Hospital care is changing, - dominated by the dollar and technology and the patient is taking second place. Nursing, traditionally known as being a caring profession, is not exempt from the changes and the traditional entrance interview to find caring students has been replaced by a computerised system. Graduates from university programs are being branded as non-caring. This research sought to find practical ways in which nurses showed caring to patients, and to develop a framework which could be used to teach and cultivate caring attributes in undergraduate students. A broad sweep of the past was taken to show how, dominated by disease and the necessity to take care of the suffering and infirm, nursing has been inextricably linked to the inability of science to cure. The discussion on the impact of the Therapeutic Revolution and a health care system, dominated by the dollar, places nursing and caring in perspective. Some philosophical, religious and psychological notions of caring were briefly explored. A participative paradigm underpins this research which uses a collaborative inquiry cyclical and reflective process of three phases. In Phase I a group of Graduate Registered Nurses reflected on the enacted/strategies/skills that were used to show caring to patients. Six key enactments were elicited from the total of 64 reflections that were submitted. Phase II constructed a framework that could be used to teach caring, which was then critiqued by an expert group of educators. Phase III returned to Phases I and II and used a process of reflection-on-reflection and a new emergent meaning of caring in nursing ensued. As a result of this reflection-on-reflection, a reconfiguration of the framework resulted in the development of the Care Connections model.

Research Doctorate - Doctor of Philosophy (PhD) / Registered nurses, while carrying out their professional roles, regularly encounter situations with ethical components. While there are research findings reporting the types of ethical challenges nurses face, their level of involvement in ethical decision-making, and reasoning processes used, how nurses actually deal with situations that challenge them personally has not been specifically explored. The purpose of this study was to investigate the psychosocial processes that can explain how registered nurses reason and make decisions when faced with ethical situations that challenge their personal values and belief systems. A grounded theory approach was used to conduct the study, allowing a substantive theory to be developed. Twenty-three nurses, currently working in metropolitan or regional areas in New South Wales, volunteered to participate in the study. Two methods of data collection were utilised, the first being semi-structured, in-depth interviews which were audio taped then transcribed. The second method used hypothetical vignettes with associated questions to which the participants were invited to anonymously return written responses. Data were managed by means of the computer program NVivo 2, while constant comparative analysis using open, axial and selective coding, as outlined by Strauss and Corbin (1998), was performed. The substantive theory which emerged from the data explains the processes used by nurses when they have to deal with ethical challenges to their personal values and beliefs. The basic psychosocial process (core category) of protecting client autonomy reveals a pattern of moral reasoning that gives priority to the client’s self-determined choices. This subsumes the key processes (subcategories) of: (1) being self-aware, (2) determining duties to other/s versus self, (3) engaging self as protector, and (4) restoring self from tension or anguish, which link to each other and to the core category to explain the various sub-processes used when protecting client autonomy is considered a priority. Findings in the study revealed that nurses who give primacy to client autonomy believe they should not impose their own preferred choices on to clients. Yet the emphasis on client autonomy is also paradoxical, since it may come at the cost of compromise and even denial of the nurses’ own autonomy and their deeply held values and beliefs. When they become aware that their personal values and beliefs are being challenged, they are at times prepared to compromise their own values or beliefs, yield to constraints, or put themselves at risk in order to protect the autonomy of clients. Such actions can leave nurses experiencing ethical tension or anguish for which they need to seek support. Opportunities to find appropriate support are not always available to them in the work environment. The findings in this study have important implications for both nurses and the nursing profession. The pattern of moral reasoning shows generosity and nurses’ commitment to their caring and advocacy roles. However, when nurses are regularly prepared to compromise their own values or beliefs because they give priority to protecting client autonomy, there is a risk they may be left with a sense of loss to their personal worth and in their ability to be moral agents. Further, in some situations it may occur out of complacency because they simply accept that it is the client’s choice, absolving the nurse of further moral responsibility. Appropriate support systems need to be available to nurses to help them deal with the consequences which may occur as a result of giving preference to clients’ choices, over their own.

Thesis (Ph. D.)--College of Saint Mary -- Omaha, 2008. / A dissertation submitted to the doctoral program of College of Saint Mary in partial fulfillment of the requirements for the degree of Doctorate in Education with an emphasis on Health Professions Education. Includes bibliographical references.

