Dissertations / Theses on the topic 'Acute care settings'
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1
Stokes, Zwitter Miriam. "Nursing organizational structures in acute care hospital settings." Case Western Reserve University School of Graduate Studies / OhioLINK, 1992. http://rave.ohiolink.edu/etdc/view?acc_num=case1059758111.
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Baker, Norma G. L. "Health care restructuring in acute care settings : implications for registered nurses' attitudes /." St. John's, NF : [s.n.], 2002.
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Ramasamy, Kasturi. "Educational Training on Falls Intervention for Elderly Patients in Acute Care Settings." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7064.
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Falls among hospitalized elderly patients are a safety concern for health care organizations and the patients they serve, but falls can be prevented through the team effort of nurses and other health care professions to promote safety within the organization. The project site was experiencing an increase in the number of patients falls and identified the need for staff education related to assessment and intervention to prevent patient falls in the elderly population. Thus, the practice-focused question for this project was whether an educational program on evidence-based fall prevention strategies using the American Medical Directors Association clinical guidelines would improve staff nurse ability to assess fall risk and apply intervention strategies for elderly patients in an acute care setting compared to standard practice. Lewin's change theory was used as the theoretical foundation for this project. A total of 29 cardiac unit staff nurses who participated in the educational program were provided information on recognizing risk factors for falls, conducting an accurate fall risk assessment using the Morse Fall Scale, and developing individualized care plan for managing fall risk. The Agency for Healthcare Research and Quality 2E Fall Knowledge Test was used in a pre- and posttest design to assess the efficacy of the educational program. The results showed a statistically significant increase (p < 0.001) in staff members' knowledge in recognizing, assessing, and managing falls. This project can improve nurse's knowledge with evidence-based recommendations in practice, which promotes positive social change through improved staff competency that may result in decreased patient falls and adverse patient outcomes.
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Byrd, Charmaine Amoy. "Nurse Education and the Reduction of Nosocomial Infections in Acute Care Settings." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3022.
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Nosocomial infections are acquired in health care settings and they can lead to catastrophic health care consequences for patients. These infections can also pose significant financial burdens on society and health care systems. Educating nurses on hand hygiene is essential to reducing infection rates. The research question for the study examined the effectiveness of hand hygiene among nurses in reduction of nosocomial infections and how can health care organizations develop educational strategies to reduce nosocomial infections to improve public confidence in health care systems. The purpose of this study was to educate nurses on how to reduce the incidence of nosocomial infections. The evidence-based practice model for this project was Florence Nightingale's environmental theory. The health belief model was used to identify the reasons for health care culture and how they inspire change. In this study, 2 licensed practical nurses and 2 registered nurses were educated on how to reduce nosocomial infections in acute care settings. Participants then completed a questionnaire to assess their knowledge of hand hygiene as a means of reducing nosocomial infections when caring for patients. All participants agreed that hand hygiene; reduces the risk of contracting a nosocomial infection, suggesting that the incidence of nosocomial infections within acute care settings maybe reduced through this education. This project has potential positive social change by educating first and second year nursing students on the importance of hand hygiene in reduction of nosocomial infections and preventing patients from sustaining further injuries while admitted in acute care settings.
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Alibhai, Alyshah Zulfikar. "The availability of acute care resources to treat major trauma in different income settings: a self-reported survey of acute care providers." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31405.
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Introduction: Injury and violence is a neglected global health problem, despite being largely predictable and therefor preventable. This study aimed to indirectly describe and compare the availability of resources to manage major trauma between high income, and low- to middle-income countries, as self-reported by delegates at the 2016 International Conference on Emergency Medicine held in Cape Town, South Africa. Materials and methods: A survey was distributed to delegates at the International Conference on Emergency Medicine 2016, Cape Town to achieve the study aim. The survey instrument was based on the 2016 NICE guidelines for the management of patients with major trauma. It captured responses from participants working in both pre- and in hospital settings. Responses were grouped according to income group (either high income, or low- to middle-income) based on the responding delegate’s nationality (using the World Bank definition for income group). A Fisher’s Exact test was conducted to compare delegate responses Results: The survey was distributed and opened by 980 delegates, of whom 392 (40%) responded. A total of 206 (53%) respondents were from high-income countries and 186 (47%) were from low- to middle-income countries. Responders of this self-reported survey described a significant discrepancy between the resources and services available to high income countries s and low- to middle-income countries to adequately care for major trauma patients both pre- and in-hospital. Shortages ranged from consumables to analgesia, imaging to specialist services, pre-hospital to in-hospital. Discussion: Resource restriction is a major concern in the care for major trauma patients in low- to middle-income countries. Current accepted reference standards does not take the resource restrictions that apply to the vast majority of the world’s injured patients into account. More research is required to describe the problem of resource restrictions in low to middle-income countries, and then working out how to overcome it.
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O'Hanlon, Katie. "Improving person-centred care in acute healthcare settings : an investigation of care mapping in the clinical neurosciences." Thesis, University of Manchester, 2013. https://www.research.manchester.ac.uk/portal/en/theses/improving-personcentred-care-in-acute-healthcare-settings-an-investigation-of-care-mapping-in-the-clinical-neurosciences(7d58b60c-1fde-4291-a043-fb6673210194).html.
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This thesis considers the provision of person-centred care (PCC) in acute healthcare. In recent years it has been increasingly recognised that healthcare should be delivered in a person-centred manner and that staff should receive training and support in relation to this. There is a growing body of literature investigating the potential benefits of PCC in relation to both patient and service level outcomes. Paper one of this thesis is a systematic review of the literature examining staff training interventions for improving PCC in acute healthcare settings. The findings offer preliminary support for the positive impact of such training interventions on patient and service level outcomes in hospital environments. The research in this area is not of a uniformly high standard and this paper concludes that further research in this area is required. Paper two is an examination of a modified version of Dementia Care Mapping (Care Mapping – Neurorehabilitation: DCM-NR), an observational tool for measuring and improving PCC. Results provide evidence of the feasibility and validity of DCM-NR in a range of Clinical Neuroscience settings. Future research should examine the impact of DCM-NR on person-centred practices over time.The critical reflection paper considers both the systematic review and the empirical study. It aims to consider both the strengths and limitations of the research, challenges encountered, clinical implications and highlights areas for future research.
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O'Connell, Beverly O. "A grounded theory study of the clinical use of the nursing process within selected hospital settings." Thesis, Curtin University, 1997. http://hdl.handle.net/20.500.11937/1517.
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The nursing process is the espoused problem solving framework that forms the basis of the way in which patient care is determined, delivered, and communicated in a multiplicity of health care settings. Although its use is widespread in educational and clinical settings, some nurse clinicians display negative attitudes towards the use of the nursing process. They claim that both the structure and language that underpins this process is cumbersome and unreflective of the way in which nursing care is planned and delivered. To date, there has been no study cited that has examined its use within a clinical setting and determined if and how the nursing process is being used and whether there is substance in the clinicians' claims. Additionally, some of the research on problem solving has used laboratory based designs that are limited as they are not sensitive to contextual factors that affect the use of a problem solving process, nor are they sensitive to the efficacy of the communication process. As patient care involves many nurses working under diverse contextual conditions, these factors need to be taken into consideration when studying this phenomenon.Using grounded theory methodology, this study examined the clinical application of the nursing process in acute care hospital settings. Specifically, it sought to answer the following two questions: (1) How is the nursing process used by nurse clinicians in acute care hospital settings? and in the absence of its use, (2) How is nursing care determined, delivered, and communicated in acute care hospital settings in Western Australia?Data were obtained from semi-structured interviews with predominantly nurse clinicians, patients, and patients' relatives, as well as participant field observations of nurse clinicians, and in-depth audits of patient records. Textual data were managed using NUD-IST and analysed using constant comparative method. Data generation and analysis proceeded simultaneously using open coding, theoretical coding, and selective coding techniques until saturation was achieved. This resulted in the generation of a substantive theory explaining clinical nursing in acute care hospital settings.The findings of this study revealed several problems with the clinical application of the nursing process. It also revealed a process used by nurses to overcome many difficulties they experienced as they tried to determine, deliver, and communicate patient care. Specifically, nurses in this study experienced the basic social problem of being in a state of "Unknowing". Properties and dimensions of unknowing were found consistently in the data and this problem was labelled as the core category. This state of "unknowing" was linked to a number of factors, such as, the existence of a fragmented and inconsistent method of determining and communicating patient care and work conditions of immense change and uncertainty. In order to deal with this problem, the nurses in this study used a basic social process termed: "Enabling Care: Working through obscurity and uncertainty". The first phase of the core process, termed: Putting the pieces together: making sense, involved four subprocesses. These subprocesses were labelled: drawing on the known, collecting and combining information, checking and integrating information, and sustaining communication. The second phase of the core process was termed Minimising uncertainty. It involved three subprocesses which were named: adapting work practices, taking control, and backing-up.The findings of this study have implications for nursing practice, research, theory, and education, as it exposes problems with the clinical application of the nursing process in acute care settings. In addition, it further explicates a substantive theory that describes a process of nursing used by nurses in these settings. As the articulated process was supported by a number of studies and opinions of nurse scholars it is worthy of being considered as being foundational to an understanding of a process of nursing used in acute care hospital settings in Western Australia.
