Nursings' lack of full professional status based on the criteria of autonomy coupled with the need for a more independent practitioner in today's complex health care system was the basis for this study. A comparison of senior nursing students from different educational programs was undertaken to determine if type of educational preparation was a predictor of professional autonomy. Schutzenhofer's (1988) Nursing Activity Scale (NAS) was used to measure and compare the level of professional autonomy of 306 senior nursing students who were within four weeks of graduation from nine nursing programs across Massachusetts. Further comparisons of students' professed autonomy as a function of demographic variables and students' perceptions of their level of participation in learning were compared. Thirty-six senior level nursing faculty were surveyed for identification of possible relationships between student and faculty scores on these variables. The majority of students surveyed (85%) scored in the high range of the autonomy scale, and the level of nursing education was not a predictor of the students' autonomy level. Variables that correlated with student autonomy levels were marriage, plans for earning an advanced nursing degree and perceived level of participation in learning. However, significant differences were found in student reported autonomy between schools at the associate degree level. Schools at the baccalaureate degree level did not differ significantly from each other. No clear relationship was found between student and faculty scores. More baccalaureate degree students reported their programs as having a more theoretical than practical focus, while the associate degree students perceived a more practical focus to their programs. Seventy-five percent of students from both programs planned to earn advanced nursing degrees. These findings have implications for nursing education. Increased opportunities for students to participate more fully in their educational process may facilitate the internalization of professional autonomy in nursing students. Such opportunities may ultimately provide the health care system with practitioners who possess the professional characteristics necessary for a more autonomous, successful practice.

The delivery system of health care to Americans is in crisis. As costs continue to escalate, and as access to services deteriorates, an increasing number of individuals in need of physical and mental health care are experiencing difficulty accessing the necessary services. Changes in economic resources have resulted in quantitative shifts in mental health service delivery. A greater number of individuals seek mental health services as a result of the stress and anxiety created from a threatened or actual loss of financial stability. This increase in demand for service comes at a time when mental health programs are experiencing a decrease in resources which has resulted in reduced access to services. The emergency mental health service utilization patterns and client characteristics have changed during the same period of time that the overall mental health care delivery system has undergone transformation. However, the changes in mental health care have not necessarily evolved out of careful rational planning, but rather as a response to chaotic shifts in the mental health system at large. The purpose of this study was to gather data about access to these mental health outpatient services as they related to client diagnostic characteristics, system ability to provide the service needed, and ability of the service to meet the client's perceived need. The implications of the findings are clear. Access to services during a crisis was dependent upon system response, degree of psychopathology and a supportive environment. Any reform effort must include adequate crisis intervention and social services to meet the need of the changing population. Education for the general population and the professional would enhance understanding of the needs of the mentally ill and service availability.

Thesis--University of Michigan.

Thesis--University of Michigan.

<p> Individuals diagnosed with dementia make up the majority of the population in skilled nursing facilities (SNFs). Certified Nursing Assistants (CNAs) are the primary caretakers of older adults living in SNFs. The purpose of this grant project was to write a proposal for funding to provide Person-Centered Care (PCC) training to help CNAs enhance their skills to better enhance the quality of life of older adults living with dementia in SNFs. </p><p> The goal of PCC training is to help CNAs better understand the signs and symptoms of Alzheimer&rsquo;s and dementia, improve communication skills, and provide strategies to manage the behavioral and psychological symptoms of dementia. Previous research on PCC has found it to be effective in improving the quality of care of older adults who are affected by dementia and who are living in nursing homes. </p><p> Actual submission or funding of the grant was not required for the successful completion of this project.</p>

<p> Fibromyalgia (FMS) goes undiagnosed in as many as 3 out of 4 people who have the disease. Primary care providers (PCPs) are the first to evaluate patients; therefore, PCPs need to be able to recognize FMS, implement initial treatment, and refer for further consultation. The Fibromyalgia Diagnostic Screening Tool (FDST), a validated instrument to identify FMS, can improve the speed and accuracy of FMS diagnosis. The purpose of this project was to familiarize PCPS with the FDST, evaluate their receptiveness to the tool, and train them in its use. The Leventhal, Diefenbach, and Levanthal, common sense model of illness provided the theoretical framework to guide this quality improvement project. A 45-minute in-service and accompanying reference manual was given to 4 participating PCPs, along with a demographic questionnaire asking about their age, race, gender, marital status, and years in practice. Following the in-service, a 10-question self-completed questionnaire consisting of a combination of open-ended and nominal scale yes/no questions, was administered. A thematic analysis revealed 2 primary barriers for diagnosis without the FDST: lengthy screening time and trouble differentiating FMS from a patient&rsquo;s other conditions. In response to one of the yes/no questions, the participants all replied that the in-service on FDST was helpful in diagnosing FMS. Implications for social change include improved diagnosis with a diagnostic screening instrument, improved quality of health care, and cost effectiveness at the system level for chronic disease prevention and management. This project demonstrates in a localized primary care setting that the FDST may offers PCPs a reliable method to diagnose FMS.</p>

