A hermeneutic-phenomenological study of paediatric intensive care unit nurses' professional identity following hospital redesign: Lessons learned for managers.

AIM: To provide insights for health care managers by exploring paediatric intensive care unit nurses' lived experience of professional identity in the context of organisational change. BACKGROUND: While professional identity improves retention of nurses and provision of quality care, outcomes of importance for managers, organisational change perturbs this identity. METHOD: The study used a hermeneutic-phenomenological design. Data were collected via individual interviews, photographs, participant observation and document review. A purposive sampling strategy was used to recruit paediatric intensive care unit nurses (n = 15) in a large Canadian paediatric hospital. RESULTS: Nurses' critical care identity eroded in this organisation due to the interplay between hospital redesign and new eligibility criteria for patient admissions. CONCLUSION: Interactions between multiple projects and the unit context, as well as nursing professional identity, need to be considered early on during project planning. This study fills an important gap in research concerning the management challenges brought about by the intersection of multiple changes. IMPLICATIONS FOR NURSING MANAGEMENT: The results from this study bring to light three important lessons for nurse managers: 1) the specific unit context should be evaluated before a project is initiated; 2) the physical environment needs to be considered when determining staffing requirements; and 3) identity transitions need to be managed.

Exploring a hermeneutic perspective of nursing through revisiting nursing health history.

In this article, the nursing health history is revisited with a hermeneutic lens to uncover means by which this tool can better serve nursing practice. It is argued that further distanciation from the developmental and medical model is necessary to accurately uncover health and history in the nurse-client encounter. Based on the works of prominent hermeneutic philosophers, such as Heidegger, Gadamer, Merleau-Ponty, Ricoeur, and Taylor, four orientations to health history and nursing are explored: orientation to caring, orientation to narrative, orientation to time, and orientation to the body. The nursing health history is used as a vehicle for illuminating the usefulness of a hermeneutic perspective in everyday nursing practice. This article reveals views of health, history, and health history that are already known to nurses and the nursing milieu but are concealed by more dominant outlooks. The hermeneutical perspective presented in this article can help to reveal the important dimensions of everyday nursing practice and foster a richer attunement with the complex health experiences of individuals.

When the paediatric intensive care unit becomes home: A hermeneutic-phenomenological study.

BACKGROUND: Family-centred care is the dominant model for providing nursing care in paediatrics. Unit layout has been shown to impact nurses' ability to provide family-centred care. Little is known about the meanings and experiences of paediatric intensive care unit nurses concerning the care they provide to families within their unique physical setting. AIM: This study examined paediatric intensive care unit nurses' lived experience of caring for families following a major hospital transformation project, which included the construction of a new unit and quality improvement changes. STUDY DESIGN: A hermeneutic-phenomenological design was selected to study a paediatric intensive care unit in a large Canadian paediatric teaching hospital. METHODS: Data were collected over a 6-month period through individual interviews, photographs, participant observation, and document review. The sample consisted of 15 paediatric intensive care unit nurses who experienced the unit both pre- and post-transformation. Data were analysed in an ongoing fashion using the method described by Benner to identify common and divergent meanings. RESULTS: Despite pride in offering a family-friendly environment, nurses' practice prejudiced a family focus in favour of patient-centred care. Nurses in this study negotiated physical and practice spaces with families by interpreting that nurses do not belong in the home-like patient room and exhibiting gatekeeping comportments. CONCLUSION: Although similar nurse comportments have been identified in prior works, no previous studies have identified these as forming a pattern of negotiating spaces with families. RELEVANCE TO CLINICAL PRACTICE: This study provides insights into the lived experience of paediatric intensive care unit nurses in relation to family care, which can stimulate reflections at an organizational level about creating environments where nurses and families can both feel at home.

Shared Vision in Nursing: An Evolutionary Concept Analysis Revealing Dualities Within the Profession.

