Papers by Adelais Markaki
Innovation in Aging, 2024
Understanding filial piety as it pertains to aging and caregiving among Chinese and Chinese Ameri... more Understanding filial piety as it pertains to aging and caregiving among Chinese and Chinese Americans (CCAs) is expected to bridge the cultural chasm in health care and improve the quality of rendered services. This concept analysis aims to understand the role of filial piety relevant to caring for aging CCAs and to propose an operational definition. We used four databases and followed Walker and Avant’s method for data extraction and analysis. A total of 26 studies met inclusion criteria and were chosen for synthesis. Synthesis of evidence identified four antecedents: (a) filial obligation as a ‘cultural gene’, (b) sense of altruism, (c) familial solidarity, and (d) societal expectation of ‘birth right’. Attributes included: familial material and emotional support, obedience, pious reverence, and societal norm. Consequences were related to caregiver burden, psychological and physical well-being, quality of life, and health equity. Operational definition of filial piety is: an intrinsic desire of adult children to support parents/elders materially and emotionally as well as an extrinsic desire to adhere to the Chinese societal moral tenet to honor family and be honorable children. Future study should examine dual roles of filial piety as a moderator of role appraisal to caregiver burden and as a mediator of resources. The permeating cultural value of filial piety affects help-seeking behavior, caregiving, family relationships, and caregiver health for CCAs. Understanding the meaning, importance, and effect of filial piety for Asians and CCAs is essential for healthcare providers to provide culturally sensitive social and psychological support to caregivers.
BMC Nursing, 2024
Background The culturally sensitive nursing practice has not embedded filial piety as a cultural ... more Background The culturally sensitive nursing practice has not embedded filial piety as a cultural value and stance pertaining to caregiving among aging Chinese and Chinese-American (CCA) families in the United States, yet it is critical for healthy aging among CCAs. Purpose To understand filial piety when caring for aging CCAs and conceptualize an operational definition and framework. Methods A systematic search was conducted in CINAHL, PubMed, Scopus, and PsycINFO databases. Analysis of the concept of filial piety among CCAs used Walker and Avant's methods. Twenty-six studies were selected in the final full-text analysis. Findings Synthesis of evidence identified four antecedents: (a) filial obligation as a 'cultural gene' , (b) sense of altruism, (c) familial solidarity, and (d) societal expectation of 'birth right'. Attributes included familial material and emotional support, obedience, pious reverence, and societal norms. Consequences were related to caregiver burden, psychological and physical well-being, quality of life, and health equity. Conclusion Filial piety is an intrinsic desire to support aging parents and an extrinsic desire to adhere to Chinese societal moral tenets. The proposed operational framework "Caregiving for aging CCAs in the United States" merits further study. Highlights • Filial piety attributes are aging-related material and physical support from family and society. • Filial piety is associated with burden on family caregivers, psychological and physical well-being, quality of life, and health equity. • Culturally-sensitive healthcare services for aging Chinese and Chinese American individuals and families in the U.S. are hindered by lack of awareness of filial piety's effect. • Operationalizing filial piety contributes to bridging the gap in nursing knowledge and understanding of the aging needs of Chinese and Chinese Americans in the U.S.
Journal of Emergency Nursing, 2023
Introduction: Accurate triage assessment by emergency
nurses is essential for prioritizing patien... more Introduction: Accurate triage assessment by emergency
nurses is essential for prioritizing patient care and providing
appropriate treatment. Under-triage and over-triage remain an
ongoing issue in care of patients who present to the emergency
department. The purpose of this literature review was to
examine factors associated with triage accuracy in the emergency
department.
Methods: We conducted an evidence-based literature review
using the Cumulative Index to Nursing and Allied Health Literature,
PubMed, and Embase. The search focused on peer reviewed
articles in English, available in full text, published between
January 2011 and December 2021.
Results: A total of 14 articles met inclusion criteria and
revealed the following 3 themes for triage accuracy: triage
nurse characteristics, patient characteristics, and work environment.
Triage nurses’ accuracy rates ranged from 59.3% to 82%,
with experience in triage associated with higher accuracy. Patient
characteristics influenced triage accuracy, with non-trauma
patients being under-triaged and trauma patients often over-triaged.
The work environment played a role, as accuracy rates
varied based on shift time and patient volume. Competing systems
between prehospital and ED triage posed challenges and
affected accuracy during fluctuations in patient volumes.
Discussion: This review underscores the complex nature of
ED triage accuracy. It highlights the importance of nurse experience,
training programs, patient characteristics, and the work
environment in enhancing triage decision making. Enhanced understanding of these factors can inform strategies to optimize
triage accuracy and improve patient outcomes.
BMC Health Services Research, 2023
Background Using a validated instrument to measure palliative care (PC) educational needs of heal... more Background Using a validated instrument to measure palliative care (PC) educational needs of health professionals is an important step in understanding how best to educate a well-versed PC workforce within a national health system. The End-of-life Professional Caregiver Survey (EPCS) was developed to measure U.S. interprofessional PC educational needs and has been validated for use in Brazil and China. As part of a larger research project, this study aimed to culturally adapt and psychometrically test the EPCS among physicians, nurses, and social workers practicing in Jamaica. Methods Face validation involved expert review of the EPCS with recommendations for linguistic item modifications. Content validation was carried out by six Jamaica-based experts who completed a formal content validity index (CVI) for each EPCS item to ascertain relevancy. Health professionals practicing in Jamaica (n = 180) were recruited using convenience and snowball sampling to complete the updated 25-item EPCS (EPCS-J). Internal consistency reliability was assessed using Cronbach's α coefficient and McDonald's φ. Construct validity was examined through confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). Results Content validation led to elimination of three EPCS items based on a CVI < 0.78. Cronbach's α ranged from 0.83 to 0.91 and McDonald's φ ranged from 0.73 to 0.85 across EPCS-J subscales indicating good internal consistency reliability. The corrected item-total correlation for each EPCS-J item was > 0.30 suggesting good reliability. The CFA demonstrated a three-factor model with acceptable fit indices (RMSEA = 0.08, CFI = 0.88, SRMR = 0.06). The EFA determined a three-factor model had the best model fit, with four items moved into the effective patient care subscale from the other two EPCS-J subscales based on factor loading. Conclusions The psychometric properties of the EPCS-J resulted in acceptable levels of reliability and validity indicating that this instrument is suitable for use in measuring interprofessional PC educational needs in Jamaica.
Journal of Psychosocial Nursing and Mental Health Services, 2022
University students’ health and well-being is critical, especially in the aftermath of the corona... more University students’ health and well-being is critical, especially in the aftermath of the coronavirus disease 2019 pandemic; however, a comprehensive and integrated approach in academic institutions remains neglected. In this context, the local experience from a pilot university-based Student Health Center at an urban campus in Greece is presented. Select health promotion and disease prevention screening and monitoring initiatives are summarized from the viewpoint of a
Strengths, Weaknesses, Opportunities, and Threats analysis, with emerging health needs and policy implications. Long-term sustainability is feasible, only if synergies and close collaboration with other university units and local health authorities are developed. A post-pandemic call to action for intervention programs that integrate physical and mental health care, as well as raise awareness among university stakeholders and health policy makers, is issued.
Journal of Nursing Scholarship, 2023
Introduction
Nursing-sensitive indicators (NSIs) measure factors influencing nursing care quality... more Introduction
Nursing-sensitive indicators (NSIs) measure factors influencing nursing care quality and patient outcomes. Established NSIs reflect general and select specialty nursing practices. However, a core set of NSIs for international pediatric oncology nursing practice does not currently exist. Without valid and reliable quality indicators, the impact of nursing care on children and adolescents with cancer cannot be effectively measured and improved. The purpose of this study was to develop a preliminary core set of NSIs for international pediatric oncology nursing that would be important, actionable, and feasible to measure across varied resource settings and countries.
