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Nursing Theses and Dissertations

Theses/dissertations from 2023 2023.

Psychological Distress, Resilience, and the Impact on Quality of Life in Breast Cancer Survivors With Taxane-Induced Peripheral Neuropathy , Lauren Schwab

Theses/Dissertations from 2022 2022

Medication-Assisted Treatment Versus 12-Step Group Therapy: A Comparative Analysis of Adherence and Abstinence In Patients With Opioid Use Disorder , Derrick C. Glymph

Theses/Dissertations from 2021 2021

Quality of Life of Older Adults with Complicated Grief Receiving Accelerated Resolution Therapy: A Mixed Methods Study , Tina M. Mason

Theses/Dissertations from 2020 2020

In Post-Extubated Patients What are the Preferred Methods of Communication During Their Experience of Endotracheal Intubation with Mechanical Ventilation , Lanette Dumas

The Effect of Hope on the Relationship between Personal and Disease Characteristics and Anxiety and Depression in Adolescents and Young Adults with Cancer , Sharon B. McNeil

Predictors of Nonadherence to Radiation Therapy Schedules Among Head and Neck Cancer Patients , Jennifer Lynn Miller

Theses/Dissertations from 2019 2019

Perceived Discrimination and Cardiovascular Outcomes in Blacks: A Secondary Data Analysis of the Heart SCORE Study , Marilyn Aluoch

Exploration of Gratitude in Cardiovascular Health: Mediators, Medication Adherence and Psychometrics , Lakeshia A. Cousin

Theses/Dissertations from 2018 2018

Fatigue-related Symptom Clusters and their Relationship with Depression, and Functional Status in Older Adults Hospice Patients with Cancer. , Suzan Fouad Abduljawad

Genetic Moderation of Pain and Fatigue Symptoms Resulting from the Mindfulness-Based Stress Reduction for Breast Cancer Program , Carissa Bea Alinat

The Moderating Effect of Religion on Death Distress and Quality of Life between Christian Cancer patients in the United States with Muslim cancer patients in Saudi Arabia , Doaa Almostadi

Prevention of Post Intensive Care Syndrome-Family with Sensation Awareness Focused Training Intervention: A Randomized Controlled Trial Pilot Study , Paula L. Cairns

Assessing Abstinence in Infants Greater Than 28 Days Old , Genieveve J. Cline

The Relationship Between Sleep Quality and Motor Function in Hospitalized Older Adult Survivors of Critical Illness , Maya N. Elías

The Role of Migration-Related Stress in Depression Among Haitian Immigrants in Florida: A Mixed Method Sequential Explanatory Approach , Dany Amanda C. Fanfan

The Effect of Depression, Inflammation and Sleep Quality on Risk for Cardiovascular Disease , Catherine L. O'Neil

Adapting SafeMedicate (Medication Dosage Calculation Skills software) For Use In Brazil , Samia Valeria Ozorio Dutra

Theses/Dissertations from 2017 2017

The Relationship Between Total Neuropathy Score-reduced, Neuropathy Symptoms and Function. , Ashraf Abulhaija

Validation of the Electronic Kids Dietary Index (E-KINDEX) Screening Tool for Early Identification of Risk for Overweight/Obesity (OW/OB) in a Pediatric Population: Associations with Quality of Life Perceptions , Patricia A. Hall

Theses/Dissertations from 2016 2016

The Effectiveness of an Intervention Designed to Improve Chlorhexidine (CHG) Bathing Technique in Adults Hospitalized in Medical Surgical Units , Janette Echemendia Denny

Levels of Distress Among Women Veterans Attending a Women’s Health Specialty Clinic in the VA Healthcare System , Debbie T. Devine

Examination of the Use of Accelerated Resolution Therapy (ART) in the Treatment of Symptoms of PTSD and Sleep Dysfunction in Veterans and Civilians , Marian Jevone Hardwick

Investigating the Mutual Effects of Depression and Spiritual Well-being on Quality of Life in Hospice Patients with Cancer and Family Caregivers Using the Actor-Partner Interdependence Model , Li-Ting Huang

The Change in Nutritional Status in Traumatic Brain Injury Patients: A Retrospective Descriptive A Retrospective Descriptive Study , Dina A. Masha'al

Exploring the Relationship Between Severity of Illness and Human Milk Volume in Very Low Birth Weight and Extremely Low Birth Weight Infants Over Six Weeks , Shannon Leigh Morse

Cardiovascular Disease Risk Scores and Novel Risk Factors in Relation to Race and Gender , Johanna Wilson

Theses/Dissertations from 2015 2015

A Comparative Evaluation of the Learner Centered Grading Debriefing Method in Nursing Education , Marisa J. Belote

Sleep, Depressive Symptoms and Cognition in Older Adults and Caregivers of Persons with Dementia , Glenna Shemida Brewster

The Relationship between Hearing Status and Cognitive Performance and the Influence of Depressive Symptoms in the Older Adult , Julie A. Daugherty

Basal Salivary Oxytocin and Skin to Skin Contact among Lactating Mothers of Premature Infants , Jessica Marie Gordon

The Relationship Between Nurses' Emotional Intelligence and Patient Outcomes , Mary Kutash

Sexual Functioning and Body Image in Younger Breast Cancer Survivors , Carly Lynn Paterson

Cognitive Load of Registered Nurses During Medication Administration , Sarah Faith Perron

A Comparison of Quality of Life between Intense and Non-Intense Treatment for Patients with Acute Myeloid Leukemia and High-Risk Myelodysplastic Syndrome , Sara Marie Tinsley

Theses/Dissertations from 2014 2014

Acculturation, Self-Efficacy and Breastfeeding Behavior in a Sample of Hispanic Women , Ivonne F. Hernandez

Knowledge and Acceptance of HPV and the HPV Vaccine in Young Men and Their Intention to be Vaccinated , Brenda Renee Jasper

The Relationships Between Sleep Disturbances, Depression, Inflammatory Markers, and Sexual Trauma in Female Veterans , Ellen Marcolongo

Examination of Possible Protective Effect of Rhesus D Positive Blood Factor on Toxoplasma-related Depressive Symptoms in Pregnancy , Lisa Lynn Parnell

Knowledge, Attitudes, and Practice of Primary Care Nurse Practitioners Regarding Skin Cancer Assessmnets: Validity and Reliability of a New Instrument , Debra Michelle Shelby

Theses/Dissertations from 2013 2013

Knowledge and Practice of Reproductive Health among Mothers and their Impact on Fetal Birth Outcomes: A Case of Eritrea , Winta Negusse Araya

Race/Ethnicity, Subjective and Objective Sleep Quality, Physical and Psychological Symptoms in Breast Cancer Survivors , Pinky H. Budhrani

Factors Predicting Pap Smear Adherence in HIV-infected Women: Using the Health Belief Model , Crystal L. Chapman Lambert

The Relationship Between Socioeconomic Status and Body Mass Index on Vitamin D Levels in African American Women with and without Diabetes Living in Areas with Abundant Sunshine , Shani Vann Davis

Predictors of Quality of Life in Patients with Cutaneous T cell Lymphoma , Darcie Marie Deaver

Relationship between dysphoric moods, risk-taking behaviors, and Toxoplasma gondii antibody titers in female veterans , Allyson Radford Duffy

Prenatal Stress, Depression, and Herpes Viral Titers , Pao-Chu Hsu

Factors Associated with Fear of Breast Cancer Recurrence Among Survivors , Jean Marie Lucas

Sickle Cell Disease: The Role of Self-Care Management , Nadine Matthie

Factors Influencing Vaccination Decisions in African American Mothers of Preschool Age Children , Chauntel Mckenzie Mcnair

The Strong Black Woman, Depression, and Emotional Eating , Michelle Renee Offutt

Development of an Investigator-designed Questionnaire Concerning Childbirth Delivery Options based on the Theory of Planned Behavior , Chun-Yi Tai

Theses/Dissertations from 2012 2012

The Mediating Effect of Distress Caused by Constipation on Predictors of Quality of Life of Hospice Patients with Cancer. , Abdel Alkhalouf

Testing a Model of Bacterial Vaginosis among Black Women , Jessica Brumley

The Effect of Tight Glycemic Control on Surgical Site Infection Rates in Patients Undergoing Open Heart Surgery , Sierra Gower

Development of a Tool for Pressure Ulcer Risk Assessment and Preventive Interventions in Ancillary Services Patients , Monica Shutts Messer

Hospice Nurses- Attitudes and Knowledge about Pain Management , Amie Jacqueline Miller

Theses/Dissertations from 2011 2011

Literacy and Hazard Communication Comprehension of Employees Presenting to an Occupational Health Clinic , Christine Bouchard

A Meta-Analysis of Cultural Competence Education in Professional Nurses and Nursing Students , Ruth Wilmer Gallagher

Relationship Between Cancer-Related Fatigue and Depression: A Pilot Study , Gloria Michelle Guess

A Comparison of Oncology and Non-Oncology Nurses in Their Knowledge of Cancer Pain Management , Nicole Houle

Evaluating Knowledge and Attitudes of Graduate Nursing Students Regarding Pain , Eric Bartholomew Jackson

Bone Marrow Transplant Nurses' Attitudes about Caring for Patients Who are Near the End of Life: A Quality Improvement Project , Leslie Lauersdorf

Translation and Adaptation of the Center for Epidemiologic Studies-Depression (CES-D) Scale Into Tigrigna Language for Tigrigna Speaking Eritrean Immigrants in the United States , Mulubrhan Fisseha Mogos

Nurse Manager Emotional Intelligence as a Predictor to Registered Nurse Job Satisfaction and RN Perceptions of the Practice Environment and the Relationship to Patient, Nursing and Hospital Outcomes , Jacqueline Cecilia Munro

The Relationship of Mid-Pregnancy Levels of Cytokines, Stress, and Depression with Gestational Age at Delivery , Melissa Molinari Shelton

Prophylactic, Risk-Reducing Surgery in Unaffected BRCA-Positive Women: Quality Of Life, Sexual Functioning and Psychological Well-Being , Sharon Tollin

Theses/Dissertations from 2010 2010

The Relationship Between FAM5C SNP (rs10920501) Variability, Metabolic Syndrome, and Inflammation, in Women with Coronary Heart Disease , Jennifer L. Cline

Women’s Perceptions of Postpartum Stress: A Narrative Analysis , Nancy Gilbert Crist

Lived Experience: Near-Fatal Adolescent Suicide Attempt , Phyllis Ann Dougherty

Exploring the Relationships among Work-Related Stress, Quality of Life, Job Satisfaction, and Anticipated Turnover on Nursing Units with Clinical Nurse Leaders , Mary Kohler

A Comparative Study of Knowledge of Pain Management in Certified and Non-Certified Oncology Nurses , Sherrie A. LaLande

Evaluating Knowledge and Attitudes of Undergraduate Nursing Students Regarding Pain Management , Jessica Latchman

Evaluation of Oncology Nurses' Knowledge, Practice Behaviors, and Confidence Specific to Chemotherapy Induced Peripheral Neuropathy , Rebecca Denise McAllister

Moderating the Effectiveness of Messages to Promote Physical Activity in Type 2 Diabetes , Rachel E. Myers

Factors Affecting the Process of Clinical Decision-Making in Pediatric Pain Management by Emergency Department Nurses , Teresa A. Russo

The Correlation Between Neuropathy Limitations and Depression in Chemotherapy Patients , Melissa Thebeau

Theses/Dissertations from 2009 2009

Fatigue Symptom Distress and Its Relationship with Quality Of Life in Adult Stem Cell Transplant Survivors , Suzan Fouad Abduljawad R.N., B.S.N.

Nursing Advocacy and the Accuracy of Intravenous to Oral Opioid Conversion at Discharge in the Cancer Patient , Maria L. Gallo R.N., O.C.N.

Transitional Care for Adolescents with HIV: Characteristics and Current Practices of the Adolescent Trials Network Systems of Care , Patricia Gilliam

The Effect of Ethical Ideology and Professional Values on Registered Nurses’ Intentions to Act Accountably , Susan R. Hartranft

Falls in Bone Marrow Transplant Patients: A Retrospective Study , Lura Henderson R.N., B.S.N.

Predictors of cancer caregiver depression symptomatology , Henry R. Rivera

Psychosocial outcomes of weight stigma among college students , Sabrina Joann Robinson

The Experience of Fatigue and Quality of Life in Patients with Advanced Lung Cancer , Andrea Shaffer

The Relationship Between Uncertainty in Illness and Anxiety in Patients With Cancer , Naima Vera

Shifting Paradigms: The Development of Nursing Identity in Foreign-Educated Physicians Retrained as Nurses Practicing in the United States , Liwliwa Reyes Villagomeza

Theses/Dissertations from 2008 2008

Prostate Cancer Screening Intention Among African American Men: An Instrument Development Study , Susan Anita Baker

The Geriatric Cancer Experience in End of Life: Model Adaptation and Testing , Harleah G. Buck

Communication Systems and HIV/AIDS Sexual Decision Making in Older Adolescent and Young Adult Females , Rasheeta D. Chandler MS, ARNP, FNP-BC

Relationship of Anger Trait and Anger Expression to C-Reactive Protein in Post-Menopausal Women , Rosalyn Gross

Identifying Patients with Cancer at Risk of Experiencing a Fall While Hospitalized , Joann M. Heaton

Modulation of Monocyte-Derived Dendritic Cell Maturation and Function by Cigarette Smoke Condensate in a Bronchial Epithelial Cell Co-Culture Model , Alison J. Montpetit

Cancer Patients with Pain: Examination of the Role of the Spouse/Partner Relationship In Mediating Quality of Life Outcomes for the Couple , Mary Ann Morgan

Development of an Ecological Model to Predict Risk for Acquisition of Clostridium difficile -Associated Diarrhea During Acute Care Hospitalization , Susan Elaine Steele

Development and Psychometric Evaluation of the Chemotherapy Induced Peripheral Neuropathy Assessment Tool , Cindy S. Tofthagen

Health Decision Behaviors: Appropriateness of Dietary Choice , Daryle Hermelin Wane

Theses/Dissertations from 2007 2007

The Relationship Between Sleep-Wake Disturbance and Pain in Cancer Patients Admitted to Hospice Home Care , Marjorie Acierno

Wheelchair Positioning and Pulmonary Function in Children with Cerebral Palsy , Lee Barks

Structural Equation Model of Exercise in Women Utilizing the Theory of Unpleasant Symptoms and Social Cognitive Variables , Sarah Elizabeth Cobb

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Home > Nursing > dissertations and theses

College of Nursing Dissertations and Theses

The College of Nursing Dissertations and Theses Series is comprised of dissertations theses authored by Marquette University's College of Nursing doctoral and master's students.

Theses/Dissertations from 2023 2023

Why We Work: Exploring the Relationships Between Work Rewards, Burnout, and Intention to Leave for Professional Nurses , Jacqueline Christianson

Examining Relationships Among Nursing Students' Views of Suffering, Positive Thinking, and Professional Quality of Life , Ruth Anne Engbers

THE IMPACT OF PEDAGOGY AND PROGRAM ON PSYCHIATRIC-MENTAL HEALTH EDUCATION FOR PRE-LICENSURE NURSING STUDENTS , Virginia F. Riggs

APPLICATION OF THE SOCIAL DETERMINANTS OF HEALTH TO GERIATRIC PATIENTS BY NURSE PRACTITIONER STUDENTS , Theresa Marie Gruenke Schnable

Theses/Dissertations from 2022 2022

Mediating Effects of Positive Thinking on Compassion Fatigue, Compassion Satisfaction, and Resilience in Nurse Leaders , Jay Randall Gottschalk

Exploring Relationships Between Depression Self-stigma and Trust in Primary Care Provider on Willingness to Seek Help , Tana Karenke

The Impact of Nutrition Literacy and Neighborhood on Diet Quality in the Mexican Origin Population , Sylvia Pena

Theses/Dissertations from 2021 2021

Experiences of Exclusively Expressing Breast Milk for Term Infants: A Qualitative Analysis , Lisa Anders

Examining the Relationship of Physical Activity, Inflammation & Adiposity on Physical Function with Gender Differences , Jeanne Hlebichuk

Securing Nasogastric Tubes in Children , Julie Ann Lavoie

Exploring Culture of Safety and Failure to Rescue , Holly Lynn Losurdo

Processes Used by Mothers in Opioid Recovery to Manage the Needs of the Maternal-Infant Dyad: A Grounded Theory Study , Nicole M. Mattson

Pregnant Women's Experiences with Gastrointestinal Discomforts and Strategies They Use to Cope , Heidi Jo Paquette

Examining Social Factors in Self-Management for Older Adults Living Alone , Margaret Salinas

Effectiveness of a Postpartum Breastfeeding Protocol for Avoiding Pregnancy and Descriptive Analysis of the Physiology of the Postpartum Transition , Mary Schneider

Theses/Dissertations from 2020 2020

Modeling Heart Failure Predictive Mortality in Skilled Nursing Facilities , Stephen Charles Biondi

Understanding the Requisite Content for Interprofessional Education on Sentinel Injuries, A Qualitative Study , Elizabeth A. Cleek

Leading Rural Nurse Academic Progression , Cynthia Jean Larsen

Theses/Dissertations from 2019 2019

The Influence of Continuity of Nursing Care in the Acute Care Setting on Readiness for Discharge and Post-Discharge Return to Hospital , Sarah J. Bahr

Understanding Baccalaureate Nursing Education Progression from the Student Perspective Using a Grounded Theory Approach , Jennifer Jean Dahlman

Identifying a History of Nonfatal Strangulation: What Impacts Screening by Healthcare, Law Enforcement and Advocates? , Jennifer Delwiche

Healthcare Provider Influence on Health Behavior Modification in Gestational Diabetics , Denise K. Fryzelka

Measuring Polyvictimization Among Vulnerable Children: A Confirmatory Factor Analysis , Kelli J. Jones

Toward Quality Preceptorship: A Dyad Sudy , Laurie Ann Kunkel-Jordan

Theses/Dissertations from 2018 2018

Qualitative Exploration of the Perceptions of Nursing Undergraduates Regarding Family Care at End-of-Life , Penny A. Alt-Gehrman

Evaluation of Clinical Growth and Nursing Student Motivation in the Traditional Clinical Learning Environment , Jessica Barkimer

United States Born Mexican Origin Women's Descriptions About Their Eating Patterns , Juanita Teresa Garcia

Comparing Interprofessional Socialization in Mixed Discipline and Nursing Student only Cohorts , Kara Groom

Chronic Stress and Reproductive Function in Female Childhood Cancer Survivors , Theresa Marie Hardy

Understanding Relationships Between Early Life Toxic Stress, Childhood Socioeconomic Disadvantage, and Allostatic Load in Adolescence , Amanda King

Pre-Death Grief, Resourcefulness and Perceived Stress Among Care Givers of Partners with Young Onset Dementia , Karie Kobiske

Home Health Care Effect in Post-Discharge Return to Hospital , Danielle M. Siclovan

The Impact of Advance Directives on the Intensity of Care Received in the Acute Care Setting in Older Adults , Marsha Helen Tyacke

Theses/Dissertations from 2017 2017

The Mediating Effects of Positive Thinking and Social Support on Suicide Resilience Among Undergraduate Students , Denise Marie Matel-Anderson

The Development and Psychometric Analysis of the MU- Fertility Knowledge Assessment Scale , Qiyan Mu

Pediatric Oncology Nurses' Experiences with Prognosis-Related Communication , Amy Rose Newman

Relationship of Exposure to Heart Failure Discharge Teaching to Readmission Within 30 Days , Becky Ann Pogacar

Theses/Dissertations from 2016 2016

Effect of Sequence of Simulated and Clinical Practicum Learning Experiences on Clinical Competency , Jamie Hansen

Experiences of Registered Nurses Who Were Not Initially Successful on the NCLEX-RN, Then Subsequently Passed , Tammy L. Kasprovich

Racially and Ethnically Underrepresented Students’ Completion of RN BSN Program: Factors Affecting Success , Patricia Ann Varga

Theses/Dissertations from 2015 2015

Role of Shared Care in the Relationship between Depressive Symptoms and Self-Care in Patients with Heart Failure , Susan Cole

Diffusion of Inclusion: Measuring Willingness , Janet A. Levey

Effects of Spiritual Care Education on Pediatric Nurses' Knowledge, Attitudes, and Competence , Cheryl Lynn Petersen

Theses/Dissertations from 2014 2014

Relationships among Uncertainty, Coping, and Psychological Distress in Older Adults with Mild Cognitive Impairment , Jennifer Sjostedt Avery

Spirituality And Religiosity In Adolescents With Sickle Cell Disease: A Descriptive Qualitative Study , Dora L. Clayton-Jones

A Feminist Perspective On Listening To Women: Birth Stories Of Vaginal Birth Following Previous Cesarean Delivery , Elizabeth Hill-Karbowski

The Influence Of Patient Activation And Social Facilitation On Engagement In Postpartum Weight Self-Management Behaviors , Jennifer Marie Ohlendorf

Hispanic Mothers' Normative Beliefs and Intentions about the Discussion of Sex-Related Topics with Their Adolescent Daughters , Dana M. Rodriguez

Antecedents of Regular Exercise among Women Who Do and Do Not Achieve Weight Loss Over Six Months , Heather Vartanian

Theses/Dissertations from 2013 2013

The Relationships Between Nurse Attributes, Site Characteristics, And Labor Support Attitudes And Behaviors Among Intrapartum Nurses , Ann Prenger Aschenbrenner

Patient Perceptions of Patient-Empowering Nurse Behaviors, Patient Activation, and Functional Health Status After Surgery , Teresa Arline Jerofke

Self-Care Behaviors of African Americans with Heart Failure: A Photovoice Project , Aimee A. Woda

Theses/Dissertations from 2012 2012

Academic Success Factors Influencing Linguistically Diverse and Native English Speaking Associate Degree Nursing Students , Josie Lynn Veal

Theses/Dissertations from 2010 2010

Associate Degree Nursing Students' Thoughts, Feelings, and Experiences of Short Study Abroad in a Low-Income Country , Cynthia Foronda

A Narrative Analysis of Perinatal Hospice Stories , Anthony Adams Lathrop

The Transition from Hospital to Home in Parents of Pediatric Solid Organ Transplant Recipients , Stacee M. Lerret

The Lived Experience of Hispanic new Graduate Nurses in the United States , Esther Morales

Pushing Techniques Used by Midwives When Providing Second Stage Labor Care , Kathryn Osborne

The Association of Spirituality, Religiosity, Depression, Anxiety, and Drug Use Among Persons Undergoing Methadone Maintenance Therapy , Linda B. Piacentine

Parenting Behaviors and Their Relationship with a Child's Weight Status , Michele L. Polfuss

African American Women's Infant Feeding Choices: Analyzing Self-Efficacy and Narratives from a Black Feminist Perspective , Karen Marie Robinson

More than S.K.I.N. Deep: Decreasing Pressure Ulcer Development in the Pediatric Intensive Care Unit , Christine A. Schindler

Theses/Dissertations from 2009 2009

Efficacy of a behavioral intervention to decrease medication transcription errors among professional nurses , Kathleen Ann Becker

Quality of Life: The Humanbecoming Perspective, A Descriptive Exploratory Study , Barbara J. Johnson Farmer

Factors Associated with Nurses' Perceptions of Patient Safety Culture in One University Hospital in China , Xianqiong Feng

The Meaning of Spirituality in Elders with Dementia , Lesley Boaz Gardiner

Understanding Relationships in Health Related Quality of Life for Parents of Children with Autism Spectrum Disorder , Norah Louise Johnson

Loneliness, Self-Esteem, Cognition, Physical Functioning, and Nursing Home Satisfaction As Predictors of Depression , Lynn Rose Maloney

The Impact of Health Literacy and Patient Trust Glycemic Control , Josephine M. Mancuso

Investigating Relationships Among Collaborative Behavior, RN Experience and Perceptions of Discharge Teaching Quality , Jane Morgan Nosbusch

Is a School Based Educational Program Effective in Changing Knowledge Regarding the Prevention of Shaken Baby Syndrome? , Margaret Kay Stelzel

Effects of Beta Blockade on Physiologic Regulation, Depressive Symptoms and Heart Failure Severity , Kimberly A. Udlis

Theses/Dissertations from 2008 2008

Self-Efficacy, Outcome Expectation, Self-Care Behavior and Glycosylated Hemoglobin Level in Persons with Type 2 Diabetes , Kathryn B. Kott

Oppression in 21st Century Nursing , Linda K. Matheson

Predictors of success and failure on the NCLEX-RN for Baccalaureate graduates , Christine L Vandenhouten

Predictors of Success and Failure on the NCLEX-RN for Baccalaureate Graduates , Christine L. Vandenhouten

Theses/Dissertations from 2007 2007

Being-With Dying: Tacit Wisdom Embedded in the Experiences of Nurses Who Attend to Dying , Virginia L. Burton

Theses/Dissertations from 1999 1999

An Organizational Case Study of Shared Leadership Development in Nursing , Vicki George

Submissions from 1971 1971

NURSES' PERCEPTIONS OF THEIR HOSPITAL'S ORGANIZATIONAL CHARACTERISTICS , AUDREY MABEL STENVALL DE BLOCK

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Home > Nursing > Elaine Marieb College of Nursing Dissertations Collection

Elaine Marieb College of Nursing Dissertations Collection

Current students, please follow this link to submit your dissertation.

