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A special issue of Nursing Reports (ISSN 2039-4403).

Deadline for manuscript submissions: 31 May 2025 | Viewed by 12659

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Prof. Ashley Shepherd

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Guest Editor

Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK
Interests: quality improvement; Innovation in nursing; continence care

Special Issue Information

Dear Colleagues,

As the largest profession in healthcare, nurses are fundamental to high-quality care. There is hardly a patient treatment or intervention that has not been handled at some point by a nurse. The Nursing and Midwifery Council Strategy (2020–2025) and the Future of Nursing (2020–2030) highlight the importance of improvement and innovation, with nurses being advocated as innovators and leaders in healthcare being called upon to support nurses in this role.

There has never been a more crucial time to give nurses the skills and opportunities to embrace innovation and make improvements to enhance productivity, improve wellbeing, and positively impact on healthcare quality and patient safety. However, creating a culture for innovation and quality improvement (QI) in nursing is not easy; it takes time to build and requires vision, strategy, support, and resources. Innovators need the space and opportunity to connect with others, brainstorm, discuss, and take risks. Greater engagement of front-line nurses in QI initiatives improves nurse-sensitive indicators; however, the number of nurses involved in QI is still worryingly low.

Innovations and Improvements led by nurses can make significant contributions to patient care, but the speed of these actions needs to improve if we are to address some of the global health challenges that face us today.

Prof. Ashley Shepherd
Guest Editor

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Keywords

innovation
nursing
quality improvement
nursing care

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13 pages, 1712 KiB

Open AccessArticle

Knowing, Being and Becoming a Person-Centred Nurse Leader: Findings from a Transformative Professional Development Programme

by Clare Cable, Tanya McCance and Brendan McCormack

Nurs. Rep. 2024, 14(4), 3165-3177; https://doi.org/10.3390/nursrep14040230 - 23 Oct 2024

Viewed by 496

Abstract

Background/Objectives Leadership is central to the development of effective workplace cultures and as such should be viewed as a practice that is relational, exercised through a process of mutual and reciprocal influence. Person-centred leadership is an approach to leadership that supports a way of being that is authentic, prioritising values lived out in action. However, there is an increasing recognition that leadership development has not been impactful in relation to workplace culture. This paper reports on the ongoing evaluation of an innovative development programme (Queen’s Nurse Development Programme), the overall aim of which was to illuminate the participants’ experiences of engaging in transformative learning and development and identify the technical and transformative outcomes arising. The programme focused on developing leadership capacity for societal change and maximising the health impact of community nursing leaders. Methods The methodological framework for evaluation was underpinned by a Collaborative Critical Creative Inquiry. Twenty community nurses were selected to undertake the programme during 2020. The collection and analysis of data was consistent with the Collaborative Critical Creative Inquiry and was conducted as a one-day workshop, with participants engaged in a cycle of creative hermeneutic analysis. Results A total of seven themes were identified, including: sense of belonging; personal growth; developing new skills; finding voice; importance of self-care; and creating a safe place. This illuminated how the transformative learning and development processes within this programme were experienced and how these enabled participants to explore how they influence their practice and workplace. It is the journey with self that generates a sense of belonging and enables personal growth and the ability to care for self and others. Conclusions The key learning from this innovative development programme is the importance of focusing on the attributes of practitioners and the key building blocks for knowing, being, and becoming a person-centred practitioner. Full article

(This article belongs to the Special Issue Nursing Innovation and Quality Improvement)

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15 pages, 956 KiB

Open AccessArticle

Functional Capacity of Institutionalized Older People and Their Quality of Life, Depressive Symptoms and Feelings of Loneliness: A Cross-Sectional Study

by Fátima Cano, Elisabete Alves, Lara Guedes de Pinho and César Fonseca

Nurs. Rep. 2024, 14(4), 3150-3164; https://doi.org/10.3390/nursrep14040229 - 23 Oct 2024

