Explore the vast range of titles available.

For the purpose of providing excellent patient care, residents need to be strong, effective leaders. The lack of clinical leadership is alarming given the detrimental effects on patient safety. The objective of the study was to assess whether a leadership training addressing transactional and transformational leadership enhances leadership skills in residents. A volunteer sample of 57 residents from postgraduate year one to four was recruited across a range of medical specialties. The residents took part in an interventional controlled trial. The four-week IMPACT leadership training provided specific strategies for leadership in the clinical environment, addressing transactional (e.g. active control, contingent reward) and transformational leadership skills (e.g. appreciation, inspirational motivation). Transactional and transformational leadership skill performance was rated (1) on the Performance Scale by an external evaluator blinded to the study design and (2) self-assessed transformational and transactional leadership skills. Both measures contained items of the Multifactor Leadership Questionnaire, with higher scores indicating greater leadership skills. Both scores were significantly different between the IMPACT group and the control group. In the IMPACT group, the Performance Scale increased 15% in transactional leadership skill performance (2.10 to 2.86) (intervention effect, 0.76; 95% CI, 0.40 to 1.13; p < .001, eta2 = 0.31) and 14% in transformational leadership skill performance (2.26 to 2.94) (intervention effect, 0.68; 95% CI, 0.27 to 1.09; p < .001, eta2 = 0.22). The self-assessed transactional skills revealed a 4% increase (3.83 to 4.03) (intervention effect, 0.20; 95% CI, 0.08 to 0.33; p < .001, eta2 = 0.18) and a 6% increase in transformational leadership skills (3.54 to 3.86) (intervention effect, 0.31; 95% CI, 0.02 to 0.40; p< .001, eta2 = 0.53). These findings support the use of the transactional and transformational leadership framework for graduate leadership training. Future studies should incorporate time-latent post-tests, evaluating the stability of the behavioral performance increase.

Introduction Toolbox training or toolbox talks is short‐term training to improve occupational health and safety practices in various sectors. These on‐the‐job trainings provide employees with opportunities to ask questions and share experiences, facilitating the enhancement of workplace safety practices. The aim of this study is to determine the impact of toolbox trainings provided to nurses on nursing‐sensitive quality indicators (pain management, pressure ulcer, patient falls, peripheral venous catheter complications, and adverse event reporting) in the workplace. Design Randomized controlled, pre‐test, post‐test, and control group design. Methods Before the toolbox training, pretest measurement instruments were used for the nurses in both the experimental and control groups, and the nursing‐sensitive quality indicators were monitored by two independent observers. Toolbox training was provided to nurses in the intervention group on their shift in the respective units. Both groups were followed up at the 8th and 12th weeks after the training. Descriptive tests, independent sample t‐tests for intergroup comparisons, and repeated and mixed ANOVA for intragroup comparisons were utilized in data analysis. Results Significant differences were found between pre‐test and post‐test scores of the nurses in the group who received toolbox training in terms of falls, pressure ulcers, pain management, peripheral venous catheter, and adverse event reporting (p < 0.01). It was observed that the application scores significantly differed among all nurses who received toolbox training according to the findings of both observers, generally increasing in the second follow‐up compared to the first, but decreasing in the third follow‐up (p < 0.05). Evaluated according to unit quality indicators, it was determined that the number of patient falls (mean 4.04, 2.32, and 1.95 respectively), pressure ulcer occurrences (mean 4.48, 2.69, and 2.45 respectively), and the number of patients experiencing peripheral venous catheter complications decreased (mean 26.79, 16.46, and 15.42 respectively) in the units where nurses who received toolbox training worked. The average number of correctly managed pain patients (mean 37.82, 71.61, 69.07 respectively) and the number of reported adverse events (mean 2.79, 6.60, 6.42 respectively) were observed to increase in the second follow‐up but decrease in the third follow‐up. Conclusions As a result, it was determined that on‐the‐job trainings increased nurses' knowledge level regarding nursing‐sensitive quality indicators, improved their practices, and enhanced unit quality indicators. According to the findings of this study, on‐the‐job trainings provided to nurses were found to be an effective method, and it is recommended to use them in addition to traditional training methods in nurses' in‐service education. Clinical Relevance There is a growing demand for shorter and different training methods in nurses' education. In addition to classical in‐service training methods, this training method, which was applied for the first time in the field of nursing, contributed to the improvement of quality indicators sensitive to nursing. Our findings emphasize that it will be useful to use this training method in future studies on improving and developing nursing‐sensitive quality indicators. Trail Registration The study has been registered with ClinicalTrials.gov (NCT05853588)

