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Fisher, Joyce Ann. "Critical thinking in critical care nurses." Virtual Press, 1996. http://liblink.bsu.edu/uhtbin/catkey/1036181.
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Critical care nurses need finely honed critical thinking skills in order to be safe, competent, and skillful practitioners of their profession. If clinical nurses do not learn how to reason effectively, they may make inappropriate decisions about their patients' care, ultimately resulting in increased patient mortality (Fonteyn, 1991). In addition, increasing nurses' decision-making and autonomy has been shown to improve job satisfaction and retention (Prescott, 1986).There are many authors who write about the need for developing critical thinking skills among practicing professional nurses (Creighton, 1984; Jenkins, 1985; Levenstein, 1981, 1983, 1984). However, research assessing the impact of continued education and clinical experience on the development of critical thinking skills is sparse.The purpose of this exploratory study is to determine if there is a relationship between the level of critical thinking skills (as measured by the Watson-Glaser Critical Thinking Appraisal Tool, 1980) in critical care nurses and the length of nursing experience, amount of continuing education pursued annually, and the level of formal nursing education completed. The conceptual framework that provides the basis for this study is Patricia Benner's (1984) application of the Dreyfus Model of Skill Acquisition to clinical nursing practice.Participants (N = 61) were obtained on a voluntary basis from the population of critical care nurses working in the intensive Care Unit, Coronary Care Unit, Cardiac Catheterization Laboratory, or Emergency Care Center of a 600 bed midwestern acute care facility. Each participant in the study was asked to sign an informed consent agreeing to participate after receiving a written and oral explanation of the study. Confidentiality of the participants was maintained by substituting identification numbers for the subjects' names on the data collection instruments. The investigator supervised the administration of the critical thinking instrument and demographic questionnaire.The Pearson product-moment correlation coefficient and a two-tailed t-test for independent samples were used to determine if there were any significant relationships between the WGCTA score and the length of critical care experience, attendance of continuing education programs, or completion of additional formal education. This data analysis supported hypothesis one with the results revealing a significant positive correlation (r = .46, p = <.001) between the WGCTA scores and the length of critical care experience. In addition, a statistically significant but weak positive correlation was found between the WGCTA scores and the length of experience in CCU (r = .52, p = .001). No significant correlation existed between the WGCTA scores and length of experience in ECC, ICU, or CCL. Hypothesis two was supported with a significant difference (t = 3.58, df = 59, p = .001) found between the critical thinking ability of the two groups, with those who have completed an additional formal program of nursing education scoring higher. A significant but weak positive correlation (r = .30, p =.020) was found between the number of continuing education programs attended annually and the WGCTA scores. Multiple regression was performed with the total WGCTA score being the dependent variable and total critical care experience, completion of additional formal education, and attendance of continuing education programs being the independent variables. Only total critical care experience entered the equation (E = 16.03, p = <.001) explaining 21% of the variance.The information gained from this study will provide direction for the review of existing orientation, continuing education, and staff development programs provided at different levels of nursing experience and make suggestions for change to enhance critical thinking skill development.School of Nursing
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Christensen, Martin. "Advancing practice in critical care nursing." Thesis, Bournemouth University, 2008. http://eprints.bournemouth.ac.uk/15988/.
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This thesis presents a body of publications in the area of critical care nursing, for the consideration of the award Doctor of Philosophy by publication. The publications and their dissemination herein contribute to a new and original body of knowledge within critical care nursing practice. This thesis aims to demonstrate how an original contribution to the advancement of critical care practice has developed through an on-going integration of academic and practice work and has led to the development of a model for advancing practice. Based on the know-that and know-how framework of advanced knowledge, consideration is given how this approach could be better developed to incorporate other dimensions attributed to experiential learning, namely pattern recognition and an exemplar of the knowing-how knowing-that framework is offered. However, it emerged that there are problems with advancing practice because it is considered the work of the advanced practitioner, yet it is contended that there needs to be a process which allows individuals to advance their own practice. Therefore, it was necessary to develop a working definition of advancing practice not only to map professional advancement of critical care nursing practice and how published works illustrate this, but to offer model of knowledge integration based around theoretical, practical, reflective and reflexive practice and supervisory support to enable individual practitioners the framework to advance practice. This thesis is presented in three chapters: Introduction, Body of Work and The Way Forward. In the first chapter, an overview of the origins and trends of advanced nursing practice and the emergence of advancing nursing practice in critical care. The purpose of this first section, however, is not to engage in the politico-professional debate on the meaning of advanced practice, because this is well developed within the literature, but is to set the scene in the context of published work. By using a narrative approach as a journey of personal discovery, a description of how published works illustrate progress in this respect and show the advancing of critical care practice.The second chapter not only comprises publications with regard to critical care nursing practice but also presents a detailed critique of these publications and their contribution to advancing critical care nursing practice and knowledge. Moreover this discussion identifies three themes which are further developed into the classification of knowledge attributable to advancing practice. In the concluding chapter, recommendations for the way forward are discussed with the development of a critical care nursing knowledge integration model. An exemplar of the model demonstrates that advancing practice in critical care is a continual process of development, analysis and practice that advances the knowledge and skill of critical care nursing. More importantly, it is the integration of all these facets that allows for the growth of the individual to become an advanced practitioner. In summary, this thesis represents a portfolio of work that makes an original contribution to critical care nursing knowledge. The product of this thesis is the development of a knowledge integration model as the basis for advancing practice:"
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Hendricks, Lucia Elizabeth. "Critical thinking : perspectives and experiences of critical care nurses." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/71821.
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Thesis (MCurr)--Stellenbosch University, 2012.ENGLISH ABSTRACT: The increasingly complex role of the critical care nurse in an intensive care environment demands a much higher level of critical thinking and clinical judgment skill than ever before. Critical thinking in nursing practice may be defined as the cognitive ability to analyse, predict and transform knowledge, ensuring quality nursing care. To reason from a nurse’s perspective requires that we learn the content of nursing; this includes the concepts, ideas and theories of nursing. The aim and objectives of the study were to explore critical care nurses’ perspectives and experiences with regards to the concept of critical thinking, facets influencing the application of critical thinking skills in clinical practice and how these impact on the delivery of quality nursing care. A qualitative approach, using a case study design was utilised. A sample of six participants, who met the study inclusion criteria and consented to participate, were interviewed individually. Subsequently, five of these six participants took part in a focus group discussion to capture additional data to clarify and enrich the individual interview data. A field worker was present during the interviewing processes to note non-verbal data and later verify transcribed data. Feasibility of the proposed study was established by conducting a pretest which elicited relevant information. Ethical approval for the study was obtained from the Health Research Ethics Committee at the Faculty of Medicine and Health Sciences, Stellenbosch University. Permission and consent was obtained from the relevant hospital group to interview nurses working in the intensive care units. Qualitative content analysis, which focuses on the content or contextual meaning, was used to analyse interview data. Coding of the data through emergent themes and sub-themes was done by the researcher and supported through independent coding to verify and strengthen the analysis and interpretation of the researcher. . The results depicted how the participants personally understood the concept of critical thinking and the components influencing the application of critical thinking skill in clinical practice. The study of the participants’ perspective of the concept of critical thinking and portrayed how they experience analytical and independent thinking, competence and confidence, as well as knowledge, skill and expertise, to influence the quality of patient care. The data revealed several themes that facilitated critical thinking in critical care nurses. These themes were ‘team support’, ‘experience and exposure’ and ‘empowering the mind’. Emergent themes elaborating the limitations of critical thinking included ‘being stressed’, ‘professional boundaries’ and ‘being busy’. Several recommendations and suggestions for future research were offered.
AFRIKAANSE OPSOMMING: Die toenemende komplekse rol van die kritieke-sorgverpleegster in ’n intensiewe-sorg omgewing verg ’n veel hoër vlak van kritiese denke en ’n kliniese oordeelvaardigheid as ooit tevore. Kritiese denke in ’n verplegingspraktyk kan gedefinieer word as die kognitiewe vermoë om te kan analiseer, om vooruit situasies te kan bepaal en die vermoë om kennis te omskep sodat kwaliteit verpleegsorg verseker kan word. Om soos ’n verpleegster te kan dink, stipuleer dat die inhoud van verpleging geleer moet word wat konsepte, idees en teorieë daarvan insluit. Die doel en oogmerke van die studie is om die ervarings en perspektiewe van kritieke-sorgverpleegsters te ondersoek, met betrekking tot die konsep van kritiese denke, fasette wat die toepassing van kritiese denkvaardighede in ’n kliniese praktyk beïnvloed en die impak daarvan op die lewering van kwaliteit verpleegsorg. Die metodologie wat toegepas is, is ’n kwalitatiewe benadering deur middel van ’n gevalle-studie ontwerp. ’n Steekproefgrootte van ses deelnemers wat aan die inklusiewe kriteria voldoen het, is mee onderhoude individueel gevoer en daarna is met vyf van hierdie ses deelnemers in ’n fokusgroep onderhoude gevoer ten einde data op te neem wat andersins verlore kon geraak het. ’n Veldwerker was teenwoordig gedurende die proses van onderhoudvoering om die opgeneemde en getranskribeerde data te verifieer. Die data-insamelingsinstrument is in die vorm van ’n onderhoudsgids ontwikkel om die navorser gedurende die onderhoudvoering te help. ’n Loodsondersoek is uitgevoer om die haalbaarheid van die voorgestelde studie te ondersoek en is sodoende geskep om relevante inligting te onthul. Etiese goedkeuring vir die studie is verkry van die Gesondheidsnavorsing Etiese Komitee aan die Fakulteit van Geneeskunde en Gesondheidswetenskappe, Universiteit Stellenbosch. Goedkeuring en toestemming is van die hospitaalgroep aan wie die hospitaal behoort verkry, waar die studie onderneem is om sodoende onderhoude te kan voer met verpleegsters wat in die intensiewe-sorgeenhede werk. ’n Primêre, kwalitatiewe inhouds analise is gebruik om omderhoud data te analiseer wat fokus op die inhoud of kontekstuele betekenis daarvan. Kodering van die data deur die toepassing van die temas en sub-temas wat voorgekom het, is deur die navorser gedoen. Die data is onafhanklik gekodeer om die analise en interpretasie van die navorser te verifieer en te bekragtig ten einde die akkuraatheid en getrouheid in die formulering van die betekenis en interpretasie van gebeure met juiste weergawe daarvan, te verseker. Die resultate wat as hooftemas vanuit die individuele onderhoude voortgespruit het, asook die van die fokusgroep het die deelnemers se eie begrip van die konsep van kritiese denke en komponente wat die toepassing van kritiese denkvaardigheid in ’n kliniese praktyk beïnvloed, getoon. Die konsep van kritiese denke het die wyse waarop analitiese en onafhankilke denke, bevoegdheid en selfvertroue, asook kennis, vaardigheid en kundigheid die kwaliteit van pasiëntsorg beïnvloed, uitgebeeld. Die voortkomende data het daartoe aanleiding gegee dat die faktore wat die fasilitering en beperking van kritiese denke beïnvloed, bespreek kon word. Data rakende fasilitering het getoon hoedat die ondersteuning van die span, ervaring, blootstelling en die verruiming van die gees, kritieke-sorgverpleegsters positief kan beïnvloed om kritiese denke in hulle daaglikse verplegingsaktiwiteite effektief te kan toepas. Data wat verband hou met beperkings het getoon hoedat stres, professionele kwessies en besigwees kritieke-sorgverpleegsters negatief kan beïnvloed in die toepassing van kritiese denke gedurende daaglikse verplegingsaktiwiteite. Verskeie aanbevelings vir toekomstige navorsing is voorgestel.
