Daylight exposure and the other predictors of burnout among nurses in a University Hospital

Resilience, Burnout and Mental Health in Nurses: A Latent Mediation Model

Background/Objectives: The burnout syndrome in nurses has been related to the development of mental health problems. On the contrary, resilience is related to adequately coping with stressful situations and better mental health. The objective was to analyze the relationship between resilience and mental health problems in nurses and estimate the proportion mediated by burnout in the association. Methods: In 2021, a total of 1165 Spanish nurses were selected through a stratified random sampling method. Participants anonymously filled in the Resilience Scale (RS-14), the Maslach Burnout Inventory Survey, and the General Health Questionnaire. To test the hypothesis proposed and explain the mediating effect of burnout empirically, structural equation modeling (SEM) was applied. A latent mediation model was computed. Results: Resilience was negatively related to burnout and mental health problems. The direct relationship between burnout and the latent health variable was positive. In addition, in view of the total effect of resilience on mental health problems and the magnitude of the indirect effect, we stated that the proportion of this effect mediated by burnout ranged from 0.486 to 0.870. Conclusions: This study reveals that fostering resilience in nurses directly and indirectly reduces burnout and improves their mental health. The implementation of resilience programs and supportive institutional policies is recommended to improve working conditions and the quality of patient care.

Improving the Mental Health of Surgical Teams Through Operating Room Design

OBJECTIVE

In this study, we aim to develop and propose an evaluation method for analyzing the design of operating rooms (ORs) from the perspective of surgical teams' reported experiences and stress levels.

BACKGROUND

Stress and burnout of surgical team members can lead to diminished performance and medical errors, which endangers the safety of both the patients and team members. The design and layout of the OR play a critical role in managing such stress.

METHODS

To understand surgical teams' spatial needs related to their experiences and stress, we administered a survey and in-depth focus group discussions to three surgical teams from the same organization. The identified spatial needs were translated into functional scenarios and spatial metrics, essentially viewing the OR through the perspective of users.

RESULTS

Our analysis revealed four integral sections-patient flow, room organization, access to facilities/medical equipment/support staff/team members, and staff well-being-identified as critical design factors associated with the experiences and stress levels of the surgical teams in the ORs.

CONCLUSIONS

We expect this method to serve as a tool for evaluating the effect of the design of OR layouts on stress, thereby supporting the well-being and resiliency of surgical teams.

The association between workplace physical environment and nurses' safety compliance: A serial mediation of psychological and behavioral factors

Aim

This study describes Jordanian intensive care unit nurses' satisfaction with their physical environment and investigates the association between workplace physical environment and nurses' safety compliance. Additionally, the study offers serial mediation analyses of psychological and behavioral factors between satisfaction with the workplace physical environment and nurses' safety compliance.

Introduction

Compliance with safety measures is a vital indicator of safety performance, as less compliance directly reflects undesirable safety outcomes among nurses, like occupational accidents, injuries, and fatalities. Social cognitive theory and the safety triad model contribute to understanding safety compliance behaviors to safety procedures. Thus, enhancing safety compliance in healthcare organizations remains a challenge and concern.

Methods

A quantitative research method was used based on cross-sectional and descriptive data from eight governmental hospitals in Jordan. The population included all intensive care unit nurses in the Ministry of Health's hospitals (n = 1104). A cluster sampling technique selected 285 nurses to participate. Empirical results were obtained through structural equation modeling (i.e., Smart PLS-SEM), which has become popular in this kind of research.

Results

The mean of Jordanian ICU nurses' satisfaction with the workplace physical environment was 3.36, which is moderate. Although the Smart PLS findings did not support the direct association between the workplace physical environment and nurses' safety compliance, serial mediation of safety participation in the workplace physical environment and nurses' safety compliance and perceived safety management commitment confirm the indirect association in the study model.

Conclusion

This study fills a gap in available safety and nursing literature, especially when considering the scarce studies that investigated the physical elements in the workplace and both safety compliance and safety participation. The findings are valuable for academicians, health providers, and policymakers and may trigger creative ideas and interventional solutions to improve nurses' safety compliance in healthcare organizations.

Coping and Caregiving: Leveraging Environmental Design to Moderate Stress Among Healthcare Workers in the Emergency Department Setting

BACKGROUND

Due to exposure to overwhelming work stressors, approximately half of emergency department (ED) physicians and nurses experience burnout, leading to lower productivity, lower quality of care, higher risk of medical errors, higher rates of absenteeism, and eventually turnover. Growing evidence suggests that the physical environment can be leveraged to support healthcare workers' well-being.

OBJECTIVES

This study aimed to identify (1) self-care behaviors that healthcare workers engage in to help them cope with job-related stress, (2) where they engage in those behaviors, (3) attributes of the built environment that may support coping behaviors.

METHODS

A mixed-methods study was conducted in three EDs, using online questionnaires (n = 85) and interviews (n = 20).

RESULTS

Job-related stress was derived from interruptions, workload and inability to take breaks, insufficient workspace, lack of privacy, unpredictability of EDs, and security concerns. Talking with a colleague, getting something to eat or drink, listening to music, and taking a walk were considered destressing activities. The bathroom was considered a place for destressing by the majority of participants, followed by outside areas, physician-only areas, and care team stations. Supportive environmental features included sufficient workspace, maximized privacy, reduced noise and clutter, controlled temperature and lighting, spaces for decompressing, spaces for documentation, close-by breakrooms with enough eating space and massage chairs, chairs with back support, standing desks, food options, and convenient bathrooms.

CONCLUSIONS

Design decisions play an important role in supporting stress reduction among healthcare workers. This study provides several strategies to achieve this aim.

Evidence-Based Design in the Hospital Environment: A Staff's Burnout Study in the COVID-19 Era

OBJECTIVE

This study aimed to evaluate the evidence-based design of the hospital physical space effect on the burnout of nurses and physicians during COVID-19. The research question was to identify the connection between daylight, nature-view windows, and hospital staff burnout during Covid-19.

BACKGROUND

The evidence-based design in the hospital environment affects the health of the medical staff. The promotion of the hospital environment has a significant effect on healthcare system improvement.

METHODS

This cross-sectional study was performed on 406 nurses and physician's burnout in Guilan province in 2020. Three questionnaires were used: demographic, physical space of the hospital, daylight, nature-view windows, and Maslach Burnout Inventory. Logistic regression (LR) analysis was used to determine the association between burnout and the hospital environment. The significance level was considered with p < .05.

RESULTS

The results showed statistically significant correlations between patient units and the environmental characteristics of the hospitals with staff's burnout (p < .001). Of note, 62.9% of physicians and 71.9% of nurses had moderate work-related burnout. The highest burnout score was seen among staffs of emergency departments adjusted multivariate LR model revealed that 27.1% of work-related burnout in nurses and physicians was predictable with age, light, marital status, and hospitals. Our results showed that accessing more daylight could reduce burnout (p = .018, odds ratio [OR] = 0.910).

