Assessing nurses' work environment: old dilemmas, new solutions

The Content, Teaching Methods and Effectiveness of Spiritual Care Training for Healthcare Professionals: A Mixed-Methods Systematic Review

CONTEXT

Spirituality has been demonstrated to play an important role in healthcare, yet many staff feel ill-equipped to deliver spiritual care. Spiritual care training programs have been developed to address this need.

OBJECTIVE

The aim of this mixed-methods systematic review was to identify spiritual care training programs for healthcare professionals or students, and to investigate program content, teaching methods, key outcomes, and identified challenges and facilitators.

METHODS

A mixed-methods systematic review was conducted. The search terms ('religio*' OR 'spiritual*' OR 'existenti*') were combined with ('educat*' OR 'train*' OR 'curricul*' OR 'program*'), AND ('care' OR 'therap*' OR 'treatment' OR 'competenc*'). Search terms were entered into the following data bases: PsycINFO, Medline, Cinahl and Web of Science. Findings were restricted to peer-reviewed studies published in English between January 2010 and February 2020.

RESULTS

Fifty-five studies were identified. The quality of studies was mixed. Programs encompassed a range of content and teaching methods. Reported outcomes included increased levels of competency across intrapersonal spirituality, interpersonal spirituality, and spiritual assessment and interventions. Identified barriers included competing healthcare priorities, negative perceptions of spirituality and spiritual care, resistance towards focusing on one's own spirituality, staff feeling inadequate, and the need for ongoing training. Facilitators included opportunities for reflection, involvement of chaplains, application of practical tools, opportunities for practice, online training, and managerial support.

CONCLUSIONS

Positive outcomes following spiritual care training were identified. Further research is needed to identify patient-related outcomes of staff training, and to examine how the benefits of such training can be maintained over time.

Can Health-care Assistant Training improve the relational care of older people? (CHAT) A development and feasibility study of a complex intervention

Background

Older people account for an increasing proportion of those receiving NHS acute care. The quality of health care delivered to older people has come under increased scrutiny. Health-care assistants (HCAs) provide much of the direct care of older people in hospital. Patients’ experience of care tends to be based on the relational aspects of that care including dignity, empathy and emotional support.

Objective(s)

We aimed to understand the relational care training needs of HCAs caring for older people, design a relational care training intervention for HCAs and assess the feasibility of a cluster randomised controlled trial to test the new intervention against HCA training as usual (TAU).

Design

(1) A telephone survey of all NHS hospital trusts in England to assess current HCA training provision, (2) focus groups of older people and carers, (3) semistructured interviews with HCAs and other care staff to establish training needs and inform intervention development and (4) a feasibility cluster randomised controlled trial.

Setting

(1) All acute NHS hospital trusts in England, and (2–4) three acute NHS hospital trusts in England and the populations they serve.

Participants

(1) Representatives of 113 out of the total of 161 (70.2%) NHS trusts in England took part in the telephone survey, (2) 29 older people or carer participants in three focus groups, (3) 30 HCA and 24 ‘other staff’ interviewees and (4) 12 wards (four per trust), 112 HCAs, 92 patients during the prerandomisation period and 67 patients during the postrandomisation period.

Interventions

For the feasibility trial, a training intervention (Older People’s Shoes™) for HCAs developed as part of the study was compared with HCA TAU.

Main outcome measures

Patient-level outcomes were the experience of emotional care and quality of life during patients’ hospital stay, as measured by the Patient Evaluation of Emotional Care during Hospitalisation and the EuroQol-5 Dimensions questionnaires. HCA outcomes were empathy, as measured by the Toronto Empathy Questionnaire, and attitudes towards older people, as measured by the Age Group Evaluation and Description Inventory. Ward-level outcomes were the quality of HCA–patient interaction, as measured by the Quality of Interaction Scale.

Results

(1) One-third of trust telephone survey participants reported HCA training content that we considered to be ‘relational care’. Training for HCAs is variable across trusts and is focused on new recruits. The biggest challenge for HCA training is getting HCAs released from ward duties. (2) Older people and carers are aware of the pressures that ward staff are under but good relationships with care staff determine whether or not their experience of hospital is positive. (3) HCAs have training needs related to ‘difficult conversations’ with patients and relatives; they have particular preferences for learning styles that are not always reflected in available training. (4) In the feasibility trial, 187 of the 192 planned ward observation sessions were completed; the response to HCA questionnaires at baseline and at 8 and 12 weeks post randomisation was 64.2%, 46.4% and 35.7%, respectively, and 57.2% of eligible patients returned completed questionnaires.

Limitations

This was an intervention development and feasibility study so no conclusions can be drawn about the clinical effectiveness or cost-effectiveness of the intervention.

