Promoting civility in nursing practice using systems thinking: Evidence-based teaching strategies for nurse educators.

There is a critical need for nurse educators to promote civility in nursing practice using systems thinking to promote quality and safety and improve patient outcomes by preventing undue patient harm. In this article, evidence is synthesized in order that readers can recognize, respond and manage workplace incivility. Systems thinking is introduced as a best practice solution for advancing a civil workplace culture. The author-created Systems Awareness Model, adapted for civility awareness, guides nurse educators with evidence-based strategies for teaching nurses the essential skills to promoting a civility culture within health systems. The strategies can be used by nurse educators in practice to interface workplace application. Proposed examples of evaluation methods are aligned with the teaching strategies. The purpose of this article is to provide nurse educators in practice with evidence-based teaching strategies and evaluation methods to address incivility in health care using a systems thinking perspective.

Using Systems Thinking to Implement the QSEN Informatics Competency.

There is an urgent need to improve the use and usability of the electronic health record (EHR) in health care to prevent undue patient harm. Professional development educators can use systems thinking and the QSEN competency, Informatics, to educate nurses about such things as nurse-sensitive indicators in preventing medical errors. This article presents teaching tips in using systems thinking to champion communication technologies that support error prevention (betterment). [J Contin Educ Nurs. 2019;50(9):392-397.].

Systems Thinking for Transitions of Care: Reliability Testing for a Standardized Rubric.

PURPOSE: The purpose of this study was to develop a standardized rubric for systems thinking across transitions of care for clinical nurse specialists. DESIGN: The design was a mixed-methods study using the Systems Awareness Model as a framework for bridging theory to practice. METHODS: Content validity was determined using a content validity index. Reliability was established using statistical analysis with Cronbach's α and intraclass correlation coefficient. Usability of the rubric was established using content analysis from focus group discussions about their experiences in using the rubric. RESULTS: Content validity was established with a content validity ratio of 1.0. Statistical analysis showed a high interrater reliability (α = 0.99), and sections of the rubric showed a strong degree of reliability with α's ranging from 0.88 to 1.00. Content analysis revealed several overall themes for usability of the rubric: clarity, objectivity, and detail. The area for improvement included adding more detail in the scholarly writing section. CONCLUSION: The research team recommends using the rubric to reflect application of systems thinking across transitions of care.

Systems Perspective for Incivility in Academia: An Integrative Review.

AIM: The purpose of this integrative review was to identify evidence of systems thinking on civility in academic settings. BACKGROUND: Incivility is present in academic systems, including nursing education. What is learned in academia translates to the workplace. Systems-based solutions may promote quality and safety in health care. METHOD: Whittemore and Knafl's integrative approach guided this study. RESULTS: Forty-nine articles were reviewed. Themes emerged describing incivility in nursing as embedded within layers of a performance-driven, oppressive hostile bureaucracy, trickling down, instilling fear, and reinforcing uncivil behavior among and between members. Other themes defined faculty-to-faculty and faculty-to-student incivilities, reasons for it, reactions to it, and suggestions for improved civility. CONCLUSION: The systems awareness model is offered as a means of promoting civility in nursing education. A lack of evidence to support how incivility in academia transfers to quality and safety in practice settings is identified as a gap for future study.

The relationships between coping, occupational stress, and emotional intelligence in newly hired oncology nurses.

