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Thesis (MCur (Interdisciplinary Health Sciences. Nursing Science))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Critical care nursing is the specialty within nursing that deals with an individual's response to life-threatening problems. These life threatening problems require continuous in-depth assessment and intense therapeutic measures and interventions. The level of nursing care is intense and the amount of documentation is enormous in the intensive care unit. Failure to document any aspects, may threaten the continuity of care and patient safety. Furthermore, it may result in negligence that may result in litigation. The purpose of this study was to retrospectively analyse nursing documentation in the intensive care units of an academic hospital in the Western Cape. The objectives set for this study were to determine whether the documentation of the: • assessment of the patients were adequate; • diagnoses were based on the assessment; • nursing care plans were based on the diagnoses; • nursing care plans were implemented and • nursing care plan shows evidence of continuous evaluation A retrospective exploratory- descriptive research design with a quantitative approach was applied to audit objectively the status of nursing documentation of patients who were admitted to the ICU’s of an academic hospital in the Western Cape in the first 48 hours of admission. Ethical approval was obtained from the University of Stellenbosch and consent from the Chief Executive Officer of the academic hospital to conduct the research in the hospital under study. The research population (N) was the documentation (files) of patients admitted in the ICU’s between 1 July 2008 and 31 December 2008. A stratified sample was drawn consisting of 151 files. The researcher collected the data personally utilising a pretested audit instrument. The reliability and validity was assured through experts in nursing science and intensive care nursing, a statistician and a research methodologist. A pilot study was conducted to pretest the instrument and the feasibility of the study. Modifications to the instrument were done based on suggestions from the experts and findings of the pilot study. Data analysis included statistical associations between variables using the Chi-square test on a 95% confidence level. Data is presented in the form of figures, tables and frequencies. The findings of the study show that the nursing documentation in the intensive unit is inadequate with the following total mean scores: • Assessment 62.6% • Nursing diagnosis 53.1% • Nursing care plans 37.1% • Implementation 72.6% • Evaluation 40.5%. In conclusion nursing documentation of patients admitted to an ICU is inadequate during the first 48 hours of admission. Poor documentation threatens the safety of patients and demands urgent improvement. Recommendations to improve the documentation include nursing practice supervision, quality improvement programmes, in-service training, evidence based practice and further research. / AFRIKAANSE OPSOMMING: Kritieke-sorg verpleging is die spesialiteit in verpleging wat betrekking het op die individu se reaksie.op lewensgevaarlike probleme.Hierdie lewensgevaarlike probleme benodig deurlopend deeglike beraming en intense terapeutiese benaderings en intervensies. In die intensiewesorg eenheid is die vlak van verpleegsorg baie intens en die dokumentasie hoeveelheid is enorm. Versuim om enige aspekte van sorg deeglik en akkuraat te dokumenteer, kan die deurlopendheid van sorg sowel as die veiligheid van die pasient bedreig. Verder kan dit tot regsstappe lei as gevolg van nalatigheid. Die doel van hierdie studie was om ‘n retrospektiewe analise van verpleeg dokumentasie in die intensiewe sorgeenhede van ‘n akademiese hospitaal in die Wes Kaap te doen. Die doelwitte van hierdie studie was om vas te stel of die dokumentasie van die: • beraming van die pasiênt voldoende gedoen is • verpleegdiagnose gebaseer is op die beraming • verpleegsorgplan gebaseer is op die diagnose • implementering van die verpleegsorgplan en • verpleegsorgplan bewyse toon. van deurlopende evaluasie ‘n Retrospektiewe eksploratiewe-beskrywende navorsingsontwerp met ‘n kwantitatiewe benadering is toegepas ten einde die status van verpleegdokumentasie van pasiente wat toegalaat is tot die intensiewesorg eenhede van ‘n akademiese hospitaal in die Wes Kaap in die eerste 48 uur na toelating te bepaal. Etiese goedkeuring is verkry van die Universiteit van Stellenbosch asook vanaf die Hoof Uitvoerende Beampte van die akademiese hospitaal om die navorsing daar uit te voer. Die navorsings populasie (N) was die dokumentasie (lêers) van die pasiente wat opgeneem is in die intensiewesorg eenheid tussen 1 Julie 2008 en 31 Desember 2008. ‘n Gestratifieerde steekproef is getrek bestaande uit 151 lêers. Die navorser het die data persoonlik kollekteer deur gebruik te maak van ‘n voortoets oudit instrument. Die betroubaarheid en geldigheid is verseker deur kundiges in verpleegkunde en intensiewesorg verpleging, asook ‘n statistikus en ‘n navorsingsmetodoloog. ‘n Loodstudie is gedoen om die instrument vooraf te toets en om die uitvoerbaarheid