Enhancing communication within nursing and multiprofessional healthcare teams

Effective communication within nursing and multiprofessional healthcare teams is essential to promote patient safety. However, communication is a complex concept comprising various elements and variables that affect how messages are delivered, received and interpreted. In this article, the author explores communication within healthcare teams and provides some insight into the factors that affect team communication, such as interpersonal relationships. The author also explores organisational culture and cultural sensitivity, and discusses some evidence-based approaches to enhancing communication within healthcare teams.

Using acceptance and commitment therapy in everyday conversations to support staff well-being

Healthcare organisations implement a range of staff well-being initiatives and increasingly focus on compassionate leadership. While formal interventions aimed at maintaining and enhancing staff well-being can be beneficial, they have practical limitations, such as staff turnover and challenges in meeting demand. Therefore, everyday conversations between nurses in leadership positions and their team members also have an important role in supporting staff well-being. One psychological model that nurse leaders may wish to use is acceptance and commitment therapy (ACT), which involves techniques such as mindfulness, acceptance and values clarification. This article outlines the principles of ACT and explains how leaders can use these to guide well-being conversations with staff.

Using the making Visible the ImpaCT Of Research (VICTOR) questionnaire to evaluate the benefits of a fellowship programme for nurses, midwives and allied health professionals

BACKGROUND

There is increasing emphasis in the UK on developing a nurse, midwife and allied health professional (NMAHP) workforce that conducts research. Training for clinical academic careers is provided by the National Institute for Health and Care Research (NIHR). However, the low number of successful applicants suggested there were barriers to achieving this. The Centre for Nursing and Midwifery Led Research (CNMR) launched a fellowship programme in 2016 to backfill two days a week of NMAHPs' time for up to a year, to give them time to make competitive applications to the NIHR.

AIM

To report a study evaluating the CNMR fellowship programme.

DISCUSSION

The making Visible the ImpaCT Of Research (VICTOR) tool ( Cooke et al 2019 ) was developed to describe the organisational impact of research. The 2016-17 CNMR fellows completed VICTOR and their responses were analysed using a framework approach. The analysis found the main benefits of participating in the programme were protected time for research, opportunities to develop collaborations, increasing intra- and inter-professional awareness of NMAHPs' research, peer-reviewed publications, and conference presentations. Challenges included a lack of support from line managers, limited value placed on NMAHPs' research and failure to backfill posts.

CONCLUSION

There were some challenges with the fellowship programme, but all recipients found it to be a positive experience and undertook significant scholarly activity.

IMPLICATIONS FOR PRACTICE

A contractual agreement must be established to foster committed partnerships between higher education institutions (HEIs) and the NHS. HEIs and the NHS should conduct frank discussions of the challenges encountered in fellowship programmes. Positive initiatives and outcomes in tertiary education and clinical settings should be shared to improve fellows' experiences and enhance partnerships between HEIs and the NHS. Job descriptions should include time allocation to review fellowship candidates' applications regardless of outcome. The showcasing of research successes and the benefits of NMAHP research must evolve to secure organisational 'buy in', which is the precursor to widening access to clinical academic pathways.

Nurses' perceptions of the influence of leadership behaviours and organisational culture on patient safety incident reporting practices

BACKGROUND

Patient safety is a priority for all healthcare organisations. Enhancing patient safety incident reporting practices requires effective leadership behaviours at all levels in healthcare organisations.

AIM

To explore nurses' perceptions of the influence of nurse managers' leadership behaviours and organisational culture on patient safety incident reporting practices.

METHOD

A descriptive, cross-sectional, correlational design was adopted with a convenience sample of 325 nurses from 15 Jordanian hospitals.

RESULTS

Respondents had positive perceptions of their nurse managers' leadership behaviours and organisational culture. There was a significant positive relationship between leadership behaviours and organisational culture (r=0.423, P<0.001) and between leadership behaviours and actual incident-reporting practices (r=0.131, P<0.001). Additionally, there was a significant positive relationship between organisational culture and incident-reporting practices (r=0.250, P<0.001).

CONCLUSION

Healthcare organisations must develop leaders who will foster a supportive and just culture that will enhance nurses' practice with regards to reporting patient safety incidents.

Increasing awareness of bullying through small-scale initiatives in higher education

Employees are entitled to work in an environment that upholds their dignity and respect, but bullying still exists in many disciplines, including in nurse education and nursing practice. Researchers have suggested that to address bullying employers need to intervene at team and/or organisational level rather than focusing solely on the individuals involved. To reduce the incidence of bullying and other adverse social behaviours in the workplace, many higher education institutions and healthcare organisations have developed dignity and respect (D&R) policies. In this article, the authors describe the development and implementation of several small-scale initiatives designed to increase awareness of bullying and D&R policy among staff and students at the School of Nursing and Midwifery at Trinity College Dublin. The interventions were informed by the concepts of distributed leadership and implementation science.

A study of error reporting by nurses: the significant impact of nursing team dynamics

Background

Error reporting is crucial for organisational learning and improving patient safety in hospitals, yet errors are significantly underreported.

Aims

The aim of this study was to understand how the nursing team dynamics of leader inclusiveness, safety climate and psychological safety affected the willingness of hospital nurses to report errors.

Methods

The study was a cross-sectional design. Self-administered surveys were used to collect data from nurses and nurse managers. Data were analysed using linear mixed models. Bootstrap confidence intervals with bias correction were used for mediation analysis.

Results

Leader inclusiveness, safety climate and psychological safety significantly affected willingness to report errors. Psychological safety mediated the relationship between safety climate and error reporting as well as the relationship between leader inclusiveness and error reporting.

Conclusion

The findings of the study emphasise the importance of nursing team dynamics to error reporting and suggest that psychological safety is especially important to error reporting.

The improvement in research orientation among clinical nurses in Qatar: a cross-sectional study

BACKGROUND

The main barrier to engaging nurses in research is the lack of research knowledge and skills.

AIM

To explore the influence of research workshops on the research orientation of nurses in a large referral hospital in Qatar.

DISCUSSION

This article describes a cross-sectional study involving 564 nurses working in 14 health facilities who attended research workshops in Qatar. The authors collected data using the Edmonton Research Orientation Survey (EROS) as well as questions considering support and barriers to research. Descriptive statistics were used to summarise and determine the sample characteristics and distribution of participants. The participants who attended the workshop were found to have a higher orientation towards the EROS sub-scales of evidence-based practice, valuing of research, involvement in research, being at the leading edge of the profession and support for research, compared to those who did not attend the workshop. There was no statistical difference between the groups in the research barrier sub-scale.

CONCLUSION

Despite significant improvements in their responses to the EROS research orientation sub-scales after attending the workshop, the nurses still reported many barriers to being actively engaged in research.

IMPLICATIONS FOR PRACTICE

Healthcare organisations should assist with integrating evidence-based practice into healthcare. There is a need for research education for clinical nurses to bring evidence into clinical practice to improve the quality of patient outcomes. Increasing the research capacity of nurses will lead to their emancipation in addressing the flaws in clinical practice and motivate them to use evidence in patient care.

