The relationship between organizational culture of nursing staff and quality of care for residents with dementia: Questionnaire surveys and systematic observations in nursing homes

Background

Since the 1990s, several studies have shown that organizational culture is an important characteristic in long-term care. However, at the moment little is known about organizational culture and its relationship with quality of care.

Objectives

In this study, the relationship between organizational culture and quality of care in long-term care was investigated using the competing values framework. Thereto, two independent measurements of quality of care were applied: the perceived quality of care by nursing staff of dementia units and the observed quality of care on the units by researchers.

Design

The study used a cross-sectional design.

Settings

Data were collected on 11 dementia units in 11 Dutch nursing homes.

Participants

All nursing staff on the units were asked to complete a questionnaire, of whom 248 staff members responded. The average response rate on the 11 units was 63%.

Methods

Data were collected during two days of field-work on each unit. Systematic observations were performed, and questionnaires were distributed among nursing staff. Data were analyzed using multilevel analyses.

Results

Organizational culture was related to both perceived and observed quality of care on the units. Units that are characterized by a clan culture provide better quality of care, both in the eyes of the nursing staff as in the eyes of outsiders. Market culture, compared to clan culture, is negatively related to quality of care in this sample.

Conclusions

The results indicate that organizational culture in long-term dementia care is important for organizational performance.     

Intrarater test-retest reliability of hip range of motion and hip muscle strength measurements in persons with hip osteoarthritis

Pua YH, Wrigley TW, Cowan SM, Bennell KL. Intrarater test-retest reliability of hip range of motion and hip muscle strength measurements in persons with hip osteoarthritis.

Objective

To examine the relative and absolute intrarater test-retest reliability of muscle strength and range of motion (ROM) measurements of the hip performed in people with hip osteoarthritis.

Design

Repeated measures.

Setting

Human movement laboratory of a university.

Participants

Participants (N=22; 10 men, 12 women; age range, 50-84y) with hip osteoarthritis.

Interventions

On 2 separate occasions, at least 1 week apart, isometric torque measurements were obtained from the hip rotators, flexors, abductors, and extensors. Passive ROMs in hip rotation, flexion, abduction, and extension were also determined.

Main Outcome Measures

Relative reliability was estimated using the intraclass correlation coefficient, model 2,2 (ICC_2,2). Absolute reliability was estimated using the coefficient of variation (CV) and the standard error (SE) of measurement.

Results

For measurements of muscle strength, ICC_2,2 ranged from .84 to .97, and the CV ranged from 8% to 15.7%. Hip extensors and internal and external rotators showed high ICC_2,2 (>.96) and low CV (<9.8%); hip abductors showed the lowest ICC_2,2 (.84) and the highest CV (15.7%). For ROM measurements, ICC_2,2 ranged from .86 to .97 and SE ranged from 3.1° to 4.7°. Hip flexion ROM showed the highest ICC_2,2 (.97) and an SE of 3.5°; hip extension ROM showed the lowest ICC_2,2 (.86) and the highest SE (4.7°).

Conclusions

Strength and ROM testing of the hip in people with hip osteoarthritis can be performed with good to excellent reliability.     

Patient Participation and Physical Activity During Rehabilitation and Future Functional Outcomes in Patients After Hip Fracture

Talkowski JB, Lenze EJ, Munin MC, Harrison C, Brach JS. Patient participation and physical activity during rehabilitation and future functional outcomes in patients after hip fracture.

Objective

To examine the association between physical activity recorded by actigraphy during therapy sessions (therapy) with therapist-rated patient participation and self-reported future functional outcomes. We hypothesized those participants who were more active during rehabilitation would have higher participation scores and better functional outcomes after hip fracture compared with those who were less active.

Design

Longitudinal study with a 3- and 6-month follow-up.

Setting

Participants were recruited from skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs).

Participants

Participants included 18 community-dwelling older adults admitted to SNFs or IRFs facilities after hip fracture. Participants were included if they were 60 years of age or older and ambulatory with or without assistance from a device or another person.

Interventions

Not applicable.

