Special Issue:
Challenges and Opportunities in Nursing
Jacqueline Dunbar-Jacob, PhD, RN
Distinguished Service Professor and Dean Emeritus, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
Elizabeth A. Schlenk, PhD, RN, CNL
Associate Professor and Associate Dean, Graduate Clinical Education, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
Patricia Tuite, PhD, RN, CCNS
Associate Professor and Director, Doctor of Nursing Practice Programs, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
Abstract
Objective: The objective of this narrative review of Doctor of Nursing Practice implementation is to present the background leading to the 2004 American Association of Colleges of Nursing recommendation that the Doctor of Nursing Practice degree be required for advanced practice, discuss the implementation of programs, identify challenges, and provide recommendations for the future.
Method: Both publications and organizational documents, such as white papers and position statements, were reviewed to identify the historical antecedents to the Doctor of Nursing Practice degree recommendation. A review of the status of the degree acceptance by professional organizations was conducted to identify current trends and challenges.
Summary: In 2004, the American Association of Colleges of Nursing voted to require the Doctor of Nursing Practice degree for advanced practice providers by 2015. This occurred within a broad initiative within health science disciplines to move to a practice doctorate. The need for the degree was supported by the Institute of Medicine 2002 recommendation for additional competencies in health professions education and the National Research Council 2005 recommendation that nursing create a clinical doctorate. The goal of the Doctor of Nursing Practice by 2015 has not been met, although programs are growing across the country with varying models of education. Currently nurse anesthesia requires the Doctor of Nursing Practice, clinical nurse specialists have a target date for the requirement of the Doctor of Nursing Practice, nurse practitioner recommendations are to move from the master’s level to the Doctor of Nursing Practice, but certification bodies have not required it, and nurse midwives will accept but have not endorsed a requirement for the Doctor of Nursing Practice. Nurse executives have recommended the Doctor of Nursing Practice for advanced leadership, but many health systems do not require it. There are multiple challenges to developing a pathway to the Doctor of Nursing Practice, including the multiple organizations influencing educational programs, the certification and licensure of graduates, and the employment practices by health systems. These challenges will have to be addressed to achieve the original goal of doctoral education for advanced practice in nursing.
Joyce E. Johnson, Petra Goodman
Abstract
Since 2011, enrollment in Doctor of Nursing Practice (DNP) and Doctor of Philosophy (Ph.D.) graduate nursing programs increased by almost 300%, suggesting that nursing had entered its “golden age.” This steep-growth trajectory reflects the concomitant growth in the number of doctoral programs, today exceeding 435 for the combined DNP and Ph.D. degrees. Unfortunately, the recent progress in advancing nurses in academic programs is hampered by a weakness in a competency crucial for nurses to complete their rigorous academic programs and disseminate research findings or evidence-based practice project interventions: academic writing proficiency. Since nursing curricula at the undergraduate level place lesser emphasis on the humanities, nursing students lack training in the liberal arts compendium of logic, grammar, and rhetoric necessary for effective and articulate communication and dissemination of knowledge in the field of nursing. Data generated from a recent national survey offers new perspectives on the pervasive problem of poor scholarly writing evidenced by students in graduate nursing programs: 97% of graduate papers contain grammatical errors, and only 13% of students demonstrate higher-order skills. While 81% of graduate program faculty ranked their own writing ability as “exceptional” or “highly proficient,” graduate faculty noted that 97% of the time, student papers evidenced numerous grammatical errors, such as flawed sentence structure, run-on sentences, punctuation errors, and ambiguous word choice. These data suggest that graduate nursing programs must pursue avenues to address student writing shortfalls.
The authors opine that the absence of action suggests that graduate nursing programs may be in a dilemma that parallels the metaphor and urban legend of the boiled frog, wherein acceptance of an unacceptable change occurs gradually through minor, unimportant, and unnoticed increments. Aimed at addressing this dilemma, the authors discuss the potential value of offering a customized writing course to refresh and improve students’ basic writing mechanics. A sample curriculum focuses on critical thinking, clarity, and logical flow. Nursing academicians must acknowledge the drift to low writing performance in their students, advance proficiency in scholarly writing to the top of the graduate nursing education’s agenda, and prepare nurses to achieve in nursing’s “golden age.”
