Cost-utility analysis is one method of determining the cost effectiveness of nursing interventions. It is heralded by the World Health Organization as the measure to determine allocation of resources. This method of measurement includes calculation of both the cost of quality-adjusted life years (QALY) and the cost of disability-adjusted life years (DALY). The purpose of this article is to present cost-utility analysis as a relevant measure for describing the value of registered nurses. First the article will present a short overview of cost effectiveness, along with a discussion of two cost-effectiveness measures, cost-effective analysis and cost-utility analysis. Then the measurement of quality-adjusted life years and disability-adjusted life years will be presented. The article will conclude by challenging nurses to develop cost-utility analyses into a meaningful and useful methodology that can provide nursing with a process to measure the economic outcomes of our nursing interventions.

Shared governance, a participative model of governance, implemented by healthcare organizations for more than 30 years has been associated with empowerment, job satisfaction, and retention of registered nurses. Recent studies document a lack of participation in shared governance by registered nurses; the reason for the change is unknown. The nurse managers' role in this change is unknown. The purpose of this non-experimental, cross-sectional survey design study was to test Bass' theory of transformational leadership that examines the relationship between the leadership style of the manager and the enculturation of shared governance in acute care hospitals in the United States. A random sample of 111 nurse managers, who were members of the American Organization of Nurse Executives, were surveyed on leadership style using the Multi-factor Leadership Questionnaire and unit governance, using the Index of Professional Nursing Governance. Data was analyzed using Pearson's Product Moment Correlation and a statistically significant positive relationship was found between transformational leadership style and shared governance. No relationship was found between other leadership styles and shared governance. There was no relationship between the achievement of a shared governance score on the participation subscale of the Index of Professional Nursing Governance and transformational leadership style. The study contributes to social change through the identification of the manager's use of a transformational leadership style to foster the autonomy and empowerment of nurses to cultivate a positive the work environment using a shared governance model, which results in registered nurse retention and decreased organizational turnover costs.

Bakgrund: Den äldre populationen ökar och många av de äldre lider av flera olika sjukdomar. Därmed ökar behovet av professionell och god omvårdnad. Den äldre människan som ofta lider av flera sjukdomar bor vanligtvis sista tiden av sitt liv på vård- och omsorgsboende. Äldre människor vårdas inte utifrån ett palliativt perspektiv trots att behov föreligger. Palliativ vård kopplas ofta ihop med människor som är under 65 år och har en obotlig sjukdom exempelvis cancer. Syfte: Att belysa hur den äldre människan vårdas i livets slut på vård- och omsorgsboende, ur de äldres, de närståendes och vårdpersonalens perspektiv. Metod: En litteraturstudie inspirerad av Friberg (2006). Tio kvalitativa artiklar och en kvantitativ artikel har analyserats och strukturerats utifrån den teoretiska referensramen. Teoretisk referensram: Den palliativa vårdens fyra hörnstenar; Symtomkontroll, teamarbete, kommunikation/delaktighet och närståendestöd. Resultat: Samtliga områden visade på stora brister i omvårdnaden om den äldre personen. Sjuksköterskan var ofta ensam i beslutet angående symtomlindring. De äldre kände sig i vägen och till besvär. Vårdpersonalen önskade mer handledning av sjuksköterskan. Närstående saknade information och delaktighet i beslut som rörde livsuppehållande åtgärder. Diskussion: Kunskap, information och kommunikationsbrist har visat sig leda till bristande omvårdnad kring den äldre personen på vård- och omsorgsboenden. Tydligare riktlinjer, samtal och en sammanhållen arbetsgrupp behövs för att kunna möta den äldre personens individuella behov. / Background: The population of elderly people is increasing and many of those suffer from multiple illnesses, thereby the need for professional and high quality care increases. The elderly suffering from multiple illnesses usually live their final years in nursing homes, and are not cared for throw a palliative approach, despite the need for it. Palliative care is often associated with people younger than 65 years and with an incurable disease, such as cancer.  Aim: To illustrate how elderly people are cared for during end- of- life in nursing homes, from the elderly, next of kin and nursing staff perspective. Method: A literature review inspired by Friberg (2006). Ten qualitative articles and one quantitative article have been analyzed and structured using the theoretical framework. Theoretical framework: The corner stones of palliative care; symptom control, teamwork, communication / involvement and support to next of kin. Result: All areas were lacking in the care of the elderly. The nurse was often alone in the decision making process regarding symptom relief for the elderly. The elderly felt that they were in nuisance and in the way for the staff. The caring staff wanted more guidance from the registered nurse. Next of kin were missing information and participation in decision making process concerning life prolonging measures. Discussion: Lack of knowledge, information and communication are shown and was leading to inadequate caring for the elderly in nursing homes. Clearer guidelines, dialogue, and a good teamwork are needed to meet the older person's individual needs.

