Discourses and critiques of breastfeeding and their implications for midwives and health professionals.

This article is a discussion of the recently emerging critique of pro-breastfeeding discourses in academic literature, and what this means for midwives and other professionals who find themselves promoting breastfeeding because of professional expectations or indeed workplace policies. Various strands in the debate are explored, starting with dominant and familiar 'evidence' and descriptions of breastfeeding and breastmilk that are carried through to international policies that advocate breast over formula feeding. We then consider evidence predominantly from social science literature that has found some women's experiences of infant feeding to be at variance with the dominant pro-breastfeeding ideology. We argue that midwives and others delivering maternity care are the means to deliver the policy aspirations contained in the World Health Organization (WHO, 2018) Baby Friendly Hospital Initiative document that makes selective positive claims about breastfeeding without adequately considering its potential drawbacks. We conclude that although the benefits of breastfeeding tend to be exaggerated in promotional material, on balance the weight of evidence still favours breast over formula feeding. We challenge the charge that breastfeeding jeopardises women's financial position by arguing that it is not breastfeeding per se that impacts negatively on women's economic prospects, but rather the way in which society is socially organised.

"Heart disease never entered my head": Women's understanding of coronary heart disease risk factors.

AIMS AND OBJECTIVES: This study investigated experiences of women with a primary diagnosis of ACS (NSTEMI & Unstable Angina). The study explored how women interpreted their risk for coronary heart disease (CHD) and how this influenced their treatment-seeking decisions. BACKGROUND: Efforts to reduce the incidence of cardiovascular disease, the number one killer of women, require aggressive risk factor modification, risk assessment and evidence-based treatments. CHD is largely preventable; however, despite the availability of evidence on prevention and risk factor reduction, it appears that misunderstandings persist. DESIGN: A naturalistic case study design guided this study. METHODS: Thirty women participated (n = 30); a within-case analysis was followed by a cross-case analysis. Data collection included participant diaries and face-to-face interviews. Data were analysed using modified analytic induction which allowed the emergence of theoretical insights. RESULTS: This article provides insight into women's perception of risk for CHD, particularly in relation to smoking. The findings provide a platform for a wider discourse on women's interpretation of their risk for CHD and their treatment-seeking decisions. The data reflect the ongoing misunderstanding that CHD affects men more than women. CONCLUSIONS: More focus is needed on risk factor management and CHD symptom presentation in women. An emphasis on the chronic disease aspect of CHD may promote a timely focus on secondary prevention and the follow-up needed through patient education and empowerment. RELEVANCE TO CLINICAL PRACTICE: This study demonstrates that primary and secondary prevention education initiatives are needed for CHD risk factor management and symptom interpretation. The implications of smoking on cardiovascular health need further dissemination. Efforts to support smoking cessation need to be strengthened and widely accessible. Primary care can have a key role to play in managing CHD risk and supporting women with positive risk factors.

'Betwixt and between health and illness' - women's narratives following acute coronary syndrome.

AIMS AND OBJECTIVES: This study investigated experiences of women with a primary diagnosis of ACS (NSTEMI and Unstable Angina) in the 6-8 week period following discharge from hospital. The aim was to report the experience of the mediating impact of a newly-diagnosed disease. BACKGROUND: Cardiovascular disease is the main cause of mortality in women. Treatment modalities have improved health outcomes and survival rates, however, quality of life and ongoing morbidity after discharge is not clearly understood from a gender specific perspective. DESIGN: A naturalistic case study design guided this study. METHODS: Thirty women participated (n = 30); a within-case followed by a cross-case analysis provided meticulous knowledge of each case. Data collection included participant diaries and face to face interviews. Data were analysed using modified analytic induction which allowed the emergence of theoretical insights. The theoretical concepts, liminality and transitioning were used to inform the analysis. Within-methods triangulation captured the depth and breadth of the women's experiences. RESULTS: The data provide an insight into women's experiences following ACS and highlight a need for support structures and services after discharge. Many women reported a period of disrupted normality following discharge from hospital. While a number of women had transitioned towards recovery, many remained in a liminal space 'betwixt and between' health and illness. Cardiac rehabilitation was reported as a positive experience for those who were attending. CONCLUSIONS: The findings provide a platform for a wider discourse on the needs of women with ACS in the immediate period after discharge from hospital. Women may benefit from gender-specific, appropriately timed, and targeted interventions to facilitate recovery and adaptation to living with CHD. RELEVANCE TO CLINICAL PRACTICE: It is essential that secondary prevention services are modelled and tailored to meet the needs of women and evaluated appropriately to ensure positive outcomes. Nursing could have a key role to play in managing and providing this support.

