Thesis (MCur.(Nursing Science)--Faculty of Health Sciences)-University of Pretoria, 2008. / Summary in English. Includes bibliographical references.

Thesis (Ed.D)--Teachers College, Columbia University, 1975. / Typescript; issued also on microfilm. Sponsor: Mary Ramshorn. Dissertation Committee: Maxine Greene. Includes bibliographical references.

Rates of induction in the United States have doubled since 1990 to 22.5% of births in 2006 while cesarean section rates are estimated to have increased 50% in the last decade to 31.8% of births in 2007. There is evidence that obstetrical interventions used for nonmedical indications carry the risk for uterine rupture, hemorrhage, and maternal or fetal morbidity or mortality. The purpose of this integrated review was to investigate what influenced women to make these choices, their perception of risk and their knowledge of potential complications of obstetrical interventions. This review of literature was conducted using the CINAHL and MEDLINE databases using various key terms including "induction", "augmentation" "awareness", "cesarean", and "decision making." Nine studies met the inclusion criteria and were included in this review. The literature suggests that women are not always included in decision making, are not fully educated on the risks, and have, over time, become more willing to accept obstetrical interventions. It has also been shown that women do not assess their own individual risk based on statistical odds, instead they judge the risk based on their understanding of complications associated with their pregnancy. The evidence supports that women need to be properly educated by caregivers and that positive natural birth experiences be portrayed to combat the influence of family/friends and social media on their decision making process. Nurses, midwifes and other healthcare professionals can use this information to assess a women's degree of knowledge and ensure they are making their decisions as informed as possible. More interventional research needs to be done regarding education and decreasing obstetrical intervention rates.

Thesis (Ed.D.) -- Teachers College, Columbia University, 1991. / Typescript; issued also on microfilm. Sponsor: Thomas A. Leemon. Dissertation Committee: Mary Mowrey-Raddock. Includes bibliographical references: (leaves 119-141).

The arrival of the modern matron into the NHS acute setting in 2001 was in response to increased public and political concern regarding standards of nursing care and the quality of patient care. As a politically motivated initiative, the modern matron role and its relationship with the concept of the traditional matron has been extensively debated. The aims of this study were to explore: 1. How far the modern matron represents continuity between the traditional matrons of the mid 20th century and the present day. 2. What socio-political forces led to the development and establishment of the modern matron? 3. From the perspective of health professionals, what impact has the modern matron had on the quality of patient care? Adopting a case study design underpinned by realistic evaluation, the study involved interviewing patients and a carer, a focus group and interviews with staff and national policy leads. Documentary analysis was undertaken on a set of traditional matron archives. A number of key themes emerged from the research, including: the importance of uniform and visibility, patient expectations, the impact of policy processes and the political rationale for national policy change. Conflict between ensuring nursing quality and operational demands, which acts as a barrier to the modern matron role, was also found. Long-held assumptions about the functions and the positioning of the traditional matron are explored, with continuity and divergence between the traditional and modern matron roles revealed. Using a realistic evaluation approach, the findings were framed whilst considering the structural and generative elements, which resulted in social interplay or visible phenomena and provided an explanation for the predicament of the modern matron. The key conclusions were that national policy decisions appeared to be diluted once locally implemented. Modern matrons in part did positively impact on care quality. The introduction of modern matrons and the quality agenda may have been the start of a national discussion about how to continually improve patient care in an arena where intermittent care quality challenges which give concern. The effect of previous national policies that impacted on senior nurses may have diverted them away from their core purpose – patient care. The modern matron guidance may have been limited before publication by the inference within it about limiting the authority of the new post-holders. There was limited evidence of the modern matrons’ visibility to patients and this was reflected by the traditional matron’s accounts. The expectation of modern matrons’ physical presence may have been drawn from assumptions embedded in nostalgia and media portrayal of the traditional matron. The thesis concludes with implications for strategic nurse leaders and national policy leads to consider how the organisational arrangements for secondary care can best support and secure the ultimate aim of consistent provision of good quality nursing care.

As Novas Tecnologias da Informação e Comunicação são uma realidade na sociedade atual e também no ensino. Na busca da utilização do ensino mediado pelo computador, ambientes virtuais de aprendizagem são utilizados visando atender às necessidades educacionais e culturais de determinados grupos. O objetivo deste trabalho é desenvolver e avaliar um ambiente virtual de aprendizagem sobre tomada de decisão em enfermagem. Para tanto, a metodologia utilizada consistiu em três fases: Concepção e Planejamento, Desenvolvimento e Avaliação. O ambiente virtual de aprendizagem sobre tomada de decisão em enfermagem desenvolvido é composto por materiais educacionais com ênfase no conteúdo (Guia de Orientação do Aluno, bibliografia, hipertexto), nas atividades (hipertexto com exercícios lúdicos, histórias em quadrinhos digitais, editor de texto coletivo, elaboração de perfil) e na interação (chat e fórum). A avaliação do ambiente foi realizada por onze especialistas das áreas de informática na educação, administração em enfermagem e informática. Os itens avaliados foram referentes aos aspectos pedagógicos (conteúdo, atividades e interação) e aos aspectos técnicos (tempo de resposta e qualidade da interface). Na maioria dos itens os especialistas avaliaram que as características foram atendidas ou parcialmente atendidas, sugerindo algumas modificações. Concluiu-se que a metodologia de desenvolvimento do ambiente virtual de aprendizagem foi um dos pontos determinantes para o sucesso do projeto. A utilização de ambientes virtuais de aprendizagem no ensino de enfermagem, ainda é uma estratégia que precisa ser amplamente pesquisada e divulgada visando à criação e a inovação de estratégias específicas para o ensino de enfermagem. / New Information and Communication Technologies are a reality in contemporary society and also in education. In the search of using computer mediated teaching, virtual teaching environments are used aiming to answer educational and cultural needs of certain groups. The objective of this study is to develop and evaluate a learning virtual environment on decision making in the Nursing field. For that, the methodology consisted in three stages: Conception and Planning, Development and Evaluation. The developed learning virtual environment on decision making in Nursing is composed by educational material with emphasis on content (Student Orientation Guide, bibliography, hypertexts), on content itself and on activities (hypertexts with playful exercises, digital frames stories, collective texts editors, profile elaboration) and on interaction (chat and forums). The evaluation of the environment was carried on by eleven specialists of areas such as Informatics in education, Administration in Nursing and to Informatics. The evaluated items referred to pedagogic aspects (content, activities and interaction) and to technical aspects (answering time and interface quality). For the most part of items, the specialists evaluated the characteristics as completely or partially satisfying, suggesting some modifications. It concluded that the development of the virtual environment methodology on learning was one of the determinative points to the project’s success. The utilization of virtual learning environment in Nursing education is still a strategy that needs to be broadly researched and divulged aiming to create specific strategies innovation to Nursing teaching.

