The significant influence that practice learning plays within undergraduate nurse education cannot be overstated. By practice learning, I mean work-based learning immersed in the activities of nursing practice, typically involving learning undertaken in placements at hospitals and other clinical worksites. Practice learning is intended to achieve standards defined by professional regulatory bodies, and aims to enhance learners' capability and employability. Learning here refers to processes through which student nurses develop capabilities to practice effectively, critically, confidently and professionally in health care settings. Practice is a key concept in this thesis, much contested in debates about professional learning in practice which I will examine in detail in chapter 2. In terms of current policy regarding practice learning, I would, however, suggest that what we have at the moment is an inherited legacy which to date has not been robustly scrutinised. Based on my experiences as a nursing educator I came to believe that it was timely for a re-examination of policies, practices and philosophies underpinning the duration and structure of the current practice learning model. Taken together, the above experiences led me to focus this thesis on the following research question: How might practice learning experiences be better designed to promote nursing capability? This thesis brings together six published papers reporting studies that I conducted to explore this question, as well as chapters explaining the background literature, theory and methodology guiding these studies. My overarching aim is to contribute to the improved practice learning experiences of undergraduate student nurses, retaining them on programmes and easing their transition into the role of newly qualified practitioners (NQP). Chapter 1 charts the history of nursing educational developments. The aim is to demonstrate the influence of government and professional policy over nursing’s development from an apprentice-style model to the current-day academic model. In charting these developments alongside reviewing the contemporary research literature, what is obvious is that the issues of support, retention, models of practice learning and curricula to prepare nurses are perennial challenges. However, as a practice-based discipline, the focus of preparation has always remained grounded in practice. Chapter 2 sets forth the theoretical constructs of this thesis. During the course of conducting the studies reported in the publications of this thesis, I became frustrated with the relative lack of emphasis on contemporary learning theory in nursing education, and the paucity of supporting evidence for the ‘reflective’ theory that seems to be dominant in nursing. The discussion presented in this chapter aims to provide an overview of the major traditions of constructivism and reflective practice, as well as their historical theoretical foundations, which have been widely adopted in nurse education. I discuss the strengths and limitations of these theories as they apply to undergraduate nurses’ practice learning and capability development. These are then contrasted via the means of a critical discussion with more novel alternative models. These include situated learning theory and legitimate peripheral participation, and practice-based learning theory as advocated by contemporary writers such as Schatzki (2002). These theories changed my thinking about practice learning and informed my efforts to develop a more cogent understanding of learning through, for and at work for undergraduate nurse education. In setting out Chapter 3, I am presenting a brief overview of these publications for a nursing education audience. Firstly, I have included information that is generally considered important to this audience, such as details about the journal’s standing and article citations, the databases searched, and the percentage of my own contributions. Secondly, I report the studies from an evidence-based perspective of prediction and control aligned with the contexts of the commissioning process and the conduct of each project. By this I mean that I treat the findings in these papers as valid and credible within the stated limitations Chapter 4 presents the six publications in their entirety for the reader Chapter 5 explains the research methodology adopted in the papers presented for this thesis, and offers my critical reflections on these methodologies. I outline the philosophy that underpins the approach taken with the research studies, discussing the interpretive stance that was taken to research and the consequent choice of qualitative approaches. The chapter also discusses the strengths and limitations of the methods employed in each of my papers along with the means used to analyse the data, and the ethical considerations that an interpretive researcher must consider. In retrospect, given where my theoretical orientation has moved (as explained in chapter 2), I now look rather more critically on the premises of these studies, their categories of definition, multiple causes and uncertainties at play. In my reflections on the research approach, I explain some of these issues. In concluding this thesis, Chapter 6 details my recommendations and some future implications for policy and practice. It also explains my plans for carrying forward different methodological and theoretical approaches in my future research work examining nurses' practice learning.

