Several issues have impacted on district nursing practice and education within the UK, which can be conceptualised within four main areas: national policy; local organisational structures and practice; professional and disciplinary theory; and practice of individuals (Bergen and While 2005). However, there has been a lack of direction in district nursing in recent years within the UK, with a decline in the number of district nurses being educated (Queen’s Nursing Institute 2014a) and the educational standards supporting district nurse education being over 20 years out of date (Nursing and Midwifery Council 2001). In addition to this, the standards of education for pre-registration nursing (Nursing and Midwifery Council 2010) have supported a graduate workforce with an increasing focus on nursing in the community. This was identified as a consideration for me as an educator when examining the future educational requirements of nurses beyond the point of registration in the community, and became the focus of this study. Knowing in practice is a key concept within this thesis, that is, the particular awareness that underpins the being and doing of a district nurse in practice (Chinn and Kramer 2008). This study explores the unique knowing of district nursing in practice, and how this professional knowing is developed. Understanding the knowing of district nurses and how this is developed will contribute to future educational frameworks and ways of supporting professional development within community nursing practice. A question that is often asked is what makes district nurse knowing different from nursing in inpatient settings, and this emerges in this thesis. A qualitative study using an interpretative approach within a case study design was adopted using three Health Boards within Scotland as the cases. Within each Health Board area, interviews were undertaken with key informants and also, group interviews with district nurses were undertaken using photo elicitation as a focussing exercise. The data were analysed using framework analysis (Spencer et al. 2003). This approach illuminated a depth and breadth of knowing in district nurse practice and how this knowing is developed. The study findings depict the complexity of knowing in district nursing, acknowledging the advancing role of district nursing practice, where the context of care is an essential consideration. The unique knowing can be described as a landscape that the district nurse must travel: crossing a variety of socio-economic areas; entering the private space of individuals, and the public space of communities; as well as acknowledging professional practice; navigating the policy agenda while maintaining clinical person-centred care; and leading others across the terrain of interprofessional working. The unique knowing in practice that characterises the expertise of district nurses is a matrix of elements that incorporates different aspects of knowing that contribute to leadership, as suggested by Jackson et al. (2009). The participants in this study recognised that due to the complexity of the district nurse role, and its continuing advancements, that district nurse education needs to move to a Master's level preparation and it needs to continue to be supported by a suitably qualified practice teacher. Furthermore, the findings within this study demonstrate that the development of the unique knowing in district nurses does not happen in isolation and it is very complex. It consists of networks, conversations, engagement with policy, understanding of professional contexts, adhering to organisational boundaries, and interaction with complex and challenging situations. Theory and practice are mutually dependent on each other; change is inevitable and is unpredictable; and practices change by having experiences, therefore change is integral to practice. Consequently, it was concluded that the interdependent elements, which interact, develop the unique knowing of district nurses in practice. Finally this thesis makes recommendations and discusses future implications for policy, practice and research.

