Managing care errors in the wards

Measuring Nurses' Organizational Well-Being: A Systematic Review of Available Instruments

This systematic review aimed to identify and compare instruments measuring nurses' organizational well-being, summarise the dimensions measured by these instruments, the statistical analysis performed for validity evidence and identify an instrument that comprehensively investigates nurses' organizational well-being. The JBI Manual for Evidence Synthesis and the PRISMA checklist were used as guidelines. The search was conducted on Medline, CINAHL, Cochrane Library and Scopus. Critical appraisal and data extraction were drawn on the COSMIN checklist. Dimensions were conceptually synthesized by the measurement concepts' similarity. Twenty-two articles were retrieved and they included 21 instruments that measured nurses' organizational well-being. The instruments vary by dimension number (range 2-19), items (range 12-118) and concept elicitation. A plurality of methodologies has been used in instrument development and assessments of evidence for validity. Only four instruments reported a concurrent criterion validity or a measurement comparison with an already tested-for-validity instrument. Similar dimensions were leadership and support, relationships and communication, work-family balance, work demands, violence, control and autonomy, satisfaction and motivation, work environment and resources, careers, and organizational policy. This review underlines the core areas of the instruments that measure nursing organizational well-being. It allows administrators and researchers to choose the appropriate instruments for monitoring this multidimensional concept.

Cardiovascular nurses and organizational well-being: a systematic review

AIMS

This systematic review assesses the organizational well-being of nurses working in cardiovascular settings and identifies environmental variables influencing it.

METHODS AND RESULTS

The Joanna Briggs Institute's methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines have been followed. The search was conducted, from the database inception up to and including 1 December 2022, on Medline (via PubMed), Cumulative Index of Nursing and Allied Health, Cochrane Library, and Scopus. Critical appraisal and data extraction were conducted using standardized tools. Six articles of high quality were included. These mostly concerned cross-sectional studies, conducted in heterogeneous contexts, which highlight the peculiarity of the cardiovascular nursing setting. Three thematic areas were identified: stressors of cardiovascular settings; outcomes of stressors on nurses; and coping strategies used by cardiovascular nurses to deal with such stress factors. Identified stress factors included a lack of autonomy, conflicts between professional and family roles, high workloads, and stressful relationships with patients and caregivers. These organizational variables could generate nurses' burnout, depression, irritability, and/or sleep disorders. In trying to cope with such stressors, cardiovascular nurses used different strategies for compensating, avoiding, escaping, or ignoring the problem, or, in other cases, became somewhat aggressive.

CONCLUSION

Considering the limited data, cardiovascular nursing coping strategies should be further investigated, so that effective pathways for preventing or limiting stress factors can be identified and applied by the organizations. Monitoring and intervening on stress factors in this care setting could improve cardiovascular nurses' organizational well-being and accordingly patients' outcomes.

REGISTRATION

PROSPERO: CRD42022355669.

Relationship between transformational leadership, adverse patient events, and nurse-assessed quality of care in emergency units: The mediating role of work satisfaction

BACKGROUND

Effective leadership plays a pivotal role in healthcare settings, particularly in the fast-paced and high-pressure environment of the emergency room, as it is closely linked to patient safety and the overall quality of care. This study assessed the mediating role of work satisfaction in the relationship between nurses' perceptions of their nurse managers' transformational leadership, reported adverse patient events, and the nurse-assessed quality of care in the emergency units.

METHODS

A cross-sectional survey design was carried out involving 283 emergency room nurses from the Philippines, utilizing standardized scales. Mediation testing was performed using Hayes' PROCESS macro in SPSS (Model 4).

RESULTS

Emergency room nurses perceived their nurse managers as highly transformational. Nurses' perceptions of transformational leadership in their nurse managers were associated with a reduction in reported adverse patient events and an increase in nurse-assessed nursing care quality. Work satisfaction partially mediated the relationship between transformational leadership and nurse-assessed nursing care quality, but it did not serve as a mediator between transformational leadership and reported adverse patient events.