The perceived impact of interprofessional information sharing on young people about their sexual healthcare.

This article presents the results from an analysis of data from service providers and young adults who were formerly in state care about how information about the sexual health of young people in state care is managed. In particular, the analysis focuses on the perceived impact of information sharing between professionals on young people. Twenty-two service providers from a range of professions including social work, nursing and psychology, and 19 young people aged 18-22 years who were formerly in state care participated in the study. A qualitative approach was employed in which participants were interviewed in depth and data were analysed using modified analytical induction (Bogdan & Biklen, 2007). Findings suggest that within the care system in which service provider participants worked it was standard practice that sensitive information about a young person's sexual health would be shared across team members, even where there appeared to be no child protection issues. However, the accounts of the young people indicated that they experienced the sharing of information in this way as an invasion of their privacy. An unintended outcome of a high level of information sharing within teams is that the privacy of the young person in care is compromised in a way that is not likely to arise in the case of young people who are not in care. This may deter young people from availing themselves of the sexual health services.

Mother's Emotional Experiences of Breastfeeding with Primary Low Milk Supply in the First Four Months Postpartum: An Interpretative Phenomenological Analysis.

Background: Primary low milk supply (PLMS) prevents mothers from producing sufficient milk to breastfeed exclusively. However, limited evidence exists regarding women's experiences of breastfeeding with PLMS. Objective: This article aims to investigate the emotional experiences of mothers breastfeeding with PLMS in the first 3 months postpartum. Materials and Methods: The study was conducted in Ireland and used a phenomenological methodology to investigate the lived experiences of breastfeeding mothers with PLMS. Nine first-time breastfeeding mothers with PLMS participated, and data collection took the form of unstructured interviews. Data analysis was completed using Interpretative Phenomenological Analysis. Results: Being in the Whirlwind is one of four superordinate themes identified in this study. This theme relates to participants' internalized experiences of breastfeeding with PLMS in the first 3 months postpartum. During this time, participants struggled to come to terms with having PLMS and became caught up in all-consuming efforts to increase their milk supply. They experienced guilt, sadness, confusion, anger, and anxiety, with many describing the early months postpartum as traumatic. Participants revealed how triple-feeding (a regime of breastfeeding, pumping, and supplementing) negatively affected their mental health and reported that supplementing with infant formula was emotionally upsetting. Conclusions: Our findings reveal that the combination of PLMS and triple feeding can negatively impact a mothers' mental health. A greater understanding among health care professionals of the emotional impact of having PLMS and triple-feeding could enhance the provision of sensitive and person-centered support for those with PLMS. Antenatal breastfeeding education should acknowledge that PLMS is a challenge for a small cohort of women and place greater emphasis on the emotional aspects of breastfeeding challenges.

An evaluation of the appropriateness and safety of nurse and midwife prescribing in Ireland.

AIM: To evaluate the clinical appropriateness and safety of nurse and midwife prescribing practice. BACKGROUND: The number of countries introducing nurse and midwife prescribing is increasing; however, concerns over patient safety remain. DESIGN: A multi-site documentation evaluation was conducted using purposeful and random sampling. The sample included 142 patients' records and 208 medications prescribed by 25 Registered Nurse Prescribers. METHODS: Data were extracted from patient and prescription records between March-May 2009. Two expert reviewers applied the modified Medication Appropriate Index tool (8 criteria) to each drug. The percentage of appropriate or inappropriate responses for each criterion was reported. Reviewer concordance was measured using the Cohen's kappa statistic (inter-rater reliability). RESULTS: Nurse or midwife prescribers from eight hospitals working in seventeen different areas of practice were included. The reviewers judged that 95-96% of medicines prescribed were indicated and effective for the diagnosed condition. Criteria relating to dosage, directions, drug-drugs or disease-condition interaction, and duplication of therapy were judged appropriate in 87-92% of prescriptions. Duration of therapy received the lowest value at 76%. Overall, reviewers indicated that between 69 (reviewer 2)-80% (reviewer 1) of prescribing decisions met all eight criteria. CONCLUSION: The majority of nurse and midwife prescribing decisions were deemed safe and clinically appropriate. However, risk of inappropriate prescribing with the potential for drug errors was detected. Continuing education and evaluation of prescribing practice, especially related to drug and condition interactions, is required to maximize appropriate and safe prescribing.

