Patient outcome data are an important factor in healthcare. Reports by the Institute of Medicine between 1999 and 2001, as well as recent research by Linda Aiken and her colleagues have added more emphasis to measures that can be taken to improve patient outcomes. Because of the role they play in healthcare facilities, nurse leaders are in a position to take the lead in improving patient outcomes. There is evidence to suggest that nurse leaders' transformational leadership behaviors are associated with positive patient outcomes. The purpose of this project was to identify the effect of transformational leadership skill-building training on nurse leaders' behavior in the acute care setting. The project included assessments of nine nurse leaders by those nurses which are supervised by the nurse leaders. The results indicated the nurse leaders' behavior score of 3.1 was in the transformational range (3.0-3.75.) Transformational leadership skill-building training followed the assessment process. A post training evaluation by the previous assessors followed the training. The distribution of the transformational leadership behavior scores did not change following the training.

The purpose of the study was to explore and describe the lived experiences of neophyte professional nurses working in ICU during their first year post graduation with the aim to discover strategies to support the nurse in critical care unit. An explorative, descriptive, interpretative qualitative design was conducted to uncover the nurse’s experiences. A purposive sampling was used which is based on belief that the researcher’s knowledge about the population can be used to hand pick sample elements. Data was collected through in-depth unstructured interviews and written narratives. Collaizi’s method of data analysis was used. The study findings revealed that neophyte professional nurses experienced difficulties and challenges in adjusting to the unit because of lack of mentors emanating from the shortage of staff. Nurses experienced mixed feelings regarding the relationship with colleagues in terms of support received. / Health Studies / M.A. (Health Studies)

Thesis (MCurr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Nurse managers are responsible to staff different hospital units and departments with sufficient, trained and experienced personnel. Most critical care units in the private healthcare in South Africa are staffed below maximum workload levels and additional staff is supplemented when needed. Current staffing management strategies comprises the application of the patient acuity score, the utilisation of contracted agency staff and ward staff who assist occasionally in the critical care unit (CCU). The aim of the study was to explore the experiences of critical care nurses regarding staffing management within critical care units in private health care institutions in the Western Cape. The following objectives were set to: - explore the experiences of CCNs regarding staffing management strategies such as o the patient acuity score o the employment of ad hoc agency staff and o the utilization of ward staff A descriptive design with a qualitative approach was applied. A sample size of n=15 was drawn from a total population of N=377, using purposive sampling technique. A pilot-test was also completed. The trustworthiness of this study was assured with the use of Lincoln and Guba’s criteria of credibility, transferability, dependability and confirmability. All ethical principles were met. The findings of the study demonstrated that nurses perceive the workload in critical care units as heavy. The utilisation of the acuity score does not really assist in relieving the workload as managers tend not to consider the staffing requirements as predicted by the acuity score due to budget constraints. The enrolled nurses who assist occasionally in the critical care unit require supervision as well as ongoing development to ensure safe and quality patient care. Yet agency nurses were perceived as either extraordinary good or incompetent. / AFRIKAANSE OPSOMMING: Verpleegbestuurders het die verantwoordelik om verskillende hospitaaleenhede en departemente met voldoende opgeleide en ervare personeel te voorsien. Die meeste kritieke sorgeenhede in Suid-Afrika word met minder as dan die maksimum werkladingsvlak beman en addisionele personeel word aangevul wanneer nodig. Huidige personeelbestuurstrategieë behels die toepassing van die pasiënt akuïteit telling, die gebruik van ingekontrakteerde agentskap-personeel en saalpersoneel wat per geleentheid in die kritiekesorgeenheid help. Die doel van die studie was om die ervaringe van kritieke-sorgverpleegsters ten opsigte van personeel bestuur binne die kritiekesorgeenhede in die privaat gesondheidsorginstellings in die Weskaap, te ondersoek. Die volgende doelwitte is gestel: - Om die ervaringe van kritieke-sorgverpleegsters aangaande personeelbestuur-strategieë te ondersoek, soos: o die pasiënt akuïteit telling o die gebruik van agentskapverpleegpersoneel en o die gebruik van saal personeel, te ondersoek ’n Beskrywende kwalitatiewe studie is toegepas. ’n Steekproef van n=15 is uit ’n totale populasie van N=377 getrek deur die doelgerigte steekproeftegniek te gebruik. ’n Loodstoetsing van die semi-gestruktureerde vraelys is ook gedoen. Die betroubaarheid van hierdie studie was verseker deur van Lincoln en Guba se kriteria vir geloofwaardigheid, oordraagbaarheid, betroubaarheid en bevestigbaarheid gebruik te maak. Daar is aan alle etiese vereistes voldoen. Die bevindings van die studie toon dat die verpleegpersoneel die werklading in die kritiekesorgeenheid as veeleisend ervaar. Die aanwending van die pasiënt akuïteit-telling dra nie werklik by tot verligting van die werklading nie, aangesien bestuurders weens begrotingsbeperkings neig om nie die personeelbenodigdhede soos deur die akuïteit-telling voorspel in ag neem nie. Die ingeskrewe verpleegsters wat per geleentheid in die kritieke-sorgeenheid hulp verleen, benodig toesig asook volgehoue ontwikkeling ten einde veilige en kwaliteit pasiëntsorg te verseker. Die agentskapverpleegpersoneel is egter as baie bekwaam of onbevoeg beskou.

