As the health care system experienced a complex tapestry of transitions in the past decade, first-line managers (FLMs) strived to maintain a sense of stability for themselves and their staff in chaotic work environments. Individuals across the nation are striving to ensure health care team members have quality work environments. The paucity of literature examining the perceptions FLMs have of their work environment prompted this study. <p>This study provided FLMs employed in regional and provincial hospitals in Saskatchewan a voice to share their perceptions of their work environments with others. It is an adaptation of the descriptive survey design used by Remus, Smith, and Schissel (2000) in their study of staff nurses. The adaptation was based on the literature, making it applicable to FLMs, and incorporating the six Quality Worklife Indicators (QWI) of the Canadian Nurses Associations (CNAs) Quality Professional Practice Environments framework. The questionnaire also incorporated open-ended questions that enabled respondents to elaborate on their perceptions of their work environments.<p>The total population of 113 FLMs in regional (FLMRs) and provincial (FLMPs) hospitals in Saskatchewan was invited to participate in this study. Sixty-nine respondents (61.1%) chose to do so. FLMRs had a higher, although not significant, response rate, (67.6% n=23) than did FLMPs (58.2% n=46). The researcher attempted to make personal contact and correspond with each invited participant when distributing the questionnaires. In the open ended questions, participants in this study described intertwined multidimensional roles and responsibilities resulting in unmanageable workloads. They faced daily challenges involving relationships, putting out fires, balancing system/personnel relationships, staffing issues, resources, time, and salary. FLMs who successfully resolved their challenges felt a sense of accomplishment or reward, increasing their self confidence in their ability to successfully fill their roles as a FLM. FLMs described that being a change agent, teamwork, recognition by others, relationships, working with patients, and control over practice as the most rewarding elements within in their practice environments. The Environment Perception Scale responses reflected positive perceptions of work environments on all subscales except control over workload. Overall, FLMPs had a slightly more positive perception of their work environments than did FLMRs, except on the control over workload subscale. However, there were no significant differences between the groups except on the innovation and creativity subscale, where FLMRs scored significantly lower.<p>Study results offer senior administrators, professional associations, government, educators, and others an opportunity to increase their understanding and awareness of the perceptions FLMs have of their practice environment. Awareness of these perceptions will facilitate supporting or strengthening the rewards FLMs perceive in their practice environments, resulting in a richer practice environment. Identification and awareness of the perceived challenges is the first step in addressing them. Educators will find these results useful in better preparing future leaders of nursing for formal management roles.

As the health care system experienced a complex tapestry of transitions in the past decade, first-line managers (FLMs) strived to maintain a sense of stability for themselves and their staff in chaotic work environments. Individuals across the nation are striving to ensure health care team members have quality work environments. The paucity of literature examining the perceptions FLMs have of their work environment prompted this study. <p>This study provided FLMs employed in regional and provincial hospitals in Saskatchewan a voice to share their perceptions of their work environments with others. It is an adaptation of the descriptive survey design used by Remus, Smith, and Schissel (2000) in their study of staff nurses. The adaptation was based on the literature, making it applicable to FLMs, and incorporating the six Quality Worklife Indicators (QWI) of the Canadian Nurses Associations (CNAs) Quality Professional Practice Environments framework. The questionnaire also incorporated open-ended questions that enabled respondents to elaborate on their perceptions of their work environments.<p>The total population of 113 FLMs in regional (FLMRs) and provincial (FLMPs) hospitals in Saskatchewan was invited to participate in this study. Sixty-nine respondents (61.1%) chose to do so. FLMRs had a higher, although not significant, response rate, (67.6% n=23) than did FLMPs (58.2% n=46). The researcher attempted to make personal contact and correspond with each invited participant when distributing the questionnaires. In the open ended questions, participants in this study described intertwined multidimensional roles and responsibilities resulting in unmanageable workloads. They faced daily challenges involving relationships, putting out fires, balancing system/personnel relationships, staffing issues, resources, time, and salary. FLMs who successfully resolved their challenges felt a sense of accomplishment or reward, increasing their self confidence in their ability to successfully fill their roles as a FLM. FLMs described that being a change agent, teamwork, recognition by others, relationships, working with patients, and control over practice as the most rewarding elements within in their practice environments. The Environment Perception Scale responses reflected positive perceptions of work environments on all subscales except control over workload. Overall, FLMPs had a slightly more positive perception of their work environments than did FLMRs, except on the control over workload subscale. However, there were no significant differences between the groups except on the innovation and creativity subscale, where FLMRs scored significantly lower.<p>Study results offer senior administrators, professional associations, government, educators, and others an opportunity to increase their understanding and awareness of the perceptions FLMs have of their practice environment. Awareness of these perceptions will facilitate supporting or strengthening the rewards FLMs perceive in their practice environments, resulting in a richer practice environment. Identification and awareness of the perceived challenges is the first step in addressing them. Educators will find these results useful in better preparing future leaders of nursing for formal management roles.

