The impact of evidence-based nursing leadership in healthcare settings: a mixed methods systematic review

BACKGROUND

The central component in impactful healthcare decisions is evidence. Understanding how nurse leaders use evidence in their own managerial decision making is still limited. This mixed methods systematic review aimed to examine how evidence is used to solve leadership problems and to describe the measured and perceived effects of evidence-based leadership on nurse leaders and their performance, organizational, and clinical outcomes.

METHODS

We included articles using any type of research design. We referred nurses, nurse managers or other nursing staff working in a healthcare context when they attempt to influence the behavior of individuals or a group in an organization using an evidence-based approach. Seven databases were searched until 11 November 2021. JBI Critical Appraisal Checklist for Quasi-experimental studies, JBI Critical Appraisal Checklist for Case Series, Mixed Methods Appraisal Tool were used to evaluate the Risk of bias in quasi-experimental studies, case series, mixed methods studies, respectively. The JBI approach to mixed methods systematic reviews was followed, and a parallel-results convergent approach to synthesis and integration was adopted.

RESULTS

Thirty-one publications were eligible for the analysis: case series (n = 27), mixed methods studies (n = 3) and quasi-experimental studies (n = 1). All studies were included regardless of methodological quality. Leadership problems were related to the implementation of knowledge into practice, the quality of nursing care and the resource availability. Organizational data was used in 27 studies to understand leadership problems, scientific evidence from literature was sought in 26 studies, and stakeholders' views were explored in 24 studies. Perceived and measured effects of evidence-based leadership focused on nurses' performance, organizational outcomes, and clinical outcomes. Economic data were not available.

CONCLUSIONS

This is the first systematic review to examine how evidence is used to solve leadership problems and to describe its measured and perceived effects from different sites. Although a variety of perceptions and effects were identified on nurses' performance as well as on organizational and clinical outcomes, available knowledge concerning evidence-based leadership is currently insufficient. Therefore, more high-quality research and clinical trial designs are still needed.

TRAIL REGISTRATION

The study was registered (PROSPERO CRD42021259624).

Factors Influencing Older Persons' Transitions to Facility-Based Care Settings: A Scoping Review

BACKGROUND AND OBJECTIVES

Older adults (≥65 years) are living longer with complex health needs and wish to remain at home as their care needs change. We aimed to determine which factors influence older persons' transitions from home living to facility-based care (FBC) settings such as long-term care facilities or assisted living.

RESEARCH DESIGN AND METHODS

Through a scoping review of 7 databases, we considered all academic literature examining factors influencing transitions from home living to FBC. Only English articles were reviewed. Based on the Meleis' Health Transition (MHT) model, we categorized findings into: (a) transition conditions; (b) patterns of response; and (c) health services and interventions.

RESULTS

We included 204 unique studies. Age, cognitive/functional impairments, and caregiver burden were the most consistent risk factors for older persons' transitions to FBC. Caregiver burden was the only consistent risk factor in both quantitative and qualitative literature. Other factors around health service use or nonmedical factors were examined in a small number of studies, or demonstrated mixed or nonsignificant results. Key research gaps relate to transitions to intermediate levels of FBC, research in public health systems, and research employing qualitative and interventional methods.

DISCUSSION AND IMPLICATIONS

We expanded the MHT model to capture informal caregivers and their critical role in transitions from home to FBC settings. More research is needed to address practical needs of clients and caregivers while at home, and self-directed care funding models could be expanded. Theory-driven interventional research focusing on caregivers and successful hospital discharge is critically needed.

Developing Framework and Strategies for Capacity Building to Apply Evidence-Informed Health Policy-Making in Iran: Mixed Methods Study of SAHSHA Project

BACKGROUND

SASHA, which stands for "evidence-informed health policy-making (EIHP)" in Persian, is a national project to draw a roadmap for strengthening EIHP in Iran. As a part of SASHA, this research aimed to develop evidence-based and context-aware policy options for increasing the capacity of decision-makers to apply EIHP in Iran.

METHODS

This was a qualitative study, which was informed by a literature review of pull efforts' capacity building programs. Based on the review, we developed policy options and validated them through an expert panel that involved twelve experts. Data were analyzed using a content analysis method.

