Key elements to support primary healthcare nurses to thrive at work: A mixed-methods sequential explanatory study.

AIM: Develop evidence-based recommendations for managers to support primary healthcare nurses to thrive at work. DESIGN: A mixed-methods sequential explanatory design. METHODS: National data were collected in 2020 via an e-survey based on a meta-analysis of antecedents of thriving from 213 primary healthcare nurses across New Zealand. Structural equation modelling analysis identified the key factors supporting primary healthcare nurses to thrive. This informed a second open-ended e-survey in 2022 of 19 nurses from one primary healthcare organization. The thematic analysis provided recommendations for improving management strategies to support thriving primary healthcare nurses. RESULTS: The vitality component of thriving significantly reduced burnout and intention to leave organization and profession. In contrast, the learning component of thriving had a significant positive effect on burnout. The key factors that support thriving at work are empowering leadership and perceived organizational supports (decreases burnout and intention to leave organization and profession through enhanced vitality). Recommendations for improving thriving were made in eight key areas: communication, effective management, professional development, scope of practice, autonomy, effective orientation, reward and work-life balance. CONCLUSIONS: Vitality is important in reducing burnout and turnover intentions. While learning was identified as increasing burnout, professional development and training for managers were identified as essential. Hence, the vitality dimension of the thriving at work construct should be studied at the dimension level, but more research is needed into the impact of learning on thriving over time. Primary healthcare nurses have identified that empowering leadership and perceived organizational support are critical factors in supporting them to thrive, and they provide specific recommendations for managers to improve these factors in the clinical setting. NO PATIENT OR PUBLIC CONTRIBUTION: This study collected data from Registered Nurses only. WHAT IS ALREADY KNOWN: A plethora of existing research focuses on resilience in nurses rather than thriving at work. Enabling employees to thrive at work contributes to improved well-being and sustainable organizational performance. WHAT THIS PAPER ADDS: Empowering leadership and perceived organizational support are the key factors that support primary healthcare nurses to thrive at work. The vitality dimension of the thriving at work construct should be studied at the dimension level, and further research is needed into the impact of learning on thriving over time. Primary healthcare nurses recommend that managers focus on improving communication, management efficiency, professional development, scope of practice, autonomy, orientation, reward and work-life balance.

Support mechanisms that enable emergency nurses to cope with aggression and violence: Perspectives from New Zealand nurses.

BACKGROUND: Although efforts to reduce aggression and violence in emergency departments are important, it is also critical to minimise harm and support staff where this occurs. This research describes support mechanisms emergency nurses value when they experience occupational aggression and violence. METHODS: A mixed-methods design including thematic analysis of six interviews and descriptive analysis of fifty-one surveys, with experienced emergency nurse participants and respondents from a single large urban emergency department. RESULTS: Four key themes summarised coping with aggression and violence: Minimising exacerbating factors (mental health, lack of understanding of zero tolerance in practice, and wait times); Support before violence (use of huddles and having experienced nurses on each shift); Support during violence (education including restraint, self-defence, de-escalation and legalities); and Support after violence (debriefing, incident reporting and a sense of 'toughness') CONCLUSION: Emergency nurses need preparation and support to competently manage complex mental health presentations, understand legal rights, communicate effectively with patients, families and colleagues and access event debriefing. Security staff are valued team members but also need adequate resourcing and preparation.

Policy recommendations to ensure that research software is openly accessible and reusable.

Research data is optimized when it can be freely accessed and reused. To maximize research equity, transparency, and reproducibility, policymakers should take concrete steps to ensure that research software is openly accessible and reusable.

Intersectionality and nursing leadership: An integrative review.

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

What Are the Three Most Essential Elements to Implants in the Esthetic Zone?

There are many essential elements to achieving long-lasting esthetic and physiologic outcomes in implant dentistry in the esthetic zone. Here are three specialists take on the three most essential elements to implants in the esthetic zone.

Daily Work-Family Conflict and Burnout to Explain the Leaving Intentions and Vitality Levels of Healthcare Workers: Interactive Effects Using an Experience-Sampling Method.

There is an intensification of work in global health systems, a phenomenon that could increase work-family conflict, exhaustion, and intentions to leave among healthcare workers. The main objective of this study is to analyze if daily work-family conflict and burnout could explain the daily leaving intentions and vitality of healthcare workers. This is a diary study, which employs an experience-sampling methodology (ESM). A total of 56 physicians, nurses, and nursing aides from intensive care and nephrology units filled out various quantitative scales during 5 working days (56 × 5 = 280 observations). Multilevel hierarchical analysis showed that daily work-family conflict and burnout were significantly associated with higher daily intentions of leaving the profession, and with lower levels of daily vitality. In addition, those workers who experienced more work-family conflict and depersonalization on a daily basis were those who showed more intentions to leave and less daily vitality, showing an interactive effect. The results highlight the importance of examining the psychosocial risks experienced by healthcare workers by employing experience-sampling methodologies, which could help us to deepen our understanding of the proximal antecedents of their intentions to leave and their psychological well-being.

