Mental health problems are a significant problem among early adolescents and are highly costly to society. Innovative work behaviors (IWB) of middle school faculty and staff are a potentially underused opportunity to address early adolescent mental health promotion. The purpose of this study was to explore IWB related to student mental health promotion in the middle school environment. Descriptive statistics, correlations, regressions, and multi-level modeling were used to examine associations and influence of faculty/staff, contextual, and school characteristics on IWB. School-level IWB was examined for associations with school-level perceptions of mental health service quantity and quality provided in participating middle schools. Longer time employed in K-12 education was associated with a statistically significant decrease in the degree of a faculty/staff member IWB. No statistically significant associations were found between school-level IWB and school level outcomes.

Background: Admissions to the pediatric intensive care unit (PICU) have increased during a time of PICU physician shortage. Nurse practitioners (NPs) are increasingly employed in PICU. PICU models of care may vary based upon practice location and thereby influence NP demand aw well as needed competencies. However, little is known about the role of and demand for PICU NPs, PICU provider team composition, and the influence of regulation on PICU NP practice. Objectives: To 1) identify the roles and functions of NPs working in the PICU; 2) examine the PICU provider team composition; and 3) identify hospital-reported internal regulatory characteristics and state regulatory environments influence on the practice of NPs. Methods: A national, quantitative, cross-sectional descriptive postal-mail survey of PICU medical directors (MDs) and lead NPs to describe: PICU NP clinical practice, labor inputs, working conditions; PICU provider supply and team composition; and state and organizational-level regulation of NP practice. Descriptive statistics, cross-tabulations, and Chi-square tests were used to test differences between institutional practices and provider reports of NPsâ roles and practice. Results: Responses were received from 97 (30.1%) PICU MDs and 59 (42.1%) PICU NPs representing 126 institutions (39.1%). More than half of respondents reported local provider (55.3%) and national physician (61.3%) shortages. The type of physician providers on the interdisciplinary PICU teams differed between institutions with and without NPs. PICUs that employ NPs had, on average, three full-time NPs. PICU NPsâ primary role was the provision of day-to-day patient care. Variations were identified in organizational-level regulation of NP care. Respondents reported a desire to increase the number of PICU NPs and scope of NP care. Conclusions: PICU NPs have been integrated into interdisciplinary team providing day-to-day patient care. Plans to increase the employment of and expand roles for PICU NPs should be examined in the context of the current roles and regulation of PICU NP practice. Future studies of diverse interdisciplinary PICU models of care, that investigate optimal incorporation of interdisciplinary providers skills and knowledge, may support achievement of positive patient and organizational outcomes.

Healthcare system factors may pose barriers to living kidney donation. Determining if and how program size, staffing, and organization play roles in live kidney donor outcomes is essential. The aim of this study was to describe the labor inputs, organization, and resources available within U.S. living donor programs and their associations with living donation inquiries, evaluations and donations. A mailed survey was sent to the living donor coordinator (LDC) at every U.S. living donor program (n=211; response rate=70%, total respondents=148). Respondent surveys were linked to the American Hospital Association and the Scientific Registry of Transplant Recipients databases to further describe hospital characteristics and transplant volumes. Descriptive statistics summarized survey responses; multiple linear regressions assessed associations of center characteristics with outcome variables. Almost three quarters (74%) of programs reported dedicated LDCs. Median number of LDC FTEs per center was 1.0 (IQR 1-2); 37% of programs reported that the LDC devoted less than 40 hours per week to the living donor program. More than one LDC FTE was associated with higher numbers of living donor inquires, evaluations, and transplants, as was having a dedicated living donor coordinator (p<0.004). Dedicating clerical staff to the program was associated with higher numbers of evaluations and transplants (p<0.003). Centers that accept donors with controlled hypertension and centers that have a kidney paired donation program reported higher numbers of LD inquires, evaluations, and transplants (p<0.021). The overall national conversion rate/donor yield from initial contact to living donor transplant was 8% and the conversion rate from evaluation to living donor transplant was 32%. This research contributes to the current knowledge of transplant centers by describing labor inputs, organizational care structures, and resources used in living donor programs across all US transplant centers. This study is also the first known study in the transplant literature that describes an association between nurse labor and living donor outcomes.

