Worldviews on Evidence-Based Nursing最新文献

Background: Globally, healthcare leaders are experiencing escalating levels of burnout and job dissatisfaction, which are exacerbated by increasing workforce turnover rates. Innovative solutions are urgently needed to address these challenges and stabilize healthcare leadership teams.

Aims: This study evaluated the implementation of a 4-day workweek for nursing and respiratory leaders as a strategy to reduce burnout, enhance well-being, and improve workforce stability.

Methods: Conducted at two hospitals in the United States, this 4-month pilot study was guided by the Institute for Healthcare Improvement's Joy in Work framework. Thirty-eight healthcare leaders voluntarily transitioned to a 4-day workweek. Biweekly, self-report surveys were used to measure burnout, job satisfaction, and joy in work. Follow-up surveys were conducted 6- and 12-months post-implementation to assess long-term outcomes and scalability.

Results: Burnout decreased from 61% to 4%, job satisfaction increased from 71% to 96%, and joy in work rose from 34% to 86%. No changes in patient safety, satisfaction, or hospital-acquired conditions were observed. Qualitative feedback emphasized enhanced work-life balance, improved morale, and decreased emotional exhaustion while identifying challenges related to workload redistribution and ensuring 24/7 accountability. Follow-up data confirmed sustained improvements in well-being and scalability without adversely impacting organizational outcomes.

Background: The COVID-19 pandemic exacerbated barriers in the nurse work environment, influencing nurse well-being. This paper examines if workplace factors moderate temporal changes in the mental and behavioral health of nurses.

Methods: Cross-sectional data from the HealthyNurse survey collected between May 2017 and July 2023 were analyzed (n = 34,273). Job resources was estimated by average agreement (0 = strongly disagree to 4 = strongly agree) with being treated with respect, recognized for efforts, and the employer values their well-being. Average agreement with working overtime, being assigned a high workload, and working through breaks estimated job demands. Multivariable regression models estimated the effect modification of job demands and job resources on changes over time in hours of sleep and odds of feeling sad, down, or depressed, past 30-day binge drinking, and current tobacco use.

Results: By each year, nurses increased sleep hours (b = 0.011; 95% CI [0.004, 0.018]), but had greater odds of poor mental health (OR = 1.102; 95% CI [1.086, 1.117]), binge drinking (OR = 1.022, 95% CI [1.007, 1.036]), and tobacco use (OR = 1.070; 95% CI [1.043, 1.098]). With higher job resources, sleep increased at a greater rate over time (b = 0.016; 95% CI [0.007, 0.024]) and the odds of binge drinking increased at a lower rate over time (OR = 0.981; 95% CI [0.965-0.998]). Conversely, the prevalence of poor mental health increased at a greater rate over time when job demands were high (OR = 1.018; 95% CI [1.004, 1.033]).

Linking evidence to action: Job demands and job resources may lead to differential mental and behavioral health among nurses. Understanding how these workplace factors can influence nurse health is an important and upstream approach to support well-being in times of crisis.

Background: On average, about 17% of new graduate registered nurses (NGN) leave within the first year of employment, leading to high turnover costs. A mentorship program can improve NGN retention and positively impact patient care. A significant opportunity exists for healthcare organizations to protect the investment of NGN.

Aim: To implement an evidence-based mentorship program to improve NGN retention.

Implementation: A 3-month mentorship program was implemented at a Magnet-designated Midwest 1300-bed integrated community-based healthcare center. Twenty matched pairs participated in the program, which was guided by the American Medical-Surgical Nurses Mentorship Program.

Outcomes: Data included results from 18 mentor-to-mentee pairs that completed the 3-month program. Post-implementation confidence/competency scores showed a slight increase from baseline. Intent to stay and job satisfaction scores were moderately high post-implementation. The average program satisfaction score for both groups was 69.5%. The cost of the program was about $4000. All mentees remained employed 3 months post-implementation, which resulted in the organization avoiding a turnover loss of approximately $480,000.

Linking evidence to practice: An evidence-based practice approach was used to address NGN turnover at a midwestern healthcare center. The initiative retained the first cohort of NGN while showing an organizational return on investment. Implementation of a 3-month mentorship program is cost-effective and can impact NGN retention and turnover.

Background: Patients with chronic kidney disease on hemodialysis experience complex symptom clusters that impact their quality of life. Simplifying symptom management is essential to improve patient care and outcomes. However, there is no comprehensive evaluation of these simplification methods in current literature.

Aim: To evaluate and synthesize strategies for simplifying the symptomatology associated with hemodialysis to improve patient outcomes and management practices.

Methods: We conducted a systematic review. We performed a comprehensive literature search across Pubmed, CINAHL, Embase, Web of Science, Scopus, CNKI, VIP database, and Wanfang in April 2024. Data synthesis was narrative due to the heterogeneity of the methodologies. Studies were selected based on predefined criteria focused on symptom simplification strategies among adult hemodialysis patients. Articles were retrieved and assessed for relevance and quality through April 2024.