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

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

An Integrative Review of How Healthcare Organizations Can Support Hospital Nurses to Thrive at Work.

BACKGROUND: Solutions that address the anticipated nursing shortage should focus on thriving at work: a positive psychological state characterized by a sense of vitality and learning, resulting in higher levels of work engagement, commitment, and wellbeing. PURPOSE: To synthesize international evidence on organizational factors that support hospital nurse wellbeing and to identify how the Social Embeddedness of Thriving at Work Model can support health managers to develop management approaches that enable nurses to thrive. METHOD: Conduct an integrative review of literature published between 2005-2019. RESULTS: Thematic analysis identified five key themes: (1) Empowerment; (2) Mood of the organization; (3) An enabling environment; (4) Togetherness with colleagues; and (5) Leaders' connectivity. CONCLUSIONS: The Social Embeddedness of Thriving at Work Model supports managers to develop management approaches that enable their nurses to thrive. Health managers should consider strategies to support nurses to thrive at work to improve nurse work engagement and wellbeing.

Developing clinical leadership in New Zealand hospice staff nurses.

BACKGROUND: Staff nurse clinical leadership is a relatively new concept that includes the elements of collaboration, coordination, patient advocacy, and often quite autonomous decision-making required of palliative care nurses. Staff nurses need structural and psychological empowerment to develop as clinical leaders. AIMS: The aim of this study was to establish baseline data regarding the self-perceived structural and psychological empowerment experienced by New Zealand hospice staff nurses and their ability to practise as clinical leaders. METHODS: An explanatory sequential mixed-methods design was used, which included questionnaires measuring structural and psychological empowerment and clinical leadership behaviours and focus group discussions. FINDINGS: Survey respondents reported that they were moderately psychologically and sometimes or rarely structurally empowered and felt that they can practise as clinical leaders most of the time. Two themes were identified from the focus groups. CONCLUSION: New Zealand staff hospice nurses felt that-despite feeling only moderately psychologically empowered, and only sometimes or rarely structurally empowered-they practise as clinical leaders most of the time.

Blended learning via distance in pre-registration nursing education: A scoping review.

Prior to the Covid-19 global pandemic, we reviewed literature and identified comprehensive evidence of the efficacy of blended learning for pre-registration nursing students who learn across distances and/or via satellite campuses. Following a methodological framework, a scoping literature review was undertaken. We searched six databases (EBSCOHOST (CINHAL plus; Education research Complete; Australia/New Zealand Reference Centre); Google Scholar; EMBASE (Ovid) [ERIC (Ovid); Medline (Ovid)]; PubMed: ProQuest Education Journals & ProQuest Nursing & Allied Health Source) for the period 2005-December 2015. Critical appraisal for critiquing qualitative and quantitative studies was undertaken, as was a thematic analysis. Twenty-eight articles were included for review, which reported nursing research (n = 23) and student experiences of blended learning in higher education (n = 5). Four key themes were identified in the literature: active learning, technological barriers, support, and communication. The results suggest that when delivered purposefully, blended learning can positively influence and impact on the achievements of students, especially when utilised to manage and support distance education. Further research is needed about satellite campuses with student nurses, to assist with the development of future educational practice.

Advancing health information technology roadmaps in long term care.

BACKGROUND: Our purpose is to provide evidence that health information technology should be a mainstay of all future health and social support services for older people globally, both within and across community and residential care services. METHODS: This work was conducted in two phases. In phase I, the authors conducted a focused exploration by selecting a convenience sample of four long term care health information technology roadmaps, developed by members of four different long term care health information technology collaboratives in United States, Australia, United Kingdom, and New Zealand. During Phase II the research team carried out an extensive systematic review of existing literature sources (2000-2018) to support roadmap assumptions. RESULTS: Using converging domains and content, we offer recommendations among five aged care roadmap domains: Strategy/Vision, Continuing Care Community, Services and Support Provided, External Clinical Support, and Administrative. Within these domains we provide recommendations in five content areas: Innovation, Policy, Evaluation, Delivery Systems and Human Resources. We recommend future strategies for LTC HIT roadmaps that include 61 emphasis areas in aged care in these content areas and domains. CONCLUSIONS: The roadmap provides a navigation tool for LTC leaders to take a strategic and comprehensive approach as they harness the potential of health information technologies to address the challenges and opportunities of LTC in the future.

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

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

An interprofessional perspective on job satisfaction in the operating room: a review of the literature.

Maintaining job satisfaction across the team in the operating room (OR) is essential for reducing staff turnover, stress, burnout, medical errors and increasing patient satisfaction. This literature review explores factors impacting on job satisfaction for OR team members, with a specific focus on nurses, anaesthetists and surgeons. A literature search from January 1997 to November 2017 was conducted using databases CINHAL, psychINFO, Medline and ABI/inform. Surgeon, anaesthetist, OR nurse and OR team job satisfaction studies were included. The search yielded 48 studies. Dominant contributing factors for all three disciplines included: work conditions, support and acknowledgement from management, and fulfilment from the clinical role. Career prospects, research opportunities, autonomy, utilising the full extent of one's skills, team dynamics/communication, pressure from management, and social support systems were also identified as significant for specific disciplines within the team. This review highlights the importance of addressing factors relating to job satisfaction from an 'OR team' perspective and considering the inter-relationship between roles. Further research into 'team satisfaction' in the OR, its measurement and its relationship with retention and productivity would be of benefit.

