Development and Testing of the Relational and Structural Components of Innovativeness Across Academia and Practice for Healthcare Progress Scale

OBJECTIVE

Using data from 5 academic-practice sites across the United States, researchers developed and validated a scale to measure conditions that enable healthcare innovations.

BACKGROUND

Academic-practice partnerships are a catalyst for innovation and healthcare development. However, limited theoretically grounded evidence exists to provide strategic direction for healthcare innovation across practice and academia.

METHODS

Phase 1 of the analytical strategy involved scale development using 16 subject matter experts. Phase 2 involved pilot testing the scale.

RESULTS

The final Innovativeness Across Academia and Practice for Healthcare Progress Scale (IA-APHPS) consisted of 7 domains: 3 relational domains, 2 structural domains, and 2 impact domains. The confirmatory factor analysis model fits well with a comparative fit index of 0.92 and a root-mean-square error of approximation of 0.06 (n = 477).

CONCLUSION

As the 1st validated scale of healthcare innovation, the IA-APHPS allows nurses to use a diagnostic tool to facilitate innovative processes and outputs across academic-practice partnerships.

A Culture of Inquiry: Practice-Based Knowledge for Nurse Leaders

A culture of inquiry has not traditionally been associated with nursing leadership. As healthcare evolves, leaders must reevaluate barriers to improving healthcare outcomes. One noted barrier has been a need for more inquisitiveness to innovate. Through an American Organization for Nursing Leadership workgroup, the authors advanced the understanding of a "culture of inquiry," applying a practice-based learning approach for knowledge development. Three recommended foundational elements are psychological safety, building connections, and using design thinking at all organizational levels.

A framework for transforming the professional identity and brand image of All Nurses as Leaders

BACKGROUND

The professional identity and brand image of nurses as leaders have not kept pace with the roles and scope of contemporary nursing practice.

PURPOSE

To provide a framework to transform the professional identity and brand image of nursing from a caring discipline to one of leaders.

METHODS

A Consensus Development Workgroup (CDW) design was used between the International Society for Professional Identity in Nursing (ISPIN) and the Institute for Brand Image of Nursing (IBIN) to advance the concept of All Nurses as Leaders across all settings and the public domain.

DISCUSSION

The goal is to occupy a position in the minds of all stakeholders that differentiates nursing in a manner that is positive, relevant, accurate, desirable, and consistent over time.

CONCLUSION

Current outcomes are endorsements, evidence-based strategies, and a framework to deconstruct the current brand image and align it with the desired brand image of All Nurses as Leaders.

Creating an Organizational Culture and Climate of Meaningful Recognition for Nurse Managers

OBJECTIVES

To examine the current nurse manager (NM) recognition culture and climate in organizations and to develop a theoretical foundation for meaningful recognition.

BACKGROUND

Nurse managers call for wider recognition, but the theoretical conceptualization and underpinnings of meaningful recognition are sparse in the literature.

METHODS

A qualitative descriptive design was used utilizing individual interviews. The study participants included 30 individuals consisting of NMs, chief nursing officers, and chief nursing executives. Content analysis was conducted.

RESULTS

A theoretical model with super-categories and supportive quotes was created to operationalize a culture and climate of meaningful recognition in the organizations represented by the sample.

CONCLUSION

This qualitative descriptive study highlights the importance of recognizing the value of NMs for their contributions to nursing leadership and patient care. Implications of recognizing NMs are counteracting the feeling of being invisible and mitigating issues within the work environment.

A Conceptual Model for Professional Identity in Nursing: An Interdependent Perspective

The purpose of this initiative was to define the development, verification, and evolution of the conceptual model for Professional Identity in Nursing. This action research design occurred over two phases, utilizing observations, a modified Norris process for model development, and focus groups. Analysis consisted of conventional content analysis and the Fawcett method for conceptual model analysis and evaluation. The model was modified, and results are presented based on the model's philosophical underpinnings, content, socialness, and evolution. The model resonates with nurses both in the United States and internationally. The interdependency shown in the model encourages collaboration, accountability, and sustainability within the profession and society.

Building the Science to Guide Nursing Administration and Leadership Decision Making

OBJECTIVE

The aim of this study was to identify the challenges, barriers, and solutions for conducting nursing administration and leadership science (NALS) research.

BACKGROUND

Evidence from leadership science should be at the forefront of nurse leaders' decision making. Yet, challenges remain in building the evidence and moving it into nursing administration and leadership practice.

METHODS

This study used a Delphi technique with open-ended questions and direct content analysis to evaluate survey responses of members of the Association for Leadership Science in Nursing and American Organization for Nursing Leadership.

