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Source publication
Aims
To explore and describe hospital nurses' perceptions of leadership behaviours in facilitating patient participation in fundamental care.
Design
An ethnographic interview study.
Methods
Individual semi‐structured interviews with 12 nurses with a bachelor's or master's degree working at a university medical centre were conducted between Februa...
Citations
... To overcome these barriers, nurses need to be supported and empowered to embrace transformational leadership. Role modelling is essential (Bahlman-van Ooijen et al. 2023) next to including all team members. In addition, facilitation by a coach has been identified as essential to developing nursing practice and improving the quality of care (McCormack, Manley, and Titchen 2013). ...
Aims
To explore how coaching can facilitate the development of an Evidence‐Based Quality Improvement (EBQI) learning culture within nursing teams in hospital and community care settings. This study also explores the specific contextual factors that influence effective outcomes.
Design
Action research.
Method
Nine teams, including 254 nurses were selected from four hospitals and two community care organisations to participate in the development of an EBQI‐learning culture under the guidance of internal and external coaches. Data were gathered from 27 focus groups with 56 unique participants (of whom 31 participated multiple times) and six individual interviews with three external coaches. Transcripts of all interviews were subjected to abductive thematic analysis.
Results
To promote an EBQI learning culture in nursing teams, it is essential that internal coaches effectively guide their team members. The internal coaches in this study focused on enhancing readiness for EBQI by providing support, encouraging involvement and motivating team members. They deepened innovation competencies including assessing daily care, implementing well‐structured changes in care practices and embedding small steps in the change process in daily routines. It was found that barriers and facilitators within the team's context can influence the development of EBQI‐learning culture and therefore need to be considered when seeking to make changes. The presence of external coaches served as a valuable resource and a motivator in supporting internal coaches to apply and improve their coaching skills.
Conclusions
To stimulate the development of an EBQI‐learning culture, internal coaches need to focus on team readiness to work with EBQI. Priority needs to be given to enhancing the care change competencies of team members. Barriers to change must also be addressed. Internal coaches require external support and motivation to continually develop coaching skills.
Reporting Method
The Standards for Reporting Qualitative Research.
Patient or Public Contribution
No patient or public contribution.
... Across these nine sites, the managers trusted staff to already facilitate patient participation, but the IFs described it as hard to ensure that enough time was set aside to work on the implementation of more person-centered patient participation. This is consistent with findings showing that time and work pressure are common barriers to enhancing patient participation, and nurses tend to focus on their tasks rather than integrating patients' needs [44]. Another limitation highlighted by the IFs was staff shortage, making staffing a priority. ...
... This can procure an attitude among staff that their abilities to affect and change routines are limited, which in turn can prevent their involvement in future implementation of new innovations. A task-oriented management approach is known to hamper knowledge implementation [43], particularly when it comes to changes to nursing practice in favor of more person-centered care [44]. This would need to be further addressed in future projects and events. ...
Background
The transfer of innovations into healthcare is laden with challenges. Although healthcare professionals are expected to adopt and fulfil new policies, a more person-centered healthcare with conditions for preference-based patient participation is anticipated.
Methods
The aim of the study was to evaluate two implementation strategies for person-centered patient participation in kidney care, including dissemination of a clinical toolkit, and additional training and support of internal facilitators. Nine Swedish kidney care units joined the study (August 2019–September 2021), strategically organized into: a control group (three sites, no support); a standard dissemination group (three sites, with a tool for patient participation and guidance disseminated to the site managers); and a facilitated implementation group (three sites, with the tool and guidance disseminated as above, plus a six-month support program for designated internal facilitators). This process evaluation was comprised of repeat interviews with managers (n = 10), internal facilitators (n = 5), recordings, and notes from the interventions, and Alberta Context Tool survey data (n = 78). Hybrid analyses comprised mixed methods: descriptive and comparative statistics, and qualitative descriptive analysis.