Shared vision has been used by the nursing community for over 20 years, but this concept and its language are not presented consistently. At its most basic level, shared vision consists of identifying what a group wants to create. The main objective of this study is to provide a concept analysis of shared vision from an evolutionary nursing perspective within health care organizations. Forty-eight nursing journal articles from 1989 to 2016 were included in the analysis. The concept is presented within the nursing literature as a process or an outcome relying on top-down or bottom-up approaches to defining the future of care. Nurses are central and active in visioning while patients and families are passive recipients. Leaders have an important role to play in shared vision.

An exploratory study of safety culture, biological risk management and hand hygiene of healthcare professionals.

AIMS: The objectives of the study were to: (1) examine the relationships between three different qualitative perceptions of safety culture and the Canadian Patient Safety Climate Survey factors; (2) determine whether these perceptions are associated with different hand hygiene practices. BACKGROUND: Healthcare-associated infections and safety cultures are a worldwide issue. During the A/H1N1 Influenza pandemic, Europe and North America did not have the same responses. Importantly, healthcare professionals' perceptions can influence patient safety through infection prevention practices like hand hygiene. DESIGN: A cross-sectional design was used with data collected in 2015. METHODS: The Canadian Patient Safety Culture Survey and hand hygiene observations were gathered from three healthcare centres (two Canadian and one European). Descriptive analyses and ANOVAs were conducted to explore healthcare professionals' safety perceptions and practices. RESULTS: The rates of hand hygiene practices varied widely between the three sites, ranging from 35-77%. One site (Site 3) was found to have the highest scores of management follow-up, feedback about incidents, supervisory leadership for safety, unit learning culture and senior leadership support for safety, and the highest levels of overall patient safety grades for the unit and organization. CONCLUSION: The quantitative results of this study support the previously described model based on qualitative results: individual culture, blaming culture and collaborative culture. Differences between continents emerged regarding infection prevention practices and the way we qualify infections. The results raise concerns about infection practices and about safety cultures and challenges worldwide.

The Effects of the Transforming Care at the Bedside Program on Perceived Team Effectiveness and Patient Outcomes.

The objective of the study was to document the impact of Transforming Care at the Bedside (TCAB) program on health care team's effectiveness, patient safety, and patient experience. A pretest and posttest (team effectiveness) and a time-series study design (patient experience and safety) were used. The intervention (the TCAB program) was implemented in 8 units in a multihospital academic health science center in Montreal, Quebec, Canada. The impact of TCAB interventions was measured using the Team Effectiveness (TCAB teams, n = 50), and Clostridium difficile-associated diarrhea and vancomycin-resistant Enterobacter rates (patient safety) and Hospital Consumer Assessment of Healthcare Providers and Systems (patient experience; n = 551 patients). The intervention was composed of 4 learning modules, each lasting 12 to 15 weeks of workshops held at the start of each module, combined with hands-on learning 1 day per week. Transforming Care at the Bedside teams also selected 1 key safety indicator to improve throughout the initiative. Pretest and posttest differences indicate improvement on the 5 team effectiveness subscales. Improvement in vancomycin-resistant Enterococcus rate was also detected. No significant improvement was detected for patient experience. These findings call to attention the need to support ongoing quality improvement competency development among frontline teams.

The Experience of Patients Engaged in Co-designing Care Processes.

This article presents the experiences of patients engaged in co-designing care under a program entitled, "Transforming Care at the Bedside," based at an academic health sciences center. This descriptive, qualitative study collected data through individual interviews. Participants included patients from 5 units in an academic health sciences center in Quebec, Canada. A total of 6 individual interviews were conducted in November 2014, 15 months after the Transforming Care at the Bedside work began in September 2013. Content analysis was used to analyze the qualitative data. Being listened to and informed gave patients an opportunity to better understand patient needs and the complexity of care in the unit and in the organization. The experience enabled patients to better translate the patient experience for the team's benefit and influence the team's perspective and decisions. Through this experience, several patients felt motivated and empowered and that they afforded consideration through this experience. This study highlights the importance of creating opportunities for patients and health care providers to share their unique experiences and expertise to better understand each other's reality. In this context, they developed a more comprehensive understanding of the issues and worked together to implement realistic changes on behalf of the patients.

