Work Schedule Characteristics, Missed Nursing Care, and Organizational Commitment Among Hospital Nurses in Korea

Missed nursing care and its relationship with nurses' moral sensitivity: a descriptive-analytical study

BACKGROUND

Missed care rates are an indicator of healthcare quality. Missed nursing care can reduce patient safety and lead to adverse events. Moral sensitivity enables nurses to interpret and respond to clients' needs according to ethical principles. Despite the importance of moral sensitivity and its role in the quality of care, the relationship between nurses' moral sensitivity and missed nursing care has not been extensively studied. This raises the question of whether there is an association between nurses' moral sensitivity and missed care. This study was conducted to investigate the relationship between nurses' moral sensitivity and missed nursing care in the medical and surgical departments of Imam Khomeini Hospital in Urmia, Iran.

METHODS

A cross-sectional study was conducted in 2022, on 202 nurses working in the medical and surgical departments of Imam Khomeini Medical Education Center, Urmia, Iran. Stratified random sampling was used to select the participants. A questionnaire on demographic characteristics, Kalisch's missed care questionnaire, and Lutzen's moral sensitivity questionnaire were used to collect data. Data were analyzed using the Pearson correlation test and linear regression analysis.

RESULTS

Most participants (52.97%) showed moderate moral sensitivity. Nurses' mean moral sensitivity and total missed care scores were 149.07 ± 21.60 and 59.45 ± 4.87, respectively. Pearson correlation test showed no significant correlation between moral sensitivity scores and the total missed care scores (r = 0.041, p = 0.152). However, in the regression analysis, moral sensitivity (β = 0.213, p < 0.001), age (β = 0.131, p < 0.001), working in rotating shifts (β = 0.183, p < 0.001), monthly income (β = 0.079, p = 0.004), work experience (β = 0.030, p = 0.010), and monthly work hours (β = 0.247, p = 0.010) influenced missed care. Approximately, 0.98% of the variance in the missed care was explained by these variables.

CONCLUSION

Our nurses reported moderate levels of moral sensitivity and a concerning level of missed care. Missed care can have detrimental effects on patient safety. Therefore, nursing managers must address this issue promptly.

Nursing Professional Commitment as a Mediator of the Relationship Between Work Environment and Missed Nursing Care Among Nurses: A Cross-Sectional Analysis

Introduction

Nursing care plays a pivotal role in promoting patient well-being and optimizing health outcomes. The nursing profession is characterized by its commitment to delivering high-quality care to patients.

Objective

The purpose of the study was to explore the role of nursing professional commitment as a mediator between the work environment and missed nursing care.

Methods

A cross-sectional analysis study "STROBE guideline" used an online structured questionnaire to collect data. It was conducted on a sample of 813 nurses who worked at seven governmental hospitals in Egypt, in the hospital wards, operating rooms, intensive care unit (ICU) or outpatient clinics, during a 4-month period from April to August 2022. Researchers used Characteristics of nurses, Nursing Work Index-Revised, Nursing Professional Commitment Scale, and MISSCARE Questionnaire to collect the data. Structural equation modeling by AMOS was used for testing nursing professional commitment as a mediator between the work environment and missed nursing care. Nurses' professional commitment was used as a mediator between work environment and missing nursing care.

Results

The working environment has a direct impact of -0.175, an indirect impact of -0.139, and a total impact of -0.314. Furthermore, professional commitment has a direct impact of -0.421. Additionally, when the working environment increases by 1, professional commitment increases by 0.33. Similarly, when the working environment increases by 1, missed care decreases by 0.175. Moreover, when professional commitment, as a mediating factor, increases by 1, missed care decreases by 0.421.

Conclusion

In conclusion, the findings of this study highlight the significant role of professional commitment as an intermediary factor between the working environment and missed nursing care. According to these results, it is necessary to formulate and implement intervention strategies to improve nurses' professional commitment and working environment, which is the key to reducing their missed nursing care.

Work-schedule management in psychiatric hospitals and its associations with nurses' emotional exhaustion and intention to leave: A cross-sectional multicenter study

BACKGROUND

Managing nurses' work schedules in hospitals is challenging because employer needs, like shift changes at short notice and overtime, may conflict with nurses' desires for a predictable and stable schedule. Nurses should have a certain degree of control over their work schedules, and their supervisors should support their needs in scheduling. How perceived control over work schedules, perceived support from supervisors in scheduling, shift changes at short notice, and overtime affect nurses' emotional exhaustion and intentions to leave has not been studied.

OBJECTIVES

The aims are (1) to describe perceived control, perceived supervisor support, shift changes at short notice, and overtime among nurses in psychiatric hospitals; (2) to assess the variation of these four factors between units at psychiatric hospitals; and (3) to investigate the association between these factors with nurses' emotional exhaustion and intentions to leave.

