Organizational Climate for Inclusion Among Nurses: A Mixed-Methods Analysis.

OBJECTIVE: The aim of this study was to answer the research question: What factors predict sense of belonging among nurses?The connection between inclusion (an element of diversity and equity) and a nurse's sense of belonging is poorly understood. METHODS: In this mixed-methods research, regression analysis of Climate for Inclusion Scale subscales and Sense of Belonging score plus thematic content analysis of questions assessing sense of belonging were conducted. Nurses (n = 131) attending a research conference in June to July 2022 were invited to participate; 131 (72%) participated. RESULTS: Climate for Inclusion Scale was positively associated with and predictive of sense of belonging (F3,113 = 71.7, P < 0.001). Themes reflecting actions to enhance sense of belonging were as follows: authentic leadership, embracing social justice, team unification, feeling heard, being seen, professional development, developing a healthier work environment, and integration of differences. CONCLUSIONS: Leaders can promote a sense of belonging among nurses by focusing on actions reflected in the themes.

Exploring correlation of nurse manager meaning and joy in work with employee engagement.

AIM: To determine the correlation between meaning and joy in work among managers with employee engagement. BACKGROUND: The Institute of Healthcare Improvement and the National Patient Safety Foundation both recognize the link between joy and meaning in work and an optimally performing healthcare system. The relationship between manager joy and employee engagement is unknown. Furthermore, the Meaning and Joy in Work Questionnaire (MJWQ) has not been previously used with nurse managers. METHOD: A descriptive correlational design was used with results from a prospective survey of nurse managers correlated with pre-existing employee engagement quality data. Chronbach's alpha was used to measure internal consistency of the tool in this population. RESULTS: No significant correlation was found between nurse manager meaning and joy in work and employee engagement (r = 0.216; NS (n = 28)) or employee perception of their manager (s = 0.227, NS (n = 28)). A significant strong correlation between employee engagement scores and employee perception of their managers (r = 0.774. p < .001 (n = 28)) was identified. Internal consistency was moderately high: value/connections (alpha = 0.736), meaningful work (alpha = 0.933), caring (alpha = 0.817) and total instrument score (alpha = 0.923). Effect size = 0.28. IMPLICATIONS FOR NURSING MANAGEMENT: While we did not find significant correlation between manager meaning and joy in work with employee engagement, the MJWQ may be a valuable tool to explore nurse manager's meaning and joy in work and the potential relationship of this construct to employee engagement and associated outcomes. The expansion of the sample size across multiple healthcare systems may lead to different results.

Enhancing Patients' Wayfinding and Visitation Experience Improves Quality of Care.

PURPOSE: To understand the impact of wayfinding challenges on patient hospital visitation experience, organizational costs, and emerging technology trends that may alleviate wayfinding challenges. DESIGN: A review of literature on the relationship of wayfinding to patient's hospital visitation experience. METHODS: A literature search identifying issues associated with wayfinding challenges in complex health care facilities was conducted. Case examples are provided to illustrate that the removal of barriers can improve the wayfinding experience. This review also informs technology trends that may effectively facilitate wayfinding in complex health care facilities. FINDINGS: Large hospital complexes exhibit many characteristics comparable to the physical features of a city environment. These complexities present challenges to patients to navigate to their destinations. An effective wayfinding system is a collection of tools that combines permanent signage, printed information, landmarks, architectural features and design elements, and human interactions. Navigational technology modeling holds the promise to aid patients and individuals with visual and cognitive challenges to find their way to their desired destinations effectively and efficiently, and improves their quality of life. CONCLUSIONS: Improved patient travel time correlates to reduce idled nursing time, with cost savings accrued to organization. Research shows that wayfinding mobile applications hold the promise of improving patients' hospital visitation experience.

Improving Surgical Start Times by Improving Wayfinding.

PURPOSE: This performance improvement project was undertaken to reduce costly delays in first-case, operating room (OR) start times. DESIGN: Two Plan, Do, Study, Act (PDSA) cycles. METHODS: In PDSA 1, student nurses observed 30 patients' paths of travel from hospital entrance to OR and documented time spent at key stopping points. Directional signs were placed after PDSA 1. PDSA 2 consisted of an electronic medical record (EMR) review of pre- and postsignage cases (n = 492 and n = 538 respectively). FINDINGS: In the initial PDSA cycle (n = 30), one reason for delay was the time patients spent finding the preoperative area (POA). Signage was placed at strategic points noted to confuse patients. PDSA cycle 2 found median presignage POA arrival times (34 minutes) were significantly higher than postsignage POA arrival times (20 minutes) (U = 51,618.0, z = -16.934, P < .001). CONCLUSIONS: Delayed wayfinding contributed to delayed OR starts but improved with appropriate signage.

