Why reducing avoidable hospital readmissions is a 'wicked' problem for leaders: A qualitative exploration of nursing and allied health perceptions.

AIMS: To investigate nursing and allied health professional perceptions of the interrelationship between avoidable hospital readmissions and fundamental care delivery. DESIGN: A qualitative, exploratory study using a critical realist approach. METHOD: One-to-one semi-structured interviews with 14 nursing and allied health professionals conducted between May and September 2019. RESULTS: Several tensions and contradictions were identified in the data, which demonstrated clinicians' perceptions about the priority of both fundamental care and two avoidable readmission conditions (aspiration pneumonia and constipation). These tensions are illustrated in two major themes: Avoidable versus inevitable; and everyone versus no one. The first theme demonstrates clinicians' perceptions that readmissions for aspiration pneumonia and constipation are not common, despite acknowledging that they generally lacked knowledge on readmission rates; and that these conditions may not be preventable in acute settings. The second theme demonstrates clinicians' perception that preventing readmissions is everyone's responsibility, however, this was coupled with a lack of articulation around how this multidisciplinary approach could be achieved, leading to a distinct lack of agency for care delivery. CONCLUSION: Articulating the tensions described in the results provides vital knowledge for understanding how clinicians may respond to initiatives designed to reduce avoidable readmissions. Avoidable hospital readmissions may be usefully understood as a wicked problem: one that is complex and requires adaptive, not linear, solutions. Wicked problems pose a challenge for leaders and managers in healthcare because top-down, hierarchical strategies are unlikely to be successful. Effective prevention of avoidable readmissions requires leaders to enable facilitator-led change through relational leadership strategies. IMPACT: Avoidable hospital readmissions are a global problem increasingly addressed via funding changes and the introduction of penalties to hospitals. This study provides insights on clinicians' perspectives of avoidable hospital readmissions and their prevention, demonstrating the complexity of this challenge and the need for healthcare leaders to enable individual and organizational readiness for change.

Contextual factors associated with organizational learning in hospitals: An instrument development study.

AIM: Develop a valid, reliable research instrument to measure contextual factors associated with organizational learning in hospitals. BACKGROUND: A valid, reliable instrument for measuring contextual factors associated with organizational learning is needed so nurse leaders and researchers can improve healthcare by facilitating and studying organizational learning. METHODS: The Organizational Learning in Hospitals model guided development of the Organizational Learning Instrument-Context. Content validity was refined and evaluated through cognitive interviews and expert reviews. The instrument was distributed to direct care nurses in Magnet® hospitals in the United States. Intraclass correlation coefficients validated the use of multilevel analyses. Construct validity was assessed using multilevel confirmatory factor analysis, and coefficient omega was used to assess internal reliability. RESULTS: Participants were 1063 nurses in 120 inpatient units in 11 Magnet® hospitals. Results were as follows: item-level content validity = 0.86-1.0, scale-level content validity = 0.95, intraclass correlation coefficients = 0.171-0.270, coefficient omega = 0.945-0.982 and standardized factors loadings = 0.672-0.964. Model fit statistics were CFI = 0.963, TLI = 0.961 and RMSEA = 0.059. [Correction added on 31 May 2022, after first online publication: In the first line of the 'Results' section, "163 nurses" has been corrected to "1063 nurses" in this version.] CONCLUSIONS: Initial testing indicates the Organizational Learning Instrument-Context has adequate levels of reliability, content validity and construct validity. IMPLICATIONS FOR NURSING MANAGEMENT: Hospital leaders and researchers may begin using this instrument to improve and study contextual factors associated with organizational learning in hospital units.

Mechanisms of organisational learning in hospitals: An instrument development study.

AIM: To develop a valid, reliable research instrument to measure mechanisms associated with organisational learning in hospitals. BACKGROUND: A valid, reliable instrument for measuring mechanisms of organisational learning would enable nurse leaders and researchers to improve health care through facilitation and study of organisational learning. METHODS: The Organizational Learning in Hospitals model was used as a framework to develop the Organizational Learning Instrument-Mechanisms. Cognitive interviews and expert reviews were used to refine and evaluate item-level and scale-level content validity. The instrument was distributed by email to a random sample of nurses working in inpatient hospitals in Utah (n = 1253). Confirmatory factor analysis was used to assess construct validity, and coefficient alpha was used to assess internal reliability. RESULTS: Item-level content validity scores were .88 to 1.0, and scale-level content validity was .98 (maximum score = 1.0). Standardized factor loadings were .539-.956, with model fit statistics as follows: comparative fit index (CFI) = .975, Tucker-Lewis index (TLI) = .973 and root mean square error of approximation (RMSEA) = .059. Coefficient alpha scores were .77-.95 for the instrument's five factors. CONCLUSIONS: Initial testing indicates the Organizational Learning Instrument-Mechanisms has adequate levels of reliability, content validity and construct validity. IMPLICATIONS FOR NURSING MANAGEMENT: Hospital leaders and researchers may begin using this instrument to improve and study the mechanisms of organisational learning in hospital units.