Parents' constructions of communication with their children about safer sex.

AIMS AND OBJECTIVES: To analyse how a sample of parents reportedly communicated with their adolescent and preadolescent children about safer sex (contraceptive and condom use). BACKGROUND: Among the plethora of existing research available on parent-child communication about sexuality (more broadly), very few studies detail the substance and tenor of what parents actually convey specifically about safer sex. DESIGN: The study adopted a qualitative methodology and involved interviewing 43 parents (32 mothers and 11 fathers). Data were analysed using modified analytical induction. RESULTS: Findings indicated that although the majority of parents professed to being open about sexuality with their children, only a minority reportedly conveyed direct messages about contraception and condom use. Moreover, these direct messages appeared to be imparted at a superficial level. Parents were more likely to communicate such messages in a tacit manner through innuendo and intimation. The complacency that parents displayed about the need to undertake safer sex education with their adolescents arose from an understanding that this was covered adequately at school and the belief that their teenager was not in a romantic relationship. In addition, some parents expressed concern that discussing safer sex with teenagers might actually encourage sexual activity. CONCLUSION: We conclude that some parents may consider themselves to have engaged in sexuality education around safer sex when it appears to be predominantly surface-level education; that what constitutes 'doing' sexuality education is far from clear-cut may cast some light on why there is little consistency in the literature on the impact of parental communication on sexual health outcomes for young people. RELEVANCE TO CLINICAL PRACTICE: For nurses engaged in sexuality health promotion with parents, we caution about presenting unequivocal messages to parents about the impact of parental communication about sexuality on adolescent sexual behaviour without due acknowledgement of the grey areas indicated in the literature.

Parents' constructions of the sexual self-presentation and sexual conduct of adolescents: discourses of gendering and protecting.

In this paper, we explore the discourses on sexuality that a sample of parents drew upon when they talked about teenage sexual self-presentation and conduct. The sample consisted of 43 parents (32 mothers and 11 fathers) of young people aged 10-19 years. Data were gathered using in-depth interviews and were analysed using a strategy known as modified analytical induction. Findings indicated that while an acceptance the traditional heterosexual script permeated participants' accounts, and protective discourses in relation to young women were brought to bear, so, too, were protective discourses invoked in relation to young men. On the whole, young women tended to be cast as sexual subjects who chose to self-sexualise and this was sometimes seen by participants as a threat to young men. We argue that the discourses that parents connoted were multiple and sometimes contradictory, and our analysis problematises the notion that conventional discourses singularly cast women as objects of male sexuality. However, the overall picture indicated that in parents' narratives, young women tended to be more heavily regulated and either viewed as needing protection from male sexual advances or castigated for encouraging them.

A risk to himself: attitudes toward psychiatric patients and choice of psychosocial strategies among nurses in medical-surgical units.

Psychiatric patients are liable to stereotyping by healthcare providers. We explored attitudes toward caring for psychiatric patients among 13 nurses working in general hospitals in Ireland. Participants thought aloud in response to a simulated patient case and described a critical incident of a patient for whom they had cared. Two attitudinal orientations were identified that correspond to stereotypical depictions of risk and vulnerability. The nurses described psychosocial care strategies that were pragmatic rather than authentically person-centered, with particular associations between risk-oriented attitudes and directive nursing care. Nurses had expectations likely to impede relationship building and collaborative care. Implications arising include the need for improved knowledge about psychiatric conditions and for access to professional development in targeted therapeutic communication skills.

Prevalent practices amongst healthcare professionals in paediatric settings in using medical interpreters for families with limited national language proficiency: A narrative scoping review.

