Describing nurses' communication about evidence-based practice change: A social network analysis of hospital nurses.

BACKGROUND: Nurses play a critical role in providing evidence-based, high-quality care to optimize patient outcomes. Models from implementation science suggest social networks may influence the adoption of evidence-based practices (EBPs). However, few studies have examined this relationship among hospital nurses. Social network analysis (SNA) mathematically evaluates patterns of communication, a critical step in implementation. Exploring hospital nurses' communication networks may provide insight into influences on the adoption of EBPs. AIMS: This study aimed to describe complete communication networks of hospital nurses for practice changes on inpatient units, including upper level nursing administrators. METHODS: This descriptive, exploratory, cross-sectional study used SNA on two inpatient units from one hospital. A sociometric survey was completed by nurses (unit to executive level) regarding communication frequency about practice changes. Network-level density, diameter, average path length, centralization, and arc reciprocity were measured. Attribute data were used to explore subnetworks. RESULTS: Surveys from 148 nurses on two inpatient adult intensive care units (response rates 90% and 98%) revealed high communication frequency. Network measures were similar across the two units and among subnetworks. Analysis identified central (charge nurses and nurse leaders) and peripheral members of the network (new-to-practice nurses). Subnetworks aligned with the weekend and shift worked. LINKING EVIDENCE TO ACTION: Established communication channels, including subnetworks and opinion leaders, should be used to maximize and optimize implementation strategies and facilitate the uptake of EBPs. Future work should employ SNA to measure the impact of communication networks on promoting the uptake of EBP and to improve patient outcomes.

Presence of Primary Care Physicians and Patients' Ability to Register: A Simulated-Patient Survey in the Paris Region.

Using the health care system fully in some countries requires patients to register with a primary care physician (PCP). Public health policies measure PCP density to maintain satisfactory local PCP supplies and limit geographic inequalities. In an exhaustive simulated-patient survey in the Paris, France region, we analyzed how well presence of PCPs was associated with patients' ability to register for care. Of 5,188 census blocks, 55.4% had at least 1 PCP; however, only 38.6% had at least 1 PCP accepting registration for office visits, and only 19.4% had at least 1 PCP accepting registration for home visits (P <.001 across the 3 indicators). Cross-block inequalities in accepting registration were steeper than those related to PCP density, indicating that this density metric offers false reassurance and is inadequate to support policy decisions.

Effectiveness of registered nurses on system outcomes in primary care: a systematic review.

BACKGROUND: Internationally, policy-makers and health administrators are seeking evidence to inform further integration and optimal utilization of registered nurses (RNs) within primary care teams. Although existing literature provides some information regarding RN contributions, further evidence on the impact of RNs towards quality and cost of care is necessary to demonstrate the contribution of this role on health system outcomes. In this study we synthesize international evidence on the effectiveness of RNs on care delivery and system-level outcomes in primary care. METHODS: A systematic review was conducted in accordance with Joanna Briggs Institute methodology. Searches were conducted in CINAHL, MEDLINE Complete, PsycINFO, and Embase for published literature and ProQuest Dissertations and Theses and MedNar for unpublished literature between 2019 and 2022 using relevant subject headings and keywords. Additional literature was identified through Google Scholar, websites, and reference lists of included articles. Studies were included if they measured effectiveness of a RN-led intervention (i.e., any care/activity performed by a primary care RN within the context of an independent or interdependent role) and reported outcomes of these interventions. Included studies were published in English; no date or location restrictions were applied. Risk of bias was assessed using the Integrated Quality Criteria for Review of Multiple Study Designs tool. Due to the heterogeneity of included studies, a narrative synthesis was undertaken. RESULTS: Seventeen articles were eligible for inclusion, with 11 examining system outcomes (e.g., cost, workload) and 15 reporting on outcomes related to care delivery (e.g., illness management, quality of smoking cessation support). The studies suggest that RN-led care may have an impact on outcomes, specifically in relation to the provision of medication management, patient triage, chronic disease management, sexual health, routine preventative care, health promotion/education, and self-management interventions (e.g. smoking cessation support). CONCLUSIONS: The findings suggest that primary care RNs impact the delivery of quality primary care, and that RN-led care may complement and potentially enhance primary care delivered by other primary care providers. Ongoing evaluation in this area is important to further refine nursing scope of practice policy, determine the impact of RN-led care on outcomes, and inform improvements to primary care infrastructure and systems management to meet care needs. PROTOCOL REGISTRATION ID: PROSPERO: International prospective register of systematic reviews. 2018. ID= CRD42018090767 .