Investigating the link between organisational justice, positive organisational behaviour and productivity in emergency nurses

BACKGROUND

Human resource management and employees' performance are fundamental to the success of healthcare organisations. Therefore, it is important to consider the factors that may affect employees' performance.

AIM

To determine the relationship between perceived organisational justice, positive organisational behaviour (POB) and the productivity of emergency nurses.

METHOD

This was a descriptive-analytical study that involved distributing questionnaires to emergency nurses working in hospitals affiliated with Mazandaran University of Medical Sciences in Iran. The researchers used proportionate stratified sampling to calculate the sample size. Three questionnaires were used to collect data on organisational justice, POB and productivity. The data were analysed using the Pearson correlation coefficient and multiple regression tests.

RESULTS

The questionnaires were distributed to 284 emergency nurses and completed by 234 of them. The results demonstrated a significant relationship between the productivity of the emergency nurses and the variables of perceived organisational justice and POB.

CONCLUSION

Higher levels of perceived organisational justice and POB in the ED setting are likely to lead to increased productivity among emergency nurses, and as a result the quality of patient care is likely to improve. Therefore, healthcare organisations should pay particular attention to the application of organisational justice, with the aim of promoting POB among nurses and increasing their productivity.

Perception of organizational climate by university staff and students in medicine and humanities: A qualitative study

Organizational climate and culture are important for research organizations because they foster research integrity and responsible conduct of research, reduce questionable research practices, and improve job satisfaction. The aim of our study was to explore how employees and students perceive organizational climate and its consequences in the university setting. We conducted semi-structured interviews with senior students and employees (teaching and non-teaching staff) from two different university schools: School of Medicine and Faculty of Humanities and Social Sciences. Participants were asked questions regarding perceived climate, working environment, and the role of the institution. The data were analyzed using reflexive thematic analysis approach. Three themes were identified. The first theme addressed the difference in the perception and understanding of organizational climate. The second theme dealt with institutional issues emanating from organizational climate. The third theme described the behavior of stakeholders in the formation of organizational climate. Organizational climate is important concept in academic organizations as it influences both employees, particularly early career researchers, and students. Institutional leadership can strongly influence organizational climate, which can in turn affect job and job satisfaction. Due to the importance of personal morality on everyday decision-making, virtue-based research integrity training could be useful in improving academic institutions' organizational climate.

The influence of the Fourth Industrial Revolution on organisational culture: An empirical investigation

The Fourth Industrial Revolution (4IR) is known to transform and create opportunities for the world of work. However, little is known about how the future workforce, such as university students, are being equipped and exposed to 4IR technologies and ways of thinking in a South African (SA) context. This study's findings contribute to understanding the influence of organisational culture on the uptake of 4IR technology within higher education (HE) in SA during a pandemic. The study uses Edgar Schein's theoretical framework to explore the organisational culture at a university in the Gauteng province. The article responds further to the questions on how 4IR technology and principles are understood and applied within the context, and how to investigate to what extent the 4IR is reflected upon or embedded in the university's culture. A qualitative research design is used, and data are gathered through in-depth, semi-structured interviews from seven purposively selected academic and senior management staff members. Thematic analysis uncovered that the university's ambitious and competitive culture contributed to a positive uptake of 4IR technology and principles, even pre-COVID-19. Furthermore, the specific influence of the university's Vice-Chancellor to build 4IR thinking into the university helped shape more 4IR thinking and technologies, such as artificial intelligence, whilst still considering the existing disparities of SA, as a developing country.

Emergency First Responders and Professional Wellbeing: A Qualitative Systematic Review

Emergency first responders (EFRs) such as police officers, firefighters, paramedics and logistics personnel often suffer high turnover due to work-related stress, high workloads, fatigue, and declining professional wellbeing. As attempts to counter this through resilience programmes tend to have limited success, there is a need for further research into how organisational policies could change to improve EFRs' professional wellbeing.

AIM

To identify the factors that may contribute to or affect EFRs' professional wellbeing.

METHODS

A systematic literature review has been carried out. Three databases (Science Direct, ProQuest, and PubMed) were searched using keywords developed based on the PICo (population, interest, and context) framework. A total of 984 articles were extracted. These were then critically appraised for the quality of the evidence presented, leading to a total of five being ultimately included for review.

RESULTS

Thematic analysis revealed that although EFRs may be exposed daily to traumatic events, factors that contribute to a decline in professional wellbeing emerge from within the organisational environment, rather than from the event itself.

CONCLUSION

The study concludes that organisational and team relations factors significantly impact EFRs ability to cope with stress. As such, organisational policy should evolve to emphasise team relations over resilience programmes.

Work-family balance in the construction industry: why gender analysis matters to develop sustainable interventions

Work-family balance (WFB) in the construction sector has rarely been studied. Hardship, atypical schedules and seasonal work create challenging conditions for parents in this male-dominated industry. Semi-structured interviews with workers (14 men, 6 women) and a survey of 789 on-site workers (85% men, 15% women) were conducted as part of a wider participatory action-research project involving governmental actors. Triangulation of the interview and survey data clarified the influence of quantitative and qualitative workload and of managerial support on work-family conflict. Results also show that male and female workers have differentiated experiences of WF issues and, consequently, develop different WF strategies while pursuing increased flexibility. The stereotyped conception of WF encourages social norms that have various impacts on mothers and fathers working in the industry. Recommendations for a cultural shift are proposed for employers in this industry, marked by a labour shortage and low retention of female workers.Practitioner summary: This paper provides a gendered analysis of work-family issues among on-site workers in the construction industry. It aims to inform ergonomists and occupational health researchers about the potential of inflexible work designs to convey stereotypes that can impact the sustainability and equity of workplace interventions.

Relationships and power: An exploration of person-centredness in an intellectual disability service in Ireland

Institutionalised cultures and imbalances of power have been identified within the literature as risk factors for the abuse of adults with intellectual disability living in residential services. Governments in the Republic of Ireland and internationally continue to support person-centredness as a framework of care that can promote cultural change within disability services as a safeguard against abuse. However, there is limited research which seeks to explore if person-centredness as a framework of care has had much impact on changing cultures within disability services as a protective factor against abuse. This study aims to explore how adults with intellectual disability living in residential services and staff experience the professional caring relationship and the framework of person-centredness. The study was based on a phenomenological approach using thematic analysis which enabled six adults with intellectual disability and six staff to participate through one-to-one interviews. The thematic analysis resulted in three main themes: (1) Conflict within the relational dynamic between service users and staff. (2) Challenges to delivering person-centred care. (3) Shared needs. Participants reported that there was conflict within the relationship between service users and staff influenced by relational and cultural issues. Participants also experienced challenges in delivering person-centred care within the service. This study revealed that as a result of wider organisational and cultural influences, person-centred cultures, which are vital to underpin changes in power imbalances, were often undermined. This research highlights that it is not enough to have a system of quality of care guided by the principles of person-centredness alone to ensure a shift in culture and safeguard against abuse of adults with intellectual disability. Rather, consideration of the relational and cultural factors that impact their lives also needs to be built into the values and practices of services offered to adults with intellectual disability.

