Interventions to promote teamwork, delegation and communication among registered nurses and nursing assistants: An integrative review

Teamwork between registered nurses and unlicensed assistive personnel in acute care settings: A scoping review

Background

Unlicensed assistive personnel are increasingly employed to support the nursing workforce in providing bedside care.

Aim

To scope the literature on the factors influencing teamwork between registered nurses and unlicensed assistive personnel in acute care settings.

Methods

A scoping review was conducted using the Arksey and O'Malley (2005) framework. Eight electronic databases were searched from inception of each database to August 2024 to locate studies that reported issues relating to teamwork between registered nurses and unlicensed assistive personnel on patient care in general wards of acute care settings. Two reviewers independently screened titles, abstracts, and full text for eligibility. The data were extracted, analysed, and synthesised using the data-based convergent qualitative synthesis.

Results

Thirty-eight studies were included. Five themes were generated: (1) role clarity, (2) delegation, (3) communication, (4) ward culture and practice, and (5) interpersonal relationships. Challenges in registered nurses-unlicensed assistive teamwork include unclear roles and responsibilities, ineffective delegation, and communication barriers. Work culture that excludes unlicensed assistive personnel from shift handovers were found to hinder shared goals for patient care. The importance of interpersonal relationships between registered nurses and unlicensed assistive personnel was highlighted to aid in the power disparity between them.

Conclusions

This review found suboptimal teamwork between registered nurses and unlicensed assistive personnel. Teamwork between registered nurses and unlicensed assistive personnel can be improved through clearly defined roles and responsibilities, better delegation practices, effective communication, and improved interpersonal relationships. Future research should focus on optimising communication processes and enhancing registered nurses' delegation skills through education.

The relationship between teamwork and the workload of nurses with missed nursing care in intensive care units in Iran: a cross-sectional study

BACKGROUND

Missed nursing care (MNC) is a major challenge faced by nurses working in intensive care units (ICU). Workplace characteristics, including teamwork and workload, can affect the extent of missed nursing care. Examining the relationship between these variables can help create strategies to enhance care. Thus, this study aimed to explore the connection between teamwork, workload, and missed nursing care in the intensive care units of hospitals in Iran.

METHODS

This descriptive cross-sectional study was conducted from August to November 2023 on 219 nurses working in the intensive care units of teaching hospitals affiliated with Hamadan University of Medical Sciences. Participants were selected through multi-stage sampling after meeting the inclusion criteria. Data were collected using the General Characteristics questionnaire, the Team-STEPPS® Teamwork Perception Questionnaire (T-TPQ), the National Aeronautics and Space Administration Task Load Index (NASA-TLX), and the MISSCARE survey. Data analysis was performed using Stata software version 14.

RESULTS

Out of 219 returned questionnaires (92.79% response rate), 194 valid responses were analyzed. Missed nursing care showed a significant negative correlation with overall teamwork (r = -0.538, P < 0.001) and its subcomponents, including team structure (r = -0.472), leadership (r = -0.303), situation assessment (r = -0.486), mutual support (r = -0.325), and communications (r = -0.517). Tenure was also significantly related to missed nursing care (p = 0.040), with nurses having less than 2 years of experience reporting the lowest missed care scores. No significant relationships were found between workload scores and demographic variables.

CONCLUSION

The relationship between teamwork, nurse workload, and missed nursing care is complex. The findings of this study emphasize the importance of effective teamwork and manageable workloads in reducing missed nursing care. However, contextual differences in nurses' work environments are of great importance in different countries.

Midwives experience of working with maternity assistants: A qualitative study

INTRODUCTION

The midwifery workforce is essential for delivering safe, high-quality maternity care, however, global staffing shortages pose significant challenges. To address these issues, incorporating midwifery assistants, including undergraduate midwifery students into the model of care has been proposed as a strategy to support midwives and maintain effective service delivery.

AIM

This study explores the Registered Midwives' experiences working with Midwifery Assistants (MAs) in an Australian tertiary maternity service.

METHODS

This study employed a qualitative exploratory design and was conducted using semi-structured interviews with 9 midwives who had experienced working with MAs in the tertiary maternity care setting.

RESULTS

The discussion highlighted three main themes from the experiences of these midwives working with MAs in tertiary maternity settings. Firstly, all types of MAs are valuable, though their scope of practice and initial knowledge base vary. Secondly, MAs enable midwives to focus on midwifery care, though their potential could be expanded. Finally, undergraduate midwifery student working as MAs gain valuable professional experience, benefiting both themselves and the midwives they assist, despite concerns about role blurring.

DISCUSSION

Midwives are essential in maternal and newborn care, however, declining numbers in Australia, result in maternity care models needing review. Maternity assistants can be integrated into care models, providing vital support. While MAs help midwives focus on clinical tasks, role blurring, and limited numbers can be challenges. Expanding MA roles, especially for midwifery students, may enhance care quality and reduce midwives' workload.

Factors influencing patient safety competency in baccalaureate nursing students: A descriptive cross-sectional study

BACKGROUND

With the rapid changes and increasing complexity of healthcare systems, there is a growing emphasis on providing safer and higher quality care. Early education on patient safety is important for preparing nurses to be competent in quality of nursing care and preventing unnecessary errors. However, most patient safety courses are not incorporated formally and fully into nursing education curricula. To integrate patient safety in the nursing curriculum and develop new strategies, assessing the strengths and weaknesses of nursing students' patient safety competency is vital.

AIM

To examine the level of patient safety competency in nursing students and explore the factors associated with it.

DESIGN

A descriptive cross-sectional design.

SETTINGS

The study was conducted in South Korea.

PARTICIPANTS

A total of 246 third- and fourth-grade nursing students.

METHODS

A structured questionnaire survey comprising the Patient Safety Competency Self-Evaluation Tool, Teamwork Attitudes Questionnaire, and an instrument evaluating the perceptions of disclosure of patient safety incidents was conducted, using an online survey tool from October 26 to November 26, 2022. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficients, and multiple linear regression analyses.

RESULTS

The average patient safety competency score was 3.8 out of 5.0. Nursing students had higher scores on attitudes and lower scores on skills and knowledge. Multiple linear regression analysis demonstrated that participants with high scores on teamwork attitudes, high perceptions of the degree of inclusion of patient safety topics in the nursing curriculum, and familiarity with open disclosure were expected to have higher patient safety competency.

CONCLUSIONS

The nursing education system should be modified to establish an integrated curriculum that includes patient safety topics. Utilizing teamwork strategies and teaching the concept of disclosure of patient safety incidents in the undergraduate nursing curriculum can help improve patient safety competency.

Effects of a mobile simulation program for nursing delegation: A randomised controlled trial

AIM

This study aims to develop the Mobile Simulation Program for Nursing Delegation (MSP-D) to enhance nurses' delegation skills and evaluate its effects on nurses' preparedness to delegate, critical thinking disposition and role ambiguity reduction.

BACKGROUND

Effective delegation is crucial for optimal patient care in nursing practice. However, many Korean nurses with insufficient delegation training in a new nursing model where they collaborate with nursing assistants.

DESIGN

A randomised controlled trial with a pre-post-test design.

PARTICIPANTS AND SETTING

The participants were 96 nurses from three general hospitals in South Korea, randomly assigned to either the experimental (n = 48) or control group (n = 48).

METHODS

The MSP-D is a mobile web-simulation and the experimental group used the MSP-D for three weeks. Data were collected pre- and post-intervention. The study was registered with the Clinical Research Information Service (KCT0007516) on 19 July 2022, with recruitment beginning on 20 August 2022.

