M.Cur. / In the cardiothoracic critical care unit, the respiratory management, post-extubation forms an important component of the total nursing care of the patient. To ensure optimal respiratory management the critical care nurse needs guidelines through which quality and continuity of nursing care can be ensured. Through the effective management of the respiratory system of the patient the critical care nurse contributes to maintaining, promoting and restoring health. In this way the critical care nurse facilitates the patient's strive towards reaching his/her objective of obtaining wholeness and he/she obtains his/her objective of quality nursing. The aim of this study is to formulate guidelines for the respiratory mangement of the cardiothoracic patient, post-extubation. A qualitative-descriptive contextual spesific reseach was followed in which a focus group interview, the opinions of field specialists and the deductive analysis of a literture study were used to formulate guidelines for the respiratory management of the cardiothoracic patient, post-extubation. An analysis was done through which the focus group interview was coded and categories were formulated. These main categories and subcategories were then further explored and described by the literature and by die opinions of the field specialists. The guidelines which were formulated must relieve the uncertainty that exists among different critical care nurses and it must ensure continuity of nursing care. After the guideliness have been established to promote the nursing practice recommendations were made for nursing practice, nursing education and for further research.

Nurse managers are essential in providing safe and effective patient care. The nurse manager position is a professional role necessary for the overall success of a hospital, clinic, or home health agency. The national education minimum for the initial entry to practice for registered nurses in the United States varies from diploma-training school to collegiate education at Associate, Bachelor, and Masters levels. Other professional healthcare workers need a Doctoral degree upon entry into practice. Nurse managers who lead multidisciplinary teams of other professionals are not required to achieve higher academic credentials in the United States beyond the initial entry to practice minimum. This study examined the relationships among nurse manager education levels, leadership style, and empowerment. It explored how the nurse managers' levels of education and empowerment correlate to the patient safety chain of transformational leadership that leads to a safety culture. Additionally, the variable Magnet designation was examined. The investigation was an observational one-sample study design (N = 142). An electronic survey was used to assess perceived leadership style, empowerment, and safety culture. Data were collected on professional social media platforms, including LinkedIn. Additionally, Nurse managers at the 2022 ANCC Magnet/Pathways Conference were approached to complete the online survey. The investigation results suggest that education does not influence leadership style or empowerment; however, this study's findings suggest that nurse managers with an undergraduate degree are significantly more effective in their leadership abilities than nurse managers with graduate degrees (p =.036). In this investigation, Doctoral-prepared nurse managers were more likely to use a transactional form of leadership than Bachelor or Masters prepared nurse managers (p = .029). The participants' empowerment levels were lower than in similar nurse manager studies before 2020. This finding may be a post-pandemic symptom. Moreover, nurse managers who work in Magnet–designated facilities are more likely to perceive their work environment as safe (p = .006). Magnet status was additionally associated with nurse managers' ability to create success and influence their team (p = .037). The ANCC Magnet and Pathways Programs may blueprint an effective, safe nursing service.

Spontaneous abortion, or miscarriage, is an event that affects approximately one in four women during their reproductive years. Despite the psychological and physiological trauma associated with the loss of pregnancy, few evidence-based practice recommendations exist to guide nursing care of women experiencing first trimester miscarriage. The purpose of this integrative review of literature was to examine research related to women's health care experiences of first trimester miscarriage and discuss common themes relating to nursing care. Inclusion criteria consisted of peer review research articles published after 2001 and available in the English language and women that experienced miscarriage during the first 12 weeks of pregnancy. Current literature was collected from Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE- EBSCOhost and PsycINFO databases using combinations of various key words. Six qualitative studies and one quasi-experimental study met the inclusion criteria and were reviewed. The results indicated that nursing care of women experiencing miscarriage should include therapeutic communication, psychological support, and provision of information and follow-up care. While there is little research reviewing nursing interventions related to first trimester miscarriage, these themes may help guide the development of further research reviewing the efficacy and effectiveness of specific nursing interventions.

