Clinical interventions, implementation interventions, and the potential greyness in between -a discussion paper

Background: There is increasing awareness that regardless of the proven value of clinical interventions, the use of effective strategies to implement such interventions into clinical practice is necessary to ensure that patients receive the benefits. However, there is often confusion between what is the clinical intervention and what is the implementation intervention. This may be caused by a lack of conceptual clarity between \u27intervention\u27 and \u27implementation\u27, yet at other times by ambiguity in application. We suggest that both the scientific and the clinical communities would benefit from greater clarity; therefore, in this paper, we address the concepts of intervention and implementation, primarily as in clinical interventions and implementation interventions, and explore the grey area in between. Discussion: To begin, we consider the similarities, differences and potential greyness between clinical interventions and implementation interventions through an overview of concepts. This is illustrated with reference to two examples of clinical interventions and implementation intervention studies, including the potential ambiguity in between. We then discuss strategies to explore the hybridity of clinical-implementation intervention studies, including the role of theories, frameworks, models, and reporting guidelines that can be applied to help clarify the clinical and implementation intervention, respectively. Conclusion: Semantics provide opportunities for improved precision in depicting what is \u27intervention\u27 and what is \u27implementation\u27 in health care research. Further, attention to study design, the use of theory, and adoption of reporting guidelines can assist in distinguishing between the clinical intervention and the implementation intervention. However, certain aspects may remain unclear in analyses of hybrid studies of clinical and implementation interventions. Recognizing this potential greyness can inform further discourse

Antecedents and Consequences of Intragroup Conflict Among Nurses in Acute Care Settings

One of the contributing factors to the current nursing shortage is job dissatisfaction due to conflict in the workplace. In order to develop strategies to reduce conflict, research is needed to understand the causes and outcomes of conflict in nursing work environments. This study tested a theoretical model linking antecedent variables (core self-evaluation, complexity of nursing care, unit size, interactional justice, managerial support, unit morale) to intragroup conflict, followed by conflict management, and ultimately, job stress and job satisfaction. A predictive, non-experimental design was used in a random sample of 277 acute care nurses in Ontario. Structural equation modeling techniques were used to analyze the hypothesized model. Final analysis revealed relatively good fit of data to the hypothesized model (Chi-square = 211.7, df = 80, CFI = .92, RMSEA=0.07). Lower core self-evaluation, higher complexity of nursing care, lower interactional justice, and poor unit morale resulted in higher intragroup relationship conflict, and ultimately a less ‘agreeable’ conflict management style, higher stress and job dissatisfaction. Conflict management style partially mediated the relationship between conflict and job satisfaction. Job stress also had a direct effect on job satisfaction and core self-evaluation had a direct effect on job stress. The study results suggest that conflict and its associated outcomes is a complex process, affected by dispositional, contextual and interpersonal factors. Nurses’ core self-evaluations, complexity of nursing care and relationships with managers and nursing colleagues influences the level of conflict they experience. How nurses manage conflict may not prevent the negative effects of conflict on job stress and job satisfaction, however learning to manage conflict using collaboration and accommodation may help nurses feel more satisfied with their jobs. In addition, education programs that contribute to an individual’s ability to feel more confident about their ability to manage conflict may help them cope more effectively with the stress generated by conflict.Ph

The Impact of Leader-Member Exchange Quality, Empowerment, and Core Self-evaluation on Nurse Manager\u27s Job Satisfaction

OBJECTIVE: The purpose of this study is to test a theoretical model linking nurse managers\u27 perceptions of the quality of the relationship with their supervisors, and empowerment to job satisfaction, and to examine the effect of a personal dispositional variable, core self-evaluation, on the relationships among these variables. BACKGROUND DATA: Nursing leadership roles have been transformed as a result of dramatic changes within healthcare in the past decade, yet research on the nature of nurse manager work life in current work environments is limited. METHODS: A nonexperimental, predictive design was used in a sample of 141 hospital-based nurse managers obtained from a provincial registry. RESULTS: Approximately 40.4% of the variance in job satisfaction was explained by leader-member exchange quality (LMX), empowerment, and core self-evaluation. CONCLUSION: Higher quality relationships with their immediate supervisor were associated with greater manager structural and psychological empowerment and, consequently, greater job satisfaction. Core self-evaluation played a strong significant role, affecting all components of the model. The results suggest that both situational and personal factors are important determinants of satisfying work environments for nurse managers