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Chang, Catherina Ivette. "Relationship between personality hardiness and critical care nurses' perception of stress and coping in the critical care environment." FIU Digital Commons, 2000. http://digitalcommons.fiu.edu/etd/2107.
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The purpose of this study was to determine the relationship between critical care nurses' perception of stress, their ability to cope with stress, and the hardiness personality they possess while working in the critical care environment. A non-experimental, descriptive, correlational survey design was applied to a convenience sample of 50 registered nurses employed in the critical care units of a South Florida health care facility. The data collection methods included a demographic survey, the Perceived Stress Scale, the Health-Related Hardiness Scale, and the COPE inventory. The results of this study demonstrated that critical care nurses are able to cope effectively despite their perception of high levels of stress. This study also determined that critical care nurses uphold high personality hardiness characteristics. The demographic variables of gender, age, years of nursing experience, years at present job, and level of education also revealed statistical significance. Further research is recommended to identify the influence of other variables such as culture, work hours, and level of job satisfaction in the critical care nurses' coping with stress and hardiness personality. The identification of instruments that may be capable of measuring any relationships between those possible variables and the constructs of hardiness and coping in the domain of nursing are also advocated, particularly in the critical care nursing population.
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Moon, Mikyung. "Relationship of nursing diagnoses, nursing outcomes, and nursing interventions for patient care in intensive care units." Diss., University of Iowa, 2011. https://ir.uiowa.edu/etd/3356.
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The purpose of the study was to identify NANDA - I diagnoses, NOC outcomes, and NIC interventions used in nursing care plans for ICU patient care and determine the factors which influenced the change of the NOC outcome scores. This study was a retrospective and descriptive study using clinical data extracted from the electronic patient records of a large acute care hospital in the Midwest. Frequency analysis, one-way ANOVA analysis, and multinomial logistic regression analysis were used to analyze the data. A total of 578 ICU patient records between March 25, 2010 and May 31, 2010 were used for the analysis. Eighty - one NANDA - I diagnoses, 79 NOC outcomes, and 90 NIC interventions were identified in the nursing care plans. Acute Pain - Pain Level - Pain Management was the most frequently used NNN linkage. The examined differences in each ICU provide knowledge about care plan sets that may be useful. When the NIC interventions and NOC outcomes used in the actual ICU nursing care plans were compared with core interventions and outcomes for critical care nursing suggested by experts, the core lists could be expanded. Several factors contributing to the change in the five common NOC outcome scores were identified: the number of NANDA - I diagnoses, ICU length of stay, gender, and ICU type.
The results of this study provided valuable information for the knowledge development in ICU patient care. This study also demonstrated the usefulness of NANDA - I, NOC, and NIC used in nursing care plans of the EHR. The study shows that the use of these three terminologies encourages interoperability, and reuse of the data for quality improvement or effectiveness studies.
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Allen, Rose. "Addressing moral distress in critical care nurses." NSUWorks, 2015. https://nsuworks.nova.edu/hpd_con_stuetd/17.
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Currey, Judy A., and mikewood@deakin edu au. "Critical care nurses' haemodynamic decision making." Deakin University. School of Nursing, 2003. http://tux.lib.deakin.edu.au./adt-VDU/public/adt-VDU20050728.094123.
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For cardiac surgical patients, the immediate 2-hour recovery period is distinguished by potentially life-threatening haemodynamic instability. To ensure optimum patient outcomes, nurses of varying levels of experience must make rapid and accurate decisions in response to episodes of haemodynamic instability. Decision complexity, nurses characteristics, and environmental characteristics, have each been found to influence nurses' decision making in some form. However, the effect of the interplay between these influences on decision outcomes has not been investigated. The aim of the research reported in this thesis was to explore variability in critical care nurses' haemodynamic decision making as a function of interplay between haemodynamic decision complexity, nurses' experience, and specific environmental characteristics by applying a naturalistic decision making design.
Thirty-eight nurses were observed recovering patients in the immediate 2-hour period after cardiac surgery. A follow-up semi-structured interview was conducted. A naturalistic decision making approach was used. An organising framework for the goals of therapy related to maintaining haemodynamic stability after cardiac surgery was developed to assist the observation and analysis of practice. The three goals of therapy were the optimisation of cardiovascular performance, the promotion of haemostasia, and the reestablishment of normothermia. The research was conducted in two phases. Phase One explored issues related to observation as method, and identified emergent themes. Phase Two incorporated findings of Phase 1, investigating the variability in nurses' haemodynamic decision making in relation to the three goals of therapy.
The findings showed that patients had a high acuity after cardiac surgery and suffered numerous episodes of haemodynamic instability during the immediate 2-hour recovery period. The quality of nurses' decision making in relation to the three goals of therapy was influenced by the experience of the nurse and social interactions with colleagues. Experienced nurses demonstrated decision making that reflected the ability to recognise subtle changes in haemodynamic cues, integrate complex combinations of cues, and respond rapidly to instability. The quality of inexperienced nurses' decision making varied according to the level and form of decision support as well as the
complexity of the task. When assistance was provided by nursing colleagues during the reception and recovery of patients, the characteristics of team decision making were observed. Team decision making in this context was categorised as either integrated or non integrated. Team decision making influenced nurses' emotions and actions and decision making practices. Findings revealed nurses' experience affected interactions with other team members and their perceptions of assuming responsibility for complex patients.
Interplay between decision complexity, nurses' experience, and the environment in which decisions were made influenced the quality of nurses' decision making and created an environment of team decision making, which, in turn, influenced nurses' emotional responses and practice outcomes. The observed variability in haemodynamic decision making has implications for nurse education, nursing practice, and system processes regarding patient allocation and clinical supervision.
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Kaddoura, Mahmoud. "New graduate nurses' perception of critical thinking development in critical care nursing training programs /." Access online resource, 2009. http://scholar.simmons.edu/bitstream/handle/10090/9655/Mahmoud%20Dissertation%207%20%20JULY.pdf?sequence=1.
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Comeau, Odette. "Delirium Screening in Adult Critical Care Patients." ScholarWorks, 2016. http://scholarworks.waldenu.edu/dissertations/1675.
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Delirium is an acute change in cognition accompanied by inattention, which affects up to 88% of adult critical care patients. Delirium causes increased hospital complications, longer lengths of hospital stay, functional disability, cognitive impairment, and increased mortality. The purpose of this evidence-based quality-improvement project was to implement and evaluate a delirium screening process in adult intensive care units at a large medical center. This included education of nurses, implementation of a structured, validated tool, and review of tool use documentation. The implementation of this project was guided by an evidence-based practice model, Disciplined Clinical Inquiry© and Lewin's change theory. Evaluation of this quality-improvement project used audits of the electronic medical record. The audits included the presence and accuracy of delirium screening documentation in the patients' medical records. Results of 3 sequential documentation audits revealed a gradual adoption of this practice change by nurse clinicians. The percentage of charts with missing, incomplete, or inaccurate data decreased from 50% on the first week to 27.9% and 25.0% on the 2nd and 3rd weeks, respectively. These findings were an indication of practice change by validating the requirement for delirium screening on the units. In the first 3 weeks alone, 17 patient audits were positive for delirium, indicating the potential for poor short-term and long-term patient outcomes if not addressed promptly. Implementation of delirium screening ensures the dignity and worth of adult critical care patients by decreasing the poor outcomes associated with the diagnosis, which is an important contribution to positive social change.
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Ferrel, Cynthia Lynn. "The experience of critical care nurses in initiating hospice care." abstract and full text PDF (free order & download UNR users only), 2008. http://0-gateway.proquest.com.innopac.library.unr.edu/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:1453534.
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Perry, Mary Barbara. "Critical care nurses' perceptions of their experience with nursing quality assurance." Thesis, University of British Columbia, 1990. http://hdl.handle.net/2429/28795.
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The purpose of this study was to describe critical care nurses' perceptions of their experiences with nursing quality assurance activities. Using an exploratory, descriptive design, data were collected in a survey, utilizing a self-administered questionnaire. A convenience sample of critical care nurses, who are members of the Canadian Association of Critical Care Nurses, was used. The results showed that these particular nurses knew what comprised the components of a nursing quality assurance program, however, their participation in these activities was low. In addition, the majority identified that the primary purpose of nursing quality assurance activities was to meet the accreditation requirements of the hospital. Finally, the results also identified that all of this particular group of nurses felt that nursing quality assurance activities involved them, and the majority felt that these activities were part of their professional responsibilities.Applied Science, Faculty of
Nursing, School of
Graduate
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Fulbrook, P. "The nature of evidence to inform critical care nursing practice." Thesis, Bournemouth University, 2003. http://eprints.bournemouth.ac.uk/295/.
