Oral health and oral care in patients in a surgical context: A quantitative study comparing patients' and nurses' assessments

AIMS

To investigate fundamental care delivery regarding oral care in a surgical context, and to compare patients' self-reported oral health with registered nurse assessments.

DESIGN

A descriptive and comparative study, with a consecutive selection.

METHODS

A patient oral health rating tool, including questions about performed oral care, was distributed to patients (n = 50), at four surgical wards in Sweden. The response rate was 72%. Oral health status was assessed by a registered nurse using the Revised Oral Assessment Guide (ROAG), and a comparison between patient and registered nurse assessment was performed by calculating Cohen's kappa coefficient and percentage agreement.

RESULTS

Patients (38%) reported severe oral symptoms, mostly dry lips and not an adequate amount of saliva, and 80% were not offered help with oral care. ROAG assessments revealed that 74% had problems with oral health. Almost half of the patients (48%) needed assistance with oral care but only 10% received help. Registered nurses assessed the patient's oral health as worse than the patient's self-assessment did.

CONCLUSION

There are deficiencies in fundamental care delivery regarding oral care in a surgical care context. Oral health assessments need to be performed by registered nurses. Routines for systematic oral assessments and for oral care need to be implemented by nurse managers to ensure that patients' fundamental care needs are fulfilled.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Oral health assessments need to be performed regularly by registered nurses since it is insufficient that patients self-assess their oral health. Nurse managers need to provide and implement routines for nurse assessments and oral care in surgical care contexts.

IMPACT

There are deficiencies in patients' oral health and oral care, and registered nurses need to perform oral health assessments. Nurse managers need to implement routines for registered nurse assessments and oral care.

PATIENT CONTRIBUTION

Patients admitted to a surgical ward were included in the study after being screened for inclusion criteria. After participants signed informed consent, they filled in a questionnaire about oral health and oral care, and a registered nurse performed an oral health assessment.

REPORTING METHOD

This study was carried out according to the STROBE checklist.

Assessment of Standardized Care Plans for People with Chronic Diseases in Primary Care Settings

BACKGROUND

Aging populations are driving a shift in emphasis toward enhancing chronic disease care, reflected in Catalonia's regional plan which prioritizes standardized nursing care plans in primary care settings. To achieve this, the ARES-AP program was established with a focus on harmonizing standards and supporting routine nursing clinical decision-making. This study evaluates nurses' perceptions of ARES-AP's standardized care plans for chronic diseases.

METHODS

A mixed-methods approach based on an ad hoc questionnaire (n = 141) and a focus group (n = 14) was used. Quantitative data were statistically analysed, setting significance at p < 0.05. Qualitative data were explored via content analysis.

RESULTS

ARES-AP training was assessed positively. The resources for motivational interviewing and care plans for the most prevalent chronic diseases were rated very positively. This study identified key factors influencing program implementation, including facilitators such as structured information and nursing autonomy, barriers such as resistance to change, motivators such as managerial support, and suggested improvements such as technological improvements and time management strategies.

CONCLUSIONS

This study identifies areas for improvement in implementing standardized nursing care plans, including additional time, motivation, enhanced IT infrastructure, and collaboration among primary care professionals. It enhances understanding of these plans in primary care, especially in managing chronic diseases in aging populations. Further research should assess the program's long-term impact on chronic patients. This study was not registered.

Servant leadership behaviour of head nurse assessment and its linkage with nurse work engagement in China

AIM

To assess the servant leadership behaviour of head nurse and its linkage with nurse work engagement in China.

DESIGN

A cross-sectional study.

METHODS

A anonymous investigation with the stratified cluster randomized sampling of nurse was conducted in Hunan Province of China in December 2020. We administered the Perceived Head Nurse Service Leadership Behaviour Scale and the Chinese version of Utrecht work engagement scale to survey, and analyse its relationships by multiple linear regression.

RESULTS

A number of 890 nurses participated in this study. The average score of the perceived servant leadership of head nurse reported by nurses was 78.90 ± 14.04, which was at a medium level. Among its six dimensions, the dimension of promote nurse development scored highest (16.04 ± 2.84), while the dimension of dedication scored lowest (11.39 ± 2.46). Official nurses reported higher perceived servant leadership scores of head nurses than those who were employed and temporary nurses (b = 1.727, 95% CI: 0.054-3.400); nurses in tertiary hospitals reported higher perceived servant leadership scores of head nurses than nurses in primary and secondary hospitals (b = 2.703, 95% CI: 0.305-5.100); and lower perceived servant leadership scores were associated with nurses' job overtime (b = -4.935, 95% CI: -6.891 to -2.978). Nurses' perceived servant leadership of head nurses were positively associated with nurses' work engagement (r = 0.336, p < .05). Multiple linear regression analysis indicated that the perceived servant leadership of head nurse affected nurses' work engagement strongly (b = 0.585, 95% CI: 0.479-0.691).

CONCLUSION

The servant leadership behaviour of head nurse in China was at the medium level, which was positively associated with nurses' work engagement. Further research should improve the power of the servant leadership behaviour of head nurse by integrating additional training, policies and support.

IMPACT

It is time to consider the servant leadership behaviour of head nurses and its linkage with nurses' work engagement in China seriously, and address the policies, guidelines, curriculum, and practice culture.

PATIENT OR PUBLIC CONTRIBUTION

The study was conducted to explore the situation of servant leadership behaviour of head nurses and its linkage with nurses' work engagement in China, which did not include input from the public or the intended participants.