Dissertations from 2023 2023

Mental Health Burden and Attitudes and Intention to Seek Mental Health Services in Saudi Women Living in the United States , Wjdan A. Almutairi, Nursing

THE MEANINGS OF DAILY ACTIVITIES AND ATTITUDES OF OLDER BREAST CANCER SURVIVORS: A CASE STUDY RESEARCH , Wadha Alquraini, Nursing

A Grounded Theory of Patient Flow Management within the Emergency Department , Ellen Benjamin, Nursing

Care With Honor And Dignity In A Long-Term Care Facility For Veterans , Sabine Clasen, Nursing

Tablet-based Cognitive Behavioral Group Intervention to Improve Step Count, Fatigue, Self-efficacy and Quality of Life in Arthritis Patients , Sarah M. Fiske, Nursing

Patterns of Substance Use and Buprenorphine Utilization to Predict Treatment Utilization for Opioid Use Disorder , Nicole M. Kent, Nursing

A Mixed Methods Comparative Case Study of the Relationship Between Community Engagement Practices, Maternal and Neonatal Health Services Utilization, and Health Outcomes , Tegemea P. Mwalingo, Nursing

AN EVALUATION OF FUNCTIONAL OUTCOMES FOR PATIENTS WITH OPIOID USE DISORDER IN A MEDICATION TREATMENT PROGRAM: WITH A FOCUS ON PREGNANT WOMEN , kristy pereira, Nursing

THE FEASIBILITY AND IMPLEMENTATION OF A STRENGTHS-BASED RESILIENCE PROGRAM FOR NURSES , Cynthia Peterson, Nursing

Dissertations from 2022 2022

Intravenous Smart Infusion Pump Safety and Flow Rate Accuracy , Jeannine Blake, Nursing

Physical Activity, Daily Step Counts and Functional Ability in Older Adults: Using NHANES Database , Chunfang(Maggie) Chen, Nursing

The Experiences and Needs of Individuals With a Variant of Uncertain Significance (VUS) on Genetic Tests for Hereditary Cancer Syndromes: A Grounded Theory Study , Danielle Gould, Nursing

Use of a Checklist as a Decision Support Aid for Heart Failure Assessment and Management , MaryAnn Hogan, Nursing

A Plant-Based Culinary Intervention to Reduce Type 2 Diabetes Risk and Improve Self-Efficacy in Latino/a/x Adults , Linda M. Koh, Nursing

THAI NOVICE NURSES’ LIVED EXPERIENCES AND PERSPECTIVES OF BREASTFEEDING AND HUMAN MILK IN THE NEONATAL INTENSIVE CARE UNIT (NICU) , Tippawan Srichalerm, Nursing

Dissertations from 2021 2021

NURSE-DELIVERED SHOE-LACING INTERVENTION: EFFECT ON COMFORT AND TOE PRESSURES FOR ACTIVE COMMUNITY-DWELLING ADULTS (AGE 65+) , Mary C. Clayton-Jones, Nursing

LOST IN TRANSLATION: A HOLISTIC PERSPECTIVE ON NURSE PEER RELATIONSHIPS , Maud B. Low, Nursing

Young Adult Cancer Survivors and Physical Activity: An Expert Consensus Study , Ann Marie Moraitis, Nursing

Perseverance: A Focused Ethnographic Study of the Emergency Triage Nurse , Ellen C. Smithline, Nursing

Examining a Fatigue Management Model That Identifies Risk Factors and Consequences of Fatigue in Older Individuals , Maral Torossian, Nursing

Hospital Assessment and Response to Environmental Pollution as a Population Health Need: Identifying Prevalence and Predictors in Community Benefit Practices , Sarah Valentine, Nursing

Dissertations from 2020 2020

DEVELOPING A HANDHELD APPLICATION: A TABLET-BASED CLINICAL EVALUATION TOOL (TABCET) FOR NURSING STUDENT EVALUATION BY CLINICAL INSTRUACTORS , Mohammed Alghenaimi, Nursing

Geographical Disparity of Adverse Childhood Experiences and Chronic Diseases in Saudi Arabia , Fahad Alhowaymel, Nursing

Mediation and Moderation of Sleep in Arthritis Fatigue , Jean L. Cody, Nursing

Dietary Transition, Food Choice Process, and Food Practices in Sub-Saharan African Pregnant Women Living in Massachusetts , Favorite Iradukunda, Nursing

Older Women’s Experiences of Intimate Partner Violence: A Phenomenological Study , Lourdes Irene, Nursing

PERCEPTIONS AND EXPERIENCES OF ADOPTING A TECHNOLOGY BASED INTERVENTION FOR ALCOHOL SCREENING AND REFERRAL TO TREATMENT IN PRIMARY CARE , Sonya L. Lachance, Nursing

The Impact of Psychosocial Treatment on Medication Treatment for Opioid Use Disorder , Tara Mariolis, Nursing

CORE CONTENT ITEMS AND CONSTRUCTS TO INFORM STUDENT NURSE HANDOFF COMMUNICATION , Kelley McAfee, Nursing

USE OF STAY S.A.F.E. STRATEGY DURING MEDICATION ADMINISTRATION IN REDUCING ERRORS , Cidalia J. Vital, Nursing

Dissertations from 2019 2019

Transgender Young Adults, Sibling Relationships, and Mental Health , Jordon Bosse, Nursing

Social Factors that Exacerbate Features of Borderline Personality Disorder in Young Adult Women Between 25 and 35 years of age Living in the Commonwealth of Puerto Rico , Erika M. Carrasquillo, Nursing

MAKING THE INVISIBLE VISIBLE: ADOLESCENT CAREGIVER EXPERIENCES IN MULTIPLE SCLEROSIS , Renee Crizer, Nursing

Cultural and Family Challenges in Type Two Diabetes Self-care for Puerto Rican Identified Hispanic Adults , Jalil Johnson, Nursing

ASSOCIATIONS BETWEEN ADVERSE CHILDHOOD EXPERIENCES AND ATTITUDES TOWARDS ABUSE AGAINST WOMEN AND CHILDREN AMONG ADOLESCENTS AND YOUNG ADULTS IN MALAWI , Nellipher Lewis Mchenga, Nursing

THE SOCIAL PROCESS OF DYING IN THE HOSPITAL: A GROUNDED THEORY STUDY , Alyson Prokop, Nursing

THE IMPACT OF PTSD AND HISTORY OF INVOLVEMENT IN THE CRIMINAL JUSTICE SYSTEM ON MEDICATION TREATMENT SUCCESS IN OPIOID USE DISORDER , Kirk Sanger, Nursing

Use of a Checklist to Facilitate the Recognition of a Transfusion Associated Adverse Event , susan scott, Nursing

Dissertations from 2018 2018

IPMTC- AN EMERGING NURSING THEORY ON TRANSITIONING INDIVIDUALS WITH TRAUMATIC BRAIN INJURY FROM LONG-TERM CARE FACILITIES TO THE COMMUNITY UNDER MEDICAID WAIVER PROGRAMS , Sylvia Abbeyquaye, Nursing

Exploring How Nurse Beliefs and Attitudes Influence End-of-Life-Care Practice , Cara Chandler, Nursing

“Tell Me A Story®”: Promoting Resiliency in Military Children , Katherine-Marie Conover, Nursing

MATERNAL OUTCOMES OF WOMEN WHO PREFER TO COMMUNICATE IN ENGLISH COMPARED TO WOMEN WHO PREFER TO COMMUNICATE IN A LANGUAGE OTHER THAN ENGLISH IN NEW ENGLAND , Katharine Green, Nursing

The Experience of Living With Breast Cancer: Puerto Rican Women Tell Their Stories , Madeline Hernández-Ramirez, Nursing

Using Motivational Interviewing to Increase Walking and Functional Ability in Older Adults: A Quasi-Experimental Study , Erin Lamoureux, Nursing

The Effect of Social Networks on Self-Care Behaviors and Health Outcomes among Older People Living with Multiple Chronic Conditions , Raeann G. LeBlanc, Nursing

The lived experience and factors affecting disclosure of pregnant victims of domestic violence , Pedro Vargas Ortiz, Nursing

Dissertations from 2017 2017

Relational-Cultural Perspectives of African American Women with Diabetes and Maintaining Multiple Roles , Ayesha Ali, Nursing

Tablet-based Self-management Intervention for Diabetes Mellitus Type II Patients: Usability and Efficacy of The ASSISTwell Tool , Mohammad Alkawaldeh, Nursing

COMPARISON OF THE EFFICACY OF ARV MEDICATIONS ALONE AND IN COMBINATION WITH HERBAL MEDICATIONS IN THE TREATMENT OF HIV AMONG NIGERIAN HIV+ PATIENTS , Abdulfattah Durojaiye, Nursing

CANCER PAIN PROCESSES IN THE HOSPICE CARING TRIAD: A GROUNDED THEORY STUDY , Olga Ehrlich, Nursing

RELATIONAL COORDINATION: A PREDICTOR OF NURSE JOB SATISFACTION, ORGANIZATIONAL COMMITMENT, AND TURNOVER INTENTION , Rawaih Falatah, Nursing

Lesbian Veterans Experiences in the Military: A Case Study , Carolyn Gustason, Nursing

EXPLORING THE BALANCE: A Path Analysis Examination of the Maintaining the Balance Model , Sheila Pennell, Nursing

Group Process, Communication, and Relating as a Core Phenomenon in an Older Adult Support and Learning Group on Aging and Health , Lisa Rose White, Nursing

Influence of Work Environment Conditions on the Ability of Critical Care Nurses to Provide Efficacious Nursing Care in Puerto Rico , Yolanda M. Torres, Nursing

Dissertations from 2016 2016

Motivations and Barriers for Saudi Nurses to Pursue a Doctoral Degree , Abdualrahman Alshehry, Nursing

Knowledge Development in Undergraduate Clinical Nursing Education , Nancy A. Craig-Williams, Nursing

Acute Pain Symptom Assessment and Management in Nonverbal Puerto Rican Patients in the Early Postoperative Period , Sherily Pereira, Nursing

Dissertations from 2015 2015

Injection Drug Users’ Perceptions of Received Nursing Care: A Case Study , Kimberly Dion, Nursing

Cup Feeding In the Neonatal ICU: The Influence of Country, Belief, Preference, and Past Behavior , Sameh Ghareeb, Nursing

A Grounded Theory Study of Social Process that Influence a Child being Overweight in Thailand , Jumpee Prasitchai, Nursing

Dissertations from 2014 2014

A Preliminary Model of Dignity Management in Hospice , Qiaohong Guo, Nursing

NEEDS OF PATIENT’S FAMILIES IN THE HOSPITAL TELE-INTENSIVE CARE UNIT , Mary L. Jahrsdoerfer, Nursing

Relational Coordination: The Perception and Experiences of Student Nurses and Nursing Faculty in a Hospital Setting , Clare Lamontagne, Nursing

Dissertations from 2012 2012

The Theory of Compromised Eating Behavior , Ellen Frances Furman, Nursing

Dissertations from 2011 2011

Nurse clinician self-disclosure: A qualitative study , Kathryn Rising Baldor

Nurse Clinician Self-Disclosure: A Qualitative Study , Kathryn Rising Baldor, Nursing

Puerto Rican Teens' Perceptions of Teen Pregnancy and Births in Holyoke, Massachusetts , Nancy J. Gilbert, Nursing

Living With a Depressed Partner , Bridget Logan, Nursing

Characteristics of patients on telehealth that influence their heart failure outcomes in the home-care setting , Kavita Radhakrishnan

Characteristics Of Patients On Telehealth That Influence Their Heart Failure Outcomes In The Home-Care Setting , Kavita Radhakrishnan, Nursing

Healing experiences of Chinese Americans with cancer illness in the United States , Jui-Wen Wu

Healing Experiences Of Chinese Americans With Cancer Illness In The United States , Jui-Wen Wu, Nursing

Dissertations from 2010 2010

The Lived Experience of College Sudents Who have Been Medicated with Antidepressants , Pamela Joan Aselton, Nursing

Transition to Fatherhood: A Puerto Rican Perspective , Suzanne Barenski, Nursing

What Women Want to Know: Assessing the Value, Relevance, And Efficacy of a Self-Management Intervention for Rural Women with Coronary Heart Disease , Holly Evans Madison, Nursing

Familiar Physical Activity to Familiar Music: The Effects on Apathy, Agitation, Eating Ability, and Dietary Intake in Institutionalized Older Adults with Dementia , Janet Ruth Moore, Nursing

Dissertations from 2009 2009

Contentment In “Songs Of The Gorilla Nation: My Journey Through Autism”: A Humanbecoming Hermeneutic Study , Susan A Bonis, Nursing

Contentment in “Songs of the Gorilla Nation: My Journey through Autism”: A humanbecoming hermeneutic study , Susan A Bonis

Feasibility of Family Participation in a Delirium Prevention Program for the Older Hospitalized Adult , Deborah Rosenbloom-Brunton, Nursing

Dissertations from 2008 2008

Nurse decision making and the prevention of adverse events , Priscilla K Gazarian

The cycle of substance misuse and victimization , Karen A Kalmakis

Qi Gong exercise to improve balance for Parkinson fall prevention , Sheree Loftus Fader

Dissertations from 2007 2007

Maternal prenatal attachment in women who conceive through in vitro fertilization , Jean Evelyn Pelski

Pain management documentation: The effects of the perception of the practice environment and clinical expertise , Joanne Goodman Samuels

Participatory action research among Thai women and girls involved in prostitution , Nicharee Thiemklin

Dissertations from 2006 2006

Transcendence in successful aging: A grounded theory of older women's strategies to age successfully , Kristal Imperio

The role of professional nursing in the origin of the Newborns' and Mothers' Health Protection Act of 1996 from a feminist perspective, 1981–1996 , Jan-Louise Leonard

Dissertations from 2005 2005

The effects of a walking program on older Chinese American immigrants with hypertension , Chun-Ying Chiang

Recovery from bulimia nervosa: A transformational journey to the sacred space within , Kathryn A Proulx

Dissertations from 2004 2004

Practitioner characteristics associated with psychosocial care for patients with fibromyalgia , Patricia M Bruckenthal

Self -selected distraction for acute procedural pain in adolescents: An intervention feasibility study , Debra A Jeffs

Stolen adolescence: The experience of adolescent girls with endometriosis , Karen M Plotkin

Health impact of intimate partner violence and abuse among Puerto Rican women living in shelters in the commonwealth of Puerto Rico , Yadira Regueira

Work empowerment, work relationships and expertise in experienced acute care nurses , Joan P Roche

Predictors of capacity to direct attention in cardiac surgery patients , Marilyn S Stapleton

Dissertations from 2003 2003

Family functioning, hope, and quality of life of school -age children with juvenile rheumatoid arthritis , Thomas William Connelly

Somatic awareness, uncertainty, and delay in care -seeking in acute heart failure , Corrine Yvonne Jurgens

Building a story: Word patterns in writing and quality of life in women with advanced breast cancer , Margaret Saul Laccetti

One thousand words of luck: Narratives and analysis of United States resident Chinese immigrants with metastatic cancer , Hung-Ru Lin

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Home > USC Columbia > Nursing, College of > Nursing Theses and Dissertations

Nursing Theses and Dissertations

Theses/dissertations from 2023 2023.

Is There a Relationship Between Direct Patient Care Registered Nurses Emotional Intelligence and Patient Satisfaction? , James J. Leach

The Impact of Shift Work on Women’s Neurological Health , Kathy Nelson

Nurse Perceptions of Caring and Professional Governance , Lan Angela Nguyen

Unlocking Population-Specific Treatments to Render Equitable Approaches and Management in Cardiovascular Disease (UPSTREAM CVD): African American Emerging Adults , Shannon Bright Smith

Substance Use Disorder Treatment Among African American Men Living in the Rural South of the United States , Serge Raoul Wandji

Theses/Dissertations from 2022 2022

Unintended Consequences of the Electronic Health Record And Cognitive Load in Emergency Department Nurses , Carolyn S. Harmon

Physical Activity and Breast Cancer Prevention Among Asian American Women , Jingxi Sheng

Theses/Dissertations from 2021 2021

Early Premature Infant Physiologic and Behavioral Indicators of ANS Instability , Karen Popp Becker

Nurses’ and Patients’ Perceptions of the Availability of Post-hospital Instrumental Support as a Predictor of 30- And 60-Day Acute Care Utilization , Beth E. Schultz

Race Is Not a Risk Factor: Examining the Influence of Models Of Care, Race, and Discrimination on Racial Disparities in Maternal Outcomes , Curisa Mae Tucker

Advancing Knowledge of Exercise as a Therapeutic Management Strategy for Women with Polycystic Ovary Syndrome , Pamela J. Wright

Theses/Dissertations from 2019 2019

Examining Caregiver Vigilance for Child Sexual Abuse , Kate K. Chappell

Exploring Turnover Among Nurse Managers, Directors, and Executives in Acute Care Hospitals , Deborah Hughes Warden

Psychometric Evaluation of Lung Cancer Stigma Among Lung Cancer Survivors in South Carolina , Lisa A. Webb

Theses/Dissertations from 2018 2018

Utilization Of The USDA Supertracker System In High Schools: A Quality Improvement Project , Twanda D. Addison

Online Risks, Sexual Behaviors, And Mobile Technology Use In Early Adolescent Children: Parental Awareness, Protective Practices, And Mediation , Kendra Allison

Implementation of a Depression Screening Tool for Cardiovascular Patients in the Primary Care Setting , Amber Nicole Ballentine

Forensic Patient Flow: An Imbalance Between Capacity And Demand , Versie J. Bellamy

An Evidence-Based Evaluation Tool To Assist Healthcare Providers In Their Assessment Of Effective mhealth Applications For The Management Of Chronic Health Conditions , Sara Belle Donevant

The Effect of a Compassion Fatigue Awareness and Self-Care Skills Educational Program on Retention Among Certified Nursing Assistants Working in a Veterans Nursing Home , Michele M. Dreher

Efficiency Of Ambulatory Blood Pressure Monitoring Vs. 5-Day Serial Monitoring In A Military Treatment Facility , Kadijatu Kakay

Initiating the Loeb Criteria in Long-term Care , Janice Khauslender

High Fidelity Simulation Experience and Development of Clinical Judgment: Recent Graduate Nurses’ Reflections , Martha Kay Lawrence

Implementing a Surgical Pathway to Reduce Operating Room Cancellation Rates , Demerise Ott Minor

Home Exercise Therapy For The Treatment Of Knee Osteoarthritis , Kezia Nixon

Assessment Of An Educational Intervention To Increase Knowledge And Intention To Take HPV Vaccine And Cervical Cancer Screening In Nigeria , Chigozie Anastacia Nkwonta

Chemotherapy Knowledge And Health Literacy Among Women With Breast Cancer , Pearman deTreville Parker

Using Ultrasound Guided Peripheral Intravenous Catheters In Difficult Access Patients , Courtney Prince

Initiating a Peer Support Program for Parents of Children With Autism Spectrum Disorder in Richland and Lexington Counties , Danielle P. Simmons

Implementation Of Provider And Workflow Strategies To Increase Adherence To Tqip Guidelines In Traumatic Brain Injury , Regina Thompson

