Occupational benefit perception of acute and critical care nurses: A qualitative meta-synthesis

Background

With the development of society, nurses have an increasingly more important role in the medical team. At the same time, due to various reasons, the number of active nurses is continuously decreasing, and the shortage of nursing personnel is becoming ever more serious. The COVID-19 pandemic made these clinical problems more serious. As the department with the greatest work pressure and the most intense pace, acute and critical care nurses are already facing serious problems related to job burnout and dismission. In the context of the COVID-19 pandemic, these problems should be solved urgently. Furthermore, with the rise of positive psychology, many scholars are turning their research direction to the positive professional experience of nurses so as to get inspiration to encourage nurses to face work with an optimistic attitude and guide nursing managers to better retain nursing talents.

Objective

The purpose of this paper is to summarize and evaluate the positive emotional experience and professional benefit of acute and critical care specialist nurses in the process of work. So as to better interpret their occupational benefit perception and guide nursing managers in adopting positive measures and promoting the development of high-quality nursing.

Methods

Cinahl plus, Embase, Medline and other twelve databases were searched for relevant literature. Meta-aggregation was used to synthesize the findings of the included studies.

Results

From a total of 12 articles included in this study, 55 main results were presented, 8 new categories were integrated, and three themes were formed: professional identity, social support, and personal growth. The professional identity included: being proud of professional ability and increasing professional value; social support included: friends and family support, organizational, environmental support, peer support, and support of patients and their families; personal growth included realizing self-worth and promoting self-development.

Conclusion

Hospital managers should pay attention to the positive emotional experience of nurses in work and based on this, provide practical and beneficial protection for nurses from the aspects of salary, learning opportunities, working environment, social support and internal personality, stimulate work enthusiasm, guide nurses to correctly face negative emotions and occupational pressure, and improve the sense of professional benefit.

Prevalence and reasons for non-nursing tasks as perceived by nurses: findings from a large cross-sectional study

AIM(S)

To describe the prevalence and reasons for non-nursing tasks as perceived by nurses.

BACKGROUND

Four types of non-nursing tasks have been identified to date: (a) auxiliary; (b) administrative, (c) expected by allied health care professionals; and (d) medical. However, no studies on a large scale have been performed with the aim of identifying the prevalence of all of these non-nursing tasks, and factors promoting or hindering their occurrence, given that they represent a clear waste of nurses' time.

METHOD(S)

A cross-sectional study in 2017, following The Strengthening the Reporting of Observational studies. All active nurses registered in an Italian provincial Nursing Board (=1331) willing to participate were involved. A questionnaire survey exploring the nature of the nursing-tasks performed in daily practice and the underlying reasons was administered via paper/pencil and e-mail.

RESULTS

733 nurses participated, of which 94.5% performed at least one type of non-nursing task, mainly administrative and auxiliary. Auxiliary tasks are less likely among nurses working in a community (Odds Ratio [OR] 0.43, 95% CI 0.29-0.63, p <0.01) or in a residential (OR 0.41, 95% CI 0.23-0.72, p <0.01) setting, in critical (OR 0.29, 95% CI 0.16-0.54, p <0.01) or surgical (OR 0.37, 95% CI 0.19-0.75, <p .01) hospital settings, and when they deal with unexpected clinical events (OR 0.58, 95% CI 0.44-0.77, p <0.01). Greater adequacy of nursing resources decreases the occurrence of auxiliary tasks (OR 0.98, 95% CI 0.97-0.99, p <0.01) while the need to compensate for a lack of resources (OR 1.44, 95% CI 1.07-1.93, p <0.01) increases it.

CONCLUSION(S)

Around one-third of shift time is devoted to non-nursing tasks; working in a hospital, in medical units, with lack of resources, and with patients with predictable clinical conditions might increase the occurrence of auxiliary tasks.

IMPLICATIONS FOR NURSING MANAGEMENT

Strategies to increase the time available for nursing care should consider the type of tasks performed by nurses, their antecedents, and the value-added to care in terms of patient' benefits.

