Nurses, especially those who care for the critically ill, are required to perform high-level intensive clinical care. It is common for complicated procedures such as therapeutic hypothermia (TH) to be done infrequently at small community hospitals. According to the 2020 recommendations by the American Heart Association (AHA), “prompt initiation of targeted temperature management (formally known as TH) is necessary for all patients who do not follow commands after return of spontaneous circulation to ensure optimal functional and neurological outcome” (Panchal et al., 2020, p.S366). These high-risk, low-frequency protocols typically require nurses to be able to perform these procedures in a time-sensitive manner. If the procedures are not done correctly, they can have negative patient outcomes. Patients are put into medically induced comas, maintained on ventilators, cooled to very low body temperatures, and often medically paralyzed to inhibit shivering. Each of these conditions has the potential for adverse outcomes and together can lead to poor neurological outcomes and even death (Kim et al., 2015). Health educators have the opportunity to provide knowledge and support to these nurses as a way to improve patient outcomes. In this study, a patient care checklist and an online self-learning module were developed for nurses to learn how to perform this high-risk procedure quickly and effectively. A focus group was then conducted with a group of nurses to gain feedback on the checklist and module, and these data informed specific changes to these materials. Then, drawing on a sample of 60 nurses and using a post-study design, data were collected to determine the effectiveness of the checklist and online module as compared to a control group of nurses who read a scholarly article on the same subject. Data were collected at two time points for both the experimental and control groups. The results indicated that nurses who used the online learning tool scored higher in the post-assessment than those in the control group (t = 6.092, p < .001, BCondition = 3.865), with a remarkably high effect size, r2 = 0.379. Moreover, 77% of the nurses agreed that protocols and checklists helped nurses minimize disparities in patient health outcomes. Additionally, 95% of the nurses agreed that patient care checklists helped them care for patients when delivering high-risk, low-volume protocols such as TH. This study demonstrated that online learning tools provide an effective way to educate nurses, and checklists and protocols support the implementation of high-risk, low-volume procedures such as TH.

