Diabetes is a condition that is primarily self-managed and lifestyle modifications such as diet, exercise, and weight management are necessary to reduce morbidity and mortality. Motivation to implement lifestyle modifications through self management is an integral part of disease management and studies have shown group medical visits are more effective than individual appointments in this patient population. The purpose of this project was to develop, implement and evaluate an evidencebased group medical visit program for up to a maximum of 8 adult patients with type 2 diabetes in a family practice setting for six months. Seven participants with abnormal A1C results accepted the invitation to attend group medical visits. Here surrounded by peers with the same diagnosis, they were able to learn and discuss methods to self manage their type 2 diabetes. At the conclusion post survey results indicate positive change in some lifestyle behaviors and improvement with hemoglobin A1C. However there was no improvement in weight management. A cost analysis reveals group medical visits may generate a small profit when compared to individual visits. Group medical visits may offer an effective means to motivate patients to make lifestyle change to reduce risk.

Current procedures for cleaning anesthesia airway equipment have been reported to be ineffective. The potential for cross-contamination from some airway equipment to a patient has been documented in several studies. In order to prevent potential infections, it should be ascertained as to why all anesthesia providers are not using disposable laryngoscope blades. The purpose of this evidence based project is to determine the perceptions of anesthesia providers regarding the use of disposable laryngoscope blades. Their frequency of use, their evaluation of ease of use, and any complications encountered when using the disposable blade before and after an in-service program designed to increase the use of disposable blades will be determined. Once Institutional Review Board (IRB) approval and written consent were obtained, anesthesia providers were asked to complete an anonymous one page questionnaire on their knowledge and practice regarding disposable laryngoscope blades. Immediately following the completion of the questionnaire, participants were given an investigator developed article to read. Participants completed the same anonymous questionnaire 3 months following the pre-intervention questionnaire. Inventory of the disposable laryngoscope blades were collected at the start of the project, at one month, and then again at three months. A total of 12 anesthesia providers participated in the evidence based practice project. An increased number of providers stated that they felt disposable laryngoscope blades were easy to use at the completion of the project and there was an increased use of disposable laryngoscope blades. At post-intervention, anesthesia providers described performance (25%) as their reason for not using the disposable laryngoscope blade which was down from the start of the project (60%). A single proportion Z-Test showed that the 23% increase in use of disposable laryngoscope blades after the intervention was statistically significant (Z=2.046, p=0.041). This evidence based project has shown that despite initial apprehension, a change in practice was evident after dissemination of the best and most recent clinical evidence regarding laryngoscope blades which should translate to improved patient outcomes.

The incidence and prevalence of overweight and obese children in the United States is a serious health concern since the complications of childhood obesity can have serious and long-term effects: cardiovascular disease, sleep apnea, type 2 diabetes, neurological disease, and pulmonary disease. Parental modeling and nutritional education focusing on the obese/overweight child’s parents has been shown as an effective strategy for improving nutritional outcomes of the recommended servings of fruits and vegetables in children from five to ten years of age. Outcomes of this study and targeted nutritional modeling included increasing vegetable and fruit consumption of the parent by at least one fruit and vegetable serving per day post-intervention through nutritional education. The project purpose was to measure the impact of a parent-focused nutritional educational intervention that increases fruit and vegetable consumption in the parents of obese and overweight children. While the study indirectly measured a nutrition education intervention aimed at children via their parents, no children were included in this project. Parents (N = 93) of obese/overweight children were provided nutritional and modeling education over three months. A participation rate of 14% (N = 13) was achieved. The majority of the parents were single African American mothers between 18 and 25 years old with one or two children living in the household, an average income less than $10,000 per year, and some college or technical education. This project used a pre-and post-test design to measure the effectiveness of a nutritional educational intervention. A descriptive analysis of the participants was computed. Differences in the pre-and post-test scores on the parental dietary modeling questionnaire and the food frequency questionnaire were analyzed. Results showed a significant increase in fruit and vegetable consumption (p < .05). The majority of the increase was due to improved fruit consumption. There was also an increase in parental modeling awareness. Parents’ understanding of the importance of parental modeling had an impact on nutritional selection of their own fruit and vegetable intake.

