The Institute of Medicine reported seven thousand deaths annually due to medication errors. It is estimated that two out of one hundred admissions experience a preventable adverse medication event resulting in an average cost of $4,700 per admission, which is $2.8 million dollars annually for a 700 bed hospital (Institute of Medicine, 1999). In Canada, medication related errors were identified as the most common adverse event (Canadian Institute for Health Information, 2007). A medication error is “any error that occurs during the process of history taking, ordering, dispensing, administering and surveillance of a medication regardless of whether harm occurred to the patient or if there was potential harm (Eslami, Abu Hanna, & de Keizer, 2007; Ong, 2007). Computerized provider order entry (CPOE) can play a vital role in the prevention of medication errors in the drug ordering stage. It was reported that the occurrence of Adverse Drug Events (ADE) was decreased by fifty-five percent with the addition of CPOE system (Berger & Kichak, 2004). However, the literature review on CPOE impact is heavily focused on the physicians’ perspective (Eslami et al., 2007; Reckmann, Westbrook, Koh, Lo, & Day, 2009; ). Nurses play a significant role in the medication process, as traditionally, nurses are involved in all the medication process stages. Research on the impact of CPOE in the entire medication process is still lacking (Househ, Ahmad, Alshaikh, & Alsuweed, 2013). Understanding the perspective of nurses on the impact of CPOE in their work will increase awareness and understanding of CPOE use among health care professionals and health informaticians. This research adopts a grounded theory approach to explore the question of “how do nurses perceive the impact of CPOE on the medication process and on collaborative practice?” Ten participants were interviewed and out of the ten, eight participants were observed during a portion of their work. The information collected was analyzed using a constant comparative method. Participants described that the CPOE supported legible order communication between care providers and departments. CPOE use removed the requirement to transcribe orders to the medication administration record, as well as, the necessity to fax the order sheet to the pharmacy. However, in the ordering stage the nurse is also involved in providing information for order decision-making. Nurses discuss probable medication orders in cases of urgent situations, or nursing assessments of the patient. In this decision-making, the information requirements of nurses involve not only the medication information, but also information about other orders such as diagnostics, laboratory, and patient care orders. Future CPOE design and CPOE implementations should consider including mobile devices, alerts, and workflow modeling with the nursing information needs. / Graduate / 0710 / 0569 / vitor@uvic.ca

M.Cur. / It has been demonstrated that mentoring improves outcomes at both the individual and organizational level. The shortage of skilled human resources in nursing has indicated the need for mentoring. However, no formalized framework exists on how mentoring in the context of nurse unit managers should occur, despite mentoring being a legal requirement (South Africa, 2004:26). The intention of this study was to develop a mentoring strategy for nurse unit managers in private hospitals in Gauteng. The mentoring needs of nurse unit managers in private hospitals in Gauteng were determined and conceptualized and a framework developed on which the development of a mentoring strategy could be based. A quantitative descriptive research design was followed to develop a mentoring strategy for Nurse Unit managers in private hospitals in Gauteng. Probability sampling was employed (Burns & Grove, 2005:348). A clustered sample (Burns & Grove, 2005:348) of private hospitals within the three regions of Tshwane, Johannesburg Central and Ekurhuleni was drawn. From these a random sample of nurse unit managers in private hospitals within the clusters was drawn. A self-developed closed-ended questionnaire (see Annexure 1) was utilized to collect data on the mentoring needs of nurse unit managers. Data was analysed using the Statistical Package of Social Sciences (SPSS), and a statistician at the University of Johannesburg was consulted. Descriptive statistics were employed to analyse data (Burns & Grove, 2005:442). Content validity was ensured and the instrument piloted to ensure its reliability. An external statistician was consulted to ensure the credibility or validity of the data analysis and interpretation. Ethical approval was sought and measures implemented to ensure the ethical nature of the study. The descriptive data that was analysed included the biographical data – age, gender, race, home language, highest level of qualification, employment status, length of service, length of position, clinical area and the number of work hours of nurse unit managers.The ANOVA statistical results revealed a moderate need for mentoring of nurse unit managers in all of the management dimensions. Recommendations for further research were outlined and a conclusion on the need for nurse unit managers to be mentored was drawn.The researcher noted from reviews of the numerous literature sources, mentoring improves the quality of patient care and cost-effectiveness, and ensures the competitiveness of private hospitals. What this study provides is insight into the mentoring needs and management functions of nurse unit managers working in private hospitals.

