<p>With the increasing demand on the health-care system and increasing human resource shortages, the delivery of critical care services is facing a crisis. Although funding is being provided to increase the number of critical care beds to meet the physical demands, the supply of qualified registered nurses (RNs) is decreasing. To increase the required staff, new graduate RNs are being hired into critical care units more than ever before. The influx of newly graduated RNs has been deemed controversial as it is viewed that new graduates are unable to engage in complex decision-making or complete the technical skills required in critical care.</p> <p>The research objective of this study was to explore the experiences of new graduate RNs entering a critical care unit and to gain an understanding of the barriers and facilitators present when transitioning to the unit. Semi-structured interviews with eleven participants were conducted with new graduates from four critical care units within two major teaching hospitals in Southwestern Ontario. A qualitative descriptive design described by Sandelowski (2000) was used for this research study. The findings describe the experiences of new graduates including the emotional experience, the times of transition, becoming a professional, embracing team support and learning to feel comfortable within the unit.</p> <p>These findings will be of interest to a broad audience including nursing students, new graduates, hospital managers and administrators, educators and policy makers. It is anticipated that these results will help inform organizational policy and programs and will direct further research on this topic.</p> / Master of Science (MSc)

Thesis advisor: Monica O'Reilly-Jacob / Background: Emergency department crowding (EDC) is a major issue affecting hospitals in the United States and has devastating consequences, including an increased risk of patient mortality. Solutions to address EDC are traditionally focused on adding resources, including increased nurse staffing ratios. However, these solutions largely ignore the value of the experience and expertise that each nurse possesses and how those attributes can impact patient outcomes. This dissertation uses Benner’s Novice to Expert theory of professional development to describe how individual emergency nurse expertise influences patient length of stay in the emergency department and how it can be part of the strategy in addressing EDC.Purpose: The purpose of this program of research was to identify, articulate, and demonstrate a new approach to emergency nurse performance evaluation that integrates patient outcome data and emergency nurse characteristics. Methods: First, in a scoping review, we explored the different approaches to measuring nurse performance using patient outcome data and identified common themes. Second, a concept analysis introduced Emergency Nurse Efficiency as a novel framework to understand how emergency nurses can be evaluated using patient outcome data. Finally, a retrospective correlational study established the association between nurse expertise and emergency patient length of stay. Results: In Chapter Two of this dissertation, the researchers conducted a scoping review of nurse performance metrics and identified twelve articles for inclusion. We identified three themes: the emerging nature of these metrics in the literature, variability in their applications, and performance implications. We further described an opportunity for future researchers to work with nurse leaders and staff nurses to optimize these metrics. In Chapter Three, we performed a concept analysis to introduce a novel metric, called Emergency Nurse Efficiency, that is a measurable attribute that changes as experience is gained and incorporates the positive impact of an individual nurse during a given time while subtracting the negative. Using this measurement to evaluate ED nurse performance could guide staff development, education, and performance improvement initiatives. In Chapter Four, we performed a retrospective correlational analysis and administered an online survey to describe the relationship between individual emergency nurses, and their respective level of expertise, and their patients’ ED LOS. We found that, when accounting for patient-level variables and the influence of the ED physicians, emergency nurses are a statistically significant predictor of their patients’ ED LOS. A higher level of clinical expertise among emergency likely produces a lower ED LOS for their patients, and nurse leaders should seek to better understand these metrics for professional development and quality improvement activities. Conclusions: This dissertation made substantial knowledge contributions to the literature regarding the evaluation of individual emergency nurses and the influence that they have on patient outcomes. It established, first, that the measurement of individual nurse performance is varied and inconsistent; second, that considering emergency nursing as a team activity similar to professional sports results in a conceptual framework that can evaluate individual performance within a group context; and, third, that there is a relationship between the individual emergency nurse and their patients’ ED LOS, and that relationship can be further understood within Benner’s Novice to Expert theoretical model. We recommend that nurse leaders use these data as part of their strategy to decrease EDC. / Thesis (PhD) — Boston College, 2023. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Bakgrund: I Sverige infördes Donation after Circulatory Death (DCD) under år 2020 för att kunna öka antalet organdonationer. Sedan dess har antalet donationer av denna typ succesivt ökat. Internationellt finns forskning i begränsad omfattning kring hur processen erfars av intensivvårds och operationssjuksköterskor. Både intensivvårds- och operationssjuksköterskor har en betydelsefull funktion i DCD-processen. Syfte: Syftet var att beskriva intensivvårds- och operationssjuksköterskors erfarenheter av DCD-processen. Metod: En kvalitativ innehållsanalysmed induktiv ansats användes, där fyra intensivvårdssjuksköterskor och fem operationssjuksköterskors intervjuades. Resultat: Resultaten visade att intensivvårds- och operationssjuksköterskorna upplevde både utmaningar och positiva känslor i samband med DCD processen.De fann trygghet i tydliga rutiner och gemenskap i samarbetet i DCD-teamen. Samtidigt kände de ansvar gentemot både donatorn och mottagarna av organen. Konklusion: Implementering av DCD-team har skapat en ny gemenskap och engagemang hos intensivvårds- och operationssjuksköterskorna. Trots att resultaten indikerar positiva upplevelser av DCD-processen är det viktigt att fortsätta utvärdera implementeringen och undersöka hur närstående och olika yrkesgrupper upplever processen för att få en mer heltäckande bild av dess effekter ochupplevelser. / Background: Donation after Circulatory Death (DCD) was introduced in 2020 to increase the number of organ donations in Sweden. The number of donations of this type has gradually increased. Internationally, there is limited research on how critical care and perioperative nurses perceive this method. Both critical care and perioperative nurses play a significant role in the DCD process. Aim: The aim was to describe critical care and perioperative nurses´ experiences of the DCD process. Method: A qualitative content analysis with an inductive approach where four critical care nurses and five perioperativenurses were interviewed. Results: The results showed that the critical care and perioperative nurses experienced both challenges and positive emotions associated with the DCD process. They found security in distinct routines and companionship incollaboration within DCD teams. At the same time, they felt responsibility towards both the donor and the recipients of the organs. Conclusion: The implementation of DCD teams has created a new sense of community and commitment among intensive care and perioperative nurses. Although the results indicate positive experiences of the DCD process, it is important to continue evaluating the implementation and investigating how family members and medical health professionals perceive the process to gain a more comprehensive understanding of its effects and experiences.

Bakgrund: Akutsjuksköterskan är specialiserad inom akutsjukvård och jobbar företrädesvis på en akutmottagning och bedriver där högkvalificerad akutsjukvård. Akutsjuksköterska som specialistutbildning är i sammanhanget en förhållandevis ny utbildning och adekvat forskning kring just akutsjuksköterskans inverkan på den utförda vården saknas således. Syfte: Syftet var att studera akutsjuksköterskors upplevelser av hur specialistkompetensen påverkar vårdandet på en akutmottagning. Metod: En kvalitativ intervjustudie med induktiv ansats. Tio specialistsjuksköterskor inom akutsjukvård intervjuades från tre olika akutmottagningar i södra Sverige. Det insamlade materialet analyserades med Graneheim och Lundmans beskrivning av manifest innehållsanalys. Resultat: Tre kategorier identifierades och beskriver akutsjuksköterskans upplevelse av hur specialistkompetensen påverkar vårdandet: Reell eller formell kunskap, förändrad syn på vårdandet och trygg i sin yrkesroll. Slutsats: Akutsjuksköterskans specialistkompetens skapar trygghet i yrkesrollen samt leder till att akutsjuksköterskan ser helheten, både sett ur ett patientperspektiv och ett organisatoriskt perspektiv. Erfarenhet kan i viss mån kompensera för specialistutbildning. Dock behövs mer forskning gällande hur akutsjuksköterskans kompetens påverkar vårdandet. / Background: Emergency nurse is a nurse who is specialized in emergency healthcare and preferably work in a emergency room and conduct highly qualified healthcare. Emergency nurse is in context a relatively new training and therefor there is a lack of research regarding how emergency nursing impact the health care. Aim: The aim was to study emergency nurses’ experience of how their specialist competence affects care in an emergency department. Methods: A qualitative interview study with an inductive approach. Ten specialist nurses in emergency care were interviewed from three different emergency departments in southern Sweden. The material that were colleceted were analyzed with Graneheim och Lundmans description of manifest content analysis. Findings: Three different categories were identified and describes how emergency nursing impact the health care: Real or formal competence, a changed view on the overall health care and confident in his role. Conclusions: Emergency nurses has an overall positive impact on the emergency nurse and creates comfort in the professional role. The emergency nurse sees the whole patient both from a patient perspectiv and from an organizational perspective. Experience can in some extent make up the lack of specialist training.  However more research is needed on how emergency nurses impact the overall health care.

