The ELEVATE Study: Evaluating the Impact of Educational Professional Governance Workshop on Nurses' Perceptions of Shared Decision-Making.

Background: The implementation of shared governance within the nursing practice results in heightened satisfaction among nurses and enhances the quality of care provided. Shared governance fosters collaborative and proactive relationships among nurses and healthcare providers, while also cultivating a sense of confidence among nurses. However, evidence suggests that a lack of awareness, reliance on traditional governance, and inadequate shared governance structures among nurses continue to exist at the unit-based council (UBC) level, including those in the Kingdom of Saudi Arabia (KSA). Purpose: The present study aimed to assess the extent of clinical nurses’ perceptions concerning shared governance at the UBC level, and to examine the variations and relationships in their perceptions based on demographic and work-related characteristics. It further explored the demographic and work-related factors that affect the overall perceptions of shared governance among clinical nurses. Methods: This quantitative study utilized a cross-sectional design and was carried out in three governmental hospitals in the KSA. The sample comprised 669 nurses, who were selected using a convenience sampling method. The Index of Professional Nursing Governance (IPNG) tool was utilized for data collection conducted between February 2025 and April 2025. Descriptive statistics alongside the t-test and analysis of variance (ANOVA), Pearson-r correlation coefficient, and multiple linear regression were utilized for data analysis. Significant findings were drawn when p ≤ 0.05. Results: The average perception of shared governance among clinical nurses at the UBC level was 180.42 out of 430, suggesting that decision-making occurs collaboratively between nurses and management. Significant differences in the average level of clinical nurses’ perceptions of shared governance were noted in relation to their educational qualifications (F = 5.015, p = 0.001) and nursing units (F = 4.157, p = 0.010). The hospital in which clinical nurses were employed (r = 0.098, p = 0.037) and nursing units (r = 0.087, p = 0.020) exhibited significant correlations with their overall shared professional governance. Furthermore, the hospital where clinical nurses were employed (β = 0.406, p = 0.001, 95% confidence interval [CI] = 0.166, 0.646) and nursing units (β = 0.326, p = 0.038, 95% CI = 0.018, 0.314) served as predictors of their overall professional shared governance. Conclusions: Clinical nurses in this study showed an initial or relatively low level of shared governance at the UBC level. The overall finding highlights a critical need for nursing managers and leaders to enhance the level of professional shared governance among clinical nurses, which may result in improved nurse retention and overall quality of nursing care. It is crucial to consider clinical nurses’ educational qualifications and working environment at the UBC level when aiming to enhance their level of professional shared governance.

The purpose of this study was to assess nurses' perceptions of shared governance using the Index of Professional Nursing Governance version 3.0 (IPNG). A goal of creating shared governance awareness among frontline nurses is to empower them to assemble and create positive change in their practice. This cross-sectional, descriptive, exploratory quantitative study design measured nurses' perceptions of shared governance on a continuum ranging from traditional to shared to self-governance in an academic medical center using the 50-item IPNG. Findings demonstrated a nascent shared governance structure with the lowest scoring items related to control over personnel. Active involvement in shared governance and education level impacted subscale scores (P < 0.05). Findings from this study supported the accreditation of the organization by the Forum for Shared Governance.

BackgroundShared governance is considered a model for mounting autonomous decision making in nursing profession and practice. This study aimed to assess how registered nurses in an outpatient department in a tertiary care hospital perceive shared governance.MethodsWe conducted a cross-sectional study among a convenient sample of registered nurses in an outpatient department. A self-administered, Index of Professional Nursing Governance (IPNG) questionnaire was used to measure the study outcome. A descriptive analysis was used to describe nurses' characteristics and study outcomes.ResultsA total of 186 nurses completed the questionnaire. Of whom, 151 (92.1%) were female, and 78 (47.3%) were aged between 20 and 30 years. Only 54 (29.3%) and 59 (31.7%) had indicated a shared decision in terms of controls and influence scales, respectively. The majority of the nurses indicated traditional shared across shared governance scales except in the access information scale.ConclusionThe findings showed a prevalent traditional nursing management style in the study setting. Supportive strategies and education must be provided for both managers and staff nurses to develop and implement shared governance in their practice.