As Novas Tecnologias da Informação e Comunicação são uma realidade na sociedade atual e também no ensino. Na busca da utilização do ensino mediado pelo computador, ambientes virtuais de aprendizagem são utilizados visando atender às necessidades educacionais e culturais de determinados grupos. O objetivo deste trabalho é desenvolver e avaliar um ambiente virtual de aprendizagem sobre tomada de decisão em enfermagem. Para tanto, a metodologia utilizada consistiu em três fases: Concepção e Planejamento, Desenvolvimento e Avaliação. O ambiente virtual de aprendizagem sobre tomada de decisão em enfermagem desenvolvido é composto por materiais educacionais com ênfase no conteúdo (Guia de Orientação do Aluno, bibliografia, hipertexto), nas atividades (hipertexto com exercícios lúdicos, histórias em quadrinhos digitais, editor de texto coletivo, elaboração de perfil) e na interação (chat e fórum). A avaliação do ambiente foi realizada por onze especialistas das áreas de informática na educação, administração em enfermagem e informática. Os itens avaliados foram referentes aos aspectos pedagógicos (conteúdo, atividades e interação) e aos aspectos técnicos (tempo de resposta e qualidade da interface). Na maioria dos itens os especialistas avaliaram que as características foram atendidas ou parcialmente atendidas, sugerindo algumas modificações. Concluiu-se que a metodologia de desenvolvimento do ambiente virtual de aprendizagem foi um dos pontos determinantes para o sucesso do projeto. A utilização de ambientes virtuais de aprendizagem no ensino de enfermagem, ainda é uma estratégia que precisa ser amplamente pesquisada e divulgada visando à criação e a inovação de estratégias específicas para o ensino de enfermagem. / New Information and Communication Technologies are a reality in contemporary society and also in education. In the search of using computer mediated teaching, virtual teaching environments are used aiming to answer educational and cultural needs of certain groups. The objective of this study is to develop and evaluate a learning virtual environment on decision making in the Nursing field. For that, the methodology consisted in three stages: Conception and Planning, Development and Evaluation. The developed learning virtual environment on decision making in Nursing is composed by educational material with emphasis on content (Student Orientation Guide, bibliography, hypertexts), on content itself and on activities (hypertexts with playful exercises, digital frames stories, collective texts editors, profile elaboration) and on interaction (chat and forums). The evaluation of the environment was carried on by eleven specialists of areas such as Informatics in education, Administration in Nursing and to Informatics. The evaluated items referred to pedagogic aspects (content, activities and interaction) and to technical aspects (answering time and interface quality). For the most part of items, the specialists evaluated the characteristics as completely or partially satisfying, suggesting some modifications. It concluded that the development of the virtual environment methodology on learning was one of the determinative points to the project’s success. The utilization of virtual learning environment in Nursing education is still a strategy that needs to be broadly researched and divulged aiming to create specific strategies innovation to Nursing teaching.

This study explored how nurses in acute and nurse-led gynaecology wards prioritised patient caseloads ranging in diversity and number of patient conditions. Statistics show that since the introduction of medical termination of pregnancy (MTOP) procedures into the National Health Service (NHS) in 1991, the number of women having this procedure is increasing year on year. To date very little is known about the impact this procedure may have had on nursing practice. The focus of this study was to explore the nursing care when this included, and did not include, caring for women having MTOP. The study was conducted in two parts. The first qualitative study employed non-participant observation and semi-structured interviews of nurses in gynaecology and surgical wards at two hospital sites to examine the external context in which nursing decisions were made. This found that nurses in gynaecology focused on emotional or psychosocial aspects more so than surgical nurses who focused on physical aspects of patient care. The second quantitative study involved a cross-sectional survey of nurses from both ward types in two hospitals sites in Scotland. Internal constructs were examined using personality and thinking styles measures. Nurses were assessed on their emotionality, that is, the numbers of times an emotional care aspect was prioritised. This found that nurses who prioritised the emotional aspects of the task tended to be more conscientious and elected preference for a ‘people-centred’ thinking style. The context in which women have TOP is also important since the findings suggest women may benefit from being cared for in nurse-led rather than in acute wards. Knowing how a person thinks about emotional and physical aspects of care also has implications for those involved in education, and career planning.