Nurse practitioners (NPs) are advanced practice nurses who provide holistic care including health promotion and disease prevention to diverse populations across the life span. A current gap in the ...literature is research that examines NP practice as it relates to lesbian, gay, bisexual, and transgender (LGBT) patients. Individuals who identify as LGBT have health concerns specific to their sexual orientation or gender identity that may not be recognized by healthcare providers, such as NPs, and which may result in poorer health outcomes than for non-LGBT persons. This exploratory qualitative descriptive study was designed to examine in detail the practice experiences of NPs in providing primary health care to LGBT patients. A convenience sample of 22 NPs, supplemented with snowball sampling, was drawn from the registry of licensed NPs in the provinces of New Brunswick, Nova Scotia, and Prince Edward Island. Data were collected via semi-structured individual interviews, which were audio-recorded and transcribed verbatim. Some brief measures of quantitative data were also collected for demographic purposes. The qualitative data were analyzed using inductive analysis. Special attention was given to ensuring credibility, dependability, transferability, and confirmability of the data and their interpretation. Key themes that emerged from analysis of the data included: filling in the knowledge gaps; fostering a therapeutic nurse-patient relationship; and sexual and psychosocial health. The research findings also highlighted the gaps that exist in the training and education on LGBT health that NPs received from their educational programs.
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DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Healthcare workforces are currently facing multiple challenges, including aging populations; increasing prevalence of long-term conditions; and shortfall of registered nurses. Employing ...non-registered support workers is common across many countries to expand service capacity of nursing teams. One task delegated to non-registered support workers is medication administration, which is considered a complex task, with associated risks. This is an important topic given the predicted global increase in patients requiring assistance with medication in community settings. This review explores the evidence on delegation of medication administration from registered nurse to non-registered support workers within community settings, to better understand factors that influence the process of delegation and its impact on service delivery and patient care.
The review followed key principles of Critical Interpretative Synthesis and was structured around Preferred Reporting Items for Systematic Reviews and Meta‐analysis guidelines. Literature searches were conducted in MEDLINE, CINAHL, Embase, and ProQuest-British Nursing Index databases. Twenty studies were included.
Findings are reported under four themes: 1, Regulatory and contextual factors; 2, Individual and team level factors; 3, Outcomes of delegation; and 4, Process of implementation and evaluation. Delegation was found to be a complex phenomenon, influenced by a myriad of interconnecting factors at the macro, meso, micro level. At the macro level, the consistency and clarity of government and state level regulations was found to facilitate or impede delegation of medication administration. Lack of clarity at the macro level, impacted at meso and micro levels, resulting in confusion around what medication administration could be delegated and who held responsibility. At the micro level, central to the interpretation of success was the relationship between the delegator and delegatee. This relationship was influenced by personal views, educational and systems factors. Many benefits were reported as an outcome of delegation, including service efficiency and improved patient care. The implementation of delegating medication administration was influenced by regulatory factors, communication, stakeholder engagement, and service champions.
Delegation of medication administration is a complex process influenced by many interrelating factors. Due to the increased risk associated with medication administration, clear and consistent regulatory and governance frameworks and procedures are crucial. Delegation of medication administration is more acceptable within a framework that adequately supports the process, backed by appropriate policy, skills, training, and supervisory arrangements. There is a need for further research around implementation, clinical outcomes and medication errors associated with delegation of medication administration.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Aim
The aim of the study was to develop recommendations for creating a healthy work environment based on current literature for nurses working within the US Military Health System (MHS). However, our ...findings would likely benefit other nursing populations and environments as well.
Design
Systematic literature review.
Data Sources
We conducted a systematic literature search for articles published between January 2010 until January 2024 from five databases: PubMed, Joanna Briggs, Embase, CINAHL and Scopus.
Methods
Articles were screened, selected and extracted using Covidence software. Article findings were synthesized to create recommendations for the development, implementation and measurement of healthy work environments.
Results
Ultimately, a total of 110 articles met the criteria for inclusion in this review. The articles informed 13 recommendations for creating a healthy work environment. The recommendations included ensuring teamwork, mentorship, job satisfaction, supportive leadership, nurse recognition and adequate staffing and resources. Additionally, we identified strategies for implementing and measuring these recommendations.
Conclusions
This thorough systematic review created actionable recommendations for the creation of a healthy work environment. Based on available evidence, implementation of these recommendations could improve nursing work environments.
Impact
This study identifies methods for implementing and measuring aspects of a healthy work environment. Nurse leaders or others can implement the recommendations provided here to develop healthy work environments in their hospitals, clinics or other facilities where nurses practice.
Reporting Method
PRISMA 2020 guidelines.
Patient or Public Contribution
No patient or public contribution.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Aim
To assess and describe reviews of nursing leadership styles associated with organizational, staff and patient outcomes.
Design
A systematic review of reviews.
Methods
Reviews describing a search ...strategy and quality assessment. The review followed the PRISMA statement. Nine databases were searched in February 2022.
