Iowa Implementation for Sustainability Framework

Background An application-oriented implementation framework designed for clinicians and based on the Diffusion of Innovations theory included 81 implementation strategies with suggested timing for use within four implementation phases. The purpose of this research was to evaluate and strengthen the framework for clinician use and propose its usefulness in implementation research. Methods A multi-step, iterative approach guided framework revisions. Individuals requesting the use of the framework over the previous 7 years were sent an electronic questionnaire. Evaluation captured framework usability, generalizability, accuracy, and implementation phases for each strategy. Next, nurse leaders who use the framework pile sorted strategies for cultural domain analysis. Last, a panel of five EBP/implementation experts used these data and built consensus to strengthen the framework. Results Participants (n = 127/1578; 8% response) were predominately nurses (94%), highly educated (94% Master’s or higher), and from across healthcare (52% hospital/system, 31% academia, and 7% community) in the USA (84%). Most (96%) reported at least some experience using the framework and 88% would use the framework again. A 4-point scale (1 = not/disagree to 4 = very/agree) was used. The framework was deemed useful (92%, rating 3–4), easy to use (72%), intuitive (67%), generalizable (100%), flexible and adaptive (100%), with accurate phases (96%), and accurate targets (100%). Participants (n = 51) identified implementation strategy timing within four phases (Cochran’s Q); 54 of 81 strategies (66.7%, p < 0.05) were significantly linked to a specific phase; of these, 30 (55.6%) matched the original framework. Next, nurse leaders (n = 23) completed a pile sorting activity. Anthropac software was used to analyze the data and visualize it as a domain map and hierarchical clusters with 10 domains. Lastly, experts used these data and implementation science to refine and specify each of the 75 strategies, identifying phase, domain, actors, and function. Strategy usability, timing, and groupings were used to refine the framework. Conclusion The Iowa Implementation for Sustainability Framework offers a typology to guide implementation for evidence-based healthcare. This study specifies 75 implementation strategies within four phases and 10 domains and begins to validate the framework. Standard use of strategy names is foundational to compare and understand when implementation strategies are effective, in what dose, for which topics, by whom, and in what context.

Supporting the Development of Informatics Competencies Among Senior Nurse Leaders in Canada

This poster will provide an overview of the various initiatives completed to support the development of informatics competencies among senior nurse leaders in Canada. These initiatives have included a literature review to uncover competencies of relevance to the Canadian context, and a Delphi study to achieve consensus on the competencies for Canada. Current and future plans will be discussed to translate these competencies into practice among senior nurse leaders.

Ethical dilemmas in nursing documentation

Background: Nursing documentation is an essential aspect of ethical nursing care. Lack of awareness of ethical dilemmas in nursing documentation may increase the risk of patient harm. Considering this, ethical dilemmas within nursing documentation need to be explored. Aim: To explore ethical dilemmas in nurses’ conversations about nursing documentation. Research design, participants and context: The study used a qualitative design. Participants were registered nurses from a Patient Hotel at a Danish University Hospital. Data were collected in three focus groups with a total of 12 participants. Data analysis consisted of qualitative content analysis inspired by Graneheim and Lundman. Ethical consideration: This study was conducted in accordance with the ethical principles of research and regulations in terms of confidentiality, anonymity and provision of informed consent. Findings: Ethical dilemmas were strongly present in nurses’ conversations about nursing documentation. These dilemmas were demonstrated in two themes: (1) a dilemma between respecting patients’ autonomy and not causing harm, which was visible in nurses’ navigation between written documentation and oral tradition, and (2) a dilemma concerning justice and fair distribution of goods, which was visible in nurses’ balancing between documenting deviations and proof of nursing practice. Discussion: Ethical dilemmas in nursing documentation regarding respecting patients’ autonomy and not causing harm accentuated discussions on professional responsibility and patient participation in clinical decisions. Dilemmas in justice and fair distribution of goods emphasised discussions on trust in relationships versus trust in electronic health records. Conclusion: Actual tendencies in the healthcare system may increase ethical dilemmas in nursing documentation. Sharing otherwise invisible and individual experiences of ethical dilemmas in nursing documentation among nurses, nurse leaders and decision-makers will enable addressing these in reflections and discussions as well as in considering adjustments of conditions for nursing documentation.

Nurse Leader Breaks Through Glass Ceiling: Making History as First Air Force Nurse Major General (1999-2005)

ABSTRACT Introduction There is a gap in the nursing literature about the significant contributions of executive military nurse leaders to the advancement of nursing as a profession and into interprofessional leadership roles. Many executive military nurse leaders have demonstrated the value of nursing leadership in non-traditional roles and paved the way to expand the leadership opportunities for nurses who would follow. The purpose of this study is to explore the personal stories, experiences, leadership strategies, and lessons learned through the eyes of the first nurse to achieve the rank of Major General in the U.S. Air Force. Materials and Methods The oral history method guided the exploration of participant memories and experiences. In compliance with the Oral History Association guidelines, the investigator obtained Institution Review Board permission, informed consent, and audiotaped interviews. An expert panel provided feedback on the appropriate language use in semi-structured interview questions with Air Force nurse executives. The oral history method provided a framework for the semi-structured interview and analysis. Active listening techniques such as exploration, clarifying, and paraphrasing helped foster deep listening. A graduate research assistant transcribed the 4-hour interview verbatim. The primary investigator emailed a copy of the transcript to the participant to verify accuracy and clarify content. Analysis involved examination and interpretation of the professional, military, nursing, and participant’s personal perspective to enhance historical understanding. Three independent coders extracted prevalent themes and subthemes during analysis. Results Repetitive major themes of courage, figuring it out, and winning others over emerged during data analysis. The major theme of courage has corresponding subthemes of tenacity, risk-taking, and re-writing the narrative. The major theme of figuring it out has subthemes of optimism, creativity, connectedness, learning, and managing change. Lastly, the winning others over theme has subthemes of emotional intelligence, teamwork, role-model/mentor, and moving from outsider to insider. The leadership strategies of taking calculated risks while remaining calm, being open to opportunities that she had never considered, and spending time learning new skills contributed to repeated advancement into higher leadership positions not previously held by a nurse within the U.S. Air Force. Conclusion The interview is packed full of leadership lessons that are just as relative today as 20 years ago. This presentation will conclude with a discussion of the most effective leadership strategies, the lasting impact of the leadership accomplishments, and current implications for nurse leaders today.