How do nurses and midwives perceive their preparedness for quality improvement and patient safety in practice? A cross-sectional national study in Ireland

Cognition of nursing translational medical research among nursing practitioners in China

BACKGROUND

Nursing translational research (TR) begins with clinical discovery and medical research and leads to clinical application in patients. TR is key to improving nursing quality and developing the nursing profession. However, its development in China remains limited, and the reasons for this are unclear. We aim to enhance the recognition of nursing TR among nursing practitioners in China by exploring their cognition about nursing TR and associated influences.

METHODS

We distributed an internet-based questionnaire to 683 nursing practitioners between February 13 and March 15, 2023. We analyzed the characteristics and cognition of nursing TR using descriptive statistics, the chi-squared test, Fisher's exact test, the Wilcoxon rank-sum test, Kruskal-Wallis H test, and stepwise logistic regression analysis. The majority (79.65%) of nursing practitioners who responded to the questionnaire were willing to participate in nursing TR.

FINDINGS

Nursing practitioners with a higher educational level, stronger recognition of the importance of nursing TR, and stronger recognition of transdisciplinary nursing TR were more willing to participate in nursing TR.

DISCUSSION

The results of this study can accelerate nursing practitioners' willingness to participate in nursing TR.

APPLICATION TO PRACTICE

We identified strategies to promote TR: provide further education, optimize courses in higher education, disseminate information, provide guidance on the importance of nursing TR, and establish a nursing TR platform with appropriate potential collaborators.

Perioperative Nurses' Perceptions of the QSEN Competencies

Since the development of the Quality and Safety Education for Nurses (QSEN) competencies, most published studies related to the topic have focused on investigating the perceptions of nursing faculty members, prelicensure and graduate nursing students, and recently graduated nurses regarding the competencies. Few researchers have explored practicing nurses' perceptions. The purpose of this study was to describe practicing perioperative nurses' perceptions of their knowledge, skills, and attitudes associated with the QSEN competencies. Survey results from 654 perioperative nurses representing 49 states showed that participants reported they were very prepared for the patient-centered care and teamwork and collaboration competencies, but they were not prepared for the quality improvement competency. Similarly, perioperative nurses reported less participation in QSEN competency-related activities when they felt not at all prepared or somewhat prepared, despite perceiving these activities to be important. Hospital leaders should support perioperative nurses' efforts to apply the QSEN competencies in the practice setting.

An Evaluation of Barriers and Facilitators for a Pressure Injury Prevention Link Nurse Role: A Mixed-Methods Study in New Zealand

PURPOSE

The purpose of this study was to identify barriers and facilitators for nurses in a pressure injury prevention (PIP) link nurse role.

DESIGN

Mixed-methods study that used nominal group technique with focus groups, followed by online surveys.

SAMPLE AND SETTING

The PIP link nurse project recruited 52 RNs; 32 completed the PIP educational program and participated in data collection. The sample was drawn from PIP link nurses, who were invited to participate in focus groups at the end of the project to identify perceived facilitators and barriers to their role. Focus groups were specific to work areas: aged care and community visiting, and hospital. Two were in an urban setting and one in a rural environment. Twenty-two PIP link nurses participated across 3 groups. To ensure comprehensive data from all involved in the project, online surveys were created using focus group priorities as the basis for questions to send to all PIP link nurses, their managers, and workplace colleagues.

METHODS

Participants were invited to participate in focus groups to identify perceived facilitators and barriers to their role. These focus groups were organized around care settings: aged care, community visiting, and hospital. Using a nominal group technique focus group process, participants were asked to identify barriers and facilitators to their role. These were shared with the group until all answers were declared and understood. Voting on order of priority then took place, with majority voting leading to a prioritized list of facilitators and barriers for each group. Considering the similarities and differences across group priorities, researchers developed online surveys representing the main facilitators and barriers from the focus groups. Surveys were then distributed to all PIP link nurses, their managers, and colleagues. Survey data were collected and analyzed in REDCap and reported as percentages of agreement to the questions for each group of respondents.

