Thesis (M.S.)--University of Michigan, 1999. / Includes bibliographical references.

Critical thinking ability is imperative for nurse practitioners in the multidimensional unfolding health care arena. Consensus as to what critical thinking entails has yet to be articulated. This non-empirical study thus set out to clarify the concept "critical thinking. Walker and Avant's (1995) proposal for conducting a concept analysis was used within the qualitative research paradigm. Literature selected from the fields of education, philosophy, nursing and psychology was consulted as the main source of data. Thematic and theoretical sampling of literature were also embarked upon during the later stage of the research to add density to emergent categories and themes. Categories were organised according to the Strauss and Corbin (1995) paradigmatic model; indicating the antecedents, disposition of the thinker, attributes and critical attributes, and outcomes of critical thinking. The findings indicate that critical thinking is a complex, multidimensional, dynamic, existential and context dependent mental operation. The essence of critical thinking is further illuminated by the construction of a model case and additional cases. The concept critical thinking is finally succinctly defined. The implications that critical thinking holds for nursing education and practice are spelled out. / Health Studies / M.A. (Health Studies)

The purpose of the study was to test a theoretical model explaining nurse practitioner judgments about the amount of interaction and participatory decision-making between nurse practitioners and physicians. The specific aims of the study included: (1) to examine the influence of nurse practitioner perceptions of care complexity and expected benefit-cost ratio of physician involvement on interaction and participatory decision-making; (2) to test a theory that integrates two alternative explanations of amount of interaction and participatory decision-making derived from social exchange theory and technology theory; and (3) to investigate the effect of practice rules on the relationships in the theoretical model. The study used a mathematical correlational design with a causal modeling methodology for model testing. A convenience sample of 38 nurse practitioners participated. Major concepts in the model were measured using a four scale magnitude estimation instrument developed for the study. The instrument consisted of operational definitions for each of the concepts and a set of 18 clinical situations scaled according to care complexity. Psychometric properties of the instrument including stability, internal consistency, content and construct validity were estimated. Matching of responses across two modalities was used to validate the production of ratio level data. Multiple regression techniques were used for theoretical model testing. In the test of the theoretical model, both care complexity and expected benefit-cost ratio had a significant impact on the nurse practitioners' judgments about amount of interaction and participatory decision-making. Predictions derived from social exchange theory and technology theory were supported. The effect of practice rules on the relationships in the model could not be determined since the index of practice rules did not achieve an acceptable level of stability. Nurse practitioner judgments about interaction and participatory decision-making were influenced by perceptions of care complexity and expectations of the benefits and costs of interaction with a specific physician. An understanding of the factors that affect nurse practitioner judgments about interaction and participatory decision-making may be used to guide interventions that enhance the fit between these structures and outcomes of care.

This dissertation evaluated the provision of two different one-to-one educational interventions, randomly assigned, to two separate groups of medical practitioners at a health maintenance organization (HMO), Cigna Healthplan of Tucson, Arizona. A control group received no intervention. Each group consisted of seven physicians and one nurse practitioner. The intervention was aimed at improving the prescribing of the anti-ulcer drugs, cimetidine, ranitidine, and sucralfate. The theoretical basis for the study involved the cognitive principle of vividness, which implies that more vivid information has greater effect on decisions. For this research, the vivid intervention included case scenarios, while the non-vivid intervention included statistical information of the results of a drug use review. Prescribing data, consisting of percentages and cost of inappropriate prescriptions, were collected for one month prior to and for two months after the intervention. Analysis of covariance was employed with the pre-intervention measures of prescribing as the covariate in each test and post-intervention measures as the dependent variables. No differences were found between the two interventions, but the control group was significantly different from the intervention groups. For the first post-intervention month, it was found that the interventions resulted in significantly lower percentages of prescriptions written inappropriately for indication, dose, or duration (P = 0.001). These percentages decreased by 36% for the intervention groups, while increasing by 14% for the control group. Costs of inappropriate prescribing per study prescription and per patient encounter were also significantly lower for the intervention groups than for the control group (P = 0.001 and P = 0.019, respectively). In the second post-intervention month, inappropriate prescribing increased slightly in the intervention groups and were no longer significantly different from the control group. The research demonstrated the effectiveness of a one-to-one educational intervention in improving drug prescribing at an HMO. The lack of differences between the two interventions may have been due to the overall effectiveness of the one-to-one educational discussion, the interpretation of the statistical information as prescribing feedback by the practitioners, or the inadequate presentation of vividness in the case scenarios.