RESULTS

The experimental group showed significant improvements in preparedness to delegate (p < 0.001), critical thinking (p = 0.038) and decreased role ambiguity (p = 0.041). compared with the control group. Debriefing analysis revealed that participants' reflections aligned with the learning objectives, indicating the study's educational goals were met.

CONCLUSION

The MSP-D is an effective educational tool for improving nurses' delegation skills and may enhance job training for nurses collaborating with nursing assistants to improve nursing care quality in a new nursing delivery model. Mobile simulation education significantly improves effectiveness due to its high accessibility and flexibility.

High-fidelity simulation training for improving nursing professional values acquisition

BACKGROUND

Nursing professional values form the basis of nursing interventions and serve as a guide for professional practice, reflecting in all interactions with patients and other healthcare professionals. As nursing professional values constitute powerful influencers in nursing practice, a strong commitment to these values is essential for nursing students to provide high-quality care.

AIM

To evaluate the impact of high-fidelity simulation training on first-year nursing students' nursing professional values acquisition.

RESEARCH DESIGN

Quasi-experimental study using a longitudinal design with a single group pre- and post-intervention evaluation.

PARTICIPANTS AND RESEARCH CONTEXT

202 first-year nursing students at the Complutense University of Madrid (Spain) participated in the study between September 2023 and May 2024. Their nursing professional values were compared at baseline and after the simulation experience using the "Nurses Professional Values Scale-Revised" (NVPS-R). The acquisition of these values was also evaluated using a verification list during simulation sessions. Five simulated scenarios recreated ethics dilemmas, where students should manage conflictive situations with a standardized patient.

ETHICAL CONSIDERATIONS

The study was approved by the Research Ethics Committee from the Complutense University of Madrid (reference code: CE_20231116_18_SAL).

RESULTS

Most of the students (84.87%) acquired the nursing professional values needed to manage adequately simulated ethical dilemmas. Nursing students significantly improved their nursing professional values after the simulation sessions. The effect size was medium for the "professional expertise" and "professional mastery" dimensions, and the total score of NVPS-R, whereas the obtained effect size was small for the "ethics" dimension.

CONCLUSION

High-fidelity simulation training using standardized patients allows first-year nursing students to acquire and improve nursing professional values. The inclusion of simulation training programs in nursing study plans to foster nursing professional values is needed to train undergraduate nursing students, providing them with the necessary ethical concepts and principles for their future clinical practice and ensuring high-quality care.

Relationship between staff experience and patient outcomes in hospital settings: an overview of reviews

OBJECTIVES

This review aimed to investigate the relationship between staff experience and patient health and experience outcomes in hospital inpatient settings.

DESIGN

Systematic review of reviews.

METHODS

Searches were performed in Medline (OVID), CINAHL and Google Scholar using key terms from relevant review articles. The search was conducted on 28 August 2023. Inclusion criteria were systematic or narrative reviews in English from 2020 onwards, focusing on inpatients in hospital and related tertiary care facilities, examining the relationship between staff experience and patient outcomes. A review of reviews approach was used, with broad definitions for staff experience (eg, hospital culture, stress and burnout) and patient outcomes (eg, adverse events and patient experience). Independent screening and quality appraisal were conducted by two researchers. An evidence map of links between staff experience and patient outcomes was created. The methodological quality of systematic reviews was assessed using the AMSTAR 2 tool and narrative reviews with the SANRA tool.

RESULTS

From 2365 citations, 21 reviews (18 systematic, 3 narrative) were included. Review quality ranged from moderate to high. Mapping revealed 66 associations between staff experience and patient outcomes. Common associations included burnout, stress and fatigue with adverse events (six reviews); communication with patient satisfaction (four reviews) and teamwork with patient satisfaction (four reviews).

CONCLUSIONS

Staff burnout, teamwork and communication practices directly impact adverse events and patient satisfaction. These findings guide hospital managers and clinicians in improving health service policies and practices. Further research is needed to strengthen the evidence base.

Teamwork, psychological detachment from work during nonwork time, and burnout experienced by hospital-based nurses

AIMS

To assess the relationships in nursing teamwork, psychological detachment from work during nonwork time, and burnout, and the mediating effect of psychological detachment on the relationship between nursing teamwork and burnout.

BACKGROUND

Nurse burnout has serious implications for nurses' health and performance and the overall functioning of their organizations. Evidence on the relationships between nursing teamwork, psychological detachment, and nurse burnout is limited. This study adds to the international body of knowledge by examining the interplay between nursing teamwork, psychological detachment, and burnout in nurses, a topic of global relevance.

METHODS

This cross-sectional study used survey data collected in May 2021 from 1115 Korean hospital nurses. The measurements included the Nursing Teamwork Survey, a subscale of the Recovery Experience Questionnaire, and the Copenhagen Burnout Inventory. We performed mediation analysis using PROCESS Macro based on 5000 bootstrapped samples to estimate the indirect effect of nursing teamwork.

RESULTS

Nurses in units with stronger teamwork were more likely to report being psychologically detached from work during nonwork time. Nurses who distanced themselves from work-related thoughts during nonwork time reported lower personal, work-related, and patient-related burnout. Nursing teamwork had significant indirect effects on each burnout outcome through psychological detachment.

CONCLUSION

By providing empirical evidence on the associations between nursing teamwork, psychological detachment, and burnout, this study enriches the international discourse on nurse burnout and the benefits of psychological detachment. Enhanced nursing teamwork can facilitate nurses' mental distance from work during nonwork time, thereby reducing burnout.

IMPLICATIONS FOR NURSING AND NURSING POLICY

Organizational efforts to manage nurse burnout can include increasing nursing teamwork among nurses and improving nurses' psychological detachment during nonwork hours. Interventions should include improving nursing teamwork and developing a supportive and collaborative unit culture.

Resilience as Safety Culture in German Emergency Medical Services: Examining Irritation and Burnout

BACKGROUND/OBJECTIVES

The stress levels in emergency services are enormous. The resulting stress can range from psychological irritation to burnout. This study examines the importance of resilience in the German EMS and its significance for the risk of irritation and burnout among EMS personnel.

METHODS

A quantitative cross-sectional online survey was conducted among 285 EMS personnel in Germany. Resilience was measured by the RS-13 Scale, irritation by the Irritation Scale (IS), and burnout by the Maslach Burnout Inventory (MBI). Sociodemographic and job-related data were also collected. A classification into resilient groups was used to compare stress levels.

RESULTS

More than one-third (39%) of the participants had a low level of resilience. EMS personnel with high levels of resilience had significantly lower scores on the cognitive and emotional irritation dimensions, as well as on the burnout dimensions of emotional exhaustion and cynicism.

CONCLUSIONS

Resilience plays an important role in the safety culture of emergency services. The results support the hypothesis that high levels of resilience lead to less stress and help people cope better with stress. Almost two-fifths of the participants had lower resilience, underscoring the need for safe communication and targeted measures to strengthen resilience. Regular training, a supportive work environment, and promoting team cohesion and social support can improve emergency responders' mental health and job performance. Future research should develop specific intervention strategies and evaluate their effectiveness to ensure the long-term health of emergency responders and improve the quality of emergency care.

