Matching Items (33)
Description
The healthcare system is plagued with increasing cost and poor quality outcomes. A major contributing factor for these issues is that outdated leadership practices, such as leader-centricity, linear thinking, and poor readiness for innovation, are being used in healthcare organizations. Through a qualitative case study analysis of innovation implementation, a new framework of leadership was uncovered. This framework presented new characteristics of leaders that led to the successful implementation of an innovation. Characteristics uncovered included boundary spanning, risk taking, visioning, leveraging opportunity, adaptation, coordination of information flow, and facilitation. These characteristics describe how leaders throughout the system were able to influence information flow, relationships, connections, and organizational context to implement innovation.
ContributorsWeberg, Daniel Robert (Author) / Fluery, Julie (Thesis advisor) / Malloch, Kathy (Thesis advisor) / Porter-O'Grady, Timothy (Committee member) / Hagler, Debra (Committee member) / Arizona State University (Publisher)
Created2013
Description
The measurement of competency in nursing is critical to ensure safe and effective care of patients. This study had two purposes. First, the psychometric characteristics of the Nursing Performance Profile (NPP), an instrument used to measure nursing competency, were evaluated using generalizability theory and a sample of 18 nurses in the Measuring Competency with Simulation (MCWS) Phase I dataset. The relative magnitudes of various error sources and their interactions were estimated in a generalizability study involving a fully crossed, three-facet random design with nurse participants as the object of measurement and scenarios, raters, and items as the three facets. A design corresponding to that of the MCWS Phase I data--involving three scenarios, three raters, and 41 items--showed nurse participants contributed the greatest proportion to total variance (50.00%), followed, in decreasing magnitude, by: rater (19.40%), the two-way participant x scenario interaction (12.93%), and the two-way participant x rater interaction (8.62%). The generalizability (G) coefficient was .65 and the dependability coefficient was .50. In decision study designs minimizing number of scenarios, the desired generalizability coefficients of .70 and .80 were reached at three scenarios with five raters, and five scenarios with nine raters, respectively. In designs minimizing number of raters, G coefficients of .72 and .80 were reached at three raters and five scenarios and four raters and nine scenarios, respectively. A dependability coefficient of .71 was attained with six scenarios and nine raters or seven raters and nine scenarios. Achieving high reliability with designs involving fewer raters may be possible with enhanced rater training to decrease variance components for rater main and interaction effects. The second part of this study involved the design and implementation of a validation process for evidence-based human patient simulation scenarios in assessment of nursing competency. A team of experts validated the new scenario using a modified Delphi technique, involving three rounds of iterative feedback and revisions. In tandem, the psychometric study of the NPP and the development of a validation process for human patient simulation scenarios both advance and encourage best practices for studying the validity of simulation-based assessments.
ContributorsO'Brien, Janet Elaine (Author) / Thompson, Marilyn (Thesis advisor) / Hagler, Debra (Thesis advisor) / Green, Samuel (Committee member) / Arizona State University (Publisher)
Created2014
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
I conducted a qualitative, comparative study on the nursing education systems in the United Kingdom and the United States, focusing on two universities—Arizona State University in Phoenix, Arizona and Leeds Beckett University in Leeds, England. The goals of my thesis included comparing the educational, economic, and cultural aspects of the countries and how those aspects impact nursing students on both sides of the pond. The educational and economic aspects were compared by utilizing existing literature and open data sources such as the university websites and publications from comparative education journals, while the cultural differences were evaluated by conducting short, one-on-one interviews with students enrolled in the Adult Health courses at both universities. The findings from the interviews were transcribed and coded, and findings from the sites were compared. While there is an extensive amount of research published regarding comparative education, there has not been much published comparing these developed countries. While there is a significant difference in the structure and cost of the nursing programs, there are more similarities than differences in culture between nursing students interviewed in the US and those interviewed in the UK.
