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The literature is replete with evidence about the effects of the work environment on nurses' stress levels, interdisciplinary collaboration, workload, job conflict, job satisfaction, and anticipated turnover. Healthcare leaders have been challenged by the American Association of Critical-Care Nurses (AACN), other professional organizations, and regulatory agencies to develop and sustain healthy work environments that support the professional practice of nursing. Magnet designation, the Beacon award, and other organizational structures and cultures led by authentic and transformational leaders have been the stimulus to ensure that workplaces are both healthy and healthful. The positive effect of healing environments on patient and provider outcomes has caused many healthcare leaders to strive to develop healing attributes within their philosophies of care and organizational cultural initiatives. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a study to evaluate the effectiveness of the evidence-based practice (EBP)-focused interactive teaching (E-FIT) strategy. BACKGROUND: Although EBP is a mandatory competency for all healthcare professionals, little is known about the effectiveness of E-FIT in nursing. METHODS: Aquasi-experimental, controlled, pre- and post-test study involving senior, 4th-year nursing students (N = 208) at two nursing schools in the USA was carried out from August 2007 to May 2008. The experimental group (n = 88) received the E-FIT strategy intervention and the control group (n = 120) received standard teaching. A Knowledge, Attitudes and Behaviors Questionnaire for Evidence-Based Practice was used to assess the effectiveness of the E-FIT strategy. RESULTS: Independent t-tests showed that the experimental group had statistically significant higher post-test Evidence-Based Practice Knowledge (mean difference = 0.25; P = 0.001) and Evidence-Based Practice Use (mean difference = 0.26; P = 0.015) subscale scores compared to the control group, but showed no statistically significant differences in Attitudes toward Evidence-Based Practice and Future Use of Evidence-Based Practice (mean difference = 0.12; P = 0.398 and mean difference = 0.13; P = 0.255 respectively). Hierarchical multiple regression analyses of the post-test data indicated that the intervention explained 7.6% and 5.1% of variance in Evidence-Based Practice Knowledge and Evidence-Based Practice Use respectively. CONCLUSION: The EBP-focused interactive teaching strategy was effective in improving the knowledge and use of EBP among nursing students but not attitudes toward or future use of EBP. [ABSTRACT FROM AUTHOR]

Nearly $200 billion of healthcare construction is expected by the year 2015, and nurse leaders must expand their knowledge and appreciation of philosophies of care and design attributes that create healing environments for patients, their families, and the staff. This bimonthly department prepares nurse leaders to use the evidence-based design process to ensure that new, expanded, and renovated hospitals facilitate optimal patient experiences and outcomes, enhance the work environment for healthcare providers, and improve organizational performance. In this article, the author uses the Planetree philosophy of care as a framework for creating healing environments to address the mind, body, and spiritual needs of patients and staff. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to look at manager and staff perceptions of the manager's leadership style and to determine what effect transformational leadership style has on job satisfaction.Background: Nursing job satisfaction is a critical element in addressing the nursing shortage. Literature supports that job satisfaction is related to nurse manager leadership style. This fact has caused nurse managers to carefully consider their leadership style and the impact it has on the nurses they manage.Methods: A descriptive correlational, comparative design was used in a convenience sample of nurse managers and their direct report nursing staff (n = 92).Results: A correlation was found between nurse manager transformational leadership style and nurse job satisfaction (r = 0.348, P < .05).Conclusion: Transformational leadership style was associated with higher levels of job satisfaction. The findings added to the knowledge about variables that are correlated with job satisfaction, which is a critical issue to nursing. [ABSTRACT FROM AUTHOR]

With nearly $200 billion of healthcare construction expected by 2015, nurse leaders must expand their knowledge and capabilities in healthcare design. This bimonthly department, edited by Jaynelle F. Stichler, DNS, RN, FACHE, prepares nurse leaders to use the evidence-based design process to ensure that new, expanded, and renovated hospitals facilitate optimal patient outcomes, enhance the work environment for healthcare providers, and improve organizational performance. The authors of this article discuss issues to be considered in determining the optimal number of patient rooms to design for an acute care patient care unit. [ABSTRACT FROM AUTHOR]

Nearly $200 billion of healthcare construction is expected by the year 2015, and nurse leaders must expand their knowledge and capabilities in healthcare design. The goal of this bimonthly department is to prepare the nurse leader in using the evidence-based design process to ensure that new, expanded, and renovated hospitals facilitate optimal patient outcomes, enhance the work environment for healthcare providers, and improve organizational performance. In this article, the author provides nurse leaders with examples of where to find data to guide decisions about the efficacy of specific design features in achieving desired outcomes. [ABSTRACT FROM AUTHOR]

