Dissertations / Theses on the topic 'Nursing sociology'

Healthcare, hospital environments, and the nursing workforce have been a focus of late in both the professional literature and public media especially in the wake of the Institute of Medicine's reports Keeping Patients Safe-Transforming the Work Environment of Nurses (IOM, 2004) and The Future of Nursing-Leading Change Advancing Health (IOM, 2011). These reports address patient safety and workforce issues such as staffing, organizational culture, and workforce characteristics. Very little research has been undertaken on the culture of night nursing or the roles, experiences and characteristics of night nurses. Therefore, a study of night nursing, using a qualitative ethnographic methodology, was chosen to address this gap. Because subcultures can influence the larger culture, knowledge regarding their unique characteristics and attributes becomes critically important especially in the culture of a large hospital.

The purpose of this study was to develop a description of night nursing as a subculture within the larger culture of nursing care and nursing practice that exists in a hospital setting. Data were collected during the researcher's 100 hours of participant observations on five differing nursing units in two hospitals, using semi-structured transcribed interviews with eight nurse informants on these same units, and through an analysis of relevant hospital documents. A synthesis of the collected data identified a subculture of night nursing with shared domains or attributes such as unique roles, rituals, hierarchies, and insider/outsider perspectives.

The final description included four themes that were extrapolated from the synthesized data: (1) night nursing is characterized by camaraderie and teamwork; (2) the environment of a night nurse is conducive to the development of critical thinking; (3) night nurses engage in a constant reflection about sleep; and (4) night nurses share a feeling of being undervalued.

The findings from this study have implications for administrators who must be aware of and understand the needs of night nurses especially related to being valued and included. For nurse educators, important implications center on preparing students for the uniqueness of the role of the night nurse, and planning formal educational offerings during the night shift for nurses. Further research is warranted using quantitative methods to validate and explore the themes and domain descriptions identified in this study.

In recent years, nursing faculty incivility has been a searing topic of research. Nursing research included studies on incivility among nursing students, incivility between nursing students and nursing faculty, and incivility in the clinical setting. However, literature specifically on nursing faculty incivility was limited. This descriptive, quantitative study examined perceived levels of workplace incivility among nursing faculty members. The sample ( n = 257) consisted of nursing faculty members employed at community colleges in North Carolina. The methodology included a non-experimental, online survey design using Martin and Hine's (2005) Uncivil Workplace Behavior Questionaireand a demographics survey. Data analysis included use of descriptive and inferential statistics. Findings revealed three themes (a) the description of workplace incivility among nursing faculty aligned with Bandura's (1977) social learning theory and Andersson and Pearson's (1999) incivility spiral; (b) workplace incivility among nursing faculty existed in the community college setting; and (c) most demographic factors did not influence the extent to which faculty members perceived uncivil behaviors among their peers. However, there were four exceptions: hostility and full-time employment, hostility and salary range, privacy invasion and ethnicity, and uncivil behaviors and the number of years of full-time teaching. Implications for nursing education included turning conflict into problem-solving and collaboration, and cultivating climates of civility and cultures of openness, inclusion, and social connectedness.

The purpose of the qualitative phenomenological study was to describe the phenomenon of being a student-parent by identifying the lived experiences of nursing students that are parents, specifically their perceptions of their experiences of how they balance their family life with their academic life successfully. Two participants were involved in the pilot test and 21 main study participants were included in the sample. The data obtained through semi-structured one-on-one interviews were analyzed using Giorgi’s method of phenomenological research. The findings of this study identified eight themes resulting from descriptions provided by the student-parents while in undergraduate nursing school and included: (1) All challenges are subjective to the personal circumstance reflecting the unique home situation, (2) Unmet personal expectations occur while in nursing school through role conflict and guilt, (3) Post-secondary education has particular demands through financial and academic obligations, (4) Support is essential to nursing school success, (5) Processes enabling student-parent success contain compromises and strategizing balance with flexibility, (6) Interactions and outcome from negative spillover imbalance family and academic obligations, (7) Organization culture of campus attributes to the student-parent perspective, and (8) Participant recommendations to stakeholders . The essence of the student-parent experience influenced a formation of a comprehensive model, titled PARENTS to inform campus leaders of strategies to enhance the student-parent experience and accommodate family influences brought to campus. Future qualitative research suggestions include exploring support systems of student-parents, children experiences of student-parents, and campus stakeholder perspectives of breastfeeding and parent planning and family-centred accommodation on campus.