Background: Where language barriers exist, trained medical interpreters provide more accurate and comprehensive communication between clinicians and service users compared to ad hoc interpreters or no interpreter at all. The nature and extent of research evidence about when and how medical interpreters are used by health professionals in paediatric settings to mediate communication with families who do not speak the national language proficiently have not yet been published. Aim: To examine the potential size and scope of available research literature about the prevalent practices of healthcare professionals in using medical interpreters in paediatric settings for families with limited national spoken language proficiency. Methods: We used an established framework for scoping reviews, including suggested modifications by JBI. Precise eligibility criteria were identified, and a comprehensive search strategy was applied. Sources of evidence were confined to primary research that spoke specifically to the research question. The process of study selection and results are presented narratively and in tabular form. Two reviewers independently engaged in the screening process, and two reviewers undertook a full paper review of the included articles, with a third consulted where an additional opinion was required. Results: We included 21 studies published between 2000-2022, most using (quantitative) survey methods. Key results captured in six themes are as follows: medical interpreters tended to be underused by health professionals, especially nurses; time was the greatest impediment to their use, but so too were difficulties with the perceived quality of interpreter services; technology was used for medical interpreting at some study sites with mixed responses; use of unauthorised interpreters was widespread; language barriers impacted on the care provider and family relationship; and cost of interpreter services tended not to be reported as a barrier to their use. Conclusions: Further scholarship is needed to understand the use of medical interpreter services with reference to the complexity of health work, as well as the social context of inequality for many families with limited national language proficiency accessing paediatric healthcare. Recent developments in video technology offer promise in improving interpreter use but require oversight for quality. We have highlighted the need for better training for and regulation of medical interpreters and clinical guidelines on the use of interpreters by healthcare professionals.

The experiences of adolescents living with a central venous access device: A qualitative analysis.

Background: Central venous access devices are used in paediatric populations for specific chronic conditions requiring long-term treatment. Very little isknown about how young people experience living with such devices. Aim: To gain a deep understanding of adolescents' (aged 12-17 years) experiences of living with a central venous access device from the perspective of the adolescents themselves, and of one of their parents. Design: A descriptive phenomenological design was chosen. Methods: The sample comprised 20 participants, 10 adolescents with a central venous access device who were purposefully selected from a paediatric unit in Ireland, along with one of each adolescent's parents. Five of the adolescents had a skin tunnelled catheter that partly sits outside the body; and five a totally implanted port contained within the body. Participants were interviewed in adolescent-parent dyads, and data were analysed using an established phenomenological method. Results: Findings are presented around three themes: (i) The process of receiving treatment; (ii) managing skin tunnelled catheters and totally implanted ports day-to-day; and (iii) activities of daily living with a skin tunnelled catheter or a totally implanted port. Participants tended to compare their current device with previously negative experiences of multiple needle punctures associated with peripheral cannula insertions. Participants were largely positive about the type of device the adolescent currently had. However, in terms of daily management of the device itself and engaging in daily activities, totally implanted ports were more favourable than skin tunnelled catheters. Participants with a totally implanted port tended to minimise the needle-stick experience to access to the totally implanted port's reservoir. Discussion: Findings from the present study on adolescents concur with those of previous studies on adults that found that individuals with a central venous access device were largely positively disposed to their device and tended to compare their experiences of it to previously negative experiences with peripheral cannula insertions. Findings also reflect existing research that has reported a favourable disposition to self-management of a central venous access device, and a greater freedom to engage in everyday activities for those with a totally implanted port compared to those with a skin tunnelled catheter. Conclusion: We conclude that the type of central venous access device may have a pervasive and important impact on the everyday lives of adolescents and this needs to be given appropriate weight in formal guidelines for clinicians.

The ending of menstruation: perspectives and experiences of lesbian and heterosexual women.

This article aims to theorize how a sample of menopausal women, lesbian and heterosexual, construct the ending of their periods, and what the experience means for them. Findings indicate that for most of the lesbian participants (who were in a sizeable minority), emotions of loss at the ending of periods were simultaneously expressed alongside positive feelings, and they engaged in greater introspection around the issue than did heterosexual women. However, lesbians did not all take up a singular subject position in relation to menstruation, indicating that there is fragmentation and plurality in how the body is experienced across a group.

The silent treatment: parents' narratives of sexuality education with young people.

This paper is based on research undertaken in Ireland that sought to understand how parents communicate with their children about sexuality. Forty-three parents were interviewed and data were analysed using analytical induction. Data indicated that while parents tended to pride themselves on the culture of openness to sexuality that prevailed in their home, they often described situations where very little dialogue on the subject actually transpired. However, unlike previous research on the topic that identified parent-related factors (such as ignorance or embarrassment) as the main impediments to parent-young person communication about sex, participants in our study identified the central obstacle to be a reticence on the part of the young person to engage in such dialogue. Participants described various blocking techniques apparently used by the young people, including claims to have full prior knowledge on the issue, physically absenting themselves from the situation, becoming irritated or annoyed, or ridiculing parents' educational efforts. In our analysis, we consider our findings in light of the shifting power of children historically and the new cultural aspiration of maintaining harmonious and democratic relations with one's offspring.

Psychosocial care in mental health nursing: a think aloud study.

