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Background: Regarding the evidence-based practice (EBP) process, nurses tend to perceive that critical appraisal of research articles is challenging. Though critical appraisal in EBP has been a frequent topic in medical education, implementing and disseminating existing EBP education for nurses are challenging in countries with limited EBP educational resources. This study aimed to evaluate changes in practice, attitude, knowledge and skills of EBP before and after an EBP workshop focused on critical appraisal among advanced practice nurses. Methods: This study was a before and after educational intervention study. The workshops were provided in small groups in 2017 and 2018. The targeted nurses were certified nurse specialists (CNSs) who provide patient care and are certified as advanced practice nurses. The workshop was designed to include at least one CNS in each group. The Japanese version of the Evidence-based Practice Questionnaire, with four subscales—practice, attitude, and knowledge and skills of research and practice—was evaluated four times: baseline, immediately after the workshop, and 3 and 6 months after the workshop. At the end of the workshop, the participants wrote their learning objectives and plans for improving their critical appraisal of EBP. A self-reflection questionnaire was distributed 3 months after the workshop, and a qualitative descriptive analysis was used. Results: Eleven CNSs participated in this study. Only the score of the knowledge and skills of research showed a statistically significant change. Many participants did not perform critical appraisal of research articles after the workshop. The facilitators were to have a role in integrating research evidence into practice and the barriers to being too busy, personnel transfers, and insufficient conditions. Conclusions: Self-efficacy for critical appraisal in EBP might increase through the EBP education workshop. Even nurses interested in EBP require ongoing learning opportunities and organizational support for EBP activities. Trial Registration: This study was retrospectively registered with University hospital Medical Information Network Clinical Trial Registry (UMINCTR) on 09/14/2018 (Registration Number. UMIN000034146). [ABSTRACT FROM AUTHOR]

Abstract Background Regarding the evidence-based practice (EBP) process, nurses tend to perceive that critical appraisal of research articles is challenging. Though critical appraisal in EBP has been a frequent topic in medical education, implementing and disseminating existing EBP education for nurses are challenging in countries with limited EBP educational resources. This study aimed to evaluate changes in practice, attitude, knowledge and skills of EBP before and after an EBP workshop focused on critical appraisal among advanced practice nurses. Methods This study was a before and after educational intervention study. The workshops were provided in small groups in 2017 and 2018. The targeted nurses were certified nurse specialists (CNSs) who provide patient care and are certified as advanced practice nurses. The workshop was designed to include at least one CNS in each group. The Japanese version of the Evidence-based Practice Questionnaire, with four subscales—practice, attitude, and knowledge and skills of research and practice—was evaluated four times: baseline, immediately after the workshop, and 3 and 6 months after the workshop. At the end of the workshop, the participants wrote their learning objectives and plans for improving their critical appraisal of EBP. A self-reflection questionnaire was distributed 3 months after the workshop, and a qualitative descriptive analysis was used. Results Eleven CNSs participated in this study. Only the score of the knowledge and skills of research showed a statistically significant change. Many participants did not perform critical appraisal of research articles after the workshop. The facilitators were to have a role in integrating research evidence into practice and the barriers to being too busy, personnel transfers, and insufficient conditions. Conclusions Self-efficacy for critical appraisal in EBP might increase through the EBP education workshop. Even nurses interested in EBP require ongoing learning opportunities and organizational support for EBP activities. Trial Registration This study was retrospectively registered with University hospital Medical Information Network Clinical Trial Registry (UMINCTR) on 09/14/2018 (Registration Number. UMIN000034146).

Summary: Purpose: To identify the relationship between emotional intelligence, occupational well-being, and work engagement among Chinese clinical nurses. Methods: This cross-sectional study is based on survey responses provided by 1744 registered nurses from a Chinese hospital. The survey utilized emotional intelligence, occupational well-being, and work engagement scales. Results: A questionnaire was distributed to nurses, and among them, 1744 filled it in. Work engagement was related to demographic characteristics. The nurses' work engagement score was 28.99±5.46. Work engagement was positively correlated with emotional intelligence (r=.94, p < .01) and occupational well-being (r=.96, p < .01). Conclusions: The current work engagement of nurses in China is at a medium level. It is influenced by emotional intelligence and occupational well-being.

BACKGROUND: The clinical nurse leader (CNL) care model has existed since 2007. However, there is limited understanding how the model can best be implemented. PURPOSE: A validated CNL Practice Survey measuring domains theorized to influence CNL implementation was used to examine the link between CNL domains and CNL implementation success. METHODS: Mixed methods were used to analyze data from a nationwide 2015 survey administered to clinicians and administrators involved in CNL initiatives. RESULTS: Of total respondents (n = 920), 543 (59%) provided success scores, with 349 (38%) providing comments. Respondents with negative comments gave significantly lower average CNL success scores. The majority of negative comments mapped onto Readiness and Structuring domains, providing details of barriers to CNL implementation success. CONCLUSIONS: Findings provide information about structural domains that can be strategically targeted to better prepare settings for CNL implementation and success.

Background: Premature infants often encounter different challenges due to their underdeveloped systems at birth and require specialized care to survive. Telecare usage as a follow-up tool is a proper line to increase infants’ health by reinforcing parents’ competency to care effectively during the post-discharge period. However, there is controversy about telecare for post-discharge infant care. This study aimed to investigate and compare the experiences of nurses and physicians about post-discharge telecare usage in premature infants. Methods: This qualitative study employed conventional content analysis. Semi-structured interviews were conducted with 30 nurses and 25 physicians using purposive sampling. The participants were recruited from three neonatal intensive care units (NICU) affiliated with Isfahan University of Medical Sciences, Iran, from October 2022 to February 2023. All participants had at least two years of experience providing teleconsultation care for premature infants through a web-based national social media platform. The interviews aimed to explore participants’ experiences with teleconsultation. Data collection spanned five months, and the analysis was guided by Granheim and Lundman’s method to extract core concepts until data saturation was reached, meaning no new information emerged from further interviews.Results: The findings demonstrated two main components, including the challenges and benefits of telecare. Both nurses and physicians generally agreed on the usefulness of telecare, but they differed in opinions regarding infant safety and trust in parents’ understanding of telecare monitoring.Conclusion: The study highlighted safety concerns and parental internet literacy levels related to telecare follow-up, advocating for its integration alongside traditional care. Valuable insights were provided for policy-makers in managing post-discharge care for premature infants, emphasizing the need for further exploration into long-term impacts and parental adherence to telecare protocols.