Educating staff nurses is pivotal in the evolving healthcare environment. Two staff development models used in the healthcare setting are unit-based and centralized. Unit-based education is a staff development model that places educators on individual units. These educators direct the educational development of staff nurses on their assigned units. Centralized education meets generalized learning needs and provides nursing departments with scheduled education sessions or impromptu meetings regarding changes to policies and procedures. In addition, centralized educators are assigned to address the learning needs of the nurses on several units with universal orientation (Cummings & McCaskey, 1992), coordinate and implement intravenous and blood transfusion therapy courses, physical assessment courses, professional update programs, and universal workshops and conferences (Cummings & McCaskey, 1992). In contrast, unit-based educators are more familiar with the unit's practices and staff nurses while providing more individualized staff education than the centralized model. This research was conducted to explore the association between the type of staff development model and staff nurses' evaluations of their clinical educators, their anxiety, and their clinical reasoning. The researcher used a quantitative descriptive comparative, cross-sectional, intact group design. The sample included staff nurses (N = 86) from a tertiary care medical center in New York City. The staff nurses were from two units with a unit-based educator and two units with a centralized educator. Data were collected from the first week of September 2022 to the first week of December 2022. Two reports are described below that are based on this research, which included administering four different scales. Not all respondents completed all four scales. The first report concerns the findings on two instruments that measured the staff nurses' evaluation of clinical educators. The Clinical Educator Evaluation Questionnaire (CEEQ), developed for this study, measured nurses' perceptions of the extent to which their staff educators' methods were consistent with Malcolm Knowles's Adult Learning Theory. The Nursing Clinical Teacher Effectiveness Inventory (NCTEI) measured staff nurses' perceptions of their current staff educators as clinical educators. An exploratory factor analysis was conducted on the CEEQ questionnaire developed by the researcher, a Pearson’s correlation analysis between the two surveys, the CEEQ and the NCTEI, and a Chi-square analysis and independent t test was conducted to compare demographic variable among the unit-based and centralized education groups was also conducted. In addition, differences between group responses for independent sample comparisons were examined using t tests. There were significant differences between the groups, t(100) = 3.31, p = .001, on the CEEQ. The 59 participants in the unit-based group scored higher (M = 119.76, SD = 19.62) than the 43 participants in the centralized group (M = 106.86, SD = 19.17) on perceptions of their instructors' methods as consistent with the adult learning theory. The groups also differed on the perceived effectiveness of their nurse educators as clinical instructors, t(94) = 2.66, p = .009, on the NCTEI. The 55 participants who represented the unit-based group (M = 250.5, SD = 70.34) had higher means than the 41 participants in the centralized group (M = 212.8, SD = 66.14). The second report concerns staff nurses' anxiety during staff education as measured using the State Anxiety Inventory (SAI) and staff nurses' self-report of their clinical reasoning as measured by the Nurses Clinical Reasoning Scale (NCRS). Differences between the group responses for independent sample comparisons were examined using t tests. The anxiety of the 48 participants in the unit-based group (M = 35.7, SD = 11.47) was compared to the anxiety of the 38 participants in the centralized group (M = 37.2, SD = 11.35). No statistically significant differences were found, t(84) = -.633, p = .528. Similarly, there was no significant difference between the groups on the NCRS, t(85) = -.188, p = .852. The 48 participants who represented the unit-based group (M = 59.1, SD = 6.61) did not differ from the 39 participants in the control group (M = 59.3 SD = 6.80) on clinical reasoning. Findings showed that the staff nurses evaluated the unit-based educators more highly but that the two models did not differ regarding their effects on anxiety and clinical reasoning. This is the first study to examine staff nurses’ evaluations of their clinical educators. Findings indicate that staff nurses reported more effectiveness for unit-based educators than centralized educators regarding practices that aligned with Malcolm Knowles’s Adult Learning Theory. In addition, this is also the first research study to examine the relationships of staff development models to anxiety and clinical reasoning during staff education. Although the two models did not differ on their effect on anxiety and clinical reasoning, additional research is recommended to explore other variables that may further justify the investment in unit-based education.

Increasing complexity in critical coronary care nursing and advancements in medical technology have resulted in the need for clearly articulated competencies consistent with current practice. This need has been identified both in the literature and in practice. The problem addressed in this study was to determine what competencies, beyond basic nursing preparation, are essential for the beginning level coronary care nurse in order to provide safe nursing practice. A three-round modified Delphi Technique was used to elicit the authority opinions of 14 experienced clinical nurse specialists currently practicing in the coronary care unit. The nurse experts identified and verified the essential cognitive and technical skills required for nurses at the beginning level of practice in coronary care units. Nine domains and 63 competency statements were generated and refined. All were designed to be learner oriented, behaviorally described, and measurable. Implications are discussed for the design of an orientation program for beginning level coronary care nurses as well as implications for further research. / Ed. D.

This thesis is a study of the experiences of nurses who have undertaken training in Solution Focused Brief Therapy (SFBT). While the clinical outcomes of using SFBT, and other psychological therapies, to treat clients have been the subject of much research, the outcomes of training therapists to use SFBT has been relatively unexplored. It is, therefore, my intention to address, in part, this uncharted area of practice. Utilising a mixed methodology, the study is divided into two Stages. In Stage I, an original Solution Focused (SF) methodology is developed and used to conduct individual interviews with twenty participants. Interviews are transcribed and treated as narrative texts, and are then subjected to multi-factored analysis enabling the synthesis of a ‘group narrative’ and the construction of a typology of experience. In Stage II, I conduct further in-depth interviews with three of the original participants and utilise a hermeneutic methodology, drawing on the work of Hans-Georg Gadamer, to engage with the texts generated from these interviews. The texts are explored thematically, and through the nursing metaparadigm of Jacqueline Fawcett, and are compared with a metaparadigm of SF practice. The research suggests that training is SFBT can have a profound effect on the clinical practice, and professional identity, of nurses, and that this is related to the paradigm of nursing which informs their practice. Where the nursing paradigm is of the dominant ‘assessment and delivery of care needs’ modality, SFBT training has little to offer the nurse; however, where the nursing paradigm reflects an ‘interpersonal, dynamic’ modality based on shared relationships, training in SFBT can be a transformative experience for the nurse. This research makes an original contribution to the field of SFBT and to our understanding of the relationship between SFBT and nursing. Building on the work of earlier scholars, it argues that SFBT is congruent with some nursing paradigms, and not all nursing paradigms as previously suggested. It also advances our understanding of how the scope and field of SF practice may be delineated.

