Dissertations / Theses on the topic 'Clinical Nursing: Secondary (Acute Care)'
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1
Ashcraft, Alyce Louise Smithson. "The clinical reasoning of expert acute care registered nurses in pre-cardiopulmonary arrest events." Thesis, Full text (PDF) from UMI/Dissertation Abstracts International, 2001. http://wwwlib.umi.com/cr/utexas/fullcit?p3008269.
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Osyanju, Bernadette. "Clinical experiences of second year nursing students on their first acute care practicum." Thesis, Osyanju, Bernadette (2012) Clinical experiences of second year nursing students on their first acute care practicum. Honours thesis, Murdoch University, 2012. https://researchrepository.murdoch.edu.au/id/eprint/41683/.
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Acute care units are known to be busy and complex in nature with many stressors of which students find challenging. While some students with prior exposures to these areas are able to cope, special cohorts of young, inexperienced, unexposed students undergo a unique experience. The first acute care practicum is important in nursing education and influences a student‘s long term goal of becoming a nurse.
This study explored the experiences of second year nursing students who did not have prior experience in acute care while undertaking their first acute care practicum. The perceptions of clinical educators on students‘ first acute care practicum was equally explored.
This explorative qualitative study was conducted on a purposive sample of four nursing students and three clinical educators. Data was obtained by conducting audio recorded interviews with clinical educators and nursing students individually, from which verbatim transcripts were derived. Thematic data analysis was employed to interpret the findings and five major themes were identified: experiencing a new environment, situational learning, experiencing stress, supporting students and reflecting on placement allocation. Students and their clinical educators acknowledged there being positive and negative experiences of the practicum that influenced clinical learning.
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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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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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Hourigan, Margaret. "Characteristics of the professional, clinical, and administrative information networks evolved by nurse managers in decentralized nursing departments in acute care hospitals /." Access Digital Full Text version, 1989. http://pocketknowledge.tc.columbia.edu/home.php/bybib/10857795.
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Thesis (Ed.D.) -- Teachers College, Columbia University, 1989.Sponsor: Elaine L. La Monica. Dissertation Committee: James E. Corter. Typescript; issued also on microfilm. Bibliography: leaves 158-166.
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Mogan, Susan. "A Clinical Practice Guideline for Pain Management in the Post Anesthesia Care Unit." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/6247.
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Ineffective pain management in the post anesthesia care unit (PACU) increases patients' risk of adverse effects including decreased mobility, infection, chronic pain, depression, cardiopulmonary complications, increased length of stay, insomnia, fatigue, and overall decrease in quality of life. The PACU in a community hospital did not provide an evidence-based pain management guideline for nurses treating postoperative patients, resulting in nurses' concerns about providing pain management. The purpose of this project was to translate evidence on pain management into an evidence-based guideline for improved nursing practice in a PACU. Evidence was obtained from a detailed literature search using multiple databases and professional organizations' guidelines. Nursing practice guidelines were developed and evaluated by 3 expert panelists using the Agree II guidelines. The panelists selected included; Two anesthesiologists, one who is trained in pain management and is also a pharmacist. The third expert is a practicing nurse practitioner in an acute setting who is also a surgical first assist and the associate director of robotics. The panel endorsed the guidelines for advancement through the hospital's review committees. Implementation of the evidence-based pain management guideline in the PACU might provide nurses with tools to guide their interventions and improve patient outcomes. Social changes resulting from the use of evidence-based pain management guidelines include decreased time to opiate administration, decreased adverse effects, improved assessment of pain, and an increase in the number of patients who receive proper pain management.
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Downey, Debora Ann. "The Effectiveness of AAC Training Protocols for Acute Care Nurses| A Randomized Controlled Trial of an Instructional On-line Medium for Clinical Skills Teaching." Thesis, The University of Iowa, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=3628382.
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Acutely ill patients, across the age continuum, often present with complex communication needs (CCN) due to motor, sensory, cognitive and linguistic barriers they may experience during their hospital encounter. While hospital administrators recognize the importance of improving communication among the healthcare team members to increase quality and safety measures, few have focused on improving the patient-provider communication process, especially for patients with CCN. Recent Joint Commission standards mandates hospitals and healthcare providers improve communication for patients with CCN across all points of the care continuum. The study investigated the effectiveness of AAC training protocols for acute care nurses and ancillary healthcare providers using an on-line instructional medium for clinical skills teaching. The study design allowed for the measurement of learning following exposure to the tutorial and the analysis of possible clinical skill application. The current study invited a total of 377 nurses and graduate students to participate. Eight-three participated in the study and were divided randomly into two groups. Seventeen (20.5%) were assigned to in the control group, and 66 (79.5%) participants were into the test group. Both groups were directed to complete a pre-test measure. This was followed by exposure to the tutorial for the test group. The groups then were instructed to complete a post-test measure. For all participants in the test condition, the mean difference score (post-pre) was 19.2. The average pre-test score was 60.8 with a standard deviation of 12.4 while the average post-test score was 80.1 with a standard deviation of 11.3. This difference was significant (p<.00001). This suggests the on-line tutorial as a mode of delivery for clinical skills teaching of AAC solutions for patients with CCN was effective. The study also involved the design of a set of scenarios to assess transfer of knowledge from the tutorial to clinical practice in a safe environment. The scenarios targeted three areas for participants to problem solve through: the development of a yes/no response, recognition of sensory issues displayed by patients with CCN; and, candidacy for AAC use in an acute care setting. The scenarios were presented to both groups after completion of the post-test measure. No significant difference across the groups was noted. However, findings suggested that the use of scenarios may be a viable method for assessing the application of clinical skills when the participant had to generate a narrative outlining clinical practice as opposed being scaffold by the selection of correct and incorrect clinical skill strategies presented. The study emphasizes the need to enhance the patient-provider communication experience for patients with CCN and outlines basic elements for nurse training modules.
