"More is not always better": Park's sweet spot theory-driven implementation strategy for viable optimal safe nurse staffing policy in practice.

AIM: This paper aims to propose Park's sweet spot theory-driven implementation strategy, which makes optimal safe staffing policy really work in nursing practice. BACKGROUND: For the last 40 years, mainstream nursing workforce research has emphasized that having more registered nurses leads to better patient outcomes, and yet staffing policies have failed to implement this crucial concept. Meanwhile, global nursing shortages have become rampant, a problem that only dilutes the skill-mix ratios in the nursing workforce. Low fertility and an aging population worldwide are then accelerating these shortages. These dire circumstances may be persisting because of unclear, unsubstantiated cost-efficiency in the nursing workforce. For this reason, there remains a dearth of well-researched evidence for a clear threshold on optimal safe staffing levels that could maximize quality of care relative to cost given limited healthcare financial budgets and which could also be fitted into each care setting. Along with that, an implementation strategy for optimal safe staffing levels is nonexistent. SOURCES OF EVIDENCE: An implementation strategy has been developed through interdisciplinary consilience-based theory synthesis of both prospective theory and regulatory focus theory combined with Park's optimized nursing staffing (sweet spot) estimation theory. DISCUSSION/CONCLUSIONS: A theory-driven novel implementation strategy is proposed, which functions as a nudge strategy that uses the synchronous balance of quality of care, nurse staffing, and cost. It illustrates (1) how to create shared value among patients, nurses, and stakeholders through robust evidence-based, informed shared decision-making rationales on the optimal safe nurse staffing levels and (2) how to induce stakeholders to overcome resistance to innovation and improve their nursing workforce through value chain in management science. IMPLICATIONS FOR NURSING WORKFORCE POLICY: This novel implementation strategy may be a viable solution to mitigate the nursing shortage by leading stakeholders (1) to compete with each other (on the basis of nursing sufficiency) and (2) to competitively demonstrate the patient-centered value (patient-perceived care quality relative to cost) of their institutions.

How, scholar, do you want to be remembered by future generations?: Finding your own balance between the ownership of knowledge and the freedom to pursue economic interests.

To assume that copyright just protects "expressions," (unlike "ideas" protected by patents), may be misleading because a particularly ordered procedure is also protected by copyright law. The procedure as well as the image of Park's Sweet Spot Theory require prior written permission from the original copyright holder for its use. Because this would stymie future generations from building further on this idea, I returned the theory-based patent to society so that prospective research and development will have no hindrances in the establishment of new knowledge/solutions in nursing science.

Strategic Significance of Low Viral Load of Human Papillomavirus in Uterine Cervical Cytology Specimens.

Infection with high-risk (HR) Human Papillomavirus (HPV) is associated with the development of precancerous lesions or invasive carcinoma of the uterine cervix. Thus, the high viral load (VL) of HR-HPV DNA currently serves as a representative quantitative marker for cervical cancer. However, the clinical significance of low HPV DNA VL remains undetermined. This study aimed to evaluate the clinical association between the low HPV DNA VL and cytology/histologic diagnosis of cervical samples. We searched the electronic medical databases for the resultant analyses of HPV genotyping among patients who underwent treatment for any cervical lesion or who had undergone gynecological examinations with any positive HPV results according to the national cancer screening service between 2015 and 2016. HPV testing with genotyping and semi-quantitative VL measurement was conducted using an AnyplexTM II H28 Detection assay (H28 assay, Seegene, Seoul, Republic of Korea). The H28 assay is a multiplex semi-quantitative real-time PCR test using the tagging of oligonucleotide cleavage and extension (TOCE) technology. The VL was semi-quantified as high (3+; positive signal before 31 PCR cycles), intermediate (2+; positive between 31 and 39 PCR cycles), or low (1+; positive after 40 PCR cycles). Out of 5940 HPV VL analyses, 356 assays (5.99%) were reported as low VL (1+) of HPV DNA. Matched cytology diagnoses were mostly negative findings (n = 347, 97.5%), except for seven cases of atypical squamous cells of undetermined significance (1.9%) and two cases of atypical glandular cells (0.6%). During the follow-up periods, abnormal cytologic diagnoses were identified, including one case of high-grade squamous intraepithelial lesion (HSIL) and two low-grade squamous intraepithelial lesions (LSILs). The matched, confirmative histologic diagnosis of HSIL cytology was compatible with chronic inflammation, wherein the two LSILs had regular check-ups. None revealed clinically concerned outcomes associated with HPV-related squamous lesions. The cytology was most likely negative for malignancy when the VL of HPV DNA was low (1+). Additional strategic monitoring and management may thus be unnecessary.