An assessment of the Libyan baccalaureate nursing education during political turmoil.

Since the Libyan Revolution in 2011, the country's nursing workforce has been struggling. Libyan nursing schools have focused on rebuilding the country's supply of nurses after many emigrated. Wanting to infuse the workforce with more baccalaureate-prepared nurses, Libyan nursing faculty invited nursing and public health representatives from a US-based academic medical institution and a non-governmental medical organization to collaborate with local stakeholders in a country-wide assessment. The purpose of this article is to outline the national programs' strengths and weaknesses and make recommendations for developing a strategy to elevate nursing education to meet international standards. This can serve as a launching point to strengthen Libya's health services provision capacity, particularly during this time of transition when opportunities may become available to move in new directions. The approach and findings may have wider application to other countries who are similarly experiencing civil and political turmoil.

Examining the critical role of advanced practice providers on a multidisciplinary transplant team.

It is well documented that Physician Assistants (PAs) and Nurse Practitioners (NPs), collectively known as Advanced Practice Providers (APPs), have a beneficial role beyond the field of primary care. APPs broad spectrum of knowledge make them particularly well suited for specializing in complex fields such as transplant. Variations in practice across transplant centers lead to questions regarding optimal use of APPs. Using job descriptions from transplant centers currently employing APPs, we sought to examine the critical role of transplant APPs beyond clinical care alone. In this review, we explore not only the general training of APPs and current utilization of APPs in transplant, but also safety, cost effectiveness, and comparison of APPs to other transplant providers. We aimed to highlight the importance of recruitment and retention of transplant specific trained APPs to provide continuity in transplant programs. Additionally, APPs expansion into transplant research, quality improvement, leadership, and management must be considered. We challenge transplant centers utilizing APPs to consider these important aspects when seeking ways to expand and optimize the critical role APPs provide on the transplant team.

System dynamics modelling of health workforce planning to address future challenges of Thailand's Universal Health Coverage.

BACKGROUND: System dynamics (SD) modelling can inform policy decisions under Thailand's Universal Health Coverage. We report on this thinking approach to Thailand's strategic health workforce planning for the next 20 years (2018-2037). METHODS: A series of group model building (GMB) sessions involving 110 participants from multi-sectors of Thailand's health systems was conducted in 2017 and 2018. We facilitated policymakers, administrators, practitioners and other stakeholders to co-create a causal loop diagram (CLD) representing a shared understanding of why the health workforce's demands and supplies in Thailand were mismatched. A stock and flow diagram (SFD) was also co-created for testing the consequences of policy options by simulation modelling. RESULTS: The simulation modelling found hospital utilisation created a vicious cycle of constantly increasing demands for hospital care and a constant shortage of healthcare providers. Moreover, hospital care was not designed for effectively dealing with the future demands of ageing populations and prevalent chronic illness. Hence, shifting emphasis to professions that can provide primary care, intermediate care, long-term care, palliative care, and end-of-life care can be more effective. CONCLUSIONS: Our SD modelling confirmed that shifting the care models to address the changing health demands can be a high-leverage policy of health workforce planning, although very difficult to implement in the short term. of health workforce planning, although very difficult to implement in the short term.

Making care more patient centered; experiences of healthcare professionals and patients with multimorbidity in the primary care setting.