Magister Curationis - MCur / Background: Complete recording of information is the foundation of continuity of care. However, the quality of patient information recording is a major problem being experienced by health services institutions in many countries. In Burundi there is a lack of accurate information recording and processing of patient information. The quality of patient information recorded is unreliable for decision making and management of healthcare delivery. Aim: This study investigated the quality of patient information record-keeping among nurses in selected hospitals in Burundi. The objectives were as follows: (a) to describe the knowledge of nurses on the benefits of the quality of patient record-keeping in selected hospitals in Burundi, (b) to describes nurses’ attitudes on the benefits of the quality of patient record-keeping in selected hospitals in Burundi, c) to determine the association between sociodemographic characteristics and nurses’ knowledge and attitudes on the benefits of the quality of patient record-keeping in selected hospitals, and (d) to identify barriers influencing the quality of record-keeping in selected hospitals in Burundi. Methodology: The study employed a quantitative research approach using a descriptive survey design. The target population for this study was N=121 nurses; an all-inclusive sampling technique was used to include all 121 qualified nurses who were working in the selected hospitals. A self-administered questionnaire was used to collect the data. The data were analysed using SPSS version 24. Statistical variables such as knowledge, attitudes and barriers were analysed using descriptive statistics to generate frequency, and cross tabulation using chi square test was also adopted to determine the association between sociodemographic characteristics and nurses’ knowledge and attitudes on the benefits of the quality of patient record-keeping. The reliability and validity of the instrument were established and a pre-test was conducted to validate the questions. All ethical principles regarding the study were adhered to. The findings from this study provide relevant information about the benefits of quality of patient record-keeping for the management of the hospitals and all relevant stakeholders in Burundi.

Nurses working in the North Carolina counties of South Central Appalachia (NC-SCA) are a unique subset of nursing professionals. A continued nursing shortage is projected in this area while staffing has improved in other areas of SCA. The purpose of this research was to ascertain the level of job embeddedness of nurses working in NC-SCA in order to offer guidance regarding retention of nurses working in this area. Actively working licensed practical nurses, registered nurses, and advanced practice nurses (nurse practitioners, certified nurse midwives, clinical nurse specialists, and certified registered nurse anesthetists) from 29 North Carolina counties included in South Central Appalachia comprise the study population. Rural Nursing Theory alongside the concept and theory of Job Embeddedness (JE) examines organizational and community influences on retention. Data collection consisted of an online survey and included a demographic questionnaire along with the JE research instrument. Understanding what keeps these nurses on the job is beneficial to nurses, health care organizations, and patients. History of living in rural area, years at job position, intent to stay, work commute in miles, and work commute drive time were significant factors in Job Embeddedess prediction.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Science in Nursing Johannesburg, 2017 / The purpose of this study was to describe the role of specialist nurses in mechanical ventilation management. The intention of the study was also to make recommendations for clinical practice and education of intensive care nurses. The setting of the study was ten (n = 10) adult intensive care units of two public hospitals in the Gauteng province. Included were trauma ICUs, cardiothoracic ICU, coronary care ICUs, major burns ICU, major injuries ICU, neurosurgery ICU and multidisciplinary ICUs. A non-experimental, descriptive, quantitative and cross-sectional survey design was used to describe the specialist nurses role in ventilation management. The final sample comprised 110 (out of 165) respondents, which yielded a response rate of 66.6% for the study. Data were collected from specialist intensive care nurses using a validated questionnaire developed by Rose et al. (2011). Data was analysed using descriptive (frequencies, means and standard deviation) and comparative statistical tests using t-tests and Chi-square analysis. Testing was done at the 0.05 level of significance. Of