Viewed by 415

Abstract

Background: The increasing number of institutionalized older individuals worldwide stresses the need to evaluate the association between the functional profile of institutionalized older adults and their quality of life (QoL), depressive symptoms and feelings of loneliness. Methods: A cross-sectional study was conducted in 19 residential facilities in Alentejo, Portugal. Between March and September 2023, all individuals aged ≥65 years were invited to complete a structured questionnaire (n = 1303). Sociodemographic and clinical data were collected, and validated scales for the Portuguese older population were used. Linear regression and unconditional binary logistic models were computed. Results: The highest level of dependence was observed in the self-care dimension (mean (SD) = 2.93 (1.21)), with 40% of participants exhibiting levels of dependence requiring daily care or total replacement. QoL was inversely associated with functionality in all dimensions, as well as with severe or complete dependence, even after adjusting for sex, age and education. Participants with depressive symptoms and feelings of loneliness were, respectively, three and two times more likely to be dependent on care (adjusted OR = 3.69, 95% CI: 1.80–7.52; adjusted OR = 2.04, 95% CI: 1.07–3.87). Conclusions: Public policies and interventions should include social and emotional support strategies alongside traditional medical interventions. Full article

(This article belongs to the Special Issue Nursing Innovation and Quality Improvement)

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17 pages, 242 KiB

Open AccessArticle

Experiences of Newly Qualified Nurses’ Engagement with Quality Improvement in Practice: A Qualitative Follow-Up Study

by Lorraine Armstrong, Ashley Shepherd and Fiona Harris

Nurs. Rep. 2024, 14(4), 2990-3006; https://doi.org/10.3390/nursrep14040218 - 14 Oct 2024

Viewed by 621

Abstract

Background: Nurse education plays an essential role in preparing future nurses to engage with quality improvement (QI) initiatives in their organisations and improve patient care. However, frontline nurses continue to report that a lack of QI knowledge hinders their abilities to engage in improvement work. In the UK, student nurses are now trained in QI within their degree to enable them to contribute to improvements once qualified. Objectives: This qualitative follow-up study investigated the sustainability of QI engagement in nurses who undertook QI training and a QI project during their degree and explored the factors influencing their engagement in QI once qualified. Methods: This paper followed the COREQ criteria to report upon 10 semi-structured interviews undertaken with registered nurses and focuses on their experiences of QI engagement post-registration. The data were investigated using an inductive thematic analysis and Nvivo 14. Findings: Five themes emerged: transition to a newly qualified nurse, QI knowledge decline, influencing factors (hierarchy, leadership, COVID-19 pandemic, data access and location), and skill transferability. Conclusions: This study showed that qualified nurses can sustain their QI knowledge and remain engaged with QI where they experience positive QI leadership and were exposed to ongoing QI activity in their preceptorship year. However, a lack of QI opportunities and a culture which does not consider QI a responsibility of new nurses is seen to hinder engagement. Educational institutions and practice partners require careful collaboration to assess and develop ongoing QI learning activities that support new nurses to engage in QI. Full article

(This article belongs to the Special Issue Nursing Innovation and Quality Improvement)

11 pages, 826 KiB

Open AccessArticle

The Kumagai Method: Feeding Techniques Using the Pigeon Baby Cleft Palate Bottle

by Shingo Ueki, Yukari Kumagai, Yumi Hirai, Eri Nagatomo, Shoko Miyauchi, Takuro Inoue, Qi An, Eri Tashiro and Junko Miyata

Nurs. Rep. 2024, 14(4), 2695-2705; https://doi.org/10.3390/nursrep14040199 - 30 Sep 2024

