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

Darbo tikslas: išanalizuoti bendruomenės slaugytojų profesines problemas ir parengti šių problemų sprendimo gaires. Uždaviniai: 1. Identifikuoti bendruomenės slaugytojų profesines problemas realizuojant skirtingus profesinius vaidmenis. 2. Nustatyti bendruomenės slaugytojų požiūrį į problemų sprendimo būdus. 3. Pateikti bendruomenės slaugytojų profesinėje veikloje išryškėjusių problemų sprendimo gaires. Tyrimo metodika: Tyrimo objektas – slaugytojų profesinės problemos. Tyrimo metodas – anoniminė anketinė bendruomenės slaugytojų apklausa (N=285). Tyrimo statistiniai duomenys buvo apdoroti programine įranga (SPSS for Windows 13.0). Hipotezės apie dviejų požymių nepriklausomumą buvo tikrinamos naudojant Chi kriterijų (χ2), laisvės laipsnių skaičių (lls) bei reikšmingumą (p). Procentinių dydžių poriniai palyginimai atlikti taikant z kriterijų. Rodiklių skirtumai laikyti statistiškai reikšmingais, kai p<0,05. Rezultatai. Dauguma slaugytojų (68,1 proc.) yra patenkinti savo darbu. Nepasitenkinimą darbe dažniausiai sukelia mažas darbo užmokestis (77,4 proc.), slaugytojų pripažinimo trūkumas (74,3 proc.), didelis darbo krūvis (50,4 proc.), savarankiškumo trūkumas (35,3 proc.). Savarankiškumo trūkumą dažniau akcentuoja didesnį darbo stažą turintys slaugytojai. Nepatenkinti karjeros galimybėmis yra 11,4 proc. visų respondentų, mažai patenkinti – 18,7 proc. Daugiausia nepatenkintų karjeros galimybėmis yra žemiausią ir aukščiausią išsilavinimą turinčių respondentų grupėse. 35,1 proc... [toliau žr. visą tekstą] / The aim of the study is to analyze the occupational problems of community nurses and prepare guidelines for the solution of these problems. Objectives of the study are the following: 1. To identify the occupational problems of community nurses in the process of realization of different occupational roles. 2. To determine the attitude of the community nurses towards the ways of problem solutions. 3. To present guidelines for the solution of problems appearing in the occupational activity of community nurses. The methodology of the research is the following: The object of the research is the occupational problems of nurses. The method of the research is an anonymous questionnaire survey of community nurses (N = 25). The data of the research was processed by software (SPSS for Windows 13.0). The hypotheses about the dependence of two features were checked using the Chi criteria (χ2), the number of freedom degrees (lls) and significance (p). The paired comparisons of percentages were made using the z criteria. The differences of indicators were assumed as statistically significant, as p<0,05. Results. The majority of the nurses (68,1 per cent) is satisfied with their work. Dissatisfaction at work is usually evoked by low salary (77,4 per cent), the lack of appreciation of nurses (74.3 per cent), big work load (50,4 per cent) and lack of independence (35,3 per cent). The lack of independence is usually emphasized by nurses who have greater length of service. 11,4 per cent of... [to full text]