Main Outcome Measures

Physical activity was quantified during participants' rehabiliation by using the actigraph accelerometer worn consecutively over 5 days. The Pittsburgh Participation Rating Scale was used to quantify patient participation during their inpatient therapy sessions. Self-reported functional outcomes were measured by the Hip Fracture Functional Recovery Scale at baseline and 3 and 6 months after fracture.

Results

Participants with higher actigraphy counts during rehabilitation were ranked by their therapists as having excellent participation compared with those who were less active. Participants who were more active reported better functional abilities at both the 3- and 6-month time points and achieved 78% and 91% recovery of self-reported prefracture function compared with those who were less active achieving 64% and 73% recovery.

Conclusions

Actigraphy provides an objective measure of physical activity exhibiting predictive validity for future functional outcomes and concurrent validity against patient participation in patients after hip fracture.     

Disparities in Utilization of Outpatient Rehabilitative Care Following Hip Fracture Hospitalization With Respect to Race and Ethnicity

Nguyen-Oghalai TU, Ottenbacher KJ, Kuo Y-F, Wu H, Grecula M, Eschbach K, Goodwin JS. Disparities in utilization of outpatient rehabilitative care following hip fracture hospitalization with respect to race and ethnicity.

Objective

To compare the prevalence of discharge home to self-care after hip fracture hospitalization among the elderly in 3 racial groups: whites, Hispanics, and blacks.

Design

Secondary data analysis.

Setting

US hospitals.

Participants

Patients (N=34,203) aged 65 and older with Medicare insurance discharged after hip fracture hospitalization between 2001 and 2005.

Interventions

Not applicable.

Main Outcome Measure

Discharge home to self-care.

Results

Bivariate analyses showed higher rates of discharge home to self-care among minorities, 16.4% for Hispanics, 8.7% for blacks, and 5.9% for whites. Hispanics had 3-fold higher odds of being discharged home to self-care, and blacks had about 50% higher odds of being discharged home to self-care after adjusting for age, sex, Klabunde's comorbidity index, income, year of admission, type of hip fracture, surgical stabilization procedure, and length of hospital stay.

Conclusions

The higher rate of discharge home to self-care among minorities underscores the risk of suboptimal outpatient rehabilitative care among minorities with hip fracture.     

Gait Patterns After Total Hip Arthroplasty and Surface Replacement Arthroplasty

Nantel J, Termoz N, Vendittoli P-A, Lavigne M, Prince F. Gait patterns after total hip arthroplasty and surface replacement arthroplasty.

Objective

To compare gait patterns in patients with total hip arthroplasty (THA) and surface hip arthroplasty.

Design

Observational study.

Setting

Outpatient biomechanical laboratory.

Participants

Two groups of 10 surface hip arthroplasty and THA patients and 10 control subjects participated in the study (N=30). The patients were volunteers recruited from a larger randomized study.

Interventions

Not applicable.

Main Outcomes Measures

Gait patterns, hip abductor muscle strength, clinical outcomes, and radiographic analyses were compared between groups.

Results

In the sagittal plane, the THA group showed a larger flexor moment and larger mechanical work in H2S and K3S power bursts compared with surface hip arthroplasty and control subjects. In the frontal plane, both THA and surface hip arthroplasty patients had smaller hip abductor muscles energy generation (H3F) than the control group. No difference was found for the hip abductor muscles strength.

Conclusions

In the THA group, the larger energy absorption in H2S and K3S would be a cost-effective mechanical adaptation to increase stability. The surface hip arthroplasty characteristics could allow the return to a more normative gait pattern compared with THA. The modification in the frontal plane in surface hip arthroplasty and THA would be related to the hip abductor muscles strength.     

How Many Trials Are Needed to Achieve Performance Stability of the Timed Up & Go Test in Patients With Hip Fracture?

Kristensen MT, Ekdahl C, Kehlet H, Bandholm T. How many trials are needed to achieve performance stability of the Timed Up & Go test in patients with hip fracture?

Objective

To examine the number of trials needed to achieve performance stability of the Timed Up & Go (TUG) test using a standardized walking aid in patients with hip fracture who are allowed full weight bearing (FWB).

