PURPOSE: The purpose of this study was to explore the experiences of registered nurses when practicing ubiety. SPECIFIC AIMS: The specific aims of the study were to: Describe the attributes of the nurse, the care environment, and the person-centered processes nurses needed to possess in order to immerse themselves physically, cognitively, and spiritually into caring for one patient at a time in midst of distractions Explore possible patient-related and nurse-related outcomes when caring for one patient at a time in amidst distractions DESIGN: Qualitative descriptive study guided with the Person-Centered Nursing (PCN) Theory by McCormack and McCance, (2006). A purposive sampling technique was used. RESULTS: 13 nurses, who were nominated to receive the Daisy Award were recruited. One overarching theme: Practicing Ubiety—Making the patient the star of that minute, and 5 subthemes emerged: anticipating and managing distractions, putting my whole self in, self-preservation, my nursing identity, favorable practice environment. In addition, patient-related and nurse-related outcomes were identified. CONCLUSION: Ubiety is a concept that is practiced by expert nurses. Results add to existing knowledge about the characteristics of exemplar nurses who practice person-centered nursing care. The importance of anticipating patient needs as a way to deal with distractions and working with nurses to individualize self-preservation strategies are emphasized.

Purpose: To understand the process of discovery and decision-making for adults with the CDH1 marker for hereditary diffuse gastric cancer (HDGC) and inherited breast cancer. Participants and Setting: Purposeful sampling included 20 participants; 17 adults (11 women and 6 men, ages 23–77) recruited through the No Stomach for Cancer organization; six participants were interviewed two times; with three healthcare providers also interviewed. Nineteen interviews were by telephone; one was in person. Methodological Approach: Grounded theory with constant comparison. Findings: The person diagnosed with the genetic marker CDH1 undergoes the decision-making process of Paving the way as they address this healthcare challenge. Paving the way explains the entry points for learning the risk, discerning testing for confirmation, choosing iterative individual cycles of surveillance, surgery, and ongoing adjustments postoperatively while normalizing to live longer. Implications for Nursing: Understanding the process of Paving the way explains and describes the nine key factors for decision-making and predicts the timing for nursing interventions for both post-genetic testing and pre- and postoperative assessment and planning. Knowledge Translation: Advocacy for the self and family is key to Paving the Way. Nursing has an opportunity to develop and expand the roles for navigator and counselor in the area of genetic testing. Patients undergoing PTG have chronic healthcare needs. Family implications for genetic testing require assessment beyond the individual.

PURPOSE: The purpose of this feasibility study was to explore the use of an online video intervention to prepare surgical patients to properly dispose of unused opioids. SPECIFIC AIMS: Describe the feasibility of recruiting, enrolling, randomizing and retaining participants who recently had a general surgery into the study. Describe the differences in opioid disposal by age, sex, education, and type of surgery for the entire sample and by treatment assignment. Describe the preliminary change in knowledge, behavioral beliefs, normative beliefs and disposal of opioids from baseline to post-intervention by group. Describe the relationship between social desirability and behavioral beliefs, normative beliefs and disposal of opioids. FRAMEWORK: The Theory of Reasoned Action was used to guide both the intervention and the measures. DESIGN: This study used a randomized controlled feasibility study to explore a novel video intervention to teach safe storage and disposal of unused opioids after general surgery. RESULTS: A total of 40 participants were enrolled in the study, average age was 44.7 (range 21-75 years), most were White, educated and employed. Recruitment took 11 weeks and the retention rate was excellent at 85%. Differences in opioid disposal was not significantly different by age, sex, education or type of surgery. The video intervention was positively received, but the majority (80%) still stored their pills unsecured. CONCLUSION: The results demonstrate that a video intervention addressing safe storage and disposal practices of unused opioids is feasible and more research is needed to determine efficacy in increasing rates of secure storage and disposal of unused opioid pills KEYWORDS: Opioids, opioid disposal, general surgery, video education

