The growing presence of electronic anesthesia record keeping and perioperative informatics systems is contributing to a database of valuable information that can significantly improve patient care and patient outcomes. Efforts such as the National Surgical Quality Improvement Project and the Surgical Care Improvement Project have analyzed quality measures that directly correlate to patient outcomes. Several of these quality indicators are influenced by the performance of anesthesia providers’ activities in the perioperative period. These programs promote timely administration of preoperative antibiotics. One of their guidelines states that preoperative antibiotic should be given within an hour prior to surgical incision. Surgical site infections are the most common postoperative complication. Reducing postoperative complications can reduce health care costs, and postoperative morbidity and mortality rates. The purpose of this project was to utilize an electronic feedback mechanism to improve anesthesia providers’ documentation of timely preoperative antibiotic administration. Electronic feedback reminders in the form of screensaver dashboards displaying updated departmental timely antibiotic percentage metrics for the day, the past week, and the past month were displayed for 16 weeks. Text messages were delivered once a week for 6 weeks showing an anesthesia providers’ prior average one week on time antibiotic along with an equivalent department on time average. The measures were effective in improving the documentation of timely antibiotic administration.

Background: Emerging evidence suggests that interactive CE activities will have the most effect in terms of knowledge and practice. Using technology to provide interactivity via computer-based applications is as effective an educational strategy as traditional education formats. Methods: A randomized controlled trial was conducted to test the effectiveness and satisfaction of educational activities provided within an online community of practice(CoP) on nurse practitioner (NP) knowledge and practice behavior. The online interactive website combined certified continuing education, professional forum, Ask-the-Experts, national guideline links, patient education tools, and professional resources. A Two-Group Control Group design was used. Study participants were assessed on knowledge and practice behavior prior to and after the six month study. Results: A sample of 66 NPs was randomly assigned to an online education only control group (n=33) or a CoP group (n=33). NPs in both groups had similar pretest knowledge assessment scores: 46% (control) vs. 49% (CoP), and pretest clinical vignette scores: 51%(control) vs. 57% (CoP). After the intervention, there was no significant increase in the posttest scores of the CoP group at 6 months compared with the posttest scores of the control group (knowledge assessment: 67% vs. 60%, p =.17; clinical vignettes: 67% vs. 74%, p =.28). Conclusions: The pilot test did not demonstrate that the intervention (CoP access) had a more positive effect on knowledge or clinical performance than access to online CE activities alone. It did however confirm the effectiveness of online education in improving knowledge.

Job dissatisfaction among nurses may contribute to disengagement and withdrawal from the profession. The degree of leadership support in the workplace influences job satisfaction, and when nurses are satisfied with their job, they provide better patient care. Guided by the social cognitive theory, which asserts a relationship between behavior change and one's surroundings, this quantitative, exploratory project sought to determine the type of nursing leadership practiced in the facility where the project took place, whether nurses were satisfied with their job, and if patients were satisfied with their care. Participants in the project included 55 registered nurses and 5 nurse managers. Three surveys of demographics, job satisfaction, and leadership styles were administered to 60 RN participants; patient satisfaction data were obtained from the hospital's last reported Hospital Consumer Assessment of Healthcare Providers and Systems survey. Descriptive statistics from the nurse surveys showed 75% were female, 56.7% had a bachelor's degree, and, most were under the age of 50 years. Results showed that 90.8% of nurses enjoyed working for the hospital, leaders primarily used transformational leadership styles, and 80.2 to 89.7% of patients were satisfied with their care. This project has implications for positive social change because healthy, transformative leadership leads to staff satisfaction and improved patient satisfaction.