Design

Prospective methodologic study.

Setting

An acute 14-bed orthopedic hip fracture unit.

Participants

Patients (N=122; 89 women, 33 men) with hip fracture with a median age (25%-75%, quartiles) of 80 (67-85) years performed the TUG on hospital discharge to their own home (n=115) or further inpatient rehabilitation (n=7).

Interventions

Not applicable.

Main Outcome Measures

After a demonstration by a physical therapist how to perform the TUG with a standardized walking aid (a 4-wheeled rollator), the patients performed 6 timed TUG trials with up to 1-minute seated rest intervals. The participants were given a few minutes to familiarize with the rollator before commencing the timed trials. Repeated-measures analysis of variance (ANOVA) with Bonferroni corrections were used to examine the number of trials needed to ensure statistically stable TUG scores.

Results

A total of 106 (87%) patients performed all 6 TUG trials, while 120 patients performed a minimum of 3 timed trials. Repeated-measures ANOVAs of both groups showed that TUG scores improved significantly (P≤.007) up to and including the third TUG trial.

Conclusions

These results suggest that the original TUG manual, described as 1 practice trial followed by 1 timed trial, needs modification when used in patients with hip fracture who are allowed FWB. The best (fastest) of 3 timed TUG trials performed with a standardized walking aid is recommended.     

Introducing a nursing guideline on depression in dementia: a multiple case study on influencing factors

Background

Successfully introducing care innovations depends on the type of care setting, the intervention and specific circumstances. In this study the factors influencing the introduction of an evidence based nursing guideline on depression in psychogeriatric nursing home residents were studied.

Methods

A mixed methods multiple case study design was used. The cases consisted of nine psychogeriatric wards participating in the intervention group of a controlled clinical trial. Eight types of data source (qualitative and quantitative) were used in the analyses. Triangulation of researchers, data and methods took place. Factors were categorized according to their organizational level: nursing home management (level 1), nursing team (level 2), CNAs (level 3), and residents (level 4).

Results

Factors influencing guideline introduction were mainly found at the levels of the nursing home management and the nursing team. Most factors concern stability of the organization and team (e.g. the inhibiting effects of reorganizations and other innovations), motivation (e.g. the facilitating presence of an opinion leader) and compatibility with current practice and vision (e.g. a facilitating emotion-oriented care vision). Factors influencing a successful application of the guideline are mainly found at CNA and resident level. At CNA level most factors relate to an emotion-oriented care vision (e.g. having a warm and creative personality). At resident level inhibiting factors mainly concern the residents’ health status (e.g. feeling sick and/or having much pain). Important facilitating factors are positive attitudes of relatives and observing a reduction of depression severity.

Conclusions

Special facilitating factors for the guideline introduction and application seem to be the presence of a local opinion leader and the positive attitudes of relatives. Together they can motivate a nursing team in using the guideline. After a successful introduction of the guideline it's important to focus on its consolidation in daily practice.     

Effect of hip protectors,falling angle and body mass index on pressure distribution over the hip during simulated falls

Background

We examined how a soft shell hip protector affects the magnitude and distribution of force to the hip during simulated falls, and how the protective effect depends on the fall direction and the amount of soft tissue padding over the hip.

Methods

Fourteen young women with either high or low body mass index participated in a “pelvis release experiment” that simulated falls resulting in either lateral, anterolateral or posterolateral impact to the pelvis with/without a soft shell hip protector. Outcome variables were the magnitude and location of peak pressure (d, theta) with respect to the greater trochanter, total impact force, and percent force applied to four defined hip regions.

Findings

The soft shell hip protector reduced peak pressure by 70%. The effect was two times greater in low than high body mass index individuals. The protector shunted the peak pressure distally along the shaft of the femur (d = 52 mm (SD 22), theta = −21° (SD 49) in the unpadded trials versus d = 81 mm (SD 23), theta = −10° (SD 35) in the padded trials). Peak force averaged 12% greater in posterolateral and 17% lower in anterolateral than lateral falls.