Nearly $200 billion of healthcare construction is expected by the year 2015, and nurse leaders must expand their knowledge and capabilities in healthcare design. This bimonthly department prepares nurse leaders to use the evidence-based design process to ensure that new, expanded, and renovated hospitals facilitate optimal patient outcomes, enhance the work environment for healthcare providers, and improve organizational performance. In this article, the author introduces important project budget terms and a method of calculating an estimation of probable cost for a building project. [ABSTRACT FROM AUTHOR]

Nearly $200 billion of healthcare construction is expected by the year 2015, and nurse leaders must expand their knowledge and capabilities in healthcare design. The goal of this bimonthly department is to prepare the nurse leader in using the evidence-based design process to ensure that new, expanded, and renovated hospitals facilitate optimal patient outcomes, enhance the work environment for healthcare providers, and improve organizational performance. In this article, the author discusses roles in healthcare design that nurse leaders can assume to ensure a successful project. [ABSTRACT FROM AUTHOR]

Nearly US$200 billion of healthcare construction is expected by the year 2015, and nurse leaders must expand their knowledge and capabilities in healthcare design. The goal of this bimonthly department is to prepare the nurse leader in using the evidence-based design process to ensure that new, expanded, and renovated hospitals facilitate optimal patient outcomes, enhance the work environment for healthcare providers, and improve organizational performance. In this article, the editor discusses the leadership competencies that are necessary to ensure nursing input into the design of hospitals and healthcare facilities. [ABSTRACT FROM AUTHOR]

Nearly $200 billion of healthcare construction is expected by the year 2015, and nurse leaders must expand their knowledge and capabilities in healthcare de-sign. The goal of this bimonthly department is to prepare the nurse leader in using the evidence-based design process to ensure that new, expanded, and renovated hospitals facilitate optimal patient outcomes, enhance the work environment for healthcare providers, and improve organizational performance. In this article, the author introduces the concept of evidence-based design and its importance to nurse executives as a decision-making framework for healthcare design. [ABSTRACT FROM AUTHOR]

Today's nurse executive is more challenged than ever to manage multiple, competing priorities in organizations with ever-diminishing financial and human resources. Accountability for ensuring positive patient outcomes, productivity goals, financial targets, retention quotas, customer and provider satisfaction goals, and other performance metrics demands that the contemporary nurse executive possess and demonstrate well-developed leadership skills and organizational management competencies. The quest for Magnet status demands that the nurse executive also excel in developing a culture and work environment that fosters professional models of care, evidence-based practice, interdisciplinary and collaborative practice, professional autonomy and quality nursing leadership. With so many demands for vision, action, performance and outcomes, what are the skills and competencies critical to ensuring success in the role of the nurse executive? What personal characteristics and skills must the nurse executive possess to face all the challenges and emerge as a visionary leader who trans-forms people and processes to achieve higher and higher levels of performance? This article answers these questions. [ABSTRACT FROM AUTHOR]

The concept of healing environments is not new. The idea of creating an environment that would facilitate healing was popular over 2000 years ago, but it has been only recently that this concept has been applied to the design of hospitals and specifically to intensive care units. Although it is necessary to address the needs of the professional staff who are caring for seriously ill patients, it is also critical to include specific elements that will enhance the patients' healing process. It has been demonstrated that views of nature, natural light, soothing colors, therapeutic sounds, and the interaction of one's family can enhance the healing process. These elements important to a patient's healing process must be considered and balanced with the needs of health care providers in the design of critical care environments. Copyright © 2001 by Aspen Publishers, Inc. [ABSTRACT FROM AUTHOR]

This article focuses on applying the patient empowerment, engagement, and activation (PEEA) model as an implementation strategy to achieve patient- or person-centered care. There is substantial evidence linking PEEA to improved patient care outcomes and reduced healthcare costs. Interrelationships among the 3 concepts are discussed and how the PEEA survey can be used to evaluate patients' activation for self-care postdischarge and their perceptions of nurses' empowering and engaging them during the care encounter., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: Drs. Failla and Ecoff disclose that they are both appraisers for the American Nurses Credentialing Center Practice Transition Accreditation Program. There are no conflicts of interest to declare.

