Validation of the Nursing Student Peripheral Intravenous Catheter Insertion Self-Confidence Scale.

Background and Purpose: It has been shown that nurse confidence predicts peripheral intravenous catheter (PIVC) insertion success. However, intravenous cannulation is a challenging skill for entry to practice students. To date, there is no well-validated measure of nursing student self-confidence in learning and performing PIVC insertion. To address this measurement gap, we created and validated the Nursing Student PIVC Insertion Self-Confidence Scale. Methods: This study employed a descriptive, cross-sectional design. Three cohorts of undergraduate entry-to-practice students at a Canadian university were recruited and assessed during their studies. Two hundred and eighty-one students completed the scale at the first data collection point and 146 at the second point. The structure of the tool was analyzed by exploratory factor analysis to extract factors and confirmatory factor analysis (CFA) was employed for validation. Results: CFA revealed a three-factor scale (PIVC Cannulation Confidence, PIVC Preparation and Securement Confidence, and PIVC Learning Confidence). It has 15 items with satisfactory goodness of fit indices. Conclusions: The Nursing Student PIVC Insertion Self-Confidence Scale is a valid and reliable scale to measure nursing students' confidence in learning about and performing PIVC insertions.

Innovative approaches to teaching vascular access to nursing students in the COVID-19 era.

PURPOSE: For the student nurse, peripheral venous cannulation is one of the most stressful skills to be learned. Although some healthcare employers/establishments offer courses on vascular access and infusion nursing as part of their onboarding programs, ultimately educational institutions should share the responsibility to ensure that graduating nurses can provide safe infusion therapies. METHODS: An innovative vascular access and infusion nursing (VAIN) curriculum was created and mapped onto the entry to practice undergraduate nursing program at McGill University in Montréal, Québec, Canada. This presented an opportunity to implement new teaching approaches. RESULTS: Students experienced multiple new teaching approaches including multimedia and experiential learning and live simulation to ensure acquisition of knowledge and psychomotor skills. The teaching approaches had to be rapidly modified with the advent of the COVID-19 pandemic. CONCLUSIONS: The VAIN curriculum emphasizes simulation and directed practice, seeking to increase competence, confidence, and knowledge. The pandemic underscored the need for flexibility and creativity in content delivery.

Nurses' knowledge on routine care and maintenance of adult vascular access devices: A scoping review.

BACKGROUND: Vascular access devices (VAD), centrally (CVAD) or peripherally (PIV) located, are common in the nursing profession. A high proportion of admitted patients require a VAD to enable administration of intravenous treatments or diagnostic modalities. As the primary caregivers for these patients, nurses are responsible for ongoing care and maintenance of these devices. OBJECTIVE: This scoping review examines the current state of practicing nurses knowledge around routine care and maintenance of adult VADs. METHODS: In the fall of 2018, the following databases were searched: Medline-Ovid 1946 to current, Embase-Ovid 1947 to current, Ebsco CINAHL Plus with full text and ProQuest Nursing & Allied Health database, and articles were selected according to the PRISMA-ScR checklist. INCLUSION CRITERIA: original research published in peer-reviewed journals; in English or French; and focused on practising nurses' knowledge about the routine care and maintenance of adult VADs. RESULTS: Of the 4,099 abstracts identified, 36 full-text articles were included. Study characteristics are reportedin addition to themes found in the literature: the relationship between demographic data and CVAD/PIV knowledge, the state of nurses' CVAD/PIV knowledge and nurses' CVAD/PIV knowledge scores. Overall, significant gaps in nurses' knowledge on the care and maintenance of VADs are noted. CONCLUSION: The variability in nurses' knowledge around both CVAD and PIV led the authors to conclude that there is room for improvement in the educational preparation of nurses and a need for workplace training. RELEVANCE TO CLINICAL PRACTICE: This scoping review intends to highlight the knowledge gap of nurses with regard to best practices for VAD routine care and maintenance and demonstrate the need for education, both in educational and healthcare institutions, to ensure high-quality care and improved patient outcomes.

