Planned change or emergent change implementation approach and nurses' professional clinical autonomy

Intensive Care Unit Nurses' Professional Autonomy: A Scoping Review

Intensive care unit (ICU) nurses' professional autonomy is a critical factor affecting their ability to sustainably provide high-quality care to patients who are critically ill and to their families. However, in the absence of a systematic or scoping review of ICU nurses' professional autonomy, limited information and evidence are available on this topic. The aim of this scoping review was to clarify the extent and type of evidence on ICU nurses' professional autonomy. This scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. The following research questions were addressed: (1) Which areas of interest and trends regarding ICU nurses' professional autonomy have been explored in studies published in scientific journals? And (2) What is known about ICU nurses' professional autonomy? The data sources included MEDLINE, CINAHL Ultimate, PsycINFO, Cochrane Library, and Ichushi-Web of the Japan Medical Abstracts Society databases. Identified studies were mapped based on their aim, design, methodology, and key findings and categorized according to their focus areas. Of the 734 identified studies, 16 were analyzed. The identified categories were as follows: "relationship between professional autonomy and mental issues," "experiences and processes of exercising professional autonomy," "relationship between professional autonomy and nurse-physician collaboration," "relationship between professional autonomy and demographic characteristics," "concept of professional autonomy," "barriers to professional autonomy," and "team approach to improve professional autonomy." Most studies have focused on the relationship between professional autonomy and mental health issues and nurse-physician collaboration and few included interventions to enable or promote the exercise of professional autonomy, highlighting a research gap. Future research should identify factors that inhibit the professional autonomy of ICU nurses and that can be changed through interventions and should develop educational and organizational change-based interventions to modify the factors.

Professional autonomy in nursing: An integrative review

AIM

To summarize knowledge of professional autonomy in nursing.

BACKGROUND

Professional autonomy is associated with experienced meaningfulness of the work. This refers to participation in decision-making and the ability to influence working practices.

EVALUATION

In an integrative review, relevant studies were retrieved from four databases. Quality was systematically evaluated using critical appraisal tools. PRISMA guidelines were followed. Inductive content analysis was used to analyse current knowledge of the focal subject.

KEY ISSUES

The search identified 27 relevant studies published between 2000 and 2019. Elements describing nurses' professional autonomy were independence in decision-making and ability to utilize one's own competence. Themes relating to nurses' professional autonomy were shared leadership, professional skills, inter- and intra-professional collaboration and healthy work environment.

CONCLUSION

Understanding the multidimensional nature of professional autonomy is essential to create attractive work environments. It is important to enable nurses to participate in decision-making and develop nursing through shared leadership to enhance the recruitment and retention of a skilled workforce.

IMPLICATIONS FOR NURSING MANAGEMENT

The findings have anticipated utility for supporting nursing practice and nurse leaders' understanding of approaches to foster nurses' professional autonomy.

An Evidence-Based Approach to Increasing Nurses' Publication Rates

BACKGROUND

Writing for publication in peer-reviewed journals is one of the most important types of writing that nurses engage in. It is essential for advancing the nursing profession, health care organizations, and individual nurses. Despite its importance, however, the rate of publication remains very low among nurses. At one large academic medical center, a baseline assessment of dissemination practices found a low publication rate. To address this, an evidence-based writing-for-publication program was designed to support professional dissemination of scholarly work.

METHODS

A 12-week workshop was designed and writers were matched with a mentor. The workshop started with a four-hour kickoff session on the process of getting published, including choosing a journal, querying an editor, drafting a manuscript, and working with coauthors. Participants also began developing an outline for their manuscript. Drafts were due to the mentor every four weeks for editing and feedback. At the end of the 12 weeks a wrap-up session was held for participants to read each other's manuscripts and give peer feedback.

OUTCOMES

As of this writing, five cohorts have completed the program, and 89 nurses participated. Twenty-nine manuscripts were completed and submitted to peer-reviewed journals; of these, 22 (76%) were accepted, four (14%) are still under review, and three (10%) were recommended for submission to a different journal. Among the 89 nurse participants, 84% reported being likely or very likely to write for publication again, and 96% reported improvement in their writing skills.

CONCLUSIONS

Without more nurses acquiring the skills to engage in writing for publication, the body of advancing knowledge that drives clinical decision-making may wane as aging, experienced nurse authors leave the profession. To protect the future of nursing, a continuous commitment to developing nurse authors across all generations is necessary. Nursing leaders and health care organizations must commit to ensuring novice nurse authors are provided with the resources to engage in disseminating knowledge.

