Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

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Critical thinking skills have emerged as a vital tool for the professional nurse confronting an explosion of technology and compressed plans of treatment. The purpose of this research was to compare the critical thinking skills of experienced registered nurses from two practice settings: the operating room and general medical-surgical floors. Critical thinking was defined as a "composite of attitudes, knowledge, and skills" (Watson-Glaser, 1980, p. 1).The research of Benner (1984) provided the foundation for this research. Benner documented the development of knowledge and skill in nursing practice. Nurses at the proficient and expert stages of development were the focus of this research.A non-random, convenience sample containing fifty one nurses was drawn from two Midwestern hospitals. Demographic data was gathered to further describe the sample. Participation in the study was voluntary and anonymity of subjects was assured.The Watson-Glaser Critical Thinking Appraisal (WGCTA) (1980) was the instrument utilized to measure the critical thinking skills of the experienced nurses. This tool has established validity and reliability and is considered a benchmark for measuring critical thinking ability.Analysis of the WGCTA (1980), results revealed a mean of 54.29, SD 9.66 for the total group of experienced registered nurses (N=5 1). For the operating room nurses (n=28) a mean of 52.71 with a SD of 9.41 was obtained. Among the medical-surgical nurses (n=23), the mean score was 56.21 with a SD of 9.81. T-test and MANOVA analysis was carried out. No significant statistical differences were found between the means in either the total scores of the WGCTA or on the five sub-tests for the two groups. The data submitted for analysis reflected a very experienced group (51 % with > 15 years nursing experience) and predominate Associate and Diploma preparation (61 %). Norming information available for the WGCTA indicated the scores obtained in this research were comparable to much larger samples drawn from nursing students and police officers.A conclusion of this research is that critical thinking, as measured by the WGCTA (1980), develops uniformly across diverse practice areas. An examination of the usefulness of the WGCTA to accurately measure the process of critical thinking in experienced nurses is recommended. More research into the important issues of critical thinking and experienced nursing practice is recommended. / School of Nursing

M.Cur. (Psychiatric Mental Health Nursing) / Psychiatric nursing is seen as a high-stress profession. The demands of caring for others, especially those who suffer from acute and chronic mental health impairment, can be extremely stressful (Lin, Probst & Hsu, 2010:2343). Psychiatric nurses run a high risk for being exposed to aggression in the work environment. The aggression that they experience is not only from hostile and aggressive mental health care users, but also from fellow colleagues. Aggression in the work environment has an overt negative psychological effect on the nurse (Yildirim, 2009:509; Bimenyimana, Poggenpoel, Myburgh & Van Niekerk, 2009:5). The aim of the research study was to explore and describe the lived experience of psychiatric nurses of aggression amongst colleagues in the work environment. A second aim was to formulate guidelines on assisting psychiatric nurses and their colleagues in order to facilitate their own mental health. The research design of the study is qualitative, explorative, descriptive and contextual in nature (Maphorisa, Poggenpoel & Myburgh, 2002:24). This qualitative approach created an opportunity to discover the phenomena of the lived experiences of psychiatric nurses of aggression amongst colleagues. The research study was conducted in two phases. In the first phase, data was collected by means of conducting in-depth phenomenological interviews, naïve sketches, observations and field notes until data saturation was achieved. In the second phase, guidelines, recommendations, challenges and a summary were formulated to address the lived experience of the psychiatric nurses of aggression amongst colleagues in the work environment. During data collection, the following question was asked in the in-depth phenomenological interviews and naive sketches, “What is your experience of aggression amongst colleagues in the work environment?” Tesch’s (Creswell, 2004:256) open coding method and an independent coder were used during data analysis.