AN ABSTRACT OF THE DISSERTATION OF Gayla Stoner, for the Doctor of Philosophy in Education degree, presented on May 16, 2015, at Southern Illinois University Carbondale. TITLE: INSTRUCTORS' PERCEPTIONS OF ONLINE INSTRUCTION WITHIN REGISTERED APPRENTICESHIP PROGRAMS MAJOR PROFESSOR: Dr. Barbara Hagler This qualitative study explored the perceptions of instructor use of online instruction within Registered Apprenticeship Programs (RAPs). The study concentrated on experienced instructors within a RAP that is part of a long-term, well-established trade union located in a major metropolitan area in the Midwestern United States. This study was informed by the methodology of a constructivist case study, which included the following methods: document review, expert panel, and in-depth interviews. Swan, Garrison, and Richardson's (2009) process-oriented model of the Community of Inquiry (CoI) with a constructivist approach served as the conceptual framework to inform this study. The purpose of this study was to contribute to the body of knowledge of online instruction within RAPs. The focus of this research study described (a) how RAP instructors perceive online instruction, (b) how their perceptions might impact the learning experiences of adult learners, and (c) how the perception of online learning may be improved among such instructors. The Office of Apprenticeship, which is within U.S. Department of Labor (DOL) Employment and Training Administration (ETA), recently revised regulations that now encourage the integration of technology-enhanced training into RAPs. Specifically, on October 29, 2008, the ETA, through its Office of Apprenticeship, exercised its statutory authority under the National Apprenticeship Act of 1937 and promulgated the first revision in more than 30 years to its longstanding regulatory rubric governing RAPs (Code of Federal Regulations, Title 29, Part 29) (Labor, 2008). These revisions, published in Title 29, Part 29 of the Code of Federal Regulations (29 CFR Part 29), embrace the use of "electronic media," including "interactive distance learning," as permissible instructional vehicles for the technical training of RAP-enrolled apprentices (Labor, 2008). As a result of the revision of 29 CFR Part 29, RAPs now have the option to augment their formal training programs with non-traditional instructional modalities for the benefit of both apprentice-sponsoring employers and enrolled apprentices. Interviewee quotes are used throughout the study to illustrate the range of interviewee opinion and to support conclusions. These findings may enable the instructor to provide quality instruction by demonstrating the elements of presence described in the CoI process-oriented model. In addition, my findings indicated there is evidence of a CoI process-oriented model that helps facilitate quality online learning within this specific RAP. I also discovered that RAP instructors recognize and encourage the benefits of online instruction for the apprentice, which includes (a) increased training opportunities and (b) the ability to maintain adult lifestyles. Additionally, instructors serve as mentors for the apprentice by providing guidance and opportunities in regard to achieving their educational goals. Also, I found that perceptions of online learning will continue to improve through the ongoing support provided by the RAP. Support includes technology-based workshops and pedagogical-based professional development opportunities. Finally, RAP instructors must continue to be educated on the advantages online instruction can bring to the self-directed apprentice. Primary conclusions from the study are the revelation of a strong community establishment within this specific RAP. This community of learners support the apprentice's ability to contribute positively to the workforce through the attainment of educational goals. In addition, RAP instructors take ownership of the responsibility to provide flexible educational offerings to the apprentice. These offerings include the delivery of quality courses that result in the benefits gained through online instruction. Also, instructor support of resources must continue to remain a priority for the RAP. Finally, I concluded that the self-directed apprentice has similar attributes as the ideal online learner. Flowing from the study's conclusions are several recommendations for this specific RAP, as well as the Employment and Training Administration. My recommendations include the suggestions for online lifelong learning and professional development course offerings, as well as the comparison of the learning outcomes of apprentices based on delivery modes. I recommended assessments and evaluations or online program evaluation in RAPs. Also, I recommended instructor creation of a mechanism for evaluating the quality of online instruction within RAPs. I recommended that RAPs continue to consider additional paths for sustainable funding. Additionally, I recommended that RAP instructors should receive more knowledge and application training in regard to the utilization of the process-oriented model theoretical framework of the Community of Inquiry. Finally, I recommended the creation of a national advisory sub-committee to serve the Federal Advisory Committee on Apprenticeship. The sub-committee would be charged with the purpose of understanding and disseminating educational and technological instruction to enhance RAPs.

abstract: Currently, there has been limited research on evaluating the social media use and competency level of registered dietitian/nutritionists (RD/N). With health information increasingly sought on social media, it is imperative to understand the social media competency of health professionals. The social media use, reach, and competency level of a nationwide RD/N sample was assessed utilizing an online survey. The sample (n=500) while mostly female (97%) was representative of RD/Ns compared to the nationwide statistics from the Commission on Dietetic Registration. The sample included RD/Ns from forty-six states with California (n=44), New York (n=42), and Texas (n=34) having the largest proportion of respondents. The majority of RD/Ns engage in social media for personal use (92.4%) and 39.2% engage for professional use. One hundred and twenty-five RD/Ns reported 777 ± 1063 (mean ± SD) social media followers. As compared to non-millennial RD/Ns, millennial RD/Ns engaged significantly more in social media for personal and professional use (+10% and +13.5% respectively, p<0.001) and scored significantly higher for social media competency (p<0.001). Additionally, food and nutrition management and consultant/private practice/industry RD/Ns had significantly higher competency scores than clinical RD/Ns (p=0.015 and p=0.046, respectively). RD/Ns who use social media personally and professionally had a significantly higher competency score than RD/Ns who did not (p<0.001). There were significant associations of Facebook, Twitter, total followers and total average followers with the social media competency score (r=0.265, 0.404, 0.338, & 0.320, respectively) in RD/Ns. Specifically, the social media competency score, was found to explain 16% of the variation in the number of Twitter followers and 10% of the variation in the average number of followers by platform. These data suggest an opportunity to increase RD/Ns’ social media reach (i.e. following) by improving competency level. / Dissertation/Thesis / Doctoral Dissertation Physical Activity, Nutrition and Wellness 2017