Representaciones sociales de la autonomía profesional de los (as) enfermeros (as) en el quirófano

Introducción: La autonomía profesional en enfermería se presenta como un tema complejo y de poca visibilidad, especialmente en sectores que demandan acciones de gran complejidad como en el quirófano. Objetivo: Analizar las representaciones sociales elaboradas por las enfermeras sobre su autonomía profesional en el quirófano. Materiales y Métodos: Estudio descriptivo y exploratorio de enfoque cualitativo, desarrollado con el apoyo teórico de la Teoría de las Representaciones Sociales. Nueve enfermeros que trabajan en la sala de operaciones de un hospital universitario en el estado de Río de Janeiro participaron en el estudio. La recopilación de datos tuvo lugar entre junio y octubre de 2017 a través de una entrevista semiestructurada. Los datos fueron sometidos a análisis temáticos. Resultados: Del análisis de datos surgieron las siguientes categorías: la autonomía profesional de la enfermera del quirófano: conocimiento, libertad de acción y poder de decisión; los límites para la autonomía profesional de la enfermera en sala de cirugía: relaciones jerárquicas y de poder, y conocimiento. Discusión: La autonomía profesional de las enfermeras en el quirófano es un objeto de representación con diferentes dimensiones, una cognitiva y una práctica, la primera de las cuales se basa esencialmente en el conocimiento técnico-científico, y la segunda en la libertad de acción y el poder de decisión necesario para el pleno ejercicio de autonomía. Conclusiones: La autonomía profesional de las enfermeras es un objeto de representación social, ya que es un cuerpo generador de conocimiento, saberes, reflexión e identidad profesional capaz de despertar actitudes y prácticas. Como citar este artigo: Milosky JP, Silva ACSS, Gomes AMT, Góes FGB, Knupp VMAO, Silva MVG. Representações sociais da autonomia profissional do enfermeiro no centro cirúrgico. Rev Cuid. 2020; 11(1): e849. http://dx.doi.org/10.15649/cuidarte.849

Organizational learning in hospitals: A realist review

AIM

To establish a middle-range theory of organizational learning in hospitals.

DESIGN

A realist review of the literature, conducted according to established standards for realist and meta-narrative evidence syntheses. Middle-range theory development was performed according to Smith and Liehr's recommendations.

DATA SOURCES

Two comprehensive scientific databases and six discipline-focused databases spanning health care, life sciences, business, sociology, and psychology were searched from inception to 12 May 2016.

REVIEW METHODS

Citations meeting the inclusion criteria were appraised using the Mixed Methods Appraisal Tool. Data extraction was guided by a focus on the contextual factors, mechanisms, and outcomes associated with organizational learning.

RESULTS

The initial search yielded 2,332 citations, 147 of which were ultimately included in the review. The included citations were generally of high quality. Reviewed evidence indicates certain aspects of organizational context can be conducive to mechanisms of organizational learning, leading to a range of positive organizational outcomes.

CONCLUSION

This review updates and expands on a previous review of the literature on organizational learning in hospitals, refines the concept of organizational learning in hospitals, and provides a middle-range theory of organizational learning in hospitals.

IMPACT

This updated review provides a strong evidence base for future work on the topic of organizational learning in hospitals. The refined concept of organizational learning makes it possible to develop reliable, valid research instruments that better reflect of the full scope of organizational learning. Finally, the middle-range theory guides researchers and clinical leaders as they advance the science and practice of organizational learning.

Innovation Implementation in the Context of Hospital QI: Lessons Learned and Strategies for Success

In 1999, the Institute of Medicine reported that 98,000 people die each year due to medical errors. In the following years, the focus on hospital quality was intensified nationally, with policymakers providing evidence-based practice guidelines for improving health care quality. However, these innovations (evidence-based guidelines) that were being produced at policy levels were not translating to clinical practice at the hospital organizational level easily, and stark variations continued to persist, in the quality of health care. Circa 2009, nearly a decade after the release of the IOM report, the health care organizational literature began referring to this challenge as "innovation implementation failure" in health care organizations (HCOs), ie, failure to implement an evidence-based practice that is new to a HCO. This stream of literature drew upon management research to explain why innovation implementation failure occurs in HCOs and what could be done to prevent it. This paper conducts an integrative review of the literature on "innovation implementation" in hospitals and health systems over the last decade, since the spotlight was cast on "innovation implementation failure" in HCOs. The review reveals that while some studies have retrospectively sought to identify the key drivers of innovation implementation, through surveys and interviews of practitioners (the "what"), other studies have prospectively sought to understand how innovation implementation occurs in hospitals and health systems (the "how"). Both make distinctive contributions to identifying strategies for success in innovation implementation. While retrospective studies have helped identify the key drivers of innovation implementation, prospective studies have shed light on how these drivers could be attained, thereby helping to develop context-sensitive management strategies for success. The literature has called for more prospective research on the implementation and sustainability of health care innovations. This paper summarizes the lessons learned from the literature, discusses the relevance of management research on innovation implementation in HCOs, and identifies future research avenues.