How to undertake annual appraisals and ongoing performance reviews

Annual appraisals, which are mandatory in most healthcare organisations, are crucial for enhancing staff performance and embedding a culture of continuous improvement within teams. Appraisals can be usefully complemented by ongoing performance reviews, which support nurse managers and staff to identify and address issues in a timely manner. The term 'performance management' often has negative connotations, but it can be a powerful tool for staff development and positive learning experiences. This article supports nurse managers to understand how to adequately prepare for and conduct appraisals and performance reviews. Reflective activity 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of.

'Guiding Lights for effective workplace cultures': enhancing the care environment for staff and patients in older people's care settings

While much attention has been given to organisational culture, there has been less focus on workplace culture. Yet workplace culture strongly influences the way care is delivered, received and experienced. An effective workplace culture is crucial for the well-being of individual staff members and teams as well as for patients' experiences and outcomes of care. This article describes the 'Guiding Lights for effective workplace cultures' which were developed by the authors and provide a framework to assist in understanding and promoting effective workplace cultures and creating environments where staff and patients feel safe and valued. There are four Guiding Lights: 'collective leadership', 'living shared values', 'safe, critical, creative learning environments' and 'change for good that makes a difference'. Each one articulates what good workplace cultures are through descriptors and intermediate outcomes and together produce a set of ultimate outcomes. The Guiding Lights provide nurses working in older people's care settings with an opportunity to learn from, and celebrate, what is going well in their workplaces and to consider areas that require further development.

Engaging with research: practical advice for nurses at every level

Nurses at every level can reflect on their active engagement with clinical research. This article aims to support nurses to understand how they can facilitate and lead research. It provides practical advice to support the integration of research evidence into care delivery and increase the opportunities for patients to participate in clinical research. This is important because patients can benefit from nurses who are knowledgeable, confident and supported in applying research evidence. Furthermore, nurses can support and inform patient choice through increased confidence and competence in engaging with research and implementing research findings. Organisational culture and leadership are also important elements in fostering environments where evidence and research are promoted throughout the nursing workforce.

Improving safety by developing trust with a just culture

This article presents a simple conceptual road map for implementing a just culture in healthcare settings. The concept of just culture was developed as one of five fundamental elements of a safety culture by psychology professor James Reason in 1997. A just culture requires an unbiased method of judging human error and is designed to develop organisational trust so that adverse medical events (errors) are reported and corrected before they combine with other errors to cause injury or death. To implement a just culture properly so as to increase organisational safety, practitioners must understand its role in enabling the error reporting needed to develop a safety culture. This article reviews these foundational concepts and explores the human causes of errors that a just culture addresses, the psychological importance of a just culture in enabling error reporting and how to implement a just culture in organisations.

Improving the Quality of Patient Care and Healthcare Staff Well-Being through an Empathy Immersion Educational Programme in New Zealand: Protocol of a Feasibility and Pilot Study

Empathy is positively related to healthcare workers and patients’ wellbeing. There is, however, limited research on the effects of empathy education delivered in acute clinical settings and its impact on healthcare consumers. This research tests the feasibility and the potential efficacy outcomes of an immersive education programme developed by the research team in collaboration with clinical partners and a multidisciplinary advisory group. Healthcare worker participants in the intervention ward will receive an 8-week immersive empathy education. The primary outcome (feasibility) will be assessed by evaluating the acceptability of the intervention and the estimated resources. The secondary outcome (efficacy) will be assessed using a quasi-experimental study design. Non-parametric tests will be used to test healthcare worker participants’ empathy, burnout, and organisational satisfaction (within-group and across groups), and healthcare consumer participants’ satisfaction (between-group) over time. Despite growing interest in the importance of empathy in professional relationships, to our knowledge, the present pilot study is the first to explore the feasibility and efficacy of an immersive empathy education in New Zealand. Our findings will provide critical evidence to support the development of a randomised cluster trial and potentially provide preliminary evidence for the effectiveness of this type of empathy education.

Applying the Nursing Ecosystem Concept to Developing Strategic Innovation and Entrepreneurial Leadership for Valued Patient Care

Research confirms entrepreneurial leadership encourages entrepreneurial behaviour and an entrepreneurial culture supports the development of 'entrepreneurial mindset'. Nurses implementing and optimizing information technology need to work with numerous stakeholders that collectively make up their ecosystem. Indeed, nurses with an entrepreneurial mindset increase their ability to sense opportunities and mobilize the resources and knowledge required to seek' informatics' opportunities to deliver patient centred care across the whole ecosystem.

Engaging nurses to achieve a culture of excellence: a children's hospital journey towards Pathway to Excellence accreditation

High-quality nursing care is linked to improved patient experience and patient outcomes, so having work environments that nurture a culture of nursing excellence is fundamental to delivering high-quality patient care. The American Nurses Credentialing Center (ANCC) runs the Pathway to Excellence programme, an international accreditation recognising healthcare organisations that provide nurses with a positive and safe practice environment in which they can excel. In 2020, Nottingham Children's Hospital became the first children's hospital in Europe to gain Pathway to Excellence accreditation, demonstrating that it has developed a culture of nursing excellence and a positive environment for nurses to work in. This article describes the hospital's journey towards accreditation. Crucial to its success were strategic planning, transformational leadership and using a change management approach, as well as effective staff engagement guided by the ADKAR model for change, an acronym representing five individual outcomes in terms of awareness, desire, knowledge, ability and reinforcement.

Organisational Culture and Mask-Wearing Practices for Tuberculosis Infection Prevention and Control among Health Care Workers in Primary Care Facilities in the Western Cape, South Africa: A Qualitative Study

Background: Although many healthcare workers (HCWs) are aware of the protective role that mask-wearing has in reducing transmission of tuberculosis (TB) and other airborne diseases, studies on infection prevention and control (IPC) for TB in South Africa indicate that mask-wearing is often poorly implemented. Mask-wearing practices are influenced by aspects of the environment and organisational culture within which HCWs work. Methods: We draw on 23 interviews and four focus group discussions conducted with 44 HCWs in six primary care facilities in the Western Cape Province of South Africa. Three key dimensions of organisational culture were used to guide a thematic analysis of HCWs’ perceptions of masks and mask-wearing practices in the context of TB infection prevention and control. Results: First, HCW accounts address both the physical experience of wearing masks, as well as how mask-wearing is perceived in social interactions, reflecting visual manifestations of organisational culture in clinics. Second, HCWs expressed shared ways of thinking in their normalisation of TB as an inevitable risk that is inherent to their work and their localization of TB risk in specific areas of the clinic. Third, deeper assumptions about mask-wearing as an individual choice rather than a collective responsibility were embedded in power and accountability relationships among HCWs and clinic managers. These features of organisational culture are underpinned by broader systemic shortcomings, including limited availability of masks, poorly enforced protocols, and a general lack of role modelling around mask-wearing. HCW mask-wearing was thus shaped not only by individual knowledge and motivation but also by the embodied social dimensions of mask-wearing, the perceptions that TB risk was normal and localizable, and a shared underlying tendency to assume that mask-wearing, ultimately, was a matter of individual choice and responsibility. Conclusions: Organisational culture has an important, and under-researched, impact on HCW mask-wearing and other PPE and IPC practices. Consistent mask-wearing might become a more routine feature of IPC in health facilities if facility managers more actively promote engagement with TB-IPC guidelines and develop a sense of collective involvement and ownership of TB-IPC in facilities.

