Development and validation of scales to measure organisational features of acute hospital wards

Night Physician-Nurse Collaboration: Developing the Scale of Physicians' Difficulties and Exploring Related Factors in Acute Care Hospitals

Background

Responding to inpatient deterioration is less favorable at night than during the day, and this may be related to barriers in collaboration between physicians and nurses. However, there had been no way to assess the problem. This study aimed to develop a scale for physicians to measure difficulties in nighttime collaboration with nurses in response to deteriorating inpatients and to identify factors associated with the developed scale scores.

Methods

We developed a draft scale of Nighttime Collaboration Difficulties between Nurses and Physicians for Physicians (NCDNP-P) based on key informant interviews with physicians. Psychometric validations, including structural validity, criterion-related validity, and reliability tests, were conducted among physicians who worked on night duty or on call in acute-care hospitals in Japan using a cross-sectional web-based questionnaire. Multiple linear regression analyses were performed using independent variables including individual backgrounds, style of working at night, and facility characteristics.

Results

By performing exploratory factor analysis, we confirmed the structural validity of the NCDNP-P, consisting of seven items and two domains (Domain 1: Dissatisfaction with reporting, Domain 2: Barriers to working with nurses). Cronbach's alpha and McDonald's omega coefficients were 0.81-0.84 and 0.81-0.89, respectively. The criterion-related validity for interprofessional collaboration was confirmed. Multiple regression analysis revealed that the variables employment status, number of night shifts, frequency of nighttime calls about patients under another physician's charge, and handover between physicians before changing shifts were statistically significantly associated with NCDNP-P scores.

Conclusion

We developed the NCDNP-P, confirming its reliability and validity. Identified factors reflect physicians' characteristics and the problems experienced working at night and may be associated with barriers in nighttime collaboration. The NCDNP-P can highlight issues in clinical settings and lead to the consideration of initiatives to address such issues.

Translation and validation study of the Indonesian version of the practice environment scale of the nursing work index

Objectives

This study aimed to translate and validate the Practice Environment Scale - Nursing Work Index (PES-NWI) among nurses in Indonesia.

Methods

A scale translation and cross-sectional validation study was conducted. The English version was translated into Indonesian, which involved five steps: forward translation, compare the translation, backward translation, compare the translation, and pilot testing with a dichotomous scale (clear or unclear). Thirty inpatient department nurses were involved in checking readability and understandability. A cross-sectional study was conducted from August to October 2022 at 17 hospitals across Indonesia, involving 350 nursing professionals. The validity test included structural validity and convergent validity. The internal consistency reliability was tested by Cronbach's α coefficient, item-total correlation, and composite reliability.

Results

Confirmatory factor analysis (CFA) showed an acceptable fit. The correlation of all dimensions was between 0.70 and 0.88, and all items had item loading higher than 0.6. Convergent validity of each dimension ranged from 0.61 to 0.74, internal consistencies with Cronbach's α coefficient was 0.97, corrected item-to-total correlation ranged from 0.62 to 0.85, and composite reliability of each dimension was higher than 0.89.

Conclusions

Good homogeneity and construct validity have been demonstrated for the Indonesian version of the PES-NWI, nursing management can use it to measure the work environment.

Organizational factors affecting nurses' tendency to report child abuse and neglect

OBJECTIVE

To examine the factors that affect the tendency of nurses working in mother and child health clinics (MCHC) to report child abuse to the authorities.

DESIGN

Cross-sectional survey.

SAMPLE

Three hundred and forty-one female nurses working in MCHC across Israel.

MEASUREMENTS

(1) Social and organizational variables; (2) the tendency to report child abuse and neglect; (3) attitudes toward reporting child abuse and neglect.

RESULTS

On average, the participants perceived that they have good collaboration with other staff members and with welfare services. They showed a favorable attitude toward reporting child abuse, but less than half (44.8%) would report child abuse suspicion to the authorities. None of the organizational variables (MCHC type, collaboration among staff, collaboration with welfare services) were correlated with the tendency to report child abuse and neglect, yet all three variables were significantly correlated with attitudes toward reporting child abuse. Nurses' attitudes toward reporting were mediated by the organizational variables.

CONCLUSIONS

The effect of the organizational factors on the actual tendency to report child abuse is mediated by nurses' attitude toward reporting. Organizational constraints probably encourage MCHC nurses to be cautious before reporting child abuse and neglect to the authorities, restricting adherence to the law, which requires direct reporting.

Psychometric evaluation of instruments measuring the work environment of healthcare professionals in hospitals: a systematic literature review

Purpose

Research shows that the professional healthcare working environment influences the quality of care, safety climate, productivity, and motivation, happiness, and health of staff. The purpose of this systematic literature review was to assess instruments that provide valid, reliable and succinct measures of health care professionals’ work environment (WE) in hospitals.

Data sources

Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, CINAHL EBSCOhost and Google Scholar were systematically searched from inception through December 2018.

Study selection

Pre-defined eligibility criteria (written in English, original work-environment instrument for healthcare professionals and not a translation, describing psychometric properties as construct validity and reliability) were used to detect studies describing instruments developed to measure the working environment.

Data extraction

After screening 6397 titles and abstracts, we included 37 papers. Two reviewers independently assessed the 37 instruments on content and psychometric quality following the COSMIN guideline.

Results of data synthesis

Our paper analysis revealed a diversity of items measured. The items were mapped into 48 elements on aspects of the healthcare professional’s WE. Quality assessment also revealed a wide range of methodological flaws in all studies.

Conclusions

We found a large variety of instruments that measure the professional healthcare environment. Analysis uncovered content diversity and diverse methodological flaws in available instruments. Two succinct, interprofessional instruments scored best on psychometrical quality and are promising for the measurement of the working environment in hospitals. However, further psychometric validation and an evaluation of their content is recommended.

Negative Behavior Among Healthcare Professionals: Integrative Review of Instruments

BACKGROUND

Behaviors that undermine a culture of safety pose a serious threat to the overall wellbeing of healthcare workers as well as to patient outcomes.

