Acute care nurse practitioners (ACNPs) are a new addition to the Canadian health care system, having been introduced in the Canadian health care system in the late 1980s. While some authors have suggested that nurse practitioners offer “something special” to patient care, no evidence to date has substantiated this claim. The findings of this grounded theory study offer a theory (Acute Care Health Professional-Patient Relationship (ACHPPR) Theory) to describe how three types of health care professionals establish relationships with patients in acute care settings (Figure 7). This qualitative study explored relationships that ACNPs, physicians and staff nurses establish with patients in a large urban multi-site university-affiliated hospital. Six quartets (patient, ACNP, physician, staff nurse) were recruited and interviews, using a semi-structured guide were audio-taped and subsequently transcribed verbatim. Each type of relationship was found to have a unique focus; ACNPs focus on making connections with patients, physicians focus on managing patients’ diseases and staff nurses focus on meeting patients’ needs. In order to establish relationships with patients, readiness conditions must be met. Health professionals use strategies to influence the achievement of readiness conditions as well as to move forward with relationship development. Each type of relationship varies in the range of potential intensity that can be achieved, which is influenced by various dimensions. Relational intensity ranges from the uncommon clinical relationship, which focuses on the patient’s disease, through the more typical professional relationship characterized by a comfortable rapport and then finally to the most relationally intense, but rare, personal relationship. If a relationship reaches professional or personal levels of relational intensity, relational products become evident. When comparing these three health professional-patient relationships, similarities and differences have been identified. Analysis of patient interviews yielded themes that substantiate the ACHPPR theory. The ACHPPR theory offers a beginning understanding of the complementary nature of three types of health professional-patient relationships in the acute care setting and has the potential to influence practice, education, theory development and future research related to ACNP-patient relationships.

Learning to care and first encounter to care patients for male nursing students introduce a unique set of dilemmas to the predominantly female nursing educational process. The purpose of this study was to describe the experience male nursing students learning to care and first encounter care patients in their first nursing practice. A purposive sampling of seven male nursing students were interviewed by internet interview and analyzed by Qualitative content analysis. The results show that the Thai male nursing student stairway to confidence in nursing they start with feelings of stressfulness, developing sensitiveness, developing co—operation and developing strategies to care and encounter with patient. The results also seem to include gender specific questions on how to handle dilemmas in the predominantly female nursing education. These may reflect facilitators and barriers of developing a caring mind among male nursing students. Implication for nursing education and practice are presented and discussed.  In the clinical practice, the method of teaching was important to encourage, but also to gain additional knowledge and support peer groups as a suitable learning environment.

Handledaren är en nyckelperson i studenternas utveckling till professionella sjuksköterskor. Syftet med denna studie var att undersöka och beskriva sjuksköterskors uppfattning om  omvårdnadshandledning av sjuksköterskestudenter. Fokusgruppsintervjuer valdes som metod. Nitton sjuksköterskor deltog i intervjuerna. Materialet bearbetades. Två huvudkategorier formulerades: Egenskaper och Kompetens med ett övergripande tema: Handledningens kvalitet. I resultatet av intervjuerna framkom faktorer som har betydelse för en god handledning och utveckling av handledarrollen: handledarens- studentens och organisationens egenskaper samt pedagogisk- yrkes och social kompetens. Det framkom att viktiga kvaliteter både hos handledare och student är intresse och motivation samt ett gemensamt ansvar för studenternas lärande. Det efterfrågas faktorer som tid och acceptans för handledning från organisationen. En professionell sjuksköterska som är en bra förebild för studenten och har en god pedagogisk kompetens är bra handledare. För att kunna utvecklas i sin handledarroll efterlyser sjuksköterskorna feedback från sina studenter. Uppfattningen var att det är roligt att vara handledare och att det är en tillfredsställelse att lyckas föra en människa framåt i sitt lärande. / The preceptor is a key person in the students development to professional nurses. The purpose with this study was to examine and describe how nurses thinking of the preceptor ship for nurse students. Focus group interviews were chosen as method. Nineteen nurses participated in the interviews. The interviews were analysed. Two main categories were developed: Characteristics and Competence with a comprehensive theme regarding the nurses understanding of the quality of preceptor ship. The result of interviews showed factors of significance for the quality and development of the preceptor ship role: the preceptor, students and the organisations characteristics as well as pedagogical, professional and social competence. It was made clear that the interest and motivation as well as a mutual responsibility for the students learning is important qualities for both the preceptor and the student. Preceptors requested factors such as time and acceptance for preceptor ship from the organisation. A good preceptor is a professional nurse that is a good model for students and has a well developed pedagogical competence. To be able to develop one’s role as a preceptor, nurses are making inquiries about feedback from their students. The opinion of the preceptors was that it is amusing to be a preceptor and that it is satisfactory to succeed in leading a human forward in her development.

