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Lathren CR, Efird-Green L, Reed D, Zimmerman S, Perreira KM, Bluth K, Sloane PD. The Prevalence and Benefits of Self-Compassion Among Professional Caregivers. J Am Med Dir Assoc 2024; 25:105099. [PMID: 38901466 DOI: 10.1016/j.jamda.2024.105099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE Self-compassion is a healthy way of responding to challenges that may help long-term care professional caregivers (ie, nursing assistants and personal care aides) cope with stress, but its use may vary in important ways. This study explored the relationships between self-compassion and caregiver demographic characteristics, anxiety and depressive symptoms, and job satisfaction in a large racially/ethnically diverse sample of professional caregivers. DESIGN Cross-sectional self-report questionnaire. SETTING AND PARTICIPANTS A total of 391 professional caregivers, including nursing assistants and personal care aides from 10 nursing homes and 3 assisted living communities in New York, California, and North Carolina. METHODS Professional caregivers were invited to complete an online questionnaire regarding stress and coping. Self-compassion was measured using the Self-Compassion for Youth Scale; anxiety and depressive symptoms were assessed using standardized screeners; and job satisfaction was assessed via an item used in a national survey. Self-compassion scores were represented by total scores and individual subscale scores. Analysis of variance was used to examine differences in self-compassion scores based on demographic characteristics, and correlation coefficients were used to explore relationships between self-compassion and mental health symptoms and job satisfaction. RESULTS Significant differences were found in self-compassion based on age, race/ethnicity, place of birth, and education. In general, older caregivers, caregivers with higher education, and caregivers born outside the United States had the highest self-compassion, whereas White caregivers had the lowest self-compassion. Self-compassion was negatively associated with anxiety and depressive symptoms and positively associated with job satisfaction. CONCLUSION AND IMPLICATIONS Professional caregivers' use of self-compassion to cope with challenges may depend on characteristics and life experiences influenced by their sociocultural background. Given the link between self-compassion and lower mental health symptoms and higher job satisfaction, it may be helpful to design and implement interventions with these differences in mind.
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Affiliation(s)
- Christine R Lathren
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Lea Efird-Green
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David Reed
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sheryl Zimmerman
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Schools of Social Work and Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Krista M Perreira
- Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karen Bluth
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Philip D Sloane
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Xu L, Sharma H, Wehby GL. Effects of the Affordable Care Act Medicaid Expansions on the Employment and Work Hours of Nursing Assistants in Hospitals and Nursing Homes. J Appl Gerontol 2024:7334648241254259. [PMID: 38797956 DOI: 10.1177/07334648241254259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
We examine the effects of the Affordable Care Act Medicaid expansions on the employment and work hours of nursing assistants (NAs). We use the 2011-2019 American Community Survey data to identify NAs likely to be affected by Medicaid expansions (income up to 138% of the federal poverty level) in nursing homes and hospitals. Using classical difference-in-differences regressions, we find that Medicaid expansions have little effect on employment and work hours among NAs in the full sample. However, there is a 4.4 percentage-point increase in the probability of working part-time (<30 hours/week) for nursing home NAs (p < .05). We found no employment effects of Medicaid expansions for hospital NAs. Our study adds to the literature on the heterogeneous effects of Medicaid expansions on work effort across occupations and workplaces. The rise in part-time employment for nursing home NAs following Medicaid expansions suggests the need for improved benefits to encourage full-time employment.
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Affiliation(s)
- Lili Xu
- Department of Health Management and Policy, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Hari Sharma
- Department of Health Management and Policy, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - George L Wehby
- Department of Health Management and Policy, College of Public Health, The University of Iowa, Iowa City, IA, USA
- National Bureau of Economic Research, Cambridge, MA, USA
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Sharma H, Xu L. Occupational Injuries in the US Nursing Homes. Med Care 2024; 62:346-351. [PMID: 38546387 DOI: 10.1097/mlr.0000000000001991] [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: 04/07/2024]
Abstract
BACKGROUND Workplace injuries adversely affect worker well-being and may worsen staffing shortages and turnover in nursing homes. A better understanding of the trends in injuries in nursing homes including organizational factors associated with injuries can help improve our efforts in addressing worker injuries. OBJECTIVE To summarize the trends in injuries and organizational correlates of injuries in US nursing homes. RESEARCH DESIGN We combine national injury tracking data from the Occupational Safety and Health Administration (2016-2019) with nursing home characteristics from Nursing Home Compare. Our outcomes include the proportion of nursing homes reporting any injuries, the mean number of injuries, and the mean number of injuries or illnesses with days away from work, or job transfer or restriction, or both (DART). We descriptively summarize trends in injuries over time. We also estimate the association between nursing home characteristics and injuries using multivariable regressions. RESULTS We find that approximately 93% of nursing homes reported at least 1 occupational injury in any given year. Injuries had a substantial impact on productivity with 4.1 DART injuries per 100 full-time employees in 2019. Higher bed size, occupancy, RN staffing, and chain ownership are associated with increased DART rates whereas higher overall nursing home star ratings and for-profit status are associated with decreased DART rates. CONCLUSIONS A high proportion of nursing homes report occupational injuries that can affect staff well-being, productivity, and quality of care. Injury prevention policies should target the types of injuries occurring in nursing homes and OSHA should monitor nursing homes reporting high and repeated injuries.