Este estudo objetiva analisar as ações voltadas para a promoção da qualidade de vida dos trabalhadores de enfermagem, desenvolvidas pelos enfermeiros que desempenham funções gerenciais. Para tanto, busca conhecer os processos destrutivos e favoráveis, determinantes dos processos saúde-doença, vivenciados pelos trabalhadores de enfermagem; apreender o significado da qualidade de vida no trabalho para estes trabalhadores; e, a partir daí, buscar propostas de intervenção para esta problemática. O estudo, de abordagem qualitativa, fundamenta-se no referencial do materialismo histórico e dialético e na determinação social do processo saúde-doença. O cenário de estudo foi um hospital universitário, de grande porte, localizado na região centro-oeste do País. A população foi constituída por 22 trabalhadores, de diversas categorias de enfermagem, representantes das unidades e turnos de trabalho do Hospital. Para a coleta de dados foram utilizados formulários para captação dos dados de caracterização da instituição e dos trabalhadores, dos acidentes de trabalho e formulário com questões norteadoras das discussões no grupo focal. Ainda, a enquête coletiva foi utilizada para o registro dos dados discutidos neste grupo. A análise dos dados permitiu evidenciar que: os acidentes de trabalho com trabalhadores de enfermagem representaram, respectivamente, 51% e 25% do total de acidentes ocorridos nos anos de 2004 e 2005, causados principalmente pelos materiais pérfuro-cortantes; que a qualidade de vida e a qualidade de vida no trabalho são indissociáveis, sendo que a motivação para o trabalho e a satisfação advém da interação e reconhecimento dos pacientes, bem como pelas relações de confiança que são estabelecidas com a equipe de trabalho; que os processos favoráveis e destrutivos da saúde permeiam o momento de trabalho; que a exposição às diversas cargas, geradoras de processos de desgaste, evidenciaram um perfil destrutivo da saúde e, conseqüentemente, o comprometimento da qualidade de vida; que não existem programas ou ações institucionalizadas que promovam a qualidade de vida trabalho. A análise ainda possibilita a apreensão do desgaste psíquico sofrido pelos enfermeiros, na gerência, frente às mudanças no contexto de trabalho e seu impacto na qualidade de vida dos trabalhadores de enfermagem; que as mudanças e os desgastes evidenciados comprometem a atuação deste profissional como cuidador da equipe, promovendo um desgaste físico e mental no cumprimento das metas organizacionais. A análise evidencia, ainda, que inexistem iniciativas voltadas à promoção da qualidade de vida dos trabalhadores como uma responsabilidade gerencial e estas são relegadas a segundo plano, na emergência de situações demandadas no dia-a-dia de trabalho. Em síntese, constata-se que inexistem propostas de promoção da qualidade de vida dos trabalhadores de enfermagem ou estas são muito tímidas. Assim, emerge o imperativo da intervenção nas diferentes realidades, por enfermeiros preparados para gerenciar a promoção da qualidade de vida dos trabalhadores de enfermagem / This study aims to analyze the actions that are directed through the promotion of nursing workers quality of life, developed by the managerial nurses. For this, it searches to know the favorable and destructive processes, as determinants of the health-i process lived by the nursing workers; to apprehend the means of work’s quality of life for them; and, then, it searches proposa of interventions for this problernatic situation. The study is based in the qualitative approach of historical and dialectic rnaterialist and on referential of the social determination of the process health-illness. The setting of study was a big university hospital, which is situated in the center west region of Brazil. The population of study was composed by 22 nursing workers. They carne from many units and shifts of work. Data coilection about institution, workers profiles and occupational accidents was made by forms. Qualitative data was collected by coliective interview in the focus group. Still, the coliective inquiry was used to register the discussion of this group. The analysis of occupational accidents data evidenced that: in the