In celebration of International Nurses Day 2024
Editor's Recommended Reads
Editor's Recommended Reads practices that support evidence-based practice (EBP) among nurses to improve patient outcomes and decrease nursing turnover Nursing leaders must make a conscientious effort to invest in Table of Contents Staff burn-out has implications for organisational and patient outcomes: would an open culture of support with structures in place prevent burn-out? Collaboration between universities and nursing placement providers is essential to ensure the well-being of the future nursing workforce Advanced Clinical Practitioners (ACPs) have a significant impact on patient outcomes and healthcare services
Commentary: Nursing issues
having a negative impact on patients. Quality of care is perceived by the nurses to be affected, though this was not significantly correlated by the patients. Organisational commitment, assessing staff’s intention to leave is negatively associated with staff burn-out, as is nurse productivity and patient experience. Commentary This paper identifies that burn-out is multifaceted and is associated with a wide range of adverse patient and organisational outcomes, including nurses scoring lower ratings for patient safety when feeling higher levels of burn-out. Interestingly, these results are regardless of demographic characteristics or working conditions, suggesting influences arrive from the actual demands of the role rather than individual factors. This is corroborated by a study 5 into National Health Service (NHS) staff’s well- being, which concluded that more support is needed for all front-line staff to help build resilience, recommending 24/7 trauma support. This review highlights how burn-out can become a negative conta- gion when working in such close proximity with other staff members and the informal ways in which staff seek to support each other in these situations (peer support). Though this is important, more structured inter- ventions need to be in place such as restorative supervision 6 High staff turnover is identified as having implications in practice, negatively impacting on staff morale, teamworking, workforce resources and significant financial implications. Some organisations have imple- mented individual interventions alongside organisational interventions resulting in longer-term improvements in staff burn-out. To concur with this, organisations need to recognise the impact of staff burn-out, having open and honest conversations with staff regarding this and the support they will offer. Having this open culture will reduce stigma and encourage staff to seek support prior to crisis. A commitment is required by organisations to adequately resource interventions, recognising the initial outlay of costs against the longer-term financial rewards. Organ- isations need to have financial backing to invest in their staff’s well- being, this will show a commitment to staff regarding a culture of value and support, ensuring efficacy of the intervention preventing it becoming a gimmick. Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Competing interests None declared. Patient consent for publication Not required. Provenance and peer review Commissioned; internally peer reviewed. © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ. References 1 MPs on the Health and Social Care Committee . How can we tackle staff burnout in the health and care sectors? read our recommendations to the Department of health and social care , 2021. 2 Kakemam E , Chegini Z, Rouhi A, et al . Burnout and its relationship to self ‐ reported quality of patient care and adverse events during COVID ‐ 19: a cross ‐ sectional online survey among nurses. J Nurs Manag 2021; 29 :1974–82. 3 Jun J , Ojemeni MM, Kalamani R, et al . Relationship between nurse burnout, patient and organizational outcomes: systematic review. Int J Nurs Stud 2021; 119 :103933. 4 Mitchell PH , Ferketich S, Jennings BM. Quality health outcomes model. American Academy of nursing expert panel on quality health care. Image J Nurs Sch 1998; 30 :43–6. 5 Health Education England (HEE) . NHS Staff and Learners’ Mental Wellbeing Commission. Developing People for Health and Healthcare , 2019. 6 Wallbank S . Maintaining professional resilience through group restorative supervision. Community Pract 2013; 86 :26-8.