CONCLUSION

The results suggested that enhancing transformational leadership behaviors among nurse leaders can foster work satisfaction in ER nurses, which, in effect, contributes to enhanced nursing quality of care provision in emergency settings.

Quality of life of critical care nurses and impact on anxiety, depression, stress, burnout and sleep quality: A cross-sectional study

OBJECTIVES

To investigate how anxiety, depression, stress, burnout, and sleep quality impact on Quality of life of critical care nurses.

BACKGROUND

Several studies reported that critical care nurses are exposed to a high risk of anxiety, depression, burnout, stress, and sleep quality, but we do not know the impact of critical care nurses.

DESIGN

A cross-sectional study.

METHODS

We have included all critical care nurses working in the intensive care unit for at least six months. Data were collected from December 1, 2021, to March 18, 2022. We evaluated the critical care nurses using the Depression Anxiety Stress Scale (DASS), Maslach Burnout Inventory scale, Pittsburgh Sleep Quality Index and Nurse Quality of Life. The primary endpoint is Quality of Life. Associations were tested using multivariate modelling.

RESULTS

A total of 140 critical care nurses were included. Multivariate regression showed the relation between emotional QoL and emotional exhaustion and DASS total score [OR = 0.14; 95% CI (0.03-0.73); p = 0.019 and OR = 3.64; 95% CI (1.07-12.32); p = 0.038, respectively]. Personal accomplishment and DASS total score have a direct relationship on quality of work-life [OR = 0.21; 95% CI (0.05-0.82); p = 0.024 and OR = 4.18; 95% CI (1.01-17.33); p = 0.049, respectively].

CONCLUSIONS

The physical quality of life is not optimal in critical care nurses, while burnout and the DASS score directly impact the emotional and work-life quality of life.

IMPLICATIONS FOR CLINICAL PRACTICE

Our research has highlighted the importance of detecting the quality of life of critical care nurses. The nurses should take proper care of their health by adopting the right health behaviours to create correct work conditions and increase the quality of care for critically ill patients.

Factors determining safety culture in hospitals: a scoping review

OBJECTIVE

To evaluate and synthesise the factors determining patient safety culture in hospitals.

METHODS

The scoping review protocol was based on the criteria of the Joanna Briggs Institute. Eligibility criteria were as follows: (1) empirical study published in a peer-reviewed journal; (2) used methods or tools to assess, study or measure safety culture or climate; (3) data collected in the hospital setting and (4) studies published in English. Relevant literature was located using PubMed, CINAHL, Web of Science and PsycINFO databases. Quantitative and qualitative analyses were performed using RStudio and the R interface for multidimensional analysis of texts and questionnaires (IRaMuTeQ).

RESULTS

A total of 248 primary studies were included. The most used instruments for assessing safety culture were the Hospital Survey on Patient Safety Culture (n=104) and the Safety Attitudes Questionnaire (n=63). The Maslach Burnout Inventory (n=13) and Culture Assessment Scales based on patient perception (n=9) were used in association with cultural instruments. Sixty-six articles were included in the qualitative analysis. In word cloud and similarity analyses, the words 'communication' and 'leadership' were most prominent. Regarding the descending hierarchical classification analysis, the content was categorised into two main classes, one of which was subdivided into five subclasses: class 1a: job satisfaction and leadership (15.56%), class 1b: error response (22.22%), class 1c: psychological and empowerment nurses (20.00%), class 1d: trust culture (22.22%) and class 2: innovation worker (20.00%).

CONCLUSION

The instruments presented elements that remained indispensable for assessing the safety culture, such as leadership commitment, open communication and learning from mistakes. There was also a tendency for research to assess patient and family engagement, psychological safety, nurses' engagement in decision-making and innovation.

PROTOCOL: Do hospital leadership styles predict patient safety indicators? A systematic review

This is the protocol for a Campbell systematic review. The objectives are as follows: The main aim of this systematic review is to identify whether hospital leadership styles predict patient safety as measured through several indicators over time. The second aim is to assess the extent to which the prediction of hospital leadership styles on patient safety indicators varies as a function of the leader's hierarchy level in the organization.