Conclusions

The intervention had high acceptability among nurse trainers and HCA learners. Viability of a definitive trial is conditional on overcoming specific methodological (patient recruitment processes) and contextual (involvement of wider ward team) challenges.

Future work

Methods to ease the burden of questionnaire completion without compromising ethics or methodological rigour need to be explored.

Trial registration

Current Controlled Trials ISRCTN10385799.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 5, No. 10. See the NIHR Journals Library website for further project information.

Leading opinion and managing change in complex organizations: Findings from the South Thames Evidence-based Practice project

Opinion-leaders have been described in the research literature as credible experts, capable of supporting, facilitating or advocating change and influencing health professionals to adopt innovatory, evidence-based approaches to their practice (Lomas et al., 1991; Thomson et al., 1999). However, information is lacking on the complexity of selection and training, and of the role support that is necessary to enable opinion-leaders to function effectively. This paper focuses on the experience of using opinion-leaders to implement practice change as part of a multi-faceted approach within the South Thames Evidence-based Practice project (STEP), drawing on information integrated from a cross-case analysis and the independent evaluation. Key findings are that the opinion-leader role is complex and challenging, and requires a broad balance of research, management and leadership competences to inform selection and training.

Can Healthcare Assistant Training (CHAT) improve the relational care of older people? Study protocol for a pilot cluster randomised controlled trial

BACKGROUND

People aged 75 years and over account for 1 in 4 of all hospital admissions. There has been increasing recognition of problems in the care of older people, particularly in hospitals. Evidence suggests that older people judge the care they receive in terms of kindness, empathy, compassion, respectful communication and being seen as a person not just a patient. These are aspects of care to which we refer when we use the term 'relational care'. Healthcare assistants deliver an increasing proportion of direct care to older people, yet their training needs are often overlooked.

METHODS/DESIGN

This study will determine the acceptability and feasibility of a cluster randomised controlled trial of 'Older People's Shoes' a 2-day training intervention for healthcare assistants caring for older people in hospital. Within this pilot, 2-arm, parallel, cluster randomised controlled trial, healthcare assistants within acute hospital wards are randomised to either the 2-day training intervention or training as usual. Registered nurses deliver 'Older People's Shoes' over 2 days, approximately 1 week apart. It contains three components: experiential learning about ageing, exploration of older people's stories, and customer care. Outcomes will be measured at the level of patient (experience of emotional care and quality of life during their hospital stay), healthcare assistant (empathy and attitudes towards older people), and ward (quality of staff/patient interaction). Semi-structured interviews of a purposive sample of healthcare assistants receiving the intervention, and all trainers delivering the intervention, will be undertaken to gain insights into the experiences of both the intervention and the trial, and its perceived impact on practice.

DISCUSSION

Few training interventions for care staff have been rigorously tested using randomised designs. This study will establish the viability of a definitive cluster randomised controlled trial of a new training intervention to improve the relational care proided by healthcare assistants working with older people in hospital.

TRIAL REGISTRATION

The study was registered as an International Standard Randomised Controlled Trial ( ISRCTN10385799 ) on 29 December 2014.

Does job complexity mitigate the negative effect of emotion-rule dissonance on employee burnout?

In interactions with clients or patients, human service workers are at risk of experiencing discrepancies between felt and organizationally mandated emotions (i.e. emotion-rule dissonance). Given the documented detrimental effects of such discrepancies on employee strain, the present study investigated whether job complexity mitigates the relation between emotion-rule dissonance and employee burnout using data from a two-wave panel study of eldercare workers (N = 583, 16-month time lag). Structural equation modelling revealed that emotion-rule dissonance at Time 1 preceded emotional exhaustion and depersonalization at Time 2. Beyond that, employees whose work offered job complexity were found to suffer less from emotional exhaustion and depersonalization when encountering discrepancies between felt and stipulated emotions compared to employees who conducted noncomplex work. Thus, designing complex tasks appears to be a crucial starting point for alleviating employee burnout in jobs that provoke emotion-rule dissonance.

Changes in work intensification and intensified learning: challenge or hindrance demands?

Purpose

– Increasing speed in many life domains is currently being discussed under the term “social acceleration” as a societal phenomenon which not only affects western societies, but may also lead to job demands arising from accelerated change. Demands such as work intensification and intensified learning and their changes over time may increase emotional exhaustion, but may also induce positive effects. The purpose of this paper is to examine how increases in demands arising from accelerated change affect employee well-being.

Design/methodology/approach

– A total of 587 eldercare workers provided data on work intensification and intensified learning as well as on exhaustion and job satisfaction at two points in time.