Purpose: This qualitative descriptive study was undertaken to describe Eastern Woodlands Native adult perspectives, health care beliefs and type 2 diabetes management experiences. Specific Aims: The specific aims were to 1) explore and describe perceptions of type 2 diabetes among Eastern Woodland Native adults and how they relate to their understandings about the cause and treatment approaches to the disease, 2) describe how family, friends, and community intersect with type 2 diabetes management, 3) describe relationships with health care providers and 4) determine resources that would help diabetes-self management within their community. Framework: The PEN-3 Model by Airhihenbuwa was the initial framework used for the study. Methods: A qualitative descriptive design with maximum variation and snowball sampling was used and data was analyzed using qualitative content analysis. Results: The overarching theme of Together We Can Return To Balance comprised five sub-themes: Coming to Know Life Paths with T2DM, Negotiating My Way Forward, Making Important Connections, Acknowledging the Imbalance, and Sticking Closer to Mother Earth illustrating physical, spiritual, and environmental health factors influencing DSM capacities. Conclusion: Native perspectives should be viewed as a crucial contextual variation for type 2 diabetes care when developing DSMES and for improving DSM capacities in these populations.

Purpose: The purpose of this study was to explore the way(s) in which family management of childhood asthma is affected by contextual influences as described in the Family Management Style Framework (FMSF) and to explore additional factors that affect family asthma management. Specific Aims: The specific aims of this study were 1) to describe the everyday experiences of childhood asthma management within families, 2) to explore the way(s) in which family management of childhood asthma is affected by contextual influences (social network, care providers & systems and resources) as described in the FMSF, and 3) to explore additional sociocultural factors (supported by the literature but not currently described in the FMSF) that affect asthma management in families. Framework: The Family Management Style Framework guided this study. Design: A qualitative descriptive design was used to gather data from a purposive sample of female primary caregivers. Demographic data were collected, and individual interviews were conducted using a flexible interview guide. Results: The findings support the contextual influences as described in the FMSF. An additional three contextual themes were identified: environment, emerging threats to health and work-life conditions. The themes are interrelated demonstrating the complexity of asthma management. Conclusion: Family management of asthma is challenging and complex. The findings move towards understanding the connection between family asthma management and the social determinants of health. Nurses can support families managing childhood asthma by considering each of the contextual influences when planning interventions and working on policy initiatives that support the health of children with asthma.

PURPOSE: The purpose of this national survey study was to describe the transition conditions (facilitators and/or inhibitors) encountered by LPN-to-RN students. SPECIFIC AIMS: (1) describe the frequency of specific transition conditions experienced by LPN-to-RN students; (2) explore relationships between transition conditions experienced by LPN-to-RN students and student (personal) and program (community) characteristics; and (3) characterize (through open-ended questions) transition conditions experienced by LPN-to-RN students that were not included in the empirically-based investigator-designed survey. FRAMEWORK: This study was framed by Meleis et al.’s (2000) transition theory; each transition condition included in the survey was linked to one or more category of transition conditions described by Meleis et al. DESIGN: In March 2020, a cross-sectional national survey was distributed to all LPN-to-RN programs in the United States. RESULTS: 873 students, in programs across 37 states, responded to the survey. The least frequently reported facilitators were emotional support from faculty and finding online courses helpful. The most frequently reported inhibitors were personal stress and balancing school with non-school responsibilities. The most frequent characteristic related to transition conditions was taking classes with non-LPNs. Respondants reported several transition conditions not included in the survey, including prior experiences (facilitator) and challenges related to the COVID-19 pandemic (inhibitor). CONCLUSION: These results suggest areas where faculty can further support LPN-to-RN students through their own actions and highlight the importance of carefully planning how to integrate LPN and non-LPN nursing students if they share classes.