Bakgrund: Den psykiska hälsan hos sjuksköterskor kan påverka den givna vårdkvaliteten gentemot patienter. Oregelbundna arbetstider, dålig arbetsmiljö och stress är några av de faktorer som kan ge en försämrad psykisk hälsa. Syfte: Syftet med detta arbete är att studera om det finns ett samband mellan skattningen av psykisk hälsa och skattning av given vårdkvalitet hos sjuksköterskor vid ett sjukhus i Mellansverige. Jämförelse görs även utifrån variablerna kön, ålder och aktiva år i sjuksköterskeprofessionen och om det finns ett samband mellan ovan variabler. Metod: Data samlades in via en enkät med två skalor; GHQ-12 som avser att upptäcka psykisk ohälsa och påvisa tecken på depression, samt ett självskattningsformulär som behandlar kvaliteten av given vård. Resultat: Det kunde inte påvisas något signifikant samband mellan skattad psykisk hälsa och skattad given vårdkvalitet. Det fanns ett statistiskt signifikant samband mellan skattad psykisk hälsa och inkludering av patienten och anhöriga i utformning och genomförandet av vården. Studien visar att kvinnliga sjuksköterskor skattar sin psykiska hälsa sämre jämfört med manliga sjuksköterskor. Slutsats: Det fanns i denna studie inget signifikant samband mellan skattad psykisk hälsa och skattad given vårdkvalitet. Vid analys av delskalor inom variabeln vårdkvalitet fann vi att sjuksköterskor som skattar en lägre psykisk hälsa även skattar att de är sämre på att inkludera patienten och/eller anhöriga i utförandet och utformningen av vården / Background: The psychological health in nurse practitioners can affect the quality of the care given to patients. Irregular work hours, bad working environment and stress are some of the factors that can result in a decline in psychological health. Objectives: The purpose of this study is to compare the self-perceived psychological health in nurse practitioners at Academic Hospital in Uppsala with their own perception of quality of given care. Comparisons will also be done regarding gender, age and active years in the nursing profession. Methods: Data was collected via a survey with two scales; GHQ-12 which is used to distinct psychological disorders and signs of depression, along with a self-assessment form regarding quality of given care. Results: There was no significant correlation between self-perceived psychological health and self-perceived quality of given care. There is a statistical significant connection between psychological health and inclusion of the patient and relatives regarding planning and giving care. This study shows that female nurses grade their psychological health as lower compared to male nurses. Conclusions: This study showed no significant correlation between self-perceived psychological health and self-perceived quality of given care. The result shows that nurses that have a lower self-perceived psychological health grade themselves lower regarding the inclusion of the patient and/or their relatives in the planning and implementation of the care

ABSTRACT Thyroid disease is one of the most common endocrine disorders in clinical practice. Critical illness is often associated with alterations in thyroid hormone functions. Thyroid dysfunction is a serious matter if managed inaccurately; it may increase morbidity and mortality. The purpose of this Doctor of Nursing Practice project is to identify the knowledge, attitudes, behaviors and practice of advanced practice nurses (acute care nurse practitioners (ACNP) and adult gerontology acute care nurse practitioners (AGACNP)) on current thyroid dysfunction management in the acute care setting. The DNP project demonstrated that most acute care nurse practitioners believe that TD screening, diagnosis and management is important in the acute care setting. The survey results also indicated that most of the AGACNP/ACNPs would initiate treatment while managing patient in an acute care setting and will likely collaborate with endocrinology for overall management or follow ups to ensure quality and comprehensive care in management of TD. Keywords: thyroid disease, thyroid dysfunction, identify, knowledge, attitudes, behaviors, acute care