Although medical practice guidelines for diabetic foot care exist globally, there is no clear guideline for nurses to direct clinical foot care practices for diabetic patients in Thailand. The purposes of this qualitative study were to explore the current practice of diabetic foot care and to develop a nursing practice guideline for effective foot care. The research design included two phases, consisting of situation exploration and practice guideline development. For the first phase, semi structured interviews were conducted among fifteen diabetic patients, five nurses, and five nurse educators at Prapokklao hospital, Thailand to discover their knowledge and practice in foot care. A content analysis approach was used in data analysis. The findings revealed that, although foot care education was available, diabetic patients lacked knowledge and had poor foot self-care practice. Nurses and educators also had inadequate knowledge about effective diabetic foot care and they had scarcely ever provided advanced practice for foot care. Moreover, patients had not been categorised regarding their foot risk level, nor had they received appropriate levels of foot care to manage their particular situations. For the second phase, a nursing practice guideline was developed. The classical Delphi technique was applied to examine experts’ agreement on the practice guideline contents. A questionnaire was developed, based on the first phase’s information and critical literature review using Soukup’s model. Twenty diabetic foot care experts from around Thailand completed the questionnaire. The acceptance of experts’ agreement was 94-100% in all aspects. A final guideline was developed which consisted of the initial risk assessment of foot ulceration and specific guidance on the interventions. This guideline, based upon local specialist expert opinion, provides a clear resource for referral and standardised procedures for evaluating footwear and screening to detect the risk of foot complications. In conclusion, this current nursing practice guideline for diabetic foot care was the first guideline for Thai nurses to care for diabetic patients in a Thai cultural context, and is based on local specialist experts’ opinion. This foundation work provides the basis for further research and evaluation concerning the prevention of foot complications and foot management for diabetic patients, including evaluating the effectiveness of the current risk assessment form and risk classification procedures.

No description available.

Thesis (MCurr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The aim of this study was to compare the impact of a four-day structured Basic Infection Prevention and Control course on the knowledge of, and adherence to, Standard Precautions in clinical nursing practice amongst nurses who had completed the course and those who did not. The specific precautionary measures of investigation included hand hygiene, personal protective equipment (PPE) and sharps management. The secondary aim of the study was to identify any personal and contextual factors that influenced the application of such Standard Precautions measures in public healthcare facilities within the Cape Winelands and Overberg District. Sixty eight students (those who had been trained) with a similar number of controls (who had not been trained) were enrolled in the study. Although both the participants and controls had the knowledge, their adherence to hand hygiene, PPE and sharps management in clinical nursing practice was poor. Staff attitude was found to be the main factor for non-adherence. The knowledge of the participants was good as they had answered most of the questions correctly. It seems as if there was retention of knowledge after the four-day Basic Infection Prevention and Control course. There were, however, no significant differences between the two groups. For both groups attitude and behavioural change must be addressed in order to improve adherence to hand hygiene, PPE and sharps management. The findings of the study will form recommendations towards improved infection prevention and control practices at public healthcare facility level in the Cape Winelands District. / AFRIKAANSE OPSOMMING: Die doel van die studie was om die impak van 'n 4-dag gestruktureerde Basiese Infeksiebeheerkursus op die kennis en toepassing van Standaard Voorsorgmaatreëls in kliniese praktyk in die Kaapse Wynland en Overberg Distrikte ondersoek, vergeleke met 'n groep wat nie die kursus bygewoon het nie. Die spesifieke Voorsorgmaatreëls wat ondersoek is, het handhigiëne, die gebruik van beskermende drag en die hantering en beheer van skerpvoorwerpe ingesluit. Die studie het ook gekyk na enige kontekstuele en persoonlike faktore wat die toepassing van Standaard Voorsorgmaatreëls in openbare gesondheidsorgfasiliteite beïnvloed. Agt en sestig verpleegkundiges het die 4-dag Basiese Infeksiebeheerkursus bygewoon en 'n gelyke aantal kontrole studente het nie die kursus bygewoon nie. Alhoewel beide groepe die kennis van handhigiëne, die dra van beskermende drag en die hantering van skerpvoorwerpe gehad het, was die toepassing van die Standaard Voorsorgmaatreëls in kliniese praktyk baie swak. Personeel se houding was die grootste faktor wat gelei het tot die nie-toepassing van Standaard Voorsorgmaatreëls. Die kennis van die kursusgangers was goed, want albei groepe het die meeste van die vrae korrek beantwoord. Die waarneming wat gemaak is, is dat die kursusgangers se kennis wel verbeter het na die bywoning van die 4-dag Basiese Infeksiebeheerkursus. Data weerspieël egter geen noemenswaardige verskille tussen die groepe nie. Beide groepe se houding en gedrag moet aangespreek word om die toepassing van handhigiëne, die dra van beskermende drag en die hantering van skerpvoorwerpe te verbeter. Die bevindinge van die studie sal gebruik word om aanbevelings te maak ten einde infeksiebeheerpraktyke in die Kaapse Wynland Distrik te verbeter.

