Indiana University-Purdue University Indianapolis (IUPUI) / Work engagement of registered nurses (RNs) has gained attention in health care, as an organizational process that is requisite to promoting optimal patient outcomes. Improving patient outcomes has caused a movement to examine what can be done to bridge the disparity between good and excellent care. Standards that enhance RN engagement to promote professional care are seen as vital to excellence. Magnet designation, awarded by the American Nurses Credentialing Center, signifies an organization meets such standards. Therefore, the purpose of this study was to evaluate whether a correlation exists between RN engagement and the organizational structures common to Magnet designation. This study also evaluated the influence of social and institutional demographics on the relationship between engagement and Magnet designation. The variables in this study included: age (generation), gender, nursing degree, years of RN experience, years of unit longevity, shift, hours scheduled and worked per week, percentage of time in direct patient care, nursing unit, and shared governance council participation. Finally, this study evaluated the influence of RN perception related to organizational support for work on the relationship between engagement and Magnet designation. A total of 370 RNs in Magnet (n = 220) and non-Magnet (n = 150) designated hospitals completed a 17-item engagement survey and a 15-item demographic survey. Major findings of the study indicated no significant difference in RN engagement between nurses who work at Magnet versus non-Magnet designated hospitals. Within the Magnet sample, significant relationships were found between engagement and shift, years of RN experience in any clinical setting, and RN perceptions related to organizational support for work. Scatter plots for nursing experience showed positive slopes for total engagement, vigor, dedication, and absorption. Post-hoc results for RN perception related to organizational support for work identified the significant areas of engagement were total engagement, vigor, and absorption. No significant post-hoc results were noted for the variable of shift. Through significant and non-significant findings, several insights were gained about engagement. As a result of this study, leadership can better assess the needs of the RN workforce to provide what RNs perceive to be important to professional practice and RN engagement.

Background: Graduate nursing academic faculty rely heavily on clinical preceptors for mentorship and clinical practicum experiences for BSN-DNP degree-seeking family nurse practitioner (FNP) students. Thus, it is important that preceptors have documented clinical competencies to assure the delivery of quality, evidence-based practice that meets regulatory requirements prior to precepting students.Objectives: The objectives of this quality improvement project were to develop and implement APRN competency validation tools (CVTs) in nurse-led clinic settings.Methods: Rapid Cycle Quality Improvement (RCQI) strategies were used to develop and implement APRN CVTs.Results: Three APRN CVTs were successfully developed, tested, refined, and implemented in four nurse-led clinics in rural east Tennessee. With one exception, the APRN preceptors had documentation of clinical competency prior to approval as a SPADES preceptor. Graduate academic faculty, preceptors, and students reported satisfaction with the SPADES project.Conclusion: CVTs are feasible tools for documentation of validated clinical APRN preceptors’ competency in nurse-led clinics. The CVTs and the medical record review checklist are available upon request from the primary author.Implications for Nursing: Use of APRN CVTs provides documentation that the preceptor uses evidence-based practice in the clinic setting prior to precepting students.

Background: Genomic sequencing is used in the Neonatal Intensive Care Unit (NICU) to diagnose babies with genetic disorders. Purpose: To explore the experiences and knowledge of nurses working in NICUs related to genomic sequencing. Methods: This was a mixed-methods, cross-sectional descriptive survey of NICU nurses attending a national conference. Quantitative data were analyzed using descriptive statistics. Qualitative data were coded into categories and themes. Results: Of 188 NICU nurses, nearly half reported experience with genomic sequencing. Among nurses with experience, 62.7% rated the amount of discussion they had with families about genomic sequencing as "0". Additionally, 72.7% of participants reported feeling unprepared to discuss genomic sequencing. NICU nurses identified potential harms and benefits associated with disclosing incidental findings, and most (83.6%) were in support of revealing incidental findings. Conclusions: To better support NICU families, nurses need to increase their understanding of genomic sequencing and increase their ability to provide genomics-informed nursing care.

