The role of healthcare leaders in implementing equitable clinical academic pathways for nurses: An integrative review.

AIM: To identify and synthesize empirical evidence on the role of healthcare leaders in the development of equitable clinical academic pathways for nurses. DESIGN: Integrative literature review. DATA SOURCES: Literature was searched using CINAHL, PubMed, ProQuest and Google Scholar databases. REVIEW METHODS: A total of 114 eligible articles published between 2010 and2022 were screened, 16 papers were selected. RESULTS: Results highlighted the need for consistent national, regional, and organizational policy approaches to developing clinical academic careers for nurses. Government health departments and National Health boards must focus on increasing engagement in research and evidence-based nursing practice for high-quality patient care. Discriminatory practices and attitudes were identified as barriers. Discrimination due to gender was evident, while the impact of race, ethnicity, and other social categories of identity are under-researched. Educational leaders must unravel misconceptions about research, highlighting its relevance to patient care and bedside nurses' work. Academic leaders together with executive nurses, research funders and professional nursing bodies must create appropriately remunerated career structures. Transformative approaches are required to develop the clinical academic nurse role and understand its value in clinical practice. CONCLUSION: Multiple elements exist within complex systems that healthcare leaders can navigate collaboratively to develop and implement clinical nurse academic roles. This requires vision, acknowledgement of the value of nursing research and the importance of evidence-based research infrastructures. IMPACT: Findings highlight the collaborative role of healthcare leaders as critical to the success of critical academic careers for nurses. This review can inform those still to formalize this innovative role for nurses. REPORTING METHOD: The review complies with the PRISMA guidelines for reporting systematic reviews. This paper contributes evidence about the healthcare leader's role in developing clinical academic pathways for nurses to the wider global clinical community. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was included in this review.

The impact of visiting restrictions in intensive care units for families during the COVID-19 pandemic: An integrative review.

AIM: To synthesize current evidence about the impact visiting restrictions in adult intensive care units have on family members during the COVID-19 pandemic. DESIGN: Integrative literature review. METHODS: A total of 104 articles were retrieved. Screening yielded a total of 23 articles which were appraised for quality. Reflexive thematic analysis was applied to synthesize findings and extract themes. DATA SOURCES: CINAHL Plus, Ovid MEDLINE, PubMed and ProQuest databases were searched for articles between January 2020 and November 2022. RESULTS: The findings were grouped into two main themes with six subthemes. Theme 1: not being present at the bedside, and Theme 2: altered communication added to family members' distress. Findings indicate that visiting restrictions imposed during the COVID-19 pandemic had negative consequences for family members. CONCLUSION: The patient and their family are inherently connected, prioritizing family presence with the return of flexible, open visitation policies in ICU must be a priority to mitigate further harm and adverse outcomes for all. REPORTING METHOD: The review complies with the PRISMA guidelines for reporting systematic reviews. IMPLICATIONS FOR PROFESSION: Nursing leaders must be included in the development of future pandemic policies that advocate family-centred care. NO PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was included in this review.

Intersectionality and nursing leadership: An integrative review.

AIMS AND OBJECTIVES: This review aimed to synthesise international research about how intersectionality has been used to explore issues within the nursing profession. The objectives were to determine which intersecting variables have been explored, how intersectionality has been operationalised, and the implications for nursing leadership. BACKGROUND: Barriers to health system leadership created at the intersection of gender, race, ethnicity, professional cadre and other socially constructed categories exist in the health workforce. Consequently, an intersectionality paradigm has been recommended to explore power, privilege and oppression issues in the nursing profession. DESIGN: An integrative systematic review method was selected for its ability to include diverse methodologies. The review complies with the PRISMA guidelines for reporting systematic reviews. METHOD: The search terms nurs* nurses nursing AND Intersectionality intersectional intersectionalism, intersect were used in December 2021 to search the Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus) PsycINFO, PubMed, Ovid, ProQuest and the first ten pages of Google Scholar from 2011 to 2021. Directed content analysis was applied to the data. RESULTS: Access to education, absence of expectations as a career and patriarchal structures support male nurses into positions of leadership in healthcare systems. Intra-group differences highlight the paradox of homogenous categories for ethnicity and gender. Being a member of an ethnic minority group hinders career progression regardless of gender. The aftereffects of colonisation exist within the nursing space. CONCLUSIONS: This review is the first to synthesise research using intersectionality to explore the impact of socially constructed identities on nursing leadership. There is a dearth of evidence specific to this topic, ignoring the diversity within this professional group. Future research should include intersectionality to discover how social categories empower or impede a nurse's career progression to leadership roles. RELEVANCE TO CLINICAL PRACTICE: An intersectionality paradigm can encourage nurses to attend to issues of power, privilege and oppression in the profession and their practice.

