Thesis (Ph. D.)--University of Washington, 1995. / Vita. Includes bibliographical references (leaves [122]-131).

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2999-01-01

The accrediting and nursing organizations are promoting patient safety and well-being by emphasizing clinical language proficiency. This presents a challenge for English as second language (ESL) nursing students in learning language skills for the clinical environment. This study explicates the experiences and reflections from nursing students, who are not native English speakers that used a virtual simulation program called vSim in relation to clinical language skills. Five students participated in this study. A qualitative study utilizing hermeneutic phenomenological methodology was used to collect experiential data and then was interpreted according to Van Manen’s (1990) data analysis method. Themes of confidence, patient safety, knowledge transfer from classroom to clinical, communication within the clinical environment, and acquisition of language skills emerged from the interviews and reflective journals. This research study shows that the use of a non -immersive virtual simulation provides a positive contribution to ESL nursing students’ experiences with clinical language skills and can provide nursing educators another teaching strategy to assist ESL nursing students achieve clinical language competency. / Graduate / 0569 / sh_samwel@rogers.com

Syfte: Studiens syfte var att jämföra en ny extubationsalgoritm med sedvanligtextubationsförfarande. Gruppen som studerades var patienter som genomgått en HIPEC-operationoch vårdats på Centrala intensivvårdsavdelningen. Metod: I En randomiserad kontrollerad klinisk pilotstudie randomiserades patienterna till en av tvågrupper. Därefter extuberades patienten enligt en studiealgoritm eller post-operativ standard. Resultat: Syresättningen var väsentligen oförändrad för studiegruppen (37,5 kPa till 36,6 kPa)medan den sjönk för kontrollgruppen (50,1 kPa till 40,6 kPa) vid jämförelse mellan 10 minuter efterankomst och 15 minuter efter extubation. Efter 13 till 18 timmars kontroll strax innan patienternalämnade intensivvårdsavdelningen var syresättningen på samma nivå som 15 minuter efterextubation för både studiegruppen och kontrollgrupp. Således kvarstod en försämrad syresättninghos kontrollgruppen vid utskrivning jämfört med 10 minuter efter ankomst. Slutsats: Studien visar att det skulle kunna vara fördelaktigt att extubera patienter enligt denstudiealgoritm som testats jämfört med dagens kliniska standard. Genom att fokusera på hur och ejnär extubationen ska ske är förhoppningen att denna studie kan bidra till att förbättra en procedursom i princip saknar konsensus. Mer forskning krävs för att kunna dra några generella slutsatser omresultatet. / Aim: To compare a new method of extubation with present standard procedure at the Central ICUafter HIPEC surgery. Method: In a randomized controlled study patients were randomized into two groups. Patients wereeither extubated according to a study algorithm based on best current knowledge, or according tostandard procedure. Results: The oxygenation remained on the same level in the study group (37,5 kPa to 36,6 kPa) butdecreased in the control group from 50,1 kPa to 40,6 kPa from 10 minutes after arrival to 15minutes after extubation. After 13 to 18 hours, just before the discharge from the ICU theoxygenation in both groups was at the same level as 15 minutes after extubation. Thus a decrease inoxygenation in the control group was found at discharge compared to 10 minutes after arrival in theICU. Conclusion: The result of the study showed that it may be benificial to extubate according to thestudy algorithm compared to present standard procedure. By directing focus from when to how theextubation is made, this study may contribute to the improvement of a clinical procedure that iscurrently lacking in scientific consencus. Further studies are needed to confirm these findings.

No description available.