Bakgrund: Vårdrelationen tycks ha stor betydelse för patientens välbefinnande och många faktorer kan påverka utvecklingen av relationen i en positiv riktning. Relationen ses främst som ett medel för att uppnå omvårdnadsmålen, men kan även utgöra ett mål i sig. Tidigare forskning fokuserar på när och hur vårdrelationen innebär ett vårdande för patienten. Studier som har ett helhetsperspektiv och en generell utgångspunkt i patienters preferenser avseende hur sjuksköterskan kan utveckla en god vårdrelation är få. För att kunna utveckla goda vård- relationer till sina patienter behöver sjuksköterskor förstå de faktorer som patienter upplever som betydelsefulla i den goda vårdrelationen. Syfte: Att beskriva faktorer som ur ett patientperspektiv har betydelse för en god vårdrelation mellan patient och sjuksköterska. Metod: För att få fördjupad kunskap om de faktorer patienter finner betydelsefulla för att en god vårdrelation ska utvecklas genomfördes en litteraturstudie av vårdvetenskapliga artiklar om patienters erfarenheter av vårdrelationen. Resultat: Studien resulterade i sex teman som beskriver patienternas förväntningar på sjuk- sköterskans kunskaper, egenskaper och handlingar inom ramen för den goda vårdrelationen. Patienterna värdesätter fysisk närvaro vid omvårdnaden, ett medmänskligt och respektfullt bemötande, att sjuksköterskan är professionell och förtroendeingivande, har ett personcent- rerat engagemang samt kommunikationsförmåga. Av sjätte temat framgår att patienten, och inte bara sjuksköterskan, lägger ner stora ansträngningar på att en vårdrelation ska utvecklas. Diskussion: Patienter vill bli sedda och respekterade som unika individer, med sina behov och förutsättningar. De vill möta en sjuksköterska som är intresserad och engagerad, inte bara i patienten som person, utan även i sin profession och utvecklingen av den, för att uppnå patientens främsta mål – nämligen förbättrad hälsa. Patienterna vill uppleva symmetri i engagemanget för relationen och utifrån detta gemensamt arbeta mot ökat välbefinnande. Resultatet har många beröringspunkter med Travelbees teori om mellanmänskliga relationer.

Abstract The aim of this study is to describe the development of nursing students' decision-making as a part of their professional skills during their nursing education. The population consisted of 32 college nursing students who had started their education in January 1987 or 1988 and 23 polytechnic nursing students who had started their education in 1996. The college students' process of learning decision - making was studied during 1988-1991 by taping clinical lessons about planning patient care (terms IV-VI) and by collecting essays prodeced by the students during the clinical periods (terms III, V and VII). Essays produced by the polytechnic students (terms III and IV) during 1997-1998 were also collected. The data were analyzed by using both quantitatively and qualitatively content analysis (deductive and inductive analysis). The results show that rational decision-making was emphasized both in college and in polytechnic. The care plans made by the students were consistent with the phases of the nursing process. Of the different phases of the nursing process the implementation and the evaluation of nursing care were most important. At the beginning of their practical training college students emphazised nursing methods, while polytechnic students focused on medical methods. In all data sets, most uttrances pertained to the physical aspects in the implementation of nursing, in the definition of nursing problems and in the evaluation of nursing. As learning proceeded from one term to the next no changes were seen. The only exception were the clinical lessons at the beginning of the education and the essays and clinical lessons during the last phases of education in which psychic support and the need to evaluate the patient's psychic condition were emphazised. At the beginning of practical training polytechnic students gave more attention to physic support of the patient than college students. Plenty of knowledge was collected about a patient for purposes of decision-making, but it was only partly utilized as the planning of care proceeded. All data sets clearly reflected the mechanical decision-making model. At the beginning of practical training the next largest category in the college students' data was the patient-centered model which was only rarely seen in the polytechnic data. In all data sets the objectives of nursing were defined in a patient-centered manner. The college data included a small number of features of the model-oriented and creative decision-making model which were not found in the polytechnic data at the beginning of practical training at all. The following features of the creative decision-making model were found setting priorities, giving reasons for choosing the nursing model, nursing problems and methods and producing alternative nursing solutions. In both data sets the students' learning level appeared to be quite low. The findings reflected superficial mechanical learning without reflection and critical thinking.

