ICU nurses’ perceptions of responsibilities and organisation in relation to organ donation—A phenomenographic study

Objectives

According to the Istanbul declaration, health services should create better routines for identifying potential donors. A previous study involving 702 intensive and critical care (ICU) nurses revealed that only 48% trusted clinical diagnosis of brain death without a confirmatory cerebral angiography. The aim was to study ICU nurses’ perceptions of their experiences of professional responsibilities and organisational aspects in relation to organ donation and how they understand and perceive brain death.

Methods

A phenomenographic method was chosen. Data collection (interviews) took place in Sweden and included fifteen nurses; one man and fourteen women, from six hospitals serving different geographic areas.

Results

The findings pertain to three domains: ICU nurses’ perceptions of (1) their professional responsibility, (2) the role of the organisation regarding organ donation and (3) death and the diagnosis of brain death.

Conclusion

The ambiguity and various perceptions of brain death diagnosis seem to be a crucial aspect when caring for a brain dead patient. The lack of structured and sufficient organisation also appears to be a limiting factor. Both these aspects are essential for the ICU nurses’ opportunities to fulfil their professional responsibility during the organ donation process.     

The mediating role of organizational justice in the relationship between transformational leadership and nurses’ quality of work life: A cross-sectional questionnaire survey

Background

The importance of transformational leadership for nurses’ well-being is increasingly acknowledged. However, there is a paucity of research examining the mechanisms that may explain the relationships between transformational leadership and nurses’ quality of work life.

Objectives

First, to examine two possible psychological mechanisms that link transformational leadership behaviors to nurses’ quality of work life. Second, to study the relationship between nurses’ quality of work life and their work engagement.

Design

Cross-sectional study design.

Settings

The study took place in 47 different hematology, oncology, and hematology/oncology units in France. Participants were nurses and auxiliary nurses.

Participants

343 nurses completed the questionnaire. Surveys were sent to all nurses working in the units. 95% were female, the average age was 36.30 years.

Methods

Nurses were asked to rate their supervisor's transformational leadership style and their perceptions of distributive and interactional justice in the unit. They were also asked to evaluate their own level of quality of work life and their work engagement.

Results

Distributive justice and interactional justice were found to fully mediate the relationship between transformational leadership and nurses’ quality of work life. In addition, nurses’ quality of work life positively related to their work engagement.

Conclusions

Transformational leaders may help ensure nurses’ quality of work life which in turn increases their work engagement. These leadership practices are thus beneficial for both employees and organization.     

Job satisfaction and job values among beginning nurses: a questionnaire survey

Background

Concepts such as the theory–practice gap and reality shock call attention to the challenges nurses experience in their professional lives. These challenges seem to be particularly acute in the transition from nursing school to work. Based on an assumption that the theories and skills taught in school are not directly applicable to nursing practice, beginning nurses may find that they are not prepared to do the work for which they have trained. Consequently, nurses may experience challenges to their work ideals, and their level of job satisfaction may decline. In addition, major life changes, such as buying a house/apartment, becoming a parent or getting married are likely to occur in the first year after graduation. Consequently, the emphasis on economic rewards may increase in the transition from school to work.

Objectives

To examine the relationship between work ideals, experiences of work and job satisfaction through a vital period in nurses’ careers. To compare beginning nurses’ job satisfaction, perceived job rewards and values with those of beginning doctors and teachers.

Participants

Survey data were collected from two cohorts of students in several educational programs in Norway. The survey was repeated among the same respondents, as workers, 3 years after graduation. Almost 3000 students were originally invited to participate. The response rate in the surveys varied from 59% to 80%.

Methods

Tabular analyses and linear regression models.

Results

The results indicate similarities in nurses’, doctors’ and teachers’ preferences for work, but differences in what they obtain. In the transition from school to work, nurses increase their emphasis on high income and job security, and 3 years after graduating, nurses’ emphasis on these two job values is higher than that of doctors and teachers. Nurses were fairly satisfied with their present job.

Conclusion

In terms of level of job satisfaction and their preferences for work, the transition from school to work for nurses seems less dramatic than initially assumed.     

