<p>Abstract Palliative care (PC) is the comprehensive management of patients diagnosed with terminal illness. Care for PC patients focuses on relieving symptoms. The purpose of this study was to determine the difference between pretest and posttest scores on the Frommelt Attitude towards the Care of the Dying (FATCOD) and the Palliative Care Quiz for Nurses (PCQN) after an educational intervention to emergency department (ED) nurses. The framework for this project was Bandura?s social cognitive theory. The FATCOD was used to assess ED nurses? attitudes toward PC, and the PCQN was used to assess ED nurses? knowledge about PC prior to the educational program. The educational intervention was developed using evidence obtained from the literature review and guided by the PCQN. The program presented to the ED nurses covered the essentials of palliative care and the information and skills needed by the ED nurse caring for the PC patient. The FATCOD and the PCQN were then administered as a posttest. A total of 70 nurses from two ED units volunteered to take part in the project. Results of the PCQN pre- and posttest showed a significant difference (p < .05), and the FATCOD pre- and posttest showed no significant difference (p = .849). The results revealed that education significantly improved knowledge of PC for the ED nurses participating in the project. Attitudes about PC were not significantly changed after the education program. The project promotes positive social change by raising awareness of the need for PC educational opportunities for ED nurses. By improving PC in the ED, patients and their families may experience increased satisfaction with end-of-life care and improved quality of life.

<p> Ethical ED nurse leadership is faced with persisting challenges to delivering culturally competent care, which is crucial in reducing widespread racial healthcare disparities. Implicit biases are continually cited as key sources driving these inequities. However, research is lacking as how to effectively reduce implicit biases and increase health provider cultural competence. This quantitative, pretest-posttest project evaluated the efficacy of a cultural competency education by investigating if and to what extent the intervention decreased implicit biases and increased perceived cultural competence. Survey data were collected from a convenience sample of 36 ED nurse staff employed at a large urban medical center in California. Data included participant scores on the Race Implicit Association Test (IAT) and the Clinical Cultural Competence Questionnaire (CCCQ). Two-tailed paired samples <i>t</i>-test (CI = 95%; <i>p</i> &lt; .05) indicated that the overall CCCQ score change of 5.5 points was statistically significant (<i>p</i> = .001) and linked to Knowledge (<i>p</i> = .000) and Attitudes subscales (<i>p</i> = .012) improvement. Race IAT changes were not statistically significant. No correlation was found between Race IAT and CCCQ scores. One-way repeated ANOVAs were used to investigate demographic variable impacts on scoring with limited value. Overall cultural competence scores were poor and Race IAT scores differed substantially from prior findings. Based on project results, the education was promising, supporting a solid, theory-based platform for strategically optimizing cultural competence and reducing health disparities in the ED care setting.</p><p>

<p>This dissertation, composed of three manuscripts, provides a foundation for the evaluation of advancing sedation and excessive respiratory depression in terms of managing post-operative patient?s pain with opioids. The first manuscript provides a framework for the concept of sedation in terms of how it is assessed and applied to post-operative pain management. The second manuscript is a qualitative review of the literature regarding the assessment of opioid induced sedation and advancing respiratory depression in regards to managing patient?s pain. The third manuscript provides the dissertation study examining expert nurses? common meanings and shared practices with sedation in the context of postoperative pain management with opioids. Using Heidegger?s interpretive phenomenological methods, interviews with expert post-anesthetic care unit nurses were conducted to capture the missing practical knowledge behind the nursing gestalt approach to managing patient?s pain. The third manuscript is currently being prepared for submission to a journal focusing on pain management nursing. Further research studies are warranted.

<p> Duties performed by staff Registered Nurses (RNs), and Nurse Managers (NMs) require a different skill set to be effective. Nursing leadership is responsible for guiding staff RNs in providing quality, effective, and cost-efficient care. Incompetent leadership may lead to decreased retention and negative patient outcomes. Quality nursing leadership positively influences professional development of staff RNs and patient care. A literature review exposed a gap in leadership training that assists new NMs to function independently and efficiently. The purpose of this original basic qualitative study, which employed Husserl and Heidegger&rsquo;s approach of phenomenology, was to explore the experiences of staff RNs who transitioned into the NM role within the last five years and practice in either a small rural hospital or large urban medical center in southeastern North Carolina. Semi-structured interviews using open-ended questions were utilized to collect rich, contextual data until data saturation occurred. Open and axial coding of the data, documented in a code/theme frequency table, facilitated the discovery of central themes within the data including: the benefit of having performed managerial duties while in a staff RN role; leadership training to introduced a broader view of NM responsibilities and techniques needed to accomplish these duties; and a dedicated mentor who provided intimate guidance during the transition. The evidence from this study aligns with the published literature regarding the transition from a staff RN role into a NM role and supports making a proposal to the hospital&rsquo;s administration for a systems-oriented NM training opportunity such as a 90-day nursing leadership orientation that included formal classes on budgeting, common human resource management issues, and how to evaluate staff. This formalized training, in concert with one-on-one mentoring with experienced NM, would ensure a smoother transition from the staff RN role into the NM role and would produce more efficient, more satisfied nursing leadership professionals who are more inclined to stay with the organization that helped their career growth.</p><p>