<p>Handledaren är en nyckelperson i studenternas utveckling till professionella sjuksköterskor. Syftet med denna studie var att undersöka och beskriva sjuksköterskors uppfattning om  omvårdnadshandledning av sjuksköterskestudenter. Fokusgruppsintervjuer valdes som metod. Nitton sjuksköterskor deltog i intervjuerna. Materialet bearbetades. Två huvudkategorier formulerades: Egenskaper och Kompetens med ett övergripande tema: Handledningens kvalitet. I resultatet av intervjuerna framkom faktorer som har betydelse för en god handledning och utveckling av handledarrollen: handledarens- studentens och organisationens egenskaper samt pedagogisk- yrkes och social kompetens. Det framkom att viktiga kvaliteter både hos handledare och student är intresse och motivation samt ett gemensamt ansvar för studenternas lärande. Det efterfrågas faktorer som tid och acceptans för handledning från organisationen. En professionell sjuksköterska som är en bra förebild för studenten och har en god pedagogisk kompetens är bra handledare. För att kunna utvecklas i sin handledarroll efterlyser sjuksköterskorna feedback från sina studenter. Uppfattningen var att det är roligt att vara handledare och att det är en tillfredsställelse att lyckas föra en människa framåt i sitt lärande.</p> / <p>The preceptor is a key person in the students development to professional nurses. The purpose with this study was to examine and describe how nurses thinking of the preceptor ship for nurse students. Focus group interviews were chosen as method. Nineteen nurses participated in the interviews. The interviews were analysed. Two main categories were developed: Characteristics and Competence with a comprehensive theme regarding the nurses understanding of the quality of preceptor ship. The result of interviews showed factors of significance for the quality and development of the preceptor ship role: the preceptor, students and the organisations characteristics as well as pedagogical, professional and social competence. It was made clear that the interest and motivation as well as a mutual responsibility for the students learning is important qualities for both the preceptor and the student. Preceptors requested factors such as time and acceptance for preceptor ship from the organisation. A good preceptor is a professional nurse that is a good model for students and has a well developed pedagogical competence. To be able to develop one’s role as a preceptor, nurses are making inquiries about feedback from their students. The opinion of the preceptors was that it is amusing to be a preceptor and that it is satisfactory to succeed in leading a human forward in her development.</p>

Control over nursing practice (CONP) is a participatory process through which nurses have input and engage in decision making about the context of practice and unit operations related to nursing practice. CONP has been associated with a number of positive outcomes related to nurse satisfaction, nurse status, effectiveness of patient care, and quality of patient outcomes. However, no comprehensive model has been created nor comprehensive analysis been conducted related to approaches for increasing CONP. This study tested a hypothesized model of antecedents to CONP developed from a review of the literature in nursing, psychology, and organizational management using a complexity theory perspective.The study used a nonexperimental, comparative design. The sample for data analysis consisted of 28 nurse managers and 583 staff nurses from 32 units in 10 hospitals. Existing instruments were used in a paper and pencil format to collect demographic and perceptual data on CONP and the hypothesized antecedent variables. Data were aggregated to provide an analysis of organizational and unit level contextual and variable effects related to CONP.Contextual regression indicated a greater influence of unit-level variables than organizational-level variables on nurses' perceptions of CONP. Regression analyses and revised model testing demonstrated that nurse manager supportiveness, implementation of a formal structure for CONP, and information flow consisting of open and accurate communication were positively related to CONP. Hierarchy of authority was negatively related to CONP. The relationship between CONP and job codification and autonomy varied based upon the measurement of the dependent variable. Manager's perception that participative decision making enhances organizational effectiveness; manager's perception that participative decision making does not reduce their power; nurses' experience, expertise, and educational preparation; and nurses' desire for control did not significantly relate to CONP as hypothesized.This study contributes to nursing research and clarifies strategies for improving the work environment for nurses by delineating antecedents to CONP in the acute care hospital setting. These data will be useful to nurses, nurse managers, and hospital administrators who want to improve patient safety, reduce patient mortality, increase nurse satisfaction, and increase nurse retention.

