Thèses sur le sujet « Professionnal nursing culture »

L'éducation thérapeutique du patient (ETP) et sa mise en œuvre dans la formation initiale des infirmiers constituent un enjeu pour la santé publique et pour le développement de la profession, dans un contexte dominé par les paradigmes biomédical et néolibéral. Dans ce contexte, des études empiriques récentes révèlent des contradictions entre les ambitions théoriques portées par divers cadres de référence et l'opérationnalisation de l'ETP sur le terrain, soulignant la complexité de sa mise en œuvre individualisée et de son enseignement. Parallèlement, la transition professionnelle des formateurs passant des soins à la formation s'effectue avec peu de préparation spécifique à ces enjeux qui s'ajoutent à ceux de la professionnalisation des étudiants dans le cadre d'une formation réformée par le LMD. De plus, l'analyse de l'évolution de la profession infirmière, tant dans sa trajectoire historique que dans ses dynamiques contemporaines, montre la persistance et la reproduction de subordination au paradigme médical, en contradiction avec les principes du prendre soin qui se trouvent au cœur de l'ETP, en tant qu'elle constitue un soin. Ces paradoxes soulèvent des interrogations sur les pratiques de formation initiale des infirmiers mises en œuvre pour permettre aux étudiants de développer des compétences d'ETP et conduisent à s'intéresser aux dynamiques culturelles qui sous-tendent les pratiques. S'il existe de nombreuses recherches sur les pratiques des formateurs en soins infirmiers, aucune d'entre elles ne traite de l'enseignement de l'ETP ni de leur dimension culturelle. Cette recherche se propose de combler cette lacune, en participant à l'intelligibilité des pratiques de formation initiale des infirmiers à l'ETP, dans leur dimension culturelle.Pour ce faire, nous nous appuyons sur un ancrage théorique combinant la phénoménologie, le pragmatisme de Dewey et l'anthropologie culturelle. Cette approche interdisciplinaire permet d'explorer trois dimensions complémentaires : le vécu subjectif des formateurs, la manière dont ils reconstruisent continuellement leur expérience en situation et les structures culturelles qui sous-tendent leurs pratiques. D'un point de vue méthodologique, nous utilisons une triangulation de méthodes combinant 20 entretiens semi-directifs avec une attention particulière au récit d'expérience et 19 entretiens s'appuyant sur les techniques de l'explicitation développées par Vermersch (1994). Notre démarche d'interprétation des données empiriques s'appuie sur la méthode d'analyse par catégories conceptualisantes (Paillé & Mucchielli, 2016). Les résultats montrent que l'expérience du soin et celle de l'ETP affinent les capacités sensibles et de transaction des formateurs leur permettant de développer des schèmes relevant du prendre soin qu'ils réinvestissent dans leurs pratiques de formation. Ils mettent en lumière des patterns culturels, tels qu'une culture de l'écoute clinique et de l'empathie transposée du soin ainsi qu'une valorisation de l'expérience dans toutes ses dimensions. Cet ensemble de savoirs laisse émerger un agir énacté s'appuyant sur une praxis psychophénoménologique
Therapeutic Patient Education (TPE) and its implementation in initial nursing education represents a significant challenge for public health and the development of the nursing profession, within a context dominated by biomedical and neoliberal paradigms. In this context, recent empirical studies reveal contradictions between the theoretical ambitions supported by various frameworks and the operationalization of TPE in practice, highlighting the complexity of its individualized implementation and teaching. Concurrently, the professional transition of educators from healthcare to teaching occurs with minimal specific preparation for these challenges, which are in addition to those of professionalizing students within a curriculum reformed by the LMD system. Moreover, analysis of the nursing profession's evolution, both in its historical trajectory and contemporary dynamics, demonstrates the persistence and reproduction of subordination to the medical paradigm, contradicting the principles of care that are central to TPE as a form of care. These paradoxes raise questions about the initial nursing education practices implemented to enable students to develop TPE competencies and lead to an interest in the cultural dynamics underlying these practices. While numerous studies exist on nursing educators' practices, none address TPE teaching or its cultural dimension. This research aims to fill this gap by contributing to the understanding of initial nursing education practices in TPE, focusing on their cultural dimension. To achieve this, we rely on a theoretical foundation combining phenomenology, Dewey's pragmatism, and cultural anthropology. This interdisciplinary approach allows for the exploration of three complementary dimensions: the subjective experiences of educators, how they continuously reconstruct their experience in situ, and the cultural structures underpinning their practices. Methodologically, we employ a triangulation of methods combining 20 semi-structured interviews with a particular focus on experience narratives and 19 interviews utilizing the explicitation techniques developed by Vermersch (1994). Our approach to interpreting empirical data is based on the method of analysis using conceptualizing categories (Paillé & Mucchielli, 2016). The results demonstrate that experiences in care and TPE refine educators' sensory and transactional capacities, allowing them to develop schemas related to care that they reinvest in their educational practices. They illuminate cultural patterns such as a culture of clinical listening and empathy transposed from care, as well as a valorization of experience in all its dimensions. This body of knowledge gives rise to an enacted agency based on a psycho-phenomenological praxis

