Development of an on-job mentorship programme to improve nursing experience for enhanced patient experience of compassionate care

Impact Assessment of Patient Experience Capacity-Building Program Using Kirkpatrick Model for Program Evaluation at a Regional Healthcare System

Introduction

The patient experience (PX) is central to improving the quality of healthcare services. We launched a PX capacity- and capability-building program at the Armed Forces Hospitals Taif Region, which is integral to our regional healthcare cluster transformation plans and is an initial step toward developing a culture of improvement in human experience in healthcare.

Methods

A multidisciplinary PX committee recruited five frontline interprofessional PX heads, one from each of our regional healthcare hospitals. The Kirkpatrick model for program evaluation was used to assess the impact on four key levels: reaction, learning, behavior, and results. A pre-program competency assessment was conducted to evaluate the level of expertise across various PX competencies, and a program curriculum was developed accordingly. Participants underwent an intensive workshop-based PX capacity-building training program. A post-program competency assessment was performed along with a post-program survey. The PX-related activities led by interprofessional frontline PX heads at their respective hospitals' post-programs were tracked. The impact on the regional PX mean score across various settings, including inpatient, outpatient, and emergency settings, was measured using Press Ganey PX surveys. Our work is reported in accordance with the SQUIRE-EDU guidelines of the EQUATOR network.

Results

The PX capacity-building program led to a significant improvement in participants' expertise across various PX competencies. Significant improvements beyond the strategic targets were observed in the PX mean score in inpatient departments pre-program (83.31) vs. post-program (86.34), with a p-value of < 0.001 across the regional healthcare system.

Conclusion

The PX capacity-building program is a first step toward major cultural change amid the healthcare cluster transformation in our regional healthcare system. The Kirkpatrick model helps evaluate the impact of PX capacity- and capability-building training programs comprehensively through an organizational approach. Sustainable improvements in PX over a long period through a capacity-building program alone remain challenging.

Nurse managers' managerial innovation and it's relation to proactivity behavior and locus of control among intensive care nurses

BACKGROUND

The nursing profession is undergoing rapid transformation, requiring innovation in management approaches and proactive behaviors among staff. Nurse Managers play a vital role through managerial innovation, but its impacts on intensive care nurses' proactivity and locus of control remain underexplored.

OBJECTIVES

This study aimed to assess the levels of Nurse Managers' managerial innovation and relate it to proactivity behaviors and locus of control orientations among intensive care nurses.

METHODS

A cross-sectional correlational design was adopted, recruiting 242 intensive care nurses from Tanta University Hospital, Egypt. Participants completed standardized questionnaires measuring perceived managerial innovation, proactivity behavior, and locus of control.

RESULTS

Nurse Managers demonstrated moderately high innovation across all dimensions, especially in continuous learning and development (mean = 4.65) and advanced technology use (mean = 4.56). Nurses exhibited sound proactivity levels, particularly in adaptability (mean = 4.40) and planning (mean = 4.35). The majority of nurses showed an internal locus of control (64.5%). Managerial innovation had significant positive correlations with nurses' proactivity (r = 0.45, p < 0.001) and internal locus of control (r = 0.42, p < 0.001). Regression analysis revealed age, gender, experience, education, and ICU type as significant predictors of proactivity and locus of control.

CONCLUSION

Innovative nursing leadership positively influences staff's proactivity levels and perceived control over their practice. This underscores the vital role of nurse managers in creating empowering environments in intensive care.

Facility managers' experiences of mentorship in a district of Gauteng province, South Africa

Background

Mentoring is recommended as a method to assist nurses in developing their leadership roles. Support and mentorship of nursing managers can yield positive results for their organisations because of the leadership quality. The lack of mentorship programmes for newly appointed facility managers has an impact on the management of the facilities.

Aim

This study aims to explore and describe how facility managers experience mentorship at primary health care (PHC) facilities.

Setting

Participants were drawn from 11 different PHC facilities falling under the three sub-districts: Emfuleni, mid-Vaal and Lesedi.

Methods

A qualitative exploratory and descriptive research design was employed to achieve the study objectives. A non-probability purposive sampling method was used to select the facility managers from three sub-districts; a signed informed consent to participate in the study was obtained from each participant. A semi-structured interview guide was used to interview purposively selected facility managers. The interviews were audio recorded and subsequently transcribed verbatim. Data were analysed using the content analysis method. Rigour was ensured, and ethical principles measures were applied.

