Applying the Patient Empowerment, Engagement, and Activation Survey to Improve Patient Outcomes.

This article focuses on applying the patient empowerment, engagement, and activation (PEEA) model as an implementation strategy to achieve patient- or person-centered care. There is substantial evidence linking PEEA to improved patient care outcomes and reduced healthcare costs. Interrelationships among the 3 concepts are discussed and how the PEEA survey can be used to evaluate patients' activation for self-care postdischarge and their perceptions of nurses' empowering and engaging them during the care encounter.

Development and Psychometric Testing of a Leadership Competency Assessment.

OBJECTIVE: This article discusses the development and psychometric testing of the Nursing Leadership Competency Assessment (LCA). BACKGROUND: Several leadership assessments are available for purchase, which are aligned with professional organizations. A competency-based leadership assessment is needed to identify the developmental needs of nurse leaders. Competent and confident nurse managers are critical to ensure positive relationships between nurse managers and clinical nurses. METHODS: A multimethod approach was used to develop and test psychometric properties of the LCA. Items were drawn from 8 sources identifying nurse leader competencies. RESULTS: The 76-item assessment had a Cronbach's α of 0.99. Confirmatory factor analysis supported 6 hypothesized factors (domains): leading self, people, organizations, change, innovation, and globally. Subscale reliabilities ranged from α = 0.87 to α = 0.98. CONCLUSIONS: The LCA has demonstrated utility in assessing nurse leader competencies and guiding the development of educational opportunities in targeted content areas for specific leadership roles.

A 1-Year Accredited Nurse Residency Program's Effect on Intent to Leave.

OBJECTIVE: This article describes the evaluation of a system-wide program to enhance new graduate nurse resident (NGNR) experience, enculturation, and commitment to the organization. BACKGROUND: Structured nurse residency programs support NGNR transition to the work environment and increase retention and organizational commitment. METHODS: The study used a descriptive, comparative design measuring NGNR perceptions of affective commitment, job satisfaction, job stress, and other variables over 3 times from baseline to 24 months. RESULTS: Findings demonstrated a reduction in affective commitment and an increase in nursing stress from baseline to 12 and 24 months of employment. The highest mean in intent to leave occurred at 12 months, highlighting the vulnerability of the NGNR at that time. CONCLUSIONS: Nurse leaders must consider resources supporting NGNRs beyond the traditional 12 months to ensure retention and organizational commitment, thereby decreasing intent to leave.

Psychometric Testing of a Patient Empowerment, Engagement, and Activation Survey.

BACKGROUND: Patient or person-centered care has become a widely used philosophical framework and yet has varying definitions and characteristics. Person-centered care has recently been conceptualized as patient empowerment, engagement, and activation with studies citing positive outcomes. PURPOSE: This study reports the psychometric properties of the Patient Empowerment, Engagement, and Activation Survey. METHODS: An instrument development and testing approach was used. RESULTS: A 21-item survey was developed demonstrating respectable Cronbach α coefficients for the total scale (α = 0.88) and for each subscale: Empowerment (α = 0.71), Engagement (α = 0.81), and Activation (α = 0.76). A regression analysis with 1 item, "I am ready to be discharged" as the dependent variable and all other items as independent variables explained 65% of the variance in readiness for discharge (P < .001). DISCUSSION: The Patient Empowerment, Engagement, and Activation Survey can be used to evaluate patients' perspectives of care quality (empowerment and engagement) and readiness for discharge (activation).

An Exploratory, Descriptive Study of Nurse Leaders' Personal and Work Experiences During Union Negotiations and Strike Events.

OBJECTIVE: This study explored the experiences, perceptions and emotional state of nurse leaders during union activities to understand the impact on their personal and professional lives. BACKGROUND: Other than anecdotal stories shared during union negotiations and strike preparations, very little evidence exists in nursing and healthcare literature about nursing unions and their impact on nurse leaders and their organizational priorities. METHODS: This study used an exploratory, descriptive design with a convenience and snowball sample of Association of California Nurse Leaders members. RESULTS: The findings indicate nurse leaders experience a range of emotional states in response to union activities with perceptions of increased workload, job stress, and constrained and deliberate communications with their staff. CONCLUSION: This study adds to the body of knowledge about nurse leader experiences and feelings during union activities.