Work-related stress, job satisfaction, and quality of work life among cardiovascular nurses in Italy: Structural equation modeling

AIM

To investigate the simultaneous effects of work-related stress and job satisfaction on cardiovascular nurses' quality of work life.

BACKGROUND

Prior research has investigated nurses' work-related stress, job satisfaction, and quality of work life as separate aspects and not in specific nursing settings, such as cardiovascular wards. Cardiovascular care settings can be particularly stressful for nurses, who are often faced with distress, depression and patients and caregivers' physical and psychological exhaustion.

METHODS

A multicenter cross-sectional study was conducted among 1126 cardiovascular nurses from 10 hospitals in Italy. Work-related stress, job satisfaction, and quality of work life were measured using valid and reliable questionnaires. Structural equation modeling was performed.

RESULTS

Nurses working in critical cardiac care units experienced more stress than their colleagues working in other cardiac units. Nurses working in cardiac outpatient clinics reported lower quality of work life than those working in other cardiac settings. There was a negative relationship between work-related stress and nurses' quality of work life, which was partially mediated by job satisfaction, indicating that stress generated by the work environment negatively affect nurses' quality of work life by reducing their job satisfaction.

CONCLUSION

Cardiovascular nurses' quality of work life is negatively affected by work-related stress. The work-related stress is mediated through job satisfaction. Nurse managers should maximize nurses' job satisfaction by providing comfort at work, supporting professional development opportunities, sharing organizational objectives, and actively listening and addressing nurses' concerns. When cardiovascular nurses' quality of work life is elevated, patients' care quality and outcomes are improved.

Analysing Researchers' Engagement in Research Hospitals: A Pilot Study in IRCCS-Italian Research Hospitals

Despite universities in the UK, USA and Australia having developed tools and strategies to enhance academic engagement, there is a paucity of information from universities and research hospitals where conceptual and theoretical research still appears more heterogeneous. In Italy, there is a growing recognition that more needs to be done to define strategies to improve research engagement. Italian research hospitals are represented by the Scientific Institute for Research, Hospitalization and Healthcare (named IRCCS from the Italian acronym of these organisations), representing the best of Italian research and the National Health Service System. This article provided a pilot description of research engagement in a representative Italian IRCCS hospital for the first time. A pilot study was developed, and a brief questionnaire was validated to explore research engagement. The identified clusters of researchers' engagement were provided to describe an initial theory-grounded framework. Based on the perspective of research administrators and the Ministry of Health during round tables, the developed questionnaire identified two clusters of researchers' engagement and measured "Project-oriented" and "Organisation-oriented" engagement. Among the responders, IRCCS senior researchers tended to have higher project-oriented engagement, while young researchers had slightly higher organisation-oriented engagement. The contribution of this article is a hypothesised two-level theory-grounded framework to study and improve research engagement activities and strategies in a research hospital, with the potential for an overlap with other European research institutions.

Towards the idea of 'clinical capital': A longitudinal study exploring nurses' dispositions and workplace manifestations in an Australian intensive care unit

OBJECTIVE

To explore the concept of 'capital' through the study of successive interventions and outcomes (patient and staff) in a quaternity intensive care unit (ICU) across a 5-year time frame.

DESIGN

A longitudinal intrinsic single site, a survey study was designed. The concept of 'capital' was explored through an adopted interpretive approach that involved understanding meanings from different sources, for example, discussions at compassion cafés, follow-up from staff-initiated activities, informal responses to organizational imperatives external to the unit (i.e. staff reductions and resource constraints), alongside empirical data about workplace climate and patient incidents.

SETTING

A single ICU employing approximately 220 registered nurses at a quaternary hospital in Queensland, Australia.

PARTICIPANTS

All nurses employed in the ICU at the time of compassion cafes participated in providing feedback to inform successive activities. All nurses in the unit had equal opportunity to complete surveys, participate in subsequent unit-based sessions, take-up options; and all nurses had a responsibility to complete incident data.