Yes / To compare and contrast job descriptions for nursing roles in out-of-hours (OOH) services to obtain a general understanding of what is required for a nurse working in this job. OOH services provide nursing services to patients either through telephone or face to face contact in care centres. Many of these services are newly created giving job opportunities to nurses working in this area. It is vital that nurses know what their role entails but also that patients and other professionals know how OOH nurses function in terms of competence and clinical role. Design: Content analysis of OOH job descriptions. Method: Content analysis of a convenience sample of 16 job descriptions of OOH nurses from 5 OOH care providers across England was undertaken. The findings were narratively synthesised, supported by tabulation. Results: Key role descriptors were examined in terms of: job titles, managerial skills, clinical skills, professional qualifications and previous experience. Content analysis of each OOH job description revealed a lack of consensus in clinical competence and skills required related to job title although there were many similarities in skills across all the roles. Conclusion: This study highlights key differences and some similarities between roles and job titles in OOH nursing but requires a larger study to inform workforce planning. Relevance to clinical practice: OOH nursing is a developing area of practice which requires clarity to ensure patient safety and quality care. What does this paper contribute to the wider global clinical community? • There is a need for a consensus of opinion for nursing roles in OOH care linked to education, professional regulation and competence, based on expectations linked to particular job titles. • Educational and professional standards are required for different roles, which has implications for the training of OOH practitioners. • Health providers trying to meet the expectations of service users for 24 hour health care globally may invest in OOH nursing to meet demand

The aim of the study was to investigate motivation, job satisfaction and attitudes of nurses in the public health services of Botswana. The objective was to discover how nurses felt about a wide range of variables in their work environment and ultimately to distil them into what they conceived as the mainstay motivators, job satisfiers and positive attitudes. The non pariel (unrivalled, unique) role of the government in creating both the hardware and the software of national health services was acknowledged and recognised with a particular reference to the primacy it placed on developing the human resources in the form of nurses, in order to realize the goals of administering the public health services efficiently and effectively. It was noted that nurses were the change agents and the axis in promoting quality standards of healthcare but in partnership with the government, which must be seen to be responsive and proactive in discharging its fiduciary responsibilities, in respect of both the content and the context of nurses’ occupational ambience. For the purposes of constructing a database from which both the government and the nurses can draw, the most salient thematic details of the theories of motivation, job satisfaction and attitudes were studied and examined and were used as a scaffolding for the empirical survey of nurses. Nine hundred questionnaires were distributed to both registered and enrolled nurses with a minimum of two years work experience in the public health sector and 702 of these were returned constituting a return rate of 78%. The findings indicated that a majority of nurses enjoyed job satisfaction in certain areas of their work namely autonomy, participating in decision-making, choice of type of nursing, change of wards or departments or work units, interpersonal relationships amongst nurses themselves and between nurses and their supervisors. Nurses also perceived the hospital as an environment in which they could continually learn and they were moreover satisfied with the nursing job or the work itself. The other end of the spectrum revealed an overwhelming majority of 92.2% of nurses who were dissatisfied with the level of pay and 88.5% who were not happy with the fringe benefits including the provision of accommodation. Working conditions were viewed as generally disliked by 67.3% of the nurses. Low pay, workload, lack of viii recognition for outstanding performance and or delayed promotional chances were singled out as being particularly disliked by 67.2%, 64.9%, 42.6% and 44.4% of the nurses respectively. Interviews held with 31 nurses yielded similar results. The research further showed that the most important motivators to nurses were dominated by competitive salary which was mentioned by 80.9% of the respondents, attractive or sufficient working conditions which were stated by 71.2% of the nurses, opportunity for continuous education which was rated by 63.8% of the nursing candidates, reduced workload which was claimed by 59.3% of the nursing cadres, opportunity for the recognition of outstanding performance and opportunity for promotion which were scored by 54.1% and 53.4% of the nurse respectively. Job satisfiers were also represented by competitive salary which received 76.1% of the nurses’ votes. Risk allowance occupied the second position with 69.1% and competitive working conditions were awarded a third ranking by 68.2% of the nurses. Those nurses who derived job satisfaction from the fact of each nursing shift being manned by an adequate number of nurses accounted for 63.1% of the sample. Competitive fringe benefits attracted 60.1% of the nurses. Opportunity to attend workshops and the need for high morale in nursing team-work were chosen as job satisfiers by 53.7% and 49.6% of the nurses respectively. In the section on recommendations the government was exhorted to invoke corrective or remedial measures in view of the detailed exegesis of the satisfactions and dissatisfactions in the nurses’ work environment and the ensuing problematique (doubtful, questionable) of raising the standards of health care in the public health services. Living up to these sanguine expectations should be the cherished longterm vision of the government if it is to meet and quench the soaring aspirations of its modernizing society for quality health care delivery and the escalating needs of the nurses. / Public Administration / D.P.A.

