Many entry-level nurses are not prepared to handle medical emergencies. Although responsible for managing the care of individuals with complex medical conditions, many of these nurses compromise the safety of patients due to a lack of experience and an inability to apply clinical judgment. The purpose of this study was to explore the perceptions of registered nurses about their transition from entry-level to advanced beginner. Bandura's social cognitive theory, along with Colaizzi's descriptive method of data analysis, provided a basis for this phenomenological study. Research questions focused on challenges that entry-level nurses have experienced with problem-solving and complex patient care that requires advanced critical thinking and the application of clinical judgment. Criterion sampling facilitated recruitment of advanced-beginner RNs, with data collected through semistructured, one-on-one interviews. Data analysis occurred in a series of steps, including extracting and developing meanings from interview transcripts, clustering meanings into description lists, and eliminating outliers. Data analysis revealed 12 major themes aligned with behavior, clinical environment, and personal/cognitive factors. Among the findings were that nurses often felt unsupported, unable to manage conflict, unprepared, unseasoned, inefficient, and unable to lead others effectively. This study was necessary because its findings may provide insights leaders in health services can use to develop strategies to better prepare entry-level nurses to care for individuals with complex medical conditions. Among the implications for positive social change are developing a better tool for the training and advancement of entry-level nurses, consequently improving patient safety and reducing health care costs.

Obesity is a major U.S. public health epidemic. A review of the current literature identified a lack of obesity counseling with individuals. The gap in practice was a lack of understanding of nutrition, nutrition labeling, and how foods affect health. The objective of this project was to identify the community assessment need related to obesity and then educate APRNs on ways to better communicate with obese patients. This project focused on an education program for advanced practice registered nurses (APRNs) on using the 5 A's framework for obesity counseling to improve their knowledge and skill in counseling their overweight and obese patients in a rural primary care clinic. Knowles' adult learning theory was used to develop the education project. The education program was presented to and evaluated by 2 APRNs at a rural health clinic. The providers requested the information be placed online so they could give the presentation their undivided attention. The audio-based PowerPoint presentation and printed copies of the presentation content were e-mailed to each of the providers. The presenter went to the clinic 3 days after placing the presentation online to obtain the evaluations and answer any questions. An impact evaluation assessed the presenter, audience learning experience, and confidence and skill of the participant. The participants reported they had a better understanding of the reality of the obese population and how they could improve their communication by using the 5 A's method of assessment. Both participants reported the presentation was clear and easy to understand. A recommendation was made to conduct a future quality improvement project expanding the use of the educational program. This project has the potential to impact social change by improving health care education and ultimately reducing obesity.

Registered nurses perceive the healthcare work environment as stressful. Stress can have a negative effect on patient care and nurses' attrition and health. In the literature, mentors have been identified as having a positive influence on nurses. This qualitative study was an examination of nurses in mentoring relationships in the early, middle, and late career stage and working in a hospital setting. Two research questions addressed mentoring relationship preferences and mentors' influence on perceived stress. Fourteen nurses were interviewed in the study. The conceptual framework was based on the career and psychosocial mentoring theory, the mentoring the adult learner theory, and the attachment theory. Data were analyzed electronically and manually into intuitively and inductively derived themes. The results of the study related to preferences showed nurses prefer mentors to be in the work setting, mentors to help nurses develop nursing competencies, and mentors to help nurses develop a positive self-concept. The difference among the nurses in the career stages was the type of competencies developed. The nurses identified that mentors had a positive influence on the perception of stress through the development of emotional intelligence and problem-solving skills with similarities and differences in the type of challenges nurses' experience. The implications for future research are studies with nurses working in other healthcare settings and quantitative studies to measure levels of stress with and without a mentor. Implications for practice are the development of mentoring programs where career stages and perception of stress are addressed. Limitations of this study were the setting and sample size. Implications for social change include the development of humanistic approaches to mentoring to address nurses' challenges and stressors in the healthcare work environment.

