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Anteayer Journal of Advanced Nursing

Factors Associated With Newly Graduated Nurses' Work Engagement: Systematic Review of Quantitative Studies

ABSTRACT

Aim

To describe the factors associated with work engagement in newly graduated nurses.

Design

Systematic review of original quantitative studies according to Joanna Briggs Institute guidelines.

Methods

The systematic review utilised PEO inclusion criteria. Original peer-reviewed quantitative studies were identified. Two researchers independently conducted a screening of study eligibility based on title, abstract, and full text. The JBI critical appraisal tool for analytical cross-sectional studies was employed to perform a rigorous methodological quality assessment. The data was extracted, tabulated, and then analysed narratively.

Data Sources

The literature search was conducted in November 2023 by screening four databases: Scopus, CINAHL (Ebsco), ProQuest, and Ovid Medline.

Results

The review included 19 articles, presenting an overview of factors associated with newly graduated nurses' work engagement. Factors were classified into seven categories explaining supportive workplace, transition and orientation to workplace, competence and career development in nursing practice, personal and psychological characteristics, work environment characteristics, stress and challenges in a work environment, and satisfaction with work.

Conclusions

To support newly graduated nurses' work engagement, nurse leaders should provide a supportive working environment and focus on new nurses' effective support systems in the workplace. Their abilities to develop and educate themselves need to be prioritised to enhance their knowledge and skills in nursing. Additionally, organisations should have policies and procedures to ensure quality orientation, and units need to implement transition and mentorship programmes.

Implications for the Profession and/or Patient Care

This research could be valuable to health care when wanting to develop and improve work engagement, especially among newly graduated nurses. The economic significance of nurses' work engagement is evident, as the cost of nurse turnover is considerable. Reducing nurse turnover and improving retention relies on understanding the factors influencing nurses' decisions to leave the organisation and the profession.

Impact

What problem did the study address? The global shortage of nurses, worsened by newly qualified nurses leaving the health sector, necessitates understanding factors influencing their work engagement; The factors associated with newly graduated nurses' work engagement were supportive work environment, transition and orientation to work, success and career development in nursing, personal and psychological characteristics, characteristics of the work environment, stress and challenges in the work environment, and job satisfaction. Where and on whom will the research have an impact? The results can be used by health care organisations to plan the preceptorship/mentoring programmes of new nurses. Identifying and understanding the factors associated with the retention of newly qualified nurses can help to attract and retain nurses and to promote the adaptation and integration of new nurses into healthcare organisations.

Reporting Method

The YNEPR author checklist has been completed and implemented during this systematic review process. Also, the Prisma 2020 checklist has been used.

Patient or Public Contribution

No patient or public contribution: systematic review.

Trial Registration

PROSPERO number: CRD42023408705 (https://www.crd.york.ac.uk/PROSPERO/)

Healthcare Professionals' Perceptions of Artificial Intelligence in Healthcare—A Systematic Review of Qualitative Studies

ABSTRACT

Aim

To identify the experiences and perceptions of healthcare professionals on artificial intelligence in healthcare.

Design

Systematic literature review of qualitative studies and meta-aggregation.

Data Sources

CINAHL, PubMed, Scopus, Medic and ProQuest were systematically searched on December 9, 2024.

Results

Twenty-six studies were included in the review, of which 25 were analysed using meta-aggregation, and the results of one study were reported narratively. A total of 185 findings were identified from the included studies that addressed the research question. These findings were aggregated into 33 categories and then into five synthesised findings as follows: (1) Perceived benefits of AI in healthcare; (2) Perceived impact of AI on professional roles and workforce dynamics; (3) Perceived impacts of AI in communication and interaction; (4) Perceived challenges of AI related to technical, financial and systemic factors; (5) Perceived ethical, cultural and regulatory considerations regarding the use of AI.

Conclusion

While AI holds significant potential to enhance efficiency and improve patient outcomes, it is essential to address the concerns raised by healthcare professionals regarding workforce dynamics, communication and ethical considerations.

Implications for the Profession

The results can inform and support the implementation of AI in healthcare and the development of AI-related education and training to meet the demands of future healthcare work.

