Nurse Unit Managers Research Articles

Cardiac rehabilitation ambassadors - a new model to enhance patient participation

Abstract Introduction Participation in outpatient Cardiac Rehabilitation (CR) is considered an integral part of secondary treatment of heart disease. Despite being considered standard care, participation remains low internationally. Encouraging patients to enrol in CR during their hospital stay is linked to higher participation. [1] This study was conducted at a hospital that provides acute cardiac and rehabilitation services in Australia. Purpose As a provider of cardiac care, we identified that increasing nurses’ knowledge of the of CR would improve their capacity to promote CR during patient’s hospital stay. Methods Utilising a quality improvement methodology, the Cardiac Ambassador Initiative was developed with key stakeholders working on cardiac units in 2022. The program consisted of an immersion experience for cardiac nurses to shadow CR nurses working in a specialist rehabilitation centre providing best practice CR for patients with a variety of cardiac conditions. To evaluate the impact of the program, cross-sectional surveys and individual interviews were conducted with participants and Nurse-Unit-Managers (NUMs). Key outcomes included: ambassadors’ knowledge and confidence to promote CR participation to their patients on the wards and NUM's perceptions of the impact of the program. Results The program was run over two years. The NUMs and CR-coordinator selected a total of 13 nurses to participate. In 2022 4 participants attended a total of 5 days each. Following evaluation, the program was modified to 3 days for participants in 2023, which enabled 9 participants to attend. All participants described not fully understanding the nature of CR and its impact on patients until they attended a program. Prior to attendance, 100% of participants considered it was important or somewhat important for patients to attend CR. Following attendance 100% of participants consider it essential or important for patients to attend. They also reported feeling more confident to discuss CR with patients and colleagues and encourage patient participation following the immersion experience. Pre-attendance 100% of participants felt either not at all confident or somewhat confident to discuss CR with their patients and this improved post program with 100% feeling very confident. 100% of participants also indicated that their confidence and skill in discussing CR with patients greatly improved and recommended that others should participate in the CR Ambassador program. Nurse Unit Managers reported that the CR Ambassadors were a valuable resource for both staff and patients on the cardiac unit and that they had identified a need to review the accessibility of CR information and referral documentation available on their wards. Conclusion The immersion experience represents a feasible and sustainable approach to establishing CR ambassadors on acute cardiac wards with the skills needed to promote CR participation to colleagues and patients.

Pre-implementation context and implementation approach for a nursing and midwifery clinician researcher career pathway: A qualitative study.

To describe the pre-implementation context and implementation approach, for a clinician researcher career pathway. Clinician researchers across all health disciplines are emerging to radically influence practice change and improve patient outcomes. Yet, to date, there are limited clinician researcher career pathways embedded in clinical practice for nurses and midwives. A qualitative descriptive design was used. Data were collected from four online focus groups and four interviews of health consumers, nursing and midwifery clinicians, and nursing unit managers (N = 20) between July 2022 and September 2023. Thematic and content analysis identified themes/categories relating to: Research in health professionals' roles and nursing and midwifery, and Research activity and culture (context); with implementation approaches within coherence, cognitive participation, collective action and reflexive monitoring (Normalization Process Theory). The Pathway was perceived to meet organizational objectives with the potential to create significant cultural change in nursing and midwifery. Backfilling of protected research time was essential. The Pathway was seen as an instrument to empower staff, foster staff retention and extend research opportunities to every nurse and midwife, while improving patient experiences and outcomes. Clinicians, consumers and managers fully supported the implementation of clinician researchers with this Pathway. The Pathway could engage all clinicians in evidence-based practice with a clinician researcher leader, effect practice change with colleagues and enhance patient outcomes. This study adheres to relevant EQUATOR guidelines using the COREG checklist. Health consumers involved in this research as participants, did not contribute to the design or conduct of the study, analysis or interpretation of the data, or in the preparation of the manuscript.

