Effective clinical nursing leadership in hospitals: barriers from the perspectives of nurse managers.

AIM: The purpose of this study was to identify barriers to effective clinical nursing leadership in Jordanian hospitals from the perspectives of nurse managers (NMs). BACKGROUND: Clinical leadership is about expertise in specialised fields and involving professionals in clinical care. Even though leadership terminology has been used in nursing and healthcare business literature, clinical leadership is still misunderstood, including its barriers. METHOD: This study adopted a qualitative narrative approach and recruited a purposive sample of 19 NMs and two associate executive directors of nursing from two hospitals. Data were collected through two focus group discussions and in-depth interviews and were analysed using content analysis. The study was guided by the 'Consolidated Criteria for Reporting Qualitative Research'. RESULT: Four themes emerged regarding barriers to effective clinical nursing leadership: (1) power differential, (2) inconsistent connectedness with physicians, (3) lack of early socialisation experiences and (4) clinical practice reform is a mutual responsibility. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: Barriers are detrimental to effective clinical leadership; they are associated with interdisciplinary and professional socialisation factors. Managers and academicians at all levels should immediately consider these barriers as a priority. Innovative clinical leaders should identify barriers to effective clinical leadership at the early stages. Thus, innovative clinical leadership programmes are warranted.

COVID-19 era-related e-learning: a cross-sectional web-scale study of cyberchondria, internet addiction and anxiety-related symptomatology among university nursing students.

OBJECTIVE: The study assessed COVID-19 era-related e-learning cyberchondria, internet addiction and anxiety-related symptomatology among nursing students. The relationships, predictors and differences between the studied concepts were measured. DESIGN: In 2021, a quantitative cross-sectional research design using a web survey with a sample size of 333 nursing students yielded a response rate of 70%. RESULTS: Nursing students had a moderate level of cyberchondria, low to moderate internet addiction, a moderate to severe level of anxiety and depression, and a normal stress level. Demographic characteristics, cyberchondria, internet addiction and anxiety-related symptomatology were significantly correlated. Grade point average, age, type of organisation where the students were trained and level of education were significant predictors of the studied variables. Significant differences in the studied concepts were found based on the sample's characteristics such as gender, type of organisations or universities where the students were trained or studied, and age. CONCLUSION: Cyberchondria, internet addiction, depression, anxiety and stress symptomatology are troublesome. Higher education organisations might benefit from examining the variables of interest and investigating the relations between internet addiction and depression and anxiety symptomatology among nursing students. Such research will aid in tailoring treatments to assist vulnerable students by targeting counselling and educational efforts toward building a future generation of nurses with reduced cyberchondria, internet addiction and anxiety-related symptomatology.

Competency in nursing practice: a concept analysis.

OBJECTIVE: Competency denotes the ability to execute a certain task or action with the necessary knowledge. Competency definitions and measurements are challenging for nursing and other professions due to their multidimensional aspects. This study aimed to clarify the concept of competency in nursing practice and propose an accurate definition. DESIGN: Walker and Avant's approach was used to elucidate the concept of competency in nursing practice. DATA SOURCES: ScienceDirect, PubMed, ProQuest, Scopus and CINAHL were searched from 1 January 2000 to 31 December 2021. ELIGIBILITY CRITERIA: We included studies with the keywords: "concept analysis", "competence", "competency" and "nursing". The search was limited to full-text studies written in English that used theoretical and empirical approaches. DATA EXTRACTION AND SYNTHESIS: We extracted the concept's uses, defining attributes, and the consequences and antecedents of the concept. RESULTS: 60 articles were identified from the search process; after excluding duplicates and works unrelated to the study aim and context following the full-text screening, 10 articles were included in this concept analysis. The common defining attributes of competency were knowledge, self-assessment and dynamic state. Competency in nursing practice had many reported positive consequences that include but are not limited to improved patient, nurse and organisational outcomes. CONCLUSIONS: Nurses can benefit from the result of this analysis in practice to implement professional care, in particular clinical contexts and situations to enhance patients' health.

How does authentic leadership influence the safety climate in nursing?

