Clinical Nurse Managers Research Articles

62 Falls prevention is everyone’s business

Abstract Background Falls among inpatients are the most commonly reported incident within the HSE and HSE funded services (NIMS). For older persons with multiple comorbidities and frailty, even a ‘minor’ injury following a fall can have a significant effect in terms of impaired or delayed rehabilitation, loss of confidence, longer stay in hospital and ultimately, a poorer quality of life. In our Hospital as part of our fall prevention strategy, an education programme for all Staff was launched to raise awareness of falls prevention and management of patients post falls. Methods In 2021 Ward A, a post -acute care rehabilitation ward had a high incidence of falls N = 56. In collaboration with Ward A’s Clinical Nurse Managers, Falls Prevention Committee, Quality Improvement and Practice Development Department a plan of action was developed to reduce the number of patients’ falls. Formal Monthly Education Awareness training for all Staff and informal Ward based training were implemented which included: Overview of falls risk factors, Information on the impact of patient falls, A review of the Hospital’s falls prevention programme and policy, Roll out of a new Multifactorial Falls Risk Assessment form which addresses risk factors and interventions to reduce falls, Reviewing the link between falls and frailty, Promoting safe mobility and activity for patients, Falls Safety Cross—to raise awareness within the team and others regarding the falls/near misses being tracked monthly and Post-fall management of patients. Results In 2021 Ward A recorded N = 56 patient falls. Following the above interventions, the number of patient falls reduced to N = 37, 34% by Quarter 42,022. Staff evaluation highlighted that staff knowledge and awareness of falls prevention and post fall management had increased. Conclusion Falls awareness training had a positive impact on reducing falls in a Rehabilitation ward.

Leadership Development Recommendations for Clinical Nurse Managers to Bolster the Postpandemic Workforce.

The postpandemic atmosphere has created a perfect storm that has necessitated a renewed prioritization to bolster support for the role of the clinical nurse manager. Role transition, competencies, mentorship, and ongoing development for the clinical nurse manager have been solidly supported in nursing leadership literature for decades. Preparing competent, ready-to-respond, people-oriented, transformational nurse leaders for these positions is essential to survival of our health care workforce. This article includes a summative review of comprehensive published findings related to nurse manager competency, development, and support. Findings have been correlated with one health system's postpandemic internal surveys, focus groups, reaction panels, and gap analysis to validate historic recommendations and prepare for program development. The purpose of this project was to endorse manager support and development recommendations and implement an evidence-based program to better prepare clinical nurse managers in today's health care leadership reality.

Nursing teamwork in general ward settings: A mixed-methods exploratory study among enrolled and registered nurses.

To examine the perceived level of nursing teamwork and factors influencing teamwork among enrolled nurses (ENs) and registered nurses (RNs) in general ward settings. The nursing care delivery model includes RNs, ENs and others who work as a team to deliver patient care. The potential impact of teamwork on nursing care highlights the need to explore the work of nursing teams. A mixed-methods exploratory study. Quantitative and qualitative data were collected concurrently from ENs and RNs in 2018. Two hundred and forty-eight (n=248) nurses completed the Nursing Teamwork Survey. Sixteen nurses participated in focus group discussions. Qualitative data were reported following COREQ guidelines, while quantitative data followed the STROBE guidelines. Both ENs and RNs scored highest for the shared mental model subscale but lowest for the team orientation subscale. Factors including qualification level, years of working experience, perceived job staffing adequacy and job satisfaction were found to influence teamwork. Three themes emerged from the qualitative findings: expectations of each other's role, delegation practices and interpersonal relationships. ENs and RNs differed in their expectations of their role in basic patient care activities and faced power struggles related to delegation practices. Open and structured communication was deemed essential in building interpersonal relationships. The ENs and RNs have clear understanding of their personal roles and responsibilities towards achieving a common goal. However, teamwork may be improved with a shared mental model in performing basic nursing care tasks, mutual support for workload management, better delegation practices, effective communication, enhanced interpersonal relationships and better team orientation. Nurse managers and educators need to work collaboratively to foster positive delegation practices in clinical practice supported by applicable team training that enhances mutual trust, backup behaviours and collective orientation in nursing teams.

