Thesis (Ph. D.)--University of Missouri--Columbia, 2002. / Typescript. Vita. Includes bibliographical references (leaves 131-142). Also available on the Internet.

This research sampled a group of 261 nurse managers to test the relationships among organizational structural variables and the utilization of nursing practice innovations. Subjects completed instruments that measured organizational complexity, centralization, formalization and the utilization of nursing practice innovations. Pearson correlations revealed a significant positive relationship between utilization of nursing practice innovations and individual perception of autonomy in decision-making. Within organizational centralization the decision-making components of organizational centralization entered into a multiple regression equation which explained 27% of the variance in utilization of nursing practice innovations, with total decision-making contributing the greatest amount of variance. Organizational complexity variables entered into a multiple regression equation which explained 2% of the variance in utilization of nursing practice innovations with the certification variable explaining the majority of the variance. Five variables related to organizational centralization and complexity together explained 28% of the variance in utilization of nursing practice innovations with the total decision-making variable explaining the majority of the variance.

Thesis (Ph. D.)--University of Washington, 1995. / Vita. Includes bibliographical references (leaves [122]-131).

A research report submitted to the Faculty of Health Science, University of Witwatersrand, Johannesburg ,in partial fulfillment of the requirements for the degree of Master of Science in Nursing, September, 2013 / Background: Despite many advances on evidence-based practice (EBP), nursing is still not based on evidence. Trained intensive care unit (ICU) nurses may be the key to EBP in the ICU. Purpose: To describe the knowledge, attitudes and practices of trained ICU nurses on EBP at an academic hospital in Gauteng. Design: Mixed methods sequential explanatory. Method: Data were collected from trained ICU nurses who were purposely selected using a validated tool (Upton & Upton, 2006) to obtain the quantitative results on their knowledge, attitudes and practices on EBP (n=100) and then followed up with 12 expert trained ICU nurses in two focus groups to explore the quantitative results in more depth. The quantitative and qualitative findings were then combined at discussion of results. Results: From the quantitative results, the majority of the nurses selected the best category: 81.0% on knowledge towards EBP, 75.0% on attitudes towards EBP and 75.0% on practices towards EBP. The qualitative results identified three categories: perceptions, challenges and suggestions. The trained ICU nurses were knowledgeable in their understanding of EBP but lacked knowledge in the skills of accessing evidence. Welcoming attitudes towards EBP were displayed but admitted to their practices being partly evidence-based due to challenges that included resistance to change, confusion of evidence, lack of resources, time and autonomy. The instrument was found to be reliable and valid with a Cronbach’s alpha of 0.94 for the entire questionnaire and the study increased its validity in the South African context. This study indicates that although trained ICU nurses are knowledgeable about EBP, they are still lacking in skills regarding EBP. Even though the trained ICU nurses have welcoming attitudes towards EBP, their practices towards EBP are not fully evidence-based due to the identified challenges. This study therefore suggests capacity building of the trained ICU nurses as well as development of their EBP skills to support EBP.

Palliative care and hospice philosophies, practice, and research can be understood as a movement to counter dehumanizing aspects of the medicalization of death—a movement to “reclaim” the individuality of dying. However, this push to singularize dying (as one’s own) becomes part of a universalizing process as death is managed within institutional spaces and medical discourses. From an ontological perspective, the individuality of mortality—i.e., dying—can be understood in opposition to the universality of death. In contemporary society, there is a paradoxical relationship within the management of death: there is an attempt to universalize the singularity of dying. This thesis is proposed to address contemporary conceptual “problems” of dying and responses to them, as historically and contextually situated, through a Heideggerian phenomenological understanding and methodological critique of selected phenomenological nursing research related to dying. The intent is to explore the ways dying is constructed as an object of phenomenology through an analysis of the ontological and epistemological ambiguities within this literature to pose the ensuing methodological implications. The thesis hopes to propose an alternate way to conceptualize dying for this literature and it aims to suggest implications for theory and method in this field of research. / Graduate / 0344