Satisfaction With the Quality Nursing Work Environment Among Psychiatric Nurses Working in Acute Care General Hospitals

BACKGROUND

The objective of this study was to investigate the impact on patient care quality of a positive, high-quality environment that is tailored to the practice of nursing. This study enabled nurses to show their professional skills and knowledge, which may help enhance job satisfaction. To date, little research has been done to assess the relationship between the nursing work environment and the job satisfaction of psychiatric nurses employed in acute wards of general hospitals.

PURPOSE

This study was designed to explain the relationship between job satisfaction and the perceived indicators of a quality nursing work environment (QNWE) after adjusting for demographic characteristics and work characteristics.

METHODS

A cross-sectional correlational design was employed, and a stratified random sample of 185 psychiatric nurses (99% response rate) working in acute wards in Taiwan was surveyed in 2013. Nurses were asked to complete a self-administered questionnaire that included measures of perceived QNWE and job satisfaction and demographic variables.

RESULTS

A statistically significant, positive relationship was found between perceived indicators of QNWE and job satisfaction (r = .813, p < .001). In the hierarchical multiple linear regression model, for the subdimensions of QNWE, the variables "perceived indicators of professional specialization and teamwork" and "support and caring" showed a significant and positive association with job satisfaction, after adjusting for personal demographic characteristics.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Job satisfaction is related to the perception of nurses regarding their work environment. Therefore, nursing managers should improve workplace satisfaction by supporting and caring for nurses and creating better career development and teamwork opportunities for nurses through job training and planning.

A randomized controlled trial on rehabilitation through caregiver-delivered nurse-organized service programs for disabled stroke patients in rural china (the RECOVER trial): design and rationale

RATIONALE

Stroke is the leading cause of death and disability in rural China. For stroke patients residing in resource-limited rural areas, secondary prevention and rehabilitation are largely unavailable, and where present, are far below evidence-based standards.

AIM

This study aims to develop and implement a simplified stroke rehabilitation program that utilizes nurses and family caregivers for service delivery, and evaluate its feasibility and effectiveness in rural China.

METHODS AND DESIGN

This 2-year randomized controlled trial is being conducted in 2-3 county hospitals located in northwest, northeast, and southwest China. Eligible and consenting stroke inpatients (200 in total) have been recruited and randomized into either a control or intervention group. Nurses in the county hospital are trained by rehabilitation specialists and in turn train the family caregivers in the intervention group. They also provide telephone follow-up care three times post discharge. The recruitment, baseline, intervention, follow-up care, and evaluation are guided by the RECOVER mobile phone app specifically designed for this study.

STUDY OUTCOME

The primary outcome is patients' Barthel Index (activities of daily living: mobility, self-care, and toileting) at 6 months. Process and economic evaluation will also be conducted.

DISCUSSION

The results of our study will generate initial high-quality evidence to improve stroke care in resource-scarce settings. If proven effective, this innovative care delivery model has the potential to improve the health and function of stroke patients, relieve caregiver burden, guide policy-making, and advance translational research in the field of stroke care.

Professional practice models for nurses in low-income countries: an integrative review

BACKGROUND

Attention is turning to nurses, who form the greatest proportion of health personnel worldwide, to play a greater role in delivering health services amidst a severe human resources for health crisis and overwhelming disease burden in low-income countries. Nurse leaders in low-income countries must consider essential context for nurses to fulfill their professional obligation to deliver safe and reliable health services. Professional practice models (PPMs) have been proposed as a framework for strategically positioning nurses to impact health outcomes. PPMs comprise 5 elements: professional values, patient care delivery systems, professional relationships, management approach and remuneration. In this paper, we synthesize the existing literature on PPMs for nurses in low-income countries.

METHODS

An integrative review of CINAHL-EBSCO, PubMed and Scopus databases for English language journal articles published after 1990. Search terms included nurses, professionalism, professional practice models, low-income countries, developing countries and relevant Medical Subject Heading Terms (MeSH).

RESULTS

Sixty nine articles published between 1993 and 2014 were included in the review. Twenty seven articles examined patient care delivery models, 17 professional relationships, 12 professional values, 11 remuneration and 1 management approach. One article looked at comprehensive PPMs.

CONCLUSIONS

Adopting comprehensive PPMs or their components can be a strategy to exploit the capacity of nurses and provide a framework for determining the full expression of the nursing role.

