nÃo hà / O transplante cardÃaco à uma modalidade terapÃutica de alta complexidade e exige do enfermeiro uma assistÃncia especÃfica, com qualidade, tendo como foco o autocuidado, uma vez que possibilita o envolvimento do paciente de maneira participativa no tratamento. Teve-se como objetivo geral avaliar o autocuidado de pacientes que realizaram transplante cardÃaco, baseado no Modelo do Autocuidado de Orem. E como especÃficos: identificar os fatores condicionantes que interferem na prÃtica do autocuidado de paciente transplantado cardÃaco apÃs a alta hospitalar; verificar os dÃficits de autocuidado de pacientes adultos que realizaram transplante cardÃaco; e correlacionar os fatores condicionantes com o Perfil de Engajamento do Autocuidado. Trata-se de um estudo descritivo-analÃtico, com delineamento transversal e natureza quantitativa, desenvolvido na Unidade de Transplante e InsuficiÃncia CardÃaca de um hospital pÃblico terciÃrio da cidade de Fortaleza-CearÃ-Brasil. A amostra foi composta por 63 pacientes transplantados cardÃacos, que atenderam aos critÃrios de inclusÃo. A coleta de dados foi realizada mediante uma entrevista individualizada, no perÃodo de outubro a dezembro de 2011. O projeto foi aprovado pelo Comità de Ãtica e Pesquisa, sob protocolo do CEP/HM: 109/11. Como resultados dos fatores condicionantes, obteve-se: sexo masculino (88,9%); a idade variou de 23 a 72 anos, predominando de 40 a 59 anos (68,3%); cor da pele nÃo-branca (74,6%), catÃlico (81,0%); casado (77,8%); procedentes do interior do estado (49,2%); nÃvel de escolaridade-ensino fundamental (71,4%); aposentado ou nÃo trabalha (82,5%); renda de atà um salÃrio mÃnimo (47,6%); miocardiopatia chagÃsica (28,6%); tempo pÃs-transplante entre um e trÃs anos (39,7%). Em relaÃÃo ao autocuidado do requisito universal, tÃm-se como dÃficit os seguintes dados: oxigenaÃÃo/respiraÃÃo (26,9%); higiene pessoal (31,7%); higiene do ambiente domiciliar (47,6%); ingestÃo de lÃquidos (39,6%); ingestÃo de alimentos (68,8%); eliminaÃÃes (20,6%); prÃtica de exercÃcio fÃsico (87,3%); sono e repouso (79,3%); interaÃÃo social (90,4%); comportamento emocional (58,7%); prevenÃÃo de doenÃa/promoÃÃo da saÃde (77,7%); tabagismo (1,58%); etilismo (3,17%); prÃtica sexual (61,9%); prevenÃÃo do cÃncer (60,3%). Quanto ao autocuidado do requisito desenvolvimental, apresentou os seguintes dÃficits: participaÃÃo das atividades educativas (39,6%); adaptaÃÃo Ãs mudanÃas apÃs transplante cardÃaco (34,9%). E ao requisito desvio de saÃde, tÃm-se os seguintes dÃficits: comparecimento Ãs consultas da equipe de saÃde (41,2%); imunizaÃÃo bÃsica (100%); uso de mÃscara descartÃvel (46%); contato com pessoas e animais domÃsticos (38%); e conhecimento (20,6%). O Perfil de Engajamento do Autocuidado variou de 88 a 113, constatando-se que a maioria dos pacientes apresentou algum dÃficit de autocuidado, pois 57,1% estavam na classe que âfrequentemente realizava autocuidadoâ. No entanto, embora nenhum paciente realizasse 100% das prÃticas de autocuidado recomendadas para o transplantado cardÃaco, 42,9% sempre realizavam o autocuidado. Conclui-se que os pacientes transplantados cardÃacos apresentam dÃficit de autocuidado para manutenÃÃo e promoÃÃo da saÃde. Portanto, à necessÃrio que os profissionais da equipe de transplante cardÃaco estejam atentos para os fatores condicionantes do autocuidado dos pacientes transplantados cardÃacos, visando estabelecer estratÃgias para reduÃÃo do dÃficit de autocuidado.

