The nurse navigator role developed in the 1990s to support African American female oncology patients' access to services. Successful in oncology, the role has expanded to support patients with diabetes, heart failure, and chronic obstructive pulmonary disease. A unique cost-effective opportunity exists for nurse navigators to fill the gap in transitional care, between the acute care setting and home, for chronically ill and other at-risk patients who are often readmitted within 30 days for treatment of the same disease. The purpose of the project was to refine the job description of the nurse navigators in a Midwestern acute care hospital. The Rosswurm and Larrabee model for evidence-based practice change supported the work. The key research question involved identifying the tasks, knowledge areas, and skills necessary for inclusion in a hospital-wide nurse navigator job description, to promote best outcomes for chronically ill and at-risk patients. Using the Oncology Nurse Navigator Role Delineation Study as the starting point, the project applied a qualitative design in reviewing the 13 nurse navigator job descriptions. The percent of nurse navigator job descriptions containing the job expectations from the delineation study was calculated and additional expectations were identified from the hospital job descriptions and the literature to create a new standardized job description containing 3 categories of job expectations: tasks, knowledge areas, and skills. Positive social change may result from nurse navigator role clarity in the hospital by decreasing service duplication, improving care collaboration, and ensuring role accountability.

Institutions are recruiting new graduate nurses to fill their vacancies. The aim of this project was to create a new graduate nurse orientation program that consists of the Essentials of Critical Care Orientation (ECCO) program created by the American Association of Critical Care Nurses (2014), scenarios, and simulation that will result in an increase in nurses' sense of their ability to provide safe patient care, communicate effectively, perform skills, and increase their sense of institutional support. The theoretical framework for this mixed methods project was Benner's "From Novice to Expert." The convenience sample participants consisted of 17 baccalaureate-prepared new graduate nurses. The Casey-Fink Graduate Nurse Experience Survey was administered prior to the orientation program and again at the completion. Content analysis was used for Section I of the survey, which pertains to the top 3 skills nurses are uncomfortable performing. In the presurvey, chest tube care, ECK/EKG/telemetry, and tracheostomy were listed. However, they were not listed on the post survey. The findings resulted in a correlation between skills that were taught during simulation and scenarios. Fisher's exact test was used for Sections II, III, and IV of the survey. There was no statistically significant difference in the pre and post survey as it pertained to questions regarding safe patient care, communication, and sense of institutional support. Results of this study are inconclusive and do not fully support the orientation program. Nurse leaders have a social mandate to ensure new graduate nurses are supported and have the resources needed to provide safe patient care. The program that was created and implemented was an attempt to assist new graduate nurses with their transition into practice.

Evidence-based practice has resulted in better patient outcomes, higher patient satisfaction, and effective patient-centered care. Leadership of a large teaching hospital determined that new nurses lacked the education and experience to design and implement an evidence-based project at the bedside, which was an expected outcome for completion of the established nurse residency program. The purpose of this project was to develop a design-only project in which Masters of Science in Nursing-prepared mentors were added to the residency program to establish the required evidence-based project. A mentor workshop was developed to guide the mentors in this role using Benner's novice to expert theoretical model. A team of stakeholders, including an expert in the field of nursing education, provided ongoing process evaluation in the development of the outcome products including the Mentor Facilitation Guide, Mentor Workshop Curriculum, Mentoring Toolkit, Pre-and Post-Mentor Workshop Survey Assessment, and Mentor Implementation Plan. Stakeholders completed a summative evaluation on the processes, outcomes, and student leadership of the project. Findings showed that the project met 100% of the stated goals and objectives, as evidenced by the stakeholders' responses to the summative evaluation regarding the degree of effectiveness for the project, process, and leadership skills. Implementation and evaluation of the project, which was developed for use in the hospitals' existing nurse residency program, will occur post-graduation. Social change will occur if new nurses learn to use evidence-based practice to support their nursing actions, resulting in improved patient care outcomes and population health.

