A central part of the nursing profession is the performance of practical skills. In order to provide adequate care, maintain patient-safety, and feel comfortable in the profession, registered nurses (RNs) need to be equipped with requisite skills. Overall aim: To explore and describe how learning and development of practical skills occurs during the preparatory phases and within the nursing profession. Method: Qualitative (I, III, IV) and quantitative methods (II) were used. Data were collected through individual interviews (I, IV), questionnaires (II) and participant observations, including informal talks (III, IV). Results: Both students and new RNs expressed a need to learn and develop practical skills (I, II, III, IV). Less than half of the new RNs had access to a clinical skill laboratory (CSL), where they could learn and practice practical skills (II). The students described that learning at a CSL had been meaning for their clinical practice. They also expressed a great need for continuing learning in real patient situations (I, III, IV). During clinical practice, preceptors and students took different approaches which affected student’s learning processesö (I, III, IV). There was a tension between learning at a CSL and learning in clinical practice sites because students perceived differences in the performance of skills. Students described that they understood that performance of skills could be done in different ways without injuring patients. However, the data also showed deviations in performances that could jeopardize patientsafety. In these situations, student’s behavior differed (I, IV). One third of new RNs deviated from evidence based guidelines when they performed practical skills which they were unfamiliar with (II). Both students and new RNs reported that reflection in connection with the performance of practical skills was not common (I, II III, IV). Conclusions: Cooperation between university CSLs and clinical settings must be intensified in order to enhance the understanding of learning processes regarding practical skills. A consensus regarding academic approaches should be reached. Universities need to support preceptors in educational issues where the importance of reflection is clarified and exemplified. Increasing patient-safety requires that new RNs receive opportunities for training in artificial environments, and that a culture that reinforces the use of guidelines and a reflective stance is cultivated.

Summary: The diploma thesis compares competency of nurses working in intensive care in The Czech Republic and Great Britain. Theoretical part of the thesis gives compact look to regulation of nursing profession, education of nurses and nursing registration in both countries. In this part are highlighted main differences of the legislation which nursing competency is based on in each country. There is also mentioned the public opinion of the nursing as a profession and its prestige related to both countries. Practical part of the thesis focuses on the interpretation of analysis of the research regarding the above mentioned topic. For the research have been used the method of collecting data by structured questionnaires. There was a questionnaire for each country in its own language. The aim of the practical part is to compare divergence of knowledge, skills and competency of nurses working in intensive care in both countries. Alternatively to assess any reason for exceeding nursing competency and to find out the explanation for that Key Words: Competency, Nurse, Critical Care, Education, Qualification, Great Britain

To ensure quality patient care hospitals invest in nursing intellectual capital by allocating financial, human and material resources for nurses to acquire the knowledge and skills necessary to provide safe patient care. This study’s purpose was to test selected propositions of the middle-range theory of nursing intellectual capital which provides a conceptualization of the influence of nurses’ knowledge, skills and experience (nursing human capital) to patient and organizational outcomes. The theory was systematically developed after a critical review of the literature. It proposes that nursing human capital (registered nurses’ experience, and knowledge and skills acquired from continuing professional development including university courses, conferences, workshops, in-services, specialty certification) is related to variables within the work environment (nurse staffing, employer support for nurse continuing professional development), which in turn, is associated with the quality of patient care (adverse events) and the recruitment and retention of nurses. The theory also proposes that nursing structural capital, nursing knowledge available within practice guidelines, is associated with the quality of patient care. A cross-sectional design was used to test the proposed relationships. The study took place in 6 acute care hospitals in two provinces of Canada. Financial, human resource and risk management data were collected from hospital departmental databases and a survey of unit managers. Data from 91 inpatient units were used with structural equation modeling to test the theory’s propositions. The results indicated that nurses’ knowledge and skills represented by the proportion of RNs with degrees and proportion of RNs with specialty certification were directly associated with low hospital-acquired infection rates. Nurse experience, measured as mean years RN professional experience and RN unit tenure, was found to be significantly related to higher RN recruitment and retention. The proportion of RNs with degrees was found to partially mediate the influence of nurse staffing on hospital-acquired infections. The results provide preliminary evidence of the association of nursing intellectual capital with patient and organizational outcomes. The findings may assist administrators with fiscal and human resource decision-making related to the education of nurses within acute care hospitals, and professional organizations with policies governing nursing education and continuing professional development.