I am only a nurse: a biographical narrative study of a nurse's self-understanding and its implication for practice

BACKGROUND

The personal is a vital part of professional nursing practice. From a psycho-social perspective, nurses produce and reproduce conceptions of the Self through experience. A literature search on nurses' self-understanding in a psycho-social perspective yields no results. Hence, the aim of this study was to investigate personal and professional experiences that may have formed the self-understanding of a nurse, and how this self-understanding may have influenced her professional practice.

METHODS

Using a single case approach, I conducted a Biographical Narrative Interview with a 50-year-old experienced Norwegian nurse. I asked the nurse to tell me the story of her life and how her work has affected her and possibly changed the way she saw herself. The overall aim of the interpretation was to understand the historically situated subjectivity in terms of the nurse's personal, social and professional constraints and chosen options.

RESULTS

The nurse's narrative of her life story made it possible to trace a common theme throughout her experiences, the experience of being "only a nurse". The nurse experienced a low status, as well as a downgrade in the competence needed to deliver quality care in professional relationships. She felt it difficult to identify with the experience of being on the bottom of the social ladder and to identify with the female, mothering ideal connected to nursing. She desired a better position, and wanted to identify with strong women. In contrast to reality, her self-understanding influenced her relationship with her patients, her professional pride and her further professional development.

CONCLUSIONS

This study shows that the professional practice of a nurse was informed by her self-understanding. This study suggests that the individual nurse must be given the opportunity to explore her professional vulnerability based on the assumption that it is both personally and socially constituted. This study indicates that the exploration of a nurse's self-understanding is one way to contribute to professional development.

An analysis of women's and children's health professional requirements in China in 2010 based on workload

BACKGROUND

To make health services more equitable and accessible for women and children and to achieve a universal coverage, human resources for women and children's health (WCH) should be evaluated. However, since there is still no consensus on the real situation of Chinese WCH professionals, we aim with this study to compare the actual and required amount of WCH professionals for China.

METHODS

The data of the actual number of WCH professionals and workload of each service type was obtained by a national institution-based sampling survey. We then estimated the time that a WCH professional spends at work (annually), the time norm of each service schedule and the required number of WCH professionals based on workload. We evaluated the situation of Chinese WCH professionals in 2010 by comparing the actual and required WCH professionals and by calculating the ratios of the actual-to-required number of staff.

RESULTS

There were 515,778 health professionals providing WCH services in the investigated 5,168 medical/health institutions in 2010. Workloads of most WCH services in east areas were larger than that in the central and the west. For women's health, the numbers of required WCH professionals were 48510, 43992, 40571 and 133073 for the east, the central, the west areas and the whole nation respectively. For children's health professionals, the corresponding numbers were 56241, 36818, 40618 and 133677 for the east, the central, the west and the whole nation.

CONCLUSIONS

The WCH professionals in China were sufficient for workload in 2010, there were still lots of potential capacities to provide better services, especially for women. Strategies should be taken to improve the quality of WCH professionals or their working motivation.

Job satisfaction of Malaysian registered nurses: a qualitative study

BACKGROUND

Job satisfaction is an important factor in health care settings. Strong empirical evidence supports a causal relationship between job satisfaction, patient safety and quality of care. However, there have not been any studies exploring the job satisfaction of Malaysian nurses.

AIM

The main purpose of this qualitative descriptive study was to explore the factors related to feelings of job satisfaction as well as job dissatisfaction experienced by registered nurses in Malaysia.

METHOD

A convenient sample of 46 Malaysian nurses recruited from a large hospital (number of beds = 895) participated in the study. A total of seven focus group discussions were conducted with nurses from surgical, medical and critical care wards. A semi-structured interview guide was used to facilitate the interviews, which were audio-recorded, transcribed verbatim and checked. The transcripts were used as data and were analysed using a thematic approach.

FINDING

The study identified three main themes that influenced job satisfaction: (1) nurses' personal values and beliefs; (2) work environment factors and (3) motivation factors. Concerning the nurses' personal values and beliefs, the ability to help people made the nurses felt honoured and happy, which indirectly contributed to job satisfaction. For work environment factors, team cohesion, benefit and reward, working conditions play an important role in the nurses' job satisfaction. Motivation factors, namely, professional development and clinical autonomy contributed to job satisfaction.

