Letteratura scientifica selezionata sul tema "321199 Nursing not elsewhere classified"

AbstractBuilders of medical informatics applications need controlled medical vocabularies to support their applications and it is to their advantage to use available standards. In order to do so, however, these standards need to address the requirements of their intended users. Overthe past decade, medical informatics researchers have begun to articulate some of these requirements. This paper brings together some of the common themes which have been described, including: vocabulary content, concept orientation, concept permanence, nonsemantic concept identifiers, polyhierarchy, formal definitions, rejection of “not elsewhere classified” terms, multiple granularities, mUltiple consistent views, context representation, graceful evolution, and recognized redundancy. Standards developers are beginning to recognize and address these desiderata and adapt their offerings to meet them.

23 Age-adjusted stroke mortality in the US has declined in recent decades. However, little is known about stroke morbidity. Using the National Hospital Discharge Survey data from 1988 to 1997, we examined the change in stroke hospitalization and case-fatality in the US. During the 10 years, age-adjusted stroke hospitalization rate increased 22% (from 381 to 463/100,000, p=0.048). By regions, stroke hospitalization rates overall were 641, 600, 562 and 438 for the South, Midwest, Northeast, and West respectively (p<0.05), and were increased in all regions during the 10 years. Overall, 58% of stroke hospitalizations were due to ischemic stroke, 13% due to hemorrhagic stroke, and 29% were classified as other stroke. The hospitalization rates were 74.8 and 332.4 per 100,000 respectively for hemorrhagic and ischemic strokes and the increase rate in 10 years were 13.5% (p=0.214) and 31.5% (p=0.044) respectively. During 10 years, stroke patients with diabetes, hypertension and congestive heart failure increased 17.4% (p=0.17), 34% (p=0.05), and 31% (p=0.091) respectively. The average length of hospital stay reduced from 11.1 to 6.2 days (decrease of 44.1%), with an average annual percentage decrease of 6.1% (p=0.012). Although the total number of patients hospitalized for stroke increased during this period, the total person-days in hospital decreased 22% (p=006). In-hospital death among stroke decreased steadily from 12.7% to 7.6% (decrease of 40%, p=0.04). In-hospital case-fatality was estimated by stratifying patients on age, gender, region, type of stroke, and other co-morbidity. Case-fatality rate was substantially higher among patients with hemorrhagic than ischemic stroke (28.0% vs 5.8%, p<0.01); among patients with congestive heart failure than those without (17.9% vs 8.5%). In addition, patients of old age (≥75 years), men, those living in the Northeast had higher case-fatality rates than those younger, women and living in elsewhere. In conclusion, the declining of age-adjusted stroke mortality in the US has not been found to be related to the decrease in incidence. However, the observed reduction in hospital case-fatality might contribute to the decline of stroke mortality.

This thesis is concerned with the information needs of informal carers, or, as they are now increasingly referred to, carers Within this thesis, the appellation carer is defined in terms chosen by carers themselves. In their words, • A carer is someone whose life is restricted by the need to assist another person to live independently at home. Information is similarly defined by reference to the perspective of the carers, whose information needs form the topic of this research. For the purposes of this thesis, therefore, information is defined as follows • information is all knowledge, ideas, facts and data which are communicated in any format either formally or informally, and which, for whatever reason, are needful for carers to know. Information has been identified as a key requirement by most of the surveys undertaken of carers since 1988. Most surveys of carers and their needs have noted the absence or deficiency of this critical resource; yet relevant information is prolific, and accessible through a multiplicity of mechanisms and formats. This thesis set out to answer four important questions: • Why, when information appears to be so widely accessible, do carers continue to assert that lack of information remains one of their key problems? • What is the role of workers and other professionals in information provision to carers? • What changes to current information provision and dissemination would remove the obstacles to carers obtaining the information they need? • Is there a role for the public library service in either creating or overseeing the provision of an information strategy for carers? These questions were examined within a Leicester-based study of a group of carers of older people, and carers who were themselves older people, during the period 1994-1996. The study followed a qualitative methodology and used a number of methods. The chief of these entailed the researcher, in her professional role as Community Care Librarian, acting as a critical friend, that is one, who through understanding the context of the presenting situation, is able to offer a helpful critique, a valued judgement and an honest response. This approach elicited a wealth of qualitative data through telephone contact with carers on a regular and frequent basis during a period of fifteen months. The study also included a sample of workers and potential information providers, already having professional responsibilities in the households of the participating carers and who were involved through a series of focused semi-structured interviews. The workers represented a range of health, social services and voluntary sector teams and organisations. The data obtained from this study was particularly rich and subtle, providing unexpected insights into considerably more than information provision, as well as confirmation of certain conjectured findings. For example, the results indicate that the carers in the study were proactive information seekers, rather than passive recipients of information despite having poor formal and informal information networks. As a result, they were almost entirely dependent upon the professional workers as sources of information. Because of restrictive multi-disciplinary and inter-agency working and a lack of systematic and effective information support, workers were unable to fulfill all the carers' expectations in this regard. The study would indicate a crucial role for an agency able to devise an effective information strategy, suitable to meet not only the needs of carers, but also of others similarly disadvantaged in information provision. Such an agency could itself act as an holistic information provider, or else take responsibility for overseeing such a service. In the perception of the study participants the public library service, in theory uniquely placed to fulfill such a role, held a low profile as an information provider. If such an opinion were to be confirmed amongst the general population, it would seem that this role could not automatically be assigned to public libraries. However, the availability of insufficient evidence to either corroborate or refute such an opinion resulted in this particular research question remaining unanswered.