CONCLUSION

Based on the result, the daylight impact on burnout reduction is more significant than other factors. It is suggested that adequate lighting, proper environmental design, and nature-view windows could create appropriate space for enhancing medical staff satisfaction and reducing burnout.

Burnout syndrome and related factors among health team employees

BACKGROUND

Burnout is not only related to mental health but also to efficiency. Thus, recognizing effective coping strategies has a significant role in improving mental health, the efficiency and productivity of human resources, and making better the level of quality of service.

OBJECTIVE

To determine burnout syndrome and examine related factors among the employees of Mashhad University of Medical Sciences.

METHOD

This cross-sectional study was conducted among 600 employees at Mashhad University of Medical Sciences. They were selected by a stratified sampling method. The data collection tool was the demographic information and the Burnout Self-Test Maslach Burnout Inventory (MBI) questionnaire. Data were analyzed through SPSS software version 20, using descriptive statistics and independent samples t-tests, one-way ANOVA, and Pearson and Spearman regression.

RESULTS

The findings showed that emotional exhaustion (EE) and depersonalization (DP) in the majority of employees were high and personal accomplishment (PA) was low at 88.33% of cases. All participants presented burnout. However, participants aged 35-40 years, those with professional and Ph.D. degrees, and research staff reported higher burnout levels.

CONCLUSION

Job burnout and its subscale levels among the employees were high. Job burnout is associated with socioeconomic status that can be affected by individual, organizational, management, and environmental factors. Therefore, this study suggests that employees need to get out of EE and DP conditions for higher job performance. Additionally, further research is required to examine the long-term effects of workplace burnout.

Barriers and facilitators of rehabilitation nursing care for patients with disability in the rehabilitation hospital: A qualitative study

Nurses play a key role in providing rehabilitation care. In this regard, identifying the factors that affect their practice can be useful in planning to improve the quality of rehabilitation nursing care. This study aims to explore the experience of nurses and members of the rehabilitation team about barriers and facilitators of rehabilitation nursing care of patients with disability in the rehabilitation hospital. This qualitative study was conducted in the main public rehabilitation hospital in Tehran, Iran. Eighteen persons including 12 nurses in clinical and managerial positions, an occupational therapist, a physical medicine specialist, a patient, and an informal caregiver participated in this study. Participants were selected based on purposeful sampling. Data were collected through 18 in-depth semi-structured interviews and analyzed based on qualitative content analysis principles. Three themes were derived from the data analysis, which represented Barriers and facilitators related to nurses (specialized knowledge and skills, psychological status, mentoring, professional communication), barriers and facilitators related to the work environment (nurses' performance evaluation, nursing workforce, comprehensive care facilities, workplace design, specialized unit), barriers and facilitators related to patients and caregivers (patient's participation in nursing care, patient adaptation, efficiency of formal caregivers). The experiences of the rehabilitation team shows that not only nurses, but also the environment, patients, and caregivers can affect the provision of care and change the quality of care. Identifying these factors can help managers, researchers, and clinical nurses to facilitate and improve rehabilitation nursing care by modifying the influencing factors.

Satisfaction with activity-support and physical home-workspace characteristics in relation to mental health during the COVID-19 pandemic

Previous research indicates that employees' mental health might be influenced by their satisfaction with physical office characteristics, such as noise, daylight, and ventilation. However, similar research on mental health in relation to working from home (WFH) is limited. Therefore, this study aimed to identify the relationships between satisfaction with physical home workspace characteristics and support of work activities and mental health while WFH during the COVID-19 pandemic. Relationships were analysed using a path analysis approach, based on a sample of 1219 office workers, who had to work fully from home. The internal relationships between the ten considered mental health variables were also studied. Results showed that satisfaction with daylight, artificial light, greenery, and views outside were directly related to one of the mental health variables and indirectly to several others. Surprisingly, satisfaction with temperature, noise, ventilation, and air quality did not seem to play a role at the home workplace. In addition, unlike at the office, personal characteristics did not relate to workspace satisfaction nor perceived support of activities at home. Furthermore, all mental health variables were related to at least one other mental health variable. Workplace managers could use these insights to formulate recommendations for employees on how to design their home-workspace.

Operating room nurses' experiences of limited access to daylight in the workplace - a qualitative interview study

Background

The operating room nurse is, among other things, responsible for patient safety and maintaining an aseptic environment. For hygienic reasons unnecessary traffic in the operating room should be avoided, which may mean that the operating room nurse works long shifts without relief. Operating departments are usually separated, where there might be no daylight opportunities in the operating room. The purpose of the study was to describe operating room nurses’ experiences of limited access to daylight in the workplace.

Method

Qualitative design with four semi-structured focus groups of totally 15 operating room nurses. The analysis was performed with a content analysis with an inductive approach.

Results

The study generated two main categories, difference in light and contact with the outer world. Operating room nurses felt that daylight affected them differently from the light from lamps, where daylight was considered important for experiencing well-being. Daylight could lead to a sensation of joy but also increased awareness and energy which seemed to improve the ability to perform at work. The limited access to daylight contributed to fatigue and led to an internal stress that affected the nurses even after work. Having opportunities to look out through windows under a workday was important to experience contact with the outside world and created a sense of time.

Conclusion

To look out can reduce the feeling of being trapped in the closed context that the operating department entails. It can also lead to increased well-being and comfort in the workplace. We consider that daylight is an important component in the physical work environment that needs to be taken into consideration in further research as well as in new construction of operations departments.

Occupational and Leisure-Time Physical Activity Have Different Relationships With Health: A Cross-Sectional Survey Study of Working Nurses

BACKGROUND

Recent research has focused on the potential benefits of physical activity in occupational settings in addition to leisure time. However, occupational physical activity (OPA) differs substantially for occupations that require heavy and repetitive physical work, such as nursing. We explored associations between leisure time and OPA and health outcomes in working nurses and midwives.

METHODS

Nurses who were enrolled in the Fit For the Future study (New South Wales, Australia) and who completed physical activity questionnaires (n = 4343) were classified according to high (HO) or low (LO) occupational and high (HL) or low (LL) leisure-time physical activity (LTPA): HO performed walking/heavy labor most/all of the time at work; HL met the guidelines of 150 minutes per week moderate to vigorous LTPA, creating 4 categories: HOLL, HOHL, LOHL, and LOLL.

RESULTS

HL predicted better self-rated health (unstandardized B = 0.51, 95% confidence interval, 0.44 to 0.57) and lower likelihood of ≥3 sick days in the past 12 months (OR: 0.71, 95% confidence interval, 0.61 to 0.83), whereas HO predicted higher likelihood of ≥3 sick days (OR: 1.17, 95% confidence interval, 1.01 to 1.35), adjusting for all variables.

CONCLUSIONS

OPA may not confer the same health benefits as LTPA for nurses. Health-promoting interventions should emphasize the importance of achieving adequate moderate to vigorous LTPA for all, including those undertaking substantial OPA.

