Effectiveness and implementation of patient safety care

Welcome to the October issue of the Journal of Nursing Management. We are pleased to present 12 articles from the US, Sweden, South Africa, Italy, the UK, China, Canada, Ireland, and Israel that address a range of topics illustrating nursing challenges and opportunities. The paper by Lee et al. determines the cost-effectiveness of hospital nursing interventions for patients undergoing total hip replacement. It is of importance because it adds knowledge about an area in which little research has been carried out on the relative economic benefits of nursing interventions (e.g. who provides what level of nursing care, what is the standard time required to deliver a certain intervention and what equipment for particular nursing interventions). The author's implications for nurse administrators include supporting nurses' documentation in order to make nursing information available. The paper by Navratil-Strawn and colleagues describes an integrated Nurse HealthLine programme that evaluates the impact of nurse-led conversation, in the US and is associated with significant cost savings built on standard economic theory. Patients receiving the right care at the right time are likely to recover faster and have lower healthcare expenditure than those who do not. The paper by Sun and colleagues focuses on the conditions necessary for work effectiveness by evaluating the psychometric properties of an adapted Chinese version of an instrument designed to measure structural empowerment among staff nurses. It was concluded that the reliability and validity of the scale were evident. Cicolini, Comparcini and Simonetti explored workplace empowerment and nurses' job satisfaction using a literature review method. The authors recommend that future research should investigate the relationship between empowerment and nurses' job satisfaction across countries and in different settings other than hospital based on the studied variables and patient outcomes. Another paper on the subject of effectiveness is the study from South Africa by Jooste and Mothiba on cost management training. Using a qualitative, exploratory design the study describes nurse managers who were formally appointed as cost centre managers with a dual role of delivering quality care and cost management. A conceptual framework for cost management training is emphasized. The second theme in this issue is the implementation of patient safety care. The Swedish paper by Sandström and colleagues reports the necessity of implementing evidence-based guidelines in the mental health field by focusing on decision-makers' attitudes to and awareness of psychosocial interventions targeting persons with schizophrenia. According to Salmela (2012), the nurse leader's awareness of the need to implement change in practice entails knowledge of relationships, processes and culture as well as supportive, reflective and culture-bearing leadership aimed at achieving genuine and sustainable change, thus ensuring safe care. However, change requires learning and knowledge (Salmela 2012), in addition to the use of guidelines that can reduce inappropriate variation in practice, enhance quality and provide safe care as well as lower healthcare costs (Sacket et al. 1996, Dopson et al. 2003, Taylor & Allen 2007). The paper by Higgins and colleagues reports the factors that influence clinical specialists' and advanced nurse practitioners' ability to enact their clinical and professional leadership roles and adds to the knowledge of their key role in supporting leadership as well as their potential to influence policy and network with professional groups. A paper from South Africa by Ngxongo and Sibiya describes the challenges of implementing a basic antenatal care programme. The authors state that although guidelines are available in almost all facilities, staff members require training in their use to ensure safe practice. White, Wells and Butterworth evaluated implementation literature pertaining to implementation experiences. They identified seven contextual characteristics that should be highlighted during implementation in order to improve the progress and success of the initiatives. In summary, effective and sound processes lead to patient safety when nurses are empowered and acknowledged as part of an interprofessional team. The aim of the paper by Heale et al. was to determine the perceptions of nurse practitioners about the level of functioning of their interprofessional teams. The management strategies that emerged include allocation of time to support interprofessional teamwork, leadership to enhance collaboration and clear delineation of the responsibilities of each team member. The papers in this special issue provide an overview of the range and scope of nursing effectiveness and implementation of patient safety care. They also present up-to-date evidence of how nurse leaders effectively address challenges in nursing practice to maintain patient safety. There are several implementation strategies for improving and maintaining patient safety. Some nursing practice activities and programmes of known dimensions are presented in this issue. The work to develop a research implementation framework for evaluating quality improvement interventions should continue by assessing the effectiveness and understanding of the change process involved in implementation. However, implementation research requires evidence-based knowledge, staff involvement and familiarity with the context in which development occurs (Severinsson & Holm 2014). Hopefully this issue will inspire the reader to actively relate to, reflect on, support and explore dimensions of nursing leadership and management. I wish you good luck in nursing practice development and research.

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