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Affiliation(s)
- Hari Sharma
- Department of Health Management and Policy, University of Iowa, Iowa City, IA
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Hebard S, Weaver G, Hansen WB, Ruppert S. Evaluation of a Pilot Program to Prevent the Misuse of Prescribed Opioids Among Health Care Workers: Repeated Measures Survey Study. JMIR Form Res 2024; 8:e53665. [PMID: 38607664 PMCID: PMC11053396 DOI: 10.2196/53665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/13/2024] [Accepted: 03/13/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Overprescription of opioids has led to increased misuse of opioids, resulting in higher rates of overdose. The workplace can play a vital role in an individual's intentions to misuse prescription opioids with injured workers being prescribed opioids, at a rate 3 times the national average. For example, health care workers are at risk for injuries, opioid dispensing, and diversion. Intervening within a context that may contribute to risks for opioid misuse while targeting individual psychosocial factors may be a useful complement to interventions at policy and prescribing levels. OBJECTIVE This pilot study assessed the effects of a mobile-friendly opioid misuse intervention prototype tailored for health care workers using the preparation phase of a multiphase optimization strategy design. METHODS A total of 33 health care practitioners participated in the pilot intervention, which included 10 brief web-based lessons aimed at impacting psychosocial measures that underlie opioid misuse. The lesson topics included: addiction beliefs, addiction control, Centers for Disease Control and Prevention guidelines and recommendations, beliefs about patient-provider relationships and communication, control in communicating with providers, beliefs about self-monitoring pain and side effects, control in self-monitoring pain and side effects, diversion and disposal beliefs, diversion and disposal control, and a conclusion lesson. Using a treatment-only design, pretest and posttest surveys were collected. A general linear repeated measures ANOVA was used to assess mean differences from pretest to posttest. Descriptive statistics were used to assess participant feedback about the intervention. RESULTS After completing the intervention, participants showed significant mean changes with increases in knowledge of opioids (+0.459; P<.001), less favorable attitudes toward opioids (-1.081; P=.001), more positive beliefs about communication with providers (+0.205; P=.01), more positive beliefs about pain management control (+0.969; P<.001), and increased intentions to avoid opioid use (+0.212; P=.03). Of the 33 practitioners who completed the program, most felt positive about the information presented, and almost 70% (23/33) agreed or strongly agreed that other workers in the industry should complete a program like this. CONCLUSIONS While attempts to address the opioid crisis have been made through public health policies and prescribing initiatives, opioid misuse continues to rise. Certain industries place workers at greater risk for injury and opioid dispensing, making interventions that target workers in these industries of particular importance. Results from this pilot study show positive impacts on knowledge, attitudes, and beliefs about communicating with providers and pain management control, as well as intentions to avoid opioid misuse. However, the dropout rate and small sample size are severe limitations, and the results lack generalizability. Results will be used to inform program revisions and future optimization trials, with the intention of providing insight for future intervention development and evaluation of mobile-friendly eHealth interventions for employees.
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Affiliation(s)
| | - GracieLee Weaver
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, United States
| | | | - Scarlett Ruppert
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, United States
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Reich J, Cantrell MA, Smeltzer SC. Attitudes and Beliefs of Nurses and Nurse Assistants toward Patients with Sickle Cell Disease: A Mixed Methods Study. Pain Manag Nurs 2024; 25:122-130. [PMID: 37865561 DOI: 10.1016/j.pmn.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 09/13/2023] [Accepted: 09/16/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Pain experienced among individuals with sickle cell disease (SCD) is the primary requirement for hospitalization. PURPOSE This study examined the relationship of age, race, and years of experience among medical-surgical nurses and nursing assistants to their attitudes in caring for SCD patients and identified barriers that influence pain management care. DESIGN, SETTING, PARTICIPANTS An explanatory sequential mixed-methods study design was used. Online survey data were collected among 56 participants and online interviews were conducted among three participants. METHODS The General Perceptions of Sickle Cell Patients (GPSCP) Scale-17, composed of four subscales, assessed providers attitudes toward patients with SCD. Two subscales assessed providers' attitudes behaviors related to acute and chronic pain management. RESULTS There was no relationship between age and years of experience to scores on four subscales. White/Caucasian study participants scored higher on the Red Flag Behaviors subscale, indicating that White/Caucasian participants had stronger beliefs concerning drug-seeking behaviors among SCD patients as compared to other ethnicities/races. Themes generated from the qualitative interview data analysis were: 1) reflections on one's own practice compared to others' practice; 2) communication as a barrier/facilitator to providing care; 3) lack of national guidelines; and 4) adjunct staff are critical to facilitating holistic care. CONCLUSIONS Racial and ethnic differences exist among medical-surgical nurses and nursing assistants' attitudes. Poor communication and lack of national standards of care are barriers to providing high quality care. CLINICAL IMPLICATIONS Culturally sensitive care, based on current practice guidelines, is needed for improved pain management care for patients with SCD.