Registered nurses (RNs) have a significant role in communicating health information to patients. The problem addressed in this study was RNs roles with health literacy and communicating health information using words that the patient understands. This study found that ambulatory RN perspectives on their roles in health literacy and patient communication may improve health outcomes and optimal wellness. The purpose of this qualitative study was to examine and describe ambulatory RN perspectives on their roles in health literacy and patient communication, as these are necessary components linked to better health outcomes. The conceptual framework for this study was the nurse role effectiveness model. Fifteen RNs participated in face-to-face, structured, interviews using open-ended questions to contribute perspectives on health literacy roles and nurse-patient communication. Data analysis consisted of Miles and Huberman's methodology to code, extract, sort, review, generalize, and examine for themes. Emergent themes and key findings of this study may improve the gap in knowledge regarding ambulatory RN perspectives on health literacy roles and patient communication, as well as more awareness of the term health literacy, increased formal training on the concepts of health literacy, and techniques to formally assess patients' understanding of health information. An opportunity exists to bridge the gap between RN knowledge of health literacy roles and patient communication. Positive social change implications for health services include promoting RN health literacy roles and strategies for effective communication to promote patient behavior changes for optimal wellness.

The small business sector has become an increasingly important segment of the Australian economy since the 1970s. Industrial relations in the sector have been assumed to be harmonious. However, to a large extent this belief about industrial relations is based on conventional wisdom rather empirical evidence. Industrial relations research in Australia has concentrated on medium to large businesses because the centralised nature of the industrial relations system encouraged a collective emphasis. This collective emphasis ensured peak representative bodies and larger organisations had a tendency to dominate while small enterprises and their employees were, to a large extent, excluded. The perceived non-problematic nature of industrial relations in the small business sector was another reason for the lack of focus on the sector. The low incidence of strike activity and the low levels of trade union membership have meant research has been concentrated on the more "difficult" areas of industrial relations. The lack of empirical research into industrial relations in the sector is an important shortcoming. There are a number of commentators who suggest that it is too simplistic to assume harmonious relations. It is likely that there is a range of industrial relations in small business, depending on a number of variables including the personality of the owner/manager and employees, the type of business and the current economic climate. The legislative framework will also have an important affect on industrial relations. This study addresses the lack of empirical research in industrial relations in the small business sector by examining the differences between small and large registered clubs in NSW. Registered clubs have an unusual ownership structure and unusual business goals. They are also unusual since they are non-profit organisations formed by groups of people who share a common interest and who have come together to pursue or promote that interest. Registered clubs are governed by a board of directors who are responsible for the formulation of policy and for ensuring that management carries out these policies. This study found that there were significant differences in regards to some aspects of employment relations. For example, small clubs were more likely to have lower rates of unionisation than large clubs. They were also likely to have lower levels of informal bargaining than large clubs. The methods of communication within the workplace were likely to be more informal in small clubs and they were less likely to have communications with a trade union. Despite this greater degree of informality in employment relations, small clubs were more likely to use award provisions to determine wages for their managers and employees. Interestingly, despite the lower level of unionisation and the greater use of awards by smaller clubs there were no significant differences between small and large club managers' perception of the impact of awards and trade unions on club flexibility. The findings from this study suggest the deregulation of the Australian industrial relations system may not have any significant benefits for small business.

There is an enduring and prevailing disparity between the clinical prevalence of alcohol, tobacco and other drug-related problems and the frequency that nurses recognise and intervene in these common problems. The extant nursing literature has long determined an urgent need for further investigation into why nurses do not respond to patients with ATOD-related problems in the consistent and effective manner that the prevalence of these costly health problems require, or in a manner that reflects the opportunities that nurses have to offer brief and timely intervention. This thesis reports and discusses the investigation of factors that determine identification, assessment and interventions of patients with alcohol, tobacco and other drug-related problems by a randomly selected sample of Registered Nurses [n=1281] in practice in New South Wales, Australia. Of particular interest was the relationship between nurses' ATOD knowledge, therapeutic attitudes and clinical activity. Multiple quantitative and qualitative methods were used, firstly to systematically investigate factors within the nurse and their clinical setting that might predict desired clinical behaviour towards addressing ATOD-related problems, and secondly, to analyse and describe nurses' self-reported perceptions, views and experiences of the issue and what aids or impedes it. The research instrument - a 72 item self-completed questionnaire was developed and refined within a process of three (3) pilot studies and test-retest method. A multiple regression model was developed to establish the predictors of key clinical behaviours. Thematic coding was used to analyse the perceptions of these nurses as to the factors that affect their ability to intervene with patients who have ATODrelated problems. Convergent and divergent concerns between quantitative and qualitative findings became apparent. Thematic analysis of open-ended responses demonstrated that nurses report a complex of factors that affect their ability and capacity to intervene with patients who have ATOD-related problems. Among these are factors located within nurses themselves, within their patient(s), within their workplace, within other health professionals and within the broader social/cultural context. The latter part of the thesis systematically considers the relationships between the quantitative and qualitative findings within this large sample of registered nurses. From this comprehensive level of analysis, workforce implications for ATOD education, training and organisational support for nurses, the most numerous group of health care workers, have been readily identified. The major empirical finding of this investigation is that there is a significant difference between positive attitudinal sets and motivation of practicing registered nurses to perform desired ATOD-related clinical activities, and the lower reported frequency at which this occurs. The qualitative findings are highly convergent with the empirical ones. It is the nurse's self-identified lack of knowledge, skills, experience and confidence that is now reported as having the greatest effect on their ability to assess, identify and offer brief and timely intervention for patients with ATOD-related problems, rather than any prevailing beliefs and attitudes that these patients were not worthy of their care, or outside the legitimate framework of their nursing role.

