Search

Multiple articles have explained the benefits of nurses as hospital board members. The Nurses on Boards Coalition has been working for several years to increase the number of nurse board members. Yet, the percentage of hospital and health care board positions filled by nurses has been decreasing. This article shares what all nurse leaders can do to increase the visibility of nurses as competent, valuable voices at the board table., Competing Interests: The author declares no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: The Doctor of Nursing Practice (DNP) programs have grown exponentially for the last 10 years across the United States. However, the intra-professional collaboration among DNP and PhD scholars is not clearly demonstrated in the literature as it relates to frequency, training models, and the outcomes of these collaborations on translation. The purposes of this paper are to: (1) examine the role for DNP nurses in symptom science research and (2) describe training models to cultivate the PhD-DNP collaboration to strengthen the translation of discoveries from nursing research, to facilitate implementation of discoveries, and to improve clinical practice of nurses., Methods: A targeted review of the literature was conducted to identify, (1) the role of the DNP, (2) examples of PhD-DNP collaborations, (3) training models that support collaborations, and (4) the outcomes of these intra-professional collaborations., Results: Two articles reported on PhD-DNP collaboration within a university setting; however, they did not address how the partnership was modeled. One additional article described an academic-hospital partnership model aimed at MSN-prepared advanced practice nurses (APRN) by which outcomes were measured. No examples were found outside of academic settings. The National Institute of Nursing Research (NINR) has established the Symptom Science Center (SSC) with an interest in training the next generation of symptom scientists. By developing a training curriculum through the NINR SSC, DNP-prepared students and practitioners can be exposed to the research enterprise and potentially develop early partnerships with PhD-prepared students and scholars that lead to research translation., Conclusion: The NINR Department of Intramural Research (DIR) and National Institutes of Health Clinical Center are dedicated to building stronger ties between PhD- and DNP-prepared scientists. The SSC can serve as an optimal platform to promote the collaboration of PhD and DNP nurses to advance symptom science translation., Clinical Relevance: Nurses have a remarkable role in early detection of disease progression. Training opportunities to cultivate the PhD-DNP collaboration have significant relevance for expediting the translation of nursing science to nursing practice., (Published by Elsevier Inc.)

Abstract: The use of personal protective equipment (PPE) by nurses during the COVID-19 pandemic can be compared with a Christian's spritiual protective action of putting on the armor of God as described in the New Testament. The use and significance of each item of PPE is compared with the equivalent article of the spiritual armor of God., (Copyright © 2021 InterVarsity Christian Fellowship.)

In response to the Future of Nursing Report, the Nurses on Boards Coalition promotes the health of communities and the nation by engaging nurses in board service. Nurses possess knowledge and skills that when leveraged in boardroom discussions and decisions may impact the health of the populations served by the board. This article highlights the insights of organizational board leaders, as they describe the impact and influence of nurse board members within their organizations., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The global COVID-19 pandemic has created unprecedented challenges to the health care workforce. Little is known about the effect of the pandemic on new RNs and their preparedness for such a crisis. This study explored the lived experiences of RNs transitioning from students to professionals during the pandemic., Method: Semistructured interviews were conducted with 15 new RNs working in acute care facilities during the Maryland COVID-19 State of Emergency., Results: Three themes were identified to describe the experiences of new nurses transitioning to practice in the midst of the COVID-19 pandemic: uncertainty, vulnerability, and resilience., Conclusion: New nurses need greater support during transition to practice. Initiatives to improve trusting relationships between new nurses and their organizations and support of the development of essential relationships (e.g., peers, frontline management, and educators) could enhance new nurses' resilience and commitment to stay with the organization. [ J Contin Educ Nurs . 2021;52(6):294-300.] .

Loch Lomond Villa is one of the largest long-term care communities within the province of New Brunswick. Our organization supports caring living environments for over 450 clients and their family members along with 354 employees., (Copyright © 2021 Longwoods Publishing.)

A Native American nurse draws on her heritage, faith, and leadership training to tackle whatever crisis is at hand., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Non-urgent and urgent telephone nursing services are increasing globally, and phenomenographic research has shown that how work is understood may influence work performance. This descriptive study makes a qualitative inductive investigation of understandings of emergency medical dispatch center work among registered nurses. Twenty-four registered nurses at three mid Swedish emergency medical dispatch centers were interviewed. Analysis based on phenomenographic principles identified five categories in the interviews: (i) Assess, prioritize, direct, or refer; (ii) Facilitate ambulance nursing work; (iii) Perform nursing care; (iv) Always be available for the public; and (v) Have the person behind the patient in mind. The first constitutes the basis of the work. The second emphasizes cooperation with and support for the ambulance staff. The third entails remotely providing nursing care, whilst the fourth stresses serving the entire population. The fifth and most comprehensive way of understanding work involves having a holistic view of the person in need, including person-centered care. Provision of high-quality emergency medical dispatch center work involves all categories. Combined, they constitute a "work map," valuable for reflection, competence development, and introduction of new staff., (© 2021 The Authors. Nursing & Health Sciences published by John Wiley & Sons Australia, Ltd.)

