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Title: CONSIDERING STRESS IN A NURSING STUDENT CONTEXT: PRE-ADMISSION TO PRE-GRADUATION.
Creator: Regner, Daniel M, Andrews, Diane, University of Central Florida
Abstract / Description: In moderation, stress is a normal response to a perceived challenge which can motivate an individual to perform at their best. Nursing students consistently report a significant amount of stress which has been found to be greater than their non-nursing peers. The purpose of this study is to assess the level of stress reported by second-semester freshman and sophomore students who have declared nursing as a major, compared with the level of stress experienced by junior and senior students who...
Show moreIn moderation, stress is a normal response to a perceived challenge which can motivate an individual to perform at their best. Nursing students consistently report a significant amount of stress which has been found to be greater than their non-nursing peers. The purpose of this study is to assess the level of stress reported by second-semester freshman and sophomore students who have declared nursing as a major, compared with the level of stress experienced by junior and senior students who are enrolled in the university's nursing program. Through this comparison, a conclusion can be drawn as to the level of stress experienced while enrolled in a nursing program, with the level of stress prior to being exposed to the challenges presented by the program. It is intended that the outcomes from this study can be utilized to address stress as it relates to a nursing student from pre-admission through graduation.
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Date Issued: 2018
Identifier: CFH2000300, ucf:45876
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH2000300

Title: EVALUATING INTERVENTIONS TO MITIGATE COMPASSION FATIGUE AMONG AT-RISK NURSING POPULATIONS.
Creator: Derayunan, Emily R, Andrews, Diane, University of Central Florida
Abstract / Description: This thesis examined the experience of compassion fatigue in nurses through analysis of research studies conducted within the past ten years. A literature review was completed using CINAHL Plus with Full Text, MEDLINE, and PsycINFO databases. Efficacy of current management strategies and interventions was evaluated. Findings indicate that educating nurses working in high-risk units improves self-recognition and lowers compassion fatigue levels. Institutional factors such as a lack of...
Show moreThis thesis examined the experience of compassion fatigue in nurses through analysis of research studies conducted within the past ten years. A literature review was completed using CINAHL Plus with Full Text, MEDLINE, and PsycINFO databases. Efficacy of current management strategies and interventions was evaluated. Findings indicate that educating nurses working in high-risk units improves self-recognition and lowers compassion fatigue levels. Institutional factors such as a lack of managerial support and organizational commitment contribute to the experience of compassion fatigue. An organization's involvement in maximizing compassion satisfaction through meaningful recognition of nurses' contributions to care and implementation of organizational prevention programs minimizes the risk of developing compassion fatigue. Once self-recognition by nurses and organizations participation level in mitigating compassion fatigue is addressed, interventions can be implemented to attenuate the experience of compassion fatigue. Resiliency programs and mindfulness-based interventions were efficacious in mitigating compassion fatigue.
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Date Issued: 2019
Identifier: CFH2000469, ucf:45723
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH2000469

Title: EXPLORING THE ART OF NURSING AND ITS INFLUENCE ON PATIENT SATISFACTION IN ACUTE CARE SETTINGS.
Creator: Tirado, Enid, Andrews, Diane, University of Central Florida
Abstract / Description: ?Nursing is a trusted profession aimed at delivering quality, patient-centered care perceived by patients as caring and satisfactory. While empiric care components are measurable as associated with clinical outcomes, patients' perceptions of care are increasingly important in determining satisfaction with the patient care experience. Not clearly defined, nor empirically measurable, the "art" of nursing is taking on increasing importance as a component of satisfaction with the patient...
Show more?Nursing is a trusted profession aimed at delivering quality, patient-centered care perceived by patients as caring and satisfactory. While empiric care components are measurable as associated with clinical outcomes, patients' perceptions of care are increasingly important in determining satisfaction with the patient care experience. Not clearly defined, nor empirically measurable, the "art" of nursing is taking on increasing importance as a component of satisfaction with the patient experience. The purpose of this integrative literature review was to review the literature in order to find common themes influencing determination of the art of nursing on patient satisfaction in acute care settings. Fourteen studies were selected and reviewed after a search of CINAHL Plus with Full Text, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ERIC, MEDLINE, PsycARTICLES, and PsycINFOCINAHL databases. Four themes that emerged: building a relationship with the patient; conducting a thorough assessment of the patient; meaningful communication with the patient, and availability of nurses for their patients. The findings suggest that the art of nursing, as grounded in the demonstration of nursing care behaviors, is a component of patients' satisfaction with the provision of care. This evidence-based knowledge is transferable to efforts in modifying nursing practices that exemplify patient-centered care.
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Date Issued: 2016
Identifier: CFH2000092, ucf:45539
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH2000092

