Working with the team: strategies employed by hospital cancer nurse specialists to implement their role

Aim. This paper describes the strategies used by cancer nurse specialists in the UK to implement their role within the multiprofessional team. Background. The prevalence of cancer increasingly preoccupies the developed world causing concern about the effective use of healthcare resources. The demand to contain healthcare costs and meet the complex needs of patients has led to the development of new and different types of nurse specialist roles. In the UK, these initiatives have been supplemented by reorganizing cancer services to ensure care is delivered by collaborative multiprofessional teams: nurse specialists are considered core team members. While role ambiguity and conflict are acknowledged as barriers to the successful introduction of new roles, little is known about the strategies used by individuals to facilitate role implementation. Design. A grounded theory design using purposive and theoretical sampling. Methods. Twenty‐nine cancer nurse specialists from five hospitals participated in observation and semistructured interviews. The data were analysed concurrently using the constant comparative method. Results. Acceptance, especially by doctors, was the main problem facing cancer nurse specialists. In addition, they experienced insufficient organizational support for their role. Difficulties with acceptance impaired nurses’ ability to provide supportive care to cancer patients. Nurse specialists responded by employing several strategies including building relationships and establishing role boundaries. Conclusions. Some strategies used by nurse specialists are more successful than others in facilitating role implementation. While recommendations exist to assist the introduction of new roles in practice, their implementation by healthcare organizations may be limited. Future approaches should focus on helping nurses develop awareness of the problems they face, why they arise and effective mechanisms for their resolution. Relevance to clinical practice. The findings highlight the mismatch between cancer policy aspirations and reality and the actions taken by nurse specialists to overcome the problems they encounter.     

Barriers to Evidence-Based Practice Utilization in Psychiatric/Mental Health Nursing

Many psychiatric/mental health nursing (PMHN) practices have been affected by old traditions and haphazard trial and error instead of by established scientific evidence. The purpose of this article is to explore and analyze the barriers surrounding evidence-based practice (EBP) in PMHN. I identify some strategies to overcome these barriers in an attempt to incorporate EBP within the framework of PMHN services. Barriers explain the lack of EBP in today's PMHN environment. The barriers identified in this research are: the nature of the evidence, the contribution of the psychiatric nursing researchers to EBP, the personal characteristics of psychiatric nurses, and organizational factors. While the barriers to EBP for PMHN practice are clearly apparent, the challenge, now, is to build up creative strategies through which psychiatric nurses are better able to provide EBP care as part of their everyday performance. Adaptation of a more dynamic form of EBP, increasing the number of PMHN researchers, conducting clinical research projects, choosing suitable journals for publication, training the psychiatric nurses about computer skills, integrating the EBP principles into nursing curricula, developing journal clubs, and offering organizational facilitators are essential prerequisites for the achievement of EBP in the PMHN field. It is no longer justifiable for psychiatric nurses to be deficient in knowledge and skill since the advantages of EBP for patients are well-documented.     

Overcoming challenges for nurse-led research in the neonatal intensive care unit

Nurse researchers have made considerable contributions to the science of nursing. Conducting studies in the clinical environment is the best way to determine what interventions are most effective. Because most research is conducted by nurses from academic settings, they often are not viewed as credible by nurses in clinical practice, nor are they accepted readily into the neonatal intensive care unit (NICU) to conduct research. This article addresses the barriers to implementing and conducting studies in the NICU setting, and provides suggestions for creating collaborative and mutually satisfying relationships between nurse researchers and healthcare staff in the NICU. Partnerships built on mutual respect are necessary to have successful research outcomes, and to continue to build knowledge for the best neonatal care.     

Ways of knowing in precision health

Precision health can provide an avenue to bridge and integrate ways of knowing for research and practice. Nurse scientists have a long-standing interest in using multiple sources of information to address research questions of significance to the profession and discipline of nursing, which can lead to much needed contributions to precision health care. In this paper, nursing scientists discuss emerging research methods including omics, electronic sensors, and geospatial data, and mixed methods that further develop nursing science and contribute to precision health initiatives. The authors provide exemplars of the types of knowledge and ways of knowing that, using these and other advanced data and analytic strategies, may advance precision health within the context of nursing science.     

