Employee engagement is a topic that has been widely studied over the course of the past 30 years. Its potential value to healthcare organizations has only begun to be recognized within the most recent decade. Numerous studies have been conducted which demonstrate that increased employee engagement contributes to improved patient outcomes, including decreased mortality and hospital acquired conditions as well as increased patient experience scores. Despite the plethora of literature available documenting the drivers of, barriers to, and outcomes associated with employee engagement hospitals have struggled to gain traction in increasing their scores. Many experts in employee engagement posit that this could be due to a lack of consistent conceptualization of the phenomenon. This qualitative descriptive study was conducted to understand the perceived attitudes and behaviors of the nurses who are engaged in their work from the perspective of both their peers and leaders. Sixteen total participants were interviewed utilizing a semi-structured interview guide with questions that were derived from Arnold Bakker’s evidence-based model of work engagement. Content analysis was utilized to identify themes and sub-themes from each of the participant group’s responses to each of the questions. There were minimal differences in the responses of the direct-care RNs as compared to the nurse leaders regarding their perceptions of the engaged nurse. Resulting themes were then synthesized and four overarching themes identified. Overarching themes were personal style, extra-role behavior, commitment to the patient, and leadership. Participant responses supported Bakker’s model, but highlighted the engaged nurse’s personality as a significant and widely overlooked contributor to engagement. By recognizing the personal attributes inherent to the engaged nurse hospitals may better understand the traits important to the recruitment of nurses who are more likely to be engaged in their work. Effective recruitment and retention of a highly engaged workforce will allow organizations to benefit from the extra-role work often demonstrated by the engaged nurse and realize improved patient outcomes as a result.