Title: DEFINING A PERSON: THE NURSE AT RISK FOR COMPASSION FATIGUE.
Creator: Johnston, Ellen, Andrews, Diane, University of Central Florida
Abstract / Description: The intent of this thesis was to examine compassion fatigue in nurses through analysis of research studies conducted within the past five years in an effort to identify predisposing factors to the experience of compassion fatigue. Individual and institutional factors were identified as well as current strategies to assist with management of compassion fatigue. Findings indicated that being new to practice, having a trait negative affect, being younger in age, having a history of exposure to...
Show moreThe intent of this thesis was to examine compassion fatigue in nurses through analysis of research studies conducted within the past five years in an effort to identify predisposing factors to the experience of compassion fatigue. Individual and institutional factors were identified as well as current strategies to assist with management of compassion fatigue. Findings indicated that being new to practice, having a trait negative affect, being younger in age, having a history of exposure to trauma and working in high emotionally stressful units predisposed individuals to the experience of compassion fatigue. Institutional factors included a lack of managerial support, organizational commitment, group cohesion, work engagement and conflicting expectations of the nurse. Institutional interventions to assist in mitigating compassion fatigue include improving managerial support, developing group cohesion and communication and providing continuing education opportunities. Institutions can also assist by offering training in resiliency techniques such as negative thought pattern identification, meditation, peer-to-peer discussions, journaling about traumatic experiences, identification and maintenance of personal/professional boundaries and physical wellness through exercise and yoga. These proposed interventions address institutional accountability in health care worker wellness as defined by the quadruple aim. Such interventions also address use of Watson's Caring Theory to emphasize the importance of nurse wellness as essential to creating caring nurse-patient relationships.
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Date Issued: 2017
Identifier: CFH0000222, ucf:44675
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0000222

Title: MINIMIZING INCIVILITY IN THE WORKPLACE TO INCREASE RETENTION OF NEW GRADUATE NURSES.
Creator: D'Ambra, Amanda, Andrews, Diane, University of Central Florida
Abstract / Description: Efforts to maintain a sufficient nurse workforce are hampered by dissatisfaction with the work environment. Incivility in the work environment is a major source of dissatisfaction. A healthy work environment is associated with higher levels of job satisfaction and improved retention. New graduate transition programs have been recommended as a deterrent to high levels of turnover associated within the first two years of employment, some of which is related to incivility. The purpose of this...
Show moreEfforts to maintain a sufficient nurse workforce are hampered by dissatisfaction with the work environment. Incivility in the work environment is a major source of dissatisfaction. A healthy work environment is associated with higher levels of job satisfaction and improved retention. New graduate transition programs have been recommended as a deterrent to high levels of turnover associated within the first two years of employment, some of which is related to incivility. The purpose of this thesis was to examine the influence of incivility in the nursing workplace on new graduate job satisfaction and determine if there is an association between participation in new graduate nurse transition programs and satisfaction with the work environment. A systematic review of the literature was performed using MEDLINE- EBSCOhost, PsycInfo, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Sixteen studies, which met search criteria, were reviewed. Themes that emerged included workplace incivility, nurse residency programs, mentoring through preceptors, and empowerment. Findings indicated that incivility in the workplace was a significant predictor of low job satisfaction in new graduate nurses. While graduate nurse transition programs are associated with improved satisfaction and retention rates for these nurses, nothing in the literature indicated that graduate nurse transition programs had a direct impact on empowerment and job satisfaction related to the incivility these nurses experience.
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Date Issued: 2012
Identifier: CFH0004244, ucf:44945
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0004244

Title: Stressors Experienced by Emergency Department Registered Nurses at the Bedside: A Phenomenological Study.
Creator: Heglund, Stephen, Wink, Diane, Andrews, Diane, Leuner, Jean, Malvey, Donna, Chase, Susan, University of Central Florida
Abstract / Description: The Emergency Department (ED) as a workplace for the Registered Nurse (RN) is a stressful environment. Reasons are thought to include interactions with other members of the interdisciplinary team as well as the situations associated with the environment of the ED such as trauma, death, sadness, joy and the general unpredictability of each moment. Studies have documented general health care workplace stress and its influence on staff, but a very limited number of studies have concentrated on...
Show moreThe Emergency Department (ED) as a workplace for the Registered Nurse (RN) is a stressful environment. Reasons are thought to include interactions with other members of the interdisciplinary team as well as the situations associated with the environment of the ED such as trauma, death, sadness, joy and the general unpredictability of each moment. Studies have documented general health care workplace stress and its influence on staff, but a very limited number of studies have concentrated on the ED. No widely published studies have identified stressors from the perspective of the ED RN.This dissertation is an interpretive phenomenological study that seeks to understand the experience of being an ED RN through the exploration of the perceptions of stress as lived by individuals who practice their art and science in this unique setting. Materials for evaluation and thematic identification were obtained through personal interviews of practicing nurses. The stories told by the participants communicated what each individual found to be negatively stressful as well as what each found to be positively stressful.Conclusions based on the findings of this work suggest a need for the ED RN to be able to depend on the presence of several factors in order to be able to function with as little distress as possible. The optimal ED environment for the RN is posited to be supportive of the individual goals of the RN, provide adequate resources and foster a communicative interdisciplinary environment. Recommendations are made to improve resource management and interdisciplinary relations.
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Date Issued: 2012
Identifier: CFE0004384, ucf:49408
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0004384

