Thesis advisor: Dorothy A. Jones / Purpose: The purpose of this study was to define, develop, and psychometrically evaluate a scale designed to measure Nurse’s Perception of the Relationship Based Care Environment. Background: Relationship is a complex multidimensional concept. It is a critical component of professional practice and core to the interaction between nurse and patient. While there are a number of scales available to measure different dimensions of relationships between nurses and other groups there is no one scale that captures multiple dimensions. Methods: Based on a review of the literature and an earlier qualitative study, a theoretical representation was developed. This representation became the framework for development of elements and items for the NPRBCE scale. The content validity of the NPRBCE scale was determined by an expert panel of Registered Nurses. Four hundred and seventy three Registered Nurse participants completed the survey. Analysis: Data were subjected to Principal Components Analysis and Cronbach’s alpha was computed to determine reliability of the scale as a whole and each of the components of the scale. Results: The final solution was a five component 56-item scale. The five components include: nurse/ other discipline; nurse/organization; nurse/ nurse; nurse/ patient- knowing the patient; and nurse/patient-respecting the patient. The scale as a whole and each of the resulting components were found to be reliable. The components were parsimonious and interpretable. Keywords: relationship based care, relationship centered care, nurse practice environment / Thesis (PhD) — Boston College, 2016. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

The power to communicate effectively and respectfully in the health care setting promotes job satisfaction, retention, and healthy relationships. Ineffective communication is one of the major causes of sentinel events, incivility, nurse turnover, and workplace hostility in the health care environment. This project examined a communication competence educational program on a spinal cord injury (SCI) nursing department and its potential to improve communication competence. The project question explored whether an educational series on incivility and creating healthy relationships would increase communication competence in nurses on the SCI unit. The project used the high reliability solutions for health care model communications improvement and creative health care management tools. The oppressed group behavior theory was used to inform this project by providing an understanding of why nursing staff may experience hostility toward one another and lack effective communication skills to promote a healthy working environment. The dauntless survey questionnaire was used pre and posteducational intervention, and the results were analyzed to assess the effects of using descriptive statistics. The educational intervention reached 81 SCI nursing staff members. Results showed a 13% increase in the staff feelings of confidence when speaking up to their peers and physicians, a 3% increase in knowing what to say when difficult situations arose, and an 11% increase in feeling competent regarding their communication skills. The findings of this project may promote social change by improving communication by the team leader, charge nurse, assistance manager, and nursing staff during shift change, walking rounds, and huddles.

Thesis advisor: Dorothy Jones / A family's unique way of being, formulated through social, economic, environmental and political factors, becomes fractured during a loved one's critical illness. Family members experience burdensome physical and emotional symptoms as they transition through the marked uncertainty endemic to high acuity illness. For some, this burden results in long term psychiatric disturbances. Assessment tools and interventions have been proposed for family members experiencing a loved one's critical illness. However, ongoing suffering suggests inherent limitations within these reductionist approaches. The need for a more encompassing disciplinary perspective is suggested. Margaret Newman's (1986, 1994, 2008) theory of Health as Expanding Consciousness (HEC) and its praxis research method was employed to explore relationship based care among intensive care unit (ICU) family members and registered nurses. HEC retains person/environmental integrity through unfolding of unitary knowledge via exploration of meaning. Additionally, its holistic perspective aligns philosophically with the belief in nursing science as the study of caring in the human health experience, endorsing both the mutuality of the nurse/client relationship and pattern recognition's capacity to inspire transformational growth. The study was performed in an eighteen bed medical ICU in the northeast region of the United States. This unit's design includes an integrated critical/palliative care model. Exploration of the study's two research questions was accomplished using the practice and research components of HEC within a sample of eight family members and six registered nurses. Results demonstrated family members' capacity to achieve consciousness expansion within the context of a loved one's critical illness. Registered nurses revealed their ability to steadfastly partner with both patients and families. Repetitive elements distinguished as thematic commonalities were recognized among both family member and registered nurse participants. Additionally, thematic integration between family members and registered nurses was appreciated. HEC was found to offer unique insights into caring relationships between ICU family members and registered nurses. / Thesis (PhD) — Boston College, 2014. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

The purpose of this study was to determine if practical wisdom can be recognized as one factor that may be attributed to the success of individuals sitting in the position of superintendent in a school district. Practical wisdom is defined as something developed over time through experiences and knowledge. It guides decision making on moral and practical issues. The changing political climate coupled with increased accountability and the increased rate at which superintendents have been retiring, have created the necessity to identify some factors that contribute to a superintendent’s success. This study provides an assessment of practical wisdom in a single case study analyzed through this research of a female superintendent in a medium sized school district.

