Integrated care competencies and their association with cross-cultural competence among registered nurses: A cross-sectional questionnaire survey.

AIM: To examine the association between the integrated care competencies and cross-cultural competence of registered nurses prior to the integration of social and healthcare services in Finland. DESIGN: A descriptive correlational cross-sectional questionnaire survey was conducted. METHODS: A simple random sample of 10,000 registered nurses was drawn from the Finnish Central Register of Valvira (National Supervisory Authority for Welfare and Health); 7000 of them were sent the online questionnaire, and a total of 1232 registered nurses participated in the study. We collected data using background questions, revised versions of the Competent Workforce for the Future tool in the four domains of client orientation, responsibility for personal or relative's welfare, fluency and clarity of services and access to the services and of the Cross-Cultural Competence of Healthcare Professional tool in the four domains of motivation/curiosity, attitude, skill and emotion/empathy. RESULTS: Participants demonstrated a high level of integrated care competencies (mean = 4.00, SD ± 0.49). An association was observed between integrated care competencies and their domains of skills, motivation/curiosity, emotions/empathy, and cross-cultural competence (p < 0.001). Female sex, older age, more working experience, employment in the private sector, and higher self-rated competence for working in a multicultural environment were positively associated with higher integrated care competencies. CONCLUSION: It is recommended that nurse managers and nurse educators emphasize the development of registered nurses' cross-cultural competence alongside integrated care competencies to meet the needs of different individuals and communities when providing integrated care. PATIENT OR PUBLIC CONTRIBUTION: Finnish registered nurses including all types of nurses, midwives and paramedics working the public and private healthcare, were involved in this study by responding to the online survey.

Nurse managers' perceptions of patient-centred care and its influence on quality nursing care and nurse job satisfaction: Empirical research qualitative.

AIM: To explore nurse managers' perceptions of patient-centered care (PCC), its influence on quality nursing care, nurse job satisfaction, and to provide baseline data for a context-driven PCC model. DESIGN: The study utilized a qualitative, phenomenological design, employing individual in-depth interviews to collect data on nurse managers' PCC perceptions until data saturation. METHODS: Sampling involved purposive selection of Northern Ghana, random selection of the tertiary hospital cluster with the three participating hospitals, and purposive sampling of the nine nurse managers. Data analysis employed thematic analysis based on a six-phase framework. Methodological trustworthiness was ensured through various strategies including prolonged engagement, supervisor discussions and crosschecking with interviewees. RESULTS: Three main themes emerged from the study including nurse managers' conceptualization of PCC, perceived patient-centred practices and its influence on nursing quality and job satisfaction. The findings emphasized the patient's individuality, cultural values, holistic care, the importance of strong nurse-patient relationships and a patient-centric environment. The nurse managers perceived PCC as positively influencing quality nursing care and nurse job satisfaction. The findings offer nuanced insights into nurse managers' perspectives on patient-centeredness and highlight areas for improvement.

Nursing and midwifery research priorities for Kenya: Results from a national Delphi survey.

BACKGROUND: The International Council of Nurses and the World Health Organization have prioritized evidence-based nursing and midwifery practice derived from nurse-led research. However, in a low-resource country like Kenya, there is a need to identify research priorities to optimize utilization of limited existing research infrastructure and funding. Kenya lacks a nursing and midwifery research strategy to guide research prioritization. INTRODUCTION: The goal of this study was to identify and describe nursing and midwifery research priorities for Kenya. METHODS: A cross-sectional Delphi survey using two iterative rounds of electronic data collection was used to reach a consensus about priorities for nursing and midwifery research in Kenya. NVivo-12 was used to analyze the qualitative data to identify categories, sub-themes, and themes; descriptive statistics were used to analyze quantitative data. RESULTS: Participants included 159 nurse managers, administrators, and educators representing regional, county, and national referral, private, and faith-based hospitals, nurse training schools, research institutions, and nursing organizations in Kenya. Staffing challenges, motivation, remuneration, and funding for higher education were ranked as the top critically important issues using a cutoff point of ≥ 70% agreement. CONCLUSION: There is a need for the development of a National Framework for Nursing and Midwifery Research Priorities in Kenya to guide research that builds excellence in meeting nursing and midwifery human resource concerns and ultimately improves patient care practices and outcomes. IMPLICATIONS FOR NURSING AND NURSING POLICY: The objective of Kenya's health goals delineated within three key national health documents cannot be attained without adequate numbers of nursing and midwifery professionals and policies that address nursing and midwifery staffing challenges, remuneration for employment, and improved funding for higher education.