Title: THE EFFECT OF JOB STRAIN IN THE HOSPITAL ENVIRONMENT: APPLYING OREM'S THEORY OF SELF CARE.
Creator: Andrews, Diane, Wan, Thomas, University of Central Florida
Abstract / Description: The purpose of this research was to evaluate the causal relationships between job strain, the practice environment and the use of coping skills in order to assist in the prediction of nurses who are at risk for voluntary turnover. It was conducted at the level of the individual nurse employee in order to better understand the health consequences associated with job strain, the factors in the professional practice environment which may contribute to the propensity to leave and the influence of...
Show moreThe purpose of this research was to evaluate the causal relationships between job strain, the practice environment and the use of coping skills in order to assist in the prediction of nurses who are at risk for voluntary turnover. It was conducted at the level of the individual nurse employee in order to better understand the health consequences associated with job strain, the factors in the professional practice environment which may contribute to the propensity to leave and the influence of coping behaviors in response to workplace stressors. It was undertaken with the intention of identifying intervention strategies which will promote a healthy workforce and the retention of nurses in the workplace. An exploratory cross-sectional survey of 1235 staff nurses employed on the intensive, progressive and general medical-surgical nursing units of seven hospitals associated with a major Central Florida healthcare network tested a client-centered model in an effort to identify nurses vulnerable to the health consequences of job strain using structural equation modeling. Human subject protection was assured. An 82 item questionnaire was used to collect demographic data and measure responses to items associated with the constructs of health status, autonomy, collaboration, decentralization, coping, satisfaction, absenteeism and intent to leave. A variety instruments that were previously demonstrated as valid and reliable were used in the construction of the instrument. Subjects were also given the option of including additional written comments. A total of 325 surveys were returned, of which 308 met inclusion criteria, for a response rate of 25%. Data analysis determined that the measurement of job strain as a function of self-assessed generic health status was predictive of propensity to leave (ã = -.21). The experience of job strain shared a strong association with indicators of mental health status. Job strain was significantly influenced by coping behavior (ã = .56) which targeted activities associated with sustaining and balancing. Anecdotal remarks suggested that the need for balance influenced perceptions regarding stressors in the workplace. The professional practice environment was associated negatively with the propensity to leave (ã = -.58). Those staff nurses who experienced higher levels of autonomy expressed a greater degree of satisfaction and lower intent to leave. The variables of collaboration and decentralization contributed minimally to the construct of professional practice. Anecdotal remarks suggested that the low contribution of collaboration and decentralization contributed to a sense of powerlessness and frustration with work related circumstances. The influence of job strain, coping and the professional practice environment upon staff nurses suggests that health promotion strategies, efforts to enhance coping behavior and promotion of a professional practice environment will increase employee satisfaction and reduce intent to leave. Adoption of policies and procedures which support the health and well-being of individual staff members will benefit employees, strengthen the organizations in which they practice and promote the overall retention of nurses in the face of looming nurse shortages.
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Date Issued: 2006
Identifier: CFE0000935, ucf:46742
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0000935

Title: PEDIATRIC MISSCARE SURVEY TO FILL IN THE GAPS.
Creator: Baker, Molly S, Diaz, Desiree, Andrews, Diane, University of Central Florida
Abstract / Description: Missed nursing care, according to Kalisch and Williams, is nursing care that is not completed to the highest quality of care, leading to an increase in hospital costs and poor patient outcomes. Missed nursing care can occur with any patient population; however, a survey by Kasich called the MISSCARE Survey has only been used in the adult and neonatal populations. Pediatric patients are a diverse and complex subset of the population, differing greatly from the adult and neonatal populations,...
Show moreMissed nursing care, according to Kalisch and Williams, is nursing care that is not completed to the highest quality of care, leading to an increase in hospital costs and poor patient outcomes. Missed nursing care can occur with any patient population; however, a survey by Kasich called the MISSCARE Survey has only been used in the adult and neonatal populations. Pediatric patients are a diverse and complex subset of the population, differing greatly from the adult and neonatal populations, thus identifying a need for a focused pediatric survey to effectively study missed nursing care in the pediatric setting. The purpose of this research, therefore, was to create and validate a pediatric nursing care survey. A convenience sample of 10 pediatric experts completed the Expert Panel Survey to determine a content validity ratio (CVR) and content validity index (CVI) of a modified, MISSCARE Survey (Kalisch and Williams, 2009). Items determined to be essential by ninety percent or more of the participants (CVR > 0.78), were included in the MISSCARE-Pediatric Survey. Results showed that the CVI of the MISSCARE-Pediatric Survey determined by the Expert Panel was 0.9, meaning the items are essential to the pediatric population (Gilbert and Prion, 2016a). The created MISSCARE-Pediatric Survey includes 18 questions in section A (Types of Missed Nursing Care), 28 questions in section B (Reasons for Missed Nursing Care), and 9 questions in Demographics. Future research will determine content reliability of the MISSCARE-Pediatric Survey.
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Date Issued: 2018
Identifier: CFH2000401, ucf:45752
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH2000401

