Thesis (Ph.D.)--University of California, San Francisco, 2009. / Source: Dissertation Abstracts International, Volume: 71-02, Section: B, page: . Adviser: Margaret Wallhagen.

<p> Bullying has long been associated with school children. In recent years, however, more attention has been paid to the bullying that has reached beyond the playground and into the workforce. One population facing this problem is staff nurses. To date, no one has found an effective way to address workplace bullying in the healthcare field, nor have effective methods been found for retaining trained nurses affected by this problem. The focus of this dissertation was on understanding nurses&rsquo; lived experiences and how nurses decided to remain in their current working position despite these problems. Taking a phenomenological approach and using the conceptual framework of resilience, the study included telephone interviews of 2 pilot study participants and 12 main study participants. Recorded and transcribed participant responses to interview questions were coded thematically and analyzed. Three main themes emerged: stories of working with workplace bullying, challenges of the lived experiences of being bullied, and special techniques of nurses being bullied. Three subthemes also emerged: despair, love of being a nurse, and resilience. This study gave a voice to nurses affected by this problem, revealing special challenges they encounter and coping strategies they employ. Hospital administrators can use the findings of this study to create social change within nurses&rsquo; working environment by implementing policies that will keep their nurses safe and happily employed. Future research should focus on workplace bullying in the nursing field and how it affects patient safety.</p><p>

by Yung Ha-ping, Hilary. / Questionnaire also in Chinese. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1994. / Includes bibliographical references (leaves 92-101). / ACKNOWLEDGEMENTS / ABSTRACT --- p.ii / LIST OF TABLES --- p.vii / LIST OF FIGURES --- p.viii / CHAPTER / Chapter 1. --- INTRODUCTION --- p.1 / Bacground of the Study --- p.1 / Significance of the Study --- p.4 / Purpose of the Study --- p.5 / Chapter 2. --- REVIEW OF LITERATURE AND THEORETICAL FRAMEWORK / Role Conception / Role --- p.6 / Role Conception --- p.7 / Nursing Role Conception --- p.8 / Role Discrepancy --- p.9 / Change of Role Conception --- p.10 / Socilaisation and Role Conception --- p.11 / Socialisation of Baccalaureate Degree Students --- p.12 / Socialisation of Hospital-based Certificate Students --- p.13 / Nursing and Ethics --- p.14 / Ethical Dilemma --- p.15 / Code of Ethics --- p.16 / Moral Development --- p.17 / Moral Reasoning and Moral Behaviour --- p.18 / Decision-making Framework --- p.20 / Ethical Decision-making in Nursing --- p.21 / Ethical Decision-making and Work Environment --- p.23 / Ethical Decision-making and Role Conception --- p.24 / Ethical Decision-making and Education --- p.25 / Learning Climate / Concept of Organizational Climate --- p.26 / Organizational Climate and Leadership --- p.28 / Ward Learning Climate --- p.28 / Ward Teaching and Learning --- p.30 / Role of Ward Staff and School Tutor in Ward Teaching --- p.31 / Role of ward Sister in Ward Teaching --- p.32 / "Relationship among Role Conception, Ethical Decision- Making and Ward Learning Climate" --- p.34 / Chapter 3. --- RESEARCH METHODOLOGY / Design of the Study --- p.38 / Hypotheses --- p.38 / Definitions --- p.39 / Subjects --- p.40 / Procedure --- p.42 / Instruments --- p.42 / Analysis Design --- p.50 / Chapter 4. --- RESULTS / Demographic Characteristics --- p.52 / Differences in Role Conception Types --- p.53 / Differences in Discrepancy Role Conception --- p.60 / Differences in Ethical Decision-making --- p.63 / Differences in Perception of Ward Learning Climate --- p.66 / "Relationship among Ethical Decision-making, Role Conception and Learning Climate" --- p.69 / Chapter 5. --- DISCUSSION / Differences in Professional Role Conception --- p.75 / Differences in Bureaucratic Role Conception --- p.79 / Differences in Service Role Conception --- p.80 / Differences in Ethical Decision-making --- p.81 / Differences in Perception of Ward Learning Climate --- p.83 / "Relationship among Ethical Decision-making, Role Conception and Learning Climate" --- p.84 / Limitations --- p.87 / Chapter 6. --- "CONCLUSION, IMPLICATIONS AND RECOMMENDATIONS" / Conclusion --- p.88 / Implications and Recommendations --- p.89 / Suggestions for Further Research --- p.90 / REFERENCES --- p.91 / APPENDICES / Chapter I. --- Code for Nurses --- p.102 / Chapter II. --- Letter of Request for Approval --- p.103 / Chapter III. --- Questionnaire Instruction --- p.104 / Chapter IV. --- Letter to Students --- p.105 / Chapter V. --- Consent Form --- p.106 / Chapter VI. --- Demographic Data --- p.107 / Chapter VII. --- Nursing Role Conception Inventory --- p.108 / Chapter VIII(A). --- Opinion About Nursing (Role Conception Questionnaire) --- p.110 / Chapter VIII(B). --- Opinion About Nursing - Chinese Version --- p.115 / Chapter IX(A). --- Judgment About Nursing Decision (JAND) (Ethical Decision-making Qusetionnaire) --- p.118 / Chapter IX(B). --- Judgment About Nursing Decision (JAND) -Chinese Version --- p.125 / Chapter X. --- Ward Learning Climate Indicators --- p.132 / Chapter XI(A). --- Ward Learning Climate Questionnaire --- p.135 / Chapter XI(B). --- Ward Learning Climate Questionnaire -Chinese Version --- p.138 / Chapter XII. --- Narrative Responses --- p.140

