Search

Nurse leaders are key drivers for the creation of quality work environments and quality patient care outcomes at the frontline of healthcare delivery. Their charge has been to provide leadership to assure quality nursing care, and ensure the satisfaction of their patients, families, staff, physicians, and hospital executives at each and every clinical care site. In this era of transparency and with the onset of accountable care organizations, the charge is now broader—outcomes must be sustained.

Technology plays a major role in nursing care. Among the challenges for nurses is being able to maintain a patient focus while surrounded by highly complex technology. The provision of high quality nursing care in technologically complex environments is particularly challenging when nurses develop relationships with their patients over an extended period of time. In these environments the potential for intimate relationships can increase. This potential for intimacy is evident in the haemodialysis context where dialysis technology, nurses and patients interface. As nurses and patients can spend up to 20 hours per week together intimate relationships can develop. This paper identifies the challenges these dialysis nurses face and introduces the concept of technological intimacy. Technological intimacy can be defined as physical touching and self disclosure, associated with closeness and knowing, that is undertaken in the full view of others in a healthcare environment dominated by technology. In the haemodialysis context technological intimacy has been scarcely acknowledged and rarely researched. Further research will assist in guiding haemodialysis nursing practice.

Quality nursing care is something that the patient wants and it is promised by the nurse. However, at this time there are still many complaints of the community, the patient's family and patients on the quality of services provided by the nurse. This study aims to see differences in the relationship of work culture with the quality of nursing service in Muhammad Sani Karimun hospital as a public hospital and Bakti Timah Karimun hospital as a privat hospital in 2018. Design of this research is Comparative design. Samples were taken stratified random sampling with total of 60 nurses for Muhammad Sani Karimun hospital and 60 nurses for Bakti Timah hospital. The result of statistical test at Muhammad Sani Karimun hospital shows there is a relationship of work culture of nurse (p value = 0, 006). Likewise in Bakti Timah hospital found a relationship of work culture nurse (p value = 0, 005) with quality service nursing. Furthermore Mann Whitney test obtained service quality variables (p value = 0.006) has a difference between Muhammad Sani Karimun hospital and Bakti Timah Karimun hospital. However, for nurse work culture variable (p value = 0, 570) there is no difference. This research is expected to be an input for the related hospitals so as to improve the quality of nursing service in particular.

This study aimed to explore the practical effect and reasonable evaluation methods of specialized high quality nursing care in operating room. Stratified random sampling was used to select 93 nurses from the operating rooms of two affiliated hospitals of Kunming Medical University in Yunnan Province. A set of “Specialized High Quality Nursing Care Items in Operating Room” was implemented in the operating rooms of the two hospitals simultaneously. The “Task Performance and Contextual Performance Scale” was used to measure and collect data of nurses in operating room before and after the implementation of the items. After the “Specialized High Quality Nursing Care Items in Operating Room” was implemented, the task performance total score and dimension scores of patient care, nursing information provision and specialized nursing skills were (58.59±1.77), (19.27±1.16), (19.50±1.11), (19.80±0.70), respectively, higher than the respective scores (37.21±1.92), (5.55±0.70), (13.78±1.12), (17.87±0.98) before the implementation, and the differences were statistically significant (t=−82.48 to −15.15, P

Background and Objectives: Nursing licensure examination is considered a gold standard is fast becoming a minimum standard in clinical practice in the nursing profession. A comprehensive literature review facilitates the aggregation of diverse literature from a variety of contexts pertaining to nursing students’ academic performance and its relation to success in nursing licensure examination. This review investigates nursing students’ academic performance and its relation to success in nursing licensure examination. Methods: CINAHL, Medline, Web of Science, ProQuest— Nursing and Allied Health Database, PubMed, and Science Direct Taylor & Francis databases were searched. Results: All studies (n=15) were conducted in the United States. Two major themes were derived from the synthesis of the findings: (i) Nursing academic courses and their grades, (ii) Different types of test-taking assessment skills strategies. Conclusion: Nursing academic courses and their grades and different types of test-taking assessment skills strategies are significantly associated with the success of the nursing licensure examination. Conclusion: More research could deliver further suggestion for nursing programs to develop actions regarding different types of test-taking assessment skills strategies and academic progression policies. This could encourage graduates to pass the nursing licensure examination and improved safe quality nursing care. This review highlights the student’s factors in success for NLE and increasing current effective actions for enhancing NLE readiness.

In principle, quality management in nursing care follows the concepts used in medicine. Occasionally, professionals develop quality requirements and pursue quality improvements by using various tools. Specific features in Germany’s nursing care are related to the binding character of seven so-called expert standards and to mandatory, external quality assessments that began in 2009 and will be conducted and published yearly. Preliminary results of these assessments show that both home health agencies and nursing homes provide on average good quality nursing care. However, assessments also revealed a huge demand for improvements concerning the quality criteria and the procedures used to calculate the results. Currently, nursing scientists, providers of care, and long-term care insurance companies are controversially discussing that matter.

