M.Cur. / The aim of the intensive care nurse is to give quality nursing to the critically ill surgical patient within the context of the family, as set out in her scope of practice. Various factors, however, affect the intensive care nurse's actions so that she does not achieve the aim. The persons close to the critically ill patient and the intensive care nurse form part of the patient's social external environment. Both of them are therefore important when facilitating health in the critically ill patient. The aim of this study is to explore and describe the experience of mutual interaction between the person close to the critically ill patient and the intensive care nurse and subsequently to create guidelines with regard to the intensive care nurse's handling of the person close to the critically ill patient during the patient's stay in an intensive care unit. The study is done by means of an exploratory, descriptive and contextual design by using the phenomenological method of interviewing. The participants were selected by purposive sampling according to selection criteria and represent various cultures. Nine persons close to the critically ill patient and six intensive care nurses comprised the participating population.

M.Cur. (Psychiatric nursing) / Withdrawal of life-support treatment is a well-known concept which has been studied often, especially from a medical point of view. The life-world of families involved in decision making concerning withdrawal of life-support of a family member is, however, an unknown field. This leads to the reaction and behavior of families to this traumatic process often begin mistakenly described by professionals as "difficult" , "passive" or "incapable of decision making". The patient and his/her family have, to a large extent, the right of self-determination and the right to take part in decision making. In the intensive care unit it often happens, according to Burger (1996:1-175), that the patient is not able to participate actively in the decision making process because of his/her illness and/or medication. The family then steps forward as decision maker and as the patient's "mouthpiece". The situation arises where the family, who must make the decision about withdrawal of life support treatment, are exposed to utterly moral conflict. Burger (1996:163) found that a family that experiences such trauma is not capable of focusing and assimilating knowledge. Members of the family have a great need for support and the intensive care nurse cannot provide that support for different reasons. One of the reasons being limited time and the other not being able to build therapeutic relationships. Because of the above mentioned, the overall objective of this study is to analyse the phenomenon of families who are involved in decision making concerning withdrawal of life-support treatment of a family member. Guidelines have been formulated according to the analysis of this phenomenon for the psychiatric nurse specialist to mobilise resources for the family to promote, maintain and restore their mental health as integral part of health. The research model of Botes (1989:1-283) is used in this study. The study is undertaken from the Judeo-Christian perspective of Nursing for the Whole Person Theory (Oral Roberts University, Anna Vaughn School of Nursing, 1990:136-142). A phenomenon analysis was undertaken in two phases. During the first phase, secondary analysis of primary data was done on the family used in Burger (1996:1-175) and was followed up by phenomenological interviews with families in the same circumstances and according to the same criteria that Burger (1996:1-175) used in her study. Data were analysed in collaboration with an independent coder. The family used for member checking in this study was also used in data control. A literature control was conducted as part of data control. On the ground of the repetitive themes from the secondary analysis and phenomenological interviews with the family involved in member checking, guidelines were formulated in phase two, based on all the data obtained from phase one, for psychiatric nursing specialists to mobilise resources for families in this situation. The proposed guidelines leave the door open for follow-up research where a model for assistance can be formulated for psychiatric nursing specialists to assist these families, since intensive care personnel are either too involved in the process, or do not always know how to build therapeutic relationships and usually also do not have enough time to attend to the patient's family.

No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / National calls for a better-educated nursing workforce are proliferating. The Institute of Medicine (IOM) challenged the nursing profession by setting the goal of having 80% of the nation's nurses prepared at the baccalaureate level (BSN) or higher by 2020. This is an ambitious goal given that, nationally, only 50% of nurses have a BSN. In fact, only 40% of nurses in Michigan have a BSN, and in the rural North-Central Region of this state, only 29% (the lowest in the state) of the nurses have a BSN. The purpose of this hermeneutic phenomenological study was to understand and interpret the meaning of being an associate degree (AD) nurse, the meaning attaining a BSN has for rural registered nurses who currently have an AD, and the barriers they experience that inform their decisions to return to school (or not). The investigator interviewed 11 AD nurses from rural North-Central Michigan and analyzed interview transcripts to identify common experiences and shared meanings using methods identified by Diekelmann, Allen, and Tanner (1989). Two themes were explicated in this study: "Getting in and Getting out" and "What Difference Does it Make?" The findings in this study challenge many of the common assumptions about academic progression in nursing and provide educators, administrators, and legislators with insight about the strategies that may be most helpful for achieving the IOM goal in rural Michigan.

