Sistematización de competencias gerenciales de directivos de enfermería en el contexto hospitalario / Systematization of managerial competencies of nursing managers in the hospital context

Introducción: En el actual contexto social, cada vez se hace más apremiante que las enfermeras que desempeñan funciones directivas posean y pongan en práctica competencias que, además de validarlas profesionalmente, les permita desempeñar su rol. Objetivo: Sistematizar las competencias gerenciales de los directivos de enfermería en el contexto hospitalario. Métodos: Revisión bibliográfica sistemática, durante 2018, de artículos publicados en inglés, español y portugués desde 2005 hasta 2018 en las bases de datos SciELO, PubMed, CUIDEN y Google académico. La pregunta guía se elaboró a través del acrónimo PICo. La estrategia de búsqueda se realizó mediante aceptación de los descriptores en Ciencias de la Salud (DeCS) "Enfermería", "Competencias gerenciales" y en inglés de (MeSH) "Professional Competence/organization and administration", "Nursing Administration Research", "Nursing Service, Hospital" y "Shared Governance, Nursing", con los operadores booleanos AND y OR, se utilizó el diagrama de flujo (PRISMA). El análisis de contenido permitió la interpretación de los referentes teóricos y la organización del conocimiento y de la bibliografía encontrada. Conclusiones: Resultan variadas e importantes las competencias gerenciales en los directivos de enfermería para mejorar la gestión administrativa y los resultados con óptima calidad en la atención de salud a las personas que requieren de las instituciones hospitalarias(AU)

Introduction: In the current social context, it is becoming increasingly urgent that nurses who perform managerial functions possess and put into practice competencies that, in addition to validating them professionally, allow them to carry out their role. Objective: To systematize the managerial competences of nursing managers in the hospital context. Methods: Systematic bibliographic review, during 2018 of articles published in English, Spanish and Portuguese from 2005 to 2018 in the SciELO, PubMed, CUIDEN and Google académico databases. The guiding question was developed through the acronym PICo. The search strategy was carried out by accepting the descriptors in Health Sciences (DeCS) "Nursing", "Management skills" and in English (MeSH) "Professional Competence / organization and administration", "Nursing Administration Research", " Nursing Service, Hospital "and" Shared Governance, Nursing ", with the Boolean operators AND and OR, the flow diagram (PRISMA) was used. The content analysis allowed the interpretation of theoretical references and the organization of knowledge and the bibliography found. Conclusions: The managerial competences in nursing managers are varied and important to improve administrative management and results with optimal quality in health care for people who require hospital institutions(AU)

El trabajo en una planta de hospitalización / Work at a Hopital Ward

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Estilos de liderança situacional adotados pelos enfermeiros na área hospitalar / Situational leadership style adopted by nurses in the hospital field

Objetivou-se analisar estilos de Liderança Situacional adotados por enfermeiros hospitalares e a associação destes com seu perfil pessoal e profissional. Estudo quantitativo, descritivo, realizado com enfermeiros que atuam no contexto hospitalar e que utilizou o modelo de liderança de Hersey e Blanchard. Os dados foram coletados por meio de questionário sociodemográfico e pelo Leadership Effectiveness and Adaptability Description. O estilo de liderança mais diretivo, focado na capacidade de persuasão foi o mais presente. O setor de atuação apresentou relação significativa ao estilo de liderança (p= 00,1), demonstrando aproximação entre assistência e perfil de liderança. Embora a população integre um grupo jovem, com pouco tempo de atuação, o predomínio do estilo de liderança Persuadir pode limitar a criatividade e potencialidade dos integrantes da equipe pelo foco ser centrado na tarefa. Estratégias que permitam alcançar elevados níveis de maturidade, podem auxiliar enfermeiros na adoção de práticas de liderança mais flexíveis.

