The purpose of this study was to examine child psychosocial adjustment (i.e., behavioural problems and self-esteem) as a function of maternal well-being, parenting competence, and maternal stress in a sample of children (8 to 16 years) with a chronic physical disorder (CPD) (n = 60) as compared to a sample of non-chronically disabled children (n = 60). While the groups did not differ on either maternal variables or child behavioural problems, CPD children had higher self-esteem than comparison group children. For both groups, mothers with high well-being, high competence, and low stress had children with fewer behavioural problems. Furthermore, mothers of older CPD children perceived themselves as more competent parents, which in turn was related to fewer behavioural problems and higher self-esteem in the child. Mothers who assessed their child's condition as less stressful also had a higher sense of well-being and/or perceived themselves as more competent mothers. While this sample consisted of children whose conditions were of mild to moderate severity, children with more severe conditions had higher self-esteem.

The primary purpose of this study was to explore the concepts of health and learning in the McGill Model of Nursing by examining the relationships between sense of coherence, self-directed continuing learning, and psychological well-being in a sample of white, middle class, English-speaking, elderly adults in a large, urban, long-term care residence. The secondary purpose was to contribute to the testing of the measurement instruments for use in studies with older adults. A quantitative, nondirectional, correlational design, using a sample of convenience, found a high positive correlation between sense of coherence and psychological well-being and a moderate positive correlation between sense of coherence and self-directed continuing learning. The results lend support to the relationship between health and learning in the McGill Model of Nursing and to the relevance of the model to gerontological nursing in long-term care. Further research is required to examine the relationship in other elderly populations.

Background: Cardiology acute care nurse practitioners (ACNP) enacting their roles in health care teams faced a number of challenges including a mix of positive and negative views of the ACNP role from health care team members, ACNP roles crossing the boundaries between the medical and nursing professions, and an expanded scope of practice that was not clearly defined. Understanding the process by which ACNP roles were enacted in teams is important since the boundaries between professions may change following the introduction of an ACNP role and affect the team's perceptions of its effectiveness. Little is known of how ACNP role enactment affects the team's perceptions of its effectiveness. Objectives: Following the introduction of a cardiology ACNP role in the health care team, the study aims to: 1) describe ACNP role components, 2) describe ACNP role enactment, and 3) explore how ACNP role enactment and boundary work of team members affect the team's perceptions of team effectiveness. Methods: The study was conducted in two university-affiliated teaching hospitals in Quebec. A descriptive multiple case study design with qualitative and quantitative data sources was used. The study produced a valid and reliable time and motion tool to measure cardiology ACNP activities. The study used Bales' interaction process analysis to identify differences in patterns of communication among team members. Findings: Team members believed they were more effective following the introduction of an ACNP role because the ACNP role filled a gap in patient care and improved team processes. The ACNP role components that were enacted were sensitive to the surrounding context and responsive to the needs of team members and patients. The patterns of communication among team members were aligned with the structural dimensions surrounding the team. A conceptual framework was developed. It highlighted the key inter-related dimensions and concepts that different stakeholder / Contexte : Les infirmières praticiennes spécialisées (IPS) en cardiologie qui exercent leur rôle au sein des équipes soignantes rencontrent certains défis. Des points de vue tant positifs que négatifs sont exprimés par les membres des équipes soignantes à l'égard du rôle même de l'IPS, du développement d'un rôle qui traverse les frontières entre les professions médicale, infirmière et autres professionnels et des modalités de pratique élargies non clairement définies. Par conséquent, il importe de comprendre le processus par lequel la pratique des IPS s'intègre aux équipes soignantes et bouleverse les frontières interprofessionnelles, et comment la présence des IPS influe sur les perceptions d'efficacité des équipes soignantes. Nous disposons de peu de données sur la relation entre le rôle des IPS et les perceptions d'efficacité des membres des équipes soignantes. Objectifs : Suite à l'introduction d'IPS en cardiologie au sein d'équipes soignantes, l'étude vise à : 1) décrire les composantes du rôle des IPS en cardiologie, 2) décrire le processus de développement du rôle des IPS, et 3) explorer comment ce processus et les changements au niveau des frontières interprofessionnelles entre les membres de l'équipe influencent leurs perceptions d'efficacité. Méthodologie : Nous avons réalisé une étude de cas multiples dans deux hôpitaux universitaires au Québec. Cette étude s'appuie sur des données qualitatives et quantitatives. Un outil de mesure des temps et mouvements valide et fiable a été développé afin d'étudier les activités des IPS en cardiologie. De plus, le système d'analyse des processus d'interaction de Bales a été utilisé pour identifier des modes de communications entre les membres des équipes. Résultats: Les membres des équipes soignantes estiment que l'introduction des IPS a amélioré leur efficacité parce qu'elles comblent une lacune en matière de soins aux patients et qu'elles per