Objective: To explore advanced practice nurses' experiences and perceptions of running nurse-led clinics in the Australian context. Background: Advanced practice nurses consult with patients through nurse-led clinics to address ever-growing clinical demands and healthcare workforce shortages. Their experiences and perceptions of running nurse-led clinics are vital, but studies offering insights into this area are scarce. Study design and methods: This study adopted a qualitative descriptive design. Using purposive and snowball sampling methods, ten semi-structured individual virtual interviews were conducted with advanced practice nurses who run nurse-led clinics in Australia. Interviews were audio recorded and transcribed verbatim. Data were analysed using thematic analysis. Reporting of this study adhered to Consolidated Criteria for Reporting Qualitative Research guidelines. Results: Three themes were constructed: 1) the genesis of nurse-led clinics; 2) perceived positive outcomes of nurse-led clinics; and 3) contextual determinants influencing nurse-led clinics. Findings show that nurses establish, manage, and expand nurse-led clinics to fulfil health service demands and patients' care needs. Though advanced practice nurses reported positive outcomes, there were several barriers that need to be addressed at all levels. Discussion: Advanced practice nurses are required to have wide-ranging knowledge and skills across the validated domains of patient care, support of systems, education, research, and professional leadership to be able to provide evidence-based holistic care. Advanced practice nurses face obstacles in running nurse-led clinics with overwhelming workloads and insufficient support. Regular communication with healthcare organisational leadership and collaboration with other healthcare workers is crucial to gain recognition and support. Conclusion: Nurse-led clinics are a valuable service that should be promoted and recognised. It is the responsibility of healthcare organisations to review current policies and provide necessary support to advanced practice nurses to enable effective and efficient nurse-led services. It is also incumbent upon governments to support funding that enables nurse-led care models across policy, funding, and healthcare levels, spanning macro-, meso-, and micro-levels. Implications for research, policy, and practice: Advanced practice nurses as participants shared experiences in establishing, running, and expanding nurse-led clinics, that can provide a framework to other nurses wanting to start nurse-led services. Advanced practice nurses are encouraged to promote their work to gain recognition and create awareness of the role of nurses in the provision of nurse-led services. More studies are needed at the global level to understand advanced practice nurses' experiences and the challenges they encounter which will assist in developing the strategies to address these barriers. What is already known about the topic? * Nurse-led clinics were introduced to mitigate the shortage of healthcare resources, accommodate increasing clinical demands, and enhance patients' experiences. * Nurse-led clinics achieve positive outcomes, however, advanced practice nurses face barriers in running nurse-led clinics. * Studies offering insights into Australian advanced practice nurses' experiences and perceptions of running nurse-led clinics are lacking. What this paper adds? * Advanced practice nurses shared experiences in establishing, running, and expanding nurse-led services which can be adopted to guide nurses new to nurse-led services. * Advanced practice nurses strived to overcome obstacles encountered in running nurse-led clinics. They need support at all levels to implement nurseled services successfully. * As this is the first study of its kind in Australia, more research is needed to promote and improve the awareness of nurse-led clinics both in Australia and globally. [ABSTRACT FROM AUTHOR]

Background: Premature infants often encounter different challenges due to their underdeveloped systems at birth and require specialized care to survive. Telecare usage as a follow-up tool is a proper line to increase infants' health by reinforcing parents' competency to care effectively during the post-discharge period. However, there is controversy about telecare for post-discharge infant care. This study aimed to investigate and compare the experiences of nurses and physicians about post-discharge telecare usage in premature infants. Methods: This qualitative study employed conventional content analysis. Semi-structured interviews were conducted with 30 nurses and 25 physicians using purposive sampling. The participants were recruited from three neonatal intensive care units (NICU) affiliated with Isfahan University of Medical Sciences, Iran, from October 2022 to February 2023. All participants had at least two years of experience providing teleconsultation care for premature infants through a web-based national social media platform. The interviews aimed to explore participants' experiences with teleconsultation. Data collection spanned five months, and the analysis was guided by Granheim and Lundman's method to extract core concepts until data saturation was reached, meaning no new information emerged from further interviews. Results: The findings demonstrated two main components, including the challenges and benefits of telecare. Both nurses and physicians generally agreed on the usefulness of telecare, but they differed in opinions regarding infant safety and trust in parents' understanding of telecare monitoring. Conclusion: The study highlighted safety concerns and parental internet literacy levels related to telecare follow-up, advocating for its integration alongside traditional care. Valuable insights were provided for policy-makers in managing post-discharge care for premature infants, emphasizing the need for further exploration into long-term impacts and parental adherence to telecare protocols. [ABSTRACT FROM AUTHOR]

Purpose/objectivesThis article describes the contributions of the clinical nurse specialist in navigating the challenges of the COVID-19 pandemic to ensure patient and staff safety while providing science-based quality of care.DescriptionThe group of clinical nurse specialists using advanced practice knowledge and skills within the 3 spheres of impact (ie, patient, organization, and nurse) developed and implemented strategies that supported frontline clinicians and met emerging organizational needs during the COVID-19 pandemic.OutcomesThe clinical nurse specialist's agility was imperative in navigating the challenges of the pandemic to ensure the safety of patients and staff by providing strategies and standardization to workflow processes across the organization.ConclusionThe group's combined clinical expertise and support of frontline nurses positioned the clinical nurse specialist to rapidly escalate the bedside nurse's concerns and provide recommendations to improve workflow while maintaining patient and staff safety.

Introducción Las últimas evidencias revelan que la infección por COVID-19 no tienen peor pronóstico en los pacientes con enfermedades inflamatorias inmunomediadas (EIMI), aunque desarrollan menor respuesta a la vacunación. Comparar la incidencia de COVID-19 y características clínicas en pacientes con EIMI entre la primera y sexta olas. Estudio observacional prospectivo de 2 cohortes de pacientes con EIMI diagnosticados de COVID-19. Primera cohorte: marzo-mayo de 2020; segunda cohorte: diciembre/2021 a febrero/2022. Se recogieron variables sociodemográficas y clínicas, y en la segunda cohorte el estado de vacunación contra la COVID-19. El análisis estadístico estableció las diferencias de las características y la evolución clínica entre ambas cohortes. De un total de 1.627 pacientes en seguimiento, contrajeron COVID-19 durante la primera ola 77 (4,60%) y 184 en la sexta (11,3%). En la sexta hubo menos hospitalizaciones, ingresos en cuidados intensivos y fallecimientos que en la primera (p = 0,000) y 180 pacientes (97,8%) tenían al menos una dosis de vacuna. La detección precoz y la vacunación han evitado la aparición de complicaciones graves. Recent evidence shows that COVID-19 infection does not have a worse prognosis in patients with immune-mediated inflammatory diseases (IMID), although they develop a worse response to vaccination. To compare the incidence of COVID-19 and clinical features in patients with IMID between the first and sixth waves. Prospective observational study of two cohorts of IMID patients diagnosed with COVID-19. First cohort March to May 2020, and second cohort December/2021 to February/2022. Sociodemographic and clinical variables were collected and, in the second cohort, COVID-19 vaccination status. Statistical analysis established differences in characteristics and clinical course between the two cohorts. In total, 1627 patients were followed up, of whom 77 (4.60%) contracted COVID-19 during the first wave and 184 in the sixth wave (11.3%). In the sixth wave, there were fewer hospitalisations, intensive care unit admissions, and deaths than in the first wave (P =.000) and 180 patients (97.8%) had at least one dose of vaccine. Early detection and vaccination have prevented the occurrence of serious complications. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to establish and implement an interdisciplinary management strategy led by senior nurses via a vascular access specialist team (VAST) at a teaching hospital. Methods: In 2021, the hospital established and implemented a nurse-led VAST management strategy to improve the quality of clinical central line maintenance. The VAST comprised senior nurses specialized in intravenous therapy, ultrasound/radiology technologists, medical doctors with central venous catheterization certificates, central line maintenance nurses, and administrative coordinators. The management strategy mainly included systemic on-the-job training for VAST members, the establishment of an interdisciplinary central line emergency “green channel,” the formation of a VAST-based, nurse-led standardized clinical rounding system, and the standardization of central line self-care instructions for patients. During the pre- (July 2020 to April 2021) and post- (May 2021 to May 2022) of the implementation the interdisciplinary management strategy, overall patients’ self-care ability, the success rate of catheterization at first time, central line management compliance rate, and patients’ satisfaction with catheter maintenance were investigated and compared. Results: The results showed the score self-care ability was increased from 74.75 ± 18.4 (pre-VAST) to 99.10 ± 23.65 (post- VAST); the success rate for catheterization at first time was improved to 100% (225/225), compared to 92.9% (209/225) at pre-VAST; the central line management compliance rate was also increased to 99.6% (224/225) at post-VAST from 93.3% (210/225) at pre-VAST. A patient satisfaction survey on catheter maintenance showed improvements in all five indicators were compared to the pre- VAST (P

