Who do you ask? predicting injury rates from survey responses

BACKGROUND

Few studies have addressed whether using manager or worker perceptions of safety policies and practices alone predict reported injury rates less accurately than using both.

OBJECTIVE

This study provides an example and describes a method that can be used to address this issue with survey instruments designed to measure safety climate, policies, or practices.

METHODS

Using multilevel logistic regression, we estimated the relationship between worker and manager perceptions of a given exposure and the odds of worker injury during the post-survey year for three safety scales. We tested whether surveying both workers and managers provides additional predictive value compared with surveying just one group.

RESULTS

Injury in the year following the survey was significantly associated with worker scores on two of the three scales. Manager responses were not significantly associated with injury and did not significantly improve injury rate prediction when added to a model with only worker survey responses.

CONCLUSIONS

The capacity of manager-only or worker-only perceptions of safety policies and practices to predict worker injuries should be established before choosing to survey just one or the other. The approach and findings in this paper can be applied to other survey instruments and in other settings to help make this choice.

Development and validation of a quality of healthy work environment instrument for shift nurses

BACKGROUND

As the importance of a healthy work environment for nurses' good practice and patient safety has been recognized, there is a need to assess nurses' perceptions of the quality of a healthy work environment.

METHODS

A conceptual framework and construct components were extracted through a literature review and in-depth interviews with shift nurses. The initial items of the instrument were developed according to the conceptual attributes, and the items were selected through content validity by ten experts. Two hundred and forty-seven shift nurses participated in this study through face-to-face surveys to test the reliability and validity of the instrument. The evaluation was used for item and confirmatory factor analyses to assess the criterion-related validity and internal consistency of the instrument. Test-retest reliability was analyzed using data from thirty-two nurses.

RESULTS

The final instrument consisted of 23 items with five components identified through confirmatory factor analysis. Criterion-related validity was established using the K-PES-NWI (r = .54). Cronbach's alpha for the total items was 0.85, and test-retest reliability was 0.73.

CONCLUSION

The quality of the healthy work environment instrument developed in this study was considered reliable and valid. The instrument developed in this study can be used to measure the quality of a healthy work environment as perceived by shift nurses and to identify preventive measures needed to improve the quality of the work environment.

The Link between Patients' Aggressive Communication and Nurses' Emotional Health Outcomes

The aggressive conduct of patients is a perennial problem that nurses face in health care. Studies have shown that such aggressiveness can be detrimental to the work and emotional wellbeing of nurses. Yet, the literature has had inconsistent findings; in some cases nurses are negatively affected by aggression, while in other cases nurses are not affected. Street and colleagues contended that such inconsistencies in research exist because social mechanisms embedded in communication are often not taken into consideration. This study adopts Street et al.'s pathways model and links patients' aggressive communication to nurses' emotional health outcomes, via the proximal outcome of communication satisfaction and the intermediate outcome of organizational identity. Results support Street et al.'s postulation and demonstrates that patients' aggressive communication does not have a direct effect on nurses' emotional health. Instead, the effect is indirect, mediated by communication satisfaction and organizational identity.

Sickness Presenteeism in Shift and Non-Shift Nurses: Using the Fifth Korean Working Conditions Survey

Nurses have reported higher rates of sickness presenteeism than other workers, which is particularly problematic because this problem is linked to care quality and patient safety. This secondary data analysis study aimed to identify the prevalence of sickness presenteeism and explore related factors among shift and non-shift nurses using the Fifth Korean Working Conditions Survey. A total of 272 nurses in Korean hospitals were included. The survey included questions on working conditions, health status, and sickness presenteeism. A multivariate logistic regression was used to identify associated factors of sickness presenteeism. Overall, 21.8% of the participants reported experiencing sickness presenteeism; shift nurses experienced more sickness presenteeism than non-shift nurses. Sickness presenteeism was greater in shift nurses who did not have rest breaks during work and in nurses who experienced quick return. Additionally, the odds of sickness presenteeism were approximately four times greater in shift nurses who experienced sleep disturbance and about four times higher in shift nurses who experienced health problems. Among non-shift nurses, the odds of sickness presenteeism were about 15 times greater in those who worked ≥53 h per week. Nurse managers and administrators should prevent sickness presenteeism in hospital nurses to provide quality care and enhance productivity.