Bakgrund: Delegering av arbetsuppgifter till omsorgspersonal är inte unikt för svensk sjukvård utan förekommer både nationellt och internationellt. Den globala bristen på legitimerade sjuksköterskor medför ett ökat behov av personal som kan utföra rutinmässiga arbetsuppgifter under delegering. Sjuksköterskor behöver delegera arbetsuppgifter för att kunna leda, prioritera och planera patienternas omvårdnad. Delegeringen av arbetsuppgifter ingår även i sjuksköterskans yrkesroll, därmed betonas vikten av att sjuksköterskan erhåller kunskap om riktlinjer och lagar gällande delegeringen. Syfte: Syftet med studien var att sammanställa sjuksköterskors upplevelser av att delegera arbetsuppgifter till omsorgspersonal inom olika vårdkontexter. Metod: Litteraturstudien bygger på tolv studier av kvalitativ ansats. Samtliga studier inhämtades från databaserna Cinahl och Pubmed. Utvalda studier har analyserats utifrån Popenoes m.fl. guide avseende artikelmatris och dataanalystabell. Valda studier har genomgått kvalitetsgranskning enligt SBU: kvalitetsgranskningsmall. Resultat: Resultatet utgör sex kategorier som besvarar litteraturstudiens syfte. Kategorierna består av Delegeringen var förenad med stort ansvar, Delegeringen upplevdes påtvingad, Delegeringen påverkade arbetsbelastningen, Upplevelser av okunskap relaterat till delegeringen, Attityder från medarbetare påverkade delegeringen, Kommunikation och relationer påverkade delegeringen. Konklusion: När sjuksköterskan delegerar enbart på grund av påtryckning från chefer sätts sjuksköterskan i en position där hen inte alltid upplever att delegeringen sker på ett korrekt och patientsäkert sätt. Däremot bidrog delegeringen till tid för planering och prioritering av patientens omvårdnad. / Background: Delegation of tasks to healthcare assistants is not unique to Swedish healthcare but occurs both nationally and internationally. The global shortage of registered nurses’ results in an increased need of healthcare assistants who can perform routine tasks under delegation. Aim: The aim of the review was to compile registered nurses’ experiences of delegating tasks to healthcare assistants in different healthcare contexts. Registered nurses need to delegate tasks in order to lead, prioritize and plan patients' care. The delegation of tasks is also part of the registered nurse's professional role, thus emphasizing the importance of the registered nurse obtaining knowledge of guidelines and laws regarding the delegation. Method: The literature review is based on twelve studies of qualitative approach. All studies were obtained from the databases Cinahl and Pubmed. Selected studies have been analyzed based on Popenoes et al. guide regarding article matrix and data analysis table. Selected studies have undergone quality review according to SBU: quality review template. Result: The results constitute six categories that answer the purpose of the literature review. The categories consisting of The delegation was associated with great responsibility, The delegation was perceived as forced, The delegation affected the workload, Experiences of ignorance related to the delegation, Attitudes from employees affected the delegation, Communication and relationships affected the delegation. Conclusion: When the registered nurse delegates under pressure from their managers, the registered nurse is put in a position where they do not always feel that the delegation takes place in a correct and patient- safe way. However, the delegation contributed to time for planning and prioritizing the patient's care.

Bakgrund: Att vara nyutexaminerad kan vara en svår utmaning, allra mest inom ett mångfacetterat yrke som sjuksköterskeyrket är. En bra start kan vara av stor vikt både för trivseln och för intentionen att stanna kvar i yrket. Syfte: Syftet med studien var att beskriva nyutexaminerade sjuksköterskors erfarenheter av första tiden som yrkesverksamma.  Metod: En litteraturstudie baserad på 10 kvalitetsgranskade kvalitativa studier. Databassökningar har genomförts i Cinahl, PubMed och PsycInfo och resultatet har analyserats med hjälp av Fribergs femstegsmodell. Resultat: Ur analysen framkom det tre teman “Nyutexaminerades erfarenheter av erhållen teoretisk och praktisk kunskap, Nyutexaminerades erfarenheter av relationer i teamet och Nyutexaminerades erfarenheter av arbetsmiljön” med sammanlagt sju subteman. Konklusion: Litteraturstudien visar på att de nyutexaminerade har många motgångar framför sig som nyutexaminerade sjuksköterskor. De har behov av både inskolning och en tillåtande miljö där de kan utvecklas i sin profession. Vidare forskning behövs för att minska avståndet mellan teori och praktik som idag är en stor del av de nyutexaminerades vardag. / Background: To be newly graduated can be challenging, even more in a multifaceted profession as the nurse profession is. A god start can be important for the professional’s wellbeing and their intensions to stay in the profession. Aim: The aim of the study was to describe newly graduated registered nurses experience of their first period of time as professionals. Methods: A literature study based on 10 quality reviewed qualitative articles. Database research was made in Cinahl, PubMed and PsycInfo and the result were analyzed using Fribergs five steps model. Results: The analysis revealed three main themes “New graduate’s experiences of acquired theoretical and practical knowledge, New graduate’s experiences of relationships in the team and New graduate’s experiences of the work environment” with the total of seven subthemes. Conclusion: The literature study shows that the new graduates have many setbacks ahead of them as newly graduated nurses. They need both an introduction period and an understanding environment where they can develop in their profession. Further research is needed to reduce the distance between theory and practice, which today is a part of the new graduates' everyday life.

