The Time to Change for Mental Health and Wellbeing via Virtual Professional Coaching: Longitudinal Observational Study.

BACKGROUND: Optimal mental health yields many benefits and reduced costs to employees and organizations; however, the workplace introduces challenges to building and maintaining mental health that affects wellbeing. While many organizations have introduced programming to aid employee mental health and wellbeing, the uptake and effectiveness of these efforts vary. One barrier to developing more effective interventions is a lack of understanding about how to improve wellbeing over time. The current study examined not only whether employer-provided coaching is an effective strategy to improve mental health and wellbeing in employees; but also how this intervention changes wellbeing in stages over time. OBJECTIVE: The goal of this study was to determine whether BetterUp, a longitudinal one-on-one virtual coaching intervention, improves components of mental health and psychological wellbeing and whether the magnitude of changes vary in stages over time. This is the first research study to evaluate the effectiveness of professional coaching through three repeated assessments, moving beyond a pre- to post-intervention design. The outcomes of this study will enable coaches and employers to design more targeted interventions by outlining when to expect maximal growth in specific outcomes throughout the coaching engagement. METHODS: Three identical assessments were completed by 391 users of BetterUp - prior to the start of coaching, after approximately 3-4 months of coaching, and again after 6-7 months of coaching. Three scales were used to evaluate psychological and behavioral dimensions that support management of mental health - stress management, resilience, and life satisfaction. Six additional scales assessed psychological wellbeing - emotional regulation, prospection ability, finding purpose and meaning, self-awareness, self-efficacy, and social connection. RESULTS: Using mixed effects modeling, varying rates of change were observed in several dimensions of mental health and psychological wellbeing. Initial rapid improvements in the first half of the intervention, followed by slower growth in the second half of the intervention, were found for prospection ability, self-awareness, self-efficacy, social connection, emotional regulation, and a reduction in stress (range of unstandardized ßs for each assessment: .10-.19). Life satisfaction improved continuously throughout the full intervention period (ß: .13). Finding purpose in meaning at work and building resilience both grew continuously throughout the coaching intervention, but larger gains were experienced in the second half of the intervention (ßs: .08-.18), requiring the full length of the intervention to realize maximal growth. CONCLUSIONS: The results demonstrate the effectiveness of the BetterUp virtual one-on-one coaching to improve psychological wellbeing, while mitigating threats to mental health such as excessive and prolonged stress, low resilience, and poor satisfaction with life. The improvements across the collection of outcomes were time-dependent and provide important insights to users and practitioners about how and when to expect maximal improvements in a range of interrelated personal and professional outcomes.

Case Study: The Impact of Nursing Professional Practice during the COVID-19 Pandemic at a Large Community Hospital in Canada.

The COVID-19 pandemic posed numerous challenges experienced by healthcare organizations. Nursing professional practice plays a crucial leadership role in supporting nursing staff and leaders in developing policies, parameters and philosophical approaches for delivering safe patient care. The professional practice leadership at Humber River Hospital, a large Canadian community hospital, implemented three key interventions in this hospital-based case study: (1) proactive workforce planning, (2) increased nursing student placements and (3) novel "stretch model of care" in the intensive care unit (ICU). The overall results following the implementation of these interventions resulted in substantial improvements. For example, proactive nursing workforce planning supported both a 98% reduction in agency utilization and an accelerated ICU certification program with an 84% certificate completion rate. Through innovative strategies, there was a significant increase (33-67%) in the number of nursing student placements during the first two years of the pandemic compared with previous years. Within the ICU setting, we maintained optimum ICU capacity that resulted in stronger partnership-driven relationships between nurses and physicians through an interprofessional "stretch model of care." Finally, we avoided emergency department closures and Code Orange calls during peaks of the pandemic.

Experiences of Nurses Working in a Fully Digital Hospital: A Phenomenological Study.

BACKGROUND: With the increasing development and integration of information and communication technology (ICT) into hospitals, there remains a lack of understanding of the impact of these technologies on the hospital's largest core users: nurses. Humber River Hospital (HRH), one of the first hospitals to completely integrate technology across all hospital systems and workflows, has sought to understand how ICTs have transformed the clinical working environment. OBJECTIVE: The aim of the study was to achieve a deeper understanding of the lived experiences of nurses practising in North America's first digital hospital. METHODS: The methodological approach was informed by van Manen's hermeneutic phenomenological methodology. Data were gathered through in-depth semi-structured interviews with eight nurses at HRH. Thematic analysis was conducted using the van Manen and Colaizzi methods of data analysis. RESULTS: Six thematic categories that formed the nurses' lived experiences of working in a digital environment were identified: safety, time, teamwork, technology failures, patient responses and adapting. CONCLUSION: Nurses at HRH identified six themes regarding their lived experiences working in a fully digital hospital that provide an insight into nurses' values and cause us to reflect on how we might use this information to further support nursing practice in the fully digital environment. Nurses at HRH seem to have normalized the nursing process within the fully digital environment. Technology appears to be viewed by nurses at HRH within the premise of nursing as an art, allowing patient responses to be acknowledged and incorporated into nursing workflows, and as a science, permitting safe care delivery. Overall, nurses perceived technology as being essential for patient safety and facilitating nursing practice. These findings offer insight into nurses' perception of ICTs, and as technological advancements continue to emerge, these findings will inform education, practice and policy.

