Tesis sobre el tema "Nursing Care – methods"

This thesis examines the present provisions for pre-conception care and the views of the providers of services. Pre-conception care is seen by some clinicians and health educators as a means of making any necessary changes in life style, corrections to imbalances in the nutritional status of the prospective mother (and father) and the assessment of any medical problems, thus maximizing the likelihood of the normal development of the baby. Pre-conception care may be described as a service to bridge the gap between the family planning clinic and the first ante-natal booking appointment. There were three separate foci for the empirical research - the Foresight organisation (a charity which has pioneered pre-conception care in Britain); the pre-conception care clinic at the West London Hospital, Hammersmith; and the West Midlands Regional Health Authority. The six main sources of data were: twenty five clinicians operating Foresight pre-conception clinics, couples attending pre-conception clinics, committee members of the Foresight organisation, staff of the West London Hospital pre-conception clinic, Hammersmith, District Health Education Officers working in the West Midlands Regional Health Authority and the members of the Ante-Natal Care Action Group, a sub-group of the Regional Health Advisory Group on Health Promotion and Preventive Medicine. A range of research methods were adopted. These were as follows: questionnaires and report forms used in co-operation with the Foresight clinicians, interviews, participant observation discussions and informal meetings and, finally, literature and official documentation. The research findings illustrated that pre-conception care services provided at the predominantly private Foresight clinics were of a rather `ad hoc' nature. The type of provision varied considerably and clearly reflected the views held by its providers. The protocol which had been developed to assist in the standardization of results was not followed by the clinicians. The pre-conception service provided at the West London Hospital shared some similarities in its approach with the Foresight provision; a major difference was that it did not advocate the use of routine hair trace metal analysis. Interviews with District Health Education Officers and with members of the Ante Natal Care Action Group revealed a tentative and cautious approach to pre-conception care generally and to the Foresight approach in particular. The thesis concludes with a consideration of the future of pre-conception care and the prospects for the establishment of a comprehensive pre-conception care service.

Background: Recognition of the significance of psychological trauma and its impact on individuals, families, communities, and society at large has greatly expanded over the past 20 years, calling for the need to develop both trauma-sensitive and trauma–responsive services. Nurses, as direct care providers who work within a holistic perspective, are positioned to play an integral role in the advancement of ‘trauma-informed care’ within healthcare services. Objectives: The specific objectives of this thesis were: a) to describe the use of social media (Facebook and LinkedIn) in the recruitment of Registered Nurses for an online survey, and b) to explore and describe the understandings and experiences related to trauma and trauma-informed care among nurses that scored the highest on this scale. Method: This was a two-phase study design using mixed methods. Phase One consisted of an online quantitative self-report survey. Participants were recruited via social media with the aim of examining nurses’ attitudes related to trauma-informed care. Phase Two consisted of a qualitative study exploring nurses’ knowledge and experiences related to trauma-informed care. The studies were conducted using a sequential approach; that is, the target sample for Phase Two (qualitative study) was identified based on the results of the survey (Phase One). Findings: From the first phase of this research, I proposed that social media, and specifically Facebook and LinkedIn, offer suitable platforms for recruiting a diverse sample of Registered Nurses to complete an online survey. Associated advantages and challenges as well as specific differences between Facebook and LinkedIn as recruitment platforms should be considered when incorporating these strategies. Four main categories emerged from the second phase of the research: “(Not)Knowing Trauma-Informed Care”, “Conceptualizing Trauma and Trauma- Informed Care”, “Nursing Care in the Context of Trauma”, and “Dynamics of the Nurse-Patient Relationship in the Face of Trauma”. These findings highlight important considerations for trauma including, the complex dynamics of trauma that affect care, the importance of both knowing trauma as a concept, but also knowing how to act in response to trauma knowledge, the need to facilitate trauma-informed care beyond mental healthcare, and the parallels between nursing and trauma-informed care. Conclusion: This Master’s thesis has explored the use of a novel survey recruitment strategy as well as emphasized the need for nurses and organizations to incorporate trauma-informed principles in the services they provide, and in their cultures as a whole. This research reinforces that the discipline of nursing is aptly situated to apply tenets of trauma-informed care and that we must further the progression of trauma-informed care in practice, policy, education, and research.

Background: The evidence base on end-of-life care in acute stroke is limited, particularly with regard to recognising dying and related decision-making. There is also limited evidence to support the use of end-of-life care pathways (standardised care plans) for patients who are dying after stroke. Aim: This study aimed to explore the clinical decision-making involved in placing patients on an end-of-life care pathway, evaluate predictors of care pathway use, and investigate the role of families in decision-making. The study also aimed to examine experiences of end-of-life care pathway use for stroke patients, their relatives and the multi-disciplinary health care team. Methods: A mixed methods design was adopted. Data were collected in four Scottish acute stroke units. Case-notes were identified prospectively from 100 consecutive stroke deaths and reviewed. Multivariate analysis was performed on case-note data. Semi-structured interviews were conducted with 17 relatives of stroke decedents and 23 healthcare professionals, using a modified grounded theory approach to collect and analyse data. The VOICES survey tool was also administered to the bereaved relatives and data were analysed using descriptive statistics and thematic analysis of free-text responses. Results: Relatives often played an important role in influencing aspects of end-of-life care, including decisions to use an end-of-life care pathway. Some relatives experienced enduring distress with their perceived responsibility for care decisions. Relatives felt unprepared for and were distressed by prolonged dying processes, which were often associated with severe dysphagia. Pro-active information-giving by staff was reported as supportive by relatives. Healthcare professionals generally avoided discussing place of care with families. Decisions to use an end-of-life care pathway were not predicted by patients’ demographic characteristics; decisions were generally made in consultation with families and the extended health care team, and were made within regular working hours. Conclusion: Distressing stroke-related issues were more prominent in participants’ accounts than concerns with the end-of-life care pathway used. Relatives sometimes perceived themselves as responsible for important clinical decisions. Witnessing prolonged dying processes was difficult for healthcare professionals and families, particularly in relation to the management of persistent major swallowing difficulties.

In Australia, the health care system is complex, constantly changing and comprised of multiple layers. Within this complex system, service fragmentation, care segmentation, and confusion about access to and provision of health care services, is likely to be the usual experience of both consumers and providers of health care. Chronic condition care coordination is frequently touted as one solution to these problems, but its implementation has been less successful. Given that access to the health care system most frequently originates in general practice, implementation within this context is particularly important. However, implementing chronic condition care coordination within general practice is not likely to be simple because a complete reorientation of general practice will be required, from an acute care focus towards the ongoing management of chronic conditions. Nurses (RNs) who work in general practice provide an opportunity for achieving this type of reorientation, but the sustainability of any changes will be dependent on the way in which practices become routinely embedded in the work of general practice. This research examines the implementation of RN-provided chronic condition care coordination in general practice. According to Normalization Process Theory (NPT) (May & Finch, 2009), the extent to which any new practice or innovation becomes embedded in usual practice is dependent on the extent to which its components are workable within the context and are capable of being integrated into existing ways of operating. Thus, the most appropriate theoretical framework to apply to the interpretation of this research is NPT.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Human Services and Social Work
Griffith Health
Full Text

Background: The concept woman-centred care is gaining currency in maternity care and is increasingly being used to guide provision of quality care. The midwifery philosophy supports woman-centred care and is associated with positive pregnancy and birth outcomes. Development of a woman-centred midwife-led model of care requires involvement of the users (women), service providers (midwives), and health administrators to ensure representativeness of the model. Purpose: The purpose of this study was to explore, through participatory methods, the views of women midwives and health service managers on current maternity care, and describe desired maternity care and develop a woman-centred maternity care model for Uasin Gishu County, Kenya. Methodology: Appreciative Inquiry 4-D cycle was used in the study. The Human Scale Development framework guided the study. Thirty two midwives, 85 women attending maternity and well-baby services at the facility, and four facility and three county health service managers participated in the study. Focus group discussions and interviews were carried out from May 2015 to April 2016 using the four phases of the Appreciative Inquiry cycle. Phase one “discovered” what best maternity care looks like, phase two “dreamt” what best maternity care would look like, phase three “designed” the model, and phase four “destiny” was used for development of implementation strategies. Data was analysed using thematic analysis augmented by thematic networks analysis and NVIVO 11 software. Ethical approval was obtained from the University of Cape Town and the Moi University and Moi Teaching and Referral Hospital Research Ethics Committees. Individual's participation was voluntary, informed consent was obtained and confidentiality maintained. There was no compensation for participation.

Background: Ethical issues experienced by healthcare providers can be associated with detrimental outcomes, however, little is known about the nature of these issues within palliative care provision in nursing homes. Aim: To provide a comprehensive understanding of care providers’ experiences of ethical issues during palliative care provision in nursing homes in the United Kingdom. Methods: A two phase, exploratory, sequential, mixed methods design was utilised. Semi-structured interviews with 13 Registered Nurses and ten Healthcare Assistants were used to explore ethical issues during palliative care provision. An instrument was developed measuring the frequency and level of distress associated with these ethical issues and utilised in a cross-sectional survey with 69 RNs and 129 HCAs. Results: Three themes grouped experiences of ethical issues. Issues in practice were found when conflicts arose between what felt right and the duty of care. Within this theme, making decisions in the residents’ best interests to prevent them from coming to harm (Mean = 2.68; SD= 1.24) was most frequently reported. Relational issues focused on conflicts within interpersonal relationships. Caring for residents who were only accepting small amounts or refusing food/fluids (Mean = 2.71; SD= 1.19) occurred most frequently. Organisational issues resulted from the structure and quality of services. Poor staff communication (Mean = 2.48; SD= 1.39); and lack of time (Mean = 2.36; SD= 1.44) resulted in the highest distress scores. No significant differences were identified between RNs and HCAs in the frequency (t= -.85, d.f. =196, p=.40), or level of distress (t= -.24, d.f. =176, p=.81) associated with ethical issues. Conclusions: Ethical issues within the UK nursing homes focus on acting within the duty of care, interpersonal relationships, and coping with a routinized organisational structure. Improved communication between healthcare professionals, residents, and families, and palliative care training may improve the palliative care experience.

Copy of author's previously published work inserted. Includes bibliographical references (leaves 273-283). Aims to identify if the current practice of post-operative vital sign collection detects complications in the first 24 hours after the patient has returned to the general ward setting using a combination of methods within a triangulated approach to data collection.

