Evidence-Based Leadership in Nursing: An Evolutionary Concept Analysis.

BackgroundNurse managers have a pivotal role in fostering unit climates supportive of implementing evidence-based practices (EBPs) in care delivery. EBP leadership behaviors and competencies of nurse managers and their impact on practice climates are widely overlooked in implementation science. The purpose of this study was to examine the contributions of nurse manager EBP leadership behaviors and nurse manager EBP competencies in explaining unit climates for EBP implementation in adult medical-surgical units.MethodsA multi-site, multi-unit cross-sectional research design was used to recruit the sample of 24 nurse managers and 553 randomly selected staff nurses from 24 adult medical-surgical units from 7 acute care hospitals in the Northeast and Midwestern USA. Staff nurse perceptions of nurse manager EBP leadership behaviors and unit climates for EBP implementation were measured using the Implementation Leadership Scale and Implementation Climate Scale, respectively. EBP competencies of nurse managers were measured using the Nurse Manager EBP Competency Scale. Participants were emailed a link to an electronic questionnaire and asked to respond within 1 month. The contributions of nurse manager EBP leadership behaviors and competencies in explaining unit climates for EBP implementation were estimated using mixed-effects models controlling for nurse education and years of experience on current unit and accounting for the variability across hospitals and units. Significance level was set at α < .05.ResultsTwo hundred sixty-four staff nurses and 22 nurse managers were included in the final sample, representing 22 units in 7 hospitals. Nurse manager EBP leadership behaviors (p < .001) and EBP competency (p = .008) explained 52.4% of marginal variance in unit climate for EBP implementation. Leadership behaviors uniquely explained 45.2% variance. The variance accounted for by the random intercepts for hospitals and units (p < .001) and years of nursing experience in current unit (p < .05) were significant but level of nursing education was not.ConclusionNurse managers are significantly related to unit climates for EBP implementation primarily through their leadership behaviors. Future implementation studies should consider the leadership of nurse managers in creating climates supportive of EBP implementation.

Best practice in nursing: A concept analysis

As the number of healthy older adults increases, robustness has emerged as an important concept to describe individual differences in adaptability and health outcomes. However, the concept remains inconsistently defined across healthcare disciplines, necessitating conceptual clarification. This study aims to conduct an evolutionary concept analysis of robustness in older adults. An evolutionary concept analysis method was conducted. Four healthcare databases (PubMed, CINAHL Complete, EMBASE, Scopus) and Google Scholar were systematically searched without publication year restrictions, excluding gray literature. Data were extracted and analyzed to identify attributes, antecedents, consequences, and related terms. Analysis of 31 studies revealed three attributes: multidimensional vitality, resilient stability, and functional autonomy. Antecedents include socioeconomic resources, beneficial lifestyle behaviors, and supportive social networks, while consequences encompass enhanced quality of life, reduced healthcare needs, and decreased mortality. Comparison with related terms confirmed robustness as distinct from successful aging, non-frailty, intrinsic capacity, and resilience. This study established conceptual boundaries for robustness, enabling healthcare professionals to move beyond age-based approaches toward individualized assessment and care strategies, providing a theoretical framework for developing measurement tools and implementing personalized interventions.