Thesis (MCur)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Complications of chronic conditions pose serious consequenses for the patient and financial implications for the health authorities, in the form of serious procedures, adaptions of medication, hospitalisation or rehabilitation. The goal of the study was to investigate the management of patients with diabetes mellitus type 2 on primary health care level. The objective of the study: • a retrospective investigation into the holistic management of patients with diabetes mellitus type 2 by CNPs. The research design was descriptive, non-experimental with a quantitative approach. The population included 896 files of patients diagnosed with diabetes mellitus type 2 over a period of 6 months at 4 clinics in the George Subdistrict. The sample consisted of 180 files, namely 20% of the population. The researcher gathered the data personally by means of a structured check list. Ethical approval was obtained by Stellenbosch University and above mentioned health authorities. Reliability and validity was ensured by means of a pilot study, as well as inputs from a statistician, experts in the fields of primary health care and a research panel. Descriptive statistics were used for data-analysis. Variables were presented in the form of tables, graphs and frequencies. Statistica Version 9 software were used and relations between the various variables were analysed by means of ANOVA (“Analysis of Variance”). By means of systematic probability sampling every second file that adhered to the inclusion criteria was drawn, until 20% saturation was reached at each clinic. Thereafter every second file was drawn from the rest of the appropriate files, until the sample was sufficient or until there were no more suitable files left over. The results of this study provide evidence that the holistic approach was not constantly applied by CNPs in patients with diabetes mellitus type 2. Drug treatment was renewed by a doctor every six months, but no attention was given to the diabetes mellitus in between the doctor's visits. Health information was given. It varied between 100% to 81%. Complications were not addressed appropriately though. In clinic A for example 6% (n=5) recorded on the condition of the patients' feet, while in clinic B 4% (n=2) addressed this issue. At clinic C nothing was recorded on this aspect, while at clinic D 13% (n=2) recorded on this. Respiratory and cardio-vascular systems often fail in patients with diabetes mellitus type 2. At clinic A CNPs enquired only in 18% (n=16) of cases about these systems, at clinic B 22% (n=11), at clinic C 27% (n=7) and at clinic D 6% (n=1). This study has the potential to stimulate further research, especially regarding the reasons why CNPs do not manage chronic patients holistically. / AFRIKAANSE OPSOMMING: Komplikasies van kroniese toestande het gevolge vir die pasiënt en koste-implikasies vir die gesondheidsdienste, byvoorbeeld ernstige ingrepe, medikasieaanpassings, hospitalisasie of rehabilitasie. Die doel van die studie was om te bepaal hoe KVPs pasiënte met diabetes mellitus tipe 2 op primêre gesondheidsorgvlak hanteer. Die doelwit van die studie: • retrospektiewe waarneming na die holistiese hantering van pasiënte met diabetes mellitus tipe 2 deur KVPs. Die navorsingsontwerp was beskrywend, nie-eksperimenteel, met ‘n kwantitatiewe benadering. Die populasie was 896 lêers van pasiënte wat oor ses maande met diabetes mellitus tipe 2 gediagnoseer was by vier klinieke in die George Subdistrik. Die steekproef was 180 lêers, naamlik 20% van die populasie. Die navorser het persoonlik data ingesamel met ‘n gestruktureerde kontrolelys. Etiese goedkeuring is verleen deur die Universiteit van Stellenbosch en bogenoemde gesondheidsowerhede. Betroubaarheid en geldigheid is verkry deur ‘n loodstudie en deur insette van 'n statistikus, primêre gesondheidsorg eksperts, asook 'n navorserspaneel. Beskrywende statistieke is aangewend vir data-analise. Veranderlikes is voorgestel in die vorm van tabelle, grafieke en frekwensies. Statistica Version 9 sagteware is gebruik en verhoudings tussen veranderlikes is geanaliseer deur van ANOVA (“analysis of variance”). Deur middel van sistematiese waarskynlikheidsteekproefbepaling is elke 2de lêer wat aan die insluitingskriteria voldoen het getrek, tot 20% saturasie by elke kliniek bereik is. Verder is elke 2de lêer uit die oorblywende lêers getrek, totdat die hoeveelheid genoeg was, of totdat daar nie meer geskikte lêers was nie. Resultate van hierdie studie bewys dat pasiënte met diabetes mellitus tipe 2, nie holisties hanteer was deur KVPs nie. Medikasie was meestal elke 6 maande deur 'n dokter hernu, sonder enige aandag aan die diabetes mellitus tipe 2 gedurende die tussen-in periodes. Gesondheidsvoorligting was goed. Dit het gewissel van 100% tot 81%. Komplikasies was egter onvoldoende aangespreek. In kliniek A het byvoorbeeld 6% (n=5) oor die toestand van die pasiënte se voete gerekordeer, terwyl in kliniek B 4% (n=2) hiervan melding gemaak het. By kliniek C was daar niks hieroor aangeteken nie, terwyl by kliniek D 13% (n=2) hieroor gerekordeer het. Respiratoriese en kardiovaskulêre sisteme versaak dikwels by pasiënte met diabetes mellitus tipe 2. By kliniek A het KVPs slegs by 18% (n=16) navraag gedoen oor hierdie sisteme, by kliniek B 22% (n=11), by kliniek C 27% (n=7) en by kliniek D 6% (n=1). Hierdie studie behoort verdere navorsing te stimuleer, veral oor die redes hoekom die KVPs nie kroniese pasiënte holisties hanteer nie.