OBJECTIVES: Associations between the varying levels of emotional intelligence in newly hired oncology nurses and their responses to stress and coping were examined. The secondary aim was to analyze whether emotional intelligence could moderate their choice of problem-focused or emotion-focused coping strategies. METHODS: Newly hired nurses (n = 114) were recruited from a national cancer institute. Data were collected through surveys using the Ways of Coping Questionnaire, the Nursing Stress Scale, and the Emotional Quotient Inventory between the eighth and twelfth weeks post-hire date. Descriptive and bivariate statistical analyses were conducted on all variables. Regression models determined whether emotional intelligence moderated the choice of coping strategies. RESULTS: Emotional intelligence had a mean value of M = 105.24, SD = 13.02, and occupational stress scores were M = 65.57, SD = 15.68. Significant negative correlations were found for occupational stress and problem-focused coping (r = -.189, P = .022), emotional intelligence and emotion-focused coping (r = -.340, P = .000), and emotional intelligence and occupational stress (r = -.428, P < 0.001). Positive correlations were noted between occupational stress and emotion-focused coping (r = .189, P = .022) and emotional intelligence and problem-focused coping (r = .340, P = .000). Emotional intelligence did not predict the choice of coping strategies. CONCLUSIONS: Although emotional intelligence did not moderate coping strategies in newly hired nurses, using problem focused coping to address occupational stress during the initial employment period may be a protective factor for coping with stress in the oncology workplace.

A Concept Analysis of Systems Thinking.

PURPOSE: This concept analysis, written by the National Quality and Safety Education for Nurses (QSEN) RN-BSN Task Force, defines systems thinking in relation to healthcare delivery. METHODS: A review of the literature was conducted using five databases with the keywords "systems thinking" as well as "nursing education," "nursing curriculum," "online," "capstone," "practicum," "RN-BSN/RN to BSN," "healthcare organizations," "hospitals," and "clinical agencies." Only articles that focused on systems thinking in health care were used. The authors identified defining attributes, antecedents, consequences, and empirical referents of systems thinking. FINDINGS: Systems thinking was defined as a process applied to individuals, teams, and organizations to impact cause and effect where solutions to complex problems are accomplished through collaborative effort according to personal ability with respect to improving components and the greater whole. Four primary attributes characterized systems thinking: dynamic system, holistic perspective, pattern identification, and transformation. CONCLUSION: Using the platform provided in this concept analysis, interprofessional practice has the ability to embrace planned efforts to improve critically needed quality and safety initiatives across patients' lifespans and all healthcare settings.

Sleep Patterns of Emergency Department Nurses on Workdays and Days Off.

BACKGROUND: Shift workers, particularly night workers, are prone to disrupted circadian rhythms and sleep deprivation resulting in fatigue and sleepiness, thereby endangering patient safety. Little is known about the sleep patterns of emergency nurses who work highly variable around-the-clock schedules to meet the demands of fluctuating patient census and acuities throughout the 24-hour period. PURPOSE: The purpose of this pilot study was to determine whether there are shift-related sleep pattern differences in emergency department nurses over seven consecutive 24-hour periods that include both workdays and days off. METHODS: A New Jersey mailing list (1514 members) was rented from the Emergency Nurses' Association. Three hundred on this list were systematically sampled and invited by mail to participate. The final sample consisted of 35 emergency nurses. Participants wore actigraphs for 24 hours each day for 7 days and completed sleep diaries upon awakening from their daily main sleep periods. Queries included caffeine and hypnotics usage. The nurses also completed the Standard Shiftwork Index General Biographical Information Section for demographic and scheduling data. Participants received a $50 honorarium upon completion of the protocol. The actigraph data were downloaded into a personal computer using Act Millennium and analyzed with Action W software (Ambulatory Monitoring, Inc., Ardsley, NY, USA). RESULTS: Sleep durations ranged from 6.6 to 8.1 hours on workdays and from 6.2 to 8.1 hours on days off. There were no significant shift- or workday-related differences in sleep patterns. However, trends indicated that, regardless of shift, workday sleep became more disturbed and less efficient toward the end of the week. Daily caffeine usage was reported by 85.9% of the sample. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Shift working nurses need to obtain adequate and consistent sleep on workdays and days off throughout the work week to reduce fatigue and to provide safe patient care. Understanding the sleep patterns of emergency nurses and their schedules is critical to facilitating the development of shift-specific sleep promotion interventions to enhance sleep and thereby counteract fatigue.

