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- All Subjects: Nursing
- Genre: Academic theses
- Creators: Lamb, Gerri
- Creators: Kelly, Lesly
Description
ABSTRACT Nursing physical fatigue is a critical issue that may lead to degradation of care delivery and ultimately result in medical errors. This issue is equally relevant due to the looming shortage of nurses, which has been linked to the physical demands and potential occupational hazards intrinsic to the profession; as well as to the graying of the nursing workforce who experiences gradual loss of strength and agility that accompanies aging as time in the career advances. In a hospital Emergency Department, the level of nursing physical fatigue can potentially reach its threshold in light of challenging workloads, scope of job assignments and demanding schedules. While in other safety-sensitive industries such as aviation and nuclear plants, similar concerns have been the object of systematic research and addressed with consequent regulations, just recently, the healthcare sector has been engaged in further investigations. This study proposed to explore the linkage between Emergency Department design-layout and nursing physical fatigue. It was expected that further understanding on this relationship would support evidence-based design propositions linking nursing wellness, job satisfaction, and performance to a higher quality of care and improved patient safety levels. To this end, data collection was performed during four weeks in a community-based hospital. A convenience sample of twenty-four eligible nurses was invited to participate in this two-part study. The first section consisted of the completion of a self-administered questionnaire, which assessed nurses' perception of the impact of working conditions on nursing physical fatigue. The second section included the monitoring, through the use of accelerometers, of nurses' actual activity intensity levels during three consecutive shifts. Among other findings, data demonstrated that nurses perceive several attributes or components of the built environment as potential contributors to physical fatigue. In addition, various operational practices and organizational protocols were linked to physical fatigue. Contrary to nurses' perception of physical fatigue, their actual physical activity levels fell mostly between sedentary or light intensity ranges. This paradox offers the opportunity for design interventions that, in alignment with operational practices and organizational protocols will enhance nurses' performance and improve nurses' retention.
ContributorsShakman, Karen (Author) / Bender, Diane (Thesis advisor) / Stein, Morris (Committee member) / Lamb, Gerri (Committee member) / Arizona State University (Publisher)
Created2011
Description
The physical environment influences the physiology, psychology, and the societal interactions of those who experience it. The environment can also influence human behavior. Critical care nurses are in constant interaction with the physical environment surrounding their patients. High acuity ICU patients are vulnerable and at risk for harm, infection, and poor outcomes while the physical and cognitive workload of nurses presents a demanding and continuous challenge.
The goal of this qualitative study was to explore and understand the way critical care nurses navigate within the patient room and interact with its features. The study of critical care nurses interacting with the patient room environment was conducted in five critical care units at three tertiary care institutions in the Eastern United States, along with another unit in the pilot study at a community hospital in the Southwest United States. Nurses were observed in their typical work environment as they performed normal tasks and patient care activities for entire day and night shifts. The study involved ethnographic field observations, individual semi-structured participant interviews, and examination of photographs and floor plans.
The exploratory study resulted in a comprehensive model for nurse navigation that includes both cognitive and action components, along with a conceptual framework for nurse behavioral activity. Repetitive patterns of nurse movement were identified and named. The findings produced recommendations for nurses’ effective use of space and architectural design of ICU patient rooms to improve patient outcomes.
The goal of this qualitative study was to explore and understand the way critical care nurses navigate within the patient room and interact with its features. The study of critical care nurses interacting with the patient room environment was conducted in five critical care units at three tertiary care institutions in the Eastern United States, along with another unit in the pilot study at a community hospital in the Southwest United States. Nurses were observed in their typical work environment as they performed normal tasks and patient care activities for entire day and night shifts. The study involved ethnographic field observations, individual semi-structured participant interviews, and examination of photographs and floor plans.
The exploratory study resulted in a comprehensive model for nurse navigation that includes both cognitive and action components, along with a conceptual framework for nurse behavioral activity. Repetitive patterns of nurse movement were identified and named. The findings produced recommendations for nurses’ effective use of space and architectural design of ICU patient rooms to improve patient outcomes.
ContributorsHamilton, D. Kirk (Author) / Lamb, Gerri (Thesis advisor) / Fleury, Julie (Committee member) / Gurses, Ayse (Committee member) / Arizona State University (Publisher)
Created2017
Description
Nurses are ideally positioned to lead the transformation of healthcare delivery in the United States, however they must be prepared to do so. The Institute of Medicine has called for nurses to become change agents and assume leadership positions across all levels in order to become full partners with physicians and other health care providers. While clinical leadership is a responsibility for all nurses, expectations for new nurse clinical leadership have not been well studied.