Objective As part of its ongoing effort to combat stigma against mental illness among health care providers, the Mental Health Commission of Canada partnered with organizations conducting anti-stigma interventions. Our objective was to evaluate program effectiveness and to better understand what makes some programs more effective than others. Our paper reports the elements of these programs found to be most strongly associated with favourable outcomes. Methods Our study employed a multi-phased, mixed-methods design. First, a grounded theory qualitative study was undertaken to identify key program elements. Next, each program (n = 22) was coded according to the presence or absence of the identified key program ingredients. Then, random-effects, meta-regression modelling was used to examine the association between program outcomes and the key ingredients. Results The qualitative analysis led to a 6-ingredient model of key program elements. Results of the quantitative analysis showed that programs that included all 6 of these ingredients performed significantly better than those that did not. Individual analyses of each of the 6 ingredients showed that including multiple forms of social contact and emphasizing recovery were characteristics of the most effective programs. Conclusions The results provide a validation of a 6-ingredient model of key program elements for anti-stigma programming for health care providers. Emphasizing recovery and including multiple types of social contact are of particular importance for maximizing the effectiveness of anti-stigma programs for health care providers.

This review aimed to synthesise the literature describing interventions to improve resilience among physicians, to evaluate the quality of this research and to outline the type and efficacy of interventions implemented. Searches were conducted in April 2017 using five electronic databases. Reference lists of included studies and existing review papers were screened. English language, peer-reviewed studies evaluating interventions to improve physician resilience were included. Data were extracted on setting, design, participant and intervention characteristics and outcomes. Methodological quality was assessed using the Downs and Black checklist. Twenty-two studies were included. Methodological quality was low to moderate. The most frequently employed interventional strategies were psychosocial skills training and mindfulness training. Effect sizes were heterogeneous. Methodologically rigorous research is required to establish best practice in improving resilience among physicians and to better consider how healthcare settings should be considered within interventions.

State health departments commonly use quality improvement coaching as an implementation strategy for improving low human papillomavirus (HPV) vaccination coverage, but such coaching can be resource intensive. To explore opportunities for improving efficiency, we compared in-person and webinar delivery of coaching sessions on implementation outcomes, including reach, acceptability, and delivery cost. In 2015, we randomly assigned 148 high-volume primary care clinics in Illinois, Michigan, and Washington State to receive either in-person or webinar coaching. Coaching sessions lasted about 1 hr and used our Immunization Report Card to facilitate assessment and feedback. Clinics served over 213,000 patients ages 11-17. We used provider surveys and delivery cost assessment to collect implementation data. This report is focused exclusively on the implementation aspects of the intervention. More providers attended in-person than webinar coaching sessions (mean 9 vs. 5 providers per clinic, respectively, p = .004). More providers shared the Immunization Report Card at clinic staff meetings in the in-person than webinar arm (49% vs. 20%; p = .029). In both arms, providers' belief that their clinics' HPV vaccination coverage was too low increased, as did their self-efficacy to help their clinics improve (p < .05). Providers rated coaching sessions in the two arms equally highly on acceptability. Delivery cost per clinic was$733 for in-person coaching versus $ 461 for webinar coaching. In-person and webinar coaching were well received and yielded improvements in provider beliefs and self-efficacy regarding HPV vaccine quality improvement. In summary, in-person coaching cost more than webinar coaching per clinic reached, but reached more providers. Further implementation research is needed to understand how and for whom webinar coaching may be appropriate. Keywords HPV vaccine, Immunization programs, Quality improvement coaching, Primary care, State health departments, Assessment and feedback

Background The Thrombolysis ImPlementation in Stroke (TIPS) trial tested the effect of a multicomponent, multidisciplinary, collaborative intervention designed to increase the rates of intravenous thrombolysis via a cluster randomized controlled trial at 20 Australian hospitals (ten intervention, ten control). This sub-study investigated changes in self-reported perceptions and practices of physicians and nurses working in acute stroke care at the participating hospitals. Methods A survey with 74 statements was administered during the pre- and post-intervention periods to staff at 19 of the 20 hospitals. An exploratory factor analysis identified the structure of the survey items and linear mixed modeling was applied to the final survey domain scores to explore the differences between groups over time. Result The response rate was 45% for both the pre- (503 out of 1127 eligible staff from 19 hospitals) and post-intervention (414 out of 919 eligible staff from 18 hospitals) period. Four survey domains were identified: (1) hospital performance indicators, feedback, and training; (2) personal perceptions about thrombolysis evidence and implementation; (3) personal stroke skills and hospital stroke care policies; and (4) emergency and ambulance procedures. There was a significant pre- to post-intervention mean increase (0.21 95% CI 0.09; 0.34; p  < 0.01) in scores relating to hospital performance indicators, feedback, and training; for the intervention hospitals compared to control hospitals. There was a corresponding increase in mean scores regarding perceptions about the thrombolysis evidence and implementation (0.21, 95% CI 0.06; 0.36; p  < 0.05). Sub-group analysis indicated that the improvements were restricted to nurses’ responses. Conclusion TIPS resulted in changes in some aspects of nurses’ perceptions relating to the evidence for intravenous thrombolysis and its implementation and hospital performance indicators, feedback, and training. However, there is a need to explore further strategies for influencing the views of physicians given limited statistical power in the physician sample. Trial registration ACTRN12613000939796 , UTN: U1111–1145-6762.

