Thesis (M.S.)--University of Michigan, 2001. / Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 2001. / Includes bibliographical references.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Science in Nursing Johannesburg, 2017 / The purpose of this study was to describe the role of specialist nurses in mechanical ventilation management. The intention of the study was also to make recommendations for clinical practice and education of intensive care nurses. The setting of the study was ten (n = 10) adult intensive care units of two public hospitals in the Gauteng province. Included were trauma ICUs, cardiothoracic ICU, coronary care ICUs, major burns ICU, major injuries ICU, neurosurgery ICU and multidisciplinary ICUs. A non-experimental, descriptive, quantitative and cross-sectional survey design was used to describe the specialist nurses role in ventilation management. The final sample comprised 110 (out of 165) respondents, which yielded a response rate of 66.6% for the study. Data were collected from specialist intensive care nurses using a validated questionnaire developed by Rose et al. (2011). Data was analysed using descriptive (frequencies, means and standard deviation) and comparative statistical tests using t-tests and Chi-square analysis. Testing was done at the 0.05 level of significance. Of the 165 surveys distributed, 110 were returned (response rate 66.6%). Ninety-seven percent stated that a 1:1 ratio was used for patients receiving mechanical ventilation. Eighty-nine percent reported ventilation education for nurses was provided during ICU orientation, and 86.4% indicated ICUs provided opportunities for on-going ventilation education. Eighty-six percent of nurses reported that they had not worked in ICUs with automated weaning modes. Fifty-nine percent stated that weaning protocols were present in ICUs, and 56.4% reported the presence of protocols for weaning failure. Most nurses agreed that nurses and doctors collaborated in key ventilation decisions, but not when decisions to extubate and initial ventilation settings are made. This study showed a marginal (2%) number of nursing autonomous input made in key ventilator decisions. Seventy percent of nurses in this study agreed that responsibility for ventilation decisions lies at the level of senior registrars and above, and in their absence, only senior nurses (>80%) were perceived to be responsible for key ventilator decisions. Regarding independent titrations of ventilator settings, without medical consultation, findings showed that nurses in this study reported a frequency of >50% of the time for titration of respiratory rate, tidal volume, decreasing pressure support, increasing pressure support, titration of inspiratory pressure and ventilation mode changes. The self-perceived nursing autonomy and influence in decision making revealed a median score of 7 out of 10 points, respectively. Nurses with higher levels of autonomy, influence in decision making and years of experience scores, frequently (>50% of the time) made independent changes to ventilation settings (p<0.05). Conversely, nurses with fewer years of experience scores, infrequently (<50% of the time) made independent changes to ventilation settings without first checking with the doctor. The study concludes that nurses to re-evaluate their role in ventilation management and focus on key ventilation settings, nurses could strengthen their contribution in the collaboration of key ventilator settings. Recommendations are made for clinical practice and education of specialist nurses. / MT2018

The aim of this study was to determine the knowledge of critical care nurses regarding forensic and liability issues in the critical care environment in order to design an education programme on the topic. A quantitative, descriptive, contextual research design was used and convenience sampling implemented. A survey, using a questionnaire as measuring instrument, was conducted among critical care nurses in selected private hospitals in South Africa. The response rate was 85%. Validity and reliability of the research was ensured. The total average percentage achieved by the group of 171 respondents was 38.46%, which was 21.54% below the set competency indicator of 60%. Only nine respondents achieved a percentage of or above 60%. Results proved that the respondents required intensive training on the topic. The outline of an education programme to address knowledge deficiencies regarding forensic and liability issues in the critical care environment was presented in PowerPoint presentation format. / Dissertation (MCur (Clinical))--University of Pretoria, 2007. / Nursing Science / MCur / unrestricted