PurposeSymptoms associated with COVID-19 infection have made the assessment and triage of cancer patients extremely complicated. The purpose of this paper is to describe the development and implementation of a COVID-19 screening tool for oncology telephone triage.MethodsAn Ambulatory Oncology Clinical Nurse Educator and three faculty members worked on the development of an oncology specific triage tool based on the challenges that oncology nurses were having with the generic COVID triage tool. A thorough search of the published literature, as well as pertinent websites, verified that no screening tool for oncology patients was available.ResultsThe screening tool met a number of essential criteria: (1) simple and easy to use, (2) included the most common signs and symptoms as knowledge of COVID-19 infection changed, (3) was congruent with the overall screening procedures of the medical center, (4) included questions about risk factors for and environmental exposures related to COVID-19, and (5) assessed patient's current cancer history and treatment status. Over a period of 3 weeks, the content and specific questions on the tool were modified based on information obtained from a variety of sources and feedback from the triage nurses.ConclusionWithin 1 month, the tool was developed and implemented in clinical practice. Oncology clinicians can modify this tool to triage patients as well as to screen patients in a variety of outpatient settings (e.g., chemotherapy infusion units, radiation therapy departments). The tool will require updates and modifications based on available resources and individual health care organizations' policies and procedures.

Aim: To explore the use and implementation of teleconsultations by primary care nurses in the context of the COVID‐19 pandemic. Background: Teleconsultation use increased rapidly during the COVID‐19 pandemic. Its implementation has been documented for physicians and specialists, but knowledge is still limited in nursing practice. Design: A sequential mixed‐methods study. Methods: Phase 1: A cross‐sectional e‐survey with 98 nurses (64 nurse clinicians [NCs] and 34 nurse practitioners [NPs]) was conducted in 2020 in 48 teaching primary care clinics in Quebec (Canada). Phase 2: Semi‐structured interviews with four NCs and six NPs were conducted in 2021 in three primary care clinics. This study adheres to STROBE and COREQ guidelines. Results: During the pandemic, telephone was the principal teleconsultation modality used by NPs and NCs compared to other teleconsultation modalities (text messages, email and video). The only variable associated with a higher likelihood of using teleconsultations was type of professional (NCs). Video consultation was almost absent from the modalities used. The majority of participants reported several facilitators to using teleconsultations in their work (e.g. web platforms and work‐family balance) and for patients (e.g. rapid access). Some barriers to utilisation were identified (e.g. lack of physical resources) for successful integration of teleconsultations at the organisational, technological and systemic levels. Participants also reported positive (e.g. assessment of cognitive deficiency) and negative (e.g. rural population) impacts of using teleconsultations during a pandemic that made the use of teleconsultations complex. Conclusion: This study highlights the potential for nurses to use teleconsultations in primary care practice and suggests concrete solutions to encourage their implementation after the pandemic. Relevance to clinical practice: Findings emphasize the need for updated nursing education, easy‐to‐use technology and the strengthening of policies for the sustainable use of teleconsultations in primary health care. Implications for the profession: This study could promote the sustainable use of teleconsultations in nursing practice. Reporting method: The study adhered to relevant EQUATOR guidelines; the STROBE checklist for cross‐sectional studies and the COREQ guidelines for qualitative studies were used for reporting. Patient or public contribution: No patient or public contribution, as the study focused on the use of teleconsultation among health professionals, specifically primary care nurses. [ABSTRACT FROM AUTHOR]

Abstract Aim To describe the clinical nurse specialist role and its outcomes and challenges. Design Participatory Action Research conducted in Finland between the fall of 2017 and the end of 2018. Methods A core participatory action research team (n = 10) led the design, implementation and evaluation of the research. Multiple data collection methods were used. The study is reported using the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) guidelines for participatory action research. Results The clinical nurse specialist used most of the time in clinical patient care followed by clinical nursing leadership and scholarship activities. Outcomes of successful implementation led to increased visibility of nursing expertise, development, integration and quality assurance of nursing processes and practice, and promotion of knowledge translation and unit and collaborator cooperation. Furthermore, role challenges were also recognized.

BACKGROUND:Health systems are actively implementing Clinical Nurse Leader (CNL)-integrated care delivery across the United States. PROBLEM:However, the CNL model is a complex health care intervention, making it difficult to generate evidence of effectiveness using traditional research frameworks. APPROACH:Participatory research is a growing alternative to traditional research frameworks, emphasizing partnership with target community members in all phases of research activities. This article describes a system-based participatory study that leveraged academic and practice knowledge to conduct research that was feasible and relevant, and which produced findings that were easily translated into systematic action by the health system. OUTCOMES:Study data were used to produce improvements in the health system's CNL onboarding process, role differentiation, performance, recruitment, and growth plus development. CONCLUSIONS:A participatory approach can be used in future CNL studies, providing a framework for research efforts and potentially speeding up CNL evidence generation and utilization in practice.

Background: Global health challenges demand the optimal use of nurses' professional competence and capability. Competencies related to the roles of advanced practice nurses have been developed, but research on these nurses' capabilities remains limited. Aim: To summarise and compare the literature on the capabilities of advanced practice nurses and the dimensions of these capabilities. Methods: We carried out a mixed methods systematic review, using CINAHL, PubMed, and Scopus to search literature published between 1998 and 2021. The quality of the selected articles was evaluated with the JBI Critical Appraisal Tools. We employed abductive content analysis, including deductive and inductive analysis. The reporting was guided by the standards of the Preferred Reporting Items for Systematic Review and Meta‐Analysis Statement. Results: Eleven articles out of 357 met the inclusion criteria. We identified all five dimensions of Hase and Davis's (1999) capability framework: can apply competencies in familiar as well as unfamiliar situations, is creative, has a high degree of self‐efficacy, knows how to learn, and works well in teams. Additionally, we found a new dimension of capability: identifies factors affecting the scope of practice. Limitations: This mixed methods systematic review was conducted about a little‐studied topic. Because country‐specific differences exist and consensus on advanced practice nursing roles is lacking, the concept of advanced practice nurse capabilities cannot be directly generalised. Conclusions: Capability is a requirement and a necessity in the performance of advanced practice nurses. Identifying and defining the dimensions of advanced practice nurses' capabilities will lead the way in developing the roles, education, and capability assessments of advanced practice nurses. Identification of advanced practice nurses' capability will facilitate role understanding, visibility, and implementation in health care services. This can improve the quality and accessibility of care and improve the cost‐effectiveness of the use of health care professionals. [ABSTRACT FROM AUTHOR]

