Key Foundations of Successful Quality Project Planning, Implementation, Evaluation, and Management : An Overview / James L. Harris and Bettina Riley -- Quality Improvement Projects and Quality Improvement Research : Advancing Translational Science / Linda Roussel -- Implementation Science, Team Science, and Translational Science : The Value for Projects / Clista Clanton and Linda Roussel -- Forming and Managing a Synergistic Interprofessional Improvement Team -- Making the Case for a Project : Organizational and Needs Assessment / Carolyn Thomas Jones and Linda Roussel -- Using Findings from Organizational Analysis and Clinical Needs Assessment to Frame Improvement Projects and Implementation /Linda Roussel and Shea Polancich -- Literature Synthesis and Organizational Alignment to Project Interventions and Implementation / Catherine Dearman and Lolita Chappel-Aiken -- Building the Improvement Project Budget : Quantifying the Cost and Quality Equation / Patricia L. Thomas and James L. Harris -- Developing Metrics That Support Project Plans, Interventions, and Programs / Patricia L. Thomas -- The Institutional Review Board Process / Catherine Dearman, Dionne Roberts, and Lolita Chappel-Aiken -- Big Data and Information Systems : Understanding the Value for Improvement Projects / James L. Harris, Todd Harlan, and Lonnie K. Williams -- Developing Metrics That Support Project Plans, Interventions, and Programs / Patricia L. Thomas and Michael Bleich -- Innovation, Diffusion, and Dissemination of Improvement Outcomes / James L. Harris and Catherine Dearman.
The dissertation "The Ethics of Bilateral Labor Agreement for Global Nurses - Perspectives from the Philippines" is written in the research area of applied ethics and examines ethical aspects of labor migration in the specific area of healthcare, with the Philippines as an example. The central questions for the dissertation are the ethical issues of nurse migration in the Philippine context. These ethical concerns give rise to how the responsibility for such migration governance should be understood and designed. More specifically, the issue of responsibility is discussed in relation to the Philippine Government, and its counterpart foreign governments, for their use of the bilateral labor agreement (BLA) as a policy measure to manage the migration of nurses. The thesis draws on from empirical studies of Filipino nurses' massive emigration and how this mobility affects individuals and the Philippine society. Historical description of the emergence of healthcare professionals as export products in the Philippines is also consulted. The country's colonial history is described, and its relevance to today's migration pattern is analyzed. Based upon the empirical data on past and present Filipino health worker emigration, identified ethical implications are examined. Among these are the rights of individuals and the division of responsibilities between origin and destination countries in order to address the ethical implications the BLAs give rise to. In the theoretical part of the work, key elements from John Rawls' theories of justice (1971, 1993, 2001) are used to identify conditions of a crafting public policy that, ideally, should be met in agreement with the members of a liberal society. Thereafter, the ideal model of a BLA is constructed based on the main principles of justice. The model is used to examine the extent to which, if at all, the existing BLAs between the Philippines and countries like Japan and Germany can be considered as ethically defensible instruments for managing the emigration of nurses. Finally, a discussion on how such agreements should be designed to be ethically defensible is offered. ; Avhandlingen "The Ethics of Bilateral Labor Agreement for Global Nurses – Perspectives from the Philippines " är författad inom forskningsområdet tillämpad etik och undersöker etiska aspekter av kompetensmigration inom det specifika området vård och omsorg, med Filippinerna som ett exempel. De mest centrala frågorna för avhandlingen är vilka etiska frågor som kompetensmigration inom området vård och omsorg i en Filippinsk kontext ger upphov till liksom hur ansvaret för sådan migration bör förstås och utformas. Mer konkret diskuteras ansvarsfrågan i relation till den Filippinska statens bruk av bilaterala avtal avseende Filippinska sjuksköterskor. Studien tar sin utgångspunkt i empiriska studier av massutvandringen av Filippinska sjuksköterskor och hur denna mobilitet påverkar enskilda individer liksom det Filippinska samhället. Den deskriptiva delen rymmer även en historisk beskrivning av framväxten av "vårdpersonal som en exportprodukt" i Filippinerna. Landets koloniala historia skildras och relevansen därav för dagens migrationsflöde analyseras. Ur den inledande empiri-fokuserade delen extraheras ett antal frågor av etisk karaktär. Dessa rör primärt de rättigheter och skyldigheter liksom ansvar och ansvarsfördelning för de identifierade etiska implikationerna av rådande kompetensmigration. I en teoretisk, analytisk del av arbetet, används centrala element ur John Rawls teorier om rättvisa (1971, 1993, 2001) för att identifiera villkor som, idealt, bör vara uppfyllda i avtal som rör medborgare. Därefter tillämpas den ideala modellen på rådande bilaterala avtal gällande arbetskraftsutvandring inom vårdsektorn. Modellen och används för att undersöka i vilken grad, om alls, som de befintliga bilaterala avtalen som Filippinerna har utverkat med länder som Japan och Tyskland kan anses vara etiskt försvarbara instrument för att kontrollera flödet av arbetskraft inom vårdsektorn. Avslutningsvis diskuteras hur sådana avtal skulle behöva utformas för att vara etiskt försvarbara.
