Prevention of and dealing with poor performance: an interview study about how professional associations aim to support healthcare professionals

Job performance and associated factors among nurses working in adult emergency departments at selected public hospitals in Ethiopia: a facility-based cross-sectional study

BACKGROUND

Optimizing the performance level of nursing staff is crucial for the efficient functioning of hospitals and better patient health outcomes. However, published data on the job performance levels and associated factors of nurses in Ethiopia is limited. Therefore, this study aimed to assess the job performance and associated factors of nurses working in adult emergency departments at selected public hospitals in Addis Ababa, Ethiopia.

METHODS

A facility-based cross-sectional study was conducted from March 25 to April 25, 2023, among 172 nurses working in the adult emergency departments of selected public hospitals in Addis Ababa, Ethiopia. A simple random sampling technique was used to select the study participants. Data were collected using pretested, self-administered structured questionnaires. Data were coded, entered into Epi-data version 4.6, and analyzed using Statistical Package for Service Solution (SPSS) Version 27.0.1 software. Data were summarized using descriptive statistics, including mean, frequency, and standard deviation. A binary logistic regression analysis was done to determine factors associated with the performance of nurses. The strength of the association was measured using an adjusted odd ratio (AOR) with a 95% confidence interval (CI), and a P-value < 0.05 was considered statistically significant.

RESULTS

The majority of nurses, 70.5% (95% CI: 63.7-77.3), rated their job performance as good. Workload [AOR = 1.70 (95% CI: 1.19-2.44)], remuneration [AOR = 1.89 (95% CI: 1.35-2.67)], rewards [AOR = 1.50 (95% CI: 1.01-2.23)], objectives to be achieved [AOR = 1.88 (95% CI: 1.32-2.67)], and feedback on performance appraisals [AOR = 1.65 (95% CI: 1.17-2.33)] were identified as significantly associated with nurses' performance.

CONCLUSION

While the majority of nurses rated their job performance as good, it is important to note that a relevant proportion of nurses rated their job performance as poor. The findings of this study identified that nurses' performance is influenced by several key factors, including workload, remuneration, rewards, objectives to be achieved, and feedback on performance appraisals. Our findings call for improving nurses' job performance; therefore, hospitals should consider implementing systems that effectively utilize performance appraisal results and recognize and encourage hardworking nurses.

Design, delivery and effectiveness of health practitioner regulation systems: an integrative review

BACKGROUND

Health practitioner regulation (HPR) systems are increasingly recognized as playing an important role in supporting health workforce availability, accessibility, quality, and sustainability, while promoting patient safety. This review aimed to identify evidence on the design, delivery and effectiveness of HPR to inform policy decisions.

METHODS

We conducted an integrative analysis of literature published between 2010 and 2021. Fourteen databases were systematically searched, with data extracted and synthesized based on a modified Donabedian framework.

FINDINGS

This large-scale review synthesized evidence from a range of academic (n = 410) and grey literature (n = 426) relevant to HPR. We identified key themes and findings for a series of HPR topics organized according to our structures-processes-outcomes conceptual framework. Governance reforms in HPR are shifting towards multi-profession regulators, enhanced accountability, and risk-based approaches; however, comparisons between HPR models were complicated by a lack of a standardized HPR typology. HPR can support government workforce strategies, despite persisting challenges in cross-border recognition of qualifications and portability of registration. Scope of practice reform adapted to modern health systems can improve access and quality. Alternatives to statutory registration for lower-risk health occupations can improve services and protect the public, while standardized evaluation frameworks can aid regulatory strengthening. Knowledge gaps remain around the outcomes and effectiveness of HPR processes, including continuing professional development models, national licensing examinations, accreditation of health practitioner education programs, mandatory reporting obligations, remediation programs, and statutory registration of traditional and complementary medicine practitioners.

CONCLUSION

We identified key themes, issues, and evidence gaps valuable for governments, regulators, and health system leaders. We also identified evidence base limitations that warrant caution when interpreting and generalizing the results across jurisdictions and professions. Themes and findings reflect interests and concerns in high-income Anglophone countries where most literature originated. Most studies were descriptive, resulting in a low certainty of evidence. To inform regulatory design and reform, research funders and governments should prioritize evidence on regulatory outcomes, including innovative approaches we identified in our review. Additionally, a systematic approach is needed to track and evaluate the impact of regulatory interventions and innovations on achieving health workforce and health systems goals.