There is a gap between organizational commitment to professional value of the nurse and the achievement of quality outcomes. This study explored the relationship between the productivity model and the professional value (PVS) model of the hospital-based registered nurse (RN). It was essential to understand how to measure nursing's contribution to patient care as a means to promote patient care outcomes. The current professional nursing dynamic provides an unprecedented opportunity for nurses to achieve their highest professional potential through increased demonstration of advocacy and accountability for the central tenets of nursing. The intent of this project was to explore the elements of the professional nursing workforce in a modern-day hospital. This study was conducted on the medical, surgical, progressive care unit (PCU) and critical care unit (CCU) of a community-based acute care hospital Washington State. A quantitative approach was undertaken utilizing a descriptive correlational study design. RNs on the identified units received electronic invitation and survey via organizational email system, resulting in a participation rate of 47.1% (N=48). The study found that PVS model achievement explained patient outcome variable variance (fall rate 86.4%, HAPU 83.1% and CAUTI 40.9%). Further, large effect size (98%) with work unit variance was demonstrated with PVS model achievement. The innovative PVS model was found to demonstrate a statistically significant difference from existing productivity model, and alignment of RN staffing with organizational quality goals. Recognizing the professional value of the RN could promote meaningful change in the healthcare landscape and optimize patient care and quality outcomes.

Moral distress is a negative emotional and somatic response to external constraints on moral action. The constraints are typically identified as a component of the work environment, called the ethical climate. Moral distress is identified as a primary reason for job attrition by up to one-quarter of registered nurses who leave their jobs. One strategy suggested to staff nurses who experience moral distress is to consult their Nurse Manager (NM). However, the moral distress of NMs who are employed in acute care hospitals is poorly understood. The purpose of this qualitative study was to examine NMs' perceptions of the external constraints on moral agency, specifically the hospital ethical climate, which leads to their experience of moral distress and how attributes of the ethical climate facilitated or impeded resolution of their moral distress. Semi-structured, audio-recorded telephone interviews were conducted with 17 NMs from across United States. An interpretive description design using an iterative process between data collection and data analysis was used. Data were analyzed through descriptive coding and thematic analysis. The participants in this study were 15 women and 2 men with a mean age of 46.4 years. The mean length of time in their current positions was slightly less than 5 years. Of the 17 hospitals represented, 6 were affiliated with a university and 4 had a religious affiliation. Fifteen of 17 NMs described situations in which the implicit and explicit values of the hospital were incongruent with their personal moral values and professional ethics. Common themes describing factors contributing to moral distress were administrative policies, negative communication patterns and relationships with physicians, issues related to staff nurses, issues related to patients and families, and multiple competing job obligations. Respondents described strategies to navigate through their moral distress. The strategies included taking a positive perspective, seeking the advice of NM colleagues, reliance on a positive relationship with a supervisor, and talking it through with family members. For 5 of the 15 NMs who experienced moral distress, their final strategy included plans to resign from their positions. Issues within the ethical climate of the hospital that were perceived to contribute to the development of moral distress among this cohort of NMs differed from those reported for staff nurses. Further examination of strategies used by NMs to improve the ethical climate may yield insights into effective ways to address moral distress for this population.

This report focuses on the use of Watson's theory of human caring for Do Not Resuscitate (DNR) patients in acute medical-surgical wards. It discusses the dilemmas facing DNR patients and their nurses and explores the solutions to these dilemmas offered by Watson's theory. Traditional nursing practice places the nurse in a difficult situation by focusing on physical health. The report discusses the philosophical assumptions underlying Watson's theory. These assumptions led Watson to focus on nursing holistically, and to emphasise an integrated approach to nursing, which promotes the comfort of the patient physically, spiritually and emotionally. Her focus is on the broader aspects of caring such as involving the care domain of nursing, instead of the narrower view of nursing which focuses on care for the 'cure' only. This appproach is particularly relevant to DNR situations because these situations involve patients for whom there is no physical cure. Watson's holistic approach to caring offers the nurses of DNR patients guidelines for their practice and meaning for their nursing actions. Because current DNR decisions are often made by medical officers but implemented by nurses, it is the nurse who may be legally liable for the patient's death. This can cause anxiety for the nurses involved. Another cause of anxiety can be the traditional focus in nursing on physical cure. In the care of DNR patients, no such cure is possible. This can leave the nurse feeling distressed and incompetent. DNR the patients, may lack of autonomy and suffer feelings of insecurity. It is in these areas that Watson's ten carative factors can offer support, for both patients and nurses. / Master of Nursing