Orientador: Edineis de Brito Guirardello
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: A prática profissional do enfermeiro é definida como um sistema que o apóia no controle sobre o cuidado prestado ao paciente e sobre o ambiente no qual esse cuidado é oferecido. As principais características de ambientes de trabalho que favorecem essa prática profissional são a autonomia, o controle sobre o ambiente e a relação colaborativa entre médicos e enfermeiros. A presença desses atributos no ambiente de trabalho contribuem para obtenção de resultados positivos para os enfermeiros: maior satisfação profissional e menor nível de exaustão emocional - "burnout"; para os pacientes: menor taxa de mortalidade e maior nível de satisfação com os cuidados recebidos e para a instituição: menores taxas de absenteísmo e rotatividade. O "Nursing Work Index - Revised" (NWI - R), é um instrumento que foi desenvolvido para avaliar a presença desses atributos no ambiente de trabalho do enfermeiro, porém não está disponível na cultura brasileira. O presente estudo teve como objetivo realizar a adaptação cultural do NWI - R e validação das suas subescalas, para a cultura brasileira. É um instrumento composto por 57 itens, dentre os quais 15 foram agrupados para derivar quatro subescalas: autonomia, controle sobre o ambiente, relações entre enfermeiros e médicos e suporte organizacional, que têm resultado em alta consistência interna. Para o procedimento metodológico de adaptação foram seguidas as etapas de: a) tradução; b) retrotradução; c) avaliação das equivalências semântica, idiomática, cultural e conceitual por um grupo de seis juízes que sugeriram alterações na maioria dos itens a fim de assegurar essas equivalências e d) pré-teste com 46 sujeitos. Participaram do estudo 278 enfermeiros de três instituições públicas. A validade das subescalas do NWI - R - Versão Brasileira foi avaliada por meio da validade relacionada com critério concorrente, em que as médias dos escores das subescalas foram comparadas com a variável satisfação com o trabalho e percepção da qualidade do cuidado oferecida ao paciente e correlacionadas com a variável intenção em deixar o emprego no próximo ano e pela validade de construto divergente, em que as médias dos itens das subescalas foram correlacionadas com as médias das subescalas do Inventário de "Burnout" de Maslach. Obtiveram-se correlações significantes tanto para a validade relacionada com critério como para a validade de construto. A confiabilidade foi avaliada por meio do coeficiente alfa de Cronbach e resultou em uma consistência interna satisfatória para os 57 itens do instrumento (a:0,95) e para as subescalas autonomia (a:0,63), controle sobre o ambiente (a:0,75), relações entre médicos e enfermeiros (a:0,75) e suporte organizacional (a:0,75). Conclui-se que o processo de adaptação do NWI - R foi realizado com sucesso e a validade e confiabilidade das subescalas foram consideradas satisfatórias, demonstrando a viabilidade da utilização das mesmas para o desenvolvimento de novas pesquisas, na cultura brasileira.
Abstract: The professional practice of a nurse is defined as a system that supports nurse controle over the delivery of nursing care and the environment in which care is delivered. The characteristics of work environment that enhance this professional practice are: autonomy, control over the work environment and relationships with physicians. The presence of these attributes in the work environment may break out positive results to nurses (higher nurse satisfaction and lower emotional exhaustion level - burnout); for patients (decreased mortality and higher patient satisfaction regarding received care) and for institutions (lower rate of absenteeism and turnover). The Nursing Work Index - Revised (NWI - R) was developed to measure these attributes of the nurse's work setting, however they are not available in brazilian culture. This study had the objective to do the cultural adaptation of the NWI - R and validate the subscales. The instrument contains 57 items and 15 were used to develop four subescales: autonomy, control over the work environment, relationships with physicians and organizational support, showing results of high internal consistence. For the methodological procedure of adaptation, the followed stages were: a) translation; b) back translation; c) the valuation of semantic, idiomatic, cultural and conceptual equivalences, which was made by a group of six judges who suggested alterations in most of the items in order to assure these the equivalences and d) pre-test with 46 persons. The sample was comprised of 278 nurses of three public institutions. The validity of the subescales NWI - R - Brazilian Version was evaluated by the validity regarding criterion, where the means of the subescales were correlated with the variables job satisfaction, perception of care quality offered to patients and the intention of leave the job in the following year and validity of divergent construct, where the subscales means were correlated with Inventory Burnout of Maslach subescales averages. Significant correlations were obtained, no only for validity regarding concurrent criterion but also for validity type construct. The reliability was evaluated by used the alpha coefficient of Cronbach showing results of satisfactory internal consistence for the 57 itens of the instrument items (a:0.95) and for the autonomy subscales (a:0.63), control over the work environment (a:0.75), relationships between physicians and nurses (a:0.75) and organizational support (a:0.75). The conclusion is that the NWI - R process of adaptation was accomplished with success and its validty and reliability of subescales were considered satisfactory , showing the viability of the instrument subescales use for the development of new researches in brazilian culture.
Mestrado
Enfermagem e Trabalho
Mestre em Enfermagem