Background: Cardiology is but one of the many clinical foci available to certified Advanced Practice Registered Nurses (APRNs). In fact, more acute care APRNs choose cardiology as their focus than any other. With such strong interest in cardiac advanced practice nursing, it is imperative to assess the adequacy of preparation for those who wish to follow this career path. Known barriers exist in the educational and clinical preparation of this APRN population, however, there is little research detailing the specifics of those barriers. Purpose: This study describes the needs of APRNs who plan to specialize in cardiology. Method and Sampling: A qualitative design was used to describe the motivation of APRNs specializing in cardiology, tools they currently utilize to achieve their specialization, and their needs based on the current approach. I recruited participants, APRNs specializing in cardiology, through meetings at a local cardiology practice. Seven APRNs specializing in cardiology with experience ranging from 10 months to 15 years, and currently working in a cardiac setting, participated in the study. Structured interviews were conducted to describe the needs of APRNs who plan to specialize in cardiology. The interviews were audiotaped and analyzed to reveal commonalities. Findings: After analyzing the audio recordings three major commonalities emerged: APRNs specializing in cardiology must overcome limited educational opportunities, APRNs specializing in cardiology require a higher level of skill than their formal training and licensing requirements provide, and the need to validate APRNs specializing in cardiology knowledge. Additional commonalities included availability and the type of degree programs, and a lack of cardiac focus in educational preparation. Conclusion: The findings showed the needs of APRNs who plan to specialize in cardiology are rooted in their educational preparation. There is a vast amount of variability among degree programs and a severe lack of cardiac focus in their educational preparation. In order to achieve competency, 100% of study participants secured a mentorship with an expert cardiac clinician for a minimum of one year post-graduation and without assistance from their educational programs. Additionally, APRNs specializing in cardiology believe a national certification or examination requirement would be beneficial to their practice.

Background: Bullying is a form of violence and is described as unwelcome aggressive behavior(s) by unrelated individuals. The prevalence of bullying in the nursing profession has been reported to be as high as 31% in the United States, and has been studied extensively in undergraduate nursing, midwifery, medical school residencies, and Certified Registered Nurse Anesthesia (CRNA) professional roles. There is a significant gap in the literature and paucity of evidence about the extent of Student Registered Nurse Anesthesia (SRNA) bullying underscored that this topic required further investigation. Purpose: To investigate whether bullying behaviors occur among anesthesia preceptors, and if so, how SRNAs perceive bullying has affected their educational experience. Methods: The American Association of Nurse Anesthetists (AANA) disseminated an online survey based on an existing tool to SRNAs for this study. The study used a quantitative descriptive methodology consisting of a survey of nine demographic questions, eight 5-point Likert scale questions, and two multiple-choice questions. Setting and sample: A nationwide online survey sent to 1500 SRNAs yielded (N=133) participants, who were predominantly female (67.67%), in front-loaded programs (52.63%) with an average age of 24-29 years old. Results: Results revealed SRNAs entering clinical rotations in 2015 and 2016 were bullied more than those entering in 2017. The majority of the respondents (89.26%) reported that they couldn't think clearly when they were bullied. More than half of SRNAs agreed (74.62%) that bullying impedes learning. Overall, CRNA preceptors (85.48%) were reported as the most frequent bullies, with MD/DO anesthesiologists reported as the second most frequent (68.55%) followed by non-CRNA nursing staff (41.94%).

