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Licentiatavhandlingens övergripande syfte var att studera konsekvenser av ökad akademisering och akademiskt lärande inom Svensk specialist-sjuksköterskeutbildning efter genomförande av ny utbildningsreform enligt Bologna. Bakgrund: Specialistsjuksköterskor förväntas i dagens hälso– och sjukvård att kunna bedriva en patientsäker och evidensbaserad vård, vilket kräver akademisk kompetens. Utbildningen till specialistsjuksköterska fördes i och med Bolognaprocessens införande i Sverige 2007 till avancerad utbildningsnivå. Både yrkesexamen och akademisk examen (magisterexamen) skulle inkluderas och integreras i samma utbildning. Detta medförde en förändring från en ämnesinriktad (samlingskodsinriktad) läroplan till en läroplan som syftar till att integrera ämnen (integrationskodsinriktad). Förutom ämnesintegrering skulle yrkesspecifika mål integreras med akademiska mål. Metod: Artikel I genomfördes i form av ett didaktiskt aktionsforskningsprojekt som pågick under 2½ år. En projektledningsgrupp (n=15-18) från fem lärosäten bildades. Denna grupp har aktivt deltagit i hela aktionsforskningsprocessen och vid projektmöten. Vid varje lärosäte utsågs en projektansvarig som ansvarade för den lokala aktionsforskningsprocessen. Dessa personer samlande in data i form av kursplaner, utbildningsplaner, studiehandledningar, minnesanteckningar från lärarmöten och möten med vårdverksamheter samt minnesanteckningar från forskargruppensmöten. Analys har gjorts med hjälp av konstant komparativ analysmetod. I artikel II användes konstruktivistisk Grounded Theory för att samla in och analysera data. Datainsamlingen påbörjades utifrån specialistsjuksköterskestudenters svar på en enkäts öppna fråga (n=120) i samband med utbildningens avslutning 2009 och 2010. Enkätsvaren reste frågor om specialistsjuksköterskans akademiska lärande. För att inhämta en djupare förståelse genomfördes intervjuer med specialistsjuksköterskor (n=12) som yrkesarbetat mellan 5 och 12 månader efter sin examen. Intervjuerna genomfördes från juni till oktober 2011. Avslutningsvis jämfördes svaren på den öppna enkätfrågan med analysen av intervjuerna. Resultat: Vid utbildningsreformens införande fanns pedagogiska motsättningar och didaktiska svårigheter som gav upphov till spänningsförhållanden mellan vårdutveckling, forskning, yrkesspecifika mål och akademiska mål. Spänningsförhållanden framkom också när specialistsjuksköterskorna inte erfor att deras akademiska kompetens tillvaratogs och värderades i vårdverksamheten. När stöd inte fanns för akademiskt lärande uppkom villrådighet och specialistsjuksköterskorna blev ambivalenta över om akademiskt lärande var meningsfullt. För att främja meningsfullt akademiskt lärande framhåller deltagarna betydelsen av samverkan och gemensamma arenor mellan lärosäten och vårdverksamhet där nyttoaspekten med akademiskt lärande tydliggörs. De spänningsförhållanden som framkommer var av både positiv och negativ karaktär.

The purpose of this study was to explore the relationship of the Clinical Nurse Leader (CNL) (AACN) role with the variables of work related stress, quality of life, job satisfaction and anticipated turnover of acute care nurses. Participants included registered nurses (RNs) (N= 94) in Florida recruited from 3 (not for profit) Magnet hospitals in the Tampa Bay Florida area. An ex post facto design was used to test the hypotheses of this study; independent t-tests compared RN’s responses on survey tools measuring work-related stress, quality of life, job satisfaction, and anticipated turnover. Multiple regression analysis was used to examine the interrelationships among these variables. RNs (N=94) completed five survey instruments, including a researcher-developed demographic form. The results of the study showed Aim1 which explored work- related stress did not show any statistical difference between the two groups. Aim 2 which explored job satisfaction and quality of life did not show a difference in the two groups when total scores were analyzed. However, the mental health subscale of the Sf-36(quality of life) was significant ( p=.021), and the general health subscale of the Sf-36 trended toward the CNL group reporting better general health (p=.080). This study revealed that Aim 3 which explored anticipated turnover was statistically significant (p=.047). Standard multiple regression showed a significant relationship existed between CNLs, work related stress and anticipated turnover. The significance of implementation of the CNL role in decreasing turnover through a relationship with these variables may have an important impact on the nursing profession. Specifically, economic implications in reducing turnover that bear further exploration and improving the nursing work environment. This research is the first study to explore the CNL role in relation to these variables.

