The purpose of this project was to identify the standards for the American Association of Critical Care Nurses (AACN). The employees of a 39-bed medical surgical unit within a 697-bed metropolitan medical center were selected through collaboration with the practicum site. Out of 68 allocated positions for this unit, only permanent employees were selected to participate. An employee presented the purpose of the project, the survey process, and inferred consent represented by online login to complete the survey. Following the online assessment, the employee explained the AACN healthy work environment standards in a subsequent presentation. The online healthy work environment assessment measured the AACN healthy work environment standards, which included skilled communication, collaboration, effective decision making, appropriate staffing, meaningful recognition, and authentic leadership. A mean score was generated by the healthy work environment online assessment tool on a scale ranging from 1 (Needs Improvement) to 5 (Excellent). Data from the online assessment were analyzed by comparing mean pre- (3.03) and post- (2.17) project results, which revealed a need for greater understanding of AACN healthy work environment standards. Increased education of the AACN healthy work environment standards and implementation of a formal program would impact nursing turnover rates, improve employee engagement, and ultimately improve the care and outcome of patients, thereby promoting positive social change.

The literature claims that workplace violence (WPV) in the health care setting is among the highest, with the majority of that violence taking place in the Emergency Department (ED). The significance of WPV in reference to nursing is that it leads to burnout, absenteeism, and the risk of nurses leaving their job all together. Leaving the nursing profession intensifies the present critical shortage. With the success of an evidence-based WPV prevention program (WPVPP), hospitals could improve the quality of work for nurses, which consequently will improve retention rates, as well as provide an environment that will be more conducive to patient care. In the evaluation of the ED at the practicum site, it was found that there was an absence regarding de-escalation education, hazard assessment, and incident reporting. To address those problems, the current project examined the extent to which implementing a WPVPP would provide a safer environment as perceived by the nurses who work in the ED. Ten health care professionals with experience and knowledge related to WPV were given an evaluation tool to measure the content validity of the survey instrument and WPVPP. The evaluation tool was comprised of 12 close- and open-ended questions. The information gained from the evaluation provided the necessary support to implement the WPVPP and evaluate the nurses' perception of safety in the ED. The implementation of a WPVPP would affect social change by improving the nurses' perception of safety, hence creating a healthy work environment that includes safety, respect, and trust.

Work environment influences the effectiveness of care for patients in any healthcare setting. It is even more important in settings such as the neonatal ICU (NICU) where this project took place. When the environment is not healthy, communication may suffer and result in poor patient outcomes and, family, patient, and staff dissatisfaction. The purpose of this quality improvement project was to understand how the implementation of the TeamSTEPPS program, for nurses in the NICU, could impact the safety culture as measured by the AACN Healthy Work Environment (HWE) tool. Lewin's professional practice change theory and the AHRQ change model were used to guide the project. The previously validated HWE survey, made up of 6 standards including communication, and leadership was provided to 71 NICU nurses with only 41 completing the baseline survey and 4 weeks later, 31 completing the post intervention survey after the TeamSTEPPS training. An independent t test was used to examine baseline and post TeamSTEPPS intervention HWE results against the HWE benchmark. Results indicated that post intervention scores met the benchmark although scores did not meet the benchmark prior to the intervention. Data were also analyzed with a paired t test to determine the significance of the improvement in the pre to post intervention results. Three of the 6 HWE standards, skilled communication (p = .004), adequate staffing (p = .002), and authentic leadership (p < .001) reached significant levels post TeamSTEPPS training compared to the pre TeamSTEPPS scores. Through the use of TeamSTEPPS training communication improved and the potential for improvement in patient safety promotes positive social change.

Thesis (Ph.D.)--Indiana University, 2009. / Title from screen (viewed on August 28, 2009). School of Nursing, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Anna M. McDaniel (Chair), Mary L. Fisher, Patricia R. Ebright, Bradley N. Doebbeling. Includes vita. Includes bibliographical references (leaves 140-154).