Interpretation

Our results indicate that the hip protector we tested had a much stronger protective benefit for low than high body mass index individuals. Next generation protectors might be developed for improved shunting of pressure away from the femur, improved protection during posterolateral falls, and greater force attenuation for low body mass index individuals.     

Reward frustration at work and intention to leave the nursing profession--prospective results from the European longitudinal NEXT study

Background

Many countries are facing a serious situation of nursing shortage, and retention of nurses is a challenge.

Objectives

To examine whether reward frustration at work, as measured by the effort-reward imbalance model, predicts intention to leave the nursing profession, using data from the European longitudinal nurses’ early exit study.

Design

A prospective study with one-year follow-up.

Methods

6469 registered female nurses working in hospitals in seven European countries who did not have intention to leave the nursing profession at baseline were included in our analyses by multivariate Poisson regression.

Results

8.24% nurses newly developed intention to leave during follow-up. High effort-reward imbalance at baseline predicted an elevated risk of intention to leave the profession (relative risk 1.33, 95% confidence interval 1.22-1.45), and reward frustration (poor salary and promotion prospects, lack of esteem) showed the strongest explanatory power. Findings were similar in a majority of the countries.

Conclusions

Results suggest that improving the psychosocial work environment, and specifically occupational rewards, may be helpful in retaining nurses and consequently reducing nursing shortage in Europe.     

Physical activity and pain following total hip arthroplasty

Objectives

To determine types and levels of physical activities and hip pain in patients who had a total hip arthroplasty 5-7 years previously.

Participants

Ninety-eight men with a mean age of 61 years (standard deviation 9 years) and 134 women with a mean age of 61 years (standard deviation 6 years).

Methods

Patients reported current physical activities and activity 2 years after surgery. Patients were also asked about pain in the operated hip associated with specific activities, and reduction of activities due to pain.

Results

Ninety-five patients reported hip pain during physical activity, most frequently during bending and lifting activities and least frequently during non-weight-bearing activities. Climbing stairs was also associated with pain. Of 137 patients who decreased their level of activity between the two time points, 57 did so because of hip pain. Their average reduction in activity was 9.1 hours/week (95% confidence interval 6.8 to 11.4 hours/week). These 57 patients reported higher levels of activity 2 years after surgery than those who did not decrease their activity because of pain.

Conclusions

This study provides important information on the types of physical activity in which total hip arthroplasty patients participate, and their association with hip pain and reduction of activity due to pain. There is a need for future research to assess a wide variety of types and levels of activities, and to determine their association with pain and revision surgery.     

The supine hip extensor manual muscle test: a reliability and validity study

Perry J, Weiss WB, Burnfield JM, Gronley JK. The supine hip extensor manual muscle test: a reliability and validity study. Arch Phys Med Rehabil 2004;85:1345-50.

Objectives

To define the relative hip extensor muscle strengths values identified by the 4 grades obtained with a supine manual muscle test (MMT) and to compare these values with those indicated by the traditional prone test.

Design

Comparison of 4 manual supine strength grades with isometric hip extension joint torque; κ statistic-determined interrater reliability, and analyses of variance identified between grade differences in torque.

Setting

Pathokinesiology laboratory.

Participants

Adult volunteers recruited from local community and outpatient clinics. Reliability testing: 16 adults with postpolio (31 limbs). Validity testing (2 groups): 18 subjects without pathology (18 limbs), and 26 people with clinical signs of hip extensor weakness (51 limbs).

Interventions

Not applicable.

Main Outcome Measures

Supine hip extensor manual muscle grade and isometric hip extension torque.

Results

Reliability testing showed excellent agreement (82%). Subjects with pathology had significant differences in mean torque (P<.01) for the assigned grade 5 (176Nm), grade 4 (103Nm), grade 3 (67Nm), and grade 2 (19Nm). Healthy adults showed significant differences between grade 5 (212Nm) and grade 4 (120Nm) in mean torque (P<.05).

Conclusions

The supine MMT is a reliable and valid method with which to assess hip extension strength.     

Effect of Acute Fatigue of the Hip Abductors on Control of Balance in Young and Older Women

Bellew JW, Panwitz BL, Peterson L, Brock MC, Olson KE, Staples WH. Effect of acute fatigue of the hip abductors on control of balance in young and older women.