CICARE communication model and hierarchical responsibility nursing coordination in the application research of elderly patients with chronic heart failure

The aim of this study was to evaluate the efficacy of implementing the CICARE communication model and hierarchical responsibility nursing coordination in managing chronic heart failure among elderly patients. From June 2021 to June 2023, 120 elderly patients diagnosed with chronic heart failure were admitted to our hospital. They were divided into 2 groups according to different treatment methods: the regular group and the observation group. Both groups of patients received nursing interventions for 3 months. Before and after the intervention, we assessed the levels of cardiac function indicators (left ventricular end-diastolic diameter, left ventricular ejection fraction, and B-type natriuretic peptide levels) and exercise tolerance (6-minute walk test) in both groups of patients. The time to clinical symptom relief, self-efficacy, and quality of life scores were compared between the 2 groups of patients. Before the intervention, there were no significant differences in cardiac function indicators between the 2 groups (P > .05). However, after the intervention, both groups exhibited improvements in left ventricular end-diastolic diameter and B-type natriuretic peptide levels, with the observation group demonstrating greater reductions compared to the control group. Furthermore, both groups showed increased left ventricular ejection fraction levels, with the observation group experiencing a significantly higher improvement. Although exercise tolerance did not differ significantly between the groups before the intervention, post-intervention analysis revealed a greater increase in 6-minute walk test distance in the observation group compared to the control group (P < .05). The time to relief of breathlessness and edema did not significantly differ between the groups (P > .05). Similarly, there were no significant differences in self-efficacy and quality of life scores between the groups before the intervention (P > .05); however, post-intervention analysis showed higher self-efficacy scores in the observation group. Application of the CICARE communication model and hierarchical responsibility nursing coordination in elderly patients with chronic heart failure can effectively improve the patients' cardiac function levels and significantly enhance their exercise tolerance, self-efficacy, and quality of life.

Implementing care-related services in care units - an interview study

BACKGROUND

The growing concern about a dwindling healthcare workforce, exacerbated by demographic changes, calls for innovative solutions. One viable approach involves implementing new professional roles and restructuring existing healthcare teams within hospital care units.

OBJECTIVES

To evaluate the implementation of an innovative task-shifting concept, care-related services (CRS), from the managers' perspective in somatic care units across the hospitals in a region in Sweden.

METHODS

The qualitative study was conducted in 2022, after the implementation of CRS. Individual interviews were conducted with 24 key stakeholders, including 14 care unit managers, six CRS managers, and four process managers. A qualitative content analysis was performed, utilizing the Consolidated Framework of Implementation Research (CFIR).

RESULTS

The implementation of CRS involved collaboration between care unit managers, CRS managers, and project managers, alongside CRS staff, registered nurses (RNs), and licensed vocational nurses (LVNs). In particular, their roles encompassed defining boundaries, establishing routines, and managing personnel. Throughout the implementation process, challenges emerged, stemming from undefined goals, difficulties in recruiting qualified CRS staff, and issues associated with seamlessly integrating CRS into existing work routines. These challenges arose due to a constrained timeframe, widespread team apprehension, shortcomings in the training of CRS staff, unclear task allocation, and an increased workload for care unit managers. Factors associated with successful CRS implementation included effective cooperation among managers and an open-minded approach.

CONCLUSIONS

Our findings highlight the crucial role of clear communication, effective recruitment, integration of CRS staff, clarification of roles, responsibilities, and defined goals for successful CRS implementation.

Health communication and shared decision-making between nurses and older adults in community setting: An integrative review

AIM

To explore the role of health communication in Shared Decision-Making (SDM) between nursing staff and older people in the community setting.

BACKGROUND

Society and healthcare services are marked by an exponentially ageing population, leading to a significant proportion of patients being older adults with highly demanding care needs. Scientific literature supports shared decision-making as a process that engages patients in their care. However, the increasing use of technology and the consequences of the COVID-19 pandemic have influenced how nurses communicate with older patients. Therefore, it is crucial to understand how to develop health communication to reach effective, shared decision-making processes.

METHODS

Whittemore and Knafl's integrative review method, the literature search comprised five databases: PubMed, CINALH, Web of Science, Scopus and PsycINFO.

RESULTS

The 12 included studies were synthesised into three study patterns: (1) nurse-older patient health communication relationship, (2) older patients' perspectives and (3) nontherapeutic communication in end-of-life care.

CONCLUSION

This review underscored the crucial role of effective health communication in shaping SDM dynamics between nursing staff and older people in the community setting. Key elements included transparent information exchange, establishing trust and maintaining communication channels with informal caregiving networks. SDM actions were aligned with preserving older people's autonomy, but communication challenges persisted, particularly in end-of-life situations. Advanced care planning was recommended to address these shortcomings and improve communication among older people, healthcare professionals and families.

IMPLICATIONS

Implementing educational measures based on verbal and nonverbal health communication in nursing training could be beneficial. Nursing research could continue to develop and refine specific communication strategies adapted to the social determinants of health for diverse clinical situations regarding older adults in the community setting.

REPORTING METHOD

The authors have adhered to relevant EQUATOR guidelines through the PRISMA 2020 checklist. No Patient or Public Contribution.

The effect of COVID-19 anxiety on nurses' productivity determinants through perceived workload and individual job performance: A Bayesian mediation analysis

This study aims to predict how COVID-19 anxiety affects productivity determinants by examining the role of perceived workload and individual job performance as mediators using Bayesian mediation analysis. To achieve the study's objectives, all nurses working at Imam Reza Hospital were recruited to participate. To gather data, all eligible and voluntary nurses were asked to complete questionnaires that included the Corona Disease Anxiety Scale (CDAS), Individual Job Performance Questionnaire (IJPQ), NASA Task Load Index (NASA-TLX), and Workforce Productivity Questionnaire. Of the total number of nurses employed, 222 (126 women and 96 men) nurses fully completed the questionnaires. Out of these, 140 individuals were married and 82 were single. The mean ± standard deviation (SD) of the age and experience were 28.56 ± 5.78 and 8.49 ± 6.50, respectively. GeNIe software version 2.0 utilized to analyze the Bayesian network. The results showed that for the high COVID-19 anxiety and high workload states, with a probability of 100 %, the probability of high evaluation and high environment increased by 16.6 % and 16.3 %, respectively, but low evaluation and low environment decreased by 22.4 % and 22 %, respectively. In the high COVID-19 anxiety and low IJP states with a probability of 100 %, most change was related to the high ability (6 % increase), low evaluation (3.9 % increase), high incentive (3.8 % increase), low ability (4.6 % decrease) and low support (2 % decrease). Regarding COVID-19 anxiety (high 100 %), workload (high 100 %) and IJP (low 100 %), most of the increase was related to high environment and high evaluation by an increase of 17.3 and 17.2 %, respectively. Also, the value of low evaluation and low environment was reduced by 24 and 23.4 %, respectively. The study's findings confirm that nurses have been more productive during the COVID-19 pandemic, despite facing high workloads and the COVID-19 anxiety.

Telemedicine and Teamwork Among Health Care Professionals: State of the Science

Background: As telemedicine becomes further rooted in standard patient care delivery, it is critical to understand how it may affect teamwork among health care providers. Understanding the state of the science between telemedicine and teamwork is an important first step. Obejctive: The purpose of this state-of-the-science review was to synthesize the published research on teamwork within the context of telemedicine. Methods: Data abstraction and analysis were structured following the Virtual Team Performance and the "Big Five" of Teamwork theoretical frameworks. The concepts within these models were used to organize data extraction. This state of the science used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Results: A total of 14 studies met the inclusion criteria after final review. The most common variables were communication, tasks, leadership, team orientation, and team cohesion. Despite variable commonalities across the included articles, there was a discrepancy between improved and reduced teamwork outcomes with telemedicine. Conclusions: Multiple teamwork variables are influential across health care teams using telemedicine technologies-those that include communication, task facilitation, leadership, team orientation, and cohesion appear to have the greatest impact. However, it is not an individual teamwork variable, type of technology, or care environment alone that influences positive or negative outcomes among health care teams using telemedicine. Instead, it is a combination of factors and mechanisms that facilitate or hinder teamwork outcomes. A comprehensive model that describes the interaction of these common variables in teamwork among blended virtual and in-person health care teams is needed.

