Thesis advisor: Judith A. Vessey / Purpose: The purpose of this study is to investigate staff nurses’ clinical decision making (CDM) regarding pediatric oncology patients’ nutritional status. Background: Malnutrition, both under- and over-nutrition, in children can lead to significant morbidity and even mortality. Pediatric cancer patients are at high risk for malnutrition secondary to the disease process and treatment side effects; malnutrition in pediatric oncology patients is associated with poorer outcomes. Pediatric oncology nurses, with frequent and consistent contact with patients, are in an ideal position to assess nutritional status. Early identification and intervention for nutritional concerns in patients has been shown to improve outcomes. However, research on the quality of pediatric oncology nurses’ CDM regarding nutritional status does not exist. Methods: A web-based survey was distributed to members of the Association of Pediatric Hematology Oncology Nurses; it was comprised of three sections: a demographic data collection form, pediatric oncology nutrition related vignettes, and the New General Self-Efficacy Scale. The vignettes were rated on a one to five scale with one being under-nourished and 5 being over-nourished. Participants were asked to report their confidence in their rating and select cues in the vignette supporting the rating. A multi-level regression analysis was utilized to assess the quality of nurses’ CDM, the confidence of the nurses’ CDM, and the factors associated with CDM. Results: No nurse or organizational factors could be identified as useful in predicting the accuracy of the participants’ nutritional rating; however, nurses were significantly likely to under-rate the vignette when comparted with the expert panel’s rating. Nurses were significantly likely to select fewer cues supportive of nutritional rating than the expert panel. Conclusions: Further research regarding nutritional assessment and nurses’ clinical decision making is warranted. Evidence-based guidelines for nutritional assessment of pediatric oncology patients should be developed and implemented to ensure this patient population receives the highest quality of care. / Thesis (PhD) — Boston College, 2018. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Many Schools of Nursing’s Deans and Directors throughout the nation find themselves hiring novice nurse educators for a wide variety of reason such as expansion of their nursing programs, retirement of nursing faculty, and presentation of other opportunities for experienced nursing faculty. Deans and Directors for Schools of Nursing in Tennessee are faced with the same challenge. As a result, the Tennessee Deans and Directors for Schools of Nursing have made a commitment to help novice nurse educators, in particular, to be successful in their new role. These Deans and Directors know the specific needs of novice nurse educators they are hiring and essential topics that these nurse educators must become familiar with in order to be successful. In 2017, the Deans and Directors for Schools of Nursing in Tennessee developed the Tennessee Nurse Educator Institute. In its third year, the Tennessee Nurse Educator Institute is offered annually before the start of the academic school year. The purpose is “to provide knowledge and skills for the novice nurse educator and a refresher for more experienced faculty.” Initially, it began as a two-day activity but since has been expanded to three days. Topics include valuable information for the novice nurse educator such as writing test items and analysis; a perspective on surviving the first year as a novice nurse educator; designing a curriculum; engaging students in the 21st century; the importance of the RN-NCLEX blueprint; the basics of clinical teaching; teaching with simulation; evaluation methods for didactic and clinical courses; developing a syllabus; and the importance of program evaluation. Since the launch of the Tennessee Nurse Educator Institute, the total number of nurse educators attending the institute is 195. At the end of the three-day educational activity, nurse educators complete an evaluation to ensure the institute is its goals. In addition, participants are asked for input on what they felt helped them the most, the strengths and weaknesses of the program, and future topics to include. Responses from the evaluations have been overwhelmingly positive. Participants completing the survey was n = 133. Results of the evaluations from the three years showed the following: 98% (131/133) of the participants strongly agreed or agreed that the purpose of the conference was met, the information received will help them be more effective in their position, and they could use the information they learned right away; and 97% (129/133) of the participants strongly agreed or agreed the conference met their expectations. No barriers or obstacles have been encountered in achieving the program’s goal. The Tennessee Deans and Directors for Schools of Nursing plan to continue with the institute every year to help meet the needs of novice and more experienced nurse educators. When nurse educators are given the proper tools to be successful, nursing education is ultimately advanced with outcomes consonant with excellence. The goal is to make sure that nursing educators are using evidence-based practice when teaching future nurses.