Indiana University-Purdue University Indianapolis (IUPUI) / Parents have increasingly participated in their children’s bedside care. Parental participation has led to more provider-parent interactions and communication during such stressful events. Helping parents through such stressful events requires nurses to be skilled communicators. Brief methods of training emotion-focused communication with newly licensed nurses are needed, but as yet are rare. The purpose of this study was to evaluate the impact of a validated brief communication (Four Habits Model) training program for newly licensed pediatric nurses. The intervention focused on ways to improve nurses’ emotion-focused conversations with parents. Information processing and Benner’s novice to expert informed this study. The intervention is based on the four habits model, with “habits” providing a structure for nurses to organize their thinking and behavior during emotion-focused conversations with parents. Thirty-five pediatric nurses with 0–24 months of nursing experience at a large mid-western children’s hospital participated in the study. Mixed methods provided data for this experimental study, using a group-by-trials repeated measures ANOVA design. Participants randomized to the intervention group participated in a one-hour three-part training: adapted four habits model content, simulated nurse-parent communication activity, and debrief. Participants randomized to the control group observed a one-hour travel video. Key outcome variables were Preparation, Communication Skills, Relationships, Confidence, Anxiety, and Total Preparation. Compared with the controls, the intervention group improved significantly in the following areas: Preparation, F(1,33) = 28.833, p < .001; Communication Skills, F(1,33) = 9.726, p = .004; Relationships, F(1,33) = 8.337, p = .007; Confidence, F(1,33) = 36.097, p < .001; and Total Preparation, F(1,33) = 47.610, p < .001. Nurses’ experience level had no effect, with the exception of Anxiety. Nurses with more experience (≥ 12 m) showed a greater reduction in Anxiety, when compared to nurses with less experience (< 12 m), F(1,31) = 5.733, p = .023. Fifty-two percent of the nurses involved in the intervention later reported specific examples of implementing the four habits when working with parents in clinical settings. A one-hour four habits communication-training program is effective in improving newly licensed nurses’ preparation for emotion-focused conversations with parents.

Simulation, in its many forms, has been a part of nursing education and practice for many years. The use of games, computer-assisted instruction, standardized patients, virtual reality, and low-fidelity to high-fidelity mannequins have appeared in the past 40 years, whereas anatomical models, partial task trainers, and role playing were used earlier. A historical examination of these many forms of simulation in nursing is presented, followed by a discussion of the roles of simulation in both nursing education and practice. A viewpoint concerning the future of simulation in nursing concludes this article.

The U.S. shortage of qualified nursing teachers and researchers is affecting national health care outcomes. Methods such as fast-tracking Baccalaureate nurses into graduate programs and embedding leadership development early into nursing curricula have been proposed to address faculty and research shortages. Early interest in nursing research careers increases likelihood of enrollment in graduate education. One way undergraduate nursing students may develop an interest in research careers is through a mentored apprenticeship with research-active faculty. In this thesis, the author uses an autoethnography methodology to examine the benefits that a mentored research apprenticeship model brought to her undergraduate experience. Her experience incorporated a variety of roles in an adolescent intervention program with Dr. Anne Norris (PI) at the University of Central Florida College of Nursing. Several themes about the experience were defined in the results. Early research exposure that socializes a student to the nursing research world may provide a means for addressing the nursing faculty shortage. This socialization can generate interest in a research career and promote undergraduate students with the essential tools and insights needed to pursue this career pathway. However, findings from this study suggest a student-mentor relationship early in the undergraduate education experience is essential.

Health Studies / D. Litt. et Phil. (Advanced Nursing Science)

Health Studies / D. Litt. et Phil. (Advanced Nursing Science)

Indiana University-Purdue University Indianapolis (IUPUI) / Gastric residual volume (GRV) is a clinical assessment to evaluate gastric emptying and enteral feeding tolerance. Factors such as the tube size, tube material, tube port configuration, placement of the tube in the gastric fluid, the amount of fluid and person completing the assessment may influence the accuracy of residual volume assessment. Little attention has been paid to assessing the accuracy of GRV measurement when the actual volume being aspirated is known, and no studies have compared the accuracy in obtaining RV using the three different techniques reported in the literature that are used to obtain aspirate in practice (syringe, suction, and gravity drainage). This in vitro study evaluated three different methods for aspirating feeding formula through two different tube sizes (10 Fr [small] and 18 Fr [large]), tube materials (polyvinyl chloride and polyurethane), using four levels of nursing experience (student, novice, experienced and expert) blinded to the five fixed fluid volumes of feeding formula in a simulated stomach, to determine if the RV can be accurately obtained. The study design consisted of a 3x2x2x4x5 completely randomized factorial ANOVA (with a total of 240 cells) and 479 RV assessments were made by the four nurse participants. All three methods (syringe, suction and gravity) used to aspirate RV did not perform substantially well in aspirating fluid, and on average, the methods were able to aspirate about 50% of the volume available. The syringe and suction techniques were comparable and produced higher proportions of RVs, although the interrater reliability of RV assessment was better with the syringe method. The gravity technique generally performed poorly. Overall, the polyvinyl chloride material and smaller tubes were associated with higher RV assessments. RV assessment is a variable assessment and the three methods did not perform well in this in vitro study. These findings should be further explored and confirmed using larger samples. This knowledge will be important in establishing the best technique for assessing RV to maximize EN delivery in practice and will contribute to future research to test strategies to optimize EN intake in critically ill patients.