Innovation in health service management: Adoption of project management offices to support major health care transformation.

AIM: To explore the characteristics that influence project management offices acceptance and adoption in healthcare sector. BACKGROUND: The creation of project management offices has been suggested as a promising avenue to promote successful organisational change and facilitate evidence-based practice. However, little is known about the characteristics that promote their initial adoption and acceptance in health care sector. This knowledge is important in the context where many organisations are considering implementing project management offices with nurse managers as leaders. METHODS: A descriptive multiple case study design was used. The unit of analysis was the project management offices. The study was conducted in three university-affiliated teaching hospitals in 2013-14 (Canada). Individual interviews (n = 34) were conducted with senior managers. RESULTS: Results reveal that project management offices dedicated to project and change management constitute an innovation and an added value that addresses tangible needs in the field. CONCLUSION: Project management offices are an innovation highly compatible with health care managers and their approach has parallels to the process of clinical problem solving and reasoning well-known to adopters. IMPLICATIONS FOR NURSING MANAGEMENT: This knowledge is important in a context where many nurses hold various roles in project management offices, such as Director, project manager, clinical expert and knowledge broker.

"We Should Talk"-Moving knowledge into action by learning to engage patients, families, and healthcare staff to communicate for patient safety.

Innovation in patient engagement and empowerment has been identified as a priority area in the Canadian healthcare system. This article describes the development and implementation of the We Should Talk campaign at an academic pediatric hospital. Through the use of a guiding theoretical framework and a multidisciplinary project team, a multimedia campaign was designed to inspire staff, patients and families to effectively communicate to improve patient safety. The We Should Talk campaign provides a case study for how an organization can foster frontline improvement through the engagement of patient, families, and healthcare providers.

What Is Your KVO? Historical Perspectives, Review of Evidence, and a Survey About an Often Overlooked Nursing Practice.

Like many nursing "sacred cows," the practice of keeping a vein open with a small infusion of intravenous solution does not have clear origins or robust evidence. A survey of Canadian nurses was conducted to determine current practices. More than 50% of respondents reported regularly using a keep-vein-open (KVO) rate between doses of intermittent medication. Frequently, the rate was not specified by the prescriber; in this case, nurses preferred 21 to 30 mL/h. Given the absence of evidence and the frequent use, it is important to ensure that KVO is used properly in the context of a medical prescription or an organizational protocol.

Bringing knowledge to action in the context of a major organizational transition.

In the context of organizational transitions in health care institutions, the decisions taken by leaders and clinicians are informed by multiple sources and by a multitude of actors at all levels of the organization. A study was conducted in the context of a major organizational transition at the McGill University Health Centre in Montreal, Quebec, Canada. The purpose was to examine the body of literature around the notions of "evidence" in decision-making processes in health care. Key informants who had a strategic decision-making role linked to the transition activities were interviewed to explore their perceptions of the types of evidence used to support changes in the organization. Results revealed that managers and clinicians relied on multiple sources of evidence and shared similar concerns about reliability and validity of scant evidence.

The project management office: transforming healthcare in the context of a hospital redevelopment project.

It has been shown that classifying projects into a typology allows improved allocation of resources and promotes project success. However, a typology of healthcare projects has yet to be developed. The projects encountered by the Transition Support Office at the McGill University Health Centre in Montreal, Quebec, where a major redevelopment project is under way, were classified into a typology unique to the healthcare context. Examples of the 3 project types, Process, People, and Practice, are provided to clarify the specific support strategies and context-adapted interventions that were instrumental to their success.

Implementation of evidence-based practices in the context of a redevelopment project in a Canadian healthcare organization.