Cultural competence learning interventions have been suggested to positively improve knowledge, attitudes, and behaviors in both professional nurses and nursing students. A meta-analysis was used to examine the effectiveness of learning interventions designed to increase the cultural competence in professional nurses and nursing students. This is the first known meta-analysis of studies on cultural competence learning interventions in professional nurses and nursing students. The meta-analysis was done using 13 research studies on cultural competence educational interventions from 1999 to 2010 that were published peer-reviewed literature found in electronic databases. Analyses were computed using a fixed-effect model and effect size data reported in terms of odds-ratio. The Comprehensive Meta-Analysis [Version 2] statistical software was used for the meta-analysis. Results of Orwin's fail-safe N, funnel plot and Duval and Tweedie's Trim and Fill revealed no evidence of publication bias. The meta-analysis demonstrated that seven of the 13 studies' individual educational interventions had a significant positive effect (odds-ratio = 4.2) on improving cultural competency of nursing students and professional nurses. The study was able to determine from the meta-analysis literature that overall, learning interventions of cultural competence in nurses and nursing students significantly translates to a positive effect on the self-perceived cultural competency of nurses and nursing students in terms of knowledge, skills, attitudes, and self-efficacy regardless of intervention type and contact time. However, there is insufficient empirical evidence to support the argument that education and training in cultural competence translates into culturally competent care or that it leads to improved client health outcomes, particularly in nurses and nursing students. The results of this study should be interpreted with caution. Limitations of the study and recommendations for future research are discussed.

The purpose of this research was to explore the professional-cultural knowledge sharing phenomenon between experienced expatriate nurses (EXPNs) and novice host-country national nurses (NHCNs) in hospital settings. The gaps in how professional-cultural knowledge is shared, along with how contextual conditions influence sharing practices are demonstrated in the literature review. In particular, the literature review revealed that less attention is paid to how knowledge integration of diverse types unfolds at an individual level through sharing practices. A lack of evidence regarding the influence of contextual conditions in the sharing of patterns in professional-cultural knowledge sharing was also revealed in the literature review. Based on a critical analysis of the relevant learning and competency development models derived from organisational learning, intercultural management, and nursing literature, a conceptual framework of the professional-cultural knowledge sharing phenomenon, which builds on the commonalities among the reviewed literature, was suggested. The suggested framework comprised five components: motivation, context awareness, repeated experimentation, reflection, and individual differences. The conceptual framework functioned as an anchor for this research that was referred to during the stages of data collection and interpretation. An integrated research design was developed utilising a combination of a qualitative approach, subjectivist epistemology, and an interpretivist philosophical paradigm. An interpretivist case study design with embedded units informed by case study principles was deemed the most appropriate to explore the contemporary conditions and address the “how” and “why” research questions about sharing practices and the influence of contextual conditions. The interpretivist case adopted qualitative data collection that interweaved data generated from familiarisation with nursing hospital settings, interviews, observations, and a document review. The use of a flexible case study design enabled the researcher to explore a range of contextual themes concerning the phenomenon under research using multiple data sources. The research findings emerged based on the data analysis approach informed by the principles of iterative analysis, qualitative data analysis, and thematic analysis. The research findings showed that professional-cultural knowledge sharing comprises three reciprocal practices: developing shared meaning, engaging in the clinical competency development, and maintaining alignment that are influenced by five intertwined contextual conditions: individual differences, situational work conditions, front-line leaders’ practices, administrative policies and practices, and expatriate human resource policies and practices. Developing shared professional-cultural meaning represents the set of activities in which EXPNs and NHCNs jointly participate to form a cohesive identity that enables a common understanding of the nursing-hospital system that is embedded in the broader national culture to evolve. Engaging in a co-equal clinical competencies development represents the mutual behavioural practices through which EXPNs and NHCNs engage with clinical sites to enable the development of NHCNs' clinical competencies. Maintaining alignment through interventional actions represents the mutual efforts of EXPNs and NHCNs to work seamlessly and achieve cohesion between the actual performed patient care activities and the espoused nursing hospital policies, standards, procedures, guidelines, and aspects of national culture. They also help EXPNs and NHCNs to face uncommon and critical situations, along with learning from actions undertaken by one another. A combination of contextual conditions influences the motivational status of EXPNs and NHCNs, which in turn is reflected in the degree of EXPN and NHCNs’ participation in professional-cultural knowledge sharing practices. The current research addresses the research gaps identified in the literature and contributes to the management and knowledge streams of the literature in several ways. The primary contribution of this research is the development of a greater picture of the professional-cultural knowledge sharing phenomenon that combines the sharing practices that take place between EXPNs and NHCNs along with the contextual conditions implicated in the sharing patterns. The research provides insights into the implicated role of individual differences with identity issues caused by competency gap and national culture-based differences, along with the strategies utilised by EXPNs and NHCNs to navigate differences and mechanisms to develop shared meaning. The research provides a detailed account that illustrates the participatory roles of novices and masters in the professional competency development process along with the strategies employed to navigate the power differential. The research also provides an empirical illustration for maintaining alignment practices, as they consist of two distinct reciprocal modes: proactive coping and reactive coordinating. The research also contributes to an emerging stream of literature that sheds light on contextualisation in management research in general, and knowledge sharing specifically, in ways that go beyond the prescriptive treatment of context as demographic context (region, culture, industry). On the practical level, a context-based approach to professional-cultural knowledge sharing between EXPNs and NHCNs provides practical insights that might enhance the effectiveness of the utilising expatriation in developing the NHCNs’ capabilities.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
Dept Bus Strategy & Innovation
Griffith Business School
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The problem addressed in this project is the high attrition rate among English as Second Language (ESL) students in a local community college associate degree nursing program. If the retention problem is addressed, the increase in the number of ESL nursing student graduates could result in a more diverse nursing workforce, reflecting the diversity of the community. The purpose of this study was to examine student and faculty views regarding factors that contribute to the academic success and retention of ESL students. To that end, a qualitative case study approach was used, guided by the theoretical frameworks of Cummins's contextual interaction theory and Freire's and Mezirow's transformational learning theory. By using purposeful sampling, 8 ESL students and 5 faculty members were interviewed in both structured and unstructured interviews. The data were decoded using Nvivo computer software to establish themes and categories for analysis. The themes pointed to faculty lacking: (a) cultural awareness and sensitivity, (b) knowledge of the academic needs of ESL students, (c) knowledge of teaching strategies to accommodate the learning of ESL students, and (d) skills to prepare ESL students for what to expect. The findings led to creating a professional development workshop for faculty and led to recommending that the director and dean of the nursing program make it mandatory for faculty to continue their education on skills to improve academic success of ESL students. The findings suggest administrators should make cultural awareness competency compulsory. These efforts and faculty training may result in broader positive social change for ESL students and faculty, administrators, and the community, improving the number of graduating nurses to serve a diverse patient population.