Newly hired nurse educators face multiple challenges in today's rapidly changing academic environment. Transitioning from clinical practice into academia without the benefit of effective mentoring may lead to dissatisfaction, frustration, and attrition. Newly hired nurse educators may find difficulty in understanding academic areas of teaching, scholarship, and service, especially if they are transitioning from clinical practice. An effective mentoring program for nurse educators provides guidance, support, resources and assistance, as well as an opportunity for experienced faculty mentoring team members to guide newly hired nurse educators through the complex world of academia. The purpose of this project was to create a sustainable mentoring program to promote successful assimilation of newly hired nurse educators into the academic environment. Methods: The method was a Plan-Do-Study-Act (PDSA) project to create an effective mentoring program for newly hired nurse educators. The project leader (scholar) guided the Faculty Mentoring Program Committee (FMPC) through the creation and progression of the faculty-mentoring program. The triad that consisted of the scholar Greta Marek, DNP, RN, CNE, her mentor M. Peggy Hays, DSN, RN, COI, and faculty Cynthia Clark, PhD, RN, ANEF, FAAN regularly discussed the project's progress. The Experienced Nurse Faculty Leadership Academy (ENFLA), sponsored by Sigma Theta Tau International/Chamberlain College of Nursing Center for Excellence in Nursing Education, provided an evidence-based program that encouraged learning and growth for the scholar. A review of the literature included searches in PubMed, CINAHL, ERIC, Ovid, Google Scholar and EBSCHO host using the search terms: academic mentoring, nursing faculty mentoring, mentoring programs, nurse educator mentoring. Limitations placed on the search were English language, peer reviewed, and a timeframe of 2000 to the present. Scholar reviewed 29 full-text articles and 20 university websites; used Watson's Theory of Human Caring and Benner's Novice to Expert models in relation to nurse educator mentoring programs. The scholar formed the FMPC at their college of nursing secondary to the need to develop a formalized faculty-mentoring program. Information from the literature review guided planning, actions and recommendations from the committee. Results: The ENFLA scholar endeavors to continue to work with the FMPC towards the mentoring program's growth and sustainability. The committee developed the program's mission, vision, goals, outcomes, logo, and a semester-by-semester structure. The FMPC created two different tracks for newly hired nurse educators: a three-semester program for experienced nurse educators and a five-semester program for novice nurse educators. The first semester of each track focuses on orientation to the university, the college, and assigned courses. Newly hired nurse educators remain a cohort, instead of the traditional dyad mentoring model. Experienced nurse educators serve as a resource person and share their expertise in teaching, scholarship, or service. The goal of remaining in a cohort would be to help newly hired nurse educators develop team-building skills, enhance collegiality, provide support, adapt to the local culture, and provide consistency. The new nursing faculty, hired during the 2014-2015 academic year, serendipitously decided to form an ad hoc committee to the FMPC, to ensure input. The ad hoc committee will collaborate with the FMPC to determine the mentoring program's effectiveness each semester through formative and summative evaluations. Conclusion: Members of the FMPC expressed a sense of renewed purpose and pride while collaborating on creating a sustainable mentoring program. Ad hoc committee members expressed optimism and excitement about working with the FMPC towards evaluating the mentoring program's effectiveness.