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Baker, Melanie Jane. "The application of evidence based practice in the acute care hospital setting: A grounded theory study of the perspective of nurses in Western Australia." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2020. https://ro.ecu.edu.au/theses/2377.
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Evidence based practice (EBP) in nursing is an important part of care provision, both in Australia and globally. The experience of applying evidence in practice presents many challenges for nurses. This study focused on the application of EBP in the acute care hospital setting. Grounded Theory methodology was used and 21 semi-structured recorded interviews with Registered Nurses from two acute care hospitals were conducted. Data were analysed using the constant comparative method.
A substantive theory was developed, Traversing the EBP Conundrum, as the process used to manage the core issue: The Challenge of Applying EBP. Time Constraints, Nurses’ Inherent Traits, and The Organisation Talking the Talk but not Walking the Walk, were conditions affecting the nurses’ daily practice. These conditions resulted in a discrepancy between the ideal mandated by the nursing profession and organisations, and the reality of working in a context of Consideration for Quality and Safety. In applying the process, nurses were found to Survive the Conundrum: Navigating Alternative Pathways; by Getting Lost in the Bush: Going Their Own Way; by Scaling New Heights Working Over and Above to Optimise Outcomes.
This study raises questions regarding the quality and safety of patient care, as well as the wellbeing of nurses, and the ideal of EBP which is mandated by professional bodies. The findings lead to recommendations including: further research into the reality of EBP for nurses and its impact upon patient outcomes, safety, nurses job satisfaction and nurse retention; consideration by the professional body as to how realistic professional and organisational expectations of EBP are in nursing; and a review of decision making by leaders in relationship to EBP, therefore quality and safety.
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Hopes, Scott L. "Healthcare IT in Skilled Nursing and Post-Acute Care Facilities: Reducing Hospital Admissions and Re-Admissions, Improving Reimbursement and Improving Clinical Operations." Scholar Commons, 2017. https://scholarcommons.usf.edu/etd/7409.
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Health information technology (HIT), which includes electronic health record (EHR) systems and clinical data analytics, has become a major component of all health care delivery and care management. The adoption of HIT by physicians, hospitals, post-acute care organizations, pharmacies and other health care providers has been accepted as a necessary (and recently, a government required) step toward improved quality, care coordination and reduced costs: “Better coordination of care provides a path to improving communication, improving quality of care, and reducing unnecessary emergency room use and hospital readmissions. LTPAC providers play a critical role in achieving these goals” (HealthIT.gov, 2013).
Though some of the impacts of evolving HIT and EHRs have been studied in acute care hospitals and physician office settings, a dearth of information exists about the deployment and effectiveness of HIT and EHRs in long-term and post-acute care facilities, places where they are becoming more essential. This dissertation examines how and to what extent health information technology and electronic health record implementation and use affects certain measurable outcomes in long term and post-acute care facilities. Monthly data were obtained for the period beginning January 1, 2016 through June 30, 2017, a total of 18 months. The level of EHR adoption was found to positively impact hospital readmission rates, employee engagement, complaint deficiencies, failed revisit surveys, staff overtime (partial EHR), staff turnover rate (full EHR) and United States Centers for Medicare and Medicaid Services (CMS) Five Star Quality score. The level of EHR adoption was found to negatively impact CMS Five Star Total score, staff retention rate (full EHR) and staff overtime (full EHR group higher than partial EHR).
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Myers, Helen. "Fall risk assessment : A prospective investigation of nurses' clinical judgement and risk assessment tools in predicting patient falls in an acute care setting." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2003. https://ro.ecu.edu.au/theses/1494.