D Streitova
Facultas Medicinae, Clinic of Anestesiology, resuscitation and Intensive Medicinae, Universitas Ostraviensis; Faculty Hospital Ostrava, Central Operating Rooms
R. Zoubkova
Facultas Medicinae, Clinic of Anestesiology, resuscitation and Intensive Medicinae, Universitas OstraviensisFaculty Hospital Ostrava, Clinic of Anestesiology, resuscitation and Intensive Medicinae
J. Vavrošová
Facultas Medicinae, Clinic of Anestesiology, resuscitation and Intensive Medicinae, Universitas Ostraviensis
Abstract
Background: Sepsis is one of the most serious complications in intensive care patients, which is associated with high mortality and morbidity of critically ill patients. Measures based on the effective prevention are one of the main strategies of treating patients. Aseptic procedures, barrier nursing techniques, selection of equipment used for the treatment as well as the replacement frequency of protective barriers are preferred nursing interventions of sepsis with regard to the prevention. The objective of this retrospective study was to assess the importance of nursing interventions and aspects of the incidence of sepsis and infectious complications in ICU patients, including analysis of erroneous nursing procedures that could affect the formation of sepsis.
Methods: A retrospective study was conducted by data collection from medical records and observation of patients hospitalized at the Clinic of Anesthesiology and Intensive-care during the period from January 2019 to December 2022. The overall sample consisted of 736 patients who were diagnosed with sepsis by a doctor according to confirmed infectious etiology. Data were processed by descriptive statistics, frequency tables and x2 (chi-square) test were used for evaluating and the Fisher’s exact test was used for small frequency (n <5). Statistical tests were assessed at the significance level of 5. There were identified 231 patients with sepsis, 106 patients with confirmed infectious etiology, 31 patients with confirmed non- infectious causes (SIRS) and 7 cases of other infectious cause was confirmed during hospitalization. Another category of patients was represented by cases, in which the positive sputum was found in injection site infection, in positive punctate in wound, in purulent secretion from the wound or bacterial findings in urine without general symptoms of infection. Nursing interventions were analyzed with regard to the prevention of sepsis patients in intensive care. Results: The largest number of sepsis was proved in 2019 (26.23%) and in 2020 (20.01%), while in 2021 (11.67%) and 202022 (14.02%) there was recognized a decrease in sepsis. According to the etiology there was significant share of VAP and catheter sepsis compared to uremic and early infection Out of the nursing procedures that have proven to be important for the prevention of VAP there were identified a closed suction method, the selection of the endotracheal tube, the use of semi recumbent position. Selection of the catheter, puncturesite selection, use of infusion filters or disinfection options were found as important examples in the prevention of catheter sepsis. Using a closed circuit system has proved to be the most effective in urinary tract infections. The results clearly show the effect of educational activities of working group on compliance with the rules of asepsis, compliance with barrier nursing activities and practices that are entirely in the hands of the nursing staff.
Conclusions: All preventive measures are in accordance with the recommendations of CDC (The Centers for Disease Control and Prevention) and SHEA (The Society for Healthcare Epidemiology of America) that recommend the education and training of the staff. The objective is to increase awareness of the necessity of preventive measures which help to reduce the incidence of infection with subsequent sepsis in patients in intensive care. Regular education and practical training can not only improve the quality of care, but we can also implement new procedures into the practice with regard to the nursing staff awareness of the importance of sepsis prevention at intensive care units.
Ruth Marchand Tappen, EdD, RN, FAAN
Florida Atlantic University
David G. Wolf, Ph.D., MSJ, MSOL,
Lynn University
Karen Southard, RN, MHA, CPHQ
Health Quality Innovators (HQI)
Sarah Worch, Ph.D.
Lynn University
Janet Marchand Sopcheck
Independent Nursing Consultant
Abstract
This article presents a quality improvement project involving the first organizational-level test of the effectiveness of a new U.S. Centers for Medicare and Medicaid Services (CMS) endorsed Decision Guide, Go to the Hospital or Stay Here? A Decision Guide for Residents, Families, Friends, and Caregivers. This Decision Guide can enhance resident and family knowledge about nursing home (NH) capabilities and is intended to reduce nursing home resident and family insistence on potentially unnecessary resident transfers and hospital readmissions.
The SQUIRE 2.0 guidelines were the framework for this project. A quality improvement project was conducted in 16 NHs in the southeastern United States to evaluate the effect of the resident and family Decision Guide on hospital readmission rates. Prior to implementation, the investigators provided an online orientation to the project followed by onsite training of nursing home personnel. The NHs then distributed and reviewed the Guide with residents and their family members. NH staff entered data related to readmissions and resident and family responses to the Guide into a secure portion of the project website. NH staff recorded data for three months before Guide implementation and for three months after Guide distribution. Three of the nursing homes lost their upper management team soon after study initiation and were unable to continue. A fourth did not provide complete data. In the 12 remaining facilities, the three-month mean number of readmissions dropped from 27 pre-intervention to 18.58, a 31.2% decrease. Participating facilities reported the Guide was very well received by residents and their families. The facilities’ personnel reported that most residents and family members were unaware of the scope of services provided by the nursing home, an information gap filled by the Decision Guide. They found that implementing this Guide in nursing homes was cost-effective, easy to use, and could substantially reduce readmissions. The results of this quality improvement project demonstrated a significant decrease in hospital readmission rates underscoring its potential for quality improvement in NH care and avoidance of burdensome hospital transfers.