BACKGROUND: Authentic leadership controls quality care and the safety of patients and healthcare professionals, especially nurses. AIM: This study examined the influence of nurses' authentic leadership on the safety climate. METHODS: In this predictive research, 314 Jordanian nurses from various hospitals were convenience sampled for cross-sectional and correlational design. This research included all hospital nurses with 1 year of experience, at least at the present hospital. SPSS (V.25) conducted descriptive statistics and multivariate analyses. As needed, sample variables' means, SD and frequencies were supplied. RESULTS: The mean scores on the entire Authentic Leadership Questionnaire and its subscales were moderate. The mean score of the SCS was below 4 (out of 5), indicating negative safety climate perceptions. A significant positive moderate association was found between nurses' authentic leadership and safety climate. Nurses' authentic leadership predicted a safe climate. Internalised moral and balanced processing subscales were significant predictors of safety climate. Being woman and having a diploma inversely predicted the nurses' authentic leadership; however, the model was insignificant. CONCLUSION: Interventions are needed to enhance the perception of the safety climate in hospitals. Nurses' authentic leadership increases their perceptions of a positive safety climate, and thus different strategies to build on nurses' authentic leadership characteristics are warranted. IMPLICATIONS FOR NURSING MANAGEMENT: The negative perceptions of the safety climate mandate that organisations create strategies to increase nurses' awareness about the safety climate. Shared leadership, learning environments and information sharing would improve nurses' perceptions of the safety climate. Future studies should examine other variables influencing safety climate with a more extensive and randomised sample. Safety climate and authentic leadership should be integrated into the nursing curricula and continuing education courses.

Attributes, skills and actions of clinical leadership in nursing as reported by hospital nurses: a cross-sectional study.

BACKGROUND: Research shows a significant growth in clinical leadership from a nursing perspective; however, clinical leadership is still misunderstood in all clinical environments. Until now, clinical leaders were rarely seen in hospitals' top management and leadership roles. PURPOSE: This study surveyed the attributes and skills of clinical nursing leadership and the actions that effective clinical nursing leaders can do. METHODS: In 2020, a cross-sectional design was used in the current study using an online survey, with a non-random purposive sample of 296 registered nurses from teaching, public and private hospitals and areas of work in Jordan, yielding a 66% response rate. Data were analysed using descriptive analysis of frequency and central tendency measures, and comparisons were performed using independent t-tests. RESULTS: The sample consists mostly of junior nurses. The 'most common' attributes associated with clinical nursing leadership were effective communication, clinical competence, approachability, role model and support. The 'least common' attribute associated with clinical nursing leadership was 'controlling'. The top-rated skills of clinical leaders were having a strong moral character, knowing right and wrong and acting appropriately. Leading change and service improvement were clinical leaders' top-rated actions. An independent t-test on key variables revealed substantial differences between male and female nurses regarding the actions and skills of effective clinical nursing leadership. CONCLUSIONS: The current study looked at clinical leadership in Jordan's healthcare system, focusing on the role of gender in clinical nursing leadership. The findings advocate for clinical leadership by nurses as an essential element of value-based practice, and they influence innovation and change. As clinical leaders in various hospitals and healthcare settings, more empirical work is needed to build on clinical nursing in general and the attributes, skills and actions of clinical nursing leadership of nursing leaders and nurses.

Nurses' authentic leadership and their perceptions of safety climate: differences across areas of work and hospitals.