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Dunton, Denise. "Sources of job satisfaction and dissatisfaction for unit clerks employed in acute care settings." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp05/mq23292.pdf.
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Latter, Susan Marianne. "Health education and health promotion : perceptions and practice of nurses in acute care settings." Thesis, King's College London (University of London), 1994. https://kclpure.kcl.ac.uk/portal/en/theses/health-education-and-health-promotion--perceptions-and-practice-of-nurses-in-acute-care-settings(ad41c917-a4f4-4db4-9e02-2f20555f91b5).html.
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The aim of this study was to examine nurses' perceptions and practice of health education and health promotion in the acute care setting. Ward sisters (n=132) working on acute wards in nine District Health Authorities were interviewed using a semi-stuctured schedule. Data were collected on perceptions of health education and health promotion, nurses' role in these activities, and factors influencing nurses' health education and promotion practice on the ward. Data were analyzed using a combination of qualitative and quantitative methods. In the second phase of the study, three wards were selected as case studies of nurses' practice. Data collection methods employed to describe nurses' practice included: non-participant observation, audio-recording of nurse-patient interactions, self-administered questionnaires and reflective field notes. A largely qualitative approach was taken to the analysis of these data. The findings from the interviews indicated that the ward sisters had limited understandings of the meaning of health education and health promotion and nurses' roles in these activities. Findings from the case study wards as a whole suggested that nurses' health education and promotion practice was generally extremely limited, although there were some differences between wards in the extent of this evolution. A number of factors may help explain these findings. These include: nurses' knowledge and skills in health education and health promotion, the philosophy, organization and management of care adopted, and the extent to which these offer opportunities for empowerment in nursing. It is suggested that nurses' perceptions and practice can be conceptualized with reference to a continuum of health promoting nursing practice, and that only limited progress has been made towards nurses' full potential. It is argued that if nurses are to develop their health promoting practice, a philosophical shift in nursing is necessary. Together with the acquisition of appropriate knowledge and skills, this may empower nurses to realise their potential.
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Matthews, Robyn D. "Examining the factors influencing self-efficacy of healthcare professionals towards end-of-life care in acute care settings." Thesis, Queensland University of Technology, 2022. https://eprints.qut.edu.au/232496/8/9368973_robyn_matthews_thesis.pdf.
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This thesis examines healthcare professionals’ confidence to provide end-of-life care in an acute hospital setting and the educational needs and preferred methods for delivering education to these health care professionals. Various factors including age, experience, thanatophobia, and personal and professional support were identified as influencing HCPs’ self-efficacy towards EOLC. The findings of this study will inform development and implementation of education and training programs targeted at increasing healthcare professionals’ competence and confidence towards providing high quality end-of-life care.
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Segaric, Cheryl Ann. "Progressively engaging : how nurses, patients and family members manage relationships in acute care hospital settings." Thesis, University of British Columbia, 2007. http://hdl.handle.net/2429/31496.
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This grounded theory study, informed by symbolic interactionism, explains how nurses, patients, and family members manage relationships in order to plan and provide care in acute care hospital settings. The study also explains the effects of contextual and systemic features associated with acute care environments and participants' personal characteristics on their efforts to manage relationships. Data collection included thirty three hours of participant observation and forty interviews. Seventeen interviews were conducted with nurses, ten with family members, and thirteen with patients. Participants were recruited from a total of ten acute care units across four community hospitals in the Fraser Health Authority of British Columbia; there were four medical units, three surgical units, two transitory care or activation units, and one community hospital intensive care unit. I constructed the basic social psychological process of progressively engaging. The process describes how nurses, patients, and family members manage their relationships during patient care by developing varying levels of engagement. The levels of engagement are represented by three stages, including: focusing on tasks, getting acquainted, and building rapport. Structural conditions and personal factors, relevant to nurses, patients, and family members, facilitate or constrain their efforts to progressively engage by contributing to or detracting from their shared perspectives. Levels of engagement ranged from 'just doing the job' to 'doing the job with heart' or making a deep human connection. Higher levels of engagement achieved in nurse, patient, and family member relationships correspond with more satisfaction expressed by participants about their relationships and nursing care. The substantive theory of progressively engaging makes a significant contribution to the family nursing theory. The process has implications for nursing education, practice, research, and administration.Applied Science, Faculty of
Nursing, School of
Graduate
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O'Connell, Beverly O. "A grounded theory study of the clinical use of the nursing process within selected hospital settings." Curtin University of Technology, School of Nursing, 1997. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=11092.
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The nursing process is the espoused problem solving framework that forms the basis of the way in which patient care is determined, delivered, and communicated in a multiplicity of health care settings. Although its use is widespread in educational and clinical settings, some nurse clinicians display negative attitudes towards the use of the nursing process. They claim that both the structure and language that underpins this process is cumbersome and unreflective of the way in which nursing care is planned and delivered. To date, there has been no study cited that has examined its use within a clinical setting and determined if and how the nursing process is being used and whether there is substance in the clinicians' claims. Additionally, some of the research on problem solving has used laboratory based designs that are limited as they are not sensitive to contextual factors that affect the use of a problem solving process, nor are they sensitive to the efficacy of the communication process. As patient care involves many nurses working under diverse contextual conditions, these factors need to be taken into consideration when studying this phenomenon.Using grounded theory methodology, this study examined the clinical application of the nursing process in acute care hospital settings. Specifically, it sought to answer the following two questions: (1) How is the nursing process used by nurse clinicians in acute care hospital settings? and in the absence of its use, (2) How is nursing care determined, delivered, and communicated in acute care hospital settings in Western Australia?Data were obtained from semi-structured interviews with predominantly nurse clinicians, patients, and patients' relatives, as well as participant field observations of nurse clinicians, and in-depth audits of patient records. Textual data were managed using NUD-IST and analysed using constant ++comparative method. Data generation and analysis proceeded simultaneously using open coding, theoretical coding, and selective coding techniques until saturation was achieved. This resulted in the generation of a substantive theory explaining clinical nursing in acute care hospital settings.The findings of this study revealed several problems with the clinical application of the nursing process. It also revealed a process used by nurses to overcome many difficulties they experienced as they tried to determine, deliver, and communicate patient care. Specifically, nurses in this study experienced the basic social problem of being in a state of "Unknowing". Properties and dimensions of unknowing were found consistently in the data and this problem was labelled as the core category. This state of "unknowing" was linked to a number of factors, such as, the existence of a fragmented and inconsistent method of determining and communicating patient care and work conditions of immense change and uncertainty. In order to deal with this problem, the nurses in this study used a basic social process termed: "Enabling Care: Working through obscurity and uncertainty". The first phase of the core process, termed: Putting the pieces together: making sense, involved four subprocesses. These subprocesses were labelled: drawing on the known, collecting and combining information, checking and integrating information, and sustaining communication. The second phase of the core process was termed Minimising uncertainty. It involved three subprocesses which were named: adapting work practices, taking control, and backing-up.The findings of this study have implications for nursing practice, research, theory, and education, as it exposes problems with the clinical application of the nursing process in acute care settings. In addition, it further explicates a substantive theory that describes a ++
process of nursing used by nurses in these settings. As the articulated process was supported by a number of studies and opinions of nurse scholars it is worthy of being considered as being foundational to an understanding of a process of nursing used in acute care hospital settings in Western Australia.
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Haniffa, Rashan. "Developing a methodology for the evaluation of acute and critical care outcomes in resource-limited settings." Thesis, University of Oxford, 2017. http://ora.ox.ac.uk/objects/uuid:0057e38d-a5ee-4089-9ee0-247c7ffb9596.