How nursing leaders promote evidence-based practice implementation at point-of-care: A four-country exploratory study.

AIMS: To describe strategies nursing leaders use to promote evidence-based practice implementation at point-of-care using data from health systems in Australia, Canada, England and Sweden. DESIGN: A descriptive, exploratory case-study design based on individual interviews using deductive and inductive thematic analysis and interpretation. METHODS: Fifty-five nursing leaders from Australia, Canada, England and Sweden were recruited to participate in the study. Data were collected between September 2015 and April 2016. RESULTS: Nursing leaders both in formal managerial roles and enabling roles across four country jurisdictions used similar strategies to promote evidence-based practice implementation. Nursing leaders actively promote evidence-based practice implementation, work to influence evidence-based practice implementation processes and integrate evidence-based practice implementation into everyday policy and practices. CONCLUSION: The deliberative, conscious strategies nursing leaders used were consistent across country setting, context and clinical area. These strategies were based on a series of activities and interventions around promoting, influencing and integrating evidence-based practice implementation. We conjecture that these three key strategies may be linked to two overarching ways of demonstrating effective evidence-based practice implementation leadership. The two overarching modes are described as mediating and adapting modes, which reflect complex, dynamic, relationship-focused approaches nursing leaders take towards promoting evidence-based practice implementation. IMPACT: This study explored how nursing leaders promote evidence-based practice implementation. Acknowledging and respecting the complex work of nursing leaders in promoting evidence-based practice implementation through mediating and adapting modes of activity is necessary to improve patient outcomes and system effectiveness.

New graduate registered nurses' experiences with psychological safety.

AIM: The purpose of this study was to gain insight into new graduate registered nurses' experiences with psychological safety. BACKGROUND: Organizational learning allows acute care hospitals to consistently provide high-quality patient care. Psychological safety is critical for organizational learning. New graduate nurses in particular need to feel psychologically safe as they transition into professional nursing practice. Understanding new graduate registered nurses' experiences of psychological safety can guide leaders and others to create work environments that foster psychological safety and organizational learning. METHOD: Semi-structured interviews were conducted with 13 newly graduated registered nurses working in inpatient hospital settings. Interviews were analyzed using thematic analysis. RESULTS: Four primary themes featured prominently in the new graduate nurses' experiences of psychological safety: building credibility, making personal connections, feeling supported and seeking safety. CONCLUSION: Understanding these themes will help nursing education programmes, nurse managers, nurse colleagues and new graduate registered nurses foster psychological safety and create environments conducive to organisational learning. IMPLICATIONS FOR NURSING MANAGEMENT: All members of the health care team involved in the new graduate registered nurses' transition to practice have a role in fostering psychological safety. Additional research is needed to better understand psychological safety and how to foster it.

Development and implementation of a peer mentoring program for early career gerontological faculty.

PURPOSE: The Hartford Gerontological Nursing Leaders (HGNL) formerly known as the Building Academic Geriatric Nursing Capacity Initiative (BAGNC), in conjunction with the National Hartford Centers of Gerontological Nursing Excellence (NHCGNE), developed and executed a peer mentoring program beginning in 2011 to enhance both (a) the experience of newly selected scholars and fellows to the NHCGNE and (b) the ongoing professional development of HGNL members. The purpose of this article is to describe key strategies used to develop and execute the peer mentoring program and to present formative program evaluation. DESIGN: The program was launched in January 2011 with seven peer mentor and mentee matches. In June 2012, the peer mentoring committee solicited feedback on the development of the peer mentoring program and changes were made for the subsequent cohorts. FINDINGS: An additional 12 matches were made in the following 2 years (2012 and 2013), for a total of 31 matches to date. We have learned several key lessons from our three cohorts regarding how to structure, implement, and carefully evaluate a peer mentoring program. CONCLUSIONS: Informal evaluation of our peer mentoring program noted several challenges for both peer mentors and mentees. Having knowledge of and addressing those challenges may increase the overall quality and effectiveness of peer mentoring programs and, in turn, benefit academic nursing by strengthening the faculty workforce. CLINICAL RELEVANCE: Findings from development and implementation of a peer mentoring program for gerontological faculty could lead to new and adaptable programs in a variety of clinical and education settings.

Nursing leaders' perceptions of the impact of the Strengths-Based Nursing and Healthcare Leadership program three months post training.

