Essential elements of professional nursing environments in Primary Care and their influence on the quality of care.

PubMed

Gea-Caballero, Vicente; Castro-Sánchez, Enrique; Júarez-Vela, Raúl; Díaz-Herrera, Miguel Ángel; de Miguel-Montoya, Isabel; Martínez-Riera, José Ramón

Nursing work environments are key determinants of care quality. Our study aimed to evaluate the characteristics of nursing environments in primary care settings in the Canary Islands, and identify crucial components of such environments to improve quality. We conducted a cross-sectional study in primary care organisations using the Practice Environment Scale - Nursing Work Index tool. We collected sociodemographic variables, scores, and selected the essential items conducive to optimal care. Appropriate parametric and non-parametric statistical tests were used to analyse relations between variables (CI = 95%, error = 5%). One hundred and forty-four nurses participated. The mean total score was 81.6. The results for the five dimensions included in the Practice Environment Scale - Nursing Work Index ranged from 2.25 - 2.92 (Mean). Twelve key items for quality of care were selected; six were positive in the Canary Islands, two were mixed, and four negative. 7/12 items were included in Dimension 2 (fundamentals of nursing). Being a manager was statistically associated with higher scores (p<.000). Years of experience was inversely associated with scores in the 12 items (p<.021). Nursing work environments in primary care settings in the Canary Islands are comparable to others previously studied in Spain. Areas to improve were human resources and participation of nurses in management decisions. Nurse managers must be knowledgeable about their working environments so they can focus on improvements in key dimensions. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Home health agency work environments and hospitalizations.

PubMed

Jarrín, Olga; Flynn, Linda; Lake, Eileen T; Aiken, Linda H

2014-10-01

An important goal of home health care is to assist patients to remain in community living arrangements. Yet home care often fails to prevent hospitalizations and to facilitate discharges to community living, thus putting patients at risk of additional health challenges and increasing care costs. To determine the relationship between home health agency work environments and agency-level rates of acute hospitalization and discharges to community living. Analysis of linked Center for Medicare and Medicaid Services Home Health Compare data and nurse survey data from 118 home health agencies. Robust regression models were used to estimate the effect of work environment ratings on between-agency variation in rates of acute hospitalization and community discharge. Home health agencies with good work environments had lower rates of acute hospitalizations and higher rates of patient discharges to community living arrangements compared with home health agencies with poor work environments. Improved work environments in home health agencies hold promise for optimizing patient outcomes and reducing use of expensive hospital and institutional care.

[Evaluation of the nurse working environment in health and social care intermediate care units in Catalonia].

PubMed

Bullich-Marín, Ingrid; Miralles Basseda, Ramón; Torres Egea, Pilar; Planas-Campmany, Carme; Juvé-Udina, María Eulalia

A favourable work environment contributes to greater job satisfaction and improved working conditions for nurses, a fact that could influence the quality of patient outcomes. The aim of the study is two-fold: Identifying types of centres, according to the working environment assessment made by nurses in intermediate care units, and describing the individual characteristics of nurses related to this assessment. An observational, descriptive, prospective, cross-sectional, and multicentre study was conducted in the last quarter of 2014. Nurses in intermediate care units were given a questionnaire containing the Practice Environment Scale of the Nursing Work Index (PES-NWI) which assesses five factors of the work environment using 31 items. Sociodemographic, employment conditions, professional and educational variables were also collected. From a sample of 501 nurses from 14 centres, 388 nurses participated (77% response). The mean score on the PES-NWI was 84.75. Nine centres scored a "favourable" working environment and five "mixed". The best valued factor was "work relations" and the worst was "resource provision/adaptation". Rotating shift work, working in several units at the same time, having management responsibilities, and having a master degree were the characteristics related to a better perception of the nursing work environment. In most centres, the working environment was perceived as favourable. Some employment conditions, professional, and educational characteristics of nurses were related to the work environment assessment. Copyright © 2015 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

Creating LGBTQ-Inclusive Care and Work Environments.

PubMed

Jones-Schenk, Jan

2018-04-01

In considering the full depth of inclusion in care and work environments (and developing inclusive engagement skills for lesbian, gay, bisexual, transgender, queer or questioning [LGBTQ] patients and their families), professional development leaders must bring these discussions and shared learnings into the open. Understanding the LGBTQ population's unique needs is essential to providing personalized health care, and inclusive work environments help to foster more inclusive care for this population. J Contin Educ Nurs. 2018;49(4):151-153. Copyright 2018, SLACK Incorporated.

An exploratory study about meaningful work in acute care nursing.

PubMed

Pavlish, Carol; Hunt, Roberta

2012-01-01

To develop deeper understandings about nurses' perceptions of meaningful work and the contextual factors that impact finding meaning in work. Much has been written about nurses' job satisfaction and the impact on quality of health care. However, scant qualitative evidence exists regarding nurses' perceptions of meaningful work and how factors in the work environment influence their perceptions. The literature reveals links among work satisfaction, retention, quality of care, and meaningfulness in work. Using a narrative design, researchers interviewed 13 public health nurses and 13 acute care nurses. Categorical-content analysis with Atlas.ti data management software was conducted separately for each group of nurses. This article reports results for acute care nurses. Twenty-four stories of meaningful moments were analyzed and categorized. Three primary themes of meaningful work emerged: connections, contributions, and recognition. Participants described learning-focused environment, teamwork, constructive management, and time with patients as facilitators of meaningfulness and task-focused environment, stressful relationships, and divisive management as barriers. Meaningful nursing roles were advocate, catalyst and guide, and caring presence. Nurse administrators are the key to improving quality of care by nurturing opportunities for nurses to find meaning and satisfaction in their work. Study findings provide nurse leaders with new avenues for improving work environments and job satisfaction to potentially enhance healthcare outcomes. © 2012 Wiley Periodicals, Inc.

Nursing work environment in Saudi Arabia.

PubMed

Aboshaiqah, Ahmad E

2015-05-01

The purpose of this study was to assess the work environment as perceived by nurses in a large tertiary hospital in Saudi Arabia. The quality of patient care services has been associated with the quality of work environment of nurses. It is therefore important to assess the work environment in order to acquire baseline data and enable the institution to benchmark their status from established quality standards. This study used a descriptive survey with 1007 staff nurses across service units of a 1000-bed government-operated hospital. The American Association of Critical-Care Nurses (AACN) Healthy Work Environment Assessment Questionnaire was used for data collection. Scores were aggregated and interpreted. Effective decision making, authentic leadership, appropriate staffing, true collaboration, skilled communication and meaningful recognition were rated as good (mean range 3.53-3.76). Healthy work environments mutually benefit patients, nurses, nurse managers, health care providers, the health team, administration, the institution and the community at large. Valuable baseline data on the status of the work environment in this setting were generated. This should allow administrators and staff to work together in improving weaknesses and strengthening further whatever gains that are attained to ensure consistent provision of safe and quality patient care. © 2013 John Wiley & Sons Ltd.

Hospital nurses' work environment, quality of care provided and career plans.

PubMed

Hinno, S; Partanen, P; Vehviläinen-Julkunen, K

2011-06-01

In several European countries, the availability of qualified nurses is insufficient to meet current healthcare requirements. Nurses are highly dissatisfied with the rising demands of the healthcare environment and increasingly considering leaving their jobs. The study aims to investigate the relationships between the characteristics of hospital nurses' work environment and the quality of care provided, and furthermore to examine Dutch nurses' career plans. A cross-sectional, questionnaire survey of registered nurses (n = 334) working in the academic and district hospitals was conducted in 2005/2006. Previously validated questionnaires translated into the participants' language were used. Factor and regression analysis were used for data analysis. Overall, nurses rated their work environment rather favourably. Five work environment characteristics were identified: support for professional development, adequate staffing, nursing competence, supportive management and teamwork. Significant relationships were found between nurses' perceptions of their work environment characteristics and quality of care provided and nurses' career plans. When work environment characteristics were evaluated to be better, nurse-assessed quality of care also increased and intentions to leave current job decreased linearly. Study findings suggest that nurses' perceptions of their work environment are important for nurse outcomes in hospital settings. Further research is needed to explore the predictive ability of the work environment for nurse, patient and organizational outcomes in hospitals. © 2011 The Authors. International Nursing Review © 2011 International Council of Nurses.

Work experience, work environment, and blood exposure among home care and hospice nurses.

PubMed

Leiss, Jack K

2012-01-01

Blood exposure rates among home care and hospice nurses (RNs) in the United States are markedly lower for nurses with more home care/hospice experience, whether or not they have more total years of nursing experience (i.e., in other work environments). This study examined whether the protective effect of home care/hospice experience was greater for nurses who worked under three types of circumstances that are typical of the home care/hospice work environment and conducive to blood exposure. A mail survey was conducted in 2006 among home care/hospice nurses in North Carolina, a largely rural state in the southeastern U.S. The adjusted response rate was 69% (n=833). Blood exposure rates were higher among nurses with ≤5 years' experience in home care/hospice. Contrary to expectations, the protective effect of more experience was greater among nurses who did not have limited access to safety devices/personal protective equipment, did not have to rush during home visits, and did not often visit homes with unrestrained pets, unruly children, poor lighting, or extreme clutter. These results suggest that characteristics of the home care/hospice work environment limit nurses' ability to use their experience to prevent blood exposure.

Using evidence-based leadership initiatives to create a healthy nursing work environment.

PubMed

Nayback-Beebe, Ann M; Forsythe, Tanya; Funari, Tamara; Mayfield, Marie; Thoms, William; Smith, Kimberly K; Bradstreet, Harry; Scott, Pamela

2013-01-01

In an effort to create a healthy nursing work environment in a military hospital Intermediate Care Unit (IMCU), a facility-level Evidence Based Practice working group composed of nursing.Stakeholders brainstormed and piloted several unit-level evidence-based leadership initiatives to improve the IMCU nursing work environment. These initiatives were guided by the American Association of Critical Care Nurses Standards for Establishing and Sustaining Healthy Work Environments which encompass: (1) skilled communication, (2) true collaboration, (3) effective decision making, (4) appropriate staffing, (5) meaningful recognition, and (6) authentic leadership. Interim findings suggest implementation of these six evidence-based, relationship-centered principals, when combined with IMCU nurses' clinical expertise, management experience, and personal values and preferences, improved staff morale, decreased staff absenteeism, promoted a healthy nursing work environment, and improved patient care.

Provider perceptions of the social work environment and the state of pediatric care in a downsized urban public academic medical center.

PubMed

Tataw, David Besong

2011-05-01

The author's purpose through this study was to document and analyze health provider perceptions of their social work environment and the state of pediatric care at Los Angeles County King/Drew Hospital and Medical Center in 2000, after the restructuring and downsizing of the hospital and its community clinics. The research results showed nurses and physicians reporting that both the quality of pediatric care and the provider social work environment were poor. Negative factors in the social work environment included: low employee morale, poorly staffed clinical teams, lack of professional autonomy, perceptions of low quality of care for pediatric patients, and interpersonal issues of poor communication and collaboration among providers. Providers also perceived a non-supportive work environment, sense of powerlessness, poor quality of work, lack of goal clarity from leadership, lack of fairness in leadership behavior, and an organizational leadership that is abandoning its core mission and values, thereby making it difficult for providers to carry out their professional functions. The author's findings in this study suggest a relationship between intra-role conflict, social employment environment and quality of care at King/Drew Medical Center in 2000. Lessons for practice are presented.

Impact of nurse work environment and staffing on hospital nurse and quality of care in Thailand.

PubMed

Nantsupawat, Apiradee; Srisuphan, Wichit; Kunaviktikul, Wipada; Wichaikhum, Orn-Anong; Aungsuroch, Yupin; Aiken, Linda H

2011-12-01

To determine the impact of nurse work environment and staffing on nurse outcomes, including job satisfaction and burnout, and on quality of nursing care. Secondary data analysis of the 2007 Thai Nurse Survey. The sample consisted of 5,247 nurses who provided direct care for patients across 39 public hospitals in Thailand. Multivariate logistic regression was used to estimate the impact of nurse work environment and staffing on nurse outcomes and quality of care. Nurses cared for an average of 10 patients each. Forty-one percent of nurses had a high burnout score as measured by the Maslach Burnout Inventory; 28% of nurses were dissatisfied with their job; and 27% rated quality of nursing care as fair or poor. At the hospital level, after controlling for nurse characteristics (age, years in unit), the addition of each patient to a nurse's workload was associated with a 2% increase in the odds on nurses reporting high emotional exhaustion (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.00-1.03; p < .05). Nurses who reported favorable work environments were about 30% less likely to report fair to poor care quality (OR 0.69; 95% CI 0.48-0.98; p < .05) compared with nurses who reported unfavorable work environments. The addition of each patient to a nurse's workload was associated with a 4% increase in the odds on nurses reporting quality of nursing care as fair or poor (OR 1.04; 95% CI 1.02-1.05; p < .001). Improving nurse work environments and nurse staffing in Thai hospitals holds promise for reducing nurse burnout, thus improving nurse retention at the hospital bedside as well as potentially improving the quality of care. Nurses should work with management and policymakers to achieve safe staffing levels and good work environments in hospitals throughout the world. © 2011 Sigma Theta Tau International.

Nursing work environment, patient safety and quality of care in pediatric hospital.

PubMed

Alves, Daniela Fernanda Dos Santos; Guirardello, Edinêis de Brito

2016-06-01

Objectives To describe the characteristics of the nursing work environment, safety attitudes, quality of care, measured by the nursing staff of the pediatric units, as well as to analyze the evolution of quality of care and hospital indicators. Methods Descriptive study with 136 nursing professionals at a paediatric hospital, conducted through personal and professional characterization form, Nursing Work Index - Revised, Safety Attitudes Questionnaire - Short Form 2006 and quality indicators. Results The professionals perceive the environment as favourable to professional practice, and consider good quality care that is also observed by reducing the incidence of adverse events and decreased length of stay. The domain job satisfaction was considered favourable to patient safety. Conclusions The work environment is favourable to nursing practice, the professionals nursing approve the quality of care and the indicators tended reducing adverse events and length of stay.

Home Health Agency Work Environments and Hospitalizations

PubMed Central

Flynn, Linda; Lake, Eileen T.; Aiken, Linda H.

2014-01-01

Background: An important goal of home health care is to assist patients to remain in community living arrangements. Yet home care often fails to prevent hospitalizations and to facilitate discharges to community living, thus putting patients at risk of additional health challenges and increasing care costs. Objectives: To determine the relationship between home health agency work environments and agency-level rates of acute hospitalization and discharges to community living. Methods and Design: Analysis of linked Center for Medicare and Medicaid Services Home Health Compare data and nurse survey data from 118 home health agencies. Robust regression models were used to estimate the effect of work environment ratings on between-agency variation in rates of acute hospitalization and community discharge. Results: Home health agencies with good work environments had lower rates of acute hospitalizations and higher rates of patient discharges to community living arrangements compared with home health agencies with poor work environments. Conclusion: Improved work environments in home health agencies hold promise for optimizing patient outcomes and reducing use of expensive hospital and institutional care. PMID:25215647

Work stress, burnout, and perceived quality of care: a cross-sectional study among hospital pediatricians.

PubMed

Weigl, M; Schneider, A; Hoffmann, F; Angerer, P

2015-09-01

Poor hospital work environments affect physicians' work stress. With a focus on hospital pediatricians, we sought to investigate associations between work stress, burnout, and quality of care. A cross-sectional study was conducted in N = 96 pediatricians of a German academic children's hospital (response rate = 73.8 %). All variables were assessed with standardized questionnaires. Multivariate regression analyses were applied to investigate associations after adjusting for potential confounders. Critically high work stress (effort/reward ratio, ERR > 1.0) was reported by N = 25 (28.4 %) participants. Pediatricians in inpatient wards had significantly more work stress than their colleagues in intensive care units and outpatient wards; 10.2 % of surveyed pediatricians reported critically high burnout. Again, inpatient ward staff reported significantly increased emotional exhaustion. After controlling for several confounders, we found that pediatricians with high work stress and emotional exhaustion reported reduced quality of care. Mediation analyses revealed that especially pediatricians' emotional exhaustion partially mediated the effect of work stress on quality of care. Results demonstrate close relationships between increased work stress and burnout as well as diminished quality of care. High work stress environments in pediatric care influence mental health of pediatricians as well as quality of patient care. • The quality of pediatricians' work environment in the hospital is associated with their work stress and burnout. • The consequences of pediatricians' work life for the quality of care need to be addressed in order to inform interventions to improve work life and care quality. • Our study shows associations between increased work stress and burnout with mitigated quality of care. • Beyond indirect effects of work stress through emotional exhaustion on quality of care we also observed direct detrimental effects of pediatricians' work stress on mitigated care quality.

Person-centered work environments, psychological safety, and positive affect in healthcare: a theoretical framework.

PubMed

Rathert, Cheryl; May, Douglas R

2008-01-01

We propose that in order to systematically improve healthcare quality, healthcare organizations (HCOs) need work environments that are person-centered: environments that support the careprovider as well as the patient. We further argue that HCOs have a moral imperative to provide a workplace where professional care standards can be achieved. We draw upon a large body of research from several disciplines to propose and articulate a theoretical framework that explains how the work environment should be related to the well-being of patients and careproviders, that is, the potential mediating mechanisms. Person-centered work environments include: 1. Climates for patient-centered care. 2. Climates for quality improvement. 3. Benevolent ethical climates. Such a work environment should support the provision of patient-centered care, and should lead to positive psychological states for careproviders, including psychological safety and positive affect. The model contributes to theory by specifying relationships between important organizational variables. The model can potentially contribute to practice by linking specific work environment attributes to outcomes for careproviders and patients.

Health care work environments, employee satisfaction, and patient safety: Care provider perspectives.

PubMed

Rathert, Cheryl; May, Douglas R

2007-01-01

Experts continue to decry the lack of progress made in decreasing the alarming frequency of medical errors in health care organizations (Leape, L. L., & Berwick, D. M. (2005). Five years after to err is human: What have we learned?. Journal of the American Medical Association, 293(19), 2384-2390). At the same time, other experts are concerned about the lack of job satisfaction and turnover among nurses (. Keeping patients safe: Transforming the work environment of nurses. Washington, DC: National Academy Press). Research and theory suggest that a work environment that facilitates patient-centered care should increase patient safety and nurse satisfaction. The present study began with a conceptual model that specifies how work environment variables should be related to both nurse and patient outcomes. Specifically, we proposed that health care work units with climates for patient-centered care should have nurses who are more satisfied with their jobs. Such units should also have higher levels of patient safety, with fewer medication errors. We examined perceptions of nurses from three acute care hospitals in the eastern United States. Nurses who perceived their work units as more patient centered were significantly more satisfied with their jobs than were those whose units were perceived as less patient centered. Those whose work units were more patient centered reported that medication errors occurred less frequently in their units and said that they felt more comfortable reporting errors and near-misses than those in less patient-centered units. Patients and quality leaders continue to call for delivery of patient-centered care. If climates that facilitate such care are also related to improved patient safety and nurse satisfaction, proactive, patient-centered management of the work environment could result in improved patient, employee, and organizational outcomes.

Nursing practice environment, quality of care, and morale of hospital nurses in Japan.

PubMed

Anzai, Eriko; Douglas, Clint; Bonner, Ann

2014-06-01

The purpose of this study was to describe Japanese hospital nurses' perceptions of the nursing practice environment and examine its association with nurse-reported ability to provide quality nursing care, quality of patient care, and ward morale. A cross-sectional survey design was used including 223 nurses working in 12 acute inpatient wards in a large Japanese teaching hospital. Nurses rated their work environment favorably overall using the Japanese version of the Practice Environment Scale of the Nursing Work Index. Subscale scores indicated high perceptions of physician relations and quality of nursing management, but lower scores for staffing and resources. Ward nurse managers generally rated the practice environment more positively than staff nurses except for staffing and resources. Regression analyses found the practice environment was a significant predictor of quality of patient care and ward morale, whereas perceived ability to provide quality nursing care was most strongly associated with years of clinical experience. These findings support interventions to improve the nursing practice environment, particularly staffing and resource adequacy, to enhance quality of care and ward morale in Japan. © 2013 Wiley Publishing Asia Pty Ltd.

Time utilization and perceived psychosocial work environment among staff in Swedish primary care settings.

PubMed

Anskär, Eva; Lindberg, Malou; Falk, Magnus; Andersson, Agneta

2018-03-07

Over the past decades, reorganizations and structural changes in Swedish primary care have affected time utilization among health care professionals. Consequently, increases in administrative tasks have substantially reduced the time available for face-to-face consultations. This study examined how work-time was utilized and the association between work time utilization and the perceived psychosocial work environment in Swedish primary care settings. This descriptive, multicentre, cross-sectional study was performed in 2014-2015. Data collection began with questionnaire. In the first section, respondents were asked to estimate how their workload was distributed between patients (direct and indirect patient work) and other work tasks. The questionnaire also comprised the Copenhagen Psychosocial Questionnaire, which assessed the psychosocial work environment. Next a time study was conducted where the participants reported their work-time based on three main categories: direct patient-related work, indirect patient-related work, and other work tasks. Each main category had a number of subcategories. The participants recorded the time spent (minutes) on each work task per hour, every day, for two separate weeks. Eleven primary care centres located in southeast Sweden participated. All professionals were asked to participate (n = 441), including registered nurses, primary care physicians, care administrators, nurse assistants, and allied professionals. Response rates were 75% and 79% for the questionnaires and the time study, respectively. All health professionals allocated between 30.9% - 37.2% of their work-time to each main category: direct patient work, indirect patient work, and other work. All professionals estimated a higher proportion of time spent in direct patient work than they reported in the time study. Physicians scored highest on the psychosocial scales of quantitative demands, stress, and role conflicts. Among allied professionals, the proportion of work-time spent on administrative tasks was associated with more role conflicts. Younger staff perceived more adverse working conditions than older staff. This study indicated that Swedish primary care staff spent a limited proportion of their work time directly with patients. PCPs seemed to perceive their work environment in negative terms to a greater extent than other staff members. This study showed that work task allocations influenced the perceived psychosocial work environment.

Ethics in practice: managed care and the changing health care environment: medicine as a profession managed care ethics working group statement.

PubMed

Povar, Gail J; Blumen, Helen; Daniel, John; Daub, Suzanne; Evans, Lois; Holm, Richard P; Levkovich, Natalie; McCarter, Alice O; Sabin, James; Snyder, Lois; Sulmasy, Daniel; Vaughan, Peter; Wellikson, Laurence D; Campbell, Amy

2004-07-20

Cost pressures and changes in the health care environment pose ethical challenges and hard choices for patients, physicians, policymakers, and society. In 2000 and 2001, the American College of Physicians, with the Harvard Pilgrim Health Care Ethics Program, convened a working group of stakeholders--patients, physicians, and managed care representatives, along with medical ethicists--to develop a statement of ethics for managed care. The group explored the impact of a changing health care environment on patient-physician relationships and how to best apply the principles of professionalism in this environment. The statement that emerged offers guidance on preserving the patient-clinician relationship, patient rights and responsibilities, confidentiality and privacy, resource allocation and stewardship, the obligation of health plans to foster an ethical environment for the delivery of care, and the clinician's responsibility to individual patients, the community, and the public health, among other issues.

Effects of work environment on patient and nurse outcomes.

PubMed

Copanitsanou, Panagiota; Fotos, Nikolaos; Brokalaki, Hero

2017-02-09

Several parameters of the nurse's work environment lead to fewer patient complications and lower nurse burnout. The aim of this systematic review was the analysis of research data related to the effect of nurses' work environments on outcomes for both patients and nurses. Medline was searched by using keywords: 'working conditions', 'work environment', 'nurses', 'nursing staff', 'patients', 'outcomes'. In total, 10 studies were included, of which 4 were cross-sectional and the remaining were descriptive correlational studies. Patients who were hospitalised in units with good work environments for the nurses were more satisfied with the nursing care than the patients in units with poor work environments. Nurses who perceived their work environment to be good experienced higher job satisfaction and lower rates of burnout syndrome. A good work environment constitutes a determinant factor for high care quality and, at the same time, relates to improved outcomes for the nurses.

The rural nurse work environment and structural empowerment.

PubMed

Krebs, Julianne P; Madigan, Elizabeth A; Tullai-McGuinness, Susan

2008-02-01

Rural health care organizations struggle to attract and retain nurses, yet much of the research has focused on characteristics of the nurse work environment or empowerment in urban hospitals. The purpose of this study was to examine the nurse work environment in rural areas across settings by describing the relationship between structural empowerment and characteristics of the nurse work environment. Nurses ( N = 97) working in home care agencies and hospitals were surveyed. Significant differences were found between the groups, with home care nurses having significantly higher empowerment scores than medical/surgical nurses. A strong correlation was found between characteristics of the nurse work environment and empowerment. Policy makers are using evidence to guide development of policies, but much of the research has been conducted in urban hospital settings. This study begins to provide evidence that differences exist between urban and rural areas and between practice settings.

Perception of the quality of care, work environment and sleep characteristics of nurses working in the National Health System.

PubMed

Moreno-Casbas, María Teresa; Alonso-Poncelas, Emma; Gómez-García, Teresa; Martínez-Madrid, María José; Escobar-Aguilar, Gema

2018-03-19

To describe nurses' perception in relation to the quality of care and their work environment, as well as to describe their quality of sleep. To analyze the relationship between ward and work shift with nurses' perception of their work environment, sleep quality and day time drowsiness. A multicentre, observational and descriptive study carried out between 2012-2014 in seven hospitals of the Spanish National Health System. Work environment, work satisfaction, sleep quality and quality of patient care were evaluated through validated tools. 635 registered nurses participated in the study. Eighty-three point seven percent perceived the quality of cares as good/excellent, and 55.1% rated the work environment of their hospital as good/excellent. PES-NWI classified 39% of hospitals as unfavourable and 20% as favourable. Fifteen point four percent of the nurses had a high level of burnout and 58.3% had low burnout. Sleep quality was 6.38 for nurses working on day shifts, 6.78 for the rotational shifts and 7.93 for night shifts. Significant differences were found between subjective sleep quality score, sleep duration, sleep disturbances and daytime dysfunction. In the provision of quality care services, there is a multitude of related factors such as shift, ward, satisfaction, and nurses' perceptions of patient safety and sleep quality. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

From organizational awareness to organizational competency in health care social work: the importance of formulating a "profession-in-environment" fit.

PubMed

Spitzer, William; Silverman, Ed; Allen, Karen

2015-01-01

Today's health care environments require organizational competence as well as clinical skill. Economically driven business paradigms and the principles underlying the Patient Protection and Affordable Care Act of 2010 emphasize integrated, collaborative care delivered using transdisciplinary service models. Attention must be focused on achieving patient care goals while demonstrating an appreciation for the mission, priorities and operational constraints of the provider organization. The educational challenge is to cultivate the ability to negotiate "ideology" or ideal practice with the practical realities of health care provider environments without compromising professional ethics. Competently exercising such ability promotes a sound "profession-in-environment" fit and enhances the recognition of social work as a crucial patient care component.

Nurse work engagement impacts job outcome and nurse-assessed quality of care: model testing with nurse practice environment and nurse work characteristics as predictors

PubMed Central

Van Bogaert, Peter; van Heusden, Danny; Timmermans, Olaf; Franck, Erik

2014-01-01

Aim: To explore the mechanisms through which nurse practice environment dimensions, such as nurse–physician relationship, nurse management at the unit level and hospital management and organizational support, are associated with job outcomes and nurse-assessed quality of care. Mediating variables included nurse work characteristics of workload, social capital, decision latitude, as well as work engagement dimensions of vigor, dedication and absorption. Background: Understanding how to support and guide nurse practice communities in their daily effort to answer complex care most accurate, alongside with the demand of a stable and healthy nurse workforce, is challenging. Design: Cross-sectional survey. Method: Based on earlier empirical findings, a structural equation model, designed with valid measurement instruments, was tested. The study population included registered acute care hospital nurses (N = 1201) in eight hospitals across Belgium. Results: Nurse practice environment dimensions predicted nurses’ ratings of job outcome variables as well as quality of care. Features of nurses’ work characteristics, e.g., perceived workload, decision latitude, social capital, and the three dimension of work engagement, played mediating roles between nurse practice environment and outcomes. A revised model, using various fit measures, explained 60% of job outcomes and 47% of nurse-assessed quality of care. Conclusion: The findings in this study show that nurse work characteristics as workload, decision latitude, and social capital, alongside with nurse work engagement (e.g., vigor, dedication, and absorption) influence nurses’ perspective of their nurse practice environment, job outcomes, and quality of care. The results underline aspects to considerate for various stakeholders, such as executives, nurse managers, physicians, and staff nurses, in setting up and organizing health care services. PMID:25431563

Nurse work engagement impacts job outcome and nurse-assessed quality of care: model testing with nurse practice environment and nurse work characteristics as predictors.

PubMed

Van Bogaert, Peter; van Heusden, Danny; Timmermans, Olaf; Franck, Erik

2014-01-01

To explore the mechanisms through which nurse practice environment dimensions, such as nurse-physician relationship, nurse management at the unit level and hospital management and organizational support, are associated with job outcomes and nurse-assessed quality of care. Mediating variables included nurse work characteristics of workload, social capital, decision latitude, as well as work engagement dimensions of vigor, dedication and absorption. Understanding how to support and guide nurse practice communities in their daily effort to answer complex care most accurate, alongside with the demand of a stable and healthy nurse workforce, is challenging. Cross-sectional survey. Based on earlier empirical findings, a structural equation model, designed with valid measurement instruments, was tested. The study population included registered acute care hospital nurses (N = 1201) in eight hospitals across Belgium. Nurse practice environment dimensions predicted nurses' ratings of job outcome variables as well as quality of care. Features of nurses' work characteristics, e.g., perceived workload, decision latitude, social capital, and the three dimension of work engagement, played mediating roles between nurse practice environment and outcomes. A revised model, using various fit measures, explained 60% of job outcomes and 47% of nurse-assessed quality of care. The findings in this study show that nurse work characteristics as workload, decision latitude, and social capital, alongside with nurse work engagement (e.g., vigor, dedication, and absorption) influence nurses' perspective of their nurse practice environment, job outcomes, and quality of care. The results underline aspects to considerate for various stakeholders, such as executives, nurse managers, physicians, and staff nurses, in setting up and organizing health care services.

RN work engagement in generational cohorts: the view from rural US hospitals.

PubMed

Sullivan Havens, Donna; Warshawsky, Nora E; Vasey, Joseph

2013-10-01

To describe staff nurse work engagement, identify predictors by generational cohort, present implications for nurse managers and suggest future research. A global nurse shortage looms. While an adequate supply of nurses is needed to ensure access to care, access to quality care may be enhanced by an adequate supply of highly engaged nurses-those who are dedicated, energized, and absorbed. Nurses have long reported the presence of energy depleting practice environments. Nurses practicing in professional practice environments may be more engaged. A non-experimental survey design was executed. Direct care Registered Nurses (n = 747) working in five rural acute care hospitals completed questionnaires to assess work engagement (Utrecht Work Engagement Scale-9), decisional involvement (Decisional Involvement Scale), relational coordination (Relational Coordination Survey) and the nursing practice environment (Practice Environment Scale of the Nursing Work Index). Descriptive, correlational and regression analyses examined work engagement and predictors by generational cohort. With the exception of the absorption component, no statistically significant differences in engagement emerged across generational cohorts. Predictors of engagement differed by cohort, however across all cohorts, professional nursing practice environments predicted nurse work engagement. Professional nursing practice environments are significantly associated with nurse work engagement. Enhancing nurse work engagement is a complex challenge. Generational cohorts may respond to different strategies to enhance engagement. © 2013 John Wiley & Sons Ltd.

Understanding significant processes during work environment interventions to alleviate time pressure and associated sick leave of home care workers--a case study.

PubMed

Andersen, Gunn Robstad; Westgaard, Rolf H

2013-11-15

Ergonomic and work stress interventions rarely show long-term positive effect. The municipality participating in this study received orders from the Norwegian Labour Inspectorate due to an identified unhealthy level of time pressure, and responded by effectuating several work environment interventions. The study aim is to identify critical factors in the interaction between work environment interventions and independent rationalization measures in order to understand a potential negative interfering effect from concurrent rationalizations on a comprehensive work environment intervention. The study, using a historic prospective mixed-method design, comprised 6 home care units in a municipality in Norway (138 respondents, response rate 76.2%; 17 informants). The study included quantitative estimations, register data of sick leave, a time line of significant events and changes, and qualitative descriptions of employee appraisals of their work situation gathered through semi-structured interviews and open survey responses. The work environment interventions were in general regarded as positive by the home care workers. However, all units were simultaneously subjected to substantial contextual instability, involving new work programs, new technology, restructurings, unit mergers, and management replacements, perceived by the home care workers to be major sources of stress. Findings suggest that concurrent changes induced through rationalization resulted in negative exposure effects that negated positive work environment intervention effects, causing an overall deteriorated work situation for the home care workers. Establishment and active utilization of communication channels from workers to managers are recommended in order to increase awareness of putative harmful and interruptive effects of rationalization measures.

Understanding significant processes during work environment interventions to alleviate time pressure and associated sick leave of home care workers – a case study

PubMed Central

2013-01-01

Background Ergonomic and work stress interventions rarely show long-term positive effect. The municipality participating in this study received orders from the Norwegian Labour Inspectorate due to an identified unhealthy level of time pressure, and responded by effectuating several work environment interventions. The study aim is to identify critical factors in the interaction between work environment interventions and independent rationalization measures in order to understand a potential negative interfering effect from concurrent rationalizations on a comprehensive work environment intervention. Methods The study, using a historic prospective mixed-method design, comprised 6 home care units in a municipality in Norway (138 respondents, response rate 76.2%; 17 informants). The study included quantitative estimations, register data of sick leave, a time line of significant events and changes, and qualitative descriptions of employee appraisals of their work situation gathered through semi-structured interviews and open survey responses. Results The work environment interventions were in general regarded as positive by the home care workers. However, all units were simultaneously subjected to substantial contextual instability, involving new work programs, new technology, restructurings, unit mergers, and management replacements, perceived by the home care workers to be major sources of stress. Findings suggest that concurrent changes induced through rationalization resulted in negative exposure effects that negated positive work environment intervention effects, causing an overall deteriorated work situation for the home care workers. Conclusions Establishment and active utilization of communication channels from workers to managers are recommended in order to increase awareness of putative harmful and interruptive effects of rationalization measures. PMID:24238560

Developing critical care skills for nurses in the ward environment: a work-based learning approach.

PubMed

Thorne, Linda; Hackwood, Helen

2002-01-01

An account of collaborative working between an NHS trust and university in responding to the critical care agenda. An 'Introduction to Critical Care Skills' course initiative, which addresses the needs of nurses caring for level 1 and 2 patients in ward areas, is discussed. Work-based learning forms the focus of skills development using core competencies related to a holistic approach to caring for patients with complex needs. A dynamic evolving process of course development is promoting quality care for patients and closely reflects the needs of those caring for acutely ill patients outside the designated critical care environment.

Using a social capital framework to enhance measurement of the nursing work environment.

PubMed

Sheingold, Brenda Helen; Sheingold, Steven H

2013-07-01

To develop, field test and analyse a social capital survey instrument for measuring the nursing work environment. The concept of social capital, which focuses on improving productive capacity by examining relationships and networks, may provide a promising framework to measure and evaluate the nurse work environment in a variety of settings. A survey instrument for measuring social capital in the nurse work environment was developed by adapting the World Bank's Social Capital - Integrated Questionnaire (SC-IQ). Exploratory factor analysis and multiple regression analyses were applied to assess the properties of the instrument. The exploratory factor analysis yielded five factors that align well with the social capital framework, while reflecting unique aspects of the nurse work environment. The results suggest that the social capital framework provides a promising context to assess the nurse work environment. Further work is needed to refine the instrument for a diverse range of health-care providers and to correlate social capital measures with quality of patient care. Social capital measurement of the nurse work environment has the potential to provide managers with an enhanced set of tools for building productive capacity in health-care organisations and achieving desired outcomes. © 2013 John Wiley & Sons Ltd.

Nurses' Perceptions of Pediatric Intensive Care Unit Environment and Work Experience After Transition to Single-Patient Rooms.

PubMed

Kudchadkar, Sapna R; Beers, M Claire; Ascenzi, Judith A; Jastaniah, Ebaa; Punjabi, Naresh M

2016-09-01

The architectural design of the pediatric intensive care unit may play a major role in optimizing the environment to promote patients' sleep while improving stress levels and the work experience of critical care nurses. To examine changes in nurses' perceptions of the environment of a pediatric critical care unit for promotion of patients' sleep and the nurses' work experience after a transition from multipatient rooms to single-patient rooms. A cross-sectional survey of nurses was conducted before and after the move to a new hospital building in which all rooms in the pediatric critical care unit were single-patient rooms. Nurses reported that compared with multipatient rooms, single-patient private rooms were more conducive to patients sleeping well at night and promoted a more normal sleep-wake cycle (P < .001). Monitors/alarms and staff conversations were the biggest factors that adversely influenced the environment for sleep promotion in both settings. Nurses were less annoyed by noise in single-patient rooms (33%) than in multipatient rooms (79%; P < .001) and reported improved exposure to sunlight. Use of single-patient rooms rather than multipatient rooms improved nurses' perceptions of the pediatric intensive care unit environment for promoting patients' sleep and the nurses' own work experience. ©2016 American Association of Critical-Care Nurses.

Work Environment and Japanese Fathers' Involvement in Child Care

ERIC Educational Resources Information Center

Ishii-Kuntz, Masako

2013-01-01

Previous studies mainly examined individual and family factors affecting Japanese fathers' involvement in child care. Along with these factors, we examine how work-related factors such as father-friendly environment at work, workplace's accommodation of parental needs, job stress, and autonomy are associated with Japanese men's participation in…

Dementia care worker stress associations with unit type, resident, and work environment characteristics: a cross-sectional secondary data analysis of the Swiss Nursing Homes Human Resources Project (SHURP).

PubMed

Vogel, Barbara; De Geest, Sabina; Fierz, Katharina; Beckmann, Sonja; Zúñiga, Franziska

2017-03-01

Although caring for residents with dementia in nursing homes is associated with various stressors for care workers, the role of the unit type, and particularly the proportion of residents with dementia, remains unclear. This study aimed to explore associations between unit type and care worker stress, taking into account additional potential stressors. This cross-sectional study was a secondary data analysis in the Swiss Nursing Homes Human Resources Project, which included data from 3,922 care workers from 156 Swiss nursing homes. Care workers' stress was measured with a shortened version of the Health Professions Stress Inventory. Generalized estimating equation models were used to assess care worker stress and its relationships with three unit types (special care units and others with high or low proportions of residents with dementia), work environment factors, and aggressive resident behavior. After including all potential stressors in the models, no significant differences between the three unit types regarding care worker stress were found. However, increased care worker stress levels were significantly related to lower ratings of staffing and resources adequacy, the experience of verbal aggression, and the observation of verbal or physical aggression among residents. Although the unit type plays only a minor role regarding care worker stress, this study confirms that work environment and aggressive behavior of residents are important factors associated with work-related stress. To prevent increases of care worker stress, interventions to improve the work environment and strengthen care workers' ability to cope with aggressive behavior are suggested.

Work engagement supports nurse workforce stability and quality of care: nursing team-level analysis in psychiatric hospitals.

PubMed

Van Bogaert, P; Wouters, K; Willems, R; Mondelaers, M; Clarke, S

2013-10-01

Research in healthcare settings reveals important links between work environment factors, burnout and organizational outcomes. Recently, research focuses on work engagement, the opposite (positive) pole from burnout. The current study investigated the relationship of nurse practice environment aspects and work engagement (vigour, dedication and absorption) to job outcomes and nurse-reported quality of care variables within teams using a multilevel design in psychiatric inpatient settings. Validated survey instruments were used in a cross-sectional design. Team-level analyses were performed with staff members (n = 357) from 32 clinical units in two psychiatric hospitals in Belgium. Favourable nurse practice environment aspects were associated with work engagement dimensions, and in turn work engagement was associated with job satisfaction, intention to stay in the profession and favourable nurse-reported quality of care variables. The strongest multivariate models suggested that dedication predicted positive job outcomes whereas nurse management predicted perceptions of quality of care. In addition, reports of quality of care by the interdisciplinary team were predicted by dedication, absorption, nurse-physician relations and nurse management. The study findings suggest that differences in vigour, dedication and absorption across teams associated with practice environment characteristics impact nurse job satisfaction, intention to stay and perceptions of quality of care. © 2012 John Wiley & Sons Ltd.

High-dependency care: experiences of the psychosocial work environment.

PubMed

Rahman, Hanif Abdul; Naing, Lin; Abdul-Mumin, Khadizah

2017-11-23

to explore high-dependency care nurses' experiences of their psychosocial work environment. four focus groups were conducted with 23 emergency and critical care hospital nurses in Brunei. All sessions were recorded, transcribed verbatim and analysed using inductive-approach thematic analysis. three major themes were identified. 'Specialisation/specific skills' explained a fundamental requirement for the high-dependency care nurses to work effectively and efficiently in their workplace. 'Task completion' narrated the pressure they experienced to complete their tasks within time constraints exacerbated by a reduced number of staff. 'Acknowledgement' signified their need for fair and adequate reward for their hard work through career progression and promotion. this study facilitates the design of future interventions and policies that promote a healthy psychosocial work environment by ensuring nurses working in these areas have the required specialisation skills, there is a balance of workload and nurse-to-patient ratios, and they are offered fairness and equity in career progression and promotion.

The environment of professional practice and Burnout in nurses in primary healthcare

PubMed Central

Lorenz, Vera Regina; Guirardello, Edinêis de Brito

2014-01-01

OBJECTIVES: to assess how nurses perceive autonomy, control over the environment, the professional relationship between nurses and physicians and the organizational support and correlate them with burnout, satisfaction at work, quality of work and the intention to quit work in primary healthcare. METHOD: cross-sectional and correlation study, using a sample of 198 nurses. The tools used were the Nursing Work Index Revised, Maslach Burnout Inventory and a form to characterize the nurses. To analyze the data, descriptive statistics were applied and Spearman's correlation coefficient was used. RESULTS: the nurses assessed that the environment is partially favorable for: autonomy, professional relationship and organizational support and that the control over this environment is limited. Significant correlations were evidenced between the Nursing Work Index Revised, Maslach Burnout Inventory and the variables: satisfaction at work, quality of care and the intent to quit the job. CONCLUSION: the nurses' perceptions regarding the environment of practice are correlated with burnout, satisfaction at work, quality of care and the intent to quit the job. This study provides support for the restructuring of work processes in the primary health care environment and for communication among the health service management, human resources and occupational health areas. PMID:25517928

Servicescape: physical environment of hospital pharmacies and hospital pharmacists' work outcomes.

PubMed

Lin, Blossom Yen-Ju; Leu, Wen-Jye; Breen, Gerald-Mark; Lin, Wen-Hung

2008-01-01

In health care, architects, interior designers, engineers, and health care administrators need to pay attention to the construction and design of health care facilities. Research is needed to better understand how health professionals and employees perceive their work environment to improve the physical environment in which they work. The purpose of this study was to test the effect of the physical environment of hospital pharmacies on hospital pharmacists' work outcomes. This cross-sectional mailed survey study of individual hospital pharmacists used a structured questionnaire developed to cover perceptions of the ambient conditions and the space/function(s) of pharmacists' work environments. It included aspects such as dispensing areas, pharmaceuticals areas, storage areas, and administrative offices. Work outcomes were job satisfaction, intentions to leave or reduce job working hours, and job-related stress. Hospital pharmacists in Taiwan (n = 182) returned the mailed surveys. Structural equation modeling was performed to validate the construct of the physical environment of a hospital pharmacy and the causal model for testing the effect of the physical environment on pharmacists' work outcomes. For hospital pharmacy workplaces, more favorable perceptions of the workplace's physical environment were positively associated with overall job satisfaction, but such perceptions were also negatively related to intentions to quit employment or to reduce working hours. However, the effect of the physical environment on job stress within the workplace was not supported. The designs of physical environments deserve attention to create more appropriate and healthier environments for hospital pharmacies. Further research should be devoted to trace more psychological responses to the physical environment from a longitudinal perspective.

Medical surgical nurses describe missed nursing care tasks-Evaluating our work environment.

PubMed

Winsett, Rebecca P; Rottet, Kendra; Schmitt, Abby; Wathen, Ellen; Wilson, Debra

2016-11-01

The purpose of the study was to explore the nurse work environment by evaluating the self-report of missed nursing care and the reasons for the missed care. A convenience sample of medical surgical nurses from four hospitals was invited to complete the survey for this descriptive study. The sample included 168 nurses. The MISSCARE survey assessed the frequency and reason of 24 routine nursing care elements. The most frequently reported missed care was ambulation as ordered, medications given within a 30 minute window, and mouth care. Moderate or significant reasons reported for the missed care were: unexpected rise in volume/acuity, heavy admissions/discharges, inadequate assistants, inadequate staff, meds not available when needed, and urgent situations. Identifying missed nursing care and reasons for missed care provides an opportunity for exploring strategies to reduce interruptions, develop unit cohesiveness, improve the nurse work environment, and ultimately leading to improved patient outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

Validation of the professional practice environment scale in nurse educators in hospitals.

PubMed

Sayers, Jan Maree; Salamonson, Yenna; DiGiacomo, Michelle; Davidson, Patricia Mary

2016-03-01

To report an assessment of the psychometric properties of the Professional Practice Environment (PPE) scale in a sample of Australian nurse educators in acute care hospitals. Although nurse educators are important in an enabling work environment, there has been no reported exploration of their satisfaction with work in acute care hospitals. The factor structure and internal consistency of the PPE scale were consistent with Erickson's eight-factor model of the items, indicating the appropriateness of the scale as an assessment tool to measure the PPE of nurse educators. The PPE scale is useful for monitoring the work environment of nurse educators in clinical practice and the environmental effects influencing their recruitment, retention and job satisfaction. This work may inform the development of integrated professional practice environments where the professional practice and workplace satisfaction of nurse educators are optimised, influencing safe, quality patient care.

Describing Nurse Leaders' and Direct Care Nurses' Perceptions of a Healthy Work Environment in Acute Care Settings, Part 2.

PubMed

Huddleston, Penny; Gray, Jennifer

2016-09-01

The American Association of Critical-Care Nurses (AACN) Healthy Work Environment Assessment Tool was developed as a simple screening tool to assess the characteristics of a healthy work environment (HWE) in critical care environments. The purposes of these 2 qualitative research studies are to explore the nurse leaders' and direct care nurses' perceptions of the meaning of a HWE, to describe the nurse leaders' and direct care nurses' perceptions of a HWE, and to define the characteristics of a HWE in acute care settings. Exploratory descriptive designs using focus groups and guided questions with tape-recorded interviews were used to define the characteristics of an HWE. The 6 original themes from AACN HWE standards and 2 new themes emerged as a result of the nurse leaders and direct care nurses defining the characteristics of a HWE, which included appropriate staffing, authentic leadership, effective decision making, meaningful recognition, skilled communication, true collaboration genuine teamwork, and physical and psychological safety. The qualitative statements from these 2 studies will be used in future studies to describe and develop HWE scales for nurse leaders and direct care nurses and to assess the psychometric properties of these new tools.

Work environment characteristics associated with quality of care in Dutch nursing homes: A cross-sectional study.

PubMed

Backhaus, Ramona; Rossum, Erik van; Verbeek, Hilde; Halfens, Ruud J G; Tan, Frans E S; Capezuti, Elizabeth; Hamers, Jan P H

2017-01-01

A lack of relationship between direct care staffing levels and quality of care, as found in prior studies, underscores the importance of considering the quality of the work environment instead of only considering staff ratios. Only a few studies, however, have combined direct care staffing with work environment characteristics when assessing the relationship with quality of care in nursing homes. To examine the relationship between direct care staffing levels, work environment characteristics and perceived quality of care in Dutch nursing homes. Cross-sectional, observational study in cooperation with the Dutch Prevalence Measurement of Care Problems. Twenty-four somatic and 31 psychogeriatric wards from 21 nursing homes in the Netherlands. Forty-one ward managers and 274 staff members (registered nurses or certified nurse assistants) from the 55 participating wards. Ward rosters were discussed with managers to obtain an insight into direct care staffing levels (i.e, total direct care staff hours per resident per day). Participating staff members completed a questionnaire on work environment characteristics (i.e., ward culture, team climate, communication and coordination, role model availability, and multidisciplinary collaboration) and they rated the quality of care in their ward. Data were analyzed using multilevel linear regression analyses (random intercept). Separate analyses were conducted for somatic and psychogeriatric wards. In general, staff members were satisfied with the quality of care in their wards. Staff members from psychogeriatric wards scored higher on the statement 'In the event that a family member had to be admitted to a nursing home now, I would recommend this ward'. A better team climate was related to better perceived quality of care in both ward types (p≤0.020). In somatic wards, there was a positive association between multidisciplinary collaboration and agreement by staff of ward recommendation for a family member (p=0.028). In psychogeriatric wards, a lower score on market culture (p=0.019), better communication/coordination (p=0.018) and a higher rating for multidisciplinary collaboration (p=0.003) were significantly associated with a higher grade for overall quality of care. Total direct care staffing, adhocracy culture, hierarchy culture, as well as role model availability were not significantly related to quality of care. Our findings suggest that team climate may be an important factor to consider when trying to improve quality of care. Generating more evidence on which work environment characteristics actually lead to better quality of care is needed. Copyright © 2016 Elsevier Ltd. All rights reserved.

Acoustics and psychosocial environment in intensive coronary care

PubMed Central

Blomkvist, V; Eriksen, C; Theorell, T; Ulrich, R; Rasmanis, G

2005-01-01

Aims: To examine the influence of different acoustic conditions on the work environment and the staff in a coronary critical care unit (CCU). Method: Psychosocial work environment data from start and end of each individual shift were obtained from three shifts (morning, afternoon, and night) for a one-week baseline period and for two four-week periods during which either sound reflecting or sound absorbing tiles were installed. Results: Reverberation times and speech intelligibility improved during the study period when the ceiling tiles were changed from sound reflecting tiles to sound absorbing ones of identical appearance. Improved acoustics positively affected the work environment; the afternoon shift staff experienced significantly lower work demands and reported less pressure and strain. Conclusions: Important gains in the psychosocial work environment of healthcare can be achieved by improving room acoustics. The study points to the importance of further research on possible effects of acoustics in healthcare on staff turnover, quality of patient care, and medical errors. PMID:15723873

Discrepancies in assessing home care workers' working conditions in a Norwegian home care service: differing views of stakeholders at three organizational levels.

PubMed

Andersen, Gunn Robstad; Westgaard, Rolf H

2015-07-25

The present study is a follow-up study of factors contributing to an undesirable quality of work environment and sick leave rate in the home care services in a Norwegian municipality. The underlying assumption is that organizational discrepancies in the perceptions and appraisals of significant factors and processes in an organization have detrimental effects on the management of the organization and on work environment conditions. Thus, the study aim is to explore potential organizational discrepancies in the appraisals of factors relating to home care workers' working conditions. The study, using a mixed-methods design, comprised six home care units. It included survey responses of home care workers (80 respondents, response rate 54 %) and qualitative descriptions of stakeholders' appraisals of organizational issues gathered through semi-structured interviews (33 interviews with stakeholders at three organizational levels). Employees at different organizational levels in the home care services expressed divergent appraisals of factors related to the working conditions of home care workers, including impact of organizational measures (i.e. time pressure, work tasks, a new work program, organizational changes, budget model, budget allocation and coping strategies). Survey responses supported interview descriptions by home care workers. Results suggest that organizational discrepancy serve as an important barrier to a sustainable, well-functioning organization in general and to quality-enhancing changes to work procedures in particular. It is recommended to improve communication channels and facilitate the exchange of information across levels to ensure a common understanding of matters significant to the organization of the home care services and to the work environment of home care workers. The prevalence and impact of organizational discrepancy should be included in organization research, particularly when exploring explanatory factors of an unhealthy organization.

Two Types of Learning Environment: Enabling and Constraining a Study of Care Work

ERIC Educational Resources Information Center

Ellstrom, Eva; Ekholm, Bodil; Ellstrom, Per-Erik

2008-01-01

Purpose: The purpose of this paper is to first elaborate on the notion of a learning environment based on an empirical study of care work. Second, to explore how aspects of a learning environment may differ between and within units in the same organization, and how to understand and explain such differences. Design/methodology/approach: The study…

The Integrality of Situated Caring in Nursing and the Environment

PubMed Central

Jarrin, Olga F.

2012-01-01

Much emphasis has been placed on the importance of the environment as a determinant of health; however, little theoretical work in nursing has specifically articulated the importance of the nursing practice environment as a factor in patient outcomes. This work advances the unitary-transformative-caring paradigm by focusing on the concept of integrality and exploring the nursing meta-paradigm concepts (nursing, environment, human being, and health) through integral philosophical inquiry. PMID:22222236

The health care work environment and adverse health and safety consequences for nurses.

PubMed

Geiger-Brown, Jeanne; Lipscomb, Jane

2010-01-01

Nurses' working conditions are inextricably linked to the quality of care that is provided to patients and patients' safety. These same working conditions are associated with health and safety outcomes for nurses and other health care providers. This chapter describes aspects of the nursing work environment that have been linked to hazards and adverse exposures for nurses, as well as the most common health and safety outcomes of nursing work. We include studies from 2000 to the present by nurse researchers, studies of nurses as subjects, and studies of workers under similar working conditions that could translate to nurses' work environment. We explore a number of work organization factors including shift work and extended work hours, safety climate and culture, teamwork, and communication. We also describe environmental hazards, including chemical hazards (e.g., waste anesthetics, hazardous drugs, cleaning compounds) and airborne and bloodborne pathogen exposure. Nurses' health and safety outcomes include physical (e.g., musculoskeletal disorders, gastrointestinal, slips, trips and falls, physical assault) and psychosocial outcomes (e.g., burnout, work-family conflict). Finally, we present recommendations for future research to further protect nurses and all health care workers from a range of hazardous working conditions.

Nurses' sleep quality, work environment and quality of care in the Spanish National Health System: observational study among different shifts

PubMed Central

Gómez-García, Teresa; Ruzafa-Martínez, María; Fuentelsaz-Gallego, Carmen; Madrid, Juan Antonio; Rol, Maria Angeles; Martínez-Madrid, María José; Moreno-Casbas, Teresa

2016-01-01

Objective The main objective of this study was to determine the relationship between the characteristics of nurses' work environments in hospitals in the Spanish National Health System (SNHS) with nurse reported quality of care, and how care was provided by using different shifts schemes. The study also examined the relationship between job satisfaction, burnout, sleep quality and daytime drowsiness of nurses and shift work. Methods This was a multicentre, observational, descriptive, cross-sectional study, centred on a self-administered questionnaire. The study was conducted in seven SNHS hospitals of different sizes. We recruited 635 registered nurses who worked on day, night and rotational shifts on surgical, medical and critical care units. Their average age was 41.1 years, their average work experience was 16.4 years and 90% worked full time. A descriptive and bivariate analysis was carried out to study the relationship between work environment, quality and safety care, and sleep quality of nurses working different shift patterns. Results 65.4% (410) of nurses worked on a rotating shift. The Practice Environment Scale of the Nursing Work Index classification ranked 20% (95) as favourable, showing differences in nurse manager ability, leadership and support between shifts (p=0.003). 46.6% (286) were sure that patients could manage their self-care after discharge, but there were differences between shifts (p=0.035). 33.1% (201) agreed with information being lost in the shift change, showing differences between shifts (p=0.002). The Pittsburgh Sleep Quality Index reflected an average of 6.8 (SD 3.39), with differences between shifts (p=0.017). Conclusions Nursing requires shift work, and the results showed that the rotating shift was the most common. Rotating shift nurses reported worse perception in organisational and work environmental factors. Rotating and night shift nurses were less confident about patients' competence of self-care after discharge. The most common nursing care omissions reported were related to nursing care plans. For the Global Sleep Quality score, difference were found between day and night shift workers. PMID:27496241

Individual and organizational predictors of health care aide job satisfaction in long term care.

PubMed

Chamberlain, Stephanie A; Hoben, Matthias; Squires, Janet E; Estabrooks, Carole A

2016-10-13

Unregulated health care aides provide the majority of direct health care to residents in long term care homes. Lower job satisfaction as reported by care aides is associated with increased turnover of staff. Turnover leads to inferior job performance and negatively impacts quality of care for residents. This study aimed to determine the individual and organizational variables associated with job satisfaction in care aides. We surveyed a sample of 1224 care aides from 30 long term care homes in three Western Canadian provinces. The care aides reported their job satisfaction and their perception of the work environment. We used a hierarchical, mixed-effects ordered logistic regression to model the relative odds of care aide job satisfaction for individual, care unit, and facility factors. Care aide exhaustion, professional efficacy, and cynicism were associated with job satisfaction. Factors in the organizational context that are associated with increased care aide job satisfaction include: leadership, culture, social capital, organizational slack-staff, organizational slack-space, and organizational slack-time. Our findings suggest that organizational factors account for a greater increase in care aide job satisfaction than do individual factors. These features of the work environment are modifiable and predict care aide job satisfaction. Efforts to improve care aide work environment and quality of care should focus on organizational context.

The Quality of Nurses' Work Environment and Workforce Outcomes From the Perspective of Swiss Allied Healthcare Assistants and Registered Nurses: A Cross-Sectional Survey.

PubMed

Lacher, Stefanie; De Geest, Sabina; Denhaerynck, Kris; Trede, Ines; Ausserhofer, Dietmar

2015-09-01

Anticipating nursing shortages, the Swiss healthcare system recently introduced the position of allied healthcare assistant (AHA). However, indicators of AHAs' integration and stability, particularly their perceptions of their work environment quality and related outcomes (i.e., burnout, job satisfaction, and intention to leave), remain unclear. (a) To describe AHAs' ratings of the quality of the nurse work environment, job satisfaction, burnout, and intention to leave their workplaces; (b) to compare AHAs' and registered nurses' (RNs') work environment quality ratings and related outcomes; and (c) to assess links between AHAs' work environment quality ratings and related workforce outcomes. A secondary analysis of RN4CAST data (October 2009 to June 2010) on 61 AHAs and 466 RNs in 13 Swiss acute care hospitals. We used descriptive statistics to summarize data of AHAs and RNs on their units and hospitals. Via binary logistic regression models, we compared AHAs and RNs and identified associations between work environment ratings and workforce outcomes. AHAs' work environment quality ratings were significantly higher than those of RNs, and were associated with lower odds of burnout and intention to leave their current job and higher odds of reported job satisfaction. This study provides primary evidence linking AHAs' work environment quality ratings to burnout, job satisfaction, and intention to leave in acute care hospitals. Given the increasing importance of AHAs for nursing care provision, hospitals should assess the quality of nurse work environment and nurse outcomes from the perspective of all nurses. © 2015 Sigma Theta Tau International.

Nursing staff's experiences of working in an evidence-based designed ICU patient room-An interview study.

PubMed

Sundberg, Fredrika; Olausson, Sepideh; Fridh, Isabell; Lindahl, Berit

2017-12-01

It has been known for centuries that environment in healthcare has an impact, but despite this, environment has been overshadowed by technological and medical progress, especially in intensive care. Evidence-based design is a concept concerning integrating knowledge from various research disciplines and its application to healing environments. The aim was to explore the experiences of nursing staff of working in an evidence-based designed ICU patient room. Interviews were carried out with eight critical care nurses and five assistant nurses and then subjected to qualitative content analysis. The experience of working in an evidence-based designed intensive care unit patient room was that the room stimulates alertness and promotes wellbeing in the nursing staff, fostering their caring activities but also that the interior design of the medical and technical equipment challenges nursing actions. The room explored in this study had been rebuilt in order to create and evaluate a healing environment. This study showed that the new environment had a great impact on the caring staffs' wellbeing and their caring behaviour. At a time when turnover in nurses is high and sick leave is increasing, these findings show the importance of interior design ofintensive care units. Copyright © 2017 Elsevier Ltd. All rights reserved.

Exploring work-life issues in provincial corrections settings.

PubMed

Almost, Joan; Doran, Diane; Ogilvie, Linda; Miller, Crystal; Kennedy, Shirley; Timmings, Carol; Rose, Don N; Squires, Mae; Lee, Charlotte T; Bookey-Bassett, Sue

2013-01-01

Correctional nurses hold a unique position within the nursing profession as their work environment combines the demands of two systems, corrections and health care. Nurses working within these settings must be constantly aware of security issues while ensuring that quality care is provided. The primary role of nurses in correctional health care underscores the importance of understanding nurses' perceptions about their work. The purpose of this study was to examine the work environment of nurses working in provincial correctional facilities. A mixed-methods design was used. Interviews were conducted with 13 nurses and healthcare managers (HCMs) from five facilities. Surveys were distributed to 511 nurses and HCMs in all provincial facilities across the province of Ontario, Canada. The final sample consisted of 270 nurses and 27 HCMs with completed surveys. Participants identified several key issues in their work environments, including inadequate staffing and heavy workloads, limited control over practice and scope of practice, limited resources, and challenging workplace relationships. Work environment interventions are needed to address these issues and subsequently improve the recruitment and retention of correctional nurses.

Nurse-perceived quality of care in intensive care units and associations with work environment characteristics: a multicentre survey study.

PubMed

Stalpers, Dewi; Van Der Linden, Dimitri; Kaljouw, Marian J; Schuurmans, Marieke J

2017-06-01

To examine nurse-perceived quality of care, controlling for overall job satisfaction among critical care nurses and to explore associations with work environment characteristics. Nurse-perceived quality of care and job satisfaction have been positively linked to quality outcomes for nurses and patients. Much evidence exists on factors contributing to job satisfaction. Understanding specific factors that affect nurse-perceived quality potentially enables for improvements of nursing care quality. A multicentre survey study was conducted in three Dutch intensive care units. The Dutch version of the Essentials of Magnetism II questionnaire was used; including the single-item indicators: (i) nurse-perceived quality of care; (ii) overall job satisfaction; and (iii) 58 statements on work environments. Data were collected between October 2013 - June 2014. The majority of 123 responding nurses (response rate 45%) were more than satisfied with quality of care (55%) and with their job (66%). No associations were found with nurse characteristics, besides differences in job satisfaction between the units. After controlling for job satisfaction, nurse-perceived quality was positively associated with the work environment characteristics: adequacy of staffing, patient-centeredness, competent peers and support for education. Patient-centeredness and autonomy were the most important predictors for overall job satisfaction. Factors that contribute to nurse-perceived quality of care in intensive care units, independent from the effects of overall job satisfaction, were identified. Hereby, offering opportunities to maximize high quality of care to critically ill patients. Research in a larger sample is needed to confirm our findings. © 2016 John Wiley & Sons Ltd.

The work environment and empowerment as predictors of patient safety culture in Turkey.

PubMed

Dirik, Hasan Fehmi; Intepeler, Seyda Seren

2017-05-01

As scant research based information is available regarding the work environment, empowerment and patient safety culture, this study from a developing country (Turkey) in which health care institutions are in a state of transition, aimed to investigate further the relationships between these three variables. A cross-sectional descriptive design was employed. The sample comprised 274 nurse participants working in a university hospital located in Izmir (Turkey). In data evaluation, descriptive statistics and hierarchical regression analyses were applied. The work environment and structural empowerment were related to the patient safety culture and explained 55% of the variance in patient safety culture perceptions. 'Support for optimal patient care', 'nurse/physician relationships' and 'staff involvement in organisational affairs' were the significant predictors. An enhancement of the work environment and providing access to empowerment structures may help health care organisations improve the patient safety culture. In light of the findings, the following actions can be recommended to inform health care leaders: providing necessary resources for nursing practise, encouraging nurses' participation in decision-making, strengthening communication within the team and giving nurses the opportunities to cope with challenging work problems to learn and grow. © 2017 John Wiley & Sons Ltd.

How Nurse Work Environments Relate to the Presence of Parents in Neonatal Intensive Care.

PubMed

Hallowell, Sunny G; Rogowski, Jeannette A; Lake, Eileen T

2017-09-25

Parental presence in the neonatal intensive care unit (NICU) is essential for families to participate in infant care and prepare them to transition from hospital to home. Nurses are the principal caregivers in the NICU. The nurse work environment may influence whether parents spend time with their hospitalized infants. To examine the relationship between the NICU work environment and parental presence in the NICU using a national data set. We conducted a cross-sectional, observational study of a national sample of 104 NICUs, where 6060 nurses reported on 15,233 infants cared for. Secondary analysis was used to examine associations between the Practice Environment Scale of the Nursing Work Index (PES-NWI) (subscale items and with a composite measure) and the proportion of parents who were present during the nurses' shift. Parents of 60% (SD = 9.7%) of infants were present during the nurses' shift. The PES-NWI composite score and 2 domains-Nurse Participation in Hospital Affairs and Manager Leadership and Support-were significant predictors of parental presence. A 1 SD higher score in the composite or either subscale was associated with 2.5% more parents being present. Parental presence in the NICU is significantly associated with better nurse work environments. NICU practices may be enhanced through enhanced leadership and professional opportunities for nurse managers and staff. Future work may benefit from qualitative work with parents to illuminate their experiences with nursing leaders and nurse-led interventions in the NICU and design and testing of interventions to improve the NICU work environment.

Nurse Outcomes in Magnet® and Non-Magnet Hospitals

PubMed Central

Kelly, Lesly A.; McHugh, Matthew D.; Aiken, Linda H.

2011-01-01

The important goals of Magnet® hospitals are to create supportive professional nursing care environments. A recently published paper found little difference in work environments between Magnet and non-Magnet hospitals. The aim of this study was to determine whether work environments, staffing, and nurse outcomes differ between Magnet and non-Magnet hospitals. A secondary analysis of data from a 4-state survey of 26,276 nurses in 567 acute care hospitals to evaluate differences in work environments and nurse outcomes in Magnet and non-Magnet hospitals was conducted. Magnet hospitals had significantly better work environments (t = −5.29, P < .001) and more highly educated nurses (t = −2.27, P < .001). Magnet hospital nurses were 18% less likely to be dissatisfied with their job (P < .05) and 13% less likely to report high burnout (P < .05). Magnet hospitals have significantly better work environments than non-Magnet hospitals. The better work environments of Magnet hospitals are associated with lower levels of nurse job dissatisfaction and burnout. PMID:21934430

Nurse Outcomes in Magnet® and Non-Magnet Hospitals

PubMed Central

Kelly, Lesly A.; McHugh, Matthew D.; Aiken, Linda H.

2017-01-01

The important goals of Magnet® hospitals are to create supportive professional nursing care environments. A recently published paper found little difference in work environments between Magnet and non-Magnet hospitals. The aim of this study was to determine whether work environments, staffing, and nurse outcomes differ between Magnet and non-Magnet hospitals. A secondary analysis of data from a 4-state survey of 26,276 nurses in 567 acute care hospitals to evaluate differences in work environments and nurse outcomes in Magnet and non-Magnet hospitals was conducted. Magnet hospitals had significantly better work environments (t = −5.29, P < .001) and more highly educated nurses (t = −2.27, P < .001). Magnet hospital nurses were 18% less likely to be dissatisfied with their job (P < .05) and 13% less likely to report high burnout (P < .05). Magnet hospitals have significantly better work environments than non-Magnet hospitals. The better work environments of Magnet hospitals are associated with lower levels of nurse job dissatisfaction and burnout. PMID:22976894

Factors predicting quality of work life among nurses in tertiary-level hospitals, Bangladesh.

PubMed

Akter, N; Akkadechanunt, T; Chontawan, R; Klunklin, A

2018-06-01

This study examined the level of quality of work life and predictability of years of education, monthly income, years of experience, job stress, organizational commitment and work environment on quality of work life among nurses in tertiary-level hospitals in the People's Republic of Bangladesh. There is an acute shortage of nurses worldwide including Bangladesh. Quality of work life is important for quality of patient care and nurse retention. Nurses in Bangladesh are fighting to provide quality care for emerging health problems for the achievement of sustainable development goals. We collected data from 288 randomly selected registered nurses, from six tertiary-level hospitals. All nurses were requested to fill questionnaire consisted of Demographic Data Sheet, Quality of Nursing Work Life Survey, Expanded Nursing Stress Scale, Questionnaire of Organizational Commitment and Practice Environment Scale of the Nursing Work Index. Data were analysed by descriptive statistics and multiple regression. The quality of work life as perceived by nurses in Bangladesh was at moderate level. Monthly income was found as the best predictor followed by work environment, organizational commitment and job stress. A higher monthly income helps nurses to fulfil their personal needs; positive work environment helps to provide quality care to the patients. Quality of work life and predictors measured by self-report only may not reflect the original picture of the quality of work life among nurses. Findings provide information for nursing and health policymakers to develop policies to improve quality of work life among nurses that can contribute to quality of nursing care. This includes the working environment, commitment to the organization and measures to reduce job stress. © 2017 International Council of Nurses.

Organization of nursing and quality of care for veterans at the end of life.

PubMed

Kutney-Lee, Ann; Brennan, Caitlin W; Meterko, Mark; Ersek, Mary

2015-03-01

The Veterans Health Administration (VA) has improved the quality of end-of-life (EOL) care over the past several years. Several structural and process variables are associated with better outcomes. Little is known, however, about the relationship between the organization of nursing care and EOL outcomes. To examine the association between the organization of nursing care, including the nurse work environment and nurse staffing levels, and quality of EOL care in VA acute care facilities. Secondary analysis of linked data from the Bereaved Family Survey (BFS), electronic medical record, administrative data, and the VA Nursing Outcomes Database. The sample included 4908 veterans who died in one of 116 VA acute care facilities nationally between October 2010 and September 2011. Unadjusted and adjusted generalized estimating equations were used to examine associations between nursing and BFS outcomes. BFS respondents were 17% more likely to give an excellent overall rating of the quality of EOL care received by the veteran in facilities with better nurse work environments (P ≤ 0.05). The nurse work environment also was a significant predictor of providers listening to concerns and providing desired treatments. Nurse staffing was significantly associated with an excellent overall rating, alerting of the family before death, attention to personal care needs, and the provision of emotional support after the patient's death. Improvement of the nurse work environment and nurse staffing in VA acute care facilities may result in enhanced quality of care received by hospitalized veterans at the EOL. Copyright © 2015 American Academy of Hospice and Palliative Medicine. All rights reserved.

Measuring nurses' perception of work environment: a scoping review of questionnaires.