Background: Incivility in health care settings was first identified in 1976. Ten years later, a nurse published an article asking colleagues, “Do we eat our young?”. In 2000, the Institute of Medicine (IOM) sent a challenge for a safer health care environment and in 2008 the Joint Commission emphasized that disruptive behavior continued to compromise patient safety. Incivility in nursing is quickly becoming a topic of interest, yet it had not been studied from a qualitative approach by exploring it as a social process.

Purpose: The purpose of this grounded theory study was to adopt an abductive process to acquire an in-depth understanding of the critical factors that trigger the existence and fuel the persistence incivility in nursing and to develop a substantive theory to address the concept of incivility.

Philosophical Underpinnings: The philosophical underpinnings that guided this study were symbolic interactionism and pragmatism. Method: A constructionist grounded theory approach by Charmaz guided the qualitative research method. Individual and focus group face-to-face interviews were conducted to collect data from 29 Registered Nurses. Data analysis involved initial, focused, axial, and theoretical coding alongside memo-writing and reflexive journaling.

Results: The theory that developed from the data grounded in the voices of Registered Nurses was self-positioning. The four main categories that emerged from the gathered data supporting the theory are neglecting, alienating, relinquishing, and finding oneself. These categories represent the critical factors triggering the existence and fueling the persistence of incivility in nursing.

Conclusion: An in-depth understanding of the critical factors triggering the existence and fueling the persistence of incivility in nursing has been acquired by adopting an abductive process through a constructionist grounded theory approach by Charmaz. The theory of self-positioning serve as a guideline to nursing education, nursing practice, nursing research, and health/public policy in implementing specific plans of action to diminish the incidence of incivility, address the health and well-being of Registered Nurses, provide quality care, and ensure patient safety.

The purpose of this qualitative phenomenological study was to uncover the lived to experiences of registered nurses who have experienced burnout during their careers, yet chose to remain in the profession, and to uncover the leadership and individual strategies that address nursing burnout. The study included the phenomenological method to explore the research questions. Fifteen registered nurses who identified an episode of burnout in their nursing career, and were still working in the nursing profession, participated in an in-depth interview. Five themes that emerged from the data were (a) burnout affects the whole person, (b) social support helps cope with burnout, (c) a healthy lifestyle is paramount to prevention and coping, (d) nurse leaders play a pivotal role in preventing and managing burnout, and (e) caring is an essential element of nursing. Recommendations for future research include an exploration of lived experiences of nurse leaders; use of the burnout scale to identify nurses with burnout with subsequent in-depth interviews; research to determine if preventive measures actually prevent burnout or merely lessen the unpleasant affects; exploration of sleep deprivation, exhaustion, and burnout; and the implementation of Watson’s Attending Nurse Caring Model.

Transgender women have the highest HIV prevalence rates of all gender and sexual minorities, yet are less likely to enter and be retained in HIV care. As a result, they are at high risk for HIV-related morbidity and mortality. This study aimed to describe the illness career of transgender women living with HIV and to describe how interactions with health care providers and important others influenced their illness trajectory. The findings are a theoretical model that includes four stages: Having the world come crashing down, shutting out the world, living in a dark world, and reconstructing the world. Relationships within the social network (family, friends, and romantic partners) and the network of health care providers provided the context of the women’s illness careers. Pivotal moments marked movement from one phase to the next. Having the World Crashing Down was the first stage that occurred when the participants were diagnosed with HIV. They felt that their lives as they knew them had been destroyed. They indicated that the “whole world just shattered” the moment they found out they had HIV. Shutting Out the World occurred next. During this stage, many participants experienced withdrawal, denial, social isolation and loneliness. As they struggled with their diagnosis, they often avoided HIV care and avoided contact with important others. During the third stage, Living in a Dark World, participants descended into a dark phase of self-destructive life and health-threatening behaviors following their diagnosis. During the fourth stage, Reconstructing the World, participants began to reestablish themselves in the world and found new ways to reengage with important others and resume meaningful life activities. Findings confirm that the illness careers of HIV-positive transgender women are influenced by the social context of the health care setting and interactions with health care providers and important others.