Title: Front-Line Registered Nurse Job Satisfaction and Predictors: A Meta-Analysis from 1980 - 2009.
Creator: Saber, Deborah Anne, Norris, Anne, Andrews, Diane, Byers, Jacqueline, Bowers, Clint, University of Central Florida
Abstract / Description: Front-line registered nurses (RNs) make up the workforce that directly affect the care of patients in a variety of different healthcare settings. RN job satisfaction is important because it is tied to retention, organizational commitment, workforce safety, patient safety, and cost savings. The strongest predictors have been difficult to determine because workplaces differ, numerous tools to measure satisfaction exist, the workforce is diversified by generations and work positions, and ongoing...
Show moreFront-line registered nurses (RNs) make up the workforce that directly affect the care of patients in a variety of different healthcare settings. RN job satisfaction is important because it is tied to retention, organizational commitment, workforce safety, patient safety, and cost savings. The strongest predictors have been difficult to determine because workplaces differ, numerous tools to measure satisfaction exist, the workforce is diversified by generations and work positions, and ongoing policy changes directly impact the work of the front-line RN. The strength and stability of the workforce depends on an accurate understanding of the predictors of job satisfaction for the front-line RN. The purpose of this study was to comprehensively, quantitatively examine predictors of front-line RN job satisfaction from 1980-2009 to provide overarching conclusions based on empirical evidence. Of interest was: the (1) estimation of large, moderate, and small predictor summary effect sizes; (2) assessment of predictor differences among decades (i.e., 1980s, 1990s, and 2000s); (3) identification of causes for predictor differences among studies (i.e., moderators); and (4) investigation of predictor differences between generations (i.e., Baby Boomers, Generation X, and Millennials).A non-a priori meta-analysis approach was guided by inclusion and exclusion criteria to review published and unpublished studies from 1980(-)2009. The search process identified 48 published and 14 unpublished studies used for analysis. Within the studies that met inclusion criteria, 27 job satisfaction predictors met inclusion for analysis. Studies were coded for Study Characteristics (e.g., Year of Publication, Country of Study) that were needed for moderator analysis. Predictors were coded for data that were necessary to calculate predictor summary effect sizes (i.e., r, n). Coding quality was maximized with a coding reliability scheme that included the primary investigator (PI) and secondary coder. A random-effects model was used to guide the calculation of summary effect sizes for each job satisfaction predictor. Publication bias was examined using funnel plots and Rosenthal's Fail-safe N. An analysis of variance (ANOVA) was used to evaluate predictor differences among decades (i.e., 1980s, 1990s, and 2000s). Heterogeneity among studies was calculated (i.e., Q-statistic, I-squared, and Tau-squared) to guide the need for moderator analysis. Moderator analyses were conducted to evaluate Study Characteristics as sources of predictor differences among studies, and to investigate the influence of Age (i.e., generation) on predictor effect sizes.The largest effect sizes were found for three predictors: Task Significance (r=.61), Empowerment (r=.55), and Control (r=.52). Moderate effect sizes were found for 10 predictors (e.g., Autonomy: r=.44; Stress: r=-.43), and small effect sizes were found for nine predictors (e.g., Wages: r=.23; Staffing Adequacy: r=.19). Significant heterogeneity between studies was present in all of the 27 predictor analyses. Effect size differences were not found between decades or generations. Moderator analysis found that the sources of the difference between studies remain unexplained indicating that unknown moderators are present.Findings from this study indicate that the largest predictors of job satisfaction for the front-line RN may be different than previously thought. Heterogeneity between studies and unidentified moderators indicate that there are significant differences among studies and more research is needed to identify the source(s) of these differences. The findings from this study can be used at the organizational, state, and national level to guide leaders to focus efforts of workplace improvements that are based on predictors that are most meaningful to front-line RNs (i.e., Task Requirements, Empowerment, and Control). Future research is needed to determine contemporary predictors of job satisfaction for the front-line RN, and the causes of heterogeneity between studies. The findings from the current study provide the critical synthesis needed to guide educational and practice recommendations aimed at supporting job satisfaction of front-line RNs, thereby, maintaining this integral component of the healthcare workforce.
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Date Issued: 2012
Identifier: CFE0004592, ucf:49220
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0004592

Title: The Self-described Experience of Coping and Adaptation Associated with Workplace Stress of Registered Nurses in the Acute Care Setting in Florida: An Ethnographic Study.
Creator: Burr, Joyce, Bushy, Angeline, Sole, Mary, Andrews, Diane, Malvey, Donna, University of Central Florida
Abstract / Description: ABSTRACTLittle is known about how nurses learn and use coping and adaptation skills in the workplace. Quantitative studies have identified the factors, nature, and outcomes of nursing stress. However, qualitative studies describing the human experience associated with workplace stress are lacking. The phenomenon of interest for this study using focused ethnographic method is the self-described experience of coping and adaptation associated with workplace stress of registered nurses working 12...
Show moreABSTRACTLittle is known about how nurses learn and use coping and adaptation skills in the workplace. Quantitative studies have identified the factors, nature, and outcomes of nursing stress. However, qualitative studies describing the human experience associated with workplace stress are lacking. The phenomenon of interest for this study using focused ethnographic method is the self-described experience of coping and adaptation associated with workplace stress of registered nurses working 12-hour shifts employed in acute care hospital facilities in east central and central Florida. Three aspects of the phenomena were examined: the self-described experiences of stress, the manner in which coping skills are acquired, and the manner in which adaptation strategies are developed by experienced bedside nursing working 12-hour shifts in acute care hospital facilities. The purposive sample included nine female bedside nurses with five or more years' experience, working 12 hour shifts in acute care hospital facilities on bedside units, with patient ratios of 4:1 or greater. Data were collected using semi-structured, digitally recorded interviews at mutually convenient locations. The qualitative data were analyzed using inductive, constant, comparative process of coding, sorting, generalizing, and memoing to guide exploration and identify emergent themes and patterns. The predominant theme of stress emerged as the overwhelming sense of duty to the patient. Additional themes of coping and adaptation were noted. Recommendations for research, education, practice and policy are offered to support a healthy and sustainable nursing workforce.
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Date Issued: 2012
Identifier: CFE0004525, ucf:49280
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0004525