Thesis advisor: Dorothy A. Jones / In Taiwan, the ability to measure the changing of health care reform and the improvement in nursing practice environment is hindered by the lack of a valid, reliable, and culture-sensitive instrument for measuring nursing practice environment. The purposes of this two-phase study were to translate and psychometrically validate the Chinese versions of the PPE Scale (CPPE). Phase I focused on translating and adapting the 38-item PPE into CPPE and evaluating the semantic and content equivalency. Semantic equivalence of the CPPE was secured using Translation Validity Indices as judged by American and bilingual experts. The content equivalence of the CPPE was supported by the satisfactory Content validity Indices. To increase the cultural sensitivity and comprehensiveness of the CPPE, 27 items were added at the suggestion of Taiwanese experts following content validation. A 66-item CPPE including 38 PPE items, 1 adapted item and 27 new items was produced for psychometric evaluation. Phase II focused on establishing the psychometric properties of the CPPE. A cross-sectional survey was conducted to test the 66-item CPPE on 977 Taiwanese nurses working in acute care settings. PCA with Varimax rotation on the 38 PPE items produced an eight-component solution for the 36-item CPPE after deleting two items. Cronbach's alpha was .90 for the total 36-item CPPE and .68 - .87 for the eight subscales. PCA with Varimax rotation on 66 items of the CPPE produced an eleven-component solution for the 58-item CPPE after deleting 8 items. Cronbach's alpha was .95 for the total 58-item CPPE and .71 - .87 for the eleven subscales. Both the 36-item CPPE and the 58-item CPPE demonstrated satisfactory test-retest reliability and concurrent validity. The psychometric structures of the 36-item CPPE and the 58-item CPPE were different from the original PPE. Both the 36-item CPPE and the 58-item CPPE were reliable and valid, but the 58-item CPPE is culturally sensitive to the Taiwanese nurses. The 58-item CPPE is useful for measuring Taiwanese nursing practice environment. / Thesis (PhD) — Boston College, 2009. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Provision of complete and responsive solution to healthcare services requires a multi-tired health delivery system. One of the aspects of healthcare hierarchy is the need for nursing care of the patient. Nursing care and observation provide basis for nurses to communicate with other aspects of healthcare system. The ability of capturing and managing nursing practice is essential to the quality of human care. The thesis proposes knowledge based decision making and analyzing system for the nurses to capture and manage the nursing practice. Moreover it allows them to monitor nursing care quality, as well as to test an aspect of an electronic healthcare record for recording and reporting nursing practice. The framework used for this system is based on nursing theory and is coupled with the quantitative analysis of qualitative data. It allows us to quantify the qualitative raw natural nursing language data. The results are summarized in the graph that shows the relative importance of those attributes with respect to each other at different instances of nurse-patient encounter. Research has been conducted by the Department of Computer and Electrical Engineering and Computer Science for the College of Nursing. / by Shubhang Tripathi. / Thesis (M.S.C.S.)--Florida Atlantic University, 2010. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2010. Mode of access: World Wide Web.

