Nurses' perceptions of the design, implementation, and adoption of machine learning clinical decision support: A descriptive qualitative study.

INTRODUCTION: The purpose of this study was to explore nurses' perspectives on Machine Learning Clinical Decision Support (ML CDS) design, development, implementation, and adoption. DESIGN: Qualitative descriptive study. METHODS: Nurses (n = 17) participated in semi-structured interviews. Data were transcribed, coded, and analyzed using Thematic analysis methods as described by Braun and Clarke. RESULTS: Four major themes and 14 sub-themes highlight nurses' perspectives on autonomy in decision-making, the influence of prior experience in shaping their preferences for use of novel CDS tools, the need for clarity in why ML CDS is useful in improving practice/outcomes, and their desire to have nursing integrated in design and implementation of these tools. CONCLUSION: This study provided insights into nurse perceptions regarding the utility and usability of ML CDS as well as the influence of previous experiences with technology and CDS, change management strategies needed at the time of implementation of ML CDS, the importance of nurse-perceived engagement in the development process, nurse information needs at the time of ML CDS deployment, and the perceived impact of ML CDS on nurse decision making autonomy. CLINICAL RELEVANCE: This study contributes to the body of knowledge about the use of AI and machine learning (ML) in nursing practice. Through generation of insights drawn from nurses' perspectives, these findings can inform successful design and adoption of ML Clinical Decision Support.

Describing nurses' communication about evidence-based practice change: A social network analysis of hospital nurses.

BACKGROUND: Nurses play a critical role in providing evidence-based, high-quality care to optimize patient outcomes. Models from implementation science suggest social networks may influence the adoption of evidence-based practices (EBPs). However, few studies have examined this relationship among hospital nurses. Social network analysis (SNA) mathematically evaluates patterns of communication, a critical step in implementation. Exploring hospital nurses' communication networks may provide insight into influences on the adoption of EBPs. AIMS: This study aimed to describe complete communication networks of hospital nurses for practice changes on inpatient units, including upper level nursing administrators. METHODS: This descriptive, exploratory, cross-sectional study used SNA on two inpatient units from one hospital. A sociometric survey was completed by nurses (unit to executive level) regarding communication frequency about practice changes. Network-level density, diameter, average path length, centralization, and arc reciprocity were measured. Attribute data were used to explore subnetworks. RESULTS: Surveys from 148 nurses on two inpatient adult intensive care units (response rates 90% and 98%) revealed high communication frequency. Network measures were similar across the two units and among subnetworks. Analysis identified central (charge nurses and nurse leaders) and peripheral members of the network (new-to-practice nurses). Subnetworks aligned with the weekend and shift worked. LINKING EVIDENCE TO ACTION: Established communication channels, including subnetworks and opinion leaders, should be used to maximize and optimize implementation strategies and facilitate the uptake of EBPs. Future work should employ SNA to measure the impact of communication networks on promoting the uptake of EBP and to improve patient outcomes.

Nurses' perception of identity, practice and support needed in primary care: A descriptive qualitative study.

AIMS: To explore how primary care registered nurses (PCRNs) describe their professional identity, their perception of their practice, and the support they need to effectively perform the responsibilities of their role. DESIGN: A qualitative descriptive design using inductive content analysis. METHODS: Semi-structured interviews were conducted with registered nurses (n = 14) working in primary care settings in the United States between June 2018 and December 2020. Inductive content analysis was used and comprised three phases: preparation, organizing, and reporting. COREQ reporting guidelines were used. RESULTS: Three categories were discovered related to PCRN identity and practice: Wearing Multiple Hats, Practicing Within Bounds and Change is a Part of Practice. There were also three categories for support needed: Entering In, Ongoing Support and Making it a Better Place. Within each category, subcategories were identified. CONCLUSION: Primary care registered nurses have a unique professional identity and practice. When entering the setting, nurses must acquire the skills and knowledge to ask the right questions and navigate the system to meet the diverse and complex needs of their patients. PCRNs recognize change is a part of practice and have ideas and visions for what the role of PCRNs could be. IMPLICATIONS FOR PROFESSION: Recognizing the unique identity and practice of PCRNs is necessary to create an environment that leverages their skills and knowledge. IMPACT: We identified key elements of PCRN identity and practice and the support necessary to meet their needs. Healthcare organizations must ensure nurses new to the practice setting receive training and support for their unique and essential role. Additionally, leaders must partner with nurses to enhance nursing practice and achieve optimal patient outcomes. REPORTING METHOD: Adherence to COREQ guidelines were maintained. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

The State of Rest Break Practices Among 12-Hour Shift Hospital Nurses in the United States.

