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Alharbi H, Alharbi K, Bahari G, Alshamlani Y, Tumala RB. Psychological distress, work environment quality, and motivation levels among nurses working in Saudi Arabia. PeerJ 2024; 12:e18133. [PMID: 39346047 PMCID: PMC11430203 DOI: 10.7717/peerj.18133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 08/29/2024] [Indexed: 10/01/2024] Open
Abstract
Background A favorable clinical environment and nurse motivation are both essential for achieving high-quality patient outcomes and organizational performance in healthcare systems, which can be highly distressing for nurses. The purpose of this study was thus to determine the associations among and influences of psychological distress, work environment quality, and motivation on one another. Methods This was a cross-sectional, descriptive-correlational study conducted with a total sample of 204 nurses in two public tertiary hospitals. We used an online survey to collect nurses' responses, which comprised the Kessler Psychological Distress Scale-6, Brief Nurses' Practice Environment Scale, and Multidimensional Work Motivation Scale. We ran the necessary statistical analyses in SPSS version 28. Results We found that nurses' psychological distress, work environment quality, and motivation were moderate. A significant, positive, and moderate relationship existed between psychological distress and work environment quality, while nurses' educational level was statistically different with their motivation level. In the regression, only the nationality, current position, and work environment variables significantly influenced psychological distress. The hospital type also significantly influenced work environment quality. No variable was found to influence nurses' motivation level, though. Conclusions We concluded that nurses' work environment quality and motivation are interconnected with the psychological stress they experience at work. Monitoring nurses' work environment quality, motivation levels, and psychological distress is thus vital to ensure better patient care.
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Affiliation(s)
- Hanan Alharbi
- Maternity and Child Nursing Department, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Kholoud Alharbi
- Nursing Administration and Education Department, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Ghareeb Bahari
- Nursing Administration and Education Department, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Yousef Alshamlani
- Nursing Affairs Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Regie Buenafe Tumala
- Medical Surgical Department, College of Nursing, King Saud University, Riyadh, Saudi Arabia
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Tawiah PA, Appiah-Brempong E, Okyere P, Adu-Fosu G, Ashinyo ME. Prevalence, risk factors and psychological consequences of workplace violence among health workers in the Greater Accra region, Ghana: a cross-sectional study. BMC Public Health 2024; 24:563. [PMID: 38388881 PMCID: PMC10882733 DOI: 10.1186/s12889-024-17962-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Globally, close to one-third of all workplace violence (WV) occurs in the health sector. Exposure to WV among healthcare professionals in Ghana has been widely speculated, but there is limited evidence on the problem. This study therefore investigated WV, its risk factors, and the psychological consequences experienced by health workers in Ghana. METHODS An analytic cross-sectional study was conducted in the Greater Accra region from January 30 to May 31, 2023, involving selected health facilities. The participants for the study were selected using a simple random sampling technique based on probability proportional-to-size. The data analyses were performed using STATA 15 software. Logistic regression analyses were employed to identify the factors associated with WV, considering a significance level of p-value < 0.05. RESULTS The study was conducted among 607 healthcare providers and support personnel across 10 public and private hospitals. The lifetime career, and one-year exposure to any form of WV was 414 (68.2%) [95% CI: (64.3-71.9%)] and 363 (59.8%) [95% CI: (55.8-63.7%)], respectively. Compared to other forms of WV, the majority of healthcare workers, 324 (53.4%) experienced verbal abuse within the past year, and a greater proportion, 85 (26.2%) became 'super alert' or vigilant and watchful following incidents of verbal abuse. Factors significantly linked to experiencing any form of WV in the previous 12 months were identified as follows: older age [AOR = 1.11 (1.06, 1.17)], working experience [AOR = 0.91 (0.86, 0.96)], having on-call responsibilities [AOR = 1.75 (1.17, 2.61)], and feeling adequately secure within health facility [AOR = 0.45 (0.26, 0.76)]. CONCLUSION There was high occurrence of WV, and verbal abuse was the most experienced form of WV. Age, work experience, on-call duties, and security within workplace were associated with exposure to WV. Facility-based interventions are urgently needed to curb the incidence of WV, especially verbal abuse.