Myocardial infarction is the death of myocardial tissue because of extended lack of blood and oxygen. Clinical pathway has emerged as one of the most famous new initiatives alleged to lower costs whilst maintaining or even improving the satisfactory level of patient care.Aim: to assess the effect of clinical pathway regarding promoting quality Nursing care of patients with MI exposed to invasive procedures through designing, Implementing, and evaluating the effect of clinical pathway intervention.Design: A quasi-experimental research design (pre posttest) changed into applied in this study.Setting: The study has been carried out in Beni-suef university Hospital, Zagazig University Hospitals.Sample: thirty nurses from the previously mentioned setting and thirty patients with myocardial infarction who are hospitalized and exposed to invasive procedures.Tools: Assessment questionnaire (pre/post test) sheet, An Observational Checklist, and Hamilton Anxiety Rating Scale (HAM-A).Results: more than fifty percent of a studied sample of nurses their ages ranged from 20-30yrs, the mean age was (29.1±3.4), females (66.9%), and have been trained in nursing college, their work experience ranged from half to one decade. There has been a statistically significant distinction concerning knowledge and practical abilities of studied nurses among pre and post application of clinical pathway. Recommendations: Extra new studies should be done for better assessment of the nurse's abilities and distribute educational booklets, pamphlets, and posters to all nurses with a purpose to enhance their degree of knowledge and skills. Keywords: Clinical Pathway, Quality Nursing Care, patients, and Myocardial Infarction.

Current federal and state legislation for mandated nurse staffing falls short of the ideal plan. Hospital nurse-staffing ratios are inadequate to maintain patient safety and quality nursing care. Mandating fixed nurse-to-patient ratios does not accommodate changes in patients' needs, evolving technology, and experience of nursing staff and will be immediately obsolete. Ideal measurement of nurse staffing incorporates nurse skill level and patient acuity. The Pennsylvania State Nurses Association supports legislation to establish patient acuity-based nurse staffing.

Quality of care is a major health concern in the hospital setting. A work environment thatsupports professional nursing as well as the spirituality of nurses, or the meaning/purpose nurses find intheir work may contribute to quality of patient care. Yet, little is known about the nursing workenvironment and even less about the spirituality of nurses. Thus, the aims of this study were to measuremedical-surgical nurses’ perceived professional work environment score and perceived spiritual well-beingscore and determine if the two instruments are related. This cross-sectional survey consisted of aconvenience sample of 68 nurses who completed the Professional Practice Environment Scale (PPE) andSpiritual Well-Being Scale (SWB) on the hospital website during working hours. Several PPE subscalescores differed significantly among the various clinical units. As the nurse’s age, and years of clinicalexperience increased, specific PPE subscale scores also increased. The nurses’ mean SWB scores were allwithin the moderate range and did not differ significantly among the clinical units. The overall PPE andSWB scores were not significantly correlated. Nursing administrators can use the PPE scores from thisstudy to address the specific needs of individual clinical units. Older and more experienced nurses mayserve as resources for younger, less experienced nurses. Both instruments can be administered repeatedlyover time to monitor trends. Based on the SWB data, nurses in this study reported average levels ofspiritual well-being. However, there is a need to learn more about the specific spiritual needs of nurses.Spirituality of nurses as well as the nurse’s work environment are separate concepts that each merit furtherinvestigation and may add to the knowledge base for increased quality patient care.

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link. none- editorial

Bariatric surgery offers an effective method of long term weight loss for the obese patient. The increase in the number of bariatric patients undergoing surgery means that an understanding of how to provide high quality nursing care to this challenging group of patients is vital. The provision of specialized nursing care, based on up to date research and knowledge will have a positive impact on the patient’s journey. This chapter deals with multidisciplinary approach to the preparation of the patient for surgery and the prevention and early recognition of perioperative/postoperative complications.

Continence problems are common after stroke. High quality nursing care can enable individuals to regain normal control over bladder function.

