The push to generate professional nurses has raised questions about the competency level of the novice nurses that are entering the workforce. Utilization of simulation laboratories is being viewed as an option for bridging the gap for the shortage of nurses, nurse educators, and clinical sites. The theory of goal attainment was used to guide this project, which aimed to develop and validate an ER simulation scenario that mimics a clinical setting as a tool for measuring nursing skills. An additional purpose, to be accomplished after graduation, will be to implement a pilot project to determine the impact of the validated simulation scenario within the nursing skills laboratories on the quality of care provided by novice nurses to patients. The validation of the ER simulation scenario was completed by having 10 local experts review the developed ER simulation scenario. The experts then completed a 5-question Likert-type scale survey. Descriptive analysis was used to evaluate the results of the survey and validate the simulation scenario tool. Results revealed that all experts strongly agreed that the ER scenario was visually appealing and had enough subject content. Most experts strongly agreed that it was easy to read and follow. Post-graduation and with the assistance of the education organization, the second part of this proposal will occur with a pilot study implementation. The significance of this project to the nursing practice is to utilize simulation as a bridge to real life practice settings. This project may contribute to the American Nurses Association Standards of best practice which works to improve patient safety as well as quality nursing care.

Background: Oral health is an integral part of the general health and quality of life. Yet oral health among older people requiring nursing care is often poor. Despite this group’s frequent contact with health care services, they tend to lose contact with dental care. In nursing care, nursing staff are tasked to assist with oral hygiene care, but this has become more demanding as many older people retain more teeth or have advanced prosthetic constructions. Previous research in the field emphasised the need of collaboration between dental- and nursing care to support the nursing staff in this task. However, there is a lack of evidence regarding the effects of these collaborations. Aim: The overall aim of the thesis is to examine two oral health programmes used within nursing care with different design regarding support from and collaboration with dental care. Methods: Quantitative research methods was used. The data in Study I comes from an oral health assessments guide (ROAG-J) performed by nursing staff in a national health register. Oral health, assessed at two occasions from older people with nursing care, were used. Study II was a controlled intervention study performed at a nursing home. The intervention involved individual coaching of nursing staff in oral hygiene care by dental hygienist for four hours per week at the ward for a period of three months. Oral assessments of older people were performed by dental hygienists and questionnaires to nursing home staff were used. Result: In Study I, 667 individuals aged 65 years or older, receiving nursing care services and assessed using ROAG-J between November 2011 and March 2014 were included. No statistically significant difference in any of the oral health variables was found between the first and subsequent assessments. At the first assessments, less than one third of participants had oral health problems. At the first assessment, status of the tongue differed in men and women (p < .01); at the subsequent assessment, gender differences were found in voice (p < .05), mucous membranes (p < .003), tongue (p < .01), and saliva (p < .006). In Study II, 33 nursing staff and 48 residents participated at the baseline measurement and 22 and 32 respectively at the 9-month follow-up. The nursing staff changed in knowledge and attitudes related to gum disease, approximal cleaning, usage of fluoride and the likelihood that older persons would express the need for oral health support. The most frequently reported oral health problems among the residents pertained to teeth and gums. The residents relatively high level of oral health was stable during the study period. Conclusions: The participants in the oral health programmes were able to maintain an acceptable level of oral health during the study periods although health was likely to decline. The nursing staff maintained a high level of knowledge and attitudes about oral health. However, there seems to be a discrepancy regarding the prevalence of oral health problems among older people. A collaboration between dental- and nursing care providers indicates a positive influence on providing oral hygiene care.