Aim: To describe the clinical nurse specialist role and its outcomes and challenges. Design: Participatory Action Research conducted in Finland between the fall of 2017 and the end of 2018. Methods: A core participatory action research team (n = 10) led the design, implementation and evaluation of the research. Multiple data collection methods were used. The study is reported using the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) guidelines for participatory action research. Results: The clinical nurse specialist used most of the time in clinical patient care followed by clinical nursing leadership and scholarship activities. Outcomes of successful implementation led to increased visibility of nursing expertise, development, integration and quality assurance of nursing processes and practice, and promotion of knowledge translation and unit and collaborator cooperation. Furthermore, role challenges were also recognized. [ABSTRACT FROM AUTHOR]

Abstract Background The nurses with long-term careers in clinical settings shows a clear declining trend. Recording the specific period in Korea’s nursing history is also important from a historical perspective. The aim of this study was to analyze the life history narrative of clinical nurses who have been in service for more than 30 years and to explore the strength and structure of their experience that enabled them to retain their long-term careers. Methods This study conducted qualitative research with a life history narrative. For data collection, biographical-narrative interview through in-depth personal interviews with six participants. The participants were clinical nurses who had worked at a general hospital for more than 30 years. The interviews were conducted in three sessions per participant, each session lasting 90–180 min. Qualitative thematic analysis was used to analyze the data. Results The narrative of their life stories were analyzed by dividing them into “Dimensions,” “Turnings” and “Adaptations”. The dimensions were categorized into individual and career dimensions. Turning points were empirical and environmental conditions that posed a threat to their career retention as nurse clinicians. Adaptations were illustrated individual methods and social interactions. Twenty-four themes were derived from the 94 thematic statements. After the abstract, four comprehensive categories emerged. The core theme for retaining long-term careers, with “Finding value in myself” comprising four themes: “acknowledgement and support from families,” “healthy relationship at work,” “trusting myself’,” and “accumulation of small achievements.” Conclusions The life narratives of participants reveal a close connection with and relationship between the changes in the social aspects, the fields of healthcare and nursing, their individual predispositions, family recognition, and organizational support at that time in Korea. The healthy interpersonal relationships in work place are the most important condition in maintaining the long-term work of nurses. The experience of nurses in one era may not be able to represent experiences in another era, so an in-depth study exploring the social context seems to be necessary. There is a need for policies and changes in the field that can keep the lives of professional women working as nurses proudly.

Clinical nurse leader (CNL)-integrated care delivery is an emerging nursing model, with growing adoption in diverse health systems. To generate a robust evidence base for this promising nursing model, it is necessary to measure CNL practice to explicitly link it to observed quality and safety outcome improvements. This study used a modified Delphi approach with an expert CNL panel to develop and test the face, content, and construct validity of the CNL Practice Survey instrument.

AIMS:To determine the power of a conceptual clinical nurse leader practice model to explain the care model's enactment and trajectory in real world settings. BACKGROUND:How nursing, organised into specific models of care, functions as an organisational strategy for quality is not well specified. Clinical nurse leader integrated care delivery is one emerging model with growing adoption. A recently validated clinical nurse leader practice model conceptualizes the care model's characteristics and hypothesizes their mechanisms of action. METHODS:Pattern matching case study design and mixed methods were used to determine how the care model's constructs were operationalized in one regional United States health system that integrated clinical nurse leaders into their care delivery system in 2010. RESULTS:The findings confirmed the empirical presence of all clinical nurse leader practice model constructs and provided a rich description of how the health system operationalized the constructs in practice. The findings support the hypothesized model pathway from Clinical Nurse Leader structuring to Clinical Nurse Leader practice and outcomes. CONCLUSION:The findings indicate analytic generalizability of the clinical nurse leader practice model. IMPLICATIONS FOR NURSING MANAGEMENT:Nursing practice organised to focus on microsystem care processes can catalyse multidisciplinary engagement with, and consistent enactment of, quality practices. The model has great potential for transferability across diverse health systems.

The Clinical Nurse Leader (CNL) is a master's prepared nurse envisioned to provide clinical leadership at the microsystem level to ensure safe, high quality patient-centered care. The American Association of Colleges of Nurses defined ten 'fundamental aspects' of CNL practice, but as the certified CNL population grows, data suggest they are filling a variety of positions besides formally designated CNL roles. This article reports the results of a systematic review of CNL literature to better understand what roles and activities certified CNLs are enacting when not hired into formally designated CNL roles. Sixty-nine articles met inclusion criteria. Roles identified include: faculty, 62%; clinical management/executive, 12%; specialty clinician, 11%; and staff nurse, 9%. In these roles, certified CNLs are reviewing literature, conducting research, and/or writing commentaries on CNL education and practice and other health foci such as alarm fatigue, insulin practices, and physical exercise for cancer-related fatigue. Results indicate that despite a lack of formal tracking of certified CNLs over time, the available information identifies a variety of roles and job titles used by this group of professional nurses. The study findings add to the body of knowledge informing overall understanding of the CNL initiative.