Indiana University-Purdue University Indianapolis (IUPUI) / Gastric residual volume (GRV) is a clinical assessment to evaluate gastric emptying and enteral feeding tolerance. Factors such as the tube size, tube material, tube port configuration, placement of the tube in the gastric fluid, the amount of fluid and person completing the assessment may influence the accuracy of residual volume assessment. Little attention has been paid to assessing the accuracy of GRV measurement when the actual volume being aspirated is known, and no studies have compared the accuracy in obtaining RV using the three different techniques reported in the literature that are used to obtain aspirate in practice (syringe, suction, and gravity drainage). This in vitro study evaluated three different methods for aspirating feeding formula through two different tube sizes (10 Fr [small] and 18 Fr [large]), tube materials (polyvinyl chloride and polyurethane), using four levels of nursing experience (student, novice, experienced and expert) blinded to the five fixed fluid volumes of feeding formula in a simulated stomach, to determine if the RV can be accurately obtained. The study design consisted of a 3x2x2x4x5 completely randomized factorial ANOVA (with a total of 240 cells) and 479 RV assessments were made by the four nurse participants. All three methods (syringe, suction and gravity) used to aspirate RV did not perform substantially well in aspirating fluid, and on average, the methods were able to aspirate about 50% of the volume available. The syringe and suction techniques were comparable and produced higher proportions of RVs, although the interrater reliability of RV assessment was better with the syringe method. The gravity technique generally performed poorly. Overall, the polyvinyl chloride material and smaller tubes were associated with higher RV assessments. RV assessment is a variable assessment and the three methods did not perform well in this in vitro study. These findings should be further explored and confirmed using larger samples. This knowledge will be important in establishing the best technique for assessing RV to maximize EN delivery in practice and will contribute to future research to test strategies to optimize EN intake in critically ill patients.

Indiana University-Purdue University Indianapolis (IUPUI) / Factor H is a newly identified phenomenon which describes a constellation of attributes of the new graduate nurse reflecting personality traits, intellectual abilities, and clinical judgment. In a previous pilot study conducted by this researcher nurse managers and experienced Registered Nurse (RN) preceptors described characteristics demonstrated by new graduate nurses demonstrating Factor H and the new graduate nurse’s ability to transition quickly and successfully into the RN role in the acute care environment. There is currently no instrument available to measure this phenomenon. The specific aim of this research was to develop and psychometrically test a scale designed to identify the presence of attributes of Factor H in the new graduate nurse. The Sims Factor H Assessment Scale (SFHAS) was developed and piloted with a sample of one hundred one new graduate nurses within three months of completing the their nursing program at one of three nursing schools in central and south central Indiana. Evidence of content validity was demonstrated through the use of the Content Validity Index conducted with a panel of four experts. Evidence of face validity was demonstrated through interviews with a group of new graduate nurses, nurse managers, and experienced RN preceptors. Principle Axis Factoring with Varimax rotation was used to demonstrate evidence of construct validity and the scale was found to have a single component which was identified as nursing personality. Evidence of criterion-related validity was demonstrated utilizing analysis of the SFHAS and the criterion scale for personality traits (NEO-FFI). Evidence of internal consistency reliability was demonstrated through analysis of inter-item correlations, Cronbach’s coefficient correlations, and item-total correlations. Test re-test reliability using interclass correlation was also conducted to demonstrate stability of the scale. The SFHAS was found to be reflective of nursing personality and not general mental ability or clinical judgment. Use of the SFHAS will allow organizations to evaluate the nursing personality of the new graduate nurse for fit into the work environment. Further study is recommended to gain clarity around the attributes which support successful transition of the new graduate nurse into practice in the acute care environment, also known as Factor H.