Results: We identified 18 eligible studies from an initial pool of 18,324 records, focusing on variable-centered, person-centered approaches and approaches to identifying the main symptoms to symptom simplification. The studies varied significantly in their methodological quality and findings but commonly reported symptom clusters that correlated with poor patient outcomes.

Linking evidence to action: This review underlines critical areas for advancement in hemodialysis patient care through strategic symptom management integration. Our findings emphasize the necessity of implementing simplified symptom assessment protocols in routine clinical practice, thereby enhancing patient engagement and outcomes. Additionally, the results advocate for ongoing research into personalized care approaches, underscoring the potential for these strategies to decrease symptom burden significantly. These insights should inform both policy and educational programs, encouraging the adoption of standardized practices across healthcare systems. Moreover, the study highlights the need for management strategies that align with patient-reported outcomes, fostering a more patient-centered approach in healthcare settings. Ultimately, this evidence should guide educational efforts to better equip healthcare providers with the tools necessary for effective symptom management in hemodialysis care.

Trial registration: PROSPERO: CRD42023473789.

Background: Evidence-based practice (EBP) attributes are associated with improved patient care outcomes. There is a paucity of knowledge on pediatric nurses' attributes based on their clinical sub-specialties.

Aim: To investigate the relationships between pediatric nurses' EBP attributes and background variables, including their academic degree, years of experience, and clinical specialty.

Methods: A convenience sample of 185 nurses participated in this descriptive, cross-sectional study. The electronic surveys included 11 background questions and the short-versions of the EBP Beliefs Scale, Organizational Culture and Readiness Scale, and EBP Implementation Scale.

Results: EBP belief scores were notably higher in pediatric nurses in neonatology, critical care, and among nurse leaders. No statistically significant difference was found in EBP organizational culture among nurse leaders, clinical nurses, and advanced practice nurses. EBP implementation was favorable in neonatology, acute care, and nurse leaders. No significant results were found in EBP attribute scores related to nurses' age, academic nursing degree, or years of experience.

Linking evidence to action: This study confirmed findings from prior studies acknowledging the impact nurse leaders have on creating and sustaining a favorable EBP culture and implementation science. Organizational attributes such as Magnet status, a shared governance structure, support for specialty certification, and EBP mentorship also reinforce nursing EBP attributes. Further research should investigate unit-level strategies and measure the impact on pediatric patient care outcomes.

Background: Previous studies regarding mind-body exercise among people with breast cancer mostly focused on one type of mind-body exercise and provided conflicting results.

Aims: This paper aims to systematically synthesize the evidence hierarchy and examine the credibility of previous meta-analyses of different types of mind-body exercises.

Methods: We searched PubMed, Embase, Cochrane Library, Web of Science, and Epitemonikos from database inception to February 2nd, 2024, for meta-analyses of randomized controlled trials. Included meta-analyses examined the effects of mind-body exercises on at least one outcome of health-related quality of life, cancer-related fatigue, depression, anxiety, and sleep quality in breast cancer patients. The random effects estimates (Hedges'G), 95% prediction interval, small study effect, and excess significance bias were calculated. Furthermore, we categorized meta-analyses based on the evidence credibility criteria and assessed quality using A Measurement Tool to Assess Systematic Reviews 2.

Results: The umbrella review included a re-analysis of 16 meta-analyses of 9 articles including 134 randomized controlled trials involving 9469 breast cancer patients and survivors. We identified 3 articles as "low" quality and 6 articles as "critically low" quality. Convincing evidence supported the effectiveness of Yoga intervention in reducing depression symptoms (G = -0.77, 95% Confidence Interval [-0.93, -0.61]). However, 11 meta-analyses were supported by weak evidence (1 for Qigong alleviated depression, 4 for Qigong, Baduanjin, Tai Chi Chuan, and Yoga improved health-related quality of life, 3 for multiple mind-body exercises, Tai Chi Chuan, and Yoga reduced cancer-related fatigue, 2 of Baduanjin and Yoga reduced anxiety, as well as 1 of Yoga improved sleep quality).

Linking evidence to action: Mind-body exercises, especially yoga, may be beneficial for improving health-related quality of life and mental health for breast cancer patients. Further high-quality interventions investigating diverse mind-body exercise interventions are warranted to ascertain the effectiveness of health-related quality of life and mental health outcomes.

Background: Prior international collaborative studies indicated that job satisfaction, a factor of nursing work wellbeing (WWB), is closely linked to retention, with notable cross-country differences. However, limited regional comparisons, especially between Central and Eastern Europe (CEE), North America, and the Middle East and North Africa (MENA), restrict understanding of nurse wellbeing and retention regional impacts, limiting tailored strategy development.

Aims: This secondary analysis study compared the effects of region on nursing WWB and job satisfaction factors in CEE, MENA, and North America, aiming to identify those CEE region-specific predictors associated with and effects on job satisfaction and, in turn, WWB.

Methods: CEE (n = 1616), MENA (n = 1562), and North America (n = 1386) data were analyzed using descriptive and linear regression analytics (p < 0.001). The CEE sample included nursing staff from Croatian (n = 301), Polish (n = 215), Serbian (n = 489), and Slovenian (n = 611) nurses and nursing assistants. Six job satisfaction factors were examined: coworkers, patient care, participative management, autonomy, professional growth, and organizational rewards.