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The burden of acute and critical illness in LMICs is high, and proportionally higher with poorer outcomes than in HIC. Structured surveillance, enabling systematic evaluation of acute and critical care outcomes, is largely lacking in LMICs. Many tools, including but not limited to prognostic models and decision-support tools, developed in HIC are mostly not validated in LMICs. In addition, acute and critical care skills training, necessary for improving the quality of care and outcomes, is not readily accessible for many healthcare workers. This thesis describes a baseline profile of acute and critical care services in Sri Lanka; the development and implementation of a national, electronic, critical and acute care surveillance system and an assessment of the feasibility of HIC decision-support tools in LMIC settings. It further describes a co-designed, sustainable, national acute and critical care training programme, supported by the surveillance platform. Baseline profile: Overall ICU mortality was 17% but no severity of illness data was available. Overall, only 5.1% of those who had CPR attempted in hospital were alive after 24 hours, with most arrests anticipated by the junior medical team. Only 4.4% of wards use DNAR instructions. The 99 national ICU's had relatively (to other LMICs) good staffing; 790 doctors (1.6 per bed) and 1989 nurses (3.9 per bed, 87.9% ICUs had 1:1 nurse to patient ratio). Evaluation of the applicability of APACHE II was hampered by arterial blood gases and electrolytes being available in only 18.7% and 63.4 % of ICU admissions respectively, and complete case records (for APACHE II) was only available in 1.6% of instances. A surveillance platform for acute and critical care, fusing mobile data entry with visual analytics, was developed and implemented in 56 Sri Lankan hospitals, supporting clinicians in finding ICU beds. The dataset confirmed the low availability of variables commonly used to detect deterioration in acutely unwell ward patients; respiratory rate (65.24 %), mentation (32.89%) and oxygen saturation (23.94%), in a cohort of 16,386 patients. The platform was used for the validation of prognostic models and EWS tools, which showed that the performance of single variable trigger systems was comparable to more complex EWS's regarding identification of at-risk patients. A simpler critical care prognostic model, (TropICS), based on variables more commonly available in LMICs and collected through the platform, was derived and evaluated, and shown to outperform APACHE II in this setting. The platform can also support critical care training; the thesis describes the development, execution, and evaluation of two clinically focused training programmes. A 2-year modular programme in Bangladesh, India and Nepal showed a positive impact on patient outcomes. In Sri Lanka, a peer-delivered, acute and critical care structured training programme was delivered to over 4,500 nurses, physiotherapists and doctors, increasing knowledge and confidence. In summary, the work in this thesis describes a setting-adapted acute and critical care surveillance system, enabling the evaluation of the feasibility and performance of prognostication and decision-support tools, providing a template for LMIC settings. The studies show the importance of evaluation of clinical and benchmarking tools for feasibility and performance, and their adaptation where necessary, prior to their implementation in LMICs. In addition, the studies show that locally developed, sustainable training programmes aimed at improving outcomes in critically ill patients are possible in resource-limited settings. This thesis provides evidence that a clinician-led data platform in a LMIC can provide opportunities to evaluate (and potentially improve) outcomes by an inter-dependent cycle of enhanced information availability, quality improvement, capacity-building, training, and research.
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Hild, Andreas. "Modes of orderings and standardisation : enacting medical and social conditions through care planning and record keeping within acute inpatient care and community care settings." Thesis, University of Manchester, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.601117.
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This thesis investigates the relationship between objects and organisational forms, with particular reference to the transformation and enactment of clinical and administrative objects, practices and relations within NHS inpatient and community care settings. Through the use of an ethnographic style of enquiry this thesis investigates inpatient admission and discharge processes in the light of various health and social care practices, service commissioning issues, the Department of Health's initiative of the Care Planning Approach and other local electronic-based initiatives, and how this relates to the notions of "good" and "bad" practices, changing regimes of trust from practitioners to administrators, and from experts to documentary evidence. In particular, a range of narratives associated with mental health care which seek to provide a coordinating frame for different relations are reviewed. This involves exploring the attempts to link different information practices and ontologically distinct objects, and how this process relies on both multiplicity and singularity (e.g. both a sense of stability and heterogenous relations). Finally, this research examines how these mediating objects and processes in acute inpatient care settings seek to contribute to the creation of composite conditions and multiple bodies that fractionally relate to one another, but also the many problems experienced by those involved in the process of mental health care. In conclusion, this thesis explores several issues relating to specific organisational practices of care planning and record keeping, as well as broader questions of how objects are both enacted and enact practices in relation to complex modes of orderings and standardisation.
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Marano, Alexis. "Non-invasive positive pressure ventilation (nppv) its uses, complications, & implications within nursing practice in acute care settings." Honors in the Major Thesis, University of Central Florida, 2012. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/580.
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The use of noninvasive positive pressure ventilation (NPPV) in acute care settings has drastically increased within the past 20 years. Research has indicated that NPPV is equally as effective as traditional mechanical ventilation(MV) in treating acute exacerbations of chronic pulmonary obstructive disease (COPD) and cardiogenic pulmonary edema. Furthermore, the risk of complication from NPPV is much lower than MV, in terms of ventilator-associated pneumonia and sepsis. It is imperative for the nurse to understand the various indications, interfaces, and potential complications associated with NPPV use. In addition to treating acute exacerbations of COPD and cardiogenic pulmonary edema, NPPV has been used for prevention of reintubation, palliative care, and status asthmaticus. Furthermore, NPPV could be delivered through various interfaces, such as nasal, facial, and helmet. Each of these interfaces could eventually cause complications for the patient, such as skin ulceration and sepsis. However, there is limited amount of research available discussing the role of the nurse in caring for the patient with NPPV. There are no standardized guidelines established to assist the nurse in this care, in terms of interface selection, prevention of complications, and staffing patterns. Several recommendations are presented at the end of this thesis to guide future nursing research, education, and clinical practice, such as exploring the role of oral care and education for NPPV patients.B.S.N.
Bachelors
Nursing
Nursing
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Boltman-Binkowski, Haaritha. "A systematic review of best practices in the acute management of postpartum haemorrhage in primary maternity care settings." University of the Western Cape, 2018. http://hdl.handle.net/11394/6893.
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Magister Curationis - MCurBackground: Postpartum haemorrhage (PPH) is one of the most preventable causes of maternal death, yet it still ranks as one of the main conditions responsible for maternal mortality. PPH occurs at a stage when a mother is the least likely to receive care, and mothers often do not survive to be referred to a more specialised level of care. This is compounded by the patient not being able to warn healthcare providers timeously about their condition and healthcare providers lacking training resulting in a lack of accuracy in diagnosis, lack of resources, and differing methods of treatment. Due to the lack of consensus in available treatment options, and the paucity of research aimed at clinical interventions for midwives at the primary care level, this research report aimed to investigate the evidence in order to establish the best practices and evidence for clinical interventions to manage postpartum haemorrhage for midwives at the primary care level. This is to ensure that the continuing education for midwives in practice is based on evidence to keep their skill set current and expose practitioners to the latest evidence based care. Aim: To systematically review all available published evidence for the acute non-pharmaceutical, non-surgical, management of PPH for use by midwives at a primary maternity care setting.
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Lim, Eric. "How mental health nurses can use recovery-focused care to reduce aggression in the acute mental health settings." Thesis, Curtin University, 2022. http://hdl.handle.net/20.500.11937/88694.
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This hybrid thesis presents a two-phase sequential exploratory mixed methods research that explored mental health nurses’ and consumers’ beliefs of how recovery-focused care can be used to reduce aggression in the acute mental health settings. The thesis is comprised of traditional thesis chapters and five peer-reviewed publications. The findings of this research provide evidence-based knowledge for mental health nurses to understand how they can translate the use of recovery-focused care clinically to reduce aggression.
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Schnabel, Eva-Luisa [Verfasser], and Hans-Werner [Akademischer Betreuer] Wahl. "Age Discrimination in Acute Care Hospital Settings? Focus on Verbal Care Interactions With Cognitively Impaired Older Patients / Eva-Luisa Schnabel ; Betreuer: Hans-Werner Wahl." Heidelberg : Universitätsbibliothek Heidelberg, 2021. http://d-nb.info/1233359274/34.
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Al-Zaru, Ibtisam Moa'wiah. "The Jordanian nurses' role as patient educators in acute care settings in the state sector : factors influencing role development." Thesis, University of Ulster, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.268621.
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Rowland, Beverly Dianne. "Conceptualization of factors that have meaning for newly licensed registered nurses completing nurse residency programs in acute care settings." Thesis, Indiana University - Purdue University Indianapolis, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10241295.
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Nurse residency programs (NRPs) have been identified as a means to promote transitioning of new nurses into the professional nursing role. Questions have arisen related to which elements within those programs are most meaningful to the development of new nurses. As the nursing shortage drives the need for quick transition and development of nurses to meet workforce needs, nursing must identify what is meaningful to nurses in their transition to practice. The purpose of this multi-site study was to explicate meaning from the experiences of newly licensed registered nurses (NLRNs) who have just completed NRPs. The research question was “What factors have meaning for NLRNs who have experienced transition to practice in nurse residency programs in acute care settings?”
