Supportive Professional Practice Research Articles

Health-promoting pedagogy: Using reflexivity to support learning and action in planetary health education.

International competencies for health promotion education require ethical practice that is supported by reflexive health promotion practitioners, yet professional bodies do not codify how health promotion curriculum should support students' skill development in reflexive practice. Reflexivity in teaching and learning was scaffolded through short, progressive reflective blogs assessments, supportive feedback/feedforward mechanisms, and nested assessment design. Student feedback is offered to demonstrate the impact of reflexive pedagogy in health promotion education. Reflexivity in teaching and learning supports students in learning the role of health promotion in planetary health and developing skills in planetary health advocacy. Explicitly teaching the practice and process of critical reflexivity can help students develop personal insight, support professional practice, and promote positive change in the health of people and our planet.

Psychosis risk among pregnant women in Ghana.

Psychotic illness, although is rare, has been reported in the perinatal period. Individuals diagnosed with psychotic illness tend to first exhibit psychotic-like experiences (PLEs), defined as subclinical psychotic symptoms that occur outside the context of sleep or drug use. However, there is a paucity of empirical data on PLEs in pregnancy to advance scholarly discourse and support professional practice. The current study investigated the prevalence and correlates of PLEs among pregnant women in Ghana, a West African state. A cross-sectional survey design was used to collect data from 702 pregnant women who responded to measures of PLEs, COVID-19 concerns and behavioral maladies such as anxiety and depressive symptoms. Descriptive and inferential statistics, namely chi square, exploratory factor analysis, MANOVA and multinomial logistic regression were used to analyze the data. The results showed that 54.2%, 27.3% and 18.5% of participants were at no/low, moderate and high risk for psychosis, respectively. A total of 44.4% participants were not distressed by PLEs, whereas 32.2% and 23.4% were a bit/quite and very distressed, respectively. Psychosis risk was elevated among pregnant women who were more concerned about the COVID-19 effects, scored high in suicidal ideation, depressive symptoms and sleep difficulties. The study showed that psychosis risk is present in pregnancy. Screening for psychosis risk in pregnancy should be prioritized for pregnant women with behavioral maladies, including suicidal tendencies, depressive symptoms, sleep difficulties and heightened concerns about COVID-19.

Defining Expertise in Cancer Nursing Practice.

Thirty-five years ago, Benner defined an expert nurse as one who applies deep knowledge and experience across different contexts and clinical situations. Since that time, there has been little exploration of expertise in cancer nursing. To explore and describe characteristics of expert cancer nurses and to consider whether Benner's typology of an expert nurse remains relevant in today's complex oncology settings. An exploratory, descriptive study using audio-recorded focus group methodology was undertaken. Audio-recordings were transcribed, and an inductive thematic analysis approach applied to the data. Nurses also documented key characteristics of expert practice on Post-it notes to illustrate dominant characteristics. Twenty-four registered nurses from a comprehensive cancer center in Australia took part in 1 of 3 focus groups. Seven key themes were identified: knowledge, leadership, adaptability, communication, motivation, patient-centered care, organization, and culture. Key word cloud characteristics included knowledge, compassion, motivation, experience, and communication. Many of the expert characteristics identified in this study reflect traits common to other nursing specialty groups. Of particular relevance to cancer nurses was "adaptability," reflecting the complexity of contemporary cancer care and reaffirming Benner's definition of an expert nurse as one who can fluidly connect knowledge and experience to unfamiliar practice contexts. Understanding characteristics of expert cancer nurses may help inform and support professional practice advancement and guide future research about select characteristics of expert cancer nurses to patient- and system-level outcomes.

School Health Research Network Wales: Development, implementation & contributing to public health policy

Abstract The School Health Research Network (SHRN) was launched in Wales in 2013 as a strategic partnership between Cardiff University, Welsh Government, Public Health Wales (part of the National Health Service) and Cancer Research UK (a research-focused charity). SHRN is led by a multidisciplinary team in the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer) at Cardiff University. SHRN aims to: 1) provide health and well-being data from a biennial survey for national, regional and local stakeholders, including schools; 2) co-produce school-based health improvement research for Wales; and 3) build capacity for evidence-informed public health policy and practice. Building on and integrating with HBSC infrastructure, a transdisciplinary complex adaptive systems (T-CAS) approach has been employed to develop SHRN, for a national culture of prevention for school health improvement. The T-CAS approach focuses on key stages and activities within a continuous network cycle to facilitate systems level change. The five key stages involve establishing transdisciplinary strategic partnerships, resource investment and linkage, network development, coproduction activities and reciprocal outputs. SHRN has successfully established new cross-sector stakeholder partnerships at multiple levels, and embedded network activity within national and local policy. It has established a programme of school engagement activities to secure membership of 212 (100%) secondary schools in Wales and building on HBSC systems and structures has developed a national data infrastructure with the biennial collection of student and school-level health and wellbeing data. SHRN has co-produced scientific evidence and established a new data-led planning system (e.g. 56 research studies co-produced). It has also secured sustainability funding from health and education, while developing research capacity to generate evidence and support professional practice.