AIM: This paper is a report of a study identifying psychosocial interventions relevant to routine care and exploring their content critically and analysing patterns in the use of these interventions. BACKGROUND: People experiencing enduring and serious mental disorders value psychosocial engagement as a means of achieving recovery and rehabilitation. However, mental health nurses' use of person-centred and directive psychosocial engagement in routine care is unclear, with the potential arising for benevolence and paternalism. METHOD: A think aloud study was carried out with 37 mental health nurses responding to a simulated case depicting a person with an enduring mental health problem. Participants were recruited from community and acute hospital facilities across Ireland and responded to two tasks: identifying the nature of the person's problems and recommending what to do next. Transcripts were coded using judgement and intervention themes designed for the purpose. Patterns in the use of psychosocial intervention themes were described and further analysed by level of experience (highly experienced or not) and practice setting (acute/community setting). FINDINGS: A task-oriented psychosocial intervention labelled structured engagement was used extensively, followed by reassurance and encouragement based on pragmatic communication. A minority of nurses used dialogue, representing person-centred care. Highly experienced community mental health nurses were the most likely to talk in terms of intensive psychosocial engagement. CONCLUSION: Relying on pragmatic problem-solving is problematic in terms of decision-making transparency and service user involvement. The use of informal knowledge in practice should be negotiated through more open discussion by nurses, including adoption of a consensus on the components of psychosocial care.

In the know: cognitive and social factors in mental health nursing assessment.

AIMS AND OBJECTIVES: To develop an integrated cognitive and social understanding of assessment in mental health nursing. BACKGROUND: Assessment is a vital component of nursing care for mental health service users, largely driven by a tacit, experiential model of assessment; this approach is at variance with an evidence-based approach to assessment. DESIGN: A qualitative design was employed in the study, with a thematic analysis carried out on transcripts of focus groups with mental health nurses. METHOD: Ten focus groups were carried out, guided by questions on nurses' contribution to care and the problems patients present with. Fifty-nine registered mental health nurses were sampled from eight acute and community mental health services across urban and rural regions in Ireland. RESULTS: References to assessment were identified (how nurses acquired information, how it was made sense of and used in the system of care). Assessment talk was characterised by reliance on a experientially based clinical schema and recognition of the task environment's shaping influence. Nurses' clinical knowledge was a pragmatic tool that permitted nurses to assess risk, promote patient engagement and work with doctors. CONCLUSIONS: Nurses strived to 'know the patient', while having to 'work the system', with implications for patient care and decision-making quality. Reliance on experiential knowledge is a professional trait, but one that renders nursing assessment 'invisible' in significant ways. RELEVANCE TO CLINICAL PRACTICE: Cognitive and social aspects of nursing decision-making have been considered apart from one another, whereas cognitions about mental health conditions are, in fact, applied in a pragmatic, task-oriented organisational system. Nurses believed that spending time with the service user led to a privileged position of knowledge in comparison with doctors ('knowing the person'), but this knowledge is frequently applied to the task of 'knowing the patient', assessing the person as a source of risk and danger.

The Irish Nursing Minimum Data Set for mental health--a valid and reliable tool for the collection of standardised nursing data.

AIMS AND OBJECTIVES: To test the validity and reliability of the newly developed Irish Nursing Minimum Data Set for mental health (I-NMDS (MH)) to ensure its clinical usability. BACKGROUND: Internationally, difficulties exist in defining the contribution mental health nursing makes to patient care. Structured information systems, like the Nursing Minimum Data Set, have been developed internationally to gather standardised information to increase the visibility of nursing in the health care system. DESIGN: This study employed a quantitative, longitudinal research design. METHOD: A convenience sample of mental health nurses (n = 184) collected data on the nursing care of patients (n = 367) from care settings attached to 11 hospitals across Ireland. Exploratory factor analysis (EFA), ridit analysis and Cronbach's alpha coefficient were used to establish the construct and discriminative validity and scale score reliability of the I-NMDS (MH). RESULTS: Goodness of Fit scores indicated that the I-NMDS (MH) possesses good construct validity. Alpha coefficients for each factor were above the recommended 0.7 level. Ridit analysis inferred that the I-NMDS (MH) discriminated between elements of nursing care across acute inpatient and community based care settings. CONCLUSIONS: The I-NMDS (MH) possesses a sound theoretical base, has scale score reliability and possesses good discriminative validity. The valid and reliable I-NMDS (MH) is the first NMDS to be developed specifically for mental health. RELEVANCE TO CLINICAL PRACTICE: Data collected using the I-NMDS (MH) will increase the visibility of the contribution mental health nurses make to healthcare delivery. In addition, it will support evidence based practice in mental health to improve further the effectiveness of nursing care in the future.

