Journal of Nursing Management最新文献

Introduction. Shifting care from hospitals into community-based settings is a major policy goal internationally. Community health services in England currently face the greatest workforce shortages of all sectors, threatening the feasibility of this policy. Moreover, little is known about the extent of variation in community workforce provision regionally and how this relates to determinants of need. Aim. To analyse regional variation in the community services workforce in England between 2010 and 2021. Methods. We obtained NHS workforce statistics data on the number of nurses and nursing support staff providing community services at each NHS organisation in England, from March 2010 to November 2021. We aggregated the organisation-level data to both regional and national levels, which enabled us to maintain consistent units of analysis across the decade. To examine longitudinal trends and regional variation in workforce provision, we calculated the number of staff per 100,000 population aged 65+ in each region and each period. We then graphed and summarised the variation and examined the correlations with levels of deprivation and rurality. Results. There was a twofold variation in community services workforce provision between English regions. In November 2021, the number of staff per 100,000 people aged over 64 ranged from 300 in the South West to 697 in the North West. Most regions experienced a reduction in provision between 2010 and 2021, with a 21.2% reduction nationally. East of England experienced the largest reduction of 39.3%, whilst London experienced a 2.1% increase. In November 2021, regions with more deprived populations had higher workforce provision and regions with a larger proportion of residents living in rural areas had lower workforce provision. Conclusions. The size of the community services workforce has fallen relative to population needs, contradictory to the policy priority to enhance care in the community. There was substantial regional variation in the size of the workforce, which has persisted throughout the decade. Workforce provision was higher in more deprived areas but lower in rural areas, potentially impacting equitable access in rural areas.

Aim. The aim of this study was to understand the current status of knowledge-attitude-practice of ICU nurses in tertiary care hospitals regarding swallowing disorders after extubation of tracheally intubated patients and to analyse the influencing factors. Design. A cross-sectional study. Background. Most patients admitted to the ICU have an endotracheal tube, which may be the cause of acute and/or chronic problems after extubation. Therefore, training of ICU nurses and early extubation are essential to prevent these problems. Methods. A convenience sample of clinical nurses (n = 627) was selected from Grade A Hospitals in Northwest, North, and Central China as the study population. Survey instruments included the Questionnaire on ICU Nurses’ Knowledge, Attitude, and Practice of Postextubation Swallowing Disorders in Patients with Tracheal Intubation. Data Sources. Data were sourced from structured questionnaire responses. Results. A total of 647 ICU nurses participated in this survey, with 627 valid questionnaires. The three dimensions of knowledge, attitude, practice, and the total score of the questionnaire on ICU nurses′ knowledge, attitude, and practice of postextubation swallowing disorders in patients with tracheal intubation were (6.46±3.09), (7.53±1.69), (4.89±2.00), and (18.88±5.18), respectively. Multiple linear regression analysis showed that the factors affecting the total score of PED among ICU nurses were age, nationality, professional title, job satisfaction, and mode of employment. Gender, age, nationality, and job satisfaction were the factors that influenced the score of knowledge. The influencing factors of attitude score include gender, age, nationality, section, professional title, job satisfaction, and mode of employment. The influencing factors of the score of knowledge include professional title and job satisfaction. Conclusion. The current status of ICU nurses’ knowledge-attitude-practice regarding postextubation dysphagia in tracheally intubated patients is generally at a moderate to low level, and the level of knowledge-attitude-practice needs to be further improved. Implications for Nursing Management. The results of the study showed that the knowledge, attitude, and practice of ICU nurses towards tracheal intubation patients’ postextubation dysphagia were in the lower middle level. Therefore, it is necessary to improve the knowledge, attitude, and practice of ICU nurses towards tracheal intubation patients’ postextubation dysphagia. This may include, but is not limited to, the development of tools for assessing PED, systematic and professional training, and the development of multidisciplinary collaborative models.