the 165 surveys distributed, 110 were returned (response rate 66.6%). Ninety-seven percent stated that a 1:1 ratio was used for patients receiving mechanical ventilation. Eighty-nine percent reported ventilation education for nurses was provided during ICU orientation, and 86.4% indicated ICUs provided opportunities for on-going ventilation education. Eighty-six percent of nurses reported that they had not worked in ICUs with automated weaning modes. Fifty-nine percent stated that weaning protocols were present in ICUs, and 56.4% reported the presence of protocols for weaning failure. Most nurses agreed that nurses and doctors collaborated in key ventilation decisions, but not when decisions to extubate and initial ventilation settings are made. This study showed a marginal (2%) number of nursing autonomous input made in key ventilator decisions. Seventy percent of nurses in this study agreed that responsibility for ventilation decisions lies at the level of senior registrars and above, and in their absence, only senior nurses (>80%) were perceived to be responsible for key ventilator decisions. Regarding independent titrations of ventilator settings, without medical consultation, findings showed that nurses in this study reported a frequency of >50% of the time for titration of respiratory rate, tidal volume, decreasing pressure support, increasing pressure support, titration of inspiratory pressure and ventilation mode changes. The self-perceived nursing autonomy and influence in decision making revealed a median score of 7 out of 10 points, respectively. Nurses with higher levels of autonomy, influence in decision making and years of experience scores, frequently (>50% of the time) made independent changes to ventilation settings (p<0.05). Conversely, nurses with fewer years of experience scores, infrequently (<50% of the time) made independent changes to ventilation settings without first checking with the doctor. The study concludes that nurses to re-evaluate their role in ventilation management and focus on key ventilation settings, nurses could strengthen their contribution in the collaboration of key ventilator settings. Recommendations are made for clinical practice and education of specialist nurses. / MT2018

Faculty of Health Sciences Schoolof Nursing Thearpeutic Sciences 0210998w 0842097202 / In order for caregivers to be better able to work with dying patients, they need to confront their fears about their own mortality and explore their feelings about their personal and professional losses. The importance of death anxiety research rests on the premise that death is an eventuality that everyone faces and how health professionals, specifically, deal with death anxiety is of considerable relevance as to the quality of care given to the terminally ill patient. The purpose of this study was to identify, explore and describe nurses’ personal fear of death (death anxiety) and explore whether an association exists between death anxiety and their attitudes towards dying patients in a private acute care hospital in Johannesburg. A quantitative, descriptive correlational survey was conducted to examine the relationship between death anxiety and nurses’ attitudes toward terminally ill patients in a private acute care hospital in the province of Gauteng in South Africa. Various extraneous variables have been identified and defined. No attempt was made to control or manipulate the situation as it was currently occurring. The study population comprised of all nurses working in this hospital who fulfilled the stipulated selection criteria. Data were obtained from nurses through the use of a self-administered questionnaire. The response rate was 42% of the expected population. A total of 93 responses were received. Descriptive statistics were used to analyze data and the significance of the relationships between variables was determined using the Fishers exact test (p-value of 0.05). The findings of this study were consistent to that of similar studies. Findings suggest high levels of death anxiety within the study population with correlating negative death attitudes. This may be associated with the fact that a significant proportion of the study sample was younger and less experienced as opposed to those who demonstrated lower levels of death anxiety and positive death attitudes and were more experienced and older. v A strong association was found between death anxiety and death attitudes. Statistically significant relationships between age and length of nursing experience/exposure were found. No significant relationships between sex, institutional support, death anxiety and death attitudes were found. Of import, the need for ongoing terminal care education was identified in this study.