To ensure quality patient care hospitals invest in nursing intellectual capital by allocating financial, human and material resources for nurses to acquire the knowledge and skills necessary to provide safe patient care. This study’s purpose was to test selected propositions of the middle-range theory of nursing intellectual capital which provides a conceptualization of the influence of nurses’ knowledge, skills and experience (nursing human capital) to patient and organizational outcomes. The theory was systematically developed after a critical review of the literature. It proposes that nursing human capital (registered nurses’ experience, and knowledge and skills acquired from continuing professional development including university courses, conferences, workshops, in-services, specialty certification) is related to variables within the work environment (nurse staffing, employer support for nurse continuing professional development), which in turn, is associated with the quality of patient care (adverse events) and the recruitment and retention of nurses. The theory also proposes that nursing structural capital, nursing knowledge available within practice guidelines, is associated with the quality of patient care. A cross-sectional design was used to test the proposed relationships. The study took place in 6 acute care hospitals in two provinces of Canada. Financial, human resource and risk management data were collected from hospital departmental databases and a survey of unit managers. Data from 91 inpatient units were used with structural equation modeling to test the theory’s propositions. The results indicated that nurses’ knowledge and skills represented by the proportion of RNs with degrees and proportion of RNs with specialty certification were directly associated with low hospital-acquired infection rates. Nurse experience, measured as mean years RN professional experience and RN unit tenure, was found to be significantly related to higher RN recruitment and retention. The proportion of RNs with degrees was found to partially mediate the influence of nurse staffing on hospital-acquired infections. The results provide preliminary evidence of the association of nursing intellectual capital with patient and organizational outcomes. The findings may assist administrators with fiscal and human resource decision-making related to the education of nurses within acute care hospitals, and professional organizations with policies governing nursing education and continuing professional development.

Peer learning är en handledningsmetod, som tydliggör anknytningen mellan teoretisk och praktisk kunskap samtidigt som ett större antal studenter kan erbjudas verksamhetsförlagd utbildning. Därför vore det av intresse att undersöka om det är en tillämpar metod i specialistsjuksköterskeutbildningen mot intensivvård. Syftet med studien var att undersöka peer learning som handledningsmetod inom specialistsjuksköterskeutbildningen mot intensivvård utifrån handledares perspektiv. Studien utfördes genom fokusgruppsintervju med en beskrivande design med induktiv ansats där data analyserades med manifest kvalitativ innehållsanalys. I studien framkom sex kategorier och fyra underkategorier. Interaktionen mellan studenterna ansågs utveckla förmågan till kommunikation och samarbete. Studenterna kunde fortsätta att bygga på befintlig kunskap, betraktades mer som jämbördiga och frångick en hämmande studentroll. Patient och anhöriga upplevdes inte misstycka till studenternas resonemang utan uttryckte snarare att de tog lärdom av det. Det unika sättet att tillvarata studenternas kunskaper och färdigheter på ledde till en tidig vidareutveckling av deras befintliga kunskaper. Den tidiga träningen i kommunikation och samarbete kan ses fördelaktigt eftersom brister i dessa genererar flest avvikelser idag. Slutsatsen är att peer learning är lämplig som handledningsmetod inom specialistsjuksköterskeutbildningen mot intensivvård. Fortsatt forskning om peer learning inom specialistsjuksköterskeutbildningar samt patienters och anhörigas upplevelser av studenternas resonemang är av stort intresse. / Peer learning is a precepting method that clarifies the link between theoretical knowledge and practical skills, and at the same time enables more students to be offered placement for clinical education. Therefore, it would be of interest to explore if the precepting strategy can be appropriate in the postgraduate nursing education in critical care. The purpose of the study was to explore peer learning as a precepting method in the postgraduate nursing education in critical care in preceptors’ point of view. The study was conducted by a focus group interview with a descriptive design with an inductive approach and data was analysed with manifest content analysis. The study revealed six categories and four subcategories. The interaction between the students was considered to develop the ability of communication and cooperation. The students could build on their former knowledge, considered as equals, and went from an inhibitive role as students. The patient and the relatives were not perceived to resent the student reasoning, they rather expressed they learned from it. The unique way to preserve students' knowledge and skills led to an early development of their already existing knowledge. The early training in communication and cooperation can be considered beneficial because deficiencies in these areas generate the most common incidents in healthcare today. The conclusion is that peer learning can be applied as a precepting method in the postgraduate nursing education in critical care. Further research of peer learning in postgraduate nursing educations is needed and also how the patient and family members experience the students' reasoning, are of great interest.