OBJECTIVE: This cross-sectional study aimed to explore the characteristics, content, and context of rest breaks taken by hospital nurses. BACKGROUND: Nurses often miss, skip, or take interrupted breaks. To improve the quality of breaks and promote within-shift recovery, it is important to understand current rest break practices including break activities and contextual challenges around them. METHODS: Survey data from 806 nurses were collected between October and November 2021. RESULTS: Most nurses did not take regular breaks. Rest breaks were often interrupted, spent being worried about work, and rarely resulted in a relaxed state. Common break activities were having a meal or a snack, and browsing the Internet. Regardless of workload, nurses considered patient acuity, staffing, and unfinished nursing tasks when deciding to take breaks. CONCLUSION: Rest break practices are of poor quality. Nurses mainly consider workload-related factors when taking breaks, which warrants the attention of nursing administration.

Psychological safety, communication openness, nurse job outcomes, and patient safety in hospital nurses.

Promoting psychological safety in a workplace is known to contribute to improved job outcomes across a wide variety of industries. This study aimed to examine the relationships between psychological safety at work and job outcomes (i.e., job satisfaction and intention to leave), and patient safety among hospital nurses; and to determine the mediating effect of communication openness on these relationships. This cross-sectional study used survey data from 867 hospital nurses working in the United States. Multiple logistic regression models and Hayes' PROCESS macro in SPSS were used. Nurses who worked in an environment with higher psychological safety levels were more likely to be satisfied in their current job, less likely to intend to leave their current job within the next year, and more likely to report favorable patient safety ratings. Communication openness mediated these relationships. When nurses feel psychologically safe at work, they are more likely to engage in open communication, which in turn can lead to greater job satisfaction, decreased turnover intention, and improved patient safety. Nurse managers should strive to develop leadership strategies that promote psychological safety in the work environment and support open communication among nurses.

Insomnia, fatigue and psychosocial well-being during COVID-19 pandemic: A cross-sectional survey of hospital nursing staff in the United States.

AIMS AND OBJECTIVES: To describe the levels of insomnia, fatigue and intershift recovery, and psychological well-being (burnout, post-traumatic stress and psychological distress), and to examine differences in these measures based on work-related characteristics among nursing staff during COVID-19 pandemic in the United States. BACKGROUND: The COVID-19 pandemic has created a major physical and psychological burden on nursing staff in the United States and worldwide. A better understanding of these conditions will lead to tailored support and resources for nursing staff during and after the pandemic. DESIGN: Cross-sectional study. METHODS: Hospital nurses and nursing assistants (N = 587) were recruited online between May-June 2020. The survey included measures on insomnia (Insomnia Severity Index) fatigue and intershift recovery (Occupational Fatigue and Exhaustion Recovery-15), burnout (Maslach Burnout Inventory-Human Services Survey), post-traumatic stress (Short Post-Traumatic Stress Disorder Rating Interview) and psychological distress (Patient Health Questionnaire-4), and questions on work and demographics. The STROBE checklist was followed for reporting. RESULTS: The sample had subthreshold insomnia, moderate-to-high chronic fatigue, high acute fatigue and low-to-moderate intershift recovery. The sample experienced increased emotional exhaustion and depersonalisation, increased personal accomplishment, moderate psychological distress and high post-traumatic stress. Nurses who cared for COVID-19 patients had significantly scored worse on almost all measures than their co-workers. Certain factors such as working hours per week and the frequency of 30-min breaks were significant. CONCLUSION: Nursing staff experienced poor sleep, fatigue and multiple psychological problems during the COVID-19 pandemic. Moreover, staff who were involved in the care of COVID-19 patients, worked more than 40 h per week and skipped 30-min breaks showed generally worse self-reported outcomes. RELEVANCE TO CLINICAL PRACTICE: Nursing administration is recommended to monitor for fatigue and distress on nursing units, re-visit current scheduling practices, reinforce rest breaks and provide access to mental health and sleep wellness resources with additional support for their front-line nursing groups.

