Exploring the effects of change on nursing practice in acute ambulatory care settings : a qualitative study

As a result of the current changes taking place in the delivery of acute care services, the emergence of acute ambulatory care (AAC) settings is expanding. According to a literature review, the volume, acuity, and complexity of patient care in these settings is increasing while the time the patients spend under the care of nurses is decreasing. Two forces, hospital downsizing and advancing technology, are identified as the major contributors to the shift in acute care delivery. The effects that these changes are having on the clinical nursing practice of registered nurses working in AAC settings are not known. Given that AAC settings are rapidly expanding, it can be anticipated that the delivery of nursing care will continue to be compressed into a shorter time frame. Therefore, the following qualitative research question was formulated: What are the problems and issues related to clinical nursing practice in acute ambulatory settings? The purpose of this study was to explore the problems and issues associated with change and clinical nursing practice including the educational needs of nurses working in MC settings. Specific objectives of the study included the following: (a) to explore the problems and issues related to nursing practice in select AAC settings; (b) to explore the similarities and differences in perspectives related to role expectation between nurse managers, nurse educators, and staff nurses; and (c) to develop a conceptual framework that will guide the construction of an instrument needed for further research. This study used semistructured individual interviews and focus group sessions to collect data from the three categories of registered nurses. More specifically, data were collected from one nurse manager, two charge nurses, two nurse educators and fifteen staff nurses, working in three different MC settings of a major teaching hospital. Collected data were separately analyzed by the researcher and an external rater following grounded theory methodology. By using open and axial coding, the problems and issues identified by nurses were grouped into several major and minor themes. In final analysis, by using selective coding, the four core themes (intensification, moderation, frustration, and adaptation) were extracted. Each core theme was presented and discussed in relation to hospital downsizing and advancing technology. The relationships among the four core themes were discussed and depicted in a model termed the "Impact and Consequence Model on Nursing Practice in MC Settings." Implications for further research are discussed and research hypotheses, based on the research findings, are presented.

Why do some adults change their minds about what is important in the visual arts? : a case study

This-~-case study used ethnographic-methodo-logy. --The research project was an introductory study of one adult's present and past experiences with the visual arts, exploring, in particular, the causes and processes that were related to the individual's changes of mind in order to develop an understanding of why that individual had changed her mind about what was significant in the visual arts. The individual who provided the data was a solid supporter of art galleries: female, middle-aged, graduate of university and college, married with two children, and living in an urban community. The data were collected from two informal conversational interviews and from a written description of one change experience selected by the participant. The individual had positive experiences with art during early childhood, in elementary and secondary school, during university, in avocational drawing and painting studio courses, and in aesthetic experiences. All of these experiences have had individual effects and, together, they have had a cumulative effect on the development of the participant's opinions and ideas about the visual arts. The experiences which had the most effect on the development of the individual's perspectives on the visual arts were handson studio, educational, and aesthetic experiences. Further research is suggested to investigate why some adults change their minds about the visual arts.