Registered nurses are the first contact for individuals seeking medical attention in the health system. These nurses have leaders who encourage them and they have goals and dreams to reach. The leadership of a hospital are responsible for creating a positive working environment so as to maintain job satisfaction for all. When subordinates are satisfied with their job they tend to stay and become more productive in their workplace. Leadership has an influence on the level of job satisfaction and therefore influences whether they leave or stay in the workplace. The objectives of the study were to describe the status of leadership, job satisfaction and the intention to leave among registered nurses in hospitals in the North-West and Free State Provinces. The relationship between leadership, job satisfaction and intention to leave among registered nurses in hospitals in the North-West and Free State Provinces was also investigated. The research design in this study was quantitative, descriptive, explanatory and contextual in nature. The sample included registered nurses (RNs) in medical and surgical units in both private and public hospitals in the North-West and Free State provinces of South Africa, (n = 204). Data was collected using the RN4CAST questionnaire. EpiData and SPSS statistical programmes were used to analyze data. The results of the study showed that most registered nurses were satisfied with the items of leadership except for the praise and recognition item (55.7%). Most registered nurses showed high levels of overall job satisfaction (70.5%), but were dissatisfied with wages (50%), study leave (40.9%) and opportunity for advancement (40.1%). Furthermore, the registered nurses showed high intention to leave their current hospitals (46.1%). The results also indicated a relationship between leadership, job satisfaction and intention to leave among registered nurses in medical and surgical wards in both private and public hospitals. Recommendations for policy, education, practice and future research were made. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

The purpose of this longitudinal study was to evaluate the enrolled nurse/registered nurse (EN/RN) programme to determine the extent to which the graduates of the programme had acquired knowledge and skills to provide primary health care services to communities using the Stufflebeam CIPP model as a framework. The study determined the extent to which the graduates perceived that their knowledge and skills in provision of primary health care services have been strengthened and the extent to which their supervisors perceived the improvement of the graduates' knowledge and skills in provision of primary health care services in clinical and primary health care settings. The programme used two models for upgrading: one year full-time residential and two year distance education. The study used methodological triangulation for data collection. Data collection tools comprised of self-administered questionnaires to the EN/RN upgrade graduates, structured group interviews to their supervisors from the hospitals and district health teams and the review of the students' examination records from Institute of Health Sciences/University of Botswana (IHS/UB). Data were collected and analyzed from the one year full-time residential graduates who completed the programme from 1995-2000 and from the two year part-time distance education graduates who completed the programme 1996-2000. The findings from the academic records indicated that out of the 1116 enrolled nurses that were admitted into the EN/RN upgrade programme between 1994-2000 nine (0.8%) withdrew from the programme due to ill health or personal reasons before writing the final examinations. This is indicative of a high retention rate in the programme. In the one year full-time residential programme, out of the 695 enrolled nurses were admitted in the programme from 1995-2000 period five (0.7%) withdrew from the programme before writing the final examinations, 690 students sat for the final examination and 640 (92.8%) passed. In the two year part-time distance education programme, out of the 421 enrolled nurses were admitted in the programme from 1996-2000 period four (0.9%) withdrew from the programme before writing the final examinations, 417 students sat for the final examinations and 402 (96.4%) passed. Out of the 1107 students from both the one year full-time residential and the two year part-time distance education programme that sat for the final IHS/UB examinations, 1042 (94.1%) passed. The academic records revealed that the programme was efficient and effective because 1042 (94.1%) out of 1107 students completed the programme in one year and two years as planned because the programme was not repetitive and there were replacement costs. This high pass rate (94.1%) is an indication that the graduates did acquire knowledge and skills for provision of primary health care services. Data analysis from the self-administered questionnaires of the graduates also revealed that the graduates perceived that their knowledge and skills for provision of primary health care services have been strengthened because of the acquisition of the new knowledge in primary health care. This complemented the high academic performance of the graduates that the graduates knowledge and skills to deliver primary health care had been strengthened. Data analysis from the structured group interviews of the supervisors of the graduates further revealed that the supervisors perceived that the knowledge of the graduates in providing primary health care services in the hospitals and the district health teams had improved. The supervisors indicated that the graduates were now providing primary health care services with less supervision in the hospitals and the health districts. / Health Studies / D.Litt et Phil. (Health Studies)