RESULTS

Survey and incident data from 2015 to 2019 identify the complexity of workplace environments. Between 35% and 45% of nurses consistently completed the survey. Activities based on staff requests initially improved incident data but did not impact the work environment; negative perceptions of the work environment at the endpoint (2019) were associated with external factors.

CONCLUSION

Quality care environments are labile; sensitive to both unit activity and external organization directives (namely staff reductions). Quality care can be sustained in adverse situations with increased nurse engagement in patient care dynamics in the short term.

IMPACT

This study articulates a previously unidentified concept, 'clinical capital'. Activities facilitating nurse engagement in broad care dynamics gave rise to a more robust climate than just focusing on social and psychological well-being activities for nurses. Participation in issues of concern about patient care can promote resilience to short term fluctuations.

Authentic leadership, perceived insider status, error management climate, and employee resilience: A cross-level study

Employee resilience is of great significance for organizations to resist pressures, overcome crises, and achieve sustainable development. However, existing research has largely failed to explore its situational triggers. Drawing on social information processing theory and social exchange theory, a cross-level study was conducted to theorize the underlying mechanisms through which authentic leadership facilitates employee resilience. Based on a two-wave time-lagged design, the data were obtained from 85 team leaders and 417 employees in China. The results of the cross-level model showed that authentic leadership was positively related to employee resilience. Perceived insider status and error management climate both played a partial mediating role in linking authentic leadership and employee resilience. Error management climate positively moderated the relationship between perceived insider status and employee resilience. This paper not only contributes to revealing the cross-level effect of authentic leadership on employee resilience but also provides some managerial practices.

Towards a New Conceptual Model for Nurses' Organizational Well-being: An Integrative Review

AIM

To summarize conceptual models of nurses' organizational well-being and identify common variables among them.

BACKGROUND

To understand how the characteristics of an organizational context affect workers' well-being, numerous conceptual models have been developed. Such models have been conceptualized in various working contexts other than healthcare, and not always considering the particularities of the profession of nursing. Evaluation This integrative review was conducted using the resources of PubMed, CINAHL, Scopus and the Cochrane Library, up until March 2022, and by applying a modified version of Cooper's five-stage methodology, in accordance with the PRISMA guideline. Key issues Six reference models focused on different organizational variables and used to evaluate nurses' organizational well-being were identified: the Effort-Reward Imbalance (ERI) model, the Job Demands-Resources (JD-R) model, the Utriainen et al. model, the Demands-Resources and Individual-Effects (DRIVE) model, the Well-Being, Health-Promoting Lifestyle and Work Environment Satisfaction (WHS) model, and the Nursing Worklife Model (NWM).

CONCLUSION

There is no consensus in the nursing literature on an all-encompassing conceptual model of nurses' organizational well-being, or on working environment characteristics to be studied or monitored for defining nurses' well-being.

IMPLICATIONS FOR NURSING MANAGEMENT

Coming to a consensus on the definition of a nurses' organizational well-being model and its variables would facilitate nursing management in monitoring and intervening on nurses' work-life quality, and in improving nursing performance and caring outcomes.

The necessary leadership skillsets for the high-reliability organization framework adoption within acute healthcare organizations

This research explores the necessary leadership skills for the successful adoption of the High-Reliability Organization (HRO) framework within acute healthcare organizations. Using a qualitative research design, organization leaders and experts at the executive, mid-level, and front-line levels were interviewed. The results were analyzed to correlate specific leadership skillsets and components to the most successful adoption strategies. In total, 20 skillsets were identified with seven representing data saturation. The seven vital skillsets include non-hierarchical leadership, transparent and continuous communication, deference to expertise, ability to innovate, motivation through recognition, reflective of self, and commitment to visibility.

