Lack Of Organizational Support Research Articles

Global neurosurgery: models for international surgical education and collaboration at one university.

International collaborations between high-income (HICs) and low- and middle-income countries (LMICs) have been developed as an attempt to reduce the inequalities in surgical care around the world. In this paper the authors review different models for international surgical education and describe projects developed by the Division of Neurosurgery at the University of Toronto in this field. The authors conducted a review of models of international surgical education reported in the literature in the last 15 years. Previous publications on global neurosurgery reported by the Division of Neurosurgery at the University of Toronto were reviewed to exemplify the applications and challenges of international surgical collaborations. The most common models for international surgical education and collaboration include international surgical missions, long-term international partnerships, fellowship training models, and online surgical education. Development of such collaborations involves different challenges, including limited time availability, scarce funding/resources, sociocultural barriers, ethical challenges, and lack of organizational support. Of note, evaluation of outcomes of international surgical projects remains limited, and the development and application of assessment tools, such as the recently proposed Framework for the Assessment of International Surgical Success (FAIRNeSS), is encouraged. Actions to reduce inequality in surgical care should be implemented around the world. Different models can be used for bilateral exchange of knowledge and improvement of surgical care delivery in regions where there is poor access to surgical care. Implementation of global neurosurgery initiatives faces multiple limitations that can be ameliorated if systematic changes occur, such as the development of academic positions in global surgery, careful selection of participant centers, governmental and nongovernmental financial support, and routine application of outcome evaluation for international surgical collaborations.

Applying a knowledge–action framework for navigating barriers to incorporating telemetry science into fisheries management and conservation: a qualitative study

Telemetry studies have produced fundamental knowledge on animal biology and ecology that has the potential to improve management of aquatic resources such as fisheries. However, the use and integration of telemetry-derived knowledge into practice remain tenuous, so we surveyed 212 fish telemetry experts to understand existing barriers for incorporating telemetry-derived knowledge into fisheries management practices. We apply a sociological knowledge–action framework to structure the findings, which revealed four primary challenges to integrating telemetry findings into management: (1) the perceived uncertainties and unclear relevance of telemetry findings; (2) the underlying motivations and constrained rationalities of actors that can lead to inaction or suboptimal decisions; (3) the constraints of institutions, governance structures, and lack of organizational support, and (4) time and mismatches in scale, culture, and world views. On a more positive note, the relational dimension (collaboration, trust, and relationship building) appears to be important for overcoming and avoiding barriers. We further provide recommendations to navigate these perceived barriers and argue that these lessons also apply to other fields of applied ecology, conservation, and resource management.

State of Privileging in Pharmacy: A Survey of Vizient-Affiliated Institutions.

Purpose: The process of privileging pharmacists is an important step in developing optimal pharmacy practice models. Currently, little published literature exists detailing the status of pharmacist privileging efforts. The objective of this study is to assess and characterize a snapshot of the current and future state of privileging practices in pharmacy at Vizient academic medical centers (AMCs) and their affiliate institutions. Methods: An electronic survey questionnaire was sent to Vizient pharmacy directors and their affiliates to assess institutional privileging practices and identify perceived or actual barriers. The survey was divided into 2 pathways based on the current status of privileging at the institution. Results: In total, 46 directors of pharmacy completed the survey. Only 33% (15/46) of pharmacy directors indicated they had a current privileging process in place. About 70% (21/30) of institutions without an established privileging process indicated they were considering establishing a process. For institutions without an established privileging process, most pharmacy directors identified a lack of organizational support and resources as barriers to implementation. Conclusion: Although credentialing and privileging is considered a national priority to aid in expanding and enhancing pharmacists' scope of practice, our survey demonstrated that few respondents currently have a privileging process in place. The results from this study may highlight important barriers and keys to success to be considered when implementing a privileging process.

Factors affecting empathetic patient care behaviour among medical doctors and nurses: an integrative literature review.