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This thesis presents a body of publications, in the area of critical care nursing, for consideration for the award of Doctor of Philosophy by Publication. The thesis is presented in three chapters: Introduction; Body of Work; and Research, Knowledge, Evidence and Practice. In the first chapter the emergence of evidence-based practice is described, in general. Initially, an overview of the origins and trends of nursing research methodology is provided; the purpose of which is to set in context the body of work. Utilising a narrative approach (Boje, 2001; McCance et aL, 2001; Sandelowski, 199 1; Vezeau, 1994) as a 'personal journal of discovery' I then reflexively describe my own development as a nurse researcher practitioner, drawing on my own publications to illustrate my progress, the development of my thinking, my research practice and the development of my understanding of pragmatice pistemology. The second chapter is comprised of my publications relevant to critical care nursing. Spanning a period of eleven years, they represent my contribution to critical care nursing knowledge. In the concluding chapter I have summarised initially my own contribution to critical care nursing knowledge, before moving on to a more detailed critique of evidence-based practice. Finally I have made recommendations for the way forward. In addition to presenting my body of work, the aim of this PhD is to challenget he current concept of evidence-based practice, arguing that its definition is too narrow to encompass the rage of different types of knowledge that nurses use when caring for critically ill patients. I have utilised my own publications, to demonstrate how a variety of approaches are necessary to provide the best evidence for developing practice. I have positioned my argument within a theoretical understanding of pragmatic epistemology. In this way, I am working towards the development of a science of practice. Simultaneously I am also, to some extent, challenging conventional concepts of what constitutes doctoral level knowledge and how a PhD looks. My conclusion is that critical care nursing knowledge is drawn from many sources, and should be applied in an integrated way that enables practitioners to make a positive difference to the life of patients.Knowledge that is not or cannot be applied to practice is therefore of no value. The valuing of practice knowledge brings with it the requirement that all forms of knowledge (and their relevant methodologies) are considered as equal,in terms of their potential to impact on practice and that nothing should be rejected on paradigmatic grounds. In contemporary healthcare evidence is hierarchically valued and this raises many questions of equity. Where the value of knowledge becomes unequal is when its application to practice is limited. The corollary of a pragmatice pistemology is that it requires a pragmatic process to make it work. For me, at this point in time, the best available is practice development. In summary,this thesis represents a construction of work that makes an original contribution to knowledge. The product of my thesis is a theory of pragmatic epistemology as the basis for a science of practice.
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Stevens, Brent Alan. "Improving the Quality of Electronic Documentation in Critical Care Nursing." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3636.
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Electronic nursing documentation systems can facilitate complete, accurate, timely documentation practices, but without effective policies and procedures in place, a gap in practice exists and quality of care may be impacted. This systematic review of literature examined current evidence regarding electronic nursing documentation quality. General systems theory and the Donabedian model of health care quality provided the framework for the project. Electronic databases PubMed and the Cumulative Index of Nursing and Allied Health were searched for articles addressing electronic nursing documentation practices. The Cochrane systematic review methodology was used to analyze the articles. Articles were excluded if published before 2001 or not in the English language. The search revealed 860 articles of which 35 were included in the final review. Most studies were quasi-experimental involving multiple interventions such as clinical decision support (CDSS), education, and audit and feedback specific documentation foci. The most reported outcomes were an improvement in documentation completeness and correctness. A multifaceted intervention strategy consisting of CDSS, education, and audit and feedback can be used to improve electronic documentation completeness and correctness. Policies and procedures regarding documentation practice should support the intended outcomes. Electronic documentation systems can improve completeness, but care should be taken not to depend on the quantity of documentation alone. Further research may shed light on the importance of concordance or plausibility, and the truth of documentation and ultimately how that can impact social determinates of health and social change.
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Odorisio, Cathy. "The relationship between critical care nurses' knowledge and attitude toward organ procurement /." Staten Island, N.Y. : [s.n.], 1991. http://library.wagner.edu/theses/nursing/1991/thesis_nur_1991_odori_relat.pdf.
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Singleton, Alsy R. "Patient satisfaction with nursing care : a comparison analysis of critical care and medical units." Virtual Press, 1997. http://liblink.bsu.edu/uhtbin/catkey/1061875.
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Patient satisfaction is an outcome of care that represents the patient's judgment on the quality of care. An important aspect of quality affecting patient's judgment can be attributed to patients' expectations and experiences regarding nursing care according to type of unit. The purpose of this study was to examine differences between patients' perceptions of satisfaction with nursing care in critical care units and medical units in one Midwestern hospital.The conceptual framework was "A Framework of Expectation" developed by Oberst in 1984, which asserted that patients have expectations of hospitals and health care professionals regarding satisfaction and dissatisfaction with care. The instrument used to measure patient satisfaction was Risser's Patient Satisfaction Scale, with three dimensions of patient satisfaction: (a) Technical-Professional, (b) Interpersonal-Educational, (c) Interpersonal-Trusting. The convenience sample included 99 patients50 from critical care units and 49 from medical wards. Participation was voluntary. The study design was comparative descriptive and data was analyzed using a t-test.The demographic data showed that the majority of patients had five or more admission. About one-third of the patients were 45-55, 56-65, 66-75, respectively. Findings related to the research questions were that: (a) 84 percent of the respondents rated overall satisfaction in the satisfactory to excellent range, (b) results of a t-test showed significant differences in overall patient satisfaction with patients being more satisfied with care in critical care units. Significant differences were found in three subscales with critical care being more satisfied. No relationship was found between patient satisfaction and age/and/or type of unit.Conclusions were that in both medical and critical care units patients were more satisfied with Technical-Professional and Interpersonal-Trusting than with Interpersonal-Educational. Also noted was that patients in the units where nurse-to-patient ratio was higher participants perceived that nurses had more time, energy and ability to meet patient expectation. Implications call for analysis of nurse/patient ratio in relation to patient satisfaction and nurses in relation to patient education as well as patient's perceptions of getting their needs met.School of Nursing
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Westbrook, Linda Oakes. "Cognitive structures of first-line nurse managers in critical care settings /." Thesis, Connect to this title online; UW restricted, 1994. http://hdl.handle.net/1773/7299.
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Patton, Lauren Ashley. "Education and Standardized Discussion Guides to EnhanceNurses' Spiritual Care Practices in the Medical Intensive Care Unit." Case Western Reserve University Doctor of Nursing Practice / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=casednp1519836081431734.
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Greaves, Judith M. "Understanding palliative care: An ethnographic study of three Australian palliative care services." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2005. https://ro.ecu.edu.au/theses/1553.
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Palliative care commenced in Australia in the early 1980s. Although the value of palliative care has become more widely recognised by the public and other health care professionals, there is still a lack of understanding about what palliative care is and the depth and scope of this specialty area of health care. The research that I present in this thesis is based on examination of palliative care practice in a selection of Australian services, undertaken with the aim of enhancing understanding of Palliative Care. The significance of the research arises from the notion that members of the Australian community should be well informed about health care options available to them. Understanding palliative care and the ability to differentiate palliative care from other end-of-life care is important if people are to make informed decisions about supporting, accessing, and using services appropriate to their needs. An interpretive ethnographic study from a symbolic interactionist perspective was undertaken in three palliative care services, one in each of the major Australian cities of Sydney. Melbourne, and Perth. Each palliative care service had been established for at least ten years, and was part of a larger health care facility. A fourth service, a purpose-built three-year-old unit, was added during the course of the research to provide contrast to the emerging analyses. As an experienced palliative care nurse, I assumed the role of marginal native as the primary research instrument. Data collection was by means of participant observation, formal and informal interviews, and examination of supplementary data sources, with two months spent in each of the three study sites. Interpretations made from ethnographic observation of these Australian palliative care services showed a diversity of practice, best understood within the context of the particular service. The major findings are presented under the headings of Politics, Place, People, and Practice of Palliative Care. Common approaches to provision of care were found in creating an appropriate physical environment for patients, with an underlying mission to "make the best of things." Patients cared for in the settings were a similar cohort of middle aged to elderly cancer patients. In general, staff shared expectations of appropriate types of patients and showed discomfort or lack of understanding in caring for non-cancer patients, or patients from non-Australian, non-Christian, and non-English speaking backgrounds. Practice diversity was highlighted by the range of technology used and variations in the availability of social activities for patients in the services. These two: areas in particular warrant further research to examine the outcomes associated with these variations, in terms of survival time, quality of life, and service costs.
These findings are particularly relevant at this time when the Australian Government is attempting to enhance access to palliative care. The diversity of practice uncovered in this study suggests that discussions and decisions about allocation of resources and development of services must take into consideration the various interpretations of palliative care services that may exist. The findings also reinforce the need for sound evidence-based studies to examine the impact of variations and the types of populations that might be best served by different types of palliative care support.
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Bennett, Paul Norman, and paul bennett@flinders edu au. "SATELLITE HAEMODIALYSIS NURSES PERCEPTIONS OF QUALITY NURSING CARE: A CRITICAL ETHNOGRAPHY." Flinders University. Nursing and Midwifery, 2009. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20090828.154836.
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People living with end stage kidney disease require dialysis or kidney transplantation to maintain life. Of those receiving dialysis in Australia, most people receive this treatment in satellite haemodialysis centres that are nurse-run, community-based clinics. Nurses provide the majority of care in these clinics with little or no on-site medical support, yet there has been minimal research exploring nursing care, or perceptions of nurses, in the satellite haemodialysis context. The major aim of this study was to explore satellite dialysis nurses perceptions of quality care. Fundamental to this aim was the premise that to improve nursing care, nurses need to understand the factors influencing satellite dialysis nursing care.
A critical ethnography exploring the culture of one satellite haemodialysis clinic, focusing on the nurses perception of quality was undertaken, with a focus on issues of power that influenced satellite dialysis nursing care. Over a period of twelve months, interviews with nurses, non-participant observation and document analysis were conducted. Of particular concern was the satellite dialysis nurses struggle with the dominant medical discourse of quantitative measurement of quality. Bourdieus notions of habitus, field and practice provided a vehicle to explore nurses dispositions that operated within the institutional conditions of the medicalised discourse and physical structure of the satellite dialysis environment.