Title: Rapid Response Teams versus Critical Care Outreach Teams: Unplanned Escalations in Care and Associated Outcomes.
Creator: Danesh, Valerie, Neff, Donna, Aroian, Karen, Andrews, Diane, Unruh, Lynn, University of Central Florida
Abstract / Description: The incidence of unplanned escalations during hospitalization is undocumented, but estimates may be as high as 1.2 million occurrences per year in the United States. Rapid Response Teams (RRT) were developed for the early recognition and treatment of deteriorating patients to deliver time-sensitive interventions, but evidence related to optimal activation criteria and structure is limited. The purpose of this study is to determine if an Early Warning Score-based Critical Care Outreach (CCO)...
Show moreThe incidence of unplanned escalations during hospitalization is undocumented, but estimates may be as high as 1.2 million occurrences per year in the United States. Rapid Response Teams (RRT) were developed for the early recognition and treatment of deteriorating patients to deliver time-sensitive interventions, but evidence related to optimal activation criteria and structure is limited. The purpose of this study is to determine if an Early Warning Score-based Critical Care Outreach (CCO) model is related to the frequency of unplanned intra-hospital escalations in care compared to a RRT system based on staff nurse identification of vital sign derangements and physical assessments. The RRT model, in which staff nurses identified vital sign derangements to active the system, was compared with the addition of a CCO model, in which rapid response nurses activated the system based on Early Warning Score line graphs of patient condition over time. Logistic regressions were used to examine retrospective data from administrative datasets at a 237-bed community non-teaching hospital during two periods: 1) baseline period, RRT model (n=5,875) (Phase 1: October 1, 2010 (-) March 31, 2011), and; 2) intervention period, RRT/CCO model (n=6,273). (Phase 2: October 1, 2011 (-) March 31, 2012). The strongest predictor of unplanned escalations to the Intensive Care Unit was the type of rapid response system model. Unplanned ICU transfers were 1.4 times more likely to occur during the Phase 1 RRT period. In contrast, the type of rapid response model was not a significant predictor when all unplanned escalations (any type) were grouped together (medical-surgical-to-intermediate, medical-surgical-to-ICU and intermediate-to-ICU). This is the first study to report a relationship between unplanned escalations and different rapid response models. Based on the findings of fewer unplanned ICU transfers in the setting of a CCO model, health services researchers and clinicians should consider using automated Early Warning score graphs for hospital-wide surveillance of patient condition as a safety strategy.
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Date Issued: 2015
Identifier: CFE0006212, ucf:51093
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0006212

Title: Pre and Post Implementation Evaluation of an Emergency Department Severe Sepsis Alert and Practice Protocol.
Creator: Williams, Darleen, Andrews, Diane, Sole, Mary Lou, Parrish, Gary, University of Central Florida
Abstract / Description: ABSTRACTSevere sepsis kills an estimated 1,400 people worldwide every day. This often fatal infectious process accounts for an estimated 215,000 deaths in the United States (US) annually. The main goal of this project was to evaluate the impact of the Emergency Department Severe Sepsis Alert and Practice Protocol (EDSSAPP) post implementation, on time to first antibiotic administration, length of stay, and mortality in patients admitted via the ORMC ED with severe sepsis.This study evaluated...
Show moreABSTRACTSevere sepsis kills an estimated 1,400 people worldwide every day. This often fatal infectious process accounts for an estimated 215,000 deaths in the United States (US) annually. The main goal of this project was to evaluate the impact of the Emergency Department Severe Sepsis Alert and Practice Protocol (EDSSAPP) post implementation, on time to first antibiotic administration, length of stay, and mortality in patients admitted via the ORMC ED with severe sepsis.This study evaluated the time to first antibiotic administration, total ED and hospital length of stay (LOS) and mortality of severe sepsis patients either with a severe sepsis alert (SSA) activated or no alert activated that were admitted to the hospital through the ED. A retrospective review of the electronic medical record (EMR) was conducted to gather the required data across three time cohorts: base line/time zero (T0), six months prior to the implementation of EDSSAPP; Time one (T1) the first six months following initial EDSSAPP implementation; and Time two (T2), six months following reinstatement of the corporate sepsis committee. The most significant finding of this study was the increased number of Severe Sepsis Alerts activated in time cohort T2 (n=113) compared to T1 (n=19). Another important finding was the decreased mortality in T2 (16.4%) compared to T0 (22.7%) and T1 (33%). Overall, the number of ED patients with severe sepsis who received antibiotics within the EDSSAPP required 60 minutes did not consistently improve across the three time cohorts, T0 (81.8%), T1 (71.7%) and T2 (80.6%).The hospital LOS of stay was increased by almost 1.5 days between those patients with a severe sepsis alert activated in T1 (9.00 days) compared to time T2 (10.48 days). There was no significant decrease in the ED LOS across time cohorts and between groups of patients who had a SSA activated versus no alert activated. However, there was a 1 hour and 28 minute decrease in ED LOS in patients who had a severe sepsis alert activated in T1 compared to T0. In addition, there was a 1 hour and 52 minutes decrease in ED LOS between patients who had a SSA activated compared to those who had no alert activated in T2.While EDSSAPP data does not demonstrate the statistically significant results that was expected, the challenges related to adherence by providers to EDSSAPP is as it is seen in the literature. Increased awareness via consistent communication of on-going audit results to ED personnel will heighten their awareness for severe sepsis and EDSSAPP. Improved collaborative efforts with the interdisciplinary team are needed to refocus everyone's efforts to increase early recognition that is followed by appropriate treatment interventions and documentation is essential. Lastly, the development of a formal process to follow up with individual providers as close to real time as possible following a SSA that includes accountability for care provided and related documentation would also contribute to both awareness and adherence.
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Date Issued: 2015
Identifier: CFE0005739, ucf:50075
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0005739

