The neonatal intensive care unit (NICU) is frequently occupied by newborns who are marginally viable, or critically unwell, and could be considered terminally ill. It is a busy, highly technical environment with an arsenal of life-saving medical equipment at its disposal, and advances in technology used in this field stretch the boundaries of viability. Despite technological advances, increases in the margins of viability and highly skilled healthcare delivery, some newborns will still die in the NICU. In recent years, palliative care for the neonatal population has become increasingly topical and part of the lexicon of contemporary neonatal practice. Evidence-based protocols are available to inform this model of care, yet in reality, provision of palliative care to newborns is ad hoc. The reasons why implementing a palliative model of care have been problematic are unclear. The purpose of this study was to identify the barriers and facilitators to palliative care practice in neonatal nursing, and to develop policy recommendations to improve this area of practice. This exploratory research was conducted to answer two research questions: 1) What are the barriers and facilitators to palliative care practice in neonatal nursing? 2) How can the identified issues be addressed to inform policy and clinical guidelines in the practice environment? Phase one of this investigation developed, pilot tested, and administered an instrument to identify the barriers and facilitators to practice. Data analysis identified three subscales that indicated facilitators and barriers to palliative care practice. The second phase of this study used a translational research approach, utilizing interpretive methods to explore and contextualise the population study findings to inform policy development to improve palliative care practice in neonatal nursing. This research has identified that the facilitators that do exist for palliative care practice are subject to caveats that impinge markedly upon these facilitators. Furthermore, the barriers that were identified pose threats to the integration of a palliative model of care into Australian neonatal nursing practice. Thus, the overall results from this research have lead to a composite understanding of the barriers and facilitators to palliative care practice in Australian neonatal nursing, which may account for the gap between support of palliative care for marginally viable and critically ill newborns, and the application of this model of care in clinical practice. Translating the survey findings into policy directives that are applicable to the clinical environment has resulted in the development of recommendations that are aimed at improving palliative care practice in the NICU.

Thesis (M.S. in Engin.)--University of Texas at Austin, 1959. / Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis (M.S.)--University of Wisconsin--Madison, 1982. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 70-73).

The qualitative study was designed to study how ethical decision-making realises in difficult care situation in nursing. A hermeneutic phenomenological approach was used. Data collection was done through writing of critical incidents by registered nurses and midwives in two hospitals in Gauteng Province. The critical incident technique was developed by Flanagan (1954:327). Narratives/stories were analysed by: naïve reading, structural analysis and comprehensive understanding (Sorlie 2000:52). The study population was 30 registered nurses and midwives, who held in-charge positions, and have dealt with ethical problems themselves. The methodology was about understanding and interpreting lived experiences in clinical practice about ethically difficult care situations in nursing. Guba's model was used for truth value, which was obtained through human experience as was lived and perceived by narrators, who then described/narrated their stories, this was true of critical incidents. The credibility of the findings depends on accurate documentation of the experience as was narrated, so that the participants would recognise their stories. The participants could not validate the findings due to sensitivity of the critical incidents. Applicability was not relevant, as it was description of a particular experience that could not be generalised. Because of the contextual nature of the study, I could not guarantee consistency, as interpretation is based on shared values, norms and beliefs in a particular profession, and is recognised by readers sharing the same values. Anonymity and confidentiality was maintained to protect the narrators, due to the sensitive nature of the study. Ethical principles and respect for human dignity was adhered to. Permission was granted by the hospital authorities as well as Research Ethics Committee at the University of Pretoria. Limitations of the study have been noted. Interpretation of the findings of realisation of ethical decision making in difficult care situations as well as guidelines for teaching ethics to nursing learners has been done Findings of the study indicate that the context and impact of realisation of ethical decision-making in difficult care situations was different to different narrators and completely dependent on the ethical problem that had to be dealt with and be realised or failed to be achieved. / Dissertation (MCur)--University of Pretoria, 2009. / Nursing Science / unrestricted

Thesis (M.S.)--University of Michigan, 1991.

Thesis (M.S.)--University of Michigan, 1991.