Nurses' awareness and acceptance of their professional responsibilities across the full breadth of safety and quality-related practices and behaviors are critical for high quality healthcare delivery. The purpose of this study was to develop and psychometrically test a new instrument to measure nurses' perceptions of their responsibilities related to healthcare quality. Participants were registered nurses, enrolled in a postgraduate program at an Australian university, who completed the Likert scale instrument with items developed from nurses' professional practice standards. Steps of pilot testing, item reduction, and confirmatory factor analysis resulted in a five-subscale, 55-item instrument with acceptable goodness-of-fit indices and good internal consistency reliability. Test-retest reliability demonstrated acceptable temporal stability. The Nurses Responsibilities in Healthcare Quality Questionnaire demonstrated acceptable validity and reliability. The instrument may assist education providers and health service managers to identify gaps between nurses' beliefs and professional role expectations, and evaluate the impact of educational and clinical initiatives designed to develop nurses' knowledge, skills, and attitudes related to healthcare quality., (© 2021 John Wiley & Sons Australia, Ltd.)

Objectives: To understand healthcare professionals' experiences and perceptions of nurses' potential or ideal roles in pharmaceutical care (PC)., Design: Qualitative study conducted through semi-structured in-depth interviews., Setting: Between December 2018 and October 2019, interviews were conducted with healthcare professionals of 14 European countries in four healthcare settings: hospitals, community care, mental health and long-term residential care., Participants: In each country, pharmacists, physicians and nurses in each of the four settings were interviewed. Participants were selected on the basis that they were key informants with broad knowledge and experience of PC., Data Collection and Analysis: All interviews were conducted face to face. Each country conducted an initial thematic analysis. Consensus was reached through a face-to-face discussion of all 14 national leads., Results: 340 interviews were completed. Several tasks were described within four potential nursing responsibilities, that came up as the analysis themes, being: 1) monitoring therapeutic/adverse effects of medicines, 2) monitoring medicines adherence, 3) decision making on medicines, including prescribing 4) providing patient education/information. Nurses' autonomy varied across Europe, from none to limited to a few tasks and emergencies to a broad range of tasks and responsibilities. Intended level of autonomy depended on medicine types and level of education. Some changes are needed before nursing roles can be optimised and implemented in practice. Lack of time, shortage of nurses, absence of legal frameworks and limited education and knowledge are main threats to European nurses actualising their ideal role in PC., Conclusions: European nurses have an active role in PC. Respondents reported positive impacts on care quality and patient outcomes when nurses assumed PC responsibilities. Healthcare professionals expect nurses to report observations and assessments. This key patient information should be shared and addressed by the interprofessional team. The study evidences the need of a unique and consensus-based PC framework across Europe., Competing Interests: The study “Perspectives of nurses’ roles in interprofessional pharmaceutical care across 14 European countries: a qualitative study in pharmacists, physicians and nurses” was supported by the Erasmus+ Programme of the European Union [grant number 2018-1-BE02-KA203-046861] and MDMJ accountants, Belgium (https://www.mdmj.be). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Within this Competing Interests Statement, we explicitly elaborate on MDMJ accountants as a commercial co-funder of this study. This organisation is an accountancy service in Belgium that financially supported the Belgian authors. No competing interests interfered with, or could reasonably be perceived as interfering with, the full and objective presentation of this research. Next to the financial support, no professional or personal competing interests can be declared about this commercial funder. The financial support consisted of a gift of 27000€, to be used as co-funding of the Belgian research team, next to the funding of the Erasmus+ programme of the European Union. No other statements relating to employment, consultancy, patents, products in development or marketed products can be declared. The Belgian authors confirm that the financial support of MDMJ accountants does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background: It is widely acknowledged that the experiences of frontline primary health care professionals during COVID-19 are important to understand how they respond and act under situations of pandemic as the gatekeepers in primary health care system. School nurses are primary health care professionals who lead health care in schools and practice in a holistic manner to address the needs of schoolchildren and school personnel. There are rising mental health concerns of frontline health care professionals with anxiety and panic disorders, somatic symptoms, and feeling isolated. No studies use a qualitative study approach to document community frontline school nursing professionals' experiences and challenges during the COVID-19 pandemic. Hence, understanding the school nurses' experiences and challenges to fight against COVID-19 in the communities is important., Purpose: This study aims to explore the experiences of school nurses during the COVID-19 pandemic in Hong Kong., Methods: A qualitative study design adopted the principles of thematic analysis. Nineteen school nurses were recruited to participate in individual semistructured interviews and shared their roles and responsibilities during the COVID-19 pandemic., Findings: Three themes indicated the school nurses' expand professional responsibilities to fight against COVID-19 emerged from the data analysis. These were "Managing Stress," "Navigating the School Through the Pandemic," and "Raising the Profile of the School Nurse Professional," DISCUSSION: Findings reveal the important role of school nursing professionals in minimizing the community-wide risk posed by pandemics and the need to integrate them into planning and implementation of school health policies and guidelines in the primary health care system. This essential role in schools is necessary to assess, implement, monitor, prevent, and reduce the spread of virus in school communities and to minimize the burden to and extra health care resources utilized in the acute care setting during COVID-19 pandemic., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Healthy work environment is essential to patients' safety, staff recruitment, retention, and organization's financial viability. It is imperative to examine, understand and mitigate any and all factors that may contribute to unhealthy work environment., Purpose: This study aimed to describe how African-born Black nurses felt their race affected their experience of the work environment and whether these experiences contributed to perceptions of unhealthy work environments., Method: Thematic analysis was performed on data obtained from unstructured interviews of 17 African born