[Analysis on workload for hospital DOTS service].

PubMed

Nagata, Yoko; Urakawa, Minako; Kobayashi, Noriko; Kato, Seiya

2014-04-01

A directly observed treatment short course (DOTS) trial was launched in Japan in the late 1990s and targeted patients with social depression at urban areas. Based on these findings, the Ministry of Health, Labour and Welfare established the Japanese DOTS Strategy in 2003, which is a comprehensive support service ensuring the adherence of tuberculosis patients to drug administration. DOTS services are initially provided at the hospital to patients with infectious tuberculosis who are hospitalized according to the Infectious Diseases Control Law. After being discharged from the hospital, the patients are referred to a public health center. However, a survey conducted in 2008 indicated that all the patients do not receive appropriate DOTS services at some hospitals. In the present study, we aimed to evaluate the protocols and workload of DOTS at hospitals that are actively involved in tuberculosis medical practice, including DOTS, to assess whether the hospital DOTS services were adequate. We reviewed a series of articles on hospital DOTS from a Japanese journal on nursing for tuberculosis patients and identified 25 activities regarding the hospital DOTS service. These 25 items were then classified into 3 categories: health education to patients, support for adherence, and coordination with the health center. In total, 20 hospitals that had > 20 authorized tuberculosis beds were selected--while considering the geographical balance, schedule of this survey, etc.--from 33 hospitals where an ex-trainee of the tuberculosis control expert training program in the Research Institute of Tuberculosis (RIT) was working and 20 hospitals that had collaborated with our previous survey on tuberculosis medical facilities. All the staff associated with the DOTS service were asked to record the total working time as well as the time spent for each activity. The data were collected and analyzed at the RIT. The working times for each activity of the DOTS service for nurses, pharmacists, ward clerks, head nurses, and doctors were 100, 90, 87, 86, and 63 min, respectively. For other professions, including medical social workers, nursing aids, nutritionists, and physical therapists, the working times for each activity of the DOTS service were 31, 18, 10, and 8 min, respectively. The professionals who spent a longer time on health education, support for patient adherence, and coordination with the health center were pharmacists, doctors, and head nurses; nurses, pharmacists, and doctors; and head nurses, doctors, and ward clerks, respectively. Aging of tuberculosis patients was associated with problems on adherence in many patients, including patients who were not suited for a standard regimen, patients whose activity of daily life had deteriorated due to senile dementia, patients with diabetes mellitus, etc. Smoking cessation and mental care for cases of multi-drug resistant disease are new challenges in tuberculosis patient care. The present study clearly indicated that activities including patient education, support for patient adherence, and coordination with the health center--essential components of the hospital DOTS service according to the Japanese DOTS Strategy--were performed by a team of professionals including doctors, nurses, pharmacists, medical social workers, etc., depending on the features and roles that they serve and the needs of each patient. For good practice of hospital DOTS, it is essential to not only provide DOTS, but also effectively provide individual or group health education and coordinate with health centers, thus aiming towards a better community DOTS service after patient discharge.

Addressing practical issues related to nursing care for international visitors to Hiroshima.

PubMed

Nishikawa, Mariko; Niiya, Kiyoka; Okayasu, Masako

2014-04-01

When nine million foreigners visited Japan in 2013, the federal government set a goal to attract an additional two and a half million visitors including medical tourists by 2020. This research investigates the attitudes and concerns of Japanese nurses when they are in a situation dealing with foreign patients. The data were collected from March through September 2010, from 114 nurses at three hospitals, in close proximity to popular tourist destinations in Hiroshima. A questionnaire was developed for this research, named Mari Meter, which included a section to write answers to an open question for the nurses to express their opinions. These responses were examined statistically and by word analysis using Text Mining Studio. Japanese nurses expressed greatest concern about payment options, foreign language skills, and issues of informed consent, when dealing with foreigners. The results confirm that, in order to provide a high quality of patient care, extra preparation and a greater knowledge of international workers and visitors are required by nursing professionals in Japan.

Diversity changes of microbial communities into hospital surface environments.

PubMed

Yano, Rika; Shimoda, Tomoko; Watanabe, Reina; Kuroki, Yasutoshi; Okubo, Torahiko; Nakamura, Shinji; Matsuo, Junji; Yoshimura, Sadako; Yamaguchi, Hiroyuki

2017-07-01

Previous works have demonstrated considerable variability in hospital cleanliness in Japan, suggesting that contamination is driven by factors that are currently poorly controlled. We undertook 16S rRNA sequence analysis to study population structures of hospital environmental microbiomes to see which factor(s) impacted contamination. One hundred forty-four samples were collected from surfaces of three hospitals with distinct sizes ("A": >500 beds, "B": 100-500 beds, "C": <100 beds). Sample locations of two ward types (Surgical and Internal) included patient room bed table (multiple) (4BT), patient overbed table (multiple) (4OT), patient room sink (multiple) (4S), patient room bed table (single) (SBT), patient overbed table (single) (SOT), patient room sink (single) (SS), nurse desk (ND), and nurse wagon (NW). Total DNA was extracted from each sample, and the 50 samples that yielded sufficient DNA were used for further 16S rRNA sequencing of hospital microbiome populations with cluster analysis. The number of assigned bacterial OTU populations was significantly decreased in hospital "C" compared to the other hospitals. Cluster analysis of sampling locations revealed that the population structure in almost all locations of hospital "C" and some locations in the other hospitals was very similar and unusually skewed with a family, Enterobacteriaceae. Interestingly, locations included patient area (4OT, 4BT, SBT) and nurse area (ND), with a device (NW) bridging the two and a place (4S and SS) shared between patients or visitors. We demonstrated diversity changes of hospital environmental microbiomes with a skewed population, presumably by medical staff pushing NWs or sinks shared by patients or visitors. Copyright © 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Job stress and temperaments in female nurses.

PubMed

Kikuchi, Y; Nakaya, M; Ikeda, M; Takeda, M; Nishi, M

2013-03-01

According to previous studies, temperament predicts a large share of the variance in job stress. It may be necessary for mental health practitioners to offer intervention strategies in accordance with individual temperament. To investigate the relationship between job stress and temperament among nurses in a general hospital and to provide insight into personality traits influencing their mental or physical health. A questionnaire survey of nurses in a general hospital. Work stress was measured using the Japanese version of the Effort-Reward Imbalance (ERI) scale. Temperament was assessed by a Japanese version of Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire (TEMPS-A). Hierarchical multiple regression analysis was used to determine the independent contribution of temperament to effort-reward ratio and over-commitment. Response rate was 48% (326/685). Temperament predicted part of the variance of the four ERI ratios (effort-reward ratio 26%; effort-esteem ratio 27%; effort-promotion ratio 26%; and effort-security ratio 18%) and also of over-commitment (38%). Depressive temperament influenced all four ERI ratios and over-commitment. Anxious temperament influenced only over-commitment. Nurses with depressive or anxious temperaments should be identified, monitored for signs of job stress and offered interventions to prevent adverse physical and mental effects.

Association between workaholism and sleep problems among hospital nurses.

PubMed

Kubota, Kazumi; Shimazu, Akihito; Kawakami, Norito; Takahashi, Masaya; Nakata, Akinori; Schaufeli, Wilmar B

2010-01-01

The present study examined the association between workaholism, the tendency to work excessively hard in a compulsive fashion, and sleep problems among Japanese nurses. A cross-sectional survey was conducted among 600 nurses from 2 university hospitals in Japan using a self-reported questionnaire on workaholism, sleep, job-related variables (i.e., job demands, job control, and worksite support), and demographic variables. A total of 394 nurses returned the questionnaire (response rate=65.7%) and complete data from 312 female nurses were used for analyses (final coverage rate=52.0%). Workaholics, as measured using the Japanese version of the Dutch Workaholism Scale, were defined as those having high scores on both the "work excessively" and "work compulsively" subscales. Logistic regression analyses revealed that workaholics had higher risks for sleep problems in terms of subjective sleep insufficiency, excessive daytime sleepiness at work, difficulty awakening in the morning, and feeling tired when waking up in the morning (odds ratios [OR] of 4.40, 3.18, 3.48, and 4.61, respectively, p<0.05). These remained significant even after adjusting for demographic and job-related variables (OR 3.41, 5.36, 2.56, and 2.77, respectively). However, no significant associations were found between workaholism and insomnia symptoms. These results suggest that workaholic nurses had higher risks for impaired awakening, insufficient sleep, and workplace sleepiness.

Association between Nurse Staffing and In-Hospital Bone Fractures: A Retrospective Cohort Study.

PubMed

Morita, Kojiro; Matsui, Hiroki; Fushimi, Kiyohide; Yasunaga, Hideo

2017-06-01

To determine if sufficient nurse staffing reduced in-hospital fractures in acute care hospitals. The Japanese Diagnosis Procedure Combination inpatient (DPC) database from July 2010 to March 2014 linked with the Surveys for Medical Institutions. We conducted a retrospective cohort study to examine the association of inpatient nurse-to-occupied bed ratio (NBR) with in-hospital fractures. Multivariable logistic regression with generalized estimating equations was performed, adjusting for patient characteristics and hospital characteristics. We identified 770,373 patients aged 50 years or older who underwent planned major surgery for some forms of cancer or cardiovascular diseases. We used ICD-10 codes and postoperative procedure codes to identify patients with in-hospital fractures. Hospital characteristics were obtained from the "Survey of Medical Institutions and Hospital Report" and "Annual Report for Functions of Medical Institutions." Overall, 662 (0.09 percent) in-hospital fractures were identified. Logistic regression analysis showed that the proportion of in-hospital fractures in the group with the highest NBR was significantly lower than that in the group with the lowest NBR (adjusted odd ratios, 0.67; 95 percent confidence interval, 0.44-0.99; p = .048). Sufficient nurse staffing may be important to reduce postsurgical in-hospital fractures in acute care hospitals. © Health Research and Educational Trust.

Multidisciplinary management of heart failure just beginning in Japan.

PubMed

Sato, Yukihito

2015-09-01

The mortality associated with end-stage heart failure (HF) is high despite the development of new and increasingly effective drugs and non-pharmacological therapies. Repetitive hospitalizations predict fatal outcomes and each hospitalization should prompt individual conversations with the patient, the family, and the caregivers. A multidisciplinary disease management program promotes the education of patients and their families and modifies their behavior, with a view to ultimately improve the prognosis and quality of life. From the early to the late stages of HF, a multidisciplinary disease management program should be implemented. In Western societies this multidisciplinary management has long been debated and endorsed, in contrast to Japan, where it has just begun. In 2012, the Japanese Nursing Association launched a certification in chronic HF nursing. A Japanese version of HF disease management should soon be developed in its own social environment. Copyright © 2015. Published by Elsevier Ltd.

Trapezius Muscle Load, Heart Rate and Time Pressure during Day and Night Shift in Swiss and Japanese Nurses

PubMed Central

NICOLETTI, Corinne; MÜLLER, Christian; TOBITA, Itoko; NAKASEKO, Masaru; LÄUBLI, Thomas

2014-01-01

The aim of the present study was to analyze the activity of the trapezius muscle, the heart rate and the time pressure of Swiss and Japanese nurses during day and night shifts. The parameters were measured during a day and a night shift of 17 Swiss and 22 Japanese nurses. The observed rest time of the trapezius muscle was longer for Swiss than for Japanese nurses during both shifts. The 10th and the 50th percentile of the trapezius muscle activity showed a different effect for Swiss than for Japanese nurses. It was higher during the day shift of Swiss nurses and higher during the night shift of Japanese nurses. Heart rate was higher for both Swiss and Japanese nurses during the day. The time pressure was significantly higher for Japanese than for Swiss nurses. Over the duration of the shifts, time pressure increased for Japanese nurses and slightly decreased for those from Switzerland. Considering trapezius muscle activity and time pressure, the nursing profession was more burdening for the examined Japanese nurses than for Swiss nurses. In particular, the night shift for Japanese nurses was characterized by a high trapezius muscle activity and only few rest times for the trapezius muscle. PMID:24633074

Trapezius muscle load, heart rate and time pressure during day and night shift in Swiss and Japanese nurses.

PubMed

Nicoletti, Corinne; Müller, Christian; Tobita, Itoko; Nakaseko, Masaru; Läubli, Thomas

2014-01-01

The aim of the present study was to analyze the activity of the trapezius muscle, the heart rate and the time pressure of Swiss and Japanese nurses during day and night shifts. The parameters were measured during a day and a night shift of 17 Swiss and 22 Japanese nurses. The observed rest time of the trapezius muscle was longer for Swiss than for Japanese nurses during both shifts. The 10th and the 50th percentile of the trapezius muscle activity showed a different effect for Swiss than for Japanese nurses. It was higher during the day shift of Swiss nurses and higher during the night shift of Japanese nurses. Heart rate was higher for both Swiss and Japanese nurses during the day. The time pressure was significantly higher for Japanese than for Swiss nurses. Over the duration of the shifts, time pressure increased for Japanese nurses and slightly decreased for those from Switzerland. Considering trapezius muscle activity and time pressure, the nursing profession was more burdening for the examined Japanese nurses than for Swiss nurses. In particular, the night shift for Japanese nurses was characterized by a high trapezius muscle activity and only few rest times for the trapezius muscle.

How nurse managers in Japanese hospital wards manage patient violence toward their staff.

PubMed

Sato, Kana; Yumoto, Yoshie; Fukahori, Hiroki

2016-03-01

This study explores nurse managers' experiences in dealing with patient/family violence toward their staff. Studies and guidelines have emphasised the responsibility of nurse managers to manage violence directed at their staff. Although studies on nursing staff have highlighted the ineffectiveness of strategies used by nurse managers, few have explored their perspectives on dealing with violence. This qualitative study adopted a grounded theory approach to explore the experiences of 26 Japanese nurse managers. The nurse managers made decisions using internalised ethical values, which included maintaining organisational functioning, keeping staff safe, advocating for the patient/family and avoiding moral transgressions. They resolved internal conflicts among their ethical values by repeating a holistic assessment and simultaneous approach consisting of damage control and dialogue. They facilitated the involved persons' understanding, acceptance and sensemaking of the incident, which contributed to a resolution of the internal conflicts among their ethical values. Nurse managers adhere to their ethical values when dealing with patient violence toward nurses. Their ethical decision-making process should be acknowledged as an effective strategy to manage violence. Organisational strategies that support and incorporate managers' ethical decision-making are needed to prevent and manage violence toward nurses. © 2014 John Wiley & Sons Ltd.

Japanese professional nurses spend unnecessarily long time doing nursing assistants' tasks.

PubMed

Kudo, Yasushi; Yoshimura, Emiko; Shahzad, Machiko Taruzuka; Shibuya, Akitaka; Aizawa, Yoshiharu

2012-09-01

In environments in which professional nurses do simple tasks, e.g., laundry, cleaning, and waste disposal, they cannot concentrate on technical jobs by utilizing their expertise to its fullest benefit. Particularly, in Japan, the nursing shortage is a serious problem. If professional nurses take their time to do any of these simple tasks, the tasks should be preferentially allocated to nursing assistants. Because there has been no descriptive study to investigate the amount of time Japanese professional nurses spent doing such simple tasks during their working time, their actual conditions remain unclear. Professional nurses recorded their total working time and the time they spent doing such simple tasks during the week of the survey period. The time an individual respondent spent doing one or more simple tasks during that week was summed up, as was their working time. Subsequently, the percentage of the summed time he or she spent doing any of those tasks in his or her summed working time was calculated. A total of 1,086 respondents in 19 hospitals that had 87 to 376 beds were analyzed (response rate: 53.3%). The average time (SD) that respondents spent doing those simple tasks and their total working time were 2.24 (3.35) hours and 37.48 (10.88) hours, respectively. The average percentage (SD) of the time they spent doing the simple tasks in their working time was 6.00% (8.39). Hospital administrators must decrease this percentage. Proper working environments in which professional nurses can concentrate more on their technical jobs must be created.

"Tugboat Annie:" nursing's hero of Pearl Harbor--Grace Lally (1897-1983).

PubMed

Hawkins, J W; Matthews, I

1991-01-01

In 1991 we will mark the 50th anniversary of the Japanese attack on Pearl Harbor. Few nurses know that the Chief Nurse aboard the USS Solace, the only hospital ship in port on that fateful day, played a critical role in caring for the survivors. Grace Lally's calm, professional manner, along with her sensitivity to the needs of her patients, her 12 nurses, and the crew of the Solace made her a hero. This study is an investigation of her role on December 7, 1941, and her contributions as a career military nurse.

Methods developed to elucidate nursing related adverse events in Japan.

PubMed

Yamagishi, Manaho; Kanda, Katsuya; Takemura, Yukie

2003-05-01

Financial resources for quality assurance in Japanese hospitals are limited and few hospitals have quality monitoring systems of nursing service systems. However, recently its necessity has been recognized. This study has cost effectively used adverse event occurrence rates as indicators of the quality of nursing service, and audited methods of collecting data on adverse events to elucidate their approximate true numbers. Data collection was conducted in July, August and November 2000 at a hospital in Tokyo that administered both primary and secondary health care services (281 beds, six wards, average length of stay 23 days). We collected adverse events through incident reports, logs, check-lists, nurse interviews, medication error questionnaires, urine leucocyte tests, patient interviews and medical records. Adverse events included the unplanned removals of invasive lines, medication errors, falls, pressure sores, skin deficiencies, physical restraints, and nosocomial infections. After evaluating the time and useful outcomes of each source, it soon became clear that we could elucidate adverse events most consistently and cost-effectively through incident reports, check lists, nurse interviews, urine leucocyte tests and medication error questionnaires. This study suggests that many hospitals in Japan could monitor the quality of the nursing service using these sources.

[Role of Visiting Nursing Care in Japanese Home Healthcare].

PubMed

Yu, Sang-Ju

2018-02-01

Taiwan's rapidly aging society is expected to make it a super-aged society in 2026. By 2060, people aged 65 or older will account for 40% of the population, a ratio that will approximate that in Japan. In Japan, the elderly population was 27.3% in 2016. By 2025, when the baby-boomers become 75 years old in Japan, issues of long-term care and end-of-life care will be more important and challenging. Since 1976, more Japanese have died in hospital settings than in home settings. Although the percentage of people dying at home increased slightly to 12.7% in 2016, after the recent introduction and promotion of home healthcare, Japan will face a significant challenge to deal with the healthcare 'tsunami' of high natural death rates, which is expected to impose a heavy death burdened on society by 2040, when the death rate is expected to reach 1,670,000/year. Therefore, the Japanese authorities have begun to promote the Community-based Integrated Care System, in which home healthcare and visiting nursing play crucial roles. This article summarizes the historical trend and current situation of visiting nursing in Japan. Japan uses a hybrid payment system for visiting nursing that is financially supported both through private medical insurance policies and Kaigo insurance (Japanese long-term care insurance). The total of 8613 visiting nursing stations that were active in community settings in 2016 cooperated with 14,000 support clinics for home healthcare and cared for 570,000 patients in home settings. We believe that visiting nursing will play an important role in home healthcare in Taiwan in the future.

Academic report on burnout among Japanese nurses.

PubMed

Kitaoka, Kazuyo; Masuda, Shinya

2013-12-01

Japanese nurses have increasingly experienced "burnout" in the past several years. Studies on Japanese nurses are required in order to explore how to prevent nursing burnout. The objectives of this report were to: (i) introduce the concept, definition, and measurement of burnout; (ii) look at an overview of the prevalence, possible causes, and consequences of burnout among Japanese nurses; and (iii) explore how to prevent burnout among nurses. The authors and co-researchers have been studying burnout among Japanese workers for more than 15 years. Therefore, previously performed studies were reviewed and summarized. In Japan, approximately 36% of human services professionals, such as nurses, were burned out compared to 18% of civil servants, and 12% of company employees. It was quite obvious that nurses are prone to burnout. The possible causes and consequences of burnout among Japanese nurses were reviewed. Excessive workloads and interpersonal conflict in the workplace were possible causes of burnout among Japanese nurses. The consequences of nurse burnout are potentially very serious, including medical accidents/errors. Issues to prevent nursing burnout were then reviewed. Enhancement of cognitive coping skills for female nurses and problem-solving skills for male nurses could contribute to prevention of burnout in nurses. The authors' previous study revealed that the new model of the organizational context of burnout developed by Leiter and Maslach could be applied to Japanese. Further examination is needed. This report supports the call to scale up burnout prevention strategy for Japanese nurses. © 2012 The Authors. Japan Journal of Nursing Science © 2012 Japan Academy of Nursing Science.

[Job retention and nursing practice environment of hospital nurses in Japan applying the Japanese version of the Practice Environment Scale of the Nursing Work Index (PES-NWI)].

PubMed

Ogata, Yasuko; Nagano, Midori; Fukuda, Takashi; Hashimoto, Michio

2011-06-01

The purpose of this study was to examine how the nursing practice environment affects job retention and the turnover rate among hospital nurses. The Practice Environment Scale of the Nursing Work Index (PES-NWI) was applied to investigate the nurse working environment from the viewpoint of hospital nurses in Japan. Methods A postal mail survey was conducted using the PES-NWI questionnaire targeting 2,211 nurses who were working at 91 wards in 5 hospitals situated in the Tokyo metropolitan area from February to March in 2008. In the questionnaire, hospital nurses were asked about characteristics such as sex, age and work experience as a nurse, whether they would work at the same hospital in the next year, the 31 items of the PES-NWI and job satisfaction. Nurse managers were asked to provide staff numbers to calculate the turnover rate of each ward. Logistic regression analyses were carried out, with "intention to retain or leave the workplace next year" as the dependent variable, with composite and 5 sub-scale scores of the PES-NWI and nurse characteristics as independent variables. Correlation coefficients were calculated to investigate the relationship between nurse turnover rates and nursing practice environments. A total of 1,067 full-time nurses (48.3%) from 5 hospitals responded. Almost all of them were men (95.9%), with an average age of 29.2 years old. They had an average of 7.0 years total work experience in hospitals and 5.8 years of experience at their current hospital. Cronbach's alpha coefficients were 0.75 for composite of the PES-NWI, and 0.77-0.85 for the sub-scales. All correlation coefficients between PES-NWI and job satisfaction were significant (P < 0.01). In the logistic regression analysis, a composite of PES-NWI, "Nurse Manager's Ability, Leadership, and Support of Nurses" and "Staffing and Resource Adequacy" among the 5 sub-scales correlated with the intention of nurses to stay on (P < 0.05). The means for turnover rate were 10.4% for nurses and 17.6% for newly hired nurses. These rates were significantly correlated to the composite and some sub-scales of the PES-NWI. The working environment for nurses is important in retaining nurses working at hospitals. We confirmed the reliability and the validity of the PES-NWI scale based on the magnitude of the Cronbach's alpha coefficient and correlation coefficient between the PES-NWI scale and job satisfaction in this study.

[Surgeons' hope: expanding the professional role of co-medical staff and introducing the nurse practitioner/physician assistant and team approach to the healthcare system].

PubMed

Maehara, Tadaaki; Nishida, Hiroshi; Watanabe, Takashi; Tominaga, Ryuji; Tabayashi, Koichi

2010-07-01

The healthcare system surrounding surgeons is collapsing due to Japan's policy of limiting health expenditure, market fundamentalism, shortage of healthcare providers, unfavorable working environment for surgeons, increasing risk of malpractice suits, and decreasing number of those who desire to pursue the surgery specialty. In the USA, nonphysician and mid-level clinicians such as nurse practitioners (NPs) and physician assistants (PAs) have been working since the 1960s, and the team approach to medicine which benefits patients is functioning well. One strategy to avoid the collapse of the Japanese surgical healthcare system is introducing the NP/PA system. The division of labor in medicine can provide high-quality, safe healthcare and increase the confidence of the public by contributing to: reduced postoperative complications; increased patient satisfaction; decreased length of postoperative hospital stay: and economic benefits. We have requested that the Ministry of Health, Labor and Welfare establish a Japanese NP/PA system to care for patients more efficiently perioperatively. The ministry has decided to launch a trial profession called "tokutei (specifically qualified) nurse" in February 2010. These nurses will be trained and educated at the Master's degree level and allowed to practice several predetermined skill sets under physician supervision. We hope that all healthcare providers will assist in transforming the tokutei nurse system into a Japanese NP/PA system.

Features of standardized nursing terminology sets in Japan.

PubMed

Sagara, Kaoru; Abe, Akinori; Ozaku, Hiromi Itoh; Kuwahara, Noriaki; Kogure, Kiyoshi

2006-01-01

This paper reports the features and relationships between standardizes nursing terminology sets used in Japan. First, we analyzed the common parts in five standardized nursing terminology sets: the Japan Nursing Practice Standard Master (JNPSM) that includes the names of nursing activities and is built by the Medical Information Center Development Center (MEDIS-DC); the labels of the Japan Classification of Nursing Practice (JCNP), built by the term advisory committee in the Japan Academy of Nursing Science; the labels of the International Classification for Nursing Practice (ICNP) translated to Japanese; the labels, domain names, and class names of the North American Nursing Diagnosis Association (NANDA) Nursing Diagnoses 2003-2004 translated to Japanese; and the terms included in the labels of Nursing Interventions Classification (NIC) translated to Japanese. Then we compared them with terms in a thesaurus dictionary, the Bunrui Goihyo, that contains general Japanese words and is built by the National Institute for Japanese Language. 1) the level of interchangeability between four standardized nursing terminology sets is quite low; 2) abbreviations and katakana words are frequently used to express nursing activities; 3) general Japanese words are usually used to express the status or situation of patients.

Feelings about Nursing Assistants that Enhance the Work Motivation of Japanese Registered Nurses and Licensed Practical Nurses.

PubMed

Kudo, Yasushi; Kono, Keiko; Kume, Ryuko; Matsuhashi, Ayako; Tsutsumi, Akizumi

Registered nurses and licensed practical nurses have received professional education, but to enhance their work motivation it is necessary to create work environments in which they can concentrate on their jobs as specialists. One of the methods to develop such work environments is to use nursing assistants effectively. We investigated professional nurses' feelings toward nursing assistants and then examined the associations between those feelings and their work motivation. The analyzed subjects were 2,170 female nurses working in 25 hospitals with from 55 to 458 beds. The average age of the respondents was 38.0 (standard deviation, 10.6 years). Factor analyses extracted four factors of professional nurses' feelings toward nursing assistants: 1. knowledge related to healthcare, 2. nursing assistants' attitudes toward work, 3. human relations, and 4. distinguishing between professional nurses' work and nursing assistants' work. Using multiple linear regression analysis, our results revealed that scores of maintaining a high motivation to work thanks to nursing assistants became lower as the ages of the respondents increased. Scores of maintaining a high motivation to work thanks to nursing assistants became higher as professional nurses gained satisfaction from: knowledge related to healthcare, nursing assistants' attitudes toward work, and human relations. Hospital managers should consider these findings to improve working environments in which professional nurses can feel motivated to work.

The process of whistleblowing in a Japanese psychiatric hospital.

PubMed

Ohnishi, Kayoko; Hayama, Yumiko; Asai, Atsushi; Kosugi, Shinji

2008-09-01

This study aims to unveil the process of whistleblowing. Two nursing staff members who worked in a psychiatric hospital convicted of large-scale wrongdoing were interviewed. Data were analyzed using a modified grounded theory approach. Analysis of the interviews demonstrated that they did not decide to whistleblow when they were suspicious or had an awareness of wrongdoing. They continued to work, driven by appreciation, affection, and a sense of duty. Their decision to whistleblow was ultimately motivated by firm conviction. Shortly after whistleblowing, wavering emotions were observed, consisting of a guilty conscience, fear of retribution, and pride, which subsequently transformed to stable emotions containing a sense of relief and regret for delayed action. It is necessary for nurses to recognize that their professional responsibility is primarily to patients, not to organizations. Nurses should also have professional judgment about appropriate allegiance and actions.

Seeing-off of dead bodies at death discharges in Japan.

PubMed

Masaki, Sakiko; Asai, Atsushi

2013-12-01

For most death discharge ('shibou tai-in') patients, hospitals in Japan offer seeing-off ('omiokuri') services, a practice characteristic of Japanese culture. When a patient dies, nurses usually perform after-death procedures before transferring the body to the mortuary, where the nurses and doctors gather to provide the seeing-off service. This study was carried out to determine differences between the nurses' and bereaved families' opinions and thoughts regarding the seeing-off service. Semi-structured interviews were conducted with 17 nurses (focus group interviews) and 6 bereaved families (personal interviews). The interviews assessed: (1) the reasons why nurses provided seeing-off services; (2) thoughts during the seeing-off service; (3) impressions of the mortuary rituals; and (4) the necessity for the seeing-off service. The results indicated that nurses expressed their courtesy and sense of appreciation during the seeing-off service, which was recognised as an important nursing role. In contrast, bereaved families felt thankful but also doubtful, particularly as regards the mortuary rituals. In light of the differences in perspective between nurses and families, it may be that the level of satisfaction with the seeing-off service is largely affected by the relationship between the family and the medical professionals before the patient's death. Our study also notes that Japanese people respect the dead body and treat it with care, reflecting the unique culture and customs of Japan.

Impact of work-life imbalance on job satisfaction and quality of life among hospital nurses in Japan.

PubMed

Makabe, Sachiko; Takagai, Junko; Asanuma, Yoshihiro; Ohtomo, Kazuo; Kimura, Yutaka

2015-01-01

This study investigated the status of work-life imbalance among hospital nurses in Japan and impact of work-life imbalance on job satisfaction and quality of life. A cross-sectional survey of 1,202 nurses (81% response rate) was conducted in three Japanese acute care hospitals. Participants were divided into four groups for actual work-life balance (Group A: 50/50, including other lower working proportion groups [e.g., 40/50]; Group B: 60/40; Group C: 70/30; and Group D: 80/20, including other higher working proportion groups [e.g., 90/10]). We also asked participants about desired work-life balance, and private and work-related perspectives. Satisfactions (job, private life, and work-life balance), quality of life, and stress-coping ability were also measured. All data were compared among the four groups. Most nurses sensed that they had a greater proportion of working life than private life, and had a work-life imbalance. Actual WLB did not fit compared to desired WLB. When the actual working proportion greatly exceeds the private life proportion, nurses' health could be in danger, and they may resign due to lower job satisfaction and QOL. Simultaneous progress by both management and individual nurses is necessary to improve work-life imbalance.

Changes to Hospital Inpatient Volume After Newspaper Reporting of Medical Errors.

PubMed

Fukuda, Haruhisa

2017-06-30

The aim of this study was to investigate the influence of medical error case reporting by national newspapers on inpatient volume at acute care hospitals. A case-control study was conducted using the article databases of 3 major Japanese newspapers with nationwide circulation between fiscal years 2012 and 2013. Data on inpatient volume at acute care hospitals were obtained from a Japanese government survey between fiscal years 2011 and 2014. Panel data were constructed and analyzed using a difference-in-differences design. Acute care hospitals in Japan. Hospitals named in articles that included the terms "medical error" and "hospital" were designated case hospitals, which were matched with control hospitals using corresponding locations, nurse-to-patient ratios, and bed numbers. Medical error case reporting in newspapers. Changes to hospital inpatient volume after error reports. The sample comprised 40 case hospitals and 40 control hospitals. Difference-in-differences analyses indicated that newspaper reporting of medical errors was not significantly associated (P = 0.122) with overall inpatient volume. Medical error case reporting by newspapers showed no influence on inpatient volume. Hospitals therefore have little incentive to respond adequately and proactively to medical errors. There may be a need for government intervention to improve the posterror response and encourage better health care safety.

The Japanese value of harmony and nursing ethics.

PubMed

Konishi, Emiko; Yahiro, Michiko; Nakajima, Naoko; Ono, Miki

2009-09-01

Harmony is one of the most fundamental Japanese values. It is derived from Confucianism and encompasses a state of mind, an action process and outcomes of the action. This article draws on research data and discusses Japanese nurses' perceptions of harmony as reflected in their everyday practice. The most important virtues for these nurses were reported as politeness and respect for other persons. The outcome from the nurses' harmonious practice, it is claimed, benefited patients and created peaceful, harmonious relationships for all. Because of the unique link between harmony and the location of interaction, the ideal 'workplace harmony' threatened some nurses' professional decision making. These nurses confused harmony with conformity by superficial agreement. The Japanese seniority system could be a major factor contributing to this problem. Ethics education that includes traditional values and concepts in Japanese culture is strongly urged.

Impact of work-life imbalance on job satisfaction and quality of life among hospital nurses in Japan

PubMed Central

MAKABE, Sachiko; TAKAGAI, Junko; ASANUMA, Yoshihiro; OHTOMO, Kazuo; KIMURA, Yutaka

2014-01-01

This study investigated the status of work-life imbalance among hospital nurses in Japan and impact of work-life imbalance on job satisfaction and quality of life. A cross-sectional survey of 1,202 nurses (81% response rate) was conducted in three Japanese acute care hospitals. Participants were divided into four groups for actual work-life balance (Group A: 50/50, including other lower working proportion groups [e.g., 40/50]; Group B: 60/40; Group C: 70/30; and Group D: 80/20, including other higher working proportion groups [e.g., 90/10]). We also asked participants about desired work-life balance, and private and work-related perspectives. Satisfactions (job, private life, and work-life balance), quality of life, and stress-coping ability were also measured. All data were compared among the four groups. Most nurses sensed that they had a greater proportion of working life than private life, and had a work-life imbalance. Actual WLB did not fit compared to desired WLB. When the actual working proportion greatly exceeds the private life proportion, nurses’ health could be in danger, and they may resign due to lower job satisfaction and QOL. Simultaneous progress by both management and individual nurses is necessary to improve work-life imbalance. PMID:25475095

Examination of a cognitive model of stress, burnout, and intention to resign for Japanese nurses.

PubMed

Ohue, Takashi; Moriyama, Michiko; Nakaya, Takashi

2011-06-01

A reduction in burnout is required to decrease the voluntary turnover of nurses. This study was carried out with the aim of establishing a cognitive model of stress, burnout, and intention to resign for nurses. A questionnaire survey was administered to 336 nurses (27 male and 309 female) who had worked for ≤5 years at a hospital with multiple departments. The survey included an evaluation of burnout (Maslach Burnout Inventory), stress (Nursing Job Stressor Scale), automatic thoughts (Automatic Thoughts Questionnaire-Revised), and irrational beliefs (Japanese Irrational Belief Test), in addition to the intention to resign. The stressors that affected burnout in the nurses included conflict with other nursing staff, nursing role conflict, qualitative workload, quantitative workload, and conflict with patients. The irrational beliefs that were related to burnout included dependence, problem avoidance, and helplessness. In order to examine the automatic thoughts affecting burnout, groups with low and high negative automatic thoughts and low and high positive automatic thoughts were established. A two-way ANOVA showed a significant interaction of these factors with emotional exhaustion, but no significant interaction with depersonalization and a personal sense of accomplishment. Only the major effect was significant. The final model showed a process of "stressor → irrational beliefs → negative automatic thoughts/positive automatic thoughts → burnout". In addition, a relationship between burnout and an intention to resign was shown. These results suggest that stress and burnout in nurses might be prevented and that the number of nurses who leave their position could be decreased by changing irrational beliefs to rational beliefs, decreasing negative automatic thoughts, and facilitating positive automatic thoughts. © 2010 The Authors. Japan Journal of Nursing Science © 2010 Japan Academy of Nursing Science.

[How to make regional medicine revive from the medical crisis or collapse due to the severe paucity of medical doctors: a plan with "the magnet hospital"].

PubMed

Itoh, Tsunetoshi

2009-01-01

In 2002-2003, the practice of doctors lending their names to appear as "staff" of hospitals became known. Problems regarding funds from public hospitals were also revealed. Tohoku University asked regional societies how to improve the medical situation, and redefined its responsibilities. The Educational Development Center for Local Medicine and Department of Local Medical Service System were set up (2005-2008). A severe shortage of medical doctors prevails in Japan: the number of doctors per population is at the 4th lowest among OECD countries, and the number per hospital bed is the lowest. We have no nursing homes whose beds are not counted as hospital beds. The number of faculty staff in Japanese medical schools is 1/3 to those of Western countries. The reported number of doctors working in hospitals and offices surpasses that by census for medical doctors by >40,000. Japanese doctors work for >60 hours per week. I propose essential plans to improve Japanese situation for medical service: 1. Immediately increase the number of doctors by at least 50%. Based on our calculation, we need 450,000 doctors. 2. When the shortage of doctors is severe, establish a magnet hospital with c.a. 500 beds for every 200,000 population, capable of treating highly emergency patients and attracting doctors who need medical training. Hospitals should not belong to each city or town. 3. Establish a comprehensive organization to nurture doctors on a long-term basis. It should consist of a medical school, hospitals, and the prefectural government. It should help doctors to move between hospitals, and be responsible both for designing doctors' career paths and for allocating them appropriately.

Experiences of Japanese Nurse Scholars: Insights for U.S. Faculty.

ERIC Educational Resources Information Center

Doutrich, Dawn

2001-01-01

Phenomenological analysis of interviews with 22 Japanese nurses with graduate degrees from U.S. schools and 3 Japanese nurse consultants showed how graduate education changed their ways of being and sense of self. They became more verbal, direct, and articulate about personal preferences. Some experienced a sense of loss or alienation upon…

Japanese and Korean Nursing Students' Motivation for Joining Disaster Relief Activities as Nurses in the Future.

PubMed

Choe, Myoung-Ae; Kuwano, Noriko; Bang, Kyung-Sook; Cho, Mi-Kyoung; Yatsushiro, Rika; Kawata, Yuki

The purpose of this study was to identify differences in motivation for joining disaster relief activities as a nurse in the future between Japanese and Korean nursing students. A descriptive 2-group comparative study design was used. The participants were 721 first- to fourth-year nursing students (Japanese, n = 324; Korean, n = 397). From June to September 2014, data were collected through a researcher-administered questionnaire and self-reported answers. The collected data were analyzed by descriptive statistics, the χ test, and the t test.No significant difference was found between Japanese and Korean students in motivation to join domestic relief activities should a disaster occur in the area in which they lived. Compared with Korean students, Japanese students strongly agreed that it is necessary to carry out relief work across borders when disasters occur in foreign countries (p = .001). Meanwhile, Japanese students showed less motivation than Korean students to join relief activities in other domestic areas and foreign countries (p = .020).The results of this study suggest that the motivation of Japanese students to join disaster relief activities as nurses in the future should a disaster occur in other domestic areas and foreign countries needs to be increased. The results also suggest that undergraduate students should be well prepared for disasters through disaster nursing education, including practical training, disaster drills, and simulation.

The Power of Traditional Design Techniques: The Effects of Viewing a Japanese Garden on Individuals With Cognitive Impairment.

PubMed

Goto, Seiko; Gianfagia, Thomas J; Munafo, John P; Fujii, Eijiro; Shen, Xuting; Sun, Minkai; Shi, Bertram Emil; Liu, Congcong; Hamano, Hiroshi; Herrup, Karl

2017-07-01

This study is to examine how viewing a Japanese garden affects Japanese patients with dementia. In a previous study, authors explored the effect on individuals with Alzheimer's disease of viewing an indoor Japanese garden at a nursing home in the United States and reported that viewing the garden significantly reduced the heart rate, evoked short-term and long-term memories, and improved behavioral symptoms. However, it was unclear whether these effects were caused by the design of Japanese garden or unfamiliarity of the design to Caucasians. We constructed a Japanese garden on the rooftop of a hospital in Japan and assessed with a total of 25 subjects on the following categories: (1) eye movement, (2) heart rate, and (3) behavior under four different conditions: (a) open view of the site before construction of the Japanese garden (the control space), (b) open view of the Japanese garden, (c) view of the Japanese garden through closed door, and (d) view of Japanese garden through closed door with the chrysanthemum scent. Findings/Results: Viewers' eyes scanned larger area while viewing the Japanese garden, and viewing the Japanese garden significantly reduced heart rate and improved behavioral symptoms than the control space. We also found that the effect of viewing the same Japanese garden differed across three conditions: the view through an open door, a closed door, and a closed door with added scent.

A literature review of disaster nursing competencies in Japanese nursing journals.

PubMed

Kako, Mayumi; Mitani, Satoko

2010-01-01

Competencies is an important concept used for assessing health professionals' capability to perform their role. By means of a literature review of Japanese professional journals this paper will investigate the competencies concept, particularly with relation to disaster nursing. The literature research was conducted using the database ichu-shi (ver. 4). All literature is written and published in Japanese and was published between 2001 and 2008. Due to an unfamiliarity of the term 'competencies' in Japanese, the key words were sought while deconstructing the meaning and concepts of 'competencies' into terms more recognisable in the Japanese context. Twelve key words: disaster, capability, education, practice, licensure, ability, function, prevention, response, planning, emergency, and disaster nursing were chosen as being most likely to find literature relevant to the English Language concept of competencies. The searched articles were then written into the disaster nursing competencies review worksheet for analysis. One hundred and twenty articles were found by searching a combination of these key words. Of these articles, those that were not in the context of disaster nursing were eliminated. As a result, 43 articles were chosen as being suitable for analysis of the context. These articles are classified into four themes. These theme groups indicated a foundation for competencies in disaster nursing. The definition of competencies in Japanese nursing journals was quite varied and cannot be easily defined as common disaster nursing competencies. Given the variety of areas and the distinct phases in disaster nursing, as well as the 'what for' and 'who governs', disaster nursing competencies will need its own discussion in order to establish the common competencies internationally.

Verification of reliability and validity of a Japanese version of the Rathus Assertiveness Schedule.

PubMed

Suzuki, Eiko; Kanoya, Yuka; Katsuki, Takeshi; Sato, Chifumi

2007-07-01

To verify the reliability and validity of a Japanese version of the Rathus Assertiveness Schedule in novice nurses to contribute to nursing management. An adequate scale is needed to measure the assertiveness and the effect of assertion training for Japanese nurses and to compare them with those in other countries. Rathus Assertiveness Schedule was adapted to Japanese with back-translation and its validity was examined in 989 novice nurses. The Japanese version showed a high coefficient of reliability in a split-half reliability test (r=0.76; P<0.01). The coefficient of reliability of Cronbach's alpha was high (r=0.84; P<0.01) indicating high internal consistency. The similarity with the concept of stress coping was shown. We extracted eight principal factors using factor analysis with varimax rotation. Elements of these factors were similar to those of the original Rathus Assertiveness Schedule. The Japanese version of Rathus Assertiveness Schedule was verified.

Job satisfaction in Japanese nurses.

PubMed

Yamashita, M

1995-07-01

This study investigated job satisfaction among nurses in Japan. The instrument for measuring occupational satisfaction of hospital nurses developed by Stamps and her associates was used. Initial items were reviewed by content experts who were familiar with measurement of work satisfaction among health professionals and nursing practice in Japan. Based on the item analysis in the cultural context, several items were reworded or eliminated from the original version. Twenty-five items were retained and translated into English by bilingual professionals. The questionnaire was administered to 613 nurses practising in a large, acute-care hospital in a southern part of Japan. The results from testing psychometric properties of the translated version of the instrument were satisfactory. It may be concluded that nurses in the study were not satisfied but not dissatisfied either. On all items, they showed relatively strong commitment to their work. However, extrinsic factors such as having little opportunities for promotion or less favourable working conditions appeared to negatively influence job satisfaction in the study. The findings support the dual factor theory of Herzberg and also Maslow's theory. Considering the lowest scored item, little opportunities for promotion, which reflects the employment system in Japan, administrators, who are usually male medical practitioners, should be made aware of a need for creating clinical ladder opportunities for nurses who would be promoted based on a merit system, instead of the current practice of a seniority system.

Exploring Japanese nurses' perceptions of the relevance and use of assertive communication in healthcare: A qualitative study informed by the Theory of Planned Behaviour.

PubMed

Omura, Mieko; Stone, Teresa E; Maguire, Jane; Levett-Jones, Tracy

2018-08-01

The hierarchical nature of healthcare environments presents a key risk factor for effective interprofessional communication. Power differentials evident in traditional healthcare cultures can make it difficult for healthcare professionals to raise concerns and be assertive when they have concerns about patient safety. This issue is of particular concern in Japan where inherent cultural and social norms discourage assertive communication. The aim of this study was to (a) explore nurses' perceptions of the relevance and use of assertive communication in Japanese healthcare environments; and (b) identify the factors that facilitate or impede assertive communication by Japanese nurses. A belief elicitation qualitative study informed by the Theory of Planned Behaviour was conducted and reported according to the COnsolidated criteria for REporting Qualitative research. Twenty-three practicing Japanese registered nurses were recruited by snowball sampling from October 2016 to January 2017. Individual face-to-face semi-structured interviews were conducted and transcribed in Japanese and then translated into English. Two researchers independently conducted a directed content analysis informed by the Theory of Planned Behaviour. Participants' responses were labelled in order of frequency for behavioural beliefs about the consequences of assertive communication, sources of social pressure, and factors that facilitate or impede assertive communication in Japanese healthcare environments. Although person-centred care and patient advocacy were core values for many of the participants, strict hierarchies, age-based seniority, and concerns about offending a colleague or causing team disharmony impeded their use of assertive communication. Novice nurses were particularly reluctant to speak up because of their perception of having limited knowledge and experience. This study identified Japanese nurses' behavioural, normative, and control beliefs in relation to assertive communication. The findings will be used to inform the development of a culturally appropriate assertiveness communication training program for Japanese nurses and nursing students. Copyright © 2018 Elsevier Ltd. All rights reserved.

A pilot study of selected Japanese nurses' ideas on patient advocacy.

PubMed

Davis, Anne J; Konishi, Emiko; Tashiro, Marie

2003-07-01

This pilot study had two purposes: (1) to review recent Japanese nursing literature nursing advocacy; and (2) to obtain data from nurses on advocacy. For the second purpose, 24 nurses at a nursing college in Japan responded to a questionnaire. The concept of advocacy, taken from the West, has become an ethical ideal for Japanese nurses but one that they do not always understand, or, if they do, they find it difficult to fulfil. They cite nursing leadership support as necessary to enacting this role. Discussion on meaning of and the rationale for advocacy in a society where goodness or badness is relative to social situations and its impact may reveal two parallel but overlapping views of morality. Such a situation would not only influence notions of advocacy but also possibly render them more complex.

Communication skills training on how to break bad news for Japanese nurses in oncology: effects of training on nurses' confidence and perceived effectiveness.

PubMed

Fukui, Sakiko; Ogawa, Keiko; Fukui, Naoshi

2010-03-01

Delivering bad news is an important communication skill for oncology nurses. No Asian study has developed a communication skills training program. We investigated the effect of such a program on the confidence and practical competence of Japanese oncology nurses. Thirty-one nurses participated, based on Western work in a 6-h workshop; the effect was assessed for 3 months. We evaluated the program effect by measuring nurse-rated confidence regarding communication with patients three times (before, immediately after, and 3 months after the program), in addition to interviewing them on the perception of the program at T3. On nurse-rated confidence in communication, 16/21 items were significantly increased 3 months after the program, and almost all nurses were positive about the course effectiveness. Communication skills training increased Japanese nurses' confidence as well as being perceived as effective.

Association of social skills with psychological distress among female nurses in Japan.

PubMed

Uchiyama, Ayako; Odagiri, Yuko; Ohya, Yumiko; Suzuki, Ayako; Hirohata, Kayoko; Kosugi, Shotaro; Shimomitsu, Teruichi

2011-01-01

Nursing is a highly stressful occupation. Because nursing work involves interaction with patients and colleagues, competence in social skills may be a key issue in stress management among nurses. However, there are very few studies among nurses focused on social skills together with social support, both of which are important aspects of job stress. The aim of this study was to examine the interrelationships between social skills and social support with job stressors, problem-solving coping, and psychological distress among Japanese nurses. Data from a self-administered questionnaire of 1,197 female nurses who worked for 5 general hospitals in Japan were analyzed. Covariance structure analysis with structural equation modeling techniques showed that social skills and social support were positively related to each other, while they were negatively associated with psychological distress and job stressors, and positively associated with problem-solving coping. Furthermore, the direct association between social skills and psychological distress was stronger than the association between social support and psychological distress. These findings suggested that improving not only social support at work but also individual social skills is important for nurses' mental health.

Visualization of hospital cleanliness in three Japanese hospitals with a tendency toward long-term care

PubMed Central

2014-01-01

Background Hospital cleanliness in hospitals with a tendency toward long-term care in Japan remains unevaluated. We therefore visualized hospital cleanliness in Japan over a 2-month period by two distinct popular methods: ATP bioluminescence (ATP method) and the standard stamp agar method (stamp method). Methods The surfaces of 752 sites within nurse and patient areas in three hospitals located in a central area of Sapporo, Japan were evaluated by the ATP and stamp methods, and each surface was sampled 8 times in 2 months. These areas were located in different ward units (Internal Medicine, Surgery, and Obstetrics and Gynecology). Detection limits for the ATP and stamp methods were determined by spike experiments with a diluted bacterial solution and a wipe test on student tables not in use during winter vacation, respectively. Values were expressed as the fold change over the detection limit, and a sample with a value higher than the detection limit by either method was defined as positive. Results The detection limits were determined to be 127 relative light units (RLU) per 100 cm2 for the ATP method and 5.3 colony-forming units (CFU) per 10 cm2 for the stamp method. The positive frequency of the ATP and stamp methods was 59.8% (450/752) and 47.7% (359/752), respectively, although no significant difference in the positive frequency among the hospitals was seen. Both methods revealed the presence of a wide range of organic contamination spread via hand touching, including microbial contamination, with a preponderance on the entrance floor and in patient rooms. Interestingly, the data of both methods indicated considerable variability regardless of daily visual assessment with usual wiping, and positive surfaces were irregularly seen. Nurse areas were relatively cleaner than patient areas. Finally, there was no significant correlation between the number of patients or medical personnel in the hospital and organic or microbiological contamination. Conclusions Ongoing daily hospital cleanliness is not sufficient in Japanese hospitals with a tendency toward long-term care. PMID:24593868

Visualization of hospital cleanliness in three Japanese hospitals with a tendency toward long-term care.

PubMed

Watanabe, Reina; Shimoda, Tomoko; Yano, Rika; Hayashi, Yasuhiro; Nakamura, Shinji; Matsuo, Junji; Yamaguchi, Hiroyuki

2014-03-04

Hospital cleanliness in hospitals with a tendency toward long-term care in Japan remains unevaluated. We therefore visualized hospital cleanliness in Japan over a 2-month period by two distinct popular methods: ATP bioluminescence (ATP method) and the standard stamp agar method (stamp method). The surfaces of 752 sites within nurse and patient areas in three hospitals located in a central area of Sapporo, Japan were evaluated by the ATP and stamp methods, and each surface was sampled 8 times in 2 months. These areas were located in different ward units (Internal Medicine, Surgery, and Obstetrics and Gynecology). Detection limits for the ATP and stamp methods were determined by spike experiments with a diluted bacterial solution and a wipe test on student tables not in use during winter vacation, respectively. Values were expressed as the fold change over the detection limit, and a sample with a value higher than the detection limit by either method was defined as positive. The detection limits were determined to be 127 relative light units (RLU) per 100 cm2 for the ATP method and 5.3 colony-forming units (CFU) per 10 cm2 for the stamp method. The positive frequency of the ATP and stamp methods was 59.8% (450/752) and 47.7% (359/752), respectively, although no significant difference in the positive frequency among the hospitals was seen. Both methods revealed the presence of a wide range of organic contamination spread via hand touching, including microbial contamination, with a preponderance on the entrance floor and in patient rooms. Interestingly, the data of both methods indicated considerable variability regardless of daily visual assessment with usual wiping, and positive surfaces were irregularly seen. Nurse areas were relatively cleaner than patient areas. Finally, there was no significant correlation between the number of patients or medical personnel in the hospital and organic or microbiological contamination. Ongoing daily hospital cleanliness is not sufficient in Japanese hospitals with a tendency toward long-term care.

An investigation of the basic education of Japanese nurses: comparison of competency with European nurses.

PubMed

Tateishi, Kazuko; Matsubayashi, Taro; Yoshimoto, Keiichi; Sakemi, Takanobu

2013-05-01

A few studies have compared nursing education systems of Japan and Europe, particularly focusing on competency. We evaluated the competency of registered Japanese nurses by comparing it with that of European nurses; the implications of evaluation for the education of nurses are discussed. Subjects were 468 European graduate nurses and 100 Japanese nurses. Study used data from the Graduates in Knowledge Society (REFLEX) survey in Europe and the Japanese language version of REFLEX (2006) used in a survey of Japanese nurses. The questionnaire referred to the survey items of REFLEX modified for use in Japan. Items common to the Japanese and European surveys were (1) The importance placed on university course elements while at university (2) Nineteen items of competency: for the abilities acquired in the present job ('Acquired skills') and those considered necessary to perform the job ('Required abilities on the job') (3) Usefulness of subject matter taught at university to the current job (1) The important course elements in Europe were 'Internship, work placement' and 'Lecture' while those in Japan were 'Theories and paradigms' and 'Lecture'. (2) The mean values for 'Acquired skills' were 5.06 for Europe and 3.73 for Japan and those for 'Required abilities on the job' were 4.86 for Europe and 5.16 for Japan. In Europe, no significant gap was observed between the above two scores, but in Japan, a big gap was found, particularly in relation to 'Ability to assert your authority'. (3) In terms of the usefulness of university-learned nursing education, Japan scored significantly lower on all five items. The content of basic university education for nursing is directly linked to the workplace in Europe but not in Japan. A comparison of competencies shows that in Japan, self-evaluation scores are low and expectations are high. Copyright © 2012 Elsevier Ltd. All rights reserved.

High prevalence of superficial white onychomycosis by Trichophyton interdigitale in a Japanese nursing home with a geriatric hospital.

PubMed

Watanabe, Seiji; Anzawa, Kazushi; Mochizuki, Takashi

2017-10-01

A mycological survey on feet was performed in a nursing home with a geriatric hospital to ascertain the prevalence of tinea lesions. Of 100 subjects, comprising 62 in the nursing home and 38 in the geriatric wing, 70 were diagnosed with tinea pedis, tinea unguium (onychomycosis) or both of which 54 had onychomycosis alone, nine tinea pedis alone and seven had co-existing onychomycosis and tinea pedis. The most common clinical type of onychomycosis was distal lateral subungual onychomycosis (DLSO) at 30 cases, followed by superficial white onychomycosis (SWO) at 23 cases. Fifteen strains of Trichophyton (T.) interdigitale isolated from 23 SWO patients comprised six molecular types (D2II, nine cases; C2II, two cases; four other types, one case of each), based on the non-transcribed spacer region (NTS) of the ribosomal DNA. The pathogen of three other SWO cases was identified as T. rubrum. Direct physical contact between the subjects was unlikely because they were bedridden most of the time. Nine T. interdigitale strains were isolated from a bathtub used by patients on the floor with a high incidence of SWO alone, and all nine strains were D2II type, which suggests nosocomial infection. Consequently, the hospital infection control policy committee was consulted, bathing arrangements were changed, and nursing staff were educated about onychomycosis. © 2017 Blackwell Verlag GmbH.

Preliminary study of online machine translation use of nursing literature: quality evaluation and perceived usability

PubMed Central

2012-01-01

Background Japanese nurses are increasingly required to read published international research in clinical, educational, and research settings. Language barriers are a significant obstacle, and online machine translation (MT) is a tool that can be used to address this issue. We examined the quality of Google Translate® (English to Japanese and Korean to Japanese), which is a representative online MT, using a previously verified evaluation method. We also examined the perceived usability and current use of online MT among Japanese nurses. Findings Randomly selected nursing abstracts were translated and then evaluated for intelligibility and usability by 28 participants, including assistants and research associates from nursing universities throughout Japan. They answered a questionnaire about their online MT use. From simple comparison of mean scores between two language pairs, translation quality was significantly better, with respect to both intelligibility and usability, for Korean-Japanese than for English-Japanese. Most respondents perceived a language barrier. Online MT had been used by 61% of the respondents and was perceived as not useful enough. Conclusion Nursing articles translated from Korean into Japanese by an online MT system could be read at an acceptable level of comprehension, but the same could not be said for English-Japanese translations. Respondents with experience using online MT used it largely to grasp the overall meanings of the original text. Enrichment in technical terms appeared to be the key to better usability. Users will be better able to use MT outputs if they improve their foreign language proficiency as much as possible. Further research is being conducted with a larger sample size and detailed analysis. PMID:23151362

End-of-life care bonus promoting end-of-life care in nursing homes: An 11-year retrospective longitudinal prefecture-wide study in Japan.

PubMed

Nishiguchi, Sho; Sugaya, Nagisa; Sakamaki, Kentaro; Mizushima, Shunsaku

2017-03-22

The end-of-life (EOL) care bonus introduced by the Japanese government works as a financial incentive and framework of quality preservation, including advance care planning, for EOL care among nursing home residents. This study aims to clarify the effects of the EOL care bonus in promoting EOL care in nursing homes. A longitudinal observational study using a questionnaire was conducted. We invited 378 nursing homes in Kanagawa prefecture in Japan, a region with a rapidly aging population, to participate in the study. The outcome was the number of residents dying in nursing homes from 2004 to 2014. In a linear mixed model, fixed-effect factors included year established, unit care, regional elderly population rate and hospital beds, adjacent affiliated hospital, full-time physician on site, physician's support during off-time, basic EOL care policy, usage of the EOL care bonus, EOL care conference, and staff experience of EOL care. A total of 237 nursing home facilities responded (62.7%). The linear mixed model showed that the availability of the EOL care bonus (coefficient 3.1, 95 % CI 0.67-5.51, p = 0.012) and years of usage of the EOL care bonus (p < 0.001) were significantly associated with increased numbers of residents dying in nursing homes. Our analysis revealed that the EOL care bonus has the potential to increase the number of residents receiving EOL care in nursing homes over several years. EOL care conferences, physician support for emergency care during off-time, and the presence of an adjacent affiliated hospital may also increase the number of residents receiving EOL care in nursing homes. These results suggest that a government financial incentive may contribute to effective EOL care among nursing home residents in other developed countries with rapidly aging populations.

Measuring the impact of an interprofessional multimedia learning resource on Japanese nurses and nursing students using the Theory of Planned Behavior Medication Safety Questionnaire.

PubMed

Omura, Mieko; Levett-Jones, Tracy; Stone, Teresa Elizabeth; Maguire, Jane; Lapkin, Samuel

2015-12-01

Interprofessional communication and teamwork are essential for medication safety; however, limited educational opportunities for health professionals and students to develop these skills exist in Japan. This study evaluated the impact of an interprofessional multimedia learning resource on registered nurses' and nursing students' intention to practice in a manner promoting medication safety. Using a quasi-experimental design, Japanese registered nurses and nursing students (n = 203) were allocated to an experimental (n = 109) or control group (n = 94). Behavioral intentions of medication safety and the predictor variables of attitudes, perceived behavioral control, and subjective norms were measured using a Japanese version of the Theory of Planned Behavior Medication Safety Questionnaire. Registered nurses in the experimental group demonstrated a greater intention to collaborate and practice in a manner that enhanced medication safety, evidenced by higher scores than the control group on all predictor variables. The results demonstrate the potential for interprofessional multimedia learning resources to positively impact the behaviors of Japanese registered nurses in relation to safe medication practices. Further research in other contexts and with other cohorts is warranted. © 2015 Wiley Publishing Asia Pty Ltd.

Rationale and design of the Japanese heart failure outpatients disease management and cardiac evaluation (J-HOMECARE).

PubMed

Tsuchihashi-Makaya, Miyuki; Matsuo, Hisashi; Kakinoki, Shigeo; Takechi, Shigeru; Tsutsui, Hiroyuki

2011-09-01

Although many studies have demonstrated the efficacy of disease management programs on mortality, morbidity, quality of life (QOL), and medical cost in patients with heart failure (HF), no study has focused on psychological status as an outcome of disease management. In addition, very little information is available on the effectiveness of disease management programs in other areas than the USA and Europe. The Japanese Heart Failure Outpatients Disease Management and Cardiac Evaluation (J-HOMECARE) is a randomized controlled trial in which 156 patients hospitalized with HF will be randomized into usual care or a home-based disease management arm receiving comprehensive advice and counseling by visiting nurses during the initial 2 months and telephone follow-up for the following 4 months after discharge. This study evaluates depression and anxiety (Hospital Anxiety and Depression Scale), mortality, readmission due to HF, and QOL (Short Form-8). Data are collected during index hospitalization and then 2, 6, and 12 months after discharge. This study started in December 2007, and the final results are expected in 2011. The J-HOMECARE will provide important information on the efficacy of disease management for psychological status as well as the effective components of disease management for patients with HF. (ClinicalTrials.gov number, NCT01284400). Copyright © 2011 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Long-term changes of information environments and computer anxiety of nurse administrators in Japan.

PubMed

Majima, Yukie; Izumi, Takako

2013-01-01

In Japan, medical information systems, including electronic medical records, are being introduced increasingly at medical and nursing fields. Nurse administrators, who are involved in the introduction of medical information systems and who must make proper judgment, are particularly required to have at least minimal knowledge of computers and networks and the ability to think about easy-to-use medical information systems. However, few of the current generation of nurse administrators studied information science subjects in their basic education curriculum. It can be said that information education for nurse administrators has become a pressing issue. Consequently, in this study, we conducted a survey of participants taking the first level program of the education course for Japanese certified nurse administrators to ascertain the actual conditions, such as the information environments that nurse administrators are in, their anxiety attitude to computers. Comparisons over the seven years since 2004 revealed that although introduction of electronic medical records in hospitals was progressing, little change in attributes of participants taking the course was observed, such as computer anxiety.

Cross-sectional online survey of research productivity in young Japanese nursing faculty.

PubMed

Oyama, Yumiko; Fukahori, Hiroki; Miyashita, Mitsunori; Narama, Miho; Kono, Ayumi; Atogami, Fumi; Kashiwagi, Masayo; Okaya, Keiko; Takamizawa, Emiko; Yoshizawa, Toyoko

2015-07-01

To investigate the factors affecting the research productivity of young nursing faculty in Japan. An online survey targeting young nursing scholars (aged ≤ 39 years) who were members of the Japan Academy of Nursing Science was conducted from October to November 2012. Of 1634 potential respondents, 648 completed the survey (39.7%), and 400 full-time faculty of a baccalaureate degree program were selected for the analysis. The numbers of English-language and Japanese publications in the past 3 years were regressed onto personal characteristics, such as academic degree and type of university. The mean numbers of publications in English and Japanese in the past 3 years were 0.41 and 1.63, respectively. Holding a doctoral degree was significantly related to a higher number of publications in English and Japanese (e(β) = 5.78 and e(β) = 1.89, respectively). Working at a national university (e(β) = 2.15), having a research assistant (e(β) = 2.05), and the ability to read research articles in English (e(β) = 2.27) were significantly related to more English-language publications. Having the confidence to conduct quantitative research (e(β) = 1.67) was related to a larger number of Japanese publications. The lack of mentoring (e(β) = 0.97) and university workload (e(β) = 0.96) were associated with a lesser number of Japanese publications. The research productivity of young nursing faculty appeared to be quite low. Strategies to enhance research productivity in young nursing faculty, such as encouraging the achievement of a doctoral degree or enrichment of research resources, should be undertaken. © 2014 The Authors. Japan Journal of Nursing Science © 2014 Japan Academy of Nursing Science.

Nurse awareness of clinical research: a survey in a Japanese University Hospital

PubMed Central

2014-01-01

Background Clinical research plays an important role in establishing new treatments and improving the quality of medical practice. Since the introduction of the concept of clinical research coordinators (CRC) in Japan, investigators and CRC work as a clinical research team that coordinates with other professionals in clinical trials leading to drug approval (registration trials). Although clinical nurses collaborate with clinical research teams, extended clinical research teams that include clinical nurses may contribute to the ethical and scientific pursuit of clinical research. Methods As knowledge of clinical research is essential for establishing an extended clinical research team, we used questionnaires to survey the knowledge of clinical nurses at Tokushima University Hospital. Five-point and two-point scales were used. Questions as for various experiences were also included and the relationship between awareness and experiences were analyzed. Results Among the 597 nurses at Tokushima University Hospital, 453 (75.9%) responded to the questionnaires. In Japan, registration trials are regulated by pharmaceutical affairs laws, whereas other types of investigator-initiated research (clinical research) are conducted based on ethical guidelines outlined by the ministries of Japan. Approximately 90% of respondents were aware of registration trials and clinical research, but less than 40% of the nurses were aware of their difference. In clinical research terminology, most respondents were aware of informed consent and related issues, but ≤50% were aware of other things, such as the Declaration of Helsinki, ethical guidelines, Good Clinical Practice, institutional review boards, and ethics committees. We found no specific tendency in the relationship between awareness and past experiences, such as nursing patients who were participating in registration trials and/or clinical research or taking a part in research involving patients as a nursing student or a nurse. Conclusions These findings suggest that clinical nurses have only limited knowledge on clinical research and the importance to have chances to make nurses aware of clinical research-related issues is suggested to establish an extended research team. Because of the study limitations, further study is warranted to determine the role of clinical nurses in establishing a suitable infrastructure for ethical pursuit of clinical research. PMID:24989623

Impact of an infection-control program on nurses' knowledge and attitude in pediatric intensive care units at Cairo University hospitals.

PubMed

Galal, Yasmine S; Labib, John R; Abouelhamd, Walaa A

2014-04-01

Healthcare-associated infection is a prominent problem among patients in pediatric intensive care units (PICU) as it could result in significant morbidity, prolonged hospitalization, and increase in medical care costs. The role of nurses is extremely important in preventing hazards and sequela of healthcare-associated infections. The aim of this study was to assess the effect of a health education program regarding infection-control measures on nurses' knowledge and attitude in PICUs at Cairo University hospitals. This was a pre-post test interventional study in which a convenient sample of 125 nurses was taken from the nursing staff in different PICUs at Cairo University hospitals. The study took place in three phases. In the first phase, the nursing staff's knowledge, attitude and practice concerning infection-control measures were tested using a self-administered pretested questionnaire and an observation checklist. The second phase included health education sessions in the form of powerpoint and video presentations; and in the third phase the nurses' knowledge and attitude on infection-control measures were reassessed. A significantly higher level of knowledge was revealed in the postintervention phase as compared with the preintervention phase with regards to the types of nosocomial infections (94.4 vs. 76.8%, P<0.001), the at-risk groups for acquiring infection (95.2 vs. 86.4%, P=0.035) and the measures applied to control nosocomial infections (89.6 vs. 68%, P<0.001). Nurses in the postintervention phase had significantly more knowledge about the types of hand washing (99.2 vs. 91.2%, P=0.006). A significantly higher percent of nurses in the postintervention phase knew the importance of avoiding recapping syringes (72.8 vs. 34.4%, P<0.001) and believed that infection-control measures could protect them completely from acquiring infection (79.2 vs. 65.6%, P=0.033). Statistically significant higher total knowledge and attitude scores were revealed in the postintervention phase as compared with the preintervention one (P<0.001). The percentage practice score of observed units was the highest among nurses in the neonatal intensive care unit at the Japanese Hospital (88%), whereas it was the lowest in the emergency pediatric unit (65%). There is scope for improvement in knowledge and attitude after educational program was offered to the nursing staff. Educational training programs should be multidisciplinary interventions in the era of quality control to help healthcare workers realize the importance of basic infection-control measures in reducing pediatric morbidity and mortality and improving the quality of care.

A Powerful Protector of the Japanese People: The History of the Japanese Hospital in Steveston, British Columbia, Canada,18961942.

PubMed

Vandenberg, Helen

2017-01-01

From 1896 to 1942, a Japanese hospital operated in the village of Steveston, British Columbia, Canada. For the first 4 years, Japanese Methodist missionaries utilized a small mission building as a makeshift hospital, until a larger institution was constructed by the local Japanese Fishermen's Association in 1900. The hospital operated until the Japanese internment, after the attack on Pearl Harbor during World War II. This study offers important commentary about the relationships between health, hospitals, and race in British Columbia during a period of increased immigration and economic upheaval. From the unique perspective of Japanese leaders, this study provides new insight about how Japanese populations negotiated hospital care, despite a context of severe racial discrimination. Japanese populations utilized Christianization, fishing expertise, and hospital work to garner more equitable access to opportunities and resources. This study demonstrates that in addition to providing medical treatment, training grounds for health-care workers, and safe refuge for the sick, hospitals played a significant role in confronting broader racialized inequities in Canada's past.

"A Powerful Protector of the Japanese People": The History of the Japanese Hospital in Steveston, British Columbia, Canada,1896-1942.

PubMed

Vandenberg, Helen

2017-01-01

From 1896 to 1942, a Japanese hospital operated in the village of Steveston, British Columbia, Canada. For the first 4 years, Japanese Methodist missionaries utilized a small mission building as a makeshift hospital, until a larger institution was constructed by the local Japanese Fishermen's Association in 1900. The hospital operated until the Japanese internment, after the attack on Pearl Harbor during World War II. This study offers important commentary about the relationships between health, hospitals, and race in British Columbia during a period of increased immigration and economic upheaval. From the unique perspective of Japanese leaders, this study provides new insight about how Japanese populations negotiated hospital care, despite a context of severe racial discrimination. Japanese populations utilized Christianization, fishing expertise, and hospital work to garner more equitable access to opportunities and resources. This study demonstrates that in addition to providing medical treatment, training grounds for health-care workers, and safe refuge for the sick, hospitals played a significant role in confronting broader racialized inequities in Canada's past.

Working with difference: Thematic concepts of Japanese nurses working in New Zealand.

PubMed

Healee, David; Inada, Kumiko

2016-03-01

The purpose of this study was to compare the differences experienced by Japanese nurses working in New Zealand from an organizational and personal perspective, using a qualitative approach. Interview data was analyzed using a thematic method to abstract increasing levels of themes until one main theme explained the data: finding a voice. This core theme demonstrated that Japanese nurses had to learn to accommodate difference while learning to speak up. Moreover, this needed to occur through a number of cultural filters. The principal conclusion was that migrant nurses face multiple personal and organizational challenges when working in a new environment. Finding a voice is the method in which nurses learn to communicate and work within new healthcare settings. Nurses use a number of filters to manage the transition. The host country needs to recognize these differences and accommodate them through orientation modules. © 2015 Wiley Publishing Asia Pty Ltd.

Clinical usefulness of library and information services in Japan: The detailed use and value of information in clinical settings.

PubMed

Sakai, Yukiko; Sato, Yoko; Sato, Masae; Watanabe, Makiko

2018-01-01

Considering that there is a lack of evidence regarding the contribution of library and information services to evidence-based medicine in actual clinical practice in Japan, the purpose of the study is to explore the current status of use and value of library and information services in clinical settings to examine the usefulness of information in implementing evidence-based medicine (EBM) into practice. A Web-based survey was conducted at seven sites (hospitals with 300-1,200 beds) and interviews conducted at five sites to investigate information behavior among health professionals (physicians, residents, and nurses) in 2016, replicating the Value Study carried out in the United States in 2010 and 2011. Using a critical incident technique, respondents answered questions about their information topics, information resources used, search location, access points, and evaluation of the information. Analysis from 598 valid responses (275 physicians, 55 residents, and 268 nurses) revealed the characteristics of information use and recognition of the value of information. Physicians and residents showed their information needs regarding clinical care using PubMed (80.4%, 65.5%), Ichushi-Web (61.8%, 63.6%), and UpToDate (40.4%, 65.5%). While physicians rely more on electronic journals (37.8%), residents use more hybrid resources including Japanese print books (38.2%) and online books (30.9% for Japanese, 32.7% for English) to confirm their knowledge. Nurses need more information close to patients and explore a wider variety of information resources such as Japanese print books (60.4%), Ichushi -Web (40.3%), Japanese online books (20.5%), and websites of academic organizations (19.0%). Although the overall recognition of the value of information was relatively modest, concrete changes in clinical practice were found in some areas. Environments with insufficient information and availability of electronic resources should be improved to increase the use of library and information services for implementing EBM.

Socialization of Japanese nursing students.

PubMed

Condon, Eileen; Sharts-Hopko, Nancy

2010-01-01

An important focus of nursing education research is the acquisition of values, behaviors, and attitudes that will influence a nurse's professional role. In this qualitative study, the process of professional socialization among Japanese nursing students was investigated. Interviews with nursing students and faculty members in Tokyo revealed that socialization of nursing students is a multidimensional process, with classroom experiences, clinical practice, and extracurricular elements all having an influence. Six themes emerged from the data: openness to others, communication, team building, reflection, extracurricular networking, and focused education. Although communication and clinical experiences are limited by cultural norms, students become socialized to the nursing profession through various other means.

Effect of preceding home-visit nursing on time to discharge in hospitalization for the treatment of behavioural and psychological symptoms of dementia among patients with limited familial care.

