The Verran Professional Governance Scale: Confirmatory and Exploratory Analysis.

This article describes psychometric testing and refinement of the Verran Professional Governance Scale (VPGS), which measures behaviors associated with professional governance. Phase 1 reduced the items on the scale based on floor and ceiling effects and redundancy of items. Phase 2 examined structural construct validity using exploratory (EFA) and confirmatory factor analysis (CFA). The final 22-item instrument demonstrates satisfactory internal consistencies and fit indices and significant positive correlation between the VPGS, job satisfaction, and control over nursing practice.

Selecting a theoretical framework to guide research on the COVID-19 pandemic impacts on nursing care delivery and the critical care work system (using Reed's Intermodern approach to theory critique).

Understanding the impact of COVID-19 on nursing care delivery in critical care work systems is urgently needed. Theoretical frameworks guide understanding of phenomena in research. In this paper, we critique four theoretical frameworks (Donabedian's Quality Model, the Quality Health Outcomes Model, the Systems Research Organizing Model, and the Systems Engineering (SEIPS) 2.0 Model) using (blinded) (2018) Intermodern philosophical perspective of nursing science. (blinded) (2018) Intermodern approach to theory critique was selected for its pragmatic perspective and focus on personal and professional health and wellbeing. The SEIPS 2.0 Model was ultimately selected to guide the study of the impact of the COVID-19 Pandemic on nursing care delivery in the critical care work systems.

Exploring the Stability of Communication Network Metrics in a Dynamic Nursing Context.

Network stability is of increasing interest to researchers as they try to understand the dynamic processes by which social networks form and evolve. Because hospital patient care units (PCUs) need flexibility to adapt to environmental changes (Vardaman, Cornell, & Clancy, 2012), their networks are unlikely to be uniformly stable and will evolve over time. This study aimed to identify a metric (or set of metrics) sufficiently stable to apply to PCU staff information sharing and advice seeking communication networks over time. Using Coefficient of Variation, we assessed both Across Time Stability (ATS) and Global Stability over four data collection times (Baseline and 1, 4, and 7 months later). When metrics were stable using both methods, we considered them "super stable." Nine metrics met that criterion (Node Set Size, Average Distance, Clustering Coefficient, Density, Weighted Density, Diffusion, Total Degree Centrality, Betweenness Centrality, and Eigenvector Centrality). Unstable metrics included Hierarchy, Fragmentation, Isolate Count, and Clique Count. We also examined the effect of staff members' confidence in the information obtained from other staff members. When confidence was high, the "super stable" metrics remained "super stable," but when low, none of the "super stable" metrics persisted as "super stable." Our results suggest that nursing units represent what Barker (1968) termed dynamic behavior settings in which, as is typical, multiple nursing staff must constantly adjust to various circumstances, primarily through communication (e.g., discussing patient care or requesting advice on providing patient care), to preserve the functional integrity (i.e., ability to meet patient care goals) of the units, thus producing the observed stability over time of nine network metrics. The observed metric stability provides support for using network analysis to study communication patterns in dynamic behavior settings such as PCUs.

Evaluating Changes in Caring Behaviors of Caritas Coaches Pre and Post the Caritas Coach Education Program.

OBJECTIVE: The aim of this study was to examine program effectiveness in changing Caritas leadership, self-caring behaviors, and perceptions of coworkers of participants who completed the Caritas Coach Education Program (CCEP). BACKGROUND: The CCEP has been a highly successful education program for individuals who wish to intellectually and experientially learn to teach, live, and practice human caring theory. METHODS: A pretest-posttest descriptive design was used to evaluate changes in perceptions of self-caring, caritas leadership, and coworker behaviors after completion of CCEP. RESULTS: The mean scores of all measures improved significantly. CONCLUSIONS: After completion of CCEP, participants demonstrated statistically significant changes in 3 caritas measures: leadership, coworker, and self-rating. Caritas Coach participants exhibited the greatest change in their self-caring scores.

A model to evaluate data science in nursing doctoral curricula.

BACKGROUND: Building on the efforts of the American Association of Colleges of Nursing, we developed a model to infuse data science constructs into doctor of philosophy (PhD) curriculum. Using this model, developing nurse scientists can learn data science and be at the forefront of data driven healthcare. PURPOSE: Here we present the Data Science Curriculum Organizing Model (DSCOM) to guide comprehensive doctoral education about data science. METHODS: Our team transformed the terminology and applicability of multidisciplinary data science models into the DSCOM. FINDINGS: The DSCOM represents concepts and constructs, and their relationships, which are essential to a comprehensive understanding of data science. Application of the DSCOM identified areas for threading as well as gaps that require content in core coursework. DISCUSSION: The DSCOM is an effective tool to guide curriculum development and evaluation towards the preparation of nurse scientists with knowledge of data science.