Healthcare professionals' empathic behaviour is an important component of quality health care. Patients' reports suggest that empathy is often lacking. Specific factors that may facilitate or inhibit empathetic behaviour have not been extensively examined. In Qatar, empathy may be affected by a completely multicultural, multilinguistic setting where healthcare professionals and patients interact. The purpose of this integrative literature review is to provide the latest evidence on factors that influence the demonstration of empathetic behaviour of nurses and physicians toward patients and to draw general conclusions that increase understanding. A literature search was conducted in CINAHL, Medline (Ovid), PsycINFO, Psychology and Behavioral Sciences Collection, Middle Eastern and Central Asian Studies, Education Research Complete, ERIC, Health Source: Nursing/ Academic databases, and Google Scholar to identify relevant studies. A total of 18 quantitative and qualitative studies that satisfied the inclusion criteria were selected to be included in the review. Three high order factors are described: organizational, personal and interpersonal, and demographic factors. Seven subfactors included: burnout, increased workload, lack of organizational support, training workshops, patient behaviour, inappropriate role modelling, and informal, experiential learning. The organizational culture is strongly implicated in inhibiting empathy. Healthcare providers' empathetic responses to patients are linked and connected to a well-resourced, collegial, professional organizational environment that builds empathy towards everyone (not only patients).

Prevalence and factors associated with burnout among frontline primary health care providers in low- and middle-income countries: A systematic review

Background: Primary health care (PHC) systems require motivated and well-trained frontline providers, but are increasingly challenged by the growing global shortage of health care workers. Burnout, defined as emotional exhaustion, depersonalization, and low personal achievement, negatively impacts motivation and may further decrease productivity of already limited workforces. The objective of this review was to analyze the prevalence of and factors associated with provider burnout in low and middle-income countries (LMICs). Methods: We performed a systematic review of articles on outpatient provider burnout in LMICs published up to 2016 in three electronic databases (EMBASE, MEDLINE, and CAB). Articles were reviewed to identify prevalence of and risk factors associated with provider burnout. Results: A total of 6,182 articles were identified, with 20 meeting eligibility criteria. We found heterogeneity in definition and prevalence of burnout. Most studies assessed burnout using the Maslach Burnout Inventory. All three dimensions of burnout were seen across multiple cadres (physicians, nurses, community health workers, and pharmacists). Frontline nurses in South Africa had the highest prevalence of high emotional exhaustion and depersonalization, while PHC providers in Lebanon had the highest reported prevalence of low personal achievement. Higher provider burnout was associated with high job stress, high time pressure and workload, and lack of organizational support. Conclusions: Our comprehensive review of published literature showed that provider burnout is an important problem across various health care providers in LMICs. Further studies are required to better measure the prevalence, causes and consequences of burnout, and guide the development of effective interventions to reduce or prevent burnout.

Increasing Project Success in China from the Perspectives of Project Risk, Methodology, Tool Use, and Organizational Support

Besides lack of organizational support, using project risk management tools and methodology effectively has been one major challenge to project success. As China is extending its project management (PM) concepts from mainly construction and national defense projects to many other industries, project managers in those new industries rely on the use of PM tools and methodologies. However, it remains unclear to what extent the use of them can increase project success. To address the research questions, this study surveyed 93 project managers in China and found that success of project execution is contingent upon: (a) project risks, (b) PM methodology, (c) organizational support, and (d) PM tool use. The presence of project risk can stimulate increased use of PM tools, thereby helping achieve project success. Organizational support and PM tool use also remain conditions for project success. This study contributes to the current literature by assessing project success from the perspectives of organizational support, PM methodology, and PM tools.

Patient safety and nursing: interface with stress and Burnout Syndrome.

