Travail en équipe et autonomie collective : une expérience dans les soins infirmiers à domicile.

INTRODUCTION: Teamwork is often identified as being a core value in care work. Studies on this topic often focus on pluri-professional configurations, whereas mono-professional teamwork has not aroused the same interest. In this study, we examine teamwork among a group of nurses providing homecare within a new organization, Soignons Humain (SoHu). SoHu was inspired by Buurtzorg, a Dutch homecare company composed of self-organized nursing teams. Given that the healthcare context for French and Dutch nurses is different, SoHu chose to focus primary on teamwork as a mechanism for improving the quality of care. PURPOSE OF RESEARCH: The article examines how this objective was implemented through the practices and representations of work: to what extent do these self-organized teams lead to deeper collaborations with other homecare actors? How does this type of organizational model differ from other forms of homecare nursing in France? How does SoHu's experience allow us to rethink nurses' autonomy in their work? RESULTS: SoHu's organizational model differs from both private nursing clinics and traditional nursing care centers. The SoHu nurses' salaried status makes it possible for them to focus on delivering holistic care and highlights their autonomous nursing role, which they claim as being central to their profession. SoHu's originality lies in its highly developed instrumentation of teamwork and its work organization that is attentive to the construction of a collective competence. The use of coaches appears to be one of the organization's key investments in sustainably supporting teamwork and, paradoxically, their collective autonomy. Following an initial learning phase, and through other types of support work (workshops and facilitation meetings), the association has attempted to create and support a propitious environment for teamwork. CONCLUSIONS: Our work calls attention to the necessary conditions for real collaborative practices to take place, wether these are inter or intra-organizational. SoHu's case shows what an organization can do to create an environment favorable to team collaboration. This consists in building reflexivity into care work with a focus on the patient and the family; investments in developing teamwork skills ; ensuring a frequency and specific type of exchange between the nursing teams; using both ad hoc arrangements and formalization of these collaborations; and finally by recognizing and objectivizing these invisible coordination practices.

Improving patient safety in two French hospitals: why teamwork training is not enough.

PURPOSE: The persistent challenges that healthcare organizations face as they strive to keep patients safe attests to a need for continued attention. To contribute to better understanding the issues currently defying patient safety initiatives, this paper reports on a study examining the aftermath of implementing a national team training program in two hospital units in France. DESIGN/METHODOLOGY/APPROACH: Data were drawn from a longitudinal qualitative study analyzing the implementation of a French patient safety program aimed at improving teamwork in hospitals. Data collection took place over a four-year period (2015-2019) in two urban hospitals in France and included multiple interviews with 31 participants and 150 h of observations. FINDINGS: Despite explicit efforts to improve inter-professional teamwork, three main obstacles interfered with healthcare professionals' attempts at safeguarding patients: perspectival variations in what constituted "patient safety", a paradoxical injunction to do more with less and conflicting organizational priorities. ORIGINALITY/VALUE: This paper exposes patient safety as misleadingly consensual and identifies a lack of alignment between stakeholders in the complex system that is a hospital. This ultimately interferes with patient safety objectives and highlights that even well-equipped, frontline actors cannot achieve long-term results without more systemic organizational changes.

A meta-ethnographic review of interprofessional teamwork in hospitals: what it is and why it doesn't happen more often.

Objectives Although interprofessional teamwork has been shown to improve patient safety, it is not yet routine practice in most hospital settings. There is also a lack of clarity regarding what teamwork actually means, with terms such as collaboration, coordination, networking and knotworking often being used interchangeably. In this study, we analyse 20 years of qualitative research on interprofessional teamwork in hospital settings and examine what it looks like and the factors influencing it. Methods The literature search included articles published between 1996 and 2016, and articles were included if they examined interprofessional teamwork within a hospital using qualitative methodology. We used meta-ethnographic analysis of eligible primary studies applying reciprocal translation and line of argument synthesis. Results Nineteen articles were included. Interprofessional teamwork was largely absent in acute care and found to be influenced by systems perpetuating power imbalances, organizational practices that interfered with interprofessional interactions, representations of teamwork and leadership. Conclusions Future strategies to improve interprofessional practices should include policies and structural changes to develop healthcare systems that facilitate these practices.

Mandatory internal mobility in French hospitals: the results of imposed management practices.

