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Thesis (M.S.)--Boston University

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The purpose of this study was two-fold: to identify role functions and characteristics perceived as important to Advanced Nurse Practitioners (ANPs) in Texas, and to identify differences in perceived importance of role functions and characteristics of ANPs according to gender, educational preparation, practice setting, and whether the practitioner entered practice before or after the current rules and regulations for ANP practice were adopted. Two questionnaires and a demographic data form were mailed to 300 ANPs in primary health care in Texas, with 152 responding. Data from the questionnaire, "Characteristics of the Advanced Nurse Practitioner," were analyzed using independent group t-tests. The findings indicated that the characteristics "person-oriented," "perceptive," and "skilled in problem-solving" were the most valued by the practitioners, while aggressive" was the least valued. Independent group t-tests were used to analyze data from the instrument, "Advanced Nurse Practitioner Functions." The results of this analysis were not significant. The Chi square test was used to further examine data from this questionnaire to determine if the responses differed from chance. With the exception of four items, all of the responses differed significantly from chance. The responses "extremely important or important" were selected significantly more frequently that any of the other options. Not appropriate," was selected significantly more often than could be expected by chance for two functions: suturing minor lacerations and performing incision and drainage of wounds. Fourteen functions were examined further using frequency, percentage of responses, and the Chi square test to determine if there were differences in responses between groups. There were significant differences in responses between ANPs in nurse-managed settings and those in physician-managed settings on four functions: ordering diagnostic tests, prescribing medications in consultation with a physician, suturing minor lacerations, and performing incision and drainage of wounds. Practice setting and educational preparation were the variables which had the greatest impact on perceived importance of the characteristics and functions to ANP practice.

BAKGRUND: Mer än var tionde kvinna drabbas av bröstcancer under sin livstid, vilken är den vanligaste cancertyp som drabbar flest kvinnor. Trots den höga incidensen har antalet friskförklarade ökat de senaste åren. Kvinnor med bröstcancer får en förändrad självbild efter diagnos och behandling, vilket generellt skapar specifika omvårdnadsbehov. Det är viktigt att hantera dessa konsekvenser av bröstcancer, då de är starkt sammankopplade med livskvaliteten. Detta medför ett ökat behov av holistisk omvårdnad med fokus på livskvalitet.  SYFTE: Att belysa sjuksköterskans stödjande roll i omvårdnaden av patienter med bröstcancer. METOD: Undersökningen genomfördes som en litteraturöversikt och utgår från artiklar baserade på kvalitativa studier. RESULTAT: Bröstcancerpatienter i olika stadier, från diagnos till efter avslutad behandling, uttrycker att sjuksköterskan varit en viktig resurs genom hela vårdprocessen. Framför allt betonas hantering av information, stöd och kompetenta sjuksköterskor. Sjuksköterskan har förmedlat emotionellt stöd, hjälpt till att navigera i systemet som omger vårdprocessen, varit kompetent, varit kunnig inom cancervård samt har förmedlat information.  SLUTSATS: Litteraturstudien visar att sjuksköterskor i de flesta fall möter bröstcancerpatienter i deras behov av stöd, information, kliniska färdigheter samt kunskap om hur systemet i hälso- och sjukvården fungerar. Det framkommer att de flesta patienter och närstående är nöjda med vården och att de har känt förtroende för sjuksköterskan. För att ett salutogent hälsoperspektiv ska kunna råda behöver de här patienterna inte bara hjälp med den fysiska vården relaterad till bröstcancer utan detta förutsätter vård i ett holistiskt perspektiv. / BACKGROUND: More than one in ten women get diagnosed with breast cancer during their lifetime. Breast cancer is currently the most common type of cancer amongst women. Despite the high incidence the number of women who are declared healthy in recent years, increase. Women with breast cancer experience an altered self-image after diagnosis and treatment which generally creates specific nursing-needs. It is important to handle these impacts of breast cancer since they are strongly connected with life quality. This increases the need of holistic nursing with a quality of life focus. PURPOSE: To highlight the nurse´s supportive role in the care of patients with breast cancer. METHOD: The survey was conducted as a literature review and based on qualitative studies. RESULT: Breast cancer patients at various stages, from diagnosis to after completed treatment express that the nurse has been an important resource throughout the care process. In particular, they emphasize managing information, being supportive and is knowledgeable. The nurse has conveyed emotional support, helped to navigate in the system surrounding the care process, owned skills and knowledge in cancer care and that supplied information. CONSLUSION: The literature review show that nurses in the majority of cases meet patients in their needs for support, information, clinical skills and knowledge of how the system of health care functions. It appears that most patients and their relatives are satisfied with the care and they have trusted the nurses. To be able to provide care with a salutogenic perspective in interest, the patients not only need physical care, they need care with a holistic perspective.