Neonatal Intensive Care Unit Nurses Working in an Open Ward: Stress and Work Satisfaction.

There is some research on the impact of open-ward unit design on the health of babies and the stress experienced by parents and nurses in neonatal intensive care units. However, few studies have explored the factors associated with nurse stress and work satisfaction among nurses practicing in open-ward neonatal intensive care units. The purpose of this study was to examine what factors are associated with nurse stress and work satisfaction among nurses practicing in an open-ward neonatal intensive care unit. A cross-sectional correlational design was used in this study. Participants were nurses employed in a 34-bed open-ward neonatal intensive care unit in a major university-affiliated hospital in Montréal, Quebec, Canada. A total of 94 nurses were eligible, and 86 completed questionnaires (91% response rate). Descriptive statistics were computed to describe the participants' characteristics. To identify factors associated with nurse stress and work satisfaction, correlational analysis and multiple regression analyses were performed with the Nurse Stress Scale and the Global Work Satisfaction scores as the dependent variables. Different factors predict neonatal intensive care unit nurses' stress and job satisfaction, including support, family-centered care, performance obstacles, work schedule, education, and employment status. In order to provide neonatal intensive care units nurses with a supportive environment, managers can provide direct social support to nurses and influence the culture around teamwork.

Facilitated engagement approach: A novel approach to guide mentor conversations.

BACKGROUND: Mentorship has been recognized as a strategy to develop leadership competencies in clinical leaders and has been integrated into leadership programs. However, there are few published frameworks to guide mentor conversations with mentees training to assume nursing leadership roles. OBJECTIVE: This study explores mentors' perceptions of 6-month mentorship, a component of the Strengths-Based Nursing Leadership program, the effectiveness of the Facilitated Engagement Approach, a pedagogical strategy developed to facilitate conversation between the mentor and mentee, and the impact of mentorship on leadership practice of mentees. METHODS: A mixed method qualitative and quantitative approach was used with semi-structured interviews and bi-weekly survey among mentors. Data were thematically analyzed. RESULTS: Mentors described the use of the Facilitated Engagement Approach to guide their mentorship conversations and found it to be effective in mentoring program participants. Mentors described techniques used and the process of deepening a reflective mentorship conversation. The Spiraling Process (58 %) and the Story Sharing Process (74 %) were integral aspects of the Facilitated Engagement Approach used. Mentorship was found to be impactful in that mentors reported a change in their mentee. CONCLUSIONS: The Facilitated Engagement Approach was an effective tool for mentees and mentors to develop leadership capacities.

Evaluation of the effectiveness of a Strengths-Based Nursing and Healthcare Leadership program aimed at building leadership capacity: A concurrent mixed-methods study.