M.Cur. (Nursing Science) / The purpose of the research study was to explore and describe the experiences of critical care nurses working in adult critical care units of a private hospital in Gauteng, following their involvement in a sentinel event. This information could enable the researcher to formulate guidelines for support of these nurses. Health care professionals aim to deliver safe, high quality care, but unfortunately, all humans can, and do make mistakes (Wakefield, 2007: 12). Since the report To err is human was released by The Institution of Medicine at Havard University (Kohn, Corrigen & Donaldson,1999), more authors have concluded that it is human to make mistakes (Erasmus, 2008:5). Mistakes in the nursing environment can be seen as sentinel events which could result in unintended harm to the patient (Muller, Bezuidenhout & Jooste, 2006:456). Sentinel events in health care, could lead to the devastating concepts of negligence, malpractice, or unprofessional practice, as nurses are held accountable for their acts and omissions according to Erasmus (2008: 5-6). The following research questions emerged:  What are the experiences of critical care nurses, following their involvement in a sentinel event, which harmed, or could have resulted in unintended harm to the patient?  What guidelines for support of these nurses could be formulated? This study was planned in two phases and the objectives of the study were: Phase 1: To explore and describe the lived experiences of nurses, working in the adult critical care units in a private hospital in Gauteng, following their involvement in a sentinel event, which harmed, or could have resulted in unintended harm to the patient. Phase 2: To formulate guidelines for support of these nurses, following their involvement in a sentinel event. A qualitative, exploratory, descriptive and contextual phenomenological research design was used to gain more information regarding critical care nurses` lived experiences, following their involvement in a sentinel event. The study was done in two adult critical care units, in a private hospital in Gauteng. Data was collected by means of six individual in - depth interviews and three naive sketches. Data analysis was done according to Tesch`s open-coding qualitative data analysis method (Creswell, 2007:156). Two main categories emerged from the data, namely the nurses` experiences following their involvement in a sentinel event and the recommendations towards guidelines for support of these nurses. The first main category was sub categorized as being personal, emotional, social and professional experiences and were found as being positive, as well as negative experiences. In the second main category, recommendations towards guidelines for support of nurses, following their involvement in a sentinel event, were proposed and these recommendations were sub- categorised as being at a personal, professional and organizational level of the nurse. In view of the findings of this study, the recommended guidelines for support of nurses, following their involvement in a sentinel event included communication, debriefing, in-service training, root cause analysis and organizational support. Consequently, the intent should be to implement these proposed guidelines for support in the hospital under study. If nurses were supported to follow these guidelines, it may help the nurses who had been involved in a sentinel event, to restore their strive for wholeness in body mind and spirit (University of Johannesburg, 2009:1) and these nurses could be able to render holistic nursing care.

The issue of occupational stress in nurses is significant because it has been associated with absenteeism, burnout and turnover among nurses. This study was an attempt to illuminate the occupational stress experience of workers in general with a focus upon nurses as subjects. Consequently, this research evaluated multiple contributory components to this stress process. Further, consideration of the fit between this stress-coping-depression model and General Systems Theory was another major focus of this study. The independent variables of daily hassles, occupational stress, primary stress appraisal, coping strategies, social support, repression and extraversion were measured in an attempt to determine their combined and singular influence upon the dependent variable of professional depression. These variables were measured by means of a paper-and-pencil self-report inventory of questionnaires mailed to a random sample of six hundred registered nurses in the state of Arizona. Analyses of returned questionnaires consisted of regression analyses of a causal model of the above noted variables. The findings indicate that emotion-focused coping strategies, especially escape avoidance and distancing strategies, demonstrated the most consistently significant effect upon depression for the total sample as well as for all of the demographic subgroups. The next most significant variable measured in this study was that of social support. This variable demonstrated an inverse relationship to depression and thereby appears to provide protection from depression when an individual is exposed to external stressors. External stressors, especially the daily hassles subscales of work, and time pressures, were also significantly related to increased depression in most of the analyses. Occupational stress, on the other hand, as measured revealed a statistically significant relationship to depression for only two subsamples of the study population, charge nurse/clinical specialists and nurses who had worked in nursing longer than 20 years. In regard to stress appraisal, the aspects of threat and stressfulness both revealed significant relationships. The appraisal of threat was significantly related to depression while stressfulness revealed influences upon both external stressors of daily hassles and occupational stress as well as upon depression.

The recent expansion of focus within medicine to include palliative care has created a new corps of professionals who fulfill a role that might be considered antithetical to their profession. This new medical role calls for individuals who have personality characteristics that will allow them to constantly face death. This study was concerned with examining, in Adlerian life style terms, the personality characteristics of one segment of that corps--the hospice home care nurse. The subjects used in this study represent the population of nurses (N = 6) who provide the care within the framework of the home care program of Hillhaven Hospice of Tucson. A structured interview was held by the researcher at which time the subjects responded to each of the items on the Life Style Interview Guide. Three experts trained in Adlerian psychology and life style interpretation collectively analyzed each life style in order to arrive at a life style summary for each nurse as well as a composite summary. The results of this study showed a high degree of similarity and consistency with regard to attitudes, personality characteristics and life style themes of the hospice home care nurses studied.