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.

Globally, the nursing profession is faced with a decline in school-leavers’ interest in nursing as a career. The decline in school leavers entering the nursing profession poses a threat to the future of nursing because, globally, the average age of nurses in many countries exceeds 40 years (International Council of Nurses, 2008). The role of marketing in attracting school leavers to careers of choice is well documented; however, there is a lack of documented marketing attempts by Nursing Education Institutions to market nursing as a career at secondary schools in the Nelson Mandela Bay Municipality. The purpose of the study was to determine the views that grade nine learners have regarding the marketing of nursing as a career to attract school-leavers to the profession. The researcher also explored and described how grade nine learners are being informed or wish to be informed of nursing as a career. Based on the findings of the study, broad guidelines were developed for nurse educators at Nursing Education Institutions so as to facilitate the marketing of nursing as a career for school leavers. To achieve the purpose of this study, a quantitative, explorative, descriptive and contextual study design was used. The study was conducted at selected senior secondary schools in the Nelson Mandela Bay Municipality. The research population in this study comprised of all grade nine learners at secondary schools in the Nelson Mandela Bay Municipality. A simple random sampling method was used to select participants. A structured self-administered questionnaire was used as the data collection tool. The data collected were analysed with the help of the statistician, using descriptive and inferential statistics. The study findings revealed that grade nine learners in the Nelson Mandela Bay Municipality had a positive response to choosing nursing as a career and that schools situated in the lower socio-economic areas had the highest percentage of grade nine learners indicating an interest in nursing as a career. The study concludes with recommendations for nursing practice, education and research. Ethical principles have been maintained throughout the study.

The nursing student who has undergone the four year diploma or degree training as a nurse also has to undergo compulsory community service as a requirement before she/he can be registered as a qualified professional nurse. While it has been compulsory for other health professionals such as doctors, dieticians or dentists to place students in compulsory community service, it has only been compulsory for nursing students since 2008. This means that the practice is relatively new in nursing and it is not clear how the newly qualified professional nurse experiences compulsory community service (CCS). The overall goal of this study is to determine the experiences of professional nurses placed at the state hospitals in Nelson Mandela Bay regarding compulsory community service clinical placement exposure and to use these descriptions to develop guidelines. The study followed a qualitative, exploratory, descriptive, contextual design. Literature was reviewed in order to identify research that was done previously regarding compulsory community service amongst health care professionals. The research population included professional nurses who underwent compulsory community service in the three state hospitals in the Nelson Mandela Bay. Purposive sampling was utilised to identify the participants. Semi-structured interviews were conducted to collect information and field notes were kept. The interviews were transcribed and Tech’s (1990) in Creswell, 2009:186) eight steps of data analysis were followed to create meaning from the data collected. An independent coder assisted with the coding process to ensure the trustworthiness of the findings. The researcher ensured the validity of the study by conforming to Lincoln and Guba’s model of trustworthiness which consists of the following four constructs, namely credibility, transferability, dependability and conformability (Lincoln & Guba, 1999, as cited in Schurink, Fouche & de Vos, 2011:419- 421). Three themes and sub themes were identified. Literature control was done to compare the findings with existing research results. The researcher ensured that the study was conducted in an ethical manner by adhering to ethical principles such as beneficence, justice and fidelity. All the participants in the study felt that the clinical placement exposure was a worthwhile experience. The participants expressed a feeling of gratitude that they were afforded this opportunity of practicing under the guidance of experienced professional nurses. To them it was an opportunity to master whatever they were taught as student nurses so that by the time they practice as independent practitioners they would be confident and knowledgeable. The CCS nurses indicated that orientation and mentorship were not always of good quality and professional nurses were not always available as in some units professional nurses were not readily accessible. The CCS nurses were left alone and isolated with no one to consult. If proper orientation and mentorship had been in place the CCS nurses would have enjoyed the community service year more and they felt that they would have benefited more. Had there been a mentoring system in place it could have gone a long way to ascertain that the participants gained confidence and were able to perform tasks independently and confidently. The participants overwhelmingly indicated that unit management should have been included in their CCS year placement. During the CCS year the CCS nurses were not exposed to unit management. This was seen by CCS nurses as a missed opportunity. Had they been afforded the opportunity to practice unit management under the supervision of unit nursing managers, professional growth and development in unit management could have been facilitated. That they were not afforded that opportunity deprived them of a valuable skill as well as personal and professional growth. In conclusion guidelines for placement of CCS nurses in the Nelson Mandela State hospitals have been formulated for implementation. Recommendations were made to enhance nursing practice, nursing education and nursing research.