There is an on-going debate among health professionals, policy-makers and politicians, as to the optimal way of delivering sexual health services to young people. There is as yet, no consensus on their best patterns of organisation or configuration. This study uses qualitative and quantitative research methods, to explore both the views of young people accessing sexual health services, expressed through in-depth interview, and variations in client satisfaction with different characteristics of service delivery, expressed through completion of a questionnaire. The key research questions are:  How does young people’s satisfaction with sexual health services vary with the age-dedication of the service; that is, whether it serves young people only, or all ages?  How does young people’s satisfaction with sexual health services vary with the integration of the service; that is, whether family planning and genito-urinary services are offered separately, or together?  How does young people’s satisfaction with sexual health services vary with the location of the service; that is, in community or hospital based services? In the qualitative component, in-depth interviews were conducted with 25 young people recruited from a purposively selected sample of young people’s services. In the survey, a total sample of 1166 was achieved. Of these, 36% were attending an integrated contraceptive and STI service and 64% were attending a more traditional ‘separate’ service. 48% attended a service dedicated to young people and 52% an all-age service. 50% attended a hospital-based service and 50% a service located in the community. Of the total sample, 22% were male and 78% female. The analysis has been done not on a comparison of services in their entirety, but on a comparison of key features of their organisation, that is, whether they are provided separately as contraceptive and STI sessions or services, or whether these aspects of sexual health provision are integrated in sessions or services (integration); on whether they are run exclusively for young people or for all ages (dedication); and on whether they are located in the community or in a hospital setting (location). Recommendations are made for future service development and delivery and implications for policy are discussed.

This thesis is a story of how I came to construct and illuminate a reflexive narrative as a journey of self-inquiry and transformation towards personal realisation. It shares a view of reflection as lived in being and becoming a reflective nurse educator in higher education. My narrative draws upon, autoethnography, critical social theory and hermeneutic perspectives. Johns (2010) six dialogical movements have been used to give structure to my narrative. Nineteen reflections generate the reflexive narrative in a hermeneutic spiral, as each text informs the other along the journey. Insights become clearer through guidance, dialogue, and engagement with the literature. Early reflections show anxiety, emotional distress and entanglement as I tried to solve student problems. Maternalism influenced my approach to being with distressed and struggling students. Gradually these feelings give way to being available, becoming student kind as an enabling relationship with students. Becoming student kind is framed through my adaptation of the Being Available Template (Johns 2013). It is realised through; listening, presence, caring, empathy, compassion and emotional intelligence. Poise, a self-management practice ensures that personal concerns and tensions do not hinder my relationships with students. Mindfulness expressed as spirituality sustains this process. This path to becoming student kind creates a learning space for student growth and development. In so doing, students are enabled to enter into a nurse patient relationship through being available. I express my empowerment through a dialogical voice, transforming my practice with individual students, in the classroom and beyond. Understanding the tensions within the complexity of university culture influencing nurse education, informs collaboration with colleagues towards a shared vision of nurse education. I turn to reflect on a journey of constructing a reflexive narrative. Five stepping stones for dialogue in advancing guided reflection as a foundation for nurse education are offered. My inquiry weaves a story of reflection as testimony to a fusion of practice and theory. I reveal practice wisdom, informing my day to day work in being available becoming student kind in relationships with students. I explore the contribution to knowledge, my practice and future research, considering the strengths and challenges therein.