<p> The purpose of this qualitative phenomenological study was to explore emergency nurses&rsquo; perception of patient-initiated violence in eastern Tennessee. Twenty-four rural eastern Tennessee nurses participated in the study. The 24 participants were assigned to one of four gender specific focus groups. The focus groups offered qualitative data associated with the phenomenon. Themes and subthemes emerged from the analysis of participants responses using Colaizzi&rsquo;s (1978) strategies. The responses were segmented and compared to identify similar phrases or words. The data analysis detected five themes. Victimization manifested as participants&rsquo; feelings and a lack of executive leadership support. Re-victimization due to rural nurses&rsquo; continual exposure to patients who previously committed violent acts. A lack of executive leadership support was identified. Self-care deficit resulting from the participants&rsquo; post-exposure symptoms. Distinct gender differences were evident in this study. Implications include exploring an open dialogue between emergency nurses, nursing leadership, and executive leadership to develop policies that support the rural emergency nurse and establish policies that mitigate violence. Gender differences can be explored through individual discussion with emergency leadership leading to an individualized action plan that can foster self-care, employee engagement, and retain staff at the bedside.</p><p>

<p> The placement of an indwelling urinary catheter (IUC) is a commonly performed clinical procedure which may become challenging for the clinician and painful for the patient. In response to urologic complications attributed to repeated failed IUC insertion attempts by nurses, a difficult urinary catheter (DUC) team program was launched in October 2012. The purpose of the doctoral project was to conduct a quality improvement evaluation of the effectiveness of the DUC team program using retrospective data from May 1, 2013 through May 31, 2017. Benner&rsquo;s novice to expert model was chosen as the theoretical framework to guide the additional training, critical thinking, problem-solving, and skill acquisition necessary for team member inclusion. The practice-focused question for the project answered whether DUC team nurses, through advanced training and demonstrated procedural competence, have been effective with DUC insertions. Sources of evidence included primary and secondary articles in peer-reviewed journals, as well as clinical evidence collected from internal sources. During the project time-line, 463 DUC team consultations were recorded with an insertion success rate of 89.6%. Based on the DUC team concept, additional didactic content and simulation training may be developed for other cognitive and skill-based clinical procedures. The implications for positive social change include improved patient safety and comfort, as well as cost savings for the organization and overall healthcare system.</p><p>

<p> Access to safe abortion care has been linked to better maternal and child health outcomes (Sedgh et al., 2012) and identified as essential for advancing women&rsquo;s economic and social equality (Lang, 2013; Bengsch, 2015). Around the world, nurses, including nurse practitioners (NPs) and certified nurse midwives (CNMs), are integral members of the health care teams that provide care to women considering or electing to have an abortion. Evidence supports NPs and CNMs as safe and effective providers of comprehensive early abortion care, and acceptable to patients (Barnard, Kim, Park, &amp; Ngo, 2015; Kallner et al., 2015; Weitz et al., 2013). </p><p> Currently in the United States (US), almost one million women have an induced abortion each year (Jones &amp; Jerman, 2017). National abortion data reveal significant disparities in rates, and inequities in access (Jerman, Jones, &amp; Onda, 2016). An inconsistent legal and regulatory landscape precludes NPs and CNMs from providing comprehensive abortion care in many states, including some where there are few providers. Vermont and New Hampshire comprise two of the four states where laws and practice regulations allow NPs and CNMs to perform aspiration abortion, and across New England. These advanced practice nurses (APRNs) are extensively involved in providing and managing the care of women undergoing medication abortion. </p><p> Little literature describes nurses&rsquo; experiences providing comprehensive early abortion care around the world, including in the US. The aim of this qualitative, exploratory, descriptive research study was to explore the experiences of NPs and CNMs who provide comprehensive early abortion care in New England. Data were collected through in-person individual interviews with seven NPs and one NP/CNM. Providing comprehensive early abortion care was generally a positive experience for most participants, though it did include challenges. Critical influences to becoming an NP or CNM who provided comprehensive early abortion care included the era in which participants came of age, values of their family of origin, exposure to feminism, reproductive rights and social justice during emerging adulthood, having a role model or mentor, and a personal experience of having an abortion were. Support at every level from interpersonal to societal was found to be a key enabling or constraining factor. Laws and regulations at the societal level were also noted to facilitate or impede abortion care provision by NPs and CNMs in the study. Finally, participants offered words of wisdom to others considering providing comprehensive early abortion care that ranged from clinical pearls to inspirational statements. They were universally encouraging in recommending this as a service to incorporate into clinical practice. This study has a number of implications for the future including the need for further research on NPs and CNMs experiences providing early abortion care in other regions of the US, and to remove state legislative and regulations that constrain practice for clinicians in this area of reproductive health care.</p><p>

