<p> <b>Purpose:</b> To describe how the role of the nurse practitioner has evolved as described in the literature from 2000&ndash;2012 using Bronfenbrenner's (1979) Socio-Ecological Model (SEM) of behavior change as adapted by McLeroy, Bibeau, Steckler, and Glanz (1988). </p><p> <b>Data Collection:</b> This study is based on the review of five large databases for literature related to nurse practitioners role evolution between the years 2000-2012. Databases used for the search were Academic Search Complete, PubMed (Medical Publications), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline (US National Library of Medicine), SCOPUS, and Cochrane Database of Systematic Review. The search terms were based on the five levels of the Socio-Ecological Model: Intrapersonal, Interpersonal, Organizational, Community, and Public Policy. Included in the search were the terms, role and utilization of nurse practitioners. </p><p> <b>Results:</b> Using the Socio-Ecological Model demonstrated how the role and utilization of nurse practitioners has changed from 2000-2012. Nurse practitioners, once serving rural, underserved, and uninsured populations now have opportunities to provide health care in many settings. </p><p> <b>Implications:</b> Nurse practitioners are important primary care providers. An increase in patient acuity and the complexity of health care have created a need for additional health care providers in primary care. Nurse practitioners are well suited to play a significant role in the present and future delivery of health care. Nurse practitioners as primary care providers need to be at the table when policy is made that relates to health care delivery. </p>

<p> The purpose of this study is to determine the level of job satisfaction of Registered nurses in Muscat and relationships to Herzberg's motivation and hygiene factors. The theoretical underpinning of this study is based on Herzberg's concepts, in which an individual's motivation and hygiene factors are met within an organization, to the extent that the individual employee will express in job satisfaction. A descriptive, nonexperimental research design was used. The Work Quality Index and a demographic survey were given to 202 registered nurses at Sultan Qaboos University Hospital (SQUH) and Royal Hospital (RH) in Muscat. The data was collected over three weeks and was analyzed, using descriptive statistic, <i>t</i>-test, ANOVA for independent mean, and correlation statistics as appropriate. The results indicate that nurses in the two hospitals had a moderate level of job satisfaction. It also proves that motivation factors and hygiene factors are significantly correlated with job satisfaction, meaning that the fulfillment of both types of factors determines the overall job satisfaction of the nurses.</p>

<p> The changes in health care over the past decade have caused hospitals across the nation to focus on improving quality outcomes for the patients they serve. One of the most preventable hospital-acquired infections is catheter-associated urinary tract infections (CAUTIs). Nursing&rsquo;s role in the prevention of CAUTI spans patients&rsquo; entire hospital stay, and quality education to nursing staff is essential for sustained reduction efforts.</p><p> The project&rsquo;s purpose was to evaluate the content and design of the nursing curriculum on CAUTI reduction given to nurses in a pediatric intensive care unit at one healthcare institution. A process evaluation showed that the curriculum had several key strengths and weaknesses and could be improved through application of Knowles&rsquo;s adult theory of learning. Management and the clinical leadership team could improve patient outcomes by building nursing curriculum with a greater focus on learners&rsquo; needs, an understanding of what motivates learners, and more involvement of the nursing staff.</p>

Background: In Canada, most people die in hospital on acute medical units. Research conducted in such units has shown that dying patients often experience uncontrolled symptoms, such as pain and breathlessness. Further, hospitalized patients with end-stage disease and their family members have reported dissatisfaction with how emotional problems were addressed as well as how they were communicated with. Palliative care is understood to be the best approach to care for patients with life-threatening illness; yet, there remain constraints within the acute medical setting that make it difficult to provide such care. Aim: The purpose of this project was to better understand how cultures of care on an acute medical ward shape care practices for dying patients and what are the implications for these patients.Methodology and Methods: A focused ethnography was conducted on an acute medical ward over a period of 10 months. Data collection methods included participant-observation (600 hours over 98 visits), fieldnotes, and semi-structured interviews with patients (n = 10), family members (n = 11), and staff members (n = 14).Results: Two competing approaches to care are at play concerning dying patients: curative and palliative. This 'philosophical divide' underpins a 'logic of care' that is then used to justify the precedence of one approach to care over another. The logic of care is expressed in the following way: that limited resources (staffing, beds, equipment, and time) are in tension with ideals of good care, leading to what is perceived to be a busy environment where staff feel obliged to