Discussion-based interprofessional education: A positive step toward promoting shared understanding between surgical residents and nurses.

Interprofessional education during medical training may improve communication by promoting collaboration and the development of shared mental models between professions. We implemented a novel discussion-based intervention for surgical residents and nurses to promote mutual understanding of workflows and communication practices. General surgery residents and inpatient nurses from our institution were recruited to participate. Surveys and paging data were collected prior to and following the intervention. Surveys contained original questions and validated subscales. Interventions involved facilitated discussions about workflows, perceptions of urgency, and technology preferences. Discussions were recorded and transcribed for qualitative content analysis. Pre and post-intervention survey responses were compared with descriptive sample statistics. Group characteristics were compared using Fisher's exact tests. Eleven intervention groups were conducted (2-6 participants per group) (n = 38). Discussions achieved three aims: Information-Sharing (learning about each other's workflows and preferences), 2) Interpersonal Relationship-Building (establishing rapport and fostering empathy) and 3) Interventional Brainstorming (discussing strategies to mitigate communication challenges). Post-intervention surveys revealed improved nurse-reported grasp of resident schedules and tailoring of communication methods based on workflow understanding; however, communication best practices remain limited by organizational and technological constraints. Systems-level changes must be prioritized to allow intentions toward collegial communication to thrive.

Hospital staff nurse perceptions of resources and resource needs during the COVID-19 pandemic.

BACKGROUND: There is a knowledge gap related to the resource needs of hospital nurses working during the Coronavirus disease 2019 (COVID-19) pandemic. PURPOSE: To investigate nurses' perceptions of organizational resources and support needs approximately 18 months after the COVID-19 pandemic began. METHOD: Cross-sectional survey of a convenience sample of 2,124 U.S. hospital nurses from July to September 2021 FINDINGS: There were some misalignments between what resources were provided to nurses and what was perceived as helpful to them. Nurses reported increased staffing, compensation, and management and leadership support most frequently as resources that could help them continue to provide safe and quality care during and after the pandemic. These were also the resources nurses most frequently reported that they wanted to be provided by their hospitals during the pandemic but were not. DISCUSSION: The findings offer valuable insights into how organizations can prepare to ensure workforce resilience during future crises.

Impact of Home Blood Pressure Data Visualization on Hypertension Medical Decision Making in Primary Care.

PURPOSE: Evidence shows the value of home blood pressure (BP) monitoring in hypertension management. Questions exist about how to effectively incorporate these readings into BP follow-up visits. We developed and implemented a tool that combines clinical and home BP readings into an electronic health record (EHR)-integrated visualization tool. We examined how this tool was used during primary care visits and its effect on physician-patient communication and decision making about hypertension management, comparing it with home BP readings on paper. METHODS: We video recorded the hypertension follow-up visits of 73 patients with 15 primary care physicians between July 2018 and April 2019. During visits, physicians reviewed home BP readings with patients, either directly from paper or as entered into the EHR visualization tool. We used conversation analysis to analyze the recordings. RESULTS: Home BP readings were viewed on paper for 26 patients and in the visualization tool for 47 patients. Access to home BP readings during hypertension management visits, regardless of viewing mode, positioned the physician and patient to assess BP management and make decisions about treatment modification, if needed. Length of BP discussion with the visualization tool was similar to or shorter than that with paper. Advantages of the visualization tool included ease of use, and enhanced and faster sense making and decision making. Successful use of the tool required patients' ability to obtain their BP readings and enter them into the EHR via a portal, and an examination room configuration that allowed for screen sharing. CONCLUSIONS: Reviewing home BP readings using a visualization tool is feasible and enhances sense making and patient engagement in decision making. Practices and their patients need appropriate infrastructure to realize these benefits.