Bakgrund: Allt fler personer kontaktar sjukvården via telefon och det medför att telefonrådgivning är ett växande område inom hälso- och sjukvården. Den gör det möjligt för sjuksköterskor och personer som ringer in att skapa en relation trots distans. Telefonrådgivningen gör sjukvården mer effektiv och avlastar de fysiska vårdmiljöerna. Problem: Personer som ringer in upplever att de inte blir uppmärksammade i samtalen och att sjuksköterskorna som arbetar med telefonrådgivning brister i bemötandet. Det framkommer även att de saknar det fysiska stödet från sjuksköterskorna. Syfte: Att skapa en översikt av sjuksköterskans erfarenheter av att arbeta med telefonrådgivning. Metod: Allmän litteraturöversikt innehållande kvalitativa och kvantitativa artiklar. Resultat: Det framkom fyra teman, de var arbetsmiljön som ett hinder eller en möjlighet, svåra samtal en del av arbetet, anamnesupptagningens betydelse och vikten av att ha kunskap och kompetens. Slutsats: Sjuksköterskornas erfarenheter visade att de tyckte att det var svårt att bedöma utan att kunna se personen samtalet gällde. I framtiden bör telefonen kompletteras med kamera och allmänsjuksköterskor bör ha mer utbildning i att kommunicera och av att använda det vårdande samtalet för att skapa relation och förståelse.

Syfte: Syftet med studien var att undersöka sjuksköterskornas beskrivning av sväljbedömning hos äldre personer med misstänkt dysfagi i kommunal hälso- och sjukvård. Metod: Metoden var en kvalitativ intervjustudie. Resultat: I resultatet visades följande kategorier ” Observationer av symtom”, ”En praktisk bedömning”, ”Närvaro vid måltiderna” , ”Kostanpassning”, ”Anpassning av vården”, ”Handledning av personal” , ”Teamträffarna hade betydelse för planering av vården” och ”Brist på kunskap och bedömningsinstrument”. Slutsats: Sjuksköterskor beskriver att sväljbedömning är en viktig uppgift i det dagliga arbetet. Sjuksköterskans närvaro och samverkan bidrar till att vägleda personalen så att inte olämpliga metoder använts, samt att närvara vid måltider och att observera en patients sväljfunktion. Sjuksköterskor som arbetar i kommunal hälso- och sjukvård behöver mer kunskaper angående sväljbedömningar samt hanteringen av ett bedömningsinstrument / Aim: The aim of this study was to investigate Registered Nurses’ (RNs) description of swallowing assessments in older people with suspected dysphagia in municipal health care. Method: The method was a qualitative interview study. Results: The results demonstrated the following categories “ Observation of symtoms”, "A practical assessment", "Attendance at mealtime", ”Adapting food", "Adaptation of care", “Supervision of staff " , "Team meetings had significance for planning of health care" , and "Lack of knowledge and assessment instruments". Conclusion: RNs describe that swallowing assessment is an important task in the daily work. The RNs presence and collaboration will help to guide staff so that no inappropriate methods are used, as well as to attend meals and observing a patient's swallowing function. RNs who work in municipal health care need more knowledge about swallowing assessments and management of an assessment instrument.

