Syftet med denna systematiska litteraturstudie var att undersöka studenters och sjuksköterskors inställning till informationsteknologi, samt studenters erfarenhet av IT och möjlighet att utnyttja IT i klinisk utbildning. Använda databaser var Medline, Science Direct, och Google Scholar. Följande sökord användes: nursing, student, documentation, attitudes to computers, computerized, och medical record. Femton artiklar ingick, varav nio hade kvantitativ ansats och sex kvalitativ ansats. Resultatet visade att yngre studenter inte hade lika högt förtroende för teknologi som äldre studenter. Resultatet var inte det väntade då yngre studenter haft möjlighet att använda datorer i grundskolan. IT i undervisningen ökade dock förtroendet för tekniken. När handdator (PDA) blev ett verktyg, blev den också ett stöd i kritiskt tänkande och informationshantering och bidrog till att öka kvaliteten på omvårdnaden. Speciellt nöjda var studenter med att ha snabb och enkel tillgång till information jämfört med att söka information i böcker. Problem med PDA kunde gälla svårighet att lära sig tekniken, negativ inställning hos personal och tekniska brister. Sättet att introducera IT hade stor betydelse för studenters benägenhet att acceptera eller ta avstånd från IT. Elektronisk patientjournal resulterade inte i bättre vård. Gamla problem kunde lösas men nya uppstod. Testresultat försvann inte men kunde fortfarande förbises. Risken fanns för motsägelsefulla medicinska data relaterat till dubbla journalföringssystem.

Purpose/Aims: The American Thoracic Society (ATS) published recommendations for alpha-1 antitrypsin deficiency (AATD) testing in 2003. This descriptive project evaluates the outcomes of ATS AATD guideline use in the setting of the pulmonary function testing (PFT) lab.The specific aims met by this descriptive project describe the prevalence of AATD cases and carriers in the sample, examine to what degree the established clinical guideline promoted accurate patient selection for the alpha-1 test in the sample, and aimed to determine whether alpha-1 antitrypsin blood levels are reduced in current smokers compared to former or never smokers.Background: Alpha-1 antitrypsin prevents lung tissue breakdown by attenuating excess elastase released from neutrophils during the inflammatory response. Smoking impairs alpha-1 antitrypsin protection at the site of lung inflammation promoting emphysema development. In the case of genetic mutation, protective alpha-1 antitrypsin levels are reduced, causing emphysema even in non-smokers. Significantly reduced protective levels of alpha-1 antitrypsin increase the odds for morbidity and early mortality from emphysema. The literature provides support for targeted testing in the population most affected.Sample/Methods: The sample population included adults 21 through 79 years completing pulmonary function testing over 18 months in a metropolitan pulmonary medicine practice and was retrospectively reviewed.Of the 521 in the sample, 190 were tested for AATD, and 24 were found to carry an abnormal genotype. However, using Table 11 from the ATS CPG failed to provide structured, consistent guidance in selecting patients for AATD testing. Still, the prevalence of the abnormal genotypes MS, MZ, SZ, and ZZ was increased in this pulmonary population compared to the published estimated prevalence for the general population.A structured decision-tree, developed from the original guideline for diagnostic testing, may provide superior guidance for AATD test patient selection in this setting. Increased case finding by targeted testing of patients in the setting of the pulmonary function lab can serve to integrate this clinical practice guideline in a consistent streamlined fashion.In this sample, no difference between AAT blood levels among ever, never, and current tobacco smokers was detected. A more powerful sample is needed.

Management of Acute Coronary Syndrome (ACS) in an emergency department setting is challenging due to the complexity of the disease and the multi-disciplinary care environment, leading to the need for standardized protocols to ensure patient safety and care quality. Clinical Practice Guidelines (CPG) for ACS are prevalent but they are not directly applicable in the ED setting due to their complex narrative nature. In this thesis we present a knowledge modeling solution, using semantic web technologies, to computerize the ACS CPG published by the American Heart Association. Our knowledge modeling approach provides a modular characterization of the CPG knowledge and offers unique mechanisms to (a) update the knowledge model in response to periodic CPG updates; and (b) streamline the ACS management clinical pathway in response to resource constraints at an institution. The computerized CPG will serve as an ACS management decision support system, targeting tertiary hospitals in Saudi Arabia.

