Attractiveness of working in home care: An online focus group study among nurses

Sustainable employability of long-term care staff in self-managing teams: A qualitative study

AIM

To discover what long-term care (LTC) staff working in self-managing teams consider necessary to remain sustainably employable.

DESIGN

Qualitative study with semi-structured interviews.

METHODS

In 2020, semi-structured interviews were conducted one-on-one with 25 LTC workers from a medium-large Dutch organization providing long-term care. All interviews were audio-recorded, anonymously transcribed verbatim and analysed with thematic content analysis in the software program Atlas.ti.

RESULTS

LTC workers indicated a need for autonomy. They wanted their control and involvement in decisions to be strengthened. Furthermore, LTC workers indicated a need for relatedness, by experiencing support, a feeling of togetherness and more time to have attention for the residents. Lastly, LTC workers expressed a need for (assistance in) further developing their competence.

CONCLUSION

In order to remain willing and able to work, LTC workers in self-managing teams want their needs for autonomy, relatedness and competence to be addressed. Working conditions are important to these LTC workers' sustainable employability since they can hinder or promote the satisfaction of their needs.

IMPLICATIONS

It is important that management in LTC is aware of the importance of LTC workers' needs for sustainable employability. We recommend that management critically reflect on and invest in addressing these needs by enhancing indicators and limiting inhibitors of the needs.

IMPACT

A robust LTC workforce is necessary to provide care to the aging population. In the context of the increasing implementation of self-managing teams in LTC organizations, understanding what workers in self-managing teams need in order to remain sustainably employable is crucial. For sustainable employability (i.e. to remain willing and able to work), interviewees indicated a need for autonomy, relatedness, and competence. Nearly all participants stressed the importance of belonging and feeling connected. Working conditions seemed to relate not only directly to the sustainable employability of LTC staff but also indirectly through their lack of contribution to the satisfaction of workers' psychological needs. The outcomes of this study primarily impact workers and management within LTC organizations with self-managing teams. They benefit from recognizing the significance of addressing workers' needs to ensure their essential and sustainable employability in the sector.

REPORTING METHOD

The Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative (COREQ) research were used.

PATIENT OR PUBLIC CONTRIBUTION

Two LTC workers provided advice and feedback regarding the materials and set up of the interviews. These two ambassadors additionally helped in reaching our population, by disseminating information about the study.

Home Care Nurses at the Heart of the Communication Web: Communication Synchronicity and Effects on the Psychosocial Work Environment

This qualitative study explores how communication practice affects Swedish home care nurses' psychosocial work environment. Data consisted of interviews and field observations, analyzed from the perspective of Media Synchronicity Theory and the Job-Demand-Control-Support model. Individual home care nurses were found to manage an interorganizational communication web. The results indicated that this web could have a protective function for the nurses. Synchronous communication was found important to control the work situation. Nevertheless, asynchronous communication was enforced when communicating with other health care organizations. This reduced the level of control for the nurses. However, when possible, the nurses also arranged their communication practice to gain control. Thus, local optimization for one group could result in suboptimization for others. We conclude that communication practice should be designed holistically and promote synchronous communication to foster well-functioning interprofessional teamwork and to create a healthy psychosocial work environment for both home care nurses and their collaborators.

The experiences and needs of nurses providing home-based palliative care: A qualitative meta-synthesis

Objective(s): We conducted a qualitative meta-synthesis of qualitative studies on nurses' experiences when caring for palliative patients to (1) identify the needs of nurses and (2) describe their experiences to provide more in-depth information. Methods: Qualitative articles published in English from 2000 to 2022 were identified from several databases through a searching strategy. Authors screened through the title, abstract, and full text of relevant studies. Articles were read repeatedly and discussed. The thematic analysis methodology was adopted to analyze the data. Results: Of 967 articles, 22 were included in our review. Notions reflecting community nurses providing palliative home care were clustered into four themes: (1) nature of community-based palliative nursing, (2) teamwork, (3) relationship with patient and family, and (4) resources. Findings also suggest establishing a sound support system, strengthening palliative education, and creating more decisive referral criteria and systems. Conclusions: The growing need for palliative home care has become challenging for community health care systems. Our study summarized various aspects of nurses providing home-based palliative care. The findings provide information for health care and education settings to improve home care systems and recruit more staff to meet the needs.