PubMed

Norman, Rebecka Maria; Sjetne, Ingeborg Strømseng

2017-01-01

Nurses' work environment has been shown to be associated with quality of care and organizational outcomes. In order to monitor the work environment, it is useful for all stakeholders to know the questionnaires that assess or evaluate conditions for delivering nursing care. The aim of this article is: to review the literature for assessed survey questionnaires that measure nurses' perception of their work environment, make a brief assessment, and map the content domains included in a selection of questionnaires. The search included electronic databases of internationally published literature, international websites, and hand searches of reference lists. Eligible papers describing a questionnaire had to be; a) suitable for nurses working in direct care in general hospitals, nursing homes or home healthcare settings; and b) constructed to measure work environment characteristics that are amenable to change and related to patient and organizational outcomes; and c) presented along with an assessment of their measurement properties. The search yielded 5077 unique articles. For the final synthesis, 65 articles met inclusion criteria, consisting of 34 questionnaires measuring nursing work environments in different settings. Most of the questionnaires that we found were developed, and tested, for registered nurses in a general hospital setting. Six questionnaires were developed specifically for use in nursing home settings and one for home healthcare. The content domains covered by the questionnaires were both overlapping and unique and the terminology in use was inconsistent. The most common content domains in the work environment questionnaires were supportive managers, collaborative relationships with peers, busyness, professional practice and autonomy. The findings from this review enhance the understanding of how "work environment" can be measured by an overview of existing questionnaires and domains. Our results indicate that there are very many work environment questionnaires with varying content.

Front-line management, staffing and nurse-doctor relationships as predictors of nurse and patient outcomes. a survey of Icelandic hospital nurses.

PubMed

Gunnarsdóttir, Sigrún; Clarke, Sean P; Rafferty, Anne Marie; Nutbeam, Don

2009-07-01

To investigate aspects of nurses' work environments linked with job outcomes and assessments of quality of care in an Icelandic hospital. Prior research suggests that poor working environments in hospitals significantly hinder retention of nurses and high quality patient care. On the other hand, hospitals with high retention rates (such as Magnet hospitals) show supportive management, professional autonomy, good inter-professional relations and nurse job satisfaction, reduced nurse burnout and improved quality of patient care. Cross-sectional survey of 695 nurses at Landspitali University Hospital, Reykjavík. Nurses' work environments were measured using the nursing work index-revised (NWI-R) and examined as predictors of job satisfaction, the Maslach burnout inventory (MBI) and nurse-assessed quality of patient care using linear and logistic regression approaches. An Icelandic adaptation of the NWI-R showed a five-factor structure similar to that of Lake (2002). After controlling for nurses' personal characteristics, job satisfaction, emotional exhaustion and nurse rated quality of care were found to be independently associated with perceptions of support from unit-level managers, staffing adequacy, and nurse-doctor relations. The NWI-R measures elements of hospital nurses' work environments that predict job outcomes and nurses' ratings of the quality of patient care in Iceland. Efforts to improve and maintain nurses' relations with nurse managers and doctors, as well as their perceptions of staffing adequacy, will likely improve nurse job satisfaction and employee retention, and may improve the quality of patient care.

Home care nurses' experience of job stress and considerations for the work environment.

PubMed

Samia, Linda W; Ellenbecker, Carol Hall; Friedman, Donna Haig; Dick, Karen

2012-01-01

Home care nurses report increased stress in their jobs due to work environment characteristics that impact professional practice. Stressors and characteristics of the professional practice environment that moderate nurses' experience of job stress were examined in this embedded multiple case study. Real life experiences within a complex environment were drawn from interviews and observations with 29 participants across two home care agencies from one eastern U.S. state. Findings suggest that role overload, role conflict, and lack of control can be moderated in agencies where there are meaningful opportunities for shared decision making and the nurse-patient relationship is supported.

Nurse Burnout and Patient Satisfaction

PubMed Central

Vahey, Doris C.; Aiken, Linda H.; Sloane, Douglas M.; Clarke, Sean P.; Vargas, Delfino

2010-01-01

Background Amid a national nurse shortage, there is growing concern that high levels of nurse burnout could adversely affect patient outcomes. Objectives This study examines the effect of the nurse work environment on nurse burnout, and the effects of the nurse work environment and nurse burnout on patients' satisfaction with their nursing care. Research Design/Subjects We conducted cross-sectional surveys of nurses (N = 820) and patients (N = 621) from 40 units in 20 urban hospitals across the United States. Measures Nurse surveys included measures of nurses' practice environments derived from the revised Nursing Work Index (NWI-R) and nurse outcomes measured by the Maslach Burnout Inventory (MBI) and intentions to leave. Patients were interviewed about their satisfaction with nursing care using the La Monica-Oberst Patient Satisfaction Scale (LOPSS). Results Patients cared for on units that nurses characterized as having adequate staff, good administrative support for nursing care, and good relations between doctors and nurses were more than twice likely as other patients to report high satisfaction with their care, and their nurses reported significantly lower burnout. The overall level of nurse burnout on hospital units also affected patient satisfaction. Conclusions Improvements in nurses' work environments in hospitals have the potential to simultaneously reduce nurses' high levels of job burnout and risk of turnover and increase patients' satisfaction with their care. PMID:14734943

Healthy work environments and staff nurse retention: the relationship between communication, collaboration, and leadership in the pediatric intensive care unit.

PubMed

Blake, Nancy; Leach, Linda Searle; Robbins, Wendy; Pike, Nancy; Needleman, Jack

2013-01-01

A healthy work environment can improve patient outcomes and registered nurse (RN) turnover. Creating cultures of retention and fostering healthy work environments are 2 major challenges facing nurse leaders today. Examine the effects of the healthy work environment (communication, collaboration, and leadership) on RN turnover from data collected from a research study. Descriptive, cross-sectional, correlational design. Pediatric critical care RNs from 10 pediatric intensive care units (PICU) completed the Practice Environment Scale of the Nursing Work Index Revised and a subscale of the Intensive Care Unit Nurse-Physician Communication Questionnaire. These staff nurses were asked whether they intend to leave their current job in the next 6 months. Statistical analysis included correlations, multiple linear regression, t tests (2-tailed), and 1-way analysis of variance. A total of 415 RNs completed the survey. There was a statistically significant relationship between leadership and the intent to leave (P < .05). There was also an inverse relationship between years of experience and intent to leave. None of the communication variables between RNs and among RNs and MDs or collaboration were significantly associated with PICU nurses' intention to leave. Effective leadership in the PICU is important to PICU RNs and significantly influences their decisions about staying in their current job.

Structural empowerment and patient safety culture among registered nurses working in adult critical care units.

PubMed

Armellino, Donna; Quinn Griffin, Mary T; Fitzpatrick, Joyce J

2010-10-01

The aim of the present study was to examine the relationship between structural empowerment and patient safety culture among staff level Registered Nurses (RNs) within adult critical care units (ACCU). There is literature to support the value of RNs' structurally empowered work environments and emerging literature towards patient safety culture; the link between empowerment and patient safety culture is being discovered. A sample of 257 RNs, working within adult critical care of a tertiary hospital in the United States, was surveyed. Instruments included a background data sheet, the Conditions of Workplace Effectiveness and the Hospital Survey on Patient Safety Culture. Structural empowerment and patient safety culture were significantly correlated. As structural empowerment increased so did the RNs' perception of patient safety culture. To foster patient safety culture, nurse leaders should consider providing structurally empowering work environments for RNs. This study contributes to the body of knowledge linking structural empowerment and patient safety culture. Results link structurally empowered RNs and increased patient safety culture, essential elements in delivering efficient, competent, quality care. They inform nursing management of key factors in the nurses' environment that promote safe patient care environments. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

The relationship between individualized care and the practice environment: an international study.

PubMed

Papastavrou, Evridiki; Acaroglu, Rengin; Sendir, Merdiye; Berg, Agneta; Efstathiou, Georgios; Idvall, Ewa; Kalafati, Maria; Katajisto, Jouko; Leino-Kilpi, Helena; Lemonidou, Chryssoula; da Luz, Maria Deolinda Antunes; Suhonen, Riitta

2015-01-01

Previous research studies have found that the better the quality of practice environments in hospitals, the better the outcomes for nurses and patients. Practice environment may influence nurses' ability to individualize care but the detailed relationship between individualized care and the professional practice environment has not been investigated widely. Some evidence exists about the association of practice environments with the level of individualization of nursing care, but this evidence is based on single national studies. The aim of this study was to determine whether nurses' views of their professional practice environment associate with their views of the level of care individualization in seven countries. This study had an international, multisite, prospective, cross-sectional, exploratory survey design. The study involved acute orthopedic and trauma surgical inpatient wards (n=91) in acute care hospitals (n=34) in seven countries, Cyprus, Finland, Greece, the State of Kansas, USA, Portugal, Sweden, and Turkey. Nurses (n=1163), registered or licensed practical, working in direct patient care, in orthopedic and trauma inpatient units in acute care hospitals in seven countries participated in the study. Self-administered questionnaires, including two instruments, the Revised Professional Practice Environment and the Individualized Care Scale-Nurse (Individualized Care Scale-Nurse A and B) were used for data collection. Data were analyzed statistically using descriptive statistics, simultaneous multiple regression analysis, and generalized linear model. Two regression models were applied to assess the predictive validity of the Revised Professional Practice Environment on the Individualized Care Scale-Nurse-A and B. The results showed that elements of the professional practice environment were associated with care individualization. Internal work motivation, cultural sensitivity, control over practice, teamwork, and staff relationship with physicians were predictors of support (Individualized Care Scale-A) for and the delivery (Individualized Care Scale-B) of individualized care. The results of this study provide evidence that environment aspect could explain variations in care individualization. These findings support the assertion that individualized care needs to be understood in a broader context than the immediate nurse-patient relationship and that careful development of the care environment may be an effective way to improve care quality and outcomes. Copyright © 2014 Elsevier Ltd. All rights reserved.

Nursing unit teams matter: Impact of unit-level nurse practice environment, nurse work characteristics, and burnout on nurse reported job outcomes, and quality of care, and patient adverse events--a cross-sectional survey.

PubMed

Van Bogaert, Peter; Timmermans, Olaf; Weeks, Susan Mace; van Heusden, Danny; Wouters, Kristien; Franck, Erik

2014-08-01

To investigate the impact of nurse practice environment factors, nurse work characteristics, and burnout on nurse reported job outcomes, quality of care, and patient adverse events variables at the nursing unit level. Nurse practice environment studies show growing insights and knowledge about determining factors for nurse workforce stability, quality of care, and patient safety. Until now, international studies have primarily focused on variability at the hospital level; however, insights at the nursing unit level can reveal key factors in the nurse practice environment. A cross-sectional design with a survey. In a cross-sectional survey, a sample of 1108 nurses assigned to 96 nursing units completed a structured questionnaire composed of various validated instruments measuring nurse practice environment factors, nurse work characteristics, burnout, nurse reported job outcomes, quality of care, and patient adverse events. Associations between the variables were examined using multilevel modelling techniques. Various unit-level associations (simple models) were identified between nurse practice environment factors, nurse work characteristics, burnout dimensions, and nurse reported outcome variables. Multiple multilevel models showed various independent variables such as nursing management at the unit level, social capital, emotional exhaustion, and depersonalization as important predictors of nurse reported outcome variables such job satisfaction, turnover intentions, quality of care (at the unit, the last shift, and in the hospital within the last year), patient and family complaints, patient and family verbal abuse, patient falls, nosocomial infections, and medications errors. Results suggested a stable nurse work force, with the capability to achieve superior quality and patient safety outcomes, is associated with unit-level favourable perceptions of nurse work environment factors, workload, decision latitude, and social capital, as well low levels of burnout. Nurses, physicians, nursing leaders, and executives share responsibility to create an environment supportive of interdisciplinary team development. Copyright © 2013 Elsevier Ltd. All rights reserved.

The Impact of Organizational Innovations in Nursing Homes on Staff Perceptions: A Secondary Data Analysis.

PubMed

Adams, Joost; Verbeek, Hilde; Zwakhalen, Sandra M G

2017-01-01

The shift in nursing home care for patients with dementia from traditional task-driven environments towards patient-centered small-scale environments has implications for nursing practice. Information about its implications for nursing staff is lacking, and only a few studies have addressed staff perceptions. We sought to explore staff perceptions of required skills and to determine differences in job satisfaction, motivation, and job characteristics of staff working in both care settings. A secondary data analysis was conducted. The data source used was drawn from a larger study testing the effects of small-scale living (Verbeek et al., 2009). Nursing staff working on a permanent basis and who were directly involved in care were eligible to participate in the study. Data on job satisfaction, motivation, and job characteristics of nursing staff working in typical small-scale and traditional care environments were derived using a questionnaire. Data were analyzed using descriptive statistics. Differences between nursing staff job satisfaction, motivation, and job characteristics were tested using multilinear regression analysis. In total, 138 staff members were included (81 staff members working in traditional nursing home wards and 57 staff members working in small-scale nursing home wards). The findings showed that in typical small-scale nursing homes, job satisfaction and job motivation were significantly higher compared to those in typical traditional nursing homes. Job autonomy and social support were also significantly higher, while job demands were significantly lower in these small-scale nursing homes. Social support was found to be the most significant predictor of job motivation and job satisfaction in both types of typical nursing homes. Nursing staff working in traditional care environments more often expressed the intention to switch to small-scale environments. Based on the findings of this study, it can be concluded that nursing homes environments differ substantially in experienced job satisfaction and job motivation. To enable a balanced work environment for nursing staff, a clear understanding of the relation between living environments and experienced job satisfaction among nursing staff is required. Since social support seems to be one of the key contributors to a supportive beneficial work climate, managers should focus on enabling this in daily nursing home care. © 2016 Sigma Theta Tau International.

Care workers health in Swiss nursing homes and its association with psychosocial work environment: A cross-sectional study.

PubMed

Dhaini, Suzanne R; Zúñiga, Franziska; Ausserhofer, Dietmar; Simon, Michael; Kunz, Regina; De Geest, Sabina; Schwendimann, Rene

2016-01-01

Previous studies have demonstrated poor health of care workers in nursing homes. Yet, little is known about the prevalence of physical and mental health outcomes, and their associations with the psychosocial work environment in nursing homes. (1) To explore the prevalence of physical and mental health outcomes of care workers in Swiss nursing homes, (2) their association with psychosocial work environment. This is a secondary data analysis of the cross-sectional Swiss Nursing Home Human Resources Project (SHURP). We used survey data on socio-demographic characteristics and work environment factors from care workers (N=3471) working in Swiss nursing homes (N=155), collected between May 2012 and April 2013. GEE logistic regression models were used to estimate the relationship between psychosocial work environment and physical and mental health outcomes, taking into account care workers' age. Back pain (19.0%) and emotional exhaustion (24.2%) were the most frequent self-reported physical and mental health. Back pain was associated with increased workload (odds ratios (OR) 1.52, confidence interval (CI) 1.29-1.79), conflict with other health professionals and lack of recognition (OR 1.72, CI 1.40-2.11), and frequent verbal aggression by residents (OR 1.36, CI 1.06-1.74), and inversely associated with staffing adequacy (OR 0.69, CI 0.56-0.84); emotional exhaustion was associated with increased workload (OR 1.96, CI 1.65-2.34), lack of job preparation (OR 1.41, CI 1.14-1.73), and conflict with other health professionals and lack of recognition (OR 1.68, CI 1.37-2.06), and inversely associated with leadership (OR 0.70, CI 0.56-0.87). Physical and mental health among care workers in Swiss nursing homes is of concern. Modifying psychosocial work environment factors offer promising strategies to improve health. Longitudinal studies are needed to conduct targeted assessments of care workers health status, taking into account their age, along with the exposure to all four domains of the proposed WHO model. Copyright © 2015 Elsevier Ltd. All rights reserved.

Exploring Environment-Intervention Fit: A Study of a Work Environment Intervention Program for the Care Sector.

PubMed

Smith, Louise Hardman; Aust, Birgit; Flyvholm, Mari-Ann

2015-01-01

Targeting occupational health and safety interventions to different groups of employees and sectors is important. The aim of this study was to explore the environment-intervention fit of a Danish psychosocial work environment intervention program for the residential and home care sector. Focus group interviews with employees and interviews with mangers were conducted at 12 selected workplaces and a questionnaire survey was conducted with managers at all 115 workplaces. The interventions enhanced the probability of employees experiencing more "good" work days, where they could make a difference to the lives of clients. The interventions may therefore be characterized as culturally compelling and having a good fit with the immediate work environment of employees. The interventions furthermore seemed to fit well with the wider organizational environment and with recent changes in the societal and economic context of workplaces. However, some workplaces had difficulties with involving all employees and adapting the interventions to the organization of work. The findings suggest that flexibility and a variety of strategies to involve all employees are important aspects, if interventions are to fit well with the care sector. The focus on employees' conceptualization of a "good" work day may be useful for intervention research in other sectors.

Exploring Environment-Intervention Fit: A Study of a Work Environment Intervention Program for the Care Sector

PubMed Central

Aust, Birgit; Flyvholm, Mari-Ann

2015-01-01

Targeting occupational health and safety interventions to different groups of employees and sectors is important. The aim of this study was to explore the environment-intervention fit of a Danish psychosocial work environment intervention program for the residential and home care sector. Focus group interviews with employees and interviews with mangers were conducted at 12 selected workplaces and a questionnaire survey was conducted with managers at all 115 workplaces. The interventions enhanced the probability of employees experiencing more “good” work days, where they could make a difference to the lives of clients. The interventions may therefore be characterized as culturally compelling and having a good fit with the immediate work environment of employees. The interventions furthermore seemed to fit well with the wider organizational environment and with recent changes in the societal and economic context of workplaces. However, some workplaces had difficulties with involving all employees and adapting the interventions to the organization of work. The findings suggest that flexibility and a variety of strategies to involve all employees are important aspects, if interventions are to fit well with the care sector. The focus on employees' conceptualization of a “good” work day may be useful for intervention research in other sectors. PMID:26380356

An integrative review of nurses' prosocial behaviours contributing to work environment optimization, organizational performance and quality of care.

PubMed

Feather, Janice; McGillis Hall, Linda; Trbovich, Patricia; Baker, G Ross

2018-04-22

To rigorously review the literature on the prosocial workplace behaviours of nurses. Prosocial workplace behaviours, predominantly organisational citizenship behaviours have been theoretically and empirically found to promote individual and group level performance in various industries. However, little consensus exists in the literature regarding the impact of nurses' workplace behaviours on the work environment and organisational performance. An integrative literature review was conducted on studies between 1980 and 2016. Nineteen articles were included related to nurses' prosocial behaviours and performance. A positive relationship was noted between workplace behaviours and individual level performance and unit level performance. Albeit multifactorial, leadership and the social structure of the work environment are important factors contributing to the workplace behaviour-performance relationship. Prosocial behaviours influence the social functioning of the work environment and offer insights into the delivery of quality care. Nurse managers should recognize the influence of leadership style and characteristics in the work environment that encourage employee participation in prosocial behaviours. These additional voluntary efforts by nursing staff may improve organisational effectiveness and quality of care. Inclusion of these behaviours in performance reviews and as cultural norms may help to foster a more collaborative work environment. © 2018 John Wiley & Sons Ltd.

Using mediation techniques to manage conflict and create healthy work environments.

PubMed

Gerardi, Debra

2004-01-01

Healthcare organizations must find ways for managing conflict and developing effective working relationships to create healthy work environments. The effects of unresolved conflict on clinical outcomes, staff retention, and the financial health of the organization lead to many unnecessary costs that divert resources from clinical care. The complexity of delivering critical care services makes conflict resolution difficult. Developing collaborative working relationships helps to manage conflict in complex environments. Working relationships are based on the ability to deal with differences. Dealing with differences requires skill development and techniques for balancing interests and communicating effectively. Techniques used by mediators are effective for resolving disputes and developing working relationships. With practice, these techniques are easily transferable to the clinical setting. Listening for understanding, reframing, elevating the definition of the problem, and forming clear agreements can foster working relationships, decrease the level of conflict, and create healthy work environments that benefit patients and professionals.

Establishing a Measurement Tool for a Nursing Work Environment in Taiwan.

PubMed

Lin, Li-Chiu; Lee, Huan-Fang; Yen, Miaofen

2017-02-01

The nursing work environment is a critical global health care problem. Many health care providers are concerned about the associations between the nursing work environment and the outcomes of organizations, nurses, and patients. Nursing work environment instruments have been assessed in the West but have not been considered in Asia. However, different cultures will affect the factorial structure of the tool. Using a stratified nationwide random sample, we created a measurement tool for the nursing work environment in Taiwan. The Nursing Work Environment Index-Revised Scale and the Essentials of Magnetism scale were used to examine the factorial structure. Item analysis, exploratory factor analysis, and confirmatory factor analysis were used to examine the hypothesis model and generate a new factorial structure. The Taiwan Nursing Work Environment Index (TNWEI) was established to evaluate the nursing work environment in Taiwan. The four factors were labeled "Organizational Support" (7 items), "Nurse Staffing and Resources" (4 items), "Nurse-Physician Collaboration" (4 items), and "Support for Continuing Education" (4 items). The 19 items explained 58.5% of the variance. Confirmatory factor analysis showed a good fit to the model (x2/df = 5.99; p < .05, goodness of fit index [GFI] = .90; RMSEA = .07). The TNWEI provides a comprehensive and efficient method for measuring the nurses' work environment in Taiwan.

[Psychosocial stress environment and health workers in public health: Differences between primary and hospital care].

PubMed

García-Rodríguez, Antonio; Gutiérrez-Bedmar, Mario; Bellón-Saameño, Juan Ángel; Muñoz-Bravo, Carlos; Fernández-Crehuet Navajas, Joaquín

2015-01-01

To describe the psychosocial environment of health professionals in public health in primary and hospital care, and compare it with that of the general Spanish working population, as well as to evaluate the effect of psychosocial risk factors on symptoms related to perceived stress. Cross-sectional study with stratified random sampling. Health care workers in the province of Granada, distributed in 5 hospitals and 4 health districts. A total of 738 employees (medical and nursing staff) of the Andalusian Health Service (SAS) were invited to take part. CopSoQ/Istas21 questionnaire developed for the multidimensional analysis of the psychosocial work environment. Stress symptoms were measured with the Stress Profile questionnaire. The response rate was 67.5%. Compared with the Spanish workforce, our sample showed high cognitive, emotional, and sensory psychological demands, possibilities for development and sense of direction in their work. Primary care physicians were the group with a worse psychosocial work environment. All the groups studied showed high levels of stress symptoms. Multivariate analysis showed that variables associated with high levels of stress symptom were younger and with possibilities for social relations, role conflict, and higher emotional demands, and insecurity at work. Our findings support that the psychosocial work environment of health workers differs from that of the Spanish working population, being more unfavorable in general practitioners. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Who wants to work with older people? Swedish student nurses' willingness to work in elderly care--a questionnaire study.

PubMed

Carlson, Elisabeth; Idvall, Ewa

2015-07-01

The aging population is a globally recognized challenge for the health care service. The growing number of older people will probably lead to increased demands for nurses working in elderly care. Clinical practice has been shown to have an impact on how student nurses perceive a particular field of nursing. To compare perceptions of the clinical learning environment in nursing homes among students considering a career in aged care or not, and to examine the difference in age, gender and previous working experience as health care assistants in elderly care between the two groups. This was a cross-sectional study using the Swedish version of the Clinical Learning Environment and Nurse Teacher evaluation scale. Consecutive sampling was performed over three semesters from September 2011 to December 2012. The survey was conducted with 183 student nurses. Mann-Whitney U-test was used to examine differences in relation to two groups namely student nurses who did or did not consider to work in elderly care. A chi-square test of independence was performed to examine the difference in age, gender and previous working experience between the two groups. The analysis leaned towards an overall positive evaluation of the clinical learning environment with more positive values for students considering a career. There were no significant differences between younger students (18-23) and older students (24-50) regarding willingness to work in elderly care or not. Neither was any significant difference displayed between students, based on gender nor for previous work experience. Age, gender and previous work experiences as health care assistants did not impact on students' willingness to work in elderly care. Future studies need to acknowledge the complexity of why student nurses choose a particular pathway in nursing by longitudinal studies following cohorts of students during the course of the nursing programme. Copyright © 2015 Elsevier Ltd. All rights reserved.

Are we on the same page? Staff nurse and manager perceptions of work environment, quality of care and anticipated nurse turnover.

PubMed

Gormley, Denise K

2011-01-01

The purpose was to examine differences in perceptions of work environment and quality of care between nurse managers and staff nurses, and the relationship between nurses' perceptions of the work environment and intention to leave. It is important for managers to understand how staff nurses perceive the work environment as these perceptions may affect nurses' intention to leave the organization. Few studies have examined the perceptions of nurses compared with nurse manager/directors regarding the organizational influences on intention to leave. This study was a cross-sectional, non-experimental design. A total of 336 nurses and managers participated from two Midwestern hospitals. Participants completed the Perceived Nurse Work Environment Scale (PNWE), Anticipated Turnover Scale (ATS), and a researcher developed perception of quality scale. Data were analysed for descriptive statistics, Analysis of Variance, and Pearson's correlation. Significant differences were found between nurses and managers on perceptions of work environment. Managers rated work environment higher than staff on all subscales. Work environment was related to anticipated turnover. Managers and staff nurses are 'not on the same page' in perceptions of work environment. Nurse managers need to understand the organizational influences that may affect nurses' intention to leave. Strategies to improve the work environment are necessary to meet the needs of the staff nurse. © 2010 The Author. Journal compilation © 2010 Blackwell Publishing Ltd.

Effects of hospital care environment on patient mortality and nurse outcomes.

PubMed

Aiken, Linda H; Clarke, Sean P; Sloane, Douglas M; Lake, Eileen T; Cheney, Timothy

2009-01-01

The objective of this study was to analyze the net effects of nurse practice environments on nurse and patient outcomes after accounting for nurse staffing and education. Staffing and education have well-documented associations with patient outcomes, but evidence on the effect of care environments on outcomes has been more limited. Data from 10,184 nurses and 232,342 surgical patients in 168 Pennsylvania hospitals were analyzed. Care environments were measured using the practice environment scales of the Nursing Work Index. Outcomes included nurse job satisfaction, burnout, intent to leave, and reports of quality of care, as well as mortality and failure to rescue in patients. Nurses reported more positive job experiences and fewer concerns with care quality, and patients had significantly lower risks of death and failure to rescue in hospitals with better care environments. Care environment elements must be optimized alongside nurse staffing and education to achieve high quality of care.

Effects of hospital care environment on patient mortality and nurse outcomes.

PubMed

Aiken, Linda H; Clarke, Sean P; Sloane, Douglas M; Lake, Eileen T; Cheney, Timothy

2008-05-01

The objective of this study was to analyze the net effects of nurse practice environments on nurse and patient outcomes after accounting for nurse staffing and education. Staffing and education have well-documented associations with patient outcomes, but evidence on the effect of care environments on outcomes has been more limited. Data from 10,184 nurses and 232,342 surgical patients in 168 Pennsylvania hospitals were analyzed. Care environments were measured using the practice environment scales of the Nursing Work Index. Outcomes included nurse job satisfaction, burnout, intent to leave, and reports of quality of care, as well as mortality and failure to rescue in patients. Nurses reported more positive job experiences and fewer concerns with care quality, and patients had significantly lower risks of death and failure to rescue in hospitals with better care environments. Care environment elements must be optimized alongside nurse staffing and education to achieve high quality of care.

Organizational ethics in Catholic health care: honoring stewardship and the work environment.

PubMed

Magill, G

2001-04-01

Organizational ethics refers to the integration of values into decision making, policies, and behavior throughout the multi-disciplinary environment of a health care organization. Based upon Catholic social ethics, stewardship is at the heart of organizational ethics in health care in this sense: stewardship provides the hermeneutic filter that enables basic ethical principles to be realized practically, within the context of the Catholic theology of work, to concerns in health care. This general argument can shed light on the specific topic of non-executive compensation programs as an illustration of organizational ethics in health care.

Nurses' sleep quality, work environment and quality of care in the Spanish National Health System: observational study among different shifts.

PubMed

Gómez-García, Teresa; Ruzafa-Martínez, María; Fuentelsaz-Gallego, Carmen; Madrid, Juan Antonio; Rol, Maria Angeles; Martínez-Madrid, María José; Moreno-Casbas, Teresa

2016-08-05

The main objective of this study was to determine the relationship between the characteristics of nurses' work environments in hospitals in the Spanish National Health System (SNHS) with nurse reported quality of care, and how care was provided by using different shifts schemes. The study also examined the relationship between job satisfaction, burnout, sleep quality and daytime drowsiness of nurses and shift work. This was a multicentre, observational, descriptive, cross-sectional study, centred on a self-administered questionnaire. The study was conducted in seven SNHS hospitals of different sizes. We recruited 635 registered nurses who worked on day, night and rotational shifts on surgical, medical and critical care units. Their average age was 41.1 years, their average work experience was 16.4 years and 90% worked full time. A descriptive and bivariate analysis was carried out to study the relationship between work environment, quality and safety care, and sleep quality of nurses working different shift patterns. 65.4% (410) of nurses worked on a rotating shift. The Practice Environment Scale of the Nursing Work Index classification ranked 20% (95) as favourable, showing differences in nurse manager ability, leadership and support between shifts (p=0.003). 46.6% (286) were sure that patients could manage their self-care after discharge, but there were differences between shifts (p=0.035). 33.1% (201) agreed with information being lost in the shift change, showing differences between shifts (p=0.002). The Pittsburgh Sleep Quality Index reflected an average of 6.8 (SD 3.39), with differences between shifts (p=0.017). Nursing requires shift work, and the results showed that the rotating shift was the most common. Rotating shift nurses reported worse perception in organisational and work environmental factors. Rotating and night shift nurses were less confident about patients' competence of self-care after discharge. The most common nursing care omissions reported were related to nursing care plans. For the Global Sleep Quality score, difference were found between day and night shift workers. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Organization of Hospital Nursing, Provision of Nursing Care, and Patient Experiences With Care in Europe

PubMed Central

Bruyneel, Luk; Li, Baoyue; Ausserhofer, Dietmar; Lesaffre, Emmanuel; Dumitrescu, Irina; Smith, Herbert L.; Sloane, Douglas M.; Aiken, Linda H.; Sermeus, Walter

2015-01-01

This study integrates previously isolated findings of nursing outcomes research into an explanatory framework in which care left undone and nurse education levels are of key importance. A moderated mediation analysis of survey data from 11,549 patients and 10,733 nurses in 217 hospitals in eight European countries shows that patient care experience is better in hospitals with better nurse staffing and a more favorable work environment in which less clinical care is left undone. Clinical care left undone is a mediator in this relationship. Clinical care is left undone less frequently in hospitals with better nurse staffing and more favorable nurse work environments, and in which nurses work less overtime and are more experienced. Higher proportions of nurses with a bachelor’s degree reduce the effect of worse nurse staffing on more clinical care left undone. PMID:26062612

Organization of Hospital Nursing, Provision of Nursing Care, and Patient Experiences With Care in Europe.

PubMed

Bruyneel, Luk; Li, Baoyue; Ausserhofer, Dietmar; Lesaffre, Emmanuel; Dumitrescu, Irina; Smith, Herbert L; Sloane, Douglas M; Aiken, Linda H; Sermeus, Walter

2015-12-01

This study integrates previously isolated findings of nursing outcomes research into an explanatory framework in which care left undone and nurse education levels are of key importance. A moderated mediation analysis of survey data from 11,549 patients and 10,733 nurses in 217 hospitals in eight European countries shows that patient care experience is better in hospitals with better nurse staffing and a more favorable work environment in which less clinical care is left undone. Clinical care left undone is a mediator in this relationship. Clinical care is left undone less frequently in hospitals with better nurse staffing and more favorable nurse work environments, and in which nurses work less overtime and are more experienced. Higher proportions of nurses with a bachelor's degree reduce the effect of worse nurse staffing on more clinical care left undone. © The Author(s) 2015.

The relationship between nurse practice environment, nurse work characteristics, burnout and job outcome and quality of nursing care: a cross-sectional survey.

PubMed

Van Bogaert, Peter; Kowalski, Christoph; Weeks, Susan Mace; Van Heusden, Danny; Clarke, Sean P

2013-12-01

To explore the mechanisms through which nurse practice environment dimensions are associated with job outcomes and nurse-assessed quality of care. Mediating variables tested included nurse work characteristics of workload, social capital, decision latitude, as well as burnout dimensions of emotional exhaustion, depersonalization, and personal accomplishment. Acute care hospitals face daily challenges to their efforts to achieve nurse workforce stability, safety, and quality of care. A body of knowledge shows a favourably rated nurse practice environment as an important condition for better nurse and patient outcome variables; however, further research initiatives are imperative for a clear understanding to support and guide the practice community. Cross-sectional survey. Grounded on previous empirical findings, a structural equation model designed with valid measurement instruments was tested. The study population was registered acute care nurses (N=1201) in two independent hospitals and one hospital group with six hospitals in Belgium. Nurse practice environment dimensions predicted job outcome variables and nurse ratings of quality of care. Analyses were consistent with features of nurses' work characteristics including perceived workload, decision latitude, and social capital, as well as three dimension of burnout playing mediating roles between nurse practice environment and outcomes. A revised model adjusted using various fit measures explained 52% and 47% of job outcomes and nurse-assessed quality of care, respectively. The study refines understanding of the relationship between aspects of nursing practice in order to achieve favourable nursing outcomes and offers important concepts for managers to track in their daily work. The findings of this study indicate that it is important for clinicians and leaders to consider how nurses are involved in decision-making about care processes and tracking outcomes of care and whether they are able to work with physicians, superiors, peers, and subordinates in a trusting environment based on shared values. The involvement of nurse managers at the unit level is especially critical because of associations with nurse work characteristics such as decision latitude and social capital and outcome variables. Further practice and research initiatives to support nurses' involvement in decision-making process and interdisciplinary teamwork are recommended. Copyright © 2013 Elsevier Ltd. All rights reserved.

The professional nursing practice environment and nurse-reported job outcomes in two European countries: a survey of nurses in Finland and the Netherlands.

PubMed

Hinno, Saima; Partanen, Pirjo; Vehviläinen-Julkunen, Katri

2012-03-01

The working environment of nurses is receiving international interest, because there is a growing consensus that identifying opportunities for improving working conditions in hospitals is essential to maintain adequate staffing, high-quality care, nurses' job satisfaction and hence their retention. Thus, the aim of this study was to investigate the relationship between nurse work environment characteristics and nurse-reported job outcomes in hospital settings in Finland and the Netherlands and to compare these results. A comparative cross-sectional nurse survey was conducted. Data were collected from the two countries randomly sampling the countries' National Nurses Association' membership databases. In this paper, the results from Registered Nurses working in hospital settings are used. In total, 869 hospital nurses participated: 535 from Finland and 334 from the Netherlands with the response rate of 44.9 and 33.4%, respectively. Fifty-five items from the Nursing Work Index-Revised were used as a main tool for the practice environment. Exploratory factor analysis was used to identify a set of internally consistent subscales. Further, logistic regression analysis and T-tests were used. Three practice environment characteristics were identified: adequacy of resources, supportiveness of management and assurance of care quality via collaborative relationships. Favourable evaluations of the adequacy of resources and supportiveness of management were positively correlated with nurse-assessed quality of care and job-related positive feelings and negatively correlated with intentions to leave a unit, organization or the entire profession. In neither of the participating countries were adverse incidents affecting nurses related to nurses' evaluations of their current professional practice environment. Compared with Finland, in the Netherlands, RN appears to evaluate the majority of work environment characteristics more positively; nevertheless, to some extent, the results were uniform as adequacy of resources and supportiveness of management were main predictors for nurse-reported job outcomes considered. © 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.

The ward atmosphere important for the psychosocial work environment of nursing staff in psychiatric in-patient care

PubMed Central

2011-01-01

Background The nursing staff working in psychiatric care have a demanding work situation, which may be reflected in how they view their psychosocial work environment and the ward atmosphere. The aims of the present study were to investigate in what way different aspects of the ward atmosphere were related to the psychosocial work environment, as perceived by nursing staff working in psychiatric in-patient care, and possible differences between nurses and nurse assistants. Methods 93 nursing staff working at 12 general psychiatric in-patient wards in Sweden completed two questionnaires, the Ward Atmosphere Scale and the QPSNordic 34+. Data analyses included descriptive statistics, the Mann-Whitney U-test, Spearman rank correlations and forward stepwise conditional logistic regression analyses. Results The data revealed that there were no differences between nurses and nurse assistants concerning perceptions of the psychosocial work environment and the ward atmosphere. The ward atmosphere subscales Personal Problem Orientation and Program Clarity were associated with a psychosocial work environment characterized by Empowering Leadership. Program Clarity was related to the staff's perceived Role Clarity, and Practical Orientation and Order and Organization were positively related to staff perceptions of the Organizational Climate. Conclusions The results from the present study indicate that several ward atmosphere subscales were related to the nursing staff's perceptions of the psychosocial work environment in terms of Empowering Leadership, Role Clarity and Organizational Climate. Improvements in the ward atmosphere could be another way to accomplish improvements in the working conditions of the staff, and such improvements would affect nurses and nurse assistants in similar ways. PMID:21679430

Effect of Rearing Environment on the Feeding Pattern of under Two Years Old Nigerian Children

ERIC Educational Resources Information Center

Asekun-Olarinmoye, Esther Olufunmilayo; Lawoyin, Taiwo Olubanke; Asekun-Olarinmoye, Ifeoluwapo Oyebola

2011-01-01

With economic pressures on families increasing, more women are working outside the home leaving their children in day care centres. In a community-based, descriptive cross-sectional study, the feeding pattern in two groups of children under two years old, cared for in two different rearing environments: home environment and day care centres, was…

The influence of facility design and human resource management on health care professionals.

PubMed

Sadatsafavi, Hessam; Walewski, John; Shepley, Mardelle M

2015-01-01

Cost control of health care services is a strategic concern for organizations. To lower costs, some organizations reduce staffing levels. However, this may not be worth the trade-off, as the quality of services will likely be reduced, morale among health care providers tends to suffer, and patient satisfaction is likely to decline. The potential synergy between human resource management and facility design and operation was investigated to achieve the goal of providing cost containment strategies without sacrificing the quality of services and the commitment of employees. About 700 health care professionals from 10 acute-care hospitals participated in this cross-sectional study. The authors used structural equation modeling to test whether employees' evaluations of their physical work environment and human resource practices were significantly associated with lower job-related anxiety, higher job satisfaction, and higher organizational commitment. The analysis found that employees' evaluations of their physical work environment and human resource practices influenced their job-related feelings and attitudes. Perceived organizational support mediated this relationship. The study also found a small but positive interaction effect between the physical work environment and human resource practices. The influence of physical work environment was small, mainly because of the high predictive value of human resource practices and strong confounding variables included in the analysis. This study specifically showed the role of facility design in reducing job-related anxiety among caregivers. Preliminary evidence is provided that facility design can be used as a managerial tool for improving job-related attitudes and feelings of employees and earning their commitment. Providing a healthy and safe work environment can be perceived by employees as an indication that the organization respects them and cares about their well-being, which might be reciprocated with higher levels of motivation and commitment toward the organization.

Factors influencing work productivity and intent to stay in nursing.

PubMed

Letvak, Susan; Buck, Raymond

2008-01-01

The researchers document the individual and workplace characteristics associated with decreased work productivity and intent to stay in nursing for nurses employed in direct patient care in the hospital setting. Factors associated with decreased work productivity were age, total years worked as a RN, quality of care provided, job stress score, having had a job injury, and having a health problem. Nurse leaders must place additional efforts on changes needed to improve the hospital workplace environment to decrease job stress, improve RNs' ability to provide quality care, and to assure the health and safety of nurses. Reducing job stress and providing adequate staffing so quality of care can be provided will enhance job satisfaction which will also encourage RNs to stay at the bedside. Improved work environments may delay older RNs' retirement from the workforce.

Conflict management style, supportive work environments and the experience of work stress in emergency nurses.

PubMed

Johansen, Mary L; Cadmus, Edna

2016-03-01

To examine the conflict management style that emergency department (ED) nurses use to resolve conflict and to determine whether their style of managing conflict and a supportive work environment affects their experience of work stress. Conflict is a common stressor that is encountered as nurses strive to achieve patient satisfaction goals while delivering quality care. How a nurse perceives support may impact work stress levels and how they deal with conflict. A correlational design examined the relationship between supportive work environment, and conflict management style and work stress in a sample of 222 ED nurses using the expanded nurse work stress scale; the survey of perceived organisational support; and the Rahim organisational conflict inventory-II. Twenty seven percent of nurses reported elevated levels of work stress. A supportive work environment and avoidant conflict management style were significant predictors of work stress. Findings suggest that ED nurses' perception of a supportive work environment and their approach to resolving conflict may be related to their experience of work stress. Providing opportunities for ED nurses in skills training in constructive conflict resolution may help to reduce work stress and to improve the quality of patient care. © 2015 John Wiley & Sons Ltd.

Creating High-Quality Health Care Workplaces. A Background Paper for Canadian Policy Research Networks' National Roundtable (Ottawa, Ontario, Canada, October 29, 2001). CPRN Work Network Discussion Paper.

ERIC Educational Resources Information Center

Koehoorn, Mieke; Lowe, Graham S.; Rondeau, Kent V.; Schellenberg, Grant; Wagar, Terry H.

Insights from a variety of research streams were synthesized to identify the key ingredients of a high-quality work environment in Canada's health care sector and ways of achieving high-quality workplaces in the sector. The following sets of interacting factors were considered: (1) the work environment and the human resource practices that shape…

Relationships among leadership practices, work environments, staff communication and outcomes in long-term care.

PubMed

Tourangeau, Ann; Cranley, Lisa; Spence Laschinger, Heather K; Pachis, Jaime

2010-11-01

To examine the role that work relationships have on two long-term care outcomes: job satisfaction and turnover intention. It is easy to overlook the impact that human relations have in shaping work environments that are conducive to organizational effectiveness. Employee job satisfaction and retention are important organizational outcomes. Six hundred and seventy-five nursing and other staff from 26 long-term care facilities were surveyed about their work environments, work group relationships, observed leadership practices, organizational support, job satisfaction and turnover intention. Higher job satisfaction was associated with lower emotional exhaustion burnout, higher global empowerment, higher organizational support, higher psychological empowerment, stronger work group cohesion and higher personal accomplishment. Higher turnover intention was associated with lower job satisfaction, higher emotional exhaustion burnout, more outside job opportunities, weaker work group cohesion, lower personal accomplishment and higher depersonalization. No relationship was found between leadership practices and job satisfaction or turnover intention. Stronger work group relationships, stronger sense of personal accomplishment and lower emotional exhaustion have direct effects on increasing job satisfaction and lowering turnover intention. To retain long-term care staff, attention should be paid to fostering positive work group cohesion, supporting and acknowledging staff accomplishments and minimizing staff burnout. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

Preparing Students for Practice in a Managed Care Environment

ERIC Educational Resources Information Center

Claiborne, Nancy; Fortune, Anne

2005-01-01

Managed care has profound effects on health and mental health service delivery in the United States. This article describes the knowledge that students need for effective social work practice within a managed care environment and evaluates a course to deliver the content. (Contains 3 tables.)

Professional Quality of Life of Veterans Affairs Staff and Providers in a Patient-Centered Care Environment.

PubMed

Locatelli, Sara M; LaVela, Sherri L

2015-01-01

Changes to the work environment prompted by the movement toward patient-centered care have the potential to improve occupational stress among health care workers by improving team-based work activities, collaboration, and employee-driven quality improvement. This study was conducted to examine professional quality of life among providers at patient-centered care pilot facilities. Surveys were conducted with 76 Veterans Affairs employees/providers at facilities piloting patient-centered care interventions, to assess demographics, workplace practices and views (team-based environment, employee voice, quality of communication, and turnover intention), and professional quality of life (compassion satisfaction, burnout, and secondary traumatic stress).Professional quality-of-life subscales were not related to employee position type, age, or gender. Employee voice measures were related to lower burnout and higher compassion satisfaction. In addition, employees who were considering leaving their position showed higher burnout and lower compassion satisfaction scores. None of the work practices showed relationships with secondary traumatic stress.

Day Care for Persons with Dementia: The Impact of the Physical Environment on Staff Stress and Quality of Care.

ERIC Educational Resources Information Center

Lyman, Karen A.

1989-01-01

Considered impact of physical environment on work-related stress and quality of care in day care center integrating demented people and other frail elderly. Examined positive and negative differences before and after move to new facility. Discusses implications for facility design and other program characteristics. (Author/CM)

Does team training work? Principles for health care.

PubMed

Salas, Eduardo; DiazGranados, Deborah; Weaver, Sallie J; King, Heidi

2008-11-01

Teamwork is integral to a working environment conducive to patient safety and care. Team training is one methodology designed to equip team members with the competencies necessary for optimizing teamwork. There is evidence of team training's effectiveness in highly complex and dynamic work environments, such as aviation and health care. However, most quantitative evaluations of training do not offer any insight into the actual reasons why, how, and when team training is effective. To address this gap in understanding, and to provide guidance for members of the health care community interested in implementing team training programs, this article presents both quantitative results and a specific qualitative review and content analysis of team training implemented in health care. Based on this review, we offer eight evidence-based principles for effective planning, implementation, and evaluation of team training programs specific to health care.

Contributing influences of work environment on sleep quantity and quality of nursing assistants in long-term care facilities: A cross-sectional study

PubMed Central

Zhang, Yuan; Punnett, Laura; McEnany, Geoffry Phillips; Gore, Rebecca

2018-01-01

The effect of shift work on nurses’ sleep is well-studied, but there are other challenging aspects of health care work that might also affect the sleep of direct caregivers. This study examined the influence of the long-term care work environment on sleep quantity and quality of nursing assistants. A cross-sectional survey collected data from 650 nursing assistants in 15 long-term care facilities; 46% reported short sleep duration and 23% reported poor sleep quality. A simple additive index of the number of beneficial work features (up to 7) was constructed for analysis with Poisson regression. With each unit increase of beneficial work features, nursing assistants were 7% less likely to report short sleep duration and 17% less likely to report poor sleep quality. These results suggest that effective workplace interventions should address a variety of work stressors, not only work schedule arrangements, in order to improve nursing assistants’ sleep health. PMID:26384714

Leadership and the psychosocial work environment in old age care.

PubMed

Lundgren, Dan; Ernsth-Bravell, Marie; Kåreholt, Ingemar

2016-03-01

To study leadership factors and their associations with psychosocial work environmental among nursing assistants who are engaged in old age care and to analyse (i) differences in the assessment of leadership factors and the assessment of psychosocial work environmental in nursing homes and home help services and (ii) the association between the psychosocial work environment and factors that are related to leadership in nursing homes and home help services. Leadership factors are an important element of the psychosocial work environment in old age care. The physical distance between leaders and nursing assistants is larger in home help services than in nursing homes. Therefore, it is important to study leadership separately in nursing homes and home help services. Assessments from 844 nursing assistants in nursing homes and 288 in home help services (45 nursing homes and 21 home help service units) were analysed. The data were analysed using linear regression. Age, gender, number of staff at the unit, number of years at the current working unit and educational level were controlled in Model 1. Summarised indexes that were based on all independent variables except the main independent variable were additionally controlled in Model 2. Psychosocial work environment was related to leadership factors, but stronger associations occurred more frequently in nursing homes than in home help services. Empowering leadership, support from superiors, the primacy of human resources and control over decisions were associated with higher assessments on all the variables that were related to the psychosocial work environment in both the nursing homes and home help services. Organisational differences in conducting leadership in old age care must be considered. Some leadership characteristics are better prerequisites for creating and maintaining a positive psychosocial work environment for nursing assistants in nursing homes and home help services. Due to the differences in organisational settings, it is important to consider the differences in prerequisites in conducting leadership. To influence nursing assistants' performance and to increase quality in old age care in the long term, appropriate leadership is necessary. © 2015 The Authors. International Journal of Older People Nursing Published by John Wiley & Sons Ltd.

Work Placements as Learning Environments for Patient Safety: Finnish and British Preregistration Nursing Students' Important Learning Events

ERIC Educational Resources Information Center

Tella, Susanna; Smith, Nancy-Jane; Partanen, Pirjo; Turunen, Hannele

2016-01-01

Learning to ensure patient safety in complex health care environments is an internationally recognised concern. This article explores and compares Finnish (n = 22) and British (n = 32) pre-registration nursing students' important learning events about patient safety from their work placements in health care organisations. Written descriptions were…

Differences in nursing practice environment among US acute care unit types: a descriptive study.

PubMed

Choi, JiSun; Boyle, Diane K

2014-11-01

The hospital nursing practice environment has been found to be crucial for better nurse and patient outcomes. Yet little is known about the professional nursing practice environment at the unit level where nurses provide 24-hour bedside care to patients. To examine differences in nursing practice environments among 11 unit types (critical care, step-down, medical, surgical, combined medical-surgical, obstetric, neonatal, pediatric, psychiatric, perioperative, and emergency) and by Magnet status overall, as well as four specific aspects of the practice environment. Cross-sectional study. 5322 nursing units in 519 US acute care hospitals. The nursing practice environment was measured by the Practice Environment Scale of the Nursing Work Index. The Practice Environment Scale of the Nursing Work Index mean composite and four subscale scores were computed at the unit level. Two statistical approaches (one-way analysis of covariance and multivariate analysis of covariance analysis) were employed with a Tukey-Kramer post hoc test. In general, the nursing practice environment was favorable in all unit types. There were significant differences in the nursing practice environment among the 11 unit types and by Magnet status. Pediatric units had the most favorable practice environment and medical-surgical units had the least favorable. A consistent finding across all unit types except neonatal units was that the staffing and resource adequacy subscale scored the lowest compared with all other Practice Environment Scale of the Nursing Work Index subscales (nursing foundations for quality of care, nurse manager ability, leadership, and support, and nurse-physician relations). Unit nursing practice environments were more favorable in Magnet than non-Magnet hospitals. Findings indicate that there are significant variations in unit nursing practice environments among 11 unit types and by hospital Magnet status. Both hospital-level and unit-specific strategies should be considered to achieve an excellent nursing practice environment in all hospital units. Copyright © 2014 Elsevier Ltd. All rights reserved.

Evaluation and comparison of health care Work Environment Scale in military settings.

PubMed

Maloney, J P; Anderson, F D; Gladd, D L; Brown, D L; Hardy, M A

1996-05-01

The purpose of this study was to describe health care providers' perceptions of their work environment at a large U.S. Army medical center, and to compare the findings to other military medical centers. The sample (N = 112) consisted of the professional nursing staff working on the nine inpatient units. The Work Environmental Scale (WES) was used to measure perceptions of the workplace relative to gender, position (head nurses, staff nurses, and agency nurses), specialty nursing (intensive care unit [ICU] versus non-ICU), education (MSN, BSN, and ADN), and patterns of differences between the WES subscales of four military medical centers. Results of the study indicate that there were no significant gender differences. Head nurses, non-ICU nurses, and MSN nurses perceived their environment more positively. There were significant differences in the WES subscales between the military hospitals. Implications for nursing using the WES were recommended.

Nurses' work environment: indicators of satisfaction.

PubMed

Suliman, Mohammad; Aljezawi, Maen

2018-01-10

This study aimed to investigate nurses' perceptions of the nursing work environment in Jordanian hospitals. Previous research has indicated a strong relationship between nurses' work environment and their satisfaction at work. However, little is known about the situation in Jordan. A cross-sectional and descriptive design was used. A sample of 500 nurses was recruited. The study was conducted using the Individual Workload Perception Revised scale (IWPS-R). A sum of 382 out of 500 nurses from three health care sectors in Jordan responded to the questionnaires (response rate = 76.4%). The results indicate that nurses working in the public hospitals had significantly better perceptions about their work environment than nurses working in private and university hospitals. Older nurses with lower academic qualifications are more likely to be satisfied with their work. Furthermore, nurses who have good perceptions of support from their manager and peers, and a manageable workload are more likely to stay in their jobs. The public hospitals are currently considered a more suitable milieu for nurses in Jordan. Other health care sectors should work to enhance nurses' working conditions. Providing a supportive work environment with a manageable workload will encourage nurses to stay in their hospitals. © 2018 John Wiley & Sons Ltd.

Practical ethical theory for nurses responding to complexity in care.

PubMed

Fairchild, Roseanne Moody

2010-05-01

In the context of health care system complexity, nurses need responsive leadership and organizational support to maintain intrinsic motivation, moral sensitivity and a caring stance in the delivery of patient care. The current complexity of nurses' work environment promotes decreases in work motivation and moral satisfaction, thus creating motivational and ethical dissonance in practice. These and other work-related factors increase emotional stress and burnout for nurses, prompting both new and seasoned nurse professionals to leave their current position, or even the profession. This article presents a theoretical conceptual model for professional nurses to review and make sense of the ethical reasoning skills needed to maintain a caring stance in relation to the competing values that must coexist among nurses, health care administrators, patients and families in the context of the complex health care work environments in which nurses are expected to practice. A model, Nurses' Ethical Reasoning Skills, is presented as a framework for nurses' thinking through and problem solving ethical issues in clinical practice in the context of complexity in health care.

Prison Nursing: Formation of a Stable Professional Identity.

PubMed

Choudhry, Khurshid; Armstrong, David; Dregan, Alexandru

The aim of this study was to analyze how working within prison environments can influence the self-identity and professional identity of nurses. The prison environment can be a difficult environment for nurses to deliver care within, with nurses having to carry out activities that seem to go against their professional role, while at the same time providing care to prisoners who have greater health needs than the general population. There is a lack of theoretical consideration of how prison nurses carry out their role in the face of such challenges. This study used a review of literature published over the last 11 years exploring nurses' beliefs, thoughts, and feelings toward delivering care within prison environment. With time, nurses working within prison environments develop specific skills to be able to deliver appropriate care to their patients. These skills include adapting to both the prison environment and the prison culture. Ultimately, adaptations lead to a change in identity allowing nurses to work effectively within prison. Providers of prison healthcare should ensure that induction (orientation) processes for new nurses are designed to address specific challenges that nurses face including the potential for cognitive dissonance. They should ensure that nurses receive training to develop and acquire the skills highlighted in this review. Ensuring that this training is in place may increase nurse retention.

Work engagement of older registered nurses: the impact of a caring-based intervention.

PubMed

Bishop, Mary

2013-10-01

The aim of this evaluation research was to measure the impact of a caring-based intervention on the level of work engagement in older nurses. Every effort is needed to retain older nurses at the bedside by assisting them to revitalise the internal motivation and self- reward that brought them to nursing. A mixed method evaluation research approach using both qualitative and quantitative measurements was used to determine the impact of a caring-based programme on improving the work engagement scores of older Registered Nurses (RNs). The results of this study suggest that leadership strategies aimed at improving work engagement using caring theories have a significant positive impact. The findings contribute to our understanding of how work engagement can be enhanced through building work environments where there is a sense of belonging and teamwork, where staff are allowed time to decompress as well as build positive work relationships. Nurse Leaders (NLs) bear a responsibility to partner with older Registered Nurses (RNs) to build engagement in their work life while enhancing the quality of care. Successful leaders will find ways to meet these unique challenges by creating a healthy work environment. © 2013 John Wiley & Sons Ltd.

42 CFR 483.15 - Quality of life.

Code of Federal Regulations, 2010 CFR

2010-10-01

... supervised social work experience in a health care setting working directly with individuals. (h) Environment. The facility must provide— (1) A safe, clean, comfortable, and homelike environment, allowing the... environment that promotes maintenance or enhancement of each resident's quality of life. (a) Dignity. The...

Absenteeism and Presenteeism among Care Workers in Swiss Nursing Homes and Their Association with Psychosocial Work Environment: A Multi-Site Cross-Sectional Study.

PubMed

Dhaini, Suzanne; Zúñiga, Franziska; Ausserhofer, Dietmar; Simon, Michael; Kunz, Regina; De Geest, Sabina; Schwendimann, René

2016-01-01

Worker productivity is central to the success of organizations such as healthcare institutions. However, both absenteeism and presenteeism impair that productivity. While various hospital studies have examined the prevalence of presenteeism and absenteeism and its associated factors among care workers, evidence from nursing home settings is scarce. To explore care workers' self-reported absenteeism and presenteeism in relation to nursing homes' psychosocial work environment factors. We performed a cross-sectional study utilizing survey data of 3,176 professional care workers in 162 Swiss nursing homes collected between May 2012 and April 2013. A generalized estimating equation ordinal logistic regression model was used to explore associations between psychosocial work environment factors (leadership, staffing resources, work stressors, affective organizational commitment, collaboration with colleagues and supervisors, support from other personnel, job satisfaction, job autonomy) and self-reported absenteeism and presenteeism. Absenteeism and presenteeism were observed in 15.6 and 32.9% of care workers, respectively. While absenteeism showed no relationship with the work environment, low presenteeism correlated with high leadership ratings (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.01-1.48) and adequate staffing resources (OR 1.18, 95% CI 1.02-1.38). Self-reported presenteeism is more common than absenteeism in Swiss nursing homes, and leadership and staffing resource adequacy are significantly associated with presenteeism, but not with absenteeism. © 2015 S. Karger AG, Basel.

Work stress of primary care physicians in the US, UK and German health care systems.

PubMed

Siegrist, Johannes; Shackelton, Rebecca; Link, Carol; Marceau, Lisa; von dem Knesebeck, Olaf; McKinlay, John

2010-07-01

Work-related stress among physicians has been an issue of growing concern in recent years. How and why this may vary between different health care systems remains poorly understood. Using an established theoretical model (effort-reward imbalance), this study analyses levels of work stress among primary care physicians (PCPs) in three different health care systems, the United States, the United Kingdom and Germany. Whether professional autonomy and specific features of the work environment are associated with work stress and account for possible country differences are examined. Data are derived from self-administered questionnaires obtained from 640 randomly sampled physicians recruited for an international comparative study of medical decision making conducted from 2005 to 2007. Results demonstrate country-specific differences in work stress with the highest level in Germany, intermediate level in the US and lowest level among UK physicians. A negative correlation between professional autonomy and work stress is observed in all three countries, but neither this association nor features of the work environment account for the observed country differences. Whether there will be adequate numbers of PCPs, or even a field of primary care in the future, is of increasing concern in several countries. To the extent that work-related stress contributes to this, identification of its organizational correlates in different health care systems may offer opportunities for remedial interventions. Copyright 2010 Elsevier Ltd. All rights reserved.

Work stress of primary care physicians in the US, UK and German health care systems

PubMed Central

Siegrist, Johannes; Link, Carol; Marceau, Lisa; von dem Knesebeck, Olaf; McKinlay, John

2010-01-01

Work-related stress among physicians has been an issue of growing concern in recent years. How and why this may vary between different health care systems remains poorly understood. Using an established theoretical model (effort-reward imbalance), this study analyses levels of work stress among primary care physicians (PCPs) in three different health care systems, the United States, the United Kingdom and Germany. Whether professional autonomy and specific features of the work environment are associated with work stress and account for possible country differences are examined. Data are derived from self-administered questionnaires obtained from 640 randomly sampled physicians recruited for an international comparative study of medical decision making conducted from 2005–2007. Results demonstrate country-specific differences in work stress- with the highest level in Germany, intermediate level in the US and lowest level among UK physicians. A negative correlation between professional autonomy and work stress is observed in all three countries, but neither this association nor features of the work environment account for the observed country differences. Whether there will be adequate numbers of PCPs, or even a field of primary care in the future, is of increasing concern in several countries. To the extent that work-related stress contributes to this, identification of its organizational correlates in different health care systems may offer opportunities for remedial interventions. PMID:20494505

Influence of socio-demographic, labour and professional factors on nursing perception concerning practice environment in Primary Health Care.

PubMed

Parro Moreno, Ana; Serrano Gallardo, Pilar; Ferrer Arnedo, Carmen; Serrano Molina, Lucía; de la Puerta Calatayud, M Luisa; Barberá Martín, Aurora; Morales Asencio, José Miguel; de Pedro Gómez, Joan

2013-11-01

To analyze the perception of nursing professionals of the Madrid Primary Health Care environment in which they practice, as well as its relationship with socio-demographic, work-related and professional factors. Cross-sectional, analytical, observational study. Questionnaire sent to a total of 475 nurses in Primary Health Care in Madrid (former Health Care Areas 6 and 9), in 2010. Perception of the practice environment using the Practice Environment Scale of the Nursing Work Index (PES-NWI) questionnaire, as well as; age; sex; years of professional experience; professional category; Health Care Area; employment status and education level. There was a response rate of 69.7% (331). The raw score for the PES-NWI was: 81.04 [95%CI: 79.18-82.91]. The factor with the highest score was "Support from Managers" (2.9 [95%CI: 2.8-3]) and the lowest "Workforce adequacy" (2.3 [95%CI: 2.2-2.4]). In the regression model (dependent variable: raw score in PES-NWI), adjusted by age, sex, employment status, professional category (coefficient B=6.586), and years worked at the centre (coefficient B=2.139, for a time of 0-2 years; coefficient B=7.482, for 3-10 years; coefficient B=7.867, for over 20 years) remained at p≤0.05. The support provided by nurse managers is the most highly valued factor in this practice environment, while workforce adequacy is perceived as the lowest. Nurses in posts of responsibility and those possessing a higher degree of training perceive their practice environment more favourably. Knowledge of the factors in the practice environment is a key element for health care organizations to optimize provision of care and to improve health care results. Copyright © 2012 Elsevier España, S.L. All rights reserved.

[Health promotion in day-care centres in Reykjavík--intervention and result of actions].

PubMed

Gudmarsdóttir, Agústa; Tómasson, Kristinn

2007-03-01

The purpose of the study was to compare wellbeing, health and work environment before and after intervention among employees of Reykjavík city day-care centre. The study is a prospective interventions study. In the year 2000 employees of 16 day-care centres responded to a questionnaire regarding work environment, health and wellbeing. Work environment evaluation was completed and the centre classified into four groups accordingly. Subsequently, the "equipment was renewed" noise protection improved and the employee received education concerning occupational health. Six months, after interventions, in the year 2002 the same questionnaire was readministered. Response rate in 2002 was 88% (n=267) but 90% in the year 2000. Work environment had improved. More employees had received instruction on good workposture and good work technique than 2 years earlier. Fewer employees used awkward posture than before. Better workspace resulted in reduced number of symptoms, also for the youngest employees. Symptoms were also fewer where unskilled employees were in majority and where the fewest of them had received proper education on work posture. In the year 2002, psychosocial wellbeing was better or equal than two years earlier. This was associated with better education and higher age even despite less workspace. Employees awareness towards noise was greatly improved. It is possible to improve work methods and work environment of employees with goal directed intervention, thus laying the ground for wellbeing at work. The interplay between the factors education and age is complex, though. Thus it is important, that all workplaces, adopt the process of "risk assessment", intervention, and then reassessment of the work environment. By doing so the goals of health promotion and good occupational health can be reached.

Nursing Workload and the Changing Health Care Environment: A Review of the Literature

ERIC Educational Resources Information Center

Neill, Denise

2011-01-01

Changes in the health care environment have impacted nursing workload, quality of care, and patient safety. Traditional nursing workload measures do not guarantee efficiency, nor do they adequately capture the complexity of nursing workload. Review of the literature indicates nurses perceive the quality of their work has diminished. Research has…

Organizational factors impacting job strain and mental quality of life in emergency and critical care units.

PubMed

Bellagamba, Gauthier; Gionta, Guillaume; Senergue, Julie; Bèque, Christine; Lehucher-Michel, Marie-Pascale

2015-01-01

This study measures the association between hospital staff's job strain (JS), mental quality of life (MQL) and how they are influenced by the organization models within emergency and critical care units. This study describes workers employed in emergency departments and intensive care units of a French public hospital. A selfadministered questionnaire was used to survey the demographic and organizational characteristics of their work, as well as work-related mental stress, psychosocial and organizational constraints, and their MQL. Among 145 workers participating in the study, 59.3% of them report job strain and 54.5% of them have low MQL scores. The majority of staff with job strain has reported working more than 2 weekends per month, were regularly on-call, worked in dysfunctional environments and did not participate in regular meetings. The staff with low MQL worked more frequently in dysfunctional environments, had significant complaints regarding employer's efforts to promote communications or provide adequate staffing levels than the workers with a high MQL score. If stress reduction and improved MQL in emergency and intensive care units is to be achieved, hospital management needs to design work schedules that provide a better balance between working and non-working hours. Additionally, ergonomic design, functional environments and improved communications needs to be implemented. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

Nurses' role transition from the clinical ward environment to the critical care environment.

PubMed

Gohery, Patricia; Meaney, Teresa

2013-12-01

To explore the experiences of nurses moving from the ward environment to the critical care environment. Critical care areas are employing nurses with no critical care experience due to staff shortage. There is a paucity of literature focusing on the experiences of nurses moving from the ward environment to the critical care environment. A Heideggerian phenomenology research approach was used in this study. In-depth semi structured interviews, supported with an interview guide, were conducted with nine critical care nurses. Data analysis was guided by Van Manen (1990) approach to phenomenological analysis. Four main themes emerged: The highs and lows, you need support, theory-practice gap, struggling with fear. The participants felt ill prepared and inexperienced to work within the stressful and technical environment of critical care due to insufficient education and support. The study findings indicated that a variety of feelings and emotions are experienced by ward nurses who move into the stressful and technical environment of critical care due to insufficient skills and knowledge. More education and support is required to improve this transition process. Copyright © 2013 Elsevier Ltd. All rights reserved.

Workplace empowerment, collaborative work relationships, and job strain in nurse practitioners.

PubMed

Almost, Joan; Laschinger, Heather K Spence

2002-09-01

To test a theoretical model linking nurse practitioners' (NPs) perceptions of workplace empowerment, collaboration with physicians and managers, and job strain. A predictive, nonexperimental design was used to test a model in a sample of 63 acute care NPs and 54 primary care NPs working in Ontario, Canada. The Conditions of Work Effectiveness Questionnaire, the Collaborative Behaviour Scale--Parts A (physicians) and B (managers), and the Job Content Questionnaire were used to measure the major study variables. The results of this study support the proposition that the extent to which NPs have access to information, support, resources, and opportunities in their work environment has an impact on the extent of collaboration with physicians and managers, and ultimately, the degree of job strain experienced in the work setting. Primary care NPs have significantly higher levels of workplace empowerment, collaboration with managers, and lower levels of job strain than acute care NPs. These findings will benefit NPs and nursing leaders in their efforts to create empowering work environments that enable NPs to provide excellent quality patient care and achieve organizational outcomes.

Physical therapists' perception of workplace ethics in an evolving health-care delivery environment: a cross-sectional survey.

PubMed

Cantu, Roberto

2018-03-30

Physical therapists are trained and obligated to deliver optimal health care and put patients first above all else. In the changing health-care environment, health-care organizations are grappling with controlling cost and increasing revenues. Moral distress may be created when physical therapists' desire to provide optimal care conflicts with their organization's goals to remain financially viable or profitable. Moral distress has been associated with low perception of ethical environment, professional burnout, and high turnover in organizations. This study identified groups who may be vulnerable to low perception of organizational ethical environment and identified self-reported strategies to remedy these perceptions. An ethics environment questionnaire was mailed to a random sample of 1200 physical therapists in Georgia. Respondents (n = 340) were analyzed by age, workplace setting, and position in organization. Therapists working in skilled nursing/assisted living environments scored the lowest on the questionnaire and voiced concerns regarding their ethical work environments. Owners and executives perceived their organizations to be more ethical than front-line clinicians. Respondent concerns included high productivity standards, aggressive coding/billing policies, decreased reimbursement, and increased insurance regulation. Possible solutions included more frequent communication between management and clinicians about ethics, greater professional autonomy, and increased training in business ethics and finance.

The development and piloting of electronic standardized measures on nursing work: combining engineering and nursing knowledge.

PubMed

Bragadóttir, Helga; Gunnarsdóttir, Sigrún; Ingason, Helgi T

2013-05-01

This paper describes the development and piloting of electronic standardized measures on nursing work (e-SMNW) for rich data gathering on the work and work environment of registered nurses (RNs) and practical nurses (PNs). Efficient and valid methods are needed to measure nursing work to enhance the optimal use of the nursing workforce for safe patient care. The study combined human factors engineering (HFE) and nursing knowledge to develop electronic standardized measures for observational studies on nursing work in acute care. The work and work environment of RNs and PNs in acute care medical and surgical inpatient units was successfully measured using e-SMNW. With predetermined items of work activities and influencing factors in the work of nurses, and full use of computer technology, multi-layered rich standardized data were gathered, analysed and displayed. The combination of nursing knowledge, HFE and computer technology enables observational data collection for a rich picture of the complex work of nursing. Information collected by standardized and multi-layered measures makes it easier to identify potential improvements, with regard to influencing factors and management of the work and work environment of nurses. Further use of computer technology in health services research is encouraged. © 2012 Blackwell Publishing Ltd.

Providing a healthy work environment for nurses: the influence on retention.

PubMed

Cohen, Jayne; Stuenkel, Diane; Nguyen, Quyen

2009-01-01

Differences in registered nurses' (RNs) perceptions of their work environment were measured with the Insel and Moos' Work Environment Scale to identify factors in the work environment that may influence retention. Statistically significant differences for perceptions of supervisor support and innovation were found between those RNs who left their unit or hospital during a 24-month period and those who stayed. Implementing strategies to promote retention of RNs to ensure safe, quality patient care is essential.

How nurses and their work environment affect patient experiences of the quality of care: a qualitative study

PubMed Central

2014-01-01

Background Healthcare organisations monitor patient experiences in order to evaluate and improve the quality of care. Because nurses spend a lot of time with patients, they have a major impact on patient experiences. To improve patient experiences of the quality of care, nurses need to know what factors within the nursing work environment are of influence. The main focus of this research was to comprehend the views of Dutch nurses on how their work and their work environment contribute to positive patient experiences. Methods A descriptive qualitative research design was used to collect data. Four focus groups were conducted, one each with 6 or 7 registered nurses in mental health care, hospital care, home care and nursing home care. A total of 26 nurses were recruited through purposeful sampling. The interviews were audiotaped, transcribed and subjected to thematic analysis. Results The nurses mentioned essential elements that they believe would improve patient experiences of the quality of nursing care: clinically competent nurses, collaborative working relationships, autonomous nursing practice, adequate staffing, control over nursing practice, managerial support and patient-centred culture. They also mentioned several inhibiting factors, such as cost-effectiveness policy and transparency goals for external accountability. Nurses feel pressured to increase productivity and report a high administrative workload. They stated that these factors will not improve patient experiences of the quality of nursing care. Conclusions According to participants, a diverse range of elements affect patient experiences of the quality of nursing care. They believe that incorporating these elements into daily nursing practice would result in more positive patient experiences. However, nurses work in a healthcare context in which they have to reconcile cost-efficiency and accountability with their desire to provide nursing care that is based on patient needs and preferences, and they experience a conflict between these two approaches. Nurses must gain autonomy over their own practice in order to improve patient experiences. PMID:24923663

Effects of a performance and quality improvement intervention on the work environment in HIV-related care: a quasi-experimental evaluation in Zambia.

