Thesis (Ph. D.)--University of North Carolina at Greensboro, 2006. / Title from PDF title page screen. Advisor: Richard Luecht; submitted to the School of Education. Includes bibliographical references (p. 89-94).

Bakgrund: Sjuksköterskor som arbetar på akutmottagningar möter dagligen patienter som är alkohol- eller narkotikapåverkade. När patienter kommer till akutmottagningen och är påverkade av alkohol eller narkotika förekommer det ofta våld. Det vårdvetenskapliga perspektivet i examensarbetet är Kaséns syn på vårdrelationen och delaktighet. Syfte: Syftet är att beskriva sjuksköterskors erfarenheter av att möta patienter som är påverkade av alkohol eller narkotika på akutmottagning. Metod: Sex narrativa intervjuer har genomförts med sjuksköterskor som arbetar på en akutmottagning i mellersta Sverige. Intervjuerna har analyserats enligt Lundman och Graneheims metod för kvalitativ innehållsanalys. Resultat: Sjuksköterskornas erfarenheter från mötet med patienter med missbruksproblematik är att de kan vara våldsamma och framförallt är det viktigt att tänka på hur man bemöter dem. De ständigt återkommande mötena med dessa patienter på akutmottagningen tar mycket av sjuksköterskornas tid. Blandmissbrukare som är påverkade av både alkohol och narkotika anses vara mest våldsamma och det finns ett uttalat behov av utbildning främst av nya narkotikapreparat som finns på marknaden. Slutsats: Sjuksköterskor bör eftersträva ett professionellt bemötande av patienter med missbruksproblematik. Däremot kan det vara svårt att finna tiden för samtal med dessa patienter. Sjuksköterskor utsätts ibland för våld och trakasserier i mötet med patienter med missbruksproblematik. Därför bör det ställas högre krav på säkerheten på akutmottagningar, för både vårdpersonal och patienter. / Background: Nurses working in emergency departments encounter patients that under the influence of alcohol or narcotics on a daily basis. When patients come to the emergency department under the influence of alcohol or narcotics, there is often violence involved. As the caring science perspective used Kaséns view of the caring relationship and the participation. Aim: The aim is to describe the nurses’ experiences of encountering patients that are under the influence of alcohol or narcotics, in the emergency department. Method: Six narrative interviews were conducted with nurses working in an emergency department in mid-central Sweden. The interviews were analyzed according to Lundman and Graneheim method for qualitative manifest content analysis. Results: The nurses’ experiences of encountering patients with substance abuse problems are that they can be violent and above all it's important to consider their response. These constant and reoccurring encounters with patients in the emergency department are time consuming for the nurses. Among the patients under the influence of both alcohol and drugs are considered to be the most violent and there is a clear and present need for training in narcotics available currently in society. Conclusion: Nurses should seek to respond professionally to patients with substance abuse problems. However, it can be challenging to find the time to talk with these patients. Sometimes nurses are subjected to violence and harassment in the encounters with patients with substance abuse problems. Therefore, higher standards should be set regarding the safety of emergency departments, for both health professionals and patients.

Att ha ett sår är en belastning och påverkar människors vardag, oavsett om såret är akut efter ett olycksfall eller efter en operation, alternativt svårläkande som vid bensår, diabetesfotsår, trycksår eller maligna tumörsår. Syftet med studien var att undersöka kunskaper hos sjuksköterskor och undersköterskor om sårbehandling inom kirurgisk verksamhet. Metoden utgjordes av en enkätundersökning hos sjuksköterskor (n=56) och undersköterskor (n=38). Resultatet visar att sjuksköterskorna kände sig mer osäkra i sitt val av behandling av svårläkande sår jämfört med undersköterskorna. Kunskaperna om sårbehandling visar att skattade kunskaper inte motsvarar svaren på kunskapsfrågorna. Nitton av 56 sjuksköterskor och 15 av 37 undersköterskor hade genomgått någon form av sårutbildning. Undersköterskorna skattar sina kunskaper om sårbehandling högre än sjuksköterskorna och känner sig mer sällan osäkra i sitt val av behandling av svårläkande sår, jämfört med sjuksköterskorna. Det är också undersköterskorna som oftast utför såromläggningar på avdelningarna. Studien visar att det finns brister i kunskaperna om sårbehandling, hos både sjuksköterskor och undersköterskor och att mer utbildning behövs. / To have a wound is a burden and affect people's everyday lives, whether the wound is acute after an accident or after surgery or difficult healing of the ulcers, diabetic foot ulcers, pressure ulcers or a malignant wound. The purpose of this study was to investigate nurses' and nursing assistant’s knowledge of wound healing in surgical wards. The method was done by using a questionnaire survey among registered Nurses (RNs) (n = 56) and nursing assistants (NAs) (n = 38). The results show that the RNs felt more insecure in their choice of treatment of severe ulcer healing compared with the NAs. Knowledge of wound healing shows that the estimated knowledge does not correspond to the answers to knowledge questions. Of the RNs answered 51 of 56 and of the NAs answered 32 of 37 that they needed more education in wound care/treatment. NAs estimated their knowledge of wound care higher than the RNs and felt less insecure in their choice of treatment of wound healing, compared with the RNs. There are also the NAs who usually perform a change of dressing on the wards. The study shows that there are gaps in knowledge in wound care/treatment, with both RNs and NAs and that more education is needed.

