Do We Make a Difference? The Effect of a Doctor of Physical Therapy Program Curriculum on Student Cultural Competence.

INTRODUCTION: Doctor of Physical Therapy (DPT) education programs have been charged with developing a culturally competent health care workforce to better meet the needs of diverse communities and reduce health inequities. The purpose of this longitudinal, quasi-experimental educational intervention study was to examine the effects of an integrated DPT program curriculum on student cultural competence at a public, midsize, midwestern university. REVIEW OF LITERATURE: There is an abundance of research on conceptual models and frameworks for the development of cultural competence within health care education with many studies relying on self-perception to measure outcomes. Using the Model of Interculturalization as a theoretical framework, this study explored the development of cultural competence among DPT students using the Intercultural Development Inventory (IDI). SUBJECTS: A purposeful convenience sample of DPT students ( n = 177) was used. METHODS: The IDI was administered to 3 student cohorts. One cohort had data at 4 different time points, including upon entry into the program (baseline) and at the end of the first, second, and third year. Two cohorts had data for 2 time points. IDI Developmental Orientation (DO) and Orientation Gap (OG) scores were used to measure cultural competence and accuracy of self-perception of cultural competence. Data analysis was performed using descriptive statistics, independent and dependent sample t -tests, and analysis of variances. RESULTS: There were no differences between the cohorts. There were statistically significant improvements in both cultural competence (DO scores) and accuracy of self-perception of cultural competence (OG scores) for 2 cohorts. However, significant change only occurred during year 1. No other differences across time for any of the cohorts were significant. DISCUSSION AND CONCLUSION: Findings can be leveraged and incorporated into recommendations for curricular revision and program reform targeting cultural competence development among DPT students.

Exploring nurses' perceptions of nurse managers' communicative relationships that encourage nurses' decisions to buy-in to initiatives that enhance patients' experiences with care.

AIM: To explore nurses' perceptions of nurse managers' (NMs') communicative relationships that encourage nurses' decisions to buy-in to organisational initiatives to enhance patients' experiences with care (PEC). BACKGROUND: The role of the nurse to patient experience is well established, yet little is known about how the communicative relationship between manager and nurse relates to nurse buy-in to PEC initiatives. METHOD: An exploratory qualitative descriptive study was conducted with 15 nurses from two inpatient medical-surgical units in a large acute care hospital using semi-structured interviews. RESULTS: Three themes were identified. The communicative relationship was developed and strengthened through the manager's: (a) multimodal approach to communicating and influencing, (b) engaging and supporting staff and (c) promoting staff-led decision-making. CONCLUSIONS: Nurses in our study who reported having a strong communicative relationship with their NM perceived that this relationship encouraged their buy-in and engagement in PEC initiatives. IMPLICATIONS FOR NURSING MANAGEMENT: An assessment of the communication between the frontline NM and his or her team is important for understanding why initiatives to support PEC are or are not yielding desired results.

Leading Change: A Case Study of the First Independent Critical-Access Hospital to Achieve Magnet® Designation.

OBJECTIVE: The aim of this study was to understand how nurses in a 25-bed critical-access hospital (CAH) led change to become the 1st to achieve Magnet®. BACKGROUND: Approximately 21% of the US population lives in rural areas served by CAHs. Rural nurse executives are particularly challenged with limited resources. METHODS: Staff nurses, nurse managers, interprofessional care providers, the chief nursing officer, and board of directors (n = 27) were interviewed. Observations of hospital units and administrative meetings were done, and hospital reports were analyzed. RESULTS: Nine themes emerged to support a conceptual model of leading change. The CAH spent 3 years of its 6-year journey establishing organizational readiness. Nurses overcame complex challenges by balancing operational support and fostering relationships. The Magnet journey led to significantly improved nurse and patient outcomes. A new organizational culture centered on shared governance, evidence-based practice, and higher education emerged. CONCLUSIONS: The journey to Magnet leads to improved nurse, patient, and organization outcomes.

Leading change: a concept analysis.

AIM: To report an analysis of the concept of leading change. BACKGROUND: Nurses have been called to lead change to advance the health of individuals, populations, and systems. Conceptual clarity about leading change in the context of nursing and healthcare systems provides an empirical direction for future research and theory development that can advance the science of leadership studies in nursing. DESIGN: Concept analysis. DATA SOURCES: CINAHL, PubMed, PsycINFO, Psychology and Behavioral Sciences Collection, Health Business Elite and Business Source Premier databases were searched using the terms: leading change, transformation, reform, leadership and change. Literature published in English from 2001 - 2015 in the fields of nursing, medicine, organizational studies, business, education, psychology or sociology were included. METHODS: Walker and Avant's method was used to identify descriptions, antecedents, consequences and empirical referents of the concept. Model, related and contrary cases were developed. RESULTS: Five defining attributes of leading change were identified: (a) individual and collective leadership; (b) operational support; (c) fostering relationships; (d) organizational learning; and (e) balance. Antecedents were external or internal driving forces and organizational readiness. The consequences of leading change included improved organizational performance and outcomes and new organizational culture and values. CONCLUSION: A theoretical definition and conceptual model of leading change were developed. Future studies that use and test the model may contribute to the refinement of a middle-range theory to advance nursing leadership research and education. From this, empirically derived interventions that prepare and enable nurses to lead change to advance health may be realized.

Exploring leadership roles, goals, and barriers among Kansas registered nurses: a descriptive cross-sectional study.

OBJECTIVES: The Institute of Medicine's Future of Nursing report advocates for full nurse leader representation across multiple settings to address current challenges in our health care system. The purpose of this study was to examine nursing leadership development needs among Kansas registered nurses (RNs). METHODS: Data were collected through an online survey and analyzed using quantitative and qualitative methods. RESULTS: Nearly 1,000 Kansas RNs participated. Most reported holding one or more leadership positions. Prevalent leadership goals were health care organization volunteer administrative roles. The most frequently identified barrier to developing leadership roles was time constraints. Many wanted to develop skills to serve on a board, 20% were interested in personal leadership development, and 19% in policy development. CONCLUSIONS: Based on the findings, the Kansas Action Coalition leadership team is developing programs to address the leadership needs of Kansas RNs. By building capacity in advanced leadership roles, RNs will be better prepared serve as full partners and lead efforts to promote the health of Kansans.

Effect of continuing education: do attendees implement the tools that are taught?

BACKGROUND: Educators are being challenged to show how participants implement in practice the objectives and outcomes of what they learn in professional development activities. Continuing education (CE) departments are being called on to document that the offerings are making a difference in practice. Participants described efforts to implement mindfulness processes after a CE workshop on managing the unexpected. METHODS: A mixed-methods approach was used. Qualitative and quantitative data were used to assess whether participants implemented mindfulness practices that they learned during a CE workshop. This pilot study used an e-mail survey and focused interviews. RESULTS: Participants self-assessed the use of practices taught at a CE workshop and identified barriers and aids to implementing practice change. Focused interviews elicited examples and provided more information about the barriers and facilitators of change that can assist with future program planning. CONCLUSION: CE can change practice in health care organizations. Additional research is needed to document best practices in CE to effect change in practice.

Cognitive flexibility as a mediator of family communication environments and young adults' well-being.

In this study, cognitive flexibility was tested as a mediator of family communication environments (i.e., family expressiveness, structural traditionalism, and avoidance of conflict) and young adults' well-being (i.e., self-esteem, mental health, and physical health). Participants included 395 young adults from first-marriage and postdivorce families. Using structural equation modeling, the results revealed that family expressiveness positively predicted young adults' cognitive flexibility, whereas avoidance of conflict emerged as a negative predictor. Cognitive flexibility, in turn, fully mediated the influence of both expressiveness and avoidance of conflict on well-being. Although structural traditionalism did not predict cognitive flexibility, it did have a direct, inverse effect on young adults' well-being. Among the more important implications of this study is the finding that structural traditionalism and avoidance of conflict, 2 aspects of a conformity orientation in families, generate different effects (i.e., direct vs. indirect) on young adult's well-being.