CONCLUSION

It is important for nurse leaders to provide more rewards, comfortable work environments and to understand issues that affect nurses' job satisfaction.

RELEVANCE TO CLINICAL PRACTICE

Our findings highlight the importance of factors that can improve nurses' job satisfaction. The study provides basic information for hospital administrators in planning effective and efficient policies to improve nursing job satisfaction in order to increase the quality of patient care and decrease nursing turnover.

Factors influencing registered nurses perception of their overall job satisfaction: a qualitative study

AIM

The purpose of this qualitative descriptive study was to explore factors related to critical care and medical-surgical nurses' job satisfaction as well as dissatisfaction in Iran.

BACKGROUND

Job satisfaction is an important factor in healthcare settings. Strong empirical evidence supports a causal relationship between job satisfaction, patient safety and quality of care.

METHOD

A convenient sample of 85 nurses from surgical, medical and critical care wards of a large hospital was recruited. Ten focus group discussions using a semi-structured interview guide were conducted. Interviews were audio-recorded, transcribed verbatim and analysed using a thematic approach.

FINDINGS

The study identified three main themes that influenced nurses' job satisfaction and dissatisfaction: (1) spiritual feeling, (2) work environment factors, and (3) motivation. Helping and involvement in patient care contributed to the spiritual feeling reported to influence nurses' job satisfaction. For work environment factors, team cohesion, benefit and rewards, working conditions, lack of medical resources, unclear nurses' responsibilities, patient and doctor perceptions, poor leadership skills and discrimination at work played an important role in nurses' job dissatisfaction. For motivation factors, task requirement, professional development and lack of clinical autonomy contributed to nurses' job satisfaction.

CONCLUSION AND IMPLICATIONS FOR NURSING AND HEALTH POLICY

Nurse managers should ensure a flexible practice environment with adequate staffing and resources with opportunities for nurses to participate in hospital's policies and governance. Policy makers should consider nurses' professional development needs, and implement initiatives to improve nurses' rewards and other benefits as they influence job satisfaction.

Senior nurse role expectations of graduate registered and enrolled nurses on commencement to practice

Objective This paper reports on a project to examine the expectations of senior nurses regarding graduate roles of registered and enrolled nurses educated in Victoria, Australia. Methods Participants completed an online survey to indicate whether predetermined competencies were in the roles of graduate enrolled or registered nurses or not in the role of either nurse. Chi-squared analysis was used to identify differences between participant groups. Results Participants expressed variations in role expectations for the different level of graduate nurse. Although basic nursing care was undertaken by both graduate enrolled and registered nurses, no specific role was identified for enrolled nurses. Differences were found in the opinions of senior nurses over the roles of graduate nurses, demonstrating considerable variation in expectations. Management, education and research roles were not identified as the role of either nurse on graduation. Differences were found in the expectations of the different senior nurse groups regarding the roles of the enrolled nurse, particularly in the new skills taught in the enrolled nurse diploma program. Conclusions Confusion exists regarding the roles of both types of nurse on graduation. Further research across Australia is required to clarify the roles of the different level of nurse in different practice contexts. What is known about the topic? Australia, like many other countries, prepares two levels of nurse for entry to practice: the degree-prepared registered nurse and the diploma-prepared enrolled nurse. Role confusion and ambiguity have been reported in the literature by many countries, including Australia, that employ two levels of nurse. What does this paper add? Great variation exists between expectations of senior nursing staff as to the role of both levels of graduate nurse. Role confusion and ambiguity exists for nurses in Australia. Role confusion and ambiguity around the scope of practice for enrolled nurses is seen as both limiting their practice and encouraging them to work at levels for which they have not been prepared. Graduate registered nurses were seen as more prepared for required graduate attributes than enrolled nurses. Care of acute, complex or deteriorating patients remains the role of registered nurses. What are the implications for practitioners? Practising nurses need to be educated as to the skills and knowledge that diploma enrolled nurses are graduating with in order to enable them to use their full range of abilities. To provide safe, quality care, registered nurses must fully understand the roles and abilities of the enrolled nurses to whom they delegate care. Organisational health policies and procedures need to be reviewed to accommodate the increased skills and knowledge of diploma-prepared enrolled nurses and enable best utilisation of their skills. Practising nurses need to be aware that enrolled nurses are not educationally prepared to care for complex or deteriorating patients. Although they are able to undertake basic nursing care, the role of caring for complex, highly acute and deteriorating patients remains in the domain of registered nurses. The increasing acuity of patients admitted to health services requires a higher skill mix of registered nurses to safely care for them.

