In contemporary Western nursing, the notion of health is considered a basic concept in all nursing theory, yet the many nursing theorists have failed to express unanimity in their various descriptions of health. This situation exists even while the achievement of health is generally identified as the goal or purpose of nursing. In Australia, the requirement that nurses become health-promoting practitioners assumes that nurses understand health in positive ways, which can be translated into nursing practice. Given the myriad definitions of health, confusion among nurses about the nature of health as it is to be promoted appeared possible, even probable.This phenomenological research aimed to illuminate the nature of nurses' understandings of health and the ways such understandings are translated into nursing practice. The purpose of the study was to describe and interpret nurses' experiences of health, and their experiences of giving health care to someone in their care, in order to illuminate the nature of health for nurses and in nursing.The manner in which this research was carried out was informed by the human science approach to phenomenology described by van Manen, which is derived from the traditions of Husserl, Heidegger and Merleau-Ponty. Thus, the inquiry was grounded in the hermeneutic phenomenological philosophical perspective, which began with the work of Husserl who recognised the need to return to the grounding of truths in human experience. The thesis is informed by two views of phenomenology. The first involves the traditional approach to phenomenology advocated by the European phenomenological philosophers while the second approach is referred to by Silverman as arising from 'American continental' philosophy.Data were generated from multiple audiotaped interviews with each of nine participants, and from personal reflection and journalling undertaken ++ / by the researcher during the research process. The dual data analyses were guided by the phenomenological approach of van Manen and by that of various nursing scholars who have used phenomenological methodology as it has evolved from American continental philosophy. These analyses included several levels of reflection undertaken by the researcher and each of the participants in the study to illustrate the nature of health in nurses' lives and in nursing.The nature of health, as revealed through the original experience of the participants, was disclosed as manifest in the lives of the participants with most descriptions conveying a sense of contentment that showed as feelings of happiness, feeling alive, complete, energised and optimistic. Health also revealed itself as transient in nature, passing quickly and without notice into and out of the lives of most of the participants. Although obvious in some ways, health simultaneously eluded clear description and, even at the completion of the exploration with each participant, was characterised by an atmosphere of elusiveness. For all the participants, health was an embodied phenomenon with a common element of energy and a sense of wellbeing. These, together with a sense that life was manageable and achievable gave to it a distinctive spirit, even while the spirit simultaneously helped to make life manageable and achievable and thus contributed to health. For all of those who participated, health presented as having the ability to transform their emotional responses to daily life events in such a way that it made those events more acceptable and the tasks of life more achievable.Although health showed as a physical, embodied state which was expressed as vitality and energy, it could not be separated from the mental / emotional state. As it was described, the following leitmotifs of health were lexically revealed: Health: ++ / A different encounter for each person, Health described as peace, Health described as feeling good about oneself, Health described as balance, Health as energy, Health as vitality and zest, Health described as happiness and/or contentment, Health described as quality of life, The 'picture of health', Health described as dignity, and Health as the unknown or the inexpressible.The nature of health-focused care in nursing showed as caring, rapport building and support, ever dependent on the social relationship that develops between each nurse-carer and the individual to whom they offer care. However, clear relationships between the meanings of health for the nurses in the study and the way they gave health care could not be elucidated. These relationships have not been identified because of the individualistic nature of health-focused care as these nurses have described it. For this reason, this research makes a strong plea for continued dialogue about the relationships between health and health-focused care in nursing.

Nursing in the contemporary Australian healthcare system, particularly in speciality areas, is acknowledged as a highly stressful and difficult undertaking. A range of factors has contributed to this situation including changes in staffing levels, patient acuity, resourcing of the healthcare system and nurse recruitment and retention. A number of studies on the intensive care environment have identified factors that cause stress and role strain in nurses. Other research has explored the coping mechanisms these nurses implement to manage work stresses. To date, no Australian studies have sought to provide an encompassing explanation of why and how nurses choose to remain working in this challenging area of practice. This study seeks to develop one possible explanation for this phenomenon. Grounded theory was selected as the most appropriate means of achieving this aim. It explores behavioural patterns and how these develop into interactive social processes. Grounded theory investigates and reveals how people manage problematic life situations, enabling emergence of a substantive theory, which is grounded in context and situation dependent research data. This research study was undertaken in three intensive care units in one area health service in New South Wales. The constant comparative analysis method was used, revealing that nursing in the intensive care environment is a stimulating, challenging experience, which at times is also frustrating and demoralising. The emergent substantive theory was titled “Traversing the path of the intensive care nursing experience”. This study achieves two objectives. It adds to the accumulated knowledge base related to intensive care nursing by offering an explanation of why and how these specialist nurses remain practising at the bedside. It substantiates the results from previous research that investigated stressors and stress management in nursing within the intensive care environment. There are a number of implications for nursing education, research and practice that can be drawn from this study. Impacting on all levels of nursing, these include the development of effective stress management, interpersonal communication techniques, recognition of competence and its assessment, and conflict mediation and management. Further research is needed into understanding nurses’ self-concept and the effect of the working environment on the delivery of effective nursing practice. / Master of Science (Hons.)

