A perceção de líderes formais de enfermagem sobre a prática baseada na evidência / Formal nurse leaders' perception of evidence-based practice / La percepción de los líderes formales de enfermería sobre la práctica basada en la evidencia

Resumo Enquadramento: A implementação da Prática Baseada na Evidência (PBE) é crucial para a qualidade dos cuidados de enfermagem. As ações desenvolvidas pelos líderes formais são essenciais para implementar a PBE, tornando-se determinante conhecer as suas perceções. Objetivo: Conhecer as perceções de líderes formais de enfermagem sobre a PBE. Metodologia: Estudo descritivo exploratório com abordagem qualitativa. Foram realizadas entrevistas semiestruturadas a 17 líderes de três hospitais portugueses. Os dados foram analisados através de análise de conteúdo e do software MAXQDA Analytics Pro 2022. Salvaguardados os pressupostos éticos. Resultados: Emergiram dois temas com respetivas categorias − Conhecimento sobre PBE (Conceito de PBE, Impacto da PBE nos resultados em saúde e Autoperceção do conhecimento sobre PBE); Papel na implementação da PBE (comportamentos e caraterísticas). Conclusão: Os líderes descreveram a sua perceção sobre o Conceito de PBE e a relação do Impacto da PBE com resultados em saúde, a necessidade de conhecimento e o seu investimento formativo, bem como o seu papel neste processo. Futuros programas formativos deverão ser implementados nesta área.

Abstract Background: The implementation of Evidence-Based Practice (EBP) is critical to the quality of nursing care. Formal leaders play a crucial role in developing interventions to implement EBP, so it is important to understand their perceptions. Objective: To examine formal nurse leaders' perceptions of EBP. Methodology: Descriptive exploratory study with a qualitative approach. Semi-structured interviews were conducted with 17 leaders from three Portuguese hospitals. Data were analyzed using content analysis and MAXQDA Analytics Pro 2022 software. All ethical principles were observed. Results: Two themes and their categories emerged − Knowledge of EBP (Concept of EBP, Impact of EBP on health outcomes, and Self-perception of the knowledge about EBP) and Role in EBP implementation (behaviors and characteristics). Conclusion: The leaders described their perception of the concept of EBP and the association between the impact of EBP and health outcomes, the need for knowledge, and the investment in training, as well as their role in this process. Future training programs should be implemented in this area.

Resumen Marco contextual: La implantación de la Práctica Basada en la Evidencia (PBE) es esencial para la calidad de los cuidados de enfermería. Las acciones emprendidas por los líderes formales son esenciales para implantar la PBE, y es fundamental conocer sus percepciones. Objetivo: Conocer las percepciones de los líderes formales de enfermería sobre la PBE. Metodología: Estudio exploratorio descriptivo con enfoque cualitativo. Se realizaron entrevistas semiestructuradas a 17 líderes de tres hospitales portugueses. Los datos se analizaron mediante análisis de contenido y el programa MAXQDA Analytic Pro 2022. Se garantizaron los presupuestos éticos. Resultados: Surgieron dos temas con sus respectivas categorías − Conocimiento sobre la PBE (Concepto de la PBE, Impacto de la PBE en los resultados sanitarios y Autopercepción del conocimiento sobre la PBE); Papel en la aplicación de la PBE (comportamientos y características). Conclusión: Los líderes describieron su percepción del concepto de PBE y la relación del Impacto de la PBE con los resultados sanitarios, la necesidad de conocimientos y su inversión formativa, así como su papel en este proceso. Los futuros programas de formación deberían aplicarse en este ámbito.

Estresse percebido e sofrimento psíquico em gestoresde saúde na pandemia da Covid-19 / Perceived stress and psychic suffering in healthmanagers in the Covid-19 pandemic