The health outcomes of men are significantly worse, when compared to their female counterpart, for the top 15 leading causes of death nationwide. At this time, men are not actively engaged in the healthcare system and didactic and clinical education does not adequately prepare providers to care for men or understand the psychology of masculinity. As of 2016 there were no primary care programs or medical schools that incorporated a specific course in men’s health promotion or the psychology of masculinity within their curriculum. This research study implemented one curricular module on the content of men’s health promotion and the psychology of masculinity. The researcher sought to understand what aspects of men’s primary healthcare and masculinity were taught within Primary Care Providers (PCP) didactic and clinical studies, what PCPs state was lacking from their curriculum, and how that translates to their ability to practice clinically. The research took place at six separate universities throughout the United States. Using a five-point Likert scaled survey, quantitative data was collected from students in six universities after they participated in a single module on men’s health promotion and masculinity. One month after students at the six universities went through the intervention, a second quantitative, five-point Likert Scale survey was collected that sought to determine what information from the module was applicable in their clinical education and settings after going through the intervention. The researcher then conducted six, qualitative, semi-structured, open-ended interviews with students who responded favorably to such an interview in quantitative evaluations through Qualtrics. Data analysis was completed through Wilcoxon Signed Rank Testing. Cohen’s d effect size was utilized to understand the significance of effect size within the data. Students in primary care agree that lack of timely healthcare, on behalf of men, is a stressor on the healthcare system and 100% of students agree they would welcome more content in their didactic education on men’s health promotion and the psychology of masculinity. Similarly, 94.5% of respondent’s state there is a need for primary care students to learn how to engage men in primary preventive care with 77% of respondents requesting more gender specific training. Students that went through the educational endeavor found value in the content delivered with 83.4% of participants stating they planned to make changes in their practice as a result of going through the educational module. Quantitative findings revealed that less than 20% of those surveyed are consistently utilizing evidence based interventions noted in literature to recruit and retain men into primary preventive care. Qualitative interviews noted that participants found themselves unconsciously unaware of their limitations in caring for men in the primary care setting, but fully aware that diverse and holistic care improves patient outcomes. Qualitative respondents also expressed a desire to grow professionally and a willingness to engage in pioneering practices that would equip them to deliver excellence in care.

Thesis (MPhil (Curriculum Studies))--Stellenbosch University, 2008.
Background to the study: The Critical Care nursing programme at the Faculty of Health Sciences (Stellenbosch University) is a one-year programme. The practical component consists of practical procedures and case presentations. Students have limited time available in the clinical areas to reach competency in the practical skills. Students tend to use the majority of the clinical teaching time available to reach competency in these practical procedures, rather than discussing the patient and learning the skills to integrate and understand the patient’s condition and treatment, which they can acquire by doing case presentations. The end result of this misuse of clinical contact time is that some of the students, by the end of their programme, still have difficulty to integrate a patient’s diagnosis and treatment regime, although they have managed to complete the expected practical procedures. Summary of the work: A case study design was used. I wanted to investigate whether one could make use of simulation and the Clinical Skills Centre (CSC) to complete the majority of the practical procedures so that more time would be available in the clinical areas for the students to do case presentations. The study focuses on describing how the tutors and students involved experienced the use of simulation, as well as how it impacted on the available teaching time in the clinical areas. Conclusions and recommendations: Some of the most important issues that were highlighted in the study and needs to be mentioned are the following: · The students highly valued supervision by a Critical Care tutor when practising their skills in the CSC. · Students indicated that they valued the opportunity to practise some of the more risky procedures in simulation, because it presents no risk to patients. · Case presentations seem important to be added to the CSC’s practical sessions in order to attempt making the practical simulated scenarios even more realistic. · The teaching at the bedside in the clinical areas used to be done somewhat ad hoc. With the teaching in the CSC now being much more structured, this necessitates the teaching at the bedside to be revisited and to be structured to a certain extent. Summary of the results: The information obtained from the Critical Care tutors and the students indicated that these two groups were largely in agreement that simulation seems to be valuable and can effectively be used in a Critical Care nursing programme.

Background: There is significant concern about nurse burnout in nursing homes. There has been little research to investigate whether training in person-centred care and supervision can reduce nursing home nurses’ burnout. Aims: To adapt training to be suitable for nursing home nurses and evaluate the impact of training and supervision on burnout and related outcomes. Study Design: Focus groups with nursing home nurses were used to inform adaptation of the training. Mixed methods were used to evaluate the impact of training and supervision employing a convergent parallel design, including a Randomised Controlled Trial with quantitative measures (primary outcome measure: the Maslach Burnout Inventory) to assess effectiveness and exploration of subjective experience using qualitative interviews. The findings of the RCT and qualitative interviews were then compared to determine the convergences and divergences. Findings: The training was adapted to include content on leadership and stress management. Hypotheses that the interventions would reduce burnout and impact on other quantitative outcomes were not supported. Qualitative interviews with nursing home nurses about training indicated that the nurses reported reduced burnout, enhanced self-efficacy, reduced isolation, better team working, more informed person centred dementia care and enhanced leadership. Nurses’ views on the impact of supervision included a range of benefits. There was convergence between quantitative measurement and subjective experience indicting significant levels of burnout, but divergence in terms of the impact of training in person-centred care and supervision. Conclusions: My study demonstrates that burnout is a significant issue for nursing home nurses in the UK. There was divergence in my findings in terms of the impact of training in person-centred care and supervision. The hypotheses about training and supervision having positive impact on burn-out were rejected. However, the qualitative findings suggest that nursing home nurses experienced positive benefits from the person-centred training and supervision, in particular on their sense of burnout, their approach to care and leadership skills. Recommendations are made regarding research, training and policy to address burnout in nursing home nurses.
Burdett Charitable Trust of Nursing

Bakgrund: Trycksår uppstår som en komplikation av vård, behandling och sjukdom varvid dessa kan uppkomma redan efter 60 minuter. Förekomsten av trycksår år 2016 ligger på 13,4 % i medelvärde över hela Sverige, vilket i jämförelse med 2015 enbart är en sänkning med 0,2%. Syfte: Att beskriva vilka omvårdnadsåtgärder sjuksköterskan kan vidta i sitt arbete för att förebygga trycksår samt att redovisa vilken urvalsmetod som använts i de valda artiklarna. Metod: Litteraturstudie med deskriptiv design som grundades på tretton artiklar av kvantitativ ansats från databaserna Cinahl och Pubmed. Huvudresultat: Resultatet av ovanstående litteraturstudie medförde fyra olika teman:1) Riskbedömning: Genom att göra en riskbedömning på patienterna inom 24 timmar efter inläggning kunde en minskad trycksårsprevalens ses. 2) Lägesändringar: Lägesändringar på patienterna varannan timme visade att uppkomsten av trycksår minskar. Vidare har det visats att positioner liggande i 30 grader är den metod som ger bäst utgång. 3) Tryckavlastning: En användning av olika tryckavlastande medel har påvisat att trycksår reducerats hos patienterna. Den bästa metoden sett utifrån skillnader på kontroll och interventionsgrupper för tryckavlastning som framkommit i föreliggande studie är användning av silicone border. 4) Samling av preventiva omvårdnadsåtgärder: En användning av olika protokoll med flertalet omvårdnadsåtgärder för att minska uppkomsten av trycksår har visat sig ge mycket god effekt. Metodologisk aspekt: 11 av artiklarna hade en tydlig redogörelse för urvalsmetoden, varav resterande två artiklar saknade beskrivning om hur urvalet hade genomförts. Slutsats: Genom föreliggande litteraturstudie har det framkommit att ovanstående teman kan användas av sjuksköterskan i det dagliga arbetet för att minska riskerna för trycksår hos sina patienter.
Background: Pressure sores occur as a complication of care, treatment and disease where these can occur already after 60 minutes. The incidence of pressure ulcers in 2016 at 13.4% averaged over the whole of Sweden, as compared to 2015 is a reduction of only 0.2%. Aim: To describe the nursing care nurse can take in their work to prevent pressure sores and to report the selection method used in the selected articles. Method: Literature study with descriptive design that was based on thirteen articles from the databases CINAHL and Pubmed. Findings: The result of the above literature led four different themes: 1) Risk Assessment: By making a risk assessment of patients within 24 hours of hospitalization the risk of pressure sores was reduced. 2) Location Changes: Location Changes to the patients every two hours showed that the incidence of pressure ulcers decreased. Further, it has been shown that positions lying at 30 degrees is the method that provides the best output. 3) Pressure relief: Use of different pressure relieving agents have shown to reduce pressure sores in patients. The best method seen from differences in the control and intervention groups for pressure relief in this study is the use of a silicon border. 4) Collection of preventive care measures: The use of different protocols with several different care methods to reduce the occurrence of pressure sores have shown the best effect. Methodological aspect: 11 of the articles had a clear description of the sampling method, with the remaining two items missing description of how the selection had been made. Conclusion: The present literature review has shown that the above themes can be used by nurses in their daily work to reduce the risk of pressure ulcers in patients.

The dependence of cardiac output measurement precision on ambient temperature and cardiac output stability was assessed by concurrent continuous and bolus thermodilution methods in postoperative cardiac surgery patients. The degree of agreement between the two methods was depended on room temperature (0.1 L/min for each degree below 25 degrees C). The agreement was also closer in trials where cardiac output was stable (< 10% variation). The continuous thermodilution method shows sufficient agreement with the bolus method for use in critical care; however, improved precision of cardiac output thermodilution measurements can be achieved by use of correction factors for cardiac instability and for ambient temperature.