Nursing policy and practice in Mongolia: Issues and the way forward.

Global inequality exists in the availability of a nursing workforce, supported evidentially by the ratio, in low-income countries, of only 9.1 nurses per 10 000 people versus 107.7 nurses per 10 000 people in high-income countries. Mongolia is no exception with 42.14 nurses per 10 000 people and a nursing shortage severe enough to endanger patient safety and well-being. This paper details both a policy analysis and contextually well-designed recommendations to strengthen Mongolia's nursing science and practice systems. Obstacles that significantly affect the successful development of nursing and midwifery professions in Mongolia include (1) a lack of strategic planning and regulation; (2) low status of nurses and midwives; (3) absence of professional representation for nurses and midwives; and (4) a dearth of strategic programs for postgraduate training of nurses and midwives. The suggested recommendations include the appointment of a chief nursing office within the government and a cohort of nurse leaders to work to establish a nursing and midwifery board as an independent, professional regulatory body in Mongolia to develop and implement standards to ensure best practice, higher standards of nurse education, and regulate the profession.

Diffusion of Innovations-Informed Knowledge Translation Strategy to Implement Optimal Safe Nursing Workforce Policy in Practice.

AIM: This study aims to develop a free, limited-edition workshop as an effective knowledge translation strategy to enhance nurse leader-perceived self-efficacy for competence using Park's Sweet Spot Theory and to evaluate its effectiveness over time. METHOD: This is a study showing the process of developing a study protocol and its details. RESULTS: A 2-day workshop was developed for innovators and early adopters among nurse leaders with a macro-level influence based on Rogers's diffusion of innovations theory, which consists of an introduction of Park's Sweet Spot Theory, hands-on experience, a summary session, and a presentation of a certificate of completion. The workshop will be held at the University of Alberta Faculty of Nursing, using the "enabling blends" mode. A hybrid design of comparative effectiveness research and analysis of change will be utilized to assess nurse leader-perceived self-efficacy. CONCLUSION: This protocol is significant as the first step in providing scientific rationales on how to effectively implement new knowledge-optimal safe nurse staffing levels derived from Park's Sweet Spot Theory-into the right (safe yet efficient) nursing workforce policy-making to alleviate global nursing shortages.

No more unimplementable nurse workforce planning.

Objective: This paper aims to spur thought-provoking practical debates on current nurse workforce staffing and scheduling systems in relation to a critical review of Ang and colleagues' (2018) article entitled "Nurse workforce scheduling in the emergency department: A sequential decision support system considering multiple objectives."Design: Discussion paper on a practical discourse in connection with the aforementioned published article.Discussion: Mathematical Programming (optimisation) (MP)-based nursing research has been published for nearly thirty years almost exclusively in industrial engineering or health business administration journals, demonstrating a widening gap between nursing research and practice. Nurse scientists' knowledge and skill of MP is insufficient, as are their interdisciplinary collaborations, setting back the advancement of nursing science. Above all, nurse scientists skilled in decision science are desperately needed for that analytic intellection which is rooted in the 'intrinsic nature and value of nursing care.' It is imperative that nurse scientists be well-prepared for the new age of the Fourth Industrial Revolution through both an education in MP and interdisciplinary collaboration with decision science experts in order to prevent potential stereotyped MP-based algorithm-driven destructive influences.Conclusions: The current global nursing shortage makes optimal nursing workforce staffing and scheduling more important. MP helps nurse executives and leaders to ensure the most efficient number of nurses with the most effective composition of nurse staffing at the right time for a reasonable cost. Nurse scientists urgently need to produce a new nursing knowledge base that is directly implementable in nursing practice.Impact Statement: Nurse scientists should take the leading role in producing the mathematical programming-integrated knowledge base that is directly implementable in practice.

