Aligning Theory and Evidence-Based Practices to Enhance Human Flourishing in Nurse Executives

Today’s nurse executives lead highly complex and bureaucratic organizations undergoing sweeping reform at an unprecedented rate of change. Change and high levels of stress are the norm in health care, and ineffective stress management can hinder organizational performance and adversely impact personal wellbeing. The risks of nurse executive burnout and unprecedented turnover led to the development of a 4-hour program to teach theory-guided and evidence-based stress management techniques. The program was intended to increase awareness, enhance effective stress management skills, and improve the nurse executive’s ability to flourish in high stress environments. A pre-intervention and 6-month post-intervention assessment (n=12) was conducted, and the results for 12 matched pairs were statistically significant for improved personal and organizational indicators of stress over time, indicating improved vitality, engagement, and sustainability. Findings validated concerns regarding the prevalence of stress in the nurse executive group and demonstrated positive outcomes for key performance indicators that support personal wellbeing, resilience, retention, and success. One nurse executive identified she no longer felt like leaving the organization and nurse executive leader turnover has decreased measurably following the intervention. The relative low costs, positive outcomes, and flexible format of this program make it feasible to support spread and enculturation of improved stress management practices that benefit both employee and organization through existing orientation and ongoing professional development strategies

Balancing life and death during the golden minute – midwives’ experiences of performing newborn resuscitation

Brendan McCormack - ORCID: 0000-0001-8525-8905 https://orcid.org/0000-0001-8525-8905Purpose: To explore midwives’ experiences in performing newborn resuscitation on maternity wards.Patients and Methods: It was a qualitative study, using a phenomenological hermeneutic approach. Individual interviews with 16 clinical midwives working in Norwegian maternity wards were conducted from August 2018 to January 2019.Results: The complexity underlying how midwives balance responsibility and vulnerability when performing newborn resuscitation during the Golden Minute was revealed. Midwives described the stress they experienced during resuscitation events and their need for support and confirmation after performing newborn resuscitation.Conclusion: The vulnerability and responsibility that midwives bear for mothers and newborns simultaneously affected midwives in several ways. We saw that midwives need support and confirmation to be prepared for newborn resuscitation. We also found that a lack of knowledge, skills and experience were barriers to midwives feeling prepared. Simulation training, including tailored programs, are suggested to improve midwives’ skills and help them feel prepared for real-life resuscitations. The importance of midwives’ assessment during the Golden Minute and further investigation from other perspectives are needed to understand fully this clinical complexity.https://doi.org/10.2147/JMDH.S2689592020pubpub1

Nursing Education Workflows in EHR Training

A need for improvement in nursing education regarding inpatient workflows and informatics skills was identified at this project site. Upon hire, nurses were required to complete a 4-hour basic class on the electronic health record (EHR) system, but this class did not include inpatient-nursing workflows needed to provide and facilitate care for patients. This project addressed the lack of EHR education on inpatient nursing workflows. The focus of this staff education project was an education class on inpatient nursing workflow provided to a nurse residency class. Sources of evidence were obtained through a literature search and pretest/post test data analysis. The literature used to support the project included articles on best practices for EHR education for nursing. The pretest and post test design was used to determine if there was an increase in EHR knowledge after the education. Benner\u27s novice-to- expert model served as the framework. The mean total proficiency scores on inpatient nursing workflows in the EHR improved from pretesting to post testing, (6.8 to 7.8, p = 0.048). The study findings showed improvement in participants\u27 average proficiency, knowledge, and clinical skills in the EHR. This project findings demonstrated the need for an inpatient nursing informatics workflow class for all nursing staff, and the findings supported an increase in education to facilitate workflow and care safety. This project promotes positive social change by improving curricula, raising awareness of how technology affects clinical care and practice, and encouraging continuous quality improvement through informatics education

A Mindfulness and Health Promotion Program to Decrease The Perception of Stress and Burnout in Psychiatric Mental Health Nurses Who Provide Driect Patient Care To Individuals in Mental Health Units With A Diagnosis of Alzheimer\u27s Type Dementia

The principle of this systems-change project is to employ a stress management and health promotion program in Alzheimer’s type units to decrease the perception of stress and burnout in psychiatric-mental health nurses providing direct care in secured units. This systems-change project will implement mindfulness techniques as an effective tool for reducing the perception of stress and burnout. The mindfulness-based stress reduction and burnout prevention program will be implemented into staff development programs for nurses working in locked and psychiatric units in the community. Mindfulness-based stress reduction is an operational tool to aid nurses psychologically and to increase work satisfaction. Behavioral and psychological symptoms of dementia often lead to admission into long-term care facilities or to nursing home placement. High levels of stress and burnout are a significant problem for registered nurses (RNs) in long-term care. RNs providing care to this population are at increased risk for elevated levels of stress and burnout. The Use of the Mindfulness Based Stress Reduction Program as an intervention will show if it is effective in decreasing the perception of stress and burnout in psychiatric nurses who work in Alzheimer’s type dementia units

