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BackgroundNurse champions are front-line practitioners who implement innovation and reconstruct policy.PurposeTo understand through a network theory lens the factors that facilitate nurse champions' engagement with radical projects, representing their actions as street-level bureaucrats (SLBs).Materials and methodsA personal-network survey was employed. Ninety-one nurse champions from three tertiary medical centers in Israel participated.FindingsGiven high network density, high levels of advice play a bigger role in achieving high radicalness compared with lower levels advice. High network density is also related to higher radicalness when networks have high role diversity.DiscussionUsing an SLB framework, the findings suggest that nurse champions best promote adoption of innovation and offer radical changes in their organizations through professional advice given by colleagues in their field network. Healthcare organizations should establish the structure and promote the development of dense and heterogeneous professional networks to realize organizations' goals and nurses' responsibility to their professional employees, patients, and society.

Abstract Aim To explore nurses’ experiences with work interruptions (WIs) through the lens of missed nursing care (MNC). Design A qualitative descriptive design. Methods Eleven small focus groups involving 34 nurses (three nurses per group on average) from acute‐care hospital wards were conducted. Nurses shared their experiences with WIs (sources, reactions and decisions) from the MNC perspective. Data analysis was conducted via content analysis. Results A preponderant theme emerged—the dynamic of controllability. Nurses who perceived a sense of controllability felt that they could decide whether to accept or reject the WI, regardless of WI type, and emotions of anger emerged. Conversely, nurses who did not perceive sense of controllability attended the secondary task: MNC occurred, and distress emotions emerged. Results emphasized that nurses are active agents prioritizing whether to omit or complete care in the face of WIs. Controllability, accompanied by active negative emotions, perpetuate a prioritization process that makes it less probable that MNC occurs.

BackgroundDespite calls for interprofessional teamwork to ensure quality care in healthcare settings, interprofessional teams do not always perform effectively. There is evidence that professional stereotypes inhibit effective interprofessional teamwork, but they haven’t been explored as a phenomenon that impacts team’s performance and quality of care.ObjectivesTo focus on professional stereotypes emerging in interprofessional teams and examine the contingency effects of interprofessional team’s faultlines, professional stereotypes, and leader’s championship behaviors on team’s quality of care.MethodsA cross-sectional nested sample of 59 interprofessional teams and 284 professionals, working in geriatric long-term-care facilities in Israel. Additionally, five to seven of the residents of each facility were randomly sampled to obtain the outcome variable. Data collection employed a multisource (interprofessional team members), multimethod (validated questionnaires and data from residents’ health records) strategy.ResultsThe results indicated that faultlines are not directly harmful to team’s quality of care; instead, they are likely to impact quality of care only when team stereotypes emerge. Furthermore, whereas teams typified by high professional stereotypes require person-oriented championship leadership, for teams typified by low team stereotypes, championship leadership harms the quality of care they provide.ConclusionThese findings have implications for handling interprofessional teams. Practically, leaders must be well-educated to better analyze team members’ needs and maintain the appropriate leadership style.

BackgroundNurse champions are front-line practitioners who implement innovation and reconstruct policy.PurposeTo understand through a network theory lens the factors that facilitate nurse champions’ engagement with radical projects, representing their actions as street-level bureaucrats (SLBs).Materials and methodsA personal-network survey was employed. Ninety-one nurse champions from three tertiary medical centers in Israel participated.FindingsGiven high network density, high levels of advice play a bigger role in achieving high radicalness compared with lower levels advice. High network density is also related to higher radicalness when networks have high role diversity.DiscussionUsing an SLB framework, the findings suggest that nurse champions best promote adoption of innovation and offer radical changes in their organizations through professional advice given by colleagues in their field network. Healthcare organizations should establish the structure and promote the development of dense and heterogeneous professional networks to realize organizations’ goals and nurses’ responsibility to their professional employees, patients, and society.

ABSTRACT Aims Design Methods Results Conclusions Implications for the Profession and/or Patient Care Impact Reporting Method Patient or Public Contribution To compare nurses' and patients' reports of missed nursing care, explore patients' perspectives and utilise these insights to elucidate discrepancies or congruence between perceptions.A descriptive mixed‐methods design combining quantitative (questionnaires) and qualitative (semi‐structured interviews) methods.In the quantitative phase, 143 nurses and 643 patients completed the MISSCARE and MISSCARE‐Patient surveys. Correlations between their total missed care scores were examined. In the qualitative phase, 68 patients participated in semi‐structured interviews analysed using thematic analysis.The correlation between nurses' and patients' perceptions of missed nursing care was nonsignificant. Qualitative findings revealed three themes: (1) patients' need to preserve individuality; (2) most patients attributed missed care to systemic factors, while some attributed it to nurses' attitudes and (3) emotional responses varied from empathetic understanding, inadvertently enabling more missed care, to frustration and assertiveness to ensure receiving necessary care.This study reveals a significant discrepancy between nurses' and patients' perceptions of missed care. Patient perspectives offer insights into this misalignment, highlighting differences in care priorities and role understanding.Enhancing nurse–patient communication and patient empowerment are crucial. Healthcare institutions should integrate patient feedback into quality initiatives, create supportive work environments and foster a patient‐centred care culture. Effectively marketing nurses' expertise and implementing strategies to manage patient assertiveness are essential.This study addresses the discrepancy in perceptions of missed nursing care between nurses and patients. It reveals how patients' care priorities and attributions influence their experience of missed care. Findings will impact healthcare policymakers, nursing educators and hospital administrators, informing strategies to improve care quality, patient satisfaction and nurse work environments across healthcare settings.The study has adhered to STROBE guidelines for the quantitative component and SRQR guidelines for the qualitative component.No patient or public contribution. [ABSTRACT FROM AUTHOR]