Burnout and compassion fatigue among organ and tissue donation coordinators: a scoping review

Objectives To collate and synthesise available literature on burnout and compassion fatigue (CF) among organ and tissue donation coordinators (OTDCs) and to respond to the research question: what is known about burnout and CF among OTDCs worldwide?Design Scoping review using Joanna Briggs Institute methodology for scoping reviews.Data sources Medline, EMBASE, PsycINFO, CINAHL, LILACS, PTSpubs and grey literature (ResearchGate, OpenGrey, Organ Donation Organization (ODO) websites, open access theses and dissertations) up to April 2020.Study selection Studies reporting aspects of burnout and CF among OTDCs, including risk and protective factors.Data extraction Two reviewers independently screened the studies for eligibility and extracted data from chosen sources using a data extraction tool developed for this study; NVIVO was used to perform a qualitative directed content analysis.Results The searches yielded 741 potentially relevant records, of which 29 met the inclusion criteria. The majority of articles were from the USA (n=7, 24%), Canada (n=6, 21%) and Brazil (n=6, 21%), published between 2013 and 2020 (n=13, 45%) in transplant journals (n=11, 38%) and used a qualitative design approach (n=12, 41%). In the thematic analysis, we classified the articles into five categories: (1) burnout characteristics, (2) CF characteristics, (3) coping strategies, (4) protective factors and (5) ambivalence.Conclusion We identified aspects of burnout and CF among OTDCs, including defining characteristics, demographic predispositions, protective factors, coping strategies, precursors, consequences and personal ambivalences. Researchers described burnout and CF characteristics but did not use consistent terms when referring to CF and burnout, which may have hindered the identification of all relevant sources. This gap should be addressed by the application of consistent terminology, systematic approaches and appropriate research methods that combine quantitative and qualitative investigation to examine the underlying reasons for the development of burnout and CF among OTDCs

Interventions to reduce moral distress and moral injury and promote moral resilience in healthcare workers, first responders and military personnel: A scoping review protocol

The objective of this scoping review is to develop a comprehensive repository of interventions to address moral distress (MD), moral injury (MI), and moral resilience (MR) among healthcare workers (HCW), first responders (FR), and military personnel (MP) so that these interventions can be mapped thematically and compared, including across these different groups. The overarching review question is as follows: What interventions to address, mitigate or improve MD, MI or MR have been developed and tested within HCW, FR and MP populations? Sub-questions include: What are the characteristics of these interventions? How are these characteristics similar or different for each of these populations? How are these characteristics similar or different for each of the primary outcomes? What are the common themes across populations and primary outcomes

Correctional nursing: a study protocol to develop an educational intervention to optimize nursing practice in a unique context

Abstract Background Nurses are the primary healthcare providers in correctional facilities. A solid knowledge and expertise that includes the use of research evidence in clinical decision making is needed to optimize nursing practice and promote positive health outcomes within these settings. The institutional emphasis on custodial care within a heavily secured, regulated, and punitive environment presents unique contextual challenges for nursing practice. Subsequently, correctional nurses are not always able to obtain training or ongoing education that is required for broad scopes of practice. The purpose of the proposed study is to develop an educational intervention for correctional nurses to support the provision of evidence-informed care. Methods A two-phase mixed methods research design will be used. The setting will be three provincial correctional facilities. Phase one will focus on identifying nurses’ scope of practice and practice needs, describing work environment characteristics that support evidence-informed practice and developing the intervention. Semi-structured interviews will be completed with nurses and nurse managers. To facilitate priorities for the intervention, a Delphi process will be used to rank the learning needs identified by participants. Based on findings, an online intervention will be developed. Phase two will involve evaluating the acceptability and feasibility of the intervention to inform a future experimental design. Discussion The context of provincial correctional facilities presents unique challenges for nurses’ provision of care. This study will generate information to address practice and learning needs specific to correctional nurses. Interventions tailored to barriers and supports within specific contexts are important to enable nurses to provide evidence-informed care

Clinical interventions, implementation interventions, and the potential greyness in between -a discussion paper