Influence of job demands and job control on work–life balance among nursing staff

Background Job control is an important factor for managing job demands and achieving work–life balance, which reflects on nursing staff performance and patient care. Aim The aim was to examine the influence of job demands and job control on work–life balance among nursing staff. Design A descriptive, correlational research design was used for this study. Setting The study was conducted at El-Sadat Central Hospital in Menoufia Governorate, which is affiliated to the Ministry of Health. Sampling A convenient sample of 150 nursing staff out of 313 constituted the study sample. Tools Data was collected by utilizing the following three tools. (I) Personal characteristics and work-related data sheet. (II) Job demands and job control questionnaire. (III) Work–life balance questionnaire. Results The results revealed that the total mean percent of job demands among nurses was 70.7%, which indicated a high level of job demands. Moreover, the mean score of job control among nurses was 64%, which indicated a moderate level of job control. Also, the mean score of work–life balance among nurses was 76.7%, which indicated a moderate level of work–life balance. Conclusion There was a highly statistically significant positive, strong correlation between job control and work–life balance among the studied nursing staff, and there was a negative correlation between job demands and both job control and work–life balance. Recommendations Nurse unit managers should support nurses with a healthy work environment, which involves good management of workload and ensuring the availability and dissemination of guidelines, standards, policies, and procedures to achieve organization.

Working effectively with consumers: Perspectives from students, teachers, nurses, and consumers.

Preparing enrolled nurses (ENs) to effectively work with mental health consumers is crucial to meeting Australia's healthcare demands. This qualitative study aimed to explore various stakeholders' perceptions regarding the mental health knowledge, skills, and attributes (KSAs) required by ENs to engage with individuals experiencing mental health issues, thus guiding future training priorities. The sample comprised 44 participants including 18 students, 3 graduate ENs, 5 experienced ENs, 5 registered nurses (RNs), 4 nurse unit managers (NUMs), 5 teachers, and 5 consumers of mental health services. Focus groups were used to collect data from the students, whilst individual interviews were conducted with all other participants. A thematic analysis revealed communication was the most vital skill for effectively working with mental health consumers. Skills such as critical thinking and clinical reasoning were also deemed crucial, given the volatile nature of the mental health inpatient environment, necessitating effective responses to acute escalations to prevent adverse outcomes for both staff and consumers. Essential knowledge components included understanding mental health disorders, symptoms, and treatments, particularly medications used for mental health issues. Participants also emphasised the importance of attributes like confidence and empathy in supporting and caring for consumers, who often experienced trauma and vulnerability. These findings provide valuable insights into the content that should be incorporated into the diploma of nursing (DN) training to produce competent graduate ENs.

간호사의 행복감, 셀프리더십, 간호조직문화 유형이 혁신행동에 미치는 영향

Purpose : This descriptive study aims to identify the influencing factors of happiness, self-leadership, and the nursing organizational culture type of nurses on innovative behavior. Methods : Data were collected from 204 nurses working in 5 hospitals with more than 100 beds in G Metropolitan City from August 15-30, 2022. Data were analyzed though descriptive statistics, t-tests, ANOVA, Pearson’s correlation, and multiple regression analysis using the SPSS WIN 26.0 program. Results : A statistically significant difference was found in innovative behavior according to the participants' marital status (t＝－2.12, p＜.05), religion (t＝1.98, p＜.05), education level (F＝8.79, p＜.001), total clinical experience (t＝－2.13, p＜.05), length of work with the current nursing unit manager (t＝－2.29, p＜.05), work type (t＝3.76, p＜.001), and satisfaction with the nursing job (F＝12.10, p＜.001). For innovative behavior of the participants, positive correlations were shown in the order of innovation- oriented culture (r＝.55, p＜.001), self-leadership (r＝.54, p＜.001), happiness (r＝.48, p＜.001), work-oriented culture (r＝.40, p＜.001), relationship-oriented culture (r＝.31, p＜.001) and hierarchy-oriented culture (r＝.27, p＜.001). The factors influencing nurses’ innovative behavior were innovation-oriented culture (β＝.36, p＜.001), self-leadership (β＝.26, p＜.001), hierarchical culture (β＝.16, p＜.01), happiness (β＝.14, p ＜.05), work-oriented culture (β＝.14, p＜.05), and work type (β＝.13, p＜.01). These factors showed a 50.9% explanatory power for nurses’ innovative behavior. Conclusion : Therefore, improving the innovative behavior of nurses requires an environment where they can enhance happiness and learn leadership through programs tailored to individual characteristics. Additionally, forming a systematic organizational culture is essential.