Objective

To examine the effects of acute fatigue of the hip abductors on the control of balance in young and older women.

Design

Pretest-posttest.

Setting

University research laboratory.

Participants

Healthy young women (n=20; age, 23.0±1.5y; height, 166.52±4.5cm; mass, 65.33±10.5kg) and community-dwelling older women (n=20; age, 71.65±7.2y; height, 162.31±3.8cm; mass, 71.16±11.6kg) without a fall history.

Intervention

Measurements of control of single-limb balance before and after fatiguing the hip abductors of the dominant leg.

Main Outcome Measure

Performance on 3 clinical assessments of control of balance: the modified Functional Reach Test in the forward, left, and right directions; the Lower-Extremity Reach Test in forward and lateral directions; and the Single-Limb Stance Time Test (SLSTT).

Results

Although the younger subjects showed a significantly greater control of balance than the older women in most tests, control of balance after acute fatigue failed to show a significant decline in either age group. The only exception to this was the SLSTT in the younger women in whom a significant 26% decline was noted (P<.05).

Conclusions

Acute fatigue of the hip abductors did not result in a decreased control of balance in healthy young or older women without fall history. Despite considerable changes in movement strategies used to complete the postfatigue tests of balance, quantitative measures of balance did not decrease.     

Stand up and be counted: measuring time spent upright after hip fracture and comparison with community dwelling older people

Objectives

Following hip fracture, the amount of time an individual spends on their feet (‘uptime’) may be an important marker of recovery. Using an automated device that measured uptime (Uptimer), we aimed to: (1) compare hip fracture patients’ uptime with age- and gender-matched community dwelling older people; (2) identify whether uptime changed during the transition from hospital to home; and (3) examine the relationship between uptime and existing functional measures.

Design

Prospective, observational study.

Setting

Rehabilitation hospital and community.

Participants

Patients undergoing rehabilitation after hip fracture surgery who aimed to return home at the end of rehabilitation, and age- and gender-matched community dwellers.

Interventions

Patients received standard care.

Main outcome measures

Uptime over 24 hours was measured on three occasions in hip fracture patients: 1 week before, 1 day before and 1 week after discharge home. Uptime over 24 hours was measured once in age- and gender-matched community dwelling older people. Functional mobility, self-reported activity, pain, mood and endurance were also assessed.

Results

Thirteen hip fracture patients (mean age 80.4 years) and 13 community dwelling participants completed testing. Once home, hip fracture patients spent 3.4 hours/day (25th, 75th percentiles 2.8, 5.2) upright, while community dwelling healthy older people were upright for 6.5 hours/day (6.1, 8.7). A trend for uptime to increase between hospital and home was observed. Hip fracture uptime at home correlated significantly with self-reported activity, functional mobility and gait endurance (P < 0.05).

Conclusions

This study highlighted uptime limitations of hip fracture patients at home. We discuss possible future directions for research using the Uptimer.     

Analysis of muscle atrophy after hip fracture in the elderly

Ogawa H, Oshita H, Ishimaru D, Yamada K, Shimizu T, Koyama Y, Akaike A, Hori H. Analysis of muscle atrophy after hip fracture in the elderly.

Objectives

To examine the relationship between muscle atrophy, ambulatory ability, and fracture type, and to make a specific rehabilitation regimen for each fracture type.

Design

Observational study.

Setting

Public hospital.

Participants

Consecutive patients (N=53) with hip fracture (mean age, 83.6y) who underwent operative treatment.

Interventions

Not applicable.

Main Outcome Measures

The ambulatory ability score and the cross-sectional areas of lower-limb muscles as measured on computed tomography scans.

Results

Muscle atrophy was not related to fracture type. Although the mean ambulatory ability score decreased significantly from 4.5±0.3 points prior to injury to 3.0±0.6 points 1 month postadmission, the degree of muscle atrophy was not associated with the decrease in ambulatory ability.

Conclusions

It seems likely that other factors are more important than muscle atrophy and fracture type in determining recovery after surgical repair of a fracture and that there is no need for rehabilitation regimens based on fracture types.     