Nurses' Quality of Life Scale: validation and psychometric properties

The Nursing Quality of Life Scale (NQOLS) is a 28-item self-report measure evaluating the four dimensions of nurses' quality of life, namely, the physical, emotional, working, and social dimensions. The purpose of this study is to assess the psychometric properties, including validity and reliability, of the NQOLS. The study enrolled 1,105 nurses who provided direct assistance to patients. The NQOLS factorial structure was tested using a cross-validation approach via Exploratory Structural Equational Modeling, which confirmed the instrument's four-dimension structure. Reliability was assessed using omega coefficients, proving excellent for all factors. Cluster analysis identified five distinct groups, each composed of participants sharing a substantial similarity with respect to their profile in the NQOLS. These five identifiable clusters presented significant differences not only in the NQOLS but also in the risk of work-related stress, emotional labour and burnout. The results show that NQOLS is a simple, reliable, lean tool for measuring nurses' overall QoL, whose various parts can additionally be used to answer specific research questions.

Effect of Chief Executive Officer’s Sustainable Leadership Styles on Organization Members’ Psychological Well-Being and Organizational Citizenship Behavior

Situational leadership theory and the contingency approach of leadership were utilized and applied based on situational theory. Based on a total of four foundational theories, that is, bottom-up spillover theory, theories of prosocial behavior, and so on, this study empirically analyzed what influence a chief executive officer’s (CEO’s) sustainable leadership styles (servant, ethical, and authentic leadership) have on the psychological well-being and organizational citizenship behaviors of organization members. The study was conducted on adult employees of midsized or larger companies (including subsidiaries) across four countries: South Korea, the United Kingdom, the United States, and South Africa. Data were obtained from 649 adult employees. SmartPLS was used to conduct structural equation modeling analysis of the data. The results were as follows: (1) CEOs’ servant and authentic leadership styles had statistically significant positive (+) effects on employees’ psychological well-being; however, ethical leadership did not. (2) CEOs’ ethical leadership had a statistically significant (+) effect on employees’ organizational citizenship behavior; however, servant and authentic leadership did not. (3) Employees’ psychological well-being had a statistically significant (+) effect on organizational citizenship behavior. CEOs are attracting more attention than ever, leading companies in today’s rapidly changing times. This suggests that it is necessary to comprehend principles that show when, where, and how important leaders are and sustainable leadership styles that can increase their chances of success. Moreover, this study derived constructive implications that a leader can overcome today’s challenges through sustainable leadership styles.

How does paradoxical leadership promote bootlegging: a TPB-based multiple mediation model

Purpose

This study aims to explore the antecedents of bootlegging from the perspective of paradoxical leadership. Based on the theory of planned behavior (TPB), it examines a multiple mediation model with harmonious innovation passion, role breadth self-efficacy and perceived error management culture as mediators, to interpret why paradoxical leadership influences employee bootlegging.

Design/methodology/approach

To test the theoretical model, data were collected from 218 full-time employees from enterprises in Chinese cities using a three-wave time-lagged design. Path-analysis and a bootstrapping approach in Mplus7 were used to examine the hypotheses of the theoretical model.

Findings

The results show that paradoxical leadership has a positive influence on bootlegging. In the multiple mediation model, the effect paths of harmonious innovation passion and role breadth self-efficacy are significant but there is an insignificant difference in their power, while the effect path of perceived error management culture is insignificant, although it has a significant simple mediating effect and sequential mediating effect.

Originality/value

This study is among the first to show the influence of paradoxical leadership on bootlegging, responding to the research call to use the paradoxical factors to capture the antecedents of innovative behaviors. Second, this study enriches the outcomes of paradoxical leadership, that of bootlegging. Third, this study provides a TPB-based mechanism of how paradoxical leadership promotes bootlegging by increasing employees’ harmonious innovation passion, role breadth self-efficacy and perceived error management culture. This provides a new theoretical perspective to explain the relationship between paradoxical leadership and employee bootlegging. It also responds to the call for exploration of the multiple pathways of leadership.

Do mistakes acceptance foster innovation? Polish and US cross-country study of tacit knowledge sharing in IT

Purpose

This study aims to understand and compare how the mechanism of innovative processes in the information technology (IT) industry – the most innovative industry worldwide – is shaped in Poland and the USA in terms of tacit knowledge awareness and sharing driven by a culture of knowledge and learning, composed of a learning climate and mistake acceptance.

Design/methodology/approach

Study samples were drawn from the IT industry in Poland (n = 350) and the USA (n = 370) and analyzed using the structural equation modeling method.