Bakgrund: Alzheimers demens medför stora kognitiva förändringar i den sjukes liv och beteende och slutar med en grav försämring och förlust av alla kognitiva och motoriska funktioner. Detta betyder en stor påfrestning inte bara för den som lider av sjukdomen utan också för närstående som vårdar dessa patienter hemma. Sjuksköterskans ledande och hälsofrämjande roll är då väsentligt för att ge stöd till inte bara för den sjuke men också för dess närstående. Syfte: Syftet var att belysa närståendes upplevelser av att vårda personer med Alzheimers demens. Metod: En litteraturöversikt genomfördes med sökningar i databaserna Academic Search Complete, Cinahl Complete och Nursing &amp; Alliades Health Database. Åtta artiklar valdes efter en kvalitetsgranskning och analysen baserat på likheter och skillnader som efteråt tematiserades. Resultat: Analysen resulterade i tre huvudteman: Vikten av familjerelationer, kultur och traditioner, vilket visade att närstående ger en stor vikt till familjen och ger en inblick av rollen som vårdare och hur de ser på sjukdomen från ett kulturellt perspektiv; bristande familjestöd, vilket visar att närstående kan känna sig övergivna av andra familjemedlemmar och att de inte alltid är villiga att vårda sin sjuke anhörig; strategier för att klara av vardagen, känslor av börda och svårigheter, vilket visar vilka strategier de vårdande närstående använder sig av för att kunna hantera den anhöriges sjukdom och sin egen roll som vårdare. Diskussion: Resultatet diskuterades utifrån Callista Roys teori. Diskussionen fokuserar på hur närstående som vårdar en anhörig med Alzheimers demens upplever en rollförändring och hur de kan återskapa balansen i livet genom att acceptera en föränderlig tillvaro och navigera genom den med hjälp av sjuksköterskans stödjande insatser. / Background: Alzheimer's dementia causes major cognitive changes in the sick's life and behavior and ends with a severe deterioration and loss of all cognitive and motor functions. This means a great stress not only for those who suffer from it but also for relatives who care for them at home. The nurse's leading and health-promoting role is essential for providing support not only for the patient but also for its relatives. Aim: The aim was to illuminate the experiences of relatives in caring for people with Alzheimer's dementia. Method: A literature review was conducted with searches from the databases Academic Search Complete, Cinahl Complete and Nursing &amp; Alliades Health Database. Eight articles were selected after a quality review and the results were analyzed and categorized into main themes. Results: The analysis resulted in three main themes: The importance of family relationships, culture and traditions, which showed that relatives give great importance to the family and provide an insight into the role of caring and how they view the disease from a cultural angle; lack of family support, which shows that relatives sometimes feel abandoned by other family members and that they are not always willing to care for their sick relative; strategies to cope with everyday life, feelings of burden and difficulties, which shows strategies that relatives use to be able to handle their relatives' illness and their own caring role. Discussion: The result was discussed based on Callista Roy's theory of adaptation. The discussion focuses on how relatives who care for a family member with Alzheimer's dementia experience a role shift and how they can restore the balance in life by accepting this change and navigate through it with the help of the nurse's support.

Bakgrund: Övervikt och fetma ökar både i Sverige och andra länder. Kost anses vara en viktigt komponent i behandlinngen. Det råder diskussion kring vilken kost som anses ge bästa resultat på vikt och hälsa. Lågkolhydratkost har lyfts fram som ett effektivt alternativ. Syfte: Att undersöka effekter av en lågkolhydratkost hos personer med övervikt eller fetma. Metod: En systematisk litteraturstudie som innehåller 15 kvantitativa vetenskapliga artiklar. Artiklarna söktes i databaserna PubMed och CINAHL. Resultat: Flera av de granskade studierna visar positiva effekter på viktminskning, blodtryck, blodsocer, HbA1c, insulinresistens och blodfetter. Kosten ansågs vara gynnsam för de som har metaboliskt syndrom och diabetes typ 2. I några av studierna förekom skilda resultat på totalkolesterol och LDL. För att undvika risker med lågkolhydratkost är det viktigt med hög kvalitet på de ingående makronutrienterna. Slutsats: Resultatet av studien visar att lågkolhydratkost kan vara en användbar metod för personer med övervikt eller fetma. Lågkolhydratkost passar dock inte alla och därför krävs noggrann övervakning och handledning från sjukvården. sjuksköterska har en viktigt roll för att förklara och delge patienten information. Det finns ett behov av fler långsiktiga studier, helst i Sverige för att säkerställa evidens att kosten passar en svensk befolkning.