The HDR CARE Scale, Inpatient Version: A validated survey instrument to measure environmental affordance for nursing tasks in inpatient healthcare settings

Rigorous healthcare design research is critical to inform design decisions that improve human experience. Current limitations in the field include a lack of consistent and valid measures that provide feedback about the role of the built environment in producing desirable outcomes. Research findings about nurses’ efficiency, quality of care, and satisfaction related to inpatient unit designs have been mixed, and there was previously no validated instrument available to quantitatively measure nurses’ ability to work efficiently and effectively in their environment. The objective of this study was to develop, refine, and validate a survey instrument to measure affordance of the care environment to nurse practice, based on various aspects of their work in inpatient units. The HDR Clinical Activities Related to the Environment (CARE) Scale Inpatient Version was developed using item design, refinement, and reliability and validity testing. Psychometric methods from classical test theory and item response theory, along with statistical analyses involving correlations and factor analysis, and thematic summaries of qualitative data were conducted. The four-phase process included (1) an initial pilot study, (2) a content validation survey, (3) cognitive interviews, and (4) a final pilot study. Results from the first three phases of analysis were combined to inform survey scale revisions before the second pilot survey, such as a reduction in the number and rewording of response options, and refinement of scale items. The updated 9-item scale showed excellent internal consistency and improved response distribution and discrimination. The factor analysis revealed a unidimensional measure of nurse practice, as well as potential subscales related to integration, efficiency, and patient care. Within the healthcare design industry, this scale is much needed to generate quantitative and standardized data and will facilitate greater understanding about the aspects of an inpatient healthcare facility that best support nurses’ ability to provide quality patient care.

Preferences for Indoor Environmental and Social Comfort of Outpatient Staff during the COVID-19 Pandemic, an Explanatory Study

While the pressure on hospital workers keeps growing, they are generally more dissatisfied with their comfort than other occupants in hospitals or offices. To better understand the comfort of outpatient workers in hospitals, clusters for preferences and perceptions of the indoor environmental quality (IEQ) and social comfort were identified in a previous study before the outbreak of the coronavirus disease 2019 (COVID-19) pandemic. This qualitative study explains the outpatient workers' main preferences for comfort during the COVID-19 pandemic. Semi-structured interviews and photo-elicitation were used. Contextual changes due to the COVID-19 pandemic were included. The questions in the interviews were based on the characteristics of the profiles, corresponding with the clusters. The data were analyzed with content analysis according to the steps defined by Gioia. Seventeen outpatient workers who had been part of the previous study participated. For some outpatient workers differentiation of preferences was illogical due to interrelations and equal importance of the comfort aspects. The main changes in perceptions of comfort due to the pandemic were worries about the indoor air quality and impoverished interaction. Because the occupants' preferences for comfort can change over time, it was suggested that further development of occupant profiles needs to accommodate changes.

In the Moment: Fostering Mindfulness and Reducing Stressors in the Healthcare Workplace

While healthcare design research has primarily focused on patient outcomes, there is a growing recognition that environmental interventions could do more by promoting the overall quality of care, and this requires expanding the focus to the health and well-being of those who deliver care to patients. Healthcare professionals are under high levels of stress, leading to burnout, job dissatisfaction, and poor patient care. Among other tools, mindfulness is recommended as a way of decreasing stress and helping workers function at higher levels. This article aims to identify potential environmental strategies for reducing work-related stressors and facilitating mindfulness in healthcare settings. By examining existing evidence on workplace mindfulness and stress-reducing design strategies, we highlight the power of the physical environment in not only alleviating stressful conditions but intentionally encouraging a mindful perspective. Strategies like minimizing distractions or avoiding overstimulation in the healthcare environment can be more effective if implemented along with the provision of designated spaces for mindfulness-based programs. Future research may explore optimal methods and hospital workers' preferences for environments that support mindfulness and stress management. The long-term goal of all these efforts is to enhance healthcare professionals' well-being, reignite their professional enthusiasm, and help them be resilient in times of stress.

Study of the Physical Environment of Waiting Areas and Its Effects on Patient Satisfaction, Experience, Perceived Waiting Time, and Behavior in China

OBJECTIVES

This study examines the physical environment in the outpatient waiting area and its effects on overall satisfaction, experience, perceived waiting time, and behavior.

BACKGROUND

Waiting can be a frustrating experience for patients. Previous studies on waiting areas in hospitals have been rooted mainly in the Western cultural context, and research focusing on the impact of the physical environment on the waiting experience with the denser patient concentration in China is important.

METHODS

Physical environment measurements, observations, and questionnaire surveys were employed.

RESULTS

The actual lighting intensity and sound level did not meet the national standards. Sound level and satisfaction with the size of the waiting area, signage system, and visual art on the wall were significant predictors (R ² = .463, p = .000) for overall satisfaction. Experiences related to the size of the waiting area, seating, signage system, and restrooms were significant predictors (R ² = .373, p = .000) of overall waiting experience. The experience related to the acoustic environment (β = -.184, p = .006) had a significant relationship with perceived waiting time. The increase in participants' behaviors of looking out of a window and the decrease in looking at other people, looking around, dozing, and looking at a wall might result from a substantial increase in lighting and the availability of a nature view from the window.

CONCLUSIONS

The effect of the physical setting of waiting areas may positively impact patient satisfaction, waiting experience, perceived waiting time, and behavior, which has implications for patient-centered design.

The Moderating Effect of Nursing Practice Environment on the Relationship between Clinical Nurses' Sleep Quality and Wellness

This study examined the moderating effect of nursing practice environment on the relationship between clinical nurses’ sleep quality and wellness. The wellness of clinical nurses is a direct outcome of individual-level health behaviors and organizational environmental factors. This study was a cross-sectional analysis. Participants were clinical nurses recruited using convenience sampling. The Nurse Practice Environment Scale, Wellness Index, and Pittsburgh Sleep Quality Index, Korean version (PSQI-K) were used. Data collected from 1874 nurses were analyzed using descriptive statistics and hierarchical multiple regression analyses. A total of 95.3% of the participants were women, and the mean age was 28.8 years. Further, 42.4% of the participants had a nursing career of 5 years or longer. The mean score for nursing practice environment was 2.24 and the mean PSQI-K score was 9.39. Nurses with less than 1 year of experience reported lower wellness scores. The wellness scores decreased with poorer sleep quality, and a more positive evaluation of the nursing practice environment predicted higher levels of wellness. Nursing practice environment had a moderating effect on the negative association of nurses’ poor sleep quality with their wellness. Regarding management, individual strategies for nurses’ well-being and organizational improvement policies may improve the nursing work environment.

Lighting Control in Patient Rooms: Understanding Nurses' Perceptions of Hospital Lighting Using Qualitative Methods

PURPOSE

This study differs in its methodological approach from previously published research by interpreting qualitative results against existing literature to understand how nurses conceptualize medical-surgical patient rooms as productive settings in relation to lighting, as well as the ways in which nurses believe these spaces could be enhanced for patient satisfaction.