<p> Healthcare management is an industry where skill sets are incremental, and Registered Nurses (RNs) must gain their clinical skills before they develop their management skills. Professional training for management-bound RNs seldom comprises more than a few disjointed days or weeklong development seminars, which is valuable but inadequate. The purpose of this original basic qualitative study, which employed Husserl and Heidegger&rsquo;s approach of phenomenology, was to explore the lived experiences of staff RNs who transitioned into the Clinical Nursing Supervisor (Nurse Manager) role within a small rural community hospital in North Carolina. Semi-structured interviews using open-ended questions were utilized to collect rich, contextual data until data saturation occurred. Open and axial coding of the data, documented in a code/theme frequency table, facilitated the discovery of central themes within the data including: a lack of orientation to the new role; inconsistent expectations of the new role; the benefits of a formal program or structured orientation for the new role, and a need to focus the hospital administration on formal leadership orientation and succession planning. The evidence from this original basic qualitative study aligns with the published literature regarding the transition from a staff RN role into a nursing leadership role and supports making a proposal to the hospital&rsquo;s administration for a systems-oriented Clinical Nursing Supervisor training opportunity such as a 90-day nursing leadership orientation that included formal classes on budgeting, common human resource management issues, and how to evaluate staff. This formalized training, in concert with one-on-one mentoring with experienced Clinical Nursing Supervisors, would ensure a smoother transition from the staff RN role into a Clinical Nursing Supervisor role and would produce more efficient, more satisfied nursing leadership professionals who are more inclined to stay with the organization that helped their career growth.</p><p>

Individuals with heart failure (HF) are often readmitted within 30 days of discharge from the hospital. Telehealth has been developed to help manage HF during this critical period. However, association of telehealth with improved HF outcomes is still unclear. There is a need to identify the patients who benefit most from telehealth and explore factors that work in conjunction with telehealth to improve HF outcomes. Therefore the purpose of this study was to explore the patient characteristic factors that impact health status and healthcare utilization outcomes of patients with HF who use telehealth in a homecare setting. A descriptive, correlational study design using retrospective chart review was employed. The sample comprised Medicare patients admitted to a New England homecare agency, with HF as a diagnosis and had used telehealth from 2008 to 2010. OASIS and electronic documentation at the homecare agency served as data sources. Descriptive statistics, logistic and multiple regression analysis were used to analyze association of patient demographic, psychosocial status, and disease characteristics with HF outcomes of patients on telehealth. The sample size was 403, of whom 70% were over 75 years of age, 55% were female, and 94% were Caucasian. Number of nursing contacts ranged 1 to 26 with a median value of 10. There were 118 (29.3%) all-cause readmissions, 76 cardiac-related hospitalizations (18.9%), 17 cases with mortality (4.2%) and 52 (12.7%) abrupt terminations of telehealth. For patients with HF on telehealth, patient characteristics such as: anxiety, high number of medications, acute cardiac events, musculoskeletal, psychiatric and anemia type of co-morbidity were associated with high nursing utilization patterns; dyspnea, high number of medications, obesity, ACEI/ARB and beta-blockers were associated with hospitalizations; and renal, psychiatric and cancer type of co-morbidities and female gender were associated with unplanned termination of telehealth. Abrupt termination of telehealth was also found to be correlated with hospitalizations. The findings of this study contribute to our understanding of healthcare utilization by patients with heart failure on telehealth.

<p> This grounded theory study describes how Nurse Practitioners (NPs) provided care to Aboriginal people in British Columbia and proposed a theoretical foundation to guide NPs interactions with Aboriginal people in providing healthcare. This study first explored NPs work with Aboriginal people. Through analysis of interview responses, insight was gained into how NPs provide care to Aboriginal people. Fourteen NPs who worked with Aboriginal people in British Columbia for at least one year during the past five years were interviewed. After each interview data were manually coded for concepts and categories from which to build theory. Memos were written for further clarity and participants were asked to verify whether or not identified concepts and categories worked, fit, and were relevant and modifiable as new data arose. The theory, Engaging Mutually, identified core categories of Initializing Engagement, Sympathetic Mutuality, and Therapeutic Enlightenment as being connected and working together to help provide effective health care. Engaging Mutually was identified as relevant to the theories of oppression, motivational expectancy, social justice, social cognitive, cultural competency, and Watson&rsquo;s caring theory. The significance of this study was to assist NPs to gain a better understanding of how to work with Aboriginal people to improve their health. This study contributes to research, theory, leadership, and nursing and NP practice. Engaging Mutually may assist NPs and other health care providers to develop appropriate health care practices when working with Aboriginal people and potentially with people from other cultures.</p>