The goal of nursing is to promote health and alleviate suffering. Using Appreciative Inquiry, this study explored the possibilities for the nursing profession to reduce the health implications of poverty. Select Saskatchewan registered nurses (RNs) engaged in appreciative interviews that identified positive experiences working with low income clients. The participants were activists challenging the status quo through their practice. Analysis illuminated the best practices of these RNs, constructing a vision for change rooted in their understanding clients realities and communicating those realities through advocacy. By bringing their personal passions to client interactions, and connecting with a broader social justice context, RNs create an opportunity to respond to the effects of income inequities on health.

Methicillin Resistant Staphylococcus aureus (MRSA) is the most commonly isolated multi-drug resistant organism in the hospital setting. MRSA can result in death among people who have no identified risk factors for infection. One-third of MRSA infections are cross-transmitted as Healthcare-Associated Infections (HAIs). It is well known that the single most effective means for decreasing the risk of HAIs is hand hygiene (HH), yet poor performance among registered nurses persists. The theoretical framework used to guide the study was the Health Belief Model (HBM). The purposes of the study were to: explore the RNs’ self-reported HH performance rate; explore the RNs’ knowledge related to MRSA; identify relationships between MRSA knowledge and HBM constructs; explore the RNs’ barriers to HH performance; identify relationships between barriers and self-reported HH performance; explore relationships among HH behaviors and constructs in the HBM; explore predictors of ‘overall HH’ performance; and identify if certain demographic characteristics are related to MRSA knowledge, self-reported HH, and HBM constructs. A cross sectional descriptive study was conducted with a sample of RNs who were randomly selected. The questionnaire mailing, which included the survey, consent, and the return-stamped envelope were distributed to 684 RNs. Completed surveys (n=120) from RNs who met the sample inclusion criteria were returned within four weeks. Self-reported HH were highest during times of increased perceived susceptibility for infection. In addition, nurses were more likely to overcome barriers to HH during ‘moments’ associated with the highest perceived susceptibility. Although MRSA knowledge did not correlate with ‘overall HH’ performance, there was a significant relationship identified with self-efficacy (r=.27, p<.01), which may influence HH behaviors. The most commonly identified barriers to HH performance were system factors (e.g. ‘a high workload’). Self-efficacy and barriers represented 26% of the variability in the regression model when applying significant correlations among HBM constructs and ‘overall HH.’ The phenomenon of the RN’s HH decision making is not completely understood. More research is needed to explain predictors for HH among registered nurses. This understanding will allow researchers to plan interventions aimed at increasing knowledge and understanding about perceived susceptibility, which may in turn improve self-efficacy behaviors for HH, which could decrease HAI rates. / text

Although older Canadians constitute a large portion of patients in hospital, many receive less-than-optimal drug care. Most registered nurses (RNs) and other health care professionals who provide older adults (OAs) with drug therapy lack pre-professional education about that practice. Concurrently, there is little research available about how RNs learn about drug therapy for OAs. Using a qualitative method, this thesis explores hospital RNs’ insights about their knowledge about drug therapy for OAs, their associated learning needs and strategies, and contextual influences on their learning. The findings illuminated RNs’ extensive knowledge, their learning needs and varied learning strategies, and constraints and facilitators of their learning. Drug therapy for OAs is a complex activity. RNs play a pivotal role in that care and have ample knowledge. RNs’ learning is holistic, ongoing, mostly informal, and reflective of many adult-learning theories. By learning, RNs build and transform their repertoires of knowledge to stay current with the quickly changing landscapes of health care, gerontological know-how, and drugs and drug practices. As a result, sometimes RNs protect not only OAs but also other hospital stakeholders from the negative effects of uninformed practice. Nurse educators should teach students about drug therapy for OAs and broaden their own views about RNs’ knowledge and learning strategies for that care. Nurse leaders should maximize chances for RNs to learn and prepare them to influence other stakeholders in ways that support learning. Hospital administrators and other stakeholders should recognize RNs’ pivotal role in drug care and support their learning through organizational changes. Communities should design strategies that ease RNs’ learning. Policymakers should replace corporatism with innovations that champion learning. Researchers and RNs should collaborate on novel projects that bolster RNs’ learning.