Clinical leadership, structural empowerment and psychological empowerment of registered nurses working in an emergency department.

AIM: To examine clinical leadership of registered nurses in an emergency department, based on evidence that it is important for nurses to feel psychologically and structurally empowered in order to act as clinical leaders. BACKGROUND: Every registered nurse has the ability to act as a clinical leader. Clinical leadership is the registered nurse's behaviours that provide direction and support to patients and the team in the delivery of patient care. This study explores the connection between the need for structural and psychological empowerment and clinical leadership behaviours. METHODS: A mixed method, non-experimental survey design was used to examine the psychological empowerment, structural empowerment and clinical leadership of registered nurses working in an emergency department. RESULTS: Emergency department nurses believe they show clinical leadership behaviours most of the time, even though their sense of being psychologically empowered is only moderate. CONCLUSION: While registered nurses believe they perform clinical leadership behaviours, it is also clear that improvements in structural and psychological empowerment would improve their ability to act as clinical leaders. IMPLICATIONS FOR NURSING MANAGEMENT: The results show that for nurses to be able to provide clinical leadership to their patients and colleagues, management must create empowering environments.

Using benchmarking to assist the improvement of service quality in home support services for older people-IN TOUCH (Integrated Networks Towards Optimising Understanding of Community Health).

Service providers and funders need ways to work together to improve services. Identifying critical performance variables provides a mechanism by which funders can understand what they are purchasing without getting caught up in restrictive service specifications that restrict the ability of service providers to meet the needs of the clients. An implementation pathway and benchmarking programme called IN TOUCH provided contracted providers of home support and funders with a consistent methodology to follow when developing and implementing new restorative approaches for service delivery. Data from performance measurement was used to triangulate the personal and social worlds of the stakeholders enabling them to develop a shared understanding of what is working and what is not. The initial implementation of IN TOUCH involved five District Health Boards. The recursive dialogue encouraged by the IN TOUCH programme supports better and more sustainable service development because performance management is anchored to agreed data that has meaning to all stakeholders.

Postanesthesia Scoring Methods: An Integrative Review of the Literature.

PURPOSE: Internationally there is no consensus on the indicators essential for determining safe recovery from anesthesia and patient readiness for discharge from the postanesthesia care unit (PACU). DESIGN: Integrative review. METHODS: Using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) as a search strategy, the literature related to PACU discharge scores were evaluated and organized into themes. FINDINGS: The traditional components of airway support, oxygenation, sedation, and circulation are common within many first stage PACU discharge scores. However, there is strong support from the literature for components such as heart rate, temperature, pain, postoperative nausea and vomiting (PONV), urine output, and surgical site assessment to also be included. The review revealed that there is no standardized time frequency in applying a first stage PACU discharge score to patients within the PACU environment. CONCLUSIONS: There is a need for the development and trial of an evidence based first stage PACU discharge score.

Randomised trial of restorative home care for frail older people in New Zealand.

Aim To establish the effectiveness of a restorative home support service on institutional-free survival in frail older people referred for needs assessment. Method A randomised controlled trial of Community Flexible Integrated Responsive Support Team versus usual care in 113 older people at risk of institutionalisation in New Zealand. Primary outcome was death or permanent institutional care evaluated in a Cox proportional hazards model adjusted for baseline prognostic variables. A variety of secondary outcomes including the health of informal caregivers were also evaluated. Results The primary outcome was lower, but not statistically significant, in the intervention group (adjusted hazard ratio 0.69, 95% confidence interval 0.4 to 1.16). Informal caregivers of interventional participants had significantly better physical and mental component scores on the 36-item Short-Form questionnaire. Conclusion Restorative home support may reduce the risk of death and institutionalisation in frail older people without affecting the health of informal caregivers.

Magnetorheological finishing of chemical-vapor deposited zinc sulfide via chemically and mechanically modified fluids.

We describe the anisotropy in the material removal rate (MRR) of the polycrystalline, chemical-vapor deposited zinc sulfide (ZnS). We define the polycrystalline anisotropy via microhardness and chemical erosion tests for four crystallographic orientations of ZnS: (100), (110), (111), and (311). Anisotropy in the MRR was studied under magnetorheological finishing (MRF) conditions. Three chemically and mechanically modified magnetorheological (MR) fluids at pH values of 4, 5, and 6 were used to test the MRR variations among the four single-crystal planes. When polishing the single-crystal planes and the polycrystalline with pH 5 and pH 6 MR fluids, variations were found in the MRR among the four single-crystal planes and surface artifacts were observed on the polycrystalline material. When polishing the single-crystal planes and the polycrystalline with the modified MR fluid at pH 4, however, minimal variation was observed in the MRR among the four orientations and a reduction in surface artifacts was achieved on the polycrystalline material.