Background: The need for adequate nursing resources to the real needs of customers is a key priority for excellence in the quality of nursing care. Hence, it is important to create nursing staff models that assess the impact in nursing care. However there has been no consensus on what variables include, constituting a current concern for managers, in particular with regard the safety in health care. Aim: This research aimed to evaluate the fit of a nursing staff model and their impact on the Nursing Care. Materials And Methods: A quantitative study, transversal and correlational was conducted. Data collection was collected through a questionnaire with three samples: nurses (629), nurses bosses (43) and clients (1290), from 43 hospitals in 8 units with different management models. The psychometric assessment study was conducted through exploratory factor analysis and confirmatory factor analysis who demonstrated adequate validity and reliability for the evaluation of the variables of nursing staff model. Results: The trajectory "Safe Environment → Quality Nursing Care" is statistically significant (BMAS.CESQ = 0.18; SE = 0.08; βMAS.CESQ = 0.15; p = 0.026) so, higher in security work environment, increase the perception of nursing care insurance and quality. Moderate and significant linear correlation (r = 0.49) between the "availability of nurses in adequate quantity" and "availability of nurses with appropriate mix of skills.“ The trajectories "Availability of nurses with appropriate mix of quality nursing skills and care" (BQUAL.CESQ = -0.02, SE = 0.04; βQUAL.CESQ = -0.03; p = 0.663) and "Availability of nurses in adequate quantity and quality of nursing care "(BQUAN.CESQ = 0.04; SE = 0.16; βQUAN.CESQ = -0.02; p = 0.791) did not reveal statistically significant. Discussion and conclusions: The indicators (manifest variables) associated with each of the latent variables from the nursing staff model are relevant to the explanation of the model. The 3 World Congress on Integrated Care, Mexico City, Mexico, 19-21 November, 2015 International Journal of Integrated Care – Volume 15, 17 Nov – URN:NBN:NL:UI:10-1-117365 – http://www.ijic.org indicators range globally, from moderate relevant to highly relevant. Latent variables presenting β> 0.6. The model reveals acceptable indices of goodness of adjustment, so it is appropriate to explain the relationships between variables. The variables "Availability of nurses with appropriate mix of skills and the adequate quantity” have weak correlations with the perception of "quality nursing care", and the skills of nurses are perceived as less relevant. The Safe Environment is not interdependent on the availability of nurses, yet it is perceived as a very important factor for the promotion of "quality nursing care." The "availability of nurses with the right mix of skills", the "availability of nurses in adequate quantity" and the "safe environment" (Structure variables) explain 2% of the variance of the variables of "quality nursing care" (process variables). Conference abstract Spanish Antecedentes: La necesidad de recursos de enfermeria adecuadas a las necesidades reales de los clientes es una prioridad clave para la excelencia en la calidad de los cuidados de enfermeria. Por lo tanto, es importante crear modelos de personal de enfermeria para evaluar el impacto en la atencion de enfermeria. Sin embargo no ha habido consenso sobre que variables debe incluir, constituyendo una preocupacion actual de los directivos, en particular con respecto a la seguridad en la atencion sanitaria. Objetivo: Esta investigacion tuvo como objetivo evaluar el ajuste de un modelo personal de enfermeria y su impacto en los cuidados de enfermeria. Materiales y metodos: Se realizo un estudio cuantitativo, transversal y correlacional. La recoleccion de datos se recogieron a traves de un cuestionario con tres muestras: enfermeras (629), enfermeras jefes (43) y clientes (1290), en 43 hospitales de 8 unidades con diferentes modelos de gestion. El estudio que se realizo la evaluacion psicometrica se realizo a traves del analisis factorial exploratorio y analisis factorial confirmatorio que demostro validez y fiabilidad adecuada para la evaluacion de las variables del modelo de personal de enfermeria. Resultados: La trayectoria "Ambiente Seguro → Cuidados de Enfermeria de calidad" es estadisticamente significativa (BMAS.CESQ = 0,18; SE = 0,08; βMAS.CESQ = 0,15; p = 0,026), de manera, superior en ambiente de trabajo de seguridad, aumentar la percepcion de los cuidados de enfermeria seguros y de calidad. Correlacion lineal moderada y significativa (r = 0,49) entre la "disponibilidad de enfermeras en cantidad suficiente" y "disponibilidad de enfermeras con combinacion adecuada de habilidades." Las trayectorias "Disponibilidad de enfermeras con combinacion adecuada de habilidades y cuidados de enfermeria de calidad" (BQUAL.CESQ = -0,02, SE = 0,04; βQUAL.CESQ = -0,03; p = 0,663) y "La disponibilidad de enfermeras en cantidad y calidad adecuada de cuidados de enfermeria "(BQUAN.CESQ = 0,04; SE = 0,16; βQUAN.CESQ = -0,02; p = 0,791) no revelo estadisticamente significativo. Discusion y conclusiones: Los indicadores (variables manifiestas) asociados a cada una de las variables latentes del modelo de personal de enfermeria son relevantes para la explicacion del modelo. Los indicadores varian en todo el mundo, desde relevante a moderada a muy relevante. Variables latentes que presentan β> 0.6. El modelo revela indices aceptables de bondad de ajuste, por lo que es adecuada para explicar las relaciones entre las variables. Las variables "Disponibilidad de enfermeras con combinacion adecuada de habilidades y la cantidad adecuada" tienen correlaciones debiles con la percepcion de "cuidados de enfermeria de calidad", y las habilidades de las enfermeras se perciben como menos relevante. El Ambiente 3 World Congress on Integrated Care, Mexico City, Mexico, 19-21 November, 2015 International Journal of Integrated Care – Volume 15, 17 Nov – URN:NBN:NL:UI:10-1-117365 – http://www.ijic.org seguro no es interdependiente de la disponibilidad de enfermeras, sin embargo, se percibe como un factor muy importante para la promocion de "los cuidados de enfermeria de calidad." La "disponibilidad de enfermeras con la combinacion adecuada de habilidades", la "disponibilidad de enfermeras en cantidad suficiente" y el "ambiente seguro" (variables de estructura) explican el 2% de la varianza de las variables de "cuidados de enfermeria de calidad" (variables de proceso).

Older adults with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and chronic depression constitute a growing population of individuals in need of quality nursing care management. Although the small amounts of research currently available focus on both middle-aged and older adults living with these chronic conditions, this article offers specific suggestions for the nursing care of older adults who have been diagnosed with HIV, have experienced the progression of HIV to AIDS, and who have lived with chronic depression prior to the onset of HIV/AIDS. Given the increasingly significant role that nurses play in the lives of older adults with chronic health conditions, this article aims to provide nurses with a number of interventions associated with 10 nursing diagnoses pertinent to the care of older adults with HIV/AIDS and chronic depression.

Absence of pressure ulcers is increasingly being used as an indicator of quality nursing care, based on the premise that pressure ulcers are preventable. This retrospective study examined the occurrence, presentation, and timing of pressure ulcer development in 150 patients undergoing cardiac surgery. Pressure ulcer incidents were recorded in groups of patients who underwent surgery with use of a standard foam OR bed mattress; use of a fluid, pressure-reducing OR bed mattress; or use of a fluid, pressuring-reducing mattress after a comprehensive educational program on pressure ulcer prevention was presented to RNs. Tcers decreased when the fluid, pressure-reducing OR bed mattresses were used in conjunction with the comprehensive RN education program.