Indiana University-Purdue University Indianapolis (IUPUI) / Objective: This study provided a qualitative description of stress and coping as perceived by today's nurse manager incumbents. Background: The healthcare work environment as a source of overwork and stress has been implicated in today's nursing shortage. Nurse managers play a pivotal role in creating work environments for staff nurses, but little is known about the nature of nurse manager work. Methods: This qualitative descriptive study determined what situations contribute to nurse manager stress, what coping strategies they utilize, what health outcomes they report, and what decision-making processes they follow to address stressful situations in their roles. A purposive sample of 21 nurse managers employed at three U.S. acute care hospitals participated in the study. Participants completed a demographic questionnaire and a 14-question interview incorporating components of the Critical Decision Method. Content analysis was completed and themes identified. Results: Difficult situations reported included feeling pressure to perform, interpersonal conflicts associated with organizational communication deficits, and issues of human resources and staffing. Nurse managers utilized a combination of emotion-focused and problem-focused coping strategies. When comparing novice nurse managers (3 years or less in role) with experienced nurse managers (greater than 3 years in role), the novices used predominantly emotion-focused coping strategies, a narrow repertoire of self-care strategies, and experienced negative psychological, physiological, and functional outcomes related to their coping efforts. Experienced nurse managers working as co-managers demonstrated mostly problem-focused coping strategies, a broad repertoire of self-care strategies, and reported no negative health outcomes. The study produced a cognitive model in the form of 10 questions that guide nurse manager decision-making related to stressful situations. The study generated four themes amenable to intervention. Conclusions: Performance expectations for nurse managers in acute care hospitals have increased since the 1990's making the role requirements unrealistic. Rising expectations increase nurse manager stress perceptions, making coping more difficult, and potentially harming nurse manager and work environment well-being. Findings from this study suggest that to address stress, coping, and complexity in the nurse manager role requires a combination of strategies that address individual factors as well as organizational culture, supportive structures, and systems that facilitate the role.

Arbetsplatsen har kommit att bli en viktigt arena där hälsan och förutsättningarna för hälsan kan påverkas. De senaste åren har det skett en positiv utveckling gällande den fysiska arbetsmiljön men inte gällande den psykosociala arbetsmiljön där speciellt anställda inom hälso- och sjukvården upplever en allt mer pressad arbetssituation. Litteraturgenomgången kring psykosociala arbetsförhållanden visar att det finns lite forskning gjord kring positiva aspekter av socialt stöd och hälsa. Detta ses som ett problem då det i arbetsmiljön ligger en avsevärd potential i främjandet av hälsa och att fokus bör förflyttas från det patogena till det salutogena synsättet. Syftet var att ur ett salutogent perspektiv se det sociala stödets betydelse på arbetsplatser inom privat hälso- och sjukvård samt undersöka medarbetarnas självuppskattade hälsa och upplevelser av arbetsplatsen och arbetssituationen. Metoden var en kvantitativ tvärsnittsstudie. En strukturerad webenkät användes för att samla in data. Totalt deltog 91 medarbetare inom närsjukvården på ett privat hälso- och sjukvårdsföretag, vilket innebar en svarsfrekvens på 43 %. Resultaten visar ett direkt positivt samband mellan socialt stöd och olika arbetsrelaterade faktorer samt hälsa. Socialt stöd medierar även effekterna av kontroll på nivån av den självuppskattade hälsan. Dock fanns det inget underlag för att socialt stöd har en större betydelse än andra arbetsrelaterade faktorer i relation till hälsa. Konklusionerna var att ett gott emotionellt klimat bidrar till gynnsamma hälsoeffekter. Ett viktigt perspektiv i det hälsofrämjande arbetet är att skapa och främja goda relationer på arbetsplatsen. Exempelvis är formella samtalsgrupper effektiva vid främjandet av goda relationer, samt bidragande till minskningen av stressupplevelser vilket även fångar in den preventiva tillämpningen. Hälsa berör flera aspekter och bör ses så holistiskt som möjligt. / The workplace has become an important arena where health- and the prospects of health can be affected. In recent years there have been positive developments regarding the physical work environment but not concerning the psychosocial development environment where employees especially in the health care system is experiencing an increasingly tight labor situation. The literature review on psychosocial working conditions show that there is little research done on the positive aspects of social support and health. This is seen as a problem when the work environment is a considerable potential in the promotion of health, and that the focus should move from the pathogenic to the salutogenic approach. The aim of this thesis was from a salutogenic perspective to study the importance of social support at workplaces in the private healthcare, and examine employees' self-estimated health and perceptions of the workplace and working conditions. The Method was a quantitative cross-sectional study. A structured web-based survey was used to collect data. A total of 91 employees of the local health services in a private healthcare company participated, representing a response rate of 43%. The Results showed a direct positive relationship between social support and various work-related factors and health. Social support also mediates the effects of control on the level of self-estimated health. However, there was no basis for social support as a greater factor than other work-related factors in relation to health. The Conclusions were that a good emotional climate contributes to beneficial health effects. An important perspective in health promotion is to create and foster good relationships in the workplace. For instance are formal discussion groups effective in the promotion of good relations, as well as contributing to the reduction of stress experiences, which also captures the preventive view. Health concerns several aspects and should be seen as holistic as possible.

