Care Work Environment Research Articles

Nurses’ Experiences at the Intensive Care Unit for COVID-19 in Indonesia: A Study of Hermeneutic Phenomenology

Background: Nurses working in Intensive Care Unit (ICU) for COVID-19 are more at risk as they interact more with infected patients. Therefore, this study aimed to explore the experience of Indonesian nurses who work in ICU for COVID-19 patients. Materials and Methods: A qualitative hermeneutic phenomenological approach was used. A total of 20 nurses working in the respective ICUs of eight COVID-19 referral tertiary hospitals in Indonesia were recruited using purposive sampling. Semistructured individual video call interviews were conducted in June–September 2021; then, Diekelmann’s hermeneutic phenomenological approach was used to analyze and interpret the data. Results: Thirteen subthemes describing the following four themes, namely, the pleasing and bad feelings, new challenges of working, nursing professional growth, and nurse resource management for COVID-19 . Conclusions: This study describes nurses’ experiences working in ICUs during the COVID-19 crisis, such as their feelings, perceived challenges, and received support. Nurse leaders play a significant role in providing adequate Personal Protective Equipment (PPE), flexible work shifts, and a caring and healing work environment. However, being aware of the limit of pressure that an individual can manage and providing adequate allowance as rewards for work in risky areas are essential to avoid burnout.

General practitioner and nurse experiences of type 2 diabetes management and prescribing in primary care: a qualitative review following the introduction of funded SGLT2i/GLP1RA medications in Aotearoa New Zealand.

To explore the views of general practitioners (GPs) and nurses on type 2 diabetes (T2D) management, including the use of recently funded T2D medications in New Zealand (NZ) and their perceived barriers to providing optimal care. T2D is a significant health concern in NZ, particularly among Māori and Pacific adults. Characterised by prolonged hyperglycaemia, T2D is generally a progressive condition requiring long-term care. Semi-structured interviews were conducted between July and December 2022 with 21 primary care clinicians (10 GPs and 11 nurses/nurse prescribers) from nine different general practice clinics across the Auckland and Waikato regions of NZ. Framework analysis was conducted to identify common themes in clinicians' perceptions and experiences with T2D management. Three themes were identified: health-system factors, new medications, and solution-based approaches. Lack of clinician time, healthcare funding, staff shortages, and burn-out were identified as barriers to T2D management under health-system factors. The two newly funded medications, empagliflozin and dulaglutide, were deemed to be a positive change for T2D care in that they improved patient satisfaction and clinical outcomes, but several clinicians were hesitant to prescribe these medications. Participants suggested that additional education and specialist diabetes support would be helpful to inform optimal medication prescribing and that better use of a multi-disciplinary team (clinical and support staff) could support T2D care by reducing workload, addressing cultural gaps in healthcare delivery, and reducing burnout. An improved primary care work environment, including appropriate professional development to support prescribing of new medications and the value of collaboration with a non-regulated workforce, may be required to facilitate optimal T2D management in primary care. Future research should focus on interventions to increase support for both clinical teams and patients while adopting a culturally appropriate approach to increase patient satisfaction and improve health outcomes.

Fostering Psychological Safety and Supporting Mental Health Among Cardiovascular Health Care Workers: A Science Advisory From the American Heart Association.

The psychological safety of health care workers is an important but often overlooked aspect of the rising rates of burnout and workforce shortages. In addition, mental health conditions are prevalent among health care workers, but the associated stigma is a significant barrier to accessing adequate care. More efforts are therefore needed to foster health care work environments that are safe and supportive of self-care. The purpose of this brief document is to promote a culture of psychological safety in health care organizations. We review ways in which organizations can create a psychologically safe workplace, the benefits of a psychologically safe workplace, and strategies to promote mental health and reduce suicide risk.