Nurse Manager Span of Control in Hospital Settings: An Integrative Review

BACKGROUND

Nurse managers face great challenges in responding to organizational demands. There exists a general mismatch between managerial span of control and the demands of the job post, which can lead to overburdening and attrition. The aim of this review was to identify the effects of the nurse manager span of control on hospital organizations.

METHODS

An integrative literature review was carried out on nurse manager span of control using the Medline, Embase and Web of Science databases.

RESULTS

21 articles were included. Our findings indicate that the span of control of nursing managers influences outcomes in inpatients, professionals, nurse managers, and the organization.

CONCLUSIONS

The span of control of each nurse manager must be assessed and adjusted to each case. An appropriate span of control will lead to improved outcomes for stakeholders and the organization as a whole.

IMPLICATIONS FOR NURSING MANAGEMENT

Tools must be developed and implemented to measure and evaluate the span of control of nurse managers. This study was not registered.

Trends in artificial intelligence in nursing: Impacts on nursing management

OBJECTIVE

To investigate the academic use of artificial intelligence (AI) in nursing.

BACKGROUND

A bibliometric analysis combined with the VOSviewer software quantification method has been utilized for a literature analysis. In recent years, this approach has attracted the interest of scholars in various research fields. Thus far, there is no publication using bibliometric analysis combined with the VOSviewer software to analyse the applications of AI in nursing.

METHOD

A bibliometric analysis methodology was used to search for relevant articles published between 1984 and March 2022. Six databases, Embase, Scopus, PubMed, CINAHL, WoS and MEDLINE, were included to identify relevant studies, and data such as the year of publication, journals, country, institutional source, field and keywords were analysed.

RESULTS

Most relevant articles were published from institutions in the United States. The League of European Research Universities has published most research studies that use AI and nursing. Scholars have mainly focused on nursing, medical informatics, computer science AI, healthcare sciences services and physics particles fields. Commonly used keywords were machine learning, care, AI, natural language processing, prediction and nurse.

CONCLUSION

Research articles were mainly published in Nurse Education Today. Research topics such as AI-assisted medical recording and medical decision making were also identified. According to this study, AI in nursing has the potential to attract more attention from researchers and nursing managers. Additional high-quality research beyond the scope of medical education, as well as on cross-domain collaboration, is warranted to explore the acceptability and effective implementation of AI technologies.

IMPLICATIONS FOR NURSING MANAGEMENT

This study provides scholars and nursing managers with structured information regarding the use of AI in nursing based on scientific and technological developments across different fields and institutions. The application of AI can improve nursing management, nursing quality, safety management and team communication, as well as encourage future international collaboration.

Assessment of resilience levels among Sri Lankan nurses: Is there room for improvement?

BACKGROUND

Developing resilience at work is an effective primary preventive measure for occupational stress. The study aimed to adopt a tool and measure current resilience levels and determine the association of work-related characteristics on resilience among Sri Lankan nurses.

METHODS

Translated, culturally adapted and validated Resilience at Work Scale- Sinhala version (RAW-S) was used to measure resilience levels in a sample of 855 government nurses from a health district. The mean RAW-S scores were calculated and appropriate cut off points were used to determine the prevalence of 'high', 'moderate' and 'low' resilience. Chi square test was used to determine the associations.

RESULTS

The overall mean RAW-S score was 69.6 (95% CI = 68.9-70.3) and the scores ranged from 28.5 to 90.3. Only 28.4% (95% CI = 25.4-31.6) of nurses showed 'high' level of resilience at work, while 55.6% (95% CI = 52.1-58.9) & 16.0% (95% CI = 13.7-18.7) had shown 'moderate' and 'low' levels of resilience respectively. The resilience levels differed significantly (p < 0.05) by type of ward that they work and by work experience.

CONCLUSIONS

This was the first study that examined the resilience levels in any health care worker category in Sri Lanka. The need of targeted, well-designed resilience building programme for ever burdened government sector nurses is clearly shown from the results, as more than two thirds of nurses had 'moderate' or 'low' level of resilience, which may not be good enough to combat the constant work stress they face on daily basis.

Early Nurse Management Experiences from Finnish COVID-19 Hubs: An In-Action Review

Primary healthcare (PHC) clinics are the point of access for many COVID-19 patients; however, the focus of crisis response work has been in securing hospital capacities. The purpose of this study was to describe the early nurse management experiences from PHC clinics within Greater Helsinki dedicated to caring for all ambulatory patients with possible COVID-19 symptoms. The study objectives were to make PHC crisis response contributions known and to provide an in-action review (IAR) of crisis response efforts. Nurse managers from the four COVID-19 hubs in Greater Helsinki were interviewed using thematic pair interviews. The data were analyzed inductively using thematic analysis, by which four main themes emerged: (1) capacity development led to a state of flux, (2) infection prevention control (IPC) was critical, (3) management of staff was essential in facilitating crisis response, and (4) respondents’ personal experiences. The state of flux stressed the provision of PHC services, but quick developments in telemedicine eased that burden. Conversation surrounding IPC was extensive, though discrepancies suggest that global efforts to standardize IPC practices must begin locally. Leadership was adjusted to accommodate for the crisis, especially regarding the motivation of staff. A vision to aspire toward in crisis recovery is needed.

Managerial qualities by the nursing coordinators: an umbrella review

OBJECTIVE

The nursing coordinator plays a crucial role within health organizations. She/he represents the connection between organi-zational needs, clinical-care needs and company objectives. In order to be a nurse manager one must have acquired managerial characteristics, including strategic, relational and operational skills.

STUDY DESIGN

In this regard, a wide-ranging review was carried out in order to analyze the managerial qualities by the nursing coor-dinators.