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Falls are a significant problem in acute care, hospital settings, and can have serious consequences, especially for older patients. Fall prevention has therefore been recognised as an important area for research and intervention. In order to target interventions and use resources effectively, a major strategy of many fall prevention programmes has been the development and/or use of risk assessment tools to identify patients who are at high risk of falling. Although many tools have been developed, few have been rigorously tested, and there is currently no evidence to support the clinical utility of fall risk assessment tools. There is a need to conduct further research to establish the efficacy of fall risk assessment tools for inpatient populations. Additionally, nurses clinical judgement in assessing fall risk may aid the development of fall risk assessment protocols and further research is needed to build on limited knowledge in this area. A prospective cohort study was used to evaluate two fall risk assessment tools and nurses' clinical judgement in predicting patient falls. Each patient was assessed for fall risk by the clinical judgement of the nurse caring for the patient and by the researcher using a data collection form containing the two fall risk assessment tools. The study wards comprised two aged care and rehabilitation wards, within a 570 bed acute care tertiary teaching hospital facility in Western Australia. Test-retest reliability of the two fall risk assessment tools and nurses' clinical judgement was established over a twenty four hour period. The ability of the fall risk assessment tools, and nurses' clinical judgements to discriminate between patients with a high probability of falling and , patients with a low probability of falling; was determined by calculating the sensitivity, specificity, positive predictive value and negative-predictive value for each method. The reference criterion used for these calculations was whether or not the patient fell within the hospitalisation period in which they were admitted to the study. In addition, the accuracy of each method was determined by calculating the number of times the risk assessment tool or clinical judgement classified the patient into the correct, fall risk category, expressed as a percentage. The same reference criterion was used for this calculation. Both the fall risk assessment tools and nurses' clinical judgement had good test-retest reliability. When assessing validity, all three methods of determining fall risk showed good sensitivity, ranging from 88% to 91 %,but poor specificity, ranging from 25% to 26%. This meant that the risk assessment methods classified too many patients who did not fall as at high risk for falling. All methods also had limited accuracy, ranging from 35% to 36%, and overall exhibited an inability to adequately discriminate between patient populations at risk of falling and those not at risk of falling. Consequently, neither nurses' clinical judgement nor the fall risk assessment tools could be recommended for assessing fall risk in the clinical setting. In addition, results indicated that there was a large difference between the accuracy of first year enrolled and registered nurses in assessing patient fall risk. First year enrolled nurses accurately predicted fall risk 44.4% of the time while first year registered nurses achieved an accuracy level of only 8.6%. These results are potentially biased, as measuring differences in accuracy between types of nurses was not a main focus of this study and in many cases the same nurse gave multiple judgements about patients' fall risk. The results however, provide an indication that further study is warranted using a specifically methodology to explore this issue. There are a number of specific recommendations arising from the results of this study. It is recommended that further studies be undertaken to assess the reliability and validity of current fall risk assessment tools in inpatient populations. If no valid and reliable fall risk assessment tool can be identified, research should be undertaken to develop such a tool. It is also recommended that studies be conducted to assess changes in fall risk profiles over time to determine if the sensitivity and specificity of instruments changes depending on the timing of the risk assessment. Differentiating between stable and transient risk factors should be an integral component of these types of studies. Further research is also required to determine if there are differences in fall risk factors between different specialties or if a generic risk assessment tool can be used for all inpatient populations. Additionally, further investigation into the clinical judgement of registered and enrolled nurses in .their first year of clinical practice should be undertaken and results reported to appropriate educational institutions. Changes in accuracy of clinical judgement in the first five years of clinical practice should also be measured.
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Downey, Debora Ann. "The effectiveness of AAC training protocols for acute care Nurses: a randomized controlled trial of an instructional on-line medium for clinical skills teaching." Diss., University of Iowa, 2014. https://ir.uiowa.edu/etd/4616.
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Acutely ill patients, across the age continuum, often present with complex communication needs (CCN) due to motor, sensory, cognitive and linguistic barriers they may experience during their hospital encounter. While hospital administrators recognize the importance of improving communication among the healthcare team members to increase quality and safety measures, few have focused on improving the patient-provider communication process, especially for patients with CCN. Recent Joint Commission standards mandates hospitals and healthcare providers improve communication for patients with CCN across all points of the care continuum. The study investigated the effectiveness of AAC training protocols for acute care nurses and ancillary healthcare providers using an on-line instructional medium for clinical skills teaching. The study design allowed for the measurement of learning following exposure to the tutorial and the analysis of possible clinical skill application. The current study invited a total of 377 nurses and graduate students to participate. Eight-three participated in the study and were divided randomly into two groups. Seventeen (20.5%) were assigned to in the control group, and 66 (79.5%) participants were into the test group. Both groups were directed to complete a pre-test measure. This was followed by exposure to the tutorial for the test group. The groups then were instructed to complete a post-test measure. For all participants in the test condition, the mean difference score (post-pre) was 19.2. The average pre-test score was 60.8 with a standard deviation of 12.4 while the average post-test score was 80.1 with a standard deviation of 11.3. This difference was significant (p
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Alasmari, Hajar Ali M. "Examining intensive care nurses' clinical decision-making associated with acute kidney injury and continuous renal replacement therapy in Saudi Arabia." Thesis, Queensland University of Technology, 2018. https://eprints.qut.edu.au/122877/1/Hajar%20Ali%20M_Alasmari_Thesis.pdf.