Occupational fatigue, individualized nursing care, and quality of nursing care among hospital nurses.

PURPOSE: This study aimed to evaluate the relationships among nurse fatigue, individualized nursing care, and nurse-reported quality of care. DESIGN: The study used a cross-sectional design. Data from 858 registered nurses providing bedside care in hospitals were collected between March and April 2021 in the United States. METHODS: Participants completed a self-administered online survey, including the Occupational Fatigue Exhaustion Recovery scale, the Individualized Care Scale-Nurse version, and a single item assessing nursing care quality. Relationships among the study variables were examined using multiple linear and logistic regression models. FINDINGS: Nurses' higher levels of acute fatigue were significantly associated with decreased perceptions of individualized nursing activities provided to patients on their last shifts, specifically related to personal life condition and decision-making control. Nurses' higher levels of chronic fatigue were significantly associated with decreased perception of individualized nursing activities provided to patients on their last shifts related to clinical condition, personal life condition, and decision-making control. Nurses with higher levels of acute or chronic fatigue, and who perceived their nursing care activities as less individualized were less likely to assess their quality of care as excellent. CONCLUSION: These findings suggest that addressing hospital nurses' acute and chronic fatigue may contribute to promoting the delivery of individualized nursing care and in improving patients' quality of care. CLINICAL RELEVANCE: Healthcare institutions are encouraged to regularly monitor and manage nurse fatigue to improve the delivery of individualized and quality nursing care to their patients.

Addressing Occupational Fatigue in Nurses: A User-Centered Design Approach for Fatigue Risk Management.

OBJECTIVE: To understand hospital nurses' current fatigue risk management (FRM), identify design goals and principles, and obtain feedback on FRM design concepts. BACKGROUND: FRM systems can address fatigue and associated risks, yet they are not widely implemented in hospital nursing. This may be due to a lack of contextually appropriate FRM tools. METHODS: A user-centered design approach was used, including interviews with 21 hospital nursing stakeholders. FINDINGS: Nurses described integrated fatigue monitoring and management activities to pursue balance between work demands and capacity to meet those demands as individual nurses, within the unit, across the hospital, and over time. Seven principles were identified and applied to 2 initial design concepts for tools to support FRM. Participants' feedback on designs was positive. CONCLUSIONS: This study advances the science and practice for FRM in nursing. The design principles and concepts from this study can be used to facilitate implementation of FRM systems in hospitals.

Occupational fatigue, workload and nursing teamwork in hospital nurses.

AIMS: To evaluate the relationships between workload, nursing teamwork and nurse fatigue and the moderating effect of nursing teamwork on the relationship between workload and fatigue. DESIGN: This cross-sectional online survey study used data from 810 United States hospital nurses collected between March and April 2021. METHODS: Workload, nursing teamwork and fatigue were measured using the Quantitative Workload Inventory, the Nursing Teamwork Survey, and the Occupational Fatigue Exhaustion Recovery scale. Hierarchical multiple linear regression models were used. RESULTS: All the nursing teamwork subscales (i.e. trust, team orientation, backup, shared mental model, team leadership) were significantly negatively related to acute and chronic fatigue. Nursing teamwork components of team orientation, shared mental model and team leadership moderated the relationship between workload and chronic fatigue. The relationships between workload and chronic fatigue were stronger when these components of nursing teamwork were high. No moderating effects were found with acute fatigue. CONCLUSION: Efforts to increase nursing teamwork may be a promising strategy in managing nurse fatigue. It is equally important to monitor and modify high workload to protect nurses from elevated fatigue. IMPACT: WHAT PROBLEM DID THE STUDY ADDRESS?: Fatigue is negatively associated with the health and safety of hospital nurses and patients. Nursing teamwork has been shown to improve the nursing care of hospitalized patients; yet, it is rarely explored in relation to nurse fatigue. WHAT WERE THE MAIN FINDINGS?: Greater nursing teamwork is significantly associated with lower acute and chronic fatigue. The relationships between workload and chronic fatigue were stronger when nursing teamwork (i.e. team orientation, shared mental model and team leadership) was high than when nursing teamwork was low. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: Improving nursing teamwork, in addition to monitoring and modifying workloads, can be a promising approach for managing fatigue in healthcare organizations.