DESIGN

Cross-sectional survey study.

SETTING(S)

Swiss psychiatric hospitals with 24-hour services.

PARTICIPANTS

Registered nurses (N = 994) from 114 adult-inpatient units.

METHODS

To describe perceived control, perceived supervisor support, shift changes at short notice, and overtime among nurses, we calculated frequencies, percentages, means, and standard deviations of their responses to the survey. To assess the variation between units, we computed intraclass correlations for the four factors. We constructed random-effects models accounting for the clustering of nurses in units for emotional exhaustion and intentions to leave separately.

RESULTS

Perception of work-schedule control was 3.32 (SD 1.39, range 0-5); perception of supervisor work-schedule support was 3.28 (SD 1.14, range 0-4). On average, 9 % of the nurses had to take over a shift at short notice at least three times per month, and 40 % worked at least 15 minute overtime on their most recent shift. Intraclass correlation for all four factors was higher than 0.05. Emotional exhaustion was significantly associated with supervisor support and overtime, and leaving intentions were significantly associated with perceived control, supervisor support and overtime.

CONCLUSION

Perceived control, perceived supervisor support, shift changes at short notice, and overtime are promising factors for interventions to prevent nurses' emotional exhaustion and allay their intentions to leave. Unit managers should provide nurses with increased predictability and influence on their work schedules. This could reduce early career endings and early retirement and counteract nurse shortages.

Clinical nurses' patient safety competency, systems thinking and missed nursing care: A cross-sectional survey

AIM

The aim of this study was to examine the relationships among patient safety competency, systems thinking and missed nursing care.

BACKGROUND

Patient safety competency and systems thinking are important nurse attributes that promote patient safety. Missed nursing care is known to negatively impact patient safety. However, how nurses' patient safety competency and systems thinking relate to missed nursing care is unknown.

METHODS

A cross-sectional survey design was used to collect data from nurses practicing in two general hospitals in South Korea. Data were collected between 3 March and 17 April 2020. Questionnaires were distributed to nurses providing direct care in general and specialty units. Patient safety competency, systems thinking and missed nursing care were measured using reliable and valid instruments. A total of 432 complete sets of data were used in final analysis.

RESULTS

Higher patient safety competency of nurses was associated with lower missed nursing care. Systems thinking partially mediated the relationship between knowledge of patient safety competency and missed nursing care, and attitudes of patient safety competency and missed nursing care.

CONCLUSIONS

The knowledge, skills and attitudes sub-scales of patient safety competency showed somewhat different effects in the relationship between missed nursing care and systems thinking, suggesting that each attribute may tap into a separate aspect of patient safety.

Artificial intelligence-based intelligent surveillance for reducing nurses' working hours in nurse-patient interaction: A two-wave study

AIM

To explore the feasibility of applying artificial intelligence in nurse-patient interaction to assist nurses in grasping patient status and reducing their working hours.

BACKGROUND

Artificial intelligence has been reshaping the health care industry and has immense potential in nursing care, but there is still a lack of suitable artificial intelligence methods to improve the efficiency of the nurse-patient interaction that takes much time of nurses.

METHODS

An artificial intelligence-based intelligent surveillance system was developed to reduce nurses' working hours in nurse-patient interaction, and a two-wave follow-up design was adopted in this study. The data were collected in a nursing home in Guangzhou, China. The first and second waves of data were recorded in the same format on the same patients by the same nurses. The only difference is the deployment of artificial intelligence technology between the two waves of data.

RESULTS

Artificial intelligence-based intelligent surveillance can provide statistical health data for nurses to grasp the patients' status more intuitively, reducing the average nurse-patient interaction time per patient from 18 to 10 min. In addition, artificial intelligence's real-time response to the abnormal health status of patients not only avoids more serious secondary injuries for patients but also prevents nurses from consuming energy in detecting emergencies.

CONCLUSION

The application of artificial intelligence has great potential to reduce nurses' working hours in nurse-patient interaction. There are still many limitations in artificial intelligence technology at this stage, and it is not feasible to completely rely on artificial intelligence. However, as a tool to assist decision-making, it can still have beneficial impacts on nursing management.

IMPLICATIONS FOR NURSING MANAGEMENT

Artificial intelligence has great potential in daily nurse-patient interaction, and nursing facility managers and nurses need to be more open to this new technology.

Determinants of missed nursing care in Jordanian hospitals during COVID-19 pandemic

AIM

The aim of the study was to examine the effect of perceived organizational support, accountability and nurses' characteristics on missed nursing care under the impact of COVID-19.

DESIGN

A cross-sectional design was used to describe and predict nurses' characteristics.

METHODS

A sample of 536 Registered Nurses participated in the study from eight hospitals in different health sectors in Jordan (three public hospitals, three private hospitals and two teaching hospitals).