Nurses' knowledge and risk perception towards seasonal influenza and vaccination and their vaccination behaviours: a cross-sectional survey

Background

Seasonal influenza has become a serious public health problem worldwide and vaccination is recognized as the most effective preventative measure. Healthcare workers can be the vectors of influenza outbreaks. Data suggest that nurses’ vaccination remains suboptimal worldwide.

Objectives

To explore the relationship among nurses’ knowledge, risk perception and their vaccination behaviours and the reasons for vaccination uptake.

Design

A cross-sectional survey.

Setting

Participants were recruited from the nurses enrolled on continuing professional education courses at a large university in London.

Participants

A sample of 522 nurses returned completed questionnaires (response rate 77.7%). Most of the respondents were women, worked in hospitals and had direct patient contact. The mean years qualified as a nurse were 11.9 ± 8.75 years.

Methods

The survey instrument examined nurses’ knowledge about influenza and vaccination, risk perception towards influenza and pandemics, vaccination behaviours and reasons for vaccination acceptance or refusal. The survey also collected data regarding gender, age, highest educational qualification, work place, clinical specialty, qualified years as a nurse, and whether they had direct patient contact.

Results

The influenza vaccination rate among the respondents was 36% with about 41% never vaccinated. Nurses with a high knowledge level were more likely to get vaccinated compared to those with a low knowledge level (p < 0.001). Vaccination rates between the high risk perception and low risk perception groups were different (p = 0.019). Sentinel knowledge items were associated with nurses’ vaccination status. Several risk perception items including personal vulnerability to influenza or H1N1, mortality risk of H1N1, and the likelihood of transmitting influenza to patients were also predictors of vaccination uptake. Vaccinated nurses were more likely to recommend vaccination to their patients (p < 0.001). The most frequent reason for vaccination refusal was concern about the side-effects of the vaccination while self-protection was the most frequent reason for vaccination uptake.

Conclusions

This study confirmed a relationship between knowledge, risk perception and vaccination behaviours among nurses. The identified sentinel items of knowledge and risk perception could inform future vaccination campaigns. The clinical specialty of nurses and the importance of accessibility to vaccination as predictors of vaccine uptake require further exploration.     

What patient characteristics guide nurses’ clinical judgement on pressure ulcer risk? A mixed methods study

Background

Nurses’ clinical judgement plays a vital role in pressure ulcer risk assessment, but evidence is lacking which patient characteristics are important for nurses’ perception of patients’ risk exposure.

Objectives

To explore which patient characteristics nurses employ when assessing pressure ulcer risk without use of a risk assessment scale.

Design

Mixed methods design triangulating observational data from the control group of a quasi-experimental trial and data from semi-structured interviews with nurses.

Setting

Two traumatological wards at a university hospital.

Participants

Quantitative data: A consecutive sample of 106 patients matching the eligibility criteria (age ≥18 years, no pressure ulcers category ≥2 at admission and ≥5 days expected length of stay). Qualitative data: A purposive sample of 16 nurses.

Methods

Quantitative data: Predictor variables for pressure ulcer risk were measured by study assistants at the bedside each second day. Concurrently, nurses documented their clinical judgement on patients’ pressure ulcer risk by means of a 4-step global judgement scale. Bivariate correlations between predictor variables and nurses’ risk estimates were established. Qualitative data: In interviews, nurses were asked to assess fictitious patients’ pressure ulcer risk and to justify their risk estimates. Patient characteristics perceived as relevant for nurses’ judements were thematically clustered. Triangulation: Firstly, predictors of nurses’ risk estimates identified in bivariate analysis were cross-mapped with interview findings. Secondly, three models to predict nurses’ risk estimates underwent multiple linear regression analysis.

Results

Nurses consider multiple patient characteristics for pressure ulcer risk assessment, but regard some conditions more important than others. Triangulation showed that these are measures reflecting patients’ exposure to pressure or overall care dependency. Qualitative data furthermore indicate that nurses are likely to trade off risk-enhancing conditions against conditions perceived to be protective. Here, patients’ mental capabilities like willingness to engage in one owns care seem to be particularly important. Due to missing information on these variables in the quantitative data, they could not be incorporated into triangulation.

