Thesis (M.S.)--Cornell University, January, 2009. / Includes bibliographical references (leaves 74-82).

Western governments face increasing demands to achieve both cost efficiency and responsiveness in their public services leading to radical and challenging transformations. Following the imposition of New Public Management (NPM) approaches within England, it is argued that similar elements of NPM can be also seen within Scottish healthcare, despite policy divergences following devolution. This thesis considers the influence of NPM on Scottish hospital frontline nursing staff in their work. It explores the ways in which managerial practices (specifically professional management; discipline & parsimony; standard setting & performance measurement; and consumerism) have shaped the working relationships, interactions, and knowledge-exchange between managers, staff and patients and the ability of staff to carry out nursing duties within an acute hospital setting. The study is a qualitative interpretivist study grounded in the methodology of adaptive theory and draws upon the works of Lipsky (1980) in order to explore how the front-line nurses cope with and resist the demands of the workplace. Based on thirty-one qualitative interviews with front-line nursing staff in an inner city hospital in Scotland, this thesis presents the findings resulting from nurses’ views of management, finances, policies, targets, audits and consumerism. The findings show that these nurses believe there has been a proliferation of targets, audits and policies, an increasing emphasis on cost efficiency and effectiveness, a drive for professional management and a greater focus on consumerism in NHS Scotland. These are all closely linked to the ethos of NPM. From the findings it can be seen that many elements influence the working relationships of the frontline hospital nursing staff. The study suggests that the main reason for conflict between managers and nursing staff is due to their differing foci. Managers are seen to concentrate on issues of targets, audits and budgets with little thought given to the impact these decisions will have on patient care or nurses’ working conditions. Furthermore the findings highlight high levels of micro-management, self-surveillance, control and the regulation of the frontline nursing staff which has led to tensions both between nursing staff and managers, but also with patients and the public. Finally, although there has supposedly been policy divergence between Scotland and England, this thesis has identified many similarities between Scottish and English polices and NPM approaches continues to influence the working relationships of front-line nursing staff within this study despite the rhetoric that Scotland has moved away from such practices.

Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2007. / Typescript. Includes bibliographical references (leaves 93-101). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / After the base and the structure formed on a monastic regime of devotion and charity, nursing has changed in profile, from activity, regulated and respected profession. Through new assignments given to nurses, it became necessary that it receive a better training their functions in modernity, which also include care management of the health unit (U.S.) where he works. From this observation defined the research problem that guided this study: What are the skills of knowledge, skills and attitudes considered of extreme importance to nursing managers?, Whose objectives are to: - Identify the level of importance of skills knowledge, skills and attitudes, according to the perception of nursing managers; - To characterize the population of nursing managers of the research institution; - Identify the skills considered extremely important by the respondents; - Talking about the skills considered extremely important by respondents. To achieve the objectives has been carried out field research, exploratory, descriptive and quantitative approach, which had 25 managers as subjects of a U.S. teaching hospital, the large city of Santa Maria-RS. A survey conducted in 2011, used a research tool in two parts: a) sociodemographic information; b) 51 items for the election of skills related skills (20 items), knowledge (16) and attitudes (15) considered extremely important for nurse managers. The result showed that among the skills considered extremely important by the nurses are: a) Knowledge: Know the health policy (62.50%); know the mission and goals of the health institution (75.00%); Knowing services developed in the U.S. (79.16%), knowledge of rules and procedures (70.83%); Knowledge of quality of service (72.73%), b) skill: Being able to communicate adequately with staff and users (95.83%); Being ethical with staff, superiors, and users (91.67%); Being able to promote and maintain relationships with staff and users (87.50%); To identify problems (82 , 61%), c) attitudes: Be fair to your team and users (70.83%); Be open to change (70.83%); have involvement with work, with staff and community (70.83% ) What favors teamwork (70.83%); Who knows accept criticism (70.83%). From the results it appears that the respondents consider very important for the unit manager skills that added to the profile will comprise an individual who has knowledge of public policies, standards, mission and objectives and assessing the quality of their work, able to communicate with others appropriately, with an ethical procedure, companionship and attention to problems, flexible, engaging, and participatory, with humility toward criticism. It is noticed that all these skills are combined in one person make up the ideal professional, morally and technically qualified to take up his managerial position, care and citizen, with ethics, knowledge and determination. The search result leaves perceive the need for further studies to investigate whether nurse managers are putting into practice in their daily life skills they consider extremely important, so that your professional performance achieves the desired objectives by all. / Após a base e a estrutura formadas sobre um regime monástico de dedicação e caridade, a enfermagem foi mudando de perfil, passando de atividade, a profissão regulamentada e respeitada. Por meio de novas atribuições entregues ao profissional enfermeiro, passou a ser necessário que este receba uma formação mais adequada as suas funções na modernidade, que incluem além dos cuidados o gerenciamento da unidade de saúde (US) onde trabalha. A partir dessa constatação foi definido o problema de pesquisa que norteou este estudo: Quais são as competências de conhecimento, habilidades e atitudes consideradas como de extrema importância para os gerentes de enfermagem?, cujos objetivos são: - Identificar o grau de importância das competências de conhecimento, habilidades e atitudes, segundo à percepção dos gerentes de enfermagem; - Caracterizar a população de gerentes de enfermagem da instituição pesquisada; - Identificar as competências consideradas de extrema importância pelos pesquisados; - Descrever sobre as competências consideradas de extrema importância pelos pesquisados. Para alcançar os objetivos foi realizada uma pesquisa de campo, de caráter exploratório, descritivo com abordagem quantitativa, que teve como sujeitos 25 gerentes de US de um hospital escola, de grande porte da cidade de Santa Maria-RS. A pesquisa realizada no ano de 2011, utilizou um instrumento de pesquisa dividido em duas partes: a) informações sociodemográficas; b) 51 itens para a eleição das competências relacionadas a habilidades (20 itens), conhecimento (16) e atitudes (15) consideradas de extrema importantes para os enfermeiros gerentes. O resultado apontou que entre as competências consideradas de extrema importância pelos enfermeiros estão: a) conhecimento: Conhecer as políticas de saúde (62,50%); Conhece a missão e os objetivos da instituição de saúde (75,00%); Conhecer os serviços desenvolvidos nas US (79,16%); Conhecimentos de normas e procedimentos (70,83%); Conhecimento da qualidade do serviço prestado (72,73%); b) habilidade: Ser capaz de comunicar-se de forma adequada com a equipe e usuários (95,83%); Ser ético com a equipe, superiores e usuários (91,67%); Ser capaz de promover e manter relacionamento com equipe e usuários (87,50%); Saber identificar problemas (82,61%); c) atitudes: Ser justo com sua equipe e usuários (70,83%); Ser aberto as mudanças (70,83%); Ter envolvimento com o trabalho, com a equipe e comunidade (70,83%); Que privilegie o trabalho em equipe (70,83%); Que saiba aceitar críticas (70,83%). Do resultado depreende-se que os pesquisados consideram de extrema importância para o gerente de unidade competências que agregadas ao seu perfil comporão um indivíduo que tem conhecimento de politicas públicas, normas, missão e objetivos e que avalia a qualidade do seu trabalho; capaz de se comunicar com os demais de maneira adequada, com um procedimento ético, de companheirismo e atento aos problemas; flexível, engajado, e participativo, sendo humildade em relação às críticas. Percebe-se que todas essas competências se reunidas numa só pessoa comporão o profissional ideal, capacitado moral e tecnicamente para assumir a sua posição gerencial, de cuidados e de cidadão, com ética, conhecimento e determinação. O resultado da pesquisa deixa perceber a necessidade de estudos posteriores que possam investigar se os enfermeiros gerentes estão colocando em prática no seu cotidiano as competências que consideram de extrema importância, de maneira que o seu desempenho profissional alcance os objetivos almejados por todos.