Findings

True learning derives from mistake acceptance. As a result of a risk-taking attitude and critical thinking, the IT industry in the USA is consistently innovation-oriented. Specifically, external innovations are highly correlated with internal innovations. Moreover, a knowledge culture supports a learning culture via a learning climate. A learning climate is an important facilitator for learning from mistakes.

Originality/value

This study revealed that a high level of mistake acceptance stimulates a risk-taking attitude that offers a high level of tacit knowledge awareness as a result of critical thinking, but critical thinking without readiness to take a risk is useless for tacit knowledge capturing.

Caregivers' engagement during in-hospital care of sABI's patients: Evaluation of informal co-production from the health providers' perspective

One of the challenges of providing healthcare services is to enhance its value (for patients, staff and the service) by integrating the informal caregivers into the care process, both concretely managing their patient's health conditions and treatment (co-executing) and participating in the whole healthcare process (co-planning). This study aims at exploring the co-production contribution to the healthcare process, analysing whether and how it is related to higher caregivers' satisfaction with service care and reduced staff burnout, in the eyes of the staff. It also investigated two possible factors supporting caregivers in their role of co-producers, namely relationship among staff and informal caregivers related to knowledge sharing (i.e. an ability determinant supporting co-production) and related to role social conflict (i.e. a willingness determinant reducing co-production). Results of a structural equation model on a sample of 119 healthcare providers employed by neurorehabilitation centers in Italy with severe acquired brain injury confirmed that knowledge sharing positively related with caregivers' co-executing and co-planning. Also, social role conflict was negatively related with co-executing but positively with co-planning. Furthermore, co-planning resulted in being unrelated to both outcomes, whereas co-executing was associated with caregivers' satisfaction, as measured by staff perceptions. Overall, our data provided initial empirical evidence supporting the ability of the determinant's contribution in allowing informal caregivers to assume an active role in both co-production domains. Furthermore, as expected, the role of conflict willingness determinant was found to be a hindering factor for co-executing but, conversely, a trigger for co-planning. This result should be considered more carefully in future studies.

Love your mistakes!—they help you adapt to change. How do knowledge, collaboration and learning cultures foster organizational intelligence?

Purpose

The study aims to determine how the acceptance of mistakes is related to adaptability to change in a broad organizational context. Therefore, it explores how knowledge, collaboration and learning cultures (including “acceptance of mistakes”) might help organizations overcome their resistance to change.

Design/methodology/approach

The study used two sample groups: students aged 18–24 years (330 cases) and employees aged >24 years (326 cases), who worked in knowledge-driven organizations. Structural equation models were developed, assessed and compared.

Findings

The effect of the “learning climate” on “adaptability to change” mediated by “acceptance of mistakes” has been detected for young students aged 18–24 years; however, this relationship is not significant for business employees aged >24 years. This result indicates that organizations, unlike universities, do not use mistakes as a tool to support learning that is to lead to change.

Research limitations/implications

Both samples used in the study were obtained from Poland. The business sample was in the majority represented by small and medium-sized enterprises. Therefore, the presented findings may only be applicable to Poland.

Practical implications

Acceptance of mistakes is vital for developing a learning culture. Mistakes help employees adapt to change. Hence, a learning culture that excludes the acceptance of mistakes is somehow artificial and may be unproductive. Paradoxically, the findings reveal that the fact that employees’ intelligence (adaptability to change) improves via mistakes does not mean that organizational intelligence will also increase. Thus, organizations that do not develop mechanisms of learning from mistakes lose the learning potential of their employees.

Originality/value

This study proposes a constant learning culture scale that includes the “acceptance of mistakes” and “learning climate” dimensions. Further, it empirically proves the value of mistakes for adaptability to change. Moreover, it also contributes to the existing literature by demonstrating the mechanism of the relationship between knowledge, collaboration and learning cultures in the context of adaptability to change. This study breaks with the convention of “exaggerated excellence” and promotes the acceptance of mistakes in organizations to develop organizational intelligence.