Bakgrund: En specialistsjuksköterska inom akutsjukvård med inriktning mot ambulans- och/eller intensivvård hanterar hjärtstopp enligt algoritmen för avancerad hjärtlung-räddning och verkar i komplexa situationer såväl prehospitalt som intrahospitalt, där krav ställs på specialistsjuksköterskan att kunna tolka tillstånd, hantera avancerad utrustning och läkemedel samt ställs inför etiska och komplexa situationer.  Syfte: Att belysa specialistsjuksköterskors erfarenheter av att delta vid hjärtstopp  Metod: Kvalitativ metod med deskriptiv ansats. Intervjuerna genomfördes med en semistrukturerad frågeguide, vilket gav möjlighet för följdfrågor. Tio deltagare intervjuades och intervjuerna analyserades med hjälp av kvalitatitv innehållsanalys av Graneheim & Lundman (2004).  Resultat: Studiens resultat presenteras i två kategorier. Den fokuserade experten samt Människan med behov för återhämtning och reflektion. Arbetet som specialistsjuksköterska inom akutsjukvård med inriktning mot ambulans- och/eller intensivvård ger deltagarna upplevelser som påverkar dem i både yrket och privat. Förberedelser att hantera situationerna sker i form av utbildning i avancerad hjärtlung-räddning men också erfarenheter av att delta vid hjärtstopp är viktiga för att utvecklas i yrkesrollen och hantera utrustningen som finns tillhanda för hjärtstopp. För att kunna hantera upplevelserna krävs, förutom stödinsatser av arbetsgivaren i form av debriefing, även informellt stöd av kollegor samt personliga copingstrategier. Konklusion: Arbetet som specialistsjuksköterska kräver avancerade kunskaper och förberedelser i form av utbildning, hantering av medicinteknisk utrustning men även upplevda erfarenheter, för att kunna formas i sin yrkesroll. Att genomföra formella debriefingar, använda kollegialt stöd och egna copingstrategier gör att specialistsjuksköterskor hanterar exponeringen av att möta patienter med hjärtstillestånd till en hanterbar situation. Dock anser en del av specialistsjuksköterskorna att det finns brister som kan förbättras vad gäller utbildning för att hantera hjärtstopp. / Background: A specialist nurse in emergency care with focus on prehospital- and/or intensive care manages algoritms for cardiac arrests and are active in complex situations, both pre- and intrahospital, were the specialist nurses have demands on them to interpret conditions, manage advanced equipment and drugs and are encountered to ethical and complex situations.  Purpose: To enlighten the experiences of specialist nurses when managing cardiac arrests, the complexity that sorrounds the situation whenever a patient is in cardiac arrest, could give the specialist nurse tools to better understand and cope with that type of emergency situations and increase safety in their professional role Method: Qualitative method with a descriptive approach. The interviews were conducted through a semi-structured interview guide. Ten participants were interviewed and the interviews were transcribed and analyzed according to qualitative content analysis by Graneheim & Lundman (2004). Result: The result of the study is presented in two categories, the focused expert and the person with need for recovery and reflection, with seven sub categories belonging to the categories. Working as a specialist nurse within emergency care with focus on prehospital- and/or intensive care and taking care of patients in cardiac arrest give the participants in this study experiences that affect them both professionally and private. Preparation to manage cardiac arrests involve training in advanced cardiopulmonary resusciation but also experiences of participating during cardiac arrests are important to evolve in their professional role and manage the equipment that are being used for cardiac arrests. To be able to manage the experiences they need to accept supportive measures from their employer and informal measures such as peer-support and personal coping strategies.  Conclusion: The role of being a specialist nurse in emergency with focus on prehospital  and/or intensive care demands advanced knowledge and preparations through education, managing medical technology equipment and lived experiences, in order to be shaped in their professional role. By conducting formal debriefings, use peer-support and their own coping strategies the specialist nurse manage to cope with exposure of meeting patients in cardiac arrest. However, some of the specialist nurses considers there should be room for improvement regarding their education to manage cardiac arrests.