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This thesis explored the dimensions of decision-making of nurses managing continuous renal replacement therapy in the intensive care unit. Variations in the levels of decision-making were largely the result of contextual factors including workforce characteristics, management practices, socialisation and organisational constraints. The concepts also constitute an explanation of the ways in which the interplay of social, organisational and technological boundaries constructed the process of nursing clinical decision-making and performance with advanced technology. These finding suggest that there is an urgent need for organisational and social change in the nursing profession in Saudi Arabia.
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Beament, Tania L. "A mixed-method study to evaluate the effectiveness of a policy-driven tool to improve the recognition of and response to clinical deterioration in acute care." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2022. https://ro.ecu.edu.au/theses/2518.
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Background: Contemporary literature identifies that clinical deterioration in the acute care setting requires an optimum level of management and that the failure to recognise this deterioration and respond effectively results in increased mortality rates. The early detection of clinical deterioration and the successful rescue of a patient relies heavily on the effectiveness of hospital systems, communication systems and multidisciplinary collaboration.
Objectives: To evaluate the effectiveness of the strategies implemented to improve the escalation of care for patients who deteriorate in hospital. Specifically, the study examined the introduction of a revised observation chart, the experiences of nurses in using the chart, and whether its use resulted in the appropriate escalation of care.
Method: A mixed-methodology approach combining a longitudinal study design with cross-sectional data collection. A quantitative research method was adopted to extract the results from the medical records of patients who had experienced a Medical Emergency Team (MET) call and establish the rate of compliance with the new policy. Patient information sourced from administrative datasets, including discharge abstracts extracted from the hospital's morbidity system and MET call database, were used to determine changes in the rates of MET calls and mortality pre- and post- policy implementation. Qualitative data collection involved focus group discussions on nurses’ experiences of implementing the policy and use of the Adult Observation Response Chart tool. The study was undertaken in the multi-day wards at one of Western Australia’s tertiary hospitals, where a new escalation policy was implemented as part of the State healthcare policy for the recognition of, and response to, the deteriorating patient.
Results: A statistically significant increase in the rate of MET calls in the post-policy intervention period compared to the pre-policy intervention phase was observed, the odds increasing by 12% post-policy intervention. Additionally, the study found a strong correlation between the number of MET calls and the Charlson Index Score (the higher the Charlson Index Score, the more likely a MET call was made). Mortality rate was not significantly different between the two periods after adjustment for other relevant factors. Three major themes were identified: chart design, communication, and the impact of the policy implementation on nurses and patients.
Conclusion: Recognising, responding to, and managing the deteriorating patient is complex, challenging, and multifaceted. The study highlighted the need for effective strategies to support the recognition of clinical deterioration and response in critical situations to enhance patient safety, optimise resources and positively change practice. Findings from the study emphasised the challenges faced when implementing a new policy leading to a change in practice. Recommendations include the refinement of policy and removal of barriers that can impact the implementation of evidence-based practice and the opportunity to improve patient outcomes.
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Lower, Tonia L. "Improving healthcare provider knowledge in acute and primary transgender health needs:The implementation of a clinical education program with urgent care and emergency room staff and providers." Otterbein University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=otbn1481300755682172.
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Dodsworth, Caroline. "How can midlife nurses be supported to deliver bedside care in the acute clinical services until retirement? : a thesis presented in partial fulfilment of the degree of Master of Philosophy (Nursing), Massey University, Turitea, Palmerston North, New Zealand." Massey University, 2008. http://hdl.handle.net/10179/902.
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As the baby boomer generation move inexorably towards retirement and the requirement for health care services increases, the supply of nurses available to provide care at the patient bedside is forecast to fall significantly short of demand. This thesis has explored the perspectives of midlife nurses, asking what it would take to keep them in bedside practice until retirement. These nurses have provided insights which offer employers of valuable senior nurses, suggestions for maximising their potential. Through the use of questionnaires and focus groups nurses aged 45 years and over were asked what the employer can do to ensure that they are able to continue to work at the patient bedside until they reach the age of retirement. The results of this research demonstrate a workforce of nurses who are passionate and committed to their profession, but feeling disillusioned and disempowered. The nursing environment has changed over the span of their career and they find the increased workload, together with increasing professional demands, too hard to cope with. They feel they have no control over their workload, their shift patterns, or the expectations of their patients and colleagues. They want their experience to be recognized but they do not want to have to prove competency; they want to have a voice but they are unwilling to pursue postgraduate education to learn how to become visible and emancipated.
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(9783206), John Broadbent. "An ethnographic examination of the influences on the relationship between mental health triage nurses and emergency department triage nurses." Thesis, 2011. https://figshare.com/articles/thesis/An_ethnographic_examination_of_the_influences_on_the_relationship_between_mental_health_triage_nurses_and_emergency_department_triage_nurses/13462049.
