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BACKGROUND: While clinicians routinely observe issues with safety and quality, they may not always speak up and intervene. Peer feedback supports nurses to speak up about errors or near misses and actively improve nursing care quality. Effective peer feedback requires addressing barriers to speaking up. PURPOSE: The purpose of this mixed methods study was to evaluate a'brain-friendly'peer feedback program´s effect on clinical nurses´ perceptions of peer review. METHODS: Nurses were surveyed before and after the implementation of a peer feedback program that integrated social cognitive neuroscience principles. Open comments were analyzed using thematic analysis. RESULTS: Responses to nearly half of survey questions improved. Thematic analysis identified institutional and personal barriers to peer feedback use, revealing the personal and social complexity of speaking up. CONCLUSIONS: Social cognitive neuroscience may enhance peer feedback programs. Research using immersive qualitative methods is needed to better understand factors supporting or impeding peer feedback.
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Grupo Associado , Humanos , Inquéritos e Questionários , Retroalimentação , Recursos Humanos de Enfermagem Hospitalar/psicologia , Feminino , Atitude do Pessoal de Saúde , Percepção , Masculino , AdultoRESUMO
Background and Purpose: Stability testing, conducted using a test-retest protocol, measures an instrument's reliability by evaluating the consistency of participant responses to survey questions with repeated testing within a short interval. No studies have measured the stability of the Verran Professional Governance Scale© (VPGS). The purpose of this study was to evaluate the test-retest reliability of the VPGS. Methods: Volunteers from a parent study using the VPGS were sent a link to a retest version of the survey 14 days after taking the initial survey with a reminder email sent 5 days after the first request. Item-level and subscale comparisons were made between participants' initial and retest responses using intraclass correlation coefficients (ICCs) applying a two-way random-effects model. Results: VPGS subscales had ICC scores of 0.71 for decision-making, 0.73 for collateral relationships, and 0.86 for professional obligation. Conclusions: Findings suggest that the VPGS demonstrates test-retest reliability. Future research should evaluate the instrument's responsiveness.
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Intermittent auscultation (IA) is an evidence-based method of fetal surveillance during labor for birthing people with low-risk pregnancies. It is a central component of efforts to reduce the primary cesarean rate and promote vaginal birth (American College of Obstetricians and Gynecologists, 2019; Association of Women's Health, Obstetric and Neonatal Nurses, 2022a). The use of intermittent IA decreased with the introduction of electronic fetal monitoring, while the increased use of electronic fetal monitoring has been associated with an increase of cesarean births. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues; and strategies to implement IA.
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Monitorização Fetal , Trabalho de Parto , Gravidez , Recém-Nascido , Feminino , Humanos , Monitorização Fetal/métodos , Frequência Cardíaca Fetal , Auscultação/métodos , Cardiotocografia/métodosRESUMO
Intermittent auscultation (IA) is an evidence-based method of fetal surveillance during labor for birthing people with low-risk pregnancies. It is a central component of efforts to reduce the primary cesarean rate and promote vaginal birth (American College of Obstetricians and Gynecologists, 2019; Association of Women's Health, Obstetric and Neonatal Nurses, 2022a). The use of intermittent IA decreased with the introduction of electronic fetal monitoring, while the increased use of electronic fetal monitoring has been associated with an increase of cesarean births. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues; and strategies to implement IA.
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Monitorização Fetal , Frequência Cardíaca Fetal , Humanos , Feminino , Gravidez , Frequência Cardíaca Fetal/fisiologia , Monitorização Fetal/métodos , Auscultação Cardíaca/métodos , Auscultação/métodos , Cardiotocografia/métodos , Cardiotocografia/normasRESUMO
Although resources are available to guide structures and processes for professional governance, limited information exists about defining and legitimizing the decisional authority needed to support direct care nurses' ownership of clinical practice as well as the role of nursing leaders. This article presents a road map for creating and implementing clinical nurse, nurse leader, and nurse executive accountability grids with clearly delineated authority to provide a decisional authority framework for professional governance in one organization.
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Processos Grupais , Enfermeiros Administradores , Humanos , Responsabilidade SocialAssuntos
Obstetrícia , Sepse , Gravidez , Feminino , Humanos , Consenso , Sepse/complicações , Sepse/diagnósticoRESUMO
ABSTRACT: Effective peer feedback is critical for the self-regulation of nursing practice and safe, high-quality care, yet peer feedback conversations can be challenging and anxiety provoking. As current literature revealed no consistent approach, taskforce members designed and implemented an innovative and standardized peer feedback program using brain science to support nurses' skills in speaking up. The new program resulted in an increase in nurses' self-reported willingness to provide peer feedback, and improvements in safety culture and nurse-sensitive quality outcomes.