Developing a haemodialysis acuity tool (the HAT study): A qualitative study.

Haemodialysis units are now managing an increasing number of patients with varying needs and levels of acuity. To maintain safety, haemodialysis patients must be placed in the most appropriate dialysis unit that has the required human and physical resources to care for them. The first step towards achieving these goals is to develop a tool specific to haemodialysis units to effectively measure patient acuity. To develop a haemodialysis acuity tool, utilising a focus group approach, in assessing patient's suitability for a specific dialysis location thus ensuring patient safety. This is a cross-sectional qualitative study via a focus group approach. Participants were nurse unit managers and team leaders of a District Renal Service. Participants were interviewed to explore their views on the elements and measures identified in the research aims. Themes for interviews were informed by current literature on acuity tools for haemodialysis patients' admission to the dialysis units. Interviews were recorded and transcribed verbatim and progressively analysed using a thematic analysis approach. Ten nurse unit managers/team leaders (100%) were interviewed and thematic analysis of the transcripts was conducted utilising the deductive approach. Five themes were identified which will form the main categories in the development of the tool, namely: Age/frailty; co-morbidity; physical; dialysis; and psychosocial. This study is instrumental in the development of the haemodialysis acuity tool which can be used in allocating dialysis location specific to patient's needs and available resources. The tool can also be used in analysing patient care processes and resource requirements based on the patients' and unit's profile.

Factors Impacting on Nurse Unit Managers’ Knowledge and Ability Importance of Managerial Competencies

Factors Impacting on Nurse Unit Managers’ Knowledge and Ability Importance of Managerial Competencies

Mediating Effect of Leader-Member Exchange on the Ethical Leadership of Nursing Unit Managers and Turnover Intention of Clinical Nurses: A Nationwide Survey using Proportional Quota Sampling

Mediating Effect of Leader-Member Exchange on the Ethical Leadership of Nursing Unit Managers and Turnover Intention of Clinical Nurses: A Nationwide Survey using Proportional Quota Sampling

An Exploration of Nurses' Experience Following a Face-to-Face or Web-Based Intervention on Patient Deterioration.

A web-based clinical simulation program, known as FIRST2ACT (Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends), was designed to increase the efficacy of clinicians' actions in the recognition and immediate response to a patient's deterioration. This study, which was nested in a larger mixed method project, used ten focus groups (n = 65) of graduate, enrolled, registered nurses, associate nurse unit managers, and general managers/educators/coordinators from four different institutions to investigate whether nurses felt their practice was influenced by participating in either a face-to-face or web-based simulation educational programme about patient deterioration. The results indicate that individuals who were less "tech-savvy" appreciated the flexibility of web-based learning, which increased their confidence. Face-to-face students appreciated self-reflection through performance evaluation. While face-to-face simulations were unable to completely duplicate symptoms, they showed nurses' adaptability. Both interventions enhanced clinical practice by improving documentation and replies while also boosting confidence and competence. Web learners initially experienced tech-related anxiety, which gradually subsided, demonstrating healthcare professionals' resilience to new learning approaches. Overall, the study highlighted the advantages and challenges of web-based and face-to-face education in clinical practice, emphasising the importance of adaptability and reflective learning for healthcare professionals. Further exploration of specific topics is required to improve practice, encourage knowledge sharing among colleagues, and improve early detection of patient deterioration.

ANALYSIS OF NURSE UNIT MANAGER SUPERVISION ON THE PERFORMANCE OF NURSES AT X HOSPITAL KEDIRI CITY, INDONESIA: A CROSS-SECTIONAL STUDY

