Hurricane Katrina devastated New Orleans in 2005. Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs) were impacted by the storm. CRNAs were required to be on duty during the storm and SRNAs’ education was disrupted by the storm. This dissertation is a compilation of three papers that represent the initial exploratory research into the impact of natural disasters on CRNAs and future CRNAs. The first article was a focused ethnography utilizing focus groups and described the shared experiences of CRNAs who were on duty in New Orleans during Hurricane Katrina and the psychosocial impact the storm had on them. Ten CRNAs participated in focus groups that were audio-recorded, transcribed and analyzed. Six major themes emerged from the study and represented how the CRNAs appraised and coped with the stressful events surrounding Hurricane Katrina. The psychosocial impact of Hurricane Katrina on the CRNAs resulted in short-term sleep disturbances and a temporary increase in alcohol consumption. The second article was also a focused ethnography that utilized focus groups to describe the shared experiences of SRNAs whose senior year was disrupted by Hurricane Katrina and the psychosocial impact the storm had on them. Ten former SRNAs participated in focus groups that were audio-recorded, transcribed, and analyzed. Three major themes emerged from the study and represented how the SRNAs appraised and coped with the stressful events surrounding Hurricane Katrina. The psychosocial impact of Hurricane Katrina on the SRNAs resulted in temporary increased alcohol consumption and anxiety. The third article discussed the results of an observational study regarding the impact of Hurricane Katrina on the outcome of the Self-Evaluation Exam (SEE) taken by senior-level students in the Louisiana State University Health Sciences Center Nurse Anesthesia Program. A convenience sample consisted of 174 former students. Regression analysis revealed the relationship between the overall percentile score of the SEE and the year the test was taken (prior to or after Hurricane Katrina) while adjusting for potential confounding variables. The findings suggest that Hurricane Katrina did not have an impact on the outcome of the SEE taken by these individuals.

Sammanfattning Bakgrund: Kronisk ledgångsreumatism eller Reumatoid Artrit (RA) är en kronisk inflammatorisk ledsjukdom och är den vanligaste artritsjukdomen vars huvudsymtom är ledvärk. RA finns i alla folkgrupper, dock med varierande prevalens. I Skandinavien ligger prevalensen på ca 0,7 %. Etnologin till RA är en blandning av genetiska och omgivningsrelaterade faktorer. Att leva med RA påverkar patienten fysiskt, känslomässigt, psykologiskt och även socialt vilket leder till att hela livssituationen påverkas. Syfte: Syftet med litteraturstudien var att beskriva erfarenheter av sjuksköterskeledd mottagning hos patienter med reumatoid artrit samt beskriva undersökningsgruppen i de inkluderade artiklarna. Metod: En litteraturstudie med beskrivande design. Huvudresultat: Patienternas erfarenhet av sjuksköterskeledd mottagning var möten i en varm, vänlig och familjär atmosfär. Vården beskrevs som personcentrerad och kompetent och var baserad utifrån varje individs speciella behov. Sjuksköterskans specialistkunskaper värderades högt och uppgavs skapa en känsla av trygghet hos patienten. Den sjuksköterskeledda mottagningen upplevdes som lättillgänglig, flexibel och skapade kontinuitet i vården. Tillgängligheten medförde också att patienten visste när och hur de skulle kontakta sjuksköterskan. Patientens erfarenhet var att en god kommunikation med vårdpersonalen, gav en ömsesidig respekt och ingav patienten ökat förtroende. Slutsats: Slutsatsen av denna studie är att sjuksköterskeledd mottagning kan skapa ett mervärde för patientens omvårdnad. Den erbjudna vården representerade för deltagarna trygghet, hopp och förtroende. För att ett mervärde ska skapas är det av största vikt med god kommunikation och relationskapande, vilket i sin tur ger trygghet och skapar en grundläggande möjlighet för hälsofrämjande omvårdnad. / Abstract Background: Chronic arthritis rheumatism or rheumatoid arthritis (RA) is a chronic inflammatory joint disease and is the most common arthritis disease, in which headache is joint pain. RA is present in all populations, with varying prevalence. In Scandinavia, the prevalence is approximately 0.7%. The ethnology of RA is a combination of genetic and environmental factors. Living with RA affect the patient physically, emotionally, psychologically and socially, meaning that the whole life situation is affected. Aim: The purpose of the literature study was to describe the experiences of nurse-led clinics for patients with rheumatoid arthritis and to present the study groups described in the articles included. Methods: A descriptive literature study Main results: Patients' experiences of nurse-led clinics were encounters in a warm, friendly and familiar atmosphere. The care was described as person-centered and competent provided and based on each individual's special needs. The nursing specialist skills were highly valued and described to create a sense of security for the patient. The nurse-led clinic was reported readily available, flexible and to create stability in the care. The accessibility also meant that the patients were aware of when and how to contact the nurse. The patient's experience was that good communication with the healthcare staff provided a mutual respect and instilled an increased patient confidence. Conclusion: The conclusion of this study was that nurse-led clinics could add value for the patient nursing care. This offered care represented familiarity, hope and confidence for the patients. To achieve added value, good communication and relationship are of the utmost importance, which in turn provide security and create a fundamental possibility in health-promoting care.