How to Address the Health of Home Care Workers: A Systematic Review of the Last Two Decades

Making home care a healthy workplace is a societal concern but research on specific interventions is still scarce. The aim of this systematic review was to provide an initial overview of interventions addressing home care workers' health. All (quasi-) experimental studies, presenting any intervention among home care employees, and reporting any outcome related to occupational health, safety, or well-being were included. PsycArticles, Medline, PubMed, and Web of Science were searched from January 2000 to February 2022. From 16,345 publications, 18 studies with 2432 participants were included and assessed with the Joanna Briggs Institute Critical Appraisal Tools. Organizational and training/educational approaches were found in five studies each, a behavioral approach in one, and seven studies presented a combined approach. Due to methodological limitations and the heterogeneity of interventions, the existing studies are insufficient to inform new programs, but emphasize the need for tailored approaches, integrated concepts, and participatory intervention development.

The mediating effect of psychosocial factors in the relationship between self-organizing teams and employee wellbeing: A cross-sectional observational study

BACKGROUND

Several benefits of working in a self-organizing team, such as higher job satisfaction and better engagement to work have been demonstrated in previous studies.

OBJECTIVE

To examine whether those employees working in a self-organizing team have higher job satisfaction and lower turnover intentions compared to those in non-self-organized teams. Further, to test whether psychosocial factors defined by the Job Demand-Control model would function as mediators.

DESIGN

A cross-sectional survey study.

SETTING(S)

Home care and assisted living facilities (with 24-h assistance).

PARTICIPANTS

Licensed practical nurses (N = 377), registered nurses, therapists and managers (N = 183), and other employees (N = 31) in services for older people.

METHODS

A survey for employees working in services for older people and who were either in the self-organized teams or in the non-self-organized teams. Data was analyzed using linear regression and mediation analyses.

RESULTS

Those employees who worked in a self-organizing team were more satisfied with their job and had lower turnover intentions compared to those in a non-self-organizing team (mean [SD] 3.9 [1.0] vs. 3.7 [1.0], p = 0.006 and 2.2 [1.2] vs. 2.5 [1.3], p = 0.006, respectively). Moreover, job demands and job strain partially mediated the effect of self-organizing teamwork on job satisfaction (Average causal mediation effect [95%CI] 0.09 [0.02-0.15] and 0.10 [0.03-0.18], respectively), as well as on turnover intentions (Average causal mediation effect [95%CI] -0.08 [-0.15 to -0.01] and -0.20 [-0.18 to -0.03], respectively).

CONCLUSIONS

In the context of older people care services, working in self-organizing teams may enhance employee wellbeing by lowering job demands and job strain, but not by improving job control. Based on the findings of this study, self-organization seems beneficial, however, it requires real autonomy for the teams and team building.

TWEETABLE ABSTRACT

Self-organizing teamwork increases job satisfaction and decreases turnover intentions via lower job demands and strain in older people care.

Teamwork in home care nursing: A scoping literature review

Due to an increased number of complex multi- and long-term ill patients, healthcare and nursing provided in patients' homes are expected to grow. Teamwork is important in order to provide effective and safe care. As care becomes more complex, the need for teamwork in home care nursing increases. However, the literature on teamwork in the patients' home environment is limited. The aim of this study is to describe the scope of the current literature on teamwork in home care nursing and outline needs for future research. Seven electronic databases were systematically searched and 798 articles were identified and screened. Seventy articles remained and were assessed for eligibility by two of the authors. Eight themes were identified among the 32 articles that met the inclusion criteria. Studies concerned with teamwork regarding isolated tasks/problems and specific teamwork characteristics were most common. Methods were predominantly qualitative. Multiple method approaches and ethnographic field studies were rare. Descriptions of the context were often lacking. The terms 'team' and 'teamwork' were inconsistently used and not always defined. However, it is apparent that teamwork is important and home care nurses play a crucial role in the team, acting as the link between professionals, the patient and their families. Future studies need to pay more attention to the context and be more explicit about how the terms team and teamwork are defined and used. More research is also needed regarding necessary team skills, effects of teamwork on the work environment and technology-mediated teamwork.

