Survey Research: Do All RN Types Have the Same Perceptions Regarding Professional Nursing Governance?

OBJECTIVE: Researchers examined professional nursing governance perception differences by RN type (clinical, manager, and other RNs), and nurse-related outcome associations. BACKGROUND: Shared governance is associated with improved nurse-related outcomes. Understanding differences in RN types regarding shared governance perceptions is important and not well studied. METHODS: Mean Index of Professional Nursing Governance (IPNG) scores from 3 hospitals' 502 RNs were used to evaluate associations by RN type and unit-based nurse-related outcomes. Descriptive and inferential statistical methods were used. RESULTS: Shared governance was the predominant finding (overall score and 4 of 6 subscale scores) with no significant differences by RN type. Traditional governance was scored for 1 subscale (control over personnel), which was not significant. There were no significant differences in the IPNG score associations with outcomes data by RN type. CONCLUSIONS: Clinical nurses, managers, and other RN types perceived their governance as shared, without significant difference in the nurses' perceptions based on role.

Pandemic Challenges: Keeping Nursing Research Alive.

Nursing has been pandemic-slammed. Although 2020 will be forever entangled with the COVID-19 pandemic, we, as nurse leaders, must continue to move forward and beyond this endemic challenge. We cannot lose focus on generating new knowledge to continue nursing excellence and move our profession forward.

Effect of Shared Governance on Nurse-Sensitive Indicator and Satisfaction Outcomes by Magnet® Recognition Status.

OBJECTIVE: Researchers examined associations between Index for Professional Nursing Governance (IPNG) types and outcomes. BACKGROUND: Effects of professional nursing governance on nurse-related outcomes by Magnet® status are not well studied. METHODS: Associations were evaluated between average IPNG scores from 2170 RNs, and nurse-sensitive indicators (NSIs) as well as patient and RN satisfaction outcomes (N = 205 study units; 20 hospitals), following Magnet requirements. RESULTS: Magnet hospitals had significantly better IPNG shared governance scores than non-Magnet hospitals (Magnet, 106.7; non-Magnet, 101.3). For Magnet hospitals, units scoring as shared governance outperformed traditional governance for 9 of 19 outcomes (47.4%) (NSI, 2; patient satisfaction, 3; RN satisfaction, 4). Self-governance outperformed shared governance for 8 of 15 outcomes (53.3%) (NSI, 2; patient satisfaction, 6; RN satisfaction, 0). For non-Magnet hospitals, shared governance significantly outperformed traditional governance for 1 of 15 outcomes (6.7%) (patient satisfaction). CONCLUSIONS: Having shared or self-governance is a strategy that can be considered by nurse leaders to improve select nurse-related outcomes.

Effect of Shared Governance on Nurse-Sensitive Indicator and Satisfaction Outcomes: An International Comparison.

OBJECTIVE: Researchers examined associations between Index for Professional Nursing Governance (IPNG) scores and outcomes, by US and international hospitals. BACKGROUND: Nursing governance and effects on nurse-related outcomes are not well studied. METHODS: Associations were evaluated using average IPNG scores from 2170 RNs and nurse-sensitive indicators (NSIs) and patient and RN satisfaction outcomes (n = 205 study units, 20 hospitals, 4 countries). RESULTS: International units had better IPNG shared governance scores (113.5; US = 100.6; P < 0.001), and outcomes outperforming unit benchmarks (6 of 15, 40.0%; US = 2 of 15, 13.3%). Shared governance significantly outperformed traditional governance for 5 of 20 (25.0%) US outcomes (patient satisfaction = 1, RN satisfaction = 4) and for 3 of 11 (27.3%) international (patient satisfaction = 1, RN satisfaction = 2). Internationally, self-governance significantly outperformed traditional governance and shared governance for 5 of 12 (41.7%) outcomes (NSI = 2, patient satisfaction = 3). CONCLUSIONS: Shared governance is a strategy that can be considered by nurse leaders for improving select outcomes.

Effect of a Nurse-Led, Patient-Centered, Gratitude Intervention on Patient Hospitalization Experience.