PubMed

Kitamura, Tatsuru; Shiota, Shigehito; Jinkawa, Shigetoshi; Kitamura, Maki; Hino, Shoryoku

2018-01-01

During hospitalization for behavioural and psychological symptoms of dementia (BPSD), it is imperative to build a support system for each patient in the community for after they obtain symptom remission. To this end, patients lacking adequate family support are less likely to be discharged to their own homes and need stronger support systems to be established. This study therefore investigated the effects of home-visit nursing before admission on time to home discharge among patients with limited familial care who were hospitalized for treatment of BPSD. A single-centre chart review study was conducted on consecutive patients admitted from home between April 2013 and September 2015 for treatment of BPSD and who had lived alone or with a working family member. Time to home discharge was compared between patients who had home-visit nursing before their admission and those who did not. In total, 58 patients were enrolled in the study, of whom 12 had preceding home-visit nursing (PHN group) and 46 did not (non-PHN group). Patients in the PHN group were younger (77.7 ± 4.9 vs. 84.1 ± 6.1 years, P = 0.0011) and had higher Mini-Mental State Examination scores (16.8 ± 7.2 vs 11.8 ± 7.3, P = 0.0287). A multivariate Cox proportional hazard regression analysis adjusted for age and Mini-Mental State Examination scores showed a higher likelihood of discharge to home in the PHN group (hazard ratio: 3.85; 95% confidence interval: 1.27-11.6;, P = 0.017) than in the non-PHN group. Home-visit nursing before admission of BPSD patients for treatment could improve the rate of discharge to home among patients with limited familial care after subsequent hospitalization. Home-visit nursing could also enhance collaborative relationships between social and hospital-based care systems, and early implementation could improve the likelihood of vulnerable patient types remaining in their own homes for as long as possible. © 2018 Japanese Psychogeriatric Society.

Maternal health care at a Japanese American relocation camp, 1942-1945: a historical study.

PubMed

McKay, S

1997-09-01

From late summer of 1942 until the fall of 1945, approximately 120,000 ethnic Japanese were confined behind barbed wire within 10 relocation camps in the United States. Although histories have been written about the relocation camps, little data are available about women's lives. This study explored women's lives and experiences with pregnancy, childbirth, and child care in a Japanese-American relocation camp. Twenty women who were ages 18 to 31 years at the time of internment at Heart Mountain, Wyoming Japanese American Relocation Camp, and one caucasian nurse who worked in the obstetric unit of the camp's hospital were interviewed. Archival, demographic, and historical data, including some prenatal records, provided information about maternity and public health care for pregnant women and new mothers. Obstetric hospital practices were typical of the 1940s in the United States. Community public health services for new mothers included formula kitchens and well-baby clinics. Infant mortality statistics from 1942 to 1945 at Heart Mountain were comparatively better for the same time period than for the state of Wyoming or the United States. These outcomes may have reflected the camp's extensive social and family support, adequate housing and food, and universal access to maternity services. The Heart Mountain internment provides a story about how women's lives are impacted by war. Since World War II, civilians, especially women and children, have increasingly been targeted during wars with profound impact upon the health of mothers and babies.

Japanese graduate nursing students' perceptions of the teaching performance of an intercultural teacher.

PubMed

Cox, Kathleen; Yamaguchi, Satomi

2010-01-01

This paper reports the results of a survey conducted to explore the perceptions of Japanese graduate nursing students about the teaching performance of an American teacher. The impact of cultural differences on classroom behavior and communication between Japanese graduate nursing students and the American teacher are also explored. Students were enrolled in a nursing education course in the first semester of the graduate program. Data for the analysis were the student opinion surveys, which included Likert scale items and space for narrative responses. Results of the survey are reported as well as the results of a follow-up meeting that was held with the students. The students emphasized the importance of the quality of the interpretation.

Relationship between maternal mindfulness and anxiety 1 month after childbirth.

PubMed

Yamamoto, Natsuki; Naruse, Takashi; Sakai, Mahiro; Nagata, Satoko

2017-10-01

To investigate the relationship between maternal mindfulness and maternal anxiety 1 month after childbirth. A cross-sectional design was used, featuring anonymous questionnaires that were completed between July and December 2014 at two Japanese hospitals. The participants (n = 151) completed the Mindful Attention Awareness Scale (Japanese version) and the State-Trait Anxiety Inventory Form X (Japanese version). The data analysis was carried out by using a hierarchical multiple regression. The state and trait anxiety scores showed significant relationships with mindfulness, the mother's age, and the perceived difference between the expectations of motherhood before childbirth and the reality of post-partum daily life. Furthermore, the amount of average sleep time in the past week (including naps) showed a negative association with the state anxiety score, whereas the marital relationship showed a positive association with trait anxiety. Finally, at 1 month post-partum, the mothers with greater mindfulness scores showed lower anxiety. Improvements in mindfulness could help mothers to reduce their post-partum anxiety. © 2016 Japan Academy of Nursing Science.

Nursing scholarship in Japan: development, facilitators, and barriers.

PubMed

Turale, Sue; Ito, Misae; Murakami, Kyoko; Nakao, Fujiko

2009-06-01

This qualitative study sought a contemporary view of the development, facilitators of, and barriers to nursing scholarship in Japan from the perspectives of the scholars. In-depth interviews were conducted with 13 scholars across Japan, which were digitally recorded, and the data were subjected to content analysis. Five themes emerged: a spirit of collectivism; a lack of nursing control; a lack of English ability; a high workload; and collaboration. The participants considered that culturally based consensus and communication behaviors, as well as the control and dominance by the medical profession, were hampering nursing scholarship. Furthermore, Japanese nurses were not in control of the profession in a period of unprecedented growth in university nursing education and a growing nursing shortage. A lack of English-speaking and English-writing abilities hindered collaboration with scholars internationally and the writing of international publications. Most of the participants felt unable to compare the extent and nature of Japanese scholarship with that of their Asian neighbors. The Japanese scholars need to grasp opportunities to learn English, collaborate with other nurses nationally and internationally, learn assertion and political skills to give them the confidence to take control of nursing education, and be more involved in research collaboration and international publications.

Patient perception of nursing service quality; an applied model of Donabedian's structure-process-outcome approach theory.

PubMed

Kobayashi, Hideyuki; Takemura, Yukie; Kanda, Katsuya

2011-09-01

Nursing is a labour-intensive field, and an extensive amount of latent information exists to aid in evaluating the quality of nursing service, with patients' experiences, the primary focus of such evaluations. To effect further improvement in nursing as well as medical care, Donabedian's structure-process-outcome approach has been applied. To classify and confirm patients' specific experiences with regard to nursing service based on Donabedian's structure-process-outcomes model for improving the quality of nursing care. Items were compiled from existing scales and assigned to structure, process or outcomes in Donabedian's model through discussion among expert nurses and pilot data collection. With regard to comfort, surroundings were classified as structure (e.g. accessibility to nurses, disturbance); with regard to patient-practitioner interaction, patient participation was classified as a process (e.g. expertise and skill, patient decision-making); and with regard to changes in patients, satisfaction was classified as an outcome (e.g. information support, overall satisfaction). Patient inquiry was carried out using the finalized questionnaire at general wards in Japanese hospitals in 2005-2006. Reliability and validity were tested using psychometric methods. Data from 1,810 patients (mean age: 59.7 years; mean length of stay: 23.7 days) were analysed. Internal consistency reliability was supported (α = 0.69-0.96), with factor analysis items of structure aggregated to one factor and overall satisfaction under outcome aggregated to one. The remaining items of outcome and process were distributed together in two factors. Inter-scale correlation (r = 0.442-0.807) supported the construct validity of each structure-process-outcome approach. All structure items were represented as negative-worded examples, as they dealt with basic conditions under Japanese universal health care system, and were regarded as representative related to concepts of dissatisfaction and no dissatisfaction. Patients' experiences with nursing service were confirmed using Donabedian's approach and can therefore be applied to improve quality of nursing practice by practitioners, managers and policy makers. © 2010 The Authors. Scandinavian Journal of Caring Sciences © 2010 Nordic College of Caring Science.

The nature of sleep in 10 bedridden elderly patients with disorders of consciousness in a Japanese hospital.

PubMed

Matsumoto, Masaru; Sugama, Junko; Nemoto, Tetsu; Kurita, Toshiharu; Matsuo, Junko; Dai, Misako; Ueta, Miyuki; Okuwa, Mayumi; Nakatani, Toshio; Tabata, Keiko; Sanada, Hiromi

2015-01-01

No previous study has satisfactorily clarified the nature of sleep in elderly bedridden people with disorders of consciousness (DOC). The objective of the present study was to clarify the sleep states of 10 elderly bedridden patients with DOC in a Japanese hospital to facilitate provision of evidence-based nursing care and appropriate adjustment of patients' environments. Nocturnal polysomnography recordings were analyzed according to the standard scoring criteria, and the patients' sleep stages and quality were investigated. Of the 10 patients, 9 showed slow wave sleep (SWS), 4 showed very high values for sleep efficiency (96-100%), and in 3 of these patients, the percentage of SWS was ≥ 20%. Furthermore, three of these four patients had 200 or more changes in sleep stage. Although the mechanism is unknown, the amount of SWS combined with the value of sleep efficiency suggests that the quality of sleep is poor in elderly bedridden patients with DOC. Further study is needed to determine better indicators of good sleep in this population. © The Author(s) 2014.

[Chronic surplus of Japanese cardiac surgeon--ideal nurse practitioner for cardiac surgery, cardiac surgeon's attitude toward the future].

PubMed

Ikegami, Hirohisa

2014-03-01

It is chronically surplus of doctors in the world of cardiac surgery. There are too many cardiac surgeons because cardiac surgery requires a large amount of manpower resources to provide adequate medical services. Many Japanese cardiac surgeons do not have enough opportunity to perform cardiac surgery operations, and many Japanese cardiac surgery residents do not have enough opportunity to learn cardiac surgery operations. There are physician assistants and nurse practitioners in the US. Because they provide a part of medical care to cardiac surgery patients, American cardiac surgeons can focus more energy on operative procedures. Introduction of cardiac surgery specialized nurse practitioner is essential to deliver a high quality medical service as well as to solve chronic problems that Japanese cardiac surgery has had for a long time.

Feasibility and clinical utility of the Japanese version of the Abbey pain scale in Japanese aged care.

PubMed

Takai, Yukari; Yamamoto-Mitani, Noriko; Chiba, Yumi; Kato, Ayako

2014-06-01

Active usage of observational pain scales in Japanese aged-care facilities has not been previously described. Therefore, to examine the feasibility and clinical utility of the Abbey Pain Scale-Japanese version (APS-J), this study examined the interrater reliability of the APS-J among a researcher, nurses, and care workers in aged-care facilities in Japan. This study also aimed to obtain nurses' and care workers' opinions on use of the scale. The following data were collected from 88 residents of two aged-care facilities: demographics, Barthel Index, Folstein Mini-Mental Examination (MMSE), 15-item Geriatric Depression Scale (GDS-15), and APS-J for pain. The researchers, nurses, and care workers independently assessed the residents' pain by using the APS-J, and intraclass correlation coefficients (ICC) for interrater reliability and Cronbach alpha for internal consistency were examined. The ICC between researchers and nurses, researchers and care workers, and nurses and care workers were 0.68, 0.74, and 0.76, respectively. Nurses and care workers were invited for focus group interviews to obtain their opinions regarding APS-J use. During these interviews, nurses and care workers stated that the observational points of APS-J subscales were the criteria they normally used to evaluate residents' pain. Several nurses and care workers reported a gap between the estimated pain intensity and APS-J score. Unclear APS-J criteria, difficulties in observing residents, and insufficient practice guidelines were also reported. Our findings indicate that the APS-J has moderate reliability and clinically utility. To facilitate APS-J usage, education and clinical guidelines for pain management may be required for nurses and care workers. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

A cross-sectional survey of policies guiding second stage labor in urban Japanese hospitals, clinics and midwifery birth centers.

PubMed

Baba, Kaori; Kataoka, Yaeko; Nakayama, Kaori; Yaju, Yukari; Horiuchi, Shigeko; Eto, Hiromi

2016-02-24

The Japan Academy of Midwifery developed and disseminated the '2012 Evidence-based Guidelines for Midwifery Care (Guidelines for Midwives)' for low-risk births to achieve a more uniform standard of care during childbirth in Japan. The objective of this study was to cross-sectional survey policy implementation regarding care during the second stage of labor at Japanese hospitals, clinics, and midwifery birth centers, and to compare those policies with the recommendations in Guidelines for Midwives. This study was conducted in the four major urbanized areas (e.g. Tokyo) of the Kanto region of Japan. Respondents were chiefs of the institutions (obstetricians/midwives), nurse administrators (including midwives) of the obstetrical departments, or other nurse/midwives who were well versed in the routine care of the targeted institutions. The Guidelines implementation questionnaire comprised 12 items. Data was collected from October 2010 to July 2011. The overall response was 255 of the 684 institutions (37%). Of the total responses 46% were hospitals, 26% were clinics and 28% were midwifery birth centers. Few institutions reported perineal massage education for 'almost all cases'. Using 'active birth' were all midwifery birth centers, 56% hospitals and 32% clinics. Few institutions used water births. The majority of hospitals (73%) and clinics (80%) but a minority (39%) of midwifery birth centers reported 'not implemented' about applying warm compress to the perineum. Few midwifery birth centers (10%) and more hospitals (38%) and clinics (50%) had a policy for valsalva as routine care. Many hospitals (90%) and clinics (88%) and fewer midwifery birth centers (54%) offered hands-on technique to provide perineal support during birth. A majority of institutions used antiseptic solution for perineal disinfection. Few institutions routinely used episiotomies for multiparas, however routine use for primiparas was slightly more in hospitals (21%) and clinics (25%). All respondents used fundal pressure as consistent with guidelines. Not many institutions implemented the hands and knees position for correcting fetal abnormal rotation. This survey has provided new information about the policies instituted in three types of institutions guiding second stage labor in four metropolitan areas of Japan. There existed considerable differences among institutions' practice. There were also many gaps between reported policies and evidence-based Guidelines for Midwives, therefore new strategies are needed in Japan to realign institution's care policies with evidenced based guidelines.

[Jeong Jongmyung, a Korean feminist and midwife of Japanese colonial period].

PubMed

Yi, Ggodme

2012-12-01

Jeong Jongmyung (1896-?) was born in Seoul and could have 4 years of formal education in a missionary girls' school. She learned Chinese writing, English, Korean, Japanese, History, Geography, and Science there, which was very rare and high education for Korean girls. But she had to quit it for poverty, and married when she was 17. Her marriage was unhappy and her husband died after 3 years. Jeong entered Severance Hospital Training School for Nurses in 1917 to have economic independence. During her training for 3 years, she studied western science and medicine and learned how to cooperate with other working girls. In 1919, Korean launched Samil Independence Movement. Jeong helped other independence activists as a nursing student and her mother had to be in prison for 3 years. After graduation, she entered the Midwifery School of General Hospital of Government General of Korea to have better position than nurse. As soon as she got midwifery license, she opened her own clinic which gave her social respect income, because there were only 25 Korean midwives in Korea. In 1922 Jeong established and became the leader of the Support Group for Working Girl Students. She continuously established and leaded social movement organizations, in 1924, the Korean Association of Nurses and the Women Comrades Society, in 1926 Jeongwoohoe, in 1927 Geunwoohoe and Shinganghoi. From 1923 Jeong got more fame by public speeches. The main contents of them were the women's problem in Korea. As the first Korean woman communist, she analyzed the Korean society and women's problem as a communist and insisted that the women's liberation movement should be gained in class struggle in cooperation with the proletariat. She was very active and aggressive in public lecture, and in everyday lives, Jeong was so warm hearted and eager to help other activists with her energy and income, so others called her their "sister, housemaid, lover, and mother". The Japanese rulers oppressed her by stopping or forbidding her lectures. In 1931 Jeong was prosecuted for the trial of reconstruction of communist party in Korea. She was sentenced to be guilty and had to be in prison until 1935. Even in prison, she helped other prisoners in labor and continued her job as a midwife after discharge. Jeong could not be active as before because of the worse ruling policy than before, but after the liberation in 1945 she went to North Korea and participated in the women's movement. The Korean Society for the History of Medicine.

Cultural factors influencing Japanese nurses' assertive communication. Part 1: Collectivism.

PubMed

Omura, Mieko; Stone, Teresa E; Levett-Jones, Tracy

2018-02-06

Culture influences the way health-care professionals communicate with each other and their ability to relate to colleagues in an assertive manner. Cultural barriers can also make it difficult for nurses to speak up even when they have concerns about patient safety. An understanding of the potential impact of cultural factors is therefore needed when developing assertiveness communication training programs. This paper presents the findings from a study that explored Japanese nurses' perceptions of how culture and values impact assertive communication in health care. Semistructured interviews with 23 registered nurses were undertaken, and data were analyzed using directed content analysis. Two major themes were identified: collectivism and hierarchy/power. In the present study, we discuss the cultural values related to collectivism that included four categories of "wa" (harmony), "uchi to soto" (inside and outside), implicit communication/ambiguity, and "nemawashi" (groundwork). The findings highlight the impact of culture on nurses' assertive communication behaviors and can be used to inform the design of culturally-appropriate assertiveness communication training programs for Japanese nurses working both within their own country or internationally. © 2018 John Wiley & Sons Australia, Ltd.

Development of the Japanese DOLOPLUS-2: a pain assessment scale for the elderly with Alzheimer's disease.

PubMed

Ando, Chiaki; Hishinuma, Michiko

2010-09-01

Pain assessment in non-communicative patients relies primarily on observation scales. The DOLOPLUS-2 is a behavioral pain assessment scale for the elderly with impaired verbal communication. It rates five somatic items, two psychomotor items, and three psychosocial items as indicators of pain. The aims of the present study were to develop a Japanese version of the DOLOPLUS-2 and to apply it to elderly patients with Alzheimer's disease (AD). The translated instrument was evaluated with reference to Japanese patients with AD experiencing pain during post-surgery rehabilitation for hip fractures and who were unable to use any self-reported pain measures. After translation and back-translation, 21 registered nurses tested 'Version 1' of the pain assessment scale on three patients. The ratings of the nurses and researcher were compared and the number of matching scores determined. Semistructured interviews were conducted with the nurses and patient case studies were recorded. The results of the interviews provided the basis for the development of 'Version 2' of the scale, which was then tested with six patients and 31 nurses using the same procedures as for the testing of Version 1. The intraclass correlation coefficient for inter-rater reliability for the Version 2 administrators was 0.90 (P < 0.001), with a 95% confidence interval of 0.88-0.92; the degree of agreement by items (0.67-0.90) was excellent. Nurses' comments for Version 1 revealed that it was 'difficult to use' and that 'some Japanese expressions and explanations needed improvement'. In contrast, the nurses' comments on Version 2 indicated that there were no problems. Analysis of patient case studies in Version 2 indicated that pain scores were high only when the patients clearly would have had pain, such as when they started with full weight bearing. On the basis of these results, we developed a final version of the Japanese DOLOPLUS-2. The findings of the present study suggest that Version 2 of the Japanese DOLOPLUS-2 can be used reliably in clinical settings to measure the pain AD patients may be experiencing. However, the final version of the Japanese DOLOPLUS-2 needs to be validated in a larger patient cohort in future studies. © 2010 The Authors. Psychogeriatrics © 2010 Japanese Psychogeriatric Society.

[The role of the "infection control nurse (ICN)" in an outbreak].

PubMed

Morishita, Sachiko

2004-01-01

The nosocomial infection and its expansion is a big problem for both customers and healthcare organizations. It is one of the most important tasks for the infection control team to prevent spreadng the hospital infection and to minimize its damage for clients and healthcare organizations. Japanese nurse association (JNA) has established the system of the certified nurses who finished authorized certification program in 15 areas including infection control in 1999. They are called "Certified Expert nurse (CEN)" and the number of CEN concerning about infection control (ICN) has reached 146 nurses in Japan in 2004. ICNs should have an ability to predict the possibility of an outbreak and to take measures to meet the situation, practically direct intervention and research for the outbreak. In this literature I have summarized the roles of ICN, introducing our experience of the scabies outbreak in our affiliated intermediate care facility for the senior citizens. It is important for ICN to research and analyze the outbreak, at the same time we have to feedback effectively to the healthcare stuffs to change their attitude and develop the system to discover the outbreak earlier by educating them.

Determinants of financial performance of home-visit nursing agencies in Japan.

PubMed

Fukui, Sakiko; Yoshiuchi, Kazuhiro; Fujita, Junko; Ikezaki, Sumie

2014-01-09

Japan has the highest aging population in the world and promotion of home health services is an urgent policy issue. As home-visit nursing plays a major role in home health services, the Japanese government began promotion of this activity in 1994. However, the scale of home-visit nursing agencies has remained small (the average numbers of nursing staff and other staff were 4.2 and 1.7, respectively, in 2011) and financial performance (profitability) is a concern in such small agencies. Additionally, the factors related to profitability in home-visit nursing agencies in Japan have not been examined multilaterally and in detail. Therefore, the purpose of the study was to examine the determinants of financial performance of home-visit nursing agencies. We performed a nationwide survey of 2,912 randomly selected home-visit nursing agencies in Japan. Multinomial logistic regression was used to clarify the determinants of profitability of the agency (profitable, stable or unprofitable) based on variables related to management of the agency (operating structure, management by a nurse manager, employment, patient utilization, quality control, regional cooperation, and financial condition). Among the selected home-visit nursing agencies, responses suitable for analysis were obtained from 1,340 (effective response rate, 46.0%). Multinomial logistic regression analysis showed that both profitability and unprofitability were related to multiple variables in management of the agency when compared to agencies with stable financial performance. These variables included the number of nursing staff/rehabilitation staff/patients, being owned by a hospital, the number of cooperative hospitals, home-death rate among terminal patients, controlling staff objectives by nurse managers, and income going to compensation. The results suggest that many variables in management of a home-visit nursing agency, including the operating structure of the agency, regional cooperation, staff employment, patient utilization, and quality control of care, have an influence in both profitable and unprofitable agencies. These findings indicate the importance of consideration of management issues in achieving stable financial performance in home-visit nursing agencies in Japan. The findings may also be useful in other countries with growing aging populations.

Determinants of financial performance of home-visit nursing agencies in Japan

PubMed Central

2014-01-01

Background Japan has the highest aging population in the world and promotion of home health services is an urgent policy issue. As home-visit nursing plays a major role in home health services, the Japanese government began promotion of this activity in 1994. However, the scale of home-visit nursing agencies has remained small (the average numbers of nursing staff and other staff were 4.2 and 1.7, respectively, in 2011) and financial performance (profitability) is a concern in such small agencies. Additionally, the factors related to profitability in home-visit nursing agencies in Japan have not been examined multilaterally and in detail. Therefore, the purpose of the study was to examine the determinants of financial performance of home-visit nursing agencies. Methods We performed a nationwide survey of 2,912 randomly selected home-visit nursing agencies in Japan. Multinomial logistic regression was used to clarify the determinants of profitability of the agency (profitable, stable or unprofitable) based on variables related to management of the agency (operating structure, management by a nurse manager, employment, patient utilization, quality control, regional cooperation, and financial condition). Results Among the selected home-visit nursing agencies, responses suitable for analysis were obtained from 1,340 (effective response rate, 46.0%). Multinomial logistic regression analysis showed that both profitability and unprofitability were related to multiple variables in management of the agency when compared to agencies with stable financial performance. These variables included the number of nursing staff/rehabilitation staff/patients, being owned by a hospital, the number of cooperative hospitals, home-death rate among terminal patients, controlling staff objectives by nurse managers, and income going to compensation. Conclusions The results suggest that many variables in management of a home-visit nursing agency, including the operating structure of the agency, regional cooperation, staff employment, patient utilization, and quality control of care, have an influence in both profitable and unprofitable agencies. These findings indicate the importance of consideration of management issues in achieving stable financial performance in home-visit nursing agencies in Japan. The findings may also be useful in other countries with growing aging populations. PMID:24400964

Relationships of job demand, job control, and social support on intention to leave and depressive symptoms in Japanese nurses.

PubMed

Saijo, Yasuaki; Yoshioka, Eiji; Kawanishi, Yasuyuki; Nakagi, Yoshihiko; Itoh, Toshihiro; Yoshida, Takahiko

2016-01-01

This study aims to elucidate the relationships among the factors of the demand-control-support model (DCS) on the intention to leave a hospital job and depressive symptoms. Participants included 1,063 nurses. Job demand, job control, and support from supervisors were found to be significantly related to both the intention to leave and depressive symptoms. Based on the odds ratios per 1 SD change in the DCS factors, low support from supervisors was found to be most related to the intention to leave, and low job control was found to be most related to depressive symptoms. In models that did not include "job demand" as an independent variable, 60-h working weeks were found to have a significantly higher odds ratio for depressive symptoms. Support from supervisors is more important in preventing intention to leave and depressive symptoms among nurses than is support from co-workers. Improving job control and avoiding long working hours may be important to prevent depressive symptoms.

Relationship between work-family conflict and a sense of coherence among Japanese registered nurses.

PubMed

Takeuchi, Tomoko; Yamazaki, Yoshihiko

2010-12-01

Work-family conflict (WFC) refers to the conflict that arises between a person's work and family life. Previous studies have reported workload, job demands, and irregular working shifts as related to the WFC among nurses and have clarified that WFC is a predictor of job satisfaction, morale, and turnover intention. Very few studies have investigated WFC among Japanese nurses and no study has taken into consideration the sense of coherence (SOC) that helps nurses to cope with stress. The present study aimed to determine the relationship between WFC and SOC and to clarify how WFC and a SOC influence the mental and physical health of nurses in order to suggest ways of establishing work environments that enable nurses to achieve a balance between their work and family life. A self-report questionnaire survey of 388 Japanese female nurses was conducted. The data from 138 nurses who were a mother and/or wife were analyzed. Work-family conflict was significantly related to the SOC. It had a larger impact on the physical and mental health of nurses than their work and family characteristics. The SOC also had a major influence on the physical and mental health of nurses, while having a buffering effect on WFC with respect to depression. Our findings underscore the importance of taking organizational steps to create work environments that contribute to an enhanced SOC in order to reduce the WFC among nurses. © 2010 The Authors. Japan Journal of Nursing Science © 2010 Japan Academy of Nursing Science.

Introducing the Professionalism Mini-Evaluation Exercise (P-MEX) in Japan: results from a multicenter, cross-sectional study.

PubMed

Tsugawa, Yusuke; Ohbu, Sadayoshi; Cruess, Richard; Cruess, Sylvia; Okubo, Tomoya; Takahashi, Osamu; Tokuda, Yasuharu; Heist, Brian S; Bito, Seiji; Itoh, Toshiyuki; Aoki, Akiko; Chiba, Tsutomu; Fukui, Tsuguya

2011-08-01

Despite the growing importance of and interest in medical professionalism, there is no standardized tool for its measurement. The authors sought to verify the validity, reliability, and generalizability of the Professionalism Mini-Evaluation Exercise (P-MEX), a previously developed and tested tool, in the context of Japanese hospitals. A multicenter, cross-sectional evaluation study was performed to investigate the validity, reliability, and generalizability of the P-MEX in seven Japanese hospitals. In 2009-2010, 378 evaluators (attending physicians, nurses, peers, and junior residents) completed 360-degree assessments of 165 residents and fellows using the P-MEX. The content validity and criterion-related validity were examined, and the construct validity of the P-MEX was investigated by performing confirmatory factor analysis through a structural equation model. The reliability was tested using generalizability analysis. The contents of the P-MEX achieved good acceptance in a preliminary working group, and the poststudy survey revealed that 302 (79.9%) evaluators rated the P-MEX items as appropriate, indicating good content validity. The correlation coefficient between P-MEX scores and external criteria was 0.78 (P < .001), demonstrating good criterion-related validity. Confirmatory factor analysis verified high path coefficient (0.60-0.99) and adequate goodness of fit of the model. The generalizability analysis yielded a high dependability coefficient, suggesting good reliability, except when evaluators were peers or junior residents. Findings show evidence of adequate validity, reliability, and generalizability of the P-MEX in Japanese hospital settings. The P-MEX is the only evaluation tool for medical professionalism verified in both a Western and East Asian cultural context.

[Building Process and Architectural Planning Characteristics of Daehan Hospital Main Building].

PubMed

Lee, Geauchul

2016-04-01

This paper explores the introduction process of Daehan Hospital from Japan as the modern medical facility in Korea, and the architectural planning characteristics as a medical facility through the detailed building process of Daehan Hospital main building. The most noticeable characteristic of Daehan Hospital is that it was designed and constructed not by Korean engineers but by Japanese engineers. Therefore, Daehan Hospital was influenced by Japanese early modern medical facility, and Japanese engineers modeled Daehan Hospital main building on Tokyo Medical School main building which was constructed in 1876 as the first national medical school and hospital. The architectural type of Tokyo Medical School main building was a typical school architecture in early Japanese modern period which had a middle corridor and a pseudo Western-style tower, but Tokyo Medical School main building became the model of a medical facility as the symbol of the medical department in Tokyo Imperial University. This was the introduction and transplantation process of Japanese modern 'model' like as other modern systems and technologies during the Korean modern transition period. However, unlike Tokyo Medical School main building, Daehan Hospital main building was constructed not as a wooden building but as a masonry building. Comparing with the function of Daehan Hospital main building, its architectural form and construction costs was excessive scale, which was because Japanese Resident-General of Korea had the intention of ostentation that Japanese modernity was superior to Korean Empire.

The Case of the Suzhou Hospital of National Medicine (1939-41): War, Medicine, and Eastern Civilization.

PubMed

Daidoji, Keiko; Karchmer, Eric I

2017-06-01

This article explores the founding of the Suzhou Hospital of National Medicine in 1939 during the Japanese occupation of Suzhou. We argue that the hospital was the culmination of a period of rich intellectual exchange between traditional Chinese and Japanese physicians in the early twentieth century and provides important insights into the modern development of medicine in both countries. The founding of this hospital was followed closely by leading Japanese Kampo physicians. As the Japanese empire expanded into East Asia, they hoped that they could revitalize their profession at home by disseminating their unique interpretations of the famous Treatise on Cold Damage abroad. The Chinese doctors that founded the Suzhou Hospital of National Medicine were close readers of Japanese scholarship on the Treatise and were inspired to experiment with a Japanese approach to diagnosis, based on new interpretations of the concept of "presentation" ( shō / zheng ). Unfortunately, the Sino-Japanese War cut short this fascinating dialogue on reforming medicine and set the traditional medicine professions in both countries on new nationalist trajectories.

The Case of the Suzhou Hospital of National Medicine (1939–41): War, Medicine, and Eastern Civilization

PubMed Central

Daidoji, Keiko; Karchmer, Eric I.

2017-01-01

This article explores the founding of the Suzhou Hospital of National Medicine in 1939 during the Japanese occupation of Suzhou. We argue that the hospital was the culmination of a period of rich intellectual exchange between traditional Chinese and Japanese physicians in the early twentieth century and provides important insights into the modern development of medicine in both countries. The founding of this hospital was followed closely by leading Japanese Kampo physicians. As the Japanese empire expanded into East Asia, they hoped that they could revitalize their profession at home by disseminating their unique interpretations of the famous Treatise on Cold Damage 傷寒論 abroad. The Chinese doctors that founded the Suzhou Hospital of National Medicine were close readers of Japanese scholarship on the Treatise and were inspired to experiment with a Japanese approach to diagnosis, based on new interpretations of the concept of “presentation” (shō / zheng 證). Unfortunately, the Sino-Japanese War cut short this fascinating dialogue on reforming medicine and set the traditional medicine professions in both countries on new nationalist trajectories. PMID:29104703

No communicable diseases this month: public health nursing at the Colorado River Relocation Center, 1942-1945.

PubMed

Coffin, Rebecca A

2014-01-01

In the name of public safety, the US government forcibly removed more than 110 000 Japanese Americans from their homes along the West Coast of the United States during World War II. Incarcerated in crude barracks located in remote locations, Japanese Americans were suddenly required to share laundry facilities, toilets, showers, and mess halls with hundreds of likewise incarcerated Japanese Americans. With conditions ripe for spreading communicable disease, public health nurses relied on health promotion techniques of the time to prevent epidemic outbreaks of diseases such as measles, polio, and tuberculosis.

Issues in healthcare services in Malaysia as experienced by Japanese retirees.

PubMed

Kohno, Ayako; Musa, Ghazali; Nik Farid, Nik Daliana; Abdul Aziz, Norlaili; Nakayama, Takeo; Dahlui, Maznah

2016-05-05

Worldwide, international retirement migration is growing in its popularity and Japanese retirees choose Malaysia as their most preferred destination. This study examines the pertinent issues related to healthcare services as experienced by Japanese retirees in this country. From January to March 2015, we conducted focus group discussions with 30 Japanese retirees who live in Kuala Lumpur and Ipoh. Guided by the social-ecological model, we discovered seven pertinent themes: 'language barriers','healthcare decisions', 'medical check-ups','healthcare insurance', 'nursing and palliative care', 'trust and distrust of healthcare services', and 'word-of-mouth information'. We identified seven pertinent issues related to healthcare services among Japanese retirees in Malaysia, of which four are especially important. These issues are explained as integrated themes within the social-ecological model. Language barriers prohibit them from having difficulty accessing to healthcare in Malaysia, but lack of will to improve their language skills exist among them. For that reason, they rely heavily on word-of-mouth information when seeking for healthcare. As a consequence, some develop feelings of trust and distrust of healthcare services. In addition, we have identified the needs for provide nursing and palliative care among Japanese retirees in Malaysia. Based on the magnitude of the discussion, we concluded that there are four crucial healthcare issues among Japanese retirees; 'language barriers', 'trust and distrust of healthcare services', 'word-of-mouth information' and 'nursing and palliative care'. We propose that further dialogue by healthcare stakeholders should be carried out to improve further the healthcare service provisions for Japanese retirees in Malaysia.

Differences in job stress experienced by female and male Japanese psychiatric nurses.

PubMed

Yada, Hironori; Abe, Hiroshi; Omori, Hisamitsu; Matsuo, Hisae; Masaki, Otsubo; Ishida, Yasushi; Katoh, Takahiko

2014-10-01

In psychiatric nursing, female nurses tend to spend more time building rapport with patients and developing cooperative working relationships with colleagues; they encounter more sexual harassment by patients. In contrast, male nurses respond to aggressive patients and tend to resist physically caring for female patients; they encounter more physical and verbal assault from patients. These gender differences might result in differences in job-related stress. We quantitatively examined gender differences in psychiatric nurses' job stress. The Psychiatric Nurse Job Stressor Scale and the Stress Reaction Scale of the Brief Job Stress Questionnaire were administered to 159 female and 85 male Japanese psychiatric nurses. The results indicated that female nurses had significantly higher stress levels than males related to psychiatric nursing ability, attitude towards nursing, and stress reactions of fatigue and anxiety. Moreover, the factors affecting stress reactions differed somewhat between sexes. In particular, male nurses reported that greater irritability was affected by patients' attitudes. Their anxiety and somatic symptoms were affected by their attitude towards nursing, and depressed mood was affected by psychiatric nursing ability. Knowledge of these differences can lead to better mental health-care interventions for psychiatric nurses. © 2014 Australian College of Mental Health Nurses Inc.

Generational differences in factors influencing job turnover among Japanese nurses: an exploratory comparative design.

PubMed

Takase, Miyuki; Oba, Keiko; Yamashita, Noriko

2009-07-01

Although nurse turnover is a serious problem, the fact that each nurse has different work-related needs/values, and leaves their job for different reasons makes it difficult for organisations to develop effective countermeasures against it. Understanding nurses' needs and the reasons for job turnover by the generation in which they were born may provide some feasible solutions. The purpose of the study was to identify specific work-related needs and values of nurses in three generations (born in 1946-1959, 1960-1974, 1975-present). The study also aimed to explore generation-specific reasons that might make nurses consider leaving the jobs. The study was conducted in three public hospitals in Japan. A convenience sample of 315 registered nurses participated in the study. A survey method was used to collect quantitative and qualitative data. Quantitative data were analysed by ANOVA, and qualitative data were analysed by content analysis. Nurses born between 1960 and 1974 embraced high needs and values in professional privileges such as autonomy and recognition, while those born after 1975 expressed low needs and values in the opportunities for clinical challenge. For nurses born between 1960 and 1974, the imbalance between their jobs and personal life made them consider leaving their jobs. For those born after 1975, losing the confidence to care made them consider turning over. Nurses born after 1960 tended to value economic return and job security more highly compared to those born between 1946 and 1959. Nurses in different generations have different sets of needs/values and reasons for job turnover. Understanding generation-specific needs and values of nurses may enable organisations and Nurse Managers to develop feasible and effective countermeasures to reduce nurse turnover.

Associations of menopausal symptoms with job-related stress factors in nurses in Japan.

PubMed

Matsuzaki, Kazuyo; Uemura, Hirokazu; Yasui, Toshiyuki

2014-09-01

The main objective was to ascertain the typical menopausal symptoms and job-related stress factors in Japanese nurses during the menopausal transition, and the associations of menopausal symptoms with job-related stress. A supplementary objective was to determine whether there were any differences in menopausal symptoms and job-related stress factors among nurses in managerial positions. One thousand seven hundred female registered nurses aged 45-60 years who were working in hospitals in Japan were asked to complete a self-administered survey that included Greene's Climacteric Scale and the Brief Job Stress Questionnaire. The proportions of nurses who reported feelings of tiredness, irritability and difficulty in concentration were higher than the proportions with other menopausal symptoms. The proportions of nurses reporting feeling unhappy or depressed and having crying spells were higher among nurses in managerial positions than among other nurses. Stresses related to 'quantitative overload' on the Brief Job Stress Questionnaire among nurses in managerial positions were significantly greater than among nurses not in managerial positions, while stresses related to 'physical overload', 'job control', 'skill discretion', 'workplace environment' and 'job satisfaction' among nurses not in managerial positions were significantly greater than they were among nurses in managerial positions. Psychological symptoms were significantly correlated with poor job-related interpersonal relationships. Health care practitioners should be aware that menopausal symptoms are associated with job-related stress during the menopausal transition. Information on the differences in these associations between nurses in managerial positions and other nurses is important as it will allow their health care to be managed on a more individual basis. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Maternal subjective well-being and preventive health care system in Japan and Finland.

PubMed

Yokoyama, Yoshie; Hakulinen, Tuovi; Sugimoto, Masako; Silventoinen, Karri; Kalland, Mirjam

2017-12-19

Maternal well-being is an important issue not only for mothers but also for their offspring and whole families. This study aims to clarify differences in subjective well-being for mothers with infants and associated factors by comparing Japanese and Finnish mothers. In Finland, 101 mothers with infants who received health check-ups at child's age 4 months participated in the study. In Japan, 505 mothers with infants who should receive health check-ups at child's age 4 months and, whose age, age of the infant and number of children matched with the Finnish mothers were selected. The factors associated with maternal subjective well-being were explored by the linear regression analysis. All Finnish mothers had individual infant health check-ups by nurses in Child Health Clinics nearly monthly. The same nurse was responsible for following up the family throughout the years. All Japanese participants received group health check-up once at child's age 3 to 4 months, and a nurse did not cover same child and their mother. Finnish mothers showed significantly better subjective well-being compared with Japanese mothers. Whereas 85% of Finnish mothers responded that they had obtained childcare information from public health nurses, significantly fewer Japanese mothers indicated the same response (8%). Linear regression analyses disclosed that mothers' subjective well-being was associated with country, mothers' stress and age. Finnish mothers had better subjective well-being than Japanese mothers. Our results may indicate that the Finnish health care system supports mothers better than the Japanese health care system does. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Prospective open-label randomized comparative, non-inferiority study of two initial antibiotic strategies for patients with nursing- and healthcare-associated pneumonia: Guideline-concordant therapy versus empiric therapy.

PubMed

Matsuda, Shuichi; Ogasawara, Takashi; Sugimoto, Shunsuke; Kato, Shinpei; Umezawa, Hiroki; Yano, Toshiaki; Kasamatsu, Norio

2016-06-01

The nursing- and healthcare-associated pneumonia guideline, proposed by the Japan Respiratory Society, recommends that patients at risk of exposure to drug-resistant pathogens, classified as treatment category C, be treated with antipseudomonal antibiotics. This study aimed to prove the non-inferiority of empirical therapy in our hospital compared with guideline-concordant therapy. This was a randomized controlled trial conducted from December 2011 to December 2012. Patients were randomized to the Guideline group receiving guideline-concordant therapy, and the Empiric group treated with sulbactam/ampicillin or ceftriaxone. The primary endpoint was in-hospital relapse of pneumonia and mortality within 30 days, with a predefined non-inferiority margin of 10%. The secondary endpoints included duration, adverse effects, and cost of antibiotic therapy. One hundred and eleven patients were assigned to the Guideline group (n = 55) and the Empiric group (n = 56; 3 of which were excluded). The incidence of relapse and death within 30 days was similar in the Guideline and the Empiric groups (31% vs. 26%, risk difference -4.5%, 95% CI -21.5% to 12.5%). While the duration of antibiotic therapy was slightly shorter in the Guideline group than in the Empiric group (7 vs. 8 days), there were no significant differences in adverse effects or cost. The efficacy of empiric therapy was comparable to guideline-concordant therapy, although non-inferiority was not proven. The administration of broad-spectrum antibiotics to patients at risk of exposure to drug-resistant pathogens may not necessarily improve the prognosis. UMIN000006792. Copyright © 2016 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Japanese nursing students' sense of belonging: A story of Uchi (insider) and Soto (outsider).

PubMed

Honda, Kazuma; Levett-Jones, Tracy; Stone, Teresa; Maguire, Jane

2016-09-01

Clinical placement experiences are the cornerstone of nursing education and a body of literature indicates that belongingness is fundamental to students' learning when undertaking placements. However, little is known about Japanese nursing students' sense of belonging and how it is influenced by their cultural values. The aim of this paper is to profile a study that: measured the extent to which Japanese nursing students' experience a sense of belonging in clinical placements, and explored the factors that impact on and are consequences of that experience. A mixed methods design was used with quantitative data collected using the Belongingness Scale-Clinical Placement Experience and qualitative data collected using semi-structured interviews. Ninety-two third and fourth year students from a large regional university in Japan completed the questionnaire; of these six also participated in interviews. The results identified similarities and differences between this and other studies of belongingness. Supportive and welcoming clinical environments facilitated participants' belongingness and motivation to learn. However, the belongingness scores of this sample were lower than those in all other studies. This may be explained, in part, by the Japanese cultural values of "Uchi (insider) and Soto" (outsider), which pervaded the participants' placement experiences and led to feelings of exclusion and alienation. Copyright © 2016 Elsevier Ltd. All rights reserved.

Characteristics of and interventions for fever in Japan.

PubMed

Ikematsu, Y

2004-12-01

As part of a larger multinational validation study of the International Classification for Nursing Practice (ICNP) alpha version, a survey was conducted in Japan to determine characteristics of 'fever' and interventions to treat febrile patients. Three hundred and fifty-six acute and critical care Japanese nurses participated in this study. The major and minor characteristics of 'fever' perceived by Japanese nurses and interventions used by the nurses in managing febrile patients were identified using the Diagnostic Content Validity (DCV) model. Two characteristics, 'increased body temperature' and 'chills' were selected as major characteristics from the standardized list of the ICNP alpha version validation study. Nine characteristics among the standardized list of characteristics were rated as minor characteristics, and six of the ICNP characteristics were rejected. 'Shivering' and 'infectious lab data' were added with a level of representativeness similar to a major characteristic by nine of the nurses. A variety of interventions to treat fever were reported. The most frequently reported intervention was cooling, followed by warming and medication. Nine dimensions were derived from all reported interventions. As well as perceived characteristics of fever, these interventions may have aspects unique to Japanese nursing practice and to the acute and critical care settings. These results can be compared to those of other populations in future studies.

[The Red Cross System for War Relief during the Second World War and Actual Conditions of Its Efforts in Burma].

PubMed

Kawahara, Yukari

2015-12-01

This paper aims to show the system for relief provided by the Japanese Red Cross relief units during the Second World War, as well as the actual activities of sixteen of its relief units dispatched to Burma. The Red Cross wartime relief efforts involved using personnel and funding prepared beforehand to provide aid to those injured in war, regardless of their status as ally or enemy. Thus they were able to receive support from the army in order to ensure safety and provide supplies. Nurses dispatched to Burma took care of many patients who suffered from malnutrition and physical injuries amidst the outbreak of infectious diseases typical of tropical areas, without sufficient replacement members. Base hospitals not meant for the front lines also came under attack, and the nurses' lives were thus in mortal danger. Of the 374 original members, 29 died or went missing in action.

Pediatric Cancer Patients' Important End-of-Life Issues, Including Quality of Life: A Survey of Pediatric Oncologists and Nurses in Japan.

PubMed

Nagoya, Yuko; Miyashita, Mitsunori; Shiwaku, Hitoshi

2017-05-01

Research into the key themes and concepts of quality of life (QOL) relevant to the end-of-life (EOL) care of pediatric cancer patients in the Japanese context is imperative. This study aimed at identifying the key items and constructive concepts of QOL at EOL of pediatric cancer patients. In 2015, pediatricians and nurses were recruited from 163 pediatric oncology treatment facilities in Japan. The questionnaire was developed on the basis of a previous qualitative study. Items that were rated as "very important" or "important" by at least 80% of the respondents were considered as "common and important" QOL items. Exploratory factor analysis was performed to conceptualize QOL of the pediatric cancer patients during EOL care. A total of 157 pediatricians and 270 nurses participated in this study. Fifty-five items were refined to 35 "common and important" QOL items. On factor analysis, 12 domains (containing 29 items) were identified: playing and learning; fulfilling wishes; spending time with family; receiving relief from physical and psychological suffering; making many wonderful memories; having a good relationship with the medical staff; having a peaceful death in the presence of family; spending time with a minimum of medical treatment; living one's life as usual; spending time in a calm hospital environment; being oneself; and having a close family. Although the respondents in this study were medical care providers rather than the patients or their family members, findings should help medical staff provide better palliative care to Japanese pediatric cancer patients.

Predictors of depressive symptoms in older Japanese primiparas at 1 month post-partum: A risk-stratified analysis.

PubMed

Iwata, Hiroko; Mori, Emi; Tsuchiya, Miyako; Sakajo, Akiko; Maehara, Kunie; Ozawa, Harumi; Morita, Akiko; Maekawa, Tomoko; Aoki, Kyoko; Tamakoshi, Koji

2016-01-01

Older maternal age has become more common in Japan. Studies suggest that older maternal age and primiparity are associated with post-partum depression. The present study aimed to identify predictors of post-partum depression in older Japanese primiparas at 1 month post-partum. Participants were 479 primiparas aged 35 years and over, drawn from a prospective cohort study. Data were collected using self-report questionnaires. Depression was measured with the Japanese version of the Edinburgh Postnatal Depression Scale. Stepwise logistic regression analysis was conducted on binary outcome variables of depression at 1 month post-partum, along with a stratified analysis based on the risk status of depression. Five predictors were identified: (i) the depression score during hospital stay; (ii) financial burden; (iii) dissatisfaction with appraisal support; (iv) physical burden in daily life; and (v) concerns about infant caretaking. Stratified analysis identified dissatisfaction with instrumental support in the low-risk group, and the Child-care Value Scale score as unique predictors in the high-risk group. These results highlight the importance of early assessment of depressive symptoms and the provision of continuous care. © 2015 Japan Academy of Nursing Science.

A multi-method study on the quality of the nurse work environment in acute-care hospitals: positioning Switzerland in the Magnet hospital research.

PubMed

Desmedt, M; De Geest, S; Schubert, M; Schwendimann, R; Ausserhofer, D

2012-12-21

Magnet hospitals share nurse work environment characteristics associated with superior patient, nurse and financial outcomes. In Switzerland, however, it is uncertain how nurses appraise their work environments. To describe the quality of the nurse work environment in 35 Swiss acute care hospitals and to benchmark findings based on international Magnet hospital research. This study used two data sources: (1) the Swiss arm of the RN4CAST study; and (2) a structured literature review. Hospitals were categorised based on Magnet and non-Magnet data. Our outcome variable of interest was the quality of nurse work environment measured with the Practice Environment Scale of the Nurse Work Index (PES-NWI). We reviewed 13 American, Canadian, and Australian studies of acute-care hospitals. Three provided Magnet hospitals' nurse work environment data, and all included non-Magnet hospitals' data. Swiss hospitals' evaluations on nurse work environment quality varied widely, but 25% achieved scores indicating "Magnet nurse work environments". Swiss hospitals' average "Nursing manager ability" subscale scores fulfilled Magnet hospital criteria, although "Nurse participation in hospital affairs" and "Nursing staffing and resource adequacy" scores neared non-Magnet levels. On average, our results indicated high quality nurse work environments in Swiss hospitals. Implementing Magnet model organisational principles might be a valuable approach for Swiss acute-care hospitals to both improve mixed and unfavourable nurse work environments and to improve nurse and patient outcomes. National benchmarking of nurse work environments and other nurse-sensitive indicators may facilitate evaluating the impact of current developments in Swiss healthcare.

Relationships of job demand, job control, and social support on intention to leave and depressive symptoms in Japanese nurses

PubMed Central

SAIJO, Yasuaki; YOSHIOKA, Eiji; KAWANISHI, Yasuyuki; NAKAGI, Yoshihiko; ITOH, Toshihiro; YOSHIDA, Takahiko

2015-01-01

This study aims to elucidate the relationships among the factors of the demand-control-support model (DCS) on the intention to leave a hospital job and depressive symptoms. Participants included 1,063 nurses. Job demand, job control, and support from supervisors were found to be significantly related to both the intention to leave and depressive symptoms. Based on the odds ratios per 1 SD change in the DCS factors, low support from supervisors was found to be most related to the intention to leave, and low job control was found to be most related to depressive symptoms. In models that did not include “job demand” as an independent variable, 60-h working weeks were found to have a significantly higher odds ratio for depressive symptoms. Support from supervisors is more important in preventing intention to leave and depressive symptoms among nurses than is support from co-workers. Improving job control and avoiding long working hours may be important to prevent depressive symptoms. PMID:26320733

Measuring hospital-wide activity volume for patient safety and infection control: a multi-centre study in Japan.

PubMed

Hayashida, Kenshi; Imanaka, Yuichi; Fukuda, Haruhisa

2007-09-03

In Japan, as in many other countries, several quality and safety assurance measures have been implemented since the 1990's. This has occurred in spite of cost containment efforts. Although government and hospital decision-makers demand comprehensive analysis of these activities at the hospital-wide level, there have been few studies that actually quantify them. Therefore, the aims of this study were to measure hospital-wide activities for patient safety and infection control through a systematic framework, and to identify the incremental volume of these activities implemented over the last five years. Using the conceptual framework of incremental activity corresponding to incremental cost, we defined the scope of patient safety and infection control activities. We then drafted a questionnaire to analyze these realms. After implementing the questionnaire, we conducted several in-person interviews with managers and other staff in charge of patient safety and infection control in seven acute care teaching hospitals in Japan. At most hospitals, nurses and clerical employees acted as the main figures in patient safety practices. The annual amount of activity ranged from 14,557 to 72,996 person-hours (per 100 beds: 6,240; per 100 staff: 3,323) across participant hospitals. Pharmacists performed more incremental activities than their proportional share. With respect to infection control activities, the annual volume ranged from 3,015 to 12,196 person-hours (per 100 beds: 1,141; per 100 staff: 613). For infection control, medical doctors and nurses tended to perform somewhat more of the duties relative to their share. We developed a systematic framework to quantify hospital-wide activities for patient safety and infection control. We also assessed the incremental volume of these activities in Japanese hospitals under the reimbursement containment policy. Government and hospital decision makers can benefit from this type of analytic framework and its empirical findings.

"Byoin" in Modern Japan: Focusing on the Terminological Introduction of "Hospital" and the Complex Formation of Its Concept.

PubMed

Kim, Youngsoo

2017-04-01

This paper aims to clarify when the term of Byoin (hospital) was introduced and how its concept was developed in modern Japan. The word "Byoin" was introduced in Japan in 1787 for the first time, but it had not been in use until early 1860s. Instead, various medical institutions performing the functions of modern medical facilities, such as Yojosho (A place for preserving health), Shijuku (private school), called by traditional names as ever. Japanese intellectuals already adopted the word Byoin and the concept of western hospital in early 1860s when their national delegates were dispatched to Europe to revise the treaties forged with western powers. Japanese translations of hospital appeared in English-Japanese/Japanese-English dictionaries published in the 1860s. For instance, the word Byoin (hospital in Japanese) was first published in a dictionary published in 1867 and unclearly connected to the words, hospital, infirmary. This paper will argue that the concept of Byoin was sophisticated through Meiji government's efforts to implement reforms distinguishing medical facilities based on their capacity of inpatients and quality. The first medical law (Isei) proclaimed by the Meiji government in 1874 articulated regulations for a hospital in eight different articles. The government established hospitals in various parts of the country, following its newly established modern medical care policies. However, in this process, Iin (hospital/clinic), another term for "hospital" appeared. Regional differences and financial issues made standardizing the concept of a hospital even more difficult. In response to the widely embedded confusion, the Japanese government made an effort to clarify the concept of a hospital, setting up provisions regarding the size of medical facilities. As a result, the word Byoin finally came to be used for a hospital with more than ten beds, while a clinic with beds below ten was called Shinryojo (clinic). On the other hand, Iin meant a medical facility less qualified than a hospital since 1933 when Japanese government made a harder restriction on the usage of Byoin.

Factors related to the burnout of Japanese female nurses with children under 3 years old.

PubMed

Takayama, Yuko; Suzuki, Eiko; Kobiyama, Atsuko; Maruyama, Akiko; Sera, Yoshiko

2017-07-01

Burnout is a common feature among healthcare professionals; however, little systematic research exists on burnout among nurses who are raising children. The burnout-related factors among female nurses with children under the age of 3 years were identified in order to ascertain potential burnout prevention methods. In total, 1681 nurses with children who worked at nine city hospitals in Kanagawa Prefecture, Japan, were sent the Maslach Burnout Inventory-Human Services Survey; 1173 nurses responded in June 2014. They were divided according to their sex and children's ages. A data analysis was undertaken for those female nurses with children who were aged under 3 years who provided valid responses (n = 158). A number of factors related to burnout in female nurses with children aged under 3 years was found via a multiple regression analysis: irritation at being unable to attend to their own affairs, over 4-6 h of overtime work per week, having a child aged under 3 years as the first or second child, little sense of work fulfillment, using a childcare facility outside the workplace, dissatisfaction with their salary, feeling ill-qualified as a parent, and a sense of inadequate support. Child care occurs during a limited period and appropriate support is needed. A workplace environment with no overtime work, a childcare facility in the workplace, and mental health support to reduce "feelings of irritation" and "feeling ill-qualified as a parent" could help to prevent burnout in female nurses with toddlers and infants. © 2016 Japan Academy of Nursing Science.

Cultural factors influencing Japanese nurses' assertive communication: Part 2 - hierarchy and power.

PubMed

Omura, Mieko; Stone, Teresa E; Levett-Jones, Tracy

2018-03-23

Hierarchy and power characterize health-care relationships around the world, constituting a barrier to assertive communication and a risk to patient safety. This issue is more problematic and complex in countries such as Japan, where deep-seated cultural values related to hierarchy and power persist. The current paper is the second of two that present the findings from a study exploring Japanese nurses' views and experiences of how cultural values impact assertive communication for health-care professionals. We conducted semistructured interviews with 23 registered nurses, following which data were analyzed using directed content analysis. Two overarching themes emerged from the analysis: hierarchy/power and collectivism. In the present study, we focus on cultural values related to hierarchy and power, including differences in professional status, gender imbalance, seniority/generation gap, bullying, and humility/modesty. The findings from our research provide meaningful insights into how Japanese cultural values influence and constrain nurses' communication and speaking up behaviors, and can be used to inform educational programs designed to teach assertiveness skills. © 2018 John Wiley & Sons Australia, Ltd.

The relationship between social skills and early resignation in Japanese novice nurses.

PubMed

Niitsuma, Mayuko; Katsuki, Takeshi; Sakuma, Yumiko; Sato, Chifumi

2012-07-01

The aim of this study was to reveal the relationship between social skills and early resignation in Japanese novice nurses. The early resignation of novice nurses has become increasingly prevalent in recent years. This study was conducted to investigate the relationship between the personal sociality of novice nurses and their early resignation. We surveyed 272 nurses with 1-3 years of experience. Instances of early resignation were studied by using a questionnaire, and their social skills were measured using Kikuchi's Scale of Social Skills:18 items (KiSS-18), a tool developed by Kikuchi to estimate sociality. Nurses with low sociality were more likely to resign than those with higher sociality. The lack of advanced social skills was closely associated with a higher likelihood of early resignation. The presence of advanced social skills appeared to potentially prevent resignation among novice nurses. Further investigation is needed to determine the causal relationship between sociality and early resignation. Social skills training for novice nurses may be of benefit in preventing early resignation. © 2011 Blackwell Publishing Ltd.

A purposeful Yet Nonimposing Approach: How Japanese Home Care Nurses Establish Relationships With Older Clients and Their Families.

PubMed

Iwasaki, Takako; Yamamoto-Mitani, Noriko; Sato, Kana; Yumoto, Yoshie; Noguchi-Watanabe, Maiko; Ogata, Yasuko

2017-11-01

Relationship development is crucial to nursing practice with families. However, little is known about the process of building relationships with multiple family members in home care settings and in various cultures. The objective of this study was to explore the experiences of home care nurses about how they established relationships with older clients and their families in Japan. Grounded theory was used to guide the research. Twenty-three expert home care nurses participated in semistructured interviews concerning their family nursing practice. The establishment of relationships with clients/family members was based on a purposeful yet nonimposing approach composed of four aspects: keeping a mindful distance from the family, not being a threat to family life, being a comfortable neighbor, and gaining trust as a competent nurse. Through a purposeful nonimposing approach, Japanese home care nurses promoted and nurtured nurse-family relationships and became involved in the life of the family. These findings provide a useful foundation to guide practice with families and grow knowledge about the process of establishing relationships with multiple family members in home settings.

[Analysis of financial statements of Japanese private hospitals (1982-1991)].

PubMed

Matsuda, S; Murata, H

1996-06-01

In order to clarify the financial situation of Japanese private hospitals, the financial statements provided by the Social Welfare and Medical Service Corporation were analyzed for the period from 1982 to 1991. The results clarified the low growth rate and low profitability of the Japanese private hospitals, although their financial situation was relatively stable. However, the efficiency of cost has been stalled in recent years and profitability has been declining due to the low turnover rate of capital. According to the CVP analysis, the Profit volume ratio of the investigated hospitals has been increased to the level of 95%. This situation means that, in the current financial situation, more than half of the Japanese private hospitals will go into the red if revenue declines 5% due to some short term change in the managerial environment.

Japanese hospitals--culture and competition: a study of ten hospitals.

PubMed

Anbäcken, O

1994-01-01

Japanese health care is characterized by a pluralistic system with a high degree of private producers. Central government regulates the prices and the financing system. All citizens are covered by a mandatory employment-based health insurance operating on a non-profit basis. The consumer has a free choice of physician and hospital. A comparison between Japan, Sweden and some other countries shows significant dissimilarities in the length of stay, number of treatments per hospital bed and year and the staffing of hospitals. About 80 per cent of the hospitals and 94 per cent of the clinics are privately owned. The typical private hospital owned by a physician has less than 100 beds. In this paper, data collected (1992/93) in an empirical study of Japanese hospitals and their leadership is presented. Also discussed are the hospitals' style of management, tools and strategies for competition and competences--personal and formal skills required of the leadership in the hospital. There follows a study of ten hospitals, among which hospital directors and chief physicians were interviewed. Interviews are also made with key persons in the Ministry of Health and Welfare and other organizations in the health care field. The result is also analysed from a cultural perspective--'what kind of impact does the Japanese culture have on the health care organization?' and/or 'what kind of sub-culture is developed in the Japanese hospitals'. Some comparisons are made with Sweden, USA, Canada and Germany. The different roles of the professions in the hospital are included in the study as well as the incentives for different kinds of strategies--specialization, growing in size, investments in new equipment, different kind of ownership and hospitals. Another issue discussed is the attempt to uncover whether there is an implicit distribution of specialties--silent agreements between hospitals, etc.

Bumping into Someone: Japanese Students' Perceptions and Observations

ERIC Educational Resources Information Center

Lieske, Carmella

2010-01-01

This pilot study explores the apologies Japanese nursing college students thought they would use in their L1 (i.e. Japanese) and their L2 (i.e. English) when bumping into each other. The students completed a questionnaire, the results of which indicated that they believed they should always apologize for bumping into someone. The paper describes…

Applying RUG-III in Japanese Long-Term Care Facilities.

ERIC Educational Resources Information Center

Ikegami, Naoki; And Others

1994-01-01

Tested U.S. nursing home case-mix system, Resource Utilization Groups, Version III (RUG-III) in Japanese long-term care facilities. Measured staff time and resident characteristics for 871 patients. Found acceptable reliability for items defining RUG-III, and system explained 44% of variance in wage-weighted staff time (cost). Japanese and U.S.…

Presence of nursing information on hospital websites in five countries: a review.

PubMed

Chen, L L; Liu, Y L

2010-06-01

The aims of this study were to (1) examine the presence of nursing information on 50 hospital websites across five countries; (2) describe the accessibility, range and depth of nursing information provided; and (3) compare the characteristics of nursing web information across the countries. Providing information on hospital website is an increasingly popular strategy for marketing hospital services, and it has been playing unique and important roles for nursing. So far, the nursing information offered via hospital websites is not uncommon worldwide, but the amount, content and form of such information presented by the institutions of different countries have not been examined systematically. Objective sampling was employed to select 50 top hospital websites from five countries, with ten for each geographical region, namely, Australia (Oceania), China (Asia), South Africa (Africa), UK (Europe) and the USA (North America). A self-developed checklist was used to examine the presence of nursing information on the above-mentioned hospital websites. The most frequently presented information on the hospital websites was nursing employment (job placement), nursing education, and news and events concerning the nursing profession, but information about other aspects of nursing was relatively lacking. The hospital websites in the USA and Australia provided more information as compared with those in China and the UK. Nursing information was almost unavailable on hospital websites in South Africa. Although the accessibility of nursing-related information has been improved, the presence of nursing information was not strong on the hospital websites across the five countries. The nursing information presented on hospital websites varied with different countries. Efforts have to be made to improve the presence and accessibility of nursing information. Information about the nursing services, professional image of nurses and nursing employment should be enhanced.

The effect of nursing professional pay structures and pay levels on hospitals' heart attack outcomes.

PubMed

Brown, Mark P

2006-01-01

The effect of nursing professionals (i.e., nurse aid/orderly, licensed practical nurse, registered nurse) pay structures and pay levels on hospitals risk-adjusted heart attack outcomes was determined. Operationalizing hospitals' heart attack outcomes as their thirty-day risk-adjusted mortality rates, a positive curvilinear relation is hypothesized between pay dispersion and hospitals' heart attack outcomes, whereas a direct relation is hypothesized between pay level and hospitals' heart attack outcomes. Pay level is also hypothesized as a moderator of the relation between pay dispersion and hospitals' heart attack outcomes. Using a sample of 138 California hospitals, support is not found for either the curvilinear relation between hospitals' nursing professionals pay dispersion and hospitals' heart attack outcomes, or the direct relation between nursing professionals' pay level and hospitals' heart attack outcomes. Support is found for the moderation hypothesis in which nursing professionals' pay level moderates the relation between hospitals' nursing professionals pay dispersion and hospitals' heart attack outcomes. Implications for practice are discussed in light of the study's results.

The Magnet Nursing Services Recognition Program

PubMed Central

Aiken, Linda H.; Havens, Donna S.; Sloane, Douglas M.

2015-01-01

OVERVIEW In an environment rife with controversy about patient safety in hospitals, medical error rates, and nursing shortages, consumers need to know how good the care is at their local hospitals. Nursing’s best kept secret is the single most effective mechanism for providing that type of comparative information to consumers, a seal of approval for quality nursing care: designation of magnet hospital status by the American Nurses Credentialing Center (ANCC). Magnet designation, or recognition of the “best” hospitals, was conceived in the early 1980s when the American Academy of Nursing (AAN) conducted a study to identify which hospitals attracted and retained nurses and which organizational features were shared by these successful hospitals, referred to as magnet hospitals. In the 1990s, the American Nurses Association (ANA), through the ANCC, established a formal program to acknowledge excellence in nursing services: the Magnet Nursing Services Recognition Program. The purpose of the current study is to examine whether hospitals selected for recognition by the ANCC application process—ANCC-accredited hospitals—are as successful in creating environments in which excellent nursing care is provided as the original AAN magnet hospitals were. We found that at ANCC-recognized magnet hospitals nurses had lower burnout rates and higher levels of job satisfaction and gave the quality of care provided at their hospitals higher ratings than did nurses at the AAN magnet hospitals. Our findings validate the ability of the Magnet Nursing Services Recognition Program to successfully identify hospitals that provide high-quality nursing care. PMID:19641439

The Effects of Nurse Staffing and Nurse Education on Patient Deaths in Hospitals With Different Nurse Work Environments

PubMed Central

Aiken, Linda H.; Cimiotti, Jeannie P.; Sloane, Douglas M.; Smith, Herbert L.; Flynn, Linda; Neff, Donna F.

2011-01-01

Context Better hospital nurse staffing, more educated nurses, and improved nurse work environments have been shown to be associated with lower hospital mortality. Little is known about whether and under what conditions each type of investment works better to improve outcomes. Objective To determine the conditions under which the impact of hospital nurse staffing, nurse education, and work environment are associated with patient outcomes. Design, Setting, and Participants Outcomes of 665 hospitals in four large states were studied through linked data from hospital discharge abstracts for 1,262,120 general, orthopedic, and vascular surgery patients, a random sample of 39,038 hospital staff nurses, and American Hospital Association data. Main outcome measures 30-day inpatient mortality and failure-to-rescue. Results The effect of decreasing workloads by one patient/nurse on deaths and failure-to-rescue is virtually nil in hospitals with poor work environments, but decreases the odds on both deaths and failures in hospitals with average environments by 4%, and in hospitals with the best environments by 9 and 10% respectively. The effect of 10% more BSN nurses decreases the odds on both outcomes in all hospitals, regardless of their work environment, by roughly 4%. Conclusions While the positive effect of increasing percentages of BSN nurses is consistent across all hospitals, lowering the patient-to-nurse ratios markedly improves patient outcomes in hospitals with good work environments, slightly improves them in hospitals with average environments, and has no effect in hospitals with poor environments. PMID:21945978

Charting the future of hospital nursing.

PubMed

Aiken, L H

1990-01-01

Nursing roles are expanding in all health care settings; however, the majority of nurses will continue to practice in hospitals for the foreseeable future. Yet hospital nursing is experiencing great ferment and turmoil. Nurses are dissatisfied increasingly with hospital practice, and vacancy and turnover rates are high enough to raise major concerns about adverse consequences for patients. This paper focuses on the nature and causes of the current problems in hospital nursing and advances recommendations for charting a new course for hospital nursing.

Potential predictors of susceptibility to occupational stress in Japanese novice nurses - a pilot study.

PubMed

Okita, Shinobu; Daitoku, Satoshi; Abe, Masaharu; Arimura, Emi; Setoyama, Hitoshi; Koriyama, Chihaya; Ushikai, Miharu; Kawaguchi, Hiroaki; Horiuchi, Masahisa

2017-04-04

Occupational stress is a known factor behind employee resignations; thus, early identification of individuals prone to such stress is important. Accordingly, in this pilot study we evaluated potential predictors of susceptibility to occupational stress in Japanese novice nurses. Forty-two female novice nurses at Kagoshima University Hospital were recruited for the study population. Each underwent physical health and urinary examinations, and completed a lifestyle questionnaire at the time of job entry. Each also completed a Brief Job Stress Questionnaire (BJSQ), related to mental health status, at job entry and 5 months post-entry. Psychological stress, somatic symptoms, and combined BJSQ scores were determined for each time point. All three stress condition scores had significantly decreased at 5 months post-entry, suggesting occupational stress. Systolic blood pressure (r = -0.324, p < 0.05) and urinary sodium (r = -0.313, p < 0.05) were significantly negatively correlated with combined BJSQ score at 5 months post-entry. Post-entry stress condition scores were significantly low in subjects reporting substantial 1-year body weight change (≤ ± 3 kg) and short times between dinner and bedtimes (≤2 h), though baseline stress condition scores were not. Urinary sodium concentration, 1-year body weight change, and pre-sleep evening meals were then targeted for multivariate analysis, and confirmed as independent explanatory variables for post-entry stress condition scores. One-year body weight change, times between dinner and bedtimes, and urinary sodium concentration are promising potential predictors of susceptibility to occupational stress, and should be further investigated in future research. ISRCTN ISRCTN17516023. Retrospectively registered 7 December 2016.

Utilization of non-US educated nurses in US hospitals: implications for hospital mortality

PubMed Central

Neff, Donna Felber; Cimiotti, Jeannie; Sloane, Douglas M.; Aiken, Linda H.

2013-01-01

Objectives To determine whether, and under what circumstance, US hospital employment of non-US-educated nurses is associated with patient outcomes. Design Observational study of primary data from 2006 to 2007 surveys of hospital nurses in four states (California, Florida, New Jersey and Pennsylvania). The direct and interacting effects of hospital nurse staffing and the percentage of non-US-educated nurses on 30-day surgical patient mortality and failure-to-rescue were estimated before and after controlling for patient and hospital characteristics. Participants Data from registered nurse respondents practicing in 665 hospitals were pooled with patient discharge data from state agencies. Main Outcomes Measure(s) Thirty-day surgical patient mortality and failure-to-rescue. Results The effect of non-US-educated nurses on both mortality and failure-to-rescue is nil in hospitals with lower than average patient to nurse ratios, but pronounced in hospitals with average and poor nurse to patient ratios. In hospitals in which patient-to-nurse ratios are 5:1 or higher, mortality is higher when 25% or more nurses are educated outside of the USA than when <25% of nurses are non-US-educated. Moreover, the effect of having >25% non-US-educated nurses becomes increasingly deleterious as patient-to-nurse ratios increase beyond 5:1. Conclusions Employing non-US-educated nurses has a negative impact on patient mortality except where patient-to-nurse ratios are lower than average. Thus, US hospitals should give priority to achieving adequate nurse staffing levels, and be wary of hiring large percentages of non-US-educated nurses unless patient-to-nurse ratios are low. PMID:23736834

Effect on mental health of a participatory intervention to improve psychosocial work environment: a cluster randomized controlled trial among nurses.

PubMed

Uchiyama, Ayako; Odagiri, Yuko; Ohya, Yumiko; Takamiya, Tomoko; Inoue, Shigeru; Shimomitsu, Teruichi

2013-01-01

Improvement of psychosocial work environment has proved to be valuable for workers' mental health. However, limited evidence is available for the effectiveness of participatory interventions. The purpose of this study was to investigate the effect on mental health among nurses of a participatory intervention to improve the psychosocial work environment. A cluster randomized controlled trial was conducted in hospital settings. A total of 434 nurses in 24 units were randomly allocated to 11 intervention units (n=183) and 13 control units (n=218). A participatory program was provided to the intervention units for 6 months. Depressive symptoms as mental health status and psychosocial work environment, assessed by the Job Content Questionnaire, the Effort-Reward Imbalance Questionnaire, and the Quality Work Competence questionnaire, were measured before and immediately after the 6-month intervention by a self-administered questionnaire. No significant intervention effect was observed for mental health status. However, significant intervention effects were observed in psychosocial work environment aspects, such as Coworker Support (p<0.01) and Goals (p<0.01), and borderline significance was observed for Job Control (p<0.10). It is suggested that a 6-month participatory intervention is effective in improving psychosocial work environment, but not mental health, among Japanese nurses.

Implementation of nursing process in clinical settings: the case of three governmental hospitals in Ethiopia, 2017.

PubMed

Semachew, Ayele

2018-03-13

The purpose of this survey was to evaluate the implementation of the nursing process at three randomly selected governmental hospitals found in Amhara Region North West Ethiopia. From the total 338 reviewed documents, 264 (78.1%) have a nursing process format attached with the patient's profile/file, 107 (31.7%) had no nursing diagnosis, 185 (54.7%) of nurses stated their plan of care based on priority, 173 (51.2%) of nurses did not document their interventions based on plan and 179 (53.0%) of nurses did not evaluate their interventions. The overall implementation of nursing process among Felege Hiwot Referal hospital, Debretabor general hospital and Finoteselam general hospitals were 49.12, 68.18, and 69.42% respectively. Nursing professionals shall improve documentation required in implementing the nursing process. Nursing managers (matron, ward heads) shall supervise the overall implementation of nursing process. Hospital nursing services managers (matrons) shall arrange and facilitate case presentations by the nursing staffs which focus on documentation and updates on nursing process. Hospitals need to establish and support nursing process coordinating staff in their institution.

[A proposal to improve nursing fee differentiation policy for general hospitals using profitability-analysis in the national health insurance].

PubMed

Kim, Sungjae; Kim, Jinhyun

2012-06-01

The purpose of this study was to propose optimal hospitalization fees for nurse staffing levels and to improve the current nursing fee policy. A break-even analysis was used to evaluate the impact of a nursing fee policy on hospital's financial performance. Variables considered included the number of beds, bed occupancy rate, annual total patient days, hospitalization fees for nurse staffing levels, the initial annual nurses' salary, and the ratio of overhead costs to nursing labor costs. Data were collected as secondary data from annual reports of the Hospital Nursing Association and national health insurance. The hospitalization fees according to nurse staffing levels in general hospitals are required to sustain or decrease in grades 1, 2, 3, 4, and 7, and increase in grades 5 and 6. It is suggested that the range between grade 2 and 3 be sustained at the current level, the range between grade 4 and 5 be widen or merged into one, and the range between grade 6 and 7 be divided into several grades. Readjusting hospitalization fees for nurse staffing level will improve nurse-patient ratio and enhance the quality of nursing care in hospitals. Follow-up studies including tertiary hospitals and small hospitals are recommended.

