Charge Nurses Research Articles

Nurse Manager's Attitudes and Preparedness Towards Effective Delegation in a Tertiary Care Public Hospital Lahore

Abstract: Background: Delegation is among the oldest concepts associated to professional and clinical nursing. With the rapid changes in the profession, delegation is becoming more important for nurse leaders and managers. It is highly expected from the manager nurses to effectively organize tasks of other health care workers and supervise them successfully. The ability of a nurse manager is very Crucial to the success of delegation among nurses. Objective: The main purpose of this study was, to assess The Nurse Managers’ attitudes and Preparedness towards Effective Delegation in a Tertiary Care Public Hospital Lahore. Method: A cross sectional descriptive survey was performed to assess the knowledge of nurse managers, (nursing supervisors, head nurses,and charge nurses) working at Punjab Institute of Cardiology & Services Hospital Lahore. A convenient sample of n=150 was used to collect the data from both hospitals, (85) from PIC and (65) from SHL. A structured adopted questionnaire was used to collect data and study's questionnaire, Data used in this study consisted of two main scales as well as demographic data sheets were collected. The data was analyzed on SPSS version 21. Results: The results of this study reveals that majority of the participants, 88% were having positive attitude towards delegation who scored 35 or above on a scale of 55 total score, while 12% had negative attitude who scored below 35 on attitude scale of 55. The results of this study indicate that 82.67% participants had good preparedness, who scored 75 or above in a total of 100 score, while remaining 17.3% scored less than 75 and had poor preparedness.

The predictive validity of charge nurse personality on objective and subjective performance of subordinates

This study examines the degree to which the Hogan Personality Inventory (HPI) predicts leadership effectiveness for charge nurses in Danish hospitals. Personality tests are implemented in health care management in an effort to improve evidence-based personnel selection and recruit more efficient leaders. However, relatively few studies of the predictive validity of personality have been conducted in hospital management. Charge nurses (n=177) from three Danish hospitals completed a five-factor, model-based personality inventory. These were coupled with data from 3,497 subordinates. Cluster-robust regression analysis was used to investigate relationships between personality and short-term sickness absence and satisfaction and leadership ratings for the subordinates. Low subordinate sickness absence was related to leader extraversion and conscientiousness. Employee satisfaction was related to leader emotional stability, extraversion, and conscientiousness. Leadership ratings were associated with emotional stability. Personality predicted both objective and subjective measures of performance, although the effects were stronger for objective than subjective measures. The results lend support to the use of validated personality measures in recruiting and promoting nurses in the health care sector. The use of personality tests should support rather than replace other talent-management measures.

Validity testing of a tool for assessing nurse safety behaviour against blood borne infections

Objective: This study was conducted to develop and verify a tool for assessing nurse safety behaviour against blood borne infections. Design: A cross-sectional correlation study design was used. Setting and Subjects: Items were developed based on reviews of related literature, published guidelines regarding the prevention of blood borne infections, and existing tools designed to assess compliance with blood borne infection control precautions.Face and content validities of the tool was assessed by expert panels. Construct validity and reliability were examined on 320 staff and charge nurses whose duties involved direct contact with patients. Results: A 12-item, 5-point Likert-type assessment tool of nurse safety behaviour against blood borne infections was devised. Construct validity, which was investigated by exploratory and confirmatory factor analysis, and reliability of the devised tool were well supported. The devised tool has a three-factor structure, ‘use of personal protective equipment’, ‘hygiene’, and ‘compliance with precautions’. These factors were found to be interrelated, were not independent of each other, and their correlations and loading coefficients indicated good discriminant and convergent validities. Conclusion: The devised 12-item assessment tool offers a clinically useful means of properly assessing safety related behaviours, and provides specific guidelines for preventive practices that should be followed by healthcare workers.

Assessing the Degree of Compassion Satisfaction and Compassion Fatigue Among Critical Care, Oncology, and Charge Nurses.

The aim of this study was to assess the degree of compassion satisfaction and compassion fatigue (CF) among critical care, oncology and charge nurses. Cumulative grief resulting from caring for critically/terminally ill patients may result in CF, leading to lower quality care and higher nurse attrition. Data were collected from 38 direct care nurses and 10 charge nurses, using the Professional Quality of Life. Charge nurses had higher secondary traumatic stress (STS) than direct care nurses. Nurses with less than 10 years of experience had lower CS than experienced nurses. Higher levels of burnout (BO) and STS were reported among charge nurses, whereas less direct care nurses had average to high BO and STS ratings. Previous studies focused on direct care nurses; our findings suggest that CF is prevalent among charge nurses as well. Interventions should be considered for clinical providers and charge nurses including debriefing, stress reduction, peer support, and team building.

