The purpose of the study was to examine critical care nurses' perceptions of the usefulness of hospital ethics committees as a coping strategy for resolving ethical dilemmas. The conceptual framework was Lazarus and Folkman's theory of stress, appraisal, and coping (1984).The convenience sample was five critical care nurses from five midwestern hospitals. Confidentiality was maintained by identifying participants as numbers.The research design for the study was an exploratory case study. The research question, nurses perceptions' of the usefulness of hospital ethics committees as a coping strategy to resolve ethical dilemmas, was analyzed using a qualitative methodology. Findings indicated that the nurses did not perceive hospital ethics committees as useful resources in ethical conflicts. Barriers to use of committees included lack of education about the committees, lack of timely intervention by committees in a crisis and risks involved in confronting physicians via committees.Conclusions were that ethics committees were not fulfilling a role as support systems empowering nurses to act as patient advocates in ethical dilemmas. Results can be used to develop strategies to increase the ethics committees' effectiveness in ethical dilemmas. / School of Nursing

The elderly are the fastest growing population in the United States. Nurses' attitudes toward caring for the elderly are a very real concern and may determine nurses' behaviors with the elderly. The purpose of this study was to examine the attitudes of nurses toward caring for the elderly residing in long term care institutions. A modified questionnaire, "Attitudes Toward Caring for the Elderly" was used. A combination of Jean Watson's theory of caring and the Ajzen & Fishbein's theory of reasoned action was the theoretical framework used for the study. Three research questions were asked. Data were collected from 32 registered nurses in four long term care institutions. Results showed that nurses attitudes toward caring for the elderly were positive. There were no significant relationships between demographic and personal data and nurses' attitudes toward caring for the elderly. Full time versus part time employment was a significant predictor of nurses attitudes toward caring for the elderly. The low reliability of the tool (Cronbach's alpha = 0.57) could have contributed to the lack of significant data. The study should be repeated after further development of validity and reliability of the tool. / School of Nursing

The recruitment, hiring, and retention of registered nurses (RNs) is of critical concern for nursing home administrators. Many times, nursing homes unsuccessfully compete with hospitals and staff relief agencies for available RNs (Braddy, Washburn, & Carroll, 1991). Understanding the factors that influence nurses to seek a particular employer is significant in recruitment and hiring. Factors related to nursing decisions to choose employment in nursing homes were identified in this descriptive study.Price and Mueller's (1981) Causal Model for Turnover (CMT) provided a conceptual framework for the study. The investigator used a revised form of an instrument developed by Price and Mueller for a 1981 study of hospital turnover. The instrument contained 67 items presented in a combination of 59 multiple choice items and 8 five-point Likert-type items. The reliability for each of the seven subscales was equal to or greater than .70.A sample of 300 full-time RNs with tenure of at least 6 months employment with a large for profit corporation was selected for this study. Questionnaires were mailed to participants with a letter of introduction from the investigator and the divisional vice president of the corporation. Subjects were provided with a self-addressed, stamped envelope to be used to return completed questionnaires. A follow-up call was done one week after the mailing requesting return of all completed questionnaires.There were no risks or ill effects from participating in this study. Respondents were free to ask any questions during the study. The agency and respondents were not identified in the sampling and the results of the study. Completion of the questionnaire was interpreted as the respondent's agreement to participate in the study.Results should help administrators understand the factors that influence registered nurses to seek employment in nursing homes. The results of the study should be utilized in reviewing current recruitment, hiring, and retention strategies. / School of Nursing

