The purpose of this project is to support health promotion of children entering foster care, ensure that children receive all health care services needed, prevent the trauma of duplication of immunizations, and reduce disruption of health care as children move through the foster care system.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal.

Pain is the most prevalent medical problem that elderly persons experience in a long-term care home. Nurses play an essential role in managing their pain. The purpose of this study was to explore nurses’ pain management practices in Ontario long-term care homes facilities. The ultimate aim was to recommend measures for effective pain management in aged people. The setting for this study was a selected long-term care home in Ontario, Canada, a 160-bed nursing home for aged people offering various medical care services. Semi-structured focus group interviews, averaging approximately one hour, were conducted. The population of this study was 45 nurses. The researcher used a purposive sampling method to select a sample of 25 nurses. Open-ended questions were used to explore pain management practices and to find barriers to effective pain management. Qualitative data analysis was used to review the data to identify common issues that recurred, and they were summarised in a narrative form. This study demonstrated the importance of recognising and overcoming barriers to the effective management of pain and reinforcing good practices in long-term care homes. Therefore, improved pain management practices are required to manage pain in a long-term care home effectively. / Health Studies / M.A. (Nursing Sciences)

The main aim of this research study was to explore attraction factors pertaining to the literature and to the occupational context of nursing personnel who have exhibited employment interest in a managed care organisation. A qualitative research approach was adopted in which semi-structured interviews were held to collect rich exploratory data from the purposeful sample of nine applicants with nursing qualifications. Twenty-five themes were identified through interpretive data analysis as being important factors in the pre-interview attraction process. The highest ranking of these were identified to be opportunities for professional and personal growth and the relationship with the managed care client, followed by salary and working hours. This study contributes knowledge to Personnel and Career Psychology in the field of Industrial and Organisational Psychology and is pertinent to organisations recruiting nurses, advising them in the formulation of contextually appropriate attraction strategies that attend to the most notable attraction factors / Industrial and Organisational Psychology / M.Com. (Industrial and Organizational Psychology)

The purpose of the study was to explore and describe the lived experiences of general nurses working at Standerton hospital medical wards which also admit psychiatric patients. A qualitative, descriptive phenomenological approach was used for the study. The study population consisted of seven general nurses working in medical wards at Standerton hospital. Purposive sampling was used to select participants who met the inclusion criteria. Researcher used in-depth face to face interviews to collect data until data saturation was achieved. Tesch’s method of qualitative data analysis was utilised to identify themes. Three themes and five sub-themes emerged from the study: theme1: perceived danger due to aggression sub-themes stress for medical patients, stress for medical patients’ families and stress for nurses. Theme 2: lack of skills in dealing with psychiatric patients’ sub- theme use of restrains. Theme 3: self fulfilling prophecy subtheme reported incidences. The study findings demonstrate the plight of general nurses who are not trained to work with psychiatric patients but continue to do so. Findings further accentuate what is already known about the labelling that goes with psychiatric patients and aggression as a resultant effect. Recommendations were made for future research, policy makers, nursing education and practice. / Health Studies / M.A. (Health Studies)

Background: Diabetes mellitus (DM) affects more than 29.1 million Americans. Standardized clinical practice guidelines recommended by regulatory healthcare agencies are the standard of care for diabetic patients and must be adhered to by healthcare professionals providing care. Purpose: The purpose of this quality improvement project was to identify Centers for Medicare and Medicaid Services’, Joint Commission on Accreditation of Healthcare Organization’s, and other professional healthcare organizations’ guidelines for nurses’ knowledge of evidence-based discharge practices; determine level of nurses’ knowledge on evidence-based discharge practice process; develop a quality improvement plan, including development of an evidence-based guideline for diabetic discharge instructions; present guideline to stakeholders; implement the guideline in fall of 2017; and evaluate nursing compliance with the guideline at a for-profit adult care hospital in South Florida. Theoretical Framework: The chronic care model was utilized as the framework. This model has been used for improving practice and preventing many chronic illnesses. Methods: Two quantitative nonparametric descriptive designs were used, the Wilcoxon signed- rank test and a paired t test. An online demographic survey and pre- and posttest surveys were administered to determine nurses’ knowledge of diabetes discharge guideline practices. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) evaluation tool evaluated the guideline, and data were analyzed with Wilcoxon and paired t tests. Results: A statistically significant difference was found in the pre-posttest survey responses for question 5 (p=0.046 Wilcoxon; p=0.041t test), and question 13 (p= 0.022 Wilcoxon; p=0.018 t test), indicating improvement. With the AGREE II tool, the multidisciplinary team evaluated the guideline at 100%, and 76% of Advanced Practice Registered Nurses (APRNs) and Registered Nurses (RNs) demonstrated compliance with guideline use. Conclusion: A standardized diabetic discharge guideline incorporated into the hospital’s discharge process provided APRNs and RNs with tools for educating and providing diabetic patients for increase in quality of life after discharge. The guideline was recommended by the administrative team for continued use throughout the hospital. Implementation of an evidence-based standardized diabetic discharge guideline to promote nurses’ adherence results in effective nursing practices and an informed patient population.

