Navigating the Tension between Being a Transformational Leader and an Efficient Leader?

Since its introduction in 2014, the quadruple aim of optimizing healthcare performance by reducing costs and improving population health, patient experience, and healthcare team well-being has not been realized. Lean, a formal quality improvement model aimed at eliminating waste, improving flow and quality of care, and increasing efficiency, has been inconsistently successful in healthcare due to poor implementation and organizational understanding. This discussion paper explores the potential for transformational leaders to support the use of lean through empowering clinical leaders. Transformational leadership is a relational style of leadership found to motivate followers by soliciting their perspectives on problem-solving while supporting each individual to reach their full potential. Although transformational leaders can foster the development of clinical leaders to influence and coordinate care, they must navigate the tension between supporting clinical leaders and the organizational demands for improved efficiency. The gains of supporting the use of lean by clinical leaders could be meaningful development of strategies aimed at the quadruple aim by supporting the daily efforts of front-line nurses and their leaders to improve the delivery of quality care

Nursing Management of Incontinence Care in Acute and Long-Term Care Settings

The purpose of this paper is to provide an overview of urinary incontinence; the effect it has on older adults and the barriers nursing staff face when managing incontinence appropriately in acute and long term care settings. A literature search between 1995 and 2016 was conducted using medical health data-bases CINAHL and Medline, using a combination of key words such as: older adult, geriatric, nursing, urinary incontinence, continence, management, promotion, and interventions. Incontinence increases the risk of falls, skin damage, depression, urinary tract infections and development of functional dependency in older adults. Although there are similar barriers that nursing teams face when implementing continence care in long term and acute care settings, there are differences in assessment patterns, nursing culture, and in how nursing attitudes affects continence care. In both settings, nursing staff focus on containment methods rather than continence promotion techniques. In order to ensure best practice in continence care with older people, nursing staff require more education on continence care and support in integrating clinical practice guidelines. More research is needed to better understand nursing perceptions of urinary incontinence and the use of continence products with hospitalized older adults.&nbsp

Older Persons’ Experiences of Ageism: A Qualitative Descriptive Study

Objective: The aim of this study was to understand how ageism impacts the self-perceptions of older persons. Methods: A qualitative descriptive study was conducted interviewing nine older persons to understand their experiences of ageism, using a semi-structured interview. Data were analyzed using content and thematic analysis. Findings: Three themes were developed from the data analysis: ‘Experiences of Ageism,’ ‘Resilience,’ and ‘Looking Forward.’ Participants discussed their personal experiences with ageism and those they witnessed other people experiencing. Despite negative experiences with ageism, participants had developed strategies to move forward in life that displayed resilience. They also had advice for how our society could strategize in diminishing ageism. Discussion: Ageism is insidious and subtly prevalent. In trying to explain why participants initially had trouble recalling instances of ageism we looked at two theories. Stereotype embodiment theory asserts that ageism is internalized. Social Emotional Selectivity theory suggests that as we age, we focus more on positive rather than negative experiences. Regardless of the cause of the subtlety of ageism, more awareness and education about ageism and ageing is needed. Conclusions: Understanding how ageism impacts older persons will provide insights into how we can create better interventions and resources to support this vulnerable population. Additional research is needed to more fully understand older people's experiences of ageism. Implications for practice: Nurses could foster awareness of ageism in their work with older persons and advocate for policies that diminish ageism in healthcare institutions

Applying Selective Optimization and Compensation Model to Mobility Adaptations of Older Adults: An Integrative Review and Implications for Nursing Care

Mobility challenges can have a significant impact on older adults’ ability to live at home independently and their quality of life. The Selective Optimization and Compensation model offers insights into how people select and adapt in order to advance their goals in life. It is not well understood how useful this model is in understanding older adults mobility challenges. An integrative review of the literature of research that has used Selective Optimization and Compensation model to examine strategies for older adults’ mobility challenges was conducted. Key Selective Optimization and Compensation behaviours identified in the literature review included giving up activities for less strenuous activities, optimizing capacity for mobility and modifying mobility behaviours. Use of the Selective Optimization and Compensation model shifted the focus to older adults’ capacity rather than their losses. Future research should continue to explore the complex connection between mobility and older adult well-being. Utilizing the Selective Optimization and Compensation model in this research might help to identify key behaviours older adults are implementing to successfully age-in-place

Nursing Education: What Fits Best in a Changing World of Education Gogies?