Black nurses in this qualitative descriptive study., Findings: Seven themes emerged from the study: disregard for personhood, poor communication, democratic disqualification, lack of recognition, missing authentic leadership, attrition, and finding control., Discussion: The finding suggests African born Black nurses' experiences are uniquely and qualitatively different from that of their American born counterparts. Creating healthy work environment require authentic nurse leaders who can influence and support others in its achievement., Competing Interests: Declaration of Competing Interest The authors have no competing interest to declare., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: The increase in the use of oral cancer drugs implies that nurses take on new roles for which education and support to patients and family members become fundamental for promoting therapeutic adherence., Objective: To describe the patients' and nurses' perceptions on the effectiveness of the educational process in oral cancer treatment., Methods: A mixed method with a convergent design was used. Data were collected using a questionnaire (structured according to the Multinational Association of Supportive Care in Cancer Teaching Tool for Patients Receiving Oral Agents for Cancer guidelines) and semistructured interviews with patients. Focus groups were used with the nurses. Quantitative data were analyzed with SPSS 22.0 (IBM SPSS 22.0, Armonk, New York). Qualitative data were analyzed using semantic analysis., Results: One hundred forty-two questionnaires were analyzed. Patients were usually informed by physicians and nurses (81%), alone (33%) or in the presence of an informal carer (29.6%). Language comprehension was high, with a significant difference between those 70 years or older (P = .04) and those younger than 70 years. From the interviews (n = 16), 3 themes were identified: emotions during communication, feeling reassured by the presence of family members and nurses, feeling welcomed and an active part of the educational process. Three themes were identified from the focus groups (n = 4): prerequisites for an effective therapeutic education, nurses' skills, and educational process barriers., Conclusions: Overall, patients were satisfied with the education received. They perceived nurses as people who can help them understand the information they have received and manage their treatment and adverse effects., Implications for Practice: This study highlighted some important points for an effective educational process: having a nurse to refer to, technical relationship competences, joint visits with physicians, and being available by phone., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: The aim of this study was to determine the pandemic impact on the relationship between nurses' perception of the authentic nurse leadership (ANL) of their manager and their perception of the work environment., Background: Both ANL and healthy work environment (HWE) contribute to staff and patient outcomes. Our 1st study of these 2 variables revealed a positive relationship. Will this be upheld in a pandemic year?, Methods: More than 5000 nurses from a national sample participated in a cross-sectional, correlational, descriptive study using the Authentic Nurse Leadership Questionnaire, the Critical Elements of a Healthy Work Environment Scale, and a pandemic impact on practice question., Results: Overall, nurses perceived ANL and HWE were present despite a high level of pandemic impact; however, when clinical nurses were separated from managers/directors, HWE was not present for frontline nurses. The moderate correlation of ANL and HWE was replicated in this larger study., Conclusions: This is the 2nd study of the positive relationship between ANL and HWE using these models, supporting ANL as an essential standard of a HWE. ANL was present for clinical nurses in a pandemic year signaling that nurse leaders rose to meet frontline leadership needs. HWE was present overall, but not for clinical nurses. Leadership is essential to work environments and outcomes especially in times of crisis and significant change., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: Researchers examined associations between Index for Professional Nursing Governance (IPNG) scores and outcomes, by US and international hospitals., Background: Nursing governance and effects on nurse-related outcomes are not well studied., Methods: Associations were evaluated using average IPNG scores from 2170 RNs and nurse-sensitive indicators (NSIs) and patient and RN satisfaction outcomes (n = 205 study units, 20 hospitals, 4 countries)., Results: International units had better IPNG shared governance scores (113.5; US = 100.6; P < 0.001), and outcomes outperforming unit benchmarks (6 of 15, 40.0%; US = 2 of 15, 13.3%). Shared governance significantly outperformed traditional governance for 5 of 20 (25.0%) US outcomes (patient satisfaction = 1, RN satisfaction = 4) and for 3 of 11 (27.3%) international (patient satisfaction = 1, RN satisfaction = 2). Internationally, self-governance significantly outperformed traditional governance and shared governance for 5 of 12 (41.7%) outcomes (NSI = 2, patient satisfaction = 3)., Conclusions: Shared governance is a strategy that can be considered by nurse leaders for improving select outcomes., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Charting a path to achieve health equity., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Recent surveys provide clues to the pandemic's effect on the profession., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Care for the Caregiver is a peer-to-peer program that provides support and guidance to clinicians who have experienced an unexpected and emotionally distressing event. Its development was preceded by communication and resolution programs that were endorsed by the Joint Commission in 2001, subsequently introduced at several U.S. medical centers, and in 2009 were incorporated within demonstration projects funded by the Agency for Healthcare Research and Quality. In August 2014, the authors introduced the Care for the Caregiver program across the MedStar Health System, which includes seven hospitals in Maryland and three in the District of Columbia. Here, they describe how the program was initially conceived and structured-and how it evolved in response to the current pandemic., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: To shape priorities for health and health care outcomes, it is essential for nurse leaders to be influential. The application and impact of influence are readily recognized, but not its characteristics., Purpose: The purpose of this project was to conduct a concept analysis of influence relative to nurse leaders., Methods: The Walker and Avant method of concept analysis was utilized., Findings: Attributes of influence include advocacy, communications skills, competency, confidence, credibility, and engagement. Antecedents of influence are authority, collaboration, integrity, and mentorship. Consequences of influence are action, change, commitment, compliance, decision-making, motivation, and resistance., Discussion: By drawing upon a systematic understanding of the concept of influence, nurse leaders are urged to develop and leverage the attributes of influence to drive and achieve collective good for the future of health and health care in society., (Copyright © 2020 Elsevier Inc. All rights reserved.)

