领导生命周期理论在不同层次护士培养中的应用

目的：探讨适合不同层次护士特点的临床培养方法。方法：根据领导生命周期理论模型，将急诊科护士分为M1、M2、M3、M4共4个层次进行培养，根据不同的计划目标进行考核、评价、调整。结果：所有参加规范化培训的护士在理论知识、操作技能、带教能力、管理能力等方面都优于传统的培养方法。结论：领导生命周期理论根据下属不同的成熟度采用不同的领导方式，能提高护士的综合素质，使各级人员各尽其才，才尽其用，提高护理管理的效率，最终提高护理工作质量。     

Hepatitis B infections in a chronic hemodialysis unit in a country where hepatitis B is endemic: a prospective study

Hepatitis B markers were determined in patients with chronic renal failure and in staff members prior to entry into the hemodialysis unit of a hospital in southern Israel, an area in which hepatitis B is endemic. Patients and staff who were negative for hepatitis B markers were followed for a mean of 26.7 and 29.2 months, respectively, between November 1975 and May 1984. New infections occurred in 25.9% of the patients and 17.3% of the staff; the difference was not statistically significant. Hepatitis B markers were found in 26% of the staff and 41% of the patients (p less than 0.05) prior to their entry into the hemodialysis unit. Furthermore, in the patients, a relatively high rate of carriers was detected (7% compared with 2% in the general population), while no carriers were detected among the staff members. Within the staff group, nurses were at particularly high risk for new infections, accounting for seven of the nine (78%) events recorded. The high risk for the nursing staff is probably due to greater exposure to blood among nurses compared with other staff members.     

The style of leadership idealized by nurses

This study focuses on nursing leadership on the basis of Grid theories. According to the authors, these theories are an alternative that allows for leadership development in nursing. The research aimed to identify and analyze the style of leadership idealized by nurses, according to their own view, and to compare the styles of leadership idealized by nurses between the two research institutions. Study subjects were 13 nurses. The results show that nurses at both institutions equally mention they idealize style 9.9, followed by 5.5 and 1.9, with a tendency to reject styles 9.1 and 1.1.     

The importance of leadership style and psychosocial work environment to staff‐assessed quality of care: implications for home help services

Work in home help services is typically conducted by an assistant nurse or nursing aide in the home of an elderly person, and working conditions have been described as solitary with a high workload, little influence and lack of peer and leader support. Relations between leadership styles, psychosocial work environment and a number of positive and negative employee outcomes have been established in research, but the outcome in terms of quality of care has been addressed to a lesser extent. In the present study, we aimed to focus on working conditions in terms of leadership and the employee psychosocial work environment, and how these conditions are related to the quality of care. The hypothesis was that the relation between a transformational leadership style and quality of care is mediated through organisational and peer support, job control and workload. A cross‐sectional survey design was used and a total of 469 questionnaires were distributed (March–April 2012) to assistant nurses in nine Swedish home help organisations, including six municipalities and one private organisation, representing both rural and urban areas (302 questionnaires were returned, yielding a 65% response rate). The results showed that our hypothesis was supported and, when indirect effects were also taken into consideration, there was no direct effect of leadership style on quality of care. The mediated model explained 51% of the variance in quality of care. These results indicate that leadership style is important not only to employee outcomes in home help services but is also indirectly related to quality of care as assessed by staff members.     

Being present in a distant room: aspects of teleconsultations with older people in a nursing home

In a telecare project in Northern Sweden, videophones have been used to facilitate teleconsultations between nurses and elders at a nursing home. The authors designed this study to elucidate qualities in the communication in the professional encounter between nurses and elders assisted by nursing staff in the teleconsultations. They interviewed 2 registered nurses and 5 nursing staff members with long experience of using videophones in the telecare project, out of 20 staff members, and analyzed them using a phenomenological-hermeneutic method. In a comprehensive interpretation, teleconsultations could be understood as glimpses of the experience of being in the other's room with a feeling of providing nursing presence. This was attained when aspects such as familiarity, safety, transparency, and interest were promoted.     