This study examined to what extent the biological sex of the nurse-physician interactants affects the interpersonal communication satisfaction experienced by the nurse. Hypotheses One and Two predicted that communication satisfaction would differ significantly across various combinations of sex of nurse and sex of physician dyads. Hypothesis Three predicted that male nurses would experience higher levels of communication satisfaction than would female nurses. Interpersonal communication satisfaction was operationalized by two self-report instruments. The sample included 153 male and female nurses. Results indicated that same-sex interactions were more satisfying for female nurses, while mixed-sex interactions were more satisfying for male nurses. Nurses reported greater communication satisfaction when interacting with female physicians. Hypothesis three was not supported.

Thesis advisor: Dorothy A. Jones / A metasynthesis of 90 published qualitative studies was conducted on the nurses’, students’, and patients’ perception of nurse caring. A mid-range theory of Nurse Caring emerged from the data, including three attributes: Presence, Concern for the Other, Knowledgeable, Competent Care, and Respect for the Person. The Nurse Caring Patient Scale (NCPS) was developed from patient descriptors within the metasynthesis. NCPS was tested to establish the psychometric properties of the instrument with 341 adult acute in-patients of a northeastern United States metropolitan teaching medical center. Initial reliability for total NCPS was .92. Factor analysis using principal components analysis with varimax rotation resulted in a parsimonious three factor solution that accounted for 50.49 % of the total variance. The final NCPS was 23 items with an alpha of .91. Component 1 (Presence, Concern for the Other) was comprised of 11 items with an alpha of .89. Component 2 (Knowledgeable, Competent Care) contained five items with an alpha of .77. Component 3 (Respect for the Person) had seven items and an alpha of .73. Participants were asked to write about an experience with a nurse. Components of caring and uncaring experiences described by participants did not add to the body of data from the metasynthesis or to the items of the NCPS. This study was limited by sample population, and the items of NCPS may be applicable only to those included in the synthesized qualitative studies. The metasynthesis of qualitative studies and mid-range theory of Nurse Caring add to the theoretical concept of caring by including the patients’ perceptions of the nurse-patient encounter. Components of Nurse Caring add competency, and respect to presence with the patient for a comprehensive definition of caring. NCPS offers nurses and administrators a valid reliable measure for patient perceptions of quality of care and satisfaction that were until now unseen and unmeasured. The theory of Nurse Caring provides nurse educators with a framework for nursing curricula, since the theory incorporates all aspects of nursing practice within its definition. / Thesis (PhD) — Boston College, 2008. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Sammanfattning  Bakgrund: Sjukhusvården förändras och kraven på specialistsjuksköterskor ändras. Transporter med patienter från små sjukhus blir fler och sträckorna längre. Upplevelsen av sin arbetsmiljö har visat sig viktig, inte minst vad gäller upplevelsen av patientsäkerheten.   Syfte: Syftet var att, ur ett arbetsmiljöperspektiv, beskriva intensivvårds- och anestesisjuksköterskors upplevelse av att arbeta på ett sjukhus utan akutkirurgi. Metod: Studien hade en kvalitativ ansats med beskrivande design. 11 semistrukturerade intervjuer utfördes med intensivvårdssjuksköterskor (n=6) och anestesisjuksköterskor (n=5). Intervjuerna analyserades med kvalitativ innehållsanalys. Huvudresultat: Under analysen av intervjuerna framträdde sex kategorier. 1. Att uppleva vikten av att rutiner följs 2. Att samverkan och personkännedom inom sjukhuset underlättar arbetet 3. Upplevelse av nuvarande uppdrag 4. Att se vikten av närliggande vård 5. Att samverka med andra sjukhus och 6. Upplevelse av tillgång till resurser och kompetens. Anestesi- och intensivvårdssjuksköterskorna upplevde att det var viktigt att följa rutiner. Att samverkan och personkännedom inom sjukhuset kan underlätta arbetet var ytterligare en upplevelse som beskrevs. De upplevde en tillfredställelse med det nuvarande uppdraget, även om en önskan att få ett utökat uppdrag beskrevs. Vikten av att ha närliggande vård beskrevs och avståndet till närmaste akutsjukhus upplevdes som ett problem. Samarbetet med andra sjukhus beskrevs ibland fungera bra och ibland fick en kamp föregå samarbetet. Upplevelsen av tillgång till resurser och kompetens beskrevs där det framkom att resursbristen kunde skapa frustration. Slutsats: Positiv upplevelse av nuvarande uppdrag. Vid akuta tillstånd där svårt skadade eller sjuka patienter kom in till sjukhuset upplevdes frustration med de resursbrister som fanns. Nyckelord: Anestesisjuksköterska, Arbetsmiljö, Intensivvårdssjuksköterska / Abstract Background: Hospital care is changing and the requirements for specialist nurses are changing. The amount of patient transports from smaller hospitals are increasing and the routes are longer. The experience of the nurses work environment has proved to be important, not least with regard to the experience of patient safety.  