Although older Canadians constitute a large portion of patients in hospital, many receive less-than-optimal drug care. Most registered nurses (RNs) and other health care professionals who provide older adults (OAs) with drug therapy lack pre-professional education about that practice. Concurrently, there is little research available about how RNs learn about drug therapy for OAs. Using a qualitative method, this thesis explores hospital RNs’ insights about their knowledge about drug therapy for OAs, their associated learning needs and strategies, and contextual influences on their learning. The findings illuminated RNs’ extensive knowledge, their learning needs and varied learning strategies, and constraints and facilitators of their learning. Drug therapy for OAs is a complex activity. RNs play a pivotal role in that care and have ample knowledge. RNs’ learning is holistic, ongoing, mostly informal, and reflective of many adult-learning theories. By learning, RNs build and transform their repertoires of knowledge to stay current with the quickly changing landscapes of health care, gerontological know-how, and drugs and drug practices. As a result, sometimes RNs protect not only OAs but also other hospital stakeholders from the negative effects of uninformed practice. Nurse educators should teach students about drug therapy for OAs and broaden their own views about RNs’ knowledge and learning strategies for that care. Nurse leaders should maximize chances for RNs to learn and prepare them to influence other stakeholders in ways that support learning. Hospital administrators and other stakeholders should recognize RNs’ pivotal role in drug care and support their learning through organizational changes. Communities should design strategies that ease RNs’ learning. Policymakers should replace corporatism with innovations that champion learning. Researchers and RNs should collaborate on novel projects that bolster RNs’ learning.

Background: Human immunodeficiency virus (HIV) is a global problem and the total number of people living with HIV is approximately 34 million. Little is known about registered nurses’ experiences of caring for children with HIV/AIDS in South Africa.   Aim: The aim of the study was to describe registered nurses’ experiences of caring for children with HIV/AIDS in South Africa. Method: A qualitative research approach was used. Data was collected by interviews which were analyzed using content analysis. The interviews were conducted at a private hospital in Cape Town, South Africa. Results: The following ten topics were found; self-fulfillment, being supportive, being hopeful, being adaptable, being non-judgmental, helplessness, loneliness, sadness, stress and frustration. Conclusion: There is a constant balance between feelings of powerlessness and the ability of being mentally strong when caring for children with HIV/AIDS.   Keywords: HIV/AIDS, children, registered nurses’ experiences, South Africa

Research Doctorate - Doctor of Philosophy (PhD) / Registered nurses, while carrying out their professional roles, regularly encounter situations with ethical components. While there are research findings reporting the types of ethical challenges nurses face, their level of involvement in ethical decision-making, and reasoning processes used, how nurses actually deal with situations that challenge them personally has not been specifically explored. The purpose of this study was to investigate the psychosocial processes that can explain how registered nurses reason and make decisions when faced with ethical situations that challenge their personal values and belief systems. A grounded theory approach was used to conduct the study, allowing a substantive theory to be developed. Twenty-three nurses, currently working in metropolitan or regional areas in New South Wales, volunteered to participate in the study. Two methods of data collection were utilised, the first being semi-structured, in-depth interviews which were audio taped then transcribed. The second method used hypothetical vignettes with associated questions to which the participants were invited to anonymously return written responses. Data were managed by means of the computer program NVivo 2, while constant comparative analysis using open, axial and selective coding, as outlined by Strauss and Corbin (1998), was performed. The substantive theory which emerged from the data explains the processes used by nurses when they have to deal with ethical challenges to their personal values and beliefs. The basic psychosocial process (core category) of protecting client autonomy reveals a pattern of moral reasoning that gives priority to the client’s self-determined choices. This subsumes the key processes (subcategories) of: (1) being self-aware, (2) determining duties to other/s versus self, (3) engaging self as protector, and (4) restoring self from tension or anguish, which link to each other and to the core category to explain the various sub-processes used when protecting client autonomy is considered a priority. Findings in the study revealed that nurses who give primacy to client autonomy believe they should not impose their own preferred choices on to clients. Yet the emphasis on client autonomy is also paradoxical, since it may come at the cost of compromise and even denial of the nurses’ own autonomy and their deeply held values and beliefs. When they become aware that their personal values and beliefs are being challenged, they are at times prepared to compromise their own values or beliefs, yield to constraints, or put themselves at risk in order to protect the autonomy of clients. Such actions can leave nurses experiencing ethical tension or anguish for which they need to seek support. Opportunities to find appropriate support are not always available to them in the work environment. The findings in this study have important implications for both nurses and the nursing profession. The pattern of moral reasoning shows generosity and nurses’ commitment to their caring and advocacy roles. However, when nurses are regularly prepared to compromise their own values or beliefs because they give priority to protecting client autonomy, there is a risk they may be left with a sense of loss to their personal worth and in their ability to be moral agents. Further, in some situations it may occur out of complacency because they simply accept that it is the client’s choice, absolving the nurse of further moral responsibility. Appropriate support systems need to be available to nurses to help them deal with the consequences which may occur as a result of giving preference to clients’ choices, over their own.

