<p> Nurse dissatisfaction occurs when the quality in communication of persons affected by a cognitive decline is impacted during the transmission process. It is necessary to understand the nurse&rsquo;s perception of this situation and how alternative augmentative communication (AAC) patient-centered care intervention (PCCI) care planning provides the most advantageous strategy. The purpose of this Direct Practice Improvement (DPI) project is to understand how ten nurses perceived their level of dissatisfaction while communicating with patients with a cognitive decline before and after implementation of an AAC PCCI care plan intervention at a Long Term Care Home (LTCH) in Southeast Iowa. This project demonstrated the importance of implementing AAC PCCI care planning as a means to decrease nurse dissatisfaction when caring for individuals with cognitive decline. Their perception was measured prior and following implementation of the care plan. The project utilized Watson&rsquo;s theory of human caring to support the perceptual and qualitative nature of this project. A case study framework using qualitative open-ended questions solicited the nurse&rsquo;s personal perceptual view and experiences in answering the clinical questions. The data results of (N=10) nurse&rsquo;s narratives were analyzed. A confidence interval of 95% provided statistical significance supporting AAC PCCI care planning implementation as a means to improve nurse satisfaction. The measurable practice outcome of this project&rsquo;s AAC PCCI care planning implementation is effective in decreasing nurse dissatisfaction. A future recommendation is to provide a quantitative approach as a means to provide additional reliability. </p><p>

<p> Inadequate nurse staffing levels by experienced Registered Nurses (RNs) are linked to higher rates of patient falls, infections, medication errors, and even death. As a result of massive reductions in nursing budgets, combined with the challenges presented by a growing nursing shortage, fewer nurses work longer hours and care for sicker patients. This situation compromises care and contributes to the nursing shortage by creating an environment that drives nurses from the bedside. The purpose of this small exploratory master&rsquo;s thesis research study, which employed Husserl and Heidegger&rsquo;s approach of phenomenology, examined the experiences of acute care RNs who regularly maintain nurse-to-patient ratios of 1:5 or greater during a 12-hour shift, and the impact these ratios have on nurse satisfaction and retention at a small rural community hospital in North Carolina through a basic qualitative research methodology. Purposive sampling was utilized, and the inclusion criteria required the participants to have an active unencumbered RN license and work in one of the acute care units at the hospital. If the RNs held any managerial or supervisory role at the hospital, they were excluded from the study. 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 current system at work, what if it goes wrong, working with others, things nurses must do, and things nurses feel. The evidence from this basic qualitative study aligns with the published literature regarding the higher nurse-to-patient staffing ratios and supports making a proposal to the hospital&rsquo;s administration for creating a patient acuity score that allows for a nurse staffing grid based on acuity, to improve patient safety and nurse satisfaction and retention.</p><p>

<p> Mental health nursing is a distinct specialty in the nursing profession. However, research has consistently shown the field of mental health nursing is not a popular career choice. In addition, the mental health nursing field is facing a significant shortage of nurses. Understanding what attracts and retains nurses to this nursing specialty is needed to aid in recruitment and retention and to ensure there will be enough qualified mental health nurses in the future to provide care for those needing mental health care services. The purpose of this study was to explore mental health perceptions of the career choice and identify what factors and/influences, if any, encouraged the decisions to choose mental health nursing or to remain employed in mental health nursing. A qualitative research design using a descriptive online survey and individual interviews was used to explore mental health nurses' perceptions of the career choice of mental health nursing. Findings from the survey and interviews revealed themes as to why mental health nurses chose a career in and stay in mental health nursing, what factors influenced these decisions, and the image of mental health nursing. Recommendations for future studies in mental health nursing included replicating the study with a larger sample size and a variety of mental health facilities, an analysis of the current U.S. mental health nursing workforce, and how nursing school experiences affect students' perceptions of mental health nursing.</p><p>

<p> A healthy working environment has been an area of interest for occupation health providers. There is anticipation that a safe working environment improves patient safety, which is associated with reduction in clinical nurse errors. Issues with medication errors and poor working environment pose a greater risk to patient safety. The aim of this qualitative study was to provide a broad understanding on nurses&rsquo; perceptions on the processes that influence a healthy working environment and the impacts of a healthy working environment on patient safety. An interpretive grounded theory methodology was used in this study to evaluate nurses&rsquo; perceptions in acute care settings. The study was carried out in a large city of Southern California and the participants consisted of a community-based purposive population of registered nurses (RNs) in a telemetry. A total of 10 participants with three years working experience in surgical units were recruited and tiered scheduled approach was used for the analysis and refinement of interview questions. The participants were all female registered nurses with three years working experience in acute care settings. The majority of the nurses had a bachelor&rsquo;s degree (44%), masters degree (22%) and 11 % had associate degree. Grounded theory method was used to identify the relevant themes from the interview responses. The transcripts revealed nurses&rsquo; perceptions on the process that facilitate a healthy working environment and HWE impacts on patient safety. The findings of the study showed that communication, teamwork and collaboration within healthcare environment are the most important factors for the development of a healthy working environment. The findings also showed the influence of a health care working environment on medication errors. Nurses reported that lack of communication, nurse shortages and micromanagement increases the chances of medical errors. Nurses reported that effective communication with the nurse leaders, managers and patients provide a stress-free working environment that result in a better care for patients. Enough nursing staff s well as teamwork and collaboration also influences patient safety.</p>

<p> Through advancements in modern medicine, human beings worldwide are living longer. The increase in life expectancy creates a need for a more qualified and knowledgeable nursing workforce for the delivery of quality geriatric health care. Although nurses are the primary care providers for vulnerable older adults, they are generally not well trained or prepared in geriatric care. Therefore, the purpose of the project was to develop an education program aimed at improving nursing knowledge of geriatric care in the long-term care (LTC) setting. The goal of the project was to answer the research question: What impact would attendance in the program have on improving nursing geriatric knowledge, retention, and job satisfaction by project end? Guided by the advancing research and clinical practice through close collaboration (ARCC) model for evidence-based practice (EBP), the learning needs of nurses in the LTC setting were assessed. The 6-week education program was designed to provide education on the basics of geriatric care, pharmacology and aging, symptom evaluation, dementia care, and geriatric physical assessment. Project participants consisted of 8 nurses who volunteered to take part in the program. The program was evaluated using a pre-test and post-test method to examine nurse&rsquo;s knowledge before and after the education program. Using a paired <i>t</i> test, the results indicated a significant increase (<i>p</i> &lt; .05) between the mean pre-test (3.75) and mean post-test (4.25) scores of nurse knowledge of geriatric care. The education program improved participant knowledge of geriatric care. Positive social change will be achieved with this scholarly project as nurses with greater knowledge gain confidence, strengthen decision making and clinical skills, and improve patient outcomes in the LTC setting.</p><p>