MATERIALS AND METHODS

The main scientific databases were con-sulted, such as PubMed, Scopus and Cochrane Library, analyzing all the systematic reviews present in the literature, published in English and Italian in the last ten years. 10 reviews were included in the article. Quality assessment of systematic reviews included in the research were evaluated using the AMSTAR checklist.

RESULTS

The coordinating nurse is the one who guides and directs the activities of other people in order to achieve company's objectives. Empowerment and leadership are the main qualities that a coordinator must possess. They represent essential characteristics for the creation of a work environment that guarantees high quality care.

CONCLUSIONS

The coordinating nurse has a crucial role in this: she/he represents the focal point for the motivation of the group. Establishing a possible program of continuing education activities in healthcare directed to healthcare professionals can be an important way for reinforcing leadership aptitude.

Assessing Nurses' Satisfaction with Continuity of Care and the Case Management Model as an Indicator of Quality of Care in Spain

Chronic diseases are treated and cared for in different healthcare settings. Continuity of care and the case management model facilitate the integration of processes and care levels. However, there is little evidence regarding the satisfaction of nurses with this model. The purpose of this study was to examine nurses' satisfaction with continuity of care and the case management model. A cross-sectional study was conducted. An ad hoc questionnaire was administrated to 437 Spanish nurses from the three health care settings that responded. This included items on socio-demographics, employment relationship, and satisfaction with continuity of care and case management. Descriptive analysis and linear regression models were performed. In total, 96.1% of the nurses expressed a high level of satisfaction with continuity of care and 80.7% with the case management model. Nurses in a primary care setting reported the greatest satisfaction with the case management model (B = 0.146, 95% CI = 0.139-0.694, p = 0.003). The nurses' higher perception of patient satisfaction was associated with greater satisfaction with continuity of care (B = 0.466, 95% CI = -0.367-0.533, p < 0.000). Nurses identified the case management model as an optimal facilitator of continuity of care. While satisfaction with continuity is high, strategies are needed to improve it in primary care centers and aged care homes.

Discriminatory Behavior in Nursing Persist Regardless of Antidiscriminatory Legislation

Discriminatory behavior seems to persist in nursing in South Africa despite the presence of antidiscriminatory legislation. Little is known on the views of nurses on discrimination related to their basic rights in the workplace. The objective of this article is to report findings of discriminatory behavior among nurses regarding race, gender, sexual orientation, age, disability, religion, and marital status. A cross-sectional descriptive survey (containing open- and close-ended questions) was conducted in public and private hospitals in the Western Cape and Gauteng provinces of South Africa and n = 573 (response rate 83%) registered nurses participated in the study. Most participants reported discrimination due to race (n = 97, 17.4%) and age (n = 58,10.4%). Statistically significant differences were found in that African nurses reported more discrimination in relation to religion than other races. A statistically significant difference was found in the responses to gender-more males than female nurses reported discriminatory behavior. Qualitative data reflected suggestions of hetero negativity among male nurses and that sexual orientation might enhance the promotion of those like oneself. Younger nurses are treated less respectful, while older nurses reported reduced developmental opportunities. African nurses described more discrimination due to race and are treated with disdain. Staff shortages, nurse staffing, and shift work seemingly enhance discriminatory practices with off duties. Nurses in the hospital environment seem to experience discrimination in relation to basic human rights resulting from an indifference among nurse management to uphold such rights.

Comparing nurse leader and manager perceptions of and strategies for nurse engagement using a positive deviance approach: A qualitative analysis

AIMS

To understand nurse leader and manager perspectives on employee engagement and their own role to foster engagement. To examine differences between managers of units with high versus low engagement.

BACKGROUND

Health systems recognize the impact of employee engagement, yet alignment of leader and frontline-manager perspectives remains unclear.

METHODS

A qualitative study at the Veteran Affairs New England Healthcare System. Leaders at five facilities (N = 13) and managers of units with high and low nurse engagement (N = 31) were interviewed.

RESULTS

Nurse leaders almost universally conceptualized staff engagement as involvement in quality improvement service, while managers defined engagement as either commitment to excellence in direct patient care or involvement in quality improvement efforts. Intra- and interprofessional attitude contagion, and organisational factors of staffing-time-workload and senior leadership support were most common to support or detract from nurse engagement. A variety of strategies were identified, including protecting nurses as people and professionals. Differences in perceived roles and constraints to engaging nurse staff exist between managers of units with high versus low engagement.

CONCLUSION

Nurse managers and leaders perceive engagement differently; strategies exist to facilitate engagement.

IMPLICATIONS FOR NURSING MANAGEMENT

Leader and manager partnerships are needed to provide clarity on and resources for engagement.

Influencing factors and strategy to the career planning of operating room nurses

Aim

This study aims to investigate the status quo of self‐career planning of nurses working in operating rooms (OR) and analyse the influencing factors.

Methods

A total of 1,418 nurses working in OR were selected and surveyed using a general data questionnaire, a nurse career planning questionnaire and an organizational career management questionnaire.

Results

Multiple linear regression analysis showed that organizational career management perception, hospital‐grade and monthly income were the influencing factors of self‐career planning score of nurses working in OR, which could explain the 56.6% variation of career organization management.

Conclusion

The status quo of self‐career planning in OR nurse was at the middle level, and the scores of different dimensions were not balanced. Reasonable self‐career planning helps the OR nurses improve their professional skills and increase their commitment to work and satisfaction.

Professional Nursing Communication Competence: Theoretical procedures for instrument development and pilot test

AIMS

To describe the theoretical procedures for the development of the Professional Nursing Communication Competence instrument, determine the content validity and describe the pilot test application.

BACKGROUND

Measuring instruments must be developed in accordance with the context and communication process by adopting theoretical procedures based on competence structures to support quality patient-centred care and nursing management.

