Thesis (PhD)--University of South Australia, 1999

Thesis (Ph. D.)--University of Missouri--Columbia, 2002. / Typescript. Vita. Includes bibliographical references (leaves 131-142). Also available on the Internet.

This study explored the ways experienced mental health nurses working within a local acute mental health NHS Foundation and Teaching Hospital Trust felt about being unobtrusively observed in their everyday clinical practice. Participants were recruited from eight local units: four Community Mental Health Teams (CMHT), one Crisis Resolution Home Treatment Team (CRHT), one inpatient ward, one in-patient rehabilitation unit and an Assertive Outreach Team (AOT).

The Professional Nurse in Relation to Academic Nursing Education The increasing demands on the nurse’s competence in the society are reflected in laws and ordinances as well as in the transition of the nursing education to universities. The overall aim of this thesis was to illuminate, describe and understand nurses’ professional awareness in relation to academic nursing education. The longitudinal studies I and II of the thesis included novice nursing students (n= 164/163), senior students (n=123/124), and nurses three to five years after graduating (n=83/82). Study III of the thesis covered a nationally random selection of nurses graduated during four different years before and after the implementation of the academic education (n=289). Study IV focused on senior students (n=155). The data were collected by means of three questionnaires: open questions where the respondents were asked to describe their views of a good nurse and a bad nurse (I); a scale for assessing the professional self in relation to others (modified Nurse Self Description Form) (II); and finally, a questionnaire designed to asses the nurses’ (III) and the students’ (IV) attitudes to and awareness of research within nursing (as developed in study III). The data were analysed by means of content analysis (I) and parametric and non-parametric statistical methods (II, III, IV), and factor analysis (III). The result was that the characteristic of a good nurse ”to do good for others” emerged strongly and retained its dominant position throughout the education and beyond. ”To be competent and skilled” was also highly favoured and gained ground during and after the training. ”To have professional courage and pride” and ”to seek professional development” were considerably less prominent but increased slightly in importance over time (I). The professional self in relation to others in similar situations were generally rated as both strong among students and experienced nurses (II). Also in this respect there was an emphasis on the aspect of doing good for others. The professional self grew stronger over time in the areas of drive, objectivity, flexibility, ability to teach, ability to communicate and sociability, whereas the desire to contribute through research and knowledge mastery decreased over time (II). The process of developing into an experienced nurse, however, entailed increased awareness of the complexity of the nursing profession. The instruments for measuring attitudes to nursing research were validated through factor analysis, which generated seven factors termed ”research language,” ”need of research knowledge,” ”participation,” ”the profession,” ”meaningfulness,” ”study literature,” and ”developing–resources” (III). Nurses (III) as well as students (IV) expressed a positive attitude to nursing research and its application to the nursing profession. However, the nurses in particular stated that they seldom read scientific journals and seldom applied nursing research in their daily work. To sum up, the research in this thesis shows that students and nurses only to a moderate extent displayed the professional awareness that the academic nursing education aims for. The traditional image of a good nurse was the most clearly manifested form of awareness, whereas insufficient awareness was registered in areas related to own responsibility for research-based practice. The result indicates a need for further collaboration between the nursing education