This thesis examines the responses of one hundred and seventy three nurses who work in emergency departments in New South Wales to the psychological tenets of stress, support and burnout. Several tools were utilised the Maslach Burnout Inventory, the Jalowiec Coping Scale and the Bailey Stress Scale. The respondents were grouped according to their place of work and numerous variables were analysed for both similarities and significant differences. Overall nurses who work in emergency departments in NSW reported that the lack of in-patient beds or exit block was the most significant stressor in their work, followed by interruptions by telephones and uncontrolled volumes of patients. Although a variety of formal support systems available to emergency nurses were identified in this study a there was not universal agreement about their usefulness. Support from colleagues however was identified as sustaining and helpful. Reported coping styles of the respondents in this study were constructive, self reliant and professional. There was a very small number of respondents who can be classified as burnt out. / Master of Science (Hons.) Health

Nursing in Indonesia is attempting to achieve a higher standard of education to enable nurses to migrate to global areas of nursing shortages. Assessment of nursing practice during undergraduate nursing education in Indonesia requires investigation to assist in achieving a higher standard of education. For assessment to occur, there are several variables reported in the literature that must be included in the process of assessment, that is assessors, students, methods and tools of measurement as well as clinical environment. It is acknowledged that those factors influence the successfulness of the clinical assessment process. The purpose of this descriptive exploratory study utilising a self report clinical instructor and student nurse questionnaire was to investigate the clinical assessment of Indonesian student nurses undertaking the professional stage of the undergraduate nursing course. Specifically, the study investigated how clinical teachers assess student nurses and how students perceive the clinical assessment process. Data were collected from four nursing institutions in Jakarta, Indonesia during July 2006. Quantitative and qualitative data analysis were undertaken to meet the purpose and objectives of the study. Quantitative data analysis utilised frequency tables, cross tabulations and ANOVA. Participants’ responses to open-ended items were analysed using content analysis procedures. The findings of this study have shown that there are many important issues surrounding the assessment of Indonesian student nurses, such as the model of assessment process employed and the characteristics of clinical instructors, students and clinical environment. From this study, it was revealed that the assessment of student nurses employed skilledv based assessment, despite the global trends towards competency-based assessment. Findings from this study also illustrate that nursing education development has been occurring in Indonesia with already half of the clinical instructor participants being educated to master’s level and most student nurse participants held diploma III qualifications prior to their Bachelor of Nursing course, which means that they want to continue their study to a higher level. However, improvement in nursing curriculum which focuses on competency-based curriculum is needed. Improvement in the nursing curriculum will lead to improvements in the nursing profession. That is a higher standards of professionalism for nursing and nurses in Indonesia. Recommendations from the study include promoting changes in curriculum, particularly regarding the assessment process to employ competency-based assessment for student nurses. This study also endorses the use of a standardized assessment in clinical setting. In addition, further research related to replication of the study at a national level and comparison of clinical assessment in other countries should be conducted.

The therapeutic relationship is the central focus of nursing work in mental health (Peplau, 1992, 1997). However, there is currently little research that has examined influences on the nurses’ capacity to effectively engage in this relationship. This study investigated the impact of nurse, patient and work environment factors on the willingness and ability of nurses to engage in therapeutic relationships. This attribute of the nurse, identified as therapeutic commitment, is essential for an effective therapeutic relationship (Lauder, et al., 2000; Rogers, 1957), which has been identified by users of mental health services as the foundation of their care (Forchuk & Reynolds, 2001). The therapeutic relationship is central to nursing in mental health and has been linked to improved patient outcomes (Horvath, 2005). Environmental factors hypothesised to impact the nurse’s therapeutic commitment included leadership, collegial nurse-doctor relationships, participation in hospital affairs, the foundations of quality nursing, clinical supervision, staffing, skill mix and patient turnover (Aiken, et al., 2008; Duffield, et al., 2009a; Estabrooks, et al., 2002; Kramer & Schmalenberg, 2004; Lake & Friese, 2006; McGillis-Hall & Doran, 2004; Needleman, et al., 2002; Proctor, 1986). These factors, together with measures of the nurse’s qualifications and experience, were assembled into an hypothesised model, based on an earlier framework that included the nurse’s perception of support, adequacy and legitimacy in their role along with their therapeutic commitment (Lauder, et al., 2000; Shaw, et al., 1978). Data were collected from 76 nurses across six mental health wards in general acute hospitals in New South Wales. A nurse survey collected the identified factors using the Practice Environment Scale of the Nursing Work Index (Lake, 2002), the Mental Health Problems Perception Questionnaire (Lauder, et al., 2000), and other questions. A ward profile was used to collect staffing, skill mix and patient movement data. Partial least squares path modelling was applied to the model in order to identify the most influential relationships. The most significant factors in the model were the foundations for quality care, nurse experience, participation in hospital affairs and clinical supervision. Services should enhance the support provided to clinical nurses in mental health through improved access to preceptorship, continued education and clinical supervision. In addition, the therapeutic commitment of nurses in mental health can be increased through improved continuity of care, access to career development opportunities such as the involvement of mental health nurses in the governance of the hospital, and improved responsiveness of administration to the needs of nurses in mental health. Engagement in these supportive activities should be enacted through structured mechanisms that both facilitate involvement and encourage evaluation. This study provides a basis on which to modify the operation of mental health services in general hospitals in order to improve the nursing work environment.

