Thesis--University of Oklahoma. / Bibliography: leaves 36-40.

Nurses have a key role in keeping patients safe from medical errors because they work at the point of care where most errors occur. Nursing work at the intersection of patients and health care systems requires high levels of cognitive activity to anticipate potential problems and effectively respond to rapidly evolving and potentially harmful situations. The literature describes nursing work at the intersection of patient and health care system as well as barriers to providing safe patient care. However, little is known about the systems knowledge nurses use to negotiate the health care system on their patients’ behalf, or how this systems information is exchanged between nurses. Using the clinical microsystem as the conceptual framework, this qualitative descriptive investigation identified and described: 1) the components of systems knowledge needed by nurses, 2) how systems information is exchanged between nurses, and 3) systems information exchanged between staff nurses and travel nurses. Data were collected from a stratified maximum variation sample of 18 nurse leaders, staff nurses, and travel nurses working within a high-functioning neonatal intensive care nursery within a large academic medical center in New England. Data collection methods included participant observation, document review, individual interviews, and a focus group session. Data were analyzed through constant comparison for emerging themes and patterns. Findings were compared for commonalities and differences within and across groups. Three components of systems knowledge emerged: structural, operational, and relational. Systems information exchange occurred through direct and indirect means. Direct means included formal and informal mechanisms. The formal mechanism of orientation was identified by each participant. Informal mechanisms such as peer teaching, problem solving, and modeling behaviors were identified by participants from each of the three nurse groups. Travel nurses’ descriptions of the common themes focused on individual efficacy. Staff nurses focused on fostering smooth unit functioning. Nurse leaders described common themes from a perspective of unit development. Four overarching domains of systems information were exchanged between staff nurses and travel nurses: practice patterns; staffing patterns and roles; tips, tricks, tidbits, and techniques; and environmental elements. Communication emerged as a common theme across nurse groups and domains of systems information exchanged. These findings have implications for nursing orientation and staff development, continuous improvement at the local level, and curriculum development.

O presente estudo buscou identificar e analisar a inserção do psicólogo na assistência a mulheres em situação de violência, na rede de serviços específicos da região metropolitana de São Paulo. A partir da perspectiva da necessidade de ações multiprofissionais e intersetoriais no enfrentamento e atenção às situações de violência de gênero, estudou-se como a assistência psicológica é organizada em serviços de diversas vocações assistenciais e como suas ações são articuladas com outros profissionais e outros serviços. Para tanto, foram levantados documentos normativos para a assistência (Ministério da Saúde e Secretaria Especial de Políticas para as Mulheres) e foram analisadas informações obtidas em entrevistas com profissionais de 109 serviços paulistas de diversas vocações assistenciais (policial, jurídico, saúde, psicossocial, abrigos, orientações básicas). Os psicólogos estavam presentes e foram solicitados em todos os tipos de serviços, com menor participação nos serviços policiais e jurídicos. Tiveram inserção tanto na capacitação e supervisão dos profissionais em geral, como no atendimento direto à clientela dos serviços. Na assistência, notou-se grande diversidade de práticas - atividades clínicas, educativas, de orientação, mediação jurídica, sendo freqüente o ajustamento destas intervenções aos objetivos e cultura hierárquica de cada categoria de serviço. No geral, os psicólogos eram chamados para atuar no fortalecimento da auto-estima, retomada da vida sexual, reestruturação da vida, elaboração da situação de violência, elaboração e saída da condição de vitimização, promoção de autonomia e busca de transformação dos padrões de relacionamento familiar/ conjugal ou de gênero. Esses objetivos estavam postos para as equipes dos serviços em geral, especialmente