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Nurses in neonatal special care nurseries with a philosophy of family centered care involve parents in the care of preterm infants. There is little research describing nurses' perspectives of parental participation in care. Using interview data obtained from one secondary level neonatal special care nursery, this study attempts to understand the meaning parental participation in care has for neonatal nurses and the way that meaning is expressed in various nursing activities. Twelve nurses were interviewed about their reaction to parental participation in various activities such as feeding and bathing their babies. These nurses are all full time staff members in the nursery. Findings of the research are that there are two main nursing perspectives of parental participation in the care of preterm infants in a special care nursery. These two perspectives are labelled the 'our baby' and 'their baby' perspective. The 'our baby' group of subjects maintain a traditional role of control of care. The 'their baby' group are committed to the philosophy of family centered care within certain boundaries. An example of the difference., in the two perspectives was discovered in the area of infant feeding. The 'our baby' nurses thought that parents engaged in this activity increased the workload while the 'their baby' nurses thought that parents decreased workload. The 'our baby' nurses treated most parents in a similar way but the 'their baby' nurses individualized their approach to parents. The 'their baby' nurses' enjoyed spending time with parents but the other group said that there were less parents to deal with when they were working at night. Both groups work side by side with little conflict. Implications for the selection and training of nurses are noted as well as implications for further research. / Education, Faculty of / Curriculum and Pedagogy (EDCP), Department of / Graduate

An exploratory study was conducted on 25 male and female patients who were admitted to a 29-bed surgical unit of a 450-bed general hospital, for diagnostic testing. The purpose of the study was to answer the following questions: (1) What situations does the patient perceive as helping him feel comfortable while he is experiencing the diagnostic regime? (2) What situations does the patient perceive as making him feel uncomfortable while he is experiencing the diagnostic regime? (3) What coping responses does the patient utilize in adapting to discomfort promoting situations during the diagnostic regime? The data for the study were collected through the utilization of a structured questionnaire for the initial visit and taped interviews with the selected patients. During the interviews, particular emphasis was placed upon exploring the patients' concerns by the use of Orlando's Open-Ended Interview Technique and a modified version of the Critical Incident Technique. The results were then categorized into themes of patient responses, tabulated, and analyzed. The results of the study revealed that the situations the patient perceived as promoting comfort or discomfort were dependent upon two significant variables: (1) The degree to which the patient's personal value system needs were met during the diagnostic regime; (2) The patient's ability to mobilize adaptive coping responses to deal with the stresses created by the diagnostic regime. The coping responses utilized by the patients in adapting to discomfort promoting experiences in hospital were numerous and highly diversified. It was noted that the patients' ability to cope adaptively was primarily influenced by their evaluation of what was happening to them. In turn, this evaluation was affected by their past experience, their present biopsychosocial state, and the duration of the uncomfortable experience. / Applied Science, Faculty of / Nursing, School of / Graduate

The research is situated in a busy intensive care unit in a tertiary referral centre university hospital in Scotland. To date no research appears to have been done with a focus on handover in intensive care, across the professions involved, examining how handover is enacted. This study makes an original contribution to the practical and pedagogical aspects of handover in intensive care both in terms of the methodology used and also in terms of its findings. In order to study handover a mixed methods approach has been adopted and fieldwork has been done in the ethnographic mode. Data has been audio recorded and transcribed and analysed to explore the clinical handovers of patients by doctors and nurses in this intensive care unit. Texts of both handover, and the artefacts involved, are reviewed. Material from journals, books, lectures and websites, including those for health care professionals, patients and relatives, and those in industry are explicated. This study explores the role of material artefacts and texts, such as the intensive care-based electronic patient record, the whiteboards in the doctors’ office, and in the ward, in the enactment of handover. Through analysis of the data I explore some of the entanglements and ontologies of handover and the multiple things of healthcare: patients, information, equipment, activities, texts, ideas, diseases, staff, diagnoses, illnesses, floating texts, responsibility, a plan, a family. The doing of handover is framed theoretically through the empirical philosophy of Mol’s identification of multiple ontologies in clinical practice (Mol, 2002). Each chapter is prefaced by a poem, each of which has relevant socio-material elements embedded in it. The significance of the findings of the research for both patient care and clinical education and learning is surfaced.

