The nurse wellbeing self-assessment supports the model of leadership influence for health professional wellbeing.

BACKGROUND: Despite emerging evidence of effective strategies for reducing burnout among health professionals, health professional burnout continues increasing. PURPOSE: A systematic Model of Leadership Influence for Health Professional Wellbeing is presented suggesting steps to measurably improve wellbeing by managing or mitigating stressors that generate burnout. METHOD: This paper examines (a) the psychometric properties of the Nurse Wellbeing Self-Assessment's (NWSAT)© four 10-item scales and (b) whether and how the Model of Leadership Influence can apply NWSAT results to reduce burnout. Using nurse survey data (N = 1,394) from one large eastern US healthcare system, the four NWSAT scales are psychometrically evaluated. FINDINGS: Predictive tests demonstrate the fit of the Model of Leadership Influence by documenting associations between NWSAT and burnout. All four NWSAT scales are strongly and inversely associated with burnout. DISCUSSION: Leaders can use NWSAT to systematically implement and evaluate a variety of strategies to improve staff wellbeing in one or more domains of NWSAT to manage or mitigate specific stressors that may otherwise contribute toward burnout.

Application of the model of leadership influence for health professional wellbeing during COVID-19.

BACKGROUND: Nurse burnout is a top patient safety concern. Workplace stress and burnout results in high turnover rates, costs, and lessened productivity and quality care. Although the relationship of burnout to patient outcomes and communication has been proposed, there is little available in terms of a theoretical framework to guide leaders in developing a comprehensive and effective approach to promoting wellbeing and reducing burnout. PURPOSE: This paper demonstrates a theoretical application of the Model of Leadership Influence for Health Professional Wellbeing to support staff wellbeing by developing targeted approaches that address the four dimensions of whole person wellbeing. METHOD: Published literature from the COVID-19 pandemic is used for context to demonstrate the use of the model. FINDINGS: The model can be used to facilitate exploration and navigation of the complex issues surrounding burnout and wellbeing. DISCUSSION: Leaders may find the model can be a useful tool to promote staff wellbeing.

Factors Associated With Law Enforcement Reporting in Patients Presenting for Medical Forensic Examinations.

Law enforcement reporting following sexual assault is lower than for other violent crimes. Sexual assault nurse examiners (SANEs) provide care for patients in the acute period following sexual assault and are well-positioned to identify and address barriers to reporting. We examined data from medical forensic examination records documented by SANEs for a 5-year period (2011-2015). We examined 347 records of women 18 and older to identify factors associated with law enforcement reporting at the time of the exam using binomial logistic regression to construct odds ratios (OR). A total of 56.5% of patients in the sample reported to law enforcement. Patients who did not voluntarily consume alcohol were more likely to report than those who did (OR = 4.45; p = .001). Patients who were not students were more likely to report than students (OR = 3.24; p = .002). Patients who had a medical forensic exam within 32 hr of the assault were more likely to report than those having exams after 32 hr (OR = 2.68; p = .007). Patients who had anogenital and/or bodily injuries were more likely to report than those who had no injuries (OR = 2.50; p = .008). Patients who were penetrated (vaginally, orally, and/or anally) were more likely to report than those who were not penetrated (OR = 2.50; p = .056). Knowing the assailant, having multiple assailants, and patient and assailant race/ethnicity were not associated with different likelihood of reporting to law enforcement. SANEs and others who work with victims of sexual assault can use data to understand and address barriers to reporting.

Development and Test of a Text-Messaging Follow-Up Program After Sexual Assault.

Patients receiving medical forensic examinations following sexual assault often do not receive important follow-up care. To address this gap, we developed and tested a bidirectional text-messaging protocol, Text-SAFE (sexual assault forensic exams). Text-SAFE included automated text messages over 37 days, covering mental health, sexually transmitted infections, medications, and pregnancy. Patients could also send and receive messages. We evaluated feasibility for broader application by examining enrollment rates, patient responses and evaluations, protocol completion and reliability, and nurse compliance with the protocol. A total of 25 patients participated: 24/25 sent at least one text; 21/25 received all messages. Participants found Text-SAFE comfortable and helpful. We identified areas for improvement.

