Background: Cardiology is but one of the many clinical foci available to certified Advanced Practice Registered Nurses (APRNs). In fact, more acute care APRNs choose cardiology as their focus than any other. With such strong interest in cardiac advanced practice nursing, it is imperative to assess the adequacy of preparation for those who wish to follow this career path. Known barriers exist in the educational and clinical preparation of this APRN population, however, there is little research detailing the specifics of those barriers. Purpose: This study describes the needs of APRNs who plan to specialize in cardiology. Method and Sampling: A qualitative design was used to describe the motivation of APRNs specializing in cardiology, tools they currently utilize to achieve their specialization, and their needs based on the current approach. I recruited participants, APRNs specializing in cardiology, through meetings at a local cardiology practice. Seven APRNs specializing in cardiology with experience ranging from 10 months to 15 years, and currently working in a cardiac setting, participated in the study. Structured interviews were conducted to describe the needs of APRNs who plan to specialize in cardiology. The interviews were audiotaped and analyzed to reveal commonalities. Findings: After analyzing the audio recordings three major commonalities emerged: APRNs specializing in cardiology must overcome limited educational opportunities, APRNs specializing in cardiology require a higher level of skill than their formal training and licensing requirements provide, and the need to validate APRNs specializing in cardiology knowledge. Additional commonalities included availability and the type of degree programs, and a lack of cardiac focus in educational preparation. Conclusion: The findings showed the needs of APRNs who plan to specialize in cardiology are rooted in their educational preparation. There is a vast amount of variability among degree programs and a severe lack of cardiac focus in their educational preparation. In order to achieve competency, 100% of study participants secured a mentorship with an expert cardiac clinician for a minimum of one year post-graduation and without assistance from their educational programs. Additionally, APRNs specializing in cardiology believe a national certification or examination requirement would be beneficial to their practice.

Background: Bullying is a form of violence and is described as unwelcome aggressive behavior(s) by unrelated individuals. The prevalence of bullying in the nursing profession has been reported to be as high as 31% in the United States, and has been studied extensively in undergraduate nursing, midwifery, medical school residencies, and Certified Registered Nurse Anesthesia (CRNA) professional roles. There is a significant gap in the literature and paucity of evidence about the extent of Student Registered Nurse Anesthesia (SRNA) bullying underscored that this topic required further investigation. Purpose: To investigate whether bullying behaviors occur among anesthesia preceptors, and if so, how SRNAs perceive bullying has affected their educational experience. Methods: The American Association of Nurse Anesthetists (AANA) disseminated an online survey based on an existing tool to SRNAs for this study. The study used a quantitative descriptive methodology consisting of a survey of nine demographic questions, eight 5-point Likert scale questions, and two multiple-choice questions. Setting and sample: A nationwide online survey sent to 1500 SRNAs yielded (N=133) participants, who were predominantly female (67.67%), in front-loaded programs (52.63%) with an average age of 24-29 years old. Results: Results revealed SRNAs entering clinical rotations in 2015 and 2016 were bullied more than those entering in 2017. The majority of the respondents (89.26%) reported that they couldn't think clearly when they were bullied. More than half of SRNAs agreed (74.62%) that bullying impedes learning. Overall, CRNA preceptors (85.48%) were reported as the most frequent bullies, with MD/DO anesthesiologists reported as the second most frequent (68.55%) followed by non-CRNA nursing staff (41.94%).

The healthcare workforce throughout the world is experiencing a shortage of healthcare workers and various strategies, processes and programs exist today of which nursing manager’s use to not only recruit nursing staff, but to retain these scarce resources. This research aims specifically to examine how career anchors and job compatibility influences the levels of job satisfaction of professional nurses. This study measured career anchors and job satisfaction to determine whether those whose job type and career anchor matched reported higher satisfaction than those whose job type and career anchor did not match. Results suggested that significant differences exist between functional nurses and managerial nurses. Specifically, the nursing group placed importance on lifestyle and service/dedication to a cause, while the managerial group places importance on functional competence and lifestyle. Finally, results indicated that job type and career anchor compatibility on their own might not be adequate predictors of job satisfaction. / Dissertation (MBA)--University of Pretoria, 2012. / Gordon Institute of Business Science (GIBS) / unrestricted

