Nursing Role Effectiveness Model Research Articles

Le rôle infirmier auprès de personnes aînées en milieux d’hébergement depuis la pandémie de COVID-19 : protocole d’une revue de la portée

<p>Introduction: The nursing role in elderly care has received increased attention during the COVID-19 pandemic. It is therefore essential to better understand the enactment of the nursing practice through professional activities carried out in long-term care facilities since the pandemic.</p><p>Objective: To identify and synthesize the activities performed by nurses caring for elderly persons in long-term care facilities since the COVID-19 pandemic through a scoping review of literature from 2020-2023. A framework combining the Nursing Role Effectiveness Model by Irvine et al. (1998) and the Cadre de référence sur l’exercice infirmier auprès des personnes hébergées en centre d’hébergement et de soins de longue durée from the Ordre des infirmières et infirmiers du Québec (2018) will allow for the identification of independent, dependent and interdependent nursing activities in these settings.</p><p>Method: The review will follow the scoping review method of the Joanna Briggs Institute (Peters et al., 2020). We will query CINAHL, MEDLINE, EMBASE, and PsycINFO databases to identify empirical studies published in English and French from 2020 to 2023. The selection of relevant studies will be carried out independently by 2 reviewers. Data on nursing activities will be extracted, categorized, and analyzed in line with the scoping review framework.</p><p>Discussion and Research Spin-offs: This research will identify nursing activities since the COVID-19 pandemic through recent studies that have addressed this topic in the context of long-term care facilities. Recommendations will be made concerning activities that are infrequently or not at all carried out by nurses, as well as factors that influence these activities.</p>

The health care management by nurses from the hospital infection control service in light of the Nursing Role Effectiveness Model

The objective was to reflect on the key concepts of the Middle Range Theory (TMA) Nursing Role Effectiveness Model (NREM) and its applicability in the management practices of Nurses working in the Hospital Infection Control Service. This is a theoretical-reflective study, which starts from the philosophical and epistemological conceptions of the TMA - NREM in order to reflect its applicability in the managerial actions of nurses who work in the Hospital Infection Control Service. For this reflection, the authors were based on the main concepts of the theory: structure (organization, nurse and patient), processes (independent, dependent and interdependent actions) and results (care sensitive to the nurse's actions). Through reflection, it can be seen that the key concepts of the aforementioned theory apply and at the same time support the theoretical reflection on the managerial actions of nurses who work in the Hospital Infection Control Service, contributing to elucidate how the interrelationship between the variables of this medium-range theory can favor better results than the reduction of infections in hospital units. It was possible to conclude that the managerial actions of nurses who work in the Hospital Infection Control Service are interrelated, capable of generating sensitive nursing care for patients hospitalized in hospital units.

Geriatric patients in the emergency department: Development of an ANP role from the perspective of the multiprofessional team

Geriatric patients in the emergency department: Development of an ANP role from the perspective of the multiprofessional team Abstract. Background: Ever-increasing numbers of geriatric patients lead to challenges in emergency departments (ED). Aim: The aim of this study is to identify the need for change in emergency care and discuss the integration of an Advanced Practice Nurse (APN) based on the practical experience of nurses and physicians. The focus lies on the interdisciplinary cooperation. Methods: Within the scope of a qualitative research approach, guided interviews with five physicians and seven nurses from two Austrian emergency departments were conducted. The qualitative content analysis according to Mayring was used for data analysis. Results: Five central main categories emerged. Nurses and physicians describe growing challenges in the care of geriatric patients in emergency departments due to a high workload, time pressure and lack of resources as well as a healthcare supply that does not meet the specific needs of geriatric patients. The integration of geriatric specialised nurses was associated with an improved patient care. Based on the structure, process and outcome criteria of the Nursing Role Effectiveness Model (NREM), the core components of an ANP role are described. Conclusion: The expansion of nursing competences and the development of defined care pathways should be further accelerated. The findings integrated in the NREM form the groundwork for the role description of the Geriatric Practice Nurse (GPN) in the ED.

Nursing contributions to virtual models of care in primary care: a scoping review protocol

IntroductionSince the onset of the COVID-19 pandemic, virtual care has gained increased attention, particularly in primary care for the ongoing delivery of routine services. Nurses have had an increased presence...