The insomnia, fatigue, and psychological well-being of hospital nurses 18 months after the COVID-19 pandemic began: A cross-sectional study.

BACKGROUND: Research has shown sleep problems, elevated fatigue, and high cases of burnout, as well as signs of post-traumatic stress and psychological distress among nurses during the COVID-19 pandemic. Many US hospitals attempted to minimise its impact on staff by providing basic resources, mental health services, and wellness programs. Therefore, it is critical to re-evaluate these well-being indices and guide future administrative efforts. PURPOSE: To determine the long-term impact of the COVID-19 pandemic after 18 months on hospital nurses' insomnia, fatigue, burnout, post-traumatic stress, and psychological distress. DESIGN: Cross-sectional. METHODS: Data were collected online mainly through state board and nursing association listservs between July-September 2021 (N = 2488). The survey had psychometrically tested instruments (Insomnia Severity Index, Occupational Fatigue Exhaustion Recovery Scale, Maslach Burnout Inventory, Short Post-Traumatic Stress Disorder, and Patient Health Questionnaire-4) and sections on demographics, health, and work. The STrengthening the Reporting of Observational studies in Epidemiology checklist was followed for reporting. RESULTS: Nurses had subthreshold insomnia, moderate-to-high chronic fatigue, high acute fatigue, and low-to-moderate intershift recovery. Regarding burnout, they experienced increased emotional exhaustion and personal accomplishment, and some depersonalisation. Nurses had mild psychological distress but scored high on post-traumatic stress. Nurses who frequently cared for patients with COVID-19 in the past months scored significantly worse in all measures than their co-workers. Factors such as nursing experience, shift length, and frequency of rest breaks were significantly related to all well-being indices. CONCLUSION: Nurses' experiences were similar to findings from the early pandemic but with minor improvements in psychological distress. Nurses who frequently provided COVID-19 patient care, worked ≥12 h per shift, and skipped rest breaks scored worse on almost all well-being indices. RELEVANCE TO CLINICAL PRACTICE: Administration can help nurses' recovery by providing psychological support, mental health services, and treatment options for insomnia, as well as re-structure current work schedules and ensure that rest breaks are taken.

Primary care nurses' perception of leadership and the influence of individual and work setting characteristics: A descriptive study.

AIMS: The aim of this study is to describe primary care nurses' perceptions of their formal leaders' leadership behaviours and outcomes and explore differences based upon nurses' individual and work setting characteristics. BACKGROUND: Formal nursing leadership is positively associated with patient, nurse workforce and organizational outcomes, yet no studies have examined primary care nurses' perception of formal leadership behaviours and outcomes in the United States. METHODS: Cross-sectional survey data from 335 primary care nurses were analysed to assess perceived leadership behaviours associated with transformational, transactional and passive-avoidant leadership styles, perceived leadership outcomes and individual and work setting characteristics. RESULTS: Positive leadership behaviours (transformational) were lower than those reported for other settings. There were significant differences in nurses' perceptions of their leaders' leadership behaviours and outcomes based upon individual and work setting characteristics. CONCLUSION: This study confirmed differences in perception of leadership and that individual and work setting characteristics influence nurses' perception of their leaders in primary care. IMPLICATIONS FOR NURSING MANAGEMENT: Leaders must be versatile and consider the unique needs of each staff member and the influence of clinic characteristics.

Risky Business: A Mediated Model of Antecedents and Consequences of Presenteeism in Nursing.

