<p> The purpose of this qualitative phenomenological study was to explore emergency nurses&rsquo; perception of patient-initiated violence in eastern Tennessee. Twenty-four rural eastern Tennessee nurses participated in the study. The 24 participants were assigned to one of four gender specific focus groups. The focus groups offered qualitative data associated with the phenomenon. Themes and subthemes emerged from the analysis of participants responses using Colaizzi&rsquo;s (1978) strategies. The responses were segmented and compared to identify similar phrases or words. The data analysis detected five themes. Victimization manifested as participants&rsquo; feelings and a lack of executive leadership support. Re-victimization due to rural nurses&rsquo; continual exposure to patients who previously committed violent acts. A lack of executive leadership support was identified. Self-care deficit resulting from the participants&rsquo; post-exposure symptoms. Distinct gender differences were evident in this study. Implications include exploring an open dialogue between emergency nurses, nursing leadership, and executive leadership to develop policies that support the rural emergency nurse and establish policies that mitigate violence. Gender differences can be explored through individual discussion with emergency leadership leading to an individualized action plan that can foster self-care, employee engagement, and retain staff at the bedside.</p><p>

<p> The placement of an indwelling urinary catheter (IUC) is a commonly performed clinical procedure which may become challenging for the clinician and painful for the patient. In response to urologic complications attributed to repeated failed IUC insertion attempts by nurses, a difficult urinary catheter (DUC) team program was launched in October 2012. The purpose of the doctoral project was to conduct a quality improvement evaluation of the effectiveness of the DUC team program using retrospective data from May 1, 2013 through May 31, 2017. Benner&rsquo;s novice to expert model was chosen as the theoretical framework to guide the additional training, critical thinking, problem-solving, and skill acquisition necessary for team member inclusion. The practice-focused question for the project answered whether DUC team nurses, through advanced training and demonstrated procedural competence, have been effective with DUC insertions. Sources of evidence included primary and secondary articles in peer-reviewed journals, as well as clinical evidence collected from internal sources. During the project time-line, 463 DUC team consultations were recorded with an insertion success rate of 89.6%. Based on the DUC team concept, additional didactic content and simulation training may be developed for other cognitive and skill-based clinical procedures. The implications for positive social change include improved patient safety and comfort, as well as cost savings for the organization and overall healthcare system.</p><p>

<p> Access to safe abortion care has been linked to better maternal and child health outcomes (Sedgh et al., 2012) and identified as essential for advancing women&rsquo;s economic and social equality (Lang, 2013; Bengsch, 2015). Around the world, nurses, including nurse practitioners (NPs) and certified nurse midwives (CNMs), are integral members of the health care teams that provide care to women considering or electing to have an abortion. Evidence supports NPs and CNMs as safe and effective providers of comprehensive early abortion care, and acceptable to patients (Barnard, Kim, Park, &amp; Ngo, 2015; Kallner et al., 2015; Weitz et al., 2013). </p><p> Currently in the United States (US), almost one million women have an induced abortion each year (Jones &amp; Jerman, 2017). National abortion data reveal significant disparities in rates, and inequities in access (Jerman, Jones, &amp; Onda, 2016). An inconsistent legal and regulatory landscape precludes NPs and CNMs from providing comprehensive abortion care in many states, including some where there are few providers. Vermont and New Hampshire comprise two of the four states where laws and practice regulations allow NPs and CNMs to perform aspiration abortion, and across New England. These advanced practice nurses (APRNs) are extensively involved in providing and managing the care of women undergoing medication abortion. </p><p> Little literature describes nurses&rsquo; experiences providing comprehensive early abortion care around the world, including in the US. The aim of this qualitative, exploratory, descriptive research study was to explore the experiences of NPs and CNMs who provide comprehensive early abortion care in New England. Data were collected through in-person individual interviews with seven NPs and one NP/CNM. Providing comprehensive early abortion care was generally a positive experience for most participants, though it did include challenges. Critical influences to becoming an NP or CNM who provided comprehensive early abortion care included the era in which participants came of age, values of their family of origin, exposure to feminism, reproductive rights and social justice during emerging adulthood, having a role model or mentor, and a personal experience of having an abortion were. Support at every level from interpersonal to societal was found to be a key enabling or constraining factor. Laws and regulations at the societal level were also noted to facilitate or impede abortion care provision by NPs and CNMs in the study. Finally, participants offered words of wisdom to others considering providing comprehensive early abortion care that ranged from clinical pearls to inspirational statements. They were universally encouraging in recommending this as a service to incorporate into clinical practice. This study has a number of implications for the future including the need for further research on NPs and CNMs experiences providing early abortion care in other regions of the US, and to remove state legislative and regulations that constrain practice for clinicians in this area of reproductive health care.</p><p>