Aim: To describe how intensive care and anesthesia nurses experience working in a hospital without emergency surgery, from a work environment perspective.  Method: The study had a qualitative approach with descriptive design. 11 semi-structured interviews were conducted with intensive care nurses (n = 6) and anesthetic nurses (n = 5). The interviews were analyzed with qualitative content analysis.  Main results: Through the analysis six categories emerged. 1. To experience the importance of following guidelines 2. That collaboration and personal knowledge within the hospital facilitates the workload 3. Experience of the current assignment 4. To see the importance of nearby care 5. The cooperation with other hospitals and 6. Experience of access to resources and competence. The anesthetic and intensive care nurses experienced that it was important to follow guidelines. The fact that collaboration and personal knowledge within the hospital can facilitate the workload was another experience that was described. They experienced a satisfaction with the current assignment, although a desire to get extended assignments was described. The importance of having nearby care was described and the distance to the nearest emergency hospital was described as a problem. The collaboration with other hospitals was sometimes described to work well and sometimes a struggle preceded the collaboration. The experience of access to resources and skills was described and it emerged that the lack of resources could create frustration.  Conclusion: Positive experience of current assignments. In emergency situations where severely injured or sick patients entered the hospital, frustration was experienced with the lack of resources that existed. Keywords: Intensive Care Nurse, Nurse anesthetist, Work Environment

With passage of the Patient Protection and Affordable Care Act (PPACA) and the publication of the Institute of Medicine’s report on the future of nursing, nurses are slated to take on an expanded role in primary healthcare delivery in the near future. Nurse practitioners, in particular, will be instrumental in filling the gap in primary care availability engendered by the increasing specialization of physician practice and increased access to healthcare made possible by the provisions of the PPACA. The need for this study was identified through gaps in the literature related to nurse practitioner practice; specifically, the paucity of quantitative research regarding patients’ perspectives of core holistic nursing values in nurse practitioner care, and, since nursing care is by definition and tradition holistic in nature, this inquiry attempted to quantify the degree to which nurse practitioner care upholds and preserves core holistic nursing values. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection

Background: In the post-operative phase, the patient's ability to communicate is impaired. The postoperative patient is therefore in great need of that the information given is being individually adapted. Objectives: The aim of this study was to investigate communicative barriers and facilitating factors between the nurse and the patient in postoperative care and to describe areas of improvement. Methods: Literature study consisting of 12 qualitative scientific original articles focusing on communication between the nurse and the patient in postoperative care and the patient's communicative needs and the nurse's approach to this. Findings: The literature study showed that barriers like stressful working conditions led to short or no communication between the nurse and the patient, and that the postoperative care time thereby was prolonged. Different language, dialects, gender, cultural beliefs and socio-economic backgrounds meant that the information from the nurses was not perceived - or interpreted correctly - and that the time spent developing the message increased the workload. Patients who took an interest in their treatment and asked questions, acted as a positive facilitator. In by doing this, the patients increased the likelihood of being helped and communicated with by the nurses. Conclusion: The result of the literature study shows that an established clear communicative interaction between the nurse and the