Objetivo: analisar o nível de estresse percebido e sofrimento psíquico em gestores de saúde na pandemia da Covid-19. Método: estudo descritivo, transversal com abordagem quantitativa. A coleta ocorreu de abril a setembro de 2021, com 40 gestores de serviço de saúde. Utilizou-se para a coleta de dados um instrumento para caracterização sociodemográfica e ocupacional e as escalas "Perceived Stress Scale-14" e "Self Reporting Questionnaire" para avaliação do estresse percebido e sofrimento psíquico. Os dados coletados foram analisados no Statistical Package for the Social Sciences versão 22.0. O presente estudo faz parte de um projeto intitulado "Trabalhadores dos Serviços de Saúde Frente à Pandemia de Covid-19", aprovado pelo Comitê de Ética em Pesquisa sob CAAE número 35260620.9.0000.5231. Resultados: a maioria dos profissionais eram do sexo feminino (90%, N=36), casados (70%, N=28), com filhos (80%, N=32), com média de idade de 45 anos e com pós--graduação (47,5%, N=19). A média dos escores relacionados ao estresse percebido foi 31,13 pontos (DP=3,77) sendo o mínimo 24 e máximo de 42 pontos. Com relação ao sofrimento psíquico, (40%, N=16) os gestores apresentaram prováveis casos de transtornos. A prática de atividades físicas e de lazer (p<0,05) tem papel importante na diminuição do estresse percebido e do sofrimento psíquico. Conclusão: os gestores em saúde apresentaram, durante a pandemia, estresse e sofrimento psíquico, resultados esses que devem ser considerados para promoção de autocuidado aos gestores de saúde, enfatizando a necessidade da realização de atividades físicas e de lazer.

Objective: to analyze the level of perceived stress and psychological suffering in health managers during the Covid-19 pandemic. Method: descriptive, cross-sectional study with a quantitative approach. The collection took place from April to September 2021, with 40 health service managers. An instrument for socio-demographic and occupational characterization and the "Perceived Stress Scale-14" and "Self Reporting Questionnaire" scales were used for the assessment of perceived stress and psychic suffering. The collected data were analyzed using the Statistical Package for the Social Sciences version 22.0. The present study is part of a project entitled "Health Service Workers in the Face of the Covid-19 Pandemic", approved by the Research Ethics Committee under CAAE number 35260620.9.0000.5231. Results: most professionals were female (90%, N=36), married (70%, N=28), with children (80%, N=32), with a mean age of 45 years and with a postgraduate degree. -graduation (47.5%, N=19). The average score related to perceived stress was 31.13 points (SD=3.77), with a minimum of 24 and a maximum of 42 points. With regard to psychic suffering, (40%, N=16) the managers presented probable cases of disorders. The practice of physical and leisure activities (p<0.05) plays an important role in reducing perceived stress and psychological distress. Conclusion: health managers presented, during the pandemic, stress and psychic suffering, results that should be considered for promoting self-care to health managers, emphasizing the need to carry out physical and leisure activities.Keywords: Health manager; Occupational stress; Covid-19; Coronavirus infections.

Peer conformity and competition shape how business managers evaluate withdrawals from Russia amid the Ukraine War.

States have long used economic sanctions in response to violations of international law as a strategy to restore order. Increasingly, firms also reject doing business with violators. In response to the war in Ukraine, hundreds of multinational corporations voluntarily withdrew from Russia, even when policymakers were still debating the extent of sanctions. How did firm managers evaluate whether to withdraw from the Russian market? Using a survey experiment with Japanese firm managers conducted three months after the Russian invasion of Ukraine in 2022, we explore how peer effects-information on what other firms are doing in response to the crisis-influence support for withdrawal of business activity with Russia. Our findings show that information about withdrawal by other firms from a diverse set of countries promotes peer conformity that increases support. In contrast, information about ongoing business with Russia by Chinese firms fosters competition that reduces support. Market exposure moderates these reactions, although the concern about peer behavior does not appear to be driven by a reputation mechanism. Our research provides insight into how business actors perceive the strategic interplay of peer influence and market dynamics in the context of geopolitical conflicts.

Bridging the generational gap between nurses and nurse managers: a qualitative study from Qatar.

BACKGROUND: The nursing workforce comprises multiple generations, each with unique values, beliefs, and expectations that can influence communication, work ethic, and professional relationships. In Qatar, the generational gap between nurses and nurse managers poses challenges to effective communication and teamwork, impacting job satisfaction and patient outcomes. AIM: This study investigates the generational gap between nurses and nurse managers in Qatar, aiming to identify strategies to enhance collaboration and create a positive work environment. METHODS: A qualitative research design was used, involving semi-structured interviews with 20 participants, including frontline nurses and senior nurse managers. Participants were purposively sampled to represent different generations. Data were collected through face-to-face and virtual interviews, then transcribed and thematically analyzed. FINDINGS: Four key themes emerged: Optimizing the Work Environment: Older generations preferred transformational and situational leadership, while younger nurses valued respect, teamwork, accountability, and professionalism. Strengthening Work Atmosphere through Communication and values: Older nurses favored face-to-face communication, while younger nurses preferred digital tools. Cultivating Respect and Empathy: Younger nurses emphasized fairness in assignments and promotions, while older nurses focused on empathy and understanding. Dynamic Enhancement of Healthcare Systems: Younger nurses were more adaptable to technology and professional development, while older nurses prioritized clinical care and patient outcomes. CONCLUSION: The study reveals significant generational differences in leadership preferences, communication styles, and adaptability to technology. Addressing these gaps through effective leadership, ongoing education, and open communication can improve job satisfaction and patient care.

