Rozprawy doktorskie na temat „Experienced Nurses”

Experienced nurses depart the workforce in significant numbers; therefore, it is critical to understand how those departures affect patient care and safety. The focus of this systematic review included appraisal of recent research to provide an understanding of strategies used in acute care settings to retain experienced nurses. Guided by Benner's model of skill acquisition, the purpose of this systematic review was to identify factors that influence the decision of nurses with experience to leave or remain working in acute care work settings. The 19 articles selected for this review were limited to those pertaining to experienced registered nurses who have worked in the acute care setting for 2 years and longer. The review excluded articles pertaining to registered nurses with fewer than 2 years of experience, who were considered at the novice or proficient level of nursing. The results of this literature review showed that management conflicts, lack of support, work environments, work schedules, and disproportionate staffing levels were among the factors leading to morale distress and burnout in experienced nurses. These findings have the potential to contribute to positive social change by guiding administrative efforts to retain experienced nurses and improve mentoring of newer nurses and, ultimately, improve patient outcomes.

Turnover of experienced nurses is a component of the nursing shortage, which has created a lack of expert nurses administering bedside care. The project site is a Chicago suburban hospital with an average first year turnover of experienced nurses at 35%. This rate is above the 27% first year turnover reported by the Metropolitan Chicago Healthcare Council. This project focused on development and evaluation of an evidence-based mentorship program supported by theory that can contribute to an increase in experienced nurse retention. A detailed literature review references causative factors of turnover, such as an increasing workload, a multigenerational and aging workforce, and a lack of belonging as reasons for job dissatisfaction and separation of employment. These factors were also cited in exit interviews of nurses resigning from the project site. Synthesis of the literature suggests that an evidence-based, theory-supported, nurse mentorship program may decrease experienced nurse turnover and increase the longevity of the nurse providing bedside care. The social cognitive career theory and components of Zey's mutual benefits model were used in the design of the mentorship program to include the mentor, mentee, and culture of the organization. Program design and materials were evaluated by 10 experienced nurses. The program was approved by 100% of the formative panel and was recommended for summative review by the 4-member nurse executive council. The summative review resulted in a final approval to implement the program. Implementation of this project will create social change through empowerment of experienced nurses and by providing strong mentors for new nurses resulting in reduced turnover of both new and experienced nurses, increased job satisfaction, reduced replacement costs, and improved patient care.

In a Level II trauma center, experienced nurses are retiring from nursing positions, which is causing an unstable workforce. According to the literature, there are not enough experienced nurses to mentor the new nurses. Evidence suggests that experienced nurses are associated with improved patient outcomes and that experienced nurse mentors can improve the work environment for less experienced nurses. Focusing on Watson's theoretical framework of caring and Covell's theoretical framework of intellectual capital, this phenomenological study explored the lived experiences of a small group of nurses. Five nurses with 15 years of experience and who had served as mentors were selected for in-depth individual interviews. Open coding and thematic analysis were used to analyze the data, and 5 themes emerged: lengthening work shifts and related effects, increasing workload and responsibilities due to higher patient acuity, learning new technologies, mentoring with a decreased patient ratio, and surveying customers as the main focus of patient care. The results of this study guided the development of a proposal for a computer-based learning module on nurse mentoring. The module explains what mentoring is, the importance of mentoring, and proper ways to mentor. Implications for positive social change include retaining intellectual capital in an organization through mentoring positions for experienced nurses.

Relatively little information has been reported about foot and ankle problems experienced by nurses, despite anecdotal evidence which suggests they are common ailments. The purpose of this study was to improve knowledge about the prevalence of foot and ankle musculoskeletal disorders (MSDs) and to explore relationships between these MSDs and proposed risk factors. A review of the literature relating to work-related MSDs, MSDs in nursing, foot and lower-limb MSDs, screening for work-related MSDs, foot discomfort, footwear and the prevalence of foot problems in the community was undertaken. Based on the review, theoretical risk factors were proposed that pertained to the individual characteristics of the nurses, their work activity or their work environment. Three studies were then undertaken. A cross-sectional survey of 304 nurses, working in a large tertiary paediatric hospital, established the prevalence of foot and ankle MSDs. The survey collected information about self-reported risk factors of interest. The second study involved the clinical examination of a subgroup of 40 nurses, to examine changes in body discomfort, foot discomfort and postural sway over the course of a single work shift. Objective measurements of additional risk factors, such as individual foot posture (arch index) and the hardness of shoe midsoles, were performed. A final study was used to confirm the test-retest reliability of important aspects of the survey and key clinical measurements. Foot and ankle problems were the most common MSDs experienced by nurses in the preceding seven days (42.7% of nurses). They were the second most common MSDs to cause disability in the last 12 months (17.4% of nurses), and the third most common MSDs experienced by nurses in the last 12 months (54% of nurses). Substantial foot discomfort (Visual Analogue Scale (VAS) score of 50mm or more) was experienced by 48.5% of nurses at sometime in the last 12 months. Individual risk factors, such as obesity and the number of self-reported foot conditions (e.g., callouses, curled toes, flat feet) were strongly associated with the likelihood of experiencing foot problems in the last seven days or during the last 12 months. These risk factors showed consistent associations with disabling foot conditions and substantial foot discomfort. Some of these associations were dependent upon work-related risk factors, such as the location within the hospital and the average hours worked per week. Working in the intensive care unit was associated with higher odds of experiencing foot problems within the last seven days, foot problems in the last 12 months and foot problems that impaired activity in the last 12 months. Changes in foot discomfort experienced within a day, showed large individual variability. Fifteen of the forty nurses experienced moderate/substantial foot discomfort at the end of their shift (VAS 25+mm). Analysis of the association between risk factors and moderate/substantial foot discomfort revealed that foot discomfort was less likely for nurses who were older, had greater BMI or had lower foot arches, as indicated by higher arch index scores. The nurses’ postural sway decreased over the course of the work shift, suggesting improved body balance by the end of the day. These findings were unexpected. Further clinical studies examining individual nurses on several work shifts are needed to confirm these results, particularly due to the small sample size and the single measurement occasion. There are more than 280,000 nurses registered to practice in Australia. The nursing workforce is ageing and the prevalence of foot problems will increase. If the prevalence estimates from this study are extrapolated to the profession generally, more than 70,000 hospital nurses have experienced substantial foot discomfort and 25-30,000 hospital nurses have been limited in their activity due to foot problems during the last 12 months. Nurses with underlying foot conditions were more likely to report having foot problems at work. Strategies to prevent or manage foot conditions exist and they should be disseminated to nurses. Obesity is a significant risk factor for foot and ankle MSDs and these nurses may need particular assistance to manage foot problems. The risk of foot problems for particular groups of nurses, e.g. obese nurses, may vary depending upon the location within the hospital. Further research is needed to confirm the findings of this study. Similar studies should be conducted in other occupational groups that require workers to stand for prolonged periods.

This research explores how experienced nurses perceive their role as clinical teachers in an environment that is challenged not only with on-going changes in healthcare delivery, but also by the expectation that it will continue to provide positive clinical learning opportunities for undergraduate student nurses. Schools of nursing in Australia have undergone rapid and far-reaching change as a consequence of the legislated transfer of nursing eduction to the tertiary sector. Expectations that nurse academics will possess higher degrees and be actively involved in research mean that faculty members have less time to be directly involved in their students’ learning during clinical practice placements. The literature indicates that the responsibility for moment to moment teaching and learning thus appears to have been implicitly given to clinical staff who may not possess any formal qualifications for teaching, yet are largely responsible for students’ learning through clinical placements. Indeed some clinicians report a worrying lack of knowledge of clinical supervision models giving cause for further concern about the nature of the clinical learning environment. Schools of nursing expect that clinical practica will provide opportunities for students to learn how to be a nurse through guided questioning, analysis and critical thinking. It is evident that in some settings, this represents an ideal situation and not the reality. Critical reflection on these issues has informed the purpose of this research and helped to shape the following questions that focus the conduct of the study: Research Question One. How do experienced nurses create positive clinical learning environments for student nurses? Research Question Two. How do experienced nurses resolve the often-contradictory demands of nursing students and those of the practice setting? Research Question Three. How do changes in the healthcare environment impact on the experienced nurse's role as a clinical teacher? The theoretical framework for this study was underpinned by the interpretive philosophies of hermeneutic phenomenology and symbolic interactionism, because they acknowledge the personal experiences and meanings of the participants. A case study approach was utilised because it acknowledges the given context of the participants. Data were collected from six experienced nurses through a series of semi-structured interviews, informal interviews and periods of participant observation supported by field notes and the researcher’s diary. Participants identified that their perception of their role as clinical teachers was constructed of three intersecting roles: that of facilitator of learning, assessor and socialiser. This study concludes that several factors influence these nurses’ perception of their role as clinical teachers. In particular, the positivist work culture of the clinical setting and nurses’ own past experiences and world view of nursing combine to shape these nurses’ perception of their role as clinical teachers. The research concludes that the expectations that students will be supported in their endeavours to be critically thinking, problem solving and reflective practitioners may, in fact, be unrealistic in the current, economically constrained, clinical environment. It is evident that experienced nurses, despite being willing to be involved with clinical teaching, have to function in rapidly changing environments that do not always offer opportunities for nurses to reflect on their practice. However, the creation of positive clinical learning environments in these circumstances requires an increased understanding and appreciation by both schools of nursing and their students of the impact of change on these nurses and their clinical environment. This appreciation may result in more effective collaboration between nursing education and nursing service to assist student nurses to learn not merely through repetitive practice and busywork, but also through opportunities to observe, question and understand their nursing practice.

