The study was a descriptive quantitative survey which endeavoured to identify challenges experienced by IMCI trained registered nurses in implementing the guidelines and procedures of the strategy when tending children under 5 years in Gaborone health district. The study also solicited for recommendations on how to address the identified challenges. The research population comprised of all the IMCI-1 trained registered nurses and systematic sampling was employed to randomly select study participants. Data were collected using a questionnaire and was analysed using Excel Advanced software package. Study findings identified challenges related to political support, cost of IMCI training, training coverage, health systems and features of the IMCI strategy. Recommendations for improving use of the strategy included garnering for more political support, adopting short duration training courses, scaling up both pre-service and in-service training as well as addressing the challenges related to health systems and the unique features of the strategy / Health Studies / M.A. (Public Health)

Det övergripande syftet var att beskriva och jämföra sjuksköterskors och underskö­terskors bedömningar av patienters smärta, näringstillstånd och hudkostym samt de­ras uppfattningar om att använda bedömningsinstrument. Vidare att beskriva sjuk­sköterskors och undersköterskors uppfattningar om hur de bedömer patienters smärta, näringstillstånd och hudkostym. Metod: Etthundrasjuttio pati­entjournaler granskades. Intervjuer med sjuksköterskor (n=9) och undersköterskor (n=9) genomfördes. Resultatet av sjuksköterskors (n=34) och undersköterskors (n=43) bedömningar jämfördes. Interbedömarreliabilitet undersöktes när sjuk­sköterskor (n=50) och undersköterskor (n=61) använde bedömningsinstrument.  Resultat: Sextio pro­cent av patientjournalerna vid inskrivningen och 78 % vid utskrivningen innehöll do­kumentation om patientens hudstatus. Det fanns dokumentation om trycksår i 15 % respektive 20 % av patientjournalerna. Patienter som var i risk för trycksårutveckling enligt Modifierad Nortonskala (MNS) erhöll i medeltal 4,6 omvårdnadsåtgärder och patienter som ej var i risk erhöll i medeltal 3,8. Det var inte några tydliga grän­ser för hur sjuksköterskor och undersköterskor genomförde bedömningar, vem som gjorde vad och på vilket sätt det gjordes. Det var inga skillnader mellan sjukskö­terskors och undersköterskors bedömningar av risk för undernäring och trycksår när det gäller poäng för initial bedömning och totalpoäng. Det var dock skillnader i deras bedömningar av enskilda delskalor och smärta. Sjuksköterskors och undersköterskors uppfattning om hur det var att använda bedömningsinstrument varierade. Inter­bedömarreliabiliteten avseende MNS, Short- Form Mini Nutritional Assessment och trycksårkortet varierade mellan och inom sjuksköterskegruppen och undersköterskegruppen. Konklusioner: Sjuksköterskor dokumenterar inte alltid bedömning av patienters hudkostym och risk för trycksårutveckling. Det är såväl likheter som skillnader mellan sjuksköterskor och undersköterskor när det gäller hur de genomför bedömningar och resultatet av deras bedömningar. Interbedömarreliabilite­ten mellan och inom sjuksköterske- och undersköterskegruppen varierar vid deras bedömning med olika bedömningsinstrument och trycksårkort. Ett viktigt led i arbetet med att säkerställa patientsäkerhet och hög vårdkvalitet är att vara steget före och fortlö­pande bedöma patienters smärta, näringstillstånd och hudkostym. / The overall aim was to describe and compare registered nurses’ (RNs’) and enrolled nurses’ (ENs’) assessments of pain, nutrition and skin and their perceptions of using assessment tools. Further to describe RNs’ and ENs’ perceptions of how they assess patients’ pain, nutrition and skin. Methods: One hundred and seventy patient records were reviewed for patients with hip fracture. Interviews were conducted with RNs (n=9) and ENs (n=9). Results of the RNs’ (n=34) and ENs’ (n=43) assessments of patients with hip fracture were compared. Interrater reliability was examined between and among RNs (n=50) and ENs (n=61) using assessment tools for assessments (n=228) of patients with hip fracture and stroke. Results: Sixty percent of patient records on admission and 78% at discharge had documentation of the patient’s skin status. Pressure ulcers were documented in 15% and 20% of patient records respectively. Patients at risk for developing pressure ulcers according to the Modified Norton Scale (MNS) received a mean of 4.6 nursing interventions, while those not at risk received a mean of 3.8. There were no established boundaries between RNs’ and ENs’ assessment who performed it and in what way it was done. There were no differences between RNs’ and ENs’ as­sessments of risk for malnutrition and pressure ulcer regarding screening or total scores. However, there were differences regarding their assessments on the subscales and patients’ pain.  RNs’ and ENs’ perceptions of using assessment tools varied. Interrater reliability regarding MNS total score was very good among RNs, good among ENs and between RNs and ENs. For Short- Form Mini Nutritional Assessment screening score, interrater reliability was good between RNs and ENs and among RNs, while it was moderate among ENs. Interrater reliability between and among RNs and ENs varied for Pressure Ulcer Card. Conclusions: RNs do not always document assessment of patients’ skin and risk for pressure ulcer. Patients at risk for pressure ulcers receive more nursing interventions than patients not at risk. There are both similarities and differences between RNs and ENs regarding how they perform their assessments and what the results of their assessments are. Interrater reliability between and among RNs and ENs varies regarding the different assessment tools. An important part of the work in establishing patient safety and high quality of care is to be one step ahead and continuously assess the patients’ pain, nutrition and skin.