To analyze studies on stress, Burnout Syndrome, and patient safety in the scope of nursing care in the hospital environment. This was an integrative literature review. Data collection was performed in February 2016 in the following databases: Medical Literature Analysis and Retrieval System Online - PubMed/MEDLINE, Latin American and Caribbean Literature in Health Sciences - LILACS. Ten scientific productions were selected, which listed that factors contributing to stress and Burnout Syndrome of nursing professionals are the work environment as a source of stress, and excessive workload as a source of failures. The analysis found that the stress and Burnout Syndrome experienced by these professionals lead to greater vulnerability and development of unsafe care, and factors such as lack of organizational support can contribute to prevent these failures. Analisar estudos que versam sobre o estresse e Síndrome de Burnout, bem como a segurança do paciente no âmbito da assistência de enfermagem no ambiente hospitalar. Tratou-se de uma revisão integrativa de literatura. O levantamento dos dados foi efetuado nas bases de dados Medical Literature Analysis and Retrieval System Online - PubMed / MEDLINE, Literatura Latino-Americana e do Caribe em Ciências da Saúde -LILACS em fevereiro de 2016. Foram selecionadas10 produções científicas que apontaram que os fatores que contribuem para o estresse e a Síndrome de Burnout dos profissionais de enfermagem são o ambiente de trabalho como fonte de estresse e a carga de trabalho excessiva como geradora de falhas. A análise apontou que o estresse e a Síndrome de Burnout vivenciada por esses profissionais acarretam maior vulnerabilidade ao desenvolvimento de uma assistência insegura e que fatores como a falta de apoio organizacional podem contribuir para dirimir essas falhas.

How do line managers experience and handle the return to work of employees on sick leave due to work-related stress? A one-year follow-up study

Purpose: To examine how line managers experience and manage the return to work process of employees on sick leave due to work-related stress and to identify supportive and inhibiting factors.Materials and methods: Semi-structured interviews with 15 line managers who have had employees on sick leave due to work-related stress. The grounded theory approach was employed.Results: Even though managers may accept the overall concept of work-related stress, they focus on personality and individual circumstances when an employee is sick-listed due to work-related stress. The lack of a common understanding of stress creates room for this focus. Line managers experience cross-pressure, discrepancies between strategic and human-relationship perspectives and a lack of organizational support in the return to work process.Conclusion: Organizations should aim to provide support for line managers. Research-based knowledge and guidelines on work-related stress and return to work process are essential, as is the involvement of coworkers. A commonly accepted definition of stress and a systematic risk assessment is also important. Cross-pressure on line managers should be minimized and room for adequate preventive actions should be provided as such an approach could support both the return to work process and the implementation of important interventions in the work environment.Implication for rehabilitationOrganizations should aim to provide support for line managers handling the return to work process.Cross-pressure on line managers should be minimized and adequate preventive actions should be provided in relation to the return to work process.Research-based knowledge and guidelines on work-related stress and return to work are essential.A common and formal definition of stress should be emphasized in the workplace.

\u2018It is a difficult topic\u2019 \u2013 a qualitative study of midwives\xb4 experiences with routine antenatal enquiry for intimate partner violence

BackgroundIntimate partner violence (IPV) during pregnancy may jeopardize maternal and fetal health (IJFWM 49:159-164, 2004; IJGO 133:269-276, 2016). In recognition of the significant public health impact of IPV, the Norwegian Directorate of Health issued new guidelines in 2014, which recommend that health professionals routinely ask all women in antenatal care about their exposure to violence. The objective of this study was to gain an in-depth understanding of midwives’ experiences with routine enquiry for intimate partner violence during the antenatal period.MethodsThe study had a qualitative design. Individual semi-structured interviews with eight midwives providing antenatal care at eight Mother and Child Health Centres (MCHC) in Norway were conducted. Graneheim and Lundmans method of content analysis inspired the analysis.ResultsThree main themes emerged: Midwives do ask about violence; It can be a challenge; and Factors that make it easier to ask. All midwives enquired, but not on a regular basis, about violence. The midwives’ personal interest in the topic was an important factor that made it easier for them to ask about violence. Lack of time, fear of not knowing how to deal with a positive answer and lack of organizational support were barriers to asking pregnant women about their experiences of violence.ConclusionMidwives were aware of the guidelines and made some efforts to implement them. However, further education and organisational support is needed to enable midwives to routinely ask all pregnant women about IVP.

Police work stressors and cardiac vagal control.