Theses/Dissertations from 2017 2017

Best Practice for Screening Adult Patients with Psoriasis for Polyautoimmunity: Celiac Disease, Rheumatoid Arthritis and Crohn’s Disease , Susan Danielle Ashbaugh

Adherence of Nurse Practitioners to JNC 8 Guidelines , Stephanie E. Averette

Losing Weight with Five A’s (5 A’s): Assess, Advise, Agree, Assist, Arrange framework and Motivational Interviewing (MI) for health behavior change counseling , Jacqueline Baer

A Quality Improvement Project to Reduce the Incidence of Clostridium difficile Infection through Implementation of Evidence-Based Terminal Clean Procedures , Tamara Cook

Tuberculosis Screening in New Healthcare Employees: A Comparison of QuantiFERON®-TB Gold In-Tube Test and Tuberculin Skin Test , Mary C. Giovannetti

Utility of the Modified Early Warning System Score in Early Sepsis Identification , Lisa E. Hart

Picturing Rest: A Photovoice Study Of African American Women’s Perceptions And Practices Of Rest , Eboni T. Herbert Harris

Developing And Implementing A Quality Assurance Strategy For Electroconvulsive Therapy , Jessa Hollingsworth

Improving Leadership Communication In Nurse-Physician Dyad Teams , Lisa James

Assessment of Providers’ Perception and Knowledge of Overactive Bladder in Women: A Quality Improvement Project , Helen Wambui Ngigi

Simulation-Based Interprofessional Education in a Rural Setting , Ann D. Scott

An Evidence-Based Process Change to Improve Mammography Adherence , Tara E. Smalls

Evaluation, Treatment, and Education In The Hospice Setting By Initiating a Formalized Pain Card , Alyssa M. Soprano

Scribes Impact On Patient And Provider Experience In The Outpatient Setting , Kimberly A. Taylor

Barriers to the Use of Guardrails On IV Smart Pumps , Ivory Williams

Theses/Dissertations from 2016 2016

Nursing Attitudes towards Suicidal Patients in the Emergency Department: Assessment Interview Training , Belinda Beaver

MySleep101©: An Educational Mobile Medical Application for Sleep Health in Primary Care , Sonya Cook

Effects Of Sepsis Protocols On Health Outcomes Of Adult Patients With Sepsis , Monika U. Mróz

Multi-Symptom Management in Hospice Patients during End-of-Life Transition , Ashley N. B. Sirianni

Theses/Dissertations from 2015 2015

Best Practice for a Standardized and Safe Registered Nurse Shift Handoff , Nancy Rankin Ewing

An Evidence-Based Approach to Prepare Interdisciplinary Team Members for Implementation of the ABCDE Bundle , Jessica Murner Hamilton

Nurses Utilizing the V.O.I.C.E.S. HIV Prevention Intervention in the Black Church Community , Jason Richard

Unexpected and Interrupted Transitions Among Newly Licensed Registered Nurses: Perspectives of Nurse Managers and Preceptors , Sheri S. Webster

Theses/Dissertations from 2014 2014

Best Practice for Antipsychotic Medication Management in Community Dwelling Older Adults with Schizophrenia , Estelle Marie Brown

The Effects of Multiple Gratitude Interventions Among Informal Caregivers of Persons with Dementia and Alzheimer's Disease , Cristy DeGregory

An Analysis of Interpreter-Mediated Healthcare Interactions , Robin Dawson Estrada

Quality Improvement Project: A Comparison of Daily Routine Chest Radiography Versus Clinically-Indicated Chest Radiography in Preventing Ventilator-Associated Pneumonia in Adult ICU Patients on Ventilators: An Evidenced Based Practice Project , Kimberly McKenney

Best Practices in High Fidelity Patient Simulation to Enhance Higher Order Thinking Skills , Kathryn S. Mock

Best Practices in the Management of Pediatric Obesity in Primary Care Clinics , Lori Moseley

Early Screening and Identification of Preschool Children Affected by Serious Emotional Disorders , Cathy Renee Robey-Williams

Theses/Dissertations from 2013 2013

Improving the Diagnostic Accuracy of Failure-to-Rescue , Amelia Marie Joseph

Best Practice Guideline For Managing Interstitial Cystitis In Adult Women , Amanda Thomas Langford

The Use of Ultrasound as an Adjunct to X-Ray For the Localization and Removal of Soft Tissue Foreign Bodies in an Urgent Care Setting , Stacy Lane Merritt

Prevention of Skin Breakdown In the Pediatric Intensive Care Unit , Lydia H. Palmer

A Pilot Intervention To Engage Nurses To Lead Transformation of The Workplace , Molly Patton

Foot Assessment In the Dialysis Unit , Karen Robertson

Emergency Department Triage Acuity Ratings: Embedding Esi Into the Electronic Medical Record , Candace Whitfield

Theses/Dissertations from 2012 2012

Best Practice to Promote Bone Health in Post-menopausal Women through Adequate Intake of Calcium and Vitamin D , Ellen Soley Adkins

Developing A Facilitated Pathway For Associate Degree Nursing Graduates to Enroll In An Rn-Bsn Program , Christy Vansant Cimineri

Pursuing Improved Quality of Life In the Atrial Fibrillation Population: Evidence-Based Practice , Jamie Hayes Cunningham

Continuous Subcutaneous Insulin Infusion in Comparison to Subcutaneous Insulin Injections in the Preschooler with Type 1 Diabetes Mellitus , Meredith D'Agostino

Transition to Motherhood-A Qualitative Study of Low Income Women's First Term Pregnancy Experiences , Lisa Bennett Duggan

Vitamin D and Calcium Supplementation For Prevention of Falls and Fractures In Older Adults , Cynthia Hartman

The Best Practice Guideline for Early Detection and Treatment of Heart Disease In Asymptomatic Adults with a Family History of Premature Coronary Artery Disease , Stephanie Brooke Huston

Best Practice Protocol for Patients with Schizophrenia and Co-Occurring Substance Use Disorders , Shauna Rae Jones

Transcultural Nursing Clinical Education: A Systematic Review of the Literature Since 2005 With Recommendations for International Immersion Clinical Courses , Deborah J. McQuilkin

Using a Consensus Process to Develop an Evidence-Based Practice Guideline for School Exclusion For Head Lice (Pediculosis Capitis) , Michelle Lorraine Myer

Using Therapeutic Writing to Deconstruct Recovery from Posttraumatic Stress Disorder (PTSD) , Pamela Phillips

Improving Outcomes by Improving Practice: Evidence-Based Assessment, Prevention and Documentation of Pressure Ulcers In the ICU. , Kristy Fry Speronis

Increasing Awareness of Fertility Preservation Options in Cancer Patients & Survivors , Norma Sweet

Identification, Prevention and Treatment of Children with Decreased Bone Density , Laura Lee Szadek

Assessment and Strategic Planning to Determine the Growth Feasibility of a Distance-Based Rural Baccalaureate Nursing Program , Amber Proctor Williams

Theses/Dissertations from 2011 2011

A Research Utilization Project: Implementation of an Evidence-Based Behavioral Treatment for Students At-Risk of Dropout at Richland Northeast High School , Kathrene Carter Berger

The Impact of the Patient Protection and Affordable Care Act of 2010 On the Evidence Based Practice of Distributive Justice Via Comfort Care In Elderly Burn Trauma Victims , Christina Pacileo Blottner

Parenting Interventions For Children Exposed to Intimate Partner Violence , Christie Michelle Furr-Roeske

Nurse State Legislators: The Journey to State Capitols , Debbie Whitman Herman

Autonomous Nurse Practitioner Practice: A Position Paper and Action Plan for Change , Patricia Susan Noser

Best Practices in The Use of Vena Cava Filters oo Prevent Pulmonary Emboli in Trauma Patients , Dennis Absher Taylor

Theses/Dissertations from 2010 2010

Assessment and Identification of Deliberate Self-Harm in the Adolescent and Young Adult Patient in the Primary Care Population , Courtney Brooks Catledge

A Best Practice Guideline for Screening and Treating Vitamin D Deficiency in a Primary Care Setting: Moving Beyond the Bones , Amy Jeanette Clark

Best Faculty Practice Plan Model for a Small College of Nursing , Sharyn Neiman Conrad

Impact of A Primary Care-Based Organ Donation Practice Initiative On Individual Willingness to Donate , Cyndi B. Faudree

Substance Abuse Treatment Avoidance, Length of Stay, and Criminal Justice Referral For Women of Reproductive Age In South Carolina Prior to and After theWhitner Decision (1993 to 2007) , Sarah J. Gareau

Childhood Obesity and School-Based Interventions: An Evidence-Based Best Practice Guideline , Jessica Guyton

The Best Practice Guideline For theTreatment of Pediatric Diaper Dermatitis , Kate Hansson Mack

A Church-Based Health Promotion Program for Older Adults: Impacts on Participants' Religiosity, Spirituality, and Social Support , Katherine Holland Pope

Dedicated Education Units: Dothey Improve Student Satisfaction? , Eileene Elizabeth Shake

Recommendation For A Best Practice Model of Hiv Management by Advanced Practice Registered Nurses In Primary Care Settings , Sabra Smith

Exploration of the Evidence to Support Clinical Practice to Decrease Hospital Readmission Rates For Patients With Chronic Pancreatitis , Shannon Bright Smith

Best Practices: Retaining Registered Nurses , Jessica Epps Wilkes

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Home > Theses and Dissertations > Dissertations > 966

Dissertations

The registered nurse experience delivering care to a difficult patient: a qualitative study.

Stacy L. Nilsen , University of San Diego Follow

Date of Award

Degree name.

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN, Chairperson; Jane M. Georges, PhD, RN, Committee Member; Christine Nibbelink, PhD, RN, Committee Member; Julie Graham, PhD, APRN, ACCNS-AG, Committee Member

difficult patient, qualitative, therapeutic engagement, altruism

Background : Nurses provide care for patients they classify as “difficult.” The phenomenon of the difficult patient is described in nursing research and is associated with a broad spectrum of behaviors ranging from non-compliant to physical violence. Despite the recommendation from bioethicists that the etiology is multifactorial, nursing research focuses on interventions to manage the patient’s behaviors. Locating the source of the difficult patient only within the patient control may create an environment where the nurse is socialized to take an authoritarian approach to care without reflection on the nurse/patient relationship dynamics. An extended exploration was needed to understand the influence of the difficult patient within the context of the nurse/patient relationship and the impact on care delivery.

Purpose/Aims : The purpose of this study was to describe how acute care hospital nurses made decisions and delivered nursing care in the context of the difficult patient.

Methods : A qualitative descriptive study using a constructivist approach was used. Informants were acute care hospital nurses with experience providing nursing care to difficult patients. Purposeful sampling with maximum variation sampling was used to select informants with diverse characteristics. Data collection included individual, semi-structured interviews, and document review of nursing notes of patients described as difficult. The sample size was seven registered nurses and thirty-seven documents. Data analysis was completed using inductive thematic analysis.

Findings : The difficult patient was described with the theme the Spectrum of the Difficult Patient. Nurse decision making in the context of the difficult patient was expressed with the themes Navigating Control and Limit Setting, Effects of Violence, Understanding and Altruistic Care, Respecting Autonomy and Moral Distress, and Role Support.

Potential Implications : Repeated exposure to difficult behaviors remains a role dissatisfier. This study presented an evolving nursing understanding of the potential for biased provision of care with the use of stigmatizing label. The social context of providing nursing care to a difficult patient is changing from an authoritarian approach to one of altruistic collaboration. Further professional development in therapeutic engagement was identified as a need. Organizations can decrease the burden of care to difficult patients through resource allocation and structural support with embedded clinical role models.

Document Type

Dissertation: USD Users Only

Digital USD Citation

Nilsen, Stacy L., "The Registered Nurse Experience Delivering Care to a Difficult Patient: A Qualitative Study" (2023). Dissertations . 966. https://digital.sandiego.edu/dissertations/966

Copyright held by the author

Available for download on Thursday, April 24, 2025

Since April 26, 2023

https://doi.org/10.22371/07.2023.007

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Nursing Dissertation Topics Ideas & Examples

Published by Alvin Nicolas at January 10th, 2023 , Revised On October 5, 2023

Choosing an appropriate nursing dissertation topic is an extremely important step toward producing an exciting and manageable research study. This post aims to help medicine and nursing students select the most appropriate dissertation title according to their research interests.

It should be noted that the subject of nursing encompasses various areas of knowledge, including but not limited to general nursing, community nursing, public health , environmental health, mental health, clinical management, health organization, and occupational health and safety.

So there is plenty to whet your appetite here. Nursing dissertations can be based on either primary research or secondary research. Primary data nursing dissertations incorporate the collection and analysis of data obtained through questionnaires and surveys. Secondary data nursing dissertations, on the other hand, make use of existing literature to test the  research hypothesis .

To help you get started with brainstorming for medicine and nursing topic ideas, we have developed a list of the latest nursing dissertation topics that can be used for writing your dissertation.

These topics have been developed by PhD-qualified writers of our team , so you can trust to use these topics for drafting your dissertation.

You may also want to start your dissertation by requesting  a brief research proposal  from our writers on any of these topics, which includes an  introduction  to the problem,  research questions , aim and objectives ,  literature review  along with the proposed  methodology  of research to be conducted.  Let us know  if you need any help in getting started.

Check our  example dissertations  to get an idea of  how to structure your dissertation .

You can review step by step guide on how to write your dissertation  here.

View our free dissertation topics database.

• Evidence-based Practice Nursing Dissertation Topics
• Child Health Nursing Dissertation Topics
• Adult Nursing Dissertation Topics
• Critical Care Nursing Dissertation Topics
• Dementia Nursing Dissertation Topics

Midwifery Dissertation Topics

• Palliative Care Nursing Dissertation Topics
• Mental Health Nursing Dissertation Topics
• Coronavirus (COVID-19) Nursing Dissertation Topics

2022 Nursing Dissertation Topics

Topic 1: assessing the parental perceptions and attitude towards the adoption of healthy behaviour patterns to control obesity and overweight concerns in young children..

Research Aim: This study aims to analyse the parent’s perceptions and attitudes in relation to healthy behaviours practises to control obesity and overweight disorders in young children. It will also focus on the obstacles parents or caregivers experience when it comes to obesity control in young children.

Topic 2: Investigating the importance of community nursing for the care of Old People suffering from Dementia- A case study of the UK.

Research Aim: This study aims to find the usefulness of nursing practise for the care of people suffering from dementia. This will also focus on how trained nurses are very professional in providing information and support to the people suffering from dementia so that they can prepare themselves to live their life well with dementia. This study will conduct a systematic review of published literature to find the potential roles of nurses in taking care of people living with dementia. Furthermore, it will also look at various characteristics and effectiveness of nurse interventions.

Topic 3: Assessing the role of midwives in providing medical services to pregnant women in low-income countries.

Research Aim: Midwives are health professionals who are specialised in taking care of pregnant women and newborn health. Women living In low-income countries are far less to get midwifery care, and it is very challenging for them to face this situation. The aim of this study is to find the role of midwives in providing medical services to pregnant women in low-income countries. Furthermore, this study will also look at the challenges and factors in getting midwifery care for women faced with low income.

Topic 4: Examining the mental health of nurses working in ICU.

Research Aim: Nurses working in critical care had significantly higher rates of emotional discomfort and poor health than other nurses, which has a negative impact on their mental health. However, it is unknown how intensive care nurses’ physical health impacts the frequency of medical mistakes. This study will examine the mental health of nurses working in ICU and how it affects their work and causes medical errors. Furthermore, it will also analyse the perception of nurses working in ICU.

Topic 5: Examing nursing practices during the stages of newborn development – A comparative study between the UK and US.

Research Aim: This study’s primary goal is to compare nursing staff practises during the stages of newborn development in the US and UK. This study will compare the effects of nurses’ care practises and will look at the challenges that occur during this process and how they handle these challenges.

Covid-19 Medicine and Nursing Research Topics

Topic 1: research to identify the training resources of nurses to combat the covid-19 pandemic.

Research Aim: Nursing staff plays a vital role in treating and recovering patients from illness. This study will identify the training programs and resources designed for nursing staff to combat the Coronavirus pandemic.

Topic 2: Research to find whether robotic nurses will be a long-lasting solution to treat the patients of Coronavirus.

Research Aim: Medical teams across the globe have been on their toes to combat coronavirus, and substantial human resources have also been invested in overcoming this crisis. This study will focus on collecting information about the idea of using robotic nurses to treat patients of Covid-19. It will reveal the advantages and disadvantages of using robotic nurses.

Topic 3: Research to analyse the risk of nurses getting affected while treating Covid-19 patients

Research Aim: This study will focus on analysing the risks faced by nurses and the medical team. It will discuss the safety measures adopted to protect the medical staff, the challenges they face, and appropriate solutions to minimise them.

Topic 4: Research to identify the impacts of Coronavirus on pharmaceutical industries

Research Aim: This study will focus on identifying the impacts of coronavirus on pharmaceutical industries, production, and supply of medicines. It will discuss the possible ways to combat COVID-19.

Topic 5: Research to know the contributions of pharmaceutical industries to combat Covid-19

Research Aim: This study will focus on identifying the contributions of pharmaceutical industries to combat Covid-19. Did COVID-19 increase the business of pharmaceutical sectors?

More Coronavirus and Nursing Dissertation Topics

• Coronavirus research: Keys to diagnosis, treatment, and prevention of SARS.
• Investigating the nurses in Australia issue plea to stop violence, theft of sanitizer and masks.
• To study and analyse the emergency Coronavirus guidelines for nurses and medical staff across the globe with a particular focus on the USA and the UK.
• Coronavirus in nursing homes: ‘We are going to see deaths’ – A case study of the UK nursing homes
• Why are nursing homes at risk during the Coronavirus pandemic? – Case study of any European state
• How nurses and medical staff can help parents and children cope with the mental issues and uncertainly in the midst of coronavirus crisis
• To devise strategies to combat testing and prevention kits in hard-hit nursing homes.
• How coronavirus has the potential to lead shortage of nurses and doctors across the globe?

Nursing and Medicine Dissertation Topics for 2021

Topic 1: impact of coronavirus on the pharmaceutical industry.

Research Aim: This research aims to identify the impact of Coronavirus on the pharmaceutical industry.

Topic 2: The role and impact of occupational safety and health in medical clinics

Research Aim: This research aims to measure the impact of occupational safety and health in medical clinics.

Topic 3: Increasing work pressure and occupational health concerns

Research Aim: This research aims to address increasing work pressure and occupational health concerns during a pandemic.

Topic 4: How researchers’ nurses may enhance the operation of clinical research?

Research Aim: The quality improvement of the performance of health care includes scientific study. The research team from the place where there was a shortage of research has established a steadily growing spectrum of testing within the Bradford Teaching Hospitals Foundation Trust. In this research, the main emphasis would be on the key role of research nurses.

Topic 15: Developing effective nursing strategies for dealing with patients possessing acute and chronic pain: A case study of NHS

Research Aim: The concept of nursing has evolved since recent times. Many health care institutions have developed effective strategies to increase nursing efficiency. Therefore, the main purpose of the research is to develop effective nursing strategies for dealing with patients possessing acute and chronic pain by analysing the case study of the NHS.

Topic 6: Critical analysis of community nursing and health care needs: A comparative analysis of UK and USA

Research Aim: Nursing and health care needs have a direct and positive relationship. The main purpose of this research is to conduct a critical analysis of community and health care needs. This research will compare the UK and USA nursing practices and provide recommendations to improve the existing strategy.

Topic 7: Analysing the societal acceptance of Marijuana: The case of developing countries

Research Aim: The purpose of this study is to contemplate upon the key benefits that the use of Marijuana, within a medicinal capacity, has. Ideally, in developing countries, the use of marijuana is considered “Taboo” or unacceptable by the members of the community/society. Hence, the study intends to analyze the societal acceptance of Marijuana within developing countries.

Topic 8: Developing effective nursing strategies for dealing with patients suffering Coronavirus disease: A case study of NHS

Research Aim: The coronavirus has taken the world by storm, infecting millions in nearly 200 countries. Many health care institutions have developed strategies to increase nursing efficiency. Therefore, the main purpose of the research is to identify effective nursing strategies for dealing with patients possessing coronavirus by analysing the case study of NHS.

Topic 9: Coronavirus research: Keys to diagnosis, treatment, and prevention of SARS

Research Aim: This research will discuss the basic life cycle and replication of the well-studied coronavirus, mouse hepatitis virus (MHV), identifying the unique characteristics of coronavirus biology and highlighting critical points where research has made significant advances, and which might represent targets for antivirals or vaccines. Areas where rapid progress has been made in SCV research, will be described. Finally, areas of need for research in coronavirus replication, genetics, and pathogenesis will be summarised.

Mental Health Dissertation Topics

• Investigating the effectiveness of psychiatric treatment and medicine for patients suffering schizophrenia – A qualitative study based on UK mental health nurses and patients
• Exploring the legal aspects of mental health research in the UK
• To study and determine the causes to increasing number of suicides in the urban youth population in the developing world
• The role of socioeconomic backgrounds on the mental health of individuals
• Investigating the impact of early maternal mental illness on children
• Parents with serious mental health problems from the perspective of professionals who offer support
• Treatment of mental health difficulties by combining psychological and complementary therapies
• To perform an interpretative phenomenological analysis to treat older people with long term mental health difficulties
• To identify the barriers and risks associated with personalization within the context of mental illness
• To explore mental illness by conducting a biographical narrative study
• Deconstructing mental health difficulties: A critical enquiry into the views and opinions of professionals dealing with families, parents, and children

How Can ResearchProspect Help?