Charge nurse facilitated clinical debriefing in the emergency department.

ABSTRACTThis paper describes the development and implementation of the INFO (immediate, not for personal assessment, fast facilitated feedback, and opportunity to ask questions) clinical debriefing process. INFO enabled charge nurses to facilitate a group debriefing after critical events across three adult emergency departments (EDs) in Calgary, Alberta. Prior to implementation at our institutions, ED critical event debriefing was a highly variable event. Post-implementation, INFO critical event debriefings have become part of our ED culture, take place regularly in our EDs (254 documented debriefings between March 2016 and September 2017), with recommendations arising from these debriefings being introduced into clinical practice. The INFO clinical debriefing process addresses two significant barriers to regular ED clinical debriefing: a lack of trained facilitators and the focus on physician-led debriefings. Our experience shows that a nurse-facilitated debriefing is feasible, can be successfully implemented in diverse EDs, and can be performed by relatively inexperienced debriefers. A structured approach means that debriefings are more likely to take place and become a routine part of improving team management of high stakes or unexpected clinical events.

Learning from errors: assessing final year medical students\u2019 reflection on safety improvement, five year cohort study

BackgroundInvestigation of real incidents has been consistently identified by expert reviews and student surveys as a potentially valuable teaching resource for medical students. The aim of this study was to adapt a published method to measure resident doctors’ reflection on quality improvement and evaluate this as an assessment tool for medical students.MethodsThe design is a cohort study. Medical students were prepared with a tutorial in team based learning format and an online Managing Incident Review course. The reliability of the modified Mayo Evaluation of Reflection on Improvement tool (mMERIT) was analysed with Generalizability G-theory. Long term sustainability of assessment of incident review with mMERIT was tested over five consecutive years.ResultsA total of 824 students have completed an incident review using 167 incidents from NHS Tayside’s online reporting system. In order to address the academic practice gap students were supervised by Senior Charge Nurses or Consultants on the wards where the incidents had been reported. Inter-rater reliability was considered sufficiently high to have one assessor for each student report. There was no evidence of a gradient in student marks across the academic year. Marks were significantly higher for students who used Section Questions to structure their reports compared with those who did not. In Year 1 of the study 21 (14%) of 153 mMERIT reports were graded as concern. All 21 of these students achieved the required standard on resubmission. Rates of resubmission were lower (3% to 7%) in subsequent years.ConclusionsWe have shown that mMERIT has high reliability with one rater. mMERIT can be used by students as part of a suite of feedback to help supplement their self-assessment on their learning needs and develop insightful practice to drive their development of quality, safety and person centred professional practice. Incident review addresses the need for workplace based learning and use of real life examples of mistakes, which has been identified by previous studies of education about patient safety in medical schools.

Commit to Sit to Improve Nurse Communication.

Commit to Sit to Improve Nurse Communication.

Evaluating fundamentals of care: The development of a unit-level quality measurement and improvement programme.

The project aimed to develop a unit-level quality measurement and improvement programme using evidence-based fundamentals of care. Feedback from patients, families, whānau, staff and audit data in 2014 indicated variability in the delivery of fundamental aspects of care such as monitoring, nutrition, pain management and environmental cleanliness at a New Zealand District Health Board. A general inductive approach was used to explore the fundamentals of care and design a measurement and improvement programme, the Patient and Whānau Centred Care Standards (PWCCS), focused on fundamental care. Five phases were used to explore the evidence, and design and test a measurement and improvement framework. Nine identified fundamental elements of care were used to define expected standards of care and develop and test a measurement and improvement framework. Four six-monthly peer reviews have been undertaken since June 2015. Charge Nurse Managers used results to identify quality improvements. Significant improvement was demonstrated overall, in six of the 27 units, in seven of the nine standards and three of the four measures. In all, 89% (n=24) of units improved their overall result. The PWCCS measurement and improvement framework make visible nursing fundamentals of care in line with continuous quality improvement to increase quality of care. Delivering fundamentals of care is described by nurses as getting ?back to basics'. Patient and family feedback supports the centrality of fundamentals of care to their hospital experience. Implementing a unit-level fundamentals of care quality measurement and improvement programme clarifies expected standards of care, highlights the contribution of fundamentals of care to quality and provides a mechanism for ongoing improvements.

