Thesis (M.S.)--University of Michigan, 1987.

Thesis (M.S.)--University of Michigan, 1987.

Thesis (Ph. D.)--University of Missouri-Columbia, 1999. / Typescript. Vita. Includes bibliographical references (leaves 215-228). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 1999. / Typescript. Vita. Includes bibliographical references (leaves 215-228). Also available on the Internet.

Background: Nurse practitioners are increasingly conducting consultations with patients on the same basis as medical doctors. However little is known about communication within nurse practitioner consultations. Research on communication in nurse practitioner consultations has identified nurse practitioners communicate with patients in a hybrid style, combining biomedical information with the discussion of subjective information from everyday life. Research has not fully explained why this hybrid style occurs in nurse practitioner consultations, nor determined its links to consultation duration, patient expectations, satisfaction, and enablement. This study was developed to address these gaps in research of communication in nurse practitioner consultations. Aim: This study aims to advance understanding of the discrete nature of the communication processes and social interactions occurring in the nurse practitioner consultation, including explicating the reasons for the occurrence of the particular communication processes and interaction styles observed in those consultations. Methods: The study was conducted in a nurse-led primary care clinic providing general practice care. Within a case study research approach mixed methods were utilised, combining structured analysis of video recorded observations of nurse practitioner consultations, questionnaire-based measures of patient expectations, satisfaction, and enablement, and interviews with some of the participants of the consultations. The sample for video recording comprised three nurse practitioners employed at the clinic, and 30 patients registered at the clinic. Questionnaire responses were provided by 71 patients, including 26 whose consultations had been video recorded. All three nurse practitioners participated in post-consultation individual interviews, and 11 patient / carers participated in post-consultation individual interviews. The video recorded consultations were analysed with the Roter Interaction Analysis System (RIAS), a method of quantified interactions frequency analysis. The questionnaire responses were analysed with descriptive statistics. Transcripts of the interviews were analysed using computerised qualitative data analysis with NVivo. Findings: A significant majority of observed social interaction in the consultations used patient-centred communication styles (p=0.005), with neither nurse practitioners nor patients or carers being significantly more verbally dominant. Nurse ii practitioners guided the sequence of consultation interaction phases, but patients and carers participated through asking questions and involvement in negotiations for care planning. Patient / carers were highly satisfied with their consultations, and significantly higher general satisfaction was noted when participants expected the nurse practitioners to be able to diagnose their presenting problem (p=0.043). Patient / carers expressed significantly higher levels of enablement than have been seen in previous studies of enablement with other types of clinicians (p=0.003). The mean consultation time length of 10.97 minutes is comparable with studies of general practitioners. The participants’ perceptions of nurse practitioner consultation communication processes and social interactions were represented through six themes; Consulting style of nurse practitioners; Nurse practitioner – GP comparisons; Lifeworld content or lifeworld style issues; Nurse practitioner role ambiguity; Creating the impression of time; and Expectations for safety netting. Contribution to knowledge: This study reveals nurse practitioner consultations comprise collaborative openness to peoples’ agendas and questions, expressions of everyday lifeworld experiences, expanded impressions of time, clear explanations augmented by integrated clinical reasoning, and participatory negotiations. These communicative features arise from a combination of social, ideological, and epistemological factors, prompting nurse practitioners to privilege how they interact with patients and carers, and to adopt a hybrid patient-centred style combining the nursing ideology of holism and their knowledge of biomedicine. This form of communication has been characterised as a stylistic exemplar for good consultation communication practice, which potentially facilitates shared decision-making. This research has resulted in new knowledge of the communication processes and social interactions used in nurse practitioner consultations, which demonstrates the importance of clinicians giving precedence to how they communicate and interact with patients so as to optimise their therapeutic outcomes without compromising the duration of consultations.

