Care Climate Research Articles

Back to the Future: Principles on Resuming Outpatient Services in the COVID-19 Era.

The rapidly changing health care climate related to coronavirus disease 2019 (COVID-19) has resulted in numerous changes to health care systems and in practices that protect both the public and the workers who serve in hospitals around the country. As a result, these past few months have seen a drastic reduction in outpatient visits. With phased reopening and appropriate guidance, health care systems are attempting to return to normal. The experiences and lessons learned are described, and we provide guiding principles to allow for a safe and effective return to outpatient care.

학교스포츠클럽 참가 중학생의 케어링분위기와 동기분위기가 운동몰입 및 스포츠인성에 미치는 영향

본 연구는 학교스포츠클럽에 참가하는 중학생의 케어링분위기, 동기분위기, 운동몰입, 스포츠인성 간의 관계를 실증적으로 규명하기 위한 목적이 있다. 이를 위해 G광역시, J남도 소재 학교스포츠클럽에 참가하는 중학생들을 대상으로 편의표본추출법을 이용하여 310명의 유효 표본 자료를 분석에 이용하였다. 가설검정을 위한 자료 분석방법으로 SPSS 23.0 프로그램을 이용하여 빈도분석, 탐색적 요인분석, 신뢰도 분석, 상관분석, 단순회귀분석 및 다중회귀분석을 실시하였다. 이상의 과정을 통해 도출된 결과는 다음과 같다. 첫째, 케어링분위기는 운동몰입의 하위요인인 인지몰입, 행위몰입에 정적인 영향을 미쳤다. 둘째, 케어링분위기는 스포츠인성의 하위요인인 자신감, 공동체의식, 자기희생, 긍정적태도에 정적인 영향을 미쳤다. 셋째, 동기분위기의 하위요인인 숙련분위기는 운동몰입에 정적인 영향을 미쳤고, 경쟁분위기는 운동몰입의 하위요인인 행위몰입에 정적인 영향을 미쳤다. 넷째, 동기분위기의 하위요인인 숙련분위기는 스포츠인성의 하위요인인 자신감, 공동체의식, 자기희생, 긍정적태도에 정적인 영향을 미쳤고, 경쟁분위기는 스포츠인성의 공동체의식, 긍정적태도에 부적인 영향을 미쳤다.

AORN Position Statement on Environmental Responsibility

<scp>AORN</scp> Position Statement on Environmental Responsibility

“It’s more than just a game”: NCCAA Division II student-athletes’ perceptions of coach caring

The construct of care within the coach–athlete relationship has only recently been examined. However, this research has yet to include athletes’ perceptions of caring coaching practice. Thus, the primary purpose of the current study was to examine self-described Christian student-athletes’ perceptions of coach caring practices. Therefore, the guiding research questions were: (a) in what ways do student-athletes feel that their coaches demonstrate care? (b) In what ways have student-athletes’ religion/spirituality shaped the way they understand and perceive care? (c) Does proximity to a caring coach practice—that is, those who are still competing versus those who have graduated—influence the ways in which student-athletes view coach caring? Eleven current and former student-athletes (mean age = 26 years; seven males, four females) from four different sports (basketball, cross country, soccer, and tennis) at one NCCAA school were interviewed. Data analysis was conducted by a six-person research team using Consensual Qualitative Research. Five domains were constructed to represent Christian University 1 student-athlete perceptions of: (I) how they learned coach caring, (II) how they defined a lack of coach caring, (III) how they defined coach caring, (IV) how they perceived the expression of the caring climate, and (V) how they perceived the expression of the Christian caring climate.

Debility Among Spinal Surgeons

As the climate of medical care continually shifts, more is expected of surgical specialists than ever before. The rate of burnout among providers appears to be increasing, whereas the career longevity of the modern physician continues to rise to meet the growing demands of our patient population. Spinal surgery is a demanding field, requiring significant amounts of mental and physical fortitude. We intend to highlight issues that cause debility in this cohort of providers. This study surveyed the members of the North American Spine Society to better ascertain the issues that plague our profession in relation to physical and mental debility. The survey included multiple-choice questions regarding demographics, burnout, and health status, among other physical and mental health concerns. We achieved a 19% response rate. Eighty percent of responders highlighted physical debility, and psychological, social, and/or behavioral debility (e.g., burnout) was reported by 39% of respondents. This study highlights the need to improve the work environment and maintain physician health. Although this report sheds light on the problems affecting our colleagues, there is much work that is needed to improve on them. Often the medical philosophy is to ignore one's own personal discomfort in the quest to help patients. In an era in which physician career longevity is needed, these issues must be identified and addressed.