C-Suite Strategies for Nurse Empowerment and Executive Accountability.

OBJECTIVE: We examined C-suite executives' strategies to empower the nursing workforce and to ensure their own accountability for nursing empowerment. BACKGROUND: Leadership affects workforce empowerment. The literature provides little formal guidance on optimal strategies C-suite executives can adopt for improving nurse empowerment or ensuring leadership accountability for empowering the workforce. METHODS: A system's top 47 executives were invited to be panelists in a Delphi study. Two Delphi rounds revealed leadership strategies for embedding empowerment and strategies for assessing leadership performance in workforce empowerment. RESULTS: C-suite executives rated specific strategies higher for nursing workforce empowerment and for holding themselves accountable. Specific strategies were rated high as easier to implement and more likely to have a major impact. CONCLUSIONS: C-suite executives implementing strategies with greater impact may accelerate nursing empowerment, especially when executives also adopt their own strategies for holding themselves accountable.

C-Suite Roles and Competencies to Support a Culture of Shared Governance and Empowerment.

OBJECTIVE: The aim of this study was to examine C-suite executives' perspectives on empowerment early in shared governance implementation. BACKGROUND: Leadership influences a workplace culture for empowerment. However, the literature lacks clarity regarding the specific roles of C-suite executives in fostering empowerment. METHODS: A system's top 47 executives were invited to participate in a Delphi study. Two Delphi rounds identified leadership empowerment philosophies, plus techniques for (a) understanding staff needs, (b) embedding empowerment, and (c) ensuing leadership accountability. In round 3, leaders rated the 3 types of techniques for ease and impact. RESULTS: Results revealed a passive C-suite culture regarding empowerment. However, C-suite executives recognized the need for active promotion of an empowering culture. Optimal techniques for understanding staff empowerment needs were identified. CONCLUSIONS: Modeling empowerment by the C-suite executives enables alignment between councils and levels of nursing leadership, allowing organizations to achieve the goals for professional nursing practice and shared governance.

A theory-based approach to nursing shared governance.

BACKGROUND: The discipline of nursing uses a general definition of shared governance. The discipline's lack of a specified theory with precepts and propositions contributes to persistent barriers in progress toward building evidence-based knowledge through systematic study. PURPOSE: The purposes of this article were to describe the development and elements of a program theory approach for nursing shared governance implementation and to recommend further testing. METHOD: Five studies using multiple methods are described using a structured framework. The studies led to the use of Lipsey's method of theory development for program implementation to develop a theory for shared governance for nursing. DISCUSSION: Nine competencies were verified to define nursing practice council effectiveness. Other findings reveal that nurse empowerment results from alignment between the competencies of self- directed work teams and the competencies of organizational leaders. Implementation of GEMS theory based nursing shared governance can advance goals at the individual, unit, department, and organization level. CONCLUSION: Advancing professional nursing practice requires that nursing concepts are systematically studied and then formalized for implementation. This article describes the development of a theoretical foundation for the systematic study and implementation of nursing shared governance.

Impact of a Shared Medical Appointment Lifestyle Intervention on Weight and Lipid Parameters in Individuals with Type 2 Diabetes: A Clinical Pilot.