patient, with individualized care, could be perceived by the patient as just as important and desirable as a quick recovery from illness. / Bakgrund: I det postoperativa skedet är patientens förmåga att kommunicera nedsatt. Den postoperativa patienten är därför i stort behov av att informationen som ges är individanpassad. Syfte: Syftet var att undersöka kommunikativa barriärer och underlättande faktorer mellan sjuksköterskan och patienten i postoperativ vård samt beskriva förbättringsområden. Metod: Litteraturstudie bestående av 12 stycken kvalitativa vetenskapliga originalartiklar med fokus på kommunikation mellan sjuksköterskan och patienten i postoperativ vård samt patientens kommunikativa behov och sjuksköterskans förhållningssätt till detta. Resultat: Litteraturstudien visade på att barriärer likt stressiga arbetsförhållanden ledde till kort eller ingen kommunikation mellan sjuksköterskan och patienten samt att den postoperativa vårdtiden därigenom blev förlängd. Olika modersmål, dialekt, kön, kulturell övertygelse och socioekonomisk bakgrund gjorde att informationen från sjuksköterskorna ej uppfattades- eller tolkades korrekt samt att tiden lagd på att få fram budskapet ökade arbetsbördan. Vad som agerade underlättande var patienter som själva var framåt och frågade om sin behandling. Detta resulterade i att dessa patienter fick hjälp samt ökade sannolikheten för kommunikation med sjuksköterskorna. Slutsats: Resultatet av litteraturstudien visade att ett etablerat tydligt kommunikativt samspel mellan sjuksköterskan och patienten, med individanpassad vård, kunde av patienten upplevas som lika viktigt och önskvärt som ett snabbt tillfrisknande från sjukdom.

Background: The number of children abused in Sweden has increased in last years. All children have the right to live a safe life and receive a good development during their upbringing. It is important that the child's basic needs are met for the child to have a good development. Being a victim of child abuse can lead to enormous consequences in the future for the child's physical and mental health. Aim: This study aimed to illuminate the nurse's experiences in suspected child maltreatment Method: A literature study based on analysis of qualitative studies according to Friberg´s five step model. Results: The results of the studies showed that responding and helping children who live in child abuse was a difficult task for the nurses to perform. The nurses were aware of their obligation to maintain the child's safety. The nurses described the basis of their experience that they encountered personal and work-related obstacles to be able to identify, remedy and report when children were suspected of being abused. The result is presented under three themes. The first theme highlights how nurses are emotionally affected. The second theme is about experiences about collaboration with other authorities. The third theme describes the nurses' need for professional development. Conclusion: The nurses should be able to give the child the right care to ensure the safety of the child and be able to give advice to the child's family. A prerequisite for providing adequate nursing needs nurses have good health science knowledge. / Antalet barn som far illa i Sverige ökar. Sjuksköterskor har skyldighet att anmäla vid misstanke om barn som far illa. Forskning visar att barn som far illa väljer att inte berätta för en vuxen eller en professionell person om misshandeln. Forskning visar även att sjuksköterskans beteende kan hindra eller stimulera patientens delaktighet samt att vårdkultur kan bidra till ett vårdlidande. Konsekvensen av att leva med utsatthet som barn kan resultera i fysisk och psykisk ohälsa senare i livet. Resultat av denna litteraturstudie baseras på sammanställning av nio kvalitativa studier. Resultatet visar att sjuksköterskornas emotionella påverkan har sin inflytande på arbetet. Sjuksköterskorna förstår sitt ansvar att reagera och hjälpa det utsatta barnet, för att sjuksköterskorna ska kunna utöva sitt ansvar krävs det en fungerande samverkan med andra verksamheter. Sjuksköterskorna upplever frustration över bristande samverkan med andra vårdenheter och myndigheter. Sjuksköterskorna uttrycker även ett behov av mer kunskap och professionell utveckling samt tydliga rutiner för att kunna upptäcka varningstecken och därefter kunna vidta relevanta åtgärder i syfte att barnets säkerhet säkerställas i god tid. Slutsatsen av detta examensarbete är att sjuksköterskorna stöter på hinder under processen att hjälpa barn och deras familj. För att sjuksköterskorna ska kunna tidigt upptäcka och vidta rätta åtgärder vid misstanke om barn som far illa krävs det förutsättningar för sjuksköterskorna att utveckla sin kunskap, en fungerande samverkan med alla berörda, samt rätt stöd för att bearbeta den emotionella påverkan som uppstår.