Results
None of the control group sites addressed patient participation. While the standard dissemination sites’ managers received and appreciated the toolkit, they made no attempts to make further use of it. In the facilitated implementation group, five internal facilitators from three sites engaged in the support program. They welcomed the opportunity to learn about preference-based patient participation, and about implementation, including potentially enhanced opportunities for preference-based patient participation via the tool. Each site’s facilitators developed a separate strategy for the dissemination of the tool: the tool was used with a few patients in each site, and only some staff were involved. Although noting a general interest in improving patient participation, the internal facilitators described limited local support. Rather, they suggested a longer support program and more local backing and engagement.
Conclusions
Facilitating person-centered patient participation is complex, given the need to address attitudes, beliefs, and behaviors. This study indicates slow uptake and change, and more efficient strategies are needed to ensure the fundamentals of care remain accessible to all.
... Rural nurses described resuscitation training as predominantly focused on the technical skills, leaving a growing need for rural nurses to develop nontechnical skills such as leadership that are specific to rural emergency departments . Nursing leadership is recognised as a critical factor in enhancing the quality of care by supporting innovation (Stanley and Stanley 2019), influencing staff behaviours (Whitby 2018) and ensuring the delivery of evidence-based practice (Ooijen et al. 2022). These skills empower nurses to lead effectively during critical situations, communicate clearly with external teams and strengthen team dynamics (Fernandez et al. 2019;Gartland et al. 2022). ...
Aim
The aim of this discussion paper is twofold: (1) To critically examine the challenges related to resuscitations among rural nurses and how these contribute to a sense of professional isolation and (2) To discuss practical solutions and strategies that could be implemented to mitigate the effects of professional isolation.
Background
Professional isolation is not unique to rural nursing practice. It is a complex issue often observed in low‐resourced environments that are geographically distant from larger hospitals, such as small rural emergency departments. With a greater research focus placed on the recruitment and retention challenges associated with professional isolation, studies often overlook the intermediary factors contributing to this issue, such as the effect of resuscitations on rural nurses. In addition, there are few studies that have evaluated interventions or strategies to address professional isolation.
Design
A critical discussion paper.
Methods
This discussion paper is based on data drawn from current evidence and is guided by the authors research experience as part of a doctoral study.
Results
Professional isolation negatively affects rural nurses' experiences of resuscitation by creating barriers to skill acquisition and professional growth and reducing career intent in rural areas. Strategies such as leadership training, rural mentorship, debriefing and cognitive aids are possible strategies that could address these challenges.
Conclusions
The trajectory of professional isolation is contingent upon the capacity of rural nurses to have access to professional avenues that enhance connection, sharing of knowledge, skills and experiences. Addressing professional isolation is crucial for the well‐being of rural nurses and the overall sustainability and growth of the rural healthcare workforce.
... In PARC, the importance of a collaborative interdisciplinary and nursing leadership structure was apparent. A shared vision at all levels of the organisation is important from staff to executive nurse levels (Ooijen et al. 2022). Similarly, the support, engagement and clinical governance provided by other disciplines, such as psychiatry, is key. ...
Aim(s)
This study reports on the implementation of a registered advanced nurse practitioner intervention. Aims include improving access, service user outcomes and integration between primary and secondary care.
Design
This paper reports the quantitative results of a mixed methods implementation study. Qualitative data are reported separately. The PARiHS framework informs the implementation process itself, with considerations for nurses and other healthcare professionals explored.
Methods
The CORE‐OM 34 item rating scale was administered both pre‐ and post‐intervention. Service user attendances in secondary care was monitored.
Results
Findings suggest that the intervention was associated with clinically significant improvements in global or generic distress, reported by service users, as evidenced by changes in the CORE‐OM scores. Access to care was recorded at an average of 3.6 days. Implementation science supported effective and safe implementation with clear governance structures.
Conclusion
Registered advanced nurse practice in mental health clinics which provide full episodes of care results in improved integration and may be associated with positive patient outcomes. Implementation science is taught on Irish nursing programmes and this is important if innovative services are to be embedded in the healthcare system.
