Nurses who provide care in robotic surgery must have sufficient special training in the operation of the da Vinci robot to perform their roles with knowledge and confidence that can yield optimal patient outcomes. The local nursing practice problem in the project facility, and the focus of this doctoral project, was the lack of an evidenced-based robotics education program for registered nurses who participate in robotic surgery. The gap in practice was nurses' lack of knowledge, which interfered with the care provided to the robotic surgical population. The purpose of this project was to develop a staff robotics education program in order to answer the question if the implementation of an evidence-based robotics education program would improve nurses' knowledge in the practice of robotic surgery. The education program was developed using Knowles adult learning theory and information obtained from a comprehensive literature search. A planning team, consisting of local clinicians with expertise in robotic surgery, provided feedback and assisted with the development of the education program and accompanying competency checklist. Ten nurses received the education, and 90-100% of the nurses reported increased knowledge and confidence regarding practice in the specialty of robotic surgery following the education. Leadership at the project site have decided to require surgical nurses receive the robotic education upon their employment and annually thereafter. The social change resulting from the use of this evidence-based robotics education program could include increased nursing performance and therefore, decreased complications for patients undergoing robotic surgery.

Managing heart failure patients in the outpatient setting can pose a challenge for nurses and health care staff due to the need to educate patients on self-care skills and management of disease. Several factors, including health literacy and numeracy, need to be considered when developing an education program for heart failure patients to promote self-care management. The purpose of this project was to provide nursing staff with a clinical practice guideline (CPG) that incorporated health and numeracy literacy assessment into an individualized education program. The Johns Hopkins nursing evidence-based practice (EBP) model, the situation-specific theory of heart failure (HF) self-care, and Wagner's chronic care model guided the development and implementation of this project. The practice-focused question for this project asked whether evidence informs a CPG intended to assess health literacy and numeracy assessment and promote an enhanced individualized education intervention in an outpatient HF population. A literature review using 20 articles from 2006-2018 was completed. Five articles were selected to review levels of evidence, and three articles were chosen to support the development of the CPG. The CPG was reviewed, refined, and validated by an expert panel of HF nurses and physicians. The CPG might support a positive social change in the practice setting by improving the tools for nurses to assess health literacy in the HF patient population and provide individualized education to influence self-care interventions.

Nurse educators are tasked with preparing safe, competent nurses but are faced with unique challenges in helping students with disabilities. Students with learning disabilities require accommodations which are alterations or adjustments within the learning environment and are developed by the instructor. The purpose of this 3-manuscript dissertation, guided by the universal design for instruction (UDI), was to explore the attitudes and instructional methods used among nursing faculty related to teaching students with learning disabilities. Three research questions were framed as parallel studies to address the gap in understanding how faculty view nursing students with disabilities, how clinical specialty influences faculty's teaching methods, and what UDI teaching methods faculty use. Nursing faculty who teach in the classroom for prelicensure nursing programs were recruited to complete the Instructional Methods and Attitudes Faculty Survey. Data from 102 participants were analyzed using a Wilcoxon-Mann-Whitney test, which indicated significant differences between the use of inclusive teaching methods (hands-on or interactive and problem solving, communication and interaction among students brainstorming, and providing class outlines or lecture slides before class). There were no differences when comparing faculty attitudes toward UDI familiarity, disability familiarity, and clinical specialty. The implementation of UDI promotes social change by creating an inclusive learning environment that increases the likelihood of success for students with learning disabilities. Future research should focus on best practices to educate faculty about inclusive teaching paradigms, such as UDI and explore faculty and student perspectives about the use and implementation of UDI.

The purpose of this body of work was to address medication errors and safe medication administration practices in relation to practicing nurses and nursing students via several different approaches. These different approaches will be presented as three separate papers but interrelated themes. The specific purpose for each paper and the corresponding research questions were addressed individually in each chapter. The approach used in the first paper was a systematic literature search of medication administration errors and the pediatric population; five themes emerged including the incidence rate of medication administration errors, specific medications involved in medication administration errors and classification of the errors, why medication administration errors occur, medication error reporting, and interventions to reduce medication errors. The approach used in the second paper included a systematic literature review and implementation of a survey, both focusing on the assessment strategies for safe medication administration with practicing nurses and nursing students. Results of both the review and the survey indicated a lack of a comprehensive assessment of safe medication administration. The approach used in the third paper was a research study to conduct a psychometric evaluation of the Safe Medication Administration (SAM) Scale with baccalaureate nursing students. Results provided evidence of the validity and reliability of the SAM Scale. This body of work exposed a gap in nursing and demonstrates the importance of having a standardized assessment of safe medication administration with evidence of validity and reliability to demonstrate competency in this area.