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Affiliation(s)
- Jessie Reich
- From the M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania.
| | - Mary Ann Cantrell
- From the M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania
| | - Suzanne C Smeltzer
- From the M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania
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Haraldsson P, Nylander E, Jonker D, Ros A, Josefsson KA. Workplace interventions focusing on how to plan, organize and design the work environment in hospital settings: A systematic review. Work 2024; 78:331-348. [PMID: 38277328 PMCID: PMC11191506 DOI: 10.3233/wor-230205] [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: 04/25/2023] [Accepted: 10/04/2023] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Occupational Health Service (OHS) is a service that should support employers and employees with their work environment. Previous research indicates the need for deeper knowledge about the effect of workplace interventions with a focus on planning, organizing and designing the workplace to improve work conditions in hospital settings. OBJECTIVE The aim was to evaluate the outcomes, workplace interventions and intervention strategies in hospital settings. METHODS A systematic literature review was conducted. CINAHL, MEDLINE, PsycInfo, Scopus, and Web of Science Core Collection were searched in September 2021. The Mixed Methods Appraisal Tool was used to evaluate the quality of the included studies. Study results are presented through a narrative synthesis. A protocol for this study was registered on the Open Science Framework. RESULTS Twenty-six studies, published between 2010 and 2021, were included. These included randomized controlled trials (RCTs), non-RCTs, and mixed methods reports with moderate to good quality. The results support the use of workplace interventions to improve work conditions, health, and well-being in hospital settings. Combinations of different interventions, tailored to the specific organization, were used. Important intervention strategies commonly used in the start-up, evaluation, and intervention of successful workplace interventions, were identified. Using a pragmatist complexity approach in workplace interventions can improve outcomes by providing clear intervention strategies and combinations of tailored interventions, related to context specific problems. CONCLUSION OHS support in workplace interventions with clear intervention strategies will contribute to improve work conditions, health and well-being in hospital settings.
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Affiliation(s)
- Patrik Haraldsson
- Occupational Safety and Health Care, Region Jönköping County, Jönköping, Sweden
- School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | | | - Dirk Jonker
- Occupational Safety and Health Care, Region Jönköping County, Jönköping, Sweden
- School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Axel Ros
- School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
- Futurum –Academy for Healthcare, Region Jönköping County, Jönköping, Sweden
| | - Kristina Areskoug Josefsson
- School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
- University West, Department of Health Sciences, Trollhättan, Sweden
- Department of Behavioural Science, Oslo Metropolitan University, Oslo, Norway
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Descatha A, Temime L, Zins M, Gilbert F, Fadel M. SOIGNANCES: The Healthcare Professionals Cohort in the CONSTANCES. J Occup Environ Med 2023; 65:e578-e579. [PMID: 37143236 DOI: 10.1097/jom.0000000000002874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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Huang PC, Chien LY, Huang HP. Assessing hand hygiene knowledge, attitude, behavior and adherence among nursing assistants: A cross-sectional study. Geriatr Nurs 2023; 51:232-237. [PMID: 37018849 DOI: 10.1016/j.gerinurse.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE This study explored hand hygiene knowledge, attitude, behaviors and adherence amongst nursing assistants. METHODS This cross-sectional study was conducted with structured questionnaires and direct observation. Nursing assistants were recruited from two long-term care facilities in eastern Taiwan from July to September, 2021. RESULTS The nursing assistants had high levels of hand hygiene knowledge, attitude, and behavior, however, the direct observational revealed hand hygiene adherence at 58.6% with 17.99 seconds duration on average. Comparing with alcohol-based hand rub, the nursing assistants performed very low adherence rate with soap and water wash, and the use of paper towel was the least followed skill applying to soap and water wash. CONCLUSIONS The study finds that hand wash with soap and water has lower adherence than the alcohol-based hand rub. Future innovations in hand hygiene, such as accessible and easy-to-use hand washing agents and easy-to-remember hand cleansing techniques will be valuable.
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Affiliation(s)
- Pei-Chun Huang
- Department of Nursing, Yuanshan Branch, Taipei Veterans General Hospital; Graduate Institute of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Tao-Yuan City 33303, Taiwan
| | - Li-Yu Chien
- Department of Nursing, Chang Gung University of Science and Technology, 261, Wen-Hua 1st Rd., Gui-Shan Dist., Tao-Yuan City 33303, Taiwan
| | - Hsiang-Ping Huang
- Department of Nursing, Chang Gung University of Science and Technology, 261, Wen-Hua 1st Rd., Gui-Shan Dist., Tao-Yuan City 33303, Taiwan.