METHODS

Content analysis was used to interpret themes emerging from nurses' subjective responses to open-ended items. Three of the facilities had older, traditional lighting systems; one had a contemporary framework.

RESULTS

A theme of environmental control over both overhead and task lighting emerged from data from all items. Although controllability was among the "best" lighting attributes, more refinement is necessary for optimal staff productivity and patient satisfaction. Daylighting was also considered to be among the best attributes. Control over light level via additional dimming capability for patients, as well as additional light sources, was prominent across the four hospitals. Unique to the more modern facility, trespassing of light was problematic for nurses considering the experiences of patients-even where modern models exist, more attention can be paid to the ways in which window shades, and light sources outside of rooms, penetrate spaces and affect users.

CONCLUSION

The finding that nurses and patients desire greater control over the lighting in patient rooms is consistent with Ulrich's theory of supportive design for healthcare and coincides with advances in lighting technology. Despite differences in the level of sophistication in lighting among the four facilities, control continues to be a primary concern for nurses.

Conflict in nursing studies: A bibliometric analysis of the top 100 cited papers

AIM

This study aimed to identify and investigate the main characteristics of the top 100 most cited studies on conflict in published in nursing category in the Web of Science database using bibliometric and social network analysis methods.

DESIGN

A retrospective bibliometric analysis was used.

METHODS

The study data were obtained from the Web of Science (WoS) database. The top 100 studies with the highest number of citations were included in the study. The study data were analysed with Excel and SPSS and they were visualized with VOSviewer.

RESULTS

It was concluded that the studies in the research were published in 38 different journals between 1974-2019 and they were conducted by 245 different authors from 24 different countries. It was further reported that the Journal of Advanced Nursing was the most productive journal and the USA was the most productive country. The most commonly used keywords were "nurse," "conflict," "nursing," "job satisfaction," "work-family conflict" and "ethical conflict."

CONCLUSION

The issue of conflict is a growing field of scientific study for nursing researchers. The quality of researches will be certainly enhanced in future with the studies published in journals with high impact factors.

IMPACT

The research of the top 100 most cited paper is a new and innovative bibliometric approach to understand nursing literature. There is very little information about the development, structure and characteristics of the existing mass of knowledge on conflict in nursing studies. The study findings establish a basis of information for planning further studies and providing guidance. In addition, this study provides researchers, scientific journals, institutions and countries with an opportunity to assess and compare their own performance in conflict literature in nursing studies. However, the fact that the most cited studies in the field of conflict in nursing is in demand by journals with high impact factor is a source of motivation for researchers studying in this field.

Encountering Suffering at Work in Health Religious Organizations: A Partial Least Squares Path Modeling Case-Study

Health religious organizations tend to offer individual attention to patients in line with their spiritual character and, at the same time, the highest service quality. This study puts the attention on the nurse-patient relationship and empirically explores a theoretical model that links nurses’ suffering at work with personal’s willingness to engage in a therapeutic and spiritual relationship with patients and the consequent effect on quality. Data has been collected in the city of Madrid (Spain) in the month of June 2019 in Santa Elena Clinic. An analytical case-study based on Partial Least Squares (PLS) path modeling is the chosen method to verify the cause-effect hypothesized relationships. This study contributes to the current academic literature by providing new knowledge and empirical evidence on the topic of the future of work in health religious organizations. The main conclusion is the necessary inclusion of suffering, even in good places to work, as a key indicator for a better management. Results should be a useful source of information for practitioners that seek to implement better human management systems in these organizations.

The Energy Saving Potential of Wide Windows in Hospital Patient Rooms, Optimizing the Type of Glazing and Lighting Control Strategy under Different Climatic Conditions

If not properly designed, the adoption of large windows can sometimes have a negative impact on building energy demand. For this reason, aggravated by the outdated building envelope of the healthcare building stock, large fenestration systems are usually avoided in hospitals, especially in old structures. However, with appropriate glazing specifications, the adoption of wider openings can result into significant energy savings, lower costs and strong positive effects on patients and staff well-being. The present study investigates how different window sizes and types of glazing affect heating, cooling and lighting energy demand in a hospital patient room. The objective is to evaluate the energy savings that may be obtained when installing larger windows and to identify the glazing properties allowing one to reach the maximum energy reductions. Simulations were carried out using nine diverse glazing systems, already available on the market, and their energy performance was evaluated in relation to two different window areas: a common size opening, characterized by a 25% Window-to-Wall Ratio (WWR), and a floor to ceiling window, with 77% WWR. The analysis was conducted taking into consideration four different orientations in four Italian cities, supposing two artificial lighting control strategies. The results highlighted how the adoption of wider windows with appropriate glazings and a daylight-linked dimming lighting control strategy may lower the primary energy demand up to 17%.

Hospital employees’ perceptions of circadian lighting: a pharmacy department case study

Purpose

An interdisciplinary body of literature has focused on the role of lighting in mitigating patient and employee stress and error-producing conditions in hospital settings. The purpose of this study is to explore how a new circadian lighting system installed in a small pharmacy unit with no penetration of natural light is experienced by staff. Psychosocial variables, such as affective organizational commitment, perceived productivity, well-being, and satisfaction with the physical work environment, were measured to further a line of inquiry that may help facilities managers and hospital administrators make optimal choices when purchasing lighting and commissioning retrofits.

Design/methodology/approach

Post-occupancy evaluation; mixed methods survey design.

Findings

While affective organizational commitment, perceived productivity, well-being and satisfaction with the physical work environment were experienced, to some extent, by employees, low average responses about whether the setting had improved, as the circadian lighting had been installed suggest that the retrofit did not affect them as positively as expected. Counter to the intention of the installation, participants did not perceive the circadian lighting as having strongly improved their levels of stress, concentration, mood or fatigue at work.

Originality/value

More research on simulated daylighting should be done to optimize occupant responses to lighting retrofits in hospitals. This case study supports recommendations to measure relevant psychosocial variables before and after a design change. Similarly, sized units within hospitals and health care facilities that possess analogous dimensions and design constraints concerning a lack of daylight penetration will benefit from this study’s mixed methods, results and interpretations.

Burnout among healthcare providers in the complex environment of the Middle East: a systematic review

BACKGROUND

Burnout is a syndrome characterized by emotional exhaustion, increased depersonalization, and a diminished sense of personal accomplishment due to chronic emotional stress at work. Burnout impacts job satisfaction, job performance, vulnerability to illnesses, and interpersonal relationships. There is a gap in the systematic data on the burden of burnout among healthcare professionals from different sectors of healthcare in Middle Eastern countries. Our objective was to examine the burden of burnout among healthcare providers in the Middle East, how it was assessed, which sectors were included, and what interventions have been used.

METHODS

Articles were found through a systematic review of search results including PubMed, Web of Science (Thomson Reuters), and PsycINFO (EBSCO) using search terms reflecting burnout in Middle Eastern countries among populations of healthcare providers. Studies were included if they examined a quantitative measure of burnout among healthcare providers in the Middle East.

