Using cognitive interviews to improve a measure of organizational readiness for implementation.

BACKGROUND: Organizational readiness is a key factor for successful implementation of evidence-based interventions (EBIs), but a valid and reliable measure to assess readiness across contexts and settings is needed. The R = MC2 heuristic posits that organizational readiness stems from an organization's motivation, capacity to implement a specific innovation, and its general capacity. This paper describes a process used to examine the face and content validity of items in a readiness survey developed to assess organizational readiness (based on R = MC2) among federally qualified health centers (FQHC) implementing colorectal cancer screening (CRCS) EBIs. METHODS: We conducted 20 cognitive interviews with FQHC staff (clinical and non-clinical) in South Carolina and Texas. Participants were provided a subset of items from the readiness survey to review. A semi-structured interview guide was developed to elicit feedback from participants using "think aloud" and probing techniques. Participants were recruited using a purposive sampling approach and interviews were conducted virtually using Zoom and WebEx. Participants were asked 1) about the relevancy of items, 2) how they interpreted the meaning of items or specific terms, 3) to identify items that were difficult to understand, and 4) how items could be improved. Interviews were transcribed verbatim and coded in ATLAS.ti. Findings were used to revise the readiness survey. RESULTS: Key recommendations included reducing the survey length and removing redundant or difficult to understand items. Additionally, participants recommended using consistent terms throughout (e.g., other units/teams vs. departments) the survey and changing pronouns (e.g., people, we) to be more specific (e.g., leadership, staff). Moreover, participants recommended specifying ambiguous terms (e.g., define what "better" means). CONCLUSION: Use of cognitive interviews allowed for an engaged process to refine an existing measure of readiness. The improved and finalized readiness survey can be used to support and improve implementation of CRCS EBIs in the clinic setting and thus reduce the cancer burden and cancer-related health disparities.

Patient Experience Coordinator: An Innovative Role to Improve Patients' Hospital Experience.

OBJECTIVE: The aim of this study was to test the impact of an innovative nonclinical support role to improve patient experiences while supporting nurse work on inpatient units. BACKGROUND: On the basis of the Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) survey, patients' experience declined nationally during the COVID-19 pandemic. A nonclinical support role, titled an Experience Coordinator, was created as a test of change to collaborate with care teams and respond to patients' and families' nonclinical needs. METHODS: This is a quality improvement (QI) project for a supportive role development and implementation. The health system's HCAHPS data were compared before and after the role was tested on 3 inpatient units. RESULTS: The HCAHPS data indicated that 5 of the 10 domains' top box ratings increased during the QI project month compared with the previous month. CONCLUSION: The study findings may support the implementation of new innovative nonclinical positions to alleviate nurses' workload and promote patients' hospital experience.

An Innovative Academic/Practice Partnership to Support Nursing Workforce Needs and Student Clinical Education.

ABSTRACT: Innovation is needed to solve nursing workforce issues during times of crisis. A collaborative effort between a hospital system and several universities resulted in the Bridge to Professional Practice Program that was implemented during a period of high patient volume and nursing student downtime. The program provided support for staffing needs and clinical hours to promote readiness for practice for students. The program evaluation outcomes and recommendations for improvement are addressed.

From Chaos to Control: One-Page Tip Sheet, a Nursing Professional Development Specialist's Essential Tool for Just-in-Time Education.

The speed of change in health care dictates that information and education must be rapidly disseminated. One-page tip sheets summarize and highlight the most important information at the point of care and provide links to further resources. The nursing professional development specialist plays a key role in facilitating and enabling rapid organizational change. [J Contin Educ Nurs. 2023;54(1):11-15.].

The uneven consequences of rapid organizational change: COVID-19 and healthcare workers.

We examine the consequences of rapid organizational change on high and low-status healthcare workers (HCWs) during the COVID-19 pandemic. Drawing on 25 interviews, we found that rapid change can create a sense of social disorder by exacerbating the uncertainty brought on by the pandemic, crystallizing the lack of training to deal with crisis, and upending taken-for-granted roles and responsibilities in health infrastructures. Our work contributes to scholarship at the intersection of organizations, professions, and social studies of medicine. First, we show how organizations that must respond with rapidity, such as during a crisis, sets up workers for failure. Second, hastily made decisions can have monumental consequences in the work lives of HCWs, but with differences based on status. All HCWs had trouble with the rearrangement of tasks and roles. Low status HCWs were more likely to feel the strain of the lack of resources and direct contact with COVID-19 patients. High status HCWs were more likely to experience their autonomy undermined - in the organization and content of their work. In these contexts of rapid change, all HCWs experienced social disorder and a sense of inevitable failure, which obscured how organizations have perpetuated inequalities between high and low status workers.

Impact of the COVID-19 Pandemic on Child and Adolescent Psychiatric Emergencies.

