Class of 2014 Abstract / Specific Aims: To assess and compare prescribing error-identification rates by healthcare professionals Methods: Pharmacists and nurses from Northwest Medical Center were invited to participate in this study. Participants completed a questionnaire that consisted of 10 fictitious patient prescriptions. They were asked to evaluate the accuracy of the prescriptions and indicated the type of error found, if any. The number of correctly identified prescribing errors, correct types of errors, and error identification rates for each group were calculated. Rasch analysis was used to assess the validity and reliability of the questionnaire. Wilcoxon and Rasch-Welch t-test were used to assess the difference in prescribing error-identification rates. Main Results: Thirty-five out of 700 nurses and 6 out of 20 pharmacists completed the questionnaire (response rate 5% and 30% respectively). Pharmacists had significantly higher error-identification rates compared to nurses (p = 0.0001). Additionally, pharmacists were able to correctly identify the type of error in each prescription (p < 0.0001). Conclusion: Pharmacists were significantly able to correctly identify more prescribing errors and more types of prescribing errors in 10 fictitious prescriptions compared to nurses. Several assumptions and limitations were identified in this study, therefore future studies are warranted.

Magister Curationis - MCur / Background and Research Problem: It is well-known that nurses around the world are exposed to various forms of violence at their workplaces. In psychiatric facilities, many of these incidents are perpetrated by patients against nurses. There is a perception that the current legislation and regulations in the country do not adequately protect psychiatric nurses (health care workers in general) against workplace violence. The preliminary literature suggested that most quantitative studies on workplace violence in psychiatric facilities have concentrated on secondary and tertiary psychiatric hospitals looking at the prevalence, the association between demographic factors and violence behaviour, nurses‟ therapeutic responses, and the impacts on the quality of care. Studies on workplace violence in a psychiatric facility for adults with intellectual disability in the country are limited. Secondly, it appeared from the preliminary literature review that similar studies have not looked at this phenomenon from the individual resilience perspective.Therefore, this study will seek to determine the factors associated with the psychological response of nurses‟ victims of inpatient violence in a psychiatric facility for adults with intellectual disability in Cape Town.Aim: To determine factors associated with the psychological response of nurses‟ victims of in-patient violence in a psychiatric facility for adults with intellectual disability in Cape Town.Objectives: To describe the (1) individual resilience of nurses working at a psychiatricfacility for adults with intellectual disability; (2) psychological response of nurses‟ victims of in-patients‟ violence at a psychiatric facility for adults with intellectual disability; and (3) association between the individual resilience characteristics and the psychological responses of nurses victims of in-patients‟ violence in a psychiatric facility for adults with intellectual disability.Methodology: Descriptive-exploratory design using a quantitative approach was used.All categories of nurses (professional nurse, enrolled nurse and enrolled nursing assistance) working at the psychiatric facility for adults with intellectual disability were eligible for the study. Convenient sampling was conducted to select 127 participants who met the inclusion criteria. Self-administered questionnaire was used to collect data. Data was analysed using the SAS V9.3 computer programme. Ethical clearance was obtained from University as well as approval from the management of the psychiatric facility prior to approaching the study participants. Results: The results of the study showed high level of resilience among nurses on Assessment of Resilience Scale (82.9%, n=104); nurses psychological responses to violence were equally distributed between avoidance (mean =4.65 and SD=1.36), intrusion (mean= 4.55 and SD=1.50), hyper arousal (mean=4.46 and SD=1.60) resulting in total mean of 13.67 (SD=4.14) on the revised Impact of Event Scale (IES-R). Measure of association between resilience and the impact of violence on the psychological wellbeing of nurses showed that nurses with high resilience score (82.9%, n=104) fitted the symptoms of PTSD on the IES-R. Spearman Rank correlations (r) analysis showed the total scores of IES-R (r=0.04, p=0.68), avoidance (r=0.01, p= 0.34), intrusion (r=0.08,p=0.34), and hyper-arousal (r= -0.002, p=0.97). Further research looking at the nurses‟ reliance and their responses using resilience theory is needed.

Class of 2005 Abstract / Objectives: The level of nurses’ satisfaction relative to pharmacy services provided at a rural medical center was evaluated and compared to data collected in a previous study at the same institution. Information obtained was utilized to determine potential areas for pharmacy service improvements. Methods: This project employed a survey research design in order to acquire demographic and descriptive data. The instrument contained 43 items including 34 scaled, 7 demographic, and 2 open-ended items. Aspects assessed by this instrument included accessibility of pharmacists, accuracy of medication delivery, quality of drug information services, and perceptions of pharmacists’ value by nursing staff. All inpatient nurse practitioners, licensed practical nurses, and registered nurses who were employed at the medical center in the winter of 2004 were eligible to participate in this study. Results: A total of 199 surveys were returned for a response rate of 43.9%. The overall level of nurses’ satisfaction with pharmacy services at the medical center had not significantly changed between the years of 2000 and 2004; however, several specific areas of pharmaceutical services changed over time. The level of nurses’ satisfaction with pharmacy services was increased in relation to the communication between pharmacists and nurses and decreased in relation to technology associated pharmacy services. Implications: The data obtained using the instrument was evaluated in order to make recommendations to the medical center Department of Pharmacy. An instrument was developed and validated to discern nurses’ level of satisfaction with pharmacy services. This methodology may be used at other institutions.