This study was an effort to evaluate the effectiveness of a two day institute on "Evaluation of Personnel" as an educational experience in the continuing education of nurses, to submit to critical analysis a method of evaluation, and to examine the relationship of educational and experiential backgrounds of the participants to the learning which took place subsequent to an observational analysis of the institute. An unstructured interview technique was used three months after its completion to elicit subjectively what respondents thought they had learned at the institute. The information was later arranged in a structured format for compilation, tabulation and analysis, both by punch card and computer. The socioeconomic background data was gathered through the use of a structured questionnaire at the time of the interview. A behavioral concept of learning was used throughout. The results revealed that 91% of the sample indicated that learning had occurred, as they perceived a change in their behavior because they had attended the institute. Further, 76% perceived a change in knowledge, 62% in attitude, and 76% in practice, while over half perceived a change in all three areas. The greatest change was perceived by those who were younger, married, had less education (academic and post basic nursing), less experience in nursing, and who were employed in the larger agencies. The perception of little or no change was indicated by those with more education (academic and post basic nursing), more experience in nursing, and who were employed in the smaller agencies. The comparisons of change to background factors revealed that, although none of the comparisons were consistently significant, there was a positive relationship of learning with age, basic academic education, post basic nursing education, years of nursing experience, and size of employing agency. Marital status, husband's occupation, parental status, income, social participation, years of head nurse experience, size and type of nursing unit and size of staff showed some interesting comparisons by observation, but the sample proved too small for accurate inferences to be drawn. The conclusions of the study were that the institute was effective as an educational experience for continuing education in the three aspects of behavioral learning examined, provided the credibility of the respondents was acceptable. The instrument used was adequate for the purpose of indicating change of behavior with the above proviso, but not adequate for revealing whether change was relevant to certain socioeconomic data. No claim can therefore be made concerning the relationship between this data and learning in a situation such as this institute. / Education, Faculty of / Educational Studies (EDST), Department of / Graduate

The aim of the study was to develop a participatory research model drawing from qualitative research about the lifeworld perspectives of people with early-stage dementia. Twelve participants with early-stage dementia were recruited from a compensatory adult school VUK (Voksenskolen for Undervisning og Kommunikation) in Denmark. They were trained in research skills to enable them to conduct a participatory research project in collaboration with the researcher. During the study, the participants informed the research project and the participatory research model. A combination of participant observations, interviews and focus groups were used with observations and interviews being conducted before the research skills' training to enable the researcher to plan the training and the participatory research project in accordance with the participants´ competencies and challenges. Data were analysed from a hermeneutic phenomenological perspective inspired from the work of Max Van Manen. The focus groups were used both during the training and the participatory research project and video data from these were analysed by a thematic analysis inspired by Braun and Clarke. The participatory research model illustrates the importance of recruiting and gaining consent from people with early-stage dementia in a way which takes into consideration the needs of the participants. It can be necessary to both adjust the recruitment strategy and the consent form. In order to allow them to be involved as active research participants, it is essential to plan and establish a research project which reflects the participants´ individual cognitive challenges. To simplify the project and establish small project groups can be supportive. Also role agreements are vital. It is essential to train and support them in different ways throughout the research process and, among other strategies; it is useful to have an errorless inspired learning environment with a structure that is repeated. Furthermore, it is important to evaluate continually to ensure the most constructive process throughout and focus groups can prompt more in-depth answers by the participants. The participants also need support and structure provided by the researcher in any dissemination phase. Furthermore, the researcher needs to invest in the interaction with the participants to establish trusting committed constructive research collaboration from the beginning. It is also important that the researcher balances the roles of being a researcher and a supporter together with being a teacher and a learner when collaborating with people with early-stage dementia. It is about balancing the power in the relationship. Furthermore, the researcher has to support the participants own peer-learning and -support together with creating a relaxed atmosphere. The participatory research model “Balanced Participation” takes these considerations into account, with the result that more people with early-stage dementia will be able to be involved in future qualitative participatory research.