Differences in Work and Non-Work Support Associations With Job Stress, Burnout, and Well-Being Between Types of Healthcare Workers

OBJECTIVE

To determine associations between work and non-work supports with employee well-being, job stress, and burnout among direct and non-direct care healthcare workers.

METHODS

Cross-sectional data were collected from 550 full-time (≥ 35 h/wk), US Amazon Mechanical Turk workers (≥ 18 years of age) in the healthcare industry, had at least one supervisor, and at least one coworker. Canonical correlational analysis assessed the shared variance of organizational, supervisor, coworker, and family/friend support on employee outcomes.

RESULTS

Non-direct care support workers indicated a significantly stronger association between work supports and employee outcomes than family/friend supports. Direct care support workers had significant support from both work and non-work sources of support.

CONCLUSION

Workplace supports are important resources for healthcare workers responsible for ensuring patient care and safety. Workplace interventions may tailor interventions to encourage types of support for subgroups within the healthcare industry.

Mitigating the Adverse Effects of 12-Hour Shifts: Nursing Leaders' Perspectives

OBJECTIVE

The purpose of this study was to explore perspectives of nurse leaders regarding strategies to mitigate the job demands of 12-hour shift work and learn their views regarding the role of breaks in offsetting the cognitive and physical demands of acute care nurses working 12-hour shifts.

BACKGROUND

The strain of long shifts can result in adverse outcomes for nurses, organizations, and patients.

METHODS

A modified, 3-round, e-Delphi solicited input from nurse leaders. First, qualitative information about support and resources to mitigate the adverse effects of 12-hour shifts was collected, and then 2 subsequent rounds used consensus identification and item ranking to develop recommendations.

RESULTS

Findings reinforce that job demands of 12-hour shifts can be mitigated via staffing practices, quiet break spaces, and the opportunity to work with familiar patients.

CONCLUSIONS

Recommendations from this work may enhance patient safety, positive organizational outcomes, and a resilient and sustainable nursing workforce.

An Integrative Total Worker Health Framework for Keeping Workers Safe and Healthy During the COVID-19 Pandemic

OBJECTIVE

The aim was to recommend an integrated Total Worker Health (TWH) approach which embraces core human factors and ergonomic principles, supporting worker safety, health, and well-being during the COVID-19 pandemic.

BACKGROUND

COVID-19 has resulted in unprecedented challenges to workplace safety and health for workers and managers in essential businesses, including healthcare workers, grocery stores, delivery services, warehouses, and distribution centers. Essential workers need protection, accurate information, and a supportive work environment with an unwavering focus on effective infection control.

METHOD

The investigators reviewed emerging workplace recommendations for reducing workers' exposures to the novel coronavirus and the challenges to workers in protecting their health. Using a theoretical framework and guidelines for integrating safety and health management systems into an organization for TWH, the investigators adapted the framework's key characteristics to meet the specific worker safety and health issues for effective infection control, providing supports for increasing psychological demands while ensuring a safe work environment.

RESULTS

The recommended approach includes six key characteristics: focusing on working conditions for infection control and supportive environments for increased psychological demands; utilizing participatory approaches involving workers in identifying daily challenges and unique solutions; employing comprehensive and collaborative efforts to increase system efficiencies; committing as leaders to supporting workers through action and communications; adhering to ethical and legal standards; and using data to guide actions and evaluate progress.

CONCLUSION

Applying an integrative TWH approach for worker safety, health, and well-being provides a framework to help managers systematically organize and protect themselves, essential workers, and the public during the COVID-19 pandemic.

APPLICATION

By using the systems approach provided by the six implementation characteristics, employers of essential workers can organize their own efforts to improve system performance and worker well-being during these unprecedented times.