Background Health care practice needs to be underpinned by high quality research evidence, so that the best possible care can be delivered. However, evidence from research is not always utilised in practice. This study used the Promoting Action on Research Implementation in Health Services (PARIHS) framework as its theoretical underpinning to test whether two different approaches to facilitating implementation could affect the use of research evidence in practice. Methods A pragmatic clustered randomised controlled trial with embedded process and economic evaluation was used. The study took place in four European countries across 24 long-term nursing care sites, for people aged 60 years or more with documented urinary incontinence. In each country, sites were randomly allocated to standard dissemination, or one of two different types of facilitation. The primary outcome was the documented percentage compliance with the continence recommendations, assessed at baseline, then at 6, 12, 18, and 24 months after the intervention. Data were analysed using STATA15, multi-level mixed-effects linear regression models were fitted to scores for compliance with the continence recommendations, adjusting for clustering. Results Quantitative data were obtained from reviews of 2313 records. There were no significant differences in the primary outcome (documented compliance with continence recommendations) between study arms and all study arms improved over time. Conclusions This was the first cross European randomised controlled trial with embedded process evaluation that sought to test different methods of facilitation. There were no statistically significant differences in compliance with continence recommendations between the groups. It was not possible to identify whether different types and “doses” of facilitation were influential within very diverse contextual conditions. The process evaluation (Rycroft-Malone et al., Implementation Science. doi: 10.1186/s13012-018-0811-0) revealed the models of facilitation used were limited in their ability to overcome the influence of contextual factors. Trial registration Current Controlled Trials ISRCTN11598502 . Date 4/2/10. The research leading to these results has received funding from the European Union’s Seventh Framework Programme (FP7/2007–2013) under grant agreement no. 223646.

Background Preterm birth (birth before 37 weeks of gestation) and its complications are the leading contributors to neonatal and under-5 mortality. The majority of neonatal deaths in Kenya and Uganda occur during the intrapartum and immediate postnatal period. This paper describes our study protocol for implementing and evaluating a package of facility-based interventions to improve care during this critical window. Methods/design This is a pair-matched, cluster randomized controlled trial across 20 facilities in Eastern Uganda and Western Kenya. The intervention facilities receive four components: (1) strengthening of routine data collection and data use activities; (2) implementation of the WHO Safe Childbirth Checklist modified for preterm birth; (3) PRONTO simulation training and mentoring to strengthen intrapartum and immediate newborn care; and (4) support of quality improvement teams. The control facilities receive both data strengthening and introduction of the modified checklist. The primary outcome for this study is 28-day mortality rate among preterm infants. The denominator will include all live births and fresh stillbirths weighing greater than 1000 g and less than 2500 g; all live births and fresh stillbirths weighing between 2501 and 3000 g with a documented gestational age less than 37 weeks. Discussion The results of this study will inform interventions to improve personnel and facility capacity to respond to preterm labor and delivery, as well as care for the preterm infant. Trial registration ClinicalTrials.gov, ID: NCT03112018 . Registered on 13 April 2017.

BACKGROUNDNursing administrators must provide cost-effective and efficient ways of orientation training. Traditional methods including classroom lecture can be costly with low retention of the information. Gamification engages the user, provides a level of enjoyment, and uses critical thinking skills. PURPOSEThe aim of this study is to explore the effectiveness, during orientation, of 3 different teaching methodsdidactic, online modules, and gamification. Specifically, is there a difference in nurses’ clinical knowledge postorientation using these learning approaches? METHODSA quasi-experimental study design with a 115-person convenience sample split nurses into 3 groups for evaluation of clinical knowledge before and after orientation. RESULTSThe gamification orientation group had the highest mean scores postorientation compared with the didactic and online module groups. CONCLUSIONSFindings demonstrate gamification as an effective way to teach when compared with more traditional methods. Staff enjoy this type of learning and retained more knowledge when using gaming elements.

Objectives. To determine the effectiveness of the COMmunity of Practice And Safety Support (COMPASS) Total Worker Health intervention for home care workers. Methods. We randomized 16 clusters of workers (n = 149) to intervention or usual-practice control conditions. The 12-month intervention was scripted and peer-led, and involved education on safety, health, and well-being; goal setting and self-monitoring; and structured social support. We collected measures at baseline, 6 months, and 12 months, which included workers’ experienced community of practice (i.e., people engaged in a common activity who interact regularly for shared learning and improvement). Implementation occurred during 2013 and 2014 in Oregon. Results. In an intent-to-treat analysis, relative to control, the intervention produced significant and sustained improvements in workers’ experienced community of practice. Additional significant improvements included the use of ergonomic tools or techniques for physical work, safety communication with consumer–employers, hazard correction in homes, fruit and vegetable consumption, lost work days because of injury, high-density lipoprotein cholesterol, and grip strength. Consumer–employers’ reports of caregiver safety behaviors also significantly improved. Conclusions. COMPASS was effective for improving home care workers’ social resources and simultaneously impacted both safety and health factors.