A research study conducted by the National Council of State Boards of Nursing noted adjunct faculty educators have significant learning requirements and that nursing education throughout the United States has not met the basic needs of novice adjunct faculty educators. Adjunct faculty at a local community college noted a deficit in the orientation process for new clinical faculty. The purpose of this quality improvement project was to develop a guideline for new clinical faculty orientation. The sources of evidence were a literature review and a survey using the Delphi process with an expert panel comprising a group of 7 interested faculty, seasoned educators, and area hospital nurse educators. The Delphi process was used to achieve consensus on methods to orient adjunct faculty to their new role of clinical nurse educator. The knowledge-to-action cycle was used as the foundation for the adjunct faculty orientation recommendations. Benner's novice-to-expert theory was used as the framework to develop and to evaluate the competency level of adjunct faculty educators. Expert panelists recommended that clinical faculty orientation consist of a mixture of group orientation workshops, peer mentoring, seminar, role-modeling, role play, and written resources. An evidence-based adjunct faculty orientation guideline has the potential to positively affect social change by improving the teaching competence of nurse clinical experts who become new adjunct faculty nurse educators; thereby improving the quality of nursing care given by novice nurses beginning clinical practice, and ultimately, promoting positive outcomes in patient care.

Background: The full-time nurse faculty shortage has resulted in nursing programs employing adjunct nursing faculty heavily into the clinical teaching component to fill the gap. Many adjunct faculty members continue to teach semester after semester; however, there is a lack of evidence to support the predictive factors that facilitate intent to stay teaching. Purpose: The purpose of this study was to better understand predictors of intent to stay teaching for associate degree (AD) adjunct clinical nurse faculty. Theoretical Framework: Frederick Herzberg’s two-factor motivator-hygiene theory (1959) was utilized as a foundation to explore the factors that impact intent to stay teaching. Methods: Adjunct clinical nurse faculty employed in associate degree nursing programs during the 2015 calendar year were invited to participate in this study. Participants were surveyed utilizing the Job Satisfaction Survey, the Nurse Educators’ Intent to Stay in Academe Scale, and demographic questionnaire via SurveyMonkey Web site. Results: Regression analysis indicated statistically significant relationships between job satisfaction, motivator, and hygiene factors with intent to stay score. In addition, faculty who had full-time employment outside of the adjunct position were found to have lower intent to stay scores compared to those working part time or not at all. Conclusions: Enhancement of adjunct clinical faculty members’ job satisfaction, motivator, and hygiene factors is necessary to retain this qualified group of educators. Improvement of intent to stay in the role can improve teaching and reduce costs at similar institutions of higher learning.