RESULTS

Focus group data indicated facilitating priorities included PIP link nurses' commitment to the role, the support they received from their managers and colleagues, and time release to complete the role. Barriers included lack of time-when other work pressures took priority, and PIP link nurses felt the focus on applying quality improvement theory was more challenging than they had anticipated. Surveys from all groups reiterated the importance of the support of the workplace team in facilitating the role, and the time pressures for the PIP link nurse were a barrier to the role.

CONCLUSION

While the funding of such projects is advantageous, it should be carefully and generously considered how much time is required if the project is to succeed so that lack of time to complete the role does not become a barrier to successful completion.

A translational research framework for nurse practitioners

AIMS

This study aims to explore a proposed translational research continuum for nurse practitioners.

BACKGROUND

Nurse practitioners are acknowledged as clinical leaders responsible for transforming health care delivery. It is important that nurse practitioners contribute to health care knowledge using scientific processes for the implementation of evidence-based practice and evaluation of outcomes of interventions for their patient groups.

EVALUATION

This paper provides a review of translational research literature including implementation science to align nurse practitioner activities to a modified translational research framework.

KEY ISSUES

A translational research framework has the potential to strengthen nursing research in the nurse practitioner role. Adapting an accepted translational research continuum for nurse practitioners places the clinical nursing leaders in an equitable research position with all health care professionals.

IMPLICATIONS FOR NURSING MANAGEMENT

The translational research continuum provides nursing management with a structure to benchmark nursing research. The continuum applies a modern research framework to support research engagement for the nurse practitioner role.

Second-order problem solving: Nurses' perspectives on learning from near misses

OBJECTIVES

Near misses happen more frequently than actual errors, and highlight system vulnerabilities without causing any harm, thus provide a safe space for organizational learning. Second-order problem solving behavior offers a new perspective to better understand how nurses promote learning from near misses to improve organizational outcomes. This study aimed to explore frontline nurses' perspectives on using second-order problem solving behavior in learning from near misses to improve patient safety.

METHODS

A qualitative exploratory study design was employed. This study was conducted in three tertiary hospitals in east China from June to November 2015. Purposive sampling was used to recruit 19 frontline nurses. Semi-structured interviews and a qualitative directed content analysis was undertaken using Crossan's 4I Framework of Organizational Learning as a coding framework.

RESULTS

Second-order problem solving behavior, based on the 4I Framework of Organizational Learning, was referred to as being a leader in exposing near misses, pushing forward the cause analysis within limited capacity, balancing the active and passive role during improvement project, and promoting the continuous improvement with passion while feeling low-powered.

CONCLUSIONS

4I Framework of Organizational Learning can be an underlying guide to enrich frontline nurses' role in promoting organizations to learn from near misses. In this study, nurses displayed their pivotal role in organizational learning from near misses by using second-order problem solving. However, additional knowledge, skills, and support are needed to maximize the application of second-order problem solving behavior when near misses are recognized.

Game-Based Quality Improvement Teaching: Using Taters in Nursing Education

BACKGROUND

Quality improvement (QI) is difficult to teach in the classroom; therefore, nursing students are often under-prepared to participate in such projects after graduation. The Plan-Do-Study-Act method is commonplace in QI instruction and is often used in nursing. This study proposed and evaluated a gameful learning approach to improve understanding and engagement of a QI process using Potato Head figures.

METHOD

An observational design was utilized. Following classroom activity, students self-selected to join focus groups to discuss gameful learning experiences in learning QI techniques. Transcripts were analyzed using thematic analysis.

RESULTS

Overall, learners found the activity was effective in teaching QI. Positive and negative themes were identified, including fun and competitive, interactive and communication, and teamwork; disconnection between QI topic and game, and unclear instruction, respectively.

CONCLUSION

Using gameful learning helped students understand and engage with QI projects that may translate to clinical practice for new graduate nurses. [J Nurs Educ. 2021;60(10):590-593.].

Thirst for change in a challenging environment: healthcare providers' perceptions of safety culture in a large Irish teaching hospital

BACKGROUND

The Irish healthcare system is currently recognised as being understaffed and under-resourced due to historic underfunding and the aftermath of the 2008 global financial crisis. This descriptive study investigated healthcare providers' perceptions of the safety culture in a large Irish teaching hospital.