The nursing profession is pivotal to the delivery of healthcare services within the UK National Health Service (NHS). However, studies have shown that an increasing number of older nurses are leaving the NHS as a result of the physical and cognitive demands of the nursing job. In particular, a growing body of literature suggests that ward nurses are at risk of sustaining work-related injuries due to the demands of their job. Responding to these challenges, the aim of this PhD research project was to develop a framework to support NHS ward nurses in the ward environment, by exploring how the architectural design features of NHS hospital wards could be improved to create a better fit between ward nurses and their work environment, by applying the Person-Environment Fit theory. The Nursing Tasks and Environmental Assessment Framework (NTEA Framework) consists of two components. The Nursing Tasks Demand Matrix (NTDM), which provides a nuanced understanding of nursing tasks on wards and the Ward Environment Assessment Tool (WEAT), which is used to conduct Post-Occupancy Evaluation of hospital wards. The two together forms the NTEA Framework, which offers a holistic approach to improving nurses’ quality of life in the workplace. The NTEA Framework may be used by facilities managers, human resource managers, occupational health advisors, ward managers and the NHS management, for refurbishments decisions, in drafting nurses’ job descriptions, to perform occupation health screening and for the assessment of the adequacy of NHS healthcare estates for ward nurses. The NTEA Framework is also a benchmarking information tool that could inform design of healthcare facilities.

The thesis proposes and defends a maxim which can serve as a foundation and guideline for professional ethics in nursing, the maxim that nurses should act so far as possible to promote patient's self-determination. The thesis is informed by philosophical ethics and by knowledge of professional nursing practice.

This qualitative thesis uses discourse analysis to examine parental resistance towards medical treatment of critically ill children. It is an investigation of the 'mobile and transitory' discourses at play in instances of resistance between parents, physicians and nurses within health care institutions, and an examination of the consequences of resistance through providing alternative ways of perceiving and therefore understanding these disagreements. The philosophical perspectives, methodology and methods used in this thesis are underpinned by selected ideas taken from the works of Michel Foucault and Pierre Bourdieu and supported by relevant literature in the fields of media, law, children, parenting, caring, serious childhood illness, medicine and nursing. The thesis obtains information from a variety of texts that includes established literature (such as medical, sociological, legal, academic and philosophical), newspaper articles, radio or television interviews, internet sources, court reports and proceedings, legal experts and other commentators - and 15 interview based texts, where the focus is on analyses of narratives of parents, doctors and nurses. In the texts gathered for this thesis, there are noticeable differences between the personal experience discourses of parents, the 'in-between' discourses of nurses, and the disciplined discourses of physicians. This thesis brings these discourses into conversation with each other suggesting that parental resistance does not occur because of an infrequent and unusual set of circumstances where a few socially isolated and/or 'difficult' parents disagree with the treatment desires of paediatric physicians. Instead, it is argued that from an examination of interview based texts, parental resistance is an omnipresent but transitory occurrence that affects many of the interactions between the parents of seriously ill children and clinical staff. It is maintained that within these interactions, the seeds of this resistance are sown in both critical decision making situations and in everyday occurrences between doctors, nurses and parents within healthcare institutions. Contributing factors to parental resistance include the use of power games by staff, the language of medicine, forms of symbolic violence, the presence or absence of trust between parents and medical staff, the effects of medical habitus, and challenges to the parental role and identity. Overall, it is proposed in this thesis that parents who resist treatment for their seriously ill child are not exceptions to the normative patient-physician relationship. Instead an analysis of their discourses and practices is able to illuminate the complex interactions between patients and medical conventions. It is therefore possible to see parents who resist medical advice not as peripheral to the medical encounter but as examples of how patient-physician relationships come to be codified, constructed and crafted through everyday discourses and practices within health care settings.

Nursing is one of the most important professions in the United States but it has historically endured high levels of shortage and turnover (Apker, Propp, & Ford, 2009; Fox & Abrahamson, 2009). A nurse’s organizational climate and culture have been shown to impact a number of job outcomes including intention to leave the organization (Aiken & Patrician, 2000), and therefore is of interest to both scholars and practitioners alike. One way to understand the context in which nurses work is through organizational identification because people make sense of their own identities in part through the organizations to which they belong (Kuhn & Nelson, 2002). However, because individuals have various identities which can reinforce but at times conflict with each other (Scott et al., 1999) and the strength of these identities can dictate outcomes such as performance (Trybou, Gemmel, Pauwels, Henninck, & Clays, 2013), it is necessary to explore how nurses connect to different identities and social collectives (e.g., team, organization, and occupation/profession) within their work. Further, these connections with the multiplicities of identifications may help explain the decisions that guide nurses’ career trajectories as well as how the perceived identity of a nurse guides individuals to choose a career in nursing. This project seeks to understand how nurses talk about their jobs and how communicating with other nurses influences their career trajectory and decision to stay in or leave their organization or the nursing profession altogether.