Thesis (Ph. D.)--College of Saint Mary -- Omaha, 2008. / A dissertation submitted to the doctoral program of College of Saint Mary in partial fulfillment of the requirements for the degree of Doctorate in Education with an emphasis on Health Professions Education. Includes bibliographical references.

Critical illness is typically associated with a catabolic stress state in which patients commonly demonstrate a systemic inflammatory response that brings about changes in their body systems. Changes in the body systems make the critically ill dependent on mechanical ventilation and inotropic support for longer periods in order to survive. However, this inflammatory response can be attenuated by the timely introduction of nutritional support to provide energy and nutrients to diminish catabolism and promote anabolism. The result could be a decrease in the morbidity and mortality rates, as well as the financial burden on the patients, institutions and the state. Since registered nurses initiate and utilise feeding protocols to achieve target goals, there is a strong need for nurse-initiated feeding protocols. These protocols should be coupled with a comprehensive nurse-directed nutritional educational intervention that will focus on their safe and effective implementation. This focus on nursing nutrition education represents a major shift away from traditional education which has focused on dietitians and physicians. Evidence suggests that incorporating guideline recommendations into nurse-initiated protocols for starting and advancing enteral feedings is an effective strategy to improve the delivery of nutritional support. The study was aimed at exploring the provision of nutritional support to critically ill hospitalised patients by registered nurses to identify and describe possible gaps in the practice, through determining the potential relationship between the provision of nutritional support and characteristics of its providers. A quantitative, descriptive correlational study was undertaken. Seventy registered nurses working in neonatal/paediatric and adult critical care units in two public and three private hospitals in East London in the Eastern Cape participated in the study. The sample also included public critical care students. The results showed that registered nurses in private hospitals have more knowledge about the importance of nutritional support than their public hospital counterparts and students. The mean score was on the question was 80.3% with the highest score of 91% which was for the private hospital nurses, followed by 77.2% for public and 71.4% for students. Again, the mean score for knowledge on timing of initiating nutritional support was 48%, the highest score being 69.4% for students followed by private hospital nurses with 49.6%. Close to 63% (n = 44) of these nurses were either unsure about the availability of nutritional protocols or clearly attested to their non-availability. This is seen as an issue of concern because a protocol is meant to be a standard document with which all members of the ICU should be familiar. It is meant to guide and facilitate the manner of working in the unit. While facilitation of maintenance of nutritional support to patients is the responsibility of registered nurses, according to Regulation 2598(1984) section 45 (1) (q) of the South African Nursing Council, 68% (n = 48) of the respondents felt that this was in the practising scope of doctors and dietitians. The study concluded that the nurses are knowledgeable about the importance of nutritional support but knowledge gaps have been identified as far as the timing of initiating nutritional support is concerned. Some attested to unavailability of standard guidelines that are tailored into protocols guiding the provision of nutritional support by registered nurses in the critical care units. Nutrition should be prioritised as an important therapy for improving the outcomes of critically ill patients. Nurses need to analyse its provision, identify barriers to nutritional strategies and engage in nutritional education to empower themselves regarding the practice. Most importantly, there is a need for nurse-initiated nutritional protocols that are tailored from the broad nutritional guidelines and aligned with the local context and ways of practising. Nutritional support should be included as a key component of the curriculum in academic programmes that specialise in critical care nursing.