As pesquisas que tratam do coping religioso-espiritual (CRE) que vem sendo publicadas ainda não abordaram esta temática com relação ao profissional de enfermagem, profissional este submetido a vários fatores de estresse originados não só de sua prática laboral, mas também oriundos do cotidiano existente fora do local de trabalho. O presente estudo foi desenvolvido com o objetivo de verificar se os profissionais de enfermagem (auxiliares, técnicos e enfermeiros) se utilizam do coping religioso-espiritual para lidar com os fatores de estresse vivenciados tanto no trabalho como na vida particular. Trata-se de um estudo transversal, descritivo de abordagem quantitativa de natureza exploratória, no qual foram convidados a participar da pesquisa todos os profissionais de enfermagem da Unidade de Urgência e Emergência do Hospital das Clínicas de Ribeirão Preto, obtendo-se uma amostra de 126 participantes aos quais foi entregue a cada profissional um envelope contendo o termo de consentimento, o Questionário Geral e a Escala CRE, que foram devidamente preenchidos fora do ambiente de trabalho e devolvidos à pesquisadora posteriormente. Os resultados mostraram que a média de CRE total foi de 3,66, a média de CREP foi de 3,11 e a média de CREN foi de 1,78 e que as mulheres fazem mais uso do coping religioso-espiritual positivo do que os homens. Com relação a situação de estresse referida pelos respondentes, verificou-se que a maioria relatou ter vivenciado uma situação de estresse em ambiente familiar (61,1%), que 25,4% relataram ter vivido uma situação de estresse no ambiente de trabalho, 2,4% referiam ter vivenciado situações de estresse em ambos os ambientes e 10,3% relataram não ter vivenciado nenhuma situação de estresse no período indicado. Apenas 0,8% não respondeu a pergunta. Os resultados obtidos por meio dos índices da escala CRE neste trabalho já eram esperados tendo em vista a religiosidade do povo brasileiro, especialmente a religiosidade da mulher brasileira, no entanto, não foi verificado o impacto do uso do coping religiosoespiritual para a saúde dessa categoria profissional, sendo necessários novos estudos, principalmente com relação ao impacto do uso da dimensão negativa do CRE, que, apesar de ter sido pouco utilizada pelos participantes deste estudo, tratase de informação importante que pode afetar a saúde daqueles que fazem seu uso, cabendo aos futuros pesquisadores na área investigar também possíveis formas trabalhar este aspecto para a realização da promoção da dimensão espiritual dos profissionais de enfermagem. / Researches published in the area of spiritual/religious coping (SRC) still not addressed this issue related to nursing professionals who are submitted to different stress factors arising not only from their work practice, but also from their everyday life outside the workplace. This study aimed to verify if nursing staff (assistants, technicians and nurses) uses the spiritual/religious coping to deal with the stress factors experienced both at work and in private life. It is a cross-sectional, descriptive, and quantitative study in which all nurses of the Emergency Unit of the Hospital das Clínicas of the University of São Paulo at Ribeirão Preto Medical School were invited to participate, obtaining a sample of 126 participants who were given an envelope containing a free consent form, the General Questionnaire, and the Spiritual Religious Coping Scale (SRCOPE Scale), which were completely filled out by the participants out of the workplace and then returned to the researcher. The results showed that the SRC average was 3.66, the positive SRC average was 3.11, the negative SRC average was 1.78, and that women make more use of positive spiritual/religious coping than men. Regarding the situation of stress mentioned by the participants, it was found that the majority reported having experienced a stressful situation in the family setting (61.1%); 25.4% reported having experienced a stressful situation in the workplace; 2.4% reported having experienced stressful situations in both environments; and 10.3% reported not having experienced any stressful situation during the period of the study. Only 0.8% of the participants did not answer the questions. The results obtained through the index of the SRC Scale were expected in view of the religiosity of the Brazilian people, especially the religiosity of Brazilian women, however, it was not seen the impact of the use of spiritual/religious coping for the health of this professional category, which warrants further studies, particularly with respect to the impact of the use of negative dimension of the SRC, which, although it was rarely used by the participants in this study, it is an important information that can affect the health of those who make its use, leaving it to future researchers in this area also investigate possible ways to work to achieve the promotion of the spiritual dimension of nursing professionals.