Health-related decision-making is a complex process given the variability of treatment options, conflicting treatment plans, time constraints and variable outcomes. This complexity may result in patients experiencing decisional regret following decision-making. Nonetheless, literature on decisional regret in the healthcare context indicates inconsistent characterization and operationalization of this concept. To conceptually define the phenomenon of decisional regret and synthesize the state of science on patients' experiences with decisional regret. A concept analysis. Rodgers' evolutionary method guided the conceptualization of this review. An interdisciplinary literature search was conducted from 2003 until 2023 using five databases, PubMed, CINAHL, Embase, PsycINFO and Web of Science. The search informed how the concept manifested across health-related literature. We used PRISMA-ScR checklist to guide the reporting of this review. Based on the analysis of 25 included articles, a conceptual definition of decisional regret was proposed. Three defining attributes underscored the negative cognitive-emotional nature of this concept, post-decisional experience relating to the decision-making process, treatment option and/or treatment outcome and an immediate or delayed occurrence. Antecedents preceding decisional regret comprised initial psychological or emotional status, sociodemographic determinants, impaired decision-making process, role regret, conflicting treatment plans and adverse treatment outcomes. Consequences of this concept included positive and negative outcomes influencing quality of life, health expectations, patient-provider relationship and healthcare experience appraisal. A conceptual model was developed to summarize the concept's characteristics. The current knowledge on decisional regret is expected to evolve with further exploration of this concept, particularly for the temporal dimension of regret experience. This review identified research, clinical and policy gaps informing our nursing recommendations for the concept's evolution. This concept analysis examines existing literature and does not require patient-related data collection. The methodological approach does not necessitate collaboration with the public.

The aim of this concept analysiswas to develop a contemporary operational definition of Clinical Judgement in nursing. Concept analysis. Rodgers' evolutionary method of concept analysis. Throughout the study, the authors followed the SRQR checklist. This concept analysis guided the development of an operational definition of clinical judgement, within the context of nursing, articulated as Clinical judgement is a reflective and reasoning process that draws upon all available data, is informed by an extensive knowledge base and results in the formation of a clinical conclusion. The purpose of this concept analysis was to propose a detailed definition of clinical judgement in nursing, that reflected its theoretical base within today's contemporary healthcare system. Using Rodgers' evolutionary method of concept analysis, surrogate terms, attributes, antecedents and consequences were identified, and a contemporary definition was developed. No patient or public contribution was required to design or undertake this research.

As the World Health Organization (WHO) emphasizes the power of innovation to build efficient, effective, and resilient health systems, redefining health systems will increasingly require nurses to lead innovation. Despite the widely recognized importance of nursing innovation in advancing health ecosystems transformation, the concept of nursing innovation remains unclear in the literature and critically warrants conceptual clarification. Clarifying the concept of nursing innovation is critically important to promote a shared understanding among health systems decision-makers, the nursing workforce, and researchers about what constitutes nursing innovation as a phenomenon. A robust conceptual foundation will also support its integration into work environments and inform empirical research that remains underexplored in nursing science, thereby advancing nursing innovation scholarship. We aimed to provide a clear conceptual foundation for nursing innovation within health ecosystems, with attention to contextual and temporal aspects, as a heuristic for further inquiry. We followed the Rodgers\' evolutionary concept analysis method. This method was chosen given its philosophical foundation grounded in dispositional theory, which conceives concepts as inductive, cyclical, evolving, and context-dependent. A comprehensive search was performed in February 2025 across five electronic databases: Ovid MEDLINE, CINAHL, Web of Science, Scopus, and Business Source Complete. All records identified were independently screened by two reviewers and included if it: 1) regarded all licensed nursing professionals as the population; 2) clearly defined nursing innovation by a) conveying the meaning explicitly or implicitly as a concept, construct, phenomenon, and/or outcome of interest and/or b) measuring nursing innovation as a means of operationalizing the concept; 3) conducted across health systems and within all specialties in healthcare delivery organizations; 4) published as peer-reviewed research, literature reviews, and discussion/theoretical papers. Literature written in English and Portuguese was considered for inclusion, as the languages of the author\'s proficiency. No timeframe was specified to allow examination of the concept across a temporal context. The components of Rodgers\' evolutionary method (antecedents, attributes, and consequences) were identified and analyzed using thematic analysis. The aggregated data were visually presented in a conceptual model, in addition to an exemplar presented to provide a practical demonstration of the concept in a relevant context. A total of 10,513 titles and abstracts were screened, resulting in 41 articles included. Articles included were published between 1993 and 2023 from seven high-income countries: Australia, China, New Zealand, Portugal, Taiwan, United Kingdom, and United States of America (USA). The antecedents of nursing innovation were grouped in seven categories: leadership support; unmet needs; nursing workforce; innovation education; emerging demands; opportunities identification; and multilevel (organizational, system, and ecosystem) enablers. The attributes of nursing innovation were described according to five main themes: innovation characteristics; innovation pathway; solution dimensions; individual characteristics; and multilevel (organizational, system, and ecosystem) characteristics. The consequences of nursing innovation were described according to three main themes: value generation & delivery; failure; and solution dimensions. We defined nursing innovation in three parts as: a) the human ability to identify unmet needs, opportunities, and/or new demands, and take strategic action by designing and implementing desirable, feasible, viable, responsible, beneficial, and sustainable solutions that can deliver measurable outcomes; and b) the human-centred design and implementation of desirable, feasible, viable, responsible, beneficial, and sustainable solutions that address unmet needs, opportunities, and/or new demands, generating and delivering clinical, experiential, systemic, professional, and social value for humans, populations, the nursing workforce, and the health ecosystem; and c) the reinvention and implementation of human-centred solutions that adapt to changing unmet needs, opportunities, and/or new demands, generating and delivering clinical, experiential, systemic, professional, and social value improvements for humans, populations, the nursing workforce, and the health ecosystem. Our definition extends beyond one-dimensional conceptualizations, establishing a multidimensional theoretical foundation. Although significant misunderstandings about the concept of nursing innovation persist in the literature, this concept analysis highlights a conceptual maturity characterized by well-defined patterns of antecedents, attributes, and consequences. Imperatively, the findings highlight the maturity of nursing innovation concept and underscore the critical need to invest in innovation education and leadership development within the nursing workforce, as well as to strengthen the multilevel infrastructure within the healthcare ecosystem, as essential enablers for advancing nursing innovation. Nursing innovation is not solely about inventing novel solutions, but also reinventing existing ones. Regardless of whether it is an invention or reinvention, perceived novelty (innovativeness) and degree of change (incremental or disruptive) remain core attributes. The state of the art is still unclear whether nursing innovation rarely leads to negative outcomes and should therefore be accelerated within health ecosystems, or if there is a lack of sufficient evidence that embraces failure as an outcome. Our definition can be used to support health system decision-makers in developing targeted interventions that stimulate the creation and strengthening of nursing innovation ecosystems. Extensive research is warranted to build upon our understanding of this concept analysis and advance nursing innovation theory.