Results

Four themes emerged from the results: the experiences on mentorship, views on mentorship, barriers to mentorship and mentorship improvement strategies.

Conclusion

The study found that there was a lack of formal mentoring in the district, and there is a need for benchmarking and the development of a formal mentorship programme.

Contribution

The results could be useful in identifying gaps, making recommendations to nursing management and future research. They could further broaden insight into the mentoring needs of facility managers.

Facilitated engagement approach: A novel approach to guide mentor conversations

BACKGROUND

Mentorship has been recognized as a strategy to develop leadership competencies in clinical leaders and has been integrated into leadership programs. However, there are few published frameworks to guide mentor conversations with mentees training to assume nursing leadership roles.

OBJECTIVE

This study explores mentors' perceptions of 6-month mentorship, a component of the Strengths-Based Nursing Leadership program, the effectiveness of the Facilitated Engagement Approach, a pedagogical strategy developed to facilitate conversation between the mentor and mentee, and the impact of mentorship on leadership practice of mentees.

METHODS

A mixed method qualitative and quantitative approach was used with semi-structured interviews and bi-weekly survey among mentors. Data were thematically analyzed.

RESULTS

Mentors described the use of the Facilitated Engagement Approach to guide their mentorship conversations and found it to be effective in mentoring program participants. Mentors described techniques used and the process of deepening a reflective mentorship conversation. The Spiraling Process (58 %) and the Story Sharing Process (74 %) were integral aspects of the Facilitated Engagement Approach used. Mentorship was found to be impactful in that mentors reported a change in their mentee.

CONCLUSIONS

The Facilitated Engagement Approach was an effective tool for mentees and mentors to develop leadership capacities.

Effectiveness of empathy portfolios in developing professional identity formation in medical students: a randomized controlled trial

BACKGROUND

Medical education requires innovative strategies to enhance empathic skills and the formation of professional identities among students. However, evidence-based teaching of empathy and professional identity formation is inadequately represented, particularly in medical curricula. This study investigated the effectiveness of empathy portfolios in developing Professional Identity Formation (PIF) among medical students and the correlation between empathy and PIF. The objectives of this study were to determine the effectiveness of empathy portfolios for teaching and nurturing PIF in medical students and to investigate the correlation between empathy and PIF.

METHODS

A randomized controlled trial was conducted at Peshawar Medical College, Pakistan. The protocol adhered to CONSORT guidelines. A total of 120 students participated in the study. Empathy and PIF were assessed using two validated questionnaires JSPE-S and PIQ before randomization. The participants were randomized in a stratified fashion into the experimental (n = 60) and control (n = 60) groups. The Participants in the intervention group attended a training workshop on portfolio use. Students maintained their portfolios and wrote reflections on incidents that evoked empathy. Independent t-tests were performed to determine whether the control and experimental groups differed in terms of mean empathy and PIF scores, and Pearson's correlation analyses were used to investigate the relationships between pre- and post-empathy, and pre-post-PIF.

RESULTS

The mean post-test scores on the Empathy and PIF showed a statistically insignificant difference of 0.75 +-17.6 for empathy and 0.45 ± 8.36 for PIF. The intervention had little influence on empathy and PIF scores, as evidenced by nonsignificant effect sizes of 0.32 and 0.36 for empathy and PIF respectively.A strong positive correlation was found between Pre-Empathy and the PIF-Total score (0.519), and between Post- empathy and the PIF-Total score (0.395) (p < 0.001).

CONCLUSIONS

Empathy had a positive linear correlation with PIF; however, the use of empathy portfolios as a three-week single-point intervention was ineffective at nurturing PIF.

Mixed methods evaluation of the Caring for Providers to Improve Patient Experience intervention

OBJECTIVE

To assess the impact of the Caring for Providers to Improve Patient Experience (CPIPE) intervention, which sought to improve person-centered maternal care (PCMC) by addressing two key drivers: provider stress and bias.

METHODS

CPIPE was successfully piloted over 6 months in two health facilities in Migori County, Kenya, in 2022. The evaluation employed a mixed-methods pretest-posttest nonequivalent control group design. Data are from surveys with 80 providers (40 intervention, 40 control) at baseline and endline and in-depth interviews with 20 intervention providers. We conducted bivariate, multivariate, and difference-in-difference analysis of quantitative data and thematic analysis of qualitative data.

