Describing a programme of implementation-effectiveness research on the organization and implementation of frontline nursing care delivery into diverse heath systems.

AIMS: The longitudinal programme of research described in this paper seeks to generate knowledge about factors influencing the implementation of a system-level intervention, the clinical nurse leader care model, involving nurses as leaders at the frontlines of care and the outcomes achievable with successful implementation. The research programme has the following aims, (a) to clarify clinical nurse leader practice, (b) develop and empirically validate a translational model of frontline care delivery that includes clinical nurse leader practice and (c) delineate the patterns of and critical outcomes of successful implementation of the clinical nurse leader care model. DESIGN: This programme of research follows a knowledge-building trajectory involving multiple study designs in both qualitative (grounded theory, case study) and quantitative (descriptive, correlational and quasi-experimental) traditions. METHODS: Multiple mixed methods within a system-based participatory framework were used to conduct this programme of implementation-effectiveness research. RESULTS: Findings are demonstrating how the clinical nurse leader care model, as a complex system-level intervention, can be implemented in diverse healthcare contexts to make a difference to patient care quality and safety. Findings also contribute to implementation science, helping to better understand the dynamic interdependencies between implementation, the interventions implemented and the contexts in which they are implemented. CONCLUSION: Findings translate into sets of evidence-informed implementation 'recipes' that health systems can match to their specific contexts and needs. This allows health systems to take on strategies that both maximize resource impact within their existing structures and support achieving intended outcomes. IMPLICATION: This programme of research is producing actionable implementation and outcome evidence about ways to organize nursing knowledge and practice into care models that can be successfully adopted within real-world healthcare settings to achieve safer and higher quality patient care.

Linking nursing outcomes classification to the self- and family management framework.

AIM: Establish linkages between components of the Self- and Family Management Framework and outcomes of the Nursing Outcomes Classification to evaluate the comprehensiveness of outcomes addressing self- and family management in the Nursing Outcomes Classification. DESIGN: Descriptive study. METHODS: Experts conducted a six-step process to establish linkages: (1) preliminary mapping of all relevant nursing outcomes to the framework; (2) development of checklists for team members serving as 'identifiers' and 'reviewers'; (3) mapping all relevant nursing outcomes to the framework; (4) final agreement on mapped outcomes; (5) establishment of inter-rater reliability; and (6) discussion of findings with authors of the Self- and Family Management Framework. RESULTS: Three hundred and sixty-three nursing outcomes were identified as related to the management of chronic disease across all components of the framework: outcomes related to patient self-management (n = 336), family functioning (n = 16) and family caregivers (n = 11). CONCLUSION: The Nursing Outcomes Classification outcomes comprehensively address self-management, and, less so, family functioning, and caregivers. IMPLICATIONS: Established linkages can be used by nurses to track and support patient and family management outcomes across the care continuum. PATIENT OR PUBLIC CONTRIBUTION: Linking standardized nursing outcomes to the Self- and Family Management Framework can assist in goal setting and measurement of nursing care during chronic disease management. This work can help describe to funders, policy makers and others invested in health care reform the specific contributions of nurses to self- and family management of chronic disease. IMPACT: This paper demonstrates the linkages between components of the Self- and Family Management Framework and Nursing Outcomes Classification outcomes. The results of this study offer the opportunity to quantify the impact of nursing care and enhance nursing practice for patients with chronic conditions as well as contribute to developing Nursing Outcomes Classification outcomes that consider self-management processes.

Associations between continuity of care, perceived control and self-care and their impact on health-related quality of life and hospital readmission-A structural equation model.

AIM: The aim of this study is to examine whether a conceptual model including the associations between continuity of care, perceived control and self-care could explain variations in health-related quality of life and hospital readmissions in people with chronic cardiac conditions after hospital discharge. DESIGN: Correlational design based on cross-sectional data from a multicentre survey study. METHODS: People hospitalized due to angina, atrial fibrillation, heart failure or myocardial infarction were included at four hospitals using consecutive sampling procedures during 2017-2019. Eligible people received questionnaires by regular mail 4-6 weeks after discharge. A tentative conceptual model describing the relationship between continuity of care, self-care, perceived control, health-related quality of life and readmission was developed and evaluated using structural equation modelling. RESULTS: In total, 542 people (mean age 75 years, 37% females) were included in the analyses. According to the structural equation model, continuity of care predicted self-care, which in turn predicted health-related quality of life and hospital readmission. The association between continuity of care and self-care was partly mediated by perceived control. The model had an excellent model fit: RMSEA = 0.06, 90% CI, 0.05-0.06; CFI = 0.90; TLI = 0.90. CONCLUSION: Interventions aiming to improve health-related quality of life and reduce hospital readmission rates should focus on enhancing continuity of care, perceived control and self-care. IMPACT: This study reduces the knowledge gap on how central factors after hospitalization, such as continuity of care, self-care and perceived control, are associated with improved health-related quality of life and hospital readmission in people with cardiac conditions. The results suggest that these factors together predicted the quality of life and readmissions in this sample. This knowledge is relevant to researchers when designing interventions or predicting health-related quality of life and hospital readmission. For clinicians, it emphasizes that enhancing continuity of care, perceived control and self-care positively impacts clinical outcomes. PATIENT OR PUBLIC CONTRIBUTION: People and healthcare personnel evaluated content validity and were included in selecting items for the short version.

Resilient ageing: a concept analysis.

AIM: This paper is a report of an analysis of the concept resilient ageing. Unique in comparison with other healthy ageing concepts, resilient ageing can be applied to all older people, regardless of age or affliction. BACKGROUND: The state of global population expansion in older people over the next 50 years calls for increased health promotion research efforts to ensure the maintenance of health and optimal quality of life for all older people. DATA SOURCES: Literature for this concept analysis was retrieved from several databases, CINAHL, PubMed PsycINFO, for the years 1990-2012. DESIGN: Rodgers's evolutionary method of concept analysis was used because of its applicability to concepts that are still evolving. METHODS: An integrative research review methodology was applied to peer-reviewed journal articles (n = 46) for an inductive analysis of the concept of resilient ageing. RESULTS: The antecedents, defining attributes, and consequence of resilient ageing were identified. Antecedents to resilient ageing were found to be adversity and protective factors, while the core attributes include coping, hardiness and self-concept. The consequence of the process of resilient ageing was optimal quality of life. Sense of coherence was found to be the surrogate term. The results obtained were further substantiated using Antonovsky's (1979) theory of salutogenesis. CONCLUSION: A theoretical definition and a model of resilient ageing were developed. In addition, a discussion was provided on the practice, policy and research implications for promoting the development of protective factors and resilient ageing.

More Thoughts About Health Policies: Focus on Conceptual Models.

The purpose of this essay is to demonstrate how existing conceptual models of nursing designed for clinical research, education, practice, and administration also can be used to guide health policy development, analysis, evaluation, and research by nurses. The concept of each of various nursing conceptual models that might be represented by health policies is identified.

Thoughts About Environment.

The purpose of this essay is to discuss what is meant by the external environment within our discipline. The essay includes an overview of attention to environment that began when human beings first inhabited the planet and has continued to contemporary times within the context of nursing conceptual models. The finally recognized need for attention to global environmental conditions that include climate and climate change is cited. The essay concludes with a call for decolonizing the disciplinary meanings of environment.