The impact of patients’ gender,race, and age on health care professionals’ pain management decisions: An online survey using virtual human technology

Background

Previous literature indicates that biases exist in pain ratings. Healthcare professionals have been found to use patient demographic cues such as sex, race, and age when making decisions about pain treatment. However, there has been little research comparing healthcare professionals’ (i.e., physicians and nurses) pain decision policies based on patient demographic cues.

Methods

The current study used virtual human technology to examine the impact of patients’ sex, race, and age on healthcare professionals’ pain ratings. One hundred and ninety-three healthcare professionals (nurses and physicians) participated in this online study.

Results

Healthcare professionals assessed virtual human patients who were male and African American to be experiencing greater pain intensity and were more willing to administer opioid analgesics to them than to their demographic counterparts. Similarly, nurses were more willing to administer opioids make treatment decisions than physicians. There was also a significant virtual human-sex by healthcare professional interaction for pain assessment and treatment decisions. The sex difference (male > female) was greater for nurses than physicians.

Conclusions

Results replicated findings of previous studies using virtual human patients to assess the effect of sex, race, and age in pain decision-making. In addition, healthcare professionals’ pain ratings differed depending on healthcare profession. Nurses were more likely to rate pain higher and be more willing to administer opioid analgesics than were physicians. Healthcare professionals rated male and African American virtual human patients as having higher pain in most pain assessment and treatment domains compared to their demographic counterparts. Similarly the virtual human-sex difference ratings were more pronounced for nurses than physicians. Given the large number of patients seen throughout the healthcare professionals’ careers, these pain practice biases have important public health implications. This study suggests attention to the influence of patient demographic cues in pain management education is needed.     

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.     

Predictors of home death of home palliative cancer care patients: a cross-sectional nationwide survey

Objectives

To identify factors influencing the place of death among home palliative cancer care patients, focusing on the role of nurses in terms of pre- and post-discharge from hospital to home care settings.

Design, settings and participants

A cross-sectional nationwide questionnaire survey was conducted at 1000 randomly selected homecare agencies in Japan. The questionnaires were completed by primary community nurses of home palliative patients just after their discharge. A total of 568 responses were analyzed (effective response rate, 69%).

Results

Multivariate logistic regression analysis revealed the following independent factors of place of death among those patients: desire for home death at referral by both patient and family caregiver; caregiver relationship to patient as daughter or daughter-in-law; totally bedridden functional status of patient; patient not suffering from depression and/or anxiety at referral; patients and caregivers duly informed about the dying process/death in detail, as well as instructed by community nurses about pain management and how to treat/prevent bedsores in home care settings.

Conclusions

This study demonstrated the importance of both the hospital and community nurses’ role in increasing the patients’ chance of dying at home. Hospital nurses should support early transfer to home palliative care according to their assessment of the desire of patient/family caregiver for home death, the patients’ clinical status, and caregivers’ ability to provide patient care at home. Community nurses should inform patients/family caregiver in detail about the dying process/death just after discharge, relieve patient pain, treat/prevent bedsores, and instruct family caregivers on their symptom control.     

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.     

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.     

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.     

Investigating patient characteristics on pain assessment using virtual human technology

Pain assessment and treatment is challenging and can be influenced by patient demographic characteristics. Few research studies have been able to specifically examine these influences experimentally. The present study investigated the effects of patients’ sex, race, age, and pain expression on healthcare students’ assessment of pain and pain‐related sequelae using virtual human (VH) technology. A lens model design was employed, which is an analogue method for capturing how individuals use environmental information to make judgments. In this study, decision‐making policies were captured at the nomothetic and idiographic level. Participants included 107 healthcare students who viewed 32 VH patients that differed in sex, race, age, and pain expression in an online study. Participants provided ratings on a 100‐point scale on the VH pain intensity, pain unpleasantness, negative mood, coping, and need for medical treatment. Nomothetic analyses revealed that female, African–American, older, and high pain expression VH were rated higher than male, Caucasian, younger, and low pain expression VH, respectively, on most of the five ratings. Idiographic analyses revealed detailed findings for individuals’ decision‐making policies. VH technology and the lens model design were shown to be highly effective in examining individuals’ decision‐making policies. Pain assessment often varied among individuals based on patient demographic and facial expression cues. This study could serve as a model for future investigations of pain assessment and treatment in healthcare students and providers.     

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.     

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.     

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.     

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.     

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.     

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.     

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

Aim

To explore the mechanisms through which nurse practice environment dimensions are associated with job outcomes and nurse-assessed quality of care. Mediating variables tested included nurse work characteristics of workload, social capital, decision latitude, as well as burnout dimensions of emotional exhaustion, depersonalization, and personal accomplishment.

Background

Acute care hospitals face daily challenges to their efforts to achieve nurse workforce stability, safety, and quality of care. A body of knowledge shows a favourably rated nurse practice environment as an important condition for better nurse and patient outcome variables; however, further research initiatives are imperative for a clear understanding to support and guide the practice community.

Design

Cross-sectional survey.

Method

Grounded on previous empirical findings, a structural equation model designed with valid measurement instruments was tested. The study population was registered acute care nurses (N = 1201) in two independent hospitals and one hospital group with six hospitals in Belgium.

Results

Nurse practice environment dimensions predicted job outcome variables and nurse ratings of quality of care. Analyses were consistent with features of nurses’ work characteristics including perceived workload, decision latitude, and social capital, as well as three dimension of burnout playing mediating roles between nurse practice environment and outcomes. A revised model adjusted using various fit measures explained 52% and 47% of job outcomes and nurse-assessed quality of care, respectively.

Conclusion

The study refines understanding of the relationship between aspects of nursing practice in order to achieve favourable nursing outcomes and offers important concepts for managers to track in their daily work. The findings of this study indicate that it is important for clinicians and leaders to consider how nurses are involved in decision-making about care processes and tracking outcomes of care and whether they are able to work with physicians, superiors, peers, and subordinates in a trusting environment based on shared values. The involvement of nurse managers at the unit level is especially critical because of associations with nurse work characteristics such as decision latitude and social capital and outcome variables. Further practice and research initiatives to support nurses’ involvement in decision-making process and interdisciplinary teamwork are recommended.