RESULTS

Open-ended responses were coded to yield super categories and supportive codes for areas with limited evidence to guide leadership practice and the challenges for conducting NALS research.

CONCLUSIONS

These findings provide future directions for continuously driving NALS research and for building and leveraging leadership science to support nursing administration decision making.

Setting the Research Agenda for Nursing Administration and Leadership Science: A Delphi Study

OBJECTIVE

The aim of this study was to identify and prioritize research topics for nursing administration and leadership science.

BACKGROUND

Nursing administration and leadership research priorities should provide a framework for building the science needed to inform practice.

METHODS

The Association for Leadership Science in Nursing (ALSN) and American Organization for Nursing Leadership (AONL) Foundation (AONL-F) for Nursing Leadership and Education collaborated on a Delphi study. Initial input on research priority items were received from ALSN and AONL members. National experts participated in a 3-round Delphi study.

RESULTS

Top-ranked priorities included: 1) nurses' health, well-being, resiliency, and safety in the workplace; 2) developing and managing a nursing workforce to meet current and future healthcare needs; 3) healthy work/practice environments for direct care nurses; 4) healthy work/ practice environments for nurse leaders; 5) quantification of nursing's value across the healthcare delivery system; and 6) nurse leader development and essential competencies.

CONCLUSIONS

Researchers and funders should use these priorities to guide future studies.

Filling the Knowledge Gap for Nurse Leaders: Next Steps Following COVID-19

The purpose of this article is to share gaps in knowledge and research related to pandemic management identified by nurse leaders during the COVID-19 pandemic. As part of a larger Delphi study, nurse leaders responded to an open-ended question about gaps in research they saw as important following the pandemic. Responses were analyzed using directed content analysis. Results are presented as 4 supercategories: Organizational leadership preparedness, adaptive leadership in crisis, innovations in care delivery, and health, well-being, and resilience.

Nurse Leader DNP Capstone Projects Evaluation: An Action Framework

BACKGROUND

Little is known about available guidelines that can be used to evaluate health systems' Doctor of Nursing Practice (DNP) capstone projects.

OBJECTIVES

The twofold purpose of this study was to identify the scope of nurse executive leadership practices, as demonstrated in final health systems' DNP Projects and propose a framework to guide evaluating health systems' DNP capstone projects.

METHODS

This qualitative study used content analysis to evaluate DNP project posters of 10 health systems' DNP students graduating from one Midwestern college of nursing. Students were engaged in activities pertinent to managerial and executive-level nurse leaders.

RESULTS

Students were engaged in activities pertinent to both managerial and executive level nurse leaders and followed AONE competencies. Leadership styles were operational and transformational. Six types of activities were identified. Leadership activities and themes were organized into a framework for action that can guide curriculum.

CONCLUSIONS

The Framework for Action themes can be used to coach students in nurse manager or executive roles and identify developmental needs of students.

IMPLICATIONS FOR NURSING

A specific new competency on impact is indicated. Use of simulation techniques is an opportunity in health systems education.

Clinical leadership development and education for nurses: prospects and opportunities

With the implementation of the Affordable Care Act, elevated roles for nurses of care coordinator, clinical nurse leader, and advanced practice registered nurse have come to the forefront. Because change occurs so fast, matching development and education to job requirements is a challenging forecasting endeavor. The purpose of this article is to envision clinical leadership development and education opportunities for three emerging roles. The adoption of a common framework for intentional leadership development is proposed for clinical leadership development across the continuum of care. Solutions of innovation and interdependency are framed as core concepts that serve as an opportunity to better inform clinical leadership development and education. Additionally, strategies are proposed to advance knowledge, skills, and abilities for crucial implementation of improvements and new solutions at the point of care.

Organizational culture and climate for promoting innovativeness

OBJECTIVE

The aim of this study is to explore the experiences of nurse leaders and nurses in a hospital whose patient care mission was stated as innovation.

BACKGROUND

Nurses are critically positioned to provide creative and innovative solutions that make a difference in the lives of patients, organizations, communities, and the profession.

METHODS

This 2-phase qualitative study used a content analysis and thematic analysis approach to describe experiences and to generate a beginning conceptual framework of the experience.

RESULTS

Results from phase 1 and phase 2 of this study demonstrate that innovativeness in nursing is a multifaceted phenomenon consisting of workplace antecedents followed by a social process.

CONCLUSIONS

Nursing innovation requires organizational commitment to allow employees to inquire and question organizational practices and issues on behalf of the mission, patient care, and nursing practice.

An examination of the sustainable adoption of whole-person care (WPC)

AIM

This study illustrates how King's theory of goal attainment was used to focus an examination of whole-person care (WPC) and to extend the range of knowledge needed for WPC and nursing practice.

