Chase, Susan

This dissertation reviews the multifaceted dimensions of male nurses in recovery
from chemical dependency in the State of Florida's Intervention Project for Nurses
Rehabilitation Program. These dimensions are not linear and fluctuation of the degree of
intensity is individualized to the lived experience of the nurse. The purpose of this
qualitative, phenomenological research study was to understand the lived experience of
male nurses who have successfully completed the rehabilitation phase and to determine
themes that influenced their vulnerability to professional impairment. The study
identified two overarching themes of person and profession. The major theme of person
had three sub-themes of pre-determined risk, altered values, and sensation seeking
behaviors. The major theme of profession had five sub-themes of masterminding,
professional heteronomy, rehabilitation, getting caught, spirituality, and the nurse becoming the nursed. A model of professional impairment graphically depicts the
interaction of these themes. Exploring the lived experiences of male nurses who have
successfully rehabilitated from chemical dependency provided understanding and
identification that can assist academic and clinical environments with prevention,
education, and early intervention.

Human Immunodeficiency Virus (HIV) results in a decline in the body's ability to
fight infection as the illness progresses. Events contributing to disease progression
include the emergence of viral mutations and loss of T -helper cells. This results in a
decline in overall physical well-being. One explanation for this occurrence is lack of
adherence with recommended treatment plans that can result in viral mutations and
replication. The health care team establishes a plan to prevent or delay this decline in
health. Can clinicians expect absolute commitment to plans of care without their knowing
their effects on patients' life? This study was conducted to answer the research question,
"What is the culture of living with HIV as it shapes adherence to plans of care for
patients in south Florida?" in order to understand HIV positive patients' responses to
managing complex medical regimens. In an effort to understand the life-world and
experiences of patients who are HIV positive, an ethnographic study was conducted to explore how patients manage the daily demands of living with IDV. In addition,
environment of care was observed to determine if it influenced adherence to medications
and plans of care. Through the use of ethnography, interviews of IDV positive patients
were conducted, several of whom had significant adherence issues and one person who
might be considered an ideal patient. Several different settings were included in the
research to determine what impact environment had on patients' adherence to
medications and plans of care. Fear, trust, self-worth, literacy, financial and disease
specific themes emerged and lead to the development of a model for adherence to plans
of care for IDV positive patients. This model may enhance clinician/patient collaboration
to achieve maximized health and delay progression of mv disease.

Caring has been identified as an essential value for baccalaureate education across all programs of study. The purpose of this phenomenological research study was to investigate the lived experience of students learning caring in a college of nursing grounded in a caring philosophy. The question guiding the research was: "What is the student's experience of learning caring in a college of nursing that has caring as a central tenet in its philosophy?" This study was guided by the caring theories of Boykin and Schoenhofer (2001), Roach (2002), and the philosopher Mayeroff (1971). The researcher interviewed seven senior baccalaureate student nurses attending a public university. The nursing program at this university was grounded in a caring philosophy. The research questions explored the students' experiences of learning caring at this school of nursing. One student shared this thought with the researcher, "I knew who I was and I knew I could care about people, but I didn't know how to use caring in nursing. The educational process helped me to transfer caring to nursing." Transcripts of the audiotaped interviews were analyzed using Colaizzi's seven-step methodology. Two major themes and six sub-themes related to learning caring emerged and an exhaustive description of the students learning of caring in a caring based curriculum was developed. The two major themes identified were: Innate Knowing of Self as Caring, and Caring in the Curriculum. The first major theme of Innate Knowing of Self as Caring is supported by the sub-themes: Being present for the patient, Being open to reshape the patient's experience, and Enhanced capacity to care. The second major theme of Caring in the Curriculum is supported by the sub-themes: Clinical experiences are valuable to learning, Doing little things to express caring, and Learning activities facilitated understanding caring. Descriptions of the two major themes and six sub-themes were portrayed with verbatim stories told to the researcher by the student participants. Finally, implications for nursing education, research, practice, theory, and policy are presented for the reader.

The nursing leader's challenging position in today's work environment may lead to an experience of stress, over-commitment, and overdoing. The purpose of this phenomenological study was to examine the meaning of caring for self by registered nurse leaders who had participated in a caring for self project in a community hospital setting. This group of 10 nursing leaders had participated in a caring for self project and had experience in nursing ranging from 18 to 32 years. One year after taking part in the caring for self project the 10 nursing leaders participated in individual taped interviews to explore the meaning of caring for self. Hermeneutic phenomenology (van Manen, 1990) was the method used for the interpretation of this research study. The depth of the lived experience of caring for self was described by each nursing leader. A metaphor of climbing a mountain to the peak of wisdom, being on the path and staying on the path regarding care of self, came from the words of the participants. In their words, the leaders communicate four common themes: Reflections on the Journey, Why Care for Self on the Journey, How to Care for Self on the Journey, and the Wisdom Learned Along the Path. Based on their reflections, recommendations include implementing creative ways to encourage care of self are for the hospital environment and educational methods to reinforce care of self for nurse leaders in the educational curriculum. A focus on care of self described by the leaders in this study may improve personal health, add to personal growth, assist in communication skills, allow for role modeling care of self to others, support setting priorities and boundaries, contribute to flexibility, and promote a work-life balance. These qualities would assist in creating a positive work environment and may influence the retention of nurses and contribute to recruiting new nursing leaders. Caring for self by nursing leaders is an important way for caring nursing theory to be brought to the practice setting. By role modeling a work-life balance nursing leaders bring the circle of caring out to others, beginning with care of self.