Recently, there has been increasing recognition of the threat of fatigue on safety. Nursing has been slow to recognize this threat. Workplace napping is a fatigue management strategy that is used in some nursing workplaces, although often hidden. This feminist interpretive phenomenological study explored the lived experience of night shift fatigue and the use of workplace napping among critical care nurses. An understanding of the meaning of night shift fatigue, the concern for safety as embodied by fear, was illuminated by exploring the phenomenological commonalities within the nurses’ historical, social and cultural world. Five main themes were identified within this overarching understanding. There is a need to recognize oppressive constraints, and share the responsibility for managing fatigue among individuals, professions and organizations. In education, practice and research, nurses must be supported through validated evidence-informed strategies to manage what is a normal consequence of shift work, thus leading to enhanced safety for both the patient and nurse.

Dissertation submitted in fulfillment of the requirements for the Degree in Masters of Technology: Nursing, Durban University of Technology, 2011. / Background Working in the intensive care unit can be traumatic for nursing personnel. Critical care nurses are faced with repeated exposure to death and dying as they are involved in caring for patients who are actively dying or who have been told that they have a terminal illness and are faced with the possibility of impending death. Critical care nurses relate in different ways to the phenomena of death and dying within their nursing profession and their scope of practice. These nurses often have a difficult time coping with the stress that comes with caring for those who are dying or relating to loved ones of those that are dying. Aim of the study The aim of the study was to explore the critical care nurse’s experiences of death and dying. Methodology A qualitative, descriptive phenomenological approach was used to guide the study. Four nurses were recruited and rich descriptions of their experiences were gained through individual face-to-face interviews. One broad question was asked: ‘What are your experiences regarding death and dying of your patients in ICU?’ iii Results The findings of this study revealed that issues such as communication, multicultural diversity, education and coping mechanisms relating to caring for the critically ill and dying patient are essential in nursing education and practice. Critical care nurses need to have support networks in place, not only to assist in providing care, but also for their own emotional support

There is a recognized nursing shortage in Canada, including specialty areas such as critical care (CC). Nursing shortages impact health care delivery, including economic, patient, and nursing outcomes. Job satisfaction is one of the most significant outcomes affected by the nursing shortage. Recruitment of inexperienced nurses in CC is a relatively new hiring practice and has resulted in a more diverse level of clinical expertise among CC nurses. Little is known about how differences in level of clinical expertise affect job satisfaction. The purpose of this study was to explore the relationship between CC nurses’ self -reported level of clinical expertise and job satisfaction. Interrelationships between additional influencing factors, such as organizational climate and personal factors were also explored. Utilizing a web based online survey, a cross-sectional survey was sent to all 788 Manitoba hospital based CC nurses, via the College of Registered Nurses of Manitoba. Respondents (N = 188) completed the Critical Care Nurse Retention Survey, which operationalized the key study variables. Sixty-five percent of the sample reported overall job satisfaction. Based on multivariate analysis, the most influential factors affecting CC nurses’ job satisfaction were nursing management, control over practice, and level of clinical expertise. Nursing management plays a vital role in facilitating optimal nursing practice. Control and autonomy may reflect a sense of satisfaction in the achievement of the knowledge and skills necessary for effective decision-making in CC. Finally, this study provides pioneering data on the importance of advancing clinical expertise to improve job satisfaction in CC nurses.

There is a recognized nursing shortage in Canada, including specialty areas such as critical care (CC). Nursing shortages impact health care delivery, including economic, patient, and nursing outcomes. Job satisfaction is one of the most significant outcomes affected by the nursing shortage. Recruitment of inexperienced nurses in CC is a relatively new hiring practice and has resulted in a more diverse level of clinical expertise among CC nurses. Little is known about how differences in level of clinical expertise affect job satisfaction. The purpose of this study was to explore the relationship between CC nurses’ self -reported level of clinical expertise and job satisfaction. Interrelationships between additional influencing factors, such as organizational climate and personal factors were also explored. Utilizing a web based online survey, a cross-sectional survey was sent to all 788 Manitoba hospital based CC nurses, via the College of Registered Nurses of Manitoba. Respondents (N = 188) completed the Critical Care Nurse Retention Survey, which operationalized the key study variables. Sixty-five percent of the sample reported overall job satisfaction. Based on multivariate analysis, the most influential factors affecting CC nurses’ job satisfaction were nursing management, control over practice, and level of clinical expertise. Nursing management plays a vital role in facilitating optimal nursing practice. Control and autonomy may reflect a sense of satisfaction in the achievement of the knowledge and skills necessary for effective decision-making in CC. Finally, this study provides pioneering data on the importance of advancing clinical expertise to improve job satisfaction in CC nurses.