Thesis (MCur (Nursing Science))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: Communication in nursing is to establish a nurse-patient relationship. Some nurses are quite effective at this whilst others are not so effective. The female patient diagnosed with cancer of the breast can face many dilemmas ranging from a physical, psychological and psychosocial domain. Nursing, being an interactive skill, requires the nurse to be able to communicate with the patient. The inability to communicate can hamper this very crucial relationship. For the purpose of this study it was decided to provide an in-depth account of the management of the nurse-patient communication in the ward. The rationale for choosing this setting (ward) were based on the comprehensive functions of a professional nurse and his/her ability to communicate. The objectives set for the study were to describe the manner in which professional nurses communicated with the patient diagnosed with cancer of the breast and who underwent a mastectomy, barriers that prohibited the communication and the patient’s perception of the communicative processes. A quantitative, exploratory and descriptive approach was applied to investigate and describe factors that influence communication between the patient with breast cancer and the professional nurse within a provincial hospital in the Western Cape. The total population included only female patients diagnosed with cancer of the breast who underwent a mastectomy and who were referred to the breast outpatient clinic. These female patients had to be diagnosed during a twenty month period as of January 2007 to August 2008 and had to be hospitalised within a ward setting after their diagnosis. The population size consisted of 27% of the total population with a 9% refusal rate. A survey was done using a six point Likert scale ranging from strongly disagree, disagree and mildly disagree to mildly agree, agree and strongly agree. The questionnaire consisting of close-ended questions were used for the collection of data and the researcher personally collected data. Ethical approval was obtained from the Committee of Human Science Research at Stellenbosch University and the Department of Health - Cape Town. Consent to conduct the research was obtained from the institution and informed consent from the participants. A pilot study was conducted to test the questionnaire which did form part of the study. A 10% sample of the population, namely 10 participants, was involved in this study. The validity and reliability was assured through the pilot study and the use of a statistician, experts in oncology nursing, an oncology doctor and the research methodologist. Data was tabulated and presented in histograms and frequencies. Statistical significant associations were drawn between variables, using the Chi square test. The Spearman rank (rho) order correlation was used to show the strength of the relationship between two continuous variables. Findings included statistical significance between the level of schooling and the nurse, who took the respondents at face value and communicated what she deemed necessary (rho=0.29, p=0.00). The respondents also showed concern and disagreed that the ward nurses provide their family with relevant information (p=0.00). R ecommendations include:  Nursing education should include a module in communication on a graduate and post graduate level  In-service training programmes should focus on the interpersonal relationship between the nurse and the patient and the importance thereof.  Continuous Quality Improvement should include patient satisfaction surveys.  Awareness campaigns about the importance of communication between the patient and the health professional should be conducted  Developing protocols and policy guidelines that can assist the nursing staff with the communication process. Since communication is an interactive process it requires skillful conduct. Nurses need to realize the importance communication plays in the health sector and the impact it has on patients, irrespective of whether it is from a verbal or non-verbal content. Effective communication or not can have an everlasting impact. / AFRIKAANSE OPSOMMING: Kommunikasie in verpleging behels die vestiging van ’n verpleegster-pasiënt verhouding. Sommige verpleegsters is taamlik