METHODS

A methodological study was employed. The instrument was developed by using content-validated theoretical construct in accordance with 33 communication theories followed by semantic analysis and content validity by experts. The instrument was tested over three phases: before the lecture on professional nursing communication competence, after the simulation scenario experience and after debriefing.

RESULTS

The instrument showed an extremely high agreement (CVI = 0.99). Linear regression suggested three domains of the 46-item content-validated instrument comprising knowledge (18 items), skills (12 items) and attitudes (16 items).

CONCLUSION

The instrument was found to measure professional communication competence with a high theoretical reliability of the contexts and processes through a simulation strategy.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing educators, managers and staff can adopt the Professional Nursing Communication Competence (IMC-CPE) instrument to improve the effectiveness level of knowledge, skills and attitudes to reduce misunderstanding among team members and health care errors.

Effect of Nurse-Based Management of Hypertension in Rural Western Kenya

Background

Elevated blood pressure is the leading cause of death worldwide; however, treatment and control rates remain very low. An expanding literature supports the strategy of task redistribution of hypertension care to nurses.

Objective

We aimed to evaluate the effect of a nurse-based hypertension management program in Kenya.

Methods

We conducted a retrospective data analysis of patients with hypertension who initiated nurse-based hypertension management care between January 1, 2011, and October 31, 2013. The primary outcome measure was change in systolic blood pressure (SBP) over one year, analyzed using piecewise linear mixed-effect models with a cut point at 3 months. The primary comparison of interest was care provided by nurses versus clinical officers. Secondary outcomes were change in diastolic blood pressure (DBP) over one year, and blood pressure control analyzed using a zero-inflated Poisson model.

Results

The cohort consisted of 1051 adult patients (mean age 61 years; 65% women). SBP decreased significantly from baseline to three months (nurse-managed patients: slope -4.95 mmHg/month; clinical officer-managed patients: slope -5.28), with no significant difference between groups. DBP also significantly decreased from baseline to three months with no difference between provider groups. Retention in care at 12 months was 42%.

Conclusions

Nurse-managed hypertension care can significantly improve blood pressure. However, retention in care remains a challenge. If these results are reproduced in prospective trial settings with improvements in retention in care, this could be an effective strategy for hypertension care worldwide.

Undergraduate nurses' perception of the nursing practice environment in university hospitals: A cross-sectional survey

OBJECTIVE

To describe the psychometric properties of the Practice Environment Scale of the Nursing Work Index (PES-NW) among undergraduate nurses and to compare their perceptions of the nursing practice environment by academic year and unit type.

BACKGROUND

Despite the fact that nursing students develop most of their undergraduate learning and training in the nursing practice environment, their perception about it has not been considered to date.

METHODS

The psychometric properties were analysed on a sample of 180 undergraduate nurses. Data collection was carried out in 2018. Data were analysed using percentages, frequencies, mean, standard deviation and Mann-Whitney U test. Factor structure was evaluated with exploratory factor analysis, and reliability was evaluated with Cronbach's alpha.

RESULTS

Psychometric analysis showed an adequate construct validity and reliability for the PES-NWI. Cronbach's Alpha was 0.884. Undergraduate nurses perceived most hospitals as favourable, scoring the 'Nurse-physician relationships' factor highest and 'Staffing and resource adequacy' factor lowest.

CONCLUSION

The PES-NWI is a valid and reliable instrument that could be applied in future research to explore nursing students' perceptions of the nursing practice environment.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers are responsible for supervising and ensuring that the nursing practice environment at university hospitals meets the necessary criteria to support the workplace learning of undergraduate nurses.

Perspectives and experiences of Chinese nurses on quality improvement initiatives: A mixed-methods study

AIM

To investigate Chinese nurses' views and experiences in relation to quality improvement implementation, as well as to determine the impact of contextual factors on nursing quality improvement initiatives.

BACKGROUND

Nurses play a major role in carrying out quality improvement initiatives. Contextual factors influence the implementation and success of quality improvement initiatives. Studies that investigated the impact of contextual factors on Chinese nurses' practice in quality improvement remain limited.

METHODS

A sequential explanatory mixed-methods design was used for this study. A quantitative cross-sectional survey was used to assess the context of quality improvement initiatives. Simple random sampling was used to recruit quality improvement teams. The sample included 356 nurses from tertiary teaching hospitals; 291 (81.7%) of them completed questionnaires. Nursing managers and nurses (n = 18) were purposively selected to participate in semi-structured interviews; their experiences and perceptions regarding the contextual factors of quality improvement initiatives were obtained.

RESULTS

In the quantitative phase, the "microsystem" (mean=5.24) and "QI team" (mean = 4.97) contexts were reported as supportive contexts. The organizational context was weak, with a mean score of 3.92. In the qualitative phase, three themes related to the contextual challenges emerged: (1) nurses' attitudes and satisfaction, (2) team efficacy, and (3) organizational infrastructure and culture.

CONCLUSIONS

Efforts to elevate organizational culture and reward systems are needed in Chinese hospitals. Further education aimed at increasing skills and knowledge should be provided, to ensure effective quality improvement implementation.

IMPLICATIONS FOR NURSING MANAGEMENT

During quality improvement initiatives, management tasks should focus on increasing nurses' satisfaction, solving skill and knowledge deficits, and clarifying nurses' roles in relation to quality improvement.

The longitudinal learning outcomes of using different teaching sequences in a nursing administration project

AIM

To examine the effects of using different teaching sequences on knowledge acquisition, knowledge retention, self-directed learning and teamwork in a nursing administration project.