A systematic review of the nature and efficacy of Rational Emotive Behaviour Therapy interventions

In the absence of a single comprehensive systematic review of Rational Emotive Behaviour Therapy interventions across all settings, we reviewed the methodological quality, effectiveness and efficacy of Rational Emotive Behaviour Therapy interventions on irrational/rational beliefs. We explored the impact of Rational Emotive Behaviour Therapy on wider outcomes (e.g., mental health) and identified the characteristics of successful interventions. PsycARTICLES, PsycINFO, Scopus, SPORTDiscus, and PubMed were systematically searched up to December 2023 with 162 Rational Emotive Behaviour Therapy intervention studies identified which included a validated measure of irrational/rational beliefs. Where possible, effect size for irrational/rational belief change was reported and data was analysed through a qualitative approach. Using the Mixed Methods Appraisal tool, methodological quality within the Sport and Exercise domain was assessed as good, whilst all other domains were considered low in quality, with insufficient detail provided on intervention characteristics and delivery. Most studies were conducted in the United States, within the Education domain, and assessed irrational beliefs in non-clinical adult samples. Overall, studies reported significant reductions in irrational beliefs, increases in rational beliefs and improvements in mental health outcomes (e.g., depression). More successful interventions were delivered by trained Rational Emotive Behaviour Therapy practitioners, adopted the ABC framework and were longer in duration. We highlight the importance of designing and conducting rigorous future Rational Emotive Behaviour Therapy research to generate clearer insights as to its impact on irrational/rational beliefs and mental health outcomes.

Analysis of the nursing effects of integrated medical and nursing care intervention in correction surgery for children with concealed penis

OBJECTIVE

This study aimed to analyze and explore the nursing effects of integrated medical and nursing care intervention in correction surgery for children with concealed penis.

METHODS

A total of 76 eligible patients with concealed penis were randomly divided into an observation group and a control group. The control group received conventional nursing care, while the observation group received integrated medical and nursing care intervention. Outcomes include pain levels, comfort status, incidence of complications, and nursing satisfaction were collected and analyzed to investigate the nursing effects of the integrated medical and nursing care model.

RESULTS

After 2/3 days of nursing intervention, the patients in the observation group had significantly lower pain scores (measured by FPS-R) compared to the control group (P < 0.05). The patients in the observation group also had significantly higher comfort scores (measured by Kolcabal) compared to the control group (P < 0.05). The incidence of complications in the observation group was significantly lower than that in the control group (2.63 vs. 23.68, P < 0.05). Parental satisfaction in the observation group was significantly higher than that in the control group (P < 0.05).

CONCLUSION

The integrated medical and nursing care intervention in correction surgery for children with concealed penis demonstrated positive nursing effects. It effectively reduced pain, improved comfort, lowered the risk of complications, and increased parental satisfaction. This approach maximizes the role of nursing care and is recommended for clinical implementation.

Factors impacting nursing assistants to accept a delegation in the acute care settings: A mixed method study

AIMS

To investigate the experience of nursing assistants being delegated nursing tasks by registered nurses.

DESIGN

Mixed method explanatory sequential design.

METHODS

A total of 79 nursing assistants working in an acute hospital in Australia completed surveys that aimed to identify their experience of working with nurses and the activities they were delegated. The survey data were analysed using descriptive statistics. Interviews with 11 nursing assistants were conducted and analysed using Braun and Clarke's thematic analysis. Results were triangulated to provide a richer understanding of the phenomena.

RESULTS

Most nursing assistants felt supported completing delegated care activities. However, there was confusion around their scope of practice, some felt overworked and believed that they did not have the right to refuse a delegation. Factors impacting the nursing assistant's decision to accept a delegation included the attitude of the nurses, wanting to be part of the team and the culture of the ward. Nursing assistants who were studying to be nurses felt more supported than those who were not.

CONCLUSIONS

Delegation is a two-way relationship and both parties need to be cognisant of their roles and responsibilities to ensure safe and effective nursing care is provided. Incorrectly accepting or refusing delegated activities may impact patient safety.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Highlights the need for implementing strategies to support safe delegation practices between the registered and unregulated workforce to promote patient safety.

IMPACT

Describes the experiences of nursing assistants working in the acute care environment when accepting delegated care from nurses. Reports a range of factors that inhibit or facilitate effective delegation practices between nurses and nursing assistants. Provides evidence to support the need for stronger education and policy development regarding delegation practices between nurses and unregulated staff.

REPORTING METHOD

Complied with the APA Style JARS-MIXED reporting criteria for mixed method research.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Delegating care as a double-edged sword for quality of nursing care: a qualitative study

BACKGROUND

Considering the significance of care delegation in enhancing the quality of nursing care and ensuring patient safety, it is imperative to explore nurses' experiences in this domain. As such, this study aimed to explore the experiences of Iranian nurses regarding the delegation of care.

METHODS

This qualitative study was conducted between 2022 and 2023, employing the content analysis method with a conventional approach. The study utilized purposeful sampling method to select qualified participants. Data collection was carried out through in-depth and semi-structured interviews utilizing open-ended questions. The data analysis process followed the steps proposed by Graneheim and Lundman (2004) and involved the use of MAXQDA version 12 software. To ensure the trustworthiness of the data, the study employed the four rigor indices outlined by Lincoln and Guba (1985).

RESULTS

In the present study, a total of 15 interviews were conducted with 12 participants, the majority of whom were women. The age range of the participants fell between 25 and 40 years. Through qualitative data analysis, eight subcategories and three main categories of "insourcing of care", "outsourcing of care" and "delegating of care to non-professionals" were identified. Additionally, the overarching theme that emerged from the analysis was "delegation of care, a double-edged sword".

CONCLUSIONS

The results of the study revealed that the delegation of care occurred through three distinct avenues: to colleagues within the same unit, to colleagues in other units, and to non-professionals. Delegating care was found to have potential benefits, such as reducing the nursing workload and fostering teamwork. However, it was also observed that in certain instances, delegation was not only unhelpful but also led to missed nursing care. Therefore, it is crucial to adhere to standardized principles when delegating care to ensure the maintenance of high-quality nursing care.

Application effect study of a combination of TeamSTEPPS with modularization teaching in the context of clinical instruction in trauma care

To explore the effect of a combination of Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) with modularization teaching in the context of clinical instruction in trauma care. A total of 244 nursing students who participated in clinical practice in orthopaedic wards from March 2020 to April 2022 were divided into two groups that received the same trauma care teaching content. The control group (n = 119) used the traditional teaching approach, and the experimental group (n = 125) utilized a combination of TeamSTEPPS with a modularization teaching model. A questionnaire was used to assess students' theoretical knowledge, practical skills, self-concepts and professional benefits after one month with the goal of determining their end-of-course performance. The theoretical knowledge scores obtained by the control group and the experimental group were 89.56 ± 4.06 and 91.62 ± 2.84, respectively, and these results were statistically significant (P < 0.05). Students preferred the combination of TeamSTEPPS with the modularization teaching model to the traditional instructional method in terms of practical skills, professional self-concepts and professional benefits (P < 0.05). The application of the combination of TeamSTEPPS with modularization teaching in the context of clinical instruction in trauma care made significant contributions to nursing students' mastery of theoretical knowledge and practical skills, enhanced their sense level of professional identity, instilled a correct occupational ideology in such students, and enhanced the professional benefits they were able to obtain.