In contemporary Western nursing, the notion of health is considered a basic concept in all nursing theory, yet the many nursing theorists have failed to express unanimity in their various descriptions of health. This situation exists even while the achievement of health is generally identified as the goal or purpose of nursing. In Australia, the requirement that nurses become health-promoting practitioners assumes that nurses understand health in positive ways, which can be translated into nursing practice. Given the myriad definitions of health, confusion among nurses about the nature of health as it is to be promoted appeared possible, even probable.This phenomenological research aimed to illuminate the nature of nurses' understandings of health and the ways such understandings are translated into nursing practice. The purpose of the study was to describe and interpret nurses' experiences of health, and their experiences of giving health care to someone in their care, in order to illuminate the nature of health for nurses and in nursing.The manner in which this research was carried out was informed by the human science approach to phenomenology described by van Manen, which is derived from the traditions of Husserl, Heidegger and Merleau-Ponty. Thus, the inquiry was grounded in the hermeneutic phenomenological philosophical perspective, which began with the work of Husserl who recognised the need to return to the grounding of truths in human experience. The thesis is informed by two views of phenomenology. The first involves the traditional approach to phenomenology advocated by the European phenomenological philosophers while the second approach is referred to by Silverman as arising from 'American continental' philosophy.Data were generated from multiple audiotaped interviews with each of nine participants, and from personal reflection and journalling undertaken ++ / by the researcher during the research process. The dual data analyses were guided by the phenomenological approach of van Manen and by that of various nursing scholars who have used phenomenological methodology as it has evolved from American continental philosophy. These analyses included several levels of reflection undertaken by the researcher and each of the participants in the study to illustrate the nature of health in nurses' lives and in nursing.The nature of health, as revealed through the original experience of the participants, was disclosed as manifest in the lives of the participants with most descriptions conveying a sense of contentment that showed as feelings of happiness, feeling alive, complete, energised and optimistic. Health also revealed itself as transient in nature, passing quickly and without notice into and out of the lives of most of the participants. Although obvious in some ways, health simultaneously eluded clear description and, even at the completion of the exploration with each participant, was characterised by an atmosphere of elusiveness. For all the participants, health was an embodied phenomenon with a common element of energy and a sense of wellbeing. These, together with a sense that life was manageable and achievable gave to it a distinctive spirit, even while the spirit simultaneously helped to make life manageable and achievable and thus contributed to health. For all of those who participated, health presented as having the ability to transform their emotional responses to daily life events in such a way that it made those events more acceptable and the tasks of life more achievable.Although health showed as a physical, embodied state which was expressed as vitality and energy, it could not be separated from the mental / emotional state. As it was described, the following leitmotifs of health were lexically revealed: Health: ++ / A different encounter for each person, Health described as peace, Health described as feeling good about oneself, Health described as balance, Health as energy, Health as vitality and zest, Health described as happiness and/or contentment, Health described as quality of life, The 'picture of health', Health described as dignity, and Health as the unknown or the inexpressible.The nature of health-focused care in nursing showed as caring, rapport building and support, ever dependent on the social relationship that develops between each nurse-carer and the individual to whom they offer care. However, clear relationships between the meanings of health for the nurses in the study and the way they gave health care could not be elucidated. These relationships have not been identified because of the individualistic nature of health-focused care as these nurses have described it. For this reason, this research makes a strong plea for continued dialogue about the relationships between health and health-focused care in nursing.