Menopause narratives: the interplay of women's embodied experiences with biomedical discourses.

Conventional approaches to menopause tend to contrast the biomedical position on menopause with women's actual experiences of it. Rather than focusing primarily on the tensions between these perspectives (biomedical vs. lay), our emphasis here is on the impact of biomedicine in shaping participants' perceptions of their status as menopausal. Based on interview data gathered from 39 women in Ireland, we argue that the cultural authority of biomedicine shaped participants' experiences of the body and how they constituted their health identity. We assert that, ironically, this was particularly the case among those who most strongly contested biomedical definitions of their situation. In addition, biomedical practitioners' definitions had a strong normalizing power in how the body was experienced. We conclude by noting that our analysis problematizes the notion of privileging "women's experiences" as advocated by some feminist perspectives. The heavy influence of biomedical discourses in shaping participants' embodied experiences demonstrates the pervasive impact of prevailing discourses on women's experiences.

Seen as core: a Delphi consensus study of essential elements of mental health nursing care in Ireland.

Continued ambiguity about the scope of mental health nursing is harmful to the discipline's identity and to patients' interests. Using a Delphi survey design, consensus was achieved on a set of 70 items representing core elements of mental health nursing among a sample of 150 mental health nurses working in Ireland. Items achieving consensus in Round 3 of the survey were composed of 28 clinical phenomena (framed as client problems), 18 direct and 12 indirect nursing interventions, and 12 nursing-sensitive outcomes of care. Mental health nurses accepted responsibility across a broad range of outcomes apart from those linked to physical care, the one domain of care rejected by participants. The findings portray mental health nursing as a psychosocial enterprise, encompassing both phenomenological and diagnosis-related elements.

The fragmented discourse of the 'knowledgeable doer': nursing academics' and nurse managers' perspectives on a master's education for nurses.

There has been a proliferation of taught masters' degrees for nurses in recent years, and like masters' programmes in other disciplines, the aspirations of such educational endeavours are far from unanimous. This article reports on part of a wider study, and focuses on a qualitative analysis of the perspectives of two key sets of stakeholders, namely academic education providers, and senior clinical nursing personnel, on masters' education for nurses. Fifteen participants were interviewed in depth, and data were subjected to a qualitative content analysis. Findings indicated that while both sets of participants invoked the discourse of the 'knowledgeable doer', that is, the notion of amalgamating a high level of theoretical knowledge with practical know how, there were also differences in how each group deployed this discourse. Academics tended to emphasise the 'knowing that' or theoretical aspect of the discourse, whereas those in senior clinical roles adduced the practical component more strongly. We argue that the discourse of the 'knowledgeable doer' is far from stable, unified and universally agreed, but rather comprises competing elements with some emphasised over others according to the subject position of the particular individual. We locate the diverse perspectives of the two sets of stakeholders within debates about the status of masters' programmes in relation to vocational and liberal education.

Social selection and professional regulation for Master's degrees for nurses.

AIM: This paper is a report of a study to understand the perspectives of two sets of stakeholders, namely clinical nursing providers and nursing academics, on how registered nurses should be selected for Master's degree programmes. BACKGROUND: The proliferation of taught Master's programmes has led to concerns about a lowering of standards. Even with the expansion of professional Master's programmes, they remain one of the least researched areas of higher education. METHOD: The sampling strategy was a combination of convenience and snowball sampling. In-depth interviews were conducted in 2006-07 with 15 stakeholders and data were subjected to thematic content analysis. FINDINGS: There were differences in service providers' and academics' perceptions of access to Master's level education for nurses. Service providers engaged in regulatory practices, as evidenced in the way in which potential candidates were judged to be suitable or not to undertake a Master's-level education. Academic participants, in contrast, tended to have far fewer concerns about the career plans of applicants and were more likely to invoke discourses of academic educational admission practices. CONCLUSION: The health services need highly skilled, educated workers whose abilities and knowledge make an impact on the provision of effective patient and client care. This level of education can be achieved through continuing education of the professions by taught Master's degrees. It is imperative that an effective partnerships between clinical service providers and academics are developed to promote understanding of their respective perceptions of admission to the degree.