This study set out to examine and describe the experiences of undergraduate students from different cultural backgrounds studying nursing across three Australian states. The researcher chose to use the grounded theory method to analyse data collected from 40 undergraduate student nurses and 32 nurse teachers. Other data resources included field observations of student nurses in clinical practice and classroom settings. All interviews were transcribed verbatim and along with field notes and memos were analysed using the constant comparative method synonymous with grounded theory. This study was set in a sociopolitical climate of disharmony in which the basic social problem of sociocultural discord: being different and not fitting in (SD) was identified and developed as the core category. The basic social psychological problem existed for culturally and linguistically diverse nursing students because they were in some way different to the majority of their White western counterparts. Differences existed in, for example, religion, dress, skin colour, beliefs, behaviours, and ways of communicating. Because these students were different they experienced discord. Discord was characterised as sociocultural because differences causing discord were rooted in either a cultural or social domain or both. Those students who experienced SD lived with feelings of social and professional isolation, discrimination, and low self esteem to name a few. For the students, experiences of sociocultural discord were largely unpredictable and occurred episodically. The fear of embarrassment, discrimination, or some other form of inequitable treatment prevented students participating actively in classes or on clinical practice. / Students, however, were unable to determine when they were likely to experience inequitable treatment and for many when it had been identified it was too late; they were amidst the experience. Others were hesitant to interact with their Australian counterparts for fear of rejection. This study occurred during a particularly disharmonic climate which permeated all aspects of the students’ lives and had the propensity to impact upon individual levels of SD. As such this climate existed as the background in this study. One of the background issues identified as impacting upon students in this study was stereotyping. In this study stereotyping was often based upon perceived cultural, religious, and/or gender norms. The physical environments, that is, university campuses and clinical practice settings in which the students were required to participate, were also found to impact upon student participants and were therefore also considered as background. In these institutions there was an obvious lack of cultural role models and students’ behaviours were often misinterpreted. Whilst some students’ families were considered as immensely supportive others were identified as being the cause of much sociocultural discord. The politics of race and culture also acted to permeate the students’ existence and these issues were given wide media coverage at the time of this research. In an effort to deal with, or counter, episodes of sociocultural discord student participants engaged the process of seeking concord to get in the right track (SC). Some of these strategies worked to reduce SD whilst others did not. These strategies consisted of saving face, covert deception, and using the “yes syndrome”. / Other strategies included clustering, trying to form friendships, and trying to interact with members of the dominant group. Many students struggled to suppress their feeling of SD by being quiet and/or ignoring differential treatment and avoiding interaction with others. Some adopted other strategies to strengthen their communication abilities in an effort to reduce discordant episodes. Many of these strategies were learnt from other students or supportive nurse teachers. Other support was attained from student counselling services and supportive family members. These were considered the influencing conditions. Unlike many grounded theories this study was unable to identify the end of the process, that is, successful outcomes. Irrespective that students implemented strategies to decrease their discord they continued to experience other discordant events throughout their undergraduate degree program. Whilst many of the findings in this research support the existing literature, this study can be considered as one of the first attempts to study student nurses from different cultural backgrounds and their experiences of nursing education in Australian universities.

This qualitative exploratory study sought to explore and analyse the perceptions of first year nursing students aged 18-25 years toward older persons in aged care facilities. The expectations of first year nursing students in relation to performing nursing care on older persons was also examined. The students’ perceptions were explored using a photo-elicitation technique to evoke an emotive response. By challenging and confronting the participants with realistic photographs of nursing care, this technique encouraged the research participants to engage in anticipatory reflection prior to their first aged care clinical placement. Data were gathered through demographic questionnaires and semi-structured photo-elicitation interviews. Findings were analysed using thematic analysis. Themes included dissecting what it means to be a nurse, recognising dependence, and the re-visioning of therapeutic relationships including considering patient dignity and empathising with older persons. A youthful reflection on the differences between young and old included participants’ fearing for themselves in future, and this was another identified theme. The photo-elicitation technique challenged and confronted participants as they became aware of the responsibilities of performing nursing care and their belief that they lacked emotional preparedness. Experiencing sensitivity and awkwardness to nakedness of older person’s bodies was also highlighted by most of the participants’ responses. The findings suggest that it is essential in this time of demographic change and the growing ageing population that nursing education responds to the challenge of an evolving health care system by providing qualified, experienced aged care nurses who are familiar with the reality of older people. Therefore, first year nursing students’ transition to aged care nursing clinical placement and the adoption of positive attitudes is paramount. Despite a large number of research studies highlighting nursing students’ disinterest in caring for older persons, there have been few studies investigating educational interventions that could assist in overcoming this negative trend. The findings from this study have important implications for teaching strategies aimed at understanding undergraduate nursing students. Using photography to elicit emotional responses can also assist with reflective practice, which can be useful to enhance self awareness and an aesthetic and personal knowing. Encouraging anticipatory reflection can help socially prepare nursing students, increase their readiness for learning and foster more positive attitudes to caring for older people prior to the students’ initial aged care clinical placement.