Semi-structured interviews were used to collect data from six NLRNs from three different NRPs after completion of their programs. Using interpretative phenomenological analysis, themes and variations within those themes were derived from the descriptive narratives provided from participant interviews. Overarching themes identified were Relationships, Reflection, Active Learning, Resources and Organizational Systems. Findings have implications for practice and education as the nursing profession strives to find ways to transform nurses in an effective and efficient manner.
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Chung, Lisa. "AN EXPLORATION OF SELECTED CHARACTERISTICS OF REGISTERED NURSES AND THEIR USE OF EVIDENCE-BASED PRACTICE IN ACUTE CARE SETTINGS." Case Western Reserve University Doctor of Nursing Practice / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=casednp1430143066.
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Cowdell, Fiona. ""That's how we do it ... we treat them all the same" : an exploration of the experiences of patients, lay carers and health and social care staff of the care received by older people with dementia in acute hospital settings." Thesis, Bournemouth University, 2008. http://eprints.bournemouth.ac.uk/10449/.
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'... we treat them all the same'. This study aimed to explore the experiences of patients, lay carers and health and social care staff of care received by older people with dementia in the acute hospital setting. In view of the ageing population, an increasing prevalence of dementia and the emerging dignity agenda this is a particularly topical subject. Four elements are included in this thesis: a literature review, a research study, a practice development project and an integrative review. A literature review sets person-focused research in the context of dementia research as a whole. It also identifies ways in which studies have been conducted in an ethical and meaningful manner. An ethnographic approach was used in the research study to collect data through observation, conversations and interviews. Findings portray a bleak picture of the care of this vulnerable group. Patients demonstrated, through words and actions, how difficult they found the experience. Lack of communication was an issue as was the obvious distress caused by delivery of personal care. Lay carers were relatively uncritical although this may have been due, in part, to the recruitment process. Staff generally appeared to have good intention. Most stated that they had received little or no preparation or education in dementia care. Many staff functioned almost entirely within thebed and body'framework. They frequently avoided communication with patients. Staff worked in a deeply embedded habitus, in which they appeared not to really think about what they were doing. They demonstrated a lack of empathy with patients. The concept that staff were working in a 'switched off mode and lacked empathy called for a practice development project that engaged them on both cognitive and emotional levels. A practice development project based on the philosophies of confluent education and situated learning was implemented. Initial evaluation has demonstrated some tangible changes in practice. An integrative review draws these elements together into a coherent whole. Potential contributions to the body of knowledge are acknowledged, as are limitations of the work. This study has shown that people with dementia, even those at an advanced stage and with superimposed physical illness, can be engaged in research that is both ethical and meaningful. It has shown that improvements in practice are possible. They need to be underpinned by a belief in the personhood of staff as well as patients. Areas for further research and practice development in this vital subject have been identified.
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Klara, Collin, and Joakim Dahlström. "När vården ändrar riktning : En litteraturstudie om sjuksköterskors upplevelse av att vårda i transitionen från kurativ till palliativ vård." Thesis, Ersta Sköndal högskola, Institutionen för vårdvetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-5877.
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Bakgrund: När en patient får en diagnos eller sjukdom kan vården vara inriktad på kurativ eller palliativ vård eller både och. Vård med kurativ inriktning syftar till att bota sjukdom medan palliativ vård syftar till att lindra den. Att vårda i transitionen kan vara komplext för sjuksköterskan vars uppgift är att stödja patienten genom hälsorelaterade transitioner. För att kunna göra det krävs en förtroendefull relation mellan patient och sjuksköterska samt tydliga riktlinjer för sjuksköterskan att förhålla sig till. Syfte: Syftet var att beskriva sjuksköterskors upplevelse av att vårda patienter i övergången från kurativ till palliativ vård. Metod: Metoden som använts är en litteraturöversikt som syftar till att skapa en överblick över det valda kunskapsområdet. Resultatet har författarna baserat på elva vetenskapliga artiklar varav 10 var kvalitativa och en var kvantitativ. Artiklarna söktes fram i databaserna Cinahl Complete, Pubmed och Medline. Resultat: Resultatet presenteras utifrån tre huvudteman med tillkommande subteman. Huvudteman; Sjuksköterskan i transitionen, Sjuksköterskans förutsättningar att vårda i transitionen och Vårdmiljöns betydelse i transitionen. Diskussion: Utifrån Meleis transitionsteori diskuterade författarna resultatet som var relaterat till sjuksköterskors upplevelser av att vårda patienter i övergången från kurativ till palliativ vård på vårdavdelningar. Konsensusbegreppet miljö diskuteras även av författarna i resultatdiskussionen utifrån inre och yttre miljöomständigheter.Background: When a patient's gets a diagnosis or a disease healthcare can be orientedon palliative or curative care. Curative aims to to cure disease, whilstpalliative care aims to alleviate. To care in the transition can be complexfor the nurse who’s aim is to support the patient through health relatedtransitions. That requires a trustful relationship between the patient andthe nurse and that the nurse has clear guidelines during the transition torelate to. To do so requires a relationship of trust between the patient andthe nurse, as well as clear guidelines for the nurse to relate to during thetransition. Aim: The aim was to highlight nurses´ experiences trough the transition fromcurative to palliative care. Method: The method was a literature review that aims to create an overview of thechosen field of knowledge. The authors created the result based on elevenscientific articles, ten were qualitative and one of them were qualitative.The articles were sought out in the databases Cinahl Complete, Pubmedand Medline. Results: The results were presented in three main themes with four additionalsubthemes. The main themes; The nurse in the transition, The nurseability to care in the transition and The meaning of the caringenvironment in the transition. Discussion: The authors have discussed the result from Meleis transitions theorywhich is related to nurse’s experiences from caring for patients in thetransition from curative to palliative care. The consensus definition ofenvironment is discussed in the result from internal and external carecircumstances.
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Zalin, Anjali. "Stress hyperglycaemia in the acute care setting." Thesis, Imperial College London, 2015. http://hdl.handle.net/10044/1/29751.
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Introduction: Stress hyperglycaemia (SH), defined as transient hyperglycaemia during illness, is seen in up to 50% of inpatients and may progress to glucose intolerance in a significant proportion. SH is also associated with increased mortality. Despite this, there is no consensus on definition and management. Existing work focuses on single disease groups, frequently reporting adverse outcomes and variable success with therapies. There is, however, a scarcity of work profiling individuals with SH in detail. It is hoped that this approach may contribute to individualised management and improved outcomes for people with the condition. Methods: The central hypotheses of this work focus on metabolic profiling and were examined through a prospective observational study. Participants were allocated into study groups based on glucose levels. A 30-day follow-up was organised for people with SH. Novel biomarkers, tools and a diabetes risk calculator were employed to provide the most detailed profile currently available of individuals with stress hyperglycaemia. Finally, results from the first multicentre trial to bear on the effect of metformin in SH are presented. Results: The prevalence of SH was 34% and 31% in prospective (n=62) and metformin (n=52) studies respectively. People with SH had lower fasting insulin levels and insulin resistance. Otherwise, few differences were found. Metabolic profile, glycaemic variability, and HbA1c values were similar in both groups. Metabolic abnormalities and marked glycaemic excursions were also seen in both groups. Metformin was well tolerated but did not result in significantly reduced glucose variability or levels during the study period. Conclusions: People with SH do not appear to be phenotypically different from people without the condition. Marked hyper- and hypoglycaemia are common in hospital patients despite apparent normal glucose levels. Increased vigilance as well as timely and appropriate interventions could significantly improve outcomes for these individuals.
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Boye-Doe, Sylvia B. "Improving Fall Prevention Strategies in an Acute-Care Setting." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3337.
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Falls with or without injuries among the elderly have become a public health concern, with falls among adults age 65 years and older increasing every year. Nurses play a role in ensuring patient safety by following fall prevention guidelines. The purpose of this evidence-based study was to implement the RE-AIM evaluation tool to determine the impact of the Safe Five program on staff compliance with the program; patients' awareness of the need for falls prevention; and falls among older adults, ages 65 years and older, admitted to an acute care nursing unit. The literature supports implementing a falls prevention program with multifactorial and interdisciplinary components, and an evaluation plan to help decrease falls in acute care settings. The Safe Five falls prevention program was implemented on the acute care nursing unit in an effort to decrease the inpatient falls rate on the unit. The inpatient falls data were collected retrospectively, 2 years pre implementation of the Safe Five program, and 8 to 10 months post implementation. Data were collected from the Safe Five checklists, recorded inpatient fall rates, and high fall risk chart audits provided by staff and nurse manager; they were then analyzed using the RE-AIM evaluation tool. The long-term effects of the Safe Five program include an 18% increase in patients' awareness of the importance of preventing falls, an 18% increase in staff compliance with the program, and a 14% decrease in inpatient fall rate on the unit. It is projected that the decrease in inpatient falls will result in decreased healthcare costs and improved patient satisfaction with the healthcare system, communication among the interdisciplinary team, and health outcomes for the patients.