RESULTS

There were 138 articles that met our inclusion criteria for this systematic review. Studies focused on burnout in the Middle East among physicians (N = 54 articles), nurses (N = 55), combined populations of healthcare workers (N = 22), and medical students (N = 7). The Maslach Burnout Inventory was the most common tool to measure burnout. Burnout is common among physicians, nurses, and other healthcare professionals, with prevalence estimates predominantly ranging between 40 and 60%. Burnout among healthcare providers in the Middle East is associated with characteristics of their work environments, exposure to violence and terror, and emotional distress and low social support.

CONCLUSIONS

Burnout is highly prevalent among healthcare providers across countries in the Middle East. Previous studies examining burnout in this region have limitations in their methodology. More thoroughly developed epidemiologic studies of burnout are necessary. Health system strengthening is needed in a region that has endured years of ongoing conflict, and there is an urgency to design and implement programs that tackle burnout among health professionals.

Interior Color and Psychological Functioning in a University Residence Hall

The research exploited a unique architectural setting of a university residence hall composed by six separate buildings that matched for every architectural detail and differed only for the interior color (violet, blue, green, yellow, orange, and red). Four hundred and forty-three students living in the six buildings for an average of 13.33 months participated in a study that assessed color preference (hue and lightness), lightness preference, and the effects of color on studying and mood. The results showed a preference for blue interiors, followed by green, violet, orange, yellow, and red. A preference bias was found for the specific color in which the student lived. Gender differences emerged for the preference of blue and violet. Room-lightness was significantly affected by the interior color. Room ceiling was preferred white. Blue as interior color was considered to facilitate studying activity. The use of differentiated colors in the six buildings was evaluated to significantly facilitate orienting and wayfinding. A significant relation was found between a calm mood and preference for blue.

An examination of the correlation between nurses' organizational trust and burnout levels

INTRODUCTION

Decrease in the organizational trust level of nurses, leads to increase turnover rate of nurses, causes an increase in workload, causes a decrease in motivation and quality of patient care. The results caused by the lack of organizational trust is important for both individuals and organizations.

AIM

To investigate the relationship between nurses' organizational trust and burnout level.

METHOD

This descriptive and relational study is carried out at an university hospital with 155 nurses who were agreed to participate. Data were collected with Identifying Information Form, Organizational Trust Inventory and Maslach Burnout Inventory. Data were analyzed with numbers, percentage, mean standard deviation, spearman correlation analysis and multiple linear regression.

FINDINGS

A negative, very weak and statistically significant relationship was found between emotional exhaustion level and trust in employer level (r = 0.304, p < 0.01) and trust in institution level (r = 0.335, p < 0.01); a negative, very weak and statistically significant relationship was found between emotional exhaustion level and trust in colleagues level (r = 0.240, p < 0.01); between depersonalization level and trust in employer level (r = 0.315, p < 0.01); between depersonalization level and trust in colleagues level (r = 0.282, p < 0.01); between reduced personal accomplishment level and trust in employer level (r = 0.238, p < 0.01).

RESULTS

It was concluded that there was a statistically significant relationship between the nurses' organizational trust level and burnout level. In addition, organizational trust was a significant predictor of emotional exhaustion, depersonalization and reduced personal accomplishment level.

The impact of windows and daylight on acute-care nurses' physiological, psychological, and behavioral health

OBJECTIVE

To investigate the physiological and psychological effects of windows and daylight on registered nurses.

BACKGROUND

To date, evidence has indicated that appropriate environmental lighting with characteristics similar to natural light can improve mood, alertness, and performance. The restorative effects of windows also have been documented. Hospital workspaces generally lack windows and daylight, and the impact of the lack of windows and daylight on healthcare employees' well being has not been thoroughly investigated.

METHODS

Data were collected using multiple methods with a quasi-experimental approach (i.e., biological measurements, behavioral mapping, and analysis of archival data) in an acute-care nursing unit with two wards that have similar environmental and organizational conditions, and similar patient populations and acuity, but different availability of windows in the nursing stations.

RESULTS

Findings indicated that blood pressure (p < 0.0001) decreased and body temperature increased (p = 0.03). Blood oxygen saturation increased (p = 0.02), but the difference was clinically insignificant. Communication (p < 0.0001) and laughter (p = 0.03) both increased, and the subsidiary behavior indicators of sleepiness and deteriorated mood (p = 0.02) decreased. Heart rate (p = 0.07), caffeine intake (p = 0.3), self-reported sleepiness (p = 0.09), and the frequency of medication errors (p = 0.14) also decreased, but insignificantly.

CONCLUSIONS

The findings support evidence from laboratory and field settings of the benefits of windows and daylight. A possible micro-restorative effect of windows and daylight may result in lowered blood pressure and increased oxygen saturation and a positive effect on circadian rhythms (as suggested by body temperature) and morning sleepiness.

KEYWORDS

Critical care/intensive care, lighting, nursing, quality care, work environment.

The Importance of Specific Workplace Environment Characteristics for Maximum Health and Performance: Healthcare Workers' Perspective

OBJECTIVE

To examine the importance of specific workplace environment characteristics for maximum health and performance, assigned by healthcare employees, and how they relate to the nature of their work.

METHODS

A cross-sectional mixed-method study was conducted with content analysis and robust regression models to examine the relationship between workplace environment characteristics and perceived importance in promoting health and performance.

RESULTS

Our findings suggest that perceptions of key environment characteristics that safeguard health and performance in healthcare workplaces may vary by employee sex, setting, and nature of healthcare work involved. Theme and model descriptions of the influence of these factors on participant perceptions are provided.

CONCLUSIONS

Employee feedback on workplace characteristics that impact health and performance could be instrumental in determining the priorities of workplace design.

Effect of Natural Sunlight on Sleep Problems and Sleep Quality of the Elderly Staying in the Nursing Home

This study was designed as an intervention study to determine the effect of light therapy on sleep problems and sleep quality of elderly people. The study sample was composed of a total of 61 elderly persons from Social Security Institution Narlıdere Municipal Nursing Home, 30 in the test group and 31 in the control group. Those 65 years and older, not diagnosed with major depression, not exercising regularly, not having sun allergy, not using sleeping pills, independent in activities of daily living, and having bad sleep quality were included in the study. The Pittsburgh Sleep Quality Index, the Demographic Data Form, and the Follow-up Form for Elderly were used for data collection, whereas the Pittsburgh Sleep Quality Index was used for sample selection. It was found that exposure to direct sunlight between 8 AM and 10 AM for 5 days seems to be effective in increasing the global sleep quality score (P < .001). In light of the findings in this study, it is suggested that allocating living places in the institution's architectural setting and providing social opportunities for elderly persons to get direct sunlight exposure can help increase the sleep quality of older adults.

Burnout among nurses working in social welfare centers for the disabled

Background

In the healthcare sector, we often come across the burnout syndrome. It is an occupational syndrome which causes, physical and emotional exhaustion. More information is needed on the dangers of burnout and how often it occurs in healthcare. The purpose of this study was to investigate burnout and factors associated with the syndrome among nurses working with people that are mentally challenged.