PubMed

Bazant, Eva; Sarkar, Supriya; Banda, Joseph; Kanjipite, Webby; Reinhardt, Stephanie; Shasulwe, Hildah; Mulilo, Joyce Monica Chongo; Kim, Young Mi

2014-12-20

Human resource shortages and reforms in HIV-related care make it challenging for frontline health care providers in southern Africa to deliver high-quality services. At health facilities of the Zambian Defence Forces, a performance and quality improvement approach was implemented to improve HIV-related care and was evaluated in 2010/2011. Changes in providers' work environment and perceived quality of HIV-related care were assessed to complement data of provider performance. The intervention involved on-site training, supportive supervision, and action planning focusing on detailed service delivery standards. The quasi-experimental evaluation collected pre- and post-intervention data from eight intervention and comparison facilities matched on defence force branch and baseline client volume. Overall, 101 providers responded to a 24-item questionnaire on the work environment, covering topics of drugs, supplies, and equipment; training, feedback, and supervision; compensation; staffing; safety; fulfilment; and HIV services quality. In bivariate analysis and multivariate analyses, we assessed changes within each study group and between the two groups. In the bivariate analysis, the intervention group providers reported improvements in the work environment on adequacy of equipment, feeling safe from harm, confidence in clinical skills, and reduced isolation, while the comparison group reported worsening of the work environment on supplies, training, safety, and departmental morale.In the multivariate analysis, the intervention group's improvement and the comparison group's decline were significant on perceived adequacy of drugs, supplies, and equipment; constructive feedback received from supervisor and co-workers; and feeling safe from physical harm (all P <0.01, except P <0.04 for equipment). Further, the item "provider lacks confidence in some clinical skills" declined in the intervention group but increased in the comparison group (P = -0.005). In multivariate analysis, changes in perceived quality of HIV care did not differ between study groups. Provider perceptions were congruent with observations of preparing drugs, supplies, equipment, and in service delivery of prevention of mother-to-child transmission of HIV and antiretroviral therapy follow-up care. The performance and quality improvement intervention implemented at Zambian Defence Forces' health facilities was associated with improvements in providers' perceptions of work environment consistent with the intervention's focus on commodities, skills acquisition, and receipt of constructive feedback.

The impact of nursing work environments on patient safety outcomes: the mediating role of burnout/engagement.

PubMed

Spence Laschinger, Heather K; Leiter, Michael P

2006-05-01

To test a theoretical model of professional nurse work environments linking conditions for professional nursing practice to burnout and, subsequently, patient safety outcomes. The 2004 Institute of Medicine report raised serious concerns about the impact of hospital restructuring on nursing work environments and patient safety outcomes. Few studies have used a theoretical framework to study the nature of the relationships between nursing work environments and patient safety outcomes. Hospital-based nurses in Canada (N = 8,597) completed measures of worklife (Practice Environment Scale of the Nursing Work Index), burnout (Maslach Burnout Inventory-Human Service Scale), and their report of frequency of adverse patient events. Structural equation modeling analysis supported an extension of Leiter and Laschinger's Nursing Worklife Model. Nursing leadership played a fundamental role in the quality of worklife regarding policy involvement, staffing levels, support for a nursing model of care (vs medical), and nurse/physician relationships. Staffing adequacy directly affected emotional exhaustion, and use of a nursing model of care had a direct effect on nurses' personal accomplishment. Both directly affected patient safety outcomes. The results suggest that patient safety outcomes are related to the quality of the nursing practice work environment and nursing leadership's role in changing the work environment to decrease nurse burnout.

Negotiated risk and resident autonomy: Frontline care staff perspectives on culture change in long term care in Nova Scotia, Canada.

PubMed

Roberts, Emily

2016-08-12

Regulating risk, freedom of action, and autonomy in decision making are problems shared by both caregivers and residents in long term care settings, and may become the subject of tension and constant negotiation. This study focuses on long term care staff and management perceptions of day to day life in a care community which has gone through a culture change transition, where small residentially scaled households replace large instutional models of care. In each household, the setting is considered to be home for the 8-12 residents, creating a major shift of roles for the caregivers; they are, in essence, coming into a home rather than institutional environment as a place of work. This potentially changes the dynamics of both patterns of work for caregivers and patterns of daily living for residents. Participant observations and care staff interviews. Several key themes emrged which include: teamwork; the culture of care; regulating risk; the physical environment and care staff empowerment. An unexpected outcome was the consensus among care staff that it is they who feel at home while working in the care households, leading to empowerment in their work roles and a deeper understanding of the importance of their role in the lives of the residents.

Nursing Practice Environment and Outcomes for Oncology Nursing

PubMed Central

Shang, Jingjing; Friese, Christopher R.; Wu, Evan; Aiken, Linda H.

2012-01-01

Background It is commonly assumed that oncology nurses experience high job-related burnout and high turnover because their work involves inherent stressors such as caring for patients with serious and often life-threatening illness. Objectives The objectives of this study were to examine the differences in outcomes such as job dissatisfaction and burnout between oncology nurses and medical-surgical nurses, and to identify factors that affect oncology nurse outcomes. Methods A secondary analysis of nurse survey data collected in 2006 including 4047 nurses from 282 hospitals in 3 states was performed; t test and χ2 test compared differences between oncology nurses and medical-surgical nurses in nurse outcomes and their assessments of nurse practice environment, as measured by the Practice Environment Scale of the Nursing Work Index. Logistic regression models estimated the effect of nurse practice environment on 4 nurse-reported outcomes: burnout, job dissatisfaction, intention to leave the current position, and perceived quality of care. Results Oncology nurses reported favorable practice environments and better outcomes than did medical-surgical nurses. All 4 subscales of the Practice Environment Scale of the Nursing Work Index studied were significantly associated with outcomes. Specifically, nurses who reported favorable nursing foundations for quality of care (eg, active in-service or preceptorship programs) were less likely to report burnout and leave their current position. Conclusions Better practice environments, including nurse foundations for quality care, can help to achieve optimal nurse outcomes. Implications for Practice Improving hospital practice environments holds significant potential to improve nurse well-being, retention, and quality of care. Specifically, hospitals should consider preceptor programs and continuing education and increase nurses’ participation in hospital decision making. PMID:22751101

Ubiquitous computing in shared-care environments.

PubMed

Koch, S

2006-07-01

In light of future challenges, such as growing numbers of elderly, increase in chronic diseases, insufficient health care budgets and problems with staff recruitment for the health-care sector, information and communication technology (ICT) becomes a possible means to meet these challenges. Organizational changes such as the decentralization of the health-care system lead to a shift from in-hospital to both advanced and basic home health care. Advanced medical technologies provide solutions for distant home care in form of specialist consultations and home monitoring. Furthermore, the shift towards home health care will increase mobile work and the establishment of shared care teams which require ICT-based solutions that support ubiquitous information access and cooperative work. Clinical documentation and decision support systems are the main ICT-based solutions of interest in the context of ubiquitous computing for shared care environments. This paper therefore describes the prerequisites for clinical documentation and decision support at the point of care, the impact of mobility on the documentation process, and how the introduction of ICT-based solutions will influence organizations and people. Furthermore, the role of dentistry in shared-care environments is discussed and illustrated in the form of a future scenario.

Location, Location, Location: Where We Teach Primary Care Makes All the Difference.

PubMed

Cassel, Christine; Wilkes, Michael

2017-04-01

Creating a new model to train a high-quality primary care workforce is of great interest to American health care stakeholders. There is consensus that effective educational approaches need to be combined with a rewarding work environment, emphasize a good work/life balance, and a focus on achieving meaningful outcomes that center on patients and the public. Still, significant barriers limit the numbers of clinicians interested in pursuing careers in primary care, including low earning potential, heavy medical school debt, lack of respect from physician colleagues, and enormous burdens of record keeping. To enlarge and energize the pool of primary care trainees, we look especially at changes that focus on institutions and the practice environment. Students and residents need training environments where primary care clinicians and interdisciplinary teams play a crucially important role in patient care. For a variety of reasons, many academic medical centers cannot easily meet these standards. The authors propose that a major part of primary care education and training be re-located to settings in high-performing health systems built on comprehensive integrated care models where primary care clinicians play a principle role in leadership and care delivery.

Identification of Causes of the Occupational Stress for Health Providers at Different Levels of Health Care.

PubMed

Trifunovic, Natasa; Jatic, Zaim; Kulenovic, Alma Dzubur

2017-06-01

To identify and compare the stressors in the work environment experienced by employees in primary health care and secondary health care, amongphysiciansand nurses. The survey was conducted to identify types of stressors by assessing health care workers employed in the primary and secondary health care services of the Public Institution, the Health Centre of the Sarajevo Canton, using a questionnaire about stress in the workplace. Among all study participants stressors connected to the organization of work, finance and communication were found to affect their mental health most strongly. The results show a significant difference between primary and secondary health care in experience of stressors related to the organization of work, communication, and stressors related to the emotional and physical risks. Primary health care physicians report a significantly higher experience of stress and impact on mental health compared with other physicians related to emotional difficulties when working in the field of palliative care. Our results also indicate a significant difference between primary and secondary health providers in experiencing stressors related to the organization of work, such as: on-call duty shifts, an inadequate working environment and in the assessment of administrative work overload. The survey identified the most intense stressors for doctors and nurses at primary and secondary levels of health care services. The results of the study indicate that doctors and nurses have a different hierarchy of stressors, as well as subjects at Primary and Secondary Health Care. The results of the study indicate that subjects et Primary Health Care perceive more stressful organizational, emotional and communicational problems.

Patient-centered care, nurse work environment and implicit rationing of nursing care in Swiss acute care hospitals: A cross-sectional multi-center study.

PubMed

Bachnick, Stefanie; Ausserhofer, Dietmar; Baernholdt, Marianne; Simon, Michael

2018-05-01

Patient-centered care is a key element of high-quality healthcare and determined by individual, structural and process factors. Patient-centered care is associated with improved patient-reported, clinical and economic outcomes. However, while hospital-level characteristics influence patient-centered care, little evidence is available on the association of patient-centered care with characteristic such as the nurse work environment or implicit rationing of nursing care. The aim of this study was to describe patient-centered care in Swiss acute care hospitals and to explore the associations with nurse work environment factors and implicit rationing of nursing care. This is a sub-study of the cross-sectional multi-center "Matching Registered Nurse Services with Changing Care Demands" study. We included 123 units in 23 acute care hospitals from all three of Switzerland's language regions. The sample consisted of 2073 patients, hospitalized for at least 24 h and ≥18 years of age. From the same hospital units, 1810 registered nurses working in direct patient care were also included. Patients' perceptions of patient-centered care were assessed using four items from the Generic Short Patient Experiences Questionnaire. Nurses completed questionnaires assessing perceived staffing and resource adequacy, adjusted staffing, leadership ability and level of implicit rationing of nursing care. We applied a Generalized Linear Mixed Models for analysis including individual-level patient and nurse data aggregated to the unit level. Patients reported high levels of patient-centered care: 90% easily understood nurses, 91% felt the treatment and care were adapted for their situation, 82% received sufficient information, and 70% felt involved in treatment and care decisions. Higher staffing and resource adequacy was associated with higher levels of patient-centered care, e.g., sufficient information (β 0.638 [95%-CI: 0.30-0.98]). Higher leadership ratings were associated with sufficient information (β 0.403 [95%-CI: 0.03-0.77) and adapted treatment and care (β 0.462 [95%-CI: 0.04-0.88]). Furthermore, higher levels of implicit rationing of nursing care were associated with lower levels of patient-centered care, e.g., adapted treatment and care (β -0.912 [95%-CI: -1.50-0.33]). Our study shows a negative association between implicit rationing of nursing care and patient-centered care: i.e.the lower the level of implicit rationing of nursing care, the better patients understood nurses, felt sufficiently informed and recognized that they were receiving highly individualized treatment. To improve patient-centered care, the nurse work environment and the level of implicit rationing of nursing care should be taken into consideration. Copyright © 2017 Elsevier Ltd. All rights reserved.

Maternity Leave: Tips for Returning to Work

MedlinePlus

... set yourself up for a successful return to work: Find dependable child care. Consider local child care providers and facilities or make other arrangements. Look for a safe, stimulating environment and qualified caregivers. Ask your baby's doctor, friends, ...

The effectiveness of an aged care specific leadership and management program on workforce, work environment, and care quality outcomes: design of a cluster randomised controlled trial.

PubMed

Jeon, Yun-Hee; Simpson, Judy M; Chenoweth, Lynn; Cunich, Michelle; Kendig, Hal

2013-10-25

A plethora of observational evidence exists concerning the impact of management and leadership on workforce, work environment, and care quality. Yet, no randomised controlled trial has been conducted to test the effectiveness of leadership and management interventions in aged care. An innovative aged care clinical leadership program (Clinical Leadership in Aged Care--CLiAC) was developed to improve managers' leadership capacities to support the delivery of quality care in Australia. This paper describes the study design of the cluster randomised controlled trial testing the effectiveness of the program. Twenty-four residential and community aged care sites were recruited as managers at each site agreed in writing to participate in the study and ensure that leaders allocated to the control arm would not be offered the intervention program. Sites undergoing major managerial or structural changes were excluded. The 24 sites were randomly allocated to receive the CLiAC program (intervention) or usual care (control), stratified by type (residential vs. community, six each for each arm). Treatment allocation was masked to assessors and staff of all participating sites. The objective is to establish the effectiveness of the CLiAC program in improving work environment, workforce retention, as well as care safety and quality, when compared to usual care. The primary outcomes are measures of work environment, care quality and safety, and staff turnover rates. Secondary outcomes include manager leadership capacity, staff absenteeism, intention to leave, stress levels, and job satisfaction. Differences between intervention and control groups will be analysed by researchers blinded to treatment allocation using linear regression of individual results adjusted for stratification and clustering by site (primary analysis), and additionally for baseline values and potential confounders (secondary analysis). Outcomes measured at the site level will be compared by cluster-level analysis. The overall costs and benefits of the program will also be assessed. The outcomes of the trial have the potential to inform actions to enhance leadership and management capabilities of the aged care workforce, address pressing issues about workforce shortages, and increase the quality of aged care services. Australian New Zealand Clinical Trials Registry (ACTRN12611001070921).

The relationship of staffing and work environment with implicit rationing of nursing care in Swiss nursing homes--A cross-sectional study.

PubMed

Zúñiga, Franziska; Ausserhofer, Dietmar; Hamers, Jan P H; Engberg, Sandra; Simon, Michael; Schwendimann, René

2015-09-01

Implicit rationing of nursing care refers to the withdrawal of or failure to carry out necessary nursing care activities due to lack of resources, in the literature also described as missed care, omitted care, or nursing care left undone. Under time constraints, nurses give priority to activities related to vital medical needs and the safety of the patient, leaving out documentation, rehabilitation, or emotional support of patients. In nursing homes, little is known about the occurrence of implicit rationing of nursing care and possible contributing factors. The purpose of this study was (1) to describe levels and patterns of self-reported implicit rationing of nursing care in Swiss nursing homes and (2) to explore the relationship between staffing level, turnover, and work environment factors and implicit rationing of nursing care. Cross-sectional, multi-center sub-study of the Swiss Nursing Home Human Resources Project (SHURP). Nursing homes from all three language regions of Switzerland. A random selection of 156 facilities with 402 units and 4307 direct care workers from all educational levels (including 25% registered nurses). We utilized data from established scales to measure implicit rationing of nursing care (Basel Extent of Rationing of Nursing Care), perceptions of leadership ability and staffing resources (Practice Environment Scale of the Nursing Work Index), teamwork and safety climate (Safety Attitudes Questionnaire), and work stressors (Health Professions Stress Inventory). Staffing level and turnover at the unit level were measured with self-developed questions. Multilevel linear regression models were used to explore the proposed relationships. Implicit rationing of nursing care does not occur frequently in Swiss nursing homes. Care workers ration support in activities of daily living, such as eating, drinking, elimination and mobilization less often than documentation of care and the social care of nursing homes residents. Statistically significant factors related to implicit rationing of care were the perception of lower staffing resources, teamwork and safety climate, and higher work stressors. Unit staffing and turnover levels were not related to rationing activities. Improving teamwork and reducing work stressors could possibly lead to less implicit rationing of nursing care. Further research on the relationship of implicit rationing of nursing care and resident and care worker outcomes in nursing homes is requested. Copyright © 2015 Elsevier Ltd. All rights reserved.

Evaluation of an educational "toolbox" for improving nursing staff competence and psychosocial work environment in elderly care: results of a prospective, non-randomized controlled intervention.

PubMed

Arnetz, J E; Hasson, H

2007-07-01

Lack of professional development opportunities among nursing staff is a major concern in elderly care and has been associated with work dissatisfaction and staff turnover. There is a lack of prospective, controlled studies evaluating the effects of educational interventions on nursing competence and work satisfaction. The aim of this study was to evaluate the possible effects of an educational "toolbox" intervention on nursing staff ratings of their competence, psychosocial work environment and overall work satisfaction. The study was a prospective, non-randomized, controlled intervention. Nursing staff in two municipal elderly care organizations in western Sweden. In an initial questionnaire survey, nursing staff in the intervention municipality described several areas in which they felt a need for competence development. Measurement instruments and educational materials for improving staff knowledge and work practices were then collated by researchers and managers in a "toolbox." Nursing staff ratings of their competence and work were measured pre and post-intervention by questionnaire. Staff ratings in the intervention municipality were compared to staff ratings in the reference municipality, where no toolbox was introduced. Nursing staff ratings of their competence and psychosocial work environment, including overall work satisfaction, improved significantly over time in the intervention municipality, compared to the reference group. Both competence and work environment ratings were largely unchanged among reference municipality staff. Multivariate analysis revealed a significant interaction effect between municipalities over time for nursing staff ratings of participation, leadership, performance feedback and skills' development. Staff ratings for these four scales improved significantly in the intervention municipality as compared to the reference municipality. Compared to a reference municipality, nursing staff ratings of their competence and the psychosocial work environment improved in the municipality where the toolbox was introduced.

Better Nurse Staffing and Nurse Work Environments Associated With Increased Survival of In-Hospital Cardiac Arrest Patients

PubMed Central

McHugh, Matthew D.; Rochman, Monica F.; Sloane, Douglas M.; Berg, Robert A.; Mancini, Mary E.; Nadkarni, Vinay M.; Merchant, Raina M.; Aiken, Linda H.

2015-01-01

Background Although nurses are the most likely first responders to witness an in-hospital cardiac arrest (IHCA) and provide treatment, little research has been undertaken to determine what features of nursing are related to cardiac arrest outcomes. Objectives To determine the association between nurse staffing, nurse work environments, and IHCA survival. Research Design Cross-sectional study of data from: (1) the American Heart Association’s Get With The Guidelines-Resuscitation database; (2) the University of Pennsylvania Multi-State Nursing Care and and Patient Safety; and (3) the American Hospital Association annual survey. Logistic regression models were used to determine the association of the features of nursing and IHCA survival to discharge after adjusting for hospital and patient characteristics. Subjects A total of 11,160 adult patients aged 18 and older between 2005 and 2007 in 75 hospitals in 4 states (Pennsylvania, Florida, California, and New Jersey). Results Each additional patient per nurse on medical-surgical units was associated with a 5% lower likelihood of surviving IHCA to discharge (odds ratio = 0.95; 95% confidence interval, 0.91–0.99). Further, patients cared for in hospitals with poor work environments had a 16% lower likelihood of IHCA survival (odds ratio = 0.84; 95% confidence interval, 0.71–0.99) than patients cared for in hospitals with better work environments. Conclusions Better work environments and decreased patient-to-nurse ratios on medical-surgical units are associated with higher odds of patient survival after an IHCA. These results add to a large body of literature suggesting that outcomes are better when nurses have a more reasonable workload and work in good hospital work environments. Improving nurse working conditions holds promise for improving survival following IHCA. PMID:26783858

The importance of leadership style and psychosocial work environment to staff-assessed quality of care: implications for home help services.

PubMed

Westerberg, Kristina; Tafvelin, Susanne

2014-09-01

Work in home help services is typically conducted by an assistant nurse or nursing aide in the home of an elderly person, and working conditions have been described as solitary with a high workload, little influence and lack of peer and leader support. Relations between leadership styles, psychosocial work environment and a number of positive and negative employee outcomes have been established in research, but the outcome in terms of quality of care has been addressed to a lesser extent. In the present study, we aimed to focus on working conditions in terms of leadership and the employee psychosocial work environment, and how these conditions are related to the quality of care. The hypothesis was that the relation between a transformational leadership style and quality of care is mediated through organisational and peer support, job control and workload. A cross-sectional survey design was used and a total of 469 questionnaires were distributed (March-April 2012) to assistant nurses in nine Swedish home help organisations, including six municipalities and one private organisation, representing both rural and urban areas (302 questionnaires were returned, yielding a 65% response rate). The results showed that our hypothesis was supported and, when indirect effects were also taken into consideration, there was no direct effect of leadership style on quality of care. The mediated model explained 51% of the variance in quality of care. These results indicate that leadership style is important not only to employee outcomes in home help services but is also indirectly related to quality of care as assessed by staff members. © 2013 John Wiley & Sons Ltd.

Employee effort - reward balance and first-level manager transformational leadership within elderly care.

PubMed

Keisu, Britt-Inger; Öhman, Ann; Enberg, Birgit

2018-03-01

Negative aspects, staff dissatisfaction and problems related to internal organisational factors of working in elderly care are well-known and documented. Much less is known about positive aspects of working in elderly care, and therefore, this study focuses on such positive factors in Swedish elderly care. We combined two theoretical models, the effort-reward imbalance model and the Transformational Leadership Style model. The aim was to estimate the potential associations between employee-perceived transformational leadership style of their managers, and employees' ratings of effort and reward within elderly care work. The article is based on questionnaires distributed at on-site visits to registered nurses, occupational therapists, physiotherapists (high-level education) and assistant nurses (low-level education) in nine Swedish elderly care facilities. In order to grasp the positive factors of work in elderly care, we focused on balance at work, rather than imbalance. We found a significant association between employees' effort-reward balance at work and a transformational leadership style among managers. An association was also found between employees' level of education and their assessments of the first-level managers. We conclude that the first-level manager is an important actor for achieving a good workplace within elderly care, since she/he influences employees' psychosocial working environment. We also conclude that there are differences and inequalities, in terms of well-being, effort and reward at the work place, between those with academic training and those without, in that the former group to a higher degree evaluated their first-level manager to perform a transformational leadership style, which in turn is beneficial for their psychosocial work environment. Consequently, this (re)-produce inequalities in terms of well-being, effort and reward among the employees at the work place. © 2017 Nordic College of Caring Science.

Physical Work Environment as a Managerial Tool for Decreasing Job-Related Anxiety and Improving Employee-Employer Relations.

PubMed

Sadatsafavi, Hessam; Walewski, John; Shepley, Mardelle

2015-01-01

The expected increase in healthcare needs resulting from the Affordable Care Act and the growing population of older citizens in the United States is challenging owners and operators of hospitals to improve quality of care and reduce operational costs. Meanwhile, studies have indicated a serious shortage in the healthcare workforce and have highlighted the critical role of employees' job-related attitudes and feelings. The main objective of this study was to test whether employees' evaluations of important environments within hospitals were significantly associated with their job-related attitudes and feelings, and whether this relationship varied across different demographic groups. About 700 healthcare professionals from 10 acute-care hospitals run by three healthcare organizations participated in this cross-sectional study. Structural equation modeling found that employees' evaluations of their physical work environment were significantly associated with lower rates of job-related anxiety, higher levels of job satisfaction, and increased rates of organizational commitment. Perceived organizational support was responsible for mediating part of these relationships, indicating that employees can perceive a healthy work environment as a sign of their organization valuing them and caring about their well-being. When distinguishing between different spaces, analysis found that satisfaction with rest areas and work spaces had the largest effect size, while the influence of patient areas was small. Employees newer to the facility and to the organization were more influenced by the physical work environment. This study provides preliminary evidence that facility design can be used as a managerial tool for improving employees' job-related attitudes and feelings and earning their commitment.

A Phenomenological Study of the Work Environment in Long-Term Care Facilities for the Older Adults.

PubMed

Choi, Sandy Pin Pin; Yeung, Cheryl Chi Yan; Lee, Joseph Kok Long

2018-05-01

Attempts to meet the increasing demand for long-term care (LTC) services have been hindered by acute staff shortages and high turnover. Distinct from previous studies, a descriptive phenomenological approach with van Kaam's controlled explication method was adopted in this study, to delineate how attributes of the LTC work environment shape the workforce crisis. Individual interviews were conducted with 40 LTC workers from 10 facilities in Hong Kong. The results suggest that the work environment in LTC facilities is not only characterized by organization- and job-related attributes that influence staff outcomes but also is a socially constructed concept with derogatory connotations that can influence staff recruitment and retention. Concerted efforts from facility administrators and policy makers are needed to improve the quality of the work environment. Future initiatives should focus on developing a vision and strategic plan to facilitate the rise of the LTC sector as a profession.

[Creation of a medical work station for use in community-based care].

PubMed

Mercier, Samuel; Desauty, Fabrice; Lamache, Christophe; Lefort, Hugues

2017-03-01

In community-based care, the teams must adapt to the environment and perform a number of technical procedures. Foldable medical equipment has been developed and patented, enabling the care provision to approach hospital standards and improving working conditions in this context. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Learning Opportunities for Nurses Working within Home Care

ERIC Educational Resources Information Center

Lundgren, Solveig

2011-01-01

Purpose: The purpose of this study is to explore home care nurses' experience of learning in a multicultural environment. Design/methodology/approach: The study was based on qualitative research design. Data were collected through repeated interviews with registered home care nurses working in a multicultural area. The data were analyzed through a…

Swedish midwives' perception of their practice environment - A cross sectional study.

PubMed

Hildingsson, Ingegerd; Fenwick, Jennifer

2015-10-01

There is a shortage of midwives in Sweden. Evidence suggests that the work environment is likely to play a part in retention and attrition rates. To explore the practice environment of Swedish midwives and factors associated with the perception of an unfavorable work environment. 475/1000 (48.6%) members of the Swedish Midwifery association completed a questionnaire including the Practice Environment Scale (PES). Differences in mean scores were calculated for the subscales of PES and midwives' background characteristics. Logistic regression was used to investigate factors most strongly associated with unfavorable working environment. The two domains that showed significant differences in terms of participant characteristics were the Staffing and resources adequacy subscale and the Foundations of quality care subscale. Midwives younger than 40 years, those with less than 10 years' experience and those with an additional academic degree rated these two domains more unfavorably. Protective factors for assessing the work environment unfavorable were mainly internal such as high quality of life and high self-efficacy. Swedish midwives were most satisfied with the midwife-doctor relationship and least satisfied with their participation in work place or hospital affairs. Midwives suffering from burnout, those who provided hospital based care and those without leadership position were more likely to assess their work environment as unfavorable. This study identified personal factors as well as work related factors to be associated with midwives' assessment of their practice work environment. Establishing healthy work places where midwives feel recognized and valued could prevent midwives from leaving the profession. Copyright © 2015 Elsevier B.V. All rights reserved.

The impact of Nursing Rounds on the practice environment and nurse satisfaction in intensive care: pre-test post-test comparative study.

PubMed

Aitken, Leanne M; Burmeister, Elizabeth; Clayton, Samantha; Dalais, Christine; Gardner, Glenn

2011-08-01

Factors previously shown to influence patient care include effective decision making, team work, evidence based practice, staffing and job satisfaction. Clinical rounds have the potential to optimise these factors and impact on patient outcomes, but use of this strategy by intensive care nurses has not been reported. To determine the effect of implementing Nursing Rounds in the intensive care environment on patient care planning and nurses' perceptions of the practice environment and work satisfaction. Pre-test post-test 2 group comparative design. Two intensive care units in tertiary teaching hospitals in Australia. A convenience sample of registered nurses (n=244) working full time or part time in the participating intensive care units. Nurses in participating intensive care units were asked to complete the Practice Environment Scale-Nursing Work Index (PES-NWI) and the Nursing Worklife Satisfaction Scale (NWSS) prior to and after a 12 month period during which regular Nursing Rounds were conducted in the intervention unit. Issues raised during Nursing Rounds were described and categorised. The characteristics of the sample and scale scores were summarised with differences between pre and post scores analysed using t-tests for continuous variables and chi-square tests for categorical variables. Independent predictors of the PES-NWI were determined using multivariate linear regression. Nursing Rounds resulted in 577 changes being initiated for 171 patients reviewed; these changes related to the physical, psychological--individual, psychological--family, or professional practice aspects of care. Total PES-NWI and NWSS scores were similar before and after the study period in both participating units. The NWSS sub-scale of interaction between nurses improved in the intervention unit during the study period (pre--4.85±0.93; post--5.36±0.89, p=0.002) with no significant increase in the control group. Factors independently related to higher PES-NWI included intervention site and less years in critical care (p<0.05). Implementation of Nursing Rounds within the intensive care environment is feasible and is an effective strategy for initiating change to patient care. Application and testing of this strategy, including identification of the most appropriate methods of measuring impact, in other settings is needed to determine generalisability. Copyright © 2010 Elsevier Ltd. All rights reserved.

Child Care Work Environments: The Relationship with Learning Environments

ERIC Educational Resources Information Center

Lower, Joanna K.; Cassidy, Deborah J.

2007-01-01

The study explores the relationship between child care program administration, organizational climate, and global quality. The recently developed Program Administration Scale (PAS; Talan & Bloom, 2004) was utilized in the study. Both program administration and organizational climate were found to be positively correlated with preschool…

The impact of personality on person-centred care: a study of care staff in Swedish nursing homes.

PubMed

Elfstrand Corlin, Tinna; Kajonius, Petri J; Kazemi, Ali

2017-06-01

In this study, we explore how personal and situational factors relate to the provision of person-centred care (PCC) in nursing homes. Specifically, we focus on the relationship between the care staff's personality traits and provision of PCC and to what extent perceptions of the working environment influences this relationship. The ultimate goal of elderly care is to meet the older person's needs and individual preferences (PCC). Interpersonal aspects of care and the quality of relationship between the care staff and the older person are therefore central in PCC. A cross-sectional Swedish sample of elderly care staff (N = 322) completed an electronic survey including measures of personality (Mini-IPIP) and person-centred care (Individualized Care Inventory, ICI). A principal component analysis was conducted on the ICI-data to separate the user orientation (process quality) of PCC from the preconditions (structure quality) of PCC. Among the five factors of personality, neuroticism was the strongest predictor of ICI user orientation. ICI preconditions significantly mediated this relationship, indicating the importance of a supportive working environment. In addition, stress was introduced as a potential explanation and was shown to mediate the impact of neuroticism on ICI preconditions. Personality traits have a significant impact on user orientation, and the perception of a supportive and stress free working environment is an important prerequisite for achieving high-quality person-centred elderly care. Understanding how personality is linked to the way care staff interacts with the older person adds a new perspective on provision of person-centred elderly care. © 2016 John Wiley & Sons Ltd.

Exploring staff perceptions on the role of physical environment in dementia care setting.

PubMed

Lee, Sook Y; Chaudhury, Habib; Hung, Lillian

2016-07-01

This study explored staff perceptions of the role of physical environment in dementia care facilities in affecting resident's behaviors and staff care practice. We conducted focus groups with staff (n = 15) in two purposely selected care facilities in Vancouver, Canada. Focus group participants included nurses, care aides, recreation staff, administrative staff, and family. Data analysis revealed two themes: (a) a supportive physical environment contributes positively to both quality of staff care interaction and residents' quality of life and (b) an unsupportive physical environment contributes negatively to residents' quality of life and thereby makes the work of staff more challenging. The staff participants collectively viewed that comfort, familiarity, and an organized space were important therapeutic resources for supporting the well-being of residents. Certain behaviors of residents were influenced by poor environmental factors, including stimulation overload, safety risks, wayfinding challenge, and rushed care This study demonstrates the complex interrelationships among the dementia care setting's physical environment, staff experiences, and residents' quality of life. © The Author(s) 2014.

The nursing work environment and quality of care: A cross-sectional study using the Essentials of Magnetism II Scale in England.

PubMed

Oshodi, Titilayo O; Crockett, Rachel; Bruneau, Benjamin; West, Elizabeth

2017-09-01

To explore the structure of the Essentials of Magnetism II (EOMII) scale using data from nurses working in England; and to describe the impact of different aspects of the nursing work environment on nurse-assessed care quality (NACQ). The EOMII Scale was developed in the United States to measure nursing work environments. It has been widely used in the United States and in a number of other countries, but has not yet been used in the UK. Cross-sectional study. Registered nurses (n = 247) providing direct patient care in two National Health Service hospitals in England completed the EOMII scale and a single-item measuring NACQ. Principal components analysis was used to assess the structure of the scale. Correlation and regression analyses were used to describe the relationships between factors and NACQ. A solution with explanatory variance of 45.25% was identified. Forty items loaded on five factors, with satisfactory consistency: (i) ward manager support; (ii) working as a team; (iii) concern for patients; (iv) organisational autonomy; and (v) constraints on nursing practice. While in univariate analyses, each of the factors was significantly associated with NACQ, in multivariate analyses, the relationship between organisational autonomy and NACQ no longer reached significance. However, a multiple mediation model indicated that the effect of organisational autonomy on NACQ was mediated by nurse manager support, working as a team and concern for patients but not constraints on nursing practice. Subscales of the EOMII identified in an English sample of nurses measured important aspects of the nursing work environment, each of which is related to NACQ. The EOMII could be a very useful tool for measuring aspects of the nursing work environment in the English Trusts particularly in relation to the quality of care. © 2017 John Wiley & Sons Ltd.

A comparative study of occupancy and patient care quality in four different types of intensive care units in a children's hospital.

PubMed

Smith, Thomas J

2012-01-01

This paper reports a comparative study of occupancy and patient care quality in four types of intensive care units in a children's hospital,: an Infant Care Center (ICC), a Medical/Surgical (Med/Surg) unit, a Neonatal Intensive Care Unit (NICU), and a Pediatric Intensive Care Unit (PICU), each featuring a mix of multi-bed and private room (PR) patient care environments. The project is prompted by interest by the project sponsor in a pre-occupancy analysis, before the units are upgraded to exclusive PR designs. Methods comprised, for each unit: (1) observations of ergonomic design features; (2) task activity analyses of job performance of selected staff; and (3) use of a survey to collect perceptions by unit nursing and house staff (HS) of indicators of occupancy and patient care quality. (1) the five most common task activities are interaction with patients, charting, and interaction with equipment, co-workers and family members; (2) job satisfaction, patient care, work environment, job, patient care team interaction, and general occupancy quality rankings by ICC and/or NICU respondents are significantly higher than those by other staff respondents; and (3) ergonomic design shortcomings noted are excess noise, problems with equipment, and work environment, job-related health, and patient care quality issues.

Employment, psychosocial work environment and well-being among migrant and native physicians in Finnish health care.

PubMed

Aalto, Anna-Mari; Heponiemi, Tarja; Keskimäki, Ilmo; Kuusio, Hannamaria; Hietapakka, Laura; Lämsä, Riikka; Sinervo, Timo; Elovainio, Marko

2014-06-01

Although international migration of physicians is increasing, research information on their adjustment to working in a new country is scarce. This study examined the differences in employment, perceptions of psychosocial work environment and well-being between migrant and native physicians in Finland. A cross-sectional survey was sent to a random sample of physicians in Finland (N = 7000) and additionally to all foreign-born physicians licensed to practice in Finland (N = 1292). The final response rates were 56% (n = 3646) among native Finns and 43% (n = 553) among foreign-born physicians. Migrant physicians worked more often in primary care and on-call services and less often in leadership positions than native Finns. They more often experienced lack of professional support and lower work-related well-being compared with native Finns. Those migrant physicians who had lived for a shorter time in Finland perceived less stress related to electronic patient records systems and higher organizational justice compared with native physicians or those foreign physicians who had migrated earlier. Foreign-born physicians are more often employed in the primary care sector, where there are most difficulties in recruiting from the native workforce in Finland. Attention should be paid to enhancing equitable career opportunities and well-being among foreign-born physicians working in Finnish health care. Although migrant physicians are relatively well adjusted to Finnish health care in terms of perceptions of psychosocial work environment, their lower well-being calls for attention. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Family Policies and Institutional Satisfaction: An Intersectional Analysis of Tenure-Track Faculty

ERIC Educational Resources Information Center

Schneller, Heather Lee

2012-01-01

Gender and faculty career advancement have been examined with a focus on academic work environment, including faculty workloads, mentoring relationships, access to research networks, and work-life balance. Previous studies concerned with gender, employment, and care work only have considered child care. Additionally, the exploration of faculty and…

Measuring Work Environment and Performance in Nursing Homes

PubMed Central

Temkin-Greener, Helena; Zheng, Nan (Tracy); Katz, Paul; Zhao, Hongwei; Mukamel, Dana B.

2008-01-01

Background Qualitative studies of the nursing home work environment have long suggested that such attributes as leadership and communication may be related to nursing home performance, including residents' outcomes. However, empirical studies examining these relationships have been scant. Objectives This study is designed to: develop an instrument for measuring nursing home work environment and perceived work effectiveness; test the reliability and validity of the instrument; and identify individual and facility-level factors associated with better facility performance. Research Design and Methods The analysis was based on survey responses provided by managers (N=308) and direct care workers (N=7,418) employed in 162 facilities throughout New York State. Exploratory factor analysis, Chronbach's alphas, analysis of variance, and regression models were used to assess instrument reliability and validity. Multivariate regression models, with fixed facility effects, were used to examine factors associated with work effectiveness. Results The reliability and the validity of the survey instrument for measuring work environment and perceived work effectiveness has been demonstrated. Several individual (e.g. occupation, race) and facility characteristics (e.g. management style, workplace conditions, staffing) that are significant predictors of perceived work effectiveness were identified. Conclusions The organizational performance model used in this study recognizes the multidimensionality of the work environment in nursing homes. Our findings suggest that efforts at improving work effectiveness must also be multifaceted. Empirical findings from such a line of research may provide insights for improving the quality of the work environment and ultimately the quality of residents' care. PMID:19330892

Improving the health care work environment: implications for research, practice, and policy.

PubMed

Harrison, Michael I; Henriksen, Kerm; Hughes, Ronda G

2007-11-01

Despite the gains to date, we need better understanding of practices for implementing and sustaining improvements in health care work environments and further study of organizational conditions affecting implementation of improvements. Limiting work hours, improving schedules, and providing sleep hygiene training will help combat clinician fatigue. Hospital crowding can be reduced through systemwide improvement of patient flow and capacity management, coupled with management support, measurement, and reporting on crowding. Long-term solutions to nurse staffing shortfalls include process redesign to enhance efficiency. Improvement of organizational climate, human resource management, and interoccupational relations will also contribute to staff retention. Evidence-based enhancements to patient rooms and other physical features in hospitals contribute directly to safety and quality and also affect staff performance. POLICY: Landrigan and his colleagues call for external restrictions on residents' work shifts. Clarke examines prospects for mandated nursing-staff ratios. Public reporting on staffing, crowding, and other risks may incent change. Reporting and pay for performance require standardized measures of targeted conditions. Organizations promoting care quality can help spread safe work practices; they can also support collaborative learning and other strategies that may enhance implementation of improvements in work environments.

Leadership and management skills of first-line managers of elderly care and their work environment.

PubMed

Abdelrazek, Fathya; Skytt, Bernice; Aly, Magda; El-Sabour, Mona Abd; Ibrahim, Naglaa; Engström, Maria

2010-09-01

To study the leadership and management skills of first-line managers (FLMs) of elderly care and their work environment in Egypt and Sweden. FLMs in Egypt and Sweden are directly responsible for staff and quality of care. However, FLMs in Sweden, in elderly care, have smaller units/organizations to manage than do their colleagues in Egypt. Furthermore, family care of the elderly has been the norm in Egypt, but in recent years institutional care has increased, whereas in Sweden, residential living homes have existed for a longer period. A convenience sample of FLMs, 49 from Egypt and 49 from Sweden, answered a questionnaire measuring leadership and management skills, structural and psychological empowerment, job satisfaction and psychosomatic health. In both countries, FLMs' perceptions of their leadership and management skills and psychological empowerment were quite high, whereas scores for job satisfaction and psychosomatic health were lower. FLMs had higher values in several factors/study variables in Egypt compared with in Sweden. The work environment, both in Egypt and Sweden, needs to be improved to increase FLMs' job satisfaction and decrease stress. The cultural differences and levels of management have an effect on the differences between the two countries. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

Caring for dying infants: experiences of neonatal intensive care nurses in Hong Kong.

PubMed

Yam, B M; Rossiter, J C; Cheung, K Y

2001-09-01

Ten registered nurses working in a neonatal intensive care unit in Hong Kong were interviewed to explore their experiences of caring for infants whose disease is not responsive to curative treatment, their perceptions of palliative care, and factors influencing their care. Eight categories emerged from the content analysis of the interviews: disbelieving; feeling ambivalent and helpless; protecting emotional self; providing optimal physical care to the infant; providing emotional support to the family; expressing empathy; lack of knowledge and counselling skills; and conflicting values in care. The subtle cultural upbringing and socialization in nurse training and workplace environment also contributed to their moral distress. Hospital and nurse administrators should consider different ways of facilitating palliative care in their acute care settings. For example, by culture-specific death education, peer support groups, bereavement teams, modification of departmental policies, and a supportive work environment. Future research could include the identification of family needs and coping as well as ethical decision-making among nurses.

The Emerging Role of Social Work in Primary Health Care: A Survey of Social Workers in Ontario Family Health Teams.

PubMed

Ashcroft, Rachelle; McMillan, Colleen; Ambrose-Miller, Wayne; McKee, Ryan; Brown, Judith Belle

2018-05-01

Primary health care systems are increasingly integrating interprofessional team-based approaches to care delivery. As members of these interprofessional primary health care teams, it is important for social workers to explore our experiences of integration into these newly emerging teams to help strengthen patient care. Despite the expansion of social work within primary health care settings, few studies have examined the integration of social work's role into this expanding area of the health care system. A survey was conducted with Canadian social work practitioners who were employed within Family Health Teams (FHTs), an interprofessional model of primary health care in Ontario emerging from a period of health care reform. One hundred and twenty-eight (N = 128) respondents completed the online survey. Key barriers to social work integration in FHTs included difficulties associated with a medical model environment, confusion about social work role, and organizational barriers. Facilitators for integration of social work in FHTs included adequate education and competencies, collaborative engagement, and organizational structures.

Pharmaceuticals and Personal Care Products in the Environment: What are the Big Questions?

EPA Science Inventory

Over the past 10-15 years, a significant amount of work has been done by the scientific, regulatory and business communities into effects and risks of pharmaceuticals and personal care products (PPCPs) in the environment. It is now timely to review the current knowledge and to...

Database nurse staffing indicators: explaining risks of staff job dissatisfaction in outpatient care.

PubMed

Kaunonen, Marja; Salin, Sirpa; Aalto, Pirjo

2015-07-01

To explore factors associated with nursing intensity, work environment intensity and nursing resources that may affect nurse job satisfaction and risk of dissatisfaction in outpatient care at one university hospital in Finland. Much research has been done to study how nursing intensity, work environment intensity and nursing resources are associated with nurse job satisfaction, but not in the context of outpatient care. This research used a cross-sectional design. The data were collected from the hospital information systems of outpatient units (n = 12) in autumn 2010. Management style showed a statistically significant association with job satisfaction. The risk of dissatisfaction increased when nursing staff had no influence over the design of their jobs, when conflicts and contradictions were not addressed in the workplace and when feedback was not processed. Nursing intensity and work environment intensity had no effect on nurse job satisfaction. Nursing resources and patient satisfaction, on the other hand, were important to nurses' job satisfaction. The results indicate that nursing management should involve nursing staff in the development of their jobs and the care delivery model. © 2013 John Wiley & Sons Ltd.

Educational innovations to foster resilience in the health professions.

PubMed

Kreitzer, Mary Jo; Klatt, Maryanna

2017-02-01

Stress and burnout of healthcare providers has become a major healthcare issue that has implications for not only workforce projections, but the cost and quality of care and the lives of healthcare providers and their families. Burnout, characterized by loss of enthusiasm for work, feelings of cynicism and a low sense of personal accomplishment is associated with early retirement, alcohol use, and suicidal ideation. Healthcare professional "wellbeing" or "care of the caregiver" is a topic that has not been significantly addressed in the education of healthcare professionals. The culture that has dominated much of education has been one where students have been expected to forego personal needs, endure stressful environments, and emerge from highly competitive and often dysfunctional environments to work in care settings where health and wellbeing is also largely ignored. Three curricular innovations are highlighted that target pre-professional students, students enrolled in health professions education and practicing health care professionals. Strategies are highlighted that both help individuals cultivate resiliency and wellbeing in their personal and professional lives and that address system issues that contribute to unhealthy learning and work environments.

Laughter therapy as an intervention to promote psychological well-being of volunteer community care workers working with HIV-affected families

PubMed Central

Hatzipapas, Irene; Visser, Maretha J.; Janse van Rensburg, Estie

2017-01-01

Abstract The study explores the experiences of volunteer community care workers working with HIV-affected families, participating in laughter therapy. Laughter therapy is being used as an intervention to positively influence individuals experiencing various forms of emotional distress. Community care workers play a vital role in the support of the HIV/AIDS-infected and -affected members in communities. The nature of this type of work and their limited training contributes to high levels of secondary trauma and emotional exhaustion. The purpose of the study was firstly, to explore the effects of working with orphans and vulnerable children (OVC) on the community care workers and secondly, to establish the impact that laughter therapy has to positively combat stresses of working within the care workers’ environment. All the community care workers from a community-based organisation that provides care for HIV/AIDS-infected and -affected OVC and their families in the greater region of Soweto, South Africa, took part in daily laughter therapy sessions for one month. To assess the experiences of participants of laughter therapy, seven community care workers agreed to participate in a mixed method assessment. Interviews were conducted before and after the intervention using the Interpretative Phenomenological Analysis as framework. As supportive data, a stress and anxiety and depression scale were added in the interview. Participants reported more positive emotions, positive coping, improved interpersonal relationships and improvement in their care work after exposure to laughter therapy. Quantitative results on stress, anxiety and depression for each participant confirmed observed changes. Laughter therapy as a self-care technique has potential as a low-cost intervention strategy to reduce stress and counteract negative emotions among people working in highly emotional environments. PMID:29169302

Laughter therapy as an intervention to promote psychological well-being of volunteer community care workers working with HIV-affected families.

PubMed

Hatzipapas, Irene; Visser, Maretha J; Janse van Rensburg, Estie

2017-12-01

The study explores the experiences of volunteer community care workers working with HIV-affected families, participating in laughter therapy. Laughter therapy is being used as an intervention to positively influence individuals experiencing various forms of emotional distress. Community care workers play a vital role in the support of the HIV/AIDS-infected and -affected members in communities. The nature of this type of work and their limited training contributes to high levels of secondary trauma and emotional exhaustion. The purpose of the study was firstly, to explore the effects of working with orphans and vulnerable children (OVC) on the community care workers and secondly, to establish the impact that laughter therapy has to positively combat stresses of working within the care workers' environment. All the community care workers from a community-based organisation that provides care for HIV/AIDS-infected and -affected OVC and their families in the greater region of Soweto, South Africa, took part in daily laughter therapy sessions for one month. To assess the experiences of participants of laughter therapy, seven community care workers agreed to participate in a mixed method assessment. Interviews were conducted before and after the intervention using the Interpretative Phenomenological Analysis as framework. As supportive data, a stress and anxiety and depression scale were added in the interview. Participants reported more positive emotions, positive coping, improved interpersonal relationships and improvement in their care work after exposure to laughter therapy. Quantitative results on stress, anxiety and depression for each participant confirmed observed changes. Laughter therapy as a self-care technique has potential as a low-cost intervention strategy to reduce stress and counteract negative emotions among people working in highly emotional environments.

[Continuing training plan in a clinical management unit].

PubMed

Gamboa Antiñolo, Fernando Miguel; Bayol Serradilla, Elia; Gómez Camacho, Eduardo

2011-01-01

Continuing Care Unit (UCA) focused the attention of frail patients, polypathological patients and palliative care. UCA attend patients at home, consulting, day unit, telephone consulting and in two hospitals of the health area. From 2002 UCA began as a management unit, training has been a priority for development. Key elements include: providing education to the workplace, including key aspects of the most prevalent health care problems in daily work, directing training to all staff including organizational aspects of patient safety and the environment, improved working environment, development of new skills and knowledge supported by the evidence-based care for the development of different skills. The unit can be the ideal setting to undertake the reforms necessary conceptual training of professionals to improve the quality of care. 2010 SESPAS. Published by Elsevier Espana. All rights reserved.

Work outcomes and their predictors in the Redesigning Daily Occupations (ReDO) rehabilitation programme for women with stress-related disorders.

PubMed

Eklund, Mona; Wästberg, Birgitta A; Erlandsson, Lena-Karin

2013-04-01

Previous research has shown that the Redesigning Daily Occupations programme reduced the degree of sick leave and increased return to work rates among women on sick leave for stress-related disorders when compared with "care as usual". To further investigate the Redesigning Daily Occupations intervention, this study explored changes in the work situation from baseline to a 12-month follow-up in the Redesigning Daily Occupations group compared with the "care as usual" group and analysed any predictors of change. A matched-control design was used and 84 women were recruited. Objective (return to work and sick leave) and subjective work outcomes (perceptions of the worker role and the work environment) were explored. Potential predictors were clinical and demographic variables and an anxiety-depression factor. In both groups, large positive effect sizes from baseline to follow-up were found regarding the objective outcomes, a moderate positive effect size was found for perceived work environment, whereas perceived worker role remained unaffected. Previous work rehabilitation predicted objective work outcomes in both groups. Higher education and older age were predictors of subjective outcomes in the Redesigning Daily Occupations group, whereas a more severe anxiety-depression rating was negative for work environment ratings in the "care as usual" group. Return to work seemed possible without a change in the women's perceptions of the worker role; rather they renegotiated their view of the work environment. The Redesigning Daily Occupations programme was found to be promising, with a positive effect on return to work and sick leave reduction. It seemed more suitable for the higher educated and older women. © 2012 The Authors Australian Occupational Therapy Journal © 2012 Occupational Therapy Australia.

Indonesia ergonomics roadmap: where we are going?

PubMed

Wignjosoebroto, Sritomo

2007-12-01

There are so many definitions for ergonomics terms such as human factors, human factors engineering, human engineering, human factors psychology, engineering psychology, applied ergonomics, occupational ergonomics, industrial ergonomics and industrial engineering. The most inclusive terms are ergonomics and human factors. Both represent the study of work and the interaction between people and their work environmental systems. The main objective is especially fitting with the need to design, develop, implement and evaluate human-machine and environment systems that are productive, comfortable, safe and satisfying to use. The work of the ergonomists in Indonesia--most of them are academicians--have one thing in common, i.e. with the appropriate type of ergonomic approaches to interventions; there would be improvements in productivity, quality of working conditions, occupational safety and health (OSH), costs reduction, better environment, and increase in profits. So many researches, training, seminars and socialization about ergonomics and OSH have been done concerning micro-to-macro themes; but it seems that we are practically still running at the same place up to now. In facts, workers are still working using their traditional or obsolete methods in poor working conditions. Accidents are still happening inside and outside industry with the main root-cause being human "unsafe behavior" and errors. Industrial products cannot compete in the global market, and so many manufacturing industries collapsed or relocated to foreign countries. This paper discusses such a roadmap and review what we ergonomists in Indonesia have done and where we are going to? This review will be treated in the field of ergonomics and OSH to take care the future Indonesia challenges. Some of the challenges faced are care for the workers, care for the people, care for the quality and productivity of work, care for the new advanced technologies, care for the environment, and last but not least care for the nation.

Association of nurse work environment and safety climate on patient mortality: A cross-sectional study.

PubMed

Olds, Danielle M; Aiken, Linda H; Cimiotti, Jeannie P; Lake, Eileen T

2017-09-01

There are two largely distinct research literatures on the association of the nurse work environment and the safety climate on patient outcomes. To determine whether hospital safety climate and work environment make comparable or distinct contributions to patient mortality. Cross-sectional secondary analysis of linked datasets of Registered Nurse survey responses, adult acute care discharge records, and hospital characteristics. Acute care hospitals in California, Florida, New Jersey, and Pennsylvania. The sample included 600 hospitals linked to 27,009 nurse survey respondents and 852,974 surgical patients. Nurse survey data included assessments of the nurse work environment and hospital safety climate. The outcome of interest was in-hospital mortality. Data analyses included descriptive statistics and multivariate random intercept logistic regression. In a fully adjusted model, a one standard deviation increase in work environment score was associated with an 8.1% decrease in the odds of mortality (OR 0.919, p<0.001). A one-standard deviation increase in safety climate score was similarly associated with a 7.7% decrease in the odds of mortality (OR 0.923, p<0.001). However, when work environment and safety climate were modeled together, the effect of the work environment remained significant, while safety climate became a non-significant predictor of mortality odds (OR 0.940, p=0.035 vs. OR 0.971, p=0.316). We found that safety climate perception is not predictive of patient mortality beyond the effect of the nurse work environment. To advance hospital safety and quality and improve patient outcomes, organizational interventions should be directed toward improving nurse work environments. Copyright © 2017 Elsevier Ltd. All rights reserved.

Psychosocial work environment and prediction of quality of care indicators in one Canadian health center.

PubMed

Paquet, Maxime; Courcy, François; Lavoie-Tremblay, Mélanie; Gagnon, Serge; Maillet, Stéphanie

2013-05-01

Few studies link organizational variables and outcomes to quality indicators. This approach would expose operant mechanisms by which work environment characteristics and organizational outcomes affect clinical effectiveness, safety, and quality indicators. What are the predominant psychosocial variables in the explanation of organizational outcomes and quality indicators (in this case, medication errors and length of stay)? The primary objective of this study was to link the fields of evidence-based practice to the field of decision making, by providing an effective model of intervention to improve safety and quality. The study involved healthcare workers (n = 243) from 13 different care units of a university affiliated health center in Canada. Data regarding the psychosocial work environment (10 work climate scales, effort/reward imbalance, and social support) was linked to organizational outcomes (absenteeism, turnover, overtime), to the nurse/patient ratio and quality indicators (medication errors and length of stay) using path analyses. The models produced in this study revealed a contribution of some psychosocial factors to quality indicators, through an indirect effect of personnel- or human resources-related variables, more precisely: turnover, absenteeism, overtime, and nurse/patient ratio. Four perceptions of work environment appear to play an important part in the indirect effect on both medication errors and length of stay: apparent social support from supervisors, appreciation of the workload demands, pride in being part of one's work team, and effort/reward balance. This study reveals the importance of employee perceptions of the work environment as an indirect predictor of quality of care. Working to improve these perceptions is a good investment for loyalty and attendance. In general, better personnel conditions lead to fewer medication errors and shorter length of stay. © Sigma Theta Tau International.

Napping during night shift: practices, preferences, and perceptions of critical care and emergency department nurses.

PubMed

Fallis, Wendy M; McMillan, Diana E; Edwards, Marie P

2011-04-01

Nurses working night shifts are at risk for sleep deprivation, which threatens patient and nurse safety. Little nursing research has addressed napping, an effective strategy to improve performance, reduce fatigue, and increase vigilance. To explore nurses' perceptions, experiences, barriers, and safety issues related to napping/not napping during night shift. A convenience sample of critical care nurses working night shift were interviewed to explore demographics, work schedule and environment, and napping/ not napping experiences, perceptions, and barriers. Transcripts were constantly compared, and categories and themes were identified. Participants were 13 critical care nurses with an average of 17 years' experience. Ten nurses napped regularly; 2 avoided napping because of sleep inertia. The need for and benefits of napping or not during night shift break were linked to patient and nurse safety. Ability to nap was affected by the demands of patient care and safety, staffing needs, and organizational and environmental factors. Nurses identified personal health, safety, and patient care issues supporting the need for a restorative nap during night shift. Barriers to napping exist within the organization/work environment.

Person-Environment Interaction in an Evolving Profession: Examining the Congruence and Job Satisfaction of Counselors

ERIC Educational Resources Information Center

Beverly, William D., Jr.

2010-01-01

John Holland's theory considers congruence between the vocational interests of the individual and characteristics of the work environment to be the primary predictor of job satisfaction and stability. The managed care model has markedly changed the demands of the work environment of mental health counselors. Changes in the way services are…

Neonatal Intensive Care Unit Layout and Nurses' Work.

PubMed

Doede, Megan; Trinkoff, Alison M; Gurses, Ayse P

2018-01-01

Neonatal intensive care units (NICUs) remain one of the few areas in hospitals that still use an open bay (OPBY) design for patient stays greater than 24 hr, housing multiple infants, staff, and families in one large room. This creates high noise levels, contributes to the spread of infection, and affords families little privacy. These problems have given rise to the single-family room NICU. This represents a significant change in the care environment for nurses. This literature review answers the question: When compared to OPBY layout, how does a single family room layout impact neonatal nurses' work? Thirteen studies published between 2006 and 2015 were located. Many studies reported both positive and negative effects on nurses' work and were therefore sorted by their cited advantages and disadvantages. Advantages included improved quality of the physical environment; improved quality of patient care; improved parent interaction; and improvements in nurse job satisfaction, stress, and burnout. Disadvantages included decreased interaction among the NICU patient care team, increased nurse workload, decreased visibility on the unit, and difficult interactions with family. This review suggests that single-family room NICUs introduce a complex situation in which trade-offs occur for nurses, most prominently the trade-off between visibility and privacy. Additionally, the literature is clear on what elements of nurses' work are impacted, but how the built environment influences these elements, and how these elements interact during nurses' work, is not as well understood. The current level of research and directions for future research are also discussed.

New 'patent accelerated care environment' aims to facilitate work flow, free up ED for acute care needs.

PubMed

2012-02-01

Faced with rising acuity levels and surging demand, Virginia Mason Medical Center modified the Clinical Decision Unit concept used in many EDs, and developed a new Patient Accelerated Care Environment (PACE) to care for observation patients, process patients for discharge, and to prepare patients for admission.The approach is designed to utilize ED beds for initial processing of patients, allowing resuscitative care if needed, and treating and releasing the patients with quick care needs. Using the Virginia Mason Production System, a methodology that is modeled after Toyota production techniques, developers designed an optimal work flow pattern and then built infrastructure to facilitate that process. All patients who present to the ED for care are seen by the ED team through a "team greet" approach. Approximately 35% to 40% of patients who come to the ED for care are transferred to the PACE unit. Patients assigned to the PACE unit typically remain there for 4 to 48 hours, depending on their care needs.

Job satisfaction, work environment and successful ageing: Determinants of delaying retirement among acute care nurses.

PubMed

Wargo-Sugleris, Michele; Robbins, Wendie; Lane, Christianne Joy; Phillips, Linda R

2018-04-01

To determine the relationships between job satisfaction, work environment and successful ageing and how these factors relate to Registered Nurses' intent to retire. Although little studied, retention of older nurses by delaying early retirement, before age 65, is an important topic for research. Qualitative and quantitative studies have indicated that job satisfaction work environment and successful ageing are key motivators in acute care Registered Nurses retention and/or delaying retirement. This study was designed to provide information to administrators and policy makers about retaining older, experienced RNs longer and more productively. This was a correlational, descriptive, cross-sectional study. An online survey of acute care Registered Nurses (N = 2,789) aged 40 years or older working in Florida was conducted from September - October 2013. Participants completed items related to job satisfaction, work environment, successful ageing and individual characteristics. Hypotheses derived from the modified Ellenbecker's Job Retention Model were tested using regression analysis. Job satisfaction scores were high. Highest satisfaction was with scheduling issues and co-workers; lowest with advancement opportunities. Successful ageing scores were also high with 81% reporting excellent or good health. Work environment explained 55% of the variance in job satisfaction. Years to retirement were significantly associated with successful ageing (p < .001), age (p < .001) and income (p < .010). This study provides quantitative evidence that environment and successful ageing are important areas that have an impact on job satisfaction and delay of retirement in older nurses and further studies in these areas are warranted to expand on this knowledge. © 2017 John Wiley & Sons Ltd.

Choosing Work and Care: Four Australian Women Negotiating Return to Paid Work in the First Year of Motherhood

ERIC Educational Resources Information Center

Boyd, Wendy; Walker, Susan; Thorpe, Karen

2013-01-01

Australian women make decisions about returning to paid work and care for their child within a policy environment that presents mixed messages about maternal employment and childcare standards. Against this background, an investigation of first-time mothers' decision-making about workforce participation and childcare was undertaken. Four women…

Canine tactical field care part three - thoracic and abdominal trauma.

PubMed

Taylor, Wesley M

2010-01-01

Military and law enforcement agencies have seen a dramatic increase in the utilization of working canines both at home and in foreign deployments. Due to the fact that professional veterinary care is sometimes distant from internal disaster or foreign deployment sites, the military medic, police tactical medic, or other first-response medical care provider may be charged with providing emergency or even basic, non-emergency veterinary care to working canines. (Editor's Note: Military veterinary detachments are collocated next to the major human treatment facilities in a deployment environment. In a deployed environment veterinary care is located in areas where they are most needed or where most of the animals are located.) The medical principles involved in treating canines are essentially the same as those for treating humans, but the human healthcare provider needs basic information on canine anatomy and physiology and common emergency conditions in order to provide good basic veterinary care until a higher level of veterinary care can be obtained. This article represents the third in a series of articles designed to provide condensed, basic veterinary information on the medical care of working canines, to include military working dogs (MWDs), police canines, federal agency employed working canines, and search and rescue dogs, to those who are normally charged with tactical or first responder medical care of human patients. This article provides and overview of the diagnosis and treatment of common traumatic injuries to the thorax and abdomen.

A narrative approach to understanding the nursing work environment in Canada.

PubMed

McGillis Hall, Linda; Kiesners, Diana

2005-12-01

Narrative interviews were conducted with hospital nurses participating in a research study designed to provide support and assistance to hospitals as they addressed work life issues for nurses in an attempt to create quality work environments. The eight interviews were conducted in a sample of Canadian hospitals and generated themes relating to an imbalance between the effort that nurses put into their work and rewards attained from it. Seigrist's ((1996) Journal of Occupational Health Psychology, 1, 27-41, (2002) In: P.L. Perrewe & D.G. Ganster (Eds.), Historical perspectives on stress and health. Research in Occupational Stress and Well Being (vol. 2). Boston, MA: Jai Press) effort-reward imbalance model was used to frame this study. The nurses' narratives suggest that multiple factors constitute the nurses' work environment and their experiences and perceptions of it. Issues which surfaced repeatedly in the interviews related to changing needs of hospitalized patients in today's health care system and the associated workload, the widespread shortage of nurses, and the imbalance this creates for nursing work. A crucial finding is the extent to which the nurse is impacted by the adequacy of care they are able to provide. These narratives outline the tremendous burden of guilt and the overcommitment that nurses bear when factors in the work environment prevent them from providing complete, quality care. Nurses are experiencing frustration and stress that is impacting their worklife, family and home life, personal health, and possibly patient outcomes.

The quality of hospital work environments and missed nursing care is linked to heart failure readmissions: a cross-sectional study of US hospitals

PubMed Central

Carthon, J Margo Brooks; Lasater, Karen B; Sloane, Douglas M; Kutney-Lee, Ann

2015-01-01

Introduction Threats to quality and patient safety may exist when necessary nursing care is omitted. Empirical research is needed to determine how missed nursing care is associated with patient outcomes. Aim The aim of this study was to examine the relationship between missed nursing care and hospital readmissions. Methods Cross-sectional examination, using three linked data sources—(1) nurse survey, (2) patient discharge data from three states (California, New Jersey and Pennsylvania) and (3) administrative hospital data— from 2005 to 2006. We explored the incidence of 30-day readmission for 160 930 patients with heart failure in 419 acute care hospitals in the USA. Logistic regression was used to assess the effect of missed care on the odds of readmission, adjusting for patient and hospital characteristics. Results The most frequently missed nursing care activities across all hospitals in our sample included talking to and comforting patients (42.0%), developing and updating care plans (35.8%) and educating patients and families (31.5%). For 4 of the 10 studied care activities, each 10 percentage-point increase in the number of nurses reporting having missed the activity was associated with an increase in the odds of readmission by 2–8% after adjusting for patient and hospital characteristics. However, missed nursing care was no longer a significant predictor of readmission once adjusting for the nurse work environment, except in the case of the delivery of treatments and procedures (OR 1.08, 95% CI 1.02 to 1.14). Conclusions Missed care is an independent predictor of heart failure readmissions. However, once adjusting for the quality of the nurse work environment, this relationship is attenuated. Improvements in nurses’ working conditions may be one strategy to reduce care omissions and improve patient outcomes. PMID:25672342

Safety factors predictive of job satisfaction and job retention among home healthcare aides.

PubMed

Sherman, Martin F; Gershon, Robyn R M; Samar, Stephanie M; Pearson, Julie M; Canton, Allison N; Damsky, Marc R

2008-12-01

Although many of the well known work characteristics associated with job satisfaction in home health care have been documented, a unique aspect of the home health care aides' (HHA) work environment that might also affect job satisfaction is the fact that their workplace is a household. To obtain a better understanding of the potential impact of the risks/exposures/hazards within the household environment on job satisfaction and job retention in home care, we recently conducted a risk assessment study. Survey data from a convenience sample of 823 New York City HHAs were obtained and analyzed. Household/job-related risks, environmental exposures, transportation issues, threats/verbal and physical abuse, and potential for violence were significantly correlated with HHA job satisfaction and job retention. Addressing the modifiable risk factors in the home health care household may improve job satisfaction and reduce job turnover in this work population.

[High-quality nursing health care environment: the patient safety perspective].

PubMed

Tu, Yu-Ching; Wang, Ruey-Hsia

2011-06-01

Patient safety is regarded as an important indicator of nursing care quality, and nurses hold frontline responsibility to maintain patient safety. Many countries now face healthcare provider shortfalls, and recognize a close correlation between adequate manpower and patient safety. Many healthcare organizations work to foster positive work environments in order to improve health service quality. The active participation and "buy in" of nurses, patients and policymakers are critical to maximize healthcare environment quality and improve patient safety. This article adopts Donabedian's theoretical "Structure-Process-Outcome" model of quality (Donabedian, 1988) and presumes all high-quality healthcare environment indicators to be linked to patient safety. In addition to raising public awareness regarding the influence of healthcare environment quality on patient safety, this research suggests certain indicators for tracking and assessing healthcare environment quality. Future research may design an empirical study based on these indicators to help further enhance healthcare environment quality and the professional development of nurses.

Family Child Care Programs within the Military System of Care

ERIC Educational Resources Information Center

Stevens, Carolyn S.

2011-01-01

Military families face challenges not found in other work environments. Shifting work schedules that are often longer than the typical 8-hour day, as well as the ever-present possibility of being deployed anywhere in the world on a moment's notice, require a child care system that is flexible but maintains high-quality standards. The U.S.…

Health Care Providers' Spirit at Work Within a Restructured Workplace.

PubMed

Wagner, Joan I J; Brooks, Denise; Urban, Ann-Marie

2018-01-01

Spirit at work (SAW) research emerged as a response to care provider determination to maintain a healthy and productive health care work environment, despite restructuring. The aim of this descriptive mixed-methods research is to present the care provider's perceptions of SAW. SAW is a holistic measure of care provider workplace outcomes, defined as the unique experience of individuals who are passionate about and energized by their work. A mixed group of licensed and unlicensed care providers in a continuing care workplace were surveyed. Eighteen Likert-type scale survey questions were further informed by two open-ended questions. Results indicated that unlicensed continuing care providers' perceptions of SAW are lower than licensed care providers. Responses suggest that open discussion between managers and team members, combined with structured workplace interventions, will lead to enhanced SAW and improved patient care. Further research on SAW within the continuing care workplace is required.

Nurses well-being in intensive care units: study of factors promoting team commitment.

PubMed

Galletta, Maura; Portoghese, Igor; Coppola, Rosa C; Finco, Gabriele; Campagna, Marcello

2016-05-01

Intensive care units (ICUs) are challenging work environments because of the critical condition of patients, and ICU nurses frequently lament low job satisfaction and high staff turnover. Nevertheless, organizational and work characteristics, and the quality of relationships with staff can help to maintain nurses' enthusiasm and increase job satisfaction. The aim of this study was to analyse how nursing work environment factors affect identification and commitment among ICU nurses. A cross-sectional study was carried out in 12 ICUs from four Italian urban hospitals. A total of 222 nurses participated and completed a self-reported questionnaire. Results show that nursing work characteristics are directly related to team commitment, and that the nursing work characteristics and team commitment relationship was mediated by both perceived supervisor support and job satisfaction. Our findings may concretely contribute to literature and offer additional suggestions to improve nurses' work conditions and patient health in ICUs. © 2014 British Association of Critical Care Nurses.

Workplace bullying in emergency nursing: Development of a grounded theory using situational analysis.