Bakgrund: Globaliseringen gör att den kulturella kompetensen hos sjuksköterskan är viktig. Studier har visat att sjuksköterskestudenter som varit på internationellt utbyte och haft sin verksamhetsförlagda utbildning (VFU) i utland utvecklat en kulturell medvetenhet och personlig utveckling. Få studier har undersökt hur utbytet påverkat studenters professionella utveckling i rollen som sjuksköterska. Syftet var att beskriva sjuksköterskestudenters uppfattning om vad de lärt sig under VFU i utland som de tror har betydelse för deras framtida omvårdnadsarbete. Metod: Studien hade en kvalitativ ansats med en deskriptiv karaktär. Fem intervjuer genomfördes med studenter som deltagit i VFU i Indien. Därefter utfördes en kvalitativ innehållsanalys med induktiv ansats. Resultat: Tre övergripande kategorier: "Lärdom om sin profession", "Lärdom om sig själv" och "Lärdom om olikheter" med respektive underkategorier skapades under analysprocessen. Studenterna fick en förståelse för vad omvårdnad är och betyder för deras profession. De upplevde en personlig utveckling i form av ökad självsäkerhet, ett kritiskt förhållningssätt samt att de blev mer öppna och ödmjuka inför det som är annorlunda. Studenterna har också insett hur viktigt det är med den kulturella kompetensen. Slutsats: Lärdomarna upplevdes vara av betydelse för sjuksköterskestudenternas framtida omvårdnadsarbete, varför det är viktigt att fler studenter får möjlighet att delta i VFU utomlands. / Background: Globalization makes cultural competence important for nurses. Studies have shown that nursing students who have been on an international exchange and participated in clinical practice abroad have developed a cultural awareness and increased their personal development. Few studies have described how exchange programs have influenced the professional development in the role as a nurse. The aim of this study was to describe nursing students' view on what they think they learned during their exchange abroad and how it will influence their role as nurses. Method: this study has a qualitative approach with a descriptive character. A systematic selection was made and five interviews were conducted with students that had been on internships in India. Subsequently, a qualitative content analysis with an inductive approach was implemented. Result: Three general categories: "Learning about profession", "Learning about oneself" and "Learning about differences" and additional subcategories were created during the analysis process. The students had gotten an understanding of what nursing is and means for their work as a nurse. They also experienced a personal development in terms of growing in confidence and critical approach. The students became more open minded and humble to things that are different. They also experienced how important it is with cultural competence. Conclusions: Nursing students' view is that these lessons will influence their role as a nurse; therefore it's important that more students get the opportunity to participate in an international exchange.