BackgroundThe foundation of a safe practice is accountability, especially outcome- rather than process-focused accountability, particularly during pandemics such as COVID-19. Accountability is an essential behavior that promotes congruence between nursing actions and standards associated with quality of care. Moreover, the scant research examining whether one accountability focus is superior in motivating humans to better task performance yields inconclusive results.AimsSystematically examine the effect of an outcome- vs. process-accountability focus on performance and identify any moderating variables.DesignSystematic review and meta-analysis.Data sourcesPsycINFO, Medline, PubMed, Scopus, and CINAHL databases, with all publications to November 2020.Review methodsA systematic search using Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. Statistical analysis and forest plots were performed using MetaXL 5.3. Heterogeneity was presented using I2 statistics and Q tests, and possible publication bias was assessed with a Doi plot and the LFK index.ResultsSeven studies representing nine experiments involving 1,080 participants were included. The pooled effect of the nine experiments on task performance failed to show significant differences (mean = −0.09; 95% Confidence Interval [95%CI]: −0.21, 0.03), but a significant moderating effect of task complexity was demonstrated. Specifically, outcome accountability exerts a beneficial effect in complex tasks (mean = −0.48 [95%CI: −0.62, −0.33]) whereas process accountability improves the performance in simpler tasks (mean = 0.96 [95%CI: 0.72, 1.20]).ConclusionThese findings demonstrated that accountability focus by itself cannot serve as a sole motivator of better performance, because task complexity moderates the link between accountability focus and task performance. Outcome accountability exerts a beneficial effect for more-complex tasks, whereas process accountability improves the performance of simpler tasks. These findings are crucial in nursing, where it is typically assumed that a focus on outcomes is more important than a focus on processes.

Aims Design Methods Results Conclusion Implication for the Profession and/or Patient Care Impact Reporting Method Patient or Public Contribution To examine a novel moderated‐mediation model, investigating whether personal accountability moderates the link between nurse workload and missed nursing care and whether missed nursing care mediates the association between workload and moral distress.Nested diary study.Data spanning from February 2019 to February 2023 were collected from 137 nurses working in various inpatient wards in two medium‐sized hospitals. Nurses reported care given to specific patients on three to five occasions across different shifts, establishing nurse‐patient dyads. Validated measures of missed nursing care, personal accountability, moral distress and workload were analyzed using mixed linear models to test the nested moderated‐mediation model.Under high workload conditions, nurses with higher personal accountability reported lower frequencies of missed nursing care compared to those with lower personal accountability. In contrast, under low workload conditions, personal accountability did not significantly influence missed nursing care occurrences. Furthermore, the interaction between workload and personal accountability indirectly affected nurses' moral distress through missed nursing care. Specifically, higher personal accountability combined with lower missed nursing care contributed to reduced levels of moral distress among nurses.The study highlights accountability's dual role—safeguarding against care omissions and influencing nurses' moral distress amid rising workload pressures.Cultivating a culture of accountability within healthcare settings can serve as a protective factor against the negative effects of workload on patient care quality and nurse psychological distress, highlighting the need for organizational interventions to promote accountability among nursing staff.By recognizing accountability's pivotal role, organizations can implement targeted interventions fostering accountability among nurses, including training programs focused on enhancing responsibility/ownership in care delivery and creating supportive environments prioritizing accountability to achieve positive patient outcomes.The study has adhered to STROBE guidelines.No patient or public contribution. [ABSTRACT FROM AUTHOR]