PURPOSE

The purpose of this integrative review is to compare reported psychometrics, feasibility, and identify commonalities among available instruments measuring negative behaviors among healthcare professionals.

METHODS

Whittemore and Knafl's integrative review methods were used to analyze pertinent instruments designed to measure negative behaviors among healthcare professionals. Multiple computerized databases including CINAHL, MEDLINE, and Scopus databases were searched in the fall of 2017 without date restrictions.

RESULTS

Violence, incivility, and bullying are the most frequently measured behaviors in healthcare workers, and a robust number of valid and reliable instruments are available.

CONCLUSIONS

To date a comprehensive review of psychometric properties and feasibility of administration is lacking. This review synthesizes the instruments measuring these behaviors, providing a resource for future research focused on mitigation and intervention strategies.

Practice educators' attitudes and perspectives of interprofessional collaboration and interprofessional practice learning for students: A mixed-methods case study

Interprofessional collaboration (IPC) is important for the delivery of effective integrated health and social care systems. Interprofessional practice learning (IPPL) enables students to learn to work together within a relevant context and prepare for future IPC. While there is some evidence that negative attitudes impact on IPC and interprofessional education, there is a dearth of research on health and social work professionals' attitudes and perspectives of IPC and IPPL opportunities for students. A mixed-methods case study was used to investigate practice educators' attitudes and perspectives of IPC and IPPL for their students. Results showed that attitudes were positive and that mainly meso- and macro-level factors, as opposed to the micro level, impacted on the implementation of IPC and IPPL for students' learning in practice settings. IPC was perceived to be best enabled by effective communication, established teams, IPPL for staff, and shared processes and policies. Close working proximity to other professionals encouraged informal communication and positive interprofessional relationships. Motivation and resources were perceived as enablers of IPPL, but there were often missed opportunities for IPPL. These findings suggest that further work is required to identify systems for improving IPC and to enhance IPPL opportunities for students learning within practice settings.

Measuring nurses' perception of work environment: a scoping review of questionnaires

Background

Nurses’ work environment has been shown to be associated with quality of care and organizational outcomes. In order to monitor the work environment, it is useful for all stakeholders to know the questionnaires that assess or evaluate conditions for delivering nursing care. The aim of this article is: to review the literature for assessed survey questionnaires that measure nurses’ perception of their work environment, make a brief assessment, and map the content domains included in a selection of questionnaires.

Methods

The search included electronic databases of internationally published literature, international websites, and hand searches of reference lists. Eligible papers describing a questionnaire had to be; a) suitable for nurses working in direct care in general hospitals, nursing homes or home healthcare settings; and b) constructed to measure work environment characteristics that are amenable to change and related to patient and organizational outcomes; and c) presented along with an assessment of their measurement properties.

Results

The search yielded 5077 unique articles. For the final synthesis, 65 articles met inclusion criteria, consisting of 34 questionnaires measuring nursing work environments in different settings. Most of the questionnaires that we found were developed, and tested, for registered nurses in a general hospital setting. Six questionnaires were developed specifically for use in nursing home settings and one for home healthcare. The content domains covered by the questionnaires were both overlapping and unique and the terminology in use was inconsistent. The most common content domains in the work environment questionnaires were supportive managers, collaborative relationships with peers, busyness, professional practice and autonomy.

Conclusions

The findings from this review enhance the understanding of how “work environment” can be measured by an overview of existing questionnaires and domains. Our results indicate that there are very many work environment questionnaires with varying content.

Electronic supplementary material

The online version of this article (10.1186/s12912-017-0256-9) contains supplementary material, which is available to authorized users.

Needs assessment for master of nursing programmes among Bangladesh nurses

AIM

This study aimed to assess the intent to enrol in a master of nursing programme among Bangladesh nurses, identify preferred programme options and measure the association among intent to enrol in the programme, clinical competency and job satisfaction.

BACKGROUND

Personal and professional aspects of potential students pursuing graduate education are beneficial in devising educational strategies. However, considering the pressing needs for higher nursing education, there are no masters of nursing programmes in Bangladesh.

METHODS

This study used a descriptive correlational design. Nurses working in Bangladesh public sector were recruited to participate in a self-administered survey (n = 260). The questionnaire consisted of perception of job satisfaction, clinical competency and the need for educational options, including the intent to enrol in a master of nursing programme, preferred specialty area, curriculum content and career goals after graduation. Data were analysed using descriptive statistics and point-biserial correlation.

RESULTS

Ninety per cent of the respondents reported that they intended to enrol in a master of nursing programme. Intention was significantly correlated with clinical competency but not with job satisfaction. The most preferred specialty areas were nursing management and education. Half of the respondents responded that teaching at nursing schools was a career goal after graduation.

DISCUSSION

The results of the needs assessment for the programme reflected the unique interest and priorities of the current status of Bangladesh.

CONCLUSIONS

The results indicate a strong motivation to enrol in a master of nursing programme, confidence in clinical competence and high demand for programme in nursing management and education. These findings should be considered to design the programme in order to meet the interest of Bangladesh nurses.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Educational needs assessments should take precedence to ensure the best possible educational outcome and to produce competent nurses who will contribute in achieving the Millennium Development Goals of Bangladesh.

Fleadapt scale: a new tool to measure frontline employee adaptability in power sector

Purpose

– An adaptable frontline employee (FLE) would be an asset for the organization, customer and to other constituents, external to the organization. Previous research by the same authors conceptualizes FLE adaptability in the power sector, using grounded theory as a multidimensional construct (Sony and Nandakumar, 2014). The purpose of this study is to explore this concept by developing a new scale to measure the FLE adaptability.

Design/methodology/approach

– The research is conducted in various phases to build up a new 41-item self-reported scale to measure adaptability of FLEs using structural equation modelling on data obtained from FLE ' s working in the power sector in India.

Findings

– The finding of the paper is a valid FLEADAPT scale which can be used for measuring adaptability of FLEs.