The profession of nursing is experiencing a shortage of qualified nursing professionals. Hospitals understaffed with nurses are likely to experience several negative consequences including low quality care, which places the health and safety of patients at risk. In order to ensure an effective selection process for hospital nurses, a structured situational interview, developed using a content validation approach, was validated using a criterion-related approach. Interviews that have a high degree of structure consistently demonstrate higher predictive validities with job performance than do interviews with less structure. The structured situational interview in this study had a high degree of structure and was developed after a job analysis was completed. Interviewee responses were evaluated using a behavioral summation scale. The results of the current study confirmed the hypothesis that there would be a positive relationship between nursing student interview scores and Grade Point Average, thus indicating that the structured interview should be useful in the selection of professionals in the field of nursing. However, the observed validity coefficient (r = .29) was lower than expected based on a review of previous research on the criterion-related validity of structured situational interviews. It is recommended that future research with this instrument use a larger sample of nurse incumbents as participants and nurse managers as interviewers. Additional interview items, developed following a content validity approach, would likely increase the reliability and the validity of the interview

Äldre personer riskerar i stor utsträckning att drabbas av undernäring och sjuksköterskor har en viktig uppgift i nutritionsarbetet kring dessa personer. Studiens syfte var att mäta attityder till äldres ätande och näringstillstånd. Det validerade instrumentet Staff Attitudes to Nutritional Nursing Care Geriatric scale (SANN-G-skalan) användes. I urvalet ingick sjuksköterskor på särskilt boende och korttidsboende i två kommuner. Två påståenden som handlade om kostpolicy och utbildning i nutrition lades till i enkäten, med möjlighet att lämna kommentar. Svarsfrekvensen var knappt 50 %. Resultatet visade att sjuksköterskorna totalt sett hade en positiv attityd. Det delområde som visade högst andel positiv attityd var individualisering som handlade om individanpassade måltider. En tredjedel av sjuksköterskorna ansåg att det sällan förekommer att äldre människor på kommunalt äldreboende är undernärda, trots att forskning visar motsatsen. För att få kunskap om hur de äldres näringstillstånd är i realiteten bör ansvariga inom respektive kommun undersöka hur många bedömningar som gjorts, vilken dokumentation som finns samt vidtagna åtgärder. Det kan vara en god grund för ett utvecklings- och förbättringsarbete där utbildning, reflektion kring arbetssätt och kommunikationsvägar bör ingå. Den positiva attityden och önskan om utbildning är gynnsam för utvecklings- och förbättringsarbete av nutrition och målttidssituation på särskilt boende och korttidsboende. / Elderly people run the risk of undernourishment to a great extent. Registered nurses have an important task in nutritional care. The aim of the study was to measure attitudes to elderly people’s eating and nutritional status. The valid instrument, Staff Attitudes to Nutritional Nursing Care Geriatric scale, (SANN-G-scale) was used. Registered nurses working in nursing homes and short-term care in two communities were selected. Two statements were added to the questionnaire, focussing on nutrition policy and further education. The percentage of answers was almost 50 %. The result showed that registered nurses overall had a positive attitude. The area that showed the highest degree of positive attitude was individualisation about the meal situation. One third of the registered nurses considered that the elderly in municipal care were rarely undernourished, although research findings are showing the opposite. To reveal the elderly´s actual nutritional status the number of assessments, the documentation and what measures have been taken must be investigated. The result could be a good foundation for development work and improvements. In this work further education, reflection about ways of working and ways of communicate should be included. The positive attitude and the registered nurses’ wish for further education are favourable for improvement of nutritional care and meal situations in nursing homes and short-term care.

