Critical care nurse leaders' moral distress: A qualitative descriptive study.

BACKGROUND: Unit-based critical care nurse leaders (UBCCNL) play a role in exemplifying ethical leadership, addressing moral distress, and mitigating contributing factors to moral distress on their units. Despite several studies examining the experience of moral distress by bedside nurses, knowledge is limited regarding the UBCCNL's experience. RESEARCH AIM: The aim of this study was to gain a deeper understanding of the lived experiences of Alabama UBCCNLs regarding how they experience, cope with, and address moral distress. RESEARCH DESIGN: A qualitative descriptive design and inductive thematic analysis guided the investigation. A screening and demographics questionnaire and a semi-structured interview protocol were the tools of data collection. PARTICIPANT AND RESEARCH CONTEXT: Data were collected from 10 UBCCNLs from seven hospitals across the state of Alabama from February to July 2023. ETHICAL CONSIDERATIONS: This study was approved by the Institutional Review Board at the University of Alabama in Huntsville. Informed consent was obtained from participants prior to data collection. FINDINGS: UBCCNLs experience moral distress frequently due to a variety of systemic and organizational barriers. Feelings of powerlessness tended to precipitate moral distress among UBCCNLs. Despite moral distress resulting in increased advocacy and empathy, UBCCNLs may experience a variety of negative responses resulting from moral distress. UBCCNLs may utilize internal and external mechanisms to cope with and address moral distress. CONCLUSIONS: The UBCCNL's experience of moral distress is not dissimilar from bedside staff; albeit, moral distress does occur as a result of the responsibilities of leadership and the associated systemic barriers that UBCCNLs are privier to. When organizations allocate resources for addressing moral distress, they should be convenient to leaders and staff. The UBCCNL perspective should be considered in the development of future moral distress measurement tools and interventions. Future research exploring the relationship between empathy and moral distress among nurse leaders is needed.

Critical care nurse leaders addressing moral distress: A qualitative study.

BACKGROUND: Moral distress (MD) occurs when clinicians are constrained from taking what they believe to be ethically appropriate actions. When unattended, MD may result in moral injury and/or suffering. Literature surrounding how unit-based critical care nurse leaders address MD in practice is limited. AIM: The aim of this study was to explore how ICU nurse leaders recognize and address MD among their staff. STUDY DESIGN: Qualitative descriptive with inductive thematic analysis. RESULTS: Five ICU nurse leaders participated in a one-time individual interview. Interview results suggest that (1) ICU nurse leaders can recognize and address MD among their staff and (2) nurse leaders experience MD themselves, which may be exacerbated by their leadership role and responsibilities. CONCLUSIONS: Further research is needed to develop interventions aimed at addressing MD among nurse leaders and equipping nurse leaders with the skills to identify and address MD within their staff and themselves. RELEVANCE TO CLINICAL PRACTICE: MD is an unavoidable phenomenon ICU nurse leaders are challenged with addressing in their day-to-day practice. As leaders, recognizing and addressing MD is a necessary task relating to mitigating burnout and turnover and addressing well-being among staff within the ICU.

Moral distress among nurse leaders: A qualitative systematic review.

Moral distress (MD) is well-documented within the nursing literature and occurs when constraints prevent a correct course of action from being implemented. The measured frequency of MD has increased among nurses over recent years, especially since the COVID-19 Pandemic. MD is less understood among nurse leaders than other populations of nurses. A qualitative systematic review was conducted with the aim to synthesize the experiences of MD among nurse leaders. This review involved a search of three databases (Medline, CINAHL, and APA PsychINFO) which resulted in the retrieval of 303 articles. PRISMA review criteria guided authors during the article review and selection process. Following the review, six articles were identified meeting review criteria and quality was assessed using the Critical Appraisal Skills Programme (CASP) Checklist for qualitative studies. No ethical review was required for this systematic review. The six studies included in this review originated from the United States, Brazil, Turkey, and Iran. Leadership roles ranged from unit-based leadership to executive leadership. Assigned quality scores based upon CASP criteria ranged from 6 to 9 (moderate to high quality). Three analytical themes emerged from the synthesis: (1) moral distress is consuming; (2) constrained by the system; and (3) adapt to overcome. The unique contributors of MD among nurse leaders include the leadership role itself and challenges navigating moral situations as they arise. The nurse leader perspective should be considered in the development of future MD interventions.