The healthcare industry is undergoing rapid changes. Nursing is in the midst of this dynamic process and is experiencing increased stress as a result. This is especially true of the oncology nurse speciality. The responsibilities of the oncology nurses are becoming more complex. Methods to intervene or master the stress are needed. If mastery of the stress is not achieved, oncology nurses may abandon their speciality and enter another field of nursing or leave the nursing profession. The purpose of this study was to examine the relationship of the stress perceived by oncology nurses and the mastery of this stress.The conceptual framework used in this study was the theory of mastery developed by Younger. The Mastery of Stress Instrument (MSI) developed by Younger was used to measure the stress component and the mastery component. A descriptive correlational study design was used. The population for this study was a convenience sample of the responding members of a midwestern chapter of the oncology nursing society (n= 39). Participation in the study was voluntary, with the MSI and the demographic data being returned by self-addressed postage-paid envelope. The MSI was identified by number only. No names were assigned to the numbers to insure anonymity of the subjects. The data was discussed as group data. No risks to the participants were identified in this study. The benefit of this study was to contribute to the data base for the MSI and to increase the awareness of stress and mastery.The research question was analyzed using the Pearson Moment Correlation Coefficient. A small but significant correlation coefficient was found between the acceptance and the growth subscales of the Mastery of Stress Instrument (r=.33, p <.05). No other significant correlation were found.Rapid changes are occurring in the healthcare environment of today. Nurses are in the center of this change and must master the increased stress experienced. The author concluded that the oncology nurses in this sample have mastered the stress they experienced possibly due to the length of time in the oncology nursing speciality. Also, the high level of education in this sample of oncology nurses indicates that the oncology nurses are more efficient at the mastery of the stress they experience. / School of Nursing

The basic philosophy of shared governance includes the right for staff nurses to practice in an environment that allows participation in the decision making process at all levels of the organization. Autonomy and responsibility support shared governance. The purpose of this study was to examine nurses’ perceptions of autonomy in a well established shared governance setting. The Neuman Systems Model served as the theoretical framework.A convenience sample of 83 (42%) staff nurses at Saint Joseph’s Hospital of Atlanta, Georgia completed the Schutzenhofer Professional Nursing Autonomy Scale. Three open ended questions were included in the questionnaire to further explore staff nurses’ perceptions of the professional practice environment. Demographic data were also collected.Findings in this study revealed no significant correlations between selected demographic variables and autonomy. More than between selected demographic variables and autonomy. More than half (65.1%) ranked in the higher level of professional autonomy, 34.9% (29) ranked in the mid level and none in the lower level. Qualitative data revealed that nurses working in a well established shared governance setting perceived control over the nursing care of patients and appreciated and the ability to make decisions regarding patient care. Respondents overwhelmingly indicated that nurses should be compensated for participation in governance activities.Conclusions from this study were that implementation of professional practice models such as shared governance improve nurses’ perceptions of autonomy and create an atmosphere in which nurses can practice the art of nursing while clearly articulating a vision for the future. Consistent and appropriate decision making by nurses facilitates the interdisciplinary plan of care and encourages trusting relationships among professional disciplines.Nurse managers are in an ideal position to create a vision by designing structures that promote staff involvement. Managers must build formal recognition programs into shared governance systems and provide nurses with the time to attend meetings. Today’s nursing leaders must be ready to create a vision, facilitate change, mentor, nurture, coach and advise staff. / School of Nursing

The nursing home industry has low registered nurse retention rates. Low retention rates can be related to job satisfaction. The nursing home industry needs qualified registered nurses (RNs) who are satisfied with all aspects of their jobs. The purpose of this study was to examine factors affecting job satisfaction of RNs currently employed in nursing homes using Herzberg's (1968) Dual Factor Theory.Herzberg (1968) has identified internal factors that motivate employees on the job. If intrinsic factors are met, the employee is satisfied. Extrinsic factors, if present, will not satisfy the employee, but will prevent dissatisfaction (Herzberg, 1968). The Minnesota Satisfaction Questionnaire - Short Form, was used to determine the intrinsic, extrinsic and general satisfaction scores of 48 (480) RNs currently employed in ten nursing homes from the midwest. Confidentiality and anonymity of the subjects were maintained as questionnaires contained no identifying information.Findings supported previous studies on job satisfaction of RNs employed in nursing homes. Participants did not identify intrinsic factors as being fully satisfactory, but responses were closer to satisfied than dissatisfied. Extrinsic factors were not sources of dissatisfaction, but responses were closer to dissatisfied than satisfied. General satisfaction scores determined respondents were not fully satisfied, but were closer to neutral scores. Responses were closer to being satisfied than not. Conclusions were that extrinsic and intrinsic factors influence job satisfaction.Implications call for examination of factors effecting job satisfaction. Managers should increase job security, social services, activites, independence and variety. Human relations, company policies and technical supervision should be open to input from staff as to how the extrinsic motivational factors can be improved. Recommendations include replication of this study with a large sample size; assuring nurses under 40 years of age participate in further studies and the need for nursing home administrators to address intrinsic and extrinsic factors that affect job satisfaction. / School of Nursing