Cette recherche a été initiée à partir des constats suivants : les étudiants en soins infirmiers français réussissent en majorité à achever leurs scolarités en dépit d’un vécu de stress important durant celles-ci, les conduisant parfois au burnout. Grâce à une approche exploratoire avec en premier une revue de littérature puis une enquête auprès de 30 participants à l’aide d’entretiens semi-directifs analysés de manière thématique, nous avons étudié ces phénomènes sous l’angle de la vulnérabilité et de la résilience. D’une part, les principaux résultats nous permettent de confirmer que la formation infirmière place l’individu dans une situation de vulnérabilité conjoncturelle. Les facteurs personnels de vulnérabilité soulignés sont entre autres : le processus de transformation identitaire opérant lors de la scolarité, les enjeux dus à un apprentissage durant la jeunesse (alterner formation et premier travail d’étudiant, apprendre à s’autogérer dans un premier appartement, s’éloigner pour la première fois du cocon familial, etc.) ou plus tard dans la vie adulte (revenir à un statut financier plus précaire, se faire encadrer par des plus âgés que soi, assumer son rôle de parent en plus de celui de ses travaux d’étudiants, etc.). Les principaux facteurs de vulnérabilité liés à l’environnement sont : la mesure difficile de l’écart entre l’idéal et la réalité, le vécu émotionnel durant l’apprentissage en stage auprès des patients, des encadrants sur le terrain souvent en souffrance dans leur travail et dont la relation pédagogique avec l’apprenti est détériorée. Les symptômes qui en découlent vont d’un simple stress, à des angoisses, des insomnies, ou encore une perte d’espoir par exemple. Ces symptômes sont parfois l’expression d’un syndrome de stress post-traumatique ou d’un burnout. D’autre part, l’enquête a révélé que des processus résilients peuvent être observés pendant les études. D’un point de vue des facteurs de protection, l’apprentissage en lui-même et des pédagogues soutenants favorisent le processus de mentalisation. Des mécanismes de défense sont également activés durant la formation comme l’altruisme lors de la relation d’aide ou l’affiliation au cours des nombreux temps de partage entre pairs. Des tuteurs potentiels de résilience à la disposition des étudiants ont été identifiés : les apprenants entre eux, les formateurs, les directeurs, les cadres de santé/maître de stage, les infirmiers, les aides-soignants et des psychologues. Nous avons identifié leurs caractéristiques comme la bienveillance dont ils font preuve, le rôle de garant de la loi, de l’éthique et de la déontologie… Enfin, nous avons analysé les nouveaux éléments apportés par cette recherche et nous les avons éclairés par des investigations complémentaires dans la littérature. Nous avons notamment comparé les publications internationales sur les risques de burnout des étudiants en soins infirmiers. Nous avons approfondi la principale caractéristique de leurs tuteurs de résilience qui est ressortie de notre enquête : la compassion. Enfin, nous avons envisagé le suivi pédagogique et l’analyse de pratique professionnelle comme deux séquences d’apprentissage permettant d’accompagner la résilience. / The vast majority of French nursing students succeed in their studies despite having experienced stress factors, that can often be associated or, indeed, lead to burnout. We conducted a literature review followed by a semi-structured interview of 30 nursing students. The aim was to explore the concepts of vulnerability and resilience and how nursing students use these to succeed in their studies. Our main results confirm that nursing training places students in a situation of temporary vulnerability. Personal factors of vulnerability identified were: the stakes due to learning during the youth or later in adult life and the process of identity. The main factors of vulnerability relating to the environment were; the difficulty in measuring the gap between the ideal and reality, the emotional experience with the patient during their placement and establishment of difficult relationships with supervisors, who are often suffering in their work. The main consequences observed were stress, anxiety, insomnia, or loss of hope. These symptoms are sometimes the expression of post-traumatic stress disorder or of a professional burnout.On the other hand, the survey revealed that resilient processes can be observed during the studies. The main protective factors identified in the study that gave the students resilience were ; learning in oneself and supportive teachers, which allows the mentalization process. Defense mechanisms are also activated during training. Altruism in the supportive relationship both with mentors and the camaradery formed with fellow students were particularly evident amongst the interview responses. Potential sources of resilience identified were: student groups, trainers, directors, health managers / supervisors, nurses, nursing aides and psychologists. In summary, we have analyzed the new elements that this research has shown and compared to previous studies that have been conducted about the risk of among nursing students. We identified the main characteristic of their resilience tutors that emerged from our investigation: compassion. Finally, we considered the pedagogical follow-up and the analysis of professional practice as the two sequences of learning to promote resilience.