Strategic Planning: Moving From Plan to Implementation.

Successful organizations depend on strategic thinkers who understand strategic planning and strategic management. These strategic leaders can proactively manage the constant environmental changes to position their organizations for a competitive advantage and avoid acting in a reactive and defensive manner. However, while organizations are often adept at developing extensive strategic plans, implementation of the plan is often poor or without a definitive strategy. This article addresses key strategies for successful implementation of changes to bring about sustainable cultural change in an organization to meet the organization's overall strategic goals, specifically through the use of implementation science.

Nursing Faculty Workforce Development Project.

A proposed nursing faculty workforce development project by a college of nursing within a research-intensive institution will increase the number of nurse faculty from the current population of BSN-prepared nurses from underserved communities in a state to earn a master of science in nursing (MSN) degree with a nursing education specialty. This project will be accomplished through partnerships between a college of nursing and academic institutions with large nursing student populations from underserved communities. In addition, the project will incorporate the employment of MSN students at academic partner institutions within a clinical nurse faculty role. The proposed project will continue after an initial federally funded grant to continue the project and address the nurse faculty shortage from diverse populations and advance health equity and culturally congruent health care in the state. The project will also enhance partnership building with stakeholders, such as statewide academic institutions, to impact underserved communities.

Creating a Business Case for Success.

Health care is a highly competitive environment where managers must compete for finite resources. The Centers for Medicare & Medicaid Services-directed reimbursement models such as value-based purchasing and pay-for-performance heavily focused on quality improvement and nursing excellence are having a major impact on financial reimbursement for health care services in the United States. As such, nurse leaders must function in a business-focused environment where decisions regarding resource allocation are driven by quantifiable data, the potential return on investment, and the organization's ability to provide quality patient care in an efficient manner. It is imperative for nurse leaders to recognize the financial impact of potential additional revenue streams, as well as avoidable costs. Nurse leaders must also be skilled at translating the return on investment for nursing-centric programs and initiatives, often hidden in anecdotal terms and cost avoidance rather than revenue generation, to ensure appropriate resource allocation and budgetary assumptions. This article uses a case study framed within the business case to review a structured approach to operationalizing nursing-centric programs and highlights key strategies for success.

AACN Essentials as the Conceptual Thread of Nursing Education.

In March 2021, the American Association of Colleges of Nursing (AACN) endorsed and published a report that included a reenvisioned framework for nursing education. This report introduced innovative and bold ideas for transforming nursing education and pedagogy from a concept-based model to a competency-based model of nursing education. This new model of nursing education establishes a core set of expectations and standards of competency-based nursing curricula common to all nursing educational programs moving forward. Before this transformative change can occur, nurse educators must first understand what is expected of them before they can adapt current nursing curricula to meet the future needs of our communities and employers. This article will dissect the Re-envisioned Essentials and provide the reader with new terminology introduced by the Essentials document, as well as the core expectations and standards established by the AACN for future nursing education and curricula. With this new understanding, we will introduce and discuss strategies supporting the transitional process of moving from concept-based educational models to competency-based models using a think-backward approach to change that begins with an alignment of program-level learning outcomes with national standards and working backwards to build assessments.

Do Nurse Managers Feel Competent in the Financial and Business Aspects of Their Roles?: Exploring Self-perceptions.

OBJECTIVE: The aim of this study was to assess the influence of 3 variables on unit-based nurse managers' self-perception of business and financial competence in patient care: 1) educational degree; 2) participation in leadership development continuing education; and 3) prior nursing management experience. BACKGROUND: Nurse managers must develop business acumen to support patient care and the nurses who provide care. Successful managers must become fluent in the language of finance and must understand how to use it. Their ability to promote continuous quality improvement (QI) in a cost-effective, resource-conscious manner is the foundation of economic viability. METHODS: A feasibility study was conducted using Facebook to recruit nurse managers nationally and to distribute an electronic survey designed to assess the unit-based managers' self-perceptions of business and financial competence in patient care. RESULTS: The strongest predictors of self-perceived business and financial competence were continuing education and MSN degree. Years of experience in a leadership role did not predict self-reported levels of business or financial competence in patient care. CONCLUSION: Findings suggest that nursing leadership competency in the area of finance is developed through continuing education. Healthcare organizations should implement comprehensive nursing leadership mentoring and orientation programs for nurse managers to improve their self-perceptions of business and financial competencies.