effektief hierin, terwyl andere nie so effektief is nie. Die vroulike pasiënt wat met borskanker gediagnoseer is, kan baie dilemmas in die gesig staar wat wissel van ’n fisiese, psigologiese tot ’n psigo-sosiale domein. Verpleging, wat ’n interaktiewe vaardigheid is, vereis dat die verpleegster met die pasiënt moet kan kommunikeer. Die onvermoë om te kan kommunikeer, kan hierdie beslissende verhouding belemmer. Vir die doel van die studie is besluit om ’n indringende verslag van die bestuur van die verpleegster-pasiënt kommunikasie in die saal te doen. Die rasionaal vir die keuse van die omgewing (saal) is gebaseer op die komprehensiewe funksies van ’n professionele verpleegster en sy/haar vermoë om te kan kommunikeer. Die doelstellings wat uiteengesit is vir hierdie studie is om die manier te beskryf waarop professionele verpleegsters met die pasiënt wat met borskanker gediagnoseer is, en wat ’n mastektomie ondergaan het, omgaan, asook die hindernisse wat kommunikasie en die pasiënt se persepsie van die kommunikatiewe prosesse belemmer het. ’n Kwantitatiewe, verkennende en beskrywende benadering is toegepas om faktore te ondersoek en te beskryf wat kommunikasie tussen die pasiënt met borskanker en die professionele verpleegster in ’n provinsiale hospitaal in die Wes-Kaap beïnvloed. Die totale bevolking het slegs vroulike pasiënte wat met kanker gediagnoseer is en ’n mastektomie ondergaan het en na die bors buite-pasiënt kliniek verwys is, ingesluit. Hierdie vroulike pasiënte moes gedurende ’n periode van twintig maande vanaf Januarie 2007 tot Augustus 2008 gediagnoseer en gehospitaliseer gewees het in ’n saalomgewing na hul diagnose. Die bevolking grootte het bestaan uit 27% van die totale bevolking met ’n 9% verwerpingskoers. ’n Opname was gedoen wat die ses punt Likert skaal gebruik wat wissel vanaf sterk verskil van mening, verskil en effense verskil van mening tot effens saamstem, saamstem en sterk saamstem. Die vraelys wat uit geslote vrae bestaan, was gebruik vir die insameling van data en die navorser het die data persoonlik gekollekteer. Etiese goedkeuring was verkry van die Raad vir Geesteswetenskaplike navorsing aan die Universiteit van Stellenbosch en die Departement van Gesondheid – Kaapstad. Toestemming om die navorsing uit te voer is verkry van die inrigting en ingeligte toestemming van die deelnemers. ’n Loodsprojek is uitgevoer om die vraelys te toets wat deel van die navorsing uitgemaak het. ’n 10% Steekproef van die bevolking, naamlik 10 deelnemers, was betrokke by die studie. Die geldigheid en betroubaarheid was verseker deur die loodsprojek en die gebruik van ’n statistikus, kenners in onkologie verpleging, ’n onkologiese dokter en die navorsingsmetodoloog. Data is getabulleer en aangebied in histogramme en frekwensies. Statistiese beduidende assosiasies is gemaak tussen veranderlikes, deur gebruik te maak van die Chi-kwadraat toets. Die Spearman rang (rho) orde korrelasie is gebruik om die sterkte van die verhouding tussen die aaneenlopende veranderlikes te wys. Bevindings het statistiese beduidendheid ingesluit tussen die vlak van geleerdheid en die verpleegster wat die respondente op sigwaarde geneem het en die kommunikasie wat sy noodsaaklik gevind het (rho=0.29, p=0.00). Die respondente het ook besorgdheid getoon en het nie saamgestem dat die saalverpleegsters hul gesinne van die relevante inligting voorsien het nie (p=0.00). A anbevelings sluit in:  Verpleegopleiding behoort ’n module in kommunikasie op graad en nagraadse vlak in te sluit.  Indiensopleidingsprogramme behoort te fokus op die interpersoonlike verhouding tussen die verpleegster en die pasiënt en die belangrikheid daarvan.  Deurlopende kwaliteitsverbetering behoort pasiënt tevredenheidsopnames in te sluit.  Bewusmakingsveldtogte oor die belangrikheid van kommunikasie tussen die pasiënt en die gesondheidsprofesioneel behoort geloods te word.  Protokolle en beleidsriglyne wat die verpleegpersoneel kan help met die kommunikasie proses behoort ontwikkel te word. Sienende dat kommunikasie ’n interaktiewe proses is, word vaardige gedrag geverg. Verpleegsters behoort die belangrikheid wat kommunikasie speel in die gesondheidssektor te besef en die impak wat dit op die pasiënte het, ongeag of dit verbaal of nie-verbaal is. Effektiewe kommunikasie aldan nie, kan ’n ewigdurende impak hê.