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Occupational Health and Safety Nursing Dissertation Topics

• To investigate occupational health and safety risks in the UK health care sector: Preventive techniques and recommended practices
• A quantitative study to evaluate the understanding and knowledge nurses have of occupational risks in an operating theatre environment
• To investigate the impact of occupational safety and health on the job performance of nurses
• To identify and discuss factors affecting the practice of occupational health nursing in London
• The role and impact of occupational safety and health in medical clinics
• To identify and discuss key occupational safety and health risks, challenges, and concerns in China
• Workplace health management and the role of occupational health nurses
• Increasing work pressure and occupational health concerns
• Occupational safety and health risks and practices among Filipino nurses
• Adopting a multi-climate approach to address patient safety issues in the nursing work environment
• To assess and understand occupational risks and nursing duties from an ergo logical perspective
• The need to realise the increasing importance of occupational safety and health issues in industrialised societies

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Environmental Health Dissertation Topics

• Improving awareness on environmental health issues by encouraging community participation
• To identify and analyse various environmental health concerns in the health care sector
• To determine the possibility of food poisoning and foot-related illness in urban regions from the perspective of environmental health
• Constrained ordinal models with application in occupational and environmental health
• To examine the impact of secondhand smoke on public health with particular focus on the relevant control strategies
• An investigation into the attitudes of bar staff workers to environmental tobacco smoke and the varying provision of smoke-free areas within public houses
• To study and understand the impact of traffic calming procedures on local air quality
• Investigating how reusable cleaning cloths can help to reduce cross-contamination within the food industry
• Analysing older driver behaviour and road safety
• To review public health nurses’ opinions on environmental hazards and health effects
• Disposing toxic wastes from the perspective of environmental health
• Recommended sanitary hygiene practices for developing countries – A quantitative study
• A qualitative study to address arsenic and lead poisoning issues

Related:  Environmental Engineering Dissertation Topics

Also Read This:   Occupational And Environmental Health Thesis And Dissertations

Evidence-Based Practice Dissertation Topics

• To identify and discuss evidence-based practices that enable nurses to provide high-quality care
• Use of evidence and knowledge management in clinical practice
• How the health care needs of elderly cancer patients can be satisfied with evidence-based nursing programme
• Investigating the use of evidence-based medicine for disease management
• To study the effectiveness of evidence-based practice in the health care industry
• To investigate the relationship between evidence-based practice and the research process
• To study the basic principles of evidence-based practice in the UK health care industry
• Why is it critical for nurses to base the foundation of their practices on reliable evidence?
• Barriers to implementing evidence-based practice and the strategies/organisations used to avoid these barriers
• The role of ethics and leadership in evidence-based nursing practice

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Health Organisations Dissertation Topics

• The Highest Attainable Standard: The World Health Organisation, Contentious Politics of Human Rights and the global health governance
• Factors contributing to efficient service delivery – A qualitative study on the implementation of health policies in Argentina
• Integrating technology, process and the people in lean healthcare
• Should World Health Organisation do more to satisfy the health care needs of people in the developing world? – The current programmes and future ambitions
• An investigation in the health care plans and associated costs of countries across the globe
• To study strategic management policies and strategies of World Health Organisation
• Investigating the power, culture, and dynamics of National Health Service in the UK
• Factors influencing the healthcare policies of new health organisations
• The extent of NHS focus on providing services to elderly
• Research trends and directions within the World Health Organisation
• Exploring practices and experiences of midwives in regards to the evaluation of maternal postnatal genital tract health
• Investigating midwifery practice in the third stage of labour
• To study the professional care in midwifery practice with a focus on woman centered-care
• To determine the factors contributing to midwives decision to stay in midwifery
• How do midwives perceive normal birth and how their ability to practice and support normality might be influenced by the professional and organisational culture of a maternity unit?
• A feminist technoscience perspective of the midwife’s role
• To investigate the challenges associated with carrying out a water-birth randomised controlled trial
• To what extend do midwives can facilitate informed choices among pregnant women?
• To identify and discuss the factors influencing the competence of midwives in a clinical setting
• The role of midwifery in relation to health risks to women due to postpartum depression

Community Nursing Dissertation Topics

• The impact of community participation on social inclusion, self-perception, and everyday lives of participants
• Quality of life, good practices, and senior citizens in residential care homes
• To investigate the impact of existing welfare ideologies and policies on the elderly in Leicestershire
• To what extent the community care has met the needs of the elderly with mental health difficulties after being discharged from long-stay psychiatric clinics? – A review of literature from the past 10 years
• Exploring the relationship between ethnicity and community nursing facilities in London
• Obesity awareness and prevention: Can food labelling help to deal with obesity problems in the USA?
• The role of community nursing practice in relation to health promotion
• Recommended practices and policies to ensure high-quality community nursing services to pregnant women
• Health care needs of children and the community nursing service in Leicestershire
• Factors affecting the quality of life of older people – A review of community nursing practices and challenges

Children Health Nursing Dissertation Topics

• Improving, recording, and perceiving school children’s health from the perspective of school health nursing
• Critical evaluation of child health nursing through education and practice
• Identifying challenges and support processes of child health nursing in developing countries
• To investigate the skills and abilities required to promote and sustain the emerging practice of child health nursing
• Leadership and intellectual skills are needed to be successful in positions of leadership and caring for children
• Caring for young people and children with complicated health needs
• To explore the effects of child patient death on nursing staff in a clinical setting: A literature review
• To understand children’s perspectives on community nursing
• To identify factors that can help to improve breastfeeding initiation practices among community nurses in the UK
• Children with congenital heart diseases and the role of parents – A literature review

Related:  Top QA on Children Health Nursing

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Clinical Management Dissertation Topics

• Clinical governance strategies and practices at National Health Services
• Hospitalised patients with diabetes and clinical decision support systems
• Developing optimum strategies for management of patients in adult intensive care units
• Clinical management of patients with prostate cancer – The risks and challenges
• Effectively managing elderly patients in a clinical setting
• Optimal management plan for patients with post-traumatic stress issues
• Use of advanced technology tools to improve clinical management efficiency
• To study various management strategies in surgical cases

Important Notes

As a student of medicine and nursing looking to get good grades, it is essential to develop new ideas and experiment with existing medicine and nursing theories – i.e., to add value and interest in the topic of your research.

The field of medicine and nursing is vast and interrelated to so many other academic disciplines like civil engineering ,  construction ,  law ,  healthcare , mental health , artificial intelligence , tourism , physiotherapy , sociology , management , marketing, cryptocurrencies and architecture . That is why it is imperative to create a project management dissertation topic that is articular, sound, and actually solves a practical problem that may be rampant in the field.

We can’t stress how important it is to develop a logical research topic; it is the basis of your entire research. There are several significant downfalls to getting your topic wrong; your supervisor may not be interested in working on it, the topic has no academic creditability, the research may not make logical sense, and there is a possibility that the study is not viable.

This impacts your time and efforts in  writing your dissertation  as you may end up in the cycle of rejection at the very initial stage of the dissertation. That is why we recommend reviewing existing research to develop a topic, taking advice from your supervisor, and even asking for help in this particular stage of your dissertation.

While developing a research topic, keeping our advice in mind will allow you to pick one of the best medicine and nursing dissertation topics that fulfil your requirement of writing a research paper and add to the body of knowledge.

Therefore, it is recommended that when finalizing your dissertation topic, you read recently published literature to identify gaps in the research that you may help fill.

Remember- dissertation topics need to be unique, solve an identified problem, be logical, and be practically implemented. Take a look at some of our sample medicine and nursing dissertation topics to get an idea for your own dissertation.

How to Structure your Dissertation on Medicine and Nursing

A well-structured   dissertation can help students   to achieve a high overall academic grade.

• A Title Page
• Acknowledgements
• Declaration
• Abstract: A summary of the research completed
• Table of Contents
• Introduction : This chapter includes the project rationale, research background, key research aims and objectives, and the research problems to be addressed. An outline of the structure of a dissertation  can also be added to this chapter.
• Literature Review :  This chapter presents relevant theories and frameworks by analysing published and unpublished literature available on the chosen research topic, in light of  research questions  to be addressed. The purpose is to highlight and discuss the relative weaknesses and strengths of the selected research area whilst identifying any research gaps. Break down of the topic, and key terms can have a positive impact on your dissertation and your tutor.
• Methodology:  The  data collection  and  analysis  methods and techniques employed by the researcher are presented in the Methodology chapter which usually includes  research design,  research philosophy, research limitations, code of conduct, ethical consideration, data collection methods and  data analysis strategy .
• Findings and Analysis:  Findings of the research are analysed in detail under the Findings and Analysis chapter. All key findings/results are outlined in this chapter without interpreting the data or drawing any conclusions. It can be useful to include  graphs ,  charts and  tables  to this chapter to identify meaningful trends and relationships.
• Discussion  and  Conclusion: The researcher presents his interpretation of results in this chapter, and states whether the research hypothesis has been verified or not. An essential aspect of this section of the paper is to draw a linkage between the results and evidence from the literature. Recommendations with regards to implications of the findings and directions for the future may also be provided. Finally, a summary of the overall research, along with final judgments, opinions, and comments, must be included in the form of suggestions for improvement.
• References:  This should be completed in accordance with your University’s requirements
• Bibliography
• Appendices:  Any additional information, diagrams, graphs that were used to  complete the  dissertation  but not part of the dissertation should be included in the Appendices chapter. Essentially, the purpose is to expand the information/data.

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A qualitative descriptive study of the COVID-19 pandemic: Impacts on nursing care delivery in the critical care work system

Associated data.

The COVID-19 pandemic drastically changed the delivery of nursing care in U.S. critical care settings. The purpose of this study was to describe nurses’ perceptions of the critical care work system during the COVID-19 pandemic in the U.S. We conducted interviews with experienced critical care nurses who worked during the pandemic and analyzed these data using deductive content analysis framed by the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model. Concepts include the critical care work system structures, nursing care processes, outcomes, and adaptations during the pandemic. Our findings revealed a description of the critical care work system framed by the SEIPS 2.0 model. We suggest how human factors engineers can utilize a human factors and engineering approach to maximize the adaptations critical care nurses made to their work system during the pandemic.

1. Introduction

The U.S. has recorded almost 80 million cases and over 870,000 deaths due to COVID-19 ( Centers for Disease Control, 2021 ). The COVID-19 pandemic led to an enormous increase in admissions to critical care settings ( Huang et al., 2020 ), and subsequently, an unprecedented need for critical care nurses. In addition to a shortage of nurses there was also a shortage of resources such as inadequate personal protective equipment (PPE) and ventilators. These changes resulted in sweeping changes to the way nursing care was delivered in U.S. critical care settings. Little is yet known about the impact of these changes on nursing care in critical care work systems.

Prior to the pandemic, trained critical care nurses did the majority of patient care in critical care ( Brilli et al., 2001 ). Typical nurse to patient ratios were 1:1 or 1:2 depending on state mandated staffing ratios ( Brilli et al., 2001 ). Low ratios facilitated the critical care nurse's ability to focus on fewer patients each shift while providing complex, life-sustaining care ( Brilli et al., 2001 ). Critical care nurses are essential to providing complete patient care and attend to complex patient care tasks; less complex tasks are delegated to nursing assistive personnel ( Shirey, 2008 ).

While the COVID-19 pandemic added complexity and stress to nurses' critical care work system, it also highlighted the baseline imbalance of demands and capacity across multiple areas of nurses’ work. Nursing documentation was a significant burden for nurses due to its level of detail and frequency ( Collins et al., 2018 ). Critical care nurses experienced high rates of burnout ( Moss et al., 2016 ), moral distress ( Sirilla et al., 2017 ) and turnover ( Nursing Solutions Inc., 2019 ). Communication has historically been a challenge between critical care team members and the patient and family ( Grant, 2015 ). There were also not enough nurses to meet the demand for nursing care in critical care ( Seda and Parrish, 2019 ). Understanding nursing care in critical care work systems is important because nursing care is linked to patient and nurse outcomes ( Cheung et al., 2008 ), which impact organizational outcomes.

According to a study by The International Council of Nurses ( ICN, 2021 ), the COVID-19 pandemic significantly impacted nurse outcomes. A majority (76%) of nurses reported on average a three-fold increase in nurse-to-patient ratios (number of nurses who care for a number of patients), which nurses reported as contributing to their exhaustion, burnout, and stress ( ICN, 2021 ). Increased nurse-to-patient ratios (having fewer nurses for more patients) and burnout are not only dangerous to nurses but can also be harmful to patients ( ICN, 2021 ). For every extra patient per nurse, Aiken et al. (2002) found a 7% increase in the odds of patient failure-to-rescue and a 7% increase in the likelihood of dying within 30 days. Nurse burnout is associated with turnover, poor patient outcomes ( Bae et al., 2010 ), and medical errors ( Hall et al., 2016 ), which all have significant financial impact on hospitals ( Hirose et al., 2018 ). The pandemic intensified the thin financial margins for hospitals, or even caused them to close their doors, as many experienced low patient censuses due to hospital avoidance early in the pandemic. Nationwide, hospitals experienced a collective $36.6 billion loss from March to June 2020 ( American Hospital Association, 2020 ). Patient care in critical care settings is very expensive ( Reardon et al., 2018 ). Considering the link between nursing care with patient, nurse, and organizational outcomes, nursing care in critical care work systems should be further understood. To persevere financially through and beyond the COVID-19 pandemic, organizations should consider ways to redesign the critical care work system. Furthermore, a systems approach is recommended to mitigate clinician burnout ( NAM, 2009 ), which urgently needs addressing for nurses' well-being.

Carayon and Perry (2021) suggest use of the Systems Engineering Initiative for Patient Safety (SEIPS) model ( Carayon et al., 2006 ) as a human factors and ergonomics approach for healthcare systems to redesign work systems in response to the COVID-19 pandemic. In the SEIPS model, Carayon et al. (2006) combined the work system model described by Smith and Carayon (2001) with Donabedian's (1988) Quality (structure-process-outcome) Model. The SEIPS model ( Carayon et al., 2006 ) is comprised of interconnected concepts including the work system (person, organization, task(s), tools & technology, and physical environment), processes (care and other), and outcomes (patient, employee, and organizational). SEIPS also incorporates Balance Theory which emphasizes the interconnectedness of the work system to adapt or facilitate overcoming barriers ( Smith and Carayon, 2001 ; Smith and Carayon-Sainfort, 1989 ). Holden et al. (2013) described a SEIPS 2.0 model in which the work system construct includes the concepts of internal and external environments, the work processes are described as physical, cognitive, and social/behavioral, and added adaptation as a concept to describe the feedback mechanism to explain the evolution of work systems ( Holden et al., 2013 ). See Fig. 1 for how the SEIPS 2.0 model has been applied for use in this study.

SEIPS 2.0 Model in this study.

Researchers suggest the COVID-19 pandemic impacted nursing care broadly in healthcare systems ( Schroeder et al., 2020 ; Aliyu et al., 2021 ); however, little research has focused specifically on nurses’ perceptions of the changes in nursing care in U.S. critical care work systems during the COVID-19 pandemic. Critical care work systems are structures that organize the provision of healthcare ( Holden et al., 2013 ) for critically ill patients experiencing life-threatening illness ( Marshall et al., 2017 ). The purpose of this study was to describe the critical care work system during the COVID-19 pandemic in the U.S. from the perceptions of nurses. The study aims were to:

• 1. Describe nurses' perceptions of the critical care work system during the COVID-19 pandemic.
• 2. Describe nurses' perceptions of how the COVID-19 pandemic impacted the critical care work system, changed the processes and outcomes, and influenced adaptation.

2.1. Participants

We recruited critical care Registered Nurses via multiple venues, including social media (Facebook, Twitter, and LinkedIn), several large hospitals in the Southwest U.S., nursing organizations, and doctoral nursing students at [redacted]. Potential participants clicked a link to complete a screening questionnaire in Qualtrics (2021) . They indicated their interest to participate and input their email address. The principal investigator (CB) reached out to potential participants via email to schedule an interview. Inclusion criteria were two or more years of experience working in an intensive care unit (ICU) in the U.S. and provided care for adult patients in the ICU for at least one month during the COVID-19 pandemic. We selected these criteria to ensure participants accrued substantial experience working in critical care both prior to, and during, the pandemic.

2.2. Procedures

The principal investigator (CB) developed a semi-structured interview guide based on the SEIPS 2.0 model. The guide included interview questions about nurses’ experiences with care; descriptions of the critical care work system structures, care processes, and outcomes; and the impacts of the COVID-19 pandemic. CB piloted interview questions with two nurses who met the inclusion criteria but did not participate in the study; the questions provoked rich responses, including descriptions of the critical care work system, nursing care processes, adaptations, and associated outcomes. Therefore, no changes were made to the interview guide.

We obtained institutional review board approval for the study prior to participant recruitment and data collection. CB conducted one interview with each participant using an online conference software with audio-only recording. Participants gave verbal consent at the beginning of the video-platform interview. Interviews took place in mid-April 2021 and lasted on average 32.4 min, in part because the participants were particularly eager to discuss the topics and were quite open with CB (who is experienced both as a nurse and as a semi-structured interviewer for qualitative descriptive research). The shortest interview lasted 25 min and the longest interview lasted 40 min. Participants received a $15 e-gift card as compensation for participation. We de-identified audio recordings by removing information, such as participant name or place of work, and replaced with “redacted.” Transcripts were transcribed verbatim using a HIPAA-certified service before uploading to Dedoose (2020) qualitative analysis software.

2.2.1. Data analysis

We analyzed interview transcripts using a deductive content analysis approach framed by the SEIPS 2.0 model. Deductive content analysis is an approach whereby codes are applied using concepts from existing theories for the purpose of supporting or extending an existing theory ( Elo and Kyngas, 2007 ). After uploading transcripts into Dedoose, CB and JR randomly selected three and coded them independently using a codebook. CB and JR then reviewed each section of the transcripts to ensure consistent application of codes and code definitions. The remaining 17 interviews were coded independently by both coders, reviewing each disagreement identified in Dedoose. We documented and saved each stage of data analysis as separate versions ( Lincoln and Guba, 1985 ). After coding all interviews and ensuring 100% agreement, CB shared a presentation via email of the codes with definitions and exemplar quotes to three critical care nurses (who met the study inclusion criteria but were not recruited for the study) to serve as member checks to support credibility and transferability ( Lincoln and Guba, 1985 ). They were then individually asked for feedback on whether the codes and exemplars were representative of their own experience. Each of these nurses described the exemplars as “difficult to read,” yet reflected experiences that were very similar to their own experiences.

Twenty experienced critical care nurses (15 women, 5 men) ranging in age from 27 to 50 years old participated in this study and were from a variety of geographic regions of the US: Southwest (11), West (1) Northwest (2), Northeast (4), and Southeast (2). Participants reported working on their “home” units including surgical, trauma, medical, neurology, and cardiac/cardiovascular critical care units. One participant moved from working on a pediatric to an adult critical care unit during the COVID-19 pandemic. See Table 1 for demographics.

Participant demographics.

We used the SEIPS 2.0 model as a framework for deductive content analysis to describe nurses’ experiences providing care in the critical care work system during the COVID-19 pandemic and how nurses adapted nursing care to avoid the impacts of system barriers on patients. Below we report on the elements from each of the main concepts (work system, processes, outcomes, and adaptations) of the SEIPS 2.0 model. In Table 2 we provide a summary of exemplar quotes.

The quotes in this table are representative of participants' descriptions of each of the elements of the SEIPS 2.0 model.

3.1. The critical care work system during the COVID-19 pandemic

Nurses’ descriptions of the work system elements aligned with the SEIPS 2.0 model; including the elements of critical care nurses, critical care patients, nursing tasks for the patient, tools and technology, organization, and internal and external environments.

3.1.1. Patients

Participants described the patients as critically ill and isolated from their family members. These were some of the most critically ill (COVID-19 and other diagnoses) patients the participants had ever cared for (see Table 2 ); as they required intravenous vasoactive medications, steroids, continuous renal replacement therapy, extracorporeal membrane oxygenation, and early mechanical ventilation.

3.1.2. Critical care nurses

The critical care nurse participants in this study were experienced (see Table 2 , Table 1 for demographics) and described themselves and their colleagues as detail-oriented. During the pandemic participants primarily provided direct nursing care for patients alongside nurses who were redeployed from other departments (neonatal ICU, obstetrics, perioperative settings).

3.1.3. Nursing tasks for the patient

Critical care nurse participants performed both typical critical care nursing tasks for the patient and atypical tasks that, during non-pandemic times, would be performed by other health care professionals. For example, nurses were at times the only ones allowed to enter patient rooms, so they communicated with respiratory therapists to obtain guidance on managing ventilators (see Table 2 ). These tasks are not typically required of critical care nurses. Additionally, they were required to delegate tasks to re-deployed nurses. Participants noted inconsistencies in the amount and type of critical care training deployed nurses received, which therefore impacted the tasks they were able to assist with, which participants described as a major barrier to care.

3.1.4. Tools & technology

The participants indicated tools, such as PPE, were in short supply, and staff were forced to reuse or purchase their own PPE. Aging and outdated equipment was a common experience among participants due to shortages (see Table 2 ). Nurses described difficulty managing aging ventilators that had been decommissioned. Masks became a barrier to communication among the interdisciplinary team; the masks made it difficult to hear coworkers’ muffled voices over negative pressure ventilation systems. The technology participants used to facilitate patient-family communication included iPad tablets supplied by the organization. In many instances organization-supplied technology for patient-family communication was not available, therefore, nurses accomplished this by using their own personal cell phones. There were also inconsistent documentation standards throughout the cycles of the pandemic. For example, several participants described feeling unsure because what was required for them to document on their patients were constantly changing. Many felt communication within the electronic health record (EHR) could have facilitated appropriate documentation.

3.1.5. Organization

Participants recounted organizational policies that constantly changed due to evolving knowledge of COVID-19 and different experiences with both unit and organization-level leadership. Policies regarding visitor restrictions were modified according to the severity of the pandemic. Some participants described leaders who clearly facilitated communication of changes and the status of resources (such as PPE), while others described leaders who were barriers to staff understanding change and lack of available resources (see Table 2 ). Participants described a general feeling of frustration with the leaders’ decisions to bring redeployed nurses to critical care with insufficient training; they felt the redeployed nurses were not able to provide assistance that was meaningful to the critical care nurses.

3.1.6. Internal environment

Participants described the internal environment of the ICUs as being retrofitted to meet patient care needs during the pandemic. Multiple participants shared how organizations created ICUs in settings that previously were used for different patient populations (eg. pediatric intensive care or unused units). As a result, several participants described cumbersome negative pressure equipment that was in the way or completely changed the environment of the unit (see Table 2 ). One participant even described how their organization resorted to opening the windows in the peak heat of the summer to create negative pressure in patient rooms.

