Expertise among critical care nurses: A grounded theory study

Differing Effects of Implementation Leadership Characteristics on Nurses' Use of mHealth Technologies in Clinical Practice: Cross-Sectional Survey Study

BACKGROUND

Leadership has been consistently identified as an important factor in shaping the uptake and use of mobile health (mHealth) technologies in nursing; however, the nature and scope of leadership remain poorly delineated. This lack of detail about what leadership entails limits the practical actions that can be taken by leaders to optimize the implementation and use of mHealth technologies among nurses working clinically.

OBJECTIVE

This study aimed to examine the effects of first-level leaders' implementation leadership characteristics on nurses' intention to use and actual use of mHealth technologies in practice while controlling for nurses' individual characteristics and the voluntariness of use, perceived usefulness, and perceived ease of use of mHealth technologies.

METHODS

A cross-sectional exploratory correlational survey study of registered nurses in Canada (n=288) was conducted between January 1, 2018, and June 30, 2018. Nurses were eligible to participate if they provided direct care in any setting and used employer-provided mHealth technologies in clinical practice. Hierarchical multiple regression analyses were conducted for the 2 outcome variables: intention to use and actual use.

RESULTS

The implementation leadership characteristics of first-level leaders influenced nurses' intention to use and actual use of mHealth technologies, with 2 moderating effects found. The final model for intention to use included the interaction term for implementation leadership characteristics and education, explaining 47% of the variance in nurses' intention to use mHealth in clinical practice (F10,228=20.14; P<.001). An examination of interaction plots found that implementation leadership characteristics had a greater influence on the intention to use mHealth technologies among nurses with a registered nurse diploma or a bachelor of nursing degree than among nurses with a graduate degree or other advanced education. For actual use, implementation leadership characteristics had a significant influence on the actual use of mHealth over and above the control variables (nurses' demographic characteristics, previous experience with mHealth, and voluntariness) and other known predictors (perceived usefulness and perceived ease of use) in the model without the implementation leadership × age interaction term (β=.22; P=.001) and in the final model that included the implementation leadership × age interaction term (β=-.53; P=.03). The final model explained 40% of the variance in nurses' actual use of mHealth in their work (F10,228=15.18; P<.001). An examination of interaction plots found that, for older nurses, implementation leadership characteristics had less of an influence on their actual use of mHealth technologies.

CONCLUSIONS

Leaders responsible for the implementation of mHealth technologies need to assess and consider their implementation leadership behaviors because these play a role in influencing nurses' use of mHealth technologies. The education level and age of nurses may be important factors to consider because different groups may require different approaches to optimize their use of mHealth technologies in clinical practice.

How does performance vary between early and late adopters of Industry 4.0? A qualitative viewpoint

Purpose

Industry 4.0 is a new trend among organizations. Some organizations have been early adopters or later adopters of Industry 4.0. The purpose of this paper is to investigate how performance effects vary between early and late adopters of Industry 4.0.

Design/methodology/approach

This study applies a qualitative research methodology using grounded theory. 14 senior management professionals who have implemented Industry 4.0 participated in this study through a theoretical and snowball sampling approach. These professionals were from manufacturing and service sectors, from North America, Europe and Asia. The study used semi structured open-ended interviews to capture the organizational performance on operational, financial, environmental and social dimensions.

Findings

The findings were analyzed in terms of four broad themes which emerged from the interviews. In operational performance the operational and implementation cost will be higher for early adopters. The late adopters may enjoy the advantage in terms of improved business models. In terms of financial performance, the early adopters may see a marginal increase in profit and increased stock price compared to late adopters. The performance on the environmental dimension will see early adopters enjoying material efficiency, energy savings and an improved image of the company compared to late adopters. In social performance, the early adopters will provide a better quality of work life, safer manufacturing environment. However, the resistance from labor unions will be higher for early adopters compared to late adopters.

Practical implications

Organizations must decide the timing of implementation of Industry 4.0. This study will act as a guide wherein they can decide to be an early adopter or late adopter based on knowledge of the resulting performance consequences.

Originality/value

This is the first paper that studies the performance effects of early versus late adopters of Industry 4.0.

Exploring the thinking, reasoning and clinical approach of expert child psychiatric nurses

BACKGROUND

Expert nurses are characterized by their deep knowledge of patient situations and understanding of patients in the context of their total situation. We know of no studies that have focused on the expert practice of child/adolescent (C/A) psychiatric mental health (PMH) advanced practice nurse.

OBJECTIVE

The purpose of this study was to gather information on how expert C/A advanced practice psychiatric nurses (APPNs) view their role and assess/treat children and adolescents with complex mental health issues.

METHOD

Expert C/A APPNs were interviewed by one of the two investigators using a semi-structured interview guide. All interviews were audiotaped and transcribed. This was a qualitative descriptive study and in line with that method, interview content was open-coded and examined for themes that were collapsed into categories.

RESULTS

Fifteen C/A PMH APPNs were interviewed. Initial categories that were distilled included descriptions of their commitment to the population, development of families as partners, an expanded approach to medication management, and how they demonstrate expertise.

CONCLUSION

Expert nurses adopt an invaluable approach to children and families-inherently patient and family-centered. They view the child/teen in terms of the multiple contexts of their lives.