Effectiveness of a Psychiatric-Mental Health Nurse Residency Program on Retention.

BACKGROUND: Nurse residency programs (NRPs) provide new graduate nurses (NGNs) with social support and experiential activities as a formal transition to clinical practice. AIMS: The study was conducted to answer the question: What is the effectiveness of an NRP in retaining NGNs in a psychiatric-mental health setting? METHOD: This study used a quantitative time-sequenced comparative study of multiple cohorts of NGNs hired into an NRP at a freestanding hospital in California. RESULTS: The study yielded a turnover rate of 11.7% in Year 1 (88.3% retention) and 2.9% in Year 2 (97.1% retention rate), which are lower than reported turnover rates (17.5% and 33.5%, respectively). Significant correlations are described in the workplace domains of knowledge and skills, social support, organizational citizenship behavior, civility, coping self-efficacy, organizational and occupational commitment, person-organizational fit, and burnout. CONCLUSIONS: NRPs are effective in attracting and retaining competent, confident NGNs in psychiatric-mental health nursing.

Safety and Security Concerns of Nurses Working in the Intensive Care Unit: A Qualitative Study.

Intensive care units (ICUs) exist to serve as a safe place for critically ill patients to receive care from skilled practitioners. In this qualitative study, ICU nurses shared their perspectives on elements that promote safety and security on their units. After obtaining institutional review board approval, participants participated in telephone interviews with a nurse researcher who has experience as a bedside ICU nurse. Five categories and 14 themes were identified and then confirmed using member checking. Results indicate that participants prefer to provide care in ICUs with no more than 12 to 14 beds and provide the following: visibility of patients and coworkers; more than 1 way to exit; and can be locked in case of emergency or threat. Nearly all respondents mentioned adequate staffing as the most important attribute of a safe, secure care environment for patients and families. More research is needed to identify design features that make the most impact on providing a safe, secure ICU environment.

Six-Month Follow-up of a Regional Evidence-based Practice Fellowship Program.

OBJECTIVE: This study examined a 6-month follow-up of a regional evidence-based practice (EBP) fellowship program and the predictors of EBP adoption at hospital units. BACKGROUND: The immediate beneficial effects of a regional EBP program are known, but the medium-term effects are not certain. METHODS: A matched pretest/posttest study was conducted using a mailed questionnaire 6 months after the completion of a 9-month regional EBP fellowship program among 3 annual cohorts of participants. RESULTS: Statistically significant improvements in the mean scores of EBP beliefs, EBP implementation, and group cohesion were found (P < .05). Of the 47 participants who completed their EBP projects, more than three-quarters reported EBP adoption at their own hospital units, and EBP beliefs were a positive predictor of EBP adoption (odds ratio, 1.12; 95% confidence interval, 1.02-1.22; P = .017). CONCLUSIONS: The outcome improvements continued 6 months after the fellowship program, and strong EBP beliefs predicted EBP adoption in the participants' units.

An exploration of nurse-physician perceptions of collaborative behaviour.

Interprofessional collaboration is a key element in providing safe, holistic patient care in the acute care setting. Trended data at a community hospital indicated opportunities for improvement in collaboration on micro, meso, and macro levels. The aim of this survey study was to assess the current state of collaboration between frontline nurses and physicians at a non-academic acute care hospital. A convenience sample of participants was recruited with a final respondent sample of 355 nurses and 82 physicians. The results indicated that physicians generally perceived greater collaboration than nurses. Physician ratings did not vary by primary practice area, whereas nurse ratings varied by clinical practice area. Nurse ratings were the lowest in the operating room and the highest in the emergency department. Text-based responses to an open-ended question were analysed by role and coded by two independent research teams. Emergent themes emphasised the importance of rounding, roles, respect, and communication. Despite recognition of the need for improved collaboration and relational behaviours, strategies to improve collaborative practice must be fostered at the meso level by organisational leaders and customised to address micro-level values. At the study site, findings have been used to address and improve collaboration towards the goal of becoming a high reliability organisation.