This study sought to determine the nursing leadership competencies clinical managers expect of new nurses in an acute care setting and to identify gaps between end-of-program nursing leadership competencies, as outlined in The Essentials of Baccalaureate Education for Professional Nursing Practice, with leadership competencies identified by clinical managers in an acute-care setting.
A single, bounded case study approach was used to collect data from nurse managers and assistant nurse managers at one acute care hospital. Data from intensive interviews, focus groups, and archival records were analyzed. Seven major themes related to clinical leadership emerged, including intentional learning, communication, professional practice, advocacy, teamwork, influencing practice, and systems thinking. Traits, mentoring, and generational differences emerged as secondary themes.
Data from this study revealed a developmental sequence for clinical leadership. Certain expectations identified as antecedent to clinical leadership emerged initially, whereas other aspects of clinical leadership, developed later in the career trajectory. It was clear that accomplishing nursing care tasks was a fundamental expectation for professional nursing practice. Communication, teamwork and advocacy are crucial leadership competencies which help the new nurse to effectively manage time and provide safe, high-quality nursing care. As the new nurse continues to develop, systems thinking and influencing nursing practice emerge as significant expectations. Nurse managers have clear expectations for how new nurses should be prepared for clinical leadership. The degree to which clinical practice partners employing new nurses and academic nursing programs educating future nurses collaborate to establish expected outcomes is variable; however, academic-practice collaborations are crucial in developing educational standards for entry to practice in complex healthcare delivery systems.
This study sought to determine the nursing leadership competencies clinical managers expect of new nurses in an acute care setting and to identify gaps between end-of-program nursing leadership competencies, as outlined in The Essentials of Baccalaureate Education for Professional Nursing Practice, with leadership competencies identified by clinical managers in an acute-care setting.
A single, bounded case study approach was used to collect data from nurse managers and assistant nurse managers at one acute care hospital. Data from intensive interviews, focus groups, and archival records were analyzed. Seven major themes related to clinical leadership emerged, including intentional learning, communication, professional practice, advocacy, teamwork, influencing practice, and systems thinking. Traits, mentoring, and generational differences emerged as secondary themes.
Data from this study revealed a developmental sequence for clinical leadership. Certain expectations identified as antecedent to clinical leadership emerged initially, whereas other aspects of clinical leadership, developed later in the career trajectory. It was clear that accomplishing nursing care tasks was a fundamental expectation for professional nursing practice. Communication, teamwork and advocacy are crucial leadership competencies which help the new nurse to effectively manage time and provide safe, high-quality nursing care. As the new nurse continues to develop, systems thinking and influencing nursing practice emerge as significant expectations. Nurse managers have clear expectations for how new nurses should be prepared for clinical leadership. The degree to which clinical practice partners employing new nurses and academic nursing programs educating future nurses collaborate to establish expected outcomes is variable; however, academic-practice collaborations are crucial in developing educational standards for entry to practice in complex healthcare delivery systems.
ContributorsMiehl, Nickolaus (Author) / Komnenich, Pauline (Thesis advisor) / Hagler, Debra (Thesis advisor) / Lamb, Gerri (Committee member) / Arizona State University (Publisher)
Created2018
Description
Job burnout, a prolonged reaction to job stress, includes mental and physical aspects of exhaustion related to professional work life. Linked to individual health-related problems, decreased job satisfaction, poor organizational commitment, and higher turnover, burnout poses a problem for both employees and organizations. The nursing profession identifies the prevalence of burnout and the resulting harmful effects in many settings, yet until now, rural critical access hospital settings have not been considered. To build and maintain a competent, healthy rural nursing workforce that responds innovatively to growing healthcare needs, it is important to examine burnout levels in rural nurses and to identify factors that might be associated with mitigating burnout.
This study focuses on how psychological capital, socio-demographic and organizational work-related factors are associated with burnout in this population. This cross-sectional, descriptive correlational study employed the Maslach Burnout Inventory for Health Professionals, the Psychological Capital Questionnaire, and a sociodemographic questionnaire assessing individual and organizational work-related factors as self-report tools. Descriptive statistics, correlations, and regression analyses were performed to assess aspects of the nurses’ work environment, while describing the relationships among the variables.Means and standard deviations were examined across key variables and compared to reports from other studies. Hypotheses predicted psychological capital would be associated with burnout (negatively associated with emotional exhaustion and depersonalization, positively associated with personal accomplishment), and that individual sociodemographic and organizational work-related factors would also be associated with BO. It was further hypothesized that PsyCap would moderate the relationship between work-related factors and BO.
