Thesis (Ph. D.)--University of Texas at Austin, 2002. / Vita. Includes bibliographical references. Available also from UMI Company.

Thesis (M Nursing)--Montana State University--Bozeman, 2010. / Typescript. Chairperson, Graduate Committee: Patricia A. Holkup. Includes bibliographical references (leaves 82-90).

M.Cur. (Intensive Care Nursing) / The nurse working in an intensive care unit is legally accountable for complete and accurate record-keeping. Record-keeping is especially important during a crisis incident as the sequential management or treatment depends on what happened before and during the crisis incident. Before she can be held accountable for complete and accurate record-keeping, the nurse must have the necessary abilities (knowledge, skills and values) . She will have to accept the responsibility and legally she will receive the authority for it. Complete and accurate record-keeping helps to maintain, improve and restore the critical patient's health. In this way the nurse working in an intensive care unit facilitates the patient's aim for wholeness and at the same time achieves her own aim for' quality nursing. The purpose of this research is accurate nursing records are kept intensive care unit. A contextual-descriptive research design, including a survey method and retrospective auditing were used to determine the completeness and accuracy of record-keeping by nurses during a crisis incident. Auditing was done on the basis of three structured control lists. The results showed that the graphic-symbolic report was more complete and accurate with regard to the patients' particulars and graphic accuracy. The results also showed that there is a great variance in the knowledge and skills of the nurses working in the intensive care unit, regarding record-keeping. Recommendations evolving from this study are: The purpose and use of the records should be clarified. The record system must be revised. Temporary staff must be accompanied on day duty by permanent staff members before they start working night duty. The allocation of the staff must be revised. A policy for record-keeping must be established. In-service training for expanding knowledge regarding record- keeping must be initiated. The purpose and the use of record-keeping must be included in the orientation program. Records must be evaluated to identify shortcomings.

Critical care nursing is a clinical specialist nursing practice discipline. The critical care nurse provides a constant presence in the care of a critically ill patient. She/he creates a thread of continuity in care through the myriad of other health care professionals and activities that form part of a patient’s stay in the critical care environment (World Federation of Critical Care Nurses [WFCCN], 2007). During conversations with people who have had intimate experience of the critical care environment, they have offered anecdotes that describe their interaction with critical care nurses who they perceive to be different from and better than other critical care nurses they encountered. Despite having met common professional requirements to be registered as a clinical specialist nurse, these distinctive, unique abilities that seem to be influential in meeting the complex needs and expectations of critically ill patients, their significant others as well as nursing and medical colleagues, are not displayed by all critical care nurses. While students of accredited postgraduate nursing programmes are required to advance their nursing knowledge and skill competence, many students do not seem to develop other, perhaps more tacit, qualities that utilisers characterise in their anecdotes of ‘different and better’ nursing practice. The overarching research question guiding this study was how can ‘different and better’ critical care nursing practice as recognised by a utiliser be explained? The purpose of this study was to develop an understanding of the qualities that those people who use critical care nursing practice recognise as ‘different and better’ to the norm of nursing practice they encounter in this discipline. The participant sample included patients’ significant others, nursing colleagues and medical colleagues of critical care nurses, collectively identified as utilisers. The stated aim of this work was to construct a grounded theory to elucidate an understanding of the qualities that a utiliser of critical care nursing recognises as ‘different and better’ critical care nursing practice in order to enhance the teaching and learning encounters between nurse educators and postgraduate students in learning programmes aiming to develop clinical specialist nurses. The method processes of grounded theory are designed to reveal and confirm concepts from within the data as well as the connections between these concepts, supporting the researcher in crafting a substantive theory that is definitively grounded in the participants’ views and stories (Streubert & Carpenter, 2011: 123, 128-129). Two data collection tools were employed in this study, namely in-depth unstructured individual interviews and naïve sketch. Constant comparative analysis, memo-writing, theoretical sampling, theoretical sensitivity and theoretical saturation as fundamental methods of data generation in grounded theory were applied. The study unfolded through three broad parts, namely: Forming & shaping this grounded theory through exploration and co-creation; Assimilating & situating this grounded theory through understanding and enfolding; Reflecting on this grounded theory through contemplating and reconnecting. The outcome of the first part of the study was my initial proposition of a grounded theory co-created in the interactions between the participants and myself. This was then challenged, developed and assimilated through a focussed literature review through the second part of the study. Through these two parts of this study, an inductively derived explanation was formed and shaped to produce an assimilated and situated substantive grounded theory named Being at Ease. This grounded theory articulates how ‘better and different’ nursing is recognised from the point of view of those who use the nursing ability of critical care nurses through the core concern ‘being at ease’ and its four categories ‘knowing self’, ‘skilled being’, connecting with intention’ and’ anchoring’. The final part of this study unfolded in my reflections on what this grounded theory had revealed about nurses and elements of nursing practice that are important to a utiliser in recognising ‘different and better’ critical care nursing. I suggest that as nurses we need to develop a language that enables us to reveal with clarity these intangible and tacit elements recognised within the being and doing of ‘different and better’ nursing. I reflected on the pivotal space of influence a teacher has with a student, and on how the elements essential in being and doing ‘different and better’ nursing need to be evident in her/his own ways of being a teacher of nursing. Teaching and learning encounters may be enhanced through drawing what this theory has shown as necessary elements that shape ‘different and better’ nurses through the moments of influence a teacher has in each encounter with a student.