Problem-based learning (PBL) is being adopted increasingly as a learning and teaching strategy within the United Kingdom. Although facilitation is recognised as being central to PBL, much of the current literature on facilitation in PBL is conflicting. This study explored the espoused and actual conceptions of PBL adopted by facilitators on a newly-developed pre-registration nursing diploma programme that employed PBL. To explore the lived experience of the PBL curriculum, a constructivist interpretist qualitative research design was adopted. For facilitation in PBL to be effective in promoting independent learning and developing critical thinking, teachers were required to sustain the newly espoused pedagogy and to adapt their actions to match. All participants possessed facilitation skills before the start of the study, however expertise in PBL facilitation took time and practice to acquire as existing skills had to be applied in new ways. Findings identified four broad approaches to facilitation: directive conventionalist, liberating supporter, nurturing socialiser and pragmatic enabler. Over time, most facilitators converged from a directive conventionalist approach towards that of a pragmatic enabler. The transitions were influenced by the need to resolve dissonance between espoused theories and theories-in-use; increased understanding of the dialogic nature of PBL; the use of communicative spaces to share and reflect on experience and an enhanced awareness of student diversity. While the findings relate specifically to PBL facilitation, they also contribute to the understanding of the types of teaching and learning strategies required by the large and increasingly diverse student body.

Made available in DSpace on 2014-12-17T14:46:57Z (GMT). No. of bitstreams: 1 RenataLP_DISSERT.pdf: 1109732 bytes, checksum: 950a12324466be8c294a3a55fb2995eb (MD5) Previous issue date: 2012-12-07 / This study is aimed to understand the nurse student s perception on death approach during the undergraduate course, to reveal feelings and meanings generated from studying this topic. The research was undertaken when the project has been approved by the ethics committee of UFRN in accordance to the Opinion Number n? 234/2012. Through a qualitative approach using a phenomenological design, grounding on the ideas of the German philosopher Martin Heidegger. It was interviewed ten students who answered the following questions: When during your undergraduate course the topic death and dying is approached? What kind of feelings that theme awakens? What is the significance of studying this subject in nursing education? The speeches analysis shows that the issue of death and dying is addressed in a very timely manner in different disciplines, there is no dialogue between them. Students reveal the fear and anxiety as feelings present when studying the topic; recognize as an important moment of reflection to understand that death is not a health care failure, but an opportunity to understand it as a natural phenomenon. In this perspective, we can conclude that the student need to be conducted in the undergraduate process, not being separated from itself to your world-with-others, but linking their concepts, understanding their feelings as human being then, respect and care for individuals as a being-toward-death. Therefore, the big challenge facing nursing education is to create an environment where death can be discussed about, between teachers and students, mainly in the disciplines that address the issue / O presente estudo tem como objetivo compreender a percep??o de estudantes de enfermagem acerca do estudo da morte no processo de forma??o acad?mica, desvelando sentimentos e significados gerados ao estudar essa tem?tica. Para sua realiza??o, o projeto foi aprovado pelo comit? de ?tica da UFRN, conforme Parecer n? 234/2012. Utiliza uma abordagem qualitativa, com enfoque fenomenol?gico, apoiando-se nas ideias do fil?sofo alem?o Martin Heidegger. Foram entrevistados dez estudantes que responderam ?s seguintes quest?es norteadoras: em que momento de sua forma??o a tem?tica morte e morrer ? estudada? A que sentimentos esse tema remete? Qual o significado de estudar esse tema na forma??o do enfermeiro? A an?lise das falas mostra que a tem?tica morte e morrer ? abordada de maneira muito pontual em disciplinas diferentes, inexistindo um di?logo entre elas. Revelam o medo e ang?stia como sentimentos presentes ao estudar o tema; reconhecem o estudo desta tem?tica como um momento importante de reflex?o para compreender que a morte n?o ? um fracasso da a??o de cuidar, sendo uma oportunidade para entend?-la como fen?meno natural. Nessa perspectiva, podemos concluir que o discente precisa ser conduzido em seu processo de forma??o n?o o separando do seu existir no mundo-com-os-outros, mas interligando seus conceitos, entendendo seus sentimentos enquanto ser, e, dessa forma, respeitar e cuidar do homem como um ser-para-a-morte. Portanto, o grande desafio para a educa??o em enfermagem ? criar espa?os de discuss?o acerca da morte, entre professores e estudantes, particularmente, nas disciplinas que abordam o tema