Bilateral effects of hospital patient-safety procedures on nurses' job satisfaction.

PubMed

Inoue, T; Karima, R; Harada, K

2017-09-01

The aim of this study was to examine how hospital patient-safety procedures affect the job satisfaction of hospital nurses. Additionally, we investigated the association between perceived autonomy and hospital patient-safety procedures and job satisfaction. Recently, measures for patient safety have been recognized as an essential requirement in hospitals. Hospital patient-safety procedures may enhance the job satisfaction of nurses by improving the quality of their work. However, such procedures may also decrease their job satisfaction by imposing excessive stress on nurses because they cannot make mistakes. The participants included 537 nurses at 10 private hospitals in Japan (The surveys were collected from March to July 2012). Factors related to hospital patient-safety procedures were demonstrated using factor analysis, and the associations between these factors and nurses' self-perceived autonomy and job satisfaction were examined using structural equation modelling. Five factors regarding hospital patient-safety procedures were extracted. Additionally, structural equation modelling revealed statistically significant associations between these factors and the nurses' self-perceived autonomy and job satisfaction. The findings showed that nurses' perceived autonomy of the workplace enhanced their job satisfaction and that their perceptions of hospital patient-safety procedures promoted their job satisfaction. However, some styles of chief nurses' leadership regarding patient safety restrict nurses' independent and autonomous decision-making and actions, resulting in a lowering of job satisfaction. This study demonstrated that hospital patient-safety procedures have ambiguous effects on nurses' job satisfaction. In particular, chief nurses' leadership relating to patient safety can have a positive or negative effect on nurses' job satisfaction. The findings indicated that hospital managers should demonstrate positive attitudes to improve patient safety for nurses' job satisfaction. In addition, policymakers in the hospitals should consider that chief nurses' leadership styles may reduce autonomy and suppress nurses' job satisfaction. © 2017 The Authors International Nursing Review published by John Wiley & Sons Ltd on behalf of International Council of Nurses.

Strengthening hospital nursing.

PubMed

Buerhaus, Peter I; Needleman, Jack; Mattke, Soeren; Stewart, Maureen

2002-01-01

Hospitals, nurses, the media, Congress, and the private sector are increasingly concerned about shortages of registered nurses (RNs) and the impact on safety and quality of patient care. Findings from a growing number of studies provide evidence of a relationship between hospital nurse staffing and adverse outcomes experienced by medical and surgical patients. These findings have policy implications for strengthening the nursing profession, monitoring the quality of hospital care associated with nursing, and improving the relationship between hospitals and the nursing profession.

Job stressors and job stress among teachers engaged in nursing activity.

PubMed

Muto, Shigeki; Muto, Takashi; Seo, Akihiko; Yoshida, Tsutomu; Taoda, Kazushi; Watanabe, Misuzu

2007-01-01

Teachers and staff members engaged in nursing activity experience more stress than other workers. However, it is unknown whether teachers engaged in nursing activity in schools for handicapped children experience even greater stress. This study evaluated job stressors and job stress among such teachers using a cross-sectional study design. The subjects were all 1,461 teachers from all 19 prefectural schools for handicapped children in Shizuoka Prefecture, Japan. We used a brief job stress questionnaire for the survey and 831 teachers completed the questionnaire. Job stressors among teachers engaged in nursing activity were compared with those among teachers not engaged in nursing activity. Job stress among such teachers was estimated by the score for total health risk, and was compared with the score in the Japanese general population. Male and female teachers engaged in nursing activity had a significantly higher level of job stressors for physical work load and job control compared with those not engaged in nursing activity. The scores for total health risk among male and female teachers engaged in nursing activity were 102 points and 98 points, respectively. These scores were not markedly above 100 points which is the mean score in the Japanese general population.

Career trajectories of nurses leaving the hospital sector in Ontario, Canada (1993-2004).

PubMed

Alameddine, Mohamad; Baumann, Andrea; Laporte, Audrey; O'Brien-Pallas, Linda; Levinton, Carey; Onate, Kanecy; Deber, Raisa

2009-05-01

This paper is a report of an analysis of the career trajectories of nurses 1 year after leaving hospitals. Although hospitals are traditionally the largest employers of nurses, technological advances and budgetary constraints have resulted in many countries in relative shrinkage of the hospital sector and a shift of care (and jobs) into home/community settings. It has been often assumed that nurses displaced from hospitals will move to work in the other workplaces, especially the community sector. Employment patterns were tracked by examining a longitudinal database of all 201,463 nurses registered with the College of Nurses Ontario (Canada) between 1993 and 2004. Focusing on the employment categories Active (Working in nursing), Eligible-Seeking nursing employment or Dropout from the nursing labour market, year-to-year transition matrixes were generated by sector and sub-sector of employment, nurse type, age group and work status. For every nurse practising nursing in any non-hospital job or in the community a year after leaving hospitals, an average of 1.3 and four nurses, respectively, dropped out of Ontario's labour market. The proportion of nurses leaving hospitals transitioning to the Dropout category ranged from 63.3% (1994-95) to 38.6% (2001-02). The proportion dropping out of Ontario's market was higher for Registered Practical Nurses (compared to Registered Nurses), increased with age and decreased with degree of casualization in nurses' jobs. Downsizing hospitals without attention to the potentially negative impact on the nursing workforce can lead to retention difficulties and adversely affects the overall supply of nurses.

The Maternity Care Nurse Workforce in Rural U.S. Hospitals.

PubMed

Henning-Smith, Carrie; Almanza, Jennifer; Kozhimannil, Katy B

To describe the maternity care nurse staffing in rural U.S. hospitals and identify key challenges and opportunities in maintaining an adequate nursing workforce. Cross-sectional survey study. Maternity care units within rural hospitals in nine U.S. states. Maternity care unit managers. We calculated descriptive statistics to characterize the rural maternity care nursing workforce by hospital birth volume and nursing staff model. We used simple content analysis to analyze responses to open-ended questions and identified themes related to challenges and opportunities for maternity care nursing in rural hospitals. Of the 263 hospitals, 51% were low volume (<300 annual births) and 49% were high volume (≥300 annual births). Among low-volume hospitals, 78% used a shared nurse staff model. In contrast, 31% of high-volume hospitals used a shared nurse staff model. Respondents praised the teamwork, dedication, and skill of their maternity care nurses. They did, however, identify significant challenges related to recruiting nurses, maintaining adequate staffing during times of census variability, orienting and training nurses, and retaining experienced nurses. Rural maternity care unit managers recognize the importance of nursing and have varied staffing needs. Policy implementation and programmatic support to ameliorate challenges may help ensure that an adequate nursing staff can be maintained, even in small-volume rural hospitals. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

Nurses' perceptions of leadership style in hospitals: a grounded theory study.

PubMed

Su, Shu-Fen; Jenkins, Mary; Liu, Po-Erh

2012-01-01

This paper explores the leadership style of hospital managers. Leadership has been widely studied in nursing from the perspective of nurses' psychological strain caused by nursing leadership. There is, however, little contained in the Western and Eastern literatures on the leadership style of hospital managers and certainly no study has explored managers' leadership style in Taiwanese hospitals from the nurses' stance. Grounded theory. A sample of 28 nurses from seven teaching hospitals in Taiwan, Republic of China was selected through theoretical sampling. A multi-step analytic procedure based on the grounded theory approach was used to analyse the qualitative data. The Chinese culture was found to affect the leadership style of Taiwanese hospital managers. They had extreme power and led nurses in a hierarchical manner. Nurse managers followed the autocratic leadership style of their hospital managers. The main category found in this study was thus hierarchical leadership. The Confucian principles of authoritarianism and obedience were found to be part of the Taiwanese hospitals' organisational cultures and strongly impacted on the managers' leadership style. Hospital managers' treatment of doctors and nurses was dependent on their social rankings. Nurses' lowly ranking fed into these enculturated managerial tendencies of using power and obedience thus increasing psychological strain on nurses. Managers of the hospitals demonstrate power and misuse obedience through their leadership style, resulting in deterioration of nurses' work environment. Nurses' managers are not given enough power by the hospitals in Taiwan. Subsequently, nurses feel themselves the lowest and most powerless subordinates. This study reveals that the Chinese cultural burdens are embedded in the leadership of Taiwanese hospitals. These findings enhance the knowledge of leadership and add to the understanding of managerial attitudes in Chinese hospitals located worldwide. © 2011 Blackwell Publishing Ltd.

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

The nurse work environment, job satisfaction and turnover rates in rural and urban nursing units.

PubMed

Baernholdt, Marianne; Mark, Barbara A

2009-12-01

The aim of the present study was to determine whether there are differences in hospital characteristics, nursing unit characteristics, the nurse work environment, job satisfaction and turnover rates in rural and urban nursing units. Research in urban hospitals has found an association between the nurse work environment and job satisfaction and turnover rates, but this association has not been examined in rural hospitals. Rural and urban nursing units were compared in a national random sample of 97 United States hospitals (194 nursing units) with between 99 and 450 beds. Significant differences were found between hospital and nursing unit characteristics and the nurse work environment in rural and urban nursing units. Both nursing unit characteristics and the work environment were found to have a significant influence on nurse job satisfaction and turnover rates. Job satisfaction and turnover rates in rural and urban nursing units are associated with both nursing unit characteristics and the work environment. Both rural and urban hospitals can improve nurse job satisfaction and turnover rates by changing unit characteristics, such as creating better support services and a work environment that supports autonomous nursing practice. Rural hospitals can also improve the work environment by providing nurses with more educational opportunities.

Job control, work-family balance and nurses' intention to leave their profession and organization: A comparative cross-sectional survey.

PubMed

Yamaguchi, Yoshiko; Inoue, Takahiro; Harada, Hiroko; Oike, Miyako

2016-12-01

The shortage of nurses is a problem in many countries. In Japan, the distribution of nurses across different care settings is uneven: the shortage of nurses in home healthcare and nursing homes is more serious than in hospitals. Earlier research has identified numerous factors affecting nurses' intention to leave work (e.g., job control, family-related variables, work-family conflict); however, these factors' levels and effect size may vary between nurses in hospitals, home healthcare, and nursing homes. This study measured job control, family-related variables, and work-family conflict among nurses in hospitals, home healthcare, and nursing homes, and compared these variables' levels and effect size on nurses' intention to leave their organization or profession between these care settings. The research design was cross-sectional. Participating nurses from hospitals, home healthcare facilities, and nursing homes self-administered an anonymous questionnaire survey; nurses were recruited from the Kyushu district of Japan. Nurses from nine hospitals, 86 home healthcare offices, and 107 nursing homes participated. We measured nurses' intention to leave nursing or their organization, perceived job control, family variables and work-family conflict. We analyzed 1461 participants (response rate: 81.7%). The level of job control, family variables, and work-family conflict affecting nurses varied between hospitals, home healthcare, and nursing homes; additionally, these variables' effect on nurses' intention to leave their organization or profession varied between these care settings. Work-family conflict, family variables, and job control most strongly predicted nurses' intention to leave their organization or profession in hospitals, home healthcare, and nursing homes, respectively. Interventions aiming to increase nurse retention should distinguish between care settings. Regarding hospitals, reducing nurses' work-family conflict will increase nurse retention. Regarding home healthcare, allowing nurses to fulfill family responsibilities will increase nurse retention. Regarding nursing home nurses, increasing nurses' job control will increase nurse retention. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Individual and organizational factors related to work engagement among home-visiting nurses in Japan.

PubMed

Naruse, Takashi; Sakai, Mahiro; Watai, Izumi; Taguchi, Atsuko; Kuwahara, Yuki; Nagata, Satoko; Murashima, Sachiyo

2013-12-01

The increasing number of elderly people has caused increased demand for home-visiting nurses. Nursing managers should develop healthy workplaces in order to grow their workforce. This study investigated the work engagement of home-visiting nurses as an index of workplace health. The aim of the present study was to reveal factors contributing to work engagement among Japanese home-visiting nurses. An anonymous, self-administered questionnaire was sent to 208 home-visiting nurses from 28 nursing agencies in three districts; 177 (85.1%) returned the questionnaires. The Job Demands-Resources model, which explains the relationship between work environment and employee well-being, was used as a conceptual guide. The authors employed three survey instruments: (i) questions on individual variables; (ii) questions on organizational variables; and (iii) the Utrecht Work Engagement Scale (Japanese version). Multiple regression analyses were performed in order to examine the relationships between individual variables, organizational variables, and work engagement. Nurse managers and nurses who felt that there was a positive relationship between work and family had significantly higher work engagement levels than others. The support of a supervisor was significantly associated with work engagement. Nurses in middle-sized but not large agencies had significantly higher work engagement than nurses in small agencies. Supervisor support and an appropriate number of people reporting to each supervisor are important factors in fostering work engagement among home-visiting nurses. © 2013 The Authors. Japan Journal of Nursing Science © 2013 Japan Academy of Nursing Science.

The effects of nurse staffing on hospital financial performance: competitive versus less competitive markets.

PubMed

Everhart, Damian; Neff, Donna; Al-Amin, Mona; Nogle, June; Weech-Maldonado, Robert

2013-01-01

Hospitals facing financial uncertainty have sought to reduce nurse staffing as a way to increase profitability. However, nurse staffing has been found to be important in terms of quality of patient care and nursing-related outcomes. Nurse staffing can provide a competitive advantage to hospitals and as a result of better financial performance, particularly in more competitive markets. In this study, we build on the Resource-Based View of the Firm to determine the effect of nurse staffing on total profit margin in more competitive and less competitive hospital markets in Florida. By combining a Florida statewide nursing survey with the American Hospital Association Annual Survey and the Area Resource File, three separate multivariate linear regression models were conducted to determine the effect of nurse staffing on financial performance while accounting for market competitiveness. The analysis was limited to acute care hospitals. Nurse staffing levels had a positive association with financial performance (β = 3.3, p = .02) in competitive hospital markets, but no significant association was found in less competitive hospital markets. Hospitals in more competitive hospital markets should reconsider reducing nursing staff, as these cost-cutting measures may be inefficient and negatively affect financial performance.

Effective strategies for nurse retention in acute hospitals: a mixed method study.

PubMed

Van den Heede, Koen; Florquin, Mieke; Bruyneel, Luk; Aiken, Linda; Diya, Luwis; Lesaffre, Emmanuel; Sermeus, Walter

2013-02-01

The realization of an organizational context that succeeds to retain nurses within their job is one of the most effective strategies of dealing with nursing shortages. First, to examine the impact of nursing practice environments, nurse staffing and nurse education on nurse reported intention to leave the hospital. Second, to provide understanding of which best practices in the organization of nursing care are being implemented to provide sound practice environments and to retain nurses. 3186 bedside nurses of 272 randomly selected nursing units in 56 Belgian acute hospitals were surveyed. A GEE logistic regression analysis was used to estimate the impact of organization of nursing care on nurse reported intention to leave controlling for differences in region (Walloon, Flanders, and Brussels), hospital characteristics (technology level, teaching status, and size) and nurse characteristics (experience, gender, and age). For the second objective, in-depth semi-structured interviews with the chief nursing officers of the three high and three low performing hospitals on reported intention to leave were held. 29.5% of Belgian nurses have an intention-to-leave the hospital. Patient-to-nurse staffing ratios and nurse work environments are significantly (p<0.05) associated with intention-to-leave. Interviews with Chief Nurse Officers revealed that high performing hospitals showing low nurse retention were--in contrast to the low performing hospitals--characterized by a flat organization structure with a participative management style, structured education programs and career opportunities for nurses. This study, together with the international body of evidence, suggests that investing in improved nursing work environments is a key strategy to retain nurses. Copyright © 2011 Elsevier Ltd. All rights reserved.

The Difficulty of Selecting the NANDA-I Nursing Diagnosis (2015-2017) of "Death Anxiety" in Japan.

PubMed

Shimomai, Kimiyo; Furukawa, Hidetoshi; Kuroda, Yuko; Fukuda, Kazuaki; Masuda, Mitsumi; Koizumi, Junko

2018-01-01

The purpose of our study was to clarify any difficulties or problems that exist in Japanese healthcare sites regarding the selection of death anxiety as a nursing diagnosis. This study was a qualitative, inductive research design. The semistructured interviews were conducted on the participants who were nurses and had 3 or more years of clinical experience in Japan. Results showed four categories: "The Japanese have a culture of avoiding death," "It is extremely difficult to match diagnostic indicators and related factors with specific patient cases," "Other diagnoses exist that are effective and enable proactive intervention," and "The definition of death anxiety and the meaning of its diagnostic indicators are unintelligible." It is thought that nursing diagnoses that reflect specific cultural backgrounds require definitions appropriate to each country and appropriate revisions to diagnostic indicators. © 2016 NANDA International, Inc.

Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care.

PubMed

Aiken, Linda H; Sloane, Douglas; Griffiths, Peter; Rafferty, Anne Marie; Bruyneel, Luk; McHugh, Matthew; Maier, Claudia B; Moreno-Casbas, Teresa; Ball, Jane E; Ausserhofer, Dietmar; Sermeus, Walter

2017-07-01

To determine the association of hospital nursing skill mix with patient mortality, patient ratings of their care and indicators of quality of care. Cross-sectional patient discharge data, hospital characteristics and nurse and patient survey data were merged and analysed using generalised estimating equations (GEE) and logistic regression models. Adult acute care hospitals in Belgium, England, Finland, Ireland, Spain and Switzerland. Survey data were collected from 13 077 nurses in 243 hospitals, and 18 828 patients in 182 of the same hospitals in the six countries. Discharge data were obtained for 275 519 surgical patients in 188 of these hospitals. Patient mortality, patient ratings of care, care quality, patient safety, adverse events and nurse burnout and job dissatisfaction. Richer nurse skill mix (eg, every 10-point increase in the percentage of professional nurses among all nursing personnel) was associated with lower odds of mortality (OR=0.89), lower odds of low hospital ratings from patients (OR=0.90) and lower odds of reports of poor quality (OR=0.89), poor safety grades (OR=0.85) and other poor outcomes (0.80

Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care

PubMed Central

Aiken, Linda H; Rafferty, Anne Marie; Bruyneel, Luk; McHugh, Matthew; Maier, Claudia B; Moreno-Casbas, Teresa; Ball, Jane E; Ausserhofer, Dietmar; Sermeus, Walter

2017-01-01

Objectives To determine the association of hospital nursing skill mix with patient mortality, patient ratings of their care and indicators of quality of care. Design Cross-sectional patient discharge data, hospital characteristics and nurse and patient survey data were merged and analysed using generalised estimating equations (GEE) and logistic regression models. Setting Adult acute care hospitals in Belgium, England, Finland, Ireland, Spain and Switzerland. Participants Survey data were collected from 13 077 nurses in 243 hospitals, and 18 828 patients in 182 of the same hospitals in the six countries. Discharge data were obtained for 275 519 surgical patients in 188 of these hospitals. Main outcome measures Patient mortality, patient ratings of care, care quality, patient safety, adverse events and nurse burnout and job dissatisfaction. Results Richer nurse skill mix (eg, every 10-point increase in the percentage of professional nurses among all nursing personnel) was associated with lower odds of mortality (OR=0.89), lower odds of low hospital ratings from patients (OR=0.90) and lower odds of reports of poor quality (OR=0.89), poor safety grades (OR=0.85) and other poor outcomes (0.80

The indirect costs of agency nurses in South Africa: a case study in two public sector hospitals.

PubMed

Rispel, Laetitia C; Moorman, Julia

2015-01-01

Globally, flexible work arrangements - through the use of temporary nursing staff - are an important strategy for dealing with nursing shortages in hospitals. The objective of the study was to determine the direct and indirect costs of agency nurses, as well as the advantages and the problems associated with agency nurse utilisation in two public sector hospitals in South Africa. Following ethical approval, two South African public sector hospitals were selected purposively. Direct costs were determined through an analysis of hospital expenditure information for a 5-year period from 2005 until 2010, obtained from the national transversal Basic Accounting System database. At each hospital, semi-structured interviews were conducted with the chief executive officer, executive nursing services manager, the maternity or critical care unit nursing manager, the human resource manager, and the finance manager. Indirect costs measured were the time spent on pre-employment checks, and nurse recruitment, orientation, and supervision. All expenditure is expressed in South African Rands (R: 1 USD=R7, 2010 prices). In the 2009/10 financial year, Hospital 1 spent R38.86 million (US$5.55 million) on nursing agencies, whereas Hospital 2 spent R10.40 million (US$1.49 million). The total estimated time spent per week on indirect cost activities at Hospital 1 was 51.5 hours, and 60 hours at Hospital 2. The estimated monetary value of this time at Hospital 1 was R962,267 (US$137,467) and at Hospital 2 the value was R300,121 (US$42,874), thus exceeding the weekly direct costs of nursing agencies. Agency nurses assisted the selected hospitals in dealing with problems of nurse recruitment, absenteeism, shortages, and skills gaps in specialised clinical areas. The problems experienced with agency nurses included their perceived lack of commitment, unreliability, and providing sub-optimal quality of patient care. Hospital managers and policy-makers need to address the effective utilisation of agency nurses and quality of patient care in tandem.

Factors influencing the use of registered nurse overtime in hospitals, 1995-2000.

PubMed

Berney, Barbara; Needleman, Jack; Kovner, Christine

2005-01-01

To assess nurse overtime in acute care general hospitals and the factors that influence overtime among various hospitals and in the same hospitals from year to year. Staffing data from 1995 to 2000 from 193 acute general hospitals in New York State were used to examine hospital characteristics (size, location, RN unionization, hospital ownership, and teaching status) to determine whether they were associated with nurse overtime. The average weekly overtime RNs worked was 4.5% of total hours, varying from almost none to 16.6%. At mean overtime levels, nurses were working less overtime than the mean for manufacturing workers, but, at the extreme, nurses were working more than 6 hours overtime per week. Significant differences were observed in the use of overtime by hospital ownership and by union status. Nurses in government hospitals worked less overtime than did those in nongovernment hospitals. Nurses in unionized hospitals worked slightly more overtime than did nurses in nonunionized hospitals. Hospitals varied dramatically in their overtime use. That some categories of hospitals (e.g., government-owned) used little overtime indicates that hospital management can find substitutes for overtime to meet fluctuating staffing needs. The finding that hospitals with similar characteristics varied greatly in their number of overtime hours also supported this conclusion.

Lower Mortality for Abdominal Aortic Aneurysm Repair in High-Volume Hospitals Is Contingent upon Nurse Staffing

PubMed Central

Wiltse Nicely, Kelly L; Sloane, Douglas M; Aiken, Linda H

2013-01-01

Objective To determine whether and to what extent the lower mortality rates for patients undergoing abdominal aortic aneurysm (AAA) repair in high-volume hospitals is explained by better nursing. Data Sources State hospital discharge data, Multi-State Nursing Care and Patient Safety Survey, and hospital characteristics from the AHA Annual Survey. Study Design Cross-sectional analysis of linked patient outcomes for individuals undergoing AAA repair in four states. Data Collection Secondary data sources. Principal Findings Favorable nursing practice environments and higher hospital volumes of AAA repair are associated with lower mortality and fewer failures-to-rescue in main-effects models. Furthermore, nurse staffing interacts with volume such that there is no mortality advantage observed in high-volume hospitals with poor nurse staffing. When hospitals have good nurse staffing, patients in low-volume hospitals are 3.4 times as likely to die and 2.6 times as likely to die from complications as patients in high-volume hospitals (p < .001). Conclusions Nursing is part of the explanation for lower mortality after AAA repair in high-volume hospitals. Importantly, lower mortality is not found in high-volume hospitals if nurse staffing is poor. PMID:23088426

National Study of Nursing Research Characteristics at Magnet®-Designated Hospitals.

PubMed

Pintz, Christine; Zhou, Qiuping Pearl; McLaughlin, Maureen Kirkpatrick; Kelly, Katherine Patterson; Guzzetta, Cathie E

2018-05-01

To describe the research infrastructure, culture, and characteristics of building a nursing research program in Magnet®-designated hospitals. Magnet recognition requires hospitals to conduct research and implement evidence-based practice (EBP). Yet, the essential characteristics of productive nursing research programs are not well described. We surveyed 181 nursing research leaders at Magnet-designated hospitals to assess the characteristics in their hospitals associated with research infrastructure, research culture, and building a nursing research program. Magnet hospitals provide most of the needed research infrastructure and have a culture that support nursing research. Higher scores for the 3 categories were found when hospitals had a nursing research director, a research department, and more than 10 nurse-led research studies in the past 5 years. While some respondents indicated their nurse executives and leaders support the enculturation of EBP and research, there continue to be barriers to full implementation of these characteristics in practice.

Nurse staffing and patient outcomes in Belgian acute hospitals: cross-sectional analysis of administrative data.

PubMed

Van den Heede, Koen; Sermeus, Walter; Diya, Luwis; Clarke, Sean P; Lesaffre, Emmanuel; Vleugels, Arthur; Aiken, Linda H

2009-07-01

Studies have linked nurse staffing levels (number and skill mix) to several nurse-sensitive patient outcomes. However, evidence from European countries has been limited. This study examines the association between nurse staffing levels (i.e. acuity-adjusted Nursing Hours per Patient Day, the proportion of registered nurses with a Bachelor's degree) and 10 different patient outcomes potentially sensitive to nursing care. DESIGN-SETTING-PARTICIPANTS: Cross-sectional analyses of linked data from the Belgian Nursing Minimum Dataset (general acute care and intensive care nursing units: n=1403) and Belgian Hospital Discharge Dataset (general, orthopedic and vascular surgery patients: n=260,923) of the year 2003 from all acute hospitals (n=115). Logistic regression analyses, estimated by using a Generalized Estimation Equation Model, were used to study the association between nurse staffing and patient outcomes. The mean acuity-adjusted Nursing Hours per Patient Day in Belgian hospitals was 2.62 (S.D.=0.29). The variability in patient outcome rates between hospitals is considerable. The inter-quartile ranges for the 10 patient outcomes go from 0.35 for Deep Venous Thrombosis to 3.77 for failure-to-rescue. No significant association was found between the acuity-adjusted Nursing Hours per Patient Day, proportion of registered nurses with a Bachelor's degree and the selected patient outcomes. The absence of associations between hospital-level nurse staffing measures and patient outcomes should not be inferred as implying that nurse staffing does not have an impact on patient outcomes in Belgian hospitals. To better understand the dynamics of the nurse staffing and patient outcomes relationship in acute hospitals, further analyses (i.e. nursing unit level analyses) of these and other outcomes are recommended, in addition to inclusion of other study variables, including data about nursing practice environments in hospitals.

Frontier nursing: nursing work and training in Alberta, 1890-1905.

PubMed

Richardson, S

1996-01-01

This article analyzes the relationship of nursing work and training from 1890 to 1905 in that part of the North West Territory which in 1905 became the province of Alberta. Primary (archival) and secondary (published) data are analyzed to determine the nature of salaried nursing work, how nurses were recruited, the conditions of employment, how women were prepared for nursing work, and the relationship between hospital training programs and the salaried work of graduate nurses. Prior to 1905, most graduate nurses in Alberta were employed in hospitals. Their work involved administration as well as attending to patients and assisting physicians. Hospital boards had difficulty recruiting graduate nurses and began training programs to remedy their labour shortage. Programs were begun by the Medicine Hat General Hospital in 1894 and the Calgary General Hospital in 1895. Hospitals with training programs soon came to rely on pupil nurses for staffing. The success of these programs stimulated other Alberta hospitals to begin training programs, and by 1915 there were 10 programs in existence. Graduates of hospital programs were expected to be entrepreneurs, seeking employment in private practice and being reimbursed on a free-for-service basis by their patients. Although they were not designed to prepare nurses for private practice, hospital training programs did achieve some integration between hospital and home nursing work, partly because the primitive conditions of Alberta hospitals matched those of the ranches, homesteads, and even town homes. Pupil nurses became oriented to private duty when they were "hired out" during their period of training to care for ill individuals in their homes.

A Trial of Nursing Cost Accounting using Nursing Practice Data on a Hospital Information System.

PubMed

Miyahira, Akiko; Tada, Kazuko; Ishima, Masatoshi; Nagao, Hidenori; Miyamoto, Tadashi; Nakagawa, Yoshiaki; Takemura, Tadamasa

2015-01-01

Hospital administration is very important and many hospitals carry out activity-based costing under comprehensive medicine. However, nursing cost is unclear, because nursing practice is expanding both quantitatively and qualitatively and it is difficult to grasp all nursing practices, and nursing cost is calculated in many cases comprehensively. On the other hand, a nursing information system (NIS) is implemented in many hospitals in Japan and we are beginning to get nursing practical data. In this paper, we propose a nursing cost accounting model and we simulate a cost by nursing contribution using NIS data.

Nurse employment contracts in Chinese hospitals: impact of inequitable benefit structures on nurse and patient satisfaction

PubMed Central

2014-01-01

Purpose Ongoing economic and health system reforms in China have transformed nurse employment in Chinese hospitals. Employment of ‘bianzhi’ nurses, a type of position with state-guaranteed lifetime employment that has been customary since 1949, is decreasing while there is an increase in the contract-based nurse employment with limited job security and reduced benefits. The consequences of inequities between the two types of nurses in terms of wages and job-related benefits are unknown. This study examined current rates of contract-based nurse employment and the effects of the new nurse contract employment strategy on nurse and patient outcomes in Chinese hospitals. Methods This cross-sectional study used geographically representative survey data collected from 2008 to 2010 from 181 hospitals in six provinces, two municipalities, and one autonomous region in China. Logistic regression models were used to estimate the association between contract-based nurse utilization, dissatisfaction among contract-based nurses, nurse intentions to leave their positions, and patient satisfaction, controlling for nurse, patient, and hospital characteristics. Principal Results Hospital-level utilization of contract-based nurses varies greatly from 0 to 91%, with an average of 51%. Contract-based nurses were significantly more dissatisfied with their remuneration and benefits than ‘bianzhi’ nurses who have more job security (P <0.01). Contract-based nurses who were dissatisfied with their salary and benefits were more likely to intend to leave their current positions (P <0.01). Hospitals with high levels of dissatisfaction with salary and benefits among contract-based nurses were rated lower and less likely to be recommended by patients (P < 0.05). Conclusions Our results suggest a high utilization of contract-based nurses in Chinese hospitals, and that the inequities in benefits between contract-based nurses and ‘bianzhi’ nurses may adversely affect both nurse and patient satisfaction in hospitals. Our study provides empirical support for the ‘equal pay for equal work’ policy emphasized by the China Ministry of Health’s recent regulations, and calls for efforts in Chinese hospitals to eliminate the disparities between ‘bianzhi’ and contract-based nurses. PMID:24418223

Nurse employment contracts in Chinese hospitals: impact of inequitable benefit structures on nurse and patient satisfaction.

PubMed

Shang, Jingjing; You, Liming; Ma, Chenjuan; Altares, Danielle; Sloane, Douglas M; Aiken, Linda H

2014-01-13

Ongoing economic and health system reforms in China have transformed nurse employment in Chinese hospitals. Employment of 'bianzhi' nurses, a type of position with state-guaranteed lifetime employment that has been customary since 1949, is decreasing while there is an increase in the contract-based nurse employment with limited job security and reduced benefits. The consequences of inequities between the two types of nurses in terms of wages and job-related benefits are unknown. This study examined current rates of contract-based nurse employment and the effects of the new nurse contract employment strategy on nurse and patient outcomes in Chinese hospitals. This cross-sectional study used geographically representative survey data collected from 2008 to 2010 from 181 hospitals in six provinces, two municipalities, and one autonomous region in China. Logistic regression models were used to estimate the association between contract-based nurse utilization, dissatisfaction among contract-based nurses, nurse intentions to leave their positions, and patient satisfaction, controlling for nurse, patient, and hospital characteristics. Hospital-level utilization of contract-based nurses varies greatly from 0 to 91%, with an average of 51%. Contract-based nurses were significantly more dissatisfied with their remuneration and benefits than 'bianzhi' nurses who have more job security (P <0.01). Contract-based nurses who were dissatisfied with their salary and benefits were more likely to intend to leave their current positions (P <0.01). Hospitals with high levels of dissatisfaction with salary and benefits among contract-based nurses were rated lower and less likely to be recommended by patients (P < 0.05). Our results suggest a high utilization of contract-based nurses in Chinese hospitals, and that the inequities in benefits between contract-based nurses and 'bianzhi' nurses may adversely affect both nurse and patient satisfaction in hospitals. Our study provides empirical support for the 'equal pay for equal work' policy emphasized by the China Ministry of Health's recent regulations, and calls for efforts in Chinese hospitals to eliminate the disparities between 'bianzhi' and contract-based nurses.

High-Risk Medication Use by Nursing Home Residents Before and After Hospitalization

PubMed Central

Stevenson, David G.; Dusetzina, Stacie B.; O’Malley, A. James; Mitchell, Susan L.; Zarowitz, Barbara J.; Chernew, Michael E.; Newhouse, Joseph P.; Huskamp, Haiden A.

2014-01-01

Background Two prominent challenges in nursing home care are ensuring appropriate medication use and achieving high quality care as residents transition from the hospital to the nursing home and back. Research about prescribing practices at this important clinical juncture is limited. Objective To analyze the use of high-risk medications by nursing home residents before and after being hospitalized. We define high-risk medications using the Beers criteria for potentially inappropriate medication use. Research Design, Subjects, Measures Using a dataset with Medicare claims for inpatient and skilled nursing facility stays, and pharmacy claims for all medications dispensed in the nursing home setting, we examine high-risk medication use for hospitalized nursing home residents before and after being hospitalized. Our study population includes 52,559 dual-eligible nursing home residents aged 65 and older who are hospitalized and then readmitted to the same nursing home in 2008. Our primary outcome of interest is the use of high-risk medications in the 30 days before hospitalization and the 30 days following readmission to the same nursing home. We define high-risk medications using the Beers criteria for potentially inappropriate medication use. Results Around one in five hospitalized nursing home residents (21%) used at least one high-risk medication the day before hospitalization. Among individuals with high-risk medication use at hospitalization, the proportion using these medications dropped to 45% after nursing home readmission but increased thereafter, to 59% by the end of the 30-day period. Conclusion We found moderate levels of high-risk medication use by hospitalized nursing home residents before and after their hospital stays, constituting an important clinical and policy challenge. PMID:25185637

Cost containment: the Pacific. Japan.

PubMed

Tajimi, K; Shimada, Y; Nishimura, S; Sirio, C A

1994-08-01

The Japanese healthcare system is structured to provide universal healthcare access to the entire Japanese population via a constitutional guarantee. Increasing costs within the Japanese healthcare system are largely attributable to the country's rapidly aging population. Intensive care services are provided primarily in large tertiary care hospitals by a relatively small cadre of dedicated critical care physicians. Triage pressure is high in many Japanese hospitals due to a relatively small proportion of ICU beds. As a result, few patients are admitted to the ICU at low risk of adverse outcome or monitoring. Costs associated with providing critical care are poorly understood because of current hospital cost accounting systems. Critical care costs have only recently become an area of concern. Nevertheless, critical care physicians are taking steps to more fully understand severity of illness, clinical outcome, and utilization of resources in order to effectively guide healthcare policy and resource allocation decisions impacting Japanese critical care.

Background and current status of postmortem imaging in Japan: short history of "Autopsy imaging (Ai)".

PubMed

Okuda, Takahisa; Shiotani, Seiji; Sakamoto, Namiko; Kobayashi, Tomoya

2013-02-10

There is a low autopsy rate and wide distribution of computed tomography (CT) and magnetic resonance imaging (MRI) scanners in Japan. Therefore, many Japanese hospitals, including 36% of the hospitals with in-patient facilities and 89% of large hospitals with ER facilities conduct postmortem imaging (PMI), use clinical scanners to screen for causes in unusual deaths as an alternative to an autopsy or to determine whether an autopsy is needed. The Japanese PMI examination procedure is generally referred to as "autopsy imaging" (Ai) and the term "Ai" is now commonly used by the Japanese government. Currently, 26 of 47 Japanese prefectures have at least one Ai Center with scanners that are dedicated for PMI. Here, we briefly review the history of Japanese PMI (Ai) from 1985 to the present. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

The interrelationship of organizational characteristics of magnet hospitals, nursing leadership, and nursing job satisfaction.

PubMed

Upenieks, Valda V

2003-01-01

This study examined whether magnet hospitals continue to provide higher levels of job satisfaction and empowerment among nurses when compared with non-magnet hospitals. Also studied at both types of hospitals was whether job satisfaction discrepancy was interlinked with leadership effectiveness and support of professional nursing practice. Nurses employed at magnet hospitals experienced higher levels of empowerment and job satisfaction due to greater access to work empowerment structures. The elements accounting for differences in empowerment and job satisfaction scores included: (1) greater accessibility of magnet nurse leaders, (2) better support of clinical nurse autonomous decision making by magnet nurse leaders, and (3) greater access to work empowerment structures such as opportunity, information, and resources at magnet hospitals.

Portuguese nurses' knowledge of and attitudes toward hospitalized older adults.

PubMed

de Almeida Tavares, João Paulo; da Silva, Alcione Leite; Sá-Couto, Pedro; Boltz, Marie; Capezuti, Elizabeth

2015-03-01

Portugal is impacted by the rapid growth of the aging population, which has significant implications for its health care system. However, nurses have received little education focusing on the unique and complex care needs of older adults. This gap in the nurses' education has an enormous impact in their knowledge and attitudes and affects the quality of nursing care provided to older adults. A cross-sectional study was conducted among 1068 Portuguese nurses in five hospitals (northern and central region) with the following purposes: (i) explore the knowledge and attitudes of nurses about four common geriatric syndromes (pressure ulcer, incontinence, restraint use and sleep disturbance) in Portuguese hospitals; and (ii) evaluate the influence of demographic, professional and nurses' perception about hospital educational support, geriatric knowledge, and burden of caring for older adults upon geriatric nursing knowledge and attitudes. The mean knowledge and attitudes scores were 0.41 ± 0.15 and 0.40 ± 0.21, respectively (the maximum score was 1). Knowledge of nurses in Portuguese hospitals about the four geriatric syndromes (pressure ulcers, sleep disturbance, urinary incontinence and restraint use) was found inadequate. The nurses' attitudes towards caring for hospitalized older adults were generally negative. Nurses who work in academic hospitals demonstrated significantly more knowledge than nurses in hospital centers. The attitudes of nurses were significantly associated with the hospital and unit type, region, hospital educational support, staff knowledge, and perceived burden of caring for older adults. The study findings support the need for improving nurses' knowledge and attitudes towards hospitalized older adults and implementing evidence-based guidelines in their practice. © 2014 Nordic College of Caring Science.

Associations of Nurse Staffing and Education With the Length of Stay of Surgical Patients.

PubMed

Cho, Eunhee; Park, Jeongyoung; Choi, Miyoung; Lee, Hye Sun; Kim, Eun-Young

2018-03-01

To examine the association of nurse staffing and education with the length of stay of surgical patients in acute care hospitals in South Korea. A cross-sectional survey design was used for a nurse survey in acute hospitals collected between 2008 and 2009. The survey data (N = 1,665) were linked with patient discharge data (N = 113,438) and hospital facility data from 58 hospitals with 100 or more beds in South Korea. The dependent variable was the length of stay, that is, the number of days a patient remained in the hospital. The independent variables were nurse staffing (number of patients per nurse) and nurses' education level (percentage of nurses with a bachelor of science in nursing [BSN] degree). A multilevel analysis was used to analyze the associations of nurse staffing and education level with the length of stay by controlling for both hospital and patient characteristics. The average proportion of nurses with a BSN in all the hospitals was 30.86%, while the average number of patients per nurse was 14.31. The median length of hospital stay for patients was about 7 days. The multilevel analysis showed that nurse staffing and nurse education level were significantly associated with the length of stay of surgical patients in acute care hospitals. A 10% increase in the average number of patients per nurse increased the length of stay by 0.284 days (p = .037). When the number of nurses with a BSN was increased by 1%, the length of stay decreased by 0.42 days (p = .025). Nurse staffing and nurses' education levels were significantly associated with the length of stay of surgical patients in South Korean hospitals. The findings from this study suggest that the South Korea healthcare system should develop appropriate strategies to improve the nurse staffing and education levels to ensure high-quality patient care in hospitals. Healthcare policymakers and nurse managers need to modify adequate nurse staffing and education levels in order to reduce the length of stay of patients. © 2017 Sigma Theta Tau International.

Philanthropic Donor Perspectives on Supporting Nursing Excellence in a Community Hospital.

PubMed

Fickley, Sharon K; Mishler, Ray R; Black, Amelia S; DeGuzman, Pam B

2016-11-01

The purpose of this research is to explore donors' perspectives on support of nursing excellence in a community hospital. Philanthropic support is rapidly becoming critical to support nursing excellence in hospitals, including continuing education, nursing research, and professional development. However, no research has examined the experience of private donors who support nursing programs in community hospitals. Structured interviews were conducted with individuals with a history of providing significant financial support (gifts >$50 000) targeted specifically for nursing in a 176- bed community hospital in the southeastern United States. Analysis was performed using descriptive content analysis. Four themes emerged that centered around making a difference, helping nurses meet new challenges, an existing foundation of service, and valuing excellent nursing care received. This research provides specific information that nursing administrators can use when seeking philanthropic gifts to support nursing excellence programs in US community hospitals.

Nurses' Perspectives on the Geriatric Nursing Practice Environment and the Quality of Older People's Care in Ontario Acute Care Hospitals.

PubMed

Fox, Mary T; Sidani, Souraya; Butler, Jeffrey I; Tregunno, Deborah

2017-06-01

Background Cultivating hospital environments that support older people's care is a national priority. Evidence on geriatric nursing practice environments, obtained from studies of registered nurses (RNs) in American teaching hospitals, may have limited applicability to Canada, where RNs and registered practical nurses (RPNs) care for older people in predominantly nonteaching hospitals. Purpose This study describes nurses' perceptions of the overall quality of care for older people and the geriatric nursing practice environment (geriatric resources, interprofessional collaboration, and organizational value of older people's care) and examines if these perceptions differ by professional designation and hospital teaching status. Methods A cross-sectional survey, using Dillman's tailored design, that included Geriatric Institutional Assessment Profile subscales, was completed by 2005 Ontario RNs and registered practical nurses to assess their perceptions of the quality of care and geriatric nursing practice environment. Results Scores on the Geriatric Institutional Assessment Profile subscales averaged slightly above the midpoint except for geriatric resources which was slightly below. Registered practical nurses rated the quality of care and geriatric nursing practice environment higher than RNs; no significant differences were found by hospital teaching status. Conclusions Nurses' perceptions of older people's care and the geriatric nursing practice environment differ by professional designation but not hospital teaching status. Teaching and nonteaching hospitals should both be targeted for geriatric nursing practice environment improvement initiatives.

[How do hospital clinical laboratories and laboratory testing companies cooperate and build reciprocal relations?].

PubMed

Kawano, Seiji

2014-12-01

As the 2nd Joint Symposium of the Japanese Society of Laboratory Medicine and the Japanese Association of Laboratory Pathologists, the symposium on clinical test out-sourcing and branch laboratories was held at the 60th General Meeting of the Japanese Society of Laboratory Medicine on November 2nd, 2013 in Kobe. For the symposium, we conducted a questionnaire survey on the usage of clinical test out-sourcing and the introduction of branch laboratories to clinical laboratories of Japanese university hospitals, both private and public, between July 25th and August 20th, 2013. Seventy-two hospitals responded to the questionnaire survey, consisting of 41 public medical school hospitals and 31 private ones. According to the survey, the selection of each clinical test for out-sourcing was mainly determined by the capacities of hospital clinical laboratories and their equipment, as well as the profitability of each test. The main concerns of clinical laboratory members of university hospitals involved the continuity of measurement principles, traceability, and standardization of reference values for each test. They strongly requested the interchangeability and computerization of test data between laboratory testing companies. A branch laboratory was introduced to six hospitals, all of which were private medical college hospitals, out of 72 university hospitals, and eight of the other hospitals were open to its introduction. The merits and demerits of introducing a branch laboratory were also discussed. (Review).

The Effects of Nurse Staffing on Hospital Financial Performance: Competitive Versus Less Competitive Markets

PubMed Central

Everhart, Damian; Neff, Donna; Al-Amin, Mona; Nogle, June; Weech-Maldonado, Robert

2013-01-01

Background Hospitals facing financial uncertainty have sought to reduce nurse staffing as a way to increase profitability. However, nurse staffing has been found to be important in terms of quality of patient care and nursing related outcomes. Nurse staffing can provide a competitive advantage to hospitals and as a result better financial performance, particularly in more competitive markets Purpose In this study we build on the Resource-Based View of the Firm to determine the effect of nurse staffing on total profit margin in more competitive and less competitive hospital markets in Florida. Methodology/Approach By combining a Florida statewide nursing survey with the American Hospital Association Annual Survey and the Area Resource File, three separate multivariate linear regression models were conducted to determine the effect of nurse staffing on financial performance while accounting for market competitiveness. The analysis was limited to acute care hospitals. Findings Nurse staffing levels had a positive association with financial performance (β=3.3; p=0.02) in competitive hospital markets, but no significant association was found in less competitive hospital markets. Practice Implications Hospitals in more competitive hospital markets should reconsider reducing nursing staff, as these cost cutting measures may be inefficient and negatively affect financial performance. PMID:22543824

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.

Changes in Patient and Nurse Outcomes Associated with Magnet Hospital Recognition

PubMed Central

Kutney-Lee, Ann; Stimpfel, Amy Witkoski; Sloane, Douglas M.; Cimiotti, Jeannie P.; Quinn, Lisa W.; Aiken, Linda H.

2015-01-01

Background Research has documented an association between Magnet hospitals and better outcomes for nurses and patients. However, little longitudinal evidence exists to support a causal link between Magnet recognition and outcomes. Objective To compare changes over time in surgical patient outcomes, nurse-reported quality, and nurse outcomes in a sample of hospitals that attained Magnet recognition between 1999 and 2007 with hospitals that remained non-Magnet. Research Design Retrospective, two-stage panel design using four secondary data sources. Subjects 136 Pennsylvania hospitals (11 “emerging” Magnets and 125 non-Magnets) Measures American Nurses Credentialing Center Magnet recognition; risk-adjusted rates of surgical 30-day mortality and failure-to-rescue, nurse-reported quality measures, and nurse outcomes; the Practice Environment Scale of the Nursing Work Index Methods Fixed effects difference models were used to compare changes in outcomes between emerging Magnet hospitals and hospitals that remained non-Magnet. Results Emerging Magnet hospitals demonstrated markedly greater improvements in their work environments than other hospitals. On average, the changes in 30-day surgical mortality and failure-to-rescue rates over the study period were more pronounced in emerging Magnet hospitals than in non-Magnet hospitals, by 2.4 fewer deaths per 1000 patients (p<.01) and 6.1 fewer deaths per 1000 patients (p=0.02), respectively. Similar differences in the changes for emerging Magnet hospitals and non-Magnet hospitals were observed in nurse-reported quality of care and nurse outcomes. Conclusions In general, Magnet recognition is associated with significant improvements over time in the quality of the work environment, and in patient and nurse outcomes that exceed those of non-Magnet hospitals. PMID:25906016

Workplace violence against nurses--prevalence and association with hospital organizational characteristics and health-promotion efforts: Cross-sectional study.

PubMed

Wei, Ching-Yao; Chiou, Shu-Ti; Chien, Li-Yin; Huang, Nicole

2016-04-01

To determine the prevalence of workplace violence and explore the role of hospital organizational characteristics and health promotion efforts in reducing hospital violence among nurses in Taiwan. Cross-sectional survey. One hundred hospitals across Taiwan. The final sample in our study comprised responses from 26,979 nurses. The data were obtained from a nationwide hospital survey, Physical and Mental Health and Safety Needs in Full-Time Health Care Staff, which was developed and conducted by the Bureau of Health Promotion, Taiwan, in 2011. The main dependent variable was whether nurses had experienced violence within the past year. Physical violence, threatened or intimidated personal safety, verbal violence or sexual harassment were all included. Of the 26,979 nurses, 13,392 nurses (49.6%) had experienced at least one episode of any type of violence in the past year; 5150 nurses (19.1%) had been exposed to physical violence, and 12,491 nurses (46.3%) had been exposed to non-physical violence. The prevalence of having experienced any violence varied widely and ranged from the highest (55.5%) in an emergency room or intensive care unit to the lowest (28.3%) among those aged 55-65 years. After adjusting for other characteristics, younger nurses were significantly more likely to be exposed to any violent threat. Nurses working in public hospitals had a significantly higher risk of workplace violence than those working in private hospitals. Significant variations were also observed among work units. Although nurses working in a certified health promoting hospital (HPH) did not have a lower risk of workplace violence, those working in an outstanding HPH had a significantly lower risk of workplace violence. A similar pattern was observed for non-physical violence. Workplace violence is a major challenge to workplace safety for nurses in hospitals. This large scale nurse survey identified individual, work and hospital characteristics associated with workplace violence among hospital nurses. Preventive efforts in reducing hospital violence shall be targeted these high risk groups and settings. This nationwide nurse survey assisted us in more clearly understanding the scope of the hospital violence facing nurses and identifying critical risk factors. The findings not only identified the most common locations of violence in hospitals but also suggested that extensive investments and efforts by hospitals in health promotion are crucial. Copyright © 2016 Elsevier Ltd. All rights reserved.

38 CFR 17.47 - Considerations applicable in determining eligibility for hospital, nursing home or domiciliary care.

Code of Federal Regulations, 2011 CFR

2011-07-01

... in determining eligibility for hospital, nursing home or domiciliary care. 17.47 Section 17.47... Nursing Home Care § 17.47 Considerations applicable in determining eligibility for hospital, nursing home... hospital or nursing home care under § 17.47(a), a veteran will be determined unable to defray the expenses...

38 CFR 17.47 - Considerations applicable in determining eligibility for hospital, nursing home or domiciliary care.

Code of Federal Regulations, 2013 CFR

2013-07-01

... in determining eligibility for hospital, nursing home or domiciliary care. 17.47 Section 17.47... Nursing Home Care § 17.47 Considerations applicable in determining eligibility for hospital, nursing home... hospital or nursing home care under § 17.47(a), a veteran will be determined unable to defray the expenses...

38 CFR 17.47 - Considerations applicable in determining eligibility for hospital, nursing home or domiciliary care.

Code of Federal Regulations, 2012 CFR

2012-07-01

... in determining eligibility for hospital, nursing home or domiciliary care. 17.47 Section 17.47... Nursing Home Care § 17.47 Considerations applicable in determining eligibility for hospital, nursing home... hospital or nursing home care under § 17.47(a), a veteran will be determined unable to defray the expenses...

38 CFR 17.47 - Considerations applicable in determining eligibility for hospital, nursing home or domiciliary care.

Code of Federal Regulations, 2014 CFR

2014-07-01

... in determining eligibility for hospital, nursing home or domiciliary care. 17.47 Section 17.47... Nursing Home Care § 17.47 Considerations applicable in determining eligibility for hospital, nursing home... hospital or nursing home care under § 17.47(a), a veteran will be determined unable to defray the expenses...

38 CFR 17.47 - Considerations applicable in determining eligibility for hospital, nursing home or domiciliary care.

Code of Federal Regulations, 2010 CFR

2010-07-01

... in determining eligibility for hospital, nursing home or domiciliary care. 17.47 Section 17.47... Nursing Home Care § 17.47 Considerations applicable in determining eligibility for hospital, nursing home... hospital or nursing home care under § 17.47(a), a veteran will be determined unable to defray the expenses...

Associations between nursing home performance and hospital 30-day readmissions for acute myocardial infarction, heart failure and pneumonia at the healthcare community level in the United States.

PubMed

Pandolfi, Michelle M; Wang, Yun; Spenard, Ann; Johnson, Florence; Bonner, Alice; Ho, Shih-Yieh; Elwell, Timothy; Bakullari, Anila; Galusha, Deron; Leifheit-Limson, Erica; Lichtman, Judith H; Krumholz, Harlan M

2017-12-01

To evaluate community-specific nursing home performance with community-specific hospital 30-day readmissions for Medicare patients discharged with acute myocardial infarction, heart failure or pneumonia. Cross-sectional study using 2009-2012 hospital risk-standardised 30-day readmission data for Medicare fee-for-service patients hospitalised for all three conditions and nursing home performance data from the Centers for Medicare & Medicaid Services Five-Star Quality Rating System. Medicare-certified nursing homes and acute care hospitals. 12,542 nursing homes and 3,039 hospitals treating 30 or more Medicare fee-for-service patients for all three conditions across 2,032 hospital service areas in the United States. Community-specific hospital 30-day risk-standardised readmission rates. Community-specific nursing home performance measures: health inspection, staffing, Registered Nurses and quality performance; and an aggregated performance score. Mixed-effects models evaluated associations between nursing home performance and hospital 30-day risk-standardised readmission rates for all three conditions. The relationship between community-specific hospital risk-standardised readmission rates and community-specific overall nursing home performance was statistically significant for all three conditions. Increasing nursing home performance by one star resulted in decreases of 0.29% point (95% CI: 0.12-0.47), 0.78% point (95% CI: 0.60-0.95) and 0.46% point (95% CI: 0.33-0.59) of risk-standardised readmission rates for AMI, HF and pneumonia, respectively. Among the specific measures, higher performance in nursing home overall staffing and Registered Nurse staffing measures was statistically significantly associated with lower hospital readmission rates for all three conditions. Notable geographic variation in the community-specific nursing home performance was observed. Community-specific nursing home performance is associated with community-specific hospital 30-day readmission rates for Medicare fee-for-service patients for acute myocardial infarction, heart failure or pneumonia. Coordinated care between hospitals and nursing homes is essential to reduce readmissions. Nursing homes can improve performance and reduce readmissions by increasing registered nursing homes. Further, communities can work together to create cross-continuum care teams comprised of hospitals, nursing homes, patients and their families, and other community-based service providers to reduce unplanned readmissions. © 2017 John Wiley & Sons Ltd.

Nursing leadership in an academic hospital in Gauteng.

PubMed

Maboko, D R

2012-10-01

This study was aimed at describing nursing leadership in an academic hospital in Gauteng, South Africa. Nurse managers' leadership styles affect nurses' attitudes, behaviour and work performance. However, little is known about how nurses experience nurse leadership and what leadership styles are found in academic hospitals in Gauteng. The study was based on Maxwell's framework of leadership (relationships, equipping, leadership and attitude). A qualitative design was used in order to describe the experiences of registered nurses and nurse managers. The population of the study was all registered nurses and nurse managers of the hospital in which the study was conducted. In phase one of the study, a discussion group with 35 registered nurses using the nominal group technique was held to respond to the following statement: 'Please explain how you have experienced leadership by nurse managers in this hospital'. In phase two of the study, five nurse managers were interviewed individually, using a semi-structured interview guide. Some nurse managers were practising autocratic leadership in this hospital. he nurse managers need to be taught about contemporary leadership styles such as transformational leadership and visionary leadership and also about supervision, role modelling and caring. © 2011 Blackwell Publishing Ltd.

Hospital nurse staffing and public health emergency preparedness: implications for policy.

PubMed

McHugh, Matthew D

2010-01-01

Hospital restructuring policies and an impending nursing workforce shortage have threatened the nation's emergency preparedness. Current emergency response plans rely on sources of nurses that are limited and overestimated. A national investment in nursing education and workforce infrastructure, as well as incentives for hospitals to efficiently maximize nurse staffing, are needed to ensure emergency preparedness in the United States. This review highlights the challenges of maintaining hospital nursing surge capacity and policy implications of a nursing shortage.

Hospital Nurse Staffing and Public Health Emergency Preparedness: Implications for Policy

PubMed Central

McHugh, Matthew D.

2010-01-01

Hospital restructuring policies and an impending nursing workforce shortage have threatened the nation’s emergency preparedness. Current emergency response plans rely on sources of nurses that are limited and overestimated. A national investment in nursing education and workforce infrastructure, as well as incentives for hospitals to efficiently maximize nurse staffing, are needed to ensure emergency preparedness in the United States. This review highlights the challenges of maintaining hospital nursing surge capacity and policy implications of a nursing shortage. PMID:20840714

Hospital Nursing Workforce Costs, Wages, Occupational Mix,and Resource Utilization.

PubMed

Welton, John M

2015-10-01

The objective of the study was to better understand how hospitals use different types of RNs, LPNs, and nurse aides in proprietary (for-profit), nonprofit, and government-owned hospitals and to estimate the wages, cost, and intensity of nursing care using a national data set. This is a cross-sectional observational study of 3,129 acute care hospitals in all 50 states and District of Columbia using data from the 2008 Occupational Mix Survey administered by the Centers for Medicare &Medicaid Services (CMS). Nursing skill mix, hours, and labor costs were combined with other CMS hospital descriptive data, including type of hospital ownership, urban or rural location, hospital beds, and case-mix index. RN labor costs make up 25.5% of all hospital expenditures annually, and all nursing labor costs represent 30.1%, which is nearly a quarter trillion dollars ($216.7 billion) per year for inpatient nursing care. On average, proprietary hospitals employ 1.3 RNs per bed and 1.9 nursing personnel per bed in urban hospitals compared with 1.7 RNs per bed and 2.3 nursing personnel per bed for nonprofit and government-owned hospitals (P G .05). States with higher ratios of RN compared with LPN licenses used fewer LPNs in the inpatient setting. The findings from this study can be helpful in comparing nursing care across different types of hospitals, ownership, and geographic locations and used as a benchmark for future nursing workforce needs and costs.

Hospital nursing workforce costs, wages, occupational mix, and resource utilization.

PubMed

Welton, John M

2011-01-01

: The objective of the study was to better understand how hospitals use different types of RNs, LPNs, and nurse aides in proprietary (for-profit), nonprofit, and government-owned hospitals and to estimate the wages, cost, and intensity of nursing care using a national data set. : This is a cross-sectional observational study of 3,129 acute care hospitals in all 50 states and District of Columbia using data from the 2008 Occupational Mix Survey administered by the Centers for Medicare & Medicaid Services (CMS). Nursing skill mix, hours, and labor costs were combined with other CMS hospital descriptive data, including type of hospital ownership, urban or rural location, hospital beds, and case-mix index. : RN labor costs make up 25.5% of all hospital expenditures annually, and all nursing labor costs represent 30.1%, which is nearly a quarter trillion dollars ($216.7 billion) per year for inpatient nursing care. On average, proprietary hospitals employ 1.3 RNs per bed and 1.9 nursing personnel per bed in urban hospitals compared with 1.7 RNs per bed and 2.3 nursing personnel per bed for nonprofit and government-owned hospitals (P < .05). States with higher ratios of RN compared with LPN licenses used fewer LPNs in the inpatient setting. : The findings from this study can be helpful in comparing nursing care across different types of hospitals, ownership, and geographic locations and used as a benchmark for future nursing workforce needs and costs.

Achieving Kaiser Permanente Quality

PubMed Central

McHugh, Matthew D.; Aiken, Linda H.; Eckenhoff, Myra E.; Burns, Lawton R.

2015-01-01

Background The Kaiser Permanente model of integrated health delivery is highly regarded for high quality and efficient health care. Efforts to reproduce Kaiser’s success have mostly failed. One factor that has received little attention and that could explain Kaiser’s advantage is its commitment to and investment in nursing as a key component of organizational culture and patient-centered care. Purpose The aim of this study was to investigate the role of Kaiser’s nursing organization in promoting quality of care. Methodology This was a cross-sectional analysis of linked secondary data from multiple sources, including a detailed survey of nurses, for 564 adult, general acute care hospitals from California, Florida, Pennsylvania, and New Jersey in 2006–2007. We used logistic regression models to examine whether patient (mortality and failure-to-rescue) and nurse (burnout, job satisfaction, and intent-to-leave) outcomes in Kaiser hospitals were better than in non-Kaiser hospitals. We then assessed whether differences in nursing explained outcomes differences between Kaiser and other hospitals. Finally, we examined whether Kaiser hospitals compared favorably with hospitals known for having excellent nurse work environments — Magnet hospitals. Findings Patient and nurse outcomes in Kaiser hospitals were significantly better compared with non-Magnet hospitals. Kaiser hospitals had significantly better nurse work environments, staffing levels, and more nurses with bachelor’s degrees. Differences in nursing explained a significant proportion of the Kaiser outcomes advantage. Kaiser hospital outcomes were comparable to Magnet hospitals, where better outcomes have been largely explained by differences in nursing. Implications An important element in Kaiser’s success is its investment in professional nursing, which may not be evident to systems seeking to achieve Kaiser’s advantage. Our results suggest that a possible strategy for achieving outcomes like Kaiser may be for hospitals to consider Magnet designation, a proven and cost-effective strategy to improve process of care through investments in nursing. PMID:26131607

Social Support Behaviors and Work Stressors among Nurses: A Comparative Study between Teaching and Non-Teaching Hospitals.

PubMed

Amarneh, Basil Hameed

2017-01-29

The concept of "work stressors" has been well studied. However, in the field of nursing, studies concerning social support behaviors are limited. The aim of this study was to compare nurse work stressors, social support behaviors, and predictors of these variables among nurses in Jordanian teaching and non-teaching hospitals. A convenience sampling technique and a comparative quantitative research design were used in the current study. Two hundred and ninety-one nurses were recruited from five teaching hospitals, and 172 were recruited from eight non-teaching hospitals in Jordan. The Nursing Stress Scale (NSS) and the Inventory of Social Supportive Behaviors (ISSB) were used to collect data. The studied variables differed across hospitals. In some subscales, as well as in some individual items of the scales, nurse work stressors and social support behaviors differed between teaching and non-teaching hospitals. In teaching hospitals, the work shift was the only predictor of nurses' work stressors, whereas the work shift and model of nursing care were predictors of social support behaviors. In non-teaching hospitals, the work shift, level of education, and model of nursing care were predictors of nurse work stressors. Predictors of social support behaviors were marital status, model of nursing, and organizational structure. Regardless of the type of hospital, nurse stressors should be assessed and, once identified, managed by providing various social support behaviors. By turning a work environment into a healthy workplace, researchers and nurse leaders believe that improvements can be realized in recruitment and patient safety and quality.

Comprehensive analysis of prognostic factors in hospitalized patients with pneumonia occurring outside hospital: Serum albumin is not less important than pneumonia severity assessment scale.

PubMed

Miyazaki, Hiroyuki; Nagata, Nobuhiko; Akagi, Takanori; Takeda, Satoshi; Harada, Taishi; Ushijima, Shinichiro; Aoyama, Takashi; Yoshida, Yuji; Yatsugi, Hiroshi; Fujita, Masaki; Watanabe, Kentaro

2018-08-01

This study aimed to elucidate factors related to 30-day mortality of pneumonia occurring outside hospital by comprehensively analyzing data considered relevant to prognosis. Data considered relevant to prognosis were retrospectively examined from clinical charts and chest X-ray images of all patients with pneumonia occurring outside hospital admitted to our hospital from 2010 to 2016. The primary outcome was 30-day mortality. Data were collected from 534 patients (317 community-acquired pneumonia and 217 nursing- and healthcare associated pneumonia patients; 338 men (63.3%); mean age, 76.2 years-old). Eighty-three patients (9.9%) died from pneumonia within 30 days from the date of admission. The numbers of patients with pneumonia severity index (PSI) classes of I/II/III/IV/V and age, dehydration, respiratory failure, orientation disturbance, pressure (A-DROP) scores of 0/1/2/3/4/5 were 29/66/127/229/83, and 71/107/187/132/30/7, respectively. Mean (standard deviation) body mass index (BMI), serum albumin, blood procalcitonin, white blood cell and C-reactive protein were 20.00 (4.12) kg/m 2 , 3.16 (0.60) g/dL, 3.69 (13.15) ng/mL, 11559.4 (5656.9)/mm 3 , and 10.92 (8.75) mg/dL, respectively. Chest X-ray images from 152 patients exhibited a pneumonia shadow over a quarter of total lung field. Logistic regression analysis revealed that PSI class or A-DROP score, BMI, serum albumin, and extent of pneumonia shadow were related to 30-day mortality. Receiver operating characteristics curve analysis revealed that serum albumin was superior to PSI class or A-DROP score for predicting 30-day mortality. Serum albumin is not less important than PSI class or A-DROP score for predicting 30-day mortality in hospitalized patients with pneumonia occurring outside hospital. Copyright © 2018 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

The indirect costs of agency nurses in South Africa: a case study in two public sector hospitals

PubMed Central

Rispel, Laetitia C.; Moorman, Julia

2015-01-01

Background Globally, flexible work arrangements – through the use of temporary nursing staff – are an important strategy for dealing with nursing shortages in hospitals. Objective The objective of the study was to determine the direct and indirect costs of agency nurses, as well as the advantages and the problems associated with agency nurse utilisation in two public sector hospitals in South Africa. Methods Following ethical approval, two South African public sector hospitals were selected purposively. Direct costs were determined through an analysis of hospital expenditure information for a 5-year period from 2005 until 2010, obtained from the national transversal Basic Accounting System database. At each hospital, semi-structured interviews were conducted with the chief executive officer, executive nursing services manager, the maternity or critical care unit nursing manager, the human resource manager, and the finance manager. Indirect costs measured were the time spent on pre-employment checks, and nurse recruitment, orientation, and supervision. All expenditure is expressed in South African Rands (R: 1 USD=R7, 2010 prices). Results In the 2009/10 financial year, Hospital 1 spent R38.86 million (US$5.55 million) on nursing agencies, whereas Hospital 2 spent R10.40 million (US$1.49 million). The total estimated time spent per week on indirect cost activities at Hospital 1 was 51.5 hours, and 60 hours at Hospital 2. The estimated monetary value of this time at Hospital 1 was R962,267 (US$137,467) and at Hospital 2 the value was R300,121 (US$42,874), thus exceeding the weekly direct costs of nursing agencies. Agency nurses assisted the selected hospitals in dealing with problems of nurse recruitment, absenteeism, shortages, and skills gaps in specialised clinical areas. The problems experienced with agency nurses included their perceived lack of commitment, unreliability, and providing sub-optimal quality of patient care. Conclusion Hospital managers and policy-makers need to address the effective utilisation of agency nurses and quality of patient care in tandem. PMID:25971399

Do Symptoms among Home Palliative Care Patients with Advanced Cancer Decide the Place of Death? Focusing on the Presence or Absence of Symptoms during Home Care.

PubMed

Okamoto, Yuko; Fukui, Sakiko; Yoshiuchi, Kazuhiro; Ishikawa, Takako

2016-05-01

Our goal was to investigate the association between actual place of death among Japanese home end-of-life care patients with advanced cancer and individual, illness, and environmental factors, including the presence or absence of symptoms. Using structured interviews, we asked 44 nurses from 19 home-visit nursing agencies about changes in status of all 123 of their home end-of-life care patients with advanced cancer between April and September 2013. The main outcome variable was actual place of death (Home/Hospital/Still surviving) and independent variables were the patient's symptoms as a time-dependent variable. Competing risk analysis was conducted with adjustment for patient individual factors (demographics, medical factors, caregiver support, and patient's and caregiver's preference for place of death) and environmental factors (availability of physician-visit and policy at discharge). Among all patients, 53 died in the hospital, 52 at home, and 16 still survived. Multivariate analyses revealed the following: 1) patients were more likely to die in the hospital when pain and dyspnea were present (adjusted sub hazard ratio [SHR]: 1.50 [95% confidence interval (CI): 1.23-1.83] and 1.71 [95% CI: 1.36-2.15], respectively); 2) patients were less likely to die in the hospital when delirium was present (adjusted SHR: 0.64 [95%CI: 0.43-0.96]); and 3) other factors associated with hospital death were patient's gender, primary cancer site, caregiver support, health care service, policy at discharge, and congruence between the patient's and family's preference for place of death. To alleviate pain and dyspnea among home end-of-life care patients, development of both a rapid admission system to a hospital/hospice/care facility in the community and specialist-level palliative care at home is needed.

26 CFR 31.3121(b)(13)-1 - Services of student nurse or hospital intern.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 15 2010-04-01 2010-04-01 false Services of student nurse or hospital intern... 1954) General Provisions § 31.3121(b)(13)-1 Services of student nurse or hospital intern. (a) Services performed as a student nurse in the employ of a hospital or a nurses' training school are excepted from...

26 CFR 31.3306(c)(13)-1 - Services of student nurse or hospital intern.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 15 2010-04-01 2010-04-01 false Services of student nurse or hospital intern...) § 31.3306(c)(13)-1 Services of student nurse or hospital intern. (a) Services performed as a student nurse in the employ of a hospital or a nurses' training school are excepted from employment, if the...

26 CFR 31.3306(c)(13)-1 - Services of student nurse or hospital intern.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 15 2011-04-01 2011-04-01 false Services of student nurse or hospital intern...) § 31.3306(c)(13)-1 Services of student nurse or hospital intern. (a) Services performed as a student nurse in the employ of a hospital or a nurses' training school are excepted from employment, if the...

26 CFR 31.3121(b)(13)-1 - Services of student nurse or hospital intern.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 15 2011-04-01 2011-04-01 false Services of student nurse or hospital intern... 1954) General Provisions § 31.3121(b)(13)-1 Services of student nurse or hospital intern. (a) Services performed as a student nurse in the employ of a hospital or a nurses' training school are excepted from...

Organizational configuration of hospitals succeeding in attracting and retaining nurses.

PubMed

Stordeur, Sabine; D'Hoore, William

2007-01-01

This paper contrasts structural and managerial characteristics of low- and high-turnover hospitals, and describes the organizational configuration of attractive hospitals. In countries facing nurse shortages and turnover, some hospitals succeed in recruiting and retaining nurses. In Magnet Hospitals, managerial practices and environmental characteristics increase nurses' job satisfaction and their commitment to the organization, which in turn decreases nurse turnover. Such an approach suggests that organizations are best understood as clusters of interconnected structures and practices, i.e. organizational configurations rather than entities whose components can be understood in isolation. From a sample of 12 hospitals whose nurse turnover was studied for 1 year, structural and organizational features of hospitals in the first and fourth quartiles, i.e. attractive (turnover <3.1%) vs. conventional (turnover >11.8%) were contrasted. A questionnaire, including perceptions of health-related factors, job demands, stressors, work schedules, organizational climate, and work adjustments antecedent to turnover, was received from 401 nurses working in attractive hospitals (response rate = 53.8%) and 774 nurses in conventional hospitals (response rate = 54.5%). Structural characteristics did not differentiate attractive and conventional hospitals, but employee perceptions towards the organization differed strikingly. Differences were observed for risk exposure, emotional demands, role ambiguity and conflicts, work-family conflicts, effort-reward imbalance and the meaning of work, all in favour of attractive hospitals (P < 0.001). Relationships with nursing management, work ability and satisfaction with working time, handover shifts and schedules were also better in attractive hospitals (P < 0.001). Job satisfaction and commitment were higher in attractive hospitals, whereas burnout and intention to leave were lower (P < 0.001). Organizational characteristics are key factors in nurse attraction and retention. Nurses face difficulties in their work situations, but some hospitals are perceived as healthy organizations. The concept of attractive institutions could serve as a catalyst for improvement in nurses' work environments in Europe.

Hospital restructuring and nursing leadership: a journey from research question to research program.

PubMed

Cummings, Greta G

2006-01-01

The 1990s brought new fiscal realities to healthcare, leading to nursing job loss estimates in tens of thousands following widespread hospital restructuring to manage costs and improve efficiency. This research aimed at examining (a) how multiple episodes of hospital restructuring leading to layoff of nurses affected nurses who remained employed and (b) whether and how nursing leadership mitigated or intensified the negative effects of hospital restructuring on nurses. This dissertation comprised 3 empirical studies leading to 5 publications. The first study was a systematic literature review; the second and third used structural equation modeling to develop and test theoretical models addressing nursing practice environments and effects of hospital restructuring on nurses. The combined findings in this dissertation illustrate that hospital restructuring had significant negative physical/emotional health effects on nurses who remained employed. Nurses who worked for resonant (emotionally intelligent) leadership reported positive health and well-being, and opportunities to provide quality patient care. Nurses who worked for dissonant leadership reported greater negative effects of hospital restructuring. These findings led to a beginning theory of relational energy--a mechanism of mitigation whereby resonant nursing leaders invest energy into collaborative relationships with nurses, thereby positively influencing health and well-being, and, ultimately, outcomes for patients.

Impact of Fall Prevention on Nurses and Care of Fall Risk Patients.

PubMed

King, Barbara; Pecanac, Kristen; Krupp, Anna; Liebzeit, Daniel; Mahoney, Jane

2018-03-19

Falls are common events for hospitalized older adults, resulting in negative outcomes both for patients and hospitals. The Center for Medicare and Medicaid (CMS) has placed pressure on hospital administrators by identifying falls as a "never event", resulting in a zero falls goal for many hospitals. Staff nurses are responsible for providing direct care to patients and for meeting the hospital no falls goal. Little is known about the impact of "zero falls" on nurses, patients and the organization. A qualitative study, using Grounded Dimensional Analysis (GDA) was conducted to explore nurses' experiences with fall prevention in hospital settings and the impact of those experiences on how nurses provide care to fall risk patients. Twenty-seven registered nurses and certified nursing assistants participated in in-depth interviews. Open, axial and selective coding was used to analyze data. A conceptual model which illustrates the impact of intense messaging from nursing administration to prevent patient falls on nurses, actions nurses take to address the message and the consequences to nurses, older adult patients and to the organization was developed. Intense messaging from hospital administration to achieve zero falls resulted in nurses developing a fear of falls, protecting self and unit, and restricting fall risk patients as a way to stop messages and meet the hospital goal. Results of this study identify unintended consequences of fall prevention message on nurses and older adult patients. Further research is needed understand how nurse care for fall risk patients.