Effect of Caring Behaviour: A Study Protocol of Caring-based Education Program

Caring behaviour is essential and crucial to nursing, and it has become an important component in providing appropriate nursing care to patients. This study aims to determine the effect(s) of a caring-based education program on critical care nurses' caring behaviour, efficacy, and work environment. This study will employ a quasi-experimental design with two groups: control (n = 40) and intervention (n = 40) from critical care settings in Penang public hospitals. The data will be analyzed using descriptive and inferential analysis; Pearson correlation coefficient, independent t-test, analysis of variance (ANOVA), and paired t-test.

Fostering Excellence in Health Care: The Imperative for Ethical Leadership Training for Nurse Leaders

Nurses and nurse leaders comprise the largest segment of the healthcare workforce and take on significant responsibility as advocates for patients, families, and their teams. As gatekeepers for safe, quality patient care and healthy work environments for their teams, nurse leaders navigate complex and often chaotic situations that require ethical assessment, analysis, and decision-making. Nurse leaders equipped with ethical knowledge, skills, and behaviors lead with strengthened confidence and reduced moral distress. This paper examines the importance of ethical leadership in healthcare; why formal training beyond academic preparation is vital; and how leaders can advocate for ongoing support and development. (99)

Setting new priorities for nursing research: The updated Swiss Nursing Research Agenda-a systematic, participative approach.

To identify current key areas for nursing research in Switzerland, we revised the Swiss Research Agenda for Nursing (SRAN) initially published in 2008. By developing a research agenda, nursing researchers internationally prioritize and cluster relevant topics within the research community. The process should be collaborative and systematic to provide credible information for decisionmakers in health care research, policy, and practice. After a participative, systematic, and critical evaluation within and outside of the Swiss Association for Nursing Science, the updated SRAN 2019-2029 defines four research priorities (new models of care, nursing care interventions, work and care environment, and quality of care and patient safety) and four transversal themes (organization of research, research methodologies, research in health care policy and public health perspectives). Adding to other national nursing research agendas, the categories are organized in a framework of key research priorities and transversal themes. They relate to the importance of global and local foci of research as well as challenges in health care services and policy systems. The agenda is an important prerequisite for enhancing the influence of nursing research in Switzerland and provides guidance for the next decade. The revised agenda ensures that research projects target key knowledge gaps and the discipline's core questions in respective countries. Nursing research should inform and influence health policy on all institutional and political levels. Therefore, the integration of public health perspectives in research is one of the most important new aspects of SRAN 2019-2029.

Engaging healthcare professionals and patient representatives in the development of a quality model for hospitals: a mixed-method study.

Top-down and externally imposed quality requirements can lead to improvement but do not seem as sustainable as intended. There is a need for a quality model that intrinsically motivates healthcare professionals to contribute to quality and safe care in hospitals. This study shows how a quality model that matches the identity and the quality vision of the organization was developed. A multimethod design with three phases was used in the development of the model at a large teaching hospital in Belgium. In the first phase, 14 focus groups and 19 interviews with staff members were conducted to obtain an overview of the quality and safety challenges, complemented by a plenary discussion with the members of the patient advisory council. In the second phase, the challenges that had been captured were further assessed using a hospital-wide survey for all hospital staff. Finally, a newly established quality review board (with internal and external stakeholders) critically evaluated the input of Phases 1 and 2 and defined the basic quality standards to be implemented in the hospital. A first evaluation 2 years after the implementation was conducted based on (i) patients' perceptions of quality of care and patient safety by publicly available indicators collected in 2016, 2019, and 2022 and (ii) staff experiences and perceptions regarding the acceptability of the new model gathered through (grouped) interviews and an open questionnaire. The quality model consists of eight broad themes, including norms for the hospital staff (n = 27), sustained with quality systems (n = 8), and organizational support (n = 6), with aid from adequate management and leadership (n = 6). The themes were converted into 46 standards. These should be supported within a safe, efficient, and caring work environment. The new model was launched in the hospital in June 2021. The evaluation shows a significant difference in quality and safety on different dimensions as perceived by hospitalized patients. The perceived added value of the participatory model is a better fit with the needs of employees and the fact that the model can be adjusted to the specific context of the different hospital departments. The lack of hard indicators is seen as a challenge in monitoring quality and safety. The participation of various stakeholders inside and outside the organization in defining the quality challenges resulted in the creation of a participatory quality model for the hospital, which leads towards a better-supported quality policy in the hospital.