Background: Skin cancer is the most common form of cancer in the United States and is a public health concern. There are over 5 million new cases of keratinocyte skin cancer (KC) (previously known as non-melanoma skin cancer) and over 65,000 new cases of melanoma annually in the United States. Skin cancer is highly preventable, although prevention methods are not commonly practiced. Nurse practitioners have a key role in educating and encouraging patients to practice skin cancer prevention methods. Purpose/Aims: The purpose of this project was to determine whether a brief educational video can improve nurse practitioner knowledge, attitudes, and behaviors regarding skin cancer and skin cancer prevention counseling. Methods: A single subject pre-test post-test design guided this project. Participants completed an online pretest assessing skin cancer knowledge, attitudes, and behaviors. Following the pretest participants were given access to the video intervention. The intervention included information about skin cancer and published guidelines about skin cancer prevention counseling. Changes in knowledge, attitudes, and behaviors and satisfaction with the intervention were assessed through a post-test. Results: A total of 30 eligible Arizona nurse practitioners completed both the pretest and posttest surveys. There was a statistically significant increase (p=.000) in knowledge from 64.17% on the pretest to 87.5% on the posttest. Attitudes about skin cancer and skin cancer counseling were fair on the pretest and significantly improved (p=.000) on the posttest. On the pretest, nurse practitioners had poor attitudes regarding skin cancer prevention counseling practice behaviors. These attitudes favorably increased (p=.009) on the posttest. Self-reported practice behaviors also improved significantly following the intervention (p=.000). Participants' attitudes regarding the intervention were generally favorable. Conclusions: A brief educational intervention offered online to nurse practitioners is highly effective for improving their knowledge, attitudes, and behaviors regarding skin cancer and skin cancer prevention counseling. The intervention is feasible to administer and is acceptable to nurse practitioners.

M.P.H., Faculty of Health Sciences, University of the Witwatersrand, 2011 / Although the nursing sector has not been spared the effects of human resource shortages and Human Immune-deficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) crisis in Lesotho, it still remains the backbone of the primary health care delivery. There is a well-established linkage between oral health and HIV/AIDS with many of the early symptoms of HIV manifesting in the oro-facial region. However, the lack of oral health personnel at primary health care levels in Lesotho makes Primary Health Care Nurse Practitioners (PHCNPs) often the first health care providers to consult, manage and refer patients with such oral lesions. Aim: To assess the “knowledge, attitude and practice” (KAP) of the PHCNPs regarding oral health and oral HIV lesions in Queen Elizabeth II (QE II) and Roma health service areas (HSA) of Maseru district in Lesotho. Objectives: To assess the demographic profile of PHCNPs in the target health facilities, their knowledge, attitude and practice regarding oral health and oral HIV lesions. Methods and Materials: The research was a descriptive cross-sectional survey. A convenience sample of 57 primary health care nurse practitioners (PHCNPs) from QE II and Roma health service areas were identified. During their monthly PHC meeting, a questionnaire was administered to assess the knowledge, attitude and practice regarding oral health and oral HIV lesions. The information gathered was both quantitative and qualitative. Data was entered and analysed using the SPSS statistical package. Results: The response rate was 87.7%. There was 100% consensus regarding the importance of oral health to the total well being of individuals. The majority of the PHCNPs recognised oral candidiasis (OC) (94.7%), bleeding gums (87.7%), herpes lesions (71.9%) and dental caries (75.4%). Lesions such as acute necrotizing ulcerative gingivitis (ANUG) (40.3%), angular cheilitis (AC) (56.1%) and apthous ulcerations (24.6%) were also recognised but to a lesser extent. The respondents associated OC (84%), herpes (61%), AC (54%), Oral Hairy Leukoplakia (OHL) (49%), Kaposi‟s‟ sarcoma (KS) (49%) with HIV/AIDS. OC was the most common lesion associated with HIV. Some lesions commonly seen in the clinics such as apthous ulceration and ANUG were not significantly associated with HIV (18% and 33%, respectively). The majority of PHCNPs (81%) indicated that they had knowledge about oral HIV lesions. Twenty nine 6 respondents (50.8 %) reported having received this knowledge through training institutions. Mass media (Radio (53%), TV (40%), and newspapers/magazines (49%)) was one of the major sources of information. Forty-four PHCNPs (77.2%) saw only Zero or one (0-1) HIV patients with oral lesions. Similarly, 15.8 % and 7% of the PHCNPs saw 11 to 20 and more than 20 (21+) HIV patients with oral lesions, respectively. The two thirds of the PHCNPs (67%) said they would not advise patients to seek care from Traditional Health Practitioners (THP) due to their lack of trust and confidence in the practices, knowledge and the patient management of the THPs. However, 16% of them reported that they would refer because they thought traditional medicine boosts the immune system. Only seven respondents (12.3%) routinely washed their hands with antiseptics. However, 44 of respondents (77.2 %) cleaned their instruments with bleach and disinfectants. The majority (89.5%) washed their hands with water and soap. Forty three respondents (75.4%) wore gloves during examination. Routine use of facemasks was limited to only 12 respondents (21.1 %). Ninety eight percent of the PHCNPs stated that they would like to learn to manage oral lesions at health centres. The majority (79%) of the respondents said that they would like to receive more training on the management of oral lesions through workshops. Conclusions: There was an observable correlation between PHCNPs self-assessment of oral health knowledge and the objective knowledge as assessed by ability to identify the oral lesions on a chart ( 2 –sided Fischer‟s test-0.000-0.261).This needs to be confirmed by undertaking a study with a larger sample size. OC was the most common lesion associated with HIV as reported by the PHCNPs. The majority of the participants (94.7%) identified OC and associated it (84%) with HIV infection. The finding indicated that with training and/or mentoring, PHCNPs are likely to confidently diagnose oral HIV lesions. PHCNPs showed a positive attitude towards learning more about the oral manifestations of HIV/AIDS. PHCNPs should be utilised more effectively in the diagnosis and management of HIV/AIDS.