Estudo exploratório, retrospectivo, de natureza quantitativa, desenvolvido com o objetivo de analisar o tempo utilizado pela equipe de enfermagem para assistir aos pacientes internados na Unidade de Terapia Intensiva Adulto (UTIA) do Hospital Universitário da Universidade de São Paulo (HU-USP), bem como verificar sua correlação com os indicadores de qualidade assistencial. O período de análise foi 01 de janeiro de 2008 a 31 de dezembro de 2009. Os dados foram coletados dos instrumentos de gestão utilizados pela chefia de enfermagem da Unidade. A análise do tempo médio de assistência despensado em relação ao tempo médio de assistência requerido pelos pacientes foi efetuada por meio do teste estatístico t pareado. Para verificar a correlação do tempo médio de cuidado despensado aos pacientes da UTIA com o indicador de qualidade incidência de perda de cateter venoso central foi utilizado o coeficiente de correlação de Sperman, enquanto que para os demais indicadores foi utilizado o coeficiente de correlação de Pearson. O tempo médio de assistência de enfermagem despensado aos pacientes, no período analisado, correspondeu a 14 horas, das quais 31% foram ministradas por enfermeiros e 69% por técnicos/auxiliares de enfermagem. Os pacientes internados requereram cerca de 16 horas de cuidados. A aplicação do teste estatístico demonstrou que as diferenças encontradas, entre as horas de assistência despensadas pela equipe de enfermagem e aquelas requeridas pelos pacientes, foi significativa (p< 0,001), sugerindo sobrecarga de trabalho aos profissionais de enfermagem da UTIA. A análise correlacional entre o tempo de assistência de enfermagem despensado por enfermeiros e o indicador de qualidade incidência de extubação acidental, evidenciou coeficiente de correlação de Pearson de (r = - 0,454), com p valor de 0,026, indicando linearidade negativa entre as variáveis, o que permitiu inferir que a incidência de extubação acidental diminui à medida que aumenta o tempo de assistência de enfermagem despensado por enfermeiros. Os resultados encontrados permitiram verificar que as horas médias de assistência de enfermagem despensadas aos pacientes da UTIA foram inferiores às preconizadas pelos órgãos oficiais brasileiros. O tempo médio de assistência requerido pelos pacientes internados, nessa Unidade, foi superior ao preconizado pela ANVISA e inferior ao estabelecido pela Resolução COFEN n°293/04. Esse dado indica que a avaliação do quantitativo de pessoal de enfermagem nas UTIs requer o conhecimento prévio das demandas assistenciais dos usuários e não apenas a utilização dos parâmetros indicados pelos órgãos oficiais, uma vez que esse procedimento pode ocasionar um super ou sub-dimensionamento de profissionais de enfermagem. Os resultados desta investigação demonstram a influência do tempo de assistência de enfermagem, provido por enfermeiros, no resultado do cuidado ministrado aos pacientes assistidos na UTIA. As limitações da presente investigação, ou seja, o fato de ter sido realizada em apenas uma Unidade de uma única Instituição, trazem restrições para a sua generalização. Assim, considera-se necessário o desenvolvimento de novas pesquisas que contribuam para a validação desse achado, no contexto nacional. O acúmulo de evidências pode contribuir para comprovar o impacto das horas de assistência de enfermagem nos resultados assistenciais e na segurança dos pacientes. / The objective of this exploratory, retrospective, quantitative study was to analyze the time spent by the nursing staff to assist patients in Adult Intensive Care Unit (AICU) of the University Hospital, University of São Paulo (UH-USP) and verify its correlation with quality care indicators. This research started on January 1st, 2008 until December 31st, 2009. Data were collected from the administration tools used by the head nursing staff of the unit. Analysis of the average length of time in relation to the average length of time required by patients was performed using the Paired t-test. The Spearman\'s correlation coefficient was used to verify the correlation of the average length of care time given to patients of the AICU with the quality indicator incidence of loss during central venous catheter insertion while for the other indicators the Pearson correlation coefficient was applied. The average length of time regarding assistance to patients, in the analyzed period, accounted for 14 hours, of which 31% were performed by nurses and 69% for technicians / nursing assistants. The hospitalized patients required approximately 16 hours of care. The application of statistical test showed that the differences found between the hours of assistance given by the nursing staff and those required by patients was significant (p < 0.001), suggestive of the heavy workload for the nurses in the AICU. The correlational analysis between length of time of nursing care given by nurses and the quality indicator incidence of accidental extubation evidence the Pearsons correlation coefficient (r = - 0.454), with p value of 0.026, indicating negative linearity between variables, which allowed us to infer that the incidence of accidental extubation decreases with increasing nursing care time given by nurses. The results revealed that the average hours of nursing care to patients of AICU were lower than those recommended by the official Brazilian Agencies. The average time of care required by patients hospitalized in this unit was higher than that recommended by ANVISA and lower than that established by COFEN Resolution Nr. 293/04. It indicates that the quantitative assessment of nursing staff in ICUs requires prior knowledge of the user´s health care demands and not only the use of parameters indicated by official agencies, since this procedure may cause an over-or under-dimensioning of nursing professionals. The results of this study showed the influence of nursing care time provided by nurses in the outcome of care given to patients assisted in the AICU. The limitations that needs to be addressed regarding the present study is the fact that it was performed in just one Unit of a unique Institution, which brought restrictions for its generalization. Thus, further studies are needed to contribute to the validation of this finding in a national context. The addition of more evidence may help to demonstrate the impact of nursing care time in health care results and patient safety.