van die navorsing te bepaal. Veranderinge is aangebring op grond van die voorstelle van die kundiges sowel as die bevindinge van die loodstudie. Data analise het ingesluit die statistiese assosiasies tussen veranderlikes deur gebruik te maak van die Chi-kwadraat toets tot ‘n 95% sekerheidsvlak. Data is aangebied in die vorm van figure, tabelle en frekwensies. Die bevindinge van die studie wys dat die verpleegdokumentasie in die intensiewesorg eenheid is onvoldoende met die volgende gemiddelde telling: • Beraming 62.6% • Verpleegdiagnose 53.1% • Verpleegsorgplanne 37.1% • Implementering 72.6% • Evaluering 40.5% Ten slotte, verpleegdokumentasie van pasiënte wat tot die intensiewesorg eenheid toegelaat is, is onvoldoende gedurende die eerste 48 uur van toelating. Swak dokumentasie bedreig die veiligheid van pasiënte en verg dringende verbetering. Aanbevelings om die dokumentasie te verbeter sluit in toesig oor verpleegpraktyke kwaliteit verbeteringsprogramme, indiensopleiding, bewysgebaseerde praktyke en verdere navorsing.

M.Cur. / The learning accompanists (nurse educator), in the didactic situation within the context of a nursing college, is midst a process of transformation. This transformation has a direct influence on the learning accompanists didactic role fulfilment. Didactic support systems enables the learning accompanist to fulfil her/his didactic role. These didactic support systems should be managed during the process of transformation, in such a way that it enables the learning accompanist to fulfil her/his didactic role. A new creative approach to the management of the didactic situation is necessary. The goal of this study is to describe guidelines for the management of didactic support systems, at a nursing college, to enable the learning accompanist to fulfil her/his didactic role. An inductive, qualitative, contextual, exploring, descriptive strategy is used to reach the goal of the study. The background and rationale of the study are described, the problem is stated as well as a central theoretical statement. The assumptions of the study are described within the framework of the nursing theory for the whole person. No explicit theoretical assumptions are made, so that the researcher is open to empirical findings and to prevent pre-conceived ideas. The methodological assumptions is based on the Botes research model. No explicit conceptual framework is used as point of departure. Because the participants are midst a process of transformation, their knowledge and experience are used as source of data, as they can express their needs and views the best. The goal of this study is reached by setting four objectives. Objective I is to explore and describe the learning accompanists need for didactic support systems, within the context of a nursing college. Objective II is to explore and describe the managements views with regard to the way they can give didactic support, within the context of a nursing college. Objective III is to describe a conceptual framework. Objective IV is derived from objective I, objective II and objective III. Objective IV is the description of guidelines for the management of didactic support systems at a nursing college. To attain objective I, exploring is done by means of interviews with learning accompanist's. One semi-structured question is: "What are your needs for didactic support systems in the college?" To attain objective II, exploring is done by means of individual interviews with role players. One central question is set: "How can you give didactic support to the learning accompanist?" The interviews are conducted by an independent moderator/interviewer and assistant. Data is recorded by means of audio tapes and field notes, whereafter transcription takes place. Data is coded by the researcher and an assistent coder. The data analysis is done through a systematic approach of text analysis, as described by Tesch (in Cresswell, 1995:155). Thereafter the empirical findings of objective I and objective II are described. The interpretations are grounded by statements from the empirical data. Statements (n = 57) are formulated from the empirical findings of objective I and objective II. From these statements (n = 57) a list of concepts are generated. These concepts are utilized to attain objective III, the describing of a conceptual framework. The survey list of Dickoff, James and Wiedenbach (1968) is utilized to describe the conceptual framework in a structured manner. Data collection is done through a literature search to correlate the empirical findings with the literature. During the description of the conceptual framework conclusion statements (n = 15) are made. These conclusion statements are utilized to attain objective IV. Objective IV is to describe guidelines for the management of didactic support systems at a nursing college. Through logical inferention 12 guidelines and possible operationalisation of each are described. The uniqueness of the study lies in the relevance within the current time frame context and that it expresses the needs of the learner accompanists and the views of the managers at a nursing college. An abundance of possibilities for further research are created.