Home health care for mechanical ventilation-dependent patients: A grounded theory study

The number of people requiring home mechanical ventilation is increasing. Both family and patients experience a quite different situation. There is a significant knowledge gap about the caring process, families and health care team responsibilities, challenges they face, and how they manage. This study aimed to discover the process of home health care (HHC) to mechanical ventilation-dependent patients. The Straus and Corbin version of the grounded theory method was used. The preliminary study was conducted in 2015, and then for updating the theory, a complementary study was done in 2019. Sampling began purposefully and then was followed by theoretical sampling. A total of 28 participants, including 14 professional health care workers, 12 family members, and two improved patients were interviewed. Data were analysed using MAXQDA 2010 with constant comparative analysis method. After this step and the formation of concepts, structure, and the relation between them and exploring the process, the related theory was presented. The data analysis revealed 64 primary categories, that have been clustered into eight categories, and finally in three main concepts of "challenging care with stress and ambivalence", "step-by-step care delegation", and "professional and limited". After organising the memos, drawing the diagrams, and writing the storyline, "challenging care with stress and ambivalence" emerged as the main concern. Families tend to provide care without reducing quality. So, using the "step-by-step care delegation" strategy they delegate the care from professional to unprofessional caregivers. This strategy could lead to the "supported independence" of families and "professional development" of nurses. Families experience a challenging situation during care delivery to mechanical ventilation-dependent patients at home. The most important challenge is insufficient insurance coverage and an inappropriate legal framework for service delivery. Hence, the study results could be used by policymakers to improve HHC policies.

Lessons Learned from Caregivers of Children with Medical Complexity: Implications for Policy & Providers

As the number of children with medical complexity living at home continues to grow, so do their care needs. Feedback from parent/guardian caregivers of children with medical complexity provides insight that can help policy makers and healthcare providers to understand more about the care provided in the home. Focus groups, a qualitative study approach, were used to more fully understand the challenges faced by parents/guardian caregivers of children with medical complexity residing in Illinois. Focus groups were conducted in the spring of 2021 to examine the issues from the parent/guardian caregiver perspective. Three main themes emerged from the focus group discussions: navigation of the system is confusing; quality of care in the home needs improvement; and caregivers need more help in providing care. Review of the discussions provided an understanding of the experiences of parent/guardian caregivers of children with medical complexity. These findings have important implications for policy makers, public health and Title V Programs, home nursing agencies, and home nurses. It is imperative that systems level upstream solutions be implemented to address the systemic challenges related to care for the child with medical complexity at home.

Home care for patients with dirty homes: a qualitative study of the problems experienced by nurses and possible solutions

BACKGROUND

Home-care nurses are often the first care professionals to enter a dirty home. The perceived problems and support needs of home-care nurses in these situations are largely unknown.

OBJECTIVE

To examine the problems home-care nurses encounter in caring for patients living in dirty homes, and possible solutions for these problems.

DESIGN

Qualitative descriptive research.

SETTING

Communities across the Netherlands.

PARTICIPANTS

Twenty-three participants to investigate the problems or needs experienced, and 20 participants to investigate solutions. Participants included patients, home-care nurses and other professionals working in the community.

METHODS

Semi-structured interviews were conducted with 23 participants and analysed according to the principles of deductive thematic analysis. Subsequently, in interviews with 4 (representatives of) patients and four focus-group sessions with 16 professionals, the problems found were validated and solutions to the problems discussed.

RESULTS

Ten subthemes emerged that were clustered into three main themes: 'dilemmas arise in choosing the right nursing care'; 'cooperation and an integrated approach are often necessary, but lacking'; 'home-care nurses have insufficient competencies'. Seven possible solutions were found: (1) strengthening collaboration between organizations in the community; (2) involving others sooner; (3) case management; (4) person-centred care; (5) taking more time; (6) providing home-care nurses with tools and support services; and (7) strengthening the competencies of nurses.

CONCLUSIONS

Care for patients with a dirty home is complex. An integrated person-centred care approach is often necessary and home-care nurses need extra support to provide such care. Interventions should not only focus on patients, but address the nurses, the organization, and the collaboration between organizations in the community.

Patient participation in electronic nursing documentation: An interview study among home-care patients

Background

Patients are increasingly expected to take an active role in their own care. Participation in nursing documentation can support patients to take this active role since it provides opportunities to express care needs and preferences. Yet, patient participation in electronic nursing documentation is not self‐evident.

Objective

To explore how home‐care patients perceive their participation in electronic nursing documentation.

Methods

Semi‐structured interviews were conducted with 21 home‐care patients. Interview transcripts were analysed in an iterative process based on the principles of reflexive inductive thematic analysis.

Results

We identified a typology with four patient types: ‘high need, high ability’, ‘high need, low ability’, ‘low need, high ability’ and ‘low need, low ability’. Several patients felt a need for participation because of their personal interest in health information. Others did not feel such a need since they trusted nurses to document the information that is important. Patients' ability to participate increased when they could read the documentation and when nurses helped them by talking about the documentation. Barriers to patients' ability to participate were having no electronic devices or lacking digital skills, a lack of support from nurses and the poor usability of electronic patient portals.