The therapeutic relationship is the central focus of nursing work in mental health (Peplau, 1992, 1997). However, there is currently little research that has examined influences on the nurses’ capacity to effectively engage in this relationship. This study investigated the impact of nurse, patient and work environment factors on the willingness and ability of nurses to engage in therapeutic relationships. This attribute of the nurse, identified as therapeutic commitment, is essential for an effective therapeutic relationship (Lauder, et al., 2000; Rogers, 1957), which has been identified by users of mental health services as the foundation of their care (Forchuk & Reynolds, 2001). The therapeutic relationship is central to nursing in mental health and has been linked to improved patient outcomes (Horvath, 2005). Environmental factors hypothesised to impact the nurse’s therapeutic commitment included leadership, collegial nurse-doctor relationships, participation in hospital affairs, the foundations of quality nursing, clinical supervision, staffing, skill mix and patient turnover (Aiken, et al., 2008; Duffield, et al., 2009a; Estabrooks, et al., 2002; Kramer & Schmalenberg, 2004; Lake & Friese, 2006; McGillis-Hall & Doran, 2004; Needleman, et al., 2002; Proctor, 1986). These factors, together with measures of the nurse’s qualifications and experience, were assembled into an hypothesised model, based on an earlier framework that included the nurse’s perception of support, adequacy and legitimacy in their role along with their therapeutic commitment (Lauder, et al., 2000; Shaw, et al., 1978). Data were collected from 76 nurses across six mental health wards in general acute hospitals in New South Wales. A nurse survey collected the identified factors using the Practice Environment Scale of the Nursing Work Index (Lake, 2002), the Mental Health Problems Perception Questionnaire (Lauder, et al., 2000), and other questions. A ward profile was used to collect staffing, skill mix and patient movement data. Partial least squares path modelling was applied to the model in order to identify the most influential relationships. The most significant factors in the model were the foundations for quality care, nurse experience, participation in hospital affairs and clinical supervision. Services should enhance the support provided to clinical nurses in mental health through improved access to preceptorship, continued education and clinical supervision. In addition, the therapeutic commitment of nurses in mental health can be increased through improved continuity of care, access to career development opportunities such as the involvement of mental health nurses in the governance of the hospital, and improved responsiveness of administration to the needs of nurses in mental health. Engagement in these supportive activities should be enacted through structured mechanisms that both facilitate involvement and encourage evaluation. This study provides a basis on which to modify the operation of mental health services in general hospitals in order to improve the nursing work environment.

The difficulties new nurses experience when first entering acute care work environments have been recognized since Kramer’s seminal work in the 1970s. Despite the implementation of interventions designed to help ease the transition, the literature continues to report that new graduates undergo stress when beginning their careers as nurses. The purpose of this study was to examine the effects of perceived demands, control, social support and self-efficacy on the job stress, job satisfaction and intention to leave of new nurses. The conceptual framework used in the study was Karasek’s (1979) Job Demands-Control-Support (JDC-S) model. This model posits that job demands increase employee stress, but that increasing control can alleviate the negative effects of high demands. Social support and self-efficacy were included in this study as potential moderators of the relationships between demands and control and the outcome variables. This was an exploratory study that utilized a cross-sectional survey was used to gather data. Surveys were mailed to the homes of new nurses working in acute care hospitals across Ontario, Canada. Data were received from 232 new nurses, a response rate of 23.8%. Nurses in the sample had an average of 18.2 months of experience. Data were analyzed using separate hierarchical regression models for each dependent variable. The results showed that the main effects of job demands, social support and self-efficacy provided partial support for the JDC-S model when examining job stress, job satisfaction and intention to leave the job. Only self-efficacy was significantly related to intention to leave the profession. There was no evidence of moderating effects of social support or self-efficacy. An understanding of factors in the work environment that influence new nurses may assist in supporting them during the transition. By exploring the effects of demands, control, social support and self-efficacy on new graduates’ job stress, job satisfaction and intention to leave, this study may provide direction to nursing leaders who are working new nurses in acute care.