What are the career planning and development practices for nurses in hospitals? Is there a difference between private and public hospitals?

PubMed

Sonmez, Betul; Yildirim, Aytolan

2009-12-01

The aim was to determine the opinions of nurse managers about career planning and development for nurses in hospitals. Career planning and development are defined as an important and necessary tool in the development of nurses as professionals and in retaining nurses in a facility. A descriptive survey. The research population comprised nurse managers in 200+ bed hospitals on the European side of Istanbul province (n = 668). The entire population was targeted and 373 nurse managers were included in the study (55.8% return rate). Data were collected with a 32-item survey form that had three sections to determine the nurse managers' demographic characteristics, the career development practices at the facility where they worked, the nurse managers' responsibilities for career development and their expected competencies and recommendations. The findings of this study suggest that the most common technique used for nurses for career development was education programs, the career development practices of private hospitals were more developed than public hospitals and the nurse managers' perceptions about career development were different according to their management level, age group and educational level (p < 0.05). Although different practices were found in public and private hospitals in Turkey there were no effective career development practices identified and the nurse managers did not have agreement on the subject of career development. Hospitals which provide opportunity for horizontal and vertical promotion and have clear development policies will be successful hospitals which are preferred by high quality nurses. This study draws attention to the importance of career planning in nursing and the need for nurse managers to take an active role in career planning and development.

The contribution of hospital nursing leadership styles to 30-day patient mortality.

PubMed

Cummings, Greta G; Midodzi, William K; Wong, Carol A; Estabrooks, Carole A

2010-01-01

Nursing work environment characteristics, in particular nurse and physician staffing, have been linked to patient outcomes (adverse events and patient mortality). Researchers have stressed the need for nursing leadership to advance change in healthcare organizations to create safer practice environments for patients. The relationship between styles of nursing leadership in hospitals and patient outcomes has not been well examined. The purpose of this study was to examine the contribution of hospital nursing leadership styles to 30-day mortality after controlling for patient demographics, comorbidities, and hospital factors. Ninety acute care hospitals in Alberta, Canada, were categorized into five styles of nursing leadership: high resonant, moderately resonant, mixed, moderately dissonant, and high dissonant. In the secondary analysis, existing data from three sources (nurses, patients, and institutions) were used to test a hypothesis that the styles of nursing leadership at the hospital level contribute to patient mortality rates. Thirty-day mortality was 7.8% in the study sample of 21,570 medical patients; rates varied across hospital categories: high resonant (5.2%), moderately resonant (7.4%), mixed (8.1%), moderately dissonant (8.8%), and high dissonant (4.3%). After controlling for patient demographics, comorbidities, and institutional and hospital nursing characteristics, nursing leadership styles explained 5.1% of 72.2% of total variance in mortality across hospitals, and high-resonant leadership was related significantly to lower mortality. Hospital nursing leadership styles may contribute to 30-day mortality of patients. This relationship may be moderated by homogeneity of leadership styles, clarity of communication among leaders and healthcare providers, and work environment characteristics.

Abortion-care education in Japanese nurse practitioner and midwifery programs: a national survey.

PubMed

Mizuno, Maki

2014-01-01

While various reports have been published concerning ethical dilemmas in nursing and midwifery, and while many nurses and midwives struggle with the conflict between personal feelings raised by abortion and the duties of their position, few studies investigate the extent and conditions of abortion-care education for registered nurses (RNs) and certified nurse-midwives (CNMs) in Japan. To describe Japanese abortion-care education programs and to investigate program directors' or other relevant persons' perceptions of abortion-care education. Descriptive study was used to determine the extent of abortion-care education programs and the respondents' perceptions of abortion-care education. All 228 Japanese nursing and/or midwifery schools were invited to participate in the study. The response rate was 33.8% (n=77). Response rate varied by program type: 18.4% (n=45) for nursing programs and 29.0% (n=32) for midwifery programs. A confidential survey requesting information about curricular coverage of ten reproductive health topics related to abortion was mailed to program directors. The results show that the majority of CNM and RN programs surveyed offer didactic exposure to instruction in family planning and contraception, emergency contraception, legal considerations, and possible medical complications. However, few programs offer clinical exposure to all 10 topics. Of the respondents, 36% reported that lack of time and the low priority given to abortion-care education were issues of curriculum priority. As for educational materials, few textbooks or guidebooks exist on abortion care in Japan, and most educators use general nursing textbooks to cover this topic. Regardless of interest in or intention to provide abortion services as part of their practice, all providers of abortion-care education need to be knowledgeable about the full range of reproductive health options, including family planning and abortion, and to be able to convey this information to clients. Copyright © 2013 Elsevier Ltd. All rights reserved.

Nurse Engagement in Shared Governance and Patient and Nurse Outcomes.

PubMed

Kutney-Lee, Ann; Germack, Hayley; Hatfield, Linda; Kelly, Sharon; Maguire, Patricia; Dierkes, Andrew; Del Guidice, Mary; Aiken, Linda H

2016-11-01

The objectives of this study were to examine differences in nurse engagement in shared governance across hospitals and to determine the relationship between nurse engagement and patient and nurse outcomes. There is little empirical evidence examining the relationship between shared governance and patient outcomes. A secondary analysis of linked cross-sectional data was conducted using nurse, hospital, and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data. Engagement varied widely across hospitals. In hospitals with greater levels of engagement, nurses were significantly less likely to report unfavorable job outcomes and poor ratings of quality and safety. Higher levels of nurse engagement were associated with higher HCAHPS scores. A professional practice environment that incorporates shared governance may serve as a valuable intervention for organizations to promote optimal patient and nurse outcomes.

Attitudes of Japanese nursing personnel toward patients who have attempted suicide.

PubMed

Kishi, Yasuhiro; Kurosawa, Hisashi; Morimura, Hiroshi; Hatta, Kotaro; Thurber, Steven

2011-01-01

The aim of this study was to examine the attitudes among Japanese nurses together with their perceived need for training in relation to understanding the nature of suicidal behavior and preventive strategies. The Understanding Suicidal Patients scale together with additional questions reflecting training and the psychiatric treatment of suicide attempters were administered. A total of 323 nurses attended this study. Overall, the nurses thought patients who attempted suicide were not treated well. The nurses who worked in the psychiatric unit or had the experience in psychiatric nursing had more favorable attitudes toward suicidal patients and viewed themselves as having more relevant skill training in dealing with suicidal patients than those who did not. The nurses who worked at emergency care/intensive care unit were less likely to understand suicidal patients, and were less inclined to be sympathetic and to verbally interact with suicidal patients concerning their problems. The nurses who have confidence in the psychiatric care of suicidal patients, confidence in their own skills, and have a need for more training had the more positive attitudes. The results suggest that less favorable attitudes may to some extent be the result of lack of knowledge regarding suicidal patients. Future studies should focus on the evaluation of educational experiences on attitudes and skill acquisition of nurses. Copyright © 2011 Elsevier Inc. All rights reserved.

Social Support Behaviors and Work Stressors among Nurses: A Comparative Study between Teaching and Non-Teaching Hospitals

PubMed Central

Amarneh, Basil Hameed

2017-01-01

Purpose: The concept of “work stressors” has been well studied. However, in the field of nursing, studies concerning social support behaviors are limited. The aim of this study was to compare nurse work stressors, social support behaviors, and predictors of these variables among nurses in Jordanian teaching and non-teaching hospitals. Design: A convenience sampling technique and a comparative quantitative research design were used in the current study. Two hundred and ninety-one nurses were recruited from five teaching hospitals, and 172 were recruited from eight non-teaching hospitals in Jordan. Methods: The Nursing Stress Scale (NSS) and the Inventory of Social Supportive Behaviors (ISSB) were used to collect data. Results: The studied variables differed across hospitals. In some subscales, as well as in some individual items of the scales, nurse work stressors and social support behaviors differed between teaching and non-teaching hospitals. In teaching hospitals, the work shift was the only predictor of nurses’ work stressors, whereas the work shift and model of nursing care were predictors of social support behaviors. In non-teaching hospitals, the work shift, level of education, and model of nursing care were predictors of nurse work stressors. Predictors of social support behaviors were marital status, model of nursing, and organizational structure. Conclusions: Regardless of the type of hospital, nurse stressors should be assessed and, once identified, managed by providing various social support behaviors. Clinical relevance: By turning a work environment into a healthy workplace, researchers and nurse leaders believe that improvements can be realized in recruitment and patient safety and quality. PMID:28146045

Nursing diagnoses, diagnosis-related group, and hospital outcomes.

PubMed

Welton, John M; Halloran, Edward J

2005-12-01

There are no nursing centric data in the hospital discharge abstract. This study investigates whether adding nursing data in the form of nursing diagnoses to medical diagnostic data in the discharge abstract can improve overall explanation of variance in commonly studied hospital outcomes. A retrospective analyses of 123,241 sequential patient admissions to a university hospital in a Midwestern city was performed. Two data sets were combined: (1) a daily collection of patient assessments by nurses using nursing diagnosis terminology (NDX); and (2) the summary discharge information from the hospital discharge abstract including diagnosis-related group (DRG) and all payer refined DRG (APR-DRG). Each of 61 daily NDX observations were collapsed as frequency of occurrence for the hospital stay and inserted into the discharge abstract. NDX was then compared to both DRG and APR-DRG across 5 hospital outcome variables using multivariate regression or logistic regression. In all statistical models, DRG, APR-DRG, and NDX were significantly associated with the 5 hospital outcome variables (P <.0001). When NDX was added to models containing either the DRG or the APR-DRG, explanatory power (R2) and model discrimination (c statistic) improved by 30% to 146% across the outcome variables of hospital length of stay, ICU length of stay, total charges, probably of death, and discharge to a nursing home (P <.0001). The findings support the contention that nursing care is an independent predictor of patient hospital outcomes. These nursing data are not redundant with the medical diagnosis, in particular, the DRG. The findings support the argument for including nursing care data in the hospital discharge abstract. Further study is needed to clarify which nursing data are the best fit for the current hospital discharge abstract data collection scheme.

Avoiding mandatory hospital nurse staffing ratios: an economic commentary.

PubMed

Buerhaus, Peter I

2009-01-01

The imposition of mandatory hospital nurse staffing ratios is among the more visible public policy initiatives affecting the nursing profession. Although the practice is intended to address problems in hospital nurse staffing and quality of patient care, this commentary argues that staffing ratios will lead to negative consequences for nurses involving the equity, efficiency, and costs of producing nursing care in hospitals. Rather than spend time and effort attempting to regulate nurse staffing, this commentary offers alternatives strategies that are directed at fixing the problems that motivate the advocates of staffing ratios.

Quality of care and patient satisfaction in hospitals with high concentrations of black patients.

PubMed

Brooks-Carthon, J Margo; Kutney-Lee, Ann; Sloane, Douglas M; Cimiotti, Jeannie P; Aiken, Linda H

2011-09-01

To examine the influence of nursing-specifically nurse staffing and the nurse work environment-on quality of care and patient satisfaction in hospitals with varying concentrations of Black patients. Cross-sectional secondary analysis of 2006-2007 nurse survey data collected across four states (Florida, Pennsylvania, New Jersey, and California), the Hospital Consumer Assessment of Healthcare Providers and Systems survey, and administrative data. Global analysis of variance and linear regression models were used to examine the association between the concentration of Black patients on quality measures (readiness for discharge, patient or family complaints, health care-associated infections) and patient satisfaction, before and after accounting for nursing and hospital characteristics. Nurses working in hospitals with higher concentrations of Blacks reported poorer confidence in patients' readiness for discharge and more frequent complaints and infections. Patients treated in hospitals with higher concentrations of Blacks were less satisfied with their care. In the fully adjusted regression models for quality and patient satisfaction outcomes, the effects associated with the concentration of Blacks were explained in part by nursing and structural hospital characteristics. This study demonstrates a relationship between nursing, structural hospital characteristics, quality of care, and patient satisfaction in hospitals with high concentrations of Black patients. Consideration of nursing factors, in addition to other important hospital characteristics, is critical to understanding and improving quality of care and patient satisfaction in minority-serving hospitals. © 2011 Sigma Theta Tau International.

For love or money: registered nurses who return to hospital practice.

PubMed

Kent, Leslie N

2015-07-01

This commentary explores the value that returning nurses bring to the hospital setting. Nurses who have left hospital practice, usually due to family obligations, often return once the children are older. They return because they love nursing or they need to make money. They are at a point in their lives where they want to make a difference and miss the nurse-patient relationship. During recessions, nurses return to hospital practice because recessions tend to affect male dominated occupations. Research and policy literature on the returning and/or older nurse was reviewed with a focus on the benefits and challenges of having returning nurses in hospital practice. Returning nurses serve as role models to younger nurses. They also bring experiential knowledge to patient situations. There is limited research on this group of nurses. Yet they are ready for reentry in short order during nursing shortages. When they return, they add value to the hospital unit. Returning nurses want shorter workdays, alternative roles, and less physically taxing work. This can be achieved by offering flexible scheduling and work hours, creating niche roles and providing a more worker friendly physical environment. © 2014 John Wiley & Sons Ltd.

Nursing Matters.

ERIC Educational Resources Information Center

Adamson, Charles

A two-semester English-for-Special-Purposes (ESP) course designed for nursing students at a Japanese university is described, including the origins and development of the course, text development, and teaching methods. The content-based course was designed to meet licensure requirements for English language training, emphasized listening and…

Can Total Body Resistance Measured Using Bioelectrical Impedance Analysis Be the Index of Dehydration in Older Japanese Patients?

PubMed

Shimizu, Miyuki; Kinoshita, Kensuke; Maeno, Takami; Kobayashi, Hiroyuki; Maeno, Tetsuhiro

2017-11-01

Dehydration in older patients has long been considered a significant health problem because it implies increased morbidity and mortality. However, dehydration is detected by a combination of physical signs and blood tests. For older people dwelling at home and in nursing homes, a simple and non-invasive method for detecting dehydration by caregivers is needed. The total body resistance is measured using bioelectrical impedance analysis and is known as an indicator of dehydration. There are no data from older Japanese patients on this issue. We performed this study to examine the relationship between dehydration and total body resistance in Japan. We performed blood tests and measured bioelectrical impedance in older outpatients aged ≥ 65 years from the Internal Medicine Department at Mito Kyodo General Hospital. Patients were classified as dehydrated and non-dehydrated using the dehydration index with a blood urea nitrogen/creatinine ratio > 20, and the mean total body resistance was compared between the two groups. Eighty-one patients were recruited in the study. In the dehydrated group, the mean total body resistance was 439 Ω at 50 kHz, which was significantly higher than that in the non-dehydrated group (408 Ω, P = 0.038). The total body resistance measurements can be used for simple assessment of dehydration among older Japanese patients.

Model construction of nursing service satisfaction in hospitalized tumor patients.

PubMed

Chen, Yongyi; Liu, Jingshi; Xiao, Shuiyuan; Liu, Xiangyu; Tang, Xinhui; Zhou, Yujuan

2014-01-01

This study aims to construct a satisfaction model on nursing service in hospitalized tumor patients. Using questionnaires, data about hospitalized tumor patients' expectation, quality perception and satisfaction of hospital nursing service were obtained. A satisfaction model of nursing service in hospitalized tumor patients was established through empirical study and by structural equation method. This model was suitable for tumor specialized hospital, with reliability and validity. Patient satisfaction was significantly affected by quality perception and patient expectation. Patient satisfaction and patient loyalty was also affected by disease pressure. Hospital brand was positively correlated with patient satisfaction and patient loyalty, negatively correlated with patient complaint. Patient satisfaction was positively correlated with patient loyalty, patient complaints, and quality perception, and negatively correlated with disease pressure and patient expectation. The satisfaction model on nursing service in hospitalized tumor patients fits well. By this model, the quality of hospital nursing care may be improved.

Model construction of nursing service satisfaction in hospitalized tumor patients

PubMed Central

Chen, Yongyi; Liu, Jingshi; Xiao, Shuiyuan; Liu, Xiangyu; Tang, Xinhui; Zhou, Yujuan

2014-01-01

This study aims to construct a satisfaction model on nursing service in hospitalized tumor patients. Using questionnaires, data about hospitalized tumor patients’ expectation, quality perception and satisfaction of hospital nursing service were obtained. A satisfaction model of nursing service in hospitalized tumor patients was established through empirical study and by structural equation method. This model was suitable for tumor specialized hospital, with reliability and validity. Patient satisfaction was significantly affected by quality perception and patient expectation. Patient satisfaction and patient loyalty was also affected by disease pressure. Hospital brand was positively correlated with patient satisfaction and patient loyalty, negatively correlated with patient complaint. Patient satisfaction was positively correlated with patient loyalty, patient complaints, and quality perception, and negatively correlated with disease pressure and patient expectation. The satisfaction model on nursing service in hospitalized tumor patients fits well. By this model, the quality of hospital nursing care may be improved. PMID:25419410

Predictors of hospital nurses' intent to stay: a cross-sectional questionnaire survey in Shanghai, China.

PubMed

Wang, L; Tao, H; Ellenbecker, C H; Liu, X H

2012-12-01

To investigate predictors of hospital nurses' intent to stay in the nursing profession. A cross-sectional survey design was adopted. Over 1000 nurses working in hospitals in Shanghai, China, were invited to complete a survey questionnaire between May and October 2009 and 919 nurses responded for an 82% response rate. Regression models explained 41.3% of variance in nurse intent to stay. Although the proposed model hypothesized 18 predictors of intent to stay, only seven were statistically significant factors of nurse intent to stay: normative commitment, economic costs commitment, age, limited alternatives commitment, praise/recognition, professional advancement opportunities and the hospital classification. Of these, the strongest predictors were normative commitment, economic costs commitment and age, which explained 37.3% of variance in nurse intent to stay. Possible strategies to improve nurses' intent to stay include employment practices that improve the work environment, increased wages and benefits, and greater professional opportunity for nurses' personal growth development and promotion. Healthcare organizations should establish an asserting and nurturing environment for nurses and improve nurses' normative commitment and economic costs commitment. Increased effort should be made to improve nurses' conditions in primary and secondary hospitals where nurses report a lower level of intent to stay in nursing. Participants came from a limited number of hospitals in Shanghai. A larger sample from different hospitals in Shanghai and other districts in Mainland China could have enhanced the generalizability of the results and increased the power of the study. © 2012 The Authors. International Nursing Review © 2012 International Council of Nurses.

Application of Nursing Process and Its Affecting Factors among Nurses Working in Mekelle Zone Hospitals, Northern Ethiopia

PubMed Central

Hagos, Fisseha; Alemseged, Fessehaye; Balcha, Fikadu; Berhe, Semarya; Aregay, Alemseged

2014-01-01

Background. Nursing process is considered as appropriate method to explain the nursing essence, its scientific bases, technologies and humanist assumptions that encourage critical thinking and creativity, and permits solving problems in professional practice. Objective. To assess the application of nursing process and it's affecting factors in Mekelle Zone Hospitals. Methods. A cross sectional design employing quantitative and qualitative methods was conducted in Mekelle zone hospitals March 2011. Qualitative data was collected from14 head nurses of six hospitals and quantitative was collected from 200 nurses selected by simple random sampling technique from the six hospitals proportional to their size. SPSS version 16.1 and thematic analysis was used for quantitative and qualitative data respectively. Results. Majority 180 (90%) of the respondents have poor knowledge and 99.5% of the respondents have a positive attitude towards the nursing process. All of the respondents said that they did not use the nursing process during provision of care to their patients at the time of the study. Majority (75%) of the respondent said that the nurse to patient ratio was not optimal to apply the nursing process. Conclusion and Recommendation. The nursing process is not yet applied in all of the six hospitals. The finding revealed that the knowledge of nurses on the nursing process is not adequate to put it in to practice and high patient nurse ratio affects its application. The studied hospitals should consider the application of the nursing process critically by motivating nurses and monitor and evaluate its progress. PMID:24649360

Measuring effectiveness of electronic medical records systems: towards building a composite index for benchmarking hospitals.

PubMed

Otieno, George Ochieng; Hinako, Toyama; Motohiro, Asonuma; Daisuke, Koide; Keiko, Naitoh

2008-10-01

Many hospitals are currently in the process of developing and implementing electronic medical records (EMR) systems. This is a critical time for developing a framework that can measure and allow for comparison the effectiveness of EMR systems across hospitals that have implemented these systems. The motivation for this study comes from the realization that there is limited research on the understanding of the effectiveness of EMR systems, and a lack of appropriate reference theoretical framework for measuring the effectiveness of EMR systems. In this paper, we propose a conceptual framework for generating a composite index (CI) for measuring the effectiveness of EMR systems in hospitals. Data used to test the framework and associated research objectives were derived from a cross-sectional survey of five stakeholders of EMR systems including chief medical officers, chief nursing officers, chief information officers, doctors and nurses in 20 Japanese hospitals. Using statistical means of standardization and principal component analysis (PCA) procedure, CI was developed by summing up the scores of four dimensions-system quality, information quality, use and user satisfaction. The process included formulating items for each dimension, condensing the data into factors relevant to the dimension and calculating the CI by summing up the product of each dimension with its respective principal component score coefficient. The Cronbach's alpha for the four dimensions used in developing CI was .843. Validation of CI revealed that it was correlated to internal dimensions (system quality, R=.828; information quality, R=.909; use, R=.969; and user satisfaction, R=.679) and to external factors (JAHIS level, R=.832 and patient safety culture, R=.585). These results suggest that CI could be a reliable and valid measure of the effectiveness of EMR systems in the responding hospitals. On benchmarking of hospitals, 30.0% (6/20) of the responding hospitals performed less than satisfactory on CI and that majority of the hospitals performed poorly on user satisfaction. CI has provided a standard way, through quantitative means, of measuring, comparing and categorizing the effectiveness of EMR systems in hospitals. CI can be a powerful tool for benchmarking the effectiveness of EMR systems in hospitals in ways that can guide hospitals in computerization process as well as benchmark their systems against other hospitals.

A new type of rural nurse residency.

PubMed

Molinari, Deana L; Monserud, Maria; Hudzinski, Dionetta

2008-01-01

The Rural Nurse Internship program is a distance education-based nurse residency designed to meet the needs of rural hospitals across the country. Nurses learn to perform the generalist role by practicing crisis assessment and management in six subnursing specialties. The collaborative yearlong residency provides preceptors, mentors, monthly seminars, and just-in-time information to novice nurses in their own hospitals using instructional technologies. Expert rural nurses teach novice employees using a standardized curriculum. Hospitals individualize the program to meet employee and hospital needs.

Lessons from America? US magnet hospitals and their implications for UK nursing.

PubMed

Buchan, J

1994-02-01

This paper examines possible implications of the US 'magnet hospital' concept for the UK nursing labour market. Magnet hospitals have been researched in the US and have been demonstrated to exhibit lower nurse turnover and higher levels of reported job satisfaction than other hospitals. Key characteristics include a decentralized organizational structure, a commitment to flexible working hours, an emphasis on professional autonomy and development, and systematic communication between management and staff. The paper examines the labour market characteristics of UK nurses and US nurses and finds many similarities. Detailed case studies of employment practice in 10 US hospitals and 10 Scottish hospitals are reported, with specific attention to remuneration practice, methods of organizing nursing care, establishment-setting and flexible hours. The paper concludes that there are features of the magnet hospital concept which are of relevance and applicable to the UK nursing labour market, but that piecemeal importation of ideas is unlikely to be beneficial.

Nurse Engagement in Shared Governance and Patient and Nurse Outcomes

PubMed Central

Kutney-Lee, Ann; Germack, Hayley; Hatfield, Linda; Kelly, Sharon; Maguire, Patricia; Dierkes, Andrew; Guidice, Mary Del; Aiken, Linda H.

2016-01-01

Objective The objective of this study was to examine differences in nurse engagement in shared governance across hospitals and to determine the relationship between nurse engagement and patient and nurse outcomes. Background There is little empirical evidence examining the relationship between shared governance and patient outcomes. Methods A secondary analysis of linked cross-sectional data was conducted using nurse, hospital, and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data. Results Engagement varied widely across hospitals. In hospitals with greater levels of engagement, nurses were significantly less likely to report unfavorable job outcomes and poor ratings of quality and safety. Higher levels of nurse engagement were associated with higher HCAHPS scores. Conclusions A professional practice environment that incorporates shared governance may serve as a valuable intervention for organizations to promote optimal patient and nurse outcomes. PMID:27755212

Illness Severity and Psychiatric Hospitalization Rates Among Asian Americans and Pacific Islanders

PubMed Central

Sentell, Tetine; Unick, George Jay; Ahn, Hyeong Jun; Braun, Kathryn L.; Miyamura, Jill; Shumway, Martha

2015-01-01

Objective The study objective was to fill research gaps about inpatient psychiatric service utilization among Asian Americans and Pacific Islanders (AA/PIs). Methods Rates of psychiatric hospitalization, illness severity, and length of stay were compared among AA/PI adults overall and across diagnoses (schizophrenia, depression, bipolar, anxiety, and other psychiatric disorders identified by All Patient Refined Diagnosis Related Groups) by using discharge data from all hospitalizations in Hawaii from December 2006 to 2010. Multivariable models adjusted for gender, age, payer, and residence. Results In multivariable analyses of total psychiatric hospitalizations, Chinese (rate ratio [RR]=.22), Japanese (RR=.23), Filipinos (RR=.30), and Native Hawaiians (RR=.37) had significantly lower rates than whites. Native Hawaiians had significantly higher hospitalization rates compared with other AA/PI groups. Length of stay was significantly longer for Chinese (length of stay ratio [LOSR]=1.53), Filipinos (LOSR=1.20), and Japanese (LOSR=1.19) compared with whites, whereas severity of illness was significantly higher for Japanese (odds ratio [OR]=1.36) and Filipinos (OR=1.30). Within specific diagnoses, Native Hawaiians had higher hospitalization rates than other AA/PI groups for depression, bipolar disorder, and anxiety disorder. Chinese, Japanese, and Filipinos had significantly higher illness severity or longer stays than whites for at least one diagnostic category. Conclusions AA/PI subgroups had lower psychiatric hospitalization rates than whites, but rates varied across AA/PI subgroups. Native Hawaiians had higher hospitalization rates for many diagnoses. Chinese, Japanese, and Filipinos had greater illness severity or longer stays than whites overall and for some diagnoses, whereas Native Hawaiians did not. Disaggregating AA/PI groups provides important insight into mental health services utilization and need. PMID:23945849

Illness severity and psychiatric hospitalization rates among Asian Americans and Pacific Islanders.

PubMed

Sentell, Tetine; Unick, George Jay; Ahn, Hyeong Jun; Braun, Kathryn L; Miyamura, Jill; Shumway, Martha

2013-11-01

OBJECTIVE The study objective was to fill research gaps about inpatient psychiatric service utilization among Asian Americans and Pacific Islanders (AA/PIs). METHODS Rates of psychiatric hospitalization, illness severity, and length of stay were compared among AA/PI adults overall and across diagnoses (schizophrenia, depression, bipolar, anxiety, and other psychiatric disorders identified by All Patient Refined Diagnosis Related Groups) by using discharge data from all hospitalizations in Hawaii from December 2006 to 2010. Multivariable models adjusted for gender, age, payer, and residence. RESULTS In multivariable analyses of total psychiatric hospitalizations, Chinese (rate ratio [RR]=.22), Japanese (RR=.23), Filipinos (RR=.30), and Native Hawaiians (RR=.37) had significantly lower rates than whites. Native Hawaiians had significantly higher hospitalization rates compared with other AA/PI groups. Length of stay was significantly longer for Chinese (length of stay ratio [LOSR]=1.53), Filipinos (LOSR=1.20), and Japanese (LOSR=1.19) compared with whites, whereas severity of illness was significantly higher for Japanese (odds ratio [OR]=1.36) and Filipinos (OR=1.30). Within specific diagnoses, Native Hawaiians had higher hospitalization rates than other AA/PI groups for depression, bipolar disorder, and anxiety disorder. Chinese, Japanese, and Filipinos had significantly higher illness severity or longer stays than whites for at least one diagnostic category. CONCLUSIONS AA/PI subgroups had lower psychiatric hospitalization rates than whites, but rates varied across AA/PI subgroups. Native Hawaiians had higher hospitalization rates for many diagnoses. Chinese, Japanese, and Filipinos had greater illness severity or longer stays than whites overall and for some diagnoses, whereas Native Hawaiians did not. Disaggregating AA/PI groups provides important insight into mental health services utilization and need.

Turnover of registered nurses in Israel: characteristics and predictors.

PubMed

Toren, Orly; Zelker, Revital; Lipschuetz, Michal; Riba, Shoshana; Reicher, Sima; Nirel, Nurit

2012-05-01

In an era of global and local nursing shortages, nursing turnover has negative consequences in terms of diminished quality of care, increased costs and economic losses and decreased job satisfaction. To examine the turnover rate of registered nurses in Israel by assessing the varying degree of turnover between economic sectors, between hospital and community facilities, and/or between types of hospitals; and by examining potential predicting factors of turnover among registered nurses. A national phone survey was undertaken in Israel consisting of a random sampling of registered nurses of working age (up to age 60). The subjects comprised 10% of a national database of 32,000 registered nurses. The turnover rate among working nurses in Israel currently stands at 23%. In addition, 13% of employed nurses have taken a temporary leave of absence for a period greater than 6 months in the past 10 years, most up to 1 year. While job satisfaction rates were relatively high (72%), Professional satisfaction rates were 60% with no significant difference between hospital and community nurses. The turnover rate of registered nurses from a hospital setting to the community was significantly higher (p<.01) than that of community registered nurses to hospitals. Predicting factors of turnover were found to be: young age, part-time work, lack of advanced professional education, academic education and low satisfaction with the nursing profession. The shift of nursing workforce is mainly from hospitals to community health settings. There is a need to monitor and understand the characteristics of job and professional satisfaction among hospital nurses in order to implement crucial organizational interventions and retain hospital nursing staffs. Since young nurses, nurses working part time and nurses with no advanced professional and academic education, tend to move more than others, efforts should be targeted at these specific groups. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Understanding Clinical Expertise: Nurse Education, Experience, and the Hospital Context

PubMed Central

McHugh, Matthew D.; Lake, Eileen T.

2010-01-01

Clinical nursing expertise is central to quality patient care. Research on factors that contribute to expertise has focused largely on individual nurse characteristics to the exclusion of contextual factors. To address this, we examined effects of hospital contextual factors and individual nurse education and experience on clinical nursing expertise in a cross-sectional analysis of data from 8,611 registered nurses. In a generalized ordered logistic regression analysis, the composition of the hospital staff, particularly the proportion of nurses with at least a bachelor of science in nursing degree, was associated with significantly greater odds of a nurse reporting a more advanced expertise level. Our findings suggest that, controlling for individual characteristics, the hospital context significantly influences clinical nursing expertise. PMID:20645420

What Are Nursing Facilities Doing to Reduce Potentially Avoidable Hospitalizations?

PubMed

Daras, Laura Coots; Wang, Joyce M; Ingber, Melvin J; Ormond, Catherine; Breg, Nathaniel W; Khatutsky, Galina; Feng, Zhanlian

2017-05-01

Hospitalizations among nursing facility residents are frequent and often potentially avoidable. A number of initiatives and interventions have been developed to reduce excessive hospitalizations; however, little is known about the specific approaches nursing facilities use to address this issue. The objective of this study is to better understand which types of interventions nursing facilities have introduced to reduce potentially avoidable hospitalizations of long-stay nursing facility residents. Cross-sectional survey. 236 nursing facilities from 7 states. Nursing facility administrators. Web-based survey to measure whether facilities introduced any policies or procedures designed specifically to reduce potentially avoidable hospitalizations of long-stay nursing facility residents between 2011 and 2015. We surveyed facilities about seven types of interventions and quality improvement activities related to reducing avoidable hospitalizations, including use of Interventions to Reduce Acute Care Transfers (INTERACT) and American Medical Directors Association tools. Ninety-five percent of responding nursing facilities reported having introduced at least one new policy or procedure to reduce nursing facility resident hospitalizations since January 2011. The most common practice reported was hospitalization rate tracking or review, followed by standardized communication tools, such as Situation, Background, Assessment, Recommendation (SBAR). We found some variation in the extent and types of these reported interventions. Nearly all facilities surveyed reported having introduced a variety of initiatives to reduce potentially avoidable hospitalizations, likely driven by federal, state, and corporate initiatives to decrease hospital admissions and readmissions. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. All rights reserved.

Association of Nurse Engagement and Nurse Staffing on Patient Safety.

PubMed

Brooks Carthon, J Margo; Hatfield, Linda; Plover, Colin; Dierkes, Andrew; Davis, Lawrence; Hedgeland, Taylor; Sanders, Anne Marie; Visco, Frank; Holland, Sara; Ballinghoff, Jim; Del Guidice, Mary; Aiken, Linda H

2018-06-08

Nurse engagement is a modifiable element of the work environment and has shown promise as a potential safety intervention. Our study examined the relationship between the level of engagement, staffing, and assessments of patient safety among nurses working in hospital settings. A secondary analysis of linked cross-sectional data was conducted using survey data of 26 960 nurses across 599 hospitals in 4 states. Logistic regression models were used to examine the association between nurse engagement, staffing, and nurse assessments of patient safety. Thirty-two percent of nurses gave their hospital a poor or failing patient safety grade. In 25% of hospitals, nurses fell in the least or only somewhat engaged categories. A 1-unit increase in engagement lowered the odds of an unfavorable safety grade by 29% (P < .001). Hospitals where nurses reported higher levels of engagement were 19% (P < .001) less likely to report that mistakes were held against them. Nurses in poorly staffed hospitals were 6% more likely to report that important information about patients "fell through the cracks" when transferring patients across units (P < .001). Interventions to improve nurse engagement and adequate staffing serve as strategies to improve patient safety.

Clinical Characteristics, Management, and Outcomes of Japanese Patients Hospitalized for Heart Failure With Preserved Ejection Fraction　- A Report From the Japanese Heart Failure Syndrome With Preserved Ejection Fraction (JASPER) Registry.

PubMed

Nagai, Toshiyuki; Yoshikawa, Tsutomu; Saito, Yoshihiko; Takeishi, Yasuchika; Yamamoto, Kazuhiro; Ogawa, Hisao; Anzai, Toshihisa

2018-05-25

Despite the specific characteristics of heart failure with preserved ejection fraction (HFpEF) having been demonstrated predominantly from registries in Western countries, important international differences exist in terms of patient characteristics, management and medical infrastructure between Western and Asian countries.Methods and Results:We performed nationwide registration of consecutive Japanese hospitalized HFpEF patients with left ventricular EF ≥50% from 15 sites between November 2012 and March 2015. Follow-up data were obtained up to 2 years post-discharge. A total of 535 patients were registered. The median age was 80 years and 50% were female. The most common comorbid conditions were hypertension (77%) and atrial fibrillation (AF: 62%), but body mass index was relatively low. In-hospital mortality rate was 1.3% and the median length of hospitalization was 16 days. By 2 years post-discharge, 40.8% of patients had all-cause death or HF hospitalization. Approximately one-half of deaths had a cardiac cause. Lower serum albumin on admission was one of the strongest independent determinants of worse clinical outcome. Japanese HFpEF patients were less obese, but had a substantially higher prevalence of AF and lower incidence of subsequent events compared with previous reports. Our findings indicated that specific preventative and therapeutic strategies focusing on AF and nutritional status might need to be considered for Japanese hospitalized patients with HFpEF.

Nurses' Perceptions Regarding the Prevalence, Detection, and Causes of Malnutrition in Canadian Hospitals: Results of a Canadian Malnutrition Task Force Survey.

PubMed

Duerksen, Donald R; Keller, Heather H; Vesnaver, Elisabeth; Laporte, Manon; Jeejeebhoy, Khursheed; Payette, Hélène; Gramlich, Leah; Bernier, Paule; Allard, Johane P

2016-01-01

Given the high prevalence of malnutrition in hospitalized patients, nurses frequently encounter patients with significantly impaired nutrition status. The objective of this study was to determine nurses' attitudes and perceptions regarding the prevalence, detection, and causes of malnutrition in Canadian tertiary care and community hospitals. In this descriptive study, a survey that focused on guidelines for nutrition support of hospitalized patients was completed by Canadian nurses working on medical and surgical wards in 11 hospitals participating in the Canadian Malnutrition Task Force study. The survey was completed by 346 of 723 nurses (response rate 48%). Over 50% of nurses underestimated the documented prevalence of malnutrition in hospitalized patients. Nurses considered identification of malnourished patients very relevant (mean 8.4 on a 10-point scale) and would integrate a 3-question nutrition screen into their admission histories (92.5%). Nurses perceived lack of assistance with eating as a significant contributor to hospital malnutrition (17% felt this was a major contributor). While only 39% of nurses reported access to nutrition-related education, 92% were interested in receiving this form of updating. Nurses consider nutrition assessment important and relevant and require access to training to improve their capacity to detect malnutrition in their patients. Nurses are vital to the nutrition care of hospitalized patients and are well positioned to screen for nutrition risk and assist in nutrition management. The role of nurses in nutrition care needs to be linked to hospital policy. © 2014 American Society for Parenteral and Enteral Nutrition.

Nurses caring for ENT patients in a district general hospital without a dedicated ENT ward score significantly less in a test of knowledge than nurses caring for ENT patients in a dedicated ENT ward in a comparable district general hospital.

PubMed

Foxton, C R; Black, D; Muhlschlegel, J; Jardine, A

2014-12-01

To assess whether there is a difference in ENT knowledge amongst nurses caring for patients on a dedicated ENT ward and nurses caring for ENT patients in a similar hospital without a dedicated ENT ward. A test of theoretical knowledge of ENT nursing care was devised and administered to nurses working on a dedicated ENT ward and then to nurses working on generic non-subspecialist wards regularly caring for ENT patients in a hospital without a dedicated ENT ward. The test scores were then compared. A single specialist ENT/Maxillo-Facial/Opthalmology ward in hospital A and 3 generic surgical wards in hospital B. Both hospitals are comparable district general hospitals in the south west of England. Nursing staff working in hospital A and hospital B on the relevant wards were approached during the working day. 11 nurses on ward 1, 10 nurses on ward 2, 11 nurses on ward 3 and 10 nurses on ward 4 (the dedicated ENT ward). Each individual test score was used to generate an average score per ward and these scores compared to see if there was a significant difference. The average score out of 10 on ward 1 was 6.8 (+/-1.6). The average score on ward two was 4.8 (+/-1.6). The average score on ward three was 5.5 (+/-2.1). The average score on ward 4, which is the dedicated ENT ward, was 9.7 (+/-0.5). The differences in average test score between the dedicated ENT ward and all of the other wards are statistically significant. Nurses working on a dedicated ENT ward have an average higher score in a test of knowledge than nurses working on generic surgical wards. This difference is statistically significant and persists despite banding or training. © 2014 John Wiley & Sons Ltd.

Correlates and predictors of missed nursing care in hospitals.

PubMed

Bragadóttir, Helga; Kalisch, Beatrice J; Tryggvadóttir, Gudný Bergthora

2017-06-01

To identify the contribution of hospital, unit, staff characteristics, staffing adequacy and teamwork to missed nursing care in Iceland hospitals. A recently identified quality indicator for nursing care and patient safety is missed nursing care defined as any standard, required nursing care omitted or significantly delayed, indicating an error of omission. Former studies point to contributing factors to missed nursing care regarding hospital, unit and staff characteristics, perceptions of staffing adequacy as well as nursing teamwork, displayed in the Missed Nursing Care Model. This was a quantitative cross-sectional survey study. The samples were all registered nurses and practical nurses (n = 864) working on 27 medical, surgical and intensive care inpatient units in eight hospitals throughout Iceland. Response rate was 69·3%. Data were collected in March-April 2012 using the combined MISSCARE Survey-Icelandic and the Nursing Teamwork Survey-Icelandic. Descriptive, correlational and regression statistics were used for data analysis. Missed nursing care was significantly related to hospital and unit type, participants' age and role and their perception of adequate staffing and level of teamwork. The multiple regression testing of Model 1 indicated unit type, role, age and staffing adequacy to predict 16% of the variance in missed nursing care. Controlling for unit type, role, age and perceptions of staffing adequacy, the multiple regression testing of Model 2 showed that nursing teamwork predicted an additional 14% of the variance in missed nursing care. The results shed light on the correlates and predictors of missed nursing care in hospitals. This study gives direction as to the development of strategies for decreasing missed nursing care, including ensuring appropriate staffing levels and enhanced teamwork. By identifying contributing factors to missed nursing care, appropriate interventions can be developed and tested. © 2016 John Wiley & Sons Ltd.

Hospitals with higher nurse staffing had lower odds of readmissions penalties than hospitals with lower staffing.

PubMed

McHugh, Matthew D; Berez, Julie; Small, Dylan S

2013-10-01

The Affordable Care Act's Hospital Readmissions Reduction Program (HRRP) penalizes hospitals based on excess readmission rates among Medicare beneficiaries. The aim of the program is to reduce readmissions while aligning hospitals' financial incentives with payers' and patients' quality goals. Many evidence-based interventions that reduce readmissions, such as discharge preparation, care coordination, and patient education, are grounded in the fundamentals of basic nursing care. Yet inadequate staffing can hinder nurses' efforts to carry out these processes of care. We estimated the effect that nurse staffing had on the likelihood that a hospital was penalized under the HRRP. Hospitals with higher nurse staffing had 25 percent lower odds of being penalized compared to otherwise similar hospitals with lower staffing. Investment in nursing is a potential system-level intervention to reduce readmissions that policy makers and hospital administrators should consider in the new regulatory environment as they examine the quality of care delivered to US hospital patients.

Nurse-physician collaboration impacts job satisfaction and turnover among nurses: A hospital-based cross-sectional study in Beijing.

PubMed

Zhang, Lin; Huang, Lei; Liu, Meng; Yan, Hong; Li, Xiue

2016-06-01

This study aims to explore the impact of physician-nurse collaboration on nurse job satisfaction and turnover in a dental hospital. Physician-nurse collaboration is important for the stability of the entire nursing team. Few studies have shown the impact on job satisfaction and turnover among nurses working in Chinese dental hospitals. This was a prospective, cross-sectional study and investigated nurses from a tertiary dental hospital in Beijing using convenience non-randomized sampling. A structured questionnaire was used to collect data, which included general information, the Index of Work Satisfaction, the Nurse-Physician Collaboration Scale and the Turnover Intention Scale. The scores of physician-nurse collaboration correlated positively with those for job satisfaction and negatively with the stated likelihood of turnover intention. Physician-nurse collaboration scores positively predicted job satisfaction and negatively predicted the likelihood of quitting the current job. In conclusion, improving the level of physician-nurse collaboration is helpful to enhance job satisfaction and reduce turnover among nurses in a dental hospital. © 2016 John Wiley & Sons Australia, Ltd.

[Development and Testing of the Taiwanese Hospital Nurses' Job Satisfaction Scale].

PubMed

Tzeng, Wen-Chii; Lin, Chiou-Fen; Lin, Lih-Ying; Lu, Meei-Shiow; Chiang, Li-Chi

2017-04-01

In the context of professional nursing, the concept of job satisfaction includes the degree to which a nurse is satisfied with the nursing profession, his/her personal adaptation to this profession, and his/her current working environment. No validated scale that addresses the job satisfaction of nurses working in hospitals currently exists in Taiwan. To develop a reliable and validated scale for measuring the job satisfaction of hospital nurses in Taiwan. A three-phase, cross-sectional study design was used. First, a literature review and expert focus group discussion were conducted to develop the initial scale items. Second, experts were invited to validate the content of the draft scale. Finally, convenience sampling was used to recruit 427 hospital nurses from 6 hospitals. These nurses completed the scale and the results were analyzed using item analysis, factor analysis, and internal consistency analysis. The 31-item Taiwanese hospital nurse job satisfaction scale developed in the present study addresses 5 factors, including supportive working environment, professional autonomy and growth, interpersonal interaction and collaboration, leadership style, and nursing workload. The overall Cronbach's α was .96. The results indicate that the developed scale provides good reliability and validity. This study confirms the validity and reliability of the developed scale. It may be used to measure the job satisfaction of nurses working in hospitals.

[War Relief of Japanese Red Cross Nurses in the Lost Battle of Burma].

PubMed

Kawahara, Yukari

2015-12-01

This paper aims to reveal changes in the relief support of the Japanese Red Cross relief units dispatched to Burma during the Second World War, from the beginning of fighting in Burma to the Japanese withdrawal. Japanese Red Cross relief units began their relief support when Japan invaded Burma in February of 1942. Counterattacks by the British, Indian and Chinese armies from December 1942 caused an increase in the number of patients. There were also many cases of malnutrition and malaria due to the extreme shortage of medical supplies as a result of the Battle of Imphal, which began in March of 1944. Bomb raids became even more intense after the battle ended in July 1944, and patients were carried into bomb shelters and caves on a daily basis. Just prior to invasion by enemy troops, they were ordered to evacuate to neighboring Thailand. Nurses from the Wakayama group hid their identity as members of the Red Cross and evacuated, with 15 out of 23 dying or being reported missing in action.

Using Publicly Reported Nursing-Sensitive Screening Indicators to Measure Hospital Performance: The Netherlands Experience in 2011.

PubMed

Stalpers, Dewi; van der Linden, Dimitri; Kaljouw, Marian J; Schuurmans, Marieke J

2016-01-01

Deliberate screening allows detection of health risks that are otherwise not noticeable and allows expedient intervention to minimize complications and optimize outcomes, especially during critical events like hospitalization. Little research has evaluated the usefulness of screening performance and outcome indicators as measures to differentiate nursing quality, although policymakers are using them to benchmark hospitals. The aims of this study were to examine hospital performance based on nursing-sensitive screening indicators and to assess associations with hospital characteristics and nursing-sensitive outcomes for patients. A secondary use of nursing-sensitive data from the Dutch Health Care Inspectorate was performed, including the mandatory screening and outcome indicators related to delirium, malnutrition, pain and pressure ulcers. The sample consisted of all 93 hospitals in the Netherlands in 2011. High- and low-performing hospitals were determined based on the overall proportion of screened patients. Descriptive statistics and analysis of variance were used to examine screening performances in relation to hospital characteristics and nursing-sensitive outcomes. Over all hospitals, the average screening rates ranged from 59% (delirium) to 94% (pain). Organizational characteristics were not different in high- and low-performing hospitals. The hospitals with the best overall screening performances had significantly better results regarding protein intake within malnourished patients (p < .01). For mortality, marginal significant effects did not remain after controlling for organizational structures. No associations were found with prevalence of pressure ulcers and patient self-reported pain scores. The screening for patient risks is an important nursing task. Our findings suggest that nursing-sensitive screening indicators may be relevant measures for benchmarking nursing quality in hospitals. Time-trend studies are required to support our findings and to further investigate relations with nursing-sensitive outcomes.

The Swedish version of the Frommelt Attitude Toward Care of the Dying scale: aspects of validity and factors influencing nurses' and nursing students' attitudes.

PubMed

Henoch, Ingela; Browall, Maria; Melin-Johansson, Christina; Danielson, Ella; Udo, Camilla; Johansson Sundler, Annelie; Björk, Maria; Ek, Kristina; Hammarlund, Kina; Bergh, Ingrid; Strang, Susann

2014-01-01

Nurses' attitudes toward caring for dying persons need to be explored. The Frommelt Attitude Toward Care of the Dying (FATCOD) scale has not previously been used in Swedish language. The objectives of this study were to compare FATCOD scores among Swedish nurses and nursing students with those from other languages, to explore the existence of 2 subscales, and to evaluate influences of experiences on attitudes toward care of dying patients. A descriptive, cross-sectional, and predictive design was used. The FATCOD scores of Swedish nurses from hospice, oncology, surgery clinics, and palliative home care and nursing students were compared with published scores from the United States, Israel, and Japan. Descriptive statistics, t tests, and factor and regression analyses were used. The sample consisted of 213 persons: 71 registered nurses, 42 enrolled nurses, and 100 nursing students. Swedish FATCOD mean scores did not differ from published means from the United States and Israel, but were significantly more positive than Japanese means. In line with Japanese studies, factor analyses yielded a 2-factor solution. Total FATCOD and subscales had low Cronbach α's. Hospice and palliative team nurses were more positive than oncology and surgery nurses to care for dying patients. Although our results suggest that the Swedish FATCOD may comprise 2 distinct scales, the total scale may be the most adequate and applicable for use in Sweden. Professional experience was associated with nurses' attitudes toward caring for dying patients. Care culture might influence nurses' attitudes toward caring for dying patients; the benefits of education need to be explored.

Influence of the Nursing Practice Environment on Job Satisfaction and Turnover Intention

PubMed Central

Lee, Sang-Yi; Kim, Chul-Woung; Kang, Jeong-Hee; Yoon, Tae-Ho; Kim, Cheoul Sin

2014-01-01

Objectives: To examine whether the nursing practice environment at the hospital-level affects the job satisfaction and turnover intention of hospital nurses. Methods: Among the 11 731 nurses who participated in the Korea Health and Medical Workers’ Union’s educational program, 5654 responded to our survey. Data from 3096 nurses working in 185 general inpatient wards at 60 hospitals were analyzed using multilevel logistic regression modeling. Results: Having a standardized nursing process (odds ratio [OR], 4.21; p<0.001), adequate nurse staffing (OR, 4.21; p<0.01), and good doctor-nurse relationship (OR, 4.15; p<0.01), which are hospital-level variables based on the Korean General Inpatients Unit Nursing Work Index (KGU-NWI), were significantly related to nurses’ job satisfaction. However, no hospital-level variable from the KGU-NWI was significantly related to nurses’ turnover intention. Conclusions: Favorable nursing practice environments are associated with job satisfaction among nurses. In particular, having a standardized nursing process, adequate nurse staffing, and good doctor-nurse relationship were found to positively influence nurses’ job satisfaction. However, the nursing practice environment was not related to nurses’ turnover intention. PMID:25284197

Why Bangladeshi nurses avoid 'nursing': social and structural factors on hospital wards in Bangladesh.

PubMed

Hadley, Mary B; Blum, Lauren S; Mujaddid, Saraana; Parveen, Shahana; Nuremowla, Sadid; Haque, Mohammad Enamul; Ullah, Mohammad

2007-03-01

In response to concerns that nurses spend less than 6% of their time on direct patient care, this study explored factors that influence nurses' behaviour in the provision of 'hands on' care in hospitals in Bangladesh. Through in-depth interviews with female nurses and patients and their co-workers in six hospitals, we identified conflicts between the inherited British model of nursing and Bangladeshi societal norms. This was most evident in the areas of night duty, contact with strangers, and involvement in 'dirty' work. The public was said to associate nursing activities with commercial sex work. As a consequence, their value on the 'bride market' decreases. To minimise the stigma associated with their profession, nurses in government hospitals distance themselves from patients, using nurse surrogates in the form of patients' relatives and hospital support workers to carry out their work. These adaptations are supported and sustained through unofficial activities developed over time within hospitals. In contrast nurses in NGO hospitals give more direct patient care themselves and do not rely on carers as much because of tight supervision and limited visitor hours. Initiatives undertaken to improve the quality of patient care, such as enlarging the nursing workforce or providing clinical instruction, which do not take into account the prevailing culture in hospitals and social conflicts faced by nurses, are unlikely to succeed. Fundamental decisions on how to care for the sick in Bangladesh are required. If the present nursing curriculum is followed, adequate supplies, supervision and accountability are prerequisites for its implementation.

42 CFR 409.12 - Nursing and related services, medical social services; use of hospital or CAH facilities.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Nursing and related services, medical social... Inpatient Hospital Services and Inpatient Critical Access Hospital Services § 409.12 Nursing and related... (b) of this section, Medicare pays for nursing and related services, use of hospital or CAH...

42 CFR 409.12 - Nursing and related services, medical social services; use of hospital or CAH facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Nursing and related services, medical social... Inpatient Hospital Services and Inpatient Critical Access Hospital Services § 409.12 Nursing and related... (b) of this section, Medicare pays for nursing and related services, use of hospital or CAH...

42 CFR 409.12 - Nursing and related services, medical social services; use of hospital or CAH facilities.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Nursing and related services, medical social... Inpatient Hospital Services and Inpatient Critical Access Hospital Services § 409.12 Nursing and related... (b) of this section, Medicare pays for nursing and related services, use of hospital or CAH...

42 CFR 409.12 - Nursing and related services, medical social services; use of hospital or CAH facilities.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Nursing and related services, medical social... Inpatient Hospital Services and Inpatient Critical Access Hospital Services § 409.12 Nursing and related... (b) of this section, Medicare pays for nursing and related services, use of hospital or CAH...

42 CFR 409.12 - Nursing and related services, medical social services; use of hospital or CAH facilities.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Nursing and related services, medical social... Inpatient Hospital Services and Inpatient Critical Access Hospital Services § 409.12 Nursing and related... (b) of this section, Medicare pays for nursing and related services, use of hospital or CAH...

Nurses' perceptions of the organizational attributes of their practice environment in acute care hospitals.

PubMed

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

2009-12-01

The aim of the present study was to examine Estonian nurses' thinking with regard to how they perceive their autonomy, control over practice, teamwork and organizational support in regional, central and general hospitals. BACKGROUND; Despite the well-documented fact that there is a need to improve nurses' working environments in hospitals to promote safe patient care, in Europe broader studies on this topic have not received priority thus far. A nationally representative stratified random sample of 478 acute care hospital nurses was surveyed using the Nursing Work Index-Revised (NWI-R) instrument in 2005/2006. Nurses perceived their autonomy, control over practice and organizational support remarkably lower than nurse-physician relationships. Age and tenure were highly related to the nurses' perceptions. The Estonian nurses' ambivalent perceptions of the organizational attributes reflected the effects ascribed to hospital reforms. There is an urgent need for nurse managers to be particularly alert and attentive with regard to nurses who have been practising the profession for more than a decade. Support for their practice should be provided with the long-term goal of assuring the retention of those experienced nurses. Continuous monitoring of nurses' perceptions should be used systematically as a tool for staffing decisions at the hospital level.

Association between home-visit nursing utilization and all-cause hospitalization among long-term care insurance beneficiaries: A retrospective cohort study.

PubMed

Ju, Yeong Jun; Lee, Hyo Jung; Kim, Woorim; Lee, Sang Ah; Han, Kyu-Tae; Park, Eun-Cheol

2017-10-01

Ensuring and improving long-term care services that use limited healthcare resources more efficiently is a major concern for many aging societies. The aim of this study was to investigate the relationship between use of home-visit nursing services and all-cause hospitalization in a home-visit nursing-recommended group. A retrospective cohort study. Population-based sample of long-term care insurance beneficiaries from the long-term care insurance 2002-2013 claims database in South Korea. Long-term care insurance beneficiaries who need one or more types of nursing care were defined as the home-visit nursing -recommended group (n=4173). The dependent variable in this study was all-cause hospitalization in the home-visit nursing-recommended population. Multivariate Cox proportional hazards regression analysis was used to identify the association between home-visit nursing service use and all-cause hospitalization. A total of 3.8% of the subjects used home-visit nursing services. When participants who used home-visit nursing services were set as the reference group, participants who did not use home-visit nursing services had a higher risk of hospitalization (hazard ratio [HR]=1.25, 95% confidence interval [CI]=1.07-1.47). Additionally, participants who did not use home-visit nursing services and who did not have a caregiver showed a marked increase in the risk of hospitalization (HR=6.81, 95% CI=1.17-39.66). Participants who did not use home-visit nursing services with greater comorbidity showed a considerable increase in risk of hospitalization (HR=1.36, 95% CI=1.09-1.70). Non-use of home-visit nursing services was associated with an increased risk of all-cause hospitalization in the home-visit nursing-recommended population. The present results suggest that the use of home-visit nursing services reduced the risk of hospitalization. Moreover, home-visit nursing may play an essential role in reducing hospitalization risk in the absence of caregiver support. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Service productivity in hospital nursing--conceptual framework of a productivity analysis].

PubMed

Thomas, D; Borchert, M; Brockhaus, N; Jäschke, L; Schmitz, G; Wasem, J

2015-01-01

Decreasing staff numbers compounded by an increasing number of cases is regarded as main challenge in German hospital nursing. These input reductions accompanied by output extensions imply that hospital nursing services have had to achieve a continuous productivity growth in the recent years. Appropriately targeted productivity enhancements require approved and effective methods for productivity acquisition and measurement. However, there is a lack of suitable productivity measurement instruments for hospital nursing services. This deficit is addressed in the present study by the development of an integrated productivity model for hospital nursing services. Conceptually, qualitative as well as quantitative aspects of nursing services productivity are equally taken into consideration. Based on systematic literature reviews different conceptual frameworks of service productivity and the current state of research in hospital nursing services productivity were analysed. On this basis nursing sensitive inputs, processes and outputs were identified and integrated into a productivity model. As an adequate framework for a hospital nursing services productivity model the conceptual approach by Grönroos/Ojasalo was identified. The basic structure of this model was adapted stepwise to our study purpose by integrating theoretical and empirical findings from the research fields of service productivity, nursing productivity as well as national and international nursing research. Special challenges existed concerning the identification of relevant influencing factors as well as the representation of nursing sensitive outputs. The final result is an integrated productivity model, which can be used as an adequate framework for further research in hospital nursing productivity. Research on hospital nursing services productivity is rare, especially in Germany. The conceptual framework developed in this study builds on established knowledge in service productivity research. The theoretical findings have been advanced and adapted to the context of German hospital nursing services. The presented productivity model represents a unique combination of services and nursing services research, which did not exist so far. By operationalisation of the model's components it can be used as the basis for further empirical -research. © Georg Thieme Verlag KG Stuttgart · New York.

Effects of nurse staffing, work environments, and education on patient mortality: An observational study

PubMed Central

Cho, Eunhee; Sloane, Douglas M.; Kim, Eun-Young; Kim, Sera; Choi, Miyoung; Yoo, Il Young; Lee, Hye Sun; Aiken, Linda H.

2014-01-01

Background While considerable evidence has been produced showing a link between nursing characteristics and patient outcomes in the U.S. and Europe, little is known about whether similar associations are present in South Korea. Objective To examine the effects of nurse staffing, work environment, and education on patient mortality. Methods This study linked hospital facility data with staff nurse survey data (N=1,024) and surgical patient discharge data (N = 76,036) from 14 high-technology teaching hospitals with 700 or more beds in South Korea, collected between January 1, 2008 and December 31, 2008. Logistic regression models that corrected for the clustering of patients in hospitals were used to estimate the effects of the three nursing characteristics on risk-adjusted patient mortality within 30 days of admission. Results Risk-adjusted models reveal that nurse staffing, nurse work environments, and nurse education were significantly associated with patient mortality (OR 1.05, 95% CI 1.00–1.10; OR 0.52, 95% CI 0.31–0.88; and OR 0.91, CI 0.83–0.99; respectively). These odds ratios imply that each additional patient per nurse is associated with an 5% increase in the odds of patient death within 30 days of admission, that the odds of patient mortality are nearly 50% lower in the hospitals with better nurse work environments than in hospitals with mixed or poor nurse work environments, and that each 10% increase in BSN nurse is associated with a 9% decrease in patient deaths. Conclusions Nurse staffing, nurse work environments, and percentages of BSN nurses in South Korea are associated with patient mortality. Improving hospital nurse staffing and work environments and increasing the percentages of BSN nurses would help reduce the number of preventable in-hospital deaths. PMID:25213091

Trends of Literature Use on Nursing Science ; A Survey of the Library of the Japanese Nursing Association

NASA Astrophysics Data System (ADS)

Yamazoe, Miyo

The literature which was used for photocopying at the Library from 1979 to 1981 was analyzed in terms of type of the users, kind of the journals, year of the publication and factors which seemed to affect the literature use. The secondary materials on nursing which are less known by librarians in other subject fields are introduced.

Caring and competency.

PubMed

Mustard, Lewis W

2002-06-01

The long-term crisis in nursing, particularly in acute care hospitals, is demonstrated in studies on negligence by the Institute of Medicine in To Err is Human: Building a Safer Health System1 and Crossing the Quality Chasm: A New Health System for the 21st Century.2 A review of the nursing literature reflects unclear definitions of competency and its component caring, and no single theory of competency has been adopted from the literature and used in the education of nurses. The American Nurses 2001 Code of Ethics does not resolve this confusion, because it does not correct the individual acts of nursing incompetencies in acute care hospitals. The author defines caring and competency by providing examples of what they are not in examining 200 actual cases of hospital nursing acts of incompetence by nursing discipline. None of these examples of imputed negligence was reported to the National Practitioner Data Bank because the "corporate shield" protected the nurses by not being named in the complaint nor named as part of the settlement against the hospital.A new model of the hospitalist, the nurse hospitalist, is presented to act as a daily teacher and facilitator for hospital nurses based on a curriculum of day-to-day examples of substandard patient care. This nurse specialist is an inpatient generalist advanced practice nurse who is employed by the hospital and reports to the chief nurse executive. The author proposes that this new model of the nurse hospitalist be devoted entirely to collaborating with nurse leaders, educators, charge nurses, and floor nurses throughout disciplines in advancing the competency of nursing. This daily proactive and prospective model of improving nursing performance in a facultative manner offers strategies to mitigate the limitations of the retrospective model of quality control. Total quality improvement practiced retroactively is ineffective. The author recommends no structural change in the institution but an educational agenda by the nurse hospitalist, with hospital administration to assist nurses in a new learning environment.

The relationship between hospital work environment and nurse outcomes in Guangdong, China: a nurse questionnaire survey.

PubMed

Liu, Ke; You, Li-Ming; Chen, Shao-Xian; Hao, Yuan-Tao; Zhu, Xiao-Wen; Zhang, Li-Feng; Aiken, Linda H

2012-05-01

This study examines the relationship between hospital work environments and job satisfaction, job-related burnout and intention to leave among nurses in Guangdong province, China. The nursing shortage is an urgent global problem and also of concern in China. Studies in Western countries have shown that better work environments are associated with higher nurse satisfaction and lower burnout, thereby improving retention and lowering turnover rates. However, there is little research on the relationship between nurse work environments and nurse outcomes in China. This is a cross-sectional study. Survey data were collected from 1104 bedside nurses in 89 medical, surgical and intensive care units in 21 hospitals across the Guangdong province in China. Stratified convenience sampling was used to select hospitals, and systematic sampling was used to select units. All staff nurses working on participating units were surveyed. The China Hospital Nurse Survey, including the Practice Environment Scale of the Nursing Work Index and Maslach Burnout Inventory, was employed to collect data from nurses. Statistical significance level was set at 0·05. Thirty-seven per cent of the nurses experienced high burnout, and 54% were dissatisfied with their jobs. Improving nurses' work environments from poor to better was associated with a 50% decrease in job dissatisfaction and a 33% decrease in job-related burnout among nurses. Burnout and job dissatisfaction are high among hospital nurses in Guangdong province, China. Better work environments for nurses were associated with decreased job dissatisfaction and job-related burnout, which may successfully address the nursing shortage in China. The findings of this study indicate that improving work environments is essential to deal with the nursing shortage; the findings provide motivation for nurse managers and policy makers to improve work environments of hospital nurses in China. © 2012 Blackwell Publishing Ltd.

Use, trends, and impacts of nurse overtime in New York hospitals, 1995--2000

NASA Astrophysics Data System (ADS)

Berney, Barbara L.

Over the last several years, nurses and their advocates have expressed concern about heavy use of overtime (OT) in hospitals and claimed that it undermines the quality of nursing care. Some hospital managers view OT as an important staffing and scheduling tool. This study examines trends in the use of nurse overtime and its effects on several nurse-sensitive patient outcomes. Previous studies have demonstrated a relationship between several patient outcomes and nurse staffing levels, but little is known about the impact of nurse overtime on patient outcomes. Using staffing and discharge data covering 1995 to 2000 from 160 acute general hospitals in New York State, this study examines hospital characteristics that are associated with the use of OT. These characteristics include size, location, RN unionization, hospital ownership and teaching status. The study examines trends in the use of OT. Finally, it uses multivariate regression to analyze the relationship between OT and the rates of six nurse-sensitive patient outcomes and mortality. Significant differences were observed in the use of OT by hospital ownership and by union status. Government hospitals used less OT than non-government hospitals. Non-union hospitals used slightly less OT than hospitals with unionized nurses. As total RN hours and straight (non-OT) hours per acute inpatient day increased, OT decreased. OT use as a percent of total inpatient RN hours increased significantly over the study period from 3.9% to 5.5%. Trends varied by hospital characteristic. This dissertation finds little evidence for an association between nurse OT and patient outcomes. One reason may be that the administrative data used track OT use and adverse events for whole years. Since OT use is episodic, data that examine the occurrence of adverse events during periods of heavy nurse overtime may be more sensitive to the impact of OT. That hospitals vary dramatically in their OT use and that some categories of hospitals (e.g. government-owned) use very little OT---without apparent effect on patient outcomes---suggests that hospital management can find substitutes for OT to meet fluctuating staffing needs.

Co-worker characteristics and nurses' safety-climate perceptions.

PubMed

Abrahamson, Kathleen; Ramanujam, Rangaraj; Anderson, James G

2013-01-01

Previous research indicates that nurses' safety-climate perceptions are influenced by individual nurse characteristics, leadership, staffing levels and workplace structure. No literature was identified that explored the relationship between nurses' safety climate perceptions and staffing composition in a particular hospital unit. This paper aims to fill some of the gaps in the research in this area. Data supplied by 430 registered nurses working in two Midwestern US hospitals were analyzed to co-worker characteristics such as education, licensure, experience and full- or part-time status. Registered nurses working in hospitals with proportionally more-experienced nurses perceived their workplaces to be significantly safer for patients. Surprisingly, co-worker licensure, education and full- or part-time status did not significantly influence nurses' safety climate perceptions. Findings indicate that safety-climate perceptions vary significantly between hospital units and experienced nurses may act as a resource that promotes a positive safety climate. Hospitals retaining experienced nurses may potentially reduce errors. The paper illustrates that the results highlight the importance of providing nurses with an environment that encourages retention and creates a workplace where experienced nurses' skills are best utilized.

Barriers to work-life balance for hospital nurses.

PubMed

Mullen, Kathleen

2015-03-01

Nurses are loyal to their patients and coworkers. They often put the needs of others before their own and sometimes even before the needs of their families. This concern for others can cause conflicts that manifest as stress. Of the more than 2 million nurses in the United States, more than 62% work in hospitals. Hospitals are known to be both rewarding and stressful places to work. Like most workers, nurses face the challenge of balancing demands and achievements of work with those in their private lives. Hospital leaders can facilitate improved work-life balance (WLB) for hospital nurses by using tools already in place. Equally important, nurses can use their knowledge and resources to nurse the nurse within, which can greatly improve their experience of WLB, independent of the demands of their work environment. © 2015 The Author(s).

Rates, patterns, causes, and costs of hospitalization of nursing home residents: a population-based study.

PubMed Central

Barker, W H; Zimmer, J G; Hall, W J; Ruff, B C; Freundlich, C B; Eggert, G M

1994-01-01

OBJECTIVES. Hospitalization of nursing home residents is a growing, poorly defined problem. The purposes of this study were to define rates, patterns, costs, and outcomes of hospitalizations from nursing homes and to consider implications for reducing this problem as part of health care reform. METHODS. Communitywide nursing home utilization review and hospital discharge data were used to define retrospectively a cohort of 2120 patients newly admitted to nursing homes; these patients were followed for 2 years to identify all hospitalizations. Resident characteristics were analyzed for predictors of hospitalization. Charges and outcomes were compared with hospitalization of community-dwelling elders. RESULTS. Hospitalization rates were strikingly higher for intermediate vs skilled levels of care (566 and 346 per 1000 resident years, respectively). Approximately 40% of all hospitalizations occurred within 3 months of admission. No strong predictors were identified. Length of stay, charges, and mortality rates were higher than for hospitalizations from the community. CONCLUSIONS. Hospitalizations from nursing homes are not easily predicted but may in large part be prevented through health care reforms that integrate acute and longterm care. PMID:7943480

Nurse practice environment, workload, burnout, job outcomes, and quality of care in psychiatric hospitals: a structural equation model approach.

PubMed

Van Bogaert, Peter; Clarke, Sean; Willems, Riet; Mondelaers, Mieke

2013-07-01

To study the relationships between nurse practice environment, workload, burnout, job outcomes and nurse-reported quality of care in psychiatric hospital staff. Nurses' practice environments in general hospitals have been extensively investigated. Potential variations across practice settings, for instance in psychiatric hospitals, have been much less studied. A cross-sectional design with a survey. A structural equation model previously tested in acute hospitals was evaluated using survey data from a sample of 357 registered nurses, licensed practical nurses, and non-registered caregivers from two psychiatric hospitals in Belgium between December 2010-April 2011. The model included paths between practice environment dimensions and outcome variables, with burnout in a mediating position. A workload measure was also tested as a potential mediator between the practice environment and outcome variables. An improved model, slightly modified from the one validated earlier in samples of acute care nurses, was confirmed. This model explained 50% and 38% of the variance in job outcomes and nurse-reported quality of care respectively. In addition, workload was found to play a mediating role in accounting for job outcomes and significantly improved a model that ultimately explained 60% of the variance in these variables. In psychiatric hospitals as in general hospitals, nurse-physician relationship and other organizational dimensions such as nursing and hospital management were closely associated with perceptions of workload and with burnout and job satisfaction, turnover intentions, and nurse-reported quality of care. Mechanisms linking key variables and differences across settings in these relationships merit attention by managers and researchers. © 2012 Blackwell Publishing Ltd.

Metrics for Electronic-Nursing-Record-Based Narratives: cross-sectional analysis.

PubMed

Kim, Kidong; Jeong, Suyeon; Lee, Kyogu; Park, Hyeoun-Ae; Min, Yul Ha; Lee, Joo Yun; Kim, Yekyung; Yoo, Sooyoung; Doh, Gippeum; Ahn, Soyeon

2016-11-30

We aimed to determine the characteristics of quantitative metrics for nursing narratives documented in electronic nursing records and their association with hospital admission traits and diagnoses in a large data set not limited to specific patient events or hypotheses. We collected 135,406,873 electronic, structured coded nursing narratives from 231,494 hospital admissions of patients discharged between 2008 and 2012 at a tertiary teaching institution that routinely uses an electronic health records system. The standardized number of nursing narratives (i.e., the total number of nursing narratives divided by the length of the hospital stay) was suggested to integrate the frequency and quantity of nursing documentation. The standardized number of nursing narratives was higher for patients aged ≥ 70 years (median = 30.2 narratives/day, interquartile range [IQR] = 24.0-39.4 narratives/day), long (≥ 8 days) hospital stays (median = 34.6 narratives/day, IQR = 27.2-43.5 narratives/day), and hospital deaths (median = 59.1 narratives/day, IQR = 47.0-74.8 narratives/day). The standardized number of narratives was higher in "pregnancy, childbirth, and puerperium" (median = 46.5, IQR = 39.0-54.7) and "diseases of the circulatory system" admissions (median = 35.7, IQR = 29.0-43.4). Diverse hospital admissions can be consistently described with nursing-document-derived metrics for similar hospital admissions and diagnoses. Some areas of hospital admissions may have consistently increasing volumes of nursing documentation across years. Usability of electronic nursing document metrics for evaluating healthcare requires multiple aspects of hospital admissions to be considered.

Metrics for Electronic-Nursing-Record-Based Narratives: Cross-sectional Analysis

PubMed Central

Kim, Kidong; Jeong, Suyeon; Lee, Kyogu; Park, Hyeoun-Ae; Min, Yul Ha; Lee, Joo Yun; Kim, Yekyung; Yoo, Sooyoung; Doh, Gippeum

2016-01-01

Summary Objectives We aimed to determine the characteristics of quantitative metrics for nursing narratives documented in electronic nursing records and their association with hospital admission traits and diagnoses in a large data set not limited to specific patient events or hypotheses. Methods We collected 135,406,873 electronic, structured coded nursing narratives from 231,494 hospital admissions of patients discharged between 2008 and 2012 at a tertiary teaching institution that routinely uses an electronic health records system. The standardized number of nursing narratives (i.e., the total number of nursing narratives divided by the length of the hospital stay) was suggested to integrate the frequency and quantity of nursing documentation. Results The standardized number of nursing narratives was higher for patients aged 70 years (median = 30.2 narratives/day, interquartile range [IQR] = 24.0–39.4 narratives/day), long (8 days) hospital stays (median = 34.6 narratives/day, IQR = 27.2–43.5 narratives/day), and hospital deaths (median = 59.1 narratives/day, IQR = 47.0–74.8 narratives/day). The standardized number of narratives was higher in “pregnancy, childbirth, and puerperium” (median = 46.5, IQR = 39.0–54.7) and “diseases of the circulatory system” admissions (median = 35.7, IQR = 29.0–43.4). Conclusions Diverse hospital admissions can be consistently described with nursing-document-derived metrics for similar hospital admissions and diagnoses. Some areas of hospital admissions may have consistently increasing volumes of nursing documentation across years. Usability of electronic nursing document metrics for evaluating healthcare requires multiple aspects of hospital admissions to be considered. PMID:27901174

The Relationship Among Change Fatigue, Resilience, and Job Satisfaction of Hospital Staff Nurses.