o primeiro. Na formulação dos objetivos dos serviços e do formato das atividades propostas percebeu-se influência de concepções e propostas assistenciais do movimento de mulheres. Observou-se que nem sempre havia distinção clara entre o trabalho do psicólogo e de outros profissionais, principalmente com relação ao trabalho do assistente social, resultando em indefinição de funções e ações. Esta indefinição poderia representar dificuldades no diálogo entre profissionais e entre serviços e na articulação de ações multiprofissional, o que comprometeria a atenção integral às mulheres em situação de violência. Por outro lado, essa indefinição pareceu possibilitar inovações na prática assistencial. Observou-se também que a articulação multiprofissional foi buscada, em geral, no interior das equipes dos próprios serviços, mas em alguns os profissionais buscaram a complementariedade de suas ações pela articulação com serviços de outras vocações assistenciais. Levantou-se a necessidade de melhores definições sobre a assistência psicológica voltada para mulheres em situação de violência, em relação ao trabalho especifico do psicólogo na rede especializada e na rede geral de atenção de São Paulo. / The aim of the present investigation was to identify and analyse the insertion of psychologists working in the network of services for assisting women experiencing violence in the metropolitan region of Sao Paulo. The organization of psychological assistance in diverse assistance vocations and the integration of psychologists in work teams and in other services were studied from the perspective of women\'s needs, and multi-professional and intersectoral actions in facing the situations and providing care for gender-based violence. For that, normative documents on violence care were researched (Ministry of Health and Department of Special Policy for Women) and data from interviews with professionals working in 109 services with diverse assistance vocations in Sao Paulo (police, justice, health, psychosocial assistance, shelters, basic assistance) were analysed. Psychologists are present and their work is requested in all types of services, but with less participation in police and justice facilities. They work in the training and supervision of other professionals, as well as directly assisting the public. A great diversity of practices was observed in the assistance - clinical, educational, orientation and judicial mediation activities - with frequent adjustment of these interventions to the objectives and hierarchical culture within each category of service. In general, psychologists are called to work in the strengthening of self-esteem, the resuming of sexual life, restructuring life itself, understanding of the situation of violence, working-out of and escape from the victim condition, promotion of autonomy and search for transformation in family/ intimate relationships or gender patterns. These objectives are put to the general teams working in the services, especially the first one. The influence of conceptions and proposals from the women\'s movement is perceived in the formulation of the services\' objectives and in the way the activities are developed. The distinction between the psychologists\' work and the work of other professionals is not always clear, especially regarding social work. This results in imprecise functions and actions, which may represent difficulties in the dialogue between professionals and services, and in the integration of multi-professional actions, potentially compromising integral care to women experiencing violence. On the other hand, this impreciseness opens up space for innovations in assistance practices. Multi-professional integration is, in general, also sought within work teams of each service, but in some of them the professionals search for complementarity in their actions and integration with services with different assistance vocations. There is a need for better definitions on the specific role of psychologists in the assistance of women experiencing violence, considering the specific network and the broader assistance network in Sao Paulo.