Conclusions

Nurses’ clinical judgement draws on well-known aetiological factors, and tends to expand conditions covered by risk assessment scales. Patients’ care dependency and self-care abilities seem to be core concepts for nurses’ risk assessment.     

Patient demographic characteristics and facial expressions influence nurses' assessment of mood in the context of pain: a virtual human and lens model investigation

Background

Sex, race, and age disparities in pain assessment and treatment have been reported in the literature. However, less is known about how these demographic characteristics influence nurses’ assessment of the emotional experiences of patients who are in pain.

Objectives

To investigate the influence of patient demographic characteristics and facial expressions on nurses’ assessment of patient mood in the context of pain.

Design

A cross-sectional study employing Virtual Human (VH) technology and lens model methodology.

Settings

The current study was delivered via the internet.

Participants

Participants consisted of 54 registered nurses currently engaged in clinical practice. Nurses were recruited from healthcare settings across the United States.

Methods

Nurses viewed 32 patient vignettes consisting of a video clip of the VH patient and text-based clinical summary information describing a post-surgical context. Patient sex, race, age, and facial expression of pain were systematically manipulated across vignettes. Participants made positive and negative mood assessment ratings on computerized visual analogue scales. Idiographic multiple regression analyses were used to examine the patient characteristics that were significant predictors of nurses’ assessment ratings. Nomothetic paired samples t-tests were used to compare ratings within cue for the entire sample.

Results

The results of idiographic and nomothetic analyses indicated that VH sex, race, age, and facial expression cues were significant predictors of the mood assessment ratings of many nurses. The age cue had the largest impact among the demographic variables.

Conclusions

The results of the current study suggest that patient demographic characteristics and facial expressions may influence how nurses assess patient emotional status in the clinical pain context. These findings may lead to greater awareness by individual nurses and nursing administrators about the influence of patient demographic characteristics on clinical decision-making. Future research is needed to better understand these relationships, with the ultimate goal of improving patient care.     

The effects of clinical experience on nurses' critical event risk assessment judgements in paper based and high fidelity simulated conditions: a comparative judgement analysis

Background

Paper based simulated patients are widely used to analyse nurses’ clinical judgements. However, developments in the physical simulation of clinical environments offer exciting, but relatively underexploited, opportunities for exploring nurses’ judgements. Critical event risk assessment is an element of acute care practice which lends itself well to simulation and in which more clinical experience is often assumed to lead to better quality judgements.

Objectives

To model nurses’ judgements of critical event risk using physical and paper simulation and to examine whether improving fidelity via physical clinical simulation impacts on the apparent benefits of clinical experience on nurses’ judgement performance.

Design

A comparative clinical judgement analysis.

Setting

A university in Northern England.

Methods

Sixty-three nursing students and 34 experienced nurses made dichotomous risk assessment judgements (“at risk” or “not at risk”) in response to 25 paper and physical simulated scenarios. These were randomly generated from a dataset of real patient case records. Clinical outcomes (the judgement criteria) for a ‘correct’ judgement were derived from the same case records. Logistic regression models were constructed to derive statistics for each nurse representing various measures of judgement performance: achievement (r_a), consistency (R_s) and clinical information use (G). These statistics were known as Lens Model statistics (from the psychological theory of Brunswik's Lens Model of judgement). Performance measures for novice and experienced nurses were compared.

Results

No significant differences in judgemental achievement (r_a) between experienced nurses and students were observed in either paper or high fidelity clinical simulations. Similarly, there were no significant differences in the nurses’ abilities to correctly match the ways they synthesised clinical information with the optimum synthesis required by the task (policy matching) (G). When faced with “paper patients” experienced nurses exercised more cognitive control/consistency (R_s) than students (P = 0.04). However, this heightened control in experienced nurses was absent when those same nurses made judgements in the higher fidelity clinical simulation environment.

Conclusion

Clinical experience made no difference to nurses’ judgement achievement (accuracy) in either the lower fidelity paper scenarios or the higher fidelity setting of the clinical simulation unit. The significant impact of clinical experience on judgement consistency was negated by the increases in fidelity offered through clinical simulation.     

