Dissertations / Theses on the topic 'Nursing care during labour'

The purpose of this thesis was to develop best practice recommendations to care for women in the second stage of labor. Evidence suggests that care of women during the second stage of labor using upright positioning, delayed pushing, application of warm compresses to the perineum, and perineal massage can improve maternal and neonatal outcomes (Aasheim et al., 2011; Brancato et al., 2008; Chang et al., 2011; Dahlen et al., 2007; Dahlen et al., 2009; Gillesby et al., 2010; Gupta et al., 2012; Kelly et al., 2010; Sanders et al., 2005; Schaub et al., 2008; Simpson & James, 2005; Terry et al., 2006; Thies-Lagergren et al., 2013). A theoretical plan for implementation and evaluation of best practice recommendations for the second stage of labor was discussed in this paper. Registered nurses implementing evidence-based recommendations within the hospital setting for pregnant women regarding delayed pushing, upright labor positions, and interventions to reduce perineal trauma and pain, would provide women care that may improve second stage of labor outcomes.

The purpose of this qualitative grounded theory study was to understand nurses’ perceptions of care that supports patients’ dignity during hospitalization at the end of life, and to propose a theoretical foundation consistent with these perceptions as a guide to practice. The research involved analyzing perceptions about processes that can explain how nurses perceive care that supports patients’ dignity at the end of life during hospitalization. The aim of the research in this study included a focus on the general problem that patients’ dignity is not always respected by healthcare providers according to the review of the literature and the acknowledgment of the lack of theories related to nurses’ perceptions of care that supports dignity during end-of-life care. A grounded theory design offered a systematic approach to developing a theoretical model from data that takes into consideration the complexities of nurses’ perceptions of care that supports dignity during hospitalization at end of life. Semistructured interviews were conducted with 11 experienced registered oncology female nurses from the northeastern region of the United States. The research involved analysis of the perceptions of nurses caring for cancer patients admitted to the hospital during end of life. The development of a beginning model for dignity care stemmed from the emergence of three major categories, which were communication, support, and facilitation. The identified subcategories were education, workshops, course curriculum, in-services, being an advocate, listening, being present, physical needs, emotional support, compassion, honoring wishes, respect, and being treated as human. The emergence and development of a dignity model may offer a process that can serve as a valuable reference in providing care that supports the dignity of patients during hospitalization at end of life.

During their clinical practicum, nursing students are involved in making decisions about the care for their patient or group of patients. The purpose of this study was to ascertain nursing students' perceptions of the variety and magnitude of factors that influence them as they are making decisions about patient care. For the study a nonexperimental approach utlizing a cross-sectional descriptive design was used. Thirty-three second year and thirty-one third year nursing students from a diploma nursing school responded to a questionnaire designed to reflect perceived domains of influence in thier clinical decision making. A subset of 18 subjects were interviewed. Some of the major findings include: 1) More second year than third year students perceived stress as a factor affecting their clinical decision making. Third year students most often mentioned the instructor-student relationship as a source of stress. Second year students most often referred to their workload and fatigue as contributing to their stress. 2) More third year than second year students preceived decision making theory and the nursing process to be an influencing factor in decision making. 3) Previous life and health-related work experience was indicated to be an influencing factor in clinical decision making more often by second year students than by third year students. 4) When asked to choose and rank five from a list of sixteen influencing factors in clinical decision making, the combined group chose the following in order; knowledge of patients and their condition, level of self confidence, knowledge of nursing proces, relationship with instructor, previous nursing experience, and previous life experience. 5) In the interviews the two most frequently mentioned guiding forces in decision making were: (a)what they (the student) or someone close to them would want and (b)patient preference. The study encourages nursing instructors to be cognizant of the variety of forces impacting student decision making in the clinical setting. It also suggests that students who are encouraged to incorporate their personal reality in an atmosphere that provides some latitude in decision making will be more likely to assume decision-making responsibility.
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Purpose. Explore the organizational barriers and examine determinants of nurses' intentions to practice continuous labour support (CLS). Design. Exploratory two-phase study using qualitative and quantitative methods. Participants. Childbirth nurses, educators and managers from two birthing units on two campuses of one hospital, in an urban city in Ontario, Canada. Phase I, N=10/10; Phase II, N = 97/129. Methods. Semi-structured interviews with content analysis followed by a survey using the Theory of Planned Behavior with descriptive, univariate and multiple regression analyses. Results. Unit acuity, method of patient assignment, need to cover other nurses for break and nurse-patient ratio, were the most frequently reported barriers. Nurses' attitude scores, subjective norm scores and intention scores toward providing CLS to women with epidural analgesia were lower than those for a non-epidural case study. Conclusions. Organizational barriers impact nurses' ability to provide CLS. Nurses have lower intentions to provide CLS to women with epidural analgesia.

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Bachelors
Nursing
Nursing

Thesis (MCur)--Stellenbosch University, 2012.
ENGLISH ABSTRACT: The importance of maintaining maternal wellbeing during the antenatal period is mandatory to the mother and the baby. Although asymptomatic maternal tachycardia could be seen as part of the physiological changes during pregnancy, it could also be a sign of a serious underlying condition. Previous studies have shown that maternal deaths could occur in women with pre-existing cardiac conditions (Naidoo, Desai & Moodley, 2002:17). The concern that many conditions associated with maternal tachycardia pass through the health care system without being noticed or investigated motivated the researcher to undertake this study. The study aimed to determine the prevalence of maternal tachycardia during late pregnancy and its association with anaemia, major cardiac diseases and/or complications and adverse maternal and perinatal outcomes. A case-control retrospective study design within a prospective study was employed with a quantitative approach. A total sample size of 204 participants, constituting 14.3% of the study population (N=1431) was purposefully selected from the Monica AN24™ recordings of the Safe Passage Study at Tygerberg Hospital to collect the data. Ethical approval was obtained from the Health Research Ethics Committee of the Faculty of Medicine and Health Sciences, Stellenbosch University and a waiver of consent had been granted. A group of 16 participants, who met the inclusion criteria, constituting 7.8% of the total sample, was selected for the pilot study. Reliability and validity was ensured by the pilot study and pre-testing the data collection instrument as it was tested under the exact circumstances as the actual study experts in the field of nursing and medical research and statistics were used. The data was analyzed by the use of the STATISTICA version 9 programme. The results show a 7.1% (n=102) prevalence of maternal tachycardia in late pregnancy. There were no pre-existing cardiac conditions in any of the groups and no maternal cardiac complications during pregnancy and delivery. The case group had a higher incidence (55.0%) of haemoglobin values lower than 11.0 g/dL than the control group (47.0%), however the Mann-Whitney U test revealed no statistically significant difference of the Hb values at 28 to 38 weeks between the case and the control groups. The participants presenting with anaemia (Hb < 11.0 g/dL) were classified as mild anaemia (Hb value of 7.0 – 10.9 g/dL). There were no participants that presented with severe anaemia (Hb value of < 7.0g/dL). There was an increased prevalence (9.1%) of infection in the participants presenting with maternal tachycardia, although this difference was not significant between the two groups. The infant outcome revealed an increased mean birth weight of 194g for the case group that presented with maternal tachycardia. Several recommendations were identified that were grounded in the study findings. The findings reveal that the current antenatal care practice in terms of not recording the maternal heart rate is sufficient.
AFRIKAANSE OPSOMMING: Die belangrikheid van die handhawing van moederlike welsyn gedurende die voorgeboorte tydperk is noodsaaklik vir die moeder en die baba. Alhoewel asimptomatiese moederlike tagikardie gesien kan word as deel van die fisiologiese veranderinge tydens swangerskap, kan dit ook 'n teken wees van 'n ernstige onderliggende toestand. Vorige studies het aangetoon dat moederlike sterftes kan voorkom in vroue met voorafgaande harttoestande (Naidoo, Desai & Moodley, 2002:17). Die kommer dat verskeie toestande wat verband hou met moederlike tagikardie, deur die gesondheidsorg stelsel kan deurglip sonder om opgemerk te word, het die navorser gemotiveer om hierdie studie te onderneem. Die studie is daarop gemik om die voorkoms van moederlike tagikardie tydens laat swangerskap en sy verbintenis met anemie, ernstige hartsiektes en/of komplikasies en ongunstige moederlike en perinatale uitkoms te bepaal. 'n Gevalkontrole retrospektiewe studie-ontwerp binne 'n voornemende studie is gebruik met 'n kwantitatiewe benadering. 'n Totale steekproefgrootte van 204 deelnemers, wat 14.3% van die populasie (N=1431) uitmaak is op ‘n doelgerigte manier uitgekies uit die Monica AN24™ opnames van die Veilige Geboorte Studie by Tygerberg Hospitaal om die data in te samel. Etiese goedkeuring is verkry van die Mensnavorsing Etiese komitee komitee van Fakulteit van Geneeskunde en Gesondheidswetenskappe van die Universiteit Stellenbosch en 'n kwytskelding van toestemming is verleen. 'n Groep van 16 deelnemers, wat voldoen aan die insluitingskriteria, wat 7,8% van die totale steekproef bestaan, is geselekteer vir die loodsstudie. Betroubaarheid en geldigheid is verseker deur die loodsstudie en die voorafgaande toets van die data-insamelingsinstrument onder presies dieselfde omstandighede as die werklike studie sowel as die gebruik van kenners in die gebied van verpleging en mediese navorsing en statistiek. Die data is ontleed deur die gebruik van die Statistica weergawe 9 program. Die resultate toon 'n 7,1% (n=102) voorkoms van moederlike tagikardie in laat swangerskap. Daar was geen onderliggende harttoestande in enige van die groepe en geen moederlike hartkomplikasies tydens swangerskap en geboorte nie. Die gevalgroep het 'n hoër voorkoms (55,0%) van Hb waardes laer as 11.0 g/dl as die kontrole groep (47.0%) gehad, maar die Mann-Whitney U-toets toon geen statisties beduidende verskil in die Hb waardes by 28-38 weke tussen die geval en die kontrolegroepe nie. Die deelnemers met anemie (Hb < 11.0 g/dl) is geklassifiseer met ligte bloedarmoede (Hb waarde van 7.0-10.9 g/dl). Daar was geen deelnemers wat erge bloedarmoede (Hb waarde van < 7.0g/dL) getoon het nie. Daar was verhoogde voorkoms (9,1%) van infeksie in die deelnemers met moederlike tagikardie, hoewel die verskil nie beduidend tussen die twee groepe was nie. Die baba uitkoms toon 'n toename in gemiddelde geboortegewig van 194g vir die gevalgroep wat met moederlike tagikardie gediagnoseer is. Verskeie aanbevelings is geïdentifiseer wat in die studie se bevindinge gegrond is. Die bevindinge dui daarop dat die huidige voorgeboortelike sorgpraktyk in terme van nie rekordering van die moederlike hartspoed voldoende is.