Made available in DSpace on 2016-03-15T19:25:45Z (GMT). No. of bitstreams: 1 Daniela de Lima Conte.pdf: 1229537 bytes, checksum: 12c2e22d3019f728244e9c7a47483c5d (MD5) Previous issue date: 2011-12-15 / Fundo Mackenzie de Pesquisa / Organizations strive to plan formal learning processes and increasingly recognize the importance of informal learning, although it is difficult to explain quantitatively their contribution to organizational performance. From Pantoja (2004), several researchers have studied informal learning strategies (ILS) and its antecedents. The main contribution of this work is to use the ILS as predictors of individual learning of nursing professionals. In other words, a professional context not yet researched and the possibility of evaluating the predictive validity of the ILS: reproduction, intrinsic reflection, extrinsic reflection, seeking help with written material interpersonal help and practical application. These strategies were measured by an instrument containing thirty-three statements. The following ILS were used as predictors of individual learning, measured by 18 items, and it was considered as second-order latent variables with the following dimensions: the frequency, the importance of individual learning and the stock of individual learning. The data was collected in four hospitals and analyzed in a dichotomic way (public vs. private). In this study, 486 respondents participated (nurses and technical nursing). The data analysis was performed by means of structural equation modeling with partial least squares estimation, allowing the evaluation of the measurement model (convergent validity, discriminant and reliability) and the structural model (significance of the structural coefficients and effect size - R2). In public environment, the latent variables had average variance extracted between 0,47 and 0,76 (convergent validity), the square root of the average variance extracted was greater than the correlations between the latent variables (discriminant validity) and composite reliability was above 0,71. In private environment, the latent variables had average variance extracted between 0,56 and 0,76 (convergent validity), the square root of the average variance extracted was greater than the correlations between the latent variables (convergent validity) and composite reliability was above 0 , 83. As for the structural model, the public hospital showed that, in the perception of these professionals, there is some possibility of individual learning (mean = 7,41 and SD = 2,17 on a scale of 1 to 10). But only the strategy interpersonal help had significant influence on individual learning. In private hospitals, it was observed that there is also this perception of individual learning (mean = 8,83 and SD = 1.08 on a scale of 1 to 10). Furthermore, all strategies have a significant relationship with the individual learning, except reproduction, which showed negative relationship with individual learning (structural coefficient = - 0,358, p <0.01). These results can be explained from the practical point of view of the organizations current situation. The public hospital had recently changed its management, for a new management model is being implemented, especially in the nursing staff, which has affected the work processes of professionals and, consequently, their learning processes. Private hospitals already have a well established management model for the nursing staff. Seals in quality and accreditation processes of learning of nursing professionals were present in this process, and are also strongly encouraged by the organization / As organizações se esforçam em planejar processos de aprendizagem formais e cada vez mais reconhecem a importância da aprendizagem informal, apesar da dificuldade de explicitar de forma quantitativa sua contribuição ao desempenho organizacional. A partir de Pantoja (2004), vários pesquisadores têm estudado estratégias de aprendizagem informal (EAI) e seus antecedentes. A principal contribuição deste trabalho é utilizar as EAI como preditoras da aprendizagem individual dos profissionais de enfermagem, ou seja, um contexto profissional ainda não pesquisado, e a possibilidade de avaliar a validade preditiva das EAI, que são: reprodução, reflexão intrínseca, reflexão extrínseca, busca de ajuda em material escrito, busca de ajuda interpessoal e aplicação prática. As estratégias foram mensuradas por um instrumento com trinta e três afirmativas. As EAI foram utilizadas como preditoras da aprendizagem individual, mensuradas por 18 itens, sendo consideradas variáveis latentes de segunda ordem, com as seguintes dimensões: frequência, importância da aprendizagem individual e estoque de aprendizagem individual. Os dados foram coletados em quatro hospitais e analisados de forma