How do work-life balance programmes influence nurses' psychological well-being? The role of servant leadership and learning goal orientation.

AIMS: Our study aims to investigate the effect of work-life balance programmes on Chinese nurses' psychological well-being, directly and indirectly, via learning goal orientation. Our research also aims to investigate the moderating role of servant leadership, a holistic leadership style that prioritizes serving employees, in the association between work-life balance programmes and psychological well-being. DESIGN: A questionnaire-based, time-lagged study (1-week interval). METHODS: From September 2022 to October 2022, we collected a total of 211 matched and valid responses from nurses working for hospitals in Jiangsu Province, China. Data regarding work-life balance programmes, servant leadership, learning goal orientation and psychological well-being were gathered using a survey administered in two waves, 1 week apart. We utilized the PROCESS Model 5 to test the moderated mediation model. RESULTS: Work-life balance programmes significantly improved nurses' psychological well-being. Moreover, learning goal orientation mediated the relationship between work-life balance programmes and psychological well-being. However, servant leadership did not moderate the association between work-life balance programmes and psychological well-being. CONCLUSION: Our study contributes to extant nursing literature by attending to the organizational strategies that promote psychological well-being. This study is novel because it evaluates the mediating and moderating process through which work-life balance programmes improve nurses' psychological well-being. IMPACT: The provision of work-life balance programmes could enhance learning goal orientation, resulting in possible improvement in nurses' psychological well-being. Moreover, servant leadership styles may contribute to psychological well-being. Our study can help nurse managers enhance their organizational strategies (e.g. work-life balance programmes) and leadership resources (e.g. servant leadership styles) to address nurses' well-being issues. PATIENT OR PUBLIC CONTRIBUTION: This paper addresses the United Nations' Sustainable Development Goal 3 regarding 'Good Health and Well-being'.

Factors influencing mindfulness among Jordanian nurses: A cross-sectional study.

AIM: The current study aimed to examine if work-related factors, psychological variables and selected demographics predict mindfulness among Jordanian nurses. BACKGROUND: Mindfulness has been associated with various work-related variables. Studies examining mindfulness antecedents in nurses are scarce. METHODS: A cross-sectional study was conducted to collect data from 173 nurses currently employed in three major referral hospitals. A demographic questionnaire and instruments to collect data about nursing mindfulness, depression, stress, work-family conflict, and family-work conflict were used. RESULTS: The bivariate analysis showed that all study variables combinations were significant except for the correlation between income and mindfulness. The best fit model showed that only four variables significantly contributed to the model: depression, stress, family-work conflict, and educational level. These variables explained 57% of the variance in mindfulness in our sample. CONCLUSIONS: Depression, stress, family-work conflict and educational levels contributed to mindfulness levels in Jordanian nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should be aware of the factors that may affect their employees' mindfulness levels and target these factors through the application of evidence-based interventions to improve nurses' levels of mindfulness, which in turn will mitigate the negative impact of lower levels of mindfulness.

A Theoretical Framework of Home-Based Professional Nursing Practice.

The purpose of this article is to introduce a descriptive middle-range theoretical framework unique to professional nursing practice provided in the patient's home. The variety of care models provided in the home, ranging from nonskilled home maintenance service to hospital-at-home programs, reinforces the need to clearly define and describe home-based professional nursing practice. This framework includes six concepts (primacy of home, patient authority, patient self-management, caregivers as collaborators, interprofessional clinical team collaboration, nurse autonomy), and four relational statements of the concepts that describe the experience of patients in their homes and home-based providers. The four theoretical statements are: (1) The patient's beliefs, habits, and self-management actions in the home are shaped by the meaning of home and the physical home environment. (2) The patient has ultimate decision-making control and authority over his/her own health-related behaviors in the home. (3) Home-based care includes interprofessional teams to provide holistic care and maximize self-management ability. (4) The home-based nurse is autonomous when working in the home with the patient/caregiver and has primary responsibility for holistic assessment and intervention. Knowledge of this theoretical framework can help nurses maintain the integrity and purpose of the professional nurse's role in home-based care as well as provide guidance for nursing education and organizational structures. Recommendations for research to test and validate the framework are provided.