This study examines relationships between the frequency and intensity of police work stressors and cardiac vagal control, estimated using the high frequency component of heart rate variability (HRV). This is a cross-sectional study of 360 officers from the Buffalo New York Police Department. Police stress was measured using the Spielberger police stress survey, which includes exposure indices created as the product of the self-evaluation of how stressful certain events were and the self-reported frequency with which they occurred. Vagal control was estimated using the high frequency component of resting HRV calculated in units of milliseconds squared and reported in natural log scale. Associations between police work stressors and vagal control were examined using linear regression for significance testing and analysis of covariance for descriptive purposes, stratified by gender, and adjusted for age and race/ethnicity. There were no significant associations between police work stressor exposure indices and vagal control among men. Among women, the inverse associations between the lack of support stressor exposure and vagal control were statistically significant in adjusted models for indices of exposure over the past year (lowest stressor quartile: M = 5.57, 95% CI 5.07 to 6.08, and highest stressor quartile: M = 5.02, 95% CI 4.54 to 5.51, test of association from continuous linear regression of vagal control on lack of support stressor β = -0.273, P = .04). This study supports an inverse association between lack of organizational support and vagal control among female but not male police officers.

Clinical Experiences of Nursing Students at a Selected Institute of Health Sciences in Botswana

Aim: The aim of the research was to explore the nursing students’ opinion and their experiences about their clinical learning. Objectives: • Explore how student nurses find their initial experiences in the clinical area. • Identify the contributory and hindering factors for effective learning in the clinical area. • Identify teaching strategies that will enhance learning in the clinical area. Background: Clinical learning is an important component of nursing education and takes place in a complex social contact of the clinical environment. Learning in a clinical setting creates challenges that are absent in a classroom. Design: Qualitative research design was used and data were collected from Level II and Level III nursing students. Convenience sampling technique was utilized to collect data from the participants. Two FGDs among level III and two among level II nursing students were conducted at the Institute of Health Sciences, Botswana. There were four focus groups discussions and each had eleven participants. Data analysis: The data were analysed by content analysis using a thematic framework approach. Results: Focus group discussions revealed that nursing students did experience initial clinical anxiety, stress, lack of teaching and guiding support, lack of organizational support and resources, inadequate clinical supervision, and role acceptance. Conclusion: The findings highlight the importance of clinical learning in the integration of nursing education and practice. Nurse educators and clinical nurses should strive to create a conducive environment, which maximises the nursing students’ clinical learning.

Barriers to Practice of Rural and Remote Nursing in Canada

The delivery of rural and remote healthcare has been identified in the literature as a unique and complex working environment for Nursing practice. This Canadian setting integrative review looks at barriers associated with rural and remote nursing. Nine articles were retained after filtering over 200 articles extracted from 4 databases. Critical Appraisal Skills Programme Checklist (CASP) for qualitative research and Quality Assessment Tool for Quantitative Studies (QATQ) were used for assessment of a total sample of N=3402 participants. Four (4) main themes (barriers) were extracted: 1) Professional Isolation, 2) Competing Demands, 3) Lack of Sustainable Continuing Educational Initiatives and 4) Lack of Organizational Support. Following analysis of the demographic data, an emerging theme of an aging workforce was also seen as a potential future barrier to rural nursing practice. Future research is required in order for sufficient and appropriate action to be taken in addressing aforementioned barriers. Recommendations for nursing practice and policy in rural and remote areas revolve around exposing nursing students to rural / remote settings, incentives for new graduate students to practice in these areas, as well as support and educational initiatives encouraging practitioners to work to their full scope of practice.

Unheard Voices: Why Former Child Welfare Workers Left Their Positions

This mixed methods study used a snowball sample (n = 54) to capture retrospective insight from former public child welfare workers about job satisfaction and reasons they left their positions. Responses to open-ended questions suggested a theme of lack of organizational support as the primary reason they left. Former workers also reported that they wanted a voice and someone to hear their concerns, greater recognition, and opportunity to practice self-care. Quantitatively, workers in their positions 8 years or longer were the most satisfied on a 19-item global scale examining job satisfaction. Respondents were unhappy with their workloads and emotional impact of their positions.