Reflections on the implementation and evaluation of a system-wide improvement programme based on the fundamentals of care: Lessons learned.

AIM: To demonstrate how implementing a system-wide measurement and improvement programme can make the delivery of the Fundamentals of Care visible in practice. DESIGN: Discussion paper. DATA SOURCES: A retrospective evaluation of the experience of implementing a system-wide peer review programme using the Promoting Action on Research Implementation in Health Services framework. IMPLICATIONS FOR NURSING: Implementing this programme engages nursing leaders at all levels in fundamental care delivery, evaluation and improvement. It positions nursing leaders as accountable for and champions of fundamental care. CONCLUSION: The peer review programme offers a solution to the complex challenge of measuring the fundamentals of care in practice. Successful implementations of this programme at two New Zealand inpatient sites have shown positive results in improved care and patient experience. This makes it worthy of consideration for other health organizations. Nursing leadership has proven to be critical to success. The Promoting Action on Research Implementation in Health Services framework highlights the components that assist with successful implementation and assists in presenting a case for change. IMPACT: This paper addressed the problem of the lack of action and dearth of quality, integrated data, visibility of the patient experience and the contribution of nursing leadership in an inpatient setting. Findings indicate that the peer review programme is translatable, modifiable and sensitive to ethnicity and disability. Using the implementation framework to evaluate the process has provided a guide for future implementations.

Indigenous Maori experiences of fundamental care delivery in an acute inpatient setting: A qualitative analysis of feedback survey data.

AIM AND OBJECTIVES: This study aimed to explore inpatient healthcare delivery experiences of Maori (New Zealand's Indigenous people) patients and their whanau (extended family network) at a large tertiary hospital in New Zealand to (a) determine why Maori are less satisfied with the relational and psychosocial aspects of fundamental care delivery compared to other ethnic groups; (b) identify what aspects of care delivery are most important to them; and (c) contribute to the refinement of the Fundamentals of Care framework to have a deeper application of Indigenous concepts that support health and well-being. BACKGROUND: Bi-annual Fundamentals of Care audits at the study site have shown that Maori are more dissatisfied with aspects of fundamental care delivery than other ethnic groups. DESIGN: Retrospective analysis of narrative feedback from survey data using an exploratory descriptive qualitative approach. METHODS: Three hundred and fifty-four questionnaires containing narrative patient experience feedback were collected from the study site's patient experience survey reporting system. Content analysis was used to analyse the data in relation to the Fundamentals of Care framework and Maori concepts of health and well-being. The research complies with the SRQR guidelines for reporting qualitative research. RESULTS: Four themes were identified: being treated with kindness and respect; communication and partnership; family is the fundamental support structure; and inclusion of culture in the delivery of care. CONCLUSION: The current iteration of the Fundamentals of Care framework does not reflect in depth how indigenous groups view health and healthcare delivery. The inclusion of an Indigenous paradigm in the framework could improve healthcare delivery experiences of Indigenous peoples. RELEVANCE TO CLINICAL PRACTICE: Research around the application and relevance of the Fundamentals of Care framework to Indigenous groups provides an opportunity to refine the framework to improve health equity, and healthcare delivery for Indigenous people.

Creating an Indigenous Maori-centred model of relational health: A literature review of Maori models of health.