Abstract The goals: The goal of the present thesis is to describe the principles of safe identification of patients by a nurse and the application of the medicines with higher risk rate. Another goal is to define procedures for prevention of a confusion of an intervention, a location or a patient at the operation theatre and to characterize the hand hygiene procedures in healthcare. The next goal was to describe a programme of prevention and reduction of falls and decubiti in hospitalized patients. The last goal focuses on the oral and telephonic prescription of medicines, on the reporting of patient examination results, and on the procedure of patient handover. Eight research questions were set in relation to these goals. Methodology: A qualitative research method based on in-depth interviews was chosen to reach the goals of the thesis. The intentional choice method was chosen for the selection of the communication partners. The research was performed in three selected hospitals of the South Bohemia Region. 20 communication partners participated in the anonymous questioning. The in-depth interviews were performed with a head nurse, with a quality manager, with perioperative nurses, with nurses from a neurology department and an after-care department. Scientific contributions of the thesis: The research deals with the current safety problems of hospitalized patients. The scientific results of the research are intended for both, specialist and the general public. The research study could serve to hospital managements as a stimulus for the improvement of the safety in the healthcare provision system. The achieved findings and conclusions: Hospitalization always brings some risk to a patient. From the point of view of the minimizing of adverse events and damage to a patient healthcare staff need to identify a patient safely, to apply risky medicines in safe manners, to prevent adverse events in operations, to adhere to the hand hygiene and the barrier nursing techniques. The healthcare staff also have to proceed correctly in the oral or telephonic prescription of medicines, in reporting of patient examination results, and in the patient handover procedures. It is in also the interest of the healthcare staff to minimize the risk of falls and to prevent the occurrence of decubiti in hospitalized patients.

Current status: Safe process treatment should be provided to every patient in every hospital. Nurses should work to avoid security violation, especially in the surgical field, associated with irreversible changes in the treatment process. Perfect mastery of these measures assures patient safety. Risk prevention, safety of the patient and the medical personnel require the involvement of all members of the multidisciplinary team (Pokojová, 2011; Škrla and Škrlová, 2003). Objective of the research: to map the attributes of postoperative care in the safe treatment of patients. To determine whether nurses master preventive measures in safe patient care and whether they ensure compliance with the principles of safe care in practice. Methods: the research analysis was chosen to be based on qualitative research method. Data acquisition was performed in semi-structured interview with nurses, supplemented with hidden observation. The participation in the interviews was voluntary and anonymous. Audio data was recorded from the interviews and transcribed verbatim. The observation aimed to determine whether nurses respect the principles of safe care for patients in the postoperative care. Research cohort: consisted of general nurses who worked at the surgical wards and recovery room. The research was conducted in one of the hospitals of South Bohemia. Twelve nurses were interviewed. The interview and hidden observation were focused on patient safety in the postoperative period. The interviews were performed at nurse day-time rooms of individual surgical wards, some of them outside the hospital. All nurses met the criterion to be a provider of nursing care for post-operative patients at surgical wards and recovery rooms. The interviews were finished when reaching the theoretical saturation, when the answers and hidden observation of the respondents started to repeat the already acquired data, i.e. after twelve interviews and observations. Results: The nurses working in surgical wards and recovery rooms are exposed to a considerable mental and physical strain. This profession is very demanding and requires not only theoretical knowledge, but also manual dexterity in practice. Nurses are involved in the care process in a considerable extent. Therefore, it is important that the care was good and safe. In the treatment process, the nurses sometimes do not comply with relevant standards and the requirements for safe treatment. It is essential to follow the identification bracelets to avoid patient mismatch, thus endangering patients' health. Some nurses checked the identification bracelets thoroughly, but there were also nurses who ignored these rules too much and gamble with the patients' health. Medication errors are the most common cause of patient injury. The risk of medication errors increases also due to improper storage of hazardous drugs. In our investigation, the medication was repeatedly stored at a different place (not returned back to the original area), poorly stored or left freely available to anyone. If the physician records are illegible, the nurses solve the issue rather by guessing or asking an assistance from colleagues in the department. This area also includes replacement of medication by nurses if the prescribed product is not available at the ward, without consulting a physician first. The negligence in the use of protective equipment during dressing changes is alarming. Possible transmission of nosocomial infections. Poor or little use of disinfectants. Conclusions: Treatment of patients in the early and late postoperative care is one of the high risk parts of the hospitalization of patients at healthcare facilities. In this period, patient monitoring and risk prevention are essential. It includes pain control, the care for surgical wounds, safe patient identification, prevention of adverse events in both medication administration and patient falls, the compliance with hand hygiene ...