Mary Ann Adamczyk, MSA, RN
School of Nursing, University of Michigan, Ann Arbor, MI
Susan Butterworth, PhD
School of Nursing, University of Michigan, Ann Arbor, MI
Carrie Dawson, MS, RN, BC-NC
School of Nursing, University of Michigan, Ann Arbor, MI
Stacia Potempa, MSN, RN, BC-NC
School of Nursing, University of Michigan, Ann Arbor, MI
Marna Flaherty-Robb, MS, RN, CNS-C
School of Nursing, University of Michigan, Ann Arbor, MI
Margaret Calarco, PhD, RN, NEA-BC
School of Nursing, University of Michigan, Ann Arbor, MI
Philip Furspan, PhD
School of Nursing, University of Michigan, Ann Arbor, MI
Kathleen Potempa, PhD, RN, FAAN
School of Nursing, University of Michigan, Ann Arbor, MI
Abstract
There are many approaches to evaluating patient-centered care used by health systems in acute care environments. Yet a growing proportion of care is happening in remote ways, using telehealth methods for chronic care management programs or health coaching for ‘patients’ living in the community, often rarely seen through in-person visits. The typical means of assuring patient-centered approaches may be overlooked or inappropriate for assessing the patient experience in telehealth or online venues. The HealthyLifetimeTM is a community-based, virtual nurse health coaching program for adults with one or more chronic diseases or risk factors. Our quality assurance program will be described, including an assessment of nurse competency using our six strategies, patient-centeredness and personalized approach to coaching, the quality and completeness of core program activities, and patient outcomes and satisfaction with the program. We use a patient case study to describe the program’s phases and quality assurance process. While patient satisfaction is an indicator of experience, the quality of the nurse-patient communication dynamic as it relates to the patient’s evolving behavior change and outcome achievement is a critical factor. We developed and validated natural language analysis methods, the Nurse Health Coaching Assessment, to assess the nurse’s use of our six strategies and the patient’s cognitive-behavioral responses – the Indicators of Health Behavior Change – which, combined, assess the quality of nurse-patient communication dynamic. The case illustrates how the program’s total quality assurance approach impacts the nurse’s notes, core program elements, and patient outcomes. Additionally, we discuss the cost and value of the program.
Katerini Philippou
Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15, Vragadinou Str, 3041 Limassol, Cyprus
Martha Kyriako
European University Cyprus, Nicosia, Cyprus, 6 Diogenis Str., 2404 Engomi, Nicosia-Cyprus
Nicos Middleton
Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15, Vragadinou Str, 3041 Limassol, Cyprus
Andreas Charalambous
Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15, Vragadinou Str, 3041 Limassol, Cyprus
Vasilios Raftopoulos
Department of HIV & STDs, Hellenic National Public Health Organization, 3-5 Agrafon str Athens, 15123, Greece, Email: Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15, Vragadinou Str, 3041 Limassol, Cyprus
Marianna Constantinou
Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15, Vragadinou Str, 3041 Limassol, Cyprus
Ekaterini Lambrinou
Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15, Vragadinou Str, 3041 Limassol, Cyprus
Abstract
A comorbidity like diabetes mellitus (DM) complicates heart failure (HF) self-care management and adherence to the therapy and results poorer clinical outcomes. This study aims to examine the various factors influencing adherence to the therapy of patients with HF and DM. A systematic literature search was established in the electronic data basis PubMed, Cochrane Library and Cumulative Index to Nursing and Allied Health Literature (CINAHL) using inclusion and exclusion criteria. The search yielded eight articles. The introduction of empowerment models in the management of patients with HF and DM made patients more involved in their self-care management and their self-monitoring behavior and adherence were increased. Patients with HF and DM during their hospitalization, were less likely to receive smoking cessation counseling and blood pressure control and experienced longer length of stay. Patients with HF preserved ejection fraction (HFpEF) and DM were less likely to receive an angiotensin convertive enzyme (ACE) inhibitor or angiotensin receptor or beta-blockers and had worse blood pressure (BP) control compared with patients with reduced ejection fraction (HFrEF) and DM. Effective self-care management of patients with HF and DM seems to depend on the type and the severity of comorbid conditions and the availability of effective therapies. Adequate support to patients with HF and DM from health professionals (HPs) is important, in order to establish self-management and adherence to the therapy.