Nursing Leaders’ Influence on Clinical Nurses’ Evidence-Based Practice Implementation: Impact of an Evidence-Based Practice Leadership Behavior Program

Division of Pulmonary and Critical Care Medicine Northwestern University Feinberg School of Medicine Chicago, IL Division of General Internal Medicine and Geriatrics Northwestern University Feinberg School of Medicine Chicago, IL Dr. Weiss received grant support from the National Heart, Lung, and Blood Institute (K23118139-01) and Parker B. Francis Fellowship Program and received support for article research from the National Institutes of Health. Dr. Baker has disclosed that he does not have any potential conflicts of interest.

Concept analysis is a technique used to determine defining attributes, with the purpose of developing a concept to expand nursing knowledge. The interrogation of attributes, antecedents, and consequences aids in clarifying ambiguity with a view to developing an operational definition. Establishing a clear definition of a concept lays the groundwork for future research and practice. Nursing students embark on a sequenced set of clinical learning experiences as a primary component of their undergraduate program. Being bullied is common in clinical practicum experiences for nursing students and is often seen as unavoidable, resulting in negative impacts on student learning, health care team functioning deterioration, decreased quality of care for patients, and negative impacts on retention and satisfaction with the nursing profession. Numerous studies have investigated the concept of bullying in the profession, yet the range of how bullying manifests creates a challenge for analysis and agreement of the concept. Rodgers’s (2000) evolutionary method was used for this literature-based concept analysis to lead to a meaningful understanding of the concept over time by identifying attributes, antecedents, and consequences. Attributes specific to bullying of nursing students in the clinical environment included intentionality, temporality, negative interactions, denied opportunities, and workload challenges. Several surrogate terms were identified in this analysis. Antecedents identified for bullying included power imbalances, working conditions, entrenched behaviour, and organizational dysfunction. Consequences associated with bullying affect students, the nursing profession, and the workplace. The most prevalent finding from this concept analysis is that bullying is used to describe many different types of behaviour. This analysis contributes to the foundation of evidence supporting the discussion around the need for continued clarity and further research on the phenomenon of bullying in the clinical environment. Further analysis is needed to clarify the concept of bullying to expand knowledge in the nursing discipline by addressing the antecedents to influence change in nursing education. Clarity on how bullying is defined is necessary to facilitate recognizing and reporting bullying and developing effective interventions.