Objective: This article discusses the development and psychometric testing of the Nursing Leadership Competency Assessment (LCA)., Background: Several leadership assessments are available for purchase, which are aligned with professional organizations. A competency-based leadership assessment is needed to identify the developmental needs of nurse leaders. Competent and confident nurse managers are critical to ensure positive relationships between nurse managers and clinical nurses., Methods: A multimethod approach was used to develop and test psychometric properties of the LCA. Items were drawn from 8 sources identifying nurse leader competencies., Results: The 76-item assessment had a Cronbach's α of 0.99. Confirmatory factor analysis supported 6 hypothesized factors (domains): leading self, people, organizations, change, innovation, and globally. Subscale reliabilities ranged from α = 0.87 to α = 0.98., Conclusions: The LCA has demonstrated utility in assessing nurse leader competencies and guiding the development of educational opportunities in targeted content areas for specific leadership roles., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

The purpose of this article is to discuss how nurse leaders influenced facility design decisions, quickly evaluated the outcomes, and rapidly adapted the environment based on their own observations, assessments, changing regulatory requirements, and the needs of patients, nurses, and the caring workforce. Nurses must validate their clinical voice in the future design of healthcare environments based on the adaptations discovered and instituted during COVID-19. Many lessons were learned and physical adaptations made during the pandemic. While the pandemic spotlighted the emotional and physical stress and strain on nurses, it is important to consider all adaptations made in the physical environment to improve care delivery., (2021 by Elsevier Inc. All rights reserved.)

Objective: This article describes the evaluation of a system-wide program to enhance new graduate nurse resident (NGNR) experience, enculturation, and commitment to the organization., Background: Structured nurse residency programs support NGNR transition to the work environment and increase retention and organizational commitment., Methods: The study used a descriptive, comparative design measuring NGNR perceptions of affective commitment, job satisfaction, job stress, and other variables over 3 times from baseline to 24 months., Results: Findings demonstrated a reduction in affective commitment and an increase in nursing stress from baseline to 12 and 24 months of employment. The highest mean in intent to leave occurred at 12 months, highlighting the vulnerability of the NGNR at that time., Conclusions: Nurse leaders must consider resources supporting NGNRs beyond the traditional 12 months to ensure retention and organizational commitment, thereby decreasing intent to leave., Competing Interests: Drs Failla and Ecoff are appraisers for the American Nurses Credentialing Center Practice Transition Accreditation Program. The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

This article describes the development and psychometric testing of a 43-item nurse residency program stakeholder evaluation. The valid and reliable survey provides nursing professional development practitioners with insight into opportunities to improve nurse residency program design and educational content. Survey results may also substantiate human and capital resources required for effective programs., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Patient or person-centered care has become a widely used philosophical framework and yet has varying definitions and characteristics. Person-centered care has recently been conceptualized as patient empowerment, engagement, and activation with studies citing positive outcomes., Purpose: This study reports the psychometric properties of the Patient Empowerment, Engagement, and Activation Survey., Methods: An instrument development and testing approach was used., Results: A 21-item survey was developed demonstrating respectable Cronbach α coefficients for the total scale (α = 0.88) and for each subscale: Empowerment (α = 0.71), Engagement (α = 0.81), and Activation (α = 0.76). A regression analysis with 1 item, "I am ready to be discharged" as the dependent variable and all other items as independent variables explained 65% of the variance in readiness for discharge (P < .001)., Discussion: The Patient Empowerment, Engagement, and Activation Survey can be used to evaluate patients' perspectives of care quality (empowerment and engagement) and readiness for discharge (activation).

Competing Interests: Declaration of competing interest Authors have no conflicts to report.

Aim: To propose a conceptual definition of health literacy incorporating system demands, burdens, and complexities that are a critical part of patients' level of health literacy., Background: Health literacy is used frequently in health care and often is confused with patients' reading and comprehension levels., Design: Walker and Avant's concept analysis method was used., Data Source: Cochrane Library, Cumulative Index of Nursing and Health Literature, OVID, PubMed, EBSCO Host databases, and Google Scholar., Review Method: The primary Search terms and MeSH terms used were health literacy, patient education, patient engagement, patient activation, health communication, health promotion, and nursing. Empirical and nonempirical articles published in English were reviewed. Ten systematic literature reviews were included., Results: A new definition of health literacy is provided based on four components that include: system demands, burdens, and complexities; measurable components, processes and outcomes; the dynamic nature of health literacy; and demonstration of the direct relationship of informed decisions to informed actions. Defining attributes, antecedents, and consequences are identified. Implications for nursing practice, education, and research are given., Conclusions: Because health literacy is a dynamic and quickly changing concept, further exploration and evolution of the concept is warranted as empirical research and theoretical literature emerge., (© 2019 Wiley Periodicals, Inc.)