Apnoeic oxygenation via high-flow nasal cannula oxygen combined with non-invasive ventilation preoxygenation for intubation in hypoxaemic patients in the intensive care unit: the single-centre,blinded, randomised controlled OPTINIV trial

Purpose

High-flow nasal cannula oxygen (HFNC) has the potential to provide apnoeic oxygenation. We decided to assess in a proof-of-concept study whether the addition of HFNC to non-invasive ventilation (NIV) could reduce oxygen desaturation during intubation, compared with NIV alone for preoxygenation, in severely hypoxaemic intensive care unit (ICU) patients with respiratory failure.

Methods

We conducted a randomised, controlled, single-centre trial with assessor-blinded outcome assessment in patients admitted to the ICU. Hypoxaemic patients requiring orotracheal intubation for respiratory failure were randomised to receive preoxygenation using HFNC [flow = 60 L/min, fraction of inspired oxygen (FiO₂) = 100 %] combined with NIV (pressure support = 10 cmH₂O, positive end-expiratory pressure = 5 cmH₂O, FiO₂ = 100 %) in the intervention group or NIV alone in the reference group prior to intubation. The primary outcome was the lowest oxygen saturation (SpO₂) during the intubation procedure. Secondary outcomes were intubation-related complications and ICU mortality.

Results

Between July 2015 and February 2016, we randomly assigned 25 and 24 patients to the intervention and reference groups, respectively. In both groups the main reasons for respiratory failure were pneumonia and ARDS. During the intubation procedure, the lowest SpO₂ values were significantly higher in the intervention group than in the reference group [100 (95–100) % vs. 96 (92–99) %, p = 0.029]. After exclusion of two patients from analysis for protocol violation, no (0 %) patients in the intervention group and five (21 %) patients in the reference group had SpO₂ below 80 % (p = 0.050). We recorded no significant difference between the groups in intubation-related complications or ICU mortality.

Conclusions

A novel strategy for preoxygenation in hypoxaemic patients, adding HFNC for apnoeic oxygenation to NIV prior to orotracheal intubation, may be more effective in reducing the severity of oxygen desaturation than the reference method using NIV alone.

     

Factors associated with nurses’ reporting of patients’ aggressive behavior: A cross-sectional survey

Background

Aggressive behavior and violence directed by patients at nurses are increasing worldwide. Aggressive behavior against nurses in their workplace can result in personal problems, such as impairment of physical and mental well-being, and, consequently, in organizational problems. Underreporting of patients’ aggressive behavior is prevalent among nurses. Although underreporting might lead to inefficient attention to strategies for preventing aggressive behavior, the reasons for such behavior not being reported frequently have not been well examined.

Objectives

To explore the frequency of nurses’ reporting to their managers of patients’ aggressive behavior by type and degree of impact suffered by the nurses, to examine the association between reporting of aggressive behavior and demographic factors, and to determine the reasons for underreporting.

Design

A questionnaire-based cross-sectional survey.

Setting

Six acute care hospitals in two regions in Japan.

Participants

A total of 1953 nurses working at general acute care hospitals participated.

Methods

Data were collected through a questionnaire seeking sociodemographic information, information on experience of aggressive behavior from patients, and the frequency with which they had reported such behavior in the previous month. The questionnaire also contained items assessing barriers to reporting of patients’ aggressive behavior. The association between the possible influencing factors and reporting behavior was assessed using multiple logistic regression analyses.

Results

Of the 1953 questionnaires distributed, 1498 (76.7%) were returned, and 1385 (70.9%) fully completed questionnaires were analyzed. More than one-third of the respondents had experienced the mildest assessed level of impact from patients’ aggressive behavior, and 70% of those hardly reported any incidents. The milder the impact was, the less the nurse victims tended to report the incident. Nurse's tendency to feel that aggressive behavior was mitigated by the situation, less work experience, and lack of confidence that management would defend staff nurses from patients’ aggressive behavior were found to be negatively associated with reporting behavior.

