Sustainability in changing clinical practice promotes evidence-based nursing care

AIM: To examine the relationship between sustained work with quality improvement (QI) and factors related to research utilization in a group of nurses. DESIGN: The study was designed as a comparative survey that included 220 nurses from various health care organizations in Sweden. These nurses had participated in uniformly designed 4-day basic training courses to manage a method for QI. METHODS: A validated questionnaire covering different aspects of research utilization was employed. The response rate was 70% (154 of 220). Nurses in managerial positions at the departmental level were excluded. Therefore, the final sample consisted of 119 respondents. Four years after the training courses, 39% were still involved in audit-related activities, while 61% reported that they had discontinued the QI work (missing = 1). RESULTS: Most nurses (80-90%) had a positive attitude to research. Those who had continued the QI work over a 4-year period reported more activity in searching research literature compared with those who had discontinued the QI work (P = 0.005). The QI-sustainable nurses also reported more frequent participation in research-related activities, particularly in implementing specific research findings in practice (P = 0.001). Some contextual differences were reported: the QI-sustainable nurses were more likely to obtain support from their chief executive (P = 0.001), consultation from a skilled researcher (P = 0.005) and statistical support (P = 0.001). Within the broader health care organization, the existence of a research committee and a research and development strategy, as well as access to research assistant staff, had a tendency to be more common for nurses who had continued the QI work. CONCLUSION: Sustainability in QI work was significantly related to supportive leadership, facilitative human resources, increased activity in seeking new research and enhanced implementation of research findings in clinical practice. It appears that these factors constitute a necessary prerequisite for professional development and the establishment of evidence-based practice.     

Quality improvement engagement and competence: A comparison between frontline nurses and nurse leaders

BackgroundNurses play a pivotal role in improving patient care. To maximize nurses’ impact on quality, nurses must have quality improvement (QI) competence and engage fully in QI initiatives.PurposeTo describe QI competence (knowledge, skills, and attitudes) among frontline nurses and leaders; and compare variations in competence among nursing roles, experience, and specialty areas.MethodsA total of 681 nurses at one heath system fully completed the Nursing Quality Improvement Practice tool electronically.FindingsHalf of the respondents reported QI engagement (53.6%). Mean knowledge scores were 5.08 (SD 1.16, 7 items). Skill proficiency was low (M = 2.82, SD = 1.03; range 1–6) although QI attitudes were favorable (M = 3.76, SD = 0.63; range 1–5). Significant differences in skills and attitudes were identified by role. QI competence among nurses employed in various specialty areas were similar.DiscussionStrategies for increasing QI competence and engagement of nurses must be created and deployed in order to improve quality and safety.     

Descriptive survey of Summer Genetics Institute nurse graduates in the USA

The purpose of this study was to describe the clinical, research, educational, and professional activities that nurses are engaged in following participation in a 2 month intramural genetics training program. An online survey was administered in 2010 to graduates of the program sponsored by the US National Institute of Nursing Research from 2000 to 2009, in Bethesda, Maryland, USA. The electronic, voluntary survey was sent to 189 graduates via email. The survey included demographic characteristics, educational preparation, professional roles and responsibilities, and attitudes about genetic testing and privacy issues. Of the 95 graduates responding to the survey, 74% had doctorates and 70% were advanced practice nurses. All respondents reported incorporating genetics knowledge into daily clinical, academic, or research practices since completing the program, with 72% reporting being involved in genetically‐focused research (52% with research funding), 32% incorporating genetics into patient care, and 79% providing genetics education. Respondents working in a hospital setting or academic institution were more likely to desire additional training in genetics. National Institute of Nursing Research graduates have successfully integrated genomics into a variety of nursing practices.     

AIDS attitudes and attitudes toward caring for dying patients

This article reports on a survey of nursing staff working in AIDS residential health care facilities. More than two - thirds of respondents expressed non - punitive attitudes towards AIDS. Certified nursing assistants were more likely to report negative attitudes toward caring for dying patients than registered nurses. In general, respondents who had less punitive AIDS attitudes also reported less negative attitudes toward caring for dying patients. Nursing staff in AIDS residential facilities may benefit from further training that addresses issues involved in working with AIDS patients and caring for dying patients.     