An Intervention to Enhance Recognition of Nursing Assistant Roles and Enhance Information-Sharing

This column describes a quasi-experimental trial that examined the effects of an intervention in which both nurses and nursing assistants shared their perceptions of the nursing assistant role on the frequency of information-sharing behaviors. In the intervention group, the frequency of nurses' linguistic responses in the intervention group increased in the nursing assistants' evaluations. The frequency of nursing assistants' linguistic response and feedback in the intervention group increased in self-evaluation and nurses' evaluation, respectively.

The Vitruvian nurse and burnout: New materialist approaches to impossible ideals

The Vitruvian Man is a metaphor for the "ideal man" by feminist posthuman philosopher Rosi Braidotti (2013) as a proxy for eurocentric humanist ideals. The first half of this paper extends Braidotti's concept by thinking about the metaphor of the "ideal nurse" (Vitruvian nurse) and how this metaphor contributes to racism, oppression, and burnout in nursing and might restrict the professionalization of nursing. The Vitruvian nurse is an idealized and perfected form of a nurse with self-sacrificial language (re)producing self-sacrificing expectations. The second half of this paper looks at how regulatory frameworks (using the example of UK's Nursing and Midwifery Council Code of Conduct) institutionalize the conditions of possibility through collective imaginations. The domineering expectations found within the Vitruvian nurse metaphor and further codified by regulatory frameworks give rise to boredom and burnout. The paper ends by suggesting possible ways to diffract regulatory frameworks to practice with affirmative ethics and reduce feelings of self-sacrifice and exhaustion among nurses.

Reducing Team Burnout Through Enhanced Scope of Practice for Nursing Assistive Personnel

Persistent nursing workforce shortages, in conjunction with the COVID-19 pandemic and increased patient acuity, have led to increased utilization of nursing assistive personnel (NAP) within acute care settings. Although the work demand of NAPs continues to increase, their delegated work autonomy remains ambiguous and diverse. This lack of clarity impacts effective teamwork, collaboration, and delegation. This study successfully enhanced the scope of practice for NAPs, resulting in increased staff and patient satisfaction.

Moderating Role of Communication Competence in the Association between Professionalism and Job Satisfaction in Korean Millennial and Generation Z Nurses: A Cross-Sectional Study

Millennial and Generation Z (MZ generation) nurses, the core of the Republic of Korean nursing workforce, are leaving hospitals. We, therefore, aimed to determine the mediating role of communication competence between nursing professionalism and job satisfaction of MZ generation nurses in Republic of Korea. A total of 188 nurses aged 20-39 years belonging to the MZ generation, who had been working in a general hospital for over six months, participated in an online survey from 27 October 2022 to 11 January 2023. Data analysis was conducted using the bootstrapping method with the SPSS PROCESS macro program to confirm the mediating role of communication competence. Job satisfaction, professionalism, and communication skills were significantly positively correlated (r = 0.36-0.72, p < 0.001). Communication competence was found to be a mediating factor in the relationship between professionalism and job satisfaction. The results showed that when professionalism related to job satisfaction, good communication further enhanced job satisfaction. In order to enhance MZ generation nurses' job satisfaction, it is necessary to improve nursing professionalism and implement training programs to improve communication skills considering generation-specific characteristics.

Delegation of insulin administration to non-registered healthcare workers in community nursing teams: A qualitative study

AIMS

To explore stakeholder perspectives on the benefits and/or disadvantages of the delegation of insulin injections to healthcare support workers in community nursing services.

DESIGN

Qualitative case study.

METHODS

Interviews with stakeholders purposively sampled from three case sites in England. Data collection took place between October 2020 and July 2021. A reflexive thematic approach to analysis was adopted.

RESULTS

A total of 34 interviews were completed: patients and relatives (n = 7), healthcare support workers (n = 8), registered nurses (n = 10) and senior managers/clinicians (n = 9). Analysis resulted in three themes: (i) Acceptance and confidence, (ii) benefits and (iii) concerns and coping strategies. Delegation was accepted by stakeholders on condition that appropriate training, supervision and governance was in place. Continuing contact between patients and registered nurses, and regular contact between registered nurses and healthcare support workers was deemed essential for clinical safety. Services were reliant on the contribution of healthcare support workers providing insulin injections, particularly during the COVID-19 pandemic. Benefits for service and registered nurses included: flexible team working, increased service capacity and care continuity. Job satisfaction and career development was reported for healthcare support workers. Patients benefit from timely administration, and enhanced relationships with the nursing team. Concerns raised by all stakeholders included potential missed care, remuneration and task shifting.

CONCLUSION

Delegation of insulin injections is acceptable to stakeholders and has many benefits when managed effectively.

IMPACT

Demand for community nursing is increasing. Findings of this study suggest that delegation of insulin administration contributes to improving service capacity. Findings highlight the essential role played by key factors such as appropriate training, competency assessment and teamwork, in developing confidence in delegation among stakeholders. Understanding and supporting these factors can help ensure that practice develops in an acceptable, safe and beneficial way, and informs future development of delegation practice in community settings.

PATIENT OR PUBLIC CONTRIBUTION

A service user group was consulted during the design phase prior to grant application and provided comments on draft findings. Two people with diabetes were members of the project advisory group and contributed to the study design, development of interview questions, monitoring study progress and provided feedback on study findings.

Collaborative practice among general ward staff on escalating care in clinical deterioration: A systematic review

AIM

To understand the issues surrounding collaborative practice and collaboration experiences among general ward staff in the escalation of care for clinically deteriorating patients.

DESIGN

A systematic synthesis without meta-analysis.

REVIEW METHODS

Seven electronic databases (CINAHL, Cochrane, Embase, PsycINFO, PubMed, Scopus and ProQuest Theses and Dissertations) were searched from their inception to 30 April 2022. Two reviewers independently screened titles, abstracts and full text for eligibility. The critical appraisal skill programme, Joanna Briggs Institute checklist for analytical cross-sectional studies and mixed methods appraisal tool were used to appraise the quality of the included studies. Both quantitative and qualitative research data were extracted, analysed and then synthesised using the data-based convergent qualitative synthesis approach. This review adhered to the Synthesis without meta-analysis (SWiM) reporting guidelines.

RESULTS

A total of 17 studies were included. Two themes and six sub-themes were generated: (1) intraprofessional factors-inadequate handover, workload and mutual support, raising and acting on concerns, and seeking help from seniors and (2) interprofessional factors-differences in communication styles, and hierarchical approach versus interpersonal relationships.

CONCLUSIONS

This systematic review highlights the need to address the intra- and interprofessional issues surrounding collaborative practice in escalation of care among general ward staff.

IMPLICATIONS FOR THE PROFESSION

Findings from this review will inform healthcare leaders and educators on the development of relevant strategies and multi-disciplinary training to foster effective teamwork among nurses and doctors, with the goal of improving the escalation of care for patients with clinical deterioration.

NO PATIENT OR PUBLIC CONTRIBUTION

This systematic review did not directly involve patient or public contribution to the manuscript.