Magnetic direction

In April 2005, the American Nurses Association (ANA) awarded St. Joseph Hospital, Nashua, NH, its highest honor for excellence in nursing: "Magnet Recognition." The Magnet Recognition Program was developed by the ANA's American Nurses Credentialing Center in the early 1980s to recognize health care organizations that provide the best in nursing care and uphold the tradition of excellence in professional nursing practice. St. Joseph began pursuing Magnet status more than three years ago, starting with a number of enhancements to nursing practices. The hospital worked hard to improve nurse-to-patient staffing and included many of its nurses on the nursing quality council, division advisory, and cultural diversity committees. Magnet program appraisers visited the hospital this January to conduct an intensive, on-site three-day examination. They interviewed patients, staff nurses, physicians, hospital employees, administrators, board members, and nursing leadership to evaluate St. Joseph's nursing care, services, and delivery of care to patients and their families. Soon after, Magnet status was bestowed.     

Challenges of Using Quality Improvement Methods in Nursing Homes that “Need Improvement”

ObjectivesQualitatively describe the adoption of strategies and challenges experienced by intervention facilities participating in a study targeted to improve quality of care in nursing homes “in need of improvement”. To describe how staff use federal quality indicator/quality measure (QI/QM) scores and reports, quality improvement methods and activities, and how staff supported and sustained the changes recommended by their quality improvement teams.Design/setting/participantsA randomized, two-group, repeated-measures design was used to test a 2-year intervention for improving quality of care and resident outcomes in facilities in “need of improvement”. Intervention group (n = 29) received an experimental multilevel intervention designed to help them: (1) use quality-improvement methods, (2) use team and group process for direct-care decision-making, (3) focus on accomplishing the basics of care, and (4) maintain more consistent nursing and administrative leadership committed to communication and active participation of staff in decision-making.ResultsA qualitative analysis revealed a subgroup of homes likely to continue quality improvement activities and readiness indicators of homes likely to improve: (1) a leadership team (nursing home administrator, director of nurses) interested in learning how to use their federal QI/QM reports as a foundation for improving resident care and outcomes; (2) one of the leaders to be a “change champion” and make sure that current QI/QM reports are consistently printed and shared monthly with each nursing unit; (3) leaders willing to involve all staff in the facility in educational activities to learn about the QI/QM process and the reports that show how their facility compares with others in the state and nation; (4) leaders willing to plan and continuously educate new staff about the MDS and federal QI/QM reports and how to do quality improvement activities; (5) leaders willing to continuously involve all staff in quality improvement committee and team activities so they “own” the process and are responsible for change.ConclusionsResults of this qualitative analysis can help allocate expert nurse time to facilities that are actually ready to improve. Wide-spread adoption of this intervention is feasible and could be enabled by nursing home medical directors in collaborative practice with advanced practice nurses.     

Partnership working by default: district nurses and care home staff providing care for older people

Older people residents in care homes that only offer residential care rely on primary healthcare services for medical and nursing needs. Research has investigated the demands that care homes staff and residents make on general practice, but not the involvement of other members of the primary healthcare team. This paper describes two consecutive studies completed in 2001 and 2003 that involved focus groups and survey methods of enquiry conducted in two settings: an England shire and inner London. The research questions that both studies had in common were (1) What is the contribution of district nursing and other primary care services to care homes that do not have on‐site nursing provision? (2) What strategies promote participation and collaboration between residents, care home staff and NHS primary care nursing staff? and (3) What are the current obstacles and aids to effective partnership working and learning? A total of 74 community‐based nurses and care home managers and staff took part in 10 focus groups, while 124 care home managers (73% of the171 surveyed) and 113 district nurse team leaders (80% of the 142 surveyed) participated in the surveys. Findings from both studies demonstrated that nurses were the most frequent NHS professional visiting care homes. Although care home managers and district nurses believed that they had a good working relationship, they had differing expectations of what the nursing contribution should be and how personal and nursing care were defined. This influenced the range of services that older people had access to and the amount of training and support care home staff received from district nurses and the extent to which they were able to develop collaborative and reciprocal patterns of working. Findings indicate that there is a need for community‐based nursing services to adopt a more strategic approach that ensures older people in care homes can access the services they are entitled to and receive equivalent health care to older people who live in their own homes.     