Background: Nurse residency programs (NRPs) provide new graduate nurses (NGNs) with social support and experiential activities as a formal transition to clinical practice., Aims: The study was conducted to answer the question: What is the effectiveness of an NRP in retaining NGNs in a psychiatric-mental health setting?, Method: This study used a quantitative time-sequenced comparative study of multiple cohorts of NGNs hired into an NRP at a freestanding hospital in California., Results: The study yielded a turnover rate of 11.7% in Year 1 (88.3% retention) and 2.9% in Year 2 (97.1% retention rate), which are lower than reported turnover rates (17.5% and 33.5%, respectively). Significant correlations are described in the workplace domains of knowledge and skills, social support, organizational citizenship behavior, civility, coping self-efficacy, organizational and occupational commitment, person-organizational fit, and burnout., Conclusions: NRPs are effective in attracting and retaining competent, confident NGNs in psychiatric-mental health nursing.

Objective: This study explored the experiences, perceptions and emotional state of nurse leaders during union activities to understand the impact on their personal and professional lives., Background: Other than anecdotal stories shared during union negotiations and strike preparations, very little evidence exists in nursing and healthcare literature about nursing unions and their impact on nurse leaders and their organizational priorities., Methods: This study used an exploratory, descriptive design with a convenience and snowball sample of Association of California Nurse Leaders members., Results: The findings indicate nurse leaders experience a range of emotional states in response to union activities with perceptions of increased workload, job stress, and constrained and deliberate communications with their staff., Conclusion: This study adds to the body of knowledge about nurse leader experiences and feelings during union activities.

Background: A culture of health requires a commitment from all-individuals, families, communities, organizations, and municipalities-to value health and make decisions reflective of a healthy society. At the individual level, health literacy is a necessary precursor to assist individuals in achieving a higher level of health., Method: One method for ensuring that staff members are routinely assessing and promoting health literacy is using competencies and practices previously identified for all health professions., Results: Cross-walking these competencies with the Health Literacy Tapestry model can be extremely helpful in framing assessment, action steps, and outcomes for nurses., Conclusion: Professional development nurse leaders have the challenge of ensuring that nurses are addressing patient health literacy as a fundamental nursing activity in every nursing-patient-family interaction. Assuming health literacy deficits as a "universal approach" to care is one method of ensuring health literacy needs are routinely addressed by staff. J Contin Educ Nurs. 2018;49(2):73-78., (Copyright 2018, SLACK Incorporated.)

Intensive care units (ICUs) exist to serve as a safe place for critically ill patients to receive care from skilled practitioners. In this qualitative study, ICU nurses shared their perspectives on elements that promote safety and security on their units. After obtaining institutional review board approval, participants participated in telephone interviews with a nurse researcher who has experience as a bedside ICU nurse. Five categories and 14 themes were identified and then confirmed using member checking. Results indicate that participants prefer to provide care in ICUs with no more than 12 to 14 beds and provide the following: visibility of patients and coworkers; more than 1 way to exit; and can be locked in case of emergency or threat. Nearly all respondents mentioned adequate staffing as the most important attribute of a safe, secure care environment for patients and families. More research is needed to identify design features that make the most impact on providing a safe, secure ICU environment.

Purpose: This article describes the development and psychometric testing of a new Postanesthesia Care Unit (PACU) Readiness for Discharge Assessment Tool (RDAT) that can be used in assessing patients' readiness for discharge from a phase 1 PACU., Design: This study used an instrument development methodology described by Waltz and Strickland that included item development and testing for content and convergent validity and interrater reliability., Methods: Items were developed from a review the literature, best practice exemplars, and input from an expert panel. Ten items were identified for patient assessment using a dichotomous response set (yes/no). Two nurses independently assessed the patients using the RDAT and Respiration, Energy, Alertness, Circulation, and Temperature, and comparing independent assessments using the RDAT., Finding: The content validity index was determined to be a = .80, and interrater reliability index was a = 1.0., Conclusions: The RDAT is a useful, safe tool to assess patients' readiness for discharge from the PACU., (Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Interprofessional collaboration is a key element in providing safe, holistic patient care in the acute care setting. Trended data at a community hospital indicated opportunities for improvement in collaboration on micro, meso, and macro levels. The aim of this survey study was to assess the current state of collaboration between frontline nurses and physicians at a non-academic acute care hospital. A convenience sample of participants was recruited with a final respondent sample of 355 nurses and 82 physicians. The results indicated that physicians generally perceived greater collaboration than nurses. Physician ratings did not vary by primary practice area, whereas nurse ratings varied by clinical practice area. Nurse ratings were the lowest in the operating room and the highest in the emergency department. Text-based responses to an open-ended question were analysed by role and coded by two independent research teams. Emergent themes emphasised the importance of rounding, roles, respect, and communication. Despite recognition of the need for improved collaboration and relational behaviours, strategies to improve collaborative practice must be fostered at the meso level by organisational leaders and customised to address micro-level values. At the study site, findings have been used to address and improve collaboration towards the goal of becoming a high reliability organisation.