Background: Beta blockers are recommended by the American College of Cardiology/American Heart Association Guidelines for high and intermediate-risk cardiac patients undergoing non-cardiac surgery. Beta blockers are a class of drugs that moderate the effects of increased catecholamine levels on the heart by selectively blocking beta receptors in the heart and blood vessels, resulting in a lower heart rate and blood pressure. Beta blocker use perioperatively has been shown to reduce the risk of ischemia and infarction. Purpose: The purpose of this project is to address beta blocker use in a group of anesthesia providers who routinely attend to high-risk and intermediate-risk cardiac patients undergoing non-cardiac surgery in a medium-sized private hospital in suburban South Florida. There are barriers to the implementation of the published guidelines for beta blocker administration, including lack of awareness of the best current practice and a lack of a formal beta blocker protocol at the institutional level. Methods: A simple and inexpensive beta blocker protocol was implemented and evaluated by various means. Beta blocker administration practices were examined and documented prior to and after protocol implementation. Beta blocker usage was examined prior to and after protocol implementation Findings/Implications: It was hypothesized that increased anesthesia provider awareness would lead to increased administration of perioperative beta blockers to high-risk and intermediate-risk cardiac patients undergoing non-cardiac procedures. Although there was a knowledge increase related to the new beta blocker protocol, no change in practice was observed.

Thesis (MA (Psychology))--University of Stellenbosch, 2007. / Much research has focused on the social and psychological dimensions of nursing; yet we have not identified the thoughts and feelings of health care professionals as a priority in trying to understand a variety of nursing phenomena. There is a need to explore how nurses understand their social and psychological worlds, specifically with regards to the phenomena of violence, abuse and neglect within health care. Therefore, this study has attempted to answer the following research question: How do nurses understand and talk about the occurrence of violence towards patients? The research question demanded the use of qualitative methods to collect and analyse data. In-depth interviews, consisting of open-ended questions were conducted. 11 female participants were enlisted from a tertiary hospital labour ward in Cape Town by means of convenience sampling. Data were transcribed and analysed using a combination of methods. In addition to more traditional methods, I have also included autoethnography in this thesis.

The purpose of this study was to explore the utilization patterns of elderly women in a nurse managed clinic (NMC). A convenience sample of 20 women, 65 and older, attending an NMC completed an questionnaire and an interview. A pilot study guided the development of the questionnaire. Interrater reliability was performed to enhance the reliability of the pattern categories developed from the interviews. The findings of this research were that elderly women utilized this NMC for: physical assessment and monitoring; health care information; evaluating a physical need; referral; emotional support; socialization; convenience; cost; familiarity/comfort; health care need; and reliability. Satisfaction was the main component of the clients' perception of their visit to the NMC. Conclusions reached were that utilization of this NMC was based mainly on perceptions of health care needs and that cost, convenience, and familiarity influenced clients in choosing this clinic in addition to their primary care provider.

This study explored how nurses in acute and nurse-led gynaecology wards prioritised patient caseloads ranging in diversity and number of patient conditions. Statistics show that since the introduction of medical termination of pregnancy (MTOP) procedures into the National Health Service (NHS) in 1991, the number of women having this procedure is increasing year on year. To date very little is known about the impact this procedure may have had on nursing practice. The focus of this study was to explore the nursing care when this included, and did not include, caring for women having MTOP. The study was conducted in two parts. The first qualitative study employed non-participant observation and semi-structured interviews of nurses in gynaecology and surgical wards at two hospital sites to examine the external context in which nursing decisions were made. This found that nurses in gynaecology focused on emotional or psychosocial aspects more so than surgical nurses who focused on physical aspects of patient care. The second quantitative study involved a cross-sectional survey of nurses from both ward types in two hospitals sites in Scotland. Internal constructs were examined using personality and thinking styles measures. Nurses were assessed on their emotionality, that is, the numbers of times an emotional care aspect was prioritised. This found that nurses who prioritised the emotional aspects of the task tended to be more conscientious and elected preference for a ‘people-centred’ thinking style. The context in which women have TOP is also important since the findings suggest women may benefit from being cared for in nurse-led rather than in acute wards. Knowing how a person thinks about emotional and physical aspects of care also has implications for those involved in education, and career planning.