Caregivers while, the biggest providers of palliative care for terminally sick patients, are often neglected in the process of providing care, which inadvertently affects their overall health and well-being. This study aims to explore the experiences of the unmet needs of the caregivers in palliative care. The literature review is based on seven quantitative, four qualitative and one mixed methodology approach studies. Results show a shortage of information given to caregivers regarding disease progression, symptomatology, support services and financial services. Furthermore the themes of unmet needs that emerged are physical, psychological, emotional, social and spiritual needs. Caregivers also reported the shortage of standard services provided by healthcare sector.  A healthy relationship scenario, where caregivers are supported to look after themselves as well as their loved ones, would boost the support they render to the patients.  The provision of needed services to caregivers, nurses, and healthcare personnel is required to fulfill a healthy relationship and further develop it by learning from the caregivers’ experiences. In conclusion, effective communication between caregivers and care providers is found to be a prerequisite for building trust and could contribute to satisfy the informational, medical, social and spiritual needs while helping to decrease health strains of caregivers.

The purpose of this study was to explore and describe nurse-patient communication during critical illness events. The theoretical structure of the study was drawn from communication, sociolinguistic, and nursing theory. Data were collected in a 374-bed private hospital in the Southwest. The sample consisted of six registered nurses and nine patients experiencing cardiac surgery. Nine observed and audiotaped nurse-patient interactions, and fourteen audiotaped partcipant interviews provided the data base for analysis. Content analysis was used to organize the data. Findings were presented in terms of language, paralanguage, and nonverbal expression, and in terms of content, process, and product of nurse-patient communication. Participants used biomedical-technical language and casual-everyday language during the interactions. Nurses talked about what patients would experience while patients talked about themselves as a way of establishing their credibility within the biomedical setting. Nurses viewed nurse-patient communication as variable depending on the patients' needs and responses. Patients viewed nurse-patient communication as straightforward, not requiring adjustment for the needs of the participants. Products of communication for patients involved increased knowledge, reassurance, and increased confidence. Products of communication for nurses involved relieving the patients' anxieties, considering the patients' remembering, and increasing the nursing staff's knowledge about the patient while helping the patient to know the goals of the nursing staff. The introduction and closure segments of the six nurse-patient interactions for preoperative preparation of the patient were analyzed. Nurses began the introductions by assuming that the patients needed relief from anxiety but the patients demonstrated politeness more than anxiety. Nurses used strategies of questioning, starting the physical assessment, topic persistence, and self-monitoring to control the closure segments. Patients used narratives and humor as control strategies. The study findings suggest conceptual areas relevant to nurse-patient communication which may ground theoretical model development for nurse-patient communication. Nurses in clinical settings can compare their patient communication experiences with the findings of the study in order to increase their understanding of expression, form, and function of nurse-patient communication.

Normal birth, defined as birth without induction of labour, anaesthetic, instruments or caesarean section conveys significant maternal and neonatal benefits. Currently one-fifth of women in the United Kingdom are obese. There is increasing evidence of the detrimental effects obesity has on intrapartum outcomes. There is a lack of research on how to minimise the associated risks of obesity through non-medicalised interventions and how to support obese women to maximise their opportunity for normal birth. This thesis aims to provide evidence to address this gap and develop an evidence-based intervention to promote normal birth. Using a methodological approach aligned with pragmatism, this research was conducted in four parts and underpinned by the Medical Research Council framework for the development of complex interventions. Part one was a national survey involving 24 maternity units. Part two was a qualitative study of the experiences of 24 health professionals and part three involved 8 obese women. The final part was a multi-disciplinary workshop that used consensus decision-making to design the intervention. Collectively, the findings suggest that intrapartum care of obese women is medicalised. Health professionals face challenges when caring for obese women but many strive to optimise the potential for normal birth by challenging practice and utilising ‘interventions’ to promote normality. The findings also demonstrate that obese women have an intrinsic fear of pregnancy and birth, have a desire for normal birth and ‘obese pregnancy’ presents a window of opportunity for change. The intervention consists of three component parts; an educational aspect (e-learning package), a clinical aspect (intrapartum care pathway) and a leadership aspect (ward champions). Whilst acknowledging the importance of safety, increasing intervention during labour for obese women may further increase the risk of complications, with detrimental effects. Addressing intrapartum management of obese women through non-medicalised interventions is of paramount importance in order to promote normality, maximise the opportunity for normal birth and reduce the associated morbidities.

