Perceived Distributive Injustice, the Key Factor in Nurse's Disruptive Behaviors: A Qualitative Study

"We are really starving for respect and support," the struggle of Iranian nurses in adhering to professional values: A qualitative study

AIMS

To investigate nurses' experiences of adhering to professional values in clinical settings.

DESIGN

A qualitative study with a conventional content analysis approach.

METHODS

This study was conducted from January 2021 to March 2022. Semi-structured interviews were conducted with 12 nurses working in different wards of five public and private hospitals in West Azerbaijan of Iran. Data were analysed using the conventional content analysis approach proposed by Graneheim and Lundman (Nurse education today, 24, 2004, 105) RESULTS: "Barriers to nurses' professional values" emerged as the main category of Iranian nurses' experiences in adhering to professional values. Three subcategories of barriers were revealed: "nurses' challenges," "professional suppressors" and "poor working conditions."

CONCLUSION

Barriers in clinical settings can overshadow nurses' professional performance and disrupt their adherence to professional values. Nursing managers must pay attention to nurses' challenges, their professional suppressors and poor working condition to help them promote their professional performance in clinical settings. Thus, nursing managers should not neglect the continuous education of nurses to assist them in increasing their clinical skills by holding practical and theoretical workshops. Improving the working conditions and clinical atmosphere by recruiting a capable workforce and applying psychological and financial support for nurses are essential to increase the quality of nursing care.

Organisational Justice and Political Agency among Nurses in Public Healthcare Organisations: A Qualitative Study Protocol

Nurses are rarely treated as equals in the social, professional, clinical, and administrative life of healthcare organisations. The primary objective of this study is to explore nurses’ perceptions of organisational justice in public healthcare institutions in Majorca, Balearic Islands, Spain, and to analyse the ways in which they exercise their political agency to challenge the institutional order when it fails to reflect their professional ethos. An ethnomethodological approach using critical discourse analysis will be employed. The main participants will be nurses occupying different roles in healthcare organisations, who will be considered central respondents, and physicians and managers, who will be considered peripheral respondents. Data generation techniques include semi-structured interviews, a sociodemographic questionnaire, and the researcher’s field diary. This is one of the first studies to address organisational justice in healthcare organisations from a macrostructural perspective and to explore nurses’ political agency. The results of this study have the potential to advance knowledge and to ensure that healthcare organisations are fairer for nurses, and, by extension, for the patients in their care.

Nursing educators' perception of disruptive behaviors in the professional work environment: A qualitative study

INTRODUCTION

Disruptive behaviors among nursing educators are a globally recognized problem. They have detrimental effects on nursing educators, the nursing profession, students and patients. This study aimed to explore nursing educators' experiences with disruptive behaviors in the professional work environment.

METHODS

The current study was conducted in 2019 and used a qualitative content analysis approach. Participants were selected purposely from nursing schools. Data was collected using semi-structured interviews with 20 nursing educators, and then analyzed according to the Graneheim and Lundman method.

RESULTS

Through analysis of the transcribed interviews, 4 categories and 10 subcategories were extracted. The categories include disrespectful interactions, inaccurate feedback on work performance, low acceptance in the clinical setting and perceived unfairness.

CONCLUSION

Disruptive behaviors among nursing educators can affect professionalism as well as the quality of education provided by them. Therefore, considering factors that lead to disruptive behaviors in the professional work environment is necessary.

Differences in advance care planning among nursing home care staff

BACKGROUND

A team-based approach has been advocated for advance care planning in nursing homes. While nurses are often put forward to take the lead, it is not clear to what extent other professions could be involved as well.

OBJECTIVES

To examine to what extent engagement in advance care planning practices (e.g. conversations, advance directives), knowledge and self-efficacy differ between nurses, care assistants and allied care staff in nursing homes.

DESIGN

Survey study.

PARTICIPANTS/SETTING

The study involved a purposive sample of 14 nursing homes in Flanders, Belgium. Nurses, care assistants and allied care staff (e.g. social workers, physical therapists) completed a survey.

ETHICAL CONSIDERATIONS

The study was approved by the University Hospital of Brussels (B.U.N. 143201834759), as part of a cluster randomized controlled trial (clinicaltrials.gov NCT03521206).

RESULTS

One hundred ninety-six nurses, 319 care assistants and 169 allied staff participated (67% response rate). After adjusting for confounders, nurses were significantly more likely than care assistants to have carried out advance care planning conversations (odds ratio 4; 95% confidence interval 1.73-9.82; p < 0.001) and documented advance care planning (odds ratio 2.67; 95% confidence interval 1.29-5.56; p < 0.001); differences not found between allied staff and care assistants. Advance care planning knowledge total scores differed significantly, with nurses (estimated mean difference 0.13 (score range 0-1); 95% confidence interval 0.08-0.17; p < 0.001) and allied staff (estimated mean difference 0.07; 95% confidence interval 0.03-0.12; p < 0.001) scoring higher than care assistants. We found no significant differences regarding self-efficacy.