Background: The nurses’ responsibility is to give good and safe health care based on nursing science and proved practice, and also keeping up to date with the latest nursing science. The most common use of research utilization is instrumental, which is nursing science directly applied when caring for patients. By acquiring and utilizing new nursing science, the nurse is able to develop safe care for patients.  Aim: The aim of this review was to describe nurses’ perceptions of implementing research science in clinical practice. Method: A literary review based on studies acquired from the database CINAHL Complete and Academic Search Complete  Result: The impact of nursing science describes that nurses believe nursing science as important for the evolvement and quality of the profession, but perceives it to be too complex to utilize. Nurses’ perceptions of barriers and facilitators towards research utilization in nursing science describe what organizational factors affect nurses´ perceptions of research utilization in nursing care. Nurses also describe that they want to utilize research, but they lack the skill to critically appraise scientific literature. Lack of time and low research availability are described as barriers towards research, and support and engagement from nursing administrators are considered a facilitator towards better research utilization. Discussion: Despite having a positive attitude towards nursing science, the result shows that the nurses today find it difficult to implement it in a clinical practice. The results indicate that there needs to be support from the management to facilitate research utilization in a clinical practice.

The current literature suggests one of the challenges of nursing today is to meet the health care needs of the growing older population, people over the age of 65. Quality of nursing is important for acutely ill older people who are the largest group of patients in terms of hospital admissions. The ageing population is a major focus for social and economic planners and policy makers. There is an increasing need for health systems to change their focus to more closely assess strategies used to manage the acutely ill older hospital population. The main aim of this study was to improve the quality of nursing care for older, acutely ill, hospitalised medical patients. The study used a mixed method triangulated approach that utilised quantitative and qualitative methods to survey perceived needs of older patients, their family members/carers and the nursing staff, in the process of developing, implementing and evaluating a new model of care using a participatory action research (PAR) process. There were three specific objectives. The first was to evaluate which aspects of nursing care were considered most important for older patients during acute hospitalisation from the perspective of older patients, their family members/carers and their nurses. The second was to develop and implement a model of care that addressed the identified nursing care needs and priorities of older patients through the PAR process. The third was to determine whether employing a PAR process, the chosen model of care addressed the identified nursing care needs and priorities and resulted in increased patient satisfaction and improved health care for older patients. This study demonstrated the implementation of a PAR process to motivate nursing staff, utilising an evidence-based model of care approach, resulted in changes to clinical nursing practice that impacted positively on older patients’ and nursing staff’s satisfaction with care provided, patient knowledge and final health outcomes. It is recommended that the findings of this study be applied to develop guidelines for acutely hospitalised medical patients, particularly for issues relating to educational sessions to increase the patient’s functional activities and knowledge levels of their medication regimes prior to discharge. / Master of Health Science (Hons)

藥品的行銷由於受到衛生署相關法令的嚴格規範，藥商通常只能透過醫師、藥師將產品資訊適時揭露給病患，無論直接訴諸媒體對患者行銷；因此，藥商行銷服務的目標客戶，一般而言僅限於醫師及藥師。 罕見疾病患為數極少，參與臨床診斷研究的醫師甚少，而治療用藥劑量的調整與投予又相當複雜，因此，患者往往需要有額外的衛教護理人員協助，才能提高其對治療藥物的醫囑性及回診率，以確保臨床的治療成效。 本研究以4C架構為方法，從病患的觀點出發，依行銷交換理論的架構，從外顯單位效益成本、資訊搜尋成本、道德危機成本、專屬陷入成本等四大因素，對罕見疾病用藥衛教護理行銷略，進行深入的分析與探討。分析結果如下： 衛教護理行銷略可適當縮減銷售團隊的規模，可進一步減少人事成本的支出，大幅降低行銷總成本，並提高產品的競爭優勢。透過衛教護理行銷略可提升產品價值曲線與客戶鏈相結合，提高整體產品總效益，藉以拉高競爭者的進入障礙。衛教護理為患者提供個人化的服務，協助患者學習注射藥物、記錄用藥情形、提醒回診日期，讓患者體驗到服務的感動與生命受到尊重的感覺，進而對衛教護理系統產生絕對的依賴性，擴大患者的專屬陷入成本，達成差異化策略行銷的目標。 謹以本研究的發現，期能為罕見疾病藥品經營者提供可行的差異化策略建議，強化產品永續經營的競爭優勢。 / Marketing of drugs due to the strict regulations of the Department of Health Act, drug manufacturers usually only through physicians, pharmacists product information to timely disclose to patients with or without direct recourse to the media marketing of patients; Therefore, the target customers of the pharmaceutical companies marketing services. Generally limited to physicians and pharmacists. Minimal number of rare diseases, and is involved in the clinical diagnosis of physician rarely, coupled with the adjustment of the treatment dose is quite complicated, therefore, patients often need to have additional health education nurses to assist in order to improve their doctor's advice and return consultation rate to ensure the clinical outcome of the treatment. In this study, the 4C framework for the method, from the viewpoint of patients, nursing care education marketing strategy on rare diseases, in-depth analysis and discussion. The results are as follows: Nursing care education appropriate to reduce the size of the sales team, personnel costs, dramatically further reducing the total cost of marketing and improve the product competitive advantage. This strategy enhances product value curve and the combination with the customer chain, to improve the total effectiveness of the overall product in order to build up the entry barriers for competitors. To provide personalized service for patients, help them learn to inject able drugs, record prescriptions and remind the date of the return visit, to enable patients to experience the feelings and life of service by the feeling of respect, and thus on the nursing care education system is absolutely dependent to increase the patient's specific holdup cost to achieve the goal of the differentiation strategy marketing. Rise to the findings of this study, of drugs for rare diseases operators to provide viable differentiation strategy recommendations to strengthen the sustainable competitive advantage in the product.