The nursing workforce shortage is not a new phenomenon but dates as far back as World War II. It is believed that the hospital nursing shortage poses a serious threat to the health and welfare of this nation. Therefore, the debate over nursing workforce shortages has been contentious and unresolved about appropriate solutions to address the shortage. Because nurses comprise the major and largest component of all health care employees and serve on the front line of patient care, a hospital's ability to attract and retain registered nurses must be met with competent, adequate and satisfied nursing staff. The nursing workforce shortage has received attention from hospital leaders and public policy makers alike in their approach to resolve this imminent national shortage of hospital nurses. Some researchers postulate there is no shortage of nurses in the United States but in response to poor working conditions, these same licensed registered nurses are consciously choosing not to work in the hospital industry due to deteriorating working conditions. To solve this problem in hospitals, the very same management and leadership practices that created this fictional crisis are the ones that can improve registered nurses' work conditions and enhance the attractiveness of nursing as a profession. The purpose of this study was to empirically describe the impact leadership practices of nurse managers and the nurse practice environment have on job satisfaction of registered nurses in two urban teaching hospitals. A cross-sectional quantitative research design using survey data was implemented to assess leadership practices of nurse managers, presence of the nurse practice environment, and job satisfaction of registered nurses. Results of this study reveal that nurse managers with exemplary leadership practices and favorable nurse practice environments have subordinate registered nurse staff with greater job satisfaction. Findings from this study might assist healthcare leaders to better understand the organizational characteristics associated with how to best organize nurse practice environments and the leadership practices of the nurse manager in better shaping the hospital environment to enhance the quality of nurses' work lives.

Leaders of organizations continually experience challenges when attempting to implement new strategies by aligning staff at various organizational levels to the new strategies. The effectiveness of alignment to strategy is demonstrated especially in how strategy manifests on the front line as staff respond to the mandate of the strategic changes. Organizational dynamics analyzed through a psychodynamic "lens" further explain the challenges of alignment to strategy. The health care industry experiences pressure to adjust their strategies to ensure quality patient care, especially because hospitals are under scrutiny to reduce hospital readmissions and address health disparities for disadvantaged groups of patients in surrounding communities. One strategy adjustment that hospitals are implementing is improving culturally competent care, which requires transformational changes in practice, especially at the front line: nurses. This qualitative, single-case study at a hospital in the eastern United States focuses on exploring nurses' experiences as they respond to a hospital's mandate of changes related to providing culturally competent care. Data were collected through 25 semistructured interviews, two focus groups, and historical and archival data. The findings from this study support literature on the challenges and tensions related to this transformative change in how care is delivered. The findings also reveal the anxiety that these challenges and tensions trigger at the institutional and individual levels and the resulting behaviors, interpreted by psychodynamic theory of basic assumption, where nurses fluctuated between approach and avoidance of the work.

As healthcare becomes more complex, patients need nurses who can advocate for their safety. This quantitative study on patient advocacy sought to understand if significant relationships existed amongst factors contributing to nurses' willingness to report wrongdoing. Factors measured were management support, knowledge of the reporting process, and experiencing and witnessing retaliation after reporting wrongdoing. Three hundred and forty one nurses from the Association of Perioperative Registered Nurses (AORN) were surveyed using a 45 question survey consisting of closed ended questions, as well as Likert-type statement questions. Inferential statistical data analysis was performed and confirmed that significant relationships do exist amongst the factors measured. Due to these findings this study may be used to further explore empirical evidence linking those factors to nurses' willingness to report wrongdoing. The outcomes of this study also confirm that healthcare leadership must focus on increasing emotional intelligence as well as the communication strategies of their healthcare leadership teams. This is evident in the data showing that nurses know how to report wrongdoing, yet fear doing so due to lack of confidence on the part of their management team as well as fears of retaliation. Further studies may be warranted in the area of patient advocacy to determine if this data can be replicated across a multi-cultural and multi-generational workforce.