Maslach Burnout Inventory results reveal similar findings to those in the global sample. However, levels of emotional exhaustion and professional accomplishment were greater in our rural nurse sample compared to published values. Higher levels of psychological capital were found to be related to decreases in depersonalization and correlated to greater professional accomplishment. Psychological capital was not found to moderate associations within this study. Intent to stay more than one year had a strong, negative correlation with emotional exhaustion. The findings suggest burnout in this sample resembles that of the global problem and sets a baseline from which psychological capital trainings may be built.
This study focuses on how psychological capital, socio-demographic and organizational work-related factors are associated with burnout in this population. This cross-sectional, descriptive correlational study employed the Maslach Burnout Inventory for Health Professionals, the Psychological Capital Questionnaire, and a sociodemographic questionnaire assessing individual and organizational work-related factors as self-report tools. Descriptive statistics, correlations, and regression analyses were performed to assess aspects of the nurses’ work environment, while describing the relationships among the variables.Means and standard deviations were examined across key variables and compared to reports from other studies. Hypotheses predicted psychological capital would be associated with burnout (negatively associated with emotional exhaustion and depersonalization, positively associated with personal accomplishment), and that individual sociodemographic and organizational work-related factors would also be associated with BO. It was further hypothesized that PsyCap would moderate the relationship between work-related factors and BO.
Maslach Burnout Inventory results reveal similar findings to those in the global sample. However, levels of emotional exhaustion and professional accomplishment were greater in our rural nurse sample compared to published values. Higher levels of psychological capital were found to be related to decreases in depersonalization and correlated to greater professional accomplishment. Psychological capital was not found to moderate associations within this study. Intent to stay more than one year had a strong, negative correlation with emotional exhaustion. The findings suggest burnout in this sample resembles that of the global problem and sets a baseline from which psychological capital trainings may be built.
ContributorsMcCay, Rebecca (Author) / Larkey, Linda K (Thesis advisor) / Kelly, Lesly (Committee member) / Todd, Michael (Committee member) / Arizona State University (Publisher)
Created2019
Description
Late preterm infants (LPIs), born between 34 and 37 weeks gestation, are at risk for a myriad of health conditions related to neuro-muscular and physiologic immaturity. However, relative stability allow many of these infants to avoid care in specialty nurseries and discharge home with their mothers after birth. Due to underlying immaturity, feeding difficulty is the most common issue LPIs experience, resulting in early breastfeeding cessation, increased risk for secondary diagnoses, and hospital readmission. The purpose of this study was to assess early breastfeeding behavior of LPIs, including testing inter-rater reliability of an assessment tool and the feeding patterns of infants over time. An extensive review of breastfeeding assessment tools resulted in the selection of the Premature Infant Breastfeeding Behavior Scale (PIBBS) based on its reliability and validity in the preterm infant population. A convenience sample of LPI dyads was recruited and used to conduct inter-rater reliability testing of PIBBS. A longitudinal one-group non-experimental study was used for observational follow-up. A strong statistical agreement of PIBBS scores occurred between mothers and a healthcare professional (Cohen’s kappa values of items ranged from .776 to 1.000, p = <.001). Participants continued using the PIBBS tool after hospital discharge until their infants expected due dates (40 weeks adjusted age). T-test analyses were conducted to examine changes in scores over time indicating increase in item scores (p = .003 - .193). PIBBS appears to be a valid and reliable tool to assess breastfeeding among LPI dyads. Incorporation of PIBBS into a comprehensive plan of care could better support and protect breastfeeding among the LPI population.
ContributorsLober, Angela (Author) / Komnenich, Pauline (Thesis advisor) / Kelly, Lesly (Thesis advisor) / Dodgson, Joan (Committee member) / Arizona State University (Publisher)
Created2018
Description
This cross-sectional descriptive study was designed to examine critical care registered nurses’ perceptions of nurse-to-nurse incivility and professional comportment, and the extent to which education, nurses’ age, nursing degree, and years of nursing experience is related to their perceptions on these topics. Professional comportment is comprised of nurses’ mutual respect, harmony in beliefs and actions, commitment, and collaboration. Yet, it was unknown whether a relationship existed between a civil or uncivil environment in the nursing profession and nurses’ professional comportment. Correlational analyses were conducted to explore the relationship between perceptions of nurse-nurse incivility and professional comportment, and the relationships between incivility and professional comportment education and perceptions of nurse-nurse incivility and professional comportment. Multiple linear regression analyses were conducted to identify predictors of perceptions of nurse-nurse incivility and professional comportment. Results indicated statistically significant relationships between perceptions of nurse-nurse incivility and professional comportment, and between professional comportment education and perceptions of professional comportment. Professional comportment education was identified as a statistically significant predictor of increased perceptions of professional comportment. Findings of the current study may assist in establishing more targeted and innovative educational interventions to prevent, or better address, nurse-nurse incivility. Future research should more clearly define professional comportment education, test educational interventions that promote professional comportment in nurses, and further validate the Nurse-Nurse Collaboration Scale as a measure of nurses' professional comportment.