formulate priorities in order to meet the demands of a hectic unit. Because not every demand can be met, this logic of care is then used to privilege curative approaches to care as well as acute care tasks over palliative ones. This has repercussions for the dying patient's experience when patients' needs are not met, which further leads to patients (as well as their family members) feeling as though they do not matter. Another social process observed was the categorization of patients as curative or palliative. One of the main implications for patients categorized as palliative is that they are seen by many staff as not belonging on the medical ward. Conclusions: In the context of a curative/palliative culture clash, curative approaches and tasks are prioritized in the care provided to dying patients. Palliative care is generally perceived as limited to those with cancer at the very end of life and for those patients not requiring acute interventions. These perceptions influence the care of the dying through delaying a palliative approach to care until patients are transferred to a dedicated palliative care ward, and also through the provision of curatively-oriented end of life care. The perception that palliative or dying patients do not belong on the ward contributes to the rationale for not providing palliative care on the ward. Implications for practice could involve reflecting on how a staff focus on tasks shifts attention away from patient –or person –centered approaches to care and is potentially marginalizing to dying patients. / Historique :Au Canada, la plupart des personnes meurent à l'hôpital à des unités de soins aigus. Les recherches menées à de telles unités ont montré que certains symptômes qu'éprouvaient les patients mourants tels la douleur et l'essoufflement étaient souvent non contrôlés. De plus, les patients hospitalisés souffrant d'une maladie terminale ainsi que les membres de leur famille ont rapporté leur insatisfaction quant à la façon dont les problèmes émotionnels étaient abordés ainsi que de la façon dont on communiquait avec eux. Les soins palliatifs sont censés être la meilleure approche en matière de soins aux patients atteints d'une maladie terminale. Cependant, il subsiste des contraintes dans les milieux de soins aigus qui rendent la prestation de ce type de soins difficile. Objectif:La raison d'être de ce projet était de mieux comprendre comment les cultures de soins en présence à une unité de soins aigus façonnent les pratiques de soins prodigués aux patients mourants et quelles en sont les implications pour ces patients.Méthodologie et méthodes:Une méthodologie ethnographique concentrée a été menée à une unité de soins aigus sur une période de 10 mois. Les méthodes de collecte des données incluaient l'observation participante (600 heures sur 98 visites), les notes prises sur le terrain et des entrevues semi-structurées avec les patients (n=10), des membres de la famille (n=11) et les membres du personnel (n= 14).Résultats:Deux approches de soins divergentes entrent en jeu quand il s'agit de patients mourants : curative et palliative. Cette «division philosophique» sous-tend une «logique de soins» qui est alors utilisée pour justifier la préséance d'un type d'approche sur l'autre. La logique de soins est exprimée de la façon suivante : que des ressources limitées (personnel, lits, équipements et temps) sont difficilement conciliables avec les idéaux de bons soins, conduisant à ce qui est perçu comme étant un milieu de travail au rythme frénétique où le personnel se sent obligé d'établir des priorités afin de répondre aux demandes d'une unité surchargée. Parce que toutes les demandes ne peuvent être satisfaites, cette logique de soins est alors utilisée pour privilégier les approches de soins curatives de même que des tâches liées aux soins aigus, aux dépens de celles liées aux soins palliatifs. Ceci a des répercussions sur l'expérience vécue par le patient mourant quand ses besoins ne sont pas satisfaits, ce qui conduit alors les patients (ainsi que les membres de leur famille) à penser qu'ils ne comptent pas. Un autre processus social était la classification des patients comme curatifs ou palliatifs. L'une des principales implications de cette classification des patients comme palliatifs est que les patients mourants sont vus par de nombreux membres du personnel comme n'appartenant pas à l'unité médicale.Conclusions:Dans le cadre d'un choc culturel curatif/palliatif, les approches et les tâches curatives ont la priorité, même en matière de soins prodigués aux patients mourants. Les soins palliatifs sont généralement perçus comme limités à ceux qui souffrent d'un cancer en toute fin de vie et aux patients qui n'ont pas besoin d'interventions de type aigu. Ces perceptions influent sur les soins prodigués aux patients mourants en retardant des soins palliatifs jusqu'à ce que les patients soient transférés à une unité de soins spécifiquement palliatifs et, en prodiguant des soins de fin de vie très largement orientés vers le curatif. La perception selon laquelle les patients palliatifs ou mourants n'appartiennent pas à l'unité participe à la justification de ne pas fournir de soins palliatifs à l'unité. Les implications quant aux pratiques peuvent inclure d'axer les soins sur le patient lui-même et ses besoins par opposition à mettre l'accent sur les tâches qui sont exécutées et à réfléchir sur la façon dont ces priorités marginalisent potentiellement les patients mourants.