This descriptive correlational study describes the relationships among 30 home care clients' perceptions of nursing invasiveness, territorial control, and satisfaction with nursing care. The self-report data were collected using a Nursing Invasiveness Scale (NIS), Index of Patient Territorial Control Perceptions (IPTCP), and Patient Satisfaction Instrument (PSI). The subjects were males and females, aged 23 to 93 years, who were receiving home care nursing. Analysis of the data suggests that the subjects perceived a low level of invasiveness by home care nurses, "much control" within their homes (their primary territories), and were highly satisfied with their nursing care. There was a significant negative correlation (r = -0.79) between perceptions of nursing invasiveness and satisfaction with nursing care. The relationships between perceptions of nursing invasiveness and territorial control (r = -0.02) and between perceived territorial control and satisfaction with nursing care (r = 0.14) were not significant.

The aim of this study was to investigate vicarious trauma experienced by caregivers working with children in residential care, who were victims of sexual abuse or assault. The objectives of the study were to determine the occurrence of vicarious trauma among caregivers working with victims of sexual abuse or assault / to describe the experiences of caregivers working with children who were victims of sexual abuse / to describe the caregiver's experience of staff support within the facility.

This thesis offers a rethinking of the role for education as critical workplace pedagogy in complex problems of health care. Taking the case of paediatric diabetes, the study explored how health-care professionals learn the work of supporting children, and their parents, to self-manage the condition. By reconceptualising work problems as sociomaterial learning struggles, this research contributes new understandings of informal professional learning in everyday health-care provision. Data were generated through fieldwork in an outpatient clinic. Particular challenges of supporting self-management in this case were the difficulties of balancing policy aspirations for empowerment with biomedical knowledge about risks to immediate and long-term health. Tracing the materialisation of learning as it unfolded in moments of health-care practice showed professionals handling multiple and contradictory flows of information. Particular challenges were posed by insulin-pump technologies, which have specific implications for professional roles and responsibilities, and introduce new risks. A key insight is that professionals were concerned primarily with the highly complicated perpetual discernment of safe parameters within which children and their parents might reasonably be allowed to contribute to self-management. Such discernment does not readily correspond to the notion of empowerment circulating in the policies and guidelines intended to enable professionals to accomplish this work. As a result, this thesis argues that the work of discernment is obscured. Learning strategies evolve, but could be supported and extended by explicit recognition of the important work of learning as it unfolds in everyday practices of supporting self-management in paediatric diabetes. Most importantly, workplace pedagogies could be developed in ways that attune to the profound challenges and uncertainties that are at stake in these practices.

Within the current context of the healthcare environment, the charge nurse role has become very important for safety and positive outcomes. There is little known about the role from the perspective of the charge nurse. This qualitative descriptive exploratory study examined the experience of being a charge nurse in acute care practice, and describes how charge nurses live caring in their support of nurses and patients. Ray's (1989, 2006) theory of Bureaucratic Caring, Swanson's (2008) caring attributes and leadership, and Boykin and Schoenhofer's (2001) theory of Nursing as Caring provided the theoretical lenses through which study findings were viewed. Semi-structured interviews were conducted with 20 charge nurses in 4 acute care facilities. Eight themes emerged from an inductive analysis of the data describing the experience of being a charge nurse in acute care practice: Creating a Safety Net, Monitoring for Quality, Showing the Way, Completing the Puzzle, Managing the Flow, Mak ing a Difference, Putting Out Fires, and Keeping Patients Happy. Participants also were asked questions about how they provide support to staff nurses and patients. Themes that reflected how charge nurses live caring in their support of staff and patients were: Jumping in the Trenches, Nurturing Staff Growth, Offering Authentic Presence, and Looking after Nurses. Additionally, the researcher used methods of narrative inquiry to get the participants to share stories of how they lived caring in their support of nurses and patients. Recommendations included the need to elevate the visibility of the charge nurse role and its importance to the organization, and provide support for leadership development. Job descriptions and competencies for charge nurses must reflect the complexity of the environment. / Charge nurse participants did not dialogue explicitly about their functions in terms of communication and intraprofessional team building. Since charge nurses have an increasing involvement with mentoring novice nurses and new staff, they would benefit from developing coaching skills. Given the current environment, their responsibilities in these areas may need to be better articulated so that they can focus on increasing these abilities. / by Terry L. Eggenberger. / Signature page missing one signature and the date. / Thesis (Ph.D.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.

Thesis advisor: Dorothy A. Jones / A metasynthesis of 90 published qualitative studies was conducted on the nurses’, students’, and patients’ perception of nurse caring. A mid-range theory of Nurse Caring emerged from the data, including three attributes: Presence, Concern for the Other, Knowledgeable, Competent Care, and Respect for the Person. The Nurse Caring Patient Scale (NCPS) was developed from patient descriptors within the metasynthesis. NCPS was tested to establish the psychometric properties of the instrument with 341 adult acute in-patients of a northeastern United States metropolitan teaching medical center. Initial reliability for total NCPS was .92. Factor analysis using principal components analysis with varimax rotation resulted in a parsimonious three factor solution that accounted for 50.49 % of the total variance. The final NCPS was 23 items with an alpha of .91. Component 1 (Presence, Concern for the Other) was comprised of 11 items with an alpha of .89. Component 2 (Knowledgeable, Competent Care) contained five items with an alpha of .77. Component 3 (Respect for the Person) had seven items and an alpha of .73. Participants were asked to write about an experience with a nurse. Components of caring and uncaring experiences described by participants did not add to the body of data from the metasynthesis or to the items of the NCPS. This study was limited by sample population, and the items of NCPS may be applicable only to those included in the synthesized qualitative studies. The metasynthesis of qualitative studies and mid-range theory of Nurse Caring add to the theoretical concept of caring by including the patients’ perceptions of the nurse-patient encounter. Components of Nurse Caring add competency, and respect to presence with the patient for a comprehensive definition of caring. NCPS offers nurses and administrators a valid reliable measure for patient perceptions of quality of care and satisfaction that were until now unseen and unmeasured. The theory of Nurse Caring provides nurse educators with a framework for nursing curricula, since the theory incorporates all aspects of nursing practice within its definition. / Thesis (PhD) — Boston College, 2008. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.