Research limitations/implications

– Although this study has provided relevant and interesting insights into the understanding of FLE adaptability, it is important to recognize its limitations. First, data in this study were obtained from firms in Western India. Although it can be said that the two samples represent a cross-section of a large number of businesses, it would be useful to obtain a broader and wider sampling frame from other countries. Because respondents’ perceptions, attitudes and behaviour are influenced by their cultures, it would be useful to test whether the existing FLE adaptability scale can be generalized to situations in other countries.

Practical implications

– FLE adaptability is identified as a key process in job performance, and hence, the scale will become an important managerial assessment tool.

Social implications

– This scale has a dimension to measure the social aspect of frontline adaptability, thus giving organizations a new tool to measure adaptability among the front lines.

Originality/value

– Despite the increasing research attention paid to the concept of FLEs, to date, there has been no valid and comprehensive operational measure of FLE adaptability. To the best of the authors’ knowledge, this is the first study to provide a comprehensive, psychometrically sound and operationally valid measure of an FLE’s adaptability.

A novel questionnaire to measure staff perception of end-of-life decision making in the intensive care unit--development and psychometric testing

PURPOSE

The aim of this study was to create a questionnaire that measures barriers and facilitators of effective end-of-life (EOL) decision making and communication and associated stress as perceived by intensive care unit (ICU) staff.

METHODS

The questionnaire was developed on the basis of a theoretical framework and discussion with ICU staff. It was pretested among 15 ICU nurses and physicians. A field test was conducted in 4 interdisciplinary ICUs of one university hospital Descriptive item analysis, exploratory factor analysis, and reliability and validity analysis were performed.

RESULTS

Overall, 174 of 284 ICU staff participated in the field test (61% response). Factor analysis indicated a 7-factor solution: (1) collaboration in the EOL context, (2) role clarity in the EOL context, (3) work-related interruptions of communication with families, (4) emotional support, (5) stress by involvement in EOL decision making and communication with families, (6) stress by work overload, and (7) taking initiative toward EOL decision making. Internal consistency of the scales was acceptable (range, 0.69-0.85). Construct validity was shown by relationships of the scales to several constructs, for example, satisfaction with EOL decision making and emotional exhaustion. Overall, 26 of 31 expected relationships achieved significance.

CONCLUSIONS

The new questionnaire meets psychometric criteria of reliability and validity and promises to be a useful quality measure of EOL decision making in the ICU.

Development and psychometric testing of a scale assessing the sharing of medical information and interprofessional communication: the CSI scale

Background

Interprofessional collaboration is essential in creating a safer patient environment. It includes the need to develop communication and coordination between professionals, implying a better sharing of medical information. Several questionnaires exist in the literature, but none of them have been developed in the French context. The objective was to develop and test the psychometric properties of the communication and sharing information (CSI) scale which assesses specifically interprofessional communication, especially the sharing of medical information and the effectiveness of communication between members of the team.

Methods

The questionnaire construction process used a literature review and involved a panel of voluntary professionals. A list of 32 items explored the quality of shared information delivered to patients and the effectiveness of interprofessional communication. The study was conducted in 16 voluntary units in a University Hospital (France), which included medical, surgical, obstetrics, intensive care, pediatrics, oncology and rehabilitation care. The scale-development process comprised an exploratory principal component analysis, Cronbach’s α-coefficients and structural equation modeling (SEM).

Results

From these 16 units, a total of 503 health professionals took part in the study. Among them, 23.9% were physicians (n = 120), 43.9% nurses (n = 221) and 32.2% nurse assistants (n = 162).

The validated questionnaire comprised 13 items and 3 dimensions relative to “the sharing of medical information” (5 items), “communication between physicians” (4 items) and “communication between nurses and nurse assistants” (4 items). The 3 dimensions accounted for 63.7% of the variance of the final questionnaire. Their respective Cronbach’s alpha coefficients were 0.80, 0.87 and 0.81. SEM confirmed the existence of the 3 latent dimensions but the best characteristics were obtained with a hierarchical model including the three latent factors and a global “communication between healthcare professionals” latent factor, bringing the 8 items linked to communication together. All the structural coefficients were highly significant (P < 0.001).

Conclusions

This self-perception CSI scale assessing several facets of interprofessional communication is the first one developed in the French context. The development study exhibited excellent psychometric properties. Further psychometric analysis is needed to establish test-retest reliability, sensibility to change and concurrent validity.

Practice environments of nurses employed in ambulatory oncology settings: measure refinement

PURPOSE/OBJECTIVES

To examine the reliability and validity of modified items from the Practice Environment Scale of the Nursing Work Index (PES-NWI) for use in the understudied ambulatory oncology setting.

DESIGN

Cross-sectional mailed survey using a modified Dillman method.

SETTING

Southeastern United States.

SAMPLE

Population-based statewide sample of 1,339 oncology nurses who reported employment outside of hospital inpatient units.

METHODS

After examining for nonresponse bias, confirmatory factor analysis using structural equation modeling and Cronbach coefficient alphas were employed to examine construct validity and internal consistency, respectively. After calculating revised subscale means for each nurse, the researchers used t tests to compare subscale means between nurses who reported their practice environment as favorable versus those who reported it as mixed or unfavorable.

MAIN RESEARCH VARIABLES

Reliability and validity of items on the adapted version of the PES-NWI.

FINDINGS

Despite a response rate of 31%, no differences in demographic characteristics were observed between the analytic sample and nonresponders. After reducing the number of items to 23, acceptable model fit was achieved with a comparative fit index of 0.95 and a root mean square error of approximation of 0.057. All five existing PES-NWI subscales, plus the new medical assistant support subscale, were significantly higher for nurses who reported favorable practice environments versus those who reported mixed or unfavorable environments.

CONCLUSIONS

A revised set of items derived from the PES-NWI has acceptable reliability and validity to measure the quality of nursing practice environments in ambulatory oncology settings. Medical assistant support is a new contribution to the item pool.

IMPLICATIONS FOR NURSING

Additional testing of this revised measure in diverse samples of nurses, including studies that correlate with patient outcomes, is a necessary next step.