DISCUSSION

While nursing home nurses conducted more advance care planning conversations and documentation than allied care staff and care assistants, these two professional groups may be a valuable support to nurses in conducting advance care planning, if provided with additional training.

CONCLUSIONS

Allied care staff and care assistants, if trained appropriately, can be involved more strongly in advance care planning to enhance relational and individual autonomy of nursing home residents, alongside nurses. Future research to improve and implement advance care planning should consider this finding at the intervention development stage.

Nurses' perception of disruptive behaviors in emergency department healthcare teams: A qualitative study

INTRODUCTION

In an emergency setting, the occurrence of disruptive behaviors hinders team participation and cooperation. Exploring nurses' perception of disruptive behaviors can lead to a better identification of these behaviors in emergency departments and the provision of better recommendations. This study aimed to explore nurses' perception of disruptive behaviors among emergency healthcare teams in hospitals affiliated to the Hamadan University of Medical Sciences, Hamadan, Iran.

METHOD

The study was carried out using qualitative content analysis in 2018-2019. Twenty participants from emergency departments of five hospitals in Hamadan, Iran, were enrolled using purposive sampling. Data were collected using semi-structured interviews that continued until data saturation. Data analysis was performed using Erlingsson and Brysiewicz's qualitative content analysis approach.

RESULTS

Three main themes emerged including observable disruptive behaviors, hidden disruptive behaviors, and trigger factors. Observable disruptive behaviors consisted of two main categories: violence and incivility. Hidden disruptive behaviors included troubling behaviors, poor communication, and irresponsibility. Finally, the trigger factors of disruptive behaviors involved two categories: professional incompetency and workplace discrimination.

CONCLUSION

Exploring nurses' perception showed that trigger factors such as professional incompetency and workplace discrimination could cause the occurrence of observable and hidden disruptive behaviors in emergency healthcare teams.

Investigating the relationship between organizational justice, job satisfaction, and intention to leave the nursing profession: A cross-sectional study

AIMS

This study aims to test a hypothetical model linking various dimensions of organizational justice to the job satisfaction and nurses' intention to leave the profession based on the theoretical assumptions of the Alexander model of voluntary turnover.

DESIGN

A cross-sectional survey.

METHODS

This study was conducted on 317 inpatient ward nurses of six teaching hospitals in Tehran, Iran during 1 September 2017-14 November 2018. Clinical nurses were recruited by a multistage random sampling. Data were collected using structured questionnaires of organizational justice, job satisfaction, and nurses' intention to leave. Data were analysed by structural equation modelling using Amos 22 statistical program.

RESULTS

The structural equation model demonstrated adequate fit and the hypothesized correlations were partially supported. The findings suggested that the distributive justice (p < .001; β = 0.24) and interactional justice (p < .001; β = 0.44) could indirectly affect the nurses' intention to leave the nursing profession via the direct impact on job satisfaction, while job satisfaction had a significant, negative effect on the nurses' intention to leave (p < .001; β = -0.71).

CONCLUSIONS

According to the results, the model fit was acceptable, suggesting the validity of the final model. Furthermore, distributive and interactional justice could reduce the intention to leave the nursing profession by influencing the job satisfaction of the clinical nurses.

IMPACT

This was one of the first studies to determine the aspects of justice that must be further emphasized by healthcare managers to increase the job satisfaction of nurses and their retention in healthcare systems. The findings indicated that fair interactions have a greater impact on job satisfaction and retention of nurses than procedural and distributive justice. The results of this study provide valuable references for nursing managers to increase the job satisfaction of nurses and their retention in healthcare settings.

Chief Nurse Executives involuntary turnover in times of health care reforms: Findings from an interpretative phenomenology study

In recent years, due to several health care system reforms in different countries, an increased involuntary turnover rate of Chief Nurse Executives has been reported around the World. However, no data on their perceived experience of their dismissal have been documented up to now in the European context. Describing the experience of involuntarily dismissed Chief Nurse Executives was the main aim of this interpretative phenomenological study. Data were collected through face-to-face audiotaped interviews performed by involving a purposeful sample of 13 Chief Nurse Executives; data analysis was performed by using the QSR NVIVO 11 software. The Chief Nurse Executives’ experience of Being fired is characterized by three main themes: (1) “Health Care Institutions are places influenced by political turbulences”; (2) “My competence and presence in the arena is despised by a range of strategies”; and (3) “Transiting from darkness to light”. According to their experience, the reason for dismissal was due to changes in the political climate and the introduction of a new chief executive officer; moreover, Being fired caused a deep pain similar to that experienced during bereavement. In some socio-political contexts, the political climate can influence the role of a Chief Nurse Executive: political membership, whether implicit or explicit, is considered of great value. In other contexts, the Chief Nurse Executives’ value is based on professional competences and achieved outcomes. At times of changes in the political climate, the peculiarities of the specific socio-political context should be evaluated as to whether one should anticipate his/her resignation or not.