Fortalecer la coordinación de enfermería para mejorar el cuidado hospitalario

Introducción: La coordinación adecuada para organizar la atención de enfermería a nivel hospitalario es decisiva frente al servicio que se ofrece a los sujetos de cuidado y al mejoramiento permanente de la institución. Objetivo: Describir qué dice la literatura mundial sobre cómo fortalecer el rol de coordinación de enfermería a nivel hospitalario. Materiales y Métodos: Búsqueda integradora de literatura bajo parámetros de Ganong, con publicaciones arbitradas, observación de seis años, sin límites geográficos, en idiomas inglés, español y portugués.  Resultados: De acuerdo con la literatura surgen tres categorías que incluyen: características del rol de coordinador de enfermería; impacto de esta coordinación en los resultados frente al sujeto de cuidado; y estrategias para fortalecer el rol de coordinación dentro de la institución. La evidencia que respalda el desarrollo de la coordinación de enfermería en el hospital es débil, con una mayoría de estudios de tipo descriptivo. Discusión: La coordinación de enfermería debe articular la dirección y la operación en el hospital y para ello requiere conocer y acompañar la directriz institucional a mediano y largo plazo y manejar estrategias de motivación y acompañamiento para facilitar su logro. Conclusiones:  En una institución hospitalaria, la enfermera coordinadora debe mantener el norte en medio de la cotidianeidad de la asistencia; acompañar y motivar al personal a su cargo mediante competencias de liderazgo, trabajo en equipo y conocimiento clínico e institucional.  Requiere para el ejercicio de su rol, proyectar el cambio y mantener un pensamiento integrador. Como citar este artículo: Laverde Contreras Olga Lucia, Sánchez Herrera Beatriz. Fortalecer la coordinación de enfermería para mejorar el cuidado hospitalario. Revista Cuidarte. 2020; 11(2): e826. http://dx.doi.org/10.15649/cuidarte.826

Literature Review of Policy Implications From Findings of the Center for Work, Health, and Well-being

OBJECTIVE

To review the publications of a Total Worker Health Center of Excellence, the Harvard T.H. Chan School of Public Health Center for Work, Health, and Well-being, in order to identify research findings relevant to either organizational or public policies.

METHODS

Two researchers independently reviewed 57 publications from 2011 to 2019 to identify cross-cutting themes that focus on working conditions or related health outcomes and their organizational and public policy implications.

RESULTS

Twelve cross-cutting themes were identified with their respective organizational and public policy implications. Several policy implications cut across work-related themes.

CONCLUSIONS

Policy implications of TWH research will aid in setting priorities to translate this from research into practice in future studies and help identify gaps that we and others can use to plan future TWH research.

Improving Working Conditions to Promote Worker Safety, Health, and Wellbeing for Low-Wage Workers: The Workplace Organizational Health Study

This paper addresses a significant gap in the literature by describing a study that tests the feasibility and efficacy of an organizational intervention to improve working conditions, safety, and wellbeing for low-wage food service workers. The Workplace Organizational Health Study tests the hypothesis that an intervention targeting the work organization and environment will result in improvements in workers' musculoskeletal disorders and wellbeing. This ongoing study is being conducted in collaboration with a large food service company. Formative evaluation was used to prioritize outcomes, assess working conditions, and define essential intervention elements. The theory-driven intervention is being evaluated in a proof-of-concept trial, conducted to demonstrate feasibility and potential efficacy using a cluster randomized design. Ten worksites were randomly assigned to intervention or control conditions. The 13-month intervention uses a comprehensive systems approach to improve workplace policies and practices. Using principles of participatory engagement, the intervention targets safety and ergonomics; work intensity; and job enrichment. The evaluation will provide a preliminary assessment of estimates of the intervention effect on targeted outcomes and inform understanding of the intervention implementation across worksites. This study is expected to provide insights on methods to improve working conditions in support of the safety and wellbeing of low-wage workers.

Coping with moral distress - The experiences of intensive care nurses: An interpretive descriptive study

BACKGROUND

Over the last three decades, there has been a growing body of literature that has described moral distress as a prominent issue that negatively affects intensive care nurses. Yet, little focus has been given to how intensive care nurses cope and continue in their practice despite being exposed to moral distress.