[Evidence for Health Promotion in Brazil: report on a rapid response serviceEvidencia para la promoción de la salud en Brasil: informe sobre un servicio de respuesta rápida]. / Evidências para a Promoção da Saúde no Brasil: relato de um serviço de resposta rápida.

Objective: Present the experience of a rapid response service to support decision-making in health systems. Methodology: Description of the processes and results of a service that produces rapid reviews and evidence maps to support decision-making under the National Health Promotion Policy, as well as the authors' perception of the work process. Results: The rapid response service started in 2020. By December 2023, 54 rapid reviews and five evidence maps had been produced, covering nine health promotion topics. These products were developed in 14 stages by a team made up of a coordinator, supervisors, proofreaders, and a librarian. The development of rapid responses involved a knowledge translation process, with continuous interactions between the requesting teams and production teams. Establishing effective communication was a critical factor in delivering products on time and in line with the needs of decision-makers and their supporters. Conclusion: Rapid response services can help improve the use of evidence for decision-making in health policies and health systems.

Objetivo: Presentación de la experiencia de un servicio de respuesta rápida para brindar apoyo a la toma de decisiones en materia de salud. Método: Se describen los procesos y resultados de un servicio de elaboración de revisiones rápidas y mapas de evidencia para brindar apoyo a la toma de decisiones en el marco de la Política Nacional de Promoción de la Salud, así como la percepción de los autores sobre el proceso de trabajo. Resultados: El servicio de respuesta rápida se inició en el 2020. Hasta diciembre del 2023, se habían elaborado 54 revisiones rápidas y cinco mapas de evidencia, que abarcaban nueve temas de promoción de la salud. Estos productos fueron elaborados en 14 etapas por un equipo formado por un coordinador, varios supervisores y revisores y un bibliotecario. La elaboración de respuestas rápidas fue un proceso de traducción del conocimiento e implicó una interacción continua entre los equipos solicitantes y el equipo de elaboración. El establecimiento de una comunicación eficaz fue un factor decisivo para entregar los productos a tiempo y en consonancia con las necesidades de los responsables de la toma de decisiones y su personal de apoyo. Conclusión: Los servicios de respuesta rápida pueden ayudar a mejorar el uso de evidencia en la toma de decisiones relacionadas con las políticas y los sistemas de salud.

Workplace resilience and compassionate care among Jordanian private sector nurses.

BACKGROUND: Compassionate care is a hallmark of the nursing profession. Yet, nursing is beset by perennial problems, not the least of which is nursing shortage and increased workload. As such, resilience becomes a critical ingredient that nurses must possess to overcome such challenges. However, there needs to be more evidence of the relationship between compassionate care and resilience within the Jordanian nursing context. AIM: To explore the relationship between workplace resilience and compassionate care among Jordanian nurses working in the private sector. METHODS: The study utilized a descriptive cross-sectional correlational design. Convenience sampling with inclusion-exclusion criteria was used to select participants from three private hospitals in Jordan. The Compassionate Care Questionnaire was used to measure levels of compassionate care, and the Resilience at Work Scale was used to measure workplace resilience. Ethical approval was obtained before data collection. RESULTS: A total of 161 nurses participated in the study. Participants had high levels of compassionate care and workplace resilience. Male nurses and nurses with lower workloads had significantly higher levels of compassionate care. Likewise, older nurses, nurses with postgraduate degrees, and nurses with experience of less than 5 years in the current area had significantly higher levels of workplace resilience. Compassionate care had a mordantly solid and significant positive relationship with workplace resilience and all its seven dimensions (living authentically, finding one's calling, maintaining perspective, managing stress, interacting cooperatively, staying healthy, and building networks. CONCLUSION: Developing workplace resilience can support nurses in implementing compassionate care. Nurse Managers and hospital administrators must consider the effects of compassionate care and workplace resilience on nurses and patients. Future research can include a longitudinal exploration of compassionate care and workplace resilience and an investigation of the levels of these variables outside a hospital setting.