BACKGROUND

Compared to other professional courses, nursing administration is relatively difficult, and it is important for nursing administration students to spend long hours working in hospitals. As such, better teaching strategies utilizing proper sequencing may yield better learning outcomes for students.

METHODS

A longitudinal quasi-experimental design was used. A total of 129 students were assigned to two groups with which different teaching sequences were used. The investigated learning outcomes were knowledge acquisition, knowledge retention, self-directed learning and teamwork. Generalized estimating equations were used to measure the learning outcomes.

RESULTS

There was no significant difference between the two teaching sequences in terms of learning effects. One teaching strategy, problem-based learning (PBL), yielded effective student learning outcomes.

CONCLUSION

PBL increased the students' self-directed learning and teamwork. This strategy can be applied to side-by-side co-teaching and post-graduate year training programmes.

IMPLICATIONS FOR NURSING MANAGEMENT

The results from this study may help hospitals retain nurses and find potential nursing leaders. Instructors and nurse managers should discuss learning goals with students in advance to enhance the students' learning outcomes.

Role of nursing leadership in providing compassionate care

This article encourages nurses to explore the concept of leadership in the constantly changing field of health and social care. All nurses have an important role in leadership, and they should consider what type of leader they want to be and what leadership skills they might wish to develop. This article examines what leadership might involve, exploring various leadership styles and characteristics and how these could be applied in nurses' practice. A core component of nursing and nursing leadership is the ability to provide compassionate care. This could correspond with the idea of servant leadership, an approach that moves the leader from a position of power to serving the team and supporting individuals to develop their potential.

Management capacity to promote nurse workplace health and safety

PURPOSE

To investigate regarding workplace health and safety factors, and to identify strategies to preserve and promote a healthy nursing workplace.

METHODS

Data collected using the Delphi technique with input from 41 key informants across four participant categories drawn from a Chinese university and four hospitals were thematically analysed.

RESULTS

Most respondents agreed on the importance of nurses' health and safety, and that nurse managers should act to protect nurses, but not enough on workplace safety. Hospital policies, staff disempowerment, workload and workplace conflicts are major obstacles.

CONCLUSION

The reality of Chinese nurses' workplaces is that health and safety risks abound and relate to socio-cultural expectations of women. Self-management of risks is neccessary, gaps exist in understanding of workplace risks among different nursing groups and their perceptions of the professional status, and the value of nurses' contribution to ongoing risks in the hospital workplace. The Chinese hospital system must make these changes to produce a safer working environment for nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

This research, based in China, presents an instructive tale for all countries that need support on the types and amounts of management for nurses working at the clinical interface, and on the consequences of management neglect of relevant policies and procedures.

Nurses' but not supervisors' safety practices are linked with job satisfaction

AIMS

To test the associations of safety practices as reported by nurses and their respective unit supervisors with job satisfaction.

BACKGROUND

Psychosocial workplace factors are associated with job satisfaction; however, it is unknown whether nurses and supervisors accounts of safety practices are differentially linked to this outcome.

METHODS

Cross-sectional study design including nurses (n = 1052) nested in 94 units in two hospitals in Boston (MA, USA). Safety practices refer to the identification and control of occupational hazards at the unit. Safety practices were measured aggregating nurses' responses per unit, and supervisory levels. Individual's job satisfaction for each nurse was the response variable.

RESULTS

Supervisors assessed safety practices more favourably than their unit nursing staff. Adjusted random intercept logistic regressions showed that the odds of higher job satisfaction were higher for nurses at units with better safety practices (OR: 1.67, 95% CI: 1.04, 2.68) compared with nurses at units that averaged lower safety practices. Supervisors' reports of safety practices were not correlated with the job satisfaction of their staff.

CONCLUSIONS

Adequate safety practices might be a relevant managerial role that enhances job satisfaction among nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing supervisors should calibrate their safety assessments with their nursing staff to improve nurses' job satisfaction.

Factors that influence influenza vaccination rates among the elderly: nurses' perspectives

AIMS

To explore which factors nurses perceive to help and hinder influenza vaccination rates among the elderly.

BACKGROUND

Influenza-related illnesses and deaths have disproportionately high prevalence among the elderly. Vaccination is an effective tool to prevent complications.

METHODS

Semistructured interviews were conducted with nurses focusing on barriers, facilitators and health care providers' roles in influencing patients to be vaccinated. Interviews were recorded, transcribed and thematically analysed.

RESULTS

Nurses identified that the prevalent barriers were fear of the vaccine's side effects, feelings of good health and technical considerations. Facilitators included ease of access and encouragement from health providers, media and social networks. The health care team was influential in raising vaccination rates through direct recommendation, providing concrete information or leading by example.

CONCLUSIONS

The health care team can influence patients to vaccinate. Investments in training nurses in the knowledge and skills needed to educate patients, and providing nurses with the necessary resources to engage patients in these discussions may be beneficial. Nurse managers can be instrumental in enhancing nurses' roles and actions to increase influenza vaccination rates among the elderly.

IMPLICATIONS FOR NURSING MANAGEMENT

It is essential to reinforce the nurses' role in promoting vaccination among seniors. Given that nurses are the largest number of health professionals, their potential outreach to large numbers of people is strong.