Este estudo busca desvelar o que é isto a prática da profissional enfermeira em hospitais públicos, segundo abordagem fenomenológica na tentativa de compreender as experiências vividas pelas enfermeiras no cotidiano de hospitais públicos. O processo de compreensão está fundamentado na fenomenologia social de Alfred Schütz, o que possibilitou desvelar a ação social da profissional enfermeira. O acesso às vivências das enfermeiras deu-se através de entrevista não diretiva diante da questão orientadora: Poderia me dizer como é o seu trabalho como enfermeira aqui no hospital? A análise das descrições permitiram a compreensão do típico da prática da enfermeira revelando revestir-se de grande complexidade. Os graus de complexidade são derivados da intensa relação face a face que acontece no ato de cuidar de outro na sua singularidade; das relações com as outras práticas de atenção a saúde; das limitações da formação técnica da enfermeira que se mostra insuficiente para dar conta dos fenômenos sociais presentes no mundo vivido no hospital; dos enfrentamentos cotidianos diante dos avanços científicos e tecnológicos que exigem reflexão profissional para incorporar-los no cuidado. A fenomenologia social de Alfred Schütz contribuiu para compreender a ação social das enfermeiras como grupo que se insere numa trama de relações sociais intersubjetivas derivadas da coexistência e convivência de uma temporalidade e um espaço comum de trabalho. / This study aimed to uncover the practice of nursing professionals in public hospitals, adopting a phenomenological approach, in an attempt to understand the experiences of nurses in the daily reality of public hospitals. The understanding process is based on the social phenomenology of Alfred Schütz, which allowed us to uncover the social action of nursing professionals. Access to nursing experiences was obtained through non-directive interviews, in view of the question: Could you tell me how your work is as a nurse here at the hospital? The analysis of their descriptions allowed for the understanding of what is typical about nursing practice, which revealed to be highly complex. The complexity levels derive from the intense face-to-face relation that occurs in caring for the singularity of others; from the relations with other health care practices; from limitations in technical nursing formation, which reveals to be insufficient for dealing with the social phenomena present in the hospital world; from the daily confrontations with scientific and technological advances, which require professional reflection to be incorporated into care. The social phenomenology of Alfred Schütz contributed to the understanding of nurses’ social actions as a group that is inserted in a web of intersubjective social relations, which derive from the coexistence and experience of a common time and work space.

With passage of the Patient Protection and Affordable Care Act (PPACA) and the publication of the Institute of Medicine’s report on the future of nursing, nurses are slated to take on an expanded role in primary healthcare delivery in the near future. Nurse practitioners, in particular, will be instrumental in filling the gap in primary care availability engendered by the increasing specialization of physician practice and increased access to healthcare made possible by the provisions of the PPACA. The need for this study was identified through gaps in the literature related to nurse practitioner practice; specifically, the paucity of quantitative research regarding patients’ perspectives of core holistic nursing values in nurse practitioner care, and, since nursing care is by definition and tradition holistic in nature, this inquiry attempted to quantify the degree to which nurse practitioner care upholds and preserves core holistic nursing values. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection

A formação pedagógica para a docência universitária no âmbito da pós-graduação stricto sensu enfrenta desafios. Os espaços para tal formação mostram-se reduzidos na universidade. A prioridade dada à formação para a pesquisa reforça a necessidade de valorizar a docência, bem como sua formação no âmbito da pós-graduação. Discute-se centralmente a importância dos conhecimentos específicos, articulados com os pedagógicos de modo que estes tragam subsídios para o professor atender mais plenamente às necessidades formativas. O estudo objetivou então, fazer uma reflexão sobre a percepção do pós-graduando acerca da formação docente, considerando os novos paradigmas que se instalam no campo da educação e da saúde. Trata-se de revisão sistemática da literatura, cujo objetivo foi levantar dados sobre o processo de formação docente na pós-graduação em Enfermagem considerando a importância de sintetizar e categorizar os estudos primários, realizados no Brasil no período de 2000 a 2012, sobre o assunto em apreço. A amostra foi constituída por dez estudos dos quais indentificou-se as situações-limites através da fala dos pós-graduandos com relação à formação pedagógica para a docência no ensino superior. Nota-se que os espaços destinados ao ensino na pós-graduação são incipientes para atender a demanda da formação docente. Contudo muitos pós-graduandos identificaram como espaços para a formação pedagógica, a existência de algumas disciplinas que fundamentam as questões relativas ao ensino e aprendizagem, além da reflexão sobre paradigmas que identificam posturas e características docentes, entre outros aspectos, bem como o Programa de aperfeiçoamento de ensino (PAE), como uma oportunidade relevante de aproximação com as questões mais amplas que dizem respeito ao processo do ensino superior e seus desafios no século XXI. / The pedagogical preparation for university teaching in the post-graduate programs faces challenges. Spaces for this development turned out to be very limited at university. The priority given to research training reinforces the need to enhance the professorship as part of their graduate program. It discusses the importance of expertise, articulated with the pedagogical knowledge so that it is beneficial for the teacher to more fully meet preparation needs. Then, the study aimed to reflect on the perception of the graduate student about teacher education, considering the new paradigms settled in education and health. This is a systematic review of the literature, whose goal was to collect data about the process of teacher education in graduate nursing, considering the importance of categorizing and synthesizing primary studies carried out in Brazil from 2000 to 2012, on the subject in appreciation. The sample consisted of ten studies which identified the limit situations through the speech of graduate students regarding pedagogical preparation for teaching in higher education. Note that the spaces for teaching in graduation are incipient to meet the demands of education. Yet, many graduate students identified as main spaces for exercising teaching knowledge, the existence of some courses concerning issues related to teaching and learning, and reflecting on paradigms that identify pedagogical postures and faculty characteristics, as well as Brazilian Improving Teaching Program, as a significant opportunity for rapprochement with the broader issues that concern the process of higher education and its challenges in XXI century.