Introduction: The role of the wound care nurse is identified as a key element in the management of patients with venous leg ulcers (VLUs). However, the literature offers fragmented knowledge of the outcomes associated with their practice., Aims: To identify, summarize, and map all available evidence based on the wound care nurses practice for the treatment of VLUs., Methods: A scoping review was conducted in May 2024 on PubMed, CINAHL, Scopus, and Cochrane Library databases. Observational or experimental studies related to patients affected by VLUs and cared for by wound care nurse specialists were included., Results: Of the 1562 articles reviewed, 9 studies met the inclusion criteria. The most frequently measured outcomes were clinical responses and included healing rate and ulcer recurrence. Less frequent outcomes were patient-reported and resource utilization measures., Conclusion: This review indicates a general predominance of outcomes related to objective clinical responses. Future studies should broaden the types of outcomes by also including patient-reported parameters (eg, pain, quality of life, stress) in order to gain greater evidence on the impact of wound care nurse specialists in the care of patients affected by VLUs., Competing Interests: The authors report no conflicts of interest., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: This article aims to share an innovative way to use virtual toolkits in large-scale education., Description of Program: An incredible number of educational needs exist at any time in the hospital setting. Sharing information with hundreds of nurses in different departments or campuses is a vast undertaking for the clinical nurse specialist (CNS). At times, the material required for a single educational endeavor can be substantial, presenting another challenge for the CNS. Based on principles from Cognitive Load Theory and microlearning, a toolkit methodology allows in-depth education to be broken down into manageable portions for leaders, CNSs, and/or nursing professional development practitioners to effectively share with staff. The toolkit educational strategy utilizes calendar reminders with educational flyers, links, and content attached, making education accessible and easy to share., Outcome: This method is an effective way to educate staff without requiring traditional class time., Conclusion: CNSs, nursing professional development practitioners, and leaders alike can use the toolkit strategy for rolling out large initiatives in smaller portions over time, which can lead to better uptake and retention of information., Competing Interests: The authors report no conflicts of interest., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: The renal clinical nurse specialist (CNS) should be the main source of support and information for people affected by kidney cancer. The CNS is best placed to offer holistic care and often gets to know the patient, especially well as they progress on second- or third-line therapies. We discuss future potential and current challenges in the United Kingdom based on our health professional experiences., Methods: This is a discussion paper based on clinical expertise and informed by current literature., Results: The CNS role for uro-oncology in many centers covers a large patient population and all 5 tumor sites: prostate, bladder, renal, testis, and penile. Urology has a decreasing workforce and increasing difficulty in recruiting to the role in these services. A number of renal CNSs are new to post due to the recruitment crisis without dedicated CNS competencies. Renal CNSs can be proven to reduce costs through managing patients' side-effect profile, ensuring people affected by cancer continue their maintenance therapies., Conclusions: Therapies for kidney cancer have revolutionized treatment for patients and improved their overall survival in recent years. With longer prognoses and specialist therapies that include targeted and immunotherapy drugs, people affected by kidney cancer need dedicated renal CNSs to support them throughout the cancer pathway., Implications for Nursing Practice: Educational projects and resources, such as the aspirant cancer career and education (ACCEND) project and RCC4Nurses, will be key to support both new and longer serving CNSs to pursue successful roles in uro-oncology while providing excellent patient care., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships That may be considered as potential competing interests: Shievon Smith reports a relationship with Pfizer Inc that includes: travel reimbursement. Shievon Smith reports a relationship with Astellas Pharma Inc that includes: speaking and lecture fees. Michelle Greenwood reports a relationship with Astellas Pharma Inc that includes: speaking and lecture fees. Requested by Prof Kelly and Prof Kotronoulas to draft an editorial for the special edition. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: Advanced medical therapies enable people to live longer with multiple comorbidities, increasing the acuity and complexity of care required upon admission into the intensive care unit. This, coupled with the shift toward a less experienced nursing workforce as skilled nurses retire or leave the critical care environment, prompted the need to re-envision how critical care is delivered. The purpose of this quality improvement project was to embed the values of staff and patient partners in a re-envisioned critical care model, which aligns the provision of high-quality care with staff skill mix and patient needs., Methods: Through a series of clinical nurse specialist-led engagement sessions with patients, families, and the members of the healthcare team who work in this environment every day, we talked about what is important in critical care. We used their words and thoughts to inform and shape a new sustainable model of critical care., Outcome: The 4 components identified as essential to achieving this vision include an acuity-complexity-based approach to care, a transition from separate high-acuity and intensive care areas to integrated units, development of a career pathway to advance practice, and exploration of opportunities to optimize the scope of the interprofessional team., Conclusion: Embedding the values and experience of the people directly connected with providing and/or experiencing critical care increases the likelihood of success in developing, implementing, and sustaining a new model of care. This multifaceted approach resulted in 4 distinct components with achievable outcomes that support this re-envisioned patient-centered sustainable model of critical care., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose/objectives: There are more than 130 000 US veterans and more than 12 500 active-duty service members who identify as transgender. Lack of training in transgender and gender-affirming care among healthcare providers in the military is still reported. The article aims to explore and advocate for the unique role of advanced practice registered nurses, especially clinical nurse specialists, in providing culturally sensitive and evidence-based care to the transgender population within the US military., Description of the Project/program: The clinical nurse specialists' pivotal role in policy advocacy and translation of evidence to improve the quality of care and patient outcomes for transgender service members is highlighted. The article also explores the historical journey of transgender care in the US military, addressing discriminatory policies and the implications of the ever-evolving regulations in military transgender healthcare., Outcome: The article aims to create awareness of clinical nurse specialist utilization in US military healthcare services to improve the care of transgender individuals in the military., Conclusion: The uncertain future for transgender service members highlights the ongoing commitment needed to navigate complex military healthcare policies and foster inclusive, evidence-based practices. Therefore, the clinical nurse specialist plays a pivotal role in shaping the future of transgender healthcare within the US military., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

