Spiritual perception, attitudes about spiritual care, and spiritual care practices among nurse practitioners

The purpose of the nonexperimental study was to examine the relationships among spiritual perception, attitudes about spiritual care, and spiritual care practices in nurse practitioners. Attitudes about providing spiritual care and spiritual care practices have been studied among nurse generalists, but little research has been conducted on nurses in advanced practice. All nurse practitioners registered by the state of Indiana were sent Reed's Spiritual Perspective Scale (SPS) and a modified version of the Nurses' Spiritual Care Perspectives Scale developed by Taylor, Highfield, and Amenta. Pearson correlation techniques were used to test for significant relationships. Statistically positive relationships were between perception of personal spirituality and 9 of the 12 spiritual care practices. Eight of the 13 items describing attitude toward providing spiritual care were statistically significant with the SPS. Implications of the findings are discussed.     

Preserving writing in doctoral education: exploring the concernful practices of schooling learning teaching

Preserving writing in doctoral education: exploring the concernful practices of schooling learning teaching ¶Many contemporary scholars have challenged the current culture of graduate education and have suggested a need to reform nursing scholarship. The purpose of this study was to describe and analyse the common practices and shared lived experiences of nurses who are students or teachers in doctoral education. Participants recruited from across the United States included 15 nurses, five of whom were current faculty members in doctoral programmes in nursing and 10 who were currently enrolled as students in doctoral programmes. Data collected from extended, non-structured interviews were analysed hermeneutically using the interpretive phenomenology of Heidegger and Gadamer as the philosophical background. The results of this study reveal that the practices of scholarship, reading, writing, thinking and dialogue are inseparable and belong together. Analysing and describing how the practices of scholarship belong together will contribute to extending an understanding of how the practices of writing can be preserved in contemporary doctoral education. 'Preserving' refers to how teachers and students perpetuate and sustain these practices in ways that are meaningful and transformative and in ways that are oppressive. This study explores the experiences that are central to becoming a scholar and suggests how their meaningfulness can be sustained and extended into the next millennium.     

Organizational commitment among general practitioners: A cross-sectional study of the role of psychosocial factors

Objective

To examine whether general practitioners (GP) working in primary health care have lower organizational commitment compared with physicians working in other health sectors. The authors also tested whether psychosocial factors (job demands, job control, and colleague consultation) explain these differences in commitment between GPs and other physicians.

Design

Cross-sectional postal questionnaire.

Setting and participants

A postal questionnaire was sent to a random sample of physicians (n = 5000) drawn from the Finnish Association database in 2006. A total of 2841 physicians (response rate 57%) returned the questionnaire, of which 2657 (545 GPs and 2090 other physicians) fulfilled all the participant criteria.

Main outcome measures

Organizational commitment was measured with two different indicators: intention to change jobs and low affective commitment.

Results

GPs were less committed to their organizations than other physicians. Work-related psychosocial factors (high job demands, low job control, and poor colleague consultation) were all significant risk factors for low organizational commitment.

Conclusions

The evidence collected suggests that policies that reduce psychological demands, such as job demands and low control, may contribute to better organizational commitment and, thus, alleviate the shortages of physicians in primary care. Furthermore, giving GPs a stronger say in decisions concerning their work and providing them with more variety in work tasks may even improve the quality of primary care. The strategies for workplace development should focus on redesigning jobs and identifying GPs at higher risk, such as those with especially high job strain.Key Words: Family practice, general practitioners, job demand-control-support model, organizational commitment, primary healthcare, psychosocial factorsAn increasing shortage of general practitioners (GPs) threatens the effective functioning of primary healthcare.

• We showed that general practitioners had lower organizational commitment (higher levels of intention to change jobs and lower levels of affective commitment) than physicians working in other health sectors.
• Work-related psychosocial factors (high job demands, low job control, and poor colleague consultation) were found to be significant risk factors for low organizational commitment.
• psychological demands, such as job demands and low control, may contribute to better organizational commitment and, thus, lessen the shortage of physicians in primary care.