Results
After screening 6992 records, 12 reviews were included reporting 85 outcomes for 17 relational, nine task‐oriented, five passive and five destructive leadership styles. Transformational leadership, which is one of the relational styles, was the most studied among all the styles. Of the outcomes, staff outcomes were the most reported, notably job satisfaction, and patient outcomes were less reported. Also, mediating factors between relational leadership styles and staff and patient outcomes were identified.
Conclusion
Extensive research shows the beneficial impacts of relational leadership; however, destructive leadership research is lacking. Relational leadership styles should be conceptually assessed. More research is needed on how nurse leadership affects patients and organizations.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Nurses are often responsible for the care of many patients at the same time and have to prioritise their daily nursing care activities. Prioritising the different assessed care needs and managing ...consequential conflicting expectations, challenges nurses’ professional and moral values.
To explore and illustrate the key aspects of the ethical elements of the prioritisation of nursing care and its consequences for nurses.
A scoping review was used to analyse existing empirical research on the topics of priority setting, prioritisation and rationing in nursing care, including the related ethical issues. The selection of material was conducted in three stages: research identification using two data bases, CINAHL and MEDLINE. Out of 2024 citations 25 empirical research articles were analysed using inductive content analysis.
Nurses prioritised patient care or participated in the decision-making at the bedside and at unit, organisational and at societal levels. Bedside priority setting, the main concern of nurses, focused on patients’ daily care needs, prioritising work by essential tasks and participating in priority setting for patients’ access to care. Unit level priority setting focused on processes and decisions about bed allocation and fairness. Nurses participated in organisational and societal level priority setting through discussion about the priorities. Studies revealed priorities set by nurses include prioritisation between patient groups, patients having specific diseases, the severity of the patient’s situation, age, and the perceived good that treatment and care brings to patients. The negative consequences of priority setting activity were nurses’ moral distress, missed care, which impacts on both patient outcomes and nursing professional practice and quality of care compromise.
Analysis of the ethical elements, the causes, concerns and consequences of priority setting, need to be studied further to reveal the underlying causes of priority setting for nursing staff. Prioritising has been reported to be difficult for nurses. Therefore there is a need to study the elements and processes involved in order to determine what type of education and support nurses require to assist them in priority setting.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Named an AJN Book of the Year and a Doody's Core Title! "This is an excellent and timely tool for advanced practice nurses." Score: 100, 5 stars -Doody's Medical Reviews Measuring the results of APN ...care has become increasingly important as a way to demonstrate the significant impact of APN nurses on practice outcomes. The third edition of this award-winning volume has been updated to provide the most current knowledge, perspectives, and research on assessing outcomes of APN care. It addresses not only the health outcomes of APN practice but the economic impact of APN care as well. Chapters discuss outcome measurement in all areas of advance practice nursing, including identifying outcomes in specialty areas and in community and ambulatory settings. The text provides detailed descriptions of how to conduct outcomes assessments, how to locate the most current instruments and measures for APN assessment, and perspectives on international initiatives in APN assessment. Examples of outcomes studies at the DNP level are culled from the most current published projects. Written by expert practitioners, educators, and researchers in APN outcomes assessment, this book will provide the essential information to help all APNs-regardless of specialty area or practice setting-to increase their skill level in designing outcomes-focused clinical research, selecting instruments, and analyzing outcomes data as critical components of their professional practice role. The third edition is completely updated and expanded to include: * A new chapter on assessing outcomes at the DNP level through data gained from the most current research * An expanded literature review on outcomes measurement research * Guidelines for selecting assessment instruments * Perspectives on an international initiative for the development of an APN research data collection toolkit * New chapter objectives and critical discussion questions
Aim
To propose a theoretical model of intention to stay (ITS) and examine the effects of perceived organizational support, job control and job satisfaction on ITS.
Design
Cross‐sectional multicentre ...survey.
Methods
The survey was conducted from January 2017‒July 2017 and comprised 3,240 clinical nurses from nine tertiary hospitals in eastern, central and western China, with 2,352 effective responses. Structural equation modelling was used to analyse the relationship between ITS and its correlative factors.
Results
The hypothesized model was supported. Job control, perceived organizational support and job satisfaction significantly and directly affected nurses' ITS. Furthermore, job control and perceived organizational support showed indirect effects on ITS, which was mediated by job satisfaction. Perceived organizational support could positively influence job control to have a further impact on job satisfaction and ITS.
Conclusion
Based on a large sample of Chinese tertiary hospital nurses, this study proposed and verified a theoretical model of nurses' ITS, revealing that organization characteristics, work characteristics and affective response to work can have an impact on ITS.
Impact
This study was the first to examine the relationships among perceived organizational support, job control, job satisfaction and ITS, enriching the theoretical model of ITS. Nurse managers can improve nurses' ITS by enhancing their perceived organizational support, job control and job satisfaction.