Design/Methods
A multiphase sequential mixed methods research design, intersected with a classical Delphi method, was utilized. Through purposive snowball sampling, 122 expert pediatric oncology nurses from 43 countries participated. Round One: Panelists identified five potential NSIs and constructs. Open-ended responses were coded and categorized through descriptive content analysis and integrated into the next round. Round Two: Panelists selected their top 10 NSIs and constructs and ranked them by importance to patient care quality. Mean importance scores were calculated through reverse scoring; the top 10 NSIs and constructs were integrated into the next round. Round Three: Panelists ranked the top 10 NSIs and constructs by order of importance for this particular population, then rated each NSI/Construct for actionability and feasibility of measurement by Likert-scale. Rounds Two and Three were analyzed using descriptive statistics. Mixed methods meta-inferences were derived from the integration of Rounds One and Three findings.
Results
Eighty-five (70%) panelists from 38 countries completed all Delphi survey rounds. The preliminary core set of NSIs and constructs identified by the expert panel, and ranked in order of importance, were as follows: safe chemotherapy administration and handling, infection prevention/control, pediatric oncology nursing orientation program, early warning score system/recognition of patient deterioration, chemotherapy/biotherapy education/course, pain assessment/management, symptom assessment/management, patient and family education, palliative/end of life care, and continuing nursing education/competency. All NSIs and constructs were rated as actionable; all but palliative/end of life care were rated as feasible to measure. Each of the 10 NSIs and constructs were nominated in Round One by at least one expert panelist from low- and middle-income and high-income countries, and at least one panelist from the Americas.
Conclusion
Preliminary core NSIs and constructs provide insight into common attributes of international pediatric oncology nursing practice that are important, actionable, and feasible for quality measurement.
Clinical Relevance
NSIs have the potential to drive quality improvement, guide comparison with other institutions, promote knowledge-sharing, and advance pediatric oncology nursing outcomes around the world. These NSIs and constructs may also be relevant to other pediatric and adult oncology settings.
Cureus, 2022
Introduction: Sense of discomfort, which is experienced in daily encounters, can develop into str... more Introduction: Sense of discomfort, which is experienced in daily encounters, can develop into stress, coexist with stress, or interplay with self-efficacy. This study presents two objectives, namely, to develop and test a new instrument called the Emotional Discomfort (EmoD) Scale and to compare the EmoD with the General Self-Efficacy (GSE) Scale.
Methods: The study was conducted in an urban primary healthcare center in Greece over a three-week period in 2020. Out of 314 individuals invited to participate, 263 accepted and completed the questionnaire. The EmoD is a five-point Likert-type eight-item scale for assessing individual reaction and sense of discomfort in daily life situations.
Results: Cronbach’s α for the new scale reached 0.730 (acceptable reliability). Participants who used psychotropic drugs scored higher in the EmoD scale compared with nonusers. GSE scores showed reverse
associations with EmoD scores. Multiple linear regression analysis indicated that an increase in self-efficacy, as measured using the GSE scale, was associated with a reduction in sense of discomfort, as measured by the EmoD scale.
Conclusions: The use of the EmoD scale can aid health or social care providers in detecting levels of emotional discomfort, a finding that is demonstrated to interplay with self-efficacy. Future studies employing the use of this new instrument could examine emotional discomfort in relation to stress coping and social isolation.
BMC Palliative Care, 2021
Background: Provision of palliative care to individuals with late-stage serious illnesses is crit... more Background: Provision of palliative care to individuals with late-stage serious illnesses is critical to reduce suffering. Palliative care is slowly gaining momentum in Jamaica but requires a highly skilled workforce, including nurses. Outmigration of nurses to wealthier countries negatively impacts the delivery of health care services and may impede palliative care capacity-building. This critical review aimed to explore the evidence pertaining to the nurse migration effect on the integration of palliative care services in Jamaica and to formulate hypotheses about potential mitigating strategies. Methods: A comprehensive search in the PubMed, CINAHL, and ProQuest PAIS databases aimed to identify articles pertinent to nurse migration in the Caribbean context. Grant and Booth's methodologic framework for critical reviews was used to evaluate the literature. This methodology uses a narrative, chronologic synthesis and was guided by the World Health Organization (WHO) Public Health Model and the Model of Sustainability in Global Nursing. Results: Data from 14 articles were extracted and mapped. Poorer patient outcomes were in part attributed to the out-migration of the most skilled nurses. 'Push-factors' such as aggressive recruitment by wealthier countries, lack of continuing educational opportunities, disparate wages, and a lack of professional autonomy and respect were clear contributors. Gender inequalities negatively impacted females and children left behind. Poor working conditions were not necessarily a primary reason for nurse migration. Four main themes were identified across articles: (a) globalization creating opportunities for migration, (b) recruitment of skilled professionals from CARICOM by high income countries, (c) imbalance and inequities resulting from migration, and (d) mitigation strategies. Thirteen articles suggested education, partnerships, policy, and incentives as mitigation strategies. Those strategies directly align with the WHO Public Health Model drivers to palliative care integration. Conclusion: Emerged evidence supports that nurse migration is an ongoing phenomenon that strains health systems in Caribbean Community and Common Market (CARICOM) countries, with Jamaica being deeply impacted. This critical review demonstrates the importance of strategically addressing nurse migration as part of palliative care integration efforts in Jamaica. Future studies should include targeted migration mitigation interventions and should be guided by the three working hypotheses derived from this review.
BMC Nursing, 2021
Background: Academic service-learning nursing partnerships (ASLNPs) integrate instruction, reflec... more Background: Academic service-learning nursing partnerships (ASLNPs) integrate instruction, reflection, and scholarship with tailored service through enriched learning experiences that teach civic responsibility and strengthen communities, while meeting academic nursing outcomes. Objective: This scoping review aimed to identify, appraise, and synthesize evidence of community focused ASLNPs that promote primary health care throughout the Americas region. Methods: A systematic search of PubMed, CINAHL, Scopus, Google Scholar, and LILACS English-language databases was performed in accordance with PRISMA guidelines. Full-text articles published since 2010 were reviewed using an inductive thematic approach stemming from the "Advancing Healthcare Transformation: a New Era for Academic Nursing Report" and the Pan American Health Organization "Strategic Directions for Nursing." Results: A total of 51 articles were included with the vast majority 47 (92.1 %) representing North America. Structured, established relationships between an academic nursing institution or program and one or more community serving entities resulted in high levels of effectiveness and innovation across settings. Five themes emerged: (a) sustaining educational standards and processes-improving academic outcomes (25.5 %), (b) strengthening capacity for collaborative practice and interprofessional education (13.7 %), (c) preparing nurses of the future (11.8 %), (d) enhancing community services and outcomes (21.6 %), and (e) conceptualizing or implementing innovative academic nursing partnerships (27.4 %). A synthesis of conceptual frameworks and models revealed six focus areas: communities/populations (26.2 %), nursing (26.2 %), pedagogy (19 %), targeted outreach (14.3 %), interprofessional collaboration (11.9 %), and health determinants (9.5 %). A proliferation in US articles, triggered by nursing policy publications, was confirmed.