Bakgrund: Psykisk ohälsa är vanligt förekommande i den svenska befolkningen, där 14% i åldrarna 16–84 år upplevde detta under 2020. Dock förekommer negativa attityder vid möte med sjukvården för denna patientgrupp. Akutmottagningen är en miljö där möten sker extra snabbt det är därför intressant att ta reda på hur sjuksköteterskor erfar dessa möten i just den miljön för att se om det går att hitta förbättringsområden. Syfte: Att beskriva sjuksköterskors erfarenheter av möten med patienter med psykisk ohälsa på akutmottagning. Metod: En beskrivande litteraturstudie baserad på elva vetenskapliga artiklar med kvalitativ och kvantitativ ansats som har sökts fram via PubMed och PsychINFO. Huvudresultat: I föreliggande litteraturstudie framkom att det fanns faktorer som påverkade hur mötet med dessa patienter erfors utifrån områdena kontext och kompetens. Inom kompetensområdet syntes förbättringsområden vad gäller kunskap, värderingar, normer och stigma, samt omvårdnad, medan kontextområdet beskrev utmaningar i miljö, arbetsbelastning och samarbete. Slutsats: I denna litteraturstudie har det blivit tydligt att möten mellan sjuksköterskor och patienter med psykisk ohälsa på akutmottagning upplevs utmanande på grund av akutmottagningens fysiska miljö, sjuksköterskornas arbetsmiljö, ett behov av kunskap och stigmatisering av patientgruppen. I föreliggande resultat ses flera studier föreslå exempelvis ökad kunskap – gärna i form av patientfall och erfarenhetsutbyte. Studier och referenslitteratur föreslår även att använda reflektion för normgranskning vilket i sin tur kan ge attitydförbättring. Att arbeta aktivt med kunskapshöjande åtgärder och granskning av värderingar kan resultera i förbättrade vårdmöten mellan patienter med psykisk ohälsa och sjuksköterskor, och i sin tur leda till förbättrad omvårdnad. / Background: Mental illness is common in the Swedish population, where 14% of people aged 16–84 experienced this in 2020. However, negative attitudes sometimes occur in meetings with healthcare providers for this patient group. Meetings are fast in the emergency department, it is therefore interesting to examine how nurses experience these meetings, in that environment particularly, to see if there is room for improvement. Aim: To describe nurses' experiences of meetings with patients with mental illness in emergency departments. Method: A descriptive literature review based on eleven scientific articles with a qualitative and quantitative approach that have been searched via PubMed and PsychINFO. Main results: This literature study showed factors of context and competence affecting patient meetings. Within the competence area, improvements were apparent regarding knowledge, values, norms and stigma, as well as nursing, while the area of context described challenges in the environment, workload and collaboration. Conclusion: In this literature review, it is apparent that meetings between nurses and patients with mental illness in the emergency department are described as challenging due to the emergency department's physical environment, the nurses' work environment, a need for knowledge and the stigmatization of the patient group. Several studies in the result suggested, for example, increased knowledge – particularly in the form of patient cases and exchange of experience. Studies and reference literature also suggested using reflection for norm evaluation, which can provide improved attitudes. Working actively by raising knowledge and evaluation of values can result in improved meetings between patients with mental illness and nurses in, and by that, result in improved care.

No description available.

Bakgrund: Sjukvården möter ökade krav på grund av befolkningsökning och avancerade behandlingsmöjligheter. Utlokalisering av patienter innebär att en patient läggs in på en annan avdelning än den som har medicinskt ansvar och specialistkompetens och kan ske på grund av en brist på vårdplatser på hemavdelningen. Swansons teori om vårdande beskriver fem steg som vårdpersonal kan använda för att främja patientens välbefinnande i vården. Sjuksköterskan har omvårdnadsansvaret för patienterna på avdelningen, oavsett vilket medicinskt team de tillhör. Syfte: Att undersöka sjuksköterskans perspektiv på vård av utlokaliserade patienter i slutenvården. Metod: Allmän litteraturöversikt innefattande kvalitativa och kvantitativa data. Resultat: Sjuksköterskorna upplevde brister och utmaningar kopplat till vårdandet av utlokaliserade patienter, inklusive hög arbetsbelastning, tidskrävande insatser, obekant utrustning, bristande kunskap/erfarenhet och kommunikation begränsade dem i deras yrkesroll. Utifrån sjuksköterskans perspektiv skapade detta en utmanade arbetsmiljö och riskerade försämrad vårdkvalité och patientsäkerhet. Konklusion: Utlokalisering leder till en sämre arbetsmiljö och hindrar sjuksköterskan från att kunna ge en god säker vård. Detta kan leda till stress för sjuksköterskan och innebära en risk för patienten. Det bör endast ske om inget annat alternativ finns. Vid utlokalisering bör ansvariga för utlokaliseringen noggrant välja bästa möjliga avdelning samt utarbeta rutiner för att underlätta samarbete mellan avdelningar. / Background: Healthcare faces increased demands due to growth in population and more advanced treatment options. Patient outlying occurs when a patient is placed in a different ward than the one medically responsible, often due to bed shortages. Swanson's Caring Theory outlines five steps that healthcare professionals can utilize to promote patient well-being. Nurses maintain responsibility for patients on their ward, regardless of medical team affiliation. Aim: To investigate the nurse’s perspective on the care of outlying patients in inpatient care Method: General literature review encompassing qualitative and quantitative data. Findings: Nurses experienced deficiencies and challenges related to caring for outlying patients, including high workload, time constraints, unfamiliar equipment, lack of knowledge/ experience and communication constraints limited them in their professional role. From the nurse’s perspective, this created a challenging work environment, risking diminished care quality and patient safety. Conclusion: Outlying leads to a poorer work environment for nurses, hindering them from providing safe, quality care. This can lead to stress for the nurse but also pose a risk to the patient. Therefore, the practice of outlying patients should only occur if no other alternatives exist. If outlying is unavoidable, careful ward selection and collaboration procedure between ward are crucial.