AIM

The aim of this study was to investigate healthcare workers' perceptions of the safety culture in a large Irish teaching hospital in a climate of national under-resourcing of healthcare.

METHODS

Seventeen semi-structured interviews were carried out with patient-attending staff between February and June 2019. Interviews were transcribed verbatim and analysed using thematic analysis.

RESULTS

Two predominant themes emerged from the interviews: (1) challenging environment and (2) thirst for change. Study participants described the poor working conditions in the hospital, but also recognised the importance of teamwork and communication in maintaining patient safety and had a strong appetite for change regarding the safety culture in the hospital.

CONCLUSION

This study highlights the complex relationship between working conditions and safety culture. Hospital staff were committed to providing the best possible care for their patients but struggled to provide safe care in a challenging work environment. A clear appetite for change was identified amongst HCPs regarding patient safety culture in Irish healthcare.

Exploring the usability of the COM-B model and Theoretical Domains Framework (TDF) to define the helpers of and hindrances to evidence-based practice in midwifery

Background

Despite the advancement of scientific research in the field of maternity care, midwives face challenges translating latest evidence into evidence-based practice (EBP) and express reticence towards leading practice change in clinical areas. This study aimed to explore midwifery leaders’ views on what factors help or hinder midwives’ efforts to translate latest evidence into everyday practice and consider them in relation to both the Capability, Opportunity, Motivation and Behaviour (COM-B) model and Theoretical Domains Framework (TDF).

Methods

This qualitative study formed part of a larger action research (AR) project that was designed to improve midwives’ EBP implementation capability. Data were obtained from eight Western Australian midwifery leaders who were employed in either managerial or executive positions within their organisation. Five midwives attended a focus group workshop and three opted for face-to-face interviews. Thematic analysis was used to code the transcribed data and group alike findings into sub-categories, which were collapsed to four major categories and one overarching core finding. These were mapped to a matrix combining the COM-B and TDF to establish the usability of these tools in midwifery contexts.

Results

Four major categories were developed from the data collected in this study. Three reported the hindrances midwives’ experienced when trying to initiate new EBPs: ‘For midwives, medical opposition and workplace culture are the biggest challenges’, ‘Fear can stop change: it’s personal for midwives’ and ‘Midwives are tired of fighting the battle for EBP; they need knowledge and the confidence to bring about practice change.’ The other major category highlighted factors midwives’ considered helpers of EBP: ‘Having stakeholder buy-in and strong midwifery leadership is a huge advantage.’ When mapped to the TDF and COM-B, these findings provided valuable insight into the helpers of and hindrances to evidence-based practice in midwifery.

Conclusion

Midwives are motivated to initiate evidence-based change yet have limited knowledge of implementation processes or the confidence to lead practice change. Factors such as inter-disciplinary buy-in, clear instruction for midwives and support from midwifery leaders were considered beneficial to implementing practice change in clinical areas. The TDF when used in combination with the COM-B was deemed useful to midwives wanting to lead practice change projects in clinical areas.

Assessment and analysis of patient safety competency of Chinese nurses with associate degrees: A cross-sectional study

Aim

To analyse the patient safety competency (PSC) of Chinese nurses with associate degrees (ADNs) and explore factors.

Design

A cross-sectional study.

Methods

A convenience sample of 451 ADNs working in 18 hospitals located in Chongqing city of China was investigated using the Patient Safety Competency Nurse Evaluation Scale (PSCNES). Descriptive and inferential statistics were used to analyse the data.

Results

ADNs had a moderate level of PSC. In terms of the six dimensions of PSC, ADNs performed well in clinical practice and safety risk management, while they performed poorly in patient-centred care and patient safety culture. Statistically significant differences were reported in two items. Firstly, ADNs who have participated in patient safety training had a higher level in all dimensions of PSC than those who have not participated in related training. Secondly, ADNs without professional titles had a higher level of patient safety culture than those with professional titles.

An integrative review to identify evidence of nurse practitioner-led changes to health-care delivery and the outcomes of such changes

AIMS

This study aimed to identify evidence of nurse practitioner-led changes to health-care delivery and the outcomes of such changes.

BACKGROUND

Changing health-care delivery is synonymous with the nurse practitioner role. The literature is critical of the lack of research by nurse practitioners, reporting the effects of a change to health-care delivery.