Within the current context of the healthcare environment, the charge nurse role has become very important for safety and positive outcomes. There is little known about the role from the perspective of the charge nurse. This qualitative descriptive exploratory study examined the experience of being a charge nurse in acute care practice, and describes how charge nurses live caring in their support of nurses and patients. Ray's (1989, 2006) theory of Bureaucratic Caring, Swanson's (2008) caring attributes and leadership, and Boykin and Schoenhofer's (2001) theory of Nursing as Caring provided the theoretical lenses through which study findings were viewed. Semi-structured interviews were conducted with 20 charge nurses in 4 acute care facilities. Eight themes emerged from an inductive analysis of the data describing the experience of being a charge nurse in acute care practice: Creating a Safety Net, Monitoring for Quality, Showing the Way, Completing the Puzzle, Managing the Flow, Mak ing a Difference, Putting Out Fires, and Keeping Patients Happy. Participants also were asked questions about how they provide support to staff nurses and patients. Themes that reflected how charge nurses live caring in their support of staff and patients were: Jumping in the Trenches, Nurturing Staff Growth, Offering Authentic Presence, and Looking after Nurses. Additionally, the researcher used methods of narrative inquiry to get the participants to share stories of how they lived caring in their support of nurses and patients. Recommendations included the need to elevate the visibility of the charge nurse role and its importance to the organization, and provide support for leadership development. Job descriptions and competencies for charge nurses must reflect the complexity of the environment. / Charge nurse participants did not dialogue explicitly about their functions in terms of communication and intraprofessional team building. Since charge nurses have an increasing involvement with mentoring novice nurses and new staff, they would benefit from developing coaching skills. Given the current environment, their responsibilities in these areas may need to be better articulated so that they can focus on increasing these abilities. / by Terry L. Eggenberger. / Signature page missing one signature and the date. / Thesis (Ph.D.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.

A new role has been developed in nursing named the Clinical Nurse LeaderSM (CNL®). This new role positions the masters prepared nurse at the patient's bedside to oversee care coordination and serve as a resource for the clinical nursing team, and to bridge the gaps in health care delivery to better meet the needs of patients in all health care delivery settings. Since this is a new role, there is a paucity of research that has been conducted surrounding these nurses. A phenomenological investigation examined the lived experiences of CNLs® to gain understanding about the meaning of leadership at the point of care and to discover the unique expressions of living caring that CNLs® experience as they embark upon this new role in the acute care hospital setting. Ten CNL® participants were interviewed for this study. Their stories about patient situations and relationships with other disciplines were shared with rich description and emotion. Hermeneutic analysis of the text revealed six essential themes. Six essential themes emerged revealing the essence of leading at the bedside and living caring in the CNL® role: navigating safe passage, pride in making a difference, bringing the bedside point of view, knowing the patient as person, helping nurses to grow, and CNLs® needing to be known, understood and affirmed. Taken as a whole through a synthesis of the themes, the understanding of the meaning of leading to CNLs® includes keeping their patients safe, being proud of their accomplishments and the respect gained from others, as well as being a helper and advocate for other nurses. / This is accomplished through their privileged place at the bedside, where they come to know their patients as person and work hand in hand with nursing colleagues. When CNLs® are supported by management, and their roles are planned and understood, they are more fully able to optimally practice and live and grow in caring. / by Barbara C. Sorbello. / Thesis (Ph.D.)--Florida Atlantic University, 2010. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2010. Mode of access: World Wide Web.