Purpose: Describe the perceptions of military registered nurses (RNs) on being prepared to provide nursing care during a deployment. Background: Injuries sustained by war are different from trauma-related injuries occurring within the Unites States. Nurses who provide care during overseas deployment encounter patients with poly-trauma, multiple and highly complex injuries; consequently, this type of nursing requires strong clinical skills beyond what is required in stateside facilities. Additionally, military nurses undergo intense stress related to overseas deployment in a war zone. In fact, military medical providers have one of the highest rates of post-traumatic stress post-deployment. Methods: This project employed a qualitative, case study approach. Semi-structured interviews were conducted with military RNs who worked as nurses during overseas deployment. A script was developed to guide the interview, and further discussion stemmed from participant responses. Recorded interviews were transcribed into text and analyzed for commonalities. Findings: Five military nurses who previously provided nursing care during overseas employment participated in this study. Commonalities included the realization that higher acuity injuries are seen in a deployed setting versus a military stateside hospital. Participants also shared fears that they would not be prepared enough to provide excellent patient care. Another commonality was not knowing how to prepare for an unknown experience. A positive commonality was the sense of pride expressed by the participants regarding their military service and deployment experience. All participants outlined what they had learned and what might have helped them to better prepare for deployment. Unanimously, more clinically relevant training was recommended. The participants shared that they had grown and changed from their deployment experience. Implications: All five participants felt a gap in perceived adequate pre-deployment preparation. They believed they lacked the training to care for the high acuity patients they would encounter during overseas deployment; this shook their self-confidence and caused them to worry about being an effective team member. Military preparedness programs should be expanded to include skills and knowledge relevant to nursing in high acuity, hostile environments. Research looking at the personal preparations, specifically mental and emotional, of military members may be helpful in determining any links between mental resilience and the development of PTSD.

The Affordable Care Act has changed the face of health care provision and services in this country, expanding access to more than 30 million people (Buerhaus et al., 2012). With increased coverage comes increased use of health care systems, in a system already saddled with a deficient number of providers (HIS Inc., 2016). The solution to this has been the inclusion of advanced practice nurses (APNs) into both primary and specialty care services. Within cardiovascular medicine, there has been a surge in the recruitment of APNs to care teams (Virani et al., 2015). With this increased need comes the recognition that generalist education and preparation does not prepare an APN to be a competent cardiovascular medicine provider. Advanced practice nurse training has long left specialization to the postgraduate orientation period (Kells, Dunn, Melchiono, & Burke, 2015), and the demands of the healthcare system outweigh the current training models. This has opened the door for the creation of postgraduate fellowship programs for APNs (Taylor, Boryhill, Burris, & Wilcox, 2017). This project focused on the evaluation of existing cardiovascular APN fellowships and proposed the creation of a postgraduate APN fellowship in cardiovascular medicine at Oregon Health and Science University (OHSU).

Magister Curationis - MCur / An increasing number of males is entering the nursing profession. The researcher in his position as a clinical supervisor at the School of Nursing at the University of the Western Cape (UWC), through informal ward rounds with student nurses in the wards, has received concerns raised by male student nurses regarding their dissatisfaction with their clinical learning. Given the paucity of literature about the experiences of males working in a profession dominated by females, the researcher embarked on this study to understand how male student nurses experienced the clinical learning environment. The aim of the study was to explore and describe the lived clinical learning experience of male student nurses during their experiential learning in the clinical setting. A descriptive phenomenological design was used. Purposive sampling was used to select participants from the second, third and fourth year of their study. Three focus group discussions, consisting of six participants per group were used to collect data. One open-ended question guided the interviews. Focus group discussions were audio-recorded and transcribed verbatim. Data analysis was conducted by means of Colaizzi`s (1978) seven steps method of qualitative analysis. Three major themes identified focused on the experiences regarding the constraints in the learning environment, the impact on the self and social support of students working in a female dominated profession. The participants in this study were male students only, but after looking at the findings and literature, the problem of not being given opportunities to practise clinical skills in a clinical learning environment, particularly according to their level of study, is a problem that faces both male and female students. The findings indicate that male nurses do have different experiences compared to female nurses because of their masculinity, hence they are limited in the care that they can provide to female patients.