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May JT, Rainbow JG. A Qualitative Description of Direct Care Workers of Lesbian, Gay, Bisexual, Transgender Older Adults. J Appl Gerontol 2023; 42:597-606. [PMID: 36384328 DOI: 10.1177/07334648221139477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Purpose: The aim of the study was to examine direct care worker (DCW) perceptions of lesbian, gay, bisexual, transgender (LGBT) older adults living in long-term care, assisted living, and home health settings. DCWs provide the closest interaction with LGBT older adults in these settings. The perceptions DCWs have toward LGBT older adults is important because the quality of care can be influenced by negative attitudes. Methodology: Qualitative description was used to synthesize what is known about DCWs' perceptions toward LGBT older adults. Results: The overarching theme, "Care is Different, but Not my Care," was supported by the categories Cues of Stereotyping, Cues of Prejudice, and DCWs' Social System and Reported Care. Application: Specific implications for practice (i.e., training, recruitment, retention strategies) and policy (i.e., mandated staffing ratios, pay) are explicated to guide future interventions to ensure equitable, quality care in health care.
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Fadel M, Roquelaure Y, Descatha A. Interventions on Well-being, Occupational Health, and Aging of Healthcare Workers: A Scoping Review of Systematic Reviews. Saf Health Work 2023; 14:135-140. [PMID: 36941932 PMCID: PMC10024230 DOI: 10.1016/j.shaw.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/12/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022] Open
Abstract
Introduction With recent higher awareness of the necessity of improving healthcare workers' well-being, we aimed to overview systematic reviews dealing with interventions on well-being, occupational health, and aging of healthcare workers. Methods From three databases (PubMed, Embase, and Web of Science), a scoping review of systematic reviews was carried out to determine current knowledge on interventions focused on the well-being or aging of healthcare workers. Only systematic reviews were considered, with appropriate extraction and quality evaluation. Results Of the total of 445 references identified, 10 systematic reviews were included, mostly published since 2019. Nurses were the most frequent targets of interventions, and mental health was the main outcome described. The overall level of quality was also heterogenous, with high to low-quality reviews. Conclusions Workers' mental health well-being was the major outcome targeted by intervention, with varying level of evidence. Further studies are needed with integrative approaches on global health and life course perspectives, with a focus on the plurality of settings, worker types, and women.
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Affiliation(s)
- Marc Fadel
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, IRSET-ESTER, SFR ICAT, CAPTV CDC, Angers, France
| | - Yves Roquelaure
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, IRSET-ESTER, SFR ICAT, CAPTV CDC, Angers, France
| | - Alexis Descatha
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, IRSET-ESTER, SFR ICAT, CAPTV CDC, Angers, France
- Department of Occupational Medicine, Epidemiology and Prevention, Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, USA
- Corresponding author. Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, IRSET-ESTER, SFR ICAT, CAPTV CDC, Angers, France
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Xu L, Sharma H. Effect of Medicaid Expansion on Health Insurance for Low-Income Nursing Home Aides. J Appl Gerontol 2023; 42:231-240. [PMID: 36206172 DOI: 10.1177/07334648221132121] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
We examine how the Affordable Care Act Medicaid expansion affected the insurance coverage and the sources of coverage among low-income nursing home aides using the 2010-2019 American Community Survey data. Insurance coverage for low-income nursing home aides increased from about 60% to nearly 90% in expansion states but rose to only about 80% in nonexpansion states. Using a difference-in-differences regression design, we find that Medicaid expansion was associated with a 5.1 percentage-point increase in overall insurance coverage. Expansion states had a 12.2 percentage-point gain in Medicaid that was partially offset by a 6.4 percentage-point reduction in private insurance coverage. Our results show that ACA Medicaid expansion increased insurance coverage for low-income nursing home aides; however, there was substantial crowd-out of private insurance coverage in this population. Policymakers should consider expanding Medicaid while incentivizing affordable private health insurance options for low-income nursing home aides to improve insurance coverage.
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Affiliation(s)
- Lili Xu
- Department of Health Management and Policy, College of Public Health, 4083University of Iowa, Iowa City, IA, USA
| | - Hari Sharma
- Department of Health Management and Policy, College of Public Health, 4083University of Iowa, Iowa City, IA, USA
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Eriksson E, Jordal M, Hjelm K, Engström M. Job satisfaction and wellbeing among migrant care workers in nursing homes: An integrative review. Nurs Open 2023; 10:3486-3505. [PMID: 36658244 PMCID: PMC10170958 DOI: 10.1002/nop2.1611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/05/2022] [Accepted: 12/22/2022] [Indexed: 01/21/2023] Open
Abstract
AIM To systematically analyse and synthesize studies investigating job satisfaction (including turnover and turnover intention) and wellbeing (physical, social and psychological including work stress, acculturation stress and sick leave) among migrant care workers in nursing homes. DESIGN An integrated review was conducted. METHODS Joanna Briggs Institute's manual guided the analysis of qualitative data (n = 31). Quantitative data (n = 17) were summarized and integrated with the qualitative findings. RESULTS Migrants described high job demands, limited control and social support, and stress possibly related to acculturation. Although, compared to natives (born in the country), inconsistent results were reported about wellbeing and job satisfaction, migrant care workers reported enjoying the relational aspects of work and feeling pride when providing care. A satisfying work environment for migrant care workers enables them enjoying working in elderly care with pride. PUBLIC CONTRIBUTION Help managers to promote an inclusive working life in line with the United Nations Sustainable Development Goal number 8.
