A qualitative study on the attributes of nurses' workplace social capital in Japan

Aim

To identify attributes of nurses' workplace social capital in Japan.

Background

Much attention has been paid to nurses' workplace social capital to improve the quality of the work environment; however, few studies are available on the attributes of nurses' workplace social capital.

Methods

Semi‐structured interviews were conducted with 32 nurses at seven hospitals. Nurses reported on the attributes of workplace social capital, such as characteristics facilitating individual positive action in an organisation, which were qualitatively analysed using the Kawakita Jiro method.

Results

The attributes of nurses' workplace social capital were organised into six groups: affirmation; exchange of appreciation; unrestricted information sharing; ability to trust; access to the strength; and altruistic reciprocity.

Conclusion

The attributes of nurses' workplace social capital included a social structure that allowed nurses to make full use of their abilities both vertically and horizontally and were supported by a sense of security. In particular, newly emerged exchange of appreciation and altruistic reciprocity were important for nurses in Japan in building cooperative relationships with others.

Implications for Nursing Management

Managing human relationships, such as exchange of appreciation and altruistic reciprocity, in clinical settings based on nurses' workplace social capital may promote positive emotions in the organisation, positive ideas among staff and cooperative teamwork, which may lead to high‐quality patient care.     

Family–school nurse partnership in primary school health care

Scand J Caring Sci; 2013; 27; 195–202 Family–school nurse partnership in primary school health care Background: The foundation of the health and well‐being of a child in primary school age is the family. To promote the child’s comprehensive health, we must develop the cooperation between the family and the primary school nurse. Aim: The aim of the study was to develop a family nursing oriented substantive theory of cooperation between primary school nurses and families. Method: The study used grounded theory based on Straussian principles. Data were collected from sixth‐graders (N = 22) using group discussions. Interviews were conducted with parents (N = 19), and the views of school nurses (N = 20) on their cooperation with families were obtained via free form essays. Findings: The core concept of the theory describing cooperation between primary school nurses and families is problem‐based communication. As a result of the analysis, nine‐2‐dimensional concepts were formed to describe this cooperation. The theory is structured further by four dimensions, which contain concepts explaining them and which also describe the relationships between the different concepts. These dimensions are the meeting between the school nurse and the family, mutual exchange of information, attending to the child’s health monitoring and being at school for the child and family. The substantive theory describing cooperation between the primary school nurse and family entails the concepts formed in the analysis, their interrelationships, as well as, the core concept. Conclusions: Primary school nurses can apply the resulting theory while working with families and while developing this cooperation. This theory can also be implemented in developing nursing education.     

Changes in paced signals may predict in‐hospital cardiac arrest

1 Background

An increasing number of patients with chronic illnesses have implanted cardiac rhythm devices such as pacemakers and implantable cardioverter‐defibrillators (ICDs). This study was conducted to identify potentially useful predictors of in‐hospital cardiac arrest (I‐HCA) within paced electrocardiogram (ECG) signals from cardiovascular patients with implanted medical devices.

2 Methods

In this retrospective study of 17 subjects, full‐disclosure ECG traces prior to the time of documented I‐HCA were analyzed to determine R‐R intervals and QRS durations (QRSd).

3 Results

Ventricular paced QRSd prolongation was observed prior to I‐HCA in 10/16 (63%) subjects. QRSd was significantly greater immediately preceding cardiac arrest than during each of the 8 hours prior to cardiac arrest (P < 0.05). Heart rate changes (measured using standard deviation) within 15 minutes of cardiac arrest were significantly greater in subjects with pulseless electrical activity (PEA)/asystolic arrest compared to those with cardiac arrests due to ventricular tachycardia/ventricular fibrillation (VT/VF) (10.13 vs 3.31; P  =  0.024). Significant differences over the 8 hours preceding cardiac arrest in heart rate (74 vs 86 beats/min; P  =  0.002) and QRS duration (172 ms vs 137 ms; P < 0.001) were observed between subjects with initial rhythms of VT/VF and those with initial rhythms of PEA/asystole.

4 Conclusions

Patterns of diagnostic ECG features can be extracted from the telemetry data of patients with implanted medical devices prior to adverse events including I‐HCA. The detection of these significant changes might have an immediate prognostic impact on the timely treatment of some patients at risk of adverse events.     

Elderly Veterans Receiving Care at a Veterans Affairs Medical Center While Enrolled in Medicare-Financed HMOs : Is the Taxpayer Paying Twice?

Elderly veterans who visit our Veterans Affairs (VA) Medical Center primary care clinic often mention they are enrolled in HMOs. Approximately 20% of patients hospitalized at our facility report health insurance coverage. Of 1,000 hospitalizations during a 6-month period in which veterans reported insurance coverage, 337 involved elderly veterans. Of these 337 hospitalizations, 218 (65%) were for 174 veterans who stated they were enrolled in a Medicare-financed HMO. The VA's Medical Care Cost Recovery Program deemed only 46 (21%) of the hospitalizations billable and received reimbursement for 20 (9%). Thus, the VA is providing costly services already paid for by the Health Care Financing Administration under prepaid capitation contracts, and recovers minimal reimbursement from the HMOs.
KEY WORDS: veterans; elderly; Medicare; HMOs; health care financing.