Linguagens padronizadas de enfermagem em ortopedia na perspectiva do nursing role effectiveness model

To analyze the standardized nursing languages in orthopedics from the perspective of the Nursing Role Effectiveness Model. Mixed method research carried out in a hospital in southern Brazil between April 2016 and February 2017. Quantitative data were collected from 85 orthopedic patients using the NANDA-International, Nursing Interventions and Outcomes, and submitted to statistical analysis. Qualitative data were collected through interviews with 10 nurses and were analyzed using content analysis. Acute pain (96%) was a prevalent nursing diagnosis. Fall Prevention (33.3%) was the most prescribed intervention. Pain Level, Body Positioning: self-initiated and Mobility showed an increase in outcome scores (p<0.001). In the interviews, nurses indicated that priority diagnoses and nursing interventions contributed to improving mobility outcomes. The findings revealed that the focus of Standardized Nursing Languages in orthopedics from the perspective of the Nursing Role Effectiveness Model lies in the context of mobility, but it needs improvements in diagnostic accuracy and electronic health record.

Staff Nurses’ Perception of the Hemodialysis Unit as Practice Environment and Patients’ Perception of Nurse Caring Behaviors and their Level of Satisfaction

Background: Despite the concomitant rise of kidney diseases and hemodialysis services nationwide, the Philippines still lacks research on hemodialysis nursing care quality. Using nursing-sensitive indicators under the Nursing Role Effectiveness Model, this study aimed to describe hemodialysis nurses’ perception of their unit as practice environment; patients’ perception of nurse caring behaviors based on Jean Watson’s 10 Caritas Processes; patients’ level of satisfaction on nursing care; and determine the association between perceived nurse caring behaviors and satisfaction levels.&#x0D; Methodology: This descriptive cross-sectional study purposely selected seven free-standing hemodialysis centers in Metro Manila. Ninety-four nurses were surveyed via complete enumeration using the Practice Environment Scale of Nursing Work Index (PES-NWI) while 345 randomly selected patients answered the Caring Factor Survey-Tagalog (CFS-T) and Patient Satisfaction of Nursing Care Quality Questionnaire-Tagalog (PSNCQQ-T). Pearson’s correlation was used to analyze the gathered data.&#x0D; Results: The study revealed that nurses perceived their respective work unit as a favorable practice environment while hemodialysis patients perceived nurse caring behaviors as practiced to a great extent and their satisfaction with nursing care as very good. The study also revealed a significant positive correlation between the process and outcome indicators (r=0.64, p=&lt;0.0001).&#x0D; Conclusion: The study reflected positive nursing-sensitive indicators in hemodialysis. However, hemodi alysis facilities should improve nurse staffing, spiritual nurse caring behavior, and facilitate a more healing environment while maintaining their current favorable qualities.

Exploring the utility of the Nursing Role Effectiveness Model in evaluating nursing contributions in primary health care: A scoping review.

AimsTo inform a discussion for the applicability of using the Nursing Role Effectiveness Model (NREM) in the primary health care setting through a synthesis of the literature that has used the model in all health care sectors.DesignScoping Review.MethodsArticles were considered for inclusion if they discussed any aspect of the NREM in health care research that presented information related to any nursing regulatory designation, such as nurse practitioner (NP), registered nurse (RN), licensed/registered practical nurse (LPN/RPN) and considered both quantitative and qualitative study designs, including expert opinions and reports.ResultsA total of 22 articles that cited and/or used the NREM were identified in this review. Only two studies were focused in the primary health care setting. There is precedence for the use of the NREM to guide research in primary health care. The NREM should be modified to incorporate the unique characteristics of the primary health care setting.

Nursing Within Primary Care Settings in Atlantic Canada: A Scoping Review

To address the prevalence of chronic diseases in Newfoundland and Labrador, the province has committed to primary health care reform, including implementing interdisciplinary primary care (PC) teams. To inform discussions regarding integrating nurse practitioners (NPs), registered nurses (RNs), and licensed practical nurses (LPNs) into these teams, better understanding of their roles in PC is needed. A scoping review was conducted to examine and synthesize existing evidence related to nursing roles and resources in PC settings across Atlantic Canada (Newfoundland and Labrador, New Brunswick, Nova Scotia, Prince Edward Island), and associated contributions to patient care. Joanna Briggs Institute scoping review methodology was used. The Nursing Role Effectiveness Model guided the review. Twenty articles met inclusion criteria. Roles of RNs and NPs in PC included chronic disease management, education, and health promotion. No literature focused on LPNs. Interdisciplinary collaboration was evident across studies. However, nurses’ functions within teams were limited by institutional constraints and other providers. PC settings with nurses had positive clinical outcomes, improved access to services, and high patient satisfaction. The prevalence of nursing in PC throughout Atlantic Canada and how nurses’ roles are enacted is unclear. There is opportunity for future inquiry into specific attributes of nursing and PC teams that result in positive patient and system outcomes.

