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This study aims to understand the organization of Emergency Department (ED) nurses in Ontario after years of restructuring and cuts made to the healthcare system. The news is currently filled with ED closures across the country due to a shortage of nurses and high hospital occupancy. The recruitment and retention of nurses in the ED has proven extremely difficult due in part to the Ontario government's Bill 124 capping nurses' wage increases at 1%. This wage freeze is inscribed in a larger rationale present internationally advocating for efficiency and marketization of all spheres of life, healthcare included. Most of the literature published on the work of ED nurses refers to ideas of performance of flow. Using Institutional Ethnography (IE) as an approach and governmentality, more specifically neoliberalism, as a perspective, this study maps the ruling relations influencing the work of nurses in the ED. It also uncovers how the neoliberal discourse was not only internalized but applied by nurses in their work environment. The methodological approach and perspective used in this study highlight how a new rationale was implemented in the management and funding of healthcare, which then led to transforming the rationale of providing care in the ED. The ED now delivers care following a supply chain rationale employing technologies of governmentality such as Electronic Medical Records (EMR) to entice a specific conduct from nurses in order to meet the demands of the market. This new rationale, coupled with the implementation and sustaining of the technologies of governmentality, has come to completely transform what an ED nurse is nowadays. This new ED subject is responsible for most aspects of care, flow, and even her own training and security. The findings suggest that the use of algorithms based on best practices (such as medical directives) came to further erode the decisional power of nurses, resulting in "checkbox" practice.

no / The Mid Staffordshire scandal is a salutary lesson that highlights unacceptable standards of poor care of patients by medical and nursing practitioners. The Francis report (2013) made 290 recommendations and a legal duty to enforce a duty of openness and transparencies has been prioritised. Fischer and Ferlie (2013) argue that rules-based regulation eroded values-based self-regulation, producing professional defensiveness and contradictions that undermine, rather than support, good patient care. The role of managers and clinical leaders will be crucial in achieving positive changes in practice; however, the return of autonomy to the practitioners remains central to re-establishing both public and professional confidence.

Syfte: Att undersöka hur sjuksköterskor inom särskilt boende resonerar kring kvalitetsuppföljningar och dess eventuella konsekvenser för omvårdnaden. Metod: Semistrukturerade intervjuer efter öppen intervjuguide med sex sjuksköterskor. Kvalitativ innehållsanalys enligt Graneheim och Lundmans metod. Huvudresultat: I vilken grad kvalitetsregistren och kvalitetsuppföljningarna integreras i omvårdnadsarbetet och dess utveckling är centralt för om dessa uppfattas som stöd eller hinder för god kvalité i omvårdnaden. Dubbel dokumentation bidrar till att sjuksköterskorna omprioriterar arbetstiden och arbetar mer konsultativt och administrativt. Detta minskar tiden för omvårdnadsobservationer och handleding av omvårdnadspersonal samt gör att kvalitetsregistreringar snarast uppfattas som ett hinder. Sjuksköterskorna använde sin professionella kunskap och kliniska erfarenhet i högre grad än registerdata vid omvårdnadsbedömningar. Dessa sågs som alltför komplexa för att kunna fångas i kryssfrågeformulär. Mer kliniska observationer efterfrågas i kvalitetsuppföljningarna för ökad medvetenhet om hög arbetsbelastning och dess eventuella konsekvenser samt för att garantera de boende god omvårdnadskvalité. Konklusion: Sjuksköterskorna upplever att de arbetar under svår tidspress. Tiden anges som essentiell för vilken omvårdnadskvalité som erbjuds. Vid beslut om registreringar av kvalitetsindikatorer bör sjuksköterskornas totala arbetsbörda beaktas. Registreringarna bör integreras i befintliga journalsystem så att sjuksköterskornas omprioriteringar inte får negativa konsekvenser för omvårdnadskvaliten. / Objective: How nurses in residential care reflect on quality follow-ups and its possible consequences for nursing care. Method: Semi-structured interviews with six nurses. Qualitative content analysis according to Graneheim and Lundman's method. Main Results: To witch degree quality follow-ups and national quality registers are integrated in Nursing care and its development is central to if these are seen as support or as obstacle to good nursing care quality. Double documentation contributes to nurses working more consultative and administrative. This reduces the time for nursing observations and guiding the nursing staff as well as contributes to national quality registers being perceived as hindrance. The nurses used their professional expertise and clinical experience to a greater degree than registry data in nursing care assessments. These were seen as too complex to be captured in questionnaires. Conclusion: The nurses perceive that they work under severe time constraints. Time is specified as essential for quality of nursing care. In decisions about quality indicators registrations nurses’ total workload should be taken into account. Registrations should be integrated into medical record used so nurses’ re-prioritizations not have negative consequences for nursing care quality.