PubMed

Wolf, Lisa A; Perhats, Cydne; Clark, Paul R; Moon, Michael D; Zavotsky, Kathleen Evanovich

2017-09-22

The Institute of Medicine recognizes that the workplace environment is a crucial factor in the ability of nurses to provide safe and effective care, and thus interactions that affect the quality and safety of the work environment require exploration. The purpose of this study was to use situational analysis to develop a grounded theory of workplace bullying as it manifests specifically in the emergency care setting. This study used a grounded theory methodology called situational analysis. 44 emergency RNs were recruited to participate in one of 4 focus group sessions, which were transcribed in their entirety, and, along with field notes, served as the dataset. This grounded theory describes the characteristics of human actors and their reactions to conditions in the practice environment that lead to greater or lesser levels of bullying, and the responses to bullying as it occurs in U.S. emergency departments. Workplace bullying is a significant factor in the dynamics of patient care, nursing work culture, and nursing retention. The impact on patient care cannot be overestimated, both in terms of errors, substandard care, and the negative effects of high turnover of experienced RNs who leave, compounded by the inexperience of newly hired RNs. An assessment of hospital work environments should include nurse perceptions of workplace bullying, and interventions should focus on effective managerial processes for handling workplace bullying. Future research should include testing of the theoretical coherence of the model, and the testing of bullying interventions to determine the effect on workplace environment, nursing intent to leave/retention, and patient outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

The effectiveness of an aged care specific leadership and management program on workforce, work environment, and care quality outcomes: design of a cluster randomised controlled trial

PubMed Central

2013-01-01

Background A plethora of observational evidence exists concerning the impact of management and leadership on workforce, work environment, and care quality. Yet, no randomised controlled trial has been conducted to test the effectiveness of leadership and management interventions in aged care. An innovative aged care clinical leadership program (Clinical Leadership in Aged Care − CLiAC) was developed to improve managers’ leadership capacities to support the delivery of quality care in Australia. This paper describes the study design of the cluster randomised controlled trial testing the effectiveness of the program. Methods Twenty-four residential and community aged care sites were recruited as managers at each site agreed in writing to participate in the study and ensure that leaders allocated to the control arm would not be offered the intervention program. Sites undergoing major managerial or structural changes were excluded. The 24 sites were randomly allocated to receive the CLiAC program (intervention) or usual care (control), stratified by type (residential vs. community, six each for each arm). Treatment allocation was masked to assessors and staff of all participating sites. The objective is to establish the effectiveness of the CLiAC program in improving work environment, workforce retention, as well as care safety and quality, when compared to usual care. The primary outcomes are measures of work environment, care quality and safety, and staff turnover rates. Secondary outcomes include manager leadership capacity, staff absenteeism, intention to leave, stress levels, and job satisfaction. Differences between intervention and control groups will be analysed by researchers blinded to treatment allocation using linear regression of individual results adjusted for stratification and clustering by site (primary analysis), and additionally for baseline values and potential confounders (secondary analysis). Outcomes measured at the site level will be compared by cluster-level analysis. The overall costs and benefits of the program will also be assessed. Discussion The outcomes of the trial have the potential to inform actions to enhance leadership and management capabilities of the aged care workforce, address pressing issues about workforce shortages, and increase the quality of aged care services. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN12611001070921) PMID:24160714

Caring Spaces, Learning Places: Children's Environments That Work.

ERIC Educational Resources Information Center

Greenman, Jim

This book is intended as a resource for those who create, adapt, and cope with settings for young children. It focuses particularly on all-day child care settings. Part 1, "Understanding Children's Settings," explores the power of the environment, or the "landscape" of children's lives--the array of settings they inhabit--and analyzes the…

The introduction of DRG funding and hospital nurses' changing perceptions of their practice environment, quality of care and satisfaction: comparison of cross-sectional surveys over a 10-year period.

PubMed

Zander, Britta; Dobler, Lydia; Busse, Reinhard

2013-02-01

As other countries which have introduced diagnosis-related groups (DRGs) to pay their hospitals Germany initially expected that quality of care could deteriorate. Less discussed were potential implications for nurses, who might feel the efficiency-increasing effects of DRGs on their daily work, which in turn may lead to an actual worsening of care quality. To analyze whether the DRG implementation in German acute hospitals (as well as other changes over the 10-year period) had measurable effects on (1) the nurse work environment (including e.g. an adequate number of nursing staff to provide quality patient care), (2) quality of patient care and safety (incl. confidence into patients' ability to manage care when discharged), and (3) whether the effects from (1) and (2)--if any--impacted on the nurses themselves (satisfaction with their current job and their choice of profession as well as emotional exhaustion). Two rounds of nurse surveys with the Practice Environment Scale of the Nursing Work Index (PES-NWI), five years before DRG implementation (i.e. in 1998/1999; n=2681 from 29 hospitals) and five years after (i.e. in 2009/2010; n=1511 from 49 hospitals). The analysis utilized 15 indicators as outcomes for (1) practice environment, (2) quality of patient care and safety, as well as (3) nurses' satisfaction and emotional exhaustion. Multivariate analyses were performed for all three sets of outcomes using SPSS version 20. Aspects of the practice environment (especially adequate staffing and supportive management) worsened within the examined time span of 10 years, which as a consequence had significant negative impact on the nurse-perceived quality of care (except for patient safety, which improved). Both the aspects of the practice environment and the quality aspects impacted substantially on satisfaction and emotional exhaustion among nurses. The DRG implementation in Germany has apparently had measurable negative effects on nurses and nurse-perceived patient outcomes, however, not as distinct as often assumed. Copyright © 2012 Elsevier Ltd. All rights reserved.

Australian primary health care nurses most and least satisfying aspects of work.

PubMed

Halcomb, Elizabeth; Ashley, Christine

2017-02-01

To identify the aspects of working in Australian primary health care that nurses rate as the most and least satisfying. The nursing workforce in Australian primary health care has grown exponentially to meet the growing demand for health care. To maintain and further growth requires the recruitment and retention of nurses to this setting. Understanding the factors that nurses' rate as the most and least satisfying about their job will inform strategies to enhance nurse retention. A cross-sectional online survey. Nurses employed in primary health care settings across Australia were recruited (n = 1166) to participate in a survey which combined items related to the respondent, their job, type of work, clinical activities, job satisfaction and future intention, with two open-ended items about the most and least satisfying aspects of their work. Patient interactions, respect, teamwork, collegiality and autonomy were identified as the most satisfying professional aspects of their role. Personal considerations such as family friendly work arrangements and a satisfactory work-life balance were also important, overriding negative components of the role. The least satisfying aspects were poor financial support and remuneration, lack of a career path, physical work environment and time constraints. National restructuring of the primary health care environment was seen as a barrier to role stability and ability to work to a full scope of practice. This study has identified a range of positive and negative professional and personal aspects of the primary health care nursing role, which may impact on staff recruitment and retention. Findings from the study should be considered by employers seeking to retain and maximise the skills of their primary health care workforce. Understanding the factors that nurses perceive as being the most and least satisfying aspects of the work is can open up dialogue about how to improve the working experience of nurses in primary health care. © 2016 John Wiley & Sons Ltd.

Building Health Promotion into the Job of Home Care Aides: Transformation of the Workplace Health Environment

PubMed Central

Muramatsu, Naoko; Yin, Lijuan; Lin, Ting-Ti

2017-01-01

Home care aides (HCAs), predominantly women, constitute one of the fastest growing occupations in the United States. HCAs work in clients’ homes that lack typical workplace resources and benefits. This mixed-methods study examined how HCAs’ work environment was transformed by a pilot workplace health promotion program that targeted clients as well as workers. The intervention started with training HCAs to deliver a gentle physical activity program to their older clients in a Medicaid-funded home care program. Older HCAs aged 50+ reported increased time doing the types of physical activity that they delivered to their clients (stretching or strengthening exercise) (p = 0.027). Almost all (98%) HCAs were satisfied with the program. These quantitative results were corroborated by qualitative data from open-ended survey questions and focus groups. HCAs described how they exercised with clients and how the psychosocial work environment changed with the program. Building physical activity into HCAs’ job is feasible and can effectively promote HCAs’ health, especially among older HCAs. PMID:28379207

Building Health Promotion into the Job of Home Care Aides: Transformation of the Workplace Health Environment.

PubMed

Muramatsu, Naoko; Yin, Lijuan; Lin, Ting-Ti

2017-04-05

Home care aides (HCAs), predominantly women, constitute one of the fastest growing occupations in the United States. HCAs work in clients' homes that lack typical workplace resources and benefits. This mixed-methods study examined how HCAs' work environment was transformed by a pilot workplace health promotion program that targeted clients as well as workers. The intervention started with training HCAs to deliver a gentle physical activity program to their older clients in a Medicaid-funded home care program. Older HCAs aged 50+ reported increased time doing the types of physical activity that they delivered to their clients (stretching or strengthening exercise) ( p = 0.027). Almost all (98%) HCAs were satisfied with the program. These quantitative results were corroborated by qualitative data from open-ended survey questions and focus groups. HCAs described how they exercised with clients and how the psychosocial work environment changed with the program. Building physical activity into HCAs' job is feasible and can effectively promote HCAs' health, especially among older HCAs.

Physician Burnout and the Calling to Care for the Dying: A National Survey.

PubMed

Yoon, John D; Hunt, Natalie B; Ravella, Krishna C; Jun, Christine S; Curlin, Farr A

2017-12-01

Physician burnout raises concerns over what sustains physicians' career motivations. We assess whether physicians in end-of-life specialties had higher rates of burnout and/or calling to care for the dying. We also examined whether the patient centeredness of the clinical environment was associated with burnout. In 2010 to 2011, we conducted a national survey of US physicians from multiple specialties. Primary outcomes were a validated single-item measure of burnout or sense of calling to end-of-life care. Primary predictors of burnout (or calling) included clinical specialty, frequency of encounters with dying patients, and patient centeredness of the clinical environments ("My clinical environment prioritizes the need of the patient over maximizing revenue"). Adjusted response rate among eligible respondents was 62% (1156 of 1878). Nearly a quarter of physicians (23%) experienced burnout, and rates were similar across all specialties. Half of the responding physicians (52%) agreed that they felt called to take care of patients who are dying. Burned-out physicians were more likely to report working in profit-centered clinical environments (multivariate odds ratio [OR] of 1.9; confidence interval [CI]: 1.3-2.8) or experiencing emotional exhaustion when caring for the dying (multivariate OR of 2.1; CI: 1.4-3.0). Physicians who identified their work as a calling were more likely to work in end-of-life specialties, to feel emotionally energized when caring for the dying, and to be religious. Physicians from end-of-life specialties not only did not have increased rates of burnout but they were also more likely to report a sense of calling in caring for the dying.

Job crafting among health care professionals: The role of work engagement.

PubMed

Bakker, Arnold B

2018-04-01

The aim of this study was to examine the impact of job crafting on the quality of the work environment of health care professionals. Job crafting refers to proactive behavior aimed at optimizing the fit between person and job. Using job demands-resources theory, we hypothesized that job crafting would be positively related to job resources and person-organisation fit, and negatively to hindrance demands. Furthermore, we hypothesized that these relationships would be qualified by work engagement. A total of 5,272 health care professionals from one of 35 different organisations filled out an electronic questionnaire (response is 55%). Regression analyses were used to test hypotheses. Consistent with hypotheses, job crafting in the form of increasing job resources was positively related to opportunities for development, performance feedback and P-O fit; and negatively related to hindrance job demands - particularly when work engagement was high. The combination of job crafting and work engagement is important for the realization of a resourceful work environment and fit between person and organisation. Interventions aimed at fostering job crafting should be tailored to the motivation of health care professionals. © 2017 John Wiley & Sons Ltd.

Conflicts in operating room: Focus on causes and resolution

PubMed Central

Attri, Joginder Pal; Sandhu, Gagandeep Kaur; Mohan, Brij; Bala, Neeru; Sandhu, Kulwinder Singh; Bansal, Lipsy

2015-01-01

The operation theater (OT) environment is the most complex and volatile workplace where two coequal physicians share responsibility of one patient. Difference in information, opinion, values, experience and interests between a surgeon and anesthesiologist may arise while working in high-pressure environments like OT, which may trigger conflict. Quality of patient care depends on effective teamwork for which multidisciplinary communication is an essential part. Troubled relationships leads to conflicts and conflicts leads to stressful work environment which hinders the safe discharge of patient care. Unresolved conflicts can harm the relationship but when handled in a positive way it provides an opportunity for growth and ultimately strengthening the bond between two people. By learning the skills to resolve conflict, we can keep our professional relationship healthy and strong which is an important component of good patient care. PMID:26543468

Preparing for Electronic Medical Record Implementation: Carolina Care Communication in an Electronic Environment.

PubMed

Carroll, Tracy; Tonges, Mary; Ray, Joel

2017-11-01

This article describes 1 organization's successful approach to mitigating the potential negative effects of a new electronic medical record on patient experience. The Carolina Care model, developed at the University of North Carolina Hospitals to actualize caring theory in practice, helped to structure and greatly facilitate this work. Seven focus areas were integrated to create the "Communication in an Electronic Environment" program with a strong emphasis on nurse-patient communication.

Creating a Positive Work Environment

ERIC Educational Resources Information Center

Anderson, Susan

2010-01-01

The author believes happy staff make for happy classrooms and happy classrooms make for happy children. However, with all the pressures facing child care programs--from the economy to state requirements--creating and maintaining a positive work environment becomes tougher and tougher. In this article, the author discusses the importance of…

Relational Climate and Health Care Costs: Evidence From Diabetes Care.

PubMed

Soley-Bori, Marina; Stefos, Theodore; Burgess, James F; Benzer, Justin K

2018-01-01

Quality of care worries and rising costs have resulted in a widespread interest in enhancing the efficiency of health care delivery. One area of increasing interest is in promoting teamwork as a way of coordinating efforts to reduce costs and improve quality, and identifying the characteristics of the work environment that support teamwork. Relational climate is a measure of the work environment that captures shared employee perceptions of teamwork, conflict resolution, and diversity acceptance. Previous research has found a positive association between relational climate and quality of care, yet its relationship with costs remains unexplored. We examined the influence of primary care relational climate on health care costs incurred by diabetic patients at the U.S. Department of Veterans Affairs between 2008 and 2012. We found that better relational climate is significantly related to lower costs. Clinics with the strongest relational climate saved $334 in outpatient costs per patient compared with facilities with the weakest score in 2010. The total outpatient cost saving if all clinics achieved the top 5% relational climate score was $20 million. Relational climate may contribute to lower costs by enhancing diabetic treatment work processes, especially in outpatient settings.

A pilot study on the effects of a team building process on the perception of work environment in an integrative hospital for neurological rehabilitation.

PubMed

Ostermann, Thomas; Bertram, Mathias; Büssing, Arndt

2010-03-09

Neurological rehabilitation is one of the most care-intensive challenges in the health care system requiring specialist therapeutic and nursing knowledge. In this descriptive pilot study, we investigated the effects of a team building process on perceived work environment, self-ascribed professional competence, life satisfaction, and client satisfaction in an anthroposophic specialized hospital for neurological rehabilitation. The team-building process consisted of didactic instruction and training in problem-solving, teambuilding and constructive conflict resolution. Seventy seven staff members and 44 patients' relatives were asked to complete a survey that included the Work Environment Scale (WES-10), a Life Satisfaction Scale (BMLSS), the Conviction of Therapeutic Competency (CTC) scale and the Client Satisfaction Questionnaire (CSQ-8). To evaluate the outcome of the team building process, we analyzed changes over time in the WES-10 subscales. Additionally the interrelationship between the WES-10 subscales with other subscales and with sociodemographic parameters like age, gender was calculated by means of a bivariate correlation analysis. The team building process had a significant positive effect on perceived work environment in only one area. There was a significant improvement in the ward staffs' perception of their ability to constructively resolve conflicts 3 years after inception of the team building process than there was before inception. However, even in a unit that utilized holistic treatment and nursing in the care of severely disable patients, such care necessitating a very heavy workload, the measurements on the Self Realization, Life Satisfaction and Conviction of Therapeutic Competency scales remained high and unchanged over the three year time period of the study. Strategic interventions might be an option to improve interpersonal relationships and finally quality of patient care.

A pilot study on the effects of a team building process on the perception of work environment in an integrative hospital for neurological rehabilitation

PubMed Central

2010-01-01

Background Neurological rehabilitation is one of the most care-intensive challenges in the health care system requiring specialist therapeutic and nursing knowledge. In this descriptive pilot study, we investigated the effects of a team building process on perceived work environment, self-ascribed professional competence, life satisfaction, and client satisfaction in an anthroposophic specialized hospital for neurological rehabilitation. The team-building process consisted of didactic instruction and training in problem-solving, teambuilding and constructive conflict resolution. Methods Seventy seven staff members and 44 patients' relatives were asked to complete a survey that included the Work Environment Scale (WES-10), a Life Satisfaction Scale (BMLSS), the Conviction of Therapeutic Competency (CTC) scale and the Client Satisfaction Questionnaire (CSQ-8). To evaluate the outcome of the team building process, we analyzed changes over time in the WES-10 subscales. Additionally the interrelationship between the WES-10 subscales with other subscales and with sociodemographic parameters like age, gender was calculated by means of a bivariate correlation analysis. Results The team building process had a significant positive effect on perceived work environment in only one area. There was a significant improvement in the ward staffs' perception of their ability to constructively resolve conflicts 3 years after inception of the team building process than there was before inception. However, even in a unit that utilized holistic treatment and nursing in the care of severely disable patients, such care necessitating a very heavy workload, the measurements on the Self Realization, Life Satisfaction and Conviction of Therapeutic Competency scales remained high and unchanged over the three year time period of the study. Conclusions Strategic interventions might be an option to improve interpersonal relationships and finally quality of patient care. PMID:20214789

The effect of transforming care at the bedside initiative on healthcare teams' work environments.

PubMed

Lavoie-Tremblay, Mélanie; O'Conner, Patricia; Harripaul, Anastasia; Biron, Alain; Ritchie, Judith; Lavigne, Genevieve L; Baillargeon, Sophie; Ringer, Justin; Macgibbon, Brenda; Taylor-Ducharme, Sharon; Sourdif, Jacynthe

2014-02-01

Different initiatives have been implemented in healthcare organizations to improve efficiency, such as transforming care at the bedside (TCAB). However, there are important gaps in understanding the effect of TCAB on healthcare teams' work environments. The specific aim of the study is to describe findings regarding the TCAB initiative effects on healthcare teams' work environments. A pretest and posttest study design was used for this study. The TCAB initiative was implemented in fall 2010 in a university health center in Montreal, Canada. The sample consisted of healthcare workers from four different care units. Statistically significant improvement was observed with the communicating specific information subscale from the measure of processes of care variable, and a significant difference was found between the support from colleagues variable, which was higher at baseline than postprogram. The differences for psychological demand, decisional latitude, and effort-reward were not significant. TCAB is an intervention that allows healthcare teams to implement change to improve patients' and families' outcomes. Ongoing energy should focus on how to improve communication among all members of the team and ensure their support. © 2013 Sigma Theta Tau International.

[Meanings and methods of territorialization in primary health care].

PubMed

Pessoa, Vanira Matos; Rigotto, Raquel Maria; Carneiro, Fernando Ferreira; Teixeira, Ana Cláudia de Araújo

2013-08-01

Territorially-based participative analytical methodologies taking the environmental question and work into consideration are essential for effective primary health care. The study analyzed work and environment-related processes in the primary health care area and their repercussions on the health of workers and the community in a rural city in Ceará, whose economy is based on agriculture for export,. It sought to redeem the area and the proposal of actions focused on health needs by the social subjects through the making of social, environmental and work-related maps in workshops within the framework of action research. Examining the situation from a critical perspective, based on social participation and social determination of the health-disease process with regard to the relations between production, environment and health, was the most important step in the participative map-making process, with the qualitative material interpreted in light of discourse analysis. The process helped identify the health needs, the redemption of the area, strengthened the cooperation between sectors and the tie between the health of the worker and that of the environment, and represented an advance towards the eradication of the causes of poor primary health care services.

The Regulatory Environment in Long Day Care: A "Double-Edged Sword" for Early Childhood Professional Practice

ERIC Educational Resources Information Center

Fenech, Marianne; Sumsion, Jennifer; Goodfellow, Joy

2006-01-01

While early childhood professionals in NSW are accountable to a substantial collection of regulatory requirements, little research has explored the outcomes of this regulatory environment, both intended and otherwise. This paper presents findings from a NSW study and shows how early childhood professionals working in long day care centres perceive…

Evaluation of the current landscape of respiratory nurse specialists in the UK: planning for the future needs of patients.

PubMed

Yorke, Janelle; Prigmore, Sam; Hodson, Matt; Stonham, Carol; Long, Hannah; Bellhouse, Sarah; Fletcher, Monica; Edwards, Sheila

2017-01-01

The National Health Service currently faces significant challenges and must optimise effective workforce planning and management. There are increasing concerns regarding poor workforce planning for respiratory medicine; a greater understanding of the role of respiratory nurse specialists will inform better workforce planning and management. This was a survey study. Two surveys were administered: an organisational-level survey and an individual respiratory nurse survey. There were 148 and 457 respondents to the organisational and individual nurse survey, respectively. Four main themes are presented: (1) breadth of service provided; (2) patient care; (3) work environment; and (4) succession planning. The majority of work conducted by respiratory nurse specialists relates to patient care outside the secondary care setting including supporting self-management in the home, supporting patients on home oxygen, providing hospital-at-home services and facilitating early discharge from acute care environments. Yet, most respiratory nursing teams are employed by secondary care trusts and located within acute environments. There was evidence of multidisciplinary working, although integrated care was not prominent in the free-text responses. High workload was reported with one-quarter of nursing teams short-staffed. Respiratory nurses reported working unpaid extra hours and a lack of administrative support that often took them away from providing direct patient care. Nearly half of the present sample either plan to retire or are eligible for retirement within 10 years. This survey report provides a current snapshot of the respiratory nurse specialist workforce in the UK. This workforce is an ageing population; the results from this survey can be used to inform succession planning and to ensure a viable respiratory nurse specialist workforce in future.

Evaluation of the current landscape of respiratory nurse specialists in the UK: planning for the future needs of patients

PubMed Central

Yorke, Janelle; Prigmore, Sam; Hodson, Matt; Stonham, Carol; Long, Hannah; Bellhouse, Sarah; Fletcher, Monica; Edwards, Sheila

2017-01-01

Introduction The National Health Service currently faces significant challenges and must optimise effective workforce planning and management. There are increasing concerns regarding poor workforce planning for respiratory medicine; a greater understanding of the role of respiratory nurse specialists will inform better workforce planning and management. Methods This was a survey study. Two surveys were administered: an organisational-level survey and an individual respiratory nurse survey. Results There were 148 and 457 respondents to the organisational and individual nurse survey, respectively. Four main themes are presented: (1) breadth of service provided; (2) patient care; (3) work environment; and (4) succession planning. The majority of work conducted by respiratory nurse specialists relates to patient care outside the secondary care setting including supporting self-management in the home, supporting patients on home oxygen, providing hospital-at-home services and facilitating early discharge from acute care environments. Yet, most respiratory nursing teams are employed by secondary care trusts and located within acute environments. There was evidence of multidisciplinary working, although integrated care was not prominent in the free-text responses. High workload was reported with one-quarter of nursing teams short-staffed. Respiratory nurses reported working unpaid extra hours and a lack of administrative support that often took them away from providing direct patient care. Nearly half of the present sample either plan to retire or are eligible for retirement within 10 years. Conclusions This survey report provides a current snapshot of the respiratory nurse specialist workforce in the UK. This workforce is an ageing population; the results from this survey can be used to inform succession planning and to ensure a viable respiratory nurse specialist workforce in future. PMID:28912954

Architectures for paediatric palliative care: how to improve quality of life and environmental well-being.

PubMed

Gola, Marco; Francalanza, Paolo Carlo; Galloni, Giulio; Pagella, Bianca; Capolongo, Stefano

2016-01-01

The influence of the environment on wellness, not only for patients themselves but for all care-givers as well, refers to the humanisation principles of spaces of care. Commencing with an analysis of existing paediatric hospices, the paper examines design suggestions for prosthetic environments, considered as a fundamental component in the healing process. A prosthetic environment can be created only through a specific knowledge of the real needs of users. Therefore, some scholars have conducted research work for defining the best practices for healing environments, supported by an assessment and comparison of case studies. The methodology is based on two phases: the first is based on interviews with experts in hospice design and management and the second, through the application of a questionnaire to several users. Discussion and Results. The output of the work is the achievement of a logical, sequential and participatory broad-spectrum process in the design of health facilities in order to cause a sustainable awareness in paediatric hospices. Starting from the research work, it is necessary to define a scientific method for implementing knowledge on health, psychological, perceptual and behavioural needs to contribute towards proper planning for meeting the real requirements of users.

Evaluating Home Day Care Mothers' Work with Young Children.

ERIC Educational Resources Information Center

Seattle Community Coll., Washington.

This checklist was developed to determine the skills of day care home mothers before and after training as observed by a day care home educator. Areas evaluated are: Professional Attitude; Parent Relationships; Nutrition; Health and Safety; Baby Care; Preparing the Teaching Environment; Guidance; Teaching Techniques, Language and Literature; Art;…

WORKING ENVIRONMENT AND JOB SATISFACTION AMONG HEALTH PROFESSIONAL WORKING AT A TERTIARY CARE HOSPITAL OF PAKISTAN.

PubMed

Aziz, Imrana; Kumar, Ramesh; Rathore, Anita; Lal, Manohr

2015-01-01

Work environment is believed to be a major factor for better performance of human resource for health in any organization. This study concentrated on multiple factors involved in job satisfaction was appraised to critique their efficient significance in calculation of the health professional liking. Factors included job matched with workers' skills/experience, incentives, supervision, administrator support; convenient work load, training, appreciation, low pay and job protection were major contributors in job satisfaction. A mix method study was done in 2014; an initial descriptive cross sectional survey was done followed by qualitative approach. Eighteen in-depth interviews with health care providers were conducted after taking written consent. Nodes, sub-nodes and final themes were generated during qualitative data analysis. Main findings and themes were, generated after making the nodes and sub-nodes from the most frequent responses. These themes were; absence of work pressure, work place safety, social support, learning opportunities, and employee influence on conditions and recognition individual or team efforts. Work environment is a major contributing factor towards job satisfaction among the health workers.

[Racial discrimination in the care environment].

PubMed

Labache, Lucette

2018-05-01

Based on interviews carried out with people from overseas working in Parisian hospitals and observations made of women from Central and North Africa working in care facilities for elderly or disabled people, this article discusses the issue of racial discrimination. We focus on the way discrimination develops, its manifestations in the care sector and the way in which it is handled. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Redesigning nursing work in long-term care environments.

PubMed

Hall, L M; O'Brien-Pallas, L

2000-01-01

The authors present a highly statistically oriented argument for examining work attitudes and activities among three groups of caregivers [RNs, RPNs, and HCAs] working in long-term care. The investigators used both work sampling, written surveys, and interviews with a sample of 46 caregivers in a large university-affiliated LTC facility in Toronto, Canada. While RNs stated their strong affinity for direct patient care activities, they perform the lowest percentage of direct care, chiefly due to their accountability for planning and coordinating the care provided by others. The HCAs who provided the bulk of direct patient care "valued it the least," apparently finding little gratification with this aspect of their role. This study suggests that there is a need to examine and clarify work roles and perceptions for all caregivers as part of any work redesign process. A higher level of RN involvement in direct patient care activities, along with "attention to enhancing the importance" of these activities for staff employed in the HCA role, could be beneficial.

[Childrearing environment and fertility in contemporary Japan (author's transl)].

PubMed

Horosima, K

1981-04-01

This study focused on the decrease in the marital fertility rate and attempted to clarify some traits in childrearing behavior which are responsible for the low fertility. Regarding the increase in difficulties in childrearing, the author pointed out the necessity and possibility of fertility study from the viewpoint of childrearing. The author proposed to regard childbearing behavior as a part of childrearing behavior and to explain childbearing behavior by childrearing environment which surrounds the couple's childrearing behavior and childrearing consciousness. Childrearing environment is composed of family formation in the household, labor force status of the mother, housing conditions, nursery facilities, and physical environment in the community; these components are all closely allied. Data obtained from 2375 mothers with preschool children were studied. There were great differences in the degree of mother's participation in the labor foce but there was a large ratio of mothers who did not live with their parents and who wanted to work outside the home if nursery facilities could be affored. Clearly the desire of women of reproductive age to work is very strong and the differences in the labor force participation rate are the result of insufficient socialized child care. The authors found a stratum of women who were strongly orientated towards working but who had chosen to live with the parents as a solution to their child care problem. We could only find small differences in fertility by family formation in the household and by work history of mother when observed. However, when the 2 were combined, there were relatively large differences (1.94-2.65 after 10 years of marriage) which has rarely been observed in social analyses of fertility thus far. The lowest fertility by work history was observed among women who had worked since before their marriages, and the largest differences in fertility between 2 family formation types was found among these women (1.94:2.24). This difference in fertility can be supposed to reflect the difference in child care conditions by family formation in household. As to the reasons for limiting births, differences were not found between these 2 family formation types. Working mothers who relied upon their parents for child care expressed relatively greater anxiety about their child's development status than those mothers in nuclear families where child care was supplied by the nursery schools. It is likely that the trend of working mothers will not diminish, and we must thus anticipate the limit of the mechanism of maintaining the fertility by child care supplied by cohabiting parents. Physical environment in the community was found to be a factor in limiting childbirth and the effect was most conspicuous among women who had continued to work in the nuclear family.

Technologies in older people's care.

PubMed

Andersson Marchesoni, Maria; Axelsson, Karin; Fältholm, Ylva; Lindberg, Inger

2017-03-01

The tension between care-based and technology-based rationalities motivates studies concerning how technology can be used in the care sector to support the relational foundation of care. This study interprets values related to care and technologies connected to the practice of good care. This research study was part of a development project aimed at developing innovative work practices through information and communication technology. Participants and research context: All staff (n = 18) working at two wards in a care facility for older people were asked to participate in interviews, and 12 accepted. We analysed the data using latent content analysis in combination with normative analysis. Ethical considerations: The caregivers were informed that participation was voluntary and that they could drop out at any time without providing any explanation. Four values were identified: 'presence', 'appreciation', 'competence' and 'trust'. Caregivers wanted to focus on care receivers as unique persons, a view that they thought was compromised by time-consuming and beeping electronic devices. Appraising from next-of-kin and been seen as someone who can contribute together with knowledge to handle different situations were other desires. The caregivers also desired positive feedback from next-of-kin, as they wanted to be seen as professionals who have the knowledge and skills to handle difficult situations. In addition, the caregivers wanted their employer to trust them, and they wanted to work in a calm environment. Caregivers' desire for disturbance-free interactions, being valued for their skills and working in a trustful working environment were interpreted as their base for providing good care. The caregivers' arguments are based on caring rationality, and sometimes they felt the technological rationality interfered with their main mission, providing quality care. Introducing new technology in caring should support the caring relationship. Although society's overall technology-based approach may have gained popularity as a problem solver, technology-based rationality may compromise a care-based rationality. A shift in attitudes towards care as a concept on all societal levels is needed.

Making Sense of Varying Standards of Care: The Experiences of Staff Working in Residential Care Environments for Adults with Learning Disabilities

ERIC Educational Resources Information Center

Hutchison, Andrew; Kroese, Biza Stenfert

2016-01-01

Research evidence reveals that adults with learning disabilities who live in residential care facilities are being exposed to considerable variation in the standards of care they receive. High profile cases of substandard care have also raised concerns regarding the appropriateness of existing care provisions and practices. While attempts have…

Exploring direct and indirect influences of physical work environment on job satisfaction for early-career registered nurses employed in hospitals.

PubMed

Djukic, Maja; Kovner, Christine T; Brewer, Carol S; Fatehi, Farida; Greene, William H

2014-08-01

We explored direct and indirect influences of physical work environment on job satisfaction in a nationally representative sample of 1,141 early-career registered nurses. In the fully specified model, physical work environment had a non-significant direct effect on job satisfaction. The path analysis used to test multiple indirect effects showed that physical work environment had a positive indirect effect (p < .05) on job satisfaction through ten variables: negative affectivity, variety, workgroup cohesion, nurse-physician relations, quantitative workload, organizational constraints, distributive justice, promotional opportunity, local and non-local job opportunities. The findings make important contributions to the understanding of the relationship between physical work environment and job satisfaction. The results can inform health care leaders' insight about how physical work environment influences nurses' job satisfaction. © 2014 Wiley Periodicals, Inc.

Work engagement and its predictors in registered nurses: A cross-sectional design.

PubMed

Wan, Qiaoqin; Zhou, Weijiao; Li, Zhaoyang; Shang, Shaomei; Yu, Fang

2018-04-23

Nurses are key staff members of health-care organizations. Nurse engagement directly influences quality of care and organizational performance. The purpose of the present study was to understand the state of work engagement and explore its predictors among registered nurses in China by using a descriptive, cross-sectional survey design (n = 1065). Work engagement was measured with the Chinese version of the Utrecht Work Engagement Scale. The results showed that the average work engagement of Chinese nurses was 3.54 (standard deviation = 1.49), and that nurses' age (β = .16, t = 5.32), job characteristics (β = .33, t = 9.43), and practice environment (β = .23, t = 6.59) were significant predictors of work engagement. Thus, nurse leaders should be encouraged to shape motivational job characteristics and create supportive practice environment so as to increase nurses' work engagement. © 2018 John Wiley & Sons Australia, Ltd.

The impact of the hospital work environment on social support from physicians in breast cancer care.

PubMed

Ansmann, Lena; Wirtz, Markus; Kowalski, Christoph; Pfaff, Holger; Visser, Adriaan; Ernstmann, Nicole

2014-09-01

Research on determinants of a good patient-physician interaction mainly disregards systemic factors, such as the work environment in healthcare. This study aims to identify stressors and resources within the work environment of hospital physicians that enable or hinder the physicians' provision of social support to patients. Four data sources on 35 German breast cancer center hospitals were matched: structured hospital quality reports and surveys of 348 physicians, 108 persons in hospital leadership, and 1844 patients. Associations between hospital structures, physicians' social resources as well as job demands and control and patients' perceived support from physicians have been studied in multilevel models. Patients feel better supported by their physicians in hospitals with high social capital, a high percentage of permanently employed physicians, and less physically strained physicians. The results highlight the importance of the work environment for a good patient-physician interaction. They can be used to develop interventions for redesigning the hospital work environment, which in turn may improve physician satisfaction, well-being, and performance and consequently the quality of care. Health policy and hospital management could create conditions conducive to better patient-physician interaction by strengthening the social capital and by increasing job security for physicians. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Role of a service corridor in ICU noise control, staff stress, and staff satisfaction: environmental research of an academic medical center.

PubMed

Wang, Zhe; Downs, Betsy; Farell, Ashley; Cook, Kimberly; Hourihan, Peter; McCreery, Shimby

2013-01-01

To investigate the role of a dedicated service corridor in intensive care unit (ICU) noise control and staff stress and satisfaction. Shared corridors immediately adjacent to patient rooms are generally noisy due to a variety of activities, including service deliveries and pickups. The strategy of providing a dedicated service corridor is thought to reduce noise for patient care, but the extent to which it actually contributes to noise reduction in the patient care environment and in turn improves staff performance has not been previously documented. A before-and-after comparison was conducted in an adult cardiac ICU. The ICU was relocated from a traditional hospital environment to a new addition with a dedicated service corridor. A total of 118 nursing staff participated in the surveys regarding pre-move and post-move environmental comfort, stress, and satisfaction in the previous and new units. Acoustical measures of noise within the new ICU and a control environment of the previous unit were collected during four work days, along with on-site observations of corridor traffic. Independent and paired sample t-tests of survey data showed that the perceived noise level was lower and staff reported less stress and more satisfaction in the new ICU (p < 0.01). Analyses of acoustical data confirmed that the new ICU was significantly quieter (p < 0.02). Observations revealed how the service corridor impacted patient care services and traffic. The addition of a dedicated service corridor works in the new unit for improving noise control and staff stress and satisfaction. Critical care/intensive care, noise, satisfaction, staff, work environment.

Contextual barriers to implementation in primary care: an ethnographic study of a programme to improve chronic kidney disease care

PubMed Central

Armstrong, Natalie; Herbert, Georgia; Brewster, Liz

2016-01-01

Background. Context is important in implementation—we know that what works in one setting may not work in the same way elsewhere. Primary care has been described as a unique context both in relation to the care delivered and efforts to carry out research and implementation of new evidence. Objective. To explore some of the distinctive features of the primary care environment that may influence implementation. Methods. We conducted an ethnographic study involving observations, interviews and documentary analysis of the ENABLE-CKD project, which involved general practices implementing a chronic kidney disease care bundle and offering self-management support tools to patients. Analysis was based on the constant comparative method. Results. Four elements of the primary care environment emerged as important influences on the extent to which implementation was successful. First, the nature of delivering care in this setting meant that prioritizing one condition over others was problematic. Second, the lack of alignment with financial and other incentives affected engagement. Third, the project team lacked mechanisms through which engagement could be mandated. Fourth, working relationships within practices impacted on engagement. Conclusions. Those seeking to implement interventions in primary care need to consider the particular context if they are to secure successful implementation. We suggest that there are particular kinds of interventions, which may be best suited to the primary care context. PMID:27297465

Contextual barriers to implementation in primary care: an ethnographic study of a programme to improve chronic kidney disease care.

PubMed

Armstrong, Natalie; Herbert, Georgia; Brewster, Liz

2016-08-01

Context is important in implementation-we know that what works in one setting may not work in the same way elsewhere. Primary care has been described as a unique context both in relation to the care delivered and efforts to carry out research and implementation of new evidence. To explore some of the distinctive features of the primary care environment that may influence implementation. We conducted an ethnographic study involving observations, interviews and documentary analysis of the ENABLE-CKD project, which involved general practices implementing a chronic kidney disease care bundle and offering self-management support tools to patients. Analysis was based on the constant comparative method. Four elements of the primary care environment emerged as important influences on the extent to which implementation was successful. First, the nature of delivering care in this setting meant that prioritizing one condition over others was problematic. Second, the lack of alignment with financial and other incentives affected engagement. Third, the project team lacked mechanisms through which engagement could be mandated. Fourth, working relationships within practices impacted on engagement. Those seeking to implement interventions in primary care need to consider the particular context if they are to secure successful implementation. We suggest that there are particular kinds of interventions, which may be best suited to the primary care context. © The Author 2016. Published by Oxford University Press.

[Development of a scale for work motivation of home care workers and influencing factors].

PubMed

Nakatani, Yasuhisa; Sugiura, Keiko; Mikami, Hiroshi

2009-02-01

To develop a scale for home care workers focusing on work motivation and to determine influential underlying factors. This study was an anonymous mailed survey of home care workers who provided home help services in July 2007. We collected information in the following areas: demographics of home care workers and care-recipients, burnout, stress, job satisfaction, life satisfaction, and self-esteem (SE). Hierarchical regression analysis was performed in order to identify factors related to work motivation. Construct validity was analyzed by factor analysis. Two subscales were obtained by the analysis and designated as "positive appraisal of the current state" (9 items) and "uplift of morale" (3 items). Content validity was analyzed by good-poor and item-total, and all correlations were strongly positive. Reliability was analyzed by internal consistency. Cronbach's ? values were 0.94 and 0.77, respectively. Concurrent validity was analyzed by correlation coefficient and a significant negative correlation was seen between the two subscales and burnout (r = -0.23--0.50), while positive correlations were noted for job or life satisfaction (r= 0.24-0.49). The positive influential factors on "positive appraisal of the current state" were satisfaction in 1) relation to care-recipients, 2) work environment for skill improvement and 3) the wages. The positive influential factors on "uplift of morale" were satisfaction with relation to care-recipients and their own life. This scale has sufficient reliability and validity. "Positive appraisal of the current state" and "uplift of morale" were confirmed as appropriate work motivation subscales for home care workers. Thus, support to augment job satisfaction with the work environment and wages appears to enhance "positive appraisal of the current state" and support to augment life satisfaction appears to enhance "uplift of morale".

Improving Work Environment Perceptions for Nurses Employed in a Rural Setting

ERIC Educational Resources Information Center

Teasley, Susan L.; Sexton, Kathleen A.; Carroll, Cathryn A.; Cox, Karen S.; Riley, Michele; Ferriell, Kathleen

2007-01-01

Context: Effective recruitment and retention of professional nurses is a survival strategy for health care facilities, especially in rural areas. Purpose: This study examines the use of the Individual Workload Perception Scale to measure nurse satisfaction by a small rural hospital in order to make positive changes in the work environment for…

Natural Environments: A Letter from a Mother to Friends, Families, and Professionals.

ERIC Educational Resources Information Center

Mullis, Lorna

2002-01-01

A mother of a son with Down syndrome discusses how her family and child care providers work with him in natural environments to support his learning in daily activities. She urges other parents to keep trying until they find the right match that works for their family. (CR)

Linking nurses' perceptions of patient care quality to job satisfaction: the role of authentic leadership and empowering professional practice environments.

PubMed

Spence Laschinger, Heather K; Fida, Roberta

2015-05-01

A model linking authentic leadership, structural empowerment, and supportive professional practice environments to nurses' perceptions of patient care quality and job satisfaction was tested. Positive work environment characteristics are important for nurses' perceptions of patient care quality and job satisfaction (significant factors for retention). Few studies have examined the mechanism by which these characteristics operate to influence perceptions of patient care quality or job satisfaction. A cross-sectional provincial survey of 723 Canadian nurses was used to test the hypothesized models using structural equation modeling. The model was an acceptable fit and all paths were significant. Authentic leadership had a positive effect on structural empowerment, which had a positive effect on perceived support for professional practice and a negative effect on nurses' perceptions that inadequate unit staffing prevented them from providing high-quality patient care. These workplace conditions predicted job satisfaction. Authentic leaders play an important role in creating empowering professional practice environments that foster high-quality care and job satisfaction.

Balancing safety and harm for older adults with dementia in rural emergency departments: healthcare professionals' perspectives.

PubMed

Hunter, Kathleen F; Parke, Belinda; Babb, Maureen; Forbes, Dorothy; Strain, Laurel

2017-01-01

The emergency department (ED) is a potentially harmful environment for older adults with dementia, and rural EDs face unique challenges in providing care to this population. The purpose of this study was to understand safety and harm in rural ED transitional care for community dwelling older adults with dementia from the perspective of healthcare professionals (HCPs). An interpretive, descriptive exploratory design from a social ecological perspective was used. Using purposive and snowball sampling, HCPs were recruited from two rural hospital EDs in two Canadian provinces. Data collection involved participant interviews using a semi-structured interview guide. Audio-recorded interviews were transcribed, transcripts coded, and themes identified using constant comparative analysis with thematic coding. A total of 12 HCPs, seven from one province and five from the other, participated in the study. HCPs worked directly in the ED or consulted in the ED from hospital-based social work, rehabilitation and community liaison services. Three themes were identified: physical environment (space, design and equipment), work environment (pressure to perform) and practice environment (family, knowledge and processes). A conceptual model was developed to illustrate how HCPs worked to balance safety and harm for older patients with dementia within a milieu created by the overlapping and synergistically interacting environments. HCPs in rural EDs working at the interface of hospital and community constantly attempt to balance promoting safety and avoiding harm for older adults with dementia. Participants perceived safety broadly, understanding that the consequences of the milieu were created through an interaction between physical, work and practice environments. These consequences related to the physical, cognitive and emotional wellbeing of older adults with dementia and their caregivers. Within the practice environment, participants identified a 'rural advantage' that was tied to their knowledge of community and the people with dementia and their caregivers who sought care in the participating EDs. However, familiarity can be a double-edged sword and to minimize potential harm healthcare professionals must seek input from caregivers regarding altered functional status, and policies to change triage to include gerontological knowledge and create elder-friendly rural ED environments are needed.

Factors promoting sustainable work in women with fibromyalgia.

PubMed

Palstam, Annie; Gard, Gunvor; Mannerkorpi, Kaisa

2013-09-01

To examine and describe the factors promoting sustainable work in women with fibromyalgia (FM). A qualitative interview study. Twenty-seven gainfully employed women with FM participated in five focus group interviews. Their median age was 52 years, ranging from 33 to 62. The interviews were recorded, transcribed verbatim and analysed by qualitative latent content analysis. Four categories were identified describing factors promoting sustainable work: the meaning of work and individual strategies were individual promoters while a favourable work environment and social support outside work were environmental promoters. The meaning of work included individual meaning and social meaning. The individual strategies included handling symptoms, the work day and long-term work life. A favourable work environment included the physical and psychosocial work environment. Social support outside work included societal and private social supports. Promoting factors for work were identified, involving individual and environmental factors. These working women with FM had developed advanced well-functioning strategies to enhance their work ability. The development of such strategies should be supported by health-care professionals as well as employers to promote sustainable work in women with FM. Work disability is a common consequence of fibromyalgia (FM). Working women with FM appear to have developed advanced well-functioning individual strategies to enhance their work ability. The development of individual strategies should be supported by health-care professionals as well as employers to promote sustainable work and health in women with FM.

Nursing leadership in intensive care units and its relationship to the work environment 1

PubMed Central

Balsanelli, Alexandre Pazetto; Cunha, Isabel Cristina Kowal Olm

2015-01-01

AIM: To establish whether there is any relationship between the work environment and nursing leadership at intensive care units (ICUs). METHOD: Correlational study conducted at four ICUs in southern São Paulo (SP), Brazil. The study population was comprised of 66 pairs (nurses and nursing technicians) established by lottery. The nurses responded to three instruments: 1) characterization; 2) a validated Portuguese version of the Nursing Work Index Revised (B-NWI-R); and 3) Grid & Leadership in Nursing: ideal behavior. The nursing technicians responded to 1) characterization and to 2) Grid and Leadership in Nursing: actual behavior, relative to the corresponding randomly-assigned nurse. The data were analyzed by means of analysis of variance (ANOVA) at p ≤ 0.05. RESULTS: The work environment was not associated with actual nursing leadership (p = 0.852). The public or private nature of the institutions where the investigated ICUs were located had no significant effect on leadership (p = 0.437). Only the nurse-physician relationship domain stood out (p = 0.001). CONCLUSION: The choice of leadership styles by nurses should match the ICU characteristics. Leadership skills could be developed, and the work environment did not exert any influence on the investigated population. PMID:25806638

Post-photorefractive keratectomy contact lens microbiological findings of individuals who work in a hospital environment.

PubMed

Pereira, Carlos Eduardo Gonçalves; Hida, Richard Yudi; Silva, Cely Barreto; de Andrade, Marizilda Rita; Fioravanti-Lui, Giovana Arlene; Lui-Netto, Adamo

2015-05-01

To describe the microbiological findings from bandage contact lenses in patients who work in a hospital environment submitted to photorefractive keratectomy (PRK). This prospective comparative case series enrolled 43 eyes of 22 volunteers (28.05 ± 3.50 years). Fourteen individuals (n = 27) were health care professionals who work in health care facilities or community physician's offices. Eight individuals (n = 16) were patients who do not work in hospital environment. Photorefractive keratectomy was performed using standard technique, and a silicone hydrogel bandage contact lens was placed on the cornea and evaluated for adequate fit. Seven days after surgery, the bandage lenses were removed and imprinted in the following culture media: blood agar, chocolate agar, anaerobic-selective agar, and Sabouraud agar. When microbial growth was detected, the microorganism was identified, colony-forming units were quantified, and morphology and Gram-staining properties were analyzed. All isolates were tested for susceptibility to various antibiotics. Significance was assessed by Fisher exact test. Microbial growth was detected in 16.27% of all contact lenses samples. No fungi or anaerobes were found. Microbial growth was only observed in bandage lenses removed from patients who work in hospital environments. Most microorganisms found were sensitive to all antibiotics tested. These results suggest that working in hospital environments increase contamination of the contact lenses after PRK.

What Causes SIDS?

MedlinePlus

... Environment Look Like? How Can Caregivers Create a Safe Sleep Environment? Babies Need Tummy ... exactly what causes SIDS at this time. Scientists and health care providers are working very hard to find the cause or causes ...

Staff personhood in dementia care settings: "Do they care about me?"

PubMed

Cooke, Heather A

2018-06-01

This article aims to examine RCAs' own experiences of personhood in dementia care settings. Conceptually, person-centred care entails fostering the personhood of residents and the residential care aides (RCAs) who provide much of their hands-on care. To date, however, staff personhood has been overlooked in the empirical literature. The study was part of a larger focused ethnographic project exploring how the organisational care environment impedes or facilitates the provision of quality dementia care. Semi-structured interviews with 23 RCAs and more than 230 hours of participant observation were conducted in two nursing homes with specialised dementia units in British Columbia, Canada. Two overarching themes, "personhood undermined-management-staff relations" and "personhood undermined-workplace policies and practices" emerged, illustrating how, despite exposure to features believed beneficial to their working environment (e.g., favourable staffing ratios, relatively good remuneration), RCAs encountered repeated affronts to their personhood. The first theme encompasses the importance of being known (i.e., as persons and of their job demands) and valued (i.e., appreciated for their work in non-monetary terms). The second highlights the salience of work-life balance, full-staffing coverage and supportive human resource practices. RCAs' experiences reveal how the ongoing search for cost-efficiencies, cost-containment and cost-accountability overshadows their individuality, indicating a key disconnect between conceptual ideals and workplace realities. Organisations are encouraged to consider creating person-centred management and workplace practices that provide tangible evidence that RCAs, and their work, matter. © 2018 John Wiley & Sons Ltd.

Psychosocial work environment factors and weight change: a prospective study among Danish health care workers.

PubMed

Gram Quist, Helle; Christensen, Ulla; Christensen, Karl Bang; Aust, Birgit; Borg, Vilhelm; Bjorner, Jakob B

2013-01-17

Lifestyle variables may serve as important intermediate factors between psychosocial work environment and health outcomes. Previous studies, focussing on work stress models have shown mixed and weak results in relation to weight change. This study aims to investigate psychosocial factors outside the classical work stress models as potential predictors of change in body mass index (BMI) in a population of health care workers. A cohort study, with three years follow-up, was conducted among Danish health care workers (3982 women and 152 men). Logistic regression analyses examined change in BMI (more than +/- 2 kg/m(2)) as predicted by baseline psychosocial work factors (work pace, workload, quality of leadership, influence at work, meaning of work, predictability, commitment, role clarity, and role conflicts) and five covariates (age, cohabitation, physical work demands, type of work position and seniority). Among women, high role conflicts predicted weight gain, while high role clarity predicted both weight gain and weight loss. Living alone also predicted weight gain among women, while older age decreased the odds of weight gain. High leadership quality predicted weight loss among men. Associations were generally weak, with the exception of quality of leadership, age, and cohabitation. This study of a single occupational group suggested a few new risk factors for weight change outside the traditional work stress models.

Simulation experience enhances physical therapist student confidence in managing a patient in the critical care environment.

PubMed

Ohtake, Patricia J; Lazarus, Marcilene; Schillo, Rebecca; Rosen, Michael

2013-02-01

Rehabilitation of patients in critical care environments improves functional outcomes. This finding has led to increased implementation of intensive care unit (ICU) rehabilitation programs, including early mobility, and an associated increased demand for physical therapists practicing in ICUs. Unfortunately, many physical therapists report being inadequately prepared to work in this high-risk environment. Simulation provides focused, deliberate practice in safe, controlled learning environments and may be a method to initiate academic preparation of physical therapists for ICU practice. The purpose of this study was to examine the effect of participation in simulation-based management of a patient with critical illness in an ICU setting on levels of confidence and satisfaction in physical therapist students. A one-group, pretest-posttest, quasi-experimental design was used. Physical therapist students (N=43) participated in a critical care simulation experience requiring technical (assessing bed mobility and pulmonary status), behavioral (patient and interprofessional communication), and cognitive (recognizing a patient status change and initiating appropriate responses) skill performance. Student confidence and satisfaction were surveyed before and after the simulation experience. Students' confidence in their technical, behavioral, and cognitive skill performance increased from "somewhat confident" to "confident" following the critical care simulation experience. Student satisfaction was highly positive, with strong agreement the simulation experience was valuable, reinforced course content, and was a useful educational tool. Limitations of the study were the small sample from one university and a control group was not included. Incorporating a simulated, interprofessional critical care experience into a required clinical course improved physical therapist student confidence in technical, behavioral, and cognitive performance measures and was associated with high student satisfaction. Using simulation, students were introduced to the critical care environment, which may increase interest in working in this practice area.

A Great Place to Work: Improving Conditions for Staff in Young Children's Programs.

ERIC Educational Resources Information Center

Jorde-Bloom, Paula

This book discusses important issues of the day care profession. Topics include evaluation of the work place and the improvement of the day care environment for the benefit of staff, parents, and children. Organizational climate is considered in terms of the different types of early childhood programs and their relationship to current knowledge…

A Qualitative Study of the Work Environments of Mexican Nurses

PubMed Central

Squires, Allison; Juarez, Adrian

2012-01-01

Background Studies of the nursing work environment are increasingly common in developed countries, but few exist in developing countries. Because of resource differences between the two contexts, researchers need to clarify what aspects of the work environments are similar and different. Objectives To study the perspectives of Mexican nurses about their work environments to determine similarities and differences to results from developed world studies. Design A secondary, directed content analysis of qualitative data from 46 Spanish language interviews using workplace-oriented themes Setting Purposively selected Mexican states from four regions of the country that reflect the country’s socioeconomic differences. Participants Practicing Mexican nurses with at least one year of clinical experience and currently working in nursing. Participants were recruited through convenience and snowball sampling techniques. Methods Initial data collection occurred in 2006 and 2008 during a broader study about professionalization processes that occurred in Mexican nursing between 1980 and 2005. The secondary, directed content analysis focused on an in-depth exploration of a central theme that emerged from the two original studies: The Workplace. The directed content analysis used themes from the global nursing work environment literature to structure the analysis: Professional relationships, organizational administrative practices, and quality of care and services. Results The three themes from the global literature were relevant for the Mexican context and a new one emerged related to hiring practices. By category, the same factors that created positive or negative perceptions of the work environment matched findings from other international studies conducted in developed countries. The descriptors of the category, however, had different conceptual meanings that illustrate the health system challenges in Mexico. Conclusions Findings from this study suggest that studies that seek to measure nursing work environments will most likely apply in Mexico and other Latin American or middle-income countries. Instruments designed to measure the work environment of nurses in these countries may prove relevant in those contexts, but require careful adaptation and systematic translations to ensure it. PMID:22386989

Barriers and facilitators for breastfeeding among working women in the United States.

PubMed

Johnston, Marina L; Esposito, Noreen

2007-01-01

To review the literature and describe the barriers and facilitators to the continuation of breastfeeding for at least 6 months by working women in the United States. A search of PubMed, CINAHL, Sociological Abstracts, ISI, PsychInfo, and ProQuest. Twenty studies based on the inclusion criteria and published between January 1, 1995, and January 2006. An ecologic framework, which includes the individual (microsystem), social support and relationships (mesosystem), and the workplace environment (exosystem). When working mothers possess certain personal characteristics and develop a strategic plan, breastfeeding is promoted. When social support is available and when support groups are utilized, lactation is also facilitated. Part-time work, lack of long mother-infant separations, supportive work environments and facilities, and child care options facilitate breastfeeding. Health care providers can use the findings of this review to promote breastfeeding among working women by using tactics geared toward the mother, her social network, and the entire community.

The Practice Environment Scale of the Nursing Work Index: An updated review and recommendations for use.

PubMed

Swiger, Pauline A; Patrician, Patricia A; Miltner, Rebecca S Susie; Raju, Dheeraj; Breckenridge-Sproat, Sara; Loan, Lori A

2017-09-01

The Practice Environment Scale of the Nursing Work Index (PES-NWI) is an instrument, which measures the nursing practice environment - defined as factors that enhance or attenuate a nurse's ability to practice nursing skillfully and deliver high quality care. The purpose of this paper is to provide an updated review of the Practice Environment Scale of the Nursing Work Index's use to date and provide recommendations that may be helpful to nursing leaders and researchers who plan to use this instrument. A narrative review of quantitative studies. PubMed, EMBASE, and the Cumulative Index to Nursing & Allied Health Literature were searched to identify relevant literature using the search terms, Practice Environment Scale of the Nursing Work Index and PES-NWI. Studies were included if they were published in English between 2010 and 2016 and focused on the relationship between the Practice Environment Scale of the Nursing Work Index and patient, nurse, or organizational outcomes. Data extraction focused on the reported survey scores and the significance and strength of the reported associations. Forty-six articles, from 28 countries, were included in this review. The majority reported significant findings between the nursing practice environment and outcomes. Although some modifications have been made, the instrument has remained primarily unchanged since its development. Most often, the scores regarding staffing and resource adequacy remained the lowest. The frequency of use of this instrument has remained high. Many researchers advocate for a move beyond the study of the connection between the Practice Environment Scale and nurse, patient, and organizational outcomes. Research should shift toward identifying interventions that improve the environment in which nurses practice and determining if changing the environment results in improved care quality. Published by Elsevier Ltd.

Role of environmental cleanliness and decontamination in care homes.

PubMed

Cousins, Gary

2016-01-06

While it is widely accepted that the environment has an important role in transmission of healthcare-associated infections, there has been a paucity of empirical investigation in this area to date, and the majority of published literature relates to acute settings. People living in care homes come into contact with a communally used environment and communally used equipment daily. Equipment may include hoists, hoist slings, clinical monitoring equipment, commodes and shower chairs. In care homes, primary responsibility for decontamination lies with the healthcare team, most of whom are not nurses. The challenge for nurses working in care homes is their accountability for the provision of safe and effective care.

Prescriptive or Interpretive Regulation at the Frontlines of Care Work in the “Three Worlds” of Canada, Germany and Norway

PubMed Central

Daly, Tamara; Struthers, Jim; Müller, Beatrice; Taylor, Deanne; Goldmann, Monika; Doupe, Malcolm; Jacobsen, Frode F.

2018-01-01

This paper examines the tension between macro level regulation and the rule breaking and rule following that happens at the workplace level. Using a comparative study of Canada, Norway, and Germany, the paper documents how long-term residential care work is regulated and organized differently depending on country, regional, and organizational contexts. We ask where each jurisdiction’s staffing regulations fall on a prescription-interpretation continuum; we define prescription as a regulatory tendency to identify what to do and when and how to do it, and interpretation as a tendency to delineate what to do but not when and how to do it. In examining frontline care workers’ strategies for accomplishing everyday social, health, and dining care tasks we explore how a policy-level prescriptive or interpretive regulatory approach affects the potential for promising practices to emerge on the frontlines of care work. Overall, we note the following associations: prescriptive regulatory environments tend to be accompanied by a lower ratio of professional to non-professional staff, a higher concentration of for-profit providers, a lower ratio of staff to residents and a sharper division of labour. Interpretive regulatory environments tend to have higher numbers of professionals relative to non-professionals, more limited for-profit provision, a higher ratio of staff to residents, and a more relational division of labour that enables the work to be more fluid and responsive. The implication of a prescriptive environment, such as is found in Ontario, Canada, is that frontline care workers possess less autonomy to be creative in meeting residents’ needs, a tendency towards more task-oriented care and less job autonomy. The paper reveals that what matters is the type of regulation as well as the regulatory tendency towards controlling frontline care workers decision-making and decision-latitude. PMID:29467547

A Principal Calling: Professionalism and Health Care Services

ERIC Educational Resources Information Center

Cornett, Becky Sutherland

2006-01-01

As health care professionals, our ''product'' is clinical service. We demonstrate professionalism by attitudes, knowledge, and behaviors that reflect a multi-faceted approach to the standards, regulations, and principles underlying successful clinical practices. The issues facing practitioners who work in health care environments are complex,…

Occupational Stress Management and Burnout Interventions in Nursing and Their Implications for Healthy Work Environments: A Literature Review.

PubMed

Nowrouzi, Behdin; Lightfoot, Nancy; Larivière, Michael; Carter, Lorraine; Rukholm, Ellen; Schinke, Robert; Belanger-Gardner, Diane

2015-07-01

This article reports on a literature review of workplace interventions (i.e., creating healthy work environments and improving nurses' quality of work life [QWL]) aimed at managing occupational stress and burnout for nurses. A literature search was conducted using the keywords nursing, nurses, stress, distress, stress management, burnout, and intervention. All the intervention studies included in this review reported on workplace intervention strategies, mainly individual stress management and burnout interventions. Recommendations are provided to improve nurses' QWL in health care organizations through workplace health promotion programs so that nurses can be recruited and retained in rural and northern regions of Ontario. These regions have unique human resources needs due to the shortage of nurses working in primary care. © 2015 The Author(s).

Caring for people with dementia disease (DD) and working in a private not-for-profit residential care facility for people with DD.

PubMed

Ericson-Lidman, Eva; Larsson, Lise-Lotte Franklin; Norberg, Astrid

2014-06-01

Caring for people with dementia and working in dementia care is described as having both rewarding and unpleasant aspects and has been studied to a minor extent. This study aims to explore care providers' narrated experiences of caring for people with dementia disease (DD) and working in a private not-for-profit residential care facility for people with DD. Nine care providers were interviewed about their experiences, the interviews were recorded, transcribed and analysed using thematic analysis. The analysis revealed that participants were struggling to perform person-centred care, which meant trying to see the person behind the disease, dealing with troublesome situations in the daily care, a two-edged interaction with relatives, feelings of shortcomings and troubled conscience, and the need for improvements in dementia care. The analysis also revealed an ambiguous work situation, which meant a challenging value base, the differently judged work environment, feelings of job satisfaction and the need for a functional leadership and management. The results illuminate participants' positive as well as negative experiences and have identified areas requiring improvements. It seems of great importance to strive for a supportive and attendant leadership, a leadership which aims to empower care providers in their difficult work. Using conscience as a driving force together in the work group may benefit care providers' health. © 2013 Nordic College of Caring Science.

Development and Testing of the Healthy Work Environment Inventory: A Reliable Tool for Assessing Work Environment Health and Satisfaction.

PubMed

Clark, Cynthia M; Sattler, Victoria P; Barbosa-Leiker, Celestina

2016-10-01

Fostering healthy work environments that enhance job satisfaction and reflect high levels of employee engagement and productivity is imperative for all organizations. This is especially true for health care organizations where unhealthy work conditions can lead to poor patient outcomes. A convenience sample of 520 nursing faculty and practice-based nurses in the United States participated in a study to test the psychometric properties of the Healthy Work Environment Inventory (HWEI). A factor analysis and other reliability analyses support the use of the HWEI as a valid and reliable instrument to measure perceptions of work environment health. The HWEI is a 20-item psychometrically sound instrument to measure perceptions of the health of the work environment. It may be completed either as an individual exercise or by all members of a team to compare perceptions of work environment health, to determine areas of strength and improvement, and to form the basis for interviewing. [J Nurs Educ. 2016;55(10):555-562.]. Copyright 2016, SLACK Incorporated.

Nurse Knowledge, Work Environment, and Turnover in Highly Specialized Pediatric End-of-Life Care.

PubMed

Lindley, Lisa C; Cozad, Melanie J

2017-07-01

To examine the relationship between nurse knowledge, work environment, and registered nurse (RN) turnover in perinatal hospice and palliative care organizations. Using nurse intellectual capital theory, a multivariate analysis was conducted with 2007 National Home and Hospice Care Survey data. Perinatal hospice and palliative care organizations experienced a 5% turnover rate. The professional experience of advanced practice nurses (APNs) was significantly related to turnover among RNs (β = -.032, P < .05). Compared to organizations with no APNs professional experience, clinical nurse specialists and nurse practitioners significantly reduced RN turnover by 3 percentage points. No other nurse knowledge or work environment variables were associated with RN turnover. Several of the control variables were also associated with RN turnover in the study; Organizations serving micropolitan (β = -.041, P < .05) and rural areas (β = -.037, P < .05) had lower RN turnover compared to urban areas. Organizations with a technology climate where nurses used electronic medical records had a higher turnover rate than those without (β = .036, P < .05). The findings revealed that advanced professional experience in the form of APNs was associated with reductions in RN turnover. This suggests that having a clinical nurse specialist or nurse practitioner on staff may provide knowledge and experience to other RNs, creating stability within the organization.

Conversation analysis as a method for investigating interaction in care home environments.

PubMed

Chatwin, John

2014-11-01

This article gives an outline of how the socio-linguistic approach of conversation analysis can be applied to the analysis of carer-patient interaction in care homes. A single case study from a routine encounter in a residential care home is presented. This is used to show how the conversation analysis method works, the kinds of interactional and communication features it can expose, and what specific contribution this kind of micro-interactional approach may make to improving quality of care in these environments. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Educational Planning for Establishing a Health-Promoting Workplace (HPW).

PubMed

Russell, Sally S

2015-01-01

The Academy of Medical-Surgical Nurses (AMSN) has had an ongoing series of articles related to Healthy Practice Environments. The AMSN website (www.amsn.org) also has a number of articles and documents about initiatives that AMSN has undertaken to promote healthy practice environments in health care settings. This articles will focus on the educational work necessary for nurses who desire to increase the healthiness of their workplace. The work is not easy, but the end result could be one that leaves a lasting legacy for those who work in that environment.

Assessing and developing critical-thinking skills in the intensive care unit.

PubMed

Swinny, Betsy

2010-01-01

A lot of resources are spent on the development of new staff in the intensive care unit (ICU). These resources are necessary because the environment in the ICU is complex and the patients are critically ill. Nurses need an advanced knowledge base, the ability to accurately define and change priorities rapidly, good communication and teamwork skills, and the ability to work in a stressful environment in order to succeed and give their patients quality care. Critical thinking helps the nurse to navigate the complex and stressful environment of the ICU. Critical thinking includes more than just nursing knowledge. It includes the ability to think through complex, multifaceted problems to anticipate needs, recognize potential and actual complications, and to expertly communicate with the team. A nurse who is able to think critically will give better patient care. Various strategies can be used to develop critical thinking in ICU nurses. Nurse leaders are encouraged to support the development of critical-thinking skills in less experienced staff with the goal of improving the nurse's ability to work in the ICU and improving patient outcomes.

Job satisfaction and work related variables in Chinese cardiac critical care nurses.

PubMed

Liu, Yun-E; While, Alison; Li, Shu-Jun; Ye, Wen-Qin

2015-05-01

To explore critical care nurses' views of their job satisfaction and the relationship with job burnout, practice environment, coping style, social support, intention to stay in current employment and other work-related variables. Nurse shortage is a global issue, especially in critical care. Job satisfaction is the most frequently cited factor linked to nurses' turnover. A convenience sample of cardiac critical care nurses (n = 215; 97.7% response rate) from 12 large general hospitals in Shanghai was surveyed from December 2010 to March 2011. Over half of the sample reported satisfaction with their jobs. Nurses with 10-20 years of professional experience and those who had taken all their holiday entitlement reported higher levels of job satisfaction. The independent variables of practice environment, intention to stay, emotional exhaustion, personal accomplishment and positive coping style explained about 55% of the variance in job satisfaction. Chinese cardiac critical care nurses' job satisfaction was related to work related variables, which are amenable to managerial action. Our findings highlight the imperative of improving intrinsic and extrinsic rewards, together with the flexibility of work schedules to promote job satisfaction and staff retention. A clinical ladder system is needed to provide promotion opportunities for Chinese nurses. © 2013 John Wiley & Sons Ltd.

Residents' and attendings' perceptions of a night float system in an internal medicine program in Canada.

PubMed

Saxena, Anurag; Desanghere, Loni; Skomro, Robert P; Wilson, Thomas W

2015-01-01

The Night Float system (NFS) is often used in residency training programs to meet work hour regulations. The purpose of this study was to examine resident and attendings' perceptions of the NFS on issues of resident learning, well-being, work, non-educational activities and the health care system (patient safety and quality of care, inter-professional teams, workload on attendings and costs of on-call coverage). A survey questionnaire with closed and open-ended questions (26 residents and eight attendings in an Internal Medicine program), informal discussions with the program and moonlighting and financial data were collected. The main findings included, (i) an overall congruency in opinions between resident and attendings across all mean comparisons, (ii) perceptions of improvement for most aspects of resident well-being (e.g. stress, fatigue) and work environment (e.g. supervision, support), (iii) a neutral effect on the resident learning environment, except resident opinions on an increase in opportunities for learning, (iv) perceptions of improved patient safety and quality of care despite worsened continuity of care, and (v) no increases in work-load on attendings or the health care system (cost-neutral call coverage). Patient safety, handovers and increased utilization of moonlighting opportunities need further exploration.

Measuring health care workers' perceptions of what constitutes a compassionate organisation culture and working environment: Findings from a quantitative feasibility survey.

PubMed

McSherry, Robert; Pearce, Paddy

2018-03-01

Health care organisation cultures and working environments are highly complex, dynamic and constantly evolving settings. They significantly influence both the delivery and outcomes of care. Phase 1 quantitative findings are presented from a larger three phase feasibility study designed to develop and test a Cultural Health Check toolkit to support health care workers, patients and organisations in the provision of safe, compassionate and dignified care. A mixed methods approach was applied. The Cultural Health Check Healthcare Workers Questionnaire was distributed across two National Health Service Hospitals in England, UK. Both hospitals allocated two wards comprising of older people and surgical specialities. The newly devised Cultural Health Check Staff Rating Scale Version 1 questionnaire was distributed to 223 health care workers. Ninety eight responses were returned giving a response rate of 44%. The Cultural Health Check Staff Rating Scale Version 1 has a significant Cronbach alpha of .775; this reliability scaling is reflected in all 16 items in the scale. Exploratory factor analysis identified two significant factors "Professional Practice and Support" and "Workforce and Service Delivery." These factors according to health care workers significantly impact on the organisation culture and quality of care delivered by staff. The Cultural Health Check Staff Rating Scale Version 1 questionnaire is a newly validated measurement tool that could be used and applied to gauge health care workers perceptions of an organisations level of compassion. Historically we have focused on identifying how caring and compassionate nurses, doctors and related allied health professionals are. This turns the attention on employers of nurses and other related organisations. The questionnaire can be used to gauge the level of compassion with a health care organisation culture and working environment. Nurse managers and leaders should focus attention regarding how these two factors are supported and resourced in the future. © 2017 John Wiley & Sons Ltd.

Applying Lean Six Sigma for innovative change to the post-anesthesia care unit.

PubMed

Haenke, Roger; Stichler, Jaynelle F

2015-04-01

Many healthcare organizations are building or renovating patient care facilities. Using Lean Six Sigma methods, nurse leaders can eliminate unnecessary waste and improve work and patient care environments. Starting with a key department like the post-anesthesia care unit is a good way to expose staff and leaders to the potential of Lean.

Proceedings of the Annual National Conference for Child Care Workers (2nd, Valley Forge, PA, October 9-12, 1980).

ERIC Educational Resources Information Center

Powell, Norman W., Jr., Ed.