by Lau Ming Ho Victor. / Thesis submitted in: Dec. 1998. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (leaves [111-120]). / Abstract also in Chinese. / Chapter Chapter 1: --- Introduction --- p.1 / Chapter Chapter 2: --- Review of Literature --- p.3 / Chapter 2.1 --- The Learning Disability Hospital as an institution --- p.3 / Chapter 2.2 --- Social Policy --- p.4 / Chapter 2.3 --- Findings of The Interpretative Studies --- p.10 / Chapter 2.3.1 --- Institutional context for staff practice --- p.10 / Chapter 2.3.2 --- Critique of Goffman work --- p.12 / Chapter 2.3.3 --- Theoretical studies in learning disability hospitals: residents as objects --- p.13 / Chapter 2.3.4 --- Institutionally-oriented practice --- p.15 / Chapter 2.3.5 --- Instrumental control --- p.15 / Chapter 2.3.6 --- A ffective control --- p.16 / Chapter 2.4 --- Observational Studies in Hospital Wards for People with Learning Disability --- p.19 / Chapter 2.5 --- Institutional Influences --- p.21 / Chapter 2.6 --- Role Redefinition of Ward Nurses --- p.22 / Chapter 2.7 --- Staff-Resident Dynamic --- p.23 / Chapter 2.8 --- Summary of Literature Review --- p.24 / Chapter 2.9 --- Aims and Objectives of Study --- p.25 / Chapter Chapter 3: --- Methods --- p.26 / Chapter 3.1 --- Operational Definition of Interaction --- p.26 / Chapter 3.2 --- Research Design --- p.26 / Chapter 3.3 --- Setting --- p.28 / Chapter 3.4 --- Data Collection Method: Systematic Observation --- p.30 / Chapter 3.4.1 --- Staff-Resident Interaction Chronograph (SRIC) --- p.30 / Chapter 3.4.2 --- Conducting the observations --- p.34 / Chapter 3.5 --- Data Collection Method: Qualitative Interview --- p.35 / Chapter 3.5.1 --- Conducting the qualitative interviews --- p.35 / Chapter 3.6 --- Sampling for Observation --- p.35 / Chapter 3.7 --- Sampling for Qualitative Interview --- p.36 / Chapter 3.8 --- Ethical issues --- p.39 / Chapter 3.9 --- Pilot Work --- p.40 / Chapter 3.10 --- Major Changes in The Main Study --- p.41 / Chapter Chapter 4: --- Reliability and Validity Issues --- p.44 / Chapter 4.1 --- Validity and Reliability of Systematic Observation --- p.44 / Chapter 4.1.1 --- Observer training --- p.44 / Chapter 4.1.2 --- Enhancement of inter-observer reliability --- p.45 / Chapter 4.1.3 --- Evidence of inter-observer reliability --- p.45 / Chapter 4.1.4 --- Validity of observational data --- p.46 / Chapter 4.2 --- Reliability and Validity of Interview Data --- p.47 / Chapter 4.2.1 --- Strategies to secure validity and reliability of interview data --- p.48 / Chapter Chapter 5: --- Data Analysis --- p.50 / Chapter 5.1 --- Analysis of Observational Data --- p.50 / Chapter 5.1.1 --- Treatment of written description of nursing behaviours --- p.50 / Chapter 5.1.2 --- Interaction and non-interaction cells --- p.51 / Chapter 5.1.3 --- Calculation of interaction rate --- p.51 / Chapter 5.2 --- Qualitative Data Analysis --- p.52 / Chapter 5.2.1 --- Immersion in the data --- p.52 / Chapter 5.2.2 --- Category building --- p.52 / Chapter Chapter 6: --- Results of Observation Data --- p.54 / Chapter 6.1 --- Overall Findings --- p.54 / Chapter 6.1.1 --- Nursing behaviours towards 'Appropriate 226}0ة resident behavior --- p.56 / Chapter 6.1.2 --- Nursing behaviours Towards 226}0بInappropriate Failure' resident behaviour --- p.57 / Chapter 6.1.3 --- Nursing behaviours Towards 226}0بInappropriate Crazy 226}0ب resident behaviour --- p.58 / Chapter 6.1.4 --- "Nursing behaviours towards 226}0بRequest, resident behaviour" --- p.59 / Chapter 6.1.5 --- Nursing behaviours towards 226}0بNeutral 226}0ة resident behaviour --- p.60 / Chapter 6.1.6 --- Resident behavioural profile in the ward and the Training Center --- p.61 / Chapter 6.2 --- Nurse-Resident Interactions in Ward --- p.62 / Chapter 6.2.1 --- Communication with residents --- p.62 / Chapter 6.2.2 --- Doing nursing care --- p.64 / Chapter 6.3 --- Not Interacting With Residents --- p.65 / Chapter 6.3.1 --- Ward activities --- p.66 / Chapter 6.3.2 --- Self-engaged activities --- p.67 / Chapter 6.3.3 --- Nursing activities --- p.68 / Chapter 6.4 --- Summary of Observational Results --- p.70 / Chapter Chapter 7: --- Results of Interview Data --- p.71 / Chapter 7.1 --- Orientation to A New Clinical Setting --- p.72 / Chapter 7.1.1 --- Meeting with residents 226}0ب disabilities --- p.72 / Chapter 7.1.2 --- Perceptions of residents lives --- p.73 / Chapter 7.1.3 --- Sense of a difference --- p.74 / Chapter 7.2 --- Stressors in Care Setting --- p.75 / Chapter 7.2.1 --- Powerless in caring --- p.75 / Chapter 7.2.2 --- Sense of frustration --- p.77 / Chapter 7.2.3 --- Relative-related stress --- p.78 / Chapter 7.3 --- Experiencing Contextual Constraints --- p.79 / Chapter 7.3.1 --- System constraints --- p.80 / Chapter 7.3.2 --- Managerial constraint --- p.81 / Chapter 7.3.3 --- Time constraint --- p.82 / Chapter 7.4 --- Personal Resolution --- p.83 / Chapter 7.4.1 --- Work attitude --- p.83 / Chapter 7.4.2 --- Self-determination --- p.84 / Chapter 7.5 --- Priority of Care --- p.85 / Chapter 7.5.1 --- Interpretation of care --- p.86 / Chapter 7.5.2 --- Dissimilar approach --- p.87 / Chapter 7.5.3 --- Preference to residents --- p.88 / Chapter Chapter 8: --- Discussion --- p.89 / Chapter 8.1 --- Comparison of present results and previous findings --- p.89 / Chapter 8.2 --- Convergence --- p.91 / Chapter 8.2.1 --- Extrinsic Factors --- p.92 / Chapter 8.2.1.1 --- Contextual constraints --- p.92 / Chapter 8.2.1.2 --- Care Problems --- p.94 / Chapter 8.2.1.2.1 --- Feeding Problems --- p.94 / Chapter 8.2.1.2.2 --- Communication Problem --- p.95 / Chapter 8.2.2 --- Intrinsic Factors --- p.96 / Chapter 8.2.2.1 --- Frustration and powerlessness --- p.97 / Chapter 8.2.2.2 --- Stress coping --- p.99 / Chapter 8.2.2.3 --- Individual work style --- p.101 / Chapter 8.2.3 --- A summary of intrinsic and extrinsic factors --- p.102 / Chapter Chapter 9: --- Recommendations and Conclusion --- p.105 / Chapter 9.1 --- Training Issues --- p.105 / Chapter 9.2 --- Implications for Organisational Change --- p.106 / Chapter 9.3 --- Conclusion --- p.107 / Chapter 9.4 --- Need For Further Research --- p.108 / Chapter 9.5 --- Limitation of the Study --- p.109 / References / Appendices / Appendix A. Geographic map of ward setting / Appendix B. A section of modified behaviour checklist / Appendix C. Interview guides / Appendix D. Observation time-table / Appendix E. Ethical approval / Appendix F. Consent form / Appendix G. Nursing behaviour codes / Appendix H. A section of interview transcript / Appendix I. Sample of interview notes / Appendix J. Sample of matrix method

