Substantial Differences in Turnover Intention Between Direct Care Workers in Chinese Hospitals and Long-Term Care Facilities

Care stressors and perceived stress among family caregivers of Chinese older adults with disabilities: The mediation effect of resilience

OBJECTIVES

Guided by the Stress Process Model, this study examined the mediating effect of resilience on the relationship between care stressors and perceived caregiving stress.

METHODS

Data were based on 234 older adults with disabilities and their caregivers from 6 urban districts and 6 rural counties from Jinan, China. Descriptive analysis, analysis of variance, ordinary least squares regression, and mediation analysis were performed.

RESULTS

Perceived stress among family caregivers of Chinese older adults with disabilities was affected by the physical and mental health of both themselves and the care recipients, as well as care intensity and financial difficulties. Resilience played a partial mediating role in the associations among three stressors (i.e. older adults' disability levels, number of chronic diseases, and caregivers' self-reported mental) and perceived caregiving stress.

CONCLUSIONS

Enhanced resilience aids caregivers' adaptation to their roles, suggesting the need for societal, spiritual, emotional, and behavioral resilience training.

The relationships between burnout, general wellbeing, and psychological detachment with turnover intention in Chinese nurses: a cross-sectional study

Background

It is critical to minimize nurse turnover to improve the quality of care and patient safety. In-depth investigation is required to better understand the factors related to nurses' turnover intentions.

Aim

This study aimed to determine the relationships between burnout, general wellbeing, and psychological detachment with turnover intention among nurses in China.

Methods

A cross-sectional survey using convenience sampling was conducted in one hospital in China between January 2023 and March 2023. A total of 536 nurses were surveyed using the General Wellbeing Schedule (GWB), the Maslach Burnout Inventory scale (MBI), the Psychological Detachment scale, and the Turnover Intention scale. The collected data were analyzed using SPSS 26.0 statistical software. The chi-square test and binary logistic regression analysis were used to explore the factors related to turnover intention.

Results

Our data demonstrated that the turnover intention scores were 13 (10, 15.75), with 56% of nurses exhibiting a high level of turnover intention. Binary logistic regression analysis results indicated that being on a contract (OR = 4.385, 95% CI = 2.196-8.754), working in the pediatrics (OR = 2.392, 95% CI = 1.267-4.514) or obstetrics (OR = 2.423, 95% CI = 1.145-5.126) department, and experiencing burnout (OR = 1.024, 95% CI = 1.008-1.041) were associated with a heightened level of turnover intention. Conversely, organizational satisfaction (OR = 0.162, 95% CI = 0.033-0.787) and general wellbeing (OR = 0.967, 95% CI = 0.946-0.989) were identified as factors that hindered the intention to leave.

Conclusions

Findings from this study suggest that nurses were employed on a contract basis, working in pediatric or obstetric departments, expressing dissatisfaction with the organization, reporting low general wellbeing, and experiencing high levels of burnout that require special attention. The identification of these risk factors can inform targeted interventions and support programs aimed at improving the wellbeing and retention of nurses in these settings.

"It's your Liangxin that tells you what to do": Interpreting workplace-induced emotions in a Chinese nursing home

How Direct Care Workers (DCWs) interpret their work and perform care activities undeniably impacts the well-being of institutionalized older adults. Despite the emotionally charged nature of paid care work, little is known about how Chinese DCWs talk about their work and construct meaning within China's unique social context of a burgeoning institutional care market and changing cultural expectations for long-term care. This study qualitatively explored Chinese DCWs' emotion work as they navigate among institutional pressures and low social recognition in an urban government-sponsored nursing home in central China. Results revealed that DCWs used Liangxin (the good heart/mind) - a ubiquitous Chinese moral notion emphasizing the unity of feeling, thought, and action - as an interpretive framework, including its four dimensions (ceyin, xiue, cirang, and shifei), to inform care practice, manage emotions, and find dignity within what can be personally demeaning and socially devalued work. Our study delineated the processes through which DCWs sympathized with the pain and struggles of the older adults in their care (ceyin xin), shamed unjust attitudes and behaviors embedded in institutional care (xiue xin), delivered family-like relational care (cirang xin), and formed and reinforced principles of good (versus bad) care (shifei xin). We also revealed the nuanced role that the cultural value of xiao (filial piety), working in tandem with liangxin, both shaped the emotional terrain of the institutional care setting and impacted how DCWs engaged in emotion work. While recognizing the effect of liangxin for incentivizing DCWs to provide relational care and renegotiate their role status, we were also alerted to the risks of overburdening and exploiting DCWs who relied solely on their liangxin to meet complex care needs.

Inequalities in Resource Distribution and Healthcare Service Utilization of Long-Term Care in China

BACKGROUND

Long-term care (LTC) services help the elderly maintain their functional ability and live with dignity. In China, the establishment of an equitable LTC system is a primary focus of the current public health reform. This paper assesses levels of equality in resources for and utilization of LTC services between urban and rural areas and economic regions in China.

METHODS

We use social services data from the China Civil Affairs Statistical Yearbooks. Gini coefficients against elderly population size are calculated for the number of institutions, beds, and workers, and the concentration index (CI) against per capita disposable income is calculated for the number of disabled residents per 1000 elderly people and the number of rehabilitation and nursing services per resident.