Testing Nursing Sensitive Outcomes in Out-Patient Drug Addicts, with “Nursing Role Effectiveness Model”

ABSTRACTOur aim was to identify factors that contribute to a better outcome in drug users and to understand the effectiveness of nursing interventions, by applying “Nursing Role Effectiveness Model” (NREM). It's a correlational, cross-sectional study with 180 drug users in a methadone program, randomly selected from three community services. We identified that treatment time, lower co-morbidities, less poly-drug use, family support and being employed contribute to a better quality of life, better mental health, less substance addiction consequences and more satisfaction with nursing care (p < 0.05). Those data were also related with nursing interventions using Structural Equation Model and we found that nursing care contributes 29% to health outcome improvement. The model revealed itself adequate to assess the effectiveness of nursing interventions (X2: 82.51/(34) = 2.426; p < 0.01, NFI = 0.927, CFI = 0.955, RFI = 0.903, GFI = 0.917, PGFI = 0.567, PCFI = 0.722, PNFI = 0.700, RMSEA = 0.089). Compared with the NREM original model, our findings reveal new relationships between the users' structural variables and the health outcomes and also relationship between units' structural variables and nurses' structural variables.

Vital signs monitoring to detect patient deterioration: An integrative literature review.

Vital signs monitoring is an important nursing assessment. Yet, nurses seem to be doing it as part of a routine and often overlooking their significance in detecting patient deterioration. An integrative literature review was conducted to explore factors surrounding ward nursing practice of vital signs monitoring in detecting and reporting deterioration. Twenty papers were included. The structural component of a Nursing Role Effectiveness Model framework, which comprises of patient, nurse and organizational variables, was used to synthesize the review. Patient variables include signs of deterioration displayed by patients which include physical cues and abnormal vital signs. Nursing variables include clinical knowledge, roles and responsibilities, and reporting of deteriorating vital signs. Organizational variables include heavy workload, technology, and observation chart design. This review has highlighted current nursing practice in vital signs monitoring. A myriad of factors were found to surround ward practice of vital signs monitoring in detecting and reporting deterioration.

Validez y confiabilidad de la Escala de Autonomía del Índice de Características del trabajo de Enfermería (SNJCI) en Bogotá- Colombia.

Autonomy is a key element in nursing practice, which can determine the independent function through its effects on the individual, the motivation and empowerment to achieve positive results. It was necessary to validate an instrument which allows the construction and application of Nursing Role Effectiveness Model. Therefore, this research focuses its goals on demonstrating the validity and reliability of the Staff Nurse Job Characteristics Index (SNJCI) scale. A methodological study evaluated the psychometric properties of the scale.Results: The instrument reports a facial and content validity above 0.80 for all the evaluated variables. The construct validity through factorial analysis resulted in the presence of 3 dimensions of the original scale. On the other hand, the reliability measured through an internal consistency check using the Cronbach Alpha Coefficient was 0.72. However after a motion to remove two items from the Spanish Translation by Rogero the scale's reliability improved to 0.76.According to this, the author concludes that the Spanish version of the Scale of Autonomy of

