The problem of this investigation was threefold: ascertaining differences in degrees of burnout as a function of registered nurses' educational tracks in Texas, ascertaining degrees of burnout for registered nurses as a function of job tenure, and examining certain demographic variables and their relationships with registered nurses' educational tracks. Nurses were classified by educational track (diploma, associate degree, baccalaureate degree) and employment (full time, part time, not active). The instrument employed comprised the Pines and Aronson Tedium-Burnout Diagnosis, for which reliability and validity were previously established, and a demographic questionnaire.

The purpose of this study was to describe Registered Nurses’ attitudes toward death and their perspectives on education and training related to death and end-of-life patient care. A complementary goal was to determine whether nurses’ attitudes and perspectives are associated with background variables. The three attitudes toward death included anxiety, escape, and neutral attitudes. The background variables of the nurses included formal educational level, age, gender, ethnicity, years of nursing practice, state of residence, and area of nursing practice. A survey including four sections was used for data collection. The first section of the survey utilized an established 32-item survey based on the Death Attitude Profile Revised survey developed by Wong, Reker, and Gesser in 1994. The questions asked how nurses felt about the topic of death. The second section of the survey was about the extent of palliative care education and training, while the third section was concerned with the demographics of the respondents. Part four of the survey included two open-ended questions regarding attitudes toward death and how prepared respondents felt in meeting their patients’ end-of-life needs. The survey was sent to state nurses’ associations across the United States in 2015. Survey Monkey was the link for the survey and it was opened for a three-week period. The original responses totaled 248 participants. Responses with any missing values were excluded. The final dataset included 167 total responses. Data was analyzed using descriptive statistics and regression analysis to determine the association between the variables of interest. The results of the study were most significant in relation to anxiety toward death. Nurses who were more experienced on the job, female, and with more formal education had lower anxiety levels, as did nurses with a higher confidence level in dealing with death. For the neutral attitudes, the best predictor was the rating of the nurses’ end-of-life preparation. The best predictor of the escape attitude was years of nursing experience. The results supported the need for college level end-of-life education and the significance role of nursing experience in relation to less anxiety towards death. The surprising result was that post-college end-of-life education actually increased the anxiety attitude toward death. More research is needed to ascertain if these results could be replicated. There is a need to determine what type of post-collegiate education would decrease death anxiety in nurses.

Registered Nurse (RN) turnover is costly for hospitals and healthcare facilities. The problem that healthcare administrators face today is their inability to retain nurses for long periods of time and the detrimental effects that come from the lack of retention. The purpose of this quantitative secondary data analysis is to explore the relationship between the retention of RNs and the geographic regions in which they work. The theoretical framework for this study was Barney's concept of viewing people as resources. Deidentified secondary data of RNs was utilized from the Healthforce Center at the University of California San Francisco to probe differences in retention rates between full-time and part-time RNs and the differences in retention rates between new graduate and specialty RNs in California geographic regions. The data was analyzed through descriptive and inferential statistical techniques to perform a t test of independent means. As a result, it was determined that there was no significance in geographic regions in California influencing the retention rates of full and part-time RNs neither was there a significant finding that geographic regions in California influence the retention rates of new graduate RNs or specialty nurses. It was concluded that the retention of RNs is determined by how well they are maintained and managed. A recommendation would be to investigate retention strategies that create longevity among RNs. This study can contribute to positive social change by having a cohesiveness that builds trust and creates a better work environment and positive outcomes for healthcare facilities which will reduce overall cost.

This study examined the effectiveness of a training program on the ability of registered nurse students to write complete nursing diagnoses. A comparison group was used as a control. There were 47 participants in the training group and 51 participants in the comparison group who received no training. Five hypotheses were used to examine the (1) complete nursing diagnoses, (2) labels, (3) clarifiers, (4) etiologies, and (5) mislabeled medical diagnoses or clinical problems as nursing diagnoses. As a pretest and posttest, participants in both groups viewed a video tape of a nursing situation and were asked to write nursing diagnoses. The training group received nine clock hours of classroom instruction on the nursing process of which three hours were on nursing diagnosis with a focus on the inclusion of label, clarifier, and etiology necessary for a complete nursing diagnosis. In the clinical component of the educational program the training group wrote nursing diagnoses as part of the nursing process. It was assumed that the comparison group did not receive comparable education. The mean difference of proportions between the pretest and posttest was computed for each group on the item tested by the hypotheses and for the difference between the two groups. Three of the five hypotheses tested in the study were accepted. The training group did have a significant increase in the average (mean) difference of proportions in the number of complete nursing diagnoses and etiologies and a significant decrease in the number of mislabeled nursing diagnoses. There was no significant difference in the number of labels and clarifiers. The training group did show a percentage increase in the number of labels and clarifiers written. There was little or no change in the comparison group over the time period of the study.