Indiana University-Purdue University Indianapolis (IUPUI) / This qualitative study was successful in utilization of grounded theory methodology to ascertain nurses’ decision-making processes following their awareness of having made a medical error, as well as how and/or if they corrected and reported the error. Significant literature documents the existence of medical errors; however, this unique study interviewed thirty nurses from adult intensive care units seeking to discover through a detailed interview process their individual stories and experiences, which were then analyzed for common themes. Common themes led to the development of a theoretical model of thought processes regarding error reporting when nurses made an error. Within this theoretical model are multiple processes that outline a shared, time-orientated sequence of events nurses encounter before, during, and after an error. One common theme was the error occurred during a busy day when they had been doing something unfamiliar. Each nurse expressed personal anguish at the realization she had made an error, she sought to understand why the error happened and what corrective action was needed. Whether the error was reported on or told about depended on each unit’s expectation and what needed to be done to protect the patient. If there was no perceived patient harm, errors were not reported. Even for reported errors, no one followed-up with the nurses in this study. Nurses were left on their own to reflect on what had happened and to consider what could be done to prevent error recurrence. The overall impact of the process of and the recovery from the error led to learning from the error that persisted throughout her nursing career. Findings from this study illuminate the unique viewpoint of licensed nurses’ experiences with errors and have the potential to influence how the prevention of, notification about and resolution of errors are dealt with in the clinical setting. Further research is needed to answer multiple questions that will contribute to nursing knowledge about error reporting activities and the means to continue to improve error-reporting rates

This qualitative study was aimed at exploring and describing the theoretical and practical experiences of second-year critical care nursing students. Purposive sampling was done, and unstructured interviews and narrative descriptions were used as data collection tools. An adaptation of Johns's Framework, the Guideline for the Facilitation of Reflection as Teaching Strategy, was used during interviews to guide participants in reflecting on theory-practice integration. Multiple strategies were used to ensure the trustworthiness of the study. Concerning patient data, communication, and the administration of life-saving medications, theory-practice integration did occur. Regarding treatment and the outcome of nursing interventions, it seemed that knowledge deficiencies and a lack of exposure to practical situations contributed to the inability to apply theory to practice. This apparent inability evoked negative feelings, such as guilt. Discrepancies between practice and theory taught led to confusion. Guided reflection assisted students in gaining a new perspective on nursing and theory-practice integration. / Health Studies / M.A. (Health Studies)

This qualitative study was aimed at exploring and describing the theoretical and practical experiences of second-year critical care nursing students. Purposive sampling was done, and unstructured interviews and narrative descriptions were used as data collection tools. An adaptation of Johns's Framework, the Guideline for the Facilitation of Reflection as Teaching Strategy, was used during interviews to guide participants in reflecting on theory-practice integration. Multiple strategies were used to ensure the trustworthiness of the study. Concerning patient data, communication, and the administration of life-saving medications, theory-practice integration did occur. Regarding treatment and the outcome of nursing interventions, it seemed that knowledge deficiencies and a lack of exposure to practical situations contributed to the inability to apply theory to practice. This apparent inability evoked negative feelings, such as guilt. Discrepancies between practice and theory taught led to confusion. Guided reflection assisted students in gaining a new perspective on nursing and theory-practice integration. / Health Studies / M.A. (Health Studies)