The aim of the study was to investigate motivation, job satisfaction and attitudes of nurses in the public health services of Botswana. The objective was to discover how nurses felt about a wide range of variables in their work environment and ultimately to distil them into what they conceived as the mainstay motivators, job satisfiers and positive attitudes. The non pariel (unrivalled, unique) role of the government in creating both the hardware and the software of national health services was acknowledged and recognised with a particular reference to the primacy it placed on developing the human resources in the form of nurses, in order to realize the goals of administering the public health services efficiently and effectively. It was noted that nurses were the change agents and the axis in promoting quality standards of healthcare but in partnership with the government, which must be seen to be responsive and proactive in discharging its fiduciary responsibilities, in respect of both the content and the context of nurses’ occupational ambience. For the purposes of constructing a database from which both the government and the nurses can draw, the most salient thematic details of the theories of motivation, job satisfaction and attitudes were studied and examined and were used as a scaffolding for the empirical survey of nurses. Nine hundred questionnaires were distributed to both registered and enrolled nurses with a minimum of two years work experience in the public health sector and 702 of these were returned constituting a return rate of 78%. The findings indicated that a majority of nurses enjoyed job satisfaction in certain areas of their work namely autonomy, participating in decision-making, choice of type of nursing, change of wards or departments or work units, interpersonal relationships amongst nurses themselves and between nurses and their supervisors. Nurses also perceived the hospital as an environment in which they could continually learn and they were moreover satisfied with the nursing job or the work itself. The other end of the spectrum revealed an overwhelming majority of 92.2% of nurses who were dissatisfied with the level of pay and 88.5% who were not happy with the fringe benefits including the provision of accommodation. Working conditions were viewed as generally disliked by 67.3% of the nurses. Low pay, workload, lack of viii recognition for outstanding performance and or delayed promotional chances were singled out as being particularly disliked by 67.2%, 64.9%, 42.6% and 44.4% of the nurses respectively. Interviews held with 31 nurses yielded similar results. The research further showed that the most important motivators to nurses were dominated by competitive salary which was mentioned by 80.9% of the respondents, attractive or sufficient working conditions which were stated by 71.2% of the nurses, opportunity for continuous education which was rated by 63.8% of the nursing candidates, reduced workload which was claimed by 59.3% of the nursing cadres, opportunity for the recognition of outstanding performance and opportunity for promotion which were scored by 54.1% and 53.4% of the nurse respectively. Job satisfiers were also represented by competitive salary which received 76.1% of the nurses’ votes. Risk allowance occupied the second position with 69.1% and competitive working conditions were awarded a third ranking by 68.2% of the nurses. Those nurses who derived job satisfaction from the fact of each nursing shift being manned by an adequate number of nurses accounted for 63.1% of the sample. Competitive fringe benefits attracted 60.1% of the nurses. Opportunity to attend workshops and the need for high morale in nursing team-work were chosen as job satisfiers by 53.7% and 49.6% of the nurses respectively. In the section on recommendations the government was exhorted to invoke corrective or remedial measures in view of the detailed exegesis of the satisfactions and dissatisfactions in the nurses’ work environment and the ensuing problematique (doubtful, questionable) of raising the standards of health care in the public health services. Living up to these sanguine expectations should be the cherished longterm vision of the government if it is to meet and quench the soaring aspirations of its modernizing society for quality health care delivery and the escalating needs of the nurses. / Public Administration and Management / D.P.A.