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"Emergency Departments are increasingly the focal point of primary access to mental health services by clients with a mental illness. Developments in the initial emergency triage assessment are inextricably linked to improving the process of triage, where clients are assessed and referred to specialist mental health services. This ethnographic study examined the interdisciplinary relationships between emergency department triage nurses and mental health triage nurses for clients presenting with a mental illness"--Abstract.
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(9834164), Sandra Sharp. "The impact of workplace culture on the provision of person centred care in an acute surgical ward: A critical ethnography." Thesis, 2016. https://figshare.com/articles/thesis/The_impact_of_workplace_culture_on_the_provision_of_person_centred_care_in_an_acute_surgical_ward_A_critical_ethnography/13387319.
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Many Australian health services espouse a method of patient care that ensures that all patients are treated as individuals, with dignity and respect. Referred to as ‘person centred care’, this philosophy is congruent with nurses’ professional philosophy and with the expectations of health care consumers. Person centred care has many stated benefits including satisfaction with care; shorter hospital stays and increased compliance with interventions. However many health care organisations and professionals find it difficult to wholly implement in practice.
This is particularly true in acute care settings where increasing acuity, technically complex care and shorter admission times pose significant challenges.
This critical ethnography presents the culture of nursing within an acute surgical ward in a regional hospital in Queensland with a specific focus on the impact this culture has on nurses’ ability to provide person centred care. Founded in critical theory and interested in manifestations of power and hegemonic structures, data were gathered using participant observation over a five month period, participant interviews and examination of clinical documents in order to describe the culture of care in this setting. In doing so it presents a broad understanding of what these nurses know, what they do and what they value. The critical perspective examines the social and political forces that shape this culture and nurses’ beliefs about themselves and their nursing practice.
This work acknowledges that power differentials and oppression operate at all levels of human interaction and influence whose voice is heard and whose is silenced (Hardcastle et al., 2005). This research was particularly interested in the ways that hierarchies of power in health care generally, and in this workplace specifically, might constrain nurses’
ability to plan and deliver nursing care according to their personal values and professional mandate and patient expectations. The intent was to reveal those oppressive organisational structures that might hinder the delivery of person centred care (Stewart, Holmes, & Usher, 2012). By revealing these dominant ideologies, nurses are free to question many of the assumptions on which nursing practice is based and perhaps generate new ideas for practice (DeForge, van Wyk, & Salmoni, 2011).
Findings demonstrate a tension existed between the person centred care nurses espoused and the task focused care they actually delivered. The perceived organisational emphasis on efficiency, cost effectiveness and the demand for measurable targets meant that the emotional and psychosocial aspects of nursing were marginalised and completing tasks became the main focus of nurses’ work. Additionally a traditional hierarchical nurse-doctor relationship meant that bedside nurses were excluded from interdisciplinary clinical decision making and doctors orders were the main way that nurses prioritised their work. This was reinforced through the communication processes and left nurses without timely information to deliver person centred care. Individual nurses had little autonomy over their work leaving them devoid of personal and professional satisfaction; needs that were met through ‘the team’ culture. Nurses cared for and about the team and keeping the team happy became nurses’ raison d’etre. Ironically ‘the team’ functioned to keep nurses efficient in their completion of tasks thereby maintaining the status quo.
This research confirms some of what is already known about the impact of workplace culture on nursing care and extends these findings to reveal how nurses are complicit in their subordination. It details how communication structures and competing priorities left nurses uninformed and unable to deliver the care they want leading to significant moral distress. In revealing dominant ideologies, barriers and facilitators to person centred care were revealed that may help move nurses toward empowered practice in the implementation of person centred care.
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(9778766), Helen Baker. "Nurses, medications and medication error: An ethnomethodological study." Thesis, 1994. https://figshare.com/articles/thesis/Nurses_medications_and_medication_error_An_ethnomethodological_study/13426118.