PubMed

Brown, Robin; Wey, Howard; Foland, Kay

2018-05-01

The purpose of this study was to examine relationships between change fatigue, resilience, and job satisfaction among novice and seasoned hospital staff nurses. Health care is typified by change. Frequent and vast changes in acute care hospitals can take a toll on nurses and cause change fatigue, which has been largely overlooked and under-researched. A descriptive correlational design was employed with 521 hospital staff nurses in one midwestern state. Participants completed three online surveys: (a) Change Fatigue Scale, (b) Connor-Davidson Resilience Scale, and (c) McCloskey/Mueller Satisfaction Scale. In a multiple regression model, job satisfaction had a statistically significant negative association with change fatigue (p < .001) and significant positive association with resilience (p < .001). A linear trend was found with hospital size (number of beds) and change fatigue (p = .001) and education level and resilience (p = .03). The results are consistent with job satisfaction among hospital nursing staff being negatively influenced by change fatigue and positively influenced by resilience, although reverse causal connections are also possible. Change fatigue may be increased by larger hospital size (number of beds), and resilience may be increased by higher educational level of hospital staff nurses. The study advanced the nursing knowledge on change fatigue, resilience, and job satisfaction of staff nurses working in acute care hospitals. Engaging in strategies aimed at preventing change fatigue in nursing staff can enhance workplace environments, job satisfaction, and retention of nurses. © 2018 Sigma Theta Tau International.

Evaluating cultural competence among Japanese clinical nurses: Analyses of a translated scale.

PubMed

Noji, Ariko; Mochizuki, Yuki; Nosaki, Akiko; Glaser, Dale; Gonzales, Lucia; Mizobe, Akiko; Kanda, Katsuya

2017-06-01

This paper describes the factor analysis testing and construct validation of the Japanese version of the Caffrey Cultural Competence Health Services (J-CCCHS). The inventory, composed of 28 items, was translated using language and subject matter experts. Psychometric testing (exploratory factor, alpha reliability, and confirmatory factor analyses) was undertaken with nurses (N = 7494, 92% female, mean age 32.6 years) from 19 hospitals across Japan. Principal components extraction with varimax rotation yielded a 5-factor solution (62.31% variance explained) that was labeled: knowledge, comfort-proximal, comfort-distal, awareness, and awareness of national policy. Cronbach α for the subscales ranged from 0.756 to 0.892. In confirmatory factor analysis using the robust maximum likelihood estimator, the chi-square test was as follows: χ 2 (340) = 14604.44, P < .001. After correlated errors were introduced, there was evidence of improved model fit (χ 2 (335) = 8681.61, P < .05) but the other indices showed improvement (RMSEA = .058 [90% CI, 0.057-0.059], TLI = .891, CFI = .903, and SRMR = .059). The discriminating power of the J-CCCHS was indicated by statistically mean differences in J-CCCHS subscale scores between predefined groups. Taking into consideration that this is the first foray into construct validation for this instrument, and that fit was improved when a subsequent data driven model was tested, and it has the ability to distinguish between known groups that are expected to differ in cultural competence, the instrument can be of value to clinicians and educators alike. © 2017 John Wiley & Sons Australia, Ltd.

Better Nurse Autonomy Decreases the Odds of 30-Day Mortality and Failure to Rescue.

PubMed

Rao, Aditi D; Kumar, Aparna; McHugh, Matthew

2017-01-01

Autonomy is essential to professional nursing practice and is a core component of good nurse work environments. The primary objective of this study was to examine the relationship between nurse autonomy and 30-day mortality and failure to rescue (FTR) in a hospitalized surgical population. This study was a secondary analysis of cross-sectional data. It included data from three sources: patient discharge data from state administrative databases, a survey of nurses from four states, and the American Hospital Association annual survey from 2006-2007. Survey responses from 20,684 staff nurses across 570 hospitals were aggregated to the hospital level to assess autonomy measured by a standardized scale. Logistic regression models were used to estimate the relationship between nurse autonomy and 30-day mortality and FTR. Patient comorbidities, surgery type, and other hospital characteristics were included as controls. Greater nurse autonomy at the hospital level was significantly associated with lower odds of 30-day mortality and FTR for surgical patients even after accounting for patient risk and structural hospital characteristics. Each additional point on the nurse autonomy scale was associated with approximately 19% lower odds of 30-day mortality (p < .001) and 17% lower odds of failure to rescue (p < .01). Hospitals with lower levels of nurse autonomy place their surgical patients at an increased risk for mortality and FTR. Patients receiving care within institutions that promote high levels of nurse autonomy have a lower risk for death within 30 days and complications leading to death within 30 days. Hospitals can actively take steps to encourage nurse autonomy to positively influence patient outcomes. © 2016 Sigma Theta Tau International.

Better Nurse Autonomy Decreases the Odds of 30-Day Mortality and Failure to Rescue

PubMed Central

Rao, Aditi D.; Kumar, Aparna; McHugh, Matthew

2017-01-01

Research Purpose Autonomy is essential to professional nursing practice and is a core component of good nurse work environments. The primary objective of this study was to examine the relationship between nurse autonomy and 30-day mortality and failure to rescue (FTR) in a hospitalized surgical population. Study Design This study was a secondary analysis of cross-sectional data. It included data from three sources: patient discharge data from state administrative databases, a survey of nurses from four states, and the American Hospital Association annual survey from 2006–2007. Methods Survey responses from 20,684 staff nurses across 570 hospitals were aggregated to the hospital level to assess autonomy measured by a standardized scale. Logistic regression models were used to estimate the relationship between nurse autonomy and 30-day mortality and FTR. Patient comorbidities, surgery type, and other hospital characteristics were included as controls. Findings Greater nurse autonomy at the hospital level was significantly associated with lower odds of 30-day mortality and FTR for surgical patients even after accounting for patient risk and structural hospital characteristics. Each additional point on the nurse autonomy scale was associated with approximately 19% lower odds of 30-day mortality (p < .001) and 17% lower odds of failure to rescue (p < .01). Conclusions Hospitals with lower levels of nurse autonomy place their surgical patients at an increased risk for mortality and FTR. Clinical Relevance Patients receiving care within institutions that promote high levels of nurse autonomy have a lower risk for death within 30 days and complications leading to death within 30 days. Hospitals can actively take steps to encourage nurse autonomy to positively influence patient outcomes. PMID:28094907

Disparities in Perinatal Quality Outcomes for Very Low Birth Weight Infants in Neonatal Intensive Care

PubMed Central

Lake, Eileen T; Staiger, Douglas; Horbar, Jeffrey; Kenny, Michael J; Patrick, Thelma; Rogowski, Jeannette A

2015-01-01

Objective To determine if hospital-level disparities in very low birth weight (VLBW) infant outcomes are explained by poorer hospital nursing characteristics. Data Sources Nurse survey and VLBW infant registry data. Study Design Retrospective study of 8,252 VLBW infants in 98 Vermont Oxford Network hospital neonatal intensive care units (NICUs) nationally. NICUs were classified into three groups based on their percent of infants of black race. Two nurse-sensitive perinatal quality standards were studied: nosocomial infection and breast milk. Data Collection Primary nurse survey (N = 5,773, 77 percent response rate). Principal Findings VLBW infants born in high-black concentration hospitals had higher rates of infection and discharge without breast milk than VLBW infants born in low-black concentration hospitals. Nurse understaffing was higher and practice environments were worse in high-black as compared to low-black hospitals. NICU nursing features accounted for one-third to one-half of the hospital-level health disparities. Conclusions Poorer nursing characteristics contribute to disparities in VLBW infant outcomes in two nurse-sensitive perinatal quality standards. Improvements in nursing have potential to improve the quality of care for seven out of ten black VLBW infants who are born in high-black hospitals in this country. PMID:25250882

Complementary Medicine and the Role of Oncology Nurses in an Acute Care Hospital: The Gap Between Attitudes and Practice.

PubMed

Admi, Hanna; Eilon-Moshe, Yael; Ben-Arye, Eran

2017-09-01

To describe hospital nurses' knowledge, attitudes, and practices regarding complementary medicine (CM); to compare the knowledge and attitudes of nurse managers to staff nurses with diverse oncology experience; and to assess attitudes toward integrating CM into the role of the hospital oncology nurse. 
. Descriptive, cross-sectional study.
. Rambam Health Care Campus in northern Israel.
. A convenience sample of 434 hospital nurses with varied oncology experience.
. Nurses completed a knowledge and attitude questionnaire developed for the current study. Data were analyzed using parametric and nonparametric statistical tests. 
. Hospital nurses' knowledge of and attitudes toward CM, and attitudes toward integrating CM into the role of the hospital oncology nurse.
. Nurses lack knowledge and are unaware of the risks associated with CM. However, they believe this approach can improve the quality of life of patients with cancer; 51% expressed an interest in receiving training. Oncology nurses were ambivalent about the feasibility of applying an integrative approach, whereas nurse managers expressed significantly more positive attitudes toward integrating CM within the scope of nursing practices.
. A large discrepancy remains between nurses' strong interest in CM and awareness of associated benefits, and their ambivalence toward its integration in their nursing practice. 
. Although improving nurses' knowledge should be mandatory, it remains insufficient; a shift in the approach to integrating CM into conventional health care is needed, from practitioners' responsibility to healthcare policymakers' responsibility. Legislations and policies are necessary, along with providing respectable infrastructures.

Evaluation of health care providers’ role transition and satisfaction in hospital-at-home for chronic obstructive pulmonary disease exacerbations: a survey study

PubMed Central

2013-01-01

Background Hospital-at-home is an accepted alternative for usual hospital treatment for patients with a Chronic Obstructive Pulmonary Disease (COPD) exacerbation. The introduction of hospital-at-home may lead to changes in health care providers’ roles and responsibilities. To date, the impact on providers’ roles is unknown and in addition, little is known about the satisfaction and acceptance of care providers involved in hospital-at-home. Methods Objective of this survey study was to investigate the role differentiation, role transitions and satisfaction of professional care providers (i.e. pulmonologists, residents, hospital respiratory nurses, generic and specialised community nurses and general practitioners) from 3 hospitals and 2 home care organisations, involved in a community-based hospital-at-home scheme. A combined multiple-choice and open-end questionnaire was administered in study participants. Results Response rate was 10/17 in pulmonologists, 10/23 in residents, 9/12 in hospital respiratory nurses, 15/60 in generic community nurses, 6/10 in specialised community nurses and 25/47 in general practitioners. For between 66% and 100% of respondents the role in early discharge was clear and between 57% and 78% of respondents was satisfied with their role in early discharge. For nurses the role in early discharge was different compared to their role in usual care. 67% of generic community nurses felt they had sufficient knowledge and skills to monitor patients at home, compared to 100% of specialised community nurses. Specialised community nurses felt they should monitor patients. 60% of generic community nurses responded they should monitor patients at home. 78% of pulmonologists, 12% of general practitioners, 55% of hospital respiratory nurses and 48 of community nurses was satisfied with early discharge in general. For coordination of care 29% of community nurses had an unsatisfied response. For continuity of care this was 12% and 10% for hospital respiratory nurses and community nurses, respectively. Conclusion A community-based early assisted discharge for COPD exacerbations is possible and well accepted from the perspective of health care providers’ involved. Satisfaction with the different aspects is good and the transfer of patients in the community while supervised by generic community nurses is possible. Attention should be paid to coordination and continuity of care, especially information transfer between providers. PMID:24074294

An Investigation of Nurses' Job Satisfaction in a Private Hospital and Its Correlates.

PubMed

Chien, Wai-Tong; Yick, Sin-Yin

2016-01-01

Nurses' job satisfaction and job stress are important issues regarding their turnovers. While there are some recent descriptive studies on job satisfaction in public hospitals, very limited research was found on this topic in private hospital setting. It is worth to examine the job satisfaction of nurses and its correlates in such a specific hospital context in Hong Kong, by which the findings can be compared with those in public hospitals, and across countries. To investigate nurses' job satisfaction, job stress and intention to quit of nurses in a private hospital, and the correlates of the nurses' job satisfaction. A cross-sectional, descriptive survey study was conducted. By using stratified random sampling in terms of nature of wards/units and working ranks, 139 full-time nurses who were working in the 400-bed private hospital for at least 6 months and provided direct nursing care were recruited in this study. Data were collected by employing a set of self-administered structured questionnaires, consisting of the Index of Work Satisfaction (job satisfaction), Anxiety-Stress Questionnaire (job stress), Michigan Organizational Assessment Questionnaire (intention to quit), and socio-demographic data. With a response rate of 74.3%, the results of the 139 respondents showed that the nurses in the private hospital had an overall moderate level of satisfaction with their work and rated the professional status as the highest satisfied domain. The nurses also reported moderate levels of job stress and intention to quit. The nurses' job satisfaction was negatively correlated with their job stress and intention to quit; whereas, the nurses' job stress was positively correlated with their intention to quit. The nurses with older in age and more post-registration experience and/or working experience in the private hospital indicated a higher level of job satisfaction, particularly with 'Pay' and 'Autonomy'. The findings suggest that the nurses in the private hospital are moderately stressful and satisfied with their work environment and relationships. A few socio-demographic characteristics of these nurses such as their age and years of clinical experiences were associated with their levels of job satisfaction and/or stress. The findings provided information for private hospitals and healthcare organizations about the need and areas for improvement of nurse's job satisfaction, thus strengthening their recruitment and retention.

Patient satisfaction and non-UK educated nurses: a cross-sectional observational study of English National Health Service Hospitals

PubMed Central

Griffiths, Peter; Sloane, Douglas M; Rafferty, Anne Marie; Ball, Jane E; Aiken, Linda H

2015-01-01

Objectives To examine whether patient satisfaction with nursing care in National Health Service (NHS) hospitals in England is associated with the proportion of non-UK educated nurses providing care. Design Cross-sectional analysis using data from the 2010 NHS Adult Inpatient Survey merged with data from nurse and hospital administrator surveys. Logistic regression models with corrections for clustering were used to determine whether the proportions of non-UK educated nurses were significantly related to patient satisfaction before and after taking account of other hospital, nursing and patient characteristics. Setting 31 English NHS trusts. Participants 12 506 patients 16 years of age and older with at least one overnight stay that completed a satisfaction survey; 2962 bedside care nurses who completed a nurse survey; and 31 NHS trusts. Main outcome measure Patient satisfaction. Results The percentage of non-UK educated nurses providing bedside hospital care, which ranged from 1% to 52% of nurses, was significantly associated with patient satisfaction. After controlling for potential confounding factors, each 10-point increase in the percentage of non-UK educated nurses diminished the odds of patients reporting good or excellent care by 12% (OR=0.88), and decreased the odds of patients agreeing that they always had confidence and trust in nurses by 13% (OR=0.87). Other indicators of patient satisfaction also revealed lower satisfaction in hospitals with higher percentages of non-UK educated nurses. Conclusions Use of non-UK educated nurses in English NHS hospitals is associated with lower patient satisfaction. Importing nurses from abroad to substitute for domestically educated nurses may negatively impact quality of care. PMID:26634400

38 CFR 17.46 - Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from active military, naval, or air service... Hospital, Domiciliary and Nursing Home Care § 17.46 Eligibility for hospital, domiciliary or nursing home...

38 CFR 17.46 - Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from...

Code of Federal Regulations, 2011 CFR

2011-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from active military, naval, or air service... Hospital, Domiciliary and Nursing Home Care § 17.46 Eligibility for hospital, domiciliary or nursing home...

38 CFR 17.46 - Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from...

Code of Federal Regulations, 2013 CFR

2013-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from active military, naval, or air service... Hospital, Domiciliary and Nursing Home Care § 17.46 Eligibility for hospital, domiciliary or nursing home...

38 CFR 17.46 - Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from...

Code of Federal Regulations, 2012 CFR

2012-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from active military, naval, or air service... Hospital, Domiciliary and Nursing Home Care § 17.46 Eligibility for hospital, domiciliary or nursing home...

38 CFR 17.46 - Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from...

Code of Federal Regulations, 2014 CFR

2014-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from active military, naval, or air service... Hospital, Domiciliary and Nursing Home Care § 17.46 Eligibility for hospital, domiciliary or nursing home...

Effects of nurse staffing, work environments, and education on patient mortality: an observational study.

PubMed

Cho, Eunhee; Sloane, Douglas M; Kim, Eun-Young; Kim, Sera; Choi, Miyoung; Yoo, Il Young; Lee, Hye Sun; Aiken, Linda H

2015-02-01

While considerable evidence has been produced showing a link between nursing characteristics and patient outcomes in the U.S. and Europe, little is known about whether similar associations are present in South Korea. To examine the effects of nurse staffing, work environment, and education on patient mortality. This study linked hospital facility data with staff nurse survey data (N=1024) and surgical patient discharge data (N=76,036) from 14 high-technology teaching hospitals with 700 or more beds in South Korea, collected between January 1, 2008 and December 31, 2008. Logistic regression models that corrected for the clustering of patients in hospitals were used to estimate the effects of the three nursing characteristics on risk-adjusted patient mortality within 30 days of admission. Risk-adjusted models reveal that nurse staffing, nurse work environments, and nurse education were significantly associated with patient mortality (OR 1.05, 95% CI 1.00-1.10; OR 0.52, 95% CI 0.31-0.88; and OR 0.91, CI 0.83-0.99; respectively). These odds ratios imply that each additional patient per nurse is associated with an 5% increase in the odds of patient death within 30 days of admission, that the odds of patient mortality are nearly 50% lower in the hospitals with better nurse work environments than in hospitals with mixed or poor nurse work environments, and that each 10% increase in nurses having Bachelor of Science in Nursing Degree is associated with a 9% decrease in patient deaths. Nurse staffing, nurse work environments, and percentages of nurses having Bachelor of Science in Nursing Degree in South Korea are associated with patient mortality. Improving hospital nurse staffing and work environments and increasing the percentages of nurses having Bachelor of Science in Nursing Degree would help reduce the number of preventable in-hospital deaths. Copyright © 2014 Elsevier Ltd. All rights reserved.

The relationship between hospital work environment and nurse outcomes in Guangdong, China: a nurse questionnaire survey

PubMed Central

Liu, Ke; You, Li-Ming; Chen, Shao-Xian; Hao, Yuan-Tao; Zhu, Xiao-Wen; Zhang, Li-Feng; Aiken, Linda H

2012-01-01

Aims and objectives This study examines the relationship between hospital work environments and job satisfaction, job-related burnout and intention to leave among nurses in Guangdong province, China. Background The nursing shortage is an urgent global problem and also of concern in China. Studies in Western countries have shown that better work environments are associated with higher nurse satisfaction and lower burnout, thereby improving retention and lowering turnover rates. However, there is little research on the relationship between nurse work environments and nurse outcomes in China. Design This is a cross-sectional study. Survey data were collected from 1104 bedside nurses in 89 medical, surgical and intensive care units in 21 hospitals across the Guangdong province in China. Methods Stratified convenience sampling was used to select hospitals, and systematic sampling was used to select units. All staff nurses working on participating units were surveyed. The China Hospital Nurse Survey, including the Practice Environment Scale of the Nursing Work Index and Maslach Burnout Inventory, was employed to collect data from nurses. Statistical significance level was set at 0·05. Results Thirty-seven per cent of the nurses experienced high burnout, and 54% were dissatisfied with their jobs. Improving nurses’ work environments from poor to better was associated with a 50% decrease in job dissatisfaction and a 33% decrease in job-related burnout among nurses. Conclusion Burnout and job dissatisfaction are high among hospital nurses in Guangdong province, China. Better work environments for nurses were associated with decreased job dissatisfaction and job-related burnout, which may successfully address the nursing shortage in China. Relevance to clinical practice The findings of this study indicate that improving work environments is essential to deal with the nursing shortage; the findings provide motivation for nurse managers and policy makers to improve work environments of hospital nurses in China. PMID:22380003

Hospital nurses working wounded: motivations and obstacles to return to work as experienced by nurses with injuries.

PubMed

Mullen, Kathleen; Gillen, Marion; Kools, Susan; Blanc, Paul

2015-01-01

Despite the high rate of work-related injuries among hospital nurses, there is limited understanding of factors that serve to motivate or hinder nurses return to work following injury. Perspectives of nurses with work related injuries, as they relate to obstacles and motivations to return to work, consequences of injury, and influences of work climate were documented. This was a sub-study of nurses taken from a larger investigation of hospital workers. A purposive sample of 16 nurses was interviewed. Analysis was carried out using grounded theory as the research method. Nurses' responses fell into four concepts: organizational influences, personal conditions, costs and losses, and employee health as influenced by workers' compensation systems. Conceptualization of these concepts resulted in key categories: injury as an expected consequence of hospital work; nursing alone versus nursing together; the impact of injury on professional, family, and social roles; and nurses' understanding of and involvement with the workers' compensation system. The findings provide new perspective into features that support or hinder nurses' with injuries return to work and corroborate existing occupational health research. Consideration of these findings by hospital and employee health managers may help promote more effective return to work programs within the hospital setting.

Institutional and economic influences on quality of nursing documentation.

PubMed

Parker, L E; Wells, K B; Buchanan, J L; Benjamin, B

1994-01-01

This study evaluates the quality of nursing documentation within the hospital record for a particularly vulnerable group of patients, the depressed aged. Specifically, the effects of prospective payment, unit type, hospital type, and nurse staffing levels on nursing documentation within hospital charts were assessed.

Characteristics of nurses and hospital work environments that foster satisfaction and clinical expertise.

PubMed

Foley, Barbara Jo; Kee, Carolyn C; Minick, Ptlene; Harvey, Susan S; Jennings, Bonnie M

2002-05-01

The purpose of this aspect of a larger study was to describe characteristics of nurses and their work environment at two military hospitals. Few studies have explored characteristics among nurses who practice in military hospitals. There is reason to believe that differences exist between nurses who work in military and civilian hospitals, some of which are required educational level, leadership experience, officer status, and career development opportunities. A descriptive design was used to address how military and civilian nurses who work in military hospitals describe their autonomy, control over practice, nurse-physician collaboration, and clinical expertise and what relationships exist among these variables. Scores on autonomy, control over practice, and nurse-physician relationships all were above midpoint for all respondents as a group, indicating positive work environments in both of the military hospitals studied. Scores from the clinical expertise instrument were well above midpoint, indicating a desirable level of clinical expertise. These findings all reflect favorably on the military hospital work environment. This information will help to make a case for instituting or preserving those nursing processes that are effective and for identifying and working to change nursing processes that are not effective. Nurses will benefit by having a more collaborative work environment.

Degree of value alignment - a grounded theory of rural nurse resignations.

PubMed

Bragg, S M; Bonner, A

2014-01-01

The shortage of nurses willing to work in rural Australian healthcare settings continues to worsen. Australian rural areas have a lower retention rate of nurses than metropolitan counterparts, with more remote communities experiencing an even higher turnover of nursing staff. When retention rates are lower, patient outcomes are known to be poorer. This article reports a study that sought to explore the reasons why registered nurses resign from rural hospitals in the state of New South Wales, Australia. Using grounded theory methods, this study explored the reasons why registered nurses resigned from New South Wales rural hospitals. Data were collected from 12 participants using semi-structured interviews; each participant was a registered nurse who had resigned from a rural hospital. Nurses who had resigned due to retirement, relocation or maternity leave were excluded. Interviews were transcribed verbatim and imported into NVivo software. The constant comparative method of data collection and analysis was followed until a core category emerged. Nurses resigned from rural hospitals when their personal value of how nursing should occur conflicted with the hospital's organisational values driving the practice of nursing. These conflicting values led to a change in the degree of value alignment between the nurse and hospital. The degree of value alignment occurred in three dynamic stages that nurses moved through prior to resigning. The first stage, sharing values, was a time when a nurse and a hospital shared similar values. The second stage was conceding values where, due to perceived changes in a hospital's values, a nurse felt that patient care became compromised and this led to a divergence of values. The final stage was resigning, a stage where a nurse 'gave up' as they felt that their professional integrity was severely compromised. The findings revealed that when a nurse and organisational values were not aligned, conflict was created for a nurse about how they could perform nursing that aligned with their internalised professional values and integrity. Resignation occurred when nurses were unable to realign their personal values to changed organisational values - the organisational values changed due to rural area health service restructures, centralisation of budgets and resources, cumbersome hierarchies and management structures that inhibited communication and decision making, out-dated and ineffective operating systems, insufficient and inexperienced staff, bullying, and a lack of connectedness and shared vision. To fully comprehend rural nurse resignations, this study identified three stages that nurses move through prior to resignation. Effective retention strategies for the nursing workforce should address contributors to a decrease in value alignment and work towards encouraging the coalescence of nurses' and hospitals' values. It is imperative that strategies enable nurses to provide high quality patient care and promote a sense of connectedness and a shared vision between nurse and hospital. Senior managers need to have clear ways to articulate and imbue organisational values and be explicit in how these values accommodate nurses' values. Ward-level nurse managers have a significant responsibility to ensure that a hospital's values (both explicit and implicit) are incorporated into ward culture.

Organization of Hospital Nursing and 30-Day Readmissions in Medicare Patients Undergoing Surgery.

PubMed

Ma, Chenjuan; McHugh, Matthew D; Aiken, Linda H

2015-01-01

Growing scrutiny of readmissions has placed hospitals at the center of readmission prevention. Little is known, however, about hospital nursing—a critical organizational component of hospital service system—in relation to readmissions. To determine the relationships between hospital nursing factors—nurse work environment, nurse staffing, and nurse education—and 30-day readmissions among Medicare patients undergoing general, orthopedic, and vascular surgery. We linked Medicare patient discharge data, multistate nurse survey data, and American Hospital Association Annual Survey data. Our sample included 220,914 Medicare surgical patients and 25,082 nurses from 528 hospitals in 4 states (California, Florida, New Jersey, and Pennsylvania). Risk-adjusted robust logistic regressions were used for analyses. The average 30-day readmission rate was 10% in our sample (general surgery: 11%; orthopedic surgery: 8%; vascular surgery: 12%). Readmission rates varied widely across surgical procedures and could be as high as 26% (upper limb and toe amputation for circulatory system disorders). Each additional patient per nurse increased the odds of readmission by 3% (OR=1.03; 95% CI, 1.00-1.05). Patients cared in hospitals with better nurse work environments had lower odds of readmission (OR=0.97; 95% CI, 0.95-0.99). Administrative support to nursing practice (OR=0.96; 95% CI, 0.94-0.99) and nurse-physician relations (OR=0.97; 95% CI, 0.95-0.99) were 2 main attributes of the work environment that were associated with readmissions. Better nurse staffing and work environment were significantly associated with 30-day readmission, and can be considered as system-level interventions to reduce readmissions and associated financial penalties.

Relationship of Wound, Ostomy, and Continence Certified Nurses and Healthcare-Acquired Conditions in Acute Care Hospitals.

PubMed

Boyle, Diane K; Bergquist-Beringer, Sandra; Cramer, Emily

The purpose of this study was to describe the (a) number and types of employed WOC certified nurses in acute care hospitals, (b) rates of hospital-acquired pressure injury (HAPI) and catheter-associated urinary tract infection (CAUTI), and (c) effectiveness of WOC certified nurses with respect to lowering HAPI and CAUTI occurrences. Retrospective analysis of data from National Database of Nursing Quality Indicators. The sample comprised 928 National Database of Nursing Quality Indicators (NDNQI) hospitals that participated in the 2012 NDNQI RN Survey (source of specialty certification data) and collected HAPI, CAUTI, and nurse staffing data during the years 2012 to 2013. We analyzed years 2012 to 2013 data from the NDNQI. Descriptive statistics summarized the number and types of employed WOC certified nurses, the rate of HAPI and CAUTI, and HAPI risk assessment and prevention intervention rates. Chi-square analyses were used to compare the characteristics of hospitals that do and do not employ WOC certified nurses. Analysis-of-covariance models were used to test the association between WOC certified nurses and HAPI and CAUTI occurrences. Just more than one-third of the study hospitals (36.6%) employed WOC certified nurses. Certified continence care nurses (CCCNs) were employed in fewest number. Hospitals employing wound care specialty certified nurses (CWOCN, CWCN, and CWON) had lower HAPI rates and better pressure injury risk assessment and prevention practices. Stage 3 and 4 HAPI occurrences among hospitals employing CWOCNs, CWCNs, and CWONs (0.27%) were nearly half the rate of hospitals not employing these nurses (0.51%). There were no significant relationships between nurses with specialty certification in continence care (CWOCN, CCCN) or ostomy care (CWOCN, COCN) and CAUTI rates. CWOCNs, CWCNs, and CWONs are an important factor in achieving better HAPI outcomes in acute care settings. The role of CWOCNs, CCCNs, and COCNs in CAUTI prevention warrants further investigation.

Relationship of Wound, Ostomy, and Continence Certified Nurses and Healthcare-Acquired Conditions in Acute Care Hospitals

PubMed Central

Bergquist-Beringer, Sandra; Cramer, Emily

2017-01-01

PURPOSE: The purpose of this study was to describe the (a) number and types of employed WOC certified nurses in acute care hospitals, (b) rates of hospital-acquired pressure injury (HAPI) and catheter-associated urinary tract infection (CAUTI), and (c) effectiveness of WOC certified nurses with respect to lowering HAPI and CAUTI occurrences. DESIGN: Retrospective analysis of data from National Database of Nursing Quality Indicators. SUBJECTS AND SETTINGS: The sample comprised 928 National Database of Nursing Quality Indicators (NDNQI) hospitals that participated in the 2012 NDNQI RN Survey (source of specialty certification data) and collected HAPI, CAUTI, and nurse staffing data during the years 2012 to 2013. METHODS: We analyzed years 2012 to 2013 data from the NDNQI. Descriptive statistics summarized the number and types of employed WOC certified nurses, the rate of HAPI and CAUTI, and HAPI risk assessment and prevention intervention rates. Chi-square analyses were used to compare the characteristics of hospitals that do and do not employ WOC certified nurses. Analysis-of-covariance models were used to test the association between WOC certified nurses and HAPI and CAUTI occurrences. RESULTS: Just more than one-third of the study hospitals (36.6%) employed WOC certified nurses. Certified continence care nurses (CCCNs) were employed in fewest number. Hospitals employing wound care specialty certified nurses (CWOCN, CWCN, and CWON) had lower HAPI rates and better pressure injury risk assessment and prevention practices. Stage 3 and 4 HAPI occurrences among hospitals employing CWOCNs, CWCNs, and CWONs (0.27%) were nearly half the rate of hospitals not employing these nurses (0.51%). There were no significant relationships between nurses with specialty certification in continence care (CWOCN, CCCN) or ostomy care (CWOCN, COCN) and CAUTI rates. CONCLUSIONS: CWOCNs, CWCNs, and CWONs are an important factor in achieving better HAPI outcomes in acute care settings. The role of CWOCNs, CCCNs, and COCNs in CAUTI prevention warrants further investigation. PMID:28328645

The financial impact of a clinical academic practice partnership.

PubMed

Greene, Mary Ann; Turner, James

2014-01-01

New strategies to provide clinical experiences for nursing students have caused nursing schools and hospitals to evaluate program costs. A Microsoft Excel model, which captures costs and associated benefits, was developed and is described here. The financial analysis shows that the Clinical Academic Practice Program framework for nursing clinical education, often preferred by students, can offer financial advantages to participating hospitals and schools of nursing. The model is potentially a tool for schools of nursing to enlist hospitals and to help manage expenses of clinical education. Hospitals may also use the Hospital Nursing Unit Staffing and Expense Worksheet in planning staffing when students are assigned to units and the cost/benefit findings to enlist management support.

Organizational effects on patient satisfaction in hospital medical-surgical units.

PubMed

Bacon, Cynthia Thornton; Mark, Barbara

2009-05-01

The purpose of this study was to examine the relationships between hospital context, nursing unit structure, and patient characteristics and patients' satisfaction with nursing care in hospitals. Although patient satisfaction has been widely researched, our understanding of the relationship between hospital context and nursing unit structure and their impact on patient satisfaction is limited. The data source for this study was the Outcomes Research in Nursing Administration Project, a multisite organizational study conducted to investigate relationships among nurse staffing, organizational context and structure, and patient outcomes. The sample for this study was 2,720 patients and 3,718 RNs in 286 medical-surgical units in 146 hospitals. Greater availability of nursing unit support services and higher levels of work engagement were associated with higher levels of patient satisfaction. Older age, better health status, and better symptom management were also associated with higher levels of patient satisfaction. Organizational factors in hospitals and nursing units, particularly support services on the nursing unit and mechanisms that foster nurses' work engagement and effective symptom management, are important influences on patient satisfaction.

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.

Salient Features and Outline of the Joint Japanese Guidelines for Safe Handling of Cancer Chemotherapy Drugs

PubMed Central

Kanda, Kiyoko; Hirai, Kazue; Iino, Keiko; Nomura, Hisanaga; Yasui, Hisateru; Kano, Taro; Ichikawa, Chisato; Hiura, Sumiko; Morita, Tomoko; Mitsuma, Ayako; Komatsu, Hiroko

2017-01-01

The purpose of this paper is to introduce the outline and describe the salient features of the “Joint Guidelines for Safe Handling of Cancer Chemotherapy Drugs” (hereinafter, “Guideline”), which were published in July 2015. The purpose of this Guideline is to provide guidance to protect against occupational exposure to hazardous drugs (HDs) to all medical personnel involved in cancer chemotherapy, including physicians, pharmacists, and nurses and home health-care providers. The Guideline was developed according to the Medical Information Network Distribution Service guidance for developing clinical practice guidelines, with reference to five authoritative guidelines used worldwide. PubMed, Cumulative Index to Nursing and Allied Health Literature, Ichushi-Web, and Cochrane Central Register of Controlled Trials were used for a systematic search of the literature. Eight clinical questions (CQs) were eventually established, and the strength of recommendation for each CQ is presented based on 867 references. The salient features of the Guideline are that it was jointly developed by three societies (Japanese Society of Cancer Nursing, Japanese Society of Medical Oncology, and Japanese Society of Pharmaceutical Oncology), contains descriptions including the definition of HDs and the concept of hierarchy of controls, and addresses exposure control measures during handling of chemotherapy drugs. Our future task is to collect additional evidence for the recommended exposure control measures and to assess whether publication of the Guideline has led to adherence of measures to prevent occupational exposure. PMID:28966958

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.

Coping with interpersonal stress and psychological distress at work: comparison of hospital nursing staff and salespeople.

PubMed

Kato, Tsukasa

2014-01-01

Hospital nurses frequently experience relationships with patients as stressors in the workplace. Nurses' coping behavior is one potential buffering factor that can reduce the effects of job stress on their psychological functioning and well-being. In this study, the association between nurses' strategies for coping with interpersonal stress from patients and their psychological distress was examined. Participants included 204 hospital nurses and 142 salespeople, who were used as a comparison group. Participants completed measures of coping with interpersonal stress and psychological distress. Hospital nurses reported more psychological distress than did salespeople. Moreover, distancing coping was correlated with high psychological distress in both nurses and salespeople, and reassessing coping was correlated with low psychological distress in nurses. For nurses only, constructive coping appeared to be an effective strategy for reducing psychological distress. It is important for nurses to understand the role of constructive coping in nurse-patient communication and interaction.

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.

Hospital churn and casemix instability: implications for planning and educating the nursing workforce.

PubMed

Chiarella, Mary; Roydhouse, Jessica K

2011-02-01

Health workforce planning is a priority for Australian governments at both state and federal levels. Nursing shortages are a significant problem and addressing these shortages is likely to be a component of any workforce plan. This paper looks at the case of hospital nursing and argues that casemix, workforce and management instability inhibit workforce planning for hospital nursing. These issues are related and any efforts to objectively plan the hospital nursing workforce must seek to address them in order to succeed.

Predictors of nursing home residents' time to hospitalization.

PubMed

O'Malley, A James; Caudry, Daryl J; Grabowski, David C

2011-02-01

To model the predictors of the time to first acute hospitalization for nursing home residents, and accounting for previous hospitalizations, model the predictors of time between subsequent hospitalizations. Merged file from New York State for the period 1998-2004 consisting of nursing home information from the minimum dataset and hospitalization information from the Statewide Planning and Research Cooperative System. Accelerated failure time models were used to estimate the model parameters and predict survival times. The models were fit to observations from 50 percent of the nursing homes and validated on the remaining observations. Pressure ulcers and facility-level deficiencies were associated with a decreased time to first hospitalization, while the presence of advance directives and facility staffing was associated with an increased time. These predictors of the time to first hospitalization model had effects of similar magnitude in predicting the time between subsequent hospitalizations. This study provides novel evidence suggesting modifiable patient and nursing home characteristics are associated with the time to first hospitalization and time to subsequent hospitalizations for nursing home residents. © Health Research and Educational Trust.

Lower Mortality in Magnet Hospitals

PubMed Central

McHugh, Matthew D.; Kelly, Lesly A.; Smith, Herbert L.; Wu, Evan S.; Vanak, Jill M.; Aiken, Linda H.

2012-01-01

Background Although there is evidence that hospitals recognized for nursing excellence— Magnet hospitals—are successful in attracting and retaining nurses, it is uncertain whether Magnet recognition is associated with better patient outcomes than non-Magnets, and if so why. Objectives To determine whether Magnet hospitals have lower risk-adjusted mortality and failure-to-rescue compared to non-Magnet hospitals, and to determine the most likely explanations. Method and Study Design Analysis of linked patient, nurse, and hospital data on 56 Magnet and 508 non-Magnet hospitals. Logistic regression models were used to estimate differences in the odds of mortality and failure-to-rescue for surgical patients treated in Magnet vs. non-Magnet hospitals, and to determine the extent to which differences in outcomes can be explained by nursing after accounting for patient and hospital differences. Results Magnet hospitals had significantly better work environments and higher proportions of nurses with bachelor’s degrees and specialty certification. These nursing factors explained much of the Magnet hospital effect on patient outcomes. However, patients treated in Magnet hospitals had 14% lower odds of mortality (OR 0.86, 95% CI 0.76-0.98, p=0.02) and 12% lower odds of failure-to-rescue (OR 0.88, 95% CI 0.77-1.01, p=0.07) while controlling for nursing factors as well as hospital and patient differences. Conclusions Magnet hospitals have lower mortality than is fully accounted for by measured characteristics of nursing. Magnet recognition likely both identifies existing quality and stimulates further positive organizational behavior that improves patient outcomes. PMID:23047129

Mitigating the impact of hospital restructuring on nurses: the responsibility of emotionally intelligent leadership.

PubMed

Cummings, Greta; Hayduk, Leslie; Estabrooks, Carole

2005-01-01

A decade of North American hospital restructuring in the 1990s resulted in the layoff of thousands of nurses, leading to documented negative consequences for both nurses and patients. Nurses who remained employed experienced significant negative physical and emotional health, decreased job satisfaction, and decreased opportunity to provide quality care. To develop a theoretical model of the impact of hospital restructuring on nurses and determine the extent to which emotionally intelligent nursing leadership mitigated any of these impacts. The sample was drawn from all registered nurses in acute care hospitals in Alberta, Canada, accessed through their professional licensing body (N = 6,526 nurses; 53% response rate). Thirteen leadership competencies (founded on emotional intelligence) were used to create 7 data sets reflecting different leadership styles: 4 resonant, 2 dissonant, and 1 mixed. The theoretical model was then estimated 7 times using structural equation modeling and the seven data sets. Nurses working for resonant leaders reported significantly less emotional exhaustion and psychosomatic symptoms, better emotional health, greater workgroup collaboration and teamwork with physicians, more satisfaction with supervision and their jobs, and fewer unmet patient care needs than did nurses working for dissonant leaders. Resonant leadership styles mitigated the impact of hospital restructuring on nurses, while dissonant leadership intensified this impact. These findings have implications for future hospital restructuring, accountabilities of hospital leaders, the achievement of positive patient outcomes, the development of practice environments, the emotional health and well-being of nurses, and ultimately patient care outcomes.

Involvement in decisions about intravenous treatment for nursing home patients: nursing homes versus hospital wards.

PubMed

Klomstad, Kristin; Pedersen, Reidar; Førde, Reidun; Romøren, Maria

2018-05-08

Many of the elderly in nursing homes are very ill and have a reduced quality of life. Life expectancy is often hard to predict. Decisions about life-prolonging treatment should be based on a professional assessment of the patient's best interest, assessment of capacity to consent, and on the patient's own wishes. The purpose of this study was to investigate and compare how these types of decisions were made in nursing homes and in hospital wards. Using a questionnaire, we studied the decision-making process for 299 nursing home patients who were treated for dehydration using intravenous fluids, or for bacterial infections using intravenous antibiotics. We compared the 215 (72%) patients treated in nursing homes to the 84 (28%) nursing home patients treated in the hospital. The patients' capacity to consent was considered prior to treatment in 197 (92%) of the patients treated in nursing homes and 56 (67%) of the patients treated in hospitals (p < 0.001). The answers indicate that capacity to consent can be difficult to assess. Patients that were considered capable to consent, were more often involved in the decision-making in nursing homes than in hospital (90% vs. 52%). Next of kin and other health personnel were also more rarely involved when the nursing home patient was treated in hospital. Whether advance care planning had been carried out, was more often unknown in the hospital (69% vs. 17% in nursing homes). Hospital doctors expressed more doubt about the decision to admit the patient to the hospital than about the treatment itself. This study indicates a potential for improvement in decision-making processes in general, and in particular when nursing home patients are treated in a hospital ward. The findings corroborate that nursing home patients should be treated locally if adequate health care and treatment is available. The communication between the different levels of health care when hospitalization is necessary, must be better. ClinicalTrials.gov NCT01023763 (12/1/09) [The registration was delayed one month after study onset due to practical reasons].

A national study of nurse leadership and supports for quality improvement in rural hospitals.

PubMed

Paez, Kathryn; Schur, Claudia; Zhao, Lan; Lucado, Jennifer

2013-01-01

This study assessed the perceptions and actions of rural hospital nurse executives with regard to patient safety and quality improvement (QI). A national sample of rural hospital nurse executives (n = 300) completed a survey measuring 4 domains related to patient safety and QI: (a) patient "Safety Culture," (b) adequacy of QI "Resources," (c) "Barriers" related to QI, and (d) "Nurse Leader Engagement" in activities supporting QI. Perceptions of Safety Culture were strong but 47% of the Resources needed to carry out QI were inadequate, 29% of Barriers were moderate to major, and 25% of Nurse Leader Engagement activities were performed infrequently. Nurse Leader Engagement in quality-related activities was less frequent among nurses in isolated and small rural town hospitals compared with large rural city hospitals. To further QI, rural nurse executives may need to use their communications and actions to raise the visibility of QI.

Effects of environment and education on knowledge and attitude of nursing students towards leprosy.

PubMed

Rajkumar, E; Julious, S; Salome, A; Jennifer, G; John, A S; Kannan, L; Richard, J

2011-01-01

The objective of this cross-sectional comparative study was to find the effects of environment and education on knowledge and attitude of nursing students towards leprosy. Data were collected, using a pretested questionnaire, from the first year and third year students of a School of Nursing attached to a leprosy specialty hospital and also from a comparable School of Nursing attached to a general hospital. The results showed that trainees acquired more knowledge on leprosy during training in both schools of nursing. However, those trained in leprosy hospital environment had higher knowledge and attitude scores than those trained in general hospital environment. The attitude of the trainees attached to leprosy hospital was favourable even before they had formal training in leprosy. Those trained in the general hospital showed more favourable attitude after training compared to before training. School of Nursing attached to leprosy hospital provided an atmosphere conducive to learning and understanding more about leprosy. The trainees retained what was learnt because of regular association with patients affected by leprosy. For employment in hospital or community based services or research related to leprosy, nurses trained in a leprosy hospital would have added value of knowledge and attitude.

[Centennial retrospective on the evolution and development of the nursing profession in Taiwan].

PubMed

Wang, Kwua-Yun; Chang, Shu-Rong

2014-08-01

This article explores the evolution and development of the Taiwanese nursing profession. After introducing the origins of nursing, this article proceeds to introduce nursing during various periods in Taiwan, including the early-Qing Dynasty, foreign missionary nursing, the Japanese Colonial Era, and the Nationalist Chinese Era following World War Two up to the present. The authors then present the current situation in the Taiwanese nursing profession in terms of gender issues, high-technology developments, educational issues, the nursing licensing examination, hiring and training, multiple role functions, and the skill-mix care model. Finally, the authors make recommendations for the further development and improvement of the nursing profession in Taiwan.

Hospitals Known for Nursing Excellence Associated with Better Hospital Experience for Patients.

PubMed

Stimpfel, Amy Witkoski; Sloane, Douglas M; McHugh, Matthew D; Aiken, Linda H

2016-06-01

To examine the relationship between Magnet recognition, an indicator of nursing excellence, and patients' experience with their hospitalization reported in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. This secondary analysis includes cross-sectional data from the 2010 HCAHPS survey, the American Hospital Association, and the American Nurses Credentialing Center. We conducted a retrospective observational study. Using common hospital identifiers, we created a matched set of 212 Magnet hospitals and 212 non-Magnet hospitals. Patients in Magnet hospitals gave their hospitals higher overall ratings, were more likely to recommend their hospital, and reported more positive care experiences with nurse communication. Magnet recognition is associated with better patient care experiences, which may positively enhance reimbursement for hospitals. © Health Research and Educational Trust.

[The Effectiveness of a Strategy for the Flexible Management of Nursing Human Resources: A Pilot Study].

PubMed

Huang, Chung-I; Lu, Meei-Shiow

2017-12-01

The flexibility of a hospital's nursing-related human resource management policies affects the working willingness and retention of nurses. To explore the effectiveness of a flexible nursing-related human resource management strategy. This quasi-experimental research used a one group pretest-posttest design. Supervisors at participating hospitals attended the "Application of Flexible Nursing Human Resources Management Strategies" workshop, which introduced the related measures and assessed nurses' pretest satisfaction. After these measures were implemented at the participating hospitals, implementation-related problems were investigated and appropriate consultation was provided. The posttest was implemented after the end of the project. Data were collected from nurses at the participating hospitals who had served in their present hospital for more than three months. The participating hospitals were all nationally certified healthcare providers, including 13 medical centers, 17 regional hospitals, and 3 district hospitals. A total of nurses 2,810 nurses took the pretest and 2,437 took the posttest. The research instruments included the "Satisfaction with working conditions and system flexibility" scale and the "Flexible nursing human resource management strategies". The effectiveness of the implemented strategy was assessed using independent samples t-test and variance analysis. The result of implementing the flexible strategies shows that the total mean of pretest satisfaction (Likert 5 scores) was 3.47 (SD = 0.65), and the posttest satisfaction was 3.52 (SD = 0.65), with significant statistical differences in task, numerical, divisional, and leading flexibility. Due to the good implementation effectiveness, the authors strongly suggest that all of the participating hospitals continue to apply this strategic model to move toward a more flexible nursing system and work.

Nursing Workforce in Hubei China: Implications for the Development of Traditional Chinese Medicine Education.

PubMed

Cai, Yi; Mao, Zongfu; Corazzini, Kirsten; Petrini, Marcia A; Wu, Bei

2015-01-01

Research evidence suggests that educating nurses about traditional Chinese medicine (TCM) significantly improves their nursing care practice and the health care outcomes of community residents. The purpose of this study was to describe the current use of TCM by China's nursing workforce, as well as the typical nurse to physician ratio and types of TCM education that nurses receive in health care facilities. A large retrospective survey was conducted in Hubei Province, China, in 2010. The sample included 620 non-TCM hospitals, 120 TCM hospitals, and 1254 community health centers (CHCs). Descriptive analysis and 1-way analysis of variance were used to test statistical differences. There were 79 447 nurses employed, of which 1527 had a TCM degree and 5689 had on-the-job TCM education. Non-TCM hospitals employed more nurses than TCM hospitals and CHCs, and TCM hospitals employed more TCM nurses than non-TCM hospitals and CHCs. The median nurse to physician ratio varied by level of urbanization and type of health care facility, from 0.6 in rural CHCs to 1.3 in rural non-TCM hospitals. Differences in TCM education preparation of nurses were significantly different in the urban and rural settings and by type of health care facility. The study suggested a shortage of nurses educated in TCM in Hubei Province China, as well as uneven TCM workforce distribution. More opportunities for TCM education are needed for nurses, especially in CHCs where health promotion and chronic disease management are the most important and mandated functions.

Nursing: the hospital's competitive edge.

PubMed

Shaffer, F A; Preziosi, P

1988-09-01

The health care marketplace is becoming increasingly competitive. The hospital has a built-in marketing force with the nursing department, because nurses are in constant, direct contact with the customer. Nursing must identify the case mix profile of the community and focus the hospital product lines to meet community needs. The nursing department should decentralize, change, measure, and innovate the staff mix needed to operationalize these product lines. The development of nursing practice standards for the case mix will help to identify the staff mix needed and create systems to efficiently manage the product lines. Nursing management must become aware of cross-subsidization and downward skill substitution of nursing personnel. Nursing information systems must generate quality reports that invoke cost consciousness on the part of nursing staff. Quality assurance programs must become unit based and complete with frequent audits to correlate length of stay with nursing quality. Correlations must be determined between nursing productivity and case mix to determine the hospital's niche in the marketplace. The transformation of health care into a competitive business industry has created many opportunities for nursing. The health care industry's incentives for efficiency along with the decreasing demand for inpatient hospital services will be the forces driving health care toward a competitive marketplace. The hospital's nursing department should be strategically positioned to become accountable for increasing market share and enhancing quality patient outcomes. The focus has shifted from the theoretical to the tactical, which is a step in the right direction, particularly for nursing. Nursing, if strategically positioned, will not only thrive but will also excel in this chaotic environment by capturing the opportunities and being innovative.

Workplace Violence and its Associated Factors among Nurses.

PubMed

Pandey, Manisha; Bhandari, Tulsi Ram; Dangal, Ganesh

2018-01-01

Workplace violence among nurses is prevalent worldwide. If nurses become aware of the workplace violence and its risk factors then only they can protect themselves. This study assessed the prevalence of workplace violence and its associated factors among nurses in Pokhara, Nepal. A hospital-based descriptive cross-sectional study was conducted in Pokhara. The required sample size of the study was 200 nurses. We adopted self-administered questionnaire developed by International Labor Office, International Council of Nurses, World Health Organization (WHO), and Public Services International. Out of 21 hospitals of Pokhara, we selected five hospitals using simple random sampling method. The number of nurses in each hospital was fixed proportionately considering the total number of employed nurses. Individual nurses were selected on the first meet first basis to gain the required number. Two-thirds (64.5%) nurses experienced some type of violence in the last six months at their workplace. The proportion of verbal violence was higher (61.5%) compared to the physical (15.5%) and sexual violence (9%). Most perpetrators of the violence were the relatives of patients and hospital employees. Age of nurses and working stations had statistically significant association with workplace violence (p-value < 0.05). Workplace violence among nurses is a noteworthy problem in Pokhara whereas nearly two-thirds of nurses faced some type of violence in last six months. It is an urge to widen awareness level of nurses on the violence thus, they can take precaution themselves and ask hospital administration and other stakeholders to address the workplace violence.

The Effect of Providing Life Support on Nurses' Decision Making Regarding Life Support for Themselves and Family Members in Japan.

PubMed

Shaku, Fumio; Tsutsumi, Madoka

2016-12-01

Decision making in terminal illness has recently received increased attention. In Japan, patients and their families typically make decisions without understanding either the severity of illness or the efficacy of life-supporting treatments at the end of life. Japanese culture traditionally directs the family to make decisions for the patient. This descriptive study examined the influence of the experiences of 391 Japanese nurses caring for dying patients and family members and how that experience changed their decision making for themselves and their family members. The results were mixed but generally supported the idea that the more experience nurses have in caring for the dying, the less likely they would choose to institute lifesupport measures for themselves and family members. The results have implications for discussions on end-of-life care. © The Author(s) 2016.

Lessons learned from conducting qualitative research in a hospital.

PubMed

Woith, Wendy Mann; Jenkins, Sheryl Henry; Astroth, Kim Schafer; Kennedy, Julie A

2014-11-01

To examine unexpected barriers to the conduct of hospital research during a study of nurses' activation of rapid response teams. We interviewed hospital nurses regarding their decisions to activate rapid response teams and encountered unexpected barriers to the conduct of this study in the hospital setting. Experience of conducting qualitative research with bedside nurses in a community hospital. Review of the reports of others who have conducted hospital research. Barriers related to administrative support, environmental distractors, constraints on nurses' time, apparent lack of investment in research by staff and a cumbersome recruitment process are identified. Recommendations on study site selection, timing of research, gaining access to nurses, scheduling and conducting interviews, and transcribing recorded data are made. As evidence is necessary to deliver safe, quality care, it is important that nurses understand and participate in research. This participation involves not only conducting research, but also serving as subjects. Given the importance of bedside nurses' willingness to engage in research, it is crucial to understand factors that impede or assist their participation. We offer several recommendations to nurses conducting research in hospitals, including: ■ Seek hospitals that are supportive of research, yet not over-invested in the process. ■ Build extra time into data collection schedules to maximize flexibility and accommodate work-place demands. ■ Emphasise the relevance and benefits of the research to nurses.

Empowerment of nursing students in the United Kingdom and Japan: a cross-cultural study.

PubMed

Bradbury-Jones, Caroline; Irvine, Fiona; Sambrook, Sally

2007-08-01

This paper is a report of a study to explore the phenomenon of empowerment cross-culturally by comparing the situations in which nursing students from the United Kingdom and Japan experienced empowerment and disempowerment in clinical practice. Empowerment has been the focus of many studies, but most focus on the experience of Registered Nurses and few have explored the phenomenon cross-culturally. This was a cross-cultural, comparative study using the critical incident technique. Anonymous written data were collected from nursing students in Japan and United Kingdom between November 2005 and January 2006. Japanese data were translated and back-translated. Analysis of the transcripts revealed three themes: Learning in Practice, Team Membership, Power. Nursing students in these countries are exposed to different educational and clinical environments, but their experiences of empowerment and disempowerment are similar. For both, learning in practice, team membership and power are associated with either empowerment or disempowerment; depending on the context. United Kingdom students are aware of the importance of acting as patient advocates, although they cannot always find the voice to perform this. Japanese students however, appear to be unaware of the concept of advocacy. Student nurse empowerment may transcend cultural differences, and learning in practice, team membership and power may be important for the empowerment of nursing students globally. Further cross-cultural exploration is required into the association between advocacy and empowerment.

Emergency nurse disaster preparedness during mass gatherings: a cross-sectional survey of emergency nurses' perceptions in hospitals in Mecca, Saudi Arabia

PubMed Central

Alzahrani, Fuad; Kyratsis, Yiannis

2017-01-01

Objectives To assess hospital emergency nurses' self-reported knowledge, role awareness and skills in disaster response with respect to the Hajj mass gathering in Mecca. Design Cross-sectional online survey with primary data collection and non-probabilistic purposive sample conducted in late 2014. Setting All 4 public hospitals in Mecca, Saudi Arabia. Participants 106 registered nurses in hospital emergency departments. Main outcome measure Awareness, knowledge, skills and perceptions of emergency nurses in Mecca with regard to mass gathering disaster preparedness. Results Although emergency nurses' clinical role awareness in disaster response was reported to be high, nurses reported limited knowledge and awareness of the wider emergency and disaster preparedness plans, including key elements of their hospital strategies for managing a mass gathering disaster. Over half of the emergency nurses in Mecca's public hospitals had not thoroughly read the plan, and almost 1 in 10 were not even aware of its existence. Emergency nurses reported seeing their main role as providing timely general clinical assessment and care; however, fewer emergency nurses saw their role as providing surveillance, prevention, leadership or psychological care in a mass gathering disaster, despite all these broader roles being described in the hospitals' emergency disaster response plans. Emergency nurses' responses to topics where there are often misconceptions on appropriate disaster management indicated a significant knowledge deficit with only 1 in 3 nurses at best or 1 in 6 at worst giving correct answers. Respondents identified 3 key training initiatives as opportunities to further develop their professional skills in this area: (1) hospital education sessions, (2) the Emergency Management Saudi Course, (3) bespoke short courses in disaster management. Conclusions Recommendations are suggested to help enhance clinical and educational efforts in disaster preparedness. PMID:28400457

Incidence and risk factors of workplace violence against nurses in a Chinese top-level teaching hospital: A cross-sectional study.

PubMed

Chen, Xiaoming; Lv, Ming; Wang, Min; Wang, Xiufeng; Liu, Junyan; Zheng, Nan; Liu, Chunlan

2018-04-01

To investigate the incidence of workplace violence involving nurses and to identify related risk factors in a high-quality Chinese teaching hospital. A cross-sectional study design was used. The final sample comprised responses from 1831 registered nurses collected with a whole-hospital survey from June 1 to June 15, 2016. The demographic characteristics of the nurses who had experienced any form of violence were collected, and logistic regression analysis was applied to evaluate the risk factors for nurses related to workplace violence. Out of the total number of nurses surveyed, 904 (49.4%) nurses reported having experienced any type of violence in the past year. The frequencies of exposure to physical and non-physical violence were 6.3% (116) and 49.0% (897), respectively. All the incidence rates of violence were lower than those of other studies based on regional hospitals in China and were at the same level found in developed countries and districts. Binary logistic regression analysis revealed that nurses at levels 2 to 4 and female nurses in clinical departments were the most vulnerable to non-physical violence. For physical violence, the two independent risk factors were working in an emergency department and having 6-10 years of work experience. Workplace violence directly threatens nurses from high-quality Chinese teaching hospitals. However, the incidence of WPV against nurses in this teaching hospital was better than that in regional hospitals. This study also provides reference material to identify areas where nurses encounter relatively high levels of workplace violence in high-quality Chinese teaching hospitals. Copyright © 2018 Elsevier Inc. All rights reserved.

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

Nursing perception of patient transitions from hospitals to home with home health.

PubMed

Smith, Shannon Bright; Alexander, Judith W

2012-01-01

The study's purpose was to determine nurses' opinions of sending patients from the hospital to home with home health services. The study occurred in the Charleston, South Carolina, Tricounty area (Berkeley, Charleston, and Dorchester counties). Home health agencies and hospitals were invited to participate. The study used a survey design to gather information on nursing perceptions of current practices and needed changes to improve transition of patients. The population was nurses (licensed practical nurses (LPNs) and registered nurses (RNs)) employed at inpatient hospitals or home health agencies in the area. Thirty-four RNs responded with no LPNs respondents. Agency administrators/chief nursing officers agreed for their agencies to participate and distributed the survey using a Research Electronic Data Capture (REDCap) Internet-based survey tool. Using the survey results and information from a literature review, the study developed a list of propositions, which participating administrators reviewed, for improving transitions to home. Both home health and hospital nurses reported a need to improve the process of sending patients from hospital to home with home health services. This study provides hospitals and home health agencies with propositions to facilitate the establishment of a process to communicate effectively patients care needs and streamline the discharging patients from the hospital to home health care; thus, improving patient transition. Case managers and discharge planners will need interagency collaboration along with evidence-based interventions to transition patients from the hospital to home with home health services with various populations. Direct patient care nurses in both hospital and home health settings should share the same accountability as case managers to ensure successful transitions.

[Subjective Workload, Job Satisfaction, and Work-Life-Balance of Physicians and Nurses in a Municipal Hospital in a Rural Area Compared to an Urban University Hospital].

PubMed

Körber, Michael; Schmid, Klaus; Drexler, Hans; Kiesel, Johannes

2018-05-01

Medical and nursing shortages in rural areas represent a current serious public health problem. The healthcare of the rural population is at risk. This study compares perceived workload, job satisfaction and work-life balance of physicians and nurses at a clinic in a rural area with two clinics of a University hospital. Physicians and nurses were interviewed anonymously with a standardized questionnaire (paper and pencil), including questions on job satisfaction, subjective workload and work-life balance. The response rate was almost 50% in the University hospital as well as in the municipal hospital. 32 physicians and 54 nurses from the University hospital and 18 physicians and 137 nurses from the municipal hospital participated in the survey. Nurses at the University hospital assessed the organization of the daily routine with 94.1% as better than those at the municipal hospital (82.4%, p=0.03). Physicians at the University hospital were able to better implement acquired knowledge at a University clinic with 87.5% than their counterparts at the municipal hospital (55.5%, p=0.02). In contrast to their colleagues at the municipal hospital, only 50% of the physicians at the University hospital subjectively considered their workload as just right (83.3% municipal, p=0.02). 96.9% of the physicians at the University hospital were "daily" or "several times a week" under time pressure (municipal 50%, p<0.01). Nurses of both hospitals had sufficient opportunity to reconcile work and family life (62.9% University hospital, 72.8% Municipal hospital). In contrast, only 20% of the physicians at the University Hospital but 42.9% of the physicians of the municipal hospital had sufficient opportunities to balance workload and family (p=0.13). The return rate of almost 50% can be described as good. Due to the small number of physicians, especially from the municipal hospital, it can be assumed that some interesting differences could not be detected. There were only slight differences between the nurses from the two hospitals. In contrast, subjective workload and stress factors reported by physicians at the University Hospital were significantly higher than those by doctors at the municipal hospital. © Georg Thieme Verlag KG Stuttgart · New York.

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.

RELIGION & CARE INTERTWINED; NURSING IN CATHOLIC HOSPITALS 1950-1965.

PubMed

Anthony, Maureen

2016-01-01

This qualitative study explores how Catholicism influenced nursing in Catholic hospitals and how nurses met the religious needs of Catholic patients in the 1950s and early 1960s. Six nurses were interviewed who graduated from Catholic schools of nursing between 1952 and 1965 and worked in Catholic hospitals. Results indicate that nursing care was inexorably entwined with meeting the religious needs of Catholic patients. Religious practices were predictable and largely linked to the Holy Sacraments.

The hospital nursing shortage. A paradox of increasing supply and increasing vacancy rates.

PubMed Central

Aiken, L H

1989-01-01

A serious shortage of nurses has developed since 1984 despite a growing number of employed nurses and a substantial decline in the number of hospital inpatient days. The evidence suggests that the shortage is the result of an increased demand for nurses, not a decline in supply. The increased demand in large part has resulted from the substitution of registered nurses for licensed practical nurses, aides, and other patient services personnel. The substitution was feasible because nurses' wages have been depressed compared with those of other hospital employees. The shortage is likely to abate if nurses' wages increase, making substitution more costly. Even in the absence of continuing wage increases, hospitals could ease the shortage by restructuring patient services and enabling nurses to spend a greater portion of their time in direct patient care. PMID:2669349

Nurses' information retrieval skills in psychiatric hospitals - are the requirements for evidence-based practice fulfilled?

PubMed

Koivunen, Marita; Välimäki, Maritta; Hätönen, Heli

2010-01-01

Nursing professionals have long recognized the importance to practice of research and the value of research evidence. Nurses still do not use research findings in practice. The purpose of this paper was to describe nurses' skills in using literature databases and the Internet in psychiatric hospitals and associations of nurses' gender, age, and job position with their information retrieval skills. The study was carried out in 2004 among nursing staff (N=183) on nine acute psychiatric wards in two psychiatric hospitals in Finland (n=180, response rate 98%). The Finnish version of the European Computer Driving Licence test (ECDL) was used as a data collection instrument. The study showed that there were clear deficits in information retrieval skills among nurses working in psychiatric hospitals. Thus, nurses' competence does not support the realization of evidence-based practice in the hospitals. Therefore, it is important to increase nurses' information retrieval skills by tailoring continuing education modules. It would be also advisable to develop centralized systems for the internal dissemination of research findings for the use of nursing staff.

Quality Evaluation of Nursing Observation Based on a Survey of Nursing Documents Using NursingNAVI.

PubMed

Tsuru, Satoko; Omori, Miho; Inoue, Manami; Wako, Fumiko

2016-01-01

We have identified three foci of the nursing observation and nursing action respectively. Using these frameworks, we have developed the structured knowledge model for a number of diseases and medical interventions. We developed this structure based NursingNAVI^® contents collaborated with some quality centred hospitals. Authors analysed the nursing care documentations of post-gastrectomy patients in light of the standardized nursing care plan in the "NursingNAVI^®" developed by ourselves and revealed the "failure to observe" and "failure to document", which leaded to the volatility of the patients' data, conditions and some situation. This phenomenon should have been avoided if nurses had employed a standardized nursing care plan. So, we developed thinking process support system for planning, delivering, recording and evaluating in daily nursing using NursingNAVI^® contents. It is important to identify the problem of the volatility of the patients' data, conditions and some situation. We developed a survey tool of nursing documents using NursingNAVI^® Content for quality evaluation of nursing observation. We recommended some hospitals to use this survey tool. Fifteen hospitals participated the survey using this tool. It is estimated that the volatilizing situation. A hospital which don't participate this survey, knew the result. So the hospital decided to use NursingNAVI^® contents in HIS. It was suggested that the system has availability for nursing OJT and time reduction of planning and recording without volatilizing situation.

New horizons: Australian nurses at work in World War I.

PubMed

Harris, Kirsty

2014-06-01

More than 3000 nurses from Australia served with the Australian Army Nursing Service or the British nursing services during World War I. These nurses served in various theatres of war including Egypt, France, India, Greece, Italy and England. They worked in numerous roles including as a surgical team nurse close to the front working under fire; nursing on hospital ships carrying the sick and wounded; or managing hospital wards overrun with patients whilst dealing with a lack of hospital necessities. The skills and roles needed to be a military nurse significantly differed to the skills required to nurse in Australia. Copyright © 2014 Elsevier Ltd. All rights reserved.

Lower Mortality in Magnet Hospitals

PubMed Central

McHugh, Matthew D.; Kelly, Lesly A.; Smith, Herbert L.; Wu, Evan S.; Vanak, Jill M.; Aiken, Linda H.

2014-01-01

Background Although there is evidence that hospitals recognized for nursing excellence—Magnet hospitals—are successful in attracting and retaining nurses, it is uncertain whether Magnet recognition is associated with better patient outcomes than non-Magnets, and if so why. Objectives To determine whether Magnet hospitals have lower risk-adjusted mortality and failure-to-rescue compared with non-Magnet hospitals, and to determine the most likely explanations. Method and Study Design Analysis of linked patient, nurse, and hospital data on 56 Magnet and 508 non-Magnet hospitals. Logistic regression models were used to estimate differences in the odds of mortality and failure-to-rescue for surgical patients treated in Magnet versus non-Magnet hospitals, and to determine the extent to which differences in outcomes can be explained by nursing after accounting for patient and hospital differences. Results Magnet hospitals had significantly better work environments and higher proportions of nurses with bachelor's degrees and specialty certification. These nursing factors explained much of the Magnet hospital effect on patient outcomes. However, patients treated in Magnet hospitals had 14% lower odds of mortality (odds ratio 0.86; 95% confidence interval, 0.76–0.98; P = 0.02) and 12% lower odds of failure-to-rescue (odds ratio 0.88; 95% confidence interval, 0.77–1.01; P = 0.07) while controlling for nursing factors as well as hospital and patient differences. Conclusions The lower mortality we find in Magnet hospitals is largely attributable to measured nursing characteristics but there is a mortality advantage above and beyond what we could measure. Magnet recognition identifies existing quality and stimulates further positive organizational behavior that improves patient outcomes. PMID:24022082

The impact of deficit reduction on the nursing labour market in Canada: unintended consequences of fiscal reform.

PubMed

Vujicic, Marko; Evans, Robert G

2005-01-01

Beginning in 1992, governments throughout Canada began reducing expenditures in an effort to eliminate fiscal deficits and reduce their alarmingly high debt burden. As part of this deficit-fighting era, governments reduced hospital expenditure levels quite dramatically. Some of the current problems in the Canadian healthcare system - the recent unrest in the nursing labour market in particular - are often attributed to this hospital downsizing era. This article examines trends in the labour market for registered nurses in Canada during the hospital downsizing period. Of particular interest is the effect of hospital spending reforms on nurse employment levels in hospitals and on the age structure of the nursing workforce. After identifying the trends, the main factors driving the trends are discussed. Results indicate that a decrease in the demand for nursing labour resulted in large staff layoffs during the restructuring period, particularly among the youngest age groups. The evidence does not support the claim that deteriorating wages and working conditions in hospitals led nurses to quit their jobs during the hospital downsizing period.

The labor market effects of California's minimum nurse staffing law.

PubMed

Munnich, Elizabeth L

2014-08-01

In 2004, California became the first state to implement statewide minimum nurse-to-patient ratios in general hospitals. In spite of years of work to establish statewide staffing regulations, there is little evidence that the law was effective in attracting more nurses to the hospital workforce or improving patient outcomes. This paper examines the effects of this legislation on employment and wages of registered nurses. By using annual financial data from California hospitals, I show that nurse-to-patient ratios in medical/surgical units increased substantially following the staffing mandate. However, survey data from two nationally representative datasets indicate that the law had no effect on the aggregate number of registered nurses or the hours they worked in California hospitals, and at most a modest effect on wages. My findings suggest that offsetting changes in labor demand due to hospital closures, combined with reclassification of workers within hospitals, and mitigated the employment effects of California's staffing regulation. This paper cautions that California's experience with minimum nurse staffing legislation may not be generalizable to states considering similar policies in very different hospital markets. Copyright © 2013 John Wiley & Sons, Ltd.

The Perceptions and Expectations Toward the Social Responsibility of Hospitals and Organizational Commitment of Nursing Staff.

PubMed

Hsieh, Sheng-Che; Chiu, Herng-Chia; Hsieh, Ya-Hui; Ho, Pei-Shen; Chen, Li-Chin; Chang, Wei-Chou

2016-09-01

The labor rights of medical workers in hospitals in Taiwan have been a key issue of discussion and controversy in recent years. Generally, poor work conditions and manpower shortages in hospitals have resulted in a vicious circle of severely overworked medical and healthcare staff and chronically low staffing and retention rates. This study employed corporate social responsibility as the conceptual framework of the social responsibility of hospitals to examine the perceptions and expectations of nurses toward the social responsibility practices of the hospital where they serve and to explore the relationship between these perceptions and organizational commitment (OC). The participants were all nurses who were employed by one medical group in southern Taiwan. Two hundred forty anonymous questionnaires, which included scales that were designed to measure the social responsibility of hospitals and OC, were distributed. Two hundred twenty-seven valid questionnaires were returned. Exploratory factor analysis was used to validate the dimension of the social responsibility of hospitals, and hierarchical multiregression analyses were used to verify the relationship between the perceptions of nurses with regard to the social responsibility practices of the hospital where nurses serve and OC. There were considerable differences between participants' perceptions and expectations toward the social responsibility of hospitals. The nurses with high perceptions toward the social responsibility practices of the hospital where they serve tended to have relatively high OC. Senior nurses who had high perceptions of the legal and rational, ethical, and economic dimensions of the social responsibility practices of the hospital where they serve exhibited relatively strong affective commitment. Nurses in junior positions who had high perceptions of the practices of ethical responsibilities exhibited relatively strong continuance commitment. Senior nurses who had high perceptions of the legal and rational, ethical, and discretionary dimensions of the social responsibility practices of the hospital where they serve exhibited relatively strong normative commitment. A friendly and humane work environment in hospital settings facilitates the implementation of social responsibility, which has been shown to foster higher levels of organizational identification and job performance among nurses and other hospital employees.

How hospitals view unit-level nurse turnover data collection: analysis of a hospital survey.

PubMed

Park, Shin Hye; Boyle, Diane K

2015-02-01

The objectives of this study were to examine the quality of unit-level nurse turnover data collection among the National Database of Nursing Quality Indicators hospitals and to identify the burdens of collecting such data. Tracking and managing nurse turnover at the unit level are critical for administrators who determine managerial strategies. Little is known about the quality of and burdens of unit-level turnover data collection. Surveys from 178 hospitals were analyzed descriptively. Most hospitals strongly agreed or agreed with the quality of unit-level turnover data collection. Hospitals identified the burdens of additional time and resources needed for unit-level turnover data collection and the difficulty of obtaining specific reasons for turnover. Collecting unit-level nurse turnover data can be important and useful for administrators to improve nurse retention, workforce stability, and quality of care. We suggest that the advantages of unit-level nurse turnover data and reports can overcome the identified burdens.

Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study.

PubMed

Aiken, Linda H; Sloane, Douglas M; Bruyneel, Luk; Van den Heede, Koen; Griffiths, Peter; Busse, Reinhard; Diomidous, Marianna; Kinnunen, Juha; Kózka, Maria; Lesaffre, Emmanuel; McHugh, Matthew D; Moreno-Casbas, M T; Rafferty, Anne Marie; Schwendimann, Rene; Scott, P Anne; Tishelman, Carol; van Achterberg, Theo; Sermeus, Walter

2014-05-24

Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. The RN4CAST study was designed to inform decision making about nursing, one of the largest components of hospital operating expenses. We aimed to assess whether differences in patient to nurse ratios and nurses' educational qualifications in nine of the 12 RN4CAST countries with similar patient discharge data were associated with variation in hospital mortality after common surgical procedures. For this observational study, we obtained discharge data for 422,730 patients aged 50 years or older who underwent common surgeries in 300 hospitals in nine European countries. Administrative data were coded with a standard protocol (variants of the ninth or tenth versions of the International Classification of Diseases) to estimate 30 day in-hospital mortality by use of risk adjustment measures including age, sex, admission type, 43 dummy variables suggesting surgery type, and 17 dummy variables suggesting comorbidities present at admission. Surveys of 26,516 nurses practising in study hospitals were used to measure nurse staffing and nurse education. We used generalised estimating equations to assess the effects of nursing factors on the likelihood of surgical patients dying within 30 days of admission, before and after adjusting for other hospital and patient characteristics. An increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% (odds ratio 1·068, 95% CI 1·031-1·106), and every 10% increase in bachelor's degree nurses was associated with a decrease in this likelihood by 7% (0·929, 0·886-0·973). These associations imply that patients in hospitals in which 60% of nurses had bachelor's degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor's degrees and nurses cared for an average of eight patients. Nurse staffing cuts to save money might adversely affect patient outcomes. An increased emphasis on bachelor's education for nurses could reduce preventable hospital deaths. European Union's Seventh Framework Programme, National Institute of Nursing Research, National Institutes of Health, the Norwegian Nurses Organisation and the Norwegian Knowledge Centre for the Health Services, Swedish Association of Health Professionals, the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet, Committee for Health and Caring Sciences and Strategic Research Program in Care Sciences at Karolinska Institutet, Spanish Ministry of Science and Innovation. Copyright © 2014 Elsevier Ltd. All rights reserved.