Conclusion

Patient participation in electronic nursing documentation varies between patients since home‐care patients differ in their need and ability to participate. Nurses should tailor their encouragement of patient participation to individual patients' needs and abilities. Furthermore, they should be aware of their own role and help patients to participate in the documentation.

Patient or Public Contribution

Home‐care patients were involved in the interviews.

What are job seekers attracted to? Examining the importance of organizational attributes across four types of job seekers in Poland and France

Purpose

The current study has two major aims: (1) investigate the factor structure and importance ratings of attributes in France vs Poland and (2) compare the importance ratings of the attribute signals sent by potential employers during the recruiting process across four different types of job seekers (i.e. new entrants, short-term unemployed, long-term unemployed and currently employed).

Design/methodology/approach

First, using a confirmatory factor analysis (CFA), the authors compare the fit of several proposed models and identify the best fit using the combined job seeker sample. The authors then examine the fit of the selected model for the France and Poland samples separately. Finally, we compare the attribute importance rating factors across groups using a Country by Job Seeker multivariate analysis of variance (MANOVA).

Findings

The CFA results on the combined sample showed that a six factor-solution with two higher-order factors (organization- and job-attributes) provided the best fit and held for both France and Poland. MANOVA results showed a significant interaction between type of job seeker and country for organizational characteristics, and main effects of country and job seeker for work–life values and characteristics.

Originality/value

Most past research on the importance of job attribute factors focused on new entrants in the United States. This study provides the first examination of job attribute factors across different countries, France and Poland, and other types of job seekers.

The Second Side of the Coin-Resilience, Meaningfulness and Joyful Moments in Home Health Care Workers during the COVID-19 Pandemic

Nursing literature predominantly focuses on job demands but is scarce for resources related to nurses' work. In the face of the COVID-19 pandemic, resources that can buffer the health-impairing effects of increased demands gain importance. The aim of this study is to explore resilience, meaning of work and joyful moments in home health care workers in South Germany during the pandemic. Resilience and meaning of work were measured quantitatively; moments of joy were investigated qualitatively by audio diaries and analyzed with qualitative content analysis. In all, 115 home health care workers (mean age = 47.83 ± 11.72; 81.75% female) filled in the questionnaires and 237 diary entries were made by 23 persons (mean age = 46.70 ± 10.40; 91.30% female). The mean scores of resilience (5.52 ± 1.04; 1-7) and meaning of work (4.10 ± 0.92; 1-5) showed high levels, with significantly higher values in females. Home care workers experienced joyful moments 334 times in 60 different types in the categories of social relationships, work content, work organization, work environment and self-care. A deeper understanding of resilience, meaning of work and joyful moments provides a basis for the development of worksite health promotion programs that address both demands and resources in home health care workers.

Impact of Intrinsic and Extrinsic Motivation on Work Engagement: A Cross-Sectional Study of Nurses Working in Long-Term Care Facilities

Nurses’ work motivation impacts their job satisfaction and work engagement, affecting their quality of care. Work motivation, a personal resource, can be categorized into intrinsic and extrinsic motivation, each of which may function differently in the job demands–resources (JD–R) model. To study the effect of nurses’ intrinsic and extrinsic work motivation on work engagement in long-term care (LTC) facilities, we randomly selected 1200 facilities from 6055 LTC facilities in eastern Japan. Two nurses from each facility completed a self-report questionnaire—newly developed for this study for evaluating intrinsic and extrinsic work motivation—to assess their work engagement, job satisfaction, and work motivation. Multiple regression analysis of 561 valid questionnaires investigated the relationship between work motivation and work engagement, indicating that intrinsic work motivation, job satisfaction, and age had a significant positive effect on work engagement, while extrinsic work motivation had no significant effect. However, half the nurses chose to work because of extrinsic work motivation, explaining the high turnover rate of nursing staff in LTC facilities. Findings indicate the importance of measures to foster nurses’ intrinsic motivation to improve work engagement. Further research should investigate how to improve the intrinsic motivation of nurses working in LTC facilities.

To what extent do home care nurses feel free to assess the care that is needed for their patients? A nationwide survey in the Netherlands

BACKGROUND AND AIMS

Patients receiving nursing care at home require a needs assessment. There are indications that practice variation exists in needs assessments performed by Dutch home care nurses. One possible cause is that nurses are differentially influenced by others when performing needs assessments. Instruments recommending what is appropriate care have the potential to protect nurses against unwarranted influences. In the Netherlands, a framework exists including general norms about performing needs assessments. We aimed to achieve insight into whether nurses, who have heard of the framework, feel more free to assess the care that is needed for their patients, and whether other actors play a role in performing needs assessments.