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Affiliation(s)
- Elisabet Eriksson
- Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Malin Jordal
- Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
| | - Katarina Hjelm
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Maria Engström
- Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
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Susanne A, Aileen B, Helen O, Susanne G, Anne-Marie B. Individual and organisational factors in the psychosocial work environment are associated with home care staffs' job strain: a Swedish cross-sectional study. BMC Health Serv Res 2022; 22:1418. [PMID: 36434716 PMCID: PMC9701045 DOI: 10.1186/s12913-022-08699-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/18/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Home care staff (HCS) provide essential service to enable older adults to age in place. However, unreasonable demands in the work environment to deliver a safe, effective service with high quality has a negative impact on the individual employee's well-being and the care provided to the older adults. The psychosocial work environment is associated with employees´ well-being, although, knowledge regarding which individual and organisational factors that contribute to job strain for HCS is limited. These factors need to be identified to develop targeted interventions and create sustainable work situations for HCS. This study aimed to explore how HCS´s perceived job strain is associated with, and to what extent can be explained by, individual and organisational factors of the psychosocial work environment and psychosomatic health. METHOD An explorative cross-sectional questionnaire survey design was used in a large Swedish county. Five home care agencies with a total of 481 HCS were asked to respond to a questionnaire regarding their perceived level of job strain (Strain in Dementia Care Scale), psychosocial work environment (QPSNordic34+), and psychosomatic health (Satisfaction with Work Questionnaire). Multiple linear regression (MLR) analyses were conducted to explore the association between job strain and individual and organisational factors. RESULTS In total, 226 (46%) HCS responded to the questionnaire. Both individual and organisational factors were significant predictors of job strain and explained a variance ranging between 39 to 51% (p = 0.001). The organisational factor job demand and the individual factor feeling worried and restless was most frequently represented in these MRL models. A higher job strain was also associated with adverse outcomes regarding leadership, organisational culture and climate, and control at work. CONCLUSION This study indicates that there is an intertwined complexity of individual and organisational factors that are associated with the HCS´s perception of job strain. Implementation of new multidimensional work strategies, such as a reablement approach, could support the development of efficient strategies for HCS and reduce the level of job strain. Policy changes for the provision of home care are also needed to support the development of a sustainable and healthy psychosocial work environment.
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Affiliation(s)
- Assander Susanne
- grid.4714.60000 0004 1937 0626Department of Neurobiology, Caring Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Bergström Aileen
- grid.4714.60000 0004 1937 0626Department of Neurobiology, Caring Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Olt Helen
- grid.4714.60000 0004 1937 0626Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Guidetti Susanne
- grid.4714.60000 0004 1937 0626Department of Neurobiology, Caring Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Theme Women´S Health and Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Boström Anne-Marie
- grid.4714.60000 0004 1937 0626Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden ,Research & Development Unit, Stockholms Sjukhem, Stockholm, Sweden
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O adoecimento dos trabalhadores de enfermagem e os riscos psicossociais no trabalho. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao03447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Denge T, Rakhudu M. Perceptions of nurses on occupational health hazards and safety practices in Ditsobotla public hospitals in North West province. Curationis 2022; 45:e1-e9. [PMID: 35924613 PMCID: PMC9350541 DOI: 10.4102/curationis.v45i1.2220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/05/2021] [Accepted: 03/13/2022] [Indexed: 11/04/2022] Open
Abstract
Background Nurses are the backbone of the healthcare system. During the fulfilment of their duties and responsibilities, they experience various types of work-related risks, which harmfully affect their health and nursing quality. Objectives This study aimed to explore and describe perceptions of nurses on occupational health hazards and safety practices in Ditsobotla public hospitals of North West province. Method An exploratory, descriptive, qualitative research design was undertaken in this study. An explorative design allowed the researcher to identify key issues regarding nurses’ perceptions on occupational health hazards and safety practices using Donabedian structure, process and outcome. A total of 15 nurses of different categories participated in the study that formed four focus group discussions. Semi-structured focus group discussions of three to four participants were conducted until data saturation is obtained and at the point where no new themes from participants’ perceptions emerged. Creswell and Clark framework of data analysis was used to analyse data. Results Three major categories emerged during data analysis: nurse’s perception on occupational health hazards in the health settings, Donabedian framework on assessing the quality of care in relation to occupational health hazards and occupational health and safety (OHS) practices. Eight themes were identified. Conclusion Nurses’ perceived different occupational hazards that affect their normal duties and responsibility in the workplace. Future interventions such as training and education on OHS policy should be adopted to promote health and well-being of the staff.
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Affiliation(s)
- Takalani Denge
- Department of Nursing Science, Faculty of Health Science, North-West University, Potchefstroom.
