This research examines hospital length of stay as a feature of contemporary health care reforms. The ideas of Michel Foucault on governmentality enable length of stay to be studied, not as numerical values of hospital use, but rather as one of the social and political processes through which certain concepts are made susceptible to measurement and part of practice. In this study length of stay is examined as a programmatic rationality, evident in the reengineering of the modern hospital. However, the focus of analysis is not the ‘effect’ of this reengineering, as seen in the substantial changes to hospital treatments and the shifting burden of responsibility for health and ill-health care to individuals and communities. Rather, analysis is directed at understanding how such rationalities make possible reengineering or shifts in the local contexts of hospital care practices. (For complete abstract open document)

Made available in DSpace on 2014-06-11T19:35:04Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-12-09Bitstream added on 2014-06-13T19:05:12Z : No. of bitstreams: 1 000742564.pdf: 1610708 bytes, checksum: 9e35bf3556dfa63e8666272b879d535d (MD5) / A operacionalização da Sistematização da Assistência de Enfermagem (SAE) como metodologia assistencial, pautada no Processo de enfermagem como método científico está presente em forma de Lei do Exercício Profissional (Lei nº 7.498/86), regulamentada pelo Decreto nº 94.406/87 e no Código de Ética dos Profissionais de Enfermagem, devendo ser realizada pelo enfermeiro para garantir uma assistência de qualidade e livre de erros. Com a aplicabilidade do Processo de Enfermagem os enfermeiros se tornam responsáveis, envolvidos e comprometidos com a assistência de enfermagem, demonstram e aprimoram conhecimento técnico científico, tem visão holística do paciente e criam elo de mútuo respeito e confiabilidade. O presente estudo teve como objetivo conhecer e compreender as percepções do Enfermeiro Supervisor Técnico de Unidade de Internação quanto à realização diária do Processo de Enfermagem na sua rotina profissional, em um hospital público universitário do interior de São Paulo. A trajetória metodológica adotada foi a vertente da fenomenologia, buscando desvelar o fenômeno, ou seja, buscar a essência, o significado da realidade vivenciada pelos sujeitos do estudo, visando a sua compreensão, o que permitiu o estudo de aspectos subjetivos e abordagem qualitativa. A região de inquérito ou perplexidade da presente pesquisa foi constituída pela situação vivenciada pelos enfermeiros e sua percepção sobre a aplicabilidade do Processo de Enfermagem, na sua rotina diária de trabalho. Os sujeitos da pesquisa foram definidos no decorrer do estudo, perfazendo nove depoimentos suficientes para desvelar a essência do fenômeno pesquisado. Todos respondiam pela mesma função, tanto na parte administrativa quanto assistencial, no contexto hospitalar, estavam vinculados a mesma Diretoria Técnica de Serviço, com mais de três anos no cargo, vivenciaram a fase do antes e após implantação... / The implementation of Nursing Process as an assistance methodology is a scientific method presents in the Professional Practice Law (Law No. 7.498/86), regulated by Decree No. 94.406/87 and Code Ethics of Professional Nursing. The Nursing Process should be performed by nurses to ensure quality of care. With the applicability of the Nursing Process, nurses become responsible, engaged and committed to nursing, and enhance technical and scientific knowledge, leading to a holistic view of the patient, creating a mutual bond of respect and reliability. The aim of this study was to identify and understand the perceptions of the Nurse Supervisor Technician from inpatient units, regard the daily realization of the Nursing Process in their professional routine, in a public university hospital in São Paulo. The methodology adopted was the phenomenology and qualitative approach, seeking to uncover the phenomenon, i.e., seeking the essence, the meaning of the reality experienced by subjects in order to understand it, which allowed the study of subjective aspects. The area of inquiry of this research was composed by the situation experienced by nurses and their perception of the suit ability of the Nursing Process in their daily work routine. The subjects were defined during the study, resulting in nine statements sufficient to extract the essence of the studied phenomenon. All nurses enrolled in this study, experienced the stage before and after implantation of this method, and assumed the same management and care activities and they were linked hierarchically to the same Board of Technical Service. All subjects answered the same research question. For the analysis of the statements collected, they were transcribed seeking the meaning of the essence, expression of meanings thematizing and interpreting the discourse, seeking convergence, divergence and idiosyncrasies of the meaning units and the synthesis units ...