Background : - The past two decades has seen an increasing emphasis placed on basing health care on the best available evidence. However, existing research has come under increasing scrutiny, which suggests its quality was often poor. This problem has been exacerbated by the ever increasing volume of health care literature. To address these difficulties systematic reviews have emerged as one of the most important ways by which research is summarised and communicated to its end-users. However, as these reviews have been primarily concerned with effectiveness, they have focused almost exclusively on randomised controlled trials. As a result, systematic reviews have excluded much of the research of nurses. Purpose : - The purpose of this study was to develop a process to systematically collect, appraise, summarise and synthesise the findings of a range of different types of research. Conceptual Framework : - To aid in the development of these expanded review methods, a conceptual framework was developed that addressed effectiveness, appropriateness and feasibility. Method : - A search of the literature was undertaken to identify published reviews of different types of research, and discussions in the health care literature related to the conduct of research reviews. These reviews and discussion papers served as the basis for developing the expanded review methods. Evaluation : - To evaluate the expanded review methods, two systematic reviews were conducted. The protocol and results of the first review on the use of music in hospitals are presented to demonstrate how the conceptual framework and expanded review methods enabled a broader evaluation of the topic. Selected results from the second review on the use of physical restraint are presented to demonstrate how the findings from a number of methodologically different types of research were incorporated into a systematic review. Conclusion : - The conduct of the two systematic reviews clearly demonstrated that the proposed expanded review process was able to rigorously collect and summarise a range of different types of research. Additionally, the conceptual framework underpinning these reviews enabled each of the studies to be located logically and coherently during the synthesis of data. / Thesis (Ph.D.)--Department of Clinical Nursing, 2001.

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Background/Objectives: Compassion fatigue (CF) is severe emotional and physical exhaustion resulting from unresolved burnout and/or secondary traumatic stress. Prevalent in registered nurses and physicians, CF negatively impacts both the caregiver and the care provided and is associated with job attrition. There is no direct measure for CF. Risk is assigned according to the intensity of each constituent part and the relationships between these parts. The purpose of this practice inquiry was to describe the risk for CF among doctor of nursing practice (DNP) students seeking nurse practitioner certification, a previously unstudied and potentially at-risk population. Design: A descriptive study was performed to describe: 1) the prevalence of compassion satisfaction; 2) the prevalence of burnout; 3) the prevalence of secondary traumatic stress; 4) the prevalence of risk profiles developed by Stamm (2010); and 5) the relationship between demographic characteristics and CF risk profiles in a sample of DNP students. Setting: The University of Arizona, College of Nursing between August 24, 2013 and November 19, 2013. Participants: 59 graduate nursing students seeking nurse practitioner certification and a DNP degree self-selected to participate in the study. Measurements: The Professional Quality of Life Scale-5 (ProQOL 5) was utilized to measure the components of CF: compassion satisfaction, burnout, and secondary traumatic stress. Patient demographics included: gender, age, years in nursing, nursing specialty, and employment status. Results: The DNP student population appears to be at-risk for CF, with 69% of the sample falling outside of the "low risk" CF profile. Stamm's (2010) five risk profiles were expanded to assign a level of risk to the 63% of participants who did not land in an existing profile. There were no statistically significant relationships between demographic variables and the expanded CF risk profiles, consistent with previous studies on the individual ProQOL components. A weak trend of increasing CF risk with years of nursing practice suggests that accumulated exposure to suffering increases CF risk. However, a small sample size and self-normalization in the ProQOL 5 limit the generalizability of the findings. Conclusion: DNP students are an at-risk population; therefore, we recommend incorporation of CF awareness and risk reduction into the DNP curriculum. Applicability of the ProQOL 5 test is hindered by scoring inconsistencies and self-normalization bias and we propose solutions. We additionally propose the concept of a single numeric index to quantify individual CF risk. Use of a single continuous variable pertaining to CF risk is likely to be crucial for future characterization, screening, and interventions.