Findings about nurses perceptions of quality dialysis care were categorised into three broad themes: what is quality; what is not quality; and what affects quality. Nurses considered technical knowledge, technical skills and personal respect as characteristics of quality. Long-term blood pressure management and arranging transport for people receiving dialysis treatment were not seen to be quality priorities. The person receiving dialysis treatment, management, nurse and environment were considered major factors influencing and determining quality dialysis nursing care. Acceptance by nurses about their position and their reluctance to challenge medical power was revealed.
Aspects of power and oppression operated for nurses and people receiving dialysis treatment within the satellite dialysis context, and this environment was perceived by the nurses as very different from hospital dialysis units. Bourdieus notions of habitus and subconscious reproduced practices were embedded in the satellite dialysis nurses behaviour and were conveyed to other nurses. In order to improve nursing care in this context, ten recommendations were proposed: 1) implementing a concordance nursing care model; 2) using a goal-setting framework; 3) increasing staff rotation between dialysis units; 4) improving satellite dialysis unit design;
5) educating satellite dialysis nurses in internet and database skills; 6) using new technologies in staff education programmes; 7) recognising increased patient acuity; 8) research exploring residential dialysis facilities; 9) introducing advanced practice nurses in a satellite collaborative model of care; and 10) requiring a structured programme of reflective practice.
Facilitating change in dialysis nursing practice was fundamental to this study and consistent with a critical approach. New understandings for the nurses may not result in practice change however, unless there is a collective review and uptake of these practices. This study offers new knowledge about quality nursing in satellite haemodialysis units, enabling nurses to critically reflect on, and improve, the quality of care they provide.
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Whelan, Ruth N. "Factors influencing critical care nurses' participation level in continuing nursing education." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape9/PQDD_0015/MQ49464.pdf.
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Albarran, John W. "Taking Cardiovascular Critical Care Nursing Forward: A Journey of Systematic Inquiry." Thesis, University of the West of England, Bristol, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.505320.
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McLean, Christopher Duncan. "Thinking about patients and talking about persons in critical care nursing." Thesis, University of Southampton, 2012. https://eprints.soton.ac.uk/349086/.
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Nursing scholarship and healthcare policy set an expectation that nurses should think about patients as persons. Nevertheless, the literature reveals that critical care nurses can struggle to perceive patients as persons, and thus suggests they may think about patients in different ways. This thesis presents the findings of an ethnographic study undertaken within one critical care unit in the United Kingdom which examined how critical care nurses do think about patients. A purposive sampling strategy recruited 7 participants representing both experienced and inexperienced critical care nurses. Data were collected over a period of 8 months during 2006 to 2007, and primarily comprised the field notes from 92 hours of participant observation supplemented by 13 tape recorded interviews. Data analysis was influenced by Foucault and Goffman and adopted the perspective of linguistic ethnography. Analysis revealed that all participants thought about patients in seven distinct ways: as ‘social beings’, as ‘valued individuals’, as ‘routine work’, as a ‘set of needs’, as a ‘body’, as ‘(un)stable’ or as a ‘medical case’. Accounts of participants’ practice revealed that they had a tacit understanding that these different ways of thinking related to aspects of one coherent whole, but no one way of thinking could be characterised as thinking about this ‘whole person’. Nurses could only think about one aspect of the patient at a time. Nurses’ practice was not guided or explained by their thinking about patients as persons, but rather expert practice was characterised by nurses’ fluid and appropriate movement between different ways of thinking about patients. When participants talked about their practice it was evident that these nurses could only legitimately talk about themselves as giving care to persons. Participants characterised some of the ways in which they had to think about patients as impersonal, and this actively hindered these nurses from describing or reflecting upon elements of their practice. There is therefore conflict and dissonance between nurses’ expectation that they should think about patients as persons, and the fact that delivering nursing care requires them to think about patients in different ways. The development of future critical care nurses will require practitioners and educators to recognise that nurses think about patients in different ways, and that expert practice is characterised by the clinical wisdom which enables nurses to think about patients in ways which are appropriate to the moment. Nurse scholars and educationalists should therefore avoid claims to a unique professional knowledge base which suggest to nurses that some ways of thinking are always inappropriate or inherently reductionist. Instead, there is a need for scholars and policy makers to articulate a vision of person centred care clearly, and in ways which avoid constructing dissonance between nurses’ ideals, and the ways in which they do and must think about patients.
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Foley, Jo Anne. "Providing Optimal Nutrition in Critical Care." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2351.
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Malnutrition among hospitalized patients is prevalent and associated with adverse outcomes. At the health care facility for which this quality improvement (QI) initiative was developed, patients were not consistently fed within the nationally recommended 48 hours. The purpose of this project was to facilitate the early initiation of enteral feedings to prevent malnutrition in a vulnerable patient group by development of an evidence-based enteral feeding policy, algorithm, and nursing education module. The find, organize, clarify, understand, select, plan, do, check, and act model provided a systematic approach for development of the project. Validation of the QI initiative was through the use of Likert scale which was completed by 2 nurses and a head dietician. The content validity index average was 1.0 for the QI initiative products (policy, algorithm, educational module). Ten team members completed a summative evaluation of the educational module and presentation using a 7 item, Likert scale. Basic descriptive analyses were employed to analyze the data, revealing broad support for the module and the DNP student's leadership. A recommendation was made to conduct an audit using a formal software program to quantify the number of patients who were not being fed within the time frame of 48 hours. Implementing an evidence-based enteral feeding protocol can be a significant intervention that produces better patient outcomes.The implications for social change in this project relates to improvements within the critical care environment.
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Kroeger, Linda L. "Critical care nurses: their knowledge and experiences regarding the acutely confused elderly." Thesis, Boston University, 1988. https://hdl.handle.net/2144/38058.
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Thesis (M.S.)--Boston UniversityPLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.
The purpose of this descriptive study was to describe critical care nurses knowledge and experience regarding the acutely confused elderly. A questionnaire, developed by the investigator, was mailed to two hundred nurses who were members of the American Association of Critical Care Nurses (AACN). The questionnaire consisted of three parts; a case study and questions assessing the respondents' knowledge of acute confusion, questions about the respondents' past personal experiences with the elderly, and a section on demographics. The response rate was 45%. The essential findings were: 1) the mean score on the knowledge items was 60% correct 2) ICU nurses had limited personal experiences with confused elderly people 3) neither level of education nor years of nursing experience affected how well the respondents did on the knowledge items 4) ICU nurses tended to attribute the cause of acute confusion in an elderly patient to ICU psychosis. Further research needs to be done on the etiology and characteristics of acute confusion and on nursing actions and interventions concerning the acutely confused elderly patient. The concept of ICU psychosis needs to be further explored.
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Mansour, Mansour. "Critical care nurses' views on medication administration : an organizational perspective." Thesis, University of Nottingham, 2009. http://eprints.nottingham.ac.uk/11014/.
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The Organizational Safety Space Model (OSSM) was developed as a tool to investigate the factors which influence the safety of industrial operations. It is applied in this study to investigate the safety of medication administration in adult critical care settings, including Intensive Care Units and High Dependency Units. In this study, semi-structured interviews were conducted with 33 adult critical care nurses. The participants’ views on the safety of medication administration were analyzed using OSSM. The data suggested that the safety of medication administration is subject to complex influences of many organizational factors. Socio-cultural factors, including lack of questioning culture, the perceived hierarchy of professions and the nature of nursing education, were identified as influential safety factors. Furthermore, organizational complexity and structures created tension between organizational, ethical and structural priorities on one side, and the requirements of safe management of medication in critical care a setting on the other, inevitably leading to tradeoffs among these organizational priorities. Some organizational factors are difficult to classify according to the OSSM and the model is not fully operational in identifying factors related to the safety of medication administration. While the OSSM’ theoretical framework helped to focus on the underpinning safety factors in the organization of medication administration, it remains unproven as an operational tool to understand the full complexities and interplays between the organization structures, professional differences and socio-cultural impacts on the safety of medication administration in adult critical care setting.
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Swickard, Scott W. "Patient Safety Events During Critical Care Transport." Case Western Reserve University School of Graduate Studies / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=case1468431671.
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Willmore, Elizabeth Elouise. "Physician Behaviors, Nursing, and Other Obstacles in End-of-Life Care: Additional Critical Care Nurse Perceptions." BYU ScholarsArchive, 2020. https://scholarsarchive.byu.edu/etd/9061.
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Background: Critical Care Nurses (CCNs) frequently provide end of life (EOL) care in intensive care units (ICUs). Barriers to EOL care in ICUs exist and have been previously published, but qualitative reports from CCNs themselves remain scarce. Qualitative data exploring barriers faced during ICU EOL care may increase awareness of obstacles and help remove them. Objective: Excluding family experiences, what are the major themes recounted by CCNs when asked to share common obstacles experienced in providing ICU EOL care? Methods: Members of the American Association of Critical-Care Nurses were randomly surveyed and responses to a single qualitative question were used. Results: There were 104 participants who provided 146 responses reflecting EOL obstacles which were divided into 11 themes; 6 physician- related obstacles and 5 nursing-and-other related obstacles. Top three EOL ICU barrier themes were inadequate physician communication, physicians giving false hope and nursing-related obstacles. Conclusion: Poor physician communication is the main obstacle noted by CCNs during ICU EOL care followed by physicians giving false hope. Heavy patient workloads were also a major barrier in CCNs providing EOL care.
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Emmons, Margaret M. "Exploring the Enteral Feeding Practices Used by Critical Care Nurses: A Dissertation." eScholarship@UMMS, 2014. https://escholarship.umassmed.edu/gsn_diss/34.
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Mechanically ventilated critically ill patients treated in the intensive care unit (ICU) require enteral feedings to maintain adequate nutrition during critical illness. Delivery of adequate enteral nutrition is also critical to the recovery of critically ill patients. Enteral nutrition has been shown to decrease length of time on the ventilator, decrease length of stay and ICU and decrease mortality. Despite all the evidence regarding the benefits of enteral nutrition, critically ill patients continue to receive less than their prescribed calories and protein. Nurses are in a unique position to influence the delivery of enteral nutrition. Nursing practices that contribute to underfeeding must be identified and corrected to ensure adequate delivery of nutrients is achieved. The purpose of the study was to describe the professional practice of critical care nurses regarding enteral feeding in mechanically ventilated critically ill patients. Several barriers were identified by the participants in the study that contributed to underfeeding including inconsistent practice regarding gastric residual volume, holding feeds when changing patient position and lack of a standardized protocol for enteral feeding. Also identified in the study was the idea that nurses do not see enteral feeding as a life-saving intervention. It is not the “sexy part” of what ICU nurses do. Enteral feeding guidelines need to be developed to include those interventions that are important to nursing practice in order to increase enteral feeding times and improve patient outcomes.