International Nurses Day 2021 literary contribution: At a fork in the research journey: a poem in resistance to publishing in highly ranked journals.

In celebration of International Nurses Day 2021 and in critique of scholars who are driven to publish as many articles as possible in highly ranked journals, a short poem is offered here. This poem has resonance for the scholarly world in terms of questioning why we keep trying to be seen as successful scholars in the eyes of others employing a publish or perish mentality rather than pursuing the true purpose of our scholarly existence. The author asks nurses, 'Why are you doing science'?

Spiritual well-being promotion for older adults: Implication for healthcare policy makers' decision making on cost savings.

A spiritual well-being-based nursing intervention may boost older adults' resilience-based recovery. Its potential contribution may have positive knock-on effects: controlling skyrocketing healthcare costs; reducing the productive population's social burden of supporting the older adults; and alleviating a generational conflict. However, healthcare policy-makers are still skeptical about investing in those healthcare resources which would develop and implement a spiritual well-being-based nursing intervention for older adults. It is time for nurse scientists, as front-line gatekeepers for patients' omnidirectional well-being, to escape from thinking within the box by actively addressing first the feasibility, then the direct and indirect effectiveness on actual patient outcomes, and finally the cost efficiency of a spiritual well-being-based nursing intervention for the added benefit of easing the decision-making of healthcare policy-makers.

Association between sleep quality and nurse productivity among Korean clinical nurses.

AIMS: To determine the association between sleep quality and nurse productivity. BACKGROUND: Although poor sleep quality may decrease nurses' productivity, the association between the two has not yet been evaluated in the literature. METHODS: A cross-sectional survey was completed in May 2014 by 188 nurses working in acute hospitals in South Korea using the Pittsburgh Sleep Quality Index. Descriptive statistics, t tests, ANOVA, Pearson's correlation, and stepwise multiple regression were conducted for data analysis. RESULTS: The prevalence of poor sleep quality was high (79.8%). Among the components of sleep quality, sleep disturbances (ß = -0.19) and subjective sleep quality (ß = -0.16) were determined to be statistically significant predictive factors of nurse productivity, in addition to shift work (ß = -0.20) and age (ß = 0.32). CONCLUSION: Poor sleep quality may lead to lower nurse productivity. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders and executives should consider measures to improve nurses' sleep quality and enhance nurse productivity. Steps that need to be considered include longer intervals between shift-work cycles, clockwise scheduling order, a longer break time after night shift work, allowing nurses to nap before / during a night shift, and providing a worksite healthy sleep programme.

Factors Influencing Patient-Perceived Satisfaction With Community-Based Case Management Services.

This study aimed to identify factors that significantly affect patient-perceived satisfaction with community-based case management services and provide practical strategies for improving patient-perceived quality of care. Secondary data analyses were performed in 2010, 2013, 2015, and 2016, which included Pearson's and Spearman's correlation, Mann-Whitney U and Kruskal-Wallis tests, and stepwise multiple regression. The response variable was measured by the Korean Patient-Perceived Satisfaction Scale of Community-Based Case Management Services (Korean-PSCCM; a 10-level Likert-type scale), whereas explanatory variables were derived from prior studies. Significant predictors of patient-perceived satisfaction with community-based case management services included "capacity to change," "patient-perceived time spent with a case manager," "support/advocacy," "working period," and "emotional connectedness."

Growth Trajectories and Detrended Intraindividual Variability to Assess Case Managers' Competency in Continuing Education.

Tracking the effectiveness of CE over time beyond simply confirming its efficacy in continuing education (CE) in nursing is crucial. However, research evidence on the analysis of change of the effectiveness of CE over time is limited, particularly in the context of case management. This methodological study aimed to introduce both a growth curve modeling and an intra-individual variability index and demonstrate step-by-step procedures and interpretations of those analyses to assess case manager competency over time, using secondary data analysis. Data were collected from 22 case managers affiliated with the Korean National Health Insurance Corporation who attended three series of CE to improve their competency between May 2008 and August 2009. Unexpected results revealed a negative fixed effect of education level in the overall estimation of case managers' competency trajectory and a negative correlation between education level and case managers' intra-individual competency inconsistency over time. J Contin Nurs Educ. 2017;48(5):230-238.