New nurses' perceptions of professional practice behaviours, quality of care, job satisfaction and career retention.

To test a model examining the effects of structural empowerment and support for professional practice on new graduate nurses' perceived professional practice behaviours, perceptions of care quality and subsequent job satisfaction and career turnover intentions. The nursing worklife model describes relationships between supportive nursing work environments and nurse and patient outcomes. The influence of support for professional practice on new nurses' perceptions of professional nursing behaviours within this model has not been tested. Structural equationmodelling in Mplus was used to analyse data from a national survey of new nurses across Canada (n=393). The hypothesised model was supported: χ²(122)=346.726, P=0.000; CFI=0.917; TLI=0.896; RMSEA=0.069. Professional practice behaviour was an important mechanism through which empowerment and supportive professional practice environments influenced nurse-assessed quality of care, which was related to job satisfaction and lower intentions to leave nursing. Job satisfaction and career retention of new nurses are related to perceptions of work environment factors that support their professional practice behaviours and high-quality patient care. Nurse managers can support new graduate nurses' professional practice behaviour by providing empowering supportive professional practice environments.

Review: The influence of authentic leadership and supportive professional practice environments on new graduate nurses’ job satisfaction

This paper makes an important contribution to understanding the role that authentic leaders play in creating supportive professional practice environments linking nurses’ perceptions of patient care, quality and job satisfaction.

The influence of authentic leadership and supportive professional practice environments on new graduate nurses’ job satisfaction

It is important to uncover new approaches to attracting and retaining newly qualified nurses in Canada to address the growing nursing workforce shortage. Authentic leadership theory proposes mechanisms that allow managers to create positive and supportive environments that facilitate new graduate nurses’ transition into practice and subsequently improve nurses’ and organizational outcomes. The purpose of this study was to test a theoretical model linking authentic leadership to new graduate nurses’ job satisfaction through its effect on supportive professional practice environments. A secondary analysis of data ( n = 93) from a larger study of new graduate nurses in their first two years of practice was conducted. Mediation multiple regression analysis was performed to determine the influence of authentic leadership and supportive professional practice environments on new graduate nurses’ job satisfaction. Measures of the Authentic Leadership Questionnaire (ALQ), the Revised Nursing Worklife Index (NWI-R) and the North Carolina Center for Nursing – Survey of Newly Licensed Nurses (NCCN-SNLN) were used. Supportive professional practice environment partially mediated the relationship between authentic leadership and new graduate nurses’ job satisfaction. The findings suggest that managers who demonstrate authentic leadership create supportive professional practice environments and are more likely to enhance new graduate nurses’ job satisfaction.

Linking nurses' perceptions of patient care quality to job satisfaction: the role of authentic leadership and empowering professional practice environments.

A model linking authentic leadership, structural empowerment, and supportive professional practice environments to nurses' perceptions of patient care quality and job satisfaction was tested. Positive work environment characteristics are important for nurses' perceptions of patient care quality and job satisfaction (significant factors for retention). Few studies have examined the mechanism by which these characteristics operate to influence perceptions of patient care quality or job satisfaction. A cross-sectional provincial survey of 723 Canadian nurses was used to test the hypothesized models using structural equation modeling. The model was an acceptable fit and all paths were significant. Authentic leadership had a positive effect on structural empowerment, which had a positive effect on perceived support for professional practice and a negative effect on nurses' perceptions that inadequate unit staffing prevented them from providing high-quality patient care. These workplace conditions predicted job satisfaction. Authentic leaders play an important role in creating empowering professional practice environments that foster high-quality care and job satisfaction.