Low commitment to one''s job influences various organizational outcomes such as high dropout rates, low job satisfaction, and low performance [1,2]. Among general practitioners (GP) organizational commitment is essential also for quality of care because GPs’ work is based on continuity of care and long-term doctor–patient relationship. However, the increasing shortage of physicians threatens the effective functioning of primary healthcare (PHC) in many countries [3,4]. Working as a GP has lost much of its attractiveness as a career option among Finnish physicians during the past 15 years [5]. Different actions have been taken to attempt to alleviate the chronic lack of GPs, for example by recruiting physicians through labour leasing companies [6]. Also the number of student places in faculties has been increased [6]. Nevertheless, the measures taken so far have not been successful in alleviating the shortage of GPs in Finland.A considerable number of studies have investigated the link between organizational commitment and psychosocial factors at work. One of the most widely studied theoretical approaches to job stress is the “Job Demand-Control-Support” (JDCS) model [7,8], which suggests that employees working under high strain – defined as high demands and low job control – have a higher risk of health problems and reduced well-being than those with no such strain. The JDCS model was initially used to explain patterns of exhaustion and job dissatisfaction [9], but was later expanded to include cardiovascular disease [10], poor health functioning [11], and sickness absenteeism [12]. The model has also been shown to predict a wide variety of motivational outcomes, such as job commitment [13–16].It has been suggested that job strain is one of the major mechanisms through which socioeconomic status affects employee well-being. According to the large body of evidence from the Whitehall II study, differences in health and well-being between civil servants of higher and lower rank are due primarily to working conditions defined by high demands and low control [17]. These results imply that high strain is more common among those working in lower than those working in higher rank occupations. Physicians are among the highest occupational groups in Finland and yet in particular those working as GPs seem to be dissatisfied with their job. It has also been suggested that of all physicians GPs have the lowest job control [18].The aim of the present study was to examine whether GPs working in PHC have lower organizational commitment (intention to change jobs and low affective commitment) compared with physicians working in other health sectors. In addition, we tested whether psychosocial factors (high job demands, low job control, and poor colleague consultation) explain the potential differences between GPs and other physicians. We took into account the potential effects of various confounding factors, such as age, gender, graduation year, specialization, being on-call, and working hours [19,15–17,20].     

Measuring practice patterns among acute care nurse practitioners

OBJECTIVE: This initiative was designed to develop a reliable instrument to measure the activities of acute care nurse practitioners (ACNPs). A sound, standardized method for measuring ACNP productivity will assist nursing leaders and administrators to demonstrate the effectiveness and productivity of ACNPs in and across institutions and systems. BACKGROUND DATA: Current research on ACNPs uses many different methodologies and research designs, and fails to provide standard definitions to measure practice patterns, making it difficult to generalize across settings. METHODS: Advisory groups from 2 New York academic health science centers developed a survey that covered the demographic, educational, and employment characteristics of ACNPs, and a 20-item classification of advanced practice nursing activities. Sixty-one ACNPs completed surveys, a 58% response rate. RESULTS: The survey found strong similarities at both institutions. ACNPs spend most of their time in 5 activities involving direct care and 4 activities within indirect care. Strong Cronbach alphas confirmed that the instrument was reliable. CONCLUSIONS/IMPLICATIONS: The availability of a reliable instrument for measuring ACNP practice patterns provides administrators with a powerful tool to demonstrate the contributions of their ACNPs. In addition, a standardized method for data collection can contribute to healthcare workforce policy discussions.     

Interventions among primary-care practitioners to improve care for preventable complications of diabetes

The National Diabetes Advisory Board recommends that diabetes prevention and control programs focus on the preventable complications of diabetes, i.e., visual impairment, lower-extremity problems, renal problems, ketoacidosis, and adverse outcomes of pregnancy. The Florida Diabetes Control Program chose to focus its efforts on the first three of these complications at the federal- and state-funded primary-care programs in Florida because these programs had access to targeted, public-sector patients and because of fiscal restraints that make the care provider the logical source of entry to the health-care system. This study sought to document the current level of care for complications of diabetes in primary-care settings, provide state-of-the-art professional education along with patient education, and evaluate changes in practice habits. Three intervention and three control primary-care centers were selected. Medical records in each center were reviewed over a 2-yr period. At intervention sites, retinopathy referrals increased from 9 to 43% (P less than .001), urinalyses increased from 69 to 94% (P less than .001), and examinations of lower extremities increased from 66 to 94% (P less than .001). There were no such changes in the control sites. Hypertension was diagnosed in nearly two-thirds of patients, and a last blood pressure of greater than 140 mmHg systolic or greater than 90 mmHg diastolic was present in 64% of the intervention group at yr 1 and declined to 56% at yr 2 (P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)     

The impact of turnover among respiratory care practitioners in a health care system: frequency and associated costs

BACKGROUND: Retention of respiratory therapists (RTs) is a desired institutional goal that reflects department loyalty and RTs' satisfaction. When RTs leave a department, services are disrupted and new therapists must undergo orientation and training, which requires time and expense. Despite the widely shared goal of minimal turnover, neither the annual rate nor the associated expense of turnover for RTs has been described. STUDY PURPOSE: Determine the rate of RT turnover and the costs related to training new staff members. METHODS: The Cleveland Clinic Health System is composed of 9 participating hospitals, which range from small, community-based institutions to large, tertiary care institutions. To elicit information about annual turnover among RTs throughout the system, we conducted a survey of key personnel in each of the hospitals' respiratory therapy departments. To calculate the costs of training, we reviewed the training schedule for an RT joining the Respiratory Therapy Section at the Cleveland Clinic Hospital. Cost estimates reflect the duration of training by various supervisory RTs, their respective wages (including benefit costs), and educational materials used in training and orientation. RESULTS: Turnover rates ranged from 3% to 18% per year. Five of the 8 institutions from which rates were available reported rates greater than 8% per year. The rate of annual turnover correlated significantly with the ratio of hospital beds to RT staff (Pearson r = 0.784, r(2) = 0.61, p = 0.02). The cost of training an RT at the Cleveland Clinic Hospital totaled $3,447.11. CONCLUSIONS: Turnover among respiratory therapists poses a substantial problem because of its frequency and expense. Greater attention to issues affecting turnover and to enhancing retention of RTs is warranted.     