Compassion Fatigue and Burnout, One Institution's Interventions.

Compassion is a complex abstract concept and is generally perceived as an emotional reaction to another person's vulnerability and suffering that motivates an individual wanting the best for the one who is suffering. It is seen as a virtuous and an inherent quality of nursing care. Nurses are exposed to various work stressors caused by myriads of complex professional and organizational challenges. In response, some nurses have developed coping mechanisms exemplified by detachment and distance in the caring relationship, whereas others have fallen victim to compassion fatigue or burnout, stressors that may increase the risk for suicide. There is a direct cost to health care organizations when the staff begin to show signs of burnout and fatigue. It is incumbent on health care leaders to establish assistance programs to improve the quality of work life of caregivers, prevent and remove work stressors to reduce turnover, and retain talent.

Reimagine Health Care Leadership, Challenges and Opportunities in the 21st Century.

PURPOSE: This paper spotlights human capital management, digital technology, and costs control as issues that healthcare leaders will face in redesigning the health care ecosystem in the 21st century. DESIGN: The paper was designed to highlight the attributes that make effective leaders. It addresses how nursing leadership can take a lead to redesign the 21st Century health care system, supported by case examples. METHODS: An expansive literature review was done using MEDLINE, SAGE, Google Scholar, and University of California San Diego Library Catalogs. The selections criteria include recent publications in English within and outside the healthcare industry. FINDINGS: Health leadership is viewed as paramount to productivity, capacity and meeting new challenges. CONCLUSIONS: Effective nursing leadership in a healthcare organization correlates with staff job satisfaction, retention, turnover and quality of care. Nursing leadership development must be supported by appropriate level of educational preparedness, and requisite set of competencies and skills.

Globalization of Health Service: Sharing of Best Practices in Perianesthesia Nursing Care, a Case Study of Cross-Border Institutional Collaboration.

Healthcare is a global concern among all nations and nursing is a global profession as evidenced by the flow of healthcare professionals across international boundaries. With English as the language of science and commerce and post-colonial influence in domestic healthcare practice and training, many former Anglo-speaking colonial settlements become parts of an expansive market for health human resources migration. The movement of health personnel mainly flows from low and medium income countries to high income countries to sustain their health systems. The resulting brain drain adversely impacts a source country's health system, leading the World Health Organization to declare global health migration as the biggest health threat of the 21st century. This report illustrates how an overseas health network achieves its goals of developing clinical and management excellence through an international exchange program. The provider institution also fulfills its mission of contributing to a more balanced, equitable and healthier world.

A Study of Role Expectations and Satisfaction With the Healthcare Coach Role.

OBJECTIVE: The research objective was to determine the expectations of and satisfaction with the healthcare coach (HCC) role among hospitalists and staff RNs, as well as expectations of case managers who collaborate with them. BACKGROUND: Care transitions occur when patients move from 1 care setting or provider to another. The Centers for Medicare & Medicaid Services developed the Community-Based Care Transitions Program to address readmission, patient safety, improved quality of care, and cost savings. METHODS: A cross-sectional study measured level of satisfaction and explored qualitatively the expectations regarding the HCC role among hospitalists and staffs RNs. Case managers were surveyed regarding expectations of the HCC role. The HCCs were surveyed regarding their new role experiences. RESULTS: On a Likert scale of 1 to 5, satisfaction with the HCC role by staff nurses averaged 3 (neutral), whereas hospitalists' mean satisfaction was 4 (satisfied). From the qualitative data, 6 themes emerged among participants: personal qualities, care navigation, system perspective, collaboration/teamwork, challenges/role confusion, and future role benefits. Two additional themes were identified by the HCCs: new knowledge and helpful skill sets. CONCLUSIONS: We recommend further evaluation of the HCC role in other organizations and across care settings.

Correlational Study of Sleep Apnea Patient Characteristics With Discharge Locations.

PURPOSE: To determine if a correlation exists between OSA patient characteristics and the PACU discharge location; and the characteristics of the patients at-risk for low saturation levels, increased number of desaturations, and longer length of stay in the PACU. DESIGN: Retrospective, correlational study design. METHOD: Chart review of OSA patients ≥ 18 years old. Correlational analysis was performed between 15 high risk patient variables and the PACU discharge disposition: home or monitored bed. Complications resulting in monitored bed admission were reviewed. FINDINGS: 153 patients' charts were reviewed. The results showed that age>60, ASA classification, anesthesia type and narcotics use in the PACU were significantly correlated (p≤.05) with a patient's discharge disposition. DISCUSSION: The findings are consistent with other OSA research except BMI was not significant in this study. CONCLUSION: The results highlighted areas for future research and implications for clinical practice that would enable the perioperative care team to deliver safe care based on evidence.

An Educational Plan for Nursing Staff in the Procedural Treatment Unit of the Sulpizio Cardiovascular Center.

Professional education for health practitioners is a continuum which commences with the first year professional school until the cessation of a professional career. This article draws on the theories and models developed by experts in curriculum design, teaching, and learning evaluation to better understand the intricacies and challenges of instructional design. Selected models, in particular Malcolm Knowles and the World Health Organization report served as a compass and benchmark to illuminate, guide, and evaluate the impact, process, contents, and outcomes of an educational program for the stakeholders. The aim of this educational program is to ensure that learners develop the knowledge, skills, and attitudes to deliver competent and quality patient-centered care. Multimodal teaching strategies are essential to meet the diverse needs of staff. Utilization of technology such as intranet and mobile applications helps to deliver educational content in a cost-effective manner. Program evaluation determines the effectiveness of teaching and helps to define ongoing needs of staff.

International service-learning: an opportunity to engage in cultural competence.

One-day international service-learning projects are an opportunity for nursing students to engage in learning cultural awareness, knowledge, and skills. At XXX University, faculty developed these international service-learning projects in Mexico where students participated in health promotion teaching for children and families and providing health care for older adults. The purpose of this article is to describe 3 types of student experiences gained during 1-day international service-learning projects. We named these experiences cultural communication, cultural confidence, and cultural surprise.

Nursing faculty roles in international service-learning projects.

The purpose of this article is to describe faculty roles related to the design and implementation of an international nursing service-learning project. The impetus for this project was the 2008 American Association of Colleges of Nursing (AACN) recommendations for using service-learning and immersion of students in diverse communities to improve nursing education in the area of cultural competency (American Association of Colleges of Nursing, 2008a). We define service-learning as a learning experience engaging students in meeting community needs in an international setting so as to offer a different perspective into community health practices and to promote cultural competency. Based on our experience with service-learning, we identified four faculty roles in developing these types of projects. We define these roles as initiator, collaborator, facilitator, and advocate. This article will discuss the application of these faculty roles in developing service-learning opportunities with students.

Can we talk? Developing a social support nursing intervention for couples.

Social support is an important influence on success during lifestyle modification attempts. According to the theory of expressed emotion, support that is perceived by the recipient as critical or overprotective is unhelpful and perhaps harmful. This article describes an intervention for couples and preliminary assessment of its feasibility and acceptability by the nurses who trialed it. Four staff nurses and 2 advanced practice nurses administered the intervention to 15 couples and reported on the benefits and limitations of the intervention. One individual in each couple had a chronic or an acute cardiac illness. The nurses perceived the intervention as valuable; even a single session stimulated discussion between the couple about important issues. Complexity, logistic barriers, and time constraints limited the technique. The authors conclude that this intervention may be most useful to clinical nurse specialists who have additional education, training in communication, and teaching and consulting skills.

Teaching staff a brief cognitive-behavioral intervention.

Lifestyle behaviors contribute significantly to the onset and course of numerous diseases and affect well-being in general. Patient education is the principal strategy nurses use to modify individuals' knowledge, attitudes, and beliefs about their health behaviors. However, current approaches are failing to induce the behavior changes necessary to reduce the incidence and prevalence of lifestyle-related disorders. In this pilot project, a brief cognitive-behavioral program was developed. The project yielded important insights into ways to improve current and develop new and more effective patient education strategies.