This study aims to evaluate the effects of leader-member exchange (LMX) on job and life satisfaction among nurses in China and to examine the mediating effect of individual and collaborative job crafting between LMX and job and life satisfaction. The study recruited 263 nurses who worked in hospitals in Zhejiang province, China. A set of self-administered questionnaires were used to measure the variables of LMX, job crafting, job and life satisfaction. The data was analyzed using the partial least square structural equation modelling (PLS-SEM). The results reveal that LMX has a significant positive influence on job crafting and job satisfaction. Collaborative job crafting has a significant positive influence on the job satisfaction of nurses, whereas individual job crafting does not. Moreover, LMX will affect job satisfaction and life satisfaction through a partial mediating effect of both individual and collaborative job crafting. Finally, the article discusses the academically and practical implications, and also provide some suggestions and directions for the future research., Competing Interests: The authors have declared that no competing interests exist.

Certified Registered Nurse Anesthetists (CRNAs) are uniquely skilled anesthesia providers with substantial experience managing critically ill patients. During the coronavirus disease 2019 (COVID) pandemic, CRNAs at a large academic medical center in the Mid-Atlantic United States experienced a shift in their daily responsibilities. As the hospital transitioned to the management of patients who tested positive for the virus that causes COVID, the severe acute respiratory syndrome-coronavirus type 2 (SARS-CoV-2), CRNAs were redeployed into the roles of respiratory therapists and intensive care unit registered nurses. Although facing the stress of the global pandemic, this facility's CRNAs proved to be flexible, capable, and necessary members of the care team for patients with COVID-19., Competing Interests: DISCLOSURES The authors have declared no financial relationships with any commercial entity related to the content of this article. The authors did not discuss off-label use within the article. Disclosure statements are available for viewing upon request., (Copyright © by the American Association of Nurse Anesthetists.)

This is the last of three articles exploring ways in which frontline nurses may be affected by recommendations of the forthcoming National Academy of Medicine Future of Nursing 2020-2030 study. For this third article, interviews were conducted with nurse leaders from diverse practice areas to see how their thinking about the future had shifted as 2020 drew to a close., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Coronavirus disease 2019 (COVID-19) has resulted in severe health, economic, social, political, and cultural consequences while thrusting Certified Registered Nurse Anesthetists (CRNAs) at the forefront of battling an often invisible enemy. A mixed-methods study was conducted to assess the impact of the COVID-19 pandemic on CRNA practice. The purpose of the qualitative component of the study, a focused ethnography, was to use personal and group interviews to determine the shared experiences of CRNAs who worked during the COVID-19 pandemic. Six themes were identified: (1) CRNAs are part of the solution, (2) doing whatever it takes, (3) CRNAs are valued contributors, (4) removal of barriers promotes positive change, (5) trying times, and (6) expertise revealed. The quantitative component of the study will be discussed in a separate article., Competing Interests: DISCLOSURES The authors have declared no financial relationship with any commercial entity related to the content of this article. The authors did not discuss off-label use within the article. Disclosure statements are available for review upon request., (Copyright © by the American Association of Nurse Anesthetists.)

Objective: Reflect on the work experienced by the nurse in coping with the COVID-19 pandemic in a public hospital of the State of Rio Grande do Norte., Methods: Reflective essay based in the professional experience in a public reference hospital for the care of patients affected by COVID-19 in the State of Rio Grande do Norte. Results were organized in two empirical categories, which emphasize potentialities and barriers in the nurse's work in the face of the COVID-19, presented by means of Ishikawa diagram., Results: Two categories emerged from the experiences: Nursing leadership in organizing health services to face COVID-19; and the performance of nursing care management in the COVID-19 pandemic., Final Considerations: It is necessary to value the nurse's work in all its attributes, as well as strengthen the interdisciplinary work processes, which collaborate to overcome the crisis caused by the pandemic.