O processo de aprendizagem escolar ocorre em um dinamismo evolutivo a partir do amadurecimento das áreas corticais superiores, o que permite a aquisição da leitura, escrita, interpretação, argumentação, cálculo e raciocínio lógico. Diversos fatores podem interferir negativamente nesse processo levando às dificuldades de aprendizagem. Essas interferências podem ser por fatores intrínsecos primários como as alterações neurobiológicas que ocorrem no Transtorno Específico de Aprendizagem e no Transtorno de Déficit de Atenção e Hiperatividade (TDAH), ou por fatores intrínsecos secundários como os problemas psicoemocionais e doenças crônicas, ou ainda por interferências extrínsecas como os ambientais desfavoráveis. Neste trabalho, foi descrito o processo de triagem interdisciplinar do Ambulatório de Distúrbio de Comportamento e Aprendizagem (ADCA) do Hospital das Clínicas da Faculdade de Medicina Ribeirão Preto da Universidade de São Paulo (HCFMRPUSP), para diagnóstico de dificuldade de aprendizagem em crianças de 6 a 10 anos procedentes de uma única escola do ensino fundamental. Devido à complexidade e interdisciplinaridade do tema abordado contou-se com profissionais da área da saúde (fonoaudiólogo, neuropediatra, neuropsicólogo, psiquiatra infantil e terapeuta ocupacional) e da educação (pedagogo) que participaram da aplicação de testes e discussão dos resultados para definição de diagnóstico. Foi realizada uma triagem baseada em análise estatística do rendimento escolar em 104 crianças, com seleção de 56 alunos (54%). No entanto, apenas 27 alunos (48%) dessa amostra concluíram as avaliações. Após a bateria de testes, todos os alunos selecionados que compareceram à avaliação, obtiveram ao menos um diagnóstico compatível com dificuldade de aprendizagem. Entre as causas mais frequentes das dificuldades de aprendizagem, encontrou-se os sintomas/transtornos de ansiedade, o TDAH e os transtornos específicos de aprendizagem, representados por 15 (55%), 13 (48%) e 6 (22%), respectivamente, dos alunos avaliados. Em alguns casos essas condições foram comórbidas. Conclui-se que a escolha por uma escola atendeu as expectativas de homogeneizar a população em estudo; a análise estatística de rendimento escolar pode ser considerado um método com boa sensibilidade; a baixa adesão às avaliações permite evidenciar o quão difícil é para os pais compreenderem a importância dessa investigação; a abordagem interdisciplinar foi uma avaliação criteriosa e conclusiva sobre os variados diagnósticos encontrados e por fim, os diagnósticos mais encontrados foram os sintomas/transtornos de ansiedade, seguido por TDAH e por Transtornos Específicos de Aprendizagem. / The process of school learning occurs in an evolutionary dynamism from the maturation of the upper cortical areas. They allow the acquisition of writing, reading, interpretation, argumentation, calculation and logical reasoning. Thus, many factors can interfer in this process negatively, generating learning disabilities. These interferences can be associated with; (1) primary intrinsic factors like the neurobiological alterations observed in the Attention Deficit Hyperactivity Disorder (ADHD) and Specific Learning Disorders (SLD); (2) secondary intrinsic factor like the psicoemotional problem or cronic diseases; (3) extrinsic interferences such as unfavorable ambient. This work described interdisciplinary evaluations to diagnose learning disabilities in children to 6 from 10 years. All the students are at the same school. It was chosen just one place to homogenize the population sample. The tests were applied in the Behavioral Disorder Learning Ambulatory (BDLA) in the Clinical Hospital of the School of Medicine of Ribeirão Preto - University of São Paulo. Due to the complexity and the interdisciplinary question, different types of health and educational professionals (speech therapist, neuropsychologist, neuropsychologist, child psychiatrist, occupational therapist and educacionalist) participated in this study. It was made a sorting of 104 children based on their school performance, which was selected 56 (54%). However, just 27 students (48%) finished the evaluation. After the tests, all students presented at least one diagnosis associated with learning disabilities. The most important causes found: 15 students (55%) with anxiety symptoms, 13 (48%) with ADHD and 6 (22%) with Specific Learning Disorders. In some situations, this conditions occurred simultaneously. In this way, it was concluded that: the statistical analysis showed a good sensibility; the lower accession in this research showed that the parents didn\'t know about the importance of this investigation; the interdisciplinary approach were carefully and conclusive evaluation of various diagnoses and the most frequence of them were: anxiety symptoms followed by ADHD and Specific Learning Disorders.