Thesis (MCur)--Stellenbosch University, 2003. / ENGLISH ABSTRACT: No clear description exists in S.A. of the role and functions of a forensic psychiatric nurse. The researcher conducted a research project based on more than 20 years of practice experience to define and describe the role and functions of the forensic nurse practitioner. A non-experimental descriptive study was done. Questionnaires and checklists were compiled to determine the perceptions of forensic psychiatric patients/clients (n =24) and nursing staff (n = 15) .The nursing activities in a selected forensic psychiatric unit was evaluated through nonparticipative observation. Results indicated that: • Patients experienced their environment as isolated and has a need for better support by the nursing staff; • Nursing staff indicated their need for more specific training in forensic psychiatric nursing; and • A need exists for specific protocols and procedures to guide his/her practice. The recommendations are made that: • A special training program for forensic psychiatric nursing needs to be planned and implemented; and • Procedures and guidelines must be established to guide the practice of the nurse practitioner. / AFRIKAANSE OPSOMMING: Daar bestaan in S.A. geen duidelike omskrywing van die rol en funksies van die forensiese psigiatriese verpleegkundige nie. Die navorser het gegrond op meer as 20 jaar praktykervaring 'n navorsingsprojek gedoen om die rol en funksies van die verpleegpraktisyn te definieer en te omskryf. 'n Nie-eksperimentele, beskrywende studie is gedoen. Vraelyste en kontrolelyste is opgestel om die persepsies van forensiese psigiatriese pasiënte/kliënte (n=24) en verpleegpersoneel (n=15) te bepaal. Die verpleegaktiwiteite in 'n geselekteerde forensiese psigiatriese eenheid is deur nie-deelnemende observasie geëvalueer. Resultate het daarop gedui dat: • Pasiënte hulle omgewing as geïsoleerd ervaar en het 'n behoefte aan beter ondersteuning deur die verpleegpersoneel; • Verpleegpersoneel het aangedui dat hulle 'n behoefte het aan spesifieke opleiding in forensiese psigiatriese verpJeging;en • Daar 'n behoefte is aan spesifieke protokolle en prosedures om sy/haar praktyk te rig . Die aanbevelings word gemaak dat: • 'n Spesiale opleidingsprogram vir forensiese psigiatriese verpleging beplan en geïmplementeer word; en • Prosedures en riglyne daargestel moet word om die praktyk van die verpleegpraktisyn te rig.

M.Cur. (Nursing) / Please refer to full text to view abstract

The purpose of this study is to gain a richer understanding of the experiences of moral distress for nursing students within the context of psychiatric-mental health clinical placements, examine strategies students use to effectively manage distress, and explore student and instructor roles as agents of change to reduce the negative impact of moral distress. Nursing students and instructors engaged in semi-structured interviews and focus groups, respectively, to examine the complexities of this phenomenon. This study utilized second-person action research based on Jürgen Habermas’ Theory of Communicative Action. Findings indicated that nursing students experience moral distress when they are powerless and lack role models to follow in taking action to address situations that are “not right”. Nursing instructors acknowledge their responsibility to prepare students for practice, but are also powerless as “guests” within the practice setting and are powerless to effect change on a hierarchical medical system. Findings indicate that both nursing education and health care institutions must make changes in their approaches to practice if they wish to empower nursing professionals to provide safe, competent, and ethical care to patients. / vii, 139 leaves ; 29 cm