Caring is a complex phenomenon that has been described and linked to several other concepts such as competence, compassion, presence, intention, interconnectedness, detachment, coping, trust, reassurance, empathy, and advocacy. The significance of exploring the patients’ lived experience of caring can provide a framework for achieving the benchmarks evaluated during a hospitalization by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The higher the scores on the patients surveys provide better the feedback on the HCAHPS, which in turns increases the funding received from Centers for Medicare and Medicaid Services (CMS). The HCAHPS are one measure used to calculate incentive payments with the Value-Based Purchasing program being the other measure. This hermeneutic phenomenological study was to explore the patients’ lived experience of caring during a minimum of a two night stay in the hospital. Watson’s caring theory was the guiding framework of this study to illuminate caring, and building relationships between the nurse and the patient. Fifteen adult patients over eighteen years of age who were hospitalized for a minimum of a two-night stay were interviewed in their private occupancy room. Following the data analysis using Van Kaam’s methods and NVivo software, two themes emerged: (1) being helped by someone who demonstrates presence and (2) being helped by someone with competence. Based on data analysis, patients expect their caregivers to demonstrate presence; this involves being available to meet their needs and providing care with competence knowing how to perform the skills and performing with proficiency.

A qualitative study, using interpretive description, was conducted at a tertiary paediatric hospital. Its purpose was to determine attitudes and beliefs of nurses and physicians about parental presence during paediatric trauma resuscitations in the Emergency Department. Parental presence was believed to have both benefits and problems for patients, parents and the trauma team. Registered nurses and physicians expressed largely similar attitudes and beliefs related to parental presence. These depended heavily on context. Most participants believed presence was appropriate with stable children and when death was imminent. In between these two ends of the continuum, participants had greater variability in their attitudes and beliefs. Findings provide insight into how health care professionals believe they can deliver the highest quality technical care for the patient while meeting the psychosocial needs of all involved. Relevance of the findings to family centred-care is discussed. Implications for nursing practice, education and research are identified.

Background Midwifery units (MUs) provide midwife-led care for women at low risk of complications. They may be located on the same site as an obstetric unit (OU), in a hospital without obstetric services or separate from any hospital. In MUs, if unforeseen complications arise, transfer to an OU may be necessary. Aim To provide evidence to contribute to the improvement of the transfer process, help make transfer safer and less distressing for women, thereby improving the care and experience of women planning to give birth in MUs. Methods A structured literature review of existing evidence was followed by three integrated component studies using different methods. The content and quality of local NHS transfer guidelines were evaluated. Data from the Birthplace national prospective cohort study were analysed to estimate transfer rates, describe the transfer process and identify factors associated with transfer. The experiences of women transferred were explored in qualitative interviews. Findings Transfer is a common event, affecting around 25% of women planning birth in MUs, although rates in different units vary. Primiparous women are more likely to be transferred than women having a second or subsequent baby. The risk of transfer for primiparous women increases with increasing age; around 50% of women having their first baby aged 40 years or over are transferred. Local NHS transfer guidelines are generally of poor quality and pay little attention to women’s experience. Women interviewed after transfer report feeling unprepared for transfer. Sensitive care and clear communication from midwives during labour facilitate feelings of control in women and help women accept transfer as the right decision and not a 'negative' event. Transfer that is perceived by women as “too late” can have potentially serious and long-lasting negative effects. Women’s experience of the transfer journey could be improved by the offer of choice in a number of areas which would help women feel 'cared for' rather than 'transported'. Having the MU midwife continue to care for the woman after transfer should be considered 'best practice'; where this is not possible a good handover is essential. Women who have experienced transfer should be offered the opportunity to talk to a midwife about their experience.

Background: Family caregivers represent a critical component in the management of the health of older adults. The inclusion of family caregivers during transitions occurring between hospital and community settings has been previously considered. However, the experience of family caregivers during transitions occurring within the same setting remains unclear. The purpose of this study was to describe the experiences of family caregivers during transitions occurring within an acute care setting. Method: A qualitative description study was conducted. Semi-structured interviews were conducted with 10 family caregivers. Interviews were audio-recorded and occurred in person or over the telephone. Analysis included coding of interview data and the development of overarching themes. Findings: In this study, family caregivers reported the following themes. These themes included: "a lack of central brain during hospitalization," "muddling through transitions alone" and "wariness towards the care delivery system. The environmental influence of the hospital setting influenced family caregivers' view of the care provided by healthcare professionals and the transitions occurring between different units. Furthermore, half of the family caregiver participants (n=5) identified as having a background in healthcare. Healthcare professionals as family caregivers (HCP-FCs) reported unique experiences from other non-healthcare family caregivers. Interviews and field notes from HCP-FC participants were analyzed separately following the same procedures as the larger study. Three themes emerged including, "seeking inclusion," "insider perspectives," and "role struggle." Conclusion: Experiences of HCP-FCs and family caregivers during hospitalization of older adults have the potential to influence perceptions regarding transitional events occurring within acute care settings. Additionally, family caregivers' and HCP-FCs' perceptions of care coordination among healthcare professionals had the potential to negatively influence perceptions of transitions occurring within the acute care setting.

Transition of care refers to the movement of patients between health care settings; it occurs each time patients move between providers within the same setting or between settings based on the patient's acute or chronic health care needs. Care transition includes the efficient and accurate exchange of information needed to provide high-quality continuity of care. A rural community hospital in in the northeastern region of the United States has a skilled nursing facility and an acute care hospital on one campus. This project focused on the development of a clinical practice guideline (CPG) for the hospital to improve communication during transitions of care. The Iowa model of evidence-based practice informed the development of the guideline. A project team developed the CPG. Five multidisciplinary experts reviewed the CPG using the appraisal of guidelines for research and evaluation (AGREE II) evaluative tool. Results for the 6 domains of the AGREE II tool showed experts' agreement greater than 90% with the guideline as developed. The creation of a CPG to improve communication during care transition could benefit nurses with improved clinical decision making and patients with improved outcomes. The CPG could impact social change by supporting the application of the principles of evidence-based nursing practice, which could result in improved care and patient outcomes.

More than 324,000 women each year are estimated as having experienced intimate partner violence (IPV) during pregnancy. Correctly identifying women experiencing all forms and severity of IPV is necessary to inform the implementation of interventions to prevent and treat IPV. This can optimally be accomplished with data from accurate screening instruments. The United States Preventative Services Task force has recently recommended that all women who are pregnant should be screened for IPV over the course of their pregnancy and postnatal visits. Currently, clinical practice and research are hindered by the lack of validated IPV screening measurements for a pregnant population. The current review examined accuracy measures of empirically tested IPV screening measures, and evaluated them for use in prenatal health care settings. Based on the information collected and presented, recommendations regarding which screens are, and are not, appropriate to use in prenatal care settings to identify IPV were presented. Further rigorous studies are needed to identify and evaluate screening measurements and procedures to increase sensitivity and suitability for use in a variety of clinical settings for pregnant women.

Background: Effective communication is vital to establish a patient-nurse relation and in order for the nurse to deliver good nursing care. Mistakes and errors are more frequent when there is a language barrier between the nurse and the patient. Method: The study was made as a qualitative interview study with a phenomenological analysis. Aim: Describe how Malaysian nurses deal with language barriers during meetings with patients with another language. Result: To deliver good nursing care to patient with another language could be difficult depending on what strategies the nurses used: how nurses experience the effectiveness of non-verbal communication, how interpreters were used and who interpreted during the patient meeting, strategies nurses used when interpreter was not an option, nurses’ interest in learning about the patient’s culture. Conclusion: To overcome language barriers is complex and often more than one strategy is needed. Patient safety is compromised when there were language barriers between the nurse and the patient.

Aim: The aim of this study was to describe intensive care nurses’ experiences communicating with patients during mechanical ventilation. Methods/design: A qualitative interview study. Interviews where analyzed using descriptive content analysis Setting: Nine intensive care nurses from two different intensive care units were interviewed using a semi structured interview guide. Background: Past research has shown that patients during mechanical ventilation in the intensive care unit, feel very vulnerable and the helplessness of being unable to speak. These patients feels that they are completely dependent on the nurses and their competence. It has been shown to be very important that the patient feels included, acknowledged and respected. Results: The analyzed data resulted in a theme; through communication strive to preserve patients´ dignity and three main categories; create relationship to the patient, minimize patients´ vulnerability and don´t give up. These main categories consist of nine subcategories Conclusion: Critical ill patients during mechanical ventilation have a very limited opportunity to communicate. Therefore the patient is put in a very vulnerable position and is completely dependent on the nurse. This study shows that the nurse by communicating with the patient strive to preserve the patients dignity.