ContributorsTahiliani, Shreja (Author) / Hagler, Debra (Thesis director) / Allen, Angela (Committee member) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor) / Barrett, The Honors College (Contributor)
Created2016-05
Description
Hematopoietic stem cell transplantation (HCT), a common treatment for various hematopoietic cancers, involves lengthy hospital stays as well as intensive chemotherapy prior to the transplant. Many patients exhibit clinically significant symptoms of depression, anxiety, or post-traumatic stress disorder (PTSD) after transplant, due to the demanding nature of the treatment process and the associated risks. However, little research has been done concerning how nurses' actions impact the emotional well-being of these patients; most studies lack evidence related to the nursing staff's precise role in this distressing situation. The purpose of this study was to explore, using a qualitative approach, participants' personal experiences with their nurses throughout all phases of treatment, focusing on interventions and actions nurses took to ease the participants' reported anxiety, depression, or PTSD symptoms. A convenience sampling method was used to recruit participants. Nine English-speaking individuals (M age = 55 years; 78% female; 67% allogeneic) from around the US were invited to participate in semi-structured in-depth interviews. Seven major themes emerged from the interviews: (1) support from nurse, (2) physical symptoms, (3) emotional/cognitive distress, (4) open/honest communication, (5) coping, (6) continuity of nurses, and (7) anticipatory guidance. Results indicated the need for heavy psychosocial support, informational support, and active listening from nurses. Implications for nursing practice included an increased need for education on the best timing for implementation of nurse-led interventions, as well as further investigation into strategies for nurses to provide optimal psychosocial care for HCT patients.
ContributorsGaney, Nicole Isabel (Author) / Kim, Sunny (Thesis director) / Hagler, Debra (Committee member) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor) / Barrett, The Honors College (Contributor)
Created2017-05
Description
Complementary and alternative medicine (CAM), also known as integrative medicine, is an important intervention used for holistic care of patients. It is patient-centered care, addressing multiple aspects of one's health ranging from physical and psychosocial to spiritual influences. CAM has been successful in patients' symptom and stress management, and has grown substantially in recent decades, especially in oncology nursing. Despite widespread use and their support for CAM therapies, nurses' lack of CAM knowledge and vocabulary are barriers to communication with patients. Also, little is known about the student nurses' awareness of CAM and the college instructors' opinions on the intervention, which are crucial in developing the college nursing education on integrative medicine. The purpose of this study was to describe the college nursing students' knowledge and their instructors' perspectives on integrative medicine and oncology care, and compared the data of the two populations. Convenience and snowball sampling were used to recruit participants from the community in College of Nursing and Health Innovation (CONHI) at Arizona State University (ASU). Five students (M age = 20.6 years; 80% female) and five nursing instructors (M age = 56.8 years; 100% female) were invited to 60-90 minute in-depth interviews on perceptions and knowledge of CAM. Four major themes emerged from the interviews: (1) Insufficient awareness and knowledge of CAM; (2) education and information needs on CAM; (3) positive attitudes toward CAM; and (4) importance of nurses' roles in CAM. Implications for nursing included need for more structured and efficient CAM in nursing programs; early exposure and education of college nursing students on CAM; and academic relationships between nursing instructors and students.
ContributorsKim, Jiwon (Author) / Kim, Sunny (Thesis director) / Langer, Shelby (Committee member) / Department of Psychology (Contributor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor) / Barrett, The Honors College (Contributor)
Created2016-12
Description
Hematopoietic stem cell transplantation (HSCT) is a unique but intense procedure used to save the lives of patients with hematopoietic malignancies. However, patients and caregivers undergoing HSCT can experience prolonged psychological distress due to an intense and distinctive transplant process. Types of psychological distress include anxiety, depression, social isolation, and post-traumatic stress disorder. Although this a significant healthcare problem, limited research has been conducted within the HSCT patient and caregiver population to investigate ways to improve their mental health. The purpose of this study was to examine the effects of an educational video intervention about post-transplant recovery in decreasing emotional distress and promoting emotional well-being in HSCT patients and caregivers. This pilot study utilized a quantitative single-group pretest-posttest design to examine the effect of educational videos on participant's emotional well-being. Four educational videos were developed using information gathered from several reliable bone marrow transplant and cancer websites. A convenience sampling method was used to recruit HSCT patient and caregiver participants. Eleven Caucasian, English-speaking individuals (6 patients, 5 caregivers; 54.5% female; M age= 43.7 years) across the United States were enrolled in the 60-90 minute online intervention. Participant responses were measured using pretest and posttest questionnaires. Results from the study found that the educational videos were effective in decreasing levels of depression and anxiety. Implications for nursing practice include the need to educate HSCT patients and caregivers about transplant recovery to decrease emotional distress. This study demonstrates the impact post-transplant education has on decreasing depression and anxiety in HSCT patients and caregivers.