Cultural diversity is affecting every aspect of society today and nurses need to be able to provide culturally competent care to remain relevant, and useful, within the current climate. Cultural immersion experiences are one of the teaching strategies that have been incorporated in an attempt to prepare nurses to be culturally competent in practice. However, there are only a few research studies that have been conducted, within the discipline of nursing, to empirically document the process and outcomes of a cultural immersion experience. Thus, the purpose of this study was to examine factors that facilitate a meaningful cultural immersion experience during a nursing program, as well as the short-term effects of such experiences on personal and professional growth and cultural awareness. The theoretical framework for the study was Leininger's theory of Culture Care Diversity and Universality.This study identified factors that were relevant and important in facilitating a meaningful cultural immersion experience within the categories of situational predetermining factors, modifying factors, and transitional factors (adjustment strategies). Situational predetermining factors identified as relevant included prior personal and professional experiences, prior attitudes and values, preparation before departure, andprior cultural knowledge. Modifying factors identified as relevant included the perception of living in another world, and being "stuck there," as well as the type of location, type of nursing experience, and people met on site. Transitional factors identified as relevant included social support from classmates and the use of coping responses such as humor, self-reliance, personal strength/faith, as well as adjustment of communication style to be able to talk with host-nationals. Finally, personal and professional growth and changes in cultural awareness were identified as outcomes of the immersion experience. Further research on the process and outcomes of cultural immersion is needed to continue to generate a base of nursing knowledge related to cultural immersion, and to assist nurse educators in the planning and execution of such experiences. / School of Nursing

M.Cur. / The manager is responsible for quality education, research and appropriate community service. The aim of this study is to provide guidelines for the purpose of excellent management of a nursing department at a distance education technikon with a view to facilitating the achievement of one of these responsibilities, that is to provide quality education. In South Africa increasing demands are being made on educational structures as everyone needs to be afforded the opportunity for education and training. This also implies demands on the training of nursing staff. Theoretical and vocational training are combined in technikon training. Therefore a nursing department at a distance education technikon should be managed excellent to meet all the demands. In an attempt to make nurse training more accessible, this study focuses on management in the context of a distance education technikon. The paradigmatic perspective guiding this study is described by means of metatheoretical, theoretical and methodological assumptions. The Nursing Theory for the Whole Person is used to state the methodological and theoretical assumptions. The methodological assumptions of this study are based on Botes's research model (1994), which implies that a functional approach has been used. In phase I of the research the experience of managers of distance education nursing departments are investigated and described on the basis of individual interviews. The data is used to formulate propositions to create a tentative conceptual framework. In phase II the experience of managers of departments at a distance education technikon is investigated and described by using a focus group interview. Propositions are formulated by using the data and, together with the statements from phase I, serve as a basis for creating a refined conceptual framework. In phase III of the research a conceptual framework based on the propositions from phase I and II as well as other literature, is described. From this the final conceptual framework is formulated. Phase IV, derived from phase III, sets out guidelines for managing a nursing department at a distance education technikon.

M.Cur. / Although clinical evaluation and examination is regarded as the basis of scientifically founded nursing care, it is inherently a subjective process. This process is complicated by the variability of four inter-related systems, namely the eyaluator, the clinical environment, the student nurse and other individuals. The purpose of the study was the analysis of current evaluation practices and the OSCE and to determine the perception of clinical educational personnel and student nurses in this regard. Consequently a descriptive exploratory survey was done by means of a questionnaire. For the purpose of this study, clinical teaching. Personnel and student nurses associated with the nine affiliated hospitals of one nursing college in the Transvaal were approached. From the obtained data it appears that clinical evaluation and examination remains, to a certain degree, a subjective process. Preconceptions probably influence human judgement. In spite of the occurrence of identified variables the OSCE appears to be a more acceptable approach to clinical examination than traditional long examination methods.