PURPOSE: The recent introduction of a project management office (PMO) in a major healthcare center, led by a nurse, provides a unique opportunity to understand how a PMO facilitates successful implementation of evidence-based practices in care delivery. DESIGN: A case study with embedded units (individuals, projects, and organization). In this study, the case is operationally defined as the PMO deployed in a Canadian healthcare center. METHODS: The sources of evidence used in this study were diverse. They consisted of 38 individual interviews, internal documents, and administrative data. The data were collected from March 2009 to November 2011. Content analysis was used to analyze the qualitative data. FINDINGS: PMO experts help improve practices, and the patients thus receive safer and better quality care. Several participants point out that they could not make the changes without the PMO's support. They mention that they succeeded in changing their practices based on the evidence and acquired knowledge of change management with the PMO members that can be transferred to their practice. CONCLUSIONS: With the leadership of the nurse director of the PMO, members provide a range of expertise and fields in evidence-based change management, project management, and evaluation. CLINICAL RELEVANCE: PMO facilitates the implementation of clinical and organizational practices based on evidence to improve the quality and safety of care provided to patients.

Turnover intention among new nurses: a generational perspective.

With the current nursing shortage, it is crucial to understand the aspects of the nursing work environment that are related to turnover in new generation nurses. The Practice Environment Scale of the Nursing Work Index was administered to new nurses in Quebec from different generations to determine what domains of the work environment were related to turnover intention. Results can help nurses in leadership and development positions target interventions to retain new graduates.

The needs and expectations of generation Y nurses in the workplace.

Generation Y nurses represent the new nursing workforce. This article describes a study examining the needs, motivations, and expectations of generation Y nurses at the start of their careers. New nurses, on average 24.1 years old in 2007, were interviewed. The generation Y nurses reported that recognition was a key motivator. Their needs are stability, flexible work schedules and shifts, recognition, opportunities for professional development, and adequate supervision.

'If we can't do more, let's do it differently!': using appreciative inquiry to promote innovative ideas for better health care work environments.

AIM: To examine the use of appreciative inquiry to promote the emergence of innovative ideas regarding the reorganization of health care services. BACKGROUND: With persistent employee dissatisfaction with work environments, experts are calling for radical changes in health care organizations. Appreciative inquiry is a transformational change process based on the premise that nurses and health care workers are accumulators and producers of knowledge who are agents of change. METHODS: A multiple embedded case study was conducted in two interdisciplinary groups in outpatient cancer care to better understand the emergence and implementation of innovative ideas. RESULTS: The appreciative inquiry process and the diversity of the group promoted the emergence and adoption of innovative ideas. Nurses mostly proposed new ideas about work reorganization. Both groups adopted ideas related to interdisciplinary networks and collaboration. A forum was created to examine health care quality and efficiency issues in the delivery of cancer care. CONCLUSION: This study makes a contribution to the literature that examines micro systems change processes and how ideas evolve in an interdisciplinary context. IMPLICATIONS FOR NURSING MANAGEMENT: The appreciative inquiry process created an opportunity for team members to meet and share their successes while proposing innovative ideas about care delivery. Managers need to support the implementation of the proposed ideas to sustain the momentum engendered by the appreciative inquiry process.

Impact of a pivot nurse in oncology on patients with lung or breast cancer: symptom distress, fatigue, quality of life, and use of healthcare resources.

PURPOSE/OBJECTIVES: To examine the impact on continuity of nursing care delivered by a pivot nurse in oncology to improve symptom relief and outcomes for patients with lung or breast cancer. DESIGN: Randomized controlled trial in which participants were randomly assigned to an intervention group (n = 93) with care by a pivot nurse in oncology and usual care by clinic nurses or to a control group (n = 97) with usual care only. SETTING: Three outpatient ambulatory oncology clinics in a large university health center in Quebec, Canada. SAMPLE: 113 patients with lung cancer and 77 patients with breast cancer. METHODS: Participants in both groups completed the Symptom Distress Scale, Brief Fatigue Inventory, and Functional Assessment of Cancer Therapy Scale-General version 4 at eight intervals over six months. Healthcare usage was evaluated through a review of hospital records. MAIN RESEARCH VARIABLES: Symptom distress, fatigue level, quality of life, and healthcare usage. FINDINGS: Researchers found no significant differences in symptom distress, fatigue, quality of life, and healthcare usage between groups. CONCLUSIONS: The new nursing role did not have an impact on the patient outcomes under study. IMPLICATIONS FOR NURSING: Experienced nurses with specialized knowledge of oncology symptom assessment and management may reduce the symptom burden experienced by ambulatory patients with breast or lung cancer during active treatment.