Introduction. The COVID-19 pandemic has had a significant impact on healthcare professionals globally, with nurses facing diverse challenges at the forefront. Despite their resilience, nurses are experiencing emotional burdens, which have contributed to a growing intention to abandon the profession. Understanding these factors is crucial for addressing the global nursing shortage. Methods. A qualitative descriptive approach was utilized for this study. Nurses who were actively working during the last waves of the pandemic in Catalonia, Spain, were intentionally recruited through social media and personal contacts, and data were collected through online semistructured interviews until data saturation was reached. Data were analyzed using Braun and Clarke’s thematic analysis method. Results. Fourteen nurses, with an average of 22.8 years of work experience, were interviewed. Thematic analysis revealed three main themes: (1) the impact of COVID-19 on health, (2) factors influencing the decision to stay, and (3) recommendations to improve crisis management. Conclusion. Nurses faced significant emotional impacts but demonstrated dedication and resilience. Their decision to persevere was influenced by factors such as responsibility, guilt, and economic stability. Urgent measures are necessary to provide tailored mental health support and recognize emotional challenges in crisis preparedness.

Aims. This study aimed to analyze the effects of the surgery preparation time on patient outcomes. Background. Postoperative complications have a decisive effect on postoperative survival. The anesthesia time is a crucial determinant of such complications. Competent operating room nurses can shorten the surgery preparation time, which is the time from when anesthesia is first administered to the making of the surgical incision. The shortening of this preparation time can shorten the anesthesia time and may reduce postoperative complications. However, discussion of this preparation time is insufficient. Therefore, this study analyzed the effect of the surgery preparation time on patient outcomes. Methods. From electronic health records data, this retrospective cohort study used the data of 1,944 patients who had been immediately admitted to the ICU after their surgery between 2017 and 2020. The patients were divided into two groups: ≥30 minutes preparation time and <30 minutes preparation time groups. We performed chi-squared tests and t-tests to determine differences in preoperation, intraoperation, and postoperation characteristics of the patients and patient outcomes based on the surgery preparation time. Furthermore, we performed a multiple logistic regression by including 12 adjusted variables to determine the influence of the surgery preparation time on patient outcomes. Results. Among the 1,944 patients, 820 were in the ≥30 minutes preparation time group and 1,124 in the <30 minutes preparation time group. The multiple logistic regression analysis showed that the surgery preparation time affects alertness (OR = 1.44; 95% CI: [1.09, 1.90]), ventilator application (OR = 1.32; 95% CI: [1.03, 1.70]), and length of stay in the ICU (OR = 1.69; 95% CI [1.16, 2.47]). Conclusions. The surgery preparation time affects postoperative patient outcomes. The competence of operating room nurses is the most essential aspect of the surgery preparation time. Implications for Nursing Management. It is important to analyze operating room nurses’ tasks, standardize the tasks, and educate nurses according to their experience level to reduce the surgery preparation time and improve patient outcomes.

Aims. (i) To evaluate the scope and quality of nurse-patient interactions recorded in the clinical notes of inpatient mental health units and (ii) to identify nursing interventions recorded in the context of the nurse-patient relationship in the clinical notes of inpatient mental health units. Design. A multimethod approach was use. Methods. Employing a quantitative cross-sectional design for the first aim, and a qualitative content analysis design of secondary data for the second aim. In total, 1,714 clinical notes were examined from 44 randomly selected patients who were hospitalized in five mental health units over the years 2022-2023. Results. The patient’s experience of the interaction was present in 69.9% (n = 1,198) of the notes. However, only 12.0% (n = 205) of the notes reached a sufficient standard of quality in terms of describing the nurse-patient interactions. Specifically, more than half of the notes did not reflect any type of nursing intervention (n = 723; 60.4%). Thirty interventions compatible with the nursing intervention classification were identified, of which more than 70% corresponded to domains in the physiological area. Conclusion. This study shows that the quantity and scope of patients’ clinical notes in mental health units do not sufficiently reflect the interventions performed by nurses, nor the quality or impact of these interventions in the context of the nurse-patient therapeutic relationship. Implications for the Profession and/or Patient Care. Improving the quality of clinical notes by integrating interventions and their impact can increase the quality of nursing care. Impact. The use of standardized nursing terminologies would contribute to the understanding of the extent and quality of nurse-patient interactions recorded in clinical notes. Thus, standardized documentation would also help to improve these interactions and their recording, which will facilitate decision-making. Reporting Method. Findings were reported using COREQ and STROBE guidelines. Patient or Public Contributions. There were no patient or public contributions.