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Affiliation(s)
- Philip Apraku Tawiah
- Department of Occupational and Environmental Health & Safety, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
- Department of Pharmacognosy and Herbal Medicine, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana.
| | - Emmanuel Appiah-Brempong
- Department of Health Promotion & Disability Studies, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Paul Okyere
- Department of Health Promotion & Disability Studies, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Geoffrey Adu-Fosu
- Physiotherapy Unit, Diagnostic and Rehabilitation Directorate, Ho Teaching Hospital, Ho, Ghana
| | - Mary Eyram Ashinyo
- Department of Quality Assurance- Institutional Care Division, Ghana Health Service Headquarters, Accra, Ghana
- Department of Maternal and Child Health, Gilling's School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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Alenazy FS, Dettrick Z, Keogh S. The relationship between practice environment, job satisfaction and intention to leave in critical care nurses. Nurs Crit Care 2023; 28:167-176. [PMID: 34882918 DOI: 10.1111/nicc.12737] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Recent studies in the Kingdom of Saudi Arabia (KSA) have shown that the increasing nursing turnover in the health care industry has become a great source of concern. The overdependence on the supply of expatriate nurses (74%) and coronavirus disease 2019 (COVID-19) travel restrictions have exacerbated this staffing issue. AIMS To examine the relationship between perception of nursing practice environment (NPE), job satisfaction and intention to leave (ITL) among critical care nurses working in the state of Ha'il in KSA. DESIGN Cross-sectional correlational (observational) design. METHODS Data were collected via electronic online survey distributed to registered critical care nurses working in King Khalid Hospital (KKH), Ha'il, KSA, between July and August 2020. Participant demographics and key variables data related to NPE, job satisfaction and ITL respectively were collected from the participants using existing and validated questionnaires. Descriptive statistics and correlational analysis and multivariable analyses were conducted. RESULTS A response rate of 98% was achieved (152/160) for the study. Findings showed that the NPE was largely favourable (M = 2.89, SD = 0.44); however, nurse participation in hospital affairs (M = 2.83, SD = 0.47) and staffing and resource adequacy (M = 2.88, SD = 0.47) scored lowest. NPE was found to be significantly correlated with job satisfaction (rs = .287, P < .01). A significant negative relationship was found between NPE and ITL (rs = -0.277**, P < .01). However, job satisfaction was associated with ITL (rs = -.007, P = .930). CONCLUSIONS Maintaining a healthy work environment and job satisfaction levels in critical care units is key to improving, recruitment and retention of nursing staff. RELEVANCE TO CLINICAL PRACTICE Critical care and hospital leaders should implement programs that enhance the quality of the practice environment. This will improve nurse participation in unit and hospital affairs, job satisfaction and intention to stay.
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Affiliation(s)
- Faisal S Alenazy
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Nursing, ICU/Critical Care, University of Ha'il, Ha'il, Kingdom of Saudi Arabia
| | - Zoe Dettrick
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Samantha Keogh
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
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Vincelette C, Rochefort CM. Adapting the Healthy Work Environment Assessment Tool for French-Canadian Intensive Care Nurses. Am J Crit Care 2023; 32:62-70. [PMID: 36587001 DOI: 10.4037/ajcc2023298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Self-administered instruments are used to measure components of work environments that cannot be measured directly. The Healthy Work Environment Assessment Tool (HWEAT) of the American Association of Critical-Care Nurses is a promising instrument. However, it is available only in English and Japanese, precluding its use in other populations and cross-national comparisons. OBJECTIVES To describe the Canadian French translation and cross-cultural adaptation of the HWEAT (F-HWEAT) and to explore its factor structure and psychometric properties. METHODS Cross-cultural adaptation of the HWEAT and collection of evidence of validity via an electronic cross-sectional survey. RESULTS A total of 564 intensive care unit nurses participated in the validation study. Confirmatory factor analysis supported the presence of a single overarching factor measured by the F-HWEAT. The Cronbach α for the instrument was 0.89 (95% CI, 0.88-0.91). The mean and median interitem correlations were both 0.32, and item-partial total correlations ranged from 0.33 to 0.64. The overall F-HWEAT score indicated that nurses believed their work environment needed improvements. Moderate positive correlations were found between the overall F-HWEAT score and nurses' perceptions of care quality (r = 0.45 [95% CI, 0.38-0.51]) and safety (r = 0.48 [95% CI, 0.40-0.55]). CONCLUSION The results support the use of the F-HWEAT in French-speaking populations. Using the F-HWEAT will help elucidate areas needing improvement and expand global dialogues about healthy critical care work environments. With this information, nurse leaders and researchers can develop and implement modern strategies to improve the work conditions of intensive care unit nurses.