ContributorsBosselman, Kate Elizabeth (Author) / Kim, Sunny (Thesis director) / Lee, Rebecca (Committee member) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor) / Barrett, The Honors College (Contributor)
Created2016-12
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
The purpose of this study was to investigate the use of the design characteristics component of the Jeffries/National League for Nursing Framework for Designing, Implementing, and Evaluating Simulations when developing a simulation-based approach to teaching structured communication to new graduate nurses. The setting for the study was a medium sized tertiary care hospital located in the southwestern United States. Participants in the study were an instructional designer (who also served as the researcher), two graduate nursing education specialists, one unit based educator, and 27 new graduate nurses and registered nurses who had been in practice for less than six months. Design and development research was employed to examine the processes used to design the simulation, implementation of the simulation by faculty, and course evaluation data from both students and faculty. Data collected from the designer, faculty and student participants were analyzed for evidence on how the design characteristics informed the design and implementation of the course, student achievement of course goals, as well as student and faculty evaluation of the course. These data were used to identify the strengths and weaknesses of the model in this context as well as suggestions for strengthening the model. Findings revealed that the model generally functioned well in this context. Particular strengths of the model were its emphasis on problem-solving and recommendations for attending to fidelity of clinical scenarios. Weaknesses of the model were inadequate guidance for designing student preparation, student support, and debriefing. Additionally, the model does not address the role of observers or others who are not assigned the role of primary nurse during simulations. Recommendations for strengthening the model include addressing these weaknesses by incorporating existing evidence in the instructional design of experiential learning and by scaffolding students during problem-solving. The results of the study also suggested interrelationships among the design characteristics that were not previously described; further exploration of this finding may strengthen the model. Faculty and instructional designers creating clinical simulations in this context would benefit from using the Jeffries/National League for Nursing Model, adding external resources to supplement in areas where the model does not currently provide adequate guidance.
ContributorsWilson, Rebecca D (Author) / Klein, James D. (Thesis advisor) / Hagler, Debra (Committee member) / Savenye, Wilhelmina (Committee member) / Arizona State University (Publisher)
Created2011
Description
Colorectal cancer (CRC) is the third most prevalent form of cancer in both genders and second highest cause of cancer-related death in the United States. Despite the availability of preventative CRC screening, Latinos as a group are of particular concern for CRC as they tend to have a lower screening rate, contributing to the possibility of late-stage diagnosis or even death. However, little is known about the perceptions of CRC screening and factors which contribute to beliefs about CRC in Latinos. Most studies are quantitative and rarely include a qualitative approach focusing on cultural aspects and communication with physicians. The purpose of this study was to explore participants' perceived facilitators and barriers to CRC screening, as well as perspectives on physician recommendation and fatalism, using a qualitative approach. A convenience and snowball sampling were used to collect the data. Eight English-speaking Latino individuals (M age=56 years; 75% female) in the Phoenix, Arizona area were invited to 60-90 minute in-depth interviews on perceptions of the colorectal cancer screening process. Ten major themes emerged from the interviews: (1) lacking awareness and knowledge of CRC screening, (2) attitude toward CRC and screening, (3) availability of preventive care, (4) physician trust, (5) fear, (6) desire for increased information, (7) personal learning, (8) lifestyle factors, (9) cultural impact, and (10) willingness to change lifestyle. Results indicated varying levels of perceived knowledge of colorectal cancer, little perceived risk of diagnosis, desire for more information, and a high level of physician trust. Implications for nursing included increased need for CRC screening educational resources, as well as further investigation of the influence of fatalistic belief in CRC screening compliance for the Latino population.
ContributorsMagdaleno, Claire Rose (Author) / Kim, Sunny (Thesis director) / McNulty, Julie (Committee member) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor) / Barrett, The Honors College (Contributor)
Created2015-12