BACKGROUND: The present study describes how primary care can be improved for patients with multimorbidity, based on the evaluation of a patient-centered care (PCC) improvement program designed to foster the eight PCC dimensions (patient preferences, information and education, access to care, physical comfort, coordination of care, continuity and transition, emotional support, and family and friends). This study characterizes the interventions implemented in practice as part of the PCC improvement program and describes the experiences of healthcare professionals and patients with the resulting PCC delivery. METHODS: This study employed a mixed-methods design. Semi-structured interviews were conducted with nine general practitioners and nurse practitioners from seven primary care practices in Noord-Brabant, the Netherlands, that participated in the program (which included interventions and workshops). The qualitative interview data were examined using thematic analysis. A longitudinal survey was conducted with 138 patients with multimorbidity from these practices to assess perceived improvements in PCC and its underlying dimensions. Paired sample t tests were performed to compare survey responses obtained at a 1-year interval corresponding to program implementation. RESULTS: The PCC improvement program is described, and themes necessary for PCC improvement according to healthcare professionals were generated [e.g. Aligning information to patients' needs and backgrounds, adapting a coaching role]. PCC experiences of patients with multimorbidity improved significantly during the year in which the PCC interventions were implemented (t = 2.66, p = 0.005). CONCLUSION: This study revealed how primary PCC can be improved for patients with multimorbidity. It emphasizes the importance of investing in PCC improvement programs to tailor care delivery to heterogenous patients with multimorbidity with diverse care needs. This study generates new perspectives on care delivery and highlights opportunities for its improvement according to the eight dimensions of PCC for patients with multimorbidity in a primary care setting.

A scoping review of the roles, training, and impact of community health workers in oral health.

OBJECTIVE: To synthesize English or Spanish-language literature on community health workers' (CHWs') roles, training, and impact in oral health. BASIC RESEARCH DESIGN: A scoping review conducted in accordance with the Arksey and O'Malley (2005) methodological framework. METHOD: Electronic literature searches were conducted in Medline (Ovid), Embase (Ovid), DOSS, CINAHL, Web of Science, and Global Health CAB from inception of the databases to April 2020. Three reviewers independently conducted the title and abstract and full-text reviews. This was followed by data charting by three reviewers and data summarizing by two reviewers. RESULTS: Out of the 36 articles that met the inclusion criteria, most took place in the United States (n=15) with most published between 2012 and 2019 (12). CHWs were incorporated in programs that focused on access to dental care (n=10), oral health promotion only (9), early childhood caries (8), oral health promotion and services (5), and oral cancer screening (4). Common roles included providing oral health education and behavior change motivation to community members, facilitating utilization of dental services, and the delivery of diagnostic and dental services to community members. Training and outcomes were not consistently described across studies. CONCLUSION: CHWs have been used in oral health programs and interventions across a wide range of locations and contexts. The implementation and scaling-up of oral health CHW programs requires appropriate provision of training as well as community embedded monitoring and evaluation structures based on rigorous methods with clearly defined outcomes.

Public health nurses in Canadian schools: An opportunity to build capacity and nursing scholarship.

Public health nurses (PHNs) in Canada have the potential to significantly benefit the health and academic outcomes of school age children with its impact lasting into adulthood. Unfortunately, cuts in government funding over the years have diminished the presence of PHNs in schools and their ability to practice to their full scope. In the midst of a pandemic, having a strong nursing presence in schools may facilitate public health efforts and reduce the burden on teachers and administration. This discussion paper will explore the current role of nurses in Canadian schools in relation to school nurses in other parts of the world. An overview of the literature looking at the impact of the school nurse on school health (i.e., student health and academic outcomes) will be presented to provide evidence in support of rebuilding nursing capacity in Canadian schools. Finally, the Framework for 21st Century School Nursing Practice will be introduced as a viable nursing theory to facilitate rebuilding PHN capacity in schools.

The principle of equivalence reconsidered: assessing the relevance of the principle of equivalence in prison medicine.

In this article we critically examine the principle of equivalence of care in prison medicine. First, we provide an overview of how the principle of equivalence is utilized in various national and international guidelines on health care provision to prisoners. Second, we outline some of the problems associated with its applications, and argue that the principle of equivalence should go beyond equivalence to access and include equivalence of outcomes. However, because of the particular context of the prison environment, third, we contend that the concept of "health" in equivalence of health outcomes needs conceptual clarity; otherwise, it fails to provide a threshold for healthy states among inmates. We accomplish this by examining common understandings of the concepts of health and disease. We conclude our article by showing why the conceptualization of diseases as clinical problems provides a helpful approach in the delivery of health care in prison.