Wound care is an important part of the daily work of nurses in all facilities like hospitals, institutes for long-term patients, social care institutions, or ambulances. In recent years, the treatment of wounds puts more and more emphasis on modern methods, mainly in the Czech Republic (CR) and Ireland. As already mentioned, nursing is constantly evolving, and possibilities for wound treatment are wide. Our aim will be to compare the ways and methods of wound treatment in three different countries. We will focus on the General Nurse, as a nursing care provider. In the theoretical part, the work was focused on characteristic of wounds, their distribution, general healing as well as concrete treatment in the countries concerned, specifically according to the competence of nurses. A major part was devoted to the education of nurses The main purpose of the research was focused on the way nurses treat wounds in Namibia, Ireland and the Czech Republic. Based on the research subject the following research questions and goals were set: Identify and describe how nurses treat wounds in the selected countries. How are wounds healed in Namibia, Ireland and the Czech Republic? How is the wound care in Namibia, Ireland and the Czech Republic? What kind of education does a nurse have to have in the countries concerned, in connection with the wound care? For the empirical part of the thesis, a qualitative approach was selected. A semi-structured interview with nurses from the selected countries was used. Further records of the wound treatment were used. These were obtained during the internship in Namibia, a personal visit to Ireland and my experience during my studies in the Czech Republic. Respondents were recruited by purposive sampling, the condition of which was wound care requiring hospital treatment. The interviews were conducted using a range of questions addressing nurses in those countries during their working hours and if needed, supplementing the required information via Skype. The research sample consisted of nine respondents - nurses from Namibia, Ireland and the Czech Republic and then records of the wound treatment of 9 patients from Namibia, the Czech Republic and Ireland were drawn. The countries have their competencies relating to this issue. In Ireland, Czech Republic there is a re-bandaging nurse, who creates a nursing plan and, if needed, consults everything with the physician. In Namibia, due to lack of nurses and physicians, only competences of local nurses which they acquired during their university studies, are sufficient. These competences lead to decisions and choice of care and wound treatment. In the Czech Republic, nurses shall consult the healing process and the course of treatment with the physician. In the area of education of nurses from the surveyed countries in connection with wound care the research investigation showed that university education is required in Namibia, in the Czech Republic as well as in Ireland. The third mentioned research question related to methods of care with clients suffering from acute or chronic wounds. Wound care in Namibia, Ireland, and in the Czech Republic does not differ in some specific procedures; however, in most cases it is very different. In severe cases of wounds, for many patients it is an unforgettable memory, which requires a professional approach, consisting of knowledge and experience. The nurse provides a unique support to the patient, education is therefore very important and unconditional in order to enable the patient coping with the situation. The results of this thesis can serve as information and study material to other grades of the surgical block and for further research on a similar topic.

