<p> The process of how nurses work in relationships to accomplish their work is presented in this dissertation. This study has made the relational work process of nurses explicit. While research demonstrates that increased nurse staffing is associated with better patient outcomes and with nurses experiencing less burnout and job dissatisfaction, the process is not explored in the empirical literature. The research question was: &ldquo;What is the process of relational work of the nurse?&rdquo; Data collection and analysis conformed to the process of classical grounded theory. Interviews were face to face with 23 registered nurses working as direct care staff nurses on inpatient units. Data analysis (constant comparison) occurred concurrently with data collection. </p><p> The core category, Coming Together to Get Through, emerged from the data as how nurses worked collectively to accomplish their work. Without the help from their nursing, and physician, colleagues they could not finish each day&rsquo;s work completely and do the best for their patients. The ten temporal categories of the process are: Spending Time, Knowing Other Nurses and Doctors, Asserting Authority, Trusting and Respecting, Being Approachable, Relying on One Another, Needing Each Other, Helping Each Other, Getting the Work Done, and Did the Best for Our Patients. This is the first study to empirically discover a basic social process that demonstrates how the nurse works in relationships. The importance of social and relational constructs and their creation in an organization posits relationships as work and the building blocks of work in organizations. Discovery of this substantive theory of relational work allowed for conceptualization of an explicit work process. This empirical knowledge fills a gap in the literature that may affect appropriate staffing levels which in turn impact both patient and professional outcomes. Future research will focus on creation of a scale of the relational work of nurses, the process of interprofessional relational work, and if high levels of relational work are a pathway to decreased levels of moral distress and burnout, as well as improved professional satisfaction, and better patient outcomes.</p>

<p> VitalSmarts^&reg; Crucial Conversations^TM general program theory might be a possible countermeasure addressing organizational culture and communication factors affecting quality and safety. This practice inquiry reports: a VitalSmarts^&reg; Crucial Conversations^TM general program logic model, a major medical center's Crucial Conversations^TM historical implementation program logic model, a clinical exemplar central line associated blood stream infection program logic model; and, findings that describe the fidelity of the major medical center's Crucial Conversations^TM historical implementation and clinical exemplar central line associated blood stream infection program logic model to the VitalSmarts^&reg; Crucial Conversations^TM general program logic model. The results demonstrated there was no fidelity between the major medical center's Crucial Conversations^TM program logic model and the VitalSmarts^&reg;^&reg; Crucial Conversations^TM general program logic model. The clinical exemplar CLABSI program logic model and VitalSmarts^&reg; Crucial Conversations^TM general program logic model fidelity differed in intended outcomes. The results might suggest that program adaptability along with program fidelity are factors that influence program strength, and these factors must be uniquely balanced within organizational dynamics to realize intended outcomes. The formative evaluation and program logic model might be a feasible methodology and applicable tool for exploring quality and safety within complex adaptive systems, such as organizational culture, where constraints possibly could exclude more rigorous scientific methodologies until factors are more understood</p>

<p>Incivility is a low-level form of violence that has been found to threaten safety and has gained increasing attention from healthcare leaders. Incivility at work causes distractions and threatens the culture of safety. Locations providing mental health services are among such high-risk areas. The purpose of this study was to evaluate the effectiveness of a nurse leader&rsquo;s educational approach to improve civility in the mental health (MH) nursing workplace using assertiveness training with role-play. </p><p> The civility score in this study was measured by staffs&rsquo; perceptions of eight items: respect; conflict resolution; cooperation; anti-discrimination; value differences; diversity acceptance; personal interest; and reliability of team members. In this study, the principal investigator (PI), a MH nurse leader, prepared and implemented a six-month plan of evidence-based actions intended to improve civility and to strengthen the sense of community. </p><p> Role-play exercises were included in assertiveness training sessions. Personalized brochures that summarized information and future direction for improving civility were prepared and distributed. </p><p> Civility awareness and assertiveness were reinforced by sharing literature, facilitating discussions, and practicing occasional role-plays to problem-solve past and current incivilities as they surfaced. Follow-up measurements showed a rapid and sharp increase in civility, with improved scores for each of the eight items. These findings support continued use of assertiveness training with role-play as an effective approach for improving civility in a culturally diverse MH nursing staff. Limitations of this study are discussed. </p>