This study focused on the experiences of ethnic minority nursing students at a predominately white institution, the Health Sciences University School of Nursing in an attempt to learn more about the stress, appraisal, and coping of this group of individuals. The University School of Nursing was selected as a comparison site as it offered a setting with no predominate ethnic group. Faculty•s perceptions of students stress, appraisal and coping were sought to provide a context for the students• experience. A review of the literature indicated that ethnic minority students in predominately white universities experience alienation. At some universities white and ethnic minority students and faculty differ in their perceptions of what should be offered as support to ethnic minority students. Studying the experiences of students at a health care science university, dedicated to the health and care of individuals provided useful insights. Of particular importance was the investigation of what constituted problematic and nonconstructive relationships and structures. Symbolic interactionism, socialization theory, stress, appraisal and coping theory and attribution theory offered sensitizing concepts from which 23 ethnic minority nursing student and 12 nursing faculty interviews were taped, and analyzed. A constant comparative method of qualitative analysis proposed by Glaser and Strauss offered a systematic approach in developing substantive concepts. Common to most nursing students was the phenomenon of making it in nursing school. Making it was characterized by two main categories, being out of control and gaining control. Being out-of-control was understood as the stress producing threats of conflicting demands of family, work and school and being sanctioned, the evaluation and approval by faculty of ones• professional performance. Gaining control included managing multiple demands, reaffirming ones• choice of nursing and disengaging from the student role to becoming a nurse. A set of experiences unique to ethnic minority students was identified when some aspect of ethnicity was central to the problematic experience. A core phenomenon of exclusion as a threat to identity emerged. Three forms of exclusion were identified: (1) linguistic difficulty; (2) interpersonal disregard; (3) ethno-cultural incongruity. Students 1 acceptance of responsibility for the problematic situation influenced their coping strategies. Holding back, keeping silent, disengaging and giving up were the usual coping responses. Only when the stakes were high, for example passing a course, would students speak out, negotiate or confront to in order to preserve their academic progression. Faculty accurately identified students 1 stresses as: staggering under the load, building a professional identity, experiencing isolation and facing cultural unresponsiveness. Faculty misidentified some of students 1 withdrawal coping behaviors as a cultural norm of being quiet or reserved. In addition, faculty offered descriptions of their own stress in teaching ethnic minority students with English as a second language such as trying to decide when to bend over backwards to help the students and when to draw the line. The most important conclusion reached was that ethnic minority students experienced a set of stressors linked to their perceptions of their ethnic status. A major stressor was exclusion, in that it interfered with the core task of becoming socialized as a nurse. Weak social bonds within the school of nursing and to the profession can hamper the recruitment of others from a particular ethnic group to the school and ultimately into the health care profession. A focus on the interpretation of interpersonal events in health care settings is crucial in surfacing the cultural nuances of understanding and meaning. Recommendations were made to: (1) develop an enriched grounded theory and promote mutual understanding through faculty, nursing staff and student group interviews and (2) increase the comprehensiveness of ethnic minority student retention data bases.