The speeches, papers, and workshops descriptions presented at the second annual National Conference for Child Care Workers are presented. Several issues relating to child care supervision, child care work, and child development are considered along with the management of group living environments and various aspects of supervision. Job…

A Cooperative Communication System for the Advancement of Safe, Effective, and Efficient Patient Care

DTIC Science & Technology

2017-02-01

for the ever-changing environment of work that must be successfully navigated. The Cooperative Communication System (CCS) is a Health Information...presented a comprehensive picture of the BICU cognitive work , including synchronization on the BICU, the barriers to safe and effective care that...room spared the need to orient participants to an unfamiliar work setting and made it possible to include environmental factors and cues that a

Environmental and occupational exposures in immigrant health.

PubMed

Eamranond, Pracha P; Hu, Howard

2008-09-23

Immigrants comprise vulnerable populations that are frequently exposed to a multitude of environmental and occupational hazards. The historical context behind state and federal legislation has helped to foster an environment that is particularly hostile toward caring for immigrant health. Current hazards include toxic exposures, air and noise pollution, motor vehicle accidents, crowded living and work environments with inadequate ventilation, poor sanitation, mechanical injury, among many others. Immigrants lack the appropriate training, materials, health care access, and other resources to reduce their exposure to preventable environmental and occupational health risks. This dilemma is exacerbated by current anti-immigrant sentiments, miscommunication between native and immigrant populations, and legislation denying immigrants access to publicly funded medical care. Given that current health policy has failed to address immigrant health appropriately and political impetus is lacking, efforts should also focus on alternative solutions, including organized labor. Labor unions that serve to educate workers, survey work environments, and defend worker rights will greatly alleviate and prevent the burden of disease incurred by immigrants. The nation's health will benefit from improved regulation of living and workplace environments to improve the health of immigrants, regardless of legal status.

The top eight issues Queensland Australia's aged-care nurses and assistants-in-nursing worried about outside their workplace: a qualitative snapshot.

PubMed

Tuckett, Anthony; Hegney, Desley; Parker, Deborah; Eley, Robert M; Dickie, Robyn

2011-10-01

The attainment of a work-life balance is an important issue for recruitment, retention and workforce planning. This paper aims to report on the free text data provided by the aged-care sector nurses around perceptions of important work-life issues. Data were written responses of aged-care nurses to the open-ended request at the end of a survey, which asked them to list up to five political/social/environmental issues concerning them outside of their work. For aged-care nurses, when asked to list political/social/environmental issues they were concerned about outside of work in late 2007, there emerged considered issues around work and life. Among the top eight themes there is an intriguing balance between the themes work, industrial relations, aged care/elder care and health-care services compared with the themes environment, water, societal values and housing. Qualitative insights into the political/social/environmental issues aged-care nurses are concerned about outside of your work suggest their desire for a labour/life or work/life harmony. Aged-care nurses place an equal importance on the nature of labour and the basics of life. The findings provide information for aged-care sector managers and workforce planners on areas in need of consideration to recruit and retain a workforce within aged care. © 2011 Blackwell Publishing Asia Pty Ltd.

Understanding Nursing Home Worker Conceptualizations about Good Care

ERIC Educational Resources Information Center

Chung, Gawon

2013-01-01

This study explored how direct care workers in nursing homes conceptualize good care and how their conceptualizations are influenced by external factors surrounding their work environment and the relational dynamics between them and residents. Study participants were drawn from a local service employees' union, and in-depth interviews were…

Workplace relationships impact self-rated health: A survey of Swedish municipal health care employees.

PubMed

Persson, Sophie Schön; Lindström, Petra Nilsson; Pettersson, Pär; Andersson, Ingemar

2018-05-22

The impact of positive social relationships on the health of municipal employees in the elder care sector in Sweden needs further examination. To explore the association between health and relationships among elderly care employees using a salutogenic perspective. Survey of all employees (n = 997) in special housing, home care and Disabled Support and Services in a Swedish municipality. The questionnaire, which had a salutogenic perspective, included information on self-rated health from the previously validated SHIS (Salutogenic Health Indicator Scale), psychosocial work environment and experiences, social climate, and health-promoting workplace relationships. The response rate was 69% . Results of a multivariable linear regression model showed four significant predictors of health: general work experiences, colleague belongingness and positive relationships with managers and care recipients. In another model, colleague belongingness was significantly related to satisfaction with care recipients, work, length of employment as well as general work experiences and relationships with managers. Strengthening of positive work relationships, not only between workmates but also with managers and care recipients, seems to be an essential area for employee health promotion. Colleague belongingness may be deepened by development of a positive work climate, including satisfactory work experiences, positive manager relationships and a stable work force.

Nurses' perceptions of their professional practice environment: a cross-sectional study.

PubMed

Cao, Yingjuan; DiGiacomo, Michelle; Salamonson, Yenna; Li, Ye; Huai, Baosha; Davidson, Patricia M

2015-12-01

To describe nurses' perceptions concerning their professional practice environment in mainland China and identify factors associated with these views. Globally, the environments in which nurses work influence the quality of nursing practice and health care. A cross-sectional descriptive survey using both paper- and online-based delivery modes was used. A convenience sampling method was used. The survey questionnaire was composed of sociodemographic items and the 38-item Chinese version of Professional Practice Environment survey. The content of the paper-based questionnaire was identical to the online survey. Pearson's chi-square test was conducted to compare the demographic characteristics of these two data sets. Descriptive statistics analysis included frequency, percentage, mean and standard deviation. Multiple linear regression analysis using the Backwards method was applied to identify independent predictors of each subscale of the 38-item Chinese version of Professional Practice Environment. A total of 573 questionnaires were analysed. The mean score of each subscale of the 38-item Chinese version of Professional Practice Environment in this study ranged from 2·66-3·05. All subscales except work motivation (3·05, standard deviation: 0·44) scored less than 3·0. Areas rated as most in need of improvement included control over practice, interpersonal interaction, supportive leadership and handling conflict, and staff relationships with physicians and autonomy. This study has identified nurses' perspectives regarding their workplaces in contemporary China. These data have provided an important baseline for developing and implementing culturally appropriate strategies to improve the working environment of Chinese nurses. A supportive and enabling work environment promotes professional development and the safety and quality of health care. Addressing these factors is important in optimising work place environments. © 2015 John Wiley & Sons Ltd.

Improving care by understanding the way we work: human factors and behavioural science in the context of intensive care

PubMed Central

Sevdalis, Nick; Brett, Stephen J

2009-01-01

Effectiveness and efficiency of care of the critically ill patient are subject to a number of systemic influences, including skills of individual physicians/nurses (technical and non-technical), team-working in the intensive care unit (ICU), and the ICU environment. We first discuss the paper of Fackler and colleagues as a contribution to the systems approach to clinical performance in the context of intensive care. We then highlight features of care delivery that are unique to intensive care and discuss the need for better understanding of human and non-human elements of the system of care of the critically ill patient as a driver for improvement of care delivery. PMID:19439048

'If we can't do more, let's do it differently!': using appreciative inquiry to promote innovative ideas for better health care work environments.

PubMed

Richer, Marie-Claire; Ritchie, Judith; Marchionni, Caroline

2009-12-01

To examine the use of appreciative inquiry to promote the emergence of innovative ideas regarding the reorganization of health care services. With persistent employee dissatisfaction with work environments, experts are calling for radical changes in health care organizations. Appreciative inquiry is a transformational change process based on the premise that nurses and health care workers are accumulators and producers of knowledge who are agents of change. A multiple embedded case study was conducted in two interdisciplinary groups in outpatient cancer care to better understand the emergence and implementation of innovative ideas. The appreciative inquiry process and the diversity of the group promoted the emergence and adoption of innovative ideas. Nurses mostly proposed new ideas about work reorganization. Both groups adopted ideas related to interdisciplinary networks and collaboration. A forum was created to examine health care quality and efficiency issues in the delivery of cancer care. This study makes a contribution to the literature that examines micro systems change processes and how ideas evolve in an interdisciplinary context. The appreciative inquiry process created an opportunity for team members to meet and share their successes while proposing innovative ideas about care delivery. Managers need to support the implementation of the proposed ideas to sustain the momentum engendered by the appreciative inquiry process.

Extrinsic High-Effort and Low-Reward Conditions at Work among Institutional Staff Caring for People with Intellectual Disabilities in Taiwan

ERIC Educational Resources Information Center

Lee, Tzong-Nan; Lin, Jin-Ding; Yen, Chia-Feng; Loh, Ching-Hui; Hsu, Shang-Wei; Tang, Chi-Chieh; Wu, Jia-Ling; Fang, Wen-Hui; Chu, Cordia M.

2009-01-01

The purposes of the present study were to determine whether extrinsic high-effort/low-reward conditions at work are associated with personal characteristics and the organizational environments. A cross-sectional survey was conducted (76.7% response rate, N = 1243) by recruiting the staff caring for people with intellectual disabilities of Taiwan…

Enhancing Competence in Health Social Work Education through Simulation-Based Learning: Strategies from a Case Study of a Family Session

ERIC Educational Resources Information Center

Craig, Shelley L.; McInroy, Lauren B.; Bogo, Marion; Thompson, Michelle

2017-01-01

Simulation-based learning (SBL) is a powerful tool for social work education, preparing students to practice in integrated health care settings. In an educational environment addressing patient health using an integrated care model, there is growing emphasis on students developing clinical competencies prior to entering clinical placements or…

Quality geriatric care as perceived by nurses in long-term and acute care settings.

PubMed

Barba, Beth Ellen; Hu, Jie; Efird, Jimmy

2012-03-01

This study focused on differences in nurses' satisfaction with the quality of care of older people and with organisational characteristics and work environment in acute care and long-term care settings. Numerous studies have explored links between nurses' satisfaction with care and work environments on the one hand and a variety of physical, behavioural and psychological reactions of nurses on the other. One key to keeping nurses in the workplace is a better understanding of nurses' satisfaction with the quality of care they provide. Descriptive design. The self-selected sample included 298 registered nurses and licensed practical nurses who provide care to minority, underserved and disadvantaged older populations in 89 long-term care and <100 bed hospitals in 38 rural counties and eight metropolitan areas in a Southern state. All completed the Agency Geriatric Nursing Care survey, which consisted of a 13-item scale measuring nurses' satisfaction with the quality of geriatric care in their practice settings and an 11-item scale examining obstacles to providing quality geriatric care. Demographic variables were compared with chi-square. Independent t-tests were used to examine differences between nurses in long-term care and acute care settings. Significant differences were found in level of satisfaction and perceived obstacles to providing quality care to older adults between participants from acute and long-term care. Participants in long-term care had greater satisfaction with the quality of geriatric care than those in acute facilities. Nurses in long-term care were more satisfied that care was evidence-based; specialised to individual needs of older adults; promoted autonomy and independence of elders; and was continuous across settings. Participants in acute facilities perceived more obstacles to providing quality geriatric care than nurses in long-term care facilities. Modification of hospital geriatric practice environments and leadership commitment to evidence-based practice guidelines that promote autonomy and independence of patients and staff could improve acute care nurses' perceptions of quality of geriatric care. © 2011 Blackwell Publishing Ltd.

Oncology nursing: Finding the balance in a changing health care system.

PubMed

Bakker, Debra; Fitch, Margaret I; Green, Esther; Butler, Lorna; Olson, Karin

2006-01-01

Health care restructuring has resulted in significant changes in the workload and work environment for oncology nurses. While recent studies describe the impact of these changes on the general nursing workforce in several countries, there have been no published studies that have focused on worklife issues of Canadian oncology nurses. Therefore, a qualitative study was conducted to gain insight about how oncology nursing has changed over the past decade and how Canadian oncology nurses are managing these changes. Analysis of telephone interviews with 51 practising oncology nurses employed across Canada revealed three major themes. The first theme, "health care milieu", portrayed a picture of the cancer care environment and patient and professional changes that occurred over the past decade. The second theme, "conflicting demands", reflects how the elements of change and social forces have challenged professional oncology nursing practice. The third theme, "finding the way", describes the patterns of behaviour that nurses used to manage the changing health care environment and make meaning out of nurses' work in cancer care. Overall, the findings portray a picture of Canadian oncology nurses in "survival mode". They face many workplace challenges, but are able to keep going "for now" because they find ways to balance their responsibilities on a daily basis and because they know and believe that their specialized nursing knowledge and skills make a difference in patient care.

A Phenomenological Study of Nurse Manager Interventions Related to Workplace Bullying.

PubMed

Skarbek, Anita J; Johnson, Sandra; Dawson, Christina M

2015-10-01

The aim of this study was to acquire nurse managers' perspectives as to the scope of workplace bullying, which interventions were deemed as effective and ineffective, and what environmental characteristics cultivated a healthy, caring work environment. Research has linked workplace bullying among RNs to medical errors, unsafe hospital environments, and negative patient outcomes. Limited research had been conducted with nurse managers to discern their perspectives. Six nurse managers from hospital settings participated in in-depth, semistructured interviews. Ray's theory of bureaucratic caring guided the study. These themes emerged: (a) awareness, (b) scope of the problem, (c) quality of performance, and (d) healthy, caring environment. Findings indicated mandated antibullying programs were not as effective as individual manager interventions. Systems must be in place to hold individuals accountable for their behavior. Communication, collective support, and teamwork are essential to create environments that lead to the delivery of safe, optimum patient care.

Observing how RNs use clinical time in a nursing home: a pilot study.

PubMed

Dellefield, Mary Ellen; Harrington, Charlene; Kelly, Ann

2012-01-01

Registered nurses (RNs) working in nursing homes (NHs) are a scarce professional resource. Their responsibilities include direct (e.g., assessment, physical care, and medication administration) and indirect care (e.g., documentation, supervision, and other activities performed away from the resident to manage their care environment). The purpose of the study was to describe the direct and indirect care distribution of RNs working day shift in an NH. All RN care was observed, although RN care associated with pressure ulcer prevention as a clinical outcome was highlighted. Work sampling was conducted using a personal data assistant-based RN Observation Measure. RNs spent 59% of their time on indirect care. Little direct care could be linked with specific clinical categories relevant to pressure ulcer prevention. RNs are challenged to use RN clinical time more strategically. Copyright © 2012 Mosby, Inc. All rights reserved.

Factors influencing registered nurses perception of their overall job satisfaction: a qualitative study.

PubMed

Atefi, N; Abdullah, K L; Wong, L P; Mazlom, R

2014-09-01

The purpose of this qualitative descriptive study was to explore factors related to critical care and medical-surgical nurses' job satisfaction as well as dissatisfaction in Iran. Job satisfaction is an important factor in healthcare settings. Strong empirical evidence supports a causal relationship between job satisfaction, patient safety and quality of care. A convenient sample of 85 nurses from surgical, medical and critical care wards of a large hospital was recruited. Ten focus group discussions using a semi-structured interview guide were conducted. Interviews were audio-recorded, transcribed verbatim and analysed using a thematic approach. The study identified three main themes that influenced nurses' job satisfaction and dissatisfaction: (1) spiritual feeling, (2) work environment factors, and (3) motivation. Helping and involvement in patient care contributed to the spiritual feeling reported to influence nurses' job satisfaction. For work environment factors, team cohesion, benefit and rewards, working conditions, lack of medical resources, unclear nurses' responsibilities, patient and doctor perceptions, poor leadership skills and discrimination at work played an important role in nurses' job dissatisfaction. For motivation factors, task requirement, professional development and lack of clinical autonomy contributed to nurses' job satisfaction. Nurse managers should ensure a flexible practice environment with adequate staffing and resources with opportunities for nurses to participate in hospital's policies and governance. Policy makers should consider nurses' professional development needs, and implement initiatives to improve nurses' rewards and other benefits as they influence job satisfaction. © 2014 International Council of Nurses.

Interprofessional learning at work: what spatial theory can tell us about workplace learning in an acute care ward.

PubMed

Gregory, Linda Rosemary; Hopwood, Nick; Boud, David

2014-05-01

It is widely recognized that every workplace potentially provides a rich source of learning. Studies focusing on health care contexts have shown that social interaction within and between professions is crucial in enabling professionals to learn through work, address problems and cope with challenges of clinical practice. While hospital environments are beginning to be understood in spatial terms, the links between space and interprofessional learning at work have not been explored. This paper draws on Lefebvre's tri-partite theoretical framework of perceived, conceived and lived space to enrich understandings of interprofessional learning on an acute care ward in an Australian teaching hospital. Qualitative analysis was undertaken using data from observations of Registered Nurses at work and semi-structured interviews linked to observed events. The paper focuses on a ward round, the medical workroom and the Registrar's room, comparing and contrasting the intended (conceived), practiced (perceived) and pedagogically experienced (lived) spatial dimensions. The paper concludes that spatial theory has much to offer understandings of interprofessional learning in work, and the features of work environments and daily practices that produce spaces that enable or constrain learning.

Use of video-feedback, reflection, and interactive analysis to improve nurse leadership practices.

PubMed

Crenshaw, Jeannette T

2012-01-01

The chronic shortage of registered nurses (RNs) affects patient safety and health care quality. Many factors affect the RN shortage in the workforce, including negative work environments, exacerbated by ineffective leadership approaches. Improvements in the use of relationship-based leadership approaches lead to healthier work environments that foster RN satisfaction and reduce RN turnover and vacancy rates in acute care settings. In this article, an innovative approach to reduce nurse turnover and decrease vacancy rates in acute care settings is described. Video feedback with reflection and interactive analysis is an untapped resource for nurse leaders and aspiring nurse leaders in their development of effective leadership skills. This unique method may be an effective leadership strategy for addressing recruitment and retention issues in a diverse workforce.

New nurses' perceptions of professional practice behaviours, quality of care, job satisfaction and career retention.

PubMed

Spence Laschinger, Heather K; Zhu, Junhong; Read, Emily

2016-07-01

To test a model examining the effects of structural empowerment and support for professional practice on new graduate nurses' perceived professional practice behaviours, perceptions of care quality and subsequent job satisfaction and career turnover intentions. The nursing worklife model describes relationships between supportive nursing work environments and nurse and patient outcomes. The influence of support for professional practice on new nurses' perceptions of professional nursing behaviours within this model has not been tested. Structural equation modelling in Mplus was used to analyse data from a national survey of new nurses across Canada (n = 393). The hypothesised model was supported: χ²(122) = 346.726, P = 0.000; CFI = 0.917; TLI = 0.896; RMSEA = 0.069. Professional practice behaviour was an important mechanism through which empowerment and supportive professional practice environments influenced nurse-assessed quality of care, which was related to job satisfaction and lower intentions to leave nursing. Job satisfaction and career retention of new nurses are related to perceptions of work environment factors that support their professional practice behaviours and high-quality patient care. Nurse managers can support new graduate nurses' professional practice behaviour by providing empowering supportive professional practice environments. © 2016 John Wiley & Sons Ltd.

Building a healthy work environment: a nursing resource team perspective.

PubMed

Vaughan, Leslie; Slinger, Trisha

2013-01-01

Leadership and staff from the London Health Sciences Centre (LHSC) Nursing Resource Team (NRT), including members of their Continuous Quality Improvement (CQI) Council, attended the first Southern Ontario Nursing Resource Team Conference (SONRTC), held March 2012 in Toronto. The SONRTC highlighted healthy work environments (HWEs), noting vast differences among the province's various organizations. Conversely, CQI Council members anecdotally acknowledged similar inconsistencies in HWEs across the various inpatient departments at LHSC. In fact, the mobility of the NRT role allows these nurses to make an unbiased observation about the culture, behaviours and practices of specific units as well as cross-reference departments regarding HWEs. Studies have documented that HWEs have a direct impact on the quality of patient care. Furthermore, the literature supports a relationship between HWEs and nurse job satisfaction. Based on this heightened awareness, the NRT CQI Council aimed to investigate HWEs at LHSC. The American Association of Critical Care Nurses (AACN) Standards for Establishing and Sustaining Healthy Work Environments was adapted in developing a survey for measuring HWEs based on the perceptions of NRT staff. Each of the departments was evaluated in terms of the following indicators: skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition and authentic leadership (AACN 2005). Ultimately, the Building a Healthy Work Environment: A Nursing Resource Team Perspective survey was employed with NRT nurses at LHSC, and data was collected for use by leadership and staff for creating HWE strategies aimed at improving the quality of patient care.

Working time use and division of labour among nurses and health-care workers in hospitals - a systematic review.

PubMed

Lavander, Päivi; Meriläinen, Merja; Turkki, Leena

2016-11-01

This systematic review aimed to synthesise the existing evidence of working time use and the division of labour among nurses and health-care workers in hospital wards. The environment of nursing work is changing. Health systems are becoming more complex and costly, and highly skilled health-care professionals are transferring to new, more demanding tasks. Changes require a division of labour that is based on the efficient use of working time. Sixteen studies were identified for the final analysis through a systematic search. The use of working time was examined mainly through six categories: direct care, indirect care, documentation, unit-related work, personal time and non-nursing duties. The division of labour was examined from the perspective of different occupational groups. Despite nurses' different educational backgrounds, certain similarities could be observed. All working groups seem to spend less than half of their working time in direct patient care. Nurse managers could influence the increasing nursing workload by supporting the right division of labour and focusing the nurses' working time use so that it benefits the patient. © 2016 John Wiley & Sons Ltd.

'I love nursing, but..'- qualitative findings from Australian aged-care nurses about their intrinsic, extrinsic and social work values.

PubMed

Tuckett, Anthony; Parker, Deborah; Eley, Robert M; Hegney, Desley

2009-12-01

Aim.  The aim of this qualitative analysis - a component of a larger survey study, was to provide insights and understandings about intrinsic and extrinsic work values for nurses in aged-care. Background.  Intrinsic and extrinsic work values impact on nurses' job satisfaction and ultimately nursing retention. This study contributes further to knowledge development in this area by building on a previous work values study in aged-care nursing. Methods.  This paper presents the qualitative research findings from the final open-ended question from a survey of nurses employed in the aged-care sector in the State of Queensland, Australia in 2007. Data from a cohort of 105 aged care sector nurses was analysed relying on deductive content analysis. Findings.  Two intrinsic work values emerged - low morale and images of nursing and two extrinsic work values emerged - remuneration and working conditions. The work value 'working conditions' comprised four aspects of aged-care work, specifically staff turnover, workplace violence, care team membership specifically the Assistants-in-Nursing and paperwork. A single social workplace value 'support by management' is discussed as identified as important to these nurses. Conclusion.  Qualitative insights into aged-care nurses' intrinsic and extrinsic work values suggest that work satisfaction is low. Workforce policy makers and employers of nurses in aged-care need to comprehend the relationship between job satisfaction, retention and work values. Relevance to clinical practice.  These findings have implications for recruitment, retention and workforce planning within the aged-care environment. © 2009 Blackwell Publishing Ltd.

$1.2 Billion Investment Needed in 2017 to Implement CCDBG Reauthorization

ERIC Educational Resources Information Center

Center for Law and Social Policy, Inc. (CLASP), 2016

2016-01-01

The Child Care and Development Block Grant (CCDBG) is the primary source of federal funding for child care subsidies for low-income families and to improve child care quality for all children. Quality child care enables parents to work or go to school while providing children with safe and enriching environments where they can learn and thrive.…

Everyday practices at the medical ward: a 16-month ethnographic field study

PubMed Central

2012-01-01

Background Modern hospital care should ostensibly be multi-professional and person-centred, yet it still seems to be driven primarily by a hegemonic, positivistic, biomedical agenda. This study aimed to describe the everyday practices of professionals and patients in a coronary care unit, and analyse how the routines, structures and physical design of the care environment influenced their actions and relationships. Methods Ethnographic fieldwork was conducted over a 16-month period (between 2009 and 2011) by two researchers working in parallel in a Swedish coronary care unit. Observations, informal talks and formal interviews took place with registered nurses, assistant nurses, physicians and patients in the coronary care unit. The formal interviews were conducted with six registered nurses (five female, one male) including the chief nurse manager, three assistant nurses (all female), two cardiologists and three patients (one female, two male). Results We identified the structures that either promoted or counteracted the various actions and relationships of patients and healthcare professionals. The care environment, with its minimalistic design, strong focus on routines and modest capacity for dialogue, restricted the choices available to both patients and healthcare professionals. This resulted in feelings of guilt, predominantly on the part of the registered nurses. Conclusions The care environment restricted the choices available to both patients and healthcare professionals. This may result in increased moral stress among those in multi-professional teams who work in the grey area between biomedical and person-centred care. PMID:22748059

Low back pain among personal care workers in an old age home: work-related and individual factors.

PubMed

Yeung, Simon S; Yuan, Jun

2011-08-01

This cross-sectional study explored the work-related and individual factors that contributed to the occurrence of low back pain and affected activities of 36 personal care workers at an old age home in Hong Kong. The study was divided into four parts: (1) a questionnaire documenting workload exposure factors; (2) a musculoskeletal symptoms survey documenting the prevalence of low back pain in this group of workers; (3) a worksite evaluation focusing on personal care workers' work postures and the work environment; and (4) an evaluation of physical fitness and lifting capacities of personal care workers. Univariate followed by multiple logistic regression analyses were used to identify the risk factors associated with low back pain that affected work activities. The results revealed that low back pain was associated with the perceived physical demands of cleaning tasks (odds ratio [OR] = 7.28, 95% confidence interval [CI] = 1.35-39.35, p < .05), perceived demands of awkward sustained back (OR = 4.46, CI = 0.86-22.97, p = .074) and neck (OR = 0.18, CI = 0.04-0.81, p < .05) postures, and thermal stress at work (OR = 49.80, CI = 0.70-3541.79, p = .072). The results of the current study indicated that the work environment contributed to low back pain at work. Workers perceived that exertion in workplaces has a role in assessing workplace risk. To avoid progression of low back pain in the workplace, work adjustment or modification should be considered when workers report high levels of perceived exertion at work. Copyright 2011, SLACK Incorporated.

Hospital Nurses' Work Environment Characteristics and Patient Safety Outcomes: A Literature Review.

PubMed

Lee, Seung Eun; Scott, Linda D

2018-01-01

This integrative literature review assesses the relationship between hospital nurses' work environment characteristics and patient safety outcomes and recommends directions for future research based on examination of the literature. Using an electronic search of five databases, 18 studies published in English between 1999 and 2016 were identified for review. All but one study used a cross-sectional design, and only four used a conceptual/theoretical framework to guide the research. No definition of work environment was provided in most studies. Differing variables and instruments were used to measure patient outcomes, and findings regarding the effects of work environment on patient outcomes were inconsistent. To clarify the relationship between nurses' work environment characteristics and patient safety outcomes, researchers should consider using a longitudinal study design, using a theoretical foundation, and providing clear operational definitions of concepts. Moreover, given the inconsistent findings of previous studies, they should choose their measurement methodologies with care.

Rural long-term care work, gender, and restructuring.

PubMed

Leach, Belinda; Joseph, Gillian

2011-06-01

Restructuring--the introduction of changes that alter the way health care is delivered for maximum efficiency and least cost--layered with rurality and with rural gender ideologies and practices, results in rural long-term care settings that have particular consequences for the women working in them, and for the residents and communities that they serve. This research investigated how rurality affects the implementation of patient classification in Ontario long-term care homes. Methods involved interviews and focus groups with front-line long-term care workers, administrators, and key participants. The findings revealed that rural long-term care delivery takes place when a restructured work environment intersects with gender ideologies and practices that take on particular characteristics when developed and sustained in a rural context. These factors shape the labor market and working conditions for rural women. We argue that this produces a uniquely rural experience for long-term care workers and conclude that those implementing classification systems must consider contextual factors as well as practical and financial exigencies.

The validation and application of the Chinese version of perceived nursing work environment scale.

PubMed

Zhao, Peng; Chen, Fen Ju; Jia, Xiao Hui; Lv, Hui; Cheng, Piao Piao; Zhang, Li Ping

2013-07-01

To improve the development of the Chinese version of Perceived Nursing Work Environment (C-PNWE) scale by examination and application and to explore the nurses' perception of their working environment in a hospital. The C-PNWE scale was translated and revised from the PNWE scale. The least of perfection is that the development of C-PNWE ignored that the psychometric properties of the PNWE instrument were established of critical care nurses and further application and testing of the PNWE in various patient care settings were recommended. This is a cross-sectional design. Nurses from different departments of a hospital were sampled by convenience sampling and investigated by self-administrated questionnaire. Data obtained through questionnaires were analysed by descriptive statistical analyses and profile analyses using the Statistical Package for the Social Sciences (SPSS) Chinese version 17.0 software. The coincident and level profile analyses indicated that these groups can merge into one group, and the profile of measurement result of this merged group would not exhibit flatness. Among six dimensions of C-PNWE scale, the Staffing and Resource Adequacy got the lowest average score. Among 41 items, 'Opportunity for staff nurse to participate in policy decisions' got the lowest mean. The C-PNWE scale shows good psychometric properties and can be used to explore nurses' perspectives of the nursing practice environment in China. And the situation of nurses' perceived working environment in China needs further study. Shaping nursing practice environments to promote desired outcomes requires valid and reliable measures to assess practice environments prior to, during and following efforts to implement change. The C-PNWE scale can be a useful measurement tool for administrators to improve the nursing work environment in China. © 2013 John Wiley & Sons Ltd.

Nursing Unit Environment Associated with Provision of Language Services in Pediatric Hospices.

PubMed

Lindley, Lisa C; Held, Mary L; Henley, Kristen M; Miller, Kathryn A; Pedziwol, Katherine E; Rumley, Laurie E

2017-04-01

Provision of language services in pediatric hospice enables nurses to communicate effectively with patients who have limited English proficiency. Language barriers contribute to ethnic disparities in health care. While language service use corresponds with improved patient comprehension of illness and care options, we lack an understanding of how the nurse work environment affects the provision of these services. Data were obtained from the 2007 National Home and Hospice Care Survey and included a study sample of 1251 pediatric hospice agencies. Variable selection was guided by structural contingency theory, which posits that organizational effectiveness is dependent upon how well an organization's structure relates to its context. Using multivariate logistic regression, we analyzed the extent to which nursing unit environment predicted provision of translation services and interpreter services. The majority of hospices provided translation services (74.9 %) and interpreter services (87.1 %). Four variables predicted translation services: registered nurse (RN) unit size, RN leadership, RN medical expertise, and for-profit status. RN medical expertise and having a safety climate within the hospice corresponded with provision of interpreter services. Findings indicate that nursing unit environment predicts provision of language services. Hospices with more specialized RNs and a stronger safety climate might include staffs who are dedicated to best care provision, including language services. This study provides valuable data on the nurse work environment as a predictor of language services provision, which can better serve patients with limited English proficiency and ultimately reduce ethnic disparities in end-of-life care for children and their families.

Nursing unit environment associated with provision of language services in pediatric hospices

PubMed Central

Lindley, Lisa C.; Held, Mary L.; Henley, Kristen M.; Miller, Kathryn A.; Pedziwol, Katherine E.; Rumley, Laurie E.

2016-01-01

Background Provision of language services in pediatric hospice enables nurses to communicate effectively with patients who have limited English proficiency. Language barriers contribute to ethnic disparities in health care. While language service use corresponds with improved patient comprehension of illness and care options, we lack an understanding of how the nurse work environment affects the provision of these services. Methods Data were obtained from the 2007 National Home and Hospice Care Survey and included a study sample of 1,251 pediatric hospice agencies. Variable selection was guided by Structural Contingency Theory, which posits that organizational effectiveness is dependent upon how well an organization’s structure relates to its context. Using multivariate logistic regression, we analyzed the extent to which nursing unit environment predicted provision of translation services and interpreter services. Results The majority of hospices provided translation services (74.9%) and interpreter services (87.1%). Four variables predicted translation services: registered nurse (RN) unit size, RN leadership, RN medical expertise, and for-profit status. RN medical expertise and having a safety climate within the hospice corresponded with provision of interpreter services. Conclusions Findings indicate that nursing unit environment predict provision of language services. Hospices with more specialized RNs and a stronger safety climate might include staff who are dedicated to best care provision, including language services. This study provides valuable data on the nurse work environment as a predictor of language services provision, which can better serve patients with limited English proficiency, and ultimately reduce ethnic disparities in end-of-life care for children and their families. PMID:27059050

Toward a Feminist Ethic of Self-Care for Environmental Educators

ERIC Educational Resources Information Center

Lloro-Bidart, Teresa; Semenko, Keri

2017-01-01

Feminist theory and philosophy have examined how dominant ideologies oppress women, nonhuman animals, and the environment. Feminist scholars also have begun to discuss how neoliberalism problematically re-inscribes women as the primary providers of care, regardless of the impact of this care work on their own well-being. This article synthesizes…

Factors Associated with the Effectiveness of Continuing Education in Long-Term Care

ERIC Educational Resources Information Center

Stolee, Paul; Esbaugh, Jacquelin; Aylward, Sandra; Cathers, Tamzin; Harvey, David P.; Hillier, Loretta M.; Keat, Nancy; Feightner, John W.

2005-01-01

Purpose: This article examines factors within the long-term-care work environment that impact the effectiveness of continuing education. Design & Methods: In Study 1, focus group interviews were conducted with staff and management from urban and rural long-term-care facilities in southwestern Ontario to identify their perceptions of the…

Developing academic surgery in a socialized health care system: a 35-year experience.

PubMed

Duranceau, Andre; Martin, Jocelyne; Liberman, Moishe; Ferraro, Pasquale

2012-07-01

The most important benefit of a socialized health care system is the elimination of the threat of personal financial ruin to pay for medical care. Serious disadvantages of a socialized health care system, particularly in a university hospital setting, include restricted financial resources for education and patient care, limited working facilities, and loss of physician-directed decision making in planning and prioritizing. This article describes how a group practice model has supported clinical and academic activities within the faculty of medicine of our university and offers this model as a possible template for other surgical and medical disciplines working in an academic socialized environment.

Nurse work environment and job-related outcomes in Brazilian hospitals.

PubMed

Dutra, Herica Silva; Cimiotti, Jeannie P; Guirardello, Edinêis de Brito

2018-06-01

It has been reported that a work environment that does not support nurses, and high levels of emotional exhaustion and job dissatisfaction are associated with nurses' intent to leave their job. The aim of this study was to determine if these work-related factors and job-related outcomes are common in Brazilian nurses. This cross-sectional study included a 2015 survey of nursing professionals who worked in 48 units of three Brazilian, acute care hospitals. Descriptive statistics were used to examine the sample and a series of logistic regression models were fit to examine two job-related outcomes of interest: job dissatisfaction and intent to leave during the next 12 months. A total of 450 completed surveys were available, where nurses reported high emotional exhaustion (26%), job dissatisfaction (28%), and an intent to leave (12%). Poor control over the work environment (OR = 2.19) and high emotional exhaustion (OR = 4.47) were associated with an increase in the odds of job dissatisfaction. Inadequate staffing (OR = 2.43), high emotional exhaustion (OR = 2.24) and job dissatisfaction (OR = 5.74) were associated with an increase in the odds that nurses would leave their job in the next 12 months. Features of the nurse work environment and high emotional exhaustion were associated with job dissatisfaction. Job dissatisfaction and inadequate staffing are likely to result in nurses leaving their job. It is imperative that hospital administrators provide a work environment that supports nursing and improves nurse outcomes and the quality of patient care. Copyright © 2018 Elsevier Inc. All rights reserved.

Challenges and possibilities for understanding men's health in twenty-first century forensic psychiatric care.

PubMed

Kumpula, Esa; Ekstrand, Per

2014-08-01

Forensic psychiatric care in Sweden constitutes a specific institutional environment in health care in terms of gender and power relationships. This context emphasizes safety and protection in an environment where men constitute a majority of the patients and staff. It involves relationships among men's health, constructions of masculinities, and issues regarding equality between women's and men's caring work. The aim of this theoretical article is to problematize men's health in relation to constructions of masculinities. Our analysis shows how the perception of health is involved in the construction of masculinities and how this plays out in daily interactions between caregivers and patients.

Job satisfaction of Malaysian registered nurses: a qualitative study.

PubMed

Atefi, Narges; Abdullah, Khatijah L; Wong, Li P

2016-01-01

Job satisfaction is an important factor in health care settings. Strong empirical evidence supports a causal relationship between job satisfaction, patient safety and quality of care. However, there have not been any studies exploring the job satisfaction of Malaysian nurses. The main purpose of this qualitative descriptive study was to explore the factors related to feelings of job satisfaction as well as job dissatisfaction experienced by registered nurses in Malaysia. A convenient sample of 46 Malaysian nurses recruited from a large hospital (number of beds = 895) participated in the study. A total of seven focus group discussions were conducted with nurses from surgical, medical and critical care wards. A semi-structured interview guide was used to facilitate the interviews, which were audio-recorded, transcribed verbatim and checked. The transcripts were used as data and were analysed using a thematic approach. The study identified three main themes that influenced job satisfaction: (1) nurses' personal values and beliefs; (2) work environment factors and (3) motivation factors. Concerning the nurses' personal values and beliefs, the ability to help people made the nurses felt honoured and happy, which indirectly contributed to job satisfaction. For work environment factors, team cohesion, benefit and reward, working conditions play an important role in the nurses' job satisfaction. Motivation factors, namely, professional development and clinical autonomy contributed to job satisfaction. It is important for nurse leaders to provide more rewards, comfortable work environments and to understand issues that affect nurses' job satisfaction. Our findings highlight the importance of factors that can improve nurses' job satisfaction. The study provides basic information for hospital administrators in planning effective and efficient policies to improve nursing job satisfaction in order to increase the quality of patient care and decrease nursing turnover. © 2014 British Association of Critical Care Nurses.

Factors associated with infant feeding of human milk at discharge from neonatal intensive care: Cross-sectional analysis of nurse survey and infant outcomes data.

PubMed

Hallowell, Sunny G; Rogowski, Jeannette A; Spatz, Diane L; Hanlon, Alexandra L; Kenny, Michael; Lake, Eileen T

2016-01-01

Nurses are principal caregivers in the neonatal intensive care unit and support mothers to establish and sustain a supply of human milk for their infants. Whether an infant receives essential nutrition and immunological protection provided in human milk at discharge is an issue of health care quality in this setting. To examine the association of the neonatal intensive care unit work environment, staffing levels, level of nurse education, lactation consultant availability, and nurse-reported breastfeeding support with very low birth weight infant receipt of human milk at discharge. Cross sectional analysis combining nurse survey data with infant discharge data. A national sample of neonatal intensive care units (N=97), nurses (N=5614) and very low birth weight infants (N=6997). Sequential multivariate linear regression models were estimated at the unit level between the dependent variable (rate of very low birth weight infants discharged on "any human milk") and the independent variables (nurse work environment, nurse staffing, nursing staff education and experience, lactation consultant availability, and nurse-reported breastfeeding support). The majority of very low birth weight infants (52%) were discharged on formula only. Fewer infants (42%) received human milk mixed with fortifier or formula. Only 6% of infants were discharged on exclusive human milk. A 1 SD increase (0.25) in the Practice Environment Scale of the Nursing Work Index composite score was associated with a four percentage point increase in the fraction of infants discharged on human milk (p<0.05). A 1 SD increase (0.15) in the fraction of nurses with a bachelor's degree in nursing was associated with a three percentage point increase in the fraction infants discharged on human milk (p<0.05). The acuity-adjusted staffing ratio was marginally associated with the rate of human milk at discharge (p=.056). A 1 SD increase (7%) in the fraction of infants who received breastfeeding support was associated with an eight percentage point increase in the fraction of infants discharged on human milk (p<0.001). Neonatal intensive care units with better work environments, better educated nurses, and more infants who receive breastfeeding support by nurses have higher rates of very low birth weight infants discharged home on human milk. Investments by nurse administrators to improve work environments and support educational preparation of nursing staff may ensure that the most vulnerable infants have the best nutrition at the point of discharge. Copyright © 2015 Elsevier Ltd. All rights reserved.

Factors associated with infant feeding of human milk at discharge from neonatal intensive care: Cross-sectional analysis of nurse survey and infant outcomes data

PubMed Central

Hallowell, Sunny G.; Rogowski, Jeannette A.; Spatz, Diane L.; Hanlon, Alexandra L.; Kenny, Michael; Lake, Eileen T.

2016-01-01

Context Nurses are principal caregivers in the neonatal intensive care unit and support mothers to establish and sustain a supply of human milk for their infants. Whether an infant receives essential nutrition and immunological protection provided in human milk at discharge is an issue of health care quality in this setting. Objectives To examine the association of the neonatal intensive care unit work environment, staffing levels, level of nurse education, lactation consultant availability, and nurse-reported breastfeeding support with very low birth weight infant receipt of human milk at discharge. Design and setting Cross sectional analysis combining nurse survey data with infant discharge data. Participants A national sample of neonatal intensive care units (N = 97), nurses (N = 5614) and very low birth weight infants (N = 6997). Methods Sequential multivariate linear regression models were estimated at the unit level between the dependent variable (rate of very low birth weight infants discharged on “any human milk”) and the independent variables (nurse work environment, nurse staffing, nursing staff education and experience, lactation consultant availability, and nurse-reported breastfeeding support). Results The majority of very low birth weight infants (52%) were discharged on formula only. Fewer infants (42%) received human milk mixed with fortifier or formula. Only 6% of infants were discharged on exclusive human milk. A 1 SD increase (0.25) in the Practice Environment Scale of the Nursing Work Index composite score was associated with a four percentage point increase in the fraction of infants discharged on human milk (p < 0.05). A 1 SD increase (0.15) in the fraction of nurses with a bachelor’s degree in nursing was associated with a three percentage point increase in the fraction infants discharged on human milk (p < 0.05). The acuity-adjusted staffing ratio was marginally associated with the rate of human milk at discharge (p = .056). A 1 SD increase (7%) in the fraction of infants who received breastfeeding support was associated with an eight percentage point increase in the fraction of infants discharged on human milk (p < 0.001). Conclusions Neonatal intensive care units with better work environments, better educated nurses, and more infants who receive breastfeeding support by nurses have higher rates of very low birth weight infants discharged home on human milk. Investments by nurse administrators to improve work environments and support educational preparation of nursing staff may ensure that the most vulnerable infants have the best nutrition at the point of discharge. PMID:26518107

Enhancing resilience in registered aged care nurses.

PubMed

Cameron, Fiona; Brownie, Sonya

2010-06-01

To identify the factors that impact the resilience of registered aged care nurses, that is their capacity to adapt to the physical, mental and emotional demands of working in aged care facilities. This study explored the lived experience of nine registered nurses working in residential aged care facilities on the Sunshine Coast, Queensland, who were asked to reflect on the phenomenon of resilience in the workplace. This study found that clinical expertise, a sense of purpose in a holistic care environment, a positive attitude and work-life balance are important determinants of resilience in aged care nurses. Resilience in nurses in residential aged care facilities is enhanced when they are able to maintain long-term, meaningful relationships with residents. Collegial support that provides opportunities to debrief and validate experiences as well as the use of humour to defuse stress promotes well-being and builds resilience in the workplace.

Caring for the Elderly at Work and Home: Can a Randomized Organizational Intervention Improve Psychological Health?

PubMed

Kossek, Ellen Ernst; Thompson, Rebecca J; Lawson, Katie M; Bodner, Todd; Perrigino, Matthew B; Hammer, Leslie B; Buxton, Orfeu M; Almeida, David M; Moen, Phyllis; Hurtado, David A; Wipfli, Brad; Berkman, Lisa F; Bray, Jeremy W

2017-12-07

Although job stress models suggest that changing the work social environment to increase job resources improves psychological health, many intervention studies have weak designs and overlook influences of family caregiving demands. We tested the effects of an organizational intervention designed to increase supervisor social support for work and nonwork roles, and job control in a results-oriented work environment on the stress and psychological distress of health care employees who care for the elderly, while simultaneously considering their own family caregiving responsibilities. Using a group-randomized organizational field trial with an intent-to-treat design, 420 caregivers in 15 intervention extended-care nursing facilities were compared with 511 caregivers in 15 control facilities at 4 measurement times: preintervention and 6, 12, and 18 months. There were no main intervention effects showing improvements in stress and psychological distress when comparing intervention with control sites. Moderation analyses indicate that the intervention was more effective in reducing stress and psychological distress for caregivers who were also caring for other family members off the job (those with elders and those "sandwiched" with both child and elder caregiving responsibilities) compared with employees without caregiving demands. These findings extend previous studies by showing that the effect of organizational interventions designed to increase job resources to improve psychological health varies according to differences in nonwork caregiving demands. This research suggests that caregivers, especially those with "double-duty" elder caregiving at home and work and "triple-duty" responsibilities, including child care, may benefit from interventions designed to increase work-nonwork social support and job control. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Small group learning: graduate health students' views of challenges and benefits.

PubMed

Jackson, Debra; Hickman, Louise D; Power, Tamara; Disler, Rebecca; Potgieter, Ingrid; Deek, Hiba; Davidson, Patricia M

2014-07-19

Abstract Background: For health care professionals, particularly nurses, the need to work productively and efficiently in small groups is a crucial skill required to meet the challenges of the contemporary health-care environment. Small group work is an educational technique that is used extensively in nurse education. The advantage of group work includes facilitation of deep, active and collaborative learning. However, small group work can be problematic and present challenges for students. Many of the challenges occur because group work necessitates the coming together of collections of individuals, each with their own personalities and sets of experiences. Aim: This study aimed to identify challenges and benefits associated with small group work and to explore options for retaining the positive aspects of group work while reducing or eliminating the aspects the students experienced as negative. Method: Online survey; thematic analysis. Results: Over all, students experienced a range of challenges that necessitated the development of problem-solving strategies. However, they were able to elucidate some enjoyable and positive aspects of group work. Implications for teaching and learning are drawn from this study. Conclusion: The ability to work effectively in small groups and teams is essential for all health care workers in the contemporary health environment. Findings of this study highlight the need for educators to explore novel and effective ways in which to engage nurses in group work.

Small group learning: Graduate health students' views of challenges and benefits.

PubMed

Jackson, Debra; Hickman, Louise D; Power, Tamara; Disler, Rebecca; Potgieter, Ingrid; Deek, Hiba; Davidson, Patricia M

2014-01-01

Abstract Background: For health-care professionals, particularly nurses, the need to work productively and efficiently in small groups is a crucial skill required to meet the challenges of the contemporary health-care environment. Small group work is an educational technique that is used extensively in nurse education. The advantage of group work includes facilitation of deep, active and collaborative learning. However, small group work can be problematic and present challenges for students. Many of the challenges occur because group work necessitates the coming together of collections of individuals, each with their own personalities and sets of experiences. This study aimed to identify challenges and benefits associated with small group work and to explore options for retaining the positive aspects of group work while reducing or eliminating the aspects the students experienced as negative. Online survey; thematic analysis. Over all, students experienced a range of challenges that necessitated the development of problem-solving strategies. However, they were able to elucidate some enjoyable and positive aspects of group work. Implications for teaching and learning are drawn from this study. The ability to work effectively in small groups and teams is essential for all health-care workers in the contemporary health environment. Findings of this study highlight the need for educators to explore novel and effective ways in which to engage nurses in group work.

Alzheimer's: Glossary

MedlinePlus

... as a nursing home. Learn more: Residential Care Working with Care Providers Adult day centers Adult day centers offer people with Alzheimer's and other dementias the opportunity to be social and to participate in activities in a safe environment. Learn more: Adult Day Centers Advance directive An ...

Threading needles in the dark: the effect of the physical work environment on nursing practice.

PubMed

Simmons, Debora; Graves, Krisanne; Flynn, Elizabeth A

2009-01-01

Frequently, the most critical calculations, considerations, and preparations for patient care and medication administration are made in noisy, dimly lit, and chaotic areas of the nursing unit. Healthcare has begun to recognize the impact of the physical work environment plays in the ability of humans to perform reliably and safely. This article reviews the draft guidelines recently released by the United States Pharmacopeia for public comment for the physical environment to promote safe medication administration.

Work, family and social environment in patients with Fibromyalgia in Spain: an epidemiological study: EPIFFAC study.

PubMed

Collado, Antonio; Gomez, Emili; Coscolla, Rosa; Sunyol, Ruth; Solé, Emília; Rivera, Javier; Altarriba, Emília; Carbonell, Jordi; Castells, Xavier

2014-11-11

Fibromyalgia (FM) is a condition characterized by widespread pain, estimated to affect 2.4% of the Spanish population. Nowadays, there are no consistent epidemiological studies on the actual impact of the disease on work and family of these patients in a representative manner; therefore, the purpose of the study is to analyze the impact on family, employment and social environment in a representative sample of patients with FM attending Primary Public Care Centers in Spain. We carried out an epidemiological study, with a probability sampling procedure, stratified, relative to the municipality size and the number of health centres, seeking territorial representation. The survey was conducted using a self-administered structured questionnaire. A sample of 325 patients with FM was studied in 35 Primary Health Care Centers (PHCCs). The sample is composed of 96.6% of women, 51.9 (8) years of mean (standard deviation- sd) age. Ninety-three percent of the patients have worked throughout their life. Mean (sd) age onset of symptoms was 37 (11) years and diagnosis of FM was established 6.6 (8) years later. Family Environment: Fifty-nine percent of patients have difficulties with their partner. Forty-four percent of the patients report to be fairly or totally dependent on a family member in household chores. The household income decreased a mean (sd) of 708 (504) Euros/month in 65% of the patients. In 81% of the patients, there was an increase in extra expenses related to the disease with a mean (sd) of 230 (192) Euros/month. Working environment: At the moment of the study, 45% of the patients had work activity (34% were working and 11% were at sick leave), 13% were unemployed seeking job and 42% were not in the labor force. Twenty-three percent of patients had some degree of permanent work disability pension. Social Environment: The degree of satisfaction with health care professionals was low and twenty-six percent of the patients were members of specific patients associations. This study finds that people with FM who visit PHCCs of Spain experience a high impact on families and employment with heavy loss of ability to work.

Effect of work during pregnancy.

PubMed

Chamberlain, G

1985-05-01

Obstetricians pay much attention to the diet and environment of the pregnant woman in prenatal care, but perhaps the woman's work also may affect pregnancy outcome. All women work in the home in addition to any work performed outside the home. The former component needs careful assessment; to get from home to work may be itself a stressful experience. In the workplace, women may encounter specific hazards of radiation or chemicals. More widespread are the problems of fatigue and boredom, which need careful assessment in relation to the outcome of pregnancy. These factors should be measured more precisely, thus allowing the physician to advise pregnant women better about the safe duration of work. Currently, advice tends to be overly cautious, as physicians are uncertain of the data on which such standards are based.

Links between social environment and health care utilization and costs.

PubMed

Brault, Marie A; Brewster, Amanda L; Bradley, Elizabeth H; Keene, Danya; Tan, Annabel X; Curry, Leslie A

2018-01-01

The social environment influences health outcomes for older adults and could be an important target for interventions to reduce costly medical care. We sought to understand which elements of the social environment distinguish communities that achieve lower health care utilization and costs from communities that experience higher health care utilization and costs for older adults with complex needs. We used a sequential explanatory mixed methods approach. We classified community performance based on three outcomes: rate of hospitalizations for ambulatory care sensitive conditions, all-cause risk-standardized hospital readmission rates, and Medicare spending per beneficiary. We conducted in-depth interviews with key informants (N = 245) from organizations providing health or social services. Higher performing communities were distinguished by several aspects of social environment, and these features were lacking in lower performing communities: 1) strong informal support networks; 2) partnerships between faith-based organizations and health care and social service organizations; and 3) grassroots organizing and advocacy efforts. Higher performing communities share similar social environmental features that complement the work of health care and social service organizations. Many of the supportive features and programs identified in the higher performing communities were developed locally and with limited governmental funding, providing opportunities for improvement.

Practice environment as perceived by nurses in acute care hospitals in Sharjah and North Emirates.

PubMed

Al-Maaitah, Rowaida; AbuAlRub, Raeda F; Al Blooshi, Sumaya

2018-04-01

To explore nurses' perceptions of their practice environment in acute care hospitals in Sharjah and North Emirates in the United Arab Emirates (UAE). The health of the environment in which registered nurses' work is critical to nursing outcomes. The interest to examine the practice environment extended to the Gulf area which has a complex healthcare system including the UAE. The study used an exploratory descriptive design with a qualitative part using two focus group interviews. The sample size was 450 nurses selected through a random sampling method. A self-administered questionnaire including the Practice Environment Scale of Nursing Work Index (PES-NWI) was used. In addition, semi-structured interviews for two focus groups were done. The results showed that UAE practicing nurses reported favorable perceptions of most aspects of their practice environment. Unfavorable perceptions were only reported for Staffing and Resource Adequacy. The analysis of focus group discussions resulted in different emerged themes such as Lack of Recognition and Career Promotion, and Nurses' Workload due to Paper and Administrative Work. The findings of this study suggest that strategic interventions are needed to secure adequate staff and resources and implement an effective system for evaluation of performance. © 2018 Wiley Periodicals, Inc.

Nurse knowledge, work environment, and turnover in highly specialized pediatric end-of-life care

PubMed Central

Lindley, Lisa C.; Cozad, Melanie J.

2016-01-01

Objective To examine the relationship between nurse knowledge and work environment and Registered Nurse (RN) turnover in perinatal hospice and palliative care organizations. Methods Using nurse intellectual capital theory, a multivariate analysis was conducted with 2007 National Home and Hospice Care Survey data. Results Perinatal hospice and palliative care organizations experienced a 5% turnover rate. The professional experience of advanced practice nurses (APNs) was significantly related to turnover among RNs (β= −0.032, P< 0.05). Compared to organizations with no APNs professional experience, clinical nurse specialists and nurse practitioners significantly reduced RN turnover by 3-percentage points. No other nurse knowledge or work environment variables were associated with RN turnover. Several of the control variables were also associated with RN turnover in the study: organizations serving micropolitan (β= −0.041, P< 0.05) and rural areas (β= −0.037, P< 0.05) had lower RN turnover, compared to urban areas. Organizations with a technology climate where nurses used electronic medical records had a higher turnover rate than those without (β= 0.036, P< 0.05). Conclusions The findings revealed that advanced professional experience in the form of APNs were associated with reductions in RN turnover. This suggests that having a clinical nurse specialist or nurse practitioner on staff may provide knowledge and experience to other RNs, creating stability within the organization. PMID:27188758

Teacher Work Environments Are Toddler Learning Environments: Teacher Professional Well-Being, Classroom Emotional Support, and Toddlers' Emotional Expressions and Behaviours

ERIC Educational Resources Information Center

Cassidy, Deborah J.; King, Elizabeth K.; Wang, Yudan C.; Lower, Joanna K.; Kintner-Duffy, Victoria L.

2017-01-01

The current study examines the professional well-being of teachers, the classroom emotional support, and the emotional experiences of toddlers in their care. Professional well-being of teachers is conceptualized to include teacher feelings about their work, autonomy in decision-making, actual wages, and perceptions of fairness of wages within the…

Ecosystems in the Backyard: Preparing a Diverse Outdoor Environment for Primary (Ages Three to Six) Children.

ERIC Educational Resources Information Center

Verschuur, Mary B.

2003-01-01

Chronicles the outdoor work of Lincoln Montessori School in Nebraska in prairie, forest, and indoor greenhouse environments, highlighting the application of prepared environment principles to the natural world. Highlights how implicit to the design are opportunities for caring, including practical life exercises with outdoor tools. Shows how…

Occupational stress and the importance of self-care and resilience: focus on veterinary nursing.

PubMed

Lloyd, Ciaran; Campion, Deirdre P

2017-01-01

Burnout and compassion fatigue are frequently mentioned in relation to veterinary work. Veterinary nursing is a caring profession and those who seek a career within this field do so because of a natural empathetic desire to care for animals. However it is the individuals who are the most caring and empathetic towards others that will be most at risk of experiencing occupational stress when they are confronted with psychologically demanding workplace roles and working environments. Burnout is considered an 'unintentional end point' for certain individuals who are exposed to chronic stress within their working environment. When suffering burnout, a person may experience emotional exhaustion, may become more cynical or they may have a reduced sense of personal accomplishment in regards to their own work. Signs of burnout can include increased levels of absenteeism at work, or the working standards of that staff member may decline below that of what would normally be expected of them. This could directly impact on patient care in the veterinary practice. Working in a role that places emotional demands on staff, such as a need to show compassion and empathy towards clients who are emotionally distressed, puts staff at risk from experiencing compassion fatigue. Workplace supports may include appropriate debriefing sessions among willing participants, particularly after an emotionally stressful encounter with a client. Taking personal responsibility for care of one's own mental and physical health is just as important as taking care of the patient's health. Personal strategies may include lifestyle changes, adopting a healthier lifestyle, reduction of working hours, and ensuring adequate sleep. Adopting healthy self-care strategies can promote characteristics of "resilience" - personal qualities or traits such as optimism, self-confidence, level headedness, hardiness, and having the ability to be resourceful during times of adversity. All veterinary staff may be better prepared to deal with occupational stress related conditions if they gain better insight and ability to recognise the condition in self and others, and if provided with the toolkits to develop coping strategies and resilience.

Undergraduate nurses' preferred use of mobile devices in healthcare settings.

PubMed

Mather, Carey; Cummings, Elizabeth; Allen, Penny

2015-01-01

The growth of digital technology has created challenges for appropriate and safe use of mobile or portable devices in healthcare environments. There is perceived risk that the use of mobile technology for learning may distract from provision of patient care if used by undergraduate students during work-integrated learning. This paper reports on a study that aimed to identify differences in preferred behavior of student nurses in their use of mobile technology during and away from the clinical practice environment. A previously validated online survey was administered to students during a period of work integrated learning in a range of healthcare settings in two Australian states. Respondents agreed that mobile devices could be beneficial to patient care. Overall, students proposed they would use mobile devices for accessing information, during work integrated learning, less than when away from the workplace. The development of policy to guide the use of mobile devices, in situ, is important to the provision of safe and competent care and improved health outcomes for patients.

Work-related factors influencing home care nurse intent to remain employed.

PubMed

Tourangeau, Ann E; Patterson, Erin; Saari, Margaret; Thomson, Heather; Cranley, Lisa

Health care is shifting out of hospitals into community settings. In Ontario, Canada, home care organizations continue to experience challenges recruiting and retaining nurses. However, factors influencing home care nurse retention that can be modified remain largely unexplored. Several groups of factors have been identified as influencing home care nurse intent to remain employed including job characteristics, work structures, relationships and communication, work environment, responses to work, and conditions of employment. The aim of this study was to test and refine a model that identifies which factors are related to home care nurse intentions to remain employed for the next 5 years with their current home care employer organization. A cross-sectional survey design was implemented to test and refine a hypothesized model of home care nurse intent to remain employed. Logistic regression was used to determine which factors influence home care nurse intent to remain employed. Home care nurse intent to remain employed for the next 5 years was associated with increasing age, higher nurse-evaluated quality of care, having greater variety of patients, experiencing greater meaningfulness of work, having greater income stability, having greater continuity of client care, experiencing more positive relationships with supervisors, experiencing higher work-life balance, and being more satisfied with salary and benefits. Home care organizations can promote home care nurse intent to remain employed by (a) ensuring nurses have adequate training and resources to provide quality client care, (b) improving employment conditions to increase income stability and satisfaction with pay and benefits, (c) ensuring manageable workloads to facilitate improved work-life balance, and (d) ensuring leaders are accessible and competent.

Development and Evaluation of a Continuing Education Program for Nursing Technicians at a Pediatric Cardiac Intensive Care Unit in a Developing Country.

PubMed

Borim, Bruna Cury; Croti, Ulisses A; Silveira, Patricia C; De Marchi, Carlos H; Moscardini, Airton C; Hickey, Patricia; Jenkins, Kathy

2017-11-01

The nursing profession faces continuous transformations demonstrating the importance of professional continuing education to extend knowledge following technological development without impairing quality of care. Nursing assistants and technicians account for nearly 80% of nursing professionals in Brazil and are responsible for uninterrupted patient care. Extensive knowledge improvement is needed to achieve excellence in nursing care. The objective was to develop and evaluate a continuing education program for nursing technicians at a pediatric cardiac intensive care unit (PCICU) using a virtual learning environment entitled EDUCATE. From July to September 2015, a total of 24 nursing technicians working at the PCICU at a children's hospital located in the northwestern region of São Paulo state (Brazil) fully participated in the continuing education program developed in a virtual learning environment using Wix platform, allowing access to video classes and pre- and post-training theoretical evaluation questionnaires outside the work environment. The evaluation tools recorded participants' knowledge evolution, technological difficulties, educational, and overall rating. Knowledge development was descriptively presented as positive in more than 66.7%. Content and training were considered "excellent" by most participants and 90% showed an interest in the use of technological resources. Technical difficulties were found and quickly resolved by 40% of participants including Internet access, login, and lack of technical expertise. The continuing education program using a virtual learning environment positively contributed to the improvement in theoretical knowledge of nursing technicians in PCICU.

Interactions between lean management and the psychosocial work environment in a hospital setting - a multi-method study.

PubMed

Ulhassan, Waqar; von Thiele Schwarz, Ulrica; Thor, Johan; Westerlund, Hugo

2014-10-22

As health care struggles to meet increasing demands with limited resources, Lean has become a popular management approach. It has mainly been studied in relation to health care performance. The empirical evidence as to how Lean affects the psychosocial work environment has been contradictory. This study aims to study the interaction between Lean and the psychosocial work environment using a comprehensive model that takes Lean implementation information, as well as Lean theory and the particular context into consideration. The psychosocial work environment was measured twice with the Copenhagen Psychosocial Questionnaire (COPSOQ) employee survey during Lean implementations on May-June 2010 (T1) (n = 129) and November-December 2011 (T2) (n = 131) at three units (an Emergency Department (ED), Ward-I and Ward-II). Information based on qualitative data analysis of the Lean implementations and context from a previous paper was used to predict expected change patterns in the psychosocial work environment from T1 to T2 and subsequently compared with COPSOQ-data through linear regression analysis. Between T1 and T2, qualitative information showed a well-organized and steady Lean implementation on Ward-I with active employee participation, a partial Lean implementation on Ward-II with employees not seeing a clear need for such an intervention, and deterioration in already implemented Lean activities at ED, due to the declining interest of top management. Quantitative data analysis showed a significant relation between the expected and actual results regarding changes in the psychosocial work environment. Ward-I showed major improvements especially related to job control and social support, ED showed a major decline with some exceptions while Ward-II also showed improvements similar to Ward-I. The results suggest that Lean may have a positive impact on the psychosocial work environment given that it is properly implemented. Also, the psychosocial work environment may even deteriorate if Lean work deteriorates after implementation. Employee managers and researchers should note the importance of employee involvement in the change process. Employee involvement may minimize the intervention's harmful effects on psychosocial work factors. We also found that a multi-method may be suitable for investigating relations between Lean and the psychosocial work environment.

Translational Cognition for Decision Support in Critical Care Environments: A Review

PubMed Central

Patel, Vimla L.; Zhang, Jiajie; Yoskowitz, Nicole A.; Green, Robert; Sayan, Osman R.

2008-01-01

The dynamic and distributed work environment in critical care requires a high level of collaboration among clinical team members and a sophisticated task coordination system to deliver safe, timely and effective care. A complex cognitive system underlies the decision-making process in such cooperative workplaces. This methodological review paper addresses the issues of translating cognitive research to clinical practice with a specific focus on decision-making in critical care, and the role of information and communication technology to aid in such decisions. Examples are drawn from studies of critical care in our own research laboratories. Critical care, in this paper, includes both intensive (inpatient) and emergency (outpatient) care. We define translational cognition as the research on basic and applied cognitive issues that contribute to our understanding of how information is stored, retrieved and used for problem-solving and decision-making. The methods and findings are discussed in the context of constraints on decision-making in real world complex environments and implications for supporting the design and evaluation of decision support tools for critical care health providers. PMID:18343731

Translational cognition for decision support in critical care environments: a review.

PubMed

Patel, Vimla L; Zhang, Jiajie; Yoskowitz, Nicole A; Green, Robert; Sayan, Osman R

2008-06-01

The dynamic and distributed work environment in critical care requires a high level of collaboration among clinical team members and a sophisticated task coordination system to deliver safe, timely and effective care. A complex cognitive system underlies the decision-making process in such cooperative workplaces. This methodological review paper addresses the issues of translating cognitive research to clinical practice with a specific focus on decision-making in critical care, and the role of information and communication technology to aid in such decisions. Examples are drawn from studies of critical care in our own research laboratories. Critical care, in this paper, includes both intensive (inpatient) and emergency (outpatient) care. We define translational cognition as the research on basic and applied cognitive issues that contribute to our understanding of how information is stored, retrieved and used for problem-solving and decision-making. The methods and findings are discussed in the context of constraints on decision-making in real-world complex environments and implications for supporting the design and evaluation of decision support tools for critical care health providers.

Developmental Characteristics of Young Dual Language Learners: Implications for Policy and Practice in Infant and Toddler Care

ERIC Educational Resources Information Center

Castro, Dina C.; Espinosa, Linda M.

2014-01-01

This article discusses the current knowledge on the developmental characteristics and contexts of care for infants and toddlers who are growing up in bilingual environments at home and in their early care settings in the united States. The authors highlight relevant findings from the work of the Center of Early Care and Education Research-Dual…

Burnout, Perceived Stress, and Job Satisfaction Among Trauma Nurses at a Level I Safety-Net Trauma Center.

PubMed

Munnangi, Swapna; Dupiton, Lynore; Boutin, Anthony; Angus, L D George

Nurses are at the forefront of our health care delivery system and have been reported to exhibit a high level of burnout. Burnout and stress in trauma nurses at a safety-net hospital can negatively impact patient care. Safety-net hospitals are confronted with unique social, financial, as well as resource problems that can potentially make the work environment frustrating. The purpose of this study was to explore the levels of burnout, stress, and job satisfaction in nurses providing care to trauma patients at a Level I safety-net trauma center. A cross-sectional survey design was used to investigate principal factors including personal and professional demographics, burnout, perceived stress, and job satisfaction. Trauma nurses working at a Level I safety-net trauma center are stressed and exhibited moderate degree of burnout. The extent of emotional exhaustion experienced by the nurses varied with work location and was highest in surgical intensive care unit nurses. The level of job satisfaction in terms of opportunities for promotion differed significantly by race and the health status of the nurses. Satisfaction with coworkers was lowest in those nurses between the ages of 60-69 years. Female nurses were more satisfied with their coworkers than male nurses. In addition, the study revealed that significant relationships exist among perceived stress, burnout, and job satisfaction. Work environment significantly impacts burnout, job satisfaction, and perceived stress experienced by trauma nurses in a safety-net hospital. Nursing administration can make an effort to understand the levels of burnout and strategically improve work environment for trauma nurses in order to minimize stressors leading to attrition and enhance job satisfaction.

The work compatibility improvement framework: an assessment of the worker-work environment interaction in the manufacturing sector.

PubMed

Genaidy, Ash M; Rinder, Magda M; A-Rehim, Amal D

2008-08-01

The manufacturing sector in the US is challenged by high health care costs and shortage of qualified workers, which are largely attributed to the degree of fit between the worker and work environment. In this regard, a healthy worker-work environment interface is a necessary and sufficient condition for the containment of health care costs and the retaining/attraction of highly qualified knowledge workers and should be based on the principles of optimum physical, cognitive and emotional health for the workers. In prior research, the Work Compatibility Improvement Framework (WCIF) was introduced as a vehicle to address these issues and was defined as the identification, improvement and maintenance of the well-being characteristics of the workforce and its interaction with the work environment through the application of engineering, medicine, management and human sciences methodologies, technologies and best practices. This paper advances WCIF by examining its applications in manufacturing with regard to the evaluation of working conditions impacting musculoskeletal/stress outcome measures. A study was conducted in a machining department of a bag packaging manufacturer in the Midwest of the United States. The work tasks were planned and executed with regard to the following aims: (1) to compute work compatibility as a function of work demands and energisers; (2) to establish whether the prevalence of musculoskeletal/stress disorders increases with a decrease in the quality of worker-work environment interface in terms of work compatibility level and other work factors such as shift and job category. A major finding is that a 'poor' work environment (a function of all work domains) results in musculoskeletal/stress disorders that are 105% and 67% higher than those for a 'good' work environment. The evening shift exhibited the poorest compatibility followed by the night shift relative to the day shift. Application of the work compatibility approach demonstrated the detection of non-added value work. It is essential to evaluate the various domains of worker-work environment interface to uncover the root causes that tend to sub-optimise the physical/cognitive/emotional health of the workforce. The WCIF was used to uncover the non-value added effort in the work process. These findings will have major implications for developing and implementing customised design interventions with the aim to maximise the benefit and reduce the cost of employees in a manufacturing enterprise. The study findings suggest that the WCIF should be pursued as a potential strategic tool for optimising human performance in an enterprise to create healthy workplaces.

Excessive workload, uncertain career opportunities and lack of funding are important barriers to recruiting and retaining primary care medical researchers: a qualitative interview study.

PubMed

Thomsen, Janus Laust; Jarbøl, Dorthe; Søndergaard, Jens

2006-10-01

Research activity in primary care has been steadily increasing, but is still insufficient and more researchers are needed. Many initiatives have been launched to recruit and retain primary care researchers, but only little is known about barriers and facilitators to a research career in primary care. To examine barriers and facilitators to recruiting and retaining primary care medical researchers. Semi-structured interviews with 33 primary care medical researchers, all medical doctors. We used a phenomenological approach to analysing the interviews. Important barriers to pursuing a research career in primary care were heavy workload, isolation at work, short-term funding and low salary. Important facilitators to attracting and retaining primary care researchers were the desire and opportunity to improve primary care, the flexible working conditions, the career opportunities, including the possibility of combining university-based research with clinical work and a friendly and competent research environment. Better strategies for recruiting and retaining researchers are a prerequisite for the development of primary care, and in future the main emphasis should be on working conditions, networking and mentoring. Studies including those primary care physicians who have chosen not to do research are highly needed.

History of pulmonary critical care nursing and where we are going.

PubMed

Lareau, Suzanne C; Mealer, Meredith

2012-09-01

Pulmonary critical care nurses have played a prominent role in the ICUs from the inception of critical care units. This article describes how the history of pulmonary critical care nursing has evolved and discusses a few of the challenges in the years to come: stress imposed by working in a critical care environment, enhancing the care of patients by altering patterns of sedation and promoting early mobilization, and dealing with increasing infection rates.