Background: People with cancer are increasingly turning to the internet to find information and support. However, little is known regarding the use of the internet and how this impacts patients’ cancer experiences and their interactions with, and within, the healthcare system. Purpose and objectives: The overarching purpose of this dissertation is to explore the ways that patients newly diagnosed with cancer use cancer-related internet information (CRII) and the role it plays in interactions with the healthcare system. The specific objectives were to: (1) qualitatively explore the content of commonly searched websites from a critical nursing perspective; (2) explore patients’ prompts to use CRII and how CRII informs the ways in which patients interact with healthcare professionals and healthcare services, and (3) document what CRII is accessed and the patterns and frequency of use. Methods: An embedded mixed methods study was conducted using interpretive description as the overarching methodology. Date sources included: (1) a qualitative review of 20 cancer websites; (2) 19 individuals newly diagnosed with cancer, who each took part in two in-depth interviews and a brief survey; and (3) 21 healthcare professionals who engaged in three focus groups (n=17) and in-depth individual interviews (n=4). Results: The dominant discourse in the websites reviewed focused on empirical information about treatment, prognosis, and cure. A dearth of sociopolitical, ethical, personal, and esthetic information was noted. Thus, when seeking CRII, patients predominantly find empirical and biomedical information. The qualitative interviews with patients revealed three key themes that characterize how patients used CRII: (1) person in context, (2) management of information, and (3) managing relationships with healthcare professionals. These themes explain how patients mobilized CRII to manage their patient experience. Patients described CRII as an important resource to process information, make decisions about their illness, and make sense of their disease. Patients also sought CRII to complement and reinforce information and support provided by healthcare professionals. The interviews and focus groups with healthcare professionals revealed two key themes with respect to their views of CRII use. These themes relate to healthcare professionals’ perceptions of patient use of the internet to manage their pragmatic concerns and priorities as well as to navigate processes and practices of the healthcare system. Healthcare professionals found that CRII could modulate patients’ interactions with the healthcare system. Healthcare professionals also acknowledged key points in the cancer trajectory where information may be lacking or where patients may have less informational support; participants felt that CRII served as a beneficial resource to address these gaps. Although healthcare professionals were supportive of patient use of CRII to meet cancer information needs, they also described concerns regarding patients finding and using untrustworthy information. Conclusions: Together, the findings from this dissertation research inform an understanding of how people with cancer use CRII to manage their cancer experience and interact with healthcare professionals and services. Findings highlight the importance of information diversity in the midst of a lack of holistic and varied information presently online. There is also a need for nurses and other healthcare professionals to be aware of the information that is available online and to understand what patients are accessing. Communication about CRII between patients and healthcare professionals may also strengthen areas of patient education that are lacking as well as encourage healthcare professionals to raise key topics of interest. Implications for Practice: There is clearly a growing need for dialogue around pervasive technologies and the nursing role in assessing and directing patients to holistic information. Oncology nurses are well situated to take the lead in their multi-disciplinary care teams to engage patients about their CRII use and to explore the tensions experienced by clinicians surrounding CRII use. CRII use is a growing trend amongst patients across all healthcare settings, and nurses are well positioned to initiate discussions and be leaders in practice. Future research is warranted to expand on the link between CRII use and the utilization of health services, the role of CRII for those in rural areas compared to those in urban areas, and the role of the family in patients’ mobilization of CRII in their cancer experience.

In this study, certified nursing assistants (CNAs) who work regularly with long-term care residents with dementia were interviewed to investigate whether they considered providing social and emotional support to people with dementia an important part of their jobs. They were given an online survey, then each participated in an in-person interview that was recorded and later transcribed and analyzed for common themes. Through data analysis, I found that the participating CNAs unanimously considered social support to be an important aspect of caring for someone with dementia, and several personal values were associated with this perspective. They also reported the trainings they had received in preparation for dementia care were largely not sufficient to prepare them for interacting effectively with the residents. Additionally, they cited various other barriers that impede their ability to provide the social support they feel is necessary to provide. Overall, this sample of CNAs did not provide great diversity, and future research should compare these results to more diverse groups.

Bakgrund: Självskadebeteende är skador mot den egna kroppen genom att skära, rispa eller bränna sig utan avsikt att ta sitt liv. Det framkommer att personal känner bristande förståelse och frustration för patienter med självskadeproblem och att de inte vet hur man ska ta hand om dem. Syfte: Att beskriva hur sjuksköterskor inom psykiatrisk heldygnsvård upplever att vårda patienter med självskadebeteende. Metod: En kvalitativ metod användes och datainsamling skedde via intervjuer med sjuksköterskor inom den psykiatriska heldygnsvården (n=14). Materialet transkriberades och analyserades med innehållsanalys. Resultat: Analysen resulterade i ett tema, tre kategorier och sex underkategorier. Temat blev ”Vad göra”, de tre kategorierna blev ”En patientgrupp i nöd”, ”En patientgrupp som berör” och ”En behövande profession”. De sex underkategorierna blev ”Dåtidens brister”, ”I stridens hetta”, ”Mig som sjuksköterska”, ”Oss i personalgruppen”, ”I behov av stöd och vägledning” och ”I kunskapstörst”. Konklusion: Patienter med självskadebeteende berör den enskilda sjuksköterskan men också personalgruppen. Upplevelser vittnar om en patientgrupp i nödliknande situation både förr och idag. Förhoppningen är att med stöd, ökad kunskap och vägledning till verksamma sjuksköterskor förändra upplevelserna av att vårda patienter med självskadebeteende
Background: Self-harm is damage to the own body and includes cut, scratch or burn without intending to take one´s own life. It appears that staff feel lack of understanding and frustration for patients who self- harms and that they don´t know how to care for them. Aim: To describe nurses experiences of caring for patients who self- harm in psychiatric inpatient care. Methods: A qualitative approach was used and data collection was done through interviews with nurses in psychiatric inpatient care (n = 14). The interviews were transcribed and analyzed by content analysis. Results: The analysis resulted in one theme, three categories and six subcategories. The theme was "What to do", the three categories were "A population in need", "A population who affect" and "A profession in need". The six subcategories were "The inadequacies of yesterday”, "In the heat of battle," "Me as a nurse," "us in the personnel”, " "In need of support and guidance," and "In thirst for knowledge". Conclusion: Patients who self- harm affects the individual nurse but also the staff group. Experiences indicate a patient population with a situation in needs, both past and present. It is hoped that with the support, increased knowledge and guidance to the active nurses changing experiences of caring for patients with self-injurious behavior.

The purpose of the study was to examine reproductive life planning practices among Title X family planning health care providers and clinical staff. Reproductive life planning is a program priority for Title X clinics, those that receive federal money for providing family planning services to low-income women and men. The goal of reproductive life planning is to decrease unwanted and unintended pregnancies and improve preconception health care however; this practice has not been described. First, a conceptual analysis was conducted to create a definition of reproductive life planning that was consistent with the literature. Reproductive life planning is a process that is centered on reproductive and other life goals and is personalized, collaborative, fluid, and focused on health-promotion. Second, a mixed methods design was used to examine reproductive life planning practices and qualitative interviews were conducted to explore barriers and facilitators to implementing reproductive life planning practices. Data were obtained from health care providers and clinical staff employed at Title X clinics in Illinois, Iowa, Minnesota, Missouri, Nebraska, and North Dakota. A total of 148 clinicians completed a web-based survey which was analyzed to describe which types of patients, the topics covered, and the frequency with which reproductive life planning was discussed during an office visit. Surveys were then examined to identify 20 providers to conduct qualitative interviews with to further explore reproductive life planning practices. The qualitative interviews were also performed to explore the barriers and facilitators clinicians face to practicing reproductive life planning. The results of the web-based questionnaire were examined mainly with medians and frequencies to examine reproductive life planning practices. Qualitative interviews were coded using a content analysis approach to two aims; one to examine how reproductive life planning was using during clinic visits and two, to identify the barriers and facilitators clinicians face when discussing reproductive life planning with patients. Findings from the survey and the interviews suggest that most clinicians are discussing pregnancy intentions with their patients. However, from the interviews, three types of scope of reproductive life planning emerged; those clinicians who screened their patients’ pregnancy intentions, those who planted the seed in the patient’s mind, and those who explored the context of a patient’s life and their goals to contextualize how pregnancy and childbearing would fit into their lives in order to clarify pregnancy intention and move toward the corresponding health behaviors. It is argued that the third group of providers is using reproductive life planning as intended by experts. Finally, barriers to RLP discussions were examined as well as approached providers used to overcome the barriers. In conclusion, many clinicians are practicing reproductive life planning as intended, however many are not. Improved training and protocols are needed to ensure clinicians are providing their patients with the best reproductive life planning discussions. Additionally, systemic structures, like access to quality family planning services, need to be improved to aid clinicians in helping their patient plan their families.

Patients in psychiatric care experience a need for and expect to develop interpersonal relationships with professional caregivers and to be respected and listened to. Despite demands for care to be person-centred and recovery-oriented, patients experience that psychiatric inpatient care fails to meet their expectations. Nursing research suggest that nurses aspire to engage with and meet the needs of patients, but that the strenuous reality of inpatient care prevents them from doing so. Exploring the content and context of psychiatric inpatient care from the perspective of professional caregivers might provide valuable insights regarding what caregivers do, and more importantly it can aid in understanding why they do what they do.This thesis aimed to explore the content and context of adult psychiatric inpatient care from the perspective of professional caregivers. This was achieved by clarifying the concept of person-centred care in the context of inpatient psychiatry, describing staff members’ reasoning on their choice of action and perceptions of interprofessional collaboration in challenging situations in inpatient psychiatric care settings, and exploring nurses’ experiences of good nursing practice in the specific context of inpatient psychiatry. A systematic review of the literature identified 34 scholarly papers that were analysed using evolutionary concept analysis. Focus group interviews were conducted with 26 professional caregivers and analysed using qualitative content analysis. Individual qualitative interviews were conducted with 12 skilled, relationship-oriented nurses and analysed using an interpretive descriptive approach to qualitative analysis.Reviewing the literature on person-centred care in inpatient psychiatry clarified how person-centred care is expected to result in quality care when interpersonal relationships are used to promote recovery. Professional caregivers’ reasoning on choice of action described different concerns in caregiver-patient interaction resulting in a focus on either meeting patients’ individual needs or solving staff members’ own problems. Describing professional caregivers’ perceptions of interprofessional collaboration suggested that they are being constrained by difficulties in collaborating with each other and a lack of interaction with patients. Exploring nurses’ experiences of good nursing practice revealed how circumstances in the clinical setting affect nurses’ ability to work through relationships. It is argued that these findings describe the workings of two opposing forces in psychiatric inpatient care. The concept of caring as a process forms the basis for discussing the content of care as a moral endeavour in which nurses strive to do good. The concept of demoralizing organizational processes is used to discuss the context of care as demoralizing and allowing for immoral actions.The main conclusions to be drawn are that, from a nursing perspective, nurses in psychiatric inpatient care need to focus on patients’ experiences and needs. For this they need sufficient resources and time to be present and develop relationships with patients.Nurses in psychiatric inpatient care also need to take personal responsibility for their professional practice. Attempts to transform psychiatric care in a person-centred direction must consider all of these aspects and their interrelatedness. Further research on psychiatric inpatient care is needed to understand more about how the content of care relates to the context of care.