<p> Healthcare management is an industry where skill sets are incremental, and Registered Nurses (RNs) must gain their clinical skills before they develop their management skills. Professional training for management-bound RNs seldom comprises more than a few disjointed days or weeklong development seminars, which is valuable but inadequate. The purpose of this original basic qualitative study, which employed Husserl and Heidegger&rsquo;s approach of phenomenology, was to explore the lived experiences of staff RNs who transitioned into the Clinical Nursing Supervisor (Nurse Manager) role within a small rural community hospital in North Carolina. Semi-structured interviews using open-ended questions were utilized to collect rich, contextual data until data saturation occurred. Open and axial coding of the data, documented in a code/theme frequency table, facilitated the discovery of central themes within the data including: a lack of orientation to the new role; inconsistent expectations of the new role; the benefits of a formal program or structured orientation for the new role, and a need to focus the hospital administration on formal leadership orientation and succession planning. The evidence from this original basic qualitative study aligns with the published literature regarding the transition from a staff RN role into a nursing leadership role and supports making a proposal to the hospital&rsquo;s administration for a systems-oriented Clinical Nursing Supervisor training opportunity such as a 90-day nursing leadership orientation that included formal classes on budgeting, common human resource management issues, and how to evaluate staff. This formalized training, in concert with one-on-one mentoring with experienced Clinical Nursing Supervisors, would ensure a smoother transition from the staff RN role into a Clinical Nursing Supervisor role and would produce more efficient, more satisfied nursing leadership professionals who are more inclined to stay with the organization that helped their career growth.</p><p>

The purpose of this study was to determine if a shared governance management structure significantly affects the level of job satisfaction of registered nurses who work in hospitals. It was also intended to document which components are identified by registered nurses as impacting on their job satisfaction or dissatisfaction. The index of Work Satisfaction (IWS) was used to measure job satisfaction among two groups of nurses, one working in a hospital with a shared governance management structure (n = 99) and the other working in a hospital without a shared governance management structure (n = 143). IWS results indicated higher levels of satisfaction among nurses at the hospital with the shared governance management structure in three of the six components, namely Autonomy, Task Requirements, and Organizational Policies. Nurses at the hospital with the shared governance management structure were asked to respond to four additional questions. These were designed to measure to what degree nurses perceived shared governance to be working on their unit as well as in their hospital. These nurses were also asked to what degree they valued shared governance for Nursing. Results indicate the majority of nurses perceived shared governance to be "working well" on their unit and at their hospital. The majority also highly valued shared governance for Nursing. The findings of this study suggest that there may be a relationship between job satisfaction of registered nurses and a management structure which encourages decision making at the staff nurse level. Implications for the restructuring of nursing organizations are drawn. Recommendations for further research are provided.

The primary purpose of this study was to identify the way in which two groups, staff nurses and nurse administrators/managers, each conceptualize the ideal and actual role of the registered nurse practicing at the bedside. Data was examined in order to identify similarities and differences in the opinions of the two groups. A questionnaire with 35 items/situations using a Likert scale was developed. Items/situations were worded to conform to a five-point response format ranging from strongly agree to strongly disagree. The role conception items/situations were designed to measure the respondent's perceptions of what the role should be and perceptions of what actually exists in the practice of the nurse role. The sample of 300 non-management nurses was randomly selected using 50 percent of the professional nurses from each unit. Nurse administrators/managers comprised a smaller number than non-managers, therefore, the questionnaire was given to this entire group. Noteworthy findings of the study include that (a) staff nurses and nurse administrators/managers agreed in their perception of what comprises the actual professional role of the nurse practicing at the bedside, (b) both groups also agreed in their perception of what comprises the ideal professional role of the staff nurse practicing at the bedside, (c) the staff nurses and nurse administrators/managers agreed in their perception of what comprised the actual bureaucratic role of the nurse practicing at the bedside, (d) the groups agreed in their perceptions of what comprised the ideal bureaucratic role of the nurse practicing at the bedside, and (e) there is a significant difference between the ideal and actual role conceptions within both the bureaucratic and professional concepts. Simply stated, the respondents of this study do not believe that nursing is being practiced the way nursing should be practiced. Implications of the study are presented and discussed, and recommendations for further study are provided.