General Mindfulness Differentially Predicted by Male and Female Exercisers’ Perceptions of Motivational Climate and Goal Orientations

Extending upon Iwasaki and Fry’s study published in 2016, the connections between mindfulness, goal orientations, and motivational climate perceptions were examined among exercisers. Participants (N = 324, 62% women) were surveyed six weeks into their group exercise classes on their perceptions of the class climate (caring, task-involving, and ego-involving), goal orientations (task and ego), and general mindfulness. Separate linear regressions for men and women were run to determine if exercisers’ perceptions of the motivational climate and their goal orientations predicted general mindfulness. Similar to previous research, ego goal orientation did not significantly predict mindfulness. In contrast to previous research, the regression model for women exercisers was not significant and predicted only 2.3% of general mindfulness variance. However, 9.6% of general mindfulness variance was predicted for men by the significant regression model. Men’s perceptions of the caring climate and their task goal orientation were similarly important positive predictors of mindfulness. By fostering a caring climate, exercise instructors have the potential to increase their participants’ general mindfulness, an important avenue for positively affecting participants’ quality of life.

Perceived Health Care Climate of Older People Attending an Exercise Program: Validation of the German Short Version of the Health Care Climate Questionnaire.

The role of perceived need support from exercise professionals in improving mental health was examined in a sample of older adults, thereby validating the short Health Care Climate Questionnaire. A total of 491 older people (M = 72.68 years; SD = 5.47) attending a health exercise program participated in this study. Cronbach's alpha was found to be high (α = .90). Satisfaction with the exercise professional correlated moderately with the short Health Care Climate Questionnaire mean value (r = .38; p < .01). The mediator analyses yielded support for the self-determination theory process model in older adults by showing both basic need satisfaction and frustration as mediating variables between perceived autonomy support and depressive symptoms. The short Health Care Climate Questionnaire is an economical instrument for assessing basic need satisfaction provided by the exercise therapist from the participant's perspective. Furthermore, this cross-sectional study supported the link from coaching style to the satisfaction/frustration of basic psychological needs, which in turn, predicted mental health. Analyses of criterion validity suggest a revision of the construct by integrating need frustration.

Return to Normalcy? Principles on Resuming Surgical Services in the COVID-19 Era.

The rapidly changing health care climate related to coronavirus disease 2019 (COVID-19) has resulted in numerous changes to health care systems and in practices that protect both the public and the workers who serve in hospitals around the country. As a result, these past few months have seen a drastic reduction in outpatient visits and surgical volumes. With phased reopening and appropriate guidance, health care systems are attempting to return to normal. Our institution has had the unique opportunity to already return operations back to full capacity. The experiences and lessons learned are described, and we provide guiding principles to allow for a safe and effective return to patient care.

Effects of exergaming on exercise capacity inpatients with heart failure: results of an international multicentre randomized controlled trial.

AbstractAimsExergaming is a new tool to increase physical activity. This study aimed to determine the effects of access to a home‐based exergame (Nintendo Wii) in patients with heart failure (HF) on exercise capacity, self‐reported physical activity and patient‐reported outcome measures.Methods and resultsWe enrolled 605 HF patients in New York Heart Association functional class I–IV, independent of ejection fraction, in an international multicentre randomized controlled trial. Patients were randomized to exergame (intervention) or motivational support (control). The primary endpoint was change in submaximal aerobic exercise capacity as measured by the distance walked in 6 min (6MWT) between baseline and 3 months. Secondary endpoints included long‐term submaximal aerobic exercise capacity, muscle function, self‐reported physical activity, exercise motivation, exercise self‐efficacy at 3, 6 and 12 months. At baseline, patients on average walked 403 ± 142 m on the 6MWT. Patients in the exergame group walked further compared to controls at 3 months (454 ± 123 vs. 420 ± 127 m, P = 0.005), at 6 months (452 ± 123 vs. 426 ± 133 m, P = 0.015) and 12 months (456 ± 122 vs. 420 ± 135 m, P = 0.004). However, correcting for baseline 6MWT values by means of a linear mixed‐effects model revealed no main effect for the intervention on 6MWT. Small significant effects on muscle function were found. Statistically significant treatment effects were found for muscle function but after correction for baseline and confounders, only the treatment effect for the heel‐rise left at 6 months was significant (P &lt; 0.05). No treatment effect was found for exercise motivation, exercise self‐efficacy, or self‐reported physical activity.ConclusionExergaming was safe and feasible in patients with HF with different profiles in different health care systems, cultures and climates. However, it was not effective in improving outcomes on submaximal aerobic exercise capacity. Subgroup analysis did not identify specific subgroups benefiting from the intervention.Clinical Trial Registration: ClinicalTrial.gov Identifier: NCT01785121.