Professional growth and development in nursing is essential for public welfare and safety. The public expects competent and safe nursing care. Student nurses spend a large number of hours in the clinical practice as part of their professional and clinical development. A clinical environment that is supportive to the improvement of student teaching and learning is imperative to the development of competency of student nurses. One strategy that has been identified to facilitate professional growth and development in student nurses is mentoring in the clinical practice. This is where student nurses are socialized into the nursing profession by experienced professional nurses. Mentoring is regarded as the deliberate pairing of student nurses with an experienced and knowledgeable person. The primary purpose of this research was to explore and describe the experiences of student nurses regarding mentoring in the clinical practice at the Eastern Campus of the Free State School of Nursing (ECFSSON). The secondary purpose was to recommend to the nursing college and clinical service areas to jointly formulate guidelines for mentoring student nurses in the clinical practice. A qualitative, exploratory, descriptive and contextual research design was chosen in order to describe the experiences of mentoring of student nurses in the clinical practice. Purposive sampling was utilized to identify participants who complied with the set selection criteria. The sample comprised student nurses who were in their final year of the four year programme. Data collection took place by means of four focus group interviews with a total of twenty four student nurses (7:6:6:5), which was followed by a confirmatory focus group interview with ten participants. Trustworthiness was ensured in accordance with the principles of credibility, transferability, dependability and confirmability. Data was captured on an audiotape and transcribed verbatim. Field notes were taken during each focus group. Content analysis of the data was analyzed by the researcher and an independent co–coder. After consensus and data saturation, four major themes and twenty–one sub–themes were identified. The first theme described the student nurses' experiences of being mentored in the clinical practice and has five sub–themes. The second theme described the student nurses' experiences regarding mentoring by personnel and has eight sub–themes. The third theme described the student nurses' experiences regarding mentoring in different disciplines. The fourth theme described the student nurses' experiences regarding mentoring in different institutions. Each of these themes was discussed together with relevant data obtained from literature and reduced to a conclusive statement which serves as a basis for recommendation to formulate guidelines for mentoring student nurses in the clinical practice. Several conclusions were reached. Student nurses have positive as well as negative experiences about their mentoring in clinical practice. The personnel in clinical practice have different roles in the mentoring of students and the responsibility of mentoring is not clear. The mentoring of lecturers from the educational institution was also experienced as not enough. The research report concluded with the researcher's evaluation of the research and recommendations for nursing service, nursing education and nursing research to improve mentoring of student nurses in clinical practice. / Thesis (M.Cur. (Nursing Education))--North-West University, Potchefstroom Campus, 2012.

The purpose of this study was to explore how physiotherapists working in stroke care understand their role(s) in the context of clinical practice and how this is mediated by their post-licensure educational experiences. Specifically the study focused on their experiences with the Bobath Concept, a well-developed post-licensure neurology physiotherapy program. This study was oriented within sociocultural theory as a way to understand how the experiences and interactions of physiotherapists mediate their professional practice and their sense of professional identity in a way not previously studied in physiotherapy literature. In order to honour the voices of the participants, this study drew on hermeneutic phenomenology and used a principled data analysis tool to present an understanding of the interrelationships involved in stroke care from their perspectives. Four physiotherapists participated in this study by responding in writing and orally to a clinical case and participating in an in-depth interview regarding their professional roles and experiences. The findings suggest that these physiotherapists understand the Bobath Concept as a professional stance which informs their practice and contributes to an ethos of caring, which is reflected in the ways they understand their roles in clinical practice.

Professional growth and development in nursing is essential for public welfare and safety. The public expects competent and safe nursing care. Student nurses spend a large number of hours in the clinical practice as part of their professional and clinical development. A clinical environment that is supportive to the improvement of student teaching and learning is imperative to the development of competency of student nurses. One strategy that has been identified to facilitate professional growth and development in student nurses is mentoring in the clinical practice. This is where student nurses are socialized into the nursing profession by experienced professional nurses. Mentoring is regarded as the deliberate pairing of student nurses with an experienced and knowledgeable person. The primary purpose of this research was to explore and describe the experiences of student nurses regarding mentoring in the clinical practice at the Eastern Campus of the Free State School of Nursing (ECFSSON). The secondary purpose was to recommend to the nursing college and clinical service areas to jointly formulate guidelines for mentoring student nurses in the clinical practice. A qualitative, exploratory, descriptive and contextual research design was chosen in order to describe the experiences of mentoring of student nurses in the clinical practice. Purposive sampling was utilized to identify participants who complied with the set selection criteria. The sample comprised student nurses who were in their final year of the four year programme. Data collection took place by means of four focus group interviews with a total of twenty four student nurses (7:6:6:5), which was followed by a confirmatory focus group interview with ten participants. Trustworthiness was ensured in accordance with the principles of credibility, transferability, dependability and confirmability. Data was captured on an audiotape and transcribed verbatim. Field notes were taken during each focus group. Content analysis of the data was analyzed by the researcher and an independent co–coder. After consensus and data saturation, four major themes and twenty–one sub–themes were identified. The first theme described the student nurses' experiences of being mentored in the clinical practice and has five sub–themes. The second theme described the student nurses' experiences regarding mentoring by personnel and has eight sub–themes. The third theme described the student nurses' experiences regarding mentoring in different disciplines. The fourth theme described the student nurses' experiences regarding mentoring in different institutions. Each of these themes was discussed together with relevant data obtained from literature and reduced to a conclusive statement which serves as a basis for recommendation to formulate guidelines for mentoring student nurses in the clinical practice. Several conclusions were reached. Student nurses have positive as well as negative experiences about their mentoring in clinical practice. The personnel in clinical practice have different roles in the mentoring of students and the responsibility of mentoring is not clear. The mentoring of lecturers from the educational institution was also experienced as not enough. The research report concluded with the researcher's evaluation of the research and recommendations for nursing service, nursing education and nursing research to improve mentoring of student nurses in clinical practice. / Thesis (M.Cur. (Nursing Education))--North-West University, Potchefstroom Campus, 2012.