Engaging general practice nurses in chronic disease self-management support in Australia: insights from a controlled trial in chronic obstructive pulmonary disease

The growing burden of chronic disease will increase the role of primary care in supporting self-management and health behaviour change. This role could be undertaken to some extent by the increased practice nurse workforce that has occurred over recent years. Mixed methods were used to investigate the potential for general practice nurses to adopt this role during a 12-month randomised controlled study of telephone-delivered health mentoring in Tasmanian practices. Nurses (general practice and community health) were trained as health mentors to assist chronic obstructive pulmonary disease patients to identify and achieve personal health related goals through action plans. Of 21% of invited practices that responded, 19 were allocated to health mentoring; however, general practice nurses were unable to train as health mentors in 14 (74%), principally due to lack of financial compensation and/or workload pressure. For five general practice nurses trained as health mentors, their roles had previously included some chronic disease management, but training enhanced their understanding and skills of self-management approaches and increased the focus on patient partnership, prioritising patients' choices and achievability. Difficulties that led to early withdrawal of health mentors were competing demands, insufficient time availability, phone calls having lower priority than face-to-face interactions and changing employment. Skills gained were rated as valuable, applicable to all clinical practice and transferable to other health care settings. Although these results suggest that training can enhance general practice nurses' skills to deliver self-management support in chronic disease, there are significant system barriers that need to be addressed through funding models and organisational change.

Staff perceptions of leadership during implementation of task-shifting in three surgical units

BACKGROUND

Registered nurses are difficult to recruit and retain. Task shifting, which involves reallocation of delegation, can reduce demand for registered nurses. Effective leadership is needed for successful task shifting.

OBJECTIVE

This study explored leadership styles of three surgical nurse unit managers. Staff completed surveys before and after the implementation of task shifting. Task shifting involved the introduction of endorsed enrolled nurses (licensed nurses who must practise under registered nurse supervision) to better utilize registered nurses.

METHODS

Implementation of task shifting occurred over 4 months in a 700-bed tertiary hospital, in southeast Queensland, Australia. A facilitator assisted nurse unit managers during implementation. The impact was assessed by comparison of data before (n = 49) and after (n = 72) task shifting from registered nurses and endorsed enrolled nurses (n = 121) who completed the Ward Organization Features Survey.

RESULTS

Significant differences in leadership and staff organization subscales across the settings suggest that how change involving task shifting is implemented influences nurses' opinions of leadership.

CONCLUSION

Leadership behaviours of nurse unit managers is a key consideration in managing change such as task shifting.

IMPLICATIONS FOR NURSING MANAGEMENT

Consistent and clear messages from leaders about practice change are viewed positively by nursing staff. In the short term, incremental change possibly results in staff maintaining confidence in leadership.

Development and initial validation of the Pharmacist Frequency of Interprofessional Collaboration Instrument (FICI-P) in primary care

BACKGROUND

Existing validated measures of pharmacist-physician collaboration focus on measuring attitudes toward collaboration and do not measure frequency of collaborative interactions.

OBJECTIVE

To develop and validate an instrument to measure the frequency of collaboration between pharmacists and general practitioners (GPs) from the pharmacist's perspective.

METHODS

An 11-item Pharmacist Frequency of Interprofessional Collaboration Instrument (FICI-P) was developed and administered to 586 pharmacists in 8 divisions of general practice in New South Wales, Australia. The initial items were informed by a review of the literature in addition to interviews of pharmacists and GPs. Items were subjected to principal component and Rasch analyses to determine each item's and the overall measure's psychometric properties and for any needed refinements.

RESULTS

Two hundred and twenty four (38%) of pharmacist surveys were completed and returned. Principal component analysis suggested removal of 1 item for a final 1-factor solution. The refined 10-item FICI-P demonstrated internal consistency reliability at Cronbach's alpha=0.90. After collapsing the original 5-point response scale to a 4-point response scale, the refined FICI-P demonstrated fit to the Rasch model. Criterion validity of the FICI-P was supported by the correlation of FICI-P scores with scores on a previously validated Physician-Pharmacist Collaboration Instrument. Validity was also supported by predicted differences in FICI-P scores between subgroups of respondents stratified on age, colocation with GPs, and interactions during the intern-training period.

CONCLUSION

The refined 10-item FICI-P was shown to have good internal consistency, criterion validity, and fit to the Rasch model. The creation of such a tool may allow for the measure of impact in the evaluation of interventions designed to improve interprofessional collaboration between GPs and pharmacists.

Job satisfaction among hospital nurses revisited: a systematic review

BACKGROUND

The current nursing shortage and high turnover is of great concern in many countries because of its impact upon the efficiency and effectiveness of any healthcare delivery system. Recruitment and retention of nurses are persistent problems associated with job satisfaction.

OBJECTIVE

To update review paper published in 2005.

DESIGN

This paper analyses 100 papers relating to job satisfaction among hospital nurses derived from systematic searches of seven databases covering English and Chinese language publications 1966-2011 (updating the original paper with 46 additional studies published 2004-2011).

FINDINGS

Despite varying levels of job satisfaction across studies, sources and effects of job satisfaction were similar. Hospital nurse job satisfaction is closely related to working conditions and the organizational environment, job stress, role conflict and ambiguity, role perception and role content, organizational and professional commitment.

CONCLUSIONS

More research is required to understand the relative importance of the many identified factors relating to job satisfaction of hospital nurses. It is argued that the absence of a robust causal model reflecting moderators or moderator is undermining the development of interventions to improve nurse retention.

Interprofessional simulated learning: short-term associations between simulation and interprofessional collaboration

BACKGROUND

Health professions education programs use simulation for teaching and maintaining clinical procedural skills. Simulated learning activities are also becoming useful methods of instruction for interprofessional education. The simulation environment for interprofessional training allows participants to explore collaborative ways of improving communicative aspects of clinical care. Simulation has shown communication improvement within and between health care professions, but the impacts of teamwork simulation on perceptions of others' interprofessional practices and one's own attitudes toward teamwork are largely unknown.