Ambulatory versus inpatient shoulder arthroplasty: a population-based analysis of trends, outcomes, and charges

BackgroundThe purpose of this study was to evaluate the clinical outcomes and cost of shoulder arthroplasty (SA) performed in ambulatory surgery centers (ASCs) compared with SA performed in hospital-based surgery settings.MethodsThe State Inpatient Databases and the State Ambulatory Surgery Databases were queried for patients undergoing primary or reverse SA between 2010 and 2014 in 5 states in either the inpatient (IP), hospital outpatient department (HOPD), or ASC setting. Outcomes included all-cause readmissions, emergency department visits within the 90-day postoperative period, and charges. Covariates included patient demographic data and procedure details. Risk factors for readmission were calculated using logistic regression analysis.ResultsWe identified 795 ASC (2%), 183 HOPD (0.5%), 38,114 (97.5%) SA procedures. The outpatient cohort was overall younger and healthier with a lower percentage of diabetes (14.1% vs. 20.2%), cardiopulmonary disease (11.4% vs. 20.4%), and obesity (10.7% vs. 15.6%). The US state and obesity were factors significantly (P < .0001) associated with readmission. The median IP charge was $62,905 (range, $41,327-$87,881) vs. $37,395 (range, $21,976-$61,775) for combined outpatient cases. When outpatient SA was stratified into ASC and HOPD cases, the median charges were $31,790 for ASC cases vs. $55,990 for HOPD cases (P < .0001). After adjustment for multiple covariates, the charges for combined outpatient SA surgery were 40% lower than those for IP SA surgery (P < .0001).ConclusionAs the current health care climate shifts toward lower-cost and higher-quality care, this study demonstrates that SAs performed in ASCs have a comparable safety profile to and significant financial advantage over SAs performed in the hospital-based setting.

Designing with care

PurposeThe purpose of this study was to explore how care theory and the ethics of care are explained by students in the online environment to clarify the factors that are more relevant in establishing and maintaining caring relations in online learning context.Design/methodology/approachUtilizing naturalistic inquiry, the researchers interviewed online students and coded transcripts using multiple coding methods within two phases of analysis. Noddings' framework for ethics of care was utilized to identify strategies and practices that enhance each of Noddings' elements in an online course experience.FindingsThe findings of this exploratory study provide evidence on how learners perceive being cared for and highlight specific instructor behaviors and course design elements that support the emergence and maintenance of a climate of care in an online learning environment. Indicators of all four elements of Noddings' framework were present in the interviews. Within the themes of each element, strategies and practices to enhance each element in an online course experience are further explained.Research limitations/implicationsEstablishing a climate of care, whether in traditional or online learning, leads to more inclusive learning experiences that are responsive to the needs of all learners. This study brought to light some of the factors that are more relevant in establishing and maintaining caring relations in online learning context.Originality/valueThe findings of this study add to the literature on the role of emotions in an online learning as viewed through the lens of care theory. The findings highlight some strategies and behaviors that promote a climate of care in an online environment from a learner's perspective.

A systematic review and meta‐synthesis of qualitative studies on pelvic organ prolapse for the development of core outcome sets

In the current climate of evidence-based health care, the aim of this meta-synthesis was to collect and systematically analyse data from primary qualitative studies on pelvic organ prolapse (POP), to identify patient-centered perspectives on the natural course of POP. Information acquired in this study may be useful for ongoing research towards the development of core outcome sets (COS) in pelvic floor disorders. A CHORUS Working Group performed a standardized search of three different databases (Medline, Embase, Scopus), from inception to October 2019. We selected qualitative studies on women's perspectives on POP that were published in the English language. Three reviewers independently evaluated the quality of eligible papers and highlighted recurrent themes based on patient perspectives. Eighteen qualitative studies including a total of 497 patients were assessed in this analysis. Our study revealed five superordinate themes, recurrently encountered in qualitative studies on POP: awareness of POP (6 studies), communication (9 studies), treatments (10 studies), effects on quality of life (6 studies), and self-image (3 studies). Five out of 10 quality criteria were met by all the studies included, based on an assessment performed using the critical appraisal skills program. This is the first synthesis of qualitative studies that address POP-related experiences of women, highlighting five superordinate themes, of which treatment was the most commonly reported one. This synthesis' findings may guide quantitative research priorities and will hopefully contribute to the development of a COS for POP.