Relevant factors affecting nurse staffing: a qualitative study from the perspective of nursing managers.

Objective: To understand the current situation of nursing manpower allocation, explore the factors affecting nurse staffing, improve nurse staffing level, and provide reference for better formulation of nursing human resources staffing standards. Methods: A descriptive research method was used to conduct semi-structured interviews with 14 nursing managers. The data were analyzed and refined by content analysis. The sample size was subject to content saturation. Results: Nine themes and twenty sub-themes of influencing factors for nursing staffing were identified across four levels: hospital level, department level, patient level, and nurse level. Conclusion: Hospital and department managers need to comprehensively consider the factors of affecting nurse staffing. Adopting multidimensional optimization measures, improving relevant systems, optimizing nurse structure, and establishing flexible and mobile nurse database to cope with public emergencies, so as to effectively improve nurse staffing and nursing service quality.

A scoping review of the educator role performed by Health Information Managers in health workplace-based education: The practitioner Health Information Manager-educator.

BACKGROUND: Health Information Managers (HIMs) play a crucial role in the management and governance of health information ensuring the accuracy, confidentiality and accessibility of health data for clinical care and business operational purposes. This role also extends to education and training in the workplace. OBJECTIVE: The aim of this scoping review was to explore and elucidate the role played by HIMs when they undertake a health workplace-based (healthcare organisation or service) educational role and/or functions as evidenced in the existing body of literature. METHOD: A scoping review of the literature to investigated the importance of the educator role for HIM health workplace-based educators. A three-step search strategy was designed to ensure a comprehensive exploration of relevant research. RESULTS: Of 63 articles assess for eligibility, 14 were included in the final analysis. All included articles acknowledged the importance of the HIM-educator workplace-based role. Half of the included articles had been published within the last 7 years. Only 8 of the 14 articles provided some description of HIM-educator attributes, suggesting that these characteristics remain unexplored. DISCUSSION: Findings from this scoping review have shed light on the limitations within the current available literature concerning the attributes of HIM health workplace-based educators. The findings also highlight an important gap in knowledge concerning the qualities of these HIM-educators. CONCLUSION: This identified gap in the literature signals a need for further exploration and investigation into the specific attributes, skills, and characteristics that define effective HIM-educators undertaking a health workplace-based educational role.

Slice-aware 5G network orchestration framework based on dual-slice isolation and management strategy (D-SIMS).

Network slicing is crucial to the 5G architecture because it enables the virtualization of network resources into a logical network. Network slices are created, isolated, and managed using software-defined networking (SDN) and network function virtualization (NFV). The virtual network function (VNF) manager must devise strategies for all stages of network slicing to ensure optimal allocation of physical infrastructure (PI) resources to high-acceptance virtual service requests (VSRs). This paper investigates two independent network slicing frameworks named as dual-slice isolation and management strategy (D-SIMS) and recommends the best of the two based on performance measurements. D-SIMS places VNFs for network slicing using self-sustained resource reservation (SSRR) and master-sliced resource reservation (MSRR), with some flexibility for the VNF manager to choose between them based on the degree to which the underlying physical infrastructure has been sliced. The present research work consists of two phases: the first deals with the creation of slices, and the second with determining the most efficient way to distribute resources among them. A deep neural network (DNN) technique is used in the first stage to generate slices for both PI and VSR. Then, in the second stage, we propose D-SIMS for resource allocation, which uses both the fuzzy-PROMETHEE method for node mapping and Dijkstra's algorithm for link mapping. During the slice creation phase, the proposed DNN training method's classification performance is evaluated using accuracy, precision, recall, and F1 score measures. To assess the success of resource allocation, metrics such as acceptance rate and resource effectiveness are used. The performance benefit is investigated under various network conditions and VSRs. Finally, to demonstrate the importance of the proposed work, we compare the simulation results to those in the academic literature.

The burdens and benefits of managing and engaging: a diary study approach to person-centred risk assessment of top executives and works council members.

The present diary study investigates the impact of daily effort-reward imbalance (ERI), subjective stress and the cortisol awakening response (CAR) as an objective measure on work engagement of top managers and high-level works council members (N = 45) on three consecutive working days. In the scope of psychosocial risk assessment, we argue that focusing on ERI as a generalized work characteristic might be more suitable for work re-design of higher leadership positions because of their highly dynamic and unpredictable psychosocial work characteristics, while at the same time having more access to job resources. The analyses reveal that both baseline and daily ERI, as well as subjective stress, influence work engagement. Our results suggest that interventions to reduce daily levels of ERI may improve the work environment of top managers and works councils by promoting work engagement and related positive health outcomes in the scope of person-centred risk assessment.