Anatomy of a Business Case.

A business case plan (BCP) provides a structured framework for evidence-based, transparent business decisions. It is an essential tool that when written well will provide you with the means to translate the cost and benefits of nursing practice proposals, often related in anecdotal terms, into quantifiable, evidence-based terms outlining return on investment and business advantages of investing in nursing initiatives. The BCP should include an analysis of the problem and associated needs, the proposed solutions with options, goals for success, implementation, and evaluation plans, as well as a risk-adjusted cost-benefit analysis. It contains the necessary information to allow decision makers to make well-informed decisions regarding resource allocation. As clinical experts seeking to compete for finite resources in the health care arena, nursing leadership must bridge the language gap between nursing and business finance. This article outlines the required elements of the BCP to provide you with a practical working definition of each element to support your future initiatives in the business of health care improvement.

Interpreting Organizational-Level Financial Statements.

An organization's financial statements reflect their financial well-being and determine their ability to meet the health care needs of the citizens in their community. It is imperative that nursing leadership recognize the key components of an organization's annual consolidated financial statements, the balance sheet and income statement, and know how to interpret them to provide efficient, high-quality health care and to be successful in their role as nurse leaders. This article provides exemplars of these key documents with detailed instructions for the interpretation and understanding of the organization's financial statements, which will enable the reader to accurately and adeptly interpret their own organization's financial statements, as well as the statements from other organizations.

Expertise among critical care nurses: A grounded theory study.

OBJECTIVES: Explore critical care nurses' personal perceptions of expertise, expert performance and transition from novice to expert performer in clinical practice. DESIGN: Following constructivist approach to grounded theory this investigation used qualitative open-ended interviews focused on the social construction of expertise in critical care nursing and the experiences of clinical practice that define that process. SETTING: A multi-site urban area in the southeastern United States. PARTICIPANTS: 10 certified critical care nurses, three males and seven females, with 10-30+ years of critical care experience. FINDINGS: Experience and knowledge are the foundation of expertise and expert performance. The higher the acuity the more frequent the experience the greater the nurses' aptitude and opportunity for learning and professional growth. It was also noted that self-actualisation was a major determinant in the development of expertise in critical care. CONCLUSION: Key findings suggested that clinical experience and personal motivation combined with self-actualisation, the drive to maximise personal potential, determine critical care nurse's trajectory towards professional excellence. Expert performance evolves over time. Knowledge acquisition and experience have an interdependent reciprocal relationship inferring that you cannot have one without the other. Social expectations and experiences have a direct impact on professional aptitude and development if expertise.

Is Facebook a viable recruitment tool?

BACKGROUND: Effective participant recruitment strategies are crucial to the success of research studies. A targeted, well-designed recruitment plan provides researchers with a rich bed of information to fully explore research questions and achieve statistically significant responses. AIM: To discuss the importance and methodology of participant recruitment in achieving reliability and validity, and to provide an example of a recent study that used Facebook to recruit participants and achieve statistically significant findings. DISCUSSION: A targeted Facebook recruitment campaign was highly successful in attracting qualified participants who could provide essential information relevant to the study's research questions. A series of Facebook posts strategically targeted the population of interest and presented them with a short, ten-minute survey. It resulted in responses from 175 qualifying participants, achieving a statistical significance greater than 90%. CONCLUSION: Successful recruitment strategies must provide access to the population of interest and in sufficient numbers to provide a good representative sample of the population of interest for the study. Facebook provides efficient cost-effective access to target populations. IMPLICATIONS FOR PRACTICE: As communication technology advances, nurse researchers must learn to adapt to the changing avenues of communication to reach potential study participants. Effective recruitment and a good representative sample is the key to reliability, validity and transferability of research findings.

A Capstone Simulation for Leadership Development: Bridging Theory to Practice.