Background: Targeted interventions have been found effective for developing leadership practices in nurses. However, to date, no leadership training program based on the Strengths-Based Nursing and Healthcare Leadership approach exists. Objectives: Demonstrate the effectiveness of a Strengths-Based Nursing and Healthcare Leadership 6-month program designed for nurse and healthcare leaders on leadership capacity and psychological outcomes. Design: Concurrent mixed-methods with nurse and healthcare leaders from five healthcare organisations in Quebec and Ontario (Canada). Settings: Participants were recruited from five Canadian health care organizations: two in Toronto (Ontario) and three in Montreal (Quebec). Participants: A total of 50 nurse leaders and healthcare leaders were included in the quantitative component, and 22 (20 nurse leaders and two healthcare leaders) participated in the qualitative individual interviews. Methods: Quantitative and qualitative (interviews) methods were used. Quantitative data (pre-post surveys) were collected from the participants before their participation in the program (Time 0), as well as after the completion of the program (Time 1). Qualitative data (individual interviews) were collected from participants at the end of the program (Time 1). Analysis was conducted using descriptive statistics, paired-sample t-tests, and thematic analysis. Results: Quantitative results suggest a significant improvement in terms of leadership capabilities, work satisfaction, and reduction in perceived stress among participants. Three themes emerged from the qualitative data analysis: 1) focus on people's strengths, 2) structure and language based on Strengths-Based Nursing and Healthcare values, and 3) building support networks. Conclusions: The Strengths-Based Nursing and Healthcare Leadership program developed to build the leadership capabilities of nurse and healthcare leaders was found to be effective. The positive impact of the 6-month program was demonstrated. It was also shown that the leadership program can help improve the leadership competencies, well-being, and work satisfaction of participating nurses and healthcare leaders. Implication: This study reinforces the importance of working with educational, research, and healthcare organizations to establish leadership development programs and mentorship opportunities. Future leadership training should use a Strengths-Based Nursing and Healthcare Leadership lens when tackling leadership and stress in the workplace.

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.

The organizational attraction of nursing graduates: using research to guide employer branding.

In the context of the global nursing shortage, only the most attractive employers are able to recruit a sufficient number of nurses to maintain high quality of care and ensure positive patient outcomes. It is important for health care organizations to align their practices and their employer marketing strategies with attraction factors important to nurses. This article presents the results of a survey of 666 nursing students graduating in the spring of 2009 in the Canadian province of Quebec. Hypotheses were tested using repeated-measures analysis of variance and post hoc tests. Consistent with hypotheses, the results showed that quality of care, type of work, compensation, and employer branding are organizational attraction factors that nursing graduates perceived as important, with quality of care being the most important one. These findings were later used by a Canadian university teaching hospital to optimize its employer branding and attraction strategy that resulted in an increase in the hiring of university-trained nurses. Further research is needed to examine organizational attractiveness for new nurses over time, across generations, and within various cultural contexts.

Implementation Leadership in the Point of Care Nursing Context: A Systematic Review Comparing Two Measurement Tools.

Introduction: Implementation leadership (IL) are effective point of care (POC) nursing leadership behaviors that facilitate contexts conducive to the successful implementation of evidence-based practices (EBPs). However, no systematic evaluation of IL tools validated for the nursing context existed. Aims: The purpose of this systematic review was to compare iterations of two IL measurement tools, the Implementation Leadership Scale (ILS) and the iLEAD, for application in a nursing context; and to critically appraise and summarize the methodological quality of studies assessing their psychometric properties. Methods: A comprehensive search was conducted in four databases. Two reviewers independently screened titles and abstracts, reviewed full-text articles, and performed extraction into data tables. Statisticians appraised the quality control aspects. Findings were narratively summarized. Results: A total of 247 records were included, where 10 for the ILS (including different versions) and one for the iLEAD met the inclusion criteria. Three studies evaluated the psychometric properties of the ILS in nursing, and its translations into Chinese and Greek. Content validity was deemed to be doubtful for both tools, but the ILS had adequate rating for comprehensiveness; methodological quality was very good for structural validity, internal consistency, hypothesis testing, and responsiveness where applicable for both scales, with the exception of cross-cultural validity which had ratings of adequate and inadequate for versions of the scales. Several study findings met the criteria for good measurement properties. No studies for either tool formally assessed feasibility. Conclusion: Applying validated and contextually relevant tools to evaluate the capacity of nursing leadership to engage in IL in real-world contexts are needed. The ILS shows promise but requires further validation for contexts with diverse and multiple nursing leaders at the POC. Feasibility needs to be further studied.

Impact of unit design on intensive care unit clinicians: a scoping review protocol.