Both parents and providers identify difficulties with their communication interactions in pediatric health care, especially around child development. Autism Spectrum Disorder (ASD) is one of the most common childhood developmental delays, but little is known about the communication processes that occur during the diagnostic period between parents and providers. The purpose of the study was to identify key elements, barriers to, and facilitators of the communication process between parents and health care providers during the diagnostic period for a child recently diagnosed with ASD. Parents were recruited from throughout the U.S. from ASD parent and community organizations and research networks. The study utilized a mixed methods design with semi-structured, one-on-one interviews and the administration of a demographic survey and standardized measures of mental health and family-centered care with 31 parents. The interviews uncovered major themes related to barriers and facilitators of communication process at both the provider and systems level, as well as parentsâ initial concerns and actions taken, provider reaction to parent concerns, and outcomes of the communication process. Facilitators included parents reporting providers listened to them, elicited their concerns, were respectful, were knowledgeable, treated parent like a partner, as well as systems issues that resulted in providers having direct communication and enough time to spend with parents. Barriers included the provider not treating parent as a partner, not listening, lack of knowledge about ASD, not giving parents information, along with systems issues resulting in providers not having enough time with parents, long wait times for diagnosis, insurance issues, and indirect communication. The majority of parents rated the diagnostic process as stressful (71.0%) and that they experienced moderate to severe symptoms of depression and anxiety (54.8%). A statistically significant inverse correlation was observed between parent reports of the number of key elements of communication and reported stress (rs = -.43, p=0.016). The results of this study can be used by health care providers to help guide the communication that occurs with families during this time, as well suggest possible areas of intervention for future research.

The Baby-Friendly Hospital Initiative (BFHI) has support from numerous policy and regulatory bodies, and has been shown to be an effective intervention to encourage women to initiate breastfeeding at the time of birth. Uptake of the BFHI has been slow in the United States (US). A significant gap in knowledge of factors that promote or block BFHI adoption and implementation exists. Therefore, the aim of this project was to identify the greatest barriers to and facilitators of the adoption and implementation of the BFHI in the US. This was a cross-sectional study using a purposive sample of perinatal health care specialists in multiple states across the US. Respondents were recruited via statewide or regional breastfeeding organizations and invited to complete an online survey. 256 respondents from twelve states completed the survey. Many organizational and policy factors that support adoption and implementation of the BFHI were identified. Some of the main facilitators of adoption and implementation included sufficient resources, workforce training, participation in statewide perinatal quality improvement collaboratives, and clearly stated goals from organizational leaders. Some of the barriers were a lack of financial support from outside organizations, insufficient organizational resources to support the costs of the program, and lack of buy-in from clinicians. This study lays the groundwork for further inquiries into the targeted identification of the greatest barriers and facilitators of adoption and implementation of the BFHI and can provide guidance to administrators and clinicians.

Obstetric emergencies account for the majority of causes of maternal death. The major causes of death in obstetric emergencies include bleeding, pregnancy induced hypertension, cord prolapse, shoulder dystocia, poor progress, placenta abruptio, placenta praevia and amniotic fluid embolism. A qualitative, descriptive phenomelogical research design was used to explore and describe the lived experiences of the advanced midwives regarding the management of obstetric emergencies in the MOUs of Gauteng province, South Africa. Semi-structured individual interviews were used to collect data from thirteen (13) advanced midwives who were purposively selected and had been working in the MOUs for two years and more after obtaining their qualifications. The seven Collaizi’s procedural steps were utilized for data analysis. Measures to ensure the trustworthiness of the study was adhered to. The findings revealed that, advanced midwives experiences psychosocial stress because of unconducive working environment and higher expectations from the patience and their families. They demonstrated professionalism even when the midwives showed lack of professionalism. In conclusion, unfavorable working conditions experienced by midwives had a negative impact in the management of pregnant women during obstetric emergencies. Management should support advanced midwives with necessary resources that will enable them to perform their duties effectively. / Dissertation (MNurs)--University of Pretoria, 2021. / Nursing Science / MNurs / Restricted