Denna studies Syfte var att beskriva hur omvårdnadspersonal och sjuksköterskor på två särskilda boenden i en kommun i Mellansverige uppfattar sin egen och varandras yrkesroll, däribland uppfattningen av sjuksköterskors ledarskap. Detta syfte har speglats utifrån designen kvalitativ ansats där resultatet är övergripande beskrivande och Metoden för studien var halvstrukturerade, ämnesfokuserade intervjuer som analyserats genom kvalitativ innehållsanalys. Resultatet som framkommer i studien var att rollerna är svåra att definiera, de generella beskrivningarna är att sjuksköterskans ansvar ligger i det sjuka och förebygga ohälsa samt att omvårdnadspersonalens huvudansvar vilar i den basala omvårdnaden men båda yrkesgrupperna anser sig dela det preventiva arbetet, omvårdnadsteknik är omvårdnadspersonalens arbetsuppgift - men anses valbar och förväntningarna på respektive yrkesgrupp skiljer sig. Varken sjuksköterska eller omvårdnadspersonal anser att sjuksköterskan har några specifika uppgifter som ledare utöver att de ska fungera som handledare och stå för kompetenshöjning på avdelningen, däremot framkommer åsikter om att det finns en naturlig ledarroll inom den medicinska vården vid specifika situationer. Slutsatser i studien var att sjuksköterskorna uppvisar bredare kunskap om arbetsuppgifterna inom yrkesrollerna än vad omvårdnadspersonalen gör, förväntningarna på varandras ansvarsområden skiljer sig och båda grupperna verkar ovetandes om ansvaret sjuksköterskor har i ledanderollen. / The aim of this study was to describe how health care assistants and registered nurses perceive their own and each other’s work roles and also how they perceived registered nurses role as a leader. A qualitative descriptive design was used. The used method was semi-structured, topic-focused interviews that were analyzed through qualitative content analysis. The result of the study shows that it was difficult to define respectively work role, the general description is that the registered nurses responsibility lies within the area of diseases and prevention of illness. The health care assistant’s main responsibility is in the area of basic nursing care and also technical care, but both occupational groups considered preventive work as a shared responsibility and the expectations on respectively occupational group differ. Neither the registered nurses nor the healthcare assistants considered registered nurses as a leader, except in the role of a mentor and the responsibility to increase competence within the healthcare assistants group when needed. But it was found that registered nurse have a natural role as a leader regarding the medical care in specific situations. The conclusions of the study was that the registered nurses has a broader knowledge of the work tasks within the work role of the two professions compared to the health care assistants, the expectations of each other’s responsibilities differ and both groups seem unaware of the leading role that is incorporated in registered nurses responsibility.

Thesis (Ed.D.)--University of West Florida, 2009. / Submitted to the Dept. of Professional and Community Leadership. Title from title page of source document. Document formatted into pages; contains 85 pages. Includes bibliographical references.

Using data from the Arizona public sex offender registry (SOR) and interview data from 30 registered sex offenders (RSOs), two probation officers, and one homeless shelter worker, this study addresses RSO housing experiences by placing RSOs at the center of the analysis. First, using a framework of social disorganization, I find RSOs are moderately segregated according to the index of dissimilarity, and tend to reside in areas characterized by lower than average median income and higher than average housing vacancies. The presence of RSOs is another indicator of social disorganization for these neighborhoods. Second, I identify issues faced by RSOs as they search for housing and the strategies they use to obtain housing. Commonly used strategies are being upfront and honest, using the assistance of friends and family members, and finding housing through private owners. Third, I assess the extent to which the RSO label operates to deter interactions or serves as the basis of harassment. Findings indicate that the RSO label can limit interactions between RSOs and others living near them. It also motivates avoidance particularly among those living in areas of low and moderate social disorganization. Many RSOs or their co-habitants have also experienced harassment due to the RSO label. These findings are problematic in terms of RSO reintegration. Lastly, I explore RSO assessments of the SOR. Many RSOs indicate concern over whether the SOR makes all RSOs appear the same. I offer a social process model in which I consider the process of labeling, stereotyping, and discrimination along with the potential for those who are stigmatized to seek out a basis to stigmatize others or distance themselves from others they perceive of as worthy of separation. I conclude by offering policy implications that are focused on the needs of communities and RSO reintegration issues.