The purpose of this study was to compare two groups of nurses's attitudes towards the elderly and the knowledge base of the nurses as to signs, symptoms and interventions with depression and dementia in the elderly. The theoretical framework for this study was Oren's (1985) self-care deficit theory. Attitude was measured using the Koan Attitude Toward Old People Scale (Koan, 1961) and knowledge was measured using a scale developed by (Myton, Allen, and Baldwin, 1991).The population studied was registered nurses working at these state hospitals in a midwestern state and agency nurses from four agencies that provide staff coverage at these hospitals. The convenience sample consisted of state nurses (n=65) and agency nurses (n=38). A cover letter explaining confidentiality and voluntary participation was attached to each survey. Completion of the survey constituted consent to participate in the study. There were no identified risks related to participation in the study.The study did not identify significant differences between groups in any of the variables involving attitude toward the elderly, ability to differentiate signs, symptoms, and interventions for dementia and depression in the elderly. Both groups were able to correctly identify signs, symptoms and interventions for dementia and depression about one-half the time. The treatment modalities are different for dementia and depression. The problem is significant because if signs, symptoms and interventions are not identified correctly the patient will not be assisted toward recovery and self-care may decrease. The recommendation for increased inservice education on gerontological nursing are applicable to both groups. / School of Nursing

The purpose of this study was to obtain an in-depth understanding of the perceptions of overseas-qualified nurses from non-English speaking backgrounds (NESB) in relation to their educational and socialisation experience whilst enrolled in a Competency Based Assessment Program (CBAP). The study was conducted using a modified grounded theory approach. There were a total of seventeen participants; fourteen NESB nurses, and three teachers who were directly involved with their education in the CBAP. The NESB nurses who participated fell into three main groups in terms of their previous professional experience. These were: � Specialist � Experienced generalist � Inexperienced generalist However, the level of skill and experience that the nurses brought to the educational and practice encounter made no difference to their experience of prejudice and lack of support, particularly in the clinical environment. The education and clinical experience they received challenged feelings of competency as much as they expanded feelings of competency. The NESB nurses� experiences of diversity also challenged their feelings of competence. In addition, the level of previous experience did not reduce the concern expressed by NESB nurses regarding the possibility of finding appropriate employment following registration. The implications of this for the profession and the health care system are that even the most experienced specialist and generalist nurses are not having their level of skill appropriately recognised and utilised in a timely way despite the current shortage of generalist and specialist nurses in Victoria. The outcome of the study led to the development of a model that has the potential to lead to a culture change in the clinical environment with a view to improving educational opportunities and experiences for NESB nurses who are enrolled in CBAP. In addition, the model has the potential to be useful in terms of providing local nurses with an opportunity to express their own thoughts and ideas in relation to the education of NESB nurses in the clinical environment. The model is based upon the theoretical perspectives of �productive diversity� and �clinical governance and organisational learning�.