RESULTS

We extracted data from 11 articles. The objectives of capacity building programs were: single-skill development, personal/professional development, and organizational development. According to these objectives, the contents and training methods of the programs vary. Capacity building programs have shown positive impacts on individual knowledge/attitudes to use EIHP. However, the impacts of programs at the organizational or the health system level remain under-researched. We followed several threads from the literature review through to the expert panel that included training the management team, instead of training managers, training for problem-solving skills, and designing tailored programs. Barriers of capacity building for EIHP regard the context of the health system (weak accountability and the widespread conflict of interest) and healthcare organizational structures (decision support systems, knowledge management infrastructures, and lack of management team). Experts suggested interventions on the barriers, particularly on resolving the conflict of interests before launching new programs. A proposed framework to increase the capacity of health policy-makers incorporates strategies at three levels: capacity building program, organizational structure, and health system context.

CONCLUSION

To prepare the context of Iranian healthcare organizations for capacity building programs, the conflict of interests needs to be resolved, decision-makers should be made more accountable, and healthcare organizations need to provide more knowledge management infrastructures and decision support systems.

Facilitating the planning and evaluation of narrative intervention reviews: Systematic Transparency Assessment in Intervention Reviews (STAIR)

Narrative reviews offer a flexible way to report intervention results and comprise the majority of reviews published in top medical journals. However variations in their transparency pose evaluation challenges, compromising their value and potentially resulting in research wastage. Calls have been made to reduce the number of narrative reviews published. Others argue narrative reviews provide an important platform and should even be placed on an equal footing to systematic reviews. We believe narrative intervention reviews can provide a vital perspective when transparent, and thus support Systematic Transparency Assessment in Intervention Reviews (STAIR). This research evaluates the transparency of 172 health-related narrative and literature reviews (K = 172), by assessing how they communicate information about the interventions they review. Eight points supporting transparency, relating to sample sizes, traceability, article numbers, and references, were assessed. Half of the reviews reported on at least four of the eight points, but 24% reported on none. Only 56% of the reviews clearly communicated full references. The STAIR* (Sample sizes, Traceability, Article numbers, Intervention numbers, References*) checklist comprises five sections, and nine points. It is proposed as a convenient tool to address STAIR and complement existing review guidelines to assist authors in planning, reviewers in evaluating, and scholars in utilising narrative reviews. The objectives of STAIR* are to: 1) encourage narrative review transparency and readability, 2) facilitate the incorporation of narrative reviews results into other research; and 3) enrich narrative review methodology with a checklist to guide, and evaluate, intervention reviews.

RESONANT LEADERSHIP PRACTICES OF NURSE MANAGERS IN THE HOSPITAL SETTING: A CROSS-SECTIONAL STUDY

ABSTRACT Objective: analyze Resonant Leadership style among the nurse managers from the perspective of nurse managers and nurses. Methods: cross-sectional study, carried out in a hospital in Guyana. Participants were 171 registered nurses and nurse managers. Data were collected from July to October 2020 using Resonant Leadership scale and a socio demographic questionnaire. Results: in self-version, the total leadership rating was 38.9 for nurses and 41.6 for managers (p=0.003). The age category at most 30 are more likely to give a low rating of themselves than the age category 50 - 69 (p = 0.046). Managers scored on average 3.44 points more than nurses for the self total leadership rating. Conclusion: resonant leadership is practiced at a moderate level and managers have higher scores. Nurse Managers can improve their leadership style.

Assessing the impact of knowledge communication and dissemination strategies targeted at health policy-makers and managers: an overview of systematic reviews

Background

The use of research evidence as an input for health decision-making is a need for most health systems. There are a number of approaches for promoting evidence use at different levels of the health system, but knowledge of their effectiveness is still scarce. The objective of this overview was to evaluate the effectiveness of knowledge communication and dissemination interventions, strategies or approaches targeting policy-makers and health managers.

Methods

This overview of systematic reviews used systematic review methods and was conducted according to a predefined and published protocol. A comprehensive electronic search of 13 databases and a manual search in four websites were conducted. Both published and unpublished reviews in English, Spanish or Portuguese were included. A narrative synthesis was undertaken, and effectiveness statements were developed, informed by the evidence identified.