DESIGN

This study used a systematic integrative review by using Torraco's approach.

DATA SOURCES

Databases Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Web of Science and SCOPUS were searched for peer-reviewed publications from 2000 to 2019.

REVIEW METHODS

A systematic approach was used to screen and analyse the literature. Inclusion/exclusion criteria were applied, and quality appraisal was undertaken by two reviewers.

RESULTS

Eighteen articles were selected. The research projects were across the community and acute care settings. Research methodologies varied including preintervention and postintervention studies, evaluation of quality improvement projects, randomized controlled trial and descriptive studies. Multiple data collection tools were used. Two major themes were identified including evidence-based practice champions and improved patient outcomes.

CONCLUSION

The nurse practitioner role is pertinent toward improving evidence-based practice in clinical settings. Positive patient outcomes and praise for clinical leadership are evident in the literature. Research by nurse practitioners to date has focused on individual services.

A survey identifying leadership and research activities among Nurse Practitioners

Background: Nurse Practitioners are identified as the ideal conduit to transform healthcare delivery internationally. Healthcare transformation requires the application of leadership and research skills. Current literature has limited information on NPs as leaders or researchers in the nursing profession.Objectives: Determine if Nurse Practitioners identify themselves as leaders in nursing. Identify the leadership and research activities and influencing characteristics of Nurse Practitioners in Ireland and Australia. Establish similarities in leadership and research activities between Nurse Practitioners in Ireland and Australia. To identify if there is a relationship between leadership and research activities.Design: A quantitative electronic survey.Methods: A survey instrument was developed by combining two previously validated instruments. Nurse Practitioners in Ireland or Australia that had practiced within the last five years, and members of the respective professional association were included. Descriptive statistics were used to describe the findings and explore relationships in the data.Results: 14% (n = 96) of Nurse Practitioners responded to the survey. Nurse Practitioners in Ireland and Australia identified themselves as leaders of the nursing profession. Nurse Practitioners work practices, leadership and research activities are similar in Ireland and Australia. The majority (n = 55, 57%), of participants reported being research active. There was an association between perceived leadership and research activities among participants.Conclusion: Nurse Practitioners in both Ireland and Australia identify themselves as leaders of the nursing profession. There is no difference in reported work practices, leadership or research activities of Nurse Practitioners in both Ireland and Australia. There is an association between perceived leadership and research activity.Impact Statement: Nurse Practitioners in Ireland and Australia percieved themselves as leaders in nursing and this perception increases with research activity.

Perspectives and experiences of Chinese nurses on quality improvement initiatives: A mixed-methods study

AIM

To investigate Chinese nurses' views and experiences in relation to quality improvement implementation, as well as to determine the impact of contextual factors on nursing quality improvement initiatives.

BACKGROUND

Nurses play a major role in carrying out quality improvement initiatives. Contextual factors influence the implementation and success of quality improvement initiatives. Studies that investigated the impact of contextual factors on Chinese nurses' practice in quality improvement remain limited.

METHODS

A sequential explanatory mixed-methods design was used for this study. A quantitative cross-sectional survey was used to assess the context of quality improvement initiatives. Simple random sampling was used to recruit quality improvement teams. The sample included 356 nurses from tertiary teaching hospitals; 291 (81.7%) of them completed questionnaires. Nursing managers and nurses (n = 18) were purposively selected to participate in semi-structured interviews; their experiences and perceptions regarding the contextual factors of quality improvement initiatives were obtained.

RESULTS

In the quantitative phase, the "microsystem" (mean=5.24) and "QI team" (mean = 4.97) contexts were reported as supportive contexts. The organizational context was weak, with a mean score of 3.92. In the qualitative phase, three themes related to the contextual challenges emerged: (1) nurses' attitudes and satisfaction, (2) team efficacy, and (3) organizational infrastructure and culture.

CONCLUSIONS

Efforts to elevate organizational culture and reward systems are needed in Chinese hospitals. Further education aimed at increasing skills and knowledge should be provided, to ensure effective quality improvement implementation.