The purpose of this dissertation is to examine nursing homes‟ compliance with state minimum nurse staffing standards and its relation to quality-of-care deficiencies. Specifically, this study, reviewing staffing standards from 50 states and the District of Columbia for the year 2007, proposes a unique algorithm to calculate the states‟ expected nurse staffing levels for individual nursing homes in order to investigate their compliance with the state nurse staffing standards. By using hierarchical linear modeling method, this study attempts to capture the impact of the staffing standards on actual nurse staffing levels under resource dependence perspectives. Path analysis using structural equation modeling was conducted to investigate both direct and indirect effects of the staffing standards on nurse staffing levels and quality-of-care deficiencies. The major findings were as follows: (1) nursing homes in states with higher state staffing standards for the categories of RN, LN, and total nurse were found to have higher RN, LN, and total staffing levels, respectively; (2) higher nurse staffing levels resulting from higher state staffing standards were significantly associated with better quality of care (less quality-of-care deficiencies cited) in nursing homes; and (3) state staffing standards were found to have much stronger contribution to nurse staffing levels than any other organizational or contextual factors while nurse staffing levels, particularly licensed staff, were found to have stronger contribution to quality-of-care deficiencies than any other organizational factors. The study findings suggest that if the goal is to increase nurse staffing levels for better quality, increasing the stringency of both federal and state nurse staffing standards would be the iv most effective way. However, the staffing standards first need technical changes to reduce their ambiguity and ensure their fairness. If the goal is to achieve better quality, merely increasing nurse staffing levels may not be effective since the variation of the quality-of-care deficiencies explained by exogenous variables was smaller than random variation 5%. If state Medicaid reimbursements can be utilized for financial incentives for better performing nursing homes, nursing homes may improve their productivity by efficiently managing organizational personnel or increasing job satisfaction among nursing practitioners. Lastly, longitudinal analysis, considering variation in length of state staffing policy implementations, is encouraged to investigate the long-term effects of state staffing standards on nurse staffing levels and quality of care.

The purpose of this study was to describe and compare the perceptions of the registered nurses and the nurse managers regarding the role of the registered nurse in integrated primary health care. Quantitative, descriptive research was conducted to determine if there were any discrepancies between role perceptions and role expectations. Data collection was done using structured questionnaires. Two groups of respondents participated in the study. The registered nurse group (n=40) provided direct clinical care in integrated primary health care settings. The second group was composed of nurse managers (n=20) managing integrated primary health care services. The findings revealed that there are some areas where there is lack of congruence between the perceptions of registered nurses and nurse managers regarding the functions that registered nurses perform. These differences may result in confusion and role conflict among registered nurses, which can ultimately impede the attainment of integrated primary health care goals. / Advanced Nursing Sciences / M.A.(Nursing Science)

In hierdie beskrywende studie is die belang van sorg in verpleegbestuur ondersoek. Die Nyberg Caring Assessment Scale (Nyberg 1989) is benut om die data in te samel. Die doel van die studie was om die sienings van verpleegbestuurders en die ervarings van verpleegkundiges betreffende sorgkonsepte te bepaal. Die data is deur middel van vraelyste by private hospitale in Pretoria ingesamel. Die data-analise het getoon dat verpleegbestuurders en verpleegkundiges sorg as belangrik in verpleegbestuur beskou. Daar is verskille betreffende die sienings van verpleegbestuurders en die ervarings van verpleegkundiges aangaande sorg in verpleegbestuur waargeneem. Dit blyk dat verpleegbestuurders en verpleegkundiges 'n behoefte aan opleiding betreffende sorg in verpleegbestuur benodig en 'n kort kursus is ontwerp om hierdie behoeftes aan te spreek / In this study the importance of caring in nursing management was researched. The Nyberg Caring Assessment Scale (Nyberg 1989) was used to collect data. The purpose of the study was to investigate viewpoints of nurse managers and experiences of nurses regarding caring concepts. The data was collected by means of questionnaires at private hospitals in Pretoria. It was clear from the data analysis that nurse managers and nurses regard caring important in nursing management. Perceptions of nurse managers and the experiences of nurses on caring in nursing management, differ. It was clear that nurse managers and nurses experience a need for training with regard to caring in nursing management and a short coarse was design to address the need / Health Studies / M.A. (Verpleegkunde)

Text in Afrikaans / In hierdie studie is die noodsaaklike bestuursrol van die rampverpleegster tydens rampoptrede en direk daarna verken, nagevors en beskryf. Haar bevoegdheid om die verskillende rampbestuurstake effektief te kan verrig voor, tydens en na rampe wat buite 'n hospitaal plaasvind, is oak nagegaan. Bestuurstake is geidentifiseer waarmee verpleegsters tydens rampsituasies buite hospitale vertroud behoort te wees. Die navorsingsprojek het deur middel van vraelyste biografiese data ingesamel met betrekking tot die persone wat as rampverpleegsters by Burgerlike Beskerming in Pretoria geregistreer is, met die doel om 'n kursus aan te beveel wat pertinent op hul behoeftes gerig is. Die rampverpleegster se behoefte aan toepaslike verdere opleiding, inoefening of leiding betreffende die ge1dentifiseerde bestuurstake, is bepaal. Dit het geblyk dat opleiding in die meeste take nodig is, en 'n kursus in rampbestuur vir verpleegkundiges is ontwerp / In this study the essential management role of the disaster nurse during disaster action was outlined, researched and described. Her competency to effectively execute disaster relief tasks before, during and after a disaster occurring outside a hospital, was studied. Management tasks were identified which nurses should have mastered regarding disaster situations occurring outside hospital boundaries. Research data were gathered by means of a questiorinaire on the biographic detail of disaster nurses registered with · Civil Defence in Pretoria, in order to recommend a course specifically aimed at fulfilling their requirements. The research project identified requirements of the disaster nurse for appropriate further training, practise and guidance regarding the identified-management tasks. It became evident that training is required in most of the tasks, and a training course for nurses in disaster management was designed / Health Studies / M.A. (Verpleegkunde)