Cancer among Indigenous Peoples (First Nations, Inuit, and Métis) is disproportionately higher than the overall Canadian population. Many Indigenous Peoples have difficulty accessing care and do not receive culturally safe care due to a longstanding history of marginalization and colonization. The role of a nurse navigator (NN) was developed to improve continuity of care and overall health outcomes for Indigenous Peoples; however, limited research exists on what a NN does or how they are perceived. Using constructivist case study methodology, this thesis explored the experiences of a NN working in a large tertiary care hospital in Ontario, Canada, and the processes the NN used to support Indigenous cancer patients in a culturally safe manner. Six in-depth semi-structured interviews were performed with health care providers and managers, and shadowing of a NN occurred over two weeks allowing direct observations of the NN that was captured in field notes and reflective journaling. Interviews were audiotaped and transcribed; all data was entered into NVIVO 12 qualitative software and coded thematically. Analysis revealed the NN to be an important complement to clinical care and key resource to navigating the health care system, providing mechanisms for building trust, and raising awareness of Indigenous historical and cultural contexts. The NN practiced non-conventional, patient-centered approaches that included engaging with the land and arts, interpreting healthcare information, advocating for and aiding autonomy over healthcare. All participants felt the NN had a positive influence on health and wellbeing. Thesis results inform healthcare delivery and nursing practice to improve quality of care and outcomes for Indigenous cancer patients.

The United States, as of October 2021, is the country with the most reported COVID-19 cases and COVID-19 deaths in the world. Since the first case was confirmed, Registered Nurses working in the acute care setting have been at the forefront of this public health crisis. As the pandemic has continued, studies have been conducted to collect, analyze, and reveal the effect of COVID-19-related stress on Registered Nurses in the United States. This critical literature review takes eleven published studies related to this topic, discusses the commonalities between them, addresses limitations in the literature and offers recommendations for future research. This review discusses five themes among the studies: the impact of inadequate PPE supply, COVID-19-related stress from direct contact with COVID-19 patients, stress levels reported by those working in the ICU setting, nurses self-isolating and the fear of infection or infecting others with COVID-19, and continued exposure to stressful work conditions during the pandemic, resulting in long-term effects, including chronic stress and post-traumatic stress disorder (PTSD). The databases used for this project were CINAHL Plus with Full Text, APA PsychInfo, and MEDLINE. This literature review suggests that COVID-19-related stress in the nursing profession in the United States produced acute and chronic stress responses. Nurses experienced various negative emotions, including burnout, stress, anxiety, and depression. Additional findings included insomnia, fatigue, and feelings of not being supported adequately by hospital administration. Based on the results, the researcher identified several recommendations to aid future research exploring the topic of COVID-19-related stress among registered nurses in the United States and how this research can be utilized when considering ways to address work-related stress and PSTD among acute care nurses in the future.

This project study addressed the problem of knowledge and skills lost by new graduate RNs while delayed in transitioning to professional nursing practice. There is a paucity of knowledge about how new RNs experience their delay and how a delay may affect their future clinical performance. Mezirow's transformation learning theory was the conceptual framework for this qualitative case study. Research questions addressed new RNs' understanding of their experiences during a delay to professional practice. A purposeful sample included 8 new RNs who had completed a New Graduate Residency Transition Program (NGRTP) after a delay to practice of 6 months to 3 years. Four managers of the RN participants were also included in the sample. Data were collected through audio-recorded semistructured interviews and manager questionnaires. Qualitative data were coded and analyzed to identify themes. Findings indicated that while waiting for a RN position, the delay to practice new RN (DTP-RN) passed through stages that reflected clinical and professional needs. The consequences of the new RNs' delay to practice may impact the required NGRTP process. Findings influenced the development of a white paper to educate hospital nurse educators and managers about the DTP-RNs' unique needs. Recommendations include a NGRTP designed to meet the transition needs of the DTP-RN. Implementation of recommendations for a NGRTP may enhance the DTP-RNs' successful transition into professional practice with a result of greater job satisfaction and decreased RN turnover.

Genom tiderna har homosexuella och de som inte varit heterosexuella klassats som avvikande. Även idag är vi styrda av normer över hur folk ska bete sig och vara. De som inte är heterosexuella har ofta i dagens samhälle ett större vårdbehov, men undviker gärna att söka vård då de inte känner att de får en förståelse från vårdpersonalen. Sjuksköterskans roll är att ge vård på lika villkor utan fördomar och genom att ha respekt för en människas egen integritet. Studiens syfte är att se hur kunskap och attityder hos sjuksköterskan påverkar vårdandet av sexuella minoriteter. Litteraturöversikten som gjorts har granskat fyra kvalitativa och fyra kvantitativa studier. Dessa åtta studier sammanställdes och Kunskap samt Attityder och värderingar uppstod då som huvudkategorier, vartefter underkategorier skapades. I dessa två huvudkategorier framkom att det finns en vilja hos sjuksköterskor att vårda sexuella minoriteter men att kunskapen saknas. Vidare diskuterades hur attityder och kunskapsbrist påverkar patienterna och att utbildning inom detta område behöver bli mer framträdande i vården samt i grundutbildningen.