BACKGROUND

Leadership implemented a faith-based innovation using continuing education for patient care that incorporates body-mind-spirit and eight principles called CREATION. Three questions arose: (1) Is there an evidence-based framework to determine whether the philosophy supports the discipline of nursing? (2) How extensive is the adoption and application of WPC? (3) Does the model make a difference in the context of nurse-patient interactions and outcomes in support of Magnet recognition criteria?

METHODS

Interpretative phenomenology was used and an interview protocol was developed to examine the adoption and movement toward a culture of WPC.

RESULTS

WPC was 'lived.' it is a relationship-oriented patient care model. However, except in direct patient care, the principles of creation were poorly diffused.

IMPLICATIONS FOR NURSING MANAGEMENT

These results contribute to nursing leadership's roles in fostering a workplace climate that enables the diffusion of innovative models of care. In addition, these results support the Institute of Medicine's call for nurses to take the lead in adopting innovations and provides leaders with actionable strategies.

Anticoagulant activity of synthetic hirudin peptides

Synthetic peptides based on the COOH-terminal 21 residues of hirudin were prepared in order to 1) evaluate the role of this segment in hirudin action toward thrombin, 2) define the shortest peptide derivative with anticoagulant activity, and 3) investigate the role of tyrosine sulfation in the peptides' inhibitory activities. A hirudin derivative of 20 amino acids, Hir45-64 (derived from residues 45-64 of the hirudin polypeptide), was found to effect a dose-dependent increase in the activated partial thromboplastin time (APTT) of normal human plasma but to have no measurable inhibitory activity toward thrombin cleavage of a tripeptidyl p-nitroanilide substrate. Anticoagulant activity in hirudin derivatives was comparable in peptides of 20, 16, and 12 residues truncated from the NH2 terminus. Additional truncated peptides prepared by synthesis and carboxypeptidase treatment reveal that the minimal sequence of a hirudin peptide fragment with maximal anticoagulant activity is contained within the sequence: NH2-Asn-Gly-Asp-Phe-Glu-Glu-Ile-Pro-Glu-Glu-Tyr-Leu-COOH. The 12-residue derivative thus identified was reacted with dicyclohexylcarbodiimide in the presence of sulfuric acid to yield a Tyr-sulfated peptide, S-Hir53-64. By comparison to unsulfated peptide, S-Hir53-64 was found to contain a specific inhibitory activity enhanced by one order of magnitude toward increase in APTT and to effect a dose-dependent increase in thrombin time of normal human plasma to yield a 4-fold increase in thrombin time with 2.5 micrograms/ml peptide using 0.8 units/ml alpha-thrombin. Comparison of S-Hir53-64 to hirudin in thrombin time and APTT assays reveals a 50-fold difference in molar specific activities toward inhibition of thrombin. Comparison of antithrombin activities of S-Hir53-64 using a variety of animal thrombins demonstrates greatest inhibitory activity toward murine, rat, and human enzymes and a 10-fold reduced activity toward bovine thrombin.

Thrombin-mediated release of factor VIII antigen from human umbilical vein endothelial cells in culture

We have examined the effects of purified human alpha-thrombin on factor VIII antigen (FVIII-Ag) release by human umbilical vein endothelial cells in culture. Alpha-thrombin induced a time and dose-dependent release of FVIII-Ag into supernatant medium. Alpha-thrombin-mediated FVIII-Ag release was not dependent on protein synthesis and was observed in both serum-free and serum-containing media. FVIII-Ag release, however, was prevented when the serine esterase activity of thrombin was inhibited. Pretreatment of human endothelial cells with alpha-thrombin, but not diisofluorophosphate-thrombin, prevented subsequent FVIII-Ag release by alpha-thrombin. Thrombin-mediated FVII-Ag release was not associated with significant 51Cr release from prelabeled endothelial monolayers. We conclude that alpha-thrombin induces release of preformed FVIII-Ag from human umbilical vein endothelial cells by a receptor-independent, nonlytic mechanism requiring serine esterase activity.

Evaluating service needs in drug-abusing clients

Patients applying for treatment to the State of Illinois' Chicago Central Intake Facility were interviewed to assess their service needs and treatment expectations; a subgroup was reinterviewed after 4 months. Patients were classified as long-term opioid-dependent, short-term opioid-dependent, or as polydrug nonopioid dependent abusers. We found high levels of housing, employment, and legal needs among all subgroups at both first and second interviews. There were significant differences between drug-use groups in reasons for seeking treatment; opioid-dependent groups gave drug-related reasons more frequently while polydrug abusers cited legal reasons. Length of time patients remained in treatment was not related to service needs.