Syftet med studien var att kartlägga urininkontinensarbetet med kvalitetsregistret Senior Alerts urininkontinensmodul i två kommuner över en bestämd tid januari till juni 2014 samt januari till juni 2015. Metoden bestod i att använda sig av registerdata som tillhandahölls av registerhållaren för Senior Alert. Resultatet visade att mer än hälften av de personer som riskbedömts i kommun G hade någon form av urininkontinens under båda tidsperioderna. I kommun M var andelen ännu högre cirka 80 %. Bakomliggande orsaker till urininkontinens visade sig vara de aspekter som nämns i Senior Alerts modul förutom förstoppningsproblematik samt nedsatt känsel i underlivet som inte framkom lika tydligt som övriga aspekter. Genom att använda Senior Alert kan ett mönster utkristalliserats och det går att erbjuda individuellt anpassade åtgärder för personer med inkontinensproblematik. Med enkla åtgärder kan personer få hjälp med avföringsregim, toalettassistans, utprovning av inkontinenshjälpmedel hjälpas enligt skalan i Senior Alert. Det vill säga skalan påvisar vilken hjälp som kan behövas för patienten, samt för vårdpersonal som sedan utför avsedda åtgärder. / The purpose of the study is to identify urinary incontinence work with quality registry Senior Alerts urinary incontinence module in two municipalities over a fixed period January to June 2014 and from January to June 2015. The method was to use the registry data that is later held by the Depositary of the Senior Alert. The result showed that more than half of the individuals in risk assessments were conducted on municipal G had any form of urinary incontinence in both periods. The municipality M proportion was even higher, about 80%. Underlying causes of urinary incontinence was found to be the aspects mentioned in the Senior Alerts module except constipation problems and loss of sensation in the genital area that is not revealed as clearly as the other aspects. Using Senior Alert, a pattern emerged, and it is possible to provide individually tailored measures for people with incontinence problems. With simple measures, can patients with feces regime, toilet assistance, testing of incontinence aids can the scale of Senior Alert be helpful. The scale demonstrates what assistance may be needed for patients, health professionals then perform the action.

ABSTRACT Introduction: The number of patients treated in inadequate hospital wards is increasing. Elderly and fragile patients with medical conditions are particularly vulnerable for being placed in inadequate hospital wards. They also run a twice as high risk of health-related complications and increased mortality. RNs obtain specific knowledge by working on specific wards. However, RNs’ experience of caring for outliers seems relatively unexplored, as few studies explore RNs’ experiences in giving nursing care to outliers. Aim: The aim of the study was to explore RNs’ experience of giving care to outliers with medical conditions at a university hospital in Sweden. Method: An interview study with 14 RNs from medical and surgical wards were conducted by semi-structured interviews. The inclusion criteria were that they had worked as an RN for minimum two years and had experience of outliers. Data were collected between December 2016 and January 2018. The interviews were transcribed and analyzed using conventional qualitative content analysis to identify categories and themes according to the aim of the study. Result: One overarching theme emerged: The interviewed nurses experienced that outliers’ medical and nursing care was delayed and therefore hospitalization was prolonged. The informants’ experience is substantiated by five main categories: Inadequate information from ER to the ward leads to concern, Nursing interventions are performed later and lead to a sense of powerlessness, Unavailable drugs lead to delayed or no drug administration, Patients on inadequate wards do not receive proper information, and The RN does not know when the patient is ready for discharge planning. Conclusion: RNs described their experience of caring for outliers as an obstacle course and that this risks prolonged hospitalization. They are not equipped to make the most appropriate decisions, as they have other specific knowledge than the specific needs of outliers, and as a result, care is not given. Keywords: outlier, registered nurse, experience, qualitative study, conventional content analysis, care undone, patient safety.