years of 2004 and 2005, the nursing workers suffered a great number of these accidents, respectively, 51% and 25% of the total and that these accidents had as main cause due needlestick materiais; analysis data also showed that the quality of life and work’s quality of life are strongly iinked and that the motivation and the satisfaction for the work corne of the interaction and recognition with of the object of work, as weli as for the reiations that are estabiished with the work tearn; that the favorable and destructive processes of health are determined in the workplace; that the exposition to diverse over workloads configures a destructive profiie of the health and the consequence is the decrease of the quality of life; that it doesn’t have institutional prograrns or institutional actions that promote the work’s quality of life. Stili, the analyze make possibie the apprehension of the psychic strain suffered by the management nurses through the changes in the context from work and the impact from this in the nursing workers quaiity of life; that the changes and the strains cornpromise the performance of these nurses as manager of the team, promoting physical and mental strain in the fulfillment of organizationai goals. The analysis evidences, stiii, that no have initiatives directed to the prornotion of workers’ quality of life as a management responsibiiity and these are relegated as the second piam, in the emergency of situations demanded in day-by-day of work. in synthesis, the study evidences that there haven’t proposais for the promotions of nursing workers’ quality of life or, if exist, these are very shy. Thus, the irnperative of the intervention in the different ones realities ernerges for prepared nurses to rnanagement the promotion of nursing workers´ quality of life

Rising health care costs place increased burden on patients, health care personnel, administrators and policymakers. Decisions in health care are influenced by data which can be transferred into valuable information and knowledge. Data sets that facilitate data collection, information management and knowledge building are needed by nurse managers to support administrative decision- making. The Nursing Management Minimum Data Set (NMMDS,,¦) offers a standardized method to capture core data that can be collected in information systems, shared and reused for multiple purposes to support safe and cost-effective care. The purpose of this descriptive study was to adapt to Iceland and clinically test the NMMDS-ICE in all adult inpatient care units in the country of Iceland (excluding psychiatry). The aims of the study were to 1) translate the NMMDS from source language (English) to target language (Icelandic); 2) to validate the translated instrument; and 3) to describe the environment, nursing care resources, and financial resources across acute adult inpatient care units in Iceland. Instrument development consisted of translation, expert validation, and psychometric testing. The target population was all adult acute care units in hospitals in Iceland, and the nurse managers (n=38) representing these units. Data collection included a mailed survey. The sample equaled the population. Furthermore, 134 staff nurses on these units (excluding staff nurses at Landspitali) completed a job satisfaction survey. Return rate was 74% for nurse managers and 71% for staff nurses. Semantic and content equivalence of the NMMDS-ICE was established. Five of seven subscales of the instrument received Cronbach¡¦s alpha score of 0.70 or higher. Results indicated that it was feasible to collect the NMMDS-ICE in hospitals in Iceland, albeit, there was an issue with time commitment to do so. The specialty services that best described the patient population were medical-, surgical services, birthing, and geriatrics. Furthermore, nurse managers seem to perceive good control on their units, and both nurse managers and staff nurses are satisfied with their job. A positive correlation was found between autonomy and satisfaction with nursing management, nursing administration, and own level of autonomy. Statistical differences were identified in environmental and staffing resources between hospitals.