Optimizing enactment of nursing roles: redesigning care processes and structures

Optimizing enactment of nursing roles: redesigning care processes and structures Karen Jackson,1 Deborah E White,2 Jeanne Besner,1 Jill M Norris21Health Systems and Workforce Research Unit, Alberta Health Services, Calgary, Alberta, Canada; 2Faculty of Nursing, University of Calgary, Calgary, Alberta, CanadaBackground: Effective and efficient use of nursing human resources is critical. The Nursing Role Effectiveness Model conceptualizes nursing practice in terms of key clinical role accountabilities and has the potential to inform redesign efforts. The aims of this study were to develop, implement, and evaluate a job redesign intended to optimize the enactment of registered nurse (RN) clinical role accountabilities.Methods: A job redesign was developed and implemented in a single medical patient care unit, the redesign unit. A mixed-methods design was used to evaluate the job redesign; a second medical patient care unit served as a control unit. Data from administrative databases, observations, interviews, and demographic surveys were collected pre-redesign (November 2005) and post-redesign (October 2007).Results: Several existing unit structures and processes (eg, model of care delivery) influenced RNs&#39; ability to optimally enact their role accountabilities. Redesign efforts were hampered by contextual issues, including organizational alignment, leadership, and timing. Overall, optimized enactment of RN role accountabilities and improvements to patient outcomes did not occur, yet this was predictable, given that the redesign was not successful. Although the results were disappointing, much was learned about job redesign.Conclusion: Potential exists to improve the utilization of nursing providers by situating nurses&#39; work in a clinical role accountability framework and attending to a clear organizational vision and well-articulated strategic plan that is championed by leaders at all levels of the organization. Health care leaders require a clear understanding of nurses&#39; role accountabilities, support in managing change, and leadership development opportunities.Keywords: nursing scope of practice, nursing role enactment, nursing role accountabilities, job redesign, leadership

The examination of nursing work through a role accountability framework

To use work analysis data to describe the amount of time registered nurses (RNs) and health care aides (HCA) spent on key clinical role accountabilities and other work activities. Health care providers are not effectively utilized. To improve their efficiency and effectiveness, it is necessary to understand how nursing providers enact their role accountabilities. Using palm pilot Function Analysis technology, observers recorded the activities of 35 registered nurse and 17 health care aides shifts on a second-by-second basis over 5days. Work activities were classified using the Nursing Role Effectiveness Model, which conceptualizes nursing practice in terms of clinical role accountabilities. The registered nurses spent a considerable amount of time on bio-medical assessment/surveillance, relatively little time was spent on patient and family psycho-social-cultural-spiritual assessment/surveillance and support. Unlike other work sampling studies, this research project examined nursing work within a role accountability framework; an important first step in the call for the measurement of the impact of nursing care. Changes to how registered nurses and health care aides enact their role will require a clear vision by unit managers and their staff of their role accountabilities, and the gap between ideal and actual practice.

An integrative review and meta‐synthesis of the scope and impact of intensive care liaison and outreach services

To determine activities and outcomes of intensive care unit Liaison Nurse/Outreach services. The review comprised two stages: (1) integrative review of qualitative and quantitative studies examining intensive care liaison/outreach services in the UK and Australia and (2) meta-synthesis using the Nursing Role Effectiveness Model as an a priori model. Acute ward patients are at risk of adverse events and patients recovering from critical illness are vulnerable to deterioration. Proactive and reactive strategies have been implemented to facilitate timely identification of patients at risk. Systematic review. A range of data bases was searched from 2000-2008. Studies were eligible for review if they included adults in any setting where intensive care unit Liaison Nurse or Outreach services were provided. From 1423 citations and 65 abstracts, 20 studies met the inclusion criteria. Intensive care liaison/outreach services had a beneficial impact on intensive care mortality, hospital mortality, unplanned intensive care admissions/re-admissions, discharge delay and rates of adverse events. A range of research methods were used; however, it was not possible to conclude unequivocally that the intensive care liaison/outreach service had resulted in improved outcomes. The major unmeasured benefit across all studies was improved communication pathways between critical care and ward staff. Outcomes for nurses in the form of improved confidence, knowledge and critical care skills were identified in qualitative studies but not measured. The varied nature of the intensive care liaison/outreach services reviewed in these studies suggests that they should be treated as bundled interventions, delivering a treatment package of care. Further studies should examine the impact of critical care support on the confidence and skills of ward nurses. Advanced nursing roles can improve outcomes for patients who are vulnerable to deterioration. The Nursing Role Effectiveness Model provides a useful framework for evaluating the impact of these roles.