Results

We included 27 systematic reviews. Three studies included only a communication strategy, while eight only included dissemination strategies, and the remaining 16 included both. None of the selected reviews provided “sufficient evidence” for any of the strategies, while four provided some evidence for three communication and four dissemination strategies. Regarding communication strategies, the use of tailored and targeted messages seemed to successfully lead to changes in the decision-making practices of the target audience. Regarding dissemination strategies, interventions that aimed at improving only the reach of evidence did not have an impact on its use in decisions, while interventions aimed at enhancing users’ ability to use and apply evidence had a positive effect on decision-making processes. Multifaceted dissemination strategies also demonstrated the potential for changing knowledge about evidence but not its implementation in decision-making.

Conclusions

There is limited evidence regarding the effectiveness of interventions targeting health managers and policy-makers, as well as the mechanisms required for achieving impact. More studies are needed that are informed by theoretical frameworks or specific tools and using robust methods, standardized outcome measures and clear descriptions of the interventions. We found that passive communication increased access to evidence but had no effect on uptake. Some evidence indicated that the use of targeted messages, knowledge-brokering and user training was effective in promoting evidence use by managers and policy-makers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12961-021-00780-4.

Measured and perceived impacts of evidence-based leadership in nursing: a mixed-methods systematic review protocol

INTRODUCTION

Despite the abundance of existing literature on evidence-based nursing practice, knowledge regarding evidence-based leadership, that is, leadership supported by an evidence-based approach, is lacking. Our aim is to conduct a mixed-methods systematic review with qualitative and quantitative studies to examine how evidence is used to solve leadership problems and to describe the measured and perceived effects of evidence-based leadership on nurses and nurse leaders and their performance as well as on organisational and clinical outcomes.

METHODS AND ANALYSIS

We will search the following databases with no year limit or language restrictions: CINAHL (EBSCO), Cochrane Library, Embase (Elsevier), PsycINFO (EBSCO), PubMed (MEDLINE), Scopus (Elsevier) and Web of Science. In addition, the databases for prospectively registered trials and other systematic reviews will be screened. We will include articles using any type of research design as long as the study includes a component of an evidence-based leadership approach. Three reviewers will independently screen all titles, abstracts and full-text articles and two reviewers will extract the data according to the appropriate checklists. The quality of each study will be appraised using specific appraisal tool fitting in study design used in each study. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) grid, PRISMA Protocols, Synthesis Without Meta-analysis and ENTREQ will guide the study process and reporting. Outcomes related to individual or group performance of nurses or nurse managers regarding leadership skills (e.g., communication skills), organisational outcomes (e.g., work environment, costs) and clinical outcomes (e.g., patient quality of life, treatment satisfaction) will be extracted and synthesised.

ETHICS AND DISSEMINATION

This systematic review will not include empirical data, and therefore, ethics approval will not be sought. The results of the review will be disseminated in a peer-reviewed scientific journal and in a conference presentation.

PROSPERO REGISTRATION NUMBER

CRD42021259624.

Quality Indicators for Older Persons' Transitions in Care: A Systematic Review and Delphi Process

We identified quality indicators (QIs) for care during transitions of older persons (≥ 65 years of age). Through systematic literature review, we catalogued QIs related to older persons' transitions in care among continuing care settings and between continuing care and acute care settings and back. Through two Delphi survey rounds, experts ranked relevance, feasibility, and scientific soundness of QIs. A steering committee reviewed QIs for their feasible capture in Canadian administrative databases. Our search yielded 326 QIs from 53 sources. A final set of 38 feasible indicators to measure in current practice was included. The highest proportions of indicators were for the emergency department (47%) and the Institute of Medicine (IOM) quality domain of effectiveness (39.5%). Most feasible indicators were outcome indicators. Our work highlights a lack of standardized transition QI development in practice, and the limitations of current free-text documentation systems in capturing relevant and consistent data.