Background: Development of nursing leadership is necessary to ensure that nurse leaders of the future are well-equipped to tackle the challenges of a burdened healthcare system. In this context, the Strengths-Based Nursing and Healthcare Leadership program was delivered to 121 participants from 5 organizations in Canada in 2021 and 2022. To date, no study used a qualitative approach to explore nursing leaders' perceptions of a leadership Strengths-Based Nursing and Healthcare Leadership program three months post training. Objective: To describe nursing leaders' perceptions of the impact of the Strengths-Based Nursing and Healthcare Leadership program three months post training. Methods: Qualitative descriptive design was used with individual semi-structured interviews. A convenient sample of nurse leaders (n = 20) who had participated in the leadership program were recruited for an individual interview three months post training. The data generated by interviews were analyzed using a method of thematic content analysis. Results: Three themes emerged from the qualitative data analysis related to the leadership program that stayed with participants three months post training: 1) mentorship: a lasting relationship, 2) human connections through Story-sharing, and 3) focus on strengths. Two other themes emerged related to the changes that they have made since attending the program: 1) seeking out different perspectives to work better as a team and 2) create a positive work environment and to show appreciation for their staff. Conclusion: The present study offers evidence of the impact of the Strengths-Based Nursing and Healthcare Leadership program three months post training. Implication: This study reinforces the importance of training using a Strengths-Based Nursing and Healthcare Leadership lens when tackling leadership.

Interprofessional Education and Essential Approach to Health care.

In today's changing landscape of the US health care system, it is imperative to have a health care delivery model that is patient-centered and delivered by a multidisciplinary collaborative team with an understanding of each other's roles and responsibilities as well as communicate effectively. Academic institutions must create partnerships with health systems and ambulatory care settings to provide health profession students with authentic and inclusive interprofessional learning opportunities which include practice-ready skills which are needed to enter the health care workforce. Nurses are well positioned to lead this effort and practice within interprofessional teams in health care organizations.

Leadership qualities faculty desire in academic leaders: An international Delphi study.

BACKGROUND: The global nursing workforce is confounded by shortages of nurses, faculty, and academic nursing leaders. Nursing academic leaders influence faculty recruitment and retention influencing the enrollment pipeline to fill nurse workforce capacity. OBJECTIVE: To identify leadership qualities nursing faculty prefer in nursing academic leaders globally. DESIGN: A multi-country exploratory design employed a three-round Delphi process including Demographic Data and open-ended questions. SETTING: An online Qualtrics survey was emailed to schools of nursing selected from seven global regions: United States (North America), Mexico (Latin America/ Caribbean), South Africa (Africa), Saudi Arabia (Middle East), Korea (Asia), Sweden (Europe), and Australia (Oceania). PARTICIPANTS: A convenience sample of faculty members employed in schools of nursing in the seven countries. METHOD: A 43-item Qualtrics survey developed from literature review of leadership qualities of nursing academic leaders was distributed to nursing faculty who participated in three Delphi rounds using descriptive statistics to analyze each round. Open-ended questions were analyzed using qualitative descriptive analysis. RESULTS: In Round 1, 54 faculty rated the 43 leadership qualities using a Likert Scale, identified the top 10, and added additional qualities not in the list. In Round 2, 26 of the original participants rated the resulting 29 leadership qualities. In Round 3, 16 of the original participants ranked their top 8 leadership qualities: mutual trust and respect; clear communication; creating a cohesive culture; assuring diversity, equity, and inclusivity; integrity; developing effective team structure; effective decision-making; and leading by example. In Round 3 participants rated nurses' preparedness for academic leadership. Open-ended questions identified 1) Strategies to prepare nurses for academic leadership roles and 2) Essential characteristics for effective academic leaders. CONCLUSION: Developing key leadership skills can increase the leadership capacity of nursing academic leaders, enhancing work environments, faculty recruitment and retention, helping mitigate a global challenge.

Nursing leaders' perspectives on research in specialist health services: A descriptive study.

AIM: This study is to gain insight into how nursing leaders perceive their contribution to research-based knowledge in hospital settings. DESIGN: The study has a qualitative descriptive design. METHODS: Nine nursing leaders were interviewed. Data were analysed based on Braun and Clarke's thematic analysis. RESULTS: Three themes were developed: the primacy of management and practicalities, delegated responsibility and lack of research competence. Even though the nurse leaders wish to be professional leaders, they seem to prioritize the day-to-day management. The nurse facilitators have been delegated, by the nurse leaders, the responsibility for the departments and the employees' professional development. The participants reported that neither their own leaders, the nurses, nor they themselves had the necessary knowledge or the interest in engaging in research. CONCLUSION: There seems to be a lack of awareness, knowledge and priority of nursing research in nursing leadership and absence of a culture of research.

Why do some health care providers disrespect and abuse women during childbirth in India?