Perceptions and predictors of organizational justice among healthcare professionals in academic hospitals in South-Eastern Nigeria

Background

Research on organizational justice in hospitals in African countries are limited despite being important for workforce performance and hospital operational efficiency. This paper investigated perceptions and predictors of organizational justice among health professionals in academic hospitals in South-east Nigeria.

Methods

The study was conducted in two teaching hospitals in Enugu State, South-east Nigeria using mixed-methods design. Randomly sampled 360 health professionals (doctors = 105, nurses = 200 and allied health professionals, AHPs = 55) completed an organizational justice scale. Additionally, semi-structured, in-depth interview with purposively selected 18 health professionals were conducted. Univariate and bivariate statistics and multivariable linear regression were used to analyze quantitative data. Statistical significance was set at alpha 0.05 level. Qualitative data were analyzed thematically using NVivo 11 software.

Results

The findings revealed moderate to high perception of different dimensions of organizational justice. Doctors showed the highest perception, whereas AHPs had the least perception. Among doctors, age and education predicted distributive justice (adjusted R² = 22%); hospital ownership and education predicted procedural justice (adjusted R² = 17%); and hospital ownership predicted interactional justice (adjusted R² = 42%). Among nurses, age, gender and marital status predicted distributive justice (adjusted R² = 41%); hospital ownership, age and gender predicted procedural justice (adjusted R² = 28%); and hospital ownership, age, marital status and tenure predicted interactional justice (R² = 35%). Among AHPs, marital status predicted distributive justice (adjusted R² = 5%), while hospital ownership and tenure predicted interactional justice (adjusted R² = 15%). Qualitative findings indicate that nurses and AHPs perceive as unfair, differences in pay, access to hospital resources, training, work schedule, participation in decision-making and enforcement of policies between doctors and other health professionals due to medical dominance. Overall, supervisors have a culture of limited information sharing with, and disrespectful treatment of, their junior colleagues.

Conclusion

Perceptions of organizational justice range from moderate to high and predictors vary among different healthcare professionals. Addressing specific socio-demographic factors that significantly influenced perceptions of organizational justice among different categories of health professionals and departure from physician-centered culture would improve perceptions of organizational justice among health professionals in Nigeria and similar settings.

The relationship amongst nurses' perceived organizational justice, work consciousness, and responsibility

BACKGROUND

Nurses' perceived organizational justice is one of the factors influencing their social responsibility and conscientiousness. Social responsibility and conscience are major requirements for providing high-quality and standardized care.

OBJECTIVE

The aim of the present study is to investigate the relationship of perceived organizational justice with work consciousness and the social responsibility of the nurses.

METHODS

The present cross-sectional study was performed on 380 nurses who had at least 1 year of job experience and willingness to participate in the study. The study was conducted in Zanjan province, Iran, in 2018. The study subjects were selected via stratified random sampling. The data were collected using an organizational justice scale, corporate social responsibility scale, and consciousness scale. Questionnaires were completed through self-reporting. The data were analyzed using partial correlation coefficient and linear regression analysis.

ETHICAL CONSIDERATIONS

Research ethics approval (with the code of IR.ZUMS.REC.1397.47) was obtained from Zanjan University of Medical Sciences.

RESULTS

The results indicated that nurses felt injustice in all dimensions of organizational justice (2.66 ± .753). They feel the most sense of injustice in distributive justice (2.19 ± .798). In three dimensions, except the ethic dimension, the social responsibility was in a desirable range (2.79 ± .703). In two dimensions, work consciousness was in a desirable range. The results showed a significant and positive relationship between all dimensions of social responsibility and all dimensions of organizational justice (r = .072). However, no statistically significant relationship was observed between the dimensions of organizational justice and conscience (r = -.002).

CONCLUSION

Based on the obtained results, social responsibility and the work consciousness of the nurses are affected by organizational justice. Therefore, nursing managers are suggested to change their management styles to reduce the sense of organizational injustice in nurses and have long-term productivity.

Exploring fair decision-making rules in nursing: A qualitative study

BACKGROUND

The decision-making process should be done according to a set of rules and principles so as to be fairly understood.

OBJECTIVES

The aim of this study was to identify the basic principles and rules used by nurses to understand justice in nurse managers' decision-making processes based on a procedural justice model. Research design and participants: This research was a qualitative study based on directed content analysis, which was performed on a group of 15 nurses working in different hospitals in Tehran, Iran. An in-depth semi-structured interview was used as the method of data collection for this study. Ethical consideration: This research has been approved by the Ethics Committee of the University of Social Welfare and Rehabilitation Sciences. The respondents were informed about the aim of the study, about voluntary participation, anonymity and confidentiality.

FINDINGS

The results of this study showed that in order to understand procedural justice, nurses use several rules, including: duties organization, managerial support, consistency, bias-suppression, accuracy, correctability, representativeness, and ethicality.

CONCLUSION

Nursing leaders must consider the importance of justice rules as one of many strategies to ensure the nurses' perception of fairness in decision-making processes.