Impact
The development of a model of care for mental health Registered Advanced Nurse Practitioners at the interface of primary and secondary care settings may be merited. Positive Advanced Recovery Connections may be associated with improving mental health outcomes and bolstering integration of primary and secondary care services. The utilisation of implementation science highlights the need for collaboration with all stakeholders to overcome barriers and recognise facilitators to attain the necessary model of integrated care.
Patient and Public Contribution
Peer recovery input was provided by members of the service Recovery College, with participation evident in all stages of the project. The psychosocial assessment template was also co‐designed.
... In addition, a qualitative focus group study with 26 nurses from different settings confirms that nurses need the opportunity to control of their nursing practice, can work autonomously, and they have to be clinically competent in order to use EBP and improve patient care (Kieft et al., 2014). Furthermore, an ethnographic study with 12 semi-structured interviews shows that nursing leaders knowledgeable about EBP methodology and research experience can help to promote EBP in organisations (Bahlman-van Ooijen et al., 2023). ...
Background:
Transformation of healthcare is necessary to ensure patients receive high-quality care. Working with the evidence-based practice (EBP) principles enables nurses to make this shift. Although working according to these principles is becoming more common, nurses base their actions too much on traditions and intuition. Therefore, to promote EBP in nursing practice and improve related education, more insight into nurses' needs is necessary to overcome existing EBP barriers.
Objective:
To identify the current needs to work with EBP principles among hospital and community care nurses and student nurses.
Design:
A qualitative, exploratory approach with focus group discussions.
Methods:
Data was collected between February and December 2020 through 5 focus group discussions with 25 nurses and student nurses from a hospital, a community care organisation, and nursing education schools (bachelor and vocational). Data were analysed using reflexive thematic analysis, and the main themes were synchronised to the seven domains from the Tailored Implementation for Chronic Diseases (TICD) checklist.
Results:
Nurses and student nurses experience EBP as complex and require more EBP knowledge and reliable, ready-to-use evidence. They wanted to be facilitated in access to evidence, the opportunity to share insights with colleagues and more time to work on EBP. The fulfilment of these needs serves to enhance motivation to engage with evidence-based practice (EBP), facilitate personal development, and empower nurses and student nurses to take more leadership in working according to EBP principles and improve healthcare delivery.
Conclusion:
Nurses experience difficulties applying EBP principles and need support with their implementation. Nurses' and student nurses' needs include obtaining more EBP knowledge and access to tailored and ready-to-use information. They also indicated the need for role models, autonomy, incentives, dedicated time, and incorporation of EBP in daily work practice.
... In addition, previous studies have revealed that nurses face challenges communicating with patients due to their busy schedules, frequent interruptions and desire for more time to engage in meaningful patient conversations [31]. In addition, nurses need to know their patients, take time, empathise with patients and create a safe and trusted environment [32]. Participants also express the need for informal conversations and meaningful interactions. ...
... Finally, establishing a solid relationship with patients is a prerequisite to showing (nursing) leadership and facilitating patient participation. Nurses demonstrate leadership by deliberately building relationships with patients, leading to improved patient participation and positive experiences in healthcare [32]. These insights hold significant importance for nurses as they work towards implementing transformative changes and cultivating an EBQI learning culture, ultimately enabling them to deliver appropriate patient care. ...
Background
Patient participation is fundamental in nursing care and has yielded benefits for patient outcomes. However, despite their compassionate care approach, nurses do not always incorporate patients' needs and wish into evidence‐based practice, quality improvement or learning activities. Therefore, a shift to continuous quality improvement based on evidence‐based practice is necessary to enhance the quality of care. The patient's opinion is an essential part of this process. To establish a more sustainable learning culture for evidence‐based quality improvement, it is crucial that nurses learn alongside their patients. However, to promote this, nurses require a deeper understanding of patients' care preferences.
Objective
To explore patients' needs and wishes towards being involved in care processes that nurses can use in developing an evidence‐based quality improvement learning culture.
Methods
A qualitative study was conducted in two hospital departments and one community care team. In total, 18 patients were purposefully selected for individual semi‐structured interviews with an average of 15 min. A framework analysis based on the fundamental of care framework was utilised to analyse the data deductively. In addition, inductive codes were added to patients' experiences beyond the framework. For reporting this study, the SRQR guideline was used.