<p> Clinical experiences are an essential part of the training of future nursing professionals. The period of clinical experience aims to develop in the student the necessary skills to practice as a nursing professional, when the academic program ends. This case study aimed to understand the opinion and explore the perception of faculty, clinical instructors, and nursing students on the meaning, contributions and challenges presented during clinical experiences. Among the themes explored in the focus groups were the meaning and importance to learning about the profession of clinical experiences, teaching strategies used during the practice scenarios, didactic relationships developed among students, clinical instructors, and teachers. The goal was to learn from all participants about what they do, their expectations, and the challenges presented during the clinical experiences.</p><p> A qualitative, descriptive and contextual research design was followed, which required conducting six focus groups to collect the information from the perspective of all the participants. Faculty, clinical instructors, and nursing students participated each in two focus groups. Collected data were transcribed, coded and analyzed in order to organize it under themes related to the research framework.</p><p> The qualitative analysis of the focus groups revealed that nursing faculty and clinical instructors perceived clinical experiences as a very important element in the training of nursing students, but that coordination between the academy and practice scenarios is disconnected and needs improvement. They also expressed that they use various learning strategies during the clinical experiences, however, they recognize it needs more structure and suggested mentoring as a strategy to consider. They affirmed that mentoring could contribute positively to enhance the teaching-learning process. Clinical instructors understand they perform mentoring roles, but they would like to have a more defined role and structured process. Nursing students, also, recognized the importance of clinical experiences in their professional training. They expressed the need to improve the communication between the academy and the practice scenarios in order to reduce the levels of anxiety they experience when entering the clinical experiences. Nursing students also expressed the need to consider the use of different teaching strategies, such as mentoring, to improve clinical experiences.</p>

Thesis (MCurr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The profession of nursing is a twofold vocation that has a scientific theory as the foundation of all nursing intervention or skill. Despite clinical preceptorship being a useful strategy of teaching, many training hospitals and clinical facilities are without this avenue of learning and where available, it is often not optimally utilised. The aim of this study was to explore the role of the clinical preceptor in enhancing nursing education at Edendale Hospital and Edendale campus of a nursing college. A mixed method approach was applied utilizing both qualitative and quantitative methods to collect information about the experiences and challenges as well as clarify existing problems. Samples were drawn from all stakeholders of nursing education i.e. nursing students, nurse educators and ward managers of Edendale Hospital and Campus using random and purposive sampling respectively. Data were collected using selfadministered questionnaires for students and nursing managers and an interview guide for focus group interviews for nurse educators. Ethical approval was sought from the Health Research Ethics Committee at the Faculty of Medicine and Health Sciences at Stellenbosch University, the Department of Health, the Kwazulu-Natal College of Nursing and Edendale Hospital and Campus. The findings of this study support Weidenbach’s Prescriptive Theory in which the author maintains that nursing is a practice discipline designed to produce explicit desired results which here refers to the enhancing of nursing education with the contribution of clinical preceptorship. Patricia Benner’s Dreyfus and novice to expert models were used to express the need for meaningful practical experience in nursing students and to shows nurse educators how to identify the practical learning needs of the students and assist them acquire competence. The results of the study suggest that the clinical preceptor is a mentor and a guide who facilitates the correlation of theory and practice in nursing education. The results also suggest that students are experiencing problems in clinical practice and that clinical preceptorship is needed. A number of recommendations are made based on limitations identified in the present teaching-learning process. One of the recommendations is that partnership building strategies be fostered between the hospital, the campus and the Faculty of Nursing Education. This team approach could clearly define the role of the clinical preceptor to ensure optimum nursing education. Further research is recommended. / AFRIKAANSE OPSOMMING: Verpleging is ’n tweeledige beroep met ’n wetenskaplike teorie as grondslag vir elke verpleegintervensie of -vaardigheid. Ten spyte daarvan dat kliniese instruksie (“preceptorship”) ’n nuttige onderrigstrategie is, ontbreek dit by baie opleidingshospitale en kliniese fasiliteite, en waar dit beskikbaar is, word dit dikwels suboptimaal aangewend. Die doel van hierdie studie was om ondersoek in te stel na hoe belanghebbendes by verpleegopleiding by Edendale-hospitaal en -verpleegkampus kliniese instruksie ervaar, en om sodoende vas te stel of kliniese instruksie verpleegopleiding by daardie fasiliteite versterk. ’n Gemengde benadering van sowel kwalitatiewe as kwantitatiewe metodes is gevolg om inligting oor die ervarings en uitdagings in te win en bestaande probleme te verklaar. Steekproewe is met behulp van onderskeidelik lukrake en doelbewuste seleksie uit alle belanghebbendes by verpleegopleiding by Edendale-hospitaal en - verpleegkampus geneem, met inbegrip van verpleegstudente, verpleegopvoeders en saalbestuurders. Data is deur middel van selfvoltooiingsvraelyste vir studente en eenheidsbestuurders, en ’n onderhoudsgids vir fokusgroepgesprekke met verpleegopvoeders ingesamel. Etiekgoedkeuring is verkry van die Gesondheidsnavorsingsetiekkomitee van die Fakulteit Geneeskunde en Gesondheidswetenskappe aan die Universiteit Stellenbosch, die Departement van Gesondheid, die KwaZulu-Natalse Verpleegkollege sowel as Edendale-hospitaal en - verpleegkampus. Die bevindinge van die studie ondersteun Wiedenbach se voorskriftelike teorie, waarin sy volhou dat verpleging ’n praktiese dissipline is wat ontwerp is om bepaalde gewenste resultate te behaal. Patricia Benner se Dreyfus- en beginner-tot-kennermodel is ook gebruik om die behoefte aan sinvolle praktiese ervaring by verpleegstudente te staaf, en om verpleegopvoeders te wys hoe om studente se praktiese leerbehoeftes te bepaal en hulle vaardighede te help ontwikkel. Die resultate van die studie dui daarop dat die kliniese instrukteer as mentor en begeleier die korrelasie tussen teorie en die praktyk van verpleegonderwys fasiliteer. Die resultate dui verder daarop dat student probleme in kliniese praktyk ervar en kliniese instruksie benodig. ’n Aantal aanbevelings word gedoen op grond van beperkinge wat in die huidige onderrig-en-leer-proses uitgewys is. Een van die aanbevelings is die ontwikkeling van strategieë om vennootskappe tussen die hospitaal, die verpleegkampus en die fakulteit verpleegkunde te bou. Hierdie spanbenadering kan die rol van die kliniese instrukteur duidelik omlyn ten einde optimale verpleegopleiding te verseker. Verdere navorsing word aanbeveel.