Methods

A cross-sectional survey was conducted, among 180 nurses working in public health centers for the disabled in multiple regions of Greece. A self-administered questionnaire with questions about socio-demographic and work-related characteristics was used, as well as the Maslach Burnout Inventory (MBI) for burnout assessment. Univariate and multivariate analyzes were performed.

Results

The burnout dimensions of emotional exhaustion (Mean = 31.36) and depersonalization (Mean = 11.27) were at high levels while personal accomplishment was at low levels (Mean = 44.02). Female nurses had a higher personal accomplishment score (Mean = 44.82, p = 0.047) than men (Mean = 42.10, p = 0.047). Marital status, daily routine and relationships with supervisors were significantly related with emotional exhaustion and personal accomplishment and professional experience with higher levels of emotional exhaustion and depersonalization. Reason for professional selection was an independent predictor for depersonalization and personal accomplishment, with those that have selected the nursing profession randomly or because of the fear of unemployment having higher scores. Moderate relationships with colleagues was an independent predictor for all burnout dimensions.

Conclusions

Nurses working in services for people with intellectual disabilities in Greece show increased burnout levels. Burnout can be prevented by offering more opportunities for professional advancement and education, new ways to provide supervisor support, provide incentives for nurses to initiate or participate in innovative programs. Specific training on conflict resolution, collaboration, reinforcement and stress coping techniques must be implemented.

The influence of facility design and human resource management on health care professionals

BACKGROUND

Cost control of health care services is a strategic concern for organizations. To lower costs, some organizations reduce staffing levels. However, this may not be worth the trade-off, as the quality of services will likely be reduced, morale among health care providers tends to suffer, and patient satisfaction is likely to decline.

PURPOSE

The potential synergy between human resource management and facility design and operation was investigated to achieve the goal of providing cost containment strategies without sacrificing the quality of services and the commitment of employees.

METHODOLOGY

About 700 health care professionals from 10 acute-care hospitals participated in this cross-sectional study. The authors used structural equation modeling to test whether employees' evaluations of their physical work environment and human resource practices were significantly associated with lower job-related anxiety, higher job satisfaction, and higher organizational commitment.

FINDINGS

The analysis found that employees' evaluations of their physical work environment and human resource practices influenced their job-related feelings and attitudes. Perceived organizational support mediated this relationship. The study also found a small but positive interaction effect between the physical work environment and human resource practices. The influence of physical work environment was small, mainly because of the high predictive value of human resource practices and strong confounding variables included in the analysis. This study specifically showed the role of facility design in reducing job-related anxiety among caregivers.

PRACTICE IMPLICATIONS

Preliminary evidence is provided that facility design can be used as a managerial tool for improving job-related attitudes and feelings of employees and earning their commitment. Providing a healthy and safe work environment can be perceived by employees as an indication that the organization respects them and cares about their well-being, which might be reciprocated with higher levels of motivation and commitment toward the organization.

Living with constant leaking of urine and odour: thematic analysis of socio-cultural experiences of women affected by obstetric fistula in rural Tanzania

Background

Obstetric fistula is a worldwide problem that affects women and girls mostly in Sub Saharan Africa. It is a devastating medical condition consisting of an abnormal opening between the vagina and the bladder or rectum, resulting from unrelieved obstructed labour. Obstetric fistula has devastating social, economic and psychological effect on the health and wellbeing of the women living with it. This study aimed at exploring social-cultural experiences of women living with obstetric fistula in rural Tanzania.

Methods

Women living with obstetric fistula were identified from the fistula ward at CCBRT hospital. Sixteen individual semi structured interviews and two (2) focus group discussions were conducted among consenting women. Interviews were transcribed verbatim and transcripts analysed independently by two researchers using a thematic analysis approach. Themes related to the experiences of living with obstetric fistula were identified.

Results

Four themes illustrating the socio-cultural experiences of women living with obstetric fistula emerged from the analysis of women experiences of living with incontinence and odour. These were keeping clean and neat, earning an income, maintaining marriage, and keeping association. Women experiences of living with fistula were largely influenced by perceptions of people around them basing on their cultural understanding of a woman.

Conclusion

Living with fistula reveals women’s day-to-day experiences of social discrimination and loss of control due to incontinence and odour. They cannot work and contribute to the family income, cannot satisfy their husband’s sexual needs and or bear children, and cannot interact with members of the community in social activities. Women experience of living with fistula was influenced by perceptions of people around them. In the eyes of these people, women who leak urine were of less value since they were not capable of carrying out ascribed social roles.

Frozen moments: flashback memories of critical incidents in emergency personnel

BACKGROUND

Emergency Department personnel regularly face highly stressful situations or critical incidents (CIs) that may subsequently be recalled as unbidden intrusive memories. In their most extreme form, such memories are reexperienced as if they were happening again in the present, as flashbacks. This study examined (1) which CIs are associated with flashback memories; (2) candidate person and work-related features that predict flashback memories; and (3) the association between flashback memories and anxiety, depression, and emotional exhaustion.

METHODS

Emergency nurses (N = 91; 80.2% female) were recruited from two urban teaching hospitals and filled in self-report questionnaires.

RESULTS

A majority (n = 59, 65%) experienced intrusive memories; almost half of the sample reported that their memories had flashback character. Those involved in resuscitations in the past week were at a fourfold risk for experiencing flashbacks. Having worked more consecutive days without taking time off was associated with a somewhat lower incidence of flashbacks. Moreover, older individuals who reported more work-related conflicts were at greater risk for experiencing flashback memories than their younger colleagues with heightened work conflict and flashback memory scores, respectively. Flashback memories were associated with heightened symptoms of anxiety, depression, and emotional exhaustion.

CONCLUSIONS

The present findings have implications for evidence-based health promotion in emergency personnel and other individuals regularly exposed to CIs.

A causal model of antecedents with burnout focusing on the intermediate role of hardy personality in Iranian nurses

Nowadays burnout is a common issue in all health systems and therapeutic professions. Burnout is caused by job stressors and results in reduction in output, increase in absenteeism and health expenses, behavioral changes, and sometimes drugs abuse. Nonetheless, people who have hardy personalities experience less exhaustion. The present research aimed to present a causal model of antecedents with burnout to emphasize the intermediate role of hardy personality in the nurses working in the public hospitals of Shiraz, Iran. The study data were collected using the Nursing Burnout Scale questionnaire (Int J Nurs Stud. 2008;45(3):418-427). In addition, the structural equation method was used as a model in order to determine the relationship between the variables. The suggested pattern in this research was checked by Leasrel software, version 8.5. The study results showed that antecedents, such as incorrect supervision, responsibility, and workload, have a significant effect on burnout. However, mediated hardy personality had no effect on burnout. The results also showed that the people who had hardy personality could manage the stressful situations well and, consequently, rarely experience burnout. Overall, if the job stressors are existent in the job environment and the individuals cannot eradicate them, they will cause burnout outbreak.