<p> Nursing programs have embraced distance learning in their curricula, but discussion is ongoing about course assignments and grading criteria to increase examination scores in nursing distance learning courses. Because course examinations are a predictor of success on the postgraduate licensing examination (NCLEX-RN), the purpose of this study was to determine whether differences existed in student examination scores between nursing distance learning courses with and without points aligned to assignments. The theoretical framework was Knowles&rsquo;s theory of andragogy, which highlights adults&rsquo; motivation and self-direction to succeed. The quantitative causal comparative study included a convenience sample of 164 students to compare archival data of 4 examination scores between 2 nursing distance-learning courses. Data analysis included an independent-groups one-tailed <i> t</i> test. No significant differences were found between the 2 courses, suggesting that students do not achieve higher examination scores with course points aligned with course assignments. Nursing administrators and faculty in nursing programs with a distance learning component will benefit from the findings of this study. Findings may be used to draft, revise, and implement assignment criteria and point alignment for nursing distance learning courses. Social change will occur when nursing distance learning faculty use problem-solving and critical thinking assignments, including case studies, discussion boards, group assignments, concept mapping and NCLEX-RN style testing in each nursing distance learning course. Because point alignment to course assignments do not significantly improve examination scores, implementation of problem-solving and critical thinking assignments is necessary to promote student learning and examination success.</p>

<p> This study took place at a Wake Technical Community College, a multi-campus institution in Raleigh, North Carolina. An evaluation of the return on investment in high fidelity simulation used by an associate degree of nursing program was conducted with valid and reliable instruments. The study demonstrated that comparable student outcomes are attainable when traditional clinical study is replaced with high fidelity simulation curriculum. Limited clinical practice space justifies the spread of simulation in college health science programs. North Carolina Administrative Code permits community colleges to replace 25% of traditional clinical with simulation. The lack of research on the cost effectiveness of high fidelity simulation has been cited as a barrier to its diffusion. Sound research demonstrating performance-based and patient-centric outcomes can provide governing bodies with evidence supporting the diffusion of high fidelity education.</p>

<p> The purpose of this study was to increase the knowledge level and change self-reported behavioral intent among a sample of healthcare providers regarding safe sleep messaging. From 1995 through 2015 in New York City, an average of one infant died every week from unsafe sleeping conditions. One agency in New York City experienced four unsafe sleep infant deaths within two months in 2010. In 2011, the city provided case managers with training on infant safety. Before this training, up to six sleep-related infant deaths were reported annually. The following year, one sleep-related infant death occurred. None occurred during the second year subsequent to the training. Current literature demonstrates healthcare providers have considerable influence on safe sleep messaging. This current study utilized a similar educational training designed for healthcare providers working in an urban health facility.</p><p> A single group pre/post-test quasi-experimental design was delivered to 23 participants. The design incorporated an online educational intervention in order to increase healthcare provider&rsquo;s knowledge level and change their self-reported behavioral intent to educate parents and caregivers on the importance of safe sleep practices. Data were gathered at pre-test and post-test to assess changes.</p><p> Final analysis, using a repeated measures general linear model, was carried out on data from the twenty-three participants who returned completed pre- and post-class surveys. There was a statistically significant change in the overall 13-item composite score reflecting knowledge level and change the self-reported behavioral intent from pretest (M=6.13, SD=2.78) to post-test (M=8.78, SD=3.79) at the p &lt;.001 level. These findings support current literature recommendations for healthcare providers to incorporate the safe sleep message into their practice. Nonetheless, supplementary research is needed to conclude whether these results coincide with communities elsewhere and to examine the issues regarding knowledge and behavioral intent regarding safe sleep messaging.</p>

A Research Report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfillment of the requirements for the degree of Master of Science in Nursing Johannesburg, 2013 / Problem-based learning is recognized as an appropriate teaching-learning strategy for the preparation and development of health professionals in South Africa. Four university nursing schools have adopted a problem-based learning (PBL) model for the design and implementation of their Bachelor of Nursing curricula. Problem-based learning is learning by facilitating the acquisition of knowledge and skills such as communication, team work, self-directed learning, problem-solving and critical thinking. Although competence is implied in students’ academic marks, it is not known how students feel about problem-based learning or whether they are satisfied with their PBL courses and how they view their own competence as a result of PBL. The purpose of the study was to determine the level of undergraduate nursing students’ satisfaction with their problem-based learning course as well as their reported competence in learning skills and processes as a result of problem-based learning. A quantitative, descriptive survey was used to collect data. The study population consisted of all nursing students enrolled in the second, third and fourth year of the Bachelor of Nursing degree in the 2010 academic year (N=42). Students who agreed to participate completed questionnaires per year of study and per PBL course. The final number of questionnaires that were analysed amounted to 92 (n=92). Data were analysed using STATA version 11. The results showed that overall, students were satisfied with the organizational aspects of their PBL course, facilitator expertise and quality of facilitation. They were less satisfied with facilitator attitude in the senior years of study. Students reported with certainty their competence in the learning processes and skills as a result of PBL; some senior students (16.3%) did not feel competent to access and use literature sources and to integrate information into and plan nursing care (17.3%). Students reported that PBL is useful, empowering, enlightening and felt that the structured use of core lectures and more practise opportunities would enhance their competence.