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Philyaw, Charlotte Evette. "Preventing Urinary Tract Infections in the Acute Care Setting." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2574.
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More than 13,000 deaths and $340 million in health care costs are the result of catheter-associated urinary tract infections (CAUTIs) annually in the United States. CAUTIs can also result in acute patient discomfort and potentially preventable exposure to antibiotics. The hospital for which this quality improvement project was developed was above the National Healthcare Safety Network CAUTI bench mark. Framed within the Iowa model of evidence-based practice, a multidisciplinary team of 8 hospital stakeholders guided the project (n=8). The purpose of the project was to develop an indwelling urinary catheter maintenance checklist using evidence-based practice guidelines related to preexisting inappropriate risk factors for catheterization and appropriate indications for catheterization, as well as evidence-based maintenance practices for care of the indwelling catheter. Each piece of evidence to be included in the checklist was evaluated by 4 content experts using a 10 item 5 point Likert scale ranging from 'strongly disagree' to 'strongly agree'. Descriptive analysis showed an average of 4.8/5 for all items with 'agree' being voiced in two of the items rather than 'strongly agree'. The checklist was completed and presented to hospital senior leadership who recommended that the checklist be incorporated into the hospital CAUTI prevention plan. All project team members (n=8) completed an 8 item 5 point Likert scale summative evaluation of the purpose, goal, objectives, and my leadership which averaged as 5 or 'strongly agree' supporting the development of the project. Implications for social change include improved patient outcomes, mindful stewardship of healthcare dollars, and increased patient and family satisfaction.
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Pugliese, Michael. "Mobile Tablet-Based Stroke Rehabilitation in the Acute Care Setting." Thesis, Université d'Ottawa / University of Ottawa, 2017. http://hdl.handle.net/10393/37016.
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Introduction: The number of stroke survivors living with post-stroke deficits is increasing worldwide. Although stroke rehabilitation can improve these deficits and promote the recovery of function when initiated early post-stroke, many survivors are not able to access rehabilitation because of a lack of resources. Early mobile tablet-based stroke rehabilitation may be a feasible means of improving access to recovery promoting therapies.
Objective: To summarize and advance the knowledge of early mobile tablet-based therapies (MTBTs) for stroke survivors with regards to feasibility and barriers to care.
Methods: This thesis is comprised of two major studies. (1) A scoping review summarizing the literature for MTBTs following stroke. (2) A cohort study testing the feasibility of a MTBT for post-stroke communication, cognitive, and fine-motor deficits.
Results: (1) Twenty-three studies of MTBTs following stroke were identified. Most of these therapies targeted communication or fine-motor deficits, and involved patients in the chronic stages of stroke. Barriers to care were summarized. (2) A 48% recruitment rate was achieved and therapy was administered a median of four days post-stroke. However, therapy adherence was very low because of frequently encountered barriers to care.
Conclusions: Stroke survivors are interested in using tablet technology to assist with their post-stroke recovery. However, early MTBT post-stroke may be challenging for some survivors because of encountered barriers to care. Regular patient-therapist communication using a convenient method of interaction appears necessary to minimize barriers and to help patients overcome barriers when they occur.
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Lungui, Ilona. "Hand Hygiene and Compliance Rates in an Acute Care Setting." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6454.
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Hospital-acquired infections (HAIs) are a significant problem faced by healthcare organizations globally. The Centers for Disease Control reported that in 2014, 722,000 patients acquired an HAI, and of those, 75,000 died as a result. This project focused on reeducating healthcare staff on hand hygiene practices to prevent HAIs. Preintervention hand hygiene compliance rates were compared to postintervention hand hygiene compliance rates on 2 units in an acute care setting to evaluate if reeducation of healthcare staff on hand hygiene protocols and practices would increase hand hygiene compliance rates. The evidence-based practice model used for this project was Nightingale's environmental theory. The research question for the study examined the effectiveness of hand hygiene reeducation on hand hygiene compliance rates. Participants included 97 nurses and ancillary staff. Hand hygiene compliance rates were compared 1 month before and 1 month after healthcare staff reeducation. Results showed an 18% increase in compliance rates following reeducation. These results might effect positive social change by reinforcing that reeducation has an impact on compliance rates for hand hygiene among nursing and ancillary staff in acute care settings.
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Belcher, Janet Maxine. "Quality Initiative to Reduce Falls in an Acute Care Setting." ScholarWorks, 2020. https://scholarworks.waldenu.edu/dissertations/7599.
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Falls are the most frequently reported incidents among hospitalized patients in the United States with at least 4 falls per 1,000 patient days occurring annually. Falls are related to high rates of mortality and morbidity and high hospital costs. The purpose of this project was to evaluate a fall prevention quality initiative to reduce falls in an acute care facility by educating staff on an evidence-based fall prevention protocol. The project sought to explore whether implementation of an evidence-based fall prevention initiative in educating nurses would affect the nurses’ professional knowledge and the number of patient fall incidences in the cardiac care unit. The theoretical framework supporting this project was Neuman’s systems theory. The Iowa model was used to guide this evidence-based project. An educational session was implemented to increase nurses’ awareness of fall prevention practices. Two sets of data were collected: the pretest and posttest results, and the number of falls on the unit. A total of 21 unit nurses participated in the pretest; 18 (86.0%) completed the posttest. The mean score on the pretest was 81.62%; the mean score was 85.89% for the posttest with a mean difference of 4.27%. A paired sample t-test revealed no statistically significant differences in scores after education. This project has implications for social change by supporting patient safety, decreased hospital stays, and reduced health care expenses to patients and health care organizations.
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Pompeii, Jo Anna. "Nonpharmacological pain management in pediatric patients in the acute care setting." Honors in the Major Thesis, University of Central Florida, 2009. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/1308.
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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.Bachelors
Nursing
Nursing
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Labiche, Eppie Ann. "Venous Thromboembolism Prevention Education for Practitioners in the Acute Care Setting." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6597.
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During the last several decades, venous thromboembolism (VTE) has been identified as a preventable health condition. The gaps in clinical practice have led to an increased incidence of VTE. The lack of using existing evidence-based VTE prevention guidelines in practice has limited the implementation of VTE risk assessment stratifications and affected the appropriateness and timeliness of addressing pharmacologic and mechanical prophylaxis. The purpose of the scholarly project was to educate practitioners on existing VTE prevention practice guidelines. The practice-focused question explored whether an educational learning activity on evidence-based VTE prevention guidelines improved the awareness, knowledge, and compliance with existing evidence-based VTE guidelines of practitioners that assess and treat patients at risk for VTE. The theoretical framework for the project was Lewin's change process theory. A total of 38 participants comprised registered nurses (82%), physicians (5%), nurse practitioners (2%), and nonclinical personnel (11%). A program evaluation was provided to determine the effectiveness of the project. The findings showed that practitioners participated in the learning activity to improve knowledge (48%), increase VTE awareness (43%), and would change the management and treatment of patients at risk for VTE (39%). Hospitalized patients at risk for VTE can benefit from the results of this project through a change in clinical practice that might decrease the incidence of VTE and potentially bring about social change by reducing the number of preventable deaths.
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Wright, Marshanell. "Decreasing Catheter-Associated Urinary Tract Infections in the Acute Care Setting." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6707.
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The most important risk factor for developing a catheter-associated urinary tract infection (CAUTI) is the prolonged use of the urinary catheter. To address the CAUTI rate at the project site, which was higher than the national benchmark, a team of healthcare practice leaders developed an evidence-based algorithm addressing the appropriate indications for inserting or discontinuing a patient's Foley catheter. Using the plan-do-study-act model, the purpose of this quality improvement evaluation project was to evaluate the effectiveness of the evidence-based Foley algorithm for decreasing the use of Foley catheters and reducing the CAUTI rate and to explore whether using the Foley algorithm shift assessment tool would reduce the incidence of Foley catheter utilization. Data were compared on the rate of CAUTI and Foley catheter use over 4 months before and 4 months after implementation of the algorithm. There was a statistically significant decrease in the Foley utilization rate after implementing the Foley algorithm; the overall CAUTI rate did not decrease. The outcome of this quality improvement evaluation project could produce social change by highlighting the need for consistent application of the algorithm. In addition, reducing the rate of Foley catheter usage could decrease the incidence of CAUTIs, reduce hospital costs, and improve overall patient health during hospitalization.