Aims and objectives: To describe newly graduated nurses’ experiences of the intervention practitioner training nurse.  Background: Newly graduated nurses need support to establish the profession. Several studies have shown that the first years in the profession, is the most challenging time. Method: The intervention practitioner training nurse was initiated to empower, and support newly graduates nurses in their professional role. Data were collected through semi-structured interviews with ten newly graduate nurses having experience of the intervention. The data were analysed using qualitative content analysis. Results: The analysis results in the overarching theme; “Organizational prerequisites” The theme consisted of three categories, "Activator" comprised the subcategories compiliating and attractive workplace. This involved that the practitioner training nurse were the activator creating a clear structure and the wards became more attractive workplaces. “Supportive nursing" comprised the subcategories present assistance, emotional support, and patient safety. This involved that practitioner training nurse constituted an important support function and helped to ensure patient safety. “Professional development” comprised the subcategories nurse's competence, feeling of security, and learning. This created the opportunity for professional development. Conclusion: The newly graduate nurses' experience of the intervention shows that the creation of an organisational structure enabled the practitioner training nurse to be an important support and to contribute to professional development. This was accomplished by strategic decision of the hospital management. Relevance to practice: The results of the current study can be transferred to other similar healthcare organizations and can be a support for managers who plan to initiate interventions to empower and support newly graduated nurses.

Syfte: Syftet med studien var att skapa djupare förståelse kring sjuksköterskors upplevelse av mellanmänsklig kommunikation med patienter med annan kulturell bakgrund. Bakgrund: Kommunikation spelar en viktig roll i kulturen och är en stor del av relationen mellan individer. Kommmunikation är en grundbult i sjuksköterskans arbete och är av högsta vikt för att kunna erbjuda en patientcentrerad och säker vård. Transkulturell medvetenhet är essentiellt för god vård, speciellt som världen blir alltmer mångkulturell. Såväl sjukvårdsturism som utökade globala samarbeten inom Hälso- och sjukvården ökar kraven på kulturell kompetens bland sjuksköterskor. Indien är ett föregångarland inom sjukvårdsturism och människor från olika kulturell bakgrund reser dit för sjukvård. Metod: Semistrukturerade intervjuer genomfördes med 12 sjuksköterskor mellan 23 och 53 år från två indiska sjukhus. Sjuksköterskorna möter ofta patienter med olika kulturell bakgrund. En tematisk innehållsanalys utfördes på det insamlade materialet. Resultat: Två tematiska inriktningar framkom från materialet; ett tema med fokus på praktiska verktyg och tekniker för att arbeta med patienter med annan kulturell bakgrund och det andra temat handlar om att bibehålla vårdkvaliteten. Utökade språkkunskaper och kommunikationsverktyg skulle underlätta sjuksköterskans arbete. Kulturell medvetenhet leder till ett ökat självförtroende hos sjuksköterskan och hjälper denna förutse eventuella behov hos patienten. Slutsats: Transkulturell medvetenhet och kommunikationsverktyg bidrar till en säkrare och mer effektiv vård. Sjuksköterskeutbildningen behöver lägga mer fokus på kulturell mångfald inom hälso- och sjukvård. Mer forskning krävs inom detta område då vården globaliseras allt mer.
Aim: The aim of the study was to gain a deeper understanding of interpersonal communication as experienced by nurses working in culturally diverse hospitals in India. Background: Communication is an important part of culture and a base in any interpersonal relationship. Communication is a foundation in the nursing occupation in order to give patient centered care which is safe and effective. Transcultural awareness in nursing is an important factor in order to give good care, especially as the world is becoming more multicultural. Medical tourism along with the expanding network of global interactions in healthcare ads to the necessity of developing culturally competent nursing care. India in one of the forerunners in medical tourism and cares for patients from many different cultural backgrounds. Method: Semi-structured interviews were conducted on a sample of 12 nurses between the age of 23 and 53, working with diverse patients at two different hospitals in India. A thematic content analysis was performed. Results: The developed themes focus on specific tools and techniques for working with culturally diverse patients and how to sustain the quality of care in diverse hospital settings. Language resources and tool which aid in communication would alleviate the nurses work. Cultural knowledge helps the nurses gain confidence and foresee possible needs of the patient. Conclusion: Highlighting transcultural interpersonal communication techniques within nursing leads to a safer and more productive practice of nursing care. Nursing education needs to prioritize cultural diversity in health care. More research needs to be conducted on the subject of interpersonal communication in culturally diverse hospital settings since healthcare is a continuously growing globalized organization.

Nursing turnover (the loss of experienced nurses from a clinical setting) remains a pressing problem for healthcare delivery in acute care inpatient settings. Turnover contributes to increased recruitment and orientation cost, reduced quality patient care, and the loss of mentorship for new nurses. The purpose of this research was to critically examine the factors that contribute to turnover of experienced nurses’ including their decision to leave clinical practice settings and seek new employment in another nursing position. The study objectives were to explore experienced nurses’ decision-making processes in leaving current clinical practice settings and to examine the personal and environmental factors experienced nurses’ perceive that influenced their decision to leave. An interpretive descriptive approach was used to guide the study. Interviews were conducted with 12 nurses, averaging 16 years in clinical practice. Participants were equally represented from clinical units, which included critical care and medical-surgical areas. The sample drew on perspectives from point-of-care nurses and nurses in leadership roles, primarily charge nurses and clinical nurse educators. The findings indicated that nurses’ decisions to leave clinical practice were influenced by several interrelated environmental and personal factors such as higher patient acuity, increased workload demands, ineffective working relationships among nurses and with physicians, gaps in leadership support, and significant impact to nurses’ health and personal well-being. When participants experienced ineffective working relationships with other nurses and a lack of leadership support, they described being ill equipped to perform their job and reported a loss of job satisfaction. The impact of high stress was evident on the health and emotional well-being for those who stayed, and family relationships and lifestyles were adversely affected. It is vital that healthcare organizations learn to minimize turnover and retain the wealth of experienced nurses in acute care settings to maintain quality patient care and contain costs. The study highlights the need of healthcare leaders to reexamine how they promote collaborative practice, enhance supportive leadership behaviours, and reduce nurses’ workplace stressors in order to retain the wealth of skills and knowledge offered by experienced clinical practice nurses.
Applied Science, Faculty of
Nursing, School of
Graduate

The Emergency Department (ED) as a workplace for the Registered Nurse (RN) is a stressful environment. Reasons are thought to include interactions with other members of the interdisciplinary team as well as the situations associated with the environment of the ED such as trauma, death, sadness, joy and the general unpredictability of each moment. Studies have documented general health care workplace stress and its influence on staff, but a very limited number of studies have concentrated on the ED. No widely published studies have identified stressors from the perspective of the ED RN. This dissertation is an interpretive phenomenological study that seeks to understand the experience of being an ED RN through the exploration of the perceptions of stress as lived by individuals who practice their art and science in this unique setting. Materials for evaluation and thematic identification were obtained through personal interviews of practicing nurses. The stories told by the participants communicated what each individual found to be negatively stressful as well as what each found to be positively stressful. Conclusions based on the findings of this work suggest a need for the ED RN to be able to depend on the presence of several factors in order to be able to function with as little distress as possible. The optimal ED environment for the RN is posited to be supportive of the individual goals of the RN, provide adequate resources and foster a communicative interdisciplinary environment. Recommendations are made to improve resource management and interdisciplinary relations.
ID: 031001340; System requirements: World Wide Web browser and PDF reader.; Mode of access: World Wide Web.; Adviser: Diane Wink.; Co-adviser: Diane Andrews.; Title from PDF title page (viewed April 15, 2013).; Thesis (Ph.D.)--University of Central Florida, 2012.; Includes bibliographical references (p. 130-135).
Ph.D.
Doctorate
Nursing
Nursing
Nursing

Practicing nurses need to be qualified at the baccalaureate level at a rate of 80% by 2020 to meet the needs of the increasingly demanding healthcare industry. Designed to meet this need, the online RN-BS (registered nurses earning a Bachelor of Science) nursing program at a local university has a declining completion rate that needs to be addressed and increased. The conceptual framework for this project was a qualitative program evaluation with a case study design; the project was designed to determine if the structure of the program was limiting student success or if factors experienced by full-time working RNs in the program were impacting success. E-mail interviews were conducted with 29 students in the online RN-BS nursing program who were selected through purposeful sampling. Research questions for this study examined the barriers faced by experienced nurses when they studied in the online RN-BS nursing program while maintaining their work schedule as RNs. Predetermined, open-ended, semistructured questions produced data that were analyzed through coding and theme identification. Themes were validated through member checking and use of an external auditor. Data revealed that students preferred the online format of the program to a face-to-face program, and they felt the local university nursing faculty was responsive and supportive. Challenges the students faced were primarily time management, cost of the program, information technology issues including learning the learning management system, group projects, and study skills. Based on the findings, an orientation program was developed that will affect social change by helping the local university nursing students complete the baccalaureate preparation they need to comply with the increasing industry demands.

