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Nurses and healthcare support staff have a higher suicide risk than the public. This elevated risk calls for increased efforts to support mental health. Additionally, nursing leaders' education on employee-specific suicide prevention is lacking.
An evidence-based project was implemented using the PICO question: Among nurse leaders at an academic healthcare system in California, does the provision of an educational program using role-playing practice and the creation of a suicide prevention toolkit versus no standard education or training improve self-efficacy and knowledge on how to take action with a team member who is suspected of being suicidal or voicing suicidal ideation?
Education sessions were planned based on the literature, with surveys collected preintervention, immediately posteducation, and 1-month postintervention to assess suicide prevention self-efficacy and knowledge. Knowledge was measured using a researcher-constructed questionnaire validated by six suicide prevention experts. The General Self-Efficacy Scale (range: 10–40) was used.
Sixty participants attended one of 11 scheduled remote-learning sessions. Mean self-efficacy significantly improved (pre: 31.3 [n = 46, min: 18, max: 40]; immediate post: 33.49 [n = 37, min: 24, max: 40]; 1-month post: 33.77 [n = 31, min: 28, max: 40]) (X 2 = 8.0184, df = 2, p = 0.01815). The proportion of incorrect knowledge questions was significantly lower postintervention (mean pre: 24.5%, immediate post: 11.5%, 1-month post: 10.7%, X 2 = 23.195, df = 2, p = 0.000001). All participants (100%, n = 55) recommended the program. Leaders reported feeling better prepared to support suicidal employees.
Project results demonstrate the need to provide suicide prevention training for leaders. The authors recommend requiring training/return demonstration competency as a component of new leaders' onboarding. This program can easily be modified for nurses from prelicensure through senior leadership.
Suicide rates in healthcare members are higher than those of the general population. Suicide prevention programs can help nursing leaders feel better prepared to support and connect at-risk healthcare workers with resources.
The Clinical Nurse Leader (CNL) care model is a different way of organizing frontline nursing care delivery in contrast to the traditional “staff nurse” model and is increasingly being adopted by health systems across the United States and abroad. However, variability in implementation and outcomes has been noted across health settings.
A recently validated CNL Practice Model provides an explanatory pathway for CNL model integration into practice. The purpose of this study was to identify and compare patterns of empirical correspondence to the CNL Practice Model and predict their influence on implementation success.
We conducted a secondary analysis of a 2015 national-level study with clinicians and administrators involved with CNL initiatives in their health system. A psychometrically validated CNL Practice Survey was used to collect data measuring the presence (0%–100%) of the five domains of the CNL Practice Model (organizational readiness, CNL structuring, CNL practices, outcomes, and value) and one measure of CNL implementation success. We modeled the complex hierarchical structure of the data using a Bayesian multilevel regression mixed modeling approach. A zero–one-inflated beta distribution, a mixture of Bernoulli distributions for the minimum and maximum responses and a beta distribution for the responses between the minimum and maximum, was used to fit success ratings in the model.
A total of 920 participants responded, 540 (59%) provided success scores. The model captured ratings skewed toward upper bound, while also adequately modeling data between the minimum and maximum values. The Bayesian model converged and gave estimates for all hierarchical parameters, which would likely have failed to converge in a pure maximum likelihood framework. The variability around success score across CNL Practice Model element ratings was greatest at the component level, 0.29 (0.18–0.48), compared to either the domain level, 0.16 (0.01–0.54), or the item level, 0.09 (0.01–0.17). The components most predictive of implementation success were (a) consensus CNL model can close gaps, (b) organization level implementation strategy, and (c) alignment of empirical CNL microsystem level structuring to the model's conceptualization.
Findings provide further empirical evidence to support the explanatory pathway proposed by the CNL Practice Model and identified specific organizational readiness and CNL workflow structures that are critical antecedents predictive of CNL practice manifestation and production of expected outcomes. Findings indicate actionable implementation evidence that can be successfully adopted across real-world healthcare settings to achieve safer and higher quality patient care.