ABSTRACTObjectivesTo examine the oral health knowledge and practices of pediatric nurses who coordinate healthcare services for special needs children and to identify those factors that influenced their perceived effectiveness in managing their patients' oral health needs.MethodsSelf‐reported data were collected from 376 nurses employed at Children's Medical Services who responded to an online survey. Likert scale scores were used to specifically assess the nurses' perceived effectiveness in addressing the oral health needs of special needs children.ResultsCharacteristics significantly associated with special needs pediatric nurses who described themselves as "effective or very effective" included: the self‐perception of being very knowledgeable about basic oral health, receiving four or more hours of continuing education training, and securing dental appointments for the majority of their pediatric special needs patients with minimal waiting times.ConclusionFindings reveal that oral health knowledge significantly influenced nurses' perceived effectiveness in addressing the oral health needs of special needs children, as well as their ability to secure timely dental appointments. These results support the need to incorporate oral health education into nursing curricula and expand upon the dental workforce available and willing to treat disabled patients.
Family caregivers of patients with moderate-to-severe traumatic brain injury (TBI) regularly visit the patient during the hospital stay and are involved in their care. As impairments caused by the TBI often preclude the patient from stating preferences for visitors, family caregivers often make decisions about visitors on the patient's behalf during the hospital stay. However, limited literature investigates this process. The purpose of this study was to describe family caregivers' experience of visitors while the patient with moderate-to-severe TBI is hospitalized. Authors used grounded theory to conduct 24 interviews with 16 family caregivers. Findings showed family caregivers manage welcome and unwelcome visitors throughout the hospital stay to protect the patient's physical and emotional safety and to conserve their own energy. Staff had limited involvement in management of unwelcome visitors. These findings have practice implications for educating hospital staff about providing family nursing and assisting families to manage unwelcome visitors and about policy implications for improving hospital visiting policies.
Developmental delay in very young children is trending upward. Maternal depressive symptoms are known to negatively impact child development and may also impact family management of the child's condition. Research on family management guided this second phase of a sequential mixed methods study. The purpose of this study was to explore mothers' perceptions of family management of their children's developmental delays. Mothers of very young children who received early intervention services were interviewed. A team-based content analysis approach revealed key findings: (a) views of the child that were not holistic, (b) condition management ability was informed by what the mother thought her child needed, (c) views of condition impact were related to adapting to possible child outcomes and experiences of isolation, and (d) parental/caregiver mutuality was impaired by conflict. Understanding perceptions of family management and influence of depressive symptoms in this context is essential to extend assessment and intervention.