Health personnel, especially nurses, are often victims of workplace violence. Unfortunately, little is known about the nurses' experience of violence. A research study was initiated to further explore the nurses' accounts of workplace violence so as to make dimensions of the nurses' experience visible and more fully understood. Interpretive description was the research methodology adopted for this study. Using theoretical sampling, ten Registered Nurses from the lower mainland and Vancouver Island, British Columbia participated in semi structured, audiotaped interviews. In this research, the nurses' experience of workplace violence emerged as a highly complex entity, deeply embedded in relationships and context. How nurses perceive the contextual factors of the organization, their immediate work environment and their individual attributes were found to play a significant role in how they respond to the phenomenon. The findings of this study suggest that organizational culture is an important determinant in managing workplace violence and that policy and administrative personnel play a pivotal role in influencing the problem. Nursing culture also influences the nurses' expectations, assumptions and actions towards violence. Participants voiced that role conflict often challenged their ability to enact acquired professional ideals and that that they routinely undertake roles in dealing with violence that are not appropriate to their level of knowledge or skill. Within the nurses' immediate work environment, bullying as well as physical and verbal abuse was commonplace. Overcrowding, long waits for service, poor environmental design and inadequate staff to patient ratios were seen as factors that increased nurses' risk. Individual factors were associated with emotional and psychological harms that nurses endured. Workplace violence affected self-concept, self-esteem, self-efficacy and the nurses' sense of control. Moral distress, self-blame, feelings of failure, loss of motivation and leaving the nursing profession were significant findings. The results of this study demonstrate a need to re-think how we can address workplace violence in nursing. Research and intervention is needed to further explore organizational policy and governing structures, the culture and climate of practice environments, and the fundamental role nursing education programs have in preparing nurses to manage workplace violence. / Applied Science, Faculty of / Nursing, School of / Graduate

No description available.

Health policy reforms have dominated health systems in African countries for over three decades. However, the impacts of these policies on nurses’ work, as well as the extent to which the nurses are involved in the policy decisions, have not been well documented. As the largest group of health professionals in the workforce, nurses’ services are necessary to achieve population health outcomes. Thus, nurses’ work concerns related to the reform of national policies should be identified and addressed. This study was carried out to examine how the national policy reforms have impacted on nurses’ work in Kenyan district health care systems and how nurses have been involved in policy processes in the health care system. Critical theory and feminist critical policy analysis perspectives guided the study. The study was implemented in two phases. The first phase involved qualitative interviews with 32 decision makers and nurses in the public health care system. The second phase involved a comparative quantitative survey of nurses and nurse managers in two districts. A sample of 169 nurses was interviewed in two district hospitals to generate data for this second phase of the study. This thesis contains three manuscripts. The first manuscript presents a qualitative analysis of the impact of policies on nurses’ work (Chapter 2). The second manuscript presents qualitative results of how nurses were involved in policy processes at various levels of the health care system (Chapter 3). The third manuscript presents results of a quantitative survey of frontline nurses’ experiences with the policy reforms, comparing two districts (Chapter 4). An integrative discussion of key findings from all these manuscripts forms the last chapter of the thesis. The findings revealed that policies meant to enhance access to services like decentralization and primary health care were more enabling to nurses’ work while those aimed at enhancing efficiency like structural adjustment programs were more constraining. The constraints included poor work environments, unchanging work conditions, increased responsibilities and dilemmas in providing care. These constraints were experienced more by nurses in the district that was poorly resourced and had poor health indicators than the district that had better resources and better health indicators. The results suggest that inadequate involvement of nurses in policy processes is a reason why their work concerns have not been addressed. There are recommendations to improve nurses’ work in the context of policy reform and to improve nurses’ abilities to participate in policy processes.

