The nurse work environment in Spanish nurses following an economic recession: From 2009 to 2014

Hospitals during economic crisis: a systematic review based on resilience system capacities framework

Background

Hospitals are the biggest users of the health system budgets. Policymakers are interested in improving hospital efficiency while maintaining their performance during the economic crisis. This study aims at analysing the hospitals’ policy solutions during the economic crisis using the resilience system capacities framework.

Method

This study is a systematic review. The search strategy was implemented on the Web of Science, PubMed, Embase, Scopus databases, and Econbiz search portal. Data were extracted and analysed through the comparative table of resilience system capacities framework and the World Health Organization (WHO) health system’s six building blocks (i.e., leadership and governance, service delivery, health workforce, health systems financing, health information systems, and medicines and equipment).

Findings

After the screening, 78 studies across 36 countries were reviewed. The economic crisis and adopted policies had a destructive effect on hospital contribution in achieving Universal Health Coverage (UHC). The short-term absorptive capacity policies were the most frequent policies against the economic crisis. Moreover, the least frequent and most effective policies were adaptive policies. Transformative policies mainly focused on moving from hospital-based to integrated and community-based services. The strength of primary care and community-based services, types and combination of hospital financing systems, hospital performance before the crisis, hospital managers’ competencies, and regional, specialties, and ownership differences between hospitals can affect the nature and success of adopted policies.

Conclusion

The focus of countries on short-term policies and undermining necessary contextual factors, prioritizing efficiency over quality, and ignoring the interrelation of policies compromised hospital contribution in UHC.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08316-4.

Novice nurses' transition to clinical setting in the COVID-19 pandemic: a phenomenological hermeneutic study

Background

: The COVID-19 pandemic both exposed and increased weaknesses in the healthcare system, so that novice nurses have become a more vulnerable group during this context.

Aim

: This study sought to illuminate experience of novice nurses in providing care during the COVID-19 pandemic.

Method

: It consists of a qualitative study conducted with data collected by means of semi-structured interviews, audio recorded, transcribed, anonymised, and analysed in the light of the phenomenological hermeneutic approach. Fourteen registered novice nurses from two health areas in northwest X, being twelve women and two men, who experienced the COVID-19 pandemic within their first five years of professional experience, were selected through a non-statistical snowball sampling.

Results

: After analysing the narratives, we identified four main themes: "Transitioning to a hostile, unknown and uncertain clinical setting from inexperience," "Invisible wounds because of being on the front line," and "Healing to return to the front line."

Discussion

: The uncertainty of an unknown illness and the lack of support during the COVID-19 pandemic has been affecting novice nurses, impacting their health conditions. At the same time, this context created opportunities for professional development. According to the interviewees, self-care and social support were elements to cope with exhaustion.

Conclusion

: Our study investigates the experiences of a group barely approached in the literature, highlighting the reality and difficulties of these nurses in transitioning to the clinical setting and providing insights to managerial leaders and educators.

Nurse admissions at a specialized mental health programme: A pre-Covid-19 retrospective review (2000-2019)

AIMS

Nursing is a stressful and emotionally demanding profession. To date, few mental health treatment interventions have been developed for them worldwide. This study aims to explore referral trends in nurses with mental disorders admitted to a pioneer specialized mental health programme in Europe from 2000 to 2019.

DESIGN

A retrospective observational study of 1297 medical e-records of nurses with mental health disorders admitted to the Galatea Care Programme in Barcelona was conducted.

METHODS

Three periods were analysed: 2000-2006, 2007-2012 and 2013-2019. Socio-demographic and clinical variables were compared. Diagnoses followed Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria.

RESULTS

Gender and age at referral did not change over time. Self-referrals grew from 85.1% in the first period to 95.3% in the last period; inpatient admissions decreased from 24.1% to 18.2%, although this was not significant; nurses were less frequently on sick leave on admission over time (59.1% vs. 45.7%); they were more likely to have a temporary contract in the second period (9.5% vs. 4.8% and 4%) and prevalence of main diagnosis changed with a considerable decrease in affective and substance use disorders after 2006 and a progressive increase in adjustment disorders during the whole period.