BMC Medical Education, 2021
Background: Global demand for standardized assessment of training needs and evaluation of profess... more Background: Global demand for standardized assessment of training needs and evaluation of professional continuing education programs across the healthcare workforce has led to various instrumentation efforts. The Hennessy-Hicks Training Needs Analysis (TNA) questionnaire is one of the most widely used validated tools. Endorsed by the World Health Organization, the tool informs the creation of tailored training to meet professional development needs. The purpose of this project was to describe TNA tool utilization across the globe and critically appraise the evidence of its impact in continuous professional development across disciplines and settings. Methods: A systematic integrative literature review of the state of the evidence across PubMed, Scopus, CINAHL, and Google Scholar databases was carried out. Full-text, peer reviewed articles and published dissertations/theses in English language that utilized the original, adapted or translated version of the TNA tool were included. Selected articles were appraised for type and level of evidence. Results: A total of 33 articles were synthesized using an inductive thematic approach, which revealed three overarching themes: individual, team/interprofessional, and organizational level training needs. Included articles represented 18 countries, with more than two thirds involving high-income countries, and one third middle-income countries. Four studies (12.1%) used the original English version instrument, 23 (69.7%) adapted the original version, and 6 (18.2%) translated and culturally adapted the tool. Twenty-three studies targeted needs at the individual level and utilized TNA to determine job roles and responsibilities. Thirteen articles represented the team/interprofessional theme, applying the TNA tool to compare training needs and perceptions among professional groups. Last, three articles used the tool to monitor the quality of care across an institution or healthcare system, demonstrating the organizational training needs theme. Conclusions: Overall evidence shows that the TNA survey is widely used as a clinical practice and educational quality improvement tool across continents. Translation, cultural adaptation, and psychometric testing within a variety of settings, populations, and countries consistently reveals training gaps and outcomes of targeted continuous professional development. Furthermore, it facilitates prioritization and allocation of limited educational resources based on the identified training needs. The TNA tool effectively addresses the "know-do" gap in global human resources for health by translating knowledge into action.
Western Journal of Nursing Research, 2021
Inadequate transition to practice increases stress for new health care providers and threatens em... more Inadequate transition to practice increases stress for new health care providers and threatens employment longevity. This
integrative review aimed to synthesize the evidence on transition process for newly graduated registered nurses and advanced
practice nurses in hospital settings and to identify enablers/barriers and mitigating strategies. Two databases were systematically
searched for articles that described the process, strategies, participant perceptions, and implications of role transition with a
final yield of 23 articles. Synthesis of the evidence revealed three major themes: (a) achieving competence for safe practice,
(b) addressing stress during transition, and (c) reducing turnover. Emotional support for new graduates was instrumental
to achieving clinical competence. Role transition adaptation was linked to anxiety, while emotional health was positively
associated with retention. Developing best practices that address skill proficiency, attending to the emotional needs of new
nurse graduates, and providing structured transition programs to improve clinical competence are the strategies of choice.
International Journal of Social Psychiatry, 2020
Background: The economic crisis’ effects on suicide rates for countries undergoing or exiting aus... more Background: The economic crisis’ effects on suicide rates for countries undergoing or exiting austerity measures
have been widely debated. This integrative review aimed to identify, appraise, and synthesize available evidence of
employment status effect on suicide mortality rates in Greece during the recent economic recession period.
Methods: A literature review of studies evaluating suicides in the general Greek population, as well as across age and
gender groups, in relation to employment during the economic crisis period was performed. PubMed electronic database
was searched for relevant articles published in English or Greek language from 2009 up to February 2020. Appraisal was
carried out based on the Hierarchy of Evidence Rating System and the GRADE guidelines.
Results: A total of 24 articles met all inclusion criteria with 20 of them at level IV, 2 at level VII, and 2 at level VIII. A
total of 18 studies reported increase of suicide rates during the economic recession period. About 12 studies examined
the co-relation between unemployment and suicide rate, with ten studies showing a positive correlation. Moreover,
thirteen studies reported data on the effect of gender and age variables on suicide rates.
Conclusion: Evidence shows that suicide mortality rates in Greece increased after the eruption of economic recession,
particularly after the implementation of radical austerity measures (2011–2014). This increase was positively correlated
with unemployment and was more prominent among males of working age. Further in depth epidemiological research of
regional variations in terms of profile and contributing or enabling factors of suicidal behavior is needed.
International Nursing Review, 2020
Aim
To critically appraise and synthesize evidence of integrated care stemming from advanced prac... more Aim
To critically appraise and synthesize evidence of integrated care stemming from advanced practice nursing in elderly primary care settings throughout the United States and Thailand.
Background
Advanced practice nurses are key to accelerating integrated elderly care in the community. Yet, their scope and capacity vary greatly across countries, making impact measurement highly challenging.
Methods
A systematic search of PubMed, CINAHL, Scopus and ThaiJo databases was performed. Full‐text articles in English or Thai language were reviewed using an inductive thematic approach from the integrated people‐centred Health Services framework, adopted by the World Health Organization.
Results
A total of 42 articles were appraised according to framework strategies: (1) people and community empowerment/engagement; (2) governance and accountability strengthening; (3) model of care reorientation; (4) service coordination; and (5) enabling environment creation. Collaborative roles and empowerment of older people were associated with higher quality of care. Thai nurses empowered individuals through community networks and resources, incorporating care models (strategy 1). In contrast, US nurses adopted a quality improvement and safety approach, incorporating technology into nursing interventions (strategy 5).
Conclusion
Advanced practice nurses employ an array of strategies and approaches in caring for older people. Although their role varies from mostly substitute (US) to supplemental (Thailand), nurses in both countries contribute towards integrated person‐centred care.
Implication for nursing practice and nursing policy
Preparing advanced practice nurses to work in the community is a prerequisite for meeting ageing population health needs in a sustainable manner. Education, professional development and leadership training opportunities should focus on capacity building in: a) strengthening mutual accountability, b) reorienting the work environment through innovative care models and c) coordinating services through partnerships to achieve universal health and ensure healthy ageing.
Worldviews on Evidence-based Nursing, 2020
Background: Burnout is a substantial phenomenon across healthcare settings, affecting more than h... more Background: Burnout is a substantial phenomenon across healthcare settings, affecting more than half of healthcare professionals and leading to negative patient and health system outcomes. Infusion center professionals (ICPs) are at increased risk of burnout attributed to high
patient volume and acuity levels. Strategies to address burnout have been developed and prioritized by the American Medical Association (AMA), the World Health Organization, and other organizations.
Aims: This quality improvement project aimed to address perceived burnout, job-related stress, and job satisfaction among nurses, physician assistants, and medical assistants at a large pediatric hospital through integration of two infusion center (IC)-based staff engagement
interventions.
Methods: A pre- and post-test study design was used. Existing team huddles in the IC were modified based on the AMA STEPS Forward program recommendations to incorporate appreciative inquiry and recognition into team and department events. Peer recognition was
tailored toward institutional core values. The Mini-Z Burnout survey was administered before and 3 months after implementation of both interventions.
Findings: Pre- to post-intervention responses revealed a higher percentage of staff reporting no burnout (57.7% vs. 75%), low levels of job-related stress (58.8% vs. 65.5%), and satisfaction with current job (70.6% vs. 82.8%). Most participants agreed or strongly agreed that structured huddles (69%) and recognition events (82.8%) were beneficial and recommended continuation (65.5% and 82.8%, respectively). Open-ended responses regarding workplace stressors focused heavily on staffing and patient acuity.
Linking Evidence to Action: Project outcomes support the integration of tailored interventions to reduce burnout among pediatric ICPs. Organizational commitment to addressing burnout can provide incentive to scale up institution-wide staff engagement interventions. Further study is needed to assess the efficiency and effectiveness of such tailored interventions across diverse settings
Nursing Outlook, 2020
Background: The concept of sustainability has received growing attention since the adoption of t... more Background: The concept of sustainability has received growing attention since the adoption of the United Nations’ (UN) Sustainable Development agenda. Yet, in the context of sweeping changes regarding the status and profile of global nursing, sustainability has not been fully conceptualized.
Purpose: To explore the concept of sustainability in global nursing in order to develop an operational definition and model.
Methods: Concept analysis using Rodger’s Evolutionary method to explicate the term “sustainability” in a global nursing context.
Findings: Key features of sustainability were described. Existing models of global nursing focus on partnerships and lack a clear conceptualization and integration of sustainability. An operational definition and model of sustainability in global nursing were developed.
Discussion: Evolutionary review and analysis led to clarity in operationalizing sustainability in global nursing. The definition and model compliment existing models and provide a road map for global nursing to contribute toward the UN Sustainable Development agenda.