Syfte: Syftet med studien var att beskriva skötares uppfattningar av specialistsjuksköterskans kompetens i psykiatrisk vård. Metod: För att analysera detta fenomen gjordes en intervjustudie med kvalitativ design och en fenomenografisk analys tillämpades. Semistrukturerade intervjuer genomfördes där nio skötare verksamma i den psykiatriska vården vid tiden för intervjutillfället deltog. Med avsikt att finna variation bland uppfattningarna bearbetades och analyserades det transkriberade materialet i en analys omfattande sju steg. Resultat: Fyra kategorier av skötarnas uppfattningar identifierades: Osynlig kompetens, otydlig kompetens, synlig kompetens och tydlig kompetens. Relationen mellan dessa kategorier förhöll sig hierarkiskt i förhållande till i vilken grad specialistsjuksköterskans kompetens uppfattades. Slutsats: Skötarens uppfattningar ger uttryck för att det finns ett starkt behov av specialistsjuksköterskans kompetens samtidigt som man inte kan se hur den urskiljer sig från skötarens egen kompetens. Områden i specialistsjuksköterskans kompetens som har stor betydelse för och kompletterar skötarens egen kompetens värdesätts särskilt, såsom specialistsjuksköterskans arbetsledarroll, samarbetsförmåga, somatiska kunskap och helhetsbild av psykiatrin i övrigt. / Aim: The aim of this study was to describe how psychiatric aides’ understand the competence of specialist nurses in psychiatric care. Methods: In order to analyze this phenomenon, a phenomenographic interview study with qualitative design was carried out. Semi-structured interviews were conducted with nine psychiatric aides, working in psychiatric in-patient care at the time of the interview. In order to find the variation among the understandings, the transcribed material was processed and analyzed through an analyze method including seven steps. Results: Four categories of understandings were identified: invisible competence, unobvious competence, visible competence and obvious competence. The relationship between these different categories took a hierarchical structure in relation to the degree of which the specialist nurse competence was understood. Conclusions: The understandings of the psychiatric aides expresses the dependence of the specialist nurse's competence while at the same time one cannot see how it distinguishes itself from the psychiatric aides’ own competence. Areas of the specialist nurse competence that are of great importance for the psychiatric aides and complement their competence are especially valued, such as: the specialist nurse’s leadership, ability to cooperate, somatic knowledge and overall knowledge of psychiatry.

In a hospital environment the focus is on quality patient care. One of the important factors to improve the quality of patient care is the implementation of a continuous professional development programme. In a continuous professional development programme of a hospital three stakeholders namely management, clinical facilitators and the nurse practitioners are identified as partners. When the stakeholders reach a point where it is believed that the continuous professional development programme does not serve its purpose to improve the quality of patient care it is time to evaluate and refine the programme. This study evaluate the critical care and high care units in a private hospital in Gauteng’s continuous professional development programme and the conclusions and recommendations are therefore limited to this specific clinical setting. The refinements recommended cannot be utilised in other clinical setting but the evaluation and research methodology can be utilised to evaluate similar continuous professional development programmes. Evaluation of a continuous professional development has the potential to negatively influence the nurse practitioners attitude towards continuous professional development. The objective of the research approach chosen namely a 4-D Appreciative Inquiry approach was to gain the collaboration of all the stakeholders in an effort to ensure that the evaluation of the continuous professional development programme of the critical care and high care units in the private hospital in Gauteng does not negatively affect the delivery of quality patient care. The Appreciative Inquiry research approach with its positive approach lends it to be the most appropriate research methodology of the study. The study utilised a Focus Group Inquiry as data a collection mechanism. From the study In-service training emerged as the element that form an important element of an effective continuous professional development programme but that it is of the at most importance that an effective Workplace learning environment exists. The supportive role of Management for a continuous professional development programme also emerged as one of the main themes required for the implementation of a continuous professional development programme. These findings were utilised in the refinement for the continuous professional development programme for the critical care and high care units in the private hospital in Gauteng. The research recommends that a steering committee be appointed to implement a pilot continuous professional development programme that incorporate the refinement elements identified. Due to the continuous improvement nature of the Appreciative Inquiry methodology it is also recommended that the pilot continuous professional development programme been re-evaluation to ensure long-term success and improvement. / Dissertation (MCur)--University of Pretoria, 2013. / gm2014 / Nursing Science / unrestricted