The COVID-19 pandemic: Narratives of front-line nurses from Wuhan, China.

This study aimed to explore the experiences of nurses in Wuhan Hospital as front-line workers during the COVID-19 pandemic. A descriptive qualitative study of such nurses was conducted from a tertiary hospital in Wuhan. Semi-structured individual interviews were undertaken with 8 registered nurses who were front-line health workers in one of the COVID-19 wards and 3 nursing managers from the response team. Five discrete themes were identified from the narratives of nurses' experiences during the COVID-19 outbreak in Wuhan: "content of fundamental care," "teamwork," "reciprocity," "nurses' own worries," and "lifelong learning and insights." Nurses in the front line of care during the COVID-19 pandemic can contribute important information from their hands-on experience for providing a holistic response to an infectious outbreak like COVID-19. The concerns nurses raised at both personal and professional levels have implications for nursing education and clinical practice settings, particularly in the time of a pandemic when nurses' well-being requires attention, and at the same time for considering organizational factors that enable nurses to provide care to patients with confidence. Hospital policies and nursing management need to be ready and adhere to flexible work planning systems and approaches during a pandemic.

The effect of a nurse manager's authentic leadership intervention on nurses' well-being: A single unit QI project.

INTRODUCTION: Nurse well-being is at the forefront of nursing leadership's focus, particularly with the impact of the ongoing COVID-19 pandemic. Nurse managers, as authentic leaders, should understand their role in supporting the spectrum of nurse well-being. At the negative end of well-being, leaders must address staff burnout as it increases nurse turnover, shortage of nurses, and poor patient outcomes. PURPOSE: The specific aim for this quality improvement (QI) project was to implement a program that could guide a nurse manager of a single inpatient unit on how to improve well-being in their nursing staff as measured by: (a) improved well-being scores to a composite score of 3.5 or greater as indicated by follow-up Culture Pulse surveys distributed in 2021; and (b) reduced absenteeism among nursing staff by 18%. RESULTS: Five surveys identical to the organization's work culture survey, that measures well-being, were sent to staff each month starting in January 2021 and ending in May 2021. The average composite score from all five surveys was 2.8, indicating an overall improvement. Absenteeism was reduced during implementation by 39%. DISCUSSION: This QI project guides nurse managers in the evidence-based interventions that can promote well-being in their staff.

Determining the effect of neuro-linguistic programming techniques on the conflict management and interpersonal problem-solving skills of nurse managers: A mixed methods study.

AIM: This study, which used quantitative and qualitative design, was conducted to explore the effect of neuro-linguistic programming techniques on the conflict management and interpersonal problem-solving skills of nurse managers. BACKGROUND: Neuro-linguistic programming is among the methods that can enable managers to achieve the desired results in managing interpersonal problems and conflicts in an organisation. METHODS: The research was carried out with a mixed methods approach. The Personal and Professional Characteristics Information Form, Interpersonal Problem-Solving Inventory and Rahim Organizational Conflict Inventory-II were applied to 41 nurse managers and nurses to collect quantitative data for the study. Semi-structured questionnaires were used to collect qualitative data in focus-group interviews held both before and 6 months after the training. RESULTS: As a result of the content analysis of the qualitative data, the nurse managers in the training group were found to have improved abilities to plan and increased flexibility, positiveness, happiness and motivation when compared to the nurse managers in the control group. Findings supporting these data were obtained in the analyses of interviews with nurses. CONCLUSION: Neuro-linguistic programming training can make a difference in terms of helping nurse managers to develop interpersonal problem- and conflict-solving skills. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers can use neuro-linguistic programming techniques for conflict management and interpersonal problem-solving occurring in their organizations. For this purpose, it is recommended that pregraduate and postgraduate neuro-linguistic programming training is provided to nurse managers.