Journal of Nursing Education, 2020
Background: Global organizations urge toward transformative,
lifelong learning for nurses and mid... more Background: Global organizations urge toward transformative,
lifelong learning for nurses and midwives. Throughout
Latin America and the Caribbean, strengthening the
quality of nursing and midwifery education is top priority.
A regional partnership of World Health Organization Collaborating
Centers aimed to develop a user-friendly, culturally
relevant, and adaptable educational quality improvement
intervention. Method: Following the five-step ADDIE
process, experts analyzed objectives and needs, designed
activities and assessments, and determined optimum delivery
of course content. A self-directed, asynchronous online
course was developed, in line with regional needs and
mandates. Three sequential online educational modules for
English-speaking and Spanish-speaking nurse and midwife
educators focused on (a) principles of teaching and learning,
(b) instructional strategies, and (c) methods to evaluate
students and courses. Content and design were externally
reviewed and culturally adapted. Conclusion: Upon completion
of pilot testing and evaluation, final course versions
in both languages are expected to become freely accessible.
Revista Latino-Americana de Enfermagem, 2019
Objetivo: apresentar o desenvolvimento de um kit de ferramentas para melhoria da qualidade da edu... more Objetivo: apresentar o desenvolvimento de um kit de ferramentas para melhoria da qualidade da educação em saúde universal e na atenção primária à saúde em escolas de enfermagem e obstetrícia na América Latina e no Caribe. Métodos: um grupo de especialistas realizou uma revisão sistemática da literatura, selecionou conteúdos-chave e desenvolveu uma versão preliminar do kit, através de uma abordagem iterativa de consenso. Posteriormente, esta versão foi submetida a revisão por parceiros internacionais. Foram efetuadas análise dos dados obtidos em entrevista cognitiva, seguida da integração de revisões e de novas ferramentas até a se alcançar a aprovação da versão final. Resultados: vinte e dois estudos foram identificados e mapeados como recursos. O Modelo de Melhoria-uma abordagem baseada em dados para a análise de desempenho-foi selecionado devido a sua ampla difusão e simplicidade na execução das seguintes fases: 1) formação de uma equipe, 2) avaliação das melhorias necessárias na educação em saúde universal e atenção primária à saúde, 3) determinação de objetivos/metas e definição de prioridades com base numa matriz, 4) estabelecimento de métricas, 5) identificação de mudanças, 6) realização de uma série de ciclos de aprendizagem Planeje-Faça-Estude-Atue, e 7) manutenção das mudanças. Conclusões: o Kit de Ferramentas para Melhoria da Qualidade da Educação, desenvolvido a partir do consenso entre as partes envolvidas, representa uma abordagem sistemática, potencialmente adaptável às diversas culturas, para aprimorar aspectos do corpo discente, do corpo docente e de programas de educação relacionados com a cobertura e o acesso à saúde universal.
Revista Latino-Americana de Enfermagem, 2019
Objetivo: presentar el desarrollo de un kit de herramientas para la mejora de la calidad de la ed... more Objetivo: presentar el desarrollo de un kit de herramientas para la mejora de la calidad de la educación en salud universal y atención primaria de salud, dirigido a las escuelas de enfermería y obstetricia en los países de América Latina y el Caribe. Métodos: un grupo de trabajo de expertos realizó una revisión sistemática de la literatura, seleccionó el contenido clave y redactó las herramientas, utilizando un consenso iterativo. Socios internacionales revisaron el kit de herramientas. Se analizaron los datos de la entrevista cognitiva, se integraron las revisiones y las nuevas herramientas, y se aprobó la versión final. Resultados: veintidós artículos fueron identificados y registrados como recursos. Se seleccionó el Modelo para Mejoramiento, un enfoque basado en datos para el análisis del desempeño, por su uso generalizado y sencillez para realizar los siguientes pasos: 1) organizar un equipo, 2) evaluar la necesidad de mejora con respecto a la educación universal en salud y atención primaria de salud, 3) establecer el objetivo e identificar las prioridades utilizando una matriz, 4) establecer métricas, 5) identificar el cambio, 6) llevar a cabo una serie de ciclos de aprendizaje Planear-Hacer-Estudiar-Actuar, y 7) mantener el cambio. Conclusiones: el Kit de Herramientas para la Mejora de la Calidad de la Educación, desarrollado mediante el consenso de las partes interesadas, proporciona un enfoque sistemático y culturalmente adaptable en potencia para mejorar las áreas de los estudiantes, profesores y programas que se encuentran asociados con el acceso y cobertura universal de salud.
Revista Latino-Americana de Enfermagem, 2019
Objective: to present the development of a toolkit for education quality improvement in universal... more Objective: to present the development of a toolkit for education quality improvement in universal health and primary health care, targeting schools of nursing and midwifery in Latin American and Caribbean countries. Methods: an expert work group conducted a systematic literature review, selected key content and completed toolkit drafting, using an iterative consensus approach. International partners reviewed the toolkit. Cognitive debriefing data were analyzed, revisions and new tools were integrated, and the final version was approved. Results: twenty-two articles were identified and mapped as resources. The Model for Improvement, a data-driven approach to performance analysis, was selected for its widespread use and simplicity in carrying out the following steps: 1) organize a team, 2) assess improvement need regarding universal health and primary health care education, 3) set an aim/goal and identify priorities using a matrix, 4) establish metrics, 5) identify change, 6) carry out a series of Plan-Do-Study-Act learning cycles, and 7) sustain change. Conclusions: the Education Quality Improvement Toolkit, developed through stakeholder consensus, provides a systematic, and potentially culturally adaptable approach to improve student, faculty, and program areas associated with universal health coverage and access.
International Nursing Review, 2019
Aim: A reciprocal partnership between two World Health Organization Collaborating Centers in the... more Aim: A reciprocal partnership between two World Health Organization Collaborating Centers in the Americas region aimed to strengthen nursing and midwifery education through innovative integration of high-fidelity simulation.
Methods/Implementation: Immersion of a visiting scholar in six-week training within a North American nursing school (host) solidified simulation champion designation, upon return at the home institution. Next, two expert nursing faculty implemented a train-the-trainer simulation course on-site. Following evaluation and virtual debriefing, a midwifery faculty visited the host institution for second-round training.
Conclusion: This ongoing program targets faculty development needs through a strong academic partnership, built upon global awareness and sustainable engagement.
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Papers by Adelais Markaki
nurses is essential for prioritizing patient care and providing
appropriate treatment. Under-triage and over-triage remain an
ongoing issue in care of patients who present to the emergency
department. The purpose of this literature review was to
examine factors associated with triage accuracy in the emergency
department.
Methods: We conducted an evidence-based literature review
using the Cumulative Index to Nursing and Allied Health Literature,
PubMed, and Embase. The search focused on peer reviewed
articles in English, available in full text, published between
January 2011 and December 2021.
Results: A total of 14 articles met inclusion criteria and
revealed the following 3 themes for triage accuracy: triage
nurse characteristics, patient characteristics, and work environment.
Triage nurses’ accuracy rates ranged from 59.3% to 82%,
with experience in triage associated with higher accuracy. Patient
characteristics influenced triage accuracy, with non-trauma
patients being under-triaged and trauma patients often over-triaged.
The work environment played a role, as accuracy rates
varied based on shift time and patient volume. Competing systems
between prehospital and ED triage posed challenges and
affected accuracy during fluctuations in patient volumes.
Discussion: This review underscores the complex nature of
ED triage accuracy. It highlights the importance of nurse experience,
training programs, patient characteristics, and the work
environment in enhancing triage decision making. Enhanced understanding of these factors can inform strategies to optimize
triage accuracy and improve patient outcomes.
Strengths, Weaknesses, Opportunities, and Threats analysis, with emerging health needs and policy implications. Long-term sustainability is feasible, only if synergies and close collaboration with other university units and local health authorities are developed. A post-pandemic call to action for intervention programs that integrate physical and mental health care, as well as raise awareness among university stakeholders and health policy makers, is issued.