Since the introduction of the Internet, there has been an increase in the adoption of this technology for educational purposes. This development and widespread availability of Internet technologies, alterations in the needs of clinical practice and the characteristics of students, have all inspired changes in nursing education (Mallow & Gilje, 1999). In response, nursing education has embraced the opportunity this communication medium offers to the diverse groups of students in nursing. These students may be studying at a distance, or due to other constraints such as time or professional commitments, studying in flexible ways where students may or may not be in the classroom. In other instances, Internet technologies are being used with the aim of enriching learning in nursing. However, despite widespread development and implementation of these innovations, the effects on nursing education have not been extensively researched (Cheek, Gilham & Mills, 1998; Gillham, 2002; Mallow & Gilje, 1999) and little is known about how the Internet contributes to teaching and learning, what learning outcomes are, or what support is required by teachers and students (Billings, 2000). At this time of rapid development of Internet-based and Internet-supported courses in the Australian nursing education system, there is a need to ensure such courses are educationally effective, clinically relevant, and that resources are appropriately assigned. This exploratory study aimed to contribute to effective discipline-specific use of internet learning environments through increased understanding of students’ and academics’ experiences of teaching practices and learning processes. There were two phases to this mixed-method study, a survey of course coordinators, and secondly, interviews with eleven students and sixteen academics. The survey of diverse schools of nursing across Australia provided foundational information about the ways the Internet was integrated into nursing education, and the preparation and supports that were offered to students for Internet-based or Internet-supported learning. Guided by a constructivist theoretical framework, and analysed thematically, the key findings of this study were drawn from the academics’ and students’ experiences in a variety of nursing courses in universities located across Australia. The Internet was employed in these courses in a variety of ways. At the time of data collection for both the survey and the interviews, more courses were Internet-supported than Internet-based. A variety of Internet information and communication features were used in courses. The survey findings provided both a context for the interview findings, and a degree of confirmation of these findings. The context reported was diverse, consistent with an emergent educational environment that has few precedents to guide its implementation. The academics’ experiences revealed that teaching in online environments was vastly different to face-to-face teaching and required different practices of teaching and learning that took into consideration the separation of teachers from learners, and learners from each other. While often enthusiastic about the new environment, many teachers needed specific preparation, support, and adequate resources to teach in this new environment. Similarly, students experienced a dislocation from the learning environments to which they were accustomed. Significant shifts were apparent in the students’ constructions of both individual and collaborative learning that were contingent upon the separation of teachers and learners, and the necessity of communicating in a written medium. Both teachers and learners revealed how, consequent upon their dislocation, they were relocating to a new interpretation of time, place and relationships in Internet learning environments, and were reconstructing teaching and learning. The reconstructions of learning included ways of relating that built learning communities predicated on a shift in focus from teaching to learning. These included both a shift in individual student’s learning, and a constructed understanding that arose variously from shaping a fundamental comprehension or challenging thinking, to expand comprehension in the group. Through new understandings and practices, the participants were beginning to construct a place for students and teachers to realise the possibilities for enriched learning that online communities can provide. The findings of this study are discussed in terms of the possibilities for teaching and learning in nursing education, and recommendations are made.