Nurses working in hospitals with paper-based systems often face the challenge of inefficiency in providing quality nursing care. Two areas of inefficiency are shift-to-shift communication among nurses and access to information related to patient care. An integrated IT system, consisting of Pocket PCs and a desktop PC interfaced to a hospital’s mainframe system, was developed. The goal was to use mobile IT to give nurses easier access to patient information. This paper describes the development of this system and reports the results of a pilot study: a comparison of time spent in taking and giving shift reports before and after the study and nurses’ perceptions of the mobile IT system. Results showed significant difference in taking shift reports and no significant difference in giving shift reports. Nurses stated that quick and easy access to updated patient information in the Pocket PC was very helpful, especially during mainframe downtime.

This article describes unique partnerships between South Dakota communities and the University of South Dakota that have been established for the purpose of assuring that nursing education opportunities are provided to individuals who are tied to the land. This includes those individuals who cannot uproot their families and move to Vermillion, the home of the University of South Dakota. As a result of these partnerships, there are hundreds of nurses throughout this state practicing nursing rather than dreaming of being a nurse. These registered nurses are providing quality nursing care within the very community that supports the educational efforts, and in turn this approach is addressing the nursing shortage.

Mayo Clinic Rochester Hospitals have experienced significant growth in the number of patients requiring the specialized nursing care offered in intermediate care areas (ICAs). To ensure quality nursing care for ICA level patients, a standardized educational program was developed. The Mayo Intermediate Care Area Nurse Internship Program was a tuition-free education program that provided additional knowledge, insights, and skills needed to develop a highly competent ICA nurse. This article will describe how the concept of an ICA nurse internship program was taken from birth of an idea to fruition.

Course objectives do not always support grading or evaluation decisions when a student demonstrates poor judgment or disrespectful interactions with others in clinical settings, classrooms, and program-related activities. Instructor attempts to help a student identify, reflect upon, and correct an inappropriate behavior are often awkward, avoided altogether, or lack an articulated set of standards to which both student and instructor can refer. Yet qualifications such as sound judgment and sensitive communication skills are essential in the provision of quality nursing care. The Essential Qualifications documents at the University of Washington School of Nursing offer a structure within which students, instructors, and administrators can identify, assess, and document action plans for student success. This article describes the legal basis and process for the formulation and use of an educational tool for assessing and guiding, outside the realm of course objectives, essential qualifications in applicants and students of nursing programs.

In the past professional identity in nursing was inculcated in students alongside institutional pride. A strong sense of professional identity is key to staff retention and recruitment and key to the delivery of quality nursing care. With the wholesale transfer of pre-registration nursing education to the third level sector, however, the reality is that students now divide their affiliations between university and healthcare institutions and professional identity development may be stymied. For this reason, there is need to explore alternative means of developing professional identity. Exposure to nursing history may counteract this tendency. Based on adult nursing students' reflections of a visit to the Florence Nightingale Museum, we discuss the potential of this activity in aiding development of critical professional identity.

Background: Nurse Shift is a routine but essential operation in hospital management. Classically, paper records have been used in nurse shift but these procedures are time consuming and inefficient. For efficiency and quality nursing care, as well as patients' wellbeing, a computerized nurse shifting information system is essential. Objective: This study aimed to estimate the performance of a computerized nurse shifting information system (CNSIS) designed to simplify the nurse shifting procedures. Methods: Seventeen female nursing staffs were recruited into this study. Two thousand and one hundred sixty six nursing shift data related to 142 inpatients from one ward during the period of November 20, 2007 to January 4, 2008, were also used in the analysis. ANOVA was used in analysing the time consumed before and after CNSIS implementation. Results: On application of CNSIS, time needed for shift (TNS) during 2nd (p

The critical care nurse is responsible and accountable for quality nursing care of the patient that has undergone cardiothoracic surgery. OpsommingDie kritieke sorgverpleegkundige is verantwoordelik en aanspreeklik vir hoe gehalteverpleging van die pasient wat koronere vatchirurgie ondergaan het. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.

This project used the Triad model integrating nurse’s clinical expertise with the best external research evidence, and took into account clinician and patient preferences in order to deliver quality nursing care. Results of Observation Data Collection (2008) • Alarms are silenced without intervention (troubleshoot alarm settings) the majority of the time. • Nurses were observed focusing on tasks at hand, apparently desensitized to alarms.