The relationship between teamwork, moral sensitivity, and missed nursing care in intensive care unit nurses

BACKGROUND

Teamwork, moral sensitivity, and missed nursing care are important healthcare challenges for Intensive Care Unit (ICU) nurses and the existence of a relationship between these variables can be useful for developing better care improvement strategies. This study aimed to determine the relationship between teamwork, moral sensitivity, and missed nursing care in ICU nurses.

METHODS

This is a descriptive cross-sectional study conducted on a total of 200 ICU nurses working at teaching hospitals affiliated to Semnan and Shahroud Universities of Medical Sciences, Semnan, Iran in 2022. Sampling was conducted using the census method. Data collection was conducted using a demographic checklist, the TeamSTEPPS Team Perception Questionnaire (T-TPQ), Lützén Moral Sensitivity Questionnaire (L-MSQ), and Kalisch and Williams Missed Nursing Care (MISSCARE) Survey. The examination of the relationship between the three variables was conducted using Pearson's correlation coefficient and multiple regression analysis.

RESULTS

The mean and standard deviation of teamwork, moral sensitivity, and missed nursing care was 3.47 ± 0.69, 64.19 ± 13.43, and 55.04 ± 34.10, respectively. The variable of teamwork had a significant positive relationship with moral sensitivity (p < .001) and a significant negative relationship with missed nursing care (p < .001). Teamwork was also a positive predictor of moral sensitivity (p < .001) and a negative predictor of missed nursing care (p < .001). The clinical experience of ICU nurses was a positive predictor of teamwork (p = .01) and a negative predictor of missed nursing care (p = .001). The age of ICU nurses was a positive predictor of moral sensitivity (p = .001) and a negative predictor of missed nursing care (p = .008).

CONCLUSION

The findings showed that a higher level of teamwork was associated with increased moral sensitivity and reduced missed nursing care among ICU nurses. Therefore, focusing on planning interventions on teamwork improvement can lead ICU nurses to improve moral sensitivity, lower missed nursing care, and promote the quality of patient care.

TeamSTEPPS®-based clinical simulation training program for critical care professionals: A mixed-methodology study

INTRODUCTION

The Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) programme has been shown to improve interprofessional work among healthcare professionals by enhancing teamwork. Intensive care professionals were trained in this methodology through the course "Simulation Trainer: Improving Teamwork through TeamSTEPPS®".

OBJECTIVES

To analyse the teamwork performance and good practice in simulation of the intensive care professionals attending the course and to explore their perceptions of the training experience carried out during the course.

METHODS

A cross-sectional descriptive and phenomenological study was carried out using a mixed methodology. The 18 course participants were administered the questionnaires "TeamSTEPPS™ 2.0 Team Performance Observation Tool" to evaluate teamwork performance and "Educational Practices Questionnaire" for good practices in simulation after the simulated scenarios. Subsequently, a group interview was conducted through a focus group with 8 attendees using the Zoom™ videoconferencing platform. A thematic and content analysis of the discourses was carried out using the interpretative paradigm. Quantitative and qualitative data were analysed using IBM SPSS Statistics™ 27.0 and MAXQDA Analytics Pro™ respectively.

RESULTS

Both the level of teamwork performance (mean = 96.25; SD = 8.257) and good practice in simulation (mean = 75; SD = 1.632) following the simulated scenarios were adequate. The following main themes were identified: satisfaction with the TeamSTEPPS® methodology, usefulness of the methodology, barriers to methodology implementation and non-technical skills improved through TeamSTEPPS®.

CONCLUSIONS

TeamSTEPPS® methodology can be a good interprofessional education strategy for the improvement of communication and teamwork in intensive care professionals, both at the care level (through on-site simulation strategies) and at the teaching level (through its inclusion in the students' curriculum).

Simulation for diversity, equity and inclusion in emergency medicine residency training: A qualitative study

Background

The last few years have seen an increased focus on diversity, equity, and inclusion (DEI) initiatives across organizations. Simulation has been used in varying degrees for teaching about DEI topics with emergency medicine; however, there are no established best practices or guidelines on this subject. To further examine the use of simulation for DEI teachings, the DEISIM work group was created as a collaboration between the Society of Academic Emergency Medicine (SAEM) Simulation Academy and the Academy for Diversity and Inclusion in Emergency Medicine (ADIEM). This study represents their findings.

Method

This qualitative study was conducted using a three-pronged approach. Initial literature search was conducted followed by a call for submission of simulation curricula. These were then followed by five focus groups. Focus groups were recorded, transcribed by a professional transcription service, and then subjected to thematic analysis.

Results

Data were analyzed and organized into four broad categories including Learners, Facilitators, Organizational/Leadership, and Technical Issues. Challenges within each of these were identified, as were potential solutions. Select pertinent findings included focused faculty development, a carefully planned approach that utilized DEI content experts and the use of simulation for workplace microaggressions or discriminations.

Conclusions

There appears to be a clear role for simulation in DEI teachings. Such curricula, however, should be undertaken with careful planning and input from appropriate and representative parties. More research is needed on optimizing and standardizing simulation-based DEI curricula.

Nursing Assistant Staffing Model: Implementation and Outcome Evaluation in Taiwan Hospitals

BACKGROUND

A key policy of the Taiwan healthcare system is promoting the hiring of nursing assistants (NAs) to reduce the workload of nurses. However, few studies in the literature have compared the relative effectiveness of different nurse staffing policies, and no studies have addressed the impact of the NA staffing (NAS) model.

PURPOSE

This study explored the current status of the NAS model as implemented in Taiwan hospitals and to investigate the methods used to evaluate the outcomes of NAS model implementation.

METHODS

A cross-sectional online survey was performed in hospitals nationwide from June 1 to December 31, 2018. There were 153 government-accredited hospitals being invited to participate in the survey.

RESULTS

Of the 139 hospitals that completed the online survey, 26% (36 hospitals) had implemented the NAS model. Many of the hospitals had hired full-time, certified NAs. Most of the tasks assigned to NAs were in the nonprofessional/general and technical work categories. In addition, medical wards were the most frequently assigned workplace, especially on day shifts. Few of the surveyed hospitals had evaluated the effectiveness of the NAS model. Improvement after implementation of the NAS model (based on the 35 outcome indicators) was found to vary significantly. The most commonly used outcome indicator was patient satisfaction. All the stakeholders, including patients, family caregivers, nurses, and nurse supervisors, supported implementation of the NAS model. However, some of the participants expressed concerns regarding the difficulties involved with model implementation.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Although the NAS model may be beneficial, further empirical research is necessary to confirm the contributions of NAs. Additional evidence regarding the benefits of the NAS model for hospital performance and patient outcomes may be expected to motivate more hospital administrators to adopt this model.

The Relationship of Nursing Teamwork and Job Satisfaction in Hospitals

Introduction

Teamwork is identified as a key contributor to patient safety and good teamwork is recognized as one of the presumptions of healthy work environment in nursing. The importance of job satisfaction in nursing has repeatedly been confirmed, but only recently has the association of job satisfaction and nursing teamwork been identified.

Objective

To identify the level of nursing teamwork in hospitals in Iceland and its relationship with job satisfaction.

Methods

This was a quantitative descriptive cross-sectional study. Data were collected with the Nursing Teamwork Survey administered to nursing staff in medical, surgical, and intensive care units in hospitals in Iceland. This study is based on data from 567 participants.

Results

A logistic regression analysis indicated that work experience on current unit and perceived staffing adequacy contributes to job satisfaction and when controlling for unit type, role, experience on current unit and staffing adequacy, those reporting better teamwork are significantly more likely to be satisfied with their current position. With an additional unit for overall nursing teamwork, participants are almost five times likelier to be satisfied with their current position.