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16
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Creapeau LJG, Johs-Artisensi JL, Lauver KJ. Leadership and Staff Perceptions on Long-term Care Staffing Challenges Related to Certified Nursing Assistant Retention. J Nurs Adm 2022; 52:146-153. [PMID: 35179142 DOI: 10.1097/nna.0000000000001122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study investigates practices that may help retain certified nursing assistants (CNAs) and address the staffing challenges faced in long-term care. BACKGROUND CNAs are critical to quality care and retention has never been more challenging. To solve this staffing crisis, understanding the unique perspective of CNAs is imperative. METHODS In semistructured interviews, 5 nursing assistants, the director of nursing, and the nursing home administrator at 59 long-term care facilities answered 4 questions, providing multiple perspectives about causes and solutions to CNA staffing challenges. RESULTS Key responses for each stakeholder group were identified. CNAs highlighted the nature of the job as a bigger challenge than leadership recognized. Although pay is a top concern, emotional support, training, relationship-building, communication, and the work culture can be equally important in reducing turnover. CONCLUSION When organizational leaders understand how to meet the needs and interests of CNAs, they can reduce turnover.
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Affiliation(s)
- Lindsey J G Creapeau
- Author Affiliations: Administrative Residency Coordinator and Instructor (Dr Creapeau), Professor and Program Director (Dr Johs-Artisensi), Professor and Department Chair (Dr Lauver), Department of Management and Marketing, University of Wisconsin-Eau Claire
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17
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Engaging Rehabilitation Technicians Through a Career Ladder During a Pandemic. Rehabil Nurs 2022; 47:43-49. [DOI: 10.1097/rnj.0000000000000361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Mass SFDLS, Centenaro APFC, Santos AFD, Andrade AD, Franco GP, Cosentino SF. Routine of the unpredictable: workloads and health of urgent and emergency nursing workers. Rev Gaucha Enferm 2022; 43:e20210007. [PMID: 35043876 DOI: 10.1590/1983-1447.2022.20210007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/09/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To know the perceptions of nursing professionals in urgent and emergency services regarding workloads and the relationship with their health. METHOD Descriptive qualitative study carried out in two urgent and emergency sectors in southern Brazil. 16 nursing professionals were interviewed. The data were subjected to thematic content analysis. RESULTS The first thematic category highlighted the workloads in the daily lives of professionals, highlighting Covid-19 as an element recently incorporated into the perception of biological load. The psychic load is enhanced by stress and suffering in the face of deaths, in addition to adverse working conditions. The second category showed the interface between the loads, the overload and the workers' health, highlighting the importance of the psychic load in mental health. CONCLUSION Workloads are enhanced by working conditions and the relationship with the profession's work object, generating overload and risk of mental illness.
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Affiliation(s)
| | - Alexa Pupiara Flores Coelho Centenaro
- Universidade Federal de Santa Maria Campus Palmeira das Missões (UFSM-PM), Departamento de Ciências da Saúde, Laboratório de Estudos em Saúde, Enfermagem e Trabalho. Palmeira das Missões, Rio Grande do Sul, Brasil
| | - Arlíni Fátima Dos Santos
- Hospital de Clínicas de Passo Fundo (HCPF). Programa de Residência Multiprofissional em Urgência e Emergência/Intensivismo. Passo Fundo, Rio Grande do Sul, Brasil
| | - Andressa de Andrade
- Universidade Federal de Santa Maria Campus Palmeira das Missões (UFSM-PM), Departamento de Ciências da Saúde, Laboratório de Estudos em Saúde, Enfermagem e Trabalho. Palmeira das Missões, Rio Grande do Sul, Brasil
| | - Gianfábio Pimentel Franco
- Universidade Federal de Santa Maria Campus Palmeira das Missões (UFSM-PM), Departamento de Ciências da Saúde, Laboratório de Estudos em Saúde, Enfermagem e Trabalho. Palmeira das Missões, Rio Grande do Sul, Brasil
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19
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Robinson-Lane SG, Block L, Bowers BJ, Cacchione PZ, Gilmore-Bykovskyi A. The Intersections of Structural Racism and Ageism in the Time of COVID-19: A Call to Action for Gerontological Nursing Science. Res Gerontol Nurs 2022; 15:6-13. [PMID: 35044863 PMCID: PMC8856583 DOI: 10.3928/19404921-20211209-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The health consequences of systemic racism and ageism have received growing attention as the coronavirus disease 2019 pandemic has illuminated long-standing inadequacies and injustices that are structurally engrained in our health systems. The current State of the Science Commentary addresses the intersecting influences of systemic racism and ageism, and other "-isms" that conspire to create disparate health outcomes for older adults from historically excluded and marginalized backgrounds. We focus specifically on the long-term care sector as a representative microcosm of structural inequities, while recognizing that these unjust barriers to health are widespread, endemic, and pervasive. We present a call to action for gerontological nursing science to engage deeply and robustly in these realities, and the ethical and scientific imperative they present to ensure that all older adults encounter just conditions for maximizing their health and well-being. [Research in Gerontological Nursing, 15(1), 6-13.].