During their clinical practicum, nursing students are involved in making decisions about the care for their patient or group of patients. The purpose of this study was to ascertain nursing students' perceptions of the variety and magnitude of factors that influence them as they are making decisions about patient care. For the study a nonexperimental approach utlizing a cross-sectional descriptive design was used. Thirty-three second year and thirty-one third year nursing students from a diploma nursing school responded to a questionnaire designed to reflect perceived domains of influence in thier clinical decision making. A subset of 18 subjects were interviewed. Some of the major findings include: 1) More second year than third year students perceived stress as a factor affecting their clinical decision making. Third year students most often mentioned the instructor-student relationship as a source of stress. Second year students most often referred to their workload and fatigue as contributing to their stress. 2) More third year than second year students preceived decision making theory and the nursing process to be an influencing factor in decision making. 3) Previous life and health-related work experience was indicated to be an influencing factor in clinical decision making more often by second year students than by third year students. 4) When asked to choose and rank five from a list of sixteen influencing factors in clinical decision making, the combined group chose the following in order; knowledge of patients and their condition, level of self confidence, knowledge of nursing proces, relationship with instructor, previous nursing experience, and previous life experience. 5) In the interviews the two most frequently mentioned guiding forces in decision making were: (a)what they (the student) or someone close to them would want and (b)patient preference. The study encourages nursing instructors to be cognizant of the variety of forces impacting student decision making in the clinical setting. It also suggests that students who are encouraged to incorporate their personal reality in an atmosphere that provides some latitude in decision making will be more likely to assume decision-making responsibility. / viii, 96 leaves ; 28 cm.

No description available.

Aim: The aim of the study was to do an epistemological analysis of the power of women as nurses working in one of the larger and more deprived regions of South Africa, namely KwaZulu-Natal. This research was based on the premises of the Standpoint theory. Concurrent to the collection of data, a literature review and a concept analysis of power, powerfulness, powerlessness and empowerment were done and incorporated where applicable in the final theoretical framework. Methodology: A phenomenological approach was used. This incorporated two to three in depth interviews with each participant, lasting an average of thirty minutes each, was used. Women, relating to the gender factor, as nurses were also marginalised in terms of class, as they belonged to the enrolled category of nurses, and race, being African. A fourth selection criterium was added to analyse the reality of locality, called rurality. The researcher applied the principle of theoretical saturation and a total number of nine women, who belonged to the enrolled category of nurses and who worked in a distinct rural health care setting, were interviewed. A second group consisting of five women enrolled nurses and working in an urban setting were interviewed, as were a third relatively contrasting group of four women registered nurses. All forty four interviews were audio taped and transcribed, and a qualitative software package called NUD*IST was used to identify and refine experiential themes. Findings: The relationship between power and rights was often layered in contradiction during the interviews and the participants portrayed a picture of being oppressed or marginalised and powerless. The women as nurses belonging to the enrolled category were alienated as women and as nurses in terms of being severed from the nursing profession and from the ruling gender of men, of being lost in an ever present routinization of activities, of being misused, maternalised and domesticated at home and at work. These phenomena were quantitatively more voiced by the rural group of women and these participants strongly emphasized the limiting influence of their prescribed scope of practice, the approach of the senior category of nurses and they conveyed a traditionalist and altruistic view of nursing and nurses. The women as registered nurses created their own freedom often away from their men as in divorce. They also sought for solutions concerning powerlessness in more global and distant terms, for example in relation to cultural practices. They communicated a sense of empowerment in terms of for example education, personal qualities and increased job satisfaction. Culture rather than race was emphasized as an essence of womens' oppression. An epistemological framework of the power of women as nurses developed by the researcher constructed the totality of empowerment in terms of fifteen transformational and hierarchial actions incorporating and adapting Dooyeweerd's theory of modalities and the surfaces of class (categorial divide), gender (the eternal carer), race (culture) and locality (rurality). These actions and reformulated concepts could be used for the development of specific strategies to facilitate the empowerment of individuals, groups and communities of women as nurses and nurses as women. Further collaborative research into the phenomenon of power, a reconceptualization of nursing education and levels of expertise and hierarchies within nursing were some of the suggestions for the way forward. / Thesis (Ph.D.)-University of Natal, Durban, 1996.

