A Research Report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfillment of the requirements for the degree of Master of Science in Nursing Johannesburg, 2013 / Problem-based learning is recognized as an appropriate teaching-learning strategy for the preparation and development of health professionals in South Africa. Four university nursing schools have adopted a problem-based learning (PBL) model for the design and implementation of their Bachelor of Nursing curricula. Problem-based learning is learning by facilitating the acquisition of knowledge and skills such as communication, team work, self-directed learning, problem-solving and critical thinking. Although competence is implied in students’ academic marks, it is not known how students feel about problem-based learning or whether they are satisfied with their PBL courses and how they view their own competence as a result of PBL. The purpose of the study was to determine the level of undergraduate nursing students’ satisfaction with their problem-based learning course as well as their reported competence in learning skills and processes as a result of problem-based learning. A quantitative, descriptive survey was used to collect data. The study population consisted of all nursing students enrolled in the second, third and fourth year of the Bachelor of Nursing degree in the 2010 academic year (N=42). Students who agreed to participate completed questionnaires per year of study and per PBL course. The final number of questionnaires that were analysed amounted to 92 (n=92). Data were analysed using STATA version 11. The results showed that overall, students were satisfied with the organizational aspects of their PBL course, facilitator expertise and quality of facilitation. They were less satisfied with facilitator attitude in the senior years of study. Students reported with certainty their competence in the learning processes and skills as a result of PBL; some senior students (16.3%) did not feel competent to access and use literature sources and to integrate information into and plan nursing care (17.3%). Students reported that PBL is useful, empowering, enlightening and felt that the structured use of core lectures and more practise opportunities would enhance their competence.

Evidenced based practice (EBP) guidelines have been developed to reduce variation in weaning, provide quality of care and patient satisfaction. Nurse led weaning has been shown to reduce weaning time, and therefore it was important to identify whether nurses have sufficient knowledge to implement EBP regarding weaning (Hansen, Fjaelberg, Nilsen et al, 2008);(Crocker, 2002:272). Weaning protocols are associated with 25.0% reduction in the duration of mechanical ventilation time, a 78.0% reduction in weaning duration, and 10.0% reduction for length of stay in ICU (Blackwood, Alderdice, Burns et al, 2011:9). The purpose of the study was to evaluate and describe intensive care nurses’ knowledge of EBP guidelines with regard to weaning the mechanically ventilated patient. Five adult intensive care units at two tertiary public sector academic hospitals were used to conduct the study in order to determine barriers to EBP. A non-experimental, descriptive, prospective two-staged design was utilized in this two part study. In Stage I of the study, the sample size comprised six (n=6) specialist expert members selected from the ICU’s at the study site using a non-probability purposive sampling method. In Stage II of the study, the sample size comprised eighty (n=80) intensive care nurse respondents selected from the ICU’s using simple random sampling. The data collection instrument developed by the researcher comprised 40 items relevant to nursing practice derived from EBP weaning guidelines. Respondents were asked to rate all the items independently using a 4-point Likert scale. Findings indicated that intensive care nurses lack adequate knowledge on weaning the critically ill patient from the mechanical ventilator. The Dreyfuss model of skill acquisition shows that improved skill performance in nursing is based on experience as well as education, yet this study showed the opposite (Dracup & Bryan-Brown, 2004). Years of experience did not influence nurses’ knowledge level, as there was no statistical difference in these items. Differences in knowledge scores between the primary nurse and shift leaders were minimal, although significant (p<0.05), indicating that shift leaders were more knowledgeable than primary nurses.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Estudo exploratÃrio com abordagem quantitativa, realizado em uma maternidade pÃblica de Fortaleza-CE, que objetivou descrever um mÃtodo de avaliaÃÃo visual aplicado ao recÃm-nascido. Para tanto, utilizou-se um formulÃrio composto por trÃs partes - 1) histÃria materna e neonatal 2) exame ocular e 3) condutas de enfermagem - o qual foi aplicado ao recÃm-nascido cuja idade gestacional ao nascimento era inferior a 37 semanas (RNPT) com o consentimento pÃs-esclarecido da mÃe no perÃodo de marÃo a maio de 2004. Os dados foram processados com o auxÃlio do software SPSS versÃo 11.0 e apresentados em forma de tabelas. Para anÃlise das tabelas 2x2 foram utilizados os testes de Fisher e para as tabelas rxc os testes de Fisher-Freeman-Halton, adotando-se o nÃvel de significÃncia de 5%. O mÃtodo foi aplicado a 114 recÃm-nascidos prematuros. Dentre os fatores