Diss. Umeå : Univ., 2004.

Nurses are often the first members of the health care team with whom patients interact. The initial impression of the nurses’ receptiveness to the patients’ needs influences the patients’ views of their overall care. Researchers have suggested that understanding communication between individuals can provide the human link, or social element, to the successful implementation and use of electronic health records, including documentation (Lanham, Leykum, & McDaniel, 2012). Zadvinskis, Chipps, and Yen (2014) identified that the helpful features of bedside documentation systems were offset by the mismatch between the system and nurse’s workflow. The purpose of this micro-ethnography study was to explore the culture of nurse-patient interaction associated with electronic documentation at the bedside. Data were collected through passive participant observation, audio-taping of the nurse-patient interactions, and informal and semi-structured interviews with the nurses. A total of twenty-six observations were conducted on three nursing units at an urban healthcare facility in New England. These three units were occupied by similar patient populations and all patients required cardiac monitoring. Three themes consistently emerged from qualitative data analysis: the nurses paused during verbal communication, the nurses played a game of tag between the patient and the computer, and the nurses performed automatic or machine-like actions. The participants described these themes in the informal and semi-structured interviews. The nurses’ actions were observed during passive participant observation, and the audio-taped interactions supported these themes. Understanding the adaptation of caregiving necessitated by bedside electronic documentation will have a positive impact on developing systems that interface seamlessly with the nurses’ workflow and encourage patients’ active participation in their care.

RESENDE, Eliana de Goes. Memórias da Administração da Enfermagem de um Hospital de ensino em Fortaleza-Ce: (RE) construção a partir da história oral. 2012. 151f. – Dissertação (Mestrado) – Universidade Federal do Ceará, Programa de Pós-graduação em Políticas Públicas e Gestão da Educação Superior, Fortaleza (CE), 2012. / Submitted by Márcia Araújo (marcia_m_bezerra@yahoo.com.br) on 2014-05-06T17:17:59Z No. of bitstreams: 1 2012-DIS-EGRESENDE.pdf: 7208411 bytes, checksum: d25fa49319925ba2aca25ae1673ba424 (MD5) / Approved for entry into archive by Márcia Araújo(marcia_m_bezerra@yahoo.com.br) on 2014-05-07T12:33:17Z (GMT) No. of bitstreams: 1 2012-DIS-EGRESENDE.pdf: 7208411 bytes, checksum: d25fa49319925ba2aca25ae1673ba424 (MD5) / Made available in DSpace on 2014-05-07T12:33:17Z (GMT). No. of bitstreams: 1 2012-DIS-EGRESENDE.pdf: 7208411 bytes, checksum: d25fa49319925ba2aca25ae1673ba424 (MD5) Previous issue date: 2012 / The objective of this study is to understand the historical trajectory of the administration of nursing at the University Hospital Walter Cantídio the period 1959 to 2011, from the narrative of ten nurses who took the highest position in nursing administration at the University Hospital since 1959, the year of his foundation until the year 2011. It is a social-historical research, a qualitative approach, which is the predominant method of oral history. Oral history brings the prospect of receiving revelations, secrets, details, etc.., So that some subjective aspect that may seem today will be clarified as well as being a modern resort that makes possible the recovery of memory and (re ) construction of history from the very words of those who experienced and participated in a given period, by their references and also his imagination. The data was through a survey of nursing management of documents HUWC who were in the central file and in the office of the office of the Coordination of nursing, such as reports, photographs, internal communications, planning for services, among others and through interviews with the nurses identified. The enterview were recorded, transcribed in full and returned to the interviewees make the verification