OBJECTIVE: This scoping review aims to identify the known impact of unit design on intensive care unit clinicians, and more specifically, to explore similarities and differences across critical care settings. INTRODUCTION: Construction and infrastructure renewal represent great opportunities for designing units that enhance patient care, as well as support the work of clinicians. A growing body of evidence is showing how unit design can impact clinical staff, but no reviews have been found that focus exclusively on clinicians within intensive care units. INCLUSION CRITERIA: The review will consider studies that include healthcare staff who offer direct patient care in adult or pediatric intensive care units. Studies that focus on the impact of design (related to physical environment features) on clinicians will be included. METHODS: The proposed systematic review will be conducted in accordance with JBI methodology for scoping reviews. The search strategy aims to find published and unpublished studies. The databases to be searched will include Embase MEDLINE, PsycINFO, Healthstar and CINAHL. Retrieved studies will be assessed against the inclusion criteria by two independent reviewers. For the papers included in the scoping review, data will be extracted and quality assessed by two independent reviewers. The extracted data will be presented in tabular form, and a narrative summary will describe how the results relate to the review objective.

Essential Professional Nursing Practices in mental health: A cross-sectional study of hospital inpatient care.

Quality organizational structures and nursing practices are key to positive patient outcomes. Whereas structures have been largely studied over the past few decades, less is known of the nursing practices that account for patient outcomes, such as patient satisfaction. This is especially true in psychiatric, mental health care settings. The aim of the present study is to determine the relative importance of eight Essential Professional Nursing Practices (EPNPs) on the satisfaction of hospitalized patients on mental health care units. A cross-sectional design was selected; 226 point-of-care mental health nurses completed the online EPNP questionnaire in Spring 2015. Statistical analyses included MANOVAs and a 2-step linear regression. A significant relationship was found between university preparation and scores on two EPNP subscales: autonomous decision-making and practicing with competent nurses. Scores on patient advocacy and control over practice subscales were significantly related to nurse-rated patient satisfaction. The findings reinforce the positive link between university education and the work of nurses and highlight the power dynamics that are salient in mental health care. The pertinence of EPNPs in psychiatric settings is brought to the fore, with practices of patient advocacy and nurse control over care examined in relation to empowerment. Implications for clinical and administrative leaders are addressed, with a focus on strategies for empowering patients and nurses.

Hospital rules and regulations: The perspectives of youth receiving psychiatric care.

BACKGROUND: Rules and regulations represent an aspect of psychiatric hospitalization about which little is known. STUDY PURPOSE: To explore the perceptions of rules from the perspective of youth receiving hospital-based psychiatric services. DESIGN: Qualitative descriptive. METHODS: Perceptions of rules were elicited through semi-structured interviews with a convenience sample of six youth. RESULTS: Rules were perceived as governing virtually all aspects of everyday living in the hospital environment. Rules were used to structure daily activities, routines, and social interactions, and were embedded within clinical protocols and treatment plans. For each participant, "making sense" or "not making sense" were central themes through which rules were interpreted as being either therapeutic or oppressive. Rules that made "no sense" negatively affected youth mood, behavior, treatment adherence, and engagement in a collaborative relationship. CONCLUSION: Working in partnership with youth in psychiatric care to establish, implement, and evaluate rules that "make sense" can promote positive health outcomes and prevent negative, unintended consequences.

Optical characterization of Pseudomonas fluorescens on meat surfaces using time-resolved fluorescence.

A scanning optical system for the detection of bacteria on meat surfaces based on fluorescence lifetime and intensity measurements is described. The system detects autofluorescent light emitted by naturally occurring fluorophores in bacteria. The technique only requires minimal sample preparation and handling, thus the chemical properties of the specimen are preserved. This work presents the preliminary results obtained from a time-resolved fluorescence imaging system for the characterization of a nonpathogenic gram-negative bacteria, Pseudomonas fluorescens. Initial results indicate that the combination of fluorescence lifetime and intensity measurements provides a means for characterizing biological media and for detecting microorganisms on surfaces.