O propósito desta pesquisa descritiva foi examinar o conhecimento e a prática de enfermeiros referente à prevenção e tratamento da úlcera de pressão e as fontes utilizadas para obter informação. Após a aprovação pelo Comitê de Ética em Pesquisa, foi solicitado que os enfermeiros de um hospital geral do interior paulista fornecessem os dados demográficos, completassem o teste de conhecimento sobre úlcera de pressão e que identificassem a freqüência de ocorrência de algumas práticas nas situações clínicas referentes à prevenção, ao tratamento e à fonte de informação utilizada. Dos 25 participantes, 96% eram mulheres entre 30 e 40 anos de idade, tendo terminado a graduação em 5 anos ou menos. Somente 8% tinham feito algum curso de especialização. Dos 46 ítens do teste, os enfermeiros responderam corretamente entre 31,1% e 89,1%. O escore mais baixo foi 18 e o mais alto foi 41. O escore médio foi 32,48 (DP 4,7). Nove enfermeiros (36%) responderam corretamente entre 51% a 69,9% dos ítens e 15 (60%) responderam corretamente mais de 70% dos ítens. Considerando os ítens relacionados a avaliação da úlcera, os escores mais baixos foram relacionados a descrição do descolamento e a presença do tecido desvitalizado no leito da ferida. Em relação à classificação da úlcera, os escores mais baixos foram relacionados a descrição do estágio I e II. Os ítens do conhecimento sobre a prevenção que obtiveram escores mais baixos foram em relação ao significado da escala de Braden e recomendações quanto a técnicas de posicionamento. Considerando a prática dos enfermeiros, 56% relataram que sempre fazem a avaliação do risco do paciente na admissão, e que documentam as medidas preventivas no prontuário do paciente (76%). Entretanto, 50% dos enfermeiros mencionaram realizar práticas inadequadas como massagem nas regiões de proeminências ósseas. Na opinião dos enfermeiros, o curativo da ferida é sempre feito pelo auxiliar de enfermagem (83.3%); entretanto, a decisão sobre o tratamento é sempre realizada pelo enfermeiro (79.2%), e às vezes pelo médico (66.7%). As práticas do tratamento da ferida mostraram uma grande variação. Alguns enfermeiros ainda usam luvas com água para proteger os calcâneos dos pacientes e às vezes usam almofadas com orifício no meio para tratar úlceras de estágio I e II. Em relação às fontes de nformações para manter-se atualizados 12,24% mencionaram que sempre participam de cursos, discussões científicas ou eventos e grupos de estudo, e 75,5% reportaram que participam às vezes. Alguns (12%) enfermeiros reportaram que sempre assinam revistas científicas ou lêem artigos científicos ou usam a biblioteca, enquanto 66,21% mencionaram que algumas vezes fazem estas atividades. Enquanto 58,3% dos enfermeiros mencionaram sempre ter acesso à Internet, somente um (4%) citou um site específico sobre úlcera de pressão. A maior parte dos enfermeiros (68%) sempre procuram outros enfermeiros da mesma instituição como fonte de informação, enquanto médicos e enfermeiros pesquisadores são consultados com menor freqüência. Os enfermeiros que referiram sempre participar em atividades de educação continuada oferecidas pela instituição(73,7%) obtiveram escores mais elevados no teste. A pesquisa identificou que, apesar dos enfermeiros apresentarem um bom nível de conhecimento no teste, algumas áreas da prevenção e tratamento da úlcera precisam de investimentos