Background: There is increasing awareness that regardless of the proven value of clinical interventions, the use of effective strategies to implement such interventions into clinical practice is necessary to ensure that patients receive the benefits. However, there is often confusion between what is the clinical intervention and what is the implementation intervention. This may be caused by a lack of conceptual clarity between intervention and implementation, yet at other times by ambiguity in application. We suggest that both the scientific and the clinical communities would benefit from greater clarity; therefore, in this paper, we address the concepts of intervention and implementation, primarily as in clinical interventions and implementation interventions, and explore the grey area in between. Discussion: To begin, we consider the similarities, differences and potential greyness between clinical interventions and implementation interventions through an overview of concepts. This is illustrated with reference to two examples of clinical interventions and implementation intervention studies, including the potential ambiguity in between. We then discuss strategies to explore the hybridity of clinical-implementation intervention studies, including the role of theories, frameworks, models, and reporting guidelines that can be applied to help clarify the clinical and implementation intervention, respectively. Conclusion: Semantics provide opportunities for improved precision in depicting what is intervention and what is implementation in health care research. Further, attention to study design, the use of theory, and adoption of reporting guidelines can assist in distinguishing between the clinical intervention and the implementation intervention. However, certain aspects may remain unclear in analyses of hybrid studies of clinical and implementation interventions. Recognizing this potential greyness can inform further discourse

Pre-entry perceptions of students entering five health professions : implications for interprofessional education and collaboration

Dysfunctional interprofessional teams are a threat to health system performance and the delivery of quality patient outcomes. Implementing strategies that prepare future health professionals to be effective collaborators requires a comprehensive understanding of how early professional socialization and professional identity formation occur. We present findings from a qualitative study, grounded in narrative methodology, examining early professional socialization among students across five health professional programs (dentistry, medicine, nursing, pharmacy, physiotherapy) in the first year of health professional training. Between April and September 2015, students (n = 49) entering programs at an Atlantic Canadian University participated in one-on-one, audiotaped interviews starting before formal program orientation. Pre-entry interviews focused on factors influencing students’ career choice and expectations of future profession and interprofessional collaboration (IPC). Findings revealed that many different experiences influenced participants’ career choice and framed the social positioning of their future career (e.g., leadership, prestige, autonomy). Participant narratives revealed the existence of stereotypes pertaining to their chosen and other health professions. Study findings provided insights that may help strengthen initiatives to promote positive professional identity formation within the context of IPC. Implications of this research highlight the need for the early introduction of IPC including pre-entry recruitment messaging for prospective health professionals

A study of leading indicators for occupational health and safety management systems in healthcare

Abstract Background In Ontario, Canada, approximately $2.5 billion is spent yearly on occupational injuries in the healthcare sector. The healthcare sector has been ranked second highest for lost-time injury rates among 16 Ontario sectors since 2009 with female healthcare workers ranked the highest among all occupations for lost-time claims. There is a great deal of focus in Ontario’s occupational health and safety system on compliance and fines, however despite this increased focus, the injury statistics are not significantly improving. One of the keys to changing this trend is the development of a culture of healthy and safe workplaces including the effective utilization of leading indicators within Occupational Health and Safety Management Systems (OHSMSs). In contrast to lagging indicators, which focus on outcomes retrospectively, a leading indicator is associated with proactive activities and consists of selected OHSMSs program elements. Using leading indicators to measure health and safety has been common practice in high-risk industries; however, this shift has not occurred in healthcare. The aim of this project is to conduct a longitudinal study implementing six elements of the Ontario Safety Association for Community and Healthcare (OSACH) system identified as leading indicators and evaluating the effectiveness of this intervention on improving selected health and safety workplace indicators. Methods A quasi-experimental longitudinal research design will be used within two Ontario acute care hospitals. The first phase of the study will focus on assessing current OHSMSs using the leading indicators, determining potential facilitators and barriers to changing current OHSMSs, and identifying the leading indicators that could be added or changed to the existing OHSMS in place. Phase I will conclude with the development of an intervention designed to support optimizing current OHSMSs in participating hospitals based on identified gaps. Phase II will pilot test and evaluate the tailored intervention. Discussion By implementing specific elements to test leading indicators, this project will examine a novel approach to strengthening the occupational health and safety system. Results will guide healthcare organizations in setting priorities for their OHSMSs and thereby improve health and safety outcomes