and the health care sector, as well as for academically highly qualified nurses as resource persons in nursing practice, to support quality development in nursing, and serve as role models for students. / Den professionella sjuksköterskan i relation till den akademiska sjuksköterskeutbildningen Kraven på en professionell sjuksköterska har ökat i samhället vilket synliggjorts genom olika lagar och författningar samt akademiseringen av sjuksköterskeutbildningen. Det övergripande syftet med avhandlingen var att belysa, beskriva och förstå sjuksköterskors professionella medvetenhet i relation till den akademiska sjuksköterskeutbildningen. Delstudie I och II, som var longitudinella, inkluderade sjuksköterskestudenter i början av utbildningen (n=164/163), i slutet av utbildningen (n=123/124) samt sjuksköterskor tre till fem år efter examen (n=83/82). Delstudie III genomfördes med ett nationellt slumpmässigt urval av sjuksköterskor (n=289) examinerade vid fyra olika tillfällen före och efter det att sjuksköterskeutbildningen blev akademiserad. Delstudie IV inkluderade sjuksköterskestudenter strax före examen (n=155). Data har insamlats med hjälp av tre frågeformulär: ett med öppna svar där deltagarna beskrev sin syn på en bra sjuksköterska (I); ett med en skala för bedömning av det professionella jaget i förhållande till andra (modifierad Nurse Self Description Form) (II); ett om sjuksköterskors (III) respektive studenters (IV) inställning till och medvetenhet om omvårdnadsforskning (utvecklades i delstudie III). Data analyserades med hjälp av innehållsanalys (I) och parametriska och icke parametriska statistiska metoder (II, III, IV) samt faktoranalys (III). Karaktäristiskt för en bra sjuksköterska var (I): ”att göra gott för andra”, vilket framträdde starkt och bibehölls till stora delar från nybörjarstudent till erfaren sjuksköterska; ”att vara kompetent och skicklig” framträdde också starkt samt ökade under och efter utbildningen; ”att vara modig och stolt i yrkesrollen” samt ”att sträva efter professionell utveckling” framkom i betydligt mindre grad men med en viss ökning över tid. Det professionella jaget i relation till andra i liknande situationer skattades generellt som starkt från nybörjarstudent till erfaren sjuksköterska (II). Även här fanns en betoning av att göra gott för andra. Det professionella jaget stärktes över tid inom arbetsförmåga, objektivitet, flexibilitet, undervisningsförmåga, kommunikationsförmåga och social förmåga medan det försvagades inom vilja att behärska kunskap och vilja att bidra till ny kunskap (II). Utvecklingen till erfaren sjuksköterska visade på en ökad medvetenhet om sjuksköterskeyrkets komplexitet. Instrumentutvecklingen för att skatta inställning till omvårdnadsforskning validerades genom faktoranalys som genererade sju faktorer benämnda ”forskningsspråket”, ”behov av forskningskunskap”, ”delaktighet”, ”professionen”, ”meningsfullhet”, ”studera litteratur” samt ”utveckling – resurs” (III). Såväl sjuksköterskor (III) som studenter (IV) angav en positiv attityd till omvårdnadsforskning och dess tillämpning i sjuksköterskans arbete. Däremot angav framför allt sjuksköterskorna att de i ringa grad läste vetenskapliga tidskrifter samt i ringa grad använde omvårdnadsforskning i det dagliga arbetet. Sammanfattningsvis framkom att studenter och sjuksköterskor endast delvis uppvisade en professionell medvetenhet relaterat till intentionerna i den akademiska sjuksköterskeutbildningen. Den medvetenhet som tydligast framkom kan relateras till den traditionella bilden av en bra sjuksköterska medan de områden som framträdde som bristfälliga kan relateras till de krav som ställs på ett professionellt arbete grundat på vetenskap och beprövad erfarenhet. Resultatet påvisar behovet av fortsatt samverkan mellan sjuksköterskeutbildningen och vårdverksamheten samt behovet av sjuksköterskor med högre akademisk utbildning som resurspersoner för utveckling av en forskningsbaserad patientvård. / <p>Vid disputationstillfället var delarbete 1, den professionella sjuksköterskan – i relation till den akademiska sjuksköterskeutbildningen, accepterat för publicering.</p>