目的提出留职意愿的理论模型,探究组织支持感、工作控制和工作满意度对留职意愿的影响。设计横断面多中心调查。方法自2017年1月至2017年7月,对中国东部、中部和西部地区9所三级医院的3,240名临床护士进行问卷调查,共获得有效问卷2,352 份。采用结构方程模型对留职意愿与其相关因素的关系进行来分析。结果所建模型对本项研究具有支持作用。调查发现,工作控制、组织支持感和工作满意度对护士留职意愿具有显著直接的影响。此外,工作控制和组织支持感对留职意愿有间接的影响,且这种影响通过工作满意度进行调节。组织支持感对工作控制有正向影响,从而进一步影响工作满意度及留职意愿。结论本研究采用中国三级医院护士大样本作为研究对象,提出了护士留职意愿的理论模型并对此进行验证,揭示了组织特征、工作特征和工作情感反应对留职意愿的影响。影响本研究首次对组织支持感、工作控制、工作满意度与留职意愿之间的关系进行研究,丰富了留职意愿的理论模型。护士管理者可通过提高护士的组织支持感、工作控制和工作满意度来提高其留职意愿。
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Oncology Nursing Practice Smoking is linked to 12 different types of cancer. Most patients attempt to quit smoking after diagnosis, but 50% of patients continue to smoke throughout treatment. This ...leads to increased oncologic complications, the development of secondary malignancies, and recurrence. The National Comprehensive Cancer Network recommends that all oncology patients be screened for tobacco use at regular intervals and receive treatment plans for all patients who use tobacco. However, oncology healthcare providers have reported they do not feel they receive adequate training to conduct tobacco use assessments and provide smoking cessation counseling. The primary objective of this quality improvement project is to increase the knowledge and confidence of radiation oncology nurses and nurse practitioners regarding tobacco assessment and cessation counseling strategies. A secondary objective is to increase the provision of smoking status assessment and cessation counseling among radiation oncology nurses and nurse practitioners through evidenced based education. Participants will complete pretest surveys assessing knowledge, confidence & how often they provide cessation counseling. Then they will attend a 30-minute tobacco assessment and cessation counseling education session. Following the education session, participants will complete the same surveys and chart audits will be conducted to assess for documentation of cessation counseling. This research study will occur during October 2022- January 2023. Providing oncology nurses with formal tobacco assessment and cessation counseling education has the potential to increase their knowledge, confidence, and the frequency in which they provide cessation counseling. This education may aid oncology patients to quit smoking which can reduce oncologic treatment complications and recurrence rates as well as improve treatment outcomes.
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DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Aim
The study was conducted to understand the experiences of nurse managers with regard to the difficulties and opportunities they encountered during the pandemic.
Background
Although many studies ...have been carried out to understand how nurses were affected in the COVID‐19 pandemic, there are few studies that treat the experiences of nurse managers.
Methods
In this qualitative descriptive study with 19 nurse managers working in pandemic management at a university hospital in Turkey during the first three waves of the pandemic, data were collected between April and July 2021 using the semi‐structured interview method. Content analysis was performed to analyse the data.
Results
Six themes were identified with respect to the experiences of nurse managers during the pandemic. These themes were initial reactions to the crisis, ineffective crisis management, excessive workload, the moral burden in decision‐making, support of colleagues and other multidisciplinary team and nurse manager empowerment.
Conclusions
The nurse managers had difficulties in their managerial roles during the pandemic. However, they also viewed the crisis as an opportunity because they were able to note the deficiencies in management at all levels of the hospital and their leadership and decision‐making roles took on more importance.
Implications for nursing management
Nurse managers may use the results of this study to be prepared for the continuing COVID‐19 pandemic and any other emergency circumstances that they may have to face in the future.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Objective
To study the relationships between newly graduated nurses’ (NGNs’) perceptions of their professional competence, and individual and organizational work‐related factors.
Methods
A ...multivariate, quantitative, descriptive, correlation design was applied. Data collection took place in November 2012 with a national convenience sample of 318 NGNs representing all main healthcare settings in Finland. Five instruments measured NGNs’ perceptions of their professional competence, occupational commitment, empowerment, practice environment, and its ethical climate, with additional questions on turnover intentions, job satisfaction, and demographics. Descriptive statistics summarized the demographic data, and inferential statistics multivariate path analysis modeling estimated the relationships between the variables.
Results
The strongest relationship was found between professional competence and empowerment, competence explaining 20% of the variance of empowerment. The explanatory power of competence regarding practice environment, ethical climate of the work unit, and occupational commitment, and competence's associations with turnover intentions, job satisfaction, and age, were statistically significant but considerably weaker. Higher competence and satisfaction with quality of care were associated with more positive perceptions of practice environment and its ethical climate as well as higher empowerment and occupational commitment.
Conclusions
Apart from its association with empowerment, competence seems to be a rather independent factor in relation to the measured work‐related factors. Further exploration would deepen the knowledge of this relationship, providing support for planning educational and developmental programs. Research on other individual and organizational factors is warranted to shed light on factors associated with professional competence in providing high‐quality and safe care as well as retaining new nurses in the workforce.
Clinical Relevance
The study sheds light on the strength and direction of the significantly associated work‐related factors. Nursing professional bodies, managers, and supervisors can use the findings in planning orientation programs and other occupational interventions for NGNs.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK, VSZLJ
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