This study examined the organizational commitment and professional development of adjunct nursing faculty as it related to socialization processes provided by their organization. This study also investigated the independent variables that contributed to affective, continuance, and normative commitment. The study was conducted using an online Survey looking at the commitment levels of adjunct nursing faculty from nursing programs in New York State. Participants self-reported demographics which assisted in providing commonality among the participants, and completed two valid, published surveys; Eisenberger, Huntington, Hutchinson, and Sowa's (1986) Survey of Perceived Organizational Commitment (SPOC) and Allen and Meyer's (1990) Three Component Model (TCM) of Organizational Commitment. Results indicated that age, one independent variable, was found to be significant for continuance commitment between two age groups; 25–40 and 55 and greater. This finding leads academic administrators to focus on their multigenerational workforce needs, which now occupies many of their teaching positions. Further research is warranted to investigate the multigenerational nursing adjunct faculty member and the relationship socialization processes has on their organizational commitment and professional development.

Workplace violence committed against emergency nurses persistently continues with many factors contributing to this global phenomenon. As a result, victims experience a myriad of personal, professional, and organizational consequences. Unfortunately, underreporting remains a troubling problem that produces an obscured picture of the actual characteristics influencing this phenomenon. Interviews, a reflexive journal, and documents were used by the author of this qualitative collective case study to achieve the purpose of this study: to understand the lived experiences and reporting behavior of emergency department nurses as crime victims The author purposively sampled 10 emergency nurses who reported workplace violence while working at a Lee Memorial Health System hospital in Lee County, Florida. Thematic cross-case analysis demonstrated that emergency nurses work in a chaotic environment and violence is underreported due to the time it takes to report and confusion with violence definitions. Findings showed that law enforcement attitudes toward reporting negatively influenced nurses but that contact outside of work had no influence. Nurses were unaware of or rejected a crime victim identity and reported receiving support from supervisors but not hospital administration. Hospital security officers and crime preventive measures were seen as ineffective. Seasonal effects, unrestrained Baker patients, along with unmet patient expectations were contributing factors to workplace violence. Future reporting was influenced by unsatisfactory outcomes and law enforcement presence.

Recommendations for practice brings together law enforcement, hospital administration and nurses to evaluate existing policies, incorporate legal topics into existing training, implement a risk assessment instrument in triage, and conduct crime prevention surveys.

Future research should include other hospitals to see if similar results are found, also investigate peer-to-peer violence, compare hospitals that have full-time law enforcement officers in the emergency department with those who do not to see if it affects the number and severity of violent incidents, and evaluate the effectiveness of using a violence risk assessment instrument in triage.

Understanding the processes involved in retaining nurses in the Emergency Department is essential for future hiring and retention; turnover rates are currently at approximately 16% in the emergency department. Using Grounded Theory Methods (Glaser & Strauss, 1967) and the conceptual framework of symbolic interaction, the process of becoming and remaining as an ED nurse was explored.

Data were collected through semi-structured, open ended interviews until data saturation occurred. The seven participants' ages ranged from 29-56 with ED nursing experience ranging from 1-17 years and nursing experience from 2-18 years. Five phases emerged from data analysis using constant comparative analysis of 183 pages of transcripts, through coding phrases, categorizing, and conceptualizing them. These phases, each with sub-categories, explained a process identified as Seeking Status. The five phases were: joining the troops, working in the trenches, passing muster, earning stripes, and looking ahead. Passing Muster emerged as the core category, the one that best explained the process and connected the other conceptual categories in this process.

The theory, Seeking Status, was compared to and contrasted with theories from nursing, sociology and anthropology such as socialization, rites of passage, adaptation, role identity, and reality shock. The theory overlapped with some of the theories explored; however it was unique in the finding regarding the significance of a two-tiered hierarchy of roles in the ED.

Implications for recruitment strategies, longer orientations and the need for preceptors for new nurses were described. Senior nurses, on the other hand, would benefit from increasing knowledge and skills regarding leadership and management strategies in their role.