<p>Today patients are more aware of their rights regarding their own care. They are more informed, more engaged and have more and individual requirements, which leads to increased demands for information and participation increases. The Health Act sets out the patients´ right to participation. Participation increases patient satisfaction with care, promotes healing and increases adherence to health care advise. The patient doesn´t always experience participation in their own care to the extent they wish, which suggests that nurse’s does not always succeed in getting the patient involved. The purpose of this study is to describe factors that are important for patient participation in nursing care in a nurse- and patient perspective. Nine research articles were analyzed with qualitative content analysis. The analysis resulted in two themes: health care relationships and communication. Through various acts of nursing care, patients experienced themselves as being seen and confirmed. Patients experienced a sense of security and trust, which is the essence of a trusting relationship, which in turn is the basis for caring and patient participation in their own care. Patient participation requires a sophisticated interaction between nurse and patient, a quest of a safe relationship that can lead the patient to see themselves seen and confirmed.</p><p> </p><p> </p><p> </p><p>Keywords: patient participation, nurse-patient relationship, nurse, care</p>

Bakgrund: Antalet intensiv -och anestesisjuksköterskor har ökat från 87 till 111 per hundra tusen invånare de senaste tjugo åren, trots detta rapporterar SCB i sin årliga arbetskraftsbarometer en stor brist för samma personalgrupp. Forskning som identifierar trivsel respektive misstrivsel på en arbetsplats och varför personal slutar, utifrån anestesisjuksköterskors perspektiv är begränsad. Denna studie är ett bidrag som ökar förståelsen för varför anestesisjuksköterskor slutar på anestesikliniken. Syfte: Att beskriva aspekter till varför anestesisjuksköterskor slutar på sina arbetsplatser inom anestesikliniken samt vad som skulle kunna ha förändrat beslutet. Metod: Deskriptiv intervjustudie med åtta anestesisjuksköterskor. Data analyserades med kvalitativ latent innehållsanalys. Resultat: Aspekterna som påverkar anestesisjuksköterskorna att avsluta sina tjänster på anestesikliniken står i ett komplext samband till varandra. Drivkraft identifierades som en viktigt faktor för att stanna på arbetsplatsen. Den består dels av inre motivation som kommer ur arbetsglädje, givande patientmöten och möjlighet till återhämtning. Drivkraften utgörs också av den yttre motivationen som består av kompetensutveckling och lönesättning. Drivkraften försvagas om dessa faktorer inte ges tillräckligt utrymme och det finns risk för att anestesisjuksköterskor slutar. Anestesisjuksköterskornas drivkraft är beroende av en förankring för att uppnå balans och inte driva iväg för långt. För att åstadkomma förankring lyfts betydelsen av självständighet fram vilken består av rimlig ansvarsfördelning, tydliga roller och respekt för varandra. Självständigheten står i ett beroende till samarbetet på arbetsplatsen. Ur ett gott kollegialt stöd växer en sammanhållning fram som skapar trivsel och förankrar anestesisjuksköterskorna i organisationen. Konklusion: Arbetet beskrivs som odelat positivt när rätt förutsättningar för att kunna utföra det på ett tillfredsställande sätt finns. Aspekterna kring varför anestesisjuksköterskorna avslutar sina tjänster på anestesiklinikerna står i ett komplext samband till varandra.