nÃo hà / O gerenciamento dos serviÃos de enfermagem à uma atividade complexa e exige competÃncia profissional. As mudanÃas na Ãrea da saÃde demandam dos profissionais enfermeiros gerentes um perfil mais flexÃvel e adaptativo, sendo necessÃrio mobilizar novas competÃncias. O presente estudo norteia sobre as competÃncias necessÃrias ao gerenciamento em enfermagem considerando as mudanÃas tecnolÃgicas e administrativas observadas em hospitais pÃblicos. Apresentam-se os novos cenÃrios gerenciais e alguns aspectos indispensÃveis à aquisiÃÃo de competÃncias como o conhecimento, habilidades e atitudes. Considera-se que o enfermeiro gerente tem a responsabilidade de proporcionar um ambiente de aprendizado em que os trabalhadores possam adquirir novas competÃncias e exercÃ-las livremente. A questÃo de pesquisa do presente estudo consistiu-se em: quais competÃncias essenciais o gerente de Enfermagem precisa ter para gerir uma instituiÃÃo de saÃde e qual seria o perfil ideal para este gestor? O objetivo geral, portanto, versou em identificar o perfil atual do gerente de Enfermagem, analisando comparativamente este perfil real com o perfil ideal preconizado na literatura vigente. A pesquisa de natureza exploratÃrio-descritiva utilizou-se de uma combinaÃÃo de mÃtodos qualitativo ao quantitativo (quali-quantitativo) e està fundamentada no conceito de gestÃo por competÃncia e seus atributos: conhecimentos, habilidades e atitudes. Constituiu-se numa pesquisa que envolveu 36 enfermeiros gerentes de unidades ambulatoriais, de imagem, clÃnicas e cirÃrgicas de um hospital pÃblico federal, da cidade de Fortaleza, o Hospital UniversitÃrio Walter CantÃdio (HUWC). Os dados foram coletados no perÃodo de novembro de 2014 a janeiro de 2015, por meio de questionÃrio eletrÃnico no google docs. A populaÃÃo foi predominante do sexo feminino (100%) e com idade entre 48 e 53 anos (36,1%). Os resultados revelaram a percepÃÃo dos pesquisados sobre perfil atual e ideal de competÃncia profissional ideal para o exercÃcio de atividades gerenciais no HUWC, com destaque para os atributos relacionados ao conhecimento de gestÃo e habilidade de planejamento estratÃgico e operacional, com habilidade de lideranÃa e trabalho em equipe, e atitude de lideranÃa e Ãtica profissional. Verificou-se que 41% dos gerentes tÃm entre 6 e 10 anos de tempo de serviÃo no cargo de gerente. Quanto ao perfil para a funÃÃo gerencial, predominaram as caracterÃsticas: lideranÃa (33%), trabalho em equipe (30%) e comunicaÃÃo/bom relacionamento interpessoal (28%). AtravÃs dos resultados, à possÃvel afirmar que os gestores sabem o que à necessÃrio para gerir um hospital de alta complexidade, comprovado no nÃvel de concordÃncia destes com os atributos da competÃncia conhecimentos, habilidades e atitudes. O perfil encontrado indica, na concepÃÃo semelhante das colaboradoras, um profissional com postura Ãtica, conhecimento tÃcnico-cientÃfico, capacidade de gerenciar e liderar sua equipe, e comprometido com a instituiÃÃo. Embora as respostas fossem superestimadas, seus efeitos foram minimizados e nÃo atrapalharam os resultados da pesquisa devido à existÃncia de correlaÃÃo entre as variÃveis. Dessa forma, depreende-se que existe empenho das chefias de Enfermagem no desenvolvimento de suas competÃncias gerenciais. Entretanto, essa disposiÃÃo nÃo tem sido elemento suficiente para superar as dificuldades de ordem polÃtica e econÃmica que perpassam um Complexo Hospitalar PÃblico. / The management of nursing services is a complex activity and requires professional competence. Changes in health care demand of professional nurses managers a more flexible and adaptive profile, being necessary to mobilize new skills. This study guides on the skills required to manage nursing considering the technological and administrative changes observed in public hospitals. Presents the new management scenarios and some aspects required for acquiring skills such as knowledge, attitudes and opportunities. Itâs considered that the nurse manager has the responsibility to provide a learning environment where workers can acquire new skills and exercise them freely. The research question of this study was: what core competencies the nursing manager must have to manage a health institution and what would be the ideal profile for this manager? The overall objective, therefore, was to identify