Using participatory action research to foster nurse leadership in Australian rural hospitals

Organizational culture, authentic leadership and quality improvement in Canadian healthcare facilities

OBJECTIVE

To investigate relationships among flexible and hierarchical organizational cultures, quality improvement domains, and authentic leadership competencies in Canadian healthcare facilities.

METHOD

Observational cross-sectional study conducted in Alberta, Canada. Nurse managers (n=226) completed a survey including validated measures of organizational culture, quality improvement and authentic leadership. Data were analyzed using descriptive statistics, Spearman's correlation coefficient and Chi-squared test (p<0.05).

RESULTS

Quality improvement through accreditation is related to organizational culture and authentic leadership. We saw a propensity for participants who reported working in a more flexible culture also reported greater quality improvement implementation and authentic leadership practices.

CONCLUSION

This study assessed and reported the relationships between flexible organizational cultures, quality improvement through the accreditation process, and authentic leadership practices of healthcare managers. Flexible organizational cultures influence the adoption of authentic leadership, participatory management model and also improves quality.

NURSING INTERFACES IN RURAL CARE: AN INTEGRATIVE REVIEW

ABSTRACT Objective: to know the issues in evidence in rural nursing. Method: a six-stage integrative review. Data was collected from May to July 2017, in the SciELO, CUIDEN, PubMed, and ScienceDirect databases, with “Rural nursing” as descriptor. The analysis used was qualitative with the construction of subsets and topics. Results: of the 30 articles analyzed, 32% addressed professional training; 25% collective health-related practices; 12% hospital care; 10% job satisfaction; 7% were dedicated to telehealth and 3% of the studies addressed the following topics: nurses' recruitment and permanence in rural areas, continuing education, and professional practice in urgency and emergency regulation centers. Conclusion: working in rural areas demands that nurses face particularities such as isolation, difficulty of access, diverse socioeconomic conditions and specific epidemiological profiles, which influence the professional practice, making it a challenge.

DEVELOPMENT AND VALIDATION OF A LEADERSHIP TRAINING PROGRAM FOR NURSES

ABSTRACT Objectives: To identify strategies that facilitate the development of leadership, correlating them with characterization of variables, and to create and validate a leadership training program for nurses. Method: developed in two phases. First: a cross-sectional study, performed in a general hospital in São Paulo, Brazil. The 70 nurses in the sample had at least three months of work experience in the institution. An instrument was used to collect data with characterization variables (gender, age, postgraduate, work shift and length of working career and contact with the theme of leadership) and collection of suggested strategies to develop more prominent leadership in the literature. Data were collected (February-April 2016) and analyzed descriptively. The Mann-Whitney and Kruskal Wallis tests were used to verify the correlations (p<0.05). Second phase: validation study of the program using the Delphi technique, from March to June 2017. Following the construction of the program, and considering the results obtained in the first phase, judges were selected with the following criteria: to be a nurse, researcher in leadership and nursing administration, with article publications in the last five years and teaching experience. Results: the strategies indicated in the first phase were: performance of experienced leaders as facilitators in the teaching-learning process (the highest scores were given by men; p=0.033) and establishment of partnerships between university and hospital (the largest choice was made by young nurses, p=0.019). In the second phase, a content validity index of 0.81 was reached, considered satisfactory. Conclusion: the program can be applied, and future studies will evaluate its effectiveness.

Collaborating with nurse leaders to develop patient safety practices

Purpose

The organisational level and leadership development are crucial elements in advancing patient safety, because patient safety weaknesses are often caused by system failures. However, little is known about how frontline leader and director teams can be supported to develop patient safety practices. The purpose of this study is to describe the patient safety development process carried out by nursing leaders and directors. The research questions were: how the chosen development areas progressed in six months’ time and how nursing leaders view the participatory development process.

Design/methodology/approach

Participatory action research was used to engage frontline nursing leaders and directors into developing patient safety practices. Semi-structured group interviews (N = 10) were used in data collection at the end of a six-month action cycle, and data were analysed using content analysis.