This study explored the complex world of nursing at a time of humungous change in the delivery of health care services. The initial focus of the research was registered nurses' use of knowledge in professional practice; however this was largely displaced by contextual issues, which emerged from the data. Eraut's (1992,1994) concepts of professional knowledge informed the data generation and the analysis. A broadly qualitative approach drawing on grounded theory and constructivism provided the methodological framework and the research methods involved observation and interview. The sample comprised registered nurses undertaking a four-year part-time degree in nursing studies. Twenty-seven were observed in a variety of clinical settings: sixteen of this group were subsequently interviewed. Six of their managers were then interviewed. Data analysis followed a pattern of literal, interpretive and reflective coding and revealed a number of key issues for registered nurses working in the United Kingdom at the time of the research. The nurses fell into three categories, the survivors, the battle weary and the battle hardened; the largest group being the battle weary. The key causes of the weariness originated from organizational constraints such as low staffing levels, poor teamwork and an inability to give appropriate care to their patients. The effects of battle weariness included low morale, which affected their motivation, tearfulness and a general fatigue. The 'survivors' (a minority) were characterized by a sense of purpose and a fulfillment from their work. The contexts in which the battle weary worked were likened to a war zone with a clearly defined battlefield. Significant changes to the traditional role of the ward sister/charge nurse have left the majority of nurses in this study feeling unsupported and with a lack of clinical leadership. The nurses, often only working at 'D' or 'E' grade, frequently found themselves trying to cope with conflicts in practice with nursing colleagues, with patients and with doctors.Professional knowledge used in practice included communication and interpersonal skills, teamwork, delivering 'hands on' care to patients and coping with the ever changing demands on the nursing time. A number of recommendations are made and include an 'enabling curriculum' for educating nurses at initial and post registration level, a return of the clinical leadership role for ward sisters and charge nurses and a renewal of the focus of nursing practice.

The nursing process is the espoused problem solving framework that forms the basis of the way in which patient care is determined, delivered, and communicated in a multiplicity of health care settings. Although its use is widespread in educational and clinical settings, some nurse clinicians display negative attitudes towards the use of the nursing process. They claim that both the structure and language that underpins this process is cumbersome and unreflective of the way in which nursing care is planned and delivered. To date, there has been no study cited that has examined its use within a clinical setting and determined if and how the nursing process is being used and whether there is substance in the clinicians' claims. Additionally, some of the research on problem solving has used laboratory based designs that are limited as they are not sensitive to contextual factors that affect the use of a problem solving process, nor are they sensitive to the efficacy of the communication process. As patient care involves many nurses working under diverse contextual conditions, these factors need to be taken into consideration when studying this phenomenon.Using grounded theory methodology, this study examined the clinical application of the nursing process in acute care hospital settings. Specifically, it sought to answer the following two questions: (1) How is the nursing process used by nurse clinicians in acute care hospital settings? and in the absence of its use, (2) How is nursing care determined, delivered, and communicated in acute care hospital settings in Western Australia?Data were obtained from semi-structured interviews with predominantly nurse clinicians, patients, and patients' relatives, as well as participant field observations of nurse clinicians, and in-depth audits of patient records. Textual data were managed using NUD-IST and analysed using constant ++ / comparative method. Data generation and analysis proceeded simultaneously using open coding, theoretical coding, and selective coding techniques until saturation was achieved. This resulted in the generation of a substantive theory explaining clinical nursing in acute care hospital settings.The findings of this study revealed several problems with the clinical application of the nursing process. It also revealed a process used by nurses to overcome many difficulties they experienced as they tried to determine, deliver, and communicate patient care. Specifically, nurses in this study experienced the basic social problem of being in a state of "Unknowing". Properties and dimensions of unknowing were found consistently in the data and this problem was labelled as the core category. This state of "unknowing" was linked to a number of factors, such as, the existence of a fragmented and inconsistent method of determining and communicating patient care and work conditions of immense change and uncertainty. In order to deal with this problem, the nurses in this study used a basic social process termed: "Enabling Care: Working through obscurity and uncertainty". The first phase of the core process, termed: Putting the pieces together: making sense, involved four subprocesses. These subprocesses were labelled: drawing on the known, collecting and combining information, checking and integrating information, and sustaining communication. The second phase of the core process was termed Minimising uncertainty. It involved three subprocesses which were named: adapting work practices, taking control, and backing-up.The findings of this study have implications for nursing practice, research, theory, and education, as it exposes problems with the clinical application of the nursing process in acute care settings. In addition, it further explicates a substantive theory that describes a ++ / process of nursing used by nurses in these settings. As the articulated process was supported by a number of studies and opinions of nurse scholars it is worthy of being considered as being foundational to an understanding of a process of nursing used in acute care hospital settings in Western Australia.

Thesis (M.S.)--Ball State University, 2009. / Title from PDF t.p. (viewed on Mar. 17, 2010). Research paper (M.S.), 3 hrs. Includes bibliographical references (p. 45-47).