Numerous studies show the risk of a breakdown in the continuity of care when a patient leaves hospital. A study was carried out of hospital-based nurses, to find out their representations with regard to their role in the hospital-home transition. The results enable areas of improvement to be identified., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Background: Hospitals need to prevent, respond to, and learn from safety risks and events perceived by patients and families, who in turn rely on nurses to respond to and report their safety concerns., Objectives: The aim of the study was to describe the process by which bedside nurses evaluate and determine the appropriate response to safety concerns expressed by patients or their families., Methods: A qualitative design was employed. We recruited inpatient bedside nurses in an 811-bed Midwest academic medical center. Nurses provided demographic information and participated in semistructured interviews designed to elicit narratives related to evaluation and response to patient- or family-expressed safety concerns. Data analysis and interpretation were guided by grounded theory., Results: We enrolled 25 nurses representing 22 units. Based on these nurses' experiences, we developed a grounded theory explaining how nurses evaluate a patient or family safety concern. Nurses make sense of the patient's or family's safety concern in order to take action. Achieving this goal requires evaluation of the meaningfulness and reasonableness of the concern, as well as the potential effect of the concern on the patient. Based on this nursing evaluation, nurses respond in ways designed to (a) manage emotions, (b) immediately resolve concerns, (c) involve other team members, and (d) address fear or uncertain grounding in reality. Nurses reported routinely handling safety concerns at the bedside without use of incident reporting., Discussion: Safety requires an interpersonal and evaluative nursing process with actions responsive to patient and family concerns. Safety interventions designed to be used by nurses should be developed with the dynamic, cognitive, sensemaking nature of nurses' routine safety work in mind. Being sensitive to the vulnerability of patients, respecting patient and family input, and understanding the consequences of dismissing patient and family safety concerns are critical to making sense of the situation and taking appropriate action to maintain safety. Measuring patient safety or planning improvement based on patient or family expression of safety concerns would be a difficult undertaking using only standard approaches. A more complex approach incorporating direct patient engagement in data collection is necessary to gain a complete safety picture., Competing Interests: The authors have no conflicts of interest to report., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Abroad, advanced practice in emergency medicine has had positive effects on populations. In France, following the reform of emergency departments, advanced practice nurses in emergency medicine will become a reality. This new profession raises certain fears. Their contribution must be alongside the patients and in the organisations. For this, patient pathways need to be identified and cooperation between the advanced practice nurses and emergency room doctors must be established., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Introduction: The informal curriculum-an essential complement to the formal curriculum-is delivered to medical trainees through learning outside the classroom. We sought to explore nurse-mediated aspects of trainee education in the informal curriculum in obstetrics and gynecology (OBGYN), as well as nursing perceptions of their role in medical trainee education., Methods: Naturalistic, non-participant observations (40 h) were performed on a tertiary care birthing unit (BU) to document teaching and learning interactions. Insights gleaned from observations informed subsequent semi-structured interviews with BU nurses (n = 10) and focus group discussions with third-year medical students who had completed an OBGYN rotation (n = 10). Thematic analysis was conducted across data sets., Results: Conceptions of nurse-mediated education differed considerably between nurses and trainees. Nurses were widely acknowledged as gatekeepers and patient advocates by both groups, although this role was sometimes perceived by trainees as impacting on learning. Interest and engagement were noted as mediators of teaching, with enhanced access to educational opportunities reported by trainees who modelled openness and enthusiasm for learning. Nurse-driven education was frequently tailored to the learner's level, with nurses feeling well positioned to share procedural knowledge or hard skills, soft skills (i.e. bedside manners), and clinical insights gained from bedside practice., Discussion: Nurses are instrumental in the education of medical trainees; however, divergence was noted in how this role is enacted in practice. Given the valuable teaching resource BU nurses present, more emphasis should be placed on interprofessional co-learning and the actualization of this role within the informal curriculum.

The recent pandemic has caused many changes in the professional and personal lives of patients, their families, and the nurses who care for them. Something the pandemic could not change is the profound gratitude that patients, families, and others have for the extraordinary compassionate care that nurses have provided., Competing Interests: The author declares no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: Declaration of Competing Interest None.