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Affiliation(s)
- Christian Vincelette
- Christian Vincelette is a PhD candidate, School of Nursing, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Quebec, Canada; Centre de Recherche, Hôpital Charles-Le Moyne, Longueuil, Quebec, Canada; and Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada
| | - Christian M Rochefort
- Christian M. Rochefort is an associate professor, School of Nursing, Faculty of Medicine and Health Sciences, Université de Sherbrooke and a researcher at Centre de Recherche Charles-Le Moyne-Saguenay-Lac-saint-Jean sur les innovations en santé (CR-CSIS), Longueuil, Quebec, Canada and CRCHUS
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Ageel M, Shbeer A. Assessment of the Critical Care Work Environment of Intensive Care Unit Nurses in Saudi Arabia. Risk Manag Healthc Policy 2022; 15:2413-2420. [PMID: 36582743 PMCID: PMC9793786 DOI: 10.2147/rmhp.s391698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Background Nurses play a major role in the delivery of complex and challenging critical care in intensive care units (ICUs). Assessment of work environment is essential indicators of hospital management and can be applied to workforce planning and identifying nursing profession needs. The American Association of Critical-Care Nurses (AACN) recognized six standards for a healthy work environment and developed the Healthy Work Environment Assessment Tool (HWEAT). The aim of this study was to assess the work environment of ICU nurses in Jazan, Saudi Arabia. Methods This cross-sectional study was conducted at public and private hospitals. Data were collected using a self-administered questionnaire that included the sociodemographic characteristics and the AACN HWEAT. Data were analyzed to obtain descriptive and inferential statistics. The Mann-Whitney U and Kruskal-Wallis tests were employed to compare demographic data, on the basis of the overall mean HWEAT score. Results The study participants were 238 ICU nurses, who were predominantly female (83%). The mean overall HWEAT score was 3.55±1.03, which is within the "good" range, and was higher for male nurses (3.66), nurses aged ≥41 years (3.76), and nurses with postgraduate education (4.04), work experiences of >10 years (3.63), and alternate work shifts (3.6). Nurses in private hospitals had significantly higher overall scores than nurses in public hospitals (3.83 vs 3.19, P<0.001). All HWEAT standards ("effective decision-making", "authentic leadership", "appropriate staffing", "true collaboration", "skilled communication", and "meaningful recognition") were rated as good (mean range, 3.43-3.63). Conclusion The study results could assist hospitals in prioritizing the adoption of AACN HWE standards. A target benchmark of "good" was established for both the overall score and each standard, which indicates a good work environment as perceived by ICU nurses. In Addition, interpersonal differences should be considered when developing improvement initiatives.
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Affiliation(s)
- Mohammed Ageel
- College of Medicine, Jazan University, Jazan, Saudi Arabia,Correspondence: Mohammed Ageel, College of Medicine, Jazan University, Jazan, Saudi Arabia, Tel +966505769570, Email
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The impact of nurse practice environment on patient outcomes and mediation effects of registered nurse outcomes in Middle Eastern acute care hospitals: A cross-sectional study. Appl Nurs Res 2022; 66:151605. [DOI: 10.1016/j.apnr.2022.151605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/21/2022] [Accepted: 06/21/2022] [Indexed: 11/18/2022]
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Vergara AC, Valencia DP, Gonzalez Gutierrez JS, López Laverde J. Entorno laboral saludable en Asia y América del Norte revisión de alcance. Rev Salud Publica (Bogota) 2022. [DOI: 10.15446/rsap.v24n2.97150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivos Realizar una revisión de alcance sobre entorno laboral saludable (ELS) en países de Asia y América del Norte.