Competency-based nurse orientation programs focus on the new nursing graduate and experienced nurse employees' ability to perform skills necessary in a new work setting. The purpose of this project was to develop a learner-focused and competency-based orientation program for new nursing employees at a large urban hospital to enhance patient safety and nurse retention. The Johns Hopkins nursing evidence-based practice model and guideline were used in the selection of articles with higher levels of evidence and research quality for the critical appraisal of literature in support of the program development. The best practices for nursing orientation content and delivery for positive effects on hospital finances, nurse turnover rates, and patient safety were the focus of the literature review. Benner's model of 5 levels of skill development was the theoretical framework for advancing skills of nurses who enter the orientation program with different expertise and skill sets. Nurse orientation materials and processes, comprising a collaborative team approach to orientation and a guideline for preceptor selection, were developed as the essential components for successful orientation at the project hospital. A nursing orientation based on the evidence may provide an infrastructure and operational process for the organization in developing the competencies of all levels of nurses, including experienced nurses transitioning to new units or duties. The social change resulting from the project will be a supportive and seamless transition of nurses into the new practice role and work environment. When implemented, this project is anticipated to increase nurse satisfaction, improve quality of health care delivery, decrease anxiety related to the new nursing role, and improve collegiality among all levels of nurses.

Critical thinking skills have emerged as a vital tool for the professional nurse confronting an explosion of technology and compressed plans of treatment. The purpose of this research was to compare the critical thinking skills of experienced registered nurses from two practice settings: the operating room and general medical-surgical floors. Critical thinking was defined as a "composite of attitudes, knowledge, and skills" (Watson-Glaser, 1980, p. 1).The research of Benner (1984) provided the foundation for this research. Benner documented the development of knowledge and skill in nursing practice. Nurses at the proficient and expert stages of development were the focus of this research.A non-random, convenience sample containing fifty one nurses was drawn from two Midwestern hospitals. Demographic data was gathered to further describe the sample. Participation in the study was voluntary and anonymity of subjects was assured.The Watson-Glaser Critical Thinking Appraisal (WGCTA) (1980) was the instrument utilized to measure the critical thinking skills of the experienced nurses. This tool has established validity and reliability and is considered a benchmark for measuring critical thinking ability.Analysis of the WGCTA (1980), results revealed a mean of 54.29, SD 9.66 for the total group of experienced registered nurses (N=5 1). For the operating room nurses (n=28) a mean of 52.71 with a SD of 9.41 was obtained. Among the medical-surgical nurses (n=23), the mean score was 56.21 with a SD of 9.81. T-test and MANOVA analysis was carried out. No significant statistical differences were found between the means in either the total scores of the WGCTA or on the five sub-tests for the two groups. The data submitted for analysis reflected a very experienced group (51 % with > 15 years nursing experience) and predominate Associate and Diploma preparation (61 %). Norming information available for the WGCTA indicated the scores obtained in this research were comparable to much larger samples drawn from nursing students and police officers.A conclusion of this research is that critical thinking, as measured by the WGCTA (1980), develops uniformly across diverse practice areas. An examination of the usefulness of the WGCTA to accurately measure the process of critical thinking in experienced nurses is recommended. More research into the important issues of critical thinking and experienced nursing practice is recommended.
School of Nursing

Thesis (MCur)--Stellenbosch University, 2012.
ENGLISH ABSTRACT: Burnout is one of the challenges that nurses are faced with in their stressful and rapidly changing work environment. The vulnerability of nurses to burnout remains a major concern which affects both the individual and institution. Knowledge about burnout and associated risk factors which influence the development of burnout is vital for early recognition and intervention. The research question which guided this study was: “What are the factors influencing the degree of burnout experienced by nurses working in neonatal intensive care units?” The objectives included determining which physical, psychological, social and occupational factors influenced the degree of burnout experienced by nurses. A descriptive, explorative research design with a quantitative approach was applied. The target population consisted of (n=105) permanent nursing staff members working in the neonatal units of two different hospitals. A convenience sampling method was used. Participants (n=102) who gave voluntary consent to participate was included in the study. Validity and reliability was supported through the use of a validated questionnaire, Maslach Burnout Inventory – General Survey including a section based on demographical information and a section based on physical, psychosocial, social and occupational factors. Validity of the questionnaire was supported by the use of a research methodologist, nurse expert and a statistician in the particular field. A pilot study was done to test the feasibility of the study and to test the questionnaire for any errors and ambiguities. Ethics approval was obtained from Stellenbosch University and permission from the Heads of the hospitals where the study was conducted. The data was analyzed with the assistance of a statistician and these are presented in histograms, tables and frequencies. The relationship between response variables and nominal input variables was analysed using analysis of variance (ANOVA). Various statistical tests were applied to determine statistical associations between variables such as the Spearman test, using a 95% confidence interval. Results have shown that participants experienced an average level of emotional exhaustion, a high level of professional efficacy and a low level of cynicism. Further analyses have shown that there is a statistical significant difference between emotional exhaustion and the rank of the participant (p=<0.01), highest qualification (p=0.05) and a high workload (p=0.01). Furthermore a statistical significant difference was found between professional efficacy and rank of participants (p=<0.01). In addition a statistical significant difference was found between cynicism and the number of years participants were in the profession (p=0.05). Multiple factors were determined in this study that influences the degree of burnout nurses experience. The majority of participants (n=56/55%) experienced decreased job satisfaction and accomplishment, (n=52/51%) of participants experienced that their workload is too much for them and (n=63/62%) participants received no recognition for their work. Recommendations are based on preventative measures, because preventing burnout is easier and more cost-effective than resolving burnout once it has occurred. In conclusion, the prevention strategies, early recognition of work stress and appropriate interventions are crucial in addressing the problem of burnout.
AFRIKAANSE OPSOMMING: Uitbranding is een van die uitdagings waarmee verpleegsters te kampe het in hulle stresvolle en vinnig veranderende werkomgewing. Die kwesbaarheid van verpleegsters vir uitbranding bly ’n kritieke bekommernis wat beide die individu en die inrigting affekteer. Kennis omtrent uitbranding en verwante risiko faktore wat die ontwikkeling van uitbranding beïnvloed, is deurslaggewend vir vroeë opsporing en intervensie. Die navorsingsvraag wat hierdie studie gelei het, is: “Wat is die faktore wat die mate van uitbranding beïnvloed wat deur verpleegsters ondervind word wat in neonatale intensiewe sorgeenhede werk?” Die doelwitte wat ingesluit is, is om te bepaal watter fisiese, sielkundige, maatskaplike en beroepsfaktore die mate van uitbranding wat deur verpleegsters ervaar word, beïnvloed. ’n Beskrywende, ondersoekende navorsingsontwerp met ’n kwantitatiewe benadering is toegepas. Die teikengroep het bestaan uit (n=105) permanente verpleegpersoneel wat in die neonatale eenhede van twee verskillende hospitale werk. ’n Gerieflikheidsteekproef metode is gebruik. Deelnemers (n=102) wat vrywillige toestemming gegee het om deel te neem, is ingesluit in die navorsingstudie. Geldigheid en betroubaarheid is ondersteun deur die gebruik van ’n geldige vraelys van “Maslach Burnout Inventory – General Survey”, asook ’n afdeling gebaseer op demografiese inligting en ’n afdeling gebaseer op fisiese, sielkundige, maatskaplike en beroepsfaktore. Geldigheid van die vraelys is ondersteun deur ’n navorsingsmetodoloog, ’n verpleegspesialis en ’n statistikus op die navorsingsgebied. ’n Loodsondersoek is gedoen om die haalbaarheid van die studie te toets en om die vraelys te toets vir enige foute en dubbelsinnighede. Etiese goedkeuring is verkry van die Universiteit van Stellenbosch en goedkeuring van die Hoofde van die hospitale waar die studie uitgevoer is. Die data is geanaliseer met die hulp van ’n statistikus en is aangebied in histogramtafels en frekwensies. Die verwantskap tussen responsveranderlikes en nominale insetveranderlikes is geanaliseer deur gebruik te maak van die analise van variansie (ANOVA). Verskeie statistiese toetse is toegepas om statistiese assosiasies tussen veranderlikes te bepaal, soos deur van die Spearmantoets gebruik te maak, met ’n 95% betroubaarheidsinterval. Resultate het bewys dat deelnemers ’n gemiddelde vlak van emosionele uitputting, ’n hoë vlak van professionele effektiwiteit en ’n lae vlak van sinisme ervaar. Verdere analise het bewys dat daar ’n statistiese beduidende verskil tussen emosionele uitputting en die rang van die deelnemers (p=<0.01) is, hoogste kwalifikasie (p=0.05) en ’n hoë werklading (p=0.01). Verder is ’n statistiese beduidende verskil gevind tussen professionele effektiwiteit en rang van deelnemers (p=<0.01). Saam hiermee is ’n statistiese beduidende verskil gevind tussen siniesheid en die aantal jare wat deelnemers in die beroep is (p=0.05). Voorts, is veelvuldige faktore bepaal in hierdie studie wat die mate van uitbranding beïnvloed wat verpleegsters ervaar. Die meeste van die deelnemers (n=56/55%) het ’n afname in werksbevrediging en -verrigting ervaar, (n=52/51%) deelnemers het ervaar dat hul werklading te veel is vir hulle en (n=63/62%) deelnemers het geen erkenning vir hulle werk ontvang nie. Aanbevelings is gebaseer op voorkomende maatreëls, want om uitbranding te voorkom, is makliker en meer koste-effektief as om uitbranding te probeer oplos as dit alreeds begin het. Ten slotte, die voorkomende strategieë, vroeë identifisering van werkstres en geskikte intervensies is deurslaggewend om die probleem van uitbranding aan te spreek.