Individual and organisational strategies to develop resilience in the nursing workforce

Nurses are likely to encounter a wide range of distressing, challenging and sometimes traumatic situations. However, the coronavirus disease 2019 (COVID-19) pandemic has created unprecedented levels of stress, risk, uncertainty and anxiety for nurses. Nurses have been working in highly challenging conditions, particularly on the front line of patient care, which has had adverse effects on their mental health and well-being. The challenges generated by the COVID-19 pandemic have called into question the notion of nursing being an innately resilient profession. Consequently, the pandemic has reinforced the need for individuals, teams and healthcare organisations to foster resilience in nurses. This article discusses the theoretical underpinnings of resilience, explains what resilience in nurses means, and describes the adverse effects of the pandemic on nurses' mental health and resilience. The article also explores how nurses' resilience can be developed and enhanced from an individual and organisational perspective.

Engaging nurses to achieve a culture of excellence: a children's hospital journey towards Pathway to Excellence accreditation

High-quality nursing care is linked to improved patient experience and patient outcomes, so having work environments that nurture a culture of nursing excellence is fundamental to delivering high-quality patient care. The American Nurses Credentialing Center (ANCC) runs the Pathway to Excellence programme, an international accreditation recognising healthcare organisations that provide nurses with a positive and safe practice environment in which they can excel. In 2020, Nottingham Children's Hospital became the first children's hospital in Europe to gain Pathway to Excellence accreditation, demonstrating that it has developed a culture of nursing excellence and a positive environment for nurses to work in. This article describes the hospital's journey towards accreditation. Crucial to its success were strategic planning, transformational leadership and using a change management approach, as well as effective staff engagement guided by the ADKAR model for change, an acronym representing five individual outcomes in terms of awareness, desire, knowledge, ability and reinforcement.

The Use of Physical Restraints on Geriatric Patients: Culture and Attitudes among Healthcare Professionals at Intermediate Care Hospitals in Majorca. A Qualitative Study Protocol

The use of physical restraints is a common practice in the care of hospitalised and institutionalised elderly people. This use is determined by factors related to the patients, their families, the healthcare professionals, the institution, and prevailing social values. Today, however, this practice is often questioned because of its physical, psychological, moral, ethical, and legal repercussions. The present study explores attitudes among healthcare professionals towards the physical restraint of geriatric patients in intermediate care hospitals in Majorca. This study is based on a qualitative design, combining an ethnomethodological approach with critical discourse analysis. The theoretical framework is drawn from Foucault’s work in this field and from Haslam’s theory of mechanisation. Individual interviews will be conducted with physicians, nurses, and nursing assistants at intermediate care hospitals in Majorca. The analysis will focus on these professionals’ knowledge, attitudes, and practices regarding the use of such measures, seeking to identify the factors, especially institutional factors, that determine the use of restraints. It is essential to determine the prevailing culture among healthcare professionals regarding the use of physical restraints on geriatric patients in order to design and propose a more dignified health care model in which such restraints are eliminated.

Understanding the Implementation of "Sit Less at Work" Interventions in Three Organisations: A Mixed Methods Process Evaluation

Long periods of workplace sitting are associated with poor health outcomes. Interventions to reduce workplace sitting time have had variable impacts, the reasons for which require further investigation. In this paper, we report on a process evaluation aiming to determine the intervention fidelity of three "sit less at work" interventions and to explore barriers and enablers to implementation, using a mixed methods "before and after" intervention study design. Convenience samples of staff were recruited from three diverse organisations to participate in pre- and post-intervention online questionnaires, objective measures of sitting time (using activPAL3™ devices) and post-intervention focus groups. Intervention implementers and key personnel were also recruited to participate in post-intervention focus groups and interviews. The process evaluation found that none of the interventions were implemented as intended, with no consistent reductions in sitting time. Contextual and organisational cultural barriers included workload pressures and the social norms of sitting, competing priorities, lack of management buy-in, and perceptions of where the responsibility for behaviour change should come from. To ensure effective implementation of future initiatives, deeper organisational-level change, requiring buy-in from all levels of management and staff, may be needed to shift organisational culture and associated social norms.

Investigating organisational justice and job satisfaction as perceived by nurses, and its relationship to organizational citizenship behaviour

BACKGROUND

Organisational justice refers to the extent to which employees perceive workplace procedures, interactions, and outcomes to be fair in nature. Previous research has found that organisational justice has been associated with an employee's commitment to their organisation, job satisfaction, and intention to leave their role. Organisational justice has also been linked to organisational citizenship behaviours, and the likelihood of these behaviours being demonstrated by employees.

AIM

To investigate staff nurses' perceptions of organisational justice and job satisfaction and its relationship to their levels of organisational citizenship behaviour.

METHOD

Perceived levels of organisational justice, job satisfaction, and levels of organisational citizenship behaviour were evaluated among 175 nurses working in two hospitals in Egypt. Analysis was undertaken to ascertain whether a correlation existed between organisational justice or job satisfaction and levels of organisational citizenship behaviour.

RESULTS

The majority of nurses in this study were found to perceive moderate levels of organisational justice. Organisational justice was positively correlated with levels of organisational citizenship behaviour, as was job satisfaction.

CONCLUSION

This study found that nurses in two hospitals in Egypt perceived moderate levels of organisational justice in their place of work. Nurse managers should pay extra attention to strategies that promote organisational justice among nurses.

Determinants of regulatory compliance in health and social care services: a systematic review protocol

Background: The delivery of high quality health and social care services is a fundamental goal for health systems worldwide. Identifying the determinants of quality is a complex task as there are a myriad of variables to choose from. Researchers in this field have assessed a range of organisational and environmental factors (for example: staff composition, facility ownership, facility size) for an association with various quality metrics. Less attention has been paid to the determinants of compliance with quality regulation. Identifying the determinants of compliance has the potential to improve regulatory processes and can inform quality improvement initiatives undertaken by service providers and policy makers. This protocol describes a systematic review which will review literature from a wide range of study designs and sources to develop an overview of the determinants of regulatory compliance in health and social care services. Methods: A wide range of study designs and grey literature will be sought for this review. Searches will be conducted using PubMed, MEDLINE, PsycInfo, SocINDEX and CINAHL databases. The studies included in the review will be subject to quality appraisal with reference to the collection of tools available from the Joanna Briggs Institute. Data extraction will be informed by the Consolidated Framework for Implementation Research (CFIR). A narrative synthesis will be conducted on the barriers, facilitators and factors associated with compliance, with reference to the concepts mapped onto the CFIR. GRADE-CERQual will be used to grade the overall body of evidence. Conclusion: The findings of this review will be useful to regulators to inform regulatory policy and practice. Service providers and policy makers may also use the findings to inform quality improvement initiatives aimed at improving compliance and quality across a range of health and social care services.