The hospital-based novice nurse is presented daily with complex patients with multiple coexisting morbidities, which demands increasing responsibility for evidence-based clinical decision-making to prevent adverse health outcomes and associated high health costs. Knowledge and confidence of novice nurses in a medical-surgical unit in the assessment and clinic management of the respiratory system was identified as a gap during onboarding of new nurses. The purpose of this doctoral staff education project was to determine whether a respiratory educational component added to a medical-surgical novice nurse's orientation would impact the respiratory confidence and knowledge of respiratory assessment and clinical management. Benner's nursing theory of novice to expert and Ericsson's theory of deliberate practice were the 2 theories for the project. To assess effectiveness, a 10-item survey was administered to nurses (N = 10) during the first week of orientation and repeated following the educational intervention. Analysis from SPSS 22.0 showed statistically significant improvement differences in confidence and knowledge on all items following the posttest (p < .05), except for confidence levels with nasal cannula/mask use (p = .151). The strongest item-correlation was between knowledge management of respiratory deterioration and knowledge of the disease effects on respiratory assessments. Basic respiratory education added to the orientation during onboarding has the potential to improve knowledge and confidence acquisition, clinical decision-making in the clinical assessment and clinical management of respiratory issues. Positive social change in the health of the community and this educational intervention will empower the novice nurses with an additional layer of respiratory education.

Self-management support (SMS) is considered an effective approach to chronic pain (CP) management. However, the provision of SMS for chronic pain patients faces challenges within primary care facilities in Ontario. An innovative SMS program led by a Registered Nurse (RN) at the Bruyère Family Health Team in Ottawa has been created for chronic pain patients. The goal of this program is to improve the current chronic pain management using SMS in an outpatient facility by harnessing the skills of primary health care team members. The hope would be that this program could be spread and scaled across other programs in the region. This thesis exists in two parts: 1. Evaluate the RN-led chronic pain self-management program to determine its effectiveness in terms of self-reported pain scales and Morphine Equivalence Quotient (MEQ) 2. Understand the perspectives of health care practitioners, administrators and patients within the RN-led chronic pain self-management program Patients meet with the RN for initial face-to-face visit for an hour, for SMS and then for at least one follow up visit. The primary outcome variables of interest were their self-reported pain evaluated using validated pain scales. Opioid use was also assessed before and after the porgram based on the MEQ. Results were analyzed using SPSSversion20. An online questionnair was distributed to team members. All responses were conceptually arranged into a SWOT analysis, which will be directed toward the ongoing management needs of the clinic. Between January 2016 and August 2018, 125 patients were seen of these 58 patients (12 males and 46 females) had at least one follow up appointment with the RN. In 46.2% of the population there was a decrease in their total opioid dose from their first to their last appointment and of these 4 patients (15.4%) had a daily MEQ of 0 by their last appointment. There was a significant average difference between patient’s daily MEQs at their first and last appointment (t20= 2.245, p<0.05). On average patients came into their first appointment with a daily MEQ of 23.88 higher than at their last visit (95% CI [1.69, 46.07]). Staff and patients who participated in the online survey identified the following strengths: multidisciplinary approach, increased accessibility for patients, cost effectiveness, better patient engagement, and no refills of opioids Canada needs a better strategy to manage the CP epidemic. This chronic pain self-management program led by an RN focuses on a multidisciplinary approach that is readily accessible to patients and integrated within primary care to best meet and prioritize the needs of chronic pain patients.

Dracaena cinnabari, the dominant endemic tree of Socotra Island (Yemen), is in serious decline. The effect this will have on the island's plant diversity remains unknown. This dissertation aimed to assess the possible role of Dracaena as a nurse plant by identifying plants associated with Dracaena understorey and by assessing the importance of Dracaena for maintaining plant diversity. In the first part of the dissertation, relevés sampled in Dracaena understorey and in open sites to record the number of individuals of vascular plants were analysed. Species richness and composition were compared between understorey and open sites, and species associated with each of these habitats were identified. Additionally, the effects of shading and leaf litter on species richness and abundance were analysed. The second part of dissertation focused on mature woody species composition of Dracaena stands and investigated spatial relations between Dracaenas and other mature woody plants. The last part of the dissertation aimed to assess the fine scale spatial relationships between stones and plants in Dracaena stands and evaluated the differences of these relationships between understorey and open sites. The results confirmed the Dracaena role as an important nurse plant. The tree enhances the environmental heterogeneity and its presence creates two distinct microhabitats (understorey and open sites). The understorey habitat, compared with open site, harbours higher number of species, including endemics. The species in Dracaena stands can be classified as either understorey specialists, open-site specialists or generalists. The decline of Dracaena will negatively affect plant diversity, will reduce abundance of rare endemic plants and will lead to homogenization of vegetation. As no other tree species exists which could replace the Dracaena, our findings underline the importance of conservation efforts to preserve Dracaena stands on Socotra and identify this species as a key umbrella species whose conservation would ensure also the protection of a number of other associated species.

