Identifying Nurses’ Perceived Barriers to Mobilizing Patients on a Medical-Surgical Unit: A Quality Improvement Project

Researchers have found that low and moderate levels of mobility are independently associated with greater functional decline in activities of daily living (ADLs) at discharge (Zisberg et al., 2011) and that bedrest promotes declines in muscle mass and muscle strength (Coker et al., 2014; Dirks et al., 2016). The negative effects of low mobility and immobility are recognized by nurses, yet most acute care nurses do not prioritize the mobilization of their patients. Interventions to increase mobilization of hospitalized patients may be more effective if they are barrier targeted. The purpose of this quality improvement project was to identify nurses’ perceived barriers to mobilizing patients on a medical-surgical unit in a community hospital. The project used a 26-item 5-point Likert style survey adapted from the Overall Provider Barriers survey; a validated self-administered survey developed by Hoyer et al. (2015). The survey identified nurses’ perceived barriers in three domains: knowledge, attitudes, and behaviors. A convenience sample of 28 nurses participated in the survey. Results demonstrated that three of the four most reported perceived barriers were in the behaviors domain, which assessed external factors that could influence the respondent’s decision to mobilize or to not mobilize a patient. The highest barriers in the behaviors domain were inadequate staffing, lack of time, and patient resistance to being mobilized. The third highest overall barrier was the perception that increasing patient mobilization would be more work for nurses. This item was in the attitudes domain, which assessed the respondent’s perception of patient safety, needs, and outcomes of mobilization and perception of available time, workload, and ability to mobilize patients. Results were consistent with previous studies that explored barriers to mobilization. Practical implications of the findings are discussed.

Development and Testing of an Acute Care Nurses' Job Satisfaction Scale (ACNJSS)

Background and PurposeFactors affecting nurses' job satisfaction in the acute care setting may differ from nurses working in other settings. The aim of this study was to develop a new tool that measure the job satisfaction of acute care nurses who provide direct patient care.MethodsContent validity then exploratory factor analysis (EFA) were used for validation of the new tool using a random sample of 349 acute care nurses.FindingsThe EFA resulted in 31 items suggesting 6 factors were present in the instrument. The identified factors were: achievement/job interest/responsibility, hospital policy, quality of supervision, peer support/work condition, growth/advancement, and benefits/job security.ConclusionA new tool for measuring acute care nurses' job satisfaction was developed based on a robust theoretical foundation and demonstrated sound psychometric properties.

Promotion or education: a content analysis of industry-authored oral health educational materials targeted at acute care nurses

ObjectivesTo assess the nature, quality and independence of scientific evidence provided in support of claims in industry-authored educational materials in oral health.DesignA content analysis of educational materials authored by the four major multinational oral health product manufacturers.SettingAcute care settings.Participants68 documents focused on oral health or oral care, targeted at acute care clinicians and identified as ‘educational’ on companies’ international websites.Main outcome measuresData were extracted in duplicate for three areas of focus: (a) products referenced in the documents, (b) product-related claims and (c) citations substantiating claims. We assessed claim–citation pairs to determine if information in the citation supported the claim. We analysed the inter-relationships among cited authors and companies using social network analysis.ResultsDocuments ranged from training videos to posters to brochures to continuing education courses. The majority of educational materials explicitly mentioned a product (59/68, 87%), a branded product (35/68, 51%), and made a product-related claim (55/68, 81%). Among claims accompanied by a citation, citations did not support the majority (91/147, 62%) of claims, largely because citations were unrelated. References used to support claims most often represented lower levels of evidence: only 9% were systematic reviews (7/76) and 13% were randomised controlled trials (10/76). We found a network of 20 authors to account for 37% (n=77/206) of all references in claim–citation pairs; 60% (12/20) of the top 20 cited authors received financial support from one of the four sampled manufacturers.ConclusionsResources to support clinicians’ ongoing education are scarce. However, caution should be exercised when relying on industry-authored materials to support continuing education for oral health. Evidence of sponsorship bias and reliance on key opinion leaders suggests that industry-authored educational materials have promotional intent and should be regulated as such.

Transition to comfort-focused care: Moral agency of acute care nurses

Background: Moving into the last phase of life comprises a developmental transition with specific needs and risks. Facilitating transitions is an important component of the work of nurses. When curative interventions are no longer helpful, nurses enact key roles in caring for patients and families. Aim: The aim of this study was to examine the experiences of registered nurses in acute care settings as they worked with patients and families to facilitate transition to comfort-focused care. Research design: Sampling, data collection, and data analysis were guided by constructivist grounded theory, chosen because of its strength in identifying and explicating social processes. Participants and context: A purposeful sample of 26 registered nurses working in acute care hospitals in one community in the northeastern United States participated in this study through semi-structured interviews. Ethical considerations: The study received approval from the university’s Institutional Review Board for the Protection of Human Subjects. Participants provided informed consent. Findings: Nurses facilitated transition to comfort-focused care by enacting their moral commitments to patients and families. They focused on building relationships, honoring patient self-determination, and maintaining respect for personhood. In this context, they discerned a need for transition, opened a discussion, and used diverse strategies to facilitate achieving consensus on the part of patients, family members, and care providers. Regardless of how the process unfolded, nurses offered support throughout. Discussion: Achievement of consensus by all stakeholders is critical in the transition to comfort-focused care. This study deepens our understanding of how nurses as moral agents utilize specific strategies to assist progress toward consensus. It also offers an example of recognizing the moral agency of nurses through listening to their voices. Conclusion: Increased understanding of effective nursing strategies for facilitating transition to comfort-focused care is essential for developing needed evidence for excellent care and strengthening end-of-life nursing education.