To live HIV positive and age into older adulthood is a new phenomenon. Research is helping to identify how the body is biologically impacted by the complex convergence of the virus, antiretroviral drug treatment, and aging. And yet there is more. One has to live in their body. Believing that stories of living with illness hold meaning, we also need to understand the lived experience of persons aging with HIV. When we engage and listen to stories of everyday lived experience, we are afforded a way to gain insight into particulars of aging with HIV, and this in turn generates understanding and compassion that can connect and teach all of humanity about the broader experience of life. The intent of this dissertation is to present the narrative inquiry I have undertaken over a five year period. I begin with an introduction to the phenomenon of aging with HIV and then present four manuscripts, two that highlight research findings related to metaphors and themes within stories, and two that focus on the interview process and narrative practice. In a concluding chapter I weave together my emergent understanding of what it means to age with HIV, narrative inquiry, and discuss implications of the findings that may take nursing and nursing care forward. In the first manuscript I address tensions that arose and troubled my narrative interviewing approach. Tensions arose when a) presence was tempered by performance, b) power by equality, c) leading by following, d) insider by outsider, e) being non-influential by social influences, and f) trust tempered by responsibility. These tensions, which I refer to as a dynamic process of breathing in the mud, can act as catalysts that ignite clarity and advance narrative interviewing. In the second manuscript I explore metaphors within the stories of 5 adults’ experiences of aging with HIV. Metaphors reveal a complex struggle of living in-between tensions of uncertainty and hope, of facing death and living in the moment, and of hurt amidst joys of evolving identity. The overarching metaphor of “shadows and sunshine” reveals that to age with HIV is to survive and live in a fragile state, balancing multiple shadows such as stigma and side effects with joyful experiences of support and belonging. In the third manuscript I present results of a narrative analysis exploring HIV and aging stories of five adults, age 55-62, who have lived with HIV for 13-24 years. In analyzing the co-constructed stories, six common storylines were identified: the illness embodied, the journey of sense making of, intimacy with death and loss, ongoing secrets and stigma, evolving identity, and living in connection. These findings illustrate the vitalness of telling one’s illness story, as sense making happens in the telling and supports one to adapt. The final manuscript is a call to action and emphasizes cultivating a narrative sensibility in nursing practice. I offer the mnemonic STORIED to help nurses weave together essential elements of a narrative practice approach: Subjective, Tell/Listen, Openness, Reflection, Invite/Intention, Engage, and Document. / Graduate / 0569 / rosanne.beuthin@shaw.ca

Bring Your Own Device (BYOD) phenomenon is important in the healthcare environment because this growing trend is totally changing the workplace landscape in healthcare organizations, such as British Columbia (BC). The organizations need to be proactive and aware of this trend to decide the best way to approach this phenomenon. Currently, there is little current research that exists in Canada in context to provide a distinct understanding of the complexities and difficulties unique to this phenomenon within the nursing practice. In order to develop an understanding of BYOD in healthcare workplace, a perspective was needed of those experiencing the phenomenon of interest. The premise of this research was to explore the BYOD phenomenon from the nursing perspective. This study focused on the experiences, views, and perceptions of nurse executives/managers about how they make decisions regarding use of personal handheld devices in the workplace. A qualitative description was undertaken and the collection of data involved telephone interviews in which participants were asked to reflect on their views and/or experiences regarding BYOD in the workplace. During the literature research process, the researcher discovered that there were similar research studies previously done in the early 2000s that found early healthcare organizational concerns with the use of personal digital assistant devices (PDA) in the clinical setting. In this study, four major themes emerged that provided an insights as to how nurse NEx/M make decisions regarding BYOD. The four major themes included: 1) management perspective, 2) opportunities, 3) disadvantages, and 4) solutions. The results of this study will aid in bringing greater awareness of BYOD to other executives and managers in nursing and should also provide information to the leaders throughout the healthcare organizations and health IT department. / Graduate