Bakgrund: Munhälsan har betydelse för den allmänna hälsan och välbefinnandet. Munhälsoproblem ökar ofta med stigande ålder, men trots att detta nedprioriteras munvården i omvårdnaden av äldre personer. Nedsatt kognition och funktionsförmåga försämrar äldre personers möjlighet att självständigt sköta sin munhälsa.  Sjuksköterskor är ansvariga för omvårdnaden, men upplever sin roll i omvårdnaden av personer med nedsatt munhälsa som oklar. Syftet: Syftet med den systematiska litteraturstudien var att sammanställa befintlig litteratur om sjuksköterskors erfarenheter av munhälsa hos äldre personer. Metod: En systematisk litteraturstudie med kvalitativ ansats baserad på nio vetenskapliga artiklar inhämtade från CINHAL och PubMed genomfördes. Statens beredning för medicinsk och social utvärdering (SBU) granskningsmall användes för relevans- och kvalitetsbedömning. För analysen av artiklarnas resultat användes metoden kvalitativ innehållsanalys av Forsberg och Wengström. Resultat: Resultatet presenteras i tre teman: munhälsa och munvård – viktigt men eftersatt; Interaktion med patienterna; avsaknad av riktlinjer, samverkan och dokumentation. Slutsats: Sjuksköterskor prioriterar inte munvård hos äldre personer. Orsaken till detta är brist på kunskap och färdigheter i ämnet, oklara riktlinjer och att de inte har en aktiv roll i munvårdsarbetet. / Background: Oral health has an impact on general health and wellbeing. Oral health problems are often increasing with aging and although this is well known oral care is still not prioritized in nursing among elderly. Cognitive and physical impairment deteriorates older persons ability to take care of their oral health independently. Registered nurses are responsible for the nursing care but experience their role in nursing among elderly with poor oral health to be unclear.Aim: The aim of the systematic review was to describe registered nurses´ experiences in oral health among elderly.Method: A systematic review with a qualitative approach based on nine scientific articles obtained from databases CINAHL och PubMed. The review templet of the Swedish agency for medical and social evaluation was used for the assessment of relevance and quality. Qualitative content analysis by Forsberg and Wengström was used for the analysis of the result of the articles. Results: The results are presented in three themes: oral health and oral care – important but neglected; interaction with patients; lack of guidelines, teamwork and documentation.Conclusion: Registered Nurses don´t prioritize oral care among elderly. The reason for this is lack of knowledge and skills in the subject, unclear policies and that they don´t take an active part of oral care nursing.

Background: Death can be viewed and understood through different perspectives and occurs in different ways after different trajectories. Death can occur in the hospital setting where the registered nurse has a leading role in the nursing of dying patients. It is the registered nurses’ responsibility that the given care has dignity and is respectful of the patient’s integrity. Registered nurses need an awareness of the feelings they may experience when patients die and apply different coping strategies in order to cope with the pressure that encounters with death can result in. Purpose: Was to describe registered nurses’ experiences of caring for patients who die in hospitals. Method: This literature review used scientific articles with qualitative method that were analysed in five steps according to Friberg (2017a) and was formed with an inductive approach. Result: After analysis of 12 scientific articles two main categories were presented: Emotional impact and The importance of personal and professional development with a total of five subcategories. Conclusion: Registered nurses experienced difficulties and challenges when caring for dying patients in the hospital setting and experienced emotional and professional effects as well as effects on their everyday life. Limitations within oneself and outer circumstances was perceived to limit the registered nurses from providing good care. Coping strategies could be applied in order to cope with these difficulties. / Bakgrund: Döden kan ses och förstås genom olika perspektiv och inträffar på olika sätt efter varierande förlopp. Dödsfall kan inträffa på sjukhus där sjuksköterskor har en ledande roll i omvårdnaden av patienter som avlider. Sjuksköterskor ansvarar för att given omvårdnad sker med värdighet och att patienters integritet respekteras. Sjuksköterskor behöver vara uppmärksamma på de egna känslor som kan uppkomma vid patienters dödsfall och tillämpa olika copingstrategier för att kunna hantera den belastning som möten med döden kan innebära. Syfte: Var att beskriva sjuksköterskors upplevelser av att vårda patienter som avlider på sjukhus. Metod: I litteraturöversikten användes vetenskapliga artiklar av kvalitativ metod som analyserades i fem steg enligt Friberg (2017a) och utformades med ett induktivt förhållningssätt. Resultat: Efter analys av 12 vetenskapliga artiklar presenterades två huvudkategorier: Emotionell påverkan och Betydelsen av personlig och professionell utveckling med totalt fem subkategorier. Slutsats: Sjuksköterskor upplevde svårigheter och utmaningar kring att vårda patienter som avlider på sjukhus och upplevde känslomässig, vardaglig och professionell påverkan. Inre begränsningar och yttre omständigheter upplevdes hindra sjuksköterskor från att ge god vård till patienter som avlider. Sjuksköterskor kunde tillämpa olika copingstrategier för att kunna hantera de svåra situationerna.