Testing the Nursing Worklife Model in Canada and Australia: A multi-group comparison study

Study aimTo test a model derived from the Nursing Worklife Model linking elements of supportive practice environments to nurses’ turnover intentions and behaviours in Canada and Australia. BackgroundWith the worldwide shortage of nurses, retaining nurses within fiscally challenged health care systems is critical to sustaining the future of the nursing workforce and ultimately safe patient care. The Nursing Worklife Model describes a pattern of relationships amongst environmental factors that support nursing practice and link to nurse turnover. This model has been tested in north American settings but not in other countries. MethodsA secondary analysis of data collected in two cross-sectional studies in Canadian and Australian hospitals (N=4816) was conducted to test our theoretical model. Multigroup structural equation modelling techniques were used to determine the validity of our model in both countries and to identify differences between countries. ResultsThe hypothesized model relationships were supported in both countries with few differences between groups. Components of supportive professional practice work environments, particularly resources, were significantly linked to nurses’ turnover intentions and active search for new jobs. Leadership played a critical role in shaping the pattern of relationships to other components of supportive practice environments and ultimately turnover behaviours. ConclusionThe Nursing Worklife Model was shown to be valid in both countries, suggesting that management efforts to ensure that features of supportive practice environments are in place to promote the retention of valuable nursing resources.

Response to the Call to Action: A National Picture of Breastfeeding Support Provided in Neonatal Intensive Care

<h2>Paper Presentation</h2><h3>Objective</h3> To measure the frequency of breastfeeding support by nurses and receipt of human milk by very low birth weight (VLBW) infants in the neonatal intensive care unit (NICU), which is not known and to determine if the numbers and qualifications of nurses, their professional practice environments, and the availability of lactation consultants increased the number of infants who received this care. <h3>Design</h3> Cross‐sectional, observational study. <h3>Setting</h3> One hundred four NICUs. <h3>Sample</h3> Participants included 6,060 nurse survey respondents, 15,233 infants who were card for by nurses on their last shifts worked, and 7,886 VLBW infants cared for in participating NICUs. <h3>Methods</h3> Secondary analysis was used to examine nurse survey data collected in 2008 from the parent study and infant hospitalization data from 104 NICUs in the Vermont Oxford Network (VON), an NICU quality collaborative. Analysis was conducted using bivariate and multiple general linear regression models. <h3>Results</h3> The majority (54%) were discharged on formula only. Few infants (6%) were discharged on exclusive human milk. The remaining infants (42%) received human milk mixed with fortifier or formula. Nurses reported providing breastfeeding support to one in five infants whose parents were present. Sixty percent of infants had parents present for part or the entire shift. Only half of the NICUs had a lactation consultant (51%). Significantly greater numbers of infants received breastfeeding support and human milk (<i>p</i> < .05) in NICUs with supportive professional practice environments, baccalaureate‐prepared nurses, and nurses with at least 5 years NICU experience. <h3>Conclusion/Implications for Nursing Practice</h3> National health care agencies including the U.S. Surgeon General and American Academy of Pediatrics have described breastfeeding and human milk as the normative standard for infant feeding and nutrition. However, the country is falling far short of the Surgeon General's recommendation for this high‐risk pediatric population. The findings suggest NICU nurses provide breastfeeding support around the clock, typically without a lactation consultant available. Our results demonstrate that nurses are essential to providing lactation care to NICU infants for whom the receipt of human milk is an issue of patient satisfaction, quality patient care, effectiveness, and survival.

Nurse practitioner job satisfaction: looking for successful outcomes

To examine overall job satisfaction and its association with extrinsic and intrinsic characteristics of job satisfaction among nurse practitioners at the chosen practice site. The objectives were to identify relevant retention and recruitment strategies, from the nurse practitioners perspective, by examining (1) what role aspects are most satisfying, and (2) approaches for successful, professional development and integration in the role. Supportive professional practice environments are particularly important to nurses' satisfaction with their work and the quality of patient care provided. Hence, research that examines nurse practitioners practice implications and barriers in today's healthcare system is essential. A descriptive-correlational design using survey methodology. A nonprobability sample of convenience was used. The outcome measures were: The Misener Nurse Practitioner Job Satisfaction Scale and two investigator-developed surveys. Participants expressed dissatisfaction with professional and monetary recognition, assertive influence, administrative support and collegial relationships. Interaction of subscale factors on overall job satisfaction and demographic survey findings has important implications for health administrators and nurse practitioners in similar organisations. Stakeholders in healthcare milieus need to be fully engaged in the redesign of the American healthcare system heeding the recommendations of the Institute of Medicine to provide safer health systems to the public. By doing this, issues related to frustration by nurse practitioners related to job satisfaction will be addressed. The need for cooperation, participation, collaboration and instrumental communication are essential in the delivery of safe, quality patient care. A better understanding of intrinsic professional rewards needs to be learned by nurse practitioners who want to seek professional satisfaction and engage in the survival and growth of the profession. Nurse practitioners armed with this translational information have viable agenda items that can be negotiated into extrinsic rewards.