Systematic review
Staff burn-out has implications for organisational and patient outcomes: would an open culture of support with structures in place prevent burn-out? 10.1136/ebnurs-2021-103437 Jane Peirson Department of Psychological Health, Wellbeing and Social Work, University of Hull, Hull, UK Correspondence to: Jane Peirson, Department of Psychological Health, Wellbeing and Social Work, University of Hull, Hull HU6 7RX, Kingston upon Hull, UK; J.A.Peirson@hull.ac.uk Commentary on : Jun, J., Ojemeni, M., et al. (2021) Relationship between nurse burnout, patient and organisational outcomes: Systematic review. J Adv Nurs 2021;119 Implications for practice and research ► ► Supporting a culture of staff well-being will have benefits on organ- isational and patient outcomes. ► ► Further research is required using a consistent theoretical/measure- ment approach to investigate the long-term effects of organisational and personal interventions to prevent burn-out. Context Growing concerns around staff burn-out and associated health compli- cations have been well researched 1 and further evidenced in current practice due to the COVID-19 pandemic. 2 The impact on the remaining staff members through absences from work, staff enduring chronic stress, burn-out, health-related conditions and the cyclical nature for further staff being affected by this, is something that the majority of health professionals relate to. This article 3 aims to take the alternative view from the individual perspective of the cause of staff burn-out, to identifying the relationship between nursing burn-out from the patient and organi- sational perspective. Methods The study conducted a comprehensive systematic review of current evidence around issues of nurse burn-out, identifying the implications of this from the perspective of the patient and organisational outcomes. The Quality Health Outcome model 4 guided the review and relevant search terms are derived from this model. An inclusion and exclusion criteria are identified along with the search strategy used. A peer-review process is used assessing the quality of the papers, resulting in identifying 20 articles that are included in the study for further appraisal and synthesis. Limitations of the literature review are identified. Findings Characteristics of participants in the studies used are primarily women, between 20 and 60 years of age, from 14 countries, nursing experience varies from less than 1 to more than 21 years. Patient safety is the most common outcome. Emotional exhaustion is consistently identified as
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Evid Based Nurs Month 2021 | volume 0 | number 0 |
Commentary
Collaboration between universities and nursing placement providers is essential to ensure the well-being of the future nursing workforce 10.1136/ebnurs-2021-103444 Anne Mills Medical Sciences and Public Health, Bournemouth University, Bournemouth BH8 8GP, UK Correspondence to: Dr Anne Mills, Human Sciences and Public Health, Bournemouth University, Bournemouth BH8 8GP, UK; amills@ bournemouth.ac.uk Commentary on : Aloufi MA, Jarden RJ, Gerdtz MF, Kapp S. Reducing stress, anxiety and depression in undergraduate nursing students: systematic review. Nurs Ed Today 2021;102:104877. 1 Implications for practice and research ► ► Joint initiatives between educational settings and placement provid- ers are required to promote student nurse well-being. ► ► Future research must ensure rigorous study design with planned long-term follow-up, to support the development of a robust body of evidence. Context Extensive research has identified the demands of nursing on emotional and physical well-being 2 and acknowledges that mental health concerns are often reported by nurses, especially student nurses, which far exceed the stress and anxiety levels reported by other students. 3 Good health and well-being within the profession is essential for the safe delivery of quality healthcare, 4 and the use of effective interventions to reduce stress, anxiety and depressed mood among staff are necessary. Methods The study 1 used a systematic review, using the Joanna Briggs Institute 5 guidelines, to investigate the effectiveness of interventions in improving mental health outcomes for nursing students. Studies published in English between 2008 and 2018 on interventions to address stress, anxiety and depressed mood in undergraduate nursing students were included. The study incorporated randomised and non-randomised control trials, experimental, quasi-experimental and pretest and post-test. A three- step search strategy was employed. The first stage refined the search terms using the MEDLINE and CINAHL databases, the second involved a comprehensive search for relevant studies across all databases, while the third searched all the references in all the included papers. Two reviewers working independently assessed studies, which met the inclusion criteria, a third reviewer was called on to resolve disagreements. Findings 1579 citations were initially found and through a process of elimination 22 papers, from 11 countries, form the basis of the study. The sample size ranged from n=34 to n=181. A range of interventions was studied, of