RESULTS

In the intervention group, average knowledge scores increased from 7.8 (SD = 2.4) at baseline to 9.5 (standard deviation [SD] = 1.8) at endline for stress (P = 0.001) and from 8.9 (SD = 1.9) to 10.7 (SD = 1.7) for bias (P = 0.001). In addition, perceived stress scores decreased from 20.9 (SD = 3.9) to 18.6 (SD = 5.3) (P = 0.019) and burnout from 3.6 (SD = 1.0) to 3.0 (SD = 1.0) (P = 0.001), with no significant change in the control group. Qualitative data indicated that CPIPE had an impact at multiple levels. At the individual level, it improved provider knowledge, skills, self-efficacy, attitudes, behaviors, and experiences. At the interpersonal level, it improved provider-provider and patient-provider relationships, leading to a supportive work environment and improved PCMC. At the institutional level, it created a system of accountability for providing PCMC and nondiscriminatory care, and collective action and advocacy to address sources of stress.

CONCLUSION

CPIPE impacted multiple outcomes in the theory of change, leading to improvements in both provider and patient experience, including for the most vulnerable patients. These findings will contribute to global efforts to prevent burnout and promote PCMC and equity.

Providing "Compassionate Care" in the Neonatal Intensive Care Unit Through Infant and Family Needs-Based Care

OBJECTIVE

Provision of compassionate care to infants and their families in the neonatal intensive care unit (NICU) is a key component of competent critical care. Although recognized as an essential aspect of NICU care, compassionate care for infants and families in a NICU setting has been underexplored. This study defined and described compassionate care according to NICU staff.

STUDY DESIGN

Voice-recorded, face-to-face individual interviews occurred with NICU nurses (n = 45), NICU nurse practitioners (n = 15), and neonatologists (n = 9) from two NICUs in the midwestern United States. Semantic content analysis was used. Consolidated criteria for Reporting Qualitative research guidelines were followed.

RESULTS

Three dynamic and interactive qualitative themes emerged: excellent standard of intensive care, commitment, and engaged family communication. A conceptual framework entitled patient and family needs-based care was developed from the qualitative interviews.

CONCLUSION

The framework developed from this study supports the therapeutic journey of NICU infants and families by integrating a focus on compassionate personalized care within the context of keen clinical and communication skillsets that staff have gained throughout their NICU careers.

KEY POINTS

· While clinical competence is emphasized as a practice standard, compassion remains a core care value.. · A working definition of compassionate care and the description of its defining pillars has been underexplored.. · This study describes the perspectives of NICU staff on the actionable components of compassionate care for ill infant and their families..

Exemplar or facilitator: An exploration of the lived experience of nurse mentors supporting the adaptation of internationally educated nurses

INTRODUCTION

Deficits in nursing workforces have led to major increases in overseas recruitment in many countries. Internationally educated nurses recruited within Ireland must complete an adaptation programme before they can practice nursing, a process contingent on the support from nurse mentors. However, it is becoming progressively difficult to identify nurses willing to act as mentors, threatening viability of overseas nurse recruitment. This research set out to address this problem by exploring the lived experiences of nurse mentors during the adaptation programme.

METHODS

An interpretative phenomenological analysis research design was utilised to explore the experiences of nurse mentors. Semi-structured interviews were conducted with a maximum variance sample of 11 nurse mentors. The data were subjected to an Interpretive Phenomenological Analysis (IPA) sequential analytical approach yielding integrative themes.

RESULTS

The lived experiences of participants coalesced into three conceptual themes, mentor identity, sustainability, and learner socialisation. Participants who self-identified as 'mentor exemplars' expressed more negative perceptions of the role when compared with nurses who positioned themselves as 'mentor facilitators'. Nurse mentors were challenged by the complexities of intercultural dissonance and insufficient time and training for their mentoring role because of the pressures of clinical service.

CONCLUSION

Although mentorship is essential for the integration of internationally educated nurses, the sustainability of the mentorship role is contingent on how it is supported through training and protected within busy clinical environments. Critically, nurse mentors need to learn how to conceptualise their role as one of facilitating the development of others rather than presenting themselves as exemplary role models.

