The effects of unit morale and interpersonal relations on conflict in the nursing unit

BACKGROUND: Health care organizations face major changes, and these changes are likely to increase conflict in organizations. Although numerous studies have focused on conflict management, few have considered causes and effect of conflict in nursing units. METHODS: The investigation tested a structural equation that examined the relationships among individual and contextual variables and intragroup conflict, job satisfaction, team performance effectiveness, and anticipated turnover. The nonrandom sample consisted of 141 nurses employed on 13 inpatient units at a state-supported, 597-bed academic medical centre in a southeastern city. RESULTS: Intragroup conflict was higher on smaller units with a higher ratio of RNs to total staff. Intragroup conflict was not associated with satisfaction with pay or anticipated turnover. In the final model, the unit morale and interpersonal relations dimension of team performance effectiveness was negatively associated with intragroup conflict and anticipated turnover, and positively associated with satisfaction with pay. High perceptions of unit morale and interpersonal relations buffered the effect of unit size and skill mix on intragroup conflict. Goodness of fit statistics indicated a good fit of the model to data. CONCLUSION: The findings have implications for nursing educators and administrators, and provide direction for future research.     

Depression and satisfaction with health coverage and medical care in the 1998 NRC Healthcare Market Guide survey

The purpose of the present study was to examine the relationships among ratings for depression and health-plan and medical-care satisfaction using data from the 1998 National Research Corporation Healthcare Market Guide® (HCMG) survey (N=120,855). Respondents in families in which one or more members had depression (self-report) gave lower satisfaction ratings than those in families in which no member had depression on four global and four composite satisfaction measures. Although satisfaction ratings, generally, were high and depression effects were small, the authors nevertheless recommend efforts to improve access and quality of mental health care.     

'Patient satisfaction': knowledge for ruling hospital reform--an institutional ethnography

Driven by funding restraint, Canadian health-care has undergone over a decade of significant reform. Hospitals are being restructured, as text-based practices of accountability bring a new business-orientation into hospital and clinical management. New forms of knowledge, generated through records of various sorts, are a necessary resource for managing care in the new environment. This paper's research uses Canadian sociologist Dorothy E. Smith's institutional ethnographic methodology to critically analyse one instance of text-based management. I analyse information about 'patient satisfaction' as it is generated through a patient survey (in which I was implicated through my involvement with a hospitalized family member). Subsequently, I have studied the management environment into which that information would be entered. I argue that in the instance analysed, the information becomes part of a dominant consumer oriented healthcare discourse that subordinates concerns about 'what actually happened' as a professional caregiver would have known it. On this basis, I contend that this sort of taken-for-granted approach to making decisions about quality care in hospitals may be seriously, even dangerously, flawed.     

The relationship between the application of the nursing ethical code and nurses' work satisfaction

Work satisfaction is known to be one of the major factors related to nurses' quality of care. Being able to apply the professional principles of training influences work satisfaction. The nursing ethical code is a good manifestation of these professional principles. The everyday strains on nurses' work might compromise the amount of energy invested in following the ethical code. The gap between the ethical requirements (as perceived by the nurse) and the perceived extent to which they are applied will influence work satisfaction through the mediating effect of role conflict. Demographic variables including age, tenure and number of children might also exert an effect. Structured questionnaires were used to measure the perceptions of nurses regarding their ability to follow the ethical code in a large hospital in Israel. Practical considerations meant that the questionnaire focused on client privacy issues in the ethical code. Results support the mediating hypothesis as the 'ethical gap' did not correlate directly with work satisfaction. This paper highlights that professionalization, manifested by the ethical code, should be applied on an everyday basis in the workplace.     

Twelve-hour shift on ITU: a nursing evaluation

This paper describes the introduction and subsequent evaluation of a 12-h shift system in a large ITU in the northeast of UK. To date, only a small number of studies has evaluated nurses working the 12-h shifts in critical care areas. To evaluate the level of staff satisfaction, data were collected by means of a questionnaire involving 41 nurses, at 3 months following the introduction of the 12-h shifts. The responses from the evaluation advocated the continuation of 12-h shifts with alternative shift patterns for nurses who felt dissatisfied with the current system. Twelve-hour shifts can be seen as a flexible system for nurses working in intensive care and may assist with staff satisfaction and improving nurse recruitment and retention.     