Background: Considering the increasing requirements and needs facing primary health care, the aspiration to use nurses as care providers has increased. This is done to improve the availability, effectiveness, and to dispense the available resources. Aim: The purpose of this study is to illuminate the patient's experiences of meeting nurses as care providers in primary health care. Method: Six qualitative, three quantitative, and one mixed method articles were analyzed to create a literature review. Results: Generally, the patients were satisfied with meeting nurses as care providers in primary health care. The result showed that the patients described relationship, trust, participation, and communication with nurses as significant aspects to feel secure. That the nurses made time available, as well as were easy to contact, were also aspects that contributed to the patients feeling secure. Uncertainties regarding the nurse's role, competence, and not being able to choose level of care were aspects that affected the insecurity. Conclusion: Nurses in primary health care have big opportunities to develop the meeting in a way that the patient feels secure in health care. Most patients experience great satisfaction with care provided by nurses. Considering the above facts, it seems possible to develop health care led by nurses. / Med de ökade behov och krav som ställs på primärvården i västvärlden och den resursbrist på personal som råder är det en ekvation som är svår att lösa. Ett sätt att möta dessa behov är att uppgiftsväxla vården och använda sjuksköterskor i stället för läkare i större utsträckning då det i tidigare studier visat på lika bra eller förbättrad tillgänglighet, effektivitet och kvalitet. Denna litteraturbaserade studie belyser patienters upplevelser av mötet med sjuksköterskor som vårdgivare inom primärvården. I resultatet har tio vetenskapliga artiklar, både kvalitativa och kvantitativa analyserats. I resultatet framkommer vikten av att utveckla en förtroendefull relation genom kommunikation och delaktighet med sjuksköterskan. En förutsättning för att det skall kunna ske är att det finns tillräckligt med tid en annan aspekt är möjligheten till kontinuitet, att träffa samma sjuksköterska vid upprepade tillfällen. Kan vården tillgodose dessa behov finns stora förutsättningar för att patienten skall känna trygghet och tillit till vården. I dagens sjukvård med ökad efterfrågan på vård, ekonomiska utmaningar och personalbrist finns risk för att dessa behov inte tillgodoses. Med en ökad kunskap hos sjuksköterskorna och vårdorganisationen om patienternas behov kan detta bidra till en mer individanpassad och tillfredsställande vård för patienten. Det visar sig också att många patienter har en oklar uppfattning om vad sjuksköterskans roll egentligen innebär.

The American Association of Colleges of Nursing (2016) contends meeting the challenge to transform care will require the successful leadership development, preparation, and role support of the next generation of nurse leaders. Despite the urgency to transform care, meeting the challenge to lead this charge cannot be accomplished without the successful recruitment and retention of Millennial nurses to leadership positions. Identifying the leadership role expectations and support variables that are important to these young managers and creating the milieus that support these views serve to address many pressing succession planning needs. This study explored the experience of being a Millennial nurse manager, seeking to understand how these young nurse managers make meaning of their lived experience. This was a qualitative interpretative phenomenological research study. Three theoretical perspectives contributed ideologies that framed this inquiry: Ray’s (1989) theory of bureaucratic caring, generational cohort theory (Strauss & Howe, 1991), and authentic leadership theory (Avolio & Gardner, 2005). A purposeful targeted national sample of 25 Millennial nurse managers with a minimum of one year of nurse manager experience in the role participated in audio-recorded telephone interviews. Content analysis identified seven themes: Coming into the Role, Learning as I Go, Having the Support of My Director, Making an Impact, Helping Staff Succeed, Managing Change, and Trying to Stay Balanced. Findings from this study suggest Millennial nurse managers gauge role success and satisfaction in relation to their perceived levels of support and development and their ability to master role expectations. Additional findings suggest adequate succession planning for the nurse manager role remains challenged by the lack of formal mandated requisites for the role. The nurse manager role as it stands varies significantly among organizational settings regarding responsibilities, mechanisms of support, number of direct reports, and span of control. Recommendations included the need to address the nurse manager role, academic requisites, and developmental variances in practice. Additionally, re-evaluating the organizational responsibility to the leadership development of these young nurse leaders is recommended to ensure their retention and success in the role. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection