EBP Change Process Form Star Model of Knowledge Transformation Capstone

EBP Change Process Form Star Model of Knowledge Transformation Capstone ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON EBP Change Process Form Star Model of Knowledge Transformation Capstone PLEASE USE ATTACHED TEMPLATE TO COMPLETE ASSIGNMENT AND ATTACHED SYSTEMATIC REVIEW FOR REFERENCE PLUS ONE ADDITIONAL OUTSIDE SCHOLARLY SOURCE EBP Change Process Form Star Model of Knowledge Transformation Capstone Identify the topic and the nursing practice issue related to this topic. (This MUST involve a nursing practice issue.)- SELECTED TOPIC: HEALTHY NURSE’S ENVIRONMENT Briefly describe your rationale for your topic selection. Include the scope of the issue/problem. Summary (Evidence to support need for a change) Describe the practice problem in your own words and formulate your PICOT question. Type the complete APA reference for the systematic review selected. List and briefly describe other sources used for data and information. List any other optional scholarly source used as a supplement to the systematic review in APA format. Briefly summarize the main findings ( in your own words ) from the systematic review and the strength of the evidence . Outline one or two evidence-based solutions you will consider for the trial project. REFERENCES: PLEASE USE ATTACHED SYSTEMATIC REVIEW AS A REFERENCE FOR THE SELECTED TOPIC 1 OUTSIDE SCHOLARLY SOURCE systematic_review_of_interventions_to_improve_nurses____work_environments.pdf ebp_process_form_9_19.docx Received: 28 November 2019 | Revised: 17 April 2020 | Accepted: 9 June 2020 DOI: 10.1111/jan.14462 REVIEW Systematic review of interventions to improve nurses’ work environments Jenniffer Torralba Paguio PhD, MA (Nursing), RN1 Jing Jing Su PhD, MSN, RN3 1 College of Nursing, University of the Philippines—Manila, Ermita, Manila, Philippines 2 | Doris Sau Fung Yu PhD, BSc2 | Abstract Aims: To evaluate the current evidence that examined the effects of nurses’ work envi- Faculty of Medicine, School of Nursing, Hong Kong University, Pokfulam, Hong Kong SAR ronment interventions on nurse, patient, and hospital outcomes; and the key interven- 3 Design: Quantitative systematic review without meta-analysis. School of Nursing, the Hong Kong Polytechnic University, Pokfulam, Hong Kong SAR Correspondence Jenniffer Torralba Paguio, College of Nursing, University of the Philippines Manila, Sotejo Hall, Pedro Gil ST., Ermita, Manila, Philippines 1000. Email: [email protected] Funding information None declared. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. tion characteristics. EBP Change Process Form Star Model of Knowledge Transformation Capstone Data Sources: Nine databases (British Nursing Index, CINAHL, EMBASE, Global Health, Global Health Archives, MEDLINE, Ovid Nursing, PubMed, and Web of Science) were searched following Systematic review Without Meta-analysis guideline to elicit studies that examined effects of interventions aimed at improving nurses’ work environments among peer-reviewed publications from inception to April 2019. Methods: Database search used the following keywords: nurs*, patient, hospital, healthcare intervention, organizational improvement, nurs*adj4 outcome, patient adj4 outcome*, hospital adj4 outcome*, and their MeSH terms. The Cochrane’s Risk of Bias in Non-Randomized Studies of Intervention (ROBINS-I) was used for quality appraisal. Donabedian model of Quality of Care was used as the framework to categorize interventions components focusing on structure and process aspects of the nurse work environments. Results: The interventions included the use of accreditation process, educational strategies, and participatory approach. By defining the interventions which demonstrated positive effects on the nurse, patient, and hospital outcomes as effective, it appears that they are more consistently characterized as focusing on process improvement, adopting participatory approach, with greater involvement of frontline and nurse executives and at unit-level implementation. Conclusion: Although the heterogeneity in the design of the review studies precludes making conclusive insights on the best evidence to improve nurses’ work environments, the review informs the major research gaps in the topic area and the ways to design better interventions to enhance the outcomes. Impact: The study provides insights on intervention components and strategies that can contribute to healthy nurse work environments. By adapting unit-level process improvements that actively involve frontline and nurse executives, nurse leaders may provide a more directed approach towards achieving favourable outcomes. EBP Change Process Form Star Model of Knowledge Transformation Capstone KEYWORDS hospital nurses, nurses, nursing, organizational improvement, practice environment, quality improvement, systematic review, work environment J Adv Nurs. 2020;76:2471–2493. wileyonlinelibrary.com/journal/jan © 2020 John Wiley & Sons Ltd | 2471 2472 | 1 | I NTRO D U C TI O N PAGUIO et al. the operational definition of nurses’ work environments as internal structures and processes of the healthcare organization (Lake, 2007). Nurse work environments are crucial in ensuring effective healthcare Structures refer to the characteristics of the setting such as healthcare systems that are responsive to workforce needs towards optimizing facility resources, personnel and organizational structure; processes patient safety, adequate number of staff and skill mix, and ensuring refer to activities, flow of management, and interactions in the orga- high reliability care teams (Aiken & Fagin, 2018; International Council nization; and where these two variables exert influence are outcomes of Nurses [ICN], 2007; Kapinos, Fitzgerald, Greer, Rutks, & Wilt, 2012; that cover nurse, patient, and hospital indicators. Simon et al., 2016). Lake (2007, p.106S) described healthy nurses’ work environments as ‘a professional practice environment [that] supports nurses to function at the highest scope of clinical practice, to work effectively in an interdisciplinary team of caregivers and to mobilize resources quickly.’ Extensive body of evidence supports this definition 2 | TH E R E V I E W 2.1 | Aims and has established the relationship of nurses’ work environments with reduction in adverse events and missed care, in-hospital days and The aim of this study was to evaluate the current evidence that ex- cost, nurse retention, reduction in burnout, and higher job satisfaction amined the effects of nurses’ work environments interventions on (Aiken et al., 2018; MacPhee, Dahinten, & Havaei, 2017; Nantsupawat nurse, patient, and hospital outcomes; and to identify the important et al., 2011; Olds, Aiken, Cimiotti, & Lake, 2017). EBP Change Process Form Star Model of Knowledge Transformation Capstone Consequently, the intervention features or characteristics that may be effective in im- lack of healthy nurses’ work environments has contributed to the proving nurses’ work environments. global nursing workforce crisis due to high staff turnover and shortages, poor working conditions, violence in the workplace, lack of professional development, and unfair pay (Aiken & Fagin, 2018). 1.1 | Background 2.2 | Design We applied a quantitative systematic review without meta-analysis design and followed the Systematic review Without Meta-analysis (SWiM) guideline for reporting this review (Campbell et al., 2020). Comprehensive understanding of factors that shape the nurses’ work environments to develop and implement strategies towards favourable outcomes may help mitigate the negative impact on poor work environments. Over the last two decades, only two systematic reviews explored interventions aimed at improving nurses’ work environments. 2.3 | Search methods 2.3.1 | Search strategy Of the two, one (Schalk, Bijl, Halfens, Hollands, & Cummings, 2010) reviewed 11 controlled intervention studies and found that the most The PICO framework was used to identify key words and MESH effective strategies employed primary nursing, violence prevention, terms which included: population of interest (hospital nurses), the education, and individualized care program. However, the meth- interventions aimed at improving the nurses’ work environments, odological issues prevented authors from making definitive recom- and the impact on nurse outcomes (job satisfaction, burnout, and mendations for nurses’ work environment improvement. Likewise, a intention to leave), nurse-sensitive patient outcomes (falls, medi- U.S.-focused review showed that strategies to improve nurses’ work cation errors, and patient satisfaction), and hospital outcomes environments followed the American Nurses Credentialing Center (safety grade, length of stay, and adverse events). The search (ANCC) standards of skilled communication, true collaboration, effec- was conducted in nine databases: British Nursing Index, CINAHL, tive decision-making, approapriate staffing, meaningful recognition, EMBASE, Global Health, Global Health Archives, MEDLINE, and authentic leadership, but studies were limited at a descriptive Ovid Nursing, PubMed, and Web of Science from inception to level (Wei, Sewell, Woody, & Rose, 2018). EBP Change Process Form Star Model of Knowledge Transformation Capstone Both reviews recommended April 2019. Searches used the following keywords nurs*, patient, that future research on nurses’ work environments improvement use hospital, healthcare intervention, organizational improvement, controlled studies that tested the effect of interventions using pre/ nurs*adj4 outcome, patient adj4 outcome*, hospital adj4 outcome*, posttest measures. As such, this review will expand this evidence by and their Mesh terms. Details of the keywords used and the full including experimental studies conducted internationally from the last search strategies used for MEDLINE are listed in Supplementary decade and critically analyse the tested interventions to give guid- Material 1 as an illustration. ance for nursing administrators in designing, testing, and achieving improved nurse, patient, and hospital outcomes. The Donabedian Quality of Care model is used to examine the focus 2.3.2 | Inclusion/exclusion criteria of strategies towards nurses’ work environment improvement by looking at structures, processes, and outcomes (Ameh, Gómez-Olivé, Kahn, Studies included those published in peer-reviewed journals Tollman, & Klipstein-Grobusch, 2017; Donabedian, 2005) by aligning using the English language and met the following criteria: use of Study design Survey design; pre-post Quasi-experimental design; pre-post; with control group Quasi-experimental design; pre-post; with control group Quasi-experimental design; pre-post; no control group Survey design; pre-post Quasi-experimental design; Interrupted time series; with control group Pre-posttest design; no control Aiken et al. (2008) (United Kingdom) Aitken et al. (2011) (Australia) Calarco (2011) (Australia) Cann and Gardner (2012) (Australia) Ceravolo et al. EBP Change Process Form Star Model of Knowledge Transformation Capstone (2012) (Unites States of America) Dearmon et al. (2013) (Unites States of America) Fennimore and Wolf (2011) (Unites States of America) Characteristics of included studies Reference (country of Origin) TA B L E 1 University hospital; Nurse executives; Pre N = 22, Post N = 21 Trauma Centre; Staff Nurses; and Nurse Executives; C: N = 25, I: N = 30 Five hospitals; Staff Nurses; and Nurse Executives (1,118); T1 N = 703 (34%) T2 N = 485 (23%) Acute surgical ward; Staff Nurses; Pre N = 32, Post N = 34 29 General units, 1 hospital; Nurse Executives; C: pre N = 747, post N = 508 I: pre N = 329, post N = 373 General intensive care units; Staff nurses; C: pre N = 53, post N = 57 I: pre N = 84, post N = 55 Acute, long-term & primary care hospitals; Staff Nurses and Nurse Executives; T1 N = 128 (53%) T2 N = 109 (50%) Settings, participants (response rate) Leadership Development for Nursing Middle Managers (40 hr); Process improvement on evidence-based leadership strategies [Educational approach] Nurse outcome: Leadership (ns) Patient outcomes: Satisfaction (ns) Falls (+) (p < 0.001) Workload (+) (p < 0.0001) Quality care (+) (p < 0.05) (Continues) Nurse outcome: Autonomy (ns) Hospital outcome: Turnover (ns) Awareness of lateral violence and assertive communication (60–90 min); Processfocused intervention on communication skills [Educational approach] Transforming Care at the Bedside (TCAB) (2 years); Quality improvement process using PDSA [Participatory approach] Patient outcomes: Satisfaction (+) (p < 0.001) Falls (ns) Medication errors (ns) Nurse outcomes: NWE (ns) Leadership (ns) Nurse outcomes: NWE (ns) Job satisfaction (ns) Autonomy (ns) Leadership (ns) Nurse outcomes: NWE (+) (p < 0.001) Job satisfaction (+) (p = 0.008) Burnout (ns) Intention to leave (+) (p = 0.03) Autonomy (+) (p < 0.01) Leadership (+) (p < 0.001) Hospital outcome: Workload (ns) Outcomes (direction of effect, p value) Practice Partnership Model of Care (6 months); Structures and processes quality improvement on teamwork, handover, comfort rounds, & setting modification [Participatory approach] Positive Organizational Scholarship (6 days); Process-focused intervention on organizational practices [Educational approach] Nursing Rounds (1 year); Process-focused intervention on optimizing nursing care [Participatory approach] Magnet® accreditation (2 years); Quality improvement process to implement 14 Forces of Magnetism [Accreditation process] Intervention name (duration), delivery (methodology) PAGUIO et al. EBP Change Process Form Star Model of Knowledge Transformation Capstone | 2473 Study design Quasi-experimental design; Interrupted time series; with control group (Pilot study) Quasi-experimental design; pre-post; with control group Pre- and posttest design; Quasi-experimental no control group Quasi-experimental design; pre-post; no control group Survey design; pre-post Pre-posttest design; Interrupted time series Gardner et al. (2009) (Australia) Hall et al. (2008) (Canada) Jeon et al. (2018) (Korea) Lavoie-Tremblay et al. (2014) (Canada) Meraviglia et al. (2009) (USA) Schneider et al. (2019) (Germany) (Continued) Reference (country of Origin) TA B L E 1 Emergency department; Staff Nurses; and Nurse Executives (29); T1 44.7%), T2 (46.5%) Rural hospital; Staff Nurses; and Nurse Executives (2,285) T1 N = 1,149 (48%) T2 N = 1,136 (51%) Health Circle meetings (7 months); Quality improvement process using action planning and implementation [Participatory approach] Nurse Friendly® hospital accreditation (9 months); Quality improvement process to meet 12 NF hospital criteria [Accreditation process] Transforming Care at the Bedside (TCAB) (21 months); Quality improvement process using PDSA [Participatory approach] Ethical Leadership Program (6 months, 7 sessions); Process improvement on competencies for ethical leadership [Educational approach] Tertiary referral hospital; Staff Nurses (158); and Nurse Executives (44) Multispecialty units; Staff nurses; T1 (64%), T2 (59%) Workplace change (6 months); Quality improvement process on workplace change initiatives [Participatory approach] Patient Comfort Rounds (2 months); Process improvement through bedside discussions on patient comfort measures [Participatory approach] Intervention name (duration), delivery (methodology) Teaching and community hospital; Staff Nurses (296); and Nurse Executives (16) Acute surgical units; Staff nurses (168); C: N = 23, I: N = 16 Settings, participants (response rate) | (Continues) Nurse outcomes: Job satisfaction (?) (p = 0.01) Burnout (?) (p = 0.01) Intention to leave (?) (p < 0.01) Autonomy (+) (p = 0.014) EBP Change Process Form Star Model of Knowledge Transformation Capstone Patient outcomes: Satisfaction (+) (? = 0.02, p = 0.02) Medication errors (ns) Hospital outcomes: Workload (+) (p = 0.010) Quality care (+) (? = ?0.02, p = 0.01) Nurse outcome: NWE (+) (p < 0.001) Nurse outcomes: Burnout (ns) Autonomy (ns) Nurse outcomes: NWE (ns) Job satisfaction (ns) Intention to leave (ns) Autonomy (+) (p < 0.001; 4.04 [1.10,6.98]) Leadership (ns) Nurse outcomes: NWE (+) (p = 0.0214) Job satisfaction (ns) Burnout (ns) Leadership (ns) Hospital outcome: Quality care (ns) Nurse outcomes: NWE (+) (p < 0.05) Autonomy (ns) Patient outcome: Satisfaction (ns) Outcomes (direction of effect, p value) 2474 PAGUIO et al. | PAGUIO et al. 2475 Nurse outcomes: NWE (?) (? = ?1.40, p < 0.001) Job satisfaction (?) (p < 0.05; 0.57 [0.39,0.91]), (p < 0.05; 0.54 [0.33,0.86]) Burnout (?) (? = 0.28, p < 0.01) Intention to leave (ns) Hospital outcome: Workload (?) (? = 0.24, p < 0.001) Quality care (?) (p < 0.01; 0.54 [0.35,0.84]) measures; involved hospital nurses; and implemented interventions directed at improving the nurses’ work environments. Studies with or without a control group were included to provide more information about the possible design for improving nurses’ work environments. Studies were excluded if they were non-primary studies, did not include baseline and quantifiable measures to reflect intervention effect, conducted in non-hospital setting, and did not include nurses as participants. 2.3.3 | Screening Productive Ward Program (4 years); Quality improvement process using PDSA on teamwork; and patient safety [Participatory approach] Duplicates and non-primary studies were removed using ProQuest® RefWorks. The two reviewers (Author 1 & Author 3) independently screened the titles, abstracts, and full texts twice based on the selection criteria. 2.4 | Search outcome and data extraction Two reviewers (Author 1 and Author 3) independently extracted data including the author, year, study objective, study design, samples, intervention (including conceptual focus and fidelity), and nurses’ work environment outcomes using standard information extraction table. EBP Change Process Form Star Model of Knowledge Transformation Capstone The characteristics of nurses’ work environments intervention programs were categorized according to the implementation strategies on Note:: ‘+’, favourable or positive change; ‘? ‘, unfavourable or negative change; ‘ns’, not significant. Acute care units of a university hospital; Staff Nurses; and Nurse Executives (878) T1 N = 293, T2 N = 324, T3 N = 261 (60%–70%) Survey design; pre-post Van Bogaert et al. (2017) (Belgium) Reference (country of Origin) TA B L E 1 (Continued) Study design Settings, participants (response rate) Intervention name (duration), delivery (methodology) Outcomes (direction of effect, p value) quasi-experimental or experimental designs with pre- and posttest nurses’ work environments structures, processes, or both according to the Donabedian model. Acceptability of the intervention generated from process evaluation was synthesized to explore the feasibility, appropriateness, and meaningfulness of nurses’ work environment improvement interventions (Heyvaert, Maes, & Onghena, 2011). 2.5 | Quality appraisal Two reviewers (Author 1 & Author 3) assessed the methodological quality independently using Cochrane’s Risk of Bias in NonRandomized Studies of Intervention (ROBINS-I) which evaluates the methodological quality of non-randomized studies based on seven domains of bias (Supplementary Material 2). It consists of four categories of risk of bias judgements ‘Critical’, ‘Serious’, ‘Moderate’, and ‘Low’, where ‘Low’ risk corresponds to the risk of bias in a high-quality randomized trial (Sterne et al., 2016). EBP Change Process Form Star Model of Knowledge Transformation Capstone Studies that were evaluated as ‘Serious’ risk were evaluated to identify presence of significant effect on outcome change and were included with caution, while those with ‘Critical risk’ were excluded. 2.6 | Synthesis Meta-analysis was less possible due to the great diversity in the approach and intervention design used to improve the nurse 2476 | PAGUIO et al. work environments as well as the use of different outcomes developed countries including: Australia (4); Belgium (1); Canada among the reviewed studies. More specifically, the tested inter- (2); Germany (1); Korea (1); UK (1); and USA (4). Nine (N = 9, 64.28%) ventions are of great variation in terms of the approach being focused on improving nurse work environment processes, while used, the mode of intervention delivery, and the key content five studies (N = 5, 35.71%) combined process improvement with and activities. Although all the studies focused on nurse, pa- modifications in nurses’ work environments structures. Strategies tient, and hospital outcomes, different aspects among these used in each intervention belonged to three categories: educational categories were captured in evaluating the intervention effects approach, accreditation process, and participatory approach. These (Table 1). interventions were measured against nurse, patient, and hospi- Due to the heterogeneity among the reviewed studies, the studies were grouped by intervention methodology as follows: educa- tal outcomes. Table 1 summarizes the characteristics of included studies. tional, participatory, accreditation, and by the Donabedian model component of focus as either structure (staffing and workload improvement, policy development, professional development, and en- 3.2 | Quality appraisal vironmental modification) or process (nursing care, teamwork and communication, autonomy, leadership, application of rapid improve- Three studies were excluded after being evaluated as ‘Critical’ ment process, and action planning) improvement. Nurses’ work risk based on ROBINS-I (Oberlies, 2014; Parsons, 2004; Rickard environ … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10