RECRUITING AND RETAINING NURSES AND FRONTLINE CARE WORKERS IN LONG-TERM CARE: THE REACH REALIST REVIEW

Abstract Introduction increasing demand for care, high staff turnover and low numbers of new staff are causing significant staff shortages in the long-term-care (LTC) sector. Solutions need to 1) take the heterogeneity of organisational and staff characteristics into account, and 2) make use of the large volume of literature describing the reasons staff join and stay in LTC work. Our research aimed to develop strategies which attract, recruit and retain Registered Nurses and frontline care workers in LTC; explain how and why strategies are effective, for which staff, the conditions needed, and the costs involved. Method This realist review involved (i) co-developing strategies and initial programme theories, (ii) systematically searching the evidence to test IPTs and develop theoretical propositions, and (iii) validating and refining propositions with stakeholder groups. Results IPTs around the following strategies were rated as important for attracting, recruiting and retaining staff in LTC, and taken forward to the testing phase of our review: rewarding and recognising staff, offering flexible working, career development opportunities, enhanced salary package, welcoming and inducting staff, listening to and providing staff feedback, developing caring work environments and effective staff interviewing. Leadership, caring cultures, teamwork, resources and adequate staffing levels are important conditions which enable these strategies lead to positive outcomes. Discussion this is the first study to use a realist approach to developing strategies focused on attracting, recruiting and retaining the LTC workforce. Our findings will be relevant at an international level. Acknowledgement: we thank Karen Winterburn and Edna Feenan for their important input throughout the project. They have both provided care home family perspectives, and have been involved throughout the development and execution of the project.

Challenging Organizational Factors Associated With Admission Delay to Intensive Care Unit-A Novel Quality Indicator.

Delays in admitting patients to the intensive care unit (ICU) can defer the timely initiation of life-sustaining therapies and invasive monitoring, jeopardizing the success of the treatment. Nevertheless, the availability of research on interventions that reduce or minimize admission delays is limited. The current study aimed to assess the factors related to delays in admission times of critically ill patients transferred to the ICU. A software was designed to follow-up, compare and measure the defined intervals of the time to admission, implemented at the ICU for 6 months. Measurements included 5 time intervals, referral department, and work shift at admission. Data from 1004 patients admitted to the ICU between July 2017 and January 2020 were analyzed in a retrospective observational study. Precisely, 53.9% of total patients were referred from the hospital emergency department, and 44% were admitted during the evening shift. Significant differences were found in time intervals between shifts, showing the morning round had the longer total admission time (median: 67.8 min). Analysis showed that admission time was longer at times of full capacity compared to times of available bed (mean: 56.4 and 40.2 min, respectively; U = 68,722, p < .05). Findings demonstrated a significant shortening of time to admission after implementing a new time monitoring software by the Institutional Quality Control Commission (U = 5072, p < .001). Our study opens doors for potential studies on applying effective initiatives in critical care settings to improve patient care and outcomes. Additionally, it generates new insights regarding how clinicians and nursing teams can jointly develop and promote multidisciplinary interventions in intensive care work environments.

Job insecurity and survivor workplace behavior following COVID-19 layoff

PurposeThis study aims to investigate the impact of job insecurity (JI) on employee work performance (WP) and service innovation behavior (SIB). It further examines the mediating role of affective commitment (AC) and the moderating role of organizational cynicism and financial job dependence (FJD).Design/methodology/approachBy using a three-wave approach, the hypotheses were tested by collecting data from 473 full-time employees and their supervisors in the Thai hotel industry.FindingsThe results demonstrated that JI negatively affected WP and SIB. AC mediated these relationships. FJD moderated these relationships such that at high levels of job dependence, the negative relationships were weaker.Research limitations/implicationsHuman resource managers may reduce the negative effects of JI by creating a supportive and caring work environment through open communication. They may communicate openly with employees about the challenges the organization is facing, and involve them in planning, decision-making and implementation to mitigate the negative effects of JI. They may also provide training and development opportunities to help employees build their skills and increase their value to the organization.Originality/valueResearch on the behavioral consequences of JI is scant in the hospitality sector. Drawing on job–demand resource theory, this study attempts to fill this gap.