Vaios Grammatis
Master of Healthcare Administration, Hellenic Open University, Greece
Ioannis Kouroutzis
Master of Healthcare Administration, Hellenic Open University, Greece; Department of Nursing, University of Thessaly, Greece
Ilda Vako
Master of Healthcare Administration, Hellenic Open University, Greece
Theodora-Paisia Apostolidi
Department of Nursing, University of Thessaly, Greece; Medical University of Sofia, Bulgaria
Vasiliki Roka
Master of Healthcare Administration, Hellenic Open University, Greece
Pavlos Sarafis
Master of Healthcare Administration, Hellenic Open University, Greece; Department of Nursing, University of Thessaly, Greece
Maria Malliarou
Master of Healthcare Administration, Hellenic Open University, Greece; Department of Nursing, University of Thessaly, Greece
Abstract
Moral distress is a situation in which nurses know the moral principles that should guide their actions but are not allowed by the constraints of the health system. Moral sensitivity is the ability of nurses to perceive the moral dimensions of certain situations or actions. Safe care is a range of services provided to patients by nurses and consequently nurses with the aim of monitoring, promoting, maintaining or restoring the health of patients. Moral distress negatively affects safe health care, and moral sensitivity is the solution to moral distress. This study investigates the relationship between both moral distress and moral sensitivity of nurses with safe nursing care. A total of 163 nurses from a General Greek Hospital participated in the research. The protocol included the Moral Resilience (RMRS), Moral Distress (MMD-HP) and Moral Sensitivity Control (Byrd’s NEST) scales.
For the Moral Resilience scale, higher scores are recorded for the moral efficacy dimension. Moderate scores are recorded for the Moral Distress scale, so nurses are characterized by moderate moral sensitivity. None of the nurses had left or considered leaving the clinic due to moral distress, up to the time of the present study. Health professionals based on Byrd’s NEST scale are characterized by moderate moral sensitivity. The greater the integrity of the relationships, the greater the reactions to moral adversity. The greater the moral distress, or the better the perceptions of the security offered by management, the greater nurses’ personal integrity. As relational integrity or the distress decreased, moral efficacy increased. The higher the moral distress of the nurses, the greater the integrity of the relationships. Nurses who had children also felt more secure about working conditions than those who did not. The greater the dynamics of the clinic, the less reactions to moral adversity. Finally, greater moral deadlock was associated with both greater personal integrity and greater relational integrity, and less moral efficacy. Increased moral sensitivity prevents the occurrence of moral distress and has a positive effect on the provision of safe health care.
Joyce E. Johnson, PhD, RN, NEA-BC, FAONL, FAAN
The Catholic University of America Conway School of Nursing 620 Michigan Avenue NW Washington, D.C. 20064
Petra Goodman, PhD, WHNP-BC, FAANP
The Catholic University of America Conway School of Nursing 620 Michigan Avenue NW Washington, D.C. 20064
Abstract
Healthcare in the U.S. is the most expensive in the world, presenting a complex environment that demands nurse leaders possess consummate business skills. This article chronicles the 30-year journey of incorporating business acumen into nursing education, detailing the resistance and gradual acceptance within the nursing profession. Despite significant progress, a notable gap remains in financial literacy and business proficiency among nurse leaders, often limiting their engagement in financial management roles. The discussion extends to the challenges and opportunities the evolving healthcare landscape presents, where business and financial competencies are increasingly essential for effective leadership.
This article aims to underscore the critical need for nurse leaders to be equipped with advanced business skills to successfully navigate the complex healthcare environment. It also emphasizes the pivotal role of nursing academia in integrating business education into program curricula. The Doctor of Nursing Practice/Master of Business Administration dual degree is presented as an innovative educational pathway designed to bridge this gap by providing comprehensive business knowledge and skills. With this degree, the next generation of nurse executives will be well-prepared to become ‘guardians at the gate’ in the complex world of healthcare, driving meaningful change and improving healthcare outcomes.