Critical illness is typically associated with a catabolic stress state in which patients commonly demonstrate a systemic inflammatory response that brings about changes in their body systems. Changes in the body systems make the critically ill dependent on mechanical ventilation and inotropic support for longer periods in order to survive. However, this inflammatory response can be attenuated by the timely introduction of nutritional support to provide energy and nutrients to diminish catabolism and promote anabolism. The result could be a decrease in the morbidity and mortality rates, as well as the financial burden on the patients, institutions and the state. Since registered nurses initiate and utilise feeding protocols to achieve target goals, there is a strong need for nurse-initiated feeding protocols. These protocols should be coupled with a comprehensive nurse-directed nutritional educational intervention that will focus on their safe and effective implementation. This focus on nursing nutrition education represents a major shift away from traditional education which has focused on dietitians and physicians. Evidence suggests that incorporating guideline recommendations into nurse-initiated protocols for starting and advancing enteral feedings is an effective strategy to improve the delivery of nutritional support. The study was aimed at exploring the provision of nutritional support to critically ill hospitalised patients by registered nurses to identify and describe possible gaps in the practice, through determining the potential relationship between the provision of nutritional support and characteristics of its providers. A quantitative, descriptive correlational study was undertaken. Seventy registered nurses working in neonatal/paediatric and adult critical care units in two public and three private hospitals in East London in the Eastern Cape participated in the study. The sample also included public critical care students. The results showed that registered nurses in private hospitals have more knowledge about the importance of nutritional support than their public hospital counterparts and students. The mean score was on the question was 80.3% with the highest score of 91% which was for the private hospital nurses, followed by 77.2% for public and 71.4% for students. Again, the mean score for knowledge on timing of initiating nutritional support was 48%, the highest score being 69.4% for students followed by private hospital nurses with 49.6%. Close to 63% (n = 44) of these nurses were either unsure about the availability of nutritional protocols or clearly attested to their non-availability. This is seen as an issue of concern because a protocol is meant to be a standard document with which all members of the ICU should be familiar. It is meant to guide and facilitate the manner of working in the unit. While facilitation of maintenance of nutritional support to patients is the responsibility of registered nurses, according to Regulation 2598(1984) section 45 (1) (q) of the South African Nursing Council, 68% (n = 48) of the respondents felt that this was in the practising scope of doctors and dietitians. The study concluded that the nurses are knowledgeable about the importance of nutritional support but knowledge gaps have been identified as far as the timing of initiating nutritional support is concerned. Some attested to unavailability of standard guidelines that are tailored into protocols guiding the provision of nutritional support by registered nurses in the critical care units. Nutrition should be prioritised as an important therapy for improving the outcomes of critically ill patients. Nurses need to analyse its provision, identify barriers to nutritional strategies and engage in nutritional education to empower themselves regarding the practice. Most importantly, there is a need for nurse-initiated nutritional protocols that are tailored from the broad nutritional guidelines and aligned with the local context and ways of practising. Nutritional support should be included as a key component of the curriculum in academic programmes that specialise in critical care nursing.

The healthcare workforce throughout the world is experiencing a shortage of healthcare workers and various strategies, processes and programs exist today of which nursing manager’s use to not only recruit nursing staff, but to retain these scarce resources. This research aims specifically to examine how career anchors and job compatibility influences the levels of job satisfaction of professional nurses. This study measured career anchors and job satisfaction to determine whether those whose job type and career anchor matched reported higher satisfaction than those whose job type and career anchor did not match. Results suggested that significant differences exist between functional nurses and managerial nurses. Specifically, the nursing group placed importance on lifestyle and service/dedication to a cause, while the managerial group places importance on functional competence and lifestyle. Finally, results indicated that job type and career anchor compatibility on their own might not be adequate predictors of job satisfaction. / Dissertation (MBA)--University of Pretoria, 2012. / Gordon Institute of Business Science (GIBS) / unrestricted

Cancer among Indigenous Peoples (First Nations, Inuit, and Métis) is disproportionately higher than the overall Canadian population. Many Indigenous Peoples have difficulty accessing care and do not receive culturally safe care due to a longstanding history of marginalization and colonization. The role of a nurse navigator (NN) was developed to improve continuity of care and overall health outcomes for Indigenous Peoples; however, limited research exists on what a NN does or how they are perceived. Using constructivist case study methodology, this thesis explored the experiences of a NN working in a large tertiary care hospital in Ontario, Canada, and the processes the NN used to support Indigenous cancer patients in a culturally safe manner. Six in-depth semi-structured interviews were performed with health care providers and managers, and shadowing of a NN occurred over two weeks allowing direct observations of the NN that was captured in field notes and reflective journaling. Interviews were audiotaped and transcribed; all data was entered into NVIVO 12 qualitative software and coded thematically. Analysis revealed the NN to be an important complement to clinical care and key resource to navigating the health care system, providing mechanisms for building trust, and raising awareness of Indigenous historical and cultural contexts. The NN practiced non-conventional, patient-centered approaches that included engaging with the land and arts, interpreting healthcare information, advocating for and aiding autonomy over healthcare. All participants felt the NN had a positive influence on health and wellbeing. Thesis results inform healthcare delivery and nursing practice to improve quality of care and outcomes for Indigenous cancer patients.