The nursing profession is expected to experience massive staff shortages due to experienced nurses reaching retirement and new nurses leaving the profession related to feelings of burnout. This study describes quantitative and qualitative perceptions of new graduate and experienced nurses employed in acute care. Two measurement tools, the Maslach Burnout Inventory (MBI) and the Conditions for Work Effectiveness Questionnaire (CWEQ-II), were administered using an online survey. An overall moderate level of burnout and empowerment were identified. Unit clusters differed in both burnout and empowerment subscale responses. New graduates differed in some responses regarding burnout, specifically depersonalization. Additionally, two open-ended questions provided insight about the participants' opinions regarding burnout and empowerment. Four burnout themes were identified: challenging work milieu, need for better compensation, desire for increased managerial support, and toll of professional demands. Four empowerment themes were also identified: feeling valued, positive communication, nurse retention, and wholesome relationships.

Syftet med studien var att beskriva yrkeserfarna sjuksköterskors upplevelser av att arbeta med och stödja nyutexaminerade sjuksköterskor. En kvalitativ och beskrivande design användes. Undersökningsgruppen bestod av åtta kvinnliga sjuksköterskor från ett sjukhus i mellansverige. Huvudresultatet visade att de yrkeserfarna sjuksköterskorna var nöjda med nyutexaminerade sjuksköterskors arbetsinsats. En viktig aspekt var att nyutexaminerade sjuksköterskor frågade vid osäkerhet för att känna tillit. Sjuksköterskorna ansåg att stöd och uppskattning för att komma in i arbetet och gemenskapen var viktigt för att nyutexaminerade sjuksköterskor skulle känna sig trygga. Trots att sjuksköterskorna upplevde att nyutexaminerade sjuksköterskor var snabblärda, duktiga och nyfikna på att ta in ny lärdom i yrket, kom det dock fram att det fanns svårigheter att fokusera och prioritera rätt. Genomgående ansågs nyutexaminerade sjuksköterskor fokusera mer på dokumentation än omvårdnadsarbetet. Sjuksköterskorna betonade att mer praktik behövdes i grundutbildningen för att bättre förbereda nyutexaminerade sjuksköterskor i klinisk verksamhet. Vidare framkom det att längre introduktionstid behövdes i klinisk verksamhet för att komma in i rutinerna och sjuksköterskerollen. Slutsatsen visade att yrkeserfarna sjuksköterskor var nöjda med arbetsinsatsen från nyutexaminerade sjuksköterskor. Det ansågs viktigt att fråga vid osäkerhet och att mer fokus behövdes på omvårdnadsarbetet. Mer praktik ansågs nödvändigt för att lättare klara av den kliniska verksamheten.
The aim of the study was to describe professional experienced nurses' experiences of working with and supporting newly qualified nurses. A qualitative and descriptive design was used. The study group consisted of eight female nurses from a hospital in central Sweden. The main results showed that the professional experienced nurses were satisfied with the graduates’ nurses’ job performance. An important aspect was that newly qualified nurses asked if unsure to feel confident. The nurses felt that support and appreciation to get into work and community was important for newly qualified nurses to feel safe. Although the nurses felt that newly qualified nurses were quick to learn, skilled and curious to take on new learning in the profession, was however shown that there were difficulties to focus and 0Tprioritize the right0 Consistentlyconsidered graduates nurses to focus more on documentation than nursing. The nurses emphasized that more training was needed in basic education to better prepare graduate nurses for clinical practice. It was also found that longer introduction where needed in clinical practice to get into the routine and the nursing role. The conclusion showed that experienced nurses were satisfied with the effort from newly graduates’ nurses. It was considered important to ask if in doubt and that more focus was needed on nursing. More training was needed to help manage the clinical operations.

The research reported in this thesis examined the changes that students undertaking the Project 2000 (UKCC, 1986) course in nursing experience. It was carried out in one school of nursing in the Midlands over a period of 3 years and the various stages of empirical enquiry involved a total of 218 questionnaires, 10 interviews and 30 stress studies. A phenomenological methodology was adopted which incorporated a 3 stage mixed method approach. During the initial 2 stages complementary data were collected from two cohorts of students (cohort 1 n=40, cohort 2 n=19) to explore their experiences of the course and identify significant issues. To identify possible changes in their methods of studying the Revised Approaches to Studying Inventory (Tait & Entwistle, 1996) was used. Insight into other changes that occurred during the course was afforded by supplementing these data with demographic data and qualitative data obtained from interviews. Two main themes arose; Changes in Approaches to Studying and Psychological Distress. In the final stage of this research each theme was considered using quantitative methods. Two instruments were developed and data was obtained from 2 samples of students (n=76, n=30). These were analysed using descriptive and inferential statistical tests and the results compared with those from earlier stages of this research and the literature. Linking the findings of this research to other enquiries also suggests that these students are typical of all Project 2000 students at this time (Yin, 1994; Bassey, 1998). Therefore, this research contends that Project 2000 students are likely; in terms of approaches to studying: (a) to change their approach to studying from a Surface Approach in favour of a Deep Approach as they see the relevance of the theory to the practice of nursing; (b) to exhibit the pattern which is common in higher education that older students tend towards a Deep Approach to studying; in terms of confidence and ability in studying: (c) by the end of the first year of the course to show no difference in confidence or ability in studying which can be attributed to their academic qualifications on entry to the course; in terms of psychological distress: (d) to experience various intensities of distress during the course associated with: • the theory component of the course (due to perceptions of irrelevance of the “health” model taught, particularly during the CFP); • loss of control (concerning the administration of the course and also the adverse group pressure exerted by the Adult Branch students in the CFP); • clinical practice (due to perceptions of not being prepared for the “curative-illness” model during the CFP, a lack of clinical skills, and sometimes due to hostility from placement staff); • assignments (due to lack of co-ordination between the different modules and clinical experiences, and related problems of time-management); • financial pressures (often resulting in additional employment to supplement bursaries); and; in terms of personal development and personal relationships: (e) to become more self-aware, assertive and non-judgemental in professional settings; (f) to have a high chance of personal difficulties with spouses or partners, particularly those students between the ages of 25-34 years.

Deliberate self harm as defined pathologically as well as socially is becoming an increasing phenomenon within forensic psychiatry. Nurses working with patients who have self harm behaviour and are confined to forensic psychiatry face different challenges which affect their feelings and attitudes in different ways, in their nursing practice. Purpose: To explore nurses’ experiences of caring for patients who suffer from deliberate self harm behaviour and are confined to forensic psychiatry. Method: Qualitative semi- structured interview s from eight nurses working within the forensic psychiatric clinic. Interviews were analysed by using a qualitative content analysis. Results: They worked strategically and emphasized the importance of teamwork, good communication and urged for the need to get necessary education, staff focused tutoring and patient focused therapy. Conclusion: Need for necessary education, patient focused therapy and staff focused tutor is needed to empower staff working with patients who are confined within forensic psychiatry and suffer from deliberate self harm behaviour.
Introduktion: Självskadebeteende beskrivs vanligtvis utifrån ett patologiskt perspektiv och är allt vanligare inom rättspsykiatrisk vård. Beteendet anses ofta vara socialt oacceptabelt i samhället. Sjuksköterskor ställs ofta inför olika emotioner och synsätt i mötet med patienter med självskadebeteende. Dessa känslor och attityder påverkar både sjuksköterskan och patienter på olika sätt. Syfte: Examensarbetets syfte var att belysa sjuksköterskors erfarenheter av att vårda patienter med självskadebeteende, som vårdas inom rättspsykiatrisk vård i Sverige. Metod: Studien har genomförts med hjälp av kvalitativa semi-strukturerade intervjuer, som analyserats med innehållsanalys. Åtta sjuksköterskor deltog i studien. Resultat: Från intervjuerna framkom det att sjuksköterskorna upplevde olika känslor och reaktioner gentemot patienter med självskadebeteende. Känslorna var av frustration, hjälplöshet, ilska, ångest och rädsla. Sjuksköterskorna betonade vikten i att ha en god kommunikation i omvårdnaden med sina kollegor, samt efterlyste behovet av utbildning och handledning till personalen samt patientfokuserad terapi. Slutsats: För att stärka sjuksköterskorna i deras omvårdnadsarbete och professionella roll gentemot patienter med självskadebeteende, som vistas inom den svenska rättspsykiatriska vården, krävs det faktabaserade utbildning och handledning för att kunna ge en god vård. Deliberate self harm as defined pathologically as well as socially is becoming an increasing phenomenon within forensic psychiatry. Nurses working with patients who have self harm behaviour and are confined to forensic psychiatry face different challenges which affect their feelings and attitudes in different ways, in their nursing practice.