The thesis presented consists of two parts: a theory and the empirical part. The theory is introduced with a brief survey of the history of the patient centred care followed with current trends in nursing. It is followed with the three key areas determining nursing care. The first one consists of the objective factors - the health care system. The second area is formed by the factors associated with the practical implementation of nursing. The third area is devoted to the role of the patient and his surroundings. Objective of the thesis: The mapping of the factors influencing patient-oriented care by the nursing staff and management in various health care institutions. Research group The research group consisted of 11 female respondents state-registered nurses, aged from 24 to 58 years of age. The respondents varied in their position, level of education, and specialization, and they worked in various health-care institutions. Among them, there were 6 registered nurses, 4 ward nurses, and 1 head nurse. The willingness to cooperate and the saturation of responses were principal in forming the research team in question. The way adopted for achieving of the objective A qualitative research method has been chosen to achieve the goal. The phenomenological focus of the work has led to the selection of the method. The data were collected using semi-structured interviews. The findings were further categorized and confronted with the source material to answer the research questions. Results The research confirms the nursing care is a complex phenomenon. The recently-adopted health care legislation shows a shift from the paternalistic concept of care on behalf of the right of the patient to self-determination. On the other hand, however, the principle of solidarity the basis of the health care system in the Czech Republic retains some paternalismus, and that can negatively affects the relationship of the patient to the nursing staff in some cases. The respondents are in agreement as to the notion of PCC but a single one respondent knows its concept. The possibility of putting the PCC in practice is hampered by a wide range of factors. According to the respondents, the major obstacle is the undernumerousness of the nursing staff, resulting in the omnipresent time stress. The excessive red-tape demands have been seen as the almost equally important factor, together with the lack of continuity of care, but also the fast-and-loose approach of some nurses. The evaluation of the cooperation between staff nurses at the bed and the nurses in senior positions differed. Staff nurses see the problem in cooperation with their superiors, lacking appreciation of their work. Management, i.e. head nurses and ward nurses are often seen as systemic obstacles. The research investigation also shows insufficient cooperation with the patient's family. Permanent changes in the nursing education concept are seen as a hindrance to the problem solution. Regretfully, the actual approach of a nurse often slides down from a vocation to a mere employment. Conclusion The problems identified in the healthcare system indicate a wide range of factors influencing the relations between the nursing staff and patients. Multidimensional patient care concepts and examples from our healthcare system illustrate how clinical, structural, and interpersonal factors can interact in the relations between nursing staff and patient. The PCC concept should enable any health-care provider to set ways to improvement the care rendered and to motivate the caring staff to adopting it.