Design Research and the Globalization of Healthcare Environments

OBJECTIVE:

Global healthcare practice has expanded in the past 20 years. At the same time the incorporation of research into the design process has gained prominence as a best practice among architects. The authors of this study investigated the status of design research in a variety of international settings. We intended to answer the question, “how pervasive is healthcare design research outside of the United States?”

METHOD:

The authors reviewed the international literature on the design of healthcare facilities. More than 500 international studies and conference proceedings were incorporated in this literature review. A team of five research assistants searched multiple databases comparing approximately 16 keywords to geographic location. Some of those keywords included: evidence-based design, salutogenic design, design research, and healthcare environment. Additional articles were gathered by contacting prominent researchers and asking for their personal assessment of local health design research studies.

RESULTS:

While there are design researchers in most parts of the world, the majority of studies focus on the needs of populations in developed countries and generate guidelines that have significant cost and cultural implications that prohibit their implementation in developing countries. Additionally, the body of literature discussing the role of culture in healthcare environments is extremely limited.

CONCLUSION:

Design researchers must address the cultural implications of their studies. Additionally, we need to expand our research objectives to address healthcare design in countries that have not been previous considered.

Impact of windows and daylight exposure on overall health and sleep quality of office workers: a case-control pilot study

STUDY OBJECTIVE

This research examined the impact of daylight exposure on the health of office workers from the perspective of subjective well-being and sleep quality as well as actigraphy measures of light exposure, activity, and sleep-wake patterns.

METHODS

Participants (N = 49) included 27 workers working in windowless environments and 22 comparable workers in workplaces with significantly more daylight. Windowless environment is defined as one without any windows or one where workstations were far away from windows and without any exposure to daylight. Well-being of the office workers was measured by Short Form-36 (SF-36), while sleep quality was measured by Pittsburgh Sleep Quality Index (PSQI). In addition, a subset of participants (N = 21; 10 workers in windowless environments and 11 workers in workplaces with windows) had actigraphy recordings to measure light exposure, activity, and sleep-wake patterns.

RESULTS

Workers in windowless environments reported poorer scores than their counterparts on two SF-36 dimensions--role limitation due to physical problems and vitality--as well as poorer overall sleep quality from the global PSQI score and the sleep disturbances component of the PSQI. Compared to the group without windows, workers with windows at the workplace had more light exposure during the workweek, a trend toward more physical activity, and longer sleep duration as measured by actigraphy.

CONCLUSIONS

We suggest that architectural design of office environments should place more emphasis on sufficient daylight exposure of the workers in order to promote office workers' health and well-being.

Burnout levels of hemodialysis nurses

BACKGROUND

Previous studies have found significant stressors experienced by nurses working in hemodialysis units. The purpose of this study was to determine the burnout levels of hemodialysis nurses working in hemodialysis units and their relation with some sociodemographic variables.

METHODS

The study was conducted between July 2012 and Sept 2012 in hemodialysis units of four hospitals, including one university, one public and two private hospitals, in the province of Erzurum. The population of the study consisted of 32 nurses rendering service in hemodialysis units of the related hospitals. Information forms, which were prepared by researchers in accordance with the literature, and aimed at determining the personal characteristics of nurses and Maslach Burnout Inventory were used for the data collection.

RESULTS

Examining mean scores obtained by nurses from the Maslach Burnout Inventory, it is observed that they scored 17.07 ± 8.29 from subscale of emotional exhaustion, 5.89 ± 4.13 from subscale of depersonalization and 20.64 ± 4.10 from subscale of personal accomplishment.

CONCLUSION

The results of the study revealed that nurses working in hemodialysis units experience a medium-level burnout in terms of subscales of emotional exhaustion, depersonalization, and a high-level burnout in terms of the subscale of personal accomplishment.

Nurses' lived experiences of intensive care unit bed spaces as a place of care: a phenomenological study

BACKGROUND

The environment of an intensive care unit (ICU) is, in general, stressful and has an impact on quality of care in terms of patient outcomes and safety. Little is known about nurses' experiences, however, from a phenomenological perspective with regard to the critical care settings as a place for the provision of care for the most critically ill patients and their families.

AIM

The aim of this study was to explore nurses' lived experiences of ICU bed spaces as a place of care for the critically ill.

DESIGN AND METHODS

A combination of qualitative lifeworld interviews and photos --photovoice methodology --was used when collecting data. Fourteen nurses from three different ICUs participated. Data were analysed using a phenomenological reflective lifeworld approach.

FINDINGS

An outer spatial dimension and an inner existential dimension constitute ICU bed spaces. Caring here means being uncompromisingly on call and a commitment to promoting recovery and well-being. The meanings of ICU bed spaces as a place of care comprise observing and being observed, a broken promise, cherishing life, ethical predicament and creating a caring atmosphere.

CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE

The architectural design of the ICU has a great impact on nurses' well-being, work satisfaction and the provision of humanistic care. Nurses need to be involved in the process of planning and building new ICU settings. There is a need for further research to highlight the quality of physical environment and its impact on caring practice.

Environmental design in acute care settings: a case study of a neurological rehabilitation unit

OBJECTIVE

The purpose of this case study was to examine environmental variables that lead to staff error in acute care settings: noise; lighting; ergonomics, furniture, and equipment; and patient room design and unit layout.

BACKGROUND

Chaudhury, Mahmood, & Valente (2009) reviewed a number of design considerations related to reducing errors by nursing staff in acute care settings. The Neurological Rehabilitation Unit (NRU) at one hospital served to further examine the design recommendations outlined by Chaudhury et al. (2009).

METHODS

Based on photographs, a site tour, interviews with the NRU manager and with the son of a patient of 5 months, comparisons were made between the NRU and the acute care setting design considerations reviewed by Chaudhury et al. (2009).

RESULTS

The NRU appeared to comply with many recommendations: enforced noise reduction was facilitated through limiting both the number of patients per room and the number of patients admitted to the unit. Distinct rooms were used for various tasks that helped to contain activity-based noise. A combination of daylighting and artificial lighting was in place, but efforts to control glare and thermal comfort were not integrated into the design. The ergonomic needs of employees were incorporated in the design of the NRU, and the layouts of patient rooms and the layout of the NRU in general also were compatible with the design recommendations reviewed by Chaudhury et al. (2009).

CONCLUSIONS

Many of the design attributes advocated by Chaudhury et al. (2009) were included in the NRU. Supplemental research should be undertaken, however, to objectively measure nursing error, efficiency, and staff satisfaction with respect to the comparisons and assumptions presented in this study.

KEYWORDS

Case study, design, hospital, satisfaction, staff.

Addressing the nursing shortage: a critical health care issue

This article explores factors that influence a nurse's choice between working in a rural and an urban area. Understanding how nurses make the choice of which type of environment is critical to addressing this shortage, especially in these hardest hit rural areas. A comprehensive literature review suggested a number of factors worthy of investigation. These factors were assessed through six focus groups and a survey. Results suggest that native geographic preferences dominate, but that value congruence, economics, work facilities and stress all play a significant role in the decision when choosing between an urban and rural work environment.