This study aimed to analyze Situational Leadership styles adopted by hospital nurses and their association with their personal and professional profile. This is a quantitative and descriptive study and the Hersey and Blanchard leadership model was used with nurses who work in hospitals. Data were collected through sociodemographic questionnaire and the Leadership Effectiveness and Adaptability Description. The more directive leadership style focused on persuasion was the most present. The activity sector showed a significant relation to the leadership style (p=00.1), demonstrating approximation between assistance and leadership profile. Although the population is composed of young group with a short time of performance, the predominance of the Coaching leadership style may limit the creativity and potential of team members for the focus to be focused on the task. Strategies to achieve high levels of maturity, can assist nurses in adopting more flexible leadership practices.

The Nurse-Patient Assignment: Purposes and Decision Factors.

OBJECTIVE: Identify purposes and decision factors of the nurse-patient assignment process. BACKGROUND: Nurse-patient assignments can positively impact patient, nurse, and environmental outcomes. METHODS: This was an exploratory study involving interviews with 14 charge nurses from 11 different nursing units in 1 community hospital. RESULTS: Charge nurses identified 14 purposes and 17 decision factors of the nurse-patient assignment process. CONCLUSIONS: The nurse-patient assignment is a complex process driven by the patient, nurse, and environment. Further study is needed to identify factors linked to patient safety, nurse, and environmental outcomes.

Métodos de pesquisa empregados na produção do conhecimento sobre administração em enfermagem / Research methods used in the production of knowledge on nursing administration

Este estudo teve por objetivo analisar e descrever as características de métodos de pesquisa empregados na produção de dissertações e teses sobre Administração em Enfermagem. Trata-se de pesquisa documental de abordagem quantitativa, contemplando 596 resumos de produtos de pesquisa sobre Administração em Enfermagem, analisados segundo as variáveis método de pesquisa, distribuição temporal, titulação e temáticas. Do total de resumos analisados, 49,8% eram pesquisas quantitativas e 43,1% qualitativas. As pesquisas descritivas somaram 74,8%, as exploratórias 21,5% e as transversais 86,7%. Quanto ao procedimento de coleta de dados, 46,8% eram estudos de caso e 25,7% levantamentos. O pensamento positivista iluminou 49,0% das pesquisas e a fenomenologia 19,3%. Apenas 38,3% das pesquisas aprofundaram a análise com referencial teórico-filosófico. Conclui-se que o conhecimento sobre Administração em Enfermagem foi constituído predominantemente de estudos quantitativos, descritivos, transversais e de estudos de caso, iluminados pelo pensamento positivista e pouco aprofundado por referencial teórico-filosófico de análise.

This study aimed to analyze and describe the characteristics of research methods used in the production of dissertations and theses on Nursing Administration. This is a documentary study of quantitative approach, covering 596 abstracts of research works on Nursing Administration, analyzed according to the variables of research method, temporal distribution, titles and themes. Of all analyzed abstracts, 49.8% were quantitative studies and 43.1% were qualitative. Descriptive studies amounted to 74.8%, exploratory to 21.5% and cross-sectional accounted for 86.7%. As for the data collection procedure, 46.8% were case studies and 25.7% were surveys. The positivist thought guided 49.0% of studies and phenomenology appeared in 19.3%. Only 38.3% of the studies deepened the analysis with the philosophical and theoretical framework. We concluded that the Nursing Administration knowledge was predominantly formed by quantitative, descriptive, cross-sectional and case studies, enlightened by the positivist thought and of little depth in the philosophical and theoretical framework of analysis.

Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study.