Critical Multiplism: A Research Strategy for Nursing Science

This paper describes critical multiplism from the perspective of the world views and models of scientific inquiry that frequently guide the work of nurse scientists. Nurse scientists may wish to consider critical multiplism as a research strategy within a dialectical model of scientific inquiry to study the multiple realities of interest to nurses. This approach to nursing knowledge development may enhance the usefulness of nursing research findings in nursing practice.     

The role of nurses in surveillance to enhance global health security: A delphi study

BackgroundInternationally, nurses are gaining recognition for their contributions to public health and global health initiatives, however, their contributions to surveillance and the detection of new and emerging infectious disease, which is an important element of global health security, remain largely unknown.PurposeThe purpose of this study was to investigate the perceptions of nurse experts related to the current and optimal roles of nurses in surveillance of new and emerging infectious diseases. Additionally, this study aimed to identify the skills needed by nurses in all practice settings for optimal performance of surveillance and to identify barriers to achieving optimal performance of surveillance.MethodsA three-round Delphi study was conducted. Nurse experts participated in Round 1 interviews followed by ranking current and optimal role, skill, and barrier statements in Rounds 2 and 3.FindingsFindings revealed four current roles and 13 optimal roles for nurses in surveillance, 13 skills needed to perform surveillance activities, and seven barriers to optimal performance of surveillance activities by nurses.DisucssionResults of this study are intended to inform nursing practice and education in the U.S., and to provide guidance on the role of nurses in surveillance of new and emerging infectious disease as part of the Global Health Security Agenda.     

Building capacity for nurse‐led research

Aim: To discuss factors that have influenced the development of research capacity among nurses in lower and middle‐income countries (LMICs). Background: Concerned health scientists have addressed the importance of building research capacity among health professionals. Strengthening capacity specifically among LMIC nurses has been infrequently discussed. Without the requisite educational preparation or an enabling environment for research, nurses are unlikely to either demand research capacity‐building opportunities or initiate research examining nursing practice and health system challenges. Methods: A scan was conducted of nine internationally funded research capacity‐building initiatives to identify programme targeting and the proportion of nurse trainees. A literature review examined graduate and post‐graduate training opportunities for LMIC nurses, and barriers and enablers to nurses' involvement in research. Informal consultations were held with nurse leaders in 15 LMICs and leaders of eight LMIC nursing organizations. Findings: The scan found a generic targeting of health professionals with a very low percentage of nurse trainees. Programmes specifically targeting nurses did attract and prepare a significant number of nurses. Factors limiting nurses' involvement in research include hierarchies of power among disciplines, scarce resources, a lack of graduate and post‐graduate education opportunities, few senior mentors, and prolonged underfunding of nursing research. Conclusions: Fully engaging LMIC nurses in health services research may yield pragmatic and evidence‐informed service delivery and policy recommendations. Investments in supports for nursing research capacity may enrich global health policy effectiveness and improve quality of care.     

Development of the Massachusetts School Nurse Research Network (MASNRN): A Practice-Based Research Network to improve the quality of school nursing practice.

When school nurses embrace evidence-based practice (EBP), higher-quality care is provided to students, their families, and the larger community. Despite this, school nursing has been slow to embrace EBP. Practice-Based Research Networks (PBRNs), which capitalize on the combined strengths of clinicians and researchers to study clinical questions, are one approach to overcoming barriers towards advancing evidence-based practice (EBP) in school nursing. This article will briefly review EBP and PBRNs. The development of Massachusetts School Nurse Research Network (MASNRN), a PBRN designed to investigate health issues common across schools and to validate school nursing practice, will then be described. Details regarding MASNRN's mission, governance, communications systems, staffing, and network maintenance and funding will be explicated. MASNRN can serve as a model for PBRN development within the broader school nursing community.     

Strategies for overcoming barriers in implementing evidence-based practice

In summary, there are a variety of strategies that can be used to overcome barriers to implementing EBP in nursing. However, these strategies must be formally evaluated to determine their effects on changing nurses' knowledge, beliefs, and attitudes about EBP as well as their effects on changes in practice. For evidence-based care to evolve more quickly in nursing, individuals and systems must make a commitment to advancing EBP and allocating resources for this purpose. Basic and graduate nursing programs must begin to teach the value and foundations of EBP if nursing is to create a culture where EBP is the "norm" and not the rarity. Since research has found that health care professionals find practice more rewarding when engaging in EBP (Dawes, 1996), this movement could help to facilitate the retention of nurses in a time when the nursing profession is facing severe shortages. Finally, since there are numerous areas in which evidence does not exist to support current nursing practices, researchers and APNs need to unite in order to design and conduct studies to answer high-priority compelling clinical questions.     