Background: Good nurses show concern for patients by caring for them effectively and attentively to foster their well-being. However, nurses cannot be taught didactically to be “good” or any trait that characterizes a good nurse. Nurses’ self-awareness of their role traits warrants further study. Objectives: This study aimed (a) to develop a strategy to elicit nurses’ self-exploration of the importance of good nurse traits and (b) to explore any discrepancies between such role traits perceived by nurses as ideally and actually important. Research design: For this mixed-method study, we used good nurse trait card play to trigger nurses’ reflections based on clinical practice. Nurse participants appraised the ideal and actual importance of each trait using a Q-sort grid. The gap between the perceived ideal and actual importance of each trait was examined quantitatively, while trait-related clinical experiences were analyzed qualitatively. Participants and research context: Participants were 35 in-service nurses (mean age = 31.6 years (range = 23–49 years); 10.1 years of nursing experience (range = 1.5–20 years)) recruited from a teaching hospital in Taiwan. Ethical considerations: The study was approved by the Institutional Review Board of the study site. Findings: Good nurse trait card play with a Q-sort grid served as an icebreaker to help nurse participants talk about their experiences as embodied in good quality nursing care. Nurses’ perceived role–trait discrepancies were divided into three categories: over-performed, least discrepant, and under-performed. The top over-performed trait was “obedience.” Discussion: Patients’ most valued traits (“patient,” “responsible,” “cautious,” and “considerate”) were perceived by participants as ideally important but were under-performed, perhaps due to experienced nurses’ loss of idealism. Conclusion: Good nurse trait card play with Q-sort grid elicited nurses’ self-dialogue and revealed evidence of the incongruity between nurses’ perceived ideal and actual importance of traits. The top over-performed trait, “obedience,” deserves more study.

Rethinking the critical care environment, an implicit call to change, can catalyze a return to nursing's intellectual roots. Healing environments, as envisioned by Florence Nightingale, involve system-level changes that require effective negotiations on behalf of our patients and ourselves. The nurse-patient relationship is central to the patient's environment and requires a comprehensive understanding of healing. Only nurses can articulate the changes necessary to ensure quality nursing care, and our collective "silencing" must be confronted if it is to change. Nurses' tendency to avoid, accommodate, or compromise when faced with conflict also must change. Giving voice to nursing concerns itself becomes a call to excellence, and those unwilling to change are best excluded. Although all of this is difficult, it is no more difficult than the nonhealing environments where we now work, and at least gives promise of more positive outcomes.

• The aims of the study were to identify indicators of quality of nursing care from the perceptions of patients and nurses, and to determine the congruence between patients' and nurses' perceptions. • The paper is presented in two parts. Part 1 included the background and methods to the study and the findings from the comparison of patients' and nurses' perceptions. Part 2 describes the perceptions of patients and nurses, and draws conclusions drawn from the study as a whole. • Patients and nurses in hospital wards were interviewed using the critical incident technique. • We grouped 4546 indicators of high and low quality nursing care generated from the interview transcripts into 316 subcategories, 68 categories and 31 themes. • The themes were grouped into eight clusters: therapeutic context for care, attitudes and sensitivity, teaching and leadership, motivation to nurse, monitoring and informing, high-dependency care, efficiency and thoroughness, reflection and anticipation. • As shown in Part 1 of the paper, congruence between patients' and nurses' perceptions of quality was high and significant, although there was some difference of emphasis. • The findings support an emerging theory of interpersonal competence and quality in nursing care.

Patients and health care professionals view quality nursing care from different perspectives. Health care professionals view competent nursing care as quality nursing care. Patients perceive quality nursing care as caring, interpersonal interactions. Institutions measure quality care through satisfaction surveys that exclude components of nurse caring behaviors. In three studies utilizing the Holistic Caring Inventory (HCI), patients perceived nurse caring behaviors and attitudes that indicated quality nursing care. The way to bridge the gap between institutions' and patients' perceptions of quality care lies in valuing the interactions that patients consider quality care and including these interactions in measures of quality care.

Multiple methods of tocolysis and fetal surveillance provide unprecedented ways to improve multifetal outcomes through meticulous antepartum care. Although few practitioners have much experience with these complicated pregnancies, knowledge is growing with the increasing incidence of multifetal pregnancy. A review of the current literature regarding antepartum surveillance provides the basis for a discussion of the techniques essential to quality nursing care during multifetal pregnancy. Guidelines are provided for nursing standards in documentation, terminology, and care during surveillance of multiple fetuses.

Recent reforms in the South African health care and educational system were founded in the ideal that the country would produce independent, critical thinkers. Nurses need to cope with diversity in a more creative way, defining their role in a complex, uncertain, rapidly changing health care environment. Learning facilitators are held accountable for finding adequate learning experiences to prepare nursing students for such practice demands so that newly qualified nurses do meet expectations for entry level clinical judgement ability. Quality clinical judgement is therefore imperative as an identified characteristic of newly qualified professional nurses. There is a scarceness of information on the concept of clinical judgement especially within the South African nursing environment. Relevant information in this regard can assist in clarifying the meaning, which will facilitate a common understanding of the concept within the clinical nursing environment. This in turn can lead to the formulation of a teaching-learning strategy to facilitate clinical judgement in undergraduate nursing students, which would be of benefit in the nursing care environment. The objective of this study was addressed in three phases. The first phase of this research analysed the concept of clinical judgement through various data sources and a review of literature to clarify the meaning and facilitate a common understanding through identification of the characteristics and to develop a connotative (theoretical) definition of the concept. The second phase of the research investigated professional nurses‟ understanding of the meaning of clinical judgement, as well as the factors that influence the development of clinical judgement within the nursing environment. During the third phase a conceptual framework for an enabling teaching-learning environment was constructed from a modern day constructivist approach to facilitate clinical judgement. The section included a description and diagrammatic presentation of the framework. The conceptual framework formed the scientific basis from which a teaching-learning strategy for the creation of an enabling teaching-learning environment to facilitate clinical judgement in undergraduate nursing students within the South African nursing environment was synthesised. A qualitative design was used for the study. During the first phase (manuscript 1) an explorative, descriptive qualitative design was used to discover the complexity and meaning of the phenomenon. Multiple data sources and search engines were consulted for the time frame 1982-2013. An extensive concept analysis resulted in a theoretical definition of the concept „clinical judgement‟, a complex cognitive skill to evaluate patient treatment alternatives within the clinical nursing environment. The second phase (manuscript 2) is qualitative in nature and explored professional nurses‟ understanding of clinical judgement, as well as the factors influencing the development of clinical judgement in undergraduate nursing students. The findings emphasised clinical judgement as skill within the nursing environment. This assisted in the development of teaching-learning strategy for the creation of an enabling teaching-learning environment to facilitate clinical judgement in undergraduate nursing students within the South African Nursing environment as the third phase (manuscript 3). Such an environment should impact positively to promotion of autonomous and accountable nursing care. PhD (Nursing), North-West University, Potchefstroom Campus, 2015