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Owen-Fisher, Gail Marie. "A study of the relationship between anxiety levels and coping skills of critical care nurses /." Staten Island, N.Y. : [s.n.], 1986. http://library.wagner.edu/theses/nursing/1986/thesis_nur_1986_owen_study.pdf.
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Ball, Carol. "Legitimate influence : the key to advanced nursing practice in adult critical care." Thesis, City University London, 2000. http://openaccess.city.ac.uk/8158/.
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At the inception of this research study the intent was to inform the debate regarding advanced nursing practice in adult critical care, in the United Kingdom. Argument within the nursing profession was vociferous concerning the nature of advanced nursing practice and to achieve some insight into the conundrum the following research question was posed, 'What is 'advanced' about advanced nursing practice in adult critical care? To pursue the research question in greater depth three aims were stated. These reflected a desire to explore the development and activity of advanced practice nurses in adult critical care; to gain a perspective of the processes involved in their socialisation and to develop a model which would reflect these elements. The research utilised grounded theory methods, within the constructivist paradigm. The purpose of this was to reflect a relativist ontology in which reality was the subject of joint interpretation and a subjectivist epistemology where the researcher and participant co-created an understanding of the phenomenon of advanced nursing practice in adult critical care, within a naturalistic context. The methodological procedures led to the construction of the substantive theory, Legitimate Influence: the key to advanced nursing practice in adult critical care. This represents a unique contribution to the extant body of nursing knowledge associated with advanced nursing practice. The central elements comprised a focus on enhanced patient stay and improved patient outcome, the development and maintenance of credibility, underpinned by an ability to engage in advanced clinical nursing practice and the development and dissemination of knowledge. The ubiquitous nature of power between, and within, professional groups was also evident in the constraints placed upon the exercise of Legitimate Influence. Participants were also able to articulate the difference between expert and advanced clinical nursing practice; critical care practice within the domain of medicine and nursing and the focus of future patient orientated nursing research. Emphasis was also placed on the importance restorative care, and the need to balance this with the exigencies of cure. The study concludes with recommendations for practice, research and policy.
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Gillespie, Rencia S. "A descriptive survey of the nursing workforce in critical care unit in hospitals of the Western Cape Province." Master's thesis, University of Cape Town, 2006. http://hdl.handle.net/11427/2949.
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Includes bibliographical references (leaves 113-121).A global shortage of Registered Nurses (RNs) has been reported internationally, and confirmed in South Africa by the National Audit of Critical Care services. Critical Care Nurses (CCNs) especially are in great demand and short supply. This has affected the quality of patient care. The purpose of this study was to perform a workforce analysis and needs assessment of critical care nursing services in the Western Cape Province as at 1 January 2005. The study design is a descriptive survey conducted on site in the critical care units of the private and public sector hospitals of the Western Cape, using a structured questionnaire, with a 96.5% return rate. Findings showed that the 35 hospitals surveyed in the public and private healthcare sectors had 80 functional critical care units including Intensive Care Units and High Care Units for adults, children and neonates, and High Dependency Units for adults. Factors that contribute to the demand for critical care nurses include the number of critical care beds, patient admissions, severity of illness, available facilities, medical, nursing and support staff. Compared to internationally accepted norms, the Western Cape units have a deficit of 74% of Registered Nurses (RNs) in the public sector hospitals, and a deficit of 82% in the private sector. This equates to an actual shortage of 3010 RNs for both sectors. If all categories of nursing staff are included in the calculation, the public sector meets 49% of its requirements and the private sector 24%. Half of the private sector and 28.9% of the public sector Registered Nurses are Critical Care Nurses. Few measures appear to be taken to recruit and retain nursing staff. The number of students being trained at both the undergraduate (300 during 2004) and the postgraduate (80 CCNs during 2004) level at the educational institutions, in conjunction with the hospitals, is inadequate. Clinical training institutions are available, but the numbers of educators and clinical mentors are inadequate to train the number of nurses required to meet the demand.
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Zomorodi, Margaret Gambrell Lynn Mary R. "Instrument development to measure critical care nursing values and behaviors when providing end-of-life care." Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2008. http://dc.lib.unc.edu/u?/etd,1909.
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Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2008.Title from electronic title page (viewed Dec. 11, 2008). "... in partial fulfillment of the requirements for the degree of Doctorate of Philosophy in the School of Nursing." Discipline: Nursing; Department/School: Nursing.
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Van, Belkum Corrien. "A process of quality improvement for outcomes-based critical care nursing education." Thesis, Stellenbosch : Stellenbosch University, 2001. http://hdl.handle.net/10019.1/52125.
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Dissertation (PhD) -- University of Stellenbosch, 2001.ENGLISH ABSTRACT: A thoughtfully planned learning program provides a blueprint for critical care nursing and gives direction to theory and clinical practice. The design of a learning program for critical care nursing that is adaptive, learner focussed and integrated, helps nurses acquire the necessary competencies (knowledge, technical skills and attitudes/values) needed for critical thinking. It also enables critical care nurses to grow professionally and to develop expertise in critical care nursing. Outcomes-based education has become the "new buzz word" in South Africa, and a paradigm shift from content-based to outcomes-based education has become essential. Institutions are concerned with efficient and effective approaches to critical care nursing delivery. The institution (nursing department) proves its worth by anticipating patient care needs and planning its learning program cognizant of the need to correlate activities with the institution's (nursing department) mission and outcomes. Planning that meets the learning needs of the critical care nursing learners not only provides the ability to meet job expectations, but also experiences for professional growth and satisfaction. In an age of nursing shortage, a well planned, integrated and outcomes orientated critical care learning program is essential. The outcome of the research was identified as a process of quality improvement for outcomes-based critical care nursing education, which included validated standards to facilitate quality critical care nursing education. This was researched by utilising an adapted Laing and Nish Model for Quality Assurance (1981) as the research strategy. Seven (7) steps were identified, namely: Step one included the identification and clarification of values; step two determined criteria, established standards for outcome, structure and process; step three ratified criteria and validated standards; step four identified and analysed factors influencing the results; step five selected appropriate actions to maintain or improve critical care nursing education; step six implemented the selected actions and in step seven, assessment (testing) was done. In steps two and three of the quality improvement process the Muller's (1996) Three Phase Model for Standard Development was implemented. Seven (7) standards were identified and formulated, namely: Standard one - Quality improvement; Standard two - Standard formulation; Standard three - Philosophy; Standard four - Legislative framework; Standard five - Curriculum development (learning program development); Standard six - Outcomes-based education; and Standard seven - Critical care nursing education. During the process of validation of the standards, standards five and six were combined and became Standard five - Outcomes-based learning program development. In step three the Delphi technique as part of the second phase of Muller's model (1996), was utilised to gain expert opinions / validation of standards. Operationalisation and assessment of the validated standards as part of a process of quality improvement for outcomes-based critical care education were done in a higher education institution. The results of this pilot study that was done supported the central theoretical assumption, namely that outcomes-based critical care nursing facilitates quality critical care nursing. The uniqueness of the research lies in the fact that in outcomes-based critical care nursing education there is no formal process of quality improvement for outcomes-based critical care nursing education. In this research, standards were developed and presented as part of a process of quality improvement for outcomes-based critical care nursing education. These standards should guide the developer of an outcomes-based critical care nursing education program during the development of the learning program (meso curriculum) and could be utilised to judge the quality of the current learning programs' quality. Five of the six standards are generic and could be utilised with minor adjustments in any higher education learning program.