This research explores how experienced nurses perceive their role as clinical teachers in an environment that is challenged not only with on-going changes in healthcare delivery, but also by the expectation that it will continue to provide positive clinical learning opportunities for undergraduate student nurses.

Personal knowledge was disclosed amongst a group of experienced registered nurses in relation to feeding severely ill patients with cancer and dementia (I,II,III), communicating with severely demented patients (IV,V), and receiving group supervision (VI). Principled ethics did not seem an adequate model for describing the ethical reasoning of experienced RNs. For the twenty RNs working in oncological care the question of whether or not to accept active euthanasia was the most urgent. The twenty RNs working in dementia care emphasized the difficulty they had in understanding the meaning of communicative cues in severely demented patients. Both groups of nurses saw themselves as advocates for their patients and seemed to reason mainly in accordance with the Golden Rule. Through a phenomenological hermeneutic analysis of video recordings of two RNs' interaction with each of four severely demented patients, it was possible to interpret the patients' vague and unclear communicative cues. But observations based on an assessment of facial muscle movements showed that it was very difficult (the FACS). Group supervision based on a narrative framework was carried out in order to support nurses working in dementia care. Interviews with the fifteen RNs showed that they experienced recognition and reassurance of worth, an increased repertoire of actions, gained new perspectives, an increased awareness of their professional role, and interdependence. It is proposed that the care of severely ill patients can be improved by the use of a narrative approach both as regards understanding patients and encouraging RNs to develop their clinical knowledge through reflecting on their own and their coworkers' narrations about care.

Diss. (sammanfattning) Umeå : Umeå universitet, 1993, härtill 6 uppsatser.

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Registered nurses [RNs] are within the frontline of professional nursing and are expected to provide a diverse range of health care services to a varied and heterogenic group of patients. They are bound by a code of ethics that mandates that nurses respect all human rights regardless of the patient’s abilities or functional status. However, research implies that RNs do not feel adequately prepared to support patients with intellectual and developmental disabilities [IDD], and that patients with IDD are often misinterpreted and misunderstood in care. Gaining in-depth knowledge about how RNs can experience nursing for this group of patients is therefore of great importance. The overall aim of this thesis was to describe, appraise, integrate and synthesise knowledge concerning nursing for patients with IDD. A further aim was to explore and describe Swedish RNs’ perceptions of providing care for patients with IDD within a home health care setting.   This thesis consisted of two studies designed to investigate various aspects of nursing and caring for patients with IDD. Paper I was a systematic review using a meta-ethnographic approach, and Paper II was an interview study using a qualitative descriptive, interpretive design. Data was collected by systematic data base searches (Paper I), and by individual interviews (Paper II). The systematic review comprised 202 RNs (Paper I) and the qualitative descriptive study comprised 20 RNs.  In the systematic review, data was analysed by a Line of Argument Synthesis [LOAs] as described by Noblit and Hare (1988), while the data in Paper II was analysed by content analysis.     Nurses’ experiences and perceptions of nursing patients with an IDD could be understood from 14 LOAs. Six of these were interpreted to reflect a tentatively more distinctive and unique conceptualisation of RNs’ experience of nursing for this group of patients. The remaining eight LOAs were interpreted to reflect a conceptualisation of nursing per se that is a universal experience regardless of context or patient group (Paper I). In Paper II, the nurse’s perceptions were interpreted to be reflected by three overarching categories: Nursing held hostage in the context of care, Care dependant on intuition and proven experience and Contending for the patient’s right to adequate care.     Absence of understanding and knowledge about IDD might be an explanation for the “otherness” that still appears to surround this group of patients. Concentrating on the person behind the disabilities label as well as on abilities instead of disabilities could be a reasonable approach in nursing care for patients with IDD. Thus, implementing nursing models focusing on person-centred care could support RNs to moderate the health and care inequalities that are still present among patients with IDD (Paper I).    As a result of the home health care context and its organisation, the RNs perceived themselves as unable to provide care in accordance with their professional values. Not mastering the available augmentative and alternative communication tool additionally meant having to provide care based on second-hand information from support staff. The RNs also perceived that caring for this group of patients involved a daily battle for the patient’s rights to receive the right care at the right place and time and by the right person (Paper II). Hence, a broad base of evidence on what actually works best in clinical practice for this group of patients, particularly in the home care context, is still needed.
Forskning visar att patienter med intellektuella funktionsnedsättningar (IF) ofta kan misstolkas och missförstås i vården. Studier visar även att hälso- och sjukvårdspersonal generellt har en begränsad kunskap om IF. Det är inte ovanligt att sjuksköterskor uppger att de känner sig oförberedda på att stödja denna grupp av patienter och att de rädda för att inte kunna kommunicera effektivt och att vårda patienter med IF. Detta kan inverka på negativt på omvårdnaden och kvaliteten på den vård som ges, vilket i sin tur kan leda till att essentiella vårdbehov inte identifieras eller uppfylls på ett lämpligt och adekvat sätt. Det finns belägg för att personer med IF inte får vård i samma utsträckning som andra samhällsmedborgare och det verkar som att vanliga omvårdnadsmetoder inte alltid är utformade för att tillgodose vårdbehoven hos patienter med IF. Dessutom finns det rapporter som visar att problem med samordning mellan olika omsorgsinstanser har bidragit till för tidiga dödsfall bland personer med IF. Följaktligen har denna befolkning särskilda vårdbehov med komplexa sjukdomsbilder som utgör en utmaning inom instanser som tillhandahåller vård och omvårdnad för denna patientgrupp.   Inom ramen för professionell omvårdnad förväntas sjuksköterskan att kunna erbjuda vård till en varierad och heterogen grupp av patienter utifrån den etiska koden som föreskriver att sjuksköterskor ska respekterar alla mänskliga rättigheter oavsett patientens förmågor eller funktionella status. Genomförda studier påvisar att sjuksköterskor utbildade i IF är bättre rustade för att tillhandahålla en säker omvårdnad av god kvalitet till denna patientgrupp. Trots detta så finns i dagsläget ingen klar beskrivning över hur sjuksköterskestudenter förbereds på att omvårda patienter med IF under sin utbildning. Nyligen publicerade internationella studier avslöjade en stor variation i väsentligt IF-innehåll med flera uppenbara luckor i sjuksköterskeprograms utbildnings- och kursplaner. Hur dessa resultat reflekteras i den svenska kontexten är osäkert men det kan inte heller uteslutas. Forskning som undersöker hur omvårdnad för denna utsatta patientgrupp kan upplevas och uppfattas av sjuksköterskorna är därför avgörande för en ökad kunskap och för att kunna utveckla av en evidensbaserad omvårdnad inom område. Det ter sig därmed angeläget att detta blir en utbildnings- och professionell prioritet. Med normaliseringsprincipen på 1960-talet följde att de stora vårdinstitutionerna stängde och patienter med IF flyttade ut till kommunerna. Sjuksköterskan inom kommunens hemsjukvård bär nu ansvaret för patienternas omvårdnad, vilket sker i patienternas hem, och är därmed också oftast den primära vårdkontakten. Kunskap om hur sjuksköterskor kan uppleva att erbjuda omvårdnad till patienter med IF (Paper I) och hur omvårdnaden som tillhandahålls i kommunal hemsjukvård kan beskrivas och uppfattas av sjuksköterskorna (Paper II) är av därför av vikt. Det övergripande syftet i denna avhandling var således att beskriva, bedöma, integrera och syntetisera kunskap rörande omvårdnad för patienter med intellektuella funktionsnedsättningar. Vidare avsågs att beskriva hur sjuksköterskor kan uppfattar omvårdnad för denna patientgrupp inom kommunal hemsjukvård. Paper I var en systematisk litteraturstudie med en meta-etnografisk ansats och Paper II var en intervjustudie med en kvalitativ, deskriptiv och tolkande design. Data samlades in genom systematiska databassökningar (Paper I) och enskilda intervjuer (Paper II). Deltagarna bestod av 203 sjuksköterskor (Paper I) respektive 20 sjuksköterskor (Paper II). I Paper I analyserades data med meta-etnografi och en ”Line of argument” synteser (LOA), medan data för Paper II analyserades med innehållsanalys. I den första studien (Papper I) kunde sjuksköterskornas upplevelser av omvårdnad för patienter med IF förstås utifrån fjorton olika ”Lines of Arguments” synteser (LOA): Baseras på långvariga relationer (A*); Baseras på förtroende (B); Gå bortom verbal kommunikation (C*); Baseras på långsiktig planering (D); Inkluderar relevanta andra för att kunna erbjuda kvalitativ omvårdnad (E); Arbetar mot negativa attityder och utanförskap (F*);  Kräver mer kunskap i omvårdnad för denna patientgrupp (G*); Behöver erkänna personen bakom etiketten ”funktionshindrad” (H); Baseras på evidens (I); Tar oberäkneliga situationer i beaktan (J*); Kräver kunskap bortom diagnosen (K); Interprofessionellt samarbete (L); Omfatta företrädarskap och beskydd (M); Förståelse för patientgruppens komplexitet (N*). Det vill säga hur de olika men relaterade studiernas resultat tillsammans, argumentationslinjen, tolkades att representera övergripande helheter bland den ursprungliga uppsättningen av delar av sjuksköterskornas upplevelser. Åtta av dessa LOA synteser, (B, D, E, H, I, K, L, M) tolkades att reflektera ett begreppsliggörande av omvårdnad per se, det vill säga en universell upplevelse av omvårdnad oavsett kontext och patientgrupp. Medan sex av LOA synteserna, A, C, F, G, J och N tolkades att kunna spegla en unik konceptualisering av sjuksköterskors upplevelse av omvårdnad för patienter med IF. I Paper II tolkades sjuksköterskornas erfarenheter att återspeglas i tre övergripande kategorier: i) Omvårdnad tagen som gisslan av vårdkontexten; Som ett resultat av hemsjukvårdens organisering erfor sjuksköterskorna sig själva som oförmögna att tillhandahålla omvårdnad i enlighet med sina professionella värderingar. De beskrev att de ständigt sysslade med ”brandsläckning” istället för att ge en kontinuerlig omvårdnad. ii) Omvårdnad beroende av intuition och beprövad erfarenhet;Sjuksköterskorna beskrev också att de inte behärskade alternativa och kompletterande kommunikationsverktyg vilket innebar att sjuksköterskan ofta behövde basera sina bedömningar och beslut för omvårdnaden på andrahandsinformation från stödpersonalen, samt iii) ”Slåss” för patienternas rätt till en adekvat vård en del av omvårdnad; I denna sista kategori reflekterades hur Sjuksköterskorna erfor att omvårdnad av denna patientgrupp kunde innebära en daglig kamp för att säkerställa patienternas rätt till vård på lämplig plats, i lämplig tid och av lämplig person. Tolv av fjorton LOA synteser (Paper I) tolkades att partiellt speglas i sjuksköterskornas erfarenheter av omvårdnad (Paper II) inom kommunal hemsjukvård; i – A*, B, E och L; ii – C*, G* och I; iii- D, F*, H, M och N*. Två av LOA synteserna (Paper I) tolkades att inte reflekteras av sjuksköterskors erfarenheter (Paper II); Tar oberäkneliga situationer i beaktan (J*) och Kräver kunskap bortom diagnosen (K). Detta indikerar att resultatet från Paper I är överförbart i kommunal hemsjukvård i Sverige (Paper II). Avsaknad av förståelse och kunskap kan vara en förklaring till stigmatiseringen som fortfarande tycks omsluta denna patientgrupp. En omvårdnad där sjuksköterskan fokuserar på personen bakom funktionshindren och på personens förmågor istället för oförmågor ter sig som en rimlig strategi för att kunna säkerställa kvalitén på den vård- och omsorg som denna grupp av patienter har rätt till. Således kan implementering av omvårdnadsmodeller som innebär en koncentration av personcentrerad vård stödja sjuksköterskor för att motverka de hälsoskillnader och ojämlikheter som fortfarande verkar vara närvarande inom denna patientgrupp (Paper I). Det som alltjämt tycks saknas, är en bred kunskapsbas av vad som faktiskt fungerar bäst och krävs i klinisk praxis, särskilt inom hemsjukvården, för denna patientgrupp. Utbildningsprogrammen till sjuksköterska och sjuksköterskeprofessionen hade stärkts av en generell/allmän debatt om detta samt om vilka kompetenser och färdigheteter som behövs för att patienter med IF ska kunna erhålla den omvårdnad och vård som krävs för denna oftast komplexa patientgrupp (Paper II).

