<p>Successful triage is the basis for sound emergency department (ED) care, whereas unsuccessful triage could result in adverse outcomes. ED triage is a rather unexplored area in the Swedish health care system. This thesis contributes to our understanding of this complex nursing task. The main focus of this study has been on the organisation, performance, and decision making in Swedish ED triage. Specific aims were to describe the Swedish ED triage context, describe and compare registered nurses’ (RNs) allocation of acuity ratings, use of thinking strategies and the way they structure the ED triage process.</p><p>In this descriptive, comparative, and correlative research project quantitative and qualitative data were collected using telephone interviews, patient scenarios and think aloud method. Both convenience and purposeful sampling were used when identifying the participating 69 nurse managers and 423 RNs from various types of hospital-based EDs throughout the country.</p><p>The results showed national variation, both in the way triage was organised and in the way it was conducted. From an organisational perspective, the variation emerged in several areas: the use of various triageurs, designated triage nurses, and triage scales. Variation was also noted in the accuracy and concordance of allocated acuity ratings. Statistical methods provided limited explanations for these variations, suggesting that RNs’ clinical experience might have some affect on the RNs’ triage accuracy. The project identified several thinking strategies used by the RNs, indicating that the RNs, amongst other things, searched for additional information, generated hypotheses about the fictitious patients and provided explanations for the interventions chosen. The RNs formed relationships between their interventions and the fictitious patients’ symptoms. The RNs structured the triage process in several ways, beginning the process by searching for information, generating hypotheses, or allocating acuity ratings. Comparison of RNs’ use of thinking strategies and the structure of the triage process based on triage accuracy revealed only slight differences.</p><p>The findings in this dissertation indicate that the way a patient is triaged, and by whom, depends upon the particular organisation of the ED. Moreover, the large variation in RNs triage accuracy and the inter-rater agreement and concordance of the allocated acuity ratings suggest that the acuity rating allocated to a patient may vary considerably, depending on who does the allocation. That neither clinical experience nor the RNs’ decision-making processes alone can explain the variations in the RNs triage accuracy indicates that accuracy might be influenced by individual and contextual factors. Future studies investigating triage accuracy are recommended to be carried out in natural settings.</p><p>In conclusion, Swedish ED triage is permeated by diversity, both in its organisation and in its performance. The reasons for these variations are not well understood.</p>

<p>The present thesis is based on four empirical studies concerning risk factors related to musculoskeletal pain (MSP), disability, and sick leave among three non-clinical samples of health care staff. Initially, in Study I, cognitive, behavioural and environmental factors related to MSP of nurses' aides<b> </b>were explored. An experimental design including baseline, intervention and follow-ups among 29 nurses' aides<b> </b>working in a home for the elderly was used to evaluate effects of a workplace intervention based on cognitive behaviour (CB)- and conventional, symptom reduction principles. In Study II, a cross-sectional and correlational design was applied. A self-administered questionnaire was used to describe and investigate the relationship between risk factors and development of persistent pain, sick leave and long sick leave among 914 municipal health care staff. In Study III and IV, a longitudinal design was used among 200 registered nurses (RN) working in a county hospital to describe and predict pain, disability and sick leave. Data collection involved two self-administered questionnaires covering: 1) work and personal factors, pain, disability and sick leave at baseline and 2) valued life dimensions at baseline. The results showed that MSP was common among the staff. Study I showed positive effects among nurses' aides<b> </b>receiving the CB principles related to MSP compared with nurses' aides receiving the conventional principles. In Study II, pain severity and expectations to be working in 6 months were associated with persistent MSP and sick leave, respectively. In Study III, pain, disability and sick leave at baseline were the strongest predictors of pain, disability and sick leave at the three-year follow-up. In Study IV, the findings support the notion that individual values in different life domains are possible predictors of pain and disability. </p>