A major focus in nursing education is on the judgement of clinical performance, and it is a complex process due to the diverse nature of nursing practice. Difficulties in the development of valid and reliable assessment measures in nursing competency continue to pose a challenge in nursing education. A holistic approach in the assessment of competency comprises knowledge, skills and professional attitudes, wherein the notion of competency incorporates professional judgement and management skills in the clinical situation. Therefore, the thesis aims to develop a holistic clinical assessment tool with a reasonable level of validity and reliability to meet the needs of clinical education. The conceptual framework underlying this research is formed by establishing a theoretical connection between the practice of learning, and of pedagogy and assessment. This research consists of five studies. In Study I, a systematic review was conducted to explore the current assessment practices and tools for nursing undergraduates. In Studies II, III and IV, a qualitative approach with focus group discussions was adopted to explore the views of final-year undergraduate nursing students, preceptors, clinical nurse leaders and academics on the clinical assessment. Based on the multiple perspectives, it therefore addresses concerns in clinical assessment. In Study V, a holistic clinical assessment tool was developed, for which a psychometric testing was conducted. The systematic review indicated that limited studies adequately evaluate the psychometric properties of the assessment instrument. The qualitative studies have raised an awareness of professional and educational issues in relation to clinical assessment. Workload, time, availability of resources, adequate preparation of preceptors, and availability of valid and reliable clinical assessment tools were deemed to influence the quality of students’ clinical learning and assessment. In addition, the presence of support systems and formal educational programs for preceptors influenced their preparation and self-confidence. Nursing leaderships in hospitals and educational institutions have a joint responsibility in shaping the holistic clinical learning environment and making holistic clinical assessment for students. The involvement of all stakeholders in the development of a valid and reliable assessment tool for clinical competency is also essential to the process. The Holistic Clinical Assessment Tool (HCAT) was developed by the author based on the systematic review, qualitative findings and the core competencies of registered nurse from the professional nursing boards. The HCAT consists of 4 domains and 36 assessment items. Furthermore, testing of the psychometric properties indicated that the HCAT has satisfactory content validity, construct validity, internal consistency and test-retest reliability. In conclusion, the HCAT is meritorious in that it carries the potential to be used as a valid measure to evaluate clinical competency in nursing students, and provide specific and ongoing feedback to enhance the students’ holistic clinical learning experience. The HCAT not only functions as a tool for self-reflection for the students, but also guides the preceptors in clinical teaching and assessment. In addition, the HCAT can be used for peer-assessment and feedback. It is imperative that the clinical and academic institutions establish various levels of ongoing support for both students and preceptors in the process of clinical assessment.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Qualified nurses cannot perform tasks and procedures with confidence due to ineffective mentoring by a clinical nurse during training. Effective mentoring by the clinical nurse, with an additional accredited qualification in his/her field should assist in the development and confidence of the student nurse. The purpose of this study was to explore the learner’s experience of mentoring and facilitation by the clinical nurse, challenges and their view of the clinical nurse, and if this could be a predictive factor to their level of an independent nurse practitioner at the end of training. A non-experimental, descriptive qualitative design was used to identify the experience of the students and newly qualified nurses regarding the amount and quality of facilitation given by the clinical nurse in practice. The research population consisted of all categories of student nurses currently in training as well as qualified nurses within the past year from different facilities. An online semi-structured questionnaire survey was distributed among 45 participants and feedback received by 32 anonymous participants in the public and private sector. The findings of the study indicated that not all newly qualified nurses are able to practice as independent nurses, there’s a lack in mentoring and facilitation by clinical nurses during training and that a clinical nurse should have an additional qualification to better the learner experience. / Health Studies / M.A. (Nursing science)

Background: ADHD and autism are two of the most common disabilities in the neuropsychiatric spectra. The symptoms of ADHD and autism are different based on gender and women belong to a risk group that have an increased risk of getting misdiagnosed. The consequences of a missed or delayed diagnosis causes suffering for both the individual and society. Aim: To explore women’s experiences of getting diagnosed with ADHD or autism as adults. Method: Literature study with a systematic approach. Based on the Tidal model, a qualitative content analysis with a deductive approach according to Elo and Kyngäs has been used. Results: The results are presented using three predetermined main categories, whilst the subcategories are based on an inductive approach. The results showed that the women’s experiences of receiving a diagnosis in adulthood mostly included positive feelings such as feeling of belonging, acceptance and increased self-esteem. However negative feelings such as doubt about the identity, stigmatization and mistrust towards the healthcare system emerged.  Conclusion: A diagnosis in adulthood causes mixed feelings and a need for support from the healthcare system. Lack of support leads to worsening of the mental health.