da histÃria materna destacaram-se as mÃdias das idades, 23 anos e de consultas de prÃ-natal igual a 3,8. SobressaÃram-se na histÃria familiar/oftalmolÃgica casos de erros de refraÃÃo (17%) seguidos por casos de diabetes (14%). Em menor freqÃÃncia, catarata (4%) e glaucoma (1%). Na histÃria pessoal sobressaiu-se a hipertensÃo arterial (12%), seguida por distÃrbios visuais (8%). Em relaÃÃo à histÃria neonatal, verificou-se que 71% dos RNPT nasceram por cesariana, 52% eram do sexo feminino e 68% apresentaram apgar inferior a sete no primeiro minuto. Quanto à classificaÃÃo da prematuridade 78% eram RNPT moderados. Constatou-se que 112 RNPT utilizaram oxigenoterapia, 71% destes de 1 a 10 dias e 68 RNPT fototerapia, 53% destes de 1 a 5 dias. A profilaxia contra a oftalmia neonatal foi realizada em 27% dos RNPT. Referindo-se ao exame ocular externo, 27% dos RNPT apresentaram alteraÃÃo na pÃlpebra, 16% na conjuntiva, 14% na esclera, 9% no ducto lacrimal, 6% na cÃrnea e 5% na pupila. Nenhum RNPT apresentou alteraÃÃo nas estruturas da sobrancelha e Ãris. Houve associaÃÃo significativa entre alteraÃÃo de esclera e uso de soluÃÃo e/ou medicamento via ocular (p= 0,055). Treze RNPT (11%) apresentaram alteraÃÃo de movimentos extra-oculares (estrabismo fisiolÃgico) e treze (11%) o reflexo vermelho alterado. Houve associaÃÃo estatisticamente significativa entre reflexo vermelho e apgar no primeiro minuto de vida (p= 0,041) e o tempo de oxigenoterapia (p= 0,028). As condutas de enfermagem, a partir dos achados da avaliaÃÃo visual, foram dirigidas ao prontuÃrio, à equipe de enfermagem, aos cuidados com a visÃo do recÃm-nascido ao utilizar terapÃuticas especÃficas, aos seus pais e a outros profissionais (encaminhamento). Os resultados indicaram que o mÃtodo utilizado foi eficiente pelo fato de ressaltar e identificar fatores que podem colaborar para alteraÃÃes visuais precoces, assim como os possÃveis achados do exame ocular do recÃm-nascido. TambÃm almejou como tecnologia contribuir para o âsaberâ e o âcomo fazerâ do enfermeiro no cuidado dirigido à saÃde ocular do recÃm-nascido. A operacionalizaÃÃo do mÃtodo de avaliaÃÃo visual mostrou-se viÃvel e necessÃria no perÃodo de internaÃÃo neonatal, como um dos cuidados do enfermeiro visando a contribuir para a minimizaÃÃo ou mesmo diminuiÃÃo dos agravos à saÃde ocular da crianÃa. / This is a quantitative study, which took place in a public maternity of Fortaleza - CE during the months of March and May of 2004. The aim was to describe the implementation of a visual evaluation during the intern of 114 premature newborns (PN) whose gestation age until birth was under 37 weeks. The babiesâ mothers gave their permission to be subject of the study. The evaluation questionnaire consisted of three categories: 1) maternal and newborn history, 2) ocular exam and 3) nursing care. The data was analysed with the help of SPSS software 11.0 version and presented through table charts. To analyse the 2x2 tables it was used Fisherâs tests and for the rxc tables, Fisher-Freeman-Haltonâs tests, adopting a significance level of 5%. Under the category maternal history, the data showed that the ageâs ratio of the mothers was 23 and 3.8 was the average number of pre - natal consultation. Under family history/ophthalmologic, it stood out deflection errors (17%) followed by diabetes (14%) and in a lower frequency, cataract (4%) and glaucoma (1%). Under personal history it stood out high blood pressure (12%) followed by visual disorder (8%). Under newborn history it was found that 71% of PN were born thought caesarean section, also 52% are female and 68% had an apgar lower than seven during the first minute of their lives. 78% were average PN according to the premature classification. It was found that 112 PN used oxigenotherapy in which 71% of them were between the ages of 1 and 10 days. Also 68 PN were under phototherapy in which 53% were between 1 and 5 days old. The prophylaxis against newborn ophthalmologic disease was done in 27% of the premature newborns. As for the external ocular exam, 27% of those babies showed alteration in the eyelid, 16% in the conjunctiva, 14% in the sclera, 9% in the lachrymal duct, 6% in the cornea and 5% in the pupil (opening of the iris). None of the premature newborns showed any alterations on the eyebrow or iris. There was a meaning variation between the sclera and the ophthalmologic medication used (p=0,055). Thirteen premature newborns (11%) showed variation of the extra-ocular movements (physiologic strabismus) and thirteen (11%) had their red reflex altered. It was found a relevant relation among the red reflex, the apgar in the first minute of the newbornsâ lives (p=0,041) and the time of oxigenotherapy treatment (p=0,028). The nursing care, based on visual assessment, was noted on the register book, informed to the nursing team, conducted as an specific treatment for the newbornsâ vision, transmitted to their parents and other professionals (if one was to be needed). The results showed that the method used was efficient because it emphasizes and identifies factors that may help cooperate treatments against premature visual disorders. Indeed a technology resource contributes to the knowledge and nursing practice for the newbornsâ visual health. The evaluation process came to be useful and necessary during a newborn intern period as one of the nursing treatments to reduce childrenâs ocular disorders.