Use of a standardized care communication checklist during multidisciplinary rounds in pediatric cardiac intensive care: a best practice implementation project.

This project aimed to improve thoroughness and continuity of care of patients in a pediatric cardiac intensive care unit. Specific objectives were to increase support of clinical nurse and family participation in multidisciplinary rounds (MDR), as well as full use of a multi-component Complex Care Checklist (CCC) by all nurses in this unit. Communication and collaboration are paramount for safe care and positive outcomes of critically ill patients hospitalized in intensive care units. Nurse participation in daily patient rounding enhances individualized goal-setting. Concomitant use of a communication checklist promotes comprehensive delivery of care. Evidence-based audit criteria were developed for this project which used the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) tools for promoting change in health practice. Direct observation of MDR processes was used to conduct a baseline and post-implementation audit. Intervention strategies relied primarily on nurse education tactics. Although attending physicians' and charge nurses' support and facilitation of clinical nurse presence during MDR rose substantially to 95% compliance, only moderate compliance (67%) was demonstrated for clinical nurses' attendance at and participation in MDR. Compliance with nurses' report of the patient's daily care plan and completion of CCC components during MDR improved moderately (52% and 54%). Family attendance at MDR did not improve. Project aims of enhanced thoroughness and continuity of care of patients with congenital heart defects were realized through an improved MDR process enhanced with a care communication checklist and clinical nurse participation. With the support of attending physicians and charge nurses, clinical nurses felt more empowered to address care concerns during MDR. The project outcomes indicated further activities are needed to assist nurses with a higher level of participating in MDR and using the CCC to its full potential. Continued evolution of the rounding process is imperative to adapting to patient needs and improving care.

Tabagism and its management in Italian Psychiatric Intensive Care General Hospital Units

The aim of this paper was to survey the current management of the problem of smoking in our Mental Health Units, the structural characteristics of the units and how a total smoking ban would be perceived by doctors and nurses. An 18 items survey about smoking habits of inpatients and department inner regulations was sent to the Head Physician and the Charge Nurse of all the Intensive Psychiatric Care General Hospital Units in Italy (228 units), in order to increase the answer rate and to investigate if the perception of the problem is eventually different between the two groups. We collected 65 answers from Head Physician and 79 from Nurses. Both groups think that the smoking rates for inpatients are between 50-100%. Most of the units is locked, with or without an external space, so that a total smoking ban is considered difficult to achieve by both groups. A very high rate of units has no specific rooms for smokers. In most cases the issue management is solved by a self-regulation, based on collecting cigarettes and lighters and granting a limited number of cigarettes per day. Anyway, an institutional intervention would be appreciated especially by nurses, who seem to be even more involved in the issue management and both of groups seem to badly judge the lack of sources to face the eventual ban: particularly the possibility to offer nicotine replacement therapy, a cognitive-behavioural support and providing more staff education would all be considered useful to implement the success rate of the ban. By the way, both of groups seem skeptical about the possibility of a total smoking-free policy in Acute Psychiatric Hospital Units. Though, a difference in the problem’s perception between the two groups has been noticed. Smoking cessation remains a neglected area in psychiatry, in part due to misconceptions about smoking in the mentally ill, i.e. the idea that smoking cessation will exacerbate mental illness, aggression and suicide risk, even though these believes are not supported by evidence; in part due to the lack of institutional intervention and the structural deficiencies of the units.

Infants in Drug Withdrawal: A National Description of Nurse Workload, Infant Acuity, and Parental Needs.

Infants in drug withdrawal have complex physiological and behavioral states, requiring intensive nursing care. The study objectives were to describe acuity, parental needs, and nurse workload of infants in drug withdrawal compared with other infants. The design was cross-sectional and involved secondary nurse survey data from 6045 staff nurses from a national sample of 104 neonatal intensive care units. Nurses reported the care of 15 233 infants, 361 (2.4%) of whom were in drug withdrawal. Three-fourths of hospitals had at least 1 infant in drug withdrawal. In these hospitals, the mean number of infants in drug withdrawal was 4.7. Infant acuity was significantly higher among infants in drug withdrawal. Parents of infants in drug withdrawal required significantly more care to address complex social situations (51% vs 12%). The number of infants assigned to nurses with at least 1 infant in withdrawal (mean = 2.69) was significantly higher than typical (mean = 2.51). Given infant acuity and parental needs, policies legislating patient-to-nurse ratios should permit professional discretion on the number of patients to assign nurses caring for infants in drug withdrawal. Managers and charge nurses should consider the demands of caring for infants in drug withdrawal in assignment decisions and provide support and education.