Thesis (Ph. D.)--University of Missouri--Columbia, 2003. / Typescript. Vita. Includes bibliographical references.

The aim of the study was to identify factors affecting quality of life in patients with schizophrenia. Method: Systematic literature review where scientific studies were searched in PubMed och Cinahl databases.   Result The analysis resulted in four categories: Life style related factors, Schizophrenia related factors, Sociodemographic factors and Mental illness. Current depressive symptoms and a high level of disease awareness affect QoL in patients with schizophrenia. The conclusion: Several factors affect quality of life in patients with schizophrenia. Some of the factors are preventable, so increased awareness regarding these factors can contribute to adequate nursing care to promote health for persons with schizophrenia.

Thesis (M.A. (Nursing)) -- University of Limpopo, 2020 / Background: Patient satisfaction with nursing care is regarded as a significant factor in defining the perception of the quality of health care service received. In South Africa, and many other countries globally, the drive to deliver health services that attest to quality has become an incentive for obtaining the views of patients and determining their levels of satisfaction. Aim: The aim of this study was to determine factors associated with patients’ satisfaction regarding nursing care provided at the selected public hospitals in the Mopani District, Limpopo Province. Objectives: The objectives of this study were to identify and describe factors associated with patients’ satisfaction regarding nursing and to determine their satisfaction with the nursing care. Method/Design: The study applied a quantitative descriptive and cross-sectional design to determine and describe the factors associated with patient satisfaction regarding nursing care. A simple random sampling method was applied in the selection of the 201 respondents in the selected public hospitals. A self-administered questionnaire, the Patient Satisfaction with Nursing Care Scale was used to collect data from inpatients. The software used to analyse the data is Statistical Package for the Social Sciences program. Permission to collect data in the public hospitals was granted by the Limpopo Department of Health while ethical clearance was obtained from the Turfloop Research Ethics Committee. Results: The study found that 77% of the respondents indicated relatively high levels of satistfaction with the nursing care they received while 23% indicated significant dissatisfaction with their nursing care. Greater satisfaction was noted with regard to the following aspects of the nursing care: nurses’ respect of patients’ rights (89%); I have been given privacy by nurses (88%); nurses deliver care competently (87%) and nurses are skillful in performing procedures (86%). The study showed no relationship v between the gender, age, educational level and employment status of the respondents and their satisfaction in the domains of affective support, health information, professional-technical competencies and decisional control. However, a there was notable association between marital status and patients’ satisfaction in the decisional control domain. The wards to which patients were admitted to were also found to be associated with their satisfaction in the affective support domain Conclusion: The predominant factor contributing to the satisfaction of the respondents in this study was affective support. This was followed by professional technical competencies. Most respondents indicated dissatisfaction with the health information and decisional control afforded to them, particularly with regard to nurses’ involvement of the family in care. Key concepts: Patient, patient satisfaction, nursing care