INTRODUCTION: While transitions of care (TOC) programs are known to decrease readmissions for heart failure (HF), significant policy and resource challenges inhibit the implementation of hospital based TOC programs, thus novel models of TOC are urgently needed. The purpose of this study is to evaluate the need and readiness of a private practice based TOC program led by DNP-prepared nurse practitioners. METHODS: In this descriptive study, cardiology providers from a private practice in the Southwest (N=14) participated in a survey on HF TOC. The practice’s electronic medical records (EMR) database was queried for patient demographic data along with other HF measures (N=3175). RESULTS: There were 1,827 females (57.5%) and 1,348 males (42.5%) with the mean age being 75.1 years +/-11.1. The 70-79 year age bracket represented 41.0% of all HF patients. The most common ICD-10 code for HF was [I50.32] Chronic Diastolic Congestive Heart Failure (N=986), which translates into 31.0% of the total HF population. Almost 30% of the providers (N=4) acknowledge that they never document their HF readmissions in the practice’s EMR. Nearly 65% percent of respondents “strongly agree,” that HF patients discharged from the hospital require a specific plan of care, while 86% of providers (N=12) either “somewhat agree” to “strongly agree” in the need for a TOC program for HF patients within their cardiology practice. Over 71% (N=10) of the providers “strongly agree” with a DNP-led TOC program for HF. CONCLUSION: This study provides encouraging results for the future implementation of a cutting edge private cardiology practice based TOC program for HF in Tucson, AZ. The study results clearly indicate the need and readiness for the Tucson-based private practice TOC program for HF. The DNP prepared nurse practitioner is thoroughly prepared to take the lead in designing, implementing and evaluating such a program and this unique role was supported by the practice. Importantly, the results of this study may provide the foundation for future studies examining the effects of private practice based TOC programs for HF.

M.Cur. (Intensive General Nursing) / Tegnological and scientific progress inevitable. The nurse working in a present, had to obtain the knowledge and to work in her area of specialization. makes specialization specialized unit at skill that she needed It is expected of a general nurse, working in a postacute care unit, to co-ordinate, implement, interpret and evaluate the different and divergent aspects of terapeutic care prescribed by a specialist. The nurse as generalist needs the additio~al support of a Clinical Nurse Specialist with advanced knowledge and nursing skills. The Clinical Nurse Specialist must be able to assist the general nurse in giving effective and quality nursing care. A exploratory and descriptive survey was undertaken by means of a interview, questionnaires and a patient acuity classification system. Data was obtained from Senior Nursing Service Managers, Nursing Service Managers, Chief Professional Nurses, senior and junior registered nurses. The purpose of the study was to determine the desirability of and functions of a Clinical Nurse Specialist in a postacute care unit. Analysis of the data obtained indicated that there is a need for. a Clinical Nurse Specialist to assist with specialized nursing care and to assure continuity of care when a patient is moved from a critical care unit to a postacute care unit.