CONCLUSION

Free, voluntary, highly confidential programmes for nurses with mental disorders may enhance voluntary and earlier help seeking. These findings can be considered when implementing specialized interventions for them in other settings. WHAT PROBLEM DID THE STUDY ADDRESS?: Nursing is a stressful and emotionally demanding profession. To date, few specialized mental health services have been developed for them worldwide. This study aims to explore referral trends in nurses with mental disorders admitted to a pioneer programme in Europe, the Galatea Care Programme in Barcelona, from 2000 to 2019. WHAT WERE THE MAIN FINDINGS?: The number of referrals to the programme grew especially after the first 7-year period. Admissions were more likely to be voluntary during the last period. Prevalence of substance use disorders at admission dropped steadily while prevalence of adjustment disorders progressively increased over the two decades. Nurses were also less likely to be on sick leave at admission. WHERE AND ON WHOM WILL THE RESEARCH HAVE IMPACT?: Free, voluntary, highly confidential programmes for nurses with mental disorders may enhance voluntary and earlier help seeking. These findings can be considered when implementing specialized interventions for them in other settings.

Healthcare Management and Quality during the First COVID-19 Wave in a Sample of Spanish Healthcare Professionals

The aim of this study was to assess how the healthcare professionals in the Castellón Province (Spain) perceive healthcare quality and management during the first COVID-19 wave. A cross-sectional study was carried out. An online survey on healthcare quality and management during the first COVID-19 wave was sent to healthcare professionals. Almost half of the sample believed that healthcare quality worsened during the first COVID-19 wave (45.3%; n = 173). Heavier workload (m = 4.08 ± 1.011) and patients' complexity (m = 3.77 ± 1.086) were the factors that most negatively impacted healthcare quality. Health department 3, primary care center, and other doctors assessed human and material resources management as significantly worse (p < 0.05). Human and material resources management and the healthcare organization negatively affected healthcare quality during the first COVID-19 wave. Significant differences were observed according to departments, services, and professionals.

Nurses' ehealth literacy and associations with the nursing practice environment

AIM

To report on ehealth literacy levels in nurses and to explore its associations with the nursing practice environment.

BACKGROUND

Nurses increasingly use the Internet and associated technologies to seek health-relevant information and manage their health.

INTRODUCTION

High ehealth literacy is a predictor of better health outcomes in diverse populations but its levels and work-related determinants have not been adequately explored in direct-care nurses.

METHODS

The sample for this cross-sectional study consisted of 200 staff nurses and nursing assistants in Greece. Participants reported during February-March 2019 their sociodemographic and work-related characteristics on a self-administered questionnaire which included the "electronic Health Literacy Scale"-eHEALS, and the "Practice Environment Scale of the Nursing Work Index"-PES-NWI. Crude and adjusted logistic regressions were performed.

FINDINGS

In adjusted models, participants that scored higher on the "Collegial nurse-physician relationships" and "Nurse participation in hospital affairs" dimensions of the clinical environment had higher odds of reporting better ehealth literacy. The lowest item score in eHEALS was related to not being able to make health decisions using Internet information.

DISCUSSION

Nurses' ehealth literacy was positively associated with some dimensions of the hospital practice environment. Nurses reported higher ehealth literacy scores in comparison to other studies; however, they were not confident in distinguishing reliable health information from Internet sources. This is quite alarming because it can directly impair the ability of nurses to provide relevant and up-to-date evidence-based care.

CONCLUSION

This is the first study to report internationally on the positive associations of a good working environment with nurses' ehealth literacy levels.

IMPLICATIONS FOR NURSING AND NURSING POLICY

Nursing policy should address the ehealth literary of nurses and integrate it into continuing professional education initiatives. Special focus should be put on nurses' ambiguity in distinguishing which ehealth information is reliable and can guide nursing practice. This should be combined with efforts to improve the nursing clinical environment and increase nurses' participation in hospital decisions.