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Socialization into the nursing profession is essential for student nurses to develop an internalized professional identity and the corresponding professional role. The espoused professional values are the foundation for the development of professional identity and commitment to the profession. Nurse educators have a responsibility to foster students' learning for the development of the student nurse as a professional. The formation and internalization of a professional identity through acquisition of values that are congruent with those espoused by the profession facilitates professional development.The purpose of this qualitative study was to examine how baccalaureate nursing students were professionally socialized into nursing values in the classroom. Mezirow's transformational learning was used to examine how nursing students came to critically reflect on personal and professional values as part of the process of professional socialization.The context for this study was a university classroom setting. A purposive sample of eight nursing students in a baccalaureate program in the first nursing, non-clinical course was used.The study used interviews, observations, and review of documents which included the informants' journals, course text, course examinations and syllabus. Two one-hour interviews were conducted with the informants at the fifth week of a seven week course and at completion. The instructor was also interviewed following completion of the course. The three classroom observations were conducted every other week to correspond with significant content areas. Journals were collected every other week.The findings suggest that nursing students do not attain the espoused professional values from the formal curriculum or role-modeling of the instructor in a classroom setting. Qualities attributed to the professional values were expressed rather than the values themselves through personal experiences. Content areas which were controversial and value-laden held the most meaning and triggered critical reflection on personal and professional values. Eight subcategories emerged from the data analysis: formal curriculum, perceived personal values, perceived values learned in the classroom, perceived values role-modeled, triggers for critical reflection, hidden curriculum, sense of belonging to the profession, and consequences of professional socialization.This study has implications for nurse educators regarding teaching strategies, nursing education and curriculum development, professions concerned with professional socialization, and adult educators interested in Mezirow's theory. Further study is recommended on aspects of belonging, triggers for critical reflection, and professional values. / Department of Educational Leadership

D.Cur. / The overall objective of this research study was to develop a model of emotional intelligence for the facilitation of wholeness in critical care nurses in South Africa. Critical care nurses often nurse three or more critically ill patients during one shift (Fiakus, 1998). The environment in the critical care unit is highly stressful, highly emotionally charged and emotionally demanding for the nurses that work there. This can lead to the nurse developing burnout (Coates, 2001 ). Burnout in a critical care nurse can have devastating consequences such as decreased well-being of the nurse, decreased quality of care, poor communication and increased costs to the employer related to absenteeism and high staff turnover (Poncet, Toullic, Papazian, Kentish-Barnes, Timsit, Pochard, Chevret, Schlemmer & Azoulay, 2006). In a study by Shipley, Jackson and Segrest (2004), it was found that staff with increased emotional intelligence enjoyed better emotional health and more satisfaction both at home and at work. The question that arose was what is the emotional intelligence of critical care nurses in South Africa. A theory-generative, exploratory, descriptive and contextual research design was used. The research study was carried out using a modification of the method of theory generation as described by Chinn and Kramer (1985). Step one dealt with the empirical phase in which the main concept was distilled from the results of the data analysis. The quantitative research design used for this phase was a typical descriptive survey design. The entire accessible population (N=380) consisted of registered nurses that attended the Critical Care Congress in 2009. They represented a wide range of registered nurses that worked or had worked in critical care in both the private and public health sectors in South Africa. The data collection instrument consisted of a biographical datasheet from which the sample (n=220) was divided into various context groups. Participation was voluntary and all participants signed a consent form. The second part of the data collection instrument consisted of the Trait Emotional Intelligence short form (TEIQue-SF). The data was analysed using SPSS. The sample consisted mainly of a group of mature, female and professionally experienced critical care nurses. They held a variety of job descriptions in critical care nursing. Nurses who are older and have more experience in critical care appear to have a higher range of emotional intelligence. This was also confirmed in a study by Shipley et al. (2004) in which emotional intelligence was associated with work experience. Based on the tests of normality, there was no significant difference in the emotional intelligence of the various context groups that were identified from the single sample (n=220). The exploratory factor analysis identified eight factors as having eigenvalues greater than 1. The statistical evidence pointed to concentrating on factors 1 and 2, and pragmatically these two factors became the focus of the model, as they form the central essence of emotional intelligence of the critical care nurse. The facilitation of inherent affective and mental resourcefulness and resilience was the main concept of the model. Step two comprised the definition and classification of the central and related concepts. This was achieved by finding dictionary meanings and their subject usage. The attributes identified were synthesised to form a definition in chapter five. Step three provided a description of the model. A visual application of the model was shown in chapter six, which highlighted the concepts as proposed by Dickoff, James and Wiedenbach (1968). Three stages of the process of facilitation of emotional intelligence were used to develop the inherent affective and mental resourcefulness and resilience of the critical care nurse. Step four entailed the description of guidelines for operationalising the model in practice to facilitate the emotional intelligence of the critical care nurse in South Africa. Evaluation of the model was undertaken according to Chinn and Kramer (1991 ). To ensure valid results a model of trustworthiness proposed by Guba (1981, in Krefting, 1999) was utilised for the macro argument for the total model. In this study ethical conduct was applied as described by Burns and Grove (2009). The limitations of the research study are highlighted in chapter seven and recommendations of the model for nursing practice, nursing research and nursing education are also made.