The master's prepared mental health nurse: an assessment of employer expectations

A needs assessment survey seemed essential to a group of faculty members engaged in updating the curriculum in a Master's program in Mental Health Nursing in a University School of Nursing in the Midwest. An attempt was made to identify those nurse administrators who interviewed and hired clinical nursing personnel in hospitals in which psychiatric services were provided. Data were obtained from 23 respondents. The findings indicated that 1) Master's-prepared mental health-psychiatric nurses are being hired in the area; 2) at least 50% of the time, MSN graduates are expected to function in middle-management or administrative roles; and 3) Comprehensive Mental Health Nursing theory and skill development, rather than subspecialties, is viewed as the most important curricular focus. The need to continue recruiting students and develop and articulate the knowledge base in Mental Health Nursing through research and theory development is critical.     

Research into oral history related to the management of the first registered nursing home in Taiwan

The "Nurses Law", promulgated in 1991, allows nurses to operate nursing care facilities (e.g., nursing homes, home care institutes). The opening in 1993 of Taiwan's first registered nursing home, the Chiang-Chin Foundation of Nursing Perspectives, under Dr. Min-Shih Du represents an important milestone in both nursing and long-term care in Taiwan. Using the oral history method, this research depicts and analyzes Chiang-Chin Foundation of Nursing Perspectives operation and management experiences over a period spanning 1993 through 2002. Research results can provide management knowledge and experience for nurses, managers, and administrators in the long-term care field. Results also provide reference for long-term care policy makers and nursing entrepreneurs, and may serve as a valuable record related to the development of nursing in Taiwan.     

Theory-based practice in a major medical centre

alligood m.r. (2011) Journal of Nursing Management 19, 981–988
Theory-based practice in a major medical centre Aims This project was designed to improve care quality and nursing staff satisfaction. Background Nursing theory structures thought and action as demonstrated by evidence of improvement in complex health-care settings. Nursing administrators selected Modelling and Role-Modelling (MRM) for the theory-based practice goal in their strategic plan. Methods An action research approach structured implementation of MRM in a 1-year consultation project in 2001–2002. Results Quality of health care improved according to national quality assessment ratings, as well as patient satisfaction and nurse satisfaction. Conclusions Modelling and Role-Modelling demonstrated capacity to structure nursing thought and action in patient care in a major medical centre. Uniformity of patient care language was valued by nurses as well as by allied health providers who wished to learn the holistic MRM style of practice. The processes of MRM and action research contributed to project success. Implications for nursing management  A positive health-care change project was carried out in a large medical centre with action research. Introducing MRM theory-based practice was a beneficial decision by nursing administration that improved care and nurse satisfaction. Attention to nursing practice stimulated career development among the nurses to pursue bachelors, masters, and doctoral degrees.     

The neuroscience nursing 2005 role delineation study: implications for certification.

A task force appointed by the American Board of Neuroscience Nursing conducted a role delineation study to define current practice in neuroscience nursing. The results were used to validate the content matrix for future Certified Neuroscience Registered Nurse (CNRN) examinations. The study employed a survey design for which the Nursing Intervention Classification taxonomy was the guiding theoretical framework. The eligible sample included all current CNRNs and all members of the American Association of Neuroscience Nursing. An invitation to participate in an online survey was successfully emailed to 2,462 neuroscience nurses; the survey was completed by 477 respondents. They rated the performance and importance of 175 neuroscience nursing activities. On the basis of data analysis conducted by Schroeder Measurement Technologies, Inc., the task force recommended revisions to the CNRN examination matrix to reflect current practice in neuroscience nursing.     