BACKGROUND: Nurses are a high-risk group for presenteeism: When one is present at work but not fully engaged. Presenteeism can occur because of multiple work, personal, and event factors and is linked to negative nurse, patient, and organizational outcomes. A model that accounts for the multiple antecedents that lead to presenteeism, as well as its consequences, is needed. OBJECTIVE: The aim of this study was to evaluate our proposed presenteeism in nursing model among registered nurses in the United States by examining the fit of the data with the model. METHODS: Four hundred forty-seven registered nurses who provide direct patient care completed a cross-sectional survey on presenteeism, its antecedents and consequences, and demographics. Structural equation modeling was used to test relationships in the proposed model and overall model fit. RESULTS: The presenteeism in nursing model holistically accounted for significant presenteeism antecedents and consequences. There were significant relationships between work environment, perceived stress and work-life balance, and presenteeism. There were also significant relationships between presenteeism and missed care, and burnout. DISCUSSION: These relationships align with prior research and identify antecedents and consequences of presenteeism. This model can be used by practitioners and researchers to develop interventions addressing presenteeism to improve health system, nurse, and patient outcomes.

Home blood pressure data visualization for the management of hypertension: using human factors and design principles.

BACKGROUND: Home blood pressure measurements have equal or even greater predictive value than clinic blood pressure measurements regarding cardiovascular outcomes. With advances in home blood pressure monitors, we face an imminent flood of home measurements, but current electronic health record systems lack the functionality to allow us to use this data to its fullest. We designed a data visualization display for blood pressure measurements to be used for shared decision making around hypertension. METHODS: We used an iterative, rapid-prototyping, user-centred design approach to determine the most appropriate designs for this data display. We relied on visual cognition and human factors principles when designing our display. Feedback was provided by expert members of our multidisciplinary research team and through a series of end-user focus groups, comprised of either hypertensive patients or their healthcare providers required from eight academic, community-based practices in the Midwest of the United States. RESULTS: A total of 40 participants were recruited to participate in patient (N = 16) and provider (N = 24) focus groups. We describe the conceptualization and development of data display for shared decision making around hypertension. We designed and received feedback from both patients and healthcare providers on a number of design elements that were reported to be helpful in understanding blood pressure measurements. CONCLUSIONS: We developed a data display for substantial amounts of blood pressure measurements that is both simple to understand for patients, but powerful enough to inform clinical decision making. The display used a line graph format for ease of understanding, a LOWESS function for smoothing data to reduce the weight users placed on outlier measurements, colored goal range bands to allow users to quickly determine if measurements were in range, a medication timeline to help link recorded blood pressure measurements with the medications a patient was taking. A data display such as this, specifically designed to encourage shared decision making between hypertensive patients and their healthcare providers, could help us overcome the clinical inertia that often results in a lack of treatment intensification, leading to better care for the 35 million Americans with uncontrolled hypertension.

Did rest breaks help with acute fatigue among nursing staff on 12-h shifts during the COVID-19 pandemic? A cross-sectional study.

AIM: This study aimed to explore whether 30-min rest breaks were as effective at lowering acute fatigue among 12-h shift hospital nursing staff who cared for patients with COVID-19 as among those who did not. DESIGN: The study was cross-sectional in design. METHODS: Data from the SAFE-CARE study collected online between May and June 2020 were used. A subsample (N = 338) comprised of nursing staff who reported working 12-h shifts, and providing direct patient care in hospitals was used in this study. Data on socio-demographics, work and rest breaks, and subjective measures of fatigue, psychological distress, sleep and health were used. Hierarchical multiple linear regression followed by stratified analyses was conducted to explore the relationships between rest breaks and acute fatigue among nursing staff groups with and without COVID-19 patient care. RESULTS: The sample, on average, had high acute fatigue. Around 72% reported providing care to patients with COVID-19, and 71% reported taking rest breaks 'sometimes', 'often' or 'always'. In the group that cared for patients with COVID-19, there was no significant relationship between rest breaks and acute fatigue (p = .507). In the group that cared for patients hospitalized for other reasons, rest breaks were associated with lower acute fatigue (p = .010). CONCLUSION: Our findings showed both the importance and inadequacy of rest breaks in reducing acute fatigue. The process of within-work recovery is complex, and routine rest breaks should be facilitated by nursing management on hospital units during and after the COVID-19 pandemic. IMPACT: Rest breaks may present an effective strategy in lowering fatigue. Although rest breaks were not associated with less fatigue among staff caring for patients with COVID-19, other co-workers experienced some fatigue recovery. For frontline nursing staff, routine rest breaks are encouraged, and a systematic evaluation pertaining the sufficiency of rest breaks during high work demands in future research is needed.

