Abstract
BackgroundTo respond better to population needs, in recent years Quebec has invested in improving the integration of services and care pathways. Nurses are on the front lines of these transformation processes, which require them to adopt new clinical practices. This updating of practices can be a source of both satisfaction and stress. The aim of this study was to gain a better understanding of the relationship between the transformation processes underlying services integration and nurses’ workplace well-being.MethodThis study was based on a descriptive cross-sectional correlational design. The target population included all nurses working in four care pathways in a Quebec healthcare establishment: palliative oncology services, mental health services, autonomy support for the elderly, and chronic obstructive pulmonary disease. In all, 107 nurses took part in the study and completed a questionnaire sent to them. Hierarchical linear regression analyses were used to examine the relationship between level of integration, measured using the Development Model for Integrated Care; nurses’ perceptions of organizational change, measured on four dimensions (challenge, responsibility, threat, control); and nurses’ workplace well-being, measured on three dimensions (negative stress, positive stress, satisfaction), as defined by the Flexihealth model.ResultsNurses in the palliative oncology care pathway, which was at a more advanced level of integration, presented a lower negative stress level and a higher positive stress level than did nurses in other care pathways. Their mean satisfaction score was also higher. More advanced integration was associated with nurses’ feeling less threatened, as well as improved workplace well-being. The perception of threat appeared to be a significant mediating variable in the relationship between level of integration and well-being.ConclusionThe association observed between level of services integration and workplace well-being contributes to a better understanding of nurses’ experiences in such situations. These results provide new perspectives on interventions that could be implemented to remedy the potential negative consequences of these types of transformations.
Highlights
To respond better to population needs, in recent years Quebec has invested in improving the integration of services and care pathways
Descriptive results regarding nurses’ perceptions of the integration processes and nurses’ well-being, by care pathways Compared to nurses in other pathways, the nurses working within the palliative oncology services (POS) pathway reported above-average perceptions of challenge, responsibility, and control, and a below-average perception of threat
It can be seen that level of integration is significantly correlated with the well-being variables—positively with positive stress and satisfaction, negatively with negative stress, and significantly negatively with the perception of threat variable
Summary
To respond better to population needs, in recent years Quebec has invested in improving the integration of services and care pathways. At the heart of each LSN is a health and social services centre (HSSC), created by merging local community health centres (CLSCs) with residential and long-term care centres (CHSLDs) and, in most cases, a hospital (CH). To fulfill their responsibility of ensuring accessibility, continuity, and quality of services for the populations they serve, HSSCs are organized into service programs that group together services and activities to meet the needs of specific populations or groups of persons with a common health or social services problem [2]. In this article we examine this relationship by exploring nurses’ perceptions of these processes
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