Improving quality of care in nursing facilities. Gerontological clinical nurse specialist as research nurse consultant

It is becoming increasingly common for nursing facilities to use Quality Indicators (QI) derived from Minimum Data Set (MDS) data for quality improvement initiatives within their facilities. It is not known how much support facilities need to effectively review QI reports, investigate problems areas, and implement practice changes to improve care. In Missouri, the University of Missouri-Columbia MDS and Nursing Home Quality Research Team has undertaken a Quality Improvement Intervention Study using a gerontological clinical nurse specialist (GCNS) to support quality improvement activities in nursing homes. Nursing facilities have responded positively to the availability of a GCNS to assist them in improving nursing facility care quality.     

Cancer nursing research in Queensland,Australia: barriers,priorities, and strategies for progress

Nursing research is an integral component of improving the care of people with cancer; however, the literature suggests that many organizational, resource, and attitudinal barriers to research remain. The aim of the present study was to systematically describe the research experience, attitudes, and opinions of nurses in Queensland, Australia, about priorities and strategies for developing cancer nursing research. A mail survey was sent to all 589 members of the Oncology Nurses Group of Queensland to assess their research knowledge, experience, and attitudes. A response rate of 54.2% (319 nurses) was obtained. Results suggest that many nurses in this study have access to and are reading available research regularly. However, many nurses reported only limited education and skills in research, scarce resources, and limited time to participate in research. Few nurses were involved in developing research proposals, were presenting at conferences, or were writing for publication. Despite these constraints, most of the sample indicated high levels of interest in participating in conducting research. Furthermore, most nurses in this study viewed research as important to patient care and as being an important role for clinical nurses. The top 3 priority areas for cancer nursing research were identified as psychosocial support, pain management, and symptom management. Specific strategies identified for developing nursing research included providing information, support, mentorship, and resources. Professional groups were viewed as having an important role in the development of nursing research in education, lobbying, and facilitating networking among researchers.     

Characteristics associated with intent to stay among Quality Improvement nurses

Kim E.K. & Hwang J.I. (2011) Characteristics associated with intent to stay among Quality Improvement nurses. International Nursing Review 58 , 89–95 Aim: The study aims to investigate characteristics associated with intent to stay among Quality Improvement (QI) nurses in Korean hospitals. Background: QI nurses have recently emerged as a new specialty area in the nursing profession in Korea. They have played a major role in coordinating and facilitating hospital‐wide QI activities. However, their frequent turnover degrades the continuity of overall QI programmes and incurs additional costs in human resource management. Methods: A cross‐sectional questionnaire survey was administered to 123 QI nurses in 123 general hospitals. The collected data included their hospital and department characteristics, work demand, job satisfaction, organizational commitment and demographics. The response rate was 94.3% (n = 116). Multiple logistic regression analysis was performed to determine the factors associated with intent to stay. Findings: Only 32.8% intended to stay in their current job. Significant factors associated with intent to stay were affective commitment and work demands. QI nurses with a higher level of affective commitment were more likely to stay [odds ratios (OR) = 2.50], whereas those with higher quantitative work demands in QI education and support were less likely to stay (OR = 0.40). Conclusion: The findings indicated that intent to stay was closely associated with work environment characteristics. Efforts to enhance their affective commitment and support their workload management are needed to increase the retention of qualified and experienced QI nurses.     

Establishing library 'key skill' confidence levels amongst a cohort of nursing students at an English university

This article presents the findings of a small-scale preliminary survey of one cohort of students studying towards a Diploma/BSc in Nursing. The survey sought to establish student characteristics and indicate their confidence levels using identified key library facilities. From questionnaires (N=64), the data confirmed the 'typicality' of the student group illuminating a breadth of prior experiences in terms of students' prior learning and perceived confidence in using library resources. Whilst a number of respondents indicated confidence using identified library resources, a significant number of students (typically over one third n=14+) indicated that they lacked confidence in and did not utilise library facilities. This suggests that they may not be using the resources to full advantage. Over half of the respondents (53% n=23) had not attended library skills training within the last two years and 9% (n=4) had not used the library although they were completing assignments. This survey points to gaps in student confidence, and by implication, use of key library skills, particularly those involving electronic resources. At a time of widening participation and the explosion of information technology, this survey is a timely reminder of the need to revisit key skill development for nursing students studying in higher education.