AFRIKAANSE OPSOMMING: 'n Weldeurdagte leerprogram dien as 'n bloudruk vir kritiekesorg-verpleging, en rig beide die teorie en die kliniese praktyk. Die ontwerp van 'n leerprogram vir kritiekesorg-verpleging wat ge"integreerd,leerder-gefokus en aanpasbaar is, help verpleegkundiges om die nodige vaardighede (kennis, tegniese vaardighede en houdings/waardes) vir kritiese denke te ontwikkel. Dit stel kritiekesorg verpleegkundiges ook in staat om professioneel te groei en om kundigheid in kritiekesorg-verpleging te ontwikkel. Uitkoms-gebaseerde onderrig is die "nuwe wagwoord" in Suid-Afrika en het 'n paradigmaskuif van inhoud-gebaseerde- na uitkoms-gebaseerde onderrig genoodsaak. Instellings is begaan oor doeltreffende en effektiewe benaderings vir die lewering van kritiekesorg verpleging. Die verrnoe van 'n instelling (departement verpleging) om pasientsorq-behoeftes te voorspel en om die kritiekesorg leerprogram se aktiwiteite in ooreenstemming met die instelling (departement verpleging) se missie en verwagte uitkomstes te beplan, bewys die waarde van die instelling (departement verpleging). 8eplanning wat aan die leerbehoeftes van die kritiekesorg-Ieerders voldoen, bevredig nie aileen hul werksverwagtinge nie, maar het ook professionele groei en genoegdoening tot gevolg. In Goed-beplande, ge"integreerde en uitkoms-georienteerde kritiekesorg leerprogram is essensieel in 'n tyd waar verpleegtekorte aan die orde van die dag is. Ten einde gehalte-verpleegonderrig te fasiliteer, is die uitkoms van die navorsing as 'n proses van gehalteverbetering vir uitkoms-gebaseerde kritiekesorgverpleegonderrig, wat gevalideerde standaarde insluit, ge"identifiseer. 'n Aangepaste Laing en Nish Model vir Gehalteversekering (1981) is as navorsingstrategie vir hierdie navorsing gebruik. Sewe (7) stappe is ge"identifiseer, naamlik: Stap een sluit die identifisering en verduideliking van waardes in; stap twee bepaal kriteria en skep standaarde vir uitkoms, struktuur en proses; stap drie bekragtig en valideer die standaarde; stap vier identifiseer en ontleed faktore wat die resultate belnvloed; stap vyf selekteer toepaslike aksies om kritiekesorg-verpleegonderrig te handhaaf of te verbeter; stap ses implementeer die geselekteerde aksies en in stap sewe is assessering (toetsing) gedoen. Muller (1996) se Drie Fase Model vir Standaardontwikkeling is in stappe twee en drie van die gehalteverbeteringsproses ge"implementeer. Sewe (7) standaarde is ge"identifiseer en geformuleer, naamlik: Standaard een - Gehalteverbetering; Standaard twee - Standaardformulering; Standaard drie - Filosofie; Standaard vier - Wetlike raamwerk; Standaard vyf - Kurrikulumontwikkeling (Ieerprogramontwikkeling); Standaard ses - Uitkoms-gebaseerde onderrig; en Standaard sewe - Kritiekesorg-verpleegonderrig. Tydens die valideringsproses van die standaarde, is standaarde vyf en ses gekombineer as Standaard vyf - Uitkomsgebasseerde leerprogramontwikkeling. Gedurende stap drie is die Delphitegniek tydens die tweede fase van Muller (1996) se model gebruik om deskundige opinies te verkry I die standaarde te valideer. Operasionalisering en assessering van die gevalideerde standaarde as deel van In sisteem van gehalteverbetering vir uitkoms-gebaseerde onderring is in 'n hoeronderwysinstelling gedoen. Die resultate van hierdie toetsstudie het die sentrale teoretiese aanname, naamlik dat uitkoms-gebaseerde kritiekesorg-verpleging gehalte kritiekesorg-verpleging fasiliteer, ondersteun. Die uniekheid van hierdie navorsing is gelee in die feit dat daar in uitkomsgebaseerde kritiekesorg-verpleegonderrig, geen formele proses van gehalteverbetering vir uitkoms-gebaseerde kritiekesorg-verpleegonderrig is nie. In hierdie navorsing is standaarde ontwikkel en aangebied as deel van In sisteem van gehalteverbetering vir uitkoms-gebaseerde kritiekesorg-verpleegonderrig. Hierdie standaarde kan tydens die ontwikkeling van die leerprogram (mesokurrikulum), die ontwikkelaar van In uitkoms-gebaseerde kritiekesorgverpleegondderigprogram begelei, en kan gebruik word om die gehalte van huidige leerprogramme te beoordeel. Vyf van die ses standaarde is generies en kan, met minimale veranderinge in enige hoer onderwys leerprogram gebruik word.
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Al, Chami Mohamad Hamze. "Economization of Home Care in Ontario: A Critical Ethnography of Nursing Actions." Thesis, Université d'Ottawa / University of Ottawa, 2021. http://hdl.handle.net/10393/42670.
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Many nursing theorists consider caring the essence of nursing practice. Yet, the meaning of caring is still elusive in nursing theories. This confusion in conceptualizing caring is exacerbated by the neoliberal socio-political and economic transformations of our societies that infuse nursing practice with economic efficiency values ‒ a condition that threatens the ethical dimensions of nursing. This critical study analyzes nursing actions in home care in Ontario and empirically reconstructs the normative dimensions of care based on nurses’ own perceptions of good care. The findings are used to critique current healthcare transformations through a critical theory of nursing actions.
This study is situated in the tradition of the Frankfurt critical school and pursues an emancipatory interest. Axel Honneth’s theory of recognition is the principal theoretical foundation complemented by Jürgen Habermas’ theory of communicative action and the interests of knowledge, in addition to the concepts of phenomenology and corporality. It uses critical ethnography as a methodological approach. Data collection included audiotaped semi-structured open-ended interviews with 18 nurses working for two different home care providers in Ottawa. Analysis demonstrates that the patient must be recognized on three dimensions: love, legal rights, and solidarity. Care is a specific form of communicative action in which patients should participate equally in decision making. Nursing actions comprise a hermeneutic-phenomenological dimension of “deep knowing” that respect the corporal and personal needs of the patient. Healthcare transformations and economic efficiency measures reinforce technical and standardized forms of care, which lead to pathologic practices that neglect patients’ corporal needs, thereby reifying patients. Nursing actions combine both technical and corporal aspects that characterize their “double logic.”
This study provides elements for a critical theory of nursing actions. Findings highlight that nurses have a vision of how nursing care should look like, but the reality of home care makes it rather impossible to realize this vision. Economization leads to a systematic violation of multiple dimensions of recognition and to reification. Nurses must resist these social pathologies and this study provides some theoretical tools to engage in this struggle.
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Krinsky, Robin S. "Fatigue and Alarm Fatigue in Critical Care Nurses." Case Western Reserve University Doctor of Nursing Practice / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=casednp1428102757.
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Ward, Barbara Diane. "Nurse Resilience| Implications on Critical Care Nurse Shortage and Proposed Intervention." Thesis, Grand Canyon University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10272948.
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Abstract Critical care nursing is experiencing a high turnover and a global shortage crisis. The number of critical care nurses (CCNs) leaving the critical care environment is at an unprecedented high rate, negatively impacting the quality of care for the most critically ill of patients.. It is not known if and to what extent CCNs resiliency is affected by self-care and how it is associated with compassion satisfaction, interprofessional relationships, professional quality of life, psychological and psychosocial impairment (PPI), or intent to leave the critical care specialty area. The purpose of this quantitative, cross-sectional, descriptive project was to ascertain if the independent variable for CCNs self-care had an associative relationship among five dependent variables reflective of CCNs resilience: (a) compassion satisfaction, (b) interprofessional relationships, (c) professional quality of life, (d) PPI, or (e) intent to leave the critical care specialty area. An innovative, web-based CCN self-care intervention was introduced and outcomes measured through the administration of a descriptive survey pre- and post-assessment to determine relational association to the variables of CCNs resilience. The project, though limited by time constraints, inferred CCNs and non-CCNs respondents are interested in self-care and creating healthy critical care environments for safe patient care. Keywords: resilience, critical care, stress management, burnout, compassion
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Vanderspank, Brandi. "The Social Construction of Intensive Care Nursing, 1960-2002: Canadian Historical Perspectives." Thèse, Université d'Ottawa / University of Ottawa, 2014. http://hdl.handle.net/10393/30922.
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Intensive care units (ICUs) emerged across Canada during the early 1960s, significantly contributing to the image of Western hospitals as places of scientific advancement that predominated over much of the twentieth century. ICUs rapidly became both a resource intensive and expensive type of care as the number and size of units increased to accommodate diverse patient populations and treatment options. Nurses enabled the formation and growth of ICUs through their constant presence and skilled care. There has been limited research, however, regarding the historical development of Canadian ICUs, the relationships between nurses and other personnel in such units, how they developed an identity as ICU nurses, or how ICU nursing became a specialty practice.
Situated within the broader histories of hospitals, healthcare, and nursing, this study uses a social history approach to examine nurses’ experiences within Canadian ICUs between 1960 and 2002. Berger and Luckmann’s Social Construction of Reality provided a lens for analysis and interpretation of oral histories, photographs, professional literature of the time period under study, and both archival and organizational records. This thesis argues that ICU nurses’ relationships with one another, in the context of a technologically complex environment, socially constructed their knowledge and skill acquisition, their socialization as ICU nurses, and the development of a specialized body of knowledge that ultimately led to formal recognition of ICU nursing as a specialty in Canada.
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LeBlanc, Allana E. "The Experience of Intensive Care Nurses Caring for Patients with Delirium." Thesis, Université d'Ottawa / University of Ottawa, 2016. http://hdl.handle.net/10393/34266.
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The purpose of this research was to seek a deep understanding of the lived experience of intensive care nurses caring for patients with delirium.
Delirium affects a large proportion of adult patients in the intensive care unit (ICU). Delirium has been linked to increased morbidity and mortality, longer intensive care and hospital length of stay, long-term cognitive impairments, short-term and long-term psychological distress, and increased hospital and health system costs. Critical care nurses play central roles in preventing, identifying, and treating ICU patients with delirium.
Semi-structured interviews were conducted with eight intensive care nurses working in an ICU in a tertiary level, university-affiliated hospital in Ontario, Canada. The researcher analyzed the interviews using an interpretive phenomenological approach as described by van Manen (1990).
The essence of the experience of critical care nurses caring for ICU patients with delirium was revealed to be finding a way to help them come through it. Six main themes emerged: It's Exhausting; Making a Picture of the Patient's Mental Status; Keeping Patients Safe: It's a Really Big Job; Everyone Is Unique; Riding It Out With Families; and Taking Every Experience With You. The findings describe how intensive care nurses find a way to help patients and their families through this complex and often distressing experience. This study has contributed to the understanding of the lived experience of ICU nurses caring for patients with delirium.
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Crocker, Cheryl. "The development of a nursing technology : making visible the nursing contribution to the development of critical care." Thesis, University of Nottingham, 2006. http://eprints.nottingham.ac.uk/11903/.