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Irving, Athene. "Factors contributing to falls in a tertiary acute care setting in Cape Town, South Africa: a descriptive study." Master's thesis, Faculty of Health Sciences, 2020. http://hdl.handle.net/11427/32677.
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Introduction. Patient falls occur frequently in the acute hospital setting and are one of the most common adverse events experienced by hospitalised patients. In-hospital falls have negative outcomes for patients, causing injuries in up to half of those who fall. Falls in hospital create additional costs for health services due to increased length of stay (LOS), and greater health resource use. In contrast to much research focused on in-hospital falls worldwide, little is known about the rate, contributing factors and outcomes of inpatient falls in the state sector in South African hospitals. At the research hospital, a Falls Policy has been in place since 2013. The chosen falls risk screening tool, the Morse Falls Scale (MFS), had not been locally validated, and therefore its ability to accurately discriminate between patients who fall and patients who do not fall was unknown. A focused analysis of local falls incident reporting, and a description of contributory factors and consequences of falls, could better inform and target falls and fall injury prevention. Furthermore, this research may assist in service development and refining the Falls Policy. Methodology. The aim of this study was to obtain broad-based data on the magnitude of patient falls, and to identify factors contributing to falls. The aim was achieved in two parts, the first was a retrospective record review design. Predictive risk factors for falls were explored by comparing two patient groups, a Fall-Group and a Non-fall Group. In the FallGroup, further objectives related to describing circumstances surrounding fall events, including activities patients were performing at the time of the fall, the time of day and day of week the fall occurred, locations of fall events, and the clinical consequences sustained as a result of the fall. The use of the existing falls risk screening tool, the MFS, as well as its predictive accuracy to correctly identify patients at increased risk of falling was investigated. Second, a survey of nurses at the research hospital was undertaken to examine nurses' knowledge, attitudes and beliefs around the Falls Policy and current falls prevention practices. Results. There were 171 reported fall events during the ten-month period, representing 11.77% of adverse events and a falls rate of 0.73 per 1000 patient occupied bed days (POBD) during this time. Significant predictive risk factors for falling were a longer LOS and having a greater number of comorbid conditions. While the mean age of the sample was 50.0 years (SD=17.3 years), the Fall Group was significantly older than the Non-fall Group (p = .004). There were significantly more deaths in the Fall Group (p = .001), and this group had a longer average LOS (p < .001) compared to the Non-fall Group. The only sub-scale from the MFS that was significantly associated with falls was walking status. Minor-moderate clinical consequences were experienced as a result of the fall in 97% of cases (n=124). This study demonstrated that the MFS in use in the hospital has a low predictive accuracy of 55% at the current cut-off score of 50. At this score, the MFS has a sensitivity of 35.9% and a specificity of 75.4%. While an initial MFS was found in each of the cases, there was only evidence of a repeat MFS in 13 participants (9.7%) in the Fall Group. The nursing survey showed 70% of respondents had not had training on the Falls Policy (n=93) and only 37% (n=49) reported receiving regular feedback on fall rates. Receptiveness of most (66%, n=91) nurses to more training in falls prevention is encouraging. Discussion. The fall rate of 0.73 falls per POBD was lower than expected when compared to international studies. At the research hospital, when the Falls Policy was introduced in 2013, a fall was not defined in the policy and as highlighted in the nursing survey, there still appears to be lack of clarity on the fall definition. The MFS had a low predictive accuracy at the current cut-off score. The low sensitivity and specificity of the MFS in this setting may be due to the MFS not being updated regularly as per the Falls Policy. A further reason for the MFS poor predictive value may be the younger age group found in this sample when compared to international studies where the scale has performed better. Recommendations. The poor predictive value of the current risk screening tool found in this study is concerning. Therefore, further investigation into whether the MFS performs better if it is updated more frequently, and if completed in full, as per the Falls Policy, is recommended. Alternatively, the hospital should consider all patients with multiple comorbidities and those with longer length of stays at high risk, and provide interventions to minimise risk as per the Falls Policy. Future research into factors contributing to fall events and falls prevention should follow a prospective design and be supported at management as well as ward level. Further investigation into the most appropriate way to reduce harm from falls is recommended at the research site. Conclusion. This descriptive study provides a starting point for the hospital to examine the Falls Policy and falls prevention strategies currently in use. It is hoped that the study will contribute to local awareness-raising and capacity-building and help the hospital evaluate current practice and set a baseline for improvement.
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Kelly, Lesly Ann. "Nursing Surveillance in the Acute Care Setting: Latent Variable Development and Analysis." Diss., The University of Arizona, 2009. http://hdl.handle.net/10150/193636.
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The nursing profession has utilized a variety of terms to describe the work that nurses do, such as observing, monitoring, and critical thinking. Nursing surveillance is a term emerging in the research and clinical environment to describe the care, both seen and unseen, by professional registered nurses. It has been described as a complex, multi-dimensional concept that influences patient outcomes, yet little research has been done to examine the concept, how it is measured, and its role in outcomes.The surveillance process includes ongoing data collection, interpretation, and synthesis for decision making. This research proposes that nursing surveillance is comprised of five dimensions: actions, expertise, early recognition, intuition, and decision making. The purpose of this study is to examine the dimensions of nursing surveillance in the acute care setting.This study used a descriptive design to survey nurses on the dimensions of nursing surveillance. The survey consisted of four existing instruments measuring expertise, early recognition, intuition, and decision making, and one new instrument measuring activities associated with nursing surveillance. A content review panel was used to develop the new Nursing Surveillance Activities Scale. A sample of 158 medical-surgical nurses participated in completing the full Nursing Surveillance Survey.The goal of the analysis was to determine how well the dimensions represented the surveillance variable; however, based on sample size, revisions to the methods were made. Factor analysis was used to analyze each instrument's items and total representation of the variable. The instruments performed adequately in psychometric testing, and modifications were made so composite development could be achieved. The dimensions were factored as a composite variable and four of the five dimensions loaded onto a single variable, while the activities dimensions loaded separately. These results can be explained through a theoretical difference between the dimensions or limitations with the newly created Nursing Surveillance Activities Scale.This study identified a relationship between the four cognitive dimensions of nursing surveillance and their representation of the variable. Future research in nursing surveillance should analyze the role of the nursing surveillance variable, including the relationship to nursing outcomes.
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Ross, Helen. "Understanding and achieving person-centred care in an acute medical ward setting." Thesis, Sheffield Hallam University, 2015. http://shura.shu.ac.uk/20799/.
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Person-centred care is a concept often referred to in healthcare. However, it is unclear how it applies to everyday clinical practice. This qualitative study aimed to explore how the concept was understood and achieved in an acute medical ward setting in order to identify potential areas for development related to research, education and practice. The research design was influenced by an interpretive approach with the aim of accessing the meanings that participants assigned to the phenomenon of person-centred care and making this evident to others. A purposive sampling strategy identified 21 participants. These consisted of seven registered nurses, four student nurses, three healthcare support workers, three allied health professionals, two professional development co-ordinators and two nursing lecturers, who all took part in either individual or paired semi-structured interviews. Gathering data from this range of practitioners adds new perspectives to the body of knowledge on person-centred care. Data were analysed using Framework Analysis, which resulted in a model of person-centred care being developed iteratively as a result of data analysis, a priori knowledge of the researcher and the findings of the literature review. The study findings emphasise that all elements of the model; organisational culture, the philosophy of the care environment, characteristics of relationships, personal qualities of staff and principles of person-centred care interlink with each other to indicate what needs to be in place for person-centred care to be achieved. The model also provides a possible structure to inform the planning of future development within education and practice. The study outcomes identify potential areas for development within research, education and practice. These include, working towards a shared vision of person-centred care in the study setting by using work based activities in order to identify ongoing development needs; the testing and evaluation of the use of the model of person-centred care in practice and education and the investigation of the feasibility of conducting a health economic study to explore the cost-benefit of providing person-centred care in acute care settings.
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Patel, Lopa. "Noise Pollution/Reduction Education for Frontline Staff in the Acute Care Setting." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6942.
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Noise levels in hospital settings have risen beyond the recommended range of 35-40 decibels, resulting in poor patient healing outcomes and other health conditions ranging from sleep deprivation, anxiety, agitation, delirium, depression, and high heart rate and blood pressure. These negative patient health experiences are evidenced by poor scores for the Hospital Consumer Assessment of Healthcare Providers and Systems, which are indicators of patients' perceptions of care. This project explored whether an educational activity for 48 direct care staff, who include registered nurses and nursing assistants, in a cardiac unit on the impact of noise pollution on patient healing would increase staff members' knowledge of interventions to reduce noise pollution. The information processing theory guided this project. Eighty-nine percent of the participants strongly agreed that the educational activity was relevant to their practice as health care providers on the cardiac monitored unit. All participants strongly agreed that they would be able to identify when the unit was noisy and when noise was impacting a patient both physiologically and psychologically. Participants indicated that they could implement the suggested behavioral modifications to promote a healing environment. Participants strongly agreed that the speaker was effective in communicating the importance of noise pollution and its impact on patient healing and ways in which to combat the problem (89%), and they were generally satisfied with the learning activity (91%). Reducing noise pollution might create a healing environment for cardiac patients, thus positively impacting patient satisfaction and well-being.