VitalSmarts^® Crucial Conversations ^TM general program theory might be a possible countermeasure addressing organizational culture and communication factors affecting quality and safety. This practice inquiry reports: a VitalSmarts^® Crucial Conversations ^TM general program logic model, a major medical center's Crucial Conversations ^TM historical implementation program logic model, a clinical exemplar central line associated blood stream infection program logic model; and, findings that describe the fidelity of the major medical center's Crucial Conversations ^TM historical implementation and clinical exemplar central line associated blood stream infection program logic model to the VitalSmarts^® Crucial Conversations^TM general program logic model. The results demonstrated there was no fidelity between the major medical center's Crucial Conversations^TM program logic model and the VitalSmarts ^®® Crucial Conversations^TM general program logic model. The clinical exemplar CLABSI program logic model and VitalSmarts^® Crucial Conversations^TM general program logic model fidelity differed in intended outcomes. The results might suggest that program adaptability along with program fidelity are factors that influence program strength, and these factors must be uniquely balanced within organizational dynamics to realize intended outcomes. The formative evaluation and program logic model might be a feasible methodology and applicable tool for exploring quality and safety within complex adaptive systems, such as organizational culture, where constraints possibly could exclude more rigorous scientific methodologies until factors are more understood

The role of mothering has always been an important area for study in nursing. However, transnational mothering, the experience of women mothering from afar, has not been well studied in the discipline. The purpose of this study was to explore the process of mothering by Mexican women in the context of their move to the United States. The conceptual framework of symbolic interaction and the methodology of grounded theory (Glaser & Strauss, 1967) were used to guide the study.

Data were collected through 13 semi-structured interviews of women from Mexico living in New York City who had at least one child under the age of 16 still living in Mexico. The results indicated that the process of transnational mothering was non-linear. Phases emerged from data analysis using Grounded Theory Methods of constant comparative analysis of transcripts, using coding, categorizing, and conceptualizing. Three final phases, each with sub categories, which explained the process of transnational mothering included reconceptualizing mothering, struggling, and embracing hope.

Reconceptualizing mothering was used to name this substantive theory that emerged. The Basic Social Process identified that fit the substantive theory that emerged was "social identity" as social identity is affected by a new understanding of one's role. The women in this study acknowledged the poor fit of their traditional roles of mothering in New York and therefore created new roles. The community that they developed and relied upon assisted with this new role adjustment. Implications for this study in the area of practice include the need for greater client advocacy and assisting transnational mothers to build and foster a community. The importance of the discipline's involvement in the area of health policy cannot be overstated as policies affecting mother child separation and reunification need a nursing voice.

Participation of colorectal cancer survivors (CRC) in the workforce has been described by clinicians, survivors, and researchers as a way to improve mood, quality of life (QOL), and survival. Maintaining self-esteem and financial independence have also been attributed to continued employment of the CRC survivor. The purpose of this cross-sectional survey was to describe patterns of employment of the CRC survivor and to examine the individual, disease, and work-related factors that influence presenteeism and perceived adequacy of sick pay (ASP) policy. The Conceptual Model of Nursing and Health Policy and the Pathways to Work Life Recovery guided the design, selection of variables, and specification of the relationship between variables. The study included 97 CRC survivors who were employed at the time of diagnosis and who had completed treatment ≥6 months and < 7 years to survey. Among working subjects, at-work limitations ("presenteeism") were measured by the Work Limitations Questionnaire (WLQ) consisting of four scales: Time Management, Physical Tasks, Mental-Interpersonal Tasks, and Output Tasks scales. The EORTC QLQ-C30 V3 was used to measure quality of life and the PHQ-9 for depression. The majority of gaps in employment occurred within the first year of diagnosis (21%) and attributed to poor health (56%), having been fired or laid off due to cancer (11%) or retirement (33%). A total of 27% had gaps in employment by 3 years; 13% were intermittent. The unemployment rate for cancer survivors in this study was 18.6% at the time of survey. Slightly over 25% of those who experienced a gap in employment did so involuntarily. Higher education (OR = 0.346, p=.006) was the only variable that significantly associated with a gap in employment. Having insurance (p=.03), QOL (p=.01), and depression (p=.003) significantly contributed to increased presenteeism. Earlier stage (OR=0.330, p=.050) and professional occupation (OR=3.281, p=.040) significantly contributed to perceptions of having an ASP policy. The importance of measuring continued employment of CRC survivors is supported in this study. The provision of an ASP policy may avoid disruption of work and create an easier transition for continued employment of the CRC survivor.