Conclusion

Study findings show that there is a significant relationship between nursing teamwork and job satisfaction. The findings of this study confirm the importance of adequate staffing and good teamwork for nurses' job satisfaction. Staffing however, will remain the most challenging part of the equation as lack of nursing staff is foreseen globally in the coming decades turning the spotlight to teamwork. All stakeholders, including clinical nurse leaders, administrators, and instructors, need to emphasize on strengthening nursing teamwork. Good teamwork with increased job satisfaction may prevent turnover and shortage of nurses, an issue expected to grow during and following the COVID-19 pandemic. Facilitating good teamwork should be one of the priorities of every nurse leader.

Administration approaches of nursing assistants in hospitals: a scoping review

OBJECTIVES

The administration of nursing assistants (NAs) is closely associated with patient outcomes, but studies evaluating intrahospital administration of NAs are limited. This study aimed to identify existing literature on intrahospital NAs' administration approaches.

DESIGN

Scoping review.

DATA SOURCES

PubMed, Embase, CINAHL, Scopus, ProQuest, CNKI, APA PsycInfo, Wanfang Med, SinoMed, Ovid Emcare, NICE, AHRQ, CADTH, JBI EBP and Cochrane DSR were searched for articles published between January 2011 and March 2022.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Qualitative, quantitative or mixed-method studies and evidence syntheses that evaluate administration approaches, models and appraisal tools of intrahospital NAs were included.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers conducted search, data selection and data extraction according to Joanna Briggs Institute guidance and methodology for scoping review. The quality of included studies was assessed using Mixed Methods Appraisal Tool or AMSTAR V.2. Data were synthesised using narrative methods and frequency effect size analysis.

RESULTS

Thirty-six studies were eligible, with acceptable quality. We identified 1 administration model, 9 administration methods, 15 educational programmes and 7 appraisal tools from the included studies. The frequency effect size analysis yielded 15 topics of the main focus at four levels, suggesting that included articles were mainly (33%) focused on the competency of NAs, and the lectures were the most (80%) used strategy in quality improvement projects. Evidence from the studies was of low-to-moderate quality, indicating huge gaps between evidence-based research and management practice.

CONCLUSIONS

Practical intrahospital administration approaches were revealed, and fifteen primarily focused topics were identified. We should explore this area more thoroughly using structured frameworks and standardised methodology. This scoping review will help managers find more effective ways to improve the quality of care. Researchers may focus more on evidence-based practice in NA administration using the 15 topics as a breakthrough.

Scoping review to identify strategies and interventions improving interprofessional collaboration and integration in primary care

OBJECTIVE

To identify strategies and interventions used to improve interprofessional collaboration and integration (IPCI) in primary care.

DESIGN

Scoping review DATA SOURCES: Specific Medical Subject Headings terms were used, and a search strategy was developed for PubMed and afterwards adapted to Medline, Eric and Web of Science.

STUDY SELECTION

In the first stage of the selection, two researchers screened the article abstracts to select eligible papers. When decisions conflicted, three other researchers joined the decision-making process. The same strategy was used with full-text screening. Articles were included if they: (1) were in English, (2) described an intervention to improve IPCI in primary care involving at least two different healthcare disciplines, (3) originated from a high-income country, (4) were peer-reviewed and (5) were published between 2001 and 2020.

DATA EXTRACTION AND SYNTHESIS

From each paper, eligible data were extracted, and the selected papers were analysed inductively. Studying the main focus of the papers, researchers searched for common patterns in answering the research question and exposing research gaps. The identified themes were discussed and adjusted until a consensus was reached among all authors.

RESULTS

The literature search yielded a total of 1816 papers. After removing duplicates, screening titles and abstracts, and performing full-text readings, 34 papers were incorporated in this scoping review. The identified strategies and interventions were inductively categorised under five main themes: (1) Acceptance and team readiness towards collaboration, (2) acting as a team and not as an individual; (3) communication strategies and shared decision making, (4) coordination in primary care and (5) integration of caregivers and their skills and competences.

CONCLUSIONS

We identified a mix of strategies and interventions that can function as 'building blocks', for the development of a generic intervention to improve collaboration in different types of primary care settings and organisations.

Understanding teamwork in rapidly deployed interprofessional teams in intensive and acute care: A systematic review of reviews

The rapid increase of acute and intensive care capacities in hospitals needed during the response to COVID-19 created an urgent demand for skilled healthcare staff across the globe. To upscale capacity, many hospitals chose to increase their teams in these departments with rapidly re-deployed inter-professional healthcare personnel, many of whom had no prior experience of working in a high-risk environment and were neither prepared nor trained for work on such wards. This systematic review of reviews examines the current evidence base for successful teamwork in rapidly deployed interprofessional teams in intensive and acute care settings, by assessing systematic reviews of empirical studies to inform future deployments and support of rapidly formed clinical teams. This study identified 18 systematic reviews for further analysis. Utilising an integrative narrative synthesis process supported by thematic coding and graphical network analysis, 13 themes were found to dominate the literature on teams and teamwork in inter-professional and inter-disciplinary teams. This approach was chosen to make the selection process more transparent and enable the thematic clusters in the reviewed papers to be presented visually and codifying four factors that structure the literature on inter-professional teams (i.e., team-internal procedures and dynamics, communicative processes, organisational and team extrinsic influences on teams, and lastly patient and staff outcomes). Practically, the findings suggest that managers and team leaders in fluid and ad-hoc inter-professional healthcare teams in an intensive care environment need to pay attention to reducing pre-existing occupational identities and power-dynamics by emphasizing skill mix, establishing combined workspaces and break areas, clarifying roles and responsibilities, facilitating formal information exchange and developing informal opportunities for communication. The results may guide the further analysis of factors that affect the performance of inter-professional teams in emergency and crisis deployment.

Delegation of medication administration from registered nurses to non-registered support workers in community care settings: A systematic review with critical interpretive synthesis

INTRODUCTION

Healthcare workforces are currently facing multiple challenges, including aging populations; increasing prevalence of long-term conditions; and shortfall of registered nurses. Employing non-registered support workers is common across many countries to expand service capacity of nursing teams. One task delegated to non-registered support workers is medication administration, which is considered a complex task, with associated risks. This is an important topic given the predicted global increase in patients requiring assistance with medication in community settings. This review explores the evidence on delegation of medication administration from registered nurse to non-registered support workers within community settings, to better understand factors that influence the process of delegation and its impact on service delivery and patient care.

METHODS

The review followed key principles of Critical Interpretative Synthesis and was structured around Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Literature searches were conducted in MEDLINE, CINAHL, Embase, and ProQuest-British Nursing Index databases. Twenty studies were included.

RESULTS

Findings are reported under four themes: 1, Regulatory and contextual factors; 2, Individual and team level factors; 3, Outcomes of delegation; and 4, Process of implementation and evaluation. Delegation was found to be a complex phenomenon, influenced by a myriad of interconnecting factors at the macro, meso, micro level. At the macro level, the consistency and clarity of government and state level regulations was found to facilitate or impede delegation of medication administration. Lack of clarity at the macro level, impacted at meso and micro levels, resulting in confusion around what medication administration could be delegated and who held responsibility. At the micro level, central to the interpretation of success was the relationship between the delegator and delegatee. This relationship was influenced by personal views, educational and systems factors. Many benefits were reported as an outcome of delegation, including service efficiency and improved patient care. The implementation of delegating medication administration was influenced by regulatory factors, communication, stakeholder engagement, and service champions.