para facilitar a implementação das recomendações baseadas em pesquisa ou outras evidências para que a prática clínica seja aperfeiçoada. / The purpose of this descriptive research was to examine a group of nurses’ knowledge concerning pressure ulcers’ prevention and management, and the sources used to get information for nursing care. Twenty-five nurses, working in a middle size general hospital in an inner city of Sao Paulo state, were asked to provide demographic information, to complete the Pressure Ulcer Knowledge Test as well to identify the frequency of some practice at clinical setting related to pressure ulcer prevention and management, and their source of information. Most nurses were female (96%), in their 30’s (56%), and had finished their BSN in 5 years or less (48%). Only 8% had any specialty education after graduating from university. Of the 46 items, nurses correctly answered between 34,1% to 89,1% . The lowest score was 18 and the highest was 41. The average score was 32,48 (SD 4,7). Nine nurses (36%) correctly answered 51% to 69,9% of the items; and 15 (60%) answered correctly more than 70% of the items. Considering the items related to pressure ulcer evaluation, lower scores were obtained related to description of undermining and the presence of slough in wound bed. Related to ulcer staging, lower scores were obtained related to description of stage II and III. Knowledge about pressure ulcer prevention was lower related to meaning of Braden scale, positioning techniques while sitting or use of the 30 degree sidelying . Regarding ulcer management, nurses reported that they always (56%) performed patient’s risk evaluation at admission and document prevention measures on patients’ records (76%). However, 50% of nurses mentioned inadequate practices as giving massages on bone prominence; 12.5% reported always giving massages, 37.5% sometimes. In the nurses’ opinion, wound care is mostly performed by nurses’ aides (83.3%); however, the decision of treatment is always made by nurses (79.2%), and sometimes by the physician (66.7%). Wound care practices showed a great variability. Some nurses still use water filled gloves to protect patients’ heels and sometimes use ring cushions to treat stage I and stage II ulcers. Related to sources of information to keep updated knowledge, 12,24% of nurses mentioned that always participated of courses, scientific discussions or meetings and study groups and 75,5 % reported that participated sometimes. Some nurses (12 %) reported that always subscribes a scientific journal or reads scientific articles or uses the library, while 66,21% mentioned that sometimes do those activities. While 58,3% of nurses always had access to the Internet, only one (4%) mentioned a specific site about pressure ulcers. Most of nurses (68%) always seek nurses from the same institution as source of information and physicians and nurse researcher are seeing less frequently. Nurses that refered to always participating in activities of continuing education offered by the institution (73,7%), obtained better scores on the knowledge test. The research has shown that although nurses have a good level of knowledge in some areas of pressure ulcer prevention, more needs to be done to facilitate the implementation of research or evidenced based recommendations in this institution in order to enhance clinical practice.