背景: 高擬真情境模擬（HFS）已成為一種流行的護理教育教學法，能讓學生安全及有效地利用高擬真情境模擬人練習護理。許多西方的研究報告指出，HFS對護理學生的自信心培育、解決問題的能力和批判性思維均有正面影響。然而，對本地護理學生所做的研究有限。基於文化差異，以及不同的學習風格，西方國家的證據未必能套用在香港的護理學生身上。 / 目的: 本研究志在探討高級護理文憑課程的學生對研究員研發的高擬真情境模擬訓練課程(HFSTP)的滿意度，及HFSTP對學生的學習自信及批判性思維發展的影響。 / 研究方法: 這項研究採用了混合方法研究設計，分為兩個階段。第一階段為準實驗性研究，利用前測後測設計，以探討HFSTP對護理學生的自信心、滿意度以及批判性思維發展的影響。共90位護理學高級文憑課程二年級學生，按他們就讀課程的要求，參加了第一階段的研究。而HFSTP是参照科爾布的經驗學習週期所研發，當中包括兩個1小時的小組研討和兩個1小時HFS實驗室培訓。第一階段的研究採用了四份問卷，包括學生滿意度和學習中自信量表（SCL），批判性思維調查（CTS），仿真設計量表（SDS）和人口表。而在SCL得分最高及最低各12位學生會被邀請參加第二階段的焦點團體訪談。這階段研究以半結構化面試指南來探索學生們對HFSTP的看法。所得數據以內容分析法作分析。 / 結果: 配對t檢驗結果表明，SCL和CTS的後測平均分均顯著高於前測（P = 0.001）。而對HFSTP的設計評價，學生評定保真度和匯報會為HFSTP學習中最重要的元素。大部份學生在定性訪談中表示滿意這嶄新的學習方法。根據定性數據分析的結果得出四大主題：（1）模擬臨床環境，（2）整體護理經驗，（3）信息和反思的思維，及（4）HFS的用量，研究人員得出結論，參照科爾布的經驗學習週期所研發的高擬真情境模擬訓練課程，是一種有效的教學策略，它能有效地提高學生的學習自信及培養出批判性思維。同時，學生表示滿意這次課程的安排。至於這次研究結果對護理教育，護理實務和高等教育管理的影響將會在這論文的最後部份發表。 / Background: High-fidelity simulation (HFS) has become a popular teaching method in nursing education that allows students to practice their nursing care skills safely and effectively on human patient stimulators. Many studies have reported the positive impacts of nursing students’ learning experience with the use of HFS on their development of self-confidence, problem solving and critical thinking. However, studies done on local nursing students are limited. Acknowledging that there may be cultural differences in the learning styles between Chinese and non-Chinese people, the existing evidence mainly come from western countries, which may have limited generalizability to Hong Kong nursing students. / Aims: This study aims to examine the satisfaction of the higher diploma nursing students on the researcher-developed high-fidelity simulation training program (HFSTP), and the effects of HFSTP on the students’ self-confidence in learning and development in critical thinking. / Methods: A mixed methods study design was used in two phases. In Phase I, a quasi-experimental, one-group pretest-posttest design was employed to investigate the effects of HFSTP on nursing students’ satisfaction, self-confidence, and critical thinking development. A total of 90 year 2 higher diploma nursing students participated in the Phase I study. The Kolb’s experiential learning cycle guided the development of the HFSTP including two 1-hour simulation tutorials and two 1-hour HFS laboratory and debriefing sessions. Four questionnaires including Student Satisfaction and Self-Confidence in Learning (SCL), Critical Thinking Survey (CTS), Simulation Design Scale (SDS), and a Demographic Sheet were employed in the Phase I study. In Phase II, a focus-group interview was conducted to explore students’ perception of HFSTP. A total of 24 students from the highest or lowest scores in the posttest SCL in Phase I were invited for the focus group interview. A self-developed semi-structured interview guide was used to explore the participants’ perception of the HFSTP. Content analysis was used for data analysis. / Results: Results of paired t-test indicated that the mean scores of both SCL and CTS in the posttest were significantly higher than those of the pretest (p = <0.001). With regard to the evaluation of the design of HFSTP, the participants rated the fidelity and debriefing sessions as the most important learning features in the HFSTP. In the qualitative interview, most of the students expressed satisfaction towards the learning of HFSTP. Four main themes (1) A mimic clinical environment, (2) Holistic care experience, (3) Information and reflective thinking, and (4) Dosage of the HFS, emerged from the analysis of the qualitative data based on students’ perceptions of having HFSTP as a new teaching strategy. Researcher concluded that the HFSTP, which is based on Kolb’s experiential learning cycle, is an effective teaching strategy for promoting nursing students’ self-confidence in learning and critical thinking development. Students were satisfied with the program design. Fidelity and debriefing sessions were reported as the two most important learning features of the HFSTP. Implications of the findings for nursing education, nursing practice and higher education administration will be presented at the end of the paper. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Fong, Wan Ching Kathryn. / Thesis (D.Nurs.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 154-161). / Abstracts also in Chinese. / Chapter CHAPTER ONE --- INTRODUCTION --- p.1 / Introduction --- p.1 / Background of the Study --- p.1 / Justification for the Study --- p.5 / Research Questions --- p.6 / Conceptual and Operational Definitions --- p.7 / Significance of the Study --- p.9 / Overview of the Study --- p.10 / Chapter CHAPTER TWO --- LITERATURE REVIEW --- p.12 / Introduction --- p.12 / Search Strategy --- p.13 / Development of Simulation --- p.13 / History of Simulation Learning in Nursing Education --- p.16 / HFS used in Nursing Education --- p.17 / Self-Confidence in Learning --- p.25 / Satisfaction with Learning Experience --- p.37 / Critical Thinking --- p.43 / Theoretical Framework: Kolb’s Experiential Learning Cycle --- p.48 / Conclusion --- p.52 / Chapter CHAPTER THREE --- METHODOLOGY --- p.55 / Introduction --- p.55 / Research Questions --- p.56 / Aims --- p.56 / Research Objectives --- p.56 / Research Design --- p.57 / Setting --- p.61 / Phase I Study --- p.63 / Phase II Study --- p.83 / Ethical Issues --- p.90 / Pilot Study --- p.91 / Summary --- p.91 / Chapter CHAPTER FOUR --- RESULTS --- p.93 / Introduction --- p.93 / Research Hypotheses --- p.94 / Phase I Study --- p.94 / Phase II Study --- p.105 / Summary --- p.126 / Chapter CHAPTER FIVE --- DISCUSSION --- p.128 / Introduction --- p.128 / Participant Recruitment and Response --- p.128 / Issues of Dropouts and Participant Non-attendance --- p.129 / Discussion on Study Findings --- p.129 / The Use of Assessment Tools --- p.142 / Limitations of the Study --- p.143 / Implications for Nursing Education --- p.144 / Implications for Nursing Practice --- p.146 / Implications for Higher Education Administration --- p.148 / Recommendations for Future Studies --- p.150 / Conclusions --- p.151 / REFERENCES --- p.154

Indiana University-Purdue University Indianapolis (IUPUI) / Nurse-physician collaboration has received much attention over the past decade in the USA. The release of three reports from the Institute of Medicine implicated poor communication and collaboration among nurses and physicians as a major contributing factor to the incidence of sentinel events and medical errors. Despite the growing awareness of the imperative related to collaboration between nurses and physicians to ensure patient safety, the problem of poor nurse-physician collaboration remains endemic throughout the country. Indian nurses, along with many other internationally educated nurses, comprise 12-15.2% of the nursing workforce in the USA. Little is known about how Indian nurses culture potentially influences their ability to effectively collaborate with physicians to ensure patient safety. The purpose of this study is to understand Indian nurses’ attitudes and perceptions about nurse-physician collaboration. Hermeneutic interpretive phenomenology as influenced by the work of Martin Heidegger guided this study through the use of interviews via Skype. The overall experience of the Indian nurses was of one experiencing a dramatic positive change in nurse-physician collaboration in the USA as compared to India. Four themes emerged describing this phenomenon: Respect/feeling heard, Being Trusted, Assurance of Accountability, and Finding Freedom. Indian nurses practicing in the USA find a freedom that empowers them to collaborate with physicians for patient safety. They, as all nurses may, benefit from continuing educational opportunities that demonstrate ways to collaborate more fully.