Competency-based nurse orientation programs focus on the new nursing graduate and experienced nurse employees' ability to perform skills necessary in a new work setting. The purpose of this project was to develop a learner-focused and competency-based orientation program for new nursing employees at a large urban hospital to enhance patient safety and nurse retention. The Johns Hopkins nursing evidence-based practice model and guideline were used in the selection of articles with higher levels of evidence and research quality for the critical appraisal of literature in support of the program development. The best practices for nursing orientation content and delivery for positive effects on hospital finances, nurse turnover rates, and patient safety were the focus of the literature review. Benner's model of 5 levels of skill development was the theoretical framework for advancing skills of nurses who enter the orientation program with different expertise and skill sets. Nurse orientation materials and processes, comprising a collaborative team approach to orientation and a guideline for preceptor selection, were developed as the essential components for successful orientation at the project hospital. A nursing orientation based on the evidence may provide an infrastructure and operational process for the organization in developing the competencies of all levels of nurses, including experienced nurses transitioning to new units or duties. The social change resulting from the project will be a supportive and seamless transition of nurses into the new practice role and work environment. When implemented, this project is anticipated to increase nurse satisfaction, improve quality of health care delivery, decrease anxiety related to the new nursing role, and improve collegiality among all levels of nurses.

Philosophiae Doctor - PhD / The purpose of this research study is to develop and describe a model to enhance the empowerment professional nurses to promote the recovery of people who have been diagnosed with depression. Depression is a prevalent psychiatric disorder that despite its increase worldwide, often goes undetected or inadequately treated. The biomedical model's reductionist and dualistic approach proves to be inadequate for nursing practice to address depression and calls for the examination of a multifaceted holistic approach. A multifaceted holistic approach views disease as having multiple causes that are amenable to multiple therapeutic interventions. Despite research evidence about the effectiveness of such an approach, an in-dept literature search did not reveal the availability of such a model to enhance the empowerment of professional nurses to promote the recovery of people who have been diagnosed with depression. The research question that emerged was: • How can professional nurses in the Western Cape be empowered to promote the recovery of people who have been diagnosed with depression? The assumption is that this question was necessary to address. To realise the purpose of this research study, the following objectives were formulated: • To explore and describe the self reported attributes needed by professional nurses to promote the recovery of people who have been diagnosed with depression. • To explore and describe how these self reported attributes can be facilitated in the work environment. • To propose a model to enhance the empowerment of professional nurses to promote the recovery of people who have been diagnosed with depression. • To develop guidelines for the operationalisation of the model. The theoretical framework for this research study was adopted from the Critical Social Theory. The research design and method used was qualitative, explorative, descriptive and contextual in nature. The research was done in two phases. In phase one the researcher did semi- structured interviews with a purposive and convenient sample of fourteen (14) professional nurses who were working in the Cape Town Metropolitan area and the West Coast.