of the reliability of the transcripts at that time there were some adjustments, fruits of new memories of the interviewees. Were also gathered documents and photos kindly provided bythe nurses interviewed. The interviews were analyzed through the use of interpretive hermeneutics – dialectic. The study was approved by the Ethics Committee in Research of Hospital University Walter Cantídio (CEP/HUWC). The history-social this result production was organized according to chronological history experienced by the protagonists and announces some issues that accompany the story of the administration of nursing HUWC, as the struggle for professional development, the relationship of power, desire and need for knowledge and scientific and technological advances, the relationship multidisciplinary, humanization of the team finally has a cycle that does not denote a linear process sequenced. In fact demonstrates a non-linear process that occurs by advances and retreats in historic times deferent, with different dynamics given the deferential historical and social conditions inherent to each person interviewed. So, like any story, that it does not end with this dissertation. It just opens the way to be traveled by others so that all is not lost and, as Le Goff recalled, the story is the daughter of memory, deservedly, have to be careful. / O objetivo deste trabalho é compreender a trajetória histórica da administração da enfermagem no Hospital Universitário Walter Cantídio no período de 1959 a 2011, a partir da narrativa de dez enfermeiras que assumiram o cargo de administração maior na Enfermagem do Hospital Universitário desde 1959, ano de sua fundação até o ano de 2011. Trata-se de uma pesquisa histórico-social, de abordagem qualitativa, cujo método predominante é a história oral. A história Oral traz a perspectiva de receber revelações, segredos, detalhes, etc., de forma que algum aspecto que possa parecer subjetivo nos dias atuais venha a ser esclarecido, além de ser um recurso moderno que torna possível o resgate da memória e (re ) construção da história a partir das próprias palavras daqueles que a vivenciaram e que participaram de um determinado período, mediante suas referências e também seu imaginário. Os dados foram por meio de um levantamento dos documentos gerenciais da enfermagem do HUWC que se encontravam no arquivo central e na secretaria da Coordenação de enfermagem, tais como: relatórios, fotografias, comunicações internas, planejamento para os serviços, entre outros e por meio de entrevistas realizadas com as enfermeiras identificadas. As entrevistas foram gravadas, transcritas na sua íntegra e retornadas para as entrevistadas fazerem a verificação da fidedignidade das transcrições, nesse momento houve alguns ajustes, frutos de novas memórias das entrevistadas. Também foram reunidos documentos e fotos gentilmente cedidos pelas enfermeiras entrevistadas. As entrevistas foram analisadas por meio do recurso interpretativo da hermenêutica – dialética. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa do Hospital Universitário Walter Cantídio ( CEP/HUWC). O resultado dessa produção histórico - social foi organizado de acordo com a trajetória cronológica vivenciada pelas protagonistas e anuncia alguns assuntos que acompanham a história da administração da enfermagem no HUWC, como a luta pela valorização profissional, a relação do poder, o desejo e a necessidade de conhecimento e de avanços científicos e tecnológicos, a relação multiprofissional, a humanização da equipe enfim, apresenta um ciclo que não denota um processo linear, sequenciado. Na verdade demonstra um processo não linear que se dá por avanços e recuos em deferentes épocas históricas, com diferentes dinâmicas dadas as dIferentes condições históricas e sociais inerentes a cada personalidade entrevistada . Portanto, como toda e qualquer história, essa também não acaba com esta dissertação. Ela apenas abre caminho que deve ser percorrido por outros para que não se percam todos e, como lembrou Le Goff, a história é filha da memória que, merecidamente, precisa ser cuidada.

No description available.