Strategies to Sustain Quality Interventions: Case Examples of Chlorhexidine Gluconate Bathing.

What Guides your Practice?

Translational research: The ingredients are only the start of the recipe for better dietetic practice

BackgroundWhile there is convincing evidence on interventions to improve bowel preparation for patients, the evidence on how to implement these evidence-based practices (EBPs) in outpatient colonoscopy settings is less certain. The Strategies to Improve Colonoscopy (STIC) study compares the effect of two implementation strategies, physician education alone versus physician education plus an implementation toolkit for staff, on adoption of three EBPs (split-dosing of bowel preparation, low-literacy education, teach-back) to improve pre-procedure and intra-procedure quality measures. The implementation toolkit contains a staff education module, website containing tools to support staff in delivering EBPs, tailored patient education materials, and brief consultation with staff to determine how the EBPs can be integrated into the existing workflow. Given adaptations to the implementation plan and intentional flexibility in the delivery of the EBPs, we utilize a pragmatic study to balance external validity with demonstrating effectiveness of the implementation strategies.Methods/DesignParticipants will include all outpatient colonoscopy physicians, staff, and patients from a convenience sample of six endoscopy settings. Aim #1 will explore the relative effect of two strategies to implement patient-level EBPs on adoption and clinical quality outcomes. We will assess the change in level and trends of clinical quality outcomes (i.e., adequacy of bowel preparation, adenoma detection) using segmented regression analysis of interrupted time series data with two groups (intervention and delayed start). Aim #2 will examine the influence of organizational readiness to change on EBP implementation. We use a PRECIS diagram to reflect the extent to which each indicator of the study was pragmatic versus explanatory, revealing a largely pragmatic study.DiscussionImplementation challenges have already motivated several adaptations to the original plan, reflecting the nature of implementation in real-world healthcare settings. The pragmatic study responds to the evolving needs of its healthcare partners and allows for flexibility in intervention delivery, thereby informing clinical decision-making in real-world settings. The current study will provide information about what works (intervention effectiveness), for whom it works (influence of Medicaid versus other insurance), in which contexts it works (setting characteristics that influence implementation), and how it works best (comparison of implementation strategies).Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0276-3) contains supplementary material, which is available to authorized users.

The purpose of this article was to analyze the concept of "the fighter in the intensive care unit (ICU)" per the scientific literature and the impact this mentality has on care administered in the ICU. A literature review and a concept analysis based on Rodger's evolutionary method were performed to identify surrogate terms, antecedents, attributes, and consequences pertaining to the "fighter" in the ICU. Thirteen articles with a focus on "the fighter" were included in this analysis. There is a strong desire to remain optimistic and maintain high spirits as a coping mechanism in the face of extreme prognostic uncertainty. Themes that emerged from the literature were the need to find inner strength and persist in the face of adversity. The concept of "the fighter in the ICU" can serve as either adaptive or maladaptive coping, depending on the larger clinical picture. Patient experiences in the ICU are fraught with physical and psychological distress. How the patient and family unit cope during this anxiety-provoking time is based on the individual. Maintaining optimism and identifying as a fighter can be healthy ways to adapt to the circumstances. This concept analysis highlights the importance of holistic care and instilling hope particularly as patients may be nearing the end of life.

Ocular frailty: A concept analysis.