Pain requiring treatment is experienced by many cancer patients at the end of life. When these patients stay at home, family caregivers are often directly implicated in pain management. There are few studies that examine the process that these family caregivers engage in when they take on the responsibility of pain management. This means we need information on whether or not these family caregivers are prepared for management to ensure proper support and optimal pain control. / The purpose of this qualitative study was to study the process used by family caregivers at home to manage the pain of palliative cancer patients using a grounded theory approach. A total of 24 family caregivers with differing relationships to the patient and differing lengths of caregiver experience participated. Family caregivers were recruited using purposeful then theoretical sampling. The data sources were taped, transcribed (semi-structured) interviews, field notes, and memos. Data analysis used Strauss & Corbin's (1998) suggestions for substantive coding: open, axial, and selective coding. / The results lead to the proposition of an explanatory theory titled "the puzzle of pain management," which include: 1) a frame of the process of "drawing on past experiences"; 2) puzzle pieces representing the process "strategizing a game plan" which include the sub-processes of "accepting responsibility," "seeking information," and "establishing a pain management relationship"; 3) puzzle pieces representing the process of "striving to respond to pain" which include the sub-processes of "determining the characteristics of pain," "implementing a strategy for pain relief," and "verifying if pain relief strategies were successful; and 4) "gauging the best fit," a decision-making process that joins the two pieces of the puzzle. / The realization that family caregivers assemble a puzzle of processes indicates that there are factors that nurses must be aware of before creating, teaching, and implementing interventions for pain management. Furthermore, the results provide information to create and subsequently administer interventions based on caregivers' existing knowledge, identified needs for information and support, and current pain management regimens. The puzzle of pain management must be validated by further studies using this theory, in part, to help create interventions that will allow us to know how useful the theory is in practice. / Keywords: family caregivers, carers, pain management, palliative care, cancer pain, home care, grounded theory

<p> Culturally sensitive care is thought to take into account a person's specific cultural values and preferences when providing mental health care services. Latinos currently comprise 17% of the total U.S. population at 50.5 million and persons of Mexican heritage constitute over 66% of all Latinos in the United States. Persons of Mexican heritage experience higher rates of mental health issues and illness with 30% lifetime incidence versus 20% incidence for Anglos. Few studies have focused on the mental health treatment preferences for persons of Mexican heritage. Treatment preferences could reflect personal characteristics, acculturation perspective about mental health issues and illness, and experience with treatment. Mass media may also influence treatment preferences and mental health information-seeking. The purpose of this study was to describe preferences for mental health treatment services for persons of Mexican heritage living in the Southwest along the United States-Mexico border. Twenty-one participants were interviewed individually and their responses analyzed using Atlas-ti qualitative analysis software. The participants reported twenty-five mental health treatment preferences. The top six preferences&mdash;medication, going to the doctor, social and family support, counseling and herbal medicines, were consistent throughout demographic categories of age, gender, income, generational status, insurance status, education, and acculturation. Self-management interventions and integrative medicine were also reported as treatment preferences. Participants reported media use of television, internet, books and magazines, in-person interaction, and radio as primary mental health information sources. Media influences on mental health included education/information, hope, normalization, and a catalyst for conversation. Ascribed meanings for anxiety, depression, substance abuse, schizophrenia, and bipolar disorder included cognitive, behavioral, and interactional reports. Mental health services for persons of Mexican heritage should include varying holistic mental health treatment practices, recognizing the need for understanding of potential meanings for mental health issues and illness. Persons of Mexican heritage report the desire for the same types of allopathic care including medications and counseling as Anglos in the US. Additionally, self-management interventions and integrative medicine therapies, as well as innovative media outreach methods were reported as integral to the holistic treatment process of obtaining help for mental health issues and illness.</p>

<p>Incivility is a low-level form of violence that has been found to threaten safety and has gained increasing attention from healthcare leaders. Incivility at work causes distractions and threatens the culture of safety. Locations providing mental health services are among such high-risk areas. The purpose of this study was to evaluate the effectiveness of a nurse leader&rsquo;s educational approach to improve civility in the mental health (MH) nursing workplace using assertiveness training with role-play. </p><p> The civility score in this study was measured by staffs&rsquo; perceptions of eight items: respect; conflict resolution; cooperation; anti-discrimination; value differences; diversity acceptance; personal interest; and reliability of team members. In this study, the principal investigator (PI), a MH nurse leader, prepared and implemented a six-month plan of evidence-based actions intended to improve civility and to strengthen the sense of community. </p><p> Role-play exercises were included in assertiveness training sessions. Personalized brochures that summarized information and future direction for improving civility were prepared and distributed. </p><p> Civility awareness and assertiveness were reinforced by sharing literature, facilitating discussions, and practicing occasional role-plays to problem-solve past and current incivilities as they surfaced. Follow-up measurements showed a rapid and sharp increase in civility, with improved scores for each of the eight items. These findings support continued use of assertiveness training with role-play as an effective approach for improving civility in a culturally diverse MH nursing staff. Limitations of this study are discussed. </p>