Over 4 million avoidable hospital admissions result from medication errors (IMS Insitute for Healthcare Informatics, 2013). Human error accounts for 80% of all medical errors (Palmieri, DeLucia, Peterson, Ott, & Green, 2008). Medication administration is a complex process. It is important to understand the cognitive load (CL) of Registered Nurses (RNs) working in an electronic health record environment to identify the risk factors of medication errors. The purpose of this study is to investigate the factors that influence the CL of RNs during medication administration who are working in an electronic health record environment. Simulated medication administration scenarios with varying degrees of multi-tasking were completed with 30 participants. When RNs multi-task during medication administration their CL increases. Furthermore, RNs who have poor sleep quality cannot process high-level tasks as well as those RNs who report a good sleep quality. Future work can limit EEG lead placement to the frontal channels of the EEG. Furthermore, replication of this study with a larger sample and a broader range of competing tasks is indicated.

Purpose: Prenatal care (PNC) is the healthcare service most often provided to women of childbearing age throughout the world. Poorly understood and defined, based on culture, and expensive for any healthcare system, PNC remains a target for change and improvement. The purpose of this cross-national qualitative research study using narrative inquiry methods was to explore consumer perspectives of individual health and routine PNC in the USA and Iceland. Methods: A purposive sampling technique was used to identify study participants (n = 32) from the United States (n = 16) and Iceland (n = 16). Data were collected via a semistructured interview which included demographic questions. Results: Content analysis processes were used to analyze the transcribed narratives to identify common conceptual themes. Subsequently, the narratives of the women from the two nations were compared to identify cultural variations about PNC. In respect to the findings, demographically the two groups were similar. Respondents from both nations preferred a more supportive role from PNC providers with adequate time to explore important personal concerns and less emphasis on monitoring weight gain during the pregnancy. Variations between the two groups related to the health care delivery system of the nation in which respondents resided. These findings have the potential for expanding the definition of PNC to include consumer perspectives. Discussion/Implication: Additional research is needed with other groups of women to validate, clarify and expand identified themes, as they may improve PNC, and ultimately, perinatal outcomes. Improving PNC holds the promise of improving infant mortality while at the same time reducing healthcare expenditures for countries around the world.
Ph.D.
Doctorate
Nursing
Nursing

Thesis (MCur)--University of Stellenbosch, 2011.
ENGLISH ABSTRACT: This research was an attempt to investigate the role of the doula during labour and the promotion of natural childbirth as well as the assessment of the effect of the presence of the doula during natural childbirth. There has been a shift from home-based deliveries to hospital-based deliveries, which does not sufficiently provide for optimal care and emotional support to the women during labour. The registered midwives in the maternity units in Port Elizabeth in the Eastern Cape region in both private and public hospitals displayed some reluctance in using the doulas during labour. The design for this study utilised a quantitative approach which is non-experimental, explorative, descriptive and contextual in nature. The data -collection method used was only the statistical data from the registered midwives’ questionnaire designed as per the format from the University of Stellenbosch. Research ethics implemented were confidentiality, informed consent, privacy, protection, information and debriefing. Validity and reliability had to be observed on this study as it was observed that the content of the study had to be closely related to what was measured, as well as consistency of the data –gathering instrument in obtaining the same results in similar situations The study took place at the Port Elizabeth Maternity Units in the Eastern Cape with registered midwives (40 in the Public Sector and 45 in the Private Sector),and 45 in the private sector of the maternity units of the selected hospitals. The results of this study and the interpretation thereof assisted the researcher to confirm that there was indeed a great need for the doulas during natural childbirth in the maternity units in the public sector, where there is a shortage of registered midwives and care workers to attend to the basic needs of the patients. The value of the contributions of the doula to support and provide comfort measures to women during labour should not be underestimated; and registered midwives should be informed about the important role of the doula and how the doula can complement the obstetrical care rendered by the midwife.
AFRIKAANSE OPSOMMING: Hierdie navorsingstudie is uitgevoer om die rol van die doula of kindergeboorte-begeleidster gedurende baring in die bevordering van natuurlike kindergeboorte asook die effek van die teenwoordigheid van laasgenoemde te ondersoek. Die klem het verskuif van tuisbevallings na hospitaal- bevallings. Hierdie tendens het veroorsaak dat daar nie genoeg voorsiening gemaak word vir versorging en emosionele ondesteuning nie. Die geregistreede vroedvroue in die verlossings-eenhede in Port Elizabeth in die Oos-Kaapse streek, in beide openbare en private hospitale toon ‘n mate van onwilligheid om doulas tydens baring te benut, Die studie ontwerp is non-eksperimenteel, eksploratief, beskrywend en kontekstueel van aard, met ‘n kwantitatiewe benadering. In kwantitatiewe studies help die ontwerp, die navorser deur middel van prosedures om akkurate en interpreteerbare data te ontwikkel. Die studie is onderneem by die Port Elizabeth se Verloskunde-eenhede in die Oos-Kaap. In hierdie hospitale is daar 40 geregistreerde vroedvroue in die Openbare- en 45 in die Privaatsektor. Die resultate van hierdie studie en die interpretasie daarvan het die navorser gehelp om te bevestig dat daar inderdaad ‘n groot behoefte bestaan vir die bydraes van kindergeboortbegeleidsterss en veral in die openbare sektor waar daar groot tekorte aan geregistreerde vroedvroue voorkom en nie genoeg personeel is om in die basiese behoeftes van die pasiënte te voorsien nie. Die waarde van die bydraes van doulas om ondersteuning en bemoedigingsmaatreëls vir die vrou tydens baring te voorsien moet nie onderskat word nie; en geregistreerde vroedvroue behoort bewus gemaak te word van die belangrike rol van die doula en hoe die doula die obstetriese sorglewering van die pasient kan komplementeer.

The focus of this study was to determine what types of information and support families wanted at the time they admitted a relative to a long-term care facility. Twenty families were interviewed by telephone, including both the primary caregiver and, where appropriate caregiving family members. It was found that half of the families felt they wanted no additional information or support than they had received, and that they were basically satisfied with the facility's admission process. The majority of the families felt that the institution also encouraged their continued involvement with their relatives after admission.

The results suggest that researchers and practitioners need to be aware, however, that the admission process if often a stressful time, and that family members may be so involved in making long-term care arrangements that they do not focus on their own needs, but only on those of the elderly patient. Support services and information should be provided on an individual basis, considering such factors as whether the caregiver is employed full-time and the distance the caregiver lives from the facility.

Master of Science

Nursing has come a long way to become a subject of university study. Clinical placement is a vital part of the study in preparing students for future nursing roles as providers of care to patients. The placement within nursing homes is a compulsory part of the clinical studies. Major actors in the clinical placement are supervisors. Their actions and support are determinant for the nursing student’s experiences, in learning and development of their clinical skills.