Background: Hospital performance challenges are receiving attention because they concern the efficiency and effectiveness of human resources in accomplishing organizational objectives and visions. Many factors influence performance, including superiors' supervision, which has an impact on the organization's overall performance results. In fact, supervision has not been carried out optimally. Purpose: to analyze how the nurse unit manager's supervision affected nurse performance. Methods: A correlational study methodology was used on 67 nurses from the inpatient room. To obtain 57 individuals, a stratified random sampling procedure was used. The data was analyzed using the Spearman rho statistical test, with a significance threshold of = 0.05. Results: From 67 respondents, 33 respondents (57.9 percent) stated that the nurse unit manager offered acceptable supervision. The 32 respondents (56.1 percent) had adequate performance. Result of the Spearman rho test obtained a p-value = 0.000 which is less than the value of alpha (0.05), so it can be concluded that H0 is rejected, meaning that there is a relationship between the supervision of the head of the room and the performance of nurses at X Hospital Kediri City. Conclusion: It was concluded that there is a link between the nurse unit manager's supervision and the performance of nurses. The study's findings also suggest that supervision can increase nurse performance because, when supervising the nurse unit manager evaluates certain activities directed at nurses, if the evaluation is corrected by the nurse, it can improve the nurse's performance.

The perceptions of nurse managers working in the mining industry on workplace relationships.

Positive workplace relationships improve the quality of healthcare provided by promoting teamwork and ensuring that challenges are addressed amicably. Nurse managers, unit managers, nurses, doctors and union leaders are obligated to establish positive working relationships to deliver quality primary healthcare service to mine workers at the clinics of the mine. However, there are negative workplace relationships at the clinics of a specific mining company that affect the quality of service delivered. The purpose of this study was to explore and describe the perceptions of primary healthcare nurse managers working in the mining industry on workplace relationships. This study was conducted in mining primary healthcare clinics located in Gauteng province, in the West Rand. A qualitative, exploratory, descriptive and contextual research design was adopted in this study. Individual interviews were conducted to collect data from the primary healthcare nurse managers, and data were analysed using thematic analysis. Trustworthiness measures and ethical principles were upheld in this study. Three themes surfaced in this study: (1) negative perceptions of primary healthcare nurse managers on workplace relationships, (2) positive perceptions of primary healthcare nurse managers on workplace relationships and (3) building workplace relationships between primary healthcare nurse managers and union leaders. Nurse managers had positive and negative perceptions on working relationships in this study. Negative workplace relationships should be prevented at all costs by resolving conflicts amicably. Resolving of conflicts amicably to build positive workplace relationships.

Exploring the role of the nurse unit manager in forensic mental health inpatient units: A qualitative study.

Forensic mental health (FMH) inpatient settings are complex working environments at times due to a number of factors including the presence of challenging behaviours that may include violence and aggression, restrictions related to legislation, extended length of stay and the impact of trauma. Nurse unit managers (NUMs) play an important role in managing the unit environment and clinical standards of care to achieve better outcomes for consumers and staff. However, the role of NUMs in an FMH setting is poorly understood. The overall aim of this study was to explore the role of NUMs working within an FMH setting in Victoria, Australia. To our knowledge, this is the first study that has examined the subject. Data were collected via focus groups from n = 32 participants which included NUMs, their managers, staff who work alongside the NUMs and the staff the NUMs manage. Data were analysed using thematic analysis and four themes were interpreted from the data, (i) lack of role clarity, (ii) the importance of clinical Leadership and forensic mental health knowledge, (iii) step up in responsibility and step down in pay and (iv) seeing the difference you make. The role of the NUM within a forensic mental health setting comes with a number of challenges, but also opportunities to enact change. An ongoing effort to better support those employed within the NUM role and make the role desirable for aspiring staff is critical to the sustainability of a skilled clinical workforce and quality of care in this complex setting.

The ACCELERATE Plus (assessment and communication excellence for safe patient outcomes) Trial Protocol: a stepped-wedge cluster randomised trial, cost-benefit analysis, and process evaluation