Use and Perceptions of Shared Decision-Making by General Surgery Faculty and Trainees.

Background: Coronary artery disease (CAD) is the leading cause of death for men and women in the United States, with myocardial infarction (MI) being a serious outcome. Plant-based diets are associated with a reduced incidence of CAD. Registered nurses (RNs) are highly trusted members of the healthcare team and are ethically responsible for providing reliable information based on scientific sources and guideline-directed recommendations. Registered nurses are optimally positioned to provide education on adopting whole foods plant-based (WFPB) diets to patients experiencing CAD inside and outside the hospital setting. It is unknown the degree to which nurses have adopted WFPB eating patterns and incorporated WFPB patient education into routine nursing care. The purpose of this study is to describe RN perceptions (susceptibility, severity, benefits and barriers, self-efficacy) related to the effect of a WFPB meal pattern for prevention and management of CAD, and RN intention to apply this dietary knowledge to their own health behaviors and nursing practices. Methods: This descriptive quasi-experimental pretest-posttest study measured concepts from the health belief model including RN perceptions of susceptibility, severity, benefits, and barriers, as well as self-efficacy and meal behaviors. The participating RNs completed these measures before and after they participated in any of the educational interventions designed using experiential learning theory. Registered nurses had the option of attending one or all three educational interventions on WFPB nutrition and CAD. Results: Eighty-six RNs working in cardiology specialties on three inpatient or one outpatient cardiac units at a large southeastern hospital system participated. The nurses believed CAD is a serious diagnosis (72/72) and that WFPB dietary patterns are cardioprotective for the prevention and management of CAD (63/72). However, nurse dietary behaviors were incongruent with their beliefs as some RNs (14/72) indicated they did not consume any vegetarian or fully plant-based meals. The most common barrier (36/72) to nurses adopting a WFPB dietary pattern was a taste preference for meat and animal products. Half of the eight nurses who completed at least one of the educational interventions and the postsurvey reported increased confidence to advise patients with CAD on the WFPB dietary pattern. Combined, participants self-reported their vegetarian or fully plant-based meal frequency increased slightly. Discussion: Registered nurses lack a working knowledge of WFPB eating patterns in their personal and professional lives, which may impact the quality of dietary education they provide to people with CAD or MI. Overcoming barriers to education on WFPB dietary patterns is important for increasing nurse confidence in teaching people with CAD about this evidence-based dietary health behavior. Conclusion: Registered nurses’ knowledge and perceptions of WFPB eating patterns may be enhanced through professional development activities. RNs may be more likely to engage with education that is frequent, brief, asynchronous, and online or part of existing onboarding such as lunch and learn events to sample WFPB foods. Future research is needed on strategies to engage and empower RNs to educate people with CAD on WFPB nutrition.

This study examined the measurement equivalency (ME) of the job embeddedness (JE) instrument for rural and urban registered nurses (RNs) using a secondary analysis of a cross-sectional mailed survey. JE represents the sum of reasons an employee remains at the present job. RNs from both rural and urban areas returned a 40-item JE instrument designed to assess their level of embeddedness. Analysis was performed using a multi-group confirmatory factor analysis for JE ratings of rural and urban RNs. The findings indicated that the original 40-item JE instrument needed to be respecified to achieve adequate fit for the sample of rural and urban RNs. This 32-item respecified instrument demonstrated that rural and urban RNs use the same metric when giving ratings for JE items. The findings of ME across rural and urban RNs facilitate comparisons between the two groups. The implications of these findings are that differences in ratings between rural and urban RNs may be attributed to real differences and not merely measurement artifact. Examination of these differences may lead to real strategies to retain nurses, thus mitigating the impact of the global nursing shortage.