Abstract: Advice from current nurse leaders can offer valuable insight for aspiring leaders. This article discusses how the collective wisdom of practicing nurse leaders can assist new leaders as they transition into the role., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Nurses are a high-risk group for presenteeism: When one is present at work but not fully engaged. Presenteeism can occur because of multiple work, personal, and event factors and is linked to negative nurse, patient, and organizational outcomes. A model that accounts for the multiple antecedents that lead to presenteeism, as well as its consequences, is needed., Objective: The aim of this study was to evaluate our proposed presenteeism in nursing model among registered nurses in the United States by examining the fit of the data with the model., Methods: Four hundred forty-seven registered nurses who provide direct patient care completed a cross-sectional survey on presenteeism, its antecedents and consequences, and demographics. Structural equation modeling was used to test relationships in the proposed model and overall model fit., Results: The presenteeism in nursing model holistically accounted for significant presenteeism antecedents and consequences. There were significant relationships between work environment, perceived stress and work-life balance, and presenteeism. There were also significant relationships between presenteeism and missed care, and burnout., Discussion: These relationships align with prior research and identify antecedents and consequences of presenteeism. This model can be used by practitioners and researchers to develop interventions addressing presenteeism to improve health system, nurse, and patient outcomes., Competing Interests: The authors have no conflicts of interest to report., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: The purpose of this study was to evaluate nurses' perceptions of decisional involvement (DI)., Background: Decisional involvement is a measure or gauge of nurses' perceived shared leadership. There has been limited research examining factors associated with actual and preferred DI., Methods: A descriptive, observational study design was used. A total of 189 RNs completed the Decisional Involvement Scale and Evidence-Based Practice Implementation Scale. Nurses' preferred DI (DI-P) and actual DI (DI-A) were analyzed, and DI total and subscale scores were compared based on nurses' demographic and clinical practice characteristics., Results: The DI-A and DI-P total scores were significantly different, including subscales for DI-A compared with DI-P score. Dissonance scores by subscale were highest for recruitment, governance, and support. Unit-based council (UBC) participants had significantly higher actual DI, compared with non-UBC participants. Nurses' perceptions of implementing evidence-based practice (EBP) was not significantly different by low versus high EBP implementation; nor were the scores significantly correlated with their DI-A or DI-P scores., Conclusions: Findings indicate nurses' perceptions of DI-A and DI-P. This study provided further examination of the differences and interrelationships between DI and nurses' demographic and clinical practice characteristics. Dissonance DI scores provide opportunities for targeting interventions to engage nurses in shared leadership., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: This research study aims to:(1) identify and explore the social network communication tools used to facilitate the adjustment process of Malaysian female expatriate nurses working in the Kingdom of Saudi Arabia (hereafter "the Kingdom" or "SA") who are accompanied by neither their spouses nor families and (2) determine how these tools facilitate their adjustment to their new environment. Emphasis is placed on this particular group of respondents primarily due to the dearth of research conducted on female expatriate nurses., Method: We conducted a preliminary study using semi-structured interviews with sixteen (16) Malaysian female expatriate nurses working in SA to obtain a broader understanding of their experiences with cross-cultural adaptation and their use of social media tools to connect with their families and friends in their home country., Results: This study uncovers numerous social media communication tools being used by female expatriate nurses to help curb their loneliness and lessen the culture shock of living and working in a foreign country. Continuous engagement with these tools helps Malaysian female expatriate nurses maintain their emotional stability, thereby enabling them to remain mentally strong and ultimately prolonging their stay in SA., Conclusions: This study's outcomes contribute significantly to the knowledge of the government, various organizations, and aspiring female expatriate nurses in the healthcare industry because the results can assist female expatriate nurses during the adjustment period, enabling them to work efficiently and successfully in the host country., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Caring in nursing helps patients feel better, whilst the absence of caring will affect patients psychologically, emotionally and physically., Aim: The aim of this article was to explore and describe primary health care (PHC) professional nurses' and PHC nurse managers' perceptions of the developed strategies to facilitate effective caring for patients in PHC clinics., Setting: This study was conducted in two PHC clinics in Ekurhuleni, an area east of the Gauteng province, South Africa., Methods: The study used a qualitative, exploratory, descriptive and contextual design. In-depth individual phenomenological interviews were conducted with eight purposively selected PHC professional nurses working in PHC clinics and two PHC nurse managers supervising PHC clinics in Ekurhuleni. Giorgi's coding method was used to analyse the data., Results: Three themes were identified from the results of the exploration and description of PHC professional nurses' and PHC nurse managers' perceptions of the developed strategies. The use of active listening skills, showing interest in what is being said, asking questions and providing constructive feedback that focuses on the issue were the most effective strategies in improving effective communication between PHC nurse managers and PHC professional nurses. The PHC professional nurses were encouraged to put patients' interests first whilst adhering to the ethical principles of nursing., Conclusion: Although caring is considered as the core of nursing practice, PHC professional nurses and PHC nurse managers perceive that rendering effective caring for patients needs to be reinforced through the use of strategies that will enable change and improve clinical practice in PHC clinics.

Objective: The aim of this study was to explore the association between religion/spirituality (r/s) and mental health outcomes in hospital-based nursing staff., Background: The relationship between r/s and health has been studied extensively. Most frequently, r/s has been studied in association with mental health outcomes, including depression, anxiety, and distress among patients. However, hospital-based nurses suffer from the mental health effects of working in high-stress work environments. To date, little research has focused on the relationship between r/s and mental health outcomes in nurses., Methods: A cross-sectional online survey was completed by 207 nurses from 6 community hospitals., Results: Approximately half of the nurses sampled identified as religious, whereas nearly 75% identified as spiritual. There were significant associations between measures of r/s and mental health outcomes such as depression, anxiety, and mental well-being., Conclusions: This whole-person assessment of nurses may inform future retention and engagement strategies focused on faith-based interventions., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