Nurses’ Practice Environment and Their Job Satisfaction: A Study on Nurses Caring for Older Adults in Shanghai

PubMed Central

Wang, Ying; Dong, Weizhen; Mauk, Kristen; Li, Peiying; Wan, Jin; Yang, Guang; Fang, Lyuying; Huan, Wan; Chen, Chun; Hao, Mo

2015-01-01

Aim To examine the job satisfaction of nurses who are caring for older adults in healthcare settings in Shanghai, and to explore the underlying factors in order to explain and predict nurses’ job satisfaction. Background China has the largest elderly population in the world, and its population is aging rapidly. Studies on job satisfaction of nurses providing care for the elderly in China can help to identify problem areas and develop strategies for the improvement of nurses’ working conditions. However, to date, this subject matter has not been thoroughly studied in the Chinese context. Previous studies in other countries show that many factors impact nurses’ job satisfaction, with the practice environment being a critical factor. There is a serious nursing shortage in China, especially in the big cities such as Shanghai. Given the increasing care demand of the aging population, learning about the job satisfaction level among nurses who are caring for older adults can provide essential information to help attract and retain nurses in this specialty area. Methods A cross-sectional survey was conducted among 444 nurses in 22 elderly care institutions in Shanghai. The Chinese version of the Index of Work Satisfaction (IWS) and the Nursing Practice Environment Scale were instruments used. Inferential statistical tests used to analyze the data included Spearman correlation analysis, one-way analysis of variance, and hierarchical regression tests. Results The average overall IWS (part B) score was 135.21 ± 19.34. Personality, job and organizational characteristics were found to be the most influential factors, and the practice environment was identified as having the strongest impact on job satisfaction (Beta = 0.494). Conclusion Job satisfaction level among nurses who are caring for older adults in Shanghai is moderate, but the data suggest that this could be greatly increased if the nursing practice environment was improved. PMID:26380980

Nurses' Practice Environment and Their Job Satisfaction: A Study on Nurses Caring for Older Adults in Shanghai.

PubMed

Wang, Ying; Dong, Weizhen; Mauk, Kristen; Li, Peiying; Wan, Jin; Yang, Guang; Fang, Lyuying; Huan, Wan; Chen, Chun; Hao, Mo

2015-01-01

To examine the job satisfaction of nurses who are caring for older adults in healthcare settings in Shanghai, and to explore the underlying factors in order to explain and predict nurses' job satisfaction. China has the largest elderly population in the world, and its population is aging rapidly. Studies on job satisfaction of nurses providing care for the elderly in China can help to identify problem areas and develop strategies for the improvement of nurses' working conditions. However, to date, this subject matter has not been thoroughly studied in the Chinese context. Previous studies in other countries show that many factors impact nurses' job satisfaction, with the practice environment being a critical factor. There is a serious nursing shortage in China, especially in the big cities such as Shanghai. Given the increasing care demand of the aging population, learning about the job satisfaction level among nurses who are caring for older adults can provide essential information to help attract and retain nurses in this specialty area. A cross-sectional survey was conducted among 444 nurses in 22 elderly care institutions in Shanghai. The Chinese version of the Index of Work Satisfaction (IWS) and the Nursing Practice Environment Scale were instruments used. Inferential statistical tests used to analyze the data included Spearman correlation analysis, one-way analysis of variance, and hierarchical regression tests. The average overall IWS (part B) score was 135.21 ± 19.34. Personality, job and organizational characteristics were found to be the most influential factors, and the practice environment was identified as having the strongest impact on job satisfaction (Beta = 0.494). Job satisfaction level among nurses who are caring for older adults in Shanghai is moderate, but the data suggest that this could be greatly increased if the nursing practice environment was improved.

Leading a multicultural work environment: reflections on the next frontier of nurse leadership.

PubMed

Washington, Deborah

2015-01-01

Nurses face the challenge of leading in a diverse society. Is the cross section of present-day nurse leaders prepared to meet the needs of patients and a work environment represented by a broader range of social backgrounds, cultural traditions, and languages? Fundamental to leaders' ability to meet diverse needs is a new framework for understanding the meaning of leadership, in which the issue of diversity is paramount. This article explores how the word leadership expresses a more complex system, when responsibility to address human needs is emphasized, and care for multilingual and multiethnic patients by a diverse, committed work environment is a focus. Under the umbrella of diversity, the necessary knowledge to create such a work environment may lack depth or may even be absent.

Environmental and Occupational Exposures in Immigrant Health

PubMed Central

Eamranond, Pracha P.; Hu, Howard

2008-01-01

Immigrants comprise vulnerable populations that are frequently exposed to a multitude of environmental and occupational hazards. The historical context behind state and federal legislation has helped to foster an environment that is particularly hostile toward caring for immigrant health. Current hazards include toxic exposures, air and noise pollution, motor vehicle accidents, crowded living and work environments with inadequate ventilation, poor sanitation, mechanical injury, among many others. Immigrants lack the appropriate training, materials, health care access, and other resources to reduce their exposure to preventable environmental and occupational health risks. This dilemma is exacerbated by current anti-immigrant sentiments, miscommunication between native and immigrant populations, and legislation denying immigrants access to publicly funded medical care. Given that current health policy has failed to address immigrant health appropriately and political impetus is lacking, efforts should also focus on alternative solutions, including organized labor. Labor unions that serve to educate workers, survey work environments, and defend worker rights will greatly alleviate and prevent the burden of disease incurred by immigrants. The nation’s health will benefit from improved regulation of living and workplace environments to improve the health of immigrants, regardless of legal status. PMID:21572847

Intervening with Care--Varying Outcomes of a Training and Development Programme in Elderly Care in Sweden

ERIC Educational Resources Information Center

Hauer, Esther; Westerberg, Kristina; Nordlund, Annika M.

2017-01-01

Awareness of the mechanisms underlying training and development (T&D) programmes is crucial in creating sustainable learning conditions in organisations. The organisational and psychosocial aspects of the work environment in Swedish elderly care is the focus of this longitudinal study, and the relation between process and results of a T&D…

Making the "Child Safe" Environment "Adult Safe": Occupational Health and Safety Concerns for Child Care Programs.

ERIC Educational Resources Information Center

Whitebook, Marcy; Ginsburg, Gerri

Results of a nonrandom nationwide survey of 89 child care workers in 20 states concerning work-related health and safety conditions confirm that similar hazardous conditions exist in child care programs throughout the nation. Results also confirm that concern and anger about such conditions and their potential consequences are widespread among…

The link between leadership and safety outcomes in hospitals.

PubMed

Squires, Mae; Tourangeau, Ann; Spence Laschinger, Heather K; Doran, Diane

2010-11-01

To test and refine a model examining relationships among leadership, interactional justice, quality of the nursing work environment, safety climate and patient and nurse safety outcomes. The quality of nursing work environments may pose serious threats to patient and nurse safety. Justice is an important element in work environments that support safety initiatives yet little research has been done that looks at how leader interactional justice influences safety outcomes. A cross-sectional survey was conducted with 600 acute care registered nurses (RNs) to test and refine a model linking interactional justice, the quality of nurse leader-nurse relationships, work environment and safety climate with patient and nurse outcomes. In general the hypothesized model was supported. Resonant leadership and interactional justice influenced the quality of the leader-nurse relationship which in turn affected the quality of the work environment and safety climate. This ultimately was associated with decreased reported medication errors, intentions to leave and emotional exhaustion. Quality relationships based on fairness and empathy play a pivotal role in creating positive safety climates and work environments. To advocate for safe work environments, managers must strive to develop high-quality relationships through just leadership practices. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

Evaluation of the 12-hour shift trial in a regional intensive care unit.

PubMed

Dwyer, Trudy; Jamieson, Lynn; Moxham, Lorna; Austen, Debbie; Smith, Karen

2007-10-01

Given the shortage of critical care nurses, emphasis has been placed upon improving their working lives through the implementation of flexible work hours. This descriptive exploratory study evaluated the effects of the implementation of the 12-hour roster in a regional intensive care unit (ICU). Staff (n = 19) completed a survey 12 weeks following the implementation of the 12-hour roster. The study demonstrated widespread acceptance (92%) positive impact on physical and psychological well-being and increased work satisfaction (58%) for the nursing participants. Similarly, nurses working both the 8- and 12-hour rosters (75%), the doctors and allied health care workers all identified increased continuity of patient care as an outcome of the 12-hour shift. Participants strongly agreed that 12-hour rostering was a good recruitment (67%) and retention (75%) strategy. In an environment with considerable shortages of experienced critical care nurses, the use of flexible shift patterns such as the 12-hour roster was a positive recruitment and recruitment strategy.

Implementing AORN recommended practices for a safe environment of care, part II.

PubMed

Kennedy, Lynne

2014-09-01

Construction in and around a working perioperative suite is a challenge beyond merely managing traffic patterns and maintaining the sterile field. The AORN "Recommended practices for a safe environment of care, part II" provides guidance on building design; movement of patients, personnel, supplies, and equipment; environmental controls; safety and security; and control of noise and distractions. Whether the OR suite evolves through construction, reconstruction, or remodeling, a multidisciplinary team of construction experts and health care professionals should create a functional plan and communicate at every stage of the project to maintain a safe environment and achieve a well-designed outcome. Emergency preparedness, a facility-wide security plan, and minimization of noise and distractions in the OR also help enhance the safety of the perioperative environment. Copyright © 2014 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Is anybody listening? A qualitative study of nurses' reflections on practice.

PubMed

Huntington, Annette; Gilmour, Jean; Tuckett, Anthony; Neville, Stephen; Wilson, Denise; Turner, Catherine

2011-05-01

To explore nurses' perceptions of the reality of practice based on data from the Nurses and Midwives e-cohort Study which examined the workforce characteristics, work-life balance and health of nurses. Recruitment and retention of the nursing workforce is of international concern as demands increase due to demographic changes, political pressure and community expectations, in a climate of economic constraint. Qualitative analysis of data from a cohort of Australian, New Zealand and UK nurses. Of the 7604 participants in the electronic cohort, 1909 provided qualitative comments of which 162 related to nursing practice; thematic analysis resulted in four high order themes. The analytical discussion is structured around 'care' as the organising construct. Four themes emerged: 'embodied care' which discusses the impact of work on the nurse's physical and emotional health; 'quantity/quality care' which addresses increasing pressures of work and ability to provide quality care; 'organisational (non)care' raising the seeming lack of support from management; and '(un)collegial/self care' where bullying and professional relationships were raised. Issues raised by participants have been discussed in the nursing literature for several years yet nurses still experience these negative aspects of nursing. It appears there is a significant gap between what is known about the practice environment, recommendations for change and change occurring: the management equivalent of the theory-practice gap, resulting in nurses intending to leave the profession. Research demonstrates that a well-qualified, stable nursing workforce improves quality of health care and health outcomes. Changing the work environment and fostering a positive workplace culture seems fundamental to supporting the retention of nurses, that this is not occurring in some areas in the current climate is a concern for the profession and those responsible for the provision of care. © 2011 Blackwell Publishing Ltd.

Social support in the workplace: nurse leader implications.

PubMed

Shirey, Maria R

2004-01-01

The state of the science as it relates to the stress-mediating role of social support in the health care work environment is explored. The ability to build a nursing leadership workforce is dependent upon a type of social support mechanism that mediates the inherent stress that comes along with managerial positions. Independent of the inevitable work-related stress associated with the nurse manager role, social support provided to current and aspiring nurse leaders is assumed to assist with coping and thriving in the work environment.

Empowering certified nurse's aides to improve quality of work life through a team communication program.

PubMed

Howe, Erin E

2014-01-01

The purpose of this pilot study was to explore the impact of a certified nurse's aide (CNA)-led interdisciplinary teamwork and communication intervention on perceived quality of work environment and six-month job intentions. CNAs are frequently excluded from team communication and decision-making, which often leads to job dissatisfaction with high levels of staff turnover. Using a mixed quantitative and qualitative approach with pre- post-program design, the intervention utilized the strategy of debriefing from the national patient safety initiative, TeamSTEPPS. Inherent in the program design, entitled Long Term Care (LTC) Team Talk, was the involvement of the CNAs in the development of the intervention as an empowering process on two wings of a transitional care unit in a long-term care facility in upstate NY. CNAs' perceptions of work environment quality were measured using a Quality of Work Life (QWL) instrument. Additionally, job turnover intent within six months was assessed. Results indicated improved scores on nearly all QWL subscales anticipated to be impacted, and enhanced perceived empowerment of the CNAs on each wing albeit through somewhat different experiential processes. The program is highly portable and can potentially be implemented in a variety of long-term care settings. Copyright © 2014 Mosby, Inc. All rights reserved.

Healthy work environments for the ageing nursing workforce.

PubMed

Stichler, Jaynelle F

2013-10-01

The aim of this article is to describe the physical challenges that ageing nurses experience and the facility design features that can promote healthy work environments to motivate nurses to continue working. Older nurses are working longer and beyond the usual retirement age. They often experience chronic fatigue and the usual physical and cognitive changes associated with aging. Nursing is a physically demanding profession and many older nurses work in pain while providing direct patient care. The literature is replete with studies focusing on the organisational factors that retain older nurses, but little research addresses design factors that facilitate nurses working longer and more safely in direct patient care. Electronic databases in medicine, nursing, psychology, and architecture were searched and evidence-based, non-evidence-based, and review articles and government and organisational newsletters were evaluated. Hospital design can help address the physical work challenges that older nurses experience. Older nurses have a wealth of knowledge and expertise, and the design of nursing units can optimize their work experience. Nurse Managers must participate in design efforts and advocate designs that support aging nurses. © 2013 John Wiley & Sons Ltd.

The changing scene of social work in hospitals: a report of a national study by the Society for Social Work Administrators in Health Care and NASW.

PubMed

Berger, C S; Cayner, J; Jensen, G; Mizrahi, T; Scesny, A; Trachtenberg, J

1996-08-01

The Society for Social Work Administrators in Health Care and NASW collaborated on a national study of the changes affecting social work services in a sample of 340 hospitals drawn from the member list of the American Hospital Association. The findings suggest that the changes affecting social work need to be viewed within the context of the dramatic changes occurring in the hospital and health care field. Although social work departments are experiencing decreases, these decreases often are not occurring at the same rate as those within the hospital overall. Growth is occurring in the types and scope of services. Social work is not being singled out for change, but it is critical that these trends continue to be monitored and proactive strategies used to enhance social work viability within a changing hospital environment.

Stabilizing and destabilizing forces in the nursing work environment: a qualitative study on turnover intention.

PubMed

Choi, Sandy Pin-Pin; Pang, Samantha Mei-Che; Cheung, Kin; Wong, Thomas Kwok-Shing

2011-10-01

The nursing work environment, which provides the context of care delivery, has been gaining increasing attention in recent years. A growing body of evidence points to an inseparable link between attributes of the nursing work environment and nurse and patient outcomes. While most studies have adopted a survey design to examine the workforce and work environment issues, this study employed a phenomenological approach to provide empirical evidence regarding nurses' perceptions of their work and work environment. The aim of this study was to advance our understanding of the phenomenon of increasing nurse turnover through exploring frontline registered nurses' lived experiences of working in Hong Kong public hospitals. A modified version of Van Kaam's controlled explication method was adopted. Individual semi-structured interviews were conducted with 26 frontline nurses recruited from ten acute regional, district and non-acute public hospitals in Hong Kong. Their perspectives in regard to their work and work environment, such as workload, manpower demand and professional values, were extensively examined, and a hypothetical description relating the nursing work environment with nurses' turnover intention was posited. Contemplation of nurses' experiences revealed the vulnerable aspects of nursing work and six essential constituents of the nursing work environment, namely staffing level, work responsibility, management, co-worker relationships, job, and professional incentives. These essential constituents have contributed to two sets of forces, stabilizing and destabilizing forces, which originate from the attributes of the nursing work environment. Nurses viewed harmonious co-worker relationships, recognition and professional development as the crucial retaining factors. However, nurses working in an unfavorable environment were overwhelmed by destabilizing forces; they expressed frustration and demonstrated an intention to leave their work environment. The nursing work environment is a complex entity comprising multiple constituents; its attributes affect nurses' perceptions of their work and work environment, which warrant special attention in addressing the phenomenon of increasing nurse turnover. Copyright © 2011 Elsevier Ltd. All rights reserved.

Wellness health care and the architectural environment.

PubMed

Verderber, S; Grice, S; Gutentag, P

1987-01-01

The stress management-wellness health care environment is emerging as a distinct facility type in the 1980s. Yet the idea is not a new one, with roots based in the Greek Asklepieon dating from 480 B.C. This and later Western transformations for health promotion embraced the therapeutic amenity inherent in meditation, solace and communality with nature based on the premise that the need for refuge from the stress inherent in one's daily life is deep-rooted in humans. A two-phase study is reported on wellness health care provider priorities, relative to the architectural features of stress-wellness centers. Representatives of 11 health care organizations responded to a telephone survey questionnaire, and 128 respondents completed a user needs questionnaire. Four major issues were addressed: image and appearance, location and setting, services provided and costs, and patterns of use. Convenience to one's place of work, a balanced mixture of clinical and nonclinical programs, a noninstitutional retreat-like environment, and membership cost structures were found to be major user considerations with respect to planning and design concepts for wellness health care environments. Directions for further research are discussed.

Advances and challenges in oral health after a decade of the "Smiling Brazil" Program.

PubMed

Scherer, Charleni Inês; Scherer, Magda Duarte dos Anjos

2015-01-01

To analyze oral health work changes in primary health care after Brazil's National Oral Health Policy Guidelines were released. A literature review was conducted on Medline, LILACS, Embase, SciELO, Biblioteca Virtual em Saúde, and The Cochrane Library databases, from 2000 to 2013, on elements to analyze work changes. The descriptors used included: primary health care, family health care, work, health care policy, oral health care services, dentistry, oral health, and Brazil. Thirty-two studies were selected and analyzed, with a predominance of qualitative studies from the Northeast region with workers, especially dentists, focusing on completeness and quality of care. Observed advances focused on educational and permanent education actions; on welcoming, bonding, and accountability. The main challenges were related to completeness; extension and improvement of care; integrated teamwork; working conditions; planning, monitoring, and evaluation of actions; stimulating people's participation and social control; and intersectorial actions. Despite the new regulatory environment, there are very few changes in oral health work. Professionals tend to reproduce the dominant biomedical model. Continuing efforts will be required in work management, training, and permanent education fields. Among the possibilities are the increased engagement of managers and professionals in a process to understand work dynamics and training in the perspective of building significant changes for local realities.

Perceptions of health and risk management among home care workers in Sweden.

PubMed

Larsson, A; Karlqvist, L; Westerberg, M; Gard, G

2013-10-01

Municipal home care workers provide high-quality services to an increasing proportion of elderly people living in private homes. The work environments and working conditions of these workers vary to a great extent, implying rapid priority-making among both employers and employees to ensure that the work can be performed in a safe way. This study aims to examine home care workers' perceptions of health, risks, working conditions, and risk management within their organization. The study was based on cross-sectional data collected from home care service staff in a municipality in the north of Sweden. Nursing assistants and care aides ( n  = 133) replied to a self-administered questionnaire. Descriptive statistics and between-group differences were analysed. Home care work was perceived to require high levels of professional skill and ingenuity, a good psychosocial work situation, but required a high physical workload. The general health, the capacity and self-efficacy of the staff in relation to work were good. Difficulty in performing risk assessments and following safety regulations due to lack of time, equipment, and information were identified. There is a need to increase participation in risk assessments among the staff, improve management support, structures, and cooperation with other divisions of the social services and the medical care organizations.

Health care managers learning by listening to subordinates' dialogue training.

PubMed

Grill, C; Ahlborg, G; Wikström, E

2014-01-01

Middle managers in health care today are expected to continuously and efficiently decide and act in administration, finance, care quality, and work environment, and strategic communication has become paramount. Since dialogical communication is considered to promote a healthy work environment, the purpose of this paper is to investigate the ways in which health care managers experienced observing subordinates' dialogue training. A qualitative study using semi-structured interviews and documents from eight middle managers in a dialogue programme intervention conducted by dialogue trainers. Focus was on fostering and assisting workplace dialogue. Conventional qualitative content analysis was used. Managers' experiences were both enriching and demanding, and consisted of becoming aware of communication, meaning perceiving interaction between subordinates as well as own silent interaction with subordinates and trainer; Discovering communicative actions for leadership, by gaining self-knowledge and recognizing relational leadership models from trainers--such as acting democratically and pedagogically--and converting theory into practice, signifying practising dialogue-promoting conversation behaviour with subordinates, peers, and superiors. Only eight managers participated in the intervention, but data afforded a basis for further research. Findings stressed the importance of listening, and of support from superiors, for well-functioning leadership communication at work. Studies focusing on health care managers' communication and dialogue are few. This study contributes to knowledge about these activities in managerial leadership.

Resources and quality of care in services for the elderly.

PubMed

Winsløw, Jacob Hilden; Borg, Vilhelm

2008-05-01

To investigate the association between resources of the workplace and the quality of care in municipal long-term care. At the municipal level, the resources comprised the proportion of care workers with a long period of professional training and the relative availability of care-giving manpower. At the level of the organizational unit, the resources comprised aspects of the psychosocial working environment. A survey of 7,500 care workers in 36 municipalities in Denmark was performed. Quality of care was measured by seven standardized questions in a questionnaire. Data on the psychosocial resources of the workplace were aggregated responses from the care workers to questions from the Copenhagen Psychosocial Questionnaire. Data on the training and relative availability of care workers were derived by combining information from payroll lists and data available from government databases. There was a positive association between psychosocial resources at the level of the organizational unit and the quality of care provided by the individual care worker. There was no association between the level of professional training of the municipal workforce of care-givers and the quality of care provided by the individual care worker. There was a complex relationship between the relative availability of care-giving manpower at the municipal level and the quality of care provided by the individual care worker. Improving the psychosocial working environment of care workers is one key to securing sufficient caring staff for the long-term care sector; increasing manpower or increasing the proportion of highly trained staff are not in themselves such keys.

Emotional labour underlying caring: an evolutionary concept analysis.

PubMed

Huynh, Truc; Alderson, Marie; Thompson, Mary

2008-10-01

This paper is a report of a concept analysis of emotional labour. Caring is considered as the essence of nursing. Underpinning caring, the internal regulation of emotions or the emotional labour of nurses is invisible. The concept of emotional labour is relatively underdeveloped in nursing. A literature search using keywords 'emotional labour', 'emotional work' and 'emotions' was performed in CINAHL, PsycINFO and REPERE from 1990 to January 2008. We analysed 72 papers whose main focus of inquiry was on emotional labour. We followed Rodgers' evolutionary method of concept analysis. Emotional labour is a process whereby nurses adopt a 'work persona' to express their autonomous, surface or deep emotions during patient encounters. Antecedents to this adoption of a work persona are events occurring during patient-nurse encounters, and which consist of three elements: organization (i.e. social norms, social support), nurse (i.e. role identification, professional commitment, work experience and interpersonal skills) and job (i.e. autonomy, task routine, degree of emotional demand, interaction frequency and work complexity). The attributes of emotional labour have two dimensions: nurses' autonomous response and their work persona strategies (i.e. surface or deep acts). The consequences of emotional labour include organizational (i.e. productivity, 'cheerful environment') and nurse aspects (i.e. negative or positive). The concept of emotional labour should be introduced into preregistration programmes. Nurses also need to have time and a supportive environment to reflect, understand and discuss their emotional labour in caring for 'difficult' patients to deflate the dominant discourse about 'problem' patients.

[Emotional labour of nursing care: an evolutionary concept analysis].

PubMed

Truc, Huynh; Alderson, Marie; Thompson, Mary

2009-06-01

Caring is considered as the essence of nursing. Underpinning caring, the internal regulation of emotions or the emotional labour of nurses is invisible. The concept of emotional labour is relatively underdeveloped in nursing. A literature search using keywords 'emotional labour', 'emotional work' and 'emotions' was performed in CINAHL, psycINFO and REPERE from 1990 to January 2008. We analysed 72 papers whose main focus of inquiry was on emotional labour. We followed Rodgers' evolutionary method of concept analysis. Emotional labour is a process whereby nurse adopt a 'work persona' to express their autonomous, surface or deep emotions during patient encounters. Antecedents to this adoption of a work persona are events occurring during patient-nurse encounters, and which consist of three elements : organization (i.e.social norms, social support), nurse (i.e.role identification, professional commitment, work experience and interpersonal skills) and job (i.e.autonomy, task routine, degree of emotional demand, interaction frequency and work complexity). The attributes of emotional labour have two dimensions : nurses' autonomous response and their work persona strategies (i.e. surface or deep acts). The consequences of emotional labour include organizational (i.e.productivity, 'cheerful environment') and nurse aspects (i.e. negative or positive) the concept of emotional labour should be introduced into preregistration programmes. Nurses also need to have time and a supportive environment to reflect, understand and discuss their emotional labour in caring for 'difficult' patients to deflate the dominant discourse about 'problem' patients.

Review of noise in neonatal intensive care units regional analysis

NASA Astrophysics Data System (ADS)

Alvarez Abril, A.; Terrón, A.; Boschi, C.; Gómez, M.

2007-11-01

This work is about the problem of noise in neonatal incubators and in the environment in the neonatal intensive care units. Its main objective is to analyse the impact of noise in hospitals of Mendoza and La Rioja. Methodology: The measures were taken in different moments in front of higher or lower severity level in the working environment. It is shown that noise produces severe damages and changes in the behaviour and the psychological status of the new born babies. Results: The noise recorded inside the incubators and the neonatal intensive care units together have many components but the noise of motors, opening and closing of access gates have been considered the most important ones. Values above 60 db and and up to 120 db in some cases were recorded, so the need to train the health staff in order to manage the new born babies, the equipment and the instruments associated with them very carefully is revealed.

Compassion Satisfaction and Compassion Fatigue Among Critical Care Nurses.

PubMed

Sacco, Tara L; Ciurzynski, Susan M; Harvey, Megan Elizabeth; Ingersoll, Gail L

2015-08-01

Although critical care nurses gain satisfaction from providing compassionate care to patients and patients' families, the nurses are also at risk for fatigue. The balance between satisfaction and fatigue is considered professional quality of life. To establish the prevalence of compassion satisfaction and compassion fatigue in adult, pediatric, and neonatal critical care nurses and to describe potential contributing demographic, unit, and organizational characteristics. In a cross-sectional design, nurses were surveyed by using a demographic questionnaire and the Professional Quality of Life Scale to measure levels of compassion fatigue and compassion satisfaction. Nurses (n = 221) reported significant differences in compassion satisfaction and compassion fatigue on the basis of sex, age, educational level, unit, acuity, change in nursing management, and major systems change. Understanding the elements of professional quality of life can have a positive effect on work environment. The relationship between professional quality of life and the standards for a healthy work environment requires further investigation. Once this relationship is fully understood, interventions to improve this balance can be developed and tested. ©2015 American Association of Critical-Care Nurses.

Work Environment Questionnaires and Army Unit Effectiveness and Satisfaction Measures

DTIC Science & Technology

1977-09-01

satisfaction indices (retention rates and disciplinary actions) and place more emphasis on these outcomes. In balance , the work environment and...last me a year"), and that "effective" supervisors and organizations planned carefully to stay within these constraints and balance expenditures over...scale was out of balance with its higher end. Most instruments reviewed used Likert scales with numerical anchors; very few provided specific descriptive

The Physical and Psychological Environment of Children in Sweden.

ERIC Educational Resources Information Center

Gronvall, Karin

1984-01-01

This article describes aspects of the environment for children in Sweden and discusses some of the measures taken or planned for improvement. The significance of the residential environment is explored, and the nature of the child care system in a country where over 80 percent of women with small children work outside the home is described. Also…

Ecosystems in the Backyard: Preparing a Diverse Outdoor Environment for Primary (Ages Three to Six) Children

ERIC Educational Resources Information Center

Verschuur, Mary B.

2013-01-01

Mary Verschuur chronicles the outdoor work of Lincoln Montessori School in prairie, forest, and indoor greenhouse environments, pointing out the application of the prepared environment principles to the natural world. Implicit to the design are opportunities for caring, including various practical life exercises with outdoor tools blended into…

Transplant Nurses' Work Environment: A Cross-Sectional Multi-Center Study.

PubMed

Kugler, Christiane; Akca, Selda; Einhorn, Ina; Rebafka, Anne; Russell, Cynthia L

2016-09-01

BACKGROUND Numerically, nurses represent the largest healthcare profession, thus setting norms for the quality and safety of direct patient care. Evidence of a global shortage of nurses in all clinical practice settings across different healthcare systems and countries has been documented. The aims of the present study were: (1) to assess work environments in a sample of German transplant nurses, and (2) to compare their statements with a US-based sample. MATERIAL AND METHODS In a cross-sectional study, 181 transplant nurses from 16 German transplant centers provided information on their work environments. The translated version of the Job Design (JD) and Job Satisfaction (JS) survey showed satisfactory internal consistency for the JD (0.78) and JS (0.93) subscales. German nurses' work environments were compared with 331 transplant nurses from the US. RESULTS The majority of transplant nurses were female (81.8%), 55.4% were age 21-40 years, and 78.1% were employed full-time. German (versus US) transplant nurses reported their job design to be best for 'skill varieties' (p≤0.0002), and worst for 'autonomy' (p≤0.01). Job satisfaction was best with 'opportunities for autonomy and growth' (p≤0.0001), and 'pay and benefits' (p≤0.0001) was lowest. A higher professional degree (OR 1.57; p≤0.03; 95% CI 1.19-2.86), and longer time in transplant (OR 1.24; p≤0.001; 95% CI 1.11-1.38) showed a positive impact on German transplant nurses' perceptions of 'job satisfaction'. Nurses with time-dependent working contracts perceived more stress negatively affecting job satisfaction (OR 1.13; p≤0.009; 95% CI 1.02-12.82). CONCLUSIONS German specialty nurses working in the field of solid organ transplantation rate their work environments with respect to job design and job satisfaction as satisfactory. Institutions' investment into satisfactory nurse work environments and specializing nurses might increase the quality of care, thus improving patient outcomes.

Perianesthesia Nurses Are My Second Family: A Qualitative Descriptive Study.

PubMed

Seefeldt, Julanne; Wood, Stacey; Bolton, Pamela; Fitzpatrick, Tara; Stegenga, Kristin; Roberts, Cristine

2017-12-01

Identify the perceptions of perianesthesia nurses regarding behaviors that promote or detract from sustaining a safe, efficient, and satisfying work environment. Two focus groups and seven individual interviews (n=14) were conducted exploring the perceptions regarding team behavior of registered nurses in one pediatric perianesthesia unit. Qualitative descriptive data collection, inductive content analysis. Nurses described a responsive, engaged health care team whose leadership is available and directive when needed, as creating an effective, satisfying work environment. Primary themes that emerged were Leadership Sets the Tone, Playing Fair, No One Gets Hurt, and Why We Stay. This nursing team acknowledged that inattentive, distracted team members cause frustration, work inequities, and care delays, potentially undermining patient safety. Results demonstrate the need to create and sustain consistently respectful perianesthesia work cultures. Research focusing on unit specific approaches to work distribution, communication, leadership, and technology use is needed. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

The views of nurses regarding caring in the workplace.

PubMed

Minnaar, A

2003-05-01

This survey describes caring in the workplace in selected health services and is part of a greater study conducted in KwaZulu-Natal, South Africa. This study describes the views of nurse managers and nurses regarding caring in the workplace. Human competence, recovery and healing are central to caring. To ensure caring and healing of patients in health services it is of the utmost importance for nurse managers to ensure a healthy and caring environment in the management of nurses. When caring is present in the workplace, nurses are more able to render caring nursing practices in the patient care environment. It is clear that to become a caring person, one must be treated in a caring way and that caring may be impaired or reinforced by the environment. The environment of interest to this study was the environment in which nurses practise. A descriptive survey with a convenience sampling explored caring in the workplace of nurses. The questionnaire was divided into two sections. Section A comprised demographic information and in section B the questionnaire consisted of Likert type questions, open-ended questions and yes/no questions. Analysis included descriptive statistics. It was found that caring was not experienced in the hospitals by nurses in the major management tasks such as respect for human dignity, two-way communication, trust between nurses and nurse managers, wellness, cultural sensitivity, support and the recognition and handling of the concerns of nurses. It was clear that although nurse managers and nurses have the knowledge and structures for the implementation of caring in the hospitals, the everyday practical application of caring needs attention. Nurse managers were aware of caring practices but nurses did not always experience caring in their places of work in the hospitals. Nurse managers and nurses should all accept responsibility for finding means to improve communication and, in particular, participative leadership strategies in the hospitals. Previous research showed that a large majority of nurses agreed on which caring concepts were important aspects in nursing management.

Mental health recovery on care farms and day centres: a qualitative comparative study of users' perspectives.

PubMed

Iancu, Sorana C; Zweekhorst, Marjolein B M; Veltman, Dick J; van Balkom, Anton J L M; Bunders, Joske F G

2014-01-01

Mental health services increasingly incorporate the vision of recovery. This qualitative study analysed and compared experiences of recovery on prevocational services, in order to assess if users make progress towards recovery, relative to a staged recovery model. Data were collected through semi-structured interviews with participants on care farms (n = 14), work (n = 7) and creative projects (n = 5). The transition from past to current lives was described as a progressive, non-linear process, with different stages guided by different goals. Participants on creative projects lacked clear goals, presented less interest in peers and high need for emotional support. Participants on work projects aimed for occupational rehabilitation, but struggled with the patient culture of the peer community. Participants on care farms aimed for daytime occupations and closer contact with society. They experienced care farms as open, real-life work settings where they could exercise responsibility and connect with people. Participants progressed towards recovery, as care farms, work- and creative projects empowered them to leave behind inactive, isolated or disorganized living. In day centres, users focused on self-reflection and personal development (creative projects) or on occupational performance (work projects), whereas on care farms, users fulfilled worker roles in a real-life, open community environment. Organized as open communities in real-life settings, care farms facilitate the reflection on personal and social responsibility, and therefore have the potential to help users internalize worker identities and improve their motivation to progress towards recovery. Supervisors on care farms are regarded by users as close contacts within the social networks they develop on the service, a position that allows supervisors to actively engage and promote users' progress towards recovery. Elements of the farm environment (such as the "normal life", presence of family members and visitors, and nature) can serve as anchors for supporting the progress towards recovery.

Neonatal Intensive Care Unit Nurses Working in an Open Ward: Stress and Work Satisfaction.

PubMed

Lavoie-Tremblay, Mélanie; Feeley, Nancy; Lavigne, Geneviève L; Genest, Christine; Robins, Stéphanie; Fréchette, Julie

2016-01-01

There is some research on the impact of open-ward unit design on the health of babies and the stress experienced by parents and nurses in neonatal intensive care units. However, few studies have explored the factors associated with nurse stress and work satisfaction among nurses practicing in open-ward neonatal intensive care units. The purpose of this study was to examine what factors are associated with nurse stress and work satisfaction among nurses practicing in an open-ward neonatal intensive care unit. A cross-sectional correlational design was used in this study. Participants were nurses employed in a 34-bed open-ward neonatal intensive care unit in a major university-affiliated hospital in Montréal, Quebec, Canada. A total of 94 nurses were eligible, and 86 completed questionnaires (91% response rate). Descriptive statistics were computed to describe the participants' characteristics. To identify factors associated with nurse stress and work satisfaction, correlational analysis and multiple regression analyses were performed with the Nurse Stress Scale and the Global Work Satisfaction scores as the dependent variables. Different factors predict neonatal intensive care unit nurses' stress and job satisfaction, including support, family-centered care, performance obstacles, work schedule, education, and employment status. In order to provide neonatal intensive care units nurses with a supportive environment, managers can provide direct social support to nurses and influence the culture around teamwork.

What implies the good work for registered nurses in municipal elderly care in Sweden?

PubMed

Josefsson, Karin; Aling, Jenny; Östin, Britt-Louise

2011-08-01

The aim was to describe registered nurses' perceptions of what the good work implies to them in municipal elderly care. A descriptive design and a structured questionnaire specifically designed for this study were used. Sixty housing units for older people and 213 nurses participated, with a response rate of 62%. The good work included the following aspects: intellectually stimulating without guilt feelings; freedom and independence with the possibility to influence; having appreciative and pleasant fellow workers and a fair and understanding manager; a good physical and risk-free environment; work security and a steady income with the possibility of improving salary through work effort; work effort should be beneficial to others; innovative thinking and initiative should be highly valued; and pride in work without compromising personal values. Employers must take this into consideration to retain those nurses already employed and recruit nurses to municipal elderly care.

Authentic leadership, organizational culture, and healthy work environments.

PubMed

Shirey, Maria R

2009-01-01

The purpose of this article is to showcase the relationship among authentic leadership, organizational culture, and healthy work environments using a stress and coping lens. A qualitative descriptive study was conducted to determine what situations contribute to nurse manager stress, what coping strategies they utilize, what health outcomes they report, and what decision-making processes they follow to address stressful situations in their roles. A purposive sample of 21 nurse managers employed at 3 US acute care hospitals completed a demographic questionnaire and 14-question interview incorporating components of the Critical Decision Method. A secondary analysis of the data was conducted to identify differences in nurse manager narratives based upon differences in the organizational cultures where the managers worked. Of the 21 nurse managers studied, differences were evident in the organizational cultures reported. Nurse managers working in the positive organizational cultures (n = 12) generally worked in healthy work environments and engaged in more authentic leadership behaviors. Conversely, nurse managers working in the negative organizational cultures (n = 9) worked in unhealthy work environments and reported less optimism and more challenges engaging in authentic leadership practices. Organizational culture and leadership matter in creating and sustaining healthy work environments. Nurse managers play a pivotal role in creating these environments, yet they need supportive structures and resources to more effectively execute their roles.

The impact of ethics and work-related factors on nurse practitioners' and physician assistants' views on quality of primary healthcare in the United States

PubMed Central

Ulrich, Connie M.; Zhou, Qiuping (Pearl); Hanlon, Alexandra; Danis, Marion; Grady, Christine

2016-01-01

Purpose Nurse practitioners (NPs) and physician assistants (PAs) provide primary care services for many American patients. Ethical knowledge is foundational to resolving challenging practice issues, yet little is known about the importance of ethics and work-related factors in the delivery of quality care. The aim of this study was to quantitatively assess whether the quality of the care that practitioners deliver is influenced by ethics and work-related factors. Methods This paper is a secondary data analysis of a cross-sectional self-administered mailed survey of 1,371 primary care NPs and PAs randomly selected from primary care and primary care subspecialties in the United States. Results Ethics preparedness and confidence were significantly associated with perceived quality of care (p < 0.01) as were work-related characteristics such as percentage of patients with Medicare and Medicaid, patient demands, physician collegiality, and practice autonomy (p < 0.01). Forty-four percent of the variance in quality of care was explained by these factors. Conclusions Investing in ethics education and addressing restrictive practice environments may improve collaborative practice, teamwork, and quality of care. PMID:24613597

The impact of ethics and work-related factors on nurse practitioners' and physician assistants' views on quality of primary healthcare in the United States.

PubMed

Ulrich, Connie M; Zhou, Qiuping Pearl; Hanlon, Alexandra; Danis, Marion; Grady, Christine

2014-08-01

Nurse practitioners (NPs) and physician assistants (PAs) provide primary care services for many American patients. Ethical knowledge is foundational to resolving challenging practice issues, yet little is known about the importance of ethics and work-related factors in the delivery of quality care. The aim of this study was to quantitatively assess whether the quality of the care that practitioners deliver is influenced by ethics and work-related factors. This paper is a secondary data analysis of a cross-sectional self-administered mailed survey of 1,371 primary care NPs and PAs randomly selected from primary care and primary care subspecialties in the United States. Ethics preparedness and confidence were significantly associated with perceived quality of care (p<0.01) as were work-related characteristics such as percentage of patients with Medicare and Medicaid, patient demands, physician collegiality, and practice autonomy (p<0.01). Forty-four percent of the variance in quality of care was explained by these factors. Investing in ethics education and addressing restrictive practice environments may improve collaborative practice, teamwork, and quality of care. Copyright © 2014 Elsevier Inc. All rights reserved.

Job-related stress in psychiatric nurses in Japan caring for elderly patients with dementia.

PubMed

Yada, Hironori; Abe, Hiroshi; Lu, Xi; Wakizaki, Yuko; Omori, Hisamitsu; Matsuo, Hisae; Ishida, Yasushi; Katoh, Takahiko

2014-11-01

We investigated the specificity and structures of job-related stress in psychiatric dementia nurses (PDNs) caring for elderly patients with serious behavioral and psychological symptoms of dementia who required substantial assistance with activities of daily living, in order to obtain fundamental knowledge toward providing mental health care for these nurses. Subjects were 244 nurses [63 PDNs and 181 other psychiatric nurses (OPNs)] Analysis of covariance to examine the specificity of job-related stress in PDNs revealed physical workload and work environment to be more significant stressors, and irritability and anxiety to be more significant stress reactions in PDNs than in OPNs. An examination of PDNs' job-related stress structures established in a structural equation model with two stress reactions confirmed as specific outcomes for PDNs revealed a significant positive influence of work environment on irritability; utilization of techniques for anxiety and physical workload influenced both stress reactions. Our findings highlight the importance of reducing physical workload and environment and establishing a structure for nursing techniques in psychiatric dementia wards to improve the mental health of PDNs.

Leadership in Surgery for Public Sector Hospitals in Jamaica: Strategies for the Operating Room

PubMed Central

Cawich, Shamir O; Harding, Hyacinth E; Crandon, Ivor W; McGaw, Clarence D; Barnett, Alan T; Tennant, Ingrid; Evans, Necia R; Martin, Allie C; Simpson, Lindberg K; Johnson, Peter

2013-01-01

The barriers to health care delivery in developing nations are many: underfunding, limited support services, scarce resources, suboptimal health care worker attitudes, and deficient health care policies are some of the challenges. The literature contains little information about health care leadership in developing nations. This discursive paper examines the impact of leadership on the delivery of operating room (OR) services in public sector hospitals in Jamaica. Delivery of OR services in Jamaica is hindered by many unique cultural, financial, political, and environmental barriers. We identify six leadership goals adapted to this environment to achieve change. Effective leadership must adapt to the environment. Delivery of OR services in Jamaica may be improved by addressing leadership training, workplace safety, interpersonal communication, and work environment and by revising existing policies. Additionally, there should be regular practice audits and quality control surveys. PMID:24355903

Methicillin-resistant Staphylococcus aureus: an overview for manual therapists().

PubMed

Green, Bart N; Johnson, Claire D; Egan, Jonathon Todd; Rosenthal, Michael; Griffith, Erin A; Evans, Marion Willard

2012-03-01

Methicillin-resistant Staphylococcus aureus (MRSA) is associated with difficult-to-treat infections and high levels of morbidity. Manual practitioners work in environments where MRSA is a common acquired infection. The purpose of this review is to provide a practical overview of MRSA as it applies to the manual therapy professions (eg, physical and occupational therapy, athletic training, chiropractic, osteopathy, massage, sports medicine) and to discuss how to identify and prevent MRSA infections in manual therapy work environments. PubMed and CINAHL were searched from the beginning of their respective indexing years through June 2011 using the search terms MRSA, methicillin-resistant Staphylococcus aureus, and Staphylococcus aureus. Texts and authoritative Web sites were also reviewed. Pertinent articles from the authors' libraries were included if they were not already identified in the literature search. Articles were included if they were applicable to ambulatory health care environments in which manual therapists work or if the content of the article related to the clinical management of MRSA. Following information extraction, 95 citations were included in this review, to include 76 peer-reviewed journal articles, 16 government Web sites, and 3 textbooks. Information was organized into 10 clinically relevant categories for presentation. Information was organized into the following clinically relevant categories: microbiology, development of MRSA, risk factors for infection, clinical presentation, diagnostic tests, screening tests, reporting, treatment, prevention for patients and athletes, and prevention for health care workers. Methicillin-resistant S aureus is a health risk in the community and to patients and athletes treated by manual therapists. Manual practitioners can play an essential role in recognizing MRSA infections and helping to control its transmission in the health care environment and the community. Essential methods for protecting patients and health care workers include being aware of presenting signs, patient education, and using appropriate hand and clinic hygiene.

Inflows of foreign-born physicians and their access to employment and work experiences in health care in Finland: qualitative and quantitative study

PubMed Central

2014-01-01

Background In many developed countries, including Finland, health care authorities customarily consider the international mobility of physicians as a means for addressing the shortage of general practitioners (GPs). This study i) examined, based on register information, the numbers of foreign-born physicians migrating to Finland and their employment sector, ii) examined, based on qualitative interviews, the foreign-born GPs’ experiences of accessing employment and work in primary care in Finland, and iii) compared experiences based on a survey of the psychosocial work environment among foreign-born physicians working in different health sectors (primary care, hospitals and private sectors). Methods Three different data sets were used: registers, theme interviews among foreign-born GPs (n = 12), and a survey for all (n = 1,292; response rate 42%) foreign-born physicians living in Finland. Methods used in the analyses were qualitative content analysis, analysis of covariance, and logistic regression analysis. Results The number of foreign-born physicians has increased dramatically in Finland since the year 2000. In 2000, a total of 980 foreign-born physicians held a Finnish licence and lived in Finland, accounting for less than 4% of the total number of practising physicians. In 2009, their proportion of all physicians was 8%, and a total of 1,750 foreign-born practising physicians held a Finnish licence and lived in Finland. Non-EU/EEA physicians experienced the difficult licensing process as the main obstacle to accessing work as a physician. Most licensed foreign-born physicians worked in specialist care. Half of the foreign-born GPs could be classified as having an ‘active’ job profile (high job demands and high levels of job control combined) according to Karasek’s demand-control model. In qualitative interviews, work in the Finnish primary health centres was described as multifaceted and challenging, but also stressful. Conclusions Primary care may not be able in the long run to attract a sufficient number of foreign-born GPs to alleviate Finland’s GP shortage, although speeding up the licensing process may bring in more foreign-born physicians to work, at least temporarily, in primary care. For physicians to be retained as active GPs there needs to be improvement in the psychosocial work environment within primary care. PMID:25103861

Inflows of foreign-born physicians and their access to employment and work experiences in health care in Finland: qualitative and quantitative study.

PubMed

Kuusio, Hannamaria; Lämsä, Riikka; Aalto, Anna-Mari; Manderbacka, Kristiina; Keskimäki, Ilmo; Elovainio, Marko

2014-08-07

In many developed countries, including Finland, health care authorities customarily consider the international mobility of physicians as a means for addressing the shortage of general practitioners (GPs). This study i) examined, based on register information, the numbers of foreign-born physicians migrating to Finland and their employment sector, ii) examined, based on qualitative interviews, the foreign-born GPs' experiences of accessing employment and work in primary care in Finland, and iii) compared experiences based on a survey of the psychosocial work environment among foreign-born physicians working in different health sectors (primary care, hospitals and private sectors). Three different data sets were used: registers, theme interviews among foreign-born GPs (n = 12), and a survey for all (n = 1,292; response rate 42%) foreign-born physicians living in Finland. Methods used in the analyses were qualitative content analysis, analysis of covariance, and logistic regression analysis. The number of foreign-born physicians has increased dramatically in Finland since the year 2000. In 2000, a total of 980 foreign-born physicians held a Finnish licence and lived in Finland, accounting for less than 4% of the total number of practising physicians. In 2009, their proportion of all physicians was 8%, and a total of 1,750 foreign-born practising physicians held a Finnish licence and lived in Finland. Non-EU/EEA physicians experienced the difficult licensing process as the main obstacle to accessing work as a physician. Most licensed foreign-born physicians worked in specialist care. Half of the foreign-born GPs could be classified as having an 'active' job profile (high job demands and high levels of job control combined) according to Karasek's demand-control model. In qualitative interviews, work in the Finnish primary health centres was described as multifaceted and challenging, but also stressful. Primary care may not be able in the long run to attract a sufficient number of foreign-born GPs to alleviate Finland's GP shortage, although speeding up the licensing process may bring in more foreign-born physicians to work, at least temporarily, in primary care. For physicians to be retained as active GPs there needs to be improvement in the psychosocial work environment within primary care.

Quality dementia care: Prerequisites and relational ethics among multicultural healthcare providers.

PubMed

Sellevold, Gerd Sylvi; Egede-Nissen, Veslemøy; Jakobsen, Rita; Sørlie, Venke

2017-01-01

Many nursing homes appear as multicultural workplaces where the majority of healthcare providers have an ethnic minority background. This environment creates challenges linked to communication, interaction and cultural differences. Furthermore, the healthcare providers have varied experiences and understanding of what quality care of patients with dementia involves. The aim of this study is to illuminate multi-ethnic healthcare providers' lived experiences of their own working relationship, and its importance to quality care for people with dementia. The study is part of a greater participatory action research project: 'Hospice values in the care for persons with dementia'. The data material consists of extensive notes from seminars, project meetings and dialogue-based teaching. The text material was subjected to phenomenological-hermeneutical interpretation. Participants and research context: Participants in the project were healthcare providers working in a nursing home unit. The participants came from 15 different countries, had different formal qualifications, varied backgrounds and ethnic origins. Ethical considerations: The study is approved by the Norwegian Regional Ethics Committee and the Norwegian Social Science Data Services. The results show that good working relationships, characterized by understanding each other's vulnerability and willingness to learn from each other through shared experiences, are prerequisites for quality care. The healthcare providers further described ethical challenges as uncertainty and different understandings. The results are discussed in the light of Lögstrup's relational philosophy of ethics and the concepts of vulnerability, ethic responsibility, trust and openness of speech. The prerequisite for quality care for persons with dementia in a multicultural working environment is to create arenas for open discussions between the healthcare providers. Leadership is of great importance.

Mindfulness in Motion (MIM): An Onsite Mindfulness Based Intervention (MBI) for Chronically High Stress Work Environments to Increase Resiliency and Work Engagement.

PubMed

Klatt, Maryanna; Steinberg, Beth; Duchemin, Anne-Marie

2015-07-01

A pragmatic mindfulness intervention to benefit personnel working in chronically high-stress environments, delivered onsite during the workday, is timely and valuable to employee and employer alike. Mindfulness in Motion (MIM) is a Mindfulness Based Intervention (MBI) offered as a modified, less time intensive method (compared to Mindfulness-Based Stress Reduction), delivered onsite, during work, and intends to enable busy working adults to experience the benefits of mindfulness. It teaches mindful awareness principles, rehearses mindfulness as a group, emphasizes the use of gentle yoga stretches, and utilizes relaxing music in the background of both the group sessions and individual mindfulness practice. MIM is delivered in a group format, for 1 hr/week/8 weeks. CDs and a DVD are provided to facilitate individual practice. The yoga movement is emphasized in the protocol to facilitate a quieting of the mind. The music is included for participants to associate the relaxed state experienced in the group session with their individual practice. To determine the intervention feasibility/efficacy we conducted a randomized wait-list control group in Intensive Care Units (ICUs). ICUs represent a high-stress work environment where personnel experience chronic exposure to catastrophic situations as they care for seriously injured/ill patients. Despite high levels of work-related stress, few interventions have been developed and delivered onsite for such environments. The intervention is delivered on site in the ICU, during work hours, with participants receiving time release to attend sessions. The intervention is well received with 97% retention rate. Work engagement and resiliency increase significantly in the intervention group, compared to the wait-list control group, while participant respiration rates decrease significantly pre-post in 6/8 of the weekly sessions. Participants value institutional support, relaxing music, and the instructor as pivotal to program success. This provides evidence that MIM is feasible, well accepted, and can be effectively implemented in a chronically high-stress work environment.

Mindfulness in Motion (MIM): An Onsite Mindfulness Based Intervention (MBI) for Chronically High Stress Work Environments to Increase Resiliency and Work Engagement

PubMed Central

Klatt, Maryanna; Steinberg, Beth; Duchemin, Anne-Marie

2015-01-01

A pragmatic mindfulness intervention to benefit personnel working in chronically high-stress environments, delivered onsite during the workday, is timely and valuable to employee and employer alike. Mindfulness in Motion (MIM) is a Mindfulness Based Intervention (MBI) offered as a modified, less time intensive method (compared to Mindfulness-Based Stress Reduction), delivered onsite, during work, and intends to enable busy working adults to experience the benefits of mindfulness. It teaches mindful awareness principles, rehearses mindfulness as a group, emphasizes the use of gentle yoga stretches, and utilizes relaxing music in the background of both the group sessions and individual mindfulness practice. MIM is delivered in a group format, for 1 hr/week/8 weeks. CDs and a DVD are provided to facilitate individual practice. The yoga movement is emphasized in the protocol to facilitate a quieting of the mind. The music is included for participants to associate the relaxed state experienced in the group session with their individual practice. To determine the intervention feasibility/efficacy we conducted a randomized wait-list control group in Intensive Care Units (ICUs). ICUs represent a high-stress work environment where personnel experience chronic exposure to catastrophic situations as they care for seriously injured/ill patients. Despite high levels of work-related stress, few interventions have been developed and delivered onsite for such environments. The intervention is delivered on site in the ICU, during work hours, with participants receiving time release to attend sessions. The intervention is well received with 97% retention rate. Work engagement and resiliency increase significantly in the intervention group, compared to the wait-list control group, while participant respiration rates decrease significantly pre-post in 6/8 of the weekly sessions. Participants value institutional support, relaxing music, and the instructor as pivotal to program success. This provides evidence that MIM is feasible, well accepted, and can be effectively implemented in a chronically high-stress work environment. PMID:26168365

Challenges in the management of chronic noncommunicable diseases by Indonesian community pharmacists.

PubMed

Puspitasari, Hanni P; Aslani, Parisa; Krass, Ines

2015-01-01

We explored factors influencing Indonesian primary care pharmacists' practice in chronic noncommunicable disease management and proposed a model illustrating relationships among factors. We conducted in-depth, semistructured interviews with pharmacists working in community health centers (Puskesmas, n=5) and community pharmacies (apotek, n=15) in East Java Province. We interviewed participating pharmacists using Bahasa Indonesia to explore facilitators and barriers to their practice in chronic disease management. We audiorecorded all interviews, transcribed ad verbatim, translated into English and analyzed the data using an approach informed by "grounded-theory". We extracted five emergent themes/factors: pharmacists' attitudes, Puskesmas/apotek environment, pharmacy education, pharmacy professional associations, and the government. Respondents believed that primary care pharmacists have limited roles in chronic disease management. An unfavourable working environment and perceptions of pharmacists' inadequate knowledge and skills were reported by many as barriers to pharmacy practice. Limited professional standards, guidelines, leadership and government regulations coupled with low expectations of pharmacists among patients and doctors also contributed to their lack of involvement in chronic disease management. We present the interplay of these factors in our model. Pharmacists' attitudes, knowledge, skills and their working environment appeared to influence pharmacists' contribution in chronic disease management. To develop pharmacists' involvement in chronic disease management, support from pharmacy educators, pharmacy owners, professional associations, the government and other stakeholders is required. Our findings highlight a need for systematic coordination between pharmacists and stakeholders to improve primary care pharmacists' practice in Indonesia to achieve continuity of care.

Challenges to neurology residency education in today's health care environment.

PubMed

Bega, Danny; Krainc, Dimitri

2016-09-01

Residency training has had to adapt to higher patient volumes, increased complexity of medical care, and the commercialized system of health care. These changes have led to a concerning culture shift in neurology. We review the relationship between the emerging health care delivery system and residency training, highlighting issues related to duty hours and work-life balance, the changing technological landscape, high patient volumes, and complex service obligations. We propose that the current challenges in health care delivery offer the opportunity to improve neurology residency through faculty development programs, bringing teaching back to the bedside, increasing resident autonomy, utilizing near-peer teaching, and rewarding educators who facilitate an environment of inquiry and scholarship, with the ultimate goal of better alignment between education and patient care. Ann Neurol 2016;80:315-320. © 2016 American Neurological Association.

Is the public healthcare sector a more strenuous working environment than the private sector for a physician?

PubMed

Heponiemi, Tarja; Kouvonen, Anne; Sinervo, Timo; Elovainio, Marko

2013-02-01

The present study examined the differences between physicians working in public and private health care in strenuous working environments (presence of occupational hazards, physical violence, and presenteeism) and health behaviours (alcohol consumption, body mass index, and physical activity). In addition, we examined whether gender or age moderated these potential differences. Cross-sectional survey data were compiled on 1422 female and 948 male randomly selected physicians aged 25-65 years from The Finnish Health Care Professionals Study. Logistic regression and linear regression analyses were used with adjustment for gender, age, specialisation status, working time, managerial position, and on-call duty. Occupational hazards, physical violence, and presenteeism were more commonly reported by physicians working in the public sector than by their counterparts in the private sector. Among physicians aged 50 years or younger, those who worked in the public sector consumed more alcohol than those who worked in the private sector, whereas in those aged 50 or more the reverse was true. In addition, working in the private sector was most strongly associated with lower levels of physical violence in those who were older than 50 years, and with lower levels of presenteeism among those aged 40-50 years. The present study found evidence for the public sector being a more strenuous work environment for physicians than the private sector. Our results suggest that public healthcare organisations should pay more attention to the working conditions of their employees.

Linking patient satisfaction with nursing care: the case of care rationing - a correlational study.

PubMed

Papastavrou, Evridiki; Andreou, Panayiota; Tsangari, Haritini; Merkouris, Anastasios

2014-01-01

Implicit rationing of nursing care is the withholding of or failure to carry out all necessary nursing measures due to lack of resources. There is evidence supporting a link between rationing of nursing care, nurses' perceptions of their professional environment, negative patient outcomes, and placing patient safety at risk. The aims of the study were: a) To explore whether patient satisfaction is linked to nurse-reported rationing of nursing care and to nurses' perceptions of their practice environment while adjusting for patient and nurse characteristics. b) To identify the threshold score of rationing by comparing the level of patient satisfaction factors across rationing levels. A descriptive, correlational design was employed. Participants in this study included 352 patients and 318 nurses from ten medical and surgical units of five general hospitals. Three measurement instruments were used: the BERNCA scale for rationing of care, the RPPE scale to explore nurses' perceptions of their work environment and the Patient Satisfaction scale to assess the level of patient satisfaction with nursing care. The statistical analysis included the use of Kendall's correlation coefficient to explore a possible relationship between the variables and multiple regression analysis to assess the effects of implicit rationing of nursing care together with organizational characteristics on patient satisfaction. The mean score of implicit rationing of nursing care was 0.83 (SD = 0.52, range = 0-3), the overall mean of RPPE was 2.76 (SD = 0.32, range = 1.28 - 3.69) and the two scales were significantly correlated (τ = -0.234, p < 0.001). The regression analysis showed that care rationing and work environment were related to patient satisfaction, even after controlling for nurse and patient characteristics. The results from the adjusted regression models showed that even at the lowest level of rationing (i.e. 0.5) patients indicated low satisfaction. The results support the relationships between organizational and environmental variables, care rationing and patient satisfaction. The identification of thresholds at which rationing starts to influence patient outcomes in a negative way may allow nurse managers to introduce interventions so as to keep rationing at a level at which patient safety is not jeopardized.

"Once the government employs you, it forgets you": Health workers' and managers' perspectives on factors influencing working conditions for provision of maternal health care services in a rural district of Tanzania.

PubMed

Mkoka, Dickson Ally; Mahiti, Gladys Reuben; Kiwara, Angwara; Mwangu, Mughwira; Goicolea, Isabel; Hurtig, Anna-Karin

2015-09-14

In many developing countries, health workforce crisis is one of the predominant challenges affecting the health care systems' function of providing quality services, including maternal care. The challenge is related to how these countries establish conducive working conditions that attract and retain health workers into the health care sector and enable them to perform effectively and efficiently to improve health services particularly in rural settings. This study explored the perspectives of health workers and managers on factors influencing working conditions for providing maternal health care services in rural Tanzania. The researchers took a broad approach to understand the status of the current working conditions through a governance lens and brought into context the role of government and its decentralized organs in handling health workers in order to improve their performance and retention. In-depth interviews were conducted with 22 informants (15 health workers, 5 members of Council Health Management Team and 2 informants from the District Executive Director's office). An interview guide was used with questions pertaining to informants' perspective on provision of maternal health care service, working environment, living conditions, handling of staff's financial claims, avenue for sharing concerns, opportunities for training and career progression. Probing questions on how these issues affect the health workers' role of providing maternal health care were employed. Document reviews and observations of health facilities were conducted to supplement the data. The interviews were analysed using a qualitative content analysis approach. Overall, health workers felt abandoned and lost within an unsupportive system they serve. Difficult working and living environments that affect health workers' role of providing maternal health care services were dominant concerns raised from interviews with both health workers and managers. Existence of a bureaucratic and irresponsible administrative system was reported to result in the delay in responding to the health workers' claims timely and that there is no transparency and fairness in dealing with health workers' financial claims. Informants also reported on the non-existence of a formal motivation scheme and a free avenue for voicing and sharing health workers' concerns. Other challenges reported were lack of a clear strategic plan for staff career advancement and continuous professional development to improve health workers' knowledge and skills necessary for providing quality maternal health care. Health workers working in rural areas are facing a number of challenges that affect their working conditions and hence their overall performance. The government and its decentralized organs should be accountable to create conducive working and living environments, respond to health workers' financial claims fairly and equitably, plan for their career advancement and create a free avenue for voicing and sharing concerns with the management. To achieve this, efforts should be directed towards improving the governance of the human resource management system that will take into account the stewardship role of the government in handling human resource carefully and responsibly.

The role of the dental surgeon in an integrated care pathway for the treatment of breathing difficulties.

PubMed

McDonald, J P

2005-04-09

We live in a professional environment in which the role of the dental surgeon is changing more rapidly than perhaps ever before. The concept of team working towards more efficient and focused delivery of care to our patients is one of the major developments, both within the practice environment through professionals complementary to dentistry, and indeed through medical and surgical colleagues in dealing with some of the wider aspects of holistic healthcare.

Increasing Military Physician Productivity in a Managed Care Environment

DTIC Science & Technology

1992-07-13

allows us to obtain to a common denominator, or one single rating even though the services are dissimilar and the input units are not "weighted." Serway ...many ideas as possible to catalyze the process. In removing barriers to productivity in the work environment, a thorough analysis of the physical ...physician and the organization has increased. The whole text of the book "Doctor’s Decisions and the Cost of Medical Care" is dedicated to this concept

Nursing Outcomes Classification implementation projects across the care continuum.

PubMed

Moorhead, S; Clarke, M; Willits, M; Tomsha, K A

1998-06-01

The health care environment in which nurses deliver care is experiencing constant change characterized by decreased lengths of stay in acute care settings, increased use of technology, increasing emphasis on computerized patient records and care planning options, increasing markets dominated by managed care, and an emphasis on outcomes rather than process. These changes dictate that nursing as a profession ensures that the work of nursing is visible in this health care environment and included in the data used to make health policy decisions. This article describes the rich history of a Midwestern hospital's use of standardized nursing languages for the last 25 years. Currently this facility is in the process of implementing the Nursing Outcomes Classification (NOC). Four projects are described that illustrate the ways nurses can use this language with diagnoses from the North American Nursing Diagnoses Association (NANDA) and interventions from the Nursing Interventions Classification (NIC).

Nursing students' experiences of the clinical learning environment in nursing homes: a questionnaire study using the CLES+T evaluation scale.

PubMed

Carlson, Elisabeth; Idvall, Ewa

2014-07-01

One major challenge facing the health care systems worldwide is the growing demand for registered nurses able to provide qualified nursing care for a vulnerable population. Positive learning experiences during clinical practice influence not only learning outcomes, but also how students reason in relation to future career choices. To investigate student nurses' experiences of the clinical learning environment during clinical practice in nursing homes, and to compare perceptions among student nurses with or without prior work experience as health care assistants in elderly care. A cross-sectional study was designed, utilising the Swedish version of the CLES+T evaluation scale. 260 student nurses (response rate 76%) who had completed a five week long clinical placement in nursing homes returned the questionnaire during the data collection period in 2011-2012. Data were analysed using descriptive statistics. Mann-Whitney U-test was used to examine differences in relation to students with or without prior experience of elderly care. Overall, the clinical learning environment was evaluated in a predominantly positive way. The sub-dimension Supervisory relationship displayed the highest mean value, and the lowest score was calculated for the sub-dimension Leadership style of the ward manager. Statistical significant differences between sub-groups were displayed for four out of 34 items. The supervisory relationship had the greatest impact on how student nurses experienced the clinical learning environment in nursing homes. It is therefore, of utmost importance that collaborative activities, between educational and nursing home settings, supporting the work of preceptors are established and maintained. Copyright © 2014 Elsevier Ltd. All rights reserved.

Health care employee perceptions of patient-centered care.

PubMed

Balbale, Salva Najib; Turcios, Stephanie; LaVela, Sherri L

2015-03-01

Given the importance of health care employees in the delivery of patient-centered care, understanding their unique perspectives is essential for quality improvement. The purpose of this study was to use photovoice to evaluate perceptions and experiences around patient-centered care among U.S. Veterans Affairs (VA) health care employees. We asked participants to take photographs of salient features in their environment related to patient-centered care. We used the photographs to facilitate dialogue during follow-up interviews. Twelve VA health care employees across two VA sites participated in the project. Although most participants felt satisfied with their work environment and experiences at the VA, they identified several areas for improvement. These included a need for more employee health and wellness initiatives and a need for enhanced opportunities for training and professional growth. Application of photovoice enabled us to learn about employees' unique perspectives around patient-centered care while engaging them in an evaluation of care delivery. © The Author(s) 2014.

Health Care Employee Perceptions of Patient-Centered Care: A Photovoice Project

PubMed Central

Balbale, Salva Najib; Turcios, Stephanie; LaVela, Sherri L.

2015-01-01

Given the importance of health care employees in the delivery of patient-centered care, understanding their unique perspective is essential for quality improvement. The purpose of this study was to use photovoice to evaluate perceptions and experiences around patient-centered care among Veterans Affairs (VA) health care employees. We asked participants to take photographs of salient features in their environment related to patient-centered care. We used the photographs to facilitate dialogue during follow-up interviews. Twelve VA health care employees across two VA sites participated in the project. Although most participants felt satisfied with their work environment and experiences at the VA, several areas for improvement were identified. These included a need for more employee health and wellness initiatives and a need for enhanced opportunities for training and professional growth. Application of photovoice enabled us to learn about employees' unique perspectives around patient-centered care while engaging them in an evaluation of care delivery. PMID:25274626

A national stakeholder consensus study of challenges and priorities for clinical learning environments in postgraduate medical education.

PubMed

Kilty, Caroline; Wiese, Anel; Bergin, Colm; Flood, Patrick; Fu, Na; Horgan, Mary; Higgins, Agnes; Maher, Bridget; O'Kane, Grainne; Prihodova, Lucia; Slattery, Dubhfeasa; Stoyanov, Slavi; Bennett, Deirdre

2017-11-22

High quality clinical learning environments (CLE) are critical to postgraduate medical education (PGME). The understaffed and overcrowded environments in which many residents work present a significant challenge to learning. The purpose of this study was to develop a national expert group consensus amongst stakeholders in PGME to; (i) identify important barriers and facilitators of learning in CLEs and (ii) indicate priority areas for improvement. Our objective was to provide information to focus efforts to provide high quality CLEs. Group Concept Mapping (GCM) is an integrated mixed methods approach to generating expert group consensus. A multi-disciplinary group of experts were invited to participate in the GCM process via an online platform. Multi-dimensional scaling and hierarchical cluster analysis were used to analyse participant inputs in regard to barriers, facilitators and priorities. Participants identified facilitators and barriers in ten domains within clinical learning environments. Domains rated most important were those which related to residents' connection to and engagement with more senior doctors. Organisation and conditions of work and Time to learn with senior doctors during patient care were rated as the most difficult areas in which to make improvements. High quality PGME requires that residents engage and connect with senior doctors during patient care, and that they are valued and supported both as learners and service providers. Academic medicine and health service managers must work together to protect these elements of CLEs, which not only shape learning, but impact quality of care and patient safety.

[Regional geriatric care concept in the District of Lippe : Structural effects and network formation in the case management-based model project].

PubMed

Şahin, Charlotte; Iseringhausen, Olaf; Hower, Kira; Liebe, Constanze; Rethmeier-Hanke, Anja; Wedmann, Bernd

2018-04-01

Regional planning of healthcare requires special consideration for the complex needs of elderly, multimorbid people living in a domestic environment. In the District of Lippe, a hospital (Klinikum Lippe) and network of ambulatory care physicians (Ärztenetz Lippe) developed and tested a geriatric care network based on case management for geriatric patients living in a domestic environment. The establishment of the geriatric care network (e.g. promoting networking acceptance and implementation) was formatively evaluated, e. g. with qualitative methods. Data were acquired by guideline-based interviews with experts and analyzed by qualitative content analysis according to Mayring. Structural effects included forming a cross-sectoral and interdisciplinary network for a functioning care network and a geriatric care pathway. The practical work of case managers (CM) is essential for communication with patients, family members and care providers as well as integrating providers into the network. A critical factor was working together with general practitioners and the close cooperation with the hospital's department of geriatric. The quality of care is improved because of exchange of information between sectors and continuity in the course of care. In the District of Lippe the quality of care was improved and structures of care were integrated by the network according to the needs of the target group. The integrative perspective was achieved in particular by the geriatric care pathway and integration of providers into the communication and care process; however, the scope of this care model could not be extended into routine care due to the rigid and subdivided health care system.

The work environment of haemodialysis nurses and its impact on patients' outcomes.

PubMed

Prezerakos, Panagiotis; Galanis, Peter; Moisoglou, Ioannis

2015-04-01

The aims of this study were to assess haemodialysis nurses' work environment and investigate the correlation between work environment and patients' outcomes. A cross-sectional study was conducted at the 11 public hospital-based haemodialysis units of the 5th Regional Health Authority of Greece. The Practice Environment Scale of the Nursing Work Index (PES-NWI) was used to assess work environment. Nurses were asked to report the frequency of a series adverse events and errors. Study population consisted of 133 nurses (response rate 89.3%). The overall PES-NWI scored just < 2.5 (Mean = 2.48, standard deviation = 0.34) indicating a non-favourable haemodialysis workplace. Nurse-physician Relations, nurse manager ability and nursing foundations for quality of care were the most favourable aspects of work environment. Multivariate logistic regression analysis identified that hypotension (odds ratio (OR) = 0.3, 95% confidence interval (CI) = 0.1-0.9, P = 0.03), venous needle disconnection (OR = 0.14, 95% CI = 0.03-0.65, P = 0.012) and patient fall (OR = 0.02, 95% CI = 0.001-0.51, P = 0.018) were associated with a non-favourable work environment. Findings have important implications for improvement of haemodialysis work environment and enhancement of patients' safety. © 2013 Wiley Publishing Asia Pty Ltd.