The purpose of this study was to examine some of the interrelationships between innovation in nursing education, professional attitudes and wastage from nursing. Five groups of students who participated in innovative nurse education courses in A.C.T. hospitals in the 1970's were surveyed by a self administered questionnaire which gathered biographical data as well as attitudinal information. Their responses were compared with those of students who had undertaken a traditional nursing course at an A.C.T. hospital in the same period. The findings of this study suggested that the instrument used may provide a better measure of satisfaction with nursing than of professional attitudes. One of the unexpected findings from the survey which suggested the need for further study was that many of those who had undertaken further nursing study indicating apparent commitment to continuing education in a chosen career would not encourage others to enter nursing. Another was that those who indicated greater career choice commitment may in fact be those who felt unable to obtain alternative employment. It was found that innovation in hospital based nurse education courses attracted different people and produced graduates with different attitudes to professional issues,who followed different career pathways compared to graduates of traditional nurse education courses. Innovative courses appear to have attracted older and better qualified entrants and to have increased the likelihood of graduates being promoted. Respondents from the innovative courses showed increased interest in continuing education and Professional Association activity than their control group colleagues. They were more frustated with the traditional role of the nurse as the selfless, dedicated worker and were less commited to their career choice, overall these findings perhaps indicated a level of dissatisfaction with nursing higher in the innovative course graduates than in the control group. These findings may support Brief's contention (1976) that expectations raised during the educational process, if not fulfilled, will lead to wastage. wastage from nursing was intimately linked with dissatisfaction with work conditions in nursing. Those who had permanently left nursing had more frequently left for work related reasons and undertaken non-nursing study than those who had left and returned or who had never left. Those who left for work related reasons were less likley to return and less likely to choose nursing again if given the chance than those who left for other reasons. Findings about the institutionalisation of innovation in nursing education were difficult to identify with certainty, since time lapse alone could explain many of the findings. Attitudes to the Professional Association were more favourabe in respondents from the later intakes into the innovative courses than from the earlier. Given the recent increases in industrial activity in nursing, this finding is consistent with time lapse. Later intakes also demonstrated greater commitment to continuing education than earlier. This too can probably be explained by the greater availability of such facilities in more recent times. In a period of shortages of nurses prepared to work in the health care facilities of Australia, and of changes in the educational preparation of nurses, the findings of this study relating to attitudes and wastage should be used as the basis for future workforce planning.

<p>Denna studies övergripande syfte var att förstå de drivkrafter som leder till att vissa sjuksköterskor söker sig till akademisk kompetensutveckling medan andra ser det som helt otänkbart. Studiens mer preciserade syfte var att undersöka hur sjuksköterskor med kompletterande studier i vårdvetenskap ser på akademisk kompetensutveckling. Följande frågeställningar fokuserades för att få en mer nyanserad bild av detta fenomen: Vad har kompetensutvecklingen inneburit för sjuksköterskorna? Vad är det för kunskap de vill utveckla och varför? Vilka drivkrafter har motiverat sjuksköterskorna till kompetensutveckling? Vilka faktorer uppfattar sjuksköterskorna har möjliggjort/försvårat deras kompetensutveckling? Den teoretiska anknytningen gjordes till följande begrepp: kompetens, kunskap och motivation. Definitioner och teorier inom respektive begrepp användes för att försöka förstå, förklara eller värdera undersökningens resultat. Studien genomfördes som en halvstrukturerad intervjuundersökning med ett allmänkvalitativt perspektiv. Respondenterna utgjordes av tio sjuksköterskor med pågående eller avslutade studier inom vårdvetenskap på grund- eller avancerad nivå. Alla var kvinnor och arbetade inom vitt skilda delar av sluten- och öppenvård inom såväl landsting som kommun. Intervjuerna spelades in på band och transkriberades ord för ord och detta material analyserades efter inspiration från Granheim och Lundmans modell för innehållsanalys. Resultatet utmynnade i de fyra kategorierna <em>drivkrafter, förutsättningar, kompetenser</em> och<em> konsekvenser. </em>Under respektive kategori kom ett flertal underkategorier att ytterligare förstärka bilden av den akademiska kompetensutvecklingens villkor. Bland de avgjort viktigaste resultaten fanns den kulturkrock mellan klinik och akademi som respondenterna upplevt i mötet med studenter och nyutbildade sjuksköterskor. I detta möte fann de en stark drivkraft till egna akademiska studier vars syfte bestod av främst två delar, att skaffa sig kunskaper inom det egna kunskapsområdet omvårdnad, samt att skaffa sig redskap för såväl forskningskonsumtion som – produktion. Att den kliniska verksamheten ännu inte var redo för akademin var en annan tydlig bild som uppstod ur sjuksköterskornas berättelser. De kunskaper som värderades högst fanns inom den praktiska produktiva delen av vården och beskrevs av sjuksköterskorna oftast som förmågor. Den personliga utvecklingen var såväl en drivkraft till som en konsekvens av studierna och denna uppfattades som central för den vidare studiemotivationen. Sjuksköterskorna beskrev sina studier som en process som närmast kunde liknas vid att göra en resa, i detta fall <em>den akademiska resan. </em></p> / <p>This study investigated the main motives for why some registered nurses choose to continue on the path of higher educational studies. More specific, this study aimed to explore how registered nurses with additional academic marks in nursing science viewed academic competence development. Following questions were used to capture the complexity of the phenomenon of academic competence development; i) What did competence development involve for the registered nurses? ii) What kind of knowledge did they strive to develop and why? iii) What were the main motives for their competence development? and finally iv) What factors did they perceive as facilitators and/or barriers for competence development? Qualitative semi-structured interviews were conducted with ten female registered nurses, who were either still enrolled or had completed basic or advanced academic studies in Nursing Science. The informants worked in different kind of specialties either in secondary or in primary care. All the interviews were taped and transcribed before being analyzed inspired by the model of content analysis as described by Graneheim and Lundman. Established theories and definitions for the concepts of competence, knowledge and motivation were used to understand, explain and/or to evaluate the findings. The content analysis revealed four categories,<em>‘motivations’, ‘conditions’, ‘competences’ and finally ‘consequences’. </em>Each category was also interpreted to include several sub categories. One of the main findings coming out from this study was the obvious culture clash experienced to occur in meetings between the informants and newly graduated registered nurses or nursing students. Experiencing this culture clash meant that the informants became strongly motivated to pursue further degrees in nursing science. Their studies mainly aimed at increasing their knowledge within their own speciality but also to increase their skills in appraising and performing nursing research. Their own individual and personal developments were interpreted to be both a motive and a consequence of taking on further academic competence development. In the analysis of the nurses stories it became obvious that clinical practice were not yet ready for nurses who departures from a theoretical and academy knowledge base in their everyday practice. Hence, practical and productive nursing knowledge, mainly described by the nurses as abilities, were more highly valued than theoretical academic knowledge. The nurses experienced that the process of continuing to develop their academic competences could be compared by a journey and in this case more specific<em> an academic journey. </em></p>