Information to Bereaved Families Following Catastrophic Losses. Why Is It Important?

Based on extensive experience from clinical practice and research, we illustrate the importance of information provided to the bereaved following the death of a family member. When something happens to loved ones, family members seek out information to reduce insecurity and to understand what has happened. The combination of good information and a caring climate is the basis of good grief crisis intervention. Facts help to replace chaos with coherence and structure, and information about one’s own and others’ reactions normalizes thoughts and reactions. We describe various strategies to help bereaved to “get a grip” on the situation.

Characteristics of High-Performing Interprofessional Health Care Teams Involving Student Pharmacists

Objective. To identify key themes of interprofessional models of care that offer experiential education opportunities for pharmacy learners. Methods. Six pharmacists from four Area Health Education Centers in North Carolina participated in individual, 60-minute interviews. Using two pre-established frameworks, the data were analyzed qualitatively by two members of the research team to identify the characteristics of interdisciplinary care teams. Results. At the level of the organization or health care system, the theme of appropriate resources and procedures emerged. At the level of the team, the themes of appropriate resources and procedures, communication, appropriate skill mix, climate, quality and outcomes of care, and respecting and understanding roles emerged. At the level of the individual, the themes of communication, respecting and understanding roles, and individual characteristics emerged. Three themes identified in a previous study failed to emerge in the interviews: leadership and management; personal rewards, training and development; and clarity of vision. Conclusion. Although a growing body of evidence highlights the importance of designing practice models to achieve interdisciplinary care that is patient-centered and effective, capacity to support learners and effectively educate them in the principles and practices of team-based care is limited. This study provides critical insight into characterizations of interprofessional models that integrate pharmacy learners. Further research is needed to better understand the barriers to designing and implementing IPE in experiential settings.

Communication With Older Patients With Cancer Using Geriatric Assessment

Older patients with cancer and their caregivers worry about the effects of cancer treatment on aging-related domains (eg, function and cognition). Quality conversations with oncologists about aging-related concerns could improve patient-centered outcomes. A geriatric assessment (GA) can capture evidence-based aging-related conditions associated with poor clinical outcomes (eg, toxic effects) for older patients with cancer. To determine whether providing a GA summary and GA-guided recommendations to oncologists can improve communication about aging-related concerns. This cluster-randomized clinical trial enrolled 541 participants from 31 community oncology practices within the University of Rochester National Cancer Institute Community Oncology Research Program from October 29, 2014, to April 28, 2017. Patients were aged 70 years or older with an advanced solid malignant tumor or lymphoma who had at least 1 impaired GA domain; patients chose 1 caregiver to participate. The primary outcome was assessed on an intent-to-treat basis. Oncology practices were randomized to receive either a tailored GA summary with recommendations for each enrolled patient (intervention) or alerts only for patients meeting criteria for depression or cognitive impairment (usual care). The predetermined primary outcome was patient satisfaction with communication about aging-related concerns (modified Health Care Climate Questionnaire [score range, 0-28; higher scores indicate greater satisfaction]), measured after the first oncology visit after the GA. Secondary outcomes included the number of aging-related concerns discussed during the visit (from content analysis of audiorecordings), quality of life (measured with the Functional Assessment of Cancer Therapy scale for patients and the 12-Item Short Form Health Survey for caregivers), and caregiver satisfaction with communication about aging-related patient concerns. A total of 541 eligible patients (264 women, 276 men, and 1 patient did not provide data; mean [SD] age, 76.6 [5.2] years) and 414 caregivers (310 women, 101 men, and 3 caregivers did not provide data; mean age, 66.5 [12.5] years) were enrolled. Patients in the intervention group were more satisfied after the visit with communication about aging-related concerns (difference in mean score, 1.09 points; 95% CI, 0.05-2.13 points; P = .04); satisfaction with communication about aging-related concerns remained higher in the intervention group over 6 months (difference in mean score, 1.10; 95% CI, 0.04-2.16; P = .04). There were more aging-related conversations in the intervention group's visits (difference, 3.59; 95% CI, 2.22-4.95; P < .001). Caregivers in the intervention group were more satisfied with communication after the visit (difference, 1.05; 95% CI, 0.12-1.98; P = .03). Quality of life outcomes did not differ between groups. Including GA in oncology clinical visits for older adults with advanced cancer improves patient-centered and caregiver-centered communication about aging-related concerns. ClinicalTrials.gov identifier: NCT02107443.