AIMS AND OBJECTIVES: Identify the key concepts, principles and values embedded within Indigenous Maori models of health and wellbeing; and determine how these could inform the development of a Maori-centred relational model of care. BACKGROUND: Improving health equity for Maori, similar to other colonised Indigenous peoples globally, requires urgent attention. Improving the quality of health practitioners' engagement with Indigenous Maori accessing health services is one area that could support improving Maori health equity. While the Fundamentals of Care framework offers a promising relational approach, it lacks consideration of culture, whanau or family, and spirituality, important for Indigenous health and wellbeing. DESIGN AND METHODS: A qualitative literature review on Maori models of health and wellbeing yielded nine models to inform a Maori-centred relational model of care. We followed the PRISMA guidelines for reporting literature reviews. RESULTS: Four overarching themes were identified that included dimensions of health and wellbeing; whanaungatanga (connectedness); whakawhanaungatanga (building relationships); and socio-political health context (colonisation, urbanisation, racism, and marginalisation). Health and wellbeing for Maori is a holistic and relational concept. Building relationships that include whanau (extended family) is a cultural imperative. CONCLUSIONS: This study highlights the importance and relevance of relational approaches to engaging Maori and their whanau accessing health services. It signals the necessary foundations for health practitioners to build trust-based relationships with Maori. Key elements for a Maori-centred model of relational care include whakawhanaungatanga (the process of building relationships) using tikanga (cultural protocols and processes) informed by cultural values of aroha (compassion and empathy), manaakitanga (kindness and hospitality), mauri (binding energy), wairua (importance of spiritual wellbeing). RELEVANCE TO CLINICAL PRACTICE: Culturally-based models of health and wellbeing provide indicators of important cultural values, concepts and practices and processes. These can then inform the development of a Maori-centred relational model of care to address inequity.

The impact of intersectionality on nursing leadership, empowerment and culture: A case study exploring nurses and managers' perceptions in an acute care hospital in Aotearoa, New Zealand.

AIM: This study determines whether the culture within an acute care hospital empowers 'all' nurses to be leaders by exploring intersectionality and nursing leadership in the context of the social environment. BACKGROUND: Nurses practice leadership in their day-to-day activities as clinical leaders alongside traditional roles of management and leadership. However, some nurses do not acknowledge nursing work as leadership activity, nor is it seen so by others where hierarchical leadership approaches remain prevalent. Social constructs of gender and race are barriers to accessing formal leadership positions for some, while dominant power structures such as class diminish the value of bedside nursing work. Unexplored is the impact of the intersection of these and other social identities on nurses being leaders. DESIGN: An embedded case study design. METHODS: Thirty-one participants participated in semi-structured interviews. Four levels of analysis including inductive and deductive approaches were applied to the data. The research complied with COREQ guidelines for reporting qualitative research. RESULTS: This study shows nurses do not identify themselves as leaders without an associated title and the pathway to leadership varies depending on intersecting social constructions. CONCLUSION: The impact of the organisational structures and the experience of navigating intersecting social constructions on nurses being leaders goes unseen, privileging some while disadvantaging others. RELEVANCE TO CLINICAL PRACTICE: Health organisations need to be aware of intersectionality in the workplace and explore equity in their structures to be genuinely empowering. Nursing leadership must examine strategies that challenge and decolonise the nursing profession. Bedside nurses should be given more power and respected as leaders of the patient experience, achievable through a renewed emphasis on the fundamentals of care and resonant leadership, which can neutralise a culture of managerialism. Intersectionality can inform the development of new nursing leadership roles that enable nurses to remain clinically active, widening opportunities.

The culture conversation: Report from the 2nd Australasian ILC meeting-Auckland 2019.