OBJECTIVE: By forcing closure of schools, curtailing outpatient services, and imposing strict social distancing, the COVID-19 pandemic has abruptly affected the daily life of millions worldwide, with still unclear consequences for mental health. This study aimed to evaluate if and how child and adolescent psychiatric visits to hospital emergency departments (EDs) changed during the pandemic lockdown, which started in Italy on February 24, 2020. METHODS: We examined all ED visits by patients under 18 years of age in the 7 weeks prior to February 24, 2020, and in the subsequent 8 weeks of COVID-19 lockdown at two urban university hospitals, in Turin and Rome, Italy. ED visits during the corresponding periods of 2019 served as a comparison using Poisson regression modeling. The clinician's decision to hospitalize or discharge home the patient after the ED visit was examined as an index of clinical severity. RESULTS: During the COVID-19 lockdown, there was a 72.0% decrease in the number of all pediatric ED visits (3,395) compared with the corresponding period in 2019 (12,128), with a 46.2% decrease in psychiatric visits (50 vs 93). The mean age of psychiatric patients was higher in the COVID-19 period (15.7 vs 14.1 years). No significant changes were found in hospitalization rate or in the prevalence distribution of the primary reason for the psychiatric ED visit (suicidality, anxiety/mood disorders, agitation). CONCLUSIONS: In the first 8 weeks of the COVID-19-induced social lockdown, the number of child and adolescent psychiatric ED visits significantly decreased, with an increase in patient age. This decrease does not appear to be explained by severity-driven self-selection and might be due to a reduction in psychiatric emergencies or to the implementation of alternative ways of managing acute psychopathology.

Causal Model Analysis of Police Officers' COVID-19 Fear, Resistance to Organizational Change Effect on Emotional Exhaustion and Insomnia.

Since the end of 2019, COVID-19 has continued to spread around the world. The police have performed various epidemic prevention and routine duties. This study explores how police officers' COVID-19 fear, resistance to organizational change, intolerance of uncertainty, and secondary trauma affect emotional exhaustion and insomnia in the context of COVID-19. A total of 205 valid police samples were collected in this study, and the established hypotheses were tested using confirmatory factor analysis and structural equation modeling. The results of the study confirmed that during the COVID-19 outbreak, secondary trauma of police officers positively affects emotional exhaustion and insomnia; intolerance of uncertainty positively affects emotional exhaustion; resistance to organizational change positively affects intolerance of uncertainty and emotional exhaustion; intolerance of uncertainty mediates the relationship between resistance to organizational change and emotional exhaustion; COVID-19 fear positively influences secondary trauma.

Between a rock and a hard place: Nurse managers' experiences of large-scale organizational change in the public health service.

BACKGROUND: Nurse managers are often at the forefront of implementing organizational changes. Studies suggest that conflicting pressures and stress are high during such times, though little is known of how nurse managers experience the continuing run of change initiatives. AIMS: To explore nurse managers' experience of large-scale organizational changes and its impact on their working lives and conditions. DESIGN: A qualitative phenomenological hermeneutical study utilizing a Ricœur-inspired method of interpretation. METHODS: Semi-structured interviews were conducted with 12 nurse managers at a public sector university hospital that had recently undergone large-scale organizational changes. Interviews were conducted in 2021 during the covid-19 pandemic. The analysis is based on the three-stage Ricœur-inspired analysis method by Pedersen and Dreyer. RESULTS: Three themes emerged outlining the nurse managers experiences of large-scale organizational change: The need for support structures to be incorporated in the change process, The need for a guiding star, and The challenge of the values embedded in the Nurse Manager mindset. These themes were consistent across both predominantly positive as well as mainly negative experiences. CONCLUSION: This study reveals the potential that receiving support from management, staff and peers has to positively influence the experiences of nurse managers during large-scale organizational changes. However, lacking a clear vision for the process negatively influences their ability to support high-level quality care within their wards, potentially increasing their feelings of stress and conflicting pressure. IMPACT: Participants offered important insight into the sparsely explored subject of nurse managers' experiences of organizational change, the complexity they face and the potentially high personal costs. The study highlights the detrimental effects of not providing support to all managers in organizations undergoing change, and the parallels to the covid-19 pandemic. No Patient or Public Contribution was required for this study due to its aim.

College Organizational Innovation Performance-Oriented Internal Mechanism Analysis Using Lightweight Deep Learning under Health Psychology.

The purpose is to improve employees' initiative and innovation performance and further improve the overall organizational efficiency of colleges. From the perspective of health psychology, this work analyzes the internal mechanism between leadership empowerment behavior and employee innovation performance at China Agricultural University. By introducing two intermediate variables: task-based psychological capital (PsyCap) and innovative PsyCap, this work puts forward a lightweight deep learning (DL) model. It constructs the college organizational innovation performance (OIP)-oriented internal evaluation system from four dimensions. They are personal development support, power appointment, participation in decision-making, and work guidance. Then, the proposed lightweight DL model reveals the internal relationship between employees' innovation performance and innovation factors using the questionnaire survey method. Overall, 360 questionnaires are distributed. The results show that the average values of the four dimensions (S, P, D, and G) of leadership empowerment are greater than 3, which are 4.3144, 4.3493, 4.4253, and 4.5286, respectively. S, P, D, and G represent empowerment, decision-making, communication, and innovation, respectively. The results show a high level of innovation performance in all dimensions. The finding proves that the influencing factors of employee innovation performance mainly include personal development support, empowerment, participation in decision-making, and work guidance. The effects of different dimensions vary significantly. Finally, the lightweight DL model can improve the analysis accuracy of the college OIP-oriented internal evaluation system. Therefore, college leaders should use the DL model and empowerment behavior to improve employees' psychological quality, innovation enthusiasm, and work efficiency, ultimately benefiting employees.