the current profile of the nursing manager, comparatively analyzing this real profile with the ideal inherent profile in the current literature. The research exploratory and descriptive nature we used a combination of qualitative methods to quantitative (qualitative and quantitative) and is based on the concept of management by competence and their attributes: knowledge, skills and attitudes. It consisted of a Survey involving 36 nurses managers of units of a federal public hospital, in Fortaleza, the University Hospital Walter CantÃdio (HUWC). Data were collected from November 2014 to January 2015, through electronic questionnaire on google docs. The population was predominantly female (100%) and aged between 48 and 53 years (36,1%). The results revealed the perception of respondents on the current profile of professional competence ideal for the exercise of managerial activities of HUWC, highlighting the attributes related to knowledge management and strategic and operational planning skills with leadership skills and teamwork, attitude and leadership and professional ethics. It was found that 41% of managers have between 6 and 10 years of service in management position. The profile for managing, predominant characteristics: leadership (33%), teamwork (30%) and communication / good interpersonal skills (28%). From the results, it is clear that managers know what it takes to manage a highly complex hospital, confirmed the level of agreement with these attributes racing knowledge, skills and attitudes. The profile indicates found in similar conception of the collaborators, a professional with ethical, technical and scientific knowledge, ability to manage and lead your team, and committed to the institution. While responses were overestimated, its effects were minimized and not hindered the search results because the correlation between the variables. Thus, it appears that there is commitment of the nursing managers to develop their management skills. However, this provision has not been sufficient element to overcome the difficulties of political and economic order that underlie a Public Hospital Complex.

Este estudo objetiva analisar as ações voltadas para a promoção da qualidade de vida dos trabalhadores de enfermagem, desenvolvidas pelos enfermeiros que desempenham funções gerenciais. Para tanto, busca conhecer os processos destrutivos e favoráveis, determinantes dos processos saúde-doença, vivenciados pelos trabalhadores de enfermagem; apreender o significado da qualidade de vida no trabalho para estes trabalhadores; e, a partir daí, buscar propostas de intervenção para esta problemática. O estudo, de abordagem qualitativa, fundamenta-se no referencial do materialismo histórico e dialético e na determinação social do processo saúde-doença. O cenário de estudo foi um hospital universitário, de grande porte, localizado na região centro-oeste do País. A população foi constituída por 22 trabalhadores, de diversas categorias de enfermagem, representantes das unidades e turnos de trabalho do Hospital. Para a coleta de dados foram utilizados formulários para captação dos dados de caracterização da instituição e dos trabalhadores, dos acidentes de trabalho e formulário com questões norteadoras das discussões no grupo focal. Ainda, a enquête coletiva foi utilizada para o registro dos dados discutidos neste grupo. A análise dos dados permitiu evidenciar que: os acidentes de trabalho com trabalhadores de enfermagem representaram, respectivamente, 51% e 25% do total de acidentes ocorridos nos anos de 2004 e 2005, causados principalmente pelos materiais pérfuro-cortantes; que a qualidade de vida e a qualidade de vida no trabalho são indissociáveis, sendo que a motivação para o trabalho e a satisfação advém da interação e reconhecimento dos pacientes, bem como pelas relações de confiança que são estabelecidas com a equipe de trabalho; que os processos favoráveis e destrutivos da saúde permeiam o momento de trabalho; que a exposição às diversas cargas, geradoras de processos de desgaste, evidenciaram um perfil destrutivo da saúde e, conseqüentemente, o comprometimento da qualidade de vida; que não existem programas ou ações institucionalizadas que promovam a qualidade de vida trabalho. A análise ainda possibilita a apreensão do desgaste psíquico sofrido pelos enfermeiros, na gerência, frente às