Bakgrund: Förekomst av språkbarriärer inom hälso- och sjukvården påverkar möjligheten för sjuksköterskor att utföra omvårdnaden. Kommunikation identifieras som en viktig faktor mellan sjuksköterskan och patient för att främja högkvalitetvård. Möjligheten att erhålla kulturkompetens ökar kvaliteten på vården. Syfte: Syftet med litteraturöversikten är att beskriva sjuksköterskors upplevelser av språkbarriärer och strategier för att övervinna dessa i omvårdnaden.Metod: Studien genomfördes som en litteraturöversikt med systematisk söksstrategi och baserades på 13 kvalitativa och två mix metod vetenskapliga artiklar. Artikel sökningar utfördes i databaser CINAHL och Pubmed.Resultat: Litteraturöversiktens resultat visar att sjuksköterskor står inför utmaningar som hindrar att främja god och säker vård när språkbarriär förekommer. Sjuksköterskor upplever att genom användningen av professionella och icke professionella tolkar har sina fördelar och sina nackdelar. Sjuksköterskor strävar att övervinna språkbarriären genom att använda sig av olika strategier.Slutsats: Språkbarriär är ett hinder för att ge en individuell omvårdnad och kunna göra en bedömning av patientens vårdbehov. Språkbarriär är ett hot mot patientenssäkerheten. Professionella och icke professionella tolkar ökar risken för att patienten inte får korrekt given information.
Background: The presence of a language barrier in health care affects the ability of nurses to perform nursing. Communication is identified as an important factor between the nurse and the patient to promote high quality care. The opportunity to obtain cultural competence increases the quality of care.Aim: The aim of the literature review is to describe the nurse's experience of language barrier , and nurses' strategies for overcoming them in nursing.Method: The study was conducted as a literature review with a systematic search strategy and was based on 13 qualitative and two mix method scientific articles. Article searches were performed in databases CINAHL and Pubmed.Results: The results of the literature review shows that nurses face challenges that prevent the promotion of good and safe care when a language barrier occurs. Nurses experience that through the use of professional and non-professional interpreters they have their advantages and disadvantages. Nurses strive to overcome the language barrier by using different strategies.Conclusion: Language barrier is an obstacle to providing individual caring and being able to make an assessment of the patient's care needs. Language barrier is a threat to patient safety. Professional and non-professional interpreters increases the risk that the patient will not recive correct information.

Significant health care disparities exist in the United States. Nurses can play an important role eliminating these disparities. International immersion experiences for undergraduate nursing students may provide long-lasting enhancements in cultural competency and improvements in professional practice. The purpose of this descriptive qualitative study is to explore how a faculty-led international immersion experience for undergraduate nursing students in public health nursing has influenced cultural competency and how this is perceived to have impacted the individuals' current professional practice. Campinha-Bacote's (2002) Process of Cultural Competence in the Delivery of Health Care Services served as a theoretical framework for the study. Participants were sampled based on their experiences in either Bangladesh or Uganda from 2011 to 2013 as part of an international immersion program for undergraduate nursing students. Participants were asked to provide a written response to three prompts. Analysis was guided by the method developed by Colaizzi (Polit & Beck, 2012). Seven individuals agreed to participate. The data collected was somewhat limited in terms of depth, but it did reveal the themes of positive personal and professional development as well as the self-perceived enhancement of one's cultural competency. These findings are discussed within the context of the literature reviewed. Finally, the methodology of this study is reflected upon and recommendations are made for a follow-up study. This study supports the idea that an international immersion experience for undergraduate nursing students is an overall positive experience and can benefit professional practice as well as enhance one's cultural competency. However, more research is still needed to assess specifically how professional practice is benefited and to what extent these benefits are maintained overtime.