Individuals with heart failure (HF) are often readmitted within 30 days of discharge from the hospital. Telehealth has been developed to help manage HF during this critical period. However, association of telehealth with improved HF outcomes is still unclear. There is a need to identify the patients who benefit most from telehealth and explore factors that work in conjunction with telehealth to improve HF outcomes. Therefore the purpose of this study was to explore the patient characteristic factors that impact health status and healthcare utilization outcomes of patients with HF who use telehealth in a homecare setting. A descriptive, correlational study design using retrospective chart review was employed. The sample comprised Medicare patients admitted to a New England homecare agency, with HF as a diagnosis and had used telehealth from 2008 to 2010. OASIS and electronic documentation at the homecare agency served as data sources. Descriptive statistics, logistic and multiple regression analysis were used to analyze association of patient demographic, psychosocial status, and disease characteristics with HF outcomes of patients on telehealth. The sample size was 403, of whom 70% were over 75 years of age, 55% were female, and 94% were Caucasian. Number of nursing contacts ranged 1 to 26 with a median value of 10. There were 118 (29.3%) all-cause readmissions, 76 cardiac-related hospitalizations (18.9%), 17 cases with mortality (4.2%) and 52 (12.7%) abrupt terminations of telehealth. For patients with HF on telehealth, patient characteristics such as: anxiety, high number of medications, acute cardiac events, musculoskeletal, psychiatric and anemia type of co-morbidity were associated with high nursing utilization patterns; dyspnea, high number of medications, obesity, ACEI/ARB and beta-blockers were associated with hospitalizations; and renal, psychiatric and cancer type of co-morbidities and female gender were associated with unplanned termination of telehealth. Abrupt termination of telehealth was also found to be correlated with hospitalizations. The findings of this study contribute to our understanding of healthcare utilization by patients with heart failure on telehealth.

Thesis (M. Arch.)--Ball State University, 2009. / Title from PDF t.p. (viewed on Dec. 14, 2009). Includes bibliographical references.

<p> This grounded theory study describes how Nurse Practitioners (NPs) provided care to Aboriginal people in British Columbia and proposed a theoretical foundation to guide NPs interactions with Aboriginal people in providing healthcare. This study first explored NPs work with Aboriginal people. Through analysis of interview responses, insight was gained into how NPs provide care to Aboriginal people. Fourteen NPs who worked with Aboriginal people in British Columbia for at least one year during the past five years were interviewed. After each interview data were manually coded for concepts and categories from which to build theory. Memos were written for further clarity and participants were asked to verify whether or not identified concepts and categories worked, fit, and were relevant and modifiable as new data arose. The theory, Engaging Mutually, identified core categories of Initializing Engagement, Sympathetic Mutuality, and Therapeutic Enlightenment as being connected and working together to help provide effective health care. Engaging Mutually was identified as relevant to the theories of oppression, motivational expectancy, social justice, social cognitive, cultural competency, and Watson&rsquo;s caring theory. The significance of this study was to assist NPs to gain a better understanding of how to work with Aboriginal people to improve their health. This study contributes to research, theory, leadership, and nursing and NP practice. Engaging Mutually may assist NPs and other health care providers to develop appropriate health care practices when working with Aboriginal people and potentially with people from other cultures.</p>

<p> Medication administration is an important task performed daily by nurses and is one of the key aspects of safe patient care. The multiple and varied roles of nurses, complexity of workplace, chaotic and technical nature of the work environment may result in cognitive overload that may overwhelm nurses, which may possibly lead to medication errors. All medication errors committed are considered serious events but some may consequently be harmful to patients. Research indicates that when medication errors occur the concern is usually for the patients involved in the incident. However, making a medication administration error has a lasting effect on the nurse as well as the patient (Schelbred &amp; Nord, 2007; Treiber &amp; Jones, 2010).</p><p> This study examined what it was like to make a medication error for eight registered nurses through in-depth and focused face to face interview using the descriptive phenomenological approach rooted in the philosophical tradition of Husserl. Two interviews were carried out with each participant and the research data were generated from a total of sixteen interviews and field notes. The transcripts were analyzed using the seven-step methodological guidelines developed by Colaizzi for data interpretation to understand the meaning of the nurses lived experiences of making medication errors.</p><p> Five theme categories emerged: Immediate <i>Impact: Psychological and Physical Reactions; Multiple Causes within Chaos: Cognitive Dimensions; Embedded Challenges: Healthcare Setting; Organizational Culture: Within the Place/Within the Person; Dynamics of Reflection: Looking Forward</i>. The essential structure of the phenomenon of making a medication administration error included the realization that a profound experience had happened to them. This resulted in physical and emotional upheavals, a threatened professional status, with low self-esteem and confidence. An overwhelming workload, a stressful work environment and ill-treatment by peers were descriptions of the cause of the errors. Nurses did offer ways to improve the system but felt their concerns were often not valued. Implications for nursing practice to improve patient outcomes, and for nursing education, to radically change the teaching of medication administration were formulated.</p>