3.1.7. External environment

Participants described considerable influence of the external environment on the critical care work system. Nurses indicated that group gatherings in the community and the general public's anti-mask sentiment directly impacted the patients, healthcare professionals, the organization, and the community. Several participants described taking care of critical care patients who did not believe they had COVID-19 despite a positive diagnosis. Consequently, participants felt frustration with political leaders for not communicating the severity of COVID-19 illness and with their community for not believing the reality of COVID-19 illness and its reverberating impacts. Participants described this as impacting not only the number of patients admitted to the ICU, but also nurse morale and the way patients' family members treated nurses.

3.2. The process of nursing care

3.2.1. physical work processes.

Participants recounted the physical work of nursing care as exhausting due to manual proning (turning a patient onto their abdomen) of patients and frequent cardiopulmonary resuscitations (see Table 2 ). Physical work was often also described as emotionally exhausting as their patients frequently died. Nurses described completing most of the patient care with fewer staff. They spent significant time donned in PPE to deliver care and facilitate video chats between patients and their family. Participants described the physical work of putting on and taking off of PPE as time-consuming, which impacted the way nursing care was delivered because care had to be done all together at the same time instead of as-needed.

3.2.2. Cognitive work processes

Participants described feeling overwhelmed by the increase in cognitive work during the pandemic (see Table 2 ) due in part to the increased tasks despite being short-staffed. Very little was known about the pathophysiology or course of illness and navigating associated changes, so nurses spent time seeking out information on how to care for patients with COVID-19. Participants described taking on the lead role in team nursing models where the critical care nurse bore the cognitive work typical of critical care nursing (critical thinking, decision-making, and documentation). They described doing this while incorporating cognitive work atypical of critical care nursing such as grouping together patient care tasks to avoid using PPE and deciphering which skills could be delegated (as appropriate for nurses re-deployed to help in critical care). Participants described confusion as to what documentation was required throughout the different surges in patient volume throughout the pandemic due to the constant changes communicated by leaders.

3.2.3. Social/behavioral work processes

The social/behavioral work participants described included learning how to work with new team members and new or additional communication responsibilities with family members (due to visitor restrictions). Participants described learning to balance the strengths and weaknesses of each team member (see Table 2 ). Due to the volume of patients, nurses described veering from the industry standard of bedside patient hand-offs to using standardized report sheets to facilitate a quick shift transition. Critical care nurses assumed the facilitation of communication between patients and their loved ones and the emotional work of being present with patients, holding their hand, as they died so they would not be alone.

3.3. Outcomes

3.3.1. patient outcomes.

Participants detailed missed care and death as patient outcomes . Patient ratios were higher during the pandemic and coupled with increased tasks, participants experienced difficulty delivering the minimum standard of nursing care (e.g. turning patients and performing activities of daily living) which resulted in missed care. Nurses rationed care to ensure the most important, life-saving tasks were completed for patients while activities of daily living were only completed if there was time (see Table 2 ). The amount of death participants witnessed during the pandemic was unparalleled in all of the nurses’ years of experience. One participant described critical care as a “fishbowl of death” during the pandemic (see Table 2 ).

3.3.2. Nurse outcomes

Participants described both negative and positive outcomes for critical care nurses. Negative nurse outcomes included stress, burnout, fatigue, and moral injury. Patient outcomes of missed nursing care and death were particularly stressful to participants and as a result, they described experiencing fatigue and burnout. Moral injury is defined as when an individual witnesses, fails to prevent, or perpetuates something that contradicts their beliefs and expectations ( Forbes et al., 2015 ). The conditions created by the pandemic produced morally injuring dilemmas outside nurses' control; some participants felt forced to make decisions outside their scope of practice while others stated they couldn't provide the minimum standard of nursing care. Positive nurse outcomes included gaining new skills and having a sense of purpose during the pandemic. The skills nurses gained included managing patients on continuous renal replacement therapy and manual proning. Nurses also described satisfaction with the rate of translation of new knowledge into practice. Despite the many challenges they experienced, participants felt a great sense of pride for having worked in critical care during the pandemic. One participant even felt their work gave them something to do where they were needed and felt safe (see Table 2 ).

3.3.3. Organizational outcomes

Organizational outcomes included significant nurse turnover; however, participants also described improved teamwork. While none of the participants left their positions, many of their peers left for nursing opportunities in outpatient settings, travel nursing, or even left the nursing profession. They described this turnover was a direct result of the stress and lack of leadership support they experienced during the pandemic. Participants reported the conditions created during the pandemic required nurses to collaborate with physicians, respiratory therapists, and leaders (who were part of proning teams) in new ways. The enhanced teamwork contributed to nurses’ enjoyment of their work despite the challenges they faced during the pandemic.

3.4. Adaptations

3.4.1. patient care adaptations.

Participants described overcoming barriers to patient care using several novel approaches including tools, technology, communication, and ways to access resources. Nurses described how the pandemic forced them out of their comfort zones and to creatively solve challenges to everyday tasks in their work. While nurses were frustrated to learn they would have to reuse PPE, they adapted by purchasing respirators (such as those bought at hardware stores) or storing the PPE in brown paper bags. During shortages of commercially available sheets designed to lift patients, nurses would place patients between two standard bed sheets and roll them together to adjust the patient in bed. To avoid unnecessary donning of PPE to enter a room, participants used long intravenous (IV) tubing to keep the IV pump outside the patient room. Nurses described experiencing difficulty communicating to others outside the patient room was difficult (due to masks muffling voices and the volume of the negative pressure equipment). They used walkie talkies (see Table 2 ) or learned sign language to communicate simple needs (such as supplies) to their colleagues. Participants described turning to social media, podcasts, and colleagues across the globe to learn how to take care of COVID-19 patients (see Table 2 ). Novel technologies, such as mechanical chest compression devices, were put in place to deliver safe and effective cardiopulmonary resuscitation while limiting hazards to staff. Because many of the COVID-19 ICUs were actually on medical-surgical units that were designed to maximize patient privacy as opposed to the standard ICU high-visibility rooms, they brought in their personal baby monitors from home to facilitate remote monitoring of patients who were susceptible to falls.

3.4.2. Coping adaptations

Participants described multiple coping strategies in order to sustain themselves as they worked throughout the pandemic. Several coped by speaking with other critical care nurses and/or seeking counseling services (see Table 2 ). While many coped by spending time with family, exercise, and rest, some participants coped by avoidance (not watching the news) and depersonalization (referring to the patient as a body). ‘Survival mode’ (e.g. compartmentalizing their work and avoiding discussion of how they were coping with loved ones) was a common description among nurses' descriptions of their coping mechanisms during the pandemic; participants described separating their personal and professional lives and using distraction.

4. Discussion

In this paper we used the SEIPS 2.0 model to frame a description of nurses’ perceptions of the critical care work system, processes, outcomes, and adaptations during the COVID-19 pandemic in the U.S. Critical care nurse participants described taking care of some of the most critically-ill patients despite short staffing, strained resources, constant change, and increased workloads. Participants described multiple barriers and facilitators to care and significant impacts on their patients, critical care nurses, and healthcare systems. Critical care nurse participants adapted patient care and their own coping strategies to sustain themselves in their work during the pandemic. The SEIPS 2.0 model framed the description of how the work system could be improved from the perception of nurses. Human factors engineers can help critical care nurses improve the critical care work system going forward.

The COVID-19 pandemic presents an opportunity for organizations to change ( Davidson and Patch, 2021 ). Carayon and Perry (2021) suggest a five principle human factors and ergonomics approach for healthcare work systems to adapt to the changes brought on by the COVID-19 pandemic. The five principles include: 1) deferring to local expertise, 2) facilitating adaptive behaviors, 3) enhancing interactions between system elements and levels, 4) re-purposing existing processes, and 5) encouraging dynamic continuous learning.

Critical care nurses spend more time than any other healthcare professional with patients ( Butler et al., 2018 ), making them the local experts in critical care work environments. Consequently, nurses can readily identify barriers and facilitators in their work systems. Human factors engineers can partner with nurses and leaders to address their needs. For example, critical care nurse participants in our study indicated re-deploying nurses to help in ICUs without appropriate critical care skills is a barrier to care. Nurses have flocked to travel nursing jobs (where nurses typically work with an external agency to address staffing shortages on a contract basis) since the beginning of the COVID-19 pandemic because of the need for highly-specialized yet flexible nurses. This has created extreme demand for ICU nurses. Therefore, human factors engineers could assist in creating algorithms for a staffing matrix that facilitates selection of ICU-trained nurses within the organization to redeploy into ICU settings when needed, or for multi-hospital healthcare systems to proactively deploy nurses from one hospital to another in anticipation of patient volume surges (with surging COVID-19 rates).

Sharing ideas across organizational departments can facilitate adaptive behaviors in an environment of constant change ( Carayon and Perry, 2021 ). Carayon and Perry (2021) suggest a rapid design-implementation-redesign process, which can be based on the creative ways nurses go about achieving their goals for work. Human factors engineers can work with nurses to understand their complex needs for communication and to help identify solutions ( Carayon and Perry, 2021 ), such as facilitating family video chats remotely (outside the patient room) to reduce PPE usage and communicating with coworkers using technology despite muffling caused by PPE.

Human factors engineers should not just pay attention to individual work systems elements, but also enhance interactions ( Carayon and Perry, 2021 ). Participants in our study shared how constant change in organizational documentation policies made it difficult for nurses to identify documentation tasks required of them, and consequently suggested an alert within the electronic health record to notify of documentation changes. However, alarm fatigue (including documentation task alerts) is a well-known phenomenon in critical care settings where excessive alarms can lead to desensitization and missed alarms ( Sendelbach et al., 2013 ). With this knowledge, human factors engineers and nurses can partake in the rapid design-implementation-redesign process to create alerts within the EHR that meaningfully communicate required documentation tasks.

Carayon and Perry (2021) suggest re-purposing processes that facilitate communication. In our study, nurse participants described a lack of clear communication from leadership regarding PPE supply status as a barrier in the work system. In the early stages of the COVID-19 pandemic, many nurses reported re-using PPE and felt unsafe doing so considering the single use design ( American Nurses Association, 2020 ). Adequate access to PPE is required to ensure safety of healthcare professionals due to repeated exposure to pathogens ( CDC, 2014 ). Therefore, human factors engineers can partner with leaders to communicate PPE status. Many organizations already communicate patient census, staffing, and other pertinent operational information on an electronic dashboard or during a morning leadership huddle, both of which could be amended to include PPE status.

Finally, human factors engineers should partner with not just nurses, but the entire interdisciplinary healthcare team in the work system, to learn their needs in real time to encourage dynamic continuous learning , resilient healthcare systems, and to address patient safety concerns ( Carayon and Perry, 2021 ). For example, one critical care nurse participant in our study shared that their hospital had resorted to opening windows in patient rooms d the peak heat of summer to create a negative pressure effect in response to a lack of available rooms with negative pressure capability. To avoid potential safety concerns regarding heat, nurses, leaders, and human factors engineers can partner with hospital engineers to address patient care needs that are safe for patients and staff.

4.1. Limitations

Limitations of this study include its cross-sectional design with a convenience sample of experienced critical care nurses working primarily day shift. Had this study been conducted at an earlier time during the course of the pandemic, participants may have recalled different details. However, participant recruitment may have been more difficult during peaks throughout the pandemic. Critical care nurses with less work experience may have different experiences and perceptions of working during the COVID-19 pandemic and its impact on nursing care.

4.2. Conclusion

The SEIPS 2.0 model provided a framework to describe nurses' perceptions of the critical care work system, processes, outcomes, and adaptations during the COVID-19 pandemic. Carayon and Perry (2021) suggest a five-principle human factors and ergonomics approach to maximize the adaptations critical care nurses made to their work system during the pandemic. We suggest how human factors engineers can utilize Carayon and Perry's (2021) suggestions to maximize the adaptations critical care nurses made to their work system during the pandemic.

Financial support

This study was supported by the Sigma Theta Tau Beta Mu Dissertation Grant.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Appendix A Supplementary data to this article can be found online at https://doi.org/10.1016/j.apergo.2022.103712 .

Appendix A. Supplementary data

The following is the Supplementary data to this article:

• Aiken L.H., Clarke S.P., Sloane D.M., Sochalski J., Silber J.H. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002; 288 (16):1987–1993. doi: 10.1001/jama.288.16.1987. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Aliyu Sainfer, Norful Allison A., Schroeder Krista, Odlum Michelle, Glica Bonnie, Travers Jasmine L. The powder keg: lessons learned about clinical staff preparedness during the early phase of the COVID-19 pandemic. Am. J. Infect. Control. 2021; 49 (4):478–483. doi: 10.1016/j.ajic.2020.10.014. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• American Hospital Association Hospitals and health systems face unprecedented financial pressures due to covid-19. 2020. https://www.aha.org/guidesreports/2020-05-05-hospitals-and-health-systems-face-unprecedented-financial-pressures-due
• American Nurses Association ANA survey of 14k nurses finds access to ppe remains a top concern. 2020. https://www.nursingworld.org/news/news-releases/2020/ana-survey-of-14k-nurses-finds-access-to-ppe-remains-a-top-concern/
• Bae S.H., Mark B., Fried B. Impact of nursing unit turnover on patient outcomes in hospitals. J. Nurs. Scholarsh. 2010; 42 (1):40–49. doi: 10.1111/j.1547-5069.2009.01319.x. PMID: 20487185. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Brilli R.J., Spevetz A., Branson R.D., Campbell G.M., Cohen H., Dasta J.F., Harvey M.A., Kelley M.A., Kelly K.M., Rudis M.I., St Andre A.C., Stone J.R., Teres D., Weled B.J. The american college of critical care medicine guidelines for the definition of an intensivist and the practice of critical care medicine: critical care delivery in the intensive care unit: defining clinical roles and the best practice model. Crit. Care Med. 2001; 29 (10):2007. doi: 10.1097/00003246-200110000-00026. 2019. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Butler R., Monsalve M., Thomas G.W., Herman T., Segre A.M., Polgreen P.M., Suneja M. Estimating time physicians and other health care workers spend with patients in an intensive care unit using a sensor network. Am. J. Med. 2018; 131 (8):972. doi: 10.1016/j.amjmed.2018.03.015. e9–972.e15. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Carayon P., Perry S. Human factors and ergonomics systems approach to the COVID-19 healthcare crisis. Int. J. Qual. Health Care: J. Int. Soc. Qual. Health Care. 2021; 33 (Supplement_1):1–3. doi: 10.1093/intqhc/mzaa109. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Carayon P., Schoofs Hundt A., Karsh B.T., Gurses A.P., Alvarado C.J., Smith M., Brennan P.F. vol. 15. 2006. Work system design for patient safety: the SEIPS model. (Quality and Safety in Health Care). Issue SUPPL. 1. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Centers for Disease Control COVID data tracker. 2021. https://covid.cdc.gov/covid-data-tracker/#datatracker-home
• Centers for Disease Control 2014. https://www.cdc.gov/hai/prevent/ppe.html
• Cheung R.B., Aiken L.H., Clarke S.P., Sloane D.M. Nursing care and patient outcomes: international evidence. Enfermería clínica. 2008; 18 (1):35–40. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Collins S., Couture B., Kang M.J., Dykes P., Schnock K., Knaplund C., Chang F., Cato K. Annual Symposium Proceedings. AMIA Symposium, 2018. 2018. Quantifying and visualizing nursing flowsheet documentation burden in acute and critical care. AMIA; pp. 348–357. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Davidson P.M., Patch M. Time for a reset and recalibration: healthcare in the post COVID era. Int. J. Nurs. Sci. 2021; 8 (2):143–144. doi: 10.1016/j.ijnss.2021.03.004. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Dedoose. (2020). Los Angeles: SocioCultural Research Consultants, LLC.
• Donabedian A. The quality of care. How can it be assessed? JAMA. 1988; 260 (12):1743–1748. doi: 10.1001/jama.260.12.1743. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Elo S., Kyngas Helvi. The qualitative content analysis process. J. Adv. Nurs. 2007; 62 (1):107–115. [ PubMed ] [ Google Scholar ]
• Forbes D., Kartal D., Lau W., Phelps A.J., O'Donnell M. Phoenix Australia - Centre for Posttraumatic Mental Health; Carlton, Melbourne: 2015. What Are Effective Interventions for Veterans Who Have Experienced Moral Injury? A Rapid Evidence Assessment. Report Prepared for the Australian Government Department of Veterans’ Affairs. [ Google Scholar ]
• Grant M. Resolving communication challenges in the intensive care unit. AACN Adv. Crit. Care. 2015; 26 (2):123–130. doi: 10.1097/NCI.0000000000000076. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hall L.H., Johnson J., Watt I., Tsipa A., O'Connor D.B. Healthcare staff wellbeing, burnout, and patient safety: a systematic review. PLoS One. 2016; 11 (7) doi: 10.1371/journal.pone.0159015. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Holden R.J., Carayon P., Gurses A.P., Hoonakker P., Hundt A.S., Ozok A.A., Rivera- Rodriguez A.J. SEIPS 2.0: a human factors framework for studying and improving the work of healthcare professionals and patients. Ergonomics. 2013; 56 (11):1669–1686. doi: 10.1080/00140139.2013.838643. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hirose M., Nakabayashi N., Fukuda S., Yamaguchi Shuhei M., Igawa M., Egami K., Honda J., Shima H. Additional medical costs due to hospital-acquired falls. J. Patient Saf. 2018; 4 (14):227–233. doi: 10.1097/PTS.0000000000000200. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Huang C., Wang Y., Li X., Ren L., Zhao J., Hu Y., Zhang L., Fan G., Xu J., Gu X., Cheng Z., Yu T., Xia J., Wei Y., Wu W., Xie X., Yin W., Li H., Liu M., Xiao Y., Gao H., Guo L., Xie J., Wang G., Jiang R., Gao Z., Jin Q., Wang J., Cao B. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395 (10223):497–506. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• International Council of Nurses International council of nurses covid-19 update. 2021. https://www.icn.ch/sites/default/files/inline-files/ICN%20COVID19%20update%20report%20FINAL.pdf
• Lincoln Y., Guba E. Naturalistic Inquiry. Sage Publications; Beverly Hills, CA: 1985. Chapter 11: establishing trustworthiness; pp. 289–331. [ Google Scholar ]
• Marshall J.C., Bosco L., Adhikari N.K., Connolly B., Diaz J.V., Dorman T., Fowler R.A., Meyfroidt G., Nakagawa S., Pelosi P., Vincent J.L., Vollman K., Zimmerman J. What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine. J. Crit. Care. 2017; 37 :270–276. doi: 10.1016/j.jcrc.2016.07.015. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• National Academy of Medicine . 2009. Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report. https://www.ncbi.nlm.nih.gov/books/NBK219958/ Retrieved from. [ PubMed ] [ Google Scholar ]
• Moss M., Good V.S., Gozal D., Kleinpell R., Sessler C.N. An official critical care societies collaborative statement-burnout syndrome in critical care health-care professionals: A call for action. Chest. 2016; 150 (1):17–26. doi: 10.1016/j.chest.2016.02.649. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Nursing Solutions Inc. 2019. 2019 National NSI healthcare retention & RN staffing report. https://pdf4pro.com/amp/cdn/2019-national-health-care-retention-amp-rn-staffing-report-5bab3b.pdf [ Google Scholar ]
• Qualtrics Qualtrics xm: the leading experience management software. 2021. https://www.qualtrics.com/
• Reardon P.M., Fernando S.M., Van Katwyk S., Thavorn K., Kobewka D., Tanuseputro P., Rosenberg E., Wan C., Vanderspank-Wright B., Kubelik D., Devlin R.A., Klinger C., Kyeremanteng K. Characteristics, outcomes, and cost patterns of high-cost patients in the intensive care unit. Crit. Care Res. Pract. 2018:5452683. doi: 10.1155/2018/5452683. 2018. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Schroeder K., Norful A.A., Travers J., Aliyu S. Nursing perspectives on care delivery during the early stages of the covid-19 pandemic: a qualitative study. Int. J. Nurs. Stud. Adv. 2020; 2 :100006. doi: 10.1016/j.ijnsa.2020.100006. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Seda G., Parrish J.S. In: Augmenting Critical Care Capacity in a Disaster. Baldisseri E., Reed M.J., Wax R., editors. Elsevier; 2019. [ PubMed ] [ Google Scholar ]
• Sendelbach S., Funk M. Alarm fatigue: a patient safety concern. AACN Adv. Crit. Care. 2013; 24 (4):378–386. [ PubMed ] [ Google Scholar ]
• Shirey M.R. Nursing practice models for acute and critical care: overview of care delivery models. Crit. Care Nurs. Clin. 2008; 20 (4):365–373. doi: 10.1016/j.ccell.2008.08.014. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Sirilla Janet, Thompson Kathrynn, Yamokoski Todd, Risser Mark D., Chipps Esther. Moral distress in nurses providing direct patient care at an academic medical center. Worldviews Evidence-Based Nurs. 2017; 14 (2):128–135. doi: 10.1111/wvn.12213. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Smith M., Carayon-Sainfort P. A balance theory of job design for stress reduction. Int. J. Ind. Ergon. 1989; 4 :67e79. [ Google Scholar ]
• Smith M., Carayon P. In: The International Encyclopedia of Ergonomics and Human Factors. Karwowski W., editor. Taylor and Francis; London: 2001. Balance theory of job design; p. 1181e1184. [ Google Scholar ]

• Open access
• Published: 28 March 2024

Nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care to nursing home residents– a qualitative study

• Rachel Gilbert 1 &
• Daniela Lillekroken   ORCID: orcid.org/0000-0002-7463-8977 1  

BMC Nursing volume  23 , Article number:  216 ( 2024 ) Cite this article

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Metrics details

Over the years, caring has been explained in various ways, thus presenting various meanings to different people. Caring is central to nursing discipline and care ethics have always had an important place in nursing ethics discussions. In the literature, Joan Tronto’s theory of ethics of care is mostly discussed at the personal level, but there are still a few studies that address its influence on caring within the nursing context, especially during the provision of end-of-life care. This study aims to explore nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents.

This study has a qualitative descriptive design. Data were collected by conducting five individual interviews and one focus group during a seven-month period between April 2022 and September 2022. Nine nurses employed at four Norwegian nursing homes were the participants in this study. Data were analysed by employing a qualitative deductive content analysis method.