Title: Maya Use and Prevalence of the Atlatl: Projectile Point Classification Function Analysis from Chich(&)#233;n Itz(&)#225;, Tikal, and Caracol.
Creator: Ciofalo, Andrew, Chase, Arlen, Chase, Diane, Barber, Sarah, University of Central Florida
Abstract / Description: Multiple scholars have briefly discussed the Maya use of the atlatl. Yet, there has never been a decisive encompassing discussion of prevalence and use of the atlatl in the Maya region with multiple lines of support from iconographic and artifactual analyses. This thesis explores the atlatl at Chich(&)#233;n Itz(&)#225;, Tikal, and Caracol Maya sites to prove that atlatl prevalence can be interpreted primarily based on projectile point (")classification function(") analysis with support from...
Show moreMultiple scholars have briefly discussed the Maya use of the atlatl. Yet, there has never been a decisive encompassing discussion of prevalence and use of the atlatl in the Maya region with multiple lines of support from iconographic and artifactual analyses. This thesis explores the atlatl at Chich(&)#233;n Itz(&)#225;, Tikal, and Caracol Maya sites to prove that atlatl prevalence can be interpreted primarily based on projectile point (")classification function(") analysis with support from iconographic and artifactual remains. The classification functions are derived from creating mutually exclusive groups of dart points and arrow points by using discrete functional analysis. Discerning between dart and arrow points can be completed with a high degree of accuracy based on maximum shoulder width of lithic points in an assemblage. Because the atlatl and bow complexes have been primarily constructed of perishable materials, the best method to determine the prevalence of atlatl use is by identifying the launcher based on projectile point identification. Using a cross-site comparison of projectile point size, the Maya use and prevalence of the atlatl will be elucidated.
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Date Issued: 2012
Identifier: CFE0004193, ucf:49034
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0004193

Title: Work and Family Conflict: A Comparative Analysis Among Staff Nurses, Nurse Managers, and Nurse Executives.
Creator: Raffenaud, Amanda, Unruh, Lynn, Liu, Albert Xinliang, Fottler, Myron, Andrews, Diane, University of Central Florida
Abstract / Description: The nursing workforce increasingly faces issues that affect clinical and managerial practice. One such issue is work-family conflict (WFC) and family-work conflict (FWC). Nurses face role strain as they confront the pressures from often competing work-and-family roles. This study assessed WFC/FWC among varying nurse roles: staff nurses, managerial nurses, and nurse executives. A random sample of 5,000 nurses, generated from registered nurses practicing in the state of Florida, was surveyed...
Show moreThe nursing workforce increasingly faces issues that affect clinical and managerial practice. One such issue is work-family conflict (WFC) and family-work conflict (FWC). Nurses face role strain as they confront the pressures from often competing work-and-family roles. This study assessed WFC/FWC among varying nurse roles: staff nurses, managerial nurses, and nurse executives. A random sample of 5,000 nurses, generated from registered nurses practicing in the state of Florida, was surveyed for this research study. Nurses were surveyed on demographics, perceptions regarding the work environment, and perceptions of WFC/FWC. Descriptively, nurses experienced more work-family conflict than family-work conflict. Regression analyses and ANOVAs indicated that staff nurses experienced less work-family conflict than nursing managers (second most) and nursing executives (highest). None of the nurse roles experienced significant levels of FWC. White nurses, compared to non-white nurses, experienced less WFC and FWC. WFC increased with shift length but FWC was not significantly affected by it. Paid leave for childbirth was associated with lower FWC. This study holds significant implication for the nursing workforce. Nurse managers and executives showed significantly higher WFC than staff nurses. This may discourage a nurse from taking on leadership roles or lead to leaving them. In an era where nurse managers and leaders are needed, efforts must be taken to decrease WFC/FWC factors. Nonwhite nurses reported higher levels of both WFC and FWC. This may contribute to tension at the workplace and a difficult family life. Leaders must continue to create platforms for nurses of all races and ethnicities to voice their work and family needs, and to be supported when doing so. Nurses working shifts over 8 hours had higher WFC levels. Although 12-hour shifts have been popular among staff and management, their use should be reevaluated. Finally, paid leave for childbirth is a program worth supporting, as it was a factor in lower FWC.
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Date Issued: 2018
Identifier: CFE0007081, ucf:51997
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0007081

