Using Transformational Learning Principles to Change Behavior in the OR

Achieving the goal of “best practice” in the perioperative field requires continuous education and reflection. Applying transformational learning principles can improve perioperative nursing practice by allowing staff members to reflect on their current practices, discover faulty assumptions, and revise them.Using a proactive approach, leaders can apply transformational learning principles on a case-by-case basis to build professional teams that are effective and efficient. Leaders who use transformational principles and act as role models can influence other staff members to be accountable for their own practice and self-development. If leaders are effective and inspirational, individual practice and even departmental or institutional cultures can be changed. AORN J 89 (May 2009) 851-860. © AORN, Inc, 2009.     

Using Lean Healthcare Techniques to Reduce Appointment Times

To reduce extended appointment times at a heart failure clinic, 3 Lean healthcare-based changes were planned and implemented one at a time over 4 months. Findings based on 1,267 appointments showed that appointment times decreased with proper implementation. Although staffing challenges and inadequate sample sizes prevented statistical analysis on consult appointments, follow-up appointment results were statistically significant based on 1-way analysis of variance and Tukey honest significant difference tests. Although the study period prevented the determination of a correlation between monthly clinic end times and average appointment times (patient throughput), in-room minute decreases suggest that lean healthcare techniques can be effective in this context.     

Lean Methodology in Health Care

Lean production is a process management philosophy that examines organizational processes from a customer perspective with the goal of limiting the use of resources to those processes that create value for the end customer. Lean manufacturing emphasizes increasing efficiency, decreasing waste, and using methods to decide what matters rather than accepting preexisting practices. A rapid improvement team at Lehigh Valley Health Network, Allentown, Pennsylvania, implemented a plan, do, check, act cycle to determine problems in the central sterile processing department, test solutions, and document improved processes. By using A3 thinking, a consensus building process that graphically depicts the current state, the target state, and the gaps between the two, the team worked to improve efficiency and safety, and to decrease costs. Use of this methodology has increased teamwork, created user-friendly work areas and processes, changed management styles and expectations, increased staff empowerment and involvement, and streamlined the supply chain within the perioperative area.     

Transformational leadership in nursing: towards a more critical interpretation

HUTCHINSON M and JACKSON D. Nursing Inquiry 2013; 20 : 11–22
Transformational leadership in nursing: towards a more critical interpretation Effective nurse leadership is positioned as an essential factor in achieving optimal patient outcomes and workplace enhancement. Over the last two decades, writing and research on nursing leadership has been dominated by one conceptual theory, that of transformational leadership. This theoretical framework has provided insight into various leader characteristics, with research findings presented as persuasive evidence. While elsewhere there has been robust debate on the merits of the transformational model of leadership, in the nursing literature, there has been little critical review of the model and the commonly used assessment instruments. In this article, we critically review more than a decade of nursing scholarship on the transformational model of leadership and its empirical evidence. Applying a critical lens to the literature, the conceptual and methodological weaknesses of much nursing research on this topic, we question whether the uncritical adoption of the transformational model has resulted in a limited interpretation of nursing leadership. Given the limitations of the model, we advocate embracing new ways of thinking about nursing leadership.     

护理本科藏族学生中医护理课程学习特点的质性研究

目的探讨跨文化背景下,内地护理本科藏族学生中医护理课程学习特点。方法2019年3月,目的抽样法选取浙江省已学习中医护理课程的18名本科藏族护生为研究对象,采用质性研究法,对其进行半结构式访谈;并采用传统内容分析法进行资料分析。结果共提炼归纳出3个主题:学习动机的发生发展;缺乏学习迁移策略;存在文化适应性问题。结论本科藏族护生学习中医护理动机逐步明确,但缺乏有效的学习方法和学习计划,对中医护理文化内涵缺乏了解。考虑到藏族护生的自身特点,中医护理教育者应针对具体原因,制定相应的教学改革模式,融合民族特色,减少文化差异对课程学习带来的冲击。     

Transformational leadership: a cascading chain reaction

Historical influences still permeate contemporary nursing practise. These are mirrored in organizational philosophies, transactional and autocratic leadership styles and disempowered staff. Whilst there is disparity amongst the theorists' definitions of leadership, there is consensus pertaining to the attributes necessary to realize effective leadership. Transformational leadership is heralded as new criterion for nurse managers, and can be achieved through training, education and professional development in key leadership competencies. To achieve a chain reaction, charismatic transformational leaders espouse intellectual stimulation and individual consideration to empower staff and enhance patient care. Nurse managers that develop and foster transformational leadership can surmount oppressive traditions and confidently navigate a complex and rapidly changing health care environment.     

Surgical Scheduling: A Lean Approach to Process Improvement

A large teaching hospital in the northeast United States had an inefficient, paper-based process for scheduling orthopedic surgery that caused delays and contributed to site/side discrepancies. The hospital’s leaders formed a team with the goals of developing a safe, effective, patient-centered, timely, efficient, and accurate orthopedic scheduling process; smoothing the schedule so that block time was allocated more evenly; and ensuring correct site/side. Under the resulting process, real-time patient information is entered into a database during the patient’s preoperative visit in the surgeon’s office. The team found the new process reduced the occurrence of site/side discrepancies to zero, reduced instances of changing the sequence of orthopedic procedures by 70%, and increased patient satisfaction.     