Nurses' perceived barriers to and facilitators of research utilization in mainland china: a cross-sectional survey

Despite the drive towards evidence-based practice, the extent to which research evidence is being implemented in nursing practice is unclear, particularly in developing countries. This study was to assess the levels of perceived barriers to and facilitators of research utilization in practice among Chinese nurses and inter-relationships between these barriers and facilitators and their socio-demographic characteristics. A cross-sectional, descriptive survey was conducted in 2011 with 743 registered nurses randomly selected from four general hospitals in China. They completed the Barriers to Research Utilization and Facilitators of Research Utilization scales. Correlation tests were used to test the relationships between the nurses’ perceived barriers and facilitators, their demographic characteristics and research training and involvement. The Chinese nurses’ level of perceived barriers was moderate on average and lower than that in previous research. Among the 10 top-ranked items, six were from the subscale ‘Organizational Characteristics’. Their perceived barriers were correlated positively with age and post-registration experience and negatively with research training undertaken. Junior diplomatic nurses reported a significantly higher degree of barriers than those senior ones with postgraduate education. Higher and more diverse barriers to research utilization in practice are perceived by Chinese nurses than those in Western countries and they are associated with a few socio-demographic factors. Future research on these barriers/facilitators and their relationships with occupational and socio-cultural factors in Chinese and other Asian nurses is recommended.

Job satisfaction among hospital nurses revisited: a systematic review

BACKGROUND

The current nursing shortage and high turnover is of great concern in many countries because of its impact upon the efficiency and effectiveness of any healthcare delivery system. Recruitment and retention of nurses are persistent problems associated with job satisfaction.

OBJECTIVE

To update review paper published in 2005.

DESIGN

This paper analyses 100 papers relating to job satisfaction among hospital nurses derived from systematic searches of seven databases covering English and Chinese language publications 1966-2011 (updating the original paper with 46 additional studies published 2004-2011).

FINDINGS

Despite varying levels of job satisfaction across studies, sources and effects of job satisfaction were similar. Hospital nurse job satisfaction is closely related to working conditions and the organizational environment, job stress, role conflict and ambiguity, role perception and role content, organizational and professional commitment.

CONCLUSIONS

More research is required to understand the relative importance of the many identified factors relating to job satisfaction of hospital nurses. It is argued that the absence of a robust causal model reflecting moderators or moderator is undermining the development of interventions to improve nurse retention.

Provider perceptions of the social work environment and the state of pediatric care in a downsized urban public academic medical center

The author's purpose through this study was to document and analyze health provider perceptions of their social work environment and the state of pediatric care at Los Angeles County King/Drew Hospital and Medical Center in 2000, after the restructuring and downsizing of the hospital and its community clinics. The research results showed nurses and physicians reporting that both the quality of pediatric care and the provider social work environment were poor. Negative factors in the social work environment included: low employee morale, poorly staffed clinical teams, lack of professional autonomy, perceptions of low quality of care for pediatric patients, and interpersonal issues of poor communication and collaboration among providers. Providers also perceived a non-supportive work environment, sense of powerlessness, poor quality of work, lack of goal clarity from leadership, lack of fairness in leadership behavior, and an organizational leadership that is abandoning its core mission and values, thereby making it difficult for providers to carry out their professional functions. The author's findings in this study suggest a relationship between intra-role conflict, social employment environment and quality of care at King/Drew Medical Center in 2000. Lessons for practice are presented.

Knowledge, attitudes, perceived vulnerability of Chinese nurses and their preferences for caring for HIV-positive individuals: a cross-sectional survey

AIMS

The study was to assess HIV/AIDS knowledge, attitudes and perceived vulnerability with potential factors.