The Design and Implementation of a Relationship-Based Care Delivery Model on a Medical- Surgical Unit by Paula A. Rodney MSN, California University of Pennsylvania, 2011 BSN, University of Virginia, 1979 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University April 2015   Patient satisfaction and clinical outcomes have become important issues in healthcare since the introduction of the Value Based Purchasing Program. Patient satisfaction, as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, was declining and hospital-acquired pressure ulcers (HAPU), falls, and catheter-associated urinary tract infections (CAUTI) were rising on the pilot unit. The purpose of this non-experimental correlational design quality improvement project was to combine information from focus groups, a content analysis of the literature on Kristen Swanson's theory of caring, and relationship-based care, to develop and implement a relationship-based care delivery model. An additional aim was to determine its impact on patient satisfaction and the reduction of HAPU, falls, and CAUTI. The model was designed and implemented by a team consisting of bedside care providers, leaders, an educator, and a student facilitator. The components of the model included scheduling for continuity of care, whiteboards, seated bedside report, hourly rounding, a nurse advocate, and 5 focused minutes of attention per shift. Descriptive statistics were used to determine the mean change in HCAHPS scores before and after implementation of the model, and revealed improvements in dimensions of communication with nursing by 13.2%, responsiveness by 12.5%, overall rating of care by 14.5%, and willingness to recommend by 8.7%. The result of audits of the pilot unit's medical records indicated a reduction in falls by 3, HAPU by 2, and CAUTI by 2 from August, the baseline month. As a result of these findings the model will be implemented on all inpatient nursing units. The target audience for this project includes nursing leaders, educators, and bedside providers with interest in patient-centered care and staff empowerment.

Past research has recommended that clinical mental health (CMHC) administrators employ a relational focus to their work, but little evidence exists that such a relational focus is actually being utilized. Guided by Rogers' principles of client-centered therapy, this study examined whether CMHC administrators possessed the knowledge and attitudes to utilize the recommendation of relational based therapy and whether implementation in the CMHC was feasible. A qualitative multiple case study design was utilized to collect personal interviews with 12 CMHC administrators who could discuss Norcross and Wampold's single recommendation about therapeutic relationships. Results were triangulated with the guide for CMHC financing, namely Rule 132, as provided by the administrators. Thematic content analysis of the data revealed that administrators were knowledgeable and in favor of the recommendation where funding could be provided. However, the administrators considered implementation unreasonable because of regulations, low financing of CMHC services primarily through Medicaid, burdensome paperwork requirements, and limited staff qualifications. Understanding these answers from CMHC administrators within the context and limitations of the CMHC should impress upon lawmakers the need for adequate financing of resources to implement the recommendation, which could result in promoting social change in the delivery of services for mental health.

Leaders of a rural Southwest Oklahoma hospital requested the development of an evidence-based program that could transform unit charge nurses into effective leaders in order to improve the leadership of direct care nurses. Nursing executive leadership discovered staff members were demonstrating high levels of stress, dissatisfaction, and burnout. Press-Ganey survey results revealed that staff felt they were not supported and did not believe nurses cared for patients' or other co-workers' well-being or safety. The Hospital Consumer Assessment of Healthcare Providers and Systems outcome scores, which were below hospital and national desired benchmarks, revealed that patients were not satisfied with the care they received. Thus, the goal of this project was to use evidence to craft a program and evaluation plan that could be used by the hospital to develop stronger charge nurse leaders. A detailed examination of evidence supported the development of a program based on the relationship-based care (RBC) model. The RBC model is a transformational leadership development program that increases leadership skills and positive interaction between people. A full program was adapted from the RBC model and designed for the rural hospital. An evaluation plan to measure the short-and long-term objectives was developed. Implementation is expected to create social change by imparting charge nurses with leadership and relationship skills, thus empowering them with greater abilities to provide care. Benner's novice to expert and Watson's theory of caring models served as the foundation of the RBC model. The goal is to present the results at the hospital level and to disseminate the findings locally at professional nursing leadership conferences.