This Grounded Theory study developed a substantive theory to explore and explain the experienced nurse’s perspective of maintaining emotional wellbeing in the Intensive Care Unit (ICU). Data were collected by recorded interviews of 15 experienced ICU registered nurses from an ICU of a metropolitan hospital in Perth, Western Australia. Emotional wellbeing was described by the participants as feelings of satisfaction and happiness, derived from the delivery of best care to patients and their families. This formed the context of the study. The core problem shared by ICU nurses was the Inability to Protect Self from Distress. Distress was described as feelings of grief, sadness, frustration and anger in response to caring for patients who were critically ill, and their families.Conditions were also identified that impacted the nurse's ability to protect self from distress: Best care; Autonomy; Teamwork; and Previous nursing and life experience. The Basic Social and Psychological Process used by nurses to protect themselves from distress, and therefore maintain their emotional wellbeing was called Protecting Self from Distress. The process was described under three phases: Delivering best care, Validating care episodes, and Distancing self from distress. The process described how nurses protected self from distress, including strategies to overcome or promote the conditions that impacted nurse wellbeing. Nurses maintain their emotional wellbeing through the delivery of best care. Best care referred to giving the best care possible given the nature of critical illness and limitations of critical care.Understanding the conditions that impacted nurse wellbeing provides valuable insight into factors that help or hinder the delivery of best care. The substantive theory outlined processes that enabled nurses to maintain their emotional wellbeing and succeed in providing best care to patients and families in the ICU. Minimising threats to the delivery of best care will promote nurse satisfaction, happiness, enhance wellbeing and may contribute to higher retention rates. The satisfaction and happiness enjoyed by nurses was found to be the reason the group in this study remained nursing in ICU.

This dissertation used an experience sampling design to examine effects of experienced workplace incivility from three categories of organizational insiders (coworkers, supervisors, and physicians) and from organizational outsiders (patients and their visitors) on targets' emotions, burnout, physical symptoms, and their own uncivil behaviors toward each of the four groups of people. Data were collected from 75 nurses with each nurse responding to online surveys twice per week for 5 consecutive weeks. Results from hierarchical linear modeling showed that within individuals, negative emotions were positively associated with experienced workplace incivility (overall and source-specific), burnout was positively associated with overall workplace incivility and incivility from coworkers, and that physical symptoms were positively associated with experienced workplace incivility from supervisors. In addition, within individuals overall and source-specific experienced workplace incivility all positively predicted targets' own uncivil behaviors correspondingly. None of the proposed moderating effects of three between-person level personality traits (emotional stability, hostile attribution bias, and emotional competence) were supported, and the only significant moderating effect found was that emotional stability moderated the relationship between experienced workplace incivility from- and targets' own uncivil behaviors toward- supervisors was opposite to the prediction. Further, both violence prevention climate and civility climate showed main effects in negatively predicting participants' own uncivil behaviors, but only violence prevention and two of its dimensions (policies and procedures, and pressure for unsafe practices) buffered some of the negative effects of experienced workplace incivility. In summary, the current study found that within individuals experienced workplace incivility had negative effects on targets' emotions, well-being, and behaviors, and that perceived violence prevention climate buffered some of the negative effects.

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.

At least one patient will experience a potentially serious intravenous (IV) drug error every day in an ’average’ hospital. IV drug errors have been estimated to be a third of all drug errors. Previous drug error research has focused on observation of nurses and errors they make but has not attempted to understand the decision-making processes used during the preparation and administration of IV drugs. The aim of this study was to explore the decision-making processes that novice and experienced IV nurses use during IV drug administration and how this influences risk taking and errors. A three-phased ethnographic study was carried out in a specialist cancer hospital, using focus groups, observation and interviews. Three focus groups with 14 registered nurses were used to develop culturally relevant definitions related to error and experience. Observation of the two wards took place over a week each. Twenty nurses were observed preparing and administering IV drugs, and then interviewed about their procedure. Data analysis was carried out using a five stage approach. Definitions of drug error, IV drug error, novice and experienced IV givers were developed from the focus groups. Four major themes were identified and represent findings from the direct observation and interview of the nurses: interruptions; lack of identification/knowing the patient; routinised behaviour; prevention of errors. One of the key findings was the lack of checking of patient identity prior to IV drug administration, which appeared to be based on the nurses feeling they knew the patient well enough although this was in contrast to the checking of drugs even if they were familiar with them. Implications for practice included: exploring new and effective methods of education based on behavioural theories; involving staff in updating and writing policies and procedures; and formal assessment of staff during IV preparation and administration.