Nurses' Reflections on Benefits and Challenges of Implementing Family-Centered Care in Pediatric Intensive Care Units.

Family-centered care is a proposed way of supporting family involvement with a child's care and decreasing distress associated with a child's critical illness by improving communication, helping manage stress and coping, and decreasing conflicts. Nurses are critical to successful implementation of family-centered care. To describe nurses' perceptions of the benefits and challenges of providing family-centered care in pediatric intensive care units. Semistructured interviews of 10 bedside and charge nurses in pediatric, cardiac, and neonatal intensive care units. Questions were related to 4 domains: the intensive care unit environment and its relationship to the structure and delivery of critical care, stressors for nurses and families, communication challenges and strategies, and involvement of families in care and decision-making. The main thematic finding was the nurses' descriptions of a "balancing act" to provide quality family-centered care. The balancing act was characterized by the interaction between 2 types of changes: (1) intensive care unit policies related to visitation hours and family presence at the bedside and (2) physical transformations in the intensive care unit from shared open space to individual private rooms. All of the nurses viewed the transition to family-centered care as having benefits for families. They also described how changes had created new challenges for the delivery of nursing care in intensive care units, particularly regarding mentorship and the safety of patients and staff.

Team coaching and rounding as a framework to enhance organizational wellbeing, & team performance

Becoming an effective front-line nurse manager is a complex and dynamic process, particularly when nurses progress to these roles within their own unit when multifaceted interpersonal factors may feature. This article reports on a project referred to as, ‘Coaching and Rounding’ in the neonatal intensive care unit of the Women's Hospital in Qatar. This project integrated leadership coaching activities with staff rounding on nurses they supervised using a structured framework. This project was designed to equip front-line nurse leaders with enhanced skills and techniques to promote a framework for developing relational leadership styles. Evaluation involved the charge nurses and staff under their supervision. Results suggested that there was improved supervisor-supervisee relationships, increased motivation and more frequent constructive feedback. The challenges to sustain these initial gains are the focus of ongoing initiatives.

Aggression Management Education for Acute Care Nurses: What’s the Evidence?

Aggression Management Education for Acute Care Nurses: What’s the Evidence?

Interprofessional Mass Casualty Incident Simulation Design Protocol to Prepare Prelicensure Nursing Students to Respond to a Disaster.

Nurses need to be prepared to respond to mass casualty incidents. Simulation is an ideal teaching intervention that can be used to prepare nursing students to effectively triage patients and allocate limited resources. This article describes a detailed interprofessional mass casualty simulation of a bus crash with 32 victims. Nursing students trained with emergency responders with students acting as charge nurses throughout the simulation. The details of the simulation are provided for faculty to replicate.

Clinical Nurses' Perception on the Importance and Performance of Nursing Managerial Competencies

Purpose: This study aimed to investigate clinical nurses' perception on nursing managerial competencies. Methods: This was a descriptive study. The data were collected from 198 nurse managers who had worked in six general hospitals using a self-reporting questionnaire. Data were analyzed by descriptive statistics, t-test, ANOVA, and Importance-Performance Analysis. Results: Only 32% of the participants had experienced nursing managerial competency training. The mean score for perceived performance of nursing managerial competency was lower than that for perceived importance. There were significant differences in perceived importance, performance, and importance-performance gaps among head, charge, and staff nurses. Importance-performance analysis showed that three of the 30 nursing managerial competencies require further development: staffing, human resources development and education, and nursing standard development competency. There were significant differences in importance-performance gaps according to age, career years in current hospital, work shift, position, nursing delivery system, and nursing managerial competency-education experience. Conclusion: A training program for developing and improving nursing managerial competencies which is focused on the gaps in importance and performance level is needed for clinical nurses. In addition, it should be considered to improve nursing work conditions such as nursing delivery system and formal appointment in order to increase the performance of nursing managerial competencies.

Cervical Spine Collar Removal by Emergency Room Nurses: A Quality Improvement Project

IntroductionThe Canadian C-Spine Rule (CCR) is a clinical decision aid to facilitate the safe removal of cervical collars in the alert, orientated, low-risk adult trauma patient. Few health care settings have assessed initiatives to train charge nurses to use the CCR. This practice improvement project conducted in a secondary trauma center in Canada aimed to (1) train charge nurses of the emergency room to use the CCR, (2) monitor its use throughout the project period, and (3) compare the assessments of the charge nurses with those of emergency physicians. MethodsThe project began with the creation of an interdisciplinary team. Clinical guidelines were established by the interdisciplinary project team. Nine charge nurses of the emergency room were then trained to use the CCR (3 on each 8-hour shift). The use of the CCR was monitored throughout the project period, from June 1 to October 5, 2016. ResultsThe 3 aims of this practice improvement project were attained successfully. Over a 5-month period, 114 patients were assessed with the CCR. Charge nurses removed the cervical collars for 54 of 114 patients (47%). A perfect agreement rate (114 of 114 patients, 100%) was attained between the assessments of the nurses and those of physicians. DiscussionThis project shows that the charge nurses of a secondary trauma center can use the CCR safely on alert, orientated, and low-risk adult trauma patients as demonstrated by the agreement in the assessments of emergency room nurses and physicians.Image 1

Provider attitudes and practice of recommended guidelines to reduce readmissions among low income minority patients

Abstract In recognition of the contributory role of patient, provider, and systems related factors to failure in transitions of care, recommendations have been made by healthcare organizations regarding best practices to improve transitions of care and reduce readmissions. The role of provider attitudes and adherence to recommended practice guidelines in care transitions has not been studied. The present study sought to determine provider attitudes and actual practice of recommended best practice strategies aimed at promoting optimal transitions of care. A cross-sectional survey was conducted among key healthcare providers involved in the discharge process at the Grady Memorial Hospital, a 953 bed academically affiliated urban safety net hospital. Of these, 131 participants completed the surveys including 73 internal medicine residents, 7 social workers, 51 nurses (5 nurse case managers, 6 inpatient unit nursing directors and charge nurses and 40 bedside nurses). There was a variation as to consideration of importance of best practices across healthcare disciplines consistent with the practice focus of each discipline. Medication reconciliation however seemed to be considered equally important across disciplines. Coordination of care, use of a multidisciplinary team and discussion of goals of care were practices considered to be least important. There was a significant discrepancy between consideration of importance of best practices and actual practice of these. This study has shown areas where key providers involved in the discharge process are not adhering to guidelines recommended to reduce readmissions. Future studies to determine barriers to guideline adherence are needed along with targeted interventions to promote provider adherence.

Identifying barriers to early mobilisation among mechanically ventilated patients in a trauma intensive care unit

Mechanically ventilated patients can be at risk for functional decline (Cameron et al., 2015). Early mobilisation of mechanically ventilated patients can improve outcomes after critical illness to prevent this decline. Although registered nurses understand the importance of early mobilisation there are nurses who are unwilling to mobilise patients. AimThe aim of this study is to examine whether nurses’ attitudes and beliefs are barriers for early mobilisation and evaluate whether an education intervention can improve early mobilisation. MethodPre-test, post-test intervention with registered nurses and charge nurses in a 22 bed trauma intensive care setting. ProcedurePre-test, post-test survey assessed perceived barriers in knowledge, attitudes, and behaviours followed by targeted education. ResultsDependent Sample T-test revealed a statistically significant increase in post-test responses for the subscales knowledge, attitudes, and behaviours with early mobilisation. This over-all increase in post-test results support that understanding barriers can improve patient outcomes. ConclusionUse of structured surveys to identify barriers for early mobilisation among nursing can assist in providing targeted education that address nurse’s perception. The education intervention appeared to have a positive impact on attitudes but it is unknown if the difference was sustained over time or affected participants practice or patient outcomes.

Recruitment rethink: getting the right nurse in the right role.

Senior nurses say it is clear when a ward is well run by a good sister or charge nurse. But it is also obvious in units where standards are not what they should be that some ward sisters or charge nurses underperform. It is clear that recruitment to this role - which is so vital for patient safety and experience - is not always a success.