Speech and language support: How physicians can identify and treat speech and language delays in the office setting.

Failure to recognize and intervene early in speech and language delays can lead to multifaceted and potentially severe consequences for early child development and later literacy skills. While routine evaluations of speech and language during well-child visits are recommended, there is no standardized (office) approach to facilitate this. Furthermore, extensive wait times for speech and language pathology consultation represent valuable lost time for the child and family. Using speech and language expertise, and paediatric collaboration, key content for an office-based tool was developed. THE TOOL AIMED TO HELP PHYSICIANS ACHIEVE THREE MAIN GOALS: early and accurate identification of speech and language delays as well as children at risk for literacy challenges; appropriate referral to speech and language services when required; and teaching and, thus, empowering parents to create rich and responsive language environments at home. Using this tool, in combination with the Canadian Paediatric Society's Read, Speak, Sing and Grow Literacy Initiative, physicians will be better positioned to offer practical strategies to caregivers to enhance children's speech and language capabilities. The tool represents a strategy to evaluate speech and language delays. It depicts age-specific linguistic/phonetic milestones and suggests interventions. The tool represents a practical interim treatment while the family is waiting for formal speech and language therapy consultation.

Le défaut de dépister et d'intervenir rapidement en cas de retards de la parole et du langage peut avoir des conséquences multiples au potentiel grave en matière de développement de la petite enfance et d'aptitudes à la littératie plus tard. Il est recommandé de procéder à l'évaluation systématique de la parole et du langage pendant les bilans de santé des enfants, mais il n'existe pas d'approche normalisée (en cabinet) pour la faciliter. De plus, les temps d'attente prolongés avant d'obtenir une consultation en orthophonie constituent une perte de temps précieux pour l'enfant et sa famille. Faisant appel à des compétences en orthophonie et à la collaboration de pédiatres, les chercheurs ont préparé le contenu essentiel d'un outil à utiliser en cabinet.L'outil visait à aider les médecins à réaliser trois grands objectifs : le dépistage rapide et précis des retards de la parole et du langage et des enfants vulnérables à des problèmes de littératie, l'aiguillage convenable vers des services d'orthophonie, au besoin, et l'enseignement aux parents, afin de les habiliter à créer des environnements de langage riches et réceptifs à la maison. À l'aide de cet outil, en collaboration avec le programme Lisez, parlez, chantez de la Société canadienne de pédiatrie et l'initiative Grow Literacy, les médecins seront mieux placés pour offrir des stratégies pratiques aux personnes qui s'occupent d'enfants afin de renforcer les capacités des enfants sur le plan de la parole et du langage.L'outil représente une stratégie pour évaluer les retards de la parole et du langage. Il dépeint les étapes linguistiques et phonétiques propres à l'âge et propose des interventions. L'outil représente un traitement provisoire pratique tandis que la famille attend une consultation officielle en orthophonie.

Physician perspectives on clinician-to-clinician telemedical consultation for gynecologic cancers: A qualitative study.

Objective: Approximately fifteen million women in the United States live > 50 miles from a gynecologic oncologist. Telemedical technology allows patients' local physicians to consult with subspecialist gynecologic oncologists without burdening patients with unnecessary in-person visits. Although critical to adoption of this technology, physicians' input into implementation of clinician-to-clinician consultation has not been sought. We therefore gathered feedback about experiences with referrals, communication, and openness to telemedical consultation from gynecologic oncologists, gynecologists, and medical oncologists. Methods: We recruited gynecologic oncologists, gynecologists, and medical oncologists from practices serving rural patients to participate in semi-structured interviews. The Consolidated Framework for Implementation Research and the Theoretical Domains Framework guided the interviews. Questions focused on factors influencing adoption and implementation of clinician-to-clinician telemedicine. Interviews were conducted via WebEx, recorded, and transcribed. Two investigators coded interviews using the combined frameworks and identified salient themes. Results: We conducted 11 interviews (6 gynecologic oncologists, 3 gynecologists, 2 medical oncologists) and identified themes encompassing communication burnout, barriers to sharing patient information, need for further logistical information, and potential benefits to patients. Conclusions: Clinician-to-clinician telemedicine may improve access to gynecologic cancer care by decreasing barriers to subspecialty expertise while simultaneously benefiting referring and consultant clinicians through improved identification and workup of patients who may need in-person consultation. To optimize desired outcomes, telemedical consultation must allow for communication of relevant patient information and records and easy integration into clinical workflow. Importantly, clinicians must perceive the consultation as improving patients' access to specialty care.