Bakgrund: Tobak är den enskilt största livsstilsfaktorn som leder till ohälsa. Att tobak är skadligt och leder till flertalet svåra sjukdomar är idag känt bland de flesta. Trots detta röker fortfarande 10% av Sveriges befolkning och ca 800 000 snusar. Inom sjukvården röker en av tio sjuksköterskor dagligen. Sjuksköterskan ses som en nyckelperson för patienten inom tobaksprevention och bör vara en förebild. Patientens sjukhusvistelse ses därför som ett bra tillfälle att lyfta frågan om att sluta med tobak. Sjuksköterskor som röker har visats vara sämre på att ge råd och vara mindre benägna att hjälpa sina patienter att sluta röka vilket strider mot den yrkesverksamma sjuksköterskans arbetsuppgift, vilken är att främja hälsa och förebygga sjukdom. Syfte: Syftet med denna studie var att undersöka användandet av tobak bland sjuksköterskestudenter vid Uppsala universitet samt studenternas syn på användning av tobak som yrkesverksamma sjuksköterskor. Metod: En kvantitativ metod valdes då ett stort antal personer skulle undersökas och en studiespecifik enkät skickades ut till totalt 632 sjuksköterskestudenter. Resultat: Av studenterna använde 38% tobak. Av dessa rökte 3,1% dagligen och 12% snusade dagligen. Studenterna ansåg att sjukvårdspersonal är förebilder i hälsoförebyggande vård och sjuksköterskor som använder tobak ansågs inte vara bra förebilder. Slutsats: Den dagliga rökningen var mindre bland sjuksköterskestudenterna jämfört med tidigare undersökningar gjorda på sjuksköterskor. Studenterna såg sjuksköterskor som förebilder för patienten inom hälsa och anser att sjukvårdspersonal bör värna om sin egen hälsa och inte bruka tobak. Det sågs en skillnad mellan studenterna som använde tobak och de som inte använde tobak.  Studenterna som inte använde tobak ansåg att en sjuksköterska som använder tobak inte är en bra förebild för patienterna och de ansågs vara mindre benägen att hjälpa patienterna att sluta med tobak. Medan de studenter som använde tobak ansåg oftare att detta inte hade någon betydelse för vården. Men de studenter som rökte planerade ändå att sluta tills de skulle ta sin examen. / Background: Tobacco is the single largest lifestyle factor leading to a bad health. That smoking is harmful and leads to many serious diseases are known among most people. Despite this 10% of the Swedish population and about one out of ten nurses at the hospital still smoke daily. Nurses are supposed to be role models and play a key role in tobacco use prevention. The patient’s time at the hospital is therefore seen as a good opportunity to raise the question about tobacco cessation. Nurses who smoke are proven to be less likely to provide advice and help these patients stop using tobacco, which is opposing the nurses tasks, to promote health and to prevent illness Aim: The purpose of this study was to investigate the use of tobacco among the nursing students at Uppsala university and the students opinion about the use of tobacco as professional nurses. Method: A quantitative method was chosen because of the large number of people that would be examined and as study specific questionnaire was sent out to a total of 632 nursing students. Results: In total 38% of students used tobacco. Among those, 3.1% were daily smokers and 12%used Swedish snus. The students considered nurses as role models for the patient in health. Nurses who used tobacco were seen as poor role models. Conclusion: The daily smoking is declining among the nursing students compared to previous studies on nurses. The students considered nurses as role models for the patients in health and they believe that hospital workers should care about their own health and not use tobacco. A difference was found between the students who used tobacco and those who did not use tobacco. The students who did not use tobacco considered that a nurse who uses tobacco is not a good role model and for the patients and are considered as not as good in giving tobacco cessation advice. The students who used tobacco thought more often that the nurses use of tobacco did not matter for the care he or she gives. At the same time the students who smoke still plan to quit smoking before graduation.

The diploma thesis deals with the function of a nurse in ensuring roles assignment in families with a child diagnosed with diabetes. It covers the topic concerning the adaptation of a child and his/her family to the chronic disease and the assistance provided by a nurse in this adaptation through the Calista Roy nursing model.