differing durations, using various measurement tools. Statistically signif- icant decreases in stress or anxiety or depressed mood were noted in 18 studies. Studies incorporating mindfulness mediation, emotional freedom technique or biofeedback training were seen to be effective for both stress and anxiety, while mindfulness-based stress reduction and stress management programmes were seen to be effective for stress, anxiety and depression. Commentary Although there is extensive recognition of the mental health concerns among nursing students and acknowledgement that many of the inter- ventions in this review were effective, the overall study sample size was small, frequently the activity was only delivered once and often there was a lack of longer-term evaluation, which provided little understanding of the intervention’s enduring benefits. Interventions which seek to address multiple well-being concerns may be more valuable in terms of resourcing and outcomes, although appropriately trained experts must be employed, especially for interventions such as mindfulness programmes. Given the extent of student nurses’ experiences of stress, anxiety and depression, the research base for this topic is small and therefore necessitates the development of a stronger more rigorous body of evidence. The importance of staff mental health and well-being within health- care is well recognised 6 with universities seeking to deliver learning envi- ronments which enhance well-being among nursing students. However, nurse education utilises multiple and varied settings to ensure students gain a wide range of both theoretical and practical learning experiences. Therefore, the responsibility for addressing stress, anxiety and depressed mood among student nurses must be shared by both educational and placement providers. Currently, interventions are frequently based in either educational or clinical settings. And therein lies the organisational challenge. To effectively develop a wellness programme to improve student mental health, it is essential that nursing educational institutions and practice placements work collaboratively at all levels, in all processes and settings to support the well-being of the current student population; as a means of contributing to a future healthy workforce. Competing interests None declared. Provenance and peer review Commissioned; internally peer reviewed. © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ. References 1 Aloufi MA , Jarden RJ, Gerdtz MF, et al . Reducing stress, anxiety and depression in undergraduate nursing students: systematic review. Nurse Educ Today 2 Sawbridge Y , Hewison A. Thinking about the emotional labour of nursing-- supporting nurses to care. J Health Organ Manag 2013; 27 :127–33. 3 Bartlett ML , Taylor H, Nelson JD. Comparison of mental health characteristics and stress between baccalaureate nursing students and non-nursing students. J Nurs Educ 2016; 55 :87–90. 4 Grønkjær LL . Nurses’ experience of stress and burnout: a literature review. Klin Sygepleje 2013; 27 :15–26. 5 Joanna Briggs Institute . Joanna Briggs Institute reviewers’ Manual . 2014 ed. Australia: Joanna Briggs Institute, 2014. 6 NHS England and Health Education England . 2018 integrated urgent care / NHS 111 workforce blueprint. workforce mental health and wellbeing. Available: https:// www.england.nhs.uk/wp-content/uploads/2018/03/workforce-mental-health- wellbeing.pdf [Accessed 15 Jul 2021].
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Evid Based Nurs Month 2021 | volume 0 | number 0 |
Commentary
Advanced Clinical Practitioners (ACPs) have a significant impact on patient outcomes and healthcare services 10.1136/ebnurs-2023-103725 Alison F Wood , 1 Robin Hyde 2 1 Division of Nursing and Paramedic Science, Queen Margaret University, Musselburgh, UK, 2 Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, UK
practitioners. The research established the contribution of ACPs to health services and the wider body of ACPs supporting change in the way care and workforce engage. Educational pathways, supervision in practice and organisational support are key for ACP success during and once competent/ qualified. Commentary AP for nurses, midwives and allied health professionals continues to develop and this research along with others, 2 3 reaffirms the rapid development. Yet, significant challenges remain and are not being adequately addressed both in education as well as by governance mechanisms across the health service and regulatory bodies. 2 3 In the UK, the pandemic and recent strike action by healthcare profes- sionals has exposed services chronically struggling, confounded by recruit- ment and retention concerns. AP has proven to be an important feature to mitigate these factors. However, there remains a disconnect between under- standing and meaningfully acting on the experiences of those working at this level against the need to sustain, progress or change services. Equally, there is an absence of the service users voice and their relationship with these developments, both at a local and national level. Healthcare in the UK is a devolved matter and while progress in relation to educational standards for ACPs across all professions has been made by bodies such as NHS England (formerly Health Education England), the other three devolved nations have adopted differing approaches. This could complicate attempts to pursue regulation. The Royal Colleges and regulatory bodies who are involved in supporting the professions must collaborate, examining the strengths and limitations which come with standardisation and regulation, including the costs