Incivility has infiltrated our institutions of higher learning as well as the world of nursing. All too familiar in nursing is the phrase “eating their young,” which aptly describes how nurses treat other nurses, even though they should be nurturing and caring professionals. The investigator explored nursing and health science students’ perceptions of student and faculty uncivil behaviors within the academic environment, seeking the levels and frequency of the problem. Bandura’s social learning theory presents a sound theoretical framework for this dissertation. The research methodology consisted of a quantitative descriptive approach. The Incivility in Higher Education-Revised (IHE-R) Survey was used to compare nursing and health science student perceptions of the level and frequency of student and faculty incivility. Descriptive statistics and independent t tests were used to compare the different student perceptions. The study results indicated that perceptions of student behavioral levels were between somewhat and moderately uncivil. Student perceptions of faculty behavioral levels were found to be more moderate. Review of the frequency levels reflected students’ frequencies to be never as compared with faculty, which indicated a frequency of sometimes. These results indicated that students perceived incivility to not be problematic within their individual programs, although it found faculty behavior levels were more uncivil even when similar behaviors were demonstrated by students. In general, these results were atypical than other results as incivility is found to be a rising problem. Further study is needed to confirm these results.

The lived experience of husbands caring for wives with dementia was investigated in order to develop a better understanding of their caregiver burden. The conceptual background for the study originated in the work of philosophical phenomenologists Edmund Husserl and Edith Stein with particular attention to their theories of inter-subjectivity and empathy. Amadeo Giorgi's Descriptive Phenomenological Method in Psychology was used for study design and analysis. Results suggest an enduring connectedness of the couples and their bonds throughout the shifting of roles and emotions as the dementia progresses. Implications for nursing include the need to employ interventions respectful of the persistence of affective awareness in those with the dementia even towards end-stage and the resulting importance of situational assessment of decisional capacity.

Graduate programs in nursing for non-nurses (GPNNN) are rapidly proliferating in response to demands for innovative strategies to increase the number of nurses to meet health care demands, both actual and anticipated. Transitions Theory (Meleis et al., 2000) provided a framework to identify the gaps in knowledge related to how individuals transition to nurse within these programs. One of the gaps in the literature that was identified was a description of the transition to nurse experience of students enrolled in a GPNNN. This qualitative descriptive research was conducted in response to this gap. It examined the transition from non-nurse to nurse through a GPNNN which prepared non-nurses for advanced nursing practice. The study had three aims: to describe the transition experienced by the students; to describe how they used their prior education and experiences in this transition; and to describe the factors they saw as facilitators and hindrances to this transition.

Responsive interviewing (Rubin & Rubin, 2012) with a purposive sample (n=17) of registered nurses enrolled in the advanced practice curriculum of the GPNNN was used. Data was collected from these nurses between September and December, 2013. Data analysis included initial codification of interviews, and within and between interview comparison of codes, resulting in re-coding and collapsing of codes. To assure the trustworthiness of the data, the criteria thoroughness, accuracy, believability and transparency were used (Rubin & Rubin, 2005).

Data analysis revealed a process of transition that occurred over three distinct time periods, Coming to Nursing (pre-enrollment), Beginning to Learn the Role as Nurse (pre-licensure), and Practicing as Nurse (post-licensure). Influences that impacted the transition across periods included personal goals, knowledge, skills, and professional growth. Indicators of transition that were known to the individual and to others were described. The individual's utilization of prior education and experiences in their personal transition experience was described as primarily influencing study habits and clinical experiences. Facilitators and hindrances to the transition included experience working as a nurse, self-identification as nurse, personal goals, the accelerated program, the programmatic focus on NCLEX style testing and the nursing pedagogy.

Interpretation of the findings of this research was informed by the literature. Identification of three periods of transition through nursing education has been described in transition to nurse in other nursing education populations (Shane, 1980a, 1980b; Neill, 2010), and is consistent with transitional patterns (Meleis, 2010). However, the three transitional periods identified in this study are peculiar to the transition experience through a GPNNN, and don't mirror the characteristics identified in transitional periods in other populations. A rich description of the transition experienced by the participants is presented including characteristics of the transitional periods, the influence of prior education and experience within the transition, and identification of factors that facilitated or hindered the transition experience. This description has not previously been described in the literature.

There are implications of this research for practice, theory, education, policy and research, and these are discussed.