"It Was Definitely an Eye-Opener to Me"-People with Disabilities' and Health Professionals' Perceptions on Combining Traditional Indoor Rehabilitation Practice with an Urban Green Rehabilitation Context

Research points to the health benefits of rehabilitation in urban green spaces. Nevertheless, more studies indicate complexity of utilising urban green spaces in an established health system context. An understanding of challenges related to rehabilitation in urban green spaces remains unaddressed. Therefore, the aim was to describe and analyse people with disabilities' and health professionals' perceptions on combining traditional indoor rehabilitation practice with an urban green rehabilitation context. The interpretive description methodology was applied supplemented by Edgar Schein's Model of Organisational Culture. Three online focus group interviews were conducted with people with disabilities (n = 4) and health professionals (n = 10). Three interrelated themes formed an understanding of rehabilitation practice in an urban green rehabilitation context: "ambivalence due to contextual change", "negotiating rehabilitation assumptions" and "expanding the frame of rehabilitation". Expanding the frame of rehabilitation to an urban green context may provide a basis for enhancing compatibility to everyday life for people with disabilities and still accommodate structural quality standards of professional rehabilitation practice.

An aged life has less value: A qualitative analysis of moral disengagement and care failures evident in Royal Commission oral testimony

AIMS AND OBJECTIVES

To identify common themes about care failures in residential aged care as described from the perspectives of older people and their families in transcripts from hearings and submission to the Australian Royal Commission. These failures are explored through the lens of moral disengagement.

BACKGROUND

Previous inquiries into care failures have highlighted widespread harm from inhumane care, caused by staff carelessness, indifference and callousness. In health care, limited consideration has been given to the moral engagement or disengagement of staff and the relationship of moral engagement with care failures.

METHOD

Qualitative latent content analysis of 22 transcripts from the Royal Commission between March 2020-August 2020. Methods are reported using the SRQR.

RESULTS

This paper presents one theme, Dehumanisation of the care process: An aged life has less value, from a larger study. Care failures relating to morally disengaged staff were found to be widespread and influenced by the environments created by organisations.

CONCLUSION

This study highlights the need for further research to identify indicators of moral disengagement among staff and explore strategies to reduce or prevent moral disengagement within organisations trusted with providing care to older people.

RELEVANCE TO CLINICAL PRACTICE

Caregiving is necessarily associated with, and shaped by, moral dimensions. The erosion or disengagement of these moral dimensions among care staff reveals important aspects of residential aged care's lived experience. Studying dynamics within aged care facilities can provide a useful analytic lens for illuminating ways that residents and their family or those close to them, experience or are impacted by moral dimensions and behaviours.

Implementation of a Quality Improvement Roadmap in the Department of Internal Medicine of an Academic Medical Centre in Singapore

Background: Clarity in directions and constant engagement efforts are crucial to implementing high-quality interventions in Quality Improvement (QI) initiatives. It underpins the success to achieve impactful improvement, effectiveness of interventions through clinical leadership and project sustainability. Our objective was to implement a QI roadmap to improve QI participation of specialists and to clearly align projects and stakeholders to achieve departmental priorities and goals.

Methods: Baseline measurement of Department of Internal Medicine (DIM) specialists involved in QI projects was performed. Root cause analysis and prioritization was conducted to determine the interventions. Series of interventions to address challenges faced by stakeholders to ensure congruency of directions that included collective learning sessions, planning of communication, and documenting progress with checkpoint meetings were carried out. A survey was conducted before and after interventions.

Results: QI projects' participation rates of DIM specialists increased to 82.6% from 26.3% with an increase in uptake in leadership roles from three to nine specialists within the 12 months. The perception survey showed a positive shift in attitudes with greater ease in applying QI tools and concepts, with an increase of 25.7% in 2020 as compared to 2018. With the ease of completing QI projects, DIM specialists became more confident after intervention at 63.2% compared to 42.1% before and also regarded the department to be much stronger in QI culture with an improvement of 51.2%. DIM QI strategic themes model was borne from developing the core focus areas of the departments in order to align existing and prospective QI projects to the established themes.

Conclusion: Department-specific goals and priorities with dedicated interventions are important in driving the interest and ownership to initiate QI projects that align to solve operational problems. The ease in creating the strategic themes model targeting key performance indicators and matching QI projects to the relevant themes, lowers activation barrier and promotes spread due to its simplicity to create and use for communication.

Continuing professional development: evaluating a masterclass for band 5 children's nurses

BACKGROUND

Continuing professional development (CPD) is an important factor in being able to recruit and retain staff. However, it is recognised that budget constraints make offering CPD difficult, and it often falls to local NHS organisations and higher education providers to develop CPD initiatives that are fit for purpose.

AIM

To evaluate the impact of a CPD masterclass on band 5 children's nurses.

METHOD

Fourteen band 5 children's nurses attended a CPD masterclass delivered as a series of workshops over one day. Participants completed questionnaires before, at the end of, and three months after the masterclass. The pre-masterclass and three-month follow-up questionnaires included the short version of the Occupational Self-Efficacy Scale.

FINDINGS

After the masterclass, all participants had a plan (or a partial plan) for their career development, compared with 79% before it. Participants felt more confident at handling challenging situations at work after the masterclass. Participants appreciated the opportunity to focus on their CPD needs and discuss them with colleagues.

CONCLUSION

Time for CPD, career development opportunities, workplace culture, learning and development, and confidence are all important factors to consider when developing CPD opportunities for band 5 children's nurses.

Enabling patient safety awareness using the Green Cross method: A qualitative description of users' experience

AIM

The Green Cross method was developed to support healthcare staff in daily patient safety work. The aim of this study was to describe users' experiences of the method when working with patient safety and their views on the core elements.

BACKGROUND

Patient safety systems need to be user-friendly to facilitate learning from adverse events. The Green Cross method is described as a simple visual method to recognise risks and preventable adverse events (PAEs) in real time. There are no previous studies describing users' experiences of the Green Cross method.

DESIGN

A qualitative descriptive design.

METHODS

32 healthcare workers and managers from different specialties in a Swedish hospital were interviewed, from May-September 2018 about their experiences of the Green Cross method; either individually or as part of a group. The interviews were analysed using thematic analysis. The study follows the COREQ guidelines for qualitative data.