Abstract Background Sweden introduced a school-based human papillomavirus (HPV) vaccination programme in 2012, and school nurses are responsible for managing the vaccinations. The aim of the present study was to investigate the attitudes and experiences of school nurses regarding the school-based HPV vaccination programme 1 year after its implementation. Methods Data were collected using a web-based questionnaire in the spring of 2013, and 83.1% (851/1024) of nurses responded. Results There were strong associations between the nurses' education about the HPV vaccine and their perceived knowledge about the vaccine and a favourable attitude towards vaccination (both p < 0.001). School nurses who received a high level of education were more likely to have a positive attitude to HPV vaccination compared with nurses with little education about HPV vaccination (adjusted odds ratio [OR] = 9.8; 95% confidence interval [CI]: 3.797–25.132). Nurses with high perceived knowledge were more likely to have a positive attitude compared with those with a low level of perceived knowledge (OR = 2.5; 95% CI: 1.299–4.955). If financial support from the government was used to fund an additional school nurse, nurses were more likely to have a positive attitude than if the financial support was not used to cover the extra expenses incurred by the HPV vaccination (OR = 2.1; 95% CI: 1.051–4.010). The majority, 648 (76.1%), had been contacted by parents with questions about the vaccine, mostly related to adverse effects. In addition, 570 (66.9%) stated that they had experienced difficulties with the vaccinations, and 337 (59.1%) of these considered the task to be time-consuming. Conclusions A high level of education and perceived good knowledge about HPV are associated with a positive attitude of school nurses to the HPV vaccination programme. Thus, nurses require adequate knowledge, education, skills and time to address the questions and concerns of parents, as well as providing information about HPV. Strategic financial support is required because HPV vaccination is a complex and time-consuming task.
Cover -- Title -- Copyright -- Contents -- Preface -- Acknowledgments -- Part I: Overview of Hospice -- Chapter 1: An Introduction to Hospice and Palliative Care -- Chapter Objectives -- Hospice Care -- Characteristics of Hospice Care -- Bereavement Care -- Palliative Care -- The Palliative Care Nurse -- Provision of Palliative Care Services -- Conclusion -- References -- Chapter 2: History and Evolution of Hospice in the United States -- Chapter Objectives -- Hospice in the United States -- Conclusion -- References -- Chapter 3: Hospice Philosophy and the Role of the Nurse -- Chapter Objectives -- Nursing and the Relief of Human Suffering -- Hospice Nursing as a Specialty Area -- Standards of Practice -- Conclusion -- References -- Chapter 4: The Hospice Interdisciplinary Team -- Chapter Objectives -- Who's on the Team? -- The RN on the Hospice Interdisciplinary Team -- Interdisciplinary Communication -- Communicating During Patient Transitions -- Managing Conflict Within the Interdisciplinary Team -- Conclusion -- References -- Part II: Essentials of Hospice Nursing -- Chapter 5: The Hospice Nurse as Case Manager -- Chapter Objectives -- The Case Management Model -- The Hospice RN as Case Manager -- The Nursing Process and Case Management -- Conclusion -- References -- Chapter 6: Goals of Care Conversations -- Chapter Objectives -- Establishing and Reestablishing Goals of Care -- Having Difficult Conversations -- Facilitating Family Conversations -- Family Meetings -- Diffusing Family Conflict -- Conclusion -- References -- Chapter 7: Establishing Hospice Eligibility -- Chapter Objectives -- Guidelines and Assessment Tools -- Documenting the Patient's Baseline and Declining Clinical Status -- Evidence of Meeting Disease-Specific Guidelines for Hospice Care -- Conclusion -- References -- Chapter 8: Hospice Admission and Levels of Care.
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Abstract Background Accessing cancer treatment requires First Nation peoples living in rural and remote communities to either commute to care, or to relocate to an urban centre for the length or part of the treatment. While Canadians living in rural and remote communities must often make difficult decisions following a cancer diagnosis, such decisions are further complicated by the unique policy and socio-historical contexts affecting many First Nation peoples in Canada. These contexts often intersect with negative healthcare experiences which can be related to jurisdictional confusion encountered when seeking care. Given the rising incidence of cancer within First Nation populations, there is a growing potential for negative health outcomes. Methods The analysis presented in this paper focuses on the experience of First Nation peoples' access to cancer care in the province of Manitoba. We analyzed policy documents and government websites; interviewed individuals who have experienced relocation ( N = 5), family members ( N = 8), healthcare providers and administrators ( N = 15). Results Although the healthcare providers (social workers, physicians, nurses, patient navigators, and administrators) we interviewed wanted to assist patients and their families, the focus of care remained informed by patients' clinical reality, without recognition of the context which impacts and constrains access to cancer care services. Contrasting and converging narratives identify barriers to early diagnosis, poor coordination of care across jurisdictions and logistic complexities that result in fatigue and undermine adherence. Providers and decision-makers who were aware of this broader context were not empowered to address system's limitations. Conclusions We argue that a whole system's approach is required in order to address these limitations.