AIM AND OBJECTIVE: This paper reports on the proceedings of the second Australasian International Learning Collaborative conference and summit. BACKGROUND: In December 2019, over a hundred people attended the second Australasian International Learning Collaborative Conference and Summit. This was the first to be held in Aotearoa New Zealand, the land where cultural safety was developed, its origins being in nursing education. Perhaps not surprisingly, culture, cultural safety and the context of care featured highly in the presentations and workshops. DESIGN AND METHODS: Discussion paper. RESULTS: A key outcome of the conference proceedings and workshops was the call for nurses and the International Learning Collaborative to work in partnership with indigenous groups to iterate the importance of the Fundamentals of Care framework and evaluate the impact of that on health equity. Other essential messages were to value establishing relationships, to continue to talk about the fundamentals of care, to research and to own them. Nurses were reminded to use their humanity to create a climate and culture in which patients and staff feel valued, safe and trusted. CONCLUSIONS: Future iterations of the Fundamentals of Care framework must incorporate indigenous worldviews, which emphasise the importance of relationships, family and spirituality on wellbeing. Such additions will provide an opportunity for the International Learning Collaborative to optimally respond and direct nursing practice. RELEVANCE TO CLINICAL PRACTICE: International Learning Collaborative members and conference attendees learned, listened and worked on meeting the challenges of consistently implementing and applying the fundamentals of care in practice and its importance to education, research and policy. The takeaway message is, when this does not happen, nurses must speak up.

Intersectionality and Critical Realism: A Philosophical Framework for Advancing Nursing Leadership.

This article presents intersectionality theory with critical realism as a philosophical framework for studying nursing leadership. In response to gaps in the current leadership literature, the aim is to develop an approach that addresses how the multiple social positions nurses hold can create an intersecting matrix of oppression that impacts on their opportunities to develop as leaders. The result is a theoretical foundation, which can inform the methodological framework of future studies. Providing evidence by which a reader can judge the merits of a chosen methodology, it sets the case for integrating intersectionality with critical realism for studying nursing leadership.

Preparing registered nurses depends on "us and us and all of us".

The primary goal of undergraduate nursing education is the preparation of graduates able to function as competent beginning clinicians. Avariety of academic-service partnerships are being used to support the clinical preparation of undergraduate nurses but, in today's demanding and fiscally challenged health and education environments, debate continues about how bestto provide students with quality learning in the clinical setting. This article reports the qualitative findings of a collaborative study undertaken to monitor implementation of a new model of clinical education for undergraduate nursing students. Three partners: a District Health Board (DHB) and two universities have developed, and are refining, a clinical education model based on the inclusion of student nurses in team nursing. In response to the question "How well is the student integration model working?" the qualitative findings, from a DHB and university staff perspective, suggest that students are better integrated within the nursing team. Registered nurses from academic and clinical backgrounds are sharing reponsibility for students' learning but there is a clear need to further develop relationships, skills and processes in order to maximise the student development. The survey results, which include the student perspective, have and are being reported separately.

The impact of postgraduate education on registered nurses working in acute care.

Since 2007, Health Workforce New Zealand has provided District Health Boards (DHBs) with funding to support nurses undertaking postgraduate education. As a result, a significant number of nurses, many working in general medical and surgical wards, have now completed a postgraduate qualification. Anecdotal evidence for one DHB indicated that there were mixed views with respect to how the increase in the number of nurses with postgraduate education had impacted on patient outcomes. Following a review of relevant literature the researchers aimed to ascertain from registered nurses working in acute medical and surgical wards their perception of the impact that further study had on their practice. A quantitative descriptive study was undertaken to answer the question of what impact postgraduate study had on the practice of those nurses working in medical and surgical wards of a District Health Board hospital? An anonymous postal survey was sent to registered nurses (N = 57), and senior nurses (N=25) working in acute medical and surgical areas of practice. The latter group consisted of 16 nurse managers and 9 nurse educators. The results showed that registered nurses, nurse managers and nurse educators all perceived the clinical practice of registered nurses as having improved in some degree as a consequence of postgraduate education. There is also a need for further research to be undertaken in other District Health Boards, especially in non-hospital based areas such as primary health care; and also to investigate ways of linking post graduate education with career pathways, as well as identifying and minimising potential barriers likely to prevent application of post graduate learning in the workplace.