Decision support systems (DSS) are traditionally designed to optimise the outcomes of a decision. This thesis explores how DSS design can also be driven by the optimisation of the decision process leading to the decision, and how it may enhance the human uptake and use of DSS. It identifies which tasks could be simplified by decision support, and how to build DSS that are likely to be readily adopted and so improve decision outcomes. It tests the hypotheses that: (a) The analysis of specific process attributes of a given clinical decision task, as well as the information needs of its users, improves the design of DSS and enhances systems?impact and acceptance. (b) The complexity of the decision task is the key process attribute that, in conjunction with the information seeking of users, shapes the outcome of the design process. The work is applied to the domain of antibiotic prescribing in critical care. To explore the first hypothesis, the key attributes of prescribing decisions associated with specific prescribing subtasks and different decision-makers and decision contexts are identified and then analysed. Based on our findings, an information-processing model of decision support for an antibiotic-prescribing task is proposed. The second hypothesis is addressed by applying and comparing metrics for decision complexity including minimum message length, cognitive effort assessment and clinical algorithm structure analysis to the prescribing task. A framework is developed to select clinical decision tasks that may benefit from automation, by characterizing decision support as a process of complexity reduction for users, and these ideas are tested in the context of antibiotic prescribing for ventilator-associated pneumonia. The hypotheses are then tested by applying the task complexity framework to the design of a DSS for antibiotic prescribing in critical care. A web-based experiment and a clinical trial of the DSS are described, both of which study the acceptability and effectiveness of the system and verify the usefulness of the design framework. Specifically, in a before-after controlled trial, with no difference in patient mortality or severity of presentation between the two periods, the use of the DSS was associated with statistically significant improvements in patient outcomes and a reduction in antibiotic usage. The length of stay and total consumption of antibiotics decreased respectively from 7.15 to 6.22 days (P=0.02) and from 1767 to 1458 defined daily doses/1000 patient days (P=0.04). The introduction of a hand-held computer-based DSS was associated with less administration of ???broad-spectrum?antibiotics. The relative impact of the uptake of the DSS on the prescribing quality was quantified. Clinicians chose to use guidelines for one third, and pathology data or the DSS for about two thirds of cases for which they were available to assist their prescribing decisions. When used, the DSS plus pathology data improved the agreement of decisions with those of an expert panel - from 65% to 97% (P=0.002). The impact of the DSS was more significant on prescribing decisions of higher complexity. The level of decision complexity appeared to affect the choice of decision support type. Prescribing guidelines were accessed more often for lower complexity decisions, whereas the infection risk DSS plus pathology data were preferred for decisions of higher complexity. The need for measurement of the effectiveness of a DSS in improving decisions, as well as their likely rate of adoption in the clinical environment, was demonstrated. The thesis concludes with a proposal to apply the framework described to the modelling of the DSS adoption and to include task complexity and user information seeking as determinants of the design and evaluation of clinical DSS.

Thesis (Ph. D.)--University of Virginia, 1989. / Includes bibliographical references (leaves 131-143). Also available online through Digital Dissertations.

Thesis (M.A.(Applied))--Victoria University of Wellington, 2004. / Includes bibliographical references.

Thesis (Ph. D.)--University of Washington, 2007. / Vita. Includes bibliographical references (leaves 66-70).

Thesis (M.S.)--Case Western Reserve University, 2008. / [School of Medicine] Department of Clinical Research. Includes bibliographical references.

Thesis (M.S.)--University of Wisconsin--Madison, 1986. / Typescript. Thesis approval page has authors' names reversed. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 195-201).