Transformational leadership: implications for nursing leaders in facilities seeking magnet designation

A perioperative nurse leader's ability to effect positive change and inspire others to higher levels of achievement is related to his or her leadership style in the practice setting and the leadership style that is present across the organization. The American Nurses Credentialing Center's Magnet™ designation and redesignation process requires the demonstration of transformational leadership as one of the components of excellence. Transformational leadership can increase nurses' job satisfaction and commitment to the organization and organizational culture. Engaging staff members in the transition to transformational leadership and developing a common mission, vision, and goals are keys to success in the surgical setting. Bass's four interrelated leadership components—idealized influence, inspirational motivation, intellectual stimulation, and individual consideration—and associated behaviors were used by surgical services leaders in an East Coast, two-hospital system to successfully achieve redesignation as a Magnet facility.     

Professional Development: 2. Professional Knowledge and Situated Learning in the Workplace

This is the second of two papers which look at the relationship between the development of individual physiotherapists and the development of physiotherapy as a profession. It explores the nature of professional knowledge and the process of professional learning which is seen to be crystallised through an integration of theory with practice in the workplace. Important influences of situated cognition and situated learning on physiotherapy practice are identified and discussed in the context of theories of social action and symbolic interaction. These theories challenge the curricular assumptions on which many undergraduate education programmes are based. It is concluded that education programmes which aim to facilitate professional development may more effectively link theory and practice to promote professional learning which is relevant to changes in the ethos and delivery of health services and work in healthcare teams.     

PBL教学模式在专本连读护生中的应用与改进策略

目的探讨PBL（problem-based learning,PBL）教学模式在专本连读护生《护理学基础》教学中的应用。方法实验组实施40学时PBL教学,对照组实施同学时量传统教学。结果97%以上的护生认为PBL教学可以提高自主学习所需要的选择信息的能力、合作学习能力、解决问题的能力,85%学生认为能提高学科知识的掌握程度,78%学生认为可提高学习主动性和兴趣。结论PBL教学是一种提高学生自主学习能力的教学法。要进一步提高PBL教学中学生的学习兴趣,必须将PBL教学与传统教学结合,优化PBL教学中问题、内容和时间的设置,强化教学和班级管理,提高教师科研水平。     

中国临床专业学生PBL教学临床实习效果分析

目的系统评价PBL教学法对我国临床专业学生临床实习效果的影响。方法计算机检索CNKI（1994～2008）、VIP（1989～2008）、万方数据库等,收集国内有关PBL教学法对比LBL教学法对临床专业学生临床实习效果的随机对照研究：在严格评价质量的基础上,使用RevMan5．0软件进行数据分析：结果最终纳入7篇研究。Meta分析结果显示：现有研究质量均不高,且异质性较大,数据无法合并,仅能采用描述性分析。PBL教学法与LBL教学法比较．有提高临床专业综合分析能力、自学能力、查阅文献能力、创新能力的趋势。结论PBL教学法相对于LBL教学法,可能会提高临床专业的教学效果,但由于纳入研究质量差异较大,有必要开展设计更严谨的随机对照试验来验证这种趋势。     

契约学习法在临床护理教学中的应用

目的探讨契约学习法在临床护理教学中的应用效果。方法将88名护士学生（以下简称护生）分为实验组（42名）,对照组（46名）。对照组采用传统的教学方法,实验组采用契约学习法进行教学,比较两组护生理论和操作等成绩的差异。结果实验组护生理论考核、操作考核、护理病历书写、读书报告书写成绩及基础护理、沟通能力和综合表现得分均优于对照组护生,两组比较,均P〈0．01,差异具有统计学意义。结论在临床教学中应用契约学习法可增强护生学习自律性,增强老师教学意识,提高教学质量。     

Learning strategies of first year nursing and medical students: A comparative study

Background

Interprofessional education (IPE), where two or more professions learn with, from, and about each other to improve collaboration and the quality of care, has been proposed as a curriculum strategy to promote mutual understanding between professions, thus helping to prepare health professionals to work in challenging contemporary health systems. Although there is support for IPE initiatives within health professional education, differences in student motivation and learning strategies are likely to contribute to the success of these initiatives.

Objective

To explore self-regulated learning strategies used by first year medical and nursing students, and to determine if these strategies were different among nursing students who were high achievers.

Design

A comparative survey design.

Setting

Nursing and medical nursing schools in a large university in the western region of Sydney, Australia.

Participants

Six hundred and sixty-five first year nursing (n = 565) and medical (n = 100) students in a large university in the western region of Sydney were surveyed to assess motivational and learning strategies using The Motivated Strategies for Learning Questionnaire (MSLQ). Data relating to sociodemographic characteristics and academic performance were also collected.

Results

Nursing students were significantly older than medical students (mean age: 24.4 years versus 19.4 years; p < 0.001), and there were also more females in the nursing student group (82% versus 56%; p < 0.001). Although nursing students had a higher mean score for extrinsic goal orientation compared to medical students (p < 0.001), medical students had higher mean scores for the other four learning strategies measured: peer learning (p = 0.003), help seeking (p = 0.008), critical thinking (p = 0.058), and time and study environment management (p < 0.001). Similarly, the grade point average (GPA) of medical students at the end of their first year was significantly higher (4.5, S.D. 1.4 versus 3.6, S.D. 1.3; p < 0.001) compared to that of nursing students.

Conclusion

While interprofessional education is seen to have many benefits for students, this study demonstrates differences in motivational and learning strategies between nursing and medical students that may impact on the success of interprofessional programs.