Prediction of Postoperative Ambulatory Status 1 Year After Hip Fracture Surgery

Hirose J, Ide J, Yakushiji T, Abe Y, Nishida K, Maeda S, Anraku Y, Usuku K, Mizuta H. Prediction of postoperative ambulatory status 1 year after hip fracture surgery.

Objectives

To assess the validity of Estimation of Physiologic Ability and Surgical Stress (E-PASS) for predicting the postoperative risk and ambulatory status long-term follow-up after hip fracture surgery and to establish an algorithm for predicting their ambulatory status.

Design

Cohort study.

Setting

Twelve hospitals belonging to the regional network for hip fracture in Japan.

Participants

The study population was composed of 421 patients; 268 underwent surgery between April 2004 and March 2006 (group A), and 153 were treated surgically between April 2006 and March 2007 (group B). All were operated at 3 surgical hospitals and, subsequently, transferred to 9 rehabilitation centers.

Interventions

Not applicable.

Main Outcome Measures

We evaluated various factors, including their E-PASS scores to determine whether there was a correlation with the patients' mortality rate and their ability to walk at discharge and 1 year after surgery (group A). Using multiple regression analysis, we then developed algorithms to predict the ability of elderly patients to walk after hip fracture surgery. We applied the algorithms to group B patients and compared their actual and predicted ambulatory status.

Results

In group A patients, the postoperative walking ability and mortality rate were highly correlated with their E-PASS scores and dementia status. In group B, our algorithms exhibited good correlations between the predicted and actual walking ability at both time points (ρ=0.6, P<.001).

Conclusions

In candidates for hip fracture surgery, the E-PASS scores exhibited a good correlation with the patients' functional and survival prognoses, and the algorithm including E-PASS scores and dementia status can accurately estimate the ambulatory status at discharge and 1 year after surgery.     

Effect of Hamstring Flexibility on Hip and Lumbar Spine Joint Excursions During Forward-Reaching Tasks in Participants With and Without Low Back Pain

Johnson EN, Thomas JS. Effect of hamstring flexibility on hip and lumbar spine joint excursions during forward-reaching tasks in participants with and without low back pain.

Objective

To examine the correlation between hamstring flexibility and hip and lumbar spine joint excursions during standardized reaching and forward-bending tasks.

Design

Retrospective analysis of data obtained during 2 previous prospective studies that examined kinematics and kinetics during forward-reaching tasks in participants with and without low back pain (LBP).

Setting

The 2 previous studies were conducted in the Motor Control Lab at Ohio University and the Orthopaedic Ergonomics Laboratory at The Ohio State University.

Participants

Data from a total of 122 subjects from 2 previous studies: study 1: 86 subjects recovered from an episode of acute LBP (recovered) and study 2 (A.I. McCallum, unpublished data): 18 chronic LBP subjects and 18 healthy-matched controls (healthy).

Interventions

Not applicable.

Main Outcome Measure

Correlation values between hamstring flexibility as measured by straight leg raise (SLR) and amount of hip and lumbar spine joint excursions used during standardized reaching and forward-bending tasks.

Results

No significant correlation was found between hamstring flexibility and hip and lumbar joint excursions during forward-bending tasks in the LBP or recovered groups. The SLR had a significant negative correlation with lumbar spine excursions during reaching tasks to a low target in the healthy group (right SLR: P=.011, left SLR: P=.004).

Conclusions

Hamstring flexibility is not strongly related to the amount of lumbar flexion used to perform forward-reaching tasks in participants who have chronic LBP or who have recovered from LBP. More research needs to be conducted to examine the influence of hamstring flexibility on observed movement patterns to further evaluate the efficacy of flexibility training in the rehabilitation of patients with LBP.     

Effects of an interdisciplinary nurse-led Delirium Prevention and Management Program (DPMP) on nursing workload: A pilot study

Background

Delirium in elderly hip-fracture patients is common and results in negative patient outcomes and increased nursing workload.

Design and objective

The study was part of an evaluation of the interdisciplinary nurse-led Delirium Prevention and Management Program (DPMP) in a Swiss university hospital. Nursing workload was compared before and after implementing the program, using a quasi-experimental design.