The purpose of this thesis was threefold – First to investigate the emergence from the existing health system of nurse practitioners as a new occupation. Second to make sense of how nurse practitioners developed as primary care providers in the province of Ontario. Third to understand the nature and development of the intra-professional relationship between primary care nurse practitioners and physicians in local practice settings. I used a case study approach, with both historical (document review) and empirical (ethnography and interview) components. The empirical data was analyzed from an interpretive perspective using thematic analysis. A number of theoretical perspectives were drawn on, including Kingdon’s Agendas, Alternatives and Public Policy model, Abbott’s Occupational Jurisdiction model, Van de Ven et al’s Innovation Journey model, and Closure Theory. The study makes 3 contributions to new knowledge. First it documents the unfolding of events and actions over time, and thus serves as a historical summary. Second it adds an analysis of the case of nurse practitioners as an emergent occupation to the existing body of sociological analyses of professions. Third, it provides insight into how nurse practitioner - physician relationships are impacted at the local level because nurse practitioners are obligated to develop a relationship with a physician in order to be able to deliver comprehensive primary care services. The empirical component of the thesis analyzes and describes the nature of this relationship at a practice level. It also describes the use of ‘workarounds’ to bypass legislated restrictions in nurse practitioners’ scope of practice. It analyzes how structural differences in the manner of regulation, payment, and employment status between nurse practitioners and family physicians contribute to different styles of practice and perpetuate the hierarchical relationships between nurses and physicians. This knowledge has potential generalization to other emerging occupations, such as physician assistants and paramedics.

Thesis--University of Minnesota. / Photocopy of typescript. Ann Arbor, Mich. : University Microfilms International, 1977. -- 21 cm. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves [119]-125).

The formalized nurse practitioner (NP) role in British Columbia is relatively new with the majority of roles implemented in primary care. The majority of primary care is delivered by physicians using the fee-for-service model. There is a shortage of general practitioners (GP) and difficulties with recruitment and retention, particularly in rural and remote locations. The uptake of the primary care NP role has been slow with challenges in understanding the extent of its contributions. This study was to identify the impacts and outcomes associated with the NP role in collaborative primary care practice. Multiple case studies where NPs were embedded into rural fee-for-service practices were undertaken to determine the outcomes at the practitioner, practice, community, and health services levels. Interviews, documents, and before and after data, were utilized to identify changes in practise, access, and acute care service utilization. The results showed that NPs affected how care was delivered, particularly through the additional time afforded each patient visit, the development of a team approach with interprofessional collaboration, and a change in style of practise from solo to group practise. This resulted in improved physician job satisfaction. Patient access to the practice improved with increased availability of appointments and practice staff experienced improved workplace relationships and satisfaction. At the community level, access to primary care improved for harder to serve populations and new linkages developed between the practice and their community. The acute care services experienced a statistically significant decrease in emergency use and admissions to hospital (p= .000). The presence of the NP improved their physician colleagues desire to remain in their current work environment. This study identified the diversity of needs that can be addressed by the NP role; the importance of time to enhance patient care, and its associated benefits, especially in the fee-for-service model; the value of the NP’s role in the community; the acceptance of the clinical competence of NPs by their physician colleagues; the outcomes generated at the practice level in terms of organizational effectiveness and service provision; and substantiated the impact of the role in improving primary care access and reducing acute care utilization. / Graduate

Thesis--University of Minnesota. / Photocopy of typescript. Ann Arbor, Mich. : University Microfilms International, 1977. -- 21 cm. Includes bibliographical references (leaves [119]-125).