Investigating and profiling the leadership behaviours of Jordanian nursing leaders.

PubMed

Mrayyan, Majd; Khasawneh, Israa

Leadership' is a social process in which a member or members of a group influence the interpretation of events, choice of goals/outcomes, organization of work activities, motivation, abilities, power relations, and shared orientations. This study identifies leadership behaviours of Jordanian nursing leaders. A descriptive comparative design was used to collect data from four governmental and three private hospitals. Data were collected during April 2005. The total number of recruited nursing leaders was 140 with a 70% response rate. T-tests and chi-squares were performed to compare the phenomenon of interest. The mean reported leadership behaviours were slightly higher in private hospitals than those in governmental hospitals. However, more than half of the time, leaders in both types of hospitals used supportive leadership behaviours. There were significant differences between governmental and private hospitals in most demographics of the sample. Based on types of hospitals and gender, differences in leadership behaviours were advantageous for nursing leaders in private hospitals, while differences based on units and wards were advantageous for nursing leaders in governmental hospitals. In general, Jordanian nursing leaders used supportive leadership behaviours. Differences in leadership behaviours have implications for nursing practice, research, and education.

Retaining nurses in their employing hospitals and in the profession: effects of job preference, unpaid overtime, importance of earnings and stress.

PubMed

Zeytinoglu, Isik Urla; Denton, Margaret; Davies, Sharon; Baumann, Andrea; Blythe, Jennifer; Boos, Linda

2006-11-01

The purpose of this paper is to examine the effects of job preference, unpaid overtime, importance of earnings, and stress in retaining nurses in their employing hospitals and in the profession. Data come from our survey of 1396 nurses employed in three teaching hospitals in Southern Ontario, Canada. Data are analyzed first for all nurses, then separately for full-time, part-time, and casual nurses. Results show that the key to understanding the effects of these variables may be to pay attention to the work status of nurses. With regards to retaining nurses in their hospitals, working in their preferred type of job is important, particularly for part-time nurses. Working unpaid and longer than agreed hours is also a factor for increasing the likelihood of part-time nurses to leave the profession. All nurses are less inclined to leave as the importance of their earnings for the family increases, but it is particularly important for part-time nurses. Stress is an ongoing concern for retaining nurses in their hospitals and within the profession. We suggest managers and policy makers pay attention to employing nurses in jobs they prefer, decrease unpaid overtime, and consider the importance of earnings for them and their families in developing policies and programs to retain nurses. More importantly, stress levels should be lowered to retain nurses.

Variations in hospitalization rates among nursing home residents: the role of facility and market attributes.

PubMed

Carter, Mary W; Porell, Frank W

2003-04-01

This study examined the contribution of facility-level and area market-level attributes to variations in hospitalization rates among nursing home residents. Three years (1991-1994) of state quarterly Medicaid case-mix reimbursement data from 527 nursing homes (NH) in Massachusetts were linked with Medicare Provider Analysis and Review hospital claims and nursing facility attribute data to produce a longitudinal, analytical file containing 72,319 person-quarter observations. Logistic regression models were used to estimate the influence of facility-level and market-level factors on hospital use, after controlling for individual-level resident attributes, including: NH diagnoses, resident-level quality of care indicators, and diagnostic cost grouping classification from previous hospital stays. Multivariate findings suggest that resident heterogeneity alone does not account for the wide variations in hospitalization rates across nursing homes. Instead, facility characteristics such as profit status, nurse staffing patterns, NH size, chain affiliation, and percentage of Medicaid and Medicare reimbursed days significantly influence NH residents' risk of hospitalization. Broader area market factors also appear to contribute to variations in hospitalization rates. Variations in hospitalization rates may reflect underutilization, as well as overutilization. Continued efforts toward identifying medically necessary hospitalizations are needed.

Burnout among hospital nurses in China.

PubMed

Lin, Frances; St John, Winsome; McVeigh, Carol

2009-04-01

The aim of this study was to examine the level of burnout and factors that contribute to burnout in hospital nurses in the People's Republic of China. While burnout among hospital nurses has been widely researched in western countries, little research has investigated burnout among hospital nurses in China. A translated version of the Maslach Burnout Inventory-Human Services Survey was used to measure burnout in 249 randomly selected nurses from various wards of a large teaching hospital in Beijing, China. Questionnaire packs were sent to the hospital wards where selected nurses worked. One hundred and twenty-eight nurses returned the completed questionnaire. The response rate was 51%. The results showed moderate levels of Emotional Exhaustion and Personal Accomplishment, and low levels of Depersonalization. Age, years of experience and professional title had a significant positive relationship with Emotional Exhaustion and Personal Accomplishment. Older, married nurses with more personal responsibilities and in a more senior position experienced higher levels of Emotional Exhaustion. The findings suggest that burnout is a significant issue for nurses in China. The results of this study indicate that working environment factors such as relationships with coworkers and managers may contribute to or mitigate burnout. There is a need to address personal and professional support, life-work balance, personal accomplishment and educational programmes to reduce burnout in nurses working in China.

[Emergency department triage: independent nursing intervention?].

PubMed

Corujo Fontes, Sergio José

2014-03-01

The branch hospital triage aimed at, as well as exercised by nurses, has evolved to meet their needs to organize and make visible the nurses' duties. However, it is still not properly considered as independent nursing intervention. Evidencing practice triage nurse in hospital as experienced by their protagonists disclosed the possible causes of this paradoxical competence. In a sample of 41 nurses, of the 52 possible with previous experience in hospital triage in the Emergency Department of the Hospital General Dr. José Molina Orosa in Lanzarote, the nurses themselves carried out an opinion survey that group together statements about different aspects of the triaje nurse. In its results, 65.8% of those polled thought the triaje nursing training to be deficient and even though nearly half 48.7%, was considered competent to decide the level of emergency, 46.3% disagreed to take this task part of their duty. It is conclusive that the training received in hospital triage, regulated and sustained, is deficient, that is the main reason why professionals have their doubts to take on an activity they are not familiar with. Triage systems do not record the entire outcome of the nursing work and nursing methodology does not seem to be quite indicative for this task.

Effort-reward imbalance and burnout among German nurses in medical compared with psychiatric hospital settings.

PubMed

Schulz, M; Damkröger, A; Heins, C; Wehlitz, L; Löhr, M; Driessen, M; Behrens, J; Wingenfeld, K

2009-04-01

The aim of this study was to investigate whether nurses' efforts and rewards, as well as the effort-reward imbalance (ERI) and burnout, differ between subjects working in psychiatric vs. medical hospitals and between nurses under education and examined nurses respectively. Furthermore, the relationship between ERI and burnout was evaluated. Nursing is associated with high levels of emotional strain and heavy workloads. Burnout and a negative ERI can result in high absenteeism and turnover and have been identified as reasons why nurses leave their profession. In the last decade, working conditions of the nursing profession have changed in Germany, but somatic and psychiatric hospitals developed in different ways. This development may lead to different profiles. A sample of 389 nurses (78.8% female) in four German hospitals was investigated. A total of 147 nurses worked in psychiatric hospitals and 236 nurses worked in medical (somatic) hospitals. Fifty participants were still under education. The Effort-Reward Imbalance Inventory measures effort, reward and overcommitment at job and provides an imbalance score between effort and reward. The Maslach Burnout Inventory with the subscales, emotional exhaustion, lack of accomplishment and depersonalization, was also used. Nurses working in medical hospitals reported more burnout and had higher ERI scores. Subjects under education were comparable to examined nurses in terms of burnout but had lower ERI scores. Multiple regression analyses showed all ERI scales to be significant predictors for emotional exhaustion, while age, field of work and educational status further predict effort or ERI respectively. At present, the working situation of nurses in different settings appears to be characterized by a perceived imbalance of effort and reward and is associated with a high risk of developing burnout symptoms.

Assessment of nurse retention challenges and strategies in Lebanese hospitals: the perspective of nursing directors.

PubMed

El-Jardali, Fadi; Merhi, Mirvat; Jamal, Diana; Dumit, Nuhad; Mouro, Gladys

2009-05-01

Assess nurse retention challenges and strategies as perceived by nursing directors in Lebanese hospitals. The Kampala Health Workforce Declaration stressed the importance of retaining an effective, responsive and equitably distributed health workforce, particularly nurses. Little is known about nurse retention challenges and strategies in Lebanon. Nursing directors of 76 hospitals participated and were sent a two-page survey on perceived retention challenges and hospital-based retention strategies. Retention challenges included unsatisfactory salary, unsuitable shifts and working hours, as well as better opportunities in other areas within or outside Lebanon. Retention strategies included implementing financial rewards and benefits, a salary scale, staff development, praise and improving work environment. Nursing directors did not address all perceived challenges in their strategies. To better manage the nursing workforce, nursing directors should regularly measure and monitor nurse turnover rates and also their causes and predictors. Nursing directors should develop, implement and evaluate retention strategies. More information is needed on the management and leadership capacities of nursing directors in addition to their span of control. Nursing directors are facing challenges in retaining their nurses. If these problems are not addressed, Lebanon will continue to lose competent and skilled nurses.

The relationship between work complexity and nurses' participation in decision making in hospitals.

PubMed

Bacon, Cynthia Thornton; Lee, Shoou-Yih Daniel; Mark, Barbara

2015-04-01

The aim of this study is to examine the relationship between work complexity and nurses' participation in decision making in hospital nursing units. Increasing nurses' participation in decision making has been used as a way to manage work complexity; however, the work of nurses in acute care hospitals has become highly complex, and strategies used to manage this complexity have not been fully explored. The relationship between work complexity and nurse participation in decision making was examined using data from the Outcomes Research in Nursing Administration project. The sample included 3,718 RNs in 278 medical-surgical units in 143 hospitals. When work complexity increased, nurses' participation in decision making decreased. When nurses have limited input into decision making, the information available to the care team may be incomplete. Barriers to nurses' participation in decision making should be explored and interventions developed so that nurses may be full participants in decision making affecting both patients and the work environment.

Stories of Exemplary Hospital Registered Nurses: A Narrative Analysis

ERIC Educational Resources Information Center

Snelson, Donna Ayers

2010-01-01

Today the multidimensional global shortage of nurses is negatively impacting the work environment of hospital nurses and causing, in a cyclical fashion, decreasing work satisfaction, increasing nurse turnover, and decreasing patient outcomes. While strategies aimed at causation of the nursing shortage must be addressed, to support nursing until…

42 CFR 482.23 - Condition of participation: Nursing services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Condition of participation: Nursing services. 482... Hospital Functions § 482.23 Condition of participation: Nursing services. The hospital must have an organized nursing service that provides 24-hour nursing services. The nursing services must be furnished or...

42 CFR 482.23 - Condition of participation: Nursing services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Condition of participation: Nursing services. 482... Hospital Functions § 482.23 Condition of participation: Nursing services. The hospital must have an organized nursing service that provides 24-hour nursing services. The nursing services must be furnished or...

42 CFR 482.23 - Condition of participation: Nursing services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 5 2013-10-01 2013-10-01 false Condition of participation: Nursing services. 482... Hospital Functions § 482.23 Condition of participation: Nursing services. The hospital must have an organized nursing service that provides 24-hour nursing services. The nursing services must be furnished or...

42 CFR 482.23 - Condition of participation: Nursing services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 5 2012-10-01 2012-10-01 false Condition of participation: Nursing services. 482... Hospital Functions § 482.23 Condition of participation: Nursing services. The hospital must have an organized nursing service that provides 24-hour nursing services. The nursing services must be furnished or...

42 CFR 482.23 - Condition of participation: Nursing services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 false Condition of participation: Nursing services. 482... Hospital Functions § 482.23 Condition of participation: Nursing services. The hospital must have an organized nursing service that provides 24-hour nursing services. The nursing services must be furnished or...

How hospitalized children and parents perceive nurses and hospital amenities: A qualitative descriptive study in Poland.

PubMed

Marcinowicz, Ludmiła; Abramowicz, Paweł; Zarzycka, Danuta; Abramowicz, Magdalena; Konstantynowicz, Jerzy

2016-03-01

A qualitative descriptive design using an interview guide approach was adopted to investigate the patient-nurse relationship and paediatric ward amenities from the perspective of parents and hospitalised children in Poland. The study included 26 parents or caregivers of hospitalised children (between 13 months and 15 years old) and 22 children (from 10 to 16 years old). Qualitative content analysis was used to analyse the recorded verbal data. Data from patients' transcripts were coded and classified in terms of topics on the patient-nurse relationship and hospital care. We identified five main topics. 1. Nurse qualities; 2. Nurse verbal behaviour; 3. Nurse tone of voice and non-verbal behaviour; 4. Hospital amenities; 5. Parents' expectations towards nurses. Our study contributes to increased understanding of parents' and children's experiences of paediatric hospital care. © The Author(s) 2014.

[From the nursing home to hospital and back again… A mixed methods study on hospital transfers from nursing homes].

PubMed

Kada, Olivia; Brunner, Eva; Likar, Rudolf; Pinter, Georg; Leutgeb, Ines; Francisci, Nina; Pfeiffer, Bettina; Janig, Herbert

2011-01-01

Hospital transfers from nursing homes are frequent, costly, often preventable, and can have negative effects on the residents' health. The present study investigated the current situation in Carinthia (Austria) regarding the characteristics of relocated nursing home residents, the proportion of avoidable transfers, the consequences of relocation from the physicians' and nurses' perspectives and ways for improving nursing home care. Retrospectively, the documentations of a regional hospital (N=4149), a rescue service (N=10754), and a social insurance agency (N=7051) were analysed; qualitative interviews with physicians (N=25) and nursing administrators (N=16) were conducted. A considerable proportion of these transports seemed to be avoidable: for example, about 40% of the ambulatory treatments in the emergency department of the investigated hospital were inappropriate. Options for improving the current situation will be discussed. Copyright © 2011. Published by Elsevier GmbH.

Reexamining Demotivators and Motivators: A Longitudinal Study of Japanese Freshmen's Dynamic System in an EFL Context

ERIC Educational Resources Information Center

Kikuchi, Keita

2017-01-01

Twenty Japanese university freshmen majoring in International Studies (N = 4) and Nursing (N = 16) participated in a 10-month project examining changes in their motivation. Using monthly focus group interviews and a 35-item questionnaire, the dynamic systems of various types of learners of English over two semesters were explored. Trajectories of…

[A Study on the Classification of Nursing Management Competencies and Development of related Behavioral Indicators in Hospitals].

PubMed

Kim, Seong Yeol; Kim, Jong Kyung

2016-06-01

The aim of this study was to classify nursing management competencies and develop behavioral indicators for nurse managers in hospitals. Also, levels of importance and performance based on developed criteria were to be identified and compared. Using expert survey we classified nursing management competencies and behavioral indicators with data from 34 nurse managers and professors. Subsequently, data from a survey of 216 nurse managers in 7 cities was used to analyze the importance-performance comparison of the classified nursing management competencies and behavioral indicators. Forty-two nursing management competencies were identified together with 181 behavioral indicators. The mean score for importance of nursing management competency was higher than the mean score for performance. According to the importance-performance analysis, 5 of the 42 nursing management competencies require further development: vision-building, analysis, change management, human resource development, and self-management competency. The classification of nursing management competencies and behavioral indicators for nurse managers in hospitals provides basic data for the development and evaluation of programs designed to increase the competency of nurse managers in hospitals.

[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.

Is what's good for the patient good for the hospital? Aligning incentives and the business case for nursing.

PubMed

Needleman, Jack

2008-05-01

This article examines the social and business case for quality related to nursing and the need to restructure incentives to align the interests of the hospital and payers with the interests of the patients. Increasing the proportion of nurses who are registered nurses is associated with net cost savings. Increasing both nursing hours and the proportion of nurses who are registered nurses would result in improved quality and fewer deaths (creating a social case for improved staffing) but would be associated with small cost increases. Cost offsets associated with reduced turnover because of higher staffing would reduce the net cost increase but not result in savings. Under current reimbursement systems, hospitals that increase nurse staffing to improve patient outcomes will likely lose money as a result. Current proposals for pay for performance would create limited incentives for improving hospital nursing care.

[Comparison between 2 groups of nursing professionals on the knowledge of pediatric pain].

PubMed

Lobete Prieto, C; Rey Galán, C; Kiza, A H

2015-01-01

To compare infant pain knowledge between a group of nurses who work in a pediatric hospital and one that works in a general hospital. Descriptive study based on the use of a validated questionnaire for assessing the knowledge and attitudes of nurses about pediatric pain (Pediatric Nurses' Knowledge and Attitude Survey Regarding Pain [PNKAS]). PNKAS questionnaire was distributed to the nursing staff of a pediatric hospital and a general hospital and the results were compared. The average score obtained in the pediatric vs. the general hospital was: mean, 51.7% vs. 47.2%, 95% confidence interval, 47.5 to 56% vs. 43.6 to 50.8% (P=.098). There were no differences between the scores in the PNKAS questionnaire between nurses working exclusively with children and nurses working with general population. Training on pediatric pain needs to be improved in nurses caring for sick children. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

The challenges of emerging HISs in bridging the communication gaps among physicians and nurses in China: an interview study.

PubMed

Wen, Dong; Zhang, Xingting; Wan, Jie; Fu, Jing; Lei, Jianbo

2017-06-12

To explore the current situation, existing problems and possible causes of said problems with regards to physician-nurse communication under an environment of increasingly widespread usage of Hospital Information Systems and to seek out new potential strategies in information technology to improve physician-nurse communication. Semi-structured interviews were conducted with 20 physicians and nurses in five leading tertiary grade A hospitals in Beijing, China (two physicians and two nurses in each hospital). The interviews primarily included three aspects comprising the current situation and problems of clinical physician-nurse communication, the application and problems of Hospital Information Systems, and assessments on the improvement of physician-nurse communication through the usage of information technology. The inductive conventional content analysis approach was employed. (1) Physicians and nurses are generally quite satisfied with the current situation of communication. However, the information needs of nurses are prone to being overlooked, and the communication methods are primarily synchronous communication such as face-to-face and phone communication. (2) Hospital Information Systems are gradually being used for physician-nurse communication; in the meantime, physicians and nurses face challenges with regards to the improvement of physician-nurse communication through the usage of information technology. Challenges differ based on the different stages of using the system and the different levels of understanding of physicians and nurses towards information technology. Their dissatisfaction mainly deals with system errors and the level of convenience in using the system. (3) In-depth interviews found that in general, physicians and nurses have a strong interest and trust in improving physician-nurse communication through appropriate information technology, e.g., communication methods such as information reminders for physicians and nurses through mobile devices and instant voice-to-text conversion methods. There are objective risks in physician-nurse communication in Chinese hospitals, and clinical information systems lack solutions to the relevant problems. Developing a dedicated, mobile, quick and convenient module for physician-nurse communication within existing hospital information system with automatic reminders for important information that segregates between synchronous and asynchronous communication according to the different types of information could help improve physician-nurse communication.

Effects of Individual Nurse and Hospital Characteristics on Patient Adverse Events and Quality of Care: A Multilevel Analysis.

PubMed

Lee, Seung Eun; Vincent, Catherine; Dahinten, V Susan; Scott, Linda D; Park, Chang Gi; Dunn Lopez, Karen

2018-06-14

This study aimed to investigate effects of individual nurse and hospital characteristics on patient adverse events and quality of care using a multilevel approach. This is a secondary analysis of a combination of nurse survey data (N = 1,053 nurses) and facility data (N = 63 hospitals) in Canada. Multilevel ordinal logistic regression was employed to examine effects of individual nurse and hospital characteristics on patient adverse events. Multilevel linear regressions were used to investigate effects of individual nurse and hospital characteristics on quality of care. Organizational safety culture was associated with patient adverse events and quality of care. Controlling for effects of nurse and hospital characteristics, nurses in hospitals with a stronger safety culture were 64% less likely to report administration of wrong medication, time, or dose; 58% less likely to report patient falls with injury; and 60% less likely to report urinary tract infections; and were more likely to report higher levels of quality of care. Additionally, the effects of individual-level baccalaureate education and years of experience on quality of care differed across hospitals, and hospital-level nurse education interacted with individual-level baccalaureate education. This study makes significant contributions to existing knowledge regarding the positive effect of organizational safety culture on patient adverse events and quality of care. Healthcare organizations should strive to improve their safety culture by creating environments where healthcare providers trust each other, work collaboratively, and share accountability for patient safety and care quality. © 2018 Sigma Theta Tau International.

Evaluation of the impact of support for nursing research on scientific productivity in seven Italian hospitals: A multiple interrupted time series study.

PubMed

Chiari, Paolo; Forni, Cristiana; Zeneli, Anita; Gianesini, Gloria; Zanin, Roberta; Braglia, Luca; Cavuto, Silvio; Guberti, Monica

2016-05-01

Nursing research is not well-developed in Italy, and knowledge of the methodologies for conducting research is lacking. In several hospitals, including those in which this study was conducted, a research center has been established to support and educate nurses on how to conduct clinical research. In this observational study, we sought to assess whether establishing a support center for nursing research has resulted in an increase in scientific production in terms of the numbers of protocols approved (primary outcome), articles published and nurse authors involved in the publications (secondary outcomes). Multiple interrupted time series. Data from 2002 to 2012 were collected in seven hospitals. Research centers have been established at various times in only four of these hospitals. A statistically significant increase in the primary outcome (the number of protocols approved by the Research Ethics Committee in which the principal investigator was a nurse) was observed in two hospitals approximately 2years after establishing a research center. The number of nursing research articles published in scientific journals with an impact factor increased but was not statistically significant. Finally, the number of nurse authors increased significantly in two hospitals with support units. Definitive conclusions could not be reached for the other two experimental hospitals because notably few post-intervention data were available. In the control hospitals, the scientific production outcomes did not change. This study shows that establishing a support center for nursing research inside hospitals can facilitate the production of research. Copyright © 2016 Elsevier Ltd. All rights reserved.

Comparing the contributions of acute and post-acute care facility characteristics to outcomes after hospitalization for hip fracture

PubMed Central

Neuman, Mark D.; Silber, Jeffrey H.; Passarella, Molly A.; Werner, Rachel M.

2016-01-01

OBJECTIVE To quantify the contribution of acute versus post-acute care factors to survival and functional outcomes after hip fracture. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study using Medicare data; subjects included previously ambulatory nursing home residents hospitalized for hip fracture between 2005 and 2009. METHODS We used logistic regression to measure the associations of hospital and nursing home factors with functional and survival outcomes at 30 and 180 days among patients discharged to a nursing facility; we quantified the contribution of hospital versus nursing home factors to outcomes via the omega statistic. RESULTS Among 45,996 hospitalized patients, 1,814 (3.9%) died during hospitalization. 42,781 (93%) were discharged alive to a nursing home. Of these, 12,126 (28%) died within 180 days and 20,479 (48%) died or were newly unable to walk within 180 days. Hospital characteristics were not consistently associated with outcomes. Multiple nursing home characteristics predicted 30- and 180-day outcomes, including bed count, chain membership, and performance on selected quality measures. Nursing home factors explained three times more variation in the odds of 30-day mortality than did hospital factors (omega, hospital versus nursing home: 0.32, 95% confidence interval (CI) 0.11, 0.96), seven times more variation in the odds of 180-day mortality (omega: 0.15, 95% CI 0.04, 0.61), and eight times more variation in the odds of 180-day death or new dependence in locomotion (omega: 0.12, 95% CI 0.05, 0.31). CONCLUSIONS Nursing home factor sex plain a larger proportion of the variation in clinical outcomes following hip fracture than do hospital factors. PMID:27811551

Development and Validation of a Tool for Measurement of Patient Satisfaction with Nursing Care at Oak Hill Hospital.

ERIC Educational Resources Information Center

Callow, Elizabeth K.

The Department of Nursing at Oak Hill Hospital, Spring Hill (Florida) did not have a measurement instrument for patient evaluation of hospital nursing services. An instrument to measure patient satisfaction with nursing was developed and validated. Criteria identified through a literature search were reviewed, modified, and validated by a…

42 CFR 440.140 - Inpatient hospital services, nursing facility services, and intermediate care facility services...

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Inpatient hospital services, nursing facility... Definitions § 440.140 Inpatient hospital services, nursing facility services, and intermediate care facility... under section 1903(i)(4) of the Act and subpart H of part 456 of this chapter. (b) Nursing facility...

42 CFR 440.140 - Inpatient hospital services, nursing facility services, and intermediate care facility services...

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Inpatient hospital services, nursing facility... Definitions § 440.140 Inpatient hospital services, nursing facility services, and intermediate care facility... section 1903(i)(4) of the Act and subpart H of part 456 of this chapter. (b) Nursing facility services...

42 CFR 440.140 - Inpatient hospital services, nursing facility services, and intermediate care facility services...

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Inpatient hospital services, nursing facility... Definitions § 440.140 Inpatient hospital services, nursing facility services, and intermediate care facility... under section 1903(i)(4) of the Act and subpart H of part 456 of this chapter. (b) Nursing facility...

42 CFR 440.140 - Inpatient hospital services, nursing facility services, and intermediate care facility services...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Inpatient hospital services, nursing facility... Definitions § 440.140 Inpatient hospital services, nursing facility services, and intermediate care facility... section 1903(i)(4) of the Act and subpart H of part 456 of this chapter. (b) Nursing facility services...

42 CFR 440.140 - Inpatient hospital services, nursing facility services, and intermediate care facility services...

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Inpatient hospital services, nursing facility... Definitions § 440.140 Inpatient hospital services, nursing facility services, and intermediate care facility... under section 1903(i)(4) of the Act and subpart H of part 456 of this chapter. (b) Nursing facility...

Lifestyle practices and the health promoting environment of hospital nurses.

PubMed

Hope, A; Kelleher, C C; O'Connor, M

1998-08-01

Lifestyle practices and the health promoting environment of hospital nurses This paper examined the lifestyle practices of hospital nurses and the impact of specific interventions in the hospital environment. The perception of nurse as health promoter and as carer of AIDS patients was also examined. A self-administered questionnaire was used to collect data at two different time periods. The sample represented 729 nurses (at pre- and post-time periods), both qualified and student nurses. Qualified nurses reported the highest stress levels while student nurses reported more negative lifestyle practices such as smoking, alcohol consumption and drug use. A greater number of current smokers (29%) consumed alcohol and used drugs than non-smokers. The impact of intervention strategies around compliance with smoking policy and work-site walk routes reduced exposure to passive smoking at work for qualified nurses and increased exercise participation for both groups of nurses. Workplace was identified as the main source of stress which included relationships at work and demands of the job. Hospital nurses experiencing high work stress were more likely to use professional support and personal coping (discuss problems with friends/family, have a good cry and eat more) than others. Nurses believed in the importance of health promotion as part of their work; however, qualified nurses felt more confident and gave more health related information than student nurses. Student nurses perceived a lower risk of contacting AIDS through work and a higher concern/worry in caring for AIDS patients than qualified nurses.

Nurses' perceptions of usefulness of nursing information system: module of electronic medical record for patient care in two university hospitals of iran.

PubMed

Kahouei, Mehdi; Baba Mohammadi, Hassan; Askari Majdabadi, Hesamedin; Solhi, Mahnaz; Parsania, Zeinab; Said Roghani, Panoe; Firozeh, Mehri

2014-02-01

For almost fifteen years, the application of computer in hospitals increasingly has become popular. Nurses' beliefs and attitudes towards computer is one of the most important indicators of the application of nursing information system. The purpose of this study was to investigate the perceptions of nurses on the usefulness of nursing information system for patient care. Here, a descriptive study was carried out. Sample was consisted of 316 nurses working in teaching hospitals in an urban area of Iran. This study was conducted during 2011 to 2012. A reliable and valid questionnaire was developed as a data collection tool. The collected data was analyzed using descriptive and inferential statistics. It was not believed that nursing information system was useful for patient care. However, it was mentioned that nursing information system is useful in some aspects of patient care such as expediting care, making early diagnosis and formulating diet plan. A significant association was found between the demographic background of sample and their perceptions of the usefulness of nursing information system (P<0.05). Totally, it can be concluded that nursing information system has a potential for improving patient care in hospital settings. Therefore, policy makers should consider implementing nursing information system in teaching hospitals.

Characteristics of nurse leaders in hospitals in the U.S.A. from 1992 to 2008.

PubMed

Westphal, Judith A

2012-10-01

Describe the nurse leader workforce in hospitals in the USA over time by exploring three research questions: (1) What are the characteristics of the nurse leader workforce in U.S. hospitals? (2) How does the nurse leader workforce change over time? (3) How do nurses in executive positions (administrators) differ from nurses in first-line supervisory positions (supervisors)? Effective nurse leaders use management skills to ensure safe patient care in hospitals in the USA. Changes in the nurse leader workforce have an impact on patient care. non-experimental design was used to explore the characteristics of 10,150 nurse leaders using the 1992, 1996, 2000, 2004 and 2008 National Sample Surveys of Registered Nurses. Number of masters and doctorally prepared nurse leaders increased from 14.5% to 23.2% along with an increase in mean age. A 30% decrease in the number of nurses in leadership positions was found. Male nurses reported significantly higher salaries P < 0.000. Nurse leaders are older and have achieved higher educational degrees. Salary disparities based on gender still prevail. Implications for nursing management  Identifying and developing future leaders with necessary skills and competencies is critical for organizational success. © 2012 Blackwell Publishing Ltd.

History of Higher Education: Educational Reform and the Emergence of the Nursing Professorate.

ERIC Educational Resources Information Center

Ruby, Jane

1999-01-01

In the late 19th century, visionary leaders pursued liberal education for nurses, moving nursing education from hospitals to universities. The nursing professorate might never have developed had nursing education remained under the jurisdiction of hospitals. (SK)

[Hospitality as an expression of nursing care].

PubMed

Barra, Daniela Couto Carvalho; Waterkemper, Roberta; Kempfer, Silvana Silveira; Carraro, Telma Elisa; Radünz, Vera

2010-01-01

Qualitative research whose purpose was to reflect and argue about the relationship between hospitality, care and nursing according to experiences of PhD students. The research was developed from theoretic and practical meeting carried through by disciplines "the care in Nursing and Health" of PhD nursing Program at Santa Catarina Federal University. Its chosen theoretical frame of Hospitality perspective while nursing care. Data were collected applying a semi-structured questionnaire at ten doctoral students. The analysis of the data was carried through under the perspective of the content analysis according to Bardin. Hospitality it is imperative for the individuals adaptation in the hospital context or any area where it is looking for health care.

Churn: patient turnover and case mix.

PubMed

Duffield, Christine; Diers, Donna; Aisbett, Chris; Roche, Michael

2009-01-01

Patient throughput and casemix changes on nursing wards are little understood aspects of nursing's responsibility for nursing wards/units as hospital operations. In this study, the movement of patients on and off wards in 27 Australian public hospitals (286 wards) were analyzed over a 5-year period. Casemix change at the nursing unit level was also examined. In the data here, medical/surgical patients moved on average more than twice in an average hospital stay of only about 4 days. The absence of ward-level metrics compromises the ability of nursing unit/ward managers to meet their own efficiency and quality standards. Measurements of churn would give nurses another way to talk about the work of nursing to senior management and would give nurse executives a way to describe hospital operations and throughput and the impact on staff, patients, and resource allocation.

Nurse staffing level and overtime associated with patient safety, quality of care, and care left undone in hospitals: A cross-sectional study.

PubMed

Cho, Eunhee; Lee, Nam-Ju; Kim, Eun-Young; Kim, Sinhye; Lee, Kyongeun; Park, Kwang-Ok; Sung, Young Hee

2016-08-01

The purpose of this study was to explore the association of nurse staffing and overtime with nurse-perceived patient safety, nurse-perceived quality of care, and care left undone. A cross-sectional survey. A total of 65 hospitals were selected from all of the acute hospitals (n=295) with 100 or more beds in South Korea by using a stratified random sampling method based on region and number of beds, and 60 hospitals participated in the study. All RNs working on the date of data collection in units randomly selected from the list of units in each hospital were invited to participate. The analyses in this study included only bedside RNs (n=3037) and hospitals (n=51) with responses from at least 10 bedside RNs. We collected data on nurse staffing level, overtime, nurse-perceived patient safety, nurse-perceived quality of care, nurse-reported care left undone, and nurse characteristics through a nurse survey. Facility data from the Health Insurance Review Agency (HIRA) were used to collect hospital characteristics. Multilevel logistic regression models considering that nurses are clustered in hospitals were used to analyze the effects of hospital nurse staffing and overtime on patient safety, quality of care, and care left undone. A higher number of patients per RN was significantly associated with higher odds of reporting poor/failing patient safety (OR=1.02, 95% CI=1.004-1.03) and poor/fair quality of care (OR=1.02, 95% CI=1.01-1.04), and of having care left undone due to lack of time (OR=1.03, 95% CI=1.01-1.05). Compared with RNs who did not work overtime, RNs working overtime reported an 88% increase in failing or poor patient safety (OR=1.88, 95% CI=1.40-2.52), a 45% increase in fair or poor quality of nursing care (OR=1.45, 95% CI=1.17-1.80), and an 86% increase in care left undone (OR=1.86, 95% CI=1.48-2.35). Our findings suggest that ensuring appropriate nurse staffing and working hours is important to improve the quality and safety of care and to reduce care left undone in hospitals. Copyright © 2016 Elsevier Ltd. All rights reserved.

Hospitals With Higher Nurse Staffing Had Lower Odds Of Readmissions Penalties Than Hospitals With Lower Staffing

PubMed Central

McHugh, Matthew D.; Berez, Julie; Small, Dylan S.

2015-01-01

The Affordable Care Act’s Hospital Readmissions Reduction Program (HRRP) penalizes hospitals based on excess readmission rates among Medicare beneficiaries. The aim of the program is to reduce readmissions while aligning hospitals’ financial incentives with payers’ and patients’ quality goals. Many evidence-based interventions that reduce readmissions, such as discharge preparation, care coordination, and patient education, are grounded in the fundamentals of basic nursing care. Yet inadequate staffing can hinder nurses’ efforts to carry out these processes of care. We estimated the effect that nurse staffing had on the likelihood that a hospital was penalized under the HRRP. Hospitals with higher nurse staffing had 25 percent lower odds of being penalized compared to otherwise similar hospitals with lower staffing. Investment in nursing is a potential system-level intervention to reduce readmissions that policy makers and hospital administrators should consider in the new regulatory environment as they examine the quality of care delivered to US hospital patients. PMID:24101063

Comparison of Reasons for Nurse Turnover in Magnet® and Non-Magnet Hospitals.

PubMed

Park, Shin Hye; Gass, Stephanie; Boyle, Diane K

2016-05-01

The aim of this study is to compare rates and reasons for registered nurse (RN) turnover by Magnet® status. Although lower RN turnover rates in Magnet hospitals have been documented well in the literature, little is known about specific separation reasons for RN turnover and whether the reasons differ between Magnet and non-Magnet hospitals. This descriptive, correlational study analyzed unit-level 2013 National Database of Nursing Quality Indicators® turnover data (2,958 units; 497 hospitals). Poisson regression and Wilcoxon-Mann-Whitney test were used. Registered nurse turnover due to environment-related reasons was higher on units in non-Magnet hospitals than units in Magnet hospitals. Units in non-Magnet hospitals had 4.684 times higher turnover rates due to staffing/workload and 1.439 times higher rates due to work schedules than did units in Magnet hospitals. Nursing administrators in both Magnet and non-Magnet hospitals need to continually strive to improve unit work environments, particularly staffing and workload conditions and work scheduling.

Health Sector Reform, Emotional Exhaustion, and Nursing Burnout: A Retrospective Panel Study in Iran.

PubMed

Sadati, Ahmad Kalateh; Rahnavard, Farnaz; Heydari, Seyed Taghi; Hemmati, Soroor; Ebrahimzadeh, Najmeh; Lankarani, Kamran Bagheri

2017-10-01

Nursing burnout is affected by various factors, including work overload. Since the inauguration of the Health Sector Evolution Plan (HSEP) in Iran in 2014, government hospitals have been required to provide health services to the public at all levels. This decision, however, has increased the volume of patients admitted to government hospitals. Because nurses are on the front line of health services, they are faced with a greater load of care provision. This study aimed to evaluate nursing burnout before and after HSEP in Iran, with an emphasis on the differences between government and private hospitals. This retrospective panel study used Maslach's burnout inventory to evaluate nursing burnout in 371 nurses working in government and private hospitals in Shiraz, Iran, before and 7 months after the health sector reform. Chi-square test and paired t test were used to compare burnout scores. The results showed that nursing burnout had changed significantly after HSEP was launched (p = .030). A more detailed assessment found that burnout and emotional exhaustion had both increased significantly in the government-hospital group (ps = .014 and .001, respectively). However, no significant change in burnout was found in the private-hospital group over the same period. The findings of this study indicate an increase in nursing burnout in government hospitals. An important issue in every health sector reform is nursing resource management, with a focus on burnout. Accordingly, policymakers should consider the work overload situation of nurses and work to prevent increased burnout, especially emotional exhaustion.

Nurse Level of Education, Quality of Care and Patient Safety in the Medical and Surgical Wards in Malaysian Private Hospitals: A Cross-sectional Study.

PubMed

Abdul Rahman, Hamzah; Jarrar, Mu'taman; Don, Mohammad Sobri

2015-04-23

Nursing knowledge and skills are required to sustain quality of care and patient safety. The numbers of nurses with Bachelor degrees in Malaysia are very limited. This study aims to predict the impact of nurse level of education on quality of care and patient safety in the medical and surgical wards in Malaysian private hospitals. A cross-sectional survey by questionnaire was conducted. A total 652 nurses working in the medical and surgical wards in 12 private hospitals were participated in the study. Multistage stratified simple random sampling performed to invite nurses working in small size (less than 100 beds), medium size (100-199 beds) and large size (over than 200) hospitals to participate in the study. This allowed nurses from all shifts to participate in this study. Nurses with higher education were not significantly associated with both quality of care and patient safety. However, a total 355 (60.9%) of respondents participated in this study were working in teaching hospitals. Teaching hospitals offer training for all newly appointed staff. They also provide general orientation programs and training to outline the policies, procedures of the nurses' roles and responsibilities. This made the variances between the Bachelor and Diploma nurses not significantly associated with the outcomes of care. Nursing educational level was not associated with the outcomes of care in Malaysian private hospitals. However, training programs and the general nursing orientation programs for nurses in Malaysia can help to upgrade the Diploma-level nurses. Training programs can increase their self confidence, knowledge, critical thinking ability and improve their interpersonal skills. So, it can be concluded that better education and training for a medical and surgical wards' nurses is required for satisfying client expectations and sustaining the outcomes of patient care.

The provision and utilisation of casemix and demographic data by nursing managers in seven hospitals.

PubMed

Blay, Nicole; Donoghue, Judith

2003-01-01

The role of the nursing manager has evolved from clinician and bed manager to one with greater accountability for evidence based practice, benchmarking and more recently, budget liability. Casemix data are widely believed to be a means of providing essential information for effective decision making and financial management but have not been widely utilised by nursing managers (Diers & Bozzo, 1999). This paper will report the results of a survey of nursing managers in seven hospitals within a metropolitan area health service. The hospitals include tertiary referral hospitals, specialist public hospitals and an affiliated public hospital for aged care and rehabilitation services. The survey sought to establish what casemix and related data were provided to nurse managers, who provided these data and how supplied data were utilised by the nurse managers. Results demonstrated that the majority of nursing managers surveyed received minimal (if any) casemix and/or demographic data on a routine basis. Some were provided with data in response to specific requests. The information that was provided varied both within and across hospitals, and no consistent methods of data distribution were available. Few nursing managers believed that the information provided aided their decision-making processes partly due to the minimalist nature of provided data while some nursing managers demonstrated a lack of understanding of the potential benefit of casemix data as a resource to support management decision making.

The First Seventy Years: Bryan Memorial Hospital School of Nursing and Bryan Memorial Hospital, 1926-1996. A Seventieth Anniversary Publication.

ERIC Educational Resources Information Center

Vontz, Marilyn J.

Celebrating the 70th anniversary of Bryan Memorial Hospital School of Nursing (BMHSN) and Bryan Memorial Hospital, in Nebraska, this monograph reviews the development and achievements of the school and hospital. Chapter 1 (1900-1919) provides a history of nursing in the early 20th century, while chapter 2 (1920-1929) describes the establishment of…

Hospitals' vertical integration into skilled nursing: a rational approach to controlling transaction costs.

PubMed

Lehrman, S; Shore, K K

1998-01-01

Using 1985 and 1988 American Hospital Association data, this study examines 1,523 hospitals nationwide and concludes that hospitals' ownership of skilled nursing facilities helps minimize the transaction costs associated with post-acute patient transfers while productively using empty hospital beds. Unfortunately, such ownership creates complex cost, quality, and accessibility trade-offs in terms of the skilled nursing care provided.

[Expectations of hospital administrators about administrative functions of nurses].

PubMed

Melo, M R; Fávero, N; Trevizan, M A; Hayashida, M

1996-01-01

The objective of the present study was to investigate hospital administrator's expectations about the administrative role played by nurses, utilizing functions proposed by the Neoclassical Theory of Administration: planning, organization, direction, and control as theoretical references. An instrument established in TREVIZAN (1989) was applied to 11 hospital administrators. The results showed they expect the four functions to be done by nurses. Therefore, the interaction between nurses and hospital administrators is critical to improve the patient's assistance.

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.

Acute hospital admissions among nursing home residents: a population-based observational study

PubMed Central

2011-01-01

Background Nursing home residents are prone to acute illness due to their high age, underlying illnesses and immobility. We examined the incidence of acute hospital admissions among nursing home residents versus the age-matched community dwelling population in a geographically defined area during a two years period. The hospital stays of the nursing home population are described according to diagnosis, length of stay and mortality. Similar studies have previously not been reported in Scandinavia. Methods The acute hospitalisations of the nursing home residents were identified through ambulance records. These were linked to hospital patient records for inclusion of demographics, diagnosis at discharge, length of stay and mortality. Incidence of hospitalisation was calculated based on patient-time at risk. Results The annual hospital admission incidence was 0.62 admissions per person-year among the nursing home residents and 0.26 among the community dwellers. In the nursing home population we found that dominant diagnoses were respiratory diseases, falls-related and circulatory diseases, accounting for 55% of the cases. The median length of stay was 3 days (interquartile range = 4). The in-hospital mortality rate was 16% and 30 day mortality after discharge 30%. Conclusion Acute hospital admission rate among nursing home residents was high in this Scandinavian setting. The pattern of diagnoses causing the admissions appears to be consistent with previous research. The in-hospital and 30 day mortality rates are high. PMID:21615911

The influence of teamwork culture on physician and nurse resignation rates in hospitals.

PubMed

Mohr, David C; Burgess, James F; Young, Gary J

2008-02-01

Employee turnover is a critical concern, particularly for hospitals, because they face a very tight labour market for hiring replacements, and high turnover itself may have substantial negative effects on the continuity and quality of patient care. Hospitals with a stronger teamwork culture may experience lower turnover but this has not been formally studied. Research on determinants of employee turnover has not separated out resignations from the larger, more inclusive definition of turnover that includes retirement. This study investigated the relationship between the teamwork culture of hospitals and physician and nurse resignation rates. The study setting was the Veterans Health Administration (VHA). Each hospital was assessed on teamwork culture based on a survey of current employees. Hospital-level resignation rates were obtained for physicians and nurses. Separate multivariate regression models on physicians and nurses were employed. The models included hospital-level characteristics and labour market variables. Analysis of covariance was also performed to attempt to further reveal effects in high versus low teamwork culture hospitals. Teamwork culture was negatively associated with nurse and physician resignation rates, but was statistically significant in the nurse resignation model only. Additional analyses indicated a 0.47 standard deviation (SD) difference in nurse resignation rates and a 0.40 SD difference in physician resignation rates between hospitals in the top and bottom quartiles of the distribution for teamwork culture. In conclusion, these results suggest that developing and emphasizing a teamwork culture may facilitate greater retention of health-care employees, especially nurses.

Educational levels of hospital nurses and surgical patient mortality.

PubMed

Aiken, Linda H; Clarke, Sean P; Cheung, Robyn B; Sloane, Douglas M; Silber, Jeffrey H

2003-09-24

Growing evidence suggests that nurse staffing affects the quality of care in hospitals, but little is known about whether the educational composition of registered nurses (RNs) in hospitals is related to patient outcomes. To examine whether the proportion of hospital RNs educated at the baccalaureate level or higher is associated with risk-adjusted mortality and failure to rescue (deaths in surgical patients with serious complications). Cross-sectional analyses of outcomes data for 232 342 general, orthopedic, and vascular surgery patients discharged from 168 nonfederal adult general Pennsylvania hospitals between April 1, 1998, and November 30, 1999, linked to administrative and survey data providing information on educational composition, staffing, and other characteristics. Risk-adjusted patient mortality and failure to rescue within 30 days of admission associated with nurse educational level. The proportion of hospital RNs holding a bachelor's degree or higher ranged from 0% to 77% across the hospitals. After adjusting for patient characteristics and hospital structural characteristics (size, teaching status, level of technology), as well as for nurse staffing, nurse experience, and whether the patient's surgeon was board certified, a 10% increase in the proportion of nurses holding a bachelor's degree was associated with a 5% decrease in both the likelihood of patients dying within 30 days of admission and the odds of failure to rescue (odds ratio, 0.95; 95% confidence interval, 0.91-0.99 in both cases). In hospitals with higher proportions of nurses educated at the baccalaureate level or higher, surgical patients experienced lower mortality and failure-to-rescue rates.

Nurse forecasting in Europe (RN4CAST): Rationale, design and methodology

PubMed Central

2011-01-01

Background Current human resources planning models in nursing are unreliable and ineffective as they consider volumes, but ignore effects on quality in patient care. The project RN4CAST aims innovative forecasting methods by addressing not only volumes, but quality of nursing staff as well as quality of patient care. Methods/Design A multi-country, multilevel cross-sectional design is used to obtain important unmeasured factors in forecasting models including how features of hospital work environments impact on nurse recruitment, retention and patient outcomes. In each of the 12 participating European countries, at least 30 general acute hospitals were sampled. Data are gathered via four data sources (nurse, patient and organizational surveys and via routinely collected hospital discharge data). All staff nurses of a random selection of medical and surgical units (at least 2 per hospital) were surveyed. The nurse survey has the purpose to measure the experiences of nurses on their job (e.g. job satisfaction, burnout) as well as to allow the creation of aggregated hospital level measures of staffing and working conditions. The patient survey is organized in a sub-sample of countries and hospitals using a one-day census approach to measure the patient experiences with medical and nursing care. In addition to conducting a patient survey, hospital discharge abstract datasets will be used to calculate additional patient outcomes like in-hospital mortality and failure-to-rescue. Via the organizational survey, information about the organizational profile (e.g. bed size, types of technology available, teaching status) is collected to control the analyses for institutional differences. This information will be linked via common identifiers and the relationships between different aspects of the nursing work environment and patient and nurse outcomes will be studied by using multilevel regression type analyses. These results will be used to simulate the impact of changing different aspects of the nursing work environment on quality of care and satisfaction of the nursing workforce. Discussion RN4CAST is one of the largest nurse workforce studies ever conducted in Europe, will add to accuracy of forecasting models and generate new approaches to more effective management of nursing resources in Europe. PMID:21501487

Nurse forecasting in Europe (RN4CAST): Rationale, design and methodology.

PubMed

Sermeus, Walter; Aiken, Linda H; Van den Heede, Koen; Rafferty, Anne Marie; Griffiths, Peter; Moreno-Casbas, Maria Teresa; Busse, Reinhard; Lindqvist, Rikard; Scott, Anne P; Bruyneel, Luk; Brzostek, Tomasz; Kinnunen, Juha; Schubert, Maria; Schoonhoven, Lisette; Zikos, Dimitrios

2011-04-18

Current human resources planning models in nursing are unreliable and ineffective as they consider volumes, but ignore effects on quality in patient care. The project RN4CAST aims innovative forecasting methods by addressing not only volumes, but quality of nursing staff as well as quality of patient care. A multi-country, multilevel cross-sectional design is used to obtain important unmeasured factors in forecasting models including how features of hospital work environments impact on nurse recruitment, retention and patient outcomes. In each of the 12 participating European countries, at least 30 general acute hospitals were sampled. Data are gathered via four data sources (nurse, patient and organizational surveys and via routinely collected hospital discharge data). All staff nurses of a random selection of medical and surgical units (at least 2 per hospital) were surveyed. The nurse survey has the purpose to measure the experiences of nurses on their job (e.g. job satisfaction, burnout) as well as to allow the creation of aggregated hospital level measures of staffing and working conditions. The patient survey is organized in a sub-sample of countries and hospitals using a one-day census approach to measure the patient experiences with medical and nursing care. In addition to conducting a patient survey, hospital discharge abstract datasets will be used to calculate additional patient outcomes like in-hospital mortality and failure-to-rescue. Via the organizational survey, information about the organizational profile (e.g. bed size, types of technology available, teaching status) is collected to control the analyses for institutional differences.This information will be linked via common identifiers and the relationships between different aspects of the nursing work environment and patient and nurse outcomes will be studied by using multilevel regression type analyses. These results will be used to simulate the impact of changing different aspects of the nursing work environment on quality of care and satisfaction of the nursing workforce. RN4CAST is one of the largest nurse workforce studies ever conducted in Europe, will add to accuracy of forecasting models and generate new approaches to more effective management of nursing resources in Europe.

Long-term Effect of Home Nursing Intervention on Cost and Healthcare Utilization for Patients with Chronic Obstructive Pulmonary Disease: A Retrospective Observational Study.

PubMed

Matsumura, Takuro; Takarada, Kana; Oki, Yutaro; Fujimoto, Yukari; Kaneko, Hiromi; Ohira, Mineko; Ishikawa, Akira

2015-01-01

The present study aimed to examine the long-term effects of a home nursing intervention on healthcare utilization and costs among patients with chronic obstructive pulmonary disease (COPD). A 3-year retrospective study. Eleven COPD patients who had received home nursing intervention after hospital discharge were enrolled. We retrospectively investigated their healthcare utilization and costs for 1 year before the intervention and during 2 years of the intervention. The number and length of hospitalizations decreased gradually from the pre-intervention period through the second year. The number of hospital and home nursing visits increased from the pre-intervention period through the first and second years. The hospitalization costs were decreased by approximately half from the pre-intervention period through the first year and from the first year through the second year. The total medical cost did not change significantly. Our home nursing intervention decreased the number and length of hospitalizations and the hospitalization costs; however, it did not affect the total medical cost. It is possible that the continuation of home nursing interventions may decrease the number of hospitalizations, number of home nursing visits, and the total medical cost by maintaining the health condition of patients. © 2014 Association of Rehabilitation Nurses.

Strategic interaction among hospitals and nursing facilities: the efficiency effects of payment systems and vertical integration.

PubMed

Banks, D; Parker, E; Wendel, J

2001-03-01

Rising post-acute care expenditures for Medicare transfer patients and increasing vertical integration between hospitals and nursing facilities raise questions about the links between payment system structure, the incentive for vertical integration and the impact on efficiency. In the United States, policy-makers are responding to these concerns by initiating prospective payments to nursing facilities, and are exploring the bundling of payments to hospitals. This paper develops a static profit-maximization model of the strategic interaction between the transferring hospital and a receiving nursing facility. This model suggests that the post-1984 system of prospective payment for hospital care, coupled with nursing facility payments that reimburse for services performed, induces inefficient under-provision of hospital services and encourages vertical integration. It further indicates that the extension of prospective payment to nursing facilities will not eliminate the incentive to vertically integrate, and will not result in efficient production unless such integration takes place. Bundling prospective payments for hospitals and nursing facilities will neither remove the incentive for vertical integration nor induce production efficiency without such vertical integration. However, bundled payment will induce efficient production, with or without vertical integration, if nursing facilities are reimbursed for services performed. Copyright 2001 John Wiley & Sons, Ltd.

Creating a context for excellence and innovation: comparing chief nurse executive leadership practices in magnet and non-magnet hospitals.

PubMed

Porter-O'grady, Tim

2009-01-01

Chief nurse executives create a context for leadership, innovation, and practice in hospitals. It is valuable to get a sense of nurse executives' perceptions regarding their leadership practices and how they value them. Furthermore, it is of interest to see if there is significant differentiation in these perceptions between chief nurse executives in Magnet hospitals and those in non-Magnet hospitals. This article discusses a study of the leadership practices of these 2 groups of nurse executive's leadership practices and reports the results. Concluding is a brief discussion regarding impact and importance of the nurse executive related to excellence and innovation.

Effective nursing care of children and young people outside hospital.

PubMed

Whiting, Lisa; Caldwell, Chris; Donnelly, Mary; Martin, Debbie; Whiting, Mark

2015-06-01

To assess the preparation required to ensure a workforce of nurses who can provide high quality out-of-hospital services for children and young people. Using mixed methods, questionnaires were sent to young people and community children's nursing teams, interviews were conducted with academic staff and clinical nurses, and focus groups were undertaken with pre-registration children's nursing students. Nurses' communication skills and clinical abilities were most important to young people. There is a range of opinions about optimum out-of-hospital clinical experience. Pre- and post-qualification education and recruitment in this area, therefore, need attention. Out-of-hospital care presents problems, but is developing rapidly. Adequate, updated training, supervision and resources are needed.

Charting the 7 c's of cultural change affecting foreign nurses: competency, communication, consistency, cooperation, customs, conformity and courage.

PubMed

Parrone, Joyce; Sedrl, Darlene; Donaubauer, Carolyn; Phillips, Marge; Miller, Marilyn

2008-01-01

Eighty-two percent of practicing RNs are located in metropolitan areas in which the predominant employment setting is the hospital according to the National Sample Survey of Registered Nurses (Services, 2000). However, despite current trends toward moderate increased enrollment in nursing schools, a 2001American Hospital Survey (AHA) among 715 member hospitals revealed that 126,000 registered nurse positions across America remain unfilled. As a result, hospitals have adopted creative solutions to ease the nursing shortage. One creative solution is to import foreign nurses. According to the Commission on Graduates of Foreign Nursing Schools (CGFNS) many come from the Philippines, are single, female and between 23-27 years of age. The foreign nurse will encounter many barriers and practice problems no matter his/her level of skill. This article explores seven areas of clinical competency that nurses from the Philippines will encounter and must surmount as well as some of the implications for nursing practice that veteran and newly graduated nurses might want to be aware of when working with foreign nurses.

Chinese nurse stress in Taiwan, Republic of China.

PubMed

Tsai, S L

1993-01-01

An exploratory study was conducted to understand the Chinese nurses' perceptions of their work stress in Taiwan, Republic of China (ROC). Data were based on the written answers to two open-ended questions from the randomly selected Chinese nurses working at 3 of the 10 first-ranked teaching hospitals that had 900-2,000 hospital beds. The findings showed that stressors in work situations for Chinese nurses were similar to those of their Western colleagues in four categories: nursing care related to patient condition, interpersonal relationships, workload, and opportunity for promotion. In addition, the Chinese respondents especially identified pressure in the role of a unit educator as stressful. Any troubled interpersonal relationship of the Chinese nurse may have been experienced as a greater source of pressure than nurses in other cultures. It is suggested that there might be some similar stressors in the nurse work situation when comparing the Chinese nurse working in the modern hospital in Taiwan to the nurses in large hospitals in the Western culture. Yet the difference between these nurses was the greater emphasis the Chinese nurses placed on the value of advanced study and interpersonal harmony.

Violence in the nursing workplace - a descriptive correlational study in a public hospital.

PubMed

Chen, Kang-Pan; Ku, Yan-Chiou; Yang, Hsiu-Fan

2013-03-01

To explore the prevalence, types and sources of violence in the nursing workplace and to assess the factors related to violence. Workplace violence in nursing is not a new phenomenon; in recent years, much more attention has been paid to the issue in Taiwan. Few studies, however, have investigated the overall distribution of violence and the reasons for not reporting these incidents in nursing workplaces. This descriptive, correlational study used structured questionnaires to collecting information about workplace violence experienced by nurses over the last year. Nurses (n = 880) working in a public hospital in southern Taiwan were invited to complete the questionnaires, with a response rate of 89·9%. Nurses working in outpatient units and emergency rooms experienced more frequent violence than those on surgical wards and intensive care units. These findings provide evidence of workplace violence in hospitals and may aid hospital and nursing administration to reduce and control violence. RELEVANCE TO NURSING PRACTICE: These results provide evidence in relation to the importance of effective communication training to nurses and will assist hospital administrations in establishing higher-quality, healthy workplace environments. © 2012 Blackwell Publishing Ltd.

Hospital nurses' lived experience of power.

PubMed

Fackler, Carol A; Chambers, Angelina N; Bourbonniere, Meg

2015-05-01

The purpose of this study was to explore hospital nurses' lived experience of power. A hermeneutic phenomenological approach informed by Merleau-Ponty's philosophy of the phenomenology of perception was used to further an understanding of nurses' embodiment of power. Fourteen hospital clinical nurses employed in intensive care units and on medical floors in two major medical centers in the northeastern United States participated in 1-hr semistructured interviews about their lived experience of power. A hermeneutic analytic approach and reflexive (cultural) bracketing produced three relational themes of power: (a) knowing my patients and speaking up for them; (b) working to build relationships that benefit patients; and (c) identifying my powerful self. Hospital clinical nurses develop a sense of power. Nurses believe power develops through acquisition of knowledge, experience, and self-confidence; this process is enhanced by exposure to good mentors. Nurses use their power to build relationships and advocate for patients. They consciously use power to improve patient care. Nurses' voices need to be heard and acknowledged. To do this in the clinical setting and beyond, hospital nurses must invite themselves or find ways to be invited into the authoritative discourse of hospital organizations. Nurses use their power to advocate for positive outcomes for patients and families. The satisfaction that comes from these positive relationships may improve nurses' perceptions of their work environment. Nurses' understanding and use of sociopolitical knowing needs further study, so that nurses may understand how to participate in current and future debates and decisions about our changing healthcare delivery systems and services. © 2015 Sigma Theta Tau International.

[Structure of nurse labor market and determinants of hospital nurse staffing levels].

PubMed

Park, Bohyun; Seo, Sukyung; Lee, Taejin

2013-02-01

To analyze the structure of Korean nurse labor market and examine its effect on hospital nurse staffing. Secondary data were obtained from Statistics Korea, Education Statistics, and Health Insurance Review & Assessment Service and Patient Survey. Intensity of monopsony in the nurse labor market was measured by Herfindahl Hirshman Index (HHI). Hospital nurse staffing level was divided into high and low. While controlling for confounding factors such as inpatient days and severity mix of patients, effects of characteristics of nurse labor markets on nurse staffing levels were examined using multi-level logistic regressions. For characteristics of nurse labor markets, metropolitan areas had high intensity of monopsony, while the capital area had competitive labor market and the unemployed nurse rate was higher than other areas. Among hospital characteristics, bed occupancy rate was significantly associated with nurse staffing levels. Among characteristics of nurse labor markets, the effect of HHI was indeterminable. The Korean nurse labor market has different structure between the capital and other metropolitan areas. But the effect of the structure of nurse labor market on nurse staffing levels is indeterminable. Characteristics such as occupancy rate and number of beds are significantly associated with nurse staffing levels. Further study in support of the effect of nurse labor market is needed.

Knowledge, compliance with good clinical practices and barriers to effective control of postoperative pain among nurses from hospitals with and without a "Hospital without Pain" certificate.

PubMed

Tomaszek, Lucyna; Dębska, Grażyna

2018-04-01

(i) To compare knowledge and compliance with good clinical practices regarding control of postoperative pain among nurses employed at hospitals with and without a "Hospital without Pain" certificate, (ii) to identify the determinants of nurses' knowledge and (iii) to define barriers to effective control of postoperative pain. Only a slight improvement in postoperative pain control has been observed recently, if any. Implementation of good clinical practices in the control of postoperative pain requires involvement of nurses. A cross-sectional study. The study included 257 nurses from hospitals with a "Hospital without Pain" certificate and 243 nurses from noncertified hospitals, with mean job seniority of 17.6 ± 9.6 years. All respondents answered 26 questions regarding postoperative pain control-related issues. Based on the answers, overall scores were calculated for (i) nurses' knowledge, (ii) compliance with good clinical practices and (iii) barriers to effective control of postoperative pain. Nurses from the certified hospitals presented with significantly higher levels of knowledge and compliance with good clinical practices and identified significantly more barriers to effective control of postoperative pain. Apart from certification of a hospital, better knowledge of postoperative pain control was determined by higher education, participation in postgraduate training programmes and other relevant courses, self-education from medical journals, employment at paediatric ward or intensive care unit. The most commonly reported barriers to effective control of pain included too low doses of painkillers prescribed by physicians and inability to modify the protocol of pain treatment by the nurse. Control of postoperative pain can be improved by enrolling nurses in various forms of continuous training and by providing them with greater autonomy in administering painkillers to surgical patients. Better quality of care offered to patients with postoperative pain can be achieved by continuous education of nurses and physicians, and greater compliance with relevant good clinical practices. © 2017 John Wiley & Sons Ltd.

Turnover intention among intensive care unit nurses in Alexandria, Egypt.

PubMed

Mosallam, Rasha; Hamidi, Samer; Elrefaay, Manal

2015-06-01

Given the difficulty in recruiting new nurses, it is imperative to retain those already in the profession. This cross-sectional study explored the relationship of demographic and work-related factors, burnout, conflict management and relationship between nurses and physicians on turnover intentions among ICU nurses in eight major hospitals in Alexandria, Egypt. Data on burnout, conflict management, nurse-physician communication, and turnover intention were collected by surveying 100 nurses in eight hospitals in Alexandria governorate. All nurses at the ICU of selected hospitals were approached (n=100) and a 47-item Likert scale questionnaire was administered to explore the factors affecting the turnover intention of ICU nurses in Alexandria. ICU nurses exhibited a mean score for turnover intention of 3.23 (mean score percentage 65.0%). There was a moderately positive statistically significant correlation between turnover intention and emotional exhaustion (r=0.29, P<0.05), nurse-physician communication (r=0.25, P<0.05), and age (r=0.21, P<0.05). The predicting factors for turnover intention were emotional exhaustion and age. Nurses turnover intention at the ICU of the selected hospitals is high and is significantly associated with nurses' emotional exhaustion, poor nurse-physician communication, and nurses age.

Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study

PubMed Central

Aiken, Linda H; Sloane, Douglas M; Bruyneel, Luk; Van den Heede, Koen; Griffiths, Peter; Busse, Reinhard; Diomidous, Marianna; Kinnunen, Juha; Kózka, Maria; Lesaffre, Emmanuel; McHugh, Matthew D; Moreno-Casbas, M T; Rafferty, Anne Marie; Schwendimann, Rene; Scott, P Anne; Tishelman, Carol; van Achterberg, Theo; Sermeus, Walter

2014-01-01

Summary Background Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. The RN4CAST study was designed to inform decision making about nursing, one of the largest components of hospital operating expenses. We aimed to assess whether differences in patient to nurse ratios and nurses’ educational qualifications in nine of the 12 RN4CAST countries with similar patient discharge data were associated with variation in hospital mortality after common surgical procedures. Methods For this observational study, we obtained discharge data for 422 730 patients aged 50 years or older who underwent common surgeries in 300 hospitals in nine European countries. Administrative data were coded with a standard protocol (variants of the ninth or tenth versions of the International Classification of Diseases) to estimate 30 day in-hospital mortality by use of risk adjustment measures including age, sex, admission type, 43 dummy variables suggesting surgery type, and 17 dummy variables suggesting comorbidities present at admission. Surveys of 26 516 nurses practising in study hospitals were used to measure nurse staffing and nurse education. We used generalised estimating equations to assess the effects of nursing factors on the likelihood of surgical patients dying within 30 days of admission, before and after adjusting for other hospital and patient characteristics. Findings An increase in a nurses’ workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% (odds ratio 1·068, 95% CI 1·031–1·106), and every 10% increase in bachelor’s degree nurses was associated with a decrease in this likelihood by 7% (0·929, 0·886–0·973). These associations imply that patients in hospitals in which 60% of nurses had bachelor’s degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor’s degrees and nurses cared for an average of eight patients. Interpretation Nurse staffing cuts to save money might adversely affect patient outcomes. An increased emphasis on bachelor’s education for nurses could reduce preventable hospital deaths. Funding European Union’s Seventh Framework Programme, National Institute of Nursing Research, National Institutes of Health, the Norwegian Nurses Organisation and the Norwegian Knowledge Centre for the Health Services, Swedish Association of Health Professionals, the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet, Committee for Health and Caring Sciences and Strategic Research Program in Care Sciences at Karolinska Institutet, Spanish Ministry of Science and Innovation. PMID:24581683

Use of a patient hand hygiene protocol to reduce hospital-acquired infections and improve nurses' hand washing.

PubMed

Fox, Cherie; Wavra, Teresa; Drake, Diane Ash; Mulligan, Debbie; Bennett, Yvonne Pacheco; Nelson, Carla; Kirkwood, Peggy; Jones, Louise; Bader, Mary Kay

2015-05-01

Critically ill patients are at marked risk of hospital-acquired infections, which increase patients' morbidity and mortality. Registered nurses are the main health care providers of physical care, including hygiene to reduce and prevent hospital-acquired infections, for hospitalized critically ill patients. To investigate a new patient hand hygiene protocol designed to reduce hospital-acquired infection rates and improve nurses' hand-washing compliance in an intensive care unit. A preexperimental study design was used to compare 12-month rates of 2 common hospital-acquired infections, central catheter-associated bloodstream infection and catheter-associated urinary tract infection, and nurses' hand-washing compliance measured before and during use of the protocol. Reductions in 12-month infection rates were reported for both types of infections, but neither reduction was statistically significant. Mean 12-month nurse hand-washing compliance also improved, but not significantly. A hand hygiene protocol for patients in the intensive care unit was associated with reductions in hospital-acquired infections and improvements in nurses' hand-washing compliance. Prevention of such infections requires continuous quality improvement efforts to monitor lasting effectiveness as well as investigation of strategies to eliminate these infections. ©2015 American Association of Critical-Care Nurses.

[Prevalence of burnout syndrome in nurses in 2 Mexican hospitals].

PubMed

Palmer-Morales, Yusvisaret; Prince-Vélez, Roberto; Searcy-Bernal, Roberto; Compean-Saucedo, Bertha

2007-01-01

To determine the prevalence of burnout syndrome in nursing staff in 2 different second level hospitals in the city of Mexicali, Baja California, Mexico. A cross-sectional study was conducted in all nursing staff (n = 698) in 2 second level hospitals (the Gynecology, Pediatrics and Family Medicine Hospital No. 31 and the General Specialist Hospital No. 30 in Mexicali). A stratified random sample was obtained from the 698 nurses, with a sample size of 184 nurses from each hospital. The Maslach Burn-out Inventory and a general questionnaire on demographic factors were used. Statistical analysis consisted of descriptive statistics and analysis of proportions using the chi-squared test. A total of 368 nurses were studied, of whom 345 (93.75%) were women. The mean age was 41.21 SD (standard deviation) = 6.59 years. The mean length of service was 15.87 (SD = 6.12) years. In both hospitals, the prevalence of burnout syndrome was 6.79% (25). Previous publications on burn-out have included studies performed in Mexico and in nurses in the emergency department of a tertiary hospital in Barcelona, as well as in other health care professionals. In comparison with these studies, the prevalence of burn-out observed in the present study was significantly lower.

Confirmation of Expectations and Satisfaction with Hospital Information Systems: A Nursing Perspective.

PubMed

Ayatollahi, Haleh; Langarizadeh, Mostafa; Chenani, Habib

2016-10-01

This study aimed to compare nurses' satisfaction with, and expectations of, hospital information systems in two teaching hospitals. This was a survey study, which was completed in 2014. The potential participants were 267 nurses who worked in two teaching hospitals and used the same hospital information system. Data were collected using two questionnaires. Both questionnaires were examined in terms of content validity and reliability. The results showed that, for a majority of nurses, their expectations of the system were not met in either hospital. Moreover, there was a significant association between the nurses' expectations and the perceived usefulness of the systems ( p < 0.001), between the nurses' expectations and their satisfaction with the systems ( p < 0.001), and between the perceived usefulness and nurses' satisfaction with the systems ( p < 0.001). The results suggested that, apart from the technical issues of implementing clinical information systems, non-technical factors should be taken into account. Among them, the nature of clinical tasks and the organizational culture require more attention to allow a successful system to be designed and implemented.

Understanding the Role of the Professional Practice Environment on Quality of Care in Magnet® and Non-Magnet Hospitals

PubMed Central

Stimpfel, Amy Witkoski; Rosen, Jennifer E.; McHugh, Matthew D.

2017-01-01

OBJECTIVE The aim of this study was to explore the relationship between Magnet Recognition® and nurse-reported quality of care. BACKGROUND Magnet® hospitals are recognized for nursing excellence and quality patient outcomes; however, few studies have explored contributing factors for these superior outcomes. METHODS This was a secondary analysis of linked nurse survey data, hospital administrative data, and a listing of American Nurses Credentialing Center Magnet hospitals. Multivariate regressions were modeled before and after propensity score matching to assess the relationship between Magnet status and quality of care. A mediation model assessed the indirect effect of the professional practice environment on quality of care. RESULTS Nurse-reported quality of care was significantly associated with Magnet Recognition after matching. The professional practice environment mediates the relationship between Magnet status and quality of care. CONCLUSION A prominent feature of Magnet hospitals, a professional practice environment that is supportive of nursing, plays a role in explaining why Magnet hospitals have better nurse-reported quality of care. PMID:26426138

Understanding the Role of the Professional Practice Environment on Quality of Care in Magnet® and Non-Magnet Hospitals

PubMed Central

Stimpfel, Amy Witkoski; Rosen, Jennifer E.; McHugh, Matthew D.

2014-01-01

OBJECTIVE The aim of this study was to explore the relationship between Magnet Recognition® and nurse-reported quality of care. BACKGROUND Magnet® hospitals are recognized for nursing excellence and quality patient outcomes; however, few studies have explored contributing factors for these superior outcomes. METHODS This was a secondary analysis of linked nurse survey data, hospital administrative data, and a listing of American Nurses Credentialing Center Magnet hospitals. Multivariate regressions were modeled before and after propensity score matching to assess the relationship between Magnet status and quality of care. A mediation model assessed the indirect effect of the professional practice environment on quality of care. RESULTS Nurse-reported quality of care was significantly associated with Magnet Recognition after matching. The professional practice environment mediates the relationship between Magnet status and quality of care. CONCLUSION A prominent feature of Magnet hospitals, a professional practice environment that is supportive of nursing, plays a role in explaining why Magnet hospitals have better nurse-reported quality of care. PMID:24316613

Emergency nurse disaster preparedness during mass gatherings: a cross-sectional survey of emergency nurses' perceptions in hospitals in Mecca, Saudi Arabia.

PubMed

Alzahrani, Fuad; Kyratsis, Yiannis

2017-04-11

To assess hospital emergency nurses' self-reported knowledge, role awareness and skills in disaster response with respect to the Hajj mass gathering in Mecca. Cross-sectional online survey with primary data collection and non-probabilistic purposive sample conducted in late 2014. All 4 public hospitals in Mecca, Saudi Arabia. 106 registered nurses in hospital emergency departments. Awareness, knowledge, skills and perceptions of emergency nurses in Mecca with regard to mass gathering disaster preparedness. Although emergency nurses' clinical role awareness in disaster response was reported to be high, nurses reported limited knowledge and awareness of the wider emergency and disaster preparedness plans, including key elements of their hospital strategies for managing a mass gathering disaster. Over half of the emergency nurses in Mecca's public hospitals had not thoroughly read the plan, and almost 1 in 10 were not even aware of its existence. Emergency nurses reported seeing their main role as providing timely general clinical assessment and care; however, fewer emergency nurses saw their role as providing surveillance, prevention, leadership or psychological care in a mass gathering disaster, despite all these broader roles being described in the hospitals' emergency disaster response plans. Emergency nurses' responses to topics where there are often misconceptions on appropriate disaster management indicated a significant knowledge deficit with only 1 in 3 nurses at best or 1 in 6 at worst giving correct answers. Respondents identified 3 key training initiatives as opportunities to further develop their professional skills in this area: (1) hospital education sessions, (2) the Emergency Management Saudi Course, (3) bespoke short courses in disaster management. Recommendations are suggested to help enhance clinical and educational efforts in disaster preparedness. 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/.