Viewed by 584

Abstract

Background/Objectives: This study aimed to identify the P-bottle feeding techniques systematically organized by Ms. Kumagai, an expert in nursing care for children with a cleft lip and/or palate (CLP), which were developed as she gained expertise in feeding affected children. Methods: We recruited three nurses who had mastered the Kumagai method for feeding with a P-bottle. Through analysis of participants’ voices and videos during interviews, we focused on aspects such as dealing with a closed mouth, inserting the nipple in cases of unilateral and bilateral CLP, dealing with the child’s movements after insertion, and key considerations when squeezing the bottle. Results: The interview analyses revealed numerous techniques used by nurses to manage the difficulties encountered while feeding children, ensuring successful provision of nourishment. Specifically, the nurses employed techniques such as placing the nipple along the midline of the child’s tongue and varying the application of force on the nipple depending on the cleft type. The nurses reported that the objectives of these techniques were to prevent ulcer formation and encourage the use of the tongue, simulating original feeding movements. Conclusions: We explored feeding techniques and the management of associated challenges. Our results suggest that the “Kumagai Method” could be valuable in improving feeding practices. Full article

(This article belongs to the Special Issue Nursing Innovation and Quality Improvement)

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12 pages, 1122 KiB

Open AccessArticle

Nurse-Driven Interventions Reduce Central Line-Associated Bloodstream Infection Close to Zero in One Pediatric Oncologic Facility: A Single-Center Retrospective Observational Study

by Federico Turoldo, Antonella Longo, Mariavittoria Sala, Denis Valentini, Nicole De Vita, Sara Toniutti, Loredana Zuppel and Natalia Maximova

Nurs. Rep. 2024, 14(4), 2668-2679; https://doi.org/10.3390/nursrep14040197 - 26 Sep 2024

Viewed by 502

Abstract

Background: Central line-associated bloodstream infections (CLABSIs) are critical infectious complications among pediatric hematology-oncology patients, and the management of central venous catheters (CVCs) by healthcare personnel can significantly influence the incidence of these infections. This study evaluates the impact of nurse-led changes in CVC management on the incidence of CLABSIs. Methods: This single-center, retrospective observational study was conducted at an urban, tertiary referral, and academic center serving pediatric patients. Results: The study cohort comprised 239 patients and 323 CVCs seen between 2012 and 2022. CLABSI was defined according to the Centers for Disease Control and Prevention definitions. Oncology nurse leaders developed CVC-specific educational modules for CLABSI prevention. All the relevant information during the CVC maintenance period was noted in the patient’s CVC logbook. A total of 24 (7%) cases of confirmed CLABSI were identified. The incidence of CVC-related infections was 0.32 cases per 1000 catheter days (95%CI: 0.19–0.45). The incidence decreased by 40% between the first and second three-year study period. Documented exit-site infection was reported in 32 (10%) cases. The correlation between exit-site infection and CLABSI was found in 9 (28%) cases. Our CVC-related infection rates are significantly lower than the incidence reported by the Italian Association of Pediatric Hematology and Oncology, which settles at 3–5 cases per 1000 catheter days. Conclusions: Our data confirm the effectiveness of local CVC management guidelines in preventing CVC-related infectious complications. Full article

(This article belongs to the Special Issue Nursing Innovation and Quality Improvement)

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11 pages, 252 KiB

Open AccessArticle

Innovation Support Reduces Quiet Quitting and Improves Innovative Behavior and Innovation Outputs among Nurses in Greece

by Ioannis Moisoglou, Aglaia Katsiroumpa, Ioanna Prasini, Parisis Gallos, Maria Kalogeropoulou and Petros Galanis

Nurs. Rep. 2024, 14(4), 2618-2628; https://doi.org/10.3390/nursrep14040193 - 25 Sep 2024