OBJECTIVE: Objectives were to evaluate patient perceptions of a nurse-led, patient-centered gratitude intervention and if nurses identified actionable items to improve patient's hospitalization experience. BACKGROUND: Research demonstrates positive effects of gratitude and caring interventions on patient health and well-being. Evidence is sparse regarding nurse-led gratitude interventions improving hospitalized patient's experiences. METHODS: In this pilot study, 91 adult medical patients completed gratitude forms twice daily for up to 6 shifts and a study discharge form documenting intervention perceptions. In response to the patients' gratitude-related feedback, RNs recorded patient experience-related actions they and interprofessional teams could implement. RESULTS: On average, patients perceived the nurse-led gratitude intervention as helpful (4.2) (1 = very unhelpful, 5 = very helpful) and improved hospitalization experiences (4.3) (1 = seldom, 5 = never). Most of the time actions were required or to be taken, based on patient gratitude intervention responses. CONCLUSIONS: Patient perceptions of nurse-led gratitude intervention demonstrated helpfulness and improved hospitalization experience.

Effect of individualized learning plans on nurse learning outcomes and risk mitigation.

INTRODUCTION: A "Primary Learner Assessment" (PLA) was created to provide an individualized learning plan, offering education as part of a 4-step computer-based process. The PLA is intended to improve learner's knowledge, skills, and patient safety perceptions, regarding interpretation of electronic fetal monitoring (EFM) data and administration of appropriate interventions in a timely fashion to mitigate fetal and maternal risks. Research was conducted to determine if learner knowledge, skills, and patient safety perceptions improved after completion of a 4-step computer-based, individualized adaptive-learning process. METHODS: Participants were registered nurses (RNs) responsible for administering and interpreting EFM, from three U.S. hospitals with labor and delivery units. This mixed method pilot study was determined to be exempt by the institutional review board; all participants provided consent. The process included four steps. In step one, RNs completed the baseline PLA. Based on incorrect quantitative and EFM interpretation responses, computer-based EFM education courses were recommended (step two). After completion of recommended courses weeks or greater of practice (step three), the RNs completed a follow-up PLA (step four). RESULTS: Of the 55 RN participants, most (85.5%) were clinical nurses, had a bachelor degree in nursing or higher (80.0%), and 11.2 average years of labor and delivery experience. There was a statistically significant improvement (P < .0001) in overall average percentage of correct PLA scores from baseline (76.7, SD = 9.1) to follow-up (82.5, SD = 6.9). Practice-related perceptions showed increased ranking of familiarity with the National Institute of Child Health and Human Development (NICHD) 2008 EFM terminology and guidelines from baseline of 49.0% to follow-up of 87.4% and of impact to which the participants integrated EFM administration and interpretation of NICHD EFM terminology and guidelines into practice from 52.8% at baseline to 94.5% at follow-up. In addition, RNs perceived improvement in their oxygen therapy competence and accuracy in interpreting EFM data with implementation of appropriate interventions. CONCLUSION: These pilot study findings support a 4-step, computer-based individualized adaptive-learning process as RNs responsible for EFM to potentially mitigate fetal and maternal risk had improved knowledge and skills. Research is warranted in larger samples.

Shared Governance During a Pandemic.

When the COVID-19 pandemic struck US hospitals in early 2020, many nurse leaders went into crisis mode management. As the pandemic ensued, shared governance endured at hospitals with well-established models, even without council meetings. At other hospitals, clinical nurses began to wonder what happened to shared governance. This article offers advice and lessons learned from the interplay between the COVID-19 pandemic and shared governance at American hospitals.

Use of Evidence-based Practice Models and Research Findings in Magnet-Designated Hospitals Across the United States: National Survey Results.