Note: / Pain requiring treatment is experienced by many cancer patients at the end of life. When these patients stay at home, family caregivers are often directly implicated in pain management. There are few studies that examine the process that these family caregivers engage in when they take on the responsibility of pain management. This means we need information on whether or not these family caregivers are prepared for management to ensure proper support and optimal pain control. The purpose of this qualitative study was to study the process used by family caregivers at home to manage the pain of palliative cancer patients using a grounded theory approach. A total of 24 family caregivers with differing relationships to the patient and differing lengths of caregiver experience participated. Family caregivers were recruited using purposeful then theoretical sampling. The data sources were taped, transcribed (semi-structured) interviews, field notes, and memos. Data analysis used Strauss & Corbin’s (1998) suggestions for substantive coding: open, axial, and selective coding.[...] / Les patients atteints de cancer en fin de v1e eprouvent souvent des douleurs qui doivent etre traitees. Lorsque ces patients demeurent a la maison, ce sont plus souvent les proches-aidants qui sont impliques directement dans la gestion de cette douleur. Peu d’etudes existent sur le processus que les prochesaidants adoptent lorsqu’ils prennent la responsabilite de gerer la douleur. Il est done opportun d’accroltre nos connaissances afin d’outiller les proches-aidants a gerer de fac;on optimale la douleur et de mieux les soutenir dans leurs roles. Le but de cette etude qualitative est d’etudier le processus que les prochesaidants utilisent lorsqu’ils prennent soin a domicile d’une personne en fin de vie. Cette etude se base sur une approche de theorisation an ere e. L’ echantillon de I’ etude se compose de 24 proches-aidants ayant des types et des durees de relation differentes avec le patient. Les proches-aidants ont ete selectionnes selon une procedure d’echantillonnage a choix raisonne, suivi par une procedure d’echantillonnage theorique. Les donnees recueillies sont basees sur des entrevues (semi-structurees) enregistrees et transcrites, ainsi que sur des notes de terrain et des memos. Les analyses de donnees ont ete basees sur les recommandations de Strauss & Corbin ( 1998) pour le codage; c’ est-a-dire codage ouvert, axial et selectif.[...]

<p> The purpose of this project was to translate evidence-based literature into policy and practice guidelines in order to improve leadership standards and skills among nurse managers and improve patient outcomes and the quality of care. Guided by the American Nurses Credentialing Center Magnet Model and Lewin's change theory, which sets the framework for creating exceptional nursing leaders, a literature search was conducted from studies ranging from 2010 to 2012 from several databases. Inclusion criteria were based on the presence of one or more leadership styles discussed in the articles and the impact of leadership style on nursing satisfaction. A total of 25 articles were found during the electronic search, but only 7 articles met the inclusion criteria for analysis. The results of this review revealed that transformational leadership enhanced nursing satisfaction rates, while transactional leadership and situational leadership contributed to low levels of nursing satisfaction rates. This project contributes to positive social change for nurse managers because there is limited research available that focuses on leadership styles and its implication for practice. This project will inform the work of nurse managers by illuminating the importance of leadership styles on nursing satisfaction and work environment conditions.</p>

<p> Healthcare today is constantly transforming as hospital systems are challenged to maximize productivity and value. Factors such as occupational stress, difficult working conditions, unresolved conflict, lack of leadership, and increased complexity of healthcare foster disruptive and uncivil behavior and directly impact work performance, patient safety, and the physical well-being of those providing or supporting the care given to patients. The objectives of this study were to: 1. assess the prevalence of incivility within a large metropolitan healthcare organization, 2. determine differences in the frequency of incivility within select occupational groups, and 3. examine the relation between incivility and productivity, organizational commitment, job satisfaction, and workplace stress. The study was a cross-sectional, correlation design, using survey methodology. Data were collected from employees working in one organization consisting of an acute care facility, outpatient centers, and ambulatory locations. The study population included direct and non-direct patient care job categories and physicians.</p>