BACKGROUND: There is a growing awareness that lifestyle behavior modifications may reduce weight and the atherogenic dyslipidemia associated with obesity and type 2 diabetes mellitus (T2DM). OBJECTIVE: We pilot the effectiveness of a diabetes educational program combining shared medical appointments (SMAs) with an 8-week DVD-based diabetes education program emphasizing a plant-based diet in lowering weight and lipids in individuals with T2DM. This pilot also employed a nonrandomized convenience sample to explore which of the educational program's target behaviors were associated with the greatest risk factor reduction. DESIGN: Forty-six adult patients with T2DM voluntarily self-selected to enroll in the educational quality improvement initiative run as part of a community clinical practice. Target behaviors measured weekly were (1) days with beans for breakfast, (2) days of exercise, (3) minutes of exercise per day, (4) days with light evening meals, (5) days with no evening meals, (6) days with no red meat, (7) days with plant-based diet, and (8) number of 8-ounce cups of water per day. Biometric measurements were taken at the beginning and end of the 2-month program. These included high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol, and triglycerides. Weight was measured weekly. Regression analysis was performed to identify which target behaviors were associated with changes in lipids and weight. RESULTS: There was a statistically significant (F = 2.429; df = 8.21; p < 0.05) decrease in weight (mean -8.9 lbs, or 4.05 kg, or 4.1% body weight, p < 0.01) during the 8-week study period. There was a positive trend in all lipid parameters, but none reached statistical significance with this sample. Exploratory weighted least-squares regression found that weight loss in the study group was most associated with higher water consumption (t = 3.16; p < 0.01), days per week with no evening meal (t = 3.03; p < 0.01), and days per week consuming beans for breakfast (t = 2.06; p = 0.05. CONCLUSIONS: In this pilot study, the DVD-based educational program delivered as part of an SMA was associated with significant weight loss but insignificant lipid changes. Behavior changes most closely associated with weight loss were increasing water consumption, eliminating evening meals, and increasing the consumption of beans for breakfast. These potentially important findings in this small sample suggest the need for a randomized clinical trial with a larger and planned sample.

An examination of the sustainable adoption of whole-person care (WPC).

AIM: This study illustrates how King's theory of goal attainment was used to focus an examination of whole-person care (WPC) and to extend the range of knowledge needed for WPC and nursing practice. BACKGROUND: Leadership implemented a faith-based innovation using continuing education for patient care that incorporates body-mind-spirit and eight principles called CREATION. Three questions arose: (1) Is there an evidence-based framework to determine whether the philosophy supports the discipline of nursing? (2) How extensive is the adoption and application of WPC? (3) Does the model make a difference in the context of nurse-patient interactions and outcomes in support of Magnet recognition criteria? METHODS: Interpretative phenomenology was used and an interview protocol was developed to examine the adoption and movement toward a culture of WPC. RESULTS: WPC was 'lived.' it is a relationship-oriented patient care model. However, except in direct patient care, the principles of creation were poorly diffused. IMPLICATIONS FOR NURSING MANAGEMENT: These results contribute to nursing leadership's roles in fostering a workplace climate that enables the diffusion of innovative models of care. In addition, these results support the Institute of Medicine's call for nurses to take the lead in adopting innovations and provides leaders with actionable strategies.

Shared governance as vertical alignment of nursing group power and nurse practice council effectiveness.

AIM(S): This study validates an instrument for measuring the effectiveness of nursing practice councils and offers a framework for measuring and understanding shared governance. BACKGROUND: Empowerment results from the vertical alignment of nursing group power with nursing unit power practices. The field lacks an instrument for measuring nurses' practice of power. METHOD(S): Two studies (n1 = 119; n2 = 248) are used to validate the Nursing Practice Council effectiveness scale (NPCes). RESULTS: NPCes is a valid and reliable index of nursing practice council effectiveness. This study suggests specific diagnostic tools to understand two levels for actualized power, one at the group or departmental level and one at the unit level. CONCLUSION(S): NPCes and the Sieloff-King Assessment of Group Power within Organizations (SKAGPO) can be used together to improve examination of shared governance. Examining group power as well as unit-level practices may give a more complete view of barriers to nurse empowerment. IMPLICATIONS FOR NURSING MANAGEMENT: Changing nursing power and practices in an organization may be made more effective by engaging and monitoring vertical alignment of strategies fostering power competencies among nurse leaders and simultaneously supporting nursing practice councils as a means of exercising nurse authority at the unit level.