Impact of Nurse Manager's Attributes on Multi-Cultural Nursing Teams: A Scoping Review.

BACKGROUND: As global migration increases, nurse managers' effectiveness in multi-cultural nursing work environments is crucial due to the rising cultural diversity within healthcare teams. Despite the increasing international recruitment of qualified nurses to address the worldwide nursing shortage, no studies have synthesised the impact of nurse managers' attributes on nurses in multi-cultural nursing teams. Therefore, it was conducted a literature review aimed to synthesise the available literature on how nurse managers' personality traits, competencies, behaviours, and leadership styles influence nurse outcomes in multi-cultural nursing teams. METHODS: Scoping review conducted according to the Joanna Briggs Institute guidelines to map the relationship or influence of nurse managers' personality traits, competencies, behaviours, and leadership styles on the outcomes of nurses in multi-cultural settings across various clinical environments. Searches were conducted across electronic databases such as CINAHL and MEDLINE, along with grey literature. RESULTS: This review included 39 studies, highlighting 29 personality traits, 9 competencies, 115 behaviours, and 5 leadership styles that impact nurses' outcomes. Key findings emphasise the importance of nurse managers being supportive, culturally competent, and effective communicators, with transformational leadership style being particularly beneficial. CONCLUSIONS: These findings provide insights for planning and developing training programmes to equip current and future nurse managers with skills to effectively lead in multi-cultural care settings.

Agricultural watershed conservation and optimization using a participatory hydrological approach.

Maximizing the impact of agricultural wastewater conservation practices (CP) to achieve total maximum daily load (TMDL) scenarios in agricultural watersheds is a challenge for the practitioners. The complex modeling requirements of sophisticated hydrologic models make their use and interpretation difficult, preventing the inclusion of local watershed stakeholders' knowledge in the development of optimal TMDL scenarios. The present study develops a seamless modeling approach to transform the complex modeling outcomes of Hydrologic Simulation Program Fortran (HSPF) into a simplified participatory framework for developing optimized management scenarios. The study evaluates seven conservation practices in the Pomme de Terre watershed in Minnesota, USA, focusing on sediment and phosphorus pollutant load reductions incorporating farmers' opinions to guide practitioners toward implementing cost-effective CPs. Results show reduced tillage and filter strips are the most cost-effective practices for non-point source pollution reduction, followed by conservation cover perennials. The integration of SAM with HSPF is crucial for sustainable field-scale implementation of conservation practices through enhanced involvement of amateur-modeling stakeholders and farmers directly connected to fields.

Beliefs, mindset and personality of farm managers working in large commercial dairy herds: Association with calf on-farm mortality.

This study aimed to describe the attitudes and personalities of farm managers (FMs) in large Estonian dairy herds and analyse the potential associations with calf mortality. The study included FMs from 114 free-stall farms with at least 100 cows. Each participant completed a questionnaire that comprised questions about the respondent and various statements to reveal their attitudes towards calves, calf mortality, and farming in general. A 7-point Likert scale was used to record the responses. The data on the number of live births and deaths and animal movement data were gathered from farm records and the Estonian Agricultural Registers and Information Board. The yearly calf mortality risk (%) during the first 21 days (YAG) and mortality rate between 22-90 days of age (OAG) adjusted for the animal time-at-risk were then calculated for each herd. Univariate negative binomial regression analysis was used to identify associations between calf mortality risk/rate, and the studied statements and variables with a p-value < 0.25 were included in a k-modes clustering analysis. The mean calf mortality risk was determined to be 5.9 % (range 0.0-26.8 %) during the first 21 days and mean calf mortality rate was 1.8 (range 0.0-9.2) deaths per 100 calf-months during 22-90 days of age. In both age group analyses, two FMs´ clusters formed based on 17 pre-selected statements. The FMs of the high-mortality cluster were found to be dissatisfied with the calf mortality levels. In the YAG analysis, FMs from high-mortality cluster gave lower priority to the issue of calf mortality, placed high importance on the influence of workers on calf mortality, and were more satisfied with the staff's performance compared to FMs of the cluster of herds with lower calf mortality. They were additionally less satisfied with their own performance and felt less recognized by the farm staff. They were also more inclined to try new products and practices on the farm and demonstrated greater empathy towards cattle. In the OAG analysis, the FMs from the higher-mortality cluster viewed reducing calf mortality more costly, had a less ambitious and target-driven management style, and rated their self-performance lower. This study determined that FMs working in herds with high calf mortality were dissatisfied and did not prioritize addressing calf mortality compared to managers working in farms with lower calf mortality. FMs' attitudes and management styles were associated with calf mortality, while the respondents' personality traits had little influence.