BackgroundNurses play an essential role in patient safety. Inadequate nursing physical assessment and communication in handover practices are associated with increased patient deterioration, falls and pressure injuries. Despite internationally implemented rapid response systems, falls and pressure injury reduction strategies, and recommendations to conduct clinical handovers at patients’ bedside, adverse events persist. This trial aims to evaluate the effectiveness, implementation, and cost–benefit of an externally facilitated, nurse-led intervention delivered at the ward level for core physical assessment, structured patient-centred bedside handover and improved multidisciplinary communication. We hypothesise the trial will reduce medical emergency team calls, unplanned intensive care unit admissions, falls and pressure injuries.MethodsA stepped-wedge cluster randomised trial will be conducted over 52 weeks. The intervention consists of a nursing core physical assessment, structured patient-centred bedside handover and improved multidisciplinary communication and will be implemented in 24 wards across eight hospitals. The intervention will use theoretically informed implementation strategies for changing clinician behaviour, consisting of: nursing executive site engagement; a train-the-trainer model for cascading facilitation; embedded site leads; nursing unit manager leadership training; nursing and medical ward-level clinical champions; ward nurses’ education workshops; intervention tailoring; and reminders. The primary outcome will be a composite measure of medical emergency team calls (rapid response calls and ‘Code Blue’ calls), unplanned intensive care unit admissions, in-hospital falls and hospital-acquired pressure injuries; these measures individually will also form secondary outcomes. Other secondary outcomes are: i) patient-reported experience measures of receiving safe and patient-centred care, ii) nurses’ perceptions of barriers to physical assessment, readiness to change, and staff engagement, and iii) nurses’ and medical officers’ perceptions of safety culture and interprofessional collaboration. Primary outcome data will be collected for the trial duration, and secondary outcome surveys will be collected prior to each step and at trial conclusion. A cost–benefit analysis and post-trial process evaluation will also be undertaken.DiscussionIf effective, this intervention has the potential to improve nursing care, reduce patient harm and improve patient outcomes. The evidence-based implementation strategy has been designed to be embedded within existing hospital workforces; if cost-effective, it will be readily translatable to other hospitals nationally.Trial registrationAustralian New Zealand Clinical Trials Registry ID: ACTRN12622000155796. Date registered: 31/01/2022.

The Effects of the Ward Environment and Language in Palliative Care: A Qualitative Exploratory Study of Victorian Nurses' Perspectives.

The current study aimed to explore regional nurses' perspectives of how bad news is delivered and the physical, natural, social, and symbolic environments where these conversations occur. In regional hospitals within Victoria, Australia, palliative and end-of-life patients are cared for in acute wards that are often busy, noisy, and do not have a palliative psychosocial focus. On the other hand, Palliative Care Units (PCUs) have more home-like dedicated spaces, yet nearly all these facilities are in metropolitan areas. Diagnostic/prognostic (bad news) conversations about life-limiting illnesses often occur at the bedside in both environments. Nurses providing palliative or end-of-life care in regional or metropolitan Victorian hospital inpatient wards were invited to interview and recruited through social media and snowballing. Six semi-structured, audio-recorded online interviews were conducted between March and May 2022, and themes were developed using reflexive thematic analysis. Semi-structured online interviews were conducted with six female, registered nurses, four of whom worked in regional Victorian hospitals and two in metropolitan PCUs as Nurse Unit Managers. Three central themes were developed: "conducting family meetings," "palliative care practice," and "the environment matters." A therapeutic environment for palliative patients and their families consists of home-like ambience and aesthetics and a psychosocial environment created by staff who can provide holistic palliative care. Holistic palliative care requires mentoring and mirroring of expert practice to increase the expertise and capacity of the palliative care workforce in acute general hospital wards.

Compassion, collaboration, and community: Strategies for staff well-being.

Compassion, collaboration, and community: Strategies for staff well-being.

Technical nurses’ perception of work environment factors that affect their performance

Background Performance is important for organizations as employee performance leads to task success also it is important for individual success and satisfaction. The performance of the nurses is especially important in accomplishing health care in continuous and effective way, also there is strong relationship between technical nurses’ performance and their work environment factors. Aim The study aimed to assess technical nurses’ perception of work environment factors that affect their performance. Design A descriptive exploratory research design was utilized. Setting Study was conducted at National Cancer Institute which is affiliated with Cairo University hospitals. Sample Convenience sample (n=96) of technical nurses was used. Tool One tool was used (work environment factors questionnaire) it composed of eight domains (68 items). Result The highest percentage of technical nurses highly perceived that environmental factors domains had extensive effect on their performance (83.3%). Added that (90.3% & 87.7%), respectively had the highest perception regarding availability of job aids and adequate resources and collegial nurse and other health team members’ relations domains. There was no statistical significant relation between work environment factors that affect technical nurses’ performance and their personal characteristics. Conclusion The study concluded that the highest percentage of staff nurses highly perceived that environmental factors domains had extensive effect on their performance added that most of them had the highest perception regarding availability of job aids and adequate resources and collegial nurse and other health team members relations domains. There was no statistical significant relation between work environment domains and nurses’ personal characteristics, workplace, years of experience and continuous education in oncology nursing. Recommendation Administrators must support nurses with a well-structured work environment, Nurse unit managers should ensure the availability and dissemination of guidelines, standards, policy, and procedures to achieve organizational objectives and nurse unit managers should support nurses with the establishment of a suitable, collaborative, and safe work environment.