METHODS

A single-arm intervention study tested the association between simulated team practice and measures of interprofessional collaboration, nurse-physician relationships, and attitudes toward health care teams. Participants were 154 post-licensure nurses, allied health professionals, and physicians. Self- and proxy-report survey measurements were taken before simulation training and two and six weeks after.

RESULTS

Multilevel modeling revealed little change over the study period. Variation in interprofessional collaboration and attitudes was largely attributable to between-person characteristics. A constructed categorical variable indexing 'leadership capacity' found that participants with highest and lowest values were more likely to endorse shared team leadership over physician centrality.

CONCLUSION

Results from this study indicate that focusing interprofessional simulation education on shared leadership may provide the most leverage to improve interprofessional care.

Validity and reliability of a multiple-group measurement scale for interprofessional collaboration

Background

Many measurement scales for interprofessional collaboration are developed for one health professional group, typically nurses. Evaluating interprofessional collaborative relationships can benefit from employing a measurement scale suitable for multiple health provider groups, including physicians and other health professionals. To this end, the paper begins development of a new interprofessional collaboration measurement scale designed for use with nurses, physicians, and other professionals practicing in contemporary acute care settings. The paper investigates validity and reliability of data from nurses evaluating interprofessional collaboration of physicians and shows initial results for other rater/target combinations.

Methods

Items from a published scale originally designed for nurses were adapted to a round robin proxy report format appropriate for multiple health provider groups. Registered nurses, physicians, and allied health professionals practicing in inpatient wards/services of 15 community and academic hospitals in Toronto, Canada completed the adapted scale. Exploratory and confirmatory factor analysis of responses to the adapted scale examined dimensionality, construct and concurrent validity, and reliability of nurses' response data. Correlations between the adapted scale, the nurse-physician relations subscale of the Nursing Work Index, and the Attitudes Toward Health Care Teams Scale were calculated. Differences of mean scores on the Nursing Work Index and the interprofessional collaboration scale were compared between hospitals.

Results

Exploratory factor analysis revealed 3 factors in the adapted interprofessional collaboration scale - labeled Communication, Accommodation, and Isolation - which were subsequently corroborated by confirmatory factor analysis. Nurses' scale responses about physician collaboration had convergent, discriminant, and concurrent validity, and acceptable reliability.

Conclusion

The new scale is suitable for use with nurses assessing physicians. The scale may yield valid and reliable data from physicians and others, but measurement equivalence and other properties of the scale should be investigated before it is used with multiple health professional groups.

Perception of ethical climate and its relationship to nurses’ demographic characteristics and job satisfaction

In this study, we examined the perception of actual and ideal ethical climate type among 95 nurses working in the internal medicine wards of one central hospital in the state of Israel. We also examined whether nurses’ demographic characteristics influence that perception and if a relationship between perceptions of an actual and an ideal ethical climate type influences nurses’ job satisfaction. A questionnaire composed of three subquestionnaires was administered and the responses analyzed using multiple linear regressions, analysis of variance and Pearson’s correlation coefficient. The results demonstrated that demographic characteristics (such as: gender, job tenure and level of education) partially influence the perception of an ideal ethical climate. Incongruence in perceptions of ‘caring’ and ‘independence’ climate types indicated a decline in nurses’ job satisfaction, while perception of actual ‘caring’ and ‘service’ climates positively influenced all aspects of job satisfaction. We recommend constructing training programs emphasizing the ethics of nursing practice and also to help lead nurses to clarify an ethical framework and guide nursing staff in dealing with ethical dilemmas.

Psychosocial factors contributing to occupational injuries among direct care workers

Direct care workers have the highest injury rate in the United States, primarily due to work-related musculoskeletal disorders. This study examined the effect of psychosocial factors (i.e., stress, job satisfaction, organizational climate, safety climate, and training) on direct care workers' injuries. On the basis of divergent work characteristics of direct care workers in facilities versus private homes, injury rates were found to be significantly different between workplaces (x(2) = 4.179, df = 1, p = .041). Tenure (77% of injuries occurred after 1 year of tenure) was significantly correlated with training, satisfaction, organizational climate, and stress. Because of the chronic nature of musculoskeletal disorders, tenure was used to choose cases for injury prediction using logistic regression. When tenure was greater than 1 year, job satisfaction [Exp(B) = 0.048, p = .028] was a predictor of injury and when tenure was greater than 3 years, both job satisfaction [Exp(B) = 0.002, p = .033] and training [Exp(B) = 31.821, p = .044] were predictors of injury. Psychosocial factors and home- versus facility-based workplaces should be considered to improve injury rates and retention among direct care workers.

Psychosocial Factors Contributing to Occupational Injuries among Direct Care Workers

Direct care workers have the highest injury rate in the United States, primarily due to work-related musculoskeletal disorders. This study examined the effect of psychosocial factors (i.e., stress, job satisfaction, organizational climate, safety climate, and training) on direct care workers' injuries. On the basis of divergent work characteristics of direct care workers in facilities versus private homes, injury rates were found to be significantly different between workplaces (χ2 = 4.179, df = 1, p = .041). Tenure (77% of injuries occurred after 1 year of tenure) was significantly correlated with training, satisfaction, organizational climate, and stress. Because of the chronic nature of musculoskeletal disorders, tenure was used to choose cases for injury prediction using logistic regression. When tenure was greater than 1 year, job satisfaction [Exp(B) = 0.048, p = .028] was a predictor of injury and when tenure was greater than 3 years, both job satisfaction [Exp(B) = 0.002, p = .033] and training [Exp(B) = 31.821, p = .044] were predictors of injury. Psychosocial factors and home- versus facility-based workplaces should be considered to improve injury rates and retention among direct care workers.

Structuring Communication Relationships for Interprofessional Teamwork (SCRIPT): a cluster randomized controlled trial

BACKGROUND

Despite a burgeoning interest in using interprofessional approaches to promote effective collaboration in health care, systematic reviews find scant evidence of benefit. This protocol describes the first cluster randomized controlled trial (RCT) to design and evaluate an intervention intended to improve interprofessional collaborative communication and patient-centred care.

OBJECTIVES

The objective is to evaluate the effects of a four-component, hospital-based staff communication protocol designed to promote collaborative communication between healthcare professionals and enhance patient-centred care.