Godkänd; 2015; 20150526 (sebgab); Akademisk avhandling som med vederbörligt tillstånd av Filosofiska fakulteten vid Luleå tekniska universitet för avläggande av Filosofie doktorsexamen kommer att offentligen försvaras i Deltasalen, D 770, Luleå tekniska universitet fredagen den 25 september 2015, kl. 10.00. Fakultetsopponent: Docent Ulla Hällgren Graneheim, Institutionen för omvårdnad, Umeå universitet Betygsnämnd: Professor Margareta Lilja, Institutionen för hälsovetenskap, Luleå tekniska universitet Professor Johan Sandström, Institutionen för ekonomi, teknik och samhälle, Luleå tekniska universitet Docent Lauri Kuosmanen, Institutionen för omvårdnad, Åbo universitet Huvudhandledare: Professor Stefan Sävenstedt, Institutionen för hälsovetenskap, Luleå tekniska universitet Biträdande handledare: Universitetslektor Malin Olsson, Institutionen för hälsovetenskap, Luleå tekniska universitet Professor Rolf Adolfsson, Institutionen för klinisk vetenskap, Umeå universitet

The welfare of the elderly population is one of the most important goals of the public health services. At macro level the Swedish National Board of Health and Welfare state that the premier goal is for elderly people to have dignified and comfortable lives. They should have a life with a sense of value and feel confident. These ethical values which are expressed on macro level or as normative ethics are expected to prevail at micro level. In our study the micro level is the caring encounter between the elderly patient, next of kin and nurses. Ethical values and morals are important aspects that influence the quality of care, videlicet in empiric ethics.

The aim of study (I) was to identify and describe the ethical values experienced by the older person in the daily interaction with nurses in a ward for older people during caring encounters. In study (II) the aim was to identify and describe the governing ethical values that next of kin experience in interaction with nurses who care for elderly patients at a geriatric clinic. Study (I) which was an empirical observational study included follow-up interviews. Twenty-two older people participated voluntarily. In study (II) interviews with fourteen next of kin were conducted. In both studies Constant comparative analysis, the core foundation of grounded theory was used.

Five categories; Being addressed, receiving respect, desiring to participate, increasing self-determination and gaining self-confidence formed the basis for the core category in study (I): Approaching. Approaching concerns the way people become closer to each other in a physical space .It also includes how people become closer to each other in a dialogue, which involves verbal or bodily communication. Approaching indicates the ethical values that guide nurses in their caring encounters with older people. This ethical value is noted by the older person and has an individual value, as well as leading to improved quality of their care. The older person will be confident and satisfied with the caring encounter if the desired components in the nurse’s approaching are exhibited.

Four categories were identified in study (II): Receiving, showing respect, facilitating participation and showing professionalism. These categories formed the basis of the core category: “Being amenable”, a concept identified in the next of kin’s description of the ethical values that they and the elderly patients perceive in the caring encounter. Being amenable means that the nurses are guided by ethical values; taking into account the elderly patient and next of kin. Nurses who focus on elderly patients’ well-being as a final principle will affect next of kin and their experience of this fundamental situation.

Bakgrund : Sjuksköterskans roll i omvårdnad inom rättspsykiatrin är komplex. Detta på grund av att utöver omvårdnaden, skall även en säker miljö upprätthållas. Tvångsåtgärder kanske också måste utföras, vilket kan påverka sjuksköterskans etiska och moraliska principer. Den mest framträdande uppgiften sjuksköterskan har är dock att genom en sjuksköterska-patient relation skapa hälsa och välbefinnande samt ge patienter en chans till att växa och utveckla sina beteende. Syfte: Syftet med studien var att beskriva aktuell forskning om sjuksköterskans attityder inom den rättspsykiatriska omvårdnaden. Metod: Litteraturöversikt som inkluderar elva kvalitativa studier. Studierna som tagits fram har analyserats och teman identifierats. Databassökningar har genomförts i PubMed, CINAHL, SveMed+ och PsycINFO. Resultat: Tre huvudteman och två subteman identifierades. Första huvudtemat var sjuksköterskans roll med subteman relationens faser och säkerhet och tvångsåtgärder. De andra två huvudteman som identifierades var maskulinitet och copingstrategier. Slutsats : De affektiva attityderna som sjuksköterskan upplever kan styra mycket av de beslut och handlingar som utförs. Detta kan påverka patienters hälsa, välbefinnande och utvecklande. Män ansåg sig själva att genom handlingskomponenten bidra till en trygg och säker miljö.
Background: The nurse has a complex role of nursing care in a forensic care setting. This due to in addition to nursing care, also a safe environment should be preserved. Coercive measures may also have to be carried out, which can affect nurse´s ethical and moral principles. The most prominent task the nurse has are however to create health and wellbeing through nurse-patient relation as well as to offer the patient an opportunity to grow and to develop his behavior. Aim: The aim with this study was to describe current research of the nurse’s attitudes about nursing care in forensic care settings Method: Literature review including eleven qualitative studies. The studies have been analyzed and themes has identified. Database searches are made in PubMed, CINAHL, SveMed+ and PsycINFO. Results: Three main themes and two sub themes were identified. The first main theme was the nurse role with the sub themes the phases of a relationship and safety and coercive measures. The two other main themes that were identified are masculinity and coping strategies. Conclusion: The affective attitudes that the nurse experiences can control much of the decisions and actions that are performed. This can affect patients' health, well-being and development. Men considered themselves to contribute, through the action component, to a safe and secure environment.

Induktiv intervjustudie med syfte att beskriva vilka erfarenheter sjuksköterskor verksamma inom somatisk vård har av att vårda personer med psykossjukdom. Resultatet visar att sjuksköterskor inom den somatiska vården har relativt mycket erfarenhet av att vårda personer med psykossjukdom. Den specifika psykiatriska kompetensen uppfattades otilräcklig och vårdandet innebar ofta känslosamma möten.

Background: Contemporary literature identifies that clinical deterioration in the acute care setting requires an optimum level of management and that the failure to recognise this deterioration and respond effectively results in increased mortality rates. The early detection of clinical deterioration and the successful rescue of a patient relies heavily on the effectiveness of hospital systems, communication systems and multidisciplinary collaboration. Objectives: To evaluate the effectiveness of the strategies implemented to improve the escalation of care for patients who deteriorate in hospital. Specifically, the study examined the introduction of a revised observation chart, the experiences of nurses in using the chart, and whether its use resulted in the appropriate escalation of care. Method: A mixed-methodology approach combining a longitudinal study design with cross-sectional data collection. A quantitative research method was adopted to extract the results from the medical records of patients who had experienced a Medical Emergency Team (MET) call and establish the rate of compliance with the new policy. Patient information sourced from administrative datasets, including discharge abstracts extracted from the hospital's morbidity system and MET call database, were used to determine changes in the rates of MET calls and mortality pre- and post- policy implementation. Qualitative data collection involved focus group discussions on nurses’ experiences of implementing the policy and use of the Adult Observation Response Chart tool. The study was undertaken in the multi-day wards at one of Western Australia’s tertiary hospitals, where a new escalation policy was implemented as part of the State healthcare policy for the recognition of, and response to, the deteriorating patient. Results: A statistically significant increase in the rate of MET calls in the post-policy intervention period compared to the pre-policy intervention phase was observed, the odds increasing by 12% post-policy intervention. Additionally, the study found a strong correlation between the number of MET calls and the Charlson Index Score (the higher the Charlson Index Score, the more likely a MET call was made). Mortality rate was not significantly different between the two periods after adjustment for other relevant factors. Three major themes were identified: chart design, communication, and the impact of the policy implementation on nurses and patients. Conclusion: Recognising, responding to, and managing the deteriorating patient is complex, challenging, and multifaceted. The study highlighted the need for effective strategies to support the recognition of clinical deterioration and response in critical situations to enhance patient safety, optimise resources and positively change practice. Findings from the study emphasised the challenges faced when implementing a new policy leading to a change in practice. Recommendations include the refinement of policy and removal of barriers that can impact the implementation of evidence-based practice and the opportunity to improve patient outcomes.

The purpose of the study: The purpose of this study is to investigate the influence of cultural diversity, in a multicultural nursing workforce, on the quality and safety of patient care and the work environment at King Abdul-Aziz Medical City, Riyadh region. Study background: Due to global migration and workforce mobility, to varying degrees, cultural diversity exists in most health services around the world, particularly occurring where the health care workforce is multicultural or where the domestic population comprises minority groups from different cultures speaking different languages. Further complexities occur when countries have a multicultural workforce which is different from the population for whom they care, in addition to the workers being from culturally diverse countries and with different languages. In Saudi Arabia the health system is mainly staffed by expatriate nurses who comprise 67.7% of the total number of nurses. Study design: This research utilised a case study design which incorporated multiple methods including survey, qualitative interviews and document review. Methods: The participant nurses were selected for the survey via a population sampling strategy; 319 nurses returned their completed Safety Climate Survey questionnaires. Descriptive and inferential statistics (Kruskal–Wallis test) were used to analyse survey data. For the qualitative component of the study, a purposive sampling strategy was used; 24 nurses were interviewed using a semi-structured interview technique. The documentary review included KAMC-R policy documents that met the inclusion criteria using a predetermined data abstraction instrument. Content analysis was used to analyse the policy documents data. Results: The data revealed the nurses‘ perceptions of the clinical climate in this multicultural environment is that it was unsafe, with a mean score of 3.9 out of 5. No significant difference was detected between the age groups or years of experience of the nurses and the perception of safety climate in this context; the study did reveal a statistically significant difference between the cultural background categories and the perception of safety climate. The qualitative phase indicated that the nurses within this environment were struggling to achieve cultural competence; consequently, they were having difficulties in meeting the patients‘ cultural and spiritual needs as well as maintaining a high standard of care. The results also indicated that nurses were disempowered in this context. Importantly, there was inadequate support by the organisation to manage the cultural diversity issue and to protect patients from any associated risks, as demonstrated by the policy documents and supported by the nurses‘ experiences. The study also illustrated the limitations of the conceptual framework of cultural competence when tested in this multicultural workforce context. Therefore, this study generated amendments to the model that is suitable to be used in the context of a multicultural nursing workforce. Conclusion: The multicultural nature of this nursing work environment is inherently risky due to the conflicts that arise from the different cultural norms, beliefs, behaviours and languages. Further, there was uncertainty within the multicultural nursing workforce about the clinical and cultural safety of the patient care environment and about the cultural safety of the nursing workforce. The findings of the study contribute important new knowledge to the area of patient and nurse safety in a multicultural environment and contribute theoretical development to the field of cultural competence. Specifically, the findings will inform policy and practice related to patient care in the context of cultural diversity.