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Project attempts to view the administration of medication from the perspective of the clinical nurses who carry it out, in the expectation that understanding will be found in the ordinary, every-day, common-sense world of nursing practice in an acute care setting.. This thesis documents an examination of the routine administration or medications by nurses in acute care settings, a process which is normally governed by detailed institutional rules. Previous research into medication error made by nurses has produced no satisfactory results in terms of understanding how the errors occur, the ways in which errors are reported or in suggesting ways in which errors may be reduced. Ethnomethodology, a methodology which allows access to the every-day world of nursing was selected so that the common-place, taken-for-granted ways in which nurses make sense of their work was examined. This approach reveals both the activities o fnurses as they go about their regular work and the tacitly held knowledge which informs their practice. As background to the study, the policies and procedures developed for the administration of medications by nurses are described through an analysis of relevant published texts and other unpublished administrative documents.The ways in which nurses work within those policies and protocols has been explicated by the use of participant observation techniques in patient care areas, as well as by formal and informal interviews of nurses holding both clinical and administrative positions. The documentary method of Garfinkel (1968) was used to interpret the data. In this method there is a constant movement between particular incidents and general knowledge of the situation; the particular is incorporated into the general and is then used as part of the background for the analysis of further particular incidents and ideas. The interpretations were validated by returning them to the participants and asking them (and other nurses who had not been involved in the original data gathering) Is this the way it is? Both participants and others agree that the practices recorded in this study are indeed those used in nursing work in the setting of this project. The results of the analysis reveal that nurses engage in tactics: that is they take the given institutional policies and rules (the strategy) and turn them to ends (the tactics) that benefit themselves. The tactics employed by nurses may be categorised as: 1) situated and embodied logics: activities and ways of thinking which are developed to reach particular goals in practical situations; 2) redefinition of error: nurses find procedures laid down by the institution almost impossible to follow in practice. In order not to be seen to be continually making errors, they have redefined error. There is not single redefinition, but rather a set of criteria by which incidents are judged to be either error or not error. 3) A further set of tactics result in the mainten-ance of nurses' position in the social structures within which they live and work. The results of this study have implications for the definition of error in the administration of medication, for real and reported error rates and for measures to reduce and correct medication error, as well as the movement of the discipline of nursing toward the status of a profession. The study also demonstrates the effectiveness of ethnomethodology for revealing the tacitly held knowledge of nurses and the ways in which this informs practice in the real world.
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(9796415), Tracy Flenady. "Understanding transgression in respiratory rate observation collection methods in the Emergency Department: A classic grounded theory analysis." Thesis, 2018. https://figshare.com/articles/thesis/Understanding_transgression_in_respiratory_rate_observation_collection_methods_in_the_Emergency_Department_A_classic_grounded_theory_analysis/13445705.
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Abnormal respiratory rates are one of the first indicators of clinical deterioration in emergency department patients. Despite the importance of respiratory rate observations, this vital sign is often missing or misrepresented on emergency department observation charts, compromising patient safety. Concurrently, there is a paucity of research reporting why this phenomenon occurs.
This research project employed a classic grounded theory analysis of qualitative data with the aim of developing a substantive theory explaining emergency department registered nurses’ reasoning when they miss or misreport respiratory rate observations. Seventy nine registered nurses currently working in emergency departments within Australia provided detailed responses from individual interviews and open ended responses from an online questionnaire.
Classic grounded theory research methods were utilised, therefore coding was central to the abstraction of data and its reintegration as theory. The three types of constant comparison synonymous with classic grounded theory methods were employed to code data. This overall approach facilitated the identification of the main concern of the participants from the substantive area of interest, and aided in the generation of theory explaining how the participants processed this issue.
The main concern identified was that registered nurses did not want to perform respiratory rate observations at each round, however organizational requirements dictate a value for the respiratory rate be included each time vital signs are collected. The theory ‘Rationalising Transgression’, explains how the participants continually resolve this problem. The study found that despite feeling professionally conflicted, nurses often erroneously record respiratory rate observations, and then rationalise this behaviour by employing several strategies that adjust the significance of the organisational requirement. These strategies include compensating, when nurses believe they are compensating for errant behaviour by adding value to the patient’s outcome. Minimalizing is employed when nurses believe that the patient’s outcome would be no different if they performed and recorded an accurate respiratory rate or not. The Trivialising strategy sanctions negligent behaviour and occurs when nurses ‘cut corners’ to get the job done.
This research reveals that despite years of continuing education regarding best practice guidelines for respiratory rate collection, suboptimal practice continues. Ideally, to combat this transgression, a culture shift must occur regarding nurses’ understanding of acceptable practice methods in regards to patient safety. Nurses must receive education in a way that permeates their understanding of the relationship between the regular collection of accurate respiratory rate observations and optimal patient outcomes.
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Gibson, Maria. "Dangerous liaisons : enterprise rationality, nursing practice and the regulation of hospital care to older people." 2010. http://arrow.unisa.edu.au:8081/1959.8/97568.