Estudo exploratório, retrospectivo, de natureza quantitativa, desenvolvido com o objetivo de analisar o tempo utilizado pela equipe de enfermagem para assistir aos pacientes internados na Unidade de Terapia Intensiva Adulto (UTIA) do Hospital Universitário da Universidade de São Paulo (HU-USP), bem como verificar sua correlação com os indicadores de qualidade assistencial. O período de análise foi 01 de janeiro de 2008 a 31 de dezembro de 2009. Os dados foram coletados dos instrumentos de gestão utilizados pela chefia de enfermagem da Unidade. A análise do tempo médio de assistência despensado em relação ao tempo médio de assistência requerido pelos pacientes foi efetuada por meio do teste estatístico t pareado. Para verificar a correlação do tempo médio de cuidado despensado aos pacientes da UTIA com o indicador de qualidade incidência de perda de cateter venoso central foi utilizado o coeficiente de correlação de Sperman, enquanto que para os demais indicadores foi utilizado o coeficiente de correlação de Pearson. O tempo médio de assistência de enfermagem despensado aos pacientes, no período analisado, correspondeu a 14 horas, das quais 31% foram ministradas por enfermeiros e 69% por técnicos/auxiliares de enfermagem. Os pacientes internados requereram cerca de 16 horas de cuidados. A aplicação do teste estatístico demonstrou que as diferenças encontradas, entre as horas de assistência despensadas pela equipe de enfermagem e aquelas requeridas pelos pacientes, foi significativa (p< 0,001), sugerindo sobrecarga de trabalho aos profissionais de enfermagem da UTIA. A análise correlacional entre o tempo de assistência de enfermagem despensado por enfermeiros e o indicador de qualidade incidência de extubação acidental, evidenciou coeficiente de correlação de Pearson de (r = - 0,454), com p valor de 0,026, indicando linearidade negativa entre as variáveis, o que permitiu inferir que a incidência de extubação acidental diminui à medida que aumenta o tempo de assistência de enfermagem despensado por enfermeiros. Os resultados encontrados permitiram verificar que as horas médias de assistência de enfermagem despensadas aos pacientes da UTIA foram inferiores às preconizadas pelos órgãos oficiais brasileiros. O tempo médio de assistência requerido pelos pacientes internados, nessa Unidade, foi superior ao preconizado pela ANVISA e inferior ao estabelecido pela Resolução COFEN n°293/04. Esse dado indica que a avaliação do quantitativo de pessoal de enfermagem nas UTIs requer o conhecimento prévio das demandas assistenciais dos usuários e não apenas a utilização dos parâmetros indicados pelos órgãos oficiais, uma vez que esse procedimento pode ocasionar um super ou sub-dimensionamento de profissionais de enfermagem. Os resultados desta investigação demonstram a influência do tempo de assistência de enfermagem, provido por enfermeiros, no resultado do cuidado ministrado aos pacientes assistidos na UTIA. As limitações da presente investigação, ou seja, o fato de ter sido realizada em apenas uma Unidade de uma única Instituição, trazem restrições para a sua generalização. Assim, considera-se necessário o desenvolvimento de novas pesquisas que contribuam para a validação desse achado, no contexto nacional. O acúmulo de evidências pode contribuir para comprovar o impacto das horas de assistência de enfermagem nos resultados assistenciais e na segurança dos pacientes. / The objective of this exploratory, retrospective, quantitative study was to analyze the time spent by the nursing staff to assist patients in Adult Intensive Care Unit (AICU) of the University Hospital, University of São Paulo (UH-USP) and verify its correlation with quality care indicators. This research started on January 1st, 2008 until December 31st, 2009. Data were collected from the administration tools used by the head nursing staff of the unit. Analysis of the average length of time in relation to the average length of time required by patients was performed using the Paired t-test. The Spearman\'s correlation coefficient was used to verify the correlation of the average length of care time given to patients of the AICU with the quality indicator incidence of loss during central venous catheter insertion while for the other indicators the Pearson correlation coefficient was applied. The average length of time regarding assistance to patients, in the analyzed period, accounted for 14 hours, of which 31% were performed by nurses and 69% for technicians / nursing assistants. The hospitalized patients required approximately 16 hours of care. The application of statistical test showed that the differences found between the hours of assistance given by the nursing staff and those required by patients was significant (p < 