Purpose: The purpose of this study was to develop a visual concept map that could assist nurse educators in explaining the concept ‘nursing’ so that students have a similar understanding, meaning and interpretation thereof. Methodology: An exploratory and descriptive qualitative study was conducted to develop a visual conceptual map that can help in the common understanding and interpretation of the concept ‘nursing’. Research approach: A qualitative research approach was used. The research approach consisted of four phases: Phase 1: A self-designed online questionnaire was used to obtain information from the nurses, registered with South African Nursing Council (SANC) and members of Democratic Nursing Organisation of South Africa (DENOSA), about their interpretation of the meaning of ‘nursing’. Phase 2 included the integrative review that was used to obtain in-depth meaning of the concept ‘nursing’ from relevant literature and documentation. Phase 3: The two sets of analysed data from Phase 1 and Phase 2 were combined and used to develop the visual conceptual map. Phase 4: The developed visual concept map was validated by the nurse educators inaugurated in Sigma Theta Tau International, the Africa Region Chapters, in order to provide a validated visual concept map based on their expertise in Africa. The outcome of the study: A validated visual concept map, agreed upon by nurse educators inaugurated in Sigma Theta Tau International, the Africa Region Chapters, based on their expertise in Africa, is available and may be of great benefit for nurse educators in teaching the meaning of the concept of nursing to student nurses in their institutions. As a teaching tool, this concept map might assist educators in explaining the meaning and interpretation of the concept ‘nursing’. / Health Studies / Ph. D. (Nursing)

Bakgrund: På en operationssal är teamarbetet viktigt, dels för att arbetet ska fungera men också för att säkerställa patientsäkerheten. En viktig aspekt i teamarbetet är att de perioperativa sjuksköterskorna känner att de andra i teamet har förståelse för deras arbetsuppgifter. Syfte: Syftet med studien var att belysa perioperativa sjuksköterskors upplevelser av teamarbetet utifrån förståelse för deras arbetsuppgifter. Metod: En kvalitativ induktiv intervjustudie genomfördes med 16 perioperativa sjuksköterskor från tre små till mellanstora sjukhus i södra Sverige. Datamaterialet analyserades utifrån en kvalitativ latent innehållsanalys. Resultat: Studien visar att det finns flera saker som påverkar teamarbetet och sjuksköterskorna upplever att även om förståelsen för deras arbete från andra teammedlemmar oftast är bra, finns det möjligheter till förbättring. Ur resultatet framträdde det övergripande temat självständighet förutsätter delaktighet, med kategorierna yrkesroll, samverkan, arbetsmiljö och patientsäkerhet och därtill hörande underkategorier. Slutsats: Nyttan är att ge perioperativ personal en insikt i vad som kan underlätta teamarbetet. Det behövs fortsatt forskning inom ämnet, men det är också viktigt att utbildningar och arbetsplatser satsar på att träna teamarbete för att öka kunskapen och förståelsen mellan professionerna. / Background: In an operating theatre teamwork is important, partly to get the job done, but also to ensure patient safety. An important aspect of teamwork is that perioperative nurses feel that the other members of the team understand their work assignments. Aim: The aim of this study was to highlight perioperative nurses' experiences of teamwork based on an understanding of their work assignments. Method: A qualitative inductive interview study was conducted with 16 perioperative nurses from three small to medium-sized hospitals in southern Sweden. The data were analyzed based on a qualitative latent content analysis. Results: The study shows that there are several aspects that affect teamwork and nurses feel that although understanding of their work assignments from other team members usually are good, there are possibilities for improvement. The overall theme independence requires participation emerged from the result, as well as the categories profession, collaboration, work environment and patient safety with related subcategories. Conclusion: To give perioperative personnel an insight into what might facilitate teamwork can be beneficial.  Further research on the topic is required, but it is also important that schools and workplaces practice teamwork to increase knowledge and understanding between different professions.

Healthcare organizations are responding to changes in reimbursements by redesigning and re-evaluating existing programs to improve patient outcomes. .One such intervention at the project setting was the re-evaluation of the treatment of patients with low risk for chest pain and implementing a cardiology nurse practitioner (NP) service focusing on the reduction of length of stay (LOS) with the goal of improving patient outcomes. The purpose of this doctor of nursing practice project was to evaluate the effectiveness of a nurse practitioner-led service on the reduction of LOS of patients with low risk for chest pain. An established evidenced-based guideline developed by the American Heart Association for the treatment of patients with low risk for chest pain was adopted by the NP service. The project was guided by both the Donabedian model of quality care and the Aday and Anderson theory of access to medical care. The project design proposal is a comparative study using retrospective data obtained from the medical records of LOS pre- and post-implementation of the project. Implications for social change include improvement in patient care on a national level, not only for patients with low risk for chest pain, but also for patients with other chronic diseases. Streamlining care will improve the financial standing of hospitals as well as provide care that is equal and equitable regardless of race or financial status. The findings of this project have strengthened the role of the APN globally as a social advocate for change, actively participating in designing and implementing programs to improve patients' outcomes.

