Aims and objectives
To identify and summarise factors and processes related to registered nurses’ patient care decision‐making in medical–surgical environments. A secondary goal of this literature ...review was to determine whether medical–surgical decision‐making literature included factors that appeared to be similar to concepts and factors in naturalistic decision making (NDM).
Background
Decision‐making in acute care nursing requires an evaluation of many complex factors. While decision‐making research in acute care nursing is prevalent, errors in decision‐making continue to lead to poor patient outcomes. Naturalistic decision making may provide a framework for further exploring decision‐making in acute care nursing practice. A better understanding of the literature is needed to guide future research to more effectively support acute care nurse decision‐making.
Design
PubMed and CINAHL databases were searched, and research meeting criteria was included. Data were identified from all included articles, and themes were developed based on these data.
Results
Key findings in this review include nursing experience and associated factors; organisation and unit culture influences on decision‐making; education; understanding patient status; situation awareness; and autonomy.
Conclusions
Acute care nurses employ a variety of decision‐making factors and processes and informally identify experienced nurses to be important resources for decision‐making. Incorporation of evidence into acute care nursing practice continues to be a struggle for acute care nurses. This review indicates that naturalistic decision making may be applicable to decision‐making nursing research.
Relevance to clinical practice
Experienced nurses bring a broad range of previous patient encounters to their practice influencing their intuitive, unconscious processes which facilitates decision‐making. Using naturalistic decision making as a conceptual framework to guide research may help with understanding how to better support less experienced nurses’ decision‐making for enhanced patient outcomes.
The aim of this study was to examine program effectiveness in changing Caritas leadership, self-caring behaviors, and perceptions of coworkers of participants who completed the Caritas Coach ...Education Program (CCEP).
The CCEP has been a highly successful education program for individuals who wish to intellectually and experientially learn to teach, live, and practice human caring theory.
A pretest-posttest descriptive design was used to evaluate changes in perceptions of self-caring, caritas leadership, and coworker behaviors after completion of CCEP.
The mean scores of all measures improved significantly.
After completion of CCEP, participants demonstrated statistically significant changes in 3 caritas measures: leadership, coworker, and self-rating. Caritas Coach participants exhibited the greatest change in their self-caring scores.
OBJECTIVE:The aim of this study was to present an instrument and comparative database designed to evaluate patients’ perceptions of caring behaviors of caregivers.
BACKGROUND:Acute care leaders are ...under pressure to improve publicly reported patient satisfaction scores. Some nurse leaders have implemented professional practice environments based on human caring theory, whereas others have used scripting to standardize communication between staff and patients.
METHODS:The Watson Caritas Patient Score (WCPS) is collected quarterly from a random sample of patients who are admitted to acute care hospital units.
RESULTS:The WCPS was able to discriminate across unit types and hospitals. Items were related to publicly reported nursing communication scores.
CONCLUSIONS:Participation in research based on human caring theory has given nurse leaders the opportunity to evaluate effectiveness of professional practice environments. It may provide the opportunity to focus staff communication with patients more authentically and in a way that enriches the experience for both.
Understanding the impact of COVID-19 on nursing care delivery in critical care work systems is urgently needed. Theoretical frameworks guide understanding of phenomena in research. In this paper, we ...critique four theoretical frameworks (Donabedian's Quality Model, the Quality Health Outcomes Model, the Systems Research Organizing Model, and the Systems Engineering (SEIPS) 2.0 Model) using Reed's (2018) Intermodern philosophical perspective of nursing science. Reed's (2018) Intermodern approach to theory critique was selected for its pragmatic perspective and focus on personal and professional health and wellbeing. The SEIPS 2.0 Model was ultimately selected to guide the study of the impact of the COVID-19 Pandemic on nursing care delivery in the critical care work systems.
•Multiple theoretical frameworks exist guiding description of the structures, processes, and outcomes in healthcare settings.•The SEIPS 2.0 Model was selected for its inclusion of the external environment, professional health and wellness, and recent use.•The Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 Model was selected for its explicit inclusion of the external environment, professional health and wellness as an outcome, and recent wide use in critical care nursing/systems research.
kramer m., maguire p. & brewer b.b. (2011) Journal of Nursing Management 19, 5–17 Clinical nurses in Magnet hospitals confirm productive, healthy unit work environments
Aim To describe extent to ...which experienced nurses in Magnet hospitals confirm healthy work environments (HWE).
Background Differentiating differences in HWE allows managers to focus attention where changes may be needed to improve nurse and patient outcomes.
Method The sample was 12 233 experienced nurses from 717 clinical units in 34 Magnet hospitals. Based on Essentials of Magnetism II unit level scores, units were grouped as very healthy work environments (VHWE), HWE or work environments needing improvement.
Results VHWE or HWE was confirmed by nurses on 82% of 540 clinical units. The most significant correlates of HWE units occur within individual hospitals. More nurses prepared at the Bachelor of Science in Nursing level or above work on VHWE or HWE units and score higher on seven essential work processes. Nurses’ ratings of quality of patient care directly correlate to quality of work environment.
Conclusions Clinical units in 34 Magnet hospitals were markedly skewed toward excellence. Visionary leadership, empowerment and collaboration have an impact on development and maintenance of HWE.
Implications for nursing management Implementation of structures that promote interdisciplinary and intradisciplinary collaboration and decision‐making positively affect development of HWE. Gap analysis of the steps/components of the eight work processes/relationships essential to HWE may enable achievement of HWEs on all hospital clinical units.