The United States has poorer population health outcomes compared to similar developed nations despite higher healthcare spending. Multiple factors contribute to this problem, including high healthcare costs, insurance coverage limitations, and a lack of focus on preventive care and wellness. Clinical Nurse Specialists (CNSs), primarily known for their impact in acute care settings, increasingly demonstrate their value in outpatient settings like home healthcare. CNSs possess graduate-level training, equipping them with the skills and expertise to develop and implement strategies that improve population health outcomes in home health settings. CNSs provide clinical leadership and support to staff while remaining at the forefront of ensuring the organization delivers high-quality patient care. Understanding the specific skills and competencies of the CNS to support the patient, family, staff, and organization is necessary to improve outcomes for patients in outpatient settings. The CNS delivers care through direct patient care, supporting nurses and nursing practice, and improving organizational systems. This unique skill set allows CNSs to influence home healthcare outcomes across various levels of care positively. This article sheds light on how CNSs enhance patient outcomes in outpatient settings like home healthcare., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose/objectives: To present evidence-based elements supporting the synergistic relationship between nurse scientists and clinical nurse specialists to improve the translation of evidence into practice., Description of the Project/program: Using best-practice elements to support the improvement of evidence-based translation, we define the roles and synergies between nurse scientists and clinical nurse specialists within clinical environments., Outcome: Five themes were identified in the literature review:● Although clinical nurse specialists and nurse scientists differ in focus and competencies, they are in key positions to collaborate to meet healthcare demands.● Clinical nurse specialists are well-equipped to implement the science developed by nurse scientists.● To meet the increased demands and complexity of the healthcare system and patient needs, organizational leadership must lend support to clinical nurse specialists and nurse scientist collaboration.● Clinical nurse specialists are well-positioned to foster interprofessional partnerships and generate opportunities for evidence-based project initiatives across healthcare disciplines.● Clinical nurse specialists should utilize professional models to inform practice to improve the review, translation, and implementation of research into practice., Conclusion: Projects conducted using a collaborative structure had a system-level impact and long-term sustainability capabilities. Additionally, projects were more likely to be disseminated by clinical nurse specialists within a formal structure., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose/aims: To describe clinical nurse specialist practice in Québec, Canada, and propose a dashboard to track role dimensions and outcomes., Design: Sequential mixed-methods study across 6 sites in Québec (June 2021 to May 2022)., Methods: Phase 1: Focus groups (n = 8) and individual interviews (n = 3) were conducted to adapt a time and motion tool. Phase 2: Time and motion studies (n = 25; 203 hours 5 minutes) described clinical nurse specialist practice. Phase 3: A rapid literature review and study participants' feedback informed the dashboard's development. Analysis: Descriptive statistics, with content analysis for qualitative data., Results: The proportion of time clinical nurse specialists spent in role dimensions included clinical (22.8%), education (11.2%), administrative/leadership (48.6%), research (9.6%), and personal (7.7%). On average, they spent 17% of work time with patients, but this varied across specialties and locations. Key dashboard characteristics and uses were identified., Conclusions: Important differences were noted in clinical nurse specialist time spent in activities across specialties and regions in Québec. Approximately one-fifth of work time was spent in direct patient care. Additional research is needed to examine the link between clinical nurse specialist practice and outcomes in other jurisdictions and test the implementation of a dashboard to make their practice more visible., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: External urine management devices were introduced into healthcare as a novel solution to avoid indwelling urinary catheter placement and the associated urinary tract infection risk for adult patients. These devices are favored among healthcare workers and patients. However, the downstream impacts of this device can be detrimental to patient outcomes when immobility is promoted through their use. Clinical nurse specialists are the ideal team member to evaluate the introduction of new technology to promote patient-focused care over task-focused care., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Examine electronic health record (EHR) use and factors contributing to documentation burden in acute and critical care nurses., Materials and Methods: A mixed-methods design was used guided by Unified Theory of Acceptance and Use of Technology. Key EHR components included, Flowsheets, Medication Administration Records (MAR), Care Plan, Notes, and Navigators. We first identified 5 units with the highest documentation burden in 1 university hospital through EHR log file analyses. Four nurses per unit were recruited and engaged in interviews and surveys designed to examine their perceptions of ease of use and usefulness of the 5 EHR components. A combination of inductive/deductive coding was used for qualitative data analysis., Results: Nurses acknowledged the importance of documentation for patient care, yet perceived the required documentation as burdensome with levels varying across the 5 components. Factors contributing to burden included non-EHR issues (patient-to-nurse staffing ratios; patient acuity; suboptimal time management) and EHR usability issues related to design/features. Flowsheets, Care Plan, and Navigators were found to be below acceptable usability and contributed to more burden compared to MAR and Notes. The most troublesome EHR usability issues were data redundancy, poor workflow navigation, and cumbersome data entry based on unit type., Discussion: Overall, we used quantitative and qualitative data to highlight challenges with current nursing documentation features in the EHR that contribute to documentation burden. Differences in perceived usability across the EHR documentation components were driven by multiple factors, such as non-alignment with workflows and amount of duplication of prior data entries. Nurses offered several recommendations for improving the EHR, including minimizing redundant or excessive data entry requirements, providing visual cues (eg, clear error messages, highlighting areas where missing or incorrect information are), and integrating decision support., Conclusion: Our study generated evidence for nurse EHR use and specific documentation usability issues contributing to burden. Findings can inform the development of solutions for enhancing multi-component EHR usability that accommodates the unique workflow of nurses. Documentation strategies designed to improve nurse working conditions should include non-EHR factors as they also contribute to documentation burden., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Abstract Background Risk perception among nurses after the COVID-19 pandemic is a crucial factor affecting their attitudes and willingness to work in clinics. Those with poor psychological status could perceive risks sensitively as fears or threats that are discouraging. This article aimed to determine whether psychological outcomes, including post-traumatic stress disorder (PTSD), depression, anxiety, and insomnia, following the COVID-19 pandemic were differentially related to the risk perceptions of nurses working in clinics and increased perceived risk. Method The participants were 668 nurse clinicians from five local hospitals. Risk perceptions and psychological outcomes were measured by adapted questionnaires via the Internet. Latent profile analysis (LPA) identified subgroups of individuals who showed similar profiles regarding the perceived risks in nursing. Multinomial regression and probit regression were used to examine the extent to which sociodemographic and psychological outcomes predicted class membership. Results LPA revealed four classes: groups with low-, mild-, moderate-, and high-level risk perceptions. Membership of the high-level risk perception class was predicted by the severity of psychological outcomes. Anxiety significantly accounted for a moderate increase in risk perceptions, while the symptoms of insomnia, depression, and PTSD accelerated the increase to the high level of risk perception class. Conclusions By classifying groups of nurse clinicians sharing similar profiles regarding risk perceptions and then exploring associated predictors, this study shows the psychological outcomes after COVID-19 significantly impacted pandemic-associated risk perceptions and suggests intervening in nurses' psychological outcomes while simultaneously focusing on work-related worries is important following the outbreak of COVID-19.

The Veterans Health Administration (VHA) Office of Nursing Services (ONS) was an early adopter of Clinical Nurse Leader (CNL) practice, generating some of the earliest pilot data of CNL practice effectiveness. In 2011 the VHA ONS CNL Implementation & Evaluation Service (CNL I&E) piloted a curriculum to facilitate CNL transition to effective practice at local VHA settings. In 2015, the CNL I&E and local VHA setting stakeholders collaborated to refine the program, based on lessons learned at the national and local level. The workgroup reviewed the literature to identify theoretical frameworks for CNL practice and practice development. The workgroup selected Benner et al.'s Novice-to-Expert model as the defining framework for CNL practice development, and Bender et al.'s CNL Practice Model as the defining framework for CNL practice integration. The selected frameworks were cross-walked against existing curriculum elements to identify and clarify additional practice development needs. The work generated key insights into: core stages of transition to effective practice; CNL progress and expectations for each stage; and organizational support structures necessary for CNL success at each stage. The refined CNL development model is a robust tool that can be applied to support consistent and effective integration of CNL practice into care delivery.

Abstract Background Adjuvant immunotherapy is revolutionising care for patients with resected stage III and IV melanoma. However, immunotherapy may be associated with toxicity, making treatment decisions complicated. This study aimed to identify factors physicians and nurses considered regarding adjuvant immunotherapy for melanoma. Methods In-depth interviews were conducted with physicians (medical oncologists, surgeons and dermatologists) and nurses managing patients with resected stage III melanoma at three Australian tertiary melanoma centres between July 2019 and March 2020. Factors considered regarding adjuvant immunotherapy were explored. Recruitment continued until data saturation and thematic analysis was undertaken. Results Twenty-five physicians and nurses, aged 28–68 years, 60% females, including eleven (44%) medical oncologists, eight (32%) surgeons, five (20%) nurses, and one (4%) dermatologist were interviewed. Over half the sample managed five or more new resected stage III patients per month who could be eligible for adjuvant immunotherapy. Three themes about adjuvant immunotherapy recommendations emerged: [1] clinical and patient factors, [2] treatment information provision, and [3] individual physician/nurse factors. Melanoma sub-stage and an individual patient’s therapy risk/benefit profile were primary considerations. Secondary factors included uncertainty about adjuvant immunotherapy’s effectiveness and their views about treatment burden patients might consider acceptable. Conclusions Patients’ disease sub-stage and their treatment risk versus benefit drove the melanoma health care professionals’ adjuvant immunotherapy endorsement. Findings clarify clinician preferences and values, aiding clinical communication with patients and facilitating clinical decision-making about management options for resected stage III melanoma.

AimsTo empirically validate a conceptual model of Clinical Nurse Leader integrated care delivery.BackgroundThere is limited evidence of frontline care delivery models that consistently achieve quality patient outcomes. Clinical Nurse Leader integrated care delivery is a promising nursing model with a growing record of success. However, theoretical clarity is necessary to generate causal evidence of effectiveness.DesignSequential mixed methods.MethodsA preliminary Clinical Nurse Leader practice model was refined and survey items developed to correspond with model domains, using focus groups and a Delphi process with a multi-professional expert panel. The survey was administered in 2015 to clinicians and administrators involved in Clinical Nurse Leader initiatives. Confirmatory factor analysis and structural equation modelling were used to validate the measurement and model structure.ResultsFinal sample n = 518. The model incorporates 13 components organized into five conceptual domains: 'Readiness for Clinical Nurse Leader integrated care delivery'; 'Structuring Clinical Nurse Leader integrated care delivery'; 'Clinical Nurse Leader Practice: Continuous Clinical Leadership'; 'Outcomes of Clinical Nurse Leader integrated care delivery'; and 'Value'. Sample data had good fit with specified model and two-level measurement structure. All hypothesized pathways were significant, with strong coefficients suggesting good fit between theorized and observed path relationships.ConclusionsThe validated model articulates an explanatory pathway of Clinical Nurse Leader integrated care delivery, including Clinical Nurse Leader practices that result in improved care dynamics and patient outcomes. The validated model provides a basis for testing in practice to generate evidence that can be deployed across the healthcare spectrum.

