Theses and Dissertations at Montana State University (MSU)
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Item Acute care nurses' self-reported competence in palliative care(Montana State University - Bozeman, College of Nursing, 2016) Hayter, Chelsi Rae; Chairperson, Graduate Committee: M. Jean Shreffler-GrantPalliative care is a health care specialty that can provide patients and their families relief from burdensome symptoms and improve quality of life when faced with a life-limiting illness. Researchers have documented that nurses' knowledge and competence in palliative care results in more timely referrals for palliative care, which can promote comfort and increase the quality of care patients receive with life-limiting illnesses. Despite the known benefits of nurses' competence in providing palliative care, there is a need for more studies to further quantify nurses' self-competence in palliative care in the United States. The purpose of this study was to examine acute care nurses' self-reported competence in providing palliative care services. A non-experimental descriptive research design was utilized in this study to better understand acute care nurses' self-reported competence in palliative care services in one urban hospital in South Central Montana. All registered acute care nurses were eligible and invited to participate in an anonymous online survey. Nurse participants completed the online survey containing standard demographic questions and an instrument that examined their self-competence in 8 domains of palliative care. Mean scores of the instrument showed that nurses in this particular acute care hospital felt they are more than moderately capable in providing palliative care services to patients and their families. Despite this finding, some nurses indicated that they did not feel at all capable in performing some domains of palliative care. Implications for nursing include further education for acute care nurses' to increase self-competence in providing palliative care services to ensure quality care is delivered to patients and their families.Item The effect of an educational intervention on improving acute care nurses' level of knowledge in providing high quality end-of-life care to patients with less than 2 weeks to live(Montana State University - Bozeman, College of Nursing, 2016) Stetzner, Katelyn Jo; Chairperson, Graduate Committee: Christina SieloffAlthough nurses, above all other health professionals, are in a prime position to positively impact the quality of end-of-life care (EOLC) individuals receive, numerous studies have identified that they are educationally unprepared to do so (White & Coyne, 2011). The purpose of this study was to determine the effect of an educational intervention on improving acute care nurses' level of knowledge regarding high quality EOLC to adult patients who are preactively and actively dying (i.e., deemed to have less than 2 weeks to live). Because "EOLC in the acute setting frequently takes place over a very short time frame when death is recognizably imminent" (Bloomer et al., 2011, p. 167), the researcher focused on the preactive and active phases of dying and the nursing interventions necessary to provide quality EOLC to patients during their final days and hours of life. The researcher explored the acute care nurses' level of EOLC knowledge, implemented an evidence-based educational intervention using the ELNEC-Core curriculum (COH & AACN, 2000), and determined whether the educational intervention successfully improved the nurses' level of knowledge in providing quality EOLC to adult patients with less than 2 weeks to live. A one-group pretest--posttest research design was implemented to test the hypothesis: Upon completion of the educational intervention the acute care nurse participants will achieve significantly higher scores on the posttest than they do on the pretest. Thirty-one acute care RNs and LPNs voluntarily participated in the study. Data were collected and stored by the software vendor in such a way that data were available only in the aggregate form for each item. Therefore, no direct pretest--posttest comparisons could be made for the individual participants. As a result, descriptive analyses were utilized to examine and report the findings of the participants' aggregate pretest and posttest results. As hypothesized, participants' answered more questions correctly on the posttest than they did on the pretest. Whereas such results could not be directly attributed to the educational intervention, the findings suggest that the participants, as a whole, possessed a higher level of EOL knowledge at the completion of the study.Item The use of a patient classification system in a medical/surgical intensive care unit : a pilot study(Montana State University - Bozeman, College of Nursing, 1988) Warren, Sue AnneItem The lived experience of emotional wellness in acute care registered nurses(Montana State University - Bozeman, College of Nursing, 2013) Clements, Rachel Eron; Chairperson, Graduate Committee: Christina SieloffEmotional wellness is not defined in the nursing literature. Instead, a great deal of effort is placed on defining stress, burnout, and compassion fatigue from a quantitative perspective. This study uses Nola Pender's Health Promotion Model (HPM) as a guide for defining emotional wellness, and applies Streubert-Speziale's ten-step method of analysis of qualitative data to define emotional wellness from the interviews of five acute care registered nurses (RN). Results indicate that four factors, Boundaries, Balance, Self-Awareness, and