Abstract Purpose: The purpose of this project was to evaluate outcomes of an existing inpatient tobacco cessation counseling program with 30-day follow-up among recently admitted tobacco-dependent patients who were tobacco-dependent. Background/Significance: Tobacco use is considered the number one most preventable cause of disease, disability, and death in the United States. Despite associated dangers, approximately 21% Americans currently smoke. This has led to increased hospital admissions and chronic disease management, costing the United States approximately $96 billion per year. Decades of research and evidence-based clinical practice guidelines substantiate that inpatient tobacco cessation counseling has the potential to improve quit rates post-hospital discharge. Method: This quality improvement project utilized existing hospital data containing demographic and medical information about patients and tobacco use behaviors. The goal was to answer the question: Does the provision of a tobacco cessation program initiated during hospitalization for persons who are tobacco-dependent (a) increase quit attempts or (b) reduce tobacco consumption? The electronic medical record was queried for data related to: demographics, insurance type, and diagnosis. Data related to smoking status and the intervention was extracted from a paper chart maintained by the certified tobacco treatment specialist. Results: Out of 176 tobacco-dependent patients admitted to the hospital, 100 (57%) indicated an intention to quit (at admission time) while only 40 (23%) reported having quit within 30 days post discharge (McNemar Test, p=0.000, n=176). The mean number of cigarettes smoked per day dropped from 19 cigarettes on admission to 13 cigarettes post discharge. [t (158)=6.7476, p=0.000]. Conclusions: This quality improvement project showed that although an inpatient smoking cessation program did not improve quit rates, it did significantly improve reduction in tobacco consumption.

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.

Ongoing evaluation of current practice and incorporation of evidence based research into guidelines and protocols is a requirement for the provision of high quality, cost efficient care. Despite some literature describing observational data, midline catheters (MCs) are not an appropriate vascular access device for Newborn Intensive Care Unit (NICU) patients due to insufficient high level evidence demonstrating safety and efficacy. In addition, national guidelines for MC use in neonatal and infant patients lacks sufficient information for safe and effective use of MCs. The results of this small, online survey indicate that while some neonatal nurses and Nurse Practitioners report the use of MC use in the NICU, there is a wide range of practice pertaining to MC unit-specific protocols, competencies, success with placement, and clinician agreement of appropriate use for this vascular access device (VAD). Multicenter, randomized control trials are needed to evaluate current MC practice in the NICU, and institutions must incorporates current, evidence based practice into policies, procedures, and guidelines.

8 ABSTRACT Title: Implementation of nursing practice standards in Nachod Regional Hospital Author: Kateřina Fialová Department: Charles University in Prague, Faculty of Humanities, Department of Management and Supervision in Social and Health Organisations Supervisor: Mgr. Petr Vrzáček, Department of Management and Supervision in Social and Health Organisations The focus of the thesis was development and especially implementation of nursing practice standards as well as exploration of non-medical health professionals' attitudes towards this process in Nachod Regional Hospital. The theoretical part clarified the concept of quality, standard, audit, accreditation, certification and also addressed the role of health and nursing care management in quality control. The practical part was divided into three research sections. The first one diagnosed nursing practice standards, their prototype version above all. The findings from this diagnosis provided two recommendations - to revise current version of methodology for standard process creation and to start changing health professionals' attitudes towards standards and standardization of nursing practice. The quantitative research in the second section analysed in detail attitudes and motivation of non-medical health professionals to make the development...