Starting Now: Implementing the Healthy Work Environment Standards Is More Important Than Ever

Type 2 diabetes mellitus is an established health problem for Indigenous Australians. One strategy to address this issue is to educate health professionals in diabetes management and education. The objective of this paper is to identify important issues that compromise the clinical practice of rural and remote Aboriginal health workers (AHWs) and registered nurses (RNs) who undertook an accredited Australian Diabetes Educators Association diabetes course and to suggest strategies to improve practice. The design used a qualitative approach and discussion schedule to elicit responses. The setting involved two Aboriginal community controlled and seven mainstream health services in the Far Western region of New South Wales. The participants were experienced diabetes educators (RNs and AHWs), managers and students currently enrolled in the course (n = 17). The results indicated issues that compromise diabetes practice and identified strategies to improve practice. Issues were: the confusing funding practices by health providers, the duplication of health services, the lack of recognition of diabetes qualifications and the transient nature of Indigenous people. Strategies included the need for: continuous dedicated diabetes health funding, a role clarification for diabetes educators, strategic diabetes planning and the importance of diabetes educators working in partnership. The conclusion from this study indicates that if the delivery of diabetes health services to Indigenous Australians is to improve it is necessary to address these identified issues.

Health professionals' knowledge and understanding about Listeria monocytogenes indicates a need for improved professional training.

Much has been written about models, aims and the concept of clinical group supervisional, although few studies are empirical or focus on intensive care. The aim of the study was to illuminate the process and describe, using qualitative content analysis, the content of conversations carried out during the course of clinical group supervision sessions among Registered Nurses (RN) and enrolled nurses (EN) working in an intensive care unit (ICU). During the supervision sessions, ENs talked about their life-world from a caring perspective, while RNs focused on their professional development. Both ENs and RNs regarded the supervision sessions as a space for relief and for sharing emotions and caring experiences, which helped to manage complex nursing care. The findings are viewed in the light of Roach's theoretical framework describing the attributes of professional care as five Cs. Clinical group supervision is interpreted as supportive in developing interpersonal skills and a sensitive nursing practice.

Screening patients admitted with stroke symptoms for risk of aspiration is often the responsibility of registered nurses (RNs). Simulation technology has become a widely used evidence-based form of training for healthcare professionals. The purpose of this study was to determine if the use of medical simulation mannequins as a training component is feasible when training and evaluating nurses administering swallowing screenings to stroke patients. A total of 32 RNs were divided into one of two training groups: didactic training only or didactic training plus simulation. Acquisition of skills was assessed immediately post-training and compared between the groups revealing significant differences between simulation group and didactic-only group for interpretation (p=0.01) and administration (p=0.05) accuracies. Following training to 100% accuracy for post-training baseline competency, maintenance of skills across participants was assessed three more times over 6weeks with the third follow-up screening completed with a standardized patient (live patient actor). While interpretation performance at each subsequent trial never equaled the baseline 100% post-training accuracy (p=0.001), steady improvement in performance was observed with each follow-up assessment. For screening administration, no significant differences in skills were evident between post-training baseline competency and the 6-week follow-up (p=0.269) further confirming improvement in skills over time. Extension of screening administration and interpretation skills to the standardized patient was evident. Findings indicate that simulation training using medical mannequins can be used to train and evaluate nurses for obtainment and maintenance of swallowing screening competency.

Our medical center leaders targeted a $30 million savings over 3 years. To achieve this goal a data driven work redesign approach was adopted and a series of time motion studies were performed. For each of 3 years, every hospital worker recorded and summarized their activity in blocks of time during 1 week. By 1995, nursing results were radically different from the previous 2 years. Bathing, turning patients, and gathering intake and output disappeared from the top 10 registered nurse (RN) activities, While professional judgement, patient education and data assessment entered the top 10. Initiatives involving skills mix and care delivery changes resulted in more focused and activity-appropriate use of RN time.