The present thesis is based on four empirical studies concerning risk factors related to musculoskeletal pain (MSP), disability, and sick leave among three non-clinical samples of health care staff. Initially, in Study I, cognitive, behavioural and environmental factors related to MSP of nurses' aides<b> </b>were explored. An experimental design including baseline, intervention and follow-ups among 29 nurses' aides<b> </b>working in a home for the elderly was used to evaluate effects of a workplace intervention based on cognitive behaviour (CB)- and conventional, symptom reduction principles. In Study II, a cross-sectional and correlational design was applied. A self-administered questionnaire was used to describe and investigate the relationship between risk factors and development of persistent pain, sick leave and long sick leave among 914 municipal health care staff. In Study III and IV, a longitudinal design was used among 200 registered nurses (RN) working in a county hospital to describe and predict pain, disability and sick leave. Data collection involved two self-administered questionnaires covering: 1) work and personal factors, pain, disability and sick leave at baseline and 2) valued life dimensions at baseline. The results showed that MSP was common among the staff. Study I showed positive effects among nurses' aides<b> </b>receiving the CB principles related to MSP compared with nurses' aides receiving the conventional principles. In Study II, pain severity and expectations to be working in 6 months were associated with persistent MSP and sick leave, respectively. In Study III, pain, disability and sick leave at baseline were the strongest predictors of pain, disability and sick leave at the three-year follow-up. In Study IV, the findings support the notion that individual values in different life domains are possible predictors of pain and disability.

Dans le cadre de cette étude, nous nous sommes intéressés aux infirmières soignantes qui possèdent un diplôme d’études collégiales ou un baccalauréat. L’infirmière est celle ayant reçu une formation collégiale et la clinicienne, une formation universitaire de premier cycle. Au niveau législatif, selon que l’infirmière soit titulaire ou non d’un baccalauréat, le champ de pratique autorisé demeure le même. Cependant, l’étendue de la pratique pourrait varier selon la formation reçue et le poste occupé. Cette étude descriptive et interprétative de type qualitatif avait pour but de décrire l’étendue de la pratique des infirmières et des infirmières cliniciennes dans une unité de médecine et de chirurgie et d’identifier les facteurs organisationnels influençant l’étendue de la pratique. Le cadre de référence ayant été utilisé est le cadre d’analyse de l’étendue de la pratique conçu pour le Collège des infirmières autorisées de la Nouvelle-Écosse (CRNNS, 2005). Selon ce cadre, l’étendue optimale de la pratique des infirmières se divise en 4 catégories distinctes, soit le processus de soins infirmiers, les pratiques relationnelles, le leadership ainsi que l’enseignement et le transfert des connaissances. La collecte de données a été conduite au moyen d’entrevues individuelles semi-structurées auprès de 8 informateurs clés soit trois infirmières et trois infirmières cliniciennes d’une unité de médecine et de chirurgie et de deux gestionnaires. Les résultats semblent montrer que les différentes composantes de l’étendue de la pratique sont mobilisées tant chez les infirmières que chez les infirmières cliniciennes interviewées. Toutefois, les résultats semblent montrer que certaines composantes, soit le leadership et le transfert des connaissances, semblent davantage mobilisées chez les infirmières cliniciennes. De plus, l’étude a permis d’identifier les différents facteurs organisationnels qui semblent influencer l’étendue de la pratique des infirmières et des infirmières cliniciennes. La charge de travail semble être le principal facteur d’influence. Nous avons aussi pu constater l’influence certaines composantes reliées à l’environnement de travail et à la composition et aux caractéristiques des équipes de soins. / The goal of this descriptive and interpretative study was to first describe the scope of nursing practice of registered nurses with a Bachelor’s degree in nursing and those with a nursing diploma in a medical and surgical unit of a regional hospital. The second goal was to identify the organizational factors that influence the scope of nursing practice in that unit. The framework that has been used is the Framework to Analyse Scope of practice, made for the College of Registered Nurses in Nova Scotia (CRNNS, 2005). According to that framework, the full scope of practice of the registered nurse is divided in 4 components: the nursing process, the professional nursing relationships, the leadership and the fonction of teaching and knowledge transfert. For this study, 8 interviews have been realized. The participants were: 3 nurses with a nursing diploma, 3 nurses with a bachelor’s degree and 2 administrators. The results seems to show that all the components of the nursing scope of practice seems to be used by the nurses with a Bachelor’s degree in nursing and those with a nursing diploma. But, the results seem to show that the nursing scope of practice is not fully extended in that unit. We remarked also that two elements of the nursing scope of practice, the leadership and the teaching and knowledge transfert, are more used by nursed with a Bachelor’s degree, compared to those with a nursing diploma. The principal factors which seem to influence the scope of nursing practice in this unit are the nursing workload and some components according to the work environment and to the composition and caracteristics of the nursing teams.