Summary In summary, I advocate continued development of measurement in- struments and criteria, conceptual frameworks applicable for the study of quality, and innovative approaches for delineation of target populations such as trials with tracer methodology. Bailit et al. (1975)state that the most important factor in improvement of the quality of care is that quality is, in fact, being evaluated. It is hoped that continued work will produce findings which can lead us to quality in practice.

Nurses over 25 years of age and with more than 10 years of health-related work experience scored highest when tested for nutritional knowledge in a study of 129 midwestern graduating nurses. Significant differences (F [2, 128] = 5.8, p= .02) were revealed between nurses with 16 or more hours of clinical practice per week in comparison to those nurses with less than 16 hours of clinical practice per week. Cultural nutrition content was the area in which graduating nurses scored the lowest while food and nutrition policies/regulations was the area with which nurses were most familiar. These results have implications for hiring graduating nurses who will need the necessary nutritional care skills to provide quality nursing care today.

The study aimed to determine the competency level on safe administration of medications among the selected graduating students of Region X. This study utilized the descriptive correlational research design. The respondents comprised 246 graduating students assigned in one of the affiliating centers of the College of the Nursing, Region X and 45 clinical instructors supervising the fourth year level. The purposive sampling technique was used in the selection of the respondents. The weighted mean and Pearson Correlation Coefficient were used. Results rewarded that the indicator of demonstrating safe care on administration of medication was rated very good. A very good competency level was also exhibited by the graduating nursing students on the aspect of sound decision making in care delivered. In terms of demonstrating safe medication administration, seven (7) parameters were rated to a very high competency level, namely: right drug, right dose, right patient, right route, right time and documentation. A moderate level of competency was established on patients’ history, drug-to-drug interaction, allergies, high alert drugs, and infection control. In conclusion, the over-all competency level on safe administration of medications is rated very good by both the clinical instructors and nursing students. However, the only indicator that is rated good is on the plan of care. The dominant competencies demonstrated by the graduating nursing students are the parameters of safe administration of medications are in terms of drug, dose, patient, route, time, documentation and approach. The affective domain on the proper demonstration of safe medication obtained the highest emphasis on academic instructions. The affective domain is the dominant focus in the clinical instruction specifically on developing the students’ value of safe care. Keywords - Competency Level, Safe Administration of Medication, Academic Instruction, Clinical Instruction

The application of the scientific method in clinical practice carried out by nurses is done through the Nursing Process. For this reason, the aim of this report is to highlight what NP means, and then, we are going to proceed with a brief explanation of this referred process, exposing, at the same time, the clinical case of a patient affected by severe mental disorder. Simi- larly, we must remark the importance of adopting a model of care, using the Pattern of Life by Nan- cy Roper, since this way, we can get to achieve quality nursing care.

Background : Respecting the uniqueness of each individual as part of person-centred approach is central to the provision of high quality nursing care. Valuing people as individuals with different needs and aspirations are attitudes to care-giving that student nurses need to develop. There is however, a scarcity of literature which focuses on assessment of student nurses’ patient-centred attitudes. Aim : To examine patient-centred attitudes among pre-registration nursing students. Design : A validated survey tool developed by Rolfe was used to measure the patient centred attitudes of nursing students in a U.K. University. Methods : The patient-centred attitudes of 149 student nurses were measured using a Patient-Centred Multi-Choice Questionnaire. Standard descriptive analyses were performed. Results : Female student nurses (n=119) undertaking undergraduate pre-registration nurse education, 20- to 29- years-old and in their third year of study dominated the sample group. The mean Patient-Centred Multi-Choice Questionnaire scores for the majority of the sample groups fell within the noticeably therapeutic attitude range. Those that scored highest within the noticeably therapeutic attitude range were males, under 20- years-old, second-year students and students studying children’s health. Conclusion: The relatively high levels of patient-centred attitudes which were evidenced, particularly the results from the male students, is reassuring. The conclusions drawn have implications for nurse recruitment strategies, assessment of prospective student patient-centred attitudes and the teaching, learning and assessment strategies deployed by nurse educators.

Newborns at risk for acute renal failure require immediate diagnosis and treatment. Supportive care must be provided while the kidney heals and begins functioning again. The critical care nurse plays a vital role in early recognition and treatment of signs and symptoms of acute renal failure. As technology improves, a greater number of acutely ill newborns are surviving. The critical care nurse is managing more neonates with acute renal failure. Expertise in caring for these infants has also improved. Quality nursing care plays a crucial role in preventing complications and improving the prognosis of neonates with renal failure.