Many patients with a traumatic brain injury (TBI) are not able to self-report in the intensive care unit (ICU). In this situation, use of behaviors suggestive of pain like grimacing is strongly recommended for pain assessment. However, TBI patients could exhibit atypical behaviors when exposed to nociceptive procedures. As such, behaviors suggestive of pain included in current clinical recommendations may not apply to TBI patients. According to vital signs, their validity for pain assessment has yet to be supported. The time has come to further describe TBI patients' specific pain behaviors and to explore the validity of vital signs and other physiologic parameters such as the biscpectral index (BIS) for the purpose of pain assessment in this population. This study aimed to validate the use of behavioral and physiologic indicators of pain in critically ill TBI patients with different level of consciousness (LOC). A repeated measure within subject design was used. TBI participants were observed for 1 minute before (i.e. baseline), during, and 15 minutes after two procedures: 1) non-invasive blood pressure: NIBP (non-nociceptive procedure), and 2) turning (nociceptive procedure). At each assessment, a behavioral checklist combining 50 items from existing pain assessment tools was used to document TBI participants' behaviors. Vital signs (i.e. systolic pressure, diastolic pressure, mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), capillary saturation (SpO2), end-tidal CO2, and intracranial pressure (ICP)) as well as the bilateral BIS were recorded continuously using a data collection computer. Video recording was used allowing evaluation of inter-rater and intra-rater agreements of observed behaviors. In conscious patients able to communicate, self-reports of pain was gathered after each assessment. A total of 45 TBI patients participated. Bilateral BIS was collected in 25 unconscious and altered LOC participants. Overall, behaviors suggestive of pain were observed more frequently during turning (median=4, p<0.001) than at baseline (median=1), or during NIBP (median=1). Behaviors most frequently observed during turning were often atypical and included frowning, flushing, sudden eye opening, eye weeping, and flexion of limbs. These behaviors were observed in 22.2-66.7% of TBI participants who reported pain during turning. Moderate to excellent chance-corrected inter-rater and intra-rater agreements (k between 0.40-0.96) were obtained for most behaviors documented. According to vital signs, RR was the only one found to increase exclusively during turning (p<0.001). RR fluctuations were also correlated to participants' self-report of pain (rpb=0.736; p<0.05). Finally, increases in BIS-R were more pronounced in participants with left-sided TBI (+17.23%; p=0.021) than those with right-sided TBI (+3.01%). In addition, a positive correlation (rs=0.986, p<0.001) was found between BIS-R fluctuations and the frequency of pain behaviors exhibited by participants with left-sided TBI during the nociceptive procedure. Similarly to what was suggested in previous studies, our findings showed that critically ill TBI patients exhibit atypical behaviors when exposed to a nociceptive procedure. Findings from this study also support previous ones that vital signs lack specificity for the detection of pain in the ICU. Finally, while our results about the potential usefulness of bilateral BIS for the detection of pain are promising, further research is warranted to examine its validity for pain assessment in TBI patients with alterations in LOC in the ICU. / Plusieurs patients avec traumatisme craniocérébral (TCC) sont incapables de communiquer à l'unité des soins intensifs (USI). Dans ces conditions, l'utilisation de comportements suggestifs de