This thesis investigates the effects of clinical facilitator nurses on medical wards in hospitals. These staff are the current culmination of recent attempts to situate nurse education in the field of clinical practice rather than merely the lecture room. Therefore, the work sets out to gain an understanding of the clinical and educational needs perceived by policy makers; the methods chosen by local managers to fulfil these needs; and the practical manifestation of these initiatives at the bedside. The thesis commences with a literature review consisting of historical context studies and a focused analysis of recent research literature. The context studies are of adult and nurse education. The review of clinical facilitator literature uses search criteria to identify and critically analyse previous research related to similar roles in the United Kingdom. The researcher uses a modified grounded theory approach as a methodological framework for collection and use of data. The data is obtained primarily by field observations; semi-structured interviews with practising clinical facilitators; and from questionnaires completed by nursing students. In addition to this generated data, information harvested from official and academic sources is used to produce theory. The discussion chapter explores the contestation that the themes generated indicate that the introduction of educationally focussed staff, into the area dominated by clinical need, is both problematic and essential. Problematic, as conflicts of role and leadership create misunderstanding and hardship for educators and clinicians. Essential, because in acute wards, where nursing skill is literally a matter of life or death for patients, a large proportion of nursing staff are in need of focussed educational support. The study proposes a model of managerial support for the introduction of educationally focused nurses in the clinical area which enables these clinical facilitators to operate in a valued and protected position.

No description available.

Hot och våld mot sjuksköterskor förekommer inom sluten vården och det är ett växande problem. Detta ses både inom somatisk och psykiatrisk vård. Hot och våld är underrapporterat, vilket är problematiskt ur synpunkten att det minskar möjligheterna att motverka, förhindra och hantera fenomenet. Olika strategier kan användas för att hantera konsekvenserna hos den enskilda sjuksköterskan efter att denne utsatts för hot och våld. Att drabbas av detta leder inte sällan till psykisk ohälsa och/eller fysisk skada som kan resultera i sjukskrivning. Arbetsmiljön är betydelsefull inom vården och patient/sjuksköterskerelationen bygger på en ömsesidig respekt samt empati. Denna vårdrelation kan vara svår att upprätthålla då hot och våld förekommer. En litteraturbaserad studie valdes till examensarbetet för att beskriva sjuksköterskors upplevelse av hot och våld inom sluten vården. Tio artiklar ur vetenskapliga tidskrifter granskades. Ett resultat sammanställdes utefter vad dessa studier kommit fram till. Utefter resultaten bildades tre teman och tio underteman som svarade till syftet i denna litteraturstudie.  Temana som framkom var, att känna sig utsatt, att inte känna stöd och att behöva hitta en lösning för att hantera hot och våld. Sjuksköterskorna önskade mer stöd från verksamheten de arbetade i för att kunna hantera fenomenet. Stödet de önskade låg i omgivningen i form av säkerhetsaspekter i arbetsmiljön. Även känslomässigt stöd upplevde sig sjuksköterskorna vara i behov av efter att de konfronterats med hot och våld. Detta för att kunna hantera sina känslor samt utveckla strategier att hantera liknande situationer i framtiden. Arbetsplatsen kan förbättra sin arbetsmiljö genom att erbjuda sjuksköterskor stöd samt hjälp att skapa personliga strategier att hantera hot och våld. Arbetsplatsen kan lära sig om utlösande faktorer och skapa ett aktivt förebyggande arbete för att förhindra hot och våld mot sjuksköterskor i framtiden. / Background: Within inpatient care violence and threats are a growing problem, which nurses are particularly exposed to in their workplace, especially by patients. It makes an impact on the relationship between them and it also creates consequences in the care of the patient and the ability of the nurse to provide it.  Aim: The aim of this study was to describe nurse experiences of threats and violence within inpatient care. Method: A literature study based on qualitative articles. Ten qualitative articles were used and analysed. Results: The results are grounded in three themes and ten sub-themes. Nurses experiences of violence and threats resulted in feelings of fear and concern when they were exposed to it. They felt difficulties to handle the problems and they asked for more strategies, both personally and in the working environment to deal with the issue.   Conclusion: The results showed that nurse's feelings in this subject were fear and concern in their profession were they need more strategies to handle situations in violence and threat. In the articles nurse's asked for more support programs and reflections from their managers.