RESULTS

Communication problems had the highest impact on missed nursing care, compared with labour resources and material resources reasons. Higher patient: nurse ratio aggravated by COVID-19 pandemic, years of experience, satisfaction with the income, perception of accountability and organizational support were among the factors associated with the levels of missed nursing care.

Structural and psychological empowerment and organizational commitment among staff nurses in Jordan

AIM

The purpose of this study was to examine the relationships between structural empowerment, psychological empowerment, and organizational commitment in Jordanian staff nurses.

BACKGROUND

Empowering nurses is one of the most effective strategies for increasing efficiency. Therefore, studying the contribution of structural and psychological empowerment to organizational commitment will provide a base for future interventions to improve nurses' working environment.

MATERIALS AND METHODS

This cross-sectional study used snowball sampling to recruit staff nurses working in Jordanian public and private hospitals. The sample consisted of 180 nurses. Data were collected using three valid and reliable self-reporting questionnaires that were distributed in electronic format.

RESULTS

Nurses reported a moderate level of both structural and psychological empowerment, and a high level of organizational commitment. Significant positive relationships were found between structural empowerment and psychological empowerment and organizational commitment (r = .62, p < .001) and (r = .57, p < .001) respectively.

CONCLUSION

Staff nurses reported moderate levels of both structural and psychological empowerment, and have a high level of organizational commitment. Positive relationships between structural empowerment, psychological empowerment, and organizational commitment were found among Jordanian staff nurses.

An evaluation of instruments measuring behavioural aspects of the nurse-patient relationship

The Fundamentals of Care Framework is an evidence-based, theory-informed framework that conceptualises high-quality fundamental care. The Framework places the nurse-patient relationship at the centre of care provision and outlines the nurse behaviours required for relationship development. Numerous instruments exist to measure behavioural aspects of the nurse-patient relationship; however, the literature offers little guidance on which instruments are psychometrically sound and best measure the core relationship elements of the Fundamentals of Care Framework. This study evaluated the quality of nurse-patient relationship instruments by (1) assessing their content development and measurement properties (e.g. dimensionality, targeting, reliability, validity) and (2) mapping instrument content to the Framework's core relationship elements: trust, focus, anticipate, know, and evaluate. Twenty-seven instruments were evaluated. Findings demonstrated that patients and nurses were rarely involved in item development. Most instruments exhibited poor measurement properties, with only one instrument having complete information on all quality indicators. Instrument content focused primarily on nurses getting to know patients and earning their trust, with only 54, 18, and 1 item(s), respectively, measuring 'focus', 'anticipate' and 'evaluate'. Hence, there does not appear to be a robust instrument measuring behavioural aspects of nurse-patient relationships, nor one capturing the relationship elements of the Fundamentals of Care Framework.

Model of Organizational Commitment Applied to Health Management Systems

In this paper, we try to build on the problems surrounding the management of human resources in health care organizations worldwide. After the analysis of the reviewed literature, we detected that the scientific community considers several recurring themes that need attention: stress, burnout, and turnover intention. Based on this, we developed a model of organizational commitment that aims to achieve performance and health quality, its main result the establishment of the appropriate management policies in order to avoid the abandonment of the organization through the search for commitment and job satisfaction. Amongst our main conclusions, we highlight the need to implement a human resources model for hospital administrators based on the relationships with "patients" not "clients" through the maintenance of a positive and strong atmosphere of staff participation. It is important to develop innovative practices related to clear job design that eliminate reasons for ambiguity and stress in executing the tasks of the healthcare system. Finally, we urge training programs in transformational leadership to promote the well-being and organizational commitment of employees.

Developing and validating the transition status scale for newly graduated nurses in China

AIM

The present study aimed to develop and examine the psychometric properties of the Transition Status Scale for Newly Graduated Nurses.

METHODS

Three phases were conducted: Phase I involved a qualitative research to explore and establish the potential items pool; Phase II reduced the items using the item analysis with a sample of 73 nurses. Phase III evaluated the psychometric properties of the final scale. Data from 814 valid questionnaires were analysed using exploratory factor analysis and confirmatory factor analysis.

RESULTS

Five factors, including 'Interpersonal integration', 'Profession-related positive emotion', 'Competence for nursing work', and 'Active coping strategies', 'Balance between work and life', accounted for 68.87% of total variance. Cronbach's α was 0.891. Confirmatory factor analysis indicated acceptable model fitness.

CONCLUSIONS

The Transition Status Scale for Newly Graduated Nurses has good psychometric properties. It can be used to measure the transition status conveniently and effectively.

IMPLICATIONS FOR NURSING MANAGEMENT

The assessment result with the Transition Status Scale for Newly Graduated Nurses can provide information about the transition status of new nurses, thereby providing reference to guide the specific nursing interventions to smooth the transition process. It can also work as an alternative instrument to compare the effectiveness of different transition programs.