0.001), suggestive of the heavy workload for the nurses in the AICU. The correlational analysis between length of time of nursing care given by nurses and the quality indicator incidence of accidental extubation evidence the Pearsons correlation coefficient (r = - 0.454), with p value of 0.026, indicating negative linearity between variables, which allowed us to infer that the incidence of accidental extubation decreases with increasing nursing care time given by nurses. The results revealed that the average hours of nursing care to patients of AICU were lower than those recommended by the official Brazilian Agencies. The average time of care required by patients hospitalized in this unit was higher than that recommended by ANVISA and lower than that established by COFEN Resolution Nr. 293/04. It indicates that the quantitative assessment of nursing staff in ICUs requires prior knowledge of the user´s health care demands and not only the use of parameters indicated by official agencies, since this procedure may cause an over-or under-dimensioning of nursing professionals. The results of this study showed the influence of nursing care time provided by nurses in the outcome of care given to patients assisted in the AICU. The limitations that needs to be addressed regarding the present study is the fact that it was performed in just one Unit of a unique Institution, which brought restrictions for its generalization. Thus, further studies are needed to contribute to the validation of this finding in a national context. The addition of more evidence may help to demonstrate the impact of nursing care time in health care results and patient safety.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-12-21T13:35:56Z No. of bitstreams: 1 Roberto Santos de Oliveira.pdf: 6262428 bytes, checksum: 39f1c09619185c6bb47ea3a4e0128673 (MD5) / Made available in DSpace on 2015-12-21T13:35:56Z (GMT). No. of bitstreams: 1 Roberto Santos de Oliveira.pdf: 6262428 bytes, checksum: 39f1c09619185c6bb47ea3a4e0128673 (MD5) Previous issue date: 2010 / EELVI Ltda / Mestrado Profissional em Enfermagem Assistencial / Estudo descritivo de abordagem qualitativa que realiza o diagnostico situacional da rede assistencial própria do Sistema Único de Saúde no município de Nova Iguaçu. Realiza o mapeamento das unidades de saúde, através de uma ferramenta conhecida como geo-referenciamento. O marco teórico se apoia nas concepções de Cecílio, Merhy, Bodstein, Hartz, Mendes, Buss entre outros; encontra suporte metodologico em Minayo e analisa os resultados a partir das concepções de Levefre sobre o discurso do sujeito coletivo. Como resultados, foram mapeadas 72 Unidades de Saúde: sendo 01 Hospital Geral, 01 Centro de Referencia Materno Infantil, 03 Unidades Mistas, 03 Centros de Atenção Psico-Social, 02 Policlínicas, 01 Centro de Saúde, 01 Posto de Saúde, 24 Unidades Básicas de Saúde, 33 Equipes de Saúde da Família e 03 Unidades da Família. A organização segue os principios estabelecidos pelo Sistema de Saúde, Nova Iguaçu operacionaliza suas ações de saúde principalmente na atenção básica, através da estratégia de saúde da família. Quando confrontamos os resultados encontrados com os parâmetros legais de cobertura assistencial, constatamos que a realidade ainda está aquém do ideal; apesar deste fato, ao situar o município dentro do Estado do Rio de Janeiro, lançando mão de estratégias de avaliação como o Indice de Desenvolvimento Humano, encontramos um crescimento, modesto mas equilibrado entre Estado e União, destacando Nova Iguaçu, através do indicador: Expectativa de vida, que recebe reflexos da assistência prestada à saúde. Conclui identificando o espaçamento geográfico da rede própria, e um esboço da área de cobertura das unidades; percebe-se que são necessárias estratégias de adequação, treinamentos e hierarquização da rede, para utilização da dinâmica de referências e contra-referências, atividades próprias do planejamento em saúde, que vem sendo desenvolvida também pela enfermeira, quando ocupa a posição de gestor. Como contribuição traz as informações coletadas na modalidade de um manual de localização para encaminhamentos entre as Unidades de saúde / A descriptive study of qualitative approach that performs the status diagnosis of the self care network of the Unified Health System in Nova Iguacu. Performs the mapping of health facilities through a tool known as geo-referencing. The theoretical framework is based on the conceptions of Cecilio, Merhy, Bodstein, Hartz, Mendes, Buss and others; finds methodological support in Minayo and analyzes the results starting from concepts of the Levefre on the collective subject discourse. The results were 72 mapped Health Units: 01 the General Hospital, 01 Center Reference Maternal and