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Ariri, Alex. "HIV Testing Practices and Provider-Identified Barriers in the Acute Care Setting." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3745.
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Despite the Centers for Disease Control and Prevention recommendations to test patients ages 13 to 64 years for HIV at health care settings, routine HIV testing is lacking. As a result, many people are unaware of their HIV seropositive status. The purpose of this quantitative cross-sectional study was to examine relationships between HIV testing and provider type, knowledge, attitudes, and behaviors regarding HIV testing in the acute care setting. The study was informed by social cognitive theory. Using a convenient sampling method, a questionnaire derived from previous surveys (Society of General Internal Medicine and University of Washington) was sent to 600 eligible acute care providers from a suburban Chicago hospital who treated HIV-negative patients ages 13 to 64 years. Completed surveys were received from 88 participants. Chi-square and multiple logistic regression testing showed no significant relationships between HIV testing and provider type (p = .09), age (p = .91), gender (p = .84), experience (p = 1), and race/ethnicity. However, knowledge of HIV testing regulations and positive attitudes about HIV testing were significantly associated with the likelihood of offering an HIV test (p = .026, p = .004 respectively). Results have some clinical importance, but also indicated a lack of routine opt-out HIV testing. Results may be used to promote HIV testing among acute care providers which could reduce HIV-status unawareness in the population.
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Hudson, Sonia A. "Systematic Literature Review on Fall Prevention in an Acute Care Hospital Setting." ScholarWorks, 2020. https://scholarworks.waldenu.edu/dissertations/7874.
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Falls, with and without injury, in acute care hospitals are quite common but can be prevented if appropriate interventions are in place to address this issue. It is imperative that nurses assess fall risks of all patients admitted to the hospital and advocate for appropriate interventions to prevent falls in those who are found to be at risk. The purpose of this project was to recommend changes to the current fall prevention protocol in the project facility, an acute care hospital, based on best practices identified in a systematic review of the literature. At the time of the project, the hospital had a high rate of falls. The clinical practice question addressed by this project focused on the evidence-based fall prevention interventions that have resulted in a decreased fall rate among patients on medical-surgical units in an acute inpatient hospital setting. This doctoral project was informed by Kolcaba's theory of caring, and the major source of evidence was a systematic review of the literature focusing on fall prevention. Findings indicated that identification of fall risk factors and implementation of multifactorial fall prevention interventions, such as fall prevention teams, unit fall team champions and use of a fall risk scale, can reduce falls on medical surgical units in acute care hospitals. It was recommended that a multidisciplinary fall prevention team be developed in conjunction with unit fall team champions and that a fall risk scale be used to bridge the practice gap. If implemented, these changes may benefit patients, nurses, and the organization as a whole through decreased falls, lengths of stay, and health care costs.
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Cummings, Cynthia L. "The Effect of Moral Distress on Nursing Retention in the Acute Care Setting." UNF Digital Commons, 2009. http://digitalcommons.unf.edu/etd/371.
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This descriptive study explored the relationship between moral distress, professional stress and intent to stay in the hospital setting. The study involved 234 nursing participants and was conducted via an online survey over a 90 day period. The survey tool consisted of 51 items taken from known moral distress, professional stress and intent to stay tools. The items were divided into frequency and intensity of occurrence. Various statistical measures were utilized to conclude that moral distress and professional stress factors were significant (p
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Berghoff, Laurie Swaney. "Nursing Self-Efficacy in the Acute Care Setting with the Neighborhood Staffing Model." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5677.
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Due to changes in health care, along with increasing technological demands, nurse's experiences increased stress. Nurses who are asked to staff another area other than their own have increased stress that can lead to increased nurse turnover, absences, and nursing dissatisfaction scores. The purpose of this quality improvement project was to assess whether limiting what units a nurse works on can reduce nurse stress, improve self-efficacy, and improve nurse job satisfaction. The design of this pilot placed like nursing units within a neighborhood staffing model for floating. The plan-do-check-act model was used as a framework to implement a change in the nurse floating practices. An electronic survey was sent to the nursing team pre and post implementation of the model. Nursing hours will also be tracked during this period of time. Data related to floating after the implementation of the neighborhood staffing model showed a significant increase in floating hours inside (13.1 vs 20.9; t=3.98, p<.001), and there was a significant decrease in hours floated outside the neighborhood (26.3 vs 18.0; t=5.15, p<.000). Self-efficacy results showed an initial decline in the nurses' self-efficacy 4 weeks after the launch and a statistically significant increase over preimplementation levels at 8 weeks (pre 28.46; post 33.51; U=5003, p<.001); on the 3rd administration of the self-efficacy survey, a statistically significant increase was seen (28.5 vs. 33.5; t=12.1, p<.001). Allowing nurses to float to similar nursing areas will result in improved self-efficacy, a precursor to reduced job stress and increased job satisfaction, which represents a positive contribution to social change for the nurses who work in the hospital system.
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Campbell, Jill L. "Incontinence-associated dermatitis in the acute care setting: An exploration of the phenomenon." Thesis, Queensland University of Technology, 2016. https://eprints.qut.edu.au/101514/1/Jill_Campbell_Thesis.pdf.
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Incontinence-associated dermatitis (IAD) is a common, painful and costly threat to skin integrity and quality of life in older hospital patients. Through an exploration of this multidimensional phenomenon, this thesis has advanced understanding of the prevalence of IAD and associated Candida colonisation and infection in the acute care setting. The novel Skin Safety Model integrates the multi-factorial influences of patient, hospital environment and situational stressors, and proposes a re-conceptualisation away from the historical focus on discrete skin injury; pioneering a new framework to guide a unified understanding of maintaining skin integrity that can be applied across the broad range of skin injuries.
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Ardura, Garcia Cristina. "Emergency care re-attendance for acute childhood asthma in a low-resource setting : the Childhood Asthma Re-attendance Assessment (CARA) study." Thesis, University of Liverpool, 2018. http://livrepository.liverpool.ac.uk/3021153/.
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Background Asthma is a public health problem in Latin America, where asthmatic children are mainly treated at emergency rooms during acute attacks. These attacks result in loss of lung function and quality of life for the asthmatic child and family, risk of death and high direct and indirect economic costs. In order to improve paediatric asthma management in Esmeraldas, Ecuador, we aimed to identify predictors of recurrent asthma attacks requiring emergency care and to explore the caregivers’ (CGs) and health care workers’ (HCWs) perceptions of barriers and facilitators to asthma health and home care access. Methods First, a systematic review and meta-analysis of published studies analysing predictors for emergency department (ED) re-attendance or hospital readmission for acute asthma in children was performed. Second, a prospective cohort study of children treated for an asthma attack at an emergency room in Esmeraldas, Ecuador, was undertaken to define the characteristics of these children, determine the rate of ED re-attendance for acute asthma and identify the predictors for this to occur. Third, a qualitative study to explore acute asthma significance and perceived barriers and facilitators for health and home care access from the asthmatic children’s CGs’ and HCWs’ perspective was performed. Results In both the meta-analysis and prospective cohort study, children of a younger age and a history of severe asthma attacks during the previous year were at a greater risk of ED re-attendance for acute asthma. Forty six percent of the children recruited during the prospective cohort suffered a subsequent asthma attack requiring emergency care in the following 6 months. Other identified predictors of ED re-attendance for acute asthma were: existing asthma diagnosis (AOR: 2.17, 95% CI: 1.19-3.94; AHR: 1.66, 95% CI: 1.15-2.39); food triggers (AOR: 1.99, 95% CI: 1.11-3.55); existing eczema diagnosis (AOR: 4.22, 95% CI 1.02-17.54); and urban residence as protective (AHR: 0.69, 95% CI: 0.50-0.95). Twelve HCWs and 20 CGs participated in the in-depth interviews and focus group discussions, expressing a differing significance of asthma attacks. This difference was also observed between experienced and inexperienced HCWs. Multiple barriers and several facilitators were identified by HCWs and CGs that affect health and home care access for asthmatic children. When shown the predictors of ED-reattendance for acute asthma combined in a risk-assessment tool, both HCWs and CGs reported finding the tool easy to use and understand, as well as a useful aid in the decision-making process concerning asthma treatment and follow-up. Conclusion A combination of several question-based predictors may result in an effective and simple risk-assessment tool to be used at the ED to identify asthmatic children at a higher risk of recurrent severe asthma attacks. Increasing CGs’ and HCWs’ asthma knowledge as well as HCWs’ communication skills, to establish a patient centred approach with a shared decision-making process could mean a difference in the quality of the asthma care in this setting. The use of the described recurrent risk assessment tool could prove useful in this process, as reported by the participants in this study.
