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To identify implementation strategies that effectively facilitate the adoption of social needs care coordination activities using enabling technologies among care management teams serving patients in community-based health centres.
Modified Delphi process.
Discrete, feasible implementation strategies were identified through literature review and semi-structured interviews with care management staff and subject matter experts in clinical informatics, workflow redesign, and product engineering. A modified Delphi was conducted with eight subject matter experts and nine health centre care management staff. Iterative rounds of online surveys were used to achieve consensus on the most relevant implementation strategies and their delivery methods.
The modified Delphi process achieved consensus on nine discrete implementation strategies needed to advance care management teams' ability to screen, refer and track social needs. Prioritised strategies included developing champions, enhancing quality improvement capacity, training staff on using enabling technologies and providing tailored technical assistance for workflow refinement. Consensus was also reached on a monthly cadence for most of the implementation strategies.
Consensus was reached on strategies to enhance care management teams' implementation of social needs screening, referrals and tracking using enabling technologies. These strategies will comprise an intervention to be pilot tested, refined and assessed in a cluster randomised clinical trial.
Findings from this study will inform the development of strategies to further the adoption of enabling technologies to support social needs care coordination.
This work is key to the design of a type 2 hybrid implementation-effectiveness trial that will assess whether user-informed, evidence-based implementation strategies can improve care management teams' adoption of enabling technologies to facilitate social needs care coordination for patients.
The research team includes a patient advisor with community-based nursing expertise and a nurse practitioner-clinical informaticist leader who was involved in data collection and interpretation of findings.
Trial registration: Clinicaltrials.gov registration # NCT06489002. Registered July 5, 2024, https://clinicaltrials.gov/study/NCT06489002?term=NCT06489002&rank=1.
Nurse leaders at every level are needed to help organizations achieve strategic goals and deliver safe patient care. Nurse leaders can find fulfillment in their roles; however, they are often prone to poor work-life balance due to the complexity and demands of their jobs. Professional well-being, consisting of an individual's overall health and the perception of good work-related quality of life, is at risk for being compromised in these nurses. Research exploring variables associated with psychosocial well-being in nurse leaders is limited.
To describe variables related to psychological well-being in nurse leaders, explore associations among these variables, and identify potential demographic and psychosocial predictors of resilience and burnout.
Participants were a convenience sample of nurse leaders from two hospitals located in the southwestern United States. We used a prospective observational design to describe the incidence of and relationships between self-compassion, satisfaction with life, resilience, perceived stress, and burnout. We then sought to identify predictors of disengagement and exhaustion (subscales of burnout) and resilience.
Participants (n = 105) were mostly female (82.7%) and white (57.7%), while one-third were charge nurses. Most reported normal to high levels of satisfaction with life (86%), self-compassion (90%), and resilience (93.3%) and 72.4% reported high stress levels. Moderately high levels of disengagement (46.4%) and exhaustion (59.1%) were also present. Higher self-compassion levels predicted higher levels of resilience. Lower satisfaction with life and self-compassion together predicted high disengagement scores, while lower self-compassion scores predicted high exhaustion scores.
When disengagement, exhaustion, and perceived stress are elevated, nurse leaders are at risk for low professional well-being and may be more prone to resignation ideation or turnover. Evidence-based interventions designed specifically for nurse leaders promoting professional well-being and emphasizing self-compassion skills are needed along with high-quality research on program outcomes.
Nurse leaders are at a higher risk for burnout post-pandemic. Resilience skills training incorporating mind–body awareness and self-compassion practices significantly improved stress, self-compassion, and mindfulness in medical professionals by the end of the training.
This study aimed to assess if a 6-h resiliency training delivered to nurse leaders would improve measures related to well-being, for example, stress, burnout, life satisfaction, self-compassion, resilience, and mindfulness by the end of the course, and if any improvements would be sustained over time.
We prospectively examined the effects of a 6-h resiliency training on well-being outcomes in nurse leaders in a longitudinal study during Spring 2022 through Fall 2022. Experienced resiliency teachers trained 46 nurse leaders. Participants took pre-, post-, and 2-months-post online surveys measuring well-being-related variables. Only 48% (n = 22) completed the entire course and surveys at all three times.