Revealing how language builds the identity of the advanced nurse practitioner.

AIMS AND OBJECTIVES: To explore how language works to enable and constrain the role of the advanced nurse practitioner (ANP) in the health system. BACKGROUND: Nurses and doctors are produced within historically established disciplinary boundaries. These boundaries are becoming more porous, offering the possibility of a more liberated identity for ANPs that will allow them to reach their full potential. Current uncertainty and confusion about ANPs' identity result in their role being underutilised. DESIGN: A critical discourse analysis design was used to explore participants' language-in-use. Findings are reported according to the COREQ research checklist. METHOD: Data were collected through seven in-depth interviews and four focus groups and analysed using Gee's (2010) Identity Building Tool. Participants included ANPs, nurses (including nurse managers), doctors and allied healthcare professionals. RESULTS: Four discourses were revealed. Participants' language-in-use worked to privilege the ANP's uniquely holistic identity. However, this aspect is also associated with a controlled identity, predominantly constrained by medics and restricted from advancing. The third discourse, the medicalised identity builds an identity that positions ANPs as medical replacements who are assigned trivial medical tasks. The final discourse constructs an independent powerful identity for the ANP that is influential and autonomous. CONCLUSIONS: Circulating discourses and conversations can influence and shape the construction of the ANP identity. Healthcare professionals need to identify and counter discourses and conversations that construct ANPs' ways of knowing and knowledge as inferior and their role as subservient. Otherwise, ANPs' identity will continue to be controlled and their advancement restricted. RELEVANCE TO CLINICAL PRACTICE: Confusion concerning the role and identity of the ANP can limit their contribution to the healthcare system. Healthcare professionals need to be aware of how language-in-use can prevent the role from developing and reaching its full potential in enhancing healthcare provision and delivery. Reporting follows the COREQ criteria.

The Clinical Nursing and Midwifery Dashboard (CNMD): A State-Wide Implementation.

The clinical nursing and midwifery dashboard (CNMD) was built to provide a near real-time information and data visualisations for nurse unit managers (NUMs) and maternity unit managers (MUMs) within only a 5-15 minutes delay from when they enter data to the integrated electronic medical records (ieMR) system. The dashboard displays metrics and information about current adult inpatients in overnight wards. The aim is to support NUMs and MUMs to manage their daily workload and have continuous visibility of patients nursing risk and safety assessment documentation. A quantitative evaluation approach was conducted to measure the impact of the dashboard on key performance indicators. Statistical analysis was completed to compare risk assessment average completion times prior to and post CNMD implementation. The results of the evaluation were positive, and the statistical analysis shows significant reduction in the average time to complete different risk assessments with p-value<0.01.

Boundary Spanning Leadership in Response to the COVID-19 Pandemic: Experience of Nurse Leaders in a Large Integrated Long-term Health Care System.

This article provides insight into the impact of boundary spanning for nurse leaders in a large integrated post-acute health care system in the southeastern part of the United States as they responded (not reacted) to the COVID-19 pandemic that threatened the lives of 2 of society's most vulnerable populations, the elderly and the disabled. Through illustrative examples, the authors describe the 6 strategies of boundary spanning leadership-buffering, reflecting, connecting, mobilizing, weaving, and transforming-that enabled these nurse leaders to respond effectively during this crisis. The literature informs on the merit of situational leadership, as no single type of leadership is right for all circumstances. Today's new novel pandemic served as a powerful catalyst for a group of nurse leaders in a large non-acute network of health care organizations, their colleagues, and other key stakeholders to reframe the boundaries that existed between their organizations and associations, thus enabling them to successfully problem solve together to accomplish several high-stakes goals.

Safety attitudes build safety culture: Nurse/midwife leaders improving health care using quantitative data.