dicotômica (público x privados), e participaram dessa pesquisa 486 respondentes (enfermeiros e técnicos de enfermagem). A análise dos dados foi realizada pela modelagem em equações estruturais com estimação por mínimos quadrados parciais, permitindo a avaliação do modelo de mensuração (validade convergente, discriminante e confiabilidade) e do modelo estrutural (significância dos coeficientes estruturais e tamanho do efeito R2). No ambiente público, as variáveis latentes apresentaram variância média extraída entre 0,47 e 0,76 (validade convergente), a raiz quadrada da variância média extraída foi superior às correlações entre as variáveis latentes (validade discriminante) e a confiabilidade composta superior a 0,71. No ambiente privado, as variáveis latentes apresentaram variância média extraída entre 0,56 e 0,76 (validade convergente), a raiz quadrada da variância média extraída foi superior às correlações entre as variáveis latentes (validade convergente) e a confiabilidade composta superior a 0,83. Quanto ao modelo estrutural, no hospital público, foi observado que, na percepção desses profissionais, há alguma possibilidade de aprendizagem individual (média = 7,41 e desvio padrão = 2,17, numa escala de 1 a 10). Mas apenas a estratégia ajuda interpessoal apresentou influência significativa com a aprendizagem individual. Nos hospitais privados, foi observado que também existe essa percepção da aprendizagem individual (média = 8,83 e desvio padrão = 1,08, numa escala de 1 a 10). E todas as estratégias apresentaram relação significante com a aprendizagem individual, exceto a reprodução, que apresentou relação negativa com a aprendizagem individual (coeficiente estrutural = - 0,358, p < 0,01). Esses resultados podem ser explicados do ponto de vista prático pela situação atual das organizações: o hospital público teve recentemente sua administração trocada, um novo modelo de gestão está sendo implantado, principalmente no corpo de enfermagem, que vem afetando os seus processos de trabalho e, consequentemente, seus processos de aprendizagem. Os hospitais privados apresentam um modelo de gestão do corpo de enfermagem bem consolidado. Estão presentes nesse ambiente selos de acreditação em qualidade e os processos de aprendizagem dos profissionais de enfermagem também são fortemente estimulados pela organização.

The purpose of the study is to explore past and current professional nursing organisations by means of historical inquiry and to explain the factors that influenced the development of such organisations, as well as the contribution that these organisations made to the professional development of South African nursing in the period between 1914 and 2014. The researcher conducted a literature review and collected data from archival primary and secondary sources. A priori codes provided structure and historical context, yet allowed flexibility. Philosophically critical realism guided the research and enabled the researcher to explain and critique the social world in which South African nursing organisations historically functioned and exerted their professional influence. The findings revealed that in the past one hundred years political, economic and cultural factors present in the social world influenced the nature of South Africa’s professional nursing organisations. Determined to create a female professional image, status and educational exclusivity, South African nursing leaders of the 20th century opted to establish the South African Trained Nurses’ Association (SATNA), a professional nursing association. Influential associations such as SATNA and the South African Nursing Association (SANA) guided the profession to develop a nursing culture based on philosophical and ethical principles of practice. The result was a recognised, respected and trained nursing corps. Over time, however, a social class system, religion, political ideology and nurses’ economic needs reshaped South Africa’s nursing associations and consequently the profession. By the end of the 20th century, South African nursing leaders accepted that nurses needed their socio-economic welfare to be prioritised and therefore the Democratic Nursing Organisation of South Africa (DENOSA), a professional organisation with a trade unionist stance, was established. The result was a trained, politicised, fragmented nursing corps struggling to find its collective professional voice. The greatest legacy bestowed on South African nursing by its first influential organisations is the professional associations evident today. Over time, the South African Nursing Association’s discussion groups that had been established in the 1950s to discuss nursing-related topics evolved into the specialist groups and associations that were present in 2014. / Health Studies / D. Litt et Phil.