Relationship of Staff Information Sharing and Advice Networks to Patient Safety Outcomes.

OBJECTIVE: The aim of this study was to compare information sharing and advice networks' relationships with patient safety outcomes. BACKGROUND: Communication contributes to medical errors, but rarely is it clear what elements of communication are key. METHODS: We investigated relationships of information-sharing and advice networks to patient safety outcomes in 24 patient care units from 3 hospitals over 7 months. Web-based questionnaires completed via Android tablets provided data to create 2 networks using ORA, a social network analysis application. Each hospital provided nurse-sensitive patient safety outcomes. RESULTS: In both networks, medication errors correlated positively with node count and average distance and negatively with clustering coefficient. Density and weighted density negatively correlated with medication errors and falls in both networks. Eigenvector and total degree centrality correlated negatively with both safety outcomes, whereas betweenness centrality positively related to falls in the information-sharing network. CONCLUSION: Technology-enabled social network analysis data collection is feasible and can provide managers actionable system-level information.

Decision-making in nursing practice: An integrative literature review.

AIMS AND OBJECTIVES: To identify and summarise factors and processes related to registered nurses' patient care decision-making in medical-surgical environments. A secondary goal of this literature review was to determine whether medical-surgical decision-making literature included factors that appeared to be similar to concepts and factors in naturalistic decision making (NDM). BACKGROUND: Decision-making in acute care nursing requires an evaluation of many complex factors. While decision-making research in acute care nursing is prevalent, errors in decision-making continue to lead to poor patient outcomes. Naturalistic decision making may provide a framework for further exploring decision-making in acute care nursing practice. A better understanding of the literature is needed to guide future research to more effectively support acute care nurse decision-making. DESIGN: PubMed and CINAHL databases were searched, and research meeting criteria was included. Data were identified from all included articles, and themes were developed based on these data. RESULTS: Key findings in this review include nursing experience and associated factors; organisation and unit culture influences on decision-making; education; understanding patient status; situation awareness; and autonomy. CONCLUSIONS: Acute care nurses employ a variety of decision-making factors and processes and informally identify experienced nurses to be important resources for decision-making. Incorporation of evidence into acute care nursing practice continues to be a struggle for acute care nurses. This review indicates that naturalistic decision making may be applicable to decision-making nursing research. RELEVANCE TO CLINICAL PRACTICE: Experienced nurses bring a broad range of previous patient encounters to their practice influencing their intuitive, unconscious processes which facilitates decision-making. Using naturalistic decision making as a conceptual framework to guide research may help with understanding how to better support less experienced nurses' decision-making for enhanced patient outcomes.

Impact of Professional Nursing Practices on Patient/Nurse Outcomes: Testing the Essential Professional Nursing Practices Instrument.

Increasing patient and healthcare system complexity and the need to accurately measure the engagement of clinical nurses (CNs) in holistic, professional nursing practice indicates that an update to the Essentials of Magnetism instrument is needed. The purposes of this research were to critique and weight items, assess the value and psychometric properties of the newly constructed Essential Professional Nursing Practices (EPNP) instrument, and establish relationships between EPNPs and CN job, practice, and nurse-assessed patient satisfaction.

Evaluation of Authentic Human Caring Professional Practices.

OBJECTIVE: The aim of this study was to present an instrument and comparative database designed to evaluate patients' perceptions of caring behaviors of caregivers. BACKGROUND: Acute care leaders are under pressure to improve publicly reported patient satisfaction scores. Some nurse leaders have implemented professional practice environments based on human caring theory, whereas others have used scripting to standardize communication between staff and patients. METHODS: The Watson Caritas Patient Score (WCPS) is collected quarterly from a random sample of patients who are admitted to acute care hospital units. RESULTS: The WCPS was able to discriminate across unit types and hospitals. Items were related to publicly reported nursing communication scores. CONCLUSIONS: Participation in research based on human caring theory has given nurse leaders the opportunity to evaluate effectiveness of professional practice environments. It may provide the opportunity to focus staff communication with patients more authentically and in a way that enriches the experience for both.

The evolution and development of an instrument to measure essential professional nursing practices.