Reporting Method

The review was conducted and reported in accordance with the PRISMA guidelines.

Patient or Public Contribution

None.

Trial Registration

PROSPERO (CRD1073200)

Innovation Competence in Healthcare: Individual, Environmental and Organisational Factors—A Mixed‐Method Systematic Review

ABSTRACT

Aims

To identify healthcare professionals' experiences of innovation competence and the factors associated with it; and to examine the instruments developed to assess innovation competence and its associated factors among healthcare professionals.

Design

A mixed-methods systematic review.

Methods

Researchers independently screened original studies by title and abstract (n = 2996) and then full text (n = 189). Eighteen studies were included: 16 quantitative and two qualitative. Qualitative data were analysed using inductive content analysis, and quantitative data were tabulated and synthesised narratively.

Data Sources

The review followed the Joanna Briggs Institute Mixed Methods Systematic Review methodology. Searches were conducted in Scopus, CINAHL, Ovid Medline, ProQuest, Web of Science, PsycArticles, and Medic. Articles published in English or Finnish with no date restrictions were included. The search covered records from database inception to August 2024.

Results

From qualitative studies, we identified three categories describing experiences of innovation competence: Competences for Innovation in Healthcare, Application and Impact of Innovation in Healthcare, and Challenges and Strategies for Implementing Innovation. Quantitative studies identified three conceptual domains: Individual Capacities in Innovation, Innovation-related Competence Behaviours, and Social and Organisational Enablers. Four categories of factors associated with innovation competence emerged: sociodemographic, career-related, organisational, and academic factors.

Conclusions

Healthcare professionals' innovation competence is a multifaceted construct encompassing individual abilities, behavioural expressions, and social and organisational engagement. A systematic and multilevel approach that targets both personal attributes and organisational enablers is needed to strengthen competence. Enhancing innovation competence can improve the healthcare sector's ability to respond to complex challenges and sustain innovation capacity.

Impact

Findings inform the development of education programmes and leadership strategies to enhance innovation competence among healthcare professionals, supporting innovation implementation in healthcare organisations.

Patient or Public Contribution

No patient or public involvement was included in this study.

Trial Registration

PROSPERO: CRD42024614551

Leadership in Culturally and Linguistically Diverse Healthcare Workplaces: A Scoping Review

ABSTRACT

Aim

To map the existing literature and research themes related to leadership in culturally and linguistically diverse healthcare workplaces and identify potential research gaps to guide future studies.

Design

A scoping review.

Methods

The review followed the Joanna Briggs Institute scoping review methodology. A total of 15,078 studies were imported into Covidence for screening. Results were analysed using inductive content analysis.

Data Sources

Searches were conducted on CINAHL, Medline (Ovid), ProQuest, Scopus, and the Finnish Medic database. Unpublished studies and grey literature were searched using MedNar. The scoping review included published and unpublished original studies in English, Finnish, and Swedish with no time or geographical limits.

Results

The review included 19 studies. This scoping review identified four main categories of leadership in culturally and linguistically diverse healthcare workplaces: promoting cultural adaptation, being a cultural mediator, ensuring competence development and continuous education, and developing culturally sensitive leadership.

Conclusions

Leaders should adopt a supportive and open leadership style to promote cultural adaptation in culturally and linguistically diverse workplaces. Leaders' cultural competence can be enhanced through continuous education and training. Leaders should provide competence development opportunities for all employees in culturally and linguistically diverse workplaces. The findings highlight the need for more research (e.g., educational intervention studies) to understand the challenges and opportunities of leading a diverse workforce in a healthcare setting.

Implications for Healthcare Management

The findings highlight the importance of leadership in promoting cultural adaptation and inclusive environments in culturally and linguistically diverse workplaces. Leaders should continually develop their cultural competence to effectively lead culturally and linguistically diverse workplaces. Developing culturally sensitive leadership requires strong communication skills and cultural understanding to promote inclusion.

Impact

Our review's results underscore the need for healthcare organisations to embrace leadership practices that are inclusive and culturally competent in increasingly diverse workplaces. As the workforce becomes more diverse, it is important to understand how leadership characteristics influence culturally and linguistically diverse healthcare workplaces.

