Nursing

The purpose of this study was to determine the relationships between the nurses' decision making model, frequency of Rapid Response Team (RRT) activation, and the nurse's skill at the early recognition of clinical deterioration. A descriptive, cross sectional quantitative design was used. The participants in this study were 167 acute care registered nurses who had activated the RRT at least once in the preceding 12 months. The participants first were asked to recall a time when they had made the decision to activate the RRT and then were asked to complete the instruments used in this study. Using the Nurse Decision-Making Instrument, the participant's decision making model then was categorized as analytic, intuitive, or mixed. The skill at early recognition of clinical deterioration was measured with the Manifestations of Early Recognition Instrument. Participant scores on the two instruments were significantly correlated with each other as well as to their frequency of RRT activation over the preceding 12 months. The findings of this study indicated that nurses who used analytical decision making activated the RRT with greater frequency than either the intuitive or mixed decision makers. In addition, registered nurses who used analytical decision making to activate the RRT tended to have higher levels of skill in the early recognition of clinical deterioration, as measured by the MER, than either the intuitive or mixed decision makers. Another finding of this study was that RNs with higher levels of skill in the early recognition of clinical deterioration tended to activate the RRT more frequently than RNs with lower levels of this skill. The implications of this study are that the use of analytical decision making may result in more frequent activation of the RRT.

This study explored the work of nursing and the social influences of eugenic policies established during the Progressive Era (1890-1930) on the writing and passage of the Social Security Act of 1935. The research questions: "Did eugenic philosophy and practice influence the Social Security Act of 1935 in relation to Maternal Health Policy?" and 'What was nursing's influence on the Social Security Act of 1935?" required the social history research method. Data were evaluated with the conclusion that eugenic policies did influence the writing and passage of the Social Security Act. Also, that nurses, and other women, played a specific, important and constructive role in developing the Act. During the late 1800s and early 1900s prominent leaders of business, science, philanthropy, and social reform supported the eugenic agenda to assure the wellbeing of hard working "Anglo-Saxon" American citizens. Industrialization and scientific advances in medicine gave Americans the impression that the "production" of healthy, intelligent children could be controlled, efficient, and predictable. Better breeding as a means for social improvement, which fueled the eugenics movement's use of science to solve social problems through governmental involvement, had two sides. Positive eugenics increased information on health and illness prevention, and established well baby clinics; however, negative eugenics advocated controlled reproduction through sterilization of persons considered "unfit." By 1935, twenty-eight states had eugenic sterilization laws. Noted reformers during this time (Lillian Wald, Jane Addams, and Florence Kelley) worked with Presidents Theodore Roosevelt and Woodrow Wilson to establish the Federal Children's Bureau. The Bureau had a direct influence on the maternal and child health policy established by the Social Security Act of 1935.

Within the current context of the healthcare environment, the charge nurse role has become very important for safety and positive outcomes. There is little known about the role from the perspective of the charge nurse. This qualitative descriptive exploratory study examined the experience of being a charge nurse in acute care practice, and describes how charge nurses live caring in their support of nurses and patients. Ray's (1989, 2006) theory of Bureaucratic Caring, Swanson's (2008) caring attributes and leadership, and Boykin and Schoenhofer's (2001) theory of Nursing as Caring provided the theoretical lenses through which study findings were viewed. Semi-structured interviews were conducted with 20 charge nurses in 4 acute care facilities. Eight themes emerged from an inductive analysis of the data describing the experience of being a charge nurse in acute care practice: Creating a Safety Net, Monitoring for Quality, Showing the Way, Completing the Puzzle, Managing the Flow, Mak ing a Difference, Putting Out Fires, and Keeping Patients Happy. Participants also were asked questions about how they provide support to staff nurses and patients. Themes that reflected how charge nurses live caring in their support of staff and patients were: Jumping in the Trenches, Nurturing Staff Growth, Offering Authentic Presence, and Looking after Nurses. Additionally, the researcher used methods of narrative inquiry to get the participants to share stories of how they lived caring in their support of nurses and patients. Recommendations included the need to elevate the visibility of the charge nurse role and its importance to the organization, and provide support for leadership development. Job descriptions and competencies for charge nurses must reflect the complexity of the environment.