Introdução: As Unidades de Terapia Intensiva (UTI) são ambientes propícios a ocorrência de Eventos Adversos (EA) devido a complexidade da assistência e das várias intervenções realizadas. Fatores relacionados aos profissionais de enfermagem, caraterísticas dos pacientes e cultura de segurança podem associar-se a ocorrência desses eventos. Identificar os fatores associados a sua ocorrência é importante para planejamento de melhorias. Objetivo: Analisar a associação entre variáveis demográficas e clínicas dos pacientes, estresse e satisfação dos profissionais de enfermagem e percepção da cultura de segurança do paciente com a ocorrência de EA de gravidade moderada e grave em UTI adulto. Método: Estudo realizado em oito UTI de um hospital universitário da cidade de São Paulo. Para coleta de dados dos pacientes realizou-se uma coorte prospectiva entre 03 de setembro e 01 de dezembro de 2012. Dados demográficos e clínicos, incluindo SAPSII, LODS, Índice de Comorbidade de Charlson (ICC) e Nursing Activities Score (NAS) e EA foram levantados das informações do prontuário e acompanhamento de 10% das passagens de plantão. Os EA foram caracterizados segundo Classificação Internacional para Segurança do Paciente (CISP) da Organização Mundial da Saúde. Para investigar o estresse, satisfação profissional e cultura de segurança, realizou-se abordagem transversal através da aplicação de três instrumentos em outubro de 2012: Lista de Sinais e Sintomas (LSS), Índice de Satisfação Profissional (ISP) e Pesquisa sobre Cultura de Segurança do Paciente nos Hospitais (HSOPSC). Para análise entre as variáveis de interesse, utilizou-se o modelo de regressão logística. Considerou-se significativos valor p>0,05. Resultados: Das 890 internações no período, houve predominância de pacientes masculinos (58,09%), com idade média de 54,11 anos. As médias do ICC e NAS foram, respectivamente, 1,82 pontos e 71,15%. A probabilidade de óbito medida pelo SAPSII foi 19,10% e pelo LODS, 28,70%. Os pacientes permaneceram internados, em média, 6,94 dias e a mortalidade observada na UTI foi 21,24%. Ocorreram 494 EA de gravidade moderada/grave. Os tipos de EA mais frequentes foram: procedimento/processo clínico (42,71%), acidentes com o paciente (28,74%) e infecção hospitalar (20,85%). Pacientes masculinos (p=0,01), submetidos a internação cirúrgica de emergência (p=0,00) e que evoluíram a óbito na UTI (p=0,00) apresentaram mais EA quando comparados aos pacientes do mesmo grupo. Também houve associação entre ocorrência de EA e prolongamento de tempo de internação (p=0,00). Na análise de correlação, observou-se significância positiva entre idade e NAS (r=0,09; p=0,01), ICC e SAPSII (r=0,21; p=0,00) e, SAPSII e LODS (r=0,60;p=0,00). A amostra dos profissionais de enfermagem consistiu de 100 enfermeiros e 187 auxiliares/técnicos de enfermagem. A maioria dos profissionais apresentou médio nível de estresse e baixa satisfação profissional, com média de 48,49 pontos (dp=8,45) e 10,95 pontos (dp=1,82), respectivamente. A percepção geral da cultura de segurança foi de 3,06 pontos. No modelo final de análise das variáveis, houve associação entre EA e tempo de internação na UTI (p=0,00), sexo (masculino; p=0,38) e condição de saída (óbito; p=0,01). Conclusões: Nenhuma característica dos profissionais de enfermagem ou a cultura de segurança apresentou associação com a ocorrência de EA. Apesar disto, a avaliação sistemática destas variáveis é necessária pois elas podem ser modificadas ao longo do tempo.
Introduction: Intensive Care Units (ICU) are environments susceptible to Adverse Events (AE) due to the complexity of assistance and the various interventions carried out. Factors related to nursing staff, patient characteristics and the safety culture may be related to mishaps. It is of utmost importance that factors associated to their occurrence be identified for improvement planning. Objective: To analyze the connection among demographic variables and patient clinics, stress and nursing professionals satisfaction and the perception of patient safety culture with the occurrence of moderate and high severity AHE in adult ICU. Method: Study carried out in eight ICUs of a university hospital in the city of São Paulo. For the collection of patient data a prospective cohort was carried out from September 03rd to December 01st 2012. Demographic and clinical data, including SAPSII, LODS, Charlson Comorbidity Index (CCI), Nursing Activities Score (NAS) and AE were collected from patient record information and follow up of 10% of the change of shift. AE were categorized according to International Classification for Patient Safety (ICPS) from the World Health Organization. To investigate stress, professional satisfaction and safety culture, a transversal approach was carried out through the application of three instruments in October 2012: List of Signs and Symptoms (LSS), Professional Satisfaction Index (PSI) and Hospital Survey On Patient Safety Culture (HSOPSC). Logistics regression model was used for analysis among variables of interest. Results p>0.05 were considered significant. Results: From the 890 admissions in the period, there was a predominance of male patients (58.09%), at an average age of 54,11 years old. CCI and NAS averages were, respectively, 1,82 points and 71,15%. Death probability measured by SAPSII was of 19,10% and by LODS, 28,70%. Patients remained hospitalized, on average, 6,94 days and the observed mortality in the ICU was 21,24%. There were 494 AE of moderate/serious severty. The most frequent types of AE were: procedure/ clinical process (42.71%), patient accidents (28,74%) and hospital infection (20.85%). Male patients (p=0.01), submitted to emergency surgical hospitalization (p=0,00) ending up in death in the ICU (p=0.00) presented more AE when compared with patients in the same group. There was also a correlation between AE occurrence and longer hospitalization (p=0,00). In the correlation analysis, positive significance between age and NAS was observed (r=0,09; p=0,01), CCI and SAPSII (r=0,21; p=0,00) and, SAPSII and LODS (r=0,60; p=0,00). The nursing professionals sample consisted of 100 nurses and 187 auxiliaries/technical nurses. The majority of professionals presented medium level of stress and low professional satisfaction, with an average of 48,49 points (dp=8,45) and 10,95 points (dp=1,82), respectively. The general perception of safety culture was of 3,06 points. In the final model of variables analysis, there was association between AE and the amount of time spent in the ICU (p=0,00), sex (male; p=0,38) and the condition of exit (obit; p=0,01). Conclusions: No characteristics of the nursing professionals or the safety culture presented association with the occurrence of AE. Despite that, the systematic evaluation of these variables is necessary for they can be modified along the way.