Veno-occlusive disease nurse management: development of a dynamic monitoring tool by the GITMO nursing group

Veno-occlusive disease (VOD) is a complication arising from the toxicity of conditioning regimens that have a significant impact on the survival of patients who undergo stem cell transplantation. There are several known risk factors for developing VOD and their assessment before the start of conditioning regimens could improve the quality of care. Equally important are early identification of signs and symptoms ascribable to VOD, rapid diagnosis, and timely adjustment of support therapy and treatment. Nurses have a fundamental role at the stages of assessment and monitoring for signs and symptoms; therefore, they should have documented skills and training. The literature defines nurses’ areas of competence in managing VOD, but in the actual clinical practice, this is not so clear. Moreover, there is an intrinsic difficulty in managing VOD due to its rapid and often dramatic evolution, together with a lack of care tools to guide nurses. Through a complex evidence-based process, the Gruppo Italiano per il Trapianto di Midollo Osseo (GITMO), cellule staminali emopoietiche e terapia cellulare nursing board has developed an operational flowchart and a dynamic monitoring tool applicable to haematopoietic stem cell transplantation patients, whether they develop this complication or not.

Improving patients' sleep: reducing light and noise levels on wards at night

There is much research concerning the psychological and physical effects of sleep deprivation on patients in healthcare systems, yet interrupted sleep on hospital wards at night remains a problem. Staff at Plymouth Hospitals NHS Trust, Devon, wanted to identify the factors that prevent patients from sleeping well at night. Two audits were carried out, between April and August 2015, to assess noise and light levels on wards at night, and to engage nurses in ways of reducing these. A number of recommendations were made based on the audit findings, many of which have been put into practice.

Reimagining Anticoagulation Clinics in the Era of Direct Oral Anticoagulants

Anticoagulation clinics were initially developed to provide safe and effective care for warfarin-treated patients with atrial fibrillation, venous thromboembolism, and mechanical valve replacement. Traditionally, these patients required ongoing laboratory monitoring and warfarin dose adjustment by expert providers. With the introduction of direct oral anticoagulants (dabigatran, rivaroxaban, apixaban, and edoxaban), many have questioned the need for anticoagulation clinic. However, we think that the growing number of oral anticoagulant choices creates an urgent need for expanding the traditional role of the anticoagulation clinic. We outline 3 key purposes that a reimagined anticoagulation clinic would serve: (1) to assist patients and clinicians with selecting the most appropriate drug and dose from a growing list of anticoagulant options (including warfarin), (2) to help patients minimize the risk of serious bleeding complications with careful long-term monitoring and peri-procedural management, and (3) to encourage ongoing adherence to these life-saving medications. We also describe how repurposing anticoagulation clinics as broader medication safety clinics would promote safe and effective care across a range of cardiovascular conditions for high-risk medications (eg, spironolactone, amiodarone). Finally, we highlight a few existing health systems that are overcoming key challenges to implementing a reimagined anticoagulation or medication safety clinic structure.

How one trust made its way out of special measures

United Lincolnshire Hospitals NHS Trust (ULHT) was placed into special measures by the Care Quality Commission in 2013 after problems were identified with its governance, patient and medicines safety, management and complaints handling. The author was appointed acting chief nurse six months later and has helped to identify and implement a package of improvements at the trust. As a result, ULHT was taken out of special measures in March 2015. This article describes the changes that were introduced and the processes involved that made this happen.

Sleep quality and insomnia in nurses with different circadian chronotypes: morningness and eveningness orientation

BACKGROUND

Morningness and eveningness preference (chronotype), an endogenous component of the circadian clock could play a key role in a worker's ability for adjusting to shift work. Morning types are those individuals who prefer going to bed and waking up early, whereas Evening types tend to sleep at later hours and find it difficult to get up in the morning.

OBJECTIVE

The objective of this study was to survey, the relationship between morningness-eveningness type, sleep quality and insomnia in shift worker nurses.

PARTICIPANTS

The participants comprised 160 nurses working in three different wards in two university hospitals in Iran.

METHODS

Nurses completed the Horne and Ostberg questionnaire to assess the distribution of morningness or eveningness preference, the Pittsburg Sleep Quality Index and Insomnia Severity Index questionnaire to measure self reported sleep quality and insomnia. Demographic information was also collected in order to explore the relationship between circadian rhythms, sleep quality and prevalence of insomnia in shift workers.

RESULTS

The results showed that the prevalence of poor sleep quality was high. More than half of the participants had poor sleep. Evening type nurses had worse sleep quality in our study (P < 0.05). There is not any significant association between the shift type and age of the nurses with their quality of sleep (P > 0.05).

CONCLUSIONS

The results suggested that nurses who had a morning sleep preference had better sleep quality. A survey of chronotype of nurses could be useful, so that individuals may be assigned to different shifts according to their sleep preference.

Handling a challenging context: experiences of facilitating evidence-based elderly care

AIM

To explore improvement facilitators' experiences of handling their commission to implement evidence-based practice in elderly care for frail older persons.

BACKGROUND

Improvement facilitators were put in place across Sweden in a time-limited project by the government, with one part of the project being to evaluate the model before establishing this facilitation of evidence-based practice in elderly care.

METHOD

Two focus groups were interviewed twice. Each group comprised three respondents. The interviews were analysed using qualitative content analysis.

FINDINGS

A main theme, 'Moving forward by adjusting to the circumstances', described how the improvement facilitators handle their commitment. Five subthemes emerged: identifying barriers, keeping focus, maintaining motivation, building bridges and finding balance.

CONCLUSION

The improvement facilitators' commitment is ambiguous because of unclear leadership of, and responsibility for the national investment. They have to handle leaders' different approaches and justify the need for evidence-based practice. The improvement facilitators did not reflect on the impact of programme adaptations on evidence-based practice.

IMPLICATIONS FOR NURSING MANAGEMENT

The findings emphasise the need for collaboration between the improvement facilitator and the nurse manager. To fully implement evidence-based practice, negotiations with current practitioners for adaptation to local conditions are necessary. Furthermore, the value of improving organisational performance needs to be rigorously communicated throughout the organisation.