Büşra Yürük
Research Assistant, Toros University, Faculty of Health Sciences, Department of Nursing, Mersin, Turkiye
Aysel Doğan
Assist. Prof. Dr., Toros University, Faculty of Health Sciences, Department of Nursing, Mersin, Turkiye
Yağmur Sürmeli
Lect. Dr, Toros University, Vocational School of Health Services, Mersin, Turkiye
Seval Cüceler
Lect. Toros University, Faculty of Health Sciences, Department of Nursing, Mersin, Turkiye
Behire Sançar
Assist. Prof. Dr., Toros University, Faculty of Health Sciences, Department of Nursing, Mersin, Turkiye
Ayşe Buket Doğan Aktaş
Lect. Balıkesir University, Department of Medical Services and Techniques, Balıkesir, Turkiye
Nazife Akan
Assist. Prof. Dr., Toros University, Faculty of Health Sciences, Department of Nursing, Mersin, Turkiye
Fatma Karasu
Assocıate Professor, Kahramanmaras Sutcu Imam University, Faculty of Health Sciences, Kahramanmaras, Turkiye
Fügen Özcanarslan
Prof. Dr., Toros University, Faculty of Health Sciences, Department of Nursing, Mersin, Turkiye
Abstract
Introduction/Objectives: The conscious application of prevention methods is crucial for the prevention of Covid-19 and similar epidemics. To this end, some restrictions and bans have been introduced in our country and in the world during the Covid-19 pandemic. However, it is believed that such restrictions and bans are not effective in preventing the spread of epidemic diseases if one is not aware of why they are applied. For this reason, this study aims to improve the protective behaviors of high school students, who are an important group for controlling the disease in the community during the Covid-19 pandemic, during Covid-19 and similar biological/chemical disasters by using the technique of peer education and a web-based educational program.
Methods: The study was a quasi-experimental one-group pretest-posttest model. The study sample consisted of 140 students who were enrolled in the schools where the study was conducted and who met the study criteria. Before the training, students were given the “Personal Information Form” and the “Biological and Chemical Disaster Protective Behavior Assessment Form”. After the training, the questionnaire “Covid-19 and similar biological/chemical disasters – protective behavior” was completed again. The study data was analyzed using the SPSS 24.0 statistical program. Descriptive statistics were used to analyze the data obtained.
Results: It was found that more than half of the students participating in the study were female, almost half of them attended 10th grade, and almost half of them had a family income that matched their expenses. After the training, it was found that students’ knowledge of social distancing and isolation rules increased and hygiene practices and mask wearing changed positively compared to before the training.
Conclusion: Individuals need to know how to protect themselves from epidemic diseases and know the right practices to minimize the damage caused by epidemic diseases. In this regard, it is recommended that nurses collaborate with different professional groups to increase the awareness and knowledge level of individuals and provide training on epidemic diseases to students. It is also recommended to identify the current situation by repeating the training conducted and ensuring that individuals update their knowledge.
Abstract
The significance of failing to protect frontline health workers, especially nurses cannot be overstated. Inadequate personal protection, psychosocial support and emergency training put our frontline of defense in jeopardy. When comparing death by occupation early evidence showed that nurses constituted the largest percentage of health workforce deaths. Other severe consequences like high levels of resignation, burnout and other signs of mental distress are a warning that health systems require fundamental change to protect and retain our frontline of health security. This is equally true in settings with both high and lower resources. Those at the frontlines pay a heavy price responding to infectious disease outbreaks, but it does not have to be.
This paper outlines key issues and potential strategies to ensure our health workers have the right environment, competence, tools, and support to protect themselves and society when needed most. Using an umbrella review, this paper sought to review the extant literature and identify the best way forward. Failure to learn from recent events such as the 2014-2016 West Africa Ebola outbreak and the COVID-19 pandemic could further exacerbate health worker shortages and our collective ability to prevent, detect and respond effectively. Protecting frontline health workers requires a multi-faceted approach including well-defined policies, adoption of best practices and continuous learning. The focus should move from broad policies and benchmarks to specific, tangible actions, including standard guidelines and protocols that use an All-Hazards Approach. Taking concrete steps to improve protection with national and local accountability that ensures adequate safety standards will be key.
Moreover, continuous learning and investment in health system strengthening are needed. The return on investment in preparedness and protection are clear. COVID-19 has shown the devastating economic and social impact of failing to be prepared. Investment is needed in innovation, including new personal protective equipment (PPE) technology, resilient supply chains that move beyond “just-in time” procurements, and competency-based experiential learning that simulates complex emergencies, in “real world” settings as much as is possible. Learning from history, including nursing pioneers, is essential.
Outbreaks begin in communities. Close community engagement and understanding of the social determinants of health for which those on the margins pay the heaviest price is central to nursing. Since this paper focuses on protection of frontline health workers, it would be remiss not to revisit nursing’s role in caregiving. This paper presents examples from 19th and 20th century nursing leaders who developed community- and person-centered models of care, led the development of hygiene and sanitation standards and examples which highlight the critical role of nurses at the frontlines. Nursing has historically been community- and person-centered. Serving as the communities’ first line of healthcare, nursing pioneers like Florence Nightengale and Lillian Wald offer guidance which is still valuable in our modern, highly connected world.
Applying lessons from both our recent and past experiences to develop robust systems for health workforce protection and preparedness is a health security priority. Now, as COVID-19 becomes an endemic disease for which an effective vaccine is available, is the time to harness these lessons learned, develop more robust standards and accountability for emergency protection and health workforce protection, without which history will repeat itself.