The content analysis generated five categories that were labelled similar to Tronto’s five phases of the care process: (i) caring about, (ii) caring for, (iii) care giving, (iv) care receiving and (v) caring with. The findings revealed that nurses’ autonomy more or less influences the decision-making care process at all five phases, demonstrating that the Tronto’s theory contributes to greater reflectiveness around what may constitute ‘good’ end-of-life care.

Conclusions

Tronto’s care ethics is useful for understanding end-of-life care practice in nursing homes. Tronto’s care ethics provides a framework for an in-depth analysis of the asymmetric relationships that may or may not exist between nurses and nursing home residents and their next-of-kin. This can help nurses see and understand the moral dimension of end-of-life care provided to nursing home residents during their final days. Moreover, it helps handle moral responsibility around end-of-life care issues, providing a more complex picture of what ‘good’ end-of-life care should be.

Peer Review reports

In recent decades, improving end-of-life care has become a global priority [ 1 ]. The proportion of older residents dying in nursing homes is rising across the world [ 2 ], resulting in a significant need to improve the quality of end-of-life care provided to residents. Therefore, throughout the world, nursing homes are becoming increasingly important as end-of-life care facilities [ 3 ]. As the largest professional group in healthcare [ 4 ], nurses primarily engage in direct care activities [ 5 ] and patient communication [ 6 ] positioning them in close proximity to patients. This proximity affords them the opportunity to serve as information brokers and mediators in end-of-life decision-making [ 7 ]. They also develop trusting relationships with residents and their next-of-kin, relationships that may be beneficial for the assessment of residents and their next-of-kin’s needs [ 8 ]. Moreover, nurses have the opportunity to gain a unique perspective that allows them to become aware of if and when a resident is not responding to a treatment [ 9 ].

When caring for residents in their critical end-of-life stage, nurses form a direct and intense bond with the resident’s next-of-kin, hence nurses become central to end-of-life care provision and decision-making in nursing homes [ 10 ]. The degree of residents and their next-of-kin involvement in the decision-making process in practice remains a question [ 11 ]. Results from a study conducted in six European countries [ 12 ], demonstrate that, in long-term care facilities, too many care providers are often involved, resulting in difficulties in reaching a consensus in care. Although nurses believe that their involvement is beneficial to residents and families, there is a need for more empirical evidence of these benefits at the end-of-life stage. However, the question of who should be responsible for making decisions is still difficult to answer [ 13 ]. One study exploring nurse’s involvement in end-of-life decisions revealed that nurses experience ethical problems and uncertainty about the end-of-life care needs of residents [ 14 ]. Another study [ 10 ] reported patients being hesitant to discuss end-of‐life issues with their next-of-kin, resulting in nurses taking over; thus, discussing end-of-life issues became their responsibility. A study conducted in several nursing homes from the UK demonstrated that ethical issues associated with palliative care occurred most frequently during decision-making, causing greater distress among care providers [ 15 ].

Previous research has revealed that there are some conflicts over end-of-life care that consume nurses’ time and attention at the resident’s end-of-life period [ 16 ]. The findings from a meta-synthesis presenting nurses’ perspectives dealing with ethical dilemmas and ethical problems in end-of-life care revealed that nurses are deeply involved with patients as human beings and display an inner responsibility to fight for their best interests and wishes in end-of-life care [ 17 ].

Within the Norwegian context, several studies have explored nurses’ experiences with ethical dilemmas when providing end-of-life care in nursing homes. One study describing nurses’ ethical dilemmas concerning limitation of life-prolonging treatment suggested that there are several disagreements between the next-of-kin’s wishes and what the resident may want or between the wishes of the next-of-kin and what the staff consider to be right [ 18 ]. Another study revealed that nurses provide ‘more of everything’ and ‘are left to dealing with everything on their own’ during the end-of-life care process [ 19 ] (p.13) . Several studies aiming to explore end-of-life decision-making in nursing homes revealed that nurses experience challenges in protecting the patient’s autonomy regarding issues of life-prolonging treatment, hydration, nutrition and hospitalisation [ 20 , 21 , 22 ]. Other studies conducted in the same context have described that nurses perceive ethical problems as a burden and as barriers to decision-making in end-of-life care [ 8 , 23 ].

Nursing, as a practice, is fundamentally grounded in moral values. The nurse-patient relationship, central to nursing care provision, holds ethical importance and significance. It is crucial to recognise that the context within which nurses practice can both shape and be shaped by nursing’s moral values. These values collectively constitute what can be termed the ethical dimension of nursing [ 24 ]. Nursing ethos and practices are rooted in ethical values and principles; therefore, one of the position statements of the International Council of Nurses [ 25 ] refers to nurses’ role in providing care to dying patients and their families as an inherent part of the International Classification for Nursing Practice [ 26 ] (e.g., dignity, autonomy, privacy and dignified dying). Furthermore, ethical competence is recognised as an essential element of nursing practice [ 27 ], and it should be considered from the following viewpoints: ethical decision-making, ethical sensitivity, ethical knowledge and ethical reflection.

The term ‘end-of-life care’ is often used interchangeably with various terms such as terminal care, hospice care, or palliative care. End-of life care is defined as care ‘to assist persons who are facing imminent or distant death to have the best quality of life possible till the end of their life regardless of their medical diagnosis, health conditions, or ages’ [ 28 ] (p.613) . From this perspective, professional autonomy is an important feature of nurses’ professionalism [ 29 ]. Professional autonomy can be defined based on two elements: independence in decision-making and the ability to use competence, which is underpinned by three themes: shared leadership, professional skills, inter- and intraprofessional collaboration and a healthy work environment [ 30 ].

As presented earlier, research studies have reported that nurses experience a range of difficulties or shortcomings during the decision-making process; therefore, autonomous practice is essential for safe and quality care [ 31 ]. Moreover, autonomous practice is particularly important for the moral dimension in end-of-life care, where nurses may need to assume more responsibility in the sense of defining and giving support to matters that are at risk of not respecting ethical principles or fulfilling their ethical, legal and professional duties towards the residents they care for.

To the best of the researchers’ knowledge, little is known about nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents; therefore, the aim of this study is to explore nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents.

Theoretical framework

Joan Tronto is an American political philosopher and one of the most influential care ethicists. Her theory of the ethics of care [ 32 , 33 , 34 ] has been chosen as the present study’s theoretical framework. The ethics of care is a feminist-based ethical theory, focusing on caring as a moral attitude and a sensitive and supportive response of the nurse to the situation and circumstances of a vulnerable human being who is in need of help [ 33 , 34 , 35 ]. In this sense, nurses’ caring behaviour has the character of a means—helping to reach the goal of nursing practice—which here entails providing competent end-of-life care.

Thinking about the process of care, in her early works [ 32 , 33 , 34 ], Tronto proposes four different phases of caring and four elements of care. Although the phases may be interchangeable and often overlap with each other, the elements of care are fundamental to demonstrate caring. The phases of caring involve cognitive, emotional and action strategies.

The first phase of caring is caring about , which involves the nurse’s recognition of being in need of care and includes concern, worry about someone or something. In this phase, the element of care is attentiveness, which entails the detection of the patient and/or family need.

The second phase is caring for , which implies nurses taking responsibility for the caring process. In this phase, responsibility is the element of care and requires nurses to take responsibility to meet a need that has been identified.

The third phase is care giving , which encompasses the actual physical work of providing care and requires direct engagement with care. The element of care in this phase is competence, which involves nurses having the knowledge, skills and values necessary to meet the goals of care.

The fourth phase is care receiving , which involves an evaluation of how well the care giving meets the caring needs. In this phase, responsiveness is the element of care and requires the nurse to assess whether the care provided has met the patient/next-of-kin care needs. This phase helps preserve the patient–nurse relationship, which is a distinctive aspect of the ethics of care [ 36 ].

In 2013, Tronto [ 35 ] updated the ethics of care by adding a fifth phase of caring— caring with —which is the common thread weaving among the four phases. When care is responded to through care receiving and new needs are identified, nurses return to the first phase and begin again. The care elements in this phase are trust and solidarity. Within a healthcare context, trust builds as patients and nurses realise that they can rely on each other to participate in their care and care activities. Solidarity occurs when patients, next-of-kin, nurses and others (i.e., ward leaders, institutional management) engage in these processes of care together rather than alone.

To the best of our knowledge, these five phases of caring and their elements of caring have never been interpreted within the context of end-of-life care. The ethics of care framework offers a context-specific way of understanding how nurses’ professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents, revealing similarities with Tronto’s five phases, which has motivated choosing her theory.

Aim of the study

The present study aims to explore nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents.

The current study has a qualitative descriptive design using five individual interviews and one focus group to explore nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents.

Setting and participants

The setting for the study was four nursing homes located in different municipalities from the South-Eastern region of Norway. Nursing homes in Norway are usually public assisted living facilities and offer all-inclusive accommodation to dependent individuals on a temporary or permanent basis [ 37 ]. The provision of care in the Norwegian nursing homes is regulated by the ‘Regulation of Quality of Care’ [ 38 ], aiming to improve nursing home residents’ quality of life by offering quality care that meets residents’ fundamental physiological and psychosocial needs and to support their individual autonomy through the provision of daily nursing care and activities tailored to their specific needs, and, when the time comes, a dignified end-of-life care in safe milieu.

End-of-life care is usually planned and provided by nurses having a post graduate diploma in either palliative nursing or oncology nursing– often holding an expert role, hence ensuring that the provision of end-of-life care meets the quality criteria and the resident’s needs and preferences [ 39 ].

To obtain rich information to answer the research question, it was important to involve participants familiar with the topic of study and who had experience working in nursing homes and providing end-of-life care to residents; therefore, a purposive sample was chosen. In this study, a heterogeneous sampling was employed, which involved including participants from different nursing homes with varying lengths of employment and diverse experiences in providing end-of-life care to residents. This approach was chosen to gather data rich in information [ 40 ]. Furthermore, when recruiting participants, the first author was guided by Malterud et al.’s [ 41 ] pragmatic principle, suggesting that the more ‘information power’ the participants provided, the smaller the sample size needed to be, and vice versa. Therefore, the sample size was not determined by saturation but instead by the number of participants who agreed to participate. However, participants were chosen because they had particular characteristics such as experience and roles which would enable understanding how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents.

The inclusion criteria for the participants were as follows: (i) to be a registered nurse, (ii) had a minimum work experience of two years employed at a nursing home, and (iii) had clinical experience with end-of-life/palliative care. To recruit participants, the first author sent a formal application with information about the study to four nursing homes. After approval had been given, the participants were asked and recruited by the leadership from each nursing home. The participants were then contacted by the first author by e-mail and scheduled a time for meeting and conducting the interviews.

Ten nurses from four different nursing homes were invited to participate, but only nine agreed. The participants were all women, aged between 27 and 65 and their work experience ranged from 4 to 21 years. Two participants had specialist education in palliative care, and one was currently engaged in a master’s degree in nursing science. Characteristics of the participants are presented in Table  1 :

Data collection methods

Data were collected through five semistructured individual and one focus group interviews. Both authors conducted the interviews together. The study was carried out between April and September 2022. Due to the insecurity related to the situation caused by the post-SARS-CoV-2 virus pandemic and concerns about potential new social distancing regulations imposed by the Norwegian government, four participants from the same nursing home opted for a focus group interview format. This decision was motivated by a desire to mitigate the potential negative impact that distancing regulations might have on data collection. The interviews were guided by an interview guide developed after reviewing relevant literature on end-of-life care and ethical dilemmas. The development of the interview guide consisted of five phases: (i) identifying the prerequisites for using semi-structured interviews; (ii) retrieving and using previous knowledge; (iii) formulating the preliminary semi-structured interview guide; (iv) pilot testing the interview guide; and (v) presenting the complete semistructured interview guide [ 42 ]. The interview guide was developed by both authors prior to the onset of the project and consisted of two demographic questions and eight main open-ended questions. The interview guide underwent initial testing with a colleague employed at the same nursing home as the first author. After the pilot phase in phase four, minor language revisions were made to specific questions to bolster the credibility of the interview process and ensure the collection of comprehensive and accurate data. The same interview guide was used to conduct individual interviews and focus group (Table  2 ).

The interviews were all conducted in a quiet room at a nursing home. Each interview lasted between 30 and 60 min and were digitally recorded. The individual interviews were transcribed verbatim by the first author. The focus group interview was transcribed by the second author.

Ethical perspectives

Prior to the onset of the data collection, ethical approval and permission to conduct the study were sought from the Norwegian Agency for Shared Services in Education and Research (Sikt/Ref. number 360,657) and from each leader of the nursing home. The study was conducted in accordance with the principles of the Declaration of Helsinki of the World Medical Association [ 43 ]: informed consent, consequences and confidentiality. The participants received written information about the aim of the study, how the researcher would ensure their confidentiality and, if they chose to withdraw from the study, their withdrawal would not have any negative consequences for their employment at nursing homes. Data were anonymised, and the digital records of the interviews were stored safely on a password-protected personal computer. The transcripts were stored in a locked cabinet in accordance with the existing rules and regulations for research data storage at Oslo Metropolitan University. The participants did not receive any financial or other benefits from participating in the study. Written consent was obtained prior to data collection, but verbal consent was also provided before each interview. None of the participants withdrew from the study.

Data analysis

The data were analysed by employing a qualitative deductive content analysis, as described by Kyngäs and Kaakinen [ 44 ]. Both researchers independently conducted the data analysis manually. The empirical data consisted of 63 pages (34,727 words) of transcripts from both individual and focus group interviews. The deductive content analysis was performed in three steps: (i) preparation, (ii) organisation and (iii) reporting of the results.

During the first step—preparation—each researcher, individually, read the transcripts several times to get an overview of the data and select units of analysis by searching for recurring codes and meanings and to carefully compare the similarities and differences between coded data. These codes were labelled independently by both researchers and placed into an analysis matrix.

During the next step—organisation—the researchers met and discussed and then compared and revised the labels several times until they agreed about the preliminary findings. During the interpretative process towards developing an understanding of the empirical data, the content of the labels referred to nurses’ perceptions about how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents, revealing similarities with the five phases of Tronto’s theory of ethics of care [ 32 , 33 ], thus assigning them to the five phases of the theory. Following this final refinement, one main category and five categories, each supported by several subcategories, were identified, as presented in Table  3 .

Reporting the results was the last step in the analysis. To enhance the understanding of the study’s findings, the findings are presented with supporting excerpts from the participants.

In qualitative studies, trustworthiness is the main parameter for appraising the rigour of the study [ 45 ]. To enhance the trustworthiness of the study, four criteria—credibility, transferability, dependability and confirmability, as described by Lincoln and Guba [ 46 ]—were applied.

To support credibility, a detailed description of the sample and the sampling process was provided. Furthermore, the interview guide and the questions that the participants were asked during the interviews are made available to the readers. Moreover, although the data were collected from five individual interviews and one focus group, triangulation of two data collection methods allowed researchers to ensure that the study is based on diverse perceptions and experiences, strengthening the credibility and impact of the study’s findings [ 47 ].

Detailed information about the sample and setting supports the assessment of the transferability of the findings. In this way, the readers can recognise and evaluate whether the findings would be applicable to similar contexts with a similar sample. Quotes from the participants’ statements are given to support the findings. Each quote ends with a number representing the code that each nurse was given before conducting the interviews (i.e., Participant in interview 1, PI1 or participant 6 in focus group interview, P6FG).

To increase dependability, the same interview guide was used to ask all participants the same questions. Dependability was also increased by the researchers reading and analysing the interviews independently and then checking the consistency of the data analysis technique with each other and discussing the analytical process until a consensus was reached.

To enhance confirmability, excerpts from the participants’ statements were included when presenting the findings, thus verifying the concordance of findings with the raw data. This demonstrates that the data were not based on preconceived notions.

Trustworthiness was also supported by member checking, meaning that the researchers sent the participants the transcripts of the interviews immediately after data collection; then, the interviews were transcribed. The participants were asked to review the transcripts and check the accuracy of the data; hence, they had the opportunity to add, remove or clarify their statements. Only one participant answered this request, stating that the transcripts were accurate, and she did not have any further comments. Despite encountering a suboptimal response from participants, the authors remain confident in the trustworthiness of the study. Rich data, derived from a combination of individual and focus group interviews, yielded diverse and nuanced responses from participants, reinforcing the credibility of the findings.

Reflexivity is the researcher’s reflection on their position during the research process [ 48 ]. Both researchers have clinical experience in providing end-of-life care to nursing home residents. Therefore, it was critical to be aware of the impact that their clinical backgrounds might have on the research process from information seeking during the analysis of data and discussion of the findings. To avoid early interpretation of the data, the researchers were aware of their preunderstanding and tried to put it on hold. Both authors engaged in discussions regarding apprehensions and reflections, actively participating in the triangulation process throughout the study to prevent potential bias during data collection, analysis, and interpretation. The theoretical framework was brought in the end of the analysis process, which helped label the emerged findings.

The analysis of the empirical data combined with an ethical reflection helped researchers to identify and understand the moral dimension of nurses’ experiences with end-of-life care provided to nursing home residents. During the analysis, an overarching category emerged– ‘The moral dimension of the provision of end-of life care’– describing nurses’ perceptions about how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents. The participants agreed that end-of-life care is a care process that undergoes several phases, with each phase having its own ethical quality or its own element of care, here according to Tronto’s moral qualities [ 34 ]. In the following section, the findings are described using Tronto’s identified moral qualities for each of the five phases of the care process [ 32 , 33 , 34 , 35 ].

Caring about—being attentive

For the participants, being autonomous was perceived as a feature that increased their awareness of the resident’s caring needs during their last days of life. The participants agreed that the caring process involves paying attention, listening and recognising residents’ unspoken needs. Moreover, it implies nurses being able to make autonomous decisions when deciding which needs to care about at one particular moment.

The participants agreed that the core values of providing end-of-life care were to alleviate suffering, maintain dignity and provide comfort care. The participants perceived caring about as having sufficient knowledge, along with the experience and autonomy in practice, as well as providing comprehensive end-of-life care for residents. For the participants, caring about during the end-of-life process means them being present and dedicated. This implies nurses carefully observing, autonomously acting, and making decisions based on their judgements, and thus, they can decide and choose their course of action promptly based on resident’s condition or side effects. Moreover, caring about involved participants being attentive to perceiving the residents’ needs when the residents could no longer articulate themselves. The participants expressed their worries about resident’s bodily deterioration, leading them to lose their ability to express needs, as shown by the following quote:

There is not much communication when residents go into their last stage of life. Well… some of them are consciously until their death, but most are sedated; therefore, it is necessary to use your knowledge and experience to assess not only their needs for food and liquids or bodily hygiene, but also, we have to monitor their response to pain killers and other medication, and if it’s too much or too little, we need to do what’s needed to reduce or increase the medication and not let them suffer (PI3).

Some of the participants expressed that attentiveness to the residents’ care needs was a skill based on their clinical gaze developed during their careers. Other participants discussed that building a close relationship with the residents while they still could walk and talk was a precondition that helped them develop a clinical gaze, hence facilitating the nurses’ being attentive. Attentiveness allowed the participants to do what was needed when knowing the residents’ needs during the provision of end-of-life care. This may be interpreted as the moral or ethical quality of caring about during the end-of-life caring process, as demonstrated by the following statement:

We have time to know the resident before their health condition worsens… We previously knew what they wanted and how they wanted… their stay at nursing home gives us the opportunity to know their preferences and needs. Morally, we are obliged to provide the same quality of care they received when they could express themselves (PI4).

Caring for—taking responsibility

According to several participants, another phase within the end-of-life caring process was taking responsibility to care for. The participants agreed that monitoring the residents in their last days implies assuming responsibility. Assuming responsibility was perceived as an autonomous caring activity. They also discussed taking this responsibility seriously, which is a moral dimension of the end-of-life caring process and, ultimately, of the nursing profession. Usually, this responsibility was taken by a nurse, but it also involved other healthcare personnel or even next-of-kin. Among these responsibilities, the participants mentioned that the end-of-life caring process included not only caring for the resident’s physiological and psychosocial needs, but also assigning permanent healthcare personnel to continuously monitor the resident. Although the participants were aware that they share responsibilities for the caring process, ‘who does what…’, they ultimately had the overall responsibility for the whole end-of-life caring process.

Another responsibility included communication, which included listening, providing information, and supporting the residents’ next-of-kin. One of the participants expressed this as follows:

When I observe that the resident’s health worsens, I inform the next-of-kin and invite the spouse or the children to a meeting together with the responsible doctor and I, and we inform the next-of-kin what they might expect. The end-of-life care is not only about the resident and their last days, but also is to care for their next-of-kin to meet their needs and to overcome guilt feelings, anger or sadness.… (PI1).

Another way to care for patients was to deliberately increase opportunities to exercise autonomy during the caring process. For instance, the focus group participants discussed issues around advanced life support during the resident’s last days of life. Being prepared and having knowledge were the preconditions that gave them the authority to identify and make decisions about residents’ needs in here-and-now moments, hence exercising their autonomy. Some participants shared their experiences with controversies between next-of-kins’ and nurses’ assessments of what is the best care for the residents during their last days of life. Therefore, the importance of taking the initiative to discuss and clarify the resident’s needs and preferences was emphasised during the focus group interview, as shown in the following quote:

Some next-of-kins express wishes for advance life support and hospitalisation for their loved ones… and sometimes, to meet their needs, we try this, but the resident is suffering. The resident comes back to us after one or two days… To avoid this, clear guidelines, and a dialogue between the resident, their next-of-kin and us at the very beginning [when the resident enters the nursing home] is important… I think that minimalising the occurrence of difficult or conflictual situations and relieving the sufferance is care for both resident and their next-of-kin (P8FG).

Care giving—knowing what, why, how and when

During the interviews, the participants also discussed the caregiving process and provided concrete examples of what their caregiving encompassed. Spending extra time with the resident, choosing to be in the room and holding their hand to maintain physical contact was perceived as an autonomous caring act and a deliberate choice. One participant described this as follows:

For me, it is important that the dying person feels or hears that I am here with him or her… how he or she feels in these moments matters to me. I do it because I want to do it.… (PI5).