The nursing practice of monitoring patients in the post-operative (PO) phase upon returning to the general ward setting has traditionally consisted of the systematic collection of vital signs and observation of other aspects of the patient's recovery. For the most part the primary focus of this monitoring has been the detection of post-operative complications. There is a need for more substantive evidence to support an appropriate frequency of post-operative observation. The aim of this research was to identify if the current practice of PO vital sign collection detects PO complications in the first 24 hours after the patient has returned to the general ward setting. Due to the complex world in which nurses practice the research was undertaken using a combination of methods within a triangulated approach to collect data. A survey of 75 hospitals providing a surgical service enabled a description of the current models of PO monitoring as found in policy documents to be made. The majority of hospitals (91%) described a variety of regulated regimens for the collection of PO observations, with the most common for vital sign collection (27%) as hourly for the first four hours and then four hourly. An observation of 282 patient hours in two surgical wards identified the current practice of PO monitoring involved nurses collecting vital signs hourly for the first four hours, three hourly for the next eight hours and then every four hours. This was despite the existence of different models being described in the policies. The records of 144 patients were audited to identify what, if any, nursing interventions detected changes in a patient's recovery and to determine whether a relationship existed between vital sign collection and the detection of complications. It was found that the complications that occurred were minor in nature, occurred infrequently, and did not have a relationship with changes in vital signs. This research found that there was no relationship between the frequency of the collection of vital signs and the occurrence or detection of complications. PO observations were collected by nurses based on traditional patterns, were collected routinely, were ritualised and were not determined by individual clinician expertise or the needs of the individual patient. Recommendations are made regarding the need for a systematic program of research and alternative models of patient observation that focus on patient need rather than organisational need and that provide more efficient and effective practice in monitoring PO patient progress. / Thesis (Ph.D.)--School of Medicine, 2003.