PurposeClinical nurse leader(TM) (CNL)-integrated care delivery is a new model for organizing master's-level nursing clinical leadership at the microsystem level. While there is growing evidence of improved patient care quality and safety outcomes associated with CNL practice, organizational and implementation characteristics that influence CNL success are not well characterized. The purpose of this study was to identify organization and implementation factors associated with perceived success of CNL integration into microsystem care delivery models.MethodsA survey was developed and administered to a nationwide sample of certified CNLs and managers, leaders, educators, clinicians, and change agents involved in planning or integrating CNLs into a health system's nursing care delivery model. Items addressed organizational and implementation characteristics and perceived level of CNL initiative success. Generalized linear modeling was used to analyze data.ResultsThe final sample included 585 respondents. The final model accounted for 35% of variance in perceived CNL initiative success, and included five variables: phase of CNL initiative, CNL practice consistency, CNL instructor or preceptor involvement, CNL reporting structure, and CNL setting ownership status.ConclusionsCNL initiative success is associated with modifiable organizational and implementation factors.Clinical relevanceStudy findings can be used to inform the development of successful implementation strategies for CNL practice integration into care delivery models to improve care quality outcomes.

BackgroundThe Clinical Nurse Leader™ (CNL) initiative is in its 2nd decade. Despite a growing theoretical and empirical body of CNL knowledge, little is known about CNLs themselves or where and how their competencies are being integrated into care delivery across the country.ObjectiveThe aim of this study was to describe certified CNL characteristics and roles as part of a larger study validating a model for CNL practice.MethodsThis study used a descriptive analysis of survey data from a national sample of certified CNLs.ResultsSurvey response rate was 19%. Sixty percent have greater than 10 years of RN experience, and 75% have additional specialty certifications. Fifty-eight percent are practicing in a formal CNL role and report a high degree of accountability for all 9 CNL essential competencies.ConclusionsFindings help understand the extent of CNL adoption and spread across the country and the level to which the initial vision of CNL practice is being achieved.

BackgroundThe Clinical Nurse Leader™ (CNL) initiative is in its 2nd decade. Despite a growing theoretical and empirical body of CNL knowledge, little is known about CNLs themselves or where and how their competencies are being integrated into care delivery across the country.ObjectiveThe aim of this study was to describe certified CNL characteristics and roles as part of a larger study validating a model for CNL practice.MethodsThis study used a descriptive analysis of survey data from a national sample of certified CNLs.ResultsSurvey response rate was 19%. Sixty percent have greater than 10 years of RN experience, and 75% have additional specialty certifications. Fifty-eight percent are practicing in a formal CNL role and report a high degree of accountability for all 9 CNL essential competencies.ConclusionsFindings help understand the extent of CNL adoption and spread across the country and the level to which the initial vision of CNL practice is being achieved.

Background: The nurses with long-term careers in clinical settings shows a clear declining trend. Recording the specific period in Korea's nursing history is also important from a historical perspective. The aim of this study was to analyze the life history narrative of clinical nurses who have been in service for more than 30 years and to explore the strength and structure of their experience that enabled them to retain their long-term careers. Methods: This study conducted qualitative research with a life history narrative. For data collection, biographical-narrative interview through in-depth personal interviews with six participants. The participants were clinical nurses who had worked at a general hospital for more than 30 years. The interviews were conducted in three sessions per participant, each session lasting 90–180 min. Qualitative thematic analysis was used to analyze the data. Results: The narrative of their life stories were analyzed by dividing them into "Dimensions," "Turnings" and "Adaptations". The dimensions were categorized into individual and career dimensions. Turning points were empirical and environmental conditions that posed a threat to their career retention as nurse clinicians. Adaptations were illustrated individual methods and social interactions. Twenty-four themes were derived from the 94 thematic statements. After the abstract, four comprehensive categories emerged. The core theme for retaining long-term careers, with "Finding value in myself" comprising four themes: "acknowledgement and support from families," "healthy relationship at work," "trusting myself'," and "accumulation of small achievements." Conclusions: The life narratives of participants reveal a close connection with and relationship between the changes in the social aspects, the fields of healthcare and nursing, their individual predispositions, family recognition, and organizational support at that time in Korea. The healthy interpersonal relationships in work place are the most important condition in maintaining the long-term work of nurses. The experience of nurses in one era may not be able to represent experiences in another era, so an in-depth study exploring the social context seems to be necessary. There is a need for policies and changes in the field that can keep the lives of professional women working as nurses proudly. [ABSTRACT FROM AUTHOR]

Background/Objective: Nurses develop the care methods they learn through specific training and this enables them to provide care in a safe, effective and efficient manner. Intensive Care Units (ICU), as complex areas in terms of care, require nurses with specific training. Due to this fact, we set ourselves the objective to validate a questionnaire that detects the training needs of intensive care nurses in Spain. Methods: A cross-sectional descriptive study, using an electronic questionnaire, adapted and validated through the Delphi technique, in 85 ICUs in Spain, for which a psychometric analysis is conducted. To explore the dimensions and determine the factorial structure, an Exploratory Factor Analysis (EFA) and a Confirmatory Factor Analysis (CFA) were carried out. Internal consistency was determined through ordinal alpha. The statistical treatment was carried out using the statistical programmes Factor Analysis 10.9.02 and IBM AMOS version 24. Results: A total of 568 Spanish intensive care nurses, randomly divided into two samples, participated in the study. The EFA presented a factorial solution with suitable values for both the Kaiser-Meyer-Olsen Index and Bartlett's Sphericity. In the CFA, the model fit achieved close to ideal values with a Comparative Fit Index (CFI) and Tucker-Lewis Index (TLI) close to values of 0.9. The values of individual reliability, internal consistency and average variance extracted were appropriate for this type of analysis. Conclusion: The dimensions detected are close to the construct that encompasses the training needs of ICU nurses. The analyses carried out indicate that there are reasonable realities for incorporating these dimensions into the field of nursing training. This study opens the possibility of incorporating new items to adjust the model to improve the explanatory variables. Our findings help us to understand the dimensions that the training programmes should incorporate. [ABSTRACT FROM AUTHOR]