Newly graduated nurses' perceptions of work environment: A cross-sectional study in China

AIM

To assess the attitudes of newly graduated nurses in China toward their work environment and identify the factors affecting their perception.

BACKGROUND

Newly graduated nurses are the primary supply to cover the nursing shortage, but their stressful transition into clinical work has contributed to high turnover for decades. Although serving as a source of stress, the work environment can also be a source of support for new nurses.

METHODS

A total of 2361 new nurses at 31 tertiary hospitals in 20 provinces were surveyed from June to November 2018, using the Chinese version of the Practice Environment Scale-Nursing Work Index. Basic information and their perception about work environment were collected.

RESULTS

New nurses rated their work environment with an overall score of 84.67 (12.85). Multiple linear regression identified that education level, monthly income, hospital type and location, participation (or not) in standardized training programmes and having (or not) a mentor/preceptor were factors significantly associated with their perception of the work environment.

CONCLUSION

The perception of newly graduated nurses in China was mainly positive overall. Nursing managers may take full advantage of factors affecting the perception of work environment to support newly graduated nurses better, to help their retention and transition.

SUMMARY STATEMENT

What is already known about the topic? Newly graduated nurses experience transition shock at the beginning of their work. Supportive work environments can help successful transition. What this paper adds? Newly graduated nurses are not fully supported in their work environment. Staffing and resource inadequacy were the poorest environmental factors. Residency programmes had the most impact on the perceptions of newly graduated nurses about their work environment.

IMPLICATIONS FOR NURSING PRACTICE

These results can guide nursing managers to support the newly graduated nurses better in their transition process, thus helping retention of nursing human resource.

Is public healthcare healthy? The role of emotional exhaustion

Purpose

This study analyzes the mediating effect of emotional exhaustion between certain job demands (workload, role conflict, and influence at work) and employees' work attitudes (affective commitment and turnover intention) in public healthcare. Furthermore, it analyzes the moderating effect of possibilities for development and the degree of freedom at work between the above-mentioned job demands and emotional exhaustion.

Design/methodology/approach

A total of 512 healthcare professionals participated in the study. The data were analyzed using structural equation modeling and a hierarchical multiple regression analysis.

Findings

The results show that emotional exhaustion fully mediates the relationship between job demands (workload and role conflict) and work attitudes (affective commitment and turnover intention). Moreover, the possibilities for development and degree of freedom at work moderate the relationship between role conflict and emotional exhaustion.

Practical implications

Strategies should be designed to prevent employees from becoming emotionally exhausted and lead them to feel more motivated, which results in a more effective public healthcare service.

Originality/value

This study stresses the importance of analyzing the role of emotional exhaustion in the public healthcare context. It demonstrates the mediating role of this variable between several antecedents and consequences, and it analyzes whether other relevant variables can moderate the negative effects of emotional exhaustion.

Evidence-based practice nurses' competency: Spanish national survey and establishment of a scale of the EBP-COQ-Prof©

Aims

To discover the level of evidence‐based practice competency of Spanish nurses, to develop a scale of the EBP‐COQ‐Prof© and to analyse the influence of different variables on the level of competency.

Background

The evidence‐based practice competency has previously been assessed using a wide variety of instruments, although these have methodological limitations and lack associated scales that allow for the interpretation of the score obtained.

Method

Observational, cross‐sectional, national study. Using an online questionnaire, data were obtained between January and March 2020 from nurses working in the National Health System. An ANOVA was performed along with multiple regression analyses. The T‐score and percentiles were calculated to obtain the scale of the EBP‐COQ‐Prof©.

Results

2,942 nurses participated. The score for the evidence‐based practice competency was 130.29 (standard deviation 17.55). The multiple regression analysis showed a model comprised of 8 variables that explained 33% of the variance.

Conclusions

The Spanish nurses have a moderate level of evidence‐based practice competency. The scale classifies the subjects into 3 levels: low, moderate and high competency.

