Taking the Fear Out of Peer Feedback: A Brain-Friendly Peer Feedback Program.

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.

A Road Map for the Development of a Decisional Authority Framework for Professional Governance Using Accountability Grids.

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.

Clinical Nurses' Perceptions of a "Brain-Friendly" Peer Feedback Program.

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.

Effect of Shared Governance on Nurse-Sensitive Indicator and Satisfaction Outcomes by Magnet® Recognition Status.

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.

Effect of Shared Governance on Nurse-Sensitive Indicator and Satisfaction Outcomes: An International Comparison.

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.

Managing the tension between caring and charting: Labor and delivery nurses' experiences of the electronic health record.

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.

Fetal Heart Rate Auscultation, 4th Edition.

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.

Fetal Heart Rate Auscultation, 4th Edition.

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.

Test-Retest Reliability of the Verran Professional Governance Scale©.

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.

The electronic health record's impact on nurses' cognitive work: An integrative review.

BACKGROUND: Technology use can impact human performance and cognitive function, but few studies have sought to understand the electronic health record's impact on these dimensions of nurses' work. OBJECTIVE: The purpose of this review was to synthesize the literature on the electronic health record's impact on nurses' cognitive work. DESIGN: Integrative review. DATA SOURCES: MEDLINE/PubMed, CINAHL, Embase, Web of Science, and PsycINFO. REVIEW METHODS: The literature search focused on 3 concepts: the electronic health record, cognition, and nursing practice, and yielded 4910 articles. Following a stepwise process of duplicate removal, title and abstract review, full text review, and reference list searches, a total of 18 studies were included: 12 qualitative, 4 mixed-methods, and 2 quantitative studies from the United States (13), Scandinavia (2), Australia (1), Austria (1), and Canada (1). The Mixed Methods Appraisal Tool was used to assess the quality of eligible studies. RESULTS: Five themes identified how nurses and other clinicians used the electronic health record and perceived its impact: 1) forming and maintaining an overview of the patient, 2) cognitive work of navigating the electronic health record, 3) use of cognitive tools, 4) forming and maintaining a shared understanding of the patient, and 5) loss of information and professional domain knowledge. Most studies indicated that forming and maintaining an overview of the patient at both the individual and team level were difficult when using the electronic health record. Navigating the volumes of information was challenging and increased clinicians' cognitive work. Information was perceived to be scattered and fragmented, making it difficult to see the chronology of events and to situate and understand the clinical implications of various data. The template-driven nature of documentation and limitations on narrative notes restricted clinicians' ability to express their clinical reasoning and decipher the reasoning of colleagues. Summary reports and handoff tools in the electronic health record proved insufficient as stand-alone tools to support nurses' work throughout the shift and during handoff, causing them to rely on self-made paper forms. Nurses needed tools that facilitated their ability to individualize and contextualize information in order to make it clinically meaningful. CONCLUSION: The electronic health record was perceived by nurses as an impediment to contextualizing and synthesizing information, communicating with other professionals, and structuring patient care. Synthesizing and communicating information at the individual and team levels are known drivers of patient safety. The findings from this review have implications for electronic health record design.

Fetal Heart Rate Auscultation, 3rd edition.

The use of intermittent auscultation (IA) for fetal surveillance during labor decreased with the introduction of electronic fetal monitoring (EFM). The increased use of EFM is associated with an increase in cesarean births. IA is an evidence-based method of fetal surveillance during labor for women with low risk pregnancies and considered one component of comprehensive efforts to reduce the primary cesarean rate and promote vaginal birth. Many clinicians are not familiar with IA practice. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues, and strategies to promote implementation of IA into practice.

Parents' Perspectives on Navigating the Work of Speaking Up in the NICU.

OBJECTIVE: To describe parents' perspectives and likelihood of speaking up about safety concerns in the NICU and identify barriers and facilitators to parents speaking up. DESIGN: Exploratory, qualitatively driven, mixed-methods design. SETTING: A 50-bed U.S. academic medical center, open-bay NICU. PARTICIPANTS: Forty-six parents completed questionnaires, 14 of whom were also interviewed. METHODS: Questionnaires, interviews, and observations with parents of newborns in the NICU were used. The qualitative investigation was based on constructivist grounded theory. Quantitative measures included ratings and free-text responses about the likelihood of speaking up in response to a hypothetical scenario about lack of clinician hand hygiene. Qualitative and quantitative analyses were integrated in the final interpretation. RESULTS: Most parents (75%) rated themselves likely or very likely to speak up in response to lack of hand hygiene; 25% of parents rated themselves unlikely to speak up in the same situation. Parents engaged in a complex process of Navigating the work of speaking up in the NICU that entailed learning the NICU, being deliberate about decisions to speak up, and at times choosing silence as a safety strategy. Decisions about how and when to speak up were influenced by multiple factors including knowing my baby, knowing the team, having a defined pathway to voice concerns, clinician approachability, clinician availability and friendliness, and clinician responsiveness. CONCLUSION: To engage parents as full partners in safety, clinicians need to recognize the complex social and personal dimensions of the NICU experience that influence parents' willingness to speak up about their safety concerns.