This study focused on Registered Nurses (RNs) working in Acute Trust surgical wards in the context of their role development, role expansion and role extension. The study originated from concerns raised by RNs undertaking the surgical pathway of the BSc Hons in clinical nursing practice, who alerted me to their dissatisfaction with their working conditions and their role. This revelation was made at a time when modernization was cascading into Acute Trusts as a result of the NHS plan (DOH 2000); simultaneously the European Working Time Directive (EWTD) was being implemented, sequentially reducing Junior Doctor’s hours of work. NHS modernization and the EWTD were the two initiatives which led the researcher to the assumption that RNs working in surgical wards were the labour force who would be absorbing the additional workload brought about by these changes, because RNs are the only health professionals in acute surgical wards with twenty-four hour contact with, and responsibility for, ward-based surgical patient care. The study was conducted in one clinical directorate of an Acute Trust hospital, comprising six in-patient surgical wards and five specialist nursing services. The methodology was ethnography, where the researcher worked as an RN for fifteen months, collecting data through Spradley’s (1980) descriptive, selective and focused phases of fieldwork. Data was analysed using what Miles and Huberman (1994) refer to as a set of ‘choreographed / custom built’ techniques. The descriptive phase of fieldwork revealed an apparent ‘staffing illusion’ on the surgical wards and RNs were found to be under tremendous pressure to manage ‘patient throughput’, and an ever increasingly dependent case mix of surgical patients, within the existing, or if possible diminishing Senior / experienced RN labour force due to the emergent evidence of a ‘cycle of staff change’ with non-clinical managers backfilling Senior RN posts with Junior RNs. For Senior RNs this backdrop meant additional support and supervision demands on their role. To get through the workload many RNs held ‘dual roles’ to enable maintenance of the surgical services within the directorate. The selective phase of fieldwork re-focused the ethnographic lens on the RNs in the context of their role development, role expansion and role extension, from which six perspectives were found: 1) role development from Junior to Senior RN, 2) role expansion dependent on shift of the day, day of the week – the co-ordinator role, 3) role extension confusion and boundary disputes, 4) hidden [role expansion and extension] talents of surgical nurses, 5) role contraction – a feeling Nursing is going backwards, and finally, 6) ‘if only I could’ – role expansion aspirations of surgical RNs. The third phase of fieldwork, described by Spradley (1980) as the focused phase, was spent validating the findings and conducting the ethnographic interviews. The findings are interpreted locally [from the perspective of RN’s working within Rodin] as ‘working to full capacity’ through ‘doing more for more with less’, as a result of the RN with the surgical directorate being sandwiched between two agendas, that of Junior Doctors EWTD and NHS modernisation. Braverman’s skill substitution / degradation of skilled work thesis is then used as an interpretative framework to conclude the thesis, the outcome of which reports a ‘triple substitution’ agenda.

Total hip replacement is one of the most extensively and highly effective operating methods in orthopaedics. The patients are brought back the self-sufficiency, life without the pain and noticeably motion restriction. Irreplaceable function here is a role of the nurse, who helps the patient to return back to his common life...The aim of this work was to find out, how the patients feel the role of the nurse and its influence to given nursing care before and after the total hip replacement as the less fulfilled. There were following research questions set: How the patients feel the role of the nurse before and after the total hip replacement? How the patients before and after the total hip replacement feel the interpretation of the nurse roles? How the patients before and after the total hip replacement feel the role of the nurse and its influence to given nursing care. Which of the nurse roles are felt by the patient as the unsatisfactory in postoperative care? The patients before and after the total hip replacement feel through the everyday nurse activities the nurse in her role of the caregiver and education giving person, following the nurse vindicator and the nurse bearer of changes. The patients feel the care thanks these roles as a quality, holistic and continual. Nevertheless was the role of the education giving named as the least fulfilled. In connection with these research results was created a manual, a Guide book for the patients before and after the total hip replacement. This Guide book was given to testing purposes. This Guide book was appreciated by the patients very positive despite a large amount of information, which were surprising for many of them. We gained some data, which gave the impulse to complete the information in the Guide.The created Guide book can´t replace the effective communication of the patient with the medical staff, which could be always the most suitable "source" of information.