Weight management practices among primary care providers

This pilot study examined how primary care providers manage patients with weight problems, an important component of primary care. A convenience sample of 17 nurse practitioners and 15 physicians were surveyed about assessments and interventions used in practice for weight management along with perceived barriers to providing effective weight management. Practice patterns between gender, profession and practice setting of the nurse practitioners were compared.     

Strangers among strangers: clients and health practitioners in health care settings

This paper describes a course assignment designed to sensitise nursing students to the meaning of the experience of being a stranger in a cultural setting where the norms and rules for behaviour are unclear or essentially unknown. This experience alerts the student to be aware of the possibility that people's usual responses to strangers in unfamiliar settings, may be an inhibitory factor in the development of a therapeutic relationship between the nurse, and other health practitioners, and their clients. Discussion is centred on the student learning which occurs, both personally and professionally, in the conduct of this assignment.     

Childhood obesity: prevention practices of nurse practitioners

PURPOSE: The purposes or this study were to (a) describe the prevention practices of nurse practitioners (NPs) regarding childhood obesity, (b) compare the practices of NPs by specialty, practice setting, and awareness of childhood obesity prevention guidelines, (c) identify relationships between prevention practices and demographic variables of NPs, and (d) examine the resources for and barriers to implementing prevention practices. DATA SOURCES: A convenience sample of 99 family NPs (FNPs) and pediatric NPs (PNPs) from the Intermountain area was used. Participants completed a questionnaire based on documented risk factors for childhood obesity as well as prevention guidelines developed by the American Academy of Pediatrics (AAP). CONCLUSIONS: NPs working in family practice or general pediatric practice settings were not consistently using the BMI-for-age index to screen for childhood obesity, as recommended by the AAP. However, they were teaching parents to promote healthy food choices and physical activity in their families. PNPs and FNPs working in a pediatric practice setting and NPs who were aware of prevention guidelines were more likely to perform several prevention strategies than FNPs working in a family practice setting and those who were unaware of guidelines. Major barriers to implementing childhood obesity prevention strategies included parental attitudes, the American lifestyle, and lack of resources for both the NP and the family. The main resources NPs used in preventing childhood obesity were a dietician, journal articles, and Web sites. IMPLICATIONS FOR PRACTICE: Although the majority of the NPs in this study reported being aware of childhood obesity prevention guidelines (73.7%), most were not consistently using BMI for age or monitoring children at increased risk for obesity. Because childhood obesity is escalating at such a rapid rate, it is critical that NPs working in family practice and pediatric practice settings take the necessary steps to help curtail obesity in childhood, including calculating BMI for age, targeting children at risk, and helping families develop healthy nutrition and physical activity habits. In addition to proper health supervision of children, NPs also need to be advocates in their communities to overcome barriers to childhood obesity prevention.     

Treatment of alcohol dependence in Swedish primary care: perceptions among general practitioners

ObjectiveTo describe general practitioners’ (GPs) attitudes to the management of patients with alcohol dependence in primary care and current treatment routines and their view on a new treatment approach; internet-based Cognitive Behavioral Therapy (iCBT).DesignA qualitative interview study with ten GPs participating in a randomized controlled trial. The interviews were analyzed using qualitative content analysis.SettingThe participating GPs were recruited via purposeful sampling from primary care clinics in Stockholm.SubjectsThe GPs were participants in an RCT investigating if iCBT when added to treatment as usual (TAU) was more effective than TAU only when treating alcohol dependence in primary care.ResultsThe GPs found alcohol important to discuss in many consultations and perceived most patients open to discuss their alcohol habits. Lack of training and treatment options were expressed as limiting factors when working with alcohol dependence. According to the respondents, routines for treating alcohol dependence were rare.ConclusionGPs believed that iCBT might facilitate raising questions about alcohol use and thought iCBT may serve as an attractive treatment option to some patients. The iCBT program did not require GPs to acquire skills in behavioral treatment, which could make implementation more feasible.

KEY POINTS

• Alcohol dependence is highly prevalent, has a large treatment gap and is relevant to discuss with patients in many consultations in primary care.
• This study is based on interviews with 10 GPs participating in a randomized controlled trial comparing internet-based Cognitive Behavioral Therapy (iCBT) for alcohol-dependent patients to treatment as usual.
• GPs viewed alcohol habits as important to discuss and they perceived most patients are open to discuss this.
• The access to iCBT seemed to increase GPs’ willingness to ask questions about alcohol and was viewed as an attractive treatment for some patients.
• The iCBT program did not require GPs to acquire skills in behavioral treatment, which might be timesaving and make implementation more feasible.