Factors Affecting Job Satisfaction of Immigrant Korean Nurses.

PURPOSE: An increasing number of foreign-born nurses are working in the United States. Nurses' job satisfaction is a critical issue for quality patient care. The purpose of this study was to examine factors affecting the job satisfaction of immigrant Korean nurses. DESIGN: We used a cross-sectional mailed survey design. A convenience sample (n = 105) of members of the Greater New York Korean Nurses Association currently working or had previously worked in the United States completed the questionnaires. We used hierarchical regression to test the effects of acculturation and life satisfaction on job satisfaction. RESULTS: Most participants were female (n = 98, 93.3%) aged 27 to 70 years (mean = 52.27 years, SD = 10.67). In the regression model, life satisfaction, self-esteem, and perceived stress predicted job satisfaction (F = 5.127, p < .001) and explained 44.5% of the variance of job satisfaction. DISCUSSION AND CONCLUSION: U.S. nurses need to gain insight into factors influencing job satisfaction in Korean nurses to promote retention and quality care.

Effects of napping on sleepiness and sleep-related performance deficits in night-shift workers: a systematic review.

Night-shift workers are prone to sleep deprivation, misalignment of circadian rhythms, and subsequent sleepiness and sleep-related performance deficits. The purpose of this narrative systematic review is to critically review and synthesize the scientific literature regarding improvements in sleepiness and sleep-related performance deficits following planned naps taken during work-shift hours by night workers and to recommend directions for future research and practice. We conducted a literature search using the Medline, PsychInfo, CINAHL, Cochrane Library, and Health and Safety Science Abstracts databases and included English-language quasi-experimental and experimental studies that evaluated the effects of a nighttime nap taken during a simulated or actual night-work shift. We identified 13 relevant studies, which consisted primarily of small samples and mixed designs. Most investigators found that, despite short periods of sleep inertia immediately following naps, night-shift napping led to decreased sleepiness and improved sleep-related performance. None of the studies examined the effects of naps on safety outcomes in the workplace. Larger-scale randomized clinical trials of night-shift napping and direct safety outcomes are needed prior to wider implementation.

Sleep and psychomotor vigilance in female shiftworkers.

The purpose of this study was to evaluate the relationships between sleep and psychomotor vigilance in female nurses and the changes in these variables over time. Participants comprised 16 staff registered nurses (10 day, 6 night; aged 30-65 years [M = 47.6; SD = 8.1]) who wore wrist actigraphs continuously and completed a 10-min psychomotor vigilance test (PVT-192, Ambulatory Monitoring, Inc., Ardsley, New York) and the Stanford Sleepiness Scale (SSS) in their homes before and after work for three consecutive 24-hr periods. Repeated measures ANOVA revealed that night nurses slept significantly less than day nurses, F(1, 15) = 26.06, p ≤ .001; M = 227.88 ± 37.03 min versus M = 365.75 ± 59.01 min, respectively, daily for three consecutive days. Night nurses napped more frequently and had more changes in the length of their main sleep periods than day nurses. Day nurses reported more wake episodes during main sleep periods. Night nurses were sleepier after work than day nurses; both groups had increased sleepiness after work for the first 2 days and similar psychomotor vigilance test results. These findings suggest that sleep deprivation, irregular sleep patterns, and sleepiness are significant issues for shiftworking nurses. Future study of the characteristics of sleep and sleepiness in a larger sample would be useful to evaluate the focus for interventions to improve sleep and alertness in shiftworking nurses.

Treatment options for insomnia.

Complaints of insomnia, including reports of difficulty initiating and remaining asleep, are often reported to primary healthcare providers. Nurse practitioners must be prepared to screen patients for this common sleep disorder as well as understand the latest treatment options for optimal patient outcomes.

Organizational culture, quality of work life, and organizational effectiveness in Korean university hospitals.