N16 Inflammatory bowel disease (IBD) Nurses’ role and level of practice in Ireland: a National online survey

Abstract Background The role of the IBD nurse is evolving in Ireland. While Ireland has a sound base of expertise and infrastructure for providing IBD services, the lack of a dedicated specialist nurse was found to be the most significant barrier to delivering best care (ISG, 2016). There is currently no data on the role and level of practice of IBD nurse nationally. Methods A cross-sectional, descriptive online survey was undertaken. The 72-item survey was adapted from the tool used in the National UK IBD standards survey (Mason et al 2012) and underpinned by the Standards and Requirements for Clinical Nurse Specialists (NMBI, 2008). The survey was distributed to all members (n = 50) of the inflammatory bowel disease Nurses Association of Ireland (IBDNAI) and members were also invited to share the survey with colleagues not on the database. Results A total of 35 nurses working in IBD services across 22 hospitals nationally completed the survey, including IBD Clinical Nurse Specialists (CNS) (24%), IBD Clinical Nurse Managers II (CNM) (18%), IBD Nurses (12%), IBD Research Nurses (12%), Staff Nurses (9%); Infusion Nurses (6%), and IBD Advanced Nurse Practitioners (6%). The majority of respondents worked in adult IBD services (94%), with most working in their IBD role between 3 to 6 years and within gastroenterology up to 10 years. Only 44% of respondents work exclusively in IBD. The highest level of education reported was masters (40%), degree (40%); however, 75% of respondents have not completed a postgraduate diploma in gastroenterology. Services provided by nurses included patient education (94%), telephone advice line (81%), coordinating biologic service (69%), screening patients prior to administrating biologics (66%), email service for patients (59%), development of initiative for the IBD service (56%), coordinating care of inpatients (53%), follow-up (53%) and rapid access clinics (53%). Over half of respondents (61%) reported working unpaid overtime (typically 1–2 hours per week), with service suspended in their absence (45%). 36% of participants conducted original research and 48% conduct audits on their service. Conclusion IBD nurse’s role and level of practice varies greatly in Ireland. Many nurses are working in diverse roles with a wide variety of titles providing an extensive service to patients, often at a higher level than is recognised within their role title. IBD nurses are highly educated and well experienced; however the lack of specialist education has resulted in nearly as many IBD CNM’s as CNS’s which is causing variation in the title of the IBD nurse. There is a need for the development of a postgraduate programme in gastroenterology to include IBD and more IBD nurse specialists to deliver a quality, evidence-based service.

Recognitions of Terminal Care among Clinical Nurse Managers

When it comes to recognitions of terminal care among hospital nurse managers, this study was conducted with focus interviews targeting 15 nurse managers with over 10 years of experience at hemato-oncological centers, hospice wards, and intensive care units of three general hospitals with more than 300 wards in 3 cities of Korea, in order to explore the nature of experience using a phenomenological research methodology. Data analysis was based on Colaizzi(1978)’s phenomenological analysis method and 19 themes and 4 theme clusters were extracted from 64 meaning formations following the in-depth interviews with the subjects. It is supposed that the study findings would help in understanding the structure of nursing students’ recognition on artistic aspects of care.

Using a Delphi Survey to Develop Clinical Nursing Research Priorities Among Nursing Management.

The aim of this study was to identify clinical nursing research priorities among nurse managers (NMs). Determining research priorities is the 1st step toward building a solid evidence base for clinical practice. NMs are well poised to identify research priorities, and yet, a literature review revealed a dearth of research priorities as determined by clinical NMs. Using a Delphi survey, 38 NMs were queried at a large, urban hospital regarding critical priorities for nursing research. Critical priorities for clinical nursing research included nursing workforce/nursing workflow and communication (categorized as critical by 68% and 53% of NMs, respectively). Other important priorities focused on falls/patient safety/hospital-acquired infections, patient/family satisfaction, emergency preparedness, patient outcomes, and collaboration/interdisciplinary research. Because NMs are positioned to direct clinical research agendas, the results provide a critical guide for policy development surrounding nursing research. Directing research toward these identified topics will help build a solid evidence base for nurses and ultimately improve patient outcomes.