Child, 03 Mixed Units, 03 Centers for Psycho-Social Care, 02 Polyclinics, 01 Health Center, 01 Health Post, 24 Basic Units Health, 33 Family Health Teams and 03 Units of the Family. The organization follows the principles established by the Health System, Nova Iguaçu operationalized its health activities mainly in primary care through the strategy of family health. When we confront the results with the legal parameters of coverage, we find that the reality is still far from ideal, despite this fact, to be located within Rio de Janeiro county, making use of assessment strategies such as Development human Index, we found a modest growth well balanced between State and Union, highlighting Nova Iguaçu, by indicator: life expectancy, which receives reflections of health care provided. It concludes by identifying the geographic spacing of the health network itself, and an outline of the coverage area of the units, one realizes that strategies are needed to adapt, training and hierarchy of the network, to use the momentum of references and cross-references, activities characteristic of planning health, and that also is being developed by the nurse, when she occupies the position of manager. As a contribution, brings the information collected in the reference guide for tracking referrals between the health units

Quality of life in long term care (LTC) is a concern for many stakeholders. The elders who are living in LTC facilities, their families, the staff, and government and policy makers are all interested in providing quality care and quality of life to those persons living within the facility. Culture change is one way for LTC facilities to begin to give decision making to the residents, and to increase quality of life of these elders. There are different culture change models that embrace the concept of person-centered care. No matter which model is chosen, the essence of the change is moving from a medical care model to a person-centered care model. vi The purpose of this project was to evaluate the effectiveness of a culture change intervention, teaching person-centered care to certified nursing assistants (CNA), on the quality of life (QOL) of alert and oriented residents living in a LTC facility. The elders, identified as alert and oriented by a score of 25 or greater on the Mini Mental State Exam (MMSE), participated in a QOL questionnaire. Two one hour in-services on person centered care were presented to the CNAs. The QOL questionnaire was re-administered to the elder participants after three months. The results illustrated that teaching person-centered care to CNAs showed significant improvement in the areas of dignity and security, and marginal significance in the area of individuality. This suggests the elder's increased feeling of respect from the staff, as well as an increased sense of belonging and confidence in the availability and assistance of the staff members. It also suggests the elders felt that they were known as individual persons and that their preferences were honored.

The purpose of this evidence-based project was to compare one-year outcomes for newly licensed Registered Nurses (NLRNs) in three organizations within the same healthcare system. All three have lower than nationally reported turnover and strategies for NLRN retention. Only one is using a Nurse Residency Program (NRP). NRPs are recognized as an effective strategy to retain newly licensed registered nurses (NLRNs) in their first year of employment (Institute of Medicine [IOM], 2010; The Advisory Board, 2007; Spector, 2007). The Commission on Collegiate Nursing Education (CCNE) (2008) defines an NRP as a series of learning sessions and work experiences that occur continuously over a 12-month period designed to assist NLRNs as they transition into their first professional nursing role. This cross-sectional, descriptive study utilized the Casey-Fink Graduate Nurse Experience Survey and intent to stay questions to collect data on NLRNs at one year post hire. Results indicated no statistically significant differences between the three sites and the subscales of the survey. There was a trend of a more positive score for professional satisfaction with Site A. Turnover was also similar between sites and lower than the reported 10% average, with Site A at 2%, Site B at 5%, and Site C at 4%. There was a statistically significant difference between Site A and C in the intent to stay in their current position, with Site A longer than Site C. The study supports the literature and evidence that a NRP is an effective strategy to decrease first year turnover. Further study is needed related to the effectiveness of the components of the NRP, length of time for mentorship, and the impact of accumulation of cohorts.