AIM: We aim to determine safety attitudes of nurses and midwives across a Local Health District in Australia and compare results 1 year later following facilitated feedback of results. BACKGROUND: Positive safety cultures are imperative for positive patient and staff outcomes. Staff member's attitude contribute to an organisations safety culture but can differ between health professional groups and across different subcultures. METHOD: The Safety Attitudes Questionnaire (SAQ-Short version) was administered to all nurses and midwives within a Local Health District in NSW, Australia in 2019 and 2020. Results were facilitated back to nursing/midwifery leadership teams with an expectation of developing and enacting an action plan, based on results. RESULTS: Of the six domains in the SAQ-Short version, five domains scores increased significantly (p < .001) over the time period. CONCLUSIONS: Measures over time are important to establish differences in perceptions and feedback on impact of actions. Facilitated feedback of results shows meaning when nursing/midwifery leadership staff have data explained and an opportunity to discuss and plan. IMPLICATIONS FOR NURSING MANAGEMENT: This study shows that facilitated feedback of quantitative survey results brings improved results when a survey is replicated. Nurse managers should enact a contextualized action plan with teams based on survey results to influence improvement in safety attitudes of staff.

Association between psychological capital and spiritual care competencies of clinical nurses: A multicentre cross-sectional study.

AIMS: To investigate the status of spiritual care competencies among clinical nurses and their relationships with psychological capital. BACKGROUND: Limited knowledge is about the influence of positive personal characteristics on nurses' spiritual care competencies. METHODS: A multicentre cross-sectional study. A total of 1717 nurses were recruited from nine separate Chinese hospitals. Online questionnaires were delivered through a local nursing association to assess socio-demographics, spiritual care competencies and psychological capital of nurses. RESULTS: Nurses had mild-to-moderate levels of spiritual care competencies and moderate levels of psychological capital. Psychological capital and its two metrics (self-efficacy and hope), spiritual care education, professional qualification and shift work were the main predictors of spiritual care competencies (each p < .05). CONCLUSION: The findings of the study show a positive relationship between psychological capital and spiritual care competencies of clinical nurses. Strengthening nurses' psychological capital could improve their spiritual care competencies. IMPLICATIONS FOR NURSING MANAGERS: Nurse managers and hospital administrators should better understand the value of psychological capital for nurses' capacity development. Effective interventions need to be implemented separately or combined with spiritual care education programmes to improve nurses' psychological capital and spiritual care competencies.

Identifying the evidence base of interventions supporting mental health nurses to cope with stressful working environments: A scoping review.

AIM: To scope the evidence on interventions used to help mental health nurses cope with stressful working environments. BACKGROUND: Nursing managers may implement interventions to support mental health nurses cope in their role. However, the evidence supporting these interventions has not been recently reviewed. METHODS: A scoping review was conducted which entailed searching and selecting potential studies, undertaking data extraction and synthesis. RESULTS: Eighteen studies published since 2000 were identified. They employed different designs, ten used quasi-experimental methods. Interventions involving active learning appeared beneficial, for example stress reduction courses and mindfulness. However, small sample sizes, short follow-up periods and variation in outcome measures make it difficult to identify the optimum interventions. No studies have considered cost-effectiveness. CONCLUSION: There is some evidence that mental health nurses benefit from interventions to help them cope with stressful working environments. However, higher quality research is needed to establish the effectiveness and cost-effectiveness of different interventions. IMPLICATIONS FOR NURSING MANAGEMENT: Managers should provide opportunities and encourage mental health nurses to engage in active learning interventions, for example mindfulness to help them cope with stressful working environments. Nurses also want managers to address organisational issues; however, no research on these types of interventions was identified.

Nurse coordinator roles in the management of patients with hepatocellular carcinoma: A French national survey.

