Voices of women veterans: My Life, My Story.

PURPOSE: To explore women veterans' experiences by writing short stories of their lives as part of a program, My Life, My Story (MLMS), and qualitatively analyzing the aggregate stories to identify themes, risks, and opportunities for changes in care. METHODS: We interviewed women veterans receiving care and/or working at the James J. Peters VA Medical Center in the Bronx, N.Y. Women researchers experienced in the narrative storytelling model, MLMS, wrote participants' short stories. Twenty-two stories were written, aggregated, coded, and reviewed multiple times until saturation; no new themes emerged. The researchers established trustworthiness, consistency, and credibility. RESULTS: Themes from data from the stories of women veterans included reasons for choosing a military career, military and postmilitary experiences, psychological and military sexual trauma (MST), access to mental health care and support, antiwomen/misogynistic perceptions, relationships, life after military service, experiences with VA care and services, and future goals. CONCLUSION: Women veterans have very different military and postmilitary experiences from men. Given the increasing number of women veterans who experience homelessness, MST, and posttraumatic stress disorder, providers, the healthcare community, and the public need to hear the voices of women veterans, learn about their military experiences, and redesign women veterans' healthcare to better meet their unique needs by improving supportive mental and physical health care services.

Current and emerging vein identification technology for phlebotomy and peripheral I.V. cannulation.

ABSTRACT: New, evidence-based technologies can improve venous access for phlebotomy and I.V. insertion, especially in patients with difficult I.V. access. This article discusses adjunctive vein access tools that can improve the success of first-time blood draws and peripheral I.V. insertion.

Creating a Comprehensive Hospital-Based Skin and Wound Care Program to Improve Outcomes and Decrease Pressure Injuries.

ABSTRACT: The author describes implementing a comprehensive skin and wound care program during her tenure as chief nurse executive to address challenges related to a lack of expert resources and knowledge of pressure injury (PI) prevention and treatment. This multifaceted program included the creation of a comprehensive, interprofessional, evidence-based skin and wound care committee; establishing a "Wound Board" for case presentations and expert consultation; providing educational programs; streamlining the processes for product evaluation, procurement, and use; decreasing costs; and hiring additional wound, ostomy, and continence nurse specialists. As a result, hospital-acquired PI incidence dropped significantly.

The Impact of Interprofessional Shared Governance and a Caring Professional Practice Model on Staff's Self-report of Caring, Workplace Engagement, and Workplace Empowerment Over Time.

OBJECTIVE: To describe the impact of the implementation of interprofessional shared governance and a caring professional practice model (Relationship-Based Care [RBC]) on the staff's self-report of caring, work engagement, and workplace empowerment over a 4-year time frame. BACKGROUND: Shared or interprofessional governance has moved mainstream within healthcare settings, particularly within agencies seeking to sustain high reliability in the offering of quality patient care services and/or interest in meeting Magnet standards or embarking upon the Pathway to Excellence. Nurse leaders report that organizations having implemented shared governance thrive, citing professional governance as key to workplace engagement and empowerment, particularly related to quality care initiatives. Transition to interprofessional shared governance structures typically takes 2 to 3 years. It is unknown whether related outcome variables are sustainable over time. METHODS: Utilizing Watson's theory of human caring and appreciative inquiry as underlying frameworks, a longitudinal, quantitative study design was employed. Interprofessional focus groups and introductory sessions were offered to inform and engage all personnel within the medical center. Motivated units were identified, professional shared governance council members elected, and unit-specific education provided. Quality improvement initiatives were facilitated within unit councils, and formal leadership programs to enhance project guidance and to support staff empowerment skills for the managers of the units that were up-and-running were provided. Preimplementation and postimplementation measurements of staff's caring, workplace engagement and work empowerment were assessed, compared, and trended across units over time. RESULTS: Only work empowerment scores among staff working within RBC units were sustainable and increased progressively and significantly over time. Work engagement levels initially rose and then stabilized over time. Caring levels remained stable despite the implementation of a caring professional practice model. Statistically significant correlations were noted between work engagement and empowerment, followed by the relationship between work engagement and caring, followed by the relationship between empowerment and caring. CONCLUSIONS: The sustainability of work empowerment is likely related to the periodic provision of education for leaders regarding leading within an empowered work environment. A stronger focus on staff caring, particularly within quality improvement initiatives, with leadership guidance, will be paramount moving forward.

Interprofessional shared governance and relationship-based care: implementation and lessons learned.