Building capacity to develop an African teaching platform on health workforce development: a collaborative initiative of universities from four sub Saharan countries

INTRODUCTION: Health systems in many low-income countries remain fragile, and the record of human resource planning and management in Ministries of Health very uneven. Public health training institutions face the dual challenge of building human resources capacity in ministries and health services while alleviating and improving their own capacity constraints. This paper reports on an initiative aimed at addressing this dual challenge through the development and implementation of a joint Masters in Public Health (MPH) programme with a focus on health workforce development by four academic institutions from East and Southern Africa and the building of a joint teaching platform. METHODS: Data were obtained through interviews and group discussions with stakeholders, direct and participant observations, and reviews of publications and project documents. Data were analysed using thematic analysis. CASE DESCRIPTION: The institutions developed and collaboratively implemented a ‘Masters Degree programme with a focus on health workforce development’. It was geared towards strengthening the leadership capacity of Health ministries to develop expertise in health human resources (HRH) planning and management, and simultaneously build capacity of faculty in curriculum development and innovative educational practices to teach health workforce development. The initiative was configured to facilitate sharing of experience and resources. DISCUSSION: The implementation of this initiative has been complex, straddling multiple and changing contexts, actors and agendas. Some of these are common to postgraduate programmes with working learners, while others are unique to this particular partnership, such as weak institutional capacity to champion and embed new programmes and approaches to teaching. CONCLUSIONS: The partnership, despite significant inherent challenges, has potential for providing real opportunities for building the field and community of practice, and strengthening the staff and organizational capacity of participant institutions. Key learning points of the paper are: *the need for long-term strategies and engagement; *the need for more investment and attention to developing the capacity of academic institutions; *the need to invest specifically in educational/teaching expertise for innovative approaches to teaching and capacity development more broadly; and *the importance of increasing access and support for students who are working adults in public health institutions throughout Africa.Web of Scienc

Payment by results and demand management: learning from the South Yorkshire laboratory

The need for effective demand management has become more transparent following the introduction of Payment by Results, Patient Choice and other reforms. This report details the findings of an empirical study exploring the South Yorkshire experience of demand management. By being ahead of the game in introducing PbR for all activity in all its acute trusts in the South Yorkshire area, the experience in South Yorkshire has the potential to inform the national roll-out of Payment by Results and Choose and Book. Specific objectives included: • assessing local perceptions of the nature and scale of changes in demand and whether this will be affected as other reforms, specifically Patient Choice, are implemented; • identifying what strategies are being developed locally to manage demand effectively; • documenting any benefits and drawbacks of different strategies for patients, PCTs, providers and the wider health economy; • identifying any facilitators and barriers to developing effective approaches for managing demand; • eliciting opinions on how current demand management strategies could be improved or adapted

Evaluating research investment and impact at a regional Australian Hospital and Health Service: a programme theory and conceptual framework

Background: Health systems in Australia and worldwide are increasingly expected to conduct research and quality improvement activities in addition to delivering clinical care and training health professionals. This study aims to inform a research impact evaluation at a regional Australian Hospital and Health Service by developing a programme theory showing how research investment is expected to have impact. Methods: This qualitative study, representing the first phase of a larger mixed methods research impact evaluation at the Townsville Hospital and Health Service (THHS), adopts a realist-informed design involving the development of a programme theory. Data were obtained between February and May 2019 from strategic documentation and interviews with six current and former health service executives and senior employees. Inductive themes were integrated into a conceptual framework to visually represent the programme theory. Results: Research at THHS has developed organically as the service has matured into a regional tertiary referral service serving a diverse rural and remote population across northern Queensland. Throughout this journey, individual THHS leaders often adopted a research development mantle despite disincentives arising from a performance-driven reporting and activity-based funding service context. Impact expectations from research investment at THHS were identified in the categories of enhanced research activity and capacity among clinicians, and improved clinical practice, health workforce capability and stability, and patient and population health. Seven contextual factors were identified as potential enablers or obstacles to these impact expectations and ambitions. Conclusions: By identifying both relevant impact types and key contextual factors, this study offers programme theory to inform a planned research impact evaluation at THHS. The conceptual framework may be useful in other regionally based health service settings. More broadly, there are opportunities for future research to test and refine hybrid versions of linear and realist research impact evaluation models that combine resource-intensive, theory-driven approaches with policy practicality