douleur (ex: grimace) est recommandée pour la détection de douleur. Or, les patients TCC pourraient présenter des réactions atypiques en réponse à la douleur. Ainsi, les comportements de douleur recommandés pourraient ne pas s'appliquer à ces derniers. Par ailleurs, la validité des signes vitaux et de d'autres paramètres physiologiques dont l'indice bispectral (BIS) mériterait d'être davantage explorée pour la détection de douleur chez cette clientèle. Ce projet visait à valider l'utilisation d'indicateurs comportementaux et physiologiques de la douleur chez les patients TCC avec différent niveaux de conscience à l'USI. Un devis prospectif à mesures répétées intra-sujets a été utilisé. Les participants TCC ont été observés pendant 1 minute avant (i.e. repos), pendant et 15 minutes après deux procédures: 1) la prise de pression artérielle non-invasive: PPNI (procédure non-nociceptive) et 2) le positionnement au lit (procédure nociceptive). À chaque observation, les comportements étaient documentés à l'aide d'une grille de collecte contenant 50 énoncés inspirés d'outils d'évaluation de la douleur existants. Les signes vitaux (i.e. systolique, diastolique, pression artérielle moyenne (PAM), fréquence cardiaque (FC), fréquence respiratoire (FR), saturation (SpO2), monoxyde de carbone (CO2) et pression intracrânienne (PIC)) ainsi que le BIS bilatéral étaient enregistrés de façon continue à l'aide d'un ordinateur de collecte de données. À chaque observation, les participants étaient enregistrés sur vidéo permettant ainsi l'évaluation de l'accord inter-juges et intra-juge des comportements notés. Chez les participants conscients, l'auto-évaluation de la douleur était recueillie. Au total, 45 patients TCC ont participé à l'étude. Les données relatives au BIS bilatéral ont été recueillies chez 25 de ces patients qui étaient inconscients ou avec conscience altérée. En général, un nombre plus élevé (p<0.001) de comportements suggestifs de douleur a été observé chez les participants lors du positionnement au lit (médiane=4), en comparaison au repos et de la PPNI (médiane=1 pour repos et PPNI). Lors du positionnement au lit, les comportements suggestifs de douleur les plus fréquemment observés étaient souvent atypiques et incluaient le rougissement du visage, l'ouverture subite des yeux, le larmoiement et la flexion des membres supérieurs/inférieur. Ces comportements étaient observés chez 22.2 à 66.7% des participants qui ont rapporté la présence de douleur lors de la procédure nociceptive. Des coefficients kappa modérés à élevés (k entre 0.40-0.96) ont été obtenus pour les accords intra-juge et inter-juges de la plupart des comportements observés. Concernant les signes vitaux, la FR s'est vu augmenter (p<0.001) exclusivement lors du positionnement au lit et ces fluctuations étaient corrélées à l'auto-évaluation de la douleur des participants conscients (rpb=0.736; p<0.05). En regard du BIS bilatéral, les participants avec TCC gauche avaient une augmentation des valeurs du BIS droit plus prononcée (+17.23%, p=0.021) que les participants TCC droit (+3.01%). Les fluctuations du BIS droit des TCC gauche étaient également fortement corrélées (rs=0.986, p<0.001) avec le nombre de comportements suggestifs de douleur exhibé par ceux-ci lors du positionnement au lit. Tel que souligné dans des travaux antérieurs, les patients TCC présenteraient des comportements atypiques lors de procédures nociceptives à l'USI. De plus, dans leur ensemble, les signes vitaux pourraient manquer de spécificité pour la détection de la douleur des patients TCC. Enfin, la validité du BIS bilatéral pour la détection de la douleur devrait être davantage examinée chez les patients TCC avant de pouvoir le considérer comme un indicateur de douleur chez cette clientèle à l'USI.

