Psychodynamic perspectives on organizational change and their relevance to Transformational Practice Development

Walsh KD, Crisp J, Moss C. International Journal of Nursing Practice 2011; 17 : 205–212 Psychodynamic perspectives on organizational change and their relevance to Transformational Practice Development In this paper we draw on the organizational psychodynamic literature, from Menzies 1960 seminal work to contemporary writers such as Manfred Kets de Vries and Adrian Carr as well as our own experience to highlight three critical paradoxes in the psychodynamics of health services. The paper highlights that behaviour and ways of interacting are influenced by intrapersonal mechanisms; and these mechanisms are critically important in the evolution of workplace cultures, and markedly influence organizational functioning. These mechanisms (and the paradoxes they pose) need to be considered in any initiative, such as Practice Development, that seeks to engage staff in workplace reform. By better understanding the psychodynamics of the workplace, we will in turn be better able to understand the mechanisms underlying the success of Practice Development processes, use these more deliberately and develop new and better processes in order to further improve the efficacy of Transformational Practice Development as an approach to practice change.     

Nurse managers’ narratives of organizational change in the English National Health Service

Aims To investigate nurse managers’ accounts of organizational change. Background While the importance of the ward manager role in delivering quality care is recognized, less is known about ward managers’ involvement in change. Methods Face to face qualitative narrative interviews were conducted. They were audio recorded, transcribed verbatim and analysed thematically. Results Managers were experiencing change that was occurring at an increasing rate. They reported that being effective communicators was central to their approach to managing change. The hybrid nature of the role informed their approach to change and enabled them to initiate and control it to a degree at ward/department level. They did not base their management approach on theory and focused activity more on the practical and contextual nature of change. Implications for nursing management Organizational change has attracted a great deal of attention in research terms; however, there are few studies that examine nurse managers’ experiences of change. The accumulated expertise and experience of this group of staff is an untapped resource in terms of mobilizing organizational change in hospitals in England. More attention to work-based learning and support would assist managers in their role.     

我国部分三级综合医院护理质量管理组织架构调查与分析

目的调查我国三级综合医院护理质量管理组织架构。方法对全国85所医院相关护理人员进行问卷调查,并采用半结构式访谈法对其中11所医院护理质量管理专家进行访谈。结果90.6%的医院护理质量管理采用三级管理;85所医院均设有护理质量管理委员会,其中9.4%的委员会中缺少护士长参与,54.1%的护理质量管理委员会由护理队伍独立组成;访谈资料归纳出3个主题为;护理质量管理组织架构和运行方式较成熟,但仍需改进;希望多部门共同参与护理质量管理以及对目前护理质量管理组织架构的建议。结论建议优化护理质量管理三级模式和运行方式,建立多部门合作机制.鼓励护士长参与质量控制,并根据医院自身实际调整护理质量管理架构,以促进护理质量持续改进。     

ON BEING AN OBSERVING PARTICIPANT IN A THERAPEUTIC INSTITUTION

The author builds on two areas of Bob Hinshelwood's work, the Cassel Hospital and institutional observation. He shows how being an observer of oneself and the institution one is working in may lead to a more balanced approach that acknowledges different levels of the organization and their tensions, instead of being caught up in them. He describes a crisis on his unit, the various institutional levels involved in generating the crisis and his way of dealing with it.     

Intent to sustain use of a mental health innovation by school providers: What matters most?

Despite innovations being routinely introduced in schools to support the mental health of students, few are successfully maintained over time. This study explores the role of innovation characteristics, individual attitudes and skills, and organizational factors in school providers’ decisions to continue use of Centervention, a technology-based tool that supports implementation of evidence-based mental health interventions (EBIs). Data were collected from 44 providers through online surveys following use of Centervention over a one-year period. When considered with individual and organizational factors, experience with Centervention (usability, usefulness and satisfaction) was found to be the most influential predictor of intent to sustain use. Results reinforce the importance of (1) differentiating between factors that predict initial adoption vs. those that enable sustainability and (2) tailoring sustainability decision models to the nature of the innovation. They also support the need to incorporate strategies to enhance provider experience during implementation of an innovation.     

恢复体验对医护人员工作绩效的影响机制研究

目的 探讨恢复体验对医护人员工作绩效的路径关系和作用机制,为管理者提供参考依据。方法 2020年5至7月选取湖北省武汉市和孝感市的6所综合性公立医院307名医护人员作为研究对象进行调查,调查内容主要包括恢复体验、职业幸福感、组织支持感和医护人员工作绩效等。运用SPSS 25.0、Mplus7.4等软件对数据进行相关分析、验证性因子分析、中介效应检验、调节效应检验等。结果 恢复体验正向影响医护人员工作绩效,差异有统计学意义(P0.05);职业幸福感在恢复体验与医护人员工作绩效之间起到部分中介作用,差异有统计学意义(P0.05);组织支持感显著正向调节职业幸福感与医护人员工作绩效的关系,差异有统计学意义(P0.05);组织支持感显著正向调节职业幸福感在恢复体验与医护人员工作绩效之间的中介作用,差异有统计学意义(差异值分别为0.34和0.09,95%的置信区间分别为0.14到0.43、0.04到0.15,均不包含0)。结论 研究从理论上揭示了恢复体验影响医护人员工作绩效的内在心理机制。提示医院管理者应重视医护人员的心理诉求,引导医护人员树立正确的幸福观,追求职业幸福,提供必要的组织支持,采取多种措施帮助医护人员恢复体验。     

Ciliogenesis and autophagy are coordinately regulated by EphA2 in the cornea to maintain proper epithelial architecture

PurposeTo understand the relationship between ciliogenesis and autophagy in the corneal epithelium.MethodssiRNAs for EphA2 or PLD1 were used to inhibit protein expression in vitro. Morpholino-anti-EphA2 was used to knockdown EphA2 in Xenopus skin. An EphA2 knockout mouse was used to conduct loss of function studies. Autophagic vacuoles were visualized by contrast light microscopy. Autophagy flux, was measured by LC3 turnover and p62 protein levels. Immunostaining and confocal microscopy were conducted to visualize cilia in cultured cells and in vivo.ResultsLoss of EphA2 (i) increased corneal epithelial thickness by elevating proliferative potential in wing cells, (ii) reduced the number of ciliated cells, (iii) increased large hollow vacuoles, that could be rescued by BafA1; (iv) inhibited autophagy flux and (v) increased GFP-LC3 puncta in the mouse corneal epithelium. This indicated a role for EphA2 in stratified epithelial assembly via regulation of proliferation as well as a positive role in both ciliogenesis and end-stage autophagy. Inhibition of PLD1, an EphA2 interacting protein that is a critical regulator of end-stage autophagy, reversed the accumulation of vacuoles, and the reduction in the number of ciliated cells due to EphA2 depletion, suggesting EphA2 regulation of both end-stage autophagy and ciliogenesis via PLD1. PLD1 mediated rescue of ciliogenesis by EphA2 depletion was blocked by BafA1, placing autophagy between EphA2 signaling and regulation of ciliogenesis.ConclusionOur findings demonstrate a novel role for EphA2 in regulating both autophagy and ciliogenesis, processes that are essential for proper corneal epithelial homeostasis.