RESULTS

Participants associated the Green Cross method with patient safety, but no core elements of the method were identified. Instead, the opportunity to be engaged in patient safety work in a systematic way was underlined by all study participants. Highlighted key areas were the simplicity and the systematic framework of the method along with a need of distinct leadership. The daily meetings promoted trust and dialogue and developed the patient safety mindset. Daily meetings, together with the visualisation of the cross, were emphasised as important by users who otherwise had limited knowledge of the entire method.

CONCLUSION

This study offers valuable information that can help deepen the understanding of how the method specifically supports patient safety work.

RELEVANCE TO CLINICAL PRACTICE

Healthcare workers are expected to report patient safety issues. This study presents user-friendly aspects of the method as well as limitations, relevant for present and future users.

Investigating the factors that influence Iranian nurses' workplace happiness

BACKGROUND

Employees who describe themselves as happy in their work are more likely to be motivated to fulfil their professional duties. Therefore, it is important that healthcare organisations and managers understand how to promote a sense of happiness among nurses.

AIM

To investigate the relationship between the concepts of psychological capital, interactional justice, supervisor support and workplace happiness, and how they are mediated by employees' trust in their supervisors.

METHOD

Self-report questionnaires were used to obtain data from nurses on the variables of trust in supervisor, psychological capital, interactional justice, supervisor support and happiness at work. The questionnaires were distributed to 250 nurses working in hospitals in the city of Hamedan, Iran, and a total of 200 respondents completed and returned them. The data were then applied to a proposed model for promoting employees' workplace happiness, which was evaluated using data analysis software.

RESULTS

The results showed that the model correctly identified a pathway for promoting workplace happiness in nurses. Moreover, it was found that psychological capital, interactional justice and supervisor support led to improved workplace satisfaction through the mediating role of nurses' trust in their supervisors.

CONCLUSION

The findings of this study indicate that paying attention to employees' psychological capital, interactional justice and supervisor support, as well maintaining employees' trust in their supervisors, could assist healthcare organisations and managers to achieve organisational targets such as increased job satisfaction.

Building workforce well-being capability: The findings of a wellness self-care programme

AIM

To implement and evaluate a co-designed staff well-being programme.

BACKGROUND

Working in health care can be physically and psychologically demanding. The job demands-resources model indicates job resources moderate the impact of job demands on staff well-being. Well-being initiatives introduced by organisations improve staff commitment, and reduce absences and incidents.

METHODS

A qualitative descriptive design was applied. In 2019, within an Australian local health district, 232 health care professionals across eight hospitals and two community settings attended a six-week well-being programme, which included a variety of self-care strategies, for example mindfulness. Nine 1-hr focus groups were completed 2-4 weeks post-programme. Data were analysed using thematic analysis to explore participants' thoughts and experiences.

RESULTS

Participants experienced joy from workshops and guilt for leaving peers with their workload. Participants developed strong interpersonal relationships with workshop attendees within a 'safe well-being space'. Broader impacts expressed by participants were; learnt coping mechanisms and proactive self-care practices and can be easily embedded into daily routines. Participants shared their 'toolkit' with colleagues, family and friends, positively impacting the well-being of people around them.

CONCLUSION

Participants encouraged by their new well-being 'toolkit' engaged with colleagues, better managed stressors and shared learnings.

IMPLICATIONS FOR NURSING MANAGEMENT

Building well-being capability within a health organisation requires nursing management to make staff well-being a strategic priority, use a co-design approach and embed coping mechanisms at the grassroots levels.

Framework for patient, family-centred care within an Australian Community Hospital: development and description

OBJECTIVE

To describe the development of a patient and family-centred care (PFCC) conceptual framework within a small community Australian Hospital.

METHODS

A scoping review of scientific and grey literature and community hospital stakeholder discussions were used to identify and design a conceptual framework for PFCC across five core pillars of leadership, engagement, service delivery, learning and environment.

RESULTS

107 publications were identified and 76 were included for data extraction. A draft framework was constructed and modified following consultation with hospital stakeholders across a small Australian Community Hospital. The 'Caring Together' framework outlines three core layers: (1) the focus of our care is the experiences of our consumers and staff; (2) concepts of leadership, environment, service delivery, engagement and learning; and (3) the overarching fundamental values of being heard, respected, valued and supported by staff and consumers at all levels in an organisation.

CONCLUSIONS

The conceptual Caring Together framework structures key PFCC concepts across organisational priority areas within an Australian healthcare setting and can be used to guide implementation of PFCC at other small hospital facilities. Changes to national and state healthcare funding may help facilitate improved hospital facility implementation of PFCC, and ultimately improve consumer healthcare satisfaction and clinical outcomes.

Insights into nurses' precarious emotional labour in the emergency department

BACKGROUND

Nurses in the emergency department (ED) work in emotionally charged situations and undertake extensive emotional labour. However, that labour is not visible to others, often overlooked and therefore undervalued. Furthermore, there is a lack of literature on the topic.

AIM

To explore ED nurses' experiences of emotional labour.

METHODS

In-depth semi-structured interviews were conducted with two staff nurses working in the ED of a large UK teaching hospital. Rigorous methods of data collection and analysis, including a strong reflexive stance, were adopted.

FINDINGS

Among three overarching themes that emerged from the data, two related more specifically to the ED: 'precarious emotional labour' and 'grieving etiquette'. Participants were found to perform sophisticated forms of emotional labour to manage the precariousness of their role, and to conceal or suppress their own feelings in order to maintain the grieving etiquette.

CONCLUSION

The ED is an environment that requires sophisticated but precarious forms of emotional labour. Recognising, valuing and supporting the emotional aspect of an ED nurse's role is essential if emergency services are to remain functional, efficient and humane.

Development of a Toolkit to support sustainable culture change in residential aged care

OBJECTIVE

This study aimed to develop and evaluate a Toolkit to support implementation of the Towards Organisational Culture Change (TOrCCh) intervention, with minimal external facilitation, in aged care facilities, to implement long-lasting organisational change.

METHODS

Eight residential aged care facilities across two Australian states participated. A Toolkit was drafted iteratively, engaging staff from participating sites and a reference group. Participating facilities undertook two change projects utilising the Toolkit. Qualitative data were collected from site project sponsors, work teams and other care staff, and analysed thematically.

RESULTS

The intervention was perceived to provide a generic approach that could be applied to solve agreed challenges in the workplace generating useful outcomes including staff development, increased communication, teamwork and leadership. The role of a project sponsor, and organisational support, was perceived as important for sustainability.

CONCLUSION

Aged care facility staff teams report they can work together effectively for sustainable improvements when provided with a Toolkit.

What do we really assess with organisational culture tools in healthcare? An interpretive systematic umbrella review of tools in healthcare

Introduction

A toxic organisational culture (OC) is a major contributing factor to serious failings in healthcare delivery. Poor OC with its consequences of unprofessional behaviour, unsafe attitudes of professionals and its impact on patient care still need to be addressed. Although various tools have been developed to determine OC and improve patient safety, it remains a challenge to decide on the suitability of tools for uncovering the underlying factors which truly impact OC, such as behavioural norms, or the unwritten rules. A better understanding of the underlying dimensions that these tools do and do not unravel is required.

