Using Data from a 360° Leadership Assessment to Enhance Nurse Manager Transformational Leadership Skills.

OBJECTIVE: The aim of this study was to compare self-perception of leadership practices among nurse managers (NMs), day shift nurses, and night shift nurses (NSNs). BACKGROUND: Nurse managers have complex roles in healthcare, with clinical, administrative, and 24-hour accountability for unit activities. Transformational leadership inspires performance beyond expectations, while transcending self-interest for the good of the organization. METHODS: A comparative, secondary data analysis study of the Leadership Practices Inventory (LPI) 2018. RESULTS: Day shift nurses' and NSNs' mean scores had lower perceptions of leadership practices than NMs' self-assessment. Day shift nurses, NSNs, and NMs identified the highest mean scores in "enable others to act" (8.57, 8.62, and 8.82, respectively). CONCLUSIONS: The LPI assessment, the defined observer groups, and unique data visualization informed development of a comprehensive follow-up plan supporting individual and group leadership development. Research examining differences in perceptions of LPI practices across observer groups, particularly direct report staff nurses, is warranted.

Preventing Falls Among Behavioral Health Patients.

BACKGROUND: Inpatient falls are among the most common hospital incidents reported. Fall-related injuries have significant implications for patients, staff, and organizations. Adult behavioral health inpatients are responsible for higher rates of injurious falls and challenge traditional fall prevention methods. An inpatient behavioral health unit in an acute care hospital identified an increased rate of injury from falls per 1,000 patient-days in three months; three falls resulted in major injury. PURPOSE: The purpose of this quality improvement (QI) report is to describe the redesign of a fall prevention program for adult behavioral health inpatients using evidence-based practice (EBP) and QI methods. METHODS: Root cause analyses (RCAs) were conducted on all three fall-related major injuries. Concurrently, a literature review identified EBP recommendations for fall prevention on behavioral health units. A fall prevention action program was developed consisting of four elements: RN education to improve Morse Fall Scale scoring, individualized fall prevention patient plans, revised staff workflow, and improved fall prevention communication. RESULTS: There were no fall-related injuries for six months and no fall-related major injuries for 12 months following implementation of the fall prevention program. Overall, this reduction in fall-related major injuries was sustained over a 21-month period. CONCLUSION: An interprofessional team approach using EBP and RCA is effective in redesigning and implementing a fall prevention program for the adult inpatient behavioral health population.

Perceptions of rounding checklists in the intensive care unit: a qualitative study.

BACKGROUND: Rounding checklists are an increasingly common quality improvement tool in the intensive care unit (ICU). However, effectiveness studies have shown conflicting results. We sought to understand ICU providers' perceptions of checklists, as well as barriers and facilitators to effective utilisation of checklists during daily rounds. OBJECTIVES: To understand how ICU providers perceive rounding checklists and develop a framework for more effective rounding checklist implementation. METHODS: We performed a qualitative study in 32 ICUs within 14 hospitals in a large integrated health system in the USA. We used two complementary data collection methods: direct observation of daily rounds and semistructured interviews with ICU clinicians. Observations and interviews were thematically coded and primary themes were identified using a combined inductive and deductive approach. RESULTS: We conducted 89 interviews and performed 114 hours of observation. Among study ICUs, 12 used checklists and 20 did not. Participants described the purpose of rounding checklists as a daily reminder for evidence-based practices, a tool for increasing shared understanding of patient care across care providers and a way to increase the efficiency of rounds. Checklists were perceived as not helpful when viewed as overstandardising care and when they are not relevant to a particular ICU's needs. Strategies to improve checklist implementation include attention to the brevity and relevance of the checklist to the particular ICU, consistent use over time, and integration with daily work flow. CONCLUSION: Our results provide potential insights about why ICU rounding checklists frequently fail to improve outcomes and offer a framework for effective checklist implementation through greater feedback and accountability.