Feminist leadership through total quality management

Feminist leadership in nursing can be achieved through Total Quality Management. Total Quality Management (TQM) is a philosophy and technology that represents the foundation of a continuously improving organization. The feminist leadership ideas practiced by nurses, such as empowering staff and decision by consensus, are also central to TQM. Feminist leadership utilizing TQM enables employees to creatively contribute to the system without fear or intimidation. Employees at all levels in the organization are then empowered. The role of the feminist leader using TQM is one of facilitator rather than authority figure. Feminist leadership in nursing can spearhead the opportunity for improvement to provide high‐quality, cost‐effective health care in a troubled and complex economic environment.     

Learning leadership: nurses opinion about their academic education

The purpose of the present study was to identify nurses opinion about aspects of their academic undergraduate education directed to form leaders of the nursing team. Therefore, authors interviewed 17 nurses from a public federal hospital who experience the condition of being staff leaders. The collected material was analyzed through the technique of content analysis. Results evidenced a dissatisfaction concerning their academic training on leadership. The approached aspects showed the importance of a reflection about the need of teaching-learning strategies that allow students to develop leadership skills.     

Implementation of a Coronavirus Disease 2019 Vaccination Condition of Employment in a Community Nursing Home

The rate of coronavirus disease 2019 (COVID-19) vaccination uptake by US nursing home staff remains low despite the increased risks of viral transmission and related morbidity and mortality in this setting. This study describes vaccine uptake activities including a COVID-19 vaccination condition of employment (COE) policy in one community nursing home. This case study summarizes the timeline of vaccination uptake activities, staff vaccination rates over time, and stakeholder perspectives around the implementation of a COVID-19 vaccination COE. Organizational data were used to calculate vaccination rates from January 1, 2021 until May 1, 2021 among all nursing home staff. Interviews were held with the executive leadership team, human resources leadership, and nursing home staff to understand the process of implementation. During a 4-month period, nursing home leaders provided 8 written handouts about COVID-19 to all staff, hosted 5 on-site vaccination clinics in partnership with area pharmacies, conducted 2 virtual presentations for staff in addition to individual outreach and internal communications. Fewer than one-half of the staff were vaccinated prior to the decision to pursue a vaccine COE on February 9, 2021. The decision to pursue a COVID-19 vaccination COE was supported by executive leadership and nursing home staff to protect the health and safety of each other and their residents. By May 1, 2021 a total of 221 of the 246 (89.8%) nursing home staff members received a COVID-19 vaccination. The facility reached 100% compliance with the vaccination COE policy with 18 people who chose to resign and 7 people who were exempt or on a leave of absence. In combination with frequent, personalized outreach, a COVID-19 vaccination COE resulted in high staff vaccination rates and minimal staff turnover. This case study provides a detailed summary of vaccination uptake activities within an organizational context to inform efforts at other healthcare facilities.     

震后基层医院护理人员培训需求调查与分析

目的了解震后护理人员培训需求,为政策制定提供依据。方法采用调查问卷,对绵阳市4个极重灾区的护理人员进行调查。结果震后护理人员学历及职称结构欠合理;仍有无证护士上岗;护理人员培训需求强烈：领导对护士培训重视力度不够。结论卫生行政主管部门应重视调整护理人员职称结构,积极创造条件向灾区输送有证护士,督促基层医院落实护士培训。     

Staff opinions about the leadership and organisation of municipal dementia care

The present study describes the opinions of experienced staff providing direct care to patients with dementia in municipal units in Sweden. The focus is mainly on leadership and other organisational factors. A purposeful sample of 31 staff members employed in municipal dementia care in both urban and rural areas in mid-Sweden were selected. Data were collected within a qualitative paradigm using semi-structured interviews which were tape-recorded and analysed using a modified phenomenographical approach. The nearly unanimous opinions of the interviewees indicated that there was a great lack of daily leadership in the units. Thus, few units had clearly formulated goals and few had regular care planning for their residents. Poorly developed teamwork was reported in the care of people with dementia especially regarding doctors, whose visits to the unit were too infrequent and too short, and did not include a direct exchange of information with other staff. In addition, little or no staff education and guidance/supervision was provided on a regular basis. In conclusion, without any unreasonable increase in cost, measures such as introducing clear leadership at the care unit level, concentrating on multi-professional teamwork, and providing education and guidance/supervision to the staff would probably result in better care for patients with dementia and their families.     