Nursing continues to evolve from a task-oriented occupation to a holistic professional practice. Increased professionalism requires accurate measurement of care processes and practice. Nursing studies often omit measurement of the relationship between structures in the work environment and processes of care or between processes of care and patient outcomes. Process measurement is integral to understanding and improving nursing practice. This article describes the development of an updated Essentials of Magnetism process measurement instrument for clinical nurses (CNs) practicing on inpatient units in hospitals. It has been renamed Essential Professional Nursing Practices: CN.

Using *ORA, a network analysis tool, to assess the relationship of handoffs to quality and safety outcomes.

Communication during patient handoffs has been widely implicated in patient safety issues. However, few studies have actually been able to quantify the relationship between handoffs and patient outcomes. We used *ORA, a dynamic network analysis tool, to examine handoffs between day and night shifts on seven units in three hospitals in the Southwest. Using *ORA's visualization and analysis capabilities, we examined the relationships between the handoff communication network metrics and a variety of patient safety quality and satisfaction outcomes. Unique network patterns were observed for different types of outcome variable (eg, safety, symptom management, self-care, and patient satisfaction). This exploratory project demonstrates the power of *ORA to identify communication patterns for large groups, such as patient care units. *ORA's network metrics can then be related to specific patient outcomes.

Measuring nursing unit environments with four composite measure.

Understanding the context in which nurses work is an important step to designing work environments in which nurses can achieve targeted quality. Developing a usable instrument for describing the work environment and the relationship to staffing is essential for the development of evidence-based staffing decisions. The major implications of the research reported here are that the work environment of nurses, while complex, can be modeled with composite variables that reflect various dimensions of that environment. This ability to model the environment with fewer variables enhances the interpretation of environmental factors that have the greatest impact on patient outcomes. This reduction is valuable to the clinician, manager, and administrator in determining the key factors that need to be altered in the work environment to improve the quality of the patient experience.

Changing our lens: seeing the chaos of professional practice as complexity.

AIM: The purpose of this evidence-based management practice project was to analyse dimensions of the Getting my Work Done issue, the only one of seven issues of highest concern for which 907 nurse interviewees were unable to identify effective strategies, formulate a 'best management practice', integrate the practice into clinical settings and evaluate results. METHOD/PROCESS: The evidence-based management practice process was used to identify the major impediment to Getting Work Done-assignment to multiple patients with simultaneous complex needs. Best management practice consisted of class presentation of a clinical-management problem scenario to 144 residents in nine Magnet hospitals, a private action commitment, class discussion and terminal action commitments. RESULTS: Responses indicated that this 'best management practice' was effective in helping newly licensed registered nurses manage and handle multiple patients with simultaneous complex needs. A major avenue of resolution was perception of professional practice responsibilities as a series of complex, interrelated, adaptive systems. CONCLUSIONS/IMPLICATIONS FOR NURSING MANAGEMENT: Perception and use of the principles of complexity science assists newly licensed registered nurses in mastering management dilemmas that inhibit professional practice. In many participating hospitals, plans are underway to expand this best practice to include input and perception exchange among experienced nurses, managers and physicians.

Simulating nursing unit performance with OrgAhead: strengths and challenges.

In this article, we briefly describe our use of a computational modeling tool, OrgAhead, details of which have been reported previously, then discuss several of the challenges computational modeling presented and our solutions. We used OrgAhead to simulate 39 nursing units in 13 Arizona hospitals and then predict changes to improve overall patient quality and safety outcomes. Creating the virtual units required (1) collecting data from managers, staff, patients, and quality and information services on each of the units; (2) mapping specific data elements (eg, control over nursing practice, nursingworkload, patient complexity, turbulence, orientation/tenure, education) to OrgAhead's parameters and variables; and then (3) validating that the newly created virtual units performed functionally like the actual units (eg, actual patient medication errors and fall rates correlated with the accuracy outcome variable in OrgAhead). Validation studies demonstrated acceptable correspondence between actual and virtual units. For all but the highest performing unit, we generated strategies that improved virtual performance and could reasonably be implemented on actual units to improve outcomes. Nurse managers, to whom we reported the results, responded positively to the unit-specific recommendations, which other methods cannot provide. In the end, resolving the modeling challenges we encountered has improved OrgAhead's functionality and usability.

Feasibility of a multi-institution collaborative to improve patient-nurse relationship quality.