目前在台灣，專科護理師參與醫療處置過程的一部分已經是一個必然的趨勢。雖然目前已針對專科護理師相關的法規做了修正，但是在實務上還是有許多需要克服的問題。修法後雖然對專科護理師的執業範圍包含非侵入性和侵入性醫療行為有了較明確的規範，專科護理師臨床執業面臨的困境還是存在。出現醫療爭議時，醫師、專科護理師、其他醫事人員及醫院的法律責任仍然有許多模糊地帶。專科護理師相關法規修法後，衛生局及醫療機構之因應準備仍有改善的空間。 本研究採用案例分析法依照案例事實、法院見解和爭點問題，討論一個發生在民國95年12月有關專科護理師與醫師的醫療爭議訴訟案件。本醫療糾紛個案是台灣專科護理師正式甄審後，發生的第一件專科護理師被起訴的醫療糾紛案件。 被告因業務過失致死案件，經檢察官提起公訴判決主文如下：主治醫師從事業務之人，因業務上之過失致人於死，處有期徒刑壹年，減為有期徒刑陸月，緩刑貳年。專科護理師從事業務之人，因業務上之過失致人於死，處有期徒刑陸月，減為有期徒刑參月，緩刑貳年。本案例經由臺灣臺北地方法院刑事判決98年度醫訴字第6號，臺灣高等法院刑事判決民國100年度醫上訴字第7號，目前檢察官上訴中。 台灣專科護理師法規未來修正的方向，需更進一步明訂專科護理師的執業範圍以符合法律明確性原則。醫師指示合法化，使醫療輔助行為之定義更明確。建立專科護理師專業能力標準與提升及評估專科護理師執業品質，加強專科護理師的訓練以及訂立專科護理師訓練醫院更完善的認證標準與訓練醫院評鑑制度。有關衛生福利部最近要制定的醫師助理法，其工作範圍與專科護理師有很多重疊之處，引進醫師助理可能造成的衝擊。制定合理的專科護理師的護病比，明定專科護理師是否可以值班?專科護理師是否可以採輪班，以符合勞基法一例一休的規定。我們仍然有很多可以改善的地方，希望有更明確的法律規範，讓合格的專科護理師加入醫療團隊的運作，提高專科護理師的專業能力藉以提升醫療服務品質。不要讓專科護理師面臨或甚至觸法的危險，最終有可能變成密醫，對於台灣的醫療會有很大的衝擊及影響。 / The participation of nurse practitioners in medical practice is a must in Taiwan now. Although amendment of law about the clinical practice for nurse practitioners was made, there are still some issues which should be further evaluated. The scope of medical practice for nurse practitioners includes invasive and non-invasive medical procedures, which were defined more clearly in the revised articles, but some ambiguous situations still persist. The juridical responsibility of doctors and nurse practitioners for medical disputes remains unclear. There is lots of space of improvement which bureau of Health and hospitals can do after the revision of related law for nurse practitioners. The method of this research is a case study including case facts, the decision of the court and the issue of disputes. This is a medical dispute regarding doctors and a nurse practitioner, which occurred in December, 2006.This is the first medical dispute happening in Taiwan after the establishment of official examination for nurse practitioners. The defendants were accused for guilty because of causing death of a patient due to professional negligence. The verdict of the superior criminal court in Taiwan in 2011 after public prosecution was as follows. The attending physician was sentenced for one year, reduced to six months and probated for 2 years because of causing death of a patient due to professional negligence. The nurse practitioner was sentenced for six months, reduced to three months and probated for 2 years because of causing death of a patient due to professional negligence. The future amendment for the law regarding nurse practitioners is as follows: first, to enact the specific scope of medical practice for nurse practitioners according to the law; second, to legalize the directions from doctors; third, to specify the definition of assisted medical practice performed by nurse practitioners; fourth, to establish the standard for evaluating the ability of nurse practitioners; fifth, to elevate and evaluate the quality of medical service from nurse practitioners; sixth, how to strengthen the training programs of nurse practitioners, to build the verification standard of hospitals which can train nurse practitioners and improve the system of accreditation; seventh, to create rational ratio of nurse practitioners to patients; eighth, to clarify whether nurse practitioners can be on duty and in shifts in the hospital according to the law. In addition, the impact for nurse practitioners by introducing physician assistant to medical service suggested by Bureau of Health is high because there is lots of overlap of medical practice between the two professionals. We hope that the participation of verified nurse practitioners under the regulation of specific law can improve the quality of medical service, otherwise, we are afraid that nurse practitioners may break the law, become fake doctors and be sentenced, which will cause great impact and bad influence of medical service in Taiwan.