Health care managers' views on and approaches to implementing models for improving care processes

AIM

To develop a deeper understanding of health-care managers' views on and approaches to the implementation of models for improving care processes.

BACKGROUND

In health care, there are difficulties in implementing models for improving care processes that have been decided on by upper management. Leadership approaches to this implementation can affect the outcome.

METHOD

In-depth interviews with first- and second-line managers in Swedish hospitals were conducted and analysed using grounded theory.

RESULTS

'Coaching for participation' emerged as a central theme for managers in handling top-down initiated process development. The vertical approach in this coaching addresses how managers attempt to sustain unit integrity through adapting and translating orders from top management. The horizontal approach in the coaching refers to managers' strategies for motivating and engaging their employees in implementation work.

CONCLUSION AND IMPLICATIONS FOR NURSING MANAGEMENT

Implementation models for improving care processes require a coaching leadership built on close manager-employee interaction, mindfulness regarding the pace of change at the unit level, managers with the competence to share responsibility with their teams and engaged employees with the competence to share responsibility for improving the care processes, and organisational structures that support process-oriented work. Implications for nursing management are the importance of giving nurse managers knowledge of change management.

Assessment of practitioners' and students' values when recruiting

The Department of Health has tasked Health Education England with introducing values-based recruitment (VBR) for all applicants to NHS-funded healthcare programmes. This article discusses the mandate with reference to the process of VBR, how this is used in an academic setting and how it is beginning to influence appointments to all healthcare posts. The benefits and potential risks of adopting the approach are identified and recommendations for nurse managers are made.

Nurse management of hypertension in rural western Kenya: implementation research to optimize delivery

BACKGROUND

Hypertension is the leading global risk factor for mortality. Hypertension treatment and control rates are low worldwide, and insufficient human resource capacity is among the contributing factors. Thus, a critical component of hypertension management is to develop novel and effective solutions to the human resources challenge. One potential solution is task redistribution and nurse management of hypertension in these settings.

OBJECTIVES

The aim of this study is to investigate whether nurses can effectively reduce blood pressure in hypertensive patients in rural western Kenya and, by extension, throughout sub-Saharan Africa.

METHODS

An initial phase of qualitative inquiry will assess facilitators and barriers of nurse management of hypertension. In addition, we will perform usability and feasibility testing of a novel, electronic tablet-based integrated decision-support and record-keeping tool for the nurses. An impact evaluation of a pilot program for nurse-based management of hypertension will be performed. Finally, a needs-based workforce estimation model will be used to estimate the nurse workforce requirements for stable, long-term treatment of hypertension throughout western Kenya.

FINDINGS

The primary outcome measure of the impact evaluation will be the change in systolic blood pressure of hypertensive individuals assigned to nurse-based management after 1 year of follow-up. The workforce estimation modeling output will be the full-time equivalents of nurses.

CONCLUSIONS

This study will provide evidence regarding the effectiveness of strategies to optimize task redistribution and nurse-based management of hypertension that can be applicable to noncommunicable disease management in low- and middle-income countries.

Administering a two-stage spiritual assessment in healthcare settings: a necessary component of ethical and effective care

AIM

This article delineates rationales for administering a spiritual assessment as a universal component of care.

BACKGROUND

The notion that nurses should identify and address patients' spiritual needs remains controversial, particularly in the UK where criticisms derived from secularization theory have appeared in the literature.

EVALUATION

To respond to these criticisms and to develop rationales supportive of spiritual assessment, I draw upon scholarship from a variety of disciplines including social work, sociology, and medicine.

KEY ISSUES

Five rationales are posited to support the concept of universal spiritual assessments: professional ethics, patient autonomy, knowledge of patients' worldviews, the identification of spiritual assets, and accrediting and governmental requirements. Criticisms based on secularization theory are discussed and analysed.

CONCLUSION

A two-stage spiritual assessment - consisting of a brief preliminary assessment followed, if necessary, by a comprehensive assessment - provides a mechanism to efficiently identify patients' spiritual needs.

IMPLICATIONS FOR NURSING MANAGEMENT

As key members of the healthcare team, nurse managers are ideally situated to ensure that all patients receive a spiritual assessment as a routine component of care. In so doing, they help ensure the provision of ethical and effective care to the diverse spiritual groups that will continue to populate the UK for the foreseeable future.

Nurse-led disease management for hypertension control in a diverse urban community: a randomized trial

BACKGROUND

Treated but uncontrolled hypertension is highly prevalent in African American and Hispanic communities.

OBJECTIVE

To test the effectiveness on blood pressure of home blood pressure monitors alone or in combination with follow-up by a nurse manager.

DESIGN

Randomized controlled effectiveness trial.

PATIENTS

Four hundred and sixteen African American or Hispanic patients with a history of uncontrolled hypertension. Patients with blood pressure ≥150/95, or ≥140/85 for patients with diabetes or renal disease, at enrollment were recruited from one community clinic and four hospital outpatient clinics in East and Central Harlem, New York City.

INTERVENTION

Patients were randomized to receive usual care or a home blood pressure monitor plus one in-person counseling session and 9 months of telephone follow-up with a registered nurse. During the trial, the home monitor alone arm was added.

MAIN MEASURES

Change in systolic and diastolic blood pressure at 9 and 18 months.

KEY RESULTS

Changes from baseline to 9 months in systolic blood pressure relative to usual care was -7.0 mm Hg (Confidence Interval [CI], -13.4 to -0.6) in the nurse management plus home blood pressure monitor arm, and +1.1 mm Hg (95% CI, -5.5 to 7.8) in the home blood pressure monitor only arm. No statistically significant differences in systolic blood pressure were observed among treatment arms at 18 months. No statistically significant improvements in diastolic blood pressure were found across treatment arms at 9 or 18 months. Changes in prescribing practices did not explain the decrease in blood pressure in the nurse management arm.