Design and Testing of a Postanesthesia Care Unit Readiness for Discharge Assessment Tool.

PURPOSE: This article describes the development and psychometric testing of a new Postanesthesia Care Unit (PACU) Readiness for Discharge Assessment Tool (RDAT) that can be used in assessing patients' readiness for discharge from a phase 1 PACU. DESIGN: This study used an instrument development methodology described by Waltz and Strickland that included item development and testing for content and convergent validity and interrater reliability. METHODS: Items were developed from a review the literature, best practice exemplars, and input from an expert panel. Ten items were identified for patient assessment using a dichotomous response set (yes/no). Two nurses independently assessed the patients using the RDAT and Respiration, Energy, Alertness, Circulation, and Temperature, and comparing independent assessments using the RDAT. FINDING: The content validity index was determined to be a = .80, and interrater reliability index was a = 1.0. CONCLUSIONS: The RDAT is a useful, safe tool to assess patients' readiness for discharge from the PACU.

Benefits of a Regional Evidence-Based Practice Fellowship Program: A Test of the ARCC Model.

BACKGROUND: The Advancing Research and Clinical practice through close Collaboration (ARCC) model postulates that improvement in nurses' evidence-based practice (EBP) beliefs results in improved EBP implementation, which in turn improves nurse-related outcomes, such as nurses' job satisfaction and group cohesion. However, there is a dearth of interventional studies that evaluate the relationships among these variables. AIMS: This study evaluated whether a regional EBP fellowship program improved participants' EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness, and examined the relationships among these improvements, using structural equation modeling. METHODS: A pretest-posttest design was used among three annual cohorts of a regional, 9-month EBP fellowship program, from 2012 to 2014, in San Diego, California. Matched pretest and posttest questionnaires, including EBP Beliefs, EBP Implementation, Job Satisfaction, Group Cohesion, and Group Attractiveness scales, were analyzed (N = 120). RESULTS: Paired t-tests showed statistically significant improvements in EBP beliefs, EBP implementation, job satisfaction, and group cohesion (p < .05). Structural equation modeling showed that improvement in EBP implementation had no direct effect on improvements in job satisfaction, group cohesion, or group attractiveness. However, improvement in EBP beliefs had direct effects on improvements in job satisfaction (ß = .24; p = .002) and group attractiveness (ß = .22; p = .010). LINKING EVIDENCE TO ACTION: A regional, collaborative EBP fellowship program was effective in improving EBP beliefs, EBP implementation, job satisfaction, and group cohesion. Improvement in EBP beliefs appears to have had direct effects on improvements in job satisfaction and group attractiveness. Regional fellowship programs that educate and support EBP champions and their mentors may enhance EBP adoption in nursing practice across multiple health care institutions.

Predictors of Evidence-Based Practice Implementation, Job Satisfaction, and Group Cohesion Among Regional Fellowship Program Participants.

BACKGROUND: A regional, collaborative evidence-based practice (EBP) fellowship program utilizing institution-matched mentors was offered to a targeted group of nurses from multiple local hospitals to implement unit-based EBP projects. The Advancing Research and Clinical Practice through Close Collaboration (ARCC) model postulates that strong EBP beliefs result in high EBP implementation, which in turn causes high job satisfaction and group cohesion among nurses. AIMS: This study examined the relationships among EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness among the fellowship program participants. METHODS: A total of 175 participants from three annual cohorts between 2012 and 2014 completed the questionnaires at the beginning of each annual session. The questionnaires included the EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness scales. RESULTS: There were positive correlations between EBP beliefs and EBP implementation (r = 0.47; p <.001), as well as EBP implementation and job satisfaction (r = 0.17; p = .029). However, no statistically significant correlations were found between EBP implementation and group cohesion, or group attractiveness. Hierarchical multiple regression models showed that EBP beliefs was a significant predictor of both EBP implementation (ß = 0.33; p <.001) and job satisfaction (ß = 0.25; p = .011). However, EBP implementation was not a significant predictor of job satisfaction, group cohesion, or group attractiveness. LINKING EVIDENCE TO ACTION: In multivariate analyses where demographic variables were taken into account, although EBP beliefs predicted job satisfaction, no significant relationship was found between EBP implementation and job satisfaction or group cohesion. Further studies are needed to confirm these unexpected study findings.