Title: Nurse Managers, Work Environment Factors and Workplace Bullying.
Creator: Parchment, Joy, Andrews, Diane, Neff, Donna, Conner, Norma, Yan, Xin, Saunders, Carol, University of Central Florida
Abstract / Description: The purpose of this dissertation is to explore relationships between authentic leadership style, global social power, job demand, job control, and workplace bullying of nurse managers in acute care settings across the United States.Over 30 years of workplace bullying research exists. Consequences are linked to intent to leave, turnover, and harmful emotional and physical effects. Published studies identifying nurse managers as targets of workplace bullying and work environment factors that...
Show moreThe purpose of this dissertation is to explore relationships between authentic leadership style, global social power, job demand, job control, and workplace bullying of nurse managers in acute care settings across the United States.Over 30 years of workplace bullying research exists. Consequences are linked to intent to leave, turnover, and harmful emotional and physical effects. Published studies identifying nurse managers as targets of workplace bullying and work environment factors that contribute to nurse managers being recipients of workplace bullying either, downward from their leaders, horizontally from their nurse manager peers, and upwards from their clinical nurses were not identified.A descriptive, cross-sectional design using an online survey was utilized. Descriptive, inferential, and multivariate analyses were used to identify relationships and the likelihood of workplace bullying occurring. Thirty-five percent (n = 80) of nurse managers reported being a target of workplace bullying. Managers sustained occasional (56%, n = 45) and severe (44%, n = 35) levels of workplace bullying, 65% (n = 43) identified their executive nurse leader as the predominate perpetrator. Authentic leadership, job demand, job control correlated significantly (p = (<).01) with workplace bullying and job demand demonstrated the strongest likelihood (OR = 3.9) for predicting workplace bullying. Nurse Managers are four times more likely to be a recipient of workplace bullying when their job responsibilities are classified as demanding. This study expanded the science and demonstrated that nurse managers, the backbone of organizations, are recipients of workplace bullying emanating predominately from executive nurse leaders, but also from clinical nurses and their nurse manager peers. Given the harmful consequences of workplace bullying, as 'guardians' of and 'advocates' for their teams, executive nursing leaders, have an ethical and operational responsibility to ensure nurse managers are able to practice in a safe environment.
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Date Issued: 2015
Identifier: CFE0005986, ucf:50771
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0005986

Title: The Impact of Relational Coordination and the Nurse on Patient Outcomes.
Creator: Dejesus, Fanya, Andrews, Diane, Sole, Mary Lou, Neff, Donna, Yan, Xin, Unruh, Lynn, University of Central Florida
Abstract / Description: Healthcare quality remains a significant issue due to fragmentation of care in our complex U.S. healthcare systems. While coordination of care is foundational to healthcare quality as well as identified as a National Priority, fragmentation and uncoordinated care continues to afflict our systems. The purpose of this study was to explore the relationship between relational coordination and adverse nurse sensitive patient outcomes, namely hospital acquired pressure ulcers, patient falls with...
Show moreHealthcare quality remains a significant issue due to fragmentation of care in our complex U.S. healthcare systems. While coordination of care is foundational to healthcare quality as well as identified as a National Priority, fragmentation and uncoordinated care continues to afflict our systems. The purpose of this study was to explore the relationship between relational coordination and adverse nurse sensitive patient outcomes, namely hospital acquired pressure ulcers, patient falls with injury, catheter- associated urinary tract infection, and central line-associated blood stream infection. A retrospective correlational survey design using cross sectional data was used to conduct this quantitative study. An electronic relational coordination survey was sent to 1124 eligible registered nurses from 43 nursing units within a 5-hospital magnet-designated healthcare system to gather their perception of the strength of relationship and communication ties of their work team. The nurse practice environment as well as nurse education were control variables. With 406 nurses who completed the survey (36% response rate), findings revealed that the stronger relational coordination ties are amongst the healthcare team, the lower the rate of adverse nurse sensitive patient outcomes as indicated by their inverse relationship. (rs=-.31, p=.050). In a Negative Binomial Regression model, relational coordination was a significant predictor (?-1.890, p=.034) of nurse sensitive patient outcomes whereas nurse education level (p=.859) and nurse practice environment (p=.230) were not. Data affirms that relational coordination, a relationship and communication intensive form of coordination does impact patient outcomes. This research provides significant information to health care leaders and institutions with goals of improving patient care outcomes through enhancement of coordination of care and optimization of healthcare teams.
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Date Issued: 2015
Identifier: CFE0005939, ucf:50823
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0005939