O propósito desta pesquisa descritiva foi examinar o conhecimento e a prática de enfermeiros referente à prevenção e tratamento da úlcera de pressão e as fontes utilizadas para obter informação. Após a aprovação pelo Comitê de Ética em Pesquisa, foi solicitado que os enfermeiros de um hospital geral do interior paulista fornecessem os dados demográficos, completassem o teste de conhecimento sobre úlcera de pressão e que identificassem a freqüência de ocorrência de algumas práticas nas situações clínicas referentes à prevenção, ao tratamento e à fonte de informação utilizada. Dos 25 participantes, 96% eram mulheres entre 30 e 40 anos de idade, tendo terminado a graduação em 5 anos ou menos. Somente 8% tinham feito algum curso de especialização. Dos 46 ítens do teste, os enfermeiros responderam corretamente entre 31,1% e 89,1%. O escore mais baixo foi 18 e o mais alto foi 41. O escore médio foi 32,48 (DP 4,7). Nove enfermeiros (36%) responderam corretamente entre 51% a 69,9% dos ítens e 15 (60%) responderam corretamente mais de 70% dos ítens. Considerando os ítens relacionados a avaliação da úlcera, os escores mais baixos foram relacionados a descrição do descolamento e a presença do tecido desvitalizado no leito da ferida. Em relação à classificação da úlcera, os escores mais baixos foram relacionados a descrição do estágio I e II. Os ítens do conhecimento sobre a prevenção que obtiveram escores mais baixos foram em relação ao significado da escala de Braden e recomendações quanto a técnicas de posicionamento. Considerando a prática dos enfermeiros, 56% relataram que sempre fazem a avaliação do risco do paciente na admissão, e que documentam as medidas preventivas no prontuário do paciente (76%). Entretanto, 50% dos enfermeiros mencionaram realizar práticas inadequadas como massagem nas regiões de proeminências ósseas. Na opinião dos enfermeiros, o curativo da ferida é sempre feito pelo auxiliar de enfermagem (83.3%); entretanto, a decisão sobre o tratamento é sempre realizada pelo enfermeiro (79.2%), e às vezes pelo médico (66.7%). As práticas do tratamento da ferida mostraram uma grande variação. Alguns enfermeiros ainda usam luvas com água para proteger os calcâneos dos pacientes e às vezes usam almofadas com orifício no meio para tratar úlceras de estágio I e II. Em relação às fontes de nformações para manter-se atualizados 12,24% mencionaram que sempre participam de cursos, discussões científicas ou eventos e grupos de estudo, e 75,5% reportaram que participam às vezes. Alguns (12%) enfermeiros reportaram que sempre assinam revistas científicas ou lêem artigos científicos ou usam a biblioteca, enquanto 66,21% mencionaram que algumas vezes fazem estas atividades. Enquanto 58,3% dos enfermeiros mencionaram sempre ter acesso à Internet, somente um (4%) citou um site específico sobre úlcera de pressão. A maior parte dos enfermeiros (68%) sempre procuram outros enfermeiros da mesma instituição como fonte de informação, enquanto médicos e enfermeiros pesquisadores são consultados com menor freqüência. Os enfermeiros que referiram sempre participar em atividades de educação continuada oferecidas pela instituição(73,7%) obtiveram escores mais elevados no teste. A pesquisa identificou que, apesar dos enfermeiros apresentarem um bom nível de conhecimento no teste, algumas áreas da prevenção e tratamento da úlcera precisam de investimentos para facilitar a implementação das recomendações baseadas em pesquisa ou outras evidências para que a prática clínica seja aperfeiçoada. / The purpose of this descriptive research was to examine a group of nurses’ knowledge concerning pressure ulcers’ prevention and management, and the sources used to get information for nursing care. Twenty-five nurses, working in a middle size general hospital in an inner city of Sao Paulo state, were asked to provide demographic information, to complete the Pressure Ulcer Knowledge Test as well to identify the frequency of some practice at clinical setting related to pressure ulcer prevention and management, and their source of information. Most nurses were female (96%), in their 30’s (56%), and had finished their BSN in 5 years or less (48%). Only 8% had any specialty education after graduating from university. Of the 46 items, nurses correctly answered between 34,1% to 89,1% . The lowest score was 18 and the highest was 41. The average score was 32,48 (SD 4,7). Nine nurses (36%) correctly answered 51% to 69,9% of the items; and 15 (60%) answered correctly more than 70% of the items. Considering the items related to pressure ulcer evaluation, lower scores were obtained related to description of undermining and the presence of slough in wound bed. Related to ulcer staging, lower scores were obtained related to description of stage II and III. Knowledge about pressure ulcer prevention was lower related