How do nurse academics value and engage with evidence-based practice across Australia: Findings from a grounded theory study

BackgroundIntegrating evidence-based practice (EBP) into undergraduate education and preparing future nurses to embrace EBP in clinical practice becomes paramount in today's complex and evolving healthcare environment. The role that EBP plays in the practical lives of nursing students will depend on the degree to which it is promoted by academics, how it is incorporated into courses and its application to clinical setting. Hence, nursing academics play a crucial role in influencing its integration into curricula. Drawn from a larger doctoral study, this paper presents findings discussing how nurse academics value and engage with EBP.MethodsGrounded theory was employed to explore processes used by nursing academics while incorporating EBP into teaching and learning practices. Twenty-three academics across Australian universities were interviewed. Nine were also observed while teaching undergraduate students. Data were collected from semi-structured interviews and non-participant observation. In keeping with the tenets of grounded theory, data collection and analysis continued until theoretical saturation was reached. In total, four categories emerged. This paper focuses on the category conceptualised as Valuing and Engaging with EBP.ResultsHow nursing academics valued and engaged with EBP was closely associated with meanings they constructed around understanding it, attitudes and commitment to implementation while teaching and working clinically. Different opinions also existed in regard to what actually constituted EBP. However, they engaged with and valued EBP by keeping themselves up-to-date, being involved in research activities, using evidence in teaching, therefore leading by example. Participants identified a number of barriers influencing their engagement with EBP including heavy workloads, limited time, lack of commitment within their schools, lack of confidence with teaching EBP, and complexity of EBP application. Faculty clinical practice, committed academics, workload management and continuing education were highlighted as facilitators.ConclusionA number of barriers prevented academics from fully engaging with EBP at academic or practice levels. Academic institutions and practice settings need to employ strategic planning to overcome such barriers.     

Patient safety to frame and reconcile nursing issues

Canadian nursing leadership is called to advance a national patient safety agenda for the delivery of safe, quality care in professional practice environments. Yet, the nursing discipline is burdened by issues and challenges related to clinical practice and workplace dilemmas that contribute to barriers and obstacles to safe, quality and humane care. We propose that the many clinical challenges faced by nurses in Canada can be more fully understood when framed by a patient safety perspective. Nurse executive leaders and nurse scientists are called to reform clinical practice and conduct research to reconcile patient care safety issues. This paper applies findings obtained from nurses via focus groups led by the Academy of Canadian Executive Nurses (ACEN) and integrates these findings into a patient safety perspective via a conceptual framework.     

Evidence based practice – what is it and how can it be encouraged in orthopaedic nursing?

Evidence based practice (EBP) has attained a position of importance as an integral part of good and effective healthcare practice. The author examines briefly the historical context of EBP. Then reviews some of the arguments against the use of EBP and explores some barriers to implementing EBP in orthopaedic nursing and reflects on possible ways forward.Evidence based practice is not new, but pressures to follow this approach are increasing. Many of these types of initiatives could be introduced blindly. However, orthopaedic nurses need to step back and, in an unbiased manner, question the underlying principles to ensure they understand what is being done and if it leads to better patient care.     

Psychoneuroimmunology: an emerging framework for nursing research

Psychoneuroimmunology (PNI) is concerned with the mechanisms of bidirectional communication between the neuroendocrine and immune systems Investigators in other disciplines have used this framework to guide the examination of possible relationships between behavioural factors and the progression of immunologically mediated illnesses and to evaluate the role of immune products m central nervous system disturbances Nurse scientists have an opportunity to make unique contributions to the growing field of PNI Unlike basic science research, which has as its goal the generation of fundamental knowledge concerning biological or behavioural processes, nursing research is driven by the need to promote excellence in nursing science as a guide for nursing practice Although a few nurse scientists have conducted PNI research to date, additional studies are needed to generate new knowledge concerning mind-body interactions in health and illness and to develop strategies that promote mental and physical well-being in persons at risk for immune dysfunction This paper highlights the few recently conducted nursing studies grounded in a PNI framework to illustrate the utility of PNI in advancing nursing science     

Translational research: essential contributions from interpretive nursing science

Translating research into practice is a central priority in the National Institutes of Health Roadmap. Nurse scientists must reevaluate how proposed research fits within and contributes not only to the development of new knowledge, but to the translation of that knowledge to the care of diverse communities and populations. Key barriers to the translation of evidence based practices in health programs and initiatives have been identified in the health services and nursing literature. Contributions that interpretive research approaches enable in addressing those barriers are articulated.     