Thesis advisor: Dorothy A. Jones
In Taiwan, the ability to measure the changing of health care reform and the improvement in nursing practice environment is hindered by the lack of a valid, reliable, and culture-sensitive instrument for measuring nursing practice environment. The purposes of this two-phase study were to translate and psychometrically validate the Chinese versions of the PPE Scale (CPPE). Phase I focused on translating and adapting the 38-item PPE into CPPE and evaluating the semantic and content equivalency. Semantic equivalence of the CPPE was secured using Translation Validity Indices as judged by American and bilingual experts. The content equivalence of the CPPE was supported by the satisfactory Content validity Indices. To increase the cultural sensitivity and comprehensiveness of the CPPE, 27 items were added at the suggestion of Taiwanese experts following content validation. A 66-item CPPE including 38 PPE items, 1 adapted item and 27 new items was produced for psychometric evaluation. Phase II focused on establishing the psychometric properties of the CPPE. A cross-sectional survey was conducted to test the 66-item CPPE on 977 Taiwanese nurses working in acute care settings. PCA with Varimax rotation on the 38 PPE items produced an eight-component solution for the 36-item CPPE after deleting two items. Cronbach's alpha was .90 for the total 36-item CPPE and .68 - .87 for the eight subscales. PCA with Varimax rotation on 66 items of the CPPE produced an eleven-component solution for the 58-item CPPE after deleting 8 items. Cronbach's alpha was .95 for the total 58-item CPPE and .71 - .87 for the eleven subscales. Both the 36-item CPPE and the 58-item CPPE demonstrated satisfactory test-retest reliability and concurrent validity. The psychometric structures of the 36-item CPPE and the 58-item CPPE were different from the original PPE. Both the 36-item CPPE and the 58-item CPPE were reliable and valid, but the 58-item CPPE is culturally sensitive to the Taiwanese nurses. The 58-item CPPE is useful for measuring Taiwanese nursing practice environment
Thesis (PhD) — Boston College, 2009
Submitted to: Boston College. Connell School of Nursing
Discipline: Nursing

Studiens syfte var att få kunskap om hur sjuksköterskor under specialistutbildning inom akutsjukvård med inriktning mot anestesisjukvård upplever förväntningar, möjligheter och hinder för lärande under deras verksamhetsförlagda utbildning. I bakgrunden finns beskrivet specialistutbildningens uppläggning och mål. Några av anestesisjuksköterskans centrala arbetsuppgifter fokuseras: mötet med patienten inför anestesi och operation och den fria luftvägen. För studien användes en kvalitativ metod med intervjuer av tio studenter. Intervjuerna bearbetades och analyserades utifrån ett sociokulturellt perspektiv på lärande, vilken utgör studiens teoretiska ram. Analysen koncentrerades mot lärande som social praxis där fyra teman framkom vilka berörde praktikplatsen, yrkesidentiteten, samspelet med handledare, patient, arbetsteam och skola i lärandesituationer samt utvärderingen. Dessa teman anknöts till Nielsen och Kvales huvudaspekter på mästarlära och situerat lärande som beskriver lärande i en praxisgemenskap, lärande som utveckling av en yrkesidentitet, lärande utan formell undervisning och utvärdering genom praxis. Resultatet visade att samspelet med handledaren hade mycket stor betydelse för studenternas möjligheter till lärande och för utvecklingen av yrkesidentiteten. De kvaliteter som studenterna ansåg viktigast hos handledaren var motivation för handledaruppdraget, aktuella yrkeskunskaper, kommunikationsförmåga och ett pedagogiskt förhållningssätt. Praktikplatsen ansågs även ha stor betydelse för studenternas möjligheter till lärande där miljön, tillträde till lärandesituationer, gemenskapen och samspelet med teamet upplevdes ge goda förutsättningar. Utvärdering i form av feedback i samband med lärandesituationer och efterföljande reflektion av utförda handlingar upplevde studenterna vara nödvändigt för lärandets progress.

Thesis (Ph. D.)--York University, 2000. Graduate Programme in Sociology.
Typescript. Includes bibliographical references (leaves 296-315). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://wwwlib.umi.com/cr/yorku/fullcit?pNQ56235.