The purpose of this study was to examine the relationship between characteristics of refreshed registered nurses and reemployment in the nursing workforce post Refresher programme. The application forms completed by the participants of the six programmes conducted by the ACT Health Authority (ACTHA, now Department of Community Services and Health ACT) provided data for a profile analysis. Employment data was derived mostly from statistics compiled by the Research Officer, Nursing, ACTHA. The findings of this study demonstrated that inactive registered nurses do return to nursing from periods of non-participation as nurses, following completion of Refresher programmes. Moreover, significant numbers of these returning nurses remain in nursing employment. In relation to that aspect of workforce planning which considers sources of supply for the registered nurse labour market an area for further study would be to explore the area of patient care in which the greater concentration of refreshed nurses were to be found post programme: acute care settings or extended care facilities. The study found that predictions of the successful reentry to nursing of the individual refreshed nurse and of retention in the nursing workforce could not be based on the characteristics of that person, alone. These findings supported the study's hypothesis that there would be no statistically significant difference between the characteristics of refreshed registered nurses who returned to, and remain in, the nursing workforce and those refreshers who either did not reenter nursing post programme or who left during the following twelve months. The characteristics examined were age, family status, post registration nursing experience, post registration nursing courses, worked as a nurse in the ACT prior to the programme, previous employment status, and time inactive from nursing pre-Refresher programme. Trends were identified which indicated that with some characteristics there was a greater likelihood of post programme reemployability in nursing. Refreshed nurses who reentered and remained in the nursing workforce tended to be younger.than those not working as nurses. There was a trend for post programme participators in the nursing workforce to have had fewer years of post registration nursing experience and to be more likely not to have obtained post registration nursing qualifications than their counterparts not working in nursing positions. Perhaps not surprisingly the study found that a higher proportion of the refreshers employed as nurses had previously worked at some stage in ACT health care facilities as registered nurses. A somewhat unexpected finding was that amongst the group of refreshed nurses working in nursing the largest contingent had been inactive from nursing for more years than was the case for those not working as nurses. The majority of refreshed registered nurses, whether they were working as nurses post programme or not had a family status of partner/husband and child(ren) and were unemployed before undertaking the Refresher programme. Refreshed registered nurses have provided a source of supply to the nursing workforce during a period of shortage of qualified nurses in the health care system. In the latter part of the 1980's there have been indications that shortage is largely confined to nurses with specialised skills. The findings from this study should assist the nursing profession in deciding the future role of programmes of reentry for inactive registered nurses who require reskilling for current clinical competence for general patient care areas.

This study examines the perceived causes of occupational stress amongst female Registered Nurses working in the clinical setting at both Calvary Public and Calvary Private Hospitals ACT Incorporated. A modified Gray-Toft, Anderson Nursing Stress Scale (1981) was used as the instrument for the research. The questionnaire was modified by the addition of six questions. The questionnaire was distributed to seventy female Registered Nurses. Twenty questionnaires were distributed to staff working within the Private Hospital and fifty to staff in the Public Hospital. Relevant data dating back to 1956 was examined regarding stress and burnout amongst nurses and allied health professionals. The results of this study, not surprisingly, supported the finding of Gray-Toft, Anderson. That is that nursing remains an inherently stressful occupation. Respondents working in both public and private hospitals indicated that Lack of Funding and Death and Dying were considered to be major sources of perceived stress. Registered Nurses working in the Public Hospital perceive higher levels of stress than do those Registered Nurses working within the Private Hospital with respect to relative staffing levels, workload and funding. Comparisons by age group indicated a generally higher reported level for the youngest age group. Comparison of full time versus part time staff indicated a significantly higher level of perceived stress from full time staff. Analysis of reported stress by ward type indicated that staff working in the "medical" groupings experienced higher perceived levels of stress than those working in the "surgical" groupings.