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Population ageing has been posed as a problem for contemporary governing in relation to the allocation and consumption of finite health care resources, in particular acute hospital care. This thesis explores how nursing practice is a key resource in the management of this ???problem???. Employing Foucault???s concept of governmentality, nursing practice is examined as a form of social government that is central to the regulation of hospital care to older people. A governmentality approach enables consideration of the relationship between the macro political context of governing, as embodied in prevailing political rationalities, and their outworking beyond the arenas of formal government in the micro practices of nurses. Specifically, in this research, it reveals how contemporary entrepreneurial rationalities of governing work at a distance to discursively shape the local practices of nurses in the regulation of hospital care to older people. Discourse analysis of interview texts, literature and documents revealed how enterprise rationality was invested in the discourses circulating in the study site, highlighting the power relationships and subject positions available to registered nurses and outcomes produced in the regulation of hospital care to older people. The analysis details how registered nurses activated a range of technologies and practices as they engaged with enterprise discourses, constituting nursing practice as an activity aimed at making up older people as dischargeable subjects. It shows how enterprise is both a practice and way of thinking that directs us toward a particular truth of hospital, hence nursing, care of older people. The thesis illustrates how changes in the ways of governing hospitals have actively transformed the meaning and practice of nursing in the provision of hospital care to older people. It shows how the values and practices that make entrepreneurial modes of government possible penetrate each layer of an organisation and can create new mentalities or ways of thinking. This was evident in this research whereby an entrepreneurial mode of governance had re-imagined the social practice of nursing as a form of the economic, such that neither recovery, nor health, but discharge assumed pre-eminence as the focus and aim of hospital care for older people and hence the goal of nursing practice. These findings suggest that hospital care of older people has become a political and economic, rather than therapeutic concern. Furthermore, nursing interventions in the hospital care of older people have become administrative rather than therapeutic, with nursing practice focused on individual older people only insofar as they are constituted as part of a population at risk of delayed discharge. The thesis contends that nurses are implicated in the politics of health care in new and different ways amid entrepreneurial rationalities of governing that promote an ethos of risk management, individualism and responsibilisation in relation to health. It argues that the replacement of an ethos of nursing as care based on client need with an ethos of nursing as risk management substitutes the therapeutic intent and practices of nursing with the technical intent of managing risk. In so doing, the thesis illustrates dangers and possibilities arising from the re-framing of health care through entrepreneurial modes of governance. It enables a critically informed consideration of what kind of practice acute care nursing could be into the future and how nurses and others can take action to positively contribute to the futures of older people they provide care to.Thesis (PhD)--University of South Australia, 2010
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(11389736), Gina Richards. "Nurse leaders' perceptions of registered nurse professionalism: A narrative inquiry." Thesis, 2020. https://figshare.com/articles/thesis/Nurse_leaders_perceptions_of_registered_nurse_professionalism_A_narrative_inquiry/16911406.
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Aim: The aim of this study was to explore nurse leaders’ perceptions of registered nurse professionalism; expand knowledge related to registered nurse professionalism, and to identify the essential attributes of registered nurse professionalism.
Background: Despite the general consensus by members of the public and the healthcare professions that professionalism is essential, a clear understanding of what constitutes professionalism is lacking. Most research studies aim to measure professionalism, with a paucity of research providing clear guidance on how to demonstrate the professional behaviours deemed essential by regulatory authorities and the public.
Research design: In this study, narrative inquiry was used to examine professionalism as a fresh and innovative approach in the research of this topic. Through storytelling, nurse leaders voiced their perceptions of the professionalism of the registered nurse in the clinical setting. Through the iterative process of the telling and the retelling of the narratives, the nurse leaders’ voices were allowed to be heard.
Data collection and analysis:
Twelve nurse leaders were interviewed from the metropolitan healthcare setting in Perth, Western Australia. Data collection consisted of semi-structured interviews, analytical memos and field notes. Focus group interviews were used to verify themes related to the professional attributes of registered nurses in the clinical setting and the influence on these attributes. The two-step approach of Miles et al. (2014) to qualitative data analysis was undertaken.
Findings: Four attributes of registered nurse professionalism were identified – respect, professional presence, accountability and collegiality. The influences which impacted on the demonstration of professionalism by the registered nurse were identified as a stable work environment. A professional framework was developed with these attributes and influences.
Conclusion: The professional framework developed provides a functional perspective of professionalism. This framework is significant because the attributes are observable and provide a clear and visible understanding of what it means to be a professional registered nurse.
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(9776972), Hanan Al-Shamaly. "The nature of caring by nurses in an intensive care unit (ICU): A focused ethnography." Thesis, 2018. https://figshare.com/articles/thesis/The_nature_of_caring_by_nurses_in_an_intensive_care_unit_ICU_A_focused_ethnography/13447982.
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As a concept, caring is inextricably intertwined with nursing. There is a plethora of literature devoted to the concept of caring, but it is nebulous and complex. Numerous theoretical and operational perspectives of caring within the context of nursing have emerged over time. The ongoing dialogue and debate about what constitutes caring within the ever-expanding domains of nursing practice are nowhere more evident than in the specialisation of the adult intensive care unit (ICU), where humanistic caring is juxtaposed with advanced technology.
The aim of this study was to explore the nature of caring in an adult ICU. The methodological framework underpinning this study was a focused ethnography undertaken in an adult intensive care setting in one of the private hospitals in Queensland, Australia. Purposive sampling was used to invite 35 registered nurses (RNs) to participate in this study. Multiple types of data were collected over a six-month period: socio-demographics, participant observations (1,632 hours), field notes, document reviews, formal interviews (n = 79), informal conversations (n = 16) and participants’ additional notes (n = 26).
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(9874655), L. Jamieson. "Exploration of a potential advanced nursing practice role for adult critical care settings." Thesis, 2000. https://figshare.com/articles/thesis/Exploration_of_a_potential_advanced_nursing_practice_role_for_adult_critical_care_settings/13424189.