BACKGROUND: New graduate nurses are expected to function autonomously and be practice-ready upon graduation. However, transitioning from the role of student to one of leadership in the professional nurse's role is a complex experience. PROBLEM: Concerns for safety and liability in an increasingly complex health care environment may limit the availability of relevant clinical experiences for nursing students to develop leadership skills. APPROACH: The Mock Hospital, a comprehensive capstone simulation, was designed to immerse senior nursing students into the leadership role of the professional nurse. OUTCOME: Positive feedback obtained from students through reflection and discussion supports the implementation of a capstone simulation. CONCLUSIONS: Supporting new graduate nurses' transition into practice, while preparing the next generation of nurses to successfully meet the challenges of a complex health care environment, will require innovative and transformative educational experiences.

Deliberate Practice and Skill Acquisition in Nursing Practice.

The purpose of this article is to describe an educational process designed to accelerate skill acquisition for new nurse graduates through deliberate practice and situated learning experiences. The concept of deliberate practice provides the framework for authentic learning experiences based on real-life situations that incorporate targeted outcomes for success while pushing their limits beyond what was previously achieved. Through deliberate practice, new graduate nurses are given the opportunity to gain valuable practical experiences that otherwise would have taken years to accomplish in a clinical practice. The structure and intensity of the experience grounded in realistic or authentic circumstances as supported by deliberate practice enhances learning to promote professional development. J Contin Educ Nurs. 2018;49(6):269-273.

Nutrition Options in Critical Care Unit Patients.

Critically ill patients have increased metabolic requirements and must rely on the administration of nutritional therapy to meet those demands. Yet, according to research almost half of all hospitalized patients are not fed, are underfed, or are malnourished while in the hospital. This article demonstrates the importance of early feedings in critical care unit, and the available options open to nurses supporting initiation and management of early feedings. Enteral nutrition has proven to be an important therapeutic strategy for improving the outcomes of critically ill patients and the critical care nurse plays an integral role in their success.

Fading a concurrent activity during self-control training for children with autism.

We evaluated a modified technique for teaching self-control and increasing the duration of waiting for access to a preferred item among 3 children with autism. Participants initially chose an immediate small reinforcer over a delayed large reinforcer and a delayed large reinforcer with a concurrent activity requirement for the duration of the delay. When the delay to the larger reinforcer with the concurrent activity requirement was gradually increased from 0 s to the terminal delay, participants switched to and maintained selection of that option, thereby demonstrating increased self-control. Finally, the duration of the concurrent activity was gradually reduced without changing the duration of the delay to the large reinforcer. All 3 participants continued to select the delayed large reinforcer, showing self-controlled responding in the absence of a concurrent activity.

Vitamin D inhibition of pro-fibrotic effects of transforming growth factor beta1 in lung fibroblasts and epithelial cells.

The mechanisms that control fibroproliferation and matrix deposition in lung fibrosis remain unclear. We speculate that vitamin D deficiency may contribute to pulmonary fibrosis since vitamin D deficiency has been implicated in several diseases. First, we confirmed the presence of vitamin D receptors (VDRs) in cultured NIH/3T3 and lung fibroblasts. Fibroblasts transfected with a vitamin D response element-reporter construct and exposed to the active vitamin D metabolite, 1,25(OH)(2)D(3), showed increased promoter activity indicating VDR functionality in these cells. Testing the effects of 1,25(OH)(2)D(3) on fibroblasts treated with transforming growth factor beta1 (TGFbeta1), considered a driver of many fibrotic disorders, we found that 1,25(OH)(2)D(3) inhibited TGFbeta1-induced fibroblast proliferation in a dose-dependent fashion. 1,25(OH)(2)D(3) also inhibited TGFbeta1 stimulation of alpha-smooth muscle actin expression and polymerization and prevented the upregulation of fibronectin and collagen in TGFbeta1-treated fibroblasts. Finally, we examined how 1,25(OH)(2)D(3) affects epithelial-mesenchymal transformation of lung epithelial cells upon exposure to TGFbeta1. We showed that the TGFbeta1-induced upregulation of mesenchymal cell markers and abnormal expression of epithelial cell markers were blunted by 1,25(OH)(2)D(3). These observations suggest that under TGFbeta1 stimulation, 1,25(OH)(2)D(3) inhibits the pro-fibrotic phenotype of lung fibroblasts and epithelial cells.