Nursing-sensitive indicators (NSIs) measure factors influencing nursing care quality and patient outcomes. Established NSIs reflect general and select specialty nursing practices. However, a core set of NSIs for international pediatric oncology nursing practice does not currently exist. Without valid and reliable quality indicators, the impact of nursing care on children and adolescents with cancer cannot be effectively measured and improved. The purpose of this study was to develop a preliminary core set of NSIs for international pediatric oncology nursing that would be important, actionable, and feasible to measure across varied resource settings and countries.
Design/Methods
A multiphase sequential mixed methods research design, intersected with a classical Delphi method, was utilized. Through purposive snowball sampling, 122 expert pediatric oncology nurses from 43 countries participated. Round One: Panelists identified five potential NSIs and constructs. Open-ended responses were coded and categorized through descriptive content analysis and integrated into the next round. Round Two: Panelists selected their top 10 NSIs and constructs and ranked them by importance to patient care quality. Mean importance scores were calculated through reverse scoring; the top 10 NSIs and constructs were integrated into the next round. Round Three: Panelists ranked the top 10 NSIs and constructs by order of importance for this particular population, then rated each NSI/Construct for actionability and feasibility of measurement by Likert-scale. Rounds Two and Three were analyzed using descriptive statistics. Mixed methods meta-inferences were derived from the integration of Rounds One and Three findings.
Results
Eighty-five (70%) panelists from 38 countries completed all Delphi survey rounds. The preliminary core set of NSIs and constructs identified by the expert panel, and ranked in order of importance, were as follows: safe chemotherapy administration and handling, infection prevention/control, pediatric oncology nursing orientation program, early warning score system/recognition of patient deterioration, chemotherapy/biotherapy education/course, pain assessment/management, symptom assessment/management, patient and family education, palliative/end of life care, and continuing nursing education/competency. All NSIs and constructs were rated as actionable; all but palliative/end of life care were rated as feasible to measure. Each of the 10 NSIs and constructs were nominated in Round One by at least one expert panelist from low- and middle-income and high-income countries, and at least one panelist from the Americas.
Conclusion
Preliminary core NSIs and constructs provide insight into common attributes of international pediatric oncology nursing practice that are important, actionable, and feasible for quality measurement.
Clinical Relevance
NSIs have the potential to drive quality improvement, guide comparison with other institutions, promote knowledge-sharing, and advance pediatric oncology nursing outcomes around the world. These NSIs and constructs may also be relevant to other pediatric and adult oncology settings.
Methods: The study was conducted in an urban primary healthcare center in Greece over a three-week period in 2020. Out of 314 individuals invited to participate, 263 accepted and completed the questionnaire. The EmoD is a five-point Likert-type eight-item scale for assessing individual reaction and sense of discomfort in daily life situations.
Results: Cronbach’s α for the new scale reached 0.730 (acceptable reliability). Participants who used psychotropic drugs scored higher in the EmoD scale compared with nonusers. GSE scores showed reverse
associations with EmoD scores. Multiple linear regression analysis indicated that an increase in self-efficacy, as measured using the GSE scale, was associated with a reduction in sense of discomfort, as measured by the EmoD scale.
Conclusions: The use of the EmoD scale can aid health or social care providers in detecting levels of emotional discomfort, a finding that is demonstrated to interplay with self-efficacy. Future studies employing the use of this new instrument could examine emotional discomfort in relation to stress coping and social isolation.
integrative review aimed to synthesize the evidence on transition process for newly graduated registered nurses and advanced
practice nurses in hospital settings and to identify enablers/barriers and mitigating strategies. Two databases were systematically
searched for articles that described the process, strategies, participant perceptions, and implications of role transition with a
final yield of 23 articles. Synthesis of the evidence revealed three major themes: (a) achieving competence for safe practice,
(b) addressing stress during transition, and (c) reducing turnover. Emotional support for new graduates was instrumental
to achieving clinical competence. Role transition adaptation was linked to anxiety, while emotional health was positively
associated with retention. Developing best practices that address skill proficiency, attending to the emotional needs of new
nurse graduates, and providing structured transition programs to improve clinical competence are the strategies of choice.
have been widely debated. This integrative review aimed to identify, appraise, and synthesize available evidence of
employment status effect on suicide mortality rates in Greece during the recent economic recession period.
Methods: A literature review of studies evaluating suicides in the general Greek population, as well as across age and
gender groups, in relation to employment during the economic crisis period was performed. PubMed electronic database
was searched for relevant articles published in English or Greek language from 2009 up to February 2020. Appraisal was
carried out based on the Hierarchy of Evidence Rating System and the GRADE guidelines.
Results: A total of 24 articles met all inclusion criteria with 20 of them at level IV, 2 at level VII, and 2 at level VIII. A
total of 18 studies reported increase of suicide rates during the economic recession period. About 12 studies examined
the co-relation between unemployment and suicide rate, with ten studies showing a positive correlation. Moreover,
thirteen studies reported data on the effect of gender and age variables on suicide rates.
Conclusion: Evidence shows that suicide mortality rates in Greece increased after the eruption of economic recession,
particularly after the implementation of radical austerity measures (2011–2014). This increase was positively correlated
with unemployment and was more prominent among males of working age. Further in depth epidemiological research of
regional variations in terms of profile and contributing or enabling factors of suicidal behavior is needed.
To critically appraise and synthesize evidence of integrated care stemming from advanced practice nursing in elderly primary care settings throughout the United States and Thailand.
Background
Advanced practice nurses are key to accelerating integrated elderly care in the community. Yet, their scope and capacity vary greatly across countries, making impact measurement highly challenging.
Methods
A systematic search of PubMed, CINAHL, Scopus and ThaiJo databases was performed. Full‐text articles in English or Thai language were reviewed using an inductive thematic approach from the integrated people‐centred Health Services framework, adopted by the World Health Organization.
Results
A total of 42 articles were appraised according to framework strategies: (1) people and community empowerment/engagement; (2) governance and accountability strengthening; (3) model of care reorientation; (4) service coordination; and (5) enabling environment creation. Collaborative roles and empowerment of older people were associated with higher quality of care. Thai nurses empowered individuals through community networks and resources, incorporating care models (strategy 1). In contrast, US nurses adopted a quality improvement and safety approach, incorporating technology into nursing interventions (strategy 5).
Conclusion
Advanced practice nurses employ an array of strategies and approaches in caring for older people. Although their role varies from mostly substitute (US) to supplemental (Thailand), nurses in both countries contribute towards integrated person‐centred care.
Implication for nursing practice and nursing policy
Preparing advanced practice nurses to work in the community is a prerequisite for meeting ageing population health needs in a sustainable manner. Education, professional development and leadership training opportunities should focus on capacity building in: a) strengthening mutual accountability, b) reorienting the work environment through innovative care models and c) coordinating services through partnerships to achieve universal health and ensure healthy ageing.
patient volume and acuity levels. Strategies to address burnout have been developed and prioritized by the American Medical Association (AMA), the World Health Organization, and other organizations.
Aims: This quality improvement project aimed to address perceived burnout, job-related stress, and job satisfaction among nurses, physician assistants, and medical assistants at a large pediatric hospital through integration of two infusion center (IC)-based staff engagement
interventions.
Methods: A pre- and post-test study design was used. Existing team huddles in the IC were modified based on the AMA STEPS Forward program recommendations to incorporate appreciative inquiry and recognition into team and department events. Peer recognition was
tailored toward institutional core values. The Mini-Z Burnout survey was administered before and 3 months after implementation of both interventions.
Findings: Pre- to post-intervention responses revealed a higher percentage of staff reporting no burnout (57.7% vs. 75%), low levels of job-related stress (58.8% vs. 65.5%), and satisfaction with current job (70.6% vs. 82.8%). Most participants agreed or strongly agreed that structured huddles (69%) and recognition events (82.8%) were beneficial and recommended continuation (65.5% and 82.8%, respectively). Open-ended responses regarding workplace stressors focused heavily on staffing and patient acuity.