Reporting Method

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was used when reporting the results.

Patient or Public Contribution

There was no patient or public contribution.

Trial Registration: The protocol was registered in the Open Science Framework (10.17605/OSF.IO/2AK73)

Profiling Healthcare Professionals' Digital Health Competence and Associated Factors: A Cross‐Sectional Study

ABSTRACT

Aim

To assess healthcare professionals' digital health competence and its associated factors.

Design

Cross-sectional study.

Methods

The study was conducted from October 2023 to April 2024 among healthcare professionals in Italy, using convenience and snowball sampling. The questionnaire included four sections assessing: (i) socio-demographic and work-related characteristics; (ii) use of digital solutions as part of work and in free time, and communication channels to counsel clients in work; and DigiHealthCom and DigiComInf instruments including measurements of (iii) digital health competence and (iv) managerial, organisational and collegiality factors. K-means cluster analysis was employed to identify clusters of digital health competence; descriptive statistics to summarise characteristics and ANOVA and Chi-square tests to assess cluster differences.

Results

Among 301 healthcare professionals, the majority were nurses (n = 287, 95.3%). Three clusters were identified: cluster 1 showing the lowest, cluster 2 moderate and cluster 3 the highest digital health competence. Most participants (n = 193, 64.1%) belonged to cluster 3. Despite their proficiency, clusters 2 and 3 scored significantly lower on ethical competence. Least digitally competent professionals had significantly higher work experience, while the most competent reported stronger support from management, organisation, and colleagues. Communication channels for counselling clients and digital device use, both at work and during free time, were predominantly traditional technologies.

Conclusion

Educational programmes and organisational policies prioritising digital health competence development are needed to advance digital transition and equity in the healthcare workforce.

Implications for the Profession

Greater emphasis should be placed on the ethical aspects, with interventions tailored to healthcare professionals' digital health competence. Training and policies involving managers and colleagues, such as mentoring and distributed leadership, could help bridge the digital divide. Alongside traditional devices, the adoption of advanced technologies should be promoted.

Reporting Method

This study adheres to the STROBE checklist.

Patient or Public Contribution

None.

Competencies Required for Hospital‐Based Wound, Ostomy, and Continence Nurses to Provide PI Care in Home Care in Japan: A Mixed‐Methods Study

ABSTRACT

Aim

To identify the competencies required for hospital-based WOC nurses to provide direct pressure injury (PI) care in home care settings in Japan.

Design

Mixed methods convergent design.

Methods

The qualitative strand used a descriptive design to explore competencies for overcoming barriers faced by hospital-based WOC nurses when providing PI care at home. The quantitative strand used a cross-sectional design to assess competencies in organising the hospital PI management system.

Results

Six competencies were identified: (1) Establish relationships with home healthcare professionals; (2) Promote hospital-based WOC nurse's expertise to home healthcare professionals; (3) Collaborate with the regional medical liaison office in WOC nurse's hospital; (4) Involve hospital administrators in home PI management; (5) Utilise social media/Information and Communication Technology for patient or home-visiting nurse communication; and (6) Utilise public or academic support projects to facilitate home-based activities. The median scoring rate for each medical staff domain on the revised Collaboration Competency Scale for WOC Nurses ranged from 80% to 91%.

Conclusion

The results of this study can serve as a practical resource to help WOC nurses expand their activities into home-care settings.

Implications for the Profession

Their ability to coordinate with staff and manage PI care within hospitals supports active engagement in home care, improving continuity and quality.

Impact

This study addressed the issue that many hospital-based WOC nurses cannot visit patients at home. The competencies identified may enable these nurses to expand their role into home care.

Reporting Method

This study followed EQUATOR guidelines, with the STROBE Statement applied to the quantitative part and the COREQ checklist to the qualitative part.

Patient or Public Contribution

Patients or the public were not involved in the study's design, conduct, or reporting.