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(9875192), S. Crane. "Participatory action research : nurses and elderly people." Thesis, 1997. https://figshare.com/articles/thesis/Participatory_action_research_nurses_and_elderly_people/13425266.
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Project "theorises the engagement in an educational participatory action research project from the localised site of a nursing home for elderly people in Victoria".. This thesis presents the theoretical and practical development of a participatory action research project from the perspective of a localised site of action, a nursing home. The research design is inductively developed by participating staff of the nursing home, both nurses and non-nurses; the design and the range of participation are both unusual features of a nursing action research project in comparison with those conducted internationally to date. The role of the 'outsider' researcher, a nursing academic and a clinical nurse, was concurrently theorised and practically developed with the changing dynamics of this research project. A process of on-going theoretical and practical analysis of the research process and action in the nursing home was achieved through the use of 'critical incidents'. 'Critical incidents' arising during this participatory action research project have been theorised through a Foucauldian view of the history of institutions and the nature of modern power (Foucault, 1977). They gave rise to new understandings of the nature of nursing in a nursing home, and paid attention to issues of power, gender and ethics within this context. Social actions within the nursing home and the research process are explored, described and considered in the change process as being gendered in production. A focus on ethics, both of self ethics within the research process and of the development of situated, negotiated ethics in relation to others' daily actions in the nursing home, is explored and theorised through some of the critical incidents. Examples of the fourteen critical incidents include the exploration of aromatherapy which formed a way of interrupting the dominant production of medical interests in social actions of the nursing home, and the challenge to new staffing and catering decisions which interrupted managerial interests. A theoretical shift in this participatory action research project, and this thesis, is to see that undertaking new action rather than reflection may be the first step in liberatory processes and that these involve altering the boundaries of self.
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Charette, Martin. "Compétences d’infirmiers nouvellement diplômés d’un programme de baccalauréat basé sur l’approche par compétences : une ethnographie ciblée d’un milieu de soins aigus." Thèse, 2018. http://hdl.handle.net/1866/21204.
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Kayser, John W. "Development and testing of a virtual nursing intervention to increase walking after a cardiac event : a randomized trial." Thèse, 2018. http://hdl.handle.net/1866/21814.
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VRZALOVÁ, Monika. "Role sestry ve screeningu deprese u seniorů." Master's thesis, 2016. http://www.nusl.cz/ntk/nusl-260905.
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The diploma thesis deals with problems of depression in older people. Mainly the work is focused on identifying and analyzing the role of nurses in screening for depression in older people in primary care, acute care, long-term care and home care. This thesis was focused on theoretical direction and was used the method of design and demonstration. In this thesis was set one main goals with five research questions. The main goal was to identify and analyze the role of nurses in screening for depression in the elderly. RQ 1: What is the role of the nurse in screening for depression in the elderly? RQ 2: What is the role of the nurse in the primary care in screening for depression in the elderly? RQ 3: What is the role of the nurse in screening for depression in hospitalized patients in acute care? RQ 4: What is the role of the nurse in screening for depression in seniors in long-term and home care? RQ 5: What rating scales and methods are used in screening for depression in the elderly? The thesis introduce the concept of depression. The following are specified the causes of and the important factors that affect depression in the elderly. It also deals the differences in the clinical symptomatology of depression in old age. It explains possibilities and various barriers in the diagnosis of depression. Another chapter introduces complete geriatric examination, diagnostic classification systems, possible screening methods and scales for detection of depression in the elderly population. It also deals methods of pharmacological and non-pharmacological treatment and its possible complications associated with older age. By reason of increased suicide rate caused by depressive disorder the issue of suicidal behavior in the elderly is introduced. The next chapter deals with the nursing process, which is used by nurses in practice. It consists of the evaluation of the patient's health condition, making nursing diagnosis, creating nursing plan and subsequent implementation and evaluation. The nursing process is also needy for providing quality care. The nursing process in the stage of nursing diagnosis, introduces possible nursing diagnosis for a patient suffering from depression, which are based on the latest classification. Finally is described the role of nurses in screening for depression in the elderly in different health facilities and their contribution to the timely evaluation of depression in the elderly. This chapter introduces the role of nurses, nursing screening and collaboration with a physician. The role of nurses in screening for depression in different medical facilities is based on the first phase of the nursing process of assessment. On the basis of objective and subjective information, the nurse will assess the overall health and mental condition of the patient. Primarily, it was investigated what is the role of the nurse in screening for depression. On the basis of content analysis and synthesis it was necessary to used and processed domestic and foreign literature. A number of relevant sources are the results of various studies and Meta-analyzes, mostly from abroad, but also from the Czech Republic. The thesis can serve as a basis for nurses. The result of this thesis is to create e-learning material available for students in the Faculty of Health and Social Sciences of South Bohemia in Ceske Budejovice in the tutorial called Moodle.