<p>Patientsäkerhet och arbetet för att hindra uppkomsten av vårdskador är ett högaktuellt område. Problemet med undvikbara vårdskador är omfattande och i Sverige uppges vårdskador orsaka 630 000 extra vårddygn på ett år, vilket medför både ett mänskligt lidande men också ekonomiska konsekvenser för samhället. Antalet patienter som skadas av vården är ett direkt mått på patientsäkerheten. Brister i kommunikation och teamarbete är en betydande orsak till att vårdskador uppstår. Syftet med studien, som utfördes som en litteraturöversikt, var att belysa faktorer som kunde påverka kommunikationen och teamarbetet i hälso- och sjukvården samt vilken betydelse dessa hade för patientsäkerheten. Femton vetenskapliga artiklar analyserades och resultatet visar att kommunikation och teamarbete påverkas av faktorer såsom <em>tillåtande klimat</em>, <em>arbetsmiljö</em>, <em>organisation och</em> <em>ledarskap</em> samt <em>utbildning i kommunikation och teamarbete.</em> Kunskap och färdigheter inom kommunikation och teamarbete ansågs vara lika viktigt som den kliniska kompetensen men har hittills inte prioriterats i tillräcklig utsträckning. Detta visar på ett ökat behov av utbildning för att på så vis kunna förbättra förutsättningarna för att utöva en patientsäker vård.</p> / <p>Patient safety and the task of preventing the occurrence of adverse events is a highly current issue. The problem with adverse events is extensive and in Sweden, adverse events are causing 630 000 additional days of health care each year resulting in human suffering as well as financial consequences for the society. The number of patients harmed due to hospital-acquired conditions is a direct measurement of patient safety.  Inadequate communication and teamwork is a significant reason for the occurrence of adverse events. The purpose of this study, performed as a literary survey, was to illustrate factors that could influence the communication and teamwork in the health care setting and the significance this had for patient safety. Fifteen scientific articles were analyzed and the results showed that communication and teamwork were influenced by a number of factors such as <em>permitting climate, work environment, organization and leadership, </em>and <em>education in communication and teamwork. </em>Knowledge and skills in communication and teamwork is just as important as the clinical skills but has, as of yet, not been prioritized enough which indicates that there is an increased need for education and training in order to improve the conditions for a safe practice in patient care.</p>

<p>Individer som blivit brännskadade upplever både fysiska och psykiska hinder. En acceptans av den nya kroppen kan ta lång tid. Under rehabiliteringsprocessen på sjukhuset arbetar det multiprofessionella teamet med denna patientgrupp för att de ska kunna klara av vardagen. Sjuksköterskan bör ha god kunskap av att vårda brännskadade patienter. Syftet med litteraturstudien var att belysa hur individen upplever sin livssituation efter en brännskada för att sjuksköterskan ska få en ökad kunskap och därigenom kunna ge en god omvårdnad. Sjutton vetenskapliga artiklar bearbetades för att sedan sammanställas till ett resultat med olika teman. Resultatet visade fem teman; <em>Upplevelsen av stöd, upplevelsen av att hantera brännskadan, upplevelsen av smärta och klåda, upplevelse av livskvaliteten efter brännskadan </em>samt<em> upplevelsen av vården.</em> Brännskadade individer behöver stöd från om-vårdnadspersonal och närstående. Copingstrategier användes för att utstå både fysisk och psykisk smärta. Livskvaliteten kunde både försämras och förbättras efter en brännskada. Att vårda patienter med brännskador kräver goda kunskaper inom omvårdnad då den omfattar många delar. Mer forskning inom området behövs för att sprida kunskap. Även en stödgrupp för brännskadade patienter borde etableras för att kontakt mellan brännskadade individer ska upprättas.</p> / <p>Individuals who have endured burn injuries experience both physical and psychological barriers. Coming to terms with lasting effects of burn injuries on the body can take a long time. The rehabilitation process in the hospital is at a multi-professional level, drawing across a large cross section of specialist skills to enable patients to cope with everyday life. Nurses need to have a good knowledge base to care for burn injured patients. The purpose of this study was to highlight how individuals feel about their life after a burn injury, to help nurses get a better understanding of the subject and therefore provide good health care. Seventeen scientific articles were analysed and then complied into a conclusion with different themes. These themes were; <em>the experience of support, the experience to cope with burns, the experience of pain and pruritus, experience of the quality of life </em>and <em>the experience of the health care. </em>Burn injured patients need support from the nursing staff and relatives. Coping strategies were used to endure both physical and mental pain. The quality of life could be either worse or better after a burn injury. Caring for patients with burns requires a high level of knowledge in nursing, as it affects the many stages of recovery. More research in this area is needed to increase know-ledge. A support group for burn patients should also be established in order to support contacts between burn injured individuals.</p>