BACKGROUND

HIV/AIDS is a public health catastrophe in China. Nurses are expected to care for nurture, comfort and advocate for all patients regardless of their condition. However, in the area of HIV/AIDS, nurses suffer as a result of expectations put on them by their professional roles.

DESIGN

This was a descriptive, cross-sectional design that used a survey approach.

METHOD

Data were collected from Summer 2003-Winter 2004.

RESULTS

Nurses reported significant perceived severity of risk from occupational exposure. Many nurses were frequently exposed to being stuck by needles (86%) and being splashed by body fluids and more than half of them (59.7%) were concerned about contracting HIV/AIDS. Nurses who had experience of finger pricks worried about potentially contacting HIV and being unaware of it (odds ratio= 0.444, p = 0.004). Nurses demonstrated a lack of knowledge and training in infectious diseases which may be a result of the fact that the study location is not considered a 'concentrated area' for infectious disease transmission; therefore, the need for the infectious diseases training has not been considered urgent.

CONCLUSIONS

A well-designed educational programme on occupational hazards and risk behaviour should be implemented to educate nurses in suburban cities and the general public. Hospital administrators should implement on-site continuing education on HIV/AIDS throughout China. Armed with better knowledge of both transmission routes and precautions, nurses can protect themselves while providing care to patients.

RELEVANCE TO CLINICAL PRACTICE

Nurses in China urgently need psychosocial and physical supports from families, friends, communities and their working environments while combating HIV epidemic. With good support system, nurses will better educate patients and their family members on how to prevent transmission not only of HIV/AIDS but of a wide range of other infectious diseases as well.

A literature review of conflict communication causes, costs, benefits and interventions in nursing

AIM

This paper reviews the literature on conflict communication in nursing in order to prioritize research, theory and interventions that will support nurse managers and staff nurses.

BACKGROUND

Conflict is pervasive in nursing and has many costs, including burnout, higher absenteeism and higher turnover. Increased and more effective use of conflict management seems important in sustaining and developing the field.

METHODS

The literature study focused on the intersection of nursing, communication and conflict. The review primarily drew from the nursing and communication disciplines.

RESULTS

While much is known about the sources and costs of conflict in nursing, more can be done to research the benefits of conflict and intervene effectively.

CONCLUSIONS

Conflict is a routine feature of nursing. Nonetheless, sources can be managed, costs decreased and benefits increased with indirect and direct interventions.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers can support themselves and others in working through conflict by normalizing conflict, employing proven proactive and reactive interventions and by helping to build integrated conflict management systems.

A review of research and strategies for burnout among Chinese nurses

Although the concept of burnout has been a significant nursing issue worldwide over the past 30 years, in China the relevant research about nursing burnout only started in the 1990s. In this time, nursing burnout has become increasingly prevalent. This article examines the research carried out both in China and internationally, in order to investigate the causes of stress that lead to burnout among nurses. With the key stressors identified, the article sets out a proposal for a programme to alleviate the stress of hospital nurses and help them to engage with their jobs.

Optimizing HIV care by expanding the nursing role: patient and provider perspectives

AIM

This paper is a report of a study conducted to explore HIV healthcare services from the perspectives of both healthcare providers and patients in order to understand how to optimize HIV nursing care.

BACKGROUND

In China, healthcare providers usually first diagnose HIV in a general hospital. Then, HIV-positive individuals are transferred to a specialist hospital. Between healthcare providers and healthcare institutions, there are many gaps in the process from diagnosis to treatment.

METHODS

One focus group with six healthcare providers and 29 in-depth interviews with people living with HIV/AIDS were conducted during 2005.

FINDINGS

Patients who were diagnosed with HIV in a general hospital often did not discuss their condition with a healthcare provider before being sent to a specialist hospital. Furthermore, since the patients had already been diagnosed, healthcare providers in the specialist hospital did not deal adequately with the disclosure process and emotional reactions to the diagnosis. They reported feeling overwhelmed in their role in providing healthcare services. Nurses reported that they were responsible for many 'non-nursing' tasks and did not have the opportunity to give the type of care they were trained to offer.

CONCLUSION

Optimizing HIV care in China will involve establishing clear boundaries between general and specialist hospitals and a division of labour among healthcare providers that eases the burden of care and takes advantage of the full scope of practice that nurses are trained to provide.