Aim The purpose of the study was to formally identify trauma care delivery problems at the study institution, implement a solution in the form of trauma case management (TCM), and measure the effect of TCM on staff satisfaction, clinical coding accuracy and patient outcomes, using practice-specific outcome variables such as in-hospital complication rates, length of stay, resource use and allied health service intervention rates. This research also aimed to make a unique contribution to the international trauma literature by addressing the lack of any evidence specifically measuring the impact of trauma case management intervention. Methods St George Hospital is a 600 bed urban Teaching Hospital of the University of NSW. It is a designated Trauma Centre, seeing around 200 severely injured patients and around 2500 injury admissions per year. A series of focus groups and a staff satisfaction survey identified perceived problems associated with trauma care, and a trauma case management program was implemented. A preliminary study was conducted with positive results and funding was obtained to provide TCM seven days a week to all trauma patient admissions. A larger clinical trial was conducted and data from 754 patients were collected over fourteen months after TCM was introduced at the study hospital. These data were compared with 777 matched patients from the previous 14 months as a control group. An audit was conducted on trauma patient clinical coding using the daily progress record kept by the trauma case manager. The data were analysed with SPSS. The statistical tests used were Mann-Whitney U, chi-squared (2) logistic regression and generalised linear models. Results Focus groups and the staff satisfaction survey identified communication and coordination as the main problems associated with trauma care delivery. Following the initial implementation of the program, staff support for TCM was overwhelming. TCM greatly improved the rate of and time to Allied Health intervention (p&lt0.0001). Results demonstrated a decrease in the occurrence of deep vein thrombosis (p&lt0.038), coagulopathy (p=0.041) and respiratory failure. A reduced hospital length of stay (LOS), particularly in the paediatric (p&lt0.05) and 45 - 64 years age group was noted. There were 6621 fewer pathology tests performed (p&lt0.0001) and the total number of bed days was 483 days less than predicted from the control group. Many hospital clinical coding errors and omissions were highlighted by the TCM record comparison. The use of TCM records resulted in Twenty eight percent of recoded records having their Australian national diagnostic related group (AN-DRG) changed, which resulted in the identification over $39,000 in unidentified funding. Conclusion TCM improves staff satisfaction, communication and clinical coding accuracy. The introduction of TCM improved the efficiency and effectiveness of trauma patient care in our institution. This initiative demonstrates that TCM results in improvements to quality of care, trauma patient morbidity, financial performance and resource use. This research makes an important and original contribution to the international trauma literature by providing the results of a clinical trial formally measuring the impact of trauma nursing case management intervention.

Rapid and chaotic changes in health care have created a need for a new type of nursing leadership. Many leadership theories have been studied and adopted by nursing. However, historical approaches to leadership will not help nurses thrive in the current health care arena.The purpose of this study was to describe a case example of nursing leadership using a topical life history of one exceptional nurse leader. The topical life history describes two representative periods in an exemplary nurse leader's life to fully describe an insider's perspective of leadership. This definition, which includes the participant's interactions with her self, others, and her environment during two significant periods during her life, will be used as the initial case for the future collection of multiple case examples in an effort to develop a definition of nursing leadership.Nursing leadership was defined, based on the interpretation of interview transcripts, as: Hard work, vision, communication, coaching/facilitating, strong values, proactivity, and charisma. Findings support various leadership theories and identified two core categories previously poorly defined in nursing leadership literature: Hard work and street smarts. Implications for nursing research, education, and practice have been identified. Recommendations for use of this study as a case example to stimulate classroom discussion have been made. Additional recommendations for further research in the areas of hard work and street smarts have also been made. / School of Nursing

