Abstract: This thesis provides an interpretive critique of the way in which knowledge is viewed, transmitted and crystallized in the practice worlds experienced by four registered nurses working in acute care hospital settings. The theoretical assumptions of critical social theory underpin both the methodological approach (case study) and the analysis of data. In-depth unstructured interview, a critically reflexive dialogue between the investigator and participant focussed on the practice world experiences of the nurse, was the principle research method. A brief analysis of documentation was also undertaken.It is argued that previous studies related to nursing practice, and to the social worlds of nursing, have been limited by their failure to take account of the socio-political context in which nursing takes place. There has been a tendency to treat the transmission of knowledge in nursing and nursing practice process of information exchange. No account of socially generated constraints on personal and professional agency, or of systematic distortions in communication within the practice setting are therefore given.The analysis of data in this study demonstrates the way in which constraints on personal and professional agency were experienced by each of the four participants. In particular, practice expressing the participant's professional nursing knowledge and values ws often denied in the face of shared understandings reflective of the institutional ideology. These shared understandings included a belief in the legitimacy of medical domination over other social factors and the support of doctor, rather than nurse or patient, centered practices.This study demonstrates that the way that nurses and other social actors come to “know” and interpret their social worlds is dependent on the socio-political contest in which that knowledge in produced. It also shows how this knowledge may be treated ad though it were 'an object'. This tendency to treat existing social relationships and practices as 'natural' hence unchallengeable masks possibilities for transformative action within the practice of nursing.It is argued that a particular form of knowledge is required if nurses are to overcome the types of constraint experienced by these four nurses. This knowledge, emancipatory knowledge, is that developed in the process of shared, socially critical self-reflection rather than solitary, self-critical reflection

Abstract: This study examines the practice world of twenty two registered nurses working in medical and surgical wards of an acute general hospital in New Zealand. It is argued that nursing practice is a complex, context-specific, activity and needs to be studied using methods that do not assume an objective, context-free reality.The work of Patricia Benner (1984) guided this study which utilized a qualitative research approach to enter the lived world of nursing practice. Through descriptions of work days and a sharing of clinical exemplars, an understanding of the broader context of nursing practice was gained, areas of skilled performance in nursing emerged, and the meaning of making a difference for the nurses in the study examined. The central role of mutual advice and support in facilitating significant incidents in practice was apparent.An examination of the types of experiences which challenge current practice and change it in some way provided insight into the importance of experience in developing clinical expertise and the vital role of local knowledge in facilitating practice. Nursing practice emerged as crucial to patient welfare and safety in the acute care setting