The effect of problem-solving and decision-making education on problem-solving and decision-making skills of nurse managers: A randomized controlled trial.

OBJECTIVES: This study was conducted to determine the effect of an education program developed to improve the problem-solving and decision-making skills of nurse managers through both self- and subordinate evaluations and to compare it with a control group without training. BACKGROUND: The most basic skill that managers should have is effective problem-solving and decision-making skills. Nevertheless, studies indicate that nurse managers' problem-solving and decision-making skills are at a moderate level and need to be improved. DESIGN: Randomized controlled, pre-test-post-test, intervention and control group design. The study was conducted at a tertiary hospital in Istanbul, Türkiye. The sample consisted of 60 nurse managers (30 intervention and 30 control groups) and 300 nurses or nurse managers working as subordinates. METHODS: After assessing the problem-solving and decision-making skills of nurse managers in the intervention and control groups by themselves and their subordinates, educational intervention was provided to the intervention-group. The problem-solving and decision-making education consists of two full days of interactive training based on case studies. Subsequent to the training, nurse managers in the intervention-group underwent a second follow-up. The third follow-up for the intervention-group, as well as the second follow-up for the control-group and all subordinates, were conducted in the third month after the training. Data were analysed using descriptive tests, independent sample t-test and dependent sample t-test for comparisons and repeated measures analysis of variance for the effectiveness of the training program. RESULTS: Significant differences were found between the mean scores of the intervention-group nurse managers in problem-solving and decision-making pre and post-test (t=-11.005, p<.001) and case evaluations (t=-10.03, p<.001). Moreover, significant differences were identified in the assessment of pre-training, post-training and 3-month post-training average scores of overall problem-solving (F=93.643, p<.001) and rational (F=7.331, p=.007), dependent (F=13.607, p<.001), avoidant (F=11.543, p<.001) and spontaneous decision-making style (F=4.393, p<.001). When evaluated by the subordinates of the nurse managers in the intervention-group, there was a notable difference in the mean scores of overall problem-solving (t=-16.237, p=.001) and rational (t=-3.472, p=.001) and dependent decision-making styles (t=4.161, p=.001) before and 3-months after the training. CONCLUSIONS: The study uncovered that the problem-solving and decision-making training provided to nurse managers led to enhancements in their respective abilities, a progression that was also noted by their subordinates. The findings underscore the significance of case-based training programs tailored to enhance the problem-solving and decision-making competencies of nurse managers.

First-line managers' experience of guideline implementation in orthopaedic nursing and rehabilitation: a qualitative study.

BACKGROUND: First-line managers have a unique role and potential in encouraging the use of evidence-based clinical practice guidelines (CPGs) and thus serve the provision of safe patient care. In acute and planned hospital care, effective yet safeguarded nursing procedures are a necessity. Little is currently known about how first-line managers engage in supporting the adoption of evidence-based nursing care and about what barriers and enablers there are for implementation of CPGs in the orthopaedic care context. PURPOSE: To investigate first-line managers' experience of clinical practice guideline implementation in orthopaedic care. METHODS: This qualitative interview study included 30 first-line nursing and rehabilitation managers in 17 orthopaedic units in Sweden. A deductive content analysis, with the Ottawa Model of Implementation Leadership as a guide, was employed. RESULTS: To the first-line managers, any guideline implementation required them to balance contexts, including their outer context (signified by the upper-level management and decision-makers) and their inner context, including staff and patients in their unit(s). Acting in response to these contexts, the managers described navigating the organization and its terms and conditions; using relations-, change-, and task-oriented leadership, such as involving the staff; motivating the change by emphasizing the patient benefits; and procuring resources, such as time and training. Even though they knew from past experience what worked when implementing CPGs, the first-line managers often encountered barriers within the contexts that hampered successful implementation. CONCLUSIONS: Although first-line managers know how to effectively implement CPGs, an organization's terms and conditions can limit their opportunities to fully do so. Organizational awareness of what supports and hinders first-line managers to offer implementation leadership can enhance opportunities to alter behaviours and conditions for the benefit of CPG implementation. TRIAL REGISTRATION: The study was registered as NCT04700969 with the U.S. National Institutes of Health Clinical Trials Registry on 8 January 2021.