How nurses who are sensation seekers justify their unsafe behaviors

Sensation seeking, risk-taking propensity and openness to experience are known predictors of unsafe behaviors. The aim of this study is to determine if individuals with these characteristics justify their unsafe behaviors by attributing them to external factors such as a lack of organizational support. We explore the interaction between sensation seeking and risk-taking propensity, explain how nurses justify their unsafe work practices, and investigate the effect of openness on directing sensation seekers' behavior. In this cross-sectional study, 108 nurses completed questionnaires and an objective task measuring risk-taking propensity. Conditional direct effect analysis showed that nurses with sensation-seeking characteristics and high level of risk-taking propensity were likely to perceive external factors as accounting for their unsafe behaviors. Furthermore, sensation seeking re-expressed as openness to experience predicted increased blame externalization. Additionally, nurses with high risk-taking propensity, leading to a focus on rewards and learning experiences, attributed unsafe work practices to external factors.

Career barriers influencing career success

Purpose– Few research has addressed the factors that undermine people’s subjective perceptions of career success. Hence, the purpose of this paper is to further illuminate the issue of career barriers in perceptions of career success for a specific group of professionals: academics.Design/methodology/approach– This study adopts an interpretative-social constructionist methodology. Complementarily, it was employed a phenomenological method in data gathering and analysis – with the use of in-depth interviews and a theme analysis. The research was undertaken with a group of 87 Portuguese academics of both sexes and in different stages of their academic careers.Findings– The findings pinpoint the existence of multi-level barriers encountered by the academics when trying to succeed in their careers. The interviewees mentioned particularly the organizational-professional career barriers pertaining to three general themes: poor collegiality and workplace relationships; the lack of organizational support and employment precariousness; and the career progression standards and expectations. At the individual life cycle level the interviewees referred to the theme of finding balance; at the same time, the gender structure was also a theme mentioned as an important career barrier in career success, particularly by the women interviewed.Research limitations/implications– One of the limitations of this research is related to the impossibility of generalizability of its findings for the general population. Nevertheless, the researcher provides enough detail that grants the reader with the ability to judge of its similarity to other research contexts.Practical implications– This research highlights the role played by distinct career barriers for a specific professional group: academics. This has implications for higher education policy-makers and for human resources managers in higher education institutions.Originality/value– The current study extends the literature on career success by offering detailed anecdotal evidence on how negative work experiences might hinder career success. This research shows that to understand career barriers to success it is useful to consider multi-level factors: organizational-level factors (e.g. poor collegiality and workplace relationships); individual-level factors (e.g. life-cycle factors such as age/career stage); and structural-level factors (e.g. gender).

Implementation Process of a Canadian Community-based Nurse Mentorship Intervention in HIV Care

We describe salient individual and organizational factors that influenced engagement of registered nurses in a 12-month clinical mentorship intervention on HIV care in Canada. The intervention included 48 nurses and 8 people living with HIV (PLWH) who were involved in group-based and one-on-one informal mentorship informed by transformative learning theory. We evaluated the process of implementing the mentorship intervention using qualitative content analysis. The inclusion of PLWH as mentors, the opportunities for reciprocal learning, and the long-term commitment of individual nurses and partner organizations in HIV care were major strengths. Challenges included the need for multiple ethical approvals, the lack of organizational support at some clinical sites, and the time commitment required by participants. We recommend that clinical mentorship interventions in HIV care consider organizational support, adhere to the Greater Involvement of People Living with HIV/AIDS principles, and explore questions of professional obligations.

If It Is Meant to Be, Let It Be: Risk communication among Bosnian Refugees Resettled in the U.S.

The purpose of this paper is to explore and understand how a Bosnian refugee community perceives and responds to the potential risk of a natural disaster in order to identify tailored approaches to improve risk communication. This is a qualitative study. Participants resettled in St Louis, Missouri were identified through criterion and snowball sampling. Thirty-three face-to-face interviews were conducted using a semi-structured interview guide. Data were analyzed using both content and thematic analysis. Findings indicate that due to their war experiences, cultural and religious understanding of natural disaster, and social influence on their risk interpretation, participants tended to underestimate the potential threat of natural disaster. Media was the main communication methods in times of potential natural disaster. Lack of organizational support during risk communication was a major concern. Ethnic radio stations and word of mouth were rated as the most popular communication channels for disseminating messages in preparation of a natural disaster. Using a community-based participatory approach to identify community needs and involve Bosnian community partners in risk communication planning, implementation, and evaluation, is vital for a Bosnian community.