Nurses' Experiences and Perceptions of Evidence‐Based Healthcare Competence: A Qualitative Systematic Review

ABSTRACT

Background

Nurses are pivotal in EBHC implementation; however, its adoption remains limited, highlighting the need to investigate nurses' experiences and perceptions of their EBHC competence.

Aim

To critically appraise and synthesise qualitative evidence of nurses' experiences and perceptions of EBHC competence.

Design

A qualitative systematic review.

Methods

The review followed the JBI methodology for qualitative systematic reviews. Inclusion criteria were qualitative studies published in Finnish, Swedish or English that explored nurses' experiences and perceptions of EBHC competence. Data were synthesised using JBI's meta-aggregation method and the findings were graded with the ConQual approach.

Data Sources

CINAHL, Medic, PubMed, Scopus and grey literature from EBSCO Open Dissertations and MedNar, searched in December 2023.

Results

Seventeen qualitative studies were included. The study findings were generated from four synthesised findings with low confidence scores. The synthesised findings were: (1) Nurses' competence in Global Health, (2) Nurses' competence in enhancing Evidence generation, (3) Nurses' competence in optimising Evidence Transfer and (4) Nurses' competence in effective implementation of evidence. A new finding of this systematic review was that nurses did not express their experiences or perceptions on evidence synthesis.

Conclusion

Nurses' experiences of EBHC competence focus mainly on evidence implementation and global health. The lack of findings to evidence synthesis suggests that core principles of the EBHC model are not yet fully embedded in nursing practice. Nurses emphasised the need for greater support for developing EBHC competence.

Implications for the Profession

Integration of EBHC into education, mentoring and adequate resources enhances nurses' competence, motivation and commitment to EBHC sub-dimensions, while also strengthening their professional confidence and development.

Impact

Strengthening nurses' EBHC competencies contributes to supporting the delivery of high-quality, effective and sustainable healthcare services.

Reporting Method

PRISMA guidelines followed.

Patient or Public Contribution

None.

Trial Registration

PROSPERO-registered: CRD42021285179

Nurses' Challenges in End‐Of‐Life Care: Aesthetic Expression of Lived Worlds

ABSTRACT

Background

When providing end-of-life care, nurses are faced with challenges related to the dying process. Aesthetic concepts exert a more profound influence than empirical evidence or logical reasoning. However, while the aesthetic aspect in end-of-life care demonstrates the inherent beauty of nursing, there are few manifestations of aesthetics to express the professional challenges in end-of-life care as experienced by nurses.

Aim

This study aimed to investigate and elucidate the lived experiences of the professional challenges encountered by nurses in end-of-life care.

Design

A hermeneutic phenomenological qualitative study was employed.

Methods

This study was conducted from September to December 2023 in China. The purposive sampling method was used to recruit ten registered hospice nurses engaged in end-of-life care in a hospital. Data collection involved ‘Storytelling and Drawing Technique’ followed by focus group discussion. van Manen's hermeneutic phenomenological approach was used in the data analysis.

Results

Essential themes were grouped based on existential themes of van Manen's four lived worlds, delineating: (1) Lived body: insufficient comprehension depth; (2) Lived space: unfavourable ambiance within the ward setting; (3) Lived time: negative impact of traditional culture; and (4) Lived human relations: intricacies inherent in decision-making dynamics.

Conclusion

After understanding the challenges of nurses in end-of-life care reflected by aesthetic expressions, proactive steps can be taken to address these issues and thereby facilitate a positive transformation.

Reporting Method

The authors have adhered to Consolidated Criteria for Reporting Qualitative Research(COREQ) Standards.

Patient or Public Contribution

No patient or public contribution

A Scoping Review on Long‐Term Care Workers' Perceptions of Robot‐Assisted Care for Older Adults in Long‐Term Care Facilities

ABSTRACT

Aims

To synthesise the current research on long-term care workers' perceptions (i.e., attitudes, concerns, and expected functions) of robot-assisted care and their perceived effects of different types of robot-assisted care for older adults in long-term care facilities.

Design

Scoping review.