CONCLUSIONS

A nurse management intervention combining an in-person visit, periodic phone calls, and home blood pressure monitoring over 9 months was associated with a statistically significant reduction in systolic, but not diastolic, blood pressure compared to usual care in a high risk population. Home blood pressure monitoring alone was no more effective than usual care.

Practice environments and their associations with nurse-reported outcomes in Belgian hospitals: development and preliminary validation of a Dutch adaptation of the Revised Nursing Work Index

AIM

To study the relationship between nurse work environment, job outcomes and nurse-assessed quality of care in the Belgian context.

BACKGROUND

Work environment characteristics are important for attracting and retaining professional nurses in hospitals. The Revised Nursing Work Index (NWI-R) was originally designed to describe the professional nurse work environment in U.S. Magnet Hospitals and subsequently has been extensively used in research internationally.

METHOD

The NWI-R was translated into Dutch to measure the nurse work environment in 155 nurses across 13 units in three Belgian hospitals. Factor analysis was used to identify a set of coherent subscales. The relationship between work environments and job outcomes and nurse-assessed quality of care was investigated using logistic and linear regression analyses.

RESULTS

Three reliable, consistent and meaningful subscales of the NWI-R were identified: nurse-physician relations, nurse management at the unit level and hospital management and organizational support. All three subscales had significant associations with several outcome variables. Nurse-physician relations had a significant positive association with nurse job satisfaction, intention to stay the hospital, the nurse-assessed unit level quality of care and personal accomplishment. Nurse management at the unit level had a significant positive association with the nurse job satisfaction, nurse-assessed quality of care on the unit and in the hospital, and personal accomplishment. Hospital management and organizational support had a significant positive association with the nurse-assessed quality of care in the hospital and personal accomplishment. Higher ratings of nurse-physician relations and nurse management at the unit level had significant negative associations with both the Maslach Burnout Inventory emotional exhaustion and depersonalization dimensions, whereas hospital management and organizational support was inversely associated only with depersonalization scores.

CONCLUSION

A Dutch version of the NWI-R questionnaire produced comparable subscales to those found by many other researchers internationally. The resulting measures of the professional practice environment in Belgian hospitals showed expected relationships with nurse self-reports of job outcomes and perceptions of hospital quality.

The success of recruiting minorities, women, and elderly into a randomized controlled effectiveness trial

BACKGROUND

Heart failure, a leading cause of hospitalization among elderly people, disproportionately afflicts African-American and other non-White populations. Studies of health care interventions often do not include these groups in proportion to numbers in the patient population. Our objective was to assess whether a randomized controlled effectiveness trial enrolled patients by ethnicity/race, gender, and age in proportion to those eligible.

METHODS

We conducted a randomized controlled trial comparing nurse management and usual care among ambulatory heart failure patients at the four hospitals in East and Central Harlem, New York. We incorporated culturally sensitive and age-appropriate strategies to enroll a demographically representative group into the trial. Recruitment proceeded in several steps: identifying patients with billing code and visit criteria, documenting systolic dysfunction, obtaining clinician permission and correct addresses, contacting patients, and enrolling eligible patients. We assessed differences by ethnicity/race and gender at successive steps in the recruitment process, and differences between enrollees and refusals regarding overall health, evaluation of medical care, and difficulty receiving care.

RESULTS

We enrolled 406 ambulatory patients by ethnicity/race and gender in proportion to the numbers eligible to be contacted (46% African-American/Black, 33% Hispanic, and 47% female). Among patients contacted, however, those 18 through 74 years were 2.0 to 3.3 times more likely than those > or = 75 years to enroll (p < 0.001).

CONCLUSIONS

The recruitment strategy successfully enrolled patients by ethnicity/race, gender, and age through 74 years, but not those > or = 75 years. Registries of patients who refuse to enroll in trials could provide guidance for clinical and public policy.

Parent satisfaction in a nurse led clinic compared with a paediatric gastroenterology clinic for the management of intractable, functional constipation

AIMS

To assess parent satisfaction with a nurse led clinic for children with intractable, functional constipation compared with a paediatric gastroenterology outpatient clinic.

METHODS

A validated questionnaire covering six separate domains in 48 statements (provision of information, empathy with the patient, technical quality and competence, attitude towards the patient, access to and continuity with the caregiver, and overall satisfaction) was employed. For all outcomes, the data were analysed on an intention-to-treat basis.

RESULTS

90/107 (84%) questionnaires were returned: 40/51 (78%) from the paediatric gastroenterology clinic and 50/56 (89%) from the nurse led clinic. Results indicated a high "total" satisfaction with the clinical care, but these were statistically significantly higher in the nurse led clinic compared with the paediatric gastroenterology clinic (median score 8.7 and 7.3 respectively, out of a maximum score of 10). This difference was consistent across all domains when the scores from those attending the nurse led clinic were compared with those attending the paediatric gastroenterology clinic (information median score 8.7 v 7.5; empathy 9.0 v 7.3; competence 9.1 v 8.0; attitude 8.7 v 7.3; access 8.2 v 6.7). All comparisons were highly statistically significant.

CONCLUSION

These results provide firm evidence that parents of children with intractable constipation are satisfied with the care they receive in both the paediatric and nursing clinic setting. Parent satisfaction, however, was significantly higher in those attending the nurse led clinic. This study adds further support to the development of a nurse led service to manage intractable, functional constipation in children.