<p>The Professional Nurse in Relation to Academic Nursing Education</p><p>The increasing demands on the nurse’s competence in the society are reflected in laws and ordinances as well as in the transition of the nursing education to universities. The overall aim of this thesis was to illuminate, describe and understand nurses’ professional awareness in relation to academic nursing education.</p><p>The longitudinal studies I and II of the thesis included novice nursing students (n= 164/163), senior students (n=123/124), and nurses three to five years after graduating (n=83/82). Study III of the thesis covered a nationally random selection of nurses graduated during four different years before and after the implementation of the academic education (n=289). Study IV focused on senior students (n=155). The data were collected by means of three questionnaires: open questions where the respondents were asked to describe their views of a good nurse and a bad nurse (I); a scale for assessing the professional self in relation to others (modified Nurse Self Description Form) (II); and finally, a questionnaire designed to asses the nurses’ (III) and the students’ (IV) attitudes to and awareness of research within nursing (as developed in study III). The data were analysed by means of content analysis (I) and parametric and non-parametric statistical methods (II, III, IV), and factor analysis (III).</p><p>The result was that the characteristic of a good nurse ”to do good for others” emerged strongly and retained its dominant position throughout the education and beyond. ”To be competent and skilled” was also highly favoured and gained ground during and after the training. ”To have professional courage and pride” and ”to seek professional development” were considerably less prominent but increased slightly in importance over time (I). The professional self in relation to others in similar situations were generally rated as both strong among students and experienced nurses (II). Also in this respect there was an emphasis on the aspect of doing good for others. The professional self grew stronger over time in the areas of drive, objectivity, flexibility, ability to teach, ability to communicate and sociability, whereas the desire to contribute through research and knowledge mastery decreased over time (II). The process of developing into an experienced nurse, however, entailed increased awareness of the complexity of the nursing profession. The instruments for measuring attitudes to nursing research were validated through factor analysis, which generated seven factors termed ”research language,” ”need of research knowledge,” ”participation,” ”the profession,” ”meaningfulness,” ”study literature,” and ”developing–resources” (III). Nurses (III) as well as students (IV) expressed a positive attitude to nursing research and its application to the nursing profession. However, the nurses in particular stated that they seldom read scientific journals and seldom applied nursing research in their daily work.</p><p>To sum up, the research in this thesis shows that students and nurses only to a moderate extent displayed the professional awareness that the academic nursing education aims for. The traditional image of a good nurse was the most clearly manifested form of awareness, whereas insufficient awareness was registered in areas related to own responsibility for research-based practice. The result indicates a need for further collaboration between the nursing education and the health care sector, as well as for academically highly qualified nurses as resource persons in nursing practice, to support quality development in nursing, and serve as role models for students.</p> / <p>Den professionella sjuksköterskan i relation till den akademiska sjuksköterskeutbildningen</p><p>Kraven på en professionell sjuksköterska har ökat i samhället vilket synliggjorts genom olika lagar och författningar samt akademiseringen av sjuksköterskeutbildningen. Det övergripande syftet med avhandlingen var att belysa, beskriva och förstå sjuksköterskors professionella medvetenhet i relation till den akademiska sjuksköterskeutbildningen.</p><p>Delstudie I och II, som var longitudinella, inkluderade sjuksköterskestudenter i början av utbildningen (n=164/163), i slutet av utbildningen (n=123/124) samt sjuksköterskor tre till fem år efter examen (n=83/82). Delstudie III genomfördes med ett nationellt slumpmässigt urval av sjuksköterskor (n=289) examinerade vid fyra olika tillfällen före och efter det att sjuksköterskeutbildningen blev akademiserad. Delstudie IV inkluderade sjuksköterskestudenter strax före examen (n=155). Data har insamlats med hjälp av tre frågeformulär: ett med öppna svar där deltagarna beskrev sin syn på en bra sjuksköterska (I); ett med en skala för bedömning av det professionella jaget i förhållande till andra (modifierad Nurse Self Description Form) (II); ett om sjuksköterskors (III) respektive studenters (IV) inställning till och medvetenhet om omvårdnadsforskning (utvecklades i delstudie III). Data analyserades med hjälp av innehållsanalys (I) och parametriska och icke parametriska statistiska metoder (II, III, IV) samt faktoranalys (III).</p><p>Karaktäristiskt för en bra sjuksköterska var (I): ”att göra gott för andra”, vilket framträdde starkt och bibehölls till stora delar från nybörjarstudent till erfaren sjuksköterska; ”att vara kompetent och skicklig” framträdde också starkt samt ökade under och efter utbildningen; ”att vara modig och stolt i yrkesrollen” samt ”att sträva efter professionell utveckling” framkom i betydligt mindre grad men med en viss ökning över tid. Det professionella jaget i relation till andra i liknande situationer skattades generellt som starkt från nybörjarstudent till erfaren sjuksköterska (II). Även här fanns en betoning av att göra gott för andra. Det professionella jaget stärktes över tid inom arbetsförmåga, objektivitet, flexibilitet, undervisningsförmåga, kommunikationsförmåga och social förmåga medan det försvagades inom vilja att behärska kunskap och vilja att bidra till ny kunskap (II). Utvecklingen till erfaren sjuksköterska visade på en ökad medvetenhet om sjuksköterskeyrkets komplexitet. Instrumentutvecklingen för att skatta inställning till omvårdnadsforskning validerades genom faktoranalys som genererade sju faktorer benämnda ”forskningsspråket”, ”behov av forskningskunskap”, ”delaktighet”, ”professionen”, ”meningsfullhet”, ”studera litteratur” samt ”utveckling – resurs” (III). Såväl sjuksköterskor (III) som studenter (IV) angav en positiv attityd till omvårdnadsforskning och dess tillämpning i sjuksköterskans arbete. Däremot angav framför allt sjuksköterskorna att de i ringa grad läste vetenskapliga tidskrifter samt i ringa grad använde omvårdnadsforskning i det dagliga arbetet.</p><p>Sammanfattningsvis framkom att studenter och sjuksköterskor endast delvis uppvisade en professionell medvetenhet relaterat till intentionerna i den akademiska sjuksköterskeutbildningen. Den medvetenhet som tydligast framkom kan relateras till den traditionella bilden av en bra sjuksköterska medan de områden som framträdde som bristfälliga kan relateras till de krav som ställs på ett professionellt arbete grundat på vetenskap och beprövad erfarenhet. Resultatet påvisar behovet av fortsatt samverkan mellan sjuksköterskeutbildningen och vårdverksamheten samt behovet av sjuksköterskor med högre akademisk utbildning som resurspersoner för utveckling av en forskningsbaserad patientvård.</p> / Vid disputationstillfället var delarbete 1, den professionella sjuksköterskan – i relation till den akademiska sjuksköterskeutbildningen, accepterat för publicering.