Findings

– Work intensification was negatively related to future job satisfaction and positively related to future emotional exhaustion, whereas intensified learning was positively associated with future job satisfaction and negatively with future emotional exhaustion.

Social implications

– Intensified demands represents a growing social as well as work-specific challenge which needs to be addressed by practitioners.

Originality/value

– Using a longitudinal perspective this study is the first to examine the relationship of increases in work intensification and intensified learning with job satisfaction and emotional exhaustion at work.

Influence of Aquariums on Resident Behavior and Staff Satisfaction in Dementia Units

The influence of an aquarium on resident behavior and staff job satisfaction in three dementia units was examined. The sample consisted of 71 individuals with dementia and 71 professional staff. A pretest–posttest design was utilized. Baseline resident behavior and staff satisfaction were obtained, and an aquarium was introduced into the setting. Post-behavioral assessment and job satisfaction surveys were completed. Residents’ behaviors improved along four domains: uncooperative, irrational, sleep, and inappropriate behaviors. The overall residents’ behavior score was significantly improved after an aquarium was introduced, F = 15.60, p < .001. Their mean disruptive behavior score decreased from 67.2 to 58.2. The staff’s satisfaction score significantly improved, F = 35.34, p < .001. Pretest to posttest mean scores improved from 149.4 to 157.9. Aquariums are an innovative way for animal-assisted therapy and nature to be introduced to specialized dementia units in long-term care.

Can spirituality be taught to health care professionals?

Although people with life-limiting conditions report a desire to have spiritual concerns addressed, there is evidence that these issues are often avoided by health care professionals in palliative care. This study reports on the longitudinal outcomes of four workshops purpose-designed to improve the spiritual knowledge and confidence of 120 palliative care staff in Australia. Findings revealed significant increases in Spirituality, Spiritual Care, Personalised Care, and Confidence in this field immediately following the workshops. Improvements in Spiritual Care and Confidence were maintained 3 month later, with Confidence continuing to grow. These findings suggest that attendance at a custom-designed workshop can significantly improve knowledge and confidence to provide spiritual care.

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.

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.

Nursing morale: predictive variables among a sample of registered nurses in Australia

AIM

This study investigates the determinants of morale among Registered Nurses in Queensland, Australia.

BACKGROUND

In light of the public discussions on the issues facing the future of nursing, it is critical to understand the factors that influence morale.

METHODS

A 160-question instrument sought information from Registered Nurses on their perceptions of 'self', work and morale. A response rate of 41% was achieved (n = 343) from a convenience sample of three acute hospitals.

RESULTS

Following binary logistic regression modelling for organizational morale, significant relationships were found with patient care provision and team interaction. Binary logistic regression modelling for personal morale revealed positive relationships with team interaction, consultation, professional recognition and lower levels of patient abuse.

CONCLUSION

The results point to a number of organizational and professional issues that can be considered by health care administrators and policy makers to develop workplaces that have a positive impact on the morale of nurses.

Self-reported perceptions of Registered Nurses working in Australian hospitals

AIM

The purpose of this study is to develop an understanding of work environments by analysing the perceptions of a sample of Registered Nurses (RNs).

BACKGROUND

Within the context of high staff turnover and a shortage of nurses in the health workforce, it is important that we understand how nurses perceive their work context and view the organisational factors that influence their attitudes towards their workplace.

METHODS

Data was collected using a 160-question survey instrument seeking information from RNs in relation to work and perceptions of the work environment and the organisation. The sample was recruited from a convenience sample of three acute hospitals in Queensland, Australia. A response rate of 41% was achieved (n=343).

RESULTS

Respondents across the three survey sites identified a number of variables that had particular impact on their working lives. Team interaction, providing good patient care, communication, and abuse towards RNs elicited strong responses by the study respondents. As well, organisational direction, strategy and management returned strong negative responses. In responding to the questions related to personal and organisational morale it was clear that respondents saw them as two distinct concepts.

CONCLUSIONS

The results of this study have implications for nurse managers in terms of understanding the nursing workforce as well as key organisational factors that have both positive and negative influences on the perceptions of nurses.

An exploration of the caring attributes and perceptions of work place change among gerontological nursing staff in England, Scotland and China (Hong Kong)

This study investigates caring attributes and perceptions of work place change among qualified and unqualified nursing staff working with older people in three countries. A Modified Caring Attributes Questionnaire and Perception of Workplace Change Schedule were administered to 737 staff. Caring attributes scores were highest for nurses working in long stay settings, and lowest in nurses aged 25-29 years. Nurses in Hong Kong appear better educated than UK counterparts. Staff development seemed more common in long stay settings. Results suggest workplace changes limiting care quality were more pronounced in Scotland. Reported job satisfaction and moral were lowest in the UK group.