Up to 80% of serious medical errors occur due to miscommunication from one provider to another (The Joint Commission, 2012). In order to ensure ongoing safe patient care, it is imperative that anesthesia providers communicate effectively and consistently when transferring patient responsibility to other providers, especially to post-anesthesia care unit (PACU) nurses. Multiple patient transfers occur each day and patients are commonly transferred between multiple providers during the same hospital stay. These opportunities are extremely vulnerable to communication errors. Structured patient handoff checklists or tools increase the consistency of information transferred from anesthesia providers to other providers. The Joint Commission recommended in 2012 that all anesthesia providers utilize a standardized patient handoff checklist to increase and improve the quality of data transferred from anesthesia provider to the PACU nurse. Certified Registered Nurse Anesthetists (CRNA) at a local surgical unit provide the bulk of patient handoffs in this postoperative unit, and currently, there is no mandated use of a standardized handoff checklist. As a result, the CRNAs provide a verbal patient handoff that is unscripted. Verbal patient handoffs differ among providers due to individual provider preference. Without using a standardized handoff checklist, there is a risk of increasing communication errors which increase medical errors and negative patient outcomes. Salzwedel (et al., 2013), in a study when utilizing a handoff checklist, concluded that critical patient data conveyed during patient handoffs increased by 32.4% to 48.7% (Salzwedel et al., 2013). Tscholl et al. (2015) and McElroy et al. (2015) through surveys, determined that data transferred between anesthesia providers was more structured. Handoff checklists increased PACU nurse satisfaction regarding the overall handoff experience (McElroy et al., 2015). No studies, to date, were found that understand the perceptions and thoughts of CRNAs regarding the utilization of patient handoff checklists or tools in clinical practice. This Doctor of Nursing Practice (DNP) project assesses the perceptions and thoughts of utilizing standardized handoff checklists among CRNAs. The hope of this study is to better understand CRNA perceptions in order to identify potential barriers or knowledge gaps regarding the benefit of utilizing a standardized patient handoff checklists. Data from this project may be used to structure future quality improvement projects aimed at decreasing communication errors and improve patient outcomes. The results of this project show the majority of CRNAs (89.5%) surveyed for this project were already familiar with handoff checklists. However, only 26.3% of those same participants agreed they currently use a standardized patient handoff checklist. Of the surveyed participants, only 36.8% were interested in utilizing a standardized patient handoff tool even though nearly 50% agreed that using a handoff checklist would increase the consistency of information transferred from anesthesia provider to nurses. This correlates with the 73.7% of participants who already believe they currently transfer pertinent patient information successfully without utilizing a standardized handoff checklist or tool. Despite studies reporting improved patient outcomes, decreased medical errors, and the Joint Commission’s recommendations to use standardized handoff checklists or tools, the majority of anesthesia providers at this facility do not choose to use handoff checklists. By surveying anesthesia providers' thoughts and perceptions, the researcher attempted to answer why anesthesia providers are not utilizing handoff checklists in their daily routines.

Magister Curationis - MCur / Background: Mental illness has become more common than many other diseases such as heart disease, cancer or diabetes. Aggression or violence by patients towards psychiatric nurses is a global issue. These nurses, therefore, face the huge challenge of providing nursing care to aggressive psychiatric patients. Without the necessary knowledge and skills, the nurses are vulnerable to all kinds of injuries, given the time spent managing aggressive patients. Purpose and objectives: The purpose of the study was to determine the level of knowledge and skills that professional nurses possess to manage the aggression of psychiatric patients. The objective of the study was to ascertain whether the knowledge and skills of professional nurses were sufficient to manage aggressive psychiatric patients. Method: A quantitative approach and descriptive design was used to conduct this study at a Psychiatric Hospital in the Western Cape, South Africa. The target population consisted of 149 professional nurses employed at the Psychiatric Hospital. The sample for the study was all-inclusive i.e. all professional nurses employed at the hospital. Only 70 participants were available for the study. Structured questionnaires were distributed to the participants for data collection and the response rate was 77% (n=54). Data analysis was done with the aid of a statistician using a Statistical Package for Social Science, version 22, and nominal as well as ordinal data was analysed using descriptive analysis. The process and purpose of the study was explained to the participants, who gave their consent, prior to the distributing of the questionnaires. The researcher obtained permission from the necessary authorities before commencing with the study. Findings: The study found that nurses were more likely to be exposed to verbal aggression as opposed to sexual aggression. It also revealed that nurses with less years of experience had more knowledge than their counterparts who had more years of experience in same position. Furthermore, the study revealed that those who had training in aggression management reported that the training did not meet their needs. Overall, the findings revealed that nurses had a fair knowledge of managing aggressive psychiatric patients. The overall findings also revealed that professional nurses had the required skills to manage aggressive patients. Recommendations: There is a need for on-going in-service training and refresher courses in the management of aggression. There should also be a needs analysis before commencing with these training courses which should be made compulsory for all staff to attend. Further studies should be conducted on the different categories of nurses, and other disciplines within nursing, to ascertain their knowledge of the management of aggression. Qualitative studies should also be conducted on nurses‟ experience of aggression in different settings.