mudanças no contexto de trabalho e seu impacto na qualidade de vida dos trabalhadores de enfermagem; que as mudanças e os desgastes evidenciados comprometem a atuação deste profissional como cuidador da equipe, promovendo um desgaste físico e mental no cumprimento das metas organizacionais. A análise evidencia, ainda, que inexistem iniciativas voltadas à promoção da qualidade de vida dos trabalhadores como uma responsabilidade gerencial e estas são relegadas a segundo plano, na emergência de situações demandadas no dia-a-dia de trabalho. Em síntese, constata-se que inexistem propostas de promoção da qualidade de vida dos trabalhadores de enfermagem ou estas são muito tímidas. Assim, emerge o imperativo da intervenção nas diferentes realidades, por enfermeiros preparados para gerenciar a promoção da qualidade de vida dos trabalhadores de enfermagem / This study aims to analyze the actions that are directed through the promotion of nursing workers quality of life, developed by the managerial nurses. For this, it searches to know the favorable and destructive processes, as determinants of the health-i process lived by the nursing workers; to apprehend the means of work’s quality of life for them; and, then, it searches proposa of interventions for this problernatic situation. The study is based in the qualitative approach of historical and dialectic rnaterialist and on referential of the social determination of the process health-illness. The setting of study was a big university hospital, which is situated in the center west region of Brazil. The population of study was composed by 22 nursing workers. They carne from many units and shifts of work. Data coilection about institution, workers profiles and occupational accidents was made by forms. Qualitative data was collected by coliective interview in the focus group. Still, the coliective inquiry was used to register the discussion of this group. The analysis of occupational accidents data evidenced that: in the years of 2004 and 2005, the nursing workers suffered a great number of these accidents, respectively, 51% and 25% of the total and that these accidents had as main cause due needlestick materiais; analysis data also showed that the quality of life and work’s quality of life are strongly iinked and that the motivation and the satisfaction for the work corne of the interaction and recognition with of the object of work, as weli as for the reiations that are estabiished with the work tearn; that the favorable and destructive processes of health are determined in the workplace; that the exposition to diverse over workloads configures a destructive profiie of the health and the consequence is the decrease of the quality of life; that it doesn’t have institutional prograrns or institutional actions that promote the work’s quality of life. Stili, the analyze make possibie the apprehension of the psychic strain suffered by the management nurses through the changes in the context from work and the impact from this in the nursing workers quaiity of life; that the changes and the strains cornpromise the performance of these nurses as manager of the team, promoting physical and mental strain in the fulfillment of organizationai goals. The analysis evidences, stiii, that no have initiatives directed to the prornotion of workers’ quality of life as a management responsibiiity and these are relegated as the second piam, in the emergency of situations demanded in day-by-day of work. in synthesis, the study evidences that there haven’t proposais for the promotions of nursing workers’ quality of life or, if exist, these are very shy. Thus, the irnperative of the intervention in the different ones realities ernerges for prepared nurses to rnanagement the promotion of nursing workers´ quality of life