Nurse Level of Education, Quality of Care and Patient Safety in the Medical and Surgical Wards in Malaysian Private Hospitals: A Cross-Sectional Study

PubMed Central

Rahman, Hamzah Abdul; Jarrar, Mu’taman; Don, Mohammad Sobri

2015-01-01

Background and Objective: Nursing knowledge and skills are required to sustain quality of care and patient safety. The number of nurses with Bachelor degrees in Malaysia is very limited. This study aims to predict the impact of nurse level of education on quality of care and patient safety in the medical and surgical wards in Malaysian private hospitals. Methodology: A cross-sectional survey by questionnaire was conducted. A total of 652 nurses working in the medical and surgical wards in 12 private hospitals participated in the study. Multistage stratified simple random sampling performed to invite nurses working in small size (less than 100 beds), medium size (100-199 beds) and large size (over than 200) hospitals to participate in the study. This allowed nurses from all shifts to participate in this study. Results: Nurses with higher education were not significantly associated with both quality of care and patient safety. However, a total 355 (60.9%) of respondents who participated in this study were working in teaching hospitals. Teaching hospitals offer training for all newly appointed staff. They also provide general orientation programs and training to outline the policies, procedures of the nurses’ roles and responsibilities. This made the variances between the Bachelor and Diploma nurses not significantly associated with the outcomes of care. Conclusions: Nursing educational level was not associated with the outcomes of care in Malaysian private hospitals. However, training programs and the general nursing orientation programs for nurses in Malaysia can help to upgrade the Diploma-level nurses. Training programs can increase their self confidence, knowledge, critical thinking ability and improve their interpersonal skills. So, it can be concluded that better education and training for a medical and surgical wards’ nurses is required for satisfying client expectations and sustaining the outcomes of patient care. PMID:26153190

Recruiting and Retaining Army Nurses: An Annotated Bibliography, 1990

DTIC Science & Technology

1990-12-01

Questionnaire and burnout as measured by Maslach Burnout Inventory . Doyle, T.C., Cooper, G.E., and Anderson, R.G. The Impact of Health Svstem ChanQes on the...Hospital Data Center. R- port of the Hospital Nursing Personnel Survey . 1987. Chicago: American Hospital Association, 1987, AHA catalogue #154752...Abstract: This report summarizes the results of the 1987 Hospital Nursing Personnel Survey conducted by the American Hospital Association Division of

Promoting Health in American-Occupied Japan Resistance to Allied Public Health Measures, 1945-1952

PubMed Central

2009-01-01

As soon as the authority of the Public Health and Welfare Section (PHW) of the Supreme Commander for Allied Powers waned in May 1951, the Japanese government overturned several measures it had implemented. Although the PHW contributed greatly toward improving public health conditions, not all of its activities were models of cooperative success. Many Japanese perceived some measures—terminated pensions for wounded Japanese veterans, lack of support for segregated orphanages for mixed-race children, and suppression of Japanese atomic bomb medical reports—as promoting US national interest at the expense of Japanese public health needs. Similarly, the PHW's upgrade of nursing education and separation of the professions of medicine and pharmacy were reversed because neither professionals nor the public saw these measures as urgent. Their reinstitution toward the end of the twentieth century suggests that the progressive measures were sound, but broke too sharply with Japanese tradition and were enforced prematurely. PMID:19542032

Descriptive information about Crohn disease: content analysis of patient education brochures.

PubMed

Tanaka, Makoto; Kawakami, Aki; Iwao, Yasushi

2010-01-01

Although providing necessary information to patients with Crohn disease (CD) can influence their quality of life, there has been no study regarding the information provided by healthcare providers to CD patients. The aim of our study was to describe the contents of brochures given to CD patients in Japanese hospitals. These brochures were compared with ones used in the United States, Canada, and the United Kingdom. Forty-nine members of the research group on inflammatory bowel disease in Japan were asked to answer a questionnaire regarding educational brochures for CD patients. We obtained 15 Japanese and three foreign brochures and conducted content analyses for seven global brochures. We received 34 replies. Only 15 (44%) of 34 hospitals gave the brochures to all newly diagnosed CD patients. In the Japanese brochures, a lot of content was devoted to nutrition therapy and self-management in terms of diet. On the contrary, foreign brochures devoted more content to symptoms and drug therapy. The existing approaches for providing information in Japanese hospitals were unsatisfactory. Furthermore, Japanese educational brochures for CD patients emphasized nutritional therapy and dietary restriction. This reflected the differences in treatment strategies among countries.

Assessment of CPR-D skills of nurses in Göteborg, Sweden and Espoo, Finland: teaching leadership makes a difference.

PubMed

Mäkinen, M; Aune, S; Niemi-Murola, L; Herlitz, J; Varpula, T; Nurmi, J; Axelsson, A B; Thorén, A-B; Castrén, M

2007-02-01

Construction of an effective in-hospital resuscitation programme is challenging. To document and analyse resuscitation skills assessment must provide reliable data. Benchmarking with a hospital having documented excellent results of in-hospital resuscitation is beneficial. The purpose of this study was to assess the resuscitation skills to facilitate construction of an educational programme. Nurses working in a university hospital Jorvi, Espoo (n=110), Finland and Sahlgrenska University Hospital, Göteborg (n=40), Sweden were compared. The nurses were trained in the same way in both hospitals except for the defining and teaching of leadership applied in Sahlgrenska. Jorvi nurses are not trained to be, nor do they act as, leaders in a resuscitation situation. Their cardiopulmonary resuscitation (CPR) skills using an automated external defibrillator (AED) were assessed using Objective Structured Clinical Examination (OSCE) which was build up as a case of cardiac arrest with ventricular fibrillation (VF) as the initial rhythm. The subjects were tested in pairs, each pair alone. Group-working skills were registered. All Sahlgrenska nurses, but only 49% of Jorvi nurses, were able to defibrillate. Seventy percent of the nurses working in the Sahlgrenska hospital (mean score 35/49) and 27% of the nurses in Jorvi (mean score 26/49) would have passed the OSCE test. Statistically significant differences were found in activating the alarm (P<0.001), activating the AED without delay (P<0.01), setting the lower defibrillation electrode correctly (P<0.001) and using the correct resuscitation technique (P<0.05). The group-working skills of Sahlgrenska nurses were also significantly better than those of Jorvi nurses. Assessment of CPR-D skills gave valuable information for further education in both hospitals. Defining and teaching leadership seems to improve resuscitation performance.

Nurses' perceptions of and participation in continuing nursing education: results from a study of psychiatric hospital nurses in Bahrain.

PubMed

Al-Majid, Sadeeka; Al-Majed, Hashmiya; Rakovski, Cyril S; Otten, Rebecca A

2012-05-01

Although many psychiatric hospital nurses in Bahrain attend at least one continuing nursing education (CNE) activity per year, many others do not. This study explored these nurses' perceptions of CNE and factors that promote or hinder participation in CNE activities. A descriptive design was used to gather data from a convenience sample of 200 nurses working at the psychiatric hospital in Bahrain. Nurses believed that CNE improved the quality of patient care and patient outcomes, increased nurses' knowledge and skills, and kept them current with advances in nursing. Participation in CNE was hindered by unavailability of CNE activities related to psychiatric nursing. The majority of nurses had positive perceptions of CNE. Their participation was hindered by unavailability of CNE activities related to psychiatric nursing. Those responsible for planning continuing education in Bahrain should consider these findings when planning future CNE activities. Copyright 2012, SLACK Incorporated.

Patient safety culture among nurses.

PubMed

Ammouri, A A; Tailakh, A K; Muliira, J K; Geethakrishnan, R; Al Kindi, S N

2015-03-01

Patient safety is considered to be crucial to healthcare quality and is one of the major parameters monitored by all healthcare organizations around the world. Nurses play a vital role in maintaining and promoting patient safety due to the nature of their work. The purpose of this study was to investigate nurses' perceptions about patient safety culture and to identify the factors that need to be emphasized in order to develop and maintain the culture of safety among nurses in Oman. A descriptive and cross-sectional design was used. Patient safety culture was assessed by using the Hospital Survey on Patient Safety Culture among 414 registered nurses working in four major governmental hospitals in Oman. Descriptive statistics and general linear regression were employed to assess the association between patient safety culture and demographic variables. Nurses who perceived more supervisor or manager expectations, feedback and communications about errors, teamwork across hospital units, and hospital handoffs and transitions had more overall perception of patient safety. Nurses who perceived more teamwork within units and more feedback and communications about errors had more frequency of events reported. Furthermore, nurses who had more years of experience and were working in teaching hospitals had more perception of patient safety culture. Learning and continuous improvement, hospital management support, supervisor/manager expectations, feedback and communications about error, teamwork, hospital handoffs and transitions were found to be major patient safety culture predictors. Investing in practices and systems that focus on improving these aspects is likely to enhance the culture of patient safety in Omani hospitals and others like them. Strategies to nurture patient safety culture in Omani hospitals should focus upon building leadership capacity that support open communication, blame free, team work and continuous organizational learning. © 2014 International Council of Nurses.

Nurses' caring and empathy in Jordanian psychiatric hospitals: A national survey.

PubMed

Alhadidi, Majdi M B; Abdalrahim, Maysoon S; Al-Hussami, Mahmoud

2016-08-01

Nurses working in psychiatric hospitals need to acquire the skills of therapeutic communication and empathy, and have higher levels of caring. The present study aims to investigate the level of caring and empathy among nurses working in psychiatric hospitals. A cross-sectional survey was utilized to collect data from 205 nurses recruited from three psychiatric hospitals in Jordan. The Background Information Questionnaire, Modified Caring Dimensions Inventory, and Toronto Empathy Questionnaire were administered to the recruited participants. The findings revealed that the sampled nurses had a high level of caring and empathy. Significant correlations were found between caring and having a specialized training in mental health nursing, and having organizational and managerial support. However, no significant correlations were found between empathy and participants' characteristics. Specialized training in mental health nursing, having organizational and managerial support, and empathy were found predictors for caring. © 2016 Australian College of Mental Health Nurses Inc.

Minimum nurse staffing legislation and the financial performance of California hospitals.

PubMed

Reiter, Kristin L; Harless, David W; Pink, George H; Mark, Barbara A

2012-06-01

To estimate the effect of minimum nurse staffing ratios on California acute care hospitals' financial performance. Secondary data from Medicare cost reports, the American Hospital Association's (AHA) Annual Survey, and the California Office of Statewide Health Planning and Development (OSHPD) are combined from 2000 to 2006 for 203 hospitals in California and 407 hospitals in 12 comparison states. The study employs a difference-in-difference analytical approach. Hospitals are grouped into quartiles based on pre-regulation nurse staffing levels in adult medical-surgical and pediatric units (quartile 1=lowest staffing). Differences in operating margin, operating expenses per day, and inpatient operating expenses per discharge for California hospitals within a staffing quartile during the period of regulation are compared to differences at hospitals in comparison states during the same period. Hospital data from Medicare cost reports are merged with nurse staffing measures obtained from AHA and from OSPHD. Relative to hospitals in comparison states, operating margins declined significantly for California hospitals in quartiles 2 and 3. Operating expenses increased significantly in quartiles 1, 2, and 3. Implementation of minimum nurse staffing legislation in California put substantial financial pressure on some hospitals. © Health Research and Educational Trust.

Implementation of nursing conceptual models: observations of a multi-site research team.

PubMed

Shea, H; Rogers, M; Ross, E; Tucker, D; Fitch, M; Smith, I

1989-01-01

The general acceptance by nursing of the nursing process as the methodology of practice enabled nurses to have a common grounding for practice, research and theory development in the 1970s. It has become clear, however, that the nursing process is just that--a process. What is sorely needed is the nursing content for that process and consequently in the past 10 years nursing theorists have further developed their particular conceptual models (CM). Three major teaching hospitals in Toronto have instituted a conceptual model (CM) of nursing as a basis of nursing practice. Mount Sinai Hospital has adopted Roy's adaptation model; Sunnybrook Medical Centre, Kings's goal attainment model; and Toronto General Hospital, Orem's self-care deficit theory model. All of these hospitals are affiliated through a series of cross appointments with the Faculty of Nursing at the University of Toronto. Two community hospitals, Mississauga and Scarborough General, have also adopted Orem's model and are related to the University through educational, community and interest groups. A group of researchers from these hospitals and the University of Toronto have proposed a collaborative project to determine what impact using a conceptual model will make on nursing practice. Discussions among the participants of this research group indicate that there are observations associated with instituting conceptual models that can be identified early in the process of implementation. These observations may be of assistance to others contemplating the implementation of conceptually based practice in their institution.

Current practice of preoperative fasting: a nationwide survey in Japanese anesthesia-teaching hospitals.

PubMed

Shime, Nobuaki; Ono, Akira; Chihara, Eiichi; Tanaka, Yoshifumi

2005-01-01

We conducted a nationwide survey to investigate the current practice of the preoperative fasting period in Japanese anesthesia-teaching hospitals. Acceptance of the clinical practice guideline published by the American Society of Anesthesiologists (ASA) was also surveyed. A written type of questionnaire was mailed to 795 teaching hospitals. The response rate of the questionnaires was 57%. Most (>90%) of the respondents had been applying a longer fasting period than the ASA-recommended minimum period specifically in adults; the median duration of fasting was 12-13 h for solids and 6-9 h for liquids. Children or infants were allowed a more liberalized fasting period, frequently being permitted an oral intake of clear fluids up to 3 h before anesthesia. The incidence of pulmonary aspiration was 1/12,500 general anesthesia cases, and application of the ASA guideline appeared not to affect the incidence. Japanese anesthesiologists were still reluctant to depart from their traditional long fasting periods, as most of them could find little benefit in reducing the fasting periods. The long preoperative fasting period is still common practice in Japanese anesthesia-teaching hospitals. A national guideline for a preoperative fasting policy is worth exploring to change the current practice.

Nursing staff intentions towards managing deteriorating health in nursing homes: A convergent parallel mixed-methods study using the theory of planned behaviour.

PubMed

O'Neill, Barbara J; Dwyer, Trudy; Reid-Searl, Kerry; Parkinson, Lynne

2018-03-01

To predict the factors that are most important in explaining nursing staff intentions towards early detection of the deteriorating health of a resident and providing subacute care in the nursing home setting. Nursing staff play a pivotal role in managing the deteriorating resident and determining whether the resident needs to be transferred to hospital or remain in the nursing home; however, there is a dearth of literature that explains the factors that influence their intentions. This information is needed to underpin hospital avoidance programs that aim to enhance nursing confidence and skills in this area. A convergent parallel mixed-methods study, using the theory of planned behaviour as a framework. Surveys and focus groups were conducted with nursing staff (n = 75) at a 94-bed nursing home at two points in time, prior to and following the implementation of a hospital avoidance program. The quantitative and qualitative data were analysed separately and merged during final analysis. Nursing staff had strong intentions, a positive attitude that became significantly more positive with the hospital avoidance program in place, and a reasonable sense of control; however, the influence of important referents was the strongest predictor of intention towards managing residents with deteriorating health. Support from a hospital avoidance program empowered staff and increased confidence to intervene. The theory of planned behaviour served as an effective framework for identifying the strong influence referents had on nursing staff intentions around managing residents with deteriorating health. Although nursing staff had a reasonable sense of control over this area of their work, they believed they benefitted from a hospital avoidance program initiated by the nursing home. Managers implementing hospital avoidance programs should consider the role of referents, appraise the known barriers and facilitators and take steps to identify those unique to their local situation. All levels of nursing staff play a role in preventing hospitalisation and should be consulted in the design, implementation and evaluation of any hospital avoidance strategies. © 2017 John Wiley & Sons Ltd.

Nurses' views of factors affecting sleep for hospitalized children and their families: A focus group study.

PubMed

Stremler, Robyn; Adams, Sherri; Dryden-Palmer, Karen

2015-08-01

Light, noise, and interruptions from hospital staff lead to frequent awakenings and detrimental changes to sleep quantity and quality for children who are hospitalized and their parents who stay with them overnight. An understanding of nurses' views on how care affects sleep for the hospitalized child and parent is crucial to the development of strategies to decrease sleep disturbance in hospital. The purpose of this descriptive qualitative study was to gain an understanding of nurses' views on their role in and influence on sleep for families; perceived barriers and facilitators of patient and parent sleep at night; strategies nurses use to preserve sleep; the distribution, between parent and nurse, of care for the child at night; views of the parent as a recipient of nursing care at night; and the nature of interactions between nurses and families at night. Thirty registered nurses from general pediatric and critical care units participated in one of four semi-structured focus groups. Four main influences on sleep were identified: child factors; environmental factors; nurse-parent interaction factors; and nursing care factors. Some of these restricted nurses' ability to optimize sleep, but many factors were amenable to intervention. Balancing strategies to preserve sleep with the provision of nursing assessment and intervention was challenging and complicated by the difficult nature of work outside of usual waking hours. Nurses highlighted the need for formal policy and mentoring related to provision of nursing care at night in pediatric settings. © 2015 Wiley Periodicals, Inc.

Investigating Children's Perception of Nurses Through Their Drawings.

PubMed

Çakirer Çalbayram, Nazan; Altundağ, Sebahat; Aydin, Bahise

2017-09-01

Hospitalized children can have various fantasies about hospital, health staff, and related tools and equipment. They need to develop new coping strategies for compliance with hospitalization.This study aimed to investigate the perception of nurses by children with acute and chronic illness through their drawings. The study was carried out using a descriptive research model. "Nurses through the eyes of sick children data collection form" was used in data collection procedure. The instruction "draw a picture of a nurse, please" was used to get the children to draw a picture. The majority of the children portrayed nurses as a smiling face. The children with chronic diseases featured nurses more in their drawings and they mentioned more nurse duties. The most important sign of the progression of nursing is that the mentioning of the modern roles of nursing by the children in their drawings and expressions. As children are influenced by their emotions, thoughts, observations, and experiences while drawing pictures, nurses can determine their thoughts about the disease, hospitals, physicians, and nurses by having sick children draw pictures.

Nurses' experiences working with nursing students in a hospital: a phenomenological enquiry.

PubMed

Lapeña-Moñux, Yolanda Raquel; Cibanal-Juan, Luis; Orts-Cortés, M Isabel; Maciá-Soler, M Loreto; Palacios-Ceña, Domingo

2016-01-01

this paper explores the experiences of registered nurses working with Spanish nursing students within the hospital. a qualitative phenomenological approach was followed. Purposeful sampling was employed. Twenty-one registered nurses, from a public hospital located in Spain, were included in the study. Data were collected by means of unstructured and semi-structured interviews and were analysed using Giorgi's proposal. The Consolidated Criteria for Reporting Qualitative Research were followed. three main themes described the experience of registered nurses: "The nurse's relationship with nursing students"; most nurses emphasized the importance of the first contact with students and they considered students' attitude to be key. "Defining the role of the student in clinical practice"; it is necessary to unify the nurse's role and interventions to avoid misleading students and establish priorities in clinical practice. "Building bridges between clinical settings and the University"; the need to establish a common ground and connection between the university and hospital clinical settings was emphasized. Nurses felt that the training program should also be designed by the clinical settings themselves. understanding the meaning of nursing students with registered nurses might gain a deeper insight into their expectations.

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 Presence of Nursing Students and Its Influence in the Quality of Care Provided by Staff Nurses.

ERIC Educational Resources Information Center

Zisberg, Anna; Bar-Tal, Yoram; Krulik, Tamar

2003-01-01

Protocol-guided observations in 15 Israeli hospitals were used to grade nursing activities. The presence of nursing students in hospitals improved the quality of care provided by 67 nurses compared to their performance in the absence of students. (Contains 30 references.) (JOW)

Evaluating Nurses Acceptance of Hospital Information Systems: A Case Study of a Tertiary Care Hospital.

PubMed

Khalifa, Mohamed

2016-01-01

This study aims at evaluating hospital information systems (HIS) acceptance factors among nurses, in order to provide suggestions for successful HIS implementation. The study used mainly quantitative survey methods to collect data directly from nurses through a questionnaire. The availability of computers in the hospital was one of the most influential factors, with a special emphasis on the unavailability of laptop computers and computers on wheels to facilitate immediate data entry and retrieval when nurses are at the point of care. Nurses believed that HIS might frequently slow down the process of care delivery and increase the time spent by patients inside the hospital especially during slow performance and responsiveness phases. Recommendations were classified into three main areas; improving system performance and availability of computers in the hospital, increasing organizational support in the form of providing training and protected time for nurses' to learn and enhancing users' feedback by listening to their complaints and considering their suggestions.

Nurse uniform wearing practices and associated factors among nurses working in Northwest Ethiopia: a cross-sectional institution based study.

PubMed

Desta, Etaferahu Alamaw; Gebrie, Mignote Hailu; Dachew, Berihun Assefa

2015-01-01

Wearing uniforms help in the formation of professional identity in healthcare. It fosters a strong self image and professional identity which can lead to good confidence and better performance in nursing practice. However, most nurses in Ethiopia are not wearing nursing uniforms and the reasons remain unclear. Therefore, the aim of this research is to assess nurse uniform wearing practices among nurses and factors associated with such practice in hospitals in Northwest Ethiopia. A hospital based cross-sectional study was conducted from March to April, 2014 in five hospitals located in Northwest Ethiopia. A total 459 nurses participated in the study. Data was collected using a pre-tested self-administered questionnaire. Descriptive statistics were analyzed in order to characterize the study population. Bivariate and multiple logistic regression models were fitted. Odds ratios with 95 % confidence intervals were computed to identify factors associated with nursing uniform practice. Nurse uniform wearing practice was found to be 49.2 % of the total sample size. Around 35 % of the respondents that did not implement nurse uniform wearing practices stated that there was no specific uniform for nurses recommended by hospital management. In addition to this, nurse uniform wearing practices were positively associated with being female [AOR = 1.58, 95 % CI (1.02, 2.44)], studying nursing by choice [AOR =3.16, 95 % CI (2.03, 4.92)], and the appeal of nursing uniforms to nurses [AOR = 3.43 95 % CI (1.96, 5.98)]. Nurse uniform wearing practices were not exceptionally prevalent in Northwest Ethiopian hospitals. However, encouraging students to pursue interest-based careers and implementing a nurse uniform wearing policy may have the potential to improve such practices.

Investigation of the relationship between structural empowerment and organizational commitment of nurses in Zanjan hospitals.

PubMed

Eskandari, Fereidoun; Siahkali, Soheila Rabie; Shoghli, Alireza; Pazargadi, Mehrnoosh; Tafreshi, Mansoreh Zaghari

2017-03-01

The demanding nature of nursing work environments signals longstanding and growing concerns about nurses' health and job satisfaction and the provision of quality care. Specifically in health care settings, nurse leaders play an essential role in creating supportive work environments to avert these negative trends and increase nurse job satisfaction. The purpose of this study was to examine the relationship between structural empowerment and organizational commitment of nurses. 491 nurses working in Zanjan hospitals participated in this descriptive-correlational study in 2010. Tools for data collection were Meyer and Allen's organizational commitment questionnaire and "Conditions for Work Effectiveness Questionnaire-II" (CWEQ-II). Data was analyzed by SPSS16. The statistical tests such as variance analysis, t-test, pearson correlation coefficient and linear regression were used for data analysis. According to the findings, the perception of nurses working in hospitals on "Structural Empowerment" was moderate (15.98±3.29). Nurses believed "opportunity" as the most important element in structural empowerment with the score of 3.18 ±0.79. Nurses working in non-academic hospitals and in non-teaching hospitals had higher organizational commitment than others. There was a significant relationship between structural empowerment and organizational commitment. Generally, structural empowerment (relatively strong) correlates with nurses' organizational commitment. We concluded that a high structural empowerment increases the organizational commitment of nurses.

Turnover intention of graduate nurses in South Korea.

PubMed

Lee, Haejung; Lim, Yeonjung; Jung, Hee Young; Shin, Youn-Wha

2012-06-01

The purpose of this study was to identify the turnover intention of graduate nurses in South Korea and to explore the correlates of turnover intention. A descriptive, correlational design was used. The participants comprised 225 female nurses who were working at 13 general hospitals and who had accumulated <12 months of clinical nursing experience since their graduation. The data were collected through a structured questionnaire that was conducted from 5-31 August 2009. The mean score for turnover intention was 7.51. Turnover intention was found to be related to the number of beds in the hospital, workplace, and duration of job orientation (theory and practice), instruction by a preceptor, job stress, clinical competence, self-efficacy, and the practice environment. In the multivariate approach, the practice environment, job stress, and the workplace were found to be significantly related to turnover intention and accounted for 36% of the said intention in the studied graduate nurses. The results support that the characteristics of magnet hospitals that improve the practice environment could play a critical role in retaining nurses in hospitals. Managerial interventions that enhance the practice environment, reduce job stress, and place graduate nurses in nursing units with a single specialty could benefit the hospitals employing such nurses. Further research to explore the effects of managerial strategies on graduate nurses' turnover intention is warranted. © 2011 The Authors; Japan Journal of Nursing Science © 2011 Japan Academy of Nursing Science.

The Productive Ward program™: a longitudinal multilevel study of nurse perceived practice environment, burnout, and nurse-reported quality of care and job outcomes.

PubMed

Van Bogaert, Peter; Van heusden, Danny; Somers, Annemie; Tegenbos, Muriel; Wouters, Kristien; Van der Straeten, Johnny; Van Aken, Paul; Havens, Donna Sullivan

2014-09-01

The objective of this study was to investigate the impact of The Productive Ward-Releasing Time to Care™ program implemented in a hospital transformation process on nurse perception related to practice environment, burnout, quality of care, and job outcomes. To address the continuously evolving complex challenges of patient care, high-performance nursing care is necessary. A longitudinal survey design was used to conduct a study in a 600-bed acute care university hospital with 3 measurement periods: T0: base line in 2006, T1 in 2011, and T2 in 2013. As part of the hospital transformation process, the productive ward program was introduced between T1 and T2. Relevant impact on nurse-physician relations, nurse management, hospital management-organizational support, nurse-reported quality of care, and job outcomes were identified. Hospital strategies and policies should be aligned with daily practices so that engaged and committed staff can promote excellent outcomes.

Baccalaureate education in nursing and patient outcomes.

PubMed

Blegen, Mary A; Goode, Colleen J; Park, Shin Hye; Vaughn, Thomas; Spetz, Joanne

2013-02-01

The aim of this study was to examine the effects of registered nurse (RN) education by determining whether nurse-sensitive patient outcomes were better in hospitals with a higher proportion of RNs with baccalaureate degrees. The Future of Nursing report recommends increasing the percentage of RNs with baccalaureate degrees from 50% to 80% by 2020. Research has linked RN education levels to hospital mortality rates but not with other nurse-sensitive outcomes. This was a cross-sectional study that, with the use of data from 21 University HealthSystem Consortium hospitals, analyzed the association between RN education and patient outcomes (risk-adjusted patient safety and quality of care indicators), controlling for nurse staffing and hospital characteristics. Hospitals with a higher percentage of RNs with baccalaureate or higher degrees had lower congestive heart failure mortality, decubitus ulcers, failure to rescue, and postoperative deep vein thrombosis or pulmonary embolism and shorter length of stay. The recommendation of the Future of Nursing report to increase RN education levels is supported by these findings.

Scoping review: Hospital nursing factors associated with 30-day readmission rates of patients with heart failure.

PubMed

Jun, Jin; Faulkner, Kenneth M

2018-04-01

To review the current literature on hospital nursing factors associated with 30-day readmission rates of patients with heart failure. Heart failure is a common, yet debilitating chronic illness with high mortality and morbidity. One in five patients with heart failure will experience unplanned readmission to a hospital within 30 days. Given the significance of heart failure to individuals, families and healthcare system, the Center for Medicare and Medicaid Services has made reducing 30-day readmission rates a priority. Scoping review, which maps the key concepts of a research area, is used. Published primary studies in English assessing factors related to nurses in hospitals and readmission of patients with heart failure were included. Other inclusion criteria were written in English and published in peer-reviewed journals. The search resulted in 2,782 articles. After removing duplicates and reviewing the inclusion and exclusion criteria, five articles were selected. Three nursing workforce factors emerged as follows: (i) nursing staffing, (ii) nursing care and work environment, and (iii) nurses' knowledge of heart failure. This is the first scoping review examining the association between hospital nursing factors and 30-day readmission rates of patients with heart failure. Further studies examining the extent of nursing structural and process factors influencing the outcomes of patients with heart failure are needed. Nurses are an integral part of the healthcare system. Identifying the factors related to nurses in hospitals is important to ensure comprehensive delivery of care to the chronically ill population. Hospital administrators, managers and policymakers can use the findings from this review to implement strategies to reduce 30-day readmission rates of patients with heart failure. © 2018 John Wiley & Sons Ltd.

The Impact of Market Orientation on Patient Safety Climate Among Hospital Nurses.

PubMed

Weng, Rhay-Hung; Chen, Jung-Chien; Pong, Li-Jung; Chen, Li-Mei; Lin, Tzu-Chi

2016-03-01

Improving market orientation and patient safety have become the key concerns of nursing management. For nurses, establishing a patient safety climate is the key to enhancing nursing quality. This study explores how market orientation affects the climate of patient safety among hospital nurses. We proposed adopting a cross-sectional research design and using questionnaires to collect responses from nurses working in two Taiwanese hospitals. Three-hundred and forty-three valid samples were obtained. Multiple regression and path analyses were conducted to test the study. Market orientation was defined as the combination of customer orientation, competitor orientation, and interfunctional coordination. Customer orientation directly affects the climate of patient safety. Although the findings only supported Hypothesis 1, competitor orientation and interfunctional coordination positively affected the patient safety climate through the mediating effects of hospital support for staff. Health care managers could encourage nurses to adopt customer-oriented perspectives to enhance their nursing care. In addition, to enhance competitor orientation, interfunctional coordination, and the patient safety climate, hospital managers could strengthen their support for staff members. © The Author(s) 2014.

An Audit of Nursing Documentation at Three Public Hospitals in Jamaica.

PubMed

Lindo, Jascinth; Stennett, Rosain; Stephenson-Wilson, Kayon; Barrett, Kerry Ann; Bunnaman, Donna; Anderson-Johnson, Pauline; Waugh-Brown, Veronica; Wint, Yvonne

2016-09-01

Nursing documentation provides an important indicator of the quality of care provided for hospitalized patients. This study assessed the quality of nursing documentation on medical wards at three hospitals in Jamaica. This cross-sectional study audited a multilevel stratified sample of 245 patient records from three type B hospitals. An audit instrument which assessed nursing documentation of client history, biological data, client assessment, nursing standards, discharge planning, and teaching facilitated data collection. Descriptive statistics were conducted using IBM SPSS, Version 19 (IBM Inc., Armonk, NY, USA). Records from three hospitals (Hospital 1, n = 119, 48.6%; Hospital 2, n = 56, 22.9%; Hospital 3, n = 70, 28.6%) were audited. Documented evidence of the patient's chief complaint (81.6%), history of present illness (78.8%), past health (79.2%), and family health (11.0%) were noted; however, less than a third of the dockets audited recorded adequate assessment data (e.g., occupation or living accommodations of patients). The audit noted 90% of records had a physical assessment completed within 24 hr of admission and entries timed, dated, and signed by a nurse. Less than 5% of dockets had evidence of patient teaching, and 13.5% had documented evidence of discharge planning conducted within 72 hr of admission. This study highlights the weakness in nursing documentation and the need for increased training and continued monitoring of nursing documentation at the hospitals studied. Additional research regarding the factors that affect nursing documentation practice could prove useful. The study provides valuable information for the development of strategic risk management programs geared at improving the quality of care delivered to clients and presents an opportunity for nurse leaders to implement structured interventions geared at improving nursing documentation in Jamaica. In light of Jamaica's epidemiologic transition of chronic diseases, gaps in nurses' documentation of client assessment, patient teaching, and discharge planning should be addressed with urgency. Patient teaching and discharge planning enable the clients to participate more effectively in their health maintenance process. © 2016 Sigma Theta Tau International.

Managerial performance and cost efficiency of Japanese local public hospitals: a latent class stochastic frontier model.

PubMed

Besstremyannaya, Galina

2011-09-01

The paper explores the link between managerial performance and cost efficiency of 617 Japanese general local public hospitals in 1999-2007. Treating managerial performance as unobservable heterogeneity, the paper employs a panel data stochastic cost frontier model with latent classes. Financial parameters associated with better managerial performance are found to be positively significant in explaining the probability of belonging to the more efficient latent class. The analysis of latent class membership was consistent with the conjecture that unobservable technological heterogeneity reflected in the existence of the latent classes is related to managerial performance. The findings may support the cause for raising efficiency of Japanese local public hospitals by enhancing the quality of management. Copyright © 2011 John Wiley & Sons, Ltd.

Nurse staffing and system integration and change indicators in acute care hospitals: evidence from a balanced scorecard.

PubMed

McGillis Hall, Linda; Peterson, Jessica; Baker, G Ross; Brown, Adalsteinn D; Pink, George H; McKillop, Ian; Daniel, Imtiaz; Pedersen, Cheryl

2008-01-01

This study examined relationships between financial indicators for nurse staffing and organizational system integration and change indicators. These indicators, along with hospital location and type, were examined in relation to the nursing financial indicators. Results showed that different indicators predicted each of the outcome variables. Nursing care hours were predicted by the hospital type, geographic location, and the system. Both nursing and patient care hours were significantly related to dissemination and benchmarking of clinical data.

Recruiting nurses through social media: Effects on employer brand and attractiveness.

PubMed

Carpentier, Marieke; Van Hoye, Greet; Stockman, Sara; Schollaert, Eveline; Van Theemsche, Bart; Jacobs, Gerd

2017-11-01

To investigate whether and how nurses' exposure to a hospital's profile on social media affects their perceptions of the hospital's brand and attractiveness as an employer. Since in many places across the globe hospitals are struggling with nursing shortages, competition is rising to be perceived as an attractive employer by this target group. Organizations are increasingly using social media for recruitment, however, little is known about its effects on potential applicants' perceptions of the organization as an employer. We thus examine whether these effects occur and rely on the media richness theory to explain the mechanisms at play. A between-subjects experimental design was applied. Three conditions were used: a control group, one condition that required visiting the Facebook page of a hospital and one condition that required visiting the LinkedIn page. The focal organization was an existing Belgian hospital which had a LinkedIn and a Facebook page. An online questionnaire was sent to nursing students and employed nurses over 5 months in 2015-2016. Nurses' exposure to the hospital's Facebook or LinkedIn page had a significant positive effect on a majority of the employer brand dimensions, both instrumental and symbolic. In addition, nurses who visited the Facebook page felt more attracted to working at the hospital. Most of these effects were mediated by social presence. Nurses' perceptions of employers can be positively influenced by seeing a hospital's social media page. Hospitals can thus employ social media to improve their employer brand image and attractiveness. © 2017 John Wiley & Sons Ltd.

26 CFR 31.3121(b)(13)-1 - Services of student nurse or hospital intern.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 15 2013-04-01 2013-04-01 false Services of student nurse or hospital intern... 1954) General Provisions § 31.3121(b)(13)-1 Services of student nurse or hospital intern. (a) Services... before 1966 as an intern (as distinguished from a resident doctor), in the employ of a hospital are...

26 CFR 31.3121(b)(13)-1 - Services of student nurse or hospital intern.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 15 2012-04-01 2012-04-01 false Services of student nurse or hospital intern... 1954) General Provisions § 31.3121(b)(13)-1 Services of student nurse or hospital intern. (a) Services... before 1966 as an intern (as distinguished from a resident doctor), in the employ of a hospital are...

26 CFR 31.3121(b)(13)-1 - Services of student nurse or hospital intern.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 15 2014-04-01 2014-04-01 false Services of student nurse or hospital intern... 1954) General Provisions § 31.3121(b)(13)-1 Services of student nurse or hospital intern. (a) Services... before 1966 as an intern (as distinguished from a resident doctor), in the employ of a hospital are...

Professor in Residence: An Innovative Academic-Practice Partnership.

PubMed

Hinic, Katherine; Kowalski, Mildred Ortu; Silverstein, Wendy

2017-12-01

This article describes an academic-practice partnership between an American Nurses Credentialing Center Magnet ® -designated hospital and an academic nurse educator that has increased the hospital's capacity for research, evidence-based practice, and support for nurses continuing their education. Through close collaboration with the full-time nurse researcher and members of the nursing education department, the professor in residence consults with clinical staff to support completion of research and evidence-based practice projects. The collaboration also has resulted in the development of a formal year-long mentoring program for clinical nurses in the area of evidence-based practice. Individual support and academic consults are offered to nurses enrolled in school to promote advancement of nurses' educational level. This collaboration has been beneficial for both the hospital and the university, increasing the capacity for scholarly activities for nurses in the hospital and serving as a forum for ongoing faculty practice and scholarship. J Contin Educ Nurs. 2017;48(12):552-556. Copyright 2017, SLACK Incorporated.

Working with local nurses to promote hospital-nursing care during humanitarian assignments overseas: experiences from the perspectives of nurses.

PubMed

Tjoflåt, Ingrid; Karlsen, Bjørg; Saetre Hansen, Britt

2016-06-01

To describe how Norwegian expatriate nurses engaged in humanitarian assignments overseas experience working with the local nurses promoting nursing care in the hospital ward. Western countries have a long tradition of providing nurses with expert knowledge in nursing care for humanitarian projects and international work overseas. Studies from humanitarian mission revealed that health workers rarely acknowledge or use the local knowledge. However, there is a lack of studies highlighting expatriate nurses' experiences working with local nurses to promote nursing care in the hospital ward. This study applies a descriptive explorative qualitative design. The data were collected in 2013 by means of seven semi-structured interviews and analysed using qualitative content analysis. The data analyses revealed three themes related to the expatriate nurses' experiences of working with the local nurses to promote nursing care in the hospital ward: (1) Breaking the code, (2) Colliding worlds and (3) Challenges in sharing knowledge. The findings reflect different challenges when working with the local nurses. Findings indicate valuable knowledge gained about local nursing care and the local health and educational system. They also demonstrate challenges for the expatriate nurses related to the local nursing standard in the wards and using the local nurses' experiences and knowledge when working together. The findings can inform nurses, humanitarian organisations and institutions working overseas regarding the recruitment and the preparation of nurses who want to work cross- culturally or in humanitarian missions overseas. © 2016 John Wiley & Sons Ltd.

[An epidemic of rotavirus infection in a nursing home for the elderly in Japan].

PubMed

Chimura, Yuri; Annaka, Megumi; Shibazaki, Sumie; Adachi, Keiko; Shinkai, Takayuki; Sadamasu, Kenji; Noguchi, Yayoi; Masuda, Yoshishige; Inamatsu, Takashi

2002-06-01

An outbreak of diarrheal disease in a Japanese home for aged is reported. Out of 202 residents, 47 cases complained of diarrhea (23.3%) during a month. Clinical symptom were diarrhea (100%) vomiting (40.4%) and fever (31.9%). Fecal examination of 9 cases revealed positive A-group rotavirus antigen. Bacterial and small round shaped virus infection was excluded. Examination of rotavirus antibody, CF titer was positive in about 50% in each age group but the titer decreased year by year. In Japan, rotavirus infection has been epidemic only in nursing home for baby and titer of antigen has been believed to be sustain by repeated provocation. However, Japanese situation is changing to be west Europe and north America.

Confidence in delegation and leadership of registered nurses in long-term-care hospitals.

PubMed

Yoon, Jungmin; Kim, Miyoung; Shin, Juhhyun

2016-07-01

Effective delegation improves job satisfaction, responsibility, productivity and development. The ageing population demands more nurses in long-term-care hospitals. Delegation and leadership promote cooperation among nursing staff. However, little research describes nursing delegation and leadership style. We investigated the relationship between registered nurses' delegation confidence and leadership in Korean long-term-care hospitals. Our descriptive correlational design sampled 199 registered nurses from 13 long-term-care hospitals in Korea. Instruments were the Confidence and Intent to Delegate Scale and Multifactor Leadership Questionnaire. Confidence in delegation significantly aligned with current-unit clinical experience, length of total clinical-nursing experience, delegation-training experience and leadership. Transformational leadership was the most statistically significant factor influencing delegation confidence. When effective delegation integrates with efficient leadership, staff can deliver optimal care to long-term-care patients. © 2016 John Wiley & Sons Ltd.

Urinary Incontinence in Hospitalised Elderly Patients: Do Nurses Recognise and Manage the Problem?

PubMed Central

Zürcher, Sabin; Saxer, Susi; Schwendimann, René

2011-01-01

This study examined to what extent nurses recognize urinary incontinence (UI) in elderly hospital patients, what UI interventions nurses realize, and if elderly inpatients are willing to raise the topic during their hospital stay. A convenience sample of 78 elderly inpatients in a Swiss hospital were screened for UI and asked if they were willing to be questioned about UI during hospitalisation. Nursing records were analysed as to whether UI had been recognized, and to collect data on interventions. Forty-one patients (51%) screened positive for UI, of whom 10 (24%) were identified as such in their nursing records. The single intervention documented was the use of incontinence pads. Only 5 patients preferred not to be asked about UI at hospital. Nurses in the study hospital should systematically ask elderly patients about UI and provide them with information on interventions. PMID:21994838

Indian hospitals and Aboriginal nurses: Canada and Alaska.

PubMed

Drees, Laurie Meijer

2010-01-01

Between 1945 and the early 1970s, both Indian Health Services in Canada (IHS), and the Alaska Native Health Service (ANS) initiated programs and activities aimed at recruiting and training nurses/nurses aides from Canadian and Alaskan Native communities. In Alaska, the Mt. Edgecumbe Hospital in Sitka acted as a training facility for Alaska Native nurses' aides, while in Canada, the Charles Camsell Hospital served a similar function. These initiatives occurred prior to the devolution of health care to Aboriginal communities. The histories of these two hospitals provide a comparative opportunity to reveal themes related to the history of Aboriginal nurse training and Aboriginal health policies in the north. The paper outlines the structure and function of two main hospitals within the Indian Health and Alaska Native Health Services, discusses the historic training, and role of Aboriginal nurses and caregivers within those systems using both archival and oral history sources.

Hospital nurses' attitudes, negative perceptions, and negative acts regarding workplace bullying.

PubMed

Ma, Shu-Ching; Wang, Hsiu-Hung; Chien, Tsair-Wei

2017-01-01

Workplace bullying is a prevalent problem in today's work places that has adverse effects on both bullying victims and organizations. To investigate the predictors of workplace bullying is an important task to prevent bullying victims of nurses in hospitals. This study aims to explore the relationships among nurses' attitudes, negative perceptions, and negative acts regarding workplace bullying under the framework of the theory of planned behavior (TPB). A total of 811 nurses from three hospitals in Taiwan were surveyed. Nurses' responses to the 201 items of 10 scales were calibrated using Rasch analysis and then subjected to path analysis with partial least-squares structural equation modeling (PLS-SEM). The instrumental attitude was significant predictors of nurses' negative perceptions to be bullied in the workplace. Instead, the other TPB components of subjective norm and perceived behavioral control were not effective predictors of nurses' negative acts regarding workplace bullying. The findings provided hospital nurse management with important implications for prevention of bullying, particularly to them who are tasked with providing safer and more productive workplaces to hospital nurses. Awareness of workplace bullying was recommended to other kinds of workplaces for further studies in future.

Characteristics of hospital-based Munchausen Syndrome by Proxy in Japan.

PubMed

Fujiwara, Takeo; Okuyama, Makiko; Kasahara, Mari; Nakamura, Ayako

2008-04-01

This article explores characteristics of Munchausen Syndrome by Proxy (MSBP) in Japan, a country which provides an egalitarian, low cost, and easy-access health care system. We sent a questionnaire survey to 11 leading doctors in the child abuse field in Japan, each located in different hospital-based sites. Child abuse doctors answered questions regarding the characteristics of MSBP cases for whom they had helped care. Twenty-one MSBP cases (20 families) were reported. Characteristics of the victims included: no differences based on sex, 4.6 years of age on average when MSBP was confirmed, and an average of 1.9 years duration of MSBP abuse. Biological mothers were at least one of the perpetrators in 95% of cases. Among the 12 cases (57%) who remained with their families, 2 victims died. Only 5% of perpetrators had a medical background or relatives who engaged in healthcare work. There are similar features of MSBP cases between Japan and other English-speaking countries, such as the UK or the US. However, perpetrators of MSBP in Japan did not have a medical background. Easier access to hospital resources in Japan may give greater opportunities for perpetrators to obtain medical knowledge from doctors or nurses. The findings suggest that perpetrators of MSBP should not be assumed to possess a medical background in a country which provides universal medical care such as Japan. A contributory factor of MSBP may be the high frequency of medical consultations and equal level of accessibility of medical resources for Japanese citizens. Social welfare services that need to decide on custody for MSBP victims should recognize the relatively high risk of life-threatening danger in their family of origin. Further collaboration between hospital staff including pediatricians, nurses, medical social workers and staff at the social welfare services is needed to protect children from MSBP.

Nurses' perceptions of research utilization in a corporate health care system.

PubMed

McCloskey, Donna Jo

2008-01-01

To explore selected characteristics of nurses based upon educational level (masters, baccalaureate, associate degree/diploma), years of experience, and hospital position (management, advanced practice, staff nurse) that might affect perceived availability of research resources, attitude towards research, support, and research use in practice. A descriptive nonexperimental mailed survey design was used for this study. Nurses in five hospitals within a corporate hospital system were surveyed using the Research Utilization Questionnaire (RUQ). The RUQ was used to measure nurses' perceptions of research utilization in the four dimensions of perceived use of research, attitude toward research, availability of research resources, and perceived support for research activities. ANOVA was used to analyze the data. Statistically significant differences (p<.001) were found in the perceived use of research, attitude toward research, availability of research resources, and perceived support for research activities based on educational level and organizational position. No significant differences were found in the perception of nurses based on years of experience. The results of this study have implications for staff nurses, administrators, advanced practice nurses, and educators working in hospital systems. The different perceptions based upon educational level and hospital position can be integrated and used at all levels of nursing practice to promote research utilization and evidence-based practice initiatives within the organizational structure. The results of this study have nursing implications within administration and for nursing practice. The different perceptions that were found based upon educational level and hospital position can be positively integrated and used by administrators and by nurses all levels of nursing practice to promote research utilization and evidence based practice initiatives within the organizational structure.

Nurses' meaning of caring with patients in acute psychiatric hospital settings: a grounded theory study.

PubMed

Chiovitti, Rosalina F

2008-02-01

The concept of caring is described as intangible, abstract, and invisible in nursing practice. This has translated into a view of caring as a personal choice or natural obligation rather than a deliberate process. While there has been movement to delineate caring within nursing in general, the psychiatric nurse's perspective on caring has been absent from theoretical works and measures constructed to describe nurse's work. To develop a substantive grounded theory of caring from the perspective of Registered Nurses working with patients in three Canadian acute psychiatric hospital settings. The qualitative research design of grounded theory methodology was used to develop a theory of caring. Three urban, acute psychiatric hospital settings in Canada. Two were general hospitals and one was a psychiatric hospital. Registered Nurses (N=17) licensed with the College of Nurses of Ontario. In-depth interviews with Registered Nurses were conducted using theoretical sampling. The data were analysed using constant comparative analysis. Protective empowering is the basic social psychological process that represents Registered Nurses' caring with patients in acute psychiatric hospital settings. Nurses accomplish protective empowering through six main categories of: (1) respecting the patient; (2) not taking the patient's behaviour personally; (3) keeping the patient safe; (4) encouraging the patient's health; (5) authentic relating; and (6) interactive teaching. The six main categories were accomplished through 27 subcategories. In the theory of protective empowering, the goal is to help patients participate in activities contributing to convalescence, health, and/or quality of life. The theory of protective empowering provides six main categories and 27 subcategories that can be transferred to funding formulas, patient health record documentation systems, nurse orientation and education programs, nurse role descriptions, and used in guiding discussions about organizational values of patient-centred care within a collaborative multidisciplinary context.

Assessment of nursing management and utilization of nursing resources with the RAFAELA patient classification system--case study from the general wards of one central hospital.

PubMed

Rainio, Anna-Kaisa; Ohinmaa, Arto E

2005-07-01

RAFAELA is a new Finnish PCS, which is used in several University Hospitals and Central Hospitals and has aroused considerable interest in hospitals in Europe. The aim of the research is firstly to assess the feasibility of the RAFAELA Patient Classification System (PCS) in nursing staff management and, secondly, whether it can be seen as the transferring of nursing resources between wards according to the information received from nursing care intensity classification. The material was received from the Central Hospital's 12 general wards between 2000 and 2001. The RAFAELA PCS consists of three different measures: a system measuring patient care intensity, a system recording daily nursing resources, and a system measuring the optimal nursing care intensity/nurse situation. The data were analysed in proportion to the labour costs of nursing work and, from that, we calculated the employer's loss (a situation below the optimal level) and savings (a situation above the optimal level) per ward as both costs and the number of nurses. In 2000 the wards had on average 77 days below the optimal level and 106 days above it. In 2001 the wards had on average 71 days below the optimal level and 129 above it. Converting all these days to monetary and personnel resources the employer lost 307,745 or 9.84 nurses and saved 369,080 or 11.80 nurses in total in 2000. In 2001 the employer lost in total 242,143 or 7.58 nurses and saved 457,615 or 14.32 nurses. During the time period of the research nursing resources seemed not have been transferred between wards. RAFAELA PCS is applicable to the allocation of nursing resources but its possibilities have not been entirely used in the researched hospital. The management of nursing work should actively use the information received in nursing care intensity classification and plan and implement the transferring of nursing resources in order to ensure the quality of patient care. Information on which units resources should be allocated to is needed in the planning of staff resources of the whole hospital. More resources do not solve the managerial problem of the right allocation of resources. If resources are placed wrongly, the problems of daily staff management and cost control continue.

[Mobile geriatric consultant services for rest homes. Study of the effects of consultations by internal medicine specialists in the medical care of rest home residents].

PubMed

Schippinger, W; Hartinger, G; Hierzer, A; Osprian, I; Bohnstingl, M; Pilgram, E H

2012-12-01

Hospital admissions are frequent among long-term residents of nursing homes and can result in detrimental complications affecting the patients' somatic, psychological, and cognitive status. In this prospective controlled study, we investigated the effects of a mobile geriatric consultant service (GECO) offered by specialists in internal medicine on frequency of hospitalizations in nursing home residents. During a 10-month observation period, residents in a control nursing home received medical attendance by general practitioners as is common in Austrian nursing homes. Residents in the intervention nursing home also received the medical service of GECO. Within the group of rest home residents receiving GECO support, a statistically significant lower frequency of acute transports to hospitals was observed in comparison to residents of the control nursing home (mean number of acute transports to hospitals/100 residents/month: 6.1 versus 11.7; p < 0.01). The number of planned non-acute hospital and specialist office presentations was also lower in the intervention nursing home (mean number of hospital and specialist office presentations/100 residents/month: 14.4 versus 18.0); however, this difference did not reach statistical significance. This study shows that a mobile medical geriatric consultant service based on specialists in internal medicine can improve medical care in nursing homes resulting in a statistically significant reduction of acute transports to hospitals.

Issues experienced while administering care to patients with dementia in acute care hospitals: A study based on focus group interviews

PubMed Central

Fukuda, Risa; Shimizu, Yasuko

2015-01-01

Objective Dementia is a major public health problem. More and more patients with dementia are being admitted to acute care hospitals for treatment of comorbidities. Issues associated with care of patients with dementia in acute care hospitals have not been adequately clarified. This study aimed to explore the challenges nurses face in providing care to patients with dementia in acute care hospitals in Japan. Methods This was a qualitative study using focus group interviews (FGIs). The setting was six acute hospitals with surgical and medical wards in the western region of Japan. Participants were nurses in surgical and internal medicine wards, excluding intensive care units. Nurses with less than 3 years working experience, those without experience in dementia patient care in their currently assigned ward, and head nurses were excluded from participation. FGIs were used to collect data from February to December 2008. Interviews were scheduled for 1–1.5 h. The qualitative synthesis method was used for data analysis. Results In total, 50 nurses with an average experience of 9.8 years participated. Eight focus groups were formed. Issues in administering care to patients with dementia at acute care hospitals were divided into seven groups. Three of these groups, that is, problematic patient behaviors, recurrent problem, and problems affecting many people equally, interact to result in a burdensome cycle. This cycle is exacerbated by lack of nursing experience and lack of organization in hospitals. In coping with this cycle, the nurses develop protection plans for themselves and for the hospital. Conclusions The two main issues experienced by nurses while administering care to patients with dementia in acute care hospitals were as follows: (a) the various problems and difficulties faced by nurses were interactive and caused a burdensome cycle, and (b) nurses do their best to adapt to these conditions despite feeling conflicted. PMID:25716983

Building capacity for the conduct of nursing research at a Veterans Administration hospital.

PubMed

Phelan, Cynthia H; Schumacher, Sandra; Roiland, Rachel; Royer, Heather; Roberts, Tonya

2015-05-01

Evidence is the bedrock of nursing practice, and nursing research is the key source for this evidence. In this article, we draw distinctions between the use and the conduct of nursing research and provide a perspective for how the conduct of nursing research in a Veterans Administration hospital can build an organization's capacity for nursing research.

[Current status of nurses' perceived professional benefits and influencing factors in 3A-level hospitals in Tianjin].

PubMed

Ma, H W; Dan, X; Xu, S H; Hou, R N; Zhao, N M

2017-06-20

Objective: To investigate the current status of nurses' perceived professional benefits in 3A-level hospitals in Tianjin, and analyze its influencing factors. Methods: A total of 421 clinical nurses from five 3A-level hospitals in Tianjin were recruited for investigation on perceived professional benefits by Nurses'Perceived Professional Benefits Scale. Results: The total score of nurses' perceived professional benefit was 110.50±14.24, the score index was 77.34%. Among five dimensions, the highest scores index was 84.80% for personal development, the lowest was 71.57% for identification by relatives and friends. Multiple linear regression analysis showed the three variables, such as department, teaching and cooperative relation between doctors and nurses entered the model, higher perceived professional benefits was observed in medical nurses, teaching nurses, and those with better cooperative relation between doctors and nurses ( P <0.05) . Conclusion: The investigated nurses in 3A-level hospitals in Tianjin show upper-moderate level of perceived professional benefits. Nursing managers should develop targeted interventions based on the factors affecting the perceived professional benefits of the nurses and further enhance their perceived professional benefits.

Impact of Nurse Staffing Mandates on Safety-Net Hospitals: Lessons from California

PubMed Central

McHugh, Matthew D; Brooks Carthon, Margo; Sloane, Douglas M; Wu, Evan; Kelly, Lesly; Aiken, Linda H

2012-01-01

Context California is the first and only state to implement a patient-to-nurse ratio mandate for hospitals. Increasing nurse staffing is an important organizational intervention for improving patient outcomes. Evidence suggests that staffing improved in California hospitals after the mandate was enacted, but the outcome for hospitals bearing a disproportionate share of uncompensated care—safety-net hospitals—remains unclear. One concern was that California's mandate would burden safety-net hospitals without improving staffing or that hospitals would reduce their skill mix, that is, the proportion of registered nurses of all nursing staff. We examined the differential effect of California's staffing mandate on safety-net and non-safety-net hospitals. Methods We used a time-series design with Annual Hospital Disclosure data files from the California Office of Statewide Health Planning and Development (OSHPD) for the years 1998 to 2007 to assess differences in the effect of California's mandate on staffing outcomes in safety-net and non-safety-net hospitals. Findings The mandate resulted in significant staffing improvements, on average nearly a full patient per nurse fewer (−0.98) for all California hospitals. The greatest effect was in those hospitals with the lowest staffing levels at the outset, both safety-net and non-safety-net hospitals, as the legislation intended. The mandate led to significantly improved staffing levels for safety-net hospitals, although there was a small but significant difference in the effect on staffing levels of safety-net and non-safety-net hospitals. Regarding skill mix, a marginally higher proportion of registered nurses was seen in non-safety-net hospitals following the mandate, while the skill mix remained essentially unchanged for safety-net hospitals. The difference between the two groups of hospitals was not significant. Conclusions California's mandate improved staffing for all hospitals, including safety-net hospitals. Furthermore, improvement did not come at the cost of a reduced skill mix, as was feared. Alternative and more targeted designs, however, might yield further improvement for safety-net hospitals and reduce potential disparities in the staffing and skill mix of safety-net and non-safety-net hospitals. PMID:22428696

Sociotechnical analysis of nurses' use of personal mobile phones at work.

PubMed

Bautista, John Robert; Lin, Trisha T C

2016-11-01

Nurses' use of personal mobiles phones at work is a growing trend in healthcare organizations. Although recent studies have explored the positive and negative implications of nurses using personal mobile phones at work, none has yet analyzed the interactions of sociotechnical components (users, technology and policy) on nurses' use of personal mobile phones at work. Identify sociotechnical interactions by analyzing each sociotechnical component (users, technology and policy) that affects nurses' use of personal mobile phones at work. In-depth interviews were conducted with 30 nurses employed in 13 hospitals in the Philippines. The respondents include staff nurses (n=23), charge nurses (n=4), and nurse managers (n=3). Staff nurses were asked on their use of personal mobile phones at work, while charge and nurse managers were asked on their observations regarding staff nurses' use of personal mobile phones at work. Responses were analyzed qualitatively using sociotechnical analysis. Sociotechnical analysis indicated that staff nurses used their personal mobile phones at work in various ways because its use helped in their nursing work, but inevitably altered a few of their routines. Although most hospitals had policies that prohibit the use of mobile phones, staff nurses justified their use of personal mobile phones by using it for work purposes and for the benefit of their patients. Staff nurses highlighted the absence of hospital-provided mobile phones as a key reason for using personal mobile phones at work. Charge nurses and nurse managers also influenced staff nurses' use of personal mobile phones at work. Nurses could use their personal mobile phones at work for work purposes to enhance their clinical performance and improve patient care. Hospital administrators can leverage on nurses' use of personal mobile phones at work by formulating policies that consider both the benefits and potential drawbacks of mobile phone usage. Recommendations are made for the formulation of hospital policies to optimize the use of personal mobile phones of nurses at work. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Comprehension of Japanese oral care-related terms among caregivers and nurses, as assessed using a newly developed instrument.

PubMed

Shibata, Satoko; Stegaroiu, Roxana; Nakazawa, Akari; Ohuchi, Akitsugu

2017-03-01

(i) To assess comprehension of oral care-related terms among caregivers and nurses working at long-term care facilities, using a newly developed test; (ii) to analyse the effect of participant characteristics on their comprehension. Effective mutual communication between dental professionals and caregivers/nurses is essential for providing information on daily oral care for institutionalised elders. A 36-item word-knowledge test in Japanese was developed to assess comprehension of oral care-related terms. The test was administered to a convenience sample of 236 nursing staff (198 caregivers and 38 nurses) at six long-term care facilities in Niigata City, Japan, and its reliability and validity were verified. Associations of participant characteristics with their responses were investigated by multiple regression analysis. Mean percentage of correct responses (accuracy rate) for nursing staff was approximately 62% (highest for oral care products and lowest for prosthodontic terms). Test internal reliability was high (Cronbach's alpha >0.8). Concurrent validity (test ability to distinguish between characteristically different groups) was confirmed. Mean accuracy rate was significantly higher among nurses (78.5 ± 19.3%) than among caregivers (58.7 ± 22.8%), and among respondents with interest in oral care (64.2 ± 21.1%) than among those with no such interest (51.5 ± 28.9%). The word-knowledge test was valid and reliable for nursing staff of six long-term care facilities in Niigata City. Their comprehension was low for perioral and intraoral structures, related symptom and disease names, and prosthodontics terms related to oral care. Understanding of oral care-related terms among the nursing staff was related to their occupation and interest in oral care. © 2016 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

[Discharge from hospital into nursing home: conditions and quality of transmissions].

PubMed

Delabrière, Isabelle; Delzenne, Emmanuelle; Gaxatte, Cédric; Puisieux, François

2014-01-01

Nursing home residents are very old, with multiple comorbidities and disabled for activities of daily living (ADLs). Therefore, they have a higher risk of accidents as falls or fractures or acute diseases as infections, which require hospitalization. Care's coordination and sharing of informations between hospitals and nursing homes are often insufficient even with agreements. Thus, discharge to nursing homes after hospitalization may be difficult for old patients because of incomplete oral or written transmissions. To examine both protocols and the quality of the return to the nursing homes after an hospitalization for old residents. A prospective multicenter study done by collecting data about consecutive returns into their nursing home after an hospitalization of more than 24 hours of nursing home residents aged 65 years and more. Twenty-eight nursing homes of the North of France were enrolled in the study. During the 3 months period of the study, 246 discharges after an hospitalization of 24 hours or more were registered. 225 residents (165 women and 60 men), mean age 85.0 ± 7.2, were concerned. Most of them were ADLs disabled, with a dementia for 47.1% of them. The average length of hospitalization was 11.6 days. At the end of hospitalization, the notification of return, which was made only in 82% of cases, was announced in average 1.3 days before the discharge. Unfortunately, in 32% of cases, the notification was made the day of the discharge. Residents went back home indifferently any day of the week but more often the Friday and less often the weekend. The day and the hour of the planned discharge were respected in 79.1% of cases. In most cases, nursing home caregivers have considered that the clinical status was stable or improved compared to the previous one. However in 28% of cases, a loss of autonomy was found. Medical doctors wrote a letter of discharge in 85.8% of cases. Nurses gave written transmissions only in 41.9% of cases. Many points concerning discharge from hospital, about old people living in nursing home, have to be improved: oral transmissions about patient's status, notification of the return, discharge's letter, nurse's transmissions and assessment of the loss of autonomy. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Attitudes of nursing staff towards computerisation: a case of two hospitals in Nairobi, Kenya

PubMed Central

2014-01-01

Background The health sector is faced with constant changes as new approaches to tackle illnesses are unveiled through research. Information, communication and technology have greatly transformed healthcare practice the world over. Nursing is continually exposed to a variety of changes. Variables including age, educational level, years worked in nursing, computer knowledge and experience have been found to influence the attitudes of nurses towards computerisation. The purpose of the study was to determine the attitudes of nurses towards the use of computers and the factors that influence these attitudes. Methods This cross sectional descriptive study was conducted among staff nurses working at one public hospital (Kenyatta National Hospital, (KNH) and one private hospital (Aga Khan University Hospital (AKUH). A convenience sample of 200 nurses filled the questionnaires. Data was collected using the modified Nurses’ Attitudes Towards Computerisation (NATC) questionnaire. Results Nurses had a favorable attitude towards computerisation. Non-users had a significantly higher attitude score compared to the users (p = 0.0274). Statistically significant associations were observed with age (p = 0.039), level of education (p = 0.025), duration of exposure to computers (p = 0.025) and attitudes towards computerisation. Conclusion Generally, nurses have positive attitudes towards computerisation. This information is important for the planning and implementation of computerisation in the hospital as suggested in other studies. PMID:24774008

Development and validation of the Geriatric In-hospital Nursing Care Questionnaire.

PubMed

Persoon, Anke; Bakker, Franka C; van der Wal-Huisman, Hanneke; Olde Rikkert, Marcel G M

2015-02-01

To develop a questionnaire, the Geriatric In-hospital Nursing Care Questionnaire (GerINCQ), to measure, in an integrated way, the care that older adults receive in the hospital and nurses' attitudes toward and perceptions about caring for older adults. Questionnaire development. Twelve university and teaching hospitals. Thirteen experienced geriatric nurses and three geriatricians from 12 hospitals evaluated an initial version of the questionnaire. Two hundred seventy-one nurses, primarily registered nurses from 11 geriatric, medical, and surgical departments in six hospitals, validated the final questionnaire. Items from two published instruments were extracted for use in the questionnaire. Content validity was confirmed using the Delphi technique with an expert panel. Internal consistency was measured by calculating Cronbach alpha; intrarater reliability was measured using test-retest correlations and intraclass correlation coefficients (ICCs); differences between hospital departments were analyzed using analysis of variance. Sensitivity to detect before-and-after changes with implementation of a geriatric care program was determined using the Student t-test. Consensus was reached after three Delphi rounds. The GerINCQ is a self-administered questionnaire to be filled out by hospital nurses that comprises five subscales with 67 items. It has good content validity (each item content validity index >0.9) and good internal consistency (Cronbach alpha = 0.86). Intrarater reliability revealed high test-retest results (ICC = 0.87). The questionnaire detected significant differences between nurses in three types of hospital departments (medical, surgical, and geriatric (P < .01). The GerINCQ was sensitive to changes after an educational program (P < .02) and had a large effect size (0.5). The GerINCQ is a reliable and valid tool and is sensitive to change over time. It is clinically relevant because it provides a quantitative measure of hospital nurses' geriatric practices, attitudes, and perceptions. Moreover, the GerINCQ is suitable for monitoring progress after implementation of geriatric improvement programs. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Attitudes of Registered and Licensed Practical Nurses About the Importance of Families in Surgical Hospital Units: Findings From the Landspitali University Hospital Family Nursing Implementation Project.

PubMed

Blöndal, Katrin; Zoëga, Sigridur; Hafsteinsdottir, Jorunn E; Olafsdottir, Olof Asdis; Thorvardardottir, Audur B; Hafsteinsdottir, Sigrun A; Sveinsdóttir, Herdis

2014-08-01

The purpose of this study was to examine attitudes of registered nurses and licensed practical nurses about the importance of the family in surgical hospital units before (T1) and after (T2) implementation of a Family Systems Nursing educational intervention based on the Calgary Family Assessment and Intervention Models. This study was part of the Landspitali University Hospital Family Nursing Implementation Project and used a nonrandomized, quasi-experimental design with nonequivalent group before and after and without a control group. There were 181 participants at T1 and 130 at T2. No difference was found in nurses' attitudes as measured by the Families Importance in Nursing Care-Nurses' Attitudes (FINC-NA) questionnaire, before and after the educational intervention. Attitudes toward families were favorable at both times. Analysis of demographic variables showed that age, work experience, and workplace (inpatient vs. outpatient units) had an effect on the nurses' attitudes toward families. The influence of work experience on attitudes toward family care warrants further exploration. © The Author(s) 2014.

We cannot staff for 'what ifs': the social organization of rural nurses' safeguarding work.

PubMed

MacKinnon, Karen

2012-09-01

Rural nurses play an important role in the provision of maternity care for Canadian women. This care is an important part of how rural nurses safeguard the patients who receive care in small rural hospitals. This study utilized institutional ethnography as an approach for describing rural nursing work and for exploring how nurses' work experiences are socially organized. Rural nurses advocated for safe healthcare environments by ensuring that skilled nurses were available for every shift, day and night, at their local hospital. Rural nurses noted that this work was particularly difficult for the provision of maternity care. This article explores two threads or cues to institutional organization that were identified in our interviews and observations; namely staffing and safety standards, and the need for flexibility in staffing in small rural hospitals. Rural nurses' concerns about ensuring that skilled nurses are available in small rural hospitals do not enter into current management discourses that focus on efficiency and cost savings or find a home within current discourses of patient safety 'competencies'. © 2011 Blackwell Publishing Ltd.

Nursing home nurses' perceptions of emergency transfers from nursing homes to hospital: A review of qualitative studies using systematic methods.

PubMed

O'Neill, Barbara; Parkinson, Lynne; Dwyer, Trudy; Reid-Searl, Kerry

2015-01-01

The aim is to describe nursing home nurses' perceptions around emergency transfers to hospital. Transfers are costly and traumatic for residents, and efforts are underway to avoid hospitalization. Nurses play a key role in transfers, yet their views are underreported. A systematic review of qualitative studies was undertaken, guided by Joanna Briggs Institute methods. From seven reviewed studies, it was clear nursing home nurses are challenged by the complexity of the transfer process and understand their need for appropriate clinical knowledge, skills and resources. Communication is important, yet nurses often use persuasive and targeted communication. Ambiguity, strained relationships and negative perceptions of residents' experiences around hospitalization contribute to conflict and uncertainty. Nurses are more confident when there is a plan. Transferring a resident is a complex process and special skills, knowledge and resources are required, but may be lacking. Efforts to formalize the transfer process and improve communication and collaboration amongst all stakeholders is needed and would be well received. Copyright © 2015 Elsevier Inc. All rights reserved.

Australian Hospital-Based Nurse Educators' Perceptions of Their Role.

PubMed

Thornton, Karleen

2018-06-01

This article presents the findings from a phenomenological study that explored the understandings of Australian hospital-based nurse educators' experiences of their role. Purposive sampling resulted in 11 nurse educators from four large metropolitan hospitals within an Australian jurisdiction. The participants were asked how they understand their role and translate that understanding into practice. Thematic analysis identified four themes representative of nurse educators' understanding of their role: Becoming an Educator, Capability Building, Panacea, and Tension. A coherent picture emerged from subthemes highlighting that nurse educators were undervalued and value is added. Being undervalued and value adding are translated into nurse educator practice as resilience, being educationally literate, investing, and having a presence. This article identifies a gap in knowledge related to understanding the nurse educator role and informs recruitment and subsequent retention of nurses into nurse educator roles at a time when the nursing workforce in Australia and internationally is about to experience a major shortfall. Findings are specific to the Australian context and are not necessarily generalizable to other hospital jurisdictions. J Contin Educ Nurs. 2018;49(6):274-281. Copyright 2018, SLACK Incorporated.

Nursing diagnoses, interventions, and patient outcomes for hospitalized older adults with pneumonia.

PubMed

Head, Barbara J; Scherb, Cindy A; Reed, David; Conley, Deborah Marks; Weinberg, Barbara; Kozel, Marie; Gillette, Susan; Clarke, Mary; Moorhead, Sue

2011-04-01

A study was conducted by academic and community hospital partners with clinical information systems that included the standardized nursing language classifications of the North American Nursing Diagnosis Association International (NANDA-I), Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC). The aim of the study was to determine the frequency of NANDA-I, NIC, and NOC (NNN) terms documented for older adults with pneumonia who were discharged from three hospitals during a 1-year period. NNN terms were ranked according to frequency for each hospital, and then the rankings were compared with previous studies. Similarity was greater across hospitals in rankings of NANDA-I and NOC terms than in rankings of NIC terms. NANDA-I and NIC terms are influenced by reimbursement and regulatory factors as well as patient condition. The 10 most frequent NNN terms for each hospital accounted only for a small to moderate percentage of the terms selected.

The Impact of the Nursing Practice Environment on Missed Nursing Care.

PubMed

Hessels, Amanda J; Flynn, Linda; Cimiotti, Jeannie P; Cadmus, Edna; Gershon, Robyn R M

2015-12-01

Missed nursing care is an emerging problem negatively impacting patient outcomes. There are gaps in our knowledge of factors associated with missed nursing care. The aim of this study was to determine the relationship between the nursing practice environment and missed nursing care in acute care hospitals. This is a secondary analysis of cross sectional data from a survey of over 7.000 nurses from 70 hospitals on workplace and process of care. Ordinary least squares and multiple regression models were constructed to examine the relationship between the nursing practice environment and missed nursing care while controlling for characteristics of nurses and hospitals. Nurses missed delivering a significant amount of necessary patient care (10-27%). Inadequate staffing and inadequate resources were the practice environment factors most strongly associated with missed nursing care events. This multi-site study examined the risk and risk factors associated with missed nursing care. Improvements targeting modifiable risk factors may reduce the risk of missed nursing care.

Relationships between compassion fatigue, burnout, and turnover intention in Korean hospital nurses.

PubMed

Sung, Kiwol; Seo, Youngsook; Kim, Jee Hee

2012-12-01

This study aimed to identify relationships between compassion fatigue, burnout, and turnover intention in Korean hospital nurses. In total, 142 hospital nurses were surveyed as part of data collection. Data related to compassion fatigue, burnout, and turnover intention were collected using a questionnaire between May 2011 and September 2011. The data analysis was performed using PASW 19.0 program, which included one-way ANOVA, independent t-tests, Pearson's correlation coefficient, and hierarchical regression analysis. This study detected a positive correlation between compassion fatigue and burnout(r=.37, p<.001), and turnover intention(r=.55, p<.001). Compassion fatigue accounted for 29.6% of the variance for turnover intention among Korean hospital nurses. The results indicate that it is necessary to reduce compassion fatigue, and turnover intention among Korean hospital nurses.

Virtual nursing grand rounds and shared governance: how innovation and empowerment are transforming nursing practice at Thanh Nhan Hospital, Hanoi, Vietnam.

PubMed

Crow, Gregory L; Nguyen, Thanh; DeBourgh, Gregory A

2014-01-01

The Vietnam Nurse Project has been operating in Hanoi since 2007. Its primary purpose is to improve nursing education through curriculum development, faculty development, and the introduction of a more student-centric teaching and learning environment. The Virtual Nursing Grand Rounds component of the project is an academic-practice partnership between the Vietnam Nurse Project at the University of San Francisco School of Nursing and Health Professions and the Thanh Nhan Hospital intensive care unit. Its goal is to improve nursing practice in the Thanh Nhan Hospital intensive care unit. The Virtual Nursing Grand Rounds is a fully interactive real-time synchronous computer technology-assisted point-to-point program that provides ongoing evidence-based staff development and consultative services.

Development and communication of written ethics policies on euthanasia in Catholic hospitals and nursing homes in Belgium (Flanders).