Conclusions

This study identified factors associated with nurses’ reporting of patients’ aggressive behavior. Underreporting was found to be associated with the level of impact, managerial attitudes, nurses’ work experience, and nurses’ perception that the behavior was mitigated by the situation. Improving education among nurses to promote reporting incidents and establishing an organized system is needed.     

Ambulatory oxygen therapy assessment: a comparative study of incremental shuttle and 6-minute walking tests

Background

Walking tests, such as the incremental shuttle walk test (ISWT) and the 6-minute walk test (6MWT), are recommended in the assessment of ambulatory oxygen for patients with chronic obstructive pulmonary disease (COPD). However, there is no evidence that these tests can be used interchangeably.

Objectives

To compare the ISWT and the 6MWT in COPD patients in terms of indication for ambulatory oxygen therapy.

Design

Crossover design.

Setting

Patients attended as outpatients.

Participants

Fifty patients with stable COPD (31 males; age 67 years, range 43 to 83 years); mean forced expiratory volume in 1 second 1.2 l [standard deviation (SD) 0.6 l] and 48.6% predicted (SD 23.4%).

Intervention

Patients performed both the ISWT and the 6MWT whilst breathing air. Breathlessness (Borg scale), percutaneous arterial oxygen saturation (SpO₂) and heart rate were measured before and after both tests.

Main outcome measures

Post-test SpO₂ and change from baseline.

Results

The mean change in saturation was −4.6% (SD 6.2%) and −2.8% (SD 5.3%) after the ISWT and the 6WMT, respectively. Using Bland and Altman plots, the limits of agreement for difference in change in SpO₂ (%) between the two tests were wide (−8.1 to 11.6) and clinically relevant. Sixteen patients (32%) and 13 patients (26%) met the criteria for ambulatory oxygen with the ISWT and the 6MWT, respectively (P = 0.32).

Conclusions

This study found a wide variation between differences in exercise oxygen desaturation after the ISWT compared with the 6MWT, supporting the premise that these tests should not be used interchangeably in the assessment of ambulatory oxygen for COPD patients.     

Impact of e-learning on nurses’ and student nurses knowledge,skills, and satisfaction: A systematic review and meta-analysis

Objective

To review the impact of e-learning on nurses’ and nursing student's knowledge, skills and satisfaction related to e-learning.

Design

We conducted a systematic review and meta-analysis of randomized controlled trials (RCT) to assess the impact of e-learning on nurses’ and nursing student's knowledge, skills and satisfaction. Electronic databases including MEDLINE (1948–2010), CINAHL (1981–2010), Psychinfo (1967–2010) and Eric (1966–2010) were searched in May 2010 and again in December 2010. All RCT studies evaluating the effectiveness of e-learning and differentiating between traditional learning methods among nurses were included.

Data extraction and quality assessment

Data was extracted related to the purpose of the trial, sample, measurements used, index test results and reference standard. An extraction tool developed for Cochrane reviews was used. Methodological quality of eligible trials was assessed.

Data synthesis

11 trials were eligible for inclusion in the analysis.

Results

We identified 11 randomized controlled trials including a total of 2491 nurses and student nurses’. First, the random effect size for four studies showed some improvement associated with e-learning compared to traditional techniques on knowledge. However, the difference was not statistically significant (p = 0.39, MD 0.44, 95% CI −0.57 to 1.46). Second, one study reported a slight impact on e-learning on skills, but the difference was not statistically significant, either (p = 0.13, MD 0.03, 95% CI −0.09 to 0.69). And third, no results on nurses or student nurses’ satisfaction could be reported as the statistical data from three possible studies were not available.

Conclusion

Overall, there was no statistical difference between groups in e-learning and traditional learning relating to nurses’ or student nurses’ knowledge, skills and satisfaction. E-learning can, however, offer an alternative method of education. In future, more studies following the CONSORT and QUOROM statements are needed to evaluate the effects of these interventions.     

Nurses’ attitudes to mental illness: A comparison of a sample of nurses from five European countries

Background

Mental health problems are of serious concern across Europe. A major barrier to the realisation of good mental health and well-being is stigma and discrimination. To date there is limited knowledge or understanding of mental health nurses’ attitudes towards mental illness and individuals experiencing mental health problems.