Abstract The aim of the study was to investigate the amount and focus of rehabilitation nursing care practices and the association of these practices to quality outcomes. Additionally, the aim of the study was to describe the characteristics and leadership models of the functional level in long-term care units providing rehabilitation nursing care. The study consists of four articles. The data for the first three articles were derived from the National Institute for Health and Welfare Resident Assessment Instrument (RAI) database. The data for the first article (n = 5312) were collected using resident level data. The second article is based on unit level information (n = 256) and data from a questionnaire sent to the nursing leaders of the functional level (n = 189) in facilities which adopted RAI. For the third article the resident level data (n = 2037) were used from the study of Laine (2005). The statistical analyses were performed by SAS statistical software for Windows. The data were presented as mean scores and confidence intervals. Regression models were used to present the associations between variables. The qualitative data for the fourth article was collected by interviews with the nursing leaders at the functional level (n = 14). The data were analysed by content analysis. The results show that residents receiving rehabilitation nursing had more impaired cognitive and physical function. The amount of rehabilitation nursing practice was associated to the nurses' assessment of residents' rehabilitation potential. Daily provision of rehabilitation nursing activity was associated to better care quality. It decreased the prevalence of bedridden residents and residents with little or no activity. It increased the amount of nursing time spent on residents. The leadership of the rehabilitation units consisted of recognizing options, promoting guidelines, reminding nurses, upholding open communication, supporting the learning process and respecting. The characteristics of rehabilitation units involved characteristics of Magnet Hospitals. The measure of rehabilitation nursing that measured the amount of rehabilitation nursing activity was usable and distinctive. In this study, measurable information about the amount of rehabilitation nursing practice was acquired. Findings of this study are usable for evaluation of nursing care outcomes and for developing nursing management. / Tiivistelmä Tutkimuksen tarkoituksena oli analysoida kuntoutumista edistävän hoitajan toiminnan määrää, kohdentumista ja sen yhteyttä hoidon laadun tuloksiin. Lisäksi tarkoituksena oli kuvata kuntoutumista edistävien osastojen tunnuspiirteitä ja lähijohtamisen menetelmiä pitkäaikaisessa laitoshoidossa. Tutkimus koostuu neljästä osajulkaisusta, josta kolmessa on käytetty valmiita tutkimusaineistoja. Ensimmäisen (n = 5312) osajulkaisun asiakastason aineisto on kerätty tekemällä poimintoja Terveyden ja hyvinvoinnin laitoksen Resident Assement Instrument (RAI) -tutkimustietokannasta. Toisessa osajulkaisussa tutkimustietokannasta on kerätty osastotason aineisto (n = 256) ja tehty poimintoja RAI-järjestelmää käyttävien osastonhoitajien toimintatietokyselystä (n = 189). Kolmannessa osajulkaisussa on hyödynnetty asiakastason aikamittaus- ja RAI-arviointiaineistoa (n = 2037), jota Laine (2005) käytti väitöskirjassaan. Analyyseissä on käytetty SAS-tilasto-ohjelmistoa. Aineisto on kuvattu keskiarvoin ja luottamusvälein. Muuttujien yhteyksiä on kuvattu käyttämällä regressiomalleja. Neljättä osajulkaisua varten on koottu laadullinen aineisto osastonhoitajien teemahaastatteluista (n = 14), joka on analysoitu sisällön analyysillä. Tulosten mukaan hoitajan kuntoutumista edistävä toiminta kohdistui niihin asiakkaisiin, joilla oli keskivaikeasti alentunut fyysinen toimintakyky ja kognitio. Hoitajan toiminta oli yhteydessä hoitajan uskoon asiakkaan kuntoutumisen mahdollisuudesta. Osastotason tarkastelussa päivittäinen kuntoutumista edistävä toiminta oli yhteydessä hoidon laadun tuloksiin, sillä se vähensi vuodepotilaiden määrää ja lisäsi asiakkaiden sosiaalista osallistumista. Se lisäsi myös asiakaskohtaista välitöntä hoitoaikaa. Lähijohtamisen menetelminä korostuivat mahdollisuuksien näkeminen, linjassa pitäminen, mieleen palauttaminen, avoin kommunikointi sekä hoitajien osaamisen tukeminen ja arvostaminen. Kuntoutumista edistävien osastojen tunnuspiirteinä korostuivat magneettisairaaloiden vetovoimatekijät. Tutkimuksessa kehitetty kuntoutumista edistävän hoitajan toiminnan määrän mittaamiseen tarkoitettu mittari osoittautui käyttökelpoiseksi ja erottelevaksi mittariksi. Tutkimuksessa saatu tieto on hyödynnettävissä kuntoutumista edistävän hoitajan toiminnan mittaamisessa kuten myös hoidon tulosten arvioinnissa. Tutkimustuloksista on hyötyä hoitotyön johtamisessa. / Sammanfattning Syftet med undersökningen var att analysera mängden av rehabiliteringsfrämjande vårdinsatser, vem