Data Sources

A search was conducted in July 2024 using five databases. Articles published between 2010 and 2024 on the perceptions and/or perceived effects of robot-assisted care for older adults among frontline long-term care workers in long-term care facilities were identified. Additionally, the reference lists of the included articles were manually searched.

Methods

A five-step framework that guided the development of research questions, screening of studies, and synthesis and presentation of data was adopted. Two authors independently screened and analysed the identified articles. Conflicts were resolved through joint-discussions.

Results

Forty-one articles were included in the review. Data were narratively synthesised into three categories: expected function of care robots, perceived effects of robot-assisted care, and attitudes and concerns regarding robot-assisted care. Subcategories were identified and presented in tabular form.

Conclusion

This review shows the physical, psychological, social, and practical benefits and limitations of different types of robot-assisted care. It also contributes to understanding long-term care workers' attitudes, concerns, and expectations regarding the function of robot-assisted care.

Implications for the Profession and/or Patient Care

Having a priori discussion with long-term care workers about their expectations regarding using robot-assisted care is needed. Improvements in the design and in the digital literacy of the workers are also necessary.

Impact

This review provides an overview of the perceptions and perceived effects of different types of robot-assisted care among care workers in long-term care facilities. The findings provide practical implications and highlight areas in need of further studies.

Reporting Method

Scoping Review (PRISMA-ScR) checklist.

Patient or Public Contribution

No Patient or Public Contribution.

Contagious Effect of Nurses' Perception of Leaders' Antisocial Behaviour

ABSTRACT

Aim

To examine the underlying mechanism that strengthens or attenuates the social contagion effect among nursing professionals.

Design

The study uses a cross-sectional design. The study's results followed the Strengthening Reporting of Observational Studies in Epidemiology (STROBE).

Methods

A Questionnaire was used as the main source of data collection. The data collection occurred between March 11 and May 12, 2024. The study used purposive sampling to select 25 health facilities. A total of 530 questionnaires were sent out, of which 323 responses were received, and 27 were excluded due to missing data and logical inconsistency. In all, 296 responses were used for the analysis, giving a valid response rate of 58.8%. The smart partial least squares partial equation modelling (Smart-PLS 4.0) was used for the study's data analysis.

Results

The results reveal that the need for recognition mediates the relationship between nursing managers' and subordinates' antisocial behaviour. Also, results from the study indicate that personal norm inversely moderated the relationship between superior antisocial behaviour and subordinate behaviour.

Conclusion

The impact of superior antisocial behaviour on junior nurses may not translate into the same level of effect, especially when the nurse perceives her role as a call to duty (i.e., has high personal norms).

Impact

The study findings confirm the crucial role personal norms and the need for recognition play in strengthening or weakening the social contagion effect of senior nurses' antisocial behaviour on junior nurses' behaviour.

Reporting Method

The study followed the Strengthening Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Patient or Public Contribution

No patient or public contribution.

Co‐Designing and Evaluating a Digital Competencies Toolkit for Nursing Students

ABSTRACT

Aim

To offer a student-focused critical evaluation of the content and use of a digital competencies discipline-specific toolkit that was co-designed with students, offering ideas for training and development across several digital skills areas, such as digital creation, research, communication, innovation, and wellbeing.

Design

A cross-sectional empirical study.

Methods

The toolkit was evaluated based on clarity, level of comprehension, accessibility, perceived relevance, and future implementation through a survey, which collected quantitative and qualitative data from 339 undergraduate nursing students in a single school and university in Scotland. Original research data were collected in June 2023.

Results

Students evaluated the toolkit positively for its clarity, comprehensive nature, and practical resources, but suggested improvements for neurodivergent learners. Most students recommended implementing the toolkit early in their course and emphasised its benefits in continuous use. The toolkit was found to be relevant for practice placements and career development. Despite study workload concerns, students were positive about upskilling, highlighting the utility of the toolkit.

Conclusion

Digital literacy is essential as healthcare increasingly relies on digital tools, behaviours and processes. This study employed co-design strategies, supporting students to act as co-producers, change agents, and partners in learning.

Implications for the Profession and/or Patient Care

The study highlights the need for continuous education in digital skills with suggestions for incorporating advanced skills for future practice, such as data analytics and artificial intelligence, and discusses the value of digital skills development in higher education to enhance student learning and future practice.