PURPOSE: This study aims to compare nurses' authentic leadership and perceptions of the safety climate and concepts association according to different areas of work and types of hospitals. DESIGN/METHODOLOGY/APPROACH: A cross-sectional design was used to conduct this comparative study on 314 Jordanian nurses. The Authentic Leadership Questionnaire (ALQ) and the Safety Climate Survey (SCS) were used. FINDINGS: Nurses in private hospitals were more educated. True leadership was mild. Unit nurses had higher ALQ and subscale mean scores. Armed forces hospitals had the highest ALQ subscales, while governmental hospitals had the lowest. The ALQ mean scores favored military hospitals. Governmental hospitals have a negative safety climate. Unit nurses had a higher SCS mean than ward nurses. Military, governmental and private hospitals are rated the safest. Nurses benefited from higher SCS scores in military hospitals. Nurses' ALQ and safety climate perceptions were moderately positive. RESEARCH LIMITATIONS/IMPLICATIONS: A larger, randomized and equal-sized sample is recommended in future studies to conclude different areas of work and hospitals. It is also recommended to report the confidence interval in further studies using different statistical methods, increasing confidence when interpreting statistical significance variables. Other mediating, moderating and predicting variables could be studied and compared across different areas of work and types of hospitals. Sample characteristics should be handled as confounding variables in the next planned study using various ways to control confounding variables such as randomization, restriction, matching, regression and statistical control. The authors plan to statistically control for the confounding variables by entering them into the regression model. Future studies could investigate safety culture; both safety culture and safety climate are formative and inclusive terms (Experts Insight, 2017). PRACTICAL IMPLICATIONS: This paper fills in the gap in the literature and practice. Authentic leadership is associated with safety climate perceptions and varies across different areas of work and hospitals. Interventions are required to improve safety climate perceptions and promote authentic leadership in all settings and hospitals. Military hospitals ranked the highest in nurses' perceptions of authentic leadership and safety climate. SOCIAL IMPLICATIONS: The current study's favorable association between authentic leadership and safety climate measurement would apply to many high-risk institutions, including public and private hospitals. It becomes necessary to include the impacts of authentic leadership on the safe climate within the nursing curriculum and continuing education courses. This may be put into action by executing a hands-on activity, followed by information and reflection conversations that highlight the link between authentic leadership and safety climate measurement. According to the findings of this study, authentic leadership appears to be a basic block in making a difference in nurses' views of safety climate. ORIGINALITY/VALUE: Authentic leadership style is a relatively new concept in the health-care sector, and its link to safety climate security still needs empirical evidence. It is still unclear how leadership resulted in more effective outcomes (Maziero et al., 2020). Few studies investigated both the concepts of authentic leadership and the nursing safety climate (Dirik and Intepeler, 2017; Lee et al., 2019a; Woo and Han, 2018). Aside from the scarcity of studies, no study has compared "working area," "department" or "hospital type" concepts. Few comparative studies have been conducted using concepts of interest. For example, authentic leadership was linked to empowerment and burnout (Laschinger et al., 2013) and nurses' satisfaction with safety climates (Vatani et al., 2021). No research has examined authentic leadership in Jordan's nursing and health-care context. Few studies focused on the safety climate other than authentic leadership (Abualrub et al., 2012) or the safety culture in Jordan rather than the safety climate (Khater et al., 2015).

Effect of addition of distraction to cryotherapy on arteriovenous cannulation-associated pain: A randomized controlled trial.

INTRODUCTION: Pain associated with the arteriovenous fistula needle is considered one of the major challenges faced by nurses and patients. This study evaluates the effectiveness of using two different approaches in combination to alleviate pain associated with arteriovenous fistula needle cannulation, and patients' satisfaction level with this method. METHODS: A randomized clinical trial was conducted on hemodialysis patients who were allocated to one to two groups: intervention (distraction plus cryotherapy) (n = 25) or control group (receiving cryotherapy alone) (n = 25). The pain level was assessed before and at the end of applying cryotherapy and distraction techniques. Patients' satisfaction level was assessed at the end of the trial. FINDINGS: After the application of cryotherapy and distraction techniques for the intervention group, the mean value of pain level was 2.12 (0.9) compared with 3.92 (0.16) for the control group. Independent t tests showed a significant difference between groups regarding the pain level with p value less than 0.05. The mean satisfaction level for the participants receiving only cryotherapy was 4.6 out of 10, compared with 5.9 for the patients who received cryotherapy and distraction techniques. DISCUSSION: The findings revealed that using two different approaches in combination to control pain associated with AV fistula cannulation was more effective than using a single strategy. The technique can be used in clinical settings to reduce pain and improve patients' satisfaction level.

Integrating evidence-based interventions in clinical settings in Jordan: a policy brief.

Background: Evidence-based nursing practice (EBNP) is considered a major and very important global paradigm shift. Unfortunately, most healthcare providers and researchers embrace the concept of evidence-based practice (EBP) without integrating this concept in clinical settings. The current situation of EBP and new practice guidelines utilization in Jordan are scarce. This policy brief aimed to discusses the process of utilizing nursing EBP in clinical settings in Jordan. Methods: The authors adopted an action plan utilizing a systematic approach to develop and implement specific strategies and policies to integrate EBP in clinical settings in Jordanian hospitals. We present an experience of one country in terms of introducing a policy brief to establish an EBP policy accompanied by developing an EBP unit in the hospital's country. Results: A comprehensive description of this policy is provided with reference to the eminent steps of policy analysis and evaluation. In fact, EBP policies and clinical practice guidelines should keep a live document and revise regularly or as needed. Overall, the authors suggest the development of a unit for EBP to deal with issues related to clinical practice guidelines. Conclusions: Expected outcomes for the introduction of the EBP unit and its policy include increase research utilization and accelerated adoption of new evidence, increase the quality of care provided, increase patient, staff, and managers satisfaction, and decrease staff workload by reducing complications associated with medical errors and outdated interventions.