The explosion of Information, Communication and Technology (ICT) use over the last 10 years within healthcare, and particularly within nursing practice, is changing the ways in which patient care is delivered. However a concern highlighted by various policy review and research evidence is that barriers to ICT usage are experienced by some groups of student nurses, particularly those who are mature and female, in a way that constrains potential impact on their professional development. This research adds to and develops the research evidence in the field by examining in what ways, and the extent to which, a group of mature, female, nursing students utilise ICT within the boundaries of one pre-registration nursing programme based on partnership working between a School of Health situated within a large university and its related NHS Trusts. By way of a qualitative, case study approach this study examines the biographical, university and clinical placement use of ICT for this group of student nurses. Consideration is given to the interconnectedness of these experiences as these students begin to develop their professional identities and learning as nurses. The experiences of this group of students are determined through interviews and observation of clinical practice. Three research questions define the parameters of the research. These are: 1) How are mature, female nursing students accessing and using ICT within nursing education? 2) What are the barriers that may prevent mature, female students from accessing and using ICT within nursing education? 3) What actions do mature, female nursing students consider may be taken to improve their knowledge and subsequent use of ICT in both their academic studies and clinical placement work? Findings from the research suggest that experiences of ICT relate to biographical history and the extent to which student nurses are supported and encouraged to engage with ICT in their university programme and on clinical placement. In particular the data suggests that for many student nurses the feeling and experiences of being generationally, emotionally and hierarchically 'locked out' of using ICT raises real challenges for the extent to which government and regulatory policy is being effectively enacted for particular groups of student nurses. This study, therefore, contributes to knowledge in and around pedagogical practice for pre-registration nurse education programmes. In particular it raises the importance of locating policy development in this area around the explicit privileging and enabling of ICT usage in all practice situations. In other words the development of a collective efficacy in nurse pre-registration programmes that is suggestive of notions of being ICT 'logged in' rather than being 'locked out' for mature, female student nurses.

The demands for high quality primary care have become strained by a deficit in the primary care physician supply and the complexity of delivering care to aging populations that are often living with complex co-morbidities. Provider co-management has emerged in practice to help alleviate some of the care delivery demands by having more than primary care provider (PCP) complete care management tasks for the same patient. There is extensive literature investigating two physicians co-managing patient care, and physician-physician assistant co-management, yet limited studies have investigated nurse practitioner (NP)-physician co-management. NPs currently are the fastest growing health care workforce in the United States. Several organizations support the expanded utilization of NPs in primary care. As more U.S. states are granting NPs independent scope of practice, which is free of physician oversight, the potential for NPs to co-manage patients with physicians, and alleviate some of the primary care strain, has increased. However, there are limited to no studies that have investigated NP-physician co-management in primary care. Further, there is a lack of evidence of PCP perspectives about co-managing care, its impact on patient and practice outcomes, or a tool to measure NP-physician co-management in practice or research. More evidence about NP-physician co-management is warranted and will be investigated in this dissertation. The purpose of this dissertation is to investigate NP-physician co-management in primary care by synthesizing the existing evidence, gathering data from PCPs about NP-physician co-management and to develop a valid and reliable tool to measure it. In Chapter 1, background of the current demands on primary care is presented and accompanied by a discussion about the need to expand the NP workforce in primary care to help meet the demand. Evidence about the history of provider co-management is presented and gaps in the literature are identified. Specific aims of the dissertation are introduced and tied to existing theoretical underpinnings. In Chapter 2, aim one of the dissertation is addressed by qualitatively obtaining data on the PCP perspective of NP-physician co-management. In Chapter 3, aim two of the dissertation is addressed. A systematic review of the literature was conducted to determine the effects of NP-physician co-management compared to a single physician delivering care. In Chapter 4, aim three is addressed. Based on the collective findings of Aim 1 and Aim 2, a new tool is developed and psychometrically tested to measure NP-physician co-management. Content validity and reliability testing of the tool is conducted. In Chapter 5, the results of the dissertation are synthesized. Practice, policy, and research implications are discussed, and strengths and limitations of the dissertation are presented.