America's health care industry is in a state of crisis. Nursing administrators are in the position to facilitate change in institutions. One aspect of nursing which has remained constant is high turnover rates. The high turnover rates have been linked to job dissatisfaction. One method of reducing turnover is to provide greater job satisfaction to staff nurses. Job satisfaction has been connected with management style (Lucas, 1991; Price & Mueller, 1981; Volk & Lucas, 1991).This study described the impact of head nurse management style on staff nurse job satisfaction. Likert's (1967) System 4 management theory was utilized as the framework in the study. All staff nurses and head nurses from three Central Indiana hospitals were given the opportunity to participate in the study. Participants completed two questionnaires, one from Price and Mueller's (1981) work on turnover to determine job satisfaction and one from Likert and Likert's (1976) work to determine management style.Data analysis was conducted to describe any variations between staff nurse experience of head nurse management style and staff nurse job satisfaction. Differences between head nurse and staff nurse description of management style were also examined. There were no identified risks as participation was voluntary and did not affect the employment status of any individual.Results of the study demonstrated agreement with previous research findings. When management style is closer to participative (system 4), greater job satisfaction is expressed. Recommendations are to provide management training and training in communication and self-awareness for head nurses, and to form unit based committees designed to achieve greater staff input in decisions affecting the unit functioning.Benefits of the study include identification of the management style which leads to improved staff nurse job satisfaction. Equipping nurse administrators with information regarding desirable management style to employ for staff nurses to experience greater job satisfaction, and training present managers in that management style are also possible benefits from the study. / School of Nursing

The basic philosophy of shared governance includes the right for staff nurses to practice in an environment that allows participation in the decision making process at all levels of the organization. Autonomy and responsibility support shared governance. The purpose of this study was to examine nurses’ perceptions of autonomy in a well established shared governance setting. The Neuman Systems Model served as the theoretical framework.A convenience sample of 83 (42%) staff nurses at Saint Joseph’s Hospital of Atlanta, Georgia completed the Schutzenhofer Professional Nursing Autonomy Scale. Three open ended questions were included in the questionnaire to further explore staff nurses’ perceptions of the professional practice environment. Demographic data were also collected.Findings in this study revealed no significant correlations between selected demographic variables and autonomy. More than between selected demographic variables and autonomy. More than half (65.1%) ranked in the higher level of professional autonomy, 34.9% (29) ranked in the mid level and none in the lower level. Qualitative data revealed that nurses working in a well established shared governance setting perceived control over the nursing care of patients and appreciated and the ability to make decisions regarding patient care. Respondents overwhelmingly indicated that nurses should be compensated for participation in governance activities.Conclusions from this study were that implementation of professional practice models such as shared governance improve nurses’ perceptions of autonomy and create an atmosphere in which nurses can practice the art of nursing while clearly articulating a vision for the future. Consistent and appropriate decision making by nurses facilitates the interdisciplinary plan of care and encourages trusting relationships among professional disciplines.Nurse managers are in an ideal position to create a vision by designing structures that promote staff involvement. Managers must build formal recognition programs into shared governance systems and provide nurses with the time to attend meetings. Today’s nursing leaders must be ready to create a vision, facilitate change, mentor, nurture, coach and advise staff. / School of Nursing

Job-communication satisfaction and its importance to nursing staff and first-line supervisors is important because people in complex health care delivery systems tend to dehumanize communication (Duldt, 1989, 1990b). The purpose of the study is to determine the level of satisfaction first-line supervisors and staff nurses have of job-communication and interpersonal relationships, and the degree of importance staff members and first-line supervisors place on job-communication and interpersonal relationships within a mid-sized acute care facility in an urban area. The theoretical framework is Duldt's Humanistic Nursing Communication Theory (Hersey & Duldt, 1989).The population was all staff nurses and first-line supervisors employed in inpatient services at a midwest hospital. The sample was comprised of about 231 registered nurses and 61% first-line supervisors who volunteered to answer the Job-Communication Satisfaction Importance Questionnaire (JCSI). The JCSI was developed by B. W. Duldt (1990) based on the work of Downs, Hazen, and Thiry as cited in Duldt (1990a). The procedures for the protection of human subjects were followed.Findings revealed that supervisors and staff nurses were satisfied with aspects of job-communication. Supervisors and staff nurses rated six of the eight topics on the JCSI as important aspects of job-communication. Aspects of job-communication and interpersonal relationships were important to supervisors and staff nurses in the facility studied.The conclusions from the study were: (a) satisfaction with job-communication and interpersonal relationships can be improved, (b) aspects of job-communication and interpersonal relationships identified in the study were important to supervisors and staff nurses. Nursing supervisors are in key positions to influence job -communication satisfaction. Organizations undergoing rapid changes need to develop and maintain communication which is satisfactory to human beings working in the organization. / School of Nursing