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Encéfalo , Medo , Humanos , Retroalimentação , Ansiedade , ComunicaçãoRESUMO
OBJECTIVE: Researchers examined associations between Index for Professional Nursing Governance (IPNG) types and outcomes. BACKGROUND: Effects of professional nursing governance on nurse-related outcomes by Magnet® status are not well studied. METHODS: Associations were evaluated between average IPNG scores from 2170 RNs, and nurse-sensitive indicators (NSIs) as well as patient and RN satisfaction outcomes (N = 205 study units; 20 hospitals), following Magnet requirements. RESULTS: Magnet hospitals had significantly better IPNG shared governance scores than non-Magnet hospitals (Magnet, 106.7; non-Magnet, 101.3). For Magnet hospitals, units scoring as shared governance outperformed traditional governance for 9 of 19 outcomes (47.4%) (NSI, 2; patient satisfaction, 3; RN satisfaction, 4). Self-governance outperformed shared governance for 8 of 15 outcomes (53.3%) (NSI, 2; patient satisfaction, 6; RN satisfaction, 0). For non-Magnet hospitals, shared governance significantly outperformed traditional governance for 1 of 15 outcomes (6.7%) (patient satisfaction). CONCLUSIONS: Having shared or self-governance is a strategy that can be considered by nurse leaders to improve select nurse-related outcomes.
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Satisfação no Emprego , Liderança , Recursos Humanos de Enfermagem Hospitalar/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Indicadores de Qualidade em Assistência à Saúde , Atitude do Pessoal de Saúde , Administração Hospitalar , Humanos , Recursos Humanos de Enfermagem Hospitalar/psicologia , Satisfação Pessoal , Qualidade da Assistência à Saúde , Estados UnidosRESUMO
Over a decade following the nationwide push to implement electronic health records (EHRs), the focus has shifted to addressing the cognitive burden associated with their use. Most research and discourse about the EHR's impact on clinicians' cognitive work has focused on physicians rather than on nursing-specific issues. Labor and delivery nurses may encounter unique challenges when using EHRs because they also interact with an electronic fetal monitoring system, continuously managing and synthesizing both maternal and fetal data. This grounded theory study explored labor and delivery nurses' perceptions of the EHR's impact on their cognitive work. Data were individual interviews and participant observations with twenty-one nurses from two labor and delivery units in the western U.S. and were analyzed using dimensional analysis. Nurses managed the tension between caring and charting using various strategies to integrate the EHR into their dynamic, high-acuity, specialty practice environment while using EHRs that were not designed for perinatal patients. Use of the EHR and associated technologies disrupted nurses' ability to locate and synthesize information, maintain an overview of the patient's status, and connect with patients and families. Individual-, group-, and environmental-level factors facilitated or constrained nurses' integration of the EHR. These findings represent critical safety failures requiring comprehensive changes to EHR designs and better processes for responding to end-user experiences. More research is needed to develop EHRs that support the dynamic and relationship-based nature of nurses' work and to align with specialty practice environments.
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Atitude Frente aos Computadores , Parto Obstétrico/psicologia , Registros Eletrônicos de Saúde/estatística & dados numéricos , Cuidados de Enfermagem/psicologia , Recursos Humanos de Enfermagem Hospitalar/psicologia , Enfermagem Obstétrica/estatística & dados numéricos , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Gravidez , Estados UnidosRESUMO
OBJECTIVE: Researchers examined associations between Index for Professional Nursing Governance (IPNG) scores and outcomes, by US and international hospitals. BACKGROUND: Nursing governance and effects on nurse-related outcomes are not well studied. METHODS: Associations were evaluated using average IPNG scores from 2170 RNs and nurse-sensitive indicators (NSIs) and patient and RN satisfaction outcomes (n = 205 study units, 20 hospitals, 4 countries). RESULTS: International units had better IPNG shared governance scores (113.5; US = 100.6; P < 0.001), and outcomes outperforming unit benchmarks (6 of 15, 40.0%; US = 2 of 15, 13.3%). Shared governance significantly outperformed traditional governance for 5 of 20 (25.0%) US outcomes (patient satisfaction = 1, RN satisfaction = 4) and for 3 of 11 (27.3%) international (patient satisfaction = 1, RN satisfaction = 2). Internationally, self-governance significantly outperformed traditional governance and shared governance for 5 of 12 (41.7%) outcomes (NSI = 2, patient satisfaction = 3). CONCLUSIONS: Shared governance is a strategy that can be considered by nurse leaders for improving select outcomes.