BACKGROUND: Stroke survivors fall 7 times more annually than same-aged healthy adults; and most fall within the first 2 to 6 months post stroke after transition of care home from the acute setting. These falls cause hip fractures and other bodily injury, further compounding post-stroke mobility, fear of falling, social isolation, and social dependence while collectively yielding poorer outcomes at greater financial burden. PROBLEM: To date, no fall prevention program has targeted stroke survivors as they prepare for transition of care home from the acute setting. PURPOSE: The purpose of this practice inquiry is to develop an evidence-based fall prevention program aimed at empowering acute stroke survivors preparing for transition of care home from the acute setting. METHODS: An extensive literature review was synthesized to assess post-stroke falls epidemiology, contributing factors, potential consequences, and the current status of ameliorative interventions. A modified conceptual framework based upon the Science of Unitary Human Beings, theories of health empowerment, cognitive plasticity, and cognitive reserve was created to synergistically inform fall prevention program development. Literature review synthesis and modified conceptual framework collectively informed subsequent construction of a mixed theory-outcome-activities approach logic model to systematically guide proposed program implementation and evaluation plans. RESULTS: A novel evidence-based empowerment-focused fall prevention program was developed for acute stroke survivors preparing for transition of care home from the acute setting. CONCLUSION: The multi-interventional Patient Empowerment at Transitions of Care Fall Prevention Program for Stroke Survivors inspires a paradigm shift in the way stroke professionals and survivors view recovery and inherent survivor potential. The proposed fall prevention program is informed by a solid theoretical foundation and rigorous literature review of high-level evidentiary support. Moreover, existing dynamic funding opportunities promote subsequent program implementation and evaluation facilitated by Patient-Centered Outcome Research Institute grant pursuit.

Syfte: Undersöka hur nyutexaminerade sjuksköterskor upplever sin första yrkesverksamma tid och om utbildningen upplevs ge en tillräcklig förberedelse inför yrket. Metod: En deskriptiv kvalitativ studie. Åtta sjuksköterskor som arbetat mellan åtta och 18 månader på en medicinsk avdelning intervjuades med semistrukturerade frågor. Alla var kvinnor och i åldrarna 24-36 år. Analysmetoden som användes var kvalitativ innehållsanalys. Resultat: Det upplevs som en stor omställning att börja arbeta som sjuksköterska. Det var mycket nytt att lära och de upplevde yrket som ansvarsfullt, vilket kunde kännas skrämmande. Successivt upplevde de att de blev tryggare i sin roll. Upplevelser av skräck och osäkerhet inför att börja arbeta var vanliga men arbetskamraterna upplevdes vara ett stort stöd. Att börja arbeta möttes med blandade känslor och den grundläggande omvårdnaden upplevdes vara det lättaste. Det som upplevdes vara mest relevant från utbildningen var kurserna med medicinskt innehåll inklusive den verksamhetsförlagda utbildningen. Det sjuksköterskorna upplevde var mindre relevant i utbildningen var den vetenskapliga metodiken samt pedagogikkurserna. Slutsats: Det kan upplevas vara en stor omställning att gå från student till legitimerad sjuksköterska och möts ofta med blandade känslor. Det finns flera delar i utbildningen som skulle kunna omarbetas för att bättre förbereda sjuksköterskan inför yrket. / Aim: Investigate newly graduated nurses experiences of their first period as nurses and if the education are perceived to provide a sufficient preparation for the nursing profession. Method: Descriptive qualitative study. Eight registered nurses who had worked between eight and 18 months at a medical ward were interviewed using semi-structured questions. All participants were female in the ages between 24-36 years. The analytical method used was qualitative content analysis. Results: It’s perceived as a major adjustment beginning to work as a nurse. There were many new things to learn and they perceived the profession as a great responsibility, which could be frightening. Gradually they experienced that they became more comfortable in their role. Experiences of fear and uncertainty were common before starting their work but their colleagues were a great support. Starting to work was met with mixed emotions and the basic nursing care was perceived to be the easiest thing. The courses with medical content and the clinical education were perceived to be relevant during the education. They felt that the scientific methodology and the pedagogical courses were less relevant. Conclusion: Going from student to registered nurse could be perceived as a big adjustment and is often met with mixed emotions. There are several elements in the education that could be revised to better prepare nurses for the profession.