Empower Staff Research Articles

Designing for sonic citizenship in Danish nursing homes

With the aim of improving the soundscape in Danish nursing homes, this paper explores how a sonic citizenship perspective can be unfolded and discussed through a design-oriented research approach. Based on the experiences from an intervention study we argue that this perspective is important in expanding the focus further than formulating final solutions and making citizens proactive beyond the transformation phase. Building on thorough analysis of 45 nursing home soundscapes various interventions were implemented in 8 nursing homes from 2022-23. Evaluation of the interventions, through a mixed-method study, showed major improvements in perceived soundscape assessment. Through interventions that attenuate unwanted institutional sounds and introduce positive sound experiences, a better balance is found between foreground and background sounds, increasing the appropriateness of the soundscapes. The assessment also showed how the improvement of the soundscapes is closely connected to the engagement and behavioral changes of the staff and how they attune themselves to the soundscape. In that regard, the authors wish to emphasize the importance of anchoring soundscape interventions in the culture, and routines of the people being and living in the environments, to make sustainable changes in an environment and empower staff to become sonic citizens.

Quality improvement scorecards driving innovation and best practice in a large community oncology practice.

417 Background: Lean Six Sigma Visual Management dashboards, or scorecards, are visual tools designed to drive and improve quality patient care, operationalize best practices, and promote a culture of operational excellence. Practice scorecards create a disciplined problem-solving culture where root causes are identified, and systemic process-based improvements are implemented. Scorecards are created to show full practice data transparency, allowing all employees and sites to see each other’s data. Scorecards are designed so that providers can efficiently review the maximum amount of data, following a Green, Yellow, Red visual cue to signify goal adherence. Methods: Phase 1 (2018 – 2019): Clinical scorecards were created and introduced to all staff on a weekly basis focusing on a few key patient metrics (ex: pain scale, pain care plan, ACP, PHQ-9, teaching/consents, patient portal access). Phase 2 (2020 – 2022): Clinical scorecards were expanded with additional patient care initiatives. New nurse navigator scorecards created (ex: patient teaching and survivorship visits). New physician and APP scorecards created with practice-specific provider metrics. Phase 3 (2023 – 2024): Scorecards updated yearly to match practice quality initiatives. New dashboards for non-clinical employees initiated. Physician and APP compensation changed to include quality metric performance tied to financial incentive. Results: Over the course of 5 years, OHC quality scorecard metrics improved from below national averages (red) to exceeding top-tier threshold goals (green). Scorecard utilization increased across all areas of the business, expanding from one scorecard in 2018 to eight in 2024. Scorecards increased overall practice data transparency leading to increase practice quality metric performance. OHC staff utilize scorecards on a weekly, monthly, and quarterly basis to drive quality improvement adherence. Improved outcomes through full data transparency increased staff participation and ownership in quality metrics and led to achieved shared savings in managed care programs. Example of metrics and results: Patient NCCN Staging 36% (2588/7263) to 96% (10299/10749), Teaching/Consents 37% (423/1147) to 97% (3067/3160), and Oral regimen NCCN entry 69% (586/845) to 98% (1037/1055). Conclusions: Visual Management dashboards or practice scorecards are instrumental in driving and supporting practice change. Scorecards allowed OHC staff to efficiently visualize practice-wide actionable data with eye-catching colors to promote optimal clinical performance. As increased data procurement is on the rise, practices can empower their staff to drive change through data utilization. OHC’s scorecards have proven to bridge the gap to goal, facilitate transparent data sharing, and empower providers and staff toward collaboration and embracing operational excellence.

Expert and operator perspectives on barriers to energy efficiency in data centers

It was last estimated in 2016 that data centers (DCs) comprise approximately 2% of total US electricity consumption. However, this estimate is currently being updated to account for the massive increase in computing needs due to streaming, cryptocurrency, and artificial intelligence (AI). To prevent energy consumption that tracks with increasing computing needs, it is imperative we identify energy efficiency strategies and investments beyond the low-hanging fruit solutions. In a two-phased research approach, we ask: What non-technical barriers still impede energy efficiency (EE) practices and investments in the data center sector, and what can be done to overcome these barriers? In particular, we are focused on social and organizational barriers to EE. In Phase I, we performed a literature review and found that technical solutions are abundant in the literature, but fail to address the top-down cultural shifts that need to take place in order to adapt new energy efficiency strategies. In Phase II, reported here, we interviewed 16 data center operators/experts to ground-truth our literature findings. Our interview protocols focus on three aspects of DC decision-making: procurement practices, metrics and monitoring, and perceived barriers to energy efficiency. We find that vendors are the key drivers of procurement decisions, advanced efficiency metrics are facility-specific, and there is convergence in the design of advanced facilities due to the heat density of parallelized infrastructure. Our ultimate goals for our research are to design DC decarbonization policies that target organizational structure, empower individual staff, and foster a supportive external market.

How to undertake an effective coaching session.

Nurse leaders and managers are being encouraged to adopt developmental and transformational leadership styles, and coaching is one tool that they can use to that effect. Beyond formal coaching relationships, the principles of coaching can be relevant to a variety of conversations with staff, for example during appraisals, clinical supervision or training. Applying the principles of coaching as a nurse leader or nurse manager appears to have benefits for all involved. Coaching can help build trusting relationships and empower staff to set themselves meaningful and solution-focused goals and actions and therefore facilitate change. However, the practice of coaching is sometimes misunderstood, while coaching that is unplanned or implemented ineffectively may compromise relationships. •Coaching is not a directive approach, instead the coach needs to adopt a non-judgemental, supportive and collaborative stance. •Coaching requires both parties to enter a learning process aimed at bringing about change and should be built on a commitment to that learning process. •Asking 'curious' questions, encouraging critical reflection and using active listening form the basis of an effective coaching conversation. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: •How this article might improve your practice when coaching a member of your immediate team or a colleague. •How you could use this information to educate nursing students and colleagues on the appropriate techniques and evidence base relating to coaching.

Infection prevention and control compliance among nurses and nursing students during COVID-19 in Malaysia

The Malaysian COVID-19 hospital admission rate and the intensive care wards usage are now declining as the health service system enters a stage of recovery in the endemic phase. This study aimed to explore the barriers to and facilitators of infection prevention and control (IPC) compliance among staff nurses and nursing students and to observe their IPC compliance when attending to the patients in the respective wards. Qualitative study using in-depth interviews was conducted with staff nurses and the nursing students as primary data collection methods and supported with direct observation in the wards. A total of 21 staff nurses and 14 undergraduate nursing students from multiple wards were purposively sampled from April to December 2022. Data were analyzed using thematic analysis in Nvivo software. Four key themes were emerged in this study such as the partcipants i) Narrating IPC compliance; ii) IPC compliance adherence; iii) Perceived barriers for noncompliance to IPC; iv) Empowering staff nurses and nursing students on IPC compliance. The study findings served as key evidence for the hospital top management and the nursing faculty in planning the strategies to improve the IPC training and monitoring by empowering staff nurses and nursing students at their teaching hospitals.

Employing ‘someone to be your voice’ in an artisanal gastronomic tourism business: Authenticity, cultural capital and human resources

The difficulty of hiring suitable staff in rural areas has been particularly challenging for small gastronomic family businesses involved in tourism. Their human resources needs may include the ability of employees to tell stories about the business, including the family history, and to assist in maintaining its authentic image for visitors. This article explores the experiences of artisanal food or beverage tourism businesses with respect to employment of staff and draws on qualitative data from case studies of South Gippsland, Victoria in Australia and the UK’s Peak District. Sixteen semi-structured interviews were conducted with relevant stakeholders. Findings suggest that familiness played an important role in the way that many of these artisanal gastronomic businesses made their decisions to employ staff, linked to issues of authenticity and cultural capital. While employing non-family members to interact with visitors in public-facing roles was generally not a preferred option, these businesses may need to train and empower non-family staff to tell the family story in a convincing and acceptable way or pursue collaborations with other artisanal businesses to overcome the problem of staff shortages.

Mental Health Simulation Training for Pharmacy workforce in Secondary Care

Abstract Introduction Simulation involves life-like scenarios followed by reflection within a facilitated debrief and is widely used in healthcare education. The NHS Long Term plan1 and HEE2 reports highlight the need for the pharmacy workforce in different sectors to be confident and competent in providing care for people with mental health illnesses. Similarly, local integrated care services (ICSs) are prioritising parity of esteem and bridging gaps between services through an improved workforce. Aim To increase the pharmacy workforce’s confidence in supporting and caring for patients with mental health illnesses, reduce stigma, and empower staff to provide a safe, effective, and equitable service. Specific objectives were to: become familiar with substance misuse & learning disabilities; improve effective communication (verbal and non-verbal); and build confidence in formulating treatment plans, talking to patients in distress and taking appropriate histories within a mental health context. Methods Participants included medicines management pharmacy technicians (MMPTs) and pharmacists who volunteered from the acute and mental health Trusts within ICS. The training format included pre-reading clinical material, simulation scenarios co-produced with service users, multi-disciplinary team teaching, and debriefs. Ethical approval not required for the evaluation of the training. We collected quantitative and fee-text data via pre- and post-simulation questionnaires (two validated scales and course specific questionnaire). The data were subjected to descriptive statistical analysis and thematic grouping of free-text data with frequency counting. Results The whole group (n=29) showed an increase in empathy and improvement in attitudes towards people with mental health illness from pre to post simulation training. The 15 measures (course specific questionnaire) and the qualitative feedback indicated that the learning objectives were met. 100% of participants either strongly agreed/agreed that the simulation training helped improve their communication skills and found the debrief and service user participation valuable. The qualitative data supported these findings: “…gained confidence in speaking to patients with different forms of mental health conditions and patients who are in distress.” Discussion/Conclusion This project was a pioneer to assess the use of mental health simulation training within secondary care between two different practice settings. Whilst a small-scale study only, the findings showed improved communication and confidence within a mental health context, particularly in talking to patients in distress. The simulation training was well received by participants and supports the use of simulation in our aim of increasing pharmacy workforce confidence in caring for those with mental illness and reducing stigma. In addition to improving clinical knowledge and skills, simulation training can also help improve pharmacy staff perceptions, attitudes, and address stigma and hence contribute towards a high quality patient care service. This project indicates the potential value of training the pharmacy workforce on a wider scale, regardless of sector, in collaboration with MDT and service users.

Partnering to enhance the postgraduate student experience

The learning and teaching team at Edith Cowan University's School of Nursing and Midwifery has partnered with postgraduate students to enhance their experience and success. Targeted initiatives throughout the curricula, including online and multimodal learning activities and resources, were co-developed in response to anecdotal evidence that some commencing students in this diverse cohort were lacking essential digital and academic literacy skills. The team is improving learning opportunities for all students by leveraging online platforms and fostering constructive relationships between staff and students to enhance self-engagement and motivation. A self-evaluation has been developed and implemented for students to gain a clear understanding of their academic and digital literacies. It is also providing important data about students' preparedness for their studies. This paper will share early findings from the research project, including scalable approaches and strategies to promote agency and empower students and staff.

150-LB: Diabetes and School Health (DASH) Program—An Innovative School-Based Health Model to Optimize Care for Youth with Type 1 Diabetes

Objectives: Pediatric type 1 diabetes (T1D) care requires collaboration of families, diabetes team and caregivers. Youth spend most of the time in school so care optimization in school is crucial. There are no evidence-based guidelines for school-based care, and management varies based on local legislation, school district, and staffing. An innovative school-based program provides an opportunity to standardize care, improve outcomes, reduce inequities, and inform guidelines for school T1D care. Methods: The Nationwide Children's Hospital (NCH) Diabetes and School Health (DASH) program is a novel school-based intervention. The intradisciplinary DASH team provides on-site education to students/staff, addresses medical/psychosocial concerns, coordinates delivery of medications/supplies, and facilitates communication. The pilot aimed to enroll 50 students identified as high risk based on their Diabetes Composite Score, a risk assessment tool developed by NCH. Qualitative and quantitative data was obtained for students, caregivers, and staff, including A1C, acute care utilization, educational mastery, quality of life, psychosocial, and health equity measures. Results: 50 students over 35 schools enrolled in the pilot. The majority used injections, 50% never used a continuous glucose monitor, and the average baseline A1C was 12%. More than 60% identified as an ethnic minority. Survey data showed over 50% of students felt others did not appreciate the burden of T1D care and endorsed T1D "burn out." Over 50% of caregivers endorsed feeling defeated/discouraged by T1D care, and worry about T1D related complications. Conclusions: DASH is a novel school-based program that provides support, education, and oversight to students at high risk of T1D complications. The program aims to standardize school-based care, empower school staff, improve self-efficacy, address inequities, decrease T1D complications and provide a framework for school based care. Disclosure A. C. H. Wood: None. A. M. Moffett: None. K. Simms: None. M. Moore: None. E. Suli: None. M. K. Irwin: None. E. Edwards: None. K. Gandhi: None.

Leadership Style and Organisational Success

Leadership is defined in business as a company's management's ability to establish and accomplish tough objectives, react quickly and effectively when required, outperform the competition, and empower staff. Encourage you to put out your best effort. It might be difficult to assess a firm's management and other qualitative features when the contrast of quantitative data is often recorded and extremely simple to compare among organizations. A company's and its employees are guided by leadership. Employees should be aware of business rules and processes, as well as the measures necessary to attain their objectives. Employees are taught how to properly meet their obligations by their bosses, and their progress is tracked on a regular basis. We addressed fundamental leadership abilities and how they are effectively helping individuals in this research. Leadership can also mention to a more holistic solution, such as the impression given by a top business or the culture created by management. The future focus of the study will be on the application and understanding of leadership qualities.

Businesses in high drug use areas as potential sources of naloxone during overdose emergencies

IntroductionNaloxone distribution remains a cornerstone of a public health approach to combating the ongoing opioid overdose crisis. Most distribution programs focus on providing naloxone to individuals who use drugs or those closely associated with them (e.g., family). Utilizing businesses as fixed location sources of naloxone could be a valuable supplemental strategy to preventing fatal overdoses that is underexplored in the literature. MethodsWe surveyed business owners and employees (N = 149) located in neighborhoods characterized by high rates of drug use in Baltimore City. Participants reported their interactions with people who use drugs as well as if they had heard of naloxone, if the business had naloxone on the premises, and how many employees were trained to use naloxone. ResultsMost participants reported seeing individuals under the influence of drugs (93%), public drug use (80%), and overdose (66%) while at work. 66% of participants had heard of naloxone. Among those who had heard of naloxone, only 39% reported that there was a naloxone kit in the business and 28% of businesses had multiple employees trained to use naloxone. ConclusionsBusinesses are underutilized as potential reliable sources of naloxone. While study participants reported high levels of exposure to drug use and overdose in and around their businesses, their ability to intervene was limited. Efforts to train employees to respond to overdoses and to keep naloxone on site are warranted to supplement existing naloxone distribution efforts and can help empower business staff to help prevent overdose mortality in their communities.

Building capacity for implementation\u2014the KT Challenge

BackgroundThe KT Challenge program supports health care professionals to effectively implement evidence-based practices. Unlike other knowledge translation (KT) programs, this program is grounded in capacity building, focuses on health care professionals (HCPs), and uses a multi-component intervention. This study presents the evaluation of the KT Challenge program to assess the impact on uptake, KT capacity, and practice change.MethodsThe evaluation used a mixed-methods retrospective pre-post design involving surveys and review of documents such as teams’ final reports. Online surveys collecting both quantitative and qualitative data were deployed at four time points (after both workshops, 6 months into implementation, and at the end of the 2-year funded projects) to measure KT capacity (knowledge, skills, and confidence) and impact on practice change. Qualitative data was analyzed using a general inductive approach and quantitative data was analyzed using non-parametric statistics.ResultsParticipants reported statistically significant increases in knowledge and confidence across both workshops, at the 6-month mark of their projects, and at the end of their projects. In addition, at the 6-month check-in, practitioners reported statistically significant improvements in their ability to implement practice changes. In the first cohort of the program, of the teams who were able to complete their projects, half were able to show demonstrable practice changes.ConclusionsThe KT Challenge was successful in improving the capacity of HCPs to implement evidence-based practice changes and has begun to show demonstrable improvements in a number of practice areas. The program is relevant to a variety of HCPs working in diverse practice settings and is relatively inexpensive to implement. Like all practice improvement programs in health care settings, a number of challenges emerged stemming from the high turnover of staff and the limited capacity of some practitioners to take on anything beyond direct patient care. Efforts to address these challenges have been added to subsequent cohorts of the program and ongoing evaluation will examine if they are successful. The KT Challenge program has continued to garner great interest among practitioners, even in the midst of dealing with the COVID-19 pandemic, and shows promise for organizations looking for better ways to mobilize knowledge to improve patient care and empower staff. This study contributes to the implementation science literature by providing a description and evaluation of a new model for embedding KT practice skills in health care settings.

Is a nudge all we need to promote deliberate clinical inertia and thoughtful clinical decision making?

Deliberate clinical inertia is the art of doing nothing as a positive response. Individual clinicians can promote deliberate clinical inertia through teaching, re-framing the act of 'doing nothing' as 'doing something' and engaging in shared decision making. Behaviour change on a larger scale requires a systematic approach. Nudging is a subtle change to the decision-making context to prompt specific choices. A nudge unit is a team of relevant professionals who engage with various multidisciplinary teams within a health service who help test and implement nudge interventions in a clinical environment. A nudge unit could be used to design environments to prompt clinicians to re-think before ordering unnecessary tests or treatments. Nudge units could improve knowledge translation, support continuous quality improvement and help build a learning health system. They could also boost collaboration and empower staff to evaluate their workplace decision-making frameworks.

Dashboards and report cards: Using staff performance to drive outcomes.

Dashboards and report cards: Using staff performance to drive outcomes.

Use of a Multidisciplinary Mechanical Ventilation Weaning Protocol to Improve Patient Outcomes and Empower Staff in a Medical Intensive Care Unit.

Prolonged duration of mechanical ventilation is associated with higher mortality and increased patient complications; conventional physician-directed weaning methods are highly variable and permit significant time that weaning is inefficient and ineffective. The primary objective of this quality improvement project was to implement a registered nurse (RN)- and respiratory therapist (RT)-driven mechanical ventilation weaning protocol in a medical intensive care unit (ICU) at a tertiary care academic medical center. This quality improvement project used a quasi-experimental design with a retrospective usual care group who underwent physician-directed (conventional) weaning (n = 51) and a prospective intervention group who underwent protocol-directed weaning (n = 54). Outcomes included duration of mechanical ventilation, ICU length of stay, reintubation rates, and RN and RT satisfaction with the weaning protocol. Patients in the RN- and RT-driven mechanical ventilation weaning protocol group had significantly lower duration of mechanical ventilation (74 vs 152 hours; P = .002) and ICU length of stay (6.7 vs 10.2 days; P = .031). There was no significant difference in reintubation rates between groups. Staff surveys indicate that both RN and RTs were satisfied with the process change. Implementation of a multidisciplinary mechanical ventilation weaning protocol is a safe and effective way to improve patient outcomes and empower ICU staff.

Empower staff

Giving staff confidence in their own abilities will help them during an inspection, writes Annette Rawstrone

Nurse Leaders Advocate for Nurses Across a Health Care System: COVID-19

The COVID-19 pandemic emphasizes the importance of nursing care globally. Nurses are the frontline staff in the care of individuals stricken with this highly infectious and deadly illness. Nurse leaders must advocate for nursing staff when staff are immersed in often overwhelming conditions. Through a case study, this article outlines how one healthcare system’s Chief Nursing Officer council worked collaboratively, jointly and with the Emergency Incident Command Structure, to operationalize CDC guidelines and support, protect, educate, and empower staff. These initiatives resulted in creative solutions, technological advances for the system, and nursing staff and leaders rising to the challenge.

Quality Improvement in a Pandemic.

Quality Improvement in a Pandemic.

Knowledge, Attitudes and Practices of Australian Trainee Childcare Educators Regarding Their Role in the Feeding Behaviours of Young Children.

Background: Early childhood (2–5 years) is acknowledged as a critical time for the establishment of healthy behaviours. The increasing number of children and amount of time spent in childcare provides strong rationale to explore the important role that childcare services and childcare educators play in influencing healthy eating behaviours of young children in their care. Methods: This study used a qualitative exploratory approach to describe the knowledge, attitudes and practices of Australian childcare trainee educators’ regarding their role in the feeding of young children. Results: All participants agreed that feeding of young children was an important part of their role, but described challenges to the promotion of healthy eating and the adoption of responsive child feeding practices. These included personal beliefs and experiences with food, the bi-directional nature of child feeding, conflicting parental requests and/or unsupportive centre-based policies and procedures. Conclusion: Training about responsive child feeding practices within the childcare sector should include all childcare staff; aim to enhance relational efficacy and communication skills with parents; and empower childcare staff to lead organisational change. To support this, childcare centres need to provide coherent centre-based healthy eating policies inclusive of healthy food provision and desirable feeding practices.

SIESTA (Sleep of Inpatients: Empower Staff to Act) for Acute Stroke Rehabilitation

SIESTA (Sleep of Inpatients: Empower Staff to Act) for Acute Stroke Rehabilitation