Aim: This study explores what type of information patients and nurses share with, or provide to, each other, and whether or not the information received was relevant and sufficient for their needs. Background: Information exchange, as part of shared decision-making, is advocated in policy and practice throughout the healthcare sector. Much of the literature on information exchange relates to one-to-one consultations with consultants or GPs. To date, no studies have explored information exchange between patients and nurses in ward settings. Nursing literature on patients’ information needs focuses on one-way information provision from nurses to patients, rather than on two-way information exchange between patients and nurses. Methods: Interactions between patients and nurses were observed and audio-recorded using a remotely controlled audio-recording system. Semi-structured individual face-to-face interviews were then conducted to clarify and add to the observation data. A multiple case study design was used for this study: each case comprised one patient, the nurses caring for that patient, and the interactions between them. A pilot study was undertaken to inform the methods for recruitment and data collection for the main study. Results: The pilot study comprised five cases (patients n=5, nurses n=3). Changes to the recruitment strategy for the main study included surgical patients being invited to participate in the same way as medical patients. There were no difficulties with the data collection methods. The main study comprised nineteen cases (patients n=19, nurses n=22). Information exchange seemed unfamiliar to ward-based nurses. The findings show that information exchange may not be a one-off event but a complex series of interactions. Patients did not distinguish between clinical and non-clinical information in the same way as nurses. Primary reasons for patients’ hospital admission were not discussed and nurses did not share information about nursing interventions. The relevance for patients and nurses differed; patients generally wanted information for reducing anxiety and socialization; nurses wanted information for assessment and care planning. In terms of sufficiency, observation sessions highlighted that insufficient information was provided, often due to lost opportunities and paternalistic practice. However, the majority of patients and nurses perceived that they had exchanged sufficient information. Conclusion: This multiple case study provides insights into the type, relevance and sufficiency of information for patients and nurses in ward settings. In ward settings, information exchange as conceptualised by Charles et al. (1997 and 1999) may be difficult to achieve due to the complexity of patient/nurse interactions. Therefore, there are implications for policy makers as policies are not context specific. However, information exchange may be helpful for reducing patients’ anxieties. The concepts of shared decision-making and information exchange are not part of ward-based cultures and philosophies, which suggests implications for patient and nurse education. Research on information exchange between patients and nurses in other ward contexts may contribute to further understanding of information exchange in ward settings.

Thesis (Ph. D.)--Georgia State University, 2006.
Title from title screen. Cecelia Grindel, committee chair; Carol Howell, Patsy Ruchala, committee members. Electronic text (159 p. : ill. (some col.)) : digital, PDF file. Description based on contents viewed June 13, 2007. Includes bibliographical references (p. 90-98).

Problem. Nurses, members of a society which tends to avoid and deny death, grief, and loss, are frequently in situations where they must interact with persons experiencing grief from death or loss. Often educational experiences have done little to prepare student nurses to cope in positive and supportive ways. Student nurses need to develop self-awareness of their attitudes and anxieties toward death, loss, and grief; modify negative attitudes; and develop a repertoire of interpersonal skills to support persons experiencing grief. Purpose. The purpose of this study was to determine if academic, and experiential learning could influence the clinical performance of student nurses and the degree of empathy and openness of the students' stated attitudes toward those experiencing or anticipating death, loss, or grief. Procedures. Attitudes of 42 nursing students were measured using the Questionnaire for Understanding the Dying Patient and His Family. A workshop was presented on attitude exploration, crisis theory, grief and loss, and communication skills. The workshop was followed by an immediate posttest using the same instrument. Selected students were given clinical assignments in a high risk maternity care center involving the care of families experiencing grief from loss or death. Eight weeks after the workshop, attitudes were measured for a third time. Clinical performance was evaluated by the student, the family, and the instructor. Findings. The level of significance was set at the .05. Significantly more positive scores were found on both the immediate and the delayed posttest than on the pretest. Evaluations by the student, the family, and the instructor were significantly more positive for the students with more open and empathetic attitudes than for students with less open and empathetic attitudes. Recommendations. Nursing education programs should include specific learning experiences which facilitate adaptation of student nurses in the modes of self-concept, role function, and interdependence as they learn to meet the holistic needs of individuals experiencing death, loss, and grief. Replication of this study using another age group or clinical setting would lend insight as to how attitudes and clinical behavior are influenced by age and by diagnosis.

Care and treatment of women with inflammatory symptoms of the breast during lactation

Inflammation of the breast during lactation causes considerable discomfort to mothers and carries a risk of early abandonment of breastfeeding. Little is known about the effects of care interventions, including acupuncture, used for these mothers or about mothers’ experiences of the complaint. Aim: to study care and treatment given at a midwife-led breastfeeding clinic to mothers with inflammatory symptoms of the breast during lactation, to gain knowledge of mothers’ experiences of being afflicted by breast inflammation and to investigate factors which may be associated with the development of breast abscess. Methods: method triangulation was used to study different aspects of the phenomenon of inflammatory symptoms of the breast during lactation; two randomised controlled trials I (n = 88) and II (n = 210), a descriptive study III (n = 210), an interview study with a Grounded Theory approach IV (n = 14), and a population-based register study V (n = 1,454,068 singleton deliveries). Results: mothers’ symptoms were more effectively relieved when acupuncture was used but acupuncture treatment did not shorten contact with health services. Nine percent (I) and 15 % (II) respectively, of mothers were prescribed antibiotics. Twelve percent experienced renewed symptoms requiring health care contact within 6 weeks (III). Seven mothers (0.1% of breastfeeding mothers) developed breast abscess, which was comparable to the figure in the population-based study (V). The presence of Group B streptococci in the breast milk was related to longer contact with health care (II). Mothers’ “will to breastfeed” may make it possible for them to withstand physical and emotional difficulties caused by the illness. Mothers considered access to clinical expertise to be an important factor in their care (IV). Primiparous mothers, those over the age of 30 years and those who give birth after 41 weeks gestation appear to be at a significantly increased risk for the development of breast abscess (V).

Conclusions: mothers’ symptoms were more effectively dissipated when acupuncture treatment was used. However, acupuncture treatment did not shorten mothers’ contact with health care services. Interventions, including acupuncture treatment for relief of symptoms may help mothers to withstand their discomfort and await the body’s own anti-inflammatory response and therefore make it possible to substantially reduce the use of antibiotic therapy for this group. The results indicate a need for a better understanding of the influence on breastfeeding of hormones administered to birthing and breastfeeding women. The availability of immediate clinical expertise is an important factor for these mothers, which health care planners should be aware of. Information on potential breastfeeding problems should be improved.

Key words: acupuncture, antibiotics, breast abscess, breastfeeding, care interventions, inflammatory symptoms, lactation mastitis

Vård och behandling av kvinnor med inflammation i brösten under amningsperioden

Bröstinflammation orsakar stort obehag för ammande mödrar och innebär en risk för att amning avslutas i förtid. Det finns ringa kunskap om effekterna av interventioner, inkluderande akupunktur, som används vid vård av dessa kvinnor. Det saknas även kunskap om mödrarnas upplevelser av bröstinflammation. Syfte: att studera vård och behandling av kvinnor med bröstinflammation vid en amningsmottagning ledd av barnmorskor, att utveckla kunskap om mödrars upplevelser av att vara drabbad av bröst inflammation samt att undersöka faktorer som kan ha betydelse för utvecklandet av bröstabscess. Metoder: metodtriangulering användes för att studera olika aspekter av fenomenet bröstinflammation under amningsperioden; två randomiserade kontrollerade studier I (n = 88) and II (n = 210), en deskriptiv studie III (n = 210), en intervjustudie med en grounded theory ansats IV (n = 14) och en populationsbaserat registerstudie V (n = 1 454 068 enkelbörds förlossningar). Resultat: mödrarnas symptom lindrades mer effektivt med akupunktur akupunkturbehandling men förkortade inte deras kontakt med vården. Nio procent (I) respektive 15 % (II) av mödrarna fick antibiotika. Tolv procent fick recidiv vilket föranledde kontakt med vården inom 6 veckor (III). Sju mödrar (0,1 % av ammande mödrar) utvecklade bröstabscess (II), vilket överensstämde med resultat i den populationsbaserade studien (V). Förekomsten av Grupp B streptococcer i bröstmjölken var relaterad till längre vårdkontakt (II). Mödrarnas viljan att amma kan göra det möjligt för dem att uthärda fysiska och emotionella svårigheter som sjukdomen innebär (IV). Tillgång till klinisk expertis var en viktig del av vården för dessa kvinnor. Att vara förstföderska kan innebära en något större risk för utveckling av bröstabscess. Mödrar över 30 år samt de som föder efter graviditetsvecka 41 har också en ökad risk för abscess (V).