Changes in Fatigue Levels and Sleep Measures of Hospital Nurses During Two 12-Hour Work Shifts.

OBJECTIVE: The aims of this study were to explore nurses' fatigue levels and sleep measures during two 12-hour consecutive day shifts and examine the relationships between nurses' fatigue levels within shifts and their previous-night sleep characteristics. BACKGROUND: Monitoring changes in fatigue and sleep is important to enable effective fatigue management. METHODS: This was a descriptive, repeated-measures study. Data were collected using surveys and actigraphy 4 times during each consecutive shift (7:00 am-7:30 pm). RESULTS: General fatigue levels started trending up 4 hours after the start of work; highest levels were reported at 7:30 pm. Fatigue levels accumulated across consecutive shifts. Subjective sleep quality was higher the night before the 2nd shift than the night before the 1st shift. Nurses' poor sleep the night before a shift was related to increased fatigue levels during the next shift. CONCLUSION: It is important to consider when fatigue management interventions will be most effective and to consider previous-night's sleep when monitoring fatigue.

The realities of practice change: Nurses' perceptions.

AIMS AND OBJECTIVES: To explore registered nurses' perceptions of practice change and describe factors that influence the adoption of practice changes. BACKGROUND: Nurses play a critical role in optimising patient outcomes. Healthcare organisations and nurses must do their part to achieve the Quadruple Aim, which requires nurses to change their practice. Nurses are ideally positioned to improve patient outcomes by changing their practice to align it with research evidence and organisational initiatives; however, this experience of practice change by nurses is grossly under-studied. DESIGN: A qualitative design, inductive content analysis, was used to understand nurses' perceptions of practice change. METHODS: Eleven registered nurses, who worked in one hospital system, participated in one-on-one semi-structured interviews. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) were followed. FINDINGS: The 11 participants described 63 distinct experiences with practice changes. Their experiences with and perceptions of practice change are categorised as (1) There is A History; (2) It's A Lot of Work; (3) It Happens to Nurses; and (4) Doing Right for the Patient. CONCLUSION: Nurses experience practice change as a central part of the work they do; it occurs frequently and multiple practice changes may co-occur. Nurses identify strategies, such as thoughtful planning, engaging nurses, and communicating the rationale for and the outcomes of the practice change, to facilitate changing practice. RELEVANCE TO CLINICAL PRACTICE: Involving nurses in practice changes could alleviate some inhibiting factors for adopting new practices. Local hospital and national policies should explore creative and practical ways to balance the competing needs of nurses providing direct care at the bedside and dedicated time to be engaged in practice change initiatives. With the ongoing focus on improving patient care and optimising patient safety, nurses should be viewed as highly valued members of the team when designing and implementing practice changes.

Older adults experiences with ambulation during a hospital stay: A qualitative study.

Older adults often lose their ability to independently ambulate during a hospital stay. Few studies have investigated older adults' experiences with ambulation during hospitalization. The purpose of this study was to understand older adults' perceptions of and experiences with ambulation during a hospital admission. A qualitative study using Inductive Content Analysis was conducted. Community-dwelling older adults (N = 11) were recruited to participant in five focus group meetings each lasting 90 min. All individuals participated in each focus group. Participants described high complexity in deciding whether or not they could ambulate. Six categories were identified: Uncertainty, Restriction Messaging, Non-Welcoming Space, Caring for Nurse and Self, Feeling Isolated, and Presenting Self. This study provides a detailed understanding of older adults' experiences and perceptions of a hospital stay. Findings from this study can serve as a foundation for future interventions to improve older adult patient ambulation during hospitalization.