OBJECTIVE: The objective of the study was to assess the feasibility of a multi-institution quality improvement collaborative to improve patient-nurse relationship quality. BACKGROUND: Patient-nurse relationships provide the foundation for nursing services and are linked to patient outcomes. Measuring the quality of these relationships is important for ongoing practice changes. METHODS: A prospective evaluation approach was used. Patients from 12 hospitals in 4 distinct areas of the United States comprised the sample. RESULTS: All 12 hospitals submitted patient data on a quarterly basis, yielding a reliable database for performance improvement. The Caring Assessment Tool (CAT) performed well, and individual hospitals used the results to improve their performance. Inconsistencies in labeling, differing sample sizes, and administrative burden limited the results. CONCLUSIONS: Adult patients were willing to provide feedback about their care during hospitalization and multiple institutions successfully participated in the project. An electronic version of the CAT with real-time analysis would decrease burden and provide more timely and accurate results for actionable practice changes.

Clinical nurses in Magnet hospitals confirm productive, healthy unit work environments.

AIM: To describe extent to which experienced nurses in Magnet hospitals confirm healthy work environments (HWE). BACKGROUND: Differentiating differences in HWE allows managers to focus attention where changes may be needed to improve nurse and patient outcomes. METHOD: The sample was 12,233 experienced nurses from 717 clinical units in 34 Magnet hospitals. Based on Essentials of Magnetism II unit level scores, units were grouped as very healthy work environments (VHWE), HWE or work environments needing improvement. RESULTS: VHWE or HWE was confirmed by nurses on 82% of 540 clinical units. The most significant correlates of HWE units occur within individual hospitals. More nurses prepared at the Bachelor of Science in Nursing level or above work on VHWE or HWE units and score higher on seven essential work processes. Nurses' ratings of quality of patient care directly correlate to quality of work environment. CONCLUSIONS: Clinical units in 34 Magnet hospitals were markedly skewed toward excellence. Visionary leadership, empowerment and collaboration have an impact on development and maintenance of HWE. IMPLICATIONS FOR NURSING MANAGEMENT: Implementation of structures that promote interdisciplinary and intradisciplinary collaboration and decision-making positively affect development of HWE. Gap analysis of the steps/components of the eight work processes/relationships essential to HWE may enable achievement of HWEs on all hospital clinical units.

Cardiovascular Consequences of Excessive Alcohol Drinking via Electrocardiogram: A Systematic Review.

ABSTRACT: There is a link between excessive alcohol drinking and an increased risk to develop cardiovascular disease, including alcoholic cardiomyopathy. This association warrants further research on the potential utility for the electrocardiogram (ECG) in the participatory management of the chronic consequences of alcohol use disorder (AUD). Our goal is to enhance understanding about the pernicious role alcohol plays on cardiac health using the ECG, an accessible, cost-effective, validated tool to inform novel targeted treatments for AUD. In this systematic review of human studies, we examine the relationship between abnormal clinically significant changes to ECG variables and excessive alcohol drinking with the goal of identifying key patterns specific to quantity of alcohol consumed. Three independent reviewers and one consensus reviewer, adhering to the PRISMA guidelines, conducted an initial review on studies published from database inception to April 19, 2019, using PubMed, Embase, CINAHL and COCHRANE databases. The initial search generated 2,225 articles. The final selected number included 153 original articles. This systematic review provides evidence of patterns of clinically significant changes to ECG variables as a consequence of excessive alcohol consumption. Future directions include investigating whether a real-time assessment, such as the ECG, in conjunction with other key behavioral and cardiac measures, can help clinicians and patients realize the progressive and insidious cardiac damage because of excessive alcohol consumption. This theory-guided nurse science review supports the development of personalized symptom monitoring to deliver tailored feedback that illuminate risk factors as a potentially transformative approach in the management of AUD.

Accurate assessment of clinical nurses' work environments: response rate needed.

Improvement of hospital unit work environments is key to quality patient care, productivity, nurse retention, and job satisfaction. Accurate measurement of such environments is necessary prior to introduction and evaluation of improvement structures and strategies. Characteristics and attributes of work environments are group level phenomena. Accurate assessment of these phenomena requires survey response rates of sufficient size to ensure sample representativeness and data that can reliably be aggregated to group level. What is the sufficient response rate? This question was answered through psychometric testing of five random samples from the population of 23 M.D. Anderson Cancer Center clinical units that had 100% response rates on an environmental survey. Response rates of 40% or more had acceptable psychometric properties for unit-specific scales.

A collaborative approach to building the capacity for research and evidence-based practice in community hospitals.

The use of best evidence to support nursing practice and the generation of new knowledge to use in practice are hallmarks of excellence. Nurses at the bedside, however, often lack the resources and knowledge necessary to change the traditional nursing culture to one in which the use of evidence is incorporated into daily care. This article describes the experience in two hospitals using a program designed to give nurses the skills needed to engage in evidence-based care.