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In the context of one Intensive Care Unit (ICU) and one High Dependency Unit (HDU), this thesis explores and analyses the nursing contribution to the development of critical care. This comprises over more than half a century, focussing on nurses' relationship with, and perceptions of one 'technology', weaning from mechanical ventilation, as part of everyday nursing practice in the new millennium. My findings suggest that nurses take a task-focussed approach to weaning, treating it as a `medical' technology transferred to them from doctors, rather than seeing its potential to become a ‘nursing technology' in which the nurse is enabled to transform weaning into a way of implementing care in order to improve patient outcomes. Analysis demonstrates when nurses work in this way weaning is delayed and as a result patients will be exposed to greater morbidity and mortality. Theoretically, my argument builds in particular on Sandelowski's (1996, 1997,1998,2000,2000a, 2000b) work on the nursing – technology relation in which she describes how technology has shaped nursing practice and was shaped by nursing practice. I build on Sandelowski's ideas to develop two concepts that are central to my argument: technology transferred and technology transformed. I have used an ethnographic approach to study nurses using technology in the work place. The empirical data were obtained through fieldwork on one critical care unit in a large teaching hospital in the Midlands over a six-month period. The methods include participant observation, interviews with twelve nurses and the collection of over two–hundred and fifty hours of field notes. My study of the nursing role in critical care contributes new knowledge to two fields: first, the history of intensive care as a specialism within the wider development of the National Health Service (NHS). My work adds to this literature by making visible the nursing contribution to that development and, in the process, raising a question about the extent to which previous histories may have been misleading: these (see for example Lassen 1953, Hamilton 1963, Ibsen 1966, Hilberman 1975, Pontoppidan, Wilson, Rie & Schneider 1977, Cule 1989, Crocket and Mercer 1995, Gilbertson 1995, Le Fanu 1999, Kesecioglu 2000) have tended to assume that its development was a result of new medical technology. Second, is the literature on 'technology' as it relates, to nursing. I believe that my definition of a 'nursing technology' makes it possible for the first time to put structures in place which will transform nurses' contribution to patient care, improving patient outcomes. I conclude that rather than extending and expanding their roles through the transfer of technology, nurses transform those technologies that preserve the nursing role and can contribute to positive outcomes for patients. Only in this way will the nursing contribution to the development of critical care be recognised and valued.
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Garwood, Bruce. "Nurses' perceptions of caring for dying patients in critical care| A phenomenologic study." Thesis, University of Phoenix, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10240722.
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Dying with dignity in the critical care unit (CCU) is a difficult process to define and limited information is available to assist with that definition. The purpose of this descriptive phenomenological study was to explore the critical care nurses lived experiences of caring for the dying patient in CCU. Understanding nurses’ perceptions and lived experiences of the phenomena will contribute to nursing knowledge, new insights for nurse leaders, and the possible development of a nursing model to guide nurses who are providing care to the dying patient. A qualitative, descriptive phenomenological methodology was used to guide this study. Twelve critical care nurses were recruited and interviewed, exploring their lived experiences of caring for the dying patient in the critical care setting. Three board questions comprised the interview guide allowing each nurse an opportunity to share their lived experiences of caring for the dying patient. Five themes emerged from the data: communication, family, technology, lack of education, and dying with dignity. Recommendations included early discussions with patients and families regarding end-of-life wishes as well as, strategies for nurses providing end-of-life care. The study participants also noted the need for increased awareness and education for patients, families and health care providers regarding end-of-life care, dying with dignity, and palliative and hospice referrals. Community education was also noted as an integral part of the awareness process. For nurses and physicians, the education should start during their basic education program and continue throughout their career especially those working in high acuity areas in health care. As in life, death and dying are important aspects of all of health care providers. Facilitating quality end-of life care could relieve pain and suffering for the dying patient and assist family members with allowing their loved one, the patient to die with dignity.
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Callender, Debra. "Compassion Fatigue Among Critical Care Nurses." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7464.
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Compassion fatigue (CF), also known as secondary traumatic stress (STS), impacts critical care nurses (CCN) through exposure to pain, suffering, and loss of those for whom they provide care and results in a reduction of compassion satisfaction (CS). High incidence of CF and turnover (TO) rates at the project site were identified among CCNs. The institution's CCN TO rate was at 81% in comparison to peers in other areas at 29%â35%. The practice-focused question asked whether leadership education on CF might ameliorate CF at the project site. The purpose of the Doctor of Nursing Practice project was to reduce the incidence of CF and TO among CCN through leadership education. Watson's theory of human caring was used as a framework. Two hundred twenty-nine CCNs completed the Professional Quality of Life survey that measures CS, STS, and burnout (BO). Comparison of 28 nursing leaders' pretest scores to posttest scores indicated a statistically significant improvement (z = -4.625, p < .001) and knowledge acquisition. BO and CF taken together explained 86% (adjusted R2 = .86) of the variance in CS (F [2, 227] = 691.33, p < .001). Identifying the nursing units with the highest CF scores and providing CF education to the leadership provides a path to reduce turnover and provide needed support to CCNs, a positive social change.
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Batch, Mary Philomena. "Communication and the casualisation of nursing : a critical ethnography." Thesis, Queensland University of Technology, 2012. https://eprints.qut.edu.au/60918/1/Mary_Batch_Thesis.pdf.
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The contemporary working environment is being rapidly reshaped by technological, industrial and political forces. Increased global competitiveness and an emphasis on productivity have led to the appearance of alternative methods of employment, such as part-time, casual and itinerant work, allowing greater flexibility. This allows for the development of a core permanent staff and the simultaneous utilisation of casual staff according to business needs. Flexible workers across industries are generally referred to as the non-standard workforce and full-time permanent workers as the standard workforce.
Even though labour flexibility favours the employer, increased opportunity for flexible work has been embraced by women for many reasons, including the gender struggle for greater economic independence and social equality. Consequently, the largely female nursing industry, both nationally and internationally, has been caught up in this wave of change. This ageing workforce has been at the forefront of the push for flexibility with recent figures showing almost half the nursing workforce is employed in non-standard capacity. In part, this has allowed women to fulfil caring roles outside their work, to ease off nearing retirement and to supplement the family income. More significantly, however, flexibility has developed as an economic management initiative, as a strategy for cost constraint. The result has been the development of a dual workforce and as suggested by Pocock, Buchanan and Campbell (2004), associated deep-seated resentment and the marginalisation of part-time and casual workers by their full-time colleagues and managers. Additionally, as nursing currently faces serious recruitment and retention problems there is urgent need to understand the factors which are underlying present discontent in the nursing profession. There is an identified gap in nursing knowledge surrounding the issues relating to recruitment and retention.
Communication involves speaking, listening, reading and writing and is an interactive process which is central to the lives of humans. Workplace communication refers to human interaction, information technology, and multimedia and print. It is the means to relationship building between workers, management, and their external environment and is critical to organisational effectiveness. Communication and language are integral to nursing performance (Hall, 2005), in twenty-four hour service however increasing fragmentation due to part-time and casual work in the nursing industry means that effective communication management has become increasingly difficult. More broadly it is known that disruption to communication systems impacts negatively on consumer outcomes.
Because of this gap in understanding how nurses view their contemporary nursing world, an interpretative ethnographic study which progressed to a critical ethnographic study, based on the conceptual framework of constructionism and interpretativism was used. The study site was a division within an acute health care facility, and the relationship between increasing casualisation of the nursing workforce and the experiences of communication of standard and non-standard nurses was explored. For this study, full-time standard nurses were those employed to work in a specific unit for forty hours per week. Non-standard nurses were those employed part-time in specific units or those nurses employed to work as relief pool nurses for shift short falls where needed. Nurses employed by external agencies, but required to fill in for shifts at the facility were excluded from this research.
This study involved an analysis of observational, interview and focus group data of standard and non-standard nurses within this facility. Three analytical findings - the organisation of nursing work; constructing the casual nurse as other; and the function of space, situate communication within a broader discussion about non-standard work and organisational culture. The study results suggest that a significant culture of marginalisation exists for nurses who work in a non-standard capacity and that this affects communication for nurses and has implications for the quality of patient care.
The discussion draws on the seven elements of marginalisation described by Hall, Stephen and Melius (1994). The arguments propose that these elements underpin a culture which supports remnants of the historically gendered stereotype "the good nurse" and these cultural values contribute to practices and behaviour which marginalise all nurses, particularly those who work less than full-time. Gender inequality is argued to be at the heart of marginalising practices because of long standing subordination of nurses by the powerful medical profession, paralleling historical subordination of women in society. This has denied nurses adequate representation and voice in decision making. The new knowledge emanating from this study extends current knowledge of factors surrounding recruitment and retention and as such contributes to an understanding of the current and complex nursing environment.
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Anthonie, Ramona F. G. "The experiences of critical nurses regarding staffing management in critical care units in private hospitals of the Cape Metropole." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/71776.
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Thesis (MCurr)--Stellenbosch University, 2012.ENGLISH ABSTRACT: Nurse managers are responsible to staff different hospital units and departments with sufficient, trained and experienced personnel. Most critical care units in the private healthcare in South Africa are staffed below maximum workload levels and additional staff is supplemented when needed. Current staffing management strategies comprises the application of the patient acuity score, the utilisation of contracted agency staff and ward staff who assist occasionally in the critical care unit (CCU). The aim of the study was to explore the experiences of critical care nurses regarding staffing management within critical care units in private health care institutions in the Western Cape. The following objectives were set to: - explore the experiences of CCNs regarding staffing management strategies such as o the patient acuity score o the employment of ad hoc agency staff and o the utilization of ward staff A descriptive design with a qualitative approach was applied. A sample size of n=15 was drawn from a total population of N=377, using purposive sampling technique. A pilot-test was also completed. The trustworthiness of this study was assured with the use of Lincoln and Guba’s criteria of credibility, transferability, dependability and confirmability. All ethical principles were met. The findings of the study demonstrated that nurses perceive the workload in critical care units as heavy. The utilisation of the acuity score does not really assist in relieving the workload as managers tend not to consider the staffing requirements as predicted by the acuity score due to budget constraints. The enrolled nurses who assist occasionally in the critical care unit require supervision as well as ongoing development to ensure safe and quality patient care. Yet agency nurses were perceived as either extraordinary good or incompetent.