Results
Participants needed a compassionate nurse who established and sustained a trusting relationship. They wanted nurses to be present and actively involved during the care delivery. Shared decision‐making improved when nurses offered fair, clear and tailored information. Mistrust or a disrupted nurse–patient relationship was found to be time‐consuming and challenging to restore.
Conclusions
Results confirmed the importance of a durable nurse–patient relationship and showed the consequences of nurses' communication on shared decision‐making. Insights into patients' care preferences are essential to stimulate the development of an evidence‐based quality improvement learning culture within nursing teams and for successful implementation processes.
... Since 2008, the ILC has supported studies into the causes and consequences of failing to meet patients' fundamental care needs and patient and staff experiences and preferences around fundamental care delivery (e.g. Amaral et al., 2022;Aspinall et al., 2022;Bahlman-van Ooijen et al., 2022;Conroy, 2018;Ekermo et al., 2023;Feo et al., 2016Feo et al., , 2019Grønkjaer et al., 2022;Jangland et al., 2016Jangland et al., , 2017Kitson, Dow, et al., 2013;Merkley et al., 2022;Mikkelsen et al., 2019;Minton et al., 2017;Mudd, Feo, McCloud, et al., 2022;Mudd, Feo, Voldbjerg, et al., 2022;Muntlin Athlin et al., 2018;Parr et al., 2018;Pentecost et al., 2020;Rey et al., 2020;Richards et al., 2018Richards et al., , 2021Sugg et al., 2021Sugg et al., , 2022van Belle et al., 2020). ...
Aim
The aim of this study was to present the third position statement from the International Learning Collaborative (ILC). The ILC is the foremost global organization dedicated to transforming fundamental care. Internationally, fundamental care is reported to be poorly delivered, delayed or missed, negatively impacting patients, their families/carers and healthcare staff and systems. Overcoming this global challenge requires profound transformation in how our healthcare systems value, deliver and evaluate fundamental care. This transformation will take both evolutionary and revolutionary guises. In this position statement, we argue how this [r]evolutionary transformation for fundamental care can and must be created within clinical practice.
Design
Position paper.
Methods
This position statement stems from the ILC's annual conference and Leadership Program held in Portland, Maine, USA, in June 2023. The statement draws on the discussions between participants and the authors' subsequent reflections and synthesis of these discussions and ideas. The conference and Leadership Program involved participants (n = 209) from 13 countries working primarily within clinical practice.
Results
The statement focuses on what must occur to transform how fundamental care is valued, prioritized and delivered within clinical practice settings globally. To ensure demonstrable change, the statement comprises four action‐oriented strategies that must be systematically owned by healthcare staff and leaders and embedded in our healthcare organizations and systems: Address non‐nursing tasks: reclaim and protect time to provide high‐value fundamental care.
Accentuate the positive: change from deficit‐based to affirmative language when describing fundamental care.
Access evidence and assess impact: demonstrate transformation in fundamental care by generating relevant indicators and impact measures and rigorously synthesizing existing research.
Advocate for interprofessional collaboration: support high‐quality, transdisciplinary fundamental care delivery via strong nursing leadership.
Conclusion
The ILC Maine Statement calls for ongoing action – [r]evolution – from healthcare leaders and staff within clinical practice to prioritize fundamental care throughout healthcare systems globally.
Implications for the Profession and/or Patient Care
We outline four action‐oriented strategies that can be embedded within clinical practice to substantially transform how fundamental care is delivered.
Specific actions to support these strategies are outlined, providing healthcare leaders and staff a road map to continue the transformation of fundamental care within our healthcare systems.
Impact
Fundamental care affects everyone across their life course, regardless of care context, clinical condition, age and/or the presence of disability.
This position statement represents a call to action to healthcare leaders and staff working specifically in clinical practice, urging them to take up the leadership challenge of transforming how fundamental care is delivered and experience globally.
Patient or Public Contribution
Patients, service users and caregivers were involved in the ILC annual conference, thus contributing to the discussions that shaped this position statement.