Predictors of new graduate nurses’ workplace well-being

New graduate nurses currently experience a stressful transition into the workforce, resulting in high levels of burnout and job turnover in their first year of practice. This study tested a theoretical model of new graduate nurses' worklife derived from the job demands-resources model to better understand how job demands (workload and bullying), job resources (job control and supportive professional practice environments), and a personal resource (psychological capital) combine to influence new graduate experiences of burnout and work engagement and, ultimately, health and job outcomes. A descriptive correlational design was used to test the hypothesized model in a sample of newly graduated nurses (N = 420) working in acute care hospitals in Ontario, Canada. Data were collected from July to November 2009. Participants were mailed questionnaires to their home address using the Total Design Method to improve response rates. All variables were measured using standardized questionnaires, and structural equation modeling was used to test the model. The final model fit statistics partially supported the original hypothesized model. In the final model, job demands (workload and bullying) predicted burnout and, subsequently, poor mental health. Job resources (supportive practice environment and control) predicted work engagement and, subsequently, lower turnover intentions. Burnout also was a significant predictor of turnover intent (a crossover effect). Furthermore, personal resources (psychological capital) significantly influenced both burnout and work engagement. The model suggests that managerial strategies targeted at specific job demands and resources can create workplace environments that promote work engagement and prevent burnout to support the retention and well-being of the new graduate nurse population.

Can Emergency Nurses' Triage Skills Be Improved by Online Learning? Results of an Experiment

Emergency nurses deal with increasing complexity of patients. In 2003 there were over 14 million ED visits in Canada. The Canadian Triage and Acuity Scale (CTAS) is a 5-level system used by ED triage nurses to classify patients. There is a need for standardized training for all triage systems. In an effort to improve access to CTAS training, a 6-week Web-based CTAS workshop was developed. We determined the impact of Web learning on the accuracy of the triage skills of registered nurses (RNs). An experimental method was used in which 132 RNs were randomized to an intervention group (n = 65) or control group (n = 67). All RNs received exactly the same content and learning activities. The experimental group differed from the control group in 3 ways: a mandatory tutorial, awarding of marks for online discussion, and completion of a workplace project. Data were collected using standard instruments, chart audit, and interviews. The Web course provided a standardized and effective educational experience that enhanced emergency nurses' triage accuracy. The mandatory online tutorial, online discussion, and workplace project increased the RNs' preparation for online learning, and these educational methods were successful in transferring triage learning to practice. Web learning can help professionals maintain competency and support professional practice. Further research is needed to provide evidence for best practices in E-learning for RNs. The accuracy of the RN's triage assessment impacts patient health, hospital accreditation, and funding.

Teams without Walls: enabling partnerships between generalists and specialists

This one-day conference for senior clinicians and NHS managers was a partnership between the King's Fund, Royal College of Physicians (RCP) and Royal College of General Practitioners (RCGP). It explored clinical partnerships and integrated care by examining how to develop constructive and workable relationships between generalists and specialists that harness clinical skills, support professional practice and deliver excellent care to patients.

Creating nursing passion through a supportive professional practice environment

Just discovered—the one sure way to obtain a 0% vacancy rate and less than 1% turnover rate for registered nurses! The ongoing nursing shortage and nurse recruitment and retention are hot topics in the public press and professional journals and conferences. These issues are also top-ranking concerns of health care organization leaders. Unfortunately, no one silver bullet can prevent RN vacancies and turnover. Numerous studies have analyzed how some hospitals use creativity and innovation to tackle nurse recruitment and retention issues. At least two different studies reached similar conclusions: an organization's professional practice environment has a great influence on nurse recruitment and retention.

Project to develop an autonomous practitioner programme.

The early 1990s has seen a rapid expansion in the nature of clinical roles in health care in response to a number of changes. Throughout 1996, The Oxford Radcliffe Hospital National Health Service (NHS) Trust, in partnership with Oxford Brookes University, School of Health Care, and the Royal College of Nursing (UK) have been collaborating to develop an educational programme at degree and masters level, to support new and evolving clinical roles in acute and primary care, across most professional health registration areas and clinical specialities. To ensure the proposed programme was 'fit for purpose'the Trust commissioned a Training Needs Analysis by the University of Birmingham and a Role Analysis by The Royal College of Nursing. Nurses and Midwives with expertise in practice, management, education and research, have collaborated to develop an innovative educational programme which enables a wide range of public and private health care professionals across acute and community settings to develop their autonomous practice. The programme is fully supported by development of policies which are appropriate to service delivery, support professional practice, multi-professional relationships, risk management and patient safety. The issue of contractual and professional responsibilities related to career development have been debated and a proactive strategy agreed. To ensure there is thorough evaluation of the area of practice, research projects to evaluate outcomes for patients as well as practitioners have been designed. This will additionally promote a culture of evidence-based practice.