abstract: Job burnout, a prolonged reaction to job stress, includes mental and physical aspects of exhaustion related to professional work life. Linked to individual health-related problems, decreased job satisfaction, poor organizational commitment, and higher turnover, burnout poses a problem for both employees and organizations. The nursing profession identifies the prevalence of burnout and the resulting harmful effects in many settings, yet until now, rural critical access hospital settings have not been considered. To build and maintain a competent, healthy rural nursing workforce that responds innovatively to growing healthcare needs, it is important to examine burnout levels in rural nurses and to identify factors that might be associated with mitigating burnout. This study focuses on how psychological capital, socio-demographic and organizational work-related factors are associated with burnout in this population. This cross-sectional, descriptive correlational study employed the Maslach Burnout Inventory for Health Professionals, the Psychological Capital Questionnaire, and a sociodemographic questionnaire assessing individual and organizational work-related factors as self-report tools. Descriptive statistics, correlations, and regression analyses were performed to assess aspects of the nurses’ work environment, while describing the relationships among the variables.Means and standard deviations were examined across key variables and compared to reports from other studies. Hypotheses predicted psychological capital would be associated with burnout (negatively associated with emotional exhaustion and depersonalization, positively associated with personal accomplishment), and that individual sociodemographic and organizational work-related factors would also be associated with BO. It was further hypothesized that PsyCap would moderate the relationship between work-related factors and BO. Maslach Burnout Inventory results reveal similar findings to those in the global sample. However, levels of emotional exhaustion and professional accomplishment were greater in our rural nurse sample compared to published values. Higher levels of psychological capital were found to be related to decreases in depersonalization and correlated to greater professional accomplishment. Psychological capital was not found to moderate associations within this study. Intent to stay more than one year had a strong, negative correlation with emotional exhaustion. The findings suggest burnout in this sample resembles that of the global problem and sets a baseline from which psychological capital trainings may be built. / Dissertation/Thesis / Doctoral Dissertation Nursing and Healthcare Innovation 2019

In 2013, the Hospital Consumer Assessment of Healthcare Providers System (HCAHPS), a national, independent metric of patient satisfaction, revealed room for improvement at a teaching hospital in the southeastern section of the United States. This project reports the development and validation of a Bedside Shift Report (BSR) policy, practice guidelines, and associated documentation. Several initiatives, models, and theories informed thinking about this project. The work of Kurt Lewin and the Institute for Healthcare Improvement- Robert Wood Johnson Foundation's joint initiative, Transforming Care at the Bedside, both guided the project in terms of the process of institutional change. SBAR (Situation Background Assessment and Recommendation Technique) was the primary model upon which communication strategies were developed. PDSA (Plan-Do-Study-Act) served as a continuous quality improvement model to inform development of the implementation and evaluation plans. Using these concepts, models, and theories, a project team led by the DNP student reviewed relevant literature and considered institutional contexts and goals in order to develop a new institutional bedside-report (BSR) policy along with practice guidelines to inform operationalization of the BSR policy. Five scholars reviewed these products with expertise in relevant content areas in order to validate essential content; both policy and practice guidelines were revised in accordance with feedback. All related documentation needed to implement the products, along with both an implementation and an evaluation plan, were also developed by the project team. Improved nurse-patient communication holds significant potential to improve patient satisfaction and to promote positive social change across the institutional service population.