Maria McCormick, DNP, RN, CPNP, CNE
Jaime Sinutko, PhD, MSN, RN
Abstract
This article discusses the process of developing a Bachelor of Science in Nursing program, providing insight into the key elements that need to be considered. The demand for skilled nurses is increasing, and institutions need to create responsive and innovative pre-licensure nursing programs to meet this demand. The article emphasizes the importance of evaluating the feasibility of such a program and identifying the resources required for successful implementation. It highlights the need for securing approval from both internal and external stakeholders, as well as funding for critical aspects such as faculty recruitment and clinical skills and simulation labs. The authors draw on their experience in conceptualizing and implementing pre-licensure nursing programs to provide valuable guidance and insights. Overall, the article offers a comprehensive review of the initial steps and crucial considerations for institutions aiming to establish robust educational pathways such as pre-licensure nursing programs.
Mihail Dimitrios
Human Resources Management Lab, Business Administration Department, University of Macedonia Thessaloniki 546 36, Thessaloniki Greece
Papatheodorou Maria
Nursing Department, Papageorgiou General Hospital, Thessaloniki; Human Resources Management Lab , Business Administration Department, University of Macedonia Thessaloniki 546 36, Thessaloniki Greece
Panagiotis Kloutsiniotis
Department of Tourism, Ionian University, Kerkyra, Greece; Human Resources Management Lab , Business Administration Department, University of Macedonia Thessaloniki 546 36, Thessaloniki Greece
Abstract
Background: Leadership becomes crucial during major crises in which one could expect high levels of burnout and decrease in patient quality of care. The Covid-19 pandemic was a major healthcare crisis where healthcare professional and infrastructure had to cope with unprecedented levels of workload and stressful working conditions. Hence, empirical models for estimating the mitigating role of authentic leadership on nurses’ burnout during the pandemic can contribute to the utilization of best practices in managing effectively the scarce nursing personnel resources.
Aims: To model the influence of leadership, through measures on structural empowerment and work-life balance, on nurses’ burnout and patients’ quality of care, and to measure the nurses΄ perception of their leadership, and the opinion of the leaders regarding their role during the Covid-19 pandemic.
Methods: An institution-based cross-sectional study conducted during the third wave of the pandemic (March-July 2021). After implementing measures to enhance structural empowerment and improve work-life balance, four questionnaires referring to Authentic leadership, Structural empowerment, Work life balance, and Work Burnout were distributed to 650 nursing personnel. Moreover, 200 patients were asked to assess the received quality of care.
Results: 530 valid questionnaires included in the study. Using structural equation modeling, we estimated that authentic leadership significantly influences burnout and preserves patients’ quality of care by enhancing structural empowerment and work-life balance. In assessing attitudes, leadership was rated high, 56±5 SD (max =80) by the nursing personnel. Head nurses rated their leadership significantly higher compared to the nurses, 62,13±10 SD, (p<0,001). Structural empowerment and work-life balance measures were rated 3,55±0.6 SD, and 2,67±0,5 SD, (max =5) respectively. On the burnout subscales, emotional exhaustion and cynicism rated 3,1±0,8 and 2,3±0,7 respectively, and high in professional efficacy, 2±0,5. Patients assessed their quality-of-care 3,8±0.48 SD, (4= very good and 5=excellent).
Conclusion: Our study demonstrates that during major crises, leadership through structural empowerment measures and better work-life conditions mitigates nurses’ burnout and lead them to high levels of professional efficacy, thus preserving patients-quality of care. Moreover, team leaders in healthcare services should be modest and aware of their tendency to overestimate their leadership abilities.
Jacqueline Bloomfield, PhD, MN, PGDip, PGDip, BN, RN, SFHEA
The University of Sydney Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, Sydney, Australia.
Christie van Diggele, BEd, Med (Management and Leadership)
Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Astrid Frotjold, PhD, RN, BA, MNS
The University of Sydney Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, Sydney, Australia.
Carl Schneider, BN, RN, BPharm, PhD, PGCert, FHEA
The University of Sydney School of Pharmacy, Faculty of, Medicine and Health, Sydney, Australia.
Rosa Howard, BSc, PhD, GradCertEdStud, FHEA
The University of Sydney School of Medicine, Faculty of, Medicine and Health, Sydney, Australia.
Christopher Roberts, MBChB MMedSci FRACGP PhD
Honorary Professor of Medical Education, The University of, Sydney School of Medicine, Faculty of Medicine and Health, Sydney, Australia.