Patient-physician communication in intercultural settings: An integrative review.

Background: Intercultural communication between physicians and patients is a prominent challenge faced by health sectors. This integrative review aims to explore and summarize the current literature examining the cultural factors impacting the communication experience of patients and physicians in healthcare settings and provide an evidence-based solution. Methods: We used Whittemore and Knafl's (2005) approach to conduct this integrated review of the literature. Primary research studies meeting the search criteria were accessed from Medline/PubMed, Embassy, CINAHL, PsycInfo, ProQuest, Scopus, Web of Science, and Cochrane Review. We included studies published in English from 2008 to 2022. A total of 1731 studies were identified, of which 34 articles were included in this review. Results: The findings revealed a difference in physicians' communicative behaviour when encountering patients from different cultural backgrounds compared to encounters with patients from the same cultural background. When communicating with patients from different cultural backgrounds, physicians were found to be authoritarian, biomedical-focused, and not involve patients in decision-making. Patients' behaviours during consultations and experience and perception of quality of care in intercultural consultations were varied and inconclusive. Often patients were found to exaggerate respect for physicians, feel uncomfortable with the direct communication style of physicians, have a less proactive attitude, demonstrate low health literacy, and feel shy. These behaviours were attributed to language differences, differences in perception of disease, perception of health communication, prejudice, assumptions, training experience of physicians, and time allocated for consultations. Further, ineffective communication in intercultural consultations was found to impact patient satisfaction, medical adherence, continuity of care, physician's job satisfaction, and ability to diagnose correctly. Conclusions: Effective communication plays a significant role in patient and physician satisfaction. Health policymakers must formulate appropriate policies that encourage expatriate physicians to develop intercultural competencies to enhance intercultural communication, improve satisfaction, quality decision-making, correct diagnosis, and enhance public health.

Training Physicians in the Digital Health Era: How to Leverage the Residency Elective.

Digital health is an expanding field and is fundamentally changing the ways health care can be delivered to patients. Despite the changing landscape of health care delivery, medical trainees are not routinely exposed to digital health during training. In this viewpoint, we argue that thoughtfully implemented immersive elective internships with digital health organizations, including start-ups, during residency are valuable for residents, residency programs, and digital health companies. This viewpoint represents the opinions of the authors based on their experience as resident physicians working as interns within a start-up health navigation and telehealth company. First, residents were able to apply their expertise beyond the traditional clinical environment, use creativity to solve health care problems, and learn from different disciplines not typically encountered by most physicians in traditional clinical practice. Second, residency programs were able to strengthen their program's educational offerings and better meet the needs of a heterogenous group of residents who are increasingly seeking nontraditional ways to learn more about care delivery transformation. Third, digital health companies were able to expand their clinical team and receive new insights from physicians in training. We believe that immersive elective internships for physicians in training provide opportunities for experiential learning in a fast-paced environment within a field that is rapidly evolving. By creating similar experiences for other resident physicians, residency programs and digital health companies have a key opportunity to influence future physician-leaders and health care innovators.

Nursing Care Delivery Models and Intraprofessional Collaborative Care: Canadian Nurse Leaders' Perspectives.

Introduction: There are many different types of nursing care delivery models used to organize and provide care in hospitals. These models are comprised of different organizational structures and staffing skill mixes. Objective: The aim of this study was to explore how nursing care delivery models promote intraprofessional collaborative care in acute care hospitals from the perspectives of nurse leaders. Methods: A qualitative descriptive approach was used for this study. Telephone interviews were conducted between January 2021 and August 2021 using an interview guide comprised of semi-structured and structured questions. Using a purposeful sampling technique, ten leaders from nine hospital systems, representing both urban and rural hospitals in the province of Ontario, Canada, participated in the study. Content analysis was conducted resulting in two overarching themes. Results: The first theme, Fluidity of the Model addresses the flexibility of the models and the impact of contextual factors such as changes in nurses' scope of practice, government funding changes, staffing mix, and organizational policies and rules. The second theme, Tools of the Trade describes the resources that hospitals implement to promote intraprofessional collaboration that indirectly impacts on patient safety. Conclusion: Nursing care delivery models need to be flexible and adaptable. All nursing care delivery models in this study used various tools to promote intraprofessional collaborative care.