Bakgrund: Under tidigt 1990-tal drabbades Uganda av en HIV epidemi och var ett av dehårdast drabbade länderna söder om Sahara. Mellan 1990 - 2010, sjönk antalet Hivinfekteradepersoner från 18 till 6 %, till följd av ökad medvetenhet och mer säkert sex. Idag har Ugandaen av de högsta nivåerna av nyligen infekterade människor. Unga vuxna i åldrarna 15–24 år ärden grupp med högst risk att bli infekterade med HIV i Uganda. Det är vanligt attsjuksköterskor runt om i världen har rådgivande samtal. Även om hur rådgivning utförs kanvariera så är målet att minska riskbeteenden och motivera till att ha säkert sex.Syfte: Syftet med den här kandidatuppsatsen är att beskriva legitimerade sjuksköterskorserfarenheter av att ha rådgivande samtal med unga vuxna om HIV.Metod: En kvalitativ studie med semistrukturerade intervjuer på Lubaga sjukhus i Kampala,Uganda. 12 legitimerade sjuksköterskor intervjuades från tre olika avdelningar, materialettranskriberades och analyserades med en induktiv kvalitativ analysmetod, inspirerat avBurnard.Resultat: Fyra teman identifierades: en komplex miljö att ha rådgivande samtal med ungavuxna, unga vuxnas försök till självhjälp, Socioekonomisk utsatthet kopplat till HIV och ungavuxnas känslor relaterat till HIV. Ur dessa fyra teman upptäcktes 11 kategorier.Konklusion: Legitimerade sjuksköterskor upplever att det finns både hjälpande och stjälpandefaktorer som påverkar deras rådgivande Sammanfattningsvis så orsakar unga vuxnas rädslaför HIV, stigma relaterat till HIV och socioekonomiska förhållanden hindrar för samtal ochhur resursfulla unga vuxna är underlättar för rådgivande samtal. / Background: In the early 1990’s Uganda suffered from a HIV-epidemic and was one of themost effected countries in Sub-Sahara Africa. However, from 1990 - 2010, the level of HIVinfected people dropped from 18 to 6 % due to awareness raising and less high-risk behaviorssuch as unsafe sex. Today, Uganda has one of the highest levels of newly infected people.Young adults in the ages 15 - 24 years old are the most exposed group to get infected withHIV in Uganda. Counseling is a common task in nursing all around the world. Although thespecifics of how counseling is performed could differ, the main goal is to reduce the numberof high-risk behaviors and motivate the person to engage in safe sex, including sexual contactand use of condoms.Aim: The purpose of this study is to describe nurses’ experiences of counseling young adultsabout HIV.Method: A qualitative study with semi-structured interviews at Lubaga hospital in Kampala,Uganda. 12 registered nurses were interviewed from three wards at the hospital, the materialwas transcript and then analyzed with an inductive qualitative content analysis approachinspired by Burnard.Results: Four themes were identified: a complex environment to counsel young adults in,young adult’s efforts to self-care, socio-economic challenges linked to HIV and young adult’sfeelings associated with HIV. Moreover, 11 categories emerged through the themes.Conclusion: Registered nurses experience both factors that burdens and facilitate counseling.In conclusion, young adults fear of HIV, HIV-related stigma and socioeconomic factors posean obstacle when counseling young adults about HIV and young adults’ resources makescounseling easier.

Introduction: In the rapidly growing and evolving healthcare systems, Continuing Professional Development (CPD) has become essential for nurses to update their knowledge and skills, achieve and maintain their competencies, and elevate their clinical functioning with the aim of providing a high standard quality of healthcare to the public as the ultimate goal. Moreover, CPD has been mandated as a licensure renewal requirement for nurses in the UAE. However, despite its importance, there is a lack of empirical studies about the effectiveness of CPD programmes in the UAE. Aim: This study explores and investigates the perspective of registered nurses (RNs), regarding the effectiveness of the Continuing Professional Development (CPD) in the UAE in order to develop CPD strategies. Research design: Advanced Multiphase Mixed Method. Methods: The study constitutes three phases: • Phase one is qualitative; data was collected through four exploratory focus group interviews with RNs from all geographical areas in Abu Dhabi. They were selected through expert purposive sampling strategy from the same selected facilities as per the sampling of phase two. Data was analysed by “Thematic Analysis Style” using QSR NVivo software. • Phase two is quantitative descriptive; a modified questionnaire Q-PDN (Questionnaire-Professional Development for Nurses) was used to collect data from RNs. The sample was selected from a population of 18,910 RNs through probability stratified sampling, utilising the probability proportional to size (PPS) sampling due to the unequal size of the units. The sample size was 400 with a 655 response rate. Data was analysed by using the SPSS software yielding descriptive and inferential statistics. • Phase three is qualitative Appreciative Inquiry where meeting(s) were conducted with nursing “key players” in the Abu Dhabi, adopting the 5-D Cycle. The nursing ‘key players” represent the role of the nursing leaders in Abu Dhabi. Data was analysed using simultaneous targeted participatory thematic analysis. Results and conclusion: The CPD strategic recommendations were developed based on the RNs’ needs and perceptions and aligned with the benchmarked international CPD practices. The main consideration was the evidence of an existing relationship between the perceived influencing factors and the RNs’ participation in CPD. The study has numerous implications towards developing CPD strategies and policies, contribution to body of knowledge, and benefiting the nurses. Keywords: Continuing Professional Development, Strategy Development, Nursing / Thesis (PhD)--University of Pretoria, 2020. / Nursing Science / PhD (Nursing) / Unrestricted