<p> This pilot study investigates the sero-conversion rates of hepatitis B vaccinated individuals. The study was completed at a community clinic in Laguna Beach, California, where 100 predominantly white male individuals who were all vaccinated for hepatitis B were tested for sero-conversion. The purpose of this pilot study was to examine if the hepatitis B sero-conversion rates in a small sample of subjects reflected that of the published data, regardless of HIV status, after a hepatitis B vaccination series was completed, while following strict vaccine protocols. The theoretical framework for this study is focused on evidence-based practice, which drives practice to integrate new research into clinical protocols. Two frameworks were implemented first the Academic Center for Evidenced-based practice (ACE) Star Model of Knowledge Transformation, and the Awareness-to-Adherence model; both of which will be applied in order for practitioners to adopt immunization recommendations. This pilot study was conducted through a non-experimental, correlational cross sectional design. This design was used to evaluate the sero-conversion rates of a subject receiving a primary vaccine series of hepatitis B and who was hepatitis B na&iuml;ve. Manufacturer published rates of sero-conversion are between 80% and 95%, depending upon the population studied. The results of the study demonstrated that sero-conversion rates were similar, but not as high as reported by the manufactures of the Hepatitis B vaccines. The data demonstrated that in HIV negative men (n=50), who received the 3 dose regimen, 78.6% sero-converted, and the sero-conversion rates of the HIV positive men was (n=48) 77%. This data is important with regard to current vaccine practice in all individuals who are vaccinated against hepatitis B. This includes healthcare workers, the immune-compromised and high-risk general populat </p>

<p>Skin integrity is one of the quality indicators used to evaluate nursing care of patients in long-term care and rehabilitation settings and yet pressure ulcers continue to occur at alarming rates among this population group. Using Patricia Benner&rsquo;s: From Novice to Expert model, the IOWA Evidence Based Model, and the Ottawa Model of Research Use (OMRU) a quality improvement practice change was implemented in a long-term care and rehabilitation facility located in the Mid-Atlantic region of the United States. The target population consisted of registered nurses and licensed practical nurses caring for patients with pressure ulcers. The sample size included ten registered nurses, twenty License Practical Nurses, and seventy-four patients with pressure ulcers. The Casper Report, Braden Scale scores, Pressure Ulcer Score for Healing (Push Tool), and Pieper Pressure Ulcer Knowledge test was used to measure the project outcomes. The project results of the pressure ulcer education program indicated that all thirty nurses completed the exam. Descriptive analysis was used and showed pre-test scores with a mean and standard deviation of 79/7.99 and post test scores of 86.6/3.69 validating an increase of knowledge retained by the nurses after the education session. Pressure ulcer data during incidence and prevalence rounds indicated a decrease in healing times of pressure ulcers using the PUSH Tool. A decrease in pressure ulcer rates were noted by the number of pressure ulcers resolved each week in wound rounds. Retrospective chart reviews confirmed improved documentation and accurate Braden score documentation by nurses throughout the facility. The overall project results are anticipated to continually improve pressure ulcer outcomes of this population and can be used as a model for long-term care and rehabilitation facilities globally. </p>

<p> <b>Objective.</b> The objective of this research is to determine if nursing unit based practice councils increase employee engagement and employee satisfaction.Background. The environment in which nurses practice influences their ability to provide safe patient care and maintain satisfaction with their position and the profession. There is a commitment towards establishing a healthy work environment where employee engagement and employee satisfaction are experienced. Unit based practice councils engage staff to contribute collaboratively in the decision-making process related to standards of care in nursing and employee practice. </p><p> <b>Design.</b> A retrospective comparative study utilizing secondary data analysis was implemented to determine the relationship between the independent variable, unit based practice council, and the dependent variables, employee engagement and employee satisfaction. This type of research design is appropriate because it will compare aggregate data that was collected prior to the implementation of a unit based practice council and after the implementation of a unit based practice council. The original data was collected as part of an annual employee survey that was implemented for the purpose of measuring employee engagement and employee satisfaction in 2010 and 2012. </p><p> <b>Sample and methods.