Mini-Review on Capacity-Building for Data-Driven Early Childhood Systems: The Consortium for Pre-primary Data and Measurement in Sub-Saharan Africa

Low- and middle-income countries (LMIC) are increasing investments in early childhood development programs, including early childhood education. As programs reach scale, there is increasing demand for evidence on impacts of investments. Little work to date has examined capacity required to effectively use data at scale in LMIC, including opportunities and barriers to integrating data into ongoing program implementation and tracking child development and quality of services at scale. Below, we outline the rationale and approach of the Consortium for Pre-primary Data and Measurement in Sub-Saharan Africa, focused on building capacity for data-driven decision-making in early childhood systems. Themes from the first phase include the importance of building diverse groups of stakeholders to define priorities for data and measurement, the need for coordinated and strategic investments in data and measurement, and the value of long-term investments in government/civil society/university partnerships to generate locally relevant data on early childhood education.

Determinants of nurse manager job satisfaction: A systematic review

BACKGROUND

Front-line nurse managers provide direct oversight of healthcare delivery to ensure organizational expectations are implemented to achieve optimal patient and staff outcomes. Ensuring the job satisfaction of front-line nurse managers is key to retaining these individuals in their roles. Understanding factors influencing job satisfaction of nurse managers can support the development and implementation of strategies to enhance job satisfaction and sustain retention.

OBJECTIVES

We aimed to systematically review the empirical literature measuring determinants of job satisfaction among nurse managers.

DESIGN

We conducted a systematic review using 11 electronic databases.

DATA SOURCES

Electronic databases included ABI Inform, Academic Search Premier, CINAHL, EMBASE, ERIC, Health Source Nursing, Medline, ProQuest Dissertations and Theses, PsychINFO, and LILACS.

REVIEW METHODS

We included research articles that examined the determinants of job satisfaction for front-line nurse managers. Two research team members independently reviewed and determined inclusion of each study. Each study was appraised independently for quality by two team members. Data extraction was completed for included studies. Content analysis was used to categorize factors associated with job satisfaction of nurse managers.

RESULTS

A total of 5608 articles were screened for inclusion or exclusion. Thirty-eight studies were included. One hundred and one factors influencing nurse manager job satisfaction were reported in the included studies. Factors were grouped into three main categories: job characteristics, organizational characteristics, and personal characteristics. Most factors were examined in single studies or their relationship with job satisfaction was equivocal. However, across these categories, findings included significant positive relationships between autonomy, power, social support among team members and job satisfaction of front-line nurse managers. A significant negative relationship between job stress and nurse manager job satisfaction was indicated in the findings.

CONCLUSIONS

Promoting autonomy, power to make decisions for change, social support, team cohesion, and strategies to reduce job stress may improve job satisfaction of front-line nurse managers. Innovative solutions such as co-management and targeted administrative and electronic resources warrant further investigation. Promoting prosocial group behaviours, team building, coaching and the implementation of wellness programs may improve social support, team cohesion, and wellbeing. Examining factors of nurse managers job satisfaction beyond the acute care setting could provide further insights into the role that the practice environment plays in nurse manager job satisfaction.

TWEETABLE ABSTRACT

Promoting autonomy, power to effect decisions for change, social support, team cohesion, and strategies to reduce job stress are important drivers of job satisfaction of front-line managers.

The Embedded Health Management Academic: A Boundary Spanning Role for Enabling Knowledge Translation Comment on "CIHR Health System Impact Fellows: Reflections on 'Driving Change' Within the Health System"

Healthcare organisations are looking at strategies and activities to improve patient outcomes, beyond clinical interventions. Increasingly, health organisations are investing significant resources in leadership, management and team work training to optimise professional collaboration, shared decision-making and, by extension, high quality services. Embedded clinical academics are a norm in, and considered a strength of, healthcare organisations and universities. Their role contributes, formally and informally, to clinical teaching, knowledge sharing and research. An equivalent, but significantly less common role, addressing the management of healthcare organisations, is the embedded health management academic (EHMA). A stimulus encouraging this intertwined embedded academic role, in both clinical and managerial fields, is the demand for the translation of knowledge between academic and industry contexts. In this essay, we describe the EHMA role, its value, impact and potential for enabling healthcare organisation improvement. Focusing on the business of healthcare, the EHMA is a conduit between sectors, stakeholders and activities, enabling different organisations and experts to co-create, share and embed knowledge. The value and impact achieved is significant and ongoing, through the nurturing of an evidence-based management culture that promotes ongoing continuous improvement and research activities.