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Dee, Joan Frances Melville. "What factors assist clinicians to determine dying in an acute setting?" Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:e46c888c-4ae7-48ed-90a4-33ac26a5d96a.
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Background: The End of Life Care Strategy stated that there should be a reduction of expected deaths in the acute setting. In order to achieve this goal, when it has been identified that where the patient's preferred place of care is home, clinicians need to be able to recognise when a patient is dying in order to achieve their preferred place of death. The aims of this study were to identify any factors that help or hinder a clinician when they are determining when irreversible dying begins and to seek consensus on which of these topics would be useful to include in an education programme. Method: A 3 stage mixed methods study was developed. Phase 1was a Systematic Review of current primary research in order to provide an evidence base for the study. Phase 2 involved unstructured interviews with clinicians in the acute setting utilising the Grounded Theory approach to the analysis identify potential factors. Phase 3 was a Delphi study used to identify which of these factors would be useful in an education programme. Conclusions: The Systematic Review identified four themes "Patient Observation", "Knowledge of the Patient", "Communication" and "Attitudes of the Clinician". These were confirmed by the interviews and a further theme "Experience" identified. The over-arching theme emerging from the findings of the interviews was that clinicians have a fear of getting the timing of the recognition of irreversible dying wrong because the decision making process is so complex and this is exacerbated by fear of missing the treatable. Many factors identified in the interviews were acknowledged as factors that could be included in an education package. It was also identified that there is the need for a culture shift in society regarding death and dying and a change in the philosophy of care for health care professionals.
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Chow, Yuen-yi, and 周婉儀. "Pre-operative music intervention to reduce patients' pre-operative anxiety in acute care setting." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B44623021.
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Haslett, Kirsten, Michael Herman, and David Lee. "Probiotics in the Prevention of Clostridium Difficile Associated Diarrhea in the Acute Care Setting." The University of Arizona, 2014. http://hdl.handle.net/10150/614188.
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Class of 2014 AbstractSpecific Aims: Clostridium difficile associated diarrhea (CDAD) frequently occurs in patients exposed to broad-spectrum antibiotics which can result in a life threatening illness. The role of probiotics in the prevention of CDAD is not well established and many medical centers across the United States are opting to remove probiotics from common CDAD prophylaxis. We aim to evaluate the efficacy of lactobacillus probiotics during the use of broad-spectrum antibiotic therapy in the acute care setting for the prophylaxis of CDAD at Kindred Hospital. Methods: We performed a single center, retrospective data analysis efficacy trial of inpatients receiving beta-lactam, fluoroquinolone or clindamycin antibiotics from the Kindred Hospital database. Two study groups will be compared: patients who received lactobacillus probiotic therapy based on protocol since May 2011 and patients who did not receive probiotic therapy. The presence or absence of CDAD will be used to evaluate probiotic efficacy. Main Results: Of the ### patients screened, ## were assigned to the treatment group and ## were assigned to the non-treatment group, a total of ## patients were analyzed for the primary endpoint. CDAD occurred in ## patients (xx%) receiving probiotic therapy while CDAD occurred in ## patients (xx%) not receiving probiotic therapy (relative risk [RR]: xx.x; p=0.xxx). Conclusion: [Anticipated] We identified no statistically significant evidence that the use of lactobacillus was effective in the prevention of CDAD. Further knowledge of the pathophysiology of CDAD and proper antibiotic use is needed for future studies.
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Bare, LaShonda Leigh. "Factors that most influence job satisfaction among cardiac nurses in an acute care setting." Huntington, WV : [Marshall University Libraries], 2004. http://www.marshall.edu/etd/descript.asp?ref=450.
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Perera, K. Prasadini N. "Impact of Post-Discharge Care Setting Following Inpatient Hospitalization on Hospital Revisits in a Medicare Population." Diss., The University of Arizona, 2013. http://hdl.handle.net/10150/301686.
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Background: In the current policy environment hospital readmissions are receiving considerable attention due to a provision in the Affordable Care Act (2010), that penalize hospitals through reduced payments for excess readmissions (the hospital readmissions reduction program (HRRP)). This program primarily holds hospitals accountable, although a multitude of factors not directly in control of hospitals can be contributory to readmissions. Of these, whether or not patients are discharged to an appropriate post-discharge care setting can be one contributory factor, and, this study evaluated the association between post-discharge care setting and hospital revisits. Methods: A retrospective analysis of the 2008 Medicare Current Beneficiary Survey (MCBS) was conducted. Three post-discharge care settings were evaluated: 1) routine discharge to home; 2) home with home healthcare; and 3) skilled nursing facility. Two outcomes were assessed: 1) 30-day all-cause hospital readmissions; and 2) 30-day all-cause hospital revisits (combination of inpatient admissions and emergency department visits). Analyses were carried out among patients with hospitalizations for any reason, as well as among a subgroup that were hospitalized for one of seven priority conditions identified in the HRRP. Weighted logistic regression analyses that incorporated information on the complex survey design were conducted. Results: Of the MCBS sample representing 46,048,125 Medicare beneficiaries (unweighted N=11,723), 4.9 percent (N= 2,293,629; unweighted N=670) contributed at least one index hospitalization to the analysis. Among hospitalization for any reason, 30-day all-cause hospital readmissions and revisits was 12.3 percent and 17.8 percent, respectively. The subgroup consisted of 31.8 percent of hospitalizations for any reason (N=730,174; unweighted N=216). Readmissions and revisits in the subgroup were 17.8 percent, and 24.5 percent, respectively. Post-discharge care setting was not significantly associated with either readmissions (P=0.966) or revisits (P=0.728) for hospitalizations for any reason. Findings for the subgroup were similar with no significant association between post-discharge care setting with either readmissions (P=0.850) or revisits (P=0.483). Conclusion: Absence of a difference in readmissions and revisits by post-discharge care setting suggests that the choice of discharge status might be appropriate following an inpatient admission. However, further research with larger sample sizes for conditions in the subgroup both together and separately is recommended.
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Anderson, Valerie Valdez. "The experience of night shift registered nurses in an acute care setting a phenomenological study /." Thesis, Montana State University, 2010. http://etd.lib.montana.edu/etd/2010/anderson/AndersonV0510.pdf.
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The night shift environment in acute care nursing is a unique and poorly understood entity. Retention of experienced nurses on the night shift is vital to the provision of quality care and the nurturing of new nurses. The goal of this phenomenological study was to elicit a description of the lived experience of experienced night shift nurses with the goal of gleaning information that would improve the work environment on the night shift. Five experienced night shift RNs participated in self-directed interviews, responding to the question, "Can you please share your experiences as an RN working the night shift?" The interview data were analyzed using Giorgi's phenomenological method to arrive at a typical and essential structure of the experience. The results revealed negative and positive aspects of working a night shift schedule. Negative aspects of night shift nursing included a feeling of being misunderstood and undervalued professionally and personally. Inadequate resources, on the night shift, was also identified as a barrier to nurse satisfaction, and negatively influencing the provision of quality nursing care and quality orientation of new nurses. Negative physiologic influences of night shift centered around poor quality and quantity of sleep. While these negative influences were consistently presented by all participants, so were the positive aspects of night shift nursing. The participants of this study were strongly invested in the teamwork they experienced within their night shift work environment. Interdependent team spirit was found to have arisen in response to the lack of resources experienced by these nurses. This teamwork, along with the other positive aspects, such as autonomous practice and positive effects on personal time, were seen as incentives for these experienced nurses to continue nursing on the night shift. Nursing administration may be able to utilize the information gleaned from this study to optimize the night shift work environment, and subsequently, increase retention of the experienced nurse. Further research is needed to clarify: the needs of experienced nurses in varying clinical settings, the needs of inexperienced night shift nurses, and the representativeness of the data found in this study to larger numbers of nurses.
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Liu, Haiping. "Nurses’ Knowledge about Assessment, Prevention, and Treatment of Skin Tears in the Acute Care Setting." Case Western Reserve University Doctor of Nursing Practice / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=casednp1575024092388924.
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Alfred, Crystal M. "Bullying: The Impact on Intention to Leave of Generational Members in the Acute Healthcare Setting." The Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu1523948285771456.
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