Linking Evidence to Action: Project outcomes support the integration of tailored interventions to reduce burnout among pediatric ICPs. Organizational commitment to addressing burnout can provide incentive to scale up institution-wide staff engagement interventions. Further study is needed to assess the efficiency and effectiveness of such tailored interventions across diverse settings
Purpose: To explore the concept of sustainability in global nursing in order to develop an operational definition and model.
Methods: Concept analysis using Rodger’s Evolutionary method to explicate the term “sustainability” in a global nursing context.
Findings: Key features of sustainability were described. Existing models of global nursing focus on partnerships and lack a clear conceptualization and integration of sustainability. An operational definition and model of sustainability in global nursing were developed.
Discussion: Evolutionary review and analysis led to clarity in operationalizing sustainability in global nursing. The definition and model compliment existing models and provide a road map for global nursing to contribute toward the UN Sustainable Development agenda.
lifelong learning for nurses and midwives. Throughout
Latin America and the Caribbean, strengthening the
quality of nursing and midwifery education is top priority.
A regional partnership of World Health Organization Collaborating
Centers aimed to develop a user-friendly, culturally
relevant, and adaptable educational quality improvement
intervention. Method: Following the five-step ADDIE
process, experts analyzed objectives and needs, designed
activities and assessments, and determined optimum delivery
of course content. A self-directed, asynchronous online
course was developed, in line with regional needs and
mandates. Three sequential online educational modules for
English-speaking and Spanish-speaking nurse and midwife
educators focused on (a) principles of teaching and learning,
(b) instructional strategies, and (c) methods to evaluate
students and courses. Content and design were externally
reviewed and culturally adapted. Conclusion: Upon completion
of pilot testing and evaluation, final course versions
in both languages are expected to become freely accessible.
Methods/Implementation: Immersion of a visiting scholar in six-week training within a North American nursing school (host) solidified simulation champion designation, upon return at the home institution. Next, two expert nursing faculty implemented a train-the-trainer simulation course on-site. Following evaluation and virtual debriefing, a midwifery faculty visited the host institution for second-round training.
Conclusion: This ongoing program targets faculty development needs through a strong academic partnership, built upon global awareness and sustainable engagement.
nurses is essential for prioritizing patient care and providing
appropriate treatment. Under-triage and over-triage remain an
ongoing issue in care of patients who present to the emergency
department. The purpose of this literature review was to
examine factors associated with triage accuracy in the emergency
department.
Methods: We conducted an evidence-based literature review
using the Cumulative Index to Nursing and Allied Health Literature,
PubMed, and Embase. The search focused on peer reviewed
articles in English, available in full text, published between
January 2011 and December 2021.
Results: A total of 14 articles met inclusion criteria and
revealed the following 3 themes for triage accuracy: triage
nurse characteristics, patient characteristics, and work environment.
Triage nurses’ accuracy rates ranged from 59.3% to 82%,
with experience in triage associated with higher accuracy. Patient
characteristics influenced triage accuracy, with non-trauma
patients being under-triaged and trauma patients often over-triaged.
The work environment played a role, as accuracy rates
varied based on shift time and patient volume. Competing systems
between prehospital and ED triage posed challenges and
affected accuracy during fluctuations in patient volumes.
Discussion: This review underscores the complex nature of
ED triage accuracy. It highlights the importance of nurse experience,
training programs, patient characteristics, and the work
environment in enhancing triage decision making. Enhanced understanding of these factors can inform strategies to optimize
triage accuracy and improve patient outcomes.
Strengths, Weaknesses, Opportunities, and Threats analysis, with emerging health needs and policy implications. Long-term sustainability is feasible, only if synergies and close collaboration with other university units and local health authorities are developed. A post-pandemic call to action for intervention programs that integrate physical and mental health care, as well as raise awareness among university stakeholders and health policy makers, is issued.
Nursing-sensitive indicators (NSIs) measure factors influencing nursing care quality and patient outcomes. Established NSIs reflect general and select specialty nursing practices. However, a core set of NSIs for international pediatric oncology nursing practice does not currently exist. Without valid and reliable quality indicators, the impact of nursing care on children and adolescents with cancer cannot be effectively measured and improved. The purpose of this study was to develop a preliminary core set of NSIs for international pediatric oncology nursing that would be important, actionable, and feasible to measure across varied resource settings and countries.
Design/Methods
A multiphase sequential mixed methods research design, intersected with a classical Delphi method, was utilized. Through purposive snowball sampling, 122 expert pediatric oncology nurses from 43 countries participated. Round One: Panelists identified five potential NSIs and constructs. Open-ended responses were coded and categorized through descriptive content analysis and integrated into the next round. Round Two: Panelists selected their top 10 NSIs and constructs and ranked them by importance to patient care quality. Mean importance scores were calculated through reverse scoring; the top 10 NSIs and constructs were integrated into the next round. Round Three: Panelists ranked the top 10 NSIs and constructs by order of importance for this particular population, then rated each NSI/Construct for actionability and feasibility of measurement by Likert-scale. Rounds Two and Three were analyzed using descriptive statistics. Mixed methods meta-inferences were derived from the integration of Rounds One and Three findings.
Results
Eighty-five (70%) panelists from 38 countries completed all Delphi survey rounds. The preliminary core set of NSIs and constructs identified by the expert panel, and ranked in order of importance, were as follows: safe chemotherapy administration and handling, infection prevention/control, pediatric oncology nursing orientation program, early warning score system/recognition of patient deterioration, chemotherapy/biotherapy education/course, pain assessment/management, symptom assessment/management, patient and family education, palliative/end of life care, and continuing nursing education/competency. All NSIs and constructs were rated as actionable; all but palliative/end of life care were rated as feasible to measure. Each of the 10 NSIs and constructs were nominated in Round One by at least one expert panelist from low- and middle-income and high-income countries, and at least one panelist from the Americas.
Conclusion
Preliminary core NSIs and constructs provide insight into common attributes of international pediatric oncology nursing practice that are important, actionable, and feasible for quality measurement.
Clinical Relevance
NSIs have the potential to drive quality improvement, guide comparison with other institutions, promote knowledge-sharing, and advance pediatric oncology nursing outcomes around the world. These NSIs and constructs may also be relevant to other pediatric and adult oncology settings.
Methods: The study was conducted in an urban primary healthcare center in Greece over a three-week period in 2020. Out of 314 individuals invited to participate, 263 accepted and completed the questionnaire. The EmoD is a five-point Likert-type eight-item scale for assessing individual reaction and sense of discomfort in daily life situations.
Results: Cronbach’s α for the new scale reached 0.730 (acceptable reliability). Participants who used psychotropic drugs scored higher in the EmoD scale compared with nonusers. GSE scores showed reverse
associations with EmoD scores. Multiple linear regression analysis indicated that an increase in self-efficacy, as measured using the GSE scale, was associated with a reduction in sense of discomfort, as measured by the EmoD scale.
Conclusions: The use of the EmoD scale can aid health or social care providers in detecting levels of emotional discomfort, a finding that is demonstrated to interplay with self-efficacy. Future studies employing the use of this new instrument could examine emotional discomfort in relation to stress coping and social isolation.
integrative review aimed to synthesize the evidence on transition process for newly graduated registered nurses and advanced
practice nurses in hospital settings and to identify enablers/barriers and mitigating strategies. Two databases were systematically
searched for articles that described the process, strategies, participant perceptions, and implications of role transition with a
final yield of 23 articles. Synthesis of the evidence revealed three major themes: (a) achieving competence for safe practice,
(b) addressing stress during transition, and (c) reducing turnover. Emotional support for new graduates was instrumental
to achieving clinical competence. Role transition adaptation was linked to anxiety, while emotional health was positively
associated with retention. Developing best practices that address skill proficiency, attending to the emotional needs of new
nurse graduates, and providing structured transition programs to improve clinical competence are the strategies of choice.
have been widely debated. This integrative review aimed to identify, appraise, and synthesize available evidence of
employment status effect on suicide mortality rates in Greece during the recent economic recession period.