<p>Syftet med litteratur studien var att beskriva vilka studier som har gjorts med fokus på ”grön omsorg” /utemiljö i vården av personer med demens, samt att beskriva personalens upplevelse av dessa omvårdnadsåtgärder och eventuella effekter på de boende. Litteratursökningar gjordes i databaserna Medline och Chinal, och resulterade i nio inkluderade studier. Resultatet visade att flertalet av studierna hade som syfte att studera utemiljö och boendes välbefinnande och beteende. Sex studier hade en icke-experimentell design, två studier hade en kvasiexperimentell design och en studie var uppdelad i två delar varav den ena delen hade en icke-experimentell design och den andra delen hade en kvasiexperimentell design. Studierna var publicerade under åren 1992-2006 och vanligast förekommande datainsamlingsmetod var observationer av funktionsförmåga/beteende hos de boende. Granskningen av artiklarna indikerade positiva förändringar, framförallt minskat aggressivt beteende och förbättrat välbefinnande vid vistelse i utemiljöer hos personer med demens. Personalen och närstående var i stort positivt inställda till dessa utemiljöer i omvårdnaden av personer med demens.</p> / <p>The aim of the review was to describe studies that have been done with focus on “green care”/exterior environment in the care of people with dementia. Another aim was to describe the staff member’s experience of these arrangements and contingent effects, on the patients. Literature search was made in Medline and Chinal databases, and resulted in nine included studies. The results indicated that a majority of these studies had outdoor environment and effects on the residents’ well being and behavior as a study purpose. Six studies had a non-experimental design, two studies had a quasi-experimental design and one study was divided into two parts of which the first part had a non-experimental design and the second part had a quasi-experimental design. The studies were published between 1992- 2006 and the most common method of collecting data was observations of functionality/behaviour of the residents. The review of the studies focusing on the exterior environment indicated positive changes in subjects with dementia. In particular a decrease of aggressive behaviour and improved well being was seen. The staff and the subjects’ relatives were all in all positive to the outdoor environments in the care of subjects with dementia.</p>

<p>Syftet med denna deskriptiva litteraturstudie var att beskriva viktiga aspekter i omvårdnaden av ungdomar med anorexia nervosa och deras föräldrar ur ungdomars, föräldrars och sjuksköterskors perspektiv. De vetenskapliga artiklarna (n=16) hittades i databaserna Medline (PubMed), PsycInfo och Academic Search Elite (ASE) och samtliga genomgick en kvalitetsanalys. I resultatet framkom att det var viktigt att sjuksköterskor utvecklade goda relationsband med anorektiska ungdomar vilket låg till grund för en effektiv behandling. Genom motivation och stöttning kunde sjuksköterskor stärka anorektikerns självkänsla och på så vis lägga en bra grund för en verksam behandling. Sjuksköterskor behövde också sätta upp regler och vara kontrollerande för att hjälpa ungdomarna att hålla sig inom behandlingens ramar. Det framkom även att det var mycket betydelsefullt att involvera föräldrarna till anorektiska ungdomar i vården och behandlingen av deras barn. Många föräldrar hade bristande förståelse och insikt i sjukdomen, sjuksköterskor borde därför informera om sjukdomens natur och dess behandling. Det var vanligt att föräldrar lade skulden för sitt barns sjukdom på sig själva och mådde psykiskt dåligt, vilket i sin tur påverkade den anorektiske ungdomens välmående negativt. Det var därför viktigt att sjuksköterskor var ett stöd också för föräldrarna.</p> / <p>The purpose of this descriptive study was to describe important aspects in the care of adolescents who suffer from Anorexia Nervosa and their parents, out of adolescents, parents and nurses perspective. The scientific articles (n=16) was searched in the database Medline (PubMed), PsychInfo and Academic Search Elite (ASE) and a quality analysis of all articles was made. In the result it was concluded that it was important that nurses developed good relationship with young people with anorexia, which in turn lead to an effective treatment. Through motivation and encouragement the nurses could strengthen the self esteem of the anorectic person and in this a good foundation for an effective treatment was build. The nurses also needed to set up rules and to be controlling in order to help the young people to stay within the framework of the treatment. It appeared also that it was very important to involve parents to anorectic youths in the care and treatment of their children. Many parents lacked understanding and knowledge of the illness, nurses should therefore inform the parents of the nature of the illness and its treatment. It was not unusual that parents blamed themselves for their children´s illness and felt psychologically bad, which in turn affected the anorectic young people´s health in a negative way. For this reason it was important that the nurses were supportive also to the parents.</p>