Aim of the study is to explore the role caring practices within the nurse-patient relationship, in facilitating effective chronic pain management in the primary health care context. Objectives are to analyse the current caring practices within the nurse-patient relationship during the management of patients with chronic pain within primary health care services; explore the challenges experienced by nurses in primary health care services when managing patients with chronic pain; observe the caring practices within the nurse patient interaction for the patients suffering from chronic pain within the Primary health care setting and explain the nurses‟ caring practices when managing their chronic pain in the primary health care setting. Method The research design for this study is sequential, explanatory and mixed method, which is more appropriate due to the complexity of the phenomenon under study. Findings: Although the survey measured the caring practices subjectively which other studies had done consistently, generally nurses associated caring as their core function within the health profession. Nurses do not actively involve the patients in the development of a treatment plan and as a result the caring behaviours that are intended to benefit the patients are not realised and, thus patients report nurses as not being caring. The results indicated that lack of an inclusive treatment plan, which can only be discovered through the development of the therapeutic NPR, is not given priority in the management of patients with chronic pain Conclusions: Caring should not be seen as concrete execution of the set of activities towards the patient but rather as a joint venture between the nurse and the patient. The strength of the model developed in this study is the identification of the nurses‟ internal readiness to create a caring environment by experiencing the love, faith and hope before engaging with the patient. / Health Studies

Aim of the study is to explore the role caring practices within the nurse-patient relationship, in facilitating effective chronic pain management in the primary health care context. Objectives are to analyse the current caring practices within the nurse-patient relationship during the management of patients with chronic pain within primary health care services; explore the challenges experienced by nurses in primary health care services when managing patients with chronic pain; observe the caring practices within the nurse patient interaction for the patients suffering from chronic pain within the Primary health care setting and explain the nurses‟ caring practices when managing their chronic pain in the primary health care setting. Method The research design for this study is sequential, explanatory and mixed method, which is more appropriate due to the complexity of the phenomenon under study. Findings: Although the survey measured the caring practices subjectively which other studies had done consistently, generally nurses associated caring as their core function within the health profession. Nurses do not actively involve the patients in the development of a treatment plan and as a result the caring behaviours that are intended to benefit the patients are not realised and, thus patients report nurses as not being caring. The results indicated that lack of an inclusive treatment plan, which can only be discovered through the development of the therapeutic NPR, is not given priority in the management of patients with chronic pain Conclusions: Caring should not be seen as concrete execution of the set of activities towards the patient but rather as a joint venture between the nurse and the patient. The strength of the model developed in this study is the identification of the nurses‟ internal readiness to create a caring environment by experiencing the love, faith and hope before engaging with the patient. / Health Studies