L’obiettivo generale del progetto di ricerca è valutare la percezione della qualità dei servizi offerti in due RSA del Nord Italia e proporre interventi di miglioramento. Nel primo capitolo della tesi sono stati descritti i principali modelli teorici della qualità dei servizi. La letteratura riconosce la mancanza di scale validate che esplorano la percezione della qualità dei servizi nelle RSA Italiane. Per questo motivo, è stato realizzato uno studio di validazione e adattamento della versione italiana della scala SERVQUAL. Nel secondo capitolo della tesi è stato presentato uno studio qualitativo retrospettivo. Partendo dagli eventi critici che si sono verificati nella RSA, sono stati analizzati i principali episodi positivi e negativi ricordati dai famigliari degli anziani. I risultati sono stati utilizzati per ipotizzare nuovi percorsi di intervento e per fornire strategie organizzative per migliorare la gestione degli eventi problematici. La letteratura riconosce l’importanza del coinvolgimento dei famigliari per il benessere degli anziani. Per questo motivo, in questo progetto di ricerca sono state delineate le basi concettuali per l’applicazione di un modello collaborativo di assessment all’interno delle RSA. Nello specifico, il terzo capitolo della tesi ha esplorato l'efficacia dell’Assessment Terapeutico attraverso una meta-analisi multilivello e nell'ultimo capitolo della tesi è stata applicata una componente del modello di Assessment Collaborativo e Terapeutico nelle RSA. / The general aim of the present research project was to broaden the knowledge and understanding of the ways in which elderly’s family members perceive the quality of service and propose interventions to improve services. To lay the ground for discussion about the quality of services offered by nursing homes, Chapter 1 provides a historical overview of the models of the quality of services. Given the lack of validated measures of the quality of services in Italian nursing homes, I presented data regarding the validation and adaptation of the Italian version of the SERVQUAL Scale. Chapter 2 introduced a retrospective qualitative study. Starting from critical events that occurred in nursing homes, I analyzed family members’ observations of the incidents. The results were used to generate new paths for interventions to improve the family members’ evaluation of services and to provide organizational strategies to improve the management of problematic events. Given the effect of family involvement on elder people’s well-being, I presented the conceptual underpinnings and the applicability of a collaborative model of assessment in nursing homes. Chapter 3 explored the effectiveness of the Therapeutic Assessment model through a multilevel meta-analytic study. From these results, a component of the Collaborative and Therapeutic Assessment model was applied in nursing homes, as described in the last chapter.

Several assumptions of the indirect reflective model of the Multidimensional Students’ Life Satisfaction Scale (MSLSS) were tested to assess its validity as a measure of adolescents’ satisfaction with life generally and with five important life domains (family, friends, living environment, school, and self perception). We also examined whether adolescents’ perceived mental and physical health status significantly explained their global quality of life (QOL) and whether these relationships were mediated by their satisfaction with the five life domains. The data were taken from a cross-sectional health survey of 8,225 adolescents in 49 schools in British Columbia, Canada. Global QOL was measured using Cantril’s ladder and a single-item rating of the adolescents’ satisfaction with their QOL. Confirmatory factor and factor mixture analyses were used to examine the measurement assumptions of the MSLSS, and structural equation modeling was applied to test the hypothesized mediation model. The Pratt index (d) was used to evaluate variable importance. The adolescents did not respond to all MSLSS items in a consistent manner. An abridged 18-item version of the MSLSS was therefore developed by selecting items that were most invariant in the sample. Good model fit was obtained when the abridged MSLSS was used to test the hypothesized mediation model, which explained 76% of the variance in global QOL. Relatively poorer mental health and physical health were significantly associated with lower satisfaction in each of the life domains. Global QOL was predominantly explained by the adolescents’ mental health status (d = 30%) and by their satisfaction with self (d = 42%) and family (d = 20%). Self and family satisfactionwere the predominant mediating variables of the relationships between mental health (45% total mediation) and physical health (68% total mediation) and global QOL.Satisfaction with life domains and perceived physical and mental health can be viewed as conditions that potentially contribute to adolescents’ global QOL. Questions about adolescents’ experiences with important life domains require more attention in population health research so as to target appropriate supportive services for adolescents, particularly those with mental or physical health challenges. / Michael Smith Foundation for Health Research / Canadian Nurses Foundation / Trinity Western University

資料1.【Nursing Ethics】掲載予定論文: http://ir.nul.nagoya-u.ac.jp/jspui/handle/2237/16635 / 名古屋大学博士学位論文 学位の種類:博士(看護学) (課程) 学位授与年月日:平成22年12月28日 資料1.【Nursing Ethics】掲載予定論文はPDFに含まれていません。