METHODS

The study is a multi-centre mixed-methods cluster randomized controlled trial involving twenty clinical teaching teams (CTTs) in general internal medicine (GIM) divisions of five Toronto tertiary-care hospitals. CTTs will be randomly assigned either to receive an intervention designed to improve interprofessional collaborative communication, or to continue usual communication practices. Non-participant naturalistic observation, shadowing, and semi-structured, qualitative interviews were conducted to explore existing patterns of interprofessional collaboration in the CTTs, and to support intervention development. Interviews and shadowing will continue during intervention delivery in order to document interactions between the intervention settings and adopters, and changes in interprofessional communication. The primary outcome is the rate of unplanned hospital readmission. Secondary outcomes are length of stay (LOS); adherence to evidence-based prescription drug therapy; patients' satisfaction with care; self-report surveys of CTT staff perceptions of interprofessional collaboration; and frequency of calls to paging devices. Outcomes will be compared on an intention-to-treat basis using adjustment methods appropriate for data from a cluster randomized design.

DISCUSSION

Pre-intervention qualitative analysis revealed that a substantial amount of interprofessional interaction lacks key core elements of collaborative communication such as self-introduction, description of professional role, and solicitation of other professional perspectives. Incorporating these findings, a four-component intervention was designed with a goal of creating a culture of communication in which the fundamentals of collaboration become a routine part of interprofessional interactions during unstructured work periods on GIM wards.

TRIAL REGISTRATION

Registered with National Institutes of Health as NCT00466297.

Resilience in the operating room: developing and testing of a resilience model

AIM

This paper is a report of a study to examine the relation of perceived competence, collaboration, control, self-efficacy, hope, coping, age, experience, education and years of employment to resilience in operating room (OR) nurses.

BACKGROUND

Resilience is viewed as a vital attribute for nurses because it augments adaptation in demanding and volatile clinical environments such as ORs. However, there has been little research into the utility of resilience as a means of dealing with workplace stress, and there is only limited understanding of variables that explain resilience in the context of nursing.

METHOD

A correlational cross-sectional survey design was used. Of a national sample of 2860 Australian OR nurses, 1430 were selected by systematic random sampling and invited to complete a questionnaire in 2006. The instrument included scales measuring perceived competence, collaboration, control, self-efficacy, hope, coping and resilience, and gathered information about the demographic characteristics of respondents.

RESULTS

Two regression models were used to develop a model of resilience. An initial model tested the hypothesis that a set of 12 explanatory variables contributed to resilience in OR nurses. Five variables (hope, self-efficacy, coping, control and competence) explained resilience at statistically significant levels. Age, experience, education and years of employment did not contribute to resilience at statistically significant levels. The final model explained 60% of the variance. In both models, the strongest explanatory variables were hope, self-efficacy and coping.

CONCLUSION

Identification of explanatory variables that contribute to resilience in ORs may assist in implementing strategies that promote these behaviours, and thus retain nurses in this specialty.

The nursing practice environment: measurement and evidence

Improvements in nurses' practice environments are essential to retain nurses and keep patients safe. The pace of improvements can accelerate if evidence is translated clearly for researchers, managers, and policymakers. This article evaluates the utility of published multidimensional instruments to measure the nursing practice environment. The assessment criteria are theoretical relevance, ease of use, and dissemination. This article also synthesizes the research that has used these instruments. Seven instruments and 54 studies are evaluated. The Practice Environment Scale of the Nursing Work Index (PES-NWI) is proposed as the most useful instrument. Its content, length, and dissemination best satisfy the set of criteria. Researchers should use the PES-NWI to generate consistent and comparable evidence; expand the content to reflect all conceptual domains; develop a short form; test the instrument in different care settings; expand the evidence of the practice environment's influence on patient outcomes; and test interventions for practice environment improvements.

Properties of a Norwegian version of the Ward Organisational Features Scales

To assess the association between nurses' practice environment and established measures of discharged patients' experiences during hospitalisation it is necessary to have a validated instrument to collect data on nurses' work environment in hospital wards. The purpose of this study was to assess the reliability and validity of a Norwegian version of the Ward Organisational Features Scales (WOFS), an instrument developed in the UK to describe environmental factors influential on the effectiveness of nursing services. After linguistic adaptation of the questionnaire, the reliability and validity were assessed in a sample of 99 nurses, of whom 46 (45%) responded. Most of the 12 tested scales showed acceptable internal consistency (10 had Cronbach's alpha > 0.70) and test-retest reliability (eight had intraclass correlation coefficient >0.70). The WOFS scales' correlations with external variables were in line with hypothesised correlations, thus supporting their validity. Scales describing nurses' influence on ward organisation and management did not perform well, probably due to differences in intraward organisation in the two countries. In spite of a limited sample size this study suggests that the majority of the scales of the WOFS showed satisfactory psychometric properties. They can be useful for assessing and describing aspects of nurses' work environment in Norwegian hospitals.

Infection control in neonatal intensive care units

Healthcare-associated infection is a major problem in acute hospital settings. Hand decontamination is considered to be the most effective means of preventing healthcare-associated infection, but is poorly performed. Few studies have examined technique, which may be important in neonatal intensive care units (NICUs) where clinical procedures are intricate and could result in contamination of many areas of the hand, resulting in cross-infection. This study examined technique in six NICUs. Eighty-eight nurses were observed. A scoring system was developed so that technique could be quantified and subjected to statistical testing. The mean score was 6.29 out of 11 when hands were washed and 3.87 out of 7 when alcohol hand rub was used, indicating that performance was not optimal. Scores for technique were not significantly different in each NICU. Senior nurses achieved higher scores for handwashing (P<0.01), as did nurses holding positive feelings about the atmosphere in their NICU (P=0.04). Junior nurses scored less well on a knowledge questionnaire than senior nurses (P<0.01). Nurses who had been employed in the neonatal unit for less than one year also scored less well (P<0.01). Differences in technique were noted when comparing the beginning and end of long shifts. These differences were not noted at the beginning and end of standard shifts.