The positive contributions of entrepreneurship towards the economic development were already proved by the previous researchers. The main aim of this study was to analyse the determinants of entrepreneurial activity in the Nordic countries over the period of years 2004‑2013 to provide the supportive empirical analysis for the Nordic entrepreneurial policy makers. Data were obtained from the various databases and were formed into the panel dataset. Entrepreneurial activity was quantified by the two variables, rate of registered business activity and established business ownership rate. For each entrepreneurial activity, acting as the dependent variable, was estimated the set of econometric models following the econometric approach with the Fixed Effects Estimator. The results obtained for the both dependent variables did not substantially differ from each other and were generally in agreement with the results obtained by the previous scholars. The hypothesis stating the positive relationship between unemployment rate, GDP per capita and entrepreneurial activity, during the analysed period, were accepted. Also the negative impact of administrative barriers on entrepreneurial activity was confirmed. However, no statistically significant empirical support was obtained for the hypothesis assuming the positive relationship between R&D sector and entrepreneurial activity.

This study focused on Registered Nurses (RNs) working in Acute Trust surgical wards in the context of their role development, role expansion and role extension. The study originated from concerns raised by RNs undertaking the surgical pathway of the BSc Hons in clinical nursing practice, who alerted me to their dissatisfaction with their working conditions and their role. This revelation was made at a time when modernization was cascading into Acute Trusts as a result of the NHS plan (DOH 2000); simultaneously the European Working Time Directive (EWTD) was being implemented, sequentially reducing Junior Doctor’s hours of work. NHS modernization and the EWTD were the two initiatives which led the researcher to the assumption that RNs working in surgical wards were the labour force who would be absorbing the additional workload brought about by these changes, because RNs are the only health professionals in acute surgical wards with twenty-four hour contact with, and responsibility for, ward-based surgical patient care. The study was conducted in one clinical directorate of an Acute Trust hospital, comprising six in-patient surgical wards and five specialist nursing services. The methodology was ethnography, where the researcher worked as an RN for fifteen months, collecting data through Spradley’s (1980) descriptive, selective and focused phases of fieldwork. Data was analysed using what Miles and Huberman (1994) refer to as a set of ‘choreographed / custom built’ techniques. The descriptive phase of fieldwork revealed an apparent ‘staffing illusion’ on the surgical wards and RNs were found to be under tremendous pressure to manage ‘patient throughput’, and an ever increasingly dependent case mix of surgical patients, within the existing, or if possible diminishing Senior / experienced RN labour force due to the emergent evidence of a ‘cycle of staff change’ with non-clinical managers backfilling Senior RN posts with Junior RNs. For Senior RNs this backdrop meant additional support and supervision demands on their role. To get through the workload many RNs held ‘dual roles’ to enable maintenance of the surgical services within the directorate. The selective phase of fieldwork re-focused the ethnographic lens on the RNs in the context of their role development, role expansion and role extension, from which six perspectives were found: 1) role development from Junior to Senior RN, 2) role expansion dependent on shift of the day, day of the week – the co-ordinator role, 3) role extension confusion and boundary disputes, 4) hidden [role expansion and extension] talents of surgical nurses, 5) role contraction – a feeling Nursing is going backwards, and finally, 6) ‘if only I could’ – role expansion aspirations of surgical RNs. The third phase of fieldwork, described by Spradley (1980) as the focused phase, was spent validating the findings and conducting the ethnographic interviews. The findings are interpreted locally [from the perspective of RN’s working within Rodin] as ‘working to full capacity’ through ‘doing more for more with less’, as a result of the RN with the surgical directorate being sandwiched between two agendas, that of Junior Doctors EWTD and NHS modernisation. Braverman’s skill substitution / degradation of skilled work thesis is then used as an interpretative framework to conclude the thesis, the outcome of which reports a ‘triple substitution’ agenda.