Methods: A literature review of studies evaluating suicides in the general Greek population, as well as across age and
gender groups, in relation to employment during the economic crisis period was performed. PubMed electronic database
was searched for relevant articles published in English or Greek language from 2009 up to February 2020. Appraisal was
carried out based on the Hierarchy of Evidence Rating System and the GRADE guidelines.
Results: A total of 24 articles met all inclusion criteria with 20 of them at level IV, 2 at level VII, and 2 at level VIII. A
total of 18 studies reported increase of suicide rates during the economic recession period. About 12 studies examined
the co-relation between unemployment and suicide rate, with ten studies showing a positive correlation. Moreover,
thirteen studies reported data on the effect of gender and age variables on suicide rates.
Conclusion: Evidence shows that suicide mortality rates in Greece increased after the eruption of economic recession,
particularly after the implementation of radical austerity measures (2011–2014). This increase was positively correlated
with unemployment and was more prominent among males of working age. Further in depth epidemiological research of
regional variations in terms of profile and contributing or enabling factors of suicidal behavior is needed.
To critically appraise and synthesize evidence of integrated care stemming from advanced practice nursing in elderly primary care settings throughout the United States and Thailand.
Background
Advanced practice nurses are key to accelerating integrated elderly care in the community. Yet, their scope and capacity vary greatly across countries, making impact measurement highly challenging.
Methods
A systematic search of PubMed, CINAHL, Scopus and ThaiJo databases was performed. Full‐text articles in English or Thai language were reviewed using an inductive thematic approach from the integrated people‐centred Health Services framework, adopted by the World Health Organization.
Results
A total of 42 articles were appraised according to framework strategies: (1) people and community empowerment/engagement; (2) governance and accountability strengthening; (3) model of care reorientation; (4) service coordination; and (5) enabling environment creation. Collaborative roles and empowerment of older people were associated with higher quality of care. Thai nurses empowered individuals through community networks and resources, incorporating care models (strategy 1). In contrast, US nurses adopted a quality improvement and safety approach, incorporating technology into nursing interventions (strategy 5).
Conclusion
Advanced practice nurses employ an array of strategies and approaches in caring for older people. Although their role varies from mostly substitute (US) to supplemental (Thailand), nurses in both countries contribute towards integrated person‐centred care.
Implication for nursing practice and nursing policy
Preparing advanced practice nurses to work in the community is a prerequisite for meeting ageing population health needs in a sustainable manner. Education, professional development and leadership training opportunities should focus on capacity building in: a) strengthening mutual accountability, b) reorienting the work environment through innovative care models and c) coordinating services through partnerships to achieve universal health and ensure healthy ageing.
patient volume and acuity levels. Strategies to address burnout have been developed and prioritized by the American Medical Association (AMA), the World Health Organization, and other organizations.
Aims: This quality improvement project aimed to address perceived burnout, job-related stress, and job satisfaction among nurses, physician assistants, and medical assistants at a large pediatric hospital through integration of two infusion center (IC)-based staff engagement
interventions.
Methods: A pre- and post-test study design was used. Existing team huddles in the IC were modified based on the AMA STEPS Forward program recommendations to incorporate appreciative inquiry and recognition into team and department events. Peer recognition was
tailored toward institutional core values. The Mini-Z Burnout survey was administered before and 3 months after implementation of both interventions.
Findings: Pre- to post-intervention responses revealed a higher percentage of staff reporting no burnout (57.7% vs. 75%), low levels of job-related stress (58.8% vs. 65.5%), and satisfaction with current job (70.6% vs. 82.8%). Most participants agreed or strongly agreed that structured huddles (69%) and recognition events (82.8%) were beneficial and recommended continuation (65.5% and 82.8%, respectively). Open-ended responses regarding workplace stressors focused heavily on staffing and patient acuity.
Linking Evidence to Action: Project outcomes support the integration of tailored interventions to reduce burnout among pediatric ICPs. Organizational commitment to addressing burnout can provide incentive to scale up institution-wide staff engagement interventions. Further study is needed to assess the efficiency and effectiveness of such tailored interventions across diverse settings
Purpose: To explore the concept of sustainability in global nursing in order to develop an operational definition and model.
Methods: Concept analysis using Rodger’s Evolutionary method to explicate the term “sustainability” in a global nursing context.
Findings: Key features of sustainability were described. Existing models of global nursing focus on partnerships and lack a clear conceptualization and integration of sustainability. An operational definition and model of sustainability in global nursing were developed.
Discussion: Evolutionary review and analysis led to clarity in operationalizing sustainability in global nursing. The definition and model compliment existing models and provide a road map for global nursing to contribute toward the UN Sustainable Development agenda.
lifelong learning for nurses and midwives. Throughout
Latin America and the Caribbean, strengthening the
quality of nursing and midwifery education is top priority.
A regional partnership of World Health Organization Collaborating
Centers aimed to develop a user-friendly, culturally
relevant, and adaptable educational quality improvement
intervention. Method: Following the five-step ADDIE
process, experts analyzed objectives and needs, designed
activities and assessments, and determined optimum delivery
of course content. A self-directed, asynchronous online
course was developed, in line with regional needs and
mandates. Three sequential online educational modules for
English-speaking and Spanish-speaking nurse and midwife
educators focused on (a) principles of teaching and learning,
(b) instructional strategies, and (c) methods to evaluate
students and courses. Content and design were externally
reviewed and culturally adapted. Conclusion: Upon completion
of pilot testing and evaluation, final course versions
in both languages are expected to become freely accessible.
Methods/Implementation: Immersion of a visiting scholar in six-week training within a North American nursing school (host) solidified simulation champion designation, upon return at the home institution. Next, two expert nursing faculty implemented a train-the-trainer simulation course on-site. Following evaluation and virtual debriefing, a midwifery faculty visited the host institution for second-round training.
Conclusion: This ongoing program targets faculty development needs through a strong academic partnership, built upon global awareness and sustainable engagement.
Background: Provision of palliative care to individuals with late-stage serious illnesses is critical to reduce suffering. Palliative care is slowly gaining momentum in Jamaica but requires a highly skilled nursing workforce. Out-migration of nurses to wealthier countries negatively impacts the delivery of health care services and may impede palliative care capacity-building.
Methods: A comprehensive search in the PubMed, CINAHL, and ProQuest PAIS databases aimed to identify articles pertinent to nurse migration in the Caribbean context. Critical review methodology used a narrative, chronologic synthesis and was guided by the World Health Organization (WHO) Public Health Model (PHM) and the Model of Sustainability in Global Nursing.
Results: Data from fourteen articles were extracted and mapped along the following themes: education, partnership, policy, and incentive-based mitigation strategies. Five articles featured nursing education as a strategy to retain nurses. Limited training capacity disincentivizes nurses to stay. Restrictive practice policies and lack of opportunities to collaborate exacerbated this effect. Continuing education strategies and investing in nursing education were key to retention. Interprofessional palliative care training opportunities were highlighted for opening lines of communication, mutual understanding, and respect among health professionals. The emerged themes directly align with the WHO PHM drivers to palliative care integration.
Conclusion: The evidence supported that nurse migration is an ongoing phenomenon that strains health systems in CARICOM countries, with Jamaica being deeply impacted. Findings suggest that Jamaican nurses will be less apt to migrate with improved education opportunities, lifting restrictive practice policies, incentivizing advanced education and leadership roles, and improved renumeration. These outcomes support educational partnerships guided by the Model of Sustainability in Global Nursing and pursued through the Pan-American Health Organization/WHO Collaborating Centers in the region.