Findings

The participatory development process enhanced collaboration and gave leaders insights into patient safety as a part of the hospital system and their role in advancing it. The chosen development areas advanced to different extents, with the greatest improvements in those areas with simple guidelines to follow and in which the leaders were most participative. The features of high-reliability organisation were moderately identified in the nursing leaders’ actions and views. For example, acting as a change agent to implement patient safety practices was challenging. Participatory methods can be used to support leaders into advancing patient safety. However, it is important that the participants are familiar with the method, and there are enough facilitators to steer development processes.

Originality/value

Research brings more knowledge of how leaders can increase their effectiveness in advancing patient safety and promoting high-reliability organisation features in the healthcare organisation.

Participants' perceptions of an intervention implemented in an Action Research Nursing Documentation Project

AIMS AND OBJECTIVES

The aim of this study is to describe healthcare professionals' experiences and perceptions of an intervention implemented in an action research project conducted to improve nursing documentation practices in four municipalities in Norway.

BACKGROUND

Documentation of individualized patient care is a continuing concern in healthcare services and could impacts the quality and safety of healthcare. Use of electronic systems has made some aspects of documentation more comprehensive, but creation of an individualized care plan remains a pressing issue.

DESIGN

A qualitative descriptive design was used.

METHODS

An action research project was conducted between 2010-2012 to improve the content and quality of nursing documentation in community healthcare services in four municipalities. One year after the project was completed four focus group interviews were conducted with healthcare professionals, one for each involved municipality. Two unit managers were interviewed individually. Qualitative content analysis was used.

RESULTS

Three themes emerged: healthcare professionals perceived competing interest; they experienced that they had to manage complexity and changes; and they highlighted a clear and visible leader as important for success.

CONCLUSIONS

Quality improvement activities are essential. Healthcare professionals experience a complicated situation when electronic health record systems do not support workflow. Further research is recommended to focus on the functionality and user interface of electronic health record systems, and on the role of leadership when implementing changes in clinical practice.

RELEVANCE TO CLINICAL PRACTICE

Stronger cooperation among policymakers, electronic health record system vendors, and healthcare professionals is essential for improving electronic health record systems and documentation practices. Involvement of end-users in these improvements can make a difference in the way the systems are perceived in the clinical workflow.

Gaps in governance: protective mechanisms used by nurse leaders when policy and practice are misaligned

BACKGROUND

Due to large geographical distances, the telephone is central to enabling rural Australian communities to access care from their local health service. While there is a history of rural nurses providing care via the telephone, it has been a highly controversial practice that is not routinely documented and little is known about how the practice is governed. The lack of knowledge regarding governance extends to the role of Directors of Nursing as clinical leaders charged with the responsibility of ensuring practice safety, quality, regulation and risk management. The purpose of this study was to identify clinical governance processes related to managing telephone presentations, and to explore Directors of Nursing perceptions of processes and clinical practices related to the management of telephone presentations to health services in rural Victoria, Australia.

METHODS

Qualitative documentary analysis and semi structured interviews were used in the study to examine the content of health service policies and explore the perceptions of Directors of Nursing in eight rural health services regarding policy content and enactment when people telephone rural health services for care. Participants were purposively selected for their knowledge and leadership role in governance processes and clinical practice. Data from the interviews were analysed using framework analysis. The process of analysis resulted in the identification of five themes.

RESULTS

The majority of policies reviewed provided little guidance for managing telephone presentations. The Directors of Nursing perceived policy content and enactment to be largely inadequate. When organisational structures failed to provide appropriate governance for the context, the Directors of Nursing engaged in protective mechanisms to support rural nurses who manage telephone presentations.

CONCLUSIONS

Rural Directors of Nursing employed intuitive behaviours to protect rural nurses practicing within a clinical governance context that is inadequate for the complexities of the environment. Protective mechanisms provided indicators of clinical leadership and governance effectiveness, which may assist rural nurse leaders to strengthen quality and safe care by unlocking the potential of intuitive behaviours. Kanter's theory of structural power provides a way of conceptualising these protective mechanisms, illustrating how rural nurse leaders enact power.