METHODS

An online questionnaire was sent to members of the Dutch Nursing Staff Panel (response 47%; n = 302) in November 2019. Only nurses who perform needs assessments were included in the analyses (n = 141). χ2-tests were used to assess the relationships between the variables of having heard of the framework, feeling free to assess the care that is needed, and the influences of others.

RESULTS

We found no relationships between having heard of the framework and feeling free to assess the care that is needed for patients or reporting influence of others. However, home care nurses who state that they are not influenced by others, feel more free to assess the care that is needed for their patients. In contrast, those who state that they are influenced by informal caregivers, or health care insurers, feel less free to assess the care that is needed.

CONCLUSION

It appears that the framework for performing needs assessments does not, in its current form, protect against influences of others. Further research is recommended to examine what kind of instruments nurses need to perform unambiguous and good needs assessments and, as such, reduce unwarranted practice variation.

Community Nurses' Preparations for and Challenges in Providing Palliative Home Care: A Qualitative Study

Hospitals have played a leading role in providing palliative care in Taiwan as its care model has developed over the past few decades. However, earlier local studies in Taiwan showed that terminal patients prefer to die at home, highlighting the need to promote community-based palliative care instead of hospital-based care. Along with this shift, how community nurses provide palliative home care merits further exploration. This qualitative descriptive study aims to understand (1) how community nurses implement community-based palliative care, (2) what preparations are needed, and (3) what challenges they may face. Purposive sampling was used for recruiting nurses. We conducted one-on-one, in-depth, semi-structured interviews. Interview recordings were transcribed verbatim and analyzed using thematic analysis. Eight community nurses with a range of experience in palliative home care were interviewed. Four major themes emerged: (1) Opportunities, (2) Qualifications, (3) Support, and (4) Commitments. Psychological preparedness, well-developed professional capabilities, external assistance, and peer support motivate community nurses to offer community-based palliative care. As the requests for palliative home care services increase, community nurses play a critical role in palliative home care. Although the sample size is small and the findings retrieved from a small number of experiences might not be generalized to every region, the study results could inform future experience-sharing and workshop sessions to train more nurses for community-based care, expanding service coverage, and providing optimal palliative care.

Developing the nursing practice environment scale for home health care: A trial study in Japan

AIM

To develop the nursing practice environment scale in home health care (NPES-HHC), which measures the attractiveness of nursing practice environments in Japan.

DESIGN

Cross-sectional study.

METHODS

The answers of 1,050 mail surveys conducted for nurses at 421 home-visit nursing agencies in Japan were analysed. Exploratory and confirmatory factor analyses of the NPES-HHC's candidate items were performed. Relationships between the newly developed NPES-HHC and participants' intention to remain at the workplace, job satisfaction and quality of care were also tested.

RESULTS

A seven-dimensional model with 37 items was obtained by exploratory factor analysis (Cronbach's alpha: 0.77-0.92). Confirmatory factor analysis supported this model. NPES-HHC scores had significant positive relations with participants' intention to remain at the workplace, job satisfaction and quality of care (p < .01). The NPES-HHC is a reliable and valid instrument to assess the attractiveness of the practice environment for home-visit nursing agencies.

The Ambassador Project: Evaluating a Five-Year Nationwide Leadership Program to Bridge the gap Between Policy and District Nursing Practice

District nurses have a crucial position in healthcare provision and are expected to use leadership practices to ensure optimal quality patient care. To better equip them, a leadership program named the ambassador project was developed to support the development of a liaison role between policy and district nursing practice. This research aims to evaluate from different perspectives the impact of this nationwide, five-year leadership program for district nurses at the organizational, regional, and societal levels. A mixed-methods study was conducted using two focus groups based on peer-to-peer shadowing (n = 14), semistructured interviews (n = 13), and an online questionnaire (n = 45). The analysis shows that the impact of a nationwide leadership program for district nurses was perceived as predominantly positive, and nurses experienced an increase in courage, assertiveness, professional pride, and leadership skills. They obtained confidence in representing the group of district nurses at the organizational, regional, and societal levels when speaking with various key stakeholders from the healthcare system. They were able to bridge the gaps among daily practice, policymaking, and politics by using translations and shaping actions and information into terms suiting the needs of those involved.

Impact of organizational context on patient outcomes in a proactive primary care program:a longitudinal observational study

BACKGROUND

The effectiveness of health care interventions is co-determined by contextual factors. Unknown is the extent of this impact on patient outcomes. Therefore, the aim of this study is to explore which characteristics of general practices are associated with patient outcomes in a proactive primary care program, the U-PROFIT 2.0.