Nursing specialization involves focusing on nursing practice in an identified specific area within the entire field of professional nursing. A defined specialty scope of practice statement and standards of professional practice, with accompanying competencies, are unique to each nursing specialty. These documents help assure continued understanding and recognition of nursing’s diverse professional contributions. The purpose of this article is to demystify the process for specialty nurses who are creating or revising their specialty nursing scope and standards of practice. We provide best practices for the developmental process based on our recently published scope and standards of specialty nursing practice. The conclusion provides strategies to disseminate scope and standards documents to appropriate stakeholders.

Made available in DSpace on 2011-05-04T12:36:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2009 / O objeto deste estudo foi o Curso de Formação Profissional de Auxiliar de Enfermagem realizado no município de Natividade, estado do Rio de Janeiro nos anos de 1995 a 1997, pela Escola de Formação Técnica em Saúde Enfª Izabel dos Santos ETIS SESDEC/RJ e teve como objetivo estudar os efeitos ocorridos na prática profissional das egressas da rede de saúde. Na implantação e no desenvolvimento deste curso foi utilizada a proposta do Projeto de Formação em Larga Escala de Pessoal de Nível Médio e Elementar para os Serviços de Saúde, mais conhecido como Projeto Larga Escala PLE, que objetivava a formação profissional de nível médio visando à qualidade da assistência à saúde da população, e que ainda hoje influencia a formação dos trabalhadores da saúde. O Projeto Larga Escala concebia que para transformar a realidade é preciso construir novas práticas de formação e de gestão na saúde, tornando necessário que a educação profissional se fundamente numa concepção que amplie os horizontes de interesses da sociedade, numa visão de mundo que posiciona e compreende o homem como centro das preocupações. Para atingir o objetivo proposto, foi realizada pesquisa em documentos na ETIS-SESDEC/RJ e aplicado um questionário com perguntas abertas e fechadas às egressas do curso. Os dados foram trabalhados dentro de uma abordagem quanti-qualitativa. Os resultados indicaram que: 100 por cento dos respondentes são do sexo feminino, a maioria (38,9 por cento) está na faixa etária entre 41 e 50 anos e 50 por cento são casadas. Quanto à escolaridade, 27,8 por cento possuem 3º grau, 11,1 por cento 3º grau incompleto, 44,4 por cento ensino médio, 11,1 por cento ensino médio incompleto e 5,5 por cento ensino fundamental. Destaca-se que 83,3 por cento das egressas encontram-se desenvolvendo atividades relacionadas à saúde e 16,7 por cento não atuam na saúde. O curso de formação profissional de auxiliar de enfermagem, em conformidade com as egressas, contribuiu para melhorar a prática, além de promover mudanças significativas nos aspectos humanístico, ético e no comprometimento com a sociedade. / The object of this study was the Nursing Assistant Professional Training Course held in the municipality of Natividade, in the State of Rio de Janeiro between the years 1995 and 1997, by the Nurse Izabel dos Santos Health Technical Training School – ETIS – SESDEC/RJ and aimed to study the effects in the professional practice of alumni of the health network. In the implementation and development of this course, the Project Proposal for the Large Scale Training of Mid- and Elementary-Personnel for Health Services, better known as the Large Scale Project – PLE, which sought the training of mid-level professionals aimed at quality health assistance of the population, and still today influences the training of health workers. The Large Scale Project understood that in order to transform reality it is necessary to construct new training practices and health management, thus making professional education necessarily base itself on an idea that broadens the horizons of the interests of society, into a worldview which places and understands humanity at the center of its worries. To meet this proposed objective, an ETIS-SESDEC/RJ documentary study was created and a questionnaire given to the graduate from the course consisting of open and closed responses. The data was elaborated within a quantitative-qualitative prism. The results indicated that: 100% of respondents were female, the majority (38.9%) is in the age group between 41 and 50 years old and 50% are married. As for schooling, 27.8% have a college education, 11.1% did not complete college, 44.4% have a high school education, 11.1 did not complete high school and 5.5% have an elementary education. It should be noted that 83.3% of alumni found them developing health related activities and 16.7% do not work in health. The nursing assistant professional training course, in confirmation with the alumni, contributed toward bettering the practice, in addition to provoking significant changes in the humanistic and ethical aspects and in the commitment to society.