Methods: The subcommittee identified a need to build writing skills incrementally across the DNP curriculum. The entire faculty developed strategies to address this need through:
• eliminating or revising writing assignments to better meet program objectives;
• revising course sequencing to introduce scholarly writing in the second semester, after students acclimated to doctoral-level work;
• developing a foundational scholarly writing course wherein faculty emphasize an individual “coach approach”; and
• providing self-paced writing enrichment modules for review before and throughout the DNP program.
Results:
Assignment mapping increased faculty’s awareness and comfort level in building incremental writing skills. The new writing course has received excellent scores and feedback, averaging a 4.73/5 “excellent course” student rating over three semesters. It has already generated two published student manuscripts with two more in progress. Feedback about writing enrichment modules will be available after Fall 2019.
Conclusion: Mastering scholarly writing is an integral skill, requiring systematic exposure and practice within a student-friendly environment. Students need time and ongoing support to reflect on and apply their learning. This educational quality improvement intervention is expected to increase DNP graduates’ ability to contribute towards scholarship and to fully participate in translating evidence-based practice.
In a 2017 staff engagement survey at a pediatric tertiary care center in the Western United States, 74% of Infusion Center (IC) staff reported insufficient time to provide care to patients, 61% reported unreasonable amounts of stress, and 48% were dissatisfied with the recognition received for doing a good job. These results are precursors for burnout which adversely impacts job performance, patient outcomes, and increases job turnover. Burnout is manifested as exhaustion, cynicism, job detachment, and feelings of ineffectiveness.
The Action Collaborative on Clinician Well-Being and Resilience is a top priority for the National Academy of Medicine. Addressing burnout requires action at institutional, state, and national levels through high-standard quality improvement projects. This work is guided by the Quadruple Aim conceptual framework which addresses: 1) improved population health; 2) reduced health costs; 3) patient experience; and 4) improved experience of providing care.
Purpose/Objectives: To evaluate the impact of two new standard staff engagement practices addressing healthcare professional burnout implemented in a pediatric oncology-based tertiary care IC.
Methods: Participants will include nurses, physician assistants, medical assistants, and patient service representatives with a primary job role in the IC. The Mini-Z Burnout Survey, a 10-item questionnaire assessing workplace factors contributing to burnout, has been adapted from the American Medical Association (AMA) Step Forward Program. The survey will be administered prior to the implementation of the new standard staff engagement practices and a second survey will be administered approximately three months after implementation of the new standard practices. New standard staff engagement practices, including daily tailored team huddles and bi-monthly staff recognition events acknowledging hospital core values, will be implemented. Outcome measures will include: burnout, job satisfaction, and job-related stress scores measured prior to and three months after implementation of new standard practices.
Outcomes: The burnout score from the Mini-Z Survey will be the primary outcome measure. Secondary outcome measures will include job-satisfaction and job-related stress scores as measured by the Mini-Z Survey. Completion rates of the huddle checklist and staff recognition events will serve as process measures. Expected outcomes include decreased burnout and job-related stress scores, and increased job satisfaction. Statistical analysis will include Wilcoxon signed rank test for ordinal data and descriptive statistics.
Learning Gaps: Participants will be introduced to the evidence-based practice strategies for addressing well-being of pediatric oncology healthcare professionals and its impact on delivery of compassionate collaborative pediatric oncology care.
Learning Outcomes: To operationalize strategies that develop, integrate, and evaluate healthcare professional well-being practices and compassionate collaborative care within pediatric oncology settings.
1) Define Primary Palliative Care (PPC) and explain its importance for the global health agenda.
2) Understand Alabama’s health outcomes, health care needs and resources.
3) Identify challenges and resources available to implementing PPC in rural Alabama.
4) Describe successful models for teaching and integrating PPC into a rural health system.
Primary health care (PHC) is closely tied to universal health (UH) aiming to reform universal coverage, service delivery, public policy, leadership, and stakeholder participation. Nurses’ and midwives’ actual and potential contribution towards UH and PHC is considerable. In light of the “2020 Nursing Now Campaign” and the “Triad meeting of Nursing and Midwifery”, administrators and faculty in Latin American and Caribbean (LAC) countries are urged to re-examine and re-align their educational program orientation and preparation of graduates.
Aim: To identify quality improvement (QI) resources for LAC schools of nursing and midwifery in order to strengthen UH and PHC outcomes.
Methods
Following a 2016 survey, all identified areas in need for improvement as well as recommendations were extensively studied by an expert group. A self-assessment QI tool guided the narrative literature review and website search. Identified resources were evaluated through a Cognitive Debriefing form.
Results
Using the Model For Improvement (MFI), QI resources were selected if addressing one or more of the following: a) “What are we trying to accomplish?”, b) “How will we know a change is an improvement?”, c) “What change can we make that will result in improvement?”. Resources were grouped under: 1) evidence, 2) best practices, 3) case studies, 4) consultation, 5) curriculum plan development, 6) measures, and 7) implementation. During the ongoing phase, a reconciliation list is developed for final review from stakeholders, including resources in Spanish and Portuguese. The outcome will be disseminated through the PAHO website.
Conclusions
Growing emphasis on UH and PHC signals an urgent need to re-evaluate priorities and goals for nursing and midwifery programs. Being knowledgeable and having easy access to linguistically and culturally adapted QI resources is a start. Integrating seamlessly throughout the plan of study, motivating faculty and students, and changing the organizational culture are the next steps towards truly embracing. Both nursing and midwifery are well equipped to make this paradigm shift.
This presentation will argue an important missing antecedent in operationalizing collaborative practice - This is compassion. Compassion is the heart of hospice and palliative care, and the key to its success in achieving the benefits associated with interprofessional collaboration. In this setting, health care providers come together to advocate, and provide supportive care for the whole person and his or her family from diagnosis through death and bereavement. The presentation will revisit collaborative practice within a hospice-driven focus on compassionate care. It will define a new concept, 'compassionate collaborative practice', present a revised practice model, and introduce strategies to promote and engage care partners in compassionate collaborative practice.
Beginning with an introduction to the historical values associated with the concept of compassion, the text goes on to provide a bio-psycho-social theoretical framework within which the concept might be further explained. The third part presents thought-provoking case studies and explores the implementation and impact of compassion in a range of healthcare settings. The fourth part investigates the role that organizations and their structures can play in promoting or hindering the provision of compassion. The book concludes by discussing how compassion may be taught and evaluated, and suggesting ways for increasing the attention paid to compassion in health care.
Developing a multi-disciplinary theory of compassionate care, and underpinned by empirical examples of good practice, this volume is a valuable resource for all those interesting in understanding and supporting compassion in health care, including advanced students, academics and practitioners within medicine, nursing, psychology, allied health, sociology and philosophy."
Background and significance: Stemming from the UABSON 2017-2020 Strategic Plan, a Global Health Task Force: 1) developed an operational definition and framework for action, and 2) applied the framework in the Faculty Productivity Database (FPD) to capture global health activities.
Project description: A Task Force developed a framework to support and document faculty activities linked to the SDGs. The framework was integrated into the FPD, through a menu-driven guide to capture activities related to SDGs. Following a pilot test of feasibility, acceptability, degree of fit, and framework validity, a toolkit was developed. It was based on the top 10 most relevant SDGs and listed definitions, key indicators, and case studies. Ongoing FDP implementation and evaluation strategies includes faculty forums, troubleshooting support, random record review, user surveys, and toolkit updates.
Conclusions and implications: Integrating a “think globally, act locally” approach to educate faculty and track activities is a promising strategy to raise awareness and accountability. The GH operational framework and FPD tool could measure faculty engagement with the UN 2030 agenda and SDGs.
Health Organization. A plan for nursing & midwifery education quality improvement in universal health and primary health care. [Internet] 2019. Available from:
https://www.uab.edu/nursing/home/images/OCGP/PAHO-WHO/QI-Toolkit-Joint-Publication.pdf