Background and objective: In the context of a rapidly evolving health care system, health care institutions strive to set a path towards an excellent professional practice environment. Since improving clinical nurse work environments is a major issue faced by nurse executives and administrators, they become challenged to establish nursing governance models, and leadership practices so that clinical nurses can engage in the work processes and relationships that are empirically linked to quality patient outcomes. The main aim of this study was to assess the current status of professional nursing governance and hospital magnet components at Alexandria Medical Research Institute, Egypt.Methods: A descriptive research design was conducted at Alexandria Medical Research Institute hospital, using a convenience sample (N = 220) that composed of two groups including; all hospital medical administrators (n = 10) and hospital nursing workforce (n = 210). Index of Professional Nursing Governance Questionnaire (IPNGQ) and Magnet Hospital Forces Interview were proved valid and reliable to measure study variables.Results: The overall mean score of professional nursing governance was (187.59 ± 63.74) reflected that staff nurses practice the first level of nursing shared governance (primarily nursing management who take the decision with some staff input). In addition, both medical administrators and nursing staff identified the hospital has a good structure, nursing leadership practices that support shared governance and magnet recognition. Structural equation model and correlation analysis revealed a positive association between overall professional nursing governance and hospital magnet components (p &lt; .05).Conclusions and recommendations: The study emphasized the hospital administrators’ important role for providing supportive organizational structures and leadership practices for increasing participation of nursing staff in work design, problem-solving, conflict resolution, committees and organizational decision-making as “key ingredients to a successful organization” in turn, lead to a healthy and magnet-like work environment. Training programs for nurses’ professional development are recommended which enhance and increases their autonomy and empowerment.

To describe shared governance in action through the example of one paediatric institution's decision to institute daily chlorhexidine bathing. Shared governance processes are discussed extensively in the literature; however, implementation of the processes can be challenging. Recently nurses at one paediatric hospital were involved in a hospital-wide practice change where the theoretical approach of shared governance was actualised. Several questions arose from direct care nurses about unwarranted variations in bathing practices across settings and whether bathing standardisation could address the recent increase in central line-associated bloodstream infections. Shared governance council members identified daily chlorhexidine bathing as a potential intervention to standardise bathing across the hospital and to decrease infection rates. At this time, chlorhexidine bathing had been widely adopted in adult hospitals but was less commonly practiced in paediatric institutions. This is a position paper describing the use of shared governance to make a house-wide practice decision and positively impact patient outcomes. Inquiry Council members conducted a systematic evidence search on best practices around chlorhexidine bathing. This evidence was used in Practice Council discussions to standardise house-wide practice. Once consensus was achieved, council members collaborated with Education Council to ensure understanding, competency, and the adoption and sustainment of the practice change. Patients with central lines are at decreased risk for acquiring a central line-associated blood stream infection due, in part, to the change in nursing practice to include daily chlorhexidine bathing. The shared governance structure was the vehicle through which this practice was vetted and instituted. This paper provides a real-life example of leveraging shared governance structures and the direct care nurse leaders within the councils when an organisation faces critical needs in patient care.

The present study examines job-related factors leading to low self-esteem in nurses. The lowering of self-esteem suggests that such nurses had difficulty in fully accepting themselves and their circumstances. Subjects were registered nurses (RN) and licensed practical nurses (LPN) at hospitals, and unemployed registered nurses (UEN) seeking employment. Questionnaires were provided at 53 hospitals and a Nurse Bank in Kanagawa Prefecture. The responses of 552 RN, 146 LPN and 433 UEN were analyzed. Questions were asked about personal life, past or present nursing experience, working conditions, nursing skills, satisfaction with work performance and self-esteem. Factors giving rise to low self-esteem were determined using logistic regression analysis and logistic discriminant analysis. Employment status and qualifications were determined to be the most important factors determining the self-esteem of nurses. The next most important factors were 'a limited number of years of experience (less than five years)' and 'dissatisfaction with discretion and responsibility as a nurse' (P < 0.01). Adjusted odds ratio for a reduction in self-esteem for LPN was 4.07 times higher than for UEN, and 2.2 times higher than for RN by logistic regression analysis. LPN are treated as unskilled workers, and thus significant differences were apparent in their performance of certain job tasks. These differences were analyzed using discriminant analysis, and were referred to as follows, 1: Advanced assessment skills, 2: Advanced technical skills, 3: Advanced communication skills, and 4: Nursing plan and documentation (positive discrimination rate was 70.8%). Job dissatisfaction is closely associated with the level of professional training. Continuous education and a feedback system for various levels of nurses are needed.