Using Action Research, Implementation Science, and Institutional Ethnography, this practice-focused research explored inhibiting and promoting factors related to implementing buprenorphine treatment within HIV primary care while simultaneously developing, installing and initially implementing an interdisciplinary buprenorphine treatment/practice. Data was collected and analyzed using constructivist grounded theory method strategies. Data collection/generation included documentary analysis, key informant interviews, field data from collaborative interdisciplinary team processes, researcher reflective practice, a patient focus group, and an interdisciplinary buprenorphine treatment/practice manual.

The research had several achievements. It identified three key implementation inhibiting categories, (1) significant and persistent bias, (2) plaguing and difficult questions, and (3) buprenorphine expectionalism. It also developed countering implementation promoting categories, (1) be an educated advocate and dispel myths, (2) identify core components of interdisciplinary buprenorphine treatment and uniformity of care, and (3) dementionalizing interdisciplinary treatment/practice. It exposed scope of practice issues and mapped out the specifics of the types of services each discipline would provide, the detail of those practices, their coordination, as well as the areas of practice where there was joint responsibility and overlap. It increased the capacity and competences of the research organization and the 18 interdisciplinary buprenorphine team members. It also explicated the many forms of power operating in the study and the importance of power sharing, adapting treatment, leadership support, structural components and resources on the development and implementation process.

This study shed light on the reality that prescribing buprenorphine and taking up the practice of treating opioid dependence/addiction means that clinicians must be prepared and skilled to provide care where issues of life and death, emotional distress, and significant uncertainties are part of the landscape. The study findings also highlight that balancing safety (both patient and staff) with control and authority is an important aspect of buprenorphine treatment. An interdisciplinary focus expanded the concept of treatment and addressed many important aspects of caring for people with opioid dependence/addiction that often go unaccounted for and/or unnoticed. Without an interdisciplinary frame, patients are at risk for receiving substandard care. This study demonstrated that the interdisciplinary practices needed to provide quality care and improve health outcomes are interdependent.

Thesis advisor: Dorothy Jones
The importance of the nurse-patient relationship to the overall well- being of the person has been explored extensively by nurses. What is largely missing from this knowledge developed to date is the patient's perspective. The purpose of this study was to develop a reliable and valid measure of patients' perceptions of feeling known by their nurses during an acute, surgical, hospital admission. The development of the PPFKN Scale was guided by Newman's theoretical framework of Health as Expanding Consciousness (1994) and data from a qualitative descriptive study conducted in 2003 (Somerville). The current investigation focused on the development and psychometric testing of the PPFKN Scale. The four themes that emerged from the earlier qualitative study were used to guide the development of the 85-item scale. This scale was exposed to a panel of nurse experts to establish inter-rater agreement and content validity, item understandability and readability. The revised scale was piloted with five participants who had experienced an inpatient, surgical admission to determine content validity, item readability and understandability. The revised 77-item scale was then administered to 327 surgical inpatients across seven general care units at a large academic urban medical center. A sample size of 296 completed surveys was analyzed. A four-component solution was devised using Principal Components Analysis with Varimax rotation. This four-component solution accounted for 63.3% variance, with a total scale Cronbach's alpha coefficient of 0.99. A component loading cut-off was set at 0.3 and items not loading at this value on the expected component were dropped. This process resulted in a reliable and valid 48 item PPFKN Scale with four components and a total scale Cronbach's alpha coefficient of 0.98
Thesis (PhD) — Boston College, 2009
Submitted to: Boston College. Connell School of Nursing
Discipline: Nursing

Older people should have a life with a sense of value and should feel confident. These ethical values, which are expressed in normative ethics, are expected to prevail in empirical ethics. Central components of nursing are the ethical issues of autonomy, beneficence, non-maleficence and the principles of justice. The general aim of this thesis is to identify and describe the ethical values that are apparent in the caring encounter and their influence on the people involved. This is done from the perspective of the older person in study (I), next of kin in study (II) and nurses in study (III). In study (IV) the aim was to synthesize the concepts from empirical studies (I- III) and analyze, compare and interrelate them with normative ethics. Studies (I, III) were empirical observational studies including follow-up interviews. Twenty-two older people participated voluntarily in study (I), and in study (III) 20 nurses participated voluntarily. In study (II) fourteen next of kin were interviewed. In studies (I- III) constant comparative analysis, the core foundation of grounded theory, was used. Five concepts were used in the analysis in study (IV); three from the grounded theory studies (I- III) and two from the theoretical framework on normative ethics i.e. the ICN code and SFS law. Five categories; being addressed, receiving respect, desiring to participate, increasing self-determination and gaining self-confidence formed the basis for the core category ‚Approaching‛ in study (I). ‘Approaching’ indicates the ethical values that guide nurses in their caring encounters with older people. These ethical values are noted by the older people and are greatly appreciated by them, and also lead to improved quality of care. Four categories were identified in study (II): Receiving, showing respect, facilitating participation and showing professionalism. These categories formed the basis of the core category ‚Being amenable‛, a concept identified in the next of kin’s description of the ethical values that they and the older patients perceive in the caring encounter. In study (III), three categories were identified: showing consideration, connecting, and caring for. These categories formed the basis of the core category ‚Corroborating‛. Corroborating deals with support and interaction. Empirical ethics and normative ethics are intertwined, according to the findings of this study (IV). Normative ethics influence the nurse’s practical performance and could have a greater influence in supporting nurses as professionals. Criteria of good ethical care according to this thesis are: showing respect, invitation to participation, allowing self-determination, and providing safe and secure care. These criteria are elements of the concept of being professional. Professionalism of nurses is shown by: the approach nurses adapt to the performance of their duties, and their competence and knowledge, but also how they apply laws and professional codes

Reflective practice, though ill-defined, has become an accepted educational concept within many health care disciplines particularly in nursing. Subsequently it has become benchmarked within Paramedic Sciences as a professional requirement for continuing education and clinical practice. However, despite the vast literature in nursing and the increasing growth of reflective practice in paramedic curricula it is unclear how it influences the students’ learning in preparation for graduate practice as future reflective practitioners. This research explored ‘to what extent does reflective practice in the paramedic curriculum influence the students’ academic and clinical learning leading to graduate practice’? A mixed methods approach with cohort samples of undergraduate health care students comprised four studies including surveys and non-participant observations of clinical simulation that were conducted in a university learning environment. The results showed overall that Paramedic students believed that they understood reflective practice and perceived it to be useful for their academic studies and clinical practice; although this is probably influenced more by formal teaching rather than the result of their own views. Students were able to describe reflective practice in ideal theoretical terms and were positive towards it regardless of their individual learning styles. However, in a clinical context, they applied it differently with significant emphasis on technical reflection. Evidence of the nature of reflective practice as it occurred during and after clinical simulation scenarios highlights a need for revised approaches to existing learning/teaching strategies with paramedic students. An extended understanding and refinement of reflective practice concepts including a new pedagogic framework to promote enhanced reflectivity are proposed. This theoretical framework is designed to accommodate reflective learning for both personal and collaborative learning related to curriculum outcomes. The use of clinical simulation for the development of reflective practice in the paramedic curriculum is supported with recommendations for further studies in academic and clinical settings.

The overall aim of the present thesis was to investigate experiences of living with multidrug-resistant bacteria (MDRB), using methicillin-resistant Staphylococcus aureus (MRSA) colonization as an illustration, and to develop and validate a tool to describe healthcare personnel’s attitudes towards patients with MDRB. A further objective was to study MRSA-colonized persons’ and healthcare personnel’s experiences of patient-professional interactions and responsibilities for infection prevention. Four empirical studies were conducted. A total of 18 MRSA-colonized persons and 20 healthcare personnel were interviewed regarding their experiences, and a total of 726 RNs responded the MDRB Attitude Questionnaire. The findings revealed the difficulties associated with living with MRSA colonization, which was described as something uncertain, and as an indefinable threat that has to be managed in both everyday life and in contacts with healthcare. Interactions with healthcare personnel were described as unprofessional owing to personnel’s inappropriate behaviour and insufficient information provision. According to the personnel, achieving adequate patient-professional interactions required having knowledge and experiences of MRSA. They also experienced difficulties in providing tailored information to patients. The MRSA-colonized persons described their unwanted responsibility to inform healthcare personnel about the colonization, but also felt responsible for limiting the spread of infection to others. Furthermore, responsibility for infection control was regarded as shared between healthcare personnel and patients. The personnel described such responsibility as a natural part of their daily work, although it was not always easy to adhere to hygiene precautions. The MRSA-colonized persons felt that healthcare personnel have insufficient knowledge of the bacteria and of hygiene precautions. The MDRB Attitude Questionnaire showed that registered nurses do have knowledge deficiencies. The MDRB Attitude Questionnaire has adequate psychometric properties. In conclusion, MRSA colonization constitutes a psychological strain for carriers, and interactions with healthcare personnel resulted in feelings of stigmatization. The present thesis indicates that there is a need to improve healthcare personnel’s knowledge, behaviour and emotional response in relation to patients with MDRB, in order to ensure patient safety and address patients’ needs. The heads of department is responsible for such improvements, and the MDRB Attitude Questionnaire is useful in identifying areas in need for improvement.