The purpose of this study was to obtain an in-depth understanding of the perceptions of overseas-qualified nurses from non-English speaking backgrounds (NESB) in relation to their educational and socialisation experience whilst enrolled in a Competency Based Assessment Program (CBAP). The study was conducted using a modified grounded theory approach. There were a total of seventeen participants; fourteen NESB nurses, and three teachers who were directly involved with their education in the CBAP. The NESB nurses who participated fell into three main groups in terms of their previous professional experience. These were: � Specialist � Experienced generalist � Inexperienced generalist However, the level of skill and experience that the nurses brought to the educational and practice encounter made no difference to their experience of prejudice and lack of support, particularly in the clinical environment. The education and clinical experience they received challenged feelings of competency as much as they expanded feelings of competency. The NESB nurses� experiences of diversity also challenged their feelings of competence. In addition, the level of previous experience did not reduce the concern expressed by NESB nurses regarding the possibility of finding appropriate employment following registration. The implications of this for the profession and the health care system are that even the most experienced specialist and generalist nurses are not having their level of skill appropriately recognised and utilised in a timely way despite the current shortage of generalist and specialist nurses in Victoria. The outcome of the study led to the development of a model that has the potential to lead to a culture change in the clinical environment with a view to improving educational opportunities and experiences for NESB nurses who are enrolled in CBAP. In addition, the model has the potential to be useful in terms of providing local nurses with an opportunity to express their own thoughts and ideas in relation to the education of NESB nurses in the clinical environment. The model is based upon the theoretical perspectives of �productive diversity� and �clinical governance and organisational learning�.

Bakgrund: Våld mot kvinnor är idag ett globalt folkhälsoproblem. Det visar sig att 30 % av kvinnorna världen över har upplevt fysiskt eller sexuellt våld i en nära relation. Kvinnor som utsätts för våld söker sig i högre grad till hälso- och sjukvården än andra kvinnor. Där är risken relativt hög att sjuksköterskor kommer att möta våldsutsatta kvinnor i vården. Sjuksköterskor utgör därför en viktig roll i mötet och att våga ställa frågan om våld till kvinnorna som söker vård. Syfte: Att beskriva sjuksköterskors erfarenhet av mötet med kvinnor som utsätts för våld i nära relationer. Metod: En litteraturöversikt där datamaterial bestod av kvalitativa och kvantitativa artiklar. Resultat: Ur analysen av datamaterialet identifieras ett huvudområde Främja kvinnans självtillit och fem områden: Sjuksköterskan behöver använda screening på alla kvinnor, Sjuksköterskan reagerar på kvinnans partners aggressivitet, Sjuksköterskan möjliggör berättande, Sjuksköterskan behöver stödja kvinnan till ökad självständighet, Sjuksköterskan visar empatisk, ödmjuk attityd. Sjuksköterskor upplever mötet med våldsutsatta kvinnor som mycket känslosamt, vilket kan frambringas då kvinnorna berättar om sin livssituation. Avsaknad av utbildning kring problemområdet påverkar sjuksköterskornas beredskap och upplevelser av osäkerhet uppkommer om hur de skall agera i mötet med kvinnor som utsätts för våld. Slutsats: Sjuksköterskor upplever svårigheter att ställa frågan till kvinnor som blivit utsatta för våld i nära relationer. Sjuksköterskor eftersträvar mer utbildning för att kunna möta dessa kvinnor som blir utsatta av sin partner. / Background: Violence against women is currently a global public health problem. Studies have shown that 30% of women worldwide have experienced physical or sexual violence in intimate relationships. Women who experience violence more likely reach out to health care providers than other women, making encounters with abused women a reasonable possibility for a nurse. Nurses consequently have an important role in meeting these women who seek care and in asking the crucial questions regarding their experiences. Purpose: To describe nurses` experiences of encounters with women who are exposed to violence in close relationships. Method: A literature review where data material consisted of qualitative and quantitative articles. Results: From the analysis of data one main area emerged; to promote women’s self-esteem with five areas: The nurse needs to use screening on all women, the nurse responds to woman’s partners aggressiveness, the nurse enables storytelling, the nurse need to support woman for increased independence, the nurse shows empathetic, humble attitude. Conclusion: The nurse experience difficulties in asking the same question to the women who have been exposed to violence in close relationships. Nurses´ need more education in order to meet these women who are exposed by their partner.