Thesis (MPH.) --University of Limpopo, 2019. / Background: The purpose of this study was to investigate the extent of adherence to Infection Prevention and Control (IP&C) practices and programs amongst healthcare workers (HCWs) in the neonatal ward at Charlotte Maxeke Central Hospital (CMCH). Methods: Quantitative research was conducted on 57 Clinicians directly providing care to the patients and 5 Health Care Workers indirectly providing care to the patients by means of supporting the environment and logistics where patients are being taken care. Data collection was done using structured questionnaires. Because the population was so small, all available HCWs, who were willing to participate in the study were selected to participate in the study. Furthermore, the SAS statistical software was used to describe and analyse data received from the data collection tools. Results: Two groups of respondents participated in the study which were (n=57) who in the neonatal ward at CMCH and Health Care Workers (n=5), most of the clinicians were having 1 – 4 years’ experience working in the neonatal unit at 54.6% followed by 5 – 9 years at 21.8%. Participants were in the age group ≤ 30 years at 39.3% followed by 31 – 40 years (32.1%) and least being at ≥ 51 years (5.4%). Clinicians included 46% of professional nurses, 28.6% Auxiliary Nursing Assistant, 16.1% student nurses and 8.9% medical doctors. The findings revealed that there are some areas where there’s inconsistent in using gloves when anticipating exposure to blood or body fluids, drying of hands after washing and removing jewellery during clinical care among clinicians particularly doctors, professional nurses and student nurses about IPC practices during clinical care. In Conclusion: There was inadequate compliance with IPC standards and there’s a need for regular trainings to improve the knowledge about IPCs and awareness of its importance among clinicians and health care workers in the neonatal unit. The IPC committee need to be revitalized by the hospital management to be able to undertake its mandate. Furthermore, the Hospital administration should provide copies of IPPC policy Guidelines in all wards/units and ensure effective implementation through vi constant supervision and adequate supplies and conduct regular audits to enhance compliance and implementation of IPPC policy. The study concluded that there was inadequate compliance with IPC and there’s a need for regular trainings to improve the knowledge about IPCs and awareness of its importance among clinicians and health care workers in the neonatal unit.

The nurse practitioner (NP) role is more prominent now than ever before in primary healthcare, positioning them as providers who defend initiatives and ongoing health agendas. Obesity is among those agendas. The concept of instrumental role modeling was explained as a combination of understanding and physical presence that gives meaning and quality to inspire change. It implied that health professionals are not merely insightful clinicians but suggested their expertise is complimented by demonstrations of wellness in knowledge and practice. This topic of weight was perceived as sensitive but must be addressed. In this grounded theory study, the perspectives of NPs from clinical and academic settings were gathered. There was an overarching need for NPs to identify how they perceived themselves consequential to how others perceived them. Using a qualitative method gaps on the construct of instrumental role modeling as an emerging theory was addressed and revealed the ambiguities NPs encountered when challenged to identify their personal perceptions of obesity when counseling weight management. Using a grounded theory design, 11 NPs were interviewed and asked about how they reconciled perceptions of instrumental role modeling around discussions of obesity. Participant remarks produced theoretical constructs that instrumental role models: 1) are mindfully responsible when interacting with others, 2) need to balance accountability, approach and awareness to develop trust, and 3) need to be aware of the creative tensions that exist between accountability and approach when discussing illnesses and their co-morbid conditions. These findings provide evaluative dialogue for positive social change in clinical settings and valuable insight regarding the topic of obesity in academia.