METHODS

A longitudinal observational study was conducted from January 2016 till October 2017. Two questionnaires were send out, one to collect characteristics of general practices such as practice neighbourhood socio-economic status, general practice versus healthcare centre (involving multiple primary care professionals), and professional- frail older patient ratio per practice of general practitioners and practice nurses. Regarding delivering the program, the practice or district nurse who delivered the program, number of years since the start of the implementation, and choice of age threshold for frailty screening were collected. Patient outcomes collected by the second questionnaire and send to frail patients were daily functioning, hospital admissions, emergency department visits, and general practice out-of-hours consultations. Linear and generalized linear mixed models were used.

RESULTS

A total of 827 frail older people were included at baseline. Delivery of the program by a district nurse compared to a practice nurse was significantly associated with a decrease in daily functioning on patient-level (β = 2.19; P = < 0.001). Duration since implementation of 3 years compared to 9 years was significantly associated with less out-of-hours consultations to a general practice (OR 0.11; P = 0.001). Applying frailty screening from the age of 75 compared to those targeted from the age of 60 showed a significant increase in emergency visits (OR 5.26; P = 0.03).

CONCLUSION

Three associations regarding the organizational context 1) the nurse who delivered the program, 2) the number of years the program was implemented and 3) the age threshold for defining a frail patient are significant and clinically relevant for frail patients that receive a proactive primary care program. In general, contextual factors need more attention when implementing complex primary care programs which can result in better balanced choices to enhance effective proactive care for older people living in the community.

The Home Healthcare Nurse: A Concept Analysis

The home healthcare nurse is a concept that has grown rapidly in the past two centuries, however, the role and meaning remain ambiguous. Continuous changes in the healthcare system have sparked confusion with patients and healthcare providers as to the essence of the home healthcare nurse. With the popularity and demand for home healthcare-based care on the rise, it is necessary to differentiate the concept of the home healthcare nurse from other related terms through a concept analysis. Using Walker and Avant's methodology, a literature search using Cumulative Index to Nursing and Allied Health Literature (CINAHL) along with dictionaries, encyclopedias, and professional organizations was performed to identify all the uses, attributes, and characteristics of the concept. Five defining attributes emerged during the analysis: autonomy, adaptability, person-centered holistic care, care coordination, and self-efficacy. Antecedents, consequences and empirical referents were identified. As a first step, this concept analysis brings clarity to the meaning and role of the home healthcare nurse from which arose an operational definition and proposed conceptual model. With the number of patients admitted to home healthcare accelerating, healthcare organizations and clinicians must distinctly understand the concept of the home healthcare nurse. Future research should include testing theoretical relationships between the home healthcare nurse and patient outcome variables to enhance nursing science and promote population health.

Nurses Working in Nursing Homes: A Mediation Model for Work Engagement Based on Job Demands-Resources Theory

This study examined the impact that the attractiveness of working in nursing homes and autonomous clinical judgment have on affective occupational commitment, and whether work engagement mediates these relationships. This analysis was based on the job demands-resources theory. The study setting was 1200 nursing homes (including long-term care welfare facilities and long-term care health facilities) in eastern Japan. An anonymous, self-report questionnaire survey was administered to two nurses from each facility, resulting in a prospective sample of 2400 participants. Overall, 552 questionnaires were analyzed, in which structural equation modeling and mediation analysis using the bootstrap method were performed. The results showed that the attractiveness of working in nursing homes does not directly affect affective occupational commitment; work engagement fully mediates the impact of attractiveness of working in nursing homes on affective occupational commitment. Additionally, autonomous clinical judgment showed a direct impact on both work engagement and affective occupational commitment, indicating that work engagement partially mediates the impact on affective occupational commitment. To increase the affective occupational commitment of nurses working in nursing homes, managers should help nurses recognize the attractiveness of working in nursing homes, and then provide appropriate support to help such nurses work in a motivated manner.