The role of a dedicated Oncology Nurse Navigator in the surgical oncology pathways: 1 year experience from a General Surgery Unit in central Italy with follow up.

The Nurse Navigator is a highly specialized nurse with technical and non-technical skills that offers individualized assistance to cancer patients, their family and caregivers to overcome health system barriers and facilitate access to care. This role was introduced in the General Surgery Unit of the Madonna del Soccorso Hospital in San Benedetto del Tronto from 1st January 2023. The primary endpoint is to compare the times taken for each step of the diagnostic-therapeutic pathway comparing the study group followed by Oncology Nurse Navigator (ONN) and the group not followed by this role. The secondary endpoints, only for the study group, were the number of patient contacts with the ONN and the time slots; the number of examinations and consultations organized by ONN; the evaluation of patient satisfaction at discharge; the number and type of problems noted during follow-up contact at 7 and 30 days after discharge. A prospective court study with historical control was conducted from 1st January 2023 in Madonna del Soccorso Hospital, Italy. The study group consists of all cancer patients cared for by ONN. The control group was created by selecting the same number of patients as the study group but taken care of in the previous 3 years (from 2020 to 2022) and, therefore, without the presence of the Nurse Navigator. The control group data come from clinical documentation. The number and time slots of contact with the ONN were recorded through the use of a company mobile phone active 24/7 through phone calls and messages. The number of examinations and consultations is known through online requests. The satisfaction assessment was carried out through the use of externally validated questionnaire Patient Satisfaction with Cancer Care (PSCC). The follow-up was performed by telephone and recorded on documentation according to established parameters. A total of 200 patients were analyzed. Both the study and control groups included 100 patients each. The average time between the first contact with the patient and the execution of the diagnostic test was 7 days in the cases compared to 28 days in the control group. The waiting time for the Multi-Disciplinary Team discussion (MDT) was 3 days for the study group compared to 6 days in the control group. The average time taken for the first oncological visit was 3 days in the study group compared to 18 days in the controls. The time from first contact to the operating session was 20 days compared to 45 in controls. Each patient had an average of 10 phone calls with the ONN. For all patients accompanied at the first diagnosis, at least 2 radiological and laboratory tests were organized. Oncology appointment for treatment evaluations after delivery of the histological report was communicated within a maximum of 3 working days. A patient satisfaction questionnaire achieved a response rate of 100%, with an average score of 87.0/90. The telephone follow-up had a response rate of 100% of patients and revealed a decrease in problems at the 30-day check-up compared to that of 7 days after discharge. (Activity of Daily Living 20% vs 8%; nutritional problems 40% vs 21%, pain 18% vs 2%; surgical wounds 45% vs 1%; mobilization 8% vs 0%). The data demonstrate that ONN service improves the quality and outcomes of surgical oncology patients' pathway. The professional role of the ONN, with predefined technical and non-technical skills, should also be officially recognized by the healthcare system and hospital administration.

Exploring the Role of Practice Managers in Dutch Oral Healthcare Practices.

INTRODUCTION AND AIMS: The practice manager (PM) is a familiar position in Dutch oral healthcare. However, little is known about in which type of practice they work and what their responsibilities are. The aims of this study were to analyse the characteristics of oral healthcare practices that employ a PM and practices that do not, to determine responsibility for tasks described in the PM function description, and to assess to what extent the role of a PM varies between those with an oral healthcare and another background, and across practices with different characteristics. METHODS: At the end of 2022, a questionnaire with questions about the employment of a PM in the practice was presented to 991 randomly selected general dental practitioners. The questions about the tasks of the PM were based on the job description of the PM drawn up by the Royal Dutch Dental Association. Data were analysed using chi-square test, one-way ANOVA, linear regression, and logistic regression analyses. RESULTS: A PM was employed in the practice of 56% of the general dental practitioners. In many cases, this PM was responsible for a large number of tasks within the sub-areas of care process, human resources, operational policy, and communication. Compared to independent practices, practices affiliated with a corporate dental company often employed a PM and the PMs had a relatively large amount of responsibility. CONCLUSION: PMs are now commonly found in Dutch oral healthcare practices, especially in ones that are affiliated with a corporate dental company. The tasks of PMs vary, suggesting an evolving professional profile.

