No abstract

Aims: To understand the strategies to influence patient outcomes by synthesizing existing evidence on effective interventions for teamwork, delegation and communication between registered nurses and nursing assistants. Background: Three-quarters of deaths in hospitals are related to breakdowns in teamwork and communication. Acute care systems utilize teams of registered nurses and nursing assistants for primary delivery of nursing care. Research has been conducted to improve the partnership between the dyad. Literature reviews are needed to synthesize the effectiveness of delegation and communication interventions between registered nurses and nursing assistants on patient outcomes. Methods: The authors applied Whittemore and Knafl's integrative review methodology to conduct an integrative review of the literature. Databases searched included Cumulative Index to Nursing and Allied Health Literature, MEDLINE and PubMed along with reference searches. Included articles were intervention studies related to teamwork, delegation or communication between registered nurses and nursing assistants, and published from 2000 to 2019. Methodological quality was assessed utilizing the Mixed Methods Appraisal Tool. The Systems Engineering Initiative for Patient Safety model 2.0 was applied as a guiding framework to analyse the findings. Results: Seven articles met the inclusion criteria. The interventions in these articles focused on building a foundation of trust and respect through simulation, education and mindful communication. Four of the seven articles measured patient outcomes including patient falls, hospital-acquired pressure injuries and patient satisfaction. Three articles reported decreased patient falls, two articles reported increased patient satisfaction, while one article reported a reduction in pressure injury. Five of the studies reported improved teamwork and/or communication, and two studies reported improved job satisfaction. Conclusions: There has been limited research on the impact of the registered nursenursing assistant relationship on patient safety and care outcomes. The existing research demonstrates a need for interventions to foster a dynamic and effective relationship between registered nurses and nursing assistants.

Background Leadership competency is required throughout nursing. Students have difficulty understanding leadership as integral to education and practice. A consistent framework for nursing leadership education, strong scholarship and an evidence base are limited. Purpose To establish an integrated leadership development model for prelicensure nursing students that recognizes leadership as a fundamental skill for nursing practice and promotes development of nursing leadership education scholarship. Method Summarizing definitions of nursing leadership, conceptualizing leadership development capacity through reviewing trends, and synthesizing existing leadership theories through directed content analysis. Discussion Nine leadership skills form the organizing structure for the Nursing Leadership Development Model. Leadership identity development is supported via dimensions of knowing, doing, being and context. Conclusion The Nursing Leadership Development Model is a conceptual map offering a structure to facilitate leadership development within prelicensure nursing students, promoting student ability to internalize leadership capacity and apply leadership skills upon entry to practice Table 4. Critical values in the social change model of leadership-Komives et al., 2013. Critical values Definitions Consciousness of self Awareness of personal beliefs, values and patterns of behavior Congruence Consistent action based on personal values, attitudes and emotions Commitment Passionate energy focuses on an activity or outcome beyond self Collaboration Ability to promote group action around a value and/or ideal Common purpose Enabling work aimed at shared goals and a common vision Controversy with civility Acceptance of differences and conflict resolution through dialogue Citizenship Active engagement in social change and community/civic responsibilities

This paper investigates the palaeoenvironments and dynamics of the Rannoch Formation in the East Shetland Basin and the sedimentology of the Etive Formation in one particular part of the basin, the southern Cormorant area. The study utilizes core and well data from the North Sea as well as comparative outcrop data from Utah, western USA.Rannoch Formation facies, coupled with a slight coarsening and cleaning upward of sand-dominated profiles above offshore shales and below channelized delta top sediments, are indicative of a prograding shoreface. The middle shoreface is dominated by hummocky cross-stratified fine sand characterised by horizontal to very low angle, planar to undulatory laminations, often cut by steeper scour features.The Etive Formation is characterized in the southern Cormorant area by development of a microtidal, wave-dominated barrier cut by associated inlet channels.These associations are consistent with an interpretation of the Rannoch Formation as a high energy, storm-dominated environment, with strong wave oscillatory motion accompanied by weak translatory currents as the most likely depositional setting. In the overlying Etive Formation, shoreline characteristics are those of a dissipative coastal system with a complex three-dimensional inshore topography and at least one nearshore bar system developed during fairweather periods.

New graduate nurse practitioner (NP) postgraduate support programs and interventions have proliferated, sparking controversy. The Institute of Medicine/National Academy of Medicine recommends residency programs for new graduate NPs; however, the NP community debates whether new graduate NPs need additional training and whether such training compromises patient access to care. This systematic review aimed to synthesize evidence regarding the effectiveness of interventions and strategies to promote the professional transition of new graduate NPs. Interventions identified in the current literature included fellowship programs and a webinar. Strategies included mentorship, experiential learning, interprofessional training, and professional socialization. The studies reviewed primarily evaluated NPs’ perceptions of the interventions’ effects on their professional transitions. The findings from this systematic review highlight challenges in evidencing postgraduate support programs. The small number of available studies underscores a critical problem for the NP community: additional evidence is needed to inform whether and how to support new graduate NPs as they transition to practice.