Availability of personal protective equipment and diagnostic and treatment facilities for healthcare workers involved in COVID-19 care: A cross-sectional study in Brazil, Colombia, and Ecuador

Many affected counties have had experienced a shortage of personal protective equipment (PPE) during the coronavirus disease (COVID-19) pandemic. We aimed to investigate the needs of healthcare professionals and the technical difficulties faced by them during the initial outbreak. A cross-sectional web-based survey was conducted among the healthcare workforce in the most populous cities from three Latin American countries in April 2020. In total, 1,082 participants were included. Of these, 534 (49.4%), 263 (24.3%), and 114 (10.5%) were physicians, nurses, and other professionals, respectively. At least 70% of participants reported a lack of PPE. The most common shortages were shortages in gown coverall suits (643, 59.4%), N95 masks (600, 55.5%), and face shields (569, 52.6%). Professionals who performed procedures that generated aerosols reported shortages more frequently (p<0.05). Professionals working in the emergency department and primary care units reported more shortages than those working in intensive care units and hospital-based wards (p<0.001). Up to 556 (51.4%) participants reported the lack of sufficient knowledge about using PPE. Professionals working in public institutions felt less prepared, received less training, and had no protocols compared with their peers in working private institutions (p<0.001). Although the study sample corresponded to different hospital centers in different cities from the participating countries, sampling was non-random. Healthcare professionals in Latin America may face more difficulties than those from other countries, with 7 out of 10 professionals reporting that they did not have the necessary resources to care for patients with COVID-19. Technical and logistical difficulties should be addressed in the event of a future outbreak, as they have a negative impact on healthcare workers. Clinical trial registration: NCT04486404.

Neurosurgeons' experiences of conducting and disseminating clinical research in low- and middle-income countries: a qualitative study protocol

INTRODUCTION

Low-income and middle-income countries (LMICs) face the greatest burden of neurotrauma. However, most of the research published in scientific journals originates from high-income countries, suggesting those in LMICs are either not engaging in research or are not publishing it. Evidence originating in high-income countries may not be generalisable to LMICs; therefore, it is important to nurture research capacity in LMICs so that a relevant evidence base can be developed. However, little is published about specific challenges or contextual issues relevant to increasing research activity of neurosurgeons in LMICs. Therefore, the aim of this study was to understand neurosurgeons' experiences of, aspirations for and ability to conduct and disseminate clinical research in LMICs.

METHODS AND ANALYSIS

This is a pragmatic qualitative study situated within the naturalistic paradigm using focus groups and interviews with a purposive sample of neurosurgeons from LMICs. First, we will conduct asynchronous online focus groups with 36 neurosurgeons to broadly explore issues relevant to the study aim. Second, we will select 20 participants for follow-up semistructured interviews to explore concepts in more depth and detail than could be achieved in the focus group. Interviews will be audio-recorded and transcribed verbatim. A thematic analysis will be conducted following Braun and Clarke's six stages and will be supported by NVIVO software.

ETHICS AND DISSEMINATION

The University of Cambridge Psychology Research Ethics Committee reviewed this study and provided a favourable opinion in January 2020 (REF PRE.2020.006). Participants will provide informed consent, be able to withdraw at any time and will have their contributions kept confidential. The findings of the study will be shared with relevant stakeholders and disseminated in conference presentations and journal publications.

STANDARDS OF KNOWLEDGE THAT FOUND NURSING PERFORMANCE IN HOME CARE

ABSTRACT Objective: to analyze the knowledge standards that found nursing practices in the home care setting. Method: qualitative study using a single case study strategy, supported by the dialectical methodological framework. Thirteen nurses who work in home care services from two municipalities in Minas Gerais, Brazil, participated. The data were obtained in 266.5 hours of participant observation and 8 hours and 58 minutes of interview and submitted to Critical Discourse Analysis. Results: empirical knowledge was revealed to be fundamental for clinical, managerial and educational care at home. The adaptations specific to this environment require aesthetic knowledge. The relational and educational actions, the decisions responsible for benefiting the individual and his family, the doubt and willingness to learn when dealing with unpredictable cases and the assessment of the socioeconomic conditions of the family, represent, respectively, personal, ethical, lack of knowledge and sociopolitical aspects present in the practice of nurses in home care. Conclusion: the particularities of home care trigger different patterns of knowledge to ensure creative, sensitive, human and responsible care. Innovation and availability to learn are part of nurses' performance in home care. The need for differentiated training is reinforced in order to respond to the increasing complexity in this field.

Becoming a Home Care Worker: Job-Seekers' Push and Pull Factors

This study examined "push and pull" factors associated with the decision to become home care workers among job-seekers in Israel. Participants completed measures of ageism, anxiety about aging, attitudes toward the home care profession, and personal relationship with older adults. Of 1,492 participants, 32.0% accepted the offer to become home care workers and were no longer in the job market, 36.7% accepted the offer but worked in the past, and 31.2% refused the offer. Compared to participants currently employed, the odds of being employed in the past were higher for participants who were younger, with poorer health and higher ageism; the odds of refusal were higher for males, Arabs, younger participants, with more education, lower ageism, and fewer personal relationship with older adults. The findings have implications for practice with job-seekers and for retaining current home care workers in the field. This may assist in expanding the home care workforce.