Slutsatser: mödrarnas symptom lindrades mer effektivt när akupunktur användes. Kontakten med vården blev dock inte förkortad av akupunkturbehandling. Interventioner som inkluderar akupunkturbehandling kan tillåta mödrar att invänta kroppens anti-inflammatoriska respons och kan därför möjliggöra en avsevärd minskning av antibiotika terapi för dessa mödrar. Resultaten visar behov av att bättre förstå hur amning påverkas av hormoner administrerade till kvinnor under förlossningsarbete och amningen. Tillgång till omedelbar klinisk expertis är en viktig faktor för dessa mödrar vilket hälso- och sjukvårdsplanerare bör vara medvetna om. Förbättrad information angående potentiella amningsproblem bör eftersträvas.

Nyckelord: akupunktur, amning, antibiotika, bröstabscess, bröstinflammation, interventioner, mastit, mjölkstockning

Opioids are used routinely in the pediatric intensive care population for analgesia, sedation, blunting of physiologic responses to stress, and safety. In children, physical dependence may occur in as little as two to three days of continuous opioid therapy. Once the child no longer needs the opioid, the medications are reduced over time. A review of the literature revealed that the majority of the published studies used either a neonatal opioid assessment tool or no assessment tool. A subsequent international survey of pediatric providers found a wide range of opioid tapering practices and sporadic use of opioid withdrawal instruments to guide practice. Since tapering routines vary among practitioners, it is not uncommon to see signs and symptoms of opioid withdrawal. A prospective, descriptive study was conducted to describe the frequency of opioid withdrawal signs and symptoms and to identify factors associated with these opioid withdrawal signs and symptoms. The sample of 25 was drawn from all patients, ages 2 weeks to 21 years admitted to the Children’s Hospital of Richmond Pediatric Intensive Care Unit (PICU) and who have received continuous infusion or scheduled opioids for at least 5 days. Data collected included: opioid withdrawal score (WAT-1), opioid taper rate (total dose of opioid per day in morphine equivalents per kilogram [MEK]), pretaper peak MEK, pretaper cumulative MEK, number of days of opioid exposure prior to taper, and age. Out of 26 enrolled participants, only 9 (45%) had opioid withdrawal on any given day. In addition, there was limited variability in WAT-1 scores. The most common symptoms notes were diarrhea, vomit, sweat, and fever. For optimal opioid withdrawal assessments, clinicians should use a validated instrument such as the WAT-1 to measure for signs and symptoms of opioid withdrawal. Further research is indicated to examine risk factors for opioid withdrawal in children.

OBJECTIVE: To establish baseline data of dental utilization and determine the predictors of receipt of dental procedures by Medicaid-enrolled senior adults who reside in Iowa nursing facilities. METHODS: This was a longitudinal retrospective analysis of Iowa Medicaid claims data for SFY 2007-2014 of senior adults who were 68 years or older upon entry to a nursing facility and continuously enrolled (eligible 58 out of 60 months) in Medicaid for three years prior to and at least two years after admission. RESULTS: Controlling for the subject and nursing facility level variables, the strongest predictor of dental utilization after entry was the receipt of a dental procedure before entry (p< 0.001). Subjects residing in a facility located in an urban area (p< 0.002) or in two regions of Iowa (p=0.035, p=0.019, respectively) also had increased odds of receiving a dental procedure. CONCLUSION: Our results show that approximately 50% of the subjects never received a dental procedure in the 5-year study period. The strongest predictor of receipt of dental procedures in the 2 years after entry was the receipt of dental procedures in the 3 years before entry. It is important for Medicaid-enrolled senior adults to establish a dental home while community-dwelling.

The purpose of the proposed qualitative phenomenological research study was to determine the lived experiences of emergency department nurses involved in family presence during resuscitation events. The phenomenological research study added to the current knowledge about family presence during resuscitation by examining an emergency department nurse’s past experiences with family presence during resuscitation and the impact they have on their decision to allow family presence in future events. The information can assist health care leaders in understanding the perceptions of emergency department nurses regarding family presence and assist in developing guidelines regarding family presence during resuscitation. The data collected also helped to identify factors which influence the nurse’s feelings about the practice and to overcome resistance to the practice.

Thesis (MCurr)--Stellenbosch University, 2013.
ENGLISH ABSTRACT: The availability and provision of good antenatal care services ensure early detection and prompt management of any complication or disease that may adversely affect pregnancy outcome. To ensure high quality care, an ongoing health education and empowerment of pregnant women with pregnancy related information, need to be provided by midwives throughout pregnancy. The purpose of this study, therefore, was to explore the pregnant women`s experiences and perceptions regarding health education given during the antenatal period. The objectives set were to - explore the content of the health education given to pregnant women by midwives during the antenatal period - determine whether the health education offered by midwives is understood by pregnant women - determine whether information regarding Health Education during antenatal period is applicable and is used by pregnant women. A qualitative approach with an explorative descriptive design was applied for the purpose of this study. The population included pregnant women who attended an antenatal clinic for the second time in 2012. Ten pregnant women were selected purposively who consented to participate in the study. The trustworthiness of this study was assured by using Lincoln and Guba`s criteria of credibility, transferability, dependability and confirmability. A pretest was done with one participant not included in the actual study. Ethics approval was obtained from the Ethics Committee of the Faculty of Medicine and Health Sciences at Stellenbosch University, reference: S12/05/136. Informed written consent was obtained from each participant which included a recording of the interview. Data was collected through semi-structured interviews using an interview guide and a tape recorder. The researcher approached two women per day for five days. A total of ten (10) pregnant women were interviewed until data saturation reached. The use of Tesch's eight steps of data analysis was used to analyse the transcribed data as described in De Vos et al. (2004:331). Findings revealed that health education was given to pregnant women at the institution under study but with minimum explanations. The midwives were perceived as supportive and regarded as a source of information and self-care agents. Antenatal attendance was regarded as important by participants. Participants indicated that their unborn babies were monitored by the midwives in order to detect abnormalities early. However, midwives emphasised non-pregnancy related complications specifically HIV/AIDS and neglected to give basic antenatal care, such as antenatal exercises, personal hygiene and diet. Language was found to be a barrier and contributed to a lack of information. Recommendations include basic antenatal aspects to be covered in the health education, such as emphasis on personal hygiene, exercises, diet and avoidance of harmful sociocultural practices. With the implementation of appropriate teaching principles language, age and involvement of influential people during health education should be considered. In conclusion, to reduce maternal morbidity and mortality rates and promoting self-care reliance, antenatal care services should be accessible to facilitate ongoing health education by midwives throughout pregnancy.
AFRIKAANSE OPSOMMING: Die beskikbaarheid en voorsiening van goeie voorgeboortesorgdienste verseker die vroeë en vinnige bestuur van enige komplikasie of siekte wat swangerskap-uitkomste nadelig mag beïnvloed. Om hoë gehalte sorg te verseker, moet gesondheidsvoorligting en bemagtiging van swangervroue rakende swangerskap inligting deurlopend deur vroedvroue verskaf word. Die doel van hierdie studie was om vervolgens die swangervrou se ervaringe en persepsies ten opsigte van gesondheidsopvoeding gedurende die voorgeboortelike stadium te ondersoek. .Die doelwitte soos gestel was om: - die inhoud van die gesondheidsvoorligting wat deur vroedvroue gedurende die voorgeboorte periode aan swangervroue verskaf word, te ondersoek - te bepaal of die gesondheidsvoorligting wat verskaf word deur vroedvroue deur swangervroue verstaan word - vas te stel of die ligting aan swangervroue gepas is en te bepaal of dit toegepas word deur swangervroue. ’n Kwalitatiewe benadering met ’n beskrywende ontwerp is vir die doel van hierdie studie toegepas. Die populasie het swangervroue ingesluit wat ’n voorgeboortekliniek vir die tweede keer gedurende 2012 besoek het. Tien vrouens is doelgerig geselekteer wat daartoe ingestem het om aan die navorsing deel te neem. Die betroubaarheid van hierdie studie was verseker deur van Lincoln en Guba se kriteria van geloofwaardigheid, oordraagbaarheid, betroubaarheid en bevestigbaarheid gebruik te maak. ’n Loodsondersoek was met een deelnemer wat nie in die werklike studie ingesluit was nie, gedoen. Etiese goedkeuring is verkry van die Etiese Komitee van die Fakulteit van Geneeskunde en Gesondheidswetenskappe aan die Universiteit van Stellenbosch, verwysing: S12/05/136. Ingeligte skriftelike toestemming is verkry van elke deelnemer wat ook ’n opname van die onderhoud ingesluit het. Data is ingesamel deur van semi-gestruktureerde onderhoude gebruik te maak met behulp van ’n onderhoudsgids en ’n bandopnemer. Die gebruik van Tesch se ag stappe van data-analise is gebruik om die getranskribeerde data te analiseer (De Vos et al., 2004:331). Bevindinge het getoon dat gesondheidsvoorligting wel aan swangervroue by die inrigting onder die soeklig met die minimum verduidelikings verskaf is. Die vroedvroue is as ondersteunend en as ’n bron van inligting, asook as selfsorgagente waargeneem. Voorgeboorte bywoning is as belangrik deur deelnemers gesien. Deelnemers het aangedui dat hulle ongebore babas gemonitor is deur vroedvroue om abnormaliteite vroeg op te spoor. Nietemin, vroedvroue het nie-verwante swangerskap komplikasies, spesifiek MIV/VIGS beklemtoon en het nagelaat om aandag te gee aan basiese voorgeboortesorg soos voorgeboorte oefeninge, persoonlike higiëne en dieet. Daar is bevind dat taal ’n hindernis is en dat dit bygedra het tot ’n gebrek aan inligting. Aanbevelings sluit in basiese voorgeboorte aspekte wat gedek moet word in gesondheidsvoorligting, soos die beklemtoning van persoonlike higiëne, oefeninge, dieet en die vermyding van nadelige sosio-kulturele praktyke. Met die implimentering van doeltreffende onderrigbeginsels moet taal, ouderdom en die betrokkenheid van invloedryke mense gedurende gesondheidsvoorligting in ag geneem word. Ten slotte, om moeder-morbiditeit en-mortaliteitsyfers te verminder en selfsorgvertroue te bevorder, behoort voorgeboortesorgdienste toeganklik te wees, sodat vroedvroue volgehoue gesondheidsvoorligting tydens swangerskap kan fasiliteer.

