Gwen Sherwood

Reflection: an educational strategy to develop emotionally-competent nurse leaders

AIM This paper explores educational strategies for nurses that focus on reflectivity and promote the development of self-awareness, relationship and communication skills and ability to lead with presence and compassion in the midst of change. BACKGROUND Today nurses move rapidly from carefully-controlled educational experiences to a fast-paced clinical world of increasing patient complexity amid calls for improved quality of care. Making the transition to clinical competence and leadership in practice requires a strong sense of self and emotional intelligence. EVALUATION Pedagogies that integrate theoretical and data-based textbook learning with experiential learning and reflection are a foundation for the development of emotionally- and intellectually-competent leaders and requires new ways of assessing learner outcomes. KEY ISSUES Reflection is a key instructional strategy for preparing transformational nurse leaders for interdisciplinary settings where they lead patient care management. The remarkable global spread of reflection in nursing education, practice and research follows an emphasis on developing self-awareness as a leadership strategy for improving individual and organizational performance. CONCLUSIONS Empirical, experiential and anecdotal evidence suggests that reflection has the potential to prepare emotionally-capable nurse leaders. IMPLICATIONS FOR NURSING MANAGEMENT As educators create more reflective and nurturing learning environments, they will promote the development of emotionally-competent nurse leaders who will, in turn, inspire individual and organizational growth and positive change in society.

Quality and safety education for advanced nursing practice

The Quality and Safety Education for Nurses (QSEN) project is a national initiative to transform nursing education to integrate quality and safety competencies. This article describes a two-year process to generate educational objectives related to quality and safety competency development in graduate programs that prepare advanced practice nurses in clinical roles. Knowledge, skills, and attitudes for each of 6 competencies are proposed to stimulate development of teaching strategies in programs preparing the next generation of advanced practice nurses.

Working Together in the Neonatal Intensive Care Unit: Provider Perspectives

OBJECTIVES: To elicit healthcare provider perceptions of working together in a neonatal intensive care unit (NICU).STUDY DESIGN: We conducted focus groups to elicit descriptions of how providers work together. The groups included one each of transport nurses, staff nurses, residents, fellows, attending physicians and two multiple provider groups. To identify themes and their descriptive elements we performed qualitative data analysis.RESULTS: There were three to seven participants per group for a total sample of 36. Provider responses to questions about working together centered around three major themes: (1) Provider Characteristics; (2) Workplace Factors and; (3) Group Influences. Provider Characteristics were defined by personal attributes, reputation, and expertise. Workplace Factors included staffing, work organization, and work environment. Group Influences were described by communication and relationships.CONCLUSIONS: Providers in this NICU described three broad organizational and interpersonal factors that influence how they work together, yet no consistent descriptions of teams or teamwork were found. The organizational factors, often far removed from bedside, should be considered when evaluating how providers work together.

Qualitative assessment of hospitalized patients' satisfaction with pain management.

Patient evaluations of effectiveness of care and satisfaction with care are useful outcome indicators of pain management. The subiective, multidimensional nature of pain is best evaluated when outcome measures include the richness of qualitative data to more fully capture the range of patient experiences. A descriptive qualitative component was added to the American Pain Society Patient Outcome Questionnaire--Modified (1995) to determine critical indicators in the pain experience affecting patient satisfaction. Four themes emerged from the data as factors affecting patient satisfaction or dissatisfaction: Patient Pain Experience, Patient Views of Health Care Providers, Patient Pain Management Experiences, and Pain Management Outcomes. The result is a typology of factors affecting patient reports of satisfaction. Satisfaction was most likely when providers effectively addressed pain control with the patient as an informed partner. Patients expressed dissatisfaction, even when pain was relieved, when providers appeared uncaring, were slow to respond, or lacked knowledge and skill. Our results offer clinicians new insights into how patients respond to pain, which could enable development of patient-oriented approaches to pain management improving quality and effectiveness of care and increasing patient satisfaction.

Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) for Quality Improvement of Pain Management in Hospitalized Adults: Preliminary Psychometric Evaluation

UNLABELLED Quality improvement (QI) is a compilation of methods adapted from psychology, statistics, and operations research to identify factors that contribute to poor treatment outcomes and to design solutions for improvement. Valid and reliable measurement is essential to QI using rigorously developed and tested instruments. The purpose of this article is to describe the evolution of the American Pain Society Patient Outcome Questionnaire (APS-POQ) for QI purposes and present a revised version (R) including instrument psychometrics. An interdisciplinary task force of the APS used a step-wise, empiric approach to revise, test, and examine psychometric properties of the societys original POQ. The APS-POQ-R is designed for use in adult hospital pain management QI activities and measures 6 aspects of quality, including (1) pain severity and relief; (2) impact of pain on activity, sleep, and negative emotions; (3) side effects of treatment; (4) helpfulness of information about pain treatment; (5) ability to participate in pain treatment decisions; and (6) use of nonpharmacological strategies. Adult medical-surgical inpatients (n = 299) from 2 hospitals in different parts of the United States participated in this study. Results provide support for the internal consistency of the instrument subscales, construct validity and clinical feasibility. PERSPECTIVE This article presents the initial psychometric properties of the APS-POQ-R for quality improvement purposes of hospitalized adult patients. Validation in additional groups of patients will be needed to demonstrate its generalizability.

Teamwork training with nursing and medical students: does the method matter? Results of an interinstitutional, interdisciplinary collaboration

Objectives The authors conducted a randomised controlled trial of four pedagogical methods commonly used to deliver teamwork training and measured the effects of each method on the acquisition of student teamwork knowledge, skills, and attitudes. Methods The authors recruited 203 senior nursing students and 235 fourth-year medical students (total N=438) from two major universities for a 1-day interdisciplinary teamwork training course. All participants received a didactic lecture and then were randomly assigned to one of four educational methods: didactic (control), audience response didactic, role play and human patient simulation. Student performance was assessed for teamwork attitudes, knowledge and skills using: (a) a 36-item teamwork attitudes instrument (CHIRP), (b) a 12-item teamwork knowledge test, (c) a 10-item standardised patient (SP) evaluation of student teamwork skills performance and (d) a 20-item modification of items from the Mayo High Performance Teamwork Scale (MHPTS). Results All four cohorts demonstrated an improvement in attitudes (F1,370=48.7, p=0.001) and knowledge (F1,353=87.3, p=0.001) pre- to post-test. No educational modality appeared superior for attitude (F3,370=0.325, p=0.808) or knowledge (F3,353=0.382, p=0.766) acquisition. No modality demonstrated a significant change in teamwork skills (F3,18=2.12, p=0.134). Conclusions Each of the four modalities demonstrated significantly improved teamwork knowledge and attitudes, but no modality was demonstrated to be superior. Institutions should feel free to utilise educational modalities, which are best supported by their resources to deliver interdisciplinary teamwork training.

Improving quality and safety education: The QSEN Learning Collaborative

As part of a national initiative to improve quality and safety education in prelicensure nursing programs, 15 schools participated in a 15-month learning collaborative sponsored by Quality and Safety Education for Nurses, funded by the Robert Wood Johnson Foundation. This article presents the rationale, design, activities, and outcomes of the collaborative. Collaborative members revised curricula, developed new teaching strategies, and established the foundation for future faculty development efforts to advance teaching of quality and safety concepts in nursing education.

Meta-Synthesis: Merging Qualitative Studies to Develop Nursing Knowledge

As the numbers of qualitative studies on a specific topic multiply, synthesis of the merged results helps to clarify the state of the field based on the research analysis. By apprehending and re-presenting findings from studies on a related topic through meta-synthesis, findings from single qualitative studies become more meaningful. The purpose of a meta-synthesis is to identify the extant qualitative research on a given topic and to translate the findings into a single representation offering a fuller understanding of the phenomenon. Synthesis of the commonalties emerging from the results of individual studies enables research on specific interventions to test their usefulness in nursing. The importance of systematic, integrative, synthesized results of non-experimental studies is underscored by the IAHC’s 1998 Synthesis Challenge. Meta-synthesis provides a needed model for conceptualizing a systematically derived research synthesis to guide development of individualized care interventions with predictable therapeutic outcomes.

The Power of Nurse-Client Encounters: Interpreting Spiritual Themes

Both clients and caregivers are confronted with their own spiritual needs in the search for meaning within the health care experience. Yet, time for reflection on the powerful nature and mutuality of care giving is often crowded out by the busyness and intensity of health care. Using a guided reflection technique, 40 nurse participants in five focus groups examined a written nurse-client encounter. Qualitative analysis of the merged data yielded five common themes and descriptive patterns: common elements in the encounter, descriptors portraying the encounter, meanings conveyed by the illness, spiritual needs uncovered, and a framework to apply to practice. Caregivers must be able to see illness as a meaning-intensive experience to be able to help clients understand their own spirituality. The reciprocity of the spiritual connection in health care encounters is proposed as a significant factor in renewal, satisfaction, and healing outcomes for both nurse and client.

Integrating quality and safety science in nursing education and practice

Worldwide, health care delivery systems are applying new quality and safety science in response to startling reports of negative patient outcomes. Many health care professionals lack the knowledge, skills and attitudes to change the systems in which they work, calling for radical redesign of nursing education to integrate new safety and quality science. This paper describes the transformation underway in nursing education in the United States to integrate quality and safety competencies through the Quality and Safety Education for Nurses (QSEN) project. A national expert panel defined the competencies and surveyed US schools of nursing to assess current implementation. To model the changes needed, a 15-school Pilot Learning Collaborative completed demonstration projects and surveyed graduating students to self-assess their achievement of the competencies. A Delphi process assessed level and placement of the competencies in the curriculum to offer educators a blueprint for spreading across curricula. Specialty organisations are cross-mapping the competencies for graduate education, educational standards have incorporated the competencies into their essentials documents, and a train the trainer faculty development model is now helping educators transform curriculum. Two key questions emerge from these findings: Are any of these projects replicable in other settings? Will these competencies translate across borders?