Creating a healthy workplace for new-generation nurses.

PURPOSE: To examine dimensions of the psychosocial work environment that influence the psychological health of new-generation nurses. BACKGROUND: While much work has been done concerning the health of nurses in general, research on the relationship between the nursing work environment and the psychological well-being of new-generation nurses at the start of their careers is limited. DESIGN: A correlational descriptive design was used for this quantitative study. Survey data were collected from new nurses (N=309) whose names were obtained from a provincial licensing registry in Quebec, Canada. FINDINGS: Among new nurses, 43.4% stated that they have a high level of psychological distress. These nurses were significantly more likely to perceive an imbalance between effort expended on the job and rewards received, low decisional latitude, high psychological demands, high job strain, as well as low social support from colleagues and superiors (p < or = 0.05). CONCLUSIONS: Understanding the relationship between the work environment and health as experienced by new-generation nurses is imperative for creating interventions to successfully recruit and retain these young nurses. CLINICAL RELEVANCE: Generation Y nurses in Quebec, faced with high levels of psychological distress because of their exposure to difficult nursing work environments, might leave the profession thereby exacerbating an already salient nursing shortage.

Addressing the turnover issue among new nurses from a generational viewpoint.

AIM: To investigate the relationship between dimensions of the psychosocial work environment and the intent to quit among a new generation of nurses. BACKGROUND: As a new generation of nurses enters the workforce, we know little about their perception of their current work environment and its impact on their intent to stay. METHOD: A self-administered questionnaire was distributed to 1002 nurses. RESULTS: The nurses who intended to quit their positions perceived a significant effort/reward imbalance as well as a lack of social support. The nurses who intended to quit the profession perceived a significant effort/reward imbalance, high psychological demands and elevated job strain. CONCLUSION: The balance between the level of effort expended and reward received plays an important role in young nurses' intent to leave. IMPLICATIONS FOR NURSING MANAGERS: Nurse Managers must offer Nexters, from the beginning of their career, a meaningful work and supportive environment. Without the efforts of the organization to improve the work environment and support nurses, this generation may not feel valued and move to another organization that will support them or another career that will offer fulfilment.

Organizational factors that support the implementation of a nursing best practice guideline.

BACKGROUND: The context of the healthcare setting may play a crucial role in influencing the implementation of best practice guidelines in nursing. Further study is required to understand these organizational factors. Two variables, organizational culture and leadership, are thought to influence the adoption of best practice guidelines. AIM: A discussion of organizational factors that influence best practice guideline adoption is presented. A small pilot study is provided as an example of methods for further research. METHODS: A quantitative survey of nursing staff was conducted. RESULTS: Results from the pilot study reveal variability in best practice guideline implementation despite the presence of a culture of organizational learning and transformational leadership. CONCLUSIONS: There is beginning evidence in the literature that culture and leadership are key elements influencing guideline implementation. In this pilot work on two inpatient units where a nursing best practice guideline was implemented, a supportive organizational culture and key people leading change were present. Implications for further studies are offered. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing leaders interested in promoting the use of best practice guidelines must pay attention to the organizational context in which nursing care occurs. A supportive culture where learning is valued coupled with transformational leadership may be key factors in the implementation and the sustainability of best practice guidelines.

Using Appreciative Inquiry to promote evidence-based practice in nursing: the glass is more than half full.

It is now understood that successful implementation of evidence-based practice (EBP) requires a focus on the context of the care setting. While the focal point of many reports is the limitations and barriers, this paper proposes a new approach to "making EBP happen." Appreciative Inquiry (AI), both a method of social research and an organizational development or change intervention, is a novel means to elicit enthusiasm and support for EBP in nursing. Readers will be introduced to the theoretical foundations and assumptions as well as the "4-D Model" of AI. It is proposed that the advanced practice nurse (APN) is in a key position to introduce and support this intervention in healthcare organizations to promote the successful implementation of EBP.