Patients with mental illness experience dissatisfaction with their care due to lack of understanding and ignorance from the nurses. The nurses’ approach might influence these patients' experience of their care. The purpose of the literature review was to describe nurses' approach in care of patients with mental illness. The literature review is based on an inductive approach and the result is based on 14 scientific papers, of which eight used a qualitative design and sex used a quantitative design. A simpler form of content analysis was used, which resulted in four themes: the importance of knowledge, preconceived perceptions, neglect and feelings of responsibility. Nurses' attitudes to mental illness are both positive and negative. Positive approaches include feelings of responsibility for patient care. Negative approaches include neglect and negative feelings such as distrust and fear. The result of the literature review indicates a need for more education about mental illness in order to reduce stigma and knowledge gaps among registered nurses in public health services. As many results articles were related to abuse problems the area seems limited, therefore more research directed toward other mental illnesses, is recommended. / Patienter med psykisk ohälsa upplever missnöje med sin omvårdnad på grund av brist på förståelse och negligering från sjuksköterskorna. Sjuksköterskorna kan påverka dessa patienters upplevelser av omvårdnaden genom sitt förhållningssätt. Syftet med litteraturstudien var att beskriva sjuksköterskors förhållningssätt i omvårdnaden av patienter med psykisk ohälsa. Litteraturstudien grundas på en induktiv ansats och resultatet baseras på 14 vetenskapliga artiklar, varav åtta artiklar är kvalitativa och sex artiklar är kvantitativa. En enklare form av innehållsanalys användes, vilket resulterade i fyra teman: kunskapens betydelse, förutfattade uppfattningar, negligering samt känslor av ansvar. Sjuksköterskors förhållningssätt till psykisk ohälsa är både positiv och negativ. Positiva förhållningssätt inkluderar känslor av ansvar för patienternas omvårdnad. Negativa förhållningssätt inbegriper bland annat negligering samt negativa känslor som misstro och rädsla. Litteraturstudiens resultat påvisar ett behov av mer utbildning om psykisk ohälsa för att reducera stigmatisering och kunskapsluckor hos legitimerade sjuksköterskor i den allmänna hälso- och sjukvården. Området upplevdes begränsat då många funna resultatartiklar berör missbruksproblematik, därför rekommenderas mer forskning riktad mot andra psykiska sjukdomar.

Bakgrund: Hjärt- och kärlsjukdomar är ett globalt växande folkhälsoproblem som dessutom är en ekonomisk last på samhället. Forskning har uppskattat att majoriteten av dödsfall kommer att bero på hjärt- och kärlsjukdomar vid år 2030. Några riskfaktorer för att utveckla hjärt- och kärlsjukdom är ett högt BMI, rökning och låg fysisk aktivitet. Forskning har visat att primärpreventivt arbete med livsstilsförändringar är något som minskar riskfaktorerna och är kostnadseffektivt för samhället. Syftet: var att beskriva vilka primärpreventiva metoder sjuksköterskan använder för att uppmuntra till livsstilsförändringar hos patienter med risk för  hjärt- och kärlsjukdom samt att beskriva hur dessa primärpreventiva metoder påverkar riskfaktorerna. Syftet var också att beskriva urvalsgrupperna i de valda vetenskapliga artiklarna. Metod: För att besvara syftet och frågeställningarna hade denna litteraturstudie en beskrivande design där tolv vetenskapliga artiklar har analyserats. Databaserna PubMed och CINAHL användes vid sökningen för att finna de vetenskapliga artiklarna. Resultat: Sjuksköterskor använde olika metoder för att uppmuntra till livsstilsförändring hos hjärt- och kärlsjuka patienter. Dessa metoder innebar att sjuksköterskan antingen fungerar som en informationsgivare eller samarbetspartner gentemot patienten. Effekten av metoderna varierade och enligt vissa studier gav de ej gav någon effekt. Slutsats: Utifrån litteraturstudiens resultatet går det ej med säkerhet att säga vilka metoder som är mest effektiva. Sammanfattningsvis kan sjuksköterskan i sitt kliniska arbete ta hänsyn till båda förhållningssätt i mötet med patienterna och anpassa metoden utifrån ett individuellt perspektiv. / Background: Coronary heart disease is a growing health issue from a global perspective. Research has estimated that coronary heart disease will stand for the majority of deaths by the year 2030.  Risk factors include a high BMI, smoking and low level physical activity. Research has also shown that lifestyle change can decrease the risk factors and is cost-effective for the society. Aim: The aim with the litterature study was to describe which primary prevention methods nurses use to encourage lifestyle change for patients at  risk of developing coronary heart disease, and to describe how these methods affect the risk factors. The purpose was also to describe the sample groups in the chosen articles. Method: To answer the study questions, the literature study had a descriptive design where twelve scientific articles were analysed and categorized. The databases PubMed and CINAHL were used to find the scientific articles. Results: Nurses use an array of different methods to encourage life style change in patients with coronary heart disease. These methods include the nurse either acting as a information giver or a collaboration partner towards the patient. The effect of these methods varied and some of the studies didn’t show any effect whatsoever. Conclusion: On the basis of the literature study, the methods nurses use and their effectiveness are inconclusive. In conclusion, the nurse can consider all of the methods in the work place, and decide which method is adequate based on the individual variations of the patients.