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.

Thesis advisor: Dorothy A. Jones / Purpose: The purpose of this study was to define, develop, and psychometrically evaluate a scale designed to measure Nurse’s Perception of the Relationship Based Care Environment. Background: Relationship is a complex multidimensional concept. It is a critical component of professional practice and core to the interaction between nurse and patient. While there are a number of scales available to measure different dimensions of relationships between nurses and other groups there is no one scale that captures multiple dimensions. Methods: Based on a review of the literature and an earlier qualitative study, a theoretical representation was developed. This representation became the framework for development of elements and items for the NPRBCE scale. The content validity of the NPRBCE scale was determined by an expert panel of Registered Nurses. Four hundred and seventy three Registered Nurse participants completed the survey. Analysis: Data were subjected to Principal Components Analysis and Cronbach’s alpha was computed to determine reliability of the scale as a whole and each of the components of the scale. Results: The final solution was a five component 56-item scale. The five components include: nurse/ other discipline; nurse/organization; nurse/ nurse; nurse/ patient- knowing the patient; and nurse/patient-respecting the patient. The scale as a whole and each of the resulting components were found to be reliable. The components were parsimonious and interpretable. Keywords: relationship based care, relationship centered care, nurse practice environment / Thesis (PhD) — Boston College, 2016. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Magister Curationis - MCur / Background: Nursing as a profession is based on firm knowledge, values, clinical skills and attitudes. In the current dynamic healthcare system nursing students are challenged to be insightful and have clinical reasoning and psychomotor skills in order to apply theory to practice. Clinical teaching is therefore considered an essential part of the undergraduate nursing curriculum, as it provides the opportunity for students to apply theory to practice in the skills laboratory and then to transfer it into real life situations. Nursing students spend time in the clinical practice environment learning the skills and values of the nursing profession, with the goal of achieving the clinical learning outcomes, as prescribed by their nursing education institution and the South African Nursing Council. During this time nursing students depend on the support of clinical supervisors and nursing staff in the clinical practice environment to meet their learning outcomes. Clinical supervisors for the undergraduate nursing programme, at the university included in the study, are tasked with clinical teaching in the skills laboratory, supervision of nursing students in clinical practice and assessment of learning. Nonetheless, there are challenges ascertained by the clinical supervisors, which inhibits students from achieving their learning outcomes. Purpose of the study: The purpose of the study was to explore and describe the clinical supervisor’s perception of students’ skills transfer from skills laboratory to the clinical environment.