This study describes the meaning intensive care unit nurses attach to their care of the brain dead patient. A phenomenological methodology was used because of its intent to understand experience as it is lived. Because these patients constitute a unique class of dead patients which require intensive nursing care and because of the scarcity of information available on the subjective experience of nurses who provide this care, the study was considered to be essential to fillful a gap in our knowledge. Data were collected through 28 interviews with 11 Caucasian female participants who work in the intensive care units of a tertiary and a quaternary care hospital within the greater Vancouver area. Their ages ranged from their early twenties to over forty years of age. They represented five religious demoninations with one participant having no religious affiliations. One nurse had cared for between two and five brain dead patients, four had provided care for six to ten brain dead patients, and six had cared for more than ten brain dead patients. Throughout the participants' accounts dissonance was the pervasive and unifying theme. The dissonance was seen in the form of either personal or interpersonal discord. The former was seen in relation to five areas: the participant's philosophy about nursing, traditional nursing care activities, the concept of brain death, organ retrieval and transplantation, and professional responsibilities in relation to meeting the nurse's own emotional needs. In contrast, the latter occurred between the nurse and families, physicians, the Pacific Organ Retrieval for Transplantation Team and nursing colleagues. Either form of dissonance results in personal distress and subsequent attempts to reduce the dissonance by distancing and/or designating another as the target of nursing care. / Applied Science, Faculty of / Nursing, School of / Graduate

M.Cur. / The purpose of this study was to describe the clinical competencies of the shift leader in the ICU setting in order to determine if there is a gap between what is expected of the shift leader and what is happening in reality. A quantitative, descriptive design was used and cluster sampling implemented. A survey, utilizing questionnaires, was used to gather data from three clusters, comprising 11 hospitals from a single private healthcare group. 251 questionnaires were distributed and 98 were returned, indicating a response rate of 39%. Validity and reliability were ensured. Results indicated that respondents classified the majority of competencies as essential competencies. None were classified as critical competencies and only four were classified as specific competencies. Shift leaders were viewed as competent by all respondents in all three clusters. Results were used to describe a typology of the competencies of the shift leader in the ICU setting.

Using grounded theory methodology, six intensive care patients were interviewed regarding their perceptions of their own needs, concerns and wants and how nurses responded to those. Each patient was interviewed three times to detect any change in responses during the hospitalization. A theme of patient-nurse negotiation emerged. Patients came into the health care setting with a "generative source," the issues and beliefs they had regarding health-care and nurses in general. This affected patients' definition of themselves, their situation, the caregiver, their relationship with the caregiver, and their own needs and expectations. When a patient's definitions of self or situation varied form the nurse's, negotiation would occur. Two main categories of negotiation were used by both patient and nurse: Personal knowledge & Strategies. If negotiation failed to bring consensus, resulting actions were negative feelings and dissatisfaction, and a sense of vulnerability for the patient. This in turn impacted negatively on the patient's generative source and definitions. As the patient progressed through the hospital system toward discharge, the greatest changes were noted in how they defined themselves and the caregiver, and in the style of negotiation they used.

published_or_final_version / Nursing Studies / Master / Master of Nursing

No description available.

This thesis describes a qualitative enquiry into the experiences of families visiting an adult intensive care unit (ICU) during a critical illness of a family member and nurses’ perceptions of families in this environment. A Grounded Theory approach was taken. Nine families (12 adults, 12 young people) with a family member in intensive care and twenty intensive care nurses in five focus groups contributed their experiences to the study through group interviews. Families described the admission of a family member as a traumatic event. The core experiences of families which emerged in the study revolved around uncertainty. Drawing on Davis’ (1963/1991, 1966) concepts of ‘clinical uncertainty’ and ‘functional uncertainty’ a number of strategies families and young people developed in dealing with the situation were identified. ‘Clinical uncertainty’ captures the unknown and unknowable aspects of critical illness. The ‘Functional uncertainty’ category emerged later in the research process and brings to light management of information disclosure for functional gain as a communication strategy. Functional uncertainty was identified in communications between nurses and families and between parents and children within families. Moreover, young people used the same ‘functional uncertainty’ strategy when disclosing information to peers within the school environment. ‘Keeping normality in life’ and ‘fishing for information’ and the associated strategies were identified as direct responses of young people to clinical and functional uncertainty. The strategies identified provide new insights into how young people process a critical illness event in their families. This emphasises the importance of listening to young people’s voices and the need to include young people in future studies. ‘Nursing in public’ emerged as an overarching theme within the data from nurses’ interviews. The contrasting interests of nurses and families in the context of critical illness became evident when open visiting policies were discussed. The promotion by policy makers and nursing scholars of a patient centred health care service and thus the implicit integration of families into care challenges nurses to adapt their working practices. Whilst this study provides evidence for the importance of integrating families into care it also shows the needs of nurses are in danger of being marginalised. Respecting the needs of families and nurses the question becomes how best to balance the competing needs of both groups. It is suggested that a ‘partnership in care’ approach which is firmly based on negotiations between nurses and families under the leadership of nurses will allow for the emergence of family care in intensive care, to the benefit of patients, families and nurses.