Patient engagement has become a widely used term, but remains a poorly understood concept in healthcare. Citations for the term during the past two decades have increased markedly throughout the healthcare-related disciplines without a common definition. Patient engagement has been credited for contributing to improved outcomes and experiences of care. Means of identifying and evaluating practices that facilitate patient engagement in care have become an ethical imperative for patient-centered care. This process begins with a definition of the concept. Concept analysis is a means of establishing a common definition of a concept through identification of its attributes, antecedents and consequences within the context of its use. Concept analysis is a methodology that has been used in social science and nursing as a means to resolve conceptual barriers to theory development in an evolving field. The methodological theory was based in the analytic philosophical tradition and sustained during the 20th century by the strength of philosophical positivism in the health sciences. This concept analysis is guided procedurally by Rogers’ evolutionary approach that incorporates postmodern philosophical principles and well-defined techniques. This dissertation is informed by the expanded and updated perspective of the neomodern era in nursing research, which advances the concept analysis methodology further. An analysis of the concept underlying the term patient engagement in the scientific literature revealed four defining attributes: personalization, access, commitment and therapeutic alliance. These defining attributes were derived through thematic analysis of over 100 individual attributes shared among six categories and three domains. The resultant definition revealed that patient engagement is both process and behavior shaped by the relationship between patient and provider and the environment where healthcare delivery takes place. Patient engagement is defined as the desire and capability to actively choose to participate in care in a way uniquely appropriate to the individual, in cooperation with a healthcare provider or institution, for the purposes of maximizing outcomes or improving experiences of care. In addition to the attributes of the concept identified in the literature, themes relevant to patient engagement were identified through inputs from six focus groups of persons living with HIV in New York City. The focus group participants were convened to inform the development of a mobile application designed to support their healthcare needs. Their experiences, insights and expectations were valuable in ascertaining those actions or behaviors that may serve to assist the patient in obtaining and adhering to care. The focus group transcripts were coded twice. The first round occurred prior to the concept analysis of the literature and used emergent coding methodology to capture meanings independent of the findings of the concept analysis. The second round occurred after the concept analysis of the literature and used the resultant attributes to perform a directed concept analysis of the transcripts. The content analyses of the transcripts from the patient perspective supported and reinforced the attributes from the concept analysis. The focus groups also highlighted another important aspect of patient engagement, that of privacy/confidentiality, which had not been specifically addressed in the concept analysis of the literature. The definition and the identified attributes serve as a heuristic in designing patient engagement strategies and as a basis for future development of the engagement concept in healthcare. The supporting concepts for engagement, especially the role of empathy in the therapeutic alliance, require further clarification and debate. While patient engagement may be promoted through face-to-face interactions or through health information technology, the defining attributes are invariable and should guide the design of engagement processes and tools. Finally, the value of understanding and exploring the defining attributes of patient engagement in medical and nursing education becomes clear, as is the need for continuing clinical training to support and encourage patient engagement skills.