Exploring the Relationship Between Psychological Capital and Turnover Among New Nurses

The COVID-19 pandemic drastically changed the health care work environment and exacerbated workplace demands and stress. New graduate nurses (NGNs) transitioning into their first registered nurse role were not exempt. Little is known about the emotional well-being of NGNs during the COVID-19 pandemic. In this article, we share NGN psychological capital (PsyCap) trends from 2019 to 2022 and explore the relationship between NGN PsyCap and turnover. Organizational, leadership, and individual implications for practice are discussed. Findings from this study can help health care leaders tailor emotional development and coping strategies for this important segment of the nursing workforce.

“Doc in the Box”: The impact of an emergency department move on interprofessional collaboration, patient care, and clinician job satisfaction

ObjectiveHealth care organizations undergo unit space reconfiguration (e.g., expansion) projects in order to accommodate rising patient volumes with limited health care space. The purpose of this study was to describe the impact of an emergency department physical space move on clinician-perceived interprofessional collaboration, patient care delivery, and clinician job satisfaction. MethodA secondary qualitative, descriptive data analysis of 39 in-depth interviews from an ethnography was conducted from August 2019 to February 2021 at an academic medical center emergency department with nurses, physicians, and patient care technicians in the Southeastern United States. The Social Ecological Model was a conceptual guide for the analysis. ResultsThree study themes, “It’s like an old dive bar”, “spatial blind spot”, and “privacy and aesthetic work environment” emerged from the 39 interviews. Clinicians perceived that the move from a centralized to decentralized work space impacted interprofessional collaboration through divided clinician work spaces. Increased square footage in the new emergency department was beneficial for patient satisfaction but contributed to difficulty monitoring patients for care escalation. However, increased space and individualized patient rooms increased perceived clinician job satisfaction. ConclusionSpace reconfiguration projects inhealth carecan have positive implications for patient care, but may result in inefficiencies to the health care team and patient care that must be considered. Study findings inform health care work environment renovation projects on an international level.

Supporting Mental Health and Psychological Resilience Among the Health Care Workforce: Gaps in the Evidence and Urgency for Action.

Since the COVID-19 pandemic started, health care workers have faced various challenges to their mental health due to extreme working conditions. Yet these workers have continued to deliver care in the face of stressors and death among their patients, family, and social networks. The pandemic highlighted weaknesses within our health care work environment, especially pertaining to a need to provide increased psychological resilience to clinicians. There has been little research to determine the best practices for psychological health in workplaces and interventions to improve psychological resilience. Although some studies have attempted to provide solutions, there are noteworthy gaps in the literature on effective interventions to use in the time of crisis. The most common include an absence of preintervention data concerning the overall mental well-being of health care workers, inconsistent application of interventions, and a lack of standard assessment tools across studies. There is an urgent need for system-level strategies that not only transform the way workplaces are organized, but also destigmatize, recognize, support, and treat mental health conditions among health care workers. There is also need for more evidence-based resources to improve resilience on the job, and thereby increase clinicians' capacity to address new medical crises. Doing so may mitigate rates of burnout and other psychological conditions in times of crisis among health care workers.

Adapting the Healthy Work Environment Assessment Tool for French-Canadian Intensive Care Nurses.

