Empowerment strategies to engage frontline perioperative nurses in shared decision making in the development process of clinical decision support tools

摘要

Abstract:Background: Collaboration between professions and practices of shared decision making through a culture of partnership contributes to a positiveworkspace for practice change. The identity of a nurse constitutes more than a caring profession. Nursing as a profession impacts major issues in society to better healthcare outcomes. Enacting nursing leadership contributes to professional practice in a multi-level healthcare system and society. Nurses as leaders facilitate collaboration and actively take part in shared decision-making every day as part of patient care. Frontline nurses do not necessarily engage in shared decision-making practices as part of professional practice councils. In addition, these nurses may not comprise the political skills to navigate magnet culture in the development of clinical decision support tools in nursing practice. Gaps arise in the application of these tools geared towards optimal health outcomes for patients due to the lack of frontline nursing perspectives and shared decision-making practices. Unit and organizational culture may influence the level of engagement of these frontline nurses in the development and execution of clinical decision support tools. Aim: The barriers and facilitators impacting engagement of frontline nurses in shared decision-making practices was explored through a knowledge translation project. Key messages from results may enhance nursing leadership, teamwork, and patient care through the utilization of Professional Practice Councils to encourage shared decision making and create a culture of partnership. Methods: The Knowledge to Action framework developed by Graham and colleagues guided a knowledge synthesis to explore these barriers and facilitators utilizing a CINAHL literature review and secondary analysis of a unit culture survey. Themes derived served as building blocks for multi-level empowerment strategies for frontline nurses to enact their leadership role as part of their nurse identity. Results: Multi-level themes revealed an absence of frontline nurses in shared decision-making processes when clinical decision support tools are developed and implemented. Decreased professional autonomy and poor teamwork are experienced by frontline nurses when they are not valued as stakeholders or decision makers in the development of these tools, leading to poor patient care. Shared governance and magnet cultures support the establishment of effective professional practice councils. Elements of magnetism are strongly associated with increased nurse autonomy and engagement in shared decision making as nurse leaders. Conclusion: The empowerment strategies ensure linkages throughout the healthcare organization and enhance effective communication between the nursing profession, unit managers/leaders, and the organizational infrastructure. Importance to nursing education in preparing frontline nurses.