The aim o f this study was to determine the key factors within the roles and functions of professional nurses working in different nursing units with the purpose for motivation for their compensation in accordance with their performance. A comparative, descriptive design was employed. Findings reveal that the professional nurse’s roles and functions in the different units show that there are some significant differences regarding certain activities while differences pertaining to other activities were not significant. However, there were factors which were subjected to a number o f limitations during the study. Apart from the significant differences, it thus appears as if the roles and functions required o f professional nurses working in the three disciplines do not vary much in content and intensity. From the findings o f this study, it therefore, does not appear as if paediatric professional nurses have a valid reason for expecting additional monetary rewards in view o f their roles and functions. / Health Studies / M.A. (Health Studies)

The purpose of this study was to explore and describe registered nurse's perceptions with regard to continuing formal education. A quantitative descriptive, explorative research design was used to study registered nurses views with regard to continuing formal education and to identify the barriers to continuing formal education as experienced by registered nurses. Convenience sampling was used to select the research sample of registered nurses working at four state health institutions in the Western Cape Province, South Africa. Descriptive statistics, based on calculations using the Microsoft (MS) Excel (for Windows 2000) programme, were used to summarise and describe the research results obtained from the questions completed by the registered nurses. The research results indicated that most registered nurses perceive continuing formal education as beneficial to their personal and professional growth and to improve the quality of patient/client care, but barriers exist which prevent or deter them from undertaking continuing formal education programmes. The main barriers were identified as structural barriers, including lack of funding, job and family responsibilities and lack of coherent staff development planning. / Health Studies / M. A. (Health Studies)

The purpose of this study was to explore and describe the perceptions of registered nurses with regard to facilitating the learning of student nurses during clinical placement. Focus group interviews with fifteen registered nurses were done, followed by participant observations in two clinical areas, to gain a clearer picture of obstacles, as well as the strategies employed during placement of student nurses in the clinical area. The :findings indicate that facilitation of the learning of student nurses during clinical placement is achieved by guidance, involvement, assisting and supervision of student nurses in the clinical area by nurses of all categories, and medical and paramedical personnel. Many obstacles were identified which obstruct the employment of strategies that are suitable for facilitation in the clinical area. Guidelines for the facilitation of learning of student nurses were recommended, to improve facilitation in the clinical area. / Health Studies / M.A. (Nursing Science)