The major purpose of this randomized controlled trial was to examine the effect of a low-cost, community-based, nurse-delivered, group psychoeducation program entitled the Chronic Pain Self-Management Program (CPSMP) on a number of pain-related and other quality of life outcomes in those experiencing an idiopathic chronic non-malignant pain problem. One hundred and ten individuals referred by community-based health care professionals, a pain clinic service, or self-referral were randomly assigned to one of two conditions: the 12-hour CPSMP intervention group or the 3-month wait-list control group. One hundred and two individuals completed the study. Results of intention-to-treat statistical analyses indicated that the treatment group had significant improvement or strong positive trends to improvement in pain, dependency, mental health, disability, vitality, self-help role behaviours and other role functioning indicators, life satisfaction, and in self-efficacy and resourcefulness compared to the wait-list control group. / An additional purpose of this study was to test the hypothesized relationships in the Self-Help Model: Learned Response to Chronic Illness Experience. Causal modeling using path analyses tested the Model at two points in time: pretest and posttest. Overall, the hypothesized pattern of relationships in the Self-Help Model were supported by the data.

<p> The aging population coupled with the complexity of the older adult patient has presented a significant challenge for the healthcare industry. The literature has shown that the elderly are the major consumers of healthcare expenditures in the United States. Caring for this population in the realm of healthcare reform will require new strategies to improve the health status of the older adult patient. The objective of this study was to complete a comprehensive literature review of geriatric care models and create a business plan applying the Nurses Improving Care for Healthsystem Elders (NICHE) program. </p><p> NICHE is a national nurse-driven geriatric program that provides the necessary resources and tools to assist healthcare organizations in enacting system-level changes, which will impact the care of the older adult patient. </p>

<p> The focus of this quasi-experimental pre-post study with mixed methods was to assess the effect of an experiential learning activity on freshmen and sophomore nursing students' cognitive and affective knowledge of sensory changes that occur in older adults as part of the aging process. Based on Kolb's Experiential Learning Theory, the students took part in an interactive learning experience using low fidelity simulation which included a Sensory Kit, a Power Point^&copy; Presentation and Unfair Hearing Test&copy;. Participants were guided through reflective observation, abstract conceptualization, active experimentation and concrete experience during the study. An overall increase in cognitive knowledge was found to have occurred in all subgroups which included those who have either worked or lived with older adults or have had previous training in a geriatric sensitivity training program as well as those who have not in the aforementioned categories. The total sample (N=72) had a pre-test Mean&plusmn;SD of 58.06&plusmn;12.29 and post-test Mean&plusmn;SD of 80.97&plusmn;9.06 with a <i>p</i> &lt; 0.0001. Affective knowledge was analyzed using the coding method in which the written data was organized into four themes: Student Experience; Anticipated Feelings of Older Adults as Experienced by the Students; Changes in Participants' Feelings towards Older Adults after the Experience and Influence on Participants for Future Practice with Older Adults. The subjects reported an overall sense of empathy along with anticipated feelings of frustration and anger, gaining a greater sense of respect and admiration for older adults as well as special safety concerns to address in their plans of care.</p>

<p> In this dissertation, the phenomenon of presence in an online educational environment is explored through the lived experiences of graduate nursing faculty who teach online. Greater understanding of the phenomenon of presence in online educational environments may lead to better learner-instructor relationships, higher levels of inquiry and critical thinking on the part of faculty and students, and ultimately better student outcomes. Utilizing principles of Hermeneutic Phenomenology and deductive inquiry, and based on the learner-centric Being There for the Online Learner Model, the author conducted in-depth interviews with a purposive sample of 13 graduate nursing faculty members who teach online at a major university in the northeast United States. The author also reviewed supporting documents pertaining to institutional structure, faculty development, the institution's learning management system, and online faculty job descriptions. Interview data were analyzed thematically, using the mixed-methods software Dedoose. Results of the study revealed four ways in which graduate nursing faculty experience the sense of presence (i.e., The Modes of Presence derived from the Being There for the Online Learner Model): Realism, Involvement, Immersion, and the Willing Suspension of Disbelief. Two broad themes, <i>Being there</i> and <i>Being Together </i> were also identified. <i>Being There</i> is the sensation that occurs when graduate nursing faculty feel or perceive they are physically in another location when teaching online. <i>Being Together</i> is the sensation that graduate nursing faculty are physically in the same space with others (i.e., their students), when they are actually separated by distance. In both cases, this is for varying lengths of time, and with varying frequency. The study identified three main conclusions: not all participants experience the sense of presence in the same way; <i>Being There</i> may also include the sensation of "Coming Here"; and, The Illusion of Nonmediation, as described in the Model, should be considered as a fifth Mode of Presence. Based upon these conclusions, I present implications for nursing education science and provide recommendations for creating the sense of presence in online educational environments.</p>