Magister Curationis - MCur / Clinical research nurses are at the frontline of clinical research. They act as nurse leaders in the area of patient-orientated research. This leadership role requires that they work independently with limited support from other nurses. The nursing practice of clinical research nurses’ associates patient care with research protocols, administration duties, management responsibilities, and role specific authority. At hospitals in the Western Cape, clinical research nurses support principal investigators in the conducting of clinical research. It was unclear how clinical research nurses in nursing units in southern suburbs, Cape Town, Western Cape Province experienced their self-leadership role in nursing practice. The aim of the study was to explore and describe the experiences of clinical research nurses’ self- leadership role in nursing practice in nursing units in the southern suburbs of Cape Town, Western Cape. In this study; a phenomenological, exploratory, descriptive, and contextual design was followed. The population consisted of all the clinical research nurses (n = 22) at Western Cape hospitals and health care institutions in the southern suburbs. Purposive sampling was applied according to selection criteria. Unstructured individual interviews were conducted until data saturation occurred. These interviews took place at a private office in the southern suburbs of the Cape Town and lasted between 45 minutes and an hour. Observation and field notes were taken during the interviews. Data was analysed by using open coding and data triangulation. The researcher applied Lincoln and Guba’s (1985) model of trustworthiness. Four themes and twenty one categories emerged from the data analysis. The findings emphasised that the clinical research nurses’ experienced their self-leadership role in nursing as an evolutionary process. The evolutionary role required that they needed to develop strategies with the aim of surviving the initial tedious and daunting phase that facilitated the development of skills needed for collaborative partnerships with stakeholders. As her general confidence increased, the clinical research nurse would be able to recognise her professional attributes and use self-leadership behaviour to enhance her daily practice. Appropriate self-leadership behaviour would assist the clinical research nurse to successfully navigate the complex, dynamic clinical research environment. Guidelines were developed from the four themes that were the result of the data analysis; namely the initial tedious and daunting phase, working in pursuit of collaborative action, personal traits of the clinical research nurse, and self-leadership behaviour. The UWC Higher Degree Committee at the Faculty of Community and Health Sciences and the Senate Research Committee respectively approved this research project. No risks were anticipated for participants in the study.

MCur / Department of Advanced Nursing Science / Professional nurses have the responsibility of supervising the care that is rendered, the nursing personnel and patients throughout 24 hours of the day, for the purpose of ensuring quality patient care and patient safety. However, it seems that this is not happening as expected because there are continuous complaints from the patients about the poor quality of care. This study was aimed at exploring the challenges that are encountered by professional nurses during supervision of care in the district hospitals of Vhembe. A qualitative study was conducted which was explorative, descriptive, contextual and guided by an Appreciative inquiry approach. A purposive sample was used where thirty-six (36) participants were recruited and consent was obtained. Individual semi structured interviews were conducted. Data was analysed according to Tesch‟s eight steps. Trustworthiness was ensured through following the principles which are credibility, dependability, confirmability, transferability and authenticity. The findings revealed multiple challenges that professional nurses encountered during supervision of care. The main themes found were lack of resources, challenges related to the supervisees, cultural changes in nursing affecting supervision, and challenges related to education and training. Apart from challenges, there were positive aspects verbalised that enhance supervision The researcher recommended that nursing practice through the Department of Health should address issues such as shortage of staff, shortage of equipment and inadequate and/or poor infrastructure. Professional nurses should be trained on diversity management and emotional intelligence in order address the ever changing culture in nursing. Students‟ accompaniment and clinical exposure should be addressed. Future research should be conducted to outline what causes these challenges in supervision in other districts so that the findings could be representable. / NRF