Quality and Safety in Health Care, Part XIV: The External Environment and Research for Diagnostic Processes.

PubMed

Harolds, Jay A

2016-09-01

The work system in which diagnosis takes place is affected by the external environment, which includes requirements such as certification, accreditation, and regulations. How errors are reported, malpractice, and the system for payment are some other aspects of the external environment. Improving the external environment is expected to decrease errors in diagnosis. More research on improving the diagnostic process is needed.

A study examining the impact of 12-hour shifts on critical care staff.

PubMed

Richardson, Annette; Turnock, Christopher; Harris, Liz; Finley, Alison; Carson, Sarah

2007-11-01

Twelve-hour shifts contribute to flexible patterns of work, but the effects on delivery of direct care and staff fatigue are important topics for deeper examination. To examine the impact and implications of 12-hour shifts on critical care staff. A staged dual approach using two focus groups (n = 16) and questionnaires (n = 147) with critical care staff from three critical care units. Positive effects were found with planning and prioritizing care, improved relationships with patients/relatives, good-quality time off work and ease of travelling to work. Less favourable effects were with caring for patients in isolation cubicles and the impact on staff motivation and tiredness. Acceptable patterns of work were suggested for 'numbers of consecutive shifts' and 'rest periods between shifts'. Most participants believed 12-hour shifts should continue. The challenge is to ensure existing systems and practices develop to improve on the less positive effects of working 12-hour shifts. This study provides nurse managers with important and relevant staff views on the impact of working 12-hour shifts. In particular to those working within a critical care environment and suggests the challenge is to ensure existing systems and practices develop to improve on the less encouraging effects of working 12-hour shifts. It adds an understanding of the senior nurse's view on the positive and negative effects of managing and organizing staff off duty to safely run a department with 12-hour shifts.

Is work stress in palliative care nurses a cause for concern? A literature review.

PubMed

Peters, Louise; Cant, Robyn; Sellick, Kenneth; O'Connor, Margaret; Lee, Susan; Burney, Sue; Karimi, Leila

2012-11-01

Palliative care nurses are at risk of work stress because their role involves exposure to frequent deaths and family grieving. Little is known about their degree of stress or whether they suffer stress or burnout more than nurses in other disciplines. The aim of this paper is to critically examine the current literature concerning stress and burnout in palliative care nurses. Sixteen papers were included in the review. Although work demands were a common cause of stress in the studies reported, there was no strong evidence that palliative care or hospice nurses experienced higher levels of stress than nurses in other disciplines. Common causes of stress were the work environment, role conflict, and issues with patients and their families. Constructive coping styles appeared to help nurses to manage stress. Managers have a key role in providing education and training for palliative care nurses to support their personal development and to help reduce vulnerability to and the impact of stress in the workplace.

Recovery, work-life balance and work experiences important to self-rated health: A questionnaire study on salutogenic work factors among Swedish primary health care employees

PubMed Central

Ejlertsson, Lina; Heijbel, Bodil; Ejlertsson, Göran; Andersson, Ingemar

2018-01-01

BACKGROUND: There is a lack of information on positive work factors among health care workers. OBJECTIVE: To explore salutogenic work-related factors among primary health care employees. METHOD: Questionnaire to all employees (n = 599) from different professions in public and private primary health care centers in one health care district in Sweden. The questionnaire, which had a salutogenic perspective, included information on self-rated health from the previously validated SHIS (Salutogenic Health Indicator Scale), psychosocial work environment and experiences, recovery, leadership, social climate, reflection and work-life balance. RESULTS: The response rate was 84%. A multivariable linear regression model, with SHIS as the dependent variable, showed three significant predictors. Recovery had the highest relationship to SHIS (β= 0.34), followed by experience of work-life balance (β= 0.25) and work experiences (β= 0.20). Increased experience of recovery during working hours related to higher self-rated health independent of recovery outside work. CONCLUSION: Individual experiences of work, work-life balance and, most importantly, recovery seem to be essential areas for health promotion. Recovery outside the workplace has been studied previously, but since recovery during work was shown to be of great importance in relation to higher self-rated health, more research is needed to explore different recovery strategies in the workplace. PMID:29439377

Recovery, work-life balance and work experiences important to self-rated health: A questionnaire study on salutogenic work factors among Swedish primary health care employees.

PubMed

Ejlertsson, Lina; Heijbel, Bodil; Ejlertsson, Göran; Andersson, Ingemar

2018-01-01

There is a lack of information on positive work factors among health care workers. To explore salutogenic work-related factors among primary health care employees. Questionnaire to all employees (n = 599) from different professions in public and private primary health care centers in one health care district in Sweden. The questionnaire, which had a salutogenic perspective, included information on self-rated health from the previously validated SHIS (Salutogenic Health Indicator Scale), psychosocial work environment and experiences, recovery, leadership, social climate, reflection and work-life balance. The response rate was 84%. A multivariable linear regression model, with SHIS as the dependent variable, showed three significant predictors. Recovery had the highest relationship to SHIS (β= 0.34), followed by experience of work-life balance (β= 0.25) and work experiences (β= 0.20). Increased experience of recovery during working hours related to higher self-rated health independent of recovery outside work. Individual experiences of work, work-life balance and, most importantly, recovery seem to be essential areas for health promotion. Recovery outside the workplace has been studied previously, but since recovery during work was shown to be of great importance in relation to higher self-rated health, more research is needed to explore different recovery strategies in the workplace.

Organisation of Prevention in Primary Health Care.

ERIC Educational Resources Information Center

Council of Europe, Strasbourg (France).

This report examines the possiblities of increasing the amount of preventive work being carried out by primary care workers in European communities. Before making practical recommendations about promoting prevention, an analysis is presented of the main present day problems. These center on the environment (not only physical but also social and…

[The margin of autonomy of nurses in psychiatry: for a clinical approach in the institution].

PubMed

Langellotti, Grégory

2013-01-01

In care units, nurses operate in working environments which offer them a margin of autonomy. When they seize upon this opportunity, they invent therapeutics tools. Their creativity as well as the pleasure given in the care contributes to the clinical dynamics within the institution.

The Relationship Between Work-Family Conflict and Job Satisfaction Among Hospital Nurses.

PubMed

AlAzzam, Manar; AbuAlRub, Raeda Fawzi; Nazzal, Ala H

2017-10-01

This study aimed to explore the incidence of work-family conflict and the association between work-family conflict and satisfaction level among Jordanian nurses. Self-administered questionnaires were used to collect data from a convenience sample of 333 Jordanian nurses using a descriptive, cross-sectional, correlational design. The results revealed that nurses were exposed to both subtypes of work and family conflict, but they experienced the work-to-family conflict more than the family-to-work conflict. Both subtypes of work and family conflict were correlated negatively with age and positively with the number of children. Being female and absence of child care facilities at workplace had positive effects on the occurrence of work-to-family conflict. Finally, the negative and significant relationship between the work and family conflict and the job satisfaction level was supported. Those findings imply that nurse administrators and policy makers should establish different strategies to support the balance between the nurses' family life and nurses' work life such as child care and elder care services and other fringe benefits. Hospitals have to promote themselves as work environments that support job satisfaction to attract nurses, hence increasing patients' satisfaction and quality of nursing care. © 2017 Wiley Periodicals, Inc.

Work and personal well-being of nurses in Queensland: Does rurality make a difference?

PubMed

Hegney, Desley; Eley, Robert; Osseiran-Moisson, Rebecca; Francis, Karen

2015-12-01

This study aims to ascertain if differences exist in the perception of the professional practice environment and personal well-being of nurses across different geographical areas in Queensland. This paper was performed on a prospective, self-report cross-sectional on-line survey. The study was conducted among the nurses employed in public and private health care settings: acute hospitals, community health and aged care in Queensland, Australia. Participants of this study were 1608 registered and enrolled nurses and assistants in nursing, current members of the Queensland Nurses Union in 2013 and who provided a workplace postcode. One thousand eight of these participants worked in major cities, while 382 in rural locations and 238 in remote areas. None. Scores of well-being as determined by the following scales: the Depression, Anxiety and Stress Scale, the Professional Quality of Life Scale version 5, the Connor-Davidson Resilience Scale and of the Professional Practice Environment using the Practice Environment Scale - Nursing Work Index Revised. Nurses employed in major cities perceived 'nursing foundations for quality care' more favourably than those from other settings. Remote area nurses had lower levels of secondary traumatic stress than nurses in major cities and rural areas. There was no difference between nurses across their geographical locations for stress, anxiety, depression, compassion satisfaction, burnout, resilience and the four other measures of the Practice Environment Scale. The study findings provide new data suggesting that, with the exception of secondary traumatic stress, the personal well-being of nurses does not differ across geographical settings. Similarly, with the exception of the subscale of 'nursing foundations for quality care' there was no difference in perceptions of the professional practice environment. As secondary traumatic stress is associated with burnout, this finding needs to be investigated further. © 2015 National Rural Health Alliance Inc.

Parent-to-parent support: a critical component of health care services for families.

PubMed

Hartman, A F; Radin, M B; McConnell, B

1992-01-01

Families of children with chronic medical conditions or disabilities face many unique difficulties. It is often necessary for them to assimilate technical medical information and participate in important decisions regarding their children's care before they have had time to adjust to their children's condition. Health care providers are not always available to help parents learn how to function in their dramatically changed roles. To adjust to their new parenting roles and work through feelings of confusion, denial, anxiety, guilt, anger, and depression, parents of children with special health care needs need opportunities to fully vent feelings, and to experience the grieving processes in their own way and at their own pace, in a nonthreatening, nonjudgmental environment. An informal support network is a powerful tool for accomplishing these tasks, for teaching day-to-day coping skills, and for supporting the establishment of new value systems that incorporate families' unique needs. The literature on family support documents ways in which parents of children with special health care needs are particularly qualified to help each other. This article briefly describes the philosophy of parent-to-parent support, its unique contributions in the health care setting, and the ways that health care providers can assist in creating an environment in which parents and professionals can work together more effectively.

Factors associated with pharmacists' perceptions of their working conditions and safety and effectiveness of patient care.

PubMed

Tsao, Nicole W; Lynd, Larry D; Gastonguay, Louise; Li, Kathy; Nakagawa, Bob; Marra, Carlo A

2016-01-01

In recent years, the role of pharmacists has changed, as have various provincial legislations, which now allow pharmacists to provide additional health services to patients. With these changes comes growing concern about how well the current pharmacy working environment is adapting and whether it may also be creating work-related stress that may contribute to potentially unsafe practices of patient care. To characterize the current working conditions of pharmacists in British Columbia, an online survey was developed and distributed to all College of Pharmacists of BC (CPBC) registrants by email. The survey consisted of questions on pharmacists' demographics, practice setting and perceptions of workplace conditions. Responses were collected from October 1 to November 10, 2013. All data were summarized using descriptive statistics, and regression models were constructed to assess the association between various factors and pharmacists' self-reported working conditions. Twenty-three percent (1241/5300) of pharmacists registered with the CPBC responded, with 78% working in the community pharmacy setting (58% chain, 19% independent). Pharmacists mostly disagreed with the statements that they had enough time for breaks or lunches or to do their jobs, as well as enough staffing support. Pharmacists' perceptions of their workplace environment were negatively associated with workplace-imposed advanced service quotas (for medication reviews, immunizations and prescription adaptations); being employed at chain store pharmacies, compared to independent pharmacies or hospitals/long-term care settings; and higher prescription volume. Pharmacists working in chain community pharmacies who are required to meet monthly quotas for expanded services reported a substantial negative impact on their working conditions and perceived safety of patient care. Can Pharm J (Ott) 2016;149:xx-xx.

Strategies to teach family assessment and intervention through an online international curriculum.

PubMed

Anderson, Kathryn Hoehn; Friedemann, Marie-Luise

2010-05-01

A Web-based certificate program for international health professionals to acquire understanding of family health and strategies to implement culturally sensitive health care of families is outlined. In four Web courses and a project, students progress interactively to apply culture, family, and interdisciplinary health system theories to assessments and clinical interventions with families in the interdisciplinary setting. Four online educational strategies to facilitate student success from the virtual classroom to actual clinical care are described: adjusting to the technology, communicating the learning progress openly, giving mutual feedback, and implementing evidence-based family care. Outcomes addressing student learning and skill enhancement, family interaction, and student and faculty experiences in the virtual learning environment are explored. Overall, students learned to work successfully with families in health care, experienced increasing comfort and competency in challenging situations, introduced family care in their work setting, and emerged as leaders while working in interdisciplinary teams.

Occupational Therapy and Primary Care: Updates and Trends

PubMed Central

Mroz, Tracy M.; Fogelberg, Donald J.; Leland, Natalie E.

2018-01-01

As our health care system continues to change, so do the opportunities for occupational therapy. This article provides an update to a 2012 Health Policy Perspectives on this topic. We identify new initiatives and opportunities in primary care, explore common challenges to integrating occupational therapy in primary care environments, and highlight international works that can support our efforts. We conclude by discussing next steps for occupational therapy practitioners in order to continue to progress our efforts in primary care. PMID:29689169

Coming and staying: a qualitative exploration of Registered Nurses' experiences working in nursing homes.

PubMed

Prentice, Dawn; Black, Margaret

2007-09-01

Aim. This paper reports on a qualitative study that explored the reasons why Registered Nurses (RNs) chose to work in nursing homes in Southern Ontario, Canada and what factors attracted them to remain. Background.  There is a paucity of information about factors associated with the recruitment and retention of RNs within long-term care (LTC) in Canada. As the population of older people is growing in Canada and elsewhere, it is essential that we better understand what attracts RNs to work and remain in this setting. Design and method. A case study approach was used in this study of nine RNs working in three nursing homes. Data were collected through in-depth interviews. Findings. Six sub-themes were identified: 'Job of Choice', 'Job of Convenience', 'Caring for the Residents', 'A Supportive Environment', 'Heavy Workload' and 'Supervisory Role of the RN'. Conclusion. Nurses chose to work in the nursing home because it was a 'Job of Convenience'. However, characteristics of the organizational environment played a major role in their remaining. Also, the caring relationship with residents played a role in the nurses remaining in this setting. Relevance to clinical practice. Strategies are provided that nurse managers may consider when planning recruitment and retention activities for LTC settings.

Radiation therapists' and radiation oncology medical physicists' perceptions of work and the working environment in Australia: a qualitative study.

PubMed

Halkett, G K B; McKay, J; Hegney, D G; Breen, Lauren J; Berg, M; Ebert, M A; Davis, M; Kearvell, R

2017-09-01

Workforce recruitment and retention are issues in radiation oncology. The working environment is likely to have an impact on retention; however, there is a lack of research in this area. The objectives of this study were to: investigate radiation therapists' (RTs) and radiation oncology medical physicists' (ROMPs) perceptions of work and the working environment; and determine the factors that influence the ability of RTs and ROMPs to undertake their work and how these factors affect recruitment and retention. Semi-structured interviews were conducted and thematic analysis was used. Twenty-eight RTs and 21 ROMPs participated. The overarching themes were delivering care, support in work, working conditions and lifestyle. The overarching themes were mostly consistent across both groups; however, the exemplars reflected the different roles and perspectives of RTs and ROMPs. Participants described the importance they placed on treating patients and improving their lives. Working conditions were sometimes difficult with participants reporting pressure at work, large workloads and longer hours and overtime. Insufficient staff numbers impacted on the effectiveness of staff, the working environment and intentions to stay. Staff satisfaction is likely to be improved if changes are made to the working environment. We make recommendations that may assist departments to support RTs and ROMPs. © 2016 John Wiley & Sons Ltd.

Environmental requirements related to patient care and the team working to ensure compliance.

PubMed

Roberts, Diane

2015-01-01

Healthcare providers are often surprised that regulations promulgated by the US Environmental Protection Agency (EPA) apply to patient care settings. Many find it strange that processes meant to heal have the potential to harm human health and the environment, and are, therefore, regulated by federal and state environmental agencies. The importance of compliance is emphasized by the fact that both the EPA and individual state agencies have the authority to impose civil and criminal penalties if they discover violations. The Joint Commission considers compliance important enough to include it as an element of performance in the Environment of Care standard.

Innovation in ambulatory care: a collaborative approach to redesigning the health care workplace.

PubMed

Johnson, Paula A; Bookman, Ann; Bailyn, Lotte; Harrington, Mona; Orton, Piper

2011-02-01

To improve the quality of patient care and work satisfaction of the physicians and staff at an ambulatory practice that had recently started an innovative model of clinical care for women. The authors used an inclusive process, collaborative interactive action research, to engage all physicians and staff members in assessing and redesigning their work environment. Based on key barriers to working effectively and integrating work and family identified in that process, a pilot project with new work practices and structures was developed, implemented, and evaluated. The work redesign process established cross-occupational care teams in specific clinical areas. Members of the teams built skills in assessing clinical operations in their practice areas, developed new levels of collaboration, and constructed new models of distributed leadership. The majority of participants reported an improvement in how their area functioned. Integrating work and family/personal life-particularly practices around flexible work arrangements-became an issue for team discussion and solutions, not a matter of individual accommodation by managers. By engaging the workforce, collaborative interactive action research can help achieve lasting change in the health care workplace and increase physicians' and staff members' work satisfaction. This "dual agenda" may be best achieved through a collaborative process where cross-occupational teams are responsible for workflow and outcomes and where the needs of patients and providers are integrated.

The evolving professional nursing self-image of students in baccalaureate programs: a cross-sectional survey.

PubMed

Milisen, Koen; De Busser, Tinne; Kayaert, Annelore; Abraham, Ivo; de Casterlé, Bernadette Dierckx

2010-06-01

We have previously examined the professional self-image of practicing nurses in Belgium and its association with various professional decisions, however there is limited knowledge about the professional self-image of nurses-to-be. Despite prior research on nursing students' perceptions of nursing or their self-esteem, students' professional image, defined as "the way students perceive themselves in their clinical practice environment and their anticipated work environment", has not been described nor compared to that of practicing nurses. To describe the professional nursing self-image among students in their final year of baccalaureate education. Cross-sectional survey. Nine geographically spread baccalaureate programs in the Flemish region of Belgium. 427 evaluable students from 455 recruited from 663 potential. Data collected in each school during regular hours using an adapted version of the BELIMAGE (Belgian professional self-image instrument for hospital nurses) including questions on personal demographics, education and competence, nursing care, team and practice environment. Voluntary participation with returned questionnaire deemed informed consent. Respondents identified several curricular components as contributing to their perceived competence. They also identified several skills deemed important to professional nursing, however did not feel competent in all of these. Important nursing care aspects included individualizing patient care, detecting care problems and potential complications, and promoting patient well-being; within a care environment with open interdisciplinary communication, where care problems could be discussed with nursing colleagues, where one cares for the same patient regularly, and led by a team leader with vision. Society's view of nursing was generally more negative than students'. Most students planned on working in nursing after their studies and many had thought about additional education at some point. Most were proud of becoming a nurse, would recommend nursing to others, and would choose nursing again as field of study. Students' evolving professional self-image was positive, rich, and enthusiastic; and higher than that observed in working nurses in a prior study. There is a significant gap between nursing care aspects deemed important and perceived competence in these areas, which has implications for both educators and future employers. Once employed, students are likely to experience differences in their perceptions of professional self-image with those of senior colleagues; another area of attention for employers. (c) 2009 Elsevier Ltd. All rights reserved.

Work environment, volume of activity and staffing in neonatal intensive care units in Italy: results of the SONAR-nurse study.

PubMed

Corchia, Carlo; Fanelli, Simone; Gagliardi, Luigi; Bellù, Roberto; Zangrandi, Antonello; Persico, Anna; Zanini, Rinaldo

2016-04-02

Neonatal units' volume of activity, and other quantitative and qualitative variables, such as staffing, workload, work environment, care organization and geographical location, may influence the outcome of high risk newborns. Data about the distribution of these variables and their relationships among Italian neonatal units are lacking. Between March 2010-April 2011, 63 neonatal intensive care units adhering to the Italian Neonatal Network participated in the SONAR Nurse study. Their main features and work environment were investigated by questionnaires compiled by the chief and by physicians and nurses of each unit. Twelve cross-sectional monthly-repeated surveys on different shifts were performed, collecting data on number of nurses on duty and number and acuity of hospitalized infants. Six hundred forty five physicians and 1601 nurses compiled the questionnaires. In the cross-sectional surveys 702 reports were collected, with 11082 infant and 3226 nurse data points. A high variability was found for units' size (4-50 total beds), daily number of patients (median 14.5, range 3.4-48.7), number of nurses per shift (median 4.2, range 0.7-10.8) and number of team meetings per month. Northern regions performed better than Central and Southern regions for frequency of training meetings, qualitative assessment of performance, motivation within the unit and nursing work environment; mean physicians' and nurses' age increased moving from North to South. After stratification by terciles of the mean daily number of patients, the median number of nurses per shift increased at increasing volume of activity, while the opposite was found for the nurse-to-patient ratio adjusted by patients' acuity. On average, in units belonging to the lower tercile there was 1 nurse every 2.5 patients, while in those belonging to the higher tercile the ratio was 1 nurse every 5 patients. In Italy, there is a high variability in organizational characteristics and work environment among neonatal units and an uneven distribution of human resources in relation to volume of activity, suggesting that the larger the unit the greater the workload for each nurse. Urgent modifications in planning and organization of services are needed in order to pursue more efficient, homogeneous and integrated regionalized neonatal care systems.

Orchestrating care: nursing practice with hospitalised older adults.

PubMed

Dahlke, Sherry Ann; Phinney, Alison; Hall, Wendy Ann; Rodney, Patricia; Baumbusch, Jennifer

2015-12-01

The increased incidence of health challenges with aging means that nurses are increasingly caring for older adults, often in hospital settings. Research about the complexity of nursing practice with this population remains limited. To seek an explanation of nursing practice with hospitalised older adults. Design. A grounded theory study guided by symbolic interactionism was used to explore nursing practice with hospitalised older adults from a nursing perspective. Glaserian grounded theory methods were used to develop a mid-range theory after analysis of 375 hours of participant observation, 35 interviews with 24 participants and review of selected documents. The theory of orchestrating care was developed to explain how nurses are continuously trying to manage their work environments by understanding the status of the patients, their unit, mobilising the assistance of others and stretching available resources to resolve their problem of providing their older patients with what they perceived as 'good care' while sustaining themselves as 'good' nurses. They described their practice environments as hard and under-resourced. Orchestrating care is comprised of two subprocesses: building synergy and minimising strain. These two processes both facilitated and constrained each other and nurses' abilities to orchestrate care. Although system issues presented serious constraints to nursing practice, the ways in which nurses were making meaning of their work environment both aided them in managing their challenges and constrained their agency. Nurses need to be encouraged to share their important perspective about older adult care. Administrators have a role to play in giving nurses voice in workplace committees and in forums. Further research is needed to better understand how multidisciplinary teams influence care of hospitalized older adults. © 2014 John Wiley & Sons Ltd.

The modern CIO: forging a new role in the managed care era.

PubMed

Griffin, J

1997-05-01

The advent of managed care has helped forge new roles for healthcare professionals. Competitive pressures, the profile of the member community, and provider network design drive healthcare delivery via the managed care model. Careful analysis and design of the managed care model charts the success or failure of the health care delivery system--usually an integrated delivery system (IDS). Therefore, those healthcare organizations that have chosen to get on the managed care bandwagon must re-invent themselves, both culturally and technologically. The chief information officer (CIO) leads this technological revolution. To work effectively, the technological infrastructure of the IDS must be closely in line with enterprise goals and objectives. In the managed care environment the old information system (IS) approach of supporting the operational needs of individual departments simply will not work. The CIO's new role will be to master the concept of managed care to ensure that enterprise-wide needs for operational, clinical, and financial information are met, and that IS and enterprise goals are aligned. CIOs who have an intuitive grasp of the managed care environment--although their numbers are growing as managed care mushrooms--make up a minority group. They are a special breed with clearly definable qualities such as business savvy and an affinity for big-picture thinking. To an IDS, a CIO with these qualities is a rare gem indeed. This article introduces Don Winschel, the associate administrator and CIO of Johnson City Medical Center (Johnson City, TN) as an example of one such modern CIO.

Advances and challenges in oral health after a decade of the “Smiling Brazil” Program

PubMed Central

Scherer, Charleni Inês; Scherer, Magda Duarte dos Anjos

2016-01-01

ABSTRACT OBJECTIVE To analyze oral health work changes in primary health care after Brazil’s National Oral Health Policy Guidelines were released. METHODS A literature review was conducted on Medline, LILACS, Embase, SciELO, Biblioteca Virtual em Saúde, and The Cochrane Library databases, from 2000 to 2013, on elements to analyze work changes. The descriptors used included: primary health care, family health care, work, health care policy, oral health care services, dentistry, oral health, and Brazil. Thirty-two studies were selected and analyzed, with a predominance of qualitative studies from the Northeast region with workers, especially dentists, focusing on completeness and quality of care. RESULTS Observed advances focused on educational and permanent education actions; on welcoming, bonding, and accountability. The main challenges were related to completeness; extension and improvement of care; integrated teamwork; working conditions; planning, monitoring, and evaluation of actions; stimulating people’s participation and social control; and intersectorial actions. CONCLUSIONS Despite the new regulatory environment, there are very few changes in oral health work. Professionals tend to reproduce the dominant biomedical model. Continuing efforts will be required in work management, training, and permanent education fields. Among the possibilities are the increased engagement of managers and professionals in a process to understand work dynamics and training in the perspective of building significant changes for local realities. PMID:26815162

Out-of-hospital emergency care providers' work and challenges in a changing care environment.

PubMed

Mikkola, Riitta; Paavilainen, Eija; Salminen-Tuomaala, Mari; Leikkola, Päivi

2018-03-01

Acutely ill patients are often treated on site instead of being transported to hospital, so wide-ranging professional competence is required from staff. The aim of this study was to describe and produce new information about out-of-hospital emergency care providers' competence, skills and willingness to engage in self-development activities, and to uncover challenges experienced by care providers in the midst of changing work practices. A quantitative questionnaire was sent to out-of-hospital emergency care providers (N = 142, response rate 53%) of one Finnish hospital district. Data were analysed using spss for Windows 22 software. Almost all respondents found their work interesting and their ability to work independently sufficient. The majority found the work meaningful. Almost 20% felt that work was dominated by constant rush, and 40%, more than half of 25-year-olds but <10% of over 45-years-olds, found the work physically straining. The majority indicated that they had a sufficient theoretical-practical basis to perform their regular duties, and more than one-third felt that they had sufficient skills to deal with multiple patient or disaster situations. Over 20% stated that they were unsure about performing new or infrequent procedures. A number of factors experienced as challenging were revealed. The results provide a basis for improving care providers' initial and further training. © 2017 Nordic College of Caring Science.

A collaborative design method to support integrated care. An ICT development method containing continuous user validation improves the entire care process and the individual work situation

PubMed Central

Scandurra, Isabella; Hägglund, Maria

2009-01-01

Introduction Integrated care involves different professionals, belonging to different care provider organizations and requires immediate and ubiquitous access to patient-oriented information, supporting an integrated view on the care process [1]. Purpose To present a method for development of usable and work process-oriented information and communication technology (ICT) systems for integrated care. Theory and method Based on Human-computer Interaction Science and in particular Participatory Design [2], we present a new collaborative design method in the context of health information systems (HIS) development [3]. This method implies a thorough analysis of the entire interdisciplinary cooperative work and a transformation of the results into technical specifications, via user validated scenarios, prototypes and use cases, ultimately leading to the development of appropriate ICT for the variety of occurring work situations for different user groups, or professions, in integrated care. Results and conclusions Application of the method in homecare of the elderly resulted in an HIS that was well adapted to the intended user groups. Conducted in multi-disciplinary seminars, the method captured and validated user needs and system requirements for different professionals, work situations, and environments not only for current work; it also aimed to improve collaboration in future (ICT supported) work processes. A holistic view of the entire care process was obtained and supported through different views of the HIS for different user groups, resulting in improved work in the entire care process as well as for each collaborating profession [4].

Safety risks associated with physical interactions between patients and caregivers during treatment and care delivery in Home Care settings: A systematic review.

PubMed

Hignett, Sue; Edmunds Otter, Mary; Keen, Christine

2016-07-01

To explore the safety risks associated with physical interactions between patients and caregivers during treatment and care delivery in Home Care settings. Seven-stage framework from the PRISMA statement for research question, eligibility (definition), search, identification of relevant papers from title and abstract, selection and retrieval of papers, appraisal and synthesis. British Nursing Index (BNI), Allied and Complementary Medicine Database (AMED), Applied Social Sciences Index and Abstracts (ASSIA), Cinahl, Cochrane Library, Embase, Ergonomics Abstracts, Health Business Elite, Health Management Information Consortium (HMIC), Medline, PsycInfo, Scopus, Social Care online, Social Science Citation Index. The included references (n=42) were critically appraised using a modified version of Downs and Black checklist and the Mixed Methods Appraisal Tool. The risk factors are reported using the modified model of human factors of health care in the home to represent the roles of both patients and caregivers in the system. The results are grouped as environment (health policy, physical and social), artefacts (equipment and technology), tasks (procedures and work schedules) and care recipient/provider. These include permanent and temporary building design and access, communication and lone working, provision of equipment and consumables, and clinical tasks. The topics with strong evidence from at least 2 papers relate to risks associated with awkward working positions, social environment issues (additional tasks and distractions), abuse and violence, inadequate team (peer) support, problems with workload planning, needle stick injuries and physical workload (moving and handling patients). As home care increases, there is a need to ensure the safety of both patients and caregivers with an understanding of the physical interactions and tasks to manage safety risks and plan safer care delivery systems. Copyright © 2016 Elsevier Ltd. All rights reserved.

Authentic leaders creating healthy work environments for nursing practice.

PubMed

Shirey, Maria R

2006-05-01

Implementation of authentic leadership can affect not only the nursing workforce and the profession but the healthcare delivery system and society as a whole. Creating a healthy work environment for nursing practice is crucial to maintain an adequate nursing workforce; the stressful nature of the profession often leads to burnout, disability, and high absenteeism and ultimately contributes to the escalating shortage of nurses. Leaders play a pivotal role in retention of nurses by shaping the healthcare practice environment to produce quality outcomes for staff nurses and patients. Few guidelines are available, however, for creating and sustaining the critical elements of a healthy work environment. In 2005, the American Association of Critical-Care Nurses released a landmark publication specifying 6 standards (skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition, and authentic leadership) necessary to establish and sustain healthy work environments in healthcare. Authentic leadership was described as the "glue" needed to hold together a healthy work environment. Now, the roles and relationships of authentic leaders in the healthy work environment are clarified as follows: An expanded definition of authentic leadership and its attributes (eg, genuineness, trustworthiness, reliability, compassion, and believability) is presented. Mechanisms by which authentic leaders can create healthy work environments for practice (eg, engaging employees in the work environment to promote positive behaviors) are described. A practical guide on how to become an authentic leader is advanced. A research agenda to advance the study of authentic leadership in nursing practice through collaboration between nursing and business is proposed.

Cognitive Tools for Assessment and Learning in a High Information Flow Environment.

ERIC Educational Resources Information Center

Lajoie, Susanne P.; Azevedo, Roger; Fleiszer, David M.

1998-01-01

Describes the development of a simulation-based intelligent tutoring system for nurses working in a surgical intensive care unit. Highlights include situative learning theories and models of instruction, modeling expertise, complex decision making, linking theories of learning to the design of computer-based learning environments, cognitive task…

Organinzing the Curriculum Storage in a Preschool/Child Care Environment.

ERIC Educational Resources Information Center

Cutler, Kay M.

2000-01-01

A preschool staff project was undertaken to develop and implement a more efficient curriculum organization plan and curriculum rotation system. The aim of the project was to provide a healthier working environment by improving communication among the teaching team, organizing curriculum storage outside the classroom, designing curriculum rotation…

Using Participatory Action Research to Develop a Working Model That Enhances Psychiatric Nurses' Professionalism: The Architecture of Stability.

PubMed

Salzmann-Erikson, Martin

2017-11-01

Ward rules in psychiatric care aim to promote safety for both patients and staff. Simultaneously, ward rules are associated with increased patient violence, leading to neither a safe work environment nor a safe caring environment. Although ward rules are routinely used, few studies have explicitly accounted for their impact. To describe the process of a team development project considering ward rule issues, and to develop a working model to empower staff in their daily in-patient psychiatric nursing practices. The design of this study is explorative and descriptive. Participatory action research methodology was applied to understand ward rules. Data consists of audio-recorded group discussions, observations and field notes, together creating a data set of 556 text pages. More than 100 specific ward rules were identified. In this process, the word rules was relinquished in favor of adopting the term principles, since rules are inconsistent with a caring ideology. A linguistic transition led to the development of a framework embracing the (1) Principle of Safety, (2) Principle of Structure and (3) Principle of Interplay. The principles were linked to normative guidelines and applied ethical theories: deontology, consequentialism and ethics of care. The work model reminded staff about the principles, empowered their professional decision-making, decreased collegial conflicts because of increased acceptance for individual decisions, and, in general, improved well-being at work. Furthermore, the work model also empowered staff to find support for their decisions based on principles that are grounded in the ethics of totality.

The impact of protocol on nurses' role stress: a longitudinal perspective.

PubMed

Dodd-McCue, Diane; Tartaglia, Alexander; Veazey, Kenneth W; Streetman, Pamela S

2005-04-01

The study examined the impact of a protocol directed at increasing organ donation on the role stress and work attitudes of critical care nurses involved in potential organ donation cases. The research examined whether the protocol could positively affect nurses' perceptions of role stress, and if so, could the work environment improvements be sustained over time. The Family Communication Coordinator (FCC) protocol promotes effective communication during potential organ donation cases using a multidisciplinary team approach. Previous research found it associated with improved donation outcomes and with improved perceptions of role stress by critical care nurses. However, the previous study lacked methodological rigor necessary to determine causality and sustainability over time. The study used a quasi-experimental prospective longitudinal design. The sample included critical care nurses who had experience with potential organ donation cases with the protocol. Survey data were collected at 4 points over 2 years. Surveys used previously validated and reliable measures of role stress (role ambiguity, role conflict, role overload) and work attitudes (commitment, satisfaction). Interviews supplemented these data. The nurses' perceptions of role stress associated with potential organ donation cases dramatically dropped after the protocol was implemented. All measures of role stress, particularly role ambiguity and role conflict, showed statistically significant and sustained improvement. Nurses' professional, unit, and hospital commitment and satisfaction reflect an increasingly positive workplace. The results demonstrate that the FCC protocol positively influenced the workplace through its impact on role stress over the first 2 years following its implementation. The findings suggest that similar protocols may be appropriate in improving the critical care environment by reducing the stress and uncertainty of professionals involved in other end-of-life situations. However, the most striking implication relates to the reality of the workplace: meeting the goals of improved patient care outcomes and those of improving the healthcare work environment are not mutually exclusive and may be mutually essential.

The nurse manager's work in the hospital environment during the 1990s and 2000s: responsibility, accountability and expertise in nursing leadership.

PubMed

Surakka, Tiina

2008-07-01

The aim of the study was to describe and compare the characteristics of the nurse manager's work in different hospital environments and at different times. Business values and pressures for cost efficiency have become a reality in health care. The data comprised the diaries of 155 nurse managers working in one Finnish health district's hospitals in the 1990s and 2000s. In addition, focus group interviews were used as a data source. The data were subjected to qualitative and quantitative content analysis. The nurse manager's work comprises responsibility activities, accountability activities, and traditional bedside nursing. They also described the recognition of the underlying premises of their work and outcome orientation. Their descriptions of work varied between university and rural hospitals, between psychiatric and somatic nursing and between different wards. The work changed in the 2000s as the nurse manager's role changed from nurse to nurse leader. It appears that nurse managers have succeeded in integrating different leadership models into their daily work pattern. A new leadership model was devised based on an emerging nursing framework. Nurse leaders should assess who can assume leadership positions in health care and on what grounds.

The context of ethics in the health care industry.

PubMed

Wells, B; Spinks, N

1996-01-01

Examines ethics in the health care industry from the perspectives of investors, employees, patients, competitors and the environment. Ethical behaviour in the health care industry is essential and desirable; however, determining which behavioural actions are ethical and which are unethical is difficult. Although never will everyone agree on specific ethical standards, everyone should agree that setting ethical standards is vital. Therefore, administrators of health care institutions and health care providers should work together to establish codes of ethics which define boundaries for ethical behaviours in the health care industry.

Health care aides use of time in a residential long-term care unit: a time and motion study.

PubMed

Mallidou, Anastasia A; Cummings, Greta G; Schalm, Corinne; Estabrooks, Carole A

2013-09-01

Organizational resources such as caregiver time use with older adults in residential long-term care facilities (nursing homes) have not been extensively studied, while levels of nurse staffing and staffing-mix are the focus of many publications on all types of healthcare organizations. Evidence shows that front-line caregivers' sufficient working time with residents is associated with performance, excellence, comprehensive care, quality of outcomes (e.g., reductions in pressure ulcers, urinary tract infections, and falls), quality of life, cost savings, and may be affiliated with transformation of organizational culture. To explore organizational resources in a long-term care unit within a multilevel residential facility, to measure healthcare aides' use of time with residents, and to describe working environment and unit culture. An observational pilot study was conducted in a Canadian urban 52-bed long-term care unit within a faith-based residential multilevel care facility. A convenience sample of seven healthcare aides consented to participate. To collect the data, we used an observational sheet (to monitor caregiver time use on certain activities such as personal care, assisting with eating, socializing, helping residents to be involved in therapeutic activities, paperwork, networking, personal time, and others), semi-structured interview (to assess caregiver perceptions of their working environment), and field notes (to illustrate the unit culture). Three hundred and eighty seven hours of observation were completed. The findings indicate that healthcare aides spent most of their working time (on an eight-hour day-shift) in "personal care" (52%) and in "other" activities (23%). One-to-three minute activities consumed about 35% of the time spent in personal care and 20% of time spent in assisting with eating. Overall, caregivers' time spent socializing was less than 1%, about 6% in networking, and less than 4% in paperwork. Re-organizing healthcare aides' routine practices may minimize the short one-to-three minute intervals spent on direct care activities, which can be interpreted as interruptions to continuity of care or waste of time. Fewer interruptions may allow healthcare aides to use their time with residents more effectively. Copyright © 2012 Elsevier Ltd. All rights reserved.

A taxonomy of nursing care organization models in hospitals

PubMed Central

2012-01-01

Background Over the last decades, converging forces in hospital care, including cost-containment policies, rising healthcare demands and nursing shortages, have driven the search for new operational models of nursing care delivery that maximize the use of available nursing resources while ensuring safe, high-quality care. Little is known, however, about the distinctive features of these emergent nursing care models. This article contributes to filling this gap by presenting a theoretically and empirically grounded taxonomy of nursing care organization models in the context of acute care units in Quebec and comparing their distinctive features. Methods This study was based on a survey of 22 medical units in 11 acute care facilities in Quebec. Data collection methods included questionnaire, interviews, focus groups and administrative data census. The analytical procedures consisted of first generating unit profiles based on qualitative and quantitative data collected at the unit level, then applying hierarchical cluster analysis to the units’ profile data. Results The study identified four models of nursing care organization: two professional models that draw mainly on registered nurses as professionals to deliver nursing services and reflect stronger support to nurses’ professional practice, and two functional models that draw more significantly on licensed practical nurses (LPNs) and assistive staff (orderlies) to deliver nursing services and are characterized by registered nurses’ perceptions that the practice environment is less supportive of their professional work. Conclusions This study showed that medical units in acute care hospitals exhibit diverse staff mixes, patterns of skill use, work environment design, and support for innovation. The four models reflect not only distinct approaches to dealing with the numerous constraints in the nursing care environment, but also different degrees of approximations to an “ideal” nursing professional practice model described by some leaders in the contemporary nursing literature. While the two professional models appear closer to this ideal, the two functional models are farther removed. PMID:22929127

Intensive care nurses' perceptions of simulation-based team training for building patient safety in intensive care: a descriptive qualitative study.

PubMed

Ballangrud, Randi; Hall-Lord, Marie Louise; Persenius, Mona; Hedelin, Birgitta

2014-08-01

To describe intensive care nurses' perceptions of simulation-based team training for building patient safety in intensive care. Failures in team processes are found to be contributory factors to incidents in an intensive care environment. Simulation-based training is recommended as a method to make health-care personnel aware of the importance of team working and to improve their competencies. The study uses a qualitative descriptive design. Individual qualitative interviews were conducted with 18 intensive care nurses from May to December 2009, all of which had attended a simulation-based team training programme. The interviews were analysed by qualitative content analysis. One main category emerged to illuminate the intensive care nurse perception: "training increases awareness of clinical practice and acknowledges the importance of structured work in teams". Three generic categories were found: "realistic training contributes to safe care", "reflection and openness motivates learning" and "finding a common understanding of team performance". Simulation-based team training makes intensive care nurses more prepared to care for severely ill patients. Team training creates a common understanding of how to work in teams with regard to patient safety. Copyright © 2014 Elsevier Ltd. All rights reserved.

Closeness, chaos and crisis: the attractions of working in acute mental health care.

PubMed

Deacon, M; Warne, T; McAndrew, S

2006-12-01

This paper makes a case for the attractiveness of acute mental health inpatient nursing (acute nursing) and argues that an altered perception of this work is essential if we are to provide the most acutely mentally ill and vulnerable people with a stable and expert nursing workforce. The discussion draws on an ethnographic study conducted in an inner-city psychiatric unit in England and the advantages of this method for understanding nursing work are described. Within our findings, we set out two overarching themes: the contextual realities of the contemporary acute ward and features of attraction that encourage nurses to work in the acute care setting. The former includes nurses' responsibility for the total ward environment and the latter the 'comfort of closeness' and 'surviving and thriving in chaos and crisis'. In conclusion, we argue that despite the unpopularity of the acute inpatient mental health environment, the highly sophisticated skills employed by acute nurses actually ensure the promotion of health for the majority of service users.

Transfer of innovation, knowledge and competencies on the care service for people with acquired disabilities: the European Project "Care for Work".

PubMed

Barchitta, M; Fragapane, S; Consoli, M T; Pennisi, C; Agodi, A

2012-01-01

The growing needs of people with disabilities require to integrate this issue into public health in order to improve political feasibility and to ensure that disability will not be left off from any strategic table. The main aim of the "Care for Work" project was to provide training contents to help workers and unemployed people to adapt their knowledge, skills and competencies to the care services sector in order to facilitate their insertion in a new employment source. The partners participating in the project are Organizations from 5 European countries. The project has been divided into seven Work Packages (WPs): three transversal WPs and four specific WPs, each addressing specific activities necessary to achieve the final objectives of the project. The "Care for Work" learning environment contains specific information and training on the techniques for caring people with acquired physical disabilities, as text documents and short training films. The project combines e-learning (Web 2.0) and mobile learning providing a flexible training platform for workers of care services sector. The "Care for Work" project offers specific training addressed to meet the new existing needs of workers of the care services sector and/or unemployed people. All the information and results of the project are available on the web page: www.careforwork.eu, and the present article is part of the WP "Valorization".

Is working in culturally diverse working environment associated with physicians' work-related well-being? A cross-sectional survey study among Finnish physicians.

PubMed

Aalto, Anna-Mari; Heponiemi, Tarja; Väänänen, Ari; Bergbom, Barbara; Sinervo, Timo; Elovainio, Marko

2014-08-01

International mobility of health care professionals is increasing, though little is known about how working in a culturally diverse team affects the native physicians' psychosocial work environment. We examined Finnish physicians' perceptions of work-related wellbeing according to whether they had foreign-born colleagues (FBCs) in their work unit. We also examined whether work-related resources moderate the potential association between work-related wellbeing and working alongside FBCs. A cross-sectional survey was conducted for a random sample of physicians in Finland in 2010 (3826 respondents, response rate 55%). Analyses were restricted to native Finnish physicians working in public health care. The results were analyzed by ANCOVA. In unadjusted analyses, having FBCs was related to poor team climate (p<0.001) and poor job satisfaction (p=0.001). Those physicians who reported high procedural justice and high job control perceived also higher job satisfaction even if they had many FBCs in the work unit (p=0.007 for interaction between FBCs and procedural justice and p<0.001 for interaction between FBCs and job control). These associations were robust to adjustments for age, sex, health care sector, specialization, on-call duty, employment contract, full-time employment and leadership position. The results indicate that culturally diverse work units face challenges related to team climate and job satisfaction. The results also show that leadership plays an important role in culturally diverse work units. The potential challenges of culturally diverse teams for native physicians may be reduced by fair decision-making and by increasing physicians' job control. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Advancing nursing leadership in long-term care.

PubMed

O'Brien, Jennifer; Ringland, Margaret; Wilson, Susan

2010-05-01

Nurses working in the long-term care (LTC) sector face unique workplace stresses, demands and circumstances. Designing approaches to leadership training and other supportive human-resource strategies that reflect the demands of the LTC setting fosters a positive work life for nurses by providing them with the skills and knowledge necessary to lead the care team and to address resident and family issues. Through the St. Joseph's Health Centre Guelph demonstration site project, funded by the Nursing Secretariat of Ontario's Ministry of Health and Long-Term Care, the Excelling as a Nurse Leader in Long Term Care training program and the Mentor Team program were developed to address these needs. Evaluation results show that not only have individual nurses benefitted from taking part in these programs, but also that the positive effects were felt in other parts of the LTC home (as reported by Directors of Care). By creating a generally healthier work environment, it is anticipated that these programs will also have a positive effect on recruitment and retention.

The Role of the Built Environment: How Decentralized Nurse Stations Shape Communication, Patient Care Processes, and Patient Outcomes.

PubMed

Real, Kevin; Bardach, Shoshana H; Bardach, David R

2017-12-01

Increasingly, health communication scholars are attending to how hospital built environments shape communication, patient care processes, and patient outcomes. This multimethod study was conducted on two floors of a newly designed urban hospital. Nine focus groups interviews were conducted with 35 health care professionals from 10 provider groups. Seven of the groups were homogeneous by profession or level: nursing (three groups), nurse managers (two groups), and one group each of nurse care technicians ("techs") and physicians. Two mixed groups were comprised of staff from pharmacy, occupational therapy, patient care facilitators, physical therapy, social work, and pastoral care. Systematic qualitative analysis was conducted using a conceptual framework based on systems theory and prior health care design and communication research. Additionally, quantitative modeling was employed to assess walking distances in two different hospital designs. Results indicate nurses walked significantly more in the new hospital environment. Qualitative analysis revealed three insights developed in relationship to system structures, processes, and outcomes. First, decentralized nurse stations changed system interdependencies by reducing nurse-to-nurse interactions and teamwork while heightening nurse interdependencies and teamwork with other health care occupations. Second, many nursing-related processes remained centralized while nurse stations were decentralized, creating systems-based problems for nursing care. Third, nursing communities of practices were adversely affected by the new design. Implications of this study suggest that nurse station design shapes communication, patient care processes, and patient outcomes. Further, it is important to understand how the built environment, often treated as invisible in communication research, is crucial to understanding communication within complex health care systems.

[Career opportunities for anesthetists: to work and live in Abu Dhabi--a report].

PubMed

Hornung, Michael

2008-11-01

This article describes an anaesthetist's experience working in a tertiary care hospital in the UAE. The health care system, with both private and government facilities, is subject to rapid development and diversification like the country as a whole. The staffing system in the hospital is based on the Anglo-American consultant model and provides a pleasant, informal work environment. Compared to a routine work day in Germany, work in the UAE is exciting and varied because of cultural differences and the nature of the cases being treated. Life in the UAE is characterized by its multinational, multicultural society which provides for absorbing encounters and great recreational opportunities including plenty of sun and sea.

Art, music, story: The evaluation of a person-centred arts in health programme in an acute care older persons' unit.

PubMed

Ford, Karen; Tesch, Leigh; Dawborn, Jacqueline; Courtney-Pratt, Helen

2018-06-01

To evaluate the impact of an arts in health programme delivered by a specialised artist within an acute older person's unit. Acute hospitals must meet the increasingly complex needs of older people who experience multiple comorbidities, often including cognitive impairment, either directly related to their admission or longer term conditions, including dementia. A focus on physical illness, efficiency and tasks within an acute care environment can all divert attention from the psychosocial well-being of patients. This focus also decreases capacity for person-centred approaches that acknowledge and value the older person, their life story, relationships and the care context. The importance of arts for health and wellness, including responsiveness to individual need, is well established: however, there is little evidence about its effectiveness for older people in acute hospital settings. We report on a collaborative arts in health programme on an acute medical ward for older people. The qualitative study used collaborative enquiry underpinned by a constructivist approach to evaluate an arts programme that involved participatory art-making activities, customised music, song and illustration work, and enlivening the unit environment. Data sources included observation of art activities, semi-structured interviews with patients and family members, and focus groups with staff. Data were transcribed and thematically analysed using a line by line approach. The programme had positive impacts for the environment, patients, families and staff. The environment exhibited changes as a result of programme outputs; patients and families were engaged and enjoyed activities that aided recovery from illness; and staff also enjoyed activities and importantly learnt new ways of working with patients. An acute care arts in health programme is a carefully nuanced programme where the skills of the arts health worker are critical to success. Utilising such skill, continued focus on person-centeredness and openness to creativity demonstrated positive impacts for patients, families, staff and the ward environment. This study affirms the contribution of an arts in health program for older persons in an acute care setting in challenging the dominance of a task based medical model and emphasising person-centred care and outcomes. © 2018 John Wiley & Sons Ltd.

Incentives for improving human resource outcomes in health care: overview of reviews.

PubMed

Misfeldt, Renee; Linder, Jordana; Lait, Jana; Hepp, Shelanne; Armitage, Gail; Jackson, Karen; Suter, Esther

2014-01-01

To review the effectiveness of financial and nonfinancial incentives for improving the benefits (recruitment, retention, job satisfaction, absenteeism, turnover, intent to leave) of human resource strategies in health care. Overview of 33 reviews published from 2000 to 2012 summarized the effectiveness of incentives for improving human resource outcomes in health care (such as job satisfaction, turnover rates, recruitment, and retention) that met the inclusion criteria and were assessed by at least two research members using the Assessment of Multiple Systematic Reviews quality assessment tool. Of those, 13 reviews met the quality criteria and were included in the overview. Information was extracted on a description of the review, the incentives considered, and their impact on human resource outcomes. The information on the relationship between incentives and outcomes was assessed and synthesized. While financial compensation is the best-recognized approach within an incentives package, there is evidence that health care practitioners respond positively to incentives linked to the quality of the working environments including opportunities for professional development, improved work life balance, interprofessional collaboration, and professional autonomy. There is less evidence that workload factors such as job demand, restructured staffing models, re-engineered work designs, ward practices, employment status, or staff skill mix have an impact on human resource outcomes. Overall, evidence of effective strategies for improving outcomes is mixed. While financial incentives play a key role in enhancing outcomes, they need to be considered as only one strategy within an incentives package. There is stronger evidence that improving the work place environment and instituting mechanisms for work-life balance need to be part of an overall strategy to improve outcomes for health care practitioners.

Telepsychiatry: Benefits and costs in a changing health-care environment.

PubMed

Waugh, Maryann; Voyles, Debbie; Thomas, Marshall R

2015-01-01

In the USA, the high cost and inefficiencies of the health care system have prompted widespread demand for a better value on investment. Reform efforts, focused on increasing effective, cost-efficient, and patient-centred practices, are inciting lasting changes to health care delivery. Integrated care, providing team-based care that addresses both physical and behavioural health needs is growing as an evidence-based way to provide improved care with lower overall costs. This in turn, is leading to an increasing demand for psychiatrists to work with primary care physicians in delivering integrated care. Telepsychiatry is an innovative platform that has a variety of benefits to patients, providers, and systems. Associated costs are changing as technology advances and policies shift. The purpose of this article is to describe the changing role of psychiatry within the environment of U.S. healthcare reform, and the benefits (demonstrated and potential) and costs (fixed, variable, and reimbursable) of telepsychiatry to providers, patients and systems.

Linking Nurses' Clinical Leadership to Patient Care Quality: The Role of Transformational Leadership and Workplace Empowerment.

PubMed

Boamah, Sheila

2018-03-01

Background While improving patient safety requires strong nursing leadership, there has been little empirical research that has examined the mechanisms by which leadership influences patient safety outcomes. Aim To test a model examining relationships among transformational leadership, structural empowerment, staff nurse clinical leadership, and nurse-assessed adverse patient outcomes. Methods A cross-sectional survey was conducted with a randomly selected sample of 378 registered nurses working in direct patient care in acute care hospitals across Ontario, Canada. Structural equation modeling was used to test the hypothesized model. Results The model had an acceptable fit, and all paths were significant. Transformational leadership was significantly associated with decreased adverse patient outcomes through structural empowerment and staff nurse clinical leadership. Discussion This study highlights the importance of transformational leadership in creating empowering practice environments that foster high-quality care. The findings indicate that a more complete understanding of what drives desired patient outcomes warrants the need to focus on how to empower nurses and foster clinical leadership practices at the point of care. Conclusion In planning safety strategies, managers must demonstrate transformational leadership behaviors in order to modify the work environment to create better defenses for averting adverse events.

Leveraging 21st Century Learning & Technology to Create Caring Diverse Classroom Cultures

ERIC Educational Resources Information Center

Tarbutton, Tanya

2018-01-01

Creating diverse caring classroom environments, for all students, using innovative technology, is the impetus of this article. Administrators and teachers in many states have worked to integrate 21st Century Learning Outcomes and Local Control and Accountability Plans (LCAP) into daily teaching and learning. These initiatives are designed to…

Finding What Works: Leadership Competencies for the Changing Healthcare Environment

ERIC Educational Resources Information Center

Herd, Ann M.; Adams-Pope, Brittany L.; Bowers, Amanda; Sims, Brittany

2016-01-01

As the world of healthcare changes rapidly, healthcare leaders and managers must hone their leadership competencies in order to remain effective in their organizations. With changes such as the Affordable Care Act, increasing medical school costs, decreased graduation rates, and increased needs for care, how are current and future healthcare…

Building a Culture of Inclusion: Disability as Opportunity for Organizational Growth and Improving Patient Care.

PubMed

Ailey, Sarah H; Brown, Paula; Friese, Tanya R; Dugan, Shelia

2016-01-01

Administrators at Rush University Medical Center have made a commitment to diversity, including accommodating disabilities in the workplace and for students. This article explains extensive multilevel accommodations instituted by Rush University Medical Center that promote organizational growth and a healthier work environment and improve patient care.

Recommendations for Child Care Centers. Revised Edition.

ERIC Educational Resources Information Center

Moore, Gary T.; Lane, Carol G.; Hill, Ann B.; Cohen, Uriel; McGinty, Tim

Part of a seven-volume series on children's environments, this monograph is a design guide for policy, planning, programming, design, and evaluation of early childhood facilities. The design guide includes 115 patterns for large, medium, and small child care centers in neighborhood and work-place settings. Many of the patterns are appropriate also…

Influence of workplace culture on nursing-sensitive nurse outcomes in municipal primary health care.

PubMed

Hahtela, Nina; Paavilainen, Eija; McCormack, Brendan; Slater, Paul; Helminen, Mika; Suominen, Tarja

2015-10-01

To explore the influence of workplace culture on sickness absences, overtime work and occupational injuries in municipal primary health care. The need to improve nursing sensitive outcomes has been highlighted. Therefore, an adequate understanding of the influence of workplace culture on nursing-sensitive nurse outcomes is essential for nurse managers to meet the requirements of improving nursing outcomes. A cross-sectional survey design was used to incorporating the data from 21 inpatient acute care units of nine organisations at the Finnish municipal primary health care system from 2011 to 2012. Findings emphasise in particular the importance of the practice environment as being an interpretative factor for nurses' absences owing to sickness, overtime work and occupational injuries. To ensure favourable nursing sensitive outcomes it is essential that there is a shared interest in the unit to invest in the creation of a supportive practice environment. Outcome improvements require a special focus on issues related to nursing management, adequate staffing and resources and intention to leave. © 2014 John Wiley & Sons Ltd.

Addressing Agricultural Issues in Health Care Education: An Occupational Therapy Curriculum Program Description

ERIC Educational Resources Information Center

Smallfield, Stacy; Anderson, Angela J.

2008-01-01

Context: Medical and allied health professionals who work in agricultural states frequently address the needs of clients who live and work in rural and frontier environments. The primary occupations of those living in rural areas include farming, ranching, or other agriculture-related work. Farming is consistently ranked as one of the most…

North Karelia regional chain of care: Finnish experiences.

PubMed

Itkonen, Pentti

2004-01-01

Information--and communication technology is one of the most important cornerstones in more and more data and knowledge intensive health care sector. However these factors don't create financial gains and productivity benefits spontaneously. They need organisational and social innovations and new business models. The growth of productivity is connected to the process and organisational innovations and not to the number of computers and the growth of using ICT. One of the problems prohibiting health care profession to move to real e-work environment is the lack of the reliable measures and on these measures based performance measurement and strategic management. Health care can be improved by utilizing ICT and tools like performance measuring are key weapons in the arsenal of new e-work environment and measuring based new strategic management. Neither public sector nor not-for-profit hospitals look for financial rewards as their ultimate proof of success. Instead, they seek to achieve ambitious missions aimed at improving the health standards and wellbeing of the citizens. ICT- based new way of managing in the public sector is just beginning to gain a critical level of digitalization and will most likely come to its own in the coming years. Therefore, it is essential to research on how the health care sector can be moved towards new regional models and clinical workflow using intelligent standard based strategic management and performance measurement. If the breakthrough of the eight-hour working day and shortening of working time are evaluated afterwards, it can be stated that they have made the society more anthropocentric and humane. During one century the annual working time has shortened from 3000 hours to 1700 hours in the European Union countries. These foundations of a more humane society--eight-hour working day and shortening of regular working time--are however disappearing in the post-industrialized information society. There are various grounds for the eight-hour working day. These grounds relate to quality of life, occupational safety and health and productivity of work. It is worth asking if the nature of work has changed in a way that the truths of an industrialized society do not hold true or has the development of working time in health care sector become uncontrolled in some new way?

Interprofessional Clinical Assignments: A Project in Nursing Education.

PubMed

Turner, Stephanie

2015-01-01

Education involving interprofessional activities helps to improve learning and the ability to work in an effective collaborative environment. In this project, 16 baccalaureate nursing students were given the opportunity to work with other members of the health care team to develop an understanding of the roles and responsibilities of each group of professionals and the communication skills needed to provide quality and safe care to patients and to positively impact their motivation to work with members of other health professions. All the students in the group documented the successful completion of these objectives in their journals.

An Interpretative Study on Nurses' Perspectives of Working in an Overcrowded Emergency Department in Taiwan.

PubMed

Chen, Li-Chin; Lin, Chun-Chih; Han, Chin-Yen; Hsieh, Chun-Lan; Wu, Chiung-Jung Jo; Liang, Hwey-Fang

2018-03-01

This study aims to gain in-depth understanding of nurses' perspectives of working in an overcrowded emergency. Symbolic interactionism and Charmaz's construction of grounded theory were used. Purposive sampling at the start of the study and a further theoretical sampling by snowball technique were used to recruit 40 registered nurses (RN) to participate in in-depth, semi-structured interviews between May and November, 2014. Data analysis included analytic techniques of initial, focused and theoretical coding. Study findings showed searching for work role is derived by the themes of Finding the role of positioning in Emergency Department (ED), Recognizing causes of ED overcrowding, and Confined working environment. Nurses' work experience which represents the RNs not gained control over their work, as care actions influenced by the problematic overcrowded circumstance of the ED environment. The findings fill a gap in knowledge about how RNs experience their work role in the context of an overcrowded Emergency Department in Taiwan. Arising from the study result include taking account of nurses' perspectives when planning staff/patient ratios, strategies to reduce waiting time and ensure that clients receive appropriate care. Copyright © 2018. Published by Elsevier B.V.

Challenges in the management of chronic noncommunicable diseases by Indonesian community pharmacists

PubMed Central

Puspitasari, Hanni P.; Aslani, Parisa; Krass, Ines

2015-01-01

Objectives: We explored factors influencing Indonesian primary care pharmacists’ practice in chronic noncommunicable disease management and proposed a model illustrating relationships among factors. Methods: We conducted in-depth, semistructured interviews with pharmacists working in community health centers (Puskesmas, n=5) and community pharmacies (apotek, n=15) in East Java Province. We interviewed participating pharmacists using Bahasa Indonesia to explore facilitators and barriers to their practice in chronic disease management. We audiorecorded all interviews, transcribed ad verbatim, translated into English and analyzed the data using an approach informed by “grounded-theory”. Results: We extracted five emergent themes/factors: pharmacists’ attitudes, Puskesmas/apotek environment, pharmacy education, pharmacy professional associations, and the government. Respondents believed that primary care pharmacists have limited roles in chronic disease management. An unfavourable working environment and perceptions of pharmacists’ inadequate knowledge and skills were reported by many as barriers to pharmacy practice. Limited professional standards, guidelines, leadership and government regulations coupled with low expectations of pharmacists among patients and doctors also contributed to their lack of involvement in chronic disease management. We present the interplay of these factors in our model. Conclusion: Pharmacists’ attitudes, knowledge, skills and their working environment appeared to influence pharmacists’ contribution in chronic disease management. To develop pharmacists’ involvement in chronic disease management, support from pharmacy educators, pharmacy owners, professional associations, the government and other stakeholders is required. Our findings highlight a need for systematic coordination between pharmacists and stakeholders to improve primary care pharmacists’ practice in Indonesia to achieve continuity of care. PMID:26445618

Teaching with Mark Dion

ERIC Educational Resources Information Center

Fusaro, Joe

2011-01-01

Mark Dion creates sculptures, installations, and interactive environments that sometimes seem contrary to what one expects from visual artists. Remarkable curiosity cabinets and carefully arranged artifacts from specific places and time periods make up a large part of his work. His work does not neatly fit into traditional lessons about elements…

The relationship of positive work environments and workplace injury: evidence from the National Nursing Assistant Survey.

PubMed

McCaughey, Deirdre; McGhan, Gwen; Walsh, Erin M; Rathert, Cheryl; Belue, Rhonda

2014-01-01

With estimates of a 51% growth in the number of nursing assistants needed by 2016, there is a critical need to examine workplace factors that negatively contribute to the recruitment and retention of nursing assistants. Studies have shown that high demands, physical stress, and chronic workforce shortages contribute to a working environment that fosters one of the highest workforce injury rates in the United States. The aim of this study was to explore the relationship between nursing assistant injury rates and key outcomes, such as job satisfaction and turnover intent, while exploring workplace environment factors, such as injury prevention training, supervisor support, and employee engagement, that can decrease the rates of workplace injury. Data from the 2004 National Nursing Assistant Survey were used to examine the negative effects of workplace injury on nursing assistants and the workplace environment factors that are related to the rate of worker injury. Nursing assistants who experience job-related injuries have lower levels of job satisfaction, increased turnover intentions, and are less likely to recommend their facility as a place to work or seek care services. It was also found that nursing assistant injury rates are related to employee ratings of injury prevention training, supervisor support, and employee engagement. NAs with multiple injuries (>2) were 1.3-1.6 times more likely to report being injured at work than NAs who had not been injured when supervisor support, employee engagement, and training ratings were low. Evidence that health care organizations can use to better understand how workplace injuries occur and insight into ways to reduce the current staggering rate of on-the-job injuries occurring in health care workplaces were offered in this study. The findings also offer empirical support for an extension of the National Institute for Occupational Health and Safety/National Occupational Research Agenda Work Organization Framework for Occupational Illness and Injury.

Healthcare professionals' work engagement in Finnish university hospitals.

PubMed

Lepistö, Sari; Alanen, Seija; Aalto, Pirjo; Järvinen, Päivi; Leino, Kaija; Mattila, Elina; Kaunonen, Marja

2017-10-10

Concerns about the sufficiency and dedication of the healthcare workforce have arisen as the baby boomer generation is retiring and the generation Y might have different working environment demands. To describe the association between work engagement of healthcare professionals' and its background factors at five Finnish university hospitals. Survey data were collected from nurses, physicians and administrative staff (n = 561) at all five university hospitals in Finland. Data were collected using an electronic questionnaire that comprised the Utrecht Work Engagement Scale (9 items) and 13 questions regarding the respondents' backgrounds. Descriptive and correlational analyses were used to examine the data. Most respondents were female (85%) and nursing staff (72%). Baby boomers (49%) were the largest generational cohort. The work engagement composite mean for the total sample was 5.0, indicating high work engagement. Significant differences in work engagement existed only among sex and age groups. The highest work engagement scores were among administrative staff. Work engagement among healthcare professionals in Finnish university hospitals is high. High work engagement might be explained by suitable job resources and challenges, as well as opportunities provided by a frontline care environment. Attention should especially be paid to meeting the needs of young people entering the workforce to strengthen their dedication and absorption. © 2017 Nordic College of Caring Science.

Changes to nurses' practice environment over time.

PubMed

Roche, Michael A; Duffield, Christine; Friedman, Sarah; Twigg, Di; Dimitrelis, Sofia; Rowbotham, Samantha

2016-07-01

To examine changes in the nursing practice environment, retention-related factors, unit stability and patient care tasks delayed or left undone, over two periods between 2004 and 2013. Positive nurse practice environments have been linked to nurse retention and care quality outcomes. The collection of the Practice Environment Scale of the Nursing Work Index, job satisfaction, intent to leave, unit instability and tasks delayed or not done at six acute-care hospitals across three Australian states, in two waves between 2004 and 2013; results from the two waves are compared. On average, practice environment scores declined slightly; nurses reported a greater difficulty in finding another nursing position, lower intent to leave their current job and greater instability in their current position. Rates of delayed tasks increased over the period, whereas rates of tasks left undone have decreased over the period. The decline in nurses' perceptions of the quality of the practice environment is disappointing, particularly given the protracted workforce shortages that have persisted. Significant organisational restructuring and turnover of nurse executives may have contributed to this decline. Managers need to apply existing evidence to improve nurse practice environments and manage instability. © 2016 John Wiley & Sons Ltd.

The University of Florida Department of Surgery: building a stronger tomorrow on yesterday's foundation.

PubMed

Behrns, Kevin E; Copeland, Edward M; Howard, Richard J

2012-01-01

Established in 1957, the University of Florida Department of Surgery has a solid foundation on which current faculty are driven to build a stronger tomorrow. The department is focused on promoting patient-centered care, expanding its research portfolio to improve techniques and outcomes, and training the surgical leaders of tomorrow. It fosters an environment where faculty, residents, students, and staff challenge long-held traditions with the goal of improving the health of our patients, the quality of our care, and the vitality of our work environment.

The work of the South Manchester Accident Rescue Team (SMART).

PubMed

Redmond, A D

1990-01-01

Skills acquired in the hospital do not necessarily translate to the scene of an accident. However, training in certain hospital specialties, particularly accident and emergency medicine, will expose doctors to dealing with very ill patients in a less rigidly structured environment. The operating theatre is a disciplined and controlled environment. Skill in anaesthesia, monitoring and operating, if tested only in these circumstances may be found to be gravely inadequate when exposed to the fluctuant and hostile environment at the site. Doctors who wish to do this sort of work or are designated to do it, must undergo regular and frequent training, especially if they are not trained in accident and emergency departments. This has long been recognised by the British Association for Immediate Care. In combination with the Royal College of Surgeons of Edinburgh they have now established a diploma in Immediate Medical Care. In urban areas the need for a doctor to attend at the scene of an accident is usually limited to entrapment. These occasions are likely to be infrequent and this can result in a lack of preparedness for such events. Interhospital transfer, primarily from peripheral hospitals to the specialist services of a teaching hospital, often involves critically ill and injured patients. The management of these cases by the mobile team provides regular, frequent exposure to working in a 'hostile' environment. Relationships with the rescue services are developed and staff become familiar with equipment and call-out procedures. The care of transported patients is improved. None of our patients have died in transit or within 6 h of arrival at base.(ABSTRACT TRUNCATED AT 250 WORDS)

Nursing leadership and management effects work environments.

PubMed

Tomey, Ann Marriner

2009-01-01

The aim of this literature search was to identify recent research related to nursing leadership and management effects on work environment using the 14 forces of magnetism. This article gives some historical perspective from the original 1983 American Academy of Nursing study through to the 2002 McClure and Hinshaw update to 2009 publications. Research publications were given a priority for references. The 14 forces of magnetism as identified by Unden and Monarch were: '1. Quality of leadership..., 2. Organizational structure..., 3. Management style..., 4. Personnel policies and programs..., 5. Professional models of care..., 6. Quality of care..., 7 Quality improvement..., 8. Consultation and resources..., 9. Autonomy..., 10. Community and the hospital..., 11. Nurse as teacher..., 12. Image of nursing..., 13. Interdisciplinary relationships... and 14. Professional development....'. Correlations have been found among positive workplace management initiatives, style of transformational leadership and participative management; patient-to-nurse ratios; education levels of nurses; quality of patient care, patient satisfaction, employee health and well-being programmes; nurse satisfaction and retention of nurses; healthy workplace environments and healthy patients and personnel. This article identifies some of the research that provides evidence for evidence-based nursing management and leadership practice.

Self-assessed occupational health and working environment of female nurses, cabin crew and teachers.

PubMed

Sveinsdóttir, Herdis; Gunnarsdóttir, Hólmfríethur; Friethriksdóttir, Hildur

2007-06-01

The aim of this study was to describe and compare the self-assessed occupational health among female nurses, cabin crew and teachers, in relation to their working environment. Similarities between the three occupations, i.e. predominantly female and service-oriented, render them interesting in comparison with respect to health and working environment. The participants were female Icelandic cabin crew, nurses and elementary school teachers. A questionnaire including items on socio-demographics, working environment (addressing work pace, job security, monotonous work, assistance, physically strenuous work and physical environmental factors) and a symptom list was used for data collection. Factor analyses on the symptom list resulted in five symptom scales: Musculoskeletal, Stress and exhaustion, Common cold, Gastrointestinal and Sound perception scale. A total of 1571 questionnaires were distributed. The response rate was 65.7-69%, depending on occupation. Data were collected in 2002. Cabin crew reported worse gastrointestinal, sound perception and common cold symptoms than nurses and teachers. Cabin crew and teachers reported worse symptoms of stress and exhaustion than nurses (p < 0.05). When compared with teachers and nurses cabin crew reported less job security and more physically strenuous and monotonous work. Nurses were likelier to seek assistance from co-workers or patients as well as to take care of an older relative than teachers and cabin crew. Regression analysis found that within each occupation distress from environmental factors resulted in higher score on all the symptom scales. Nurses experience less stress and exhaustion than teachers and cabin crew. In comparison with one or both of the other occupations nurses are more likely to assist each other with their work, experience job security, reporting physically complex work and take care of older relatives. This should be highlighted as positive aspects of nurses' work praised as displaying responsibility and interconnectedness of nurses'.