Nursing education has roots in religious organizations, and apprenticeship approaches to ‘training’ nurses. Over time nursing education has moved to universities; yet retaining the critical practice nature of nursing. As a practice profession, nursing educators have to face the realities of ensuring that knowledge, skills, and values are taught in order for graduates to meet the entry to practice competencies. As graduates, nurses must also have the capacity to assess their knowledge gaps and be self-directed in filling those gaps so that they are providing evidence-based practice to those in their care. Educators must facilitate learning within best education practice, often identified as learner-centred approaches. In this discussion paper, we examine how nursing education has evolved, we critically examine the broader concepts of pedagogy, andragogy, heutagogy and academagogy, and discuss how these fit within learner-centred approaches to nursing education. Résumé Les racines de la formation en sciences infirmières remontent aux organisations religieuses et aux approches d’apprentis pour « former » les infirmières. Au fil du temps, la formation en sciences infirmières s’est déplacée vers les universités, tout en conservant la nature essentielle de la pratique infirmière. Dans le cadre d’une discipline professionnelle, les infirmières professeures et enseignantes doivent faire face aux réalités de l’acquisition des connaissances, du développement des compétences et de l’appropriation des valeurs afin que les diplômées accèdent avec compétence à leur champ de pratique. En tant que diplômées, les infirmières doivent également avoir la capacité d’évaluer les lacunes dans leurs connaissances et de les combler de manière autonome afin d’offrir une pratique fondée sur des résultats probants aux personnes dont elles s’occupent. Les professeures et enseignantes doivent faciliter l’apprentissage dans le cadre des pratiques exemplaires en matière de formation, souvent identifiées comme des approches centrées sur l’apprenante. Dans cet article de discussion, nous examinons l’évolution de la formation en sciences infirmières, nous examinons de manière critique les concepts plus larges de pédagogie, d’andragogie, d’héutagogie et d’académagogie, et discutons de la manière dont ceux-ci s’intègrent dans les approches de la formation en sciences infirmières centrées sur l’apprenante

Engaging Nursing Students in Meaningful Education Pertaining to Gerontological Nursing Studies: A Qualitative Descriptive Study

Background: Older people are the greatest users of healthcare and nurses represent the largest number of healthcare professionals within the healthcare system to provide care to them. This fact highlights the need to understand how nursing students are learning to work with older people. Although studies identify that practicing nurses have gaps in their knowledge regarding the care of older people, these studies do not address how nursing curricula and education pertaining to gerontology needs to be improved. Conducting research surrounding nursing students’ experiences working with older people in their undergraduate nursing program can be used to improve how student nurses are learning about caring for older people. Methods: A descriptive qualitative analysis used conventional content and thematic analysis of interview transcriptions, to identify factors that influence students’ perceptions of working with older people and students’ learning needs related to working with older people. Findings: Three themes emerged from the data analysis: perceptions about working with older people, preparation to work with older people, and advice for improving education. Findings from this study showed that nursing students’ perceptions of working with older people were influenced by their clinical learning environment, past experiences, and theory courses that generally concentrate on adults as opposed to older people. Conclusion: There is a need for faculties to commit to providing more resources for a rich educational experience related to older people. Addressing ageist perspectives, in addition to how students learn and the learning environment in which they learn, will better prepare graduates for the future of nursing and positively impact the quality of the care older people receive. Implications for Nursing Practice: Enhancing the gerontology content within the nursing curriculum and the clinical environment could help increase the perception, willingness, and competence of graduating nursing students to contribute to positive health outcomes for older people

Bladder and Bowel Symptoms, Dementia and Responsive Behaviors: An Integrative Review

Background: Dementia has become a worldwide healthcare and research focus. However, there is currently little research linking bladder and bowel symptoms with responsive behaviors in dementia. Aim: The aim of this integrative review was to identify research literature that explores the role of bladder and bowel symptoms as triggers of responsive behaviors  in persons with dementia. Design: This integrative review was informed by the method of Whittemore and Knafl and guidelines by Torraco. Methods: Electronic databases of Ovid Medline, Embase, PSYCInfo, Cochrane, EBSCO/CINAHL, Scopus, and Web of Science were searched. Five studies met inclusion criteria. They were assessed for quality using the Mixed Methods Appraisal Tool. Studies were compared, analyzed, and synthesized. Results: The categories developed were: (1) bladder and bowel symptoms examined, (2) relationship of behavior measurement to responsive behaviors, and (3) associations between incontinence and behaviors symptoms. Conclusion: The findings of this investigation demonstrate a limited understanding of the association between bladder and bowel symptoms with responsive behaviors. The conceptualization of behaviors as problems was evident in the studies. This conceptualization is not reflective of a contemporary view of behaviors as an expression of an unmet need. Future research is needed to understand the association between bladder and bowel symptoms and responsive behaviors

What Facilitates Green Team Success in Implementing Environmentally Sustainable Initiatives in Health Care

Objective: To identify the factors that contribute to the success of environmentally sustainable initiatives in health care. Background: Climate change contributes to severe health consequences for global populations. Despite mandates of nonmaleficence and health promotion, resource intensive health care systems contribute to increasing climate change. Health care professionals have been called to mitigate the environmental impact of the health care system. Nurses are particularly important in this work as they are an integral part of health care systems and are the primary providers of care in hospitals, which are the most resource intensive institutions within health care. Nurses are encouraged to engage in climate action by creating, leading, or participating in green teams to enact environmental sustainability initiatives. Methods: In this study, an integrative review of the literature was performed. The search strategy employed three electronic databases. After inclusion criteria were considered, 13 studies were included in the final sample. Content analysis was used to analyze these studies for patterns, themes, and relationships. Results: Policy, external collaboration, organisation, and staff engagement were four mainthemes of facilitative factors that contributed to the success of environmentally sustainable initiatives in health care. Conclusion: Knowledge about the facilitative factors identified and examined in this review could guide nurses to reduce health care’s environmental impact through successful environmentally sustainable initiatives