AIM: To describe the impact of a mandatory internal mobility policy on nurses working in French state-funded health establishments. BACKGROUND: Public hospitals in France rely on the internal mobility of nursing staff to respond to organisational needs, to reduce costs and to increase productivity. However, there is very little data on the impact of such management practices on the nurses themselves. METHOD: A cross-sectional study, including 3077 nurses from 35 hospitals in the region of Paris, was conducted. Data were collected using a validated self-assessment questionnaire. RESULTS: Forty per cent of French nurses are required to work in different units. This mobility differs according to individual characteristics [age (P = 0.04), length of service (P = 0.017)] and type of environment [hospital (P < 0.0001), specialty (P < 0.0001)]. CONCLUSION: We can distinguish two types of approaches for implementing a mandatory staff nurse mobility policy. The first is an event that is regular, planned and lasts for several days. The second is an event that is irregular, short and organised the day before or the day of the change. Overall, while nurses are dissatisfied with all types of mandatory unit changes, this dissatisfaction is primarily a result of the irregular mobility events. IMPLICATIONS FOR NURSING MANAGEMENT: This study demonstrates the importance of implementing a planned inter-unit mobility event and proposes recommendations for this type of implementation.

Do Magnet®-accredited hospitals show improvements in nurse and patient outcomes compared to non-Magnet hospitals: a systematic review.

BACKGROUND: The Magnet model proposes an accreditation for hospitals having demonstrated a healthy work environment and, as a result, positive staff and patient outcomes. Yet there are conflicting findings surrounding the actual impact of Magnet's organizational model on these outcomes, as well as a wide range of designs influencing the quality of these results. OBJECTIVES: To conduct a systematic review that explores the effect of Magnet accreditation on objective nurse and patient outcomes. TYPES OF PARTICIPANTS: Magnet and non-Magnet accredited hospitals matched according to their similarity (e.g. size, type [urban or rural], level of acuity, location, etc.). Hospitals could be either university based or non-teaching hospitals and in any geographical location. As the focus of the study was outcomes specific to Magnet accreditation, studies reporting on "reputational Magnets" (the original hospitals), Magnet-aspiring and non-Magnet hospitals alone were excluded from the review. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST: Exposure to Magnet accreditation. A Magnet hospital is defined as a hospital with American Nursing Credentialing Center -designated Magnet status at the time of study and having received this accreditation in the last four years, as this is the length of time for which the accreditation is valid, after which the hospital must reapply for another four-year accreditation. TYPES OF STUDIES: This review considered any quantitative study comparing nurse and patient outcomes in Magnet accredited hospitals with those in non-Magnet hospitals. Controlled clinical trials, controlled before and after and interrupted time series were considered first. When these were not available, case-controlled, descriptive comparative and descriptive correlational designs were considered. All studies presenting a "case study" with no comparison and other studies reporting on interviews and other qualitative data were excluded. TYPES OF OUTCOMES: The outcomes of interest were nurse outcomes related to turnover and absenteeism, as measured by the actual turnover rate if available, or the Anticipated Turnover Scale, the Revised Nursing Work Index or the Maslach Burnout Inventory, as well as nursing-sensitive patient outcomes (such as fall rates and hospital-acquired pressure ulcers) as measured by retrospective patient records, discharge abstracts, incident reports and reimbursement forms. SEARCH STRATEGY: Both published and unpublished literature between 1994 and 2014 were searched. The electronic databases searched were the following: CINAHL, MEDLINE, EMBASE, Academic Search Complete and Web of Science. Other resources included ProQuest Dissertations & Theses Database /Dissertation Abstracts Online and OpenGrey, the American Hospital Association and the American Nurses Credentialing Center websites, and the Sigma Theta Tau International library of abstracts. In April 2015, a search update was conducted including the years 2014-2015 in the databases listed above. METHODOLOGICAL QUALITY: No cut-off point for the Joanna Briggs Institute appraisal tool criteria was selected for inclusion of studies. DATA EXTRACTION: Data from included studies were extracted using the Joanna Briggs Institute Data Extraction Form for experimental/observational studies. Two reviewers extracted the data independently and results were compared for accuracy and categorized according to nurse and patient outcomes. DATA SYNTHESIS: All the studies analyzed retrospective data obtained from either combined databases or from questionnaires. The methodological heterogeneity and poor quality of the designs did not make it possible to pool quantitative results in a statistical meta-analysis. Results are presented in descriptive narrative form. RESULTS: From the 141 screened studies, ten met the inclusion criteria. Nine of these studies were retrospective analyses of data extracted from existing databases, one study collected original data. Of the seven studies examining patient outcomes, three found clear statistically significant improvements related to lower pressure ulcers, patient falls, failure to rescue and 30-day inpatient mortality in Magnet hospitals compared to non-Magnet hospitals. In the studies examining nurse outcomes, three found statistically significant improvements related to higher job satisfaction and lower intent to leave and turnover rates in Magnet compared to non-Magnet hospitals. CONCLUSIONS: Based on the mixed results and poor quality in the research designs in the ten included studies, it was not possible to conclude that Magnet accreditation has effects on nurse and patient outcomes. There is a need for more robust designs that can confidently measure the impact of hospital accreditation on objective outcomes.