This paper reports on a study that aimed to understand how remote area nurses implemented primary health care principles in the Australian remote health care setting. Twenty-four Registered Nurses and Nurse Practitioners who worked in remote health services without inpatient facilities were interviewed using constructivist grounded theory methods. Findings revealed that nurses in this study aimed to practice in a way that was guided by Indigenous empowerment and social justice. However, some nurses questioned elements of their practice such as 'chasing' people for appointments or routine screening required by clinical guidelines that may not reflect the values of Indigenous peoples. Nurses expressed concern that they may be reinforcing past colonising practices and their actions may be considered paternalistic rather than empowering. Nurses in this study wanted to develop partnerships and provide nursing care that aligned with the health and wellbeing expectations of communities. However, ways of communicating the needs of communities and the development of partnerships between health providers and communities need to be developed. The present study calls for further research from the perspective of remote community members in order to develop ways of sharing knowledge about health and wellbeing between remote area nurses and communities.

We report our experience in using virtual technology in our emergency department (ED) to meet communication needs of our patients who have limited English proficiency (LEP) during the COVID-19 pandemic. Our project aim was to improve communication between our ED staff and patients who have LEP. Specifically, our primary aim was to eliminate the use of healthcare staff as ad hoc interpreters by 50% in our ED by using virtual medical interpreters within 2 months. To achieve our goal, several strategies were employed. First, we assessed the need for interpreters in our ED by tracking the number of times our nursing staff is pulled away from their nursing role to help other staff as an ad hoc interpreter. Second, a patient survey was conducted to understand their thoughts and needs for interpretation in the ED. Third, we developed strategies in improving access to interpreters in our ED. During the COVID-19 pandemic, we conducted a trial of using 'Interpreter on Wheels' (IOW) in our ED. In a 2-month period, we had 477 virtual interpretation encounters totaling 4123 interpretation minutes of IOW usage. We found that it satisfied not only our communication needs but also reduced some of our potential infection control risks during the pandemic., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The aims of this study were to explore women's and health professionals' perspectives of preconception care and whether expanding the role of practice nurses (PNs) to provide preconception care is acceptable. In a descriptive qualitative approach, 23 semistructured interviews and three focus groups were conducted with women (n=14), PNs (n=8), GPs (n=10) and practice managers (n=2) in the state of Victoria, Australia, between September and December 2019. An inductive process of thematic analysis identified five themes and 12 subthemes. Women and health professionals viewed preconception to be when a woman is planning a pregnancy. Women wanted personalised preconception care, and receiving this from a PN was considered to be acceptable. If the role of PNs is expanded, PNs would require training and professional recognition of their role to provide preconception care. Funding barriers were discussed by PNs, GPs and practice managers, along with potential solutions, such as Medicare item numbers and checklists to streamline consultations. Other resources in the wider community, such as schools, were identified as important aspects of a coordinated approach. Overall, expanding the role of PNs to provide preconception care was acceptable to women and health professionals to increase women's awareness and uptake of preconception care.

Objective: The aim of this study was to understand the attitudes of front-line clinical nurses toward hospice care in the fight against the COVID-19 pandemic, to provide a source of reference for hospice care education and training in hospitals treating patients with COVID-19., Method: Front-line nurses from a designated COVID-19 hospital in Wuhan, China, participated. Participants completed the Chinese versions of the General Information Questionnaire, the Frommelt Attitudes Toward Care of the Dying Scale, the Jefferson Scale of Empathy, and the General Self-Efficacy Scale., Results: A total of 149 questionnaires were included in the analysis. The median total hospice care attitudes score was median 102.00(interquartile range, 95.5-120.50). The nurses' attitudes toward hospice care were significantly associated with their age, knowledge of hospice care, level of empathy, and self-efficacy., Conclusion: The attitudes of front-line nurses toward hospice care need to be improved. Hospital departments should establish an effective public health emergency strategy, provide training to increase front-line nurses' knowledge and practical experience of hospice care, cultivate nurses' empathy, and enhance their sense of self-efficacy, in order to improve the quality of hospice care for patients and their families.

There has been little research about the experiences of nurses transitioning into community nursing (CN), despite the growing demand for nurses in this setting and impending shortfall in the nursing workforce in Australia. In this study, nurses from a busy metropolitan CN service were interviewed to explore how they experienced their first months in their new role. The interviews were analysed thematically, with three themes emerging: Adaptation, Focus of Care and Context. Participants detailed their experiences adjusting to new work practices and the community setting, and expanded on their enjoyment from increased autonomy, career goal recognition and rewarding patient relationships and outcomes. The findings of this study are aligned with previous literature about nurses entering the primary healthcare setting from acute care, and particularly highlight the need to individually tailor orientation, preceptorship and ongoing career development programs to each nurse.