Job satisfaction in nursing: validation of a new instrument for the UK

AIM

To develop a new, valid and reliable instrument that has been designed and evaluated to measure job satisfaction as perceived by nurses with specific aspects of contemporary nursing.

BACKGROUND

Job satisfaction is a key concept within workforce research in nursing and is particularly important within the present climate in the UK due to findings linking satisfaction with both quality of care and retention of nurses.

METHOD(S)

Exploratory and confirmatory factor analyses were carried out on a large longitudinal dataset from a study of Adult-branch diploma-qualified nurses in England who completed the scale at three time-points after qualification.

RESULTS

A six-factor solution was supported and replicated in a further sample of recently qualified graduate nurses. The instrument was also acceptably reliable.

CONCLUSION

This new instrument is a concise, highly practical and flexible tool, which can be used in a range of health care settings and in different measurement contexts.

A Review of Instruments Measuring Nurse-Physician Collaboration

OBJECTIVE

To review instruments used to measure nurse-physician collaboration and compare the strengths and potential opportunities of each instrument.

BACKGROUND

Nurse-physician collaboration has been studied using a variety of instruments. The ability to generalize the outcomes of studies and build on the findings is predicated on acceptable validity and reliability metrics of these instruments.

METHODS

A literature search using PubMed and Health and Psychological Instruments databases was conducted for articles published between 1990 and May 2004 to identify instruments measuring staff nurse-physician collaboration. After the instruments were identified, a second search was conducted to identify at least one peer-reviewed article describing the psychometrics of the instrument. Articles identified were then entered into the ISI Web of Science Citation Index to identify the instruments that had been used in at least 2 other studies. These selected instruments were then reviewed for the following information: background for the development of the tool, description of the tool, initial psychometric testing, and strengths and potential applications for each instrument.

RESULTS

Five instruments met study criteria: the Collaborative Practice Scale, Collaboration and Satisfaction About Care Decisions, ICU Nurse-Physician Questionnaire, Nurses Opinion Questionnaire, and the Jefferson Scale of Attitudes Toward Physician Nurse Collaboration.

CONCLUSIONS

The identified instruments have undergone initial reliability and validity testing and are recommended for future research on nurse-physician collaboration.

Nursing observations during the first 24 hours after a surgical procedure: what do we do?

AIMS AND OBJECTIVES

The purpose of the study was to describe what constitutes postoperative nursing monitoring during the initial 24 hours on the ward including the components of observation, frequency and time spent with patients.

BACKGROUND

The literature provides little guidance as to the best practice of postoperative surveillance. To understand the practice of monitoring patients after returning to the ward from a surgical procedure it is important to describe the current practice.

DESIGN

The study involved a non-participant observation of nursing practice.

METHOD

Data were generated via observation of postoperative patients in the first 24 hours after returning to the ward. This occurred in the general surgical units of two different South Australian hospitals over an 8-week period.

RESULTS

A total of 81 patients were observed for 282 patient hours. Vital sign collection generally reflected a traditional pattern of hourly for the first four hours, reducing to four hourly across the 12- to 24-hour period. The frequency and duration of patient-nurse interactions, observations recorded and the collection of other clinical data such as pain, oxygen saturations and nausea are also discussed.

RELEVANCE TO CLINICAL PRACTICE

The findings presented here depict the current nursing practice of postoperative monitoring in two different settings, providing insight into what constitutes contemporary postoperative surveillance.

CONCLUSION

Before inroads can be made to identify the best practice of postoperative patient surveillance a clear cognisance of practice needs to be identified.

Job satisfaction among nurses: a literature review

The current nursing shortage and high turnover is of great concern in many countries because of its impact upon the efficiency and effectiveness of any health-care delivery system. Recruitment and retention of nurses are persistent problems associated with job satisfaction. This paper analyses the growing literature relating to job satisfaction among nurses and concludes that more research is required to understand the relative importance of the many identified factors to job satisfaction. It is argued that the absence of a robust causal model incorporating organizational, professional and personal variables is undermining the development of interventions to improve nurse retention.

Approaches to learning: psychometric testing of a study process questionnaire

BACKGROUND

One method of evaluating students' learning is to measure surface, deep and achieving approaches to learning using a questionnaire. In comparison with research on student nurses' learning styles, there has been little examination of their 'approaches to learning'. Much of the 'approaches to learning' research has been conducted with higher education students in Australia and Hong Kong and this kind of measurement is viewed as a valid and reliable way to assess learning.

AIM

The aim of study reported here was to establish the validity of an 'approaches to learning' questionnaire, the study process questionnaire, for use with student nurses by undertaking psychometrical testing, including exploratory factor analysis.

METHOD

The study process questionnaire is a 42-item questionnaire measuring surface, deep and achieving approaches to learning. It was distributed to 300 student nurses attending a common foundation programme in a higher education establishment in the United Kingdom (UK) in July 2000. Principal components analysis was conducted to determine the validity of the deep, surface and achievement scales in the questionnaire.

RESULTS

A new factor structure was identified comprising three main scales which were similar in content but not identical to the original questionnaire. The deep factor correlated positively and significantly with grade performance average and sociology examination results.

CONCLUSION

The study process questionnaire is a valid and useful tool for nurse teachers to gain knowledge about student nurses' approaches to learning. Deep learning appears to influence academic performance. More work is required to elucidate the complex nature of deep learning.

Nurse-led inpatient care: opening the 'black box'

With recent evaluations contradicting early reports of improved outcomes from nurse-led inpatient care, the 'black box' of nurse-led care must be opened in order to examine the model of treatment. We present findings on the processes of care in one nurse-led unit (NLU), compared with an acute ward. Patterns and quality of nursing care were quantified using bar-code technology to measure type, frequency and duration of nursing activities and Quality Patient Care Scale to measure the quality of care. NLU quality matched, but did not exceed, quality on the acute ward. Patterns of care differed between wards, but activities associated with therapeutic nursing were no more frequent on the NLU. These findings support the hypothesis that disappointing outcomes in recent evaluations may be linked to failure to implement a therapeutic model of nursing.