No description available.

Background: Since 2012, nurse practitioners (NPs) in Ontario have the professional capacity to assume the role of the most responsible provider (MRP) in hospitals; however, few have implemented this model. Aim: To explore the barriers and facilitators to the integration of the NP as MRP model of care in a hospital setting. Methods: A qualitative descriptive design with secondary data collected from a larger study, was used with principles from integrated knowledge translation. Findings: Thirteen barriers and eleven facilitators were found, such as: (i) challenges with off hour coverage; (ii) funding and remuneration; (iii) discrepancies in the employment standards regulations; and (iv) lack of a critical mass. Facilitators included the plan for role implementation, establishment of trust and leadership from the team. Conclusion: Many barriers, predominantly at the healthcare system-level, make it difficult to integrate the NP as MRP model of care in hospitals.

Bakgrund: Att förlora en familjemedlem leder till sorg. Enligt litteraturen räknas sorgen som en akut stress- eller krisreaktion vilken ses som en normal process, men den har förmåga att utvecklas patogent. Egentlig depression och ökad suicidrisk är konsekvenser av felaktigt bemötande och ofullständig sorgebearbetning. För att undvika dessa konsekvenser behöver de sörjande individerna upptäckas och bemötas på ett lämpligt sätt. Syfte: Beskriva sorgereaktioner hos individer efter en familjemedlems bortgång med fokus på behovet av stöd från sjuksköterskan. Metod: En litteraturstudie genomfördes för att sammanställa relevant och aktuell forskning. Fem kvalitativa forskningsartiklar, två tvärsnittsstudier samt en artikel med mixad metod inkluderades i resultatet och analyserades via integrerad analys. Resultat: Analysen resulterade i tre kategorier: Sjuksköterskor och sorgeservice, Att förstå sorgens påverkan samt Bemötande av sorg. Det framkommer även att sjuksköterskor behöver öka sin förståelse för sorgens uttryck och kunskap om bemötandet av sörjande individer. Sorgeservice beskrevs som ensamt, osynligt arbete och förståelse från organisationen saknades. Slutsats: Flertalet sjuksköterskor upplever rädsla och osäkerhet vid första mötet med sörjande individer. Sjukvården brister i bemötandet och gemensamma riktlinjer gällande bemötande samt stöd vid sorg saknas. Författarna ser ett behov av tillägg i universitetens sjuksköterskeutbildning gällande en fördjupande kurs i bemötande av sörjande individer.

Background: Stroke is a common disease in Sweden and between 25 000–30 000 people fall ill every year. A stroke causes oxygen deficiency and can lead to lifelong disabilities for the patient. Multidisciplinary teams work together where the nurse plays an important role for the care and the process of recovery. Aim: Highlight nurses' experiences of caring for patients who have had a stroke. Method: The design of the study is a literature study with a qualitative approach. The study is based on ten articles and was analyzed using Friberg’s five-step analysis. Results: Two themes and six subthemes emerged. Nurses felt that their care was important for the patient's recovery but wanted further specialized training. Multidisciplinary collaboration was perceived as important both for the development of knowledge and the patient's care. Nurses highlighted relatives' participation in patient care. However, there were daily challenges of, among other things, time pressure and understaffing. Conclusion: The study showed that nurses wish to provide good care for their patients and that their care was important. However, they experience daily challenges. Through organizational changes such as increased staff density and continuing education, the role of the nurse can be strengthened and lead to improved patient care.