AFRIKAANSE OPSOMMING: Verpleegbestuurders het die verantwoordelik om verskillende hospitaaleenhede en departemente met voldoende opgeleide en ervare personeel te voorsien. Die meeste kritieke sorgeenhede in Suid-Afrika word met minder as dan die maksimum werkladingsvlak beman en addisionele personeel word aangevul wanneer nodig. Huidige personeelbestuurstrategieë behels die toepassing van die pasiënt akuïteit telling, die gebruik van ingekontrakteerde agentskap-personeel en saalpersoneel wat per geleentheid in die kritiekesorgeenheid help. Die doel van die studie was om die ervaringe van kritieke-sorgverpleegsters ten opsigte van personeel bestuur binne die kritiekesorgeenhede in die privaat gesondheidsorginstellings in die Weskaap, te ondersoek. Die volgende doelwitte is gestel: - Om die ervaringe van kritieke-sorgverpleegsters aangaande personeelbestuur-strategieë te ondersoek, soos: o die pasiënt akuïteit telling o die gebruik van agentskapverpleegpersoneel en o die gebruik van saal personeel, te ondersoek ’n Beskrywende kwalitatiewe studie is toegepas. ’n Steekproef van n=15 is uit ’n totale populasie van N=377 getrek deur die doelgerigte steekproeftegniek te gebruik. ’n Loodstoetsing van die semi-gestruktureerde vraelys is ook gedoen. Die betroubaarheid van hierdie studie was verseker deur van Lincoln en Guba se kriteria vir geloofwaardigheid, oordraagbaarheid, betroubaarheid en bevestigbaarheid gebruik te maak. Daar is aan alle etiese vereistes voldoen. Die bevindings van die studie toon dat die verpleegpersoneel die werklading in die kritiekesorgeenheid as veeleisend ervaar. Die aanwending van die pasiënt akuïteit-telling dra nie werklik by tot verligting van die werklading nie, aangesien bestuurders weens begrotingsbeperkings neig om nie die personeelbenodigdhede soos deur die akuïteit-telling voorspel in ag neem nie. Die ingeskrewe verpleegsters wat per geleentheid in die kritieke-sorgeenheid hulp verleen, benodig toesig asook volgehoue ontwikkeling ten einde veilige en kwaliteit pasiëntsorg te verseker. Die agentskapverpleegpersoneel is egter as baie bekwaam of onbevoeg beskou.
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Forozeiya, Dana. "Critical Care Nurses’ Experiences of Coping with Moral Distress." Thesis, Université d'Ottawa / University of Ottawa, 2017. http://hdl.handle.net/10393/35894.
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Over the last three decades, there has been a growing body of literature that has described moral distress as a prominent issue that negatively affects critical care nurses. However, little focus has been given to how nurses cope and continue on in their practice despite the hardship that moral distress can cause. This study sought to reveal nurses’ strategies of coping with moral distress to allow for a better understanding of this aspect of critical care nurses’ experiences. This study adopted a qualitative design that used Thorne’s (2008) approach to interpretative description. Face-to-face, semi-structured interviews were conducted with seven critical care nurses employed within two ICUs of a tertiary care academic hospital. Interviews were analyzed using Aronson’s (1995) approach to thematic analysis. The experience of coping with moral distress had an overarching theme of being “like grass in the wind.” Four major themes were identified: Going Against What I Think is Best, Moral Distress- It’s Just Inherent in Our Job, It Just Felt Awful, and Dealing with It.
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Baxter, Marian. ""Being certain": Moral distress in critical care nurses." VCU Scholars Compass, 2012. http://scholarscompass.vcu.edu/etd/2939.
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Published literature has focused on understanding moral distress from a descriptive standpoint. Missing from the literature is an exploration of the role a nurse can play in his/her/own moral distress.A qualitative study with an interpretive design incorporated Clandinin and Connelly' narrative methodology. Results highlighted assumptions were made by participants in the absence of resources, which led them to" know the right action to take" from their own perspective.
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Mallory, Caitlin Brook. "Critical Care Nurses' Experiences of Family Behaviors as Obstacles in End-of-Life Care." BYU ScholarsArchive, 2017. https://scholarsarchive.byu.edu/etd/6903.
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Background: Critical care nurses (CCNs) frequently provide end-of-life care for critically ill patients. CCNs may face many obstacles while trying to provide quality EOL care. Some research focusing on obstacles CCNs face while trying to provide quality EOL care has been published; however, research focusing on family behavior obstacles is limited. Research focusing on family behavior as an EOL care obstacle may provide additional insight and improvement in care. Objective: What are the predominant themes noted when CCNs share their experiences of common obstacles, relating to families in providing EOL care? Methods: A random geographically dispersed sample of 2,000 members of the American Association of Critical-Care Nurses was surveyed. Responses from a qualitative question on the questionnaire were analyzed. Results: Sixty-seven EOL obstacle experiences surrounding issues with families' behavior were analyzed for this study. Experiences were categorized into 8 themes. Top three common obstacle experiences included families in denial, families going against patient wishes and advance directives, and families directing care which negatively impacted patients. Conclusions: In overcoming EOL obstacles, it may be beneficial to have proactive family meetings to align treatment goals and to involve palliative care earlier in the ICU stay.
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Mamet, Wendy Ellen. "An examination of how critical care nurses' knowledge, attitudes, and concerns impact their administration of opoid analgesics /." Staten Island (M.S.) -- Wagner College, N.Y. : [s.n.], 1995. http://library.wagner.edu/theses/nursing/1995/thesis_nur_1995_mamet_exami.pdf.
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Pryor, James Russell. "Improving Sepsis Care for Non-Critical Care Hospitalized Patients by Using the Three Hour Treatment Bundle from the Surviving Sepsis Campaign." Thesis, Brandman University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10253593.
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Purpose: The purpose of this clinical scholarly project was to plan and execute a sepsis education presentation on identifying sepsis and using the three hour treatment bundle from the Surviving Sepsis Campaign to treat sepsis. The target audience is non-critical care inpatient nurses in a medium sized acute care community hospital.
Methods: Nurses were assigned a course over HealthStream, a web-based platform, which included the presentation along with a pre-test and post-test, and a consent statement to have their score reports analyzed. A descriptive analysis of group pre-test and post-test scores, compliance with completing each component of the three hour treatment bundle, sepsis mortality, and sepsis length of stay was completed.
Findings: There were 586 nurses who completed the course. A total of 172 nurses consented to having their test scores analyzed. The same test was used for the pre-test and the post-test. Overall, the mean test score for the pre-test was 75% and the mean post-test score was 92.6%. Completion compliance with each of the four components of the three hour treatment bundle increased in the 90 days following the education. Unfortunately, sepsis mortality and sepsis length of stay increased in the 90 days following the education using an outcome/expected variance ratio.
Conclusions: This project increased the post-test scores over pre-test scores. There was a linear relationship between increased post-test scores and at least one component (initial lactate vii measurement) of the three hour treatment bundle. There were confounding factors that might contribute to increased compliance of the treatment bundles. This method of education delivery proved useful for one person to provide education to a large group of nurses over a short period of time and allowed for the nurses to complete the course when they had time to do so.
Recommendations: This project should be expanded to include other areas of the hospital such as wound care, surgery clinic, emergency department, and other outpatient areas. In addition, the program could be modified for critical care unit nurses to include training on the six hour treatment bundle which focuses on critical care interventions.
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Page, Pamela. "Critical illness survivorship and implications for care provision : a constructivist grounded theory." Thesis, City, University of London, 2016. http://openaccess.city.ac.uk/17242/.
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Background: In the context of increasing survivorship from critical illness it is important to enhance our understanding of the subjective experience of survivors and their families. The critical illness experience is enormously complex, varied and multifaceted. The need to consider the legacy of critical care beyond physiological survival is imperative. Aims of the study: The study aimed to formulate a substantive, middle range theory in relation to patient and family’s critical illness trajectory. Further, to discern and understand the responses of critical care nurses to survivorship needs. Methods: Working within a relativist ontology and a constructivist grounded theory methodology, a series of in-depth interviews were undertaken with survivors of critical illness (n=16), family members (n=15) (phase 1) and critical care nurses (n=11) (phase 2). Interviews were undertaken in a District General Hospital setting in England. All interviews were transcribed verbatim. Constant comparative analysis and data collection occurring concurrently with theoretical sampling commencing from the outset. Findings: Survivors of critical illness invariably entered a liminal state between life and death on admission and during their stay in the Adult General Critical Care Unit (AGCCU). They frequently experienced vivid, hallucinatory experiences which placed them in a different world or liminal space where they could move or transcend in and out of different realities or worlds. The core difficulty can be summarised as follows; survivors have little recall of the factual events of their critical illness within AGCCU but relatives have lived the whole event in a very real and ingraining manner. This can result in family members and survivors experiencing totally different versions or narratives of the critical illness episode; constructing the concept of dualistic worlds. Nurses working within AGCCU found themselves bounded by the walls of the critical care unit and experienced personal and professional conflicts in their role, as they bear witness to critically ill patients and their families. The critical care environment was identified as a demanding place of work which appeared to limit nurses to immediacy of care in the here and now. The specialist knowledge and skill that nurses provided were central to physiological survival but they are unable to support the onward survivorship trajectory. Conclusion: Survivors of critical illness, together with family members experience numerous challenges and adversities when endeavouring to readjust to life post critical care. This study has identified a middle range theory of dualistic worlds between and within the survivor and family member experiences. These temporal events occur during and after critical illness and expose a non-linear, fluid journey towards a new normal. Exploring the dynamic interplay between intrapersonal, interpersonal and societal factors has provided theoretical insights into critical illness survivorship and the legacy of critical care. Nurses in AGCCU bear witness to the early stages of the survivorship trajectory and provide complex care in support of survival; however they, are bounded by the walls of AGCCU such is the proximity to death and the pressure of work. They are unable to support the onward survivorship journey.
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Redman, Pam. "Effectiveness of a Critical Care Nurse Residency Program." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3201.
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The importance of nurse residency programs is addressed in the literature; however, a review of residency program outcomes and effectiveness is needed. Guided by Roy's adaptation model and Deming's plan-do-check-act model, the purpose of this quality improvement project was to assess the current state of a longstanding critical care nurse residency program in meeting organizational goals and objectives and to recommend modifications to the program related to external factors, internal challenges, and educational deficits of nurses entering the program. A review of the evidence-based literature and feedback from focus groups of leadership stakeholders were used to develop recommendations for residency program improvement. Using qualitative analysis of the focus group data, three common themes emerged related to external factors: financial resources, patient acuity, and generational differences that influence nurse satisfaction with the residency program. Three additional themes emerged related to organizational barriers to satisfaction with the program: preceptor availability and development, limited training hours due to productivity standards, and leader time to support novice nurses. Reality shock when starting to practice in the high acuity critical care area was the most frequently reported educational deficit among new nurses. Recommendations for program improvement included obtaining feedback from residency program participants and preceptors, initiating preceptor development pathways, reinstituting a dedicated cost center for nurse residents' training, and using competency assessment tools to customize training plans for residency program participants. This project has the potential for social change by increasing job satisfaction and retention of new nurses and improving health outcomes in critical care patients.