Few studies of walkability include both perceived and audited walkability measures. We examined perceived walkability (Neighborhood Environment Walkability Scale-Abbreviated, NEWS-A) and audited ...walkability (Irvine-Minnesota Inventory, IMI) measures for residents living within 2 km of a "complete street"-one renovated with light rail, bike lanes, and sidewalks. For perceived walkability, we found some differences but substantial similarity between our final scales and those in a prior published confirmatory factor analysis. Perceived walkability, in interaction with distance, was related to complete street active transportation. Residents were likely to have active transportation on the street when they lived nearby and perceived good aesthetics, crime safety, and traffic safety. Audited walkability, analyzed with decision trees, showed three general clusters of walkability areas, with 12 specific subtypes. A subset of walkability items (
= 11), including sidewalks, zebra-striped crosswalks, decorative sidewalks, pedestrian signals, and blank walls combined to cluster street segments. The 12 subtypes yielded 81% correct classification of residents' active transportation. Both perceived and audited walkability were important predictors of active transportation. For audited walkability, we recommend more exploration of decision tree approaches, given their predictive utility and ease of translation into walkability interventions.
Quality organizational structures and nursing practices are key to positive patient outcomes. Whereas structures have been largely studied over the past few decades, less is known of the nursing ...practices that account for patient outcomes, such as patient satisfaction. This is especially true in psychiatric, mental health care settings. The aim of the present study is to determine the relative importance of eight Essential Professional Nursing Practices (EPNPs) on the satisfaction of hospitalized patients on mental health care units. A cross‐sectional design was selected; 226 point‐of‐care mental health nurses completed the online EPNP questionnaire in Spring 2015. Statistical analyses included MANOVAs and a 2‐step linear regression. A significant relationship was found between university preparation and scores on two EPNP subscales: autonomous decision‐making and practicing with competent nurses. Scores on patient advocacy and control over practice subscales were significantly related to nurse‐rated patient satisfaction. The findings reinforce the positive link between university education and the work of nurses and highlight the power dynamics that are salient in mental health care. The pertinence of EPNPs in psychiatric settings is brought to the fore, with practices of patient advocacy and nurse control over care examined in relation to empowerment. Implications for clinical and administrative leaders are addressed, with a focus on strategies for empowering patients and nurses.
Caring Science Research Watson, Jean; Brewer, Barbara B.
The Journal of nursing administration
45, Issue:
5
Journal Article
Peer reviewed
With the release of the 2014 standards, the Magnet Recognition Program continues to embark on a new course in relation to healthcare reform and new indicators of health, beyond medical treatment of ...disease and conventional acute care approaches. There is evidence of new interprofessional models of caring and healing and well-being based on extending the current Magnet components. There are now increa ing numbers of Magnet-designated hospitals (and those preparing for Magnet) using caring theory and caring science leadership in implementing new models of caring and healing practices, research, and scholarship. Here, Warson and Brewer discuss criteria, evidence, and measurement in nursing administration.
•Nine network metrics exhibited stability over seven months in an Information-Sharing and an Advice Network.•Four network metrics, Hierarchy, Fragmentation, Isolate Count, and Clique Count, exhibited ...instability.•Slight differences were found between day and night shifts in the Information-Sharing and the Advice Networks.
Network stability is of increasing interest to researchers as they try to understand the dynamic processes by which social networks form and evolve. Because hospital patient care units (PCUs) need flexibility to adapt to environmental changes (Vardaman et al., 2012), their networks are unlikely to be uniformly stable and will evolve over time. This study aimed to identify a metric (or set of metrics) sufficiently stable to apply to PCU staff information sharing and advice seeking communication networks over time. Using Coefficient of Variation, we assessed both Across Time Stability (ATS) and Global Stability over four data collection times (Baseline and 1, 4, and 7 months later). When metrics were stable using both methods, we considered them “super stable.” Nine metrics met that criterion (Node Set Size, Average Distance, Clustering Coefficient, Density, Weighted Density, Diffusion, Total Degree Centrality, Betweenness Centrality, and Eigenvector Centrality). Unstable metrics included Hierarchy, Fragmentation, Isolate Count, and Clique Count. We also examined the effect of staff members’ confidence in the information obtained from other staff members. When confidence was high, the “super stable” metrics remained “super stable,” but when low, none of the “super stable” metrics persisted as “super stable.” Our results suggest that nursing units represent what Barker (1968) termed dynamic behavior settings in which, as is typical, multiple nursing staff must constantly adjust to various circumstances, primarily through communication (e.g., discussing patient care or requesting advice on providing patient care), to preserve the functional integrity (i.e., ability to meet patient care goals) of the units, thus producing the observed stability over time of nine network metrics. The observed metric stability provides support for using network analysis to study communication patterns in dynamic behavior settings such as PCUs.
This article describes psychometric testing and refinement of the Verran Professional Governance Scale (VPGS), which measures behaviors associated with professional governance. Phase 1 reduced the ...items on the scale based on floor and ceiling effects and redundancy of items. Phase 2 examined structural construct validity using exploratory (EFA) and confirmatory factor analysis (CFA). The final 22-item instrument demonstrates satisfactory internal consistencies and fit indices and significant positive correlation between the VPGS, job satisfaction, and control over nursing practice.
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