Other participants said that being autonomous when they actually provided caregiving to residents helped them make continuous assessments based on knowledge about what , how , how much , when and why to care. Knowledge and skills were decisive factors in providing competent care and making autonomous decisions during the caregiving phase; hence, competence was perceived as a moral dimension of caregiving. One of the participants said the following:

Caregiving at end-of-life is not only about giving morphine according to the doctor’s prescription… it involves all the judgements you have to make, all the skills you have… from preventing the occurrence of bedsores to knowing when to stop feeding but preventing thirst… think about all this knowledge and experience you must have to be able to make autonomous bedside judgements about when , why and so on.… (PI2).

Care giving at the end-of-life was described as all the necessary activities a nurse does to provide comfort and compassionate care to a dying resident. Among these activities, providing fundamental care and keeping residents comfortable and free of pain were seen as parts of the caregiving process. Moreover, adequate pain relief and symptom management were described as the moral dimension of care giving at this stage of end-of-life care, as one of the participants from the focus group interview said:

You cannot be passive when you see that the resident is suffering. I cannot go home and think that I should have done one or the other. It is against the nurses’ code of ethics and my personal moral and ethical principles. You have to act… I have to do what is needed… first thing first… pain relief and then personal hygiene! (P9FG)

Some of the participants mentioned some challenges they encountered during the care giving process. They said that care giving implies also standing in demanding situations. The lack of healthcare personnel with necessary knowledge or formal palliative care education or handling ethical dilemmas was seen as demanding situations that influenced the provision of care giving. Most of the participants felt that they were alone during the decision-making processes, which increased their awareness of their professional autonomy:

Sometimes, during weekends or evenings, I am the only nurse among the healthcare staff, and I have an overall responsibility for all nursing home residents. I have to prioritise who gets my attention and who needs me the most. Things can happen, regardless of whether it is Friday evening or weekend. I have to make a decision and do what is needed: to be with the dying resident and to support his or her next-of-kin in that moment. (PI5)

Care receiving—assessing caregiving

Several participants stated that, during the care-giving process, it was important to assess how the resident receive the care provided at the end-of-life stage. This was possible by monitoring the resident’s state of being but to also assess the outcomes of their care giving activities. They also reflected on their assessments and how they subsequently dealt with those assessments.

All the participants were confident in their knowledge and with their care giving at the end-of-life stage. They were aware that their care activities had consequences for the residents’ physiological and psychosocial needs. The assessment of the resident’s state of being was made by nurses listening, observing and interpreting resident’s response to care giving as signs of comfort or discomfort. One of the participants explained this as follows:

When providing personal care, if the resident presents any signs that can be interpreted as discomfort, I think that priority number one is me not causing more pain or suffering. However, I also understand that this person needs more pain killers, so I have to make sure that this person receives adequate medicine. (PI5)

Some participants also discussed the importance of assessing their care giving activities. They mentioned the importance of their assessments of the benefits of all care giving against the burden of all interventions and treatments. Their professional autonomy allowed them to make decisions about how to eschew care giving that was inappropriately and burdensome and choose the best comforting care for the resident. The participants stated that knowledge and experience were important in making such decisions, and their professional autonomy facilitated making choices of the best and less burdensome care giving. One of the participants said the following:

We have to assess whether the care giving provided meets the resident’s needs or not, whether the care comforts or perceives it as a burden and how the resident responds to this provision of care. (PI4)

During the interviews, some of the participants revealed a feeling of guilt when assessing that care giving altered the resident’s state of being, thus leading to new needs for care. They also discussed that the moral obligation and intention to relieve the suffering of the resident should override the foreseen but unintended harmful effects of care giving, including medication or other care interventions. One of the participants shared her experience as follows:

I still remember the attitude some of us had for a while ago… too much or too often morphine depresses the respiration and leads to death… I was struggling with feelings of guilt and even moral distress when I observed residents were still suffering because the medication they received had little or maybe no effect. I called the doctor and explained the situation… usually, the experienced doctors listen to us… and he [the doctor] prescribed more morphine.… (PI3).

Documentation of the response to care giving was also an issue discussed during the interviews. Some participants emphasised the importance of keeping detailed reports for a proper assessment of the care giving and medication and its outcomes. All reports were digitally written. Informal discussions between nurses and next-of-kin were also documented, especially when next-of-kin evaluated the care their loved ones received. The participants indicated that the more written information there was, the better. One participant acknowledged the following:

There is no such thing as ‘too much information’… being open about the morphine’s side effects and what to expect in the next hours or days is important for them [next-of-kin]. It helps them understand that end-of-life care is a process, not a quick fix procedure. (PI5)

Caring with—It is a teamwork process

During the interviews, most of the participants reflected upon the end-of-life caring process and its occurrence within the context of care in nursing home. The participants discussed that end-of-life care is not only about the responsibilities nurses have towards residents and their next-of-kin, but also the responsibilities of others who may influence the caring process. They perceived the caring process as an interplay between residents, next-of-kin, and themselves, along with how they relate to each other, which influences the caring process. However, as several participants asserted, this process did not occur in a vacuum: it occurred within an organisational context, which then influenced the caring process from the very beginning. One participant emphasised the importance of stable healthcare personnel within a caring organisation:

High staff turnover does not facilitate good end-of-life caregiving. Both residents and their next-of-kin need continuity and predictability in caring for and among healthcare personnel. They need somebody they know and trust… being exposed to new people every day increases their stress levels. (PI1)

Other participants discussed the importance of the leadership style and how the leader’s support influenced the culture of end-of-life care at the ward. The participants revealed that, within a caring context where their natural potential was enhanced through an enabling leadership style, they felt that they could provide competent and compassionate end-of-life care. One of the participants from the focus group stated that a positive leadership style supports nurses’ professional autonomy, thus helping them control the caring process, to have independence and to increase their ability to make clinical decisions and competent judgements regarding resident’s end-of-life care. One participant shared her experience as follows:

My leader gives me the freedom to make decisions when it comes to deciding what is best for the resident… She [the leader] enables me to be autonomous during the caring process, and this makes me aware of what and how to care.… (PI2).

The participants from the focus group interview also discussed how the nursing home’s caring culture influences care practice. They perceived the nursing home’s caring culture as positive, enabling good end-of-life care but also defective and an obstacle to care. They emphasised the importance of providing dignifying end-of-life care for residents. During the focus group interview, two of the participants engaged in a dialogue:

End-of-life care is providing care to the most vulnerable people, and it should be dignified… To do so, I have to provide care in a ‘caring room’ filled with dignity. (P7FG) Although next-of-kin and I have different perspectives of what good end-of-life care might be, we care together, we are a caring team which ensures in our own way that the resident receives competent care.… Yes, you [P7] mentioned this ‘caring room’… maybe we should open the door more often into this room and invite next-of-kin. (P6FG)

The aim of the present study was to explore nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents. In the following, we discuss these perceptions in relation to Tronto’s [ 32 , 35 ] ethics of care framework and other supporting literature. To identify the moral dimension of these perceptions, we have related them to the moral qualities corresponding to each phase of the care process, as described by Tronto [ 33 , 35 ].

In the first phase of the care process—caring about—the participants discussed the importance of being attentive to which type of care needs to be provided, which is the moral quality of the first phase of care. Similar to findings from another study [ 49 ], findings from the present study revealed that some participants perceived autonomous practice as carrying out actions based on their decisions. Caring about entails detecting the resident’s needs, hence obliging nurses to ‘do something’ [ 50 ]. This particular skill was seen as an autonomous caring activity, that is, the nurses’ deliberate choice of putting on hold their self-interest and/or agenda and ‘a capacity genuinely to understand the perspective of the other in need’ [ 35 ] (p.34) , here nursing home resident.

In Tronto’s view [ 33 ], nurses’ attentiveness contributes to building up a caring relationship with a patient. The findings from the current study reveal that nurses perceived the provision of competent and compassionate end-of-life care as a result of their clinical gaze developed through certain activities, attitudes and knowledge of the patient, and through mutual relationships between the residents, next-of-kin and them. These results are supported by findings from previous studies that emphasise the importance of the nurse’s past experiences with the resident [ 51 ] and the significance of developing a good relationship with the resident and their next-of-kin [ 8 , 23 , 52 , 53 , 54 ] to provide adequate care. Moreover, similar to findings from other studies [ 55 , 56 ], the present study reveal that, to respond to the resident’s end-of-life care needs, nurses must bring not only their professional knowledge, clinical experience and ability to work autonomously but even ethical sensitivity. These findings enforce Gastman’s [ 50 ] view on caring, in which caring should respond to the patient’s care needs. This involves nurses having empathy, capacity of judgement and the ability to see what is required in a specific situation (here, end-of-life care), which, according to Gastmans [ 50 ], is inherent in the moral dimension of nursing practice.

The second phase of care—caring for—refers to nurses taking on the burden of meeting the needs identified in the first phase, that is, caring about. There was no ambiguity, and the participants had no doubts regarding who had the responsibility for the provision of end-of-life care to nursing home residents. The nurses’ responsibility was seen as a moral dimension of care. In line with Pursio et al.’s study [ 30 ], the present findings indicate that the freedom to make patient care decisions and work independently has a positive impact on the moral dimension of end-of-life care for nursing home residents. However, nurses’ work was not only about meeting residents’ needs, but also to create a safe milieu, a communicative space together with each other and with the resident’s next-of-kin, thus sharing power and control over the care process. Similar findings are displayed in an integrative literature review [ 53 ], demonstrating that a positive culture of collaborative and reciprocal relationships, a willingness to engage and become engaged and nurses communicating with intent to share and support rather than inform all lead to facilitating decision-making in nursing homes. According to Tronto [ 35 ], to facilitate end-of-life decision-making, nurses must take the initiative to allocate responsibilities; otherwise, the nurses withdraw themselves from their responsibility. By exercising their professional autonomy to assign responsibilities, nurses strive to mitigate the power imbalance among residents, their next-of-kin, and themselves, thereby preventing the occurrence of potential power struggles in their relationships [ 34 ]. This proactive approach helps prevent the emergence of end-of-life care dilemmas that could undermine the moral dimension of end-of-life care.

The third phase of care—care giving—requires, according to Tronto [ 35 ], the moral quality of nurses’ competence, meaning nurses directly engaging with care. The findings revealed that the nurses provided end-of-life care, and to do so, they needed to have competence, which implies the nurses having the knowledge, skills and values necessary to know what, why, how and when to provide end-of-life adequately. In addition, good end-of-life care requires the competence to individualise care—to provide competent care based on the resident’s physical, psychological, cultural and spiritual needs [ 57 ] while considering the resident’s context of care. Nurses’ competence is crucial for their autonomy; however, to effectively utilize their competence, nurses must be capable of assessing care needs and responding promptly [ 30 ]. Otherwise, delays in assessing residents’ care needs could undermine the moral dimension of end-of-life care. To provide individualised competent care, it is necessary that nurses make continuous assessments. As the findings reveal, the nurses were concerned with providing competent care, that is, adequate pain management. If the care provided was incompetent and led to more pain for the resident, the nurses perceived psychological distress—a state of being that resulted in response to a variety of moral events—leading to the nurses feeling anger, frustration, guilt, powerlessness and stress [ 58 ]. According to Tronto [ 34 ] (p.17) , ‘incompetent care is not only a technical problem, but a moral one’; however, as the findings reveal, the provision of competent care also depends on the nurses’ ability to prioritise decision-making when standing alone. Although nurses’ professional autonomy enabled them to make decisions and choose the right what , how , how much , when , and why , the lack of adequately educated healthcare personnel make the decision-making process a technical problem, which could weaken the moral dimension of end-of -life care.

The fourth phase—care receiving—involves the moral quality responsiveness. This means nurses being responsive to the reaction of the nursing home residents to end-of-life care process. As the findings have revealed, nursing home residents are vulnerable to nurses’ act of care or lack of care. According to Gastmans [ 59 ], care is a reciprocal practice that occurs within the framework of a relationship between the care provider (nurse) and care receiver (resident). The reciprocity consists of nurses assessing that the care provided actually meets the resident’s needs for pain management and other physiological and spiritual needs. The nurses had to make autonomous end-of-life care decisions to meet the resident’s needs. This involved the nurse’s attention to care giving to not be perceived as power abuse, which could have negative consequences for the moral dimension of end-of-life care provision.

According to Tronto [ 33 ], vulnerability may lead to unequal relationships where power abuse may occur. Nursing home residents are in a vulnerable position because they rely on nurses’ competence and ability to alleviate suffering and assess and reassess the residents’ responsiveness to pain management. To avoid an unequal relationship between resident and nurse, nurses must assess whether the care provided is competent or incompetent. Besides assessing and documenting the care provided and its outcomes, informal discussions between the resident’s next-of-kin and nurses were also assessed as important for next-of-kin perceiving a balanced power and equal position within the relationship. However, because each end-of-life act of care may alter the resident’s state of being, responsiveness requires more attentiveness [ 34 ]. Nurses must therefore meet the resident’s new needs for care with compassion and a commitment to maintaining the highest quality of life throughout the evolving stages of the resident’s end-of-life journey.

The final phase of care—caring with—requires that solidarity and trust are the foundation of all care giving to meet caring needs [ 35 ]. The moral quality of this caring phase is solidarity. The findings from the present study suggest that the nurses felt solidarity with both the residents and their leaders. The nurses felt that they were given the support and freedom to act autonomously when making decisions regarding end-of-life care, but similar to findings from a previous study [ 22 ], they also recognised the impact that organisational factors, such as leadership and care culture, may have on the justice and equality of the care provided when they prioritise care to whom needed it the most. Similar to findings from another study [ 49 ], participants in the present study described autonomy as the ability to make independent decisions and prioritise care for those who needed it most. However, according to Tronto [ 35 ], all nurses have a responsibility to help determine how care activities and responsibilities should be allocated. Residents, their next-of-kin and other healthcare personnel may have different views on how they may perceive appropriate, compassionate and dignified end-of-life care [ 20 , 21 ].Therefore, it is important to have transparency in nurse–resident–next-of-kin relations if the element of power within the relationship should be replaced by trust. Otherwise, the nurses’ autonomy may negatively influence the moral dimension of end-of-life care provided to nursing home residents. By opening the door of the “caring room” and inviting next-of-kin to participate in the care process, nurses may contribute to a greater reflectiveness around what may constitute ‘good’ end-of-life care.

Strengths and limitations

One of the strengths of the study is the use of Joan Tronto’s theory of the ethics of care [ 32 , 34 , 35 ] and its five phases and elements of care to discuss the study’s findings. This allows a deeper understanding of how nurses’ professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents. Another strength lies in the utilisation of two distinct methods of data collection: individual and focus group interviews. These approaches provided diverse datasets that shed light on various aspects of how nurses’ professional autonomy impacts the moral dimension of end-of-life care. Furthermore, the inclusion of participants with varying work experiences from four nursing homes enhances the richness and depth of the data generated from the interviews, further strengthening the quality of the study. Member checking ensures that the researcher’s interpretations accurately reflect the participants’ experiences and perspectives, thereby enhancing the validity of the study. This practice can be considered one of the methodological strengths of the study.

The current study has also some limitations that need to be considered. First, a limitation may be related to the size of the participant sample. The sample consisted of only nine nurses, a number that may be seen as a limitation in data collection. To challenge this limitation, the researchers posed follow-up questions during the interviews, thus offering the participants the opportunity to provide rich descriptions of their experiences with end-of-life care. Even though the sample consisted of only nine nurses, these participants reflected on and described their everyday work experiences. The participants’ rich descriptions were evaluated as possessing sufficient information power [ 41 ], thereby enhancing the overall quality of dialogues during interviews– a notable strength.

Second, the findings are limited to these nine participants and their personal work experiences in four different Norwegian nursing homes. This means that the sample is small and context dependent, which may limit the transferability and generalisability of the findings.

A third limitation pertains to the potential influence of the chosen theoretical framework on researchers’ preunderstanding during data analysis. To avoid bias, the theoretical framework was introduced at the end of the data analyses and after the coding process was conducted. The theoretical framework contributed to situating the knowledge from the empirical data into theoretical knowledge and vice versa. However, to be certain about interpretations and knowing that the qualitative nature of the study cannot completely exclude the impact of the preunderstanding on the analysis of the data, both researchers were aware of their theoretical preunderstanding and tried not to make conclusions beforehand.

The ethics of care framework provides opportunities for nurses to analyse their own caring activities during the provision of end-of-life care to nursing home residents. The exploration of the moral dimension of the provision of end-of-life care, utilising Tronto’s theory, revealed that moral qualities, such as attentiveness, responsibility, competence, responsiveness, and solidarity are influenced to a certain extent by nurses’ autonomy. What is crucial for the provision of competent end-of-life care is the nurses’ awareness of acting properly in accordance with the moral qualities to each of the phases of caring. Therefore, to provide competent end-of-life care nurses must be attentive to residents’ care needs, take on the responsibility for the care provided to ensure that residents’ needs are met, provide competent care based on knowledge, skills and values and assess how residents respond to the care provided. In other words, this is the basic nursing process in action, and this problem-solving approach is needed for the provision of competent end-of-life care.

Data availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at Oslo Metropolitan University.

Abbreviations

Participant in interview [number of the individual interview

Participant [number] in Focus Group interview

World Health Organization. Palliative Care. Key Facts. 2020. https://www.who.int/palliativecare/en/ . Accessed 13 February 2023.

Broad JB, Gott M, Kim H, Boyd M, Chen H, Connolly MJ. Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential aged care settings in 45 populations, using published and available statistics. Int J Public Health. 2013;58(2):257–67.

Article   PubMed   Google Scholar  

Hoben M, Chamberlain SA, Knopp-Sihota JA, Poss JW, Thompson GN, Estabrooks CA. Impact of symptoms and Care practices on nursing home residents at the end of life: a rating by front-line Care Providers. JAMDA. 2016;17(2):155–61.

PubMed   Google Scholar  

World Health Organization. Nursing and midwifery. Key Facts. 2022. https://www.who.int/news-room/fact-sheets/detail/nursing-and-midwifery . Accessed 22 February 2023.

Westbrook JI, Ampt A. Design, application and testing of the Work Observation Method by activity timing (WOMBAT) to measure clinicians’ patterns of work and communication. Int J Med Inf. 2009;78(Suppl 1):S25–33.

Article   Google Scholar  

Munyisia EN, Yu P, Hailey D. How nursing staff spend their time on activities in a nursing home: an observational study. J Adv Nurs. 2011;67(9):1908–17.

Hernández-Marrero P, Fradique E, Pereira SM. Palliative care nursing involvement in end-of-life decision-making: qualitative secondary analysis. Nurs Ethics. 2019;26(6):1680–95.

Bollig G, Gjengedal E, Rosland JH. They know!-Do they? A qualitative study of residents and relatives views on advance care planning, end-of-life care, and decision-making in nursing homes. Palliat Med. 2016;30(5):456–70.

Dillworth J, Dickson VV, Mueller A, Shuluk J, Yoon HW, Capezuti E. Nurses’ perspectives: hospitalized older patients and end-of-life decision-making. Nurs Crit Care. 2016;21(2):e1–11.

Shimada C, Hirayama R, Wakui T, Nakazato K, Obuchi S, Ishizaki T, Takahashi R. Reconsidering long-term care in the end-of-life context in Japan. Geriatr Geront Int. 2016;16(S1):132–9.

Low LPL. Decision-making experiences and patterns in Residential Care homes for older residents, Family members and Care Providers. In: Grazia DO, Antonio G, Daniele S, editors. Gerontology. Rijeka: IntechOpen; 2018.

Google Scholar  

ten Koppel M, Pasman HRW, van der Steen JT, van Hout HPJ, Kylänen M, Van den Block L, et al. Consensus on treatment for residents in long-term care facilities: perspectives from relatives and care staff in the PACE cross-sectional study in 6 European countries. BMC Palliat Care. 2019;18(1):73.

Article   PubMed   PubMed Central   Google Scholar  

Paganini MC, Bousso RS. Nurses’ autonomy in end-of-life situations in intensive care units. Nurs Ethics. 2015;22(7):803–14.

Odachi R, Tamaki T, Ito M, Okita T, Kitamura Y, Sobue T. Nurses’ experiences of End-of-life care in Long-Term Care hospitals in Japan: balancing improving the quality of life and sustaining the lives of patients dying at hospitals. Asian Nurs Res (Korean Soc Nurs Sci). 2017;11(3):207–15.

Muldrew Née Preshaw DH, McLaughlin D, Brazil K. Ethical issues experienced during palliative care provision in nursing homes. Nurs Ethics. 2019;26(6):1848–60.

Munn JC, Dobbs D, Meier A, Williams CS, Biola H, Zimmerman S. The end-of-life experience in long-term care: five themes identified from focus groups with residents, family members, and staff. Gerontologist. 2008;48(4):485–94.

Karlsson M, Berggren I, Kasén A, Söderlund M. A qualitative Metasynthesis from nurses’ perspective when dealing with ethical dilemmas and ethical problems in end-of-Life Care. Int J Hum Caring. 2015;19(1):40–8.

Gjerberg E, Førde R, Pedersen R, Bollig G. Ethical challenges in the provision of end-of-life care in Norwegian nursing homes. Soc Sci Med. 2010;71(4):677–84.

Svendsen SJ, Landmark BT. Dying patients in nursing homes: nurses provide more of everything and are left to deal with everything on their own. Sykepleien Forskning. 2017;12:e63396.

Dreyer A, Forde R, Nortvedt P. Autonomy at the end of life: life-prolonging treatment in nursing homes—relatives’ role in the decision-making process. J Med Ethics. 2009;35(11):672.

Article   CAS   PubMed   Google Scholar  

Dreyer A, Førde R, Nortvedt P. Life-prolonging treatment in nursing homes: how do physicians and nurses describe and justify their own practice? J Med Ethics. 2010;36(7):396.

Dreyer A, Førde R, Nortvedt P. Ethical decision-making in nursing homes: influence of organizational factors. Nurs Ethics. 2011;18(4):514–25.

Bollig G, Schmidt G, Rosland JH, Heller A. Ethical challenges in nursing homes–staff’s opinions and experiences with systematic ethics meetings with participation of residents’ relatives. Scand J Caring Sci. 2015;29(4):810–23.

Scott PA. Nursing and the ethical dimension of practice. In: Scott PA, editor. Key concepts and issues in nursing Ethics. Cham: Springer International Publishing; 2018.