<p><strong>Background. </strong>Interprofessional collaboration is a cogent strategy to promote retention and safe, quality nursing care among new graduate nurses. This sandwich thesis describes a research project undertaken to understand how new graduate nurses engage in interprofessional collaboration.</p> <p><strong>Objective. </strong>The aim was to comprehensively understand the individual, team, and organizational factors that influence new graduate nurse engagement in interprofessional collaboration.</p> <p><strong>Methods. </strong>An integrative review of the new graduate nurse literature was conducted within the context of interprofessional collaboration. Applying the Structuration Model of Interprofessional Collaboration as a framework, a mixed methods study examined the team and organizational predictors of new graduate nurse engagement in interprofessional collaboration, and explored factors that influenced confidence among new graduate nurses toward interprofessional collaboration. Quantitative data were collected via mailed surveys. Follow-up interviews were conducted to explain the quantitative findings.</p> <p><strong>Results. </strong>The integrative review revealed individual, team, and organizational factors that were reported to influence new graduate nurse engagement in interprofessional collaboration. The review concluded a gap in the current knowledge of the issue, and literature that was weak to moderate in quality. The team and organizational predictors of new graduate nurse engagement in interprofessional collaboration were: satisfaction with the team, number of team strategies, participation in a mentorship or preceptorship experience, accessibility of manager, and accessibility and proximity of educator or professional practice leader. The interviews revealed respect, team support, and face-to-face interprofessional interactions as team facilitators. Supportive leadership and preceptorship or mentorships were organizational facilitators. Several variables had a relationship with new graduate nurse confidence in interprofessional collaboration. A model that explains this confidence was developed from the qualitative findings.</p> <p><strong>Conclusion. </strong>The Structuration Model of Interprofessional Collaboration was a valuable</p> <p>framework for understanding the structural elements of new graduate nurse engagement in interprofessional collaboration. This thesis identifies implications for education, practice and research.</p> / Doctor of Philosophy (PhD)

Bakgrund: Psykisk ohälsa ökar i Sverige. Rapporter visar att patienter med psykisk ohälsa utsätts för stigmatiserande attityder och bristande vård. Att belysa omvårdnadspersonals erfarenheter kan leda till en djupare förståelse för vården av patienter med psykisk ohälsa. Syfte: Att belysa omvårdnadspersonals erfarenheter av att vårda patienter med psykisk ohälsa inom öppenvården i Sverige. Metod: Litteraturstudien baserades på åtta kvalitativa artiklar. Sökningar genomfördes i databaserna CINAHL och Pubmed. Analysen baserades på Graneheim och Lundmans (2004) artikel. Resultat: Analysen resulterade i tre huvudteman: "behovet av mer resurser”, “vikten av kompetens” och "en krävande professionell roll". Konklusion: Vården av patienter med psykisk ohälsa är komplex och det finns ett behov av mer resurser i form av tid, utbildning och interprofessionellt samarbete för att göra omvårdnadspersonal mer trygga och mötet mer givande. I dagsläget orsakar dessa möten omvårdnadspersonal stress och känslor av otillräcklighet. / Background: The frequency of mental illness is increasing in Sweden. Reports show that patients with mental illness are exposed to stigmatizing attitudes and lack of care in healthcare. Highlighting the experiences of nursing staff can lead to a deeper understanding of the care of patients with mental illness. Aim: To illuminate nursing staff’s experiences of caring for patients with mental illness in outpatient care in Sweden. Methods: Qualitative literature study based on eight articles. Searches were conducted in Cinahl and Pubmed. The analysis was conducted based on a model by Graneheim and Lundman (2004).   Results: The analysis resulted in three themes; “the need for more resources”, “the importance of competence” and “a demanding professional role”. Conclusion: Caring for patients with mental illness is a complex matter and there is a need for additional resources in the shape of time, education and interprofessional collaboration. This in order to make nursing staff more comfortable and the meetings more rewarding. At present these meetings cause stress and feelings of inadequacy in nursing staff.