Cooperation of nurses and physicians from the perspective of nursing management Master's thesis was focused on the cooperation of nurses and physicians from the perspective of nursing management. Nursing care and nursing management has an irreplaceable role in health care. The world of medicine, nursing care and health care is an extremely complex organizational system, which is not surely represented only by physicians and nurses, but these, however, are still the dominant persons on the scene. The first objective of this thesis was to make a survey of cooperation between nurses and physicians during the nursing process in the care of patients from the perspective of nursing management in departments of surgery and internal medicine. The second objective was to identify problem areas in cooperation between nurses and physicians from the perspective of nursing management in departments of surgery and internal medicine, and the third objective was to find out the way the nursing management tackles problem situations in cooperation between nurses and physicians in departments of surgery and internal medicine. To meet these objectives four research questions were stated: 1. In what areas do nurses and physicians cooperate during the nursing process while providing care for patients from the perspective of nursing management in their respective departments? 2. How do nurses assess and perceive cooperation with physicians from the perspective of nursing management in their respective departments? 3. Are there problem areas in cooperation of nurses and physicians from the perspective of nursing management in their respective departments? 4. How does nursing management tackle problem situations in cooperation between nurses and physicians in their respective departments? The research was conducted in the hospital, where I was given information under the condition of anonymity of the respondents interviewed. The responders were chief nurses and senior staff nurses working in departments of surgery and internal medicine. The investigation conducted is a qualitative research. Interviews with the structure of questions to non-standardized interviews were conducted with the respondents according to question structures of the non-standardized interview. Subsequently, transcripts of interviews and data categorization in tables according to the Ritchie and Spencer´s framework analysis were made. The survey suggests the following conclusions. Nurses and physicians cooperate within the nursing process in providing care for patients from the perspective of nursing management in departments of surgery and internal medicine at the stage of problem solving. Nurses appreciate cooperation with physicians on the basis of mutual respect, but they still feel the prevailing dominance of physicians. From the perspective of nursing management there are problematic areas in cooperation between nurses and physicians. Nursing management tackles problem situation in cooperation between nurses and physicians by seeking common solutions. It will be possible to provide the health care facilities, where the research was conducted, with the outcomes of the research. Thinking about the possible improvement in mutual cooperation as early as during physicians´ and nurses´ studies, to introduce various measures to improve cooperation between nurses and physicians by organizing joint seminars and cultural events could lead to meeting the purpose. It is necessary to raise physicians´ awareness of nursing process and to carry out further research on this topic.

Fragestellung: Mitarbeitende in kinder- und jugendpsychiatrischen (KJP) Einrichtungen stehen im Spannungsverhältnis zwischen der Durchsetzung von Rauchverboten für Patient_innen und dem eigenen Rauchverhalten. Bisher fehlen Daten, ob und wo Mitarbeitende rauchen und welche Entwöhnungsangebote KJP-Einrichtungen ihnen anbieten. Methodik: In einer Onlinestudie beantworteten n = 78 leitende Mitarbeitende deutscher KJP-Einrichtungen (41.9 % aller Angeschriebenen) Fragen zu stationsübergreifenden sowie stationsspezifischen Nichtraucherschutzmaßnahmen sowie zu Tabakentwöhnungsmaßnahmen. Ergebnisse: Umfassende Rauchverbote werden selten umgesetzt (< 20 % der Einrichtungen). Mitarbeitende dürfen vorrangig im Außengelände rauchen (z. B. in Raucherzonen: 69 bis 78 % je nach Stationstyp). Entwöhnungsangebote für Mitarbeitende bietet nur jede zweite KJP an (47 %). Schlussfolgerungen: Die Daten weisen auf zukünftige Handlungsfelder der Tabakkontrolle in der KJP-Pflege hin: transparente Regeln, Weiterbildungen und Ausbau betrieblicher Entwöhnungsangebote. / Objective: Whereas, on the one hand, employees in child and adolescent psychiatric institutions (CAP) have to enforce smoking bans among patients, on the other hand, they have a high likelihood of being smokers themselves. Little data are available on the enforcement of smoking regulations and what cessation support is offered by CAP institutions. Method: In an online survey, n = 78 senior staff members or directors of German CAP institutions (41.9 % of all addressed CAP institutions) responded to questions on smoking regulations, exceptions, and cessation support for employees. Results: The enforcement of comprehensive smoking bans is rarely reported (<20 % of CAP institutions). Employees are exempted or allowed to smoke mostly outside of the building (e. g., in designated smoking areas: 69-78 % depending on ward type). Cessation support was offered by less than half of the CAP institutions (47%). Conclusions: The data presented point toward future areas for tobacco control in CAP care, including transparent regulations, staff training, and dissemination of support for occupational smoking cessation.