Clinical research is conducted to advance human medicine by developing efficacious treatments and improving patient outcomes when new therapies are developed and implemented. Clinical trials are a subset of the types of clinical research conducted on human volunteers in the development of new drugs, devices and other therapies. Prior to the start of a trial, a country’s regulatory authority must review the trial to ensure it is scientifically and ethically sound. In Canada, the regulatory authority is Health Canada. The International Conference on Harmonization (ICH) of technical requirements for the registration of pharmaceutics for humans aims to provide ethical and scientific quality standards for design, conduct, data collection and reporting in clinical trials. The Good Clinical Practice (GCP) Guidelines were created by the ICH Steering Committee to assure the public that rights, safety and well being of subjects are protected according to the Declaration of Helsinki, and the clinical data obtained in a ICH/GCP compliant clinical trial will meet regulatory requirements. Health Canada has adopted the ICH/GCP Guidelines and therefore, in Canada, all clinical trials involving humans must comply with these Guidelines. The clinical trial coordinator is an important and central position on the research team executing many trial duties and communications. Regulatory authorities, Research Ethics Boards and the sponsor, overlook the role and responsibilities of a highly trained clinical coordinator, despite their vital and central position. The GCP Guidelines also fail to address the role and responsibilities of a clinical coordinator. Disconnect between guidelines, regulatory expectations and actual trial conduct provides an apparent need to formalize and clearly define the role and scope of a clinical coordinator. The Registered Nurse (RN) brings professionalism, knowledge, skill and a holistic perspective to the expanded role of a clinical coordinator and to the clinical trial. Highly trained health professionals are capable of assuming more responsibilities and executing clinical trial design, setup and management as compared to the traditional administrative roles of the clinical coordinator. The expanded role of the clinical coordinator is especially beneficial for Principal Investigator initiated trials due to limited research personnel and resources. Postoperative adhesions are a common complication following pelvic surgery, therefore, this clinical trial is relevant and a response to a healthcare need. My graduate studies focused on the development and set up of the clinical trial Protocol ADE002-2013 Phase I Trial of L-Alanyl-L-Glutamine for the Reduction of Peritoneal Adhesions in Adult Females Undergoing Myomectomy. My thesis is a discussion of general Canadian clinical trial research information followed by an explanation of how we executed the information to design and set up our PI initiated clinical trial. The value of the expanded role of the clinical coordinator as a member of the research team will also be discussed.