Objective: This study examined a 6-month follow-up of a regional evidence-based practice (EBP) fellowship program and the predictors of EBP adoption at hospital units., Background: The immediate beneficial effects of a regional EBP program are known, but the medium-term effects are not certain., Methods: A matched pretest/posttest study was conducted using a mailed questionnaire 6 months after the completion of a 9-month regional EBP fellowship program among 3 annual cohorts of participants., Results: Statistically significant improvements in the mean scores of EBP beliefs, EBP implementation, and group cohesion were found (P < .05). Of the 47 participants who completed their EBP projects, more than three-quarters reported EBP adoption at their own hospital units, and EBP beliefs were a positive predictor of EBP adoption (odds ratio, 1.12; 95% confidence interval, 1.02-1.22; P = .017)., Conclusions: The outcome improvements continued 6 months after the fellowship program, and strong EBP beliefs predicted EBP adoption in the participants' units.

Background: The Advancing Research and Clinical practice through close Collaboration (ARCC) model postulates that improvement in nurses' evidence-based practice (EBP) beliefs results in improved EBP implementation, which in turn improves nurse-related outcomes, such as nurses' job satisfaction and group cohesion. However, there is a dearth of interventional studies that evaluate the relationships among these variables., Aims: This study evaluated whether a regional EBP fellowship program improved participants' EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness, and examined the relationships among these improvements, using structural equation modeling., Methods: A pretest-posttest design was used among three annual cohorts of a regional, 9-month EBP fellowship program, from 2012 to 2014, in San Diego, California. Matched pretest and posttest questionnaires, including EBP Beliefs, EBP Implementation, Job Satisfaction, Group Cohesion, and Group Attractiveness scales, were analyzed (N = 120)., Results: Paired t-tests showed statistically significant improvements in EBP beliefs, EBP implementation, job satisfaction, and group cohesion (p < .05). Structural equation modeling showed that improvement in EBP implementation had no direct effect on improvements in job satisfaction, group cohesion, or group attractiveness. However, improvement in EBP beliefs had direct effects on improvements in job satisfaction (β = .24; p = .002) and group attractiveness (β = .22; p = .010)., Linking Evidence to Action: A regional, collaborative EBP fellowship program was effective in improving EBP beliefs, EBP implementation, job satisfaction, and group cohesion. Improvement in EBP beliefs appears to have had direct effects on improvements in job satisfaction and group attractiveness. Regional fellowship programs that educate and support EBP champions and their mentors may enhance EBP adoption in nursing practice across multiple health care institutions., (© 2017 Sigma Theta Tau International.)

Background: A regional, collaborative evidence-based practice (EBP) fellowship program utilizing institution-matched mentors was offered to a targeted group of nurses from multiple local hospitals to implement unit-based EBP projects. The Advancing Research and Clinical Practice through Close Collaboration (ARCC) model postulates that strong EBP beliefs result in high EBP implementation, which in turn causes high job satisfaction and group cohesion among nurses., Aims: This study examined the relationships among EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness among the fellowship program participants., Methods: A total of 175 participants from three annual cohorts between 2012 and 2014 completed the questionnaires at the beginning of each annual session. The questionnaires included the EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness scales., Results: There were positive correlations between EBP beliefs and EBP implementation (r = 0.47; p <.001), as well as EBP implementation and job satisfaction (r = 0.17; p = .029). However, no statistically significant correlations were found between EBP implementation and group cohesion, or group attractiveness. Hierarchical multiple regression models showed that EBP beliefs was a significant predictor of both EBP implementation (β = 0.33; p <.001) and job satisfaction (β = 0.25; p = .011). However, EBP implementation was not a significant predictor of job satisfaction, group cohesion, or group attractiveness., Linking Evidence to Action: In multivariate analyses where demographic variables were taken into account, although EBP beliefs predicted job satisfaction, no significant relationship was found between EBP implementation and job satisfaction or group cohesion. Further studies are needed to confirm these unexpected study findings., (© 2016 Sigma Theta Tau International.)