Implications for Nursing Management

The scale proposed for the EBP‐COQ‐Prof© could be utilized to facilitate the diagnosis of evidence‐based practice competency, and to monitor and plan individual and collective strategies to improve this competency.

Changes in nurse job outcomes after 4 years of a Best Practice Spotlight Organization® programme implementation in the Spanish National Health Context

AIM

To evaluate the changes produced after the application of the Best Practice Spotlight Organization® (BPSO^® ) Program on the attitude towards the evidence-based practice, the nurses' perception of the organisational climate and nurse outcomes in a health area of the Spanish National Health System.

BACKGROUND

There is limited research that associates strategies of evidence-based practice implementation with changes on the work environment and nurse outcomes.

METHODS

Cross-sectional study that compared data on the nurses' perception of the work environment. Five guidelines were implemented between 2012 and 2015 in a health area. Data were collected in 2012 and 2016/2017, using a questionnaire consisting of five previously validated tools. X² , t test, ANOVA and multivariate analysis were carried out.

RESULTS

A total of 451 nurses participated. Compared with the baseline evaluation in 2012, several outcomes changed significantly (p < .001), nurses were younger and were more satisfied with "salary", "annual leaves" and "sick leave". The rest of the nurse outcomes were not modified.

CONCLUSIONS

Nurses' perception of the work environment is favourable, although the application of the BPSO^® Program has not produced any major changes.

IMPLICATIONS FOR NURSING MANAGEMENT

Measures are suggested that are oriented towards the planning of staffing and the increase in the participation of the nursing staff in programmes of implementation of guidelines.

Impact of the implementation of best practice guidelines on nurse's evidence-based practice and on nurses' work environment: Research protocol

AIM

To determine the impact of the Best Practice Spotlight Organization® initiative on nurses' perception of their work environment and their attitudes to evidence-based practice.

DESIGN

Quasi-experimental, multicentre study. The intervention is the participation in Best Prectice Spotilight Organizations to implement Best Practice Guidelines.

METHODS

The study will include seven centres in the interventional group and 10 in the non-equivalent control group, all of them belonging to the Spanish national health system. The Practice Environment Scale of the Nursing Work Index, and the Health Sciences Evidence-Based Practice Questionnaire will be administered to a sample of 1,572 nurses at the beginning of the programme and at 1 year. This 3-year study started in April 2018 and will continue until December 2021. Statistical analyses will be carried out using the SPSS 25.0. This project was approved by the Drug Research Ethics Committee of the Parc de Salut Mar and registered in Clinical Trials.

DISCUSSION

The study findings will show the current state of nurses' perception of their work environment and attitudes to evidence-based practice, and possible changes in these parameters due to the programme.

IMPACT

The findings could provide a strong argument for health policymakers to scale up the Best Practice Spotlight Organization® initiative in the Spanish national health system.

Prevalence and Predictors of Burnout in Midwives: A Systematic Review and Meta-Analysis

The prevalence of burnout in midwives has been briefly studied. Given the negative effects of burnout syndrome in the physical and mental health, and also related to the quality of care provided, rates of absenteeism and sick leave; identifying related factors for the syndrome are needed. The aim was to determine the prevalence, levels, and factors related to the burnout syndrome, measured with the Copenhagen Burnout Inventory in midwives. A systematic review and meta-analysis were selected from CINAHL, LILACS, ProQuest, PsycINFO, PubMed, SciELO, and Scopus databases, with the search equation “burnout AND (midwife OR midwives OR nurses midwives)”. Fourteen articles were found with a total of 8959 midwives. Most of the studies showed moderate levels of personal burnout. The prevalence obtained was 50% (95% CI = 38–63) for personal burnout; 40% (95% CI = 32–49) for work-related burnout; and 10% (95% CI = 7–13) for client-related burnout. Midwives’ age, less experience, and living alone constitute the main related factors, as well as, the scarcity of resources, work environment, and the care model used. Most midwives present personal and work-related burnout, which indicates a high risk of developing burnout. Personal factors and working conditions should be taken into account when assessing burnout risk profiles of midwives.