Authentic leadership, empowerment and burnout: a comparison in new graduates and experienced nurses.

PubMed

Laschinger, Heather K Spence; Wong, Carol A; Grau, Ashley L

2013-04-01

To examine the effect of authentic leadership and structural empowerment on the emotional exhaustion and cynicism of new graduates and experienced acute-care nurses. Employee empowerment is a fundamental component of healthy work environments that promote nurse health and retention, and nursing leadership is key to creating these environments. In a secondary analysis of data from two studies we compared the pattern of relationships among study variables in two Ontario groups: 342 new graduates with <2 years of experience and 273 nurses with more than 2 years of experience. A multi-group path analysis using Structural Equation Modelling indicated an acceptable fit of the final model (χ(2) = 17.52, df = 2, P < 0.001, CFI = 0.97, IFI = 0.97 and RMSEA = 0.11). Authentic leadership significantly and negatively influenced emotional exhaustion and cynicism through workplace empowerment in both groups. The authentic behaviour of nursing leaders was important to nurses' perceptions of structurally empowering conditions in their work environments, regardless of experience level, and ultimately contributed to lower levels of emotional exhaustion and cynicism. Leadership training for nurse managers may help develop the empowering work environments required in today's health-care organizations in order to attract and retain nurses. © 2012 Blackwell Publishing Ltd.

The physical environment and patients' activities and care: A comparative case study at three newly built stroke units.

PubMed

Anåker, Anna; von Koch, Lena; Sjöstrand, Christina; Heylighen, Ann; Elf, Marie

2018-04-20

To explore and compare the impact of the physical environment on patients' activities and care at three newly built stroke units. Receiving care in a stroke unit instead of in a general ward reduces the odds of death, dependency and institutionalized care. In stroke units, the design of the physical environment should support evidence-based care. Studies on patients' activities in relation to the design of the physical environment of stroke units are scarce. This work is a comparative descriptive case study. Patients (N = 55) who had a confirmed diagnosis of stroke were recruited from three newly built stroke units in Sweden. The units were examined by non-participant observation using two types of data collection: behavioural mapping analysed with descriptive statistics and field note taking analysed with deductive content analysis. Data were collected from April 2013 - December 2015. The units differed in the patients' levels of physical activity, the proportion of the day that patients spent with health professionals and family presence. Patients were more physically active in a unit with a combination of single and multi-bed room designs than in a unit with an entirely single-room design. Stroke units that were easy to navigate and offered variations in the physical environment had an impact on patients' activities and care. Patients' activity levels and interactions appeared to vary with the design of the physical environments of stroke units. Stroke guidelines focused on health status assessments, avoidance of bed-rest and early rehabilitation require a supportive physical environment. © 2018 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

Hospital Magnet Status, Unit Work Environment, and Pressure Ulcers.

PubMed

Ma, Chenjuan; Park, Shin Hye

2015-11-01

To identify how organizational nursing factors at different structural levels (i.e., unit-level work environment and hospital Magnet status) are associated with hospital-acquired pressure ulcers (HAPUs) in U.S. acute care hospitals. A cross-sectional observational study used data from the National Database of Nursing Quality Indicators®. Responses from 33,845 registered nurses (RNs) were used to measure unit work environments. The unit of analysis was the nursing unit, and there were 1,381 units in 373 hospitals in the United States. Unit work environment was measured by the Practice Environment Scale of Nurse Working Index (PES-NWI). Multilevel logistic regressions were used to estimate the effects of unit work environment and hospital Magnet status on HAPUs. All models were controlled for hospital and unit characteristics when considering clustering of units within hospitals. Magnet hospital units had 21% lower odds of having an HAPU than non-Magnet hospital units (95% confidence interval [CI], 0.64-0.98). With one unit increase of the PES-NWI score, units had 29% lower odds of having an HAPU (95% CI, 0.55-0.91). When including both hospital Magnet status and unit work environment in the model, hospital Magnet status no longer had a significant effect on HAPUs (odds ratio [OR] = 0.82; 95% CI, 0.66-1.02), whereas the significant effect of unit work environment persisted (OR = 0.73; 95% CI, 0.56-0.93). Both hospital and unit environments were significantly associated with HAPUs, and the unit-level work environment can be more influential in reducing HAPUs. Investment in the nurse work environments at both the hospital level and unit level has the potential to reduce HAPUs; and additional to hospital-level initiatives (e.g., Magnet recognition program), efforts targeting on-unit work environments deserve more attention. © 2015 Sigma Theta Tau International.

Personal care assistants' experiences of caring for people on home mechanical ventilation.

PubMed

Israelsson-Skogsberg, Åsa; Lindahl, Berit

2017-03-01

The aim of this study was to describe personal care assistants' (PCA) experiences of working with a ventilator-assisted person at home. Data were collected from fifteen audiotaped semistructured interviews with PCAs supporting a child or adult using home mechanical ventilation (HMV). Thirteen women and two men participated; their working experience with HMV users ranged from one to 17 years (median 6 years). Data were subjected to qualitative content analysis in an inductive and interpretive manner. Five categories emerged from the data: Being part of a complex work situation; Taking on a multidimensional responsibility; Caring carried out in someone's home; Creating boundaries in an environment with indistinct limits; and Being close to another's body and soul. The participants felt very close to the person they worked with, both physically and emotionally. They had a great responsibility and therefore a commensurate need for support, guidance and a well-functioning organisation around the HMV user. There is international consensus that advanced home care will continue to expand and personal care assistance is key in this development. We suggest that one way to move forward for PCAs working with HMV users is to create multiprofessional teams led by a key-person who coordinates the individual needs. More research is needed within this area from a broad perspective including the HMV-assisted persons, relatives, personal care assistants and management organisations. © 2016 Nordic College of Caring Science.

Interdisciplinary shared governance: a partnership model for high performance in a managed care environment.

PubMed

Anderson, D A; Bankston, K; Stindt, J L; Weybright, D W

2000-09-01

Today's managed care environment is forcing hospitals to seek new and innovative ways to deliver a seamless continuum of high-quality care and services to defined populations at lower costs. Many are striving to achieve this goal through the implementation of shared governance models that support point-of-service decision making, interdisciplinary partnerships, and the integration of work across clinical settings and along the service delivery continuum. The authors describe the key processes and strategies used to facilitate the design and successful implementation of an interdisciplinary shared governance model at The University Hospital, Cincinnati, Ohio. Implementation costs and initial benefits obtained over a 2-year period also are identified.

Work stress, occupational burnout and depression levels: a clinical study of paediatric intensive care unit nurses in Taiwan.

PubMed

Lin, Tzu-Ching; Lin, Huey-Shyan; Cheng, Su-Fen; Wu, Li-Min; Ou-Yang, Mei-Chen

2016-04-01

This study aimed to examine the relationship between work stress and depression; and investigate the mediating effect of occupational burnout among nurses in paediatric intensive care units. The relationships among work stress, occupational burnout and depression level have been explored, neither regarding occupational burnout as the mediating role that causes work stress to induce depression nor considering the paediatric intensive care unit context. A cross-sectional correlational design was conducted. One hundred and forty-four female paediatric intensive care unit nurses from seven teaching hospitals in southern Taiwan were recruited as the participants. Data were collected by structured questionnaires including individual demographics, the Nurse Stress Checklist, the Occupational Burnout Inventory and the Taiwan Depression Questionnaire. The results indicated that after controlling for individual demographic variables, the correlations of work stress with occupational burnout, as well as work stress and occupational burnout with depression level were all positive. Furthermore, occupational burnout may exert a partial mediating effect on the relationship between work stress and depression level. This study provides information about work stress, occupational burnout and depression level, and their correlations, as well as the mediating role of occupational burnout among paediatric intensive care unit nurses. It suggests government departments and hospital administrators when formulating interventions to prevent work stress and occupational burnout. These interventions can subsequently prevent episodes of depression in paediatric intensive care unit nurses, thereby providing patients with a safe and high-quality nursing environment. © 2016 John Wiley & Sons Ltd.

Implementing healthy work environment standards in an academic workplace: An update.

PubMed

Harmon, Rebecca B; DeGennaro, Gina; Norling, Meg; Kennedy, Christine; Fontaine, Dorrie

In 2005 the American Association of Critical Care Nurses defined six Healthy Work Environment (HWE) standards for the clinical setting (AACN, 2005), which were reaffirmed and expanded in 2016 (AACN, 2016). These clinical standards were adapted for use in the academic setting by Fontaine, Koh, and Carroll in 2012. The intention of this article is threefold: to present a revised version of the academic workplace standards which are appropriate for all School of Nursing (SON) employees, staff as well as faculty; to proposes the addition of a seventh standard, self-care, which provides the foundation for all standards; and to describe the continuing implementation of these seven standards at the University of Virginia School of Nursing (UVA SON). Copyright © 2017 Elsevier Inc. All rights reserved.

The effects of integrated care on quality of work in nursing homes: a quasi-experiment.

PubMed

Boumans, Nicolle P G; Berkhout, Afke J M B; Vijgen, Sylvia M C; Nijhuis, Frans J N; Vasse, Rineke M

2008-08-01

In nursing homes there is a gradual move from traditional care to integrated care. Integrated care means a demand-oriented, small-scale, co-operated and coordinated provision of services by different caregivers. This integration has direct effect on the work of these separate disciplines. With the introduction of integrated care the quality of work of these caregivers should be assured or even be improved. The purpose of this study was to examine the implementation of integrated care in the nursing home sector and its effects on the quality of work of the caregivers (work content, communication and co-operation and worker's outcomes). A non-equivalent pre-test/post-test control group design was used in this study. Two nursing homes in the Netherlands participated in the study. One nursing home provided the five experimental nursing wards and the other nursing home provided four control wards. Data were selected by means of written questionnaires. The results showed that the intervention appeared to be only successful on the somatic wards. The caregivers of these wards were more able to create a home-like environment for their residents, to use a demand-oriented working method and to integrate the provision of care and services. Regarding the effects of the intervention on quality of work factors, the results included an increase of social support by the supervisor, an increase of the degree of collaboration and a decrease in job demands. No changes were found for the worker's outcomes such as job satisfaction. The intervention on the psycho-somatic wards was unsuccessful. Although the introduction of integrated care on the somatic wards was successful, the effects on quality of work were limited. Next to quantitative research, more qualitative in-depth research is needed to examine models of integrated care and their effects on the work of caregivers within health care organisations, with special attention for specific characteristics of different types of nursing home care (somatic vs. psycho-geriatric).

Inverse roles of emotional labour on health and job satisfaction among long-term care workers in Japan.

PubMed

Tsukamoto, Erika; Abe, Takeru; Ono, Michikazu

2015-01-01

Emotional labour increases among long-term care workers because providing care and services to impaired elders causes conflicting interpersonal emotions. Thus, we investigated the associations between emotional labour, general health and job satisfaction among long-term care workers. We conducted a cross-sectional study among 132 established, private day care centres in Tokyo using a mail survey. The outcome variables included two health-related variables and four job satisfaction variables: physical and psychological health, satisfaction with wages, interpersonal relationships, work environment and job satisfaction. We performed multiple regression analyses to identify significant factors. Directors from 36 facilities agreed to participate. A total of 123 responses from long-term care workers were analysed. Greater emotional dissonance was associated with better physical and psychological health and worse work environment satisfaction (partial regression coefficient: -2.93, p = .0389; -3.32, p = .0299; -1.92, p = .0314, respectively). Fewer negative emotions were associated with more job satisfaction (partial regression coefficient: -1.87, p = .0163). We found that emotional labour was significantly inversely associated with health and job satisfaction. Our findings indicated that the emotional labour of long-term care workers has a negative and positive influence on health and workplace satisfaction, and suggests that care quality and stable employment among long-term care workers might affect their emotional labour. Therefore, we think a programme to support emotional labour among long-term care workers in an organized manner and a self-care programme to educate workers regarding emotional labour would be beneficial.

Monitoring and Identifying in Real time Critical Patients Events.

PubMed

Chavez Mora, Emma

2014-01-01

Nowadays pervasive health care monitoring environments, as well as business activity monitoring environments, gather information from a variety of data sources. However it includes new challenges because of the use of body and wireless sensors, nontraditional operational and transactional sources. This makes the health data more difficult to monitor. Decision making in this environment is typically complex and unstructured as clinical work is essentially interpretative, multitasking, collaborative, distributed and reactive. Thus, the health care arena requires real time data management in areas such as patient monitoring, detection of adverse events and adaptive responses to operational failures. This research presents a new architecture that enables real time patient data management through the use of intelligent data sources.

Medical care delivery in the US space program

NASA Technical Reports Server (NTRS)

Stewart, Donald F.

1991-01-01

The stated goal of this meeting is to examine the use of telemedicine in disaster management, public health, and remote health care. NASA has a vested interest in providing health care to crews in remote environments. NASA has unique requirements for telemedicine support, in that our flight crews conduct their job in the most remote of all work environments. Compounding the degree of remoteness are other environmental concerns, including confinement, lack of atmosphere, spaceflight physiological deconditioning, and radiation exposure, to name a few. In-flight medical care is a key component in the overall support for missions, which also includes extensive medical screening during selection, preventive medical programs for astronauts, and in-flight medical monitoring and consultation. This latter element constitutes the telemedicine aspect of crew health care. The level of in-flight resources dedicated to medical care is determined by the perceived risk of a given mission, which in turn is related to mission duration, planned crew activities, and length of time required for return to definitive medical care facilities.

A review of chronic pain impact on patients, their social environment and the health care system.

PubMed

Dueñas, María; Ojeda, Begoña; Salazar, Alejandro; Mico, Juan Antonio; Failde, Inmaculada

2016-01-01

Chronic pain (CP) seriously affects the patient's daily activities and quality of life, but few studies on CP have considered its effects on the patient's social and family environment. In this work, through a review of the literature, we assessed several aspects of how CP influences the patient's daily activities and quality of life, as well as its repercussions in the workplace, and on the family and social environment. Finally, the consequences of pain on the health care system are discussed. On the basis of the results, we concluded that in addition to the serious consequences on the patient's life, CP has a severe detrimental effect on their social and family environment, as well as on health care services. Thus, we want to emphasize on the need to adopt a multidisciplinary approach to treatment so as to obtain more comprehensive improvements for patients in familial and social contexts. Accordingly, it would be beneficial to promote more social- and family-oriented research initiatives.

Nurses' attitudes towards older people care: An integrative review.

PubMed

Rush, Kathy L; Hickey, Stormee; Epp, Sheila; Janke, Robert

2017-12-01

To examine hospital nurses' attitudes towards caring for older adults and delineate associated factors contributing to their attitudes. Population ageing is of international significance. A nursing workforce able to care for the ageing population is critical for ensuring quality older adult care. A synthesis of research related to nurses' attitudes towards older adult care is important for informing care quality and the nursing workforce issues. A systematic integrative review process guided the review. Cumulative Index of Nursing and Allied Health Literature and Medline databases were searched for primary research published between 2005-2017. A total of 1,690 papers were screened with 67 papers read in-depth and eight selected for this review that met the inclusion/exclusion criteria. Nurses' held coexisting positive and negative attitudes towards generic and specific aspects of older adult care. Negative attitudes, in particular, were directed at the characteristics of older adults, their care demands or reflected in nurses' approaches to care. Across jurisdictions, work environment, education, experience and demographics emerged as influences on nurses' attitudes. There is a paucity of research examining nurses' attitudes towards older adult care. The limited evidence indicates that attitudes towards older people care are complex and contradictory. Influences on nurses' attitudes need further study individually and collectively to build a strong evidence base. Interventional studies are needed as are the development of valid and reliable instruments for measuring nurses' attitudes towards older adult care. Bolstering postgraduate gerontological preparation is critical for promoting nurses' attitudes towards older adult care. Creating age-friendly work environments, including appropriate resource allocation, is important to support older people care and facilitate positive nursing attitudes. © 2017 John Wiley & Sons Ltd.

[A Survey of the Perception of Nurses Toward the Practice Environment at a Regional Teaching Hospital in Central Taiwan].

PubMed

Hung, Jui-Tai; Lin, Ching-Wen; Wen, Wei-Chun; Lin, Esther Ching-Lan

2015-08-01

The nursing practice environment has been shown to wield significant influence on nursing retention and nursing quality of care. Because a large percentage of Taiwan nurses currently work at regional teaching hospitals, exploring the perception toward the practice environment of nurses working at this type of hospital is important. This study explored the perception of nurses working at a regional teaching hospital in central Taiwan toward their practice environment. A cross-sectional research design with a sample of 474 nurses from a regional hospital in central Taiwan was conducted. Instruments including the demographic data and the Chinese-version Practice Environment Scale-Nursing Work Index (CPES-NWI) were anonymously self-administered. Overall, participants were moderately satisfied with their practice environment, with the greatest dissatisfaction focused on staffing and resource adequacy. Work unit and nursing level, respectively, had significant impacts on perceptions regarding the practice environment. Furthermore, discriminant analysis identified two new compound variables: 1) adequate staffing resources and partnership in the workplace and 2) supportive administrative management environment. Participants who worked in medical and surgical units were significantly more dissatisfied with the adequacy of staffing resources and partnership in the workplace than participants who worked in acute/intensive and special units. Participants at the N2 level were significantly more dissatisfied with the supportive nature of the administrative management environment. These findings support that the nursing practice environment of regional hospitals may be improved using several measures, including: modifying the staffing and resource adequacy of nurses, fostering collaborative nurse-physician relationships, and further involving nurses in administrative management and decision-making.

Toward creating family-friendly work environments in pediatrics: baseline data from pediatric department chairs and pediatric program directors.

PubMed

McPhillips, Heather A; Burke, Ann E; Sheppard, Kate; Pallant, Adam; Stapleton, F Bruder; Stanton, Bonita

2007-03-01

The objective was to determine baseline characteristics of pediatric residency training programs and academic departments in regard to family-friendly work environments as outlined in the Report of the Task Force on Women in Pediatrics. We conducted Web-based anonymous surveys of 147 pediatric department chairs and 203 pediatric program directors. The chair's questionnaire asked about child care, lactation facilities, family leave policies, work-life balance, and tenure and promotion policies. The program director's questionnaire asked about family leave, parenting, work-life balance, and perceptions of "family-friendliness." The response rate was 52% for program directors and 51% for chairs. Nearly 60% of chairs reported some access to child care or provided assistance locating child care; however, in half of these departments, demand almost always exceeded supply. Lactation facilities were available to breastfeeding faculty in 74% of departments, although only 57% provided access to breast pumps. A total of 78% of chairs and 90% of program directors reported written maternity leave policies with slightly fewer reporting paternity leave policies. The majority (83%) of chairs reported availability of part-time employment, whereas only 27% of program directors offered part-time residency options. Most departments offered some flexibility in promotion and tenure. Although progress has been made, change still is needed in many areas in pediatric departments and training programs, including better accessibility to quality child care; improved lactation facilities for breastfeeding mothers; clear, written parental leave policies; and flexible work schedules to accommodate changing demands of family life.

Collegial relationship breakdown: a qualitative exploration of nurses in acute care settings.

PubMed

Cowin, Leanne S

2013-01-01

Poor collegial relations can cause communication breakdown, staff attrition and difficulties attracting new nursing staff. Underestimating the potential power of nursing team relationships means that opportunities to create better working environments and increase the quality of nursing care can be missed. Previous research on improving collegiality indicates that professionalism and work satisfaction increases and that staff attrition decreases. This study explores challenges, strengths and strategies used in nursing team communication in order to build collegial relationships. A qualitative approach was employed to gather nurses experiences and discussion of communication within their nursing teams and a constant comparison method was utilised for data analysis. A convenience sampling technique was employed to access both Registered Nurses and Enrolled Nurses to partake in six focus groups. Thirty mostly female nurses (ratio of 5:1) participated in the study. Inclusion criteria consisted of being a nurse currently working in acute care settings and the exclusion criteria included nursing staff currently working in closed specialty units (i.e. intensive care units). Results revealed three main themes: (1) externalisation and internalisation of nursing team communication breakdown, (2) the importance of collegiality for retention of nurses and (3) loss of respect, and civility across the healthcare workplace. A clear division between hierarchies of nurses was apparent in how nursing team communication was delivered and managed. Open, respectful and collegial communication is essential in today's dynamic and complex health environments. The nurses in this study highlighted how important nursing communication can be to work motivation and how leadership fosters teamwork.

"The Record is Our Work Tool!"-Physicians' Framing of a Patient Portal in Sweden.

PubMed

Grünloh, Christiane; Cajander, Åsa; Myreteg, Gunilla

2016-06-27

Uppsala County in Sweden launched an eHealth patient portal in 2012, which allows patients to access their medical records over the Internet. However, the launch of the portal was critically debated in the media. The professionals were strongly skeptical, and one reason was possible negative effects on their work environment. This study hence investigates the assumptions and perspectives of physicians to understand their framing of the patient portal in relation to their work environment. The study uses the concept of technological frames to examine how physicians in different specialties make sense of the patient portal in relation to their work environment. A total of 12 semistructured interviews were conducted with physicians from different specialties. Interviews were transcribed and translated. A theoretically informed thematic analysis was performed. The thematic analysis revealed 4 main themes: work tool, process, workload, and control. Physicians perceive medical records as their work tool, written for communication within health care only. Considering effects on work environment, the physicians held a negative attitude and expected changes, which would affect their work processes in a negative way. Especially the fact that patients might read their test results before the physician was seen as possibly harmful for patients and as an interference with their established work practices. They expected the occurrence of misunderstandings and needs for additional explanations, which would consequently increase their workload. Other perceptions were that the portal would increase controlling and monitoring of physicians and increase or create a feeling of mistrust from patients. Regarding benefits for the patients, most of the physicians believe there is only little value in the patient portal and that patients would mostly be worried and misunderstand the information provided. Supported by the study, we conclude: (1) The transfer of a paper-based health care process where patients read on paper into a digital process challenges current work practices and has consequences for the work environment. Mostly, this is explained by the changing positions between the physicians and the patient: the latter can drive the process, which reduces the physicians' ability to guide the patient. (2) The physicians' experiences were expressed as worries: patients would not understand the content of the record and become unnecessarily anxious from misunderstandings. The concerns are to some extent based on a generalized view of patients, which might disregard those, who already actively participate in health care. This study hence reveals a need to provide physicians with information about the values for patients from using patient portals. (3) A change of work practices may be beneficial to increase patient participation, but such changes should preferably be designed and discussed with physicians. However, the strong resistance from the physicians made this challenging when launching the patient portal.

Delegation in Correctional Nursing Practice.

PubMed

Tompkins, Frances

2016-07-01

Correctional nurses face daily challenges as a result of their work environment. Common challenges include availability of resources for appropriate care delivery, negotiating with custody staff for access to patients, adherence to scope of practice standards, and working with a varied staffing mix. Professional correctional nurses must consider the educational backgrounds and competency of other nurses and assistive personnel in planning for care delivery. Budgetary constraints and varied staff preparation can be a challenge for the professional nurse. Adequate care planning requires understanding the educational level and competency of licensed and unlicensed staff. Delegation is the process of assessing patient needs and transferring responsibility for care to appropriately educated and competent staff. Correctional nurses can benefit from increased knowledge about delegation. © The Author(s) 2016.

Linking patient satisfaction with nursing care: the case of care rationing - a correlational study

PubMed Central

2014-01-01

Background Implicit rationing of nursing care is the withholding of or failure to carry out all necessary nursing measures due to lack of resources. There is evidence supporting a link between rationing of nursing care, nurses’ perceptions of their professional environment, negative patient outcomes, and placing patient safety at risk. The aims of the study were: a) To explore whether patient satisfaction is linked to nurse-reported rationing of nursing care and to nurses’ perceptions of their practice environment while adjusting for patient and nurse characteristics. b) To identify the threshold score of rationing by comparing the level of patient satisfaction factors across rationing levels. Methods A descriptive, correlational design was employed. Participants in this study included 352 patients and 318 nurses from ten medical and surgical units of five general hospitals. Three measurement instruments were used: the BERNCA scale for rationing of care, the RPPE scale to explore nurses’ perceptions of their work environment and the Patient Satisfaction scale to assess the level of patient satisfaction with nursing care. The statistical analysis included the use of Kendall’s correlation coefficient to explore a possible relationship between the variables and multiple regression analysis to assess the effects of implicit rationing of nursing care together with organizational characteristics on patient satisfaction. Results The mean score of implicit rationing of nursing care was 0.83 (SD = 0.52, range = 0–3), the overall mean of RPPE was 2.76 (SD = 0.32, range = 1.28 – 3.69) and the two scales were significantly correlated (τ = −0.234, p < 0.001). The regression analysis showed that care rationing and work environment were related to patient satisfaction, even after controlling for nurse and patient characteristics. The results from the adjusted regression models showed that even at the lowest level of rationing (i.e. 0.5) patients indicated low satisfaction. Conclusions The results support the relationships between organizational and environmental variables, care rationing and patient satisfaction. The identification of thresholds at which rationing starts to influence patient outcomes in a negative way may allow nurse managers to introduce interventions so as to keep rationing at a level at which patient safety is not jeopardized. PMID:25285040

[Work-related stress risk assessment in a home care agency].

PubMed

Latocca, R; Riva, M A; D'Orso, M; Ploia, P; Rocca, S; De Vito, G; Cesana, G

2012-01-01

The workload, the quality of professional relationships and emotional involvement have a significant impact on distress and burnout in health care-workers; this impact has an hight variability among the different environments and different care facilities (hospital, erderly nursing homes, home care). The risk assessment of work-related stress performed in 2010 in a homecare agency highlighted organizational problems related to the content/context of work and risk factors for health and safety. High turn-over is evidenced as critical among the "sentinel events". The level of job-strain was moderate, even if some critical issues were evidenced especially in the group of physiotherapists; nurses were configured as a homogeneous group with a low level of job-strain. In informative meetings the workers identified the discomfort related to the time for transferring patients from their homes in a high-traffic metropolitan area was identified as the most critical aspect.

[Nursing motivation leadership].

PubMed

Chen, Ia-Ling; Hung, Chich-Hsiu

2007-02-01

The concept of "patients treated as guests" is emphasized in today's medical service and patient-center nursing care. However, with rapid changes in health insurance and hospital accreditation systems as well as increasing consumer awareness, the nurse manager must both efficiently relieve the working pressure of nurses and motivate them. However, it would be an extreme challenge for nurse managers to build a team in which each member works in a self-fulfilling work environment and achieves a high quality of care. This article presents several theories and techniques that relate to motivation strategies. These strategies can serve as a guide and a reference for nurse managers to inspire teamwork and raise morale. It can be expected that increasing nurse satisfaction, performance, and care quality will decrease turnover and desertion rates. Hopefully, this article will assist nurse managers to become better leaders and to achieve success in providing efficient services and good of nursing care quality.

Healthy Places for Healthy People 2017-2018 Application

EPA Pesticide Factsheets

Application for technical assistance to work with community leaders and health care partners to create downtowns and neighborhoods that can improve health, protect the environment, and support economic growth.

Work-based learning in health care environments.

PubMed

Spouse, J

2001-03-01

In reviewing contemporary literature and theories about work-based learning, this paper explores recent trends promoting life-long learning. In the process the paper reviews and discusses some implications of implementing recent policies and fostering le arning in health care practice settings. Recent Government policies designed to provide quality health care services and to improve staffing levels in the nursing workforce, have emphasized the importance of life-long learning whilst learning-on-the-job and the need to recognize and credit experiential learning. Such calls include negotiation of personal development plans tailored to individual educational need and context-sensitive learning activities. To be implemented effectively, this policy cann ot be seen as a cheap option but requires considerable financial resourcing for preparation of staff and the conduct of such activities. Successful work-based learning requires investment in staff at all levels as well as changes to staffing structures in organizations and trusts; changes designed to free people up to work and learn collaboratively. Creating an organizational environment where learning is prized depends upon a climate of trust; a climate where investigation and speculation are fostered and where time is protected for engaging in discussions about practice. Such a change may be radical for many health care organizations and may require a review of current policies and practices ensuring that they include education at all levels. The nature of such education also requires reconceptualizing. In the past, learning in practice settings was seen as formal lecturing or demonstration, and relied upon behaviourist principles of learning. Contemporary thinking suggests effective learning in work-settings is multi-faceted and draws on previously acquired formal knowledge, contextualizes it and moulds it according to situations at hand. Thinking about work-based learning in this way raises questions about how such learning can be supported and facilitated.

Occupational therapy practice in emergency care: Occupational therapists' perspectives.

PubMed

Spang, Lisa; Holmqvist, Kajsa

2015-01-01

Emergency care takes place in a complex work environment that is characterized by critically ill patients, short hospital stays, and a wide variety of different healthcare professionals. Studies of occupational therapists' (OTs) experiences of working within emergency care have shown that they often experience difficulties in explaining the essence of occupational therapy and have to justify their approaches. Much effort has been made in Sweden to help OTs dispel the notion that occupational therapy is difficult to explain, and the aim of this study was to describe how Swedish OTs perceive their work in emergency care. A qualitative descriptive approach was taken, and 14 interviews were conducted with OTs working in emergency care. Qualitative content analysis was used to analyse the data. The overall theme that emerged was "Feeling established through deliberate occupation-based work". The underlying categories showed different strategies used by the OTs to provide occupational therapy in an emergency care context. Deliberate strategies were used to demonstrate the effectiveness of occupational therapy and its approaches to patients and other health care professionals, and this resulted in the OTs feeling both established and needed. Unlike the OTs in previous studies, the Swedish OTs experienced no difficulties in explaining occupational therapy and could make convincing arguments for their interventions. Parallel to their clinical work, the OTs worked with on-going development to find ways to improve their approaches. In summary, these Swedish OTs seem to have been provided with a professional language and the knowledge required to establish themselves in an emergency care setting.

Influence of the helicopter environment on patient care capabilities: Flight crew perceptions

NASA Technical Reports Server (NTRS)

Meyers, K. Jeffrey; Rodenberg, Howard; Woodard, Daniel

1994-01-01

Flight crew perceptions of the effect of the rotary wing environment on patient care capabilities have not been subject to statistical analysis. We hypothesized that flight crew perceived significant difficulties in performing patient care tasks during air medical transport. A survey instrument was distributed to a convenience sample of flight crew members from twenty flight programs. Respondents were asked to compare the difficulty of performing patient care tasks in rotary wing and standard (emergency department or intensive care unit) settings. Demographic data collected on respondents included years of flight experience, flights per month, crew duty position, and primary aircraft in which the respondent worked. Statistical analysis was performed as appropriate using Student's t-test, type 111 sum of squares, and analysis of variance. Alpha was defined as p is less than or equal to .05. Fifty-five percent of programs (90 individuals) responded. All tasks were rated significantly more difficult in the rotary wing environment. Ratings were not significantly correlated with flight experience, duty position, flights per month, or aircraft used. We conclude that the performance of patient care tasks are perceived by air medical flight crew to be significantly more difficult during rotary wing air medical transport than in hospital settings.

Influence of the helicopter environment on patient care capabilities: flight crew perceptions

NASA Technical Reports Server (NTRS)

Myers, K. J.; Rodenberg, H.; Woodard, D.

1995-01-01

INTRODUCTION: Flight crew perceptions of the effect of the rotary-wing environment on patient-care capabilities have not been subject to statistical analysis. We hypothesized that flight crew members perceived significant difficulties in performing patient-care tasks during air medical transport. METHODS: A survey was distributed to a convenience sample of flight crew members from 20 flight programs. Respondents were asked to compare the difficulty of performing patient-care tasks in rotary-wing and standard (emergency department or intensive care unit) settings. Demographic data collected on respondents included years of flight experience, flights per month, crew duty position and primary aircraft in which the respondent worked. Statistical analysis was performed as appropriate using Student's t-test, type III sum of squares, and analysis of variance. Alpha was defined as p < 0.05. RESULTS: Fifty-five percent of programs (90 individuals) responded. All tasks were significantly rated more difficult in the rotary-wing environment. Ratings were not significantly correlated with flight experience, duty position, flights per month or aircraft used. CONCLUSIONS: We conclude that the performance of patient-care tasks are perceived by air medical flight crew to be significantly more difficult during rotary-wing air medical transport than in hospital settings.

Strategies for enhancing perioperative safety: promoting joy and meaning in the workforce.

PubMed

Morath, Julianne; Filipp, Rhonda; Cull, Michael

2014-10-01

Workforce safety is a precondition of patient safety, and safety from both physical and psychological harm in the workplace is the foundation for an environment in which joy and meaning can exist. Achieving joy and meaning in the workplace allows health care workers to continuously improve the care they provide. This requires an environment in which disrespectful and harmful behaviors are not tolerated or ignored. Health care leaders have an obligation to create workplace cultures that are characterized by respect, transparency, accountability, learning, and quality care. Evidence suggests, however, that health care settings are rife with disrespectful behavior, poor teamwork, and unsafe working conditions. Solutions for addressing workplace safety problems include defining core values, tasking leaders to act as role models, and committing to becoming a high-reliability organization. Copyright © 2014 AORN, Inc. Published by Elsevier Inc. All rights reserved.

The N2N instrument to evaluate healthy work environments: an Italian validation.

PubMed

Palese, Alvisa; Dante, Angelo; Tonzar, Laura; Balboni, Bernardo

2014-02-01

The aims of the study were to (a) validate N2N Healthy Work Environment tool, (b) assess the healthiness of work environments as perceived by nurses themselves and (c) identify the factors associated with Italian nurses' perception of work environment healthiness. The linguistic and cultural adaptation of USA-N2N Healthy Work Environments was achieved through a process of forward/backward translation. Content validity was assessed by three expert nurses. The stability of the instrument was checked with a test/retest evaluation. The instrument psychometric properties, the confirmatory factor analysis as well the healthiness of the work environment and its determinant factors were evaluated with a sample of 294 nurses. The content and face validity of the N2N Healthy Work Environment instrument was confirmed. The instrument demonstrated good internal consistency (α of 0.82), excellent stability values (ρ > 0.70) and high levels of acceptability (response rate: 96.4 %). The confirmatory factor analysis has corroborated the existence of two factors as documented in the original instrument (Mays et al. in J Nurs Manag 19:18-26, 2011). Eighty-seven (29.6 %) nurses perceived the work environment where they work as "healthy". Working under a functional model of care delivery (χ(2) 24.856, p 0.000) and being responsible for one project or more (χ(2) 5.256, p 0.021) were associated with healthy environments. The instrument--valid and reliable, short in the number of items, easy to understand and based on international standards--allows a systematic assessment of the healthiness of the environment and might provide not only the opportunity to evaluate the effects of new organizational models and interventions, but also the possibility to activate a process of self-analysis and a process of ongoing review. The instrument can be used to systematically check the healthiness of Italian working environments, allowing for organizational diagnosis, targeted interventions and international comparisons.

Re-examining Social Work Roles and Tasks with Foster Care

ERIC Educational Resources Information Center

Fulcher, Leon C.; McGladdery, Suzanne

2011-01-01

In order to promote developmental outcomes with children and young people and to nurture their positive health and well-being in foster care, social workers and case managers are required to direct professional attention toward both the child or young person and her/his daily living environment(s)--at home, at school, and in the local…

Child Care Changes, Home Environment Quality, and the Social Competence of African American Children at Age 3

ERIC Educational Resources Information Center

Bratsch-Hines, Mary E.; Vernon-Feagans, Lynne

2013-01-01

Research Findings: Recent work has demonstrated that the changes young children experience in their child care settings before age 5 may be related to subsequent development, especially social development. Several of these studies have included samples of middle-class children, with almost no emphasis on understanding these processes for…

Bouncers, Brokers, and Glue: The Self-Described Roles of Social Workers in Urban Hospitals

ERIC Educational Resources Information Center

Craig, Shelley L.; Muskat, Barbara

2013-01-01

Social workers delivering services in health care settings face unique challenges and opportunities. The purpose of this study was to solicit input from social workers employed in urban hospitals about their perceptions of the roles, contribution, and professional functioning of social work in a rapidly changing health care environment. Using…

Relationships among work stress, job satisfaction, mental health, and healthy lifestyle behaviors in new graduate nurses attending the nurse athlete program: a call to action for nursing leaders.

PubMed

Melnyk, Bernadette Mazurek; Hrabe, David P; Szalacha, Laura A

2013-01-01

Although nurses are educated to take outstanding care of others, they themselves often have poor health outcomes, including high rates of depression and obesity, which are associated with stressful work environments. Furthermore, a high percentage of new graduate nurses leave their positions in the first year of employment, resulting in exorbitant costs to health care systems. The aim of this study was to determine the relationships among key variables that influence job satisfaction and healthy lifestyle behaviors of new graduate nurses, including workplace stress, work environment, lifestyle beliefs, and mental health. A descriptive correlational design was used with baseline data from 61 new graduate nurses attending the 2-day Nurse Athlete program, a workshop that focuses on nutrition, energy management, and physical activity. Higher levels of workplace stress were associated with higher levels of depression and anxiety as well as lower levels of resiliency, job satisfaction, and healthy lifestyle beliefs. Nurse leaders and managers must invest in creating healthy work environments for new and experienced nurses as well as provide mental health screening, resources, and intervention programs that focus on education and skills-building in health promoting behaviors, including emotional regulation of stress, anxiety, and depression.

Effects of work environment and job characteristics on the turnover intention of experienced nurses: The mediating role of work engagement.

PubMed

Wan, Qiaoqin; Li, Zhaoyang; Zhou, Weijiao; Shang, Shaomei

2018-06-01

To assess turnover intention among experienced nurses and explore the effects of work environment, job characteristics and work engagement on turnover intention. The nursing shortage is an urgent concern in China. A high turnover rate of experienced nurses could have serious effects on the quality of care, costs and the efficiency of hospitals. It is crucial to explore the predictors of turnover intention and develop strategies tailored to experienced nurses. A descriptive, cross-sectional survey design. A total of 778 experienced nurses from seven hospitals was surveyed on their work engagement, job characteristics, work environment and turnover intention in March-May 2017. Structural equation modelling was used to test a theoretical model and the hypotheses. The results showed that 35.9% of experienced nurses had high-level turnover intention. The final model explained 50% of the variance in experienced nurses' turnover intention and demonstrated that: (1) work environment was positively associated with higher work engagement and lower turnover intention and work engagement partially mediated the relationship between work environment and turnover intention; and (2) job characteristics were positively related to higher work engagement and lower turnover intention and work engagement fully mediated the relationship between job characteristics and turnover intention. The study confirms the intrinsic and extrinsic motivators on work engagement posited by job demands-resources model. Theory-driven strategies to improve work environment, enhance job characteristics and promote wok engagement are needed to address the nursing shortage and high turnover intention among experienced nurses. © 2018 John Wiley & Sons Ltd.

Strangers in a strange land: work experiences of foreign nurses in Parma's territory.

PubMed

Vesperoni, Pietro; Masera, Giuliana

2015-03-13

The purpose of this research is to explore, investigate and describe experiences and points of view of foreign nurses working in the area of Parma. We focalize particularly on two areas of interest: negativities and positivities in experiences related to the process of integration into the new working environment. The literature search has revealed that the phenomenon of "nursing immigration" is numerically significant in Italy and more particularly in Emilia Romagna. From studies conducted in other countries (UK, USA, Canada, Australia and Iceland) there are two categories of factors which influence the process of integration of foreign nurses in the new working environment, facilitators and barriers. For this study we followed the phenomenological method . A total of twelve foreign nurses were interviewed in the months of October and November 2013 in the territory of Parma working in various professional fields (medicine, critical care and surgery). We did not impose any structure to interviews so that respondents were free to express their lived experiences spontaneously. All interviews were recorded, transcribed verbatim and analyzed by the method of Giorgi (1970). Results obtained from the analysis of interviews revealed seven themes, divided in positivities and negativities. Positivities are psycho-social support (Italian colleagues, fellow countrymen, patients), opportunities of cultural enrichment, positive work ethic. negativities are difficulty of language and communication, and inequalities racial prejudice, differences in care practices and inadequate opportunities for professional growth related to the Italian working environment. The study concludes by pointing out the importance of the role that foreign nurses can play in our health care system and how the results of this search can help all professionals in the health sector to have a greater understanding of their experiences. This knowledge can make a contribution to the development of new quantitative research in the same area and then to the formation of new strategies for hospitality and support.

Factor structure of the geriatric care environment scale.

PubMed

Kim, Hongsoo; Capezuti, Elizabeth; Boltz, Marie; Fairchild, Susan; Fulmer, Terry; Mezey, Mathy

2007-01-01

Older adults comprise approximately 60% of all adult, nonobstetric hospital admissions. Nurses Improving Care for Health System Elders (NICHE) is a national program aimed at system improvement to achieve patient-centered care for older adults. The NICHE hospitals use the Geriatric Institutional Assessment Profile (GIAP) to assess their institutional readiness to provide quality care to older adults and to document improvement in geriatric care delivery. To explore the factorial structure of the 28-item Geriatric Care Environment Scale (GCES) of the GIAP, test its validity with a sample of staff registered nurses (RNs), and evaluate its invariance across 4 groups of RNs who worked at 4 different types of hospitals. Staff RNs (N = 9,400) at 71 acute hospitals, who responded to the GIAP from 1999 to 2004, were split randomly into 2 groups for cross-validation. A 3-step data analysis was completed. The a priori factor structure was developed using exploratory factor analysis. The obtained factor model was validated, and its invariance by types of hospitals was examined by confirmatory factor analyses. The GCES is internally consistent (Cronbach's alpha = .93) and accounts for approximately 55% of the total variance. The 4 factors extracted from the exploratory factor analysis are Aging-Sensitive Care Delivery, Resource Availability, Institutional Values Regarding Older Adults and Staff, and Capacity for Collaboration. The 4-factor structured model is validated in a half-randomly selected sample (normed fit index [NFI] = .931, nonnormed fit index [NNFI] = .933, comparative fit index [CFI] = .939, root-mean-square error of approximation [RMSEA] = .058) and does not vary significantly across the 4 groups of RNs who worked at the 4 different types of hospitals (NFI = .969, NNFI = .975, CFI = .976, RMSEA = .027). The GCES is a reliable measure of RN perception of how care provided to older adults reflects age-sensitive principles and the organizational practice environment that supports or hinders care delivery.

Role of effective nurse-patient relationships in enhancing patient safety.

PubMed

Conroy, Tiffany; Feo, Rebecca; Boucaut, Rose; Alderman, Jan; Kitson, Alison

2017-08-02

Ensuring and maintaining patient safety is an essential aspect of care provision. Safety is a multidimensional concept, which incorporates interrelated elements such as physical and psychosocial safety. An effective nurse-patient relationship should ensure that these elements are considered when planning and providing care. This article discusses the importance of an effective nurse-patient relationship, as well as healthcare environments and working practices that promote safety, thus ensuring optimal patient care.

Factors influencing nurses' perceptions of occupational safety.

PubMed

Samur, Menevse; Intepeler, Seyda Seren

2017-01-02

To determine nurses' perceptions of occupational safety and their work environment and examine the sociodemographic traits and job characteristics that influence their occupational safety, we studied a sample of 278 nurses. According to the nurses, the quality of their work environment is average, and occupational safety is insufficient. In the subdimensions of the work environment scale, it was determined that the nurses think "labor force and other resources" are insufficient. In the occupational safety subdimensions "occupational illnesses and complaints" and "administrative support and approaches," they considered occupational safety to be insufficient. "Doctor-nurse-colleague relationships," "exposure to violence," and "work unit" (eg, internal medicine, surgical, intensive care) are the main factors that affect occupational safety. This study determined that hospital administrations should develop and immediately implement plans to ameliorate communication and clinical precautions and to reduce exposure to violence.

Authentic leadership and nurses' voice behaviour and perceptions of care quality.

PubMed

Wong, Carol A; Spence Laschinger, Heather K; Cummings, Greta G

2010-11-01

The purpose of the present study was to test a theoretical model linking authentic leadership with staff nurses' trust in their manager, work engagement, voice behaviour and perceived unit care quality. Authentic leadership is a guide for effective leadership needed to build trust and healthier work environments because there is special attention given to honesty, integrity and high ethical standards in the development of leader-follower relationships. A non-experimental, predictive survey design was used to test the hypothesized model in a random sample of 280 (48% response rate) registered nurses working in acute care hospitals in Ontario. The final model fitted the data acceptably (χ(2)=17.24, d.f.=11, P=0.10, IFI=0.99, CFI=0.99, RMSEA=0.045). Authentic leadership significantly and positively influenced staff nurses' trust in their manager and work engagement which in turn predicted voice behaviour and perceived unit care quality. These findings suggest that authentic leadership and trust in the manager play a role in fostering trust, work engagement, voice behaviour and perceived quality of care. Nursing leaders can improve care quality and workplace conditions by paying attention to facilitating genuine and positive relationships with their staff. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

Practice environment and its association with professional competence and work-related factors: perception of newly graduated nurses.

PubMed

Numminen, Olivia; Ruoppa, Eija; Leino-Kilpi, Helena; Isoaho, Hannu; Hupli, Maija; Meretoja, Riitta

2016-01-01

To explore newly graduated nurses' (NGN) perception of their practice environment and its association with their self-assessed competence, turnover intentions and job satisfaction as work-related factors. The impact of practice environment on nurses' work is important. Positive practice environments are associated with positive organisational, nurse and patient outcomes. How this applies to NGNs needs further exploration. A cross-sectional descriptive correlation design was used. Data were collected with PES-NWI and NCS instruments from 318 Finnish registered nurses, and analysed statistically. Newly graduated nurses' perception of their practice environment was mainly positive. Most positive perceptions related to collegial nurse-physician relations, and the least positive to staffing and resource adequacy. Positive perceptions were also associated with higher professional competence, higher perceptions of quality of care and lower intentions to leave the job or profession. The findings revealed strong and significant associations between practice environment and work-related factors. Practice environment is an important element in supporting NGNs' competence, retention and job satisfaction. Nursing management should pay attention to NGNs' perceptions of their practice environment. Management's ability to create and maintain positive practice environments can foster NGNs' professional development and job satisfaction, and consequently retain them in the workforce. © 2015 John Wiley & Sons Ltd.

Nursing challenges for universal health coverage: a systematic review1

PubMed Central

Schveitzer, Mariana Cabral; Zoboli, Elma Lourdes Campos Pavone; Vieira, Margarida Maria da Silva

2016-01-01

Objectives to identify nursing challenges for universal health coverage, based on the findings of a systematic review focused on the health workforce' understanding of the role of humanization practices in Primary Health Care. Method systematic review and meta-synthesis, from the following information sources: PubMed, CINAHL, Scielo, Web of Science, PsycInfo, SCOPUS, DEDALUS and Proquest, using the keyword Primary Health Care associated, separately, with the following keywords: humanization of assistance, holistic care/health, patient centred care, user embracement, personal autonomy, holism, attitude of health personnel. Results thirty studies between 1999-2011. Primary Health Care work processes are complex and present difficulties for conducting integrative care, especially for nursing, but humanizing practices have showed an important role towards the development of positive work environments, quality of care and people-centered care by promoting access and universal health coverage. Conclusions nursing challenges for universal health coverage are related to education and training, to better working conditions and clear definition of nursing role in primary health care. It is necessary to overcome difficulties such as fragmented concepts of health and care and invest in multidisciplinary teamwork, community empowerment, professional-patient bond, user embracement, soft technologies, to promote quality of life, holistic care and universal health coverage. PMID:27143536

Registered nurses' perceptions of conditions for patient education - focusing on organisational, environmental and professional cooperation aspects.

PubMed

Bergh, Anne-Louise; Karlsson, Jan; Persson, Eva; Friberg, Febe

2012-09-01

To describe nurses' perceptions of conditions for patient education, focusing on organisational, environmental and professional cooperation aspects, and to determine any differences between primary, municipal and hospital care. Although patient education is an important part of daily nursing practice, the conditions for this work are unclear and require clarification. A stratified random sample of 701 (83%) nurses working in primary, municipal and hospital care completed a 60-item questionnaire. The study is part of a larger project. The study items relating to organisation, environment and professional cooperation were analysed using descriptive statistics, non-parametric tests and content analysis. Conditions for patient education differ. Nurses in primary care had better conditions and more managerial support, for example in the allocation of undisturbed time. Conditions related to organisation, environment and cooperation need to be developed further. In this process, managerial support is important, and nurses must ask for better conditions in order to carry through patient education. Managerial support for the development of visible patient education routines (e.g. allocation of time, place and guidelines) is required. One recommendation is to designate a person to oversee educational work. © 2012 Blackwell Publishing Ltd.

Nurses' use of mobile devices to access information in health care environments in australia: a survey of undergraduate students.

PubMed

Mather, Carey; Cummings, Elizabeth; Allen, Penny

2014-12-10

The growth of digital technology has created challenges for safe and appropriate use of mobile or portable devices during work-integrated learning (WIL) in health care environments. Personal and professional use of technology has outpaced the development of policy or codes of practice for guiding its use at the workplace. There is a perceived risk that portable devices may distract from provision of patient or client care if used by health professionals or students during employment or WIL. This study aimed to identify differences in behavior of undergraduate nurses in accessing information, using a portable or mobile device, when undertaking WIL compared to other non-work situations. A validated online survey was administered to students while on placement in a range of health care settings in two Australian states. There were 84 respondents, with 56% (n=47) reporting access to a mobile or portable device. Differences in use of a mobile device away from, compared with during WIL, were observed for non-work related activities such as messaging (P<.001), social networking (P<.001), shopping on the Internet (P=.01), conducting personal business online (P=.01), and checking or sending non-work related texts or emails to co-workers (P=.04). Study-related activities were conducted more regularly away from the workplace and included accessing University sites for information (P=.03) and checking or sending study-related text messages or emails to friends or co-workers (P=.01). Students continued to access nursing, medical, professional development, and study-related information away from the workplace. Undergraduate nurses limit their access to non-work or non-patient centered information while undertaking WIL. Work-related mobile learning is being undertaken, in situ, by the next generation of nurses who expect easy access to mobile or portable devices at the workplace, to ensure safe and competent care is delivered to their patients.

Burnout in the intensive care unit professionals: A systematic review.

PubMed

Chuang, Chien-Huai; Tseng, Pei-Chi; Lin, Chun-Yu; Lin, Kuan-Han; Chen, Yen-Yuan

2016-12-01

Burnout has been described as a prolonged response to chronic emotional and interpersonal stress on the job that is often the result of a period of expending excessive effort at work while having too little recovery time. Healthcare workers who work in a stressful medical environment, especially in an intensive care unit (ICU), may be particularly susceptible to burnout. In healthcare workers, burnout may affect their well-being and the quality of professional care they provide and can, therefore, be detrimental to patient safety. The objectives of this study were: to determine the prevalence of burnout in the ICU setting; and to identify factors associated with burnout in ICU professionals. The original articles for observational studies were retrieved from PubMed, MEDLINE, and Web of Science in June 2016 using the following MeSH terms: "burnout" and "intensive care unit". Articles that were published in English between January 1996 and June 2016 were eligible for inclusion. Two reviewers evaluated the abstracts identified using our search criteria prior to full text review. To be included in the final analysis, studies were required to have employed an observational study design and examined the associations between any risk factors and burnout in the ICU setting. Overall, 203 full text articles were identified in the electronic databases after the exclusion of duplicate articles. After the initial review, 25 studies fulfilled the inclusion criteria. The prevalence of burnout in ICU professionals in the included studies ranged from 6% to 47%. The following factors were reported to be associated with burnout: age, sex, marital status, personality traits, work experience in an ICU, work environment, workload and shift work, ethical issues, and end-of-life decision-making. The impact of the identified factors on burnout remains poorly understood. Nevertheless, this review presents important information, suggesting that ICU professionals may suffer from a high level of burnout, potentially threatening patient care. Future work should address the effective management of the factors negatively affecting ICU professionals.

Nurses’ Use of Mobile Devices to Access Information in Health Care Environments in Australia: A Survey of Undergraduate Students

PubMed Central

2014-01-01

Background The growth of digital technology has created challenges for safe and appropriate use of mobile or portable devices during work-integrated learning (WIL) in health care environments. Personal and professional use of technology has outpaced the development of policy or codes of practice for guiding its use at the workplace. There is a perceived risk that portable devices may distract from provision of patient or client care if used by health professionals or students during employment or WIL. Objective This study aimed to identify differences in behavior of undergraduate nurses in accessing information, using a portable or mobile device, when undertaking WIL compared to other non-work situations. Methods A validated online survey was administered to students while on placement in a range of health care settings in two Australian states. Results There were 84 respondents, with 56% (n=47) reporting access to a mobile or portable device. Differences in use of a mobile device away from, compared with during WIL, were observed for non-work related activities such as messaging (P<.001), social networking (P<.001), shopping on the Internet (P=.01), conducting personal business online (P=.01), and checking or sending non-work related texts or emails to co-workers (P=.04). Study-related activities were conducted more regularly away from the workplace and included accessing University sites for information (P=.03) and checking or sending study-related text messages or emails to friends or co-workers (P=.01). Students continued to access nursing, medical, professional development, and study-related information away from the workplace. Conclusions Undergraduate nurses limit their access to non-work or non-patient centered information while undertaking WIL. Work-related mobile learning is being undertaken, in situ, by the next generation of nurses who expect easy access to mobile or portable devices at the workplace, to ensure safe and competent care is delivered to their patients. PMID:25499736

Nurses' clinical experiences of the inverse bed position on a neurointensive care unit--a phenomenographic study.

PubMed

Dahl, Asa; Nyberg, Helene; Edéll-Gustafsson, Ulla

2003-10-01

Our knowledge of unstable critically ill patients placed in an inverse bed position on the neurointensive care unit (NICU) is fairly limited. The purpose of this study was to ascertain the variation in nurses' conceptions of the impact of clinical experiences on the care and working environments among patients with the head towards the centre of the room on an NICU. An important research question was: how is the nursing care of patients facing inwards on an NICU perceived? Interviews were conducted and analysed with 15 nurses, using the method of phenomenography. From a nursing perspective, four descriptive categories were found, which partly distinguished the nursing psychosocial environment from the physical environment. These were safety and security of mobile computer tomography (CT) on the NICU, availability and overview, integrated holistic view in an open nursing psychosocial environment and adaptation of practical equipment. In conclusion, inverse bed position is important for more individualised neurointensive nursing care among unstable patients subjected to frequent CT scans on the unit. More stable patients should be turned back to the traditional bed position in order to promote their recovery process. This new knowledge is important for the development of quality assurance, with regard to, amongst other things, the patient's dignity.

Occupational Stigma as a Primary Barrier To Health Care For Street-Based Sex Workers in Canada

PubMed Central

Lazarus, Lisa; Deering, Kathleen N; Nabess, Rose; Gibson, Kate; Tyndall, Mark W; Shannon, Kate

2011-01-01

Individuals working in the sex industry continue to experience many negative health outcomes. As such, disentangling the factors shaping poor health access remains a critical public health priority. Within a quasi-criminalised prostitution environment, this study aimed to evaluate the prevalence of occupational stigma associated with sex work and its relationship to barriers to accessing health services. Analyses draw on baseline questionnaire data from a community-based cohort of women in street-based sex work in Vancouver, Canada (2006–8). Of a total of 252 women, 141 (58.5%) reported occupational sex work stigma (defined as hiding occupational sex work status from family, friends and/or home community), while 125 (49.6%) reported barriers to accessing health services in the previous six months. In multivariable analysis, adjusting for socio-demographic, interpersonal and work environment risks, occupational sex work stigma remained independently associated with an elevated likelihood of experiencing barriers to health access. Study findings indicate the critical need for policy and societal shifts in views of sex work as a legitimate occupation, combined with improved access to innovative, accessible and non-judgmental health care delivery models for street-based sex workers that include the direct involvement of sex workers in development and implementation. PMID:22084992

Burnout, role conflict, job satisfaction and psychosocial health among Hungarian health care staff: a questionnaire survey.

PubMed

Piko, Bettina F

2006-03-01

There is a growing interest in the psychosocial work environment of health care staff since they are at high risk for burnout, role conflict and job dissatisfaction. Burnout, as a type of prolonged response to chronic job-related stressors, has a special significance in health care where staff experience both psychological-emotional and physical stress. Burnout and the other negative aspects of the job of health care staff have major behavioural and health implications. The present study investigated the interrelationships among burnout, role conflict and job satisfaction in a sample of Hungarian health care staff. The study also investigated how these indicators of psychosocial work climate influence respondents' frequency of psychosomatic symptoms. A questionnaire survey (anonymous questionnaires) has been carried out to detect these interrelationships. Two major hospitals in Szeged, Hungary. Questionnaires were distributed to 450 health care staff among whom 55.7% were registered nurses. All together, 201 questionnaires were returned and analyzed, giving a response rate of 44.6%. Questionnaire contained items on work and health-related information (i.e., burnout, job satisfaction, role conflict, and psychosomatic symptoms) and on some basic sociodemographics. Beyond descriptive statistics, correlation and multiple regression analyses were computed. Findings show that emotional exhaustion and depersonalization scores were higher, while scores on personal accomplishment was lower as compared to Canadian, Norwegian or US samples. Burnout, particularly emotional exhaustion (p<.001), was found to be strongly related to job dissatisfaction. Schooling was inversely related to satisfaction with the job (p<.05). While job satisfaction was a negative predictor of each type of burnout subscale (p<.001), role conflict was a factor contributing positively to emotional exhaustion (p<.001) and depersonalization scores (p<.001). The study results underline the importance of the role of psychosocial work environment and the interrelationships among burnout, role conflict, job satisfaction and psychosomatic health among Hungarian health care staff.

Managing work-related stress in the district nursing workplace.

PubMed

Burke, Michelle

2013-11-01

This article aims to highlight the issue of work-related stress within the district nursing workplace. It will acknowledge how the management of work-related stress has previously been discussed within nursing literature and will consider the emerging relationship between staff working conditions, staff wellbeing and quality of patient care. It will reintroduce the Health and Safety Executive's (HSE's) Management Standards approach to tackling work-related stress, which provides management support to reduce environmental work stressors and encourage enabling work environments and a positive workplace culture.

Clinical leadership: using observations of care to focus risk management and quality improvement activities in the clinical setting.

PubMed

Ferguson, Lorraine; Calvert, Judy; Davie, Marilyn; Fallon, Mark; Fred, Nada; Gersbach, Vicki; Sinclair, Lynn

2007-04-01

In an era when patient safety and quality of care are a daily concern for health care professionals, it is important for nurse managers and other clinical leaders to have a repertoire of skills and interventions that can be used to motivate and engage clinical teams in risk assessment and continuous quality improvement at the level of patient care delivery. This paper describes how a cohort of clinical leaders who were undertaking a leadership development program used a relatively simple, patient-focused intervention called the 'observation of care' to help focus the clinical team's attention on areas for improvement within the clinical setting. The main quality and safety themes arising out of the observations that were undertaken by the Clinical Leaders (CLs) were related to the environment, occupational health and safety, communication and team function, clinical practice and patient care. The observations of care also provided the CLs with many opportunities to acknowledge and celebrate exemplary practice as it was observed as a means of enhancing the development of a quality and safety culture within the clinical setting. The 'observation of care' intervention can be used by Clinical Leader's to engage and motivate clinical teams to focus on continuously improving the safety and quality of their own work environment and the care delivered to patients within that environment.

The culture contributing to interruptions in the nursing work environment: An ethnography.

PubMed

Hopkinson, Susan G; Wiegand, Debra L

2017-12-01

To understand the occurrence of interruptions within the culture of the medical nursing unit work environment. Interruptions may lead to errors in nursing work. Little is known about how the culture of the nursing work environment contributes to interruptions. A micro-focused ethnographic study was conducted. Data collection involved extensive observation of a nursing unit, 1:1 observations of nurses and follow-up interviews with the nurses. Data were analysed from unstructured field notes and interview transcripts. The definitions of interruption and culture guided coding, categorising and identification of themes. A framework was developed that describes the medical nursing unit as a complex culture full of unpredictable, nonlinear changes that affect the entire interconnected system, often in the form of an interruption. The cultural elements contributing to interruptions included (i) the value placed on excellence in patient care and meeting personal needs, (ii) the beliefs that the nurses had to do everything by themselves and that every phone call was important, (iii) the patterns of changing patients, patient transport and coordination of resources and (iv) the normative practices of communicating and adapting. Interruptions are an integral part of the culture of a medical nursing unit. Uniformly decreasing interruptions may disrupt current practices, such as communication to coordinate care, that are central to nursing work. In future research, the nursing work environment must be looked at through the lens of a complex system. Interventions to minimise the negative impact of interruptions must take into account the culture of the nursing as a complex adaptive system. Nurses should be educated on their own contribution to interruptions and issues addressed at a system level, rather than isolating the interruption as the central issue. © 2017 John Wiley & Sons Ltd.

Differences in work environment for staff as an explanation for variation in central line bundle compliance in intensive care units.

PubMed

Lee, Yuna S H; Stone, Patricia W; Pogorzelska-Maziarz, Monika; Nembhard, Ingrid M

Central line-associated bloodstream infections (CLABSIs) are a common and costly quality problem, and their prevention is a national priority. A decade ago, researchers identified an evidence-based bundle of practices that reduce CLABSIs. Compliance with this bundle remains low in many hospitals. The aim of this study was to assess whether differences in core aspects of work environments-workload, quality of relationships, and prioritization of quality-are associated with variation in maximal CLABSI bundle compliance, that is, compliance 95%-100% of the time in intensive care units (ICUs). A cross-sectional study of hospital medical-surgical ICUs in the United States was done. Data on work environment and bundle compliance were obtained from the Prevention of Nosocomial Infections and Cost-Effectiveness Refined Survey completed in 2011 by infection prevention directors, and data on ICU and hospital characteristics were obtained from the National Healthcare Safety Network. Factor and multilevel regression analyses were conducted. Reasonable workload and prioritization of quality were positively associated with maximal CLABSI bundle compliance. High-quality relationships, although a significant predictor when evaluated apart from workload and prioritization of quality, had no significant effect after accounting for these two factors. Aspects of the staff work environment are associated with maximal CLABSI bundle compliance in ICUs. Our results suggest that hospitals can foster improvement in ensuring maximal CLABSI bundle compliance-a crucial precursor to reducing CLABSI infection rates-by establishing reasonable workloads and prioritizing quality.

Nonlinear Analysis to Detect if Excellent Nursing Work Environments Have Highest Well-Being.

PubMed

Casalicchio, Giuseppe; Lesaffre, Emmanuel; Küchenhoff, Helmut; Bruyneel, Luk

2017-09-01

To detect potentially nonlinear associations between nurses' work environment and nurse staffing on the one hand and nurse burnout on the other hand. A cross-sectional multicountry study for which data collection using a survey of 33,731 registered nurses in 12 European countries took place during 2009 to 2010. A semiparametric latent variable model that describes both linear and potentially nonlinear associations between burnout (Maslach Burnout Inventory: emotional exhaustion, depersonalization, personal accomplishment) and work environment (Practice Environment Scale of the Nursing Work Index: managerial support for nursing, doctor-nurse collegial relations, promotion of care quality) and staffing (patient-to-nurse ratio). Similar conclusions are reached from linear and nonlinear models estimating the association between work environment and burnout. For staffing, an increase in the patient-to-nurse ratio is associated with an increase in emotional exhaustion. At about 15 patients per nurse, no further increase in emotional exhaustion is seen. Absence of evidence for diminishing returns of improving work environments suggests that continuous improvement and achieving excellence in nurse work environments pays off strongly in terms of lower nurse-reported burnout rates. Nurse staffing policy would benefit from a larger number of studies that identify specific minimum as well as maximum thresholds at which inputs affect nurse and patient outcomes. Nurse burnout is omnipresent and has previously been shown to be related to worse patient outcomes. Additional increments in characteristics of excellent work environments, up to the highest possible standard, correspond to lower nurse burnout. © 2017 Sigma Theta Tau International.

Construction of a new model of job engagement, psychological empowerment and perceived work environment among Chinese registered nurses at four large university hospitals: implications for nurse managers seeking to enhance nursing retention and quality of care.

PubMed

Fan, Yuying; Zheng, Qiulan; Liu, Shiqing; Li, Qiujie

2016-07-01

To explore the relationships among perceived work environment, psychological empowerment and job engagement of clinical nurses in Harbin, China. Previous studies have focused on organisational factors or nurses' personal characteristics contributing to job engagement. Limited studies have examined the effects of perceived work environment and psychological empowerment on job engagement among Chinese nurses. A cross-sectional quantitative survey with 923 registered nurses at four large university hospitals in China was carried out. Research instruments included the Chinese versions of the perceived nurse work environment scale, the psychological empowerment scale and the job engagement scale. The relationships of the variables were tested using structural equation modelling. Structural equation modelling revealed a good fit of the model, χ(2) /df = 4.46, GFI = 0.936, CFI = 0.957. Perceived work environment was a significant positive direct predictor of psychological empowerment and job engagement. Psychological empowerment was a significant positive direct contributor to job engagement and had a mediating effect on the relationship between perceived work environment and job engagement. Perceived work environment may result in increased job engagement by facilitating the development of psychological empowerment. For nurse managers wishing to increase nurse engagement and to achieve effective management, both perceived work environment and psychological empowerment are factors that need to be well controlled in the process of nurse administration. © 2016 John Wiley & Sons Ltd.

Roles and Educational Effects of Clinical Case Studies in Home Medical Care.

PubMed

Ohsawa, Tomoji; Shimazoe, Takao

2017-01-01

Due to the progression of aging in Japan, pharmacists need to participate in home medical care. To enable pharmacists with no previous experience to participate in home medical care of patients with various diseases in the home environment, it is necessary to adopt an approach of training them in advance. It is thought useful for such clinical training to include patient case studies, which may facilitate the training of pharmacists for home medical care through simulated experience. "The working group to create home clinical cases for education" was launched by a group of university faculty, who have educational knowledge, and trained pharmacists who work with the patients at home. The home care cases were compiled by the university faculty members and the home care practice pharmacists. Working pharmacists and students at pharmaceutical college studied the same case studies of home medical care, and their self-evaluations were compared. They showed that the students rated themselves higher than the pharmacists. One of the reasons was the systematic education of the case studies. The clinical case studies are a good educational tool to promote home care medicine in pharmacies and university pharmaceutical colleges.

Transforming Practice with Older People through an Ethic of Care

PubMed Central

Ward, Lizzie; Barnes, Marian

2016-01-01

This article explores the relevance of deliberative practices framed by feminist care ethics to social work practice with older people. It draws on two connected projects which brought together older people: practitioners and academics. The first was a participatory research project in which the significance of care to well-being in old age emerged. The second was a knowledge exchange project which generated learning resources for social care practice based on the research findings of the first project. Here we analyse selected transcripts of recordings from meetings of both projects to consider the ways that discussions about lived experiences and everyday lives demonstrate care through this dialogue. Using this analysis, we propose that care ethics can be useful in transforming relationships between older people and those working with them through the creation of hybrid spaces in which ‘care-full deliberation’ can happen. We argue that such reflective spaces can enable transformative dialogue about care and its importance to older people and offer a counterbalance to the procedurally driven environments in which much social work practice takes place and can support practice more attuned to the circumstances and concerns of older people. PMID:27559205

Transforming Practice with Older People through an Ethic of Care.

PubMed

Ward, Lizzie; Barnes, Marian

2016-06-01

This article explores the relevance of deliberative practices framed by feminist care ethics to social work practice with older people. It draws on two connected projects which brought together older people: practitioners and academics. The first was a participatory research project in which the significance of care to well-being in old age emerged. The second was a knowledge exchange project which generated learning resources for social care practice based on the research findings of the first project. Here we analyse selected transcripts of recordings from meetings of both projects to consider the ways that discussions about lived experiences and everyday lives demonstrate care through this dialogue. Using this analysis, we propose that care ethics can be useful in transforming relationships between older people and those working with them through the creation of hybrid spaces in which 'care-full deliberation' can happen. We argue that such reflective spaces can enable transformative dialogue about care and its importance to older people and offer a counterbalance to the procedurally driven environments in which much social work practice takes place and can support practice more attuned to the circumstances and concerns of older people.

Nurses' work environment and intent to leave in Lebanese hospitals: implications for policy and practice.

PubMed

El-Jardali, Fadi; Alameddine, Mohamad; Dumit, Nuhad; Dimassi, Hani; Jamal, Diana; Maalouf, Salwa

2011-02-01

The dual burden of nursing shortages and poor work environments threatens quality of patient care and places additional pressures on resource-stretched health care systems, particularly in the Eastern Mediterranean Region (EMR). There is a paucity of research in the EMR examining the quality of nurses' work environment and its association to nurses' intent to leave their jobs/countries. Systematically examine the characteristics of nurses' work environment and their relation to nurses' intent to leave their jobs within the context of Lebanon. A secondary objective is to assess the utility and validity of the NWI-R within the context of the EMR. A cross-sectional survey design was utilized to survey a total of 1793 registered nurses in 69 Lebanese hospitals. The survey instrument included questions on nurses' background, hospital characteristics, intent to leave, and the Revised Nurse Working Index (NWI-R). Data analysis included descriptive statistics for demographic characteristics, t-test and ANOVA to assess differences in agreement scores, and a multinomial logistic regression model to predict intent to leave. Thematic analysis of open-ended questions was utilized to extract themes that fit under issues relating to nurses' work environment in Lebanese hospitals. The NWI-R subscale with the lowest mean score related to control. Younger nurses had lower scores on organizational support and career development. Regression analysis revealed that for every 1 point score decrease on career development there was a 93% increase in likelihood of reporting intent to leave country. Likewise, for every 1 point score decrease on participation there was an observed 51% and 53% increase in likelihood of reporting intent to leave country and hospital, respectively. Findings show that hospital characteristics (size, accreditation status and presence of a recruitment and retention strategy) were significantly associated with NWI-R subscales. Participation, control and career development were key work environment challenges contributing to the attrition on nurses from Lebanese hospitals. Although some of the issues identified are country specific, others would certainly be relevant to other countries in the EMR. Addressing these challenges would require a strong and coordinated action from governments, professional bodies, policy makers and health managers. Copyright © 2010 Elsevier Ltd. All rights reserved.