de riktades till och hur de relaterar till vårdkvalitet. Dessutom var avsikten att beskriva vad som kännetecknar rehabiliteringsfrämjande avdelningar och ledarskapsmodeller inom institutionsvården. Undersökningen består av fyra delpublikationer: i tre av dem användes existerande forskningsmaterial. Materialet på klientnivå (n = 5312) som användes i den första delpublikationen samlades in genom axplock ur forskningsdatabasen Resident Assessment Instrument (RAI) på Institutet för hälsa och välfärd (THL). Den andra delpublikationen består av material på avdelningsnivå (n = 256) och material ur en enkät om verksamhetsuppgifter (n = 189) riktad till de avdelningsskötare som använder RAI-systemet. Den tredje delpublikationen omfattar tidmätnings- och RAI-bedömningsmaterial (n = 2037) på klientnivå som Laine (2005) använde i sin doktorsavhandling. I analyserna har SAS-dataprogramvara använts. Materialet har beskrivits med medelvärden och konfidensintervaller. Variablernas förhållanden till varandra har illustrerats med regressionsmodeller. För den fjärde delpublikationen har ett kvalitativt material insamlats från temaintervjuer med avdelningsskötare (n = 14) och analyserats med innehållsanalys. Resultaten visar att vårdarens rehabiliteringsfrämjande vårdinsatser riktade sig på de klienter som hade medelsvårt nedsatt fysisk funktionsförmåga och kognition. Vårdinsatserna var sammankopplade med vårdarens uppfattning om klientens rehabiliteringsmöjligheter. I studien på avdelningsnivå relaterade den dagliga rehabiliteringsfrämjande vårdinsatsen till vårdkvalitet. Antalet sängliggande klienter minskade och det sociala deltagandet hos klienterna ökade, även den direkta vårdtiden per klient ökade. Bland de metoder som avdelningsskötarna använde för ledarskap framhävdes upptäckandet av möjligheter, linjehållning, påminnelser, öppen kommunikation samt stödandet och värdesättandet av vårdarnas kompetens. Särskilt kännetecknande för de rehabiliteringsfrämjande avdelningarna visade sig vara magnetsjukhusens dragningskraft. För att mäta mängden rehabiliteringsfrämjande vård som gavs, utvecklades en mätare, vilken visade sig vara användbar och urskiljande. De resultat som denna forskning gett kan tillämpas för att lyfta fram mätbarheten av rehabiliteringsfrämjande vårdinsatser såsom även till att utvärdera vårdresultaten. Forskningsresultaten kan också utnyttjas till att utveckla ledarskapet inom vårdarbetet.

M.Cur. / The intra-aortic balloon pump is a volume displacement device that is used to provide partial support to the left ventricle. The IABP is an effective and general used circulatory support device. The nursing of a patient on IABP therapy requires demonstration of specific clinical competence by the critical care nurse. Clinical competence is defined as the ability of the critical care nurse to integrate his/her knowledge, skills and values and to demonstrate it during nursing of a patient on IABP with the aim to promote the patient's health. The aim of this research had been to evaluate the clinical competence of the critical care nurse during the nursing of a patient on IABP, and to make recommendations according to that regarding education, the practice and research. The relationship between the components of clinical competence namely knowledge, skills and values that were set as aim, were also established. A quantitative, contextual, descriptive, correlational research design had been used in the study to compile a self-developed evaluation instrument that had been used to evaluate the clinical competence of the critical care nurse. The evaluation instrument consisted of a questionnaire that evaluated the knowledge of the critical care nurse, a check list that evaluated the skills of the critical care nurse and a semantic differential scale that evaluated the values of the critical care nurse during the nursing of a patient on IABP therapy. After the data was analyzed, it appeared that critical care nurses don't possess the necessary knowledge and skills to nurse patients on IABP, and as such are not clinically competent to nurse patients on IABP. iii Recommendations were made regarding education, the practice and research in order to improve the clinical competence of critical care nurses during the nursing of a patient on IABP therapy

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)