In 1993, a group of unionized bedside nurses took control of their state nursing association. In 1995, they disenfranchised themselves from the American Nurses Association, which historically had billed itself as - THE voice of the profession of nursing. This study utilizes a case study format to look at who they are, what their intentions are, and what their vision is for the future of the profession. Twenty questions were submitted to key participants identified by the California Nurses Association (CNA). The questions were organized into three main areas: the period leading up to the disenfranchisement, the period of growth after the takeover up until the historic passage of the ratio laws and whistle blower protection, and the period after the passage of the laws wherein the association began a national movement. This movement continues to evolve, and in December, 2009, the CNA (now the National Nurses United) became the largest nursing organization in the country. As the title of the study implies, one intention of the study is to look at the implications for the profession of nursing and the inevitable political implications for the national healthcare debate. Another purpose is to introduce this group to the academic and professional nursing communities, which until now have largely ignored them. Still another purpose is to lay out a blueprint for other state nursing associations who may wish to empower themselves, to analyze the process by which this group has grown to political prominence. No other nursing association has been able to duplicate their political success. Finally, the study raises many crucial questions which nursing academics and nursing leaders must address if nursing is going to able to utilize our only real political power, the power of numbers. Uniting the field, or at least growing the association to significant numerical strength, is the only way nursing can become an equal partner in the national healthcare debate.

Provision of complete and responsive solution to healthcare services requires a multi-tired health delivery system. One of the aspects of healthcare hierarchy is the need for nursing care of the patient. Nursing care and observation provide basis for nurses to communicate with other aspects of healthcare system. The ability of capturing and managing nursing practice is essential to the quality of human care. The thesis proposes knowledge based decision making and analyzing system for the nurses to capture and manage the nursing practice. Moreover it allows them to monitor nursing care quality, as well as to test an aspect of an electronic healthcare record for recording and reporting nursing practice. The framework used for this system is based on nursing theory and is coupled with the quantitative analysis of qualitative data. It allows us to quantify the qualitative raw natural nursing language data. The results are summarized in the graph that shows the relative importance of those attributes with respect to each other at different instances of nurse-patient encounter. Research has been conducted by the Department of Computer and Electrical Engineering and Computer Science for the College of Nursing.

A new role has been developed in nursing named the Clinical Nurse LeaderSM (CNL®). This new role positions the masters prepared nurse at the patient's bedside to oversee care coordination and serve as a resource for the clinical nursing team, and to bridge the gaps in health care delivery to better meet the needs of patients in all health care delivery settings. Since this is a new role, there is a paucity of research that has been conducted surrounding these nurses. A phenomenological investigation examined the lived experiences of CNLs® to gain understanding about the meaning of leadership at the point of care and to discover the unique expressions of living caring that CNLs® experience as they embark upon this new role in the acute care hospital setting. Ten CNL® participants were interviewed for this study. Their stories about patient situations and relationships with other disciplines were shared with rich description and emotion. Hermeneutic analysis of the text revealed six essential themes. Six essential themes emerged revealing the essence of leading at the bedside and living caring in the CNL® role: navigating safe passage, pride in making a difference, bringing the bedside point of view, knowing the patient as person, helping nurses to grow, and CNLs® needing to be known, understood and affirmed. Taken as a whole through a synthesis of the themes, the understanding of the meaning of leading to CNLs® includes keeping their patients safe, being proud of their accomplishments and the respect gained from others, as well as being a helper and advocate for other nurses.