The implementation of evidence-based clinical practice guidelines in primary health care can substantially improve health promotion, early disease detection and the reduction of the burden of chronic disease. However, the implementation of evidence into clinical practice is a highly complex endeavour that has been said to occur in a 'black box‘, defying easily reached explanations of how it happens in practice. The aim of this study is to explore the 'black box‘ of guideline implementation associated with primary health care nurses‘ use of a guideline that targets high health need populations in a region of New Zealand. The potential for improvement of cardiovascular health overall and the reduction of the marked disparities between Mäori (indigenous people of New Zealand) and non-Mäori drives the imperative to enact the recommendations of the Assessment and Management of Cardiovascular Risk guideline. Primary health care nurses are well positioned at the frontline of healthcare to implement the guideline and an investigation of the realities of their practice as they do so will help to illuminate the contents of this particular 'black box‘. The aim is achieved in two components by: 1. Exploring the complexities of primary health care nurses‘ use of the New Zealand Assessment and Management of Cardiovascular Risk guideline. 2. Employing the Promoting Action on Research Implementation in Health Services (PARiHS) framework to identify the enablers and barriers to guideline implementation in the primary health care setting. Method Both components of this study involve qualitative methods. The first component involves qualitative description utilising focus groups and interviews to explore the perceptions and experiences of a range of primary health care professionals involved in implementing the AMCVR guideline and thematic analysis of data. The second component utilises template analysis of the data, based on the Promoting Action of Research Implementation in Health Services (PARiHS) framework. There are three elements of the PARiHS framework: Evidence, Context and Facilitation. This second component of the study is a systematic analysis of the enablers and barriers encountered by nurses as they implement the AMCVR guideline. Results The first component of the study generated four themes, which together have provided a rich portrait of the realities for nurses as they implemented the guideline. The four themes are self-managing client, everyday nursing practice, developing new relationships in the health team, and impact on health care delivery. The template analysis revealed that there were several enablers and barriers to guideline implementation in relation to Evidence and Context and that Facilitation was not occurring in a planned way. Conclusion Successful guideline implementation demands multidisciplinary, transformational practice development to create an effective workplace culture. Practice development is a powerful approach well suited to supporting primary health care nurses to maximise their practice-based knowledge and skills, and for them to contribute to the development of systems that will meet the information and communication requirements of successful guideline implementation. The imperative to improve cardiovascular health overall and specifically to address Mäori health inequity mandates sustained effort and mobilisation of resources to ensure successful implementation of the AMCVR guideline.

The implementation of evidence-based clinical practice guidelines in primary health care can substantially improve health promotion, early disease detection and the reduction of the burden of chronic disease. However, the implementation of evidence into clinical practice is a highly complex endeavour that has been said to occur in a 'black box‘, defying easily reached explanations of how it happens in practice. The aim of this study is to explore the 'black box‘ of guideline implementation associated with primary health care nurses‘ use of a guideline that targets high health need populations in a region of New Zealand. The potential for improvement of cardiovascular health overall and the reduction of the marked disparities between Mäori (indigenous people of New Zealand) and non-Mäori drives the imperative to enact the recommendations of the Assessment and Management of Cardiovascular Risk guideline. Primary health care nurses are well positioned at the frontline of healthcare to implement the guideline and an investigation of the realities of their practice as they do so will help to illuminate the contents of this particular 'black box‘. The aim is achieved in two components by: 1. Exploring the complexities of primary health care nurses‘ use of the New Zealand Assessment and Management of Cardiovascular Risk guideline. 2. Employing the Promoting Action on Research Implementation in Health Services (PARiHS) framework to identify the enablers and barriers to guideline implementation in the primary health care setting. Method Both components of this study involve qualitative methods. The first component involves qualitative description utilising focus groups and interviews to explore the perceptions and experiences of a range of primary health care professionals involved in implementing the AMCVR guideline and thematic analysis of data. The second component utilises template analysis of the data, based on the Promoting Action of Research Implementation in Health Services (PARiHS) framework. There are three elements of the PARiHS framework: Evidence, Context and Facilitation. This second component of the study is a systematic analysis of the enablers and barriers encountered by nurses as they implement the AMCVR guideline. Results The first component of the study generated four themes, which together have provided a rich portrait of the realities for nurses as they implemented the guideline. The four themes are self-managing client, everyday nursing practice, developing new relationships in the health team, and impact on health care delivery. The template analysis revealed that there were several enablers and barriers to guideline implementation in relation to Evidence and Context and that Facilitation was not occurring in a planned way. Conclusion Successful guideline implementation demands multidisciplinary, transformational practice development to create an effective workplace culture. Practice development is a powerful approach well suited to supporting primary health care nurses to maximise their practice-based knowledge and skills, and for them to contribute to the development of systems that will meet the information and communication requirements of successful guideline implementation. The imperative to improve cardiovascular health overall and specifically to address Mäori health inequity mandates sustained effort and mobilisation of resources to ensure successful implementation of the AMCVR guideline.