安徽省乡镇卫生院护士培训需求调查分析

目的了解安徽省乡镇卫生院护士培训需求,为构建符合国情、省情的基层护士规范化培养模式及实施路径提供依据。方法采用自行设计的乡镇卫生院护士培训需求调查问卷对安徽省16个市乡镇卫生院护士进行调查。采用SPSS 20.0软件对数据进行统计分析。结果安徽省乡镇卫生院护士培训意愿较高,其中皖北地区护士培训意愿较皖南、皖中地区高（χ2=19.243,P<0.01）;培训内容调查结果显示,4 359名（81.7% ）乡镇卫生院护士选择急诊急救为首要培训项目;培训方式中,3 242名（60.8%）护士选择了网络学习或视频课件培训方式;乡镇卫生院护士不能参加培训原因中,4 262名（39.2%）护士认为基层护士缺乏,工作无人接替是首要原因。结论安徽省乡镇卫生院护士培训意愿较高,多数护士能充分认识到培训的必要性,基层医疗机构应考虑不同地区、不同学历间护士培训需求差异,结合基层护士的实际情况开展针对性培训,以实现护理资源共享、护理工作水平提高以及全面护理质量持续改进。     

The challenge of operating within staffing budgets on the maternity unit at New England Memorial Hospital despite a fluctuating census

Project: Improve staffing policies and procedures on the Maternity unit to reduce the chronic practice of exceeding the budget for nursing hours per patient day (NHPPD). Principals: Maternity Service nursing staff and unit secretary. Process Improvement Method: Plan-Do-Check-Act. Timeline: Begun: March 1991. Results reported here: FY 1992 (October 1, 1991-September 30, 1992). Key Findings: Patient census fluctuated dramatically from shift to shift. To staff the unit during peak times, nurses from other units were floated in, but many lacked sufficient obstetrics training. Conversely, at slack times, OB nurses were floated to other units. All the above factors resulted in nursing dissatisfaction as well as the Maternity unit exceeding its nurse staffing budget by 25 percent. Improvements: Unit-based staffing, which eliminated floating and increased ownership on the unit, was implemented, along with other changes in operations, policies, and procedures. A charge nurse position was created and implemented to coordinate activities between shifts. Staffing policies and procedures were clarified and updated. Results: Nursing hours per patient day are now on budget, and nursing morale is also improved.     

Pay for performance in hospitals: implications for nurses and nursing care

As pay-for-performance programs gain momentum, hospital administrators and clinical leaders will need to consider the organization's infrastructure and measures that promote quality management initiatives. Many hospital performance measures by the Centers for Medicare & Medicaid Services involve chronic diseases that may be best managed by an interdisciplinary team-based approach, of which nurses are significant members. While the primary focus of pay-for-performance has been concentrated on physicians, comparatively less attention has been given to the potential impact on nurses and nursing care. Moreover, the impact of the pay-for-performance measures on nursing labor and processes has not been well studied. Within acute care settings, increasing attention has focused on the structure of nursing, such as number and skill mix of nursing personnel, processes of care, and influence on patient outcomes. As pay-for-performance standards evolve and encompass patient outcomes, attention to nursing's contribution will follow. Nursing leadership will need to address a number of strategies to (a) address the impact of pay-for-performance on nursing performance measures as well as (b) on staff nurses' ability to contribute to the organization's efforts in achieving pay-for-performance standards, including education, documentation, team collaboration, and patterns of care.     

浅谈护士长综合素质的影响力

本文从护士长的综合素质影响力的重要性出发,重点以下几个方面介绍了护士长的综合素质的影响力:护士长的职业态度和职业价值观;护士长的性格和能力;护士长的知识和技能;护士长的领导艺术和技巧。只有在这些方面不断提升护士长的综合素质,才能有利于激励其他护理人员,便于和患者交流,对于医院的护理工作发展也具有积极的作用。