Linking the Practice Environment to Nurses' Job Satisfaction Through Nurse‐Physician Communication

To investigate direct and indirect relationships among the practice environment, nurse-physician (RN-MD) communication, and job satisfaction, as is posited in the nursing role effectiveness model (NREM). Survey. Surveys were sent to a random sample of 500 hospital nurses throughout Michigan, and 332 (66%) responded. Main study instruments were the Conditions for Work Effectiveness Questionnaire-II (CWEQ-II), the Practice Environment Scale of the Nursing Work Index (PES-NWI), the ICU Nurse-Physician Questionnaire, and the Index of Work Satisfaction (IWS), Part B. Inferential statistical tests included multiple regression, t tests, and one-way analysis of variance. Practice environment (PES-NWI) and empowerment (CWEQ-II) scales explained 20% of the variance in RN-MD communication. The combination of both environment scales (PES-NWI and CWEQ-II) and RN-MD communication explained 61% of the variance in nursing job satisfaction scores. RN-MD communication was also a significant mediating variable in the relationship between structure (practice environment and empowerment scales) and outcome (nursing job satisfaction). Factors in the practice environment contributed both directly to nursing job satisfaction and also indirectly through RN-MD communication. Study findings showed that a practice environment favorable to nurses improved both nurses' perceptions of their communications with physicians and their job satisfaction.

Oral Hygiene in the Elderly: A Quality Improvement Initiative

This paper describes a unit-based quality improvement initiative to ameliorate mouth care of elderly residents in a long-term care facility. Using the Nursing Role Effectiveness Model developed by Irvine et at. (1998) as the organizing framework, this project highlights the importance of the nurse's role in quality improvement initiatives.

An empirical test of the Nursing Role Effectiveness Model.

This study investigated the propositions depicted in the Nursing Role Effectiveness Model, in which nurse and patient structural variables were expected to influence nurses' role performance, which, in turn was expected to affect patient outcome achievement. RATIONALE/BACKGROUND: Increasingly, nurses are expected to demonstrate their contribution to patient outcome achievement as a basis for evaluating practice and for monitoring improvements in practice. A model was developed that describes nursing practice in relationship to the roles nurses assume in health care, and links patient and system outcomes to nurses' role functions (Nursing Economics 1998: 16, 58-64, 87). A cross-sectional design was used to collect data on the structure, process, and outcome variables. Data were collected through structured questionnaires and chart audit, involving a total of 372 patients and 254 nurses from 26 general medical-surgical units in a tertiary care hospital. Patient structural variables included medical diagnosis, age, gender and education. Nurse structural variables included educational preparation and length of hospital experience. The unit structural variables included the adequacy of time to provide care, autonomy, and role tension. The quality of nurses' independent role performance was assessed by collecting data from patients on their perception of the quality of nursing care. Nurses' interdependent role performance was assessed by collecting data from nurses on the quality of nurse communication and co-ordination of care. Patient outcomes were assessed through self-report and consisted of the patients' therapeutic self-care ability, functional status, and mood disturbance at the time of hospital discharge. Structural equation modelling was used to test the hypothesized relationships among the structural, process, and outcome variables. Patients viewed nurses' independent role performance more effective on units where nurses reported less autonomy but more time to provide care. The quality of nurse communication was higher on units where nurses had higher education, more autonomy, less hospital experience, and lower role tension. However, the co-ordination of care was more effective on units where nurses had higher education, greater hospital experience, less autonomy and role tension. The three role performance variables were associated with patients' therapeutic self-care ability at hospital discharge. Nurses' independent role performance was associated with better patient functional status and less mood disturbance at hospital discharge. The role performance variables fully mediated the effect of the structural variables on patient outcomes, lending support for the proposition that nurses' role performance explains the relationship between structural variables, such as nurse education and autonomy, and patient outcome achievement. The Nursing Role Effectiveness Model provides a well-defined conceptual framework to guide the evaluation of outcomes of nursing care. For the most part the hypothesized relationships among the variables were supported. However, further work is needed to develop an understanding of how nurses engage in their co-ordinating role functions and how we can measures these role activities.

A conceptual framework for evaluating the nurse practitioner role in acute care settings.

The conceptualization and enactment of the ACNP role varies across settings, potentially leading to variability in outcome achievement. A conceptual framework for evaluating the ACNP role is proposed. The framework is an adaptation of the Nursing Role Effectiveness Model which was developed to facilitate the identification and investigation of nursing-sensitive outcomes. The framework represents the complex system of interrelated factors that are present in the ACNP practice situation and that affect role effectiveness. It includes three components: (i) structure--encompassing patient, ACNP and organizational variables; (ii) process--consisting of the ACNP role components (clinician, educator, researcher and administrator) and the ways in which the role is enacted; and (iii) outcomes--including patient- and cost-related outcomes. The framework proposes specific relationships among the structure, process and outcomes components. Empirical support for the framework propositions is provided, based on a review of pertinent literature. Implications for future ACNP impact studies are discussed.