Objectives

To describe and compare attitudes towards mental illness and those experiencing mental health problems across a sample of registered nurses working in mental health settings from five European countries and the factors associated with these attitudes.

Design

A questionnaire survey.

Settings

A total of 72 inpatient wards and units and five community facilities in Finland, Lithuania, Ireland, Italy and Portugal.

Participants

810 registered nurses working in mental health settings.

Methods

The data were collected using The Community Attitudes towards the Mentally Ill (CAMI) scale, which is a 40-item self-report questionnaire. The data were analysed using quantitative methods.

Results

Nurses’ attitudes were mainly positive. Attitudes differed across countries, with Portuguese nurses’ attitudes being significantly more positive and Lithuanian nurses’ attitudes being significantly more negative than others’. Positive attitudes were associated with being female and having a senior position.

Conclusions

Though European mental health nurses’ attitudes to mental illness and people with mental health problems differ significantly across some countries, they are largely similar. The differences observed could be related to wider social, cultural and organisational circumstances of nursing practice.     

Rest break organization in geriatric care and turnover: A multimethod cross-sectional study

Background

Various determinants of nurses’ work motivation and turnover behavior have been examined in previous studies. In this research, we extend this work by investigating the impact of care setting (nursing homes vs. home care services) and the important role of rest break organization.

Objectives

We aimed to identify direct and indirect linkages between geriatric care setting, rest break organization, and registered nurses’ turnover assessed over a period of one year.

Design

We designed a multimethod cross-sectional study.

Setting

80 nursing units (n = 45 nursing homes, n = 35 home care) in 51 German geriatric care services employing 597 registered nurses.

Methods

We gathered documentary, interview, and observational data about the organization of rest breaks, registered nurses’ turnover, and additional organizational characteristics (type of ownership, location, nursing staff, clients, and client-to-staff-ratio).

Results

The findings show that the rest break system in geriatric nursing home units is more regularly as well as collectively organized and causes less unauthorized rest breaks than in home care units. Moreover, the feasibility of collective rest breaks was, as predicted, negatively associated with registered nurses’ turnover and affected indirectly the relation between care setting and registered nurses’ turnover. Care setting, however, had no direct impact on turnover. Furthermore, registered nurses’ turnover was higher in for-profit care units than in public or non-profit units.

Conclusions

This study reveals significant differences in rest break organization as a function of geriatric care setting and highlights the role of collective rest breaks for nursing staff retention. Our study underlines the integration of organizational context variables and features of rest break organization for the analysis of nursing turnover.     

Conservative versus liberal oxygenation targets in critically ill children: the randomised multiple-centre pilot Oxy-PICU trial

Background

Oxygen saturation monitoring for children receiving respiratory support is standard worldwide. No randomised clinical trials have compared peripheral oxygen saturation (SpO₂) targets for critically ill children. The harm of interventions to raise SpO₂ to >?94% may exceed their benefits.

Methods

We undertook an open, parallel-group randomised trial of children >?38 weeks completed gestation and <?16 years of age receiving invasive or non-invasive respiratory support and supplemental oxygen who were admitted urgently to one of three paediatric intensive care units. A ‘research without prior consent’ approach was employed. Children were randomly assigned to a liberal oxygenation group (SpO₂ targets >?94%) or a conservative oxygenation group (SpO₂ = 88–92% inclusive). Outcomes were measures of feasibility: recruitment rate, protocol adherence and acceptability, between-group separation of SpO₂ and safety. The Oxy-PICU trial was registered before recruitment: ClinicalTrials.gov identifier NCT03040570.