RESULTS

The Gini coefficients against the elderly population in urban areas indicate relatively good equality. In rural areas, the Gini coefficients have increased rapidly from relatively low values since 2015. The CI values in both urban and rural areas are positive, indicating that utilization is concentrated in the richer population. In rural areas, the CI values for rehabilitation and nursing have remained above 0.50 for the last three years, implying high levels of income-related inequality. The negative CI values for rehabilitation and nursing services in urban areas in the Central economic region and rural areas in the Western region imply a concentration of resource utilization toward poorer groups. The Eastern region shows relatively high internal inequality.

CONCLUSION

Inequalities exist between urban and rural areas in the utilization of LTC services, despite similar numbers of institution and bed resources. Resource distribution and healthcare service utilization are more equal in urban areas, creating a low level of equilibrium. This urban-rural split is a source of risk for both formal and informal LTC. The Eastern region has the largest number of resources, the highest level of utilization, and the greatest internal variation. In the future, the Chinese government should enhance support for the utilization of services for the elderly with LTC needs.

Relationship between turnover intention and workplace personal relations among care workers employed by elder care facilities

BACKGROUND

This study focuses on care workers at elder care facilities to examine what factors (including workplace personal relations) influence turnover intention and to what extent. Based on this analysis, the study discusses the content of workplace personal relations problems in qualitative terms.

METHODS

The study targeted care workers at elder care facilities. There were 406 participants with no missing data who were analyzed. The survey period ranged from September to November 2021. Questions consisted of basic attributes, turnover intention, problems with workplace personal relations, content of personal relation problems, and psychological distress.

RESULTS

Female care workers were 2.25 times more likely than male care workers to have turnover intention. Care workers with workplace personal relation problems were 1.97 times more likely than those without these problems to have high turnover intention. Moreover, with regard to psychological distress, the ratio increased to 4.99 times. The following six categories were extracted from the text data on workplace personal relation problems: insufficient communication, bullying, sense of unfair workload, different attitudes to care work, difficulty in guidance for subordinates/new staff, and labelling.

CONCLUSIONS

Gender, workplace personal relation problems, and psychological distress have shown to affect care workers' turnover intentions. To prevent care worker turnover, future studies should focus on the development and impact of strategies to improve workplace personal relations specific to care workers, targeting the six factors identified in this study.

Caregiving stress among family caregivers of older adults living with disabilities in China

OBJECTIVES

This study aimed to describe caregiving stress among family caregivers of Chinese older adults living with disabilities, and explore how care intensity, financial expenses, and care difficulties are associated with caregiving stress.

METHODS

Data of 220 older adult-caregiver dyads were collected from 6 urban districts and 6 rural counties from Shandong province, China. Descriptive analyses and multivariate ordinal logistic regression analyses were performed.

RESULTS

Family caregivers providing nine or more hours of care per day reported higher caregiving stress than those who provided fewer than nine hours. Caregivers who experienced insufficient care abilities, economic hardships, or time conflicts were more likely to report caregiving stress. Financial support provided to older adults was not associated with caregiving stress.

CONCLUSIONS

Family caregivers of Chinese older adults with disabilities are experiencing excessive caregiving stress. Social support groups and China's long-term care insurance system should be promoted to better assist family caregivers.

The prevalence of turnover intention and influencing factors among emergency physicians: A national observation

BACKGROUND

High turnover among physicians in emergency department is a great challenge in China. However, the rate and the reasons why physicians intend to leave have not been extensively studied yet. Therefore, this study aimed to identify the risk factors of turnover intention among physicians in emergency department.

METHODS

A national cross-sectional survey was conducted from July to August 2018 in China. A total of 10 457 physicians in emergency department were investigated using a structured self-administered questionnaire, which included demographic characteristics, work-related factors, turnover intention, the Patient Health Questionnaire and Positive and Negative Affect Scale. The stepwise logistic regression analysis was applied to identify the risk factors of turnover intention among physicians.

RESULTS

A total of 55.18% of the physicians in emergency department reported turnover intention in China. Turnover intention were more likely to be reported among physicians who were male (odds ratio (OR) = 1.25, 95% confidence interval (CI)  = 1.13-1.38); who perceived medical errors (OR = 1.35, 95% CI = 1.23-1.47); who had a lower average monthly income; who provided out-of-hospital resuscitation services; who experienced physical violence (OR = 1.39, 95% CI = 1.26-1.54) and who reported higher score on negative affect and depressive tendency (OR = 1.06, 95% CI = 1.05-1.08; OR = 1.10, 95% CI = 1.09-1.12). Conversely, physicians who perceived shortage of manpower (OR = 0.74, 95% CI = 0.66-0.81), or reported higher score on positive affect (OR = 0.96, 95% CI = 0.94-0.97) were inclined to stay in emergency department.

CONCLUSION

This study shows that turnover intention among physicians in emergency department is high in China and was significantly associated with gender, average monthly income, perceived shortage of physicians, the times for provide out-of-hospital resuscitation services, exposure to workplace violence, depressive tendency, positive affect and negative affect. Targeted interventions are required to improve the retention rate among physicians in emergency department from the comprehensive aspects.