Parents' perceptions of staff competency in a neonatal intensive care unit

* The aim of this study was to explore and describe parents' perceptions of staff competency in a neonatal intensive care unit (NICU). The study set out to use a grounded theory approach that was modified because of a number of constraints. Eight parents whose babies met a number of inclusion criteria were interviewed using focused conversational interviews. They were then transcribed and thematically analysed. The research approach was modified as the study developed because of practical and ethical access reasons: the sampling strategy and lack of opportunity to exploit fully the constant comparative method. * Four key themes which conceptualize competency as caring emerged from the data: parents are facilitated to integrate into the unit and do not feel a burden; parents feel in control whilst in the unit; parents have a choice to opt out from observing tasks and procedures on their baby; parents and the interprofessional team communicate well and provide appropriate information. These are discussed in the context of available literature. * In conclusion, the results of the study serve to highlight how parents' perceptions of competence in a professional are not based solely on skills and tasks but on many caring behaviours. The grounded theory approach has generated a number of areas for exploration, in particular, ideas about the conceptual basis of caring in an NICU context and its links to competence. The caring behaviours involve learning to share responsibility with families. The findings suggest that when there is 'a handing over' of control to parents and a greater emphasis on parent support, they feel less like 'guests'. These ideas are supported by the available literature. A number of methodological issues are raised.     

The psychological contracts of National Health Service nurses

AIMS: Following the psychological contract model of the employee-employer exchange relationship is offered as a means of understanding the expectations of a UK sample of 223 National Health Service (NHS) nurses in association with their leaving intentions. DESIGN AND METHODS: A pilot study involving 21 NHS nurses, using the repertory grid technique was conducted to elicit contract expectations. Twenty-nine categories of expectation were identified through content analysis. The study proper, employed a survey developed on the basis of results from the pilot study to identify contract profiles among 223 nurses from three London/South-east NHS hospitals, using the Q-sort method. Type of contract held (relational/transactional), satisfaction (job and organization), and leaving intentions were also examined. RESULTS: Q-analysis yielded four contract profiles among the nurses sampled: 'self-development and achievement'; 'belonging and development'; 'competence and collegiality' and 'autonomy and development'. Correlation analysis demonstrated that leaving intentions were associated with a need for personal autonomy and development, and the violation of expectations for being appreciated, valued, recognized and rewarded for effort, loyalty, hard-work and achievement, negative endorsement of a relational contract, positive endorsement of a transactional contract, and job and organizational dissatisfaction. CONCLUSION: Findings illustrate the diagnostic utility of the term psychological contract for understanding the expectations of NHS nurses. The potential significance of these findings for managing nurse retention is highlighted.     

现代医院质量管理的金标准--"病人满意率"

借鉴现代企业的管理理念,探讨质量服务管理的目标就是“顾客满意”和“感动服务”,将病人满意率纳入医院质量控制的重中之重,并从医学的科学属性上阐述了实施“大质量观”的必要性,以促进医院诚信文化建设的全面提升。     

Sexual esteem,sexual satisfaction,and sexual behavior among people with physical disability

This study investigated the association between the severity and duration of physical disability and sexual esteem, sexual depression, sexual satisfaction, and the frequency of sexual behavior. A total of 1,196 participants completed the study. There were 748 participants (367 males, 381 females) who had a physical disability and 448 participants (171 males, 277 females) who were able-bodied. The age range of participants was 18–69 years, with a mean age of 36.39 years (SD = 10.41). The results demonstrated that people with more severe physical impairments experienced significantly lower levels of sexual esteem and sexual satisfaction and significantly higher levels of sexual depression than people who had mild impairments or who did not report having a physical impairment. The study also found that people with more severe physical disabilities engaged in mutual sexual activity significantly less frequently. Women with physical disabilities had significantly more positive feelings about their sexuality and significantly more frequent mutual sexual experiences than their male counterparts. For people with physical disabilities, the frequency of oral sex and nude cuddling were significant predictors of sexual satisfaction in men, while the frequency of deep kissing predicted sexual satisfaction in women. Furthermore, the viewing of erotica was significantly related to sexual dissatisfaction in men. Finally, it was found that people who had experienced their physical impairment for a longer period of time reported significantly more positive feelings about their sexuality. Implications of these findings are discussed and suggestions are made for future research.