Bakgrund: Munhälsan är central för välbefinnandet, livskvalitet och hälsa. Att förebygga ohälsa i munnen är en viktig hälsoinsats för den äldre patienten. Munvård är likväl en omvårdnadsintervention som ofta hamnar långt ner i prioriteringslistan inom vård och omsorg. Flera vårdgivare och professioner är involverade i äldres munhälsa och munvård vilket leder till otydlig ansvarsfördelning och kräver därför väl fungerande samverkan. Sjuksköterskan inom kommunal hälso- och sjukvård har ansvar att tillgodose patientens grundläggande vårdbehov ur ett helhetsperspektiv. Syfte: Syftet med studien är att beskriva sjuksköterskors, inom kommunal hälso- och sjukvård, uppfattningar om sin egen kunskap, förhållningssätt och ansvar angående munhälsa, munhälsobedömning och munvård hos den äldre patienten samt att undersöka om yrkeserfarenhet påverkar uppfattningarna. Metod: En kvantitativ tvärsnittsstudie genomfördes där data samlades in genom webbenkätundersökning. Deskriptiva data presenterades i text och tabell. Data analyserades med Kruskal Wallis test där statistiska signifikansen sattes till p<0,05. Analytisk statistik presenterades i text, tabeller och cirkeldiagram. Inklusionskriterier var sjuksköterskor inom kommunal hälso- och sjukvård. Sjuksköterskor med nattjänstgöring exkluderades. Resultat: Huvudfynden visade att nästintill alla respondenter erhållit utbildning i munhälsa och munvård i någon form och övervägande del skattade sin kunskap hög i att utföra munvård och genomföra munhälsobedömning enligt ROAG. Resultatet visade att det rådde viss osäkerhet kring sjuksköterskans ansvar för patientens munhälsa, ändå ansåg majoriteten av respondenterna att de hade ansvar för patientens munhälsa och att handleda omvårdnadspersonal i munvård. Respondenternas förhållningssätt till utförande av munvård och genomförande av munhälsobedömning enligt ROAG skattades generellt lågt i avseende hur de upplevde det som obehagligt, tålamodskrävande, tidskrävande eller att det utgjorde ett personligt intrång för patienten. Slutsats: Resultatet visade att sjuksköterskorna i studien hade fått utbildning i munhälsa och munvård i någon form och att de skattade sin kunskap högt, vilket var oväntat. Sjuksköterskans kunskap kunde bidra till att munvård fick samma prioritet som övriga grundläggande vårdbehov och därmed minskade risken för vårdskador. Det fanns viss osäkerhet kring ansvarsfördelningen gällande patienten munhälsa och munvård men majoriteten av sjuksköterskorna i studien uppfattade dock att de hade ett ansvar vilket kunde öka möjligheten att förändringar i patientens munhälsa upptäcktes innan ohälsa i munnen försämrade patientens välbefinnande och livskvalitet. Gällande förhållningssätt påviades att sjuksköterskorna gjorde sitt yttersta för att munvård och munhälsobedömning kunde utföras med respekt för den äldres integritet och självbestämmande och ingå som en naturlig del i god omvårdnad. / Background: Oral health is central to well-being, quality of life and health. Preventing oral health is an important health measure for the elderly patient. Oral care is nevertheless a nursing intervention that often ends up far down the priority list in health and care. Several care providers and professions are involved in the elderly's oral health and oral care, which leads to an unclear division of responsibilities and therefore requires well-functioning collaboration. The nurse in municipal health care is responsible for meeting the patient's basic care needs from a holistic perspective. Aim: The aim of the study is to describe nurses', in municipal health care, perceptions of their own knowledge, attitudes and responsibilities regarding oral health, oral health assessment and oral care in the elderly patient and to investigate whether professional experience affects perceptions. Method: A quantitative cross-sectional study was conducted where data were collected through web survey. Descriptive data were presented in text and table. Data were analyzed with Kruskal Wallis test where the statistical significance was set at p<0.05. Analytical statistics were presented in text, tables and pie charts. Inclusion criteria were nurses in municipal health and medical care. Nurses on night duty were excluded. Results: The main findings showed that almost all respondents received education in oral health and oral care in some form and the vast majority valued their knowledge highly in performing oral care and conducting oral health assessment according to ROAG. The results showed that there was some uncertainty about the nurse's responsibility for the patient's oral health, yet most of the respondents considered that they were responsible for the patient's oral health and to supervise nursing staff in oral care. The respondents' approach to performing oral care and performing oral health assessment according to ROAG was generally underestimated in terms of how they perceived it as unpleasant, patient, time-consuming or that it constituted a personal intrusion for the patient. Conclusion: The results showed that the nurses in the study had received education in oral health and oral care in some form and that they valued their knowledge highly, which was unexpected. The nurse's knowledge could contribute to oral care being given the same priority as other basic care needs and thereby reducing the risk of care injuries. There was some uncertainty about the division of responsibilities regarding the patient's oral health and oral care, but most of the nurses in the study perceived that they had a responsibility which could increase the possibility that changes in the patient's oral health were detected before oral health impaired the patient's well-being. The current approach showed that the nurses did their utmost to ensure that oral care and oral health assessment could be performed with respect for the elderly's integrity and self-determination and be included as a natural part of good nursing.