What Does this Paper Contribute to the Wider Global Clinical Community?
The strategies and actions outlined in this position statement are relevant to all clinical settings globally, providing practical strategies and actions that can be employed to enhance fundamental care for all patients and their families/carers.
By outlining the importance of both evolutionary and revolutionary change, we identify ways in which healthcare systems globally can begin making the necessary steps towards radical fundamental care transformation, regardless of where they are in the change journey.
... The nurses in the study reinforced the role of leaders in the team as paramount, with this role not necessarily being assigned to the unit managers but to the elements who stand out and are recognized by the team as elements who motivate others, manage critical situations and master conflicts. This is consistent with the characteristics of leaders identified in another study, which defines leader as a competent professional who develops leadership behaviours over time, based on work experience, setting an example, motivating and inspiring colleagues to act and always focusing on improving the quality of care (Bahlman-vanOoijen et al., 2022). This leader's commitment assumes a transformational leadership process that allows the team's interests to be developed, taking into account common purposes(Ree & Wiig, 2020). is a need for a new generation of patient safety leaders who are qualified to create the needed conditions and organizational and team cultures, ensuring that all systems and procedures meet the highest standards of care (World Health Organization, 2020). ...
Aim
To explore nurse‐midwives' perceptions of safety culture in maternity hospitals.
Design
A descriptive phenomenological study was conducted using focus groups and reported following the Consolidated Criteria for Reporting Qualitative Research.
Methods
Data were obtained through two online focus group sessions in June 2022 with 13 nurse‐midwives from two maternity hospitals in the central region of Portugal. The first focus group comprised 6 nurse‐midwives, and the second comprised 7 nurse‐midwives. Qualitative data were analysed using content analysis.
Findings
Two main themes emerged from the data: (i) barriers to promoting a safety culture; (ii) safety culture promotion strategies. The first theme is supported by four categories: ineffective communication, unproductive management, instability in teams and the problem of errors in care delivery. The second theme is supported by two categories: managers' commitment to safety and the promotion of effective communication.
Conclusion
The study results show that the safety culture in maternity hospitals is compromised by ineffective communication, team instability, insufficient allocation of nurse‐midwives, a prevailing punitive culture and underreporting of adverse events. These highlight the need for managers to commit to providing better working conditions, encourage training with the development of a fairer safety culture and encourage reporting and learning from mistakes. There is also a need to invest in team leaders who allow better conflict management and optimization of communication skills is essential.
Impact
Disseminating these results will provide relevance to the safety culture problem, allowing greater awareness of nurse‐midwives and managers about vulnerable areas, and lead to the implementation of effective changes for safe maternal and neonatal care.
Patient or Public Contribution
There was no patient or public contribution as the study only concerned service providers, that is, nurse‐midwives themselves.
... Across these nine sites, the managers trusted staff to already facilitate patient participation, but the IFs described it as hard to ensure that enough time was set aside to work on the implementation of patient participation. This is consistent with ndings showing that time and work pressure are common barriers to enhancing patient participation, and nurses tend to focus on their tasks rather than integrating patients' needs [47]. Another limitation highlighted by the IFs was staff shortage, making sta ng a priority. ...
... This can procure an attitude among staff that their abilities to affect and change routines are limited, which in turn can prevent their involvement in future implementation of new innovations. A taskoriented management approach is known to hamper knowledge implementation [46], particularly when it comes to changes to nursing practice in favor of more person-centered care [47]. This would need to be further addressed in future projects and events. ...
Background
The transfer of innovations into healthcare is laden with challenges. Although healthcare professionals are expected to adopt and fulfil new policies, a more person-centered healthcare, with conditions allowing preference-based patient participation is anticipated.
Methods
The aim of the study was to evaluate two implementation strategies for person-centered patient participation in kidney care, including dissemination of a clinical tool, and training and support of internal facilitators. Nine Swedish kidney care units participated in the study (August 2019–September 2021), strategically organized into: a control group (three sites, no support); a standard dissemination group (three sites, with a tool for patient participation and guidance disseminated to the site managers); and an implementation group (three sites, with the tool and guidance disseminated as above, plus a six-month support program for designated internal facilitators). This process evaluation was comprised of repeat interviews with managers (n = 10), internal facilitators (n = 5), recordings, and notes from the interventions, and Alberta Context Tool survey data (n = 78). Hybrid analyses comprised mixed methods: descriptive and comparative statistics, and qualitative descriptive analysis.