Cultural influences in mentoring endeavors: applying the Cultural Framework Analysis Process

Purpose – The purpose of this paper is to examine the usability of the Cultural Framework Analysis Process, a strategy designed to examine cultural factors in mentoring endeavors and to identify whether there are patterns of cultural elements that served to hinder or facilitate mentoring programs across a variety of organizations and contexts. The process also involves identifying methods for overcoming the barriers and enhancing the facilitating factors. Design/methodology/approach – Graduate students in a class on mentoring were given an assignment to analyze a mentoring program using the Cultural Framework Analysis Process. They were also asked to share their most significant learning outcomes. Data were gathered by two student groups over a two-year period. Researchers determined the usability of the analysis process by evaluating the quality of the student submissions. They aggregated the data and conducted a content analysis on the facilitating and hindering factors to determine commonalities and the lessons learned. Findings – The Cultural Framework Analysis Process appears to be a useful tool in examining and dealing with cultural elements in mentoring programs and relationships. The barriers and facilitating factors were closely related to one another. The five barriers to success were matching processes; mentee attitude toward matching; lack of organizational support; static or closed organizational culture; and organizational or community culture. The five factors that facilitated mentoring endeavors were: comprehensive and flexible matching; mentee/mentor attitudes; training; organizational culture and demonstrated commitment; and a focus on mentees. Practical implications – The ability to examine the cultural elements in the context of mentoring is vital in assuring mentoring success. Having a description of how the process was conducted should be of value to those wanting to engage in similar analyses. The findings related to the factors identified should help guide those engaged in mentoring endeavors to become more aware of elements to consider and deal with as they create and operationalize their programs. Originality/value – There is a need to enhance the knowledge about the cultural factors involved in mentoring programs and relationships. This research study expands the understanding and presents findings about barriers and supports to mentoring that have not been previously reported. It also provides a mechanism for others to conduct similar analyses as they develop, implement and research mentoring endeavors.

Norwegian midwives' use of screening for and brief interventions on alcohol use in pregnancy

ObjectiveThis study assessed the current screening for and brief intervention (BI) on alcohol use in pregnancy among midwives in Norway, as well as perceived barriers for such practice. Design, setting and participantsAn Internet and telephone survey was conducted among all 200 registered municipal midwives in the Norwegian health regions North, West and South in the period December 2013–May 2014. Of these, 103 midwives were reached and responded (52%). Measurement and findingsMost of the midwives (97%) asked the pregnant women about their alcohol use at their first consultation. 42% of the midwives reported using a screening instrument. When asked which one, AUDIT or TWEAK was mentioned by 16%. The need for more training in screening tools was reported by 66%. Sixty-four percent of midwives working in municipalities that had received special training compared with 50% among the rest said that they intervened themselves if alcohol use was detected (χ2 = 0.32, P = .645). Motivational Interviewing was well known and frequently used. Low perceived BI competence and finding it difficult to discuss alcohol use with parents with a different ethnicity both reduced chances of carrying out a BI. Time constraints and lack of organizational support were other frequently mentioned barriers. Key conclusions and implications for practiceIt seems that the Norwegian midwives find screening and brief interventions for alcohol use to be important and part of their job, but still could use more training, stronger guidelines and more time for following up parents.

Correlates of hopelessness in the high suicide risk police occupation

Police officers are chronically exposed to work stress. We examined specific stressors that may be associated with hopelessness, a possible risk factor for suicide in this high suicide risk population. The study included 378 officers (276 men and 102 women) with complete data. Analysis of variance was used to estimate mean levels of hopelessness scores as associated with stress, adjusted for age, gender, and race/ethnicity. Posttraumatic symptoms were tested as a modifier of the association between stress and hopelessness. Increasing stress of administrative practices and lack of support were significantly associated with increasing hopelessness among officers (p < .006 – hopelessness range: 1.64–2.65; and p < .001 – hopelessness range 1.60–2.80, respectively). Posttraumatic stress disorder (PTSD) symptoms significantly modified the association between lack of organizational support and hopelessness (p < .010) with significant association only among individuals with higher PTSD symptoms (p < .001). Results suggest that hopelessness is associated with specific stressors in police work, and this is modified by posttraumatic symptomatology.