BACKGROUND: All nurses have responsibilities to enculturate evidence-based practice (EBP) and translate and implement research findings into nursing care, practices, and procedures. AIMS: To report EBP-related findings from the national Hospital-Based Nursing Research Characteristics, Care Delivery Outcomes, and Economic Impact Survey questionnaire. METHODS: In this cross-sectional survey research study of 181 nursing research leaders, 127 responded to these questions: "Has your hospital adopted or does it use a model of evidence-based practice?" "If yes, what is the name of the model and how is it used?" "Does your hospital implement (translate) findings from nursing research into clinical practice?" "Describe how your hospital implements these findings and whose responsibility it is." "What factors do you believe facilitate the implementation of findings from nursing research into clinical practice at your hospital?" Qualitative content analyses were used. RESULTS: Over 90% of nursing research leaders specified that their hospital used an EBP model and implements findings into practice. The most frequently reported models were the Iowa Model of Evidence-Based Practice, Johns Hopkins Nursing Evidence-Based Practice Model, and Advancing Research and Clinical Practice Through Close Collaboration Model. EBP models were used most frequently for education and training, nurse residency programs, and EBP and research fellowships. Findings were implemented through policy and procedure committee processes, shared governance structures, and EBP processes. Those responsible for implementing findings were project leads, nursing professional practice councils, and clinical nurse specialists and advanced practice nurses. Implementation facilitators were nursing leadership, dissemination of findings, and engaged and educated nurses. LINKING EVIDENCE TO ACTION: These new findings report >90% EBP model use and implementation. All nurses, especially our leaders, have responsibilities to evaluate EBP and how nursing research findings are implemented (translated) into practice. Ideally, engaged and educated nurses who enculturate, support, and sustain EBP will facilitate advancing nursing practice to improve patient and work environment-related outcomes.

Health Care Workers' Use and Cleaning of X-Ray Aprons and Thyroid Shields.

We evaluated the use and cleaning of x-ray aprons and thyroid shields by surveying rural hospital system health care workers who wear x-ray aprons and thyroid shields. One hundred fifty-five of the 173 respondents were RNs (89.6%), and 94 respondents were from inpatient or outpatient surgical settings (54.3%). One hundred thirty-five respondents (78.0%) reported soiled x-ray aprons or thyroid shields, and 52 (30.1%) reported shield odors. Eighty-three participants (48.0%) indicated they never spot cleaned. Standard department cleaning never occurred for 37 x-ray aprons or thyroid shields (21.4%); and 114 x-ray aprons or thyroid shields (65.9%) contacted a patient or patient item 1 to 10 times per shift. Twenty-six participants (15%) specified there were policies and procedures for cleaning x-ray aprons and thyroid shields. Use of evidence-based cleaning guidelines and manufacturer's requirements for effective spot and standard cleaning of the protective aprons and thyroid shields are warranted.

Evaluation of Text Messaging Effects on Health Goal Adherence in the Management of Participants With Chronic Diseases.

PURPOSE OF THE STUDY: The study purpose was to determine whether text messaging health-related messages, questions, and reminders to community case management participants with chronic diseases increased health goal adherence. PRIMARY PRACTICE SETTING: This study was conducted by a rural community case management, hospital-affiliated program. METHODOLOGY AND SAMPLE: This pilot, quasiexperimental study measured health goal adherence, the degree to which an individual continues work toward self-identified health goals under limited supervision, before and after a text messaging intervention. All participants were receiving community case management services for chronic disease. Participants completed baseline and follow-up surveys regarding a text messaging intervention. RESULTS: Most participants were African Americans, had diabetes, with equal numbers by gender, an average age of 57.8 years, and had been in the community case management program for 3-5 years. Participants were sent a total of 1,654 messages/questions and 571 reminders. At follow-up, respondents who reported "Did you work on your health goals?" increased significantly (p = .0430). However, no differences were found for "Did you go to your health care appointments?" and "Did you take your medicines as you should?" No differences were noted in reported visits/hospitalizations overall or specifically at the research site. Lastly, study member visit/hospitalization numbers did not change significantly at follow-up. IMPLICATIONS FOR COMMUNITY CASE MANAGEMENT PRACTICE: Although text messaging is not meant to take the place of face-to-face interactions, it does provide community case managers with an additional modality of communication with patients to offer support and important care reminders, and to facilitate patient participation in his or her care.

Pilot evaluation of isolation patients' perceptions on ability to identify types of health care workers when wearing isolation gowns.

In a survey research study, perceptions of 50 hospitalized patients on contact isolation were evaluated regarding their ability to identify health care worker (HCW) type in isolation gowns with no hospital badge under or on the gown, in isolation gowns with the hospital badge partially visible through the gown, and in isolation gowns with a preprinted large font Registered Nurse and Nursing Technician sticker badge on the outside of the gown. Patients ranked their ability to identify HCWs when entering their hospital room as important (average ranking, 8.0, where 0 was not at all important and 10 was very important); 28 patients (56%) specified all HCWs entering their hospital room should wear a preprinted large font sticker badge on the outside of their isolation gowns. Patients found little difficulty identifying HCW type with the large font preprinted sticker badge (average difficulty ranking, 1.0, where 0 is not at all difficult and 10 is very difficult), a simplistic method to improve HCW type identification.