Objectives

The aim of this study is to provide an overview of existing tools to assess OC and the tangible and intangible OC dimensions these tools address.

Methods

An interpretive umbrella review was conducted. Literature reviews were considered for inclusion if they described multiple tools and their dimensional characteristics in the context of OC, organisational climate, patient safety culture or climate. OC tools and the underlying dimensions were extracted from the reviews. A qualitative data analysis software program (MAX.QDA 2007) was used for coding the dimensions, which resulted in tangible and intangible themes.

Results

Fifteen reviews met our inclusion criteria. A total of 127 tools were identified, which were mainly quantitative questionnaires covering tangible key dimensions. Qualitative analyses distinguished nine intangible themes (commitment, trust, psychological safety, power, support, communication openness, blame and shame, morals and valuing ethics, and cohesion) and seven tangible themes (leadership, communication system, teamwork, training and development, organisational structures and processes, employee and job attributes, and patient orientation).

Conclusion

This umbrella review identifies the essential tangible and intangible themes of OC tools. OC tools in healthcare do not seem to be designed to determine deeper underlying dimensions of culture. We suggest approaching complex underlying OC problems by focusing on the intangible dimensions, rather than putting the tangible dimensions up front.

Quality improvement report: setting up a staff well-being hub through continuous engagement

The coronavirus pandemic has presented a new set of challenges for the frontline National Health Service staff. It is not only the long working hours but also the uncertainty and increase in patient mortality that has affected mental health and staff well-being. Hospitals all around the country have rightly responded with various well-being initiatives to help their staff such as wobble rooms and developing online resources. Our vision was to set up a safe space for staff away from clinical noise to enable and encourage mindfulness and psychological resilience through a calm and serene environment. We used the continuous quality improvement methodology and administered an initial needs assessment survey to see if our trust staff will be interested in having such a space. Within our team, we managed to secure a place, and used donations to hospital charity and set up a space within a week. Since opening the hub, we have had excellent feedback from various staff groups. Immediate feedback was obtained using emoji stickers asking for feelings before and after visit. A mood board was put up allowing anonymous expression of feelings. Delayed feedback was requested using a repeat survey. We believe that while there is a lot of talk about well-being and an increasing number of resources being offered electronically, the need for a neat and quiet space cannot be overlooked. We collect feedback on a weekly basis and adapt the space to meet the needs of staff. Long-term impact of such spaces will be reassessed at a later stage.

Assessing the effect of physical activity and exercise on nurses' well-being

It is generally accepted that physical activity has many health benefits, such as improved cardiorespiratory fitness, muscular fitness and bone health. Despite this, inactivity remains a significant health challenge in the UK and globally, contributing to conditions such as coronary heart disease and diabetes mellitus. Nurses have an important health promotion role in recommending the potential benefits of physical activity to the general public. However, research suggests that many nurses may not be undertaking enough physical activity themselves, despite the active nature of the nursing role. This article investigates the evidence that increased physical activity has the potential to improve the well-being of nurses. The article also examines the effect of physical activity on indicators of well-being, including feeling states such as affect, mood and emotion; depression; and sleep.

Using problem-based learning to improve patient safety in the emergency department

Pressures from rising patient numbers and overcrowding in emergency departments (EDs) are putting patients' safety at risk. Beyond improved provision of resources, two elements are essential to patient safety in emergency care - work culture and staff training. In traditional training environments, the teacher dispenses knowledge to nursing students in a classroom setting. However, problem-based learning (PBL) and the related concept of team-based learning (TBL) aim to enhance learners' knowledge and skills in non-technical subjects, such as patient safety, as well as their ability to address challenges they encounter in clinical practice. This article explores the theories that underpin PBL and TBL and discusses how they can be used by nurse educators to motivate staff and improve patient safety in the ED.

Measuring and Assessing Healthcare Organisational Culture in the England's National Health Service: A Snapshot of Current Tools and Tool Use

Healthcare Organisational Culture (OC) is a major contributing factor in serious failings in healthcare delivery. Despite an increased awareness of the impact that OC is having on patient care, there is no universally accepted way to measure culture in practice. This study was undertaken to provide a snapshot as to how the English National Health Service (NHS) is currently measuring culture. Although the study is based in England, the findings have potential to influence the measurement of healthcare OC internationally. An online survey was sent to 234 NHS hospital trusts, with a response rate of 35%. Respondents who completed the online survey, on behalf of their representative organisations, were senior clinical governance leaders. The findings demonstrate that the majority of organisations, that responded, were actively measuring culture. Significantly, a wide variety of tools were in use, with variable levels of satisfaction and success. The majority of tools had a focus on patient safety, not on understanding the determining factors which impact upon healthcare OC. This paper reports the tools currently used by the respondents. It highlights that there are deficits in these tools that need to be addressed, so that organisations can interpret their own culture in a standardised, evidence-based way.

Interprofessional shared governance and relationship-based care: implementation and lessons learned

Shared decision-making has become a hot topic in healthcare. This article describes a step-by-step, 'how-to' approach to implementation of an interprofessional shared governance and relationship-based care model at a 300-bed tertiary academic medical centre in a large metropolitan area in the US and outlines the lessons learned. The project, undertaken in 'waves', encompassed inpatient and ambulatory services and has been sustained for over eight years.

Factors in facilitating an organisational culture to prevent pressure ulcers among older adults in health-care facilities

OBJECTIVE

Despite the availability of high-quality clinical practice guidelines, pressure ulcers (PU) continue to develop among older adults in acute and long-term health-care facilities. Except during acute medical crisis or near end-of-life, most PUs are preventable and their development is a health-care quality indicator. The aim of this study was to understand which factors facilitate pressure ulcer prevention among adults over 65 years-of-age receiving care in health-care facilities.

METHOD

A critical literature review from three scholarly databases examined components of organisational culture associated with PU prevention. Research papers involving adults >65 years-of-age who were admitted to acute and long-term health-care facilities with PU prevention programmes between 2010 and 2017 were included. A secondary manual search included literature discussing health-care organisational culture, with a total of 41 articles reviewed.

RESULTS

Based on a synthesis of this literature, the Factors Facilitating Pressure Ulcer Prevention Model was developed to depict five multilevel factors for PU prevention among older adults in health-care facilities. These five factors are: senior leadership, education, ongoing quality improvement, clinical practice, and unit level champions.

CONCLUSION

Ongoing prioritisation of these factors sustains PU prevention and assists health-care facilities to redefine their culture, expand education programmes, and promote accountability to improve health outcomes of older adults receiving care.