Optimizing staffing, quality, and cost in home healthcare nursing: theory synthesis.

AIMS: To propose a new theory pinpointing the optimal nurse staffing threshold delivering the maximum quality of care relative to attendant costs in home health care. BACKGROUND: Little knowledge exists on the theoretical foundation addressing the inter-relationship among quality of care, nurse staffing, and cost. DESIGN: Theory synthesis. DATA SOURCES: Cochrane Library, PubMed, CINAHL, EBSCOhost Web and Web of Science (25 February - 26 April 2013; 20 January - 22 March 2015). IMPLICATIONS FOR NURSING: Most of the existing theories/models lacked the detail necessary to explain the relationship among quality of care, nurse staffing and cost. Two notable exceptions are: 'Production Function for Staffing and Quality in Nursing Homes,' which describes an S-shaped trajectory between quality of care and nurse staffing and 'Thirty-day Survival Isoquant and Estimated Costs According to the Nurse Staff Mix,' which depicts a positive quadric relationship between nurse staffing and cost according to quality of care. A synthesis of these theories led to an innovative multi-dimensional econometric theory helping to determine the maximum quality of care for patients while simultaneously delivering nurse staffing in the most cost-effective way. The theory-driven threshold, navigated by Mathematical Programming based on the Duality Theorem in Mathematical Economics, will help nurse executives defend sufficient nurse staffing with scientific justification to ensure optimal patient care; help stakeholders set an evidence-based reasonable economical goal; and facilitate patient-centred decision-making in choosing the institution which delivers the best quality of care. CONCLUSIONS: A new theory to determine the optimum nurse staffing maximizing quality of care relative to cost was proposed.

Korean Patient-Perceived Satisfaction Scale of Community-Based Case Management Services (Korean-PSCCM): Development and Psychometric Evaluation.

This study aimed to develop and psychometrically test an instrument for measuring patient-perceived satisfaction with community-based case management services in Korea. The study was conducted in 4 phases: Phase I, development of the instrument; Phase II, pilot testing of the instrument; Phase III, a large-scale study to test reliability and validity; and Phase IV, conversion of the new instrument from Korean to English. The new instrument was determined to have six factors-advocacy of case manager, outcome of care, communication skills, practice of a healthy lifestyle, referral, and recognition of risk factors-and also shown to be reliable.

Head-to-head comparison of udenafil vs amlodipine in the treatment of secondary Raynaud's phenomenon: a double-blind, randomized, cross-over study.

OBJECTIVE: RP is a reversible vasoconstriction of digital arteries that causes pain and skin discoloration. This study compared the efficacy of the new phosphodiesterase type 5 inhibitor udenafil with that of the calcium channel blocker amlodipine in the treatment of secondary RP. METHODS: A total of 29 patients with secondary RP associated with connective tissue diseases were enrolled in this double-blind, randomized, cross-over study. The patients were randomized to receive udenafil 100 mg/day or amlodipine 10 mg/day for 4 weeks. After a washout period they were crossed over to the other drug for another 4 weeks. The primary outcome was RP frequency before and after treatment. The secondary outcomes were RP condition scores, RP duration, number of digital ulcers, HAQ, physician global assessment and digital artery flow before and after treatment. RESULTS: Amlodipine and udenafil both decreased the rate of RP attack significantly. The drugs did not differ in terms of RP frequency or any of the secondary outcomes except for digital blood flow; udenafil improved it significantly better than amlodipine (P = 0.021). Udenafil was well tolerated without serious adverse effects. CONCLUSION: Udenafil and amlodipine have comparable efficacy in improving RP attacks. In addition, udenafil improves the blood flow in digital arteries compared with amlodipine. TRIAL REGISTRATION: www.clinicaltrials.gov, protocol number NCT01280266.