Conceptions of learning research: variations amongst French and Swedish nurses. A phenomenographic study.

BACKGROUND: The development of nursing research capacity and interactions with cultural and structural issues is at various stages throughout Europe. This process appears to be remarkably similar irrespective of the country. Sweden has developed this capacity since the 1990s, whereas France is experiencing a transition. Nevertheless, knowledge about how nurses conceive their learning about nursing research and transitioning toward being researchers is scarce. OBJECTIVES: The aim of this study was to explore French and Swedish RNs' conceptions of research education and educational passage toward research and to describe how learning research contributes to the understanding of their norms and practices. DESIGN: A phenomenographic approach was used to understand and describe the qualitatively different ways in which French and Swedish RNs conceive research and its apprenticeship. SETTINGS AND PARTICIPANTS: A purposive maximum variation sampling of five French and five Swedish Nurse Researchers with PhDs. METHODS: Individual in-depth interviews conducted in France and Sweden between November 2012 and March 2013 were analysed using phenomenography. FINDINGS: The analysis revealed one main category, "Organisational factors to sustain individual apprenticeship". Three descriptive categories have emerged from the data and its variations amongst French and Swedish nurses: (1) entrance into research--modes of commitment; (2) nurses' engagement--the need for dedicated support; and (3) research as the means to resolve nursing situations. CONCLUSIONS: This study demonstrates how registered nurses have integrated nursing and researcher roles following different efficient paths. Education in nursing research is part of the strategy needed for the development of nursing research and is supported by the integration of research and practice.

Using Bourdieu's theory of practice to understand ICT use amongst nurse educators.

BACKGROUND: Implementing changes in practice in either clinical or educational settings remains challenging. In the context of Information and Communication Technologies (ICT) adoption, the literature focuses either on organisational factors influencing its implementation, or on individual factors influencing its adoption into practice. Separately both fail to examine the issue holistically. Bourdieu's theory of practice provides a method for reconciling the two. OBJECTIVE: To provide a practical example of how Bourdieu's theory of practice can be employed to better understand nurse educators' responses to ICT. DESIGN: Exploratory descriptive design, using a Bourdieusian case-study to guide a documentary analysis. METHODS: In 2009 a two-part study was conducted within a Department of Nursing (DON) in higher education (HE) in England. First Bourdieu's theory of practice was used to develop a case-study; then nurse educators were recruited for a Q-methodology (Q) study. This paper focuses exclusively on the case study and the use of the theory of practice to interpret the findings from the Q-study. RESULTS: Nursing's transition into academia, promotions criteria in HE and the value placed on research over teaching have influenced educators' responses to technology. CONCLUSION: The use of Bourdieu's framework provides a rich and contextual backdrop for understanding how organisational factors interact to influence individuals' responses to technology adoption.

E-learning adoption in pre-registration training.

Despite the advances in technology and the many ways in which it can be used in education, many academics are reluctant to include technology in their teaching. Past studies have been unsuccessful in finding out the reasons for this. This article analyses a study that looked into the reasons why nurse educators in particular are reluctant to adopt technology in their teaching practice.

[Q-methodology, an innovative technique for nursing research]. / La méthode Q, une approche innovante pour la recherche infirmière.

Q-Methodology offers an alternative to traditional methodological approaches. It is similar to qualitative methods while at the same time guaranteeing a statistical data analysis. It can be particularly interesting for the development of nursing sciences.

Developing the Serious Games potential in nursing education.