Introduktion: Sjuksköterskor har arbetat med telefonrådgivning över 50 år. Tanken var att minska antalet besök till läkare samt öka tillgängligheten genom att uppringare redan i början av sjukdomsprocessen slussas till rätt vårdnivå. Sjuksköterskor som sitter i telefonrådgivning skall kunna göra adekvata och riktiga omvårdnadsbedömningar utifrån uppringarens individuella hälsoproblem. Syfte: Att belysa sjuksköterskors erfarenheter av svårigheter i telefonrådgivning.  Metod: Systematisk litteraturstudie utifrån Polit och Becks niostegmodell. Studien baseras på åtta artiklar från CINAHL och PubMed. Sju kvalitativa och en mixad artikel mellan januari 2010 till januari 2020 inkluderas. Artiklarna analyserades genom Graneheim och Lundmans innehållsanalys. Resultat: Sjuksköterskor möter svårigheter i telefonrådgivning, belysta i tre kategorier: kommunikation, utsatthet och organisation. Slutsatser: Sjuksköterskor hade svårigheter i telefonrådgivning, vilka bör underlättas genom utbildning i kommunikationsfärdigheter, utveckling av beslutstöd, stöd från kollegor och tid för återhämtning.

Certified Registered Nurse Anesthetists (CRNAs) administer more than 43 million anesthetics within the United States and practice in every setting where there is anesthesia. Stress and burnout can be a common problem for CRNAs. The purpose of this correlation study was to examine the relationship between emotional intelligence (EI) and burnout syndrome among CRNAs. The research questions assessed CRNAs and the relationship between EI and burnout syndrome, the burnout score and the four dimensions of EI, and EI and the three dimensions of burnout. Certified and recertified CRNAs (N = 506) completed the Wong and Law Emotional Intelligence Scale, the Maslach Burnout Inventory, and a demographics survey. The results of a correlation analysis and linear regression indicate that there is a correlation between EI and burnout syndrome for CRNAs and when increasing the EI score by one unit, a 20% reduction in burnout occurs. A relationship also exists between the burnout score and the four dimensions of EI for CRNAs, with self-emotion appraisal and regulation of emotion statistically significant (p < 0.05). Each component of burnout syndrome correlated with a CRNA's EI score, with diminished personal accomplishment having the strongest correlation (r = .451; p < 0.05). EI is present for CRNAs, and there is an inverse relationship with burnout syndrome, which is a new contribution to the literature. Regarding positive social change, results may yield modifications in the education of Student Registered Nurse Anesthetist (SRNA) or opportunities for CRNAs to build additional EI skills. This study offers healthcare administrators insight that EI is a factor in reducing burnout and beneficial to increasing wellness of the healthcare staff.

Indiana University-Purdue University Indianapolis (IUPUI) / New nurses report feeling unprepared, incompetent, and highly stressed, contributing to first-year turnover rates of 25% in some healthcare organizations. Turnover, combined with a preparation-practice gap, has alerted advocacy organizations and researchers to recommend the development of nurse residency programs. Nurse residency programs are a post-graduate training period where new nurses receive enhanced clinical education in the healthcare setting. While highly variable in structure and attributes, programs usually include educational sessions, clinical immersion, and role socialization opportunities. Evidence supports that new nurses participating in nurse residency programs experience positive outcomes, including increased confidence, competence, and decreased turnover rates. Despite this, only half of the hospitals nationwide have implemented a program with most designed around a single health system mission. This dissertation study aimed to identify the attributes of nurse residency programs influencing the newly licensed registered nurse. An integrative review of the literature and evolutionary concept analysis was completed to examine the state of the science of nurse residency programs. Findings revealed a lack of conceptual and theoretical design and variability among program structures, creating a gap in the literature about the attributes of programs that are most influencing new nurses. Based on the literature's noted gaps, a qualitative description study was conducted. Purposive sampling strategies were used to recruit nurses who recently completed varied program models across the United States. New nurses reported the attributes of programs and described how those positively and negatively influenced the transition to practice experience. The overarching themes revealed that new nurses need a cadre of highly supportive individuals across the clinical and educational continuum who espouse astute interpersonal and communication skills. New nurses desire engaging activities with intra and interprofessional team members for clinical skill application, knowledge advancement, and role socialization. New nurses need the structure of meetings at times and in a sequence conducive to learning; and for preceptorship experiences to be facilitated by trained preceptors, on a unit, and of a length that supports confidence for autonomous practice. Future research will include the development and testing of an evaluation tool based on the findings from this study.