Older Adults’ Perspectives about Primary Care: Informing Nurse Practitioner Led Primary Care

This study describes community dwelling older adults’ experiences in accessing and using primary care services from a spectrum of primary care model. This study reports the findings from one focus group. Older adults shared their past and current experiences with primary care and their opinions to inform the design of a new nurse practitioner led primary care service. Inductive thematic analysis was used to develop themes and subthemes. The themes were: lack of voice and value in primary care; communicating information; and primary care vision of older adults for older adults. Older adults have specific health concerns that are currently not being addressed in primary health care systems. Understanding the experiences of older adults’ utilization of primary care services is an important starting point in changing health systems. The findings from this study could be used to inform the ongoing development for a prototype nurse practitioner primary health care service embedded within a social service organization in Western Canada

Percepções e experiências de idosos com a atividade Sit-to-stand: Um estudo etnográfico de pré-viabilidade

Objetivo: o objetivo deste estudo de pré-viabilidade foi examinar percepções e experiências da atividade de Sit-to-stand com idosos brasileiros residentes em suas casas, no meio urbano. Método: o método exploratório foi etnografia focada. Foi utilizada a amostragem intencional para recrutar 20 idosos. Foram utilizados cinco meios de geração de dados: inquéritos sociodemográficos, observações participantes, entrevistas informais, entrevistas formais semiestruturadas e notas de campo. Os dados foram analisados mediante análise de conteúdo qualitativo. Resultados: a experiência dos idosos com problemas de mobilidade na realização da atividade Sit-to-stand dependia de suas expectativas de mobilidade envolvendo muitos fatores coordenados que, de forma conjunta, influenciaram suas crenças e atitudes em relação à atividade, suas preferências, seus comportamentos e percepções culturais. Os participantes deste estudo pareciam considerar a atividade aprazível; no entanto, as deficiências mais perceptíveis para o engajamento dos participantes na atividade Sit-to-stand surgiram de falhas em suas necessidades pessoais e intrapessoais. Conclusão: as recomendações geradas a partir dos achados do estudo convocam a concepção de estratégias de implementação da intervenção Sit-to-stand adaptadas às necessidades dessa população em particular.Objetivo: el propósito de este estudio de viabilidad previa fue examinar percepciones y experiencias con respecto a la actividad Sit-to-stand entre los adultos mayores de Brasil que viven en sus hogares en comunidades urbanas. Método: el método de exploración se enfocó en la etnografía. Se utilizó muestreo intencional para reclutar 20 adultos mayores. Se emplearon cinco medios para generar datos, a saber: encuestas sociodemográficas, observaciones participantes, entrevistas informales, entrevistas formales semiestructuradas y notas de campo. Para el análisis de los datos se recurrió a análisis de contenido cualitativo. Resultados: la experiencia de los adultos mayores con problemas de movilidad en relación con la actividad Sit-to-stand dependió de sus expectativas en torno a la movilidad, las cuales implicaron muchos factores que actuaron en conjunto para influenciar sus creencias y actitudes con respecto a la actividad, al igual que preferencias, conductas y percepciones culturales. Aparentemente, a los participantes de este estudio la actividad les resultó amena; sin embargo, los inconvenientes más notorios para adoptar la actividad Sit-to-stand surgió en la forma de déficits en sus necesidades personales e intrapersonales. Conclusión: las recomendaciones resultantes de los hallazgos del estudio indican la necesidad de diseñar estrategias de implementación para la intervención Sit-to-stand a la medida de las necesidades de este grupo poblacional específico.Objective: the purpose of this pre-feasibility study was to examine perceptions and experiences of a Sit-to-stand activity with urban Brazilian community-dwelling older people in their homes. Method: the exploration method was focused ethnography. Purposive sampling was used to recruit 20 older people. Five means of data generation were used, namely: socio-demographic surveys, participant observations, informal interviews, formal semi-structured interviews, and field notes. Data analysis was qualitative content analysis. Results: the experience of mobility-challenged older people with the Sit-to-stand activity was dependent on their mobility expectations involving many factors that worked together to influence their beliefs and attitudes towards the activity, preferences, behaviors, and cultural perceptions. The participants of this study seemed to find the activity enjoyable; however, the most noticeable shortcomings for their engagement in the Sit-to-stand activity emerged as gaps in their personal and intrapersonal needs. Conclusion: the recommendations generated from the study findings call for the design of implementation strategies for the Sit-to-stand intervention that are tailored to this particular population’s needs