2021; Code of Ethics for Nurses. International Council of Nurses (ICN), Geneva. https://www.icn.ch/sites/default/files/2023-04/ICN_Code-of-Ethics_EN_Web_0_0.pdf . Accessed 5 March 2023.

2017; International Classification for Nursing Practice (ICNP), Geneva. https://www.icn.ch/sites/default/files/inline-files/Palliative_Care.pdf .

Poikkeus T, Numminen O, Suhonen R, Leino-Kilpi H. A mixed-method systematic review: support for ethical competence of nurses. J Adv Nurs. 2014;70(2):256–71.

Izumi S, Nagae H, Sakurai C, Imamura E. Defining end-of-life care from perspectives of nursing ethics. Nurs Ethics. 2012;19(5):608–18.

Ohnsorge K, Keller HR, Widdershoven GA, Rehmann-Sutter C. Ambivalence’ at the end of life: how to understand patients’ wishes ethically. Nurs Ethics. 2012;19(5):629–41.

Pursio K, Kankkunen P, Sanner-Stiehr E, Kvist T. Professional autonomy in nursing: an integrative review. J Nurs Manag. 2021;29(6):1565–77.

Kramer M, Schmalenberg C. The practice of clinical autonomy in hospitals: 20 000 nurses tell their story. Crit Care Nurse. 2008;28(6):58–71.

Fisher B, Tronto JC. Towards a Feminist Theory of Care. In: Abel E, Nelson M, editors. Circles of care. Albany, NY: SUNNY; 1990.

Tronto JC. Moral boundaries: a political argument for an Ethic of Care. 1st ed. New York: Routledge; 1993.

Tronto JC. An Ethic of Care. Generations: J Am Soc Aging. 1998;22(3):15–20.

CAS   Google Scholar  

Tronto JC. Caring democracy: markets, Equality, and Justice. NYU; 2013.

Edwards SD. Is there a distinctive care ethics? Nurs Ethics. 2011;18(2):184–91.

Jacobsen FF, Mekki TE. Health and the Changing Welfare State in Norway: a Focus on Municipal Health Care for Elderly Sick. Ageing Int. 2012;37:125–42.

Norwegian Ministry of Health and Care Services. Forskrift om kvalitet i pleie - og omsorgstjenestene (Regulation on quality of care). 2003. [In Norwegian]. https://lovdata.no/dokument/SF/forskrift/2003-06-27-792 . Accessed 20 February 2023.

Mæhre KS, Bergdahl E, Hemberg J. Patients’, relatives’ and nurses’ experiences of palliative care on an advanced care ward in a nursing home setting in Norway. Nurs Open. 2023;10(4):2464–76.

Polit DF, Beck CT. Nursing research: generating and assessing evidence for nursing practice. 11th ed. Philadelphia: Wolters Kluwer; 2021.

Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by Information Power. Qual Health Res. 2016;26(13):1753–60.

Kallio H, Pietilä A-M, Johnson M, Kangasniemi M. Systematic methodological review: developing a framework for a qualitative semi-structured interview guide. J Adv Nurs. 2016;72(12):2954–65.

World Medical Association Declaration of Helsinki. Ethical principles for Medical Research Involving human subjects. JAMA. 2013;310(20):2191–4.

Kyngäs H, Kaakinen P. Deductive content analysis. In: Kyngäs H, Mikkonen K, Kääriäinen M, editors. The application of content analysis in Nursing Science Research. Cham: Springer International Publishing; 2020.

Chapter   Google Scholar  

Kyngäs H, Kääriäinen M, Elo S. The trustworthiness of Content Analysis. In: Kyngäs H, Mikkonen K, Kääriäinen M, editors. The application of content analysis in Nursing Science Research. Cham: Springer Nature Switzerland AG; 2020.

Lincoln YS, Guba EG. Naturalistic inquiry. Beverly Hills, Calif.: Sage; 1985.

Book   Google Scholar  

Helen N, Roberta H. Triangulation in research, with examples. Evid Based Nurs. 2019;22(3):67.

Berger R. Now I see it, now I don’t: researcher’s position and reflexivity in qualitative research. Qual Res. 2015;15(2):219–34.

Oshodi TO, Bruneau B, Crockett R, Kinchington F, Nayar S, West E. Registered nurses’ perceptions and experiences of autonomy: a descriptive phenomenological study. BMC Nurs. 2019;18(1):51.

Gastmans C. Care as a moral attitude in nursing. Nurs Ethics. 1999;6(3):214–23.

Lachman VD. Applying the ethics of care to your nursing practice. Medsurg Nurs. 2012;21(2):112.

Roberts AR, Ishler KJ. Family involvement in the nursing home and Perceived Resident Quality of Life. Gerontologist. 2017;58(6):1033–43.

Lynch B, Ryan AA, O’Neill M, Penney S. The factors that influence care home residents’ and families’ engagement with decision-making about their care and support: an integrative review of the literature. BMC Geriatr. 2022;22(1):873.

Hedman M, Häggström E, Mamhidir AG, Pöder U. Caring in nursing homes to promote autonomy and participation. Nurs Ethics. 2019;26(1):280–92.

Alshammari F, Sim J, Lapkin S, Stephens M. Registered nurses’ knowledge, attitudes and beliefs about end-of-life care in non-specialist palliative care settings: a mixed studies review. Nurse Educ Pract. 2022;59:103294.

Ghaemizade Shushtari SS, Molavynejad S, Adineh M, Savaie M, Sharhani A. Effect of end-of-life nursing education on the knowledge and performance of nurses in the intensive care unit: a quasi-experimental study. BMC Nurs. 2022;21(1):102.

Vanlaere L, Gastmans C. A personalist approach to care ethics. Nurs Ethics. 2011;18(2):161–73.

Morley G, Bradbury-Jones C, Ives J. What is ‘moral distress’ in nursing? A feminist empirical bioethics study. Nurs Ethics. 2020;27(5):1297–314.

Gastmans C. The care perspective in healthcare ethics. In: Davis AJ, Tschudin V, de Raeve L, editors. Essentials of teaching and learning in nursing ethics. New York: Churchill Livingstone Elsevier; 2006.

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Acknowledgements

We would like to express gratitude to the nurses who participated in this study, thereby contributing to the data collection. Additionally, we extend our thanks to the Oslo Metropolitan University Library for granting approval and for their support in covering the publication fee of this article.

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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D.L. contributed to the study conception, data collection, and analysis, and wrote the main manuscript text. R.G. was involved in data collection, analysis, reflection, and manuscript writing. D.L. was responsible for administrative work related to journal submission and was also involved in reviewing and editing the manuscript. R.G. and D.L. have read and approved the manuscript before submission.

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Correspondence to Daniela Lillekroken .

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The Norwegian Agency for Shared Services in Education and Research approved the study protocol (Sikt/Ref. number 360657) and concluded that the study was not subject to the Norwegian Health Research Act (LOV-2008-06-20-44; https://lovdata.no/dokument/NL/lov/2008-06-20-44 ). An English version of the Norwegian Health Research Act can be found at: https://www.uib.no/en/med/81598/norwegian-health-research-act . This study does not aim to get insight into participants’ health status, sexuality, ethnicity, and political affiliation (sensitive information), therefore, no additional approval from a local ethics committee or institutional review board (IRB) was necessary to be obtained to conduct the study. This study was performed according to principles outlined in the Declaration of Helsinki, and in accordance with Oslo Metropolitan University’s guidelines and regulations. Data were kept confidential and used only for this research purpose. The researchers provided verbal and written information about the study. Informed consent was obtained from all participants prior data collection.

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Gilbert, R., Lillekroken, D. Nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care to nursing home residents– a qualitative study. BMC Nurs 23 , 216 (2024). https://doi.org/10.1186/s12912-024-01865-5

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• End-of-life
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Shatley, Joseph Andrew, and L. Lee Glenn. "Sexuality and Quality of Life of Breast Cancer Patients Post Mastectomy." Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/etsu-works/7510.

Neuling, Sandra J. "Psychosocial needs and responses in breast cancer recovery /." Title page, contents and abstract only, 1989. http://web4.library.adelaide.edu.au/theses/09PH/09phn487.pdf.

Yackzan, Susan G. "FACTORS INFLUENCING PREFERENCE FOR SURGICAL CHOICE AMONG WOMEN WITH EARLY STAGE BREAST CANCER." UKnowledge, 2017. https://uknowledge.uky.edu/nursing_etds/34.

Ariche, Haifa, and Jelena Trifkovic. "Leva livet efter mastektomi : Kvinnornas upplevelser efter mastektomi." Thesis, Högskolan Kristianstad, Sektionen för Hälsa och Samhälle, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-8294.

Banfors, Ida, and Maja Högdahl. "Kvinnor med bröstcancer och deras upplevelser efter mastektomi : en litteraturöversikt." Thesis, Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-8198.

Loritsch, Mary Brewer. "Do surgeons influence the treatment rates for T1 breast cancer patients at the local level of health care?" Diss., This resource online, 1995. http://scholar.lib.vt.edu/theses/available/etd-11182008-063136/.

Kirshbaum, Marilyn. "Disseminating research evidence to breast care nurses : the case of exercise for breast cancer patients." Thesis, University of Manchester, 2004. http://eprints.hud.ac.uk/10717/.

Topping, Annie. "Being there for women : the work of breast care nurses." Thesis, University of Huddersfield, 2001. http://eprints.hud.ac.uk/id/eprint/4754/.

Williams, Anne. "A qualitative study of supported self-care in women with lymphoedema associated with breast cancer." Thesis, Edinburgh Napier University, 2011. http://researchrepository.napier.ac.uk/Output/4705.

Björnemalm, Victoria, and Elin Grip. "Kvinnor med bröstcancer och deras erfarenheter av omvårdnad efter genomförd mastektomi : En litteraturöversikt." Thesis, Högskolan Dalarna, Omvårdnad, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:du-29429.

Sundin, Ida, and Ida Koplik. "Kvinnors upplevelser av mastektomi till följd av en bröstcancerdiagnos." Thesis, Högskolan i Gävle, Medicin- och vårdvetenskap, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-29538.

Andersson, Julia, and Lina Jonsson. "Kvinnors erfarenheter av mastektomi till följd av bröstcancer: : En litteraturstudie." Thesis, Umeå universitet, Institutionen för omvårdnad, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-177856.

Dahl, Ebba, and Ulrika Nilsson. "Kvinnors upplevelser av bröstrekonstruktion i samband med bröstcancer eller vid risk för bröstcancer : en litteraturstudie." Thesis, Röda Korsets Högskola, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-107.

Nilsson, Sara, and Sofi Svensson. "Kvinnors erfarenheter av att få en bröstrekonstruktion efter mastektomi : En allmän litteraturstudie." Thesis, Högskolan i Halmstad, Akademin för hälsa och välfärd, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-42021.

Paterson, Lesley Alison. "Factors influencing communication between the patient diagnosed with cancer of the breast and the professional nurse." Thesis, Stellenbosch : University of Stellenbosch, 2009. http://hdl.handle.net/10019.1/4071.

Larsson, Hanna, and Nilsson Felicia Unga. "Kvinnors erfarenheter av att leva med bröstcancer efter genomgången mastektomi : En litteraturstudie." Thesis, Umeå universitet, Institutionen för omvårdnad, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-183639.

Bawati, Sundos, and Mona Abdi. "Kvinnors upplevelser av sjuksköterskans stöd innan en mastektomi : En litteraturstudie." Thesis, Malmö universitet, Fakulteten för hälsa och samhälle (HS), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-40311.

Cruickshank, Susanne. "The effectiveness of an intervention by specialist breast care nurses to address the perceived needs and enhance the quality of life of women with breast cancer receiving follow-up care : a randomised controlled trial." Thesis, Edinburgh Napier University, 2014. http://researchrepository.napier.ac.uk/Output/7557.

Tomtin, Therese, and Julia Saveman. "Kvinnors upplevelse av att drabbas av bröstcancer och genomgå en kirurgisk behandling : En litteraturstudie." Thesis, Umeå universitet, Institutionen för omvårdnad, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-178128.

Kreulen, Grace Joanne 1947. "Self-care, utilization, cost, quality and health status outcomes of a psychobehavioral nursing intervention: women experiencing treatment for breast cancer." Diss., The University of Arizona, 1994. http://hdl.handle.net/10150/565541.

Tailor, Bharti. "The experiences of South Asian women with breast cancer and the complexities of whole person care." Thesis, University of Southampton, 2008. https://eprints.soton.ac.uk/71891/.

Hjerpe, Sandra, and Sara Larsson. "Inte bara förlust av ett bröst : Kvinnors upplevelser efter en mastektomi." Thesis, Röda Korsets Högskola, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-1982.

Crafoord, Anja, and Pamela Francis. "Kvinnors kroppsuppfattning efter mastektomi till följd av bröstcancer : en litteraturöversikt." Thesis, Sophiahemmet Högskola, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-3689.

Olsson, Elin, and Almström Frida Rönnberg. "Bröstcancerdrabbade kvinnors erfarenheter av mastektomi, med fokus på kroppsuppfattning : En litteraturstudie." Thesis, Umeå universitet, Institutionen för omvårdnad, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-178713.

Mohamud, Ali Khadijo, and Panit Åkerman. "Kvinnors upplevelser av kroppen efter mastektomi vid bröstcancer : En litteraturöversikt." Thesis, Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-7572.

Granli, Johanna, and Elin Hedén. "Kvinnors upplevelser av mastektomi vid bröstcancer : En analys av bloggar." Thesis, Högskolan i Skövde, Institutionen för hälsovetenskaper, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:his:diva-19587.

Saldén, Mirja, and Daniel Pejer. "Kvinnnors kroppsuppfattning efter mastektomi på grund av bröstcancer : En litteraturöversikt." Thesis, Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-8418.

Oliveira, Mariza Silva de. "Self care of the woman in the whitewashing of the mastectomy: study of appearance validation and content of the educative technology." Universidade Federal do CearÃ, 2006. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=362.

Rockström, Monica, and Isaura Rodriguez. "Sjuksköterskans stödjande roll i omvårdnaden av patienter med bröstcancer : En litteraturstudie." Thesis, Röda Korsets Högskola, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-1859.

Carter, Sue A. "A Description of BMI and the Incidence of Breast Cancer in the Premenopausal Woman." Walsh University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=walsh1429279507.

Ödling, Gunvor. "Professional caregivers' experiences of caring for women with breast cancer on a surgical ward /." Umeå : Univ, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-371.

Törnquist, Julia, and Tove Wessman. "Kroppsuppfattning och livskvalitet i relation till sexualitet hos kvinnor efter mastektomi." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-432429.

Ingelsson, Veronicka, and Evastina Noltorp. "Kvinnan, bröstet och kroppen : En litteraturstudie om kvinnors upplevelser kring sin kropp efter en mastektomi." Thesis, Kristianstad University, School of Health and Society, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-6907.

Syftet: Syftet med studien var att belysa kvinors upplevelser av kroppen efter en cancerrelaterad mastektmoi. Bakgrund: Allt fler kvinnor drabbas av bröstcancer i dagsläget. Detta har gjort att behandlingen har utvecklats och fler kvinnor överlever sin bröstcancer. Den kirurgiska metoden mastektomi är ett alternativ till att avlägsna bröstcancern vilket kan påverka kvinnans upplevelse av kroppen både fysiskt och psykiskt.Sjuksköterskan har en betydande roll kring kvinnorna. Metod: Detta är en litteraturstudie som bygger på artiklar med kvantitativa samt kvalitativa metoder. Resultat: Resultatet visar att flertalet kvinnor som har genomgått en mastektomi får en förändrad uppfattning om kroppen. Även upplevelser som påverkar den psykiska hälsan är identifierade såsom upplevelsen av förlust och känslan av att vara oattraktiv. Slutsats: Det som framkom var att hänsyn bör tas till att försöka förbättra kvinnornas acceptans av den kroppsliga förändringen. Då flertalet kvinnor har uttryckt en negativ påverkan på den. Ytterligare aspekt att ta hänsyn till är kvinnans relation med eventuell partner. Sjuksköterskan bör integrera honom i omvårdnaden och även ge honom den stöttning han är i behov av. Det är inte bara en förändring för kvinnan utan också för mannen.

Silva, Anna Paula Sousa da. "Basic actions for early detection and risk factors for breast cancer in women at a primary care center in Fortaleza-CearÃ." Universidade Federal do CearÃ, 2008. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=2512.

Nordqvist, Annelie, and Sjöman Kristoffer Turesson. "Vad händer efter avslutandet av primär behandling för bröstcancer? : En litteraturöversikt om kvinnors upplevelser av uppföljningsvården." Thesis, Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-7248.

Frison, Fernanda Sucasas 1986. "Dança circular e qualidade de vida em mulheres mastectomizadas = um estudo piloto." [s.n.], 2011. http://repositorio.unicamp.br/jspui/handle/REPOSIP/308264.

Fransson, Ariana, Malin Bergman, and Olivia Tollesson. "Kvinnors upplevelser av sexuell hälsa relaterat till mastektomi vid bröstcancer." Thesis, Jönköping University, Hälsohögskolan, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-52688.

Dingley, Catherine E. "Inner strength as a predictor of quality of life and self-management in women with cancer /." Connect to full text via ProQuest. Limited to UCD Anschutz Medical Campus, 2008.

Arving, Cecilia. "Individual psychosocial support for breast cancer patients : Quality of life, psychological effects, patient satisfaction, health care utilization and costs." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7929.

Hellström, Tina, and Kallnäs Karolina Holmén. "Fysisk aktivitet som omvårdnadsåtgärd till personer med bröstcancer: en litteraturöversikt." Thesis, Högskolan Dalarna, Omvårdnad, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:du-33804.

Egnell, Tilda, and Johanna Ragnarsson. "Kvinnors kroppsuppfattning efter bröstcancerbehandling – En litteraturöversikt." Thesis, Högskolan Dalarna, Omvårdnad, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:du-27783.

Nicolau, Sandra Regina Terra Campos. "Cuidados sensíveis de enfermagem a mulheres submetidas a mastectomia: subsídios para uma ação educativa com enfoque na dimensão ética e estética." Universidade Federal Fluminense, 2015. https://app.uff.br/riuff/handle/1/3059.

Kelley, Marjorie M. "Engaging with mHealth to Improve Self-regulation: A Grounded Theory for Breast Cancer Survivors." The Ohio State University, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=osu157365193302496.

Hansson, Sara, and Pia Malmgren. "Bröstcancer. En litteraturstudie om hur bröstcancerdrabbade kvinnor och män upplever och hanterar sin sjukdom." Thesis, Malmö högskola, Fakulteten för hälsa och samhälle (HS), 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-26537.

Brorsson, Lisa, and Sofia Hasselquist. "Kvinnors upplevelser efter genomgången mastektomi : En litteraturöversikt." Thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ, Avd. för omvårdnad, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-39796.

Lindström, Graff Louise, and Martina Giernalczyk. "Kvinnors upplevelser efter mastektomi : En allmän litteraturstudie." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-397820.

Bexhorn, Hanna, and Lovisa Furegård. "Vilka former av stöd främjar den psykiska hälsan hos kvinnor med bröstcancer : En litteraturstudie." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-347448.

Birk, Noeli Maria. "A espiritualidade de mulheres com câncer de mama: um estudo na ótica da teoria do cuidado transpessoal." Universidade Federal de Santa Maria, 2016. http://repositorio.ufsm.br/handle/1/7485.

Fjelner, Maria, and Elinor Lundahl. "Bröstcancerdiagnostiserade kvinnors upplevelse av emotionellt stöd från vårdpersonal." Thesis, Ersta Sköndal högskola, Institutionen för vårdvetenskap, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-1566.

Freitas, Sandra Carvalho de. "Proposta de uma tecnologia de cuidado de enfermagem solidário no controle do câncer do colo do útero e mama." Universidade Federal de Juiz de Fora (UFJF), 2013. https://repositorio.ufjf.br/jspui/handle/ufjf/4561.

URI nursing, therapy students offer parents a 'short time to step away' with respite care

KINGSTON – Four hours can mean so much.

For a parent or parents of a special needs child, life can often be so busy, so demanding, that there's seemingly no time to get the chores done, or to calmly go grocery shopping, or to just take a walk. Some special needs parents will struggle to tell you the last time they were able to go out for lunch. Or just sit down and read a book.

Acutely aware of how important an occasional respite is for the mental, emotional and physical well-being of these parents, Christine McCane, a nursing professor at the University of Rhode Island, has created a weekly respite program at the university's Department of Physical Therapies facilities in Independence Square, on the edge of campus, with plenty of parking and easy building access for those with disabilities.

The respite time lasts four hours, from noon to 4 p.m. To a special needs parent, four hours of freedom can feel like a week's vacation to the rest of us. Many such parents simply don't have anyone qualified and/or available to give them a break.

McGrane's staff includes URI students from the nursing, physical therapy, human development and family science programs. For the nursing and PT students, time worked in the respite program counts toward their clinical hours.

The children play with toys and sports equipment, and enjoy the outdoors when weather permits. There's a large video screen in the lecture hall.

It's all for free. About 20 children have been taking part in the program, which goes far beyond babysitting.

Who qualifies for respite care?

McGrane tries to maintain a 1-to-1 student-to-child ratio, with a 2-to-1 ratio for children with more complex needs. The children include those with autism (across the full spectrum), Down syndrome, cerebral palsy, and brain injuries.

“We provide direct care in a group setting, and families get some respite to step away and do whatever it is they feel they need to do to take care of themselves,” McGrane is quoted in saying on the school's website.

URI students get direct-care experience

She said the URI students learn from each other, with, for example, PT students guiding nursing students on getting a child in different positions to improve head control. Nursing students can help with tube feeding and other medical needs.

“The nice thing about having the students is they have expertise, and they learn from each other,” McGrane said.

A member of the Family Caregiver Alliance of Rhode Island, McGrane said the goal is to expand the respite program.

McGrane's dissertation project for her recently completed Ph.D. in nursing explored whether respite care alleviated stress for parents of special needs children. Her research included pre- and post-program stress surveys for parents. She said she found a significant drop in stress levels when parents get even a “short time to step away.”

Any parents of children with special needs interested in applying for the respite care program can contact McGrane at  [email protected]  or 401-874-5347.

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