The United States health care system is facing an unprecedented nursing shortage, increasing complexity of care, and fewer experienced nurse mentors. These factors contribute to a cycle of burnout, turnover, decreased quality and safety, and a worsening financial bottom line. Improving these contributing factors depends on our ability to mitigate the structural causes of burnout and turnover. The clinical nurse specialist role is essential to improving the work environment, advancing evidence-based nursing practice, reducing turnover, and stabilizing the bottom line., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: This quality improvement project aimed to reduce central line bacteremias (central line-associated bloodstream infections [CLABSIs]) in a neonatal ICU (NICU) to a CLABSI rate of zero using a clinical nurse specialist (CNS)-led neonatal peripherally inserted central catheter (PICC) team., Background: The NICU at the study site was experiencing more than twice the National Healthcare Safety Network average CLABSI rate at 2.2 per 1000 line-days with an estimated cost of $2 072 806 to the organization., Methods: In early 2009, the CNS guided the unit from on-demand PICC placement to a dedicated team of PICC certified nurses who assumed total care of PICC line insertion and maintenance. The project used a continual, rapid cycle quality improvement model to incorporate the current evidence-based practices., Results: The CNS-led PICC team has maintained a zero CLABSI rate for 9 years with only 1 CLABSI since June 2022., Conclusions: The adoption of a CNS-led PICC team was instrumental in achieving a zero CLABSI rate over a prolonged period., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

The Clinical Nurse Specialist (CNS) role has been instrumental in advancing nursing practice, healthcare delivery, and patient outcomes across various specialties, particularly in emergency care. This manuscript provides an extensive review of the history of CNSs in emergency settings, exploring the development of the practice model, the challenges encountered, and their impact on patient and organizational outcomes., Competing Interests: Disclosure:The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Learning Disability Liaison Nurses have been shown to improve hospital experiences and this is an emerging role in Ireland. This research qualitatively explored the impact of a Clinical Nurse Specialist Acute Hospital Liaison from the perspective of staff in an intellectual disability community organisation. Participants identified significant challenges with supporting people attending hospitals including accessing and understanding information, anxieties and not being prepared for transitions through the hospital. The findings demonstrate the introduction of this role is a supportive, positive step with reports of improved information sharing, feeling better prepared and alleviating anxieties related to supporting someone in hospital. The findings clearly identify that this role has considerable benefits when set in a community organisation. This role has had a positive impact on service users and staff when interacting with hospitals, providing evidence of the value of this role in Ireland and also of they having a specialist qualification in the role., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Competing Interests: The author reports no conflicts of interest.

Clinical nurse educators (CNEs) are expert clinical nurses tasked with supporting the orientation and professional development of nurses on clinical units, yet CNEs themselves often do not receive a formal orientation to support their role transition. CNEs at a large academic medical center participate in a quality improvement program aimed at developing communication skills for difficult conversations, feedback, and debriefing. Findings highlight some of the interpersonal communication challenges CNEs encounter, which endorse the need for a formal CNE orientation and mentoring program., Competing Interests: Disclosure The authors have no conflicts of interest to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background/scope: The Clinical Nurse Specialist in Nutrition is a professional capable of providing specialist clinical assistance and leadership-related clinical nutrition. To date, although their role has already been identified, there is still uncertainty about how this figure can actually fit into the various global health systems. The purpose of this review is to clarify and define the role of this professional aimed at analysing clinical experiences and data from nutrition scientific societies., Methodology: A systematic literature review was conducted using the Prisma Statement in the Cochrane Library databases and subsequently in PubMed, Embase, CINAHL, Scopus and Web of Science. In addition, a manual search of studies published in Google Scholar was conducted for the analysis of 'grey literature'. Out of 3,320 identified records, 20 studies were included in the present review. [Correction added on 06 June 2024, after first online publication: The preceding sentence has been corrected from "Out of 2,348 identified records, 21 studies were included in the present review." to "Out of 3,320 identified records, 20 studies were included in the present review" in this version.] RESULTS: The development of specific training, certification and qualification protection courses is contributing to the development of this professional in various hospital and community clinical contexts. The clinical experiences identified have shown that this figure is able to provide specialist assistance by offering high levels of safety, efficacy and quality of the care provided., Conclusions/ Implications for Nursing: The implementation of nurse nutrition specialist, to date, is still limited at the global level, and training programmes coordinated between scientific societies and nursing universities could be the basis for the development of this specialization in countries where today this figure is not yet present., (© 2023 International Council of Nurses.)

High-reliability organizations aim to achieve zero harm. The clinical nurse specialist (CNS) is an advanced practice RN who adds value to the leadership team. The CNS is proficient in influencing care delivery across the continuum and the master of developing collaborative relationships that aid in the discovery of deficiencies in care and generation of innovative ideas to minimize deficiencies. This column provides some examples of the impact and role of the CNS., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Aims and Objectives: To describe a grading system that can be used to evaluate core competency of clinical nurse specialists (CNSs) at different levels., Background: Evaluate core competence of CNSs at different levels reflects the quality of nursing and the development of the nursing profession., Design: This research employed the Delphi method., Methods: The STROBE checklist for observational cross-sectional studies was followed to report this research study. This study consisted of two main phases: a literature review and semistructured interviews. Individual semistructured interviews were conducted with 11 healthcare experts and two patients. Two rounds of questionnaire surveys were administered to 21 nursing experts using the Delphi method. The CNSs were classified as primary, intermediate or advanced based on their years of work, professional titles and educational qualifications., Results: The graded competency evaluation system consisted of five first-level indicators (clinical practice, consulting guidance and teaching, scientific research innovation, management and discipline development, and ethical decision-making), 15 second level indicators, and 40 third-level indicators. The authority coefficients (Cr) of the experts were .865 and .901. The Kendall's concordance coefficients of the three-level indicators were .417, .289 and .316 for primary CNSs; .384, .294 and .337 for intermediate CNSs; and .489, .289 and .239 for advanced CNSs., Conclusion: The graded use evaluation system in clinical practice initially involves a comprehensive evaluation of the core abilities of CNSs. This is a tool for cultivating and grading the abilities of specialised nurses that can promote a practical upwards spiral., Relevance to Clinical Practice: The evaluation system can promote the scientific management and continuous improvement of CNSs in clinical nursing and can serve as a practical and objective reference for the effective management and development of CNSs., Patient or Public Contribution: Patients participated in the data collection process, during which they shared their health-seeking experience with our research team., (© 2024 John Wiley & Sons Ltd.)

Objective: to analyze the enablers and barriers to nurses' professional role fulfillment during pandemics and disasters. Materials and methods: this was an integrative review based on the SALSA analytical method, carried out in eight databases, namely: Medline, Proquest, CINAHL, Web of Science, BVS, SpringerLink, Scopus, and Pubmed. The descriptors used were the following: 'nurse's role' AND 'pandemic' AND 'patient' AND 'coronavirus infection', in English, Spanish and Portuguese. Filters along with inclusion and exclusion criteria were applied to the 11,031 articles found, after which the final sample consisted of a total of 32 articles. Results: considering the objectives set and the results obtained, it is noted that all actions focused on three main instances, namely: a) training and updating for role performance; b) predictors, enablers, and barriers for exercising the role in the face of a pandemic; and c) evidence of the role in the face of pandemics. Conclusion: this study allowed understanding both the barriers and the enablers that allow the fulfillment of nurses' professional role in the face of pandemics or catastrophes. It also clarified that emerging infectious diseases must be addressed in an immediate, collaborative, and multidisciplinary way. Nurses' experience, leadership, and professional training are key attributes that these professionals possess to enable their role to be more proactive during an emergency situation. [ABSTRACT FROM AUTHOR]