BACKGROUND: Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. The RN4CAST study was designed to inform decision making about nursing, one of the largest components of hospital operating expenses. We aimed to assess whether differences in patient to nurse ratios and nurses' educational qualifications in nine of the 12 RN4CAST countries with similar patient discharge data were associated with variation in hospital mortality after common surgical procedures. METHODS: For this observational study, we obtained discharge data for 422,730 patients aged 50 years or older who underwent common surgeries in 300 hospitals in nine European countries. Administrative data were coded with a standard protocol (variants of the ninth or tenth versions of the International Classification of Diseases) to estimate 30 day in-hospital mortality by use of risk adjustment measures including age, sex, admission type, 43 dummy variables suggesting surgery type, and 17 dummy variables suggesting comorbidities present at admission. Surveys of 26,516 nurses practising in study hospitals were used to measure nurse staffing and nurse education. We used generalised estimating equations to assess the effects of nursing factors on the likelihood of surgical patients dying within 30 days of admission, before and after adjusting for other hospital and patient characteristics. FINDINGS: An increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% (odds ratio 1·068, 95% CI 1·031-1·106), and every 10% increase in bachelor's degree nurses was associated with a decrease in this likelihood by 7% (0·929, 0·886-0·973). These associations imply that patients in hospitals in which 60% of nurses had bachelor's degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor's degrees and nurses cared for an average of eight patients. INTERPRETATION: Nurse staffing cuts to save money might adversely affect patient outcomes. An increased emphasis on bachelor's education for nurses could reduce preventable hospital deaths. FUNDING: European Union's Seventh Framework Programme, National Institute of Nursing Research, National Institutes of Health, the Norwegian Nurses Organisation and the Norwegian Knowledge Centre for the Health Services, Swedish Association of Health Professionals, the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet, Committee for Health and Caring Sciences and Strategic Research Program in Care Sciences at Karolinska Institutet, Spanish Ministry of Science and Innovation.

Use of implementation theory: a focus on PARIHS.

BACKGROUND: Limited understanding and application of theory in implementation research contributes to variable effectiveness of implementation studies. Better understanding of direct experiences with theory could improve implementation research and the potency of interventions. AIMS: This study was a conceptual exercise aimed at characterizing experiences with and applications of the Promoting Action on Research Implementation in Health Services (PARIHS) framework. METHODS: This was a structured, qualitative study involving document reviews and interviews used to answer the following overarching questions about nine implementation research centers: Why and how was PARIHS used? What strengths and weaknesses were identified for PARIHS? FINDINGS: PARIHS was being used for varied purposes, at varied levels, in varied ways, and to a varying extent within and across centers. Lack of implementation theory use in investigators' early years was common. Variability in the nature of theory use was attributable to characteristics of the centers, individual investigators, and features of PARIHS. Strengths and weaknesses of the PARIHS framework were identified. LINKING EVIDENCE TO ACTION: The study provides information to researchers and theorists about the use of one well-known implementation framework. The information suggests areas for improvements in PARIHS as well as theory use in general, and should assist in the development of theory-based programs of research.

An action research approach to practice, service and legislative change.

AIMS: To describe the action research approach taken to engage a multidisciplinary group of health professionals and managers from five rural health services with government officers in redesigning their emergency care services and informing legislative change. BACKGROUND: The diminishing size of the medical workforce across rural Victoria in Australia captured the Victorian state government's attention when this threatened the sustainability of emergency care services in rural and remote hospitals in 2006. The government funded the collaborative practice model pilot between 2006 and 2008 to develop and test an alternative model of emergency care service in which nurses practised at a more advanced and autonomous level. DATA SOURCES: Data were sourced from a combination of interviews, focus groups and patient records. REVIEW METHODS: Qualitative data were analysed using convergent interview and thematic analysis. Quantitative data were analysed using frequencies and cross tabulations. DISCUSSION: The three critical success factors owing to action research are presented. It provided a politically safe approach to service, policy and legislative change, ensured collaboration permeated the endeavour and helped to shift the focus from a technical to an emancipatory approach to action research. CONCLUSION: Action research was key to the success achieved by the participants in changing clinical practice, service delivery and the Victorian Drugs Poisons and Controlled Substances Act (1981) to authorise registered nurses to supply medicines. IMPLICATIONS FOR PRACTICE: This paper offers an approach that nurses in practice, management and government can take to drive changes at practice, service and legislative levels in advanced nursing practice.

Roadmap for a participatory research-practice partnership to implement evidence.