Introduction. Falls among hospitalized patients continue to pose a serious threat to patient safety worldwide. Effective fall-prevention education is considered vital for fall prevention. Nurses' resilience and proactivity may improve the fall-prevention education nurses provide to patients, but how to motivate nurses' proactivity remains unsolved. This study aimed to examine whether (1) nurse's resilience and social capital are jointly associated with nurse proactivity and (2) adherence to procedures further moderates the relationships between nurse proactivity and the fall prevention education provided to patients by the nurse. Methods. A nested (∼3 patients per nurse) cross-sectional observational design has been employed in this study. 101 bedside registered nurses were recruited from fourteen internal and surgical wards at a medium-size hospital. For each nurse, ∼3 of their newly admitted patients were recruited (total of 271 patients). Nurses completed validated questionnaires on personal resilience, social capital, following procedures, and sociodemographic data. Fall-prevention education was assessed via a short-structured interview with patients. Hypotheses were analyzed using the Hayes PROCESS macro. Results. Social capital, nurse resilience, and their interaction were associated with proactive behavior. Proactive behavior, adherence to procedures, and their interaction (β = −0.57, p < 0.01) were associated with patient education for fall prevention given by nurses. The moderated-mediation model was significant under medium and high levels of social capital and low levels of adherence to procedures. Conclusion. The study highlights the importance of nurse proactivity in educating patients about fall prevention, especially when adherence to procedures in the ward is perceived as low. Furthermore, nurses' proactivity can be promoted by nurturing both their resilience and their social capital. Nursing managers should nurture proactivity at the work environment of the 21-century, by fostering resilience and enculturing social capital. Concomitantly, employees should be educated at ways to promote personal resilience and engage in wise proactivity. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to test a moderated-mediation model, explaining how and under which circumstances a process- or an outcome-accountability focus affects performance. Design: Randomized controlled design, using screen-based simulations. Methods: Data were collected during 2021. Two screen-based simulations of medication administration (for low- and high-complexity tasks) were used. Each participant was randomly assigned to one of the six experimental conditions. Nurses completed validated questionnaires on strain levels and their perceptions of the simulated task complexity and accountability focus. Performance was assessed via validated checklists assessing nurses' performance of the simulation. Results: Task complexity significantly moderated the relationship between accountabilityfocus conditions and strain. For the process-accountability-focus condition, strain levels were lower during high-complexity tasks compared with low-complexity tasks, while for the outcome-accountability-focus condition, strain levels were lower during lowcomplexity tasks compared with high-complexity tasks. The highest strain levels were observed under the no accountability-focus condition. Additionally, this interaction had an impact on performance, with nurses' strain playing a mediating role. Conclusions: Any accountability focus reduces strain levels and enhances performance compared with having no accountability focus. The choice of accountability focus should be based on task-complexity considerations. Implications for the Profession and Patient Care: Managers can effectively reduce nurses' strain and improve performance by prioritizing outcome accountability focus for simpler tasks and process accountability focus for complex tasks. Impact: The study addressed previous ambiguous findings regarding the type of accountability focus that better motivates nurses' performance. By considering accountability focus, nurse managers can balance nurses' strain levels with improved performance. Reporting Method: We have adhered to the relevant EQUATOR guidelines: CONSORT. Patient or Public Contribution: There is no patient or public contribution, as the study only concerns the providers of the service, that is the nurses themselves. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To evaluate the relationship between nurse–patient‐initiated participation, nurses' attitudes towards patient's participation, and patients' adherence to treatment. Specifically, to (1) explore nurse–patient participation during haemodialysis and quantify the information into measurable indices; (2) determine the haemodialysis patient's adherence to treatment; (3) describe nurses' attitudes towards patient participation; and (4) establish the relationships between nurse–patient‐initiated participation, nurses' attitudes towards patient participation and patients' adherence to treatment. Background: To improve haemodialysis patients' health, it is crucial to identify nurses' and patients' factors facilitating adherence to treatment. Design: An exploratory‐sequential mixed‐methods (quantitative and qualitative) design. Methods: All nurses working at a dialysis ward (n = 30) and their randomly selected patients (n = 102) participated. Qualitative data on nurse–patient‐initiated participation were derived from transcribed nurse–patient conversations and quantified for further analyses. Nurses' attitudes towards patient participation were collected via questionnaire, and adherence to treatment via observed reduction in prescribed haemodialysis time. [CONSORT‐SPI guidelines]. Results: Content analysis of the conversations indicated that nurse‐initiated participation focused on patient's medical condition, treatment plan and education; while patients initiated more small talk. Non‐adherence to treatment was significant (Mean = 0.19 h; SD = 0.33). Regression analyses indicated that nurses' attitude towards participation was negatively linked to patient adherence, while patient–nurse‐initiated participation was unrelated. Nurses' attitudes towards patient participation moderated the relationship between nurse–patient‐initiated participation and patient adherence: the more positive the attitude towards inclusion the more negative the link between patient or nurse‐initiated participation and patient adherence. Conclusions: The findings provided paradoxical insights: Nurses' positive attitudes towards participation lead them to accept the patient's position for shortening haemodialysis treatment, so that adherence to care decreases. Relevance to clinical practice: Nurses require education on negotiating methods to help achieve patient adherence while respecting the patient's opinion. Patients should be educated how to approach nurses, seeking the information they need. [ABSTRACT FROM AUTHOR]