The difficulties new nurses experience when first entering acute care work environments have been recognized since Kramer’s seminal work in the 1970s. Despite the implementation of interventions designed to help ease the transition, the literature continues to report that new graduates undergo stress when beginning their careers as nurses. The purpose of this study was to examine the effects of perceived demands, control, social support and self-efficacy on the job stress, job satisfaction and intention to leave of new nurses. The conceptual framework used in the study was Karasek’s (1979) Job Demands-Control-Support (JDC-S) model. This model posits that job demands increase employee stress, but that increasing control can alleviate the negative effects of high demands. Social support and self-efficacy were included in this study as potential moderators of the relationships between demands and control and the outcome variables. This was an exploratory study that utilized a cross-sectional survey was used to gather data. Surveys were mailed to the homes of new nurses working in acute care hospitals across Ontario, Canada. Data were received from 232 new nurses, a response rate of 23.8%. Nurses in the sample had an average of 18.2 months of experience. Data were analyzed using separate hierarchical regression models for each dependent variable. The results showed that the main effects of job demands, social support and self-efficacy provided partial support for the JDC-S model when examining job stress, job satisfaction and intention to leave the job. Only self-efficacy was significantly related to intention to leave the profession. There was no evidence of moderating effects of social support or self-efficacy. An understanding of factors in the work environment that influence new nurses may assist in supporting them during the transition. By exploring the effects of demands, control, social support and self-efficacy on new graduates’ job stress, job satisfaction and intention to leave, this study may provide direction to nursing leaders who are working new nurses in acute care.

Nurses are being promoted to head nurse positions without adequate preparation in leadership and management. One reason this problem exists is because nursing managers are being selected from different levels of basic nursing education programs. Only baccalaureate education has a curriculum designed to develop professional nurse leaders.The purpose of the study was to determine the relationship of leadership effectiveness styles of head nurses drawn from a stratified random sample of hospitals in the state of Indiana, to type of basic nursing education program, and experience in a head nurse position.Data were collected from 204 out of 343 head nurses practicing in hospitals in the state of Indiana accredited by the Joint Commission on Accreditation. A Leader Effectiveness and Adaptability Description Instrument measuring four styles of leadership effectiveness as formalized by Hersey and Blanchard, and a Demographic Data Sheet were utilized for data collection.Decisions about three null hypotheses were made at the 0.05 level by use of step-wise multiple regression analysis, and chi square procedures.Major findings include:1. The magnitude and/or direction of the relationship between entry-level preparation and leadership effectiveness styles of head nurses did not vary with years of experience in a head nurse position.2. There was no significant relationship between entry-level preparation and leadership effectiveness when experience was controlled.3. There was no significant relationship between experience and leadership effectiveness when entry-level preparation was controlled.4. Other data concerning major and alternate styles utilized by head nurses, and the number of style used were reported. The predominant major style of head nurses was High Task/ High Relationship. The predominant alternate style was Low Task/High Relationship...5. Head nurses used all four styles.6. All effectiveness style scores for head nurses were in the effective range.Conclusions1. Leadership effectiveness styles of head nurses do not depend on entry-level preparation and experience.2. Leadership effectiveness styles of head nurses do not depend on the type of basic nursing education program with experience controlled.3. Leadership effectiveness styles of head nurses do not depend on years of experience with entry-level controlled. 4. Head nurses predominantly use two styles of leadership: High Task/High Relationship, and Low Task/Low Relationship.5. Head nurses are able to vary leadership styles to meet the needs of the situation.6. Head nurses have effective styles.

Assignment (MCur)--University of Stellenbosch, 2008. / Bibliography. Also available via the Internet.

Thesis (Ph.D)--Virginia Commonwealth University, 2009. / Prepared for: School of Nursing. Title from title-page of electronic thesis. Includes bibliographical references.

Thesis (M.S.) in Nursing--University of Maine, 2009. / Includes vita. Includes bibliographical references (leaves 48-54).