Nurses make up a significant source of direct care for individuals, families, and communities. The problematic distribution of nurses and the potential to lose practicing nurses emphasizes the importance of retention and support of nursing professionals, especially in rural locations. One of the best ways to discover what is important to nurses is to ask and listen to the replies. The focus for this dissertation is the lived experience of registered nurses in a six-county area in three adjoining states in rural South Central Appalachia. The purpose of this study is to interpret and understand the lived experience of contemporary RN practice in rural Appalachia. The two aims of the study are to 1) understand the lived experience of contemporary nurses in rural Appalachia, and 2) understand the lived experience of nurses as they relate to the place of residence and the place of employment. The chapters include the research proposal and three manuscripts. Chapter 1 contains the background and significance. Chapter 2 is the literature review. Chapter 3 includes sampling and recruitment in rural areas. The findings are discussed in Chapter 4. Chapter 5 contains an integration of all manuscripts, discussion of the contribution to nursing science, direction for future research, and implications for nursing practice. Manuscripts are ready for submission and will be formatted per author guidelines prior to submitting. The first manuscript, “Perceptions of Nursing in Appalachia: A State of the Science Paper,” is a literature review. The manuscript reviews the literature surrounding nurses in Appalachia. It was published in the Journal of Transcultural Nursing in January, 2018 (Brewer, 2018). The second manuscript, “The Lived Experience of Nursing in Appalachia: Sampling and Recruitment,” examines the researcher’s experience with sampling and recruitment. The second manuscript will be submitted to the Online Journal of Rural Nursing and Health Care. The third manuscript, “Living and Working as a Nurse in Appalachia: A Phenomenological Study,” provides findings, implications, and future research. This paper describes findings and identifies themes of the data. The third manuscript is ready for publication to the Journal of Transcultural Nursing. The conclusion presents dissertation summary comments.

No / Nursing Lecturer, Catherine Kelsey, reflects on developing her Celebrating Nursing Practice project.

The objective of this study was to describe the lived experience of caring for persons who had a peaceful death in the intensive care units in Thailand. A qualitative research design informed by hermeneutic phenomenology was used to analyze data. Participants were 10 intensive care nurses working at adult intensive care units in south Thailand. A snowball purposive sampling method was used to select the participants. Participant inclusion criteria were at least six months' critical care nursing experience, experience in caring for a person who had peaceful death, able to describe peaceful death, and willing to participate in this study. Participants who met the inclusion criteria were interviewed. Face-to-face individual verbal interviews were conducted in the Thai language. These interviews were audiotape recorded. Descriptions were transcribed and translated for data analysis. Van Manen's (1990) hermeneutic phenomenological approach was used to analyze and interpret the data. The findings of this study were presented in each of 4 categories of the lived world of temporality, of spatiality, of corporeality, and of relationality. The description of the lived experience of caring for persons who had a peaceful death in ICU was, "understanding the other through the valuing of experience and enhancing relations with others by recognizing time is short and is a priority." This study may contribute to nursing knowledge of the end-of-life care to enhance a peaceful death in intensive care units congruently with Thai culture and society. In addition, this study directs the translations of its knowledge into implications that will benefit in helping Thai nursing to move forward. The implications of this study in advance will benefit terminally ill persons and family members regarding receiving good quality end-of-life care. / by Waraporn Kongsuwan. / Thesis (Ph.D.)--Florida Atlantic University, 2009. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2009. Mode of access: World Wide Web.

A qualitative, grounded theory study was undertaken to explore and describe how nurses conceptualise spiritual nursing care, and how they integrate spiritual nursing care in practice. An in-depth literature review through concept analysis on the phenomenon was conducted to assist the researcher with theoretical sensitivity and theoretical saturation. In-depth Individual interviews and focus group interviews were conducted to generate data. Interviews were audio-taped and transcribed by the researcher verbatim. Symbolic Interactionism was the philosophical base for the study. Data analysis was done through the use of the NUD*Ist computer soft ware programme version 4.0. The direct quotes of participants were coded and arranged into meaning units for analysis. A constant comparison method of data analysis was applied by following a process of open, axial and selective coding. Tech’s (1990:142-145) eight steps of analysis to analyse textual qualitative data was used until themes, categories and subcategories were identified and developed. Data analysis revealed that nurses had difficulty to differentiate spiritual nursing care from emotional, psychological or religious care. Nurses still felt inadequately prepared educationally on how to integrate spiritual nursing care in nursing practice. A Humane Care Model and practice guidelines were developed to guide nurses in clinical practice on how to provide such care. Recommendations proposed that the matter be taken up by nurse managers, educators and nurse clinicians to guide nurses in this regard. / Health Studies / D. Litt. et Phil. (Health Studies)