PubMed

Gastmans, Chris; Lemiengre, Joke; de Casterlé, Bernadette Dierckx

2006-10-01

To describe whether and how Catholic hospitals and nursing homes in Belgium (Flanders) have developed written ethics policies on euthanasia and communicated these policies to their employees, patients, and patient's relatives. A cross-sectional mail survey of general directors of Catholic hospitals and nursing homes in Belgium (Flanders). Of the 298 targeted institutions, 81% of hospitals and 62% of nursing homes returned complete questionnaires. A high percentage of Catholic hospitals (79%) and a moderate percentage of nursing homes (30%) had written ethics policies on euthanasia. Both caregivers and healthcare administrators were involved in the development and approval of these policies. Physicians and nurses were best informed about the policies. More than half of the nursing homes (57%) took the initiative to inform both residents and relatives about the policies, while only one hospital did so. The high prevalence of written ethics policies on euthanasia in Flemish Catholic hospitals may reflect the concern of healthcare administrators to maintain the quality of care for patients requesting euthanasia. However, the true contribution of these policies to quality end-of-life care and to supporting caregivers remains unknown and needs further research. Legislation and centrally developed guidelines might influence healthcare institutions to develop ethics policies.

MI group launch.

PubMed

2002-10-01

The RCN minor injuries group was due to be launched last month as Emergency Nurse went to press. The sub-group of the RCN A&E Nursing Association is to be chaired by Mark Preston, senior nurse and modern matron at Alfred Bean Hospital, East Yorkshire. A&E sister at the Royal Preston Hospital Sarifa Kabir is to be secretary, with clinical nurse manager at Heatherwood Hospital, Berkshire, Gail King as vice chair.

Barriers to participation in governance and professional advancement: a comparison of internationally educated nurses and registered nurses educated in the United States.

PubMed

Wheeler, Rebecca M; Foster, Jennifer W

2013-01-01

This study compared the perspectives of internationally educated nurses (IENs) and registered nurses (RNs) educated in the United States regarding participation in hospital governance structures and professional advancement. Nurses' participation in hospital governance is reported to contribute to empowerment. No research has examined how IENs' perceptions about participation in governance compared with those of U.S. RNs. Semistructured interviews were held with 82 nurses in 2 urban hospitals. Forty nurses were reinterviewed to follow up on themes. Internationally educated nurses and US RNs shared similar perspectives. Nurses in both samples did not value participation in governance, lacked guidance about how to advance, and preferred to at the bedside. Strategies to encourage nurses to participate in and value governance and professional advancement opportunities should be explored and adopted.

[Laboratory management fee in national health insurance; what is required from clinical laboratory physicians? --message from Chairpersons].

PubMed

Kimura, Satoshi; Koshiba, Masahiro

2013-06-01

The laboratory management fee (LMF) in national health insurance ("Kentai-Kensa-Kanri-Kasan" in Japanese) has had a major impact on Japanese clinical laboratories, especially in recent years. In 2012, the fee was raised to approximately 5,000 yen per admitted patient. In order to address this national support, clinical pathologists are required to increase their knowledge and skills. On the other hand, there are insufficient clinical pathologists in Japan. In order to solve this problem, the Japanese Society of Laboratory Medicine (JSLM) approved a new license for Qualified Clinical Laboratory Managing Physicians (CLMPs), in addition to Certified Clinical Laboratory Physicians (CCLPs). The requirements to become a CLMP are less strict than for CCLP. There are approximately 500 CLMPs and 600 CCLPs in this country. The aim of this symposium was to offer opportunities to increase attendees' clinical skills, especially CLMPs and young clinical pathologists. Four CCLPs were chosen as speakers from a university hospital, a major city hospital, a medium-sized acute care hospital, and a university hospital anatomical pathologist, together with a chief medical technologist from a university hospital. All the speakers presented their ideal role models of clinical pathologists matching LMF requirements. JSLM together with the Japanese Association of Clinical Laboratory Physicians (JACLaP) sponsored this symposium. It was a successful meeting with more than two hundred attendees.

Whistleblowing in Japan.

PubMed

Davis, Anne J; Konishi, Emiko

2007-03-01

This article, written from research data, focuses on the possible meaning of the data rather than on detailed statistical reporting. It defines whistleblowing as an act of the international nursing ethical ideal of advocacy, and places it in the larger context of professional responsibility. The experiences, actions, and ethical positions of 24 Japanese nurses regarding whistleblowing or reporting a colleague for wrongdoing provide the data. Of these respondents, similar in age, educational level and clinical experience, 10 had previously reported another nurse and 12 had reported a physician for a wrongful act. These data raise questions about overt actions to expose a colleague in a culture that values group loyalty and saving face. Additional research is needed for an in-depth understanding of whistleblowing, patient advocacy and professional responsibility across cultures, especially those that value group loyalty, saving face and similar concepts to the Japanese Ishin Denshin, where the value is on implicit understanding requiring indirect communication. Usually, being direct and openly discussing sensitive topics is not valued in Japan because such behavior disrupts the most fundamental value, harmony (wa).

In their own words: The experience of professional nurses in a Northern Vietnamese women's hospital.

PubMed

Ng'ang'a, Njoki; Byrne, Mary Woods; Ngo, Toan Anh

2014-01-01

Abstract Background: Nurses in Vietnam, as is typical of many low-income countries, are hampered from impacting health outcomes by low occupational status, overcrowded hospitals and few career development opportunities. In order to understand the current practice environment encountered by nurses in Vietnam in the most realistic way, we listened to the voices of nurses currently performing nursing roles in Vietnam. The purpose of this study was to explore the emic (insider) perspectives on cultural meaning applied by nurses at a northern Vietnamese women's hospital to influence professional practice and interpret experience. A micro-ethnography approach was used. Seven nurses and one Vice Dean of a school of nursing were interviewed. Data collection consisted of open-ended interviews, participant observation and journal recordings. Spradley's (1979, 1980) Development Research Sequence was used to guide data collection and analysis. Five themes emerged. These were the big number of patients is a burden for nurses; nurses do not, cannot make their own decisions (but they can and do); my feeling depends on doctor's feeling; nurses learn more from doctor; and just a few nurses can attend the [Vietnamese Nurses Association] meeting. The experiences described by the nurses and the Vice Dean of a nursing school reflect the challenges of practicing nursing in one Vietnamese hospital and the resourcefulness of nurses in overcoming those challenges. Recurrent themes highlight the need to better position nurses in Vietnam to advance toward full expression of the professional nursing role.

Workplace bullying among Nurses in South Taiwan.

PubMed

Fang, Li; Huang, Su-Hui; Fang, Shu-Hui

2016-09-01

This study was to investigate bullying among hospital nurses and its correlates. Chinese people were unlikely to express their opinions or pursue individual rights. Workplace bullying took place more easily among the educated people within Chinese culture. However, studies related to workplace bullying among hospital nurses in Taiwan were still limited. A cross-sectional design. Two hundred and eighty-five nurses who worked in the regional teaching hospital in south Taiwan were recruited. The significant predictors of workplace bullying were identified by using linear regression analysis. The mean of overall bullying was 1·47, showing that the frequency of the nurses having experienced workplace bullying was between 'never' and 'now and then'. The most frequent bullying item was 'being yelled at or being the target of anger', followed by 'being the objects of untruthful criticism' and 'having views ignored'. Hospital nurses working in the Emergency room would gain 10·888 points more in the overall bullying scale compared with those who worked in operation rooms or haemodialysis rooms. They were more likely to be bullied. Hospital nurses with one year increase in nursing experience were 0·207 points less likely to be bullied. Reducing workplace bullying among hospital nurses was an essential method to provide quality assurance to health care. Nurse managers should build up zero tolerance policy to decrease nurses' exposure to workplace bullying. Training programmes related to bullying prevention are suggested to avoid workplace bullying. The contents of the educational training programmes or workshops should incorporate the characteristics and consequences of the workplace bullying, and the strategies to deal with bullying. © 2016 John Wiley & Sons Ltd.

Perceived Transcultural Self-Efficacy of Nurses in General Hospitals in Guangzhou, China

PubMed Central

Li, Juan; He, Zhuang; Luo, Yong; Zhang, Rong

2016-01-01

Background Conflicts arising from cultural diversity among patients and hospital staff in China have become intense. Hospitals have an urgent need to improve transcultural self-efficacy of nurses for providing effective transcultural nursing. Objective The purpose of the research was to (a) evaluate the current status of perceived transcultural self-efficacy of nurses in general hospitals in Guangzhou, China; (b) explore associations between demographic characteristics of nurses and their perceived transcultural self-efficacy; and (c) assess the reliability and validity of scores on the Chinese version of the Transcultural Self-Efficacy Tool (TSET). Methods A cross-sectional survey of registered nurses from three general hospitals was conducted. Quota and convenience sampling were used. Participants provided demographic information and answered questions on the TSET. Results A total of 1,156 registered nurses took part. Most nurses had a moderate level of self-efficacy on the Cognitive (87.9%), Practical (87%), and Affective (89.2%) TSET subscales. Nurses who were older; who had more years of work experience, higher professional titles, higher incomes, and a minority background; and who were officially employed (not temporary positions) had higher perceived transcultural self-efficacy. Reliability estimated using Cronbach’s alpha was .99 for the total TSET score; reliability for the three subscales ranged from .97 to .98. Confirmatory factor analysis of TSET scores showed good fit with a three-factor model. Conclusion The results of this study can provide insights and guidelines for hospital nursing management to facilitate design of in-service education systems to improve transcultural self-efficacy of nurses. PMID:27454552

Changes in hospital nurse work environments and nurse job outcomes: an analysis of panel data.

PubMed

Kutney-Lee, Ann; Wu, Evan S; Sloane, Douglas M; Aiken, Linda H

2013-02-01

One strategy proposed to alleviate nursing shortages is the promotion of organizational efforts that will improve nurse recruitment and retention. Cross-sectional studies have shown that the quality of the nurse work environment is associated with nurse outcomes related to retention, but there have been very few longitudinal studies undertaken to examine this relationship. To demonstrate how rates of burnout, intention to leave, and job dissatisfaction changed in a panel of hospitals over time, and to explore whether these outcomes were associated with changes in nurse work environments. A retrospective, two-stage panel design was chosen for this study. Survey data collected from large random samples of registered nurses employed in Pennsylvania hospitals in 1999 and 2006 were used to derive hospital-level rates of burnout, intention to leave current position, and job dissatisfaction, and to classify the quality of nurses' work environments at both points in time. A two-period difference model was used to estimate the dependence of changes in rates of nurse burnout, intention to leave, and job dissatisfaction on changes in nurse work environments between 1999 and 2006 in 137 hospitals, accounting for concurrent changes in nurse staffing levels. In general, nurse outcomes improved between 1999 and 2006, with fewer nurses reporting burnout, intention to leave, and job dissatisfaction in 2006 as compared to 1999. Our difference models showed that improvements in work environment had a strong negative association with changes in rates of burnout (β=-6.42%, p<0.01) intention to leave (β=-4.10%, p<0.01), and job dissatisfaction (β=-8.00%, p<0.01). Improvements in nurse work environments over time are associated with lower rates of nurse burnout, intention to leave current position, and job dissatisfaction. Copyright © 2012 Elsevier Ltd. All rights reserved.

Knowledge gap regarding dementia care among nurses in Taiwanese acute care hospitals: A cross-sectional study.

PubMed

Lin, Pei-Chao; Hsieh, Mei-Hui; Chen, Meng-Chin; Yang, Yung-Mei; Lin, Li-Chan

2018-02-01

The quality of dementia care in hospitals is typically substandard. Staff members are underprepared for providing care to older people with dementia. The objective of the present study was to examine dementia care knowledge, attitude and behavior regarding self-education about dementia care among nurses working in different wards. This was a descriptive cross-sectional study. The present study was carried out from July 2013 to December 2013. In total, 387 nurses working in different wards were recruited from two hospitals in Taiwan by using convenience sampling. The nurses completed a self-report questionnaire on demographic data, experience and learning behavior, and attitude towards dementia care, and a 16-item questionnaire on dementia care knowledge. Descriptive and inferential statistics were used to analyze the status and differences in dementia care knowledge among nurse in different wards. The average dementia care knowledge score was 10.46 (SD 2.13), with a 66.5% mean accuracy among all nurses. Dementia care knowledge was significantly associated with age, nursing experience, possession of a registered nurse license, holding a bachelor's degree, work unit, training courses and learning behavior towards dementia care. The dementia care knowledge of the emergency room nurses was significantly lower than that of the psychiatric and neurology ward nurses. A significantly lower percentage of emergency room nurses underwent dementia care training and actively searched for information on dementia care, compared with the psychiatric and neurology ward nurses. Hospital nurses show a knowledge gap regarding dementia care, especially emergency room nurses. Providing dementia care training to hospital nurses, particularly emergency room nurses, is crucial for improving the quality of care for patients with dementia. Geriatr Gerontol Int 2018; 18: 276-285. © 2017 Japan Geriatrics Society.

Euthanasia and assisted suicide in Dutch hospitals: the role of nurses.

PubMed

van Bruchem-van de Scheur, G G; van der Arend, Arie J G; Huijer Abu-Saad, Huda; van Wijmen, Frans C B; Spreeuwenberg, Cor; Ter Meulen, Ruud H J

2008-06-01

To report a study on the role of nurses in euthanasia and physician-assisted suicide in hospitals, conducted as part of a wider study on the role of nurses in medical end-of-life decisions. Issues concerning legislation and regulation with respect to the role of nurses in euthanasia and physician-assisted suicide gave the Dutch Minister for Health reason to commission a study on the role of nurses in medical end-of-life decisions in hospitals, homecare and nursing homes. A questionnaire was sent in 2003 to 692 nurses employed in 73 hospital locations. The response suitable for analysis was from 532 (76.9%) nurses. Data were quantitatively analysed using spss version 11.5 for Windows. In almost half of the cases (45.1%), the nurse was the first with whom patients discussed their request for euthanasia or physician-assisted suicide. Consultations between physicians and nurses quite often took place (78.8%). In several cases (15.4%), nurses themselves administered the euthanatics with or without a physician. It is not self-evident that hospitals have guidelines concerning euthanasia/physician-assisted suicide. In the decision-making process, the consultation between the physician and the nurse needs improvement. In administering the euthanatics, physicians should take responsibility and should not leave these actions to nurses. Guidelines may play an important role to improve the collaboration between physicians and nurses and to prevent procedural, ethical and legal misunderstandings. Nurses in clinical practice are often closely involved in the last stage of a person's life. Consequently, they are often confronted with caring for patients requesting euthanasia or physician-assisted suicide. The results provide relevant information and may help nurses in defining their role in euthanasia and physician-assisted suicide, especially in case these practices should become legalised.

Musculoskeletal disorders among nursing staff: a comparison of five hospitals in Uganda

PubMed Central

Munabi, Ian Guyton; Buwembo, William; Kitara, David Lagoro; Ochieng, Joseph; Nabirye, Rose Chalo; Mwaka, Erisa Sabakaki

2014-01-01

Introduction Low and middle income countries have severe nursing staff shortages which is associated with risk of poor quality of patient care and increased patient exposure to adverse events. This is accompanied with increased risk of musculoskeletal disorders to the nursing staff. This paper sets out to identify and compare factors associated with musculoskeletal disorders among nursing staff in 5 different hospitals in Uganda. Methods This was a cross sectional study on nurses from 5 different hospitals in Uganda. The study used a 12 month recall of reported Musculoskeletal disorders (MSD) among nurses. Ethical approval was obtained. Logistic regression analysis and ANOVA were used. The level of significance was set at 0.05 for all statistical tests. Results There were 755 respondents of whom 433 (58.4%) were nurses. The prevalence of MSD at anybody site was 80.8%. There were significant differences in reported MSD among nursing staff across different hospital settings which were worse in the public hospitals as compared to the private and private not for profit hospitals (p <0.001). Age (adjusted OR 1.03, 95% CI 1.01-1.06), self reported poor general health status (adj OR 4.5, 95% CI 2.8-7.24) and stress as suggested by waking up tired in the morning (adj OR 3.4, 95% CI 2.17-5.32) were significant associated factors for MSD in this population. Conclusiom Reported MSD among nursing staff across 5 different hospitals is worse in public as compared to private hospitals. Age, self reported poor general health status and stress were important factors for MSD in this population. PMID:25018829

Willingness of nurses to report medication administration errors in southern Taiwan: a cross-sectional survey.

PubMed

Lin, Yu-Hua; Ma, Su-mei

2009-01-01

Underreporting of medication administering errors (MAEs) is a threat to the quality of nursing care. The reasons for MAEs are complex and vary by health professional and institution. The purpose of this study was to explore the prevalence of MAEs and the willingness of nurses to report them. A cross-sectional study was conducted involving a survey of 14 medical surgical hospitals in southern Taiwan. Nurses voluntarily participated in this study. A structured questionnaire was completed by 605 participants. Data were collected from February 1, 2005 to March 15, 2005 using the following instruments: MAEs Unwillingness to Report Scale, Medication Errors Etiology Questionnaire, and Personal Features Questionnaire. One additional question was used to identify the willingness of nurses to report medication errors: "When medication errors occur, should they be reported to the department?" This question helped to identify the willingness or lack thereof, to report incident errors. The results indicated that 66.9% of the nurses reported experiencing MAEs and 87.7% of the nurses had a willingness to report the MAEs if there were no consequences for reporting. The nurses' willingness to report MAEs differed by job position, nursing grade, type of hospital, and hospital funding. The final logistic regression model demonstrated hospital funding to be the only statistically significant factor. The odds of a willingness to report MAEs increased 2.66-fold in private hospitals (p = 0.032, CI = 1.09 to 6.49), and 3.28 in nonprofit hospitals (p = 0.00, CI = 1.73 to 6.21) when compared to public hospitals. This study demonstrates that reporting of MAEs should be anonymous and without negative consequences in order to monitor and guide improvements in hospital medication systems.

Space and place in the construction and performance of gendered nursing identities.

PubMed

Halford, Susan; Leonard, Pauline

2003-04-01

This paper draws on recent research conducted in two contrasting NHS hospitals: one a large District General, the other a small Community hospital; to look at hospitals as organizational spaces. This includes both the physical environment as well as how these spaces are inhabited and used. This paper aims to explore the ways in which hospital spaces impact on the working lives of nurses. The research employed two main methods. Two phases of round the clock non-participant observation were carried out within each hospital, one at the beginning of the research period and one at the end. This generated thick description of the diversity of spaces, as well as individuals' use of space. In addition, more than 50 in-depth unstructured interviews were conducted with both nurses and doctors. Three aspects of the relationship between nurse and hospital spaces are considered. First, the degree of access that nurses have to the different hospital spaces is limited, and many are confined to the wards in which they work. The high proportion of female nurses working on wards means that there are marked gender differences in access to hospital spaces. There are also marked professional differences when nurses are compared to doctors who have much greater freedom to roam and there are differences in the amount of private space allocated to nurses and doctors. Second, styles of bodily movement in space are also highly differentiated by profession and gender. Third, different spaces have very different meanings attached to them, and this has a strong impact on styles of performance and identity. Attention to space thus offers original insights to nurses working conditions as well as to inter-professional relations.

Job conditions, job satisfaction, somatic complaints and burnout among East African nurses.

PubMed

van der Doef, Margot; Mbazzi, Femke Bannink; Verhoeven, Chris

2012-06-01

To describe job conditions, job satisfaction, somatic complaints and burnout of female East African nurses working in public and private hospitals and to determine how these well-being outcomes are associated with job conditions. Insight into job conditions, health and well-being status and their interrelation is virtually lacking for East African nurses. Cross-sectional survey of 309 female nurses in private and public hospitals in Kenya, Tanzania and Uganda. Nurses completed a survey assessing job conditions and job satisfaction (the Leiden Quality of Work Life Questionnaire-nurses version), somatic complaints (subscale of the Symptom CheckList) and burnout (Maslach Burnout Inventory). The East African nurses show high levels of somatic complaints, and nearly one-third of the sample would be labelled as burned out. In comparison with a Western European nurses reference group, the nurses score unfavourably on job conditions that require financial investment (e.g. workload, staffing, equipment and materials). On aspects related to the social climate (e.g. decision latitude, cooperation), however, they score more favourably. In comparison with private hospital nurses, public hospital nurses score similarly on aspects related to the social climate, but worse on the other job conditions. Public hospital nurses have a lower job satisfaction than private hospital nurses, but show comparable levels of somatic complaints and burnout. Strongest correlates of low job satisfaction are low supervisor support and low financial reward. Burnout is mainly associated with high workload and inadequate information provision, whereas somatic complaints are associated with demanding physical working conditions. Improvement in job conditions may reduce the high levels of burnout and somatic complaints and enhance job satisfaction in East African nurses. Efforts and investments should be made to improve the job conditions in East African nurses as they are key persons in the delivery of health care. © 2012 Blackwell Publishing Ltd.

Care in Nursing Facilities after Palliative Consult.

PubMed

Carpenter, Joan G; Berry, Patricia H; Ersek, Mary

2018-04-01

Despite hospital palliative care consultations during which goals of care are discussed in the context of poor prognoses, older adults are admitted to nursing homes for post-acute care where the focus is on rehabilitation. The purpose of this qualitative descriptive study was to describe factors that influence discontinuity between a palliative care consult and nursing home care and explore the potential consequences of this discontinuity. Twelve adults (mean age of 80 years) were enrolled from one community hospital and nursing home in the mid-Atlantic United States. Semi-structured interviews and medical record reviews were used to elicit information about clinical course, care processes, and patient/family preferences at hospital discharge and up to four times after nursing home admission. Data were analyzed using inductive content analysis techniques. Analysis revealed two themes: Inadequate Communication characterized by the lack of information about the palliative care consult after hospital discharge and Prognosis Incongruence evidenced by data demonstrating a discrepancy between hospital prognosis and nursing home care. Ongoing communication between settings to re-address goals of care, prognosis, and symptoms-the central tenets of palliative care-is lacking. Efforts to improve access to comprehensive palliative care delivery after hospitalization and during nursing home transitions are greatly needed.

Nurses' work-related stress in China: a comparison between psychiatric and general hospitals.

PubMed

Qi, Yun-Ke; Xiang, Yu-Tao; An, Feng-Rong; Wang, Jing; Zeng, Jiao-Ying; Ungvari, Gabor S; Newhouse, Robin; Yu, Doris S F; Lai, Kelly Y C; Ding, Yan-Ming; Yu, Liuyang; Zhang, Xiang-Yang; Chiu, Helen F K

2014-01-01

Little is known about the level of work-related stress in nurses in China.This study compared the level of work-related stress between female nurses working in psychiatric and general hospitals in China. A descriptive comparative cross-sectional design was used.A consecutive sample of nurses from two psychiatric hospitals (N = 297) and a medical unit (N = 408) of a general hospital completed a written survey including socio-demographic data and a measure of work-related stress (Nurse Stress Inventory). Compared to the nurses working in the general hospital, those working in the psychiatric setting had a higher level of stress in the domains of working environment and resources (p < .001) and patient care (p < .001), but lower workload and time (p < .001).Multivariate analyses revealed that college or higher level of education(b = .1, p < .001), exposure to violence in the past 6 months (b = .2, p < .001),longer working experience, and working in psychiatric hospitals were associated with high work-related stress (b = .2, p < .001). Considering the harmful effects of work-related stress, specific stress management workshops and effective staff supportive initiatives for Chinese nurses are warranted.

An integrative review of communication between parents and nurses of hospitalized technology-dependent children.

PubMed

Giambra, Barbara K; Stiffler, Deborah; Broome, Marion E

2014-12-01

With advances in health care, the population of children who are technology-dependent is increasing and, therefore, the need for nurses to understand how best to engage in communication with the parents of these children is critical. Shared communication between the parents of hospitalized technology-dependent children and their nurses is essential to provide optimal care for the child. The components and behaviors of the parent-nurse communication process that improve mutual understanding of optimal care for the child had not previously been examined. Among parents of hospitalized technology-dependent children and their nurses, what communication behaviors, components, concepts, or processes improve mutual understanding of optimal care for the child? An integrative review of both qualitative and quantitative studies was conducted. Key words including communication, hospitalized, nurse, parent, pediatric, and technology-dependent were used to search databases such as Cumulative Index to Nursing and Allied Health and Medline for years 2000-2014. The data regarding the process of parent-nurse communication were extracted as they related to the mutual understanding of optimal care for the child. The data were grouped into themes and compared across studies, designs, populations, and settings. Six articles were identified that provided information regarding the processes of shared communication among the parents of hospitalized technology-dependent children and their nurses. Providing clear information, involving parents in care decisions, trust and respect for each other's expertise, caring attitudes, advocacy, and role negotiation were all found to be important factors in shared parent-nurse communication. The results of this integrative review inform our understanding of the parent-nurse communication process. The findings provide nurses with an understanding of strategies to better engage in respectful, engaging, and intentional communication with parents of hospitalized technology-dependent children and improve patient outcomes. © 2014 Sigma Theta Tau International.

Attractiveness of people-centred and integrated Dutch Home Care: A nationwide survey among nurses.

PubMed

Maurits, Erica E M; de Veer, Anke J E; Groenewegen, Peter P; Francke, Anneke L

2018-07-01

The World Health Organization is calling for a fundamental change in healthcare services delivery, towards people-centred and integrated health services. This includes providing integrated care around people's needs that is effectively co-ordinated across providers and co-produced by professionals, the patient, the family and the community. At the same time, healthcare policies aim to scale back hospital and residential care in favour of home care. This is one reason for the home-care nursing staff shortages in Europe. Therefore, this study aimed to examine whether people-centred, integrated home care appeals to nurses with different levels of education in home care and hospitals. A questionnaire survey was held among registered nurses in Dutch home-care organisations and hospitals in 2015. The questionnaire addressed the perceived attractiveness of different aspects of people-centred, integrated home care. In total 328 nurses filled in the questionnaire (54% response rate). The findings showed that most home-care nurses (70% to 97%) and 36% to 76% of the hospital nurses regard the different aspects of people-centred, integrated home care as attractive. Specific aspects that home-care nurses find attractive are promoting the patient's self-reliance and having a network in the community. Hospital nurses are mainly attracted to health-related prevention and taking control in complex situations. No clear differences between the educational levels were found. It is concluded that most home-care nurses and a minority of hospital nurses feel attracted to people-centred, integrated home care, irrespective of their educational level. The findings are relevant to policy makers and home-care organisations who aim to expand the home-care nursing workforce. © 2018 John Wiley & Sons Ltd.

Scheduling nursing personnel on a microcomputer.

PubMed

Liao, C J; Kao, C Y

1997-01-01

Suggests that with the shortage of nursing personnel, hospital administrators have to pay more attention to the needs of nurses to retain and recruit them. Also asserts that improving nurses' schedules is one of the most economic ways for the hospital administration to create a better working environment for nurses. Develops an algorithm for scheduling nursing personnel. Contrary to the current hospital approach, which schedules nurses on a person-by-person basis, the proposed algorithm constructs schedules on a day-by-day basis. The algorithm has inherent flexibility in handling a variety of possible constraints and goals, similar to other non-cyclical approaches. But, unlike most other non-cyclical approaches, it can also generate a quality schedule in a short time on a microcomputer. The algorithm was coded in C language and run on a microcomputer. The developed software is currently implemented at a leading hospital in Taiwan. The response to the initial implementation is quite promising.

[Introduction of the psychoprophylactic method and its influence on the prenatal care program for institutional parturition in Japan: the practice in the Central Hospital of Maternity of the Japanese Red Cross Society and Oomori Red Cross Hospital, 1953-1964].

PubMed

Fujihara, Satoko; Tsukisawa, Miyoko

2014-03-01

The psychoprophylactic method is one of the methods for providing 'painless childbirth without drugs' and was invented by applying I. Pavlov's theory of higher nervous activity. In 1951, it was adopted as a national policy in the Union of Soviet Socialist Republics. This method was then introduced in the People's Republic of China in 1952. In 1953, it was brought to Japan by Masatomo SUGAI, an obstetrician, and was introduced into the Central Hospital of Maternity of the Japanese Red Cross Society with the support of the director, Naotarou KUJI. The practice of this method by the research team, which consisted of the obstetricians and midwives of the Central Hospital of Maternity of the Japanese Red Cross Society and Oomori Red Cross Hospital, resulted in the initiation and characterization of the prenatal care program to encourage the autonomy of the pregnant women for normal parturition in the institutions of Japan.

Nurse managers' role in older nurses' intention to stay.

PubMed

Armstrong-Stassen, Marjorie; Freeman, Michelle; Cameron, Sheila; Rajacic, Dale

2015-01-01

The purpose of this paper is to propose and test a model of the underlying mechanisms linking perceived availability of human resource (HR) practices relevant to older nurses and older nurses' intentions to stay with their hospitals. Quantitative data were collected from randomly selected older registered nurses (N=660) engaged in direct patient care in hospitals in Canada. Structural equation modelling was used to test the hypothesized model. The relationship between perceptions of HR practices (performance evaluation, recognition/respect) and intentions to stay was mediated by the perceived fairness with which nurse managers managed these HR practices and nurse manager satisfaction. When nurse managers were perceived to administer the HR practices fairly (high perceived procedural justice), older nurses were more satisfied with their nurse manager and, in turn, more likely to intend to stay. The cross-sectional research design does not allow determination of causality. It is important that nurse managers receive training to increase their awareness of the needs of older nurses and that nurse managers be educated on how to manage HR practices relevant to older nurses in a fair manner. Equally important is that hospital administrators and HR managers recognize the importance of providing such HR practices and supporting nurse managers in managing these practices. The findings increase the understanding of how HR practices tailored to older nurses are related to the intentions of these nurses to remain with their hospital, and especially the crucial role that first-line nurse managers play in this process.

Developing a charging system for a nursing specialty: ET nursing.

PubMed

Lowery, G E; Gage, J; Lowenstein, A

1994-05-01

Because of limited resources and economic constraints, justifying the existence of ET nurses has become an economic challenge for hospitals and nurses. To justify the role of the ET nurse, a charging system for enterostomal therapy was developed at a corporate, for-profit hospital. Three months after implementation, an evaluation of the system demonstrated that revenue was generated in excess of the ET nurse's salary.

Effects of a high milk intake during the pre-weaning period on nutrient metabolism and growth rate in Japanese Black cattle.

PubMed

Matsubara, Atsuko; Takahashi, Hideyuki; Saito, Akira; Nomura, Aoi; Sithyphone, Khounsaknalath; Mcmahon, Christopher D; Fujino, Ryoichi; Shiotsuka, Yuji; Etoh, Tetsuji; Furuse, Mitsuhiro; Gotoh, Takafumi

2016-09-01

This study aimed to determine the effects of feeding an increased volume of high-fat milk during the early post-natal life on metabolite concentrations in the blood, the expression of key genes regulating intermediary metabolism in the skeletal muscles, and the rate of growth of Japanese Black cattle. All calves were fed a high-fat milk replacer (crude protein, 26%; crude fat, 25.5%; total dissolved nitrogen, 116%). Control calves (n = 4) were nursed with 500 g milk replacer until 3 months of age, whereas calves in the experimental group (n = 4) were nursed with 1800 g milk replacer until 3 months, and then the volume was gradually reduced until 5 months. Body weight was significantly higher in the experimental group than in the control group at 7 months. Plasma glucose concentrations were significantly lower in the experimental group. Expression of glucose-transporter-4 messenger RNA (mRNA) was lower, whereas that of glucose transporter 1, cluster of differentiation 36, and carnitine palmitoyltransferase-1b mRNA was significantly higher in the Longissimus thoracis of the experimental group. Nutritional status during early post-natal life appears to strongly influence the growth rate and glucose and lipid metabolism in Japanese Black cattle. © 2015 Japanese Society of Animal Science.

Nurse stress at two different organizational settings in Alexandria.

PubMed

Zaghloul, Ashraf Az; Abou El Enein, Nagwa Y

2009-04-15

The objective of the study was to explore the difference in stress levels among nurses working at two different health care organizations and the determinants of nurse stress within each organization. Job stress is defined as the harmful emotional and physical reactions resulting from the interactions between the worker and her/his work environment where the demands of the job exceed the worker's capabilities and resources. A convenient sample of nurses in two hospitals in Alexandria; Shark Al Madina (n = 120) and Karmouz (n = 170) hospitals. All nurses present at the time of the study were approached to be included in the study. The response rate for Shark Al Madina hospital was 94% and for Karmouz hospital, 71%. Data collection took place using a nurse stress questionnaire previously developed and tested for validity and reliability to measure stress in clinical nursing practice. The 5% level of significance was used throughout the statistical analysis for all relevant tests. The highest mean stress scores were the same for both hospitals. The dimension of coping with new situations was 2.7 ± 0.6 at Shark Al Madina hospital and was 2.5 ± 0.7 at Karmouz hospital while the dimension of job security was 2.7 ± 0.6 and 2.5 ± 0.7 at Shark Al Madina and Karmouz hospitals, respectively. Stepwise multiple regression for Shark Al Madina hospital model revealed workload (β = 1.38), security (β = 5.04), and shortage of support staff (β = 3.39). For the Karmouz hospital model, stepwise multiple regression revealed security (β = 4.78) and shortage of resources (β = 3.66). Stressors among nurses appear to be the same despite the differences in organizational or hierarchical structure where they work or the type of consumer they serve. It is important to reduce occupational stress in nurses and to strengthen their coping resources to prevent nurse burnout. This could be achieved with job redesign, modification of shift work systems, and by offering occupational health education as well as assurance regarding job security especially during the global financial crisis.

Nurse stress at two different organizational settings in Alexandria

PubMed Central

Zaghloul, Ashraf AZ; Abou El Enein, Nagwa Y

2009-01-01

Objective: The objective of the study was to explore the difference in stress levels among nurses working at two different health care organizations and the determinants of nurse stress within each organization. Job stress is defined as the harmful emotional and physical reactions resulting from the interactions between the worker and her/his work environment where the demands of the job exceed the worker’s capabilities and resources. Methodology: A convenient sample of nurses in two hospitals in Alexandria; Shark Al Madina (n = 120) and Karmouz (n = 170) hospitals. All nurses present at the time of the study were approached to be included in the study. The response rate for Shark Al Madina hospital was 94% and for Karmouz hospital, 71%. Data collection took place using a nurse stress questionnaire previously developed and tested for validity and reliability to measure stress in clinical nursing practice. The 5% level of significance was used throughout the statistical analysis for all relevant tests. Results: The highest mean stress scores were the same for both hospitals. The dimension of coping with new situations was 2.7 ± 0.6 at Shark Al Madina hospital and was 2.5 ± 0.7 at Karmouz hospital while the dimension of job security was 2.7 ± 0.6 and 2.5 ± 0.7 at Shark Al Madina and Karmouz hospitals, respectively. Stepwise multiple regression for Shark Al Madina hospital model revealed workload (β = 1.38), security (β = 5.04), and shortage of support staff (β = 3.39). For the Karmouz hospital model, stepwise multiple regression revealed security (β = 4.78) and shortage of resources (β = 3.66). Conclusion: Stressors among nurses appear to be the same despite the differences in organizational or hierarchical structure where they work or the type of consumer they serve. It is important to reduce occupational stress in nurses and to strengthen their coping resources to prevent nurse burnout. This could be achieved with job redesign, modification of shift work systems, and by offering occupational health education as well as assurance regarding job security especially during the global financial crisis. PMID:21197346

Participant action research with bedside nurses to identify NANDA-International, Nursing Interventions Classification, and Nursing Outcomes Classification categories for hospitalized persons with diabetes.

PubMed

Minthorn, Crista; Lunney, Margaret

2012-05-01

Experienced bedside nurses identified 14 nursing diagnoses, 78 interventions, and 76 health outcomes for hospitalized persons with diabetes. Using these terms, the nursing department revised the standards of care and the electronic health record. Nurses' engagement in generating knowledge translated to increased interest in research. This methodology is recommended for other agencies. Copyright © 2012 Elsevier Inc. All rights reserved.

Comparison of potentially preventable hospitalizations related to diabetes among Native Hawaiian, Chinese, Filipino, and Japanese elderly compared with whites, Hawai'i, December 2006-December 2010.

PubMed

Sentell, Tetine L; Ahn, Hyeong Jun; Juarez, Deborah T; Tseng, Chien-Wen; Chen, John J; Salvail, Florentina R; Miyamura, Jill; Mau, Marjorie L M

2013-07-25

Approximately 25% of individuals aged 65 years or older in the United States have diabetes mellitus. Diabetes rates in this age group are higher for Asian American and Pacific Islanders (AA/PI) than for whites. We examined racial/ethnic differences in diabetes-related potentially preventable hospitalizations (DRPH) among people aged 65 years or older for Japanese, Chinese, Filipinos, Native Hawaiians, and whites. Discharge data for hospitalizations in Hawai'i for people aged 65 years or older from December 2006 through December 2010 were compared. Annual rates of DRPH by patient were calculated for each racial/ethnic group by sex. Rate ratios (RRs) were calculated relative to whites. Multivariable models controlling for insurer, comorbidity, diabetes prevalence, age, and residence location provided final adjusted rates and RRs. A total of 1,815 DRPH were seen from 1,515 unique individuals. Unadjusted RRs for DRPH by patient were greater than 1 in all AA/PI study groups compared with whites, but were highest among Native Hawaiians and Filipinos [corrected]. In fully adjusted models accounting for higher diabetes prevalence in AA/PI groups, Native Hawaiian (adjusted rate ratio [aRR] = 1.59), Filipino (aRR = 2.26), and Japanese (aRR = 1.86) men retained significantly higher rates of diabetes-related potentially preventable hospitalizations than whites, as did Filipino women (aRR = 1.61). Native Hawaiian, Filipino, and Japanese men and Filipino women aged 65 years or older have a higher risk than whites for DRPH. Health care providers and public health programs for elderly patients should consider effective programs to reduce potentially preventable hospitalizations among Native Hawaiian, Filipino, and Japanese men and Filipino women aged 65 years or older.

Reducing nurses'. Workload using a computerized nursing support system linked to the hospital information system.

PubMed

Ito, C; Satoh, I; Michiya, H; Kitayama, Y; Miyazaki, K; Ota, S; Satoh, H; Sakurai, T; Shirato, H; Miyasaka, K

1997-01-01

A computerised nursing support system (CNSS) linked to the hospital information system (HIS) was developed and has been in use for one year, in order to reduce the workload of nurses. CNSS consists of (1) a hand held computer for each nurse (2) desk-top computers in the nurses' station and doctors' rooms (3) a data server (4) an interface with the main hospital information system. Nurses enter vital signs, food intake and other information about the patients into the hand held computer at the bed-side. The information is then sent automatically to the CNSS data server, which also receives patients' details (prescribed medicines etc.) from the HIS. Nurses and doctors can see all the information on the desk-top and hand held computers. This system was introduced in May 1995 into a university hospital ward with 40 beds. A questionnaire was completed by 23 nurses before and after the introduction of CNSS. The mean time required to post vital data was significantly reduced from 121 seconds to 54 seconds (p < 0.01). After three months 30% of nurses felt CNSS had reduced their workload, while 30% felt it had complicated their work; after five months 70% noted a reduction and 0% reported that CNSS had made their work more complex. The study therefore concludes that the interface between a computerised nursing support system and the hospital information system reduced the workload of nurses.

Organizational culture affecting quality of care: guideline adherence in perioperative antibiotic use.

PubMed

Ukawa, Naoto; Tanaka, Masayuki; Morishima, Toshitaka; Imanaka, Yuichi

2015-02-01

The objective of this work was to elucidate aspects of organizational culture associated with hospital performance in perioperative antibiotic prophylaxis using quantitative data in a multicenter and multidimensional study. Cross-sectional retrospective study using a survey data and administrative data. Eighty-three acute hospitals in Japan. A total of 4856 respondents in the organizational culture study, and 23 172 patients for the quality indicator analysis. Multilevel models of various cultural dimensions were used to analyze the association between hospital organizational culture and guideline adherence. The dependent variable was adherence or non-adherence to Japanese and CDC guidelines at the patient level and main independent variable was hospital groups categorized according to organizational culture score. Other control variables included hospital characteristics such as ownership, bed capacity, region and urbanization level of location. The multilevel analysis showed that hospitals with a high score in organizational culture were more likely to adhere to the Japanese and CDC guidelines when compared with lower scoring hospitals. In particular, the hospital group with high scores in the 'collaboration' and 'professional growth' dimensions had three times the odds for Japanese guideline adherence in comparison with low-scoring hospitals. Our study revealed that various aspects of organizational culture were associated with adherence to guidelines for perioperative antibiotic use. Hospital managers aiming to improve quality of care may benefit from improving hospital organizational culture. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Associations of Psychosocial Factors with Maternal Confidence among Japanese and Vietnamese Mothers

ERIC Educational Resources Information Center

Goto, Aya; Nguyen, Quang Vinh; Nguyen, Thi Tu Van; Pham, Nghiem Minh; Chung, Thi Mong Thuy; Trinh, Huu Phuc; Yabe, Junko; Sasaki, Hitomi; Yasumura, Seiji

2010-01-01

We conducted this cross-sectional study among 392 Japanese and 294 Vietnamese mothers who attended routine child health visits in a Japanese city and at a tertiary hospital in Vietnam, in order to investigate the prevalence and associated sociodemographic, parenting, and psychological characteristics of low maternal confidence in child rearing…

Hospitalization of nursing home residents: the effects of states' Medicaid payment and bed-hold policies.

PubMed

Intrator, Orna; Grabowski, David C; Zinn, Jacqueline; Schleinitz, Mark; Feng, Zhanlian; Miller, Susan; Mor, Vince

2007-08-01

Hospitalizations of nursing home residents are costly and expose residents to iatrogenic disease and social and psychological harm. Economic constraints imposed by payers of care, predominantly Medicaid policies, are hypothesized to impact hospitalizations. Federally mandated resident assessments were merged with Medicare claims and eligibility files to determine hospitalizations and death within 150 days of baseline assessment. Nursing home and market characteristics were obtained from the Online Survey Certification and Reporting, and the Area Resource File, respectively. States' average daily Medicaid nursing home payments and bed-hold policies were obtained independently. Prospective cohort study of 570,614 older (> or =65-year-old), non-MCO (Medicare Managed Care), long-stay (> or =90 days) residents in 8,997 urban, freestanding nursing homes assessed between April and June 2000, using multilevel models to test the impact of state policies on hospitalizations controlling for resident, nursing home, and market characteristics. Overall, 99,379 (17.4 percent) residents were hospitalized with rates varying from 8.4 percent in Utah to 24.9 percent in Louisiana. Higher Medicaid per diem was associated with lower odds of hospitalizations (5 percent lower for each $10 above average $103.5, confidence intervals [CI] 0.91-0.99). Hospitalization odds were higher by 36 percent in states with bed-hold policies (CI: 1.12-1.63). State Medicaid bed-hold policy and per-diem payment have important implications for nursing home hospitalizations, which are predominantly financed by Medicare. This study emphasizes the importance of properly aligning state Medicaid and federal Medicare policies in regards to the subsidy of acute, maintenance, and preventive care in the nursing home setting.

Hospitalization of Nursing Home Residents: The Effects of States' Medicaid Payment and Bed-Hold Policies

PubMed Central

Intrator, Orna; Grabowski, David C; Zinn, Jacqueline; Schleinitz, Mark; Feng, Zhanlian; Miller, Susan; Mor, Vince

2007-01-01

Objective Hospitalizations of nursing home residents are costly and expose residents to iatrogenic disease and social and psychological harm. Economic constraints imposed by payers of care, predominantly Medicaid policies, are hypothesized to impact hospitalizations. Data Sources/Study Setting Federally mandated resident assessments were merged with Medicare claims and eligibility files to determine hospitalizations and death within 150 days of baseline assessment. Nursing home and market characteristics were obtained from the Online Survey Certification and Reporting, and the Area Resource File, respectively. States' average daily Medicaid nursing home payments and bed-hold policies were obtained independently. Study Design Prospective cohort study of 570,614 older (≥65-year-old), non-MCO (Medicare Managed Care), long-stay (≥90 days) residents in 8,997 urban, freestanding nursing homes assessed between April and June 2000, using multilevel models to test the impact of state policies on hospitalizations controlling for resident, nursing home, and market characteristics. Principal Findings Overall, 99,379 (17.4 percent) residents were hospitalized with rates varying from 8.4 percent in Utah to 24.9 percent in Louisiana. Higher Medicaid per diem was associated with lower odds of hospitalizations (5 percent lower for each $10 above average $103.5, confidence intervals [CI] 0.91–0.99). Hospitalization odds were higher by 36 percent in states with bed-hold policies (CI: 1.12–1.63). Conclusions State Medicaid bed-hold policy and per-diem payment have important implications for nursing home hospitalizations, which are predominantly financed by Medicare. This study emphasizes the importance of properly aligning state Medicaid and federal Medicare policies in regards to the subsidy of acute, maintenance, and preventive care in the nursing home setting. PMID:17610442

The effectiveness of risk management program on pediatric nurses' medication error.

PubMed

Dehghan-Nayeri, Nahid; Bayat, Fariba; Salehi, Tahmineh; Faghihzadeh, Soghrat

2013-09-01

Medication therapy is one of the most complex and high-risk clinical processes that nurses deal with. Medication error is the most common type of error that brings about damage and death to patients, especially pediatric ones. However, these errors are preventable. Identifying and preventing undesirable events leading to medication errors are the main risk management activities. The aim of this study was to investigate the effectiveness of a risk management program on the pediatric nurses' medication error rate. This study is a quasi-experimental one with a comparison group. In this study, 200 nurses were recruited from two main pediatric hospitals in Tehran. In the experimental hospital, we applied the risk management program for a period of 6 months. Nurses of the control hospital did the hospital routine schedule. A pre- and post-test was performed to measure the frequency of the medication error events. SPSS software, t-test, and regression analysis were used for data analysis. After the intervention, the medication error rate of nurses at the experimental hospital was significantly lower (P < 0.001) and the error-reporting rate was higher (P < 0.007) compared to before the intervention and also in comparison to the nurses of the control hospital. Based on the results of this study and taking into account the high-risk nature of the medical environment, applying the quality-control programs such as risk management can effectively prevent the occurrence of the hospital undesirable events. Nursing mangers can reduce the medication error rate by applying risk management programs. However, this program cannot succeed without nurses' cooperation.

Leading Change: A Case Study of the First Independent Critical-Access Hospital to Achieve Magnet® Designation.

PubMed

Nelson-Brantley, Heather V; Ford, Debra J; Miller, Karen L; Stegenga, Kristin A; Lee, Robert H; Bott, Marjorie J

2018-03-01

The aim of this study was to understand how nurses in a 25-bed critical-access hospital (CAH) led change to become the 1st to achieve Magnet®. Approximately 21% of the US population lives in rural areas served by CAHs. Rural nurse executives are particularly challenged with limited resources. Staff nurses, nurse managers, interprofessional care providers, the chief nursing officer, and board of directors (n = 27) were interviewed. Observations of hospital units and administrative meetings were done, and hospital reports were analyzed. Nine themes emerged to support a conceptual model of leading change. The CAH spent 3 years of its 6-year journey establishing organizational readiness. Nurses overcame complex challenges by balancing operational support and fostering relationships. The Magnet journey led to significantly improved nurse and patient outcomes. A new organizational culture centered on shared governance, evidence-based practice, and higher education emerged. The journey to Magnet leads to improved nurse, patient, and organization outcomes.

The strategies of Japanese public health nurses in medication support for high-risk tuberculosis patients.

PubMed

Shimamura, Tamae; Taguchi, Atsuko; Kobayashi, Sayuri; Nagata, Satoko; Magilvy, Joan Kathy; Murashima, Sachiyo

2013-07-01

The purpose of this study was to describe the support provided by Japanese public health nurses (PHNs) to high-risk tuberculosis (TB) patients, focusing specifically on the support aimed at preventing interruptions in treatment. A qualitative descriptive approach was used with a convenience sample of 11 PHNs in Japan who cared for TB patients at highest risk for medication adherence problems. Semi-structured interviews were conducted to learn the scope and practice of PHNs with high-risk TB patients. Data were analyzed using a qualitative descriptive analysis process. One main theme was identified: "Supporting the patients in overcoming tuberculosis, regaining health, and living a healthier life." Three categories with five subcategories described the nurses' activities: (1) empathetic and reliable support, (2) motivational strategies for medication adherence, and (3) developing a foundation for healthier life. The nurses interviewed described creative and extraordinary strategies used to promote medication adherence and facilitate development of a healthy posttreatment lifestyle. Their approach was patient-centered and culturally congruent. Findings may be transferrable to PHN practice in other regions as care for this economically disadvantaged and marginalized population is a critical need. © 2012 Wiley Periodicals, Inc.

The Attitude Scale towards Distance Nursing Education (AstDNE)

ERIC Educational Resources Information Center

Boz Yuksekdag, Belgian; Unsal Barlas, Gul

2015-01-01

In this study, a measurement is seen as an instrument to measure the attitudes of the nurses towards the distance nursing education was developed. The study population consist of nurses who working in two hospitals of the ministry of health and two special hospitals in Istanbul. The sample of the study consisted of 194 nurses who agreed to…

[Development of a measurement of intellectual capital for hospital nursing organizations].

PubMed

Kim, Eun A; Jang, Keum Seong

2011-02-01

This study was done to develop an instrument for measuring intellectual capital and assess its validity and reliability in identifying the components, human capital, structure capital and customer capital of intellectual capital in hospital nursing organizations. The participants were 950 regular clinical nurses who had worked for over 13 months in 7 medical hospitals including 4 national university hospitals and 3 private university hospitals. The data were collected through a questionnaire survey done from July 2 to August 25, 2009. Data from 906 nurses were used for the final analysis. Data were analyzed using descriptive statistics, Cronbach's alpha coefficients, item analysis, factor analysis (principal component analysis, Varimax rotation) with the SPSS PC+ 17.0 for Windows program. Developing the instrument for measuring intellectual capital in hospital nursing organizations involved a literature review, development of preliminary items, and verification of validity and reliability. The final instrument was in a self-report form on a 5-point Likert scale. There were 29 items on human capital (5 domains), 21 items on customer capital (4 domains), 26 items on structure capital (4 domains). The results of this study may be useful to assess the levels of intellectual capital of hospital nursing organizations.

What Is an Ophthalmologist?

MedlinePlus

... medical tests and minor office surgery. Ophthalmic Registered Nurse These clinicians have undergone special nursing training and ... with hospital or office surgery. Some ophthalmic registered nurses also serve as clinic or hospital administrators. Ophthalmic ...

Changes in Hospital Nurse Work Environments and Nurse Job Outcomes: An Analysis of Panel Data

PubMed Central

Wu, Evan S.; Sloane, Douglas M.; Aiken, Linda H.; Fagin, Claire M.

2013-01-01

Background One strategy proposed to alleviate nursing shortages is the promotion of organizational efforts that will improve nurse recruitment and retention. Cross-sectional studies have shown that the quality of the nurse work environment is associated with nurse outcomes related to retention, but there have been very few longitudinal studies undertaken to examine this relationship. Objectives To demonstrate how rates of burnout, intention to leave, and job dissatisfaction changed in a panel of hospitals over time, and to explore whether these outcomes were associated with changes in nurse work environments. Methods A retrospective, two-stage panel design was chosen for this study. Survey data collected from large random samples of registered nurses employed in Pennsylvania hospitals in 1999 and 2006 were used to derive hospital-level rates of burnout, intentions to leave current positions, and job dissatisfaction, and to classify the quality of nurses’ work environments at both points in time. A two-period difference model was used to estimate the dependence of changes in rates of nurse burnout, intentions to leave, and job dissatisfaction on changes in nurse work environments between 1999 and 2006 in 137 hospitals, accounting for concurrent changes in nurse staffing levels. Results In general, nurse outcomes improved between 1999 and 2006, with fewer nurses reporting burnout, intentions to leave, and job dissatisfaction in 2006 as compared to 1999. Our difference models showed that improvements in work environment had a strong negative association with changes in rates of burnout (β =−6.42%, p<0.01) intentions to leave (β =−4.10%, p<0.01), and job dissatisfaction (β =−8.00%, p<0.01). Conclusions Improvements in nurse work environments over time are associated with lower rates of nurse burnout, intentions to leave current positions, and job dissatisfaction. PMID:22902135

‘Care left undone’ during nursing shifts: associations with workload and perceived quality of care

PubMed Central

Ball, Jane E; Murrells, Trevor; Rafferty, Anne Marie; Morrow, Elizabeth; Griffiths, Peter

2014-01-01

Background There is strong evidence to show that lower nurse staffing levels in hospitals are associated with worse patient outcomes. One hypothesised mechanism is the omission of necessary nursing care caused by time pressure—‘missed care’. Aim To examine the nature and prevalence of care left undone by nurses in English National Health Service hospitals and to assess whether the number of missed care episodes is associated with nurse staffing levels and nurse ratings of the quality of nursing care and patient safety environment. Methods Cross-sectional survey of 2917 registered nurses working in 401 general medical/surgical wards in 46 general acute National Health Service hospitals in England. Results Most nurses (86%) reported that one or more care activity had been left undone due to lack of time on their last shift. Most frequently left undone were: comforting or talking with patients (66%), educating patients (52%) and developing/updating nursing care plans (47%). The number of patients per registered nurse was significantly associated with the incidence of ‘missed care’ (p<0.001). A mean of 7.8 activities per shift were left undone on wards that are rated as ‘failing’ on patient safety, compared with 2.4 where patient safety was rated as ‘excellent’ (p <0. 001). Conclusions Nurses working in English hospitals report that care is frequently left undone. Care not being delivered may be the reason low nurse staffing levels adversely affects quality and safety. Hospitals could use a nurse-rated assessment of ‘missed care’ as an early warning measure to identify wards with inadequate nurse staffing. PMID:23898215

Technology-mediated awareness: facilitating the handling of (un)wanted interruptions in a hospital setting.

PubMed

Klemets, Joakim; Evjemo, Tor Erik

2014-09-01

Nurses' work in hospital departments is highly collaborative and includes communication with a variety of actors. To further support nurses' communications, wireless phones, on which nurses receive both nurse calls and ordinary phone calls, have been introduced. However, while they ensure high availability among the mobile nurses, these phones also contribute to an increased number of interruptions. This paper aims to discover whether all interruptions caused by the wireless phones are unwanted. Further, it investigates how nurses handle these interruptions in a hospital setting in order to construct a foundation for guidelines to use in designing these types of systems. Qualitative and ethnographically inspired fieldwork, including workshops with both ordinary and student nurses from a Norwegian hospital, was undertaken. Patients from two hospital departments were interviewed. Nurses struggle to handle interruptions caused by the wireless nurse call system. Deciding whether to abort an activity or not to respond to an interruption is regarded as stressful. The decision is further complicated by the complex nature of the interruptions. At the same time, patients anticipate that nurses are able to make these judgements with limited information. Nurses' work is highly collaborative, and nurses depend on one another to carry out their work and manage interruptions. The dual nature of the interruptions is complex, and whether an interruption is wanted or unwanted depends on many factors. Nurses manage interruptions mainly by making their own activities visible and monitoring colleagues' work. Therefore, nurses' awareness of colleagues' activities is a key factor in how they handle interruptions in the form of nurse calls. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Hospital nurses' individual priorities, internal psychological states and work motivation.

PubMed

Toode, K; Routasalo, P; Helminen, M; Suominen, T

2014-09-01

This study looks to describe the relationships between hospital nurses' individual priorities, internal psychological states and their work motivation. Connections between hospital nurses' work-related needs, values and work motivation are essential for providing safe and high quality health care. However, there is insufficient empirical knowledge concerning these connections for the practice development. A cross-sectional empirical research study was undertaken. A total of 201 registered nurses from all types of Estonian hospitals filled out an electronic self-reported questionnaire. Descriptive statistics, Mann-Whitney, Kruskal-Wallis and Spearman's correlation were used for data analysis. In individual priorities, higher order needs strength were negatively correlated with age and duration of service. Regarding nurses' internal psychological states, central hospital nurses had less sense of meaningfulness of work. Nurses' individual priorities (i.e. their higher order needs strength and shared values with the organization) correlated with their work motivation. Their internal psychological states (i.e. their experienced meaningfulness of work, experienced responsibility for work outcomes and their knowledge of results) correlated with intrinsic work motivation. Nurses who prioritize their higher order needs are more motivated to work. The more their own values are compatible with those of the organization, the more intrinsically motivated they are likely to be. Nurses' individual achievements, autonomy and training are key factors which influence their motivation to work. The small sample size and low response rate of the study limit the direct transferability of the findings to the wider nurse population, so further research is needed. This study highlights the need and importance to support nurses' professional development and self-determination, in order to develop and retain motivated nurses. It also indicates a need to value both nurses and nursing in healthcare policy and management. © 2014 International Council of Nurses.

The Evaluation of the Health Information Exchange with the Number of Usage and the Introduction of Outpatient to the Hospitals at Nagasaki Japan.

PubMed

Matsumoto, Takehiro; Honda, Masayuki

2017-01-01

Health Information Exchange (HIE) has been gradually spreading in Japan. But the effect and evaluation of these systems have not been proven. The aim of this study is to examine the effect of the Japanese HIE through the evaluation of the clinical activities in Nagasaki University Hospital. The electric medical records of 5335 patients were shared in the Ajisai-net, which was Japanese HIE in Nagasaki, from 2009 to 2015. And the number of shared patients increased every year, and the annual average number was 762.1. On the other hand, the number of the patients who was introduced from clinics to our hospital and whose medical records were shared in the Ajisai-net increased every year. In conclusion, the usage of Japanese HIE is useful for the clinical consultation and medical care, and these systems have the good effect on the hospital management in Japan.

Nursing practice in a post-Soviet country from the perspectives of Armenian nurses: a qualitative exploratory study.

PubMed

Poghosyan, Lusine; Poghosyan, Hermine; Berlin, Kristen; Truzyan, Nune; Danielyan, Lusine; Khourshudyan, Kristine

2012-09-01

The purpose of this qualitative descriptive study was to explore the views of head and staff nurses about nursing practice in the hospitals of Armenia. Armenia inherited its nursing frameworks from the Soviet Union. After the Soviet collapse, many changes took place to reform nursing. However, to date little has been systematically documented about nursing practice in Armenia. Qualitative descriptive design was implemented. Three major hospitals in Yerevan, the capital city of Armenia, participated in the study. Purposeful sampling was used. Forty-three nurses participated, 29 staff and fourteen head nurses. Data were collected through five focus groups comprised of seven to ten participants. A focus group guide was developed. The researcher facilitated the discussions in Armenian, which were audio taped. The research assistant took notes. Data were transcribed and translated into English, imported into atlas.ti 6.1 qualitative software, and analysed by three authors. Five themes were extracted. Lack of role clarity theme was identified from the head nurse data. The practice environment theme was identified from the staff nurse data. Nursing education, value, respect and appreciation of nursing, and becoming a nurse were common themes identified from both head and staff nurse data. Head nurses lack autonomy, do not have clear roles and are burdened with documentation. Staff nurses practice in challenging work environments with inadequate staffing and demanding workloads. All nurses reported the need to improve nursing education. This is the first study conducted in Armenia exploring nursing practice in the hospitals from the nurses' perspectives. Nurses face challenges that may impact their wellbeing and patient care. Understanding challenges nursing practice faces in the hospitals in Armenia will help administrators and care providers to take actions to improve nursing practice and subsequently patient care. © 2012 Blackwell Publishing Ltd.

OCCUPATIONAL TRENDS IN IDAHO HOSPITALS AND LICENSED NURSING HOMES.

ERIC Educational Resources Information Center

BEEMAN, ADDISON C.

THE PURPOSE OF THIS STUDY WAS TO OBTAIN INFORMATION ON THE CURRENT LABOR FORCE IN HOSPITALS AND NURSING HOMES AND FUTURE MANPOWER NEEDS WHICH WOULD BE HELPFUL TO PLANNERS OF VOCATIONAL EDUCATIONAL PROGRAMS, EMPLOYERS, WORKERS, AND YOUTH ENTERING THE LABOR MARKET. ADMINISTRATORS OR PERSONNEL OFFICERS OF 14 HOSPITALS AND 13 NURSING HOMES,…

Older nurses' experiences of providing direct care in hospital nursing units: a qualitative systematic review.

PubMed

Parsons, Karen; Gaudine, Alice; Swab, Michelle

2018-03-01

Most developed countries throughout the world are experiencing an aging nursing workforce as their population ages. Older nurses often experience different challenges then their younger nurse counterparts. With the increase in older nurses relative to younger nurses potentially available to work in hospitals, it is important to understand the experience of older nurses on high paced hospital nursing units. This understanding will lend knowledge to ways of lessening the loss of these highly skilled experienced workers and improve patient outcomes. To identify, evaluate and synthesize the existing qualitative evidence on older nurses' experiences of providing direct care to patients in hospital nursing units. The review considered studies which included registered nurses 45 years and over who work as direct caregivers in any type of in-patient hospital nursing unit. The phenomenon of interest was the experience of older nurses in providing direct nursing care in any type of in-patient hospital nursing unit (i.e. including but not limited to medical/surgical units, intensive care units, critical care units, perioperative units, palliative care units, obstetrical units, emergency departments and rehabilitative care units). The review excluded studies focussing entirely on enrolled nurses, licensed practical nurses and licensed vocational nurses. Qualitative data including, but not limited to the following methodologies: phenomenology, grounded theory, ethnography, action research and feminist research. The databases CINAHL, PubMed, PsycINFO, Embase, AgeLine, Sociological Abstracts and SocINDEX were searched from inception; the search was conducted on October 13, 2017; no date limiters or language limiters were applied. Each paper was assessed by two independent reviewers for methodological quality using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Any disagreements that arose between the reviewers were resolved through discussion. Data extraction was conducted by two independent reviewers using the standardized qualitative data extraction tool from JBI. The qualitative research findings were pooled using JBI methodology. The JBI process of meta-aggregation was used to identify categories and synthesized findings. Twelve papers were included in the review. Three synthesized findings were extracted from 12 categories and 75 findings. The three synthesized findings extracted from the papers were: (1) Love of nursing: It's who I am and I love it; (2) It's a rewarding but challenging and changing job; it's a different job and it can be challenging; (3) It's a challenging job; can I keep up? Older nurses love nursing and have created an identity around their profession. They view their profession positively and believe their job to be unlike any other, yet they identify many ongoing challenges and changes. Despite their desire to continue in their role they are often faced with hardships that threaten their ability to stay at the bedside. A key role of hospital administrators to keep older nurses in the workplace is to develop programs to prevent work related illness and to promote health. Given the low ConQual scores in the current systematic review, additional research is recommended to understand the older nurses' experience in providing direct care in hospital nursing units as well as predicting health age of retirement and length of bedside nursing.

Patient turnover and nursing employment in Massachusetts hospitals before and after health insurance reform: implications for the Patient Protection and Affordable Care Act.

PubMed

Shindul-Rothschild, Judith; Gregas, Matt

2013-01-01

The Affordable Care Act is modeled after Massachusetts insurance reforms enacted in 2006. A linear mixed effect model examined trends in patient turnover and nurse employment in Massachusetts, New York, and California nonfederal hospitals from 2000 to 2011. The linear mixed effect analysis found that the rate of increase in hospital admissions was significantly higher in Massachusetts hospitals (p<.001) than that in California and New York (p=.007). The rate of change in registered nurses full-time equivalent hours per patient day was significantly less (p=.02) in Massachusetts than that in California and was not different from zero. The rate of change in admissions to registered nurses full-time equivalent hours per patient day was significantly greater in Massachusetts than California (p=.001) and New York (p<.01). Nurse staffing remained flat in Massachusetts, despite a significant increase in hospital admissions. The implications of the findings for nurse employment and hospital utilization following the implementation of national health insurance reform are discussed.

Scheduling nurses’ shifts at PGI Cikini Hospital

NASA Astrophysics Data System (ADS)

Nainggolan, J. C. T.; Kusumastuti, R. D.

2018-03-01

Hospitals play an essential role in the community by providing medical services to the public. In order to provide high quality medical services, hospitals must manage their resources (including nurses) effectively and efficiently. Scheduling of nurses’ work shifts, in particular, is crucial, and must be conducted carefully to ensure availability and fairness. This research discusses the job scheduling system for nurses in PGI Cikini Hospital, Jakarta with Goal Programming approach. The research objectives are to identify nurse scheduling criteria and find the best schedule that can meet the criteria. The model has hospital regulations (including government regulations) as hard constraints, and nurses’ preferences as soft constraints. We gather primary data (hospital regulations and nurses’ preferences) through interviews with three Head Nurses and distributing questionnaires to fifty nurses. The results show that on the best schedule, all hard constraints can be satisfied. However, only two out of four soft constraints are satisfied. Compared to current scheduling practice, the resulting schedule ensures the availability of nurses as it satisfies all hospital’s regulations and it has a higher level of fairness as it can accommodate some of the nurses’ preferences.

Factors influencing nurses' job satisfaction in selected private hospitals in England.

PubMed

Lephalala, R P; Ehlers, V J; Oosthuizen, M J

2008-09-01

The quantitative descriptive survey used self-completion questionnaires to study factors influencing nurses' job satisfaction in selected private hospitals in England. Herzberg's Theory of Motivation was used to contextualise the results obtained from 85 completed questionnaires. In terms of Herzberg's Theory of Motivation, the most important extrinsic (hygiene) factor was no satisfaction with their salaries compared to nurses' salaries in other private hospitals in England, in the NHS and even at their own hospitals. However, most nurses were satisfied with the other extrinsic factors (organisation and administration policies, supervision and interpersonal relations). The most important intrinsic factors (motivators), influencing nurses' job satisfaction was their lack of satisfaction with promotions (including the fact that their qualifications were reportedly not considered for promotions), lack of advancement opportunities and being in dead-end jobs, and lack of involvement in decision- and policy-making activities. Nurses' levels of job satisfaction might be enhanced if promotion policies could be consistent, advancement opportunities implemented, qualifications considered for promotions, salary issues clarified, and if nurses could be involved in decision- and policy-making. Enhanced levels of job satisfaction could help to reduce turnover rates among registered nurses at the private hospitals in England that participated in this study.

Factors influencing nurse-assessed quality nursing care: A cross-sectional study in hospitals.

PubMed

Liu, Ying; Aungsuroch, Yupin

2018-04-01

To propose a hypothesized theoretical model and apply it to examine the structural relationships among work environment, patient-to-nurse ratio, job satisfaction, burnout, intention to leave and quality nursing care. Improving quality nursing care is a first consideration in nursing management globally. A better understanding of factors influencing quality nursing care can help hospital administrators implement effective programmes to improve quality of services. Although certain bivariate correlations have been found between selected factors and quality nursing care in different study models, no studies have examined the relationships among work environment, patient-to-nurse ratio, job satisfaction, burnout, intention to leave and quality nursing care in a more comprehensive theoretical model. A cross-sectional survey. The questionnaires were collected from 510 Chinese nurses in four Chinese tertiary hospitals in January 2015. The validity and internal consistency reliability of research instruments were evaluated. Structural equation modelling was used to test a theoretical model. The findings revealed that the data supported the theoretical model. Work environment had a large total effect size on quality nursing care. Burnout largely and directly influenced quality nursing care, which was followed by work environment and patient-to-nurse ratio. Job satisfaction indirectly affected quality nursing care through burnout. This study shows how work environment past burnout and job satisfaction influences quality nursing care. Apart from nurses' work conditions of work environment and patient-to-nurse ratio, hospital administrators should pay more attention to nurse outcomes of job satisfaction and burnout when designing intervention programmes to improve quality nursing care. © 2017 John Wiley & Sons Ltd.

[Mental health in the hospital. Analysis of conditions of risk by department, age and gender, for the creation of best practices for the health of nurses].

PubMed

Salerno, Silvana; Dimitri, Laura; Livigni, Lucilla; Magrini, Andrea; Talamanca, Irene Figà

2015-01-01

Nurses mental health is still a major and unachieved goal in many public hospital settings. Hospital work organization analysis shows differences in health professions, hospital units, age and gender. To analyse work organisation and its effects on nurses mental health in three high risks hospital units (Oncoematology, First Aid, General Medicine) in order to improve good practices for nurses health. The Method of Organizational Congruences (72 hours of observation) has been used to detect organizational constraints and their possible effects on nurses' mental health. General Health Questionnaire (Goldberg D., 12 items) and the Check up Surveys for burnout (Leiter MP and Maslach C.) have been used to evaluate the mental health status of the 80 nurses employed (78% women). High emotional work load in oncoematology Unit, high monotony and repetitiveness with lower emotional load in first Aid Unit, High mental and physical workload in General Medicine Unit. Burnout was significantly higher in General Medicine Unit, followed by First Aid Unit and oncoematology Unit. Female nurses reported more chronic diseases than males. The GHQ showed high frequency of minor psychiatric disorders (58%) in all units, higher in General Medicine Unit (78%). The overall results show how organizational constraints and mental health conditions differ per hospital units, age groups and gender. Good nursing practices, to prevent mental health problems, should therefore be developed specifically in each hospital unit according to these results.

Analyzing the nursing organizational structure and process from a scheduling perspective.

PubMed

Maenhout, Broos; Vanhoucke, Mario

2013-09-01

The efficient and effective management of nursing personnel is of critical importance in a hospital's environment comprising approximately 25 % of the hospital's operational costs. The nurse organizational structure and the organizational processes highly affect the nurses' working conditions and the provided quality of care. In this paper, we investigate the impact of different nurse organization structures and different organizational processes for a real-life situation in a Belgian university hospital. In order to make accurate nurse staffing decisions, the employed solution methodology incorporates shift scheduling characteristics in order to overcome the deficiencies of the many phase-specific methodologies that are proposed in the academic literature.

Components of nurse innovation: a model from acute care hospitals.

PubMed

Neidlinger, S H; Drews, N; Hukari, D; Bartleson, B J; Abbott, F K; Harper, R; Lyon, J

1992-12-01

Components that promote nurse innovation in acute care hospitals are explicated in the Acute Care Nursing Innovation Model. Grounded in nursing care delivery systems and excellent management-organizations perspectives, nurse executives and 30 nurse "intrapreneurs" from 10 innovative hospitals spanning the United States shared their experiences and insights through semistructured, tape-recorded telephone interviews. Guided by interpretive interactionist strategies, the essential components, characteristics, and interrelationships are conceptualized and described so that others may be successful in their innovative endeavors. Successful innovation is dependent on the fit between and among the components; the better the fit, the more likely the innovation will succeed.

Ethical dilemmas among nurses as they transition to hospital case management: implications for organizational ethics, part I.

PubMed

O'Donnell, Lolita T

2007-01-01

To describe the experiences of ethical concerns by clinical nurses as they transitioned into their new role in hospital case management. Through this study, an attempt was made to explore experiences of ethical concerns and identify the implications for organizational ethics. In this study, nurse case managers practicing in the acute hospital setting, military, not-for-profit community, and teaching hospitals were interviewed. The majority of the nurse case manager participants were engaged in hospital discharge planning and utilization review activities. An interpretive phenomenological approach was used to identify the themes inherent in ethical concerns and articulate them within the context of hospital nurse case management. Fifteen participants were interviewed to obtain a qualitative description of the nurse case managers' lived experiences of ethical dilemmas and how they were resolved. Nurse case managers' perceptions of solutions/options to resolve such ethical dilemmas were explored. As nurses transition into the expanded role of case management in the present healthcare delivery system, they frequently face situations demanding ethical choices and judgments to accommodate diverse patient interests and needs. These ethical decisions required in daily practice in case management represent ethical dilemmas to nurses. The insights derived from the analysis of the interviews have implications for nursing practice, education, policy, ethics, and research; recommendations for organizations employing nurse case managers in terms of recruitment, orientation, training, and continued need for educational support are identified. 1. The clinical decisions required in daily practice of case management represented challenges to the nurses. This highlights the critical role of adequate educational orientation to case management for beginning case managers. 2. Nurse case managers should be cognizant of the "disconnect" that could occur between their obligations to the organizations that employ them and the healthcare needs of the patients that they advocate for. 3. Aside from the importance of linking patient care outcomes with accountability, nurse case managers may need to advocate for policy change and system reform.

Gender, politics, and regionalism: factors in the evolution of registered psychiatric nursing in Manitoba, 1920-1960.

PubMed

Hicks, Beverly

2011-01-01

In Canada, psychiatric nursing care is provided by two kinds of nurses. East of Manitoba, it is provided by registered nurses who may or may not have specialized psychiatric nursing education. In the four western provinces, a distinct professional group, registered psychiatric nurses, also provide care. Saskatchewan was the first province to achieve distinct legislation, in 1948, followed by British Columbia in 1951, Alberta in 1955, and Manitoba in 1960. Several factors coalesced to sway Manitoba to adopt the distinct profession model. First, there was little interest by the general nursing body in mental hospital nursing. Second, the other three western provinces had formed a Canadian Council of Psychiatric Nursing that encouraged mental hospital attendants and nurses in Manitoba. Third, a group of male attendants took on leadership roles supported by the mental hospital superintendents. Finally, Manitoba was culturally and geographically more aligned with western than eastern Canada.

Workplace practices for retaining older hospital nurses: implications from a study of nurses with eldercare responsibilities.

PubMed

Rosenfeld, Peri

2007-05-01

Attempts to address the nursing shortage must consider the aging nursing supply and the decreased labor participation among nurses at age 55 and older. Efforts to retain older, experienced nurses have been meager, and little attention is paid to the role of eldercare in decisions to leave the profession. This pilot study examines current workplace practices that may contribute to early withdrawal of older nurses from the hospital workforce. Interviews with 28 elder caregiving registered nurses and assistive nursing personnel at a New York hospital were conducted. Respondents reported that successful management of their dual roles rests on identifying units and shifts that suit their needs, erecting clear boundaries between home and work, and their love of nursing. "Caregiver-friendly" practices such as creative, flexible scheduling; access to social workers; financial and legal services; and increased awareness among managers about caregiver strains were recommended.