Background: There has been wide interest shown in the manner in which ethical dimensions in nursing practice are approached and addressed. As a result a number of ethical decision making models have been developed to tackle these problems. However, in this thesis it has been argued that the ethical dimensions of nursing practice are still not clearly understood and responded in Brunei. Design and method: This thesis describes a qualitative analysis into the Bruneian nurses’ perceptions of ethical dimensions in nursing practice. Drawing on constructivist grounded theory as a method of inquiry, twenty eight practicing and administrative nurses were individually interviewed. The nurses described how ethical dimensions were perceived in their practice, by means of the difficulties they are facing in the real world of nursing practice; how they have responded to these difficulties, and why they make such responses. Findings: The nurses described three ethical dimensions in their practice, namely ‘nurse at work’ which illustrates the ethical dimensions within the work environment; ‘nurse and doctor’ that elucidates the ethical dimensions in the nurse and doctor relationship and ‘nurse and patient’ which further examines ethical aspects in patient care. ‘Taking responsibility’ and ‘shifting responsibility to others’ were identified as approaches that the nurses took in responding to the ethical dimensions with the aim of avoiding the conflict and maintaining ward harmony. These responses provide new insights into how nurses’ response to ethical dimension in the ward settings where it puts strong emphasis on the nurses’ understanding of responsibility placed upon them as a professional nurse. ‘Negotiating ethical responsibility’ emerged as a core category within the data which illustrate that nurses’ responses to the ethical dimensions form a continuous process, involving constant consideration of the two types of responses. The core category described that ethical dimensions in the nurses’ practice were contextualised in the ‘ethical responsibility’ that is placed upon them within the nursing organisation. This thesis has expanded the current theoretical knowledge of ethical dimensions by elaborating on the concerns experienced in nursing practice and the responses individual nurses utilise to negotiate and discharge their ethical responsibilities at work. The study has also extended emphasis to the reasoning and responses that nurses are engaged in, whilst at the same time, negotiating ethical responsibility regarding the context in which they are placed during their working hours. This core category provides a number of possible implications for future research, nursing practice, education and policy, which would facilitate the exploration of ethical understanding for nurses in Brunei, and enable the provision of an ethical environment, so making ethical dimensions more transparent.

Thesis advisor: Susan . Kelly-Weeder / Thesis advisor: Judith . Shindul-Rothschild / BACKGROUND: The influenza virus is uniquely capable of creating pandemic illness in our population. The unpredictability of pandemics necessitates plans that will allow registered nurses to expand current capacity to care for ill individuals. It has been documented that personnel resources, often nurses, are a limiting factor in the health care system’s ability to care for large influxes of patients. Prior research has shown that an outbreak of an infectious disease, such as influenza, may lead to healthcare workers (HCWs) intentionally staying out of work. The potential increase in patient demand coupled with a decrease in the number of critical care nurses reporting to work will strain the ability of healthcare systems to meet the needs of patients. To date, research has not studied critical care nurses’ intentions to report to work during a pandemic influenza. PURPOSE: The purpose of this study was to examine the percent of critical care nurses that intend to report to work during an influenza pandemic. Covariates that may influence CCNs intention to report included personal, professional, and employer characteristics. Additionally, the impact of threat (perceived susceptibility to influenza and perceived severity of an influenza pandemic) and efficacy (perceived self-efficacy and perceived efficacy of the overall response) on intentions were analyzed. METHODS: A cross-sectional and descriptive design was utilized. Participants were recruited through the American Association of Critical Care Nurses. The final sample totaled 245 critical care nurses from across the United States. The participants completed an adapted version of the Johns Hopkins Public Health Infrastructure Response Survey Tool (JH~PHIRST) as well as personal demographics and information on their primary employer. Data were analyzed using bivariate methods and logistic regression. RESULTS: This study found that nearly 87% of CCNs intend to report during a pandemic flu, but this number drops to 78% if severity of the pandemic is factored in and further declines to 63% if the CCNs are asked to work extra. Perceived self-efficacy is a primary factor in explaining CCNs intend to report to work. CCNs with high perceived self-efficacy were6.221 (95% CI: 2.638-14.673) times more likely to report than those with low perceived self-efficacy. Perceived self-efficacy continues to significantly impact intentions to report to work when the severity of the pandemic is considered as well as when CCNs are asked to work extra. CCNs with high perceived self-efficacy are consistently, significantly more likely to intend to report than those with low perceived self-efficacy. CONCLUSION: Perceived self-efficacy is related to CCN intentions to report to work during a pandemic flu emergency. Future research should examine methods for increasing CCN perceived self-efficacy, including professional, educational and employment factors. / Thesis (PhD) — Boston College, 2020. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.