Nursing has undergone major changes under the influence of recent social events. Due to the influence of new circumstances, it was also necessary to radically approach to the new concept of nursing fields. Then we can register attempts to make the nursing profession independent. That is why the main representatives of this profession have adopted more efficient approach to the care for the patient. The development of the research in nursing helps them significantly, as well as high level of education of nurses, new management techniques and monitoring of the quality of provided nursing care. All mentioned elements lead to support and strengthening of autonomy of the nursing field. We dealt with this issue, because we perceive the position of nursing and the social status of nurses as unsatisfactory. With creating our diploma thesis we would like to contribute to a few literary sources, that are directly engaged in the issue of autonomy of the nursing field. The theoretical part of our thesis was divided into two parts. In the first part we focus on the explanation of the concept of autonomy of nursing and the impact of activity of the nurse with regards to the autonomy of the profession. The second part of the thesis makes clear elements, which significantly strengthen the autonomy of the nursing field. The aim of this thesis is the following: 1. To explore whether nurses and doctors consider nursing as an autonomous scientific field. 2. To map barriers preventing the perception of nursing as an autonomous scientific field. 3. To determine current possibilities for strengthening the autonomy of the nursing field. The empirical part of the thesis is formed by the combination of quantitative and qualitative research. In the quantitative part of the investigation, we were interested in three research hypotheses. 1. Nurses perceive education as a potential acquisition of skills in order to ensure the autonomy of the profession for the benefit of the patient. 2. Nurses present nursing in public as a separate profession. 3. Status of the autonomy of nursing allows to promote results of the research in providing the nursing care. The method of querying with the assistance of questionnaire was used for the data processing of the quantitative part of the research. It contained 41 questions. There were used closed, half-open and open questions in the questionnaire. There were used pie charts and tables for processing of responses. The 2nd degree classification was used for the statistical evaluation of the results. The researched group for the quantitative part of the investigation were nurses from ambulant and bedded sectors of two health care facilities. There were distributed 220 questionnaires in total, 134 (100 %) correctly completed pieces were kept for processing. The querying method using the technique of semi-structured questionnaire containing seven open questions was used for the qualitative part of the research. Four chairwomen of sections of ČAS, who received the questionnaire via e-mail, actively participated on the investigation of the research. Individual responses were analyzed and subsequently processed into diagrams. In this empirical investigation we identified the answers to three research questions. 1. What is the position of chairwomen of sections of ČAS for promoting and defending nursing as an autonomous profession? 2. What obstacles perceived by chairwomen of sections of ČAS slow down the enforcement of autonomy of the nursing field? 3. What can be done to strengthen the autonomy of nursing in the group of other science or professional disciplines? The research questions sent in the form of half-structured questionnaire were answered by four chairwomen of sections of ČAS. We found out on the basis of obtained results, that nurses do not consider nursing as an autonomous scientific field.

The dissertation is divided into theoretical and practical parts. The theoretical part deals with the historical equipment of nursing and nursing education in the Czech Republic, further the legislation, the implementation of nursing education and a personality of a nurse. For the processing of the empirical part there was chosen the method of quantitative and qualitative research inquiry. For the quantitative inquiry there was chosen the method of asking by means the technique of a questionnaire and for the qualitative part of the research inquiry there was chosen the method of asking, namely the method of half-structured interview with opened questions. For the quantitative inquiry there were prepared two sorts of questionnaire, the first for the nurses, namely the universal nurses from experience and the second for patients, it means for the non ? professional public within the Southern Bohemia. There were set six surmises for this part of inquiry. The results of the inquiry were elaborated into diagrams and tables. In the quantitative part of the research inquiry were verified six hypothesis, that were set in advance: 1. The interest of nurses for the education follows more from the legislative aiming than from interest about more quality nursing care of a patient. The results show us that the need of credit is for the nurses more important than the need of more quality care for a patient. The first hypothesis was confirmed. 2. Choice of the courses of lifelong learning depends more on the amount of financial claims than on the orientation on care that provided. There follows from the research inquiry that for the nurses is more important the interestingness of an event than the amount of financial costs. The second hypothesis was disproved. 3. Motivation for the nurses for education is more the system of university education than the increasing of the quality of care. The results show that the nurses are more motivated by the need of a university education than by a better care of a patient. The third hypothesis was verified. 4. Implementation of an output of education isn´t incremental to its application in the real environment. The research inquiry showed us, there is no big possibility for the nurses to implement the results of their education in practice. The fourth hypothesis was verified. 5. The patient?s don´t distinguish, if the nursing care is provided by a qualified nurse or by another member of a nursing team. The fifth hypothesis was verified. 6. The patient?s don´t perceive nurses according to their education, but to a uniform. The results show, that the patients are not knowledgeable in the nursing staff neither according to their uniform nor their education. The sixth hypothesis was disproved. There were approached 12 respondents for the qualitative part of the research inquiry, within the Southern Bohemia again. The interviews were taken down, rewritten and analysed. The obtained data were categorized. There was set Research question for the qualitative part of the research inquiry: What is the meaning of nurses about the implementation of their education I the praxis? There was finding out by the research inquiry, that the nurses generally welcome the university education, mainly because of the reason, that the nurses come in praxis in a higher age. The lifelong learning should be also beneficial for them, but this has its shortcomings, namely in the financial part and it isn´t supported by the employers. They can also see the problem in implementation of their obtained knowledge from education in non ? interest of their employer and other members of nursing team.