Magister Curationis - MCur / In 2011, a structured electronic system for the staffing of agency nurses was implemented in the Western Cape as part of the Nursing Information Management System (NIMS). This electronic system was developed to ensure a fair tendering process for the procurement of agency staff, providing information on agency expenditure, maximum wage rates and adherence to principles and rules of supply chain management. Although technology is used more and more in healthcare services within the Western Cape, some professional nurses could lack the skills needed to implement the electronic system appropriately. A descriptive and quantitative design was followed to determine the competence levels of professional nurses in utilising the electronic staffing system for agency nurses in public hospitals in the Metropole, Western Cape. The aim of the study was to develop guidelines for nurse managers according to which they can train professional nurses in hospitals to utilise the electronic system for staffing of agency nurses. Assumptions were adapted from the theoretical framework of Benner (1984) on different levels of competencies and used as theoretical departure of the study. The accessible population for this study was all the professional nurses in hospitals within the Metropole of the Western Cape Government Health registered as users on the database, called the Nursing Information Management System (NIMS) (N=278). This population served as the total inclusive sample for the study. The method of data collection was a self-administered structured questionnaire. The data was analysed by using the SPSS Version 24 software program and descriptive and inferential statistics were conducted.

Approximately 40,000 certified registered nurse anesthetists (CRNAs) are included in the anesthesia workforce in the United States. They provide a critical portion of anesthesia care throughout the country often practicing in rural and underserved areas of America. CRNAs are educated and trained to provide high-quality, cost-effective care for patients. Policy makers and health care organizations consistently call for policies to enable these providers to deliver care to the full extent of their education and training. The National Academy of Medicine (former Institute of Medicine) recommends in their seminal report, The Future of Nursing: Leading Change, Advancing Health, that CRNAs practice to their full potential as full partners with physicians. In order to promote CRNA ability to practice to the full extent of their training and education and assure that patients have access to safe anesthesia services, both policy and organizational influences on their care provision and should be taken into account. Whereas focus has been paid to policy restrictions and their influence on CRNA care, little is known about organizational influences on CRNA care or organizational structures that are present in the employment settings of CRNAs. Organizational climate, which is employees’ perceptions of and experience with organizational structures within their employment settings, has been studied in healthcare settings. Studying organizational climate in healthcare settings is important because research concludes that organizational climate of healthcare settings impacts providers and patients. Registered nurse (RN) organizational climate has been well studied, and researchers identified that important aspects of RN organizational climate include autonomy, control over practice, teamwork, and collaborative relationships with physicians and staff. When RN organizational climate is favorable, job satisfaction and nurse retention improve, and patients receive high-quality care. Researchers have also studied nurse practitioner (NP) organizational climate and have identified climate characteristics that enable NPs to function to their full capacity, while promoting job retention, decreasing costs, and improving access to care. Whereas evidence is clear that organizational climate is an important concept to study within healthcare organizations, little is known about CRNA organizational climate or how it impacts CRNA outcomes or patient outcomes, nor do we know how to measure organizational climate and further asses it. Therefore, this dissertation investigates CRNA organizational climate and adapts a tool to measure CRNA organizational climate. In Chapter 1, a background on CRNA contributions to anesthesia care in the United States is presented. In addition, challenges and restrictions affecting CRNA practice are discussed, and studying the concept of CRNA organizational climate is introduced. The theoretical and empirical underpinnings guiding the dissertation are presented, and the three aims of the dissertation are stated. In Chapter 2, aim one of the dissertation is addressed. Aim one of the dissertation is achieved by systematically reviewing and synthesizing evidence regarding CRNA working conditions and outcomes. This evidence lays the foundation for studying CRNA organizational climate. In Chapter 3, aim two of the dissertation is addressed. This aim is achieved by selecting an instrument to adapt to measure CRNA organizational climate. In this chapter, the processes of content validity testing and reliability testing of the Certified Registered Nurse Anesthetist Organizational Climate Questionnaire (CRNA-OCQ), the adapted instrument to measure CRNA organizational climate, are presented. In Chapter 4, aim three of the dissertation is addressed. This aim is achieved by the further psychometric testing of the CRNA-OCQ, which is presented in this chapter. In this chapter, the CRNA-OCQ is refined and finalized through conducting exploratory factor analysis. In addition, the internal consistency reliability of CRNA-OCQ subscales is assessed. In Chapter 5, results from the three included studies are discussed and synthesized. In addition, practice, policy, and research recommendations are presented. Lastly, the strengths and limitations of the dissertation are discussed before the conclusion.