Bakgrund: Medkänsla är en viktig del av omvårdnaden och en egenskap sjuksköterskan förväntas ha. Medkännande omvårdnad innebär ett moraliskt agerande där aktiva handlingar avser att lindra lidande, vilket möjliggör ett partnerskap grundat på tillit mellan patienten och sjuksköterskan. Trots att medkännande omvårdnad innebär samhälleliga vinster saknas det ibland i vården. Om medkänsla betraktas som en huvudkompetens kan den bli ett kraftfullt stöd i förverkligandet av god omvårdnad. Syfte: Att beskriva sjuksköterskors erfarenheter av medkännande omvårdnad för vuxna patienter i en somatisk slutenvårdskontext. Metod: En litteraturstudie genomfördes där tio kvalitativa artiklar analyserades genom tematisk analys. Resultat: Analysen visade att utövandet av medkännande omvårdnad förfinas i takt med ökad arbetslivserfarenhet. Förmågan att utöva medkännande omvårdnad ansågs bero på personliga faktorer såväl som förhållandet mellan patienten och sjuksköterskan. Organisatoriska aspekter såsom arbetsmiljö, där tid ansågs vara en avgörande faktor, kan påverka den medkännande omvårdnaden. Slutsats: Sjuksköterskor behöver erfarenhet och stöd för att utföra medkännande omvårdnad och därmed öka omvårdnadens kvalitet. Mängden disponibel tid är en viktig arbetsmiljöfaktor som påverkar partnerskap och sjuksköterskans förmåga att ha ett holistiskt synsätt. Vidare forskning rekommenderas. Det finns behov av att implementera medkännande omvårdnad som kunskapsområde i sjuksköterskeutbildningen. / Background: Compassion is fundamental in nursing care and is also a trait the nurse is expected to have. Compassionate nursing care defines as a moral act where the actions aim to relieve suffering. It is an important facilitator for the patient’s trust towards the nurse. Lack of compassion can partly explain health care deficiencies. Defining compassion as a main competence would enhance the realization of compassionate nursing care. Aim: The aim of the study was to describe nurses’ experiences of compassionate nursing care for adults in a somatic hospital setting. Method: A literature study based on ten qualitative articles was conducted with a thematic analysis. Results: Compassionate nursing care refines as experience grows. Compassion is influenced by the nurse’s traits. Furthermore, a holistic approach is needed for compassionate nursing care. Organizational aspects such as the work environment may also have an impact. Conclusion: To perform compassionate nursing care and thereby enhancing the quality of care, nurses need experience and support. The amount of available time affects the creation of partnership and the nurse’s holistic viewpoint. Further research is recommended. There is a need for implementation of compassionate nursing care as a competence area in the nursing education.

Bakgrund: Tidigare forskning visar att uteblivna omvårdnadsåtgärder förekommer på vårdavdelningar. Det leder i vissa fall till svåra konsekvenser för patienten, med ökad morbiditet och mortalitet. Syfte: Att undersöka vilka omvårdnadsåtgärder som uteblir inom intensivvården, och vilka orsaker som leder till uteblivna omvårdnadsåtgärder. Metod: En litteraturöversikt med deskriptiv design för att granska kvantitativa artiklar. Resultat: Resultatet visar att uteblivna omvårdnadsåtgärder förekom även inom intensivvården. Åtgärder som uteblev var bland annat hygienrutiner, mobilisering, stöd och undervisning. Läkemedelsrelaterade avvikelser inträffade i mindre utsträckning än på vårdavdelningar men ledde till svårare konsekvenser för patienten. Flera brister i arbetsmiljön medförde att omvårdnadsåtgärder uteblev. Sjuksköterskor stördes i sitt arbete, av bland annat kollegor och övervakningsutrustning. Otillräcklig bemanning hade en stor betydelse för förekomsten av uteblivna omvårdnadsåtgärder. Bra kommunikation och samarbete minskade frekvensen. När sjuksköterskor konsulterade varandra inför åtgärder inträffade färre misstag, och när en checklista användes aktivt under ronden minskade bland annat respiratortid och mortalitetsrisken för patienten. Hög utbildningsnivå och lång yrkeserfarenhet kunde minska förekomsten av uteblivna omvårdnadsåtgärder. Uteblivna omvårdnadsåtgärder förekom i lägre utsträckning inom intensivvården jämfört med vårdavdelningar men tenderade att ha en större negativ påverkan på patienten. Slutsats: Litteraturöversikten visar att uteblivna omvårdnadsåtgärder förekommer inom intensivvården i mindre utsträckning än på vårdavdelningar, men att det påverkar patienten mer negativt då det inträffar. Det är av vikt att förbättra arbetsmiljö, kommunikation och samarbete för sjuksköterskor, och att främja utbildning och yrkeserfarenhet för att minska risken för att omvårdnadsåtgärder uteblir. / Background: Previous research indicates that missed nursing care occurs in health care units. In sometimes this leads to serious consequences for patients, with increased morbidity and mortality. Aim: To investigate what missed nursing care that occurs in intensive care, and the reasons for missed nursing care. Methods: A literature review with descriptive design for reviewing quantitative articles. Result: Missed nursing care was also present in intensive care. Missed nursing actions included hygiene routines, mobilization, support and teaching. Medication errors occurred to a lesser extent than in health care units but led to more severe consequences for patients. Shortcomings in the work environment led to missed nursing care. Nurses were often disturbed in their work, and inadequate staffing was strongly associated with missed nursing care. God communication and teamwork reduced the frequency. When nurses consulted each other before acting fewer mistakes occurred. When using a checklist actively during rounds respiration time and the risk of mortality for the patient was reduced. High levels of education and long professional experience were important for reducing missed nursing care. Missed nursing care was less common in intensive care but tended to have a greater negative impact on the patient. Conclusion: This review demonstrates that missed nursing care is less frequent in intensive care than in health care units but has a greater negative impact on the patient. It is important to improve the working environment, communication and teamwork for nurses, to promote education and professional experience to reduce missed nursing care.