The purpose of this longitudinal study was to evaluate the enrolled nurse/registered nurse (EN/RN) programme to determine the extent to which the graduates of the programme had acquired knowledge and skills to provide primary health care services to communities using the Stufflebeam CIPP model as a framework. The study determined the extent to which the graduates perceived that their knowledge and skills in provision of primary health care services have been strengthened and the extent to which their supervisors perceived the improvement of the graduates' knowledge and skills in provision of primary health care services in clinical and primary health care settings. The programme used two models for upgrading: one year full-time residential and two year distance education. The study used methodological triangulation for data collection. Data collection tools comprised of self-administered questionnaires to the EN/RN upgrade graduates, structured group interviews to their supervisors from the hospitals and district health teams and the review of the students' examination records from Institute of Health Sciences/University of Botswana (IHS/UB). Data were collected and analyzed from the one year full-time residential graduates who completed the programme from 1995-2000 and from the two year part-time distance education graduates who completed the programme 1996-2000. The findings from the academic records indicated that out of the 1116 enrolled nurses that were admitted into the EN/RN upgrade programme between 1994-2000 nine (0.8%) withdrew from the programme due to ill health or personal reasons before writing the final examinations. This is indicative of a high retention rate in the programme. In the one year full-time residential programme, out of the 695 enrolled nurses were admitted in the programme from 1995-2000 period five (0.7%) withdrew from the programme before writing the final examinations, 690 students sat for the final examination and 640 (92.8%) passed. In the two year part-time distance education programme, out of the 421 enrolled nurses were admitted in the programme from 1996-2000 period four (0.9%) withdrew from the programme before writing the final examinations, 417 students sat for the final examinations and 402 (96.4%) passed. Out of the 1107 students from both the one year full-time residential and the two year part-time distance education programme that sat for the final IHS/UB examinations, 1042 (94.1%) passed. The academic records revealed that the programme was efficient and effective because 1042 (94.1%) out of 1107 students completed the programme in one year and two years as planned because the programme was not repetitive and there were replacement costs. This high pass rate (94.1%) is an indication that the graduates did acquire knowledge and skills for provision of primary health care services. Data analysis from the self-administered questionnaires of the graduates also revealed that the graduates perceived that their knowledge and skills for provision of primary health care services have been strengthened because of the acquisition of the new knowledge in primary health care. This complemented the high academic performance of the graduates that the graduates knowledge and skills to deliver primary health care had been strengthened. Data analysis from the structured group interviews of the supervisors of the graduates further revealed that the supervisors perceived that the knowledge of the graduates in providing primary health care services in the hospitals and the district health teams had improved. The supervisors indicated that the graduates were now providing primary health care services with less supervision in the hospitals and the health districts. / Health Studies / D.Litt et Phil. (Health Studies)

The purpose of this qualitative study was to explore and describe the extent to which registered nurses’ practice was affected by emergency department overcrowding. Participants were recruited from a tertiary hospital by using the purpose sampling method. Data collection was done using a semi-structured interview guide. Individual interviews were conducted with eight registered nurses working in the paediatric emergency department. Data analysis was conducted using thematic content analysis and Yin’s (2003:178) five-phase cycle. The study findings revealed that the lack of professional nurse leadership and the difficult existing relationship with the physicians were obstacles that had to be obviated if the paediatric ED were to function optimally and best practice were to be achieved. It was revealed that a problematic issue in the setting was that the most critical decisions on allocating where patients should be treated were made by physicians who have more authority than nurses. It was recommended that the ED need to be clearly defined in the policies as an outpatient, emergency care or as an episodic patient care area as “Admission” can mean admission to the ED or admission as an inpatient/boarded patient. / Health Studies / M.A. (Health Studies)