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There is evidence that older Canadians have a higher incidence of presenting to the emergency department (ED) than any other age group. These visits may be made more complex if individuals are also cognitively impaired or have dementia. The purpose of this study was to explore ED nurses’ experiences of caring for adults with dementia in the ED. Using an interpretive descriptive approach, 12 registered nurses working in different EDs in an urban setting in Western Canada were interviewed about these experiences. Using the thematic analysis process described by Braun and Clarke, four themes were identified: 1) not a priority; 2) not the right place; 3) get them in, get them out; and 4) getting it wrong. The nurses identified that challenges in the care of persons with dementia in the ED are created by the fast-paced and chaotic environment of the ED, staffing, issues with disposition, and safety concerns. Suggestions for improving the care of persons with dementia were provided by the nurses. / October 2016

Background: The rate of childhood cancer survivors has grown to nearly 80% in the past few decades. Current evidence reveals that primary care providers report feeling unprepared with inadequate knowledge about the variable types of late effects and diagnostic screenings recommended for childhood cancer survivors (Dulko et al., 2013; Potosky et al., 2011). However, the current evidence reflects data mainly from physicians. None of the current literature addresses the specific preparedness of primary care nurse practitioners. Such data would be helpful in better understanding how education and current resources affect nurse practitioner preparedness for such a narrow, but growingly prevalent, patient population.Purpose: To assess primary care nurse practitioner preparedness when caring for childhood cancer survivors.Methods: This descriptive study obtained data using a survey disseminated to primary care nurse practitioner members of the Puget Sound Nurse Practitioner Association in Seattle, WA. Analysis was conducted by calculating the means and modes for each survey item. Results: This sample (n=5) revealed that 50% of nurse practitioners identify as feeling adequately trained to care for childhood cancer survivors. Time and insurance coverage were not found to be barriers to care. Less than 50% of nurse practitioners utilized guidelines from the Children’s Oncology Group. The most wanted resources included the Children’s Oncology Group guidelines, survivor care plans, and electronic health record prompts. Discussion: According to the results of this study imply that nurse practitioners in the Seattle area feel adequately prepared to care for childhood cancer survivors. In addition, nurse practitioners identify that clinical practice guidelines may be beneficial in guiding their care. However, certain limitations, including small sample size, may affect the trustworthiness of the results. Thus, more research is warranted to gather more comprehensive knowledge and understanding regarding nurse practitioner preparedness when caring for childhood cancer survivors in the primary care setting.

Thesis advisor: Dorothy Jones / Background/Purpose: The growth of clinical research trials to improve patient outcomes has significantly affected nursing and the implementation of the nurse research coordinator role. The purpose of this study was to explore how the research nurse coordinator (RNC) perceives this role and associated responsibilities for patients enrolled in a clinical research study and associated problems and ethical tensions that emerge during the delivery of a clinical research protocol. The research questions were 1) How does the RNC perceive his or her role responsibility for patients enrolled in a clinical trial? 2) Does the nurse experience ethical tension during the implementation of the RNC role? Methods: A qualitative descriptive study was used to answer the questions. RNCs from a large Northeastern teaching hospital participated in 1:1 interviews with the investigator. Data were analyzed for this study according to the methods described in Lincoln and Guba (1985) for qualitative research and presented as themes. Results: Eleven RNC participated in the study. Data from the interviews were distilled into five final themes: 1) The RNC develops intentional and mutual relationships with patients and their families that fosters trust; 2) In coming to know the patient the RNC as a clinical expert is able to advocate for the unique needs of patients enrolled in clinical trials; 3) The RNC is respected by the team for his or her skills and as a result is able to practice autonomously; 4) In reflecting on past experiences, RNCs identify with medical science philosophy of cure as opposed to nursing’s one of caring/healing and; 5) In reflecting on some aspects of clinical trials, RNCs recognize ethical tensions and as such are able to influence protocol implementation and future studies. Knowledge gained from this study provides insights about the RNC role perception and highlighted multiple dimensions of care delivery faced by nurses who practice as an RNC. The study participants described practicing in the RNC role with clarity about the role and described practicing with autonomy and independence. / Thesis (PhD) — Boston College, 2016. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Thesis (M.Cur.) -- University of Limpopo, 2018 / Graduate throughput of student nurses is one of the priorities of the National Department of Health in Republic of South Africa. New nurse graduates are expected to curb the obvious shortage of nurses in the nursing profession.The purpose of the study was to design the strategies to enhance graduate throughput of student nurses. The study design was quantitative, cross-sectional descriptive, research design. The study population included all student nurses who have repeated a level of study. Probability cluster random sampling was employed to select the respondents based on the examination results for both levels. Data were collected through a self-developed questionnaire. Questionnaires were distributed to 239 respondents (167 student nurses and 72 nurse-educators were completed and returned and questionnaires were analysed) Ethical clearance was obtained from Turfloop Research Ethics Committee, Limpopo Province Department of Health Ethics Committee and Limpopo College Campuses management. The researcher ensured that measures of reliability and validity are adhered to and ethical principle for conducting research that involves human-beings was considered. Data were analysed using Statistical Package for Social Sciences (SPSS) version 23 for Windows. Descriptive statistics were used to analyse, describe and summarize data in which the findings were presented in the form of distribution tables, graphs and inferential statistics. The study revealed that poor academic performance and achievement of student nurses was caused by work overload, academic stress, anxiety, low morale, lack of dedication, prioritizing social activities and ill health.Strategies to overcome the causes of poor academic performance and achievement of student nurses were developed. The strategies are-; selection criteria, adequate resources and equipment, conducive-learning environment, student nurses counselling, student nurses discipline, academic curriculum, strategies and programs, innovative teaching strategies, expertise placement, in-service trainings, mutual student-nurse, nurse-educator relationship, adequate resources and equipment as well as awards and incentives.