Objective: To examine self-perceived fatigue among nurses and to quantify levels of fatigue and the ability to recover from fatigue between worked shifts across various work characteristics., Background: Fatigue is associated with working long hours, disruption of sleep, and inadequate time to recover between shifts. Fatigue degrades the nurses' performance leading to poorer patient outcomes and increased occupational injuries., Methods: This quantitative study surveyed 573 nurses across 5 hospitals in the southeastern United States., Results: Significant levels of acute fatigue were associated with working labor and delivery and medical-surgical units and working a 12-hour shift. Nurses working night shift and on the behavioral health unit showed a significantly lower ability to recover between worked shifts., Conclusions: Fatigue threatens safety and the quality of patient care. Leaders should ensure that nurses take duty-free breaks and schedule adequate time off to recover between worked shifts., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

This article explores the experiences and learnings of 2 ambulatory care nurse leaders on the front lines of the Covid-19 pandemic using the theory "navigating through chaos" as a framework., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

As stories of dying alone from COVID-19 pervade the news, a reminder of the intimacy and love that can surround a hospice patient's last moments., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Education, employment, housing, neighborhood safety, and traumatic life experiences influence people's health, and poor health as a result of inequities in these areas cannot be remedied by medical care alone. Although social determinants of health threaten the attainment of a healthy life for people across North America, nurses are positioned to be leaders in a movement toward health equity. Nurses can follow the example of Jesus in loving their neighbors as themselves by addressing the social needs of patients, championing health system change, educating their communities, and advocating for Health in All Policies.

Background: Confusion about what a do-not-resuscitate (DNR) order means, including its misinterpretation as "do not treat," has been extensively documented in the literature. Yet there is a paucity of research concerning nurses' perspectives on DNR orders., Purpose and Design: This mixed-methods study was designed to explore nurses' perspectives on the meaning and interpretation of DNR orders in relation to caring for hospitalized adults with such orders., Methods: Direct care nurses on three units in a large urban hospital were asked to respond online to a case study by indicating how they would prioritize care based on the patient's DNR designation. These nurses were then invited to participate in open-ended interviews with a nurse researcher. Interviews were audiotaped, transcribed, and analyzed., Findings: A total of 35 nurses responded to the case study survey. The majority chose to prioritize palliative care, despite no indication that any plan of care was in place. Thirteen nurses also completed a one-on-one interview. Analysis of interview data revealed this overarching theme: varying interpretations of DNR orders among nurses were common, resulting in unintended consequences. Participants also reported perceived variances among health care team members, patients, and family members. Such misinterpretations resulted in shifts in care, varying responses to deteriorating status, tension, and differences in role expectations for health care team members., Conclusions: Nurses have opportunities to address misconceptions about care for patients with DNR orders through practice, education, advocacy and policy, and research., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

When a curriculum evaluation of a BSN program at a public university revealed a content gap on spirituality and spiritual assessment, faculty developed an elective covering a nurse's role in spiritual care and assessment of patients. The resulting 300-level course was of hybrid design and received positive evaluation from students after implementation.

The Neuman Systems Model was developed to create a structure to depict nursing clients as complex systems, in constant energy exchange with their environments, comprised of multiple interrelated parts. It has been widely used in practice, education, research, and administration. An analysis of the theory, based upon Meleis' methods, was conducted. The theory has high utility and a large circle of contagiousness despite its complexity, lack of teleology, and level of abstractness. Based upon this analysis, a new model entitled the Neuman Systems Model Perspective of Nurse-Led Interprofessional Collaborative Practice has been created to provide a framework for the care of community-dwelling older adults. As a first step in its development, this new model will be used to guide a mixed-methods study evaluating an interprofessional collaborative practice intervention for community-dwelling older adults.

As development of the Future of Nursing 2020-30 Report by the National Academy of Medicine is underway, the nursing profession is positioned to continue positively impacting health and health equity in the United States. Progress to date engenders hope that nurses will continue to take a significant role in reducing health disparities. The work to create a culture of health aligns with the Christian imperative to "love your neighbor as yourself."

Background: Many Dutch nurse practitioners (NPs) work together with physicians and specialized nurses (SNs) in outpatient clinics, although the latter have questioned the added value of NPs in the outpatient clinic. Clarification of the distinction between and the added value of both nursing professions in relation to each other could lead to optimal use of the unique competencies of each type of nurse., Purpose: To explore NPs' perspectives on their added value in relation to SNs in the outpatient clinic., Methodological Orientation: Data were analyzed by Braun and Clarke's thematic analysis. The CanMEDS competences were used to identify the NPs' comments about their practice., Sample: Twelve semi-structured interviews were conducted with NPs from two hospital settings., Conclusions: The added value of NPs was most evident in: nursing leadership, integrating care and cure and performing an expert level of nursing expertise, and competencies in science. To optimize their roles, NPs and SNs need to make all team members aware of their unique competences and promote role clarification., Implications for Practice: This study provides barriers in barriers that influence optimal positioning of NPs within the interdisciplinary team, stresses the importance of discussion on the optimal skill mix within the interdisciplinary team, and describes the NPs' leadership role because this is the encompassing link between the main competencies of their practice. Addressing and overcoming these findings could improve the NPs' positioning and effective collaboration within (the outpatient clinic's) interprofessional teams.