Maternal and perinatal mortality is one of the biggest challenges to public health, especially in developing countries. South Africa?s health care system is struggling to meet the “health for all” criteria against a backdrop of staff shortages (especially midwives) in an HIV/AIDS epidemic. These factors, together with the economic constraints of a developing country, places great demands on delivering cost–effective, safe, quality intrapartum care that exceeds expectations. The challenge for the manager is to organise the available resources to render the best quality of care cost effectively within the shortest period of time. Various reasons exist for the alarming shortage of nurses and midwives globally and also in South Africa. Unhealthy practice environments are the main cause of the problem as such environments have an impact on the job satisfaction of the midwives as well on patient satisfaction. In the turmoil of the health care system, patients are demanding greater quality of care and are insisting not only on excellent clinical skills, but also on empathetic and personalised care. This research was conducted to make a meaningful contribution to the body of knowledge, specifically knowledge related to quality intrapartum care through the development of a Quality Improvement Intervention Programme (QIIP?). The research was conducted in two phases including five objectives. The first objective gave a theoretical foundation of quality intrapartum care. The second objective included a situational analysis of the resources (personnel and equipment) and determine the quality improvement initiatives that could be implemented for intrapartum care. The third objective determined the practice environment in maternity units at Level 2 hospitals in the North West province that may influence quality intrapartum care. The fourth and last objective of Phase 1 determined the perceptions of management and midwives regarding the facilitating and impeding factors that influence the quality of intrapartum care. From the data that emerged from the first four objectives, specific themes kept repeating themselves, namely structure (what must be in place, e.g. infrastructure and human resources), process (what we do, e.g. life–long learning and implementation of policies) and outcome (the results, e.g. patient satisfaction and a positive practice environment). These collectively contribute to the quality of intrapartum care rendered. Phase 2 consisted of the development of a “Quality Improvement Intervention Programme (QIIP?)” for intrapartum care. In this phase the data from the first four objectives were used to develop the QIIP?. The QIIP? will be marketed as an accreditation tool for maternity units to measure themselves against the best in the world. Qualifying for QIIP? accreditation means improving the quality of intrapartum care resulting in satisfied patients, the establishment of a positive practice environment and a decrease in the Maternal Mortality Rate (MMR). / Thesis (Ph.D. (Nursing))--North-West University, Potchefstroom Campus, 2011.

Maternal and perinatal mortality is one of the biggest challenges to public health, especially in developing countries. South Africa?s health care system is struggling to meet the “health for all” criteria against a backdrop of staff shortages (especially midwives) in an HIV/AIDS epidemic. These factors, together with the economic constraints of a developing country, places great demands on delivering cost–effective, safe, quality intrapartum care that exceeds expectations. The challenge for the manager is to organise the available resources to render the best quality of care cost effectively within the shortest period of time. Various reasons exist for the alarming shortage of nurses and midwives globally and also in South Africa. Unhealthy practice environments are the main cause of the problem as such environments have an impact on the job satisfaction of the midwives as well on patient satisfaction. In the turmoil of the health care system, patients are demanding greater quality of care and are insisting not only on excellent clinical skills, but also on empathetic and personalised care. This research was conducted to make a meaningful contribution to the body of knowledge, specifically knowledge related to quality intrapartum care through the development of a Quality Improvement Intervention Programme (QIIP?). The research was conducted in two phases including five objectives. The first objective gave a theoretical foundation of quality intrapartum care. The second objective included a situational analysis of the resources (personnel and equipment) and determine the quality improvement initiatives that could be implemented for intrapartum care. The third objective determined the practice environment in maternity units at Level 2 hospitals in the North West province that may influence quality intrapartum care. The fourth and last objective of Phase 1 determined the perceptions of management and midwives regarding the facilitating and impeding factors that influence the quality of intrapartum care. From the data that emerged from the first four objectives, specific themes kept repeating themselves, namely structure (what must be in place, e.g. infrastructure and human resources), process (what we do, e.g. life–long learning and implementation of policies) and outcome (the results, e.g. patient satisfaction and a positive practice environment). These collectively contribute to the quality of intrapartum care rendered. Phase 2 consisted of the development of a “Quality Improvement Intervention Programme (QIIP?)” for intrapartum care. In this phase the data from the first four objectives were used to develop the QIIP?. The QIIP? will be marketed as an accreditation tool for maternity units to measure themselves against the best in the world. Qualifying for QIIP? accreditation means improving the quality of intrapartum care resulting in satisfied patients, the establishment of a positive practice environment and a decrease in the Maternal Mortality Rate (MMR). / Thesis (Ph.D. (Nursing))--North-West University, Potchefstroom Campus, 2011.

No description available.