Abstract Background Accessing cancer treatment requires First Nation peoples living in rural and remote communities to either commute to care, or to relocate to an urban centre for the length or part of the treatment. While Canadians living in rural and remote communities must often make difficult decisions following a cancer diagnosis, such decisions are further complicated by the unique policy and socio-historical contexts affecting many First Nation peoples in Canada. These contexts often intersect with negative healthcare experiences which can be related to jurisdictional confusion encountered when seeking care. Given the rising incidence of cancer within First Nation populations, there is a growing potential for negative health outcomes. Methods The analysis presented in this paper focuses on the experience of First Nation peoples' access to cancer care in the province of Manitoba. We analyzed policy documents and government websites; interviewed individuals who have experienced relocation (N = 5), family members (N = 8), healthcare providers and administrators (N = 15). Results Although the healthcare providers (social workers, physicians, nurses, patient navigators, and administrators) we interviewed wanted to assist patients and their families, the focus of care remained informed by patients' clinical reality, without recognition of the context which impacts and constrains access to cancer care services. Contrasting and converging narratives identify barriers to early diagnosis, poor coordination of care across jurisdictions and logistic complexities that result in fatigue and undermine adherence. Providers and decision-makers who were aware of this broader context were not empowered to address system's limitations. Conclusions We argue that a whole system's approach is required in order to address these limitations.
Background: Accessing cancer treatment requires First Nation peoples living in rural and remote communities to either commute to care, or to relocate to an urban centre for the length or part of the treatment. While Canadians living in rural and remote communities must often make difficult decisions following a cancer diagnosis, such decisions are further complicated by the unique policy and socio-historical contexts affecting many First Nation peoples in Canada. These contexts often intersect with negative healthcare experiences which can be related to jurisdictional confusion encountered when seeking care. Given the rising incidence of cancer within First Nation populations, there is a growing potential for negative health outcomes. Methods The analysis presented in this paper focuses on the experience of First Nation peoples' access to cancer care in the province of Manitoba. We analyzed policy documents and government websites; interviewed individuals who have experienced relocation (N = 5), family members (N = 8), healthcare providers and administrators (N = 15). Results Although the healthcare providers (social workers, physicians, nurses, patient navigators, and administrators) we interviewed wanted to assist patients and their families, the focus of care remained informed by patients' clinical reality, without recognition of the context which impacts and constrains access to cancer care services. Contrasting and converging narratives identify barriers to early diagnosis, poor coordination of care across jurisdictions and logistic complexities that result in fatigue and undermine adherence. Providers and decision-makers who were aware of this broader context were not empowered to address system's limitations. Conclusions We argue that a whole system's approach is required in order to address these limitations. ; Applied Science, Faculty of ; Non UBC ; Nursing, School of ; Reviewed ; Faculty
Abstract Background To identify barriers to participation in a primary oral health care programme aimed at preventing early childhood caries, as perceived by nurses. Methods Of a total of 140 randomly selected nurses employed in 40 government health centres in Lima, 123 completed a pre-tested questionnaire. Background variables were districts' 'socio-economic status' (SES) and 'years of experience'. Factor analysis was performed. ANOVA was applied for testing the influence of the background variables on the barrier factors. Chi-square test was applied to test for differences between single item barriers and the background variables. The Likert-scale (1–4) was used. Results There was no statistical significant effect of 'SES' or of 'years of experience' of nurses on any of the 7 barrier factors, nor on the 11 single item barrier factors. The highest mean score (3.81) was obtained for the barrier factor ' importance of oral health' , followed by 'perceived responsibility' (3.44). The lowest mean score was (1.70) for 'knowledge on caries prevention' . Conclusions Nurses consider oral health very important and are willing to participate actively in programmes aimed at reducing Early Childhood Caries, provided that they will be trained well and that the director and dentists of the health centre give their consent.