Syfte: Att undersöka hur sjuksköterskor inom särskilt boende resonerar kring kvalitetsuppföljningar och dess eventuella konsekvenser för omvårdnaden. Metod: Semistrukturerade intervjuer efter öppen intervjuguide med sex sjuksköterskor. Kvalitativ innehållsanalys enligt Graneheim och Lundmans metod. Huvudresultat: I vilken grad kvalitetsregistren och kvalitetsuppföljningarna integreras i omvårdnadsarbetet och dess utveckling är centralt för om dessa uppfattas som stöd eller hinder för god kvalité i omvårdnaden. Dubbel dokumentation bidrar till att sjuksköterskorna omprioriterar arbetstiden och arbetar mer konsultativt och administrativt. Detta minskar tiden för omvårdnadsobservationer och handleding av omvårdnadspersonal samt gör att kvalitetsregistreringar snarast uppfattas som ett hinder. Sjuksköterskorna använde sin professionella kunskap och kliniska erfarenhet i högre grad än registerdata vid omvårdnadsbedömningar. Dessa sågs som alltför komplexa för att kunna fångas i kryssfrågeformulär. Mer kliniska observationer efterfrågas i kvalitetsuppföljningarna för ökad medvetenhet om hög arbetsbelastning och dess eventuella konsekvenser samt för att garantera de boende god omvårdnadskvalité. Konklusion: Sjuksköterskorna upplever att de arbetar under svår tidspress. Tiden anges som essentiell för vilken omvårdnadskvalité som erbjuds. Vid beslut om registreringar av kvalitetsindikatorer bör sjuksköterskornas totala arbetsbörda beaktas. Registreringarna bör integreras i befintliga journalsystem så att sjuksköterskornas omprioriteringar inte får negativa konsekvenser för omvårdnadskvaliten. / Objective: How nurses in residential care reflect on quality follow-ups and its possible consequences for nursing care. Method: Semi-structured interviews with six nurses. Qualitative content analysis according to Graneheim and Lundman's method. Main Results: To witch degree quality follow-ups and national quality registers are integrated in Nursing care and its development is central to if these are seen as support or as obstacle to good nursing care quality. Double documentation contributes to nurses working more consultative and administrative. This reduces the time for nursing observations and guiding the nursing staff as well as contributes to national quality registers being perceived as hindrance. The nurses used their professional expertise and clinical experience to a greater degree than registry data in nursing care assessments. These were seen as too complex to be captured in questionnaires. Conclusion: The nurses perceive that they work under severe time constraints. Time is specified as essential for quality of nursing care. In decisions about quality indicators registrations nurses’ total workload should be taken into account. Registrations should be integrated into medical record used so nurses’ re-prioritizations not have negative consequences for nursing care quality.

Bakgrund: Svensk och internationell forskning berörande transpersoners hälsa och livssituation visar att diskriminerande behandling av transpersoner sträcker sig över så gott som alla samhällsinstitutioner. Diskriminering av transpersoner i hälso- och sjukvård är ett allvarligt problem som resulterat i en misstro till och ett undvikande av att söka hälso- och sjukvård bland transpersoner. I denna studie har problemet utforskats från perspektivet av sjuksköterskor i kontexten av somatisk akutsjukvård där sjuksköterskan kan vara den första kontakten mellan patienten och sjukvården. Trots att vårdtiderna kan vara korta, kan sjuksköterskans bemötande av patienten på akutmottagningen ha en stor påverkan på patientens fortsatta förtroende för sjukvården. Syfte: Avsikten var att identifiera förbättringsområden i omvårdnad av transpersoner genom att utforska sjuksköterskors upplevda möjligheter och begränsningar i vården av patienter med transidentitet på somatiska akutmottagningar. Metod: I arbetet användes en kvalitativ ansats med fokusgrupper. Studiedeltagarna innefattade tjugotvå sjuksköterskor från fem olika somatiska akutmottagningar i Mellansverige. Materialet bearbetades och analyserades enligt kvalitativ innehållsanalys med induktiv ansats. Resultat: Innehållsanalysen resulterade i tre huvudkategorier och sex underkategorier. Resultaten visar att sjuksköterskorna upplever sig vårda patienter med ett likvärdigt förhållningssätt, utan att påverkas av sina personliga åsikter. Sjuksköterskorna upplevde en avsaknad av kunskap gällande vården av transpersoner. Sjuksköterskorna identifierade brister i vården, såsom möjlighet till mer personcentrerade inställningar på sjuksköterskornas arbetsinstrument och hjälpmedel. Slutsats: Personcentrerad omvårdnad identifierades som ett område för förbättring i sjuksköterskornas arbete för att stärka transpersoners position inom hälso- och sjukvård. Sjuksköterskor kan genom att representera professionen i organisationer som rör hbtq-frågor stärka relationen mellan hbtq-personer och sjukvården. / Background: Swedish and international research regarding the general health and living situation of transgender persons demonstrates experiences of discrimination from several community institutions. Discrimination of transgender persons in health care is a serious issue that has been shown to result in loss of faith and an avoidance of seeking medical attendance. This paper examines the issue from the perspective of registered nurses in a context of somatic emergency medical care, where nurses may be the first contact between the patient and the health care system. Despite the relatively fast treatment patients receive in emergency medical care, the treatment by a registered nurse can have a big impact on patients’ future perception of the health care system. Aim: The purpose of the study was to identify areas of improvement in the care of transgender persons by exploring registered nurses experiences of challenges and possibilities in the care of patients who identify as trans, in emergency medical care units. Method: The study held a qualitative approach with focus groups as a method. Study participants included twenty-two registered nurses emerging from five separate emergency wards in central Sweden. Data was processed and analyzed with content analysis with an inductive approach. Results: The content analysis resulted in three main categories and six subcategories. The results demonstrated that participating nurses perceived their treatment was given in a ‘natural’ manner, not affected by their personal attitudes. Nurses experienced a lack of knowledge regarding the care of transgender persons and believed education and a more inclusive work environment to be factors having a big impact on the relationship between a nurse and a transgender patient. Conclusion: Person-centered care was identified as a possible area for improvement in the registered nurses work with the aim to strengthen the position of transgender patients in healthcare. By representing the profession of registered nurses in organizations concerning lgbt-issues, the relationship between lgbt-persons and healthcare can be improved.