Métodos Revisión de documentos de diversos diseños metodológicos resultantes de la matriz PRISMA obtenidos en bases de datos como Scopus, PubMed, Biblioteca Virtual de la Salud (BVS) y otros motores de búsqueda entre los años 2015 y 2020 empleando los descriptores Healthy, Workplace, Enviroment Work y conectores AND y OR.
Resultados Se obtuvo un total de 36 documentos finales. El 66,7% de los estudios encontrados fueron en países de América del Norte. El 44,4% de las publicaciones se realizaron en el año 2019 y 2020. Se halló que la base de datos que más arrojó publicaciones acerca de ELS fue Scopus y la revista que más publicó fue BVS; igualmente los temas más relevantes para alcanzar ELS fueron la promoción de la salud en el lugar de trabajo mediante la intervención de estrategias encaminadas a los estilos de vida saludables y el impacto de la productividad.
Conclusiones Las estrategias de ELS permiten que los programas de promoción de la salud sean implementados en las empresas con el fin de mejorar los estilos de vida y las condiciones laborales de los trabajadores, incentivando la actividad física, la alimentación balanceada, disminuyendo la ingesta de bebidas alcohólicas y el tabaquismo. Los ELS se relaciona con la mejora continua debido a que favorece el aumento de la productividad y por ende es importante que se puedan implementar en el contexto de la educación, negocios, comercio y desarrollo económico.
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Gassas RS, Ahmed ME. Development and psychometric evaluation of nurses' perception towards the gap between knowledge and practice. Nurs Open 2022; 9:1497-1505. [PMID: 34985205 PMCID: PMC8859036 DOI: 10.1002/nop2.1174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 10/18/2021] [Accepted: 12/15/2021] [Indexed: 11/05/2022] Open
Abstract
AIM The aim of the study was to develop a survey instrument and psychometrically evaluate nurses' perceptions of the gap between knowledge and practice. Although the nursing literature has widely documented a gap between knowledge and practice, no instrument has been developed to measure this gap. DESIGN Psychometric analysis was done on 513 nurses working in different positions at two large hospitals in Jeddah City. METHODS Cronbach's alpha was used to determine the internal consistency and reliability of the research instrument, and a panel of experts evaluated the validity of the tool's content. RESULT The content validity index computed from expert rankings was 0.89. Factor analysis yielded four major components: knowledge, practice, environment and learning. Cronbach's alpha indicated a high level of internal consistency and reliability for the component items. The newly developed scale will facilitate measuring nurses' perceptions of the knowledge-practice gap in clinical settings.
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Affiliation(s)
- Roaa Sabri Gassas
- King Abdulaziz Medical City, National Guard Health Affairs, Jeddah City, Saudi Arabia
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Leger K, Lajoie D, Wood LJ. Understanding Inpatient Surgical Nurses' Meaningful Recognition Preferences. J Nurs Adm 2021; 51:614-619. [PMID: 34817469 DOI: 10.1097/nna.0000000000001083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nurse leaders have a responsibility to nurture a work environment that prioritizes meaningful recognition. This quality improvement project explored the perceptions of meaningful recognition of inpatient pediatric surgical nurses. Meaningful recognition provides a chance to honor all voices, particularly those that have not been previously heard. To be heard is to be honored and to be recognized is to be valued.