Timely identification of frailty & comprehensive multidisciplinary assessment on a newly established specialist geriatric ward

Introduction: Beaumont Hospital catchment area has a 20% higher proportion of over 65’s and over 85’s than the national average. Between 2011 and 2026 it is predicted that there will be 44% increase in the population of North Dublin over 65 years of age 1. Older people are admitted to hospital more frequently, have longer length of stay and occupy more bed days in acute hospitals than any other patient group. Many older people are frail and present to hospital with acute or sub-acute illnesses often accompanied by functional and/or cognitive deteriorations. Furthermore, once hospitalised frail older people are at huge risk of further hospital based deconditioning due to reduction in habitual activity and sleep deprivation. Once identified, the gold standard for the acute management of frailty in older people is early multidisciplinary team (MDT) assessment and delivery of high quality care with an emphasis on reduction in unnecessary delays and proactive case-management.Extensive research has shown that frail older patients who receive timely access to coordinated care under specialist geriatric teams (SGT) on a specialist geriatric ward (SGW), in the form of comprehensive geriatric assessment, have an increased likelihood of returning home, as well as reduced mortality rate following acute hospital admission 2. Aim and practice change implemented: This change management project was completed in conjunction with the SGT on a newly established SGW (Hardwicke ward). It was carried out as part of a larger ward redevelopment project. This particular project took place over a 4 week period in April/May 2016. The following key stakeholders were involved; patients, MDT, Clinical Nurse Managers, Geriatricians, Project Sponsor (Physiotherapy Manager). This project utilised quality improvement (QI) methodology incorporating; process mapping, development of a driver diagram, data collection and implementing multiple plan-do-study-act cycles to rapidly test changes (IHI, 2016). The following project aim was established: To standardise a process to identify 100% of frail patients over 75 years of age who are admitted to Hardwicke ward under the care of a Geriatrician and ensure referral to all relevant multidisciplinary team members within 24 hours of admission by May 13th 2016. Highlights: (innovation, impact and outcomes) A number of standardised processes have now been successfully implemented on Hardwicke ward for frailty triage, prompt referral to MDT and completion of common MDT assessment documentation. These standardised processes have led to 100% of new patients over 75 years of age being screened for frailty and all relevant MDT referrals being sent via a standardised method (electronic referral) within 24 hours of admission to the ward. This has increased from a baseline of 40% at initial data collection on week one. The result is a more efficient, standardised, co-ordinated and patient-focused process which has led to a reduction in unnecessary wait times and thus a reduction in the risk of hospital-associated de-conditioning in frail older people. The use of QI methodology and interdisciplinary working were key factors in the success of this project. A clear line of sight with the National Clinical Programme for Older People 3 was also crucial to its success. Sustainability and trasferability: Future areas for further development are focused on the following; Stabilise and embed the current standardised processes into practice on Hardwicke ward (incorporating succession planning and ongoing training for Junior rotational staff) Further streamline the processes to reduce inefficiencies utilising QI methodology Spread the learning to other acute wards & MDTs initially focusing on a 2nd SGW

Monitoring and Improving Quality Care through the development of an automated audit tool

Introduction (comprising context and problem statement) The Health Information and Quality Authority (2016) specify that designated centres for older people must monitor, review and improve the quality of care and experience of residents on an ongoing basis. Although the Kerry Community Hospitals/ Nursing Units undertake regular audits, the paper based process is time consuming and fails to provide real time data with trend analysis consistently throughout the year. Short description of change implement : Viclarity provide compliance monitoring solutions to healthcare organisations in Ireland, the United Kingdom and America. Total quality management initiatives develop customer focused processes and procedures to meet internal and external clients, real data and constant monitoring are essential to measure the improvement progress (Trofino 2000). Viclaritys innovative platform would facilitate the Kerry Community Hospitals/ Nursing Units to track and manage all of their audits and paper based processes in one system using a colour coded dashboard. Aim and theory of change : The aim of this project is to customise Viclaritys pre-built audit templates to create an automated audit tool that monitors each of the Kerry Community Hospitals/ Nursing Units in accordance with evidence based practice and the regulatory standards for designated centres for older people in Ireland (Health Information and Quality Authority 2016) Targeted population and stakeholders : Residents, Health Care Assistants, Registered Nurses, Clinical Nurse Managers, Clinical Development Co-ordinator, Directors of Nursing, Area Manager Timeline : A timeline of 12 months has been assigned to this quality improvement initiative. Designing the customised audits Trialling the system to ensure it is meeting service need and user friendly Resolving any technical issues Installation / implementing across all sites Highlights (innovation, impact and outcomes) The colour coded dashboard will provide live information on all audits conducted Instant visual identification of non-compliance, action plan required by the system to specify how non-compliance will be addressed thus promoting quality of the service The system has a fully integrated CA/PA feature built in and delivers detailed informative reports with one click, promoting a more efficient and effective service Exception reports with action plans that specify how the issue will be resolved and who is responsible for same, thus monitoring and improving the quality, effectiveness and efficiency of the service. Comments and sustainability : Regular consultation and collaboration between Viclarity and Clinical Development Co-ordinator to ensure the customised audits are updated in accordance with any evidence based changes in hospital policy or regulatory standards. Comments and transferability : Implementation throughout the 6 Community Hospitals/ Nursing Units Transferable to all designated centres for older people Easily modified to transfer into any healthcare organisation/ service References : 1- Health Information and Quality Authority. National Standards for Residential Care Settings for Older People in Ireland. Health Information and Quality Authority. 2016. 2- Trofino A.J. Transformational Leadership: moving total quality management to world class organisations. International Nursing Review. 2000;47: 232-242.

Evaluating the systematic implementation of the 'Let Me Decide' advance care planning programme in long term care through focus groups: staff perspectives.

BackgroundThe ‘Let Me Decide’ Advance Care Planning (LMD-ACP) programme offers a structured approach to End-of-Life (EoL) care planning in long-term care for residents with and without capacity to complete an advance care directive/plan. The programme was implemented in three homes in the South of Ireland, with a view to improving quality of care at end of life. This paper will present an evaluation of the systematic implementation of the LMD-ACP programme in the homes. MethodsFocus groups were conducted with 15 Clinical Nurse Managers and two Directors of Nursing where the programme had been implemented. A semi-structured topic guide was used to direct questions that addressed implementation process, challenges implementing advance care planning, advantages/disadvantages and recommendations for the future. Data was analysed using manifest content analysis.ResultsFive key categories emerged, with 16 corresponding subcategories. These subcategories emerged as a result of 37 codes. Key benefits of the programme included enhancing communication, changing the care culture, promoting preference-based care and avoiding crisis decision making. Establishing capacity among residents and indecision were among the main challenges reported by staff. DiscussionA number of recommendations were proposed by participants and included multi-disciplinary team involvement, and a blended approach to education on the topic. According to participants relationships with residents deepened, there was a more open and honest environment with family, end of life care focused more on symptom management, comfort and addressing spiritual care needs as opposed to crisis decision making and family conflict.ConclusionThe introduction of the LMD-ACP programme enhanced the delivery of care in the long-term care sites and led to a more open and positive care environment.

Structural Empowerment of Clinical Nurse Managers

The purpose of this study was to describe perceptions of structural empowerment of clinical nurse managers (CNMs) in 1 large healthcare system. The recruitment and retention of CNMs are crucial to the future of healthcare institutions. Understanding the extent to which CNMs feel supported in the work environment and have access to resources, information, support, and opportunities to learn and develop will be beneficial to organizational effectiveness. The sample included 140 CNMs from 1 large healthcare system in the northeastern United States. Consistent with previous research, CNMs in the present study had moderate levels of empowerment. They had lower than expected subscale scores on the resources subscale and acceptable scores on the subscales of support, formal power, and informal power. In the current changing healthcare environment, it is important to gain more understanding of the role of CNMs who are crucial to quality care and patient and nurse satisfaction. This study provides important baseline information about perceptions of structural empowerment among CNMs. Interventions that can be initiated to enhance the CNM empowerment are presented.

Telephone Coaching for Clinical Nurse Managers

The coaching process enabled me to take time away from my reactive day to think and plan and imagine. —Clinical Nurse Manager

Preparation for management: an exploratory study to ascertain perceptions of F grade nurses and clinical nurse managers

This paper reviews relevant literature and discusses the results of a small study designed to investigate how nurses are responding to the changes in the structure of the NHS which have reduced their role in management. The findings suggest that nurses who are currently at F grade level and their clinical nurse managers (CNM) are aware of the need for nurses seeking career progression to participate in education and training programmes related to nursing and management, particularly those which provide recognized qualifications, and that many are currently striving to achieve this. The findings also suggest that nurses want support to enable them to undertake further study, but that due to increasing pressure of work it is becoming more and more difficult for CNMs to provide the level of support they consider helpful. Nurses and CNMs urge those developing courses in management to ensure that courses are flexible to enable varying types of participation and tailoring to individual needs.