MSc (Nursing), Faculty of Health Sciences, University of the Witwatersrand / Nurses working with critically ill patients in intensive care units (ICUs) have a unique role to play in health care. They spend 24 hours with patients and come into contact with all the disciplines which come to review these patients. Nurses therefore need to effectively collaborate with the multidisciplinary teams, especially physicians, in order to meet patients’ needs and maximise patient care outcomes. The purpose of this study was to identify and describe nurses’ perceptions towards nurse-physician collaboration in the intensive care units. A non experimental descriptive study design was utilised in this study. Data were collected using a questionnaire developed from the Jefferson Scale of Attitude toward Physician-Nurse Collaboration with additional two open-ended questions to cover the rest of the study objectives. Data were analysed using descriptive and inferential statistics as well as content analysis. Results showed that nurses working in Intensive Care units (ICUs) had positive attitude towards nurse-physician collaboration regardless of gender, years of working in the ICUs and whether registered intensive critical care nurse or not. The findings also showed that nurses perceive that the process of nurse-physician collaboration in Intensive Care Units provokes a number of challenges, such as superior-subordinate relationships which exist between nurses and physicians, workload and overlapping responsibilities hence, nurses feel inferior, undermined, mostly overwork and become frustrated. However, nurses suggested that promoting team-work; a focus on patient-centered care and staff motivation would assist in creating effective collaborative environment. collaborative environment

As pesquisas que tratam do coping religioso-espiritual (CRE) que vem sendo publicadas ainda não abordaram esta temática com relação ao profissional de enfermagem, profissional este submetido a vários fatores de estresse originados não só de sua prática laboral, mas também oriundos do cotidiano existente fora do local de trabalho. O presente estudo foi desenvolvido com o objetivo de verificar se os profissionais de enfermagem (auxiliares, técnicos e enfermeiros) se utilizam do coping religioso-espiritual para lidar com os fatores de estresse vivenciados tanto no trabalho como na vida particular. Trata-se de um estudo transversal, descritivo de abordagem quantitativa de natureza exploratória, no qual foram convidados a participar da pesquisa todos os profissionais de enfermagem da Unidade de Urgência e Emergência do Hospital das Clínicas de Ribeirão Preto, obtendo-se uma amostra de 126 participantes aos quais foi entregue a cada profissional um envelope contendo o termo de consentimento, o Questionário Geral e a Escala CRE, que foram devidamente preenchidos fora do ambiente de trabalho e devolvidos à pesquisadora posteriormente. Os resultados mostraram que a média de CRE total foi de 3,66, a média de CREP foi de 3,11 e a média de CREN foi de 1,78 e que as mulheres fazem mais uso do coping religioso-espiritual positivo do que os homens. Com relação a situação de estresse referida pelos respondentes, verificou-se que a maioria relatou ter vivenciado uma situação de estresse em ambiente familiar (61,1%), que 25,4% relataram ter vivido uma situação de estresse no ambiente de trabalho, 2,4% referiam ter vivenciado situações de estresse em ambos os ambientes e 10,3% relataram não ter vivenciado nenhuma situação de estresse no período indicado. Apenas 0,8% não respondeu a pergunta. Os resultados obtidos por meio dos índices da escala CRE neste trabalho já eram esperados tendo em vista a religiosidade do povo brasileiro, especialmente a religiosidade da mulher brasileira, no entanto, não foi verificado o impacto do uso do coping religiosoespiritual para a saúde dessa categoria profissional, sendo necessários novos estudos, principalmente com relação ao impacto do uso da dimensão negativa do CRE, que, apesar de ter sido pouco utilizada pelos participantes deste estudo, tratase de informação importante que pode afetar a saúde daqueles que fazem seu uso, cabendo aos futuros pesquisadores na área investigar também possíveis formas trabalhar este aspecto para a realização da promoção da dimensão espiritual dos profissionais de enfermagem. / Researches published in the area of spiritual/religious coping (SRC) still not addressed this issue related to nursing professionals who are submitted to different stress factors arising not only from their work practice, but also from their everyday life outside the workplace. This study aimed to verify if nursing staff (assistants, technicians and nurses) uses the spiritual/religious coping to deal with the stress factors experienced both at work and in private life. It is a cross-sectional, descriptive, and quantitative study in which all nurses of the Emergency Unit of the Hospital das Clínicas of the University of São Paulo at Ribeirão Preto Medical School were invited to participate, obtaining a sample of 126 participants who were given an envelope containing a free consent form, the General Questionnaire, and the Spiritual Religious Coping Scale (SRCOPE Scale), which were completely filled out by the participants out of the workplace and then returned to the researcher. The results showed that the SRC average was 3.66, the positive SRC average was 3.11, the negative SRC average was 1.78, and that women make more use of positive spiritual/religious coping than men. Regarding the situation of stress mentioned by the participants, it was found that the majority reported having experienced a stressful situation in the family setting (61.1%); 25.4% reported having experienced a stressful situation in the workplace; 2.4% reported having experienced stressful situations in both environments; and 10.3% reported not having experienced any stressful situation during the period of the study. Only 0.8% of the participants did not answer the questions. The results obtained through the index of the SRC Scale were expected in view of the religiosity of the Brazilian people, especially the religiosity of Brazilian women, however, it was not seen the impact of the use of spiritual/religious coping for the health of this professional category, which warrants further studies, particularly with respect to the impact of the use of negative dimension of the SRC, which, although it was rarely used by the participants in this study, it is an important information that can affect the health of those who make its use, leaving it to future researchers in this area also investigate possible ways to work to achieve the promotion of the spiritual dimension of nursing professionals.