The research reported in this thesis explored the perceived value of transition support programs for newly registered nurses in New South Wales and the health care facilities offering such programs. Although transition support programs have been designed and implemented in various forms since the transfer of nurse education to the tertiary sector, there remains little evaluative evidence of the value of such programs. Two groups of registered nurses formed the participants in this study. The first were new graduate nurses who completed a transition support program within the past 12 months. The second comprised experienced nurses who worked with new graduate nurses during their transition support program. The study was carried out in seven hospitals in area health services across and around Sydney, representing both small and large facilities with bed numbers ranging from 195 to 530. Data were collected from four sources including the printed materials made available by sample hospitals. Questionnaires, interviews and observations were used to determine the purposes, outcomes and strengths and weaknesses of transition support programs. The data were analysed using descriptive statistics and theme extraction. The themes described the ways in which the transition support programs were used to facilitate the transition of the newly registered nurse to confident beginning practitioner. There was widespread belief from the study participants that some aspects of nurse education at university were inadequate. As a result, various structures and policies were required to support the new graduate nurses as they entered the workplace. The transition support programs were used to increase nursing staff for the study hospitals and to provide new learning opportunities for new graduate nurses to enable them to develop the clinical and professional skills required of competent registered nurses. The rotational aspect of the transition support programs were used to provide staff for the less popular areas of the hospital as well as a variety of experiences and skill development opportunities that were considered lacking in the current undergraduate education of nurses. The work environment where the programs operate were described as difficult with nurses exposed to violence and bullying practices from fellow staff and frequently required to work with a less than ideal number or appropriate skill mix of nursing staff. The hospitals also used the transition support program to exert a controlling influence over the new graduate nurse by way of roster management, assessment of skills and the expectation that each nurse would complete a transition support program before being offered full time work. The thesis concludes with recommendations and future research avenues. It would be useful for hospitals to conduct formal evaluations of the transition support program they offer to provide the most effective program possible. One source of information could be sought from the new graduate nurses regarding their needs during the first six months of employment. It is also suggested that a study be commenced that investigates the reasons behind the perception that nurse education at universities in New South Wales is inadequate.

This research explores how registered nurses constructed their leadership role during the provision of health care services in acute care, adult hospitals in Brisbane, Queensland, Australia. As health care organizations change to meet the demands of the twenty first century, nurses in Australia are coming to realize there is a dissonance between what they perceive to be the relevance of their work and the perception of the relevance of nurses’ work by others in the health care system. Consequently, nurses’ contributions to health care services are not recognized. The literature highlights that one way to address this problem is to articulate the various leadership roles contemporary nurses are asked to undertake. This is the aim of this thesis. This research seeks to illuminate the role of the nurse within changing health care systems by making clear the nature of their work through the perspectives of leadership. Consequently, the purpose of this study is to explore how nurses have undertaken leadership initiatives in their role as health care providers within contemporary health care organisations. The literature review generated following research questions: 1. How do nurses describe leadership within their health care organisations? 2. How do nurses experience leadership within their health care team? 3. How do nurses construct their leadership role whilst providing health careservices? In order to legitimate its findings this study aimed to provide a clear theoretical framework. In order to gain a clear understanding of the personal experiences and meanings of the participants, the theoretical framework for this study was underpinned by the interpretive philosophies the epistemological framework of constructionism and the theoretical perspective of symbolic interactionism. The methodology of case study enabled an empirical investigation of a contemporary nursing phenomenon, leadership wherein the researcher was able to pose questions to those nurses from whom most could be learned. Data were collected through two stages. In stage one, the exploratory stage data was collected through three focus group interviews. Stage two aided deeper exploration of the nurses’ leadership constructs with data obtained through one-to-one interviews. Analysis of the data enabled the development of a model of nurse leadership. Participants identified that their leadership was constructed through three perspectives of Self as Leader, Self and Others and Self in Action. The findings contrast the nurses’ unique leadership constructs to those of health care organisations, highlight the lack of acknowledgment for nurse leadership within health care teams, and demonstrate how the nurses’ leadership constructs influence their decision to act in the provision of patient care. This study concludes that as the nurses come to realise traditional leadership models are incompatible with their goal of achieving patient centred care, they have developed a different style of leadership to achieve their vision of patient centred care. Finally this study offers recommendations in the areas of nursing practice, nursing education and research.