Hepatocellular carcinoma (HCC) mostly occurs in patients with chronic liver disease (CLD). HCC treatment may have a direct impact on CLD prognosis. HCC management can therefore become complex, involving multiple health care providers, such as oncologists, hepatologists, radiologists, and surgeons. In France, dedicated nurses have been involved in patient care pathways. Their impact is poorly documented. PURPOSE: To determine the country-wide distribution of HCC nurse coordinators in French health care settings and to describe their roles and responsibilities. PATIENTS AND METHODS: A survey using a multi-item questionnaire (including center characteristics, nurse coordinator characteristics, and quality indicators such as patient care pathway initiation timeline, scheduled length of hospital stay, diagnostic disclosure process) was conducted. All French liver cancer centers planning to participate in a prospective national cohort study for patients with HCC (CHIEF Cohort) were invited to take part in the survey. Bivariate analysis compared centers with a nurse coordinator to those without. RESULTS: Among the 42 of 72 centers that replied, 14 treated fewer than 75 HCC patients. Treatment mostly took place in hepatology units (34/42). Sixteen nurse coordinators were part of the health care team in 13 of the 42 centers. Among these 13 centers, 11 were university hospitals and 11 followed more than 75 patients per year. The median number of patients followed in these centers was 300 (min-max 44-600) in 2017. All nurse coordinators were involved in providing patient information and counseling. Other roles included treatment monitoring (13/16), care coordination (12/16), psychological support (12/16) and treatment planning (11/16). Thirteen nurse coordinators conducted diagnostic disclosure nurse consultations; seven conducted initial patient contact consultations; and six held outpatient nurse consultations, with wide heterogeneity between centers. The presence of a nurse coordinator was associated with completion of the full diagnostic disclosure process (p = 0.045). CONCLUSION: In France, nurse coordinators for HCC patient pathway management are present mainly in university hepatology units with a caseload of more than 75 patients per year. All provide patient information and counseling but their roles in care coordination, patient support and holistic assessment are heterogeneous and not standardized.

The influence of team mindfulness on nurses' presenteeism: A cross-sectional study from the perspective of sensemaking.

AIM: This study explores the influence of team mindfulness on nurses' presenteeism. The mediation effect of perceived empathic concern and perceived insider status and the moderating effect of organisational formalization are assessed. BACKGROUND: Nurses are prone to presenteeism. Few studies have explored the influence of the organisational environment on nurses' presenteeism. Studies that consider organisational, work-related and person-related factors on the decision-making process influencing nurses' presenteeism are scarce. METHODS: Using a cross-sectional survey, data from 396 nurses were gathered from three time points and multiple regression analyses were used to test each hypothesis. RESULTS: (a) Team mindfulness reduces nurses' presenteeism. (b) Both perceived empathic concern and perceived insider status mediate the relationship between team mindfulness and nurses' presenteeism. (c) Organisational formalization exerts a positive moderating effect on the relationship between team mindfulness and perceived empathic concern. CONCLUSIONS: Team mindfulness reduces nurses' presenteeism through affective (perceived empathic concern) and cognitive (perceived insider status) sensemaking paths. Organisational formalization is a situational factor to improve the effectiveness of team mindfulness. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers need to devote themselves to cultivating team mindfulness, building an atmosphere to promote perceived empathic concern and perceived insider status, and promoting a formal organisational structure.

Nurse Leaders Employ Contemplative Practices to Promote Healthcare Professional Well-being and Decrease Anxiety.

OBJECTIVE: The purpose of this study was to test the effectiveness of a daylong resilience retreat on healthcare professionals' anxiety levels, intention to engage in mindfulness practices, and self-efficacy around mindfulness. BACKGROUND: Caregiver burnout is a concern that needs to be addressed at the organizational level so that professionals can reduce their risk of psychological injury while providing high-quality care. The COVID-19 (novel coronavirus) pandemic has exacerbated symptoms of burnout among nurses nationally. METHODS: Ten sessions of daylong resilience retreats were delivered to independent groups of nurses, nurse practitioners, and other healthcare professionals. Preretreat and postretreat assessments were completed using a 19-item survey developed by the research team to assess state anxiety, intention to engage in mindfulness practices, and self-efficacy around mindfulness. RESULTS: One hundred six healthcare professionals completed the resilience retreats. There was a statistically significant decrease in state anxiety scores following the retreat. The majority of the participants reported high intentions to engage in mindfulness practices and felt confident about incorporating mindfulness in their lives. CONCLUSIONS: Brief resilience retreats endorsed by nurse leadership can reduce perceived anxiety and facilitate engagement in contemplative practices, which are associated with a decrease in the risk of burnout.