ContributorsOja, Kenneth John (Author) / Komnenich, Pauline (Thesis advisor) / Hagler, Debra (Thesis advisor) / Kelly, Lesly (Committee member) / Arizona State University (Publisher)
Created2015
Description
Type 2 diabetes mellitus (T2DM) is a chronic disease affecting more than ten percent of the U.S. adults. Approximately 50 percent of people with diabetes fail to achieve glycemic targets of A1C levels below seven percent. Poor glycemic control disproportionately affects minority populations such as Korean Americans (KAs). Successful diabetes self-management requires a comprehensive approach that takes into account depression, sleep, and acculturation to achieve good glycemic control. Therefore, the purposes of this study were to: 1) describe the levels of glycemic control, depressive symptoms, sleep quality and duration, and acculturation; 2) examine an association of depressive symptoms with glycemic control; 3) identify mediational roles of sleep quality and sleep duration of less than 6 hours between depressive symptoms and glycemic control; and 4) explore a moderation role of acculturation between depressive symptoms and glycemic control in KAs with T2DM. This is a cross-sectional, descriptive correlational study. A total of 119 first generation KAs with T2DM were recruited from Korean communities in Arizona. A1C levels, the Center for Epidemiological Studies Depression Scale, the Pittsburgh Sleep Quality Index, the Suinn-Lew Asian Self-Identity Acculturation scale, the International Physical Activity Questionnaire, and the Berlin Questionnaire were measured. Descriptive statistics, multiple regression analyses, path analyses, and the Sobel tests were conducted for data analyses of this study. Poor glycemic control (A1C ≥ 7 %), high depressive symptoms (CES-D ≥ 16), poor sleep quality (PSQI > 5), and short sleep duration (< 6 hours) were prevalent among KAs with T2DM. The mean score of acculturation (2.18) indicated low acculturation to Western culture. Depressive symptoms were revealed as a significant independent predictor of glycemic control. Physical activity was negatively associated with glycemic control, while cultural identity was positively related to glycemic control. Sleep quality and sleep duration of less than 6 hours did not mediate the relationship between depressive symptoms and glycemic control. Acculturation did not moderate the association between depressive symptoms and glycemic control. Diabetes self-management interventions of a comprehensive approach that considers depressive symptoms, sleep problems, and cultural differences in minority populations with T2DM are needed.
ContributorsJeong, Mihyun (Author) / Reifsnider, Elizabeth G. (Thesis advisor) / Belyea, Michael (Committee member) / Petrov, Megan (Committee member) / Kelly, Lesly (Committee member) / Arizona State University (Publisher)
Created2017
Description
Masters Entry into Professional Nursing (MEPN) students are entry level students in an accelerated nursing curriculum with a minimum requirement of a Bachelor’s degree in a non-nursing discipline. This qualitative descriptive study sought to explore the experiences of MEPN students during the program using the conceptual framework of Schon’s reflection-in-action and an associated lens of interprofessional education and practice. Nine participants were recruited using maximum variation sampling. Participants were all female, over the age of 21, all recent graduates of a MEPN program, with previous baccalaureate degrees in the sciences and humanities. Data were analyzed using directed content analysis. Participants identified five steps in the MEPN journey: (1) Choosing to Pursue Nursing, (2) Coming into MEPN, (3) Bridging Disciplines to Become a Nurse, (4) Reflecting on the Journey, and (5) Being a Nurse. They identified facilitators and barriers they encountered navigating the program and described the knowledge they brought from their prior discipline and provided examples of how they applied it in nursing practice during the MEPN program.
The findings have significant implications for nursing practice and nursing education. The essential elements of Schon’s framework for effective problem solving were evident and necessary for building knowledge in practice. Participants recognized the need to think differently when solving professional practice problems consistent with the process of reflection-in-action. They acknowledged benefits and challenges of working with peers in interprofessional education and practice.
Faculty can more purposefully use what students bring from other disciplines to support interprofessional relationships and reflection-in-action in clinical practice.