Primary health care as a model for the provision of health services was introduced by the World Health Organization In the mid 1970s. Initially viewed as a means of health promotion and advancement of wellness in developing countries., it was soon to be adopted by industrialised countries to assist in relieving the demand on acute care services. This was to be achieved through education of the community towards good health practices and the preparation of nurses to practice in the community, outside of the acute care environment Australian nurses were slow to respond to this philosophy of health care and this study has sought to examine why this is so. It has been found that there are a multitude of reasons for the lack of action In the decade or more following the Declaration of Alma Ata and the major Issues have been identified and elaborated. Some of the major reports of the time that were associated with and had some Influence on health care and nurse education have been examined to identify recommendations and how much they support the ethos of primary health care. These include the Sax committee report of 1978 and a submission by the Department of Employment and Industrial Relations In 1987. As part of the investigation, nursing curricula from around Australia in the mid 1980s have been examined to determine the degree of the primary health care content according to guidelines recommended by the World Health Organization. It was found that generally at that time, there was a deficit In the preparation of undergraduate students of nursing for practice In the area of primary health care when the world, including industrialised nations, was making moves towards this model of health care delivery. Factors Influencing the slow response of nursing have been examined and finally recommendations for further studies have been put forward.

<p>Overweight and obesity in children is an extensive and accelerating </p><p> problem in the western world. The risk factors for overweight are well-</p><p> known and well-documented. Focus should lie in the prophylactic work </p><p> in order to prevent overweight and obesity in preschool children.</p><p> The aim of our study has been to highlight the role of the district</p><p> nurse in her/his work to prevent overweight and obesity in preschool </p><p> children. The study was carried out through studies as a literature </p><p> review. In order to support the parents and taking their circumstances </p><p> and conditions into consideration, it was considered very important that </p><p> the district nurse paid attention to the view of the parents on the weight </p><p> of their child. Parents were considered to have an important role in </p><p> giving their children healthy eating habits. The attitude of the district </p><p> nurse was relevant as to how she/he treated the overweight and how </p><p> she/he tackled the preventive work. Professional practice and training </p><p> within the field were important factors in making the district nurse </p><p> succeed in her/his work to prevent overweight and obesity in children. </p><p> Lack of time and lack of parental commitment and attitude were the </p><p> main reasons for limiting the district nurse in her work to prevent </p><p> overweight and obesity in children. Personnel within the primary care </p><p> should supervise and coordinate health promoting measures in order to </p><p> prevent overweight and obesity in children. The district nurse plays a </p><p> unique part in influencing the parents very early on in their children’s </p><p> life by arranging regular and repeated visits to the child welfare center. </p><p> The basis for a successful work by the district nurse is training and the </p><p> fact that she is made aware of her own attitudes towards overweight. </p><p> More research is imperative to support and develop guidelines for </p><p> preventing overweight and obesity in children.</p>