An action research project to evaluate the clinical practice facilitator role for junior nurses in an acute hospital setting

It has been well documented that newly qualified nurses require support in developing confidence and professional competence. Although preceptorship models have gone some way in addressing this need, innovative and flexible models of facilitation and development are also required to respond to local demands. In the project reported here a number of supernumerary clinical practice facilitators (CPFs) were appointed to support both healthcare assistants and newly qualified registered nurses to enhance their competence and clinical skills. It was anticipated that they might also encourage awareness of other professional issues, such as evidence-based practice, as well as having a positive influence on the clinical learning environment and staff morale. This article describes how an action research approach was used to establish the CPF role in a variety of clinical areas across a large inner-city National Health Service Trust. It outlines the evaluation undertaken and the further contribution that such roles could provide.

Action research in action: reflections on a project to introduce Clinical Practice Facilitators to an acute hospital setting

AIMS OF THE PAPER

The process and philosophical basis of action research are discussed in this article by reviewing the insights that were gained from a study designed to enhance the support available to junior nursing staff in an acute hospital setting.

RATIONALE

It has been well documented that newly qualified nurses require help to develop professional competencies. With this in mind, the role of Clinical Practice Facilitator was established within a National Health Service (NHS) Trust to enhance clinical skill acquisition and the professional development of newly registered nurses and health care assistants.

DESIGN

In order to facilitate the inception, development and subsequent evaluation of these new roles, an action research approach was adopted. Strategies used to encourage collaboration and flexibility during the project are also discussed.

RESULTS

The primary aims of the project were achieved and the authors suggest that the choice of action research was significant to the successful outcome. However, a number of issues arose which deserve more attention including the importance of the interpersonal skills of the action researcher and the value of action research to facilitate change which is relevant at both an individual and organizational level.

Hospital nurses' job satisfaction, individual and organizational characteristics

Hospital nurses' job satisfaction, individual and organizational characteristics Using the Ward Organizational Features Scales (WOFS), relationships between aspects of the organization of acute hospital wards, nurses' personal characteristics and nurses' job satisfaction are examined among a nationally representative sample of 834 nurses in England. The analysis contributes to a growing body of evidence demonstrating the importance of interpersonal relationships to nurses' job satisfaction. In particular, the positive contribution of the cohesiveness of ward nursing staff is highlighted, but the potential for many current NHS staffing strategies and work environments to undermine the development of cohesive working relationships is also noted. Other influential factors are nurses' relationships with medical staff, perceptions of their workload and their evaluation of the appropriateness of the system of nursing being practised. The importance of measuring nurses' subjective assessments of their work environment is emphasized. A weak association was found between grade and job satisfaction. Individual nurse characteristics were found not to be associated with job satisfaction.

The changing nature of nurses' job satisfaction: an exploration of sources of satisfaction in the 1990s

This paper focuses on the changing nature of nurses' job satisfaction. It compares the major sources of satisfaction and dissatisfaction experienced by acute ward nurses in the English National Health Service (NHS) in the early 1990s, with sources identified in previous research. In the light of findings from a pilot study, the suitability of existing research approaches and measurement tools for portraying nurses' contemporary work experiences is examined. The study comprised content analysis of a random sample of 130 nurses' comments about ward organizational issues, collected as part of a national survey. Findings suggest that new measurement tools need to be developed, because new sources of satisfaction and dissatisfaction emerged, directly associated with change arising out of the introduction of the NHS internal market. These include pressures associated with new roles, role conflict, lack of job security, 'tight' resources, using new technology, a perceived lowering of standards of patient care, coping with increased amounts of paperwork, and the experience of working in a rapidly and constantly changing environment. Findings also suggest that the nature of nurses' job satisfaction is increasingly being shaped by their position within the organization, denoted by clinical grade, and the organizational culture of individual NHS Trusts. Ward leaders experience dissatisfaction as a result of role conflict and strain, while nurses of lower clinical grades are increasingly concerned with managerial and resource constraints on their ability to provide good quality care. Nurses' satisfaction with management and morale were found to be significantly different between NHS Trusts. While findings may be specific to England, it is argued that they have relevance for the wider, international nursing community. This is because developing an understanding of the changing nature of nurses' job satisfaction may help to resolve recruitment and retention problems.

Assessing the validity of questionnaire scales designed to assess the organisation of nursing in acute care hospital wards

This study was carried out to assess the validity of a nurses' opinion questionnaire designed to measure organisational features of hospital wards. Data collection tools were developed for an asessment of the physical environment, observation of nurses and patients, and observations of ward rounds and handovers. Data from the study were compared with the responses from questionnaires completed by ward staff. The findings were encouraging but not conclusive. Although a degree of support for the initial criterion validation of the scales of the nurses' opinion scales was evident, further studies are advisable. The study raises issues relating to the assessment of criterion validity, and these are discussed.

Nursing organizational practice and its relationship with other features of ward organization and job satisfaction

This paper describes a new classification of ward organizational practice in nursing. Data related to aspects of ward nursing practice were collected by postal survey from a nationally representative sample of 74 acute hospital wards, and subjected to hierarchical cluster analysis. The model which was deemed to best 'fit' the data, provided three types of ward practices, which have been named: 'devolved', 'two tier' and 'centralized' nursing. The distinguishing features of the three classifications are similar but not identical to accepted 'ideal types' of primary, team and functional systems. The relationships between wards in each of the three identified categories and other ward organizational practice processes of nursing care and job satisfaction are described.

Clinical specialty and organizational features of acute hospital wards

Ward clinical specialty is a variable which has been largely ignored in studies of nursing organization and effectiveness. Analysis of data collected from a nationally representative sample of 83 acute medical, surgical and orthopaedic hospital wards demonstrates that while wards had similar staffing resources, differences exist in the likelihood of adopting a nursing organizational system with devolved authority, in nurses' views of prevailing hierarchical attitudes, and their perceived influence over a range of organizational features of the ward. Medical wards were more likely to have developed organizational practices associated with increasing nursing autonomy.