Impact

The research offers insights of international relevance into the development of a digital competencies toolkit that proposes nursing-specific educational digital skills interventions. The work fosters inclusivity, continuous digital skills improvement, and professional readiness.

Reporting Method

The work followed the Equator Standards for Quality Improvement Reporting Excellence in Education.

Patient or Public Contribution

No patient or public contribution.

THE Effect of Mentoring Programmes on Newly Graduated Nurses' Retention and Turnover: An Umbrella Review

ABSTRACT

Aim

To summarise the effect of mentoring within mentoring programmes on the retention and turnover of newly graduated nurses in healthcare settings.

Design

An umbrella review.

Methods

Two independent reviewers screened the titles, abstracts and full texts for eligibility and critically appraised the included reviews using the JBI critical appraisal. The findings were tabulated and synthesised.

Data Sources

The search was conducted in five electronic databases (CINAHL, OvidMedline, ProQuest, Scopus, Cochrane and Medic) in November 2023.

Results

Out of 450 Papers, 13 systematic and integrative reviews were included. Thirteen mentoring programmes were identified and categorised into three groups based on their content: didactic mentoring programmes, interaction-based mentoring programmes and combined mentoring programmes. Across these programme types, retention among newly graduated nurses ranged from 72% to 100% at the 1-year mark and 70% to 98% at 2 years. Turnover rates showed consistent reductions, with post-intervention rates ranging from 3.5% to 20% compared to pre-intervention rates of up to 50%. Several studies reported statistically significant improvements in retention and turnover, particularly in programmes integrating structured education and preceptorship models.

Conclusions

Several different mentoring programmes have been developed to support the transition of newly graduated nurses. Mentoring programmes that provide ongoing support and structured guidance increase retention and reduce turnover among newly graduated nurses.

Implications for the Profession and/or Patient Care

Effective mentoring programmes are key to ensuring high-quality patient care and a sufficient supply of qualified nurses in the future.

Impact

The findings can provide information for developing transition support and mentoring programmes for newly graduated nurses.

Reporting Method

This umbrella review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

Patient or Public Contribution

No patient or public contribution.

Trial and Protocol Registration

The umbrella review protocol was registered in PROSPERO: CRD42023478044.

Relationships Between Nurses' Self‐Leadership Practices, Professional Autonomy, Job Satisfaction and Intention to Leave: A Structural Equation Modelling Approach

ABSTRACT

Aim

To explain the relationships between nurses' self-leadership and professional autonomy, job satisfaction, and intention to leave the profession.

Design

A descriptive cross-sectional study design.

Methods

A total of 230 registered nurses responded to a survey including a Finnish version of the Dempster Practice Behaviour Scale and the Revised Self-Leadership Questionnaire in fall 2024. Structural equation modelling was used to test hypotheses.

Results

Nurses assessed their self-leadership practices as moderately good. The model indicated that self-goal setting, evaluating beliefs and assumptions, and job satisfaction have positive relationships with professional autonomy, while self-reward and self-punishment have negative relationships with it. It also demonstrated that natural reward strategies have a positive relationship with job satisfaction, while self-punishment has a negative relationship with it. Nurses' professional autonomy and job satisfaction reduce their intention to leave, while evaluating beliefs and assumptions increase it.

Conclusion

Goal setting and using constructive mindsets develop ways of thinking that positively impact nurses' autonomy. This, in turn, leads to higher job satisfaction and lower intention to leave. Natural reward strategies that involve performing meaningful tasks surrounded by empowering people increase job satisfaction. However, not all self-leadership strategies are beneficial: self-punishment can lower professional autonomy and job satisfaction. Additionally, evaluating one's own beliefs and assumptions might increase the intention to leave due to reflective thoughts about the profession.

Implications

Implementing professional autonomy and self-leadership practices in organisational structures enhances nurses' valuable role. Empowering leadership encourages nurses to set goals, evaluate beliefs and assumptions, and reward themselves. Moreover, nurses' self-punishment can be avoided with a healthy, open work environment. Self-leadership skills should be strengthened in nursing education to prepare nurses for work demands.