The transition from student to new graduate nurse is a difficult conversion. The challenges of the new graduate are the demanding workload, lack of clinical skills, and incivility from staff nurses and unfamiliar institutional cultures. More than 40% of new graduate nurses report making medication errors and feel unprepared to recognize and intervene in life-threatening complications that keep the patient safe from harm. Preceptorship is a clinical instructive model in which a professional relationship provides new graduate nurses with access to a clinical expert and role model within a preset time frame. The goal of the program was to evaluate the outcomes of a preceptorship program that individualized a teaching-learning method in which a new graduate nurse was assigned a clinical expert in order to experience the day-to-day practice with a role model and a resource in the clinical setting. At the conclusion of the orientation process, the graduate nurse identified confidence in their ability to complete assigned skills, they were more motivated to remain on staff in the facility, and the retention of the new graduate nurses increased from 40% to 100% at the 1 year mark. The graduate nurses evaluated the program, the preceptor and the assigned competencies and the facility and the probability of continuing on staff. The surveys were collected by management, and evaluated for rigor, which revealed encouraging results of the program. The facilitation and integration of the preceptor program for new graduate nurses changed the perception of competency within the facility as it relates to the discipline of nursing and moves the graduate toward professional growth, establishing a changing environment in the facility's community of healthcare.

Walden University College of Health Sciences This is to certify that the doctoral study by Rickey King has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Marisa Wilson, Committee Chairperson, Health Services Faculty Dr. Murielle Beene, Committee Member, Health Services Faculty Dr. Deborah Lewis, University Reviewer, Health Services Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2015 Abstract Development of Emotional Intelligence Training for Certified Registered Nurse Anesthetists by Rickey King MSNA, Gooding Institute of Nurse Anesthesia, 2006 BSN, Jacksonville University, 2003 ASN, Oklahoma State University, 1988 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University February 2016 The operating room is a high stress, high stakes, emotionally charged area with an interdisciplinary team that must work cohesively for the benefit of all. If an operating room staff does not understand those emotions, such a deficit can lead to decreased effective communication and an ineffectual response to problems. Emotional intelligence is a conceptual framework encompassing the ability to identify, assess, perceive, and manage emotions. The research question for this project is aimed at understanding how an educational intervention could help to improve the emotional intelligence of anesthetists and their ability to communicate with other operation room staff to produce effective problem solving. The purpose of this scholarly project was to design a 5-week evidence-based, educational intervention that will be implemented for 16 nurse anesthetists practicing in 3 rural hospitals in Southern Kentucky. The Emotional and Social Competency Inventory - University Edition will be offered to the nurse anesthetists prior to the educational intervention and 6 weeks post implementation to determine impact on the 12 core concepts of emotional intelligence which are categorized under self-awareness, social awareness, self-management, and relationship management. It is hoped that this project will improve emotional intelligence, which directly impacts interdisciplinary communication and produces effective problem solving and improved patient outcomes. The positive social change lies in the ability of the interdisciplinary participants to address stressful events benefitting patients, operating room personnel, and the anesthetist by decreasing negative outcomes and horizontal violence in the operating room.

Experienced nurses depart the workforce in significant numbers; therefore, it is critical to understand how those departures affect patient care and safety. The focus of this systematic review included appraisal of recent research to provide an understanding of strategies used in acute care settings to retain experienced nurses. Guided by Benner's model of skill acquisition, the purpose of this systematic review was to identify factors that influence the decision of nurses with experience to leave or remain working in acute care work settings. The 19 articles selected for this review were limited to those pertaining to experienced registered nurses who have worked in the acute care setting for 2 years and longer. The review excluded articles pertaining to registered nurses with fewer than 2 years of experience, who were considered at the novice or proficient level of nursing. The results of this literature review showed that management conflicts, lack of support, work environments, work schedules, and disproportionate staffing levels were among the factors leading to morale distress and burnout in experienced nurses. These findings have the potential to contribute to positive social change by guiding administrative efforts to retain experienced nurses and improve mentoring of newer nurses and, ultimately, improve patient outcomes.

Research has found that the turnover rate of graduate nurses within their first year is significantly high. Specialties such as pediatric and emergency nursing have even a higher turnover rate. It has been suggested that significant amounts of stress and lack of skills are responsible for the turnovers. This quality improvement project, which is theoretically based on Benner's novice to expert theory, will examine if a lack of a specialized pediatric emergency graduate nurse orientation program is a contributing factor. The purpose of the project is to improve retention of graduate nurses by implementing a specialized orientation program that focuses on pediatric emergency nursing. The research question examined the effect of a specialized graduate nurse orientation program on increasing retention, nurses' competency, and job satisfaction. This project takes the hospital's original orientation program of 6 generalized classes and hands-on orientation and adds a more specialized approach. The Emergency Nurses Association (ENA) Core Curriculum of specialized skills and didactic classes for pediatric emergency nursing (developed by the ENA pediatric committee based on evidence and gold standard practice); evaluation tools (developed by researcher) for both the preceptor and orientee; and face-to-face meetings between the educator, preceptor and orientee were the tools used for specializing the orientation program. It is anticipated that the results will show that increase in retention. In terms of social change, it is anticipated increased nursing retention will increase nursing knowledge and job satisfaction, which will ultimately lead to improved patient outcomes and decreased mortality rates.