</b> The sample includes an aggregate group of hospital workers, including all healthcare employees (registered nurse, unit clerks, and clinical care technicians) within each of the 4 nursing units within an Urban Level 1 Trauma Magnet Academic Medical Center located in New Jersey. The researcher contacted the nursing directors for each of the 4 units under study, to access and utilize aggregate data. E-mails were received from each participating director to confirm agreement for data collection. </p><p> A retrospective comparative study utilizing secondary data analysis was implemented to determine the relationship between the independent variable unit based practice council and the dependent variables employee engagement and employee satisfaction. This type of research design is appropriate because it will compare aggregate data that was collected prior to the implementation of a unit based practice council and after implementation of a unit based practice council.</p><p> <b>Findings.</b> The researcher was hoping to see if there was an increase in employee engagement and employee satisfaction after the implementation of a unit based practice council. </p><p> <b>Importance to Nursing.</b> The presence of a unit based practice council creates a climate that is supported by leadership and is essential to staff where employees feel empowered when given autonomy and decision making. Nursing leaders should provide venues to ensure the development of employee confidence for control of practice and collaboration amongst the health care team. Staff then identify that they have an impact on their work which leads to improved employee engagement and employee satisfaction.</p>

<p> <b>Background:</b> Pain is part of the human experience. The management of pain is a problem of significant magnitude in the United States. Nurses are on the forefront of this issue with the capacity to assess and respond to patients needs. Nurses' knowledge and attitudes towards pain can predict the nurses' ability to adequately meet patient's pain reduction needs. </p><p> <b>Objective:</b> The aim of this DNP project was to replicate a 1996 study comparing outcomes of the attitudes and knowledge regarding pain survey of a convenience sample of medical-surgical nurses in 2013 with nurses from 1996 to determine if attitudes towards pain have changed. </p><p> <b>Method:</b> Cross-sectional, descriptive, comparative design. The Nurses' Knowledge and Attitudes Survey Regarding Pain (NKASRP) and a demographic survey were utilized to assess the nurses' knowledge level and attitudes toward pain and pain management. </p><p> <b>Sample:</b> A convenience sample of nurses (n=58) from nine in-patient, medical-surgical units at a large multi-facility health care system volunteered to participate. </p><p> <b>Results:</b> No significant differences were found between the attitudes on pain from the 1996 and 2013 respondents. The mean score on the NKASRP was 67%. No significant correlations were identified between any demographic variable and nurses' scores. </p><p> <b>Conclusion:</b> Despite increased educational preparation since 1996, the mean score on the NKASRP remained well below what is considered average knowledge. Nursing academics and hospital orientations need to evaluate nurses' attitudes and knowledge and provide the education that can help nurses provide adequate pain management to patients.</p>

<p> This study focused on perceptions of novice adjunct faculty experiencing transition from nursing service to the teaching role; the comparison of novice adjuncts' self-identified responsibilities and challenges to experienced full-time faculty members' expectations for successful role performance; and topics for continued role development. Using transitions theory (Meleis, 2010) as the conceptual basis, interviews from a purposive sample of 14 novice nursing adjuncts and 10 experienced full-time nursing faculty members were examined using thematic analysis. Four themes were detected: (1) knowing requirements: must read/must follow; (2) evolving teaching role identity; (3) teaching role management; and (4) faculty relationship development. Subcategories contained issues related to policy, role conflict, learning needs, complexity of evaluation, managing student issues, communication, and the importance of transitional support. Implications included: assessing for adjunct role insufficiency, valuing the clarification of role responsibilities, recognizing the significance of supplementation to novice adjuncts, and educational topics identification to enhance and expedite the adjunct teaching role.</p>