Background A healthy workplace culture enables nurses to experience valuable learning in the workplace. Learning in the workplace is valuable as it can enable the provision of evidence based and continuously improving safe patient care, which is central to achieving good patient outcomes. Therefore, nurses need to learn within a workplace that supports the implementation of evidence based, professional practice and enables the best patient outcomes; the influence of workplace culture may play a role in this. Objectives To critically appraise and synthesize the best available qualitative evidence to understand both the nurse’s learning experiences within the workplace, and the factors within the workplace culture that influence those learning experiences. Inclusion criteria Participants Registered and enrolled nurses, regulated by a nursing and midwifery authority and/or recognised health practitioner regulation agency (or its international equivalent). Phenomena of interest The nurse’s learning experience, either within an acute health care workplace, or within a workplace related learning environment and the influence of workplace culture on the nurse’s learning experience (within the workplace, or workplace related learning environment). Context This review considered studies that included nurses working in an acute health care organization within a Western culture. Studies This review considered studies that focused on qualitative evidence and included phenomenological, grounded theory and critical theory research designs. Search strategy Published and unpublished studies in English from 1980-2013 were sought using a three-step search strategy. Methodological quality Methodological quality was assessed by two assessors using a standardized checklist from the Joanna Briggs Institute (JBI) Qualitative Assessment and Review Instrument (QARI). Data collection Qualitative data was extracted from included papers using the JBI-QARI standardized data extraction tool. Data synthesis Qualitative research findings were pooled using the JBI QARI Instrument. This involved the aggregation and synthesis of findings to generate a set of categories which were then subjected to a meta-synthesis in order to produce a single comprehensive set of synthesized findings that could be used as a basis for evidence-based practice. Results Fourteen articles were identified following appraisal and a total of 105 findings (85 unequivocal and 20 credible) were extracted from included studies and grouped into eight categories based on similarity of meaning. Subsequently, categories were grouped into two synthesized findings. The two synthesized findings were as follows: 1. Organizational influences Enabling nurses to demonstrate accountability for their own learning, along with clear organizational systems that provide resources, time, adequate staffing and support, demonstrates encouragement and value of nurses’ learning and education. 2. Relational Dynamics Nurses value their peers, expert nurses, preceptors, mentors and educators to facilitate and encourage their learning and professional development. Conclusion An optimal workplace culture is central for nurses to experience valuable and relevant learning in the workplace. To emphasize the importance of nurses’ learning in the workplace, working and learning is understood as an integrated experience. Consequently, a dual system that enables nurses to demonstrate accountability for their own learning, along with clear organizational and educational systems is required to demonstrate the value in nurses’ learning and education.
Thesis (M.Clin.Sc.) -- University of Adelaide, School of Translational Health Science, 2015

The South African Military Health Service (SAMHS) Nursing College offers a four-year integrated nursing programme leading to registration as a professional nurse at the South African Nursing Council (SANC). Student nurses assume a dual role when entering the SAMHS to commence with nurse training – that of a soldier and a nurse. Because student nurses have to assume dual roles, hidden aspects of military culture may influence the professional socialisation of student nurses in one way or another. With a view to determining whether the military environment does indeed impose any influence on student nurses’ professional socialisation, this study set out to explore the multifaceted context in which these students find themselves. Given the organisational and locational complexity of the SAMHS Nursing College, its campuses and the three military hospitals in South Africa, the population was narrowed down to an accessible target population comprising nurse educators and student nurses of the SAMHS Nursing College (Main Campus). Included in the two samples were nurse educators at the SAMHS Nursing College who had at least three years’ experience as nurse educators and who were registered with the SANC as nurse educators, and student nurses registered at the SANC for the fouryear Integrated Nursing Programme and who were in their fourth year of training. A qualitative constructivist grounded theory study was conducted based on the researcher’s philosophical assumptions. The researcher made use of focus groups and critical-incident narratives to collect data. In keeping with the constructivist paradigm adopted for this study, Charmaz’s (2014) data-analysis approach was followed. Concepts derived from the qualitative data were used to develop a substantive model to create an awareness of the existence of a hidden curriculum, to guide role players through the impact of the hidden curriculum on students’ professional socialisation and to help them to understand how their contribution could improve the outcome of the professional socialisation process
Health Studies
D. Litt. et Phil. (Health studies)

The early professional history of black South African nurses has not been the principal focus of local historians. Consequently, a qualitative historical inquiry was conducted into the available literature on the economic, social, political and cultural factors that influenced the professional development of black South African nurses from 1908–1994. Non-probability, purposive sampling assisted in assembling a corpus of historically rich data for analysis using time-specific a priori codes. The findings revealed that; culturally, black South African nurses had to adapt to a Western-dominated scientific health view; educationally, they had to master specialised formal Western terminology presented in a ‘foreign’ language (English) and, socio-politically, they had to adapt to being regarded as an elitist middle-class in the black community while remaining marginalised in the white-dominated workplace. Recommendations include expanding the historical research base, designing more effective strategies for promoting cultural sensitivity, and prioritising the focus on teaching and student retention.
Health Studies
M.A. (Health Studies)

Current research and evidence into Continuing Professional Development (CPD) has mostly centred on effective delivery formats to engage consumers. The perceptions and approaches that influence an individual engaging in CPD have yet to be explored, particularly in nursing. This qualitative research grounded in critical social constructionism and critical ethnography explores the perceptions and influences for regional intensive care nurses from Victoria, Australia as they engage in CPD. Participants from three field sites participated in semi-structured interviews. Through interviews the major themes of fear and vulnerability, isolation, professional inconsistencies and a myriad of concern for the nursing profession were identified. Threaded throughout each theme was the social influence of workplace upon nurses’ perceptions and their approaches toward CPD and the sharing of acquired knowledge amongst colleagues. The theoretical perspective of Pierre Bourdieu have been used to explore and discuss the findings of the research through the positions of orthodoxy and heterodoxy. These two positions allow the reality and the rhetoric of mandatory CPD for Australian nurses to be revealed, as shared by the participants. Orthodoxy and heterodoxy bring to light a disconnect between the regulatory body of the Australian Nursing and Midwifery Board (NMBA), and the nurses it registers. Nurses engage in CPD influenced by peers and often as a means of protection or a strategic tool to acquire and hold capital and power. The NMBA mandates CPD for knowledge growth and practice change. The findings reveal that nurses’ and the NMBA appear to be playing a game creating a state of illusio, with many nurses looking to mandatory CPD to maintain their employability rather than, public protection. This research highlights the symbolic power of CPD exposing the influences of social culture, habitus and the field in which nurses’ practice. Recommendations of this research suggest that the current model of CPD is fundamentally flawed. Significant changes need to be undertaken to achieve the goal of public protection through a contemporary and knowledgeable workforce.