The Association between Mental Health Symptoms and Quality and Safety of Patient Care before and during COVID-19 among Canadian Nurses.

(1) Background: While the association between nurse mental health and quality and safety of patient care delivery was well documented pre-pandemic, fewer research studies have examined this relationship in the context of COVID-19. This study examines the impact of various mental health symptoms experienced by nurses on quality and safety before and during the COVID-19 pandemic; (2) Methods: A secondary analysis of cross-sectional survey data from 4729 and 3585 nurses in one Canadian province between December 2019 and June-July 2020 was conducted. Data were analyzed using between group difference tests and logistic regression; (3) Results: Compared to pre-COVID-19, during COVID-19 nurses reported a higher safety grade, a greater likelihood of recommending their units for care and lower quality of nursing care. Most mental health symptoms were higher during COVID-19 and higher levels of mental health symptoms were correlated with lower ratings of quality and safety both pre- and during COVID-19; (4) Conclusion: Mental health symptoms have implications for nurses' quality and safety of patient care delivery, with the association between mental health symptoms and quality and safety following a dose-response relationship before and during COVID-19. These findings suggest that it is worthwhile for nurse mental health symptoms to be included as hospital level performance metrics.

Association of Physician Referrals with Timely Cancer Care Using Tumor Registry and Claims Data.

More Americans are being screened for and more are surviving colorectal cancer due to advanced treatments and better quality of care; however, these benefits are not equitably distributed among diverse or older populations. Differential care delivery outcomes are driven by multiple factors, including access to timely treatment that comes from high-quality care coordination. Providers help ensure such coordinated care, which includes timely referrals to specialists. Variation in referrals between providers can also result in differences in treatment plans and outcomes. Patients who are more often referred between the same diagnosing and treating providers may benefit from more timely care compared to those who are not. Our objective is to examine patterns of referral, or patient-sharing networks (PSNs), and our outcome, treatment delay of 30-days (yes/no). We hypothesize that if a patient is in a PSN they will have lower odds of a 30-day treatment initiation delay. Our observational population-based analysis using the National Cancer Institute (NCI)-linked tumor registry and Medicare claims database includes records for 27,689 patients diagnosed with colorectal cancer from 2001 to 2013, and treated with either chemotherapy, radiotherapy, or surgery. We modeled the adjusted odds of a delay and found 17.04% of patients experienced a 30-day delay in initial treatment. Factors that increased odds of a delay were lack of membership in a PSN (adjusted odds ratio [AOR]: 2.20; 95% confidence interval [CI]: 1.71-2.84), racial/ethnic minority status, and having multiple comorbidities. Provider characteristics significantly associated with greater odds of a delay were if dyads were not in the same facility (AOR: 1.95; 95% CI: 1.81-2.10), if providers were different genders, most notably male (diagnosing) and female (treating) [AOR: 1.23; 95% CI: 1.08-1.40, p = 0.0015]. PSNs appear to be associated with reduced of a care delay. The associations observed in our study address the demand for developing multilevel interventions to improve the delivery and coordination of high-quality of care for older cancer patients.

The Relationship Between Nursing Care Delivery Models, Emotional Exhaustion, and Quality of Nursing Care Among Jordanian Registered Nurses.