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Affiliation(s)
- Kierrah Leger
- Author Affiliations: Nurse Manager, Solid Organ Transplant Unit (Dr Leger); Director of Nursing Research Surgical Programs, Nurse Scientist Surgical Programs, Nurse Scientist Emergency Services (Dr Lajoie); and Executive Vice President, Patient Care Operations & System Chief Nursing Officer, Sporing Carpenter Chair for Nursing (Dr Wood), Boston Children's Hospital, Boston, Massachusetts
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Kester KM. A multifaceted approach to tackling nurse turnover. Nurs Manag (Harrow) 2020; 51:22-28. [PMID: 32472856 DOI: 10.1097/01.numa.0000662652.32499.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Kelly M Kester
- Kelly M. Kester is the heart services clinical operations director at Duke University Hospital in Durham, N.C
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Han J, Kang H, Kwon GH. Impact of intelligent healthscape quality on nurse job outcomes and job satisfaction: A test of the moderating effect of innovativeness. J Nurs Manag 2019; 28:43-53. [DOI: 10.1111/jonm.12875] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 09/03/2019] [Accepted: 09/12/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Jieun Han
- Graduate School of Technology and Innovation Management Hanyang University Seoul Korea
| | - Hyo‐Jin Kang
- Department of Service Design Engineering Sungshin Women's University Seoul Korea
| | - Gyu Hyun Kwon
- Graduate School of Technology and Innovation Management Hanyang University Seoul Korea
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Albashayreh A, Al Sabei SD, Al‐Rawajfah OM, Al‐Awaisi H. Healthy work environments are critical for nurse job satisfaction: implications for Oman. Int Nurs Rev 2019; 66:389-395. [DOI: 10.1111/inr.12529] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
| | | | - Omar M. Al‐Rawajfah
- College of Nursing Sultan Qaboos University Muscat Oman
- Faculty of Nursing Al Al‐Bayt University Mafraq Jordan
| | - Huda Al‐Awaisi
- Directorate of Nursing Sultan Qaboos University Hospital Muscat Oman
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Al-Maaitah R, AbuAlRub RF, Al Blooshi S. Practice environment as perceived by nurses in acute care hospitals in Sharjah and North Emirates. Nurs Forum 2018; 53:213-222. [PMID: 29364526 DOI: 10.1111/nuf.12245] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM To explore nurses' perceptions of their practice environment in acute care hospitals in Sharjah and North Emirates in the United Arab Emirates (UAE). BACKGROUND The health of the environment in which registered nurses' work is critical to nursing outcomes. The interest to examine the practice environment extended to the Gulf area which has a complex healthcare system including the UAE. METHODS The study used an exploratory descriptive design with a qualitative part using two focus group interviews. The sample size was 450 nurses selected through a random sampling method. A self-administered questionnaire including the Practice Environment Scale of Nursing Work Index (PES-NWI) was used. In addition, semi-structured interviews for two focus groups were done. RESULTS The results showed that UAE practicing nurses reported favorable perceptions of most aspects of their practice environment. Unfavorable perceptions were only reported for Staffing and Resource Adequacy. The analysis of focus group discussions resulted in different emerged themes such as Lack of Recognition and Career Promotion, and Nurses' Workload due to Paper and Administrative Work. CONCLUSIONS The findings of this study suggest that strategic interventions are needed to secure adequate staff and resources and implement an effective system for evaluation of performance.
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Salar AR, Ahmadi F, Navipour H. Turbulent Atmosphere-Based Dominant Management Behavior of the Head Nurses in Clinical Wards: A Qualitative Study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e21754. [PMID: 27186386 PMCID: PMC4867159 DOI: 10.5812/ircmj.21754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 08/11/2014] [Accepted: 08/18/2014] [Indexed: 11/16/2022]
Abstract
Background: Nursing management is the most important aspect for providing high-quality nursing care. Therefore, skillful nursing managers, such as head nurses, are required to accomplish this goal. High-quality nursing care is one of the most important principles of health organizations to ensure society’s health. Objectives: The goal of the conventional content analysis is to explain the dominant experienced-based behavior of the head nurses in clinical wards. Materials and Methods: This study was conducted by applying a quality study approach with a common content analysis model (Granheim and Lundmen). The participants were 25 head nurses who were working in the wards of various hospitals in Zahedan City. They were selected via the purposeful sampling method. The data were collected thoroughly and continued until a saturation stage was reached. Results: The result of data analysis was the theme “turbulent atmosphere-based management,” which consists of five categories as follows: the work culture of the ward, job burnout, negligent evaluation, job conflict, and decision making with limited effects. Conclusions: The analysis of the findings of the present study through considering the defined categories demonstrated that, to modify and correct the turbulent atmosphere-based management, several important measures are required and need to be continually monitored.
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Affiliation(s)
- Ali Reza Salar
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran
| | - Fazlollah Ahmadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran
- Corresponding Author: Fazlollah Ahmadi, Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran. Tel: +98-82883590, Fax: +98-82883558, E-mail:
| | - Hassan Navipour
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran
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