The Daily Basic Psychological Need Satisfaction and Work Engagement of Nurses: A ‘Shortitudinal’ Diary Study

Nurses’ satisfaction and work engagement have been linked to patient outcomes. Nightshift nurses provide healthcare to the population and experience unique challenges in performing their healthcare tasks. Therefore, the current study aimed to investigate the daily basic needs satisfaction and work engagement of nightshift nurses in accordance with the satisfaction of three basic psychological needs as indicated by the Self-Determination Theory. A quantitative, ‘shortitudinal’ design (diary study; over a few days) with a multi-level research approach using a daily diary survey method was completed by a convenience sample of nurses working the nightshift in a public hospital (n = 33). The results revealed that the daily need for autonomy and need for relatedness did not significantly predict variance in daily work engagement. However, need for competence did significantly predict variance in daily work engagement, and general emotional load explained significant variability in daily need satisfaction of competence. Lastly, general role clarity had a negative impact on the daily variability in work engagement. This study provides healthcare organisations with explanations for variance in nursing performance and suggests possible interventions to address nursing outcomes in accordance with the three basic needs of nightshift nurses in daily activity.

Health systems factors impacting the integration of midwifery: an evidence-informed framework on strengthening midwifery associations

Introduction

Midwifery associations are organisations that represent midwives and the profession of midwifery. They support midwives to reduce maternal and newborn mortality and morbidity by promoting the overall integration of midwifery in health systems. Our objective was to generate a framework for evidence-informed midwifery association strengthening.

Methods

A critical interpretive synthesis complemented by key informant interviews, focus groups, observations, and document review was used to inform the development of concepts and theory. Three electronic bibliographical databases (CINAHL, EMBASE and MEDLINE) were searched through to 2 September 2020. A coding structure was created to guide the synthesis across the five sources of evidence.

Results

A total of 1634 records were retrieved through electronic searches and 57 documents were included in the critical interpretive synthesis. Thirty-one (31) key informant interviews and five focus groups were completed including observations (255 pages) and audio recordings. Twenty-four (24) programme documents were reviewed. The resulting theoretical framework outlines the key factors by context, describes the system drivers that impact the sustainability of midwifery associations and identifies the key-enabling elements involved in designing programmes that strengthen midwifery associations.

Conclusion

Midwifery associations act as the web that holds the profession together and are key to the integration of the profession in health systems, supporting enabling environments and improving gender inequities. Our findings highlight that in order to strengthen midwifery (education, regulation and services), we have to lead with association strengthening. Building strong associations is the foundation necessary to create formal quality midwifery education systems and to support midwifery regulation and accreditation mechanisms.

Psychological capital and organisational citizenship behaviour in selected public hospitals in the Eastern Cape Province of South Africa

Orientation: The relationship between psychological capital (PsyCap) and organisational citizenship behaviour (OCB) is important to establish especially in the South African public hospitals where the quality of healthcare services have been reported to have deteriorated.Research purpose: The purpose of this study was to examine the relationship between psychological capital and organisational citizenship behaviour among nurses in the public hospitals.Motivation for the study: There is crisis in the public nursing sector as nurses are reported to be working under pressure as a result of increased workload and responsibilities beyond their scope of practice (in terms of doing the work that they are not trained for and more work than they can handle), in addition to rapidly changing work environments.Research approach, design and method: The present study follows a quantitative cross-sectional design using a questionnaire on a sample of 228 nurses from public hospitals in the Eastern Cape Province, South Africa.Main findings: The findings of the study confirm that psychological capital has a significant positive relationship with organisational citizenship behaviour.Practical/managerial implications: The study recommends management to recognise the area of OCB in the public hospitals and work in nurturing and retaining those nurses capable of displaying such behaviours.Contribution/value add: The study validates aspect of reciprocity of the Social exchange theory. Nurses with high levels of hope, self-efficacy, resilience and optimism showed reciprocity through the display of OCBs. The study also validates the aspect of job resources in eroding job demands from the Job demands resources model.