Estudo exploratório e descritivo, com abordagem quantitativa, realizado num Centro de Saúde em Portugal, cujos objetivos foram caraterizar idosos hipertensos em tratamento ambulatorial e identificar fatores de risco cardiovascular associados à hipertensão arterial sistémica. A amostra foi constituída por 250 idosos que aceitaram responder a um inquérito estruturado. Dos idosos questionados, 43,6% apresentavam sobrepeso e 39,6% obesidade. Cabe salientar que 69,6% apresentavam valores de pressão arterial >140/90 mmHg e 50,4% apresentavam valores de colesterol total >200mg/dl. Conclui-se, portanto, que a maioria dos idosos não apresentava valores da pressão arterial controlados, assim como de outros fatores de risco cardiovascular, destacando a importância das intervenções de enfermagem às pessoas idosas e família, de forma a encorajar e fazer interagir, a responsabilidade pessoal no autocuidado para o controle da doença crônica, e o acesso a cuidados de enfermagem de qualidade, com vista à promoção de um envelhecimento mais saudável. Exploratory and descriptive study with a quantitative approach, performed in a Health Centre in Portugal, whose goals were to characterize older adults with hypertension and identify cardiovascular risk factors associated with systemic arterial hypertension. The sample consisted of 250 older adults who, in a free and enlightened way, agreed to answer a structured interview. From the older adults surveyed, 43.6% were overweight and 39.6% were obese. It should be noted that 69.6% of the older adults had blood pressure over 140/90 mmHg and 50.4% had total cholesterol >200 mg/dl. In conclusion, the majority of the older adult respondents had uncontrolled blood pressure levels as well as other cardiovascular risk factors, which highlights the importance of self-care in the control of chronic hypertension and better access to quality nursing care to promote healthier aging. Estudio exploratorio, descriptivo y cuantitativo, realizado en un Centro de Salud en Portugal, cuyos objetivos fueron caracterizar ancianos hipertensos en tratamiento ambulatorio e identificar factores de riesgo cardiovascular asociados a la hipertensión arterial sistémica. La muestra fue constituida por 250 ancianos que aceptaran contestar a un cuestionario estructurado. De los ancianos encuestados, 43,6% presentaban sobrepeso y 39,6% obesidad. Hay que señalar que 69,6% de los ancianos presentaban valores de presión arterial >140/90 mmHg y 50,4% presentaban colesterol total >200 mg/dl. Se concluye que la mayoría de los ancianos no estaban controlados los valores de la presión arterial, así como otros factores de riesgo cardiovascular, destacando la importancia de intervenciones de Enfermería a los ancianos y familiares de forma a encorajar la responsabilidad personal en auto-cuidado para el control de enfermedad crónica y el acceso a los cuidados de Enfermería de calidad con vista a la promoción de un envejecimiento saludable.

Caring for pneumonectomy patients presents the nurse with challenges such as early detection of potentially fatal complications, promoting postoperative recovery, and preparing the patient for a life with one lung. Changes in healthcare practice and treatment modalities contribute to the challenge of providing quality nursing care for all patients.

目的 探讨深化优质护理工作对护士工作绩效的影响。方法 采用护士工作绩效量表，对162名临床护士的工作绩效情况进行问卷调查，比较优质护理开展初期与深入开展4年后的得分差异。结果 优质护理活动开展初期与深入开展后护士的工作绩效总分及健康教育能力、计划和评价能力、沟通合作能力、专业发展能力等维度得分差异均有统计学意义 ( P

Patient teaching has always been a part of quality nursing care. It is now more important than ever in order to ensure quality care and safety after discharge from the hospital. Nursing managers must develop cost-effective strategies for patient education in the current atmosphere of cost-containment and constant changes in health care. One method of accomplishing this is to utilize a hospital computer system to provide teaching materials and a documentation tool.

The purpose of this study was to examine the everyday methods by which nurses evaluate quality care. The method was qualitative; specifically, a grounded theory approach was used. The sample comprised 18 registered nurses from a large hospital in the south of England. Data was collected through tape recorded interviews and the constant comparative method used to analyze the data. The findings revealed that although nurses used objective methods such as evaluating planned care as part of the nursing process, they also used more subjective methods such as peer review and intuition. The study seeks to explain the value of these less formal methods of evaluation and recognises how difficult they may be to substantiate in light of the recent health care reforms. It is suggested that the use of a more formalised process of peer review using reflection as its foundation would enable nurses to satisfy managerial concerns for a measurable outcome to quality.