Thesis advisor: Dorothy A. Jones / Thesis advisor: Pamela J. Grace / The purpose of the study was to explore the relationship between multiple variables within a model of critical thinking and moral reasoning that support and refine the elements that significantly correlate with accuracy and clinical decision-making. <bold>Background:</bold> Research to date has identified multiple factors that are integral to clinical decision-making. The interplay among suggested elements within the decision making process particular to the nurse, the patient, and the environment remain unknown. Determining the clinical usefulness and predictive capacity of an integrated ethically driven environmental model of decision making (IEDEM-CD) in emergency settings in facilitating accuracy in problem identification is critical to initial interventions and safe, cost effective, quality patient care outcomes. Extending the literature of accuracy and clinical decision making can inform utilization, determination of staffing ratios, and the development of evidence driven care models. <bold>Methodology:</bold> The study used a quantitative descriptive correlational design to examine the relationships between multiple variables within the IEDEM-CD model. A purposive sample of emergency nurses was recruited to participate in the study resulting in a sample size of 200, calculated to yield a power of 0.80, significance of .05, and a moderate effect size. The dependent variable, accuracy in clinical decision-making, was measured by scores on clinical vignettes. The independent variables of moral reasoning, perceived environment of care, age, gender, certification in emergency nursing, educational level, and years of experience in emergency nursing, were measures by the Defining Issues Test, version 2, the Revised Professional Practice Environment scale, and a demographic survey. These instruments were identified to test and refine the elements within the IEDEM-CD model. Data collection occurred via internet survey over a one month period. Rest's Defining Issues Test, version 2 (DIT-2), the Revised Professional Practice Environment tool (RPPE), clinical vignettes as well as a demographic survey were made available as an internet survey package using Qualtrics TM. Data from each participant was scored and entered into a PASW database. The analysis plan included bivariate correlation analysis using Pearson's product-moment correlation coefficients followed by chi square and multiple linear regression analysis. <bold>Findings: </bold>The elements as identified in the IEDEM-CD model supported moral reasoning and environment of care as factors significantly affecting accuracy in decision-making. Findings reported that in complex clinical situations, higher levels of moral reasoning significantly affected accuracy in problem identification. Attributes of the environment of care including teamwork, communication about patients, and control over practice also significantly affected nurses' critical cue recognition and selection of appropriate interventions. Study results supported the conceptualization of the IEDEM-CD model and its usefulness as a framework for predicting clinical decision making accuracy for emergency nurses in practice, with further implications in education, research and policy / Thesis (PhD) — Boston College, 2011. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Thesis advisor: Dorothy A. Jones / Understanding Chief Nurse Executive (CNE) influence is essential for the discipline of nursing. There are approximately 5000 CNEs in the United States, all are tasked with being the primary identifiable leader representing organizations in which they are employed and the nursing profession of which they are a part. In this capacity, the CNE is the gatekeeper for the advancement of the majority of the 2.4 million nurses practicing in the U.S. Literature suggests that early CNEs lacked influence and often were not recognized members of organizational executive teams. Today, after two decades of struggle, CNEs are identified as essential executive team members. However, they still self identify as being less influential than their C-suite counterparts, leaving us to question, "Having gotten to the table, now what?" This study was designed as an initial step toward answering this question through Validation of the Adams Influence Model (AIM). The AIM is a framework that can be used to understand the influence of the CNE in the acute care setting. The study exposed the AIM to a qualitative data set collected as part of an academic medical center's Survey of the Professional Practice Environment. Directed content analysis was used to categorize survey responses and identify influence content toward validation and refinement of the AIM's operational definitions. Study results validated AIM influence factors and influence attributes with some refinement. In addition to development of a refined AIM, study findings also helped identify continued research opportunities. These research potentials included the exploration of; influence instrument development, the influence process, differences between influence and power, and the relationship between CNE influence, practice/ work environments and patient outcomes. As a discipline, nursing must continue to understand the influence of the CNE. These individuals are leading the profession, at what pace and in what direction cannot be left to chance. / Thesis (PhD) — Boston College, 2008. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.