Improving throughput in the B. Tech. Nursing Sciences programme is a complex issue as not only the theoretical but also the practical component and undefined inner strengths of the student influence success. The purpose of this article is to report factors in the prospective students’ social background, their perceptions of nursing and nurses and their motivation that could influence their academic success in the first year of study. The research design was contextual, qualitative and exploratory. Triangulation of data gathering methods was obtained by using two instruments, a targeted selection interview and a written instrument. Data analysis was done through Tesch’s approach. The results indicate that prospective students perceive a nurse to be functioning from the affective domain, and that they judge themselves to be strong in the affective domain. The cognitive domain was rarely mentioned (7%). Due to the myths regarding the nursing profession, the profession continue to attract students who are interested in the myth and not the reality.

The transformation from an industrial to a knowledge age has brought about a fast-changing world-focus and a competitive economy. The nursing profession, as part of the larger economy, is challenged by this transformation due to globalisation, internationalisation, capitalism within a consumer society, an ageing workforce, staff shortages, international migration and advanced technology. It is argued that these challenges are impacting directly on the nursing profession as a part of the global economy. This impact is intensified due to the ethos of nursing that is evaluated from a profit perspective and does not value the core values of nursing, that of caring and trust. The managerial strategies that are applied in nursing does not sufficiently harness and direct nurses. Focus is placed on nurse leaders as crucial role players in directing the nursing profession in peril. A call was made by followers for a different type of nurse leaders to lead this challenged profession, in an international arena. Social capital, being an abstract and multi-facet concept is presented as a possible framework to assist with the above crisis. Extremely limited literature was found on the utilisation of social capital to develop nurse leadership amongst these challenges. The research question, and later comprehensive aim, was formulated to examine how a theory in Nursing Science for authentic leadership embedded in a social capital framework, can be constructed. Theory construction of a middle-range theory was conducted in three phases. Phase One implied concept identification, descriptions, definitions and analysis. The actual theory construction was achieved in Phase Two, whilst Phase Three detailed the theory evaluation and guidelines for operationalisation. Main and related concepts were identified as agent, recipient, context, procedure, goal and dynamics. Data collection was conducted by means of a comprehensive literature search of all available national and international literature and included theories, textbooks and articles. Data saturation was achieved after no new information surfaced, n=188. The main concepts, authentic leadership (agent) and social capital (procedure) underwent a comprehensive concept analysis. Related concepts, namely the professional nurse (recipient), South African hospitals (context), positive impact on the triple bottom line (goal) and trust (dynamics) underwent a literature analysis. The theory was graphically portrayed and described by means of a model. The theory was submitted to a panel of experts (n=6). The panel was selected following purposive sampling due to specific inclusion criteria for expertise in social capital, and/or leadership and/or theory construction. The evaluation of the theory was conducted according to a specific framework for critical reflection. Guidelines for the operationalisation of the theory were formulated on a macro-, meso- and micro-level. The final step was the evaluation of the research and recommendations were made. / Thesis (Ph.D. (Nursing))--North-West University, Potchefstroom Campus, 2009.