Promoting healthcare and wellbeing requires the dedication of a multi-tiered health service delivery system, which is comprised of specialists, medical doctors and nurses. A holistic view to a patient care perspective involves emotional, mental and physical healthcare needs, in which caring is understood as the essence of nursing. Properly and efficiently capturing and managing nursing knowledge is essential to advocating health promotion and illness prevention. This thesis proposes a document-indexing framework for automating classification of nursing knowledge based on nursing theory and practice model. The documents defining the numerous categories in nursing care model are structured with the help of expert nurse practitioners and professionals. These documents are indexed and used as a benchmark for the process of automatic mapping of each expression in the assessment form of a patient to the corresponding category in the nursing theory model. As an illustration of the proposed methodology, a prototype application is developed using the Latent Semantic Indexing (LSI) technique. The prototype application is tested in a nursing practice environment to validate the accuracy of the proposed algorithm. The simulation results are also compared with an application using Lucene indexing technique that internally uses modified vector space model for indexing. The result comparison showed that the LSI strategy gives 87.5% accurate results compared to the Lucene indexing technique that gives 80% accuracy. Both indexing methods maintain 100% consistency in the results.

The objective of this study was to describe the lived experience of caring for persons who had a peaceful death in the intensive care units in Thailand. A qualitative research design informed by hermeneutic phenomenology was used to analyze data. Participants were 10 intensive care nurses working at adult intensive care units in south Thailand. A snowball purposive sampling method was used to select the participants. Participant inclusion criteria were at least six months' critical care nursing experience, experience in caring for a person who had peaceful death, able to describe peaceful death, and willing to participate in this study. Participants who met the inclusion criteria were interviewed. Face-to-face individual verbal interviews were conducted in the Thai language. These interviews were audiotape recorded. Descriptions were transcribed and translated for data analysis. Van Manen's (1990) hermeneutic phenomenological approach was used to analyze and interpret the data. The findings of this study were presented in each of 4 categories of the lived world of temporality, of spatiality, of corporeality, and of relationality. The description of the lived experience of caring for persons who had a peaceful death in ICU was, "understanding the other through the valuing of experience and enhancing relations with others by recognizing time is short and is a priority." This study may contribute to nursing knowledge of the end-of-life care to enhance a peaceful death in intensive care units congruently with Thai culture and society. In addition, this study directs the translations of its knowledge into implications that will benefit in helping Thai nursing to move forward. The implications of this study in advance will benefit terminally ill persons and family members regarding receiving good quality end-of-life care.

The graying of America as a sociological and health care phenomenon continues to dictate the demand for creative and innovative interventions that can directly influence the quality of life of nursing home residents. Creative Reminiscence is a program that fosters the active reliving of the past through narration, such as in story-telling, and the use of creative art expression to uncover meaningful life events or valuable life experiences. The purpose of this study was to investigate and describe the meaningful life events elicited by the experience of Creative Reminiscence using a phenomenographic approach. Existing (archived) data-transcribed interviews, poetry and painting on planters that were obtained from 20 participants of the Creative Reminiscence program entitled Le Jardin de Sante were analyzed. Five variations of meaningful memories evoked by Creative Reminiscence were identified. These are described as follows: (a) memories that rejuvenate the elder's sense of connectio n; (b) memories that revive the elder's sense of love and intimacy; (c) memories that restore the elder's sense of being; (d) memories that reassert the elder's sense of control; and (e) memories that reinstitute the elder's sense of purpose. In a caring interaction with Creative Reminiscence, the nursed are able to transcend, moving back in time (past) to appreciate segment(s) of their lives, with triumphs and disappointments that give meaning to their inner conflict/human struggle (present), and integrate a sense of confidence and acceptance of their lives to sustain well-being and a sense of wholeness. This research highlights the similarities and differences in the description of memories by the nursing home residents evoked during Creative Reminiscence.

Professional competence is expected of all nurses in practice. Although new nurses have met the competency requirement for practice legally, opinions vary among new nurses and nurse administrators as to whether new nurses are indeed competent to practice nursing. The purpose of this phenomenological research study was to learn what new nurses think about professional competence. The research question guiding this study was, "What is professional competence from the perspective of newly licensed registered nurses?"