Participants

Included were 200 patients who were 65 years of age or older, recovering from hip-fracture surgery on a trauma ward (intervention) or on the other surgery wards.

Methods

Workload was compared before and after implementing the program on the trauma ward and was also compared on other surgery wards. Nursing workload for each patient was evaluated by means of data obtained from the nursing workload management system. Data were collected in a 4-month timeframe in 2004 and 2005 respectively. Differences for workload in total and workload for day, evening, and night shifts on postoperative days 1-5 were calculated, controlled by co-morbidity. Subgroup analysis was performed for patients categorized by nurses as ‘confused’.

Results

Total workload decreased slightly from Year 1 to 2 by 6.4% and 4.2% for patients on the trauma ward and other surgery wards. However, workload during night shifts on the trauma ward decreased significantly by 22% (p = .004), while there was not a significant change on the other surgery wards. Sub-analyses for ‘confused’ patients found that the workload at night on the trauma ward decreased significantly by 23% (p = .01), while it did not change significantly on other surgery wards. Higher co-morbidity and nurses’ labelling patients as ‘confused’ were associated with increased workload (p < .001).

Conclusions

After implementing the program, decreased workload at night was found on the trauma ward. Delirium was detected and treated more quickly which led to less care needed at night. The reason for the slight drop in workload on all wards requires further investigation.     

Role stress and personal resources in nursing: A cross-sectional study of burnout and engagement

Background

The experience of role stress has been linked to burnout as an important job stressor, but the impact of this stressor in the context of engagement (characterized by vigor, dedication, and absorption) has not yet been sufficiently studied among nurses. Personal resources also appear to influence the process of burnout and engagement.

Objectives

This study examines the influence of role stress and personal resources (optimism, hardy personality and emotional competence) in nursing on burnout and engagement dimensions.

Design and results

Cross-sectional data from 508 nurses from general hospitals in Madrid (Spain) showed that both role stress and personal resources were related to burnout and engagement dimensions, although role stress was more closely related to nursing burnout, whereas personal resources were more closely related to nursing engagement. In addition, optimism as a personal resource, showed a moderator effect on exhaustion and the three dimensions of engagement.

Conclusions

The study provides additional support about role stress as an important predictor of burnout and engagement in nursing, even after controlling for personal resources and socio-demographic variables.     

Student nurses’ de-escalation of patient aggression: A pretest-posttest intervention study

Background

Experts recommend staff training to prevent and manage aggressive situations involving patients or their relatives. However, in many countries this subject is not covered in pre-registration nursing education. In addition, the evidence regarding its impact on practical placements remains weak.

Objective

This study examines the influence of an aggression management training programme for nursing students on their performance in de-escalating aggressive patients.

Design

Pretest-posttest within-and-between-groups design.

Setting

A School of Nursing in Germany.

Participants

Convenience sample out of six classes of nursing students at differing educational levels (10th to 28th month of nursing education, n = 78, mean age = 22).

Methods

In a cross-sectional and longitudinal two groups before and after design nursing students encountered two scenarios (A or B) with simulation patients. After completing the training, each student was confronted with the unknown other scenario. De-escalation experts from three German-speaking countries evaluated 156 video scenes using the De-escalating Aggressive Behaviour Scale (DABS), not knowing whether the videos had been recorded before or after the training. Mean values and statistical significance tests were computed to compare the results.

Results

The performance levels of students who had been trained rose significantly from 2.74 to 3.65 as measured by the DABS on a 5-point Likert scale (Wilcoxon test p < .001). The trained students managed scenario A significantly better than the untrained students (untrained 2.50, trained 3.70; Mann-Whitney-U-test p < .001,). Similar results were found for scenario B (untrained 3.01, trained 3.61; Mann-Whitney-U-test p < .001). No significant differences were found in the pretest results irrespective the students’ age or duration of previous nursing education.

Conclusions

Aggression management training is able to improve nursing students’ performance in de-escalating aggressive behaviour. A maturation-effect on the de-escalating performance due to general nursing education or age is unlikely.