to meaning of Braden scale, positioning techniques while sitting or use of the 30 degree sidelying . Regarding ulcer management, nurses reported that they always (56%) performed patient’s risk evaluation at admission and document prevention measures on patients’ records (76%). However, 50% of nurses mentioned inadequate practices as giving massages on bone prominence; 12.5% reported always giving massages, 37.5% sometimes. In the nurses’ opinion, wound care is mostly performed by nurses’ aides (83.3%); however, the decision of treatment is always made by nurses (79.2%), and sometimes by the physician (66.7%). Wound care practices showed a great variability. Some nurses still use water filled gloves to protect patients’ heels and sometimes use ring cushions to treat stage I and stage II ulcers. Related to sources of information to keep updated knowledge, 12,24% of nurses mentioned that always participated of courses, scientific discussions or meetings and study groups and 75,5 % reported that participated sometimes. Some nurses (12 %) reported that always subscribes a scientific journal or reads scientific articles or uses the library, while 66,21% mentioned that sometimes do those activities. While 58,3% of nurses always had access to the Internet, only one (4%) mentioned a specific site about pressure ulcers. Most of nurses (68%) always seek nurses from the same institution as source of information and physicians and nurse researcher are seeing less frequently. Nurses that refered to always participating in activities of continuing education offered by the institution (73,7%), obtained better scores on the knowledge test. The research has shown that although nurses have a good level of knowledge in some areas of pressure ulcer prevention, more needs to be done to facilitate the implementation of research or evidenced based recommendations in this institution in order to enhance clinical practice.

Nursing faculty are responsible for graduating competent students and being competent themselves; however, the required competencies of clinical nursing faculty who instruct students in the clinical area are unidentified. The practice problem addressed in this project was the lack of a structured, organized process for identifying initial and ongoing competencies of a clinical nursing facility. The purpose of this project was to explore nursing faculty clinical competency and provide a multimethod, multispecialty approach for implementing clinical nursing faculty competency. The target population was clinical nursing faculty (n= 30) in an academic setting. This project explored the impact of a multimethod, multispecialty approach for assessment and evaluation of clinical nursing faculty competency. The project was guided by Benner's theory of novice to expert; Roger's theory of diffusion and innovation; and the plan, do, check, act model. The study analyzed the data obtained from clinical nursing faculty demographics, and competency validation of 3 clinical and 3 academic, remediation, and retesting outcomes. Descriptive statistics and t test were utilized in analyzing the data. The project findings revealed the clinical nursing faculty members are 100% clinically competent and 68.7% academically competent in the areas evaluated. The project findings have implications for social change through role modeling of leadership skills by clinical nursing faculty and improving student clinical instruction by cultivating competent clinical nursing faculty.

Clinical nursing practice is on the cusp of significant and unrelenting change amid globalization, austerity measures and technological advancements as the world moves out of the industrial age into the knowledge age. With advances in technology, theory and research, the potential changes to future nursing practice are unlimited. Understanding the process nurses undertake to change their practice in light of these predicted trends is critical if outcomes for patients are to be safe and effective. Yet, there was a paucity of published research that investigate the process of nursing practice change. Thus, the purpose of this study was to describe the process registered nurses undertake to change their clinical practice. The study used an interpretive description methodology and involved interviewing 15 registered nurses with various backgrounds and experience in Doha, Qatar. Data were analyzed using constant comparison methods, simultaneous data collection and analysis, and intensive memoing. The findings revealed an overall theme of asing the dis-ease’, in addition to three sub-themes: disruption, actioning and stabilizing. The study provide simportant insights into how nurses change their clinical practice. A significant contribution of this study is the role of the individual in changing nursing practice. / Graduate / 2020-06-03