<p>Sammanfattning</p><p>Det övergripande syftet med denna studie var att undersöka vuxnas upplevelse av att studera, i perspektivet socialisation och identiteters rekonstruktion genom studier. Studiens preciserade syfte var hur individen rekonstrueras genom studier med frågeställningar utifrån centrala temata i den teoretiska ramen: Hur uppstår mötet med det rekonstruerande självet? Hur upplever och vad blir konsekvensen av individens möte med den generaliserade andre? Hur upplever individen mötet med de signifikanta symbolerna och vad innebär detta möte? Undersökningen har genomförts i form av en kvalitativ, öppen riktad intervjuundersökning. Respondenterna bestod av nio kvinnor studerande på Omvårdnadsprogrammet och Barn och fritidsprogrammet, inom den kommunala vuxenutbildningen. Data som framkom vid intervjuerna transkriberades ord för ord och analyserades därefter utifrån en teoriram som grundade sig på Moira von Wright och George Herbert Meads symbolinteraktionistiska perspektiv. I resultatet framkom tre centrala temata, som betydelsefulla för den vuxnas upplevelse av att studera. Dessa var möten – relationer, hinder och lärande. Det som framkom ur det empiriska resultatet som väsentligt, när det gällde upplevelsen av att studera som vuxen, var mötet med andra studerande och lärare. De hinder som beskrevs var tidsbrist och problem med att uttrycka sig, såväl muntligt som skriftligt, detta gällde även de studerande med svenska som första språk. Motiven till att studera som vuxen var en förhoppning om ökade möjligheter att få en fast anställning, en säker inkomst och en upplevelse av ökad gemenskap i samhället. Det som också upplevdes som betydelsefullt var att få de kunskaper som efterfrågades av arbetsgivare, samt att erhålla kunskaper som innebar ökade möjligheter att göra ett bra arbete. I studien framkom även en förhoppning om att genom studier få en ökad insikt och förståelse för hur det svenska samhället fungerade. Flera av respondenterna uttryckte att deras studier fått dem att se med nya ögon på tillvaron och sitt liv. Mitt resultat visade att det rekonstruerande självet uppstod genom lärande i interaktion med individens miljö. Ett samspel som var beroende av tillgängligheten till de signifikanta symbolerna och den generaliserade andre. Möjligheten att del av de signifikanta symbolerna, förmågan att kommunicera, framkom i sin tur som avgörande för mötet med den generaliserade andre och var också den faktor som gav möjlighet till känslan av samhörighet, utveckling och trygghet.</p>