Using Consultants in the Design, Construction, and Occupancy of New Healthcare Facilities.

Nurse leaders are critical players in the design, construction, and occupancy of new healthcare facilities or renovation projects. While most hospitals and healthcare systems have internal resources needed to manage large projects, there is often a recognized need for expertise of external consultants during various phases of design and construction. The purpose of this article is to provide an overview of types of external consultants that can be contracted to ensure the success of the project from concept through initial occupancy.

Using Magnet® as a framework for nurse participation in facility design.

Magnet® Model component NE6EO indicates that nurses should be involved in workflow improvements and space design to improve nursing practice. The Magnet Model can be used as a framework for ensuring that the structures and processes are in place to support nurses' participation in the design of new facilities or remodel spaces.

Applying Lean Six Sigma for innovative change to the post-anesthesia care unit.

Many healthcare organizations are building or renovating patient care facilities. Using Lean Six Sigma methods, nurse leaders can eliminate unnecessary waste and improve work and patient care environments. Starting with a key department like the post-anesthesia care unit is a good way to expose staff and leaders to the potential of Lean.

Teaching future nurses in the clinical setting: the clinical nurses' perspective.

This article shares the findings of a qualitative study exploring clinical nurses' perceptions of teaching nursing students as a preceptor. The results will inform program design and nurse executives in supporting these relationships.

Patients' perceptions of the quality of discharge teaching and readiness for discharge.

PURPOSE: This study evaluated the effectiveness of a change to an interprofessional discharge planning/teaching process with more patient and family engagement. DESIGN: A quantitative survey design was used to measure the effectiveness of the interprofessional discharge planning and teaching process in improving patient and provider outcomes. METHODS: The project used the Quality of Discharge Teaching (QDTS) and Readiness for Hospital Discharge Scale (RHDS) instruments to measure the patients' perceptions of readiness for discharge. Patient satisfaction rates were measured before and after the change. FINDINGS: The new interprofessional discharge planning/teaching process significantly improved patient satisfaction levels from pre- to postimplementation (p<.05). There were significant differences in both pre (n=36) and post (n=31) data for information needed as compared to information received (p<.05). Significant improvements were noted in total QDTS (p=.01) and the Expected Support subscale of the RHDS (p=.038). CONCLUSIONS AND CLINICAL RELEVANCE: The findings of this study indicate the importance of an interprofessional approach to discharge teaching to improve patient satisfaction and the quality of teaching. Adult learning theory and patient-centered care using a patient-engagement model is recommended for inpatient rehabilitation and home settings after discharge.

Facility design and healthcare-acquired infections: state of the science.

Healthcare-associated infections (HAIs) are a serious threat to patients and healthcare providers. Although human factors are commonly studied in an attempt to reduce HAIs, less is known about the effect of specific facility design features on mitigating the transmission of pathogens from human to human. This facility design department aims to expand nurse leaders' knowledge and competencies in health facility design. This article discusses the state of the science in the relationship of facility design on reducing HAIs.

A conceptual model for healthcare facility design.

A conceptual model for healthcare facility design provides nurse leaders a framework for measuring the effect of specific or more global design features on patient, provider, and organizational outcomes. The model can help to explain relationships among variables of interest in facility design and be used to guide research studies or measures of change or improvement.