In a Level II trauma center, experienced nurses are retiring from nursing positions, which is causing an unstable workforce. According to the literature, there are not enough experienced nurses to mentor the new nurses. Evidence suggests that experienced nurses are associated with improved patient outcomes and that experienced nurse mentors can improve the work environment for less experienced nurses. Focusing on Watson's theoretical framework of caring and Covell's theoretical framework of intellectual capital, this phenomenological study explored the lived experiences of a small group of nurses. Five nurses with 15 years of experience and who had served as mentors were selected for in-depth individual interviews. Open coding and thematic analysis were used to analyze the data, and 5 themes emerged: lengthening work shifts and related effects, increasing workload and responsibilities due to higher patient acuity, learning new technologies, mentoring with a decreased patient ratio, and surveying customers as the main focus of patient care. The results of this study guided the development of a proposal for a computer-based learning module on nurse mentoring. The module explains what mentoring is, the importance of mentoring, and proper ways to mentor. Implications for positive social change include retaining intellectual capital in an organization through mentoring positions for experienced nurses.

Uncontrolled pain has proven effects on both physiological and psychological responses of hospitalized patients. These incapacitating sequelae most often negatively impact patient outcomes resulting in unnecessary suffering and prolong hospitalizations. First line nurses often have preconceived notions about a patient's pain without developing an individualized patient context that considers appropriate pain management knowledge translated from best practice standards. Guided by Bandura's social learning theory and Lippitt's change theory, the purpose of this quality improvement project was to determine if use of the Curriculum Outline on Pain for Nursing from the International Association for the Study of Pain (IASP) improved nursing knowledge of pain management for hospitalized patients. The Knowledge and Attitude Survey Regarding Pain was given as a pretest and posttest to assess the knowledge of 100 registered nurses from an acute care hospital, before and after an education intervention was provided. The results of the paired pretests and posttests indicated a statistically significant difference t(99) = 0.03, (p < 0.05) following use of the IASP Curriculum. Use of the IASP Outline Curriculum, coupled with sustainability strategies, has a strong probability of impacting nurses' knowledge and subsequently contributing to positive social change for the community of patients expecting optimal clinical outcomes from their nurses.

The United States has a nursing shortage that is projected to grow to over 500,000 by the year 2030. This is an issue for leaders because the nursing shortage affects health care organizations sustainability. The purpose of this qualitative descriptive phenomenological study was to identify and report the lived experiences of new graduate nurses (NGNs) in oncology and whether unit of first choice (UFC) effected their intention to remain after 2 years of practice. The research question considered the lived experiences of NGNs in oncology units who either had oncology as their UFC or were placed on an oncology unit even though oncology was not their UFC during their first 2 years. The framework theories that provided a lens were Herzberg'€™s motivational hygiene, Burns'€™ transformational leadership theory and von Bertalanffy'€™s general systems theory. Data were collected from semistructured interviews attaining data saturation with 10 NGNs in Central Florida. Data analysis involved using hand-coding and NVivo 12 Plus. The findings revealed the negative impacts of the nursing shortage, cycle of nurse turnover in oncology, positive and negative experiences in oncology, and reducing turnover and increasing NGN retention in oncology. Application of the findings of this study by nursing leaders may improve new graduate nurse hiring practices and retention, as leaders consider the result that unit of first choice has on NGN retention. Retaining NGNs could result in a positive social impact by lowering hospital employment costs, improving community stability, making health care more affordable to the community, and reducing medical errors.

Ceasing tobacco use benefits smokers regardless of age; therefore, it is essential for health care providers to consistently identify smokers and offer evidence-based cessation treatments to those wanting to stop smoking as a proactive approach towards tobacco abstinence. The purpose of this doctoral project, which was underpinned by the knowledge-to-action framework, was to educate nurse practitioners about evidence-based tobacco cessation interventions and assess the impact of the education on their knowledge base, skills, and self-confidence in implementing tobacco-cessation protocols. Participants (n = 14) completed a knowledge-based questionnaire and the Skills and Confidence for Smoking Cessation Tool before and after an education intervention based on the Rx for Change program. Paired sample t-tests were completed to analyze the pretest and posttest results. The results indicated a statistically significant increase (p < .05) in perceived knowledge, skills, and confidence among nurse practitioners related to tobacco cessation education. These findings support the use of tobacco cessation education for nurse practitioners to improve this aspect of care and provide patients with effective interventions to improve quit rates. The impact of this project on positive social change includes fostering a healthier lifestyle for tobacco users that extends to family and community.