Barriers to nurse entrepreneurship: a study of the process model of entrepreneurship

PURPOSE: The potential for nurse entrepreneurship to contribute to the effectiveness of healthcare delivery is well acknowledged, yet it has not been fully realized. Using the process model of entrepreneurship, we attempted to glean information from nursing professionals through focus groups on the barriers to starting a business. DATA SOURCES: Two focus groups were used and expert moderators conducted these exercises. The first focus group included two hospital administrators, a nurse entrepreneur, an ophthalmology entrepreneur, and a dean of the nursing school familiar with nurse entrepreneurship. The second focus group used 20 students in a nurse practitioner program. CONCLUSIONS: The study findings indicate nurse practitioners and other nursing professionals do recognize the potential of nurse entrepreneurship. However, several barriers prevent them from exploiting the identified opportunity. IMPLICATIONS FOR PRACTICE: While the barriers are significant, we believe they can be overcome with coordinated action by individual nurses, professional associations, and public policy initiatives. Several suggestions are offered to nurses seeking to become nurse entrepreneurs.     

Migration of Lebanese nurses: a questionnaire survey and secondary data analysis

BACKGROUND: Nursing is becoming a mobile profession. Nurse migration is multifactorial and not limited to financial incentives. Non-economic factors that might lead to migration include poor recruitment and retention strategies, poor job satisfaction and working conditions, socio-political and economic stability, and the poor social image of the nursing profession. Lebanon is facing a problem of excessive nurse migration to countries of the Gulf, North America and Europe. No study has been conducted to understand the determinants and magnitude of the problem. OBJECTIVE: The objective of this study is to provide an evidence base for understanding the incidence of nurse migration out of Lebanon, its magnitude and reasons. DESIGN: A cross-sectional research design comprising both quantitative and qualitative methods was employed to achieve the stated objectives. This includes a survey of nursing schools in Lebanon, survey of nurse recruitment agencies, secondary data analysis and survey of migrant nurses. RESULTS: An estimated one in five nurses that receive a bachelors of science in nursing migrates out of Lebanon within 1 or 2 years of graduation. The majority of nurses migrate to countries of the Gulf. The main reasons for migration included: shift work, high patient/nurse ratios, lack of autonomy in decision-making, lack of a supportive environment, and poor commitment to excellent nursing care. Further, nurses reported that combinations of financial and non-financial incentives can encourage them to return to practice in Lebanon. The most recurring incentives (pull factors) to encourage nurses to return to practice in Lebanon included educational support, managerial support, better working conditions, utilization of best nursing practices and autonomy. CONCLUSION: Nurse migration and retention have become major health workforce issues confronting many health systems in the East Mediterranean Region. Our study demonstrated that nurse migration is a product of poor management and lack of effective retention strategies and sufficient knowledge about the context, needs and challenges facing nurses. Nurse migration in Lebanon underscores the importance of developing a monitoring system that would identify implications and help implement innovative retention strategies. Nurse migration out of Lebanon is likely to persist and even increase if underlying factors are not properly resolved.     

Nurses at the table: A naturalistic inquiry of nurses on governing boards

In an environment in which there is little or no nursing presence on governing boards in healthcare organizations (HCOs), physicians, and nonclinicians take responsibility for keeping the other board members apprised of the quality of patient care, including nursing‐generated, patient safety initiatives. Governing boards in HCOs are either not appointing nurses to governing boards or are not appointing nurses in numbers that are commensurate with the size and vital contributions of the profession. As a result, competent nursing professionals with an intimate understanding of quality care and patient safety are not in decision‐making roles that may redesign health care and improve patient care. The purpose of this qualitative study was to describe experiences of nurse board members who hold governing board appointments in HCOs, and to describe the facilitators of and barriers to holding governing board appointments, as experienced by those nurse board members. This novel research employed naturalistic inquiry to explore the experiences of 12 nurse board members who held appointments with voting privileges in HCOs. From the interview data emerged four distinct themes: leveraging relationships and networking, valuing the mission of the board, feeling respected for my participation, and committing to board work. Facilitators of and barriers to governing board appointments were suggested. Findings validated the few previous research studies found in the literature and have implications for nursing leadership and governance.