Viewed by 450

Abstract

Background: Innovation is a crucial issue in healthcare services since it can affect job-related variables such as productivity, satisfaction, and burnout. The aim of our study was to examine the impact of innovation support on quiet quitting, innovative behavior, and innovation outputs among nurses. Methods: We conducted a cross-sectional study in Greece during April 2024. We employed a convenience sample of nurses. We followed the reporting of observational studies in epidemiology (STROBE). We used the following instruments: (a) the innovation support inventory (ISI) to measure innovation support; (b) the quiet quitting scale (QQS) to measure quiet quitting; (c) the innovative behavior inventory (IBI) to measure innovative behavior; and (d) the innovation outputs (IO) scale to measure innovation outputs. Our study questionnaire was anonymous, and nurses gave their informed consent to participate. The Ethics Committee of the Faculty of Nursing, National and Kapodistrian University of Athens, approved our study protocol, while we followed the guidelines of the Declaration of Helsinki. Results: Our study population included 328 nurses with a mean age of 42.3 years (standard deviation: 9.7). Among them, 89.9% were females. Our multivariable analysis identified a negative relationship between innovation support and quiet quitting. Moreover, we found that managerial support and cultural support improved several aspects of innovative behavior, such as idea generation, idea search, idea communication, implementation starting activities, involving others, and overcoming obstacles. Additionally, managerial support improved innovation outputs. Conclusions: Our findings suggested the positive impact of innovation support on quiet quitting, innovative behavior, and innovation outputs among nurses. Organizations and nurses’ managers should establish an innovative working environment to improve nurses’ passion, motives, and productivity. Full article

(This article belongs to the Special Issue Nursing Innovation and Quality Improvement)

9 pages, 207 KiB

Open AccessArticle

When Infections Are Found: A Qualitative Study Characterizing Best Management Practices for Central Line-Associated Bloodstream Infection and Catheter-Associated Urinary Tract Infection Performance Monitoring and Feedback

by Alice A. Gaughan, Sarah R. MacEwan, Megan E. Gregory, Jennifer L. Eramo, Laura J. Rush, Courtney L. Hebert and Ann Scheck McAlearney

Nurs. Rep. 2024, 14(2), 1058-1066; https://doi.org/10.3390/nursrep14020080 - 27 Apr 2024

Viewed by 2048

Abstract

Healthcare-associated infections (HAIs) remain a significant patient safety problem that can lead to illness and death, despite the implementation of clinical bundles to prevent HAIs. Management practices can support HAI prevention, but their role in HAI performance monitoring and feedback is not well understood. To address this knowledge gap, we previously conducted semi-structured interviews with staff at 18 hospitals to examine the role of management practices around the prevention of central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs). Interview transcripts were analyzed to identify themes related to HAI performance monitoring and feedback. The current analysis focuses on 10 higher-performing hospitals that were successful in preventing CLABSIs and CAUTIs. These institutions had robust practices including timely event analysis, leadership engagement, and multidisciplinary participation in HAI reviews. Across these sites, we found common goals including investigating HAIs without blame and identifying opportunities for improvement. Management practices such as timely analysis of HAIs, collaboration between facility leadership and multidisciplinary team members, and a focus on identifying the failure of a procedure or protocol, rather than the failure of staff members, are all approaches that can support infection prevention efforts. These management practices may be especially important as hospitals attempt to address increases in CLABSI and CAUTI rates that may have occurred during the coronavirus pandemic. Full article

(This article belongs to the Special Issue Nursing Innovation and Quality Improvement)

22 pages, 1084 KiB

Open AccessArticle

Determining the Innovativeness of Nurses Who Engage in Activities That Encourage Innovative Behaviors

by Marion Leary, George Demiris, J. Margo Brooks Carthon, Pamela Z. Cacchione, Subhash Aryal and Jose A. Bauermeister

Nurs. Rep. 2024, 14(2), 849-870; https://doi.org/10.3390/nursrep14020066 - 3 Apr 2024

Viewed by 1368

Abstract

Background: We sought to understand the innovativeness of nurses engaging in innovative behaviors and quantify the associated characteristics that make nurses more able to innovate in practice. We first compared the innovativeness scores of our population; then we examined those who self-identified as an innovator versus those who did not to explore differences associated with innovativeness between these groups. Methods: A cross-sectional survey study of nurses in the US engaging in innovative behaviors was performed. We performed an exploratory factor analysis (EFA) to determine the correlates of innovative behavior. Results: Three-hundred and twenty-nine respondents completed the survey. Respondents who viewed themselves as innovators had greater exposure to HCD/DT workshops in the past year (55.8% vs. 36.6%, p = 0.02). The mean innovativeness score of our sample was 120.3 ± 11.2 out of a score of 140. The mean innovativeness score was higher for those who self-identified as an innovator compared with those who did not (121.3 ± 10.2 vs. 112.9 ± 14.8, p =< 0.001). The EFA created four factor groups: Factor 1 (risk aversion), Factor 2 (willingness to try new things), Factor 3 (creativity and originality) and Factor 4 (being challenged). Conclusion: Nurses who view themselves as innovators have higher innovativeness scores compared with those who do not. Multiple individual and organizational characteristics are associated with the innovativeness of nurses. Full article