Nurses' knowledge regarding advance directives may affect their administration and completion in end‐of‐life care. Confidence among nurses is a barrier to the provision of quality end‐of‐life care. This study investigated nurses' knowledge of advance directives and perceived confidence in end‐of‐life care, in Hong Kong, Ireland, Israel, Italy and the USA using a cross‐sectional descriptive design (n = 1089). In all countries, older nurses and those who had more professional experience felt more confident managing patients' symptoms at end‐of‐life and more comfortable stopping preventive medications at end‐of‐life. Nurses in the USA reported that they have more knowledge and experience of advance directives compared with other countries. In addition, they reported the highest levels of confidence and comfort in dealing with end‐of‐life care. Although legislation for advance directives does not yet exist in Ireland, nurses reported high levels of confidence in end‐of‐life care.
Stress experienced by nurses affects personal life, physical and mental health, and work efficiency. The long – term and constant stress experienced at work can escalate into burnout. And some stress management strategies can be effective in managing and reducing the stress experienced. The aim of this research –to analyze the stress management of nurses serving in the primary military health care centers. Research methodology.Quantitative research has been fullfiled with the questionnaire used as a research instrument. The Perceived Stress Scale – 10 (PSS – 10) and the Four – Factor Stress Management Methodology have been applied. 79 respondents have been included into the research sample. The research has been accomplished in compliance with ethical principles. SPSS 15.0 for Windows software package has been used for the analysis of data. Research results. The level of subjectively perceived stress among nurses serving in primary military health care centers was found to be low. However, two – thirds of nursing staff at the site at least sometimes feel covered in stress and excitement. And a third feel that sometimes or more often thet do not cope with their responsibilities and the tasks they receive. One in five nurses feel they can almost never or never manage their annoyance. It turned out that nurses serving in primary military health care centers mostly use problem – solving and social support stress – coping strategies. The least used – emotional discharges. Nurses serving primary military health care centers using active stress management strategies experience lower level of stress. No statistically significant relationship was found betweed the age, length of service, length of service in civilian health care institutions and subjectively perceived stress levels of nurses serving in primary military health care centers. Conclusion. Nurses serving in primary military health care centers using active stress management strategies experience lower levels of stress.
Stress experienced by nurses affects personal life, physical and mental health, and work efficiency. The long – term and constant stress experienced at work can escalate into burnout. And some stress management strategies can be effective in managing and reducing the stress experienced. The aim of this research –to analyze the stress management of nurses serving in the primary military health care centers. Research methodology.Quantitative research has been fullfiled with the questionnaire used as a research instrument. The Perceived Stress Scale – 10 (PSS – 10) and the Four – Factor Stress Management Methodology have been applied. 79 respondents have been included into the research sample. The research has been accomplished in compliance with ethical principles. SPSS 15.0 for Windows software package has been used for the analysis of data. Research results. The level of subjectively perceived stress among nurses serving in primary military health care centers was found to be low. However, two – thirds of nursing staff at the site at least sometimes feel covered in stress and excitement. And a third feel that sometimes or more often thet do not cope with their responsibilities and the tasks they receive. One in five nurses feel they can almost never or never manage their annoyance. It turned out that nurses serving in primary military health care centers mostly use problem – solving and social support stress – coping strategies. The least used – emotional discharges. Nurses serving primary military health care centers using active stress management strategies experience lower level of stress. No statistically significant relationship was found betweed the age, length of service, length of service in civilian health care institutions and subjectively perceived stress levels of nurses serving in primary military health care centers. Conclusion. Nurses serving in primary military health care centers using active stress management strategies experience lower levels of stress.
The views of a sample of Xhosa-speaking psychiatric nurses on traditional healing and its role in mental health care in South Africa are examined. We explore how the nurses manage apparent incompatibilities between their practice of Western psychiatry and the use of traditional healing services. Under normal circumstances this incongruity appears unproblematic for the respondents; these systems co-exist pluralistically in their experience. However, when questioned about the possible cooperation of these systems, respondents give views inconsistent with their pluralistic world-view and promote psychiatry's hegemony. Implications for healthcare planning are discussed.