Faculty Ability to Care and Caring Characteristics in School of Nursing Climate: A National Survey.

This study surveyed faculty ability to care and perception of caring characteristics within school of nursing climate. Caring within schools of nursing is not well understood. A stratified, random, multistage cluster national sample of 2,043 faculty were surveyed using the Caring Ability Inventory and the Caring Characteristics Within the School of Nursing Climate instruments. No significant differences on the Caring Ability Inventory were identified by school type. Significant differences were noted in faculty perceptions of a caring climate by school type. State universities and community colleges scored lower on the Trust/Teamwork, Support, and Respect subscales and total Caring Characteristics Within the School of Nursing Climate. Community college scores were lower than private, not-for-profit, and state university scores (p < .05) on the Valued subscale. Further research is needed to describe and evaluate the caring climate within schools of nursing and the effectiveness of specific strategies to facilitate caring in the school of nursing climate.

Percutaneous Vertebroplasty: A History of Procedure, Technology, Culture, Specialty, and Economics.

Percutaneous vertebroplasty (VP) progressed from a virtually unknown procedure to one performed on hundreds of thousands of patients annually. The development of VP provides a historically exciting case study into a rapidly adopted procedure. VP was the synthesis of information gained from spinal biopsy developments, the inception of biomaterials used in medicine, and the unique health care climate in France during the 1980s. It was designed as a revolutionary technique to treat vertebral body fractures with minimal side effects and was rapidly adopted and marketed in the United States. The impact of percutaneous vertebroplasty on spine surgery was profound.

Identifying the Most Autonomy-Supportive Message Frame in Digital Health Communication: A 2x2 Between-Subjects Experiment.

BackgroundThe effectiveness of digital health communication may be increased by enhancing autonomy supportiveness.ObjectiveThis study aimed to identify the most autonomy-supportive message frame within an intervention for increasing vegetable intake by testing the effect of the following 2 strategies: (1) using autonomy-supportive language and (2) providing choice.MethodsA Web-based 2 (autonomy-supportive vs controlling language)×2 (choice vs no choice) experiment was conducted among 526 participants, recruited via a research panel. The main outcome measures were perceived autonomy support (measured using the Virtual Care Climate Questionnaire, answered with scores 1 to 5), perceived relevance (measured with one question, answered with scores 1 to 5), and overall evaluation of the intervention (measured with 1 open-ended question, answered with scores 1 to 10).ResultsChoice had a significant positive effect on the overall evaluation of the intervention (b=.12; P=.003), whereas for participants with a high need for autonomy, there was a significant positive effect on perceived relevance (b=.13; P=.02). The positive effect of choice on perceived autonomy support approached significance (b=.07; P=.07). No significant effects on any of the three outcomes were observed for language.ConclusionsResults suggest that provision of choice rather than the use of autonomy-supportive language can be an easy-to-implement strategy to increase the effectiveness of digital forms of health communication, especially for people with a high need for autonomy.

How Abusive Supervision Affects Employees' Unethical Behaviors: A Moderated Mediation Examination of Turnover Intentions and Caring Climate.

Drawing on psychological contract theory, this research contributes to the unethical behavior literature by exploring employees’ turnover intentions as a mediator of the relationship between abusive supervision and employees’ unethical behavior and the moderating role of the caring climate in the relationship between turnover intentions and unethical behavior. The results from a sample of 679 reveal that turnover intentions mediate relationship between abusive supervision and subordinates’ unethical behavior, and caring climate moderates the positive relationship between turnover intentions and subordinates’ unethical behavior. We also find that the indirect effect is moderated by the caring climate. The theoretical and practical implications are discussed.

Predictors of quality of care provided for older adults.

The work conditions in which the nurses provide care for older adults affect the quality of care. (a) To describe the quality of care for older adults as perceived by the nurse; (b) to examine the relationship between occupational stress, work climate, employee development and quality of care for older people; and (c) to determine the predictors of quality of care provided for older adults. A descriptive correlational design was used in this study. A multi-strategic sampling technique was used to recruit a sample of 500 nurses providing care for older adults in hospitals and health care centres. Almost 80% of the participating nurses reported that their workplace was insufficiently staffed. Quality of care was significantly associated with occupational stress, nurses' competence and employee development. Significant predictors of quality of care were occupational stress, work climate and employee development. Enhancing nurses' work climate, decreasing occupational stress and increasing chances for employee development would improve the quality of care provided for older adults. Health institutions have the opportunity to implement work environment improvements that increase support for advancing staff knowledge and skills by providing additional support for continuing education regarding the care of older adults.