O estudo tem como objetivo identificar e analisar as ações dos profissionais de enfermagem que atuam na Estratégia Saúde da Família, com vistas a favorecer o trabalho em equipe e prática interprofissional colaborativa. Pesquisa exploratória quantitativa e qualitativa, desenvolvida em duas fases: a primeira como análise documental para identificar as ações realizadas pelos enfermeiros e pelos auxiliares/técnicos de enfermagem na Estratégia Saúde da Família, a segunda fase para construção de mapas de ações a partir da voz dos profissionais e para validação do mapa de ações construído na primeira fase. A coleta de dados foi composta por busca e seleção de documentos oficiais sobre a política de Atenção Primária à Saúde, a regulamentação da prática profissional e formação dos profissionais e realização de oficinas de trabalho com profissionais de enfermagem que atuam na Atenção Primária à Saúde. Na análise dos mapas construídos com base na análise documental e nas oficinas, foram identificadas as ações específicas e comuns, assim como sua distribuição por eixos de atenção à saúde com análise de frequência e taxa de concordância entre os participantes. Na análise qualitativa utilizou-se referencial do processo de trabalho de enfermagem, em particular das suas duas dimensões: assistencial e gerencial. Os resultados apresentam mapas de ações específicas de enfermeiros, com 198 ações, e de auxiliares/técnicos de enfermagem, com 153 ações validadas. Tanto na análise documental como na análise dos relatos dos profissionais de ambas as categorias, houve, na dimensão assistencial, predomínio de ações dos eixos prevenção de agravos e recuperação da saúde e, na dimensão gerencial, predomínio dos eixos gestão do processo de trabalho e serviços e documentação. Contudo, para as duas categorias, verificou-se diferença na distribuição das dimensões assistencial e gerencial, visto que a análise documental mostrou predomínio da dimensão assistencial e a análise dos relatos dos profissionais, predomínio da dimensão gerencial. Houve reconhecimento de mais de 90% das ações descritas nos mapas específicos dos enfermeiros e dos auxiliares/técnicos de enfermagem como comuns a outros profissionais, porém apenas 3,5% e 0,65% das ações comuns, respectivamente as categorias descritas, foram validadas com taxa de concordância igual ou superior a 75%. O compartilhamento de ações comuns ocorre entre auxiliares/técnicos de enfermagem, enfermeiros e médicos, com pouca referência aos agentes comunitários de saúde, profissionais do Núcleo Ampliado de Saúde da Família e nenhuma aos profissionais de Saúde Bucal. Conclui-se que há indução das políticas de Atenção Primária à Saúde na ampliação da dimensão assistencial do processo de trabalho de enfermagem, com ênfase na prevenção de agravos, porém os profissionais indicam ainda o predomínio da dimensão gerencial com foco na gestão do processo de trabalho e serviços. Os mapas de ações construídos para ambas as categorias podem subsidiar a definição de competências e responsabilidades dos profissionais de enfermagem na Estratégia Saúde da Família. O reconhecimento da existência de ações comuns entre profissionais de diferentes áreas, embora incipientes e de pequena monta, pode fortalecer o trabalho interprofissional colaborativo. / The aim of this study is to identify and analyze the actions of nursing professionals working in the Family Health Strategy, with a view to fostering teamwork and interprofessional collaborative practice. Quantitative and qualitative exploratory research was developed in two phases: First, a documentary analysis to identify the actions performed by nurses and nursing assistants / technicians at the Family Health Strategy; second, to build action maps originated from the voices of professionals and for validation of the map of actions built in the first phase. Data collection consisted of searching for and selecting official documents regarding the Primary Health Care policy, regulations of professional practice and training professionals, and holding workshops with nursing professionals working in primary care. The analysis of the maps constructed based on the documentary analysis and in the workshops identified the specific and common actions and their distribution by health care axes with frequency analysis and agreement rate among the participants. In the qualitative analysis, a reference was made to the nursing work process, in particular regarding its two dimensions: care and management. The results present specific actions maps of nurses, with 198 actions, and nursing assistants / technicians, with 153 validated actions. There was a predominance of actions of the axes of prevention of injuries and recovery of health both in the documentary analysis and in the analysis of the reports of the professionals of both categories in the healthcare dimension. In the managerial dimension, there was predominance of the axes referred to management of the work process and services and documentation. However, for the two categories, there was a difference in the distribution of the healthcare and managerial dimensions, since the documentary analysis showed predominance of the healthcare dimension and on the analysis of the professionals\' speeches there is a predominance of the managerial dimension. There was recognition of more than 90% of the actions described in the specific maps of nurses and nursing assistants technician as common to other professionals, but only 3.5% and 0.65 % respectively of the common actions were validated with equal or higher concordance rates to 75%. The sharing of common actions occurs between nursing assistants / technicians, nurses and physicians, with little reference regarding community health workers and professionals of the Family Health Expanded Team, and none of the Oral Health professionals. It is concluded that there is an induction of Primary Health Care policies in the expansion of the healthcare dimension of the nursing work process, with emphasis on the prevention of diseases, but the practitioners also indicate the predominance of the managerial dimension focused on the management of the work process and services. The action maps built for both categories support the definition of competencies and responsibilities of nursing professionals in the Family Health Strategy. The recognition of the existence of a small set of incipient common actions among different professional groups has potential to strengthen the interprofessional collaborative work.