Background. Although retaining new nurses is imperative for the future of the nursing profession, it remains a challenging task in the healthcare industry. Understanding the career journey of new graduates as they transition from students to nurses is vital. However, longitudinal studies investigating the factors influencing retention during this period are lacking. Aim. The aim of this study is to identify the influencing factors and develop a longitudinal prediction model for new graduate nurse retention. Methods. A secondary data analysis was conducted using the New Nurse e-Cohort Study dataset from two survey periods, November–December 2020 and February–March 2022. The participants were categorized into either retention or turnover groups based on their turnover experiences. A decision tree based on classification and regression tree (CART) analysis was utilized. Results. Of the total 586 participants, 463 (79%) were in the retention group. The CART model highlighted that new nurses’ retention was significantly associated with younger age, higher readiness for practice (clinical problem-solving) during the nursing program, lower transition shock (such as confusion in professional values, loss of social support, and conflicts between theory and practice), and a higher person-environment fit (person-job fit). The predictive accuracy of the CART model was 79.7%. Conclusion. To retain new nurses, nursing educators and hospital managers should collaborate to prepare nursing students for actual practice, offer support during organizational socialization, and foster healthy professional values for competence in the workplace. Implications for Nursing Management. Transforming the educational strategies of nursing programs and hospital management policies is imperative to ultimately enhance the retention of new graduate nurses.

Aim. To identify the barriers and enablers to the implementation of a national policy to increase and develop the advanced nurse practitioner (ANP) workforce in Ireland. Background. The Department of Health (Ireland) introduced a policy to increase the number of ANPs to 2% of the nursing workforce. Evaluation provides information to inform successful policy implementation and development of ANP roles in healthcare services. Methods. Qualitative descriptive design. Twenty candidate ANPs participated in four focus groups. Nine key stakeholders were also interviewed. Results. Analysis identified four barriers: lack of infrastructural resources; delay in releasing and arranging replacements for candidate ANPs; role resistance from administration, allied healthcare professionals and other nurses; and lack of organisational readiness. The five enablers were: supportive physicians; Nursing and Midwifery Practice Development Units; supportive directors of nursing; role awareness and clarity; and educational preparation. Conclusions. This evaluation identifies barriers and enablers to the implementation of a national policy to increase the critical mass of advanced practitioners within the healthcare services. Evaluation at the implementation phase informed the roll-out of future advanced practice initiatives. Implications for Nursing Management. To support advanced practice development, leadership, infrastructure, and resource planning are needed to harness known enablers and address identified barriers to the implementation and sustainability of these posts.

The COVID-19 pandemic has exacerbated the difficulties nurses face, resulting in higher turnover rates and workforce shortages. This study investigated the relationships between nurses’ moral distress, burnout, and turnover intention during the last stage of the COVID-19 pandemic. It also explored the coping strategies nurses use to mitigate moral distress. Utilizing a mixed-method approach, this study analyzed data from 307 nurses caring for patients with COVID-19 in acute care hospitals through an online survey conducted in November 2022. Our data analysis encompassed quantitative methods, including descriptive statistics and path analysis, using a generalized structural equation model. For the qualitative aspect, we examined open-ended responses from 246 nurses using inductive content analysis. The quantitative findings revealed that nurses’ moral distress had a significant direct effect on turnover intention. In addition, burnout significantly mediated the relationship between moral distress and turnover intention. Qualitative analyses contextualized the relationships uncovered in the quantitative analyses. The qualitative analysis identified various positive and negative coping strategies. Positive strategies included a commitment to minimize COVID-19 transmission risks, adopting a holistic approach amidst the challenges posed by the pandemic, voicing concerns for patient safety, engaging in continuous learning, and prioritizing self-care. Conversely, negative strategies involved adopting avoidance behaviors stemming from feelings of powerlessness and adopting a passive approach to one’s role. Notably, some participants shifted from positive to negative coping strategies because of institutional barriers and challenges. The findings underscore the importance for hospital administrators and nurse managers to acknowledge the impact of the pandemic-related challenges encountered by nurses and recognize the link among moral distress, burnout, and turnover intention. It highlights the essential role of organizational and managerial support in fostering effective coping strategies among nurses to address moral distress.