CNL integrated care delivery is a frontline nursing care model that is being increasingly adopted by health systems across the United States and abroad. However, variability in CNL implementation and outcomes has been noted across health settings, limiting its evidence base. Findings of this study contribute a better understanding about the variability of CNL practice and outcomes found in the literature and contribute empirical and conceptual clarity about the relationships between modes of CNL implementation and successful adoption in healthcare settings.
Intimate partner violence (IPV) is associated with multiple adverse health consequences. Nurses (including midwives) are well positioned to identify patients subjected to IPV, and provide care, support, and referrals. However, studies about nursing response to IPV are limited especially in low- and middle-income countries (LMICs). The study aimed to examine nurses' perceived preparedness and opinions toward IPV and to identify barriers and facilitators in responding to IPV.
An explanatory sequential mixed-methods study was conducted by collecting quantitative data first and explaining the quantitative findings with qualitative data.
The study was conducted in two tertiary general hospitals in northeastern (Shenyang city) and southwestern (Chengdu city) China with 1500 and 1800 beds, respectively. A total of 1071 survey respondents (1039 female [97.0%]) and 43 interview participants (34 female [79.1%]) were included in the study. An online survey was administered from September 3 to 23, 2020, using two validated scales from the Physician Readiness to Manage Intimate Partner Violence Survey. In-depth, semistructured interviews were conducted from September 15 to December 23, 2020, guided by the Consolidated Framework for Implementation Research.
The survey respondents largely agreed with feeling prepared to manage IPV, e.g., respond to discourses (544 [50.8%] of 1071) and report to police (704 [65.7%] of 1071). The findings of surveyed opinions (i.e., Response competencies; Routine practice; Actual activities; Professionals; Victims; Alcohol/drugs) were mixed and intertwined with social desirability bias. The quantitative and qualitative data were consistent, contradicted, and supplemented. Key qualitative findings were revealed that may explain the quantitative results, including lack of actual preparedness, absence of IPV-related education, training, or practice, and socially desirable responses (especially those pertaining to China's Anti-domestic Violence Law). Commonly reported barriers (e.g., patients' reluctance to disclose; time constraints) and facilitators (e.g., patients' strong need for help; female nurses' gender advantage), as well as previously unreported barriers (e.g., IPV may become a workplace taboo if there are healthcare professionals known as victims/perpetrators of IPV) and facilitators (e.g., nurses' responses can largely meet the first-line support requirements even without formal education or training on IPV) were identified.
Nurses may play a unique and important role in responding to IPV in LMICs where recognition is limited, education and training are absent, policies are lacking, and resources are scarce. Our findings support World Health Organization recommendations for selective screening.
The study highlights the great potential of nurses for IPV prevention and intervention especially in LMICs. The identified barriers and facilitators are important evidence for developing multifaceted interventions to address IPV in the health sector.
In response to the aging population, the Department for Professional Development in the Nursing Division at the Israeli Ministry of Health has invested significant resources in training registered nurses for post-basic certification in the field of geriatrics. However, little is known about how the nurses implement the scope of practice in the field and how they maximize their full potential following the training.
To assess whether nurses' full potential is maximized in geriatric acute and long-term geriatric care, and community settings in Israel.
A quantitative, cross-sectional study.
The study population is a convenience sample of registered nurses who completed post-basic certification in geriatric care (n = 287). The participants completed a self-administered questionnaire addressing socio-demographic and occupational characteristics, implementation of the scope of practice, and a professional satisfaction questionnaire.
Baseline demographic variables were summarized using means and counts, with frequency counts and percentages used for the scope of practice. A one-way ANOVA was utilized to examine the differences between the workplace and the scope of practice. Chi-square was used to examine practice types and the workplace.
Nurses in all surveyed geriatric settings reported average to high overall performance in independent decision-making activities and delegated duties. The majority (66%) reported very high satisfaction with the completion of the post basic certification education However overall performance differed significantly between the different geriatric settings.
Most of the nurses with a post-basic geriatric certification are satisfied with their scope of practice, feel valued by colleagues and managers, and are able to practice independently within their professional scope. This can have a positive impact on the care of the older adult population.
Administrators should ensure that nurses with a post-basic geriatric certification are able to maximize their scope of practice. Specifically, we recommend nurse managers to leverage the results of this study and advocate for nurses to fulfill their full potential in their scope of practice.
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