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Affiliation(s)
| | | | | | - Pamela Z. Cacchione
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Andrea Gilmore-Bykovskyi
- School of Nursing, Madison, Wisconsin, USA,University of Wisconsin-Madison Center for Health Disparities Research, Madison, Wisconsin, USA
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20
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Scales K. Transforming Direct Care Jobs, Reimagining Long-Term Services and Supports. J Am Med Dir Assoc 2021; 23:207-213. [PMID: 34973168 DOI: 10.1016/j.jamda.2021.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/24/2021] [Accepted: 12/04/2021] [Indexed: 12/20/2022]
Abstract
The diverse array of individuals who receive long-term services and supports share one common experience, which is the need for assistance with personal care and/or other daily activities. The direct care workers (including nursing assistants, home health aides, and personal care aides) who provide this assistance play a critical role in keeping individuals safe, supporting their health and well-being, and helping prevent adverse outcomes. Yet despite decades of research, advocacy, and incremental policy and practice reform, direct care workers remain inadequately compensated, supported, and respected. Long-standing direct care job quality concerns are linked to high turnover and job vacancy rates in this workforce, which in turn compromise the availability and quality of essential care for older adults and people with disabilities-which has never been more evident than during the COVID-19 pandemic. This special article makes the case for transforming direct care jobs and stabilizing this workforce as a centerpiece of efforts to reimagine long-term services and supports system in the United States, as a public health priority, and as a social justice imperative. Drawing on research evidence and examples from the field, the article demonstrates that a strong, stable direct care workforce requires: a competitive wage and adequate employment benefits for direct care workers; updated training standards and delivery systems that prepare these workers to meet increasingly complex care needs across settings, while also enhancing career mobility and workforce flexibility; investment in well-trained frontline supervisors and peer mentors to help direct care workers navigate their challenging roles; and an elevated position for direct care workers in relation to the interdisciplinary care team. The article concludes by highlighting federal and state policy opportunities to achieve direct care job transformation, as well as discussing research and practice implications.
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21
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Covington‐Ward Y. Bodily Burdens: Physical Abuse, Workplace Injury, and Understanding Intersectionality through the Experiences of African Immigrant Direct Care Health Workers. TRANSFORMING ANTHROPOLOGY 2021. [DOI: 10.1111/traa.12214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Haraldsson P, Areskoug-Josefsson K, Rolander B, Strengbom E, Jonker D. Comparing the Structured Multidisciplinary work Evaluation Tool (SMET) questionnaire with technical measurements of physical workload in certified nursing assistants in a medical ward setting. APPLIED ERGONOMICS 2021; 96:103493. [PMID: 34116412 DOI: 10.1016/j.apergo.2021.103493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/29/2021] [Accepted: 06/02/2021] [Indexed: 06/12/2023]
Abstract
The Certified Nursing Assistant (CNA) is an important part of the workforce in hospitals and nursing homes, whose work includes heavy and repetitive work tasks including patient manual handling. The Structured Multidisciplinary work Evaluation Tool (SMET) questionnaire is an Occupational Health Service method for evaluation of the work environment. The aim of this study is to compare the SMET questionnaire with technical measurements of physical workload in CNAs in a medical ward setting. 16 CNA's participated voluntarily to 8 h of measurements during one workday. Physical workload was measured with surface electromyography and inclinometers, and the work environment was evaluated with the SMET questionnaire during the same working day. Spearman's rho was used in the statistical correlation analysis between measurements. This study shows strong, statistically significant correlations between the items in the SMET questionnaire and measured physical workload, n CNAs.
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Affiliation(s)
- P Haraldsson
- Occupational Safety and Health Care, Region Jönköping County, Jönköping, Sweden; School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - K Areskoug-Josefsson
- School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden; Faculty of Health Studies, VID Specialized University, Sandnes, Norway; Department of Behavioural Science, Oslo Metropolitan University, Oslo, Norway
| | - B Rolander
- Futurum - Academy for Healthcare, Region Jönköping County, Jönköping, Sweden; School of Health and Welfare, Department of Behavioural Science and Social Work, Jönköping University, Jönköping, Sweden
| | - E Strengbom
- Occupational Safety and Health Care, Region Jönköping County, Jönköping, Sweden
| | - D Jonker
- Occupational Safety and Health Care, Region Jönköping County, Jönköping, Sweden; School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
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23
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Bluth K, Lathren C, Silbersack Hickey JVT, Zimmerman S, Wretman CJ, Sloane PD. Self-compassion training for certified nurse assistants in nursing homes. J Am Geriatr Soc 2021; 69:1896-1905. [PMID: 33837539 PMCID: PMC8273132 DOI: 10.1111/jgs.17155] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND/OBJECTIVES Certified nursing assistants (CNAs) who work in nursing homes (NHs) face significant work and personal stress. Self-compassion training has been shown to decrease stress postintervention in previous studies among healthcare providers and those in helping professions. This study examines the feasibility, acceptability, and preliminary outcomes of self-compassion training to address CNA stress and well-being. DESIGN Pre-post intervention. SETTING Three mid-size, nonprofit NHs in North Carolina. PARTICIPANTS Thirty CNAs, with a mean age of 49, 96% of whom were female, and 83% black/African American. INTERVENTION In one NH, participants received an 8-week, 2.5-h/session (20 h total) group intervention. At the time of recruitment for NHs 2 and 3, a briefer format (6-week, 1-h/session; 6 h total) became available and was preferred by CNAs, thus both NHs 2 and 3 participants received a 6-h group intervention. All interventions occurred in meeting rooms within participating NHs during shift changes. MEASUREMENTS Intervention attendance, retention, and acceptability; self-compassion, stress, burnout, depression, and attitudes toward residents with dementia, and job satisfaction pre-, post-, 3-month post-, and 6-month postintervention were assessed. RESULTS Attendance and program satisfaction were high, and attrition was low for both training formats. Self-compassion was significantly improved at all time periods (p < 0.001), and stress and depression improved significantly through 3 months (p < 0.05), but not 6 months. No statistically significant change in job satisfaction was noted. CONCLUSION Self-compassion interventions are feasible and acceptable for CNAs working in NHs and show promise for managing stress and improving well-being and compassion toward residents. The briefer 6-h format may maximize participation, while still providing benefits.