Item development for a patient-reported measure of compassionate healthcare in action

BACKGROUND

Compassionate care is a fundamental component of healthcare today; yet, many measures of compassionate care are subjective in focus and lack clarity around what compassionate care looks like in practice. Measures mostly relate to physical healthcare settings, neglecting mental healthcare. They also lack significant involvement of people with lived experience (PLE) of healthcare delivery in their development. This study aimed to begin the process of developing a new patient-reported measure, one that captures the observable actions of compassionate care delivery or 'compassionate healthcare in action' by any healthcare professional working in any care setting. The study involves PLE of healthcare delivery, both patients and staff, throughout.

METHODS

A multistage mixed-methods scale development process was followed. First, items were derived inductively from reflexive thematic analysis of patient and clinician interviews about what compassionate care meant to them (n = 8), with additional items derived deductively from a literature review of existing measures. Next, a panel of patient, clinician and researcher experts in compassionate care was recruited (Round 1: n = 33, Round 2: n = 29), who refined these items in a two-round modified online Delphi process.

RESULTS

Consensus was reached on 21 items of compassionate care in action relating to six facets: understanding, communication, attention, action, emotional sensitivity and connection. These items will form the basis for further scale development.

CONCLUSIONS

This item development work has laid the foundation of a potential new tool to systematically measure what compassionate healthcare in action looks like to patients. Further research is underway to produce a valid and reliable version of this proposed new measure. We have outlined these initial stages in detail in the hope of encouraging greater transparency and replicability in measure development, as well as emphasising the value of involving PLE throughout the process.

PATIENT OR PUBLIC CONTRIBUTION

This study involved PLE of both physical and mental healthcare (as staff, patients and service users) throughout the development of the new measure, including initial project conceptualisation and participation in item generation and refinement stages.

Enhancing Quality of Congenital Heart Care Within Resource-Limited Settings

Over 90% of the world's children with congenital heart disease (CHD) are born in the resources poor settings of low- to middle-income countries (LMICs). The shortfall in human and material resources and dysfunctional health systems leads to poor quality of care (QoC) which contributes substantially to suboptimal outcomes of patients with CHD in LMICs. Notwithstanding these challenges, it is possible to develop a quality improvement (QI) framework that can have a significant impact on outcomes and prevent a number of deaths. In this review, we examine the common barriers to implementing effective QI processes in LMICs. Using examples of successful QI initiatives in LMIC, we propose a broad framework that focuses on simple, yet effective measures involving cohesive efforts of all key participants guided and nurtured by a leadership that strongly values QoC.

Mentoring the Wellbeing of Specialist Pediatric Palliative Care Medical and Nursing Trainees: The Quality of Care Collaborative Australia

BACKGROUND

The Quality of Care Collaborative Australia (QuoCCA), working across 6 tertiary centers throughout Australia, builds capability in the generalist and specialist pediatric palliative care (PPC) workforce, by providing education in metropolitan and regional areas. As part of the education and mentoring framework, Medical Fellows and Nurse Practitioner Candidates (trainees) were funded by QuoCCA at four tertiary hospitals throughout Australia.

OBJECTIVE

This study explores the perspectives and experiences of clinicians who had occupied the QuoCCA Medical Fellow and Nurse Practitioner trainee positions in the specialised area of PPC at Queensland Children's Hospital, Brisbane, to identify the ways in which they were supported and mentored to maintain their wellbeing and facilitate sustainable practice.

METHODS

Discovery Interview methodology was used to collect detailed experiences of 11 Medical Fellows and Nurse Practitioner candidates/trainees employed by QuoCCA from 2016 to 2022.

RESULTS

The trainees were mentored by their colleagues and team leaders to overcome challenges of learning a new service, getting to know the families and building their competence and confidence in providing care and being on call. Trainees experienced mentorship and role modelling of self-care and team care that promoted wellbeing and sustainable practice. Group supervision provided dedicated time for reflection as a team and development of individual and team wellbeing strategies. The trainees also found it rewarding to support clinicians in other hospitals and regional teams that cared for palliative patients. The trainee roles provided the opportunity to learn a new service and broaden career horizons as well as establish wellbeing practices that could be transferred to other areas.

CONCLUSION

Collegial interdisciplinary mentoring, with the team learning together and caring for each other along common goals, contributed immensely to the wellbeing of the trainees as they developed effective strategies to ensure their sustainability in caring for PPC patients and families.