Stuart Lane, MBBS PhD FCICM AFRACMA MQHR MEduLdr
The University of Sydney Medical School, Head of Intensive, Care Medicine, Sydney Medical School, Australia; Senior Staff Specialist, in Intensive Care Medicine, Nepean Hospital.
Abstract
The need for interprofessional education within healthcare education is widely accepted, yet healthcare educators continue to grapple with the challenges associated with integrating authentic interprofessional learning activities within curricula. Timetabling conflicts, shortage of teaching spaces, geographical separation, the need for educator training, varying assessment needs, lack of organisational commitment, and suboptimal attitude by faculties towards Interprofessional Education, continue to be identified as barriers making it seemingly unachievable by many.
We describe an introductory Interprofessional Education workshop that was successfully delivered to over 2600 first-year health students across 13 health disciplines at an Australian university, demonstrating how as a team of interprofessional educators we achieved the unachievable, successfully overcoming many of the obstacles to IPE. We outline the importance of authentic learning activities constructively aligned to learning outcomes and assessment, and the necessity of student, early facilitator, and faculty engagement, to overcome logistical and practical challenges. Finally, we discuss the changes to the workshop necessitated COVID-19, and future challenges and directions.
Ekaterini Lambrinou, PhD, Associate Professor
Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15, Vragadinou Str, 3041 Limassol, Cyprus
Maria Thodi, RN
Intensive Cardiology Care Unit & Heart Failure Unit, Department of Cardiology, Athens University Hospital Attikon
Anastasia Samara, MSc
Nicosia General Hospital. Nicosia – Limassol Old Road, No. 215, 2029 Strovolos, Nicosia – Cyprus
Katerina Philippou, MSc
Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15, Vragadinou Str, 3041 Limassol, Cyprus
Lefkios Paikousis, MSc
Research Associate, Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15, Vragadinou Str, 3041 Limassol, Cyprus
Panayiota Sentouxi, MSc
Intensive Care Unit, American Medical Center/American Heart Institute, 215,Spyrou Kyprianou Ave. 2047 Strovolos P.O. Box 25610, 1311 Nicosia, Cyprus Nicosia, Cyprus
Gerasimos Filippatos, MD, FESC, FHFA, FHFSA (h)
Professor of Cardiology, National and Kapodistrian University of Athens Chair, Department of Cardiology, Athens University Hospital Attikon; Vice President Onassis Cardiac Surgery Center; President Hellenic Heart Failure Society
Vasiliki Bistola, MD
Consultant Cardiologist, Heart Failure Unit, Department of Cardiology, Athens University Hospital Attikon
John Parissis, MD
Professor, Department of Emergency Medicine, National and Kapodistrian University of Athens, Athens, Greece, Department of Cardiology, Athens University Hospital Attikon
Martha Kyriakou, PhD
Research Associate, Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15, Vragadinou Str, 3041 Limassol, Cyprus; Nicosia General Hospital. Nicosia – Limassol Old Road, No. 215, 2029 Strovolos, Nicosia – Cyprus
Abstract
Background: Self-care of patients with heart failure (HF) is essential for the effective self-management of their disease, especially during the pandemic era. Self-care assessment instruments give the opportunity to Health Professionals to early recognize possible self-care needs and management of patients with HF.
Aim: The translation and validation of the Greek version of the instrument “Self-Care of Heart Failure Index’’ (Gr-SCHFI), as well as the investigation of the psychometric properties of the instrument in a Greek-speaking population with HF.
Methods: It’s a methodological study of an instrument validation. The psychometric properties of the Greek version of Gr-SCHFI were evaluated through reliability factors (Cronbach’s a and Composite Reliability), reliability of repeat test-retest and validity measures (content validity and concurrent validity). Brislin’s (1970) methodology was used to translate the instrument to Greek language.
Results: The study involved 176 patients, of whom 138 (78%) were men with an average of 69 years old. Most participants were in the NYHA III category [76 (57%)]. Confirmatory factor analysis showed very good measurements in the criteria: RMSEA = 0.07, CFI = 0.97, GFI = 0.98, AGFI = 0.98, NFI = 0.95, TLI = 0.97. The Cronbach’s alpha index and the Composite reliability index had satisfactory internal coherence indicators (Cronbach’s alpha 0.80-0.92, and Composite reliability 0.88-0.96, respectively).
Conclusions: The Gr-SCHFI scale is a reliable and valid self-care assessment instrument for patients with HF. Self-care is necessary in HF where the evaluation and assessment of the self-care of the specific population is very important along the trajectory of the disease.
Theresa A. Kessler, PhD, RN, ACNS-BC, CNE, FAAN
Professor and Kreft Endowed Chair for the Advancement of Nursing Science, Valparaiso University, College of Nursing and Health Professions.