Men’s s Health in Nursing Practice: A Survey of Senior Nurses

Background: Australian men are likelier to die younger than women, often from preventable diseases or conditions. Gendered health promotion has improved men’s engagement with health services, with nurses playing a central role in information and healthcare design. The primary aim of this research was to survey senior clinical and executive nurses on their understanding and perception of men’s health. Methods: A cross-sectional quantitative online survey was attended by senior nurses within a single hospital setting in metropolitan Sydney between June 2022 and July 2022. Sampling selection was conducted of nurses who currently hold senior clinical or management roles within the health district (Nurse Manager, Nurse Unit Manager, Director of Nursing, Nurse Practitioner, Transitional Nurse Practitioner, Clinical Nurse Consultant, Clinical Nurse Specialist, Nurse Educator, Clinical Nurse Educator) with descriptive analysis applied to interpret the data sets. Results: A total of 84 responses were received, representing a 33% survey participation rate. A key finding was that 89.1% of senior nurses believed that traditional masculine traits affected health-seeking behaviour. However, 60.2% had not discussed men’s-specific agencies with male patients, and 33.7% of senior nurses believed that gender was not a determinant of health. There was strong endorsement (74.6%) for a men’s health education program to be developed specifically for nurses. Conclusion: The results of this single-site online survey of senior nurses illustrate that while foundational understandings of gender as a determinant of health were divided, there remained strong endorsement for targeted men’s health promotion to patients and the development of men’s health educational programs to support nurses in providing holistic care for their male patients.

Managing in Critical Care Settings: A Qualitative Study of South African Nurse Unit Managers and the Psychological Contract.

Little is written about the management of psychological contracts by nurse unit managers (NUMs) in critical care settings and how this perspective contributes to the performance, experiences, and views of nurses and nursing teams. Psychological contracts are important regulators of the employer-employee relationship, with managers (NUMs) being the embodiment of the employer in managing the contract. This qualitative study answers a call for research on the NUM perspective of the psychological contract given the role they play in the wellbeing of critical care nurses and quality of care provided. The study aims to understand the expectations and obligations that constitute the psychological contract NUMs have with their nursing teams, the nature of the contract, and how NUMs practically manage these aspects on their teams. Using an interpretive qualitative research design and a purposive sampling technique, semi-structured interviews were conducted with 10 of the 14 NUMs from a public health facility about critical incidents relating to their obligations and expectations of managing critical care nurses. A thematic analysis of their responses revealed five main themes that represent the contents of their psychological contracts with critical care nurses: professional commitment and obligation; leading by example; trust and support; teamwork; and on-the-job training and further development. In their discussion of these components, the NUMs also revealed how they manage the psychological contract with nurses. Based on the expectations and obligations NUMs hold with their staff, their psychological contracts were found to be largely relational, with elements of the balanced type, suggesting that they rely on interpersonal connection and coordination, as well as knowledge dissemination, to uphold the contract. This contract appears to be effective in inculcating the commitment of nurses to their profession and professional standards through the building of trust and offering of support. However, recommendations are offered to ensure NUMs are best prepared to sustain these psychological contracts and continue to support nurse wellbeing and related patient care.

Effects of Nursing Unit Managers’ Authentic Leadership, Transformational Leadership, and Transactional Leadership on Turnover Intention in Advanced Beginner Nurses: Mediation Effects of Positive Psychological Capital

Effects of Nursing Unit Managers’ Authentic Leadership, Transformational Leadership, and Transactional Leadership on Turnover Intention in Advanced Beginner Nurses: Mediation Effects of Positive Psychological Capital

Sustainable, safe ICU staffing: an interview study with ICU Nurse Unit Managers

Sustainable, safe ICU staffing: an interview study with ICU Nurse Unit Managers