OBJECTIVE

To describe intensive care nurses' experiences of coping with moral distress.

RESEARCH METHODS/SETTING

A qualitative design using an interpretative descriptive approach. Semi-structured interviews were conducted with seven intensive care nurses.

FINDINGS

The shared experience of coping with moral distress was explicated through the overarching theme of being Like Grass in the Wind. Four major themes emerged: Going Against What I Think is Best, Moral Distress - It's Just Inherent in Our Job, It Just Felt Awful, and Dealing with It. The findings also reflected actions associated with turning towards or turning away from morally distressing situations.

CONCLUSION

By developing coping strategies such as seeking social support, nurses can move forward in their practice and meaningfully engage with patients and families experiencing critical illness. When successful coping is not attained, nurses are at risk of becoming morally disengaged within their practice.

The worksite heart health improvement project's impact on behavioral risk factors for cardiovascular disease in long-term care: A randomized control trial

BACKGROUND

Long-term care workers are at high risk for cardiovascular disease, in part because of their poor health habits.

OBJECTIVE

The purpose of this study is to test the impact of the Worksite Heart Health Improvement Project (WHHIP) on subjective behavioral cardiovascular risk factors over time among long-term care staff.

DESIGN

The WHHIP was a 12-month cluster randomized control trial conducted in four long-term care facilities. The exercise, nutrition, and stress management intervention lasted 9-months and was implemented during paid work time.

SETTING AND PARTICIPANTS

Ninety-eight long-term care workers consented to participate in the study.

METHODS

Survey data included: mood, dietary salt intake, dietary fat intake, sleep quality, and sleep duration.

RESULTS

A significant positive short-term intervention effect at 9-month (p = .037) and long-term effect at 12-month for mood (p = .039) was found, signifying reduction in mood symptoms in the treatment group over time. The intervention group also showed longer sleep time (p = .016) and better sleep quality (p = .046) at 12-months. The intervention group had less dietary sodium intake at 9-months (p = .036); yet, this was not maintained over time.

CONCLUSION

The WHHIP demonstrated the ability to improve participants' mood, sleep and sodium intake over time. Lessons learned particularly the challenges faced implementing the WHHIP and the solutions recommended provide critical insights to strengthen future programs with this population.

Social Network Analysis of peer-specific safety support and ergonomic behaviors: An application to safe patient handling

This study applied Social Network Analysis (SNA) to test whether advice-seeking interactions among peers about safe patient handling correlate with a higher frequency of equipment use. Patient-care workers (n=38) at a community hospital in Oregon nominated peers they would consult for advice regarding safe patient handling. Results show a positive correlation between identifying more peers for safe patient handling advice and using equipment more frequently. Moreover, nurses with more reciprocal advice seeking nominations used safe patient handling equipment more frequently. However, employees who would be more consulted about safe patient handling by their peers did not use equipment more frequently than nurses with fewer nominations. Despite the small sample size, the magnitude of the adjusted regressions coefficients ranged between 3 to 4 standard deviations. These results suggest that having more or reciprocal sources of peer-based support may trigger ergonomic related behaviors such as frequent utilization of equipment.

Nurses' but not supervisors' safety practices are linked with job satisfaction

AIMS

To test the associations of safety practices as reported by nurses and their respective unit supervisors with job satisfaction.

BACKGROUND

Psychosocial workplace factors are associated with job satisfaction; however, it is unknown whether nurses and supervisors accounts of safety practices are differentially linked to this outcome.

METHODS

Cross-sectional study design including nurses (n = 1052) nested in 94 units in two hospitals in Boston (MA, USA). Safety practices refer to the identification and control of occupational hazards at the unit. Safety practices were measured aggregating nurses' responses per unit, and supervisory levels. Individual's job satisfaction for each nurse was the response variable.