Effect of ABCDE Bundle Implementation on Prevalence of Delirium in Intensive Care Unit Patients.

BACKGROUND: The ABCDE bundle incorporates multidisciplinary measures to improve and/or preserve patients' physical, functional, and neurocognitive status through awakening and breathing coordination, delirium prevention and management, and early physical mobility. OBJECTIVES: To quantify the prevalence and duration of delirium in patients in the intensive care unit (ICU) before and after implementation of the ABCDE bundle. METHODS: Delirium prevalence was defined as the percentage of patients who had at least 1 positive delirium score on the Intensive Care Delirium Screening Checklist (ICDSC) during the ICU stay; delirium duration was the number of days during the ICU stay that a positive ICDSC score was noted. Retrospective data were collected from before and after implementation of the ABCDE bundle. RESULTS: Of the 159 records reviewed (80 before and 79 after bundle implementation), most were for white men (mean age, 66.3 years). After implementation of the ABCDE bundle, the prevalence of delirium decreased significantly (from 38% to 23%, P = .01) and the mean number of days of delirium decreased significantly (from 3.8 to 1.72 days, P < .001). The number of patients with delirium-free stays increased after bundle implementation. CONCLUSIONS: Implementation of the ABCDE bundle led to significant decreases in the prevalence and duration of delirium in ICU patients.

Timing of Newborn Pulse Oximetry Screenings for Critical Congenital Heart Defects Before Discharge.

OBJECTIVE: To determine if there would be positive results from a second pulse oximetry screening (POS) completed for newborns at discharge at 28 to 48 hours of age in addition to the newborn POS completed at 24 to 25 hours of age. DESIGN: Prospective descriptive research study. SETTING: Rural, mid-Atlantic, 13-bed, level I hospital. PARTICIPANTS: Newborns (N = 1,002) at 35 weeks' gestation or older discharged from the newborn nursery. METHODS: Registered nurses (RNs) performed POS at 24 to 25 hours of age (POS 1) and at discharge but less than 48 hours of age (POS 2). Data related to critical congenital heart defects were collected. RESULTS: There were no positive POS results (O2 saturation ≤ 90%) at POS 1 or POS 2, and no additional diagnostic tests were ordered as a result of POS. Although one full-term newborn had negative results at POS 1 and POS 2, the RN identified a murmur, and a subsequent echocardiogram was used to detect tetralogy of Fallot and pulmonary atresia. The RNs detected concerning conditions in 14 newborns that resulted in 28 additional tests, including echocardiograms (9), chest x-ray imaging (8), laboratory testing (7), electrocardiograms (3), and ultrasound imaging (1). CONCLUSIONS: The POS-positive result rate was 0 for newborns at POS 1 and POS 2. Therefore, our study findings supported Maryland's mandate of one POS completed within 24 to 48 hours of birth. Nurses must continue to be vigilant about assessing newborns, including screening for critical congenital heart defects and congenital heart defects.

Nurses' Perceptions on Ebola Care in the United States, Part 2: A Qualitative Analysis.

OBJECTIVE: This study examined qualitative comments from an online survey of nurses' perceptions regarding care of persons under investigation and patients with confirmed Ebola virus disease (EVD) in the United States. BACKGROUND: Additional insight into nurses' perceptions regarding EVD was warranted. METHODS: Survey design used convenience sampling of RNs, licensed practical nurses, and nurse technicians, who responded to 8 open-ended survey questions. RESULTS: Most respondents (618/966 [64.0%]) provided comments. The top 5 of the 13 primary themes were lack of preparedness/readiness; training, education, and improved communications needed; fear of EVD transmission; lack of personal protective equipment (PPE) and infection prevention; and nurses not treated professionally. CONCLUSIONS: Noting multiple concerns, most respondents reported that EVD care could be most safely provided when all parties involved are prepared and when nurses are educated and trained in evidence-driven practices with appropriate PPE and infection control procedures.