BACKGROUND: Our research team has undertaken implementation of evidence in the form of practice guideline recommendations for populations in hospital, community, and long-term care settings with diverse provider and patient populations (people with chronic wounds, e.g., pressure and leg ulcers, heart failure, stroke, diabetes, palliative care, cancer, and maternity care). Translating evidence into clinical practice at the point of care is a complex and often overwhelming challenge for the health system as well as for individual practitioners. PURPOSE: To ensure that best available evidence is integrated into practice, "local evidence" needs to be generated and this process accomplishes a number of things: it focuses all involved on the "same page," identifies important facilitating factors as well as barriers, provides empirical support for planning, and in itself is a key aspect of implementation. In doing this work, we developed a roadmap, the Queen's University Research Roadmap for Knowledge Implementation (QuRKI) that outlines three major phases of linked research and implementation activity: (1) issue identification/clarification; (2) solution building; and (3) implementation, evaluation, and nurturing the change. In this paper, we describe our practical experience as researchers working at point-of-care and how research can be used to facilitate the implementation of evidence. An exemplar is used to illustrate the fluid interplay of research and implementation activities and present the range of supporting research. IMPLICATIONS: QuRKI serves as a guide for researchers in the formation of a strategic alliance with the practice community for undertaking evidence-informed reorganization of care. Using this collaborative approach, researchers play an integral role in focusing on, and using evidence during all discussions. We welcome further evaluation of its usefulness in the field.

Case study methodology in nurse migration research: an integrative review.

The migration of nurses combined with a global nursing shortage affects the supply of nurses and access to health services in many countries. The purpose of this article was to conduct an integrative review of case study methodology (CSM) in nurse migration research. Findings identify where studies using CSM have been conducted, by whom, and the themes explored. More studies using CSM are required to answer the important "how" and "why" questions related to nurse migration. Nurses should take a leadership role in this research.

Neonatal nurse staffing and delivery of clinical care in the SSBC Newborn Network.

OBJECTIVE: To measure nursing workload and timely completion of essential tasks in relation to the staffing levels recommended by the British Association of Perinatal Medicine (BAPM) in Staffordshire, Shropshire and Black Country Newborn Network. METHODS: A prospective observational study was conducted measuring the time taken by selected nurses to undertake the necessary tasks for babies receiving different levels of care in the Network's six constituent neonatal units. An independent observer was used. The unit and individual's workload was evaluated against BAPM standards. Delays in essential predetermined tasks were recorded. The impact on quantity of care given and on the number of delayed tasks were compared between those with the recommended workload or less and those overstretched. RESULTS: Between October 2008 and February 2009, 89 nurses were observed caring for 244 neonates over 534 h. 54% of nursing shifts failed to meet BAPM standards. Nurses with workload greater than the BAPM-recommended levels demonstrated a 28% decrease in median time spent on clinical care per baby. 92 (17%) essential tasks were delayed >1 h or not done. Delays/omissions were more likely when BAPM standards were not met (53% vs 40%, p=0.049). In nursing observations without delays/omissions, accommodating for adequate nursing breaks and working in the same area, nurses could cater for no more than 1.2, 1.5 and 2.7 babies in intensive care, high dependency care and special care, respectively. CONCLUSION: Understaffing leads to measurable problems including delays to essential treatment and reduced clinical care. BAPM standards are not aspirational and should be regarded as a minimum. Further research on optimising nursing care efficiency with limited nursing resources is necessary.

Practices for caring in nursing: Brazilian research groups.

BACKGROUND: The present study considers the production of knowledge and the interactions in the environment of research and their relationships in the system of caring in nursing and health. AIM: To elaborate a theoretical model of the organization of the practices used for caring, based on the experiences made by the research groups of administration and management in nursing, in Brazil. METHODS: The study is based on grounded theory. Twelve leaders of research groups, working as professors in public universities in the south and the south-east of Brazil, distributed in sample groups, were interviewed. FINDINGS: The core phenomenon 'research groups of administration and management in nursing: arrangements and interactions in the system of caring in nursing' was derived from the categories: conceptual bases and contexts of the research groups; experiencing interactions in the research groups; functionality of the research groups; and outputs of the research groups. The research groups are integrated in the system of caring in nursing. CONCLUSIONS: The activities of the Brazilian administration and management in nursing research groups are process oriented and in a process of constant renovation, socially relevant, operate in a complex scenario and contribute to the advancement of the organizations of the system of caring in nursing through strengthening the connection among academia, service and community.

Realizing electronic medical record benefits: an easy-to-do usability study.