According to Maslow's theory, clear air is the highest priority which hierarchical human needs for maintaining the vitality of the human. İndividuals can not maintain the respiratory function effectively any reason (such as chronic obstructive pulmonary disease (COPD), lung cancer, pneumonia, tuberculosis, asthma and cystic fibrosis disease) that cause unabling to fulfill task of these constructions. From the report of the Global Burden of the Diseases that is updated in 2010 by World Health Organization, within non-communicable (chronic) diseases; chronic respiratory diseases, cardiovascular diseases, cancers and diabetes are the biggest killer which cause estimated 35 million deaths every year. In addition to these data, the cause of deaths rank in the world, COPD is fourth. Also in this report, the cause of death in the ranking for the year 2030, COPD is expected to rise to third place (WHO, 2010). Developments in technology and health care allow early diagnosis of diseases and optimal treatment application in case of illness. Long-term oxygen therapy is the most commonly used method for espiratory diseases. So, for a high quality nursing care that provide by nurses, it is important that nurses be aware of basic concepts of oxygen therapy, methods of application and possible complications. ÖzetMaslow’ un teorisine göre, insan gereksinimleri hiyerarşik sıralamasında insanın canlılığını sürdürebilmesi için en öncelikli karşılaması gereken gereksinimi temiz havadır. Herhangi bir nedenle bu yapılar görevini yerine getiremediği durumlarda (Kronik Obstrüktif Akciğer Hastalığı (KOAH), akciğer kanseri, pnomöni, tüberküloz, astım ve kistik fibrozis gibi hastalıklar) bireyler solunum sistemi fonksiyonunu etkin bir şekilde sürdüremez. Dünya Sağlık Örgütü’nün (DSÖ), 2010 yılında güncellediği Hastalıkların Küresel Yükü başlıklı raporunda bulaşıcı olmayan (kronik) hastalıkların içinde kronik solunum yolu hastalıkları, kalp damar hastalıkları, kanserler ve diyabet ile beraber dünyanın en büyük katilleri olup, her yıl tahminen 35 milyon ölüme neden olmaktadır. Bu verilere ek olarak, dünyada ölüm nedeni sıralamasında solunum sistemi hastalıklarından, KOAH dördüncü sırada yer almaktadır. Ayrıca bu raporda, 2030 yılı için öngörülen ölüm nedeni sıralamasında, KOAH’ın üçüncü sıraya yükseleceği tahmin edilmektedir (DSÖ, 2010). Teknolojide ve sağlık alanında ki gelişmeler, hastalıklara erken tanı koymasına ve hastalık durumunda en uygun tedavi yöntemini uygulamasına olanak sağlamaktadır. KOAH’da en sık kullanılan tedavi yöntemi uuzun süreli oksijen tedavisidir. Bu nedenle hemşirelerin kaliteli bir hemşirelik bakımı vermeleri için, oksijen tedavisinin temel kavramlarını, uygulama yöntemlerini, gelişebilecek komplikasyonları bilmesi önemlidir.

Distance-or distance contact education provides registered nurses with an ideal opportunity for professional growth. This method also fulfils a need to study without the problem of being absent from family, occupational and social responsibilities. It seemed that students are enthusiastic about their studies despite personal, financial and other difficulties. At the end of the course students claimed that their self-confidence improved and that they were better equipped to give high quality nursing care. Using the Spearman Correlation Coefficient there was substantial correlation between the matric results and the final course symbol for this group of students [alpha .05 (p.002)]. No correlation existed between the selection average of 1-9 and the different subjects as for example General Nursing and Ethos.

The importance of specialized nursing in an elderly surgical patient is driven by the fact that age advancement predisposes an elderly surgical patient to higher risk of surgery. This is because of age-related physiological changes which include decrease in cognition, cardiac, respiratory, renal functions and other co-morbid conditions. Decline in sensory functions further increases the challenges in nursing care for this complex group of patients. Consistency in provision of quality nursing care promotes the comfort and assurance that enhances the post-operative recovery. This chapter discusses the essential nursing considerations for this unique group of geriatric surgical patients.

To prepare future nurses who can deliver high quality nursing care to teen mothers, a better understanding of the nursing students' perception of teen mothers is needed. A descriptive cross-sectional study was conducted among 228 nursing students to evaluate the psychometric properties of the Positivity Toward Teen Mothers (PTTM) scale, to explore nursing students' general empathy and attitudes toward teen mothers, and to investigate the predictors of nursing students' attitudes toward teen mothers. Principal component factor analysis with varimax rotation resulted in a 19-item PTTM-Revised scale with Non-judgmental and Supportive subscales. Cronbach's alphas for the subscales were 0.84 and 0.69, respectively, and 0.87 for the total scale. Simultaneous multiple regression models showed that general empathy and having a teen mother in the family or as an acquaintance were significant predictors of positive attitudes toward teen mothers, whereas age was a significant negative predictor. The PTTM-Revised scale is a promising instrument for assessing attitudes toward teen mothers.

The very-low-birth-weight (VLBW) infant is at high risk for developing infection during the antenatal, prenatal, and postnatal periods. The six major predisposing factors are perinatal infections, an immature immune system, decreased natural defenses, disease states and disorders leading to infection, side effects of medication, and prolonged hospitalization and iatrogenic complications of lifesaving therapies. Quality nursing care plays a crucial role in recognizing signs and symptoms of sepsis and facilitating a timely diagnostic evaluation. Prevention, prompt diagnosis, and treatment will reduce the high morbidity and mortality rates associated with sepsis in the VLBW infant.

The inadequacies and failings of nursing care in our hospitals have been in the news recently and seem to have triggered much public comment, and even discontent. I was somewhat surprised to see Dr Clare Gerada’s name linked in agreement with the views of Dr Peter Carter, general secretary of the Royal College of Nursing. It seems that Dr Carter wants relatives to free up nursing time by feeding and caring for relatives in hospital. There are very real problems delivering good quality nursing care these days that must be addressed, and soon, but this suggestion cannot provide much of an answer. Most relatives will be happy to do what they can when they can. However, so many relatives need to work, and others live a significant distance from hospitalised family members. A majority, one feels, will be uneasy and ill prepared when carrying out intimate nursing tasks. None can provide 24-hour professional care. Dr Gerada may well have been misreported but surely this is not Royal College of General Practitioners policy.