Grieving quietly whilst navigating the journey: The impact of managing end-of-life conversations on nurses working in adult general wards

Background The management of end-of-life conversations in hospital settings has been discussed and debated for more than a decade, with commentary being raised by the government, national bodies, and regulators (DoH 2008, 2009, 2017; PHSO, 2015; CQC, 2016). Many studies have evidenced the way in which this can be improved in specialist settings; however, there is a dearth of empirical evidence in general wards where most hospitalised patients die (ONS, 2021). Aim The aim of this study was to explore the impact managing end-of-life conversations has on nurses working in adult acute general (non-specialist) inpatient wards. Method A constructivist grounded theory approach was used (Charmaz, 2014), with data collection occurring in four district general hospitals in the East of England. Purposeful and theoretical sampling recruited a total of eleven registered nurses. Data were collected using semi-structured interviews, which were audio recorded, transcribed verbatim and were analysed using the constant comparison method on the NVivo QSR system. Findings Five theoretical categories were co-constructed from the data to explain the processes of managing end-of-life conversations and their subsequent impacts. The categories of walking the path with the dying, walking the path with the grieving, battling time, becoming lost and finding the way form the substantive theory of Navigating the Journey (Grieving Quietly), which evidences the cyclical and complex paths nurses take during each patient or familial interaction. Positive or negative impacts were predicated by the accessibility or lack of internal and external resources and time. Conclusion The proposed substantive theory of Navigating the Journey (Grieving Quietly) offers an insight into multiple microprocesses that occur when nurses enter conversations with the dying and the grieving. Further work is required to ensure that nurses have ready access to practical resources, meaningful education and supervision that will enable them to best succeed such journeys

Coaching Nurse Leaders in Conflict Management and Team Building to Improve Retention

Abstract Problem: Retention of assistant nurse managers (ANMs) was identified as a concern from interviews with executive leadership and ANMs employed at a large hospital within a Northern California integrated health system. The nurse leader orientation training was reviewed, with gaps identified in conflict management and team building. Context: The attrition rate of U.S. nurse managers in 2010 was 8.3%, higher than executive nurse leaders, with replacement costs equal to 75% - 125% of a nurse manager’s salary (Loveridge, 2017). Employee turnover and dissatisfaction due to conflict can have detrimental effects on retention, productivity, morale, and quality of patient care. Intervention: The intervention in this project included individualized training and coaching of ANMs working in acute inpatient units. Measures: The Rahim Organizational Conflict Inventory-II, the Nurse Manager Job Satisfaction and Intent to Stay Scale, and questionnaires developed to evaluate training method, modules, and effectiveness of the DNP facilitator/coach were used to evaluate s project outcomes. Results: ANM participants approach conflict using primarily the collaborating conflict management style. ANM job satisfaction scores improved post-intervention while intent to remain scores remained stable. All ANMs who participated in the project remained in their positions. The training was evaluated as practical, relevant, and effective, with reported increased knowledge and comfort with conflict management and team building. Conclusions: The results suggested that “on-the-spot” experiential learning, training, and coaching had a positive effect on ANM satisfaction and retention. Keywords: Conflict management, teambuilding, teamwork, coaching conflict management, nurse manager retentio

Exploring the training and scope of practice of GPs in England, Germany and Spain

OBJECTIVE: To explore general practitioner (GP) training, continuing professional development, scope of practice, ethical issues and challenges in the working environment in three European countries. METHOD: Qualitative study of 35 GPs from England, Germany and Spain working in urban primary care practices. Participants were recruited using convenience and snowball sampling techniques. Semi-structured interviews were recorded, transcribed and analysed by four independent researchers adopting a thematic approach. RESULTS: Entrance to and length of GP training differ between the three countries, while continuing professional development is required in all three, although with different characteristics. Key variations in the scope of practice include whether there is a gatekeeping role, whether GPs work in multidisciplinary teams or singlehandedly, the existence of appraisal processes, and the balance between administrative and clinical tasks. However, similar challenges, including the need to adapt to an ageing population, end-of-life care, ethical dilemmas, the impact of austerity measures, limited time for patients and gaps in coordination between primary and secondary care are experienced by GPs in all three countries. CONCLUSION: Primary health care variations have strong historical roots, derived from the different national experiences and the range of clinical services delivered by GPs. There is a need for an accessible source of information for GPs themselves and those responsible for safety and quality standards of the healthcare workforce. This paper maps out the current situation before Brexit is being implemented in the UK which could see many of the current EU arrangements and legislation to assure professional mobility between the UK and the rest of Europe dismantled