The Centers for Medicare and Medicaid Services recommends new guidelines that shift healthcare delivery in nursing homes and long-term care facilities from an institutional model to a person-centered care model. Although clinical outcomes are measured and tracked, there was limited literature about the challenges non-clinical departments face in a nursing facility during implementation of a person-centered model. The purpose of this qualitative study was to explore the challenges non-clinical staff experience while transitioning to an Eden Alternative philosophy, a person-centered care model. The theoretical foundation of this study relied upon Bressers' Contextual Interaction Theory. The research questions for this study focused on the specific challenges that affect non-clinical staff from a staffing, operating, and risk management standpoint. The research questions focused on the internal and external motivations for staff as well as whether or not identifying such challenges will allow a nursing facility to achieve full Eden certification. The researcher for this study utilized a case study approach to explore the responses of 15 directors of non-clinical departments across the United States. Semi-structured interviews, Eden Warmth Survey data, and Minimum Data Set 3.0 data were used to gather data from participants and facilities involved. After using open coding for data analysis, significant findings in this study included that directors needed corporate buy in, continuous education, proper staffing and financial funding in order to achieve and maintain compliance. The study implications for social change involves addressing non-clinical department challenges directly and thus creating fewer barriers when embracing person-centered care models, such as the Eden Alternative model, as an environment for aging, compared to institutionalized approaches.

Thesis (MSc (Nursing))--Cape Peninsula University of Technology, 2018
Primary health care (PHC) is a frontline health care approach. It is the point of contact where people are kept well and where their quality of life is improved. All people diagnosed as HIV- positive are retested prior to antiretroviral therapy (ART) initiation to verify their serostatus. ART initiation is seen as a non-emergency treatment that provides many benefits if its initiation is accelerated, for example following up pregnant women after being diagnosed with HIV. However, accelerated initiation may lead clients to start treatment before they are ready to adhere to treatment outcomes. The purpose of this study was to describe the nurse support for young adults during a first antiretroviral therapy visit at an urban primary health care clinic in Malawi. A descriptive phenomenological design was followed at an urban setup in Zomba city, Malawi. The sample was selected through purposive sampling until data saturation was obtained. Individual semi- structured interviews were conducted with young adults aged 19 25 who have visited the clinic for their first ART according to an interview schedule and field notes for around 30 minutes in a private room. The data was analysed using distinctive process and a consensus meeting was held between the researcher and independent coder. The findings of the study could help the PHC services to retain and re-engage the young adults in HIV care and aid the Government of Malawi in achieving its Sustainable Development Goal (SDG) 3. Principles of trustworthiness and ethics were adhered to throughout the research process. Six themes, each with separate categories, emerged from the data analysis on the experience of young adults during their first visit for ART at an urban PHC clinic in Malawi. The results indicated the need for an environment that enhances a client-orientated approach with a focus on holistic well-being. Knowledge management should be used to provide relevant and sufficient information to a newcomer while maintaining ethics under difficult circumstances. The legal environment should have a focus on supporting clients that need comprehensive ART treatment. Motivation of the patient regarding taking antiretroviral treatment (ART) is thus essential. Young adults express the need to be supported by nurses with relevant information, privacy and confidentiality and the trusting client/nurse relationship which could help them to retain in ART care. Recommendations of this study was that nurses should be offered in-service training on youthfriendly programmes which focuses on the health care of young adults during their HIV/ART services. Nurses need to create trusting relationship for the young adults and providing in door game at the waiting area to keep them busy as they are waiting for the services. Nursing managers to lobby for funding to extend the clinic and be role models in providing relevant information to young adults. It was concluded that a first visit was both positive and challenging to the participant s; however, they experienced the health providers on the first visit to be caring and supportive.

Aim: The overall aim of this thesis was to acquire knowledge about daily life with focus on eating problems during the trajectory of care for patients with head and neck cancer treated with radiotherapy. Method: The data in study I were gained from medical and nursing records of 50 patients. Documented parameters of eating problems, their causes and consequences, and undertaken interventions were collected before treatment, during radiotherapy, and one, six, and twelve months after completion of treatment, using a study-specific audit instrument. Data were analysed with descriptive and inferential non-parametric statistics. In study II eight patients were interviewed during the radiotherapy treatment period with focus on experiences of eating problems. In study III nine patients were interviewed six to twelve weeks after treatment with the focus on experiences of daily life during the trajectory of care having eating problems. In study IV twelve patients were interviewed about their conceptions of the significance of a supportive nursing care clinic during the whole trajectory of care. Data were analysed with interpretative phenomenology (II, III) and phenomenography (IV). Findings: The four studies showed that being a patient in the trajectory of care often meant that life was disturbed and threatened. This was partly due to the eating problems and their consequences, which could occur during the whole trajectory of care (I, III, IV) but was experienced as most intense and severe during radiotherapy (II) and the nearest weeks after completion of radiotherapy (III, IV). The disturbances and threats experienced due to eating problems could affect the whole person as they were physical (I-IV), psychological, social and existential (II, III). The experiences of eating problems due to the tumour and its treatment and the experience of having cancer per se were strongly connected as one phenomenon, which disturbed and threatened the informants’ daily life. The other part that disturbed the patients’ life was the waiting in suspense. A long and trying waiting in uncertainty was experienced due to lack of knowledge and support, practical as well as emotional. This was most pronounced during pauses in radiotherapy (III) and after completion of the treatment when the lack of support from the health care was obvious (I, II, III). The patients were then most often left to their own devices. In order to endure, they needed both inner strength, described as own coping strategies, and strength from outside, described as support from family, friends and health care professionals (II, III). The nurse clinic was found to give a hand to hold during the whole trajectory of care (IV). It could meet these patients’ needs of knowledge, care and support, both concerning practical measures related to the eating problems and other side-effects of the treatment, and concerning their emotional needs. In addition the nurse clinic could support the relatives in their worries and anxiety (IV). Conclusion: This thesis showed the necessity of continuous assessment, treatment and evaluation of patients’ problems, and the patients’ needs of information and support throughout the trajectory of care.