Certified nurse aides provide approximately 65% of care to more than 1.4 million older adults residing in nursing homes who have been diagnosed with 1 or more chronic illnesses or debilitating conditions. Licensed nurses rely on nurse aides to report potentially harmful status changes in geriatric residents. Nurse aides often receive limited education and do not have a structured care process to guide them in their practice in the geriatric population. The purpose of this educational quality improvement project was to develop a geriatric-specific nurse aide care process to increase the knowledge of student nurse aides regarding processes to identify and observe potentially harmful status changes in geriatric residents, and what changes to report immediately to a licensed nurse. The knowledge-to-action model was used to address the practice problem and to guide the translation of this evidence-based project into practice. The methodology used to guide data collection and analysis was a 1-group, quasi experimental, pretest/posttest design to compare participants' knowledge before the intervention with their learning outcomes after the educational intervention was implemented. The findings revealed an increase in the knowledge of student nurse aides after the educational intervention. The project may promote social change on an organizational level by demonstrating the need for a structured geriatric care process for nurse aides prior to their entry into the long-term care workforce to improve care outcomes for geriatric residents. The project may involve social change at the state level because incorporating this process may require additional hours in the nurse aide education program curriculum.

The nursing shortage and high turnover rates are a problem in Canada and the world over. The purpose of this single case study was to explore leadership strategies that nurse leaders in specialty care clinics in Canada use to reduce nurse turnover. The participants were 7 nurse leaders from a single organization with specialty care clinics across Canada who all had above average nurse retention rates when compared to the case organization's average nurse retention rate. The authentic leadership theory was the conceptual framework. Data sources for this study were company documents, participants' semistructured interview responses, member checking of the interviews, and reflexive journal notes. Methodological triangulation was used to enhance validity. Data were analyzed using Yin's 5-step approach to qualitative data analysis. Data analysis yielded 4 categories of strategy themes for reducing nurse turnover: moral perspective, self-awareness, relational transparency, and balanced processing. The results of this study have the potential for positive social change in specialty care by providing senior leadership and nurse leaders of specialty care clinics with strategies that can contribute to nurse-retention initiatives. The availability of more nurses might improve the outcomes of patients who depend on these clinics for their regular infusion of specialty medicines to treat their critical illnesses, such as cancer or rare genetic diseases, where delay in treatment due to the unavailability of nurses can result in adverse consequences for patient care.

Den här avhandlingen handlar om vårdlärares arbete med simulering av arbetsuppgifter i metodrum Ett metodrum kan ses som en hybrid mellan klassrum och sjukhussal. I denna skolmiljö övas arbetsuppgifter som förekommer inom vård och omsorg. Det saknas patienter att öva på och ibland sjukvårdsmaterial, vilket innebär en utmaning för vårdläraren att skapa en autentisk miljö. Syftet med studien är att undersöka hur vårdlärare arbetar med simulering av arbetsuppgifter i metodrumsundervisning för vuxna elever. Avhandlingen grundar sig på ett sociokulturellt perspektiv och har analyserats med hjälp av kvalitativ innehållsanalys. Tre metodrumslektioner från tre olika skolor ljudinspelades digitalt : venprovtagning, urinkatetrisering och såromläggning. Resultatet visar att vårdlärarna arbetar med tre olika simuleringsaktiviteter: Tekniskt utförande, Tolkande och Bemötande. Simuleringsaktiviteternas utförande varierar med lektionsinnehållet. Studien visar vilka redskap i metodrumsundervisningen som är vanligt förekommande och hur de används. Ingela Leibring har bakgrund som barnmorska och arbetar för närvarande som vårdlärare inom kommunal vuxenutbildning i Karlstad samt är utbildningsledare för Yrkeshögskolans utbildning till barnspecialiserad undersköterska. / This study centres on clinical skills laboratory teaching in municipal adult education. This type of teaching takes place in a school setting and is hybrid of a nursing and healthcare environment. Future professional tasks are simulated and practised here. Three different schools were visited and three clinical skills laboratory lessons were recorded with a digital audio recorder. The following tasks were included in the study: venipuncture, urinary catheterisation, and wound dressing. The analysis was performed as a qualitative content analysis informed by a sociocultural perspective. The aim of the study is to extend the knowledge of how teachers approach the simulation of tasks in clinical skills laboratory training. The study identifies three simulation activities and their application: technical performance, interpretation, and treatment.  The main teaching tools used in the lessons were the teacher’s body/hands, different physical tools specific to the respective laboratory session and the teacher’s language. All the simulation tasks – venipuncture, urinary catheterisation and wound dressing ­– were included in the sessions. A similarity was that technical performance on the whole was the most common feature in all the laboratory lessons. A difference emerged when the clinical skills laboratory lesson was divided into the components: introduction, students practise themselves, and conclusion. The lesson introduction included treatment to nearly the same extent as technical performance. Differences related to lesson content were evident in the activities interpretation and treatment. A common pattern was that the teachers shifted between everyday language and professional language when they worked with simulation. They named their patients and gave the students immediate response.

Thesis (M.S.)--University of Michigan, 1992.

Thesis (M.S.)--University of Michigan, 1993.

Thesis (M.S.)--University of Michigan, 1993.