IMPLICATIONS FOR NURSING MANAGEMENT

During quality improvement initiatives, management tasks should focus on increasing nurses' satisfaction, solving skill and knowledge deficits, and clarifying nurses' roles in relation to quality improvement.

Perceptions and experiences of nurses involved in quality-improvement processes in acute healthcare facilities: a qualitative systematic review protocol

OBJECTIVE

The objective of this review is to understand the perceptions of nurses working in acute healthcare environments in relation to quality-improvement processes.

INTRODUCTION

Quality improvement requirements and processes are firmly embedded in contemporary healthcare practice; however, the evidence is unclear on the extent to which nurses are engaged across the continuum of quality improvement. Nurses are required to consult these processes, but clinical nurses in particular may have limited input into the planning and implementation of quality improvement.

INCLUSION CRITERIA

The population to be reviewed is nurses working in acute healthcare settings. The phenomena of interest is the perceptions and experiences of these nurses in relation to quality-improvement processes.

METHODS

A defined search strategy will be used. PubMed, CINAHL, Embase, and SCOPUS will be searched. Informit, MedNar, and ProQuest will be searched to identify gray literature. The search will be limited to studies published in English. No date limits will be set. After screening the titles and abstracts of identified citations, potentially relevant studies will be retrieved in full. The review will be conducted following the JBI methodology for qualitative evidence. The JBI process of meta-aggregation will be used to identify categories and synthesize findings. The ConQual approach will be used to assess confidence in the findings. Synthesis of the data will be presented in a table with accompanying narrative.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42019146833.

Perceptions of inpatients and nurses towards the importance of nurses' caring behaviours in rehabilitation: A comparative study

AIMS

This study was conducted to describe and compare nurses' and inpatients' perceptions of caring attitudes and behaviours in rehabilitation.

METHODS

A comparative descriptive design was used. Perceptions of caring attitudes and behaviours were compared between 34 nurses working in rehabilitation and 64 elderly patients, using the Caring Nurse Patient Inventory-23, to explore Watson's carative factors through four dimensions. Patients' and nurses' ratings of importance for each dimension were compared. The study data were collected from 8 November 2017 to 5 May 2018.

RESULTS

Patients' and nurses' responses showed high scores in terms of their perceptions of caring, with nurses having the higher scores, and significant differences were found between patients and nurses. Patients scored items linked to clinical aspects of caring as the most important, whereas nurses scored items linked to humanistic and clinical caring as equally important. Comfort care was considered important for nurses and patients. Both groups considered relational caring items as the least important.

CONCLUSION

Results show that patients and nurses value clinical aspects of care, which is the visible aspect of care. The Caring Nurse Patient Inventory-23 is a reliable instrument to measure the nurses' and patients' perception of caring behaviours in rehabilitation.

Newly graduated nurses' clinical competencies and need for further training in acute care hospitals

AIM

To assess self-reported clinical competence and the need for further training among newly graduated registered nurses (NGRNs) working in Swedish acute care hospital settings.

BACKGROUND

NGRNs are expected to take full responsibility for patients' nursing care in an increasingly complex clinical context, and professional nurses' clinical competence is critical in providing high-quality and safe nursing care.

DESIGN

A cross-sectional design.

METHODS

Data were collected using the 50-item ProffNurse SAS II. A total of 85 NGRNs who had recently commenced working with direct patient care at three hospitals in central Sweden participated in the study. The response rate was 69%. The STROBE cross-sectional reporting guidelines were used.

RESULTS

The NGRNs assessed their clinical competence as being highest in areas relating to team collaboration and ethics and lowest in areas relating to professional development and direct clinical practice. The need for further training was greatest in areas such as direct clinical practice and patient safety and lowest in areas such as team collaborating and ethics.

CONCLUSION

The use of instruments to identify NGRNs' self-assessed clinical competence is of value when designing and evaluating introductory programmes for NGRNs taking on positions in acute care hospital settings. The availability of experienced nurses from whom NGRNs can gain clinical competence and learn from is of importance, both from the perspective of the NGRNs themselves and patient safety.

RELEVANCE TO CLINICAL PRACTICE

An understanding of NGRNs' clinical competence and their need for further training may assist in both planning and organising nursing programmes and in making clinical policy decisions when designing introduction programmes in acute care settings.