RESULTS

Supervisors assessed safety practices more favourably than their unit nursing staff. Adjusted random intercept logistic regressions showed that the odds of higher job satisfaction were higher for nurses at units with better safety practices (OR: 1.67, 95% CI: 1.04, 2.68) compared with nurses at units that averaged lower safety practices. Supervisors' reports of safety practices were not correlated with the job satisfaction of their staff.

CONCLUSIONS

Adequate safety practices might be a relevant managerial role that enhances job satisfaction among nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing supervisors should calibrate their safety assessments with their nursing staff to improve nurses' job satisfaction.

Antecedents and outcomes of nurses' rest break organization: A scoping review

OBJECTIVES

To prevent an accumulation of strain during work and to reduce error risk, many countries have made rest breaks mandatory. In the nursing literature, insufficient rest break organization is often reported. However, the outcomes of nurses' rest break organization and its anteceding factors are less clear.

DATA SOURCES

We searched for academic literature on nurses' rest break organization in electronic databases (PubMed, Medline, PsycArticles, PsycINFO, CINAHL).

REVIEW METHODS

Our search yielded 93 potentially relevant articles published between 01/1990 and 04/2016. The final sample in our scoping review consisted of 36 publications and included data from 35 independent and international study samples and two reviews.

RESULTS

Several studies reported a high prevalence of missed, interrupted, or delayed rest breaks in nursing. Nurses' rest breaks often related to better physical and mental well-being but did not affect motivational outcomes and performance systematically. Results on the effects of napping breaks were inconsistent. Rest break activities and high quality rest break areas are further factors that relieve nurses from job demands and can be helpful in coping with them. Several study results indicated that temporal and quantitative work demands, job resources, and individual characteristics influence rest break organization. However, most of these findings stem from studies that do not allow causal conclusions to be drawn.

CONCLUSIONS

Well-designed rest breaks influence nurses' occupational well-being and behavior positively. However, the mechanisms and moderating break-, work-, and person-related factors involved in producing these effects are not well understood today. Thus, further theory building and stronger empirical data are needed.

Integrating worksite health protection and health promotion: A conceptual model for intervention and research

There is increasing recognition of the value added by integrating traditionally separate efforts to protect and promote worker safety and health. This paper presents an innovative conceptual model to guide research on determinants of worker safety and health and to inform the design, implementation and evaluation of integrated approaches to promoting and protecting worker health. This model is rooted in multiple theories and the premise that the conditions of work are important determinants of individual safety and health outcomes and behaviors, and outcomes important to enterprises such as absence and turnover. Integrated policies, programs and practices simultaneously address multiple conditions of work, including the physical work environment and the organization of work (e.g., psychosocial factors, job tasks and demands). Findings from two recent studies conducted in Boston and Minnesota (2009-2015) illustrate the application of this model to guide social epidemiological research. This paper focuses particular attention on the relationships of the conditions of work to worker health-related behaviors, musculoskeletal symptoms, and occupational injury; and to the design of integrated interventions in response to specific settings and conditions of work of small and medium size manufacturing businesses, based on a systematic assessment of priorities, needs, and resources within an organization. This model provides an organizing framework for both research and practice by specifying the causal pathways through which work may influence health outcomes, and for designing and testing interventions to improve worker safety and health that are meaningful for workers and employers, and responsive to that setting's conditions of work.

Implementing an Integrated Health Protection/Health Promotion Intervention in the Hospital Setting: Lessons Learned From the Be Well, Work Well Study

OBJECTIVE

This study reports findings from a proof-of-concept trial designed to examine the feasibility and estimates the efficacy of the "Be Well, Work Well" workplace intervention.

METHODS

The intervention included consultation for nurse managers to implement changes on patient-care units and educational programming for patient-care staff to facilitate improvements in safety and health behaviors. We used a mixed-methods approach to evaluate feasibility and efficacy.

RESULTS

Using findings from process tracking and qualitative research, we observed challenges to implementing the intervention due to the physical demands, time constraints, and psychological strains of patient care. Using survey data, we found no significant intervention effects.

CONCLUSIONS

Beyond educating individual workers, systemwide initiatives that respond to conditions of work might be needed to transform the workplace culture and broader milieu in support of worker health and safety.