Evaluation of physically and mentally fatiguing tasks and sources of fatigue as reported by registered nurses

AIMS

To identify fatiguing tasks and develop a model of sources of fatigue in nursing work.

BACKGROUND

Research has identified multiple factors contributing to occupational fatigue; however, comprehensive consideration of diverse factors identified by nurses as contributing to fatigue in nursing work systems is lacking.

METHODS

Content and frequency analyses were performed on previously unpublished data from an online survey of registered nurses. Responses from 100 registered nurses to questions related to the most fatiguing tasks in their work and factors that cause those tasks to be most fatiguing were analysed.

RESULTS

Physically demanding patient care tasks, and organisation, management and logistics tasks, respectively, were listed as the most frequent physically and mentally fatiguing. Time and multitasking demands were listed frequently as sources of both fatigue dimensions.

CONCLUSIONS

Registered nurses reported working in environments that include physically and mentally fatiguing tasks. They identified factors related to work content demands, including physical and mental task demands as well as time and multitasking demands, as most frequently contributing to fatigue.

IMPLICATIONS FOR NURSING MANAGEMENT

This work and our conceptual model of sources of fatigue provide a framework to support nurses, nursing managers and administrators to develop strategies to reduce fatigue among RNs.

Sleep Quality among Female Hospital Staff Nurses

Purpose. To investigate sleep quality of hospital staff nurses, both by subjective questionnaire and objective measures. Methods. Female staff nurses at a regional teaching hospital in Northern Taiwan were recruited. The Chinese version of the pittsburgh sleep quality index (C-PSQI) was used to assess subjective sleep quality, and an electrocardiogram-based cardiopulmonary coupling (CPC) technique was used to analyze objective sleep stability. Work stress was assessed using questionnaire on medical worker's stress. Results. A total of 156 staff nurses completed the study. Among the staff nurses, 75.8% (117) had a PSQI score of ≥5 and 39.8% had an inadequate stable sleep ratio on subjective measures. Nurses with a high school or lower educational degree had a much higher risk of sleep disturbance when compared to nurses with a college or higher level degree. Conclusions. Both subjective and objective measures demonstrated that poor sleep quality is a common health problem among hospital staff nurses. More studies are warranted on this important issue to discover possible factors and therefore to develop a systemic strategy to cope with the problem.

Why give birth in health facility? Users' and providers' accounts of poor quality of birth care in Tanzania

Background

In Tanzania, half of all pregnant women access a health facility for delivery. The proportion receiving skilled care at birth is even lower. In order to reduce maternal mortality and morbidity, the government has set out to increase health facility deliveries by skilled care. The aim of this study was to describe the weaknesses in the provision of acceptable and adequate quality care through the accounts of women who have suffered obstetric fistula, nurse-midwives at both BEmOC and CEmOC health facilities and local community members.

Methods

Semi-structured interviews involving 16 women affected by obstetric fistula and five nurse-midwives at maternity wards at both BEmOC and CEmOC health facilities, and Focus Group Discussions with husbands and community members were conducted between October 2008 and February 2010 at Comprehensive Community Based Rehabilitation in Tanzania and Temeke hospitals in Dar es Salaam, and Mpwapwa district in Dodoma region.

Results

Health care users and health providers experienced poor quality caring and working environments in the health facilities. Women in labour lacked support, experienced neglect, as well as physical and verbal abuse. Nurse-midwives lacked supportive supervision, supplies and also seemed to lack motivation.

Conclusions

There was a consensus among women who have suffered serious birth injuries and nurse midwives staffing both BEmOC and CEmOC maternity wards that the quality of care offered to women in birth was inadequate. While the birth accounts of women pointed to failure of care, the nurses described a situation of disempowerment. The bad birth care experiences of women undermine the reputation of the health care system, lower community expectations of facility birth, and sustain high rates of home deliveries. The only way to increase the rate of skilled attendance at birth in the current Tanzanian context is to make facility birth a safer alternative than home birth. The findings from this study indicate that there is a long way to go.

Corporate Sustainability: The Environmental Design and Human Resource Management Interface in Healthcare Settings

Purpose of the Paper:

The purpose of this study is to provide healthcare organizations with a new perspective for developing strategies to enrich their human resource capabilities and improve their performance outcomes. The focus of this study is on leveraging the synergy between organizational management strategies and environmental design interventions.

Background:

This paper proposes a framework for linking the built environment with the human resource management system of healthcare organizations. The framework focuses on the impact of the built environment regarding job attitudes and behaviors of healthcare workers. Research from the disciplines of strategic human resource management, resource-based view of firms, evidence-based design, and green building are utilized to develop the framework.

Theoretical Framework:

The positive influence of human resource practices on job attitudes and behaviors of employees is one mechanism to improve organizational performance outcomes. Organizational psychologists suggest that human resource practices are effective because they convey that the organization values employee contributions and cares about their well-being. Attention to employee socio-emotional needs can be reciprocated with higher levels of motivation and commitment toward the organization. In line with these findings, healthcare environmental studies imply that physical settings and features can have a positive influence on job attitudes and the behavior of caregivers by providing for their physical and socio-emotional needs.

Conclusions:

Adding the physical environment as a complementary resource to the array of human resource practices creates synergy in improving caregivers' job attitudes and behaviors and enhances the human capital of healthcare firms.

What makes a healthier nurse, workplace or leisure physical activity? Informed by the Australian and New Zealand e-Cohort Study

AIM AND OBJECTIVE

To investigate health differences between nurses who report meeting the daily physical activity recommendations in or away from the workplace.

BACKGROUND

Adhering to the national physical activity recommendations has known health benefits. Whilst often considered a workplace active profession, data are emerging of poor health amongst nurses. However, health differences between workplace or leisure-time physically active nurses are understudied.

DESIGN

The investigation is an observation study of Australian and New Zealand nurses. Data were generated from the longitudinal, population-based, observational e-Cohort nursing survey.

METHODS

Data were informed and groups defined by the self-reported minutes per day of moderate physical activity collected from a large international survey of practicing nurses (n = 2264). Groups were: Group (G) 1--high workplace (≥30 minutes/day)/high leisure (≥30 minutes/day), G2--high workplace/low leisure (<30 minutes/day), G3--low workplace/low leisure (<30 minutes/day) and G4--low workplace/high leisure.

RESULTS

G2 had a high BMI and were younger than G4. G4 were significantly more active away from work and more likely to report cycling to work than G2. In contrast, G2 were most likely to have taken sick days because of their health (χ(2) = 19·101), have difficulty sleeping most of the time and have a medical history of diagnosed anxiety and depression.

CONCLUSIONS

This study shows that improved well-being can be achieved in nursing cohort through leisure-time physical activity.

RELEVANCE TO CLINICAL PRACTICE

This research shows that nurse should consider leisure-time physical activity necessary to maintain and prolong health and that workplace activity is not a sufficient stimulus. This has important implications for workforce planners and administrators.