CONCLUSION

Delegation of medication administration is a complex process influenced by many interrelating factors. Due to the increased risk associated with medication administration, clear and consistent regulatory and governance frameworks and procedures are crucial. Delegation of medication administration is more acceptable within a framework that adequately supports the process, backed by appropriate policy, skills, training, and supervisory arrangements. There is a need for further research around implementation, clinical outcomes and medication errors associated with delegation of medication administration.

Exploring utilisation of the allied health assistant workforce in the Victorian health, aged care and disability sectors

Background

Allied health assistants (AHAs) support allied health professionals (AHPs) to meet workforce demands in modern healthcare systems. Previous studies have indicated that AHAs may be underutilised in some contexts. This study aims to identify factors contributing to the effective utilisation of AHAs across health, aged care and disability sectors and possible pathway elements that may optimise AHA careers in Victoria.

Methods

Using an interpretive description approach data collection included a workforce survey and semi structured interviews (individual and group). Data analysis included descriptive statistics, independent t-tests and thematic analysis. Participants included allied health assistants, allied health professionals and allied health leaders in the health, aged care or disability sectors; educators, managers or student of allied health assistance training; and consumers of Victorian health, disability or aged care services.

Results

The literature scan identified numerous potential barriers to and enablers of AHA workforce utilisation. A total of 727 participants completed the survey consisting of AHAs (n = 284), AHPs & allied health leaders (n = 443). Thirteen group and 25 individual interviews were conducted with a total of 119 participants. Thematic analysis of the interview data identified four interrelated factors (system, training, individual and workplace) in pre-employment training and workplace environments. These factors were reported to contribute to effective utilisation of the AHA workforce across health, aged care and disability sectors. Study findings were also used to create a conceptual diagram of potential AHA career pathway elements.

Conclusion

This study identified pre-employment and workplace factors which may contribute to the optimal utilisation of the AHA workforce across Victorian health, aged care and disability sectors. Further study is needed to investigate the transferability of these findings to national and global contexts, and testing of the conceptual model.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07171-z.

Relational Quality Between the RN and Nursing Assistant: Essential for Teamwork and Communication

OBJECTIVE

Nurse (RN) and nursing assistant (NA) relational quality was examined along with associations between relational quality and evaluations of teamwork and communication.

BACKGROUND

RN and NA teams constitute the primary nursing care delivery method, and the quality of their relationship affects system capacity for improving patient outcomes; adverse events are linked to communication and teamwork breakdowns.

METHODS

RN (N = 889) and NA (263) relational quality was examined using a cross-sectional secondary analysis from system assessment with the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture.

RESULTS

RN and NA perceived relational quality indicated significant differences in teamwork and safety grade ratings, with both groups reporting perceived teamwork as high when patient safety grade was low.

CONCLUSIONS

This study supports the benefits of improving the RN-NA teamwork-communication relationship. An enhanced RN-NA relational quality can be used by nurse leaders to optimize patient care delivery outcomes.

An integrative review on interventions for strengthening professional governance in nursing

AIM

To identify the interventions for strengthening professional nursing governance and describe their outcomes.

BACKGROUND

The ever-changing health care environment requires empowering governance structures and shared decision-making. The costly nature of reshaping governance makes the identification of effective interventions vital.

EVALUATION

An integrative review was carried out between January 2007 and May 2020 in the CINAHL, PubMed, Scopus, PsycINFO, Business source, Cochrane and Medic databases. The quality of the 12 included studies was evaluated with the Joanna Briggs Institute critical appraisal tools.

KEY ISSUES

Eight studies reported that the implemented interventions had positively influenced organisation regarding creating positive work environments, building new leadership competencies and increasing personnel's ability to take part in decision-making. The overall quality of the evidence was judged to be moderate.

CONCLUSION

Comprehensive decision-making structures, efficient teamwork and transformational leadership competencies among nurse leaders enable personnel to participate in decision-making. Further research is needed to identify the most effective interventions for improving professional governance.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse leaders have to ensure that personnel have adequate opportunities to congregate and decide over matters concerning their work. Positive organisational climate and relational leadership style, along with highly functioning teams, are important prerequisites to nursing councils producing the desired outcomes.

Relational Quality of Registered Nurses and Nursing Assistants: Influence on Patient Safety Culture

Registered nurses (RNs) working within acute care hospitals have an incredible responsibility to provide safe care in a complex environment which requires trust, teamwork, and communication. Nursing assistants (NAs) play a critical role in working with RNs to meet these growing demands of inpatient care. Minimal evidence exists exploring the relational quality between RNs and NAs within hospitals. The aim of this study is to explore RN and NA behaviors and experiences that promote patient safety and teamwork and enhance communication between RNs and NAs within the hospital environment. Qualitative analysis was used, with two focus groups which included six participants within each group (three RNs and three NAs) from two separate inpatient units. Transcripts were reviewed and coded for themes. Collaborative teamwork and two-way communication were commonly reported as behaviors that promote patient safety. Trust between RNs and NAs was identified as a key component of positive relationships between RNs and NAs. Participants identified four common behaviors that build trust, which were accountability, effective conflict resolution, collaborative teamwork, and prioritizing patient needs. Finally, teamwork was identified as a common strategy to increase communication effectiveness between RNs and NAs. High relational quality (RQ) between the RN and NA is an important component of teamwork and patient safety culture.

The influence of empowered work environments on the psychological experiences of nursing assistants during COVID-19: a qualitative study

Background

Nursing Assistants (NA) who feel empowered tend to perform their duties better, have higher morale and job satisfaction, and are less likely to leave their jobs. Organizational empowerment practices in hospitals likely shape the psychological experiences of empowerment among these personnel; however, little is known about this relationship.

Objective

We used qualitative inquiry to explore the relationship between organizational empowerment structural components and feelings of psychological empowerment among hospital frontline workers during a public health emergency.

Methods

Kanter’s Theory of Structural Empowerment and Spreitzer’s Psychological Empowerment in the Workplace Framework were applied to identify the conceptual influences of organizational practices on psychological experiences of empowerment. In-depth interviews were conducted with a convenience sample of NAs, caring for hospitalized COVID-19 patients. Directed content analysis was performed to generate a data matrix consisting of the psychological experiences of meaning, competence, self-determination, and impact embedded under the organizational structural components of information, resources, support, and opportunity.

Results

Thirteen NAs (mean age = 42 years, 92% female) completed interviews. Information, or lack thereof, provided to the NAs influenced feelings of fear, preparation, and autonomy. Resources (e.g., protocols, equipment, and person-power) made it easier to cope with overwhelming emotions, affected the NAs’ abilities to do their jobs, and when limited, drove NAs to take on new roles. NAs noted that support was mostly provided by nurses and made the NAs feel appreciated, desiring to contribute more. While NAs felt they could consult leadership when needed, several felt leadership showed little appreciation for their roles and contributions. Similar to support, the opportunity to take care of COVID-19 patients yielded a diverse array of emotions, exposed advances and gaps in NA preparation, and challenged NAs to autonomously develop new care practices and processes.

Conclusion

Management and empowerment of healthcare workers are critical to hospital performance and success. We found many ways in which the NAs’ psychological experiences of empowerment were shaped by the healthcare system’s empowerment-related structural conditions during a public health emergency. To further develop an empowered and committed critical workforce, hospitals must acknowledge the organizational practice influence on the psychological experiences of empowerment among NAs.