Thesis advisor: Christopher Maxwell / Though much research has been done on the subject of substituting nurse practitioners for physicians as health care providers, both analytic methods and results have been inconsistent. Various studies have shown nurse practitioners to provide equivalent or improved care especially in primary care settings. However, no consensus has been reached on whether or not and under what conditions this substitution is economically efficient. Because of variation in productivity and substitution rates, the economic viability of nurse practitioners must be assessed on a department specific basis, taking into account differences in nurse practitioners’ job descriptions.One specific area this economic efficiency could be assessed in is in the diagnosis of ear infections. A study conducted through the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey showed that 15% of pediatric visits included a diagnosis of middle ear infection (Freid, 1998). If employed properly, nurse practitioners could be used to achieve significant cost savings in this area.This thesis is intended to address the economic efficiency of nurse practitioners as compared to physicians in diagnosing ear infections. First nurse practitioner quality in this specific area will be assessed by comparing nurse practitioner diagnosis error rates to physician error rates based on surveys asking both types of providers to provide diagnoses based on tympanic membrane images collected through previous telemedicine visits. Next the economic practicality of employing nurse practitioners in this field will be assessed in terms of the relative costs of these errors, measured as the cost of unnecessary prescriptions in the case of overdiagnosis and the cost of an unnecessary follow-up visit in the case of underdiagnosis. / Thesis (BA) — Boston College, 2012. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: College Honors Program. / Discipline: Economics Honors Program. / Discipline: Economics.

Thesis advisor: Patricia Tabloski / Fatigue is a factor in human error particularly on tasks requiring sustained attention (Dinges, 1995). Work-hour studies of staff nurses have demonstrated that the risks of making an error increased when nurses worked longer shifts (Rogers, Hwang, Scott, Aiken, and Dinges, 2004. Workload in anesthesia care can vary widely with diverse cognitive and physical demands (Gaba and Lee, 1990; Weinger, Herndon, Zornow, Paulus, Gaba, and Dallen, 1994; Weinger, Reddy, and Slagle, 2004; Weinger and Slagle 2001). The purpose of the study was to examine the influence of work hours and workload on fatigue in certified registered nurse anesthetists (CRNAs). A predictive, correlational design was employed and utilized an electronic survey of 10,000 active certified and active recertified CRNAs. A total of 928 CRNAs completed the survey which included a self-report of work hours. Workload was measured by the NASA Task Load Index and fatigue by the Checklist Individual Strength (CIS-20). Hierarchical multiple regression analysis was applied to the data to test the hypotheses that 1) after controlling for demographic variables, the number of work hours and workload will positively influence post-shift fatigue in nurse anesthetists and 2) after controlling for demographic variables, there will be an interaction between work hours and workload in nurse anesthetists. Work hours and workload explained 19 % of the variance in fatigue in nurse anesthetists with the greatest contribution being from the number of work hours and the workload dimension of performance satisfaction. The study findings suggest that increasing hours of anesthesia time and increasing workload, particularly dissatisfaction with meeting the goals of the anesthetic (performance dimension) increase fatigue in nurse anesthetists. The implications for practice, policy, and research are discussed. / Thesis (PhD) — Boston College, 2013. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.