A cross-sectional study investigating the associations of person-organisation and person-group fit with staff outcomes in mental healthcare

OBJECTIVES

Organisational and workplace cultures are fundamental determinants of health systems performance; through better understanding of the dimensions of culture there is the potential to influence them, and subsequently improve safety and quality of care, as well as the experiences of both patients and staff. One promising conceptual framework for studying culture in healthcare is person-environment (P-E) fit. Comprising person-organisational (P-O) and person-group (P-G) components, P-E fit is defined as the extent to which individuals are compatible with their work environment. The aim of this study was to examine the associations of P-O and P-G fit with staff outcomes in mental healthcare.

SETTING AND PARTICIPANTS

Participants (n=213) were staff and volunteers at 31 primary mental health facilities across six states of Australia.

PRIMARY AND SECONDARY OUTCOME MEASURES

Staff outcomes, comprising burnout (depersonalisation and emotional exhaustion), job satisfaction and work stress.

DESIGN

A multidimensional survey tool was used to measure P-O and P-G fit, and staff outcomes. Multiple regression analyses were used to test the associations between fit and outcome measures.

RESULTS

The regression analyses indicated that, based on a Bonferroni adjusted alpha value of α=00417, P-O fit accounted for 36.6% of the variability in satisfaction (F=8.951, p≤0.001); 27.7% in emotional exhaustion (F=6.766, p≤0.001); 32.8% in depersonalisation (F=8.646, p≤0.001); and 23.5% in work stress (F=5.439, p≤0.001). The P-G fit results were less conclusive, with P-G fit accounting for 15.8% of the variability in satisfaction (F=4.184, p≤0.001); 10.0% in emotional exhaustion (F=2.488, p=0.014); 28.6% in depersonalisation (F=8.945, p≤0.001); and 10.4% in work stress (F=2.590, p=0.032). There was no statistically significant increase in the variability accounted for when the interaction term of P-O and P-G fit was added to the regression.

CONCLUSIONS

The findings highlight that staff's perception of their workplace and organisational culture can have implications for staff well-being.

It Needs More Than Just User Participation: Combining Perspectives of Clinical Leaders and Chief Information Officers on Determinants of Hospitals' IT Innovativeness

Although user participation may facilitate the realisation of IT innovations, various literature analyses show only minimal to moderate evidence for such effects possibly due to disregard of mediating factors. Against this background, this study examines the extent to which joint intrapreneurship of clinical leaders and IT leaders as well as a distinct innovation culture mediate the effect of user participation on hospitals' IT innovativeness. IT innovativeness was measured by the availability and usability of IT functions and by the perceived 'innovative power' of a hospital. An empirical model was developed and tested with data from 168 clinical leaders and IT leaders who participated pairwise in a survey representing 84 German hospitals. Three parallel mediation analyses indicated that the participation of users could only lead to IT innovativeness if they were accompanied by intrapreneurial leadership on the part of clinical directors and IT leaders and if a pronounced innovation culture prevailed.

Organisational enablers and barriers to the recognition of sexuality in aged care: A systematic review

AIM

To identify organisational characteristics and practices that promote or inhibit the recognition of sexuality in the care of older people in health and aged care settings.

BACKGROUND

Sexuality in old age is poorly understood by health professionals and rarely addressed in care planning and delivery. Nurse managers are ideally placed to lead organisations in promoting a culture of acceptance that enables the expression of sexuality.

EVALUATION

A search for research/expert opinion papers published from January 2004 to February 2017 was undertaken. Two reviewers performed data extraction and appraisal of 34 included studies using Joanna Briggs Institute tools. The primarily qualitative research was analysed to identify 152 findings that were organised into 22 categories and combined into four syntheses.

KEY ISSUE(S)

An organisation's philosophies frame the way older people's sexuality is perceived. Cultivating a culture and environment of acceptance, engagement and knowledge and delivering care in a way that promotes opportunity for safe and private expression of sexuality are key enabling factors.

CONCLUSION(S)

Organisations and nurse leaders can support and facilitate older adults' expression of their sexuality through the review and development of philosophies, policies, procedures, staff attitudes and knowledge and the creation of a conducive environment.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers play a pivotal role in developing a sexuality-positive organisational ethos by ensuring policies, care practices, the environment and amenities are supportive of the expression of sexuality and by role modelling attitudes of respect and inclusivity.

Senior stakeholder views on policies to foster a culture of openness in the English National Health Service: a qualitative interview study

OBJECTIVES

To examine the experiences of clinical and managerial leaders in the English healthcare system charged with implementing policy goals of openness, particularly in relation to improving employee voice.

DESIGN

Semi-structured qualitative interviews.

SETTING

National Health Service, regulatory and third-sector organisations in England.

PARTICIPANTS

Fifty-one interviewees, including senior leaders in healthcare organisations (38) and policymakers and representatives of other relevant regulatory, legal and third-sector organisations (13).

MAIN OUTCOME MEASURES

Not applicable.

RESULTS

Participants recognised the limitations of treating the new policies as an exercise in procedural implementation alone and highlighted the need for additional 'cultural engineering' to engender change. However, formidable impediments included legacies of historical examples of detriment arising from speaking up, the anxiety arising from increased monitoring and the introduction of a legislative imperative and challenges in identifying areas characterised by a lack of openness and engaging with them to improve employee voice. Beyond healthcare organisations themselves, recent legal cases and examples of 'blacklisting' of whistle-blowers served to reinforce the view that giving voice to concerns was a risky endeavour.

CONCLUSIONS

Implementation of procedural interventions to support openness is challenging but feasible; engineering cultural change is much more daunting, given deep-rooted and pervasive assumptions about what should be said and the consequences of mis-speaking, together with ongoing ambivalences in the organisational environment about the propriety of giving voice to concerns.

Does a hospital culture influence adherence to infection prevention and control and rates of healthcare associated infection? A literature review

Background

Over 4 million patients acquire a healthcare-associated infection (HCAI) in Europe every year, indicating possible shortcomings in hospitals converting evidence-based infection prevention and control (IPC) strategies into universal adherence. We present a literature review exploring whether insufficient adherence could be culturally based.

Aim

To find empirical evidence if and how specific traits of organisational culture improve adherence to IPC strategies utilising HCAI rates as the marker of system failures or successes.

Methods

PubMed, CINAHL, PsycINFO and the British Nursing index database were searched from January 2007 to June 2018. Hand-searching, Google Scholar and the snowball effect completed the investigation. The quality of the studies was assessed with the guidance of CASP and Cochrane tools.

Results

Twenty papers were eligible for data extraction and thematic analysis. Studies predominantly report positive findings for the association, but none were determined high quality due to multiple methodological concerns. Analysing both quantitative and qualitative research revealed eight major themes: hospital cultures with better HCAI rates foster safety culture; have a generative leadership style; embrace innovation; ensure interventions fit local context; accept long-term orientation; engage and empower health professionals; promote collaboration and communication; and see the benefits of a non-punitive climate.

Interpretation

The literature linking organisational culture and HCAI rates is suggestive, but not conclusive, indicating caution about their inferences. Leaving cultural growth to chance or allowing for weak or toxic cultures impedes on our IPC strategies and equivalently our HCAI rates.