PURPOSE: This study investigated correlates and predictors of organizational effectiveness, focusing on organizational culture and quality of work life. DESIGN: Convenience sample of 145 nurses working in Korean university hospitals responded to a self-administered questionnaire. FINDINGS: There were significant correlations between organizational culture, quality of work life, and organizational effectiveness. R2 was 44.7% in the hierarchical multiple regression model, explaining and predicting organizational effectiveness. DISCUSSION: Intact organizational culture and quality of work life for nurses will undoubtedly lead to improved organizational effectiveness. Without efficient and effective nursing care, desired patient outcomes cannot be achieved.

Health, work variables, and job satisfaction among nurses.

BACKGROUND: Evidence from several studies suggests that there is widespread job dissatisfaction among nurses. Coupled with a critical shortage of RNs, this situation threatens the provision of safe healthcare. OBJECTIVE: The purpose of this study was to explore the relationships and relative contributions of selected work (stress, work load, weekends off), shift worker health (sleep, depression), and demographic variables (age, number of individuals needing care after work) to job satisfaction in a random, nationwide sample of 247 critical care RNs. METHODS: The Dillman Tailored Design Method of survey research was used to recruit participants and collect data. A descriptive, correlational design evaluated the relationships between the variables. RESULTS: There were no significant differences in these variables among self-defined day-, night-, and rotating-shift nurses. Hierarchical regression analyses indicated that more weekends off per month and less depression and emotional stress contributed significantly to job satisfaction in nurses. CONCLUSIONS: Improvements in scheduling and interventions designed to reduce depression and emotional stress may help to improve job satisfaction in nurses and aid in nurse recruitment and retention.

Sleep is related to physical function and emotional well-being after cardiac surgery.

BACKGROUND: Emotional well-being and physical function are important quality-of-life outcomes after cardiac surgery. Alterations in sleep patterns, including sleep deprivation and altered circadian patterning, also are common. The relations among sleep pattern alterations, physical function, and emotional well-being are not well understood. OBJECTIVE: This study aimed to examine the relations of sleep patterns to physical function and emotional well-being 4 and 8 weeks after cardiac surgery. METHODS: Cardiac surgery patients (n = 72) wore wrist actigraphs and completed sleep diaries for 3 days during postoperative weeks 4 and 8. They also completed the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index, and the Medical Outcomes Survey Short Form 36 preoperatively and at postoperative weeks 4 and 8. Pearson correlations and hierarchical multiple regression analysis were used to analyze the data. RESULTS: Mean sleep efficiency was 71% at 4 weeks and 74% at 8 weeks, as measured with wrist actigraphy. According to participants' self-report, 64% experienced sleep disturbance at 4 weeks and 47% at 8 weeks. Sleep pattern variables, including sleep efficiency and self-reported sleep quality, explained 16% of the variance in physical function at 4 weeks. Self-reported sleep quality explained 8% of the variance in physical function at 8 weeks as well as 12% of the variance in emotional well-being at postoperative week 4 and 13% of the variance at postoperative week 8, after control was used for the contributions of baseline physical function, emotional well-being, age, and sex. CONCLUSIONS: The results suggest that sleep contributes to both physical functional and emotional well-being 4 and 8 weeks after cardiac surgery.

Correlates of fatigue in critical care nurses.

The purposes of this study were to examine shift-related differences in chronic fatigue and the contributions of sleep quality, anxiety, and depression to chronic fatigue among a random nationwide sample (N = 142) of female critical care nurses. Twenty-three percent of this sample met criteria for clinical depression. Day and night nurses did not differ in their reports of chronic fatigue. Night nurses reported more depression and poorer sleep quality than did day nurses. Regression analyses indicated that among the variables of global sleep quality, depression, and anxiety, depression and sleep quality were the most relevant to the explanation of chronic fatigue. These findings suggest the need for studies of strategies to promote sleep and improve mood in critical care nurses.