This study was prompted by concern for the method of promoting continuity of care for persons discharged from hospital. Descriptive in design, the purpose of the study was to examine selected factors affecting the communication process employed between general staff nurses in hospitals: and personnel in community agencies with regard to the referral of patients with a long-term illness from the hospital to the community setting. The data were gathered by means of a self-administered questionnaire, designed to seek information related to each of the study's three hypotheses. It was completed by fifty-seven general staff nurses on selected nursing units of eight general hospitals in and near Vancouver, British Columbia. The units were chosen on the basis of the average number of patients with a long-term illness usually present on the unit. From analysis of the data the following conclusions were drawn. Although general staff nurses who participated in this study could recognize needs in patients which indicate the necessity for referral to community resources, they did not appear to have an adequate knowledge of available community agencies. When these nurses made referrals, the lines of communication used were frequently indirect. / Applied Science, Faculty of / Nursing, School of / Graduate

The purpose of this exploratory study was to determine the role behavior and the determinant factors influencing the achievement of such role behaviors by the B.S.N, graduates, May 1976, in the basic program of the University of British Columbia School of Nursing. Questions asked were: 1. What kind of role behaviors do University of British Columbia graduates have at the time of graduation, May 1976, and after three months employment in the hospital? 2. What are the determinant factors that influenced achievement of role behaviors of these B.S.N, graduates of the University of British Columbia School of Nursing? Marlene Kramer's Integrative Role Behavior scale and open-ended questionnaire were used to derive the information pertinent to the research problem. Kramer's Integrative Role Behavior scale was administered twice, once at graduation time, and the other three months after employment in the hospital. The open-ended questionnaire was administered after employment only. The study sample were 17 B.S.N.'s who were working in the hospitals throughout British Columbia and answered both sets of questionnaires at the two designated times. Analysis of the data included descriptive analysis, frequency tables, and the use of the T. test. The findings of the study showed that the University of British Columbia B.S.N.'s selected professional role behavior significantly higher at graduation time than upon employment. Besides, role behaviors appeared to be immediately responsive to exposure to the work system. The changes of role behavior upon employment were a higher selection of bureaucratic and integrative role behavior and lower selection of professional role behavior. The changes in selection of bureaucratic and integrative role behaviors were not statistically significant, but the trend of change was as literature suggested. The determinant factors in development of role behavior were mostly the result of ideal nursing education and actual work as a nurse following employment. In the educational setting instructors were instrumental in shaping the ideas of the nurse's role among B.S.N.'s. The study showed that these B.S.N.'s valued their education positively and their work settings (hospitals) negatively. The study suggests more extensive research on the problem. In the meantime, the three groups involved - i.e. nurse educators, nursing service administrators and B.S.N.'s involved - should share their frustrations and suggestions for better client care. / Applied Science, Faculty of / Nursing, School of / Graduate

The purpose of this study was to investigate the construct validity of the Index of Work Satisfaction developed by Slavitt and others (1978) to measure job satisfaction for nurses. Based upon need satisfaction theories, the scale contained seven subscales which were believed to explain job satisfaction. A global satisfaction level item was added in an attempt to obtain a separate measure of the dependent variable. A review of the literature revealed that a valid tool for measuring nurses' job satisfaction does not presently exist. The instrument was modified, pilot-tested for reliability and after a second phase of modification, was administered to a volunteer sample of 177 staff nurses representing several hospital and community work settings. Multiple regression and discriminant function analyses were performed on the data, and the results of these analyses were interpreted in terms of the construct validity of the job satisfaction scale. Results indicated that the scale is highly reliable, and that three of the subscales explained approximately 30 percent of the variance in the scores on the global satisfaction measure of job satisfaction. High intercorrelation of the subscales with each other and with the total scores hindered the interpretation of the variance in the total scores explained by each of the significant variables. The results of the analyses suggest that the high reliability of this version of the tool makes it a psychometrically useful measurement of job satisfaction for nurses, to the extent that job satisfaction is comprised of the seven components contained in the scale. Regarding its construct validity, there is conclusive evidence that the linear additive model of job satisfaction on which the instrument is based does not allow a complete view of the construct. Whether the three significant predictors of the total score, Professional Status, Administration, and Interaction, are part of one broader construct, or whether they interact in some unique way, could not be determined because of the multicollinearity problem. A major difficulty throughout the study was the lack of a reliable alternate measure of the criterion. The global satisfaction item responses did not correlate highly with the total test scores, and this self-report, Likert-type item would be subject to the same response bias as the questionnaire itself. Apart from the demonstration that the Professional Status, Administration, and Interaction components appear to contribute to the measurement of the construct, the study failed to gather evidence in support of the construct validity of the modified Slavitt scale. It can be concluded, therefore, that the scale 'reliably measures some aspects of job satisfaction for nurses, but one cannot state with confidence that it actually measures the complex attitude which comprises the construct "job satisfaction." Recommendations have been made for appropriate use of the tool and for further construct validation studies. / Applied Science, Faculty of / Nursing, School of / Graduate

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01