Organizational culture and roles in promoting nurse specialty certifications: A qualitative study in the United States

Objectives

Nursing specialty certification validates nurses' mastery of specialty knowledge in disease management, education, or leadership above entry-level education and licensing. Research suggests direct relationships between nursing certifications and patient care quality. However, nurses' specialty certification rates are still low. This study aims to better understand nurses' perceptions of the facilitators and barriers in promoting nurses' desires and ability to obtain specialty certifications, which exclude advanced nursing practice roles, such as nurse practitioner or nurse midwife.

Methods

This qualitative descriptive study took place virtually across the United States from May 2022 to September 2022. The study sample was a nested sample of a large national survey study. Among the nurses agreeing to be interviewed, a purposive sampling method was used to achieve maximum variation in diversity, such as years as a nurse, race, ethnicity, and certification status. Information saturation was used to gauge the sample size. Data were collected via in-depth virtual face-to-face interviews. The coding process was based on Colaizzi's method of data analysis.

Results

Twenty nurses participated in the study. Five major themes emerged related to organizational culture and strategies to foster nurse specialty certifications. The five organizational strategies included 1) sharing resources, 2) a culture of ownership and a sense of belonging, 3) mentorship and role modeling, 4) recognizing nurses' efforts and accomplishments, and 5) cultivating a sense of meaning, purpose, and support.

Conclusions

The findings indicate that organizational culture and leadership significantly promote continuing learning environments. Organizations need to develop an organizational culture that promotes nurses' specialty certifications. This study identified significant areas that are important to support nurses seeking certifications. Additional research is needed to evaluate which interventions significantly impact initial and continued certification levels, especially in the post-COVID-19 era.

Implementation evaluation of a leadership development intervention for improved family experience in a private paediatric care hospital, Pakistan

Background

A study from a tertiary care center in Pakistan demonstrated that a leadership development intervention led to improved family experience of care outcomes. The objective of the current paper is to assess the implementation of this intervention and identify barriers and facilitators to inform sustainability and scalability.

Methods

A working group designed the intervention using a theory-of-change model to strengthen leadership development to achieve greater employee engagement. The interventions included: i) purpose and vision through purpose-driven leadership skills trainings; ii) engaging managers via on-the-job mentorship programme for managers, iii) employee voice i.e., facilitation of upward communication to hear the employees using Facebook group and subsequently inviting them to lead quality improvement (QI) projects; and iv) demonstrating integrity by streamlining actions taken based on routine patient experience data. Implementation outcomes included acceptability, adoption, fidelity across degree & quality of execution and facilitators & barriers to the implementation. Data analyzed included project documentation records and posts on the Facebook group.

Analysis indicated acceptability and adoption of the intervention by the employees as178 applications for different QI projects were received. Leadership sessions were delivered to 455 (75%) of the employees and social media communication was effective to engage employees. However, mentorship package was not rolled out nor the streamlined processes for action on patient experience data achieved the desired fidelity. Only 6 QI projects were sustained for at least a year out of the 18 approved by the working group. Facilitators included leadership involvement, real-time recognition and feedback and value-creation through participation by national and international celebrities. Challenges identified were the short length of the intervention and incentives not being institutionalized.

The authors conclude that leadership development through short training sessions and on-going communications facilitated by social media were the key processes that helped achieve the outcomes. However, a long-term strategy is needed for individual managerial behaviours to sustain.

Scaling Nurturing Care Interventions in the Health Sector: A Theory of Change Perspective

Nurturing care interventions postulated on strengthening caregiver-child relationships have proven to be effective for improving early childhood development outcomes in low- and middle-income countries. Hence, a scale-up of the interventions has been recommended with an emphasis on the health sector given the contact with families in the critical first 3 years of life. However, an effective scale-up of an integrated intervention through healthcare requires a theory of change approach elucidating pathways of sustainable change. From this viewpoint, I reflect on my experience of scaling the intervention in a private pediatric care setting. I realized that buy-in from the health sector required realization of benefits to include health outcomes framed as the potential to improve the quality of life and the process of recovery; sustainable behavior change required a culture that promoted nurturing care highlighting the role of leadership; subsequently improving the experience of frontline staff and at an individual level, this could be achieved through the provision of supportive supervision-rooted in a framework of compassion. The lessons learned are shared to be considered for future integration efforts.