Demand for healthcare services is rising dramatically as the proportion of older adults in the United States increases, and the success of these healthcare organizations depends on cooperation among patients, doctors, and nurses. These interpersonal interactions come with costs associated with managing one's emotions in ways that are in line with completing job tasks effectively, especially as past research has demonstrated that nurses are likely to experience and respond to incivility, and nurses of minority backgrounds even moreso. This study examines the effect of experiencing incivility on engaging in surface acting, or simulating emotions that are not actually felt; how these two factors influence well-being outcomes; and the impact of racial differences in these relationships. A sample of 100 Black and White nurses participated in this research. Results indicate that experiencing incivility increases emotional exhaustion both directly and indirectly through engaging in surface acting in response to incivility. Additionally, findings suggest that Black nurses are more likely than White nurses to experience incivility from other nurses. These results highlight how incivility can contribute to burnout and negative health outcomes and that this effect may be particularly salient among Black nurses.

No description available.

Studiet har haft til formål at undersøge, hvorledes to fagprofessioners rolleopfattelse påvirker deres arbejde og indbyrdes relation inden for klinisk anæstesi. Der er valgt et kvalitativt afsæt med et salutogenetisk perspektiv med hovedvægt på at skabe et billede af forventningerne til den gode fagprofessionelle og det gode samarbejde. Samtidig afdækkes forskellige potentielle konfliktfelter. Rolleopfattelsen fremstår som et handlingsideal, der har fælles træk uafhængigt af professionsbaggrund. Der synes at være god overensstemmelsen mellem professionernes forventninger til rolle og mandat. Dette kan danne basis for et godt samarbejde, men samtidig skabe grobund for konflikter. Der afdækkes en anerkendelse af værdien af begge fagprofessioners spidskompetencer i mødet med patienten. Typen af samspil mellem professionerne er afhængig af opgavernes karakter samt deltagernes personlighed og erfaringer. Overføring af opgaver til den anden profession kan opfattes som en provokation mod professionernes integritet. Hierarki og revirbeskyttelse synes at kunne give anledning til en vis rigiditet i arbejdets organisering. Viden og færdigheder udveksles på tværs af professionerne. Dette islæt af empowerment synes at resultere i en unik kollegialitet og binding. Ingen af de fagprofessionelle ønsker at arbejde i en monofaglig kontekst. Men den udtalte overlapning kan give anledning til mellemmenneskelige udfordringer i forhold til både at give hinanden rum samtidig med, at man kræver plads til egne kompetencer og værdier. / The study has had the purpose of examining how the self-perception of two professions affects their work and mutual relation in the area of clinical anaesthesia. A qualitative starting point with a salutogenetic perspective has been chosen with emphasis on creating a clear picture of expectations about what is good professionally and what is good teamwork. Concurrently, different potential areas of conflict are uncovered. The perception of roles appears as an ideal about how to act, which has common features independently of professional background. There appears to be good accordance between the different professions and their expectations of roles and mandate. This can create a basis for good co-operation, but at the same be a cause of conflict. Acknowledgement of the value of both professions’ core competences in dealing with patients is uncovered. The type of teamwork between the professions is dependent on the character of the assignment as well as the participants’ personality and experience. Transferral of assignments to the other profession can be seen as provocation against the integrity of both professions. Hierarchy and turf-protection appears to give rise to certain rigidity in the organisation of the work. Knowledge and skills are exchanged across the professions. This strain of empowerment seems to result in a unique collegiate spirit and binding. Neither of the two professions want to work in a mono professional context. But the pronounced overlap can give rise to inter-human challenges in connection to giving each other space while also demanding room for one’s own competencies and values. / <p>ISBN 978-9185721-40-5</p>