Dans le cadre de cette étude, nous nous sommes intéressés aux infirmières soignantes qui possèdent un diplôme d’études collégiales ou un baccalauréat. L’infirmière est celle ayant reçu une formation collégiale et la clinicienne, une formation universitaire de premier cycle. Au niveau législatif, selon que l’infirmière soit titulaire ou non d’un baccalauréat, le champ de pratique autorisé demeure le même. Cependant, l’étendue de la pratique pourrait varier selon la formation reçue et le poste occupé. Cette étude descriptive et interprétative de type qualitatif avait pour but de décrire l’étendue de la pratique des infirmières et des infirmières cliniciennes dans une unité de médecine et de chirurgie et d’identifier les facteurs organisationnels influençant l’étendue de la pratique. Le cadre de référence ayant été utilisé est le cadre d’analyse de l’étendue de la pratique conçu pour le Collège des infirmières autorisées de la Nouvelle-Écosse (CRNNS, 2005). Selon ce cadre, l’étendue optimale de la pratique des infirmières se divise en 4 catégories distinctes, soit le processus de soins infirmiers, les pratiques relationnelles, le leadership ainsi que l’enseignement et le transfert des connaissances. La collecte de données a été conduite au moyen d’entrevues individuelles semi-structurées auprès de 8 informateurs clés soit trois infirmières et trois infirmières cliniciennes d’une unité de médecine et de chirurgie et de deux gestionnaires. Les résultats semblent montrer que les différentes composantes de l’étendue de la pratique sont mobilisées tant chez les infirmières que chez les infirmières cliniciennes interviewées. Toutefois, les résultats semblent montrer que certaines composantes, soit le leadership et le transfert des connaissances, semblent davantage mobilisées chez les infirmières cliniciennes. De plus, l’étude a permis d’identifier les différents facteurs organisationnels qui semblent influencer l’étendue de la pratique des infirmières et des infirmières cliniciennes. La charge de travail semble être le principal facteur d’influence. Nous avons aussi pu constater l’influence certaines composantes reliées à l’environnement de travail et à la composition et aux caractéristiques des équipes de soins. / The goal of this descriptive and interpretative study was to first describe the scope of nursing practice of registered nurses with a Bachelor’s degree in nursing and those with a nursing diploma in a medical and surgical unit of a regional hospital. The second goal was to identify the organizational factors that influence the scope of nursing practice in that unit. The framework that has been used is the Framework to Analyse Scope of practice, made for the College of Registered Nurses in Nova Scotia (CRNNS, 2005). According to that framework, the full scope of practice of the registered nurse is divided in 4 components: the nursing process, the professional nursing relationships, the leadership and the fonction of teaching and knowledge transfert. For this study, 8 interviews have been realized. The participants were: 3 nurses with a nursing diploma, 3 nurses with a bachelor’s degree and 2 administrators. The results seems to show that all the components of the nursing scope of practice seems to be used by the nurses with a Bachelor’s degree in nursing and those with a nursing diploma. But, the results seem to show that the nursing scope of practice is not fully extended in that unit. We remarked also that two elements of the nursing scope of practice, the leadership and the teaching and knowledge transfert, are more used by nursed with a Bachelor’s degree, compared to those with a nursing diploma. The principal factors which seem to influence the scope of nursing practice in this unit are the nursing workload and some components according to the work environment and to the composition and caracteristics of the nursing teams.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Patients who are hospitalized and are without voice would like to participate in their care. This requires clear communication. Speak for Myself™ (SFM) was developed for use at the bedside so that communication may be facilitated between patient and nurse when the patient is voiceless. The objective of this study was to evaluate Speak for Myself™ at the bedside and to measure the outcomes. This was a mixed methods, one group pre-test-post-test, quasi-experimental study. Twenty adult patients in three hospitals in South Florida agreed to use Speak for Myself™ during their acute care hospital stay (M = 8.86 hours). This group of participants (n = 20) ranged from 45 to 91 years old (males = 14; females = 6). Of the participants, 15 (75%) self-identified as European American, 2 (10%) self-identified as Hispanic, 2 (10%) self-identified as African American, and 1 (5%) self-identified as Asian. Ten of the participants (50%) were in respiratory failure. Two (10%) were receiving oxygenation measures related to unspecified complications of their illnesses. Of the remaining eight participants (40%), one each was receiving oxygenation measures due to atrial fibrillation, arteriosclerotic heart disease, cardiogenic shock, endocarditis, neck abscess, renal failure, status post seizure activity, and tongue metastasis. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection