Governance Councils Research Articles

Caregiver Fatigue

This article describes the profound impact of fatigue and the process by which 1 academic medical center assessed fatigue levels, and associated factors, among nursing personnel in their effort to develop a comprehensive fatigue management program. To adequately perform amid high patient acuity and in today's fast paced healthcare environment, nurses must be attentive and react quickly and appropriately with clear judgment and reasoning-abilities that can be greatly impaired by fatigue. Nursing leaders are instrumental in systematically addressing work-related fatigue and implementing processes designed to prevent fatigue and overwork; however, baseline measures are necessary if the efficacy of these initiatives is to be assessed. The 15-item Occupational Fatigue Exhaustion/Recovery scale was used to assess current fatigue levels among nursing staff at a university medical center. Demographic and schedule-related questions were used to examine the characteristics of the population and identify any associated factors. Work-related fatigue is prevalent among all nursing staff, but differences were noted based on the respondent's position, age, and typical work shift. Nursing administrators and shared governance councils can address the factors contributing to work-related fatigue and negatively impacting nursing personnel's ability to rest and recuperate. Nurse leader involvement is needed to develop comprehensive fatigue reduction strategies.

Evidence-Based Nursing Practice: The PEACE Framework

At NewYork-Presbyterian Hospital (NYP), we believe that in order to provide safe, effective, efficient, quality, and cutting-edge patient care, the provision of nursing services should be evidence based. To realize this belief, in 2011, over 75 clinical nurses from the various NYP sites developed the PEACE framework to facilitate evidence-based practice (EBP) review and the conduct of research utilization. These nurses were members of the nursing evidence-based practice and research (NEBPR) collaborative, shared governance councils.

The Effects of Clinical, and Sub‐Clinical mTBI on Cognitive Function in Varsity Athletes

Emerging research suggests that head trauma, causing clinical (medically diagnosed, ie. concussion), or sub‐clinical minor Traumatic Brain Injury (mTBI) is cumulative and correlates negatively with cognitive function. Given the high prevalence of head trauma in contact athletics, better understanding the relationship between contact‐athletic activity, mTBI, and independent aspects of cognitive function is imperative.Sixty‐eight varsity football athletes were recruited to examine how cumulative head trauma and self‐reported mTBI affect cognitive function. Participants completed a 12‐test online cognitive battery (www2.cbstrials.com) at time points prior to, bi‐weekly throughout, and after the season. With each cognitive test, participants also completed a personal history questionnaire to assess their ongoing athletic activity and mTBI status. Through assessing three distinct aspects of cognitive function (verbal ability, short‐term memory, and reasoning ability) via the cognitive battery in a longitudinal fashion, we will comprehensively examine the effects of contact athletic participation on independent aspects of cognitive function. Results look to better characterize the relationship between mTBI and cognitive function as well as inform sport decisions made by athletes, recreationalists and athletic governance councils to guide participation and safe play decisions.

Risk Management, Board Effectiveness and Firm Value: Evidence from S&P/Asx200 Companies

Risk management has become a significant part of firm management after the recent financial crisis. In this study we examine risk management at enterprise level (Enterprise Risk Management or ERM), the effectiveness of audit & risk committee and the relation of ERM implementation to firm performance and firm value for a sample of S&P/ASX200 companies. ERM is the focus of all strategic management efforts as it gives a long run competitive advantage to businesses. Prior studies show mixed evidence on the performance effects of ERM for companies. Though various committees (e.g. COSO) and corporate governance councils (e.g. ASXCG Council) recommend firms to adopt ERM, its implementation and resulting benefits are inadequate. Prior literature on corporate governance supports the view that stronger governance mechanisms are needed for an effective implementation of management strategies. Following this, we test the effectiveness of the board in risk management implementation. Here we test the audit and risk committee effectiveness of our sample firms, using independence, power, size, and expertise of directors in the committee and compliance level of firms as the core stimulating factors of effectiveness, and the influence of effective committees on firm performance and firm value. Though our results show negative impact of ERM on firm performance and firm value, for firms with effective audit and risk committees, ERM implementation has positive and significant outcome on firm performance and value. There is evidence that the firms have increased awareness of the benefits of effective risk management after the financial crisis period compared to the pre-crisis period. Our results present further evidence that for firms with effective committees, this positive impact on firm value is pronounced more in the period after the recent global financial crisis.

Leveraging Shared Governance Councils to Advance Evidence‐Based Practice: The EBP Council Journey

This column shares the best evidence-based strategies and innovative ideas on how to facilitate the implementing of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787.

Letters

Letters

Making RN Orientation Better: Improving the Bone Marrow Transplant Experience

s / Biol Blood Marrow Transplant 20 (2014) S297eS315 S309 time to review the resume & invite those who expressed an interest in working in BMT, to take part in the program. Methods, Intervention, & Analysis: The PNA Program is a 10-week program where the leadership team provides the PNA with a chance to experience the inpatient arena, as well as the outpatient area of BMT. This is a unique opportunity for students to experience caring for patients in two unique settings without having the pressure of committing to transplant nursing as a career. The PNA is employed as a 40hour a week employee, with the time being split between working with the Registered Nurse and the Nursing Care Assistant. These 10 weeks are spent investing in this PNA. The investment in these nursing students has turned out to be very profitable. Over the past 4 years our applicant pool has been these same nursing students who want to come back & work in the area of BMT. Findings & Interpretation: Even though we have not changed our orientation program to reflect time spent as a PNA, we have found that as a new graduate the PNA has a better grasp on the foundations of BMT. Their assessment skills are outstanding and they are able to care for the more complex patient sooner in their professional development process. Discussion & Implications: Through the years we have to face some challenges with this tactic. One year, due to the staffing challenge we all face, there were six new hires being brought in during the time we would normally commit to having a PNA working on the unit. Due to the number of preceptors needed we were unable to provide the PNA with the opportunity to work in BMT. Other than this obstacle we have made this work. Currently the recruitment rate among PNA’s is 67% with hopes of improving this rate with the help of our unit based Work Culture, Clinical Practice and Education Shared Governance Councils.

Three structures for a healthy work environment.

Three structures for a healthy work environment.

Community Leadership and Gender Equality: Experiences of Representation in Local Governance in Timor‐Leste

In Timor‐Leste, women lack a voice in customary governance processes. Since independence in 2002, the Timor‐Leste government has adopted policies that provide equal rights for men and women and promote the inclusion of women in decision‐making structures at national and local levels. Women's participation in democratic governance has been supported by international development agencies. This article draws on field research in Timor‐Leste in 2011 to investigate the experiences of women leaders in national and local governance structures. It analyzes the strategies to promote a national women's agenda in national politics as well as the challenges for women representatives on community governance councils. A case study on domestic violence provides analysis of the inconsistencies between customary leadership and the constitutional right to equality. The article argues that greater integration of the customary and national governance systems would better support the human rights principles to which Timor‐Leste is committed.

Women’s Rights and Sovereignty/Autonomy

In recent years in both the United States and Latin America, indigenous peoples have taken increasing control over local justice, creating indigenous courts and asserting more autonomy in the administration of justice in their tribes, regions, or communities. New justice spaces, such as the Chickasaw District Courts in Oklahoma and the Zapatista Good Governance Councils in Chiapas, work to resolve conflict based largely on indigenous ‘customs and traditions.’ Many of the cases brought before these local legal bodies are domestic cases that directly involve issues of gender, women’s rights and culture. Yet the relationship between ‘indigenous traditions’ and women’s rights has been a fraught one. This forum article considers how these courts emerged in the context of neoliberalism and whether they provide new venues for indigenous women to pursue their rights and to challenge gendered social norms or practices that they find oppressive.

Nursing Portfolio Study

Professional portfolios allow staff to document their participation in areas of education, certification, shared governance councils, national nursing organizations, and community outreach. In this study, nurses tracked their professional development in a virtual electronic portfolio. A preperception/postperception questionnaire for both staff and unit directors revealed that nursing portfolios proved to be a valuable tool during annual performance reviews to acknowledge accomplishments and encourage continued professional growth of individual direct-care staff nurses.

From Partnership to Innovation

In Creative Nursing 2012, our overarching theme of Partnerships in Practice led us from an exploration of the frontiers of a new paradigm in professional relationships; through ways to educate nurses in understanding, creating, and navigating these relationships; to living the relationships as we bring the art and science of nursing to those we serve. This issue focuses on the structures that support and enhance partnerships in practice: shared governance, primary nursing, and unitbased councils (those that foster evidence-based practice and those that design effective, humane policies to address the realities of providing care at all hours). Our guest editor, Tim Porter-O'Grady, literally wrote the book on shared governance 25 years ago. In this issue, he presents his own new paradigm in "Reframing Knowledge Work: Shared Governance in the Postdigital Age." Then, in an example of the synergy that earns our journal its title, Adelphi University nursing professor Patricia Donohue-Porter advocates for an immersive culture of shared governance within nursing-a culture nourished by elements of classical scholarship such as scholarly inquiry, conscious reflection, persistent critique, and intellectual creation, and characterized by scholarly virtues described by philosophers and nursing theorists. Equally passionate advocacy for the role of primary nursing in giving "practical, functional life to the relationship of professional trust between registered nurses and their patients" is provided by health care consultant Shirley Ruch, who issues a call for "clarity, empowerment, and accountability." When our editorial board chose Sharing Governance as our final issue on partnerships, we wished to create a link with democracy because we see shared governance as the ultimate democratic process and want to emphasize its relevance to the wider society. Nursing professor Lori Steffen reviews Healing the Heart of Democracy: The Courage to Create a Politics Worthy of the Human Spirit by Parker Palmer. And "This I Believe About Nursing in a Changing World," an essay by nursing scholar, ethicist, and thought leader Katharine Densford, is as relevant today as it was when written in 1964. The scholarly impulse that makes nurses professionals rather than technicians moves us to partner in interdisciplinary groups to enhance the care we provide through studying best practices and implementing and evaluating quality improvement initiatives. We present two articles in the "Outcomes" section that offer exciting vistas of what can be achieved when unit-based councils are empowered to act to their full capacity. Julie Ann Sakowski and colleagues from Sutter Health in California describe a 5-year project to promote evidence-based practice through unit councils. The significant gains in quality of care that they are able to report are truly inspiring. And consultant Susan Wessel presents outcomes from several organizations throughout the country after the formation of unit practice councils to implement Relationship-Based Care. These organizations report advances in a myriad of variables, both clinical (e.g., ventilator-associated pneumonias and central line-associated bloodstream infections) and operational (e.g., patients' willingness to recommend and nurse satisfaction). Employing unit-based councils to manage staffing and scheduling is advocated by ChrysMarie Suby of the Labor Management Institute. These issues may seem far afield from the scholarly pursuit of a culture of shared governance, but they are vital to nurses striving to provide excellent care to patients while remaining healthy themselves. When schedules are restructured so that nurses are no longer working seven 12-hour shifts in a row, the impacts on patient safety and caregiver health cannot be overestimated. In our ongoing feature on Nursing Salons, Sheryl Ramstad, an attorney and judge who is beginning a new career in nursing, gives the history of salons going back to 17th-century France, "Coming from the legal profession, which is steeped in rich traditions like the Inns of Court and the Socratic method, I appreciated the historical underpinnings and attended to increase my knowledge of my new profession. …

Sustainability in Perianesthesia Nursing Practice

The Post Anesthesia Care Unit (PACU) and Same Day Surgery (SDS) departments each have their own Unit Based shared governance Councils (UBC) comprised of staff nurses and unit leaders. The UBCs decided to look for opportunities to decrease costs and impact on the environment. Paper usage and proper disposal of waste were identified as two key areas.

Developing and Implementing a Nursing Professional Practice Model in a Large Health System

A large healthcare system was challenged to develop a nursing professional practice model that would apply to and be understood by nurses at all levels and across all entities of the organization. A team was convened, composed of direct care nurses, educators, clinical nurse specialists, Magnet program directors, managers, and directors, representing 5 hospitals, the organization institute for nursing, and system support services. The group drafted a model describing nursing across the organization. The draft model was vetted in nursing governance councils across the entity. The model includes a theoretical framework; a mission, vision, and values; elements of professional practice; internal accountabilities; and nursing outcomes. Nurses learned about the model through Web-based and face-to-face training, through participation in a professional practice model blog and group discussions.

Evaluating the Effectiveness of Pediatric Pain Management Guidelines

In response to unit nursing quality and patient satisfaction concerns, the shared governance councils identified opportunities to improve overall assessment and management of pain in hospitalized pediatric patients. Together, the unit-shared governance councils evaluated current practice and reviewed the literature to develop comprehensive Pediatric Pain Assessment and Management Guidelines. The purpose of this study was to evaluate the effectiveness of implementing an evidence-based pain assessment and management guideline on nurses' knowledge, ability to assess and manage the patients' pain, and patient/family satisfaction with staff's management of pain. This intervention study with a pre-post design included three assessment intervals described as baseline and 3 and 6 months after guideline implementation. The sample included pediatric and pediatric intensive care unit (PICU) nursing staff, retrospective chart reviews of pediatric and PICU patients, and patient/parent satisfaction scores. No differences were found between nurses' knowledge and attitudes regarding pain before and after implementation of the guideline. Significant increases in pain assessment, use of correct tool, and reassessment were found following implementation. Although improving, there was no difference in patient/family satisfaction after guideline implementation.

Walk the Talk: Promoting Control of Nursing Practice and a Patient-Centered Culture

Walk the Talk: Promoting Control of Nursing Practice and a Patient-Centered Culture

The Magnet Designation Process

Twelve nurse leaders and 12 registered nurses from 2 hospitals were interviewed to gain an understanding on the process for preparing for magnet designation. These leaders and nurses provided insight into whether a cultural shift within the organization was occurring while striving for magnet designation and the level of staff nurses' engagement during the process. Donabedian's framework provided the conceptual context for this study. According to Donabedian, stable organizational structures will influence professional nursing processes and result in better outcomes as measured by magnet status. The authors discuss how a magnet culture is achieved when structural factors such as adequate staffing and pay are present before building the processes, as well as the ways certain ingredients such as professional governance councils need to be primed to achieve the desired magnet outcome. However, transforming the culture into a "valued-practice" magnet organization entails a paradigm shift marked by the willingness to share information and the depth and breadth of commitment toward staff engagement in fulfilling the mission of a culture that truly values nursing expertise.

Organizational commitment and governance for supply chain success

PurposeTo examine the nature and extent of commitment to supply chain collaboration. Also, to explore the state of supply chain governance structures.Design/methodology/approachA multi‐method survey and in‐depth interview methodology was employed to gather data. Content analysis was then used to identify the types and extent of managerial support for supply chain initiatives.FindingsFour types of managerial support are needed to achieve the highest levels of supply chain success: top management support, broad‐based functional support, channel support, and infrastructural/governance support. None of the interview companies have put all four types of support in place. Leading‐edge governance relies on cross‐functional/inter‐organizational teams, executive governance councils, customer advisory boards, supplier advisory councils and a modified reporting structure that overseas all value‐added activities from product conceptualization to customer relationship management. Again, none of the interview companies have established all aspects of an effective supply chain governance structure.Originality/valueMuch has been written on the need to focus on supply chains and create more cooperative and integrative relationships with key organizations in the supply chain; however, little has been written concerning the commitment levels among those involved in the supply chain or the types of governance structures that should be utilized within a given organization or along the supply chain. This paper bridges this gap, providing a benchmark for managerial commitment and presenting a composite governance structure based on observed best practices. Both academics and practitioners can use the insights provided to work toward a better understanding of supply chain commitment and governance.

Balancing nurse empowerment with improved practice and care: An evaluation of the impact of shared governance

This paper reports on the preliminary findings of a two-year ethnographic study of the implementation of shared governance at Kettering General Hospital NHS Trust. Key aims of the study were to identify the impact of shared governance on clinical practice and patient care, and the effects of its implementation on nurses and midwives. The findings suggest that the early impact of shared governance related primarily to effects on the professional environment and culture of nursing, particularly increased information-sharing and feelings of empowerment. Impact on patient care and service delivery was limited, with key obstacles to successful implementation including poor communication systems, lack of a means of publicising the work of shared governance councils, and difficulties finding the best ways of managing time spent away from clinical areas on practice and professional development issues. There was evidence that shared governance could have an indirect impact on patient care in the longer term. We suggest that it may have to be accepted that, initially, the early impact of shared governance is felt mainly by health professionals, and that the desired impacts on service delivery are the indirect benefits of more empowered and professionally accountable nurses and midwives in the longer term.

Regional governance and regional councils

National Civic ReviewVolume 85, Issue 2 p. 53-58 Article Regional governance and regional councils J. Eugene Grigsby III, J. Eugene Grigsby IIISearch for more papers by this author J. Eugene Grigsby III, J. Eugene Grigsby IIISearch for more papers by this author First published: Spring/Summer 1996 https://doi.org/10.1002/ncr.4100850211Citations: 5AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume85, Issue2Spring/Summer 1996Pages 53-58 RelatedInformation