Title: Impact of Interruption Frequency on Nurses' Performance, Satisfaction, and Cognition During Patient-Controlled Analgesia Use in the Simulated Setting.
Creator: Campoe, Kristi, Talbert, Steven, Sole, Mary Lou, Andrews, Diane, Jentsch, Florian, University of Central Florida
Abstract / Description: Problem: Interruption during medication administration is a significant patient safety concern within health care, especially during the administration of high risk medications in nursing. Patient-controlled analgesia (PCA) devices are frequently associated with adverse events and have a four-fold increased risk of patient injury compared to non-PCA related adverse events. While the nature and frequency of interruptions have been established for nurses' medication processes, the impact of...
Show moreProblem: Interruption during medication administration is a significant patient safety concern within health care, especially during the administration of high risk medications in nursing. Patient-controlled analgesia (PCA) devices are frequently associated with adverse events and have a four-fold increased risk of patient injury compared to non-PCA related adverse events. While the nature and frequency of interruptions have been established for nurses' medication processes, the impact of interruption frequency on nurses' PCA interaction has not been fully measured or described.Purpose: The purposes of this study were to quantify the impact of interruption frequency on registered nurses' (RN) performance, satisfaction, and cognitive workload during PCA interaction, and to determine nurses' perceptions of the impact of interruption frequency.Methods: This study employed a mixed-method design. First, an experimental repeated measures design was used to quantify the impact of interruption frequency on a purposive sample of nine medical-surgical RNs. The RNs completed PCA programming tasks in a simulated laboratory nursing environment for each of four conditions where interruption frequency was pre-determined. Four established human factors usability measures were completed for each of the four test conditions. The research questions were answered using repeated measures analysis of variance with (RM-ANOVA), McNamar's test, and Friedman's test. After each experiment, semi-structured interviews were used to collect data that were analyzed using inductive qualitative content analysis to determine RNs' perceptions of the impact of interruption frequency. Results: Results of the RM-ANOVA were significant for the main effect of interruption frequency on efficiency F(3,24)=9.592, p = .000. McNemar's test did not show significance for the impact of interruption frequency on effectiveness (accuracy). Friedman test showed participant satisfaction was significantly impacted by interruption frequency (x2=9.47, df=3, p=0.024). Friedman test showed no significance for the main effect of interruption frequency on cognitive workload scores by condition type (x2=1.88, df=3, p=0.599). Results of the qualitative content analysis revealed two main categories to describe nurses' perception of interruption frequency: the nature of interruptions and nurses' reaction to the interrupted work environment.Discussion/Implications: The results suggested that interruption frequency significantly affected task completion time and satisfaction for participants but not participant accuracy or cognitive workload. A high error rate during PCA programming tasks indicated the need to evaluate the conditions in which RNs complete PCA programming as each error presents potential risk of patient harm. RNs' described the impact of interruption frequency as having a negative impact on the work environment and subsequently implement compensating strategies to counterbalance interruptions. RNs' perceived that patient safety was negatively impacted by frequent interruption. RNs experienced negative intrapersonal consequences as a results of frequent interruption. Additional study is needed to better understand the impact of interruption frequency on RNs' performance accuracy and cognitive workload.
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Date Issued: 2015
Identifier: CFE0005770, ucf:50099
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0005770

Nurse (3)	+ -
Emergency Department (2)	+ -
Stress (2)	+ -
Coping (1)	+ -
Critical Care Nurisng (1)	+ -

Distress (1)	+ -
ED (1)	+ -
Early Warning Score (1)	+ -
Emergency Nursing (1)	+ -
Eustress (1)	+ -
Health Status (1)	+ -
Intent to Leave (1)	+ -
Job Strain (1)	+ -
Medical-surgical nursing (1)	+ -
Mindfulness (1)	+ -
New graduate nurse (1)	+ -
Nurse managers (1)	+ -
Nursing (1)	+ -
Nursing workforce (1)	+ -
Oncology Nursing (1)	+ -
Patient-centered care (1)	+ -
Pre-Licensure (1)	+ -
Professional Practice (1)	+ -
RN (1)	+ -
Rapid Response Team (1)	+ -
Resiliency (1)	+ -
Satisfaction (1)	+ -
Self-Care (1)	+ -
Stressor (1)	+ -
Stressors in Nursing Students (SINS) scale (1)	+ -

ETD Collection (11)	+ -
Honors Collection (6)	+ -

University of Central Florida (17)	+ -
Andrews, Diane (16)	+ -
Neff, Donna (3)	+ -
Sole, Mary Lou (3)	+ -
Unruh, Lynn (3)	+ -

Malvey, Donna (2)	+ -
Yan, Xin (2)	+ -
Aroian, Karen (1)	+ -
Baker, Molly S (1)	+ -
Barber, Sarah (1)	+ -
Bowers, Clint (1)	+ -
Burr, Joyce (1)	+ -
Bushy, Angeline (1)	+ -
Byers, Jacqueline (1)	+ -
Campoe, Kristi (1)	+ -
Chase, Arlen (1)	+ -
Chase, Diane (1)	+ -
Chase, Susan (1)	+ -
Ciofalo, Andrew (1)	+ -
Conner, Norma (1)	+ -
D'Ambra, Amanda (1)	+ -
Danesh, Valerie (1)	+ -
Dejesus, Fanya (1)	+ -
Derayunan, Emily R (1)	+ -
Diaz, Desiree (1)	+ -
Fottler, Myron (1)	+ -
Heglund, Stephen (1)	+ -
Jentsch, Florian (1)	+ -
Johnston, Ellen (1)	+ -
Leuner, Jean (1)	+ -

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