Self-administered instruments are used to measure components of work environments that cannot be measured directly. The Healthy Work Environment Assessment Tool (HWEAT) of the American Association of Critical-Care Nurses is a promising instrument. However, it is available only in English and Japanese, precluding its use in other populations and cross-national comparisons. To describe the Canadian French translation and cross-cultural adaptation of the HWEAT (F-HWEAT) and to explore its factor structure and psychometric properties. Cross-cultural adaptation of the HWEAT and collection of evidence of validity via an electronic cross-sectional survey. A total of 564 intensive care unit nurses participated in the validation study. Confirmatory factor analysis supported the presence of a single overarching factor measured by the F-HWEAT. The Cronbach α for the instrument was 0.89 (95% CI, 0.88-0.91). The mean and median interitem correlations were both 0.32, and item-partial total correlations ranged from 0.33 to 0.64. The overall F-HWEAT score indicated that nurses believed their work environment needed improvements. Moderate positive correlations were found between the overall F-HWEAT score and nurses' perceptions of care quality (r = 0.45 [95% CI, 0.38-0.51]) and safety (r = 0.48 [95% CI, 0.40-0.55]). The results support the use of the F-HWEAT in French-speaking populations. Using the F-HWEAT will help elucidate areas needing improvement and expand global dialogues about healthy critical care work environments. With this information, nurse leaders and researchers can develop and implement modern strategies to improve the work conditions of intensive care unit nurses.

An Exploratory Examination of the Effect of Self-Care Practices on Job Satisfaction and Organizational Commitment

ABSTRACT Purpose The National Association of Social Workers encourages self-care among practitioners. Self-care may prevent secondary traumatic stress, however, research examining self-care and other employee-related outcomes is dearth. Job satisfaction and organizational commitment are important for client, employee, and agency outcomes, but self-care’s role is unclear. Methods The relationship between employee self-care practices, job satisfaction, and organizational commitment was considered among 137 practitioners from a single US state during the Covid-19 pandemic. Results Job satisfaction was positively correlated with tenure, caring workplaces, and professional self-care. Organizational commitment was positively associated with hours worked, caring work environments, and professional self-care. Discussion Professional self-care was the most important self-care domain for job satisfaction and organizational commitment, but the least utilized form of self-care. Findings suggest the need to nurture organizational cultures emphasizing the importance of professional self-care and climates emphasizing employee safety during pandemics. Conclusion Replication among larger samples with representation from gender diverse and BIPOC practitioners is recommended.

Assessment of the Critical Care Work Environment of Intensive Care Unit Nurses in Saudi Arabia.

Nurses play a major role in the delivery of complex and challenging critical care in intensive care units (ICUs). Assessment of work environment is essential indicators of hospital management and can be applied to workforce planning and identifying nursing profession needs. The American Association of Critical-Care Nurses (AACN) recognized six standards for a healthy work environment and developed the Healthy Work Environment Assessment Tool (HWEAT). The aim of this study was to assess the work environment of ICU nurses in Jazan, Saudi Arabia. This cross-sectional study was conducted at public and private hospitals. Data were collected using a self-administered questionnaire that included the sociodemographic characteristics and the AACN HWEAT. Data were analyzed to obtain descriptive and inferential statistics. The Mann-Whitney U and Kruskal-Wallis tests were employed to compare demographic data, on the basis of the overall mean HWEAT score. The study participants were 238 ICU nurses, who were predominantly female (83%). The mean overall HWEAT score was 3.55±1.03, which is within the "good" range, and was higher for male nurses (3.66), nurses aged ≥41 years (3.76), and nurses with postgraduate education (4.04), work experiences of >10 years (3.63), and alternate work shifts (3.6). Nurses in private hospitals had significantly higher overall scores than nurses in public hospitals (3.83 vs 3.19, P<0.001). All HWEAT standards ("effective decision-making", "authentic leadership", "appropriate staffing", "true collaboration", "skilled communication", and "meaningful recognition") were rated as good (mean range, 3.43-3.63). The study results could assist hospitals in prioritizing the adoption of AACN HWE standards. A target benchmark of "good" was established for both the overall score and each standard, which indicates a good work environment as perceived by ICU nurses. In Addition, interpersonal differences should be considered when developing improvement initiatives.