Chronic obstructive pulmonary disease (COPD) is a major health problem in the United States. Acute exacerbations of COPD are primarily responsible for the physical, psychological and economic burden of this disease. Early identification and treatment of exacerbations is important to improve patient and healthcare outcomes. Little is known about how patients with COPD recognize an impending exacerbation and subsequently decide to seek treatment. The purpose of this qualitative descriptive study was to explore and describe symptom recognition and treatment delay in individuals experiencing an acute exacerbation of chronic obstructive pulmonary disease (COPD). Leventhal’s Common Sense Model of illness representation undergirded this study. Using semi-structured interviews, adults hospitalized with an acute exacerbation of COPD were asked to describe their symptom experience and self care behaviors, including treatment seeking, in the days to weeks prior to hospitalization. Data analysis revealed one main theme: Recognizing, responding and reacting to change, and six subthemes: Something’s coming, Here we go again, Seeking urgent treatment, Riding it out, Not in charge anymore and My last day that richly described the COPD exacerbation experience. The study revealed that patients experience an illness prodrome prior to exacerbation and have a recurrent exacerbation symptom pattern that was self-recognized. Treatment seeking was most influenced by the speed and acuity of exacerbation onset, severity of breathlessness, fears of death, nature of patient-provider relationship and the perception of stigmatization during prior healthcare encounters. These findings are important for the development of interventions to improve patient recognition and management of COPD exacerbations in the future.

Background: Hospital-procedures can be perceived as intimidating by children. There are situations in pediatric care where the childrens' care can be compromised if they are afraid and therefore not treated.Purpose: The purpose of the study was to highlight the parents' experiences of childrens' fear of hospital procedures and how the fears could have been relieved.Design: Descriptive interview study.Method: The study's design was qualitative where data was collected using eleven interviews. The interviews were analyzed using qualitative content analysis with inductive approach. Participants were caregivers to children aged six to twelve years, who were hospitalized. Twelve parents participated in the study. Data collection took place in February to March in 2017.Results: The results of the study are presented on the basis of two categories with eight subcategories: Cause of fear including four subcategories: experiencing pain, the feeling of being disadvantaged, hospital stay and medical procedures. Factors causing security including four subcategories: family presence, preparedness and participation, cared for by child-qualified staff and staff continuity.Conclusion: The study shows that hospitalized children experience fear due to varied causes. The cause for hospitalization is not always the reason for their fears. Child-focused care is required where healthcare staff ask for the child's perspective. Through child-focused nursing, dialogue is conducted with the child allowing expressions of what causes fear. Based on that information the healthcare staff and the child can address the unpleasant experiences and try to reduce the fear.
Bakgrund: Procedurer kan upplevas som skrämmande av barn. Det finns situationer inom pediatrisk vård där barnets vård kan äventyras om de är rädda och de av den anledningen inte får sin behandling.Syfte: Syftet med studien var att belysa föräldrars upplevelser och erfarenheter av barns rädslor i samband med sjukhusförlagda procedurer samt hur rädslorna hade kunnat lindras.Design: Deskriptiv intervjustudie.Metod: Studiens design var kvalitativ där data samlades in med hjälp av elva intervjuer. Intervjuerna analyserades med kvalitativ innehållsanalys med induktiv ansats. Deltagarna var vårdnadshavare som hade barn inlagda på sjukhus i åldern sex till tolv år. Totalt deltog tolv föräldrar i studien. Data samlades in under februari-mars månad, år 2017.Resultat: Studiens resultat presenteras utifrån två kategorier med åtta underkategorier: Orsak till rädsla innefattande fyra underkategorier: upplevelsen av smärta, känslan av att vara i underläge, sjukhusvistelse samt medicinska procedurer. Trygghetsskapande faktorer innefattande fyra underkategorier: närhet till familjen, förberedelse och delaktighet, vård av barn kompetent personal samt personalkontinuitet.Slutsats: Studien visar att barn som befinner sig på sjukhus upplever rädsla av varierande orsaker. Inläggningsorsaken är inte alltid grunden till deras rädslor. Det krävs ett barnfokuserat omhändertagande där vårdpersonalen efterfrågar barnets perspektiv. I den barnfokuserad omvårdnad förs en dialog med barnen där de själva får berätta vad som gör dem rädda. Utifrån den informationen kan vårdpersonalen tillsammans med barnet ta sig an obehagliga upplevelser och försöka reducera rädslan.

Two main goals of geriatric rehabilitation are to re-establish ability for physical function in order to facilitate independence in activities of daily living (ADL), and to promote an optimal degree of well-being, i.e. life satisfaction, in the individual. In this research a new scale, the General Motor Function assessment scale (GMF), was developed and evaluated. Subsequently, factors perceived as important for the life satisfaction of people undergoing geriatric rehabilitation were investigated.

The GMF includes both mobility and upper limb functions and comprises three subscales covering different aspects of functioning, namely performance-related Dependence, Pain and Insecurity. The clinical practicality of the GMF was evaluated by a field test. Its psychometric properties were analysed in both hospital and community-based settings of geriatric rehabilitation, using non-parametric statistical methods. The results indicated that the GMF is clinically adequate, possesses good reliability and is sensitive enough to demonstrate changes from pre- to post-intervention in different forms of geriatric rehabilitation.

For investigation of perceptions of life satisfaction, individual qualitative interviews were conducted with old (80+) care recipients and with their significant others, who had a helping relationship with them. The results revealed that habitual activity, independence and adaptation were generally considered to be important for the life satisfaction of the care recipients. Recalling of pleasant past memories in an effort to achieve current life satisfaction was a commonly used adaptive strategy among the care recipients. This strategy created a temporary sense of life satisfaction, with a potential for concealing dissatisfaction with conditions that might otherwise be correctable. From the perspective of the significant others, protection of the continuity of the care recipients’ self was seen as vital for the latter's life satisfaction, and was thus an underlying general purpose of the informal caregiving.

Bakgrund: Att vårda patienter i vaket tillstånd kräver större förberedelser och hänsyn på operationssalen. Operationssjuksköterskor behöver tillgodose patienten och ge god omvårdnad och samtidigt säkerställa en säker och steril högteknologisk miljö. Studier har visat att patienters upplevelse under operation påverkas av operationssjuksköterskans bemötande. Genom att öka medvetenhet och kunskap om operationssjuksköterskans möte med vakna patienter intraoperativt kan patienters upplevelse under operation förbättras.  Syfte: Att beskriva operationssjuksköterskors erfarenheter av att vårda patienter som genomgår kirurgi i vaket tillstånd.  Metod: En kvalitativ intervjustudie med elva stycken operationssjuksköterskor. Intervjuerna analyserades med kvalitativ innehållsanalys.  Resultat: Resultatet presenteras i fyra kategorier: Att patienten är i fokus och direkt få ett kvitto på arbetet, Att sträva efter ett gott samarbete och professionalitet inom teamet, Att vilja minska oro och skydda patienten, Att vara lyhörd och ge patienten möjlighet till delaktighet Slutsats: Denna studie visade att operationssjuksköterskorna lade fokus på patienten då de genomgick kirurgi i vaket tillstånd och de ville vara lyhörda för patientens behov för att ge dem en bra upplevelse. De ville skydda patienten från obehag och även verka som patientens företrädare.