<p> The purpose of this study was to evaluate the influence of pre-work factors (healthcare experience, type of education, type and frequency of simulation exposure) and work factors (type and frequency of simulation exposure) on perceptions of transfer of learning, confidence and competence development, and RN role preparedness. The study participants consisted of 251 new graduate registered nurses obtained from the North Carolina Board of Nursing (NCBON) registered nurse licensure database. A descriptive correlation design was utilized to explore the impact of simulation on perception of gains in transfer of learning, confidence and competence development, and RN role preparedness. Frequencies and percentages, independent t-tests, and Pearson product-moment correlation were applied to the data set. The study results showed simulation activities occurred more frequently in pre-licensure programs compared to new nurse orientation programs, and higher transfer of learning gains were noted in those nurses who participated in both pre-licensure and orientation simulation activities. Further, simulation exposure in both programs had positive influences on confidence, competence, RN role preparedness and pre-licensure transfer of learning. For nurses with both pre-licensure and new nurse orientation simulation experience, moderate to strong correlations were observed in associate degree nurses, with and without previous healthcare experience, and in bachelor degree nurses with previous healthcare experience. Further research is needed on a larger representation of advanced beginner new graduates. Ideally, transfer of learning and new nurse outcome measures should be evaluated with a more diverse, national representation of new graduates. Continued research on simulation-based orientation experiences is needed as more hospitals are implementing this strategy into their new nurse transition programs.</p>

<p> <i><b>Aim</b></i> &ndash; To identify any discrepancy between new graduate nurses&rsquo; perceptions of their professional roles before they begin practice and what they experience at the initiation of their duties. </p><p> <i><b>Background</b></i> &ndash; Turnover and attrition is a major issue within the nursing profession. Better understanding of new graduate perceptions will provide the opportunity to identify stressors that can be addressed to slow the rate of turnover.</p><p> <i><b>Method</b></i> &ndash; A case study research design was selected for data collection from a population of newly licensed Registered Nurses at the initiation of professional responsibilities. </p><p> <i><b>Evaluation</b></i> &ndash; Survey results were clustered thematically to look for common results among responses.</p><p> <i><b>Implications for Nursing</b></i> &ndash; Identifying discrepancies between expectations and reality can guide nursing leadership and educators to create strategies to better prepare new nurses for practice, reduce stress and anxiety, and limit the amount of turnover and attrition.</p>

<p> Simulators ranging from low- to high-fidelity are used by nurse educators to train student nurses. The usefulness of the high-fidelity simulators expose student nurses to clinical situations has been debated for many years. Few nursing schools have embraced the use of high technology simulators in teaching and learning. The purpose of this study was to (a) determine how different types of simulators are used to train student nurses and to (b) examine educator and student perceptions regarding the use of simulators in clinical practice. Two surveys were developed to examine the perceptions of nurse educators and nursing students in 4 training sites. A total of 26 nurse educators and 296 nursing students participated in the study.</p><p> The data from the surveys identified their perceptions on the function, benefits, limitations, challenges, and concerns regarding simulator use in clinical settings. Findings from this study indicated that (a) nurse educators were significantly more likely to use low-fidelity simulators (84.6%) than medium- or high-fidelity simulators and (b) they have utilized simulators for all size classes between 35 to 50 students. The greatest challenge reported by educators regarding simulator use (61.5%) was the need for ongoing training and education and technical support with high-fidelity simulators.</p><p> The majority of the students in their first or second year of nursing education reported high satisfaction for experiences using simulators, such as teamwork and collaboration (78.7%) and increase in skill competency (77.7%). Nursing students (69.3%) experienced some anxiety working with simulators, especially using high-fidelity simulators.</p><p> A critical recommendation stated by nurse educators was an expressed request that the administration provide for (a) initial and ongoing training on simulators and technical support and (b) time to prepare scenarios or funds to purchase scenarios that include use of high-fidelity simulators. An important recommendation for students was to include orientation to and practice in the simulation lab at the beginning of the nursing program, moving from low-fidelity to high-fidelity simulators throughout the program to reduce their anxiety using high-fidelity simulators.</p>