Smartphone Technology: Enabling Prioritization of Patient Needs and Enhancing the Nurse-Patient Relationship.

BACKGROUND: Mobile health (mHealth) is a rapidly growing field with the potential to transform healthcare delivery. Smartphone technologies have been developed and integrated into the patient call bell system for healthcare staff to receive calls; however, there is a lack of high-quality evidence to support the implementation and evaluate the effectiveness of these devices in a healthcare setting. AIM: The aim of this study is to explore nurses' perceptions of smartphone technology devices in enhancing the nurse-patient relationship and improving nursing workflows. METHODS: A semi-structured focus group and interviews were used to illicit nurses' experiences with smartphone technology. Interviews were audio recorded, transcribed and subjected to a content analysis to identify emerging themes from the data. RESULTS: Interviews with nurses provided insight into the benefits and challenges of smartphone use in the clinical setting. Multiple benefits were identified by nurse participants, including time management and convenience, prioritization, patient safety and enhancement of the nurse-patient relationship. CONCLUSION: There are multiple benefits of smartphone technology for both nurses and patients. Hospitals proposing to introduce smartphone technology need to educate patients and families about the clinical use of smartphones to avoid unfavourable perceptions. Smartphone technology must be interoperable with the electronic medical record to optimize interprofessional communication and exchange of patient information.

Generational Differences in Hospital Technology Adoption: A Cross-Sectional Study.

BACKGROUND: The advancement of technological change within healthcare means that it is essential for nurses to have the necessary technological skills to deliver safe and efficient nursing care. Few studies have examined whether generational differences affect the adoption of technology within the healthcare system. AIM: The primary purpose of this study was to explore predictors that influence the adoption of technology. METHODS: In this cross-sectional study, nurses were asked to rate their level of competency on 20 key skills related to clinical technological devices (CTDs) in a self-administered questionnaire. Participants' demographic data and level of proficiency related to personal computer skills were also collected. Multiple linear regression analysis was used to examine whether demographic characteristics and personal computer skills predicted higher scores related to CTDs. RESULTS: Sixty-three nurses completed the questionnaires. Overall mean score for skills related to CTD was high at 3.74 (SD = 0.75) out of 5. Length of employment at the hospital and previous exposure to the technology used at the hospital (ß = 0.06, p = 0.021; ß = 0.054, p = 0.011, respectively) were the only variables significantly associated with higher CTD skills scores. Generational cohort, gender, years of nursing experience and self-rated proficiency related to personal computer skills were not related to higher CTD skills scores. CONCLUSION: The results of this study emphasize that consistent exposure to technology enhances its adoption. Generational cohort did not play a role in the perception of nurses' technology competency at Humber River Hospital.

Optimizing Nursing Practice through Integration of Best Practice Guidelines into Electronic Medical Records.

A commitment to best practice guidelines (BPGs) is crucial for ensuring the safety of patients. Recognizing the power of information technology, Humber River Hospital has integrated BPGs into the electronic medical record (EMR) infrastructure. The large-scale implementation institutes a uniform standard of care and ensures adherence to BPGs through a forcing function designed to require nurses to complete and document the necessary assessments. The initiative strengthens the audit process and provides the opportunity to identify long-term trends. The implications of the quality improvement initiative are discussed. Due to the widespread use of EMRs, the replication of this initiative is economically feasible in other healthcare settings.

Digging deeper into the shared variance among safety-related climates: the need for a general safety climate measure.

We combined three independent streams of workplace climate research, safety, violence prevention, and civility, to devise a general safety climate scale that explicitly addressed a variety of risks. A confirmatory factor analysis suggested that a higher-order factor may be responsible for the similarity in relationships across these safety-related climate measures with exposure to organizational hazards and resulting employee outcomes. As a result, a concise 10-item measure was developed and validated to assess a possible general safety climate factor. Further analyses suggested that the use of a general safety climate measure did not attenuate the relationships with workplace hazards and employee outcomes. Although different safety-related climate variables may be theoretically distinct, there may not be a measurable benefit in promoting one form of climate over others. Future studies should consider employing the general safety climate measure in place of domain-specific climate measures, unless the domain-specific climate is solely of interest.