Results
None of the control group sites addressed patient participation. While the standard dissemination sites’ managers received and appreciated the tool and the accompanying guidance package, they made no attempts to make further use of it. In the facilitated implementation group, five internal facilitators from three sites engaged in the support program. They welcomed the opportunity to learn about preference-based patient participation, and about implementation, including potentially enhanced opportunities for preference-based patient participation via the tool. Each site’s facilitators developed a separate strategy for the dissemination of the tool: the tool was used with a few patients in each site, and only some staff were involved. Although noting a general interest in improving patient participation, the internal facilitators described limited local support. Rather, they suggested a longer support program and more local backing and engagement.
Conclusions
Facilitating person-centered patient participation is complex, given the need to address attitudes, beliefs, and behaviors. This study indicates slow uptake and change, and more efficient strategies are needed to ensure the fundamentals of care remain accessible to all.
... Studies were conducted in Iran (n = 3), Canada (n = 2), Australia (n = 1), Jordan (n = 1), South Korea (n = 1), the Netherlands (n = 1), the United Kingdom (n = 1), and one study was conducted with nurse leaders from four different countries: Australia, Canada, England, and Sweden. In six studies, the majority of participants were female (26,27,(29)(30)(31)(32); in one study, all participants were female (34); in three studies, gender was not mentioned (33,35,36); and in one study the majority of participants (57,14%) were male (28). ...
... According to the analyzed literature, nurse leaders are supportive (30,34), passionate, committed (35), competent, reflective, enthusiastic, inspiring, and critical professionals (26) who are responsible for care in all its dimensions (26,34), thus nurse leaders are always looking for new knowledge and skills (26,28), and they are also mentors and monitors who share knowledge and information (30,33) and provide directions to other team members (33). The role of nursing leaders in collecting data to create policies and procedures and developing evidence-based practice was also reported (33). ...
... According to the analyzed literature, nurse leaders are supportive (30,34), passionate, committed (35), competent, reflective, enthusiastic, inspiring, and critical professionals (26) who are responsible for care in all its dimensions (26,34), thus nurse leaders are always looking for new knowledge and skills (26,28), and they are also mentors and monitors who share knowledge and information (30,33) and provide directions to other team members (33). The role of nursing leaders in collecting data to create policies and procedures and developing evidence-based practice was also reported (33). ...
Context: Leadership is the process of influencing people to achieve common goals. In all nurses' roles, leadership is emphasized since nurse leaders' attitudes influence nurses’ job satisfaction and retention and, consequently, the quality of care. Objective: This study aimed to explore the scientific literature concerning different aspects of leadership in nursing. Methods: This is an integrative review of qualitative studies in which four electronic databases (Medline, PubMed, Scopus, and Google Scholar) were searched. Articles published in the last ten years (2013 - 2022) were searched by titles using the descriptors "qualitative," "leadership," and "nursing" linked by the Boolean Operator AND. The search carried out in July 2022 was not limited by the publication language. A total of 63 studies were identified, and 11 original primary research articles were included. The quality of articles was assessed using the Critical Appraisal Skills Program (CASP). Qualitative content analysis was performed to analyze the obtained data. Results: The results were organized into three categories: (1) the importance of nursing leadership and leaders' roles; (2) ethical leadership; and (3) nursing leadership education. Personal characteristics of nurse leaders and leadership skills were indicated as factors influencing staff nurses’ attitudes and reflecting on the quality of care. Training in nursing leadership since the early years of nursing education is essential for future nursing leaders. Conclusions: Nurse leaders influence other team members and patients; consequently, nursing leadership impacts the quality of care. Therefore, training on leadership should be addressed in nursing schools in undergraduate and postgraduate courses and health institutions through continuing education.