Support, define emotional wellness. Future research is suggested to further define emotional wellness, and its principles should be explored further in nursing research, education, and leadership and management to determine its long-term relevance and applicability to the nursing profession. Ultimately, the definition of emotional wellness is intended to benefit all nurses regardless of professional role or setting by reflecting the common emotional needs of all within the profession.Item Collegiality amongst nurses and nurse practitioners in the acute care setting : a nurse's perspective(Montana State University - Bozeman, College of Nursing, 2013) Schroder, Heather Ann; Chairperson, Graduate Committee: Karen ZulkowskiHealthcare is an ever changing entity. With current restructuring and projected physician shortfalls, there is a movement of nurse practitioners into the acute care setting. Little research has been done to examine nurses' perceptions of interactions with nurse practitioners in the acute care setting, and how these perceptions can influence the interpersonal dynamics of the nurse-nurse practitioner relationship. Research has shown that improved collaboration leads to improved collegiality amongst colleagues; which in turn leads to improved patient outcomes. The purpose of this descriptive study was to examine nurses' perceptions of either their observed or actual experiences regarding collaboration, and therefore collegiality, amongst the nurse practitioners they work with in the acute care setting. Additionally, this study investigated whether or not there was a difference in the level of collegiality between a Magnet designated hospital and a non-Magnet designated hospital. The sample was comprised of 222 nursing staff. The Collaboration and Satisfaction about Care Decisions survey was completed by nurses currently employed in two acute care hospitals in a city in the North West. Total collaboration scores were calculated for each participant; scores range from 0 to 56, with 0-18 being non-collaborative, 19-37 being neutral, and 35-56 being collaborative. The mean collaboration score for the sample was 36.91, showing neutral collaboration amongst nurses and nurse practitioners in the acute care setting. The data also showed that there was no difference in collaboration between a Magnet and a non-Magnet designated hospital (0.078 > 0.05). By identifying nursing's perceived level of collaboration, and collegiality with nurse practitioners, institutions would have a platform for which further investigation into and improvement of these relationships can take place. Improvement in the collegiality of nurses and nurse practitioners leads to benefits for both staff and patients. Of significance an unintended result of the study was that 25.3% of nurses were unaware of the difference in practice between nurse practitioners and physician assistants in the acute care setting. This gap in knowledge could have potentially negative future implications for advanced practice nursing.Item The experience of night shift registered nurses in an acute care setting : a phenomenological study(Montana State University - Bozeman, College of Nursing, 2010) Anderson, Valerie Valdez; Chairperson, Graduate Committee: Patricia A. HolkupThe night shift environment in acute care nursing is a unique and poorly understood entity. Retention of experienced nurses on the night shift is vital to the provision of quality care and the nurturing of new nurses. The goal of this phenomenological study was to elicit a description of the lived experience of experienced night shift nurses with the goal of gleaning information that would improve the work environment on the night shift. Five experienced night shift RNs participated in self-directed interviews, responding to the question, "Can you please share your experiences as an RN working the night shift?" The interview data were analyzed using Giorgi's phenomenological method to arrive at a typical and essential structure of the experience. The results revealed negative and positive aspects of working a night shift schedule. Negative aspects of night shift nursing included a feeling of being misunderstood and undervalued professionally and personally. Inadequate resources, on the night shift, was also identified as a barrier to nurse satisfaction, and negatively influencing the provision of quality nursing care and quality orientation of new nurses. Negative physiologic influences of night shift centered around poor quality and quantity of sleep. While these negative influences were consistently presented by all participants, so were the positive aspects of night shift nursing. The participants of this study were strongly invested in the teamwork they experienced within their night shift work environment. Interdependent team spirit was found to have arisen in response to the lack of resources experienced by these nurses. This teamwork, along with the other positive aspects, such as autonomous practice and positive effects on personal time, were seen as incentives for these experienced nurses to continue nursing on the night shift. Nursing administration may be able to utilize the information gleaned from this study to optimize the night shift work environment, and subsequently, increase retention of the experienced nurse. Further research is needed to clarify: the needs of experienced nurses in varying clinical settings, the needs of inexperienced night shift nurses, and the representativeness of the data found in this study to larger numbers of nurses.