Nurse leaders were mostly female (n = 38, 83%) and white (n = 27, 59%) with an average age of 44.72 [SD = 9.5] years. Median years of experience were 15.5 [3.5–47]. One-way repeated measures ANOVA demonstrated a significant effect across time on stress (p = 0.02), self-compassion (p = 0.02), mindfulness (p = 0.04), and the exhaustion subscale of burnout (p = 0.008) but the significant changes occurred by the 2-month follow-up. Resilience, life satisfaction, and disengagement scores did not significantly change.
Baseline stress and burnout scores were high in 43.5%–63% of the nurse leaders, indicating a need for continued support of nurse leaders to reduce stress and burnout. Post resiliency training, scores in perceived stress and exhaustion decreased significantly over time, demonstrating the efficacy of this 6-h program to improve key variables related to well-being in nurse leaders. While baseline self-compassion scores were already high in nurse leaders, statistically significant improvements in self-compassion and mindfulness, but not resilience, occurred 2 months after this resiliency training program. Significant changes in key variables related to well-being occurred 2 months post training, indicating the need for further exposure and time with practices taught in the course. Nurse leaders need support to break away from work tasks to participate in psychoeducational trainings and interventions to improve well-being. We need further applied research on how to improve well-being in clinicians from a systems and environmental perspective.
Delay in detecting acute deterioration in older adults in care homes is associated with avoidable hospitalizations and adverse outcomes, including premature death.
Underpinned by the Knowledge to Action Framework, this study aimed to understand the barriers and enablers to direct care staff detecting and responding to the early signs of acute deterioration in care home residents.
Online focus groups or interviews with regulated (registered and enrolled nurses) and unregulated (assistants in nursing and personal care workers) direct care staff from participating care homes were conducted. Homes were recruited using disproportionate stratified random sampling to include metropolitan, inner regional, and outer regional care homes. Interview and focus group recordings were transcribed verbatim and analyzed using inductive thematic analysis.
Eighty direct care staff (n = 48 regulated; n = 32 unregulated) from eight care homes participated. Fifteen focus groups (n = 7 unregulated staff, n = 8 regulated staff) and two interviews (n = 1 regulated staff, n = 1 unregulated staff) were conducted between July 2021 and October 2022. Four themes related to the barriers and enablers of detecting and responding to acute deterioration were generated: decision-making within the scope of practice; resource availability; streamlined communication; and teamwork.
Findings highlight the challenges direct care staff encounter in being able to detect early signs of acute deterioration and implement appropriate care pathways. Perceived barriers and enablers highlighted in this study need to be considered when developing and implementing programs to optimize the timely detection of, and response to, acute deterioration in care homes.
Workforce knowledge, experience, and confidence deficits are significant barriers to detecting acute deterioration, while the unique workforce mix in care homes poses additional challenges for the accurate detection of early signs of acute deterioration. Knowing the resident, working as a team, and valuing the contribution of aged care staff and families in managing acute deterioration are enablers to achieving better outcomes for residents experiencing acute deterioration.
During the COVID-19 pandemic, acute care nurse managers functioned in a critical role by helping to advance the mission and goals of their organization while navigating a rapidly evolving healthcare landscape. This resulted in high levels of ongoing job-related stress which is linked to negative physical, psychological, and job-related outcomes. Little is known about the perceptions regarding their own professional well-being during this time.
The aim of this study was to qualitatively describe acute care nurse managers' perceptions of and barriers to their professional well-being.
Using a qualitative descriptive approach, nurse managers from a hospital system in the southwestern United States responded to two short-answer, survey-based questions in 2022: (1) “Describe the definition of nurse-manager well-being in your own words” and (2) “What do you feel is your biggest barrier to professional well-being?” Reflexive thematic analysis was utilized to analyze participant responses (N = 80).
Professional well-being is a complex concept influenced by the nurse manager's ability to navigate work–life balance; care for their own physical, emotional, and spiritual selves; give and receive support from stakeholders; and manage feelings of thriving vs. struggling in the role. Barriers most cited as influencing well-being included having too little time to get things done coupled with increasing workloads, feeling stuck in the middle among stakeholders, and coping with ongoing staffing challenges.
The definition of and barriers to well-being are influenced by the specific needs and experiences of the nurse manager. While not all barriers can be immediately removed, the identification of individual and organization-specific barriers needs to be taken seriously, reviewed by those who can promote change, and evidence-based solutions for improvement piloted or implemented when feasible.
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