BACKGROUND: Disrespect and abuse during childbirth can result in fear of childbirth. Consequently, women may be discouraged to seek care, increasing the likelihood for women to choose elective cesarean section in order to avoid humiliation, postnatal depression and even maternal mortality. This study investigates the causes underlying mistreatment of women during childbirth by health care providers in India, where evidence of disrespect and abuse has been reported. METHODS: Qualitative research was undertaken involving 34 in-depth interviews with midwifery and nursing leaders from India who represent administration, advocacy, education, regulation, research and service provision at state and national levels. Data are analysed thematically with NVivo12. The analysis added value by bringing an international perspective from interviews with midwifery leaders from Switzerland and the United Kingdom. FINDINGS: The factors leading to disrespect and abuse of women relate to characteristics of both women and their midwives. Relevant woman-related attributes include her age, gender, physical appearance and education, extending to the social environment including her social status, family support, culture of abuse, myths around childbirth and sex-based discrimination. Midwife-related factors include gender, workload, medical hierarchy, bullying and powerlessness. DISCUSSION: The intersectionality of factors associated with mistreatment during childbirth operate at individual, infrastructural, social and policy levels for both the women and nurse-midwives, and these factors could exacerbate existing gender-based inequalities. Maternal health policies should address the complex interplay of these factors to ensure a positive birthing experience for women in India. CONCLUSION: Maternal health interventions could improve by integrating women-centred protocols and monitoring measures to ensure respectful and dignified care during childbirth.

Emotional intelligence and authentic leadership among Saudi nursing leaders in the Kingdom of Saudi Arabia.

BACKGROUND: Previous studies have found that emotional intelligence has a remarkable influence on authentic leadership. However, the conceivable relationship between emotional intelligence and authentic leadership was unclear, as were the hypothetical bases used in previous studies. PURPOSE: To determine the correlation between emotional intelligence and authentic leadership of the nursing leaders and the socio-demographic characteristics by which emotional intelligence and authentic leadership vary. METHODS: Data derived from 152 of the distributed 180 questionnaires were analyzed (84.44% response rate). Nurse leaders in the academy of the Kingdom of Saudi Arabia were assessed from April to July of 2019. t-Tests were used to test gender differences, while the Analysis of variance (ANOVA) tests were employed for age, position, and years of experience. The relationship between the emotional intelligence and authentic leadership scores was analyzed using Pearson's correlation coefficients (bivariate r). The relationships of the four dimensions in the emotional intelligence construct and overall emotional intelligence were assessed using multiple regression analysis and simple linear regression analysis. RESULTS: Age and years of experience significantly and positively related to emotional intelligence, whereas gender, age, and years of experience in the current position (p = 0.026) were significant regarding authentic leadership. The emotional intelligence total score strongly and positively related to authentic leadership. The regression results on the four emotional intelligence dimensions indicated that the extent of using emotions had the strongest influence on authentic leadership (B = 0.99) followed by appraisal of one's emotions (B = 0.70) and appraisal of others' emotions (B = 0.69). The simple regression analysis indicated that, for every one-point increase in total emotional intelligence score, authentic leadership score increased by 0.086. CONCLUSION: Age and years of experience were significant factors explaining variation in emotional intelligence, whereas gender, age, and years of experience in the current position were significant for explaining variation in authentic leadership. Using emotions was the strongest influence on authentic leadership, and the emotional intelligence dimension measuring regulation of emotion had no significant influence on authentic leadership.

Don't Come Late to the Party: Step Up and Lead.

Abstract  

Administration of care to older patients in transition from hospital to home care services: home nursing leaders' experiences.

BACKGROUND: Older persons in transition between hospital and home care services are in a particularly vulnerable situation and risk unfortunate consequences caused by organizational inefficiency. The purpose of the study reported here was to elucidate how home nursing leaders experience the administration of care to older people in transition from hospital to their own homes. METHODS: A qualitative study design was used. Ten home nursing leaders in two municipalities in southern Norway participated in individual interviews. The interview texts were audio taped, transcribed verbatim and analyzed by use of a phenomenological-hermeneutic approach. RESULTS: Three main themes and seven subthemes were deduced from the data. The first main theme was that the home nursing leaders felt challenged by the organization of home care services. Two subthemes were identified related to this. The first was that the leaders lacked involvement in the transitional process, and the second was that they were challenged by administration of care being decided at another level in the municipality. The second main theme found was that the leaders felt that they were acting in a shifting and unsettled context. Related to this, they had to adjust internal resources to external demands and expectations, and experienced lack of communication with significant others. The third main theme identified was that the leaders endeavored to deliver care in accordance with professional values. The two related subthemes were, first, that they provided for appropriate internal systems and routines, and, second, that they prioritized available professional competence, and made an effort to promote a professional culture. CONCLUSION: To meet the complex needs of the patients in a professional way, the home nursing leaders needed to be flexible and pragmatic in their administration of care. This involved utilizing available professional competence appropriately. The coordination and communication between the different organizational levels and units were pointed out as major factors requiring improvement.