Shared decision-making has become a hot topic in healthcare. This article describes a step-by-step, 'how-to' approach to implementation of an interprofessional shared governance and relationship-based care model at a 300-bed tertiary academic medical centre in a large metropolitan area in the US and outlines the lessons learned. The project, undertaken in 'waves', encompassed inpatient and ambulatory services and has been sustained for over eight years.

Developing a transcultural nursing leadership institute in China.

Globalization has been the hallmark of the 21st century. This article focuses on developing the Transcultural Nursing Leadership Institute (TCNLI) in China. This project built a leadership program in Wenzhou, China, empowering and supporting nurses to solve problems in their own practices with evidence-based approaches and local resources using the Dreyfus International Health Foundation's method Problem Solving for Better Health (PSBH).The partnership began when I was a Visiting Professor in Wenzhou, China and established collegial relationships with the Dean of the School of Nursing and the Chief Nursing Officers of the affiliated hospitals. In contrast to previous visiting scholars who went to China to lecture on health issues, I sought to develop a sustainable program and make a lasting contribution to the nursing practice in Wenzhou. The PSBH model was the method for what became the TCNLI. The TCNLI has taught over 200 nursing leaders to develop and implement major projects and connected them to the global nursing community by facilitating joint research, publications, and education. The journeys "across the bridge" from New York to Wenzhou have taken nursing and healthcare leaders from the United States to China and reciprocally welcomed leaders from Wenzhou to the United States for professional experiences. Outcomes of our partnership include more than 200 completed change projects. International partnerships within the global healthcare community provide a vehicle to navigate the complexities of transcultural differences and ultimately a way to bridge the gap and improve global healthcare.

Structural empowerment and anticipated turnover among behavioural health nurses.

AIM: The aim of this pilot study was to examine the relationship between structural empowerment and anticipated turnover among behavioural health nurses. BACKGROUND: There have been several studies relating structural empowerment to a range of organizational characteristics and personal attributes of nurses themselves. There are also previous studies linking the key variables in the present study, but no previous research of behavioural health nurses was available. METHODS: A quantitative design was used for this cross-sectional pilot study. All registered nurses (RN) working on inpatient units in the study facility were invited to participate (n = 97). An anonymous survey was sent to all potential participants. RESULTS: The response rate was 53% (n = 50). The majority of participants perceived themselves as moderately empowered. There was a significant negative correlation between empowerment and anticipated turnover. CONCLUSION: The results of this pilot study among behavioural health nurses are similar to the results among nurses working in other clinical areas. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should be cognizant of the factors that enhance nurses' perceptions of empowerment, particularly related to issues of retention and anticipated turnover among behavioural health nurses.

Perceptions of structural empowerment: differences between nationally certified perinatal nurses and perinatal nurses who are not nationally certified.

BACKGROUND: Although there has been previous research linking perceptions of empowerment to specialty certification among critical care nurses, no research in this area has been conducted among nationally certified perinatal nurses. METHODS: A comparative quantitative survey design was used. Participants included 80 perinatal registered nurses from one community hospital in New York. RESULTS: Registered nurses who were nationally certified in a perinatal specialty had higher total empowerment scores and higher scores on five of the six subscales. CONCLUSION: This study supports the results of previous studies focused on differences in empowerment among nationally certified nurses and nurses without national certification. Because much of the preparation for certification is done within continuing education, nurse leaders must be cognizant of the value of certification and must develop and implement programs to support certification in the workplace.

The effect of a holistic program on health-promoting behaviors in hospital registered nurses.

PURPOSE: The purpose of the study was to examine the effect of a holistic program, the Collaborative Care Model (CCM) Program, and the development of a self-care plan on health-promoting behaviors in hospital nurses. DESIGN: A quasi-experimental, pretest, posttest, repeated measure, comparison-group design was used. METHOD: The study was conducted in a large, academic medical center in the northeast. The experimental group included registered nurses (RNs) from units in one institution introduced to the CCM and development of a self-care plan in an 8-hour program. The control group received no intervention. Data were collected using the Health Promoting Lifestyle Profile II instrument (HPLP II); a 52-question Likert-type scale with six subscales examining health-promoting behaviors. FINDINGS: Using repeated measures analysis of variance there was a significant increase (p = .02) in the overall HPLP II mean, spirituality ( p = .04), interpersonal relations (p = .04), and nutrition scores (p = .04) of the experimental group as compared over time with the control group. CONCLUSIONS: The CCM plus the development of a self-care plan significantly increased overall health promoting behaviors, and spirituality, interpersonal relations, and nutrition scores in these RNs.