Nurse engagement is essential for organizational success. If organizations can engage nurses, they may be able to improve organization and patient outcomes. The purpose of the evidence-based practice project was to use current evidence of direct supervisor influence on nurse engagement to create an educational program for clinical leads to use in their interactions with direct reports. The relationship-based care model was used as a framework for the project, and concepts included work engagement, nurse engagement, recognition versus meaningful recognition, professional development, communication, transformational leadership, and authentic leadership. Before and after attending the education program, clinical leads were given a self-assessment on a 5-point Likert scale to assess their perception of their leadership skills. The data were analyzed using SPSS descriptive statistics to describe differences in pre and post education self-assessments. All of the questions had increased means following the education program. The most improvement was in the following areas: coordinating relationships among staff improved by50% and accepting and using constructive criticism improved by 50%. Clinical leads recognized that having the knowledge and tools would give them the ability to impact nurse engagement. Researchers should continue to study the leader's influence on nurse engagement in relationship to other environmental factors that influence nurse engagement; as well as, how to better prepare leaders to engage nurses in his/her professional roles.

Background Respectful maternity care (RMC) is a fundamental human right and has been shown to increase utilisation of maternity services and improve maternal and neonatal outcomes. The original intent of this doctoral program of research was to investigate midwives’ understanding of RMC and women’s experiences of respectful care. Due to sudden global COVID-19 restrictions on travel and the health care system, the program of work changed to focus on students’ understanding and practice of RMC. Obstetric nurses are the main maternity care providers in Nepal. Aim This program of research aimed to assess undergraduate nursing students’ perceptions of RMC and measure any potential change in their perceptions after an education intervention. Methods A multi-method design was used. A series of five studies was conducted and included two systematic reviews of the literature; tool development and testing using cross-sectional surveys; and a quasi-experimental pre-post-test educational intervention study with a qualitative evaluation. Findings A systematic review (Study 1) was commenced pre-COVID-19 to critique the quality of tools that measure women’s experiences of respectful or disrespectful maternity care during labour and birth. Methodological quality was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. This published review identified six tools without ‘sufficient’ high quality evidence to adequately measure women’s experience of RMC. The search was subsequently updated to identify tools that aim to measure midwifery/nursing students’ perceptions of RMC. The lack of available, reliable tools provided the basis for the next study. Using the approach to scale development by DeVellis (2017), a tool to measure students’ perceptions of RMC was drafted and tested (Study 2). A total of 268 Nepalese nursing students were invited to complete an online survey of the draft tool. The 18-item Student Perceptions of Respectful Maternity Care (SPRMC) scale was developed and published. Survey findings also highlighted the need to improve students’ understanding of RMC. A mixed-methods systematic review to assess RMC educational interventions targeting midwives, nurses, or students was conducted (Study 3). There was relatively little research in this field. Of the nine included studies, most had been conducted in low-income African countries. Variation in content, delivery method, duration, timing of pre-post-test evaluation methods, and findings from multiprong interventions hindered robust conclusions. This review was published. In order to use the SPRMC scale as an outcome measure of the educational intervention, the validity of the scale was determined by comparing perceptions of RMC between Nepalese and Jordanian midwifery and nursing students (Study 4). This published paper reported on survey findings with 276 Bachelor’s degree or diploma level students. Perceptions of RMC were more positive among Jordanian students (t (199.97) = 6.68, p < 0.001). However, most students in both countries reported witnessing disrespect and abuse towards childbearing women. Nepalese students were more likely to observe poor adherence to women’s privacy and confidentiality. Subsequently, an online education intervention was developed, implemented, and evaluated in Nepal (Study 5). This published paper reported on a non-randomised quasi-experimental pre-post study with 89 undergraduate nursing students from three medical colleges. Students from site A (n = 40) were recruited to the intervention group and site B and C (n = 49) to the control group. The intervention group completed six hours of online (synchronous) education (2 hours x 3 weeks) in addition to their regular classes, whereas the control group attended their usual classroom studies. Both groups completed an online survey consisting of the SPRMC scale before and two weeks post-intervention. The intervention group also completed a survey on quality and relevance of the intervention. Independent t-test, paired t-test, and ANCOVA were used to analyse the quantitative data, and inductive thematic analysis was used for the qualitative data. Students in the intervention group reported a significant increase in perceptions towards RMC (F(1,86) = 28.1, p < 0.001, ηp2 = 0.25). Thematic analysis identified three themes: empowerment through RMC, motivation to initiate change, and becoming a respectful clinician (second revision submitted). Conclusions This program of work is novel in developing the SPRMC scale, providing evidence about students’ perceptions of RMC and witnessing of disrespect and abuse from two countries, and developing and evaluating a RMC education intervention. Attention now needs to be directed towards improving the practice of RMC among midwives/nurses to enhance women’s experience of care. Several avenues for further research include: further testing of the SPRMC tool with a large diverse sample of maternity professionals in different contexts, incorporation of RMC components into midwifery/nursing curricula, assessment of changes in students’ practice, and longer follow-up. This thesis consists of nine chapters. Notably, Chapter 2, the literature review, presents one published systematic review, and Chapters 4 – 8 present five published/submitted research articles reporting on other studies to promote RMC. The final chapter discusses the main findings, strengths, and limitations, as well as implications for future practice, education, and research.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing & Midwifery
Griffith Health
Full Text

With an increasing migrant population there is a growing need to organize interpreting practices in healthcare in order to deliver equitable high-quality care. This thesis focuses on healthcare institutions’ organization of interpreting services. The aim of the study was to explore interpreting practices in a healthcare context by comparing two different healthcare areas – elderly and emergency healthcare. The study aimed to highlight the impact of the organizational and institutional context. This study was designed as an explorative and descriptive qualitative study including 79 healthcare professionals with experience of interpreting practices recruited via purposeful sampling in elderly and emergency healthcare. Data were collected through individual and focus-group interviews and analysed with inductive qualitative content analysis. The main findings show that the processes and structures around interpreting practices were complex and mainly linked to individual and interpersonal levels and, to a limited extent, to the institutional level. On the institutional level the Public Procurement Act was the only formal policy to follow. On individual and interpersonal level interpreting practices were structured by self-established informal workplace routines developed by the professional groups. The norms and routines used was determined by access to interpreters, time aspects, characteristics of the care given, health conditions and the person’s problem, expectations and requests from the person and also from healthcare professionals. There were wishes for improvement, with better flexibility in access to professional interpreters, training for users and interpreters, and also better technical solutions and equipment. In conclusion, the use of interpreters was rooted in the organizational environment of interpreting practice, including the availability of laws, policy and guidelines, and closely related to individuals’ language skills, cultural values and social factors. The use of professional interpreters was based on the nature of care in context and access to interpreters and determined by health professionals’ estimation of the person’s current health status in order to deliver fast and individualized care based on humanistic values. Thus, it is important to consider organizational framework and cultural awareness when formulating interpreting practices adapted to the context, and formal guidelines in order to achieve the aim of personcentered and equal health care.

Background: Alarm interpretation and management are fundamental to managing critically ill patients. 1 There is little research as to the decision process nurses use to prioritize alarms or manage specific monitor parameters. Objective: The purpose of this study is to gain insight into the intricacy of the intensive care unit (ICU) nurses'critical decision process, using a human performance framework, when responding to monitor alarms. Method: Design: Descriptive design using semi-structured interview. Open-ended questions were developed based on the critical decision method (CDM) to explore ICU nurses' critical decision making process related to monitor alarms. Sixteen ICU nurses at a community hospital were interviewed to elicit perceptions and thought processes related to monitor alarms. Results: Responses to monitor alarms were affected by nursing experience, tones of the alarm, nurses' knowledge of the patient's condition as well as immediate visualization of patient to judge the urgency of an alarm. Both advanced beginner and expert nurses had similar initial response to monitor alarms; however, expert nurses added depth to their immediate assessment process by using previous experiences, intuition, and clinical expertise. Advanced beginner nurses frequently look to expert nurses for advice, guidance, and examples of clinical expertise. The majority of nurses had little or no formal training on the cardiac monitors used by that facility and all felt it would be beneficial in monitor alarm management. Conclusion: Understanding the decision-making process used by nurses can guide the development of policies and learning experiences that are crucial clinical support for alarm management.

This is a dissertation Programme Postgraduate Sensu Strictu Nursing, School of Nursing and Pharmacy, Federal University of Alagoas. Given that cancer at some point in evolution of the disease patients need to solve food problems, nursing adopts guidance to patients and their families as part of their care process, thus seeking a comprehensive and humane care. Based on this finding , this paper focuses the response of family members of cancer patients to dietary changes presented by the patient seriously ill. Aims to identify the experience of handling the family regarding the power of family severely affected by cancer at home. Qualitative, descriptive and exploratory survey conducted via guided by the Family Management Style Framework model interviews - FMSF , conducted with 10 family caregivers home. The results indicate that the sample had as main characteristics the fact that the caregiver being a woman, aged 51-60 years percapta low family income and parental great proximity to the patient. The families identified the food situation as being inappropriate; view The food usually eaten to cause health disorders in the critically ill patient and difficulty in providing the satisfaction of the biopsychosocial demands related to the supply of food. From the speech was possible to describe the behavior of management having the family caregiver modified the patient's diet in line with what you believe is a healthy, family caregiver modified the preparation and supply of the diet, the family caregiver changed his own attitude. Thus, the consequence perceived by the caregiver which were reflected in the discovery of effective strategies and confirmation of their previously developed skills.
Tendo em vista que os pacientes oncológicos em algum momento de evolução da doença necessitam resolver problemas alimentares, a enfermagem adota a orientação aos pacientes e seus familiares como parte de seu processo cuidar, buscando assim uma assistência integral e mais humana. Com base nesta constatação, este trabalho tem como objeto a resposta dos familiares de pacientes oncológicos às alterações alimentares apresentadas pelo doente gravemente enfermo. Teve como objetivos conhecer a experiência de manejo da família referente a alimentação do familiar gravemente acometido pela doença oncológica no domicílio. Pesquisa qualitativa, descritiva e exploratória realizada através de entrevistas norteadas pelo modelo Family Management Style Framework - FMSF, com 10 cuidadores familiares. Os resultados apontam que a amostra teve como características principais o fato do cuidador ser mulher, na faixa etária de 51 a 60 anos, baixa renda familiar percapta e grande proximidade parental com o paciente. As famílias identificaram a situação alimentar como sendo inapropriada; a comida usualmente ingerida vista como causadora de transtornos a saúde do paciente gravemente enfermo e, tendo ainda dificuldade em proporcionar a satisfação das demandas biopsicossociais relacionadas ao fornecimento da alimentação. A partir das falas dos sujeitos foi possível descrever o comportamento de manejo tendo o cuidador familiar modificado a dieta do paciente em consonância com o que acredita ser uma alimentação saudável; a modificação do preparo e oferta da dieta; além do familiar ter modificado sua própria atitude quando não foi possível alterar a do paciente. Neste movimento, a consequências percebidas pelo cuidador se refletiram no descobrimento de estratégias eficientes na condução do manejo do problema alimentar e na confirmação de suas habilidades previamente desenvolvidas. Contudo, com o agravamento característico da evolução do câncer, o familiar se viu diante de um problema gradativo com evolução negativa, no qual percebeu-se impotente frente as questões de manejo.