Results

A total of 159 children met the inclusion criteria, of whom 119 (75%) were randomised between April and July 2017, representing a rate of 10 patients per month per site. The mean time to randomisation from first contact with an intensive care team was 1.9 (SD 2.2) h. Consent to continue in the study was obtained in 107 cases (90%); the children’s parents/legal representatives were supportive of the consent process. The median (interquartile range, IQR) of time-weighted individual mean SpO₂ was 94.9% (92.6–97.1) in the conservative oxygenation group and 97.5% (96.2–98.4) in the liberal group [difference 2.7%, 95% confidence interval (95% CI) 1.3–4.0%, p?<?0.001]. Median (IQR) time-weighted individual mean FiO₂ was 0.28 (0.24–0.37) in the conservative group and 0.37 (0.30–0.42) in the liberal group (difference 0.08, 95% CI 0.03–0.13, p?<?0.001). There were no significant between-group differences in length of stay, duration of organ support or mortality. Two prespecified serious adverse events (cardiac arrests) occurred, both in the liberal oxygenation group.

Conclusion

A definitive clinical trial of peripheral oxygen saturation targets is feasible in critically ill children.

     

Factors affecting the integration of immigrant nurses into the nursing workforce: A double hermeneutic study

Background

Variations in nursing practice and communication difficulties pose a challenge for the successful integration into the workforce of immigrant nurses. Evidence for this is found in cultural clashes, interpersonal conflicts, communication problems, prejudiced attitudes and discrimination towards immigrant nurses. While the evidence shows that integrating immigrant nurses into the nursing workforce is shaped by factors that are socially constructed, studies that examine social structures affecting workforce integration are sparse.

Objectives

The aim of this study was to examine interplaying relationships between social structures and nurses’ actions that either enabled or inhibited workforce integration in hospital settings.

Design

Giddens’ Structuration Theory with double hermeneutic methodology was used to interpret 24 immigrant and 20 senior nurses’ perceptions of factors affecting workforce integration.

Results

Four themes were identified from the data. These were: (1) employer-sponsored visa as a constraint on adaptation, (2) two-way learning and adaptation in multicultural teams, (3) unacknowledged experiences and expertise as barriers to integration, and (4) unquestioned sub-group norms as barriers for group cohesion. The themes presented a critical perspective that unsuitable social structures (policies and resources) constrained nurses’ performance in workforce integration in the context of nurse immigration. The direction of structural changes needed to improve workforce integration is illustrated throughout the discussions of policies and resources required for workforce integration at national and organisational levels, conditions for positive group interactions and group cohesion in organisations.

Conclusion

Our study reveals inadequate rules and resources used to recruit, classify and utilise immigrant nurses at national and healthcare organisational levels can become structural constraints on their adaptation to professional nursing practice and integration into the workforce in a host country. Learning from each other in multicultural teams and positive intergroup interaction in promoting intercultural understanding are enablers contributing to immigrant nurses’ adaptation and workforce integration.     

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

Objective

To investigate aspects of nurses’ work environments linked with job outcomes and assessments of quality of care in an Icelandic hospital.

Background

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.

Methods

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.

Results

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.

Conclusions

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.     

Work motivation of nurses: a literature review

Objectives

The aim of this review is to describe nurses’ work motivation from the perspective of staff nurses. This information would be useful for the development of motivation strategies and further research into nurses’ work motivation.

Design

A thorough review of the research literature.

Data sources

The literature search was performed using four databases: CINAHL, PubMed, PsychINFO, and SocINDEX. Only studies that met the following criteria were selected for review: (1) were published between 1990 and 2009, (2) were written in English, (3) dealt with work motivation, (4) concerned working staff nurses, (5) involved empirical research, (6) clearly and explicitly provided the research results about the factors affecting nurses’ work motivation. Altogether 24 studies met these criteria and were included in this review.

Review methods

Inductive content analysis was carried out to analyse and categorise the data.

Results

Nursing research has neither clear understanding nor consensus about the concept of work motivation; nor has a universal definition been adopted. Despite limited empirical evidence it may be concluded that staff nurses appear to be motivated. Five categories of factors affecting their work motivation were identified: (1) work-place characteristics, (2) working conditions, (3) personal characteristics, (4) individual priorities, and (5) internal psychological states.

Conclusions

Further research is needed to gain a more comprehensive insight into nurses’ work motivation and the factors affecting it. This can be achieved by defining the concept of work motivation as precisely as possible, working out a pertinent research methodology, and subsequently developing and testing a theoretical model of nurses’ work motivation.