A new role has been developed in nursing named the Clinical Nurse LeaderSM (CNL®). This new role positions the masters prepared nurse at the patient's bedside to oversee care coordination and serve as a resource for the clinical nursing team, and to bridge the gaps in health care delivery to better meet the needs of patients in all health care delivery settings. Since this is a new role, there is a paucity of research that has been conducted surrounding these nurses. A phenomenological investigation examined the lived experiences of CNLs® to gain understanding about the meaning of leadership at the point of care and to discover the unique expressions of living caring that CNLs® experience as they embark upon this new role in the acute care hospital setting. Ten CNL® participants were interviewed for this study. Their stories about patient situations and relationships with other disciplines were shared with rich description and emotion. Hermeneutic analysis of the text revealed six essential themes. Six essential themes emerged revealing the essence of leading at the bedside and living caring in the CNL® role: navigating safe passage, pride in making a difference, bringing the bedside point of view, knowing the patient as person, helping nurses to grow, and CNLs® needing to be known, understood and affirmed. Taken as a whole through a synthesis of the themes, the understanding of the meaning of leading to CNLs® includes keeping their patients safe, being proud of their accomplishments and the respect gained from others, as well as being a helper and advocate for other nurses. / This is accomplished through their privileged place at the bedside, where they come to know their patients as person and work hand in hand with nursing colleagues. When CNLs® are supported by management, and their roles are planned and understood, they are more fully able to optimally practice and live and grow in caring. / by Barbara C. Sorbello. / Thesis (Ph.D.)--Florida Atlantic University, 2010. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2010. Mode of access: World Wide Web.

With passage of the Patient Protection and Affordable Care Act (PPACA) and the publication of the Institute of Medicine’s report on the future of nursing, nurses are slated to take on an expanded role in primary healthcare delivery in the near future. Nurse practitioners, in particular, will be instrumental in filling the gap in primary care availability engendered by the increasing specialization of physician practice and increased access to healthcare made possible by the provisions of the PPACA. The need for this study was identified through gaps in the literature related to nurse practitioner practice; specifically, the paucity of quantitative research regarding patients’ perspectives of core holistic nursing values in nurse practitioner care, and, since nursing care is by definition and tradition holistic in nature, this inquiry attempted to quantify the degree to which nurse practitioner care upholds and preserves core holistic nursing values. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection