Transitions of care for hospital discharges in a primary care network.

Transitions to and from primary care are a time of concern, especially for patients with chronic conditions and complex care needs. The Edmonton Southside Primary Care Network (ESPCN) developed a process for nurses to ensure timely post-discharge follow-up calls and physician appointments after hospitalization, assessing readmission risk with LACE and Clinical Frailty scores. Over 84% of eligible high-risk discharges received follow-up within 14 days. Of 7,400 index discharges, 1,464 had an emergency department revisit and 725 patients were readmitted within 30 days. Overall, ESPCN rates of readmission (9.8%) and rates of Family Practice Sensitive Conditions (FPSC) (5.7%) were significantly lower than national and provincial rates. FPSC rates for high-risk patients were significantly lower than low- or medium-risk groups. Consistent processes that support nursing involvement enable primary care teams to focus on those with highest risk for adverse outcomes and support patients to access the most appropriate place for the care they need.

A Taxonomy of Supports and Barriers to Family-Centered Adult Critical Care: A Qualitative Descriptive Study.

Family-centered care (FCC) improves the quality and safety of health care provision, reduces cost, and improves patient, family, and provider satisfaction. Despite several decades of advocacy, research, and evidence, there are still challenges in uptake and adoption of FCC practices in adult critical care. The objective of this study was to understand the supports and barriers to family-centered adult critical care (FcACC). A qualitative descriptive design was used to develop a taxonomy. Interviews and focus groups were conducted with 21 participants in Alberta, Canada, from 2013 to 2014. Analysis revealed two main domains of supports and barriers to FcACC: PEOPLE and STRUCTURES. These domains were further classified into concepts and subconcepts that captured all the reported data. Many factors at individual, group, and organizational levels influenced the enactment of FcACC. These included health care provider beliefs, influence of primary versus secondary tasks, perceptions of family work, nurses' emotional labor, and organizational culture.

Work engagement in professional nursing practice: A systematic review.

BACKGROUND: Work engagement in professional nursing practice is critically important to consider when addressing key challenges of health systems, including the global nursing shortage, pressures to reduce health care spending, and increasing demands for quality care and positive outcomes for patients. However, research on work engagement in professional nursing practice has not yet been synthesized and therefore, does not provide a sufficient foundation of knowledge to guide practice and further research. OBJECTIVES: The overall aim of this systematic review is to determine what is currently known about the antecedents and outcomes of work engagement in professional nursing practice. DESIGN: Systematic review. DATA SOURCES: The search strategy included eight electronic databases: CINAHL, MEDLINE, PsycINFO, PROQUEST, SCOPUS, Web of Science, EMBASE, and Business Source Complete. The search was conducted in October 2013. Quantitative and qualitative research that examined relationships between work engagement and antecedent or outcome factors was included. REVIEW METHODS: Quality assessment, data extractions, and analysis were completed on all included studies. Data extracted from included studies were synthesized through descriptive and narrative synthesis. Content analysis was used to categorize factors into themes and categories. RESULTS: 3621 titles and abstracts were screened and yielded 113 manuscripts for full text review. Full text review resulted in 18 included studies. All factors examined were grouped into either influences or outcomes of work engagement. A total of 77 influencing factors were categorized into 6 themes: organizational climate, job resources, professional resources, personal resources, job demands, and demographic variables. A total of 17 outcomes of work engagement were categorized into 3 themes: performance and care outcomes, professional outcomes, and personal outcomes. Based on the results, we adapted the Job Demands-Resources (JD-R) model and developed the Nursing Job Demands-Resources (NJD-R) model for work engagement in professional nursing practice, which reflects key adaptations related to organizational climate and professional resources. CONCLUSIONS: Our findings indicate that a wide range of antecedents, at multiple levels, are related to registered nurses' work engagement. Positive outcomes of work engagement are valuable to both performance and the individual nurse. The NJD-R model offers nursing science a valuable beginning framework to understand the current evidence, further direct nursing research, and begin to guide practice and policy. The results offer opportunities for nurse leaders to promote work engagement in professional nurses through action on organizational level resources.

Work engagement in nursing practice: a relational ethics perspective.

The concept of work engagement has existed in business and psychology literature for some time. There is a significant body of research that positively correlates work engagement with organizational outcomes. To date, the interest in the work engagement of nurses has primarily been related to these organizational outcomes. However, the value of work engagement in nursing practice is not only an issue of organizational interest, but of ethical interest. The dialogue on work engagement in nursing must expand to include the ethical importance of engagement. The relational nature of work engagement and the multiple levels of influence on nurses' work engagement make a relational ethics approach to work engagement in nursing appropriate and necessary. Within a relational ethics perspective, it is evident that work engagement enables nurses to have meaningful relationships in their work and subsequently deliver ethical care. In this article, I argue that work engagement is essential for ethical nursing practice. If engagement is essential for ethical nursing practice, the environmental and organizational factors that influence work engagement must be closely examined to pursue the creation of moral communities within healthcare environments.

Influences on clinical reasoning in family and psychosocial interventions in nursing practice with patients and their families living with chronic kidney disease.

AIMS: To explore how Registered Nurses address psychosocial issues for patients and their families living with chronic kidney disease. BACKGROUND: It is in the scope of registered nursing practice to address the emotional, psychological and relational implications of living with chronic disease through psychosocial and family interventions. Patients living with chronic kidney disease frequently report poor quality of life and numerous psychosocial issues; however, they do not find that these issues are always adequately addressed. DESIGN: This research was hermeneutic inquiry as guided by Gadamer's philosophy of understanding. METHODS: Family/psychosocial nursing practices are examined from the perspective of self-reports of Registered Nurses working in acute care nephrology units. Interviews with nurses were conducted throughout 2012. RESULTS: Nurses attribute, or explain, patient and family member behaviour in a variety of ways. These explanations may or may not align with actual patient/family reasons for behaviour. Nurses' explanations influence subsequent nursing practice. While there is some evidence of practices that overcome biased attributions of patient behaviour, the cognitive processes by which nurses develop these explanations are more complex than previously reported in nursing literature. CONCLUSION: Clinical reasoning and subsequent nursing practice are influenced by how nurses explain patients'/families' behaviour. Exploration of this issue with the support of social cognition literature suggests a need for further research with significant implications for nursing education and practice to improve family/psychosocial interventions.