Results: The CEE region reported statistically significant lower mean scores and negative effects across all six job satisfaction factors compared to MENA and North America. Satisfaction with coworkers had the largest effect within the CEE region when compared to MENA and North America (ϐ = -0.26), while satisfaction with participative management had the smallest regional effect (ϐ = -0.10). Findings informed operational discussions for CEE-targeted retention interventions.

Linking evidence to action: Job satisfaction subscale factors facilitate the identification of empirically- and theoretically-informed operational actions to improve CEE nursing job satisfaction as an important factor of WWB and contribute to nursing retention.

Background: Nationally and in Hawaii, nurses are in crisis with high rates of distress, burnout, and intent to change jobs. Organizations need evidence-based strategies to support nurse well-being.

Purpose: Informed by the National Academy of Medicine Factors Affecting Clinician Well-Being Model, this study aimed to identify individual and external factors associated with nurses' well-being.

Methods: In December 2023, an online survey of hospital-based nurses from two major hospitals, representing various unit types, was conducted in Hawaii. Survey measures included individual (role, personal characteristics, skills/abilities) and external factors (organizational, environmental) that support clinician well-being. The outcome (well-being) was measured using the well-being index (scores ranged from -2 [excellent] to 9 [very poor]). The analysis included general linear modeling with stepwise backward selection.

Results: The final sample included 552 nurses. Years of experience were evenly distributed, and the majority worked ≥ 36 h/week (85.9%), worked in intensive-focused or other specialties units (53.8%), and identified as female (87.3%). The nurses identified their race/ethnicity as 27% Filipino, 23% White, 14% Japanese, 11% Other Asian, 6.1% Hispanic, 5.1% Native Hawaiian/Pacific Islander (NHPI), and 14% mixed or other race. The average well-being score was 2.8 (SD = 2.3). NHPI had the lowest (Mean ± SD = 2.2 ± 2.2), and Filipino and White nurses had the highest well-being scores (3.0 ± 2.2; 3.0 ± 2.0, respectively), although no significant racial/ethnic difference was found. Several internal and external factors were significantly associated with well-being. For example, working ≥ 36 h/week, reports of experienced burnout, having primary caregiving responsibility outside of work, lower self-reported physical health, and the experience of workplace violence all increased average well-being scores (worsened well-being). In contrast, having higher personal resilience, no leadership responsibilities, the belief that their organization is responsive to complaints and concerns, and appropriate ancillary staff to support their work all decreased average well-being scores (improved well-being).

Linking evidence to action: Healthcare organizational leaders and policymakers must urgently correct system issues contributing to burnout, suboptimal mental health, decreased well-being, and attrition among nurses. Healthcare organizations should cultivate wellness cultures and provide infrastructure that offers evidence-based interventions to support nurses' well-being.

Background: Female patients with an acute cardiovascular event face a care disparity due to implicit bias (IB) by clinical providers in the emergency department (ED).

Objective: The objective of this study is to evaluate and compare the effects of IB training on clinical practice change in the cardiac care of men versus women through education on IB, comparing attitudes of clinicians pre- and post-education. The implementation of the evidence-based practice project included 30 days after education. Attitudes and perceptions of the IB training were measured with a 10-item survey and open-ended feedback on the education for future use.

Outcomes: The Wilcoxon signed-rank test demonstrated significant increases in staff knowledge post-education. Pearson chi-square tests used to evaluate educational effects for before and after education showed that younger female patients (under 50 years of age) had evidence of pre/post differences in frequency of electrocardiogram tests and desired changes in troponin lab assessments. Before the education, evidence of gender difference disparities, except for EKG testing and troponin labs for older patients, existed. Post-education, evidence of gender differences in medications used for younger patients was also revealed.

Implications for practice: Education on IB creates awareness potentially altering cardiovascular care positively.

Background: Unsupervised exercise is beneficial for pregnant women, and ongoing exercise may affect the course of pregnancy. Therefore, promoting continued exercise among women is critical.

Aims: To implement a home-based exercise program, guided by the COM-B model theory, and assess its effects on depression, sleep quality, and sense of control among pregnant women.

Methods: Pregnant women (N = 100) were selected and randomly assigned in a 1:1 ratio to either the intervention or the control group. Both groups received exercise instruction. The intervention group received an additional intervention based on the COM-B model theory. Depression and sleep quality were evaluated at 28 and 35 weeks of gestation, while women's sense of control was assessed at 35 weeks of gestation.

Results: In total, 91 participants completed the study, with 100 included in the intention-to-treat analysis. The intervention group showed improvement in depression at 28 and 35 weeks of gestation and in sleep quality at 35 weeks. Although there was no significant difference in the sense of control between the groups, the intervention group demonstrated better emotional control.

Linking evidence to action: A theory-guided exercise intervention shows benefits in improving third-trimester depression, sleep quality, and emotional control. Therefore, exercise programs during pregnancy should consider to encompass capacities, opportunities, and motivations to encourage exercise behavior.