The purpose of this study was to develop a substantive theory or at least a set of theoretical propositions explaining the process of nurse-patient interaction in the presence of technology. This study was undertaken in Perth, Western Australia. The grounded theory method was chosen to undertake this research.The study's informants consisted of nurses. Theoretical sampling led to the inclusion of patients and patients' relatives. Purposive and theoretical sampling were used to choose the informants. Data were obtained using field observations and formal and informal interviews with nurses and post-discharge patients. Data analysis was conducted using the constant comparative method (Glaser and Strauss, 1967), writing memos and drawing a schema. The Ethnograph software package (Seidel, 1988) was used to organize and manage the data.The findings of the study indicated that nurses were stymied in their person-centered interactions with patients in the presence of technology. Nurses used the process of navigating the course of interaction to deal with this problem. The process of navigating the course of interaction consisted of three phases. These were the phases of embarking, steering and veering and disembarking. The action/interaction of the process occurred during the steering and veering phase and four specific strategies of interaction became evident in this research. These strategies of interaction were steadying, demurring, coasting and maximizing. The strategies of interaction used by nurses did not center on one type.There was rather a movement between strategies during and between interactions with patients in the presence of technology. This movement was termed oscillating connections. Conditions that modified the core process of navigating the course of interaction were also identified. The findings of the study provide an understanding of the problem encountered by nurses in their interaction with patients in the presence of technology and the process used by the nurses to deal with this problem.

Aim: This study explores what type of information patients and nurses share with, or provide to, each other, and whether or not the information received was relevant and sufficient for their needs. Background: Information exchange, as part of shared decision-making, is advocated in policy and practice throughout the healthcare sector. Much of the literature on information exchange relates to one-to-one consultations with consultants or GPs. To date, no studies have explored information exchange between patients and nurses in ward settings. Nursing literature on patients’ information needs focuses on one-way information provision from nurses to patients, rather than on two-way information exchange between patients and nurses. Methods: Interactions between patients and nurses were observed and audio-recorded using a remotely controlled audio-recording system. Semi-structured individual face-to-face interviews were then conducted to clarify and add to the observation data. A multiple case study design was used for this study: each case comprised one patient, the nurses caring for that patient, and the interactions between them. A pilot study was undertaken to inform the methods for recruitment and data collection for the main study. Results: The pilot study comprised five cases (patients n=5, nurses n=3). Changes to the recruitment strategy for the main study included surgical patients being invited to participate in the same way as medical patients. There were no difficulties with the data collection methods. The main study comprised nineteen cases (patients n=19, nurses n=22). Information exchange seemed unfamiliar to ward-based nurses. The findings show that information exchange may not be a one-off event but a complex series of interactions. Patients did not distinguish between clinical and non-clinical information in the same way as nurses. Primary reasons for patients’ hospital admission were not discussed and nurses did not share information about nursing interventions. The relevance for patients and nurses differed; patients generally wanted information for reducing anxiety and socialization; nurses wanted information for assessment and care planning. In terms of sufficiency, observation sessions highlighted that insufficient information was provided, often due to lost opportunities and paternalistic practice. However, the majority of patients and nurses perceived that they had exchanged sufficient information. Conclusion: This multiple case study provides insights into the type, relevance and sufficiency of information for patients and nurses in ward settings. In ward settings, information exchange as conceptualised by Charles et al. (1997 and 1999) may be difficult to achieve due to the complexity of patient/nurse interactions. Therefore, there are implications for policy makers as policies are not context specific. However, information exchange may be helpful for reducing patients’ anxieties. The concepts of shared decision-making and information exchange are not part of ward-based cultures and philosophies, which suggests implications for patient and nurse education. Research on information exchange between patients and nurses in other ward contexts may contribute to further understanding of information exchange in ward settings.

Aim: The overall aim of this thesis was to acquire knowledge about whether tactile touch as a complementary method can (i) promote comfort and (ii) reduce stress reactions during care in an intensive care unit (ICU) Method: In Paper I, five nurses with a touch therapist training were interviewed about their experiences of preparation before giving tactile touch in an ICU. To analyse the meaning of preparation as a phenomenon, Giorgi’s descriptive phenomenological approach was used. In Paper II and III a randomised controlled trial was set up to investigate the effects of a five-day tactile touch intervention on patients’ oxytocin levels in arterial blood (II), on patients’ blood pressure, heart rate and blood glucose level, and on patients’ levels of anxiety, sedation and alertness (III). Forty-four patients were randomised to either an intervention group (n = 21) or a control group (n = 23). Data were analysed with non-parametric statistics. In Paper IV, six patients who had received the tactile touch intervention were interviewed to illuminate the experience of receiving tactile touch during intensive care. To gain a deeper understanding of the phenomenon and to illuminate the meaning, Ricoeur’s phenomenological hermeneutical method, developed by Lindseth and Norberg, was used. Findings: The nurses need four constituents (inner balance, unconditional respect for the patients’ integrity, a relationship with the patient characterized by reciprocal trust and a supportive environment) to be prepared and go through the transition from nurse to touch therapist (I). In the intervention study, no significant differences were shown for oxytocin levels between intervention and control group over time or within each day (II). There were significantly lower levels of anxiety for patients in the intervention group. There were no significant differences between the intervention and control groups for blood pressure, heart rate, the use of drugs, levels of sedation or blood glucose levels (III). The significance of receiving tactile touch during intensive care was described as the creation of an imagined room along with the touch therapist. In this imagined room, the patients enjoyed tactile touch and gained hope for the future (IV). Conclusion: Nurses needed internal and external balance to be prepared for providing tactile touch. Patients did not notice the surroundings as much as the nurses did. Patients enjoyed the tactile touch and experienced comfort. The impact on stress parameters were limited, except for levels of anxiety which declined significantly. The results gave some evidence for the benefit of tactile touch given to patients in intensive care.

Thesis (MCur)--Stellenbosch University, 2011.
ENGLISH ABSTRACT: The 21st century teaching environment is unique in its diversity, and challenges academic staff to create a teaching environment that is conducive to all current learners. Various teaching methods are available and affordable, but technology remains an essential investment for the future of higher education institutions. The goal of the study was to evaluate the perceptions of student nurses regarding the effectiveness of the teaching methods which they experienced at a nursing college in the Western Cape Province. The objectives included an evaluation of the effectiveness of teaching methods as perceived and experienced by students of: - The traditional (green/whiteboard) lecture - Group activity - Self-activity - The use of technology such as PowerPoint presentations and video clips. An explorative descriptive research design was applied with a quantitative approach. The target population (N=1238) consisted of nursing students following the programme leading to registration as a professional nurse. Stratified random sampling was used to select the sample of participants (n=267). Data was collected personally by the researcher with a self-administered questionnaire which consisted of predominantly closed questions. Ethics approval to conduct this study was obtained from Stellenbosch University including permission from all other relevant parties. Reliability and validity of the study were assured through a pilot study, consultation with experts in nursing, education and statistics. The reliability of the questions were tested using the Cronbach alpha coefficient test which varied between .89 and .94. The data was analysed with the support of a statistician and was expressed as frequencies in tables and histograms. Descriptive statistics and post-hoc analyses including tests for statistical associations were performed. Results include a significant difference in generation X participants and the green/whiteboard teaching methods (Spearman p-value = 0.02) and their preference of the traditional lecture as a teaching method (Spearman p-value = <0.01). The perceived effectiveness of the teaching methods on student performance varied between very helpful and not helpful. Only (n = 49/19%) of participants experienced the traditional lecture as being very helpful on their general academic performance, in comparison to the effect of group work (n = 69/26%) and self-activity (n = 102/39%). Furthermore, no significant results were obtained between the participants and the perceived effect of the teaching methods. Open-ended questions showed that participants regarded the teaching strategies as boring and ancient and that much of the unhappiness expressed stems from the difference in the needs of millennials and the lack of change and obstinacy existing amongst academics. Recommendations include an increase in the use of technology, a blended approach to teaching, the re-training of academic staff, measures in counteracting a boring classroom environment, orientation for neophyte academics and students, workload perception of students and class size. In conclusion should recommendations be implemented a complete transformation of the college under study will result. It may force the education institution to move out of complacency, to a more vigorous and dynamic education environment that enables them to emerge as an Higher Education Institution (HEI) of good standing.
AFRIKAANSE OPSOMMING: Die een-en-twintigste-eeuse onderwysomgewing is uniek wat betref diversiteit en daag akademiese personeel uit om teenswoordig ’n onderwysomgewing te skep wat bevorderlik is vir alle leerders. Verskeie onderwysmetodes is beskikbaar en bekostigbaar, maar tegnologie bly ’n noodsaaklike belegging vir die toekoms van hoër onderwysinstansies. Die doel van hierdie studie was om die effektiwiteit van die gebruik van onderwysmetodes wat waargeneem en ondervind word deur studentverpleegkundiges by ’n spesifieke Verpleegkollege in die Wes-Kaap, te evalueer. Die doelwitte sluit in die evaluering aangaande die effektiwiteit soos waargeneem en ondervind deur studente van die volgende onderwysmetodes: - Die tradisionele groen/witbord lesing - Groepaktiwiteit - Selfaktiwiteit - Die gebruik van tegnologie soos PowerPoint-aanbiedings en video-insetsels. ’n Ondersoekende, beskrywende navorsingsontwerp met ’n kwantitatiewe benadering is toegepas. Die teikengroep is (n=1238) wat uit verpleegstudente bestaan wat die program vir die van ’n geregistreerde professionele verpleegster volg. ’n Gestratifieerde ewekansige steekproef is gebruik om die deelnemers (n=267) te selekteer. Data is self deur die navorser ingesamel deur gebruik te maak van ’n selfgeadministreerde vraelys wat hoofsaklik uit geslote vrae bestaan het. Etiese goedkeuring om die studie na te vors, is verkry van die Universtiteit van Stellenbosch, asook die van al die betrokke partye. Betroubaarheid en geldigheid van die studie is verseker deur ’n loodsondersoek, sowel as raadpleging met deskundiges op die gebied van Verpleging, Opvoedkunde en Statistiek. Die betroubaaarheid van die vrae is getoets deur gebruik te maak van die Cronbach-alpha koëffisiënt toets wat tussen .89 en .94 gevarieer het. Die data is geanaliseer met die ondersteuning van ’n statistikus en word voorgestel as frekwensies in tabelle en histogramme. Beskrywende statistieke en post-hoc analises, insluitende toetse vir statistiese assossiasies, is uitgevoer. Resultate sluit in ’n beduidende verskil in generasie x-deelnemers en die groen- of witbord onderwysmetodes (Spearman p-waarde = 0.02) en hul voorkeur vir die tradisionele lesing as ’n onderrigmetode (Spearman p-aarde >0.01). Die effektiwiteit van die onderwysmetodes op studenteprestasies wat waargeneem is, varieer tussen baie waardevol en van geen waarde nie. Slegs (n=49/19%) van die deelnemers het die tradisionele lesing as baie waardevol vir hul algemene akademiese prestasie ervaar, in vergelyking met die effek van groepwerk (n=69/26%) en self-aktiwiteit (n=102/39%). Vervolgens, is geen beduidende resultate verkry tussen die deelnemers en die effek van die onderrigmetodes wat waargeneem is nie. Ope vrae bewys dat deelnemers die onderwysstrategieë as vervelig en verouderd beskou en dat baie van die ongelukkigheid wat deurgevoer is, voortspruit uit die verskil in die behoeftes van die milleniums en die gebrek aan geneentheid, asook halsstarrigheid by akademici om te verander. Aanbevelings sluit in ’n toename in die gebruik van tegnologie, ’n saamgestelde benadering tot onderrig, die heropleiding van akademiese personeel, maatstawwe om ’n vervelige klaskameratmosfeer teen te werk, oriëntering vir neofiet akademici en studente se persepsie van werklading en klasgrootte. Ten slotte, indien aanbevelings geïmplementeer word, sal ’n volslae transformasie van die kollege onder die soeklig, plaasvind. Dit mag die opvoedkundige instansie forseer om te beweeg vanuit ’n toestand van gemaksugtigheid na ’n meer ondernemende en dinamiese onderrigomgewing wat in staat sal wees om as ’n Hoër Onderwysinstansie van formaat te funksioneer.