Background: Inappropriately selected models of nursing care delivery and emotional exhaustion of nurses at work not only affect the nurses' health, but also the health of their patients. Purpose: To examine the relationship between nursing care delivery models, nurses' emotional exhaustion, and quality of nursing care. Methods: A cross-sectional survey that used a convenience sampling technique was employed. A total of 160 participants completed the study. Participants provided information about nursing care delivery models, nurses, emotional exhaustion, and quality of nursing care. Results: Participants had a moderate level of emotional exhaustion. No statistically significant difference in the scores of quality of nursing care and emotional exhaustion were found according to the type of care delivery model (P > .05). Emotional exhaustion was significantly and negatively correlated with the (nursing staff characteristics) subscale of quality of nursing care (r = -.183, P = .021). There was a significant difference in emotional exhaustion in regard to shift duty, marital status, education level, years of experience, salary, and working area). Only marital status significantly predicted emotional exhaustion (t = 2.57, B = -8.98, P = .011). Conclusions: Quality of nursing care was associated with nurses' emotional exhaustion rather than models of nursing care delivery. As nurses' emotional exhaustion could negatively affect the quality of nursing care, addressing the emotional exhaustion of nurses is important to improve patient outcomes.

Experiences of Health Care Professionals Working Extra Weekends to Reduce COVID-19-Related Surgical Backlog: Cross-sectional Study.

BACKGROUND: During the quiescent periods of the COVID-19 pandemic in 2020, we implemented a weekend-scheduled pediatric surgery program to reduce COVID-19-related backlogs. Over 100 staff members from anesthesiologists to nurses, surgeons, and administrative and supporting personnel signed up to work extra weekends as part of a novel weekend elective pediatric surgery program to reduce COVID-19-related backlog: Operating Room Ramp-Up After COVID-19 Lockdown Ends-Extra Lists (ORRACLE-Xtra). OBJECTIVE: In this study, we sought to evaluate staff perceptions and their level of satisfaction and experiences with working extra scheduled weekend elective surgical cases at the end of the 3-month pilot phase of ORRACLE-Xtra and identify key factors for participation. METHODS: Following the pilot of ORRACLE-Xtra, all perioperative staff who worked at least 1 weekend list were invited to complete an online survey that was developed and tested prior to distribution. The survey collected information on the impact of working weekends on well-being, overall satisfaction, and likelihood of and preferences for working future weekend lists. Logistic regression was used to estimate the association of well-being with satisfaction and willingness to work future weekend lists. RESULTS: A total of 82 out of 118 eligible staff responded to the survey for a response rate of 69%. Staff worked a median of 2 weekend lists (IQR 1-9). Of 82 staff members, 65 (79%) were satisfied or very satisfied with working the extra weekend elective lists, with surgeons and surgical trainees reporting the highest levels of satisfaction. Most respondents (72/82, 88%) would continue working weekend lists. A sense of accomplishment was associated with satisfaction with working on the weekend (odds ratio [OR] 19.97, 95% CI 1.79-222.63; P=.02) and willingness to participate in future weekend lists (OR 17.74, 95% CI 1.50-200.70; P=.02). Many (56/82, 68%) were willing to work weekend lists that included longer, more complex cases, which was associated with a sense of community (OR 0.12, 95% CI 0.02-0.63; P=.01). CONCLUSIONS: Staff participating in the first 3 months of the ORRACLE-Xtra program reported satisfaction with working weekends and a willingness to continue with the program, including doing longer, more complex cases. Institutions planning on implementing COVID-19 surgical backlog work may benefit from gathering key information from their staff.

A study protocol to evaluate the implementation and effectiveness of the Clinical Nurse Leader Care Model in improving quality and safety outcomes.

AIMS: Patients are harmed or die every year because of unsafe, inappropriate or inadequate healthcare delivery. Registered Nurses are a recognized patient safety strategy. However, variability in research findings indicate the relationship is not as simple as "more nurses=better outcomes." Hence, currently there exists no evidence-based frontline nursing care model. One emerging model is the Clinical Nurse Leader care model. DESIGN: This Hybrid Type II Implementation-Effectiveness study will evaluate the effect of the care model on standardized quality and safety outcomes and identify implementation characteristics that are sufficient and necessary to achieve outcomes. METHODS: This study leverages a natural experiment in 66 clinical care units in nine hospitals across five states in the United States that have implemented the Clinical Nurse Leader care model. RESULTS: Findings will elucidate Registered Nurse's mechanisms of action as organized into frontline models of care and link actions to improved care quality and safety.