(This article belongs to the Special Issue Nursing Innovation and Quality Improvement)

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11 pages, 272 KiB

Open AccessArticle

Experiences for Geriatric Care from Nursing Students’ Knowledge: A Qualitative Approach

by Elsa Gil-Mateu, Silvia Reverté-Villarroya, Núria Albacar-Riobóo and Josep Barceló-Prats

Nurs. Rep. 2024, 14(2), 733-743; https://doi.org/10.3390/nursrep14020056 - 27 Mar 2024

Viewed by 2114

Abstract

(1) Background: Studies have shown that clinical experience has an impact on how students perceive geriatric care. The vulnerability of older people particularly allows students to reflect on and evaluate their learning. In this context, communication between tutors and students is important to guiding a contextualized view of the complexity of clinical situations. The principal objective was to explore the feelings, perceptions, and experiences of nursing students in geriatric care units during their practices. (2) Methods: This is a qualitative study using content analysis where the data collected were analyzed deductively. An intentional sample of 81 nursing degree students enrolled in the subject of clinical practices. During these sessions, a dynamic discussion forum was incorporated. (3) Results: There were 6 forums with a total of 591 participants, with an average of 98.5 per forum. Four categories emerged: humanization, geriatric nurse, aging, and learning. (4) Conclusions: A change of management oriented to the person-centered model would improve the quality in the residences and as well as in the expectations of the students towards geriatric nursing. Changing perspectives could be a way to confront and become aware of the fallacies of care that have been evidenced. This study was not registered. Full article

(This article belongs to the Special Issue Nursing Innovation and Quality Improvement)

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14 pages, 868 KiB

Open AccessProtocol

Artificial Intelligence in Wound Care Education: Protocol for a Scoping Review

by Rúben Encarnação, Tânia Manuel, Hélder Palheira, João Neves-Amado and Paulo Alves

Nurs. Rep. 2024, 14(1), 627-640; https://doi.org/10.3390/nursrep14010048 - 14 Mar 2024

Cited by 3 | Viewed by 2663

Abstract

As healthcare continues evolving in the age of digital technology, the integration of artificial intelligence has emerged as a powerful force, particularly in wound care. The education of healthcare professionals in wound care is crucial for ensuring they acquire the necessary knowledge and skills, optimizing patient outcomes. This paper outlines the protocol for a scoping review with the goal of mapping and analyzing the current scientific evidence regarding the potential impact of artificial intelligence in wound care education. The current protocol follows the JBI methodological framework. The search was conducted in December 2023 in the following databases: CINAHL Complete (via EBSCOhost), MEDLINE (via PubMed), Cochrane Library, Academic Search Complete, Scientific Electronic Library Online (Scielo), Scopus, and Web of Science. Electronics searches were conducted in the Scientific Open Access Scientific Repositories of Portugal (RCAAP) and ProQuest Dissertations and Theses, OpenAIRE, and Open Dissertations databases to access gray literature. Additionally, searches were performed on Google Scholar and specific journals such as the International Wound Journal, Skin Research and Technology, Journal of Wound Care, and Wound Repair and Regeneration. The initial database searches retrieved a total of 11,323 studies. After removing duplicates, a total of 6450 studies were submitted for screening. Currently, 15 studies are included in this review, and data charting and analysis are underway. The findings of this scoping review will likely provide insights into the application of artificial intelligence in wound care education. Full article

(This article belongs to the Special Issue Nursing Innovation and Quality Improvement)

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