No description available.

Background: Sexually transmitted infection (STI) rates represent a significant health disparity among young adult African American women. A major factor contributing to this issue is inconsistent condom use. This is especially a challenge for the state of Georgia, which has a high incidence of STI among the southern states. STI prevention counseling delivery through primary care providers is the primary recommendation from the Centers for Disease Control and Prevention and U.S. Preventive Services Taskforce. However, knowledge, attitudes, and practices of STI prevention counseling by advanced practice registered nurses (APRN) who care for young adult African American women are unknown in Georgia.Purpose: This doctor of nursing practice project investigated knowledge, attitudes, and practices of STI prevention by Georgia APRNs caring for young adult African American women on an outpatient basis and determined congruency of their counseling with primary prevention guide-lines. Methods: The design was descriptive cross-sectional. An online survey using Qualtrics software was distributed via professional listservs and postal mail to eligible Georgia APRNs currently in practice. Participants' knowledge of STI, STI prevention, and current practice guidelines and recommendations were assessed using knowledge questionnaires including true/false and multiple choice questions. Participants' attitudes regarding STI prevention counseling with young African American women and current APRN behaviors, in relation to current practice guidelines, were measured using Likert-type scales. Outcomes: The final sample size included 22 participants. Forty initiated the survey, ten did not meet eligibility criteria, six ended the survey during eligibility screening, and two ended the survey after completing less than seven percent of it. In general, participants were knowledgeable of STI and the majority of participants were knowledgeable of the CDC and USPSTF guidelines. The majority of participants felt comfortable discussing sexual practices with patients and providing feedback and advice on reducing STI risk behavior. However, the majority of participants did not believe that their current practice setting actively supported their delivery of STI prevention counseling. Overall, participants' practices were more congruent with the CDC guidelines compared to the USPSTF guidelines. This was reflected in knowledge and practice behaviors, specifically assessing for STI, providing feedback on risk behavior, and advising on behavior change with STI-infected patients and those at risk for STI. Fewer chose the USPSTF as their established practice guideline. This was revealed in practice behaviors pertaining to 'high-risk' counseling, as few tended to set goals for STI risk behavior change, document behavior goals, refer to STI resources, or follow up with referrals made to other STI risk reduction programs. Practice implications: Although overall APRN knowledge of STI was high, there were some knowledge deficits relating to appropriate barrier methods for viral-based STI and high-risk sexual behaviors associated with HBV. There was also a lack of knowledge and practice behaviors of the USPSTF STI prevention counseling guidelines. Therefore, future studies and interventions should aim to educate APRNs about these knowledge and practice insufficiencies.

A central part of the nursing profession is the performance of practical skills. In order to provide adequate care, maintain patient-safety, and feel comfortable in the profession, registered nurses (RNs) need to be equipped with requisite skills. Overall aim: To explore and describe how learning and development of practical skills occurs during the preparatory phases and within the nursing profession. Method: Qualitative (I, III, IV) and quantitative methods (II) were used. Data were collected through individual interviews (I, IV), questionnaires (II) and participant observations, including informal talks (III, IV). Results: Both students and new RNs expressed a need to learn and develop practical skills (I, II, III, IV). Less than half of the new RNs had access to a clinical skill laboratory (CSL), where they could learn and practice practical skills (II). The students described that learning at a CSL had been meaning for their clinical practice. They also expressed a great need for continuing learning in real patient situations (I, III, IV). During clinical practice, preceptors and students took different approaches which affected student’s learning processesö (I, III, IV). There was a tension between learning at a CSL and learning in clinical practice sites because students perceived differences in the performance of skills. Students described that they understood that performance of skills could be done in different ways without injuring patients. However, the data also showed deviations in performances that could jeopardize patientsafety. In these situations, student’s behavior differed (I, IV). One third of new RNs deviated from evidence based guidelines when they performed practical skills which they were unfamiliar with (II). Both students and new RNs reported that reflection in connection with the performance of practical skills was not common (I, II III, IV). Conclusions: Cooperation between university CSLs and clinical settings must be intensified in order to enhance the understanding of learning processes regarding practical skills. A consensus regarding academic approaches should be reached. Universities need to support preceptors in educational issues where the importance of reflection is clarified and exemplified. Increasing patient-safety requires that new RNs receive opportunities for training in artificial environments, and that a culture that reinforces the use of guidelines and a reflective stance is cultivated.

The purpose of this study is to determine the possible relationship between post-doctoral research productivity of doctorally prepared nurses and instructional experiences of doctoral study, conditions of employment and other factors that may be related to research productivity. The design of the study is causal comparative.