A presente pesquisa teve como objetivos: reconhecer nos discursos de gerentes e enfermeiras que atuam em assistência domiciliária (AD), na cidade de São Paulo, a identificação dos critérios utilizados para dimensionar o pessoal de enfermagem nesse tipo de assistência e propor um modelo que norteie o dimensionamento desse profissional. O estudo apoiou-se no método qualitativo, os dados foram coletados por meio de entrevistas semi-estruturadas e analisados pelo processo de análise de conteúdo, segundo Bardin (1977). As questões norteadoras foram a descrição da indicação de um paciente para AD e como planejam o pessoal de enfermagem. Participaram do estudo 48 profissionais de 24 instituições, sendo 24 gerentes e 24 enfermeiras responsáveis pela enfermagem. Destes, oito eram do setor público e 40 do privado. A média do tempo de experiência em AD dos gerentes foi de 11,83 e das enfermeiras, 6,94 anos. Todos os discursos foram submetidos à análise interpretativa, evidenciando a construção de três categorias: a elegibilidade do paciente, o tempo despendido na assistência e o perfil profissional. A primeira categoria constituiu-se dos critérios de indicação do paciente que, na maioria, são de competência do médico do hospital, posteriormente, avaliados pelo médico da AD. A enfermeira e a assistente social verificam a viabilidade da prestação de serviço. A estabilidade clínica e a presença do cuidador familiar são um dos principais pré-requisitos de elegibilidade do paciente, para todos os serviços independente de recurso financeiro. As condições adequadas de moradia, sua localização e redução dos custos hospitalares são componentes para eleição do paciente. O grau de dependência dos cuidados de enfermagem foi apontado pelos entrevistados como determinante para a classificação do paciente ao tipo de modalidade de AD, monitoramento, atendimento e internação domiciliária e consistiu na segunda categoria. A terceira categoria foi o perfil profissional, fator essencial no dimensionamento do pessoal de enfermagem em AD. As enfermeiras, técnicos e auxiliares de enfermagem que atuam via cooperativa, precisam agir com postura adequada no ambiente do paciente e seus familiares, e a qualidade de prestação de serviços está intimamente relacionada à presença de supervisão, orientação e direção da enfermeira. A identificação dessas categorias possibilitou vislumbrar um caminho para proposição de um modelo, para dimensionar o pessoal de enfermagem domiciliária e transformar dados intuitivos em cientificamente embasados. / The present research aimed to: recognize on discourses from managers and nurses who work with home care (HC) at the city of Sao Paulo, the identification of frameworks used for dimensioning the nursing staff in this kind of care and propose a model to guide the dimensioning of this professional. The study was based on the qualitative method; data was collected by semi-structured interviews and analyzed by the process of content analysis, according to Bardin (1977). The guiding questions were the description of indication of a patient to HC and how they plan nursing staff. Forty-eight professionals from 24 facilities attended the study, in which 24 were managers and 24 were nurses responsible for nursing. From these, 8 were from public setting and 40 from private. The average time of experience in HC for managers was 11.83 years and nurses 6.94. All discourses were submitted to interpretation analysis, becoming evident the creation of 3 categories: the patient eligibility, time spent in care and the professional profile. The first category was constituted of criteria for patient indication in which, most of the time, are the responsibility of the physician in the hospital, and subsequently, (s)he will be evaluated by the physician from HC. The nurse and social worker verify the feasibility of service delivery. The clinical stability and the presence of the family caretaker are one of the main requirements of patient eligibility for all services regardless of financial resources. The adequate housing conditions, its location and hospital cost reduction are components for patient election. The dependence degree of nursing care was pointed out by the respondents as determining for patient classification to the type of modality of HC, monitoring, attendance and home commitment and it consisted of the second category. The third category was the professional profile, essential factor on dimensioning the nursing home care staff and changing intuitive data into scientific-based ones.