Nurses' perceptions of the performance of nurse managers and senior hospital management during the COVID-19 pandemic.

BACKGROUND: The first waves of the COVID-19 pandemic had a negative impact on health systems and health professionals, due to the high number of cases and a lack of preparation. The aim of this study was to understand how nurses working in hospital units and in intensive care perceived the performance of nurse managers and senior hospital management during the first two waves of the pandemic. METHODS: The phenomenological approach proposed by Giorgi was used to investigate perceptions of the performance of nurse managers and senior hospital management during the first two waves of the COVID-19 pandemic in Spain. Fourteen clinical nurses who worked on the front line in inpatient units or intensive care units of the Health Services of Extremadura and Madrid in the first (March-April 2020) and second (October-November 2020) waves of the COVID-19 pandemic participated in this study. The data was collected through semi-structured interviews, following a script of themes, in a theoretical sample of nurses who were worked during the pandemic. RESULTS: Two main themes emerged from the analysis of the data: (1) perceptions about the performance of nurse managers and senior hospital managers during the first and second waves of the pandemic (health system failure; belief that senior hospital management professionals could have managed the pandemic better; recognizing the efforts of middle management (nursing supervisors); insufficient institutional support) and (2) strategies employed by nurses to compensate for the weaknesses in pandemic management. CONCLUSIONS: The clinical nurses perceived that the nurse managers demonstrated better management of the pandemic than the hospital's senior management, which they attribute to their proximity, empathy, accessibility, and ability to mediate between them and the senior management. The nurses also believe that the senior management of the hospitals was to blame for organisational failures and the poor management of the pandemic.

Physiotherapist managers views on advanced practice physiotherapy in Ireland. A qualitative study.

INTRODUCTION: The introduction of physiotherapists working with advanced scope of practice has contributed to improvements in healthcare services. OBJECTIVE: This qualitative study explores the views of physiotherapist managers on the Advanced Practice Physiotherapy role and the barriers and enablers to progression of this career pathway. METHODS: A qualitative focus group study was conducted online with 10 purposefully sampled physiotherapist managers. The focus groups were audio-recorded, transcribed and thematically analyzed. RESULTS: Three main themes were identified; 1) Physiotherapists working in advanced practice are recognized as experts and strong advocates for the physiotherapy profession; 2) Barriers to Advanced Practice Physiotherapy in Ireland include inconsistent role definition and protection, a lack of legislation and uncertainty concerning clinical governance; and 3) Physiotherapist managers can support Advanced Practice Physiotherapy through mentoring and resource provision, and implementation of the Advanced Practice Competency Framework. CONCLUSION: Physiotherapist managers recognized the value of Advanced Practice Physiotherapy to the Irish health service but suggest that the role and reporting structures need to be clarified. They highlighted barriers preventing the full potential of this these roles being realized and provided suggestions to support the progression of this healthcare model.

HPV Self-Sampling in the Workplace: A Qualitative Study of Benefits, Barriers, and Opportunities for Improvement Perceived by Health Professionals and Managers.

AIM: To inform the implementation of Human Papillomavirus Self-Sampling (HPV-SS) in the workplace, we assessed the perspectives of healthcare professionals and managers on the benefits, barriers, and opportunities for improvement of a pilot program. METHODS: A qualitative descriptive study based on in-depth telephone interviews was conducted between June and August 2023. Data were analyzed through inductive thematic analysis. Fifteen health professionals from different companies and fifteen managers from the Mexican Institute of Social Security (IMSS) were interviewed. RESULTS: Participants identified several benefits of the HPV-SS, including ease of use, privacy, convenience, affordability, reduced workplace absences, and promotion of a prevention culture. However, there were also individual and organizational barriers to program implementation. The former consisted of women's concerns about collecting a reliable sample or injuring themselves, lack of confidence in the HPV test, fear of positive results, and discomfort caused by the brush used to collect the sample. Organizational barriers included failure to follow up on positive test results, lack of knowledge of program indicators, perceived negative impact on the established Pap smear cervical cancer screening indicator, and the lack of government regulations supporting HPV testing. To improve the program, participants suggested disseminating information through mass media campaigns and social networks, providing companies with additional support from IMSS preventive staff, extending the work hours of IMSS Family Medicine clinics, and training IMSS health staff on the follow-up of women with HPV test results. CONCLUSIONS: The study findings suggest potential areas for improvement in HPV-SS programs.