This capstone project evaluated the Idaho Plate Method (IPM) as an effective nutrition self-management program for adults with type 2 diabetes mellitus (T2DM) with limited health literacy (LHL) in one rural clinic in West Virginia. A one-way pretest-posttest design was used to evaluate the effects of the program on food choices, confidence, and HbA1c. A convenience sample of 30 volunteers participated in the program with 3-month follow-up data collected on 22 volunteers. A Wilcoxon test was conducted to evaluate choices of fruits, vegetables, and fatty foods and participant confidence in making healthful food choices. Data analysis found significant differences in fruit intake (z = -1.98, p 0.05); vegetables intake (z = -2.58, p .01); and skim milk intake (z = -2.094, p .04). There was a decrease intake of French-fries and fried potatoes (z = -2.26, p .02); butter or margarine on bread or pancakes (z = -2.494, p .01); regular fat hot dogs (z = -2.693, p<0.01); and total fat consumption ( z = -2.50, p .01). A significant increase in confidence was found in participants ability to prepare or share food with non-diabetics (z = -3.10, p .002); to choose appropriate foods when hungry (z = -2.72, p = .006); to eat smaller portions at dinner (z = -2.46, p .014); and to add less fat than a recipe calls for (z = -2.10, p .035). Paired t-test analysis compared pretest-posttest HbA1c results with a very nearly significant difference between the HbA1c pretest ( M = 7.96, SD = 1.83) and posttest (M = 7.34, SD = 1.60), t (24) = 2.02, p .055). Limitations of the study included the study design, lack of participants with LHL, high attrition rate, and study time restraints. Conclusions found, despite limitations, adults in rural WV with T2DM increased confidence in making healthy food choices, choosing healthy foods, and improving their glycemic control using the IPM.

Magister Curationis - MCur
The clinical Skills Laboratory Method (SLM) is currently utilised at some universities in South Africa. This is an innovative clinical teaching and learning strategy that allows learner nurses to set their own goals and take responsibility for their learning. In 2007, the method had been introduced to the new first-year learners and subsequently the second, third and fourth year student levels followed. The skills laboratory method consists of five phases: orientation, visualisation, guided practice, independent learning, and assessment. It allows learners the opportunity to observe, practise, and develop their clinical skills in a safe and risk-free environment. In addition, it might assist learners with developing their critical thinking, critical reasoning, and decision-making abilities. As a clinical facilitator at a university, the researcher observed that certain problems occurred in relation to the implementation of the phases. The purpose of this study was to explore and describe learners’ perceptions of the manner in which the facilitators implemented the SLM and to describe guidelines for facilitators to improve the comprehensive implementation of the SLM of an undergraduate nursing programme. A quantitative, explorative, and descriptive research design was used to investigate how learner nurses perceive the skills laboratory method and to what extent the phases of the method were implemented. The accessible population (N = 980) consisted of learner nurses who were enrolled for a Bachelor of Nursing degree at a university in the Western Cape Province. In this study systematic stratified random sampling were used because class lists of all registered learner nurses from first to fourth year were available. The researcher identified every fourth learner (k = 4) of the four years respectively (n = 276). The researcher collected the data personally by means of a survey questionnaire with closed-ended questions that required responses to be indicated according to a 5-point Likert scale. It took approximately 15 - 20 minutes to complete the questionnaire. Descriptive statistics and a factor analysis were performed to reduce the data with the purpose of making it more interpretable. Data was analysed with the assistance of a statistician who used the Statistical Package for Social Sciences Version 21 (SPSS). For interpretation purposes, the researcher presented the statistical information in tables and figures. Twelve factors emerged from the factor analysis: (i) information received during orientation, (ii) introduction during orientation, (iii) orientation to resources in the skills laboratory, (iv) facilitator interaction during visualisation, (v) progression of demonstrations, (vi) authenticity of simulation, (vii) progression of guided practices, (viii) facilitator feedback during guided practice, (ix) encouragement during independent practice, (x) support during independent practice, (xi) planning of assessments, and (xii) facilitator’s role during assessments.The findings indicated that although facilitators did implement the phases of the SLM, some facilitators omitted or did not fully adhere to all the steps in each of the five phases. Factors such as the information and organisation during the orientation phase, knowledge and behaviour of facilitators throughout the phases, teaching strategies used by facilitators during demonstrations, and feedback to learners during assessments required attention. Twelve guidelines were described from those findings with the aim of improving the comprehensive implementation of the SLM and it was recommended that facilitators implement those factors to ensure positive learning experiences for learner nurses. The researcher ensured validity and reliability during the study and adhered to ethical considerations.

Despite the rapid growth of online learning and student enrollment at for-profit colleges, previous research has found that employers are wary of job applicants with credentials earned from these sources. This study compared the attitudes of health care recruiters toward four different RN-to-BSN degree options based on the method of instruction (classroom, online) and the type of college (traditional, for-profit). A sample of 116 health care recruiters from across the United States completed an online survey. The study revealed that there were significant differences in the perceived advantage in the hiring process, credibility, concerns about credentials and likelihood to recommend hiring. Applicants with RN-to-BSN degrees from traditional colleges and via classroom instruction were clearly most favored and those with degrees earned through online instruction at for-profit colleges were perceived the least favorably. An online degree from a traditional college was determined to be more acceptable than an online degree from a for-profit college but still less acceptable than a degree earned through classroom instruction at a traditional college. The implication of these findings is that the return on education for students earning college degrees online or from for-profit colleges may be inhibited by employer perceptions regarding the quality of credentials earned in these environments.

Bakgrund: Palliativ vård i livets slutskede bör så långt som möjligt verka för att personen får dö på den plats som överensstämmer med uttryckt önskan, i närvaro av för den sjuka personen betydelsefulla personer. De flesta som drabbats av en allvarlig obotlig sjukdom önskar att få vårdas och dö i sitt eget hem. Trots det dör de flesta på sjukhus. Syfte: Att beskriva sjuksköterskans erfarenheter av varför den palliativa vården i hemmet avbryts.  Metod: Kvalitativa intervjuer genomfördes med 11 sjuksköterskor verksamma i palliativ hemsjukvård. Materialet analyserades med induktiv innehållsanalys.  Resultat: Vid analysen bildades tre kategorier. Förändrade förutsättningar, som innebär att personen som är sjuk och närstående behöver uppleva trygghet, orka och vara införstådda i situationen. Hemmet blir arbetsplats. Att skapa plats för vård och ha flera, ibland okända personer i hemmet kan vara svårt av integritetsskäl. Vårdens otillräcklighet innefattar kompetens och tillgänglighet inom hemsjukvården, men också organisationens struktur och samverkan med andra vårdgivare.  Slutsats: Ska personer i palliativ vård kunna kvarstanna i hemmet behövs mycket resurser och stöd från hemsjukvård och läkare. Orsakerna till att personer i palliativ vård lämnar sina hem är att de söker mer vård och stöd. Det borde vara av intresse att stärka hemsjukvårdens förutsättningar.
Background: Palliative end of life care should facilitate for sick persons to die in a place complied with expressed desire, in presence of significant people. Most people affected by serious incurable diseases, wish to be cared for and die at home. Despite this, most people die in hospitals. Aim: To describe nurses' experiences of why palliative care in the home gets interrupted. Methods: Qualitative interviews were conducted with 11 nurses in palliative care. The material was analyzed with inductive content analysis. Results: The analysis formed three categories. Changed conditions, meaning that the person and the relatives need to experience security, have strength and need to be aware. The home becomes a workplace. To create room for care and have multiple, sometimes unknown people present, can affect the privacy. Inadequacy of care includes skills and availability within the care, but also the organization's structure and collaboration with other health care providers. Conclusion: If people in palliative care should be able to remain at home, much resources and support are needed from home care and physicians. The reason that people in palliative care leave their homes is that they are seeking for more care and support. It should be of interest to strengthen home care conditions.