involved, both financial and non-financial. The inclusion of both qualified and trainees from differing professional groups within the data set is important as AP as a level of practice covers many registered professionals, not just nursing. Higher Education Institu- tions (HEIs) and stakeholders must work together so that masters pathways support the differing learning needs of the professions and services. Simi- larly, the competitive UK education sector needs to have the courage to do things differently. For example, accepting not every programme can facil- itate every ACPs learning needs nor service needs. The specialist needs of some populations and services likely requires a shift to investing in specific UK hubs of AP education, ensuring programmes attract the right expertise to sustain long-term delivery. Twitter Alison F Wood @alisonwood_phd Competing interests None declared. Provenance and peer review Commissioned; internally peer reviewed. © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
Correspondence to: Dr Alison F Wood, Queen Margaret University, Musselburgh, UK; Awood1@qmu.ac.uk
Commentary on : Mann C, Timmons S, Evans C, Pearce R, Overton C, Hinsliff-Smith K, Conway J. Exploring the role of advanced clinical practitioners (ACPs) and their contribution to health services in England: A qualitative exploratory study. Nurse Educ Pract. 2023 Feb;67:103546. doi: 10.1016/j.nepr.2023.103546. Epub 2023 Jan 24. Implications for practice and research ► Workforce planning needs focus on the level of practice required for service demand and not ‘what role is needed’. Planners must appreciate the contributions and limitations of practice different advanced clinical practitioners (ACPs) bring. ► Research is needed to move beyond capturing the advancement of roles to exploring changes, in practice and education, and evaluating the improvements made, particularly with advanced practice (AP) regu- lation being reviewed by the Nursing and Midwifery Council (NMC). Context Advanced Practice (AP) is a phenomenon which in the last century may be traced back to the post second world war era. During the 1960s, coun- tries such as the USA and Canada led the way with the UK following with seminal developments in the 1980s. The nursing profession has dominated, demonstrating many added benefits both for the profession as well as patients. However, recent policy and political developments in the UK have borne the expansion to other professional health workforces culminating in the 'ACP'. Despite this progress, disparity exists between the four UK nations both in terms of policy, standards and in appreciating the mecha- nisms which support this level of practice. Methods This qualitative study 1 collected data from 63 participants in online semi- structured interviews throughout 2020. Participants all worked within England and included trainee ACPs (n=13), educators (n=21) and 9 qualified ACPs of various professions. Recruitment was via email to ACP networks and subsequent targeted recruitment to ensure a mix of professions. The interview data were thematically analysed. Findings The research team presented the three broad themes, such as the ACP role, barriers and facilitators to the ACP role and contribution of these roles to health services. The findings highlighted a variance in reported levels of practice including understanding and acceptance for the role. Simi- larly, added a challenge to those who educate ACPs with learners and roles are different, parallels are not always possible between services and
ORCID iDs Alison F Wood http://orcid.org/0000-0002-5625-8778 Robin Hyde http://orcid.org/0000-0002-9848-495X
References 1 Mann C , Timmons S, Evans C, et al . Exploring the role of advanced clinical practitioners (Acps) and their contribution to health services in England: A qualitative exploratory study nurse education in practice. Nurse Education in Practice 2023;67:103546. 2 Strachan H , Hoskins G, Wells M, et al . A realist evaluation case study of the implementation of advanced nurse practitioner roles in primary care in Scotland. J Adv Nurs 2022;78:2916–32. 3 Stewart-Lord A , Beanlands C, Khine R, et al . The role and development of advanced clinical practice within Allied health professions: A mixed method study. J Multidiscip Healthc 2020;13:1705–15.
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Evid Based Nurs Month 2023 | volume 0 | number 0 |
Commentary: Adult nursing
Nursing leaders must make a conscientious effort to invest in practices that support evidence-based
point to a need for improved focus and investment in resources to promote the use of EBP in practice. Commentary Although experts in clinical and academic organisations reference the importance of EBP, empirical data are lacking to quantify the value of EBP. Thus, this study makes a significant contribution to support EBP programmes by clearly articulating the positive financial benefits with improved outcomes as well as the ramifications of worse outcomes when not investing in EBP. Consistent with other authors who found EBP leads to improved patient outcomes and a significant ROI benefit, Connor et al 1 in a scoping review found implementation of EBP improved outcomes such as decreased infec- tions, decreased length of stay, readmission and decreased mortality. The Melnyk et al ’s 5 study builds on previous work by the same authors who completed a national descriptive study of 276 CNEs in 2016 where they identified low rates of EBP implementation in hospitals and found one-third of facilities did not meet quality benchmarks and had high rates of compli- cations. 