Adverse drug events, resulting in preventable patient harm or death, are of great concern. To keep patients safe, hospitals have implemented barcode medication administration (BCMA) technology for RNs who have accepted this technology with varying levels of satisfaction. When nurses are dissatisfied with a BCMA system, they may find alternative methods to complete their work. Framed by the Technology Acceptance Model (Davis, 1989), this analytic, cross-sectional study aimed to understand the relationship between BCMA satisfaction and workarounds, perceived ease of use (PEOU) and perceived usefulness (PU) of a BCMA system by 80 hospital-based RNs in northeastern US. Data were collected using the Workaround Usage and Satisfaction with Barcoding Instrument for Nurses (WUSBIN), which was adapted from Hurley's (2006) Medication Administration System-Nurses Assessment of Satisfaction Scale (MAS-NAS) Halbesleben and Rathert's (2010) Workaround Assessment. Results suggested that RNs who were more satisfied with the BCMA system were less likely to use workarounds than nurses who were less satisfied (r2(78)= -.681, p < .05). Significant relationships were noted among BCMA Satisfaction and PEOU (r2(78) = -.725, p < .05), Workaround Usage and PEOU (r2(78) =.943, p < .05) and Workaround Usage and PU (r2(78)=.501, p < .05). RNs perceived the BCMA system to be easy to use (PEOU), but not very useful (PU). BCMA Satisfaction was significantly related to the use of six workarounds, while Workaround Usage was significantly related to five. Significant relationships were also noted among both BCMA Satisfaction (r2(78) = -.393, p < .01), and Workaround Usage (r2(78) = .423, p < .01) with the total number of workarounds used. Significant relationships were found among demographic variables, BCMA Satisfaction, and Workaround Usage. Since admitting to the use of workarounds may be a sensitive matter for RNs, measuring BCMA satisfaction may help understand the state of patient safety related to medication administration. Based on high satisfaction scores and low workaround usage, a profile may be developed to identify nurse champions to improve quality of care. Further research is indicated to fully understand these possibilities. / School of Nursing / Nursing / PhD / Dissertation

Increasing demographic diversity, persistent health disparities, and ongoing efforts to reduce health care costs have made cultural and linguistic competence in the United States health care system a premier concern. Integral to improving cultural competence in health care is providing health professionals with adequate education and training in cultural competence. For this reason, there has been increasing attention paid by academia across health-related disciplines and by national organizations and governmental health agencies to delineating what cultural competence in education and training entails. Though a multidisciplinary body of literature on developing curricula related to cultural competence for health professionals exists, still lacking from this literature is sufficient input from the dietetic profession. The purpose of this cross-sectional internet-based research was to create a curricular model of core curricular competencies related to cultural competence for the education and training of registered dietitians. A random sample of registered dietitians rated 73 proposed curricular competencies for essentiality on a 7-point Likert-like scale (1 = Not a priority; 7 = Essential). Exploratory principal components analysis (PCA) with Varimax rotation condensed the proposed competencies with similar variances of responses into factors (model domains) and eliminated competencies which accounted for too little or ambiguous variance. Factors were assigned unique labels based on the prevailing themes of their respective competencies and further interpreted in terms of respondent characteristics via multivariate general analysis of variance (MANOVA). Results based on a 17.9% (n=1,090) rate of response produced a model with 69 competencies and 7 domains: Communication and Relationships; Community Collaboration; Disparities and Diversity in Health Care; Information Access, Analysis, and Use; Bias Management; Food Environments; and Models and Definitions. Significant differences in mean factor ratings were detected between respondents who differed by race and by experience working with diverse individuals and groups. This model is representative of existing research on cultural competence, but it is the first unique to dietetics. It may be used by dietetic education and training programs to systematically plan, implement, and evaluate curricula for cultural competence.