Bakgrund: När en patient drabbas av hjärtstopp ingår det i allmänsjuksköterskans uppgifter att påbörja HLR för att försöka rädda patientens liv. På allmän vårdavdelning används mer avancerad behandling, så kallad S-HLR. En hjärtstoppsituation kan upplevas skrämmande för sjuksköterskan eftersom hen sannolikt behöver gå från en mer lugn till en akut situation. Det kan kännas påfrestande men kunskap och erfarenhet hjälper hen att agera. Behandlingen av hjärtstopp utförs i team tillsammans med flera professioner vilket innebär att det är viktigt med ett väl fungerande teamarbete. Syfte: Syftet med studien var att undersöka allmänsjuksköterskors upplevelser av att vårda vid ett hjärtstopp på vårdavdelningar. Metod: Som metod valdes en kvalitativ intervjustudie där resultatet baserades på sju semistrukturerade intervjuer. Intervjuerna transkriberades och analyserades sedan med en kvalitativ innehållsanalys som besvarade syftet för studien. Resultat: Resultatet visade på att det fanns fyra kategorier som bidrog till upplevelsen av hjärtstopp; ”Kunskap om hjärtstopp” där vikten av utbildning, rutiner och erfarenhet påtalades. ”När hjärtstopp pågår” som innefattar första reaktionen, HLR-situationen och att avbryta HLR. ”Att arbeta i team” bestående av samarbete, trygghet och verktyg för teamet. Slutligen ”Bearbetning efter hjärtstopp” som handlade om debriefing, uppföljning och uppfattning om hjärtstopp. Alla dessa områden bildade tillsammans en uppfattning av hjärtstopp. Slutsats: Hjärtstoppsvård är en påfrestande situation som sjuksköterskan minns länge och det är därför viktigt att avdelningarna arbetar med samtliga kategorier som framkommit i resultatet för att stödja och underlätta för de sjuksköterskor som engageras vid ett hjärtstopp på en vårdavdelning. / Background: When a patient has a cardiac arrest, it is included in the RN's duties to start CPR in order to try to save the patient's life. In the general nursing ward, more advanced treatment, so-called hospital CPR, is used. A cardiac arrest can be daunting for the nurse because they probably need to shift from a calm situation to an emergency situation. It may feel stressful, but knowledge and experience helps the RN to act. The treatment of cardiac arrest is performed in teams with several professions which means that it is important to have a good teamwork. Aim: The aim of the study was to investigate the RN’s experiences of caring for a cardiac arrest occurring at nursing wards. Method: As a method, a qualitative interview study was chosen, based on seven semi- structured interviews. The interviews were transcribed and then analyzed with a qualitative content analysis that suited the aim of the study. Result: The result showed that there were four categories that contributed to the experience of cardiac arrest; "Knowledge of cardiac arrest", emphasizing the importance of education, routines and experience. "When cardiac arrest is in progress" that includes the first response, CPR situation, and termination of CPR. "Working in team" consisting of cooperation, safety and instruments for teamwork. Finally, "Processing after cardiac arrest" that involved debriefing, follow-up and perception of cardiac arrest. All of these areas together formed an idea of ​​cardiac arrest. Conclusion: Cardiac arrest is an urgent situation that the nurse remembers for a long time, and it is therefore important that the wards work with all categories identified in the results to support and facilitate the nurses engaged in a cardiac arrest in a nursing ward.

The purpose of this multiple case study was to explore strategies that healthcare facility leaders in Central Minnesota use to recruit and retain qualified nurses. Participants were 6 healthcare facility leaders including 2 nursing directors, 2 human resource personnel, 1 nurse supervisor/administrator, and 1 nurse recruiter who had the knowledge and experience in recruitment and retention of Registered Nurses (RNs) in healthcare facilities in Central Minnesota. The Herzberg 2-factor theory was the conceptual framework. Semistructured interviews were used to collect data. Data were analyzed using Morse's 4 steps data analysis process. The major themes were recruitment strategies and retention incentives. The recruitment strategies were the various hiring methods participants used to attract and gain RNs, and the retention incentives were the benefits that motivated and retained RNs. Participants relied on both recruitment strategies and retention incentives to manage the shortages of RNs. The results provide healthcare facility leaders with additional information about how to successfully recruit and retain qualified RNs, which may lead to a larger and potentially satisfied nursing population. Social implications include strengthening the nursing workforce, increasing productivity for healthcare facilities, providing better customer service and increased patient satisfaction, and contributing to more satisfied RNs and families, as well as helping the local communities and the economy.

The United States continues to be affected by a severe, long-standing nursing shortage that is not projected to resolve within the next 10 or more years. Unsuccessful passage of the National Council Licensure Examination for Registered Nurses (NCLEX-RN) among graduate nurses remains one of several key contributors to the nursing shortage. The goal of this study was to identify if either cumulative fall semester GPA; the overall prenursing science, mathematics, and English GPA; type of high school background; TOEFL score; clinical pass or fail; and on-time program completion best predicted passage of NCLEX-RN. Archived records from the academic years of 2006-2010 of students/graduates of a small, private BSN program were analyzed. A nonconcurrent, prospective design of secondary data was guided by the theoretical implications of the Seidman retention formula that surmises that early identification of academic problems is a necessary precursor to implementations that promote academic success. Significant, positive correlations were found between GPA of prenursing courses and achievement in clinical courses and on-time nursing program completion. Forward and backward, logistic regression procedures revealed that clinical performance was the strongest predictor of NCLEX-RN success but with an inverse relationship. Implications for positive social change include retention of BSN students to improve graduation rates. This ultimately will foster achievement on the NCLEX-RN, resulting in more graduates will be able to competently serve the health care needs of individuals and communities and alleviation of the nursing shortage.