw nurses filling in referral forms for patients they’d hardly met and certainly the HCAs had far greater knowledge of the patients than the nurses making the recommendations. (Cara: Interview 1)

I thought I would be more involved in the technical side of care. If I’m honest I found the day to day stuff monotonous. (Janine: Interview 1)

This process of reassessment occurred in all participants with the exception of Gwen. Her expectations appeared to match her experiences of the role and she was accepting of the criticisms made by other students. This could have been influenced by her previous awareness through family members who were already part of the profession, or her own experiences of using the health care system which gave her a more accurate portrayal of the nursing role. Others recognised how they were basing their expectations on lay images, which they now described as inaccurate and outdated. These images were associated with the laudatory construction of the nurse and expressed in sentimental language as discussed by Fealy (2004). Despite this reassessment, Chloe, Jenny, Cara, Rachel and Samantha showed evidence of an affiliation with the role through statements that implied their satisfaction with their decision to pursue nursing as a career, due to the rewards they had gained from their experiences so far.

I don’t think there’s been a day that I’ve regretted coming to study to be a nurse. Even on the shittiest days on placement, I’ve not thought I don’t want to do this anymore. I’ve never thought that. It was obviously the right choice. (Samantha: Interview 2)

I’m so glad I made this decision two years ago to do this. I can’t actually imagine doing anything else now. I’m excited about the future despite all the challenges in

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the NHS. I’m adaptable and open to change and I find it exciting. (Rachel: Interview 3)

There was also evidence, over time, of an acceptance of previous criticisms of the role amongst some. For example, at month nineteen Samantha described mastering administration as a significant achievement.

I have the assessment documentation sussed now. I spent most of my time completing these forms and not very much time with the patients on this placement. It feels good to know I can complete the paper work well and my mentor was impressed by how quickly I managed to get my head around it. (Samantha: Interview 4)

As the programme progressed and students experienced different nursing roles they appeared to become enthused by the potential career options which they had not previously envisaged. They identified how the clinical context had a strong impact on the nursing role and specifically the level of autonomy and influence they had over patient care. Gwen, Cara, Richard and Jenny raised the issue of accountability and responsibility. Gwen and Jenny were concerned about this, because the level of accountability exceeded what they had expected. Cara and Richard were critical of how fear of accountability negatively influenced and constrained nursing practice and there was unresolved dissonance in relation to how they would manage this once qualified. The majority identified role models whom they admired as a result of their ability to navigate these constraints, positively lead others, possess advanced knowledge or manage high levels of responsibility. The desire to progress through specialisation of role, as opposed to management, was a frequent theme arising from the perception that this would enable them to maintain patient contact and in turn achieve job satisfaction.

The reassessment process ultimately resulted in the majority appearing comfortable with the notion that there was a place for them within the nursing profession, as a result of the varied nature and context of the role. Towards the end of the programme they described the nursing role as a privileged position, because of the unique influence they had on an individual in providing care during a time of emotional or physical distress.

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I don’t think many people have that privileged position that we do. You think of many people who go to work every day and don’t get any enjoyment out of it at all. I just can’t imagine anything worse. I go in, I get involved, chatting to everyone and I just love it. (Rachel: Interview 5)

It’s a real privilege but I’m scared to take on the position because I just want to do my best. It feels that you have been given such a unique opportunity, that it’s really important to do as well as you can. (Cara: Interview 5)

In terms of deviant cases within this theme, Jenny and Richard raise interesting issues. Despite early statements of affiliation with the nursing role, Jenny opted at month nineteen to pursue a career in medicine. Her rationale for this revealed numerous contradictions to her previous positions. Most significantly, this concerned her motivation to pursue nursing as a career due to high levels of patient contact and her discomfort with the level of accountability she perceived nurses to have, which she was unsure she could manage. It is likely that medicine would involve less patient contact and higher levels of responsibility which she now described as her reason for changing her career path. Conversely, throughout the programme, Richard questioned his position in relation to nursing. This was attributed to a perceived clash in philosophy, lack of permission to think freely and a concern regarding how he would be received by others within the profession. At month thirteen this appeared to be resolved as a result of a placement in which he felt acceptance and appreciation. However, this was challenged by subsequent placements where his concerns were reconfirmed. This led to Richard being very specific about the type of environment he would require in order to work happily within the profession. The challenge of ensuring he could secure these conditions within his working environment left him feeling vulnerable as he completed the course.

I will need to find a team who get me and aren’t threatened by what I stand for. But I have experienced teams where they felt the need to almost pull me in to be like them. They’ve got their own bubble of interpretation and way of viewing things and who should want to challenge that? That depressed me and even when I’d try and chip away at it you found nothing would change because everyone was running around like headless chickens. I find my own conclusions by drawing upon a youth worker, philosophy, theology, psychology, psychiatry, medication, diabetes, troubles

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in my own life, my own journey and it clicks and I pull it all together. Some of these people have no room for that and I’ve found most don’t think that way. So I’m not sure how I’m going to navigate the way forward. I feel caught between a rock and a hard place. On the one hand they say they want people like me in the NHS and on the other hand they don’t want to touch me with a barge pole (Richard: Interview 5)