Psychometric assessment of the Spiritual Climate Scale Arabic version for nurses in Saudi Arabia.

AIM: To assess the psychometric properties of the Spiritual Climate Scale Arabic version for Saudi nurses. BACKGROUND: Evidence showed that a high level of spiritual climate in the workplace is associated with increased productivity and performance, enhanced emotional intelligence, organisational commitment and job satisfaction among nurses. METHOD: A convenient sample of 165 Saudi nurses was surveyed in this descriptive, cross-sectional study. Cronbach's α and intraclass correlation coefficient of the 2 week test-retest scores were computed to establish reliability. Exploratory factor analysis was performed to support the validity of the Spiritual Climate Scale Arabic version. RESULTS: The Spiritual Climate Scale Arabic version manifested excellent content validity. Exploratory factor analysis supported a single factor with an explained variance of 73.2%. The Cronbach's α values of the scale ranged from .79 to .88, while the intraclass correlation coefficient value was .90. The perceived spiritual climate was associated with the respondents' hospital, gender, age and years of experience. CONCLUSIONS: Findings of this study support the sound psychometric properties of the Spiritual Climate Scale Arabic version. IMPLICATIONS FOR NURSING MANAGEMENT: The Spiritual Climate Scale Arabic version can be used by nurse managers to assess the nurses' perception of the spiritual climate in any clinical area. This process can lead to spiritually centred interventions, thereby ensuring a clinical climate that accepts and respects different spiritual beliefs and practices.

Cryotherapy intervention in relieving arteriovenous fistula cannulation-related pain among hemodialysis patients at the King Khalid Hospital, Tabuk, Kingdom of Saudi Arabia.

Pain during arteriovenous fistula (AVF) cannulation remains a common problem in hemodialysis (HD) patients that leads to noncompliance to lifetime maintenance HD. This study was performed to determine the effect of cryotherapy on reducing pain during AVF cannulation among HD patients in the King Khalid Hospital, Tabuk, Kingdom of Saudi Arabia. This is an experimental study which included 62 patients undergoing HD through an AVF. Randomization was used to assign the patients into the experimental (received cryotherapy) and control (no cryotherapy) groups. The Arabic version of Wong-Baker pain rating scale was used to determine the pain score. There was a significant difference in the pre-and post-intervention pain scores among the experimental group, while there was no such difference in the control group. The null hypothesis was rejected based on a P <0.05. Our study suggests that cryotherapy intervention to relieve AVF cannulation-related pain among adult patients undergoing HD is effective. Therefore, it is recommended that cryotherapy should be considered as a complementary intervention to reduce pain related to AVF cannulation.

Solitude, Religious and Cultural Uniqueness in a Foreign Environment: Adjustments as an Arab Student.

Arab-Muslims have extremely religious-centered and restrictive cultural practices. Living in a foreign country where Islam is a minority religion and culture is categorically different entails a great deal of adjustment. This study explored how Arab-Muslim International Students live and cope in a non-Arab, non-Muslim country. The authors used phenomenological approach with Colaizzi's method of analysis to (1) explore the lived experience of the Arab students' academic and social life and (2) come up with recommendations that can be supported by universities in Philippines and other countries with Arab students. Emergent themes include Hybrid vision and empowerment from education beyond borders "Tatallo at wa kudurat," Stigma in the Arab world "Hallah," Islam as way of life "Al Islam: Manhaj Hayyat," and Future of the Arab-Muslim students "Wahaa." The major concepts that emerged from the lived experience of these students focused on the practical reasons for quality education, challenges along the way, culture shock, the stigma, and misconceptions about Arabs and Muslims. They experienced discrimination, the impact of stereotyping and misconceptions about the Arab-Muslims. Their tenacity of the Islam faith has become a coping mechanism and kept them enormously strong. They also strived to show the real meaning of being Muslim, and finally, looking forward to how they can become the oasis in the desert. The Arab-Muslim International Students experience difficult adjustments in a foreign country to acquire high quality education, while holding on to their Islam faith and keeping their culture intact.