The changing context of mental health care provision in the United Kingdom in the last three decades has seen significant change in acute inpatient services. Service users have expressed dissatisfaction about current service provision and care. Nurses continue to represent the largest professional group providing care in these services. Comparatively little is known from nurses' perspectives about the present nature of the nurse-patient relationship in acute mental health inpatient settings. The purpose of this research study was to explore with a sample of 14 registered mental nurses, their experiences about the nature of the nurse-patient relationship. An interpretive, phenomenological approach was adopted. The principal research question asked 'What are registered mental nurses' experiences of the nature of the nurse-patient relationship in working age acute inpatient mental health care settings?' Following ethical approval, unstructured, individual interviews were used as the primary method of data collection. Transcribed interview texts were analysed hermeneutically, supplemented with the researcher's field notes and reflective journal. Key findings included the impact of poor ward environments, increased patients' acuity of illness, and multiple, competing demands placed on nursing time. Although nurses valued human interpersonal relationships with patients, they struggled to achieve their aspirations for the nurse-patient relationship, owing to a range of factors including organisational constraints, inexperience, and limited post-registration professional development. Nurses could experience stress and emotional fatigue, and their needs for support were not always met. These factors may challenge possibilities for the development of therapeutic nurse-patient relationships. Whilst nurses appear to acknowledge the benefits of therapeutic nurse-patient relationships, they may be insufficiently prepared to achieve their ideals, given the challenges of working within an area of practice which provides for short term admissions focussed on acute risk management and containment.

Registered nurses entering a Nurse Prescriber programme participated in a mixed methods case study to explore the extent of their bioscience knowledge and the confidence with which that knowledge was held. Forty two Nurse Prescriber students, aged 26 – 55 years, from a range of job roles were recruited. Using questionnaires and interviews, both quantitative and qualitative data were obtained. An examination of the Nurse Prescribers’ views of pre-registration nursing demonstrated that the knowledge gained had been related to practice but had been both superficial and lacking in breadth. The bioscience in pre-registration programmes had not sufficiently prepared the participants for their roles as registered nurses. The importance of experiences gained as a registered nurse in the practice setting in the learning of bioscience was strongly emphasised. Participants reported greater learning of bioscience by informal methods such as work experience, use of books and the Internet and discussion with colleagues than from experiences in the classroom. Interviewees placed particularly strong emphasis on the importance of learning from medical colleagues. The role of post-registration programmes emerged as important in learning bioscience because it related to the job role. Post-registration courses also emerged as significant in giving confidence to the registered nurse. Confidence increased not just in terms of the knowledge held, but also in terms of nurses’ ability to communicate with patients, relatives, and doctors, their ability to understand nursing skills, and their willingness to admit when something was not known.

This project study addressed the problem of frequent turnover of nurse managers at a Northeastern community hospital. The lack of retention of nurse managers has led to attenuated support for the nursing staff who continued to hold the front line in patient care. The purpose of this qualitative bounded case study was to explore nurse managers' experiences with turnover in order to identify strategies for enhancing retention. Work empowerment and servant leadership theories served as the frameworks for the study. Research questions focused on nurse managers' perceptions of empowerment and servant leadership characteristics that were important in decisions to assume and remain in a management/leadership role. Data collection included audio-recorded interviews with seven current or past full-time nurse managers, and observation of three of the participants at a leadership meeting. Interview transcripts were open coded and thematically analyzed. Observation data were categorized according to empowerment and servant leadership characteristics. Five themes were identified that related to research questions: struggling in management transition, seeking opportunity for transformation, being committed but powerless, embarking unprepared on an unplanned journey, and having the presence to lead others by serving. The findings of this study guided development of a 12-month program for new nurse managers that integrated characteristics of servant leadership to empower leaders and others. These contributions may promote positive social change by preparing new nurse managers for their role and developing their skills to become successful nurse managers.

The aim of this thesis has been to map the ethical journey of experienced nurses now practising in rural and remote hospitals in central and south-west Queensland and in domiciliary services in Brisbane. One group of the experienced nurses in the study were Directors of Nursing in rural and remote hospitals. These nurses were “hands on”, “multi-skilled “ nurses who also had the task of managing the hospital. Also there were two Directors of Nursing from domiciliary services in Brisbane. A grounded theory method was used. The nurses were interviewed and the data retrieved from the interviews was coded, categorised and from these categories a conceptual framework was generated. The literature which dealt with the subject of ethical decision making and nurses also became part of the data. The study revealed that all these nurses experienced moral distress as they made ethical decisions. The decision making categories revealed in the data were: the area of financial management; issues as end of life approaches; allowing to die with dignity; emergency decisions; experience of unexpected death; the dilemma of providing care in very difficult circumstances. These categories were divided into two chapters: the category related to administrative and financial constraints and categories dealing with ethical issues in clinical settings. A further chapter discussed the overarching category of coping with moral distress. These experienced nurses suffered moral distress as they made ethical decisions, confirming many instances of moral distress in ethical decision making documented in the literature to date. Significantly, the nurses in their interviews never mentioned the ethical principles used in bioethics as an influence in their decision making. Only one referred to lectures on ethics as being an influence in her thinking. As they described their ethical problems and how they worked through them, they drew on their own previous experience rather than any knowledge of ethics gained from nursing education. They were concerned for their patients, they spoke from a caring responsibility towards their patients, but they were also concerned for justice for their patients. This study demonstrates that these nurses operated from the ethic of care, tempered with the ethic of responsibility as well as a concern for justice for their patients. Reflection on professional experience, rather than formal ethics education and training, was the primary influence on their ethical decision making.

Nurse academics are constantly facing new challenges from governmental and professional groups calling for the preparation of students to be able to work with increasing complex patient cases at a time of reduction in clinical placements (NMC, 2010a and b). Simulation is a method that has been embraced, by some, for preparing for these challenges, with the potential to escalate student skills and knowledge in a meaningful way (Benner, 1984). The aim of this study was to explore and make explicit the characteristics that make simulation effective within nurse education. An explorative, qualitative case study was chosen to collect spoken data from twenty-four participants through focus groups. Participants included both students undertaking nurse training, and academics involved in the delivery of simulation. Content analysis facilitated exploration of each participant's contribution resulting in the emergence and construction of three themes (Creswell, 2007; Polit and Beck, 2014). 1. The approaches that academics use to integrate simulation into the curriculum; 2. The influences and decisions academics make to deliver simulationbased education, and their impact upon the student learning experience; 3. Evidence for the transference of skills to the realities of clinical practice. A conceptual framework has been developed and presented through the data analysis process (Saldana, 2012), which has culminated in the presentation of a unique model for 'Developing Simulation Practice in Nurse Education' (DSPiNE). The model relates to two key processes derived both during and following simulation activities (1) the preparedness for clinical practice, described as the process whereby the student gains insight into their current practice abilities; and (2) the transference to clinical practice, described as the process whereby the student gains insight into their readiness for future practice requirements. This study concludes that purposeful positive behavioural change could be achieved with the implementation of the DSPiNE model within nurse education.

Includes abstract.
Includes bibliographical references.
The phenomenological study explored the experience of role transition of newly qualified nurses undertaking compulsory community service in health service facilities in the Western Cape in 2011.

Background: previous studies have revealed that newly hired nurses experience stress and anxiety when entering a new clinical setting. Failure to support and prepare these nurses may affect their ability to deliver the required level of nursing care. Preceptorship is a time limited, organised clinical instructional programme, which promotes staff development, improves nursing education, reduces nursing shortages, promotes staff retention and decreases staff turnover. Little evidence expounds about how newly hired nurses perceive preceptorship. The impact of preceptorship on the clinical nursing care of newly hired experienced nurses has not been investigated or verified globally neither has it been investigated from a Saudi context. Aims and Objectives: the study aimed to explore the nature of preceptorship and its impact on clinical nursing care as perceived by the nurses who had taken part in a preceptorship programme in Saudi Arabia. The study elicited the participants' understanding and expectations of the preceptorship programme in an attempt to identify those factors that may be directly related to the success or failure of the programme. Furthermore, it aimed to examine the role of preceptorship in developing the clinical practice of newly hired experienced nurses. Methodology: a qualitative design based on the principles of naturalistic inquiry underpinned this study. Thirty national and international nurses of five different grades across wards in one Saudi hospital were first purposively and subsequently convenience sampled to take part in the study. Most participants were of international origin, possessing various levels of experience and education. Preceptees were younger and less experienced than other programme stakeholders. Data were generated using tape-recorded semi-structured individual and focus groups interviews. This action was also supported by a review of the hospital's preceptorship policy documents. All the interviews were transcribed verbatim and analysed concurrently using thematic analysis based on a constant comparative method. Findings and discussion: Six themes were derived from the interview data to generate an account of participants' experiences. Social learning theory was used as an explanatory framework for understanding the study's findings. Thus, preceptorship was seen as an important supportive, learning process, although inconsistencies were highlighted related to the participants' understanding and expectations of the programme. The duration of preceptorship was also contested with some needing longer than allocated. Hence, confusion arose regarding when preceptorship should begin and end due to ambiguities within the preceptorship policy documentation. Furthermore, participants perceived preceptorship had a mixed impact on clinical nursing care depending on preceptee/preceptor preparation and workload. Surprisingly recruitment was found to have the biggest impact on the success or failure of the preceptorship programme an unexpected and new finding highlighted by this study. Conclusion: preceptorship is important for the integration of newly hired experienced nurses into their new roles. The meaning of preceptorship as applied to each hospital needs to be defined and articulated clearly and concisely. In order to meet the objectives of preceptorship, policy documentation needs to be clearer, and recruitment processes need to be reviewed in order to match both preceptee experience and qualifications with organisational requirements.