ContributorsMueller, Judith Marie (Author) / Lamb, Gerri (Thesis advisor) / Evans, Bronwynne (Committee member) / Krahe Billings, Eve (Committee member) / Arizona State University (Publisher)
Created2023
Description
This body of research sought to explore relationships between cognitive function and physical activity (PA), sedentary behavior (SB), and sleep, independently and in conjunction, in mid-life to older adults with no known cognitive impairment. Aging is associated with cognitive decline, and lifestyle behaviors such as PA, SB, and sleep, may mitigate this decline. First, a systematic review and meta-analysis was conducted to examine the effect of aerobic PA interventions on memory and executive function in sedentary adults. Second, a longitudinal study was conducted to examine the association between SB and odds of incident cognitive impairment, and SB and cognitive decline in older adults. Last, a cross-sectional study was conducted to examine the joint associations between different levels of sleep with levels of PA, and sleep with levels of sedentary time on memory and executive function. This body of research provided evidence to support the association between aerobic PA and improved cognitive function, SB and incident cognitive impairment and cognitive function declines, and the joint association of sleep and different levels of PA and ST on cognitive function by hypertension status.
ContributorsHoffmann, Nicole M (Author) / Lee, Rebecca E (Thesis advisor) / Petrov, Megan E (Thesis advisor) / Marek, Karen (Committee member) / Arizona State University (Publisher)
Created2020
Description
This descriptive research used social network analysis to explore the influence of relationships and communication among hospital nursing (RN, LPN, CNA) and discharge planning staff on adherence to evidence-based practices (EBP) for reducing preventable hospital readmissions. Although previous studies have shown that nurses are a valued source of research information for each other, there have been few studies concerning the role that staff relationships and communication play in adherence to evidence-based practice. The investigator developed the Relational Model of Communication and Adherence to EBP from diffusion of innovation theory, social network theories, relational coordination theory, and quality improvement literature.
The study sample consisted of 10 adult-medical surgical units, five home care agencies and six long-term care facilities. A total of 273 hospital nursing and discharge planning staff and 69 post-acute staff participated. Hospital staff completed a survey about communication patterns for patient care and patient discharge and about communication quality on the unit. Hospital and post-acute care staff completed surveys about relationship quality and demographic characteristics. Evidence-based practice adherence rates for risk assessment, medication reconciliation, and discharge summary were measured as documented in the electronic medical record.
Social network analysis was used to analyze the communication patterns for patient care communication at the unit. These findings were correlated with (1) aggregate responses for communication quality, (2) aggregate responses for relationship quality, and (3) EBP adherence. Statistically significant relationships were found between communication patterns, and communication quality and relationship quality. There were
ii
two significant relationships between communication quality, and EBP adherence. Limitations in response rates and missing data prevented the analysis of all of the hypothesized relationships.
The findings from this study provide empirical support for the role of social networks and relationships among staff in adoption of, and adherence to, EBP. Social network theory and social network analysis, especially the concept of knowledge sharing, provide ways to understand and leverage the influence of peer relationships. Future studies are needed to better understand the contribution that relationships among staff (social networks) have in the adoption of and adherence to EBP among nursing staff. Further model development and multilevel studies are
The study sample consisted of 10 adult-medical surgical units, five home care agencies and six long-term care facilities. A total of 273 hospital nursing and discharge planning staff and 69 post-acute staff participated. Hospital staff completed a survey about communication patterns for patient care and patient discharge and about communication quality on the unit. Hospital and post-acute care staff completed surveys about relationship quality and demographic characteristics. Evidence-based practice adherence rates for risk assessment, medication reconciliation, and discharge summary were measured as documented in the electronic medical record.
Social network analysis was used to analyze the communication patterns for patient care communication at the unit. These findings were correlated with (1) aggregate responses for communication quality, (2) aggregate responses for relationship quality, and (3) EBP adherence. Statistically significant relationships were found between communication patterns, and communication quality and relationship quality. There were
ii
two significant relationships between communication quality, and EBP adherence. Limitations in response rates and missing data prevented the analysis of all of the hypothesized relationships.
The findings from this study provide empirical support for the role of social networks and relationships among staff in adoption of, and adherence to, EBP. Social network theory and social network analysis, especially the concept of knowledge sharing, provide ways to understand and leverage the influence of peer relationships. Future studies are needed to better understand the contribution that relationships among staff (social networks) have in the adoption of and adherence to EBP among nursing staff. Further model development and multilevel studies are
ContributorsSolomons, Nan M (Author) / Lamb, Gerri (Thesis advisor) / Verran, Joyce (Committee member) / Marek, Karen (Committee member) / Arizona State University (Publisher)
Created2016