The purpose of the study was to determine professional nurses’ knowledge of culture- competent care at selected medical and oncology wards and outpatient departments in Mopani District, Limpopo Province. A quantitative descriptive design was used and data collected from one hundred and five professional nurses by means of a structured questionnaire. The study found that cultural knowledge needs to be nurtured through continuing education and mentoring and that culture-competent care should be included in the curriculum. Furthermore, cultural knowledge is not effective if there is no correlation of theory and practice and early clinical placement of student nurses during their basic training
Health Studies
M. A. (Health Studies)

An increase in reports of undesirable professional behaviour in the nursing profession has prompted the question: How could the internalisation of skills, knowledge, values and beliefs be guided in student nurses to help them become effectively socialised as professional nurses? Using a sequential exploratory mixed-methods approach, the study addressed the above question. The researcher used focus-group interviews and field notes to explore and describe the perceptions of professional nurses and experiences of student nurses regarding the professional socialisation of students. The data generated from these findings were further used to determine and describe educators’ (N=128) perceptions on their teaching and facilitation of professional socialisation of students, using a self-administered questionnaire. The findings of both the qualitative and quantitative data were integrated to develop and validate guidelines to support educators and professional nurses in the professional socialisation of students. To establish rigour, the researcher applied measures of trustworthiness and performed validity and reliability tests. The qualitative data were analysed by utilising Tesch’s method of data analysis. The themes that emerged as influential in the professional socialisation of students were related to the professional nurse as role model, clinical supervisor, the educator, clinical learning environment, values and beliefs of the nursing profession and cultural and gender orientations. The quantitative data were analysed using descriptive and inferential statistics. Educators’ teaching and facilitation strategies revealed that the educator as a role model, the clinical environment, teaching approaches and cultural awareness were important social determinants in the professional socialisation of students. The qualitative and quantitative data were integrated to develop guidelines that were validated by field and guideline experts. The guidelines for educators and professional nurses addressed issues such as the professional nurse as role model and clinical supervisor, the creation of a positive clinical learning environment, the educator as role model, the teaching and support of students, the work ethic of the professional nurse and educator, the students’ behaviour and cultural awareness. These guidelines propose recommendations for educators and professional nurses to support the professional socialisation of students.
Health Studies
D. Litt. et Phil. (Health Studies)

Traditional male circumcision is a rite of passage among the AmaXhosa in South Africa. According to the custom of male traditional circumcision, initiates should remain in the bush for the entire seclusion period. The AmaXhosa male initiates encounter complications due to a ritual that has gone wrong. Common complications are penile sepsis, dehydration, penile amputations and septicaemia. As a last resort, when the AmaXhosa male initiates do not improve from complications associated with the custom they are referred to hospital for admission (Meintjes, 1998; Warren-Brown, 1998). The main purposes of this study were, first to explore and describe the delivery of care to the hospitalized AmaXhosa male initiates whilst in the hands of healthcare professionals and professional care system. Second, to describe what constitutes culturally appropriate care for hospitalized AmaXhosa male initiates. This study took place in three research sites, that included one rural hospital and two urban hospitals which admitted the AmaXhosa male initiates of traditional circumcision. A total of 13 hospitalized AmaXhosa male initiates and nine health professionals took part in this study. Leininger's ethnonursing qualitative research approach was used to guide this study. Data were collected, using purposive sampling, by means of unstructured interviews using guides, tape-recorder, and field notes. The study was first piloted at Umlamli Hospital using the same data collecting strategies as for the major study. Data from key and general informants were analysed separately using Leininger's (1991) four-phase method. This was carried out in order to answer the research questions and research purposes. Major themes and patterns emerged from this process.
Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2009.

The purpose of the study was to determine how professional nurses perceive their roles in patient centered care in various units, in three regional hospitals in Mpumalanga Province. The main objectives of this study were to determine * whether the working environment in provincial hospitals is supportive of patient centered care * what factors could hinder the provision of patient centered care * the extent to which patient centered care is provided to patients in provincial hospitals * professional nurses' perception of their role in patient-centered care The researcher used the descriptive exploratory method. A questionnaire with closed and open-ended questions was used to collect data from professional nurses in the three hospitals. Seventy- two (72) respondents returned the completed questionnaires. The findings indicated that the professional nurses perceived patients' and nurses' lack of knowledge as the biggest hindrance to patient centered care. Patients and relatives seemed to be less involved in their own care and the lack of information given to patients by professional nurses subsequently contributed to patients' inability to make
Health Studies
M.A. (Health Studies)