6 From the surveys, CNEs believed EBP was important for promoting quality of care, but a low priority with little funding allocated to support EBP implementation. 6 In order to encourage EBP, administrators must support nurses use of evidence in their practice by investing in resources including training, time and mentors. This study is important as it demonstrates institutions with a greater investment in evidence-based resources and mentors, reap the rewards with improved patient outcomes and decreased nursing turnover. Taking into consideration the fact that the highest investment by an insti- tution in this study was still relatively low, a greater investment may result in more significant outcomes. Resources to enhance knowledge and skills of nurses to use EBP posi- tively influences the quality of care. 2 Creating a culture of clinical inquiry and striving to improve EBP knowledge and skills among nurses is essential for healthcare and nursing practice; nursing administrators play a signifi- cant role by allocating funds to support EBP. We cannot advance as a profession and continue to identify opportuni- ties to improve patient care without this financial commitment by leaders. Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Competing interests None declared. Provenance and peer review Commissioned; internally peer reviewed. © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ. References 1 Connor L , Dean J, McNett M, et al . Evidence-based practice improves patient outcomes and Healthcare system return on investment: findings from a Scoping review. Worldviews Evid Based Nurs 2023;20:6–15. 2 Alatawi M , Aljuhani E, Alsufiany F, et al . Barriers of implementing evidence-based practice in nursing profession: a literature review. AJNS 2020;9:35. 3 Son ğ ur C , Özer Ö, Gün Ç, et al . Patient safety culture, evidence-based practice and performance in nursing. Syst Pract Action Res 2018;31:359–74. 4 Curtis K , Fry M, Shaban RZ, et al . Translating research findings to clinical nursing practice. J Clin Nurs 2017;26:862–72. 5 Melnyk BM , Hsieh AP, Messinger J, et al . Budgetary investment in evidence-based practice by chief nurses and stronger EBP cultures are associated with less turnover and better patient outcomes. Worldviews Ev Based Nurs 2023;20:162–71. 10.1111/ wvn.12645 Available: https://sigmapubs.onlinelibrary.wiley.com/toc/17416787/20/2 6 Melnyk BM , Gallagher-Ford L, Thomas BK, et al . A study of chief nurse executives indicates low prioritization of evidence-based practice and shortcomings in hospital performance metrics across the United States. Worldviews Evid Based Nurs 2016;13:6–14.
practice (EBP) among nurses to improve patient outcomes and decrease nursing turnover 10.1136/ebnurs-2023-103771
Jan Powers Nursing, Parkview Health System, Fort Wayne, Indiana, USA
Correspondence to: Dr Jan Powers, Nursing, Parkview Health System, Westfield, Indiana, USA; Jan.powers@parkview.com
Commentary on : Melnyk BM, Hsieh AP, Messinger J, Thomas B, Connor L, Gallagher-Ford L. Budgetary investment in evidence- based practice by chief nurses and stronger EBP cultures are associated with less turnover and better patient outcomes. Worldviews Evid Based Nurs. 2023 Apr; 20 (2):162-171. doi: 10.1111 / wvn. 12645 . Epub 2023 Apr 12 . Implications for practice and research ► Providing evidence-based practice (EBP) resources including time, training and mentorship to nurses will improve patient outcomes and increase nursing engagement and decrease turnover of staff. ► Future research should be conducted on a larger scale to identify im- provements and resulting return on investment (ROI) from evidence- based implementations. Context It is well known that using evidence-based interventions in practice has positive effects on improving outcomes and safety for patients. 1–4 Nursing leaders must support a culture of EBP to impact not only patient outcomes, but also nursing outcomes by increasing decision making confidence, which enhances nursing practice. 2 This study by Melnyk et al further explores the direct association with investment of EBP to patient and nurse outcomes. 5 Methods This descriptive, correlational study by Melnyk et al used a survey design including assessments for EBP and implementation culture as well as objec- tive nationally reported data as quality indicators. This study aimed to iden- tify relationships between investment in the nursing budget for EBP and outcomes for patients and nurses. Findings Response rate for this study was 2.3% with a final sample of 115 out of 5026 invited chief nurse executives (CNEs)/Chief Nursing Officers (CNOs) in the USA completing the survey. The majority 90/115 (78.3%) of CNE/CNOs allocated less than 10% of their budget to EBP and one third had no budget allocated to EBP. The authors identified an association with an increase in the budget amount for EBP resources and fewer patient falls and trauma, less nursing turnover and stronger EBP culture. Organisations with a greater number of EBP projects also had an associated improvement in patient outcomes. These findings
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Evid Based Nurs Month 2023 | volume 0 | number 0 |
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