Objectives. To examine the effectiveness of a patient-family (carer) partnership intervention on the BP control, self-care and self-efficacy for hypertensive people, and dyadic-relationship quality, depressive and anxiety symptoms, and health-related quality of life for the family dyads (hypertensive people and family carers) in rural communities of mainland China. Design. A randomised controlled trial. Methods. A total of 110 family dyads were randomly recruited from village clinics and randomly allocated to the intervention group (n = 55) or control group (n = 55). Family dyads in the control group received usual care. In addition to the usual care, family dyads in the intervention group received the individual-based, five-session patient-family (carer) partnership intervention. The primary outcomes included SBP, DBP, and the proportion of people with normal controlled BP. EuroQol five-dimensional-five-level (EQ-5D-5L) was adopted to evaluate participants’ health-related quality of life. Data were collected at the baseline (T0), one-month (T1), and three-month postintervention (T2). Generalised estimating equation model was adopted to test the study hypotheses on all study outcomes. Results. Compared with the control group, hypertensive people in the intervention group had a greater reduction in SBP by 10.10 mmHg and DBP by 4.66 mmHg and a larger proportion of people with normal BP at T2, as well as statistically significant improvements at T1 and T2 in dyadic relationship, self-care, antihypertensive drug-titration rate, anxiety symptoms, and health-related quality of life. The intervention also had statistically significant positive effects on family carer’s dyadic relationship and health-related quality of life at T1 and T2. Conclusion. The patient-family (carer) partnership intervention has the potential to improve hypertensive people’s BP control and family dyad’s dyadic-relationship quality and mental health at short-to-medium term follow-ups. Implications for the Profession and/or Patient Care. This study provided evidence and direction to support healthcare providers in developing and implementing patient-family (carer) partnership intervention for hypertension care in rural areas. This trial is registered with ChiCTR1900027087.

Background and Objectives. The scarce empirical and scientific information concerning evidence-informed management reports various benefits for nurse managers, including reduced staff turnover, enhanced working environments, and improved patient outcomes and policy implementation. This review summarizes best available evidence on facilitating utilization of evidence-informed management practices by nurse managers in healthcare facilities. The review could assist in a comprehensive overview of determinants that could assist nurse managers’ successful utilization of evidence-informed management. Methods. An integrative review of the literature was conducted, including peer-reviewed articles published between 2010 and 2022. The databases used were BioMed Central, CINAHL Complete, MEDLINE Complete, PubMed (via EBSCOhost), the Complimentary Index (Taylor and Francis, Elsevier, Wiley, and Springer), Sabinet, ScienceDirect, and Scopus, followed by a manual search using Google Scholar and a citation search. Johns Hopkins Nursing Evidence-based Practice Research and non-Research evidence tools were used for appraisal. Thematic analysis was used to synthesize the extracted data. Results. Based on thirteen determinants influencing nurse managers’ utilization of evidence-informed management practices, three themes were identified from a total of thirteen relevant studies: (1) Nurse manager determinants in utilization of evidence-informed management (Microlevel); (2) Organizational determinants in utilization of evidence-informed management (Mesolevel); (3) External stakeholders and context determinants of utilization of evidence-informed management practices (Macrolevel). Conclusion. The themes were found to be interconnected and interdependent, facilitating the effective utilization of evidence-informed management by nurse managers at micro-, meso-, and macrolevels, but highlight the need for strengthening health systems and support. Future studies are required to provide a more comprehensive understanding of the determinants influencing nurse managers’ utilization of evidence-informed management practices. Implications for Nursing Management. For nurse managers to optimally utilize evidence-informed management, executive management and policymakers require to provide resources and support such as continuous education, incentives, effective communication, funding structures, and ownership.