Despite the acceptance of best practice as a standard for quality health care delivery, the exact nature of what constitutes best practice does not share universal definition or application. The purpose of this dissertation is to propose an integrative conceptual representation of nursing best practice from the philosophical perspective of complexity science.A five-step concept clarification approach was used to identify the concept, systematize observations and descriptions, develop an operational definition, construct a model, and formulate hypotheses. An expert panel explored preliminary validity of the definition and model.Purposive recruitment of clinicians and scholars was conducted for expert panel membership. The expert panel rated the strength of the model dimensions of adequacy, representative-ness, consistency, clarity, simplicity, generalness, accessibility, importance, and relevance, as well as interest in development and application. Narrative data from open-ended questions was incorporated into model refinement.Clinician properties and context properties emerged as two principle domains of interdependent influence. Key dynamic processes included critical thinking by which clinicians operationalize properties into practice choices, and informative reflection by which the organization monitors and improves performance through information flow and learning. All aspects of the conceptual model, with the exception of consistency of relationships, were ultimately rated as strengths by the expert panel. Relationships among constructs were identified as complex, diverse, and difficult to isolate. Expert perception was that clinician and context properties most likely equally influence nursing best practice, but that context properties may have greater influence than clinician properties over time.This model incorporates a full range of interdependence across clinician and context domains of influence. This model requires further operationalization of constructs prior to formal validity testing. The application of complexity science introduces challenges to research and measurement in the study of complex adaptive systems. The model presented in this dissertation provides a perspective from which a better understanding of health care system interdependencies may arise.

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Bibliography: leaves 226-236. / xiii, 236 leaves, 1 leaf of plate : [1] col ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / A study which examines the healing experiences of a group of people from a Victorian Community devastated by the 1983 Ash Wednesday bushfire. Using a theoretical framework of constructionism the study identifies amongst those interviewed an 'ecological postmodern cosmology.' This is used to formulate ideas about how this cosmology could inform nurses' work enabling them to create an environment of care and compassion. / Thesis (Ph.D.)--University of Adelaide, Dept. of Clinical Nursing, 1996

Este estudo focaliza como o enfermeiro está sendo formado para atuar na area de hanseníase e como se configura a realidade concreta de sua prática nos serviços públicos de saúde junto ao programa de controle da endemia. Partiu-se do referencial teórico sobre a questão da saúde no Brasil, com enfoque histórico-social da mesma, sem perder de vista o componente biológico do processo saúde-doença. Fez-se uma análise do sistema de saúde vigente com ênfase na política atual, e a inserção do Programa de Controle da Hanseníase nesse contexto. Buscou-se, ainda, registrar a situação epidemiológica da hanseníase, caracterizando-a como um problema de saúde pública. A formação do enfermeiro foi verificada junto aos docentes responsáveis pelo ensino da hanseníase em 66,60% dos Cursos de Graduação em Enfermagem do Estado de São Paulo. As informações sobre o desenvolvimento de sua prática na área de hanseníase foram obtidas através dos próprios enfermeiros nas unidades ambulatoriais da rede de serviços públicos do Estado; utilizou-se um formulário próprio para o levantamento de dados que ocorreu durante o primeiro semestre de 1989. Os resultados obtidos apontam para uma deficiência no ensino da hanseníase, sendo necessário dar maior importância ao tema, através de uma reformulação do mesmo nos currículos dos Cursos de Graduação em Enfermagem. Foram identificadas como sendo papel do enfermeiro em hanseníase as seguintes funções: educação em saúde, assistência de enfermagem, administração de serviços e vigilância epidemiológica. A prevenção de incapacidade foi a atividade que apresentou a maior freqüência de respostas nas questões relacionadas ao ensino assim como naquelas vinculadas ao papel do enfermeiro no programa de controle da hanseníase. / This study is about how the nurses has been trained to work with hanseniasis and how the concrete reality of that practice is related to the public health services within the control program of that endemic disease. A social historical approach of the health issues in Brazil, has been used as a theoretical framework, without loosing the biological component of the health-sickness process. The present health system has been analysed emphasizing the political system in course, and the insertion of a Hanseniasis Program in the context. The epidemiological situation of Hansen\'s disease was also registered, been characterized as a public health problem. The nurse\'s training was verified in 66,60% graduation nursing training schools of the state of São Paulo, together with the lecturers responsable for the teaching of hanseniasis subjects. The informations about the development of the practice in this field was obtained from nurses working in the outpatients clinics of the public health system of the state. Data was collected during the first semester of 1989, with a specific formulary. The results obtained showed a poor Hansen\'s disease education, being necessary an emphasis on the subject, through a curriculum reformulation. The following functions have been identified as being the nurse\'s role in hanseniasis: health education, nursing assistance, administration services and epidemiological control. The prevention of disabilities was the activity that appeared with a higher frequency in the answers to questions related to teaching as well as those related to the nursing role in the Hansen\'s Disease Control Program.