Heuristic evaluation is a type of study that is useful for uncovering usability issues in a human-computer interface such as the electronic medical record (EMR). Findings can be very useful in overcoming usability problems to better realize the benefits of the EMR. Correction of the usability violations will improve the efficiency and effectiveness of EMRs. The authors discuss their use of heuristic evaluation to assess usability issues found in their nursing electronic documentation system.

Adjusting for patient acuity in measurement of nurse staffing: two approaches.

BACKGROUND: Researchers who examine the relationship between nurse staffing and quality of care frequently rely on the Medicare case mix index to adjust for patient acuity, even though it was developed originally based on medical diagnoses and may not accurately reflect patients' needs for nursing care. OBJECTIVES: The aim of this study was to examine the differences between unadjusted measures of nurse staffing (registered nurses per 1,000 adjusted patient days) and case mix adjusted nurse staffing and nurse staffing adjusted with nursing intensity weights, which were developed to reflect patients' needs for nursing care. METHOD: Secondary data were used from 579 hospitals in 13 states from 2000 to 2006. Included were three measures of nurse staffing and hospital characteristics including ownership, geographic location, teaching status, hospital size, and percent Medicare inpatient days. RESULTS: Measures of nurse staffing differed in important ways. The differences between the measures were related systematically to ownership, geographic location, teaching status, hospital size, and percentage Medicare inpatient days. DISCUSSION: Without an accurate method to incorporate acuity into measurement of nurse staffing, research on the relationship between staffing and quality of care will not reach the full potential to inform practice.

The use of "lives saved" measures in nurse staffing and patient safety research: statistical considerations.

BACKGROUND: Lives saved predictions are used to quantify the impact of certain remedial measures in nurse staffing and patient safety research, giving an indication of the potential gain in patient safety. Data collected in nurse staffing and patient safety are often multilevel in structure, requiring statistical techniques to account for clustering in the data. OBJECTIVE: The purpose of this study was to assess the impact of model specifications on lives saved estimates and inferences in a multilevel context. METHODS: A simulation study was carried out to assess the impact of model assumptions on lives saved predictions. Scenarios considered were omitting an important covariate, taking different link functions, neglecting the correlations coming from the multilevel data structure, and neglecting a level in a multilevel model. Finally, using a cardiac surgery data set, predicted lives saved from the random intercept logistic model and the clustered discrete time logistic model were compared. RESULTS: Omitting an important covariate, neglecting the association between patients within the same hospital, and the complexity of the model affect the prediction of lives saved estimates and the inferences thereafter. On the other hand, a change in the link function led to the same predicted lives saved estimates and standard deviations. Finally, the lives saved estimates from the two-level random intercept model were similar to those of the clustered discrete time logistic model, but the standard deviations differed greatly. CONCLUSIONS: The results stress the importance of verifying model assumptions. It is recommended that researchers use sensitivity analyses to investigate the stability of lives saved results using different statistical models or different data sets.

Showcasing differences between quality improvement, evidence-based practice, and research.

The literature confirms that much confusion exists regarding the terms quality improvement (QI), evidence-based practice (EBP), and research. A multifaceted approach was used to provide clarity regarding these three equally important concepts. First, the authors present a synthesis of the literature that discusses differences between QI, EBP, and research. Second, the authors introduce a newly created comparative table that synthesizes current literature and showcases differences between QI, EBP, and research. Finally, the authors highlight uses of the comparative table within multiple settings.

Instruments to assess organizational readiness for evidence-based practice.

In this department, Dr Newhouse highlights hot topics in nursing outcomes, research, and evidence-based practice relevant to the nurse administrator. The goal is to discuss the practical implications for nurse leaders in diverse healthcare settings. Content includes evidence-based projects and decision making, locating measurement tools for quality improvement and safety projects, using outcome measures to evaluate quality, practice implications of administrative research, and exemplars of projects that demonstrate innovative approaches to organizational problems. In this article, the author discusses the importance of assessing the readiness of the organization in accelerating evidence-based practice initiatives and provides a description and references of potential instruments to measure organizational readiness.