Shortened hospital stays, high patient acuity and technological advances demand that nurses increasingly make decisions under conditions of uncertainty and risk (Ebright et al., 2003). With rising trends towards out-patient care, nurses will need to perform complex problem-solving within a dynamic and changing environment for which there is not one clear solution (Schofield et al., 2010; Wolff et al., 2009). The development of sharp clinical reasoning skills, as well as skills in detection, monitoring, investigation and evaluation are therefore essential (Aitken et al., 2002). Yet few nursing students have long-term exposure to home-care and community situations. This is primarily due to scarce human resources and the time-consuming requirements of student supervision (Duque et al., 2008). When students are given the opportunity to experience home-care or community visits these tend to be unstructured leading to wide variations in their competencies. New pedagogical tools are needed to adequately and consistently prepare nurses for the skills they will need to care for patients outside acute care settings. Advances in Information and Communications Technologies (ICT) offer an opportunity to explore innovative pedagogical solutions that could help students develop these skills in a safe environment. A three-phased project is underway that aims to create and test a Serious Game to improve nurses' clinical reasoning and detection skills in home-care and community settings. The first phase of this project involves the development of a scenario, the game engine and the graphic design and will be the focus of this paper. The second and third phases will test the Serious Game as an educational intervention and will be reported in subsequent papers.

Exploring the underlying factors influencing e-learning adoption in nurse education.

AIMS: To report a study undertaken to explore the underlying factors influencing e-learning adoption in nurse education. BACKGROUND: Despite e-learning's high profile it has not been readily integrated into teaching practice in nurse education. Previous research has identified generic, cross-disciplinary factors but has left out 'soft' factors. DESIGN: The study adopted an exploratory descriptive design. METHODS: Q-methodology was used to explore e-learning adoption in a Division of Nursing located in an institution of Higher Education in the UK. Between September-December 2009, 38 participants were recruited to participate in Q-sorts and post-sort interviews. The Q-sort data were factor analysed and the interviews were coded to their respective factors to develop in-depth narratives. FINDINGS: Four factors were identified: 'E-learning advocates' saw e-learning's potential to improve nurse education and prepare future nurses for their evolving role; the 'Humanists' had avoided e-learning because they valued human interaction; the 'Sceptics' doubted that technology could improve learning outcomes; and the 'Pragmatics,' only used e-learning as a tool to post lecture notes online to supplement what they covered in class. CONCLUSION: The findings point to the variety of responses existing among nurse academics faced with integrating e-learning into their teaching. Moving beyond the binary labels commonly attributed to those considered either 'early adopters' or 'laggards,' the findings contribute to the literature by revealing a wider breadth of views and responses towards technology. Acknowledging these views can inform future e-learning strategies and lead to improvement in e-learning use in nurse education.

[The bibliography and referencing software]. / La bibliographie et les systèmes de référencement.

The bibliographic references of scientific papers can be managed by dedicated software. This provides a rigorous referencing system, which can be enriched, imported and shared if necessary.

Developing Q-methodology to explore staff views toward the use of technology in nurse education.

Technology in education is moving quickly in terms of the hardware and software applications available, but also due to the expectations of an increasingly digitally competent student population. Academics have to rethink their pedagogy in relation to these changes. Nurse educators, in particular, must face the challenge of effectively integrating technology into what is essentially a hands-on, people-centred profession. To date, the factors most commonly cited as barriers to the adoption of e-learning by academics have focused on explicit and tangible ('hard') issues. Less frequently mentioned are the implicit and tacit ('soft') factors which are harder to identify. This article describes a pilot study using Q-methodology to explore the limitations of commonly used research methods in identifying how these hard and soft issues are prioritised by individuals, through the voices of nurse educators.

Nursing education: in pursuit of cosmopolitanism.

Changing demographics, globalization, and an increasingly complex health care system demands progressive approaches to reaching our goals of competent transcultural care. Despite original contributions made by pioneers in cultural appreciation, nursing curricula are still falling short in addressing these issues in both education and practice. Many nurses enter their fields with little knowledge of the societal injustices and educational inequities that haunt the populations they care for. A cosmopolitan approach to nursing education is proposed to assist students in recognizing the complexity and uniqueness of individual experiences, rather than merely attempting to place them into categories based on gender, culture, race, or age. Being a global citizen and a cosmopolitan nurse requires participation in, and valuing of, the common good of society as a whole. Practicing the profession outside of comfort zones can lead to an appreciation for how all our choices are part of a complex global network. Nursing education should be responsible for developing in students the deepest knowledge base as well as the highest degree of critical independence. Cosmopolitan nurses could be the model for 21st century practitioners and future nurse leaders.