Globally the population is ageing and as a consequence people are living longer with multiple chronic conditions. A range of factors, including decreased lengths of hospital stay and a greater focus on community based care, has lead to an increasing acuity of patients admitted to acute care settings, many with complex care needs. To date, models of nursing care in acute settings have been configured to focus on acute, procedural care and do not meet the unique needs of the older person. In order to ensure optimal health outcomes of older hospitalised people, nursing care needs to be responsive to the priorities and needs of patients and their families. This study sought to collaboratively develop a model of nursing care with nurse clinicians to improve the care of older people in the acute care setting. Model development was driven by an action research framework, using evidence-based principles and a comprehensive needs assessment. A three phased, mixed method design was embedded within the overarching conceptual and philosophical framework of action research. The first phase of the study comprised a needs assessment and allowed appraisal of the needs of patients as perceived by patients, carer’s and nurses, this was performed using the Caring Activity Scale [CAS](1). Qualitative data and semi-structured interviews added depth to the survey data and qualified responses by confirming that patients thought that nurses did the best they could within a culture of busyness, while patients strived to maintain and sustain their own independence. Managing the discharge process and carer burden arose mainly from the carer semi-structured interviews only. Data revealed significant differences between patients, carer’s and nurses in relation to priority and satisfaction with care. Patients did not place a large importance on discharge care which contrasted with the focus of nursing initiatives. During the subsequent phases of the study a collaborative approach, using action research principles, was used to develop and implement a model of nursing care. A key feature of this model was the introduction of a team structure with a focus on patient centred care. Significant differences were identified in the pre model and post model patient groups in relation to satisfaction with care, with the post model group more satisfied than the pre group model group. Further, improvements in functional status and medication knowledge were demonstrated among patients cared for under the new model. This study has demonstrated that developing a model of care appropriate to the needs of patients, carer’s and nurses can be achieved through the use of action research principles. Study data illustrates the importance of collaboration, empowerment and change management principles in driving clinical improvement and patient satisfaction with care. The findings also underscore the importance of promoting and educating patients and carers as well as nurses about the importance of discharge planning to optimise post-discharge health outcomes. / Doctor of Philosophy (PhD)

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Thesis (M.Sc.) (Hons.) (Social Ecology) -- University of Western Sydney, Hawkesbury, 1993. / Bibliography : leaves 214-232.

Thesis (Ph.D.)--University of Western Sydney, 2007. / A thesis presented to the University of Western Sydney, College of Health and Science, School of Nursing, in fulfilment of the requirements for the degree of Doctor of Philosophy. Includes bibliographies.

Thesis (Ph. D.)--Illinois State University, 2001. / Title from title page screen, viewed May 2, 2006. Dissertation Committee: Patricia Klass (chair), Edward Hines, David Strand, Susan Winchip. Includes bibliographical references (leaves 78-82) and abstract. Also available in print.