Reporting Method

The STROBE checklist.

Patient or Public Contribution

No patient or public contribution.

Emergency clinicians' use of adult and paediatric sepsis pathways: An implementation redesign using the behaviour change wheel

Abstract

Aims

To identify facilitators and barriers and tailor implementation strategies to optimize emergency clinician's use of adult and paediatric sepsis pathways.

Design

A qualitative descriptive study using focus group methodology.

Methods

Twenty-two emergency nurses and ten emergency medical officers from four Australian EDs participated in eight virtual focus groups. Participants were asked about their experiences using the New South Wales Clinical Excellence Commission adult and paediatric sepsis pathways using a semi-structured interview template. Facilitators and barriers to use of the sepsis pathways were categorized using the Theoretical Domains Framework. Tailored interventions were selected to address facilitators and barriers, and a re-implementation plan was devised guided by the Behaviour Change Wheel.

Results

Thirty-two facilitators and 58 barriers were identified corresponding to 11 Theoretical Domains Framework domains. Tailored strategies were selected to optimize emergency clinicians' use of the sepsis pathways including refinement of existing education and training programmes, modifications to the electronic medical record system, introduction of an audit and feedback system, staffing strategies and additional resources.

Conclusion

The implementation of sepsis pathways in the Emergency Department setting is complex, impacted by a multitude of factors requiring tailored strategies to address facilitators and barriers and optimize uptake.

Implications for Patient Care

This study presents a theory-informed systematic approach to successfully implement and embed adult and paediatric sepsis pathways into clinical practice in the Emergency Department.

Impact

Optimizing uptake of sepsis pathways has the potential to improve sepsis recognition and management, subsequently improving the outcome of patients with sepsis.

Reporting Method

The Consolidated Criteria for REporting Qualitative research guided the preparation of this report.

Patient or Public Contribution

Nil.

Intrinsic Influences on Medical Emergency Team Call Stand‐Down Decision‐Making: An Observational Study

ABSTRACT

Aim

The aim of this research was to describe factors that influence Intensive Care Unit liaison nurses' decision to stand down a medical emergency team call response. The decision to end a medical emergency team response for a deteriorating patient is referred to as the medical emergency team call stand-down decision. Intensive Care Unit liaison nurses, also known internationally as critical care outreach nurses, make medical emergency team call stand-down decisions in complex and challenging clinical environments. However, the factors influencing these decisions are not well described in the literature.

Design

Exploratory descriptive qualitative study.

Methods

Seven Intensive Care Unit liaison nurses who attended medical emergency team calls in a large acute metropolitan tertiary referral public hospital, with a mature three-tiered rapid response system, were observed and interviewed. Observations of 50 medical emergency team call responses and 50 post medical emergency team call interviews were conducted between March 2022 and August 2022. Findings were analysed using inductive content analysis.

Results

Intensive Care Unit liaison nurse decisions to stand down MET call responses were influenced by three intrinsic factors: (1) propositional knowledge, (2) experiential knowledge, (3) situational knowledge and information processing styles. Intensive Care Unit liaison nurses utilised these intrinsic factors to support their decision to terminate medical emergency team call response.

Conclusion

This study explored the intrinsic influences on individual Intensive Care Unit liaison nurses in deciding to end a medical emergency team call. By highlighting these individual influences on decision-making, the findings may be used to support medical emergency team responders educational needs and identification of potential heuristics and biases inherent in clinical decision-making which contribute to adverse events.

Patient or Public Contribution

No patient or public contribution.

Implications for Profession and/or Patient Care

By understanding the influences on an individual's clinical decision-making, strategies can be put in place for educational development and support for experiential learning. The study highlights areas of potential bias and heuristic use that may lead to sub-optimal clinical decisions and increased risk for deteriorating patients. Research findings can be applied internationally to a range of rapid response systems and critical care outreach teams that respond to deteriorating patients.

Reporting Method

The consolidated criteria for reporting qualitative research (COREQ) guidelines were used for reporting this study.

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