Due to the fragmented structure of the health organisation in South Africa, there is often difficulty in assuring good co-ordination between in-patient and domiciliary health facilities. This results in the discharge of patients from hospital with poor prospects for the continuity of health care in the community. At Groote Schuur Hospital, approximately 44% of the hospital beds in the white section of the Hospital are occupied by patients in the age group of sixty-five years and over. This group of patients must be regarded as particularly vulnerable with regard to the transition of the care in a hospital to their own home for some of the following reasons: - * The nature of the disease - The chronic and recurrent nature of the degenerative diseases of old age often results in varying degrees of disability. in the aged patient. Many geriatric patients suffer from several unrelated clinical conditions, and thus there is a need to coordinate the many health services required. * Social circumstances - The aged population frequently live alone or with a frail relative, often in poor economic circumstances. * Re-admission rate - The geriatric re-admission rate following discharge is high. As the first principle of geriatric care is to restore independence, and to help patients live away from the hospital environment, the provision of extended care facilities for vulnerable patients is of utmost importance. A structured interview was used to assess the need for extended care facilities of 172 white patients over the age of 60 years who were discharged from Groote Schuur Hospital during March to May of 1981. An attempt was made to evaluate how effectively these needs were being met in the community following discharge. It was found that 34% of the patients interviewed were not getting the nursing care and support in the community which they needed to facilitate rehabilitation. The most vulnerable patients as regards aftercare were: - * The aged * The chronically ill * Patients who live alone or without social support * Patients whose illness leads to temporary or permanent disability * Patients hospitalised for prolonged periods. It was found that the patients interviewed were given insufficient preparation, while still in hospital, for the problems they would be faced with on discharge. No systematic policy exists to ensure that health care staff give adequate information to the patient on discharge from hospital. The ward sister was found to play a vital role in making the preparations for a patient's transfer from hospital to home. A questionnaire was designed to assess the Groote Schuur ward sisters' attitudes towards the importance of discharge planning. An analysis of the ward sisters' response indicated that great variation existed in the attitudes towards the importance of this task. An investigation into the existing community services for geriatric patients was undertaken. An attempt was made to assess the limitations and gaps which exist in the provision of services for the aged. Finally, the role of the recently established Department of Community Liaison at Groote Schuur Hospital was investigated. It was evident that the Community Liaison nurse had proved to be an invaluable member of the health team of a large, specialist hospital such as Groote Schuur. The activities of the Community Liaison nurse led to improved continuity of care for patients needing extended care facilities in the community.