The purpose of this study is to explore the nature of firm–bank exchange. Using a qualitative research method and existing theory, by capturing transaction-based and relationship-based elements, I examine ten firms and eight different bank services important for the exchange between the firms and their banks. The study indicates that the exchange is more complex than previous theories have proclaimed, since the nature of the exchange differs when central elements of different bank services are compared. There are bank services, such as bank account and loans, which have a high degree of both transaction-based and relationship-based elements. Saving and investment are also indicated as consisting of both transaction-based and relationship-based elements. Other services, such as depositing of cash, digital depositing and payments clearly have a higher proportion of transaction-based elements than of relationship-based elements, but depositing of cash differs somewhat from digital depositing regarding some of the elements investigated. The study suggests that advising has a high level of relationship-based elements, while the transaction-based elements are much less evident. For the service exchange of money, both transaction-based and relationship-based elements are present at a level below medium. This demonstrates that firm–bank exchange has a multidimensional nature. / Syftet med denna explorativa studie är att undersöka beskaffenheten på utbytet av olika banktjänster mellan små och medelstora företag och banker. Med hjälp av befintlig teori och kvalitativ metod identifieras transaktionsbaserade och relationsbaserade element. Tio företag och åtta banktjänster studerades och resultaten indikerar att utbytet är mer komplext än tidigare studier antyder. Utbytet skiljer sig nämligen åt när de olika banktjänsternas transaktionsbaserade och relationsbaserade element jämförs. Banktjänster som bankkonto och lån karaktäriseras av en hög nivå av både transaktionsbaserade och relationsbaserade element. Även för sparande och investeringar förekommer såväl transaktionsbaserade som relationsbaserade element, men på en något lägre nivå. Tjänster som insättning av kontanter, elektroniska insättningar och betalningar har en klart högre nivå av transaktionsbaserade element än relationsbaserade element, men insättning av kontanter skiljer sig något från digitala insättningar för de element som undersökts. Tjänsten rådgivning karaktäriseras av en hög nivå av relationsbaserade element, medan de transaktionsbaserade elementen är mindre framträdande. Växling indikerar en nivå under medium för både transaktionsbaserade samt relationsbaserade element. Sammantaget påvisar detta att utbytet mellan små och medelstora företag och deras banker har en multidimensionell karaktär.

Background: Although reverse logistics becomes more important nowadays to reach organisation goals, organisations are still plagued by data uncertainty and low supply chain visibility. In an attempt to remove those barriers to reach an effective reverse logistics operation, organisations have started to integrate industry 4.0 technologies among themselves and their reverse logistics partners. However, the introduction of industry 4.0 influence collaboration among reverse logistics partners posing a threat to successful implementation of industry 4.0 and to solving current reverse logistics operational problems. Purpose: The primary aim of this study is to provide insights what factors influence the facilitation of collaboration between supply chain partners through adopting Industry 4.0 within reverse logistics. Additionally, this study's secondary aim is to provide insights in how the concepts of industry 4.0, collaboration and reverse logistics relate to each other. Method: This study is performed as qualitative inductive research with a relativist ontology and a constructionist epistemology. The research design consists of an explorative multiple case study in which data has been collected through semi-structured interviews which have been found through purposive sampling. The data analysis of this research has been performed with a thematic analysis. Conclusion: The results show that three distinct factors have emerged from this study. General perception (1) in which a negative feeling towards reverse logistics has been described. Relationship-based collaboration (2) that describes that trust is the single-most important factor in relationships. Collaborative network 4.0 (3) which displays four stages of technological adaptations in reverse logistics streams.

<p><strong>Abstract</strong></p> <p>Social work’s heritage involves valuing relationship-based work, while attending to social justice issues. The emotional intensity inherent in social work practice, combined with the stress that is currently characteristic in managerial practice environments, can diminish capacity for relationship-based work, and relegate social justice issues to the periphery. Mindfulness practice has recently has been the subject of investigation for potential benefits that might accrue to helping professionals.</p> <p>Through an interpretive social science and social constructive lens, a small qualitative study was undertaken to explore the experiences of social workers who have a personal practice of mindfulness, with a view to understanding what mindfulness offers to social workers. The seven participants had extensive social work experience, as well as their own well-developed practice of mindfulness.</p> <p>Informed by grounded theory, findings suggest that mindfulness complements the traditional roots of social work. The phrase, ‘bringing yourself home’, is utilized as a central metaphor for an explanatory model for what mindfulness offers to social workers. Mindfulness is a practice that can ‘bring social workers home’ in two significant ways. Firstly, mindfulness can assist social workers in the personal realm by nourishing their connection to their inner self so that they can be authentic and empathetic in doing solid relationship-based social work practice. Secondly, mindfulness can help bring social workers ‘home’ to the roots of social work practice, by keeping them attuned to their professional values in terms of social justice issues.</p> / Master of Social Work (MSW)