Factors Influencing Nursing Practice for Physical Restraints among Nurses in the Intensive Care Unit

Purpose : This study aimed to identify the factors influencing physical restraint-related practice among nurses working in the intensive care unit (ICU).Methods : The participants consisted of 169 ICU nurses in three general hospitals in B and U cities. Data were collected from December 2021 to January 2022 through a structured selfadministered questionnaire. Demographic characteristics, physical restraint-related practice, Person-centered Critical Care Nursing (PCCN), work environment, and attitudes toward physical restraint use were measured. For data analyses, hierarchical multiple regressions were conducted using SPSS/WIN 25.0.Results : Clinical careers in the ICU, better work environments, higher PCCN levels, and more positive attitudes toward physical restraint use were associated with a better practice of physical restraints, which together explained 35.5% of the total variance of the outcome.Conclusion : Our findings suggest that to promote a safe physical restraintrelated practice among ICU nurses, it is important to improve the nursing environment, prepare guidelines for applying PCCN, and provide education for endorsing positive attitudes toward the use of physical restraints.

Appropriate Staffing After the Pandemic: A New Challenge for Healthy Work Environments

Appropriate Staffing After the Pandemic: A New Challenge for Healthy Work Environments

Medical-surgical nurse leaders' experiences with safety culture: An inductive qualitative descriptive study.

The aim of this study is to describe safety culture as experienced by medical-surgical nurse leaders. Safety culture remains a barrier in safer patient care. Nurse leaders play an important role in creating and supporting a safety culture. We used an inductive qualitative descriptive study using semistructured interviews, document review and observations in a Midwestern community hospital in the United States. Results of the study are as follows: making sure nurses are keeping patients safe, making sure nurses have nursing interventions in place, expecting nurses to stop unsafe acts or escalate when they feel uncomfortable, making sure nurses have what they need to provide safe care, organization prioritizes patient safety and making sure nurses are learning and growing emerged as themes describing safety culture. Nurse leaders made sure patients were safe by making sure everyone was doing their best to provide safe care. Insufficient time, too many priorities, insufficient resources, poor physician behaviours and lack of respect for their role emerged as barriers to leading a safety culture. Organizations must remove barriers for nurse leaders to develop and lead a safety culture. Nurse leaders must learn to advocate successfully for safe nursing care and professional work environments.

Diagnosing, Managing, and Supporting Return to Work of Adults With Rotator Cuff Disorders: A Clinical Practice Guideline.

OBJECTIVE: To develop a clinical practice guideline covering the assessment, management, and return to work of adults with rotator cuff disorders. DESIGN: Clinical practice guideline. METHODS: Using systematic reviews, appraisal of the literature, and an iterative approach to obtain consensus from key stakeholders, clinical recommendations and algorithms were developed in the context of the health care system and work environment of the province of Quebec (Canada). RESULTS: Recommendations (n = 73) and clinical decision algorithms (n = 3) were developed to match the objectives. The initial assessment should include the patient's history, a subjective assessment, and a physical examination. Diagnostic imaging is only necessary in select circumstances. Acetaminophen, nonsteroidal anti-inflammatory drugs, and injection therapies may be useful to reduce pain in the short term. Clinicians should prescribe an active and task-oriented rehabilitation program (exercises and education) to reduce pain and disability in adults with rotator cuff disorders. Subacromial decompression is not recommended to treat rotator cuff tendinopathy. Surgery is appropriate for selected patients with a full-thickness rotator cuff tear. A return-to-work plan should be developed early, in collaboration with the worker and other stakeholders, and must combine multiple strategies to promote return to work. CONCLUSION: This clinical practice guideline was developed to assist the multidisciplinary team of clinicians who provide health care for adults with a rotator cuff disorder. The CPG guides clinical decisionmaking for diagnosis and treatment, and planning for successful return to work. J Orthop Sports Phys Ther 2022;52(10):647-664. Epub: 27 July 2022. doi:10.2519/jospt.2022.11306.