Lynette Rayman, DNPS, RN, CNE
Associate Professor and Assistant Dean for Undergraduate Nursing, Valparaiso University, College of Nursing and Health Professions.
Abstract
Background: College students are assumed to be generally healthy, thus, elevated blood pressure can be easily missed in this population. However, recent research on college students has demonstrated increasing rates of elevated blood pressure. Situations that increase risk of elevated BP include higher levels of stress related to college education as well as other common stress producing events in life. Additionally, college students may engage in behaviors that increase risk such as eating poor diets, drinking alcohol, and not exercising regularly. The purpose of this study was to assess the prevalence of elevated blood pressure and risk factors in undergraduate college students and develop a campus wide educational initiative.
Methods: Undergraduate students at a faith-based, Midwestern university (n = 138) participated in a cross-sectional study. Demographic data, standardized BP measurements, risk factors, and perceived stress levels were collected via a Google form and in-person assessments.
Results: Fifty-two percent of college students had an elevated systolic blood pressure, and 30% had elevated diastolic blood pressure. Male students had significantly higher systolic (X2 = 101.343, p = .005) and diastolic blood pressure readings (X2 = 144.44, p < .001) compared to female students. There was no association between year in school and stress levels (X2 = 315.83, p = .102). Stress and systolic blood pressure were not correlated (r = .121, p = .180) nor were stress and diastolic blood pressure (r = .075, p = .408). Following the educational initiative, 96% of students (n = 91) were able to accurately define elevated blood pressure, risk factors for hypertension, and strategies to lower blood pressure.
Conclusions: It is vital that blood pressure assessments become a priority for college students. These assessments must be followed by interventions aimed at reducing blood pressure levels, stress, and risk factors related to hypertension to prevent the long-term effects of cardiovascular disease. Healthcare providers on college campuses, including and perhaps most effectively students in health-related fields, should be involved in working with this population to increase awareness and screening efforts.
Yan Jiang
General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China; Yan Jiang and Chaoran Wang contributed equally to this paper
Chaoran Wang
Ningxia Medical University, Yinchuan, Ningxia, China ; Yan Jiang and Chaoran Wang contributed equally to this paper
Juan Li
General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
Guangli Mi
General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
Yanan Wang
General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
Shuling Tian
General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
Abstract
Objective: To explore the clinical effects of quality control circle (QCC) activities on the preparation of instruments, team cooperation and clinical satisfaction of posterior cervical surgery.
Methods: The clinical randomization table was used to select 100 patients who underwent posterior single open-door laminoplasty in the Department of orthopedics of our hospital from January 2020 to January 2021 as the study subjects. In the experimental group, quality control circle activities were used to prepare the surgical instruments before operation, including 32 males and 18 females, with an average age of 58.3 ± 10.5 years; The control group did not use quality control circle activities to prepare the surgical instruments before operation, including 27 males and 22 females, with an average age of 60.5 ± 9.8 years. First, the “quality control circle” activity group was established to carry out quality control circle activity steps such as theme selection, plan formulation, status analysis, goal establishment, problem rectification, specific implementation, effect evaluation and effect evaluation. The database was established by software, and the t-test and chi square test were used for statistical analysis to compare the pre-operative instrument preparation rate of the two groups of patients undergoing cervical posterior single open-door laminoplasty. Finally, the improvement of team consciousness, nursing knowledge, nursing quality, consciousness response and other qualities of all circle members in the experimental group before and after the use of quality control circle activities were analyzed, and the clinical satisfaction of patients and their families, anesthesiologists and chief surgeons with the operation and the integrity rate of equipment preparation were compared between the two groups.
Results: The overall integrity rate of the instruments in the experimental group was 90%, and the overall integrity rate of the instruments in the control group was 74%. The integrity rate of the instruments in the experimental group was significantly higher than that in the control group (P < 0.01). After the implementation of quality control circle activities, the team consciousness, nursing knowledge, nursing quality and consciousness reaction of the circle members in the experimental group were significantly improved compared with those before the implementation of quality control circle activities, and the difference between the two groups was statistically significant (P < 0.01). The overall satisfaction of patients and their families, anesthesiologists, and chief surgeons in the experimental group was 92%, 88%, and 90%, and that of the control group was 76%, 68%, and 74%, respectively. The overall satisfaction of the experimental group was significantly higher than that of the control group (P < 0.05); The integrity rate of surgical instruments preparation in the experimental group was 90%, and that in the control group was 74%. The experimental group was significantly higher than the control group (P < 0.01).
Conclusion: The application of quality control circle activities can improve the integrity of instrument preparation for posterior cervical surgery, improve the satisfaction of patients, family members and medical staff, and improve the quality of surgical care.