Bakgrund: I december 2019 började den nya sjukdomen COVID-19 spridas i världen. Människor har påverkats direkt och indirekt av pandemin och sjuksköterskor har en viktig roll på frontlinjen av pandemin. Syfte: Syftet med studien var att beskriva sjuksköterskors erfarenheter av vården av patienter med COVID-19. Metod: En litteraturstudie genomfördes, baserad på nio empiriska artiklar med kvalitativ metod från databaserna CINAHL och PubMed. Artiklarna kvalitetsgranskades och analyserades med en metod från Friberg. Resultat: Vid analysen framtogs tre kategorier, Förändringar inom vården, Konsekvenser för kropp och själ och Strävan efter att ge god vård samt tillhörande nio subkategorier. Sjuksköterskors hälsa påverkades på och utanför arbetet. De behövde arbeta i en omväxlande och pressad situation där informationsläget var osäkert. Arbetet på frontlinjen försvårades och bidrog till bristande patientsäkerhet. Konklusion: Det var påfrestande för sjuksköterskor att arbeta på frontlinjen och möjligheten att ge god vård påverkades. Det behövs en allsidig grundläggande pandemiberedskap, tillräckligt med skyddsutrustning och utbildning för att vara bättre förberedd. Utöver det krävs olika typer av stöd för att minska den negativa påverkan hos sjuksköterskor. / Background: In December 2019, the new disease COVID-19 began to spread around the world. People have been directly and indirectly affected by the pandemic and registered nurses had an important role on the frontlines of the pandemic. Aim: The aim of the study was to describe registered nurses’ experiences of the care for patients with COVID-19. Methods: A literature review was conducted based on nine empirical articles with qualitative methods from the databases CINAHL and PubMed. The quality of the articles was examined and the articles were analyzed with a method from Friberg. Results: During the analysis three categories were identified, Changes in health care, Consequences for the body and soul and The effort to provide good care with nine associated subcategories. The registered nurses’ health was affected at and outside of work. They had to work in various and pressured situations where the state of the information was uncertain. The work on the frontline became more difficult and contributed to a lack of patient safety. Conclusion: It was stressful for registered nurses to work on the frontlines and the ability to provide good care was affected. Versatile and fundamental pandemic preparedness, enough personal protective equipment and education is needed to be better prepared. Besides that, registered nurses need to be offered different types of support to decrease the negative impact on them.

Den vanligaste orsaken till att patienter kommer till akutmottagningarna är på grund av smärta. De största svårigheterna som sjuksköterskor upplever på akutmottagningen är att patienterna erhåller otillräcklig smärtbedömning och smärtlindring. Patienter som är i behov av smärtlindring erhåller inte detta i samma omfattning om de har tolkbehov, vilket kan bero på kommunikationshinder, språkförbistring, oklar vakenhetsgrad, intoxikation, demens eller svårigheter i att beskriva smärtans intensitet, duration och placering. Det ställer krav på att sjuksköterskorna i kommunikationen med dessa patienter är lyhörda och uppmärksamma på patienternas uttryck och hur de beskriver sin smärta.Syftet var att undersöka vilka strategier som sjuksköterskor på akutmottagningar nyttjar vid smärtbedömning av patienter med nedsatt kommunikationsförmåga. Metoden som användes var en kvalitativ, empirisk studie där fyra fokusgruppsintervjuer användes för insamling av datamaterial. Totalt 18 sjuksköterskor från 3 akutmottagningar deltog. Fokusgruppsintervjuerna ljudinspelades, transkriberades och därefter analyserades materialet med hjälp av en kvalitativ innehållsanalys utifrån en induktiv ansats.Resultat presenteras i tre huvudkategorier: Subjektiv värdering, Objektiv triagering och Explicera samt nio underkategorier. Det framkom olika strategier som sjuksköterskor används vid smärtbedömning av patienter med nedsatt kommunikationsförmåga. Beroende på vilken nedsatt kommunikationsförmåga patienter har, krävs det olika tillvägagångssätt för att omhänderta dem på ett optimalt sätt på akutmottagningen. Slutsats var att användandet av specifika anpassade smärtskattningsskalor till patienter med nedsatt kommunikationsförmåga inte används utan andra strategier nyttjas istället. Genom att bruka enskilda eller flera strategier i samband med smärtbedömning kan det generera en förbättrad omvårdnad för patienterna. / Pain is the most common complaint by patients at the emergency department. Nurses experience that the biggest difficulties at the emergency department are patients inadequate pain assessment and pain relief. Patients that are in need of pain relief will not receive this in the same extent if they require interpretation which can derive from communication obstacles, language barriers, uncertain consciousness, intoxication, dementia or difficulties to describe the intensity, duration and localization of the pain. This sets tough requirement on nurses in their communication with these kinds of patients and demands them to be observant and responsive to the patient’s expressions and how they describe their pain.The aim was to examine what type of strategies nurses at emergency department use to assess pain in patients with impaired communication abilities.A qualitative empirical study was chosen as method and four focus group interviews was conducted to collect data. A total of eighteen registered nurses from three different emergency department participated. The focus groups interviews were recorded, transcribed and then analysed with a qualitative inductive analysis method.The result is presented in three main categories: Subjective assessment, Objective evaluation and Explicate followed by nine subcategories. Different strategies emerged that were used by nurses in assessing pain in patients with reduced communication abilities. Depending on what kind of communication impairment the patients have, different courses of action were implemented to take care of the patients in the most favourable way at the emergency department.The conclusion derived in that specific adapted pain assessment scales were not used for patients with impaired communication abilities but rather other strategies were used instead. By using individual or multiple strategies when assessing patients, it may procreate an improvement in the care of the patients.