Understanding the autonomy-meaningful work relationship in nursing: A theoretical framework

BACKGROUND

Within nursing literature, the value and contribution of autonomy to nurse work satisfaction has been consistently demonstrated. Given the current forms of work and today's technology, the scope of freedom a nurse has over and in work has expanded in many different ways. However, although autonomy is viewed as an important antecedent to meaningful work (MW), no formal theory exists attempting to explain the relationships between the various different forms of autonomy and MW. Such a theoretical framework would guide health care organizations to direct resources specifically toward those types of autonomy that are most likely to cultivate the MW and its associated outcomes such as job satisfaction.

PURPOSE

To address this important gap, this article introduces a theoretical, empirically testable model of autonomy-MW that is suitable for the contemporary work environment of nurses.

METHOD

Drawing from research and theory in nursing literature, organizational sciences, and business ethics on autonomy and MW, the model is presented in four parts: the proposed relationships between perceived (1) professional autonomy, (2) individual autonomy, (3) group autonomy with core dimensions of MW, and (4) the proposed relationships between these three forms of autonomy with the dimensions "inspiration" and "facing reality."

FINDINGS

By using a multidimensional MW construct, our model offers fine-tuned propositions regarding how different types of autonomy influence different dimensions of MW.

DISCUSSION

The model proposes that the three forms of autonomy relate differently to the dimensions of MW. This model can be used as starting point for empirical research on autonomy-MW relationships.

International priorities for home care education, research, practice, and management: Qualitative content analysis

BACKGROUND

Despite growing demand for home care nursing, there is a growing home care workforce shortage, due in part to hospital-centric nursing curricula that lead students to undervalue of home care and community practice setting (Van Iersel et al., 2018a, 2018b).

OBJECTIVES

Articulate an international vision for the future of home care education, research, practice, and management shared by experienced home care nurses working in leadership roles.

DESIGN

Qualitative content analysis.

SETTINGS AND PARTICIPANTS

The sample included 50 home care professionals from 17 countries.

METHODS

Home care nurse leaders (in education, research, practice, and management roles) were recruited through professional international nursing networks to participate in a structured online survey about priorities for the future of home care in 2014. Responses were open coded by two independent researchers. Preliminary categories and sub-themes were developed by the research team and revised after a modified member-checking process that included presentation and discussion of preliminary findings at three international nursing meetings in 2015 and 2016.

RESULTS

Four major themes emerged reflecting international priorities for the future of home care education, research, practice, and management: 1) Build the evidence base for home care; 2) Design better systems of care; 3) Develop leaders at all levels; and 4) Address payment and policy issues.

CONCLUSIONS

Collectively, the findings provide a major call to action for nurse educators to re-design existing pre- and post-licensure educational programs to meet the growing demand for home care nurses. Innovations in education that focus on filling gaps in the evidence-base for community nursing practice, and improving access to continuing education and evidence-based resources for practicing home care nurses and nurse managers should be prioritized.

Attractiveness of people-centred and integrated Dutch Home Care: A nationwide survey among nurses

The World Health Organization is calling for a fundamental change in healthcare services delivery, towards people-centred and integrated health services. This includes providing integrated care around people's needs that is effectively co-ordinated across providers and co-produced by professionals, the patient, the family and the community. At the same time, healthcare policies aim to scale back hospital and residential care in favour of home care. This is one reason for the home-care nursing staff shortages in Europe. Therefore, this study aimed to examine whether people-centred, integrated home care appeals to nurses with different levels of education in home care and hospitals. A questionnaire survey was held among registered nurses in Dutch home-care organisations and hospitals in 2015. The questionnaire addressed the perceived attractiveness of different aspects of people-centred, integrated home care. In total 328 nurses filled in the questionnaire (54% response rate). The findings showed that most home-care nurses (70% to 97%) and 36% to 76% of the hospital nurses regard the different aspects of people-centred, integrated home care as attractive. Specific aspects that home-care nurses find attractive are promoting the patient's self-reliance and having a network in the community. Hospital nurses are mainly attracted to health-related prevention and taking control in complex situations. No clear differences between the educational levels were found. It is concluded that most home-care nurses and a minority of hospital nurses feel attracted to people-centred, integrated home care, irrespective of their educational level. The findings are relevant to policy makers and home-care organisations who aim to expand the home-care nursing workforce.