Nurses and midwives are well placed to improve the health outcomes of patients in a number of areas, so the fields of nursing and midwifery must include the ability to conduct rigorous research, synthesize findings into relevant evidence, and use research to inform practice. However, clinical nursing issues in regions such as the Eastern Mediterranean Region (EMR) are often under-researched. The three projects included in this proposal are part of a larger study funded by the Columbia University President’s Global Innovation Fund in collaboration with the Office of Global Initiatives of Columbia University School of Nursing. This dissertation includes three aims: (a) conduct a scoping review of published clinical nursing research to assess the current state of research in the region, (b) conduct a formal program evaluation of a Research Summit that identified clinical nursing and midwifery research priorities and developed an action plan for the EMR, and (c) describe perceptions of barriers and facilitators to research utilization among nurse leaders in the EMR. The results of the scoping review demonstrated that there was limited clinical nursing and midwifery research that has been conducted in the Region. The program evaluation indicated that the Summit was successful and a number of actionable projects have been carried out as a result. Furthermore, the results of the Barriers Scale (Funk et al., 1991) showed that the main barriers to research utilization were lack of funding and resources, lack of support, lack of interest, and lack of training while the main facilitators were placed into the categories of improving support and research culture, resources, and education and training. GDP also significantly impacted the extent to which participants experienced barriers to research utilization. It is important that more Region-specific research be carried out. In order to do this, the research skills of nurse/midwife researchers need to be enhanced and the dissemination of their research supported. Nurse and midwife researchers in the Region should develop consensus regarding specific regional clinical research topics to be given priority and provide support so that nurse and midwifery researchers overcome any barriers they face regarding utilizing clinical research in their practice so that patients can be provided with better and safer care.

This Ph.D. by Publication essay organises my work in four sections: Between Practice and Research; Between Practice and Clinical/Operational Management; Between Practice and Policy; and Between Practice and the Public. A context-setting introduction puts the work in the temporal frame of the 1960's through 2001 and announces the point of view taken on nursing: the reason for the existence of the modern health care delivery system is to provide nursing care. In the first section, the publications deal with the development of clinical nursing research methods. My particular effort was to conceptualise the relationship between nursing practice and research. The publications show how that relationship was actualised. The second section contains work done 20 years or so after that reported in the first section, but the work is closely related. Here, the publications deal with the extension of the notion of nursing practice research to clinical/operational management using the rich administrative data produced by casemix (Diagnosis Related Groups - DRGs). This body of work reveals nursing as resource. The third section holds literature review and policy analysis that provide the contexts for nursing practice. Publications deal particularly with the 'expanded role' of nursing as nurse practitioner, nurse-midwife and nurse anesthetist. Research and policy are knit together in this section. In the fourth section, I connect nursing to public forums. The concluding section draws together the themes that have occurred throughout: valuing nursing and making the discipline visible and credible in terms the world understands. The thesis ends with a metaphor that makes research, operations and policy one with public practice: nursing as craft. / This Ph.D. by Publication essay organises my work in four sections: Between Practice and Research; Between Practice and Clinical/Operational Management; Between Practice and Policy; and Between Practice and the Public. A context-setting introduction puts the work in the temporal frame of the 1960's through 2001 and announces the point of view taken on nursing: the reason for the existence of the modern health care delivery system is to provide nursing care. In the first section, the publications deal with the development of clinical nursing research methods. My particular effort was to conceptualise the relationship between nursing practice and research. The publications show how that relationship was actualised. The second section contains work done 20 years or so after that reported in the first section, but the work is closely related. Here, the publications deal with the extension of the notion of nursing practice research to clinical/operational management using the rich administrative data produced by casemix (Diagnosis Related Groups - DRGs). This body of work reveals nursing as resource. The third section holds literature review and policy analysis that provide the contexts for nursing practice. Publications deal particularly with the 'expanded role' of nursing as nurse practitioner, nurse-midwife and nurse anesthetist. Research and policy are knit together in this section. In the fourth section, I connect nursing to public forums. The concluding section draws together the themes that have occurred throughout: valuing nursing and making the discipline visible and credible in terms the world understands. The thesis ends with a metaphor that makes research, operations and policy one with public practice: nursing as craft.

This study describes the types of statements made by nurses as first impressions (hypotheses) of patient problems treatable by nurses in response to limited information (cues). Subjects were nine groups of nurses (n = 243), who varied in length of experience and in educational level from diploma students through masters students. / Completion of a paper and pencil task yielded 4199 hypotheses which were classified into 13 categories. Major differences were found between types offered by a group of master's students who had studied the diagnostic process and the remaining groups. Of the former's hypotheses, 85.6% were nursing diagnoses compared with a range of 35.5 - 61.4% from the latter. / Possible reasons for nurses' inability to make nursing diagnoses are failure to hypothesize the presence of appropriate problems and a lack of distinction between a nursing diagnosis, a medical diagnosis, data and plans for care.