Bakgrund: Tidigare forskning har visat att patienter som överrapporteras från intensivvårdsavdelning till vårdavdelning är i en särskilt sårbar situation och att bristfälliga överrapporteringar är ett internationellt patientsäkerhetsproblem. Syfte: Syftet var att beskriva intensivvårdssjuksköterskors och avdelningssjuksköterskors upplevelser av överrapportering av patienter från intensivvårdsavdelning till vårdavdelning. Syftet var också att beskriva vad intensivvårdssjuksköterskor och avdelningssjuksköteskor ansåg vara viktigt vid överrapporteringen. Metod: Studien hade en kvalitativ ansats med beskrivande design. Åtta semistrukturerade intervjuer gjordes med intensivvårdssjuksköterskor (n=4) och legitimerade sjuksköterskor på vårdavdelning (n=4). Intervjuerna analyserades därefter med kvalitativ innehållsanalys. Huvudresultat: Vid analys av intervjuerna framträdde sex kategorier 1) Att se vikten av samverkan, 2) Att ta emot och ge relevant information för den fortsatta vården på vårdavdelningen, 3) Att ge och ta emot information från ett kunskapsområde till ett annat, 4) Miljöns betydelse vid överrapportering, 5) Att ha behov av strukturerad rapport och 6) Att känna ansvar. Intensivvårdssjuksköterskor och sjuksköterskor från vårdavdelning upplevde att brist på förberedelser inför överrapportering försvårade samarbetet. De upplevde att olika information var viktig vid överrapportering på grund av deras olika kunskapsområden. Båda yrkesgrupperna önskade att informationen skulle vara tydlig med relevant information för den fortsatta vården. De upplevde att miljön med frekventa störningar gjorde att information missades och att en strukturerad rapport gjorde överrapporteringen tydligare. De uttryckte också att de har ett ansvar vid informationsöverföringen. Slutsatser: Samverkan, strukturerad information för den fortsatta vården, kunskap, miljö och ansvar kan ha betydelse vid överrapportering och att utrymme för förbättring finns för att öka patientsäker överrapportering av patient mellan vårdinrättningar. / Background: Studies have shown that the patients that are handed over from the intensive care unit to ward are in a particular vulnerable situation, and that deficient handover is an international patient safety problem. Aim: The aim was to describe the intensive care nurse's and ward nurse's experiences of handover patients from the intensive care unit to the ward. The aim was also to describe what the intensive care nurses and ward nurses considered important during the handover. Method: The study had a qualitative approach with descriptive design. Eight semi structured interviews with intensive care unit nurses (n=4) and registered ward nurses (n=4) were conducted. The interviews were analyzed with qualitative content analysis. Main results: Thorough the analyze six categories emerged 1) To see the importance of collaboration, 2) To receive and provide relevant information for the continuum of care, 3) To give and receive information from one level at knowledge to another, 4) The importance of the environments during handover, 5) The need of a structured handover, and 6) To feel the responsibility. The intensive care nurses and the registered ward nurses experienced that lack of preparation before the handover complicated the cooperation during handover. They expressed that different information was important during handover and that they had different areas of knowledge. Both professional groups wanted the information to be clear and relevant for the continued care. They felt that the environment, with frequent interruptions, resulted in missing information and that a structured report made the handover more direct. They also felt that they had a responsibility in the transfer of information. Conclusions: Collaboration, structured information relevant for the continued care, knowledge, the environment, and responsibility can be important during handover and there is room for improvement to increase patient safe handover between healthcare facilities.