Indiana University-Purdue University Indianapolis (IUPUI) / Caring relationships established between nurse managers and staff nurses promote positive work environments. However, research about staff nurses' perceptions of nurse manager caring behaviors is limited. A 94-item Caring Assessment Tool-Administration (CAT-adm©) was developed to measure staff nurses' perceptions of nurse managers' caring behaviors; however, it lacked robust psychometric testing. This study was undertaken to establish the CAT-adm© survey as a reliable and valid tool to measure staff nurses' perceptions of nurse managers' caring behaviors. The Quality-Caring Model® (QCM®) served as the theoretical framework. Specific aims were to 1) evaluate construct validity of the CAT-adm© survey by describing factors that account for variance in staff nurses' perceptions of nurse manager caring, 2) estimate internal consistency, and 3) conduct item reduction analysis. Four research questions were: 1) Will the factor structure of observed data fit an 8-factor solution? 2) What is the internal consistency reliability of the CAT- adm©? 3) What items can be reduced while maintaining an acceptable factor structure? and 4) What are staff nurses' perceptions of nurse manager caring behaviors? A cross-sectional descriptive design was used. A sample of 703 staff nurses from Midwestern, Midatlantic and Southern Regions of the U.S. completed the CAT-adm© survey electronically. Analysis included Confirmatory Factor Analysis (CFA), Exploratory Factor Analysis (EFA), univariate analysis, and descriptive statistics. CFA did not support an 8-factor solution. EFA supported a two-factor solution and demonstrated significant shared variance between the two factors. This shared variance supported a one-factor solution that could conceptually be labeled Caring Behaviors. Random selection reduced the scale to 25-items while maintaining a Cronbach's Alpha of .98. Using the new 25-item scale, the composite score mean of staff nurses' perceptions of nurse manager caring behaviors indicated a moderately high level of caring. Suggestions for nursing administration, nurse manager practice, leadership, education and for future research were given. The new 25-item CAT-adm© survey has acceptable reliability and validity. The 25-item CAT-adm© survey provides hospital administrators, nurse managers, and researchers with an instrument to collect valuable information about the caring behaviors used by nurse managers in relationship with staff nurses.

Every year, millions of medical errors are committed, costing not only patient health and satisfaction, but thousands of lives and billions of dollars. Errors occur in many areas of the healthcare environment, including the profession of nursing. Nurses provide and delegate patient care and consequently, standard nursing responsibilities such as medication administration, charting, patient education, and basic life support protocol may be incorrect, inadequate, or omitted. Although there is much literature about errors among the general nurse population and there is indication that new nurses commit more errors than experienced nurses, not much literature asks the following question: What are the factors contributing to the commission of errors, including the omission of standard nursing care, among new nurses? Ten studies (quantitative, qualitative, and mixed-mode) were examined to identify these factors. From the 10 studies, the researcher identified the three themes of lack of experience, stressful working conditions, and interpersonal and intrapersonal factors. New nurses may not have had enough clinical time, may develop poor habits, may not turn to more experienced nurses and other professionals, may be fatigued from working too many hours with not enough staffing, may not be able to concentrate at work, and may not give or receive adequate communication. Based on these findings and discussion, suggested implications for nursing practice include extended clinical experience, skills practice, adherence to the nursing process, adherence to medications standards such as the five rights and independent double verification, shorter working hours, adequate staffing, no-interruption and no-phone zones, creating a culture of support, electronically entered orders, translation phones, read-backs, and standardized handoff reports.

Critically ill patients experience overwhelming communication problems; caused by intubation and cognitive, sensory or language deficits that distance the patients from communicating their needs and wants from nurses and loved ones. The purpose of this study was to explore communication patterns and strategies with the aim of implementing intervention strategies for nurse/patient communication in the intensive care units. The American Association of Critical Care Nurses’ Synergy Model for Patient Care was used to guide the study. A mixed method approach using quasi-experimental design combining quantitative and qualitative data collections and analysis was used. Concurrent data collection for quantitative and qualitative data was used. Auditing of patient’s files, protocols, family counselling conference and in-service books and a survey for nurses was used for quantitative data. Qualitative data collection was through interviewing nurses and nurse managers. Lack of documentation and use of other communication strategies were the key findings of the study. In accordance with the model used for the study clinical judgment and moral distress were found to be common among nurses. Lack of collaboration between nurses and other health care workers was also attributed to poor communication with mechanically ventilated patients. Conclusions derived from the study are that nurses need to be supported through informal and formal training on documentation and use of communication methods available / Health Studies / D. Litt. et Phil. (Health Studies)