Magister Curationis - MCur
Patients' experiences of being nursed by student nurses at a teaching hospital in the Western Cape. Results: Three main themes were discovered after the data analysis; methods of identification of student-nurses by patients; positive perceptions of student-nurses by patients and the negative perceptions of student-nurses by the patients. Conclusion: Patients’ experiences with student nurses in their roles during their practicum vary considerably. Some patients reported that the students were very good to them, friendly; making conversations with them that would lighten up their moods. They asserted also that they felt comfortable with the technique and execution of the nursing care process by the student nurses, confirming that they see nothing wrong with them. Conversely, other patients did not hold the student nurses in high esteem and said that they were not very good with discharging their nursing duties and were sometimes found wanting in the execution of certain nursing procedures. Consequently, their experiences were not so good ranging from boredom to extreme pain during the nursing care from students. Emanating from the bad experiences that these patients have had with student nurses, they have become sceptical when it comes to receiving nursing care from student nurses and would refuse should they have the opportunity to decide.

The aim of this study is to assess the pre-registration preparation of nurses as a means for producing women and men capable of doing new things, not simply repeating what other generations had done. The issues which are examined are:-(1) The purposes of nurse education (11) The extant forms of knowledge (111) The nature of teacher/student relationships in the process of learning. The study was carried out in three stages:- (1) Analysis of the literature from 1947 to 1963 by abstracting and utilising grounded theory approaches to identify the essential issues.(11) Opinion survey of student nurses utilising content and structural analysis of the audio-taped recordings of interviews to develop a theory of nurse education in the 1980's,(ill) Experimental testing of one operational hypothesis describing the effect of teacher behaviours on the student nurse’s clinical decision making. It is concluded that the pre-registration preparation of nurses is not an educational experience on the grounds that the extant forms of knowledge and the prevalent teacher/student relationships are inconsistent with the production of a critical, reflective and self-reliant practitioner. Because of this, the recommendations of UKCC Project 2000 must be carefully planned and closely monitored if the problems of the theory/practice gap are to be minimised rather than exacerbated.

Thesis (Ph. D.)--University of Sydney, 2007.
Title from title screen (viewed 22 November 2007). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Faculty of Education and Social Work. Degree awarded 2007 ; thesis submitted 2006. Includes bibliographical references. Also issued in print.

Thesis (MHSc--Health Science) -- AUT University, 2007.
Includes bibliographical references. Also held in print (xi, 107 leaves : ill. ; 30 cm.) in North Shore Campus Theses Collection (T 610.73099623 IRO)

This phenomenological study describes the lived experience of ten registered nurses who provided a standard of nursing care that they perceived to be impeded because of their negative reactions to their patient's condition. Purposeful sampling was used to recruit participants via an advertisement in a local nursing organisation's newsletter. In-depth interviews generated data about the nurses' personal and professional experiences. Data analysis incorporated the qualitative methods of Huserrlian (descriptive) phenomenology and Colaizzi's method of data analysis. Findings revealed that during some stage of the nurses' careers they had reacted negatively to a patient's condition. These negative reactions included frustration, annoyance, nurses fearing for their own safety, revulsion, sadness and feelings of guilt that impeded care had been provided. These reactions translated into behaviours that were associated with providing nursing care to the patient that the nurses themselves perceived to be of impeded quality. Behaviours included not being there or spending less time with the patient, not communicating well and having less rapport with the patient, not meeting the patient's psychological and social needs and not meeting the patient's spiritual needs. The nurses found their awareness that this had occurred disturbing and they devised strategies to cope personally and also to ensure that a better quality of care was provided in subsequent situations. Strategies included discussions with colleagues, arranging for colleagues to provide care for the patient, mental preparation, and using individual coping strategies.There was a pattern of contextual factors impeding the provision of good care. These factors included an existing poor rapport with the patient, a bad experience with a patient with similar characteristics, time pressures and a lack of autonomy, chronic work stress, low staffing levels, a lack of clinical experience, negative reactions to the patient's condition by other staff members, a lack of visits by the patient's significant others and disagreement with the patient's medical treatment.

This phenomenological study describes the lived experience of ten registered nurses who provided a standard of nursing care that they perceived to be impeded because of their negative reactions to their patient's condition. Purposeful sampling was used to recruit participants via an advertisement in a local nursing organisation's newsletter. In-depth interviews generated data about the nurses' personal and professional experiences. Data analysis incorporated the qualitative methods of Huserrlian (descriptive) phenomenology and Colaizzi's method of data analysis. Findings revealed that during some stage of the nurses' careers they had reacted negatively to a patient's condition. These negative reactions included frustration, annoyance, nurses fearing for their own safety, revulsion, sadness and feelings of guilt that impeded care had been provided. These reactions translated into behaviours that were associated with providing nursing care to the patient that the nurses themselves perceived to be of impeded quality. Behaviours included not being there or spending less time with the patient, not communicating well and having less rapport with the patient, not meeting the patient's psychological and social needs and not meeting the patient's spiritual needs. The nurses found their awareness that this had occurred disturbing and they devised strategies to cope personally and also to ensure that a better quality of care was provided in subsequent situations. Strategies included discussions with colleagues, arranging for colleagues to provide care for the patient, mental preparation, and using individual coping strategies.
There was a pattern of contextual factors impeding the provision of good care. These factors included an existing poor rapport with the patient, a bad experience with a patient with similar characteristics, time pressures and a lack of autonomy, chronic work stress, low staffing levels, a lack of clinical experience, negative reactions to the patient's condition by other staff members, a lack of visits by the patient's significant others and disagreement with the patient's medical treatment.

Different studies show that stress is a common feeling that newly graduated nurses experience during the first period in the profession. What causes the stress are high expectations that they have on themselves and the expectations from colleagues, as well as the fear of making a mistake while working as a nurse. Newly graduate nurses go through five stages of development from being novice to expert. The aim of this study was to describe work experiences of newly graduate nurses in hospital ward settings. The research method was a literature study based on ten qualitative articles. Articles were analyzed by using the method of Friberg (2012). Four main themes were identified: experiences of leadership; experiences of the relationship with colleagues; experiences of support; experiences of knowledge level. Colleagues and managers must respond to the needs of newly graduated nurses in an adequate way to create a friendly and supportive working environment, which in turn can contribute to the professional development of the newly graduated nurse. Nursing education should prepare students for professional careers in terms of socialization, leadership and organization.

The nursing profession is facing a potentially devastating shortage of nurses by the year 2020. Contributing to the shortage is the retirement of experienced nurses who are over the age of 45, and an aging baby boomer population. The loss will place a considerable strain on the overloaded health systems. As a result, it is important to identify successful strategies for addressing the problem of experienced nurse retention. Therefore, the purpose of this project was to conduct a systematic review of literature to answer the question of what retention strategies have been used to prevent the loss of the experienced nurse who is approaching retirement age. The systematic review, guided by Benner's theory of novice to expert and Kanter's empowerment theory, included quantitative, qualitative and mixed methods studies published between 2007 and 2017. Studies published in the United States and Canada were 8studies selected for detailed review, were graded using the Joanna Briggs Institute grading criteria. The themes identified in this study included five key indicators: nurse autonomy and empowerment (75%), stress and burnout (62%), workplace engagement (68%), leadership commitment (56%), and training/career development action plans (56%). The key indicators may provide the basis for recommendations for managers and leaders in promoting experienced nurse retention in their work settings. Positive social change is possible when management takes into consideration the value of the key indicators above in experienced nurse retention efforts. By retaining experienced nurses, the nursing profession can promote positive patient outcomes and a mentoring plan for nurses approaching retirement age.

Vertical violence is the term used to describe abusive and bullying behaviours among a group of people with unequal power. Vertical violence is used in this study because the recipients of abusive behaviours are students. The goal of this phenomenological study was to elicit a description of the lived experience of nursing students with vertical violence during their clinical placements in three major hospitals in Palestine. Findings suggest that nursing students are experiencing and witnessing bullying behaviours in different forms, most notably by staff nurses and head nurses. Students reported that their experiences with vertical violence lessen as they advance in their clinical education and gain more skills. The majority of the students told someone about their experiences. Experiencing vertical violence was found to impact the students' learning, socialization and clinical practice. The students reported using different coping strategies to deal with vertical violence. Implications for practice include ensuring that if the issue of vertical violence is not dealt with, it will have a detrimental effect on the student nurses and on their practice. Recommendations include providing policies to address this issue and provide reporting guidelines for student nurses. Also teaching nursing students and nurses about vertical violence is to be a top priority for the schools of nursing and hospital managements.