The thesis is focused on a research and the evaluation of the nurse role during the invasive methods in chronic pain treatment and on a research the patient satisfaction and expectation with the nurses approach during the invasive methods in chronic pain treatment. The basis for the thesis processing is qualitative ? quantitative research carried out in the departments of pain treatment in four hospitals, in University Hospital Motol, University Hospital Brno, Hospital České Budějovice a.s., University Hospital PlzeňAlejSvobody. Qualitative research focuses on nurses working in the department of pain treatment using a method of questioning with the technique of non-standardized interview. Within qualitative research, we was looking for the answer to the research question: What is the nurse role during the invasive technique in chronic pain treatment? It was found, from the results of the interviews and their analysis, that nurses have within the invasive performance wide field of action and their role is changing in various stages of the entire performance. In all phases of the invasive performance, it´s essential the communication between the nurse and the patient. In the phase before the invasive performance and afterwards is the most dominated the educational role, except for the nursing role. Quantitative research using the questionnaire was intended for patients in the departments of pain treatment. The following predetermined hypothesis were verified using quantitative research: H1: Patients are satisfied with the nurses approach during the invasive techniques in pain treatment. H2: Patients with chronic pain during the invasive methods are expecting especially the empathetic approach from nurses. Evaluation of the questionnaires, which were voluntarily completed by patients, can be ended that both given hypothesis H1 and H2 have been confirmed and that the targets of qualitative researches have been met. The space for improvement can be found in the patient education before the invasive performance. Therefore We created educational material for patients. This educational material is not intended to replace the education conducted by nurses, it rather serves as a basis for the questions preparation that the patient will want to clarify before the invasive performance.

Bakgrund: Inflammatorisk tarmsjukdom är en kronisk tarmsjukdom som ofta drabbar unga patienter och som ofta kräver livslång behandling. Vid avbrott av behandling drabbas patienten ofta av skov som kan vara svårbehandlade. På sikt kan obehandlad inflammatorisk tarmsjukdom leda till kolorektalcancer. Syfte: Syftet var att belysa patientens erfarenhet och behov av stöd och information vid inflammatorisk tarmsjukdom. Metod: En litteraturöversikt enligt Friberg, (2017) har genomförts. Artiklarna söktes fram via databaserna; PubMed, Cinahl complete och Academic Search Complete. Litteraturöversikten grundar sig på åtta vårdvetenskapliga studier, varav fyra utfördes med mixad metod, tre med kvalitativ metod och en med kvantitativ metod. Resultat: Resultatet presenteras utifrån två teman och fem underteman som framkom i analysen av studierna; Det första temat var Information till patient med IBD, med tre underteman; Informationens innehåll till patient med IBD, Hur läkemedlsinformation kan ges till patient med IBD och Behov av utbildning för sjuksköterskor för att tillmötesgå patientens behov av information. Det andra temat var Relation mellan sjuksköterska och patient med tillhörande underteman; Patientens behov av att ha en relation med sin sjuksköterska och Patientens behov av en relation med sjuksköterska från barn till vuxenvård. Diskussion: Resultatet diskuteras utifrån tidigare forskning samt utifrån Travelbees omvårdnads teori. Det fanns stöd för att patienten har ett behov av information och en relation med sjuksköterska. / Background: Inflammatory bowel disease is a chronic intestinal disease that often requires a lifelong treatment. With the occurrence of an interruption the patient may be stricken by episodes that is difficult to treat. Eventually an untreated inflammatory bowel disease could evolve to colorectal cancer. Aim: The aim was to describe the patient’s experiences and its need for support and information regarding the inflammatory bowel disease. Method:A literature review according to Friberg, (2017) have been carried through. The literature review is established on eight scientifically studies, which out of four was carried on with mixed methods, three with a quality method and one on quantitative method. The articles were provided via the data platforms; PubMed, Cinahl Complete and Academic Search Complete. Results: The result is presented under two major themes and five sub themes. First theme being: Information of disease and treatment with three sub themes; Content of information for a patient with IBD, how information about treatement is given to a patient with IBD and the need of education to nurses to fulfill the patient’s need of information and the second theme being: relationship between nurse and the patient and two sub themes being; The patient’s need of a good relation to its nurse and the patient’s need of a good relationship with the nurse from child to adult care. Discussion: The result has been discussed towards prior studies a to wards prior studies a towards Travelbees theory in care taking. There is support for believing that the patient needs information and a good relation towards the nurse.