This project draws upon both social identity theory and self-categorization theory to help explain how nurses communicate and situate themselves among others in their workplaces. Social identity theory and self-categorization theory are suited for this study’s social constructionist approach and the topic of this research because they explain how the strength and multiplicities of identification within an organization are constructed and shaped by communication with others. Data collection methods for this study consist of in-depth interviews with nurses of specific licensures, posts collected online from a nurse discussion forum, and a questionnaire of nurse forum participants. This study applies a mixed methods approach consisting of qualitative and quantitative analyses. In doing so, this project contributes in several ways including extending our understanding of (1) the connections between the multiplicities of identification; (2) how nurses construct meaning in their jobs to guide career decisions; (3) the nature of nurses’ interactions in online spaces; (4) nurse career decisions; and (5) nurses’ perceptions of the nursing profession before entering the profession.

Stroke recovery is complex and poorly understood. As a legacy of pervasive pessimism in the face of limited treatment, it is conceptualised and researched from biomedical and psychosocial perspectives that address impairment, problems of performance, quality of life, burden and disruption. Little stroke research is conducted once professional input has ceased, and yet considerable change occurs after this period with evidence that post-stroke wellbeing is independent of impairment and function -- many people do well in the face of poor prognoses, while others remain miserable despite 'good recovery'. Current advances in acute stroke management are generating increasing optimism, but lack of understanding about individuals' post-stroke experiences and long-term outcomes continues. While it is recognised that the impact of stroke on the lives of survivors and families is profound, rehabilitation focuses on recovery as task achievement and measured functional outcomes. For many survivors and their families 'recovery' is contested, ambiguous and extended. For some, it becomes a lifetime marathon because stroke represents an assault, not only to the body, but to the self and the lifeworld -- it is a 'life' event. This narrative inquiry into life after stroke explores recovery as a process taking place over time and conceptualised as a life transition. The work is grounded in narrative theory with the concept of transition providing the lens and focus for the research, its processes and analyses. Individuals' stories remain intact enabling evocation of diverse stroke meanings and the mapping of individual experience. Bringing these whole stories into conversation with each other elucidates post-stroke transition which is interpreted in light of theories of response to traumatic loss and informed by narrative theory. The thesis presents stories of trauma, loss and grief, situated in past lives and selves where assumptions about selves and future lives are shattered. The future makes no sense in terms of participants' past and present lives; life plots are lost and stroke therefore represents 'lost futures'. Stories of moving on to new lives are focused on being and doing in the present and have an expectant view of life. Although mindful of past lives and enduring losses, survivors actively engage in processes to reconfigure their lives with hope for a meaningful future. Transition is interpreted as 'reconfiguring the future'. The life tasks of reconfiguration are embedded in dynamic models of traumatic loss where grief is conceptualised as recursive movement between loss and meaning reconstruction evident in narratives that slowly move towards wellbeing. Despite broad recognition that loss and grief are part of the stroke experience, they are rarely addressed; where attention is paid it is likely embedded in explanatory models of staged response that oversimplify human experience. This thesis offers a new framework. It represents a fresh interpretation that highlights the ongoing traumatic impact of stroke. The post-stroke journeys of survivors and families are affected by individual circumstances and meanings. Although their stories are permeated with loss, many people move forward towards lives worth living. This interpretation suggests ways of reconfiguring lives in the face of devastation and ongoing traumatic loss. The work identifies a complex interaction of individual, emotional and social factors contributing to transitions to wellbeing following stroke and thus adds to a prospective vision of post-stroke life that can inform rehabilitation, discharge and stroke support strategies. Post-stroke transition will be enhanced when we use narrative framing and understanding to guide rehabilitative practice that uses meaning-centred models to prepare survivors and their families for a return to the lifeworld.
Thesis (PhD)--University of South Australia, 2009

Seligman (2011) introduced well-being theory as a multidimensional model to increase and measure well-being. The PERMA model of well-being theory defines well-being in terms of five constructs: Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment. Together, these five constructs are the foundation of individual and community well-being. The end goal of well-being theory is flourishing, which is defined as optimal well-being, where one is in the upper range of all five PERMA elements. The purpose of this study was to test whether all five PERMA elements of well-being could be derived from items in the 2018 Purdue Student Experience at a Research University (SERU) survey, thus providing support for the multidimensional model in context of undergraduate students at a research-intensive university. Using confirmatory factor analysis, all five PERMA constructs were supported with use of 32 items and demonstrated good model fit statistics. A second order PERMA well-being construct was built and demonstrated adequate model fit with RMSEA = 0.04. In the full PERMA model, all 32 items were significant at p < .05. In the full PERMA model, all five constructs were significant at p < .001. Accomplishment had the highest factor loading (0.76) and Meaning had the lowest factor loading (0.25). Results from this study provide initial support for use of well-being theory in context of undergraduate students.