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Affiliation(s)
- Karen Bluth
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, NC
| | - Christine Lathren
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Sheryl Zimmerman
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Christopher J. Wretman
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Philip D. Sloane
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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24
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Scales K. It Is Time to Resolve the Direct Care Workforce Crisis in Long-Term Care. THE GERONTOLOGIST 2021; 61:497-504. [PMID: 32853357 PMCID: PMC7499598 DOI: 10.1093/geront/gnaa116] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Indexed: 11/15/2022] Open
Abstract
Nearly 4.6 million direct care workers-including personal care aides, home health aides, and nursing assistants-provide daily support to older adults and people with disabilities across a range of settings in the United States, predominantly in long-term care (LTC). Even as the population grows older and drives up demand for LTC, the sector continues its decades-long struggle to fill direct care positions and stabilize this essential workforce. Recent events and emerging trends have converged, however, to produce new opportunities to address this longstanding workforce crisis, including the unprecedented attention generated by the coronavirus disease 2019 (COVID-19) pandemic and the systemic shifts to managed care and value-based payment in LTC. This Forum article outlines the pressing direct care workforce challenges in LTC before describing these potential levers of change, emphasizing the importance of not just expanding the workforce but also maximizing direct care workers' contributions to the delivery of high-quality services for a growing and evolving population of LTC consumers.
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25
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Ginsburg LR, Hoben M, Easterbrook A, Anderson RA, Estabrooks CA, Norton PG. Fidelity is not easy! Challenges and guidelines for assessing fidelity in complex interventions. Trials 2021; 22:372. [PMID: 34051830 PMCID: PMC8164256 DOI: 10.1186/s13063-021-05322-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 05/10/2021] [Indexed: 12/30/2022] Open
Abstract
Background Fidelity in complex behavioural interventions is underexplored and few comprehensive or detailed fidelity studies report on specific procedures for monitoring fidelity. Using Bellg’s popular Treatment Fidelity model, this paper aims to increase understanding of how to practically and comprehensively assess fidelity in complex, group-level, interventions. Approach and lessons learned Drawing on our experience using a mixed methods approach to assess fidelity in the INFORM study (Improving Nursing home care through Feedback On perfoRMance data—INFORM), we report on challenges and adaptations experienced with our fidelity assessment approach and lessons learned. Six fidelity assessment challenges were identified: (1) the need to develop succinct tools to measure fidelity given tools tend to be intervention specific, (2) determining which components of fidelity (delivery, receipt, enactment) to emphasize, (3) unit of analysis considerations in group-level interventions, (4) missing data problems, (5) how to respond to and treat fidelity ‘failures’ and ‘deviations’ and lack of an overall fidelity assessment scheme, and (6) ensuring fidelity assessment doesn’t threaten internal validity. Recommendations and conclusions Six guidelines, primarily applicable to group-level studies of complex interventions, are described to help address conceptual, methodological, and practical challenges with fidelity assessment in pragmatic trials. The current study offers guidance to researchers regarding key practical, methodological, and conceptual challenges associated with assessing fidelity in pragmatic trials. Greater attention to fidelity assessment and publication of fidelity results through detailed studies such as this one is critical for improving the quality of fidelity studies and, ultimately, the utility of published trials. Trial registration ClinicalTrials.gov NCT02695836. Registered on February 24, 2016 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05322-5.
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Affiliation(s)
- Liane R Ginsburg
- School of Health Policy & Management, Faculty of Health, York University, Toronto, Ontario, M3J 1P3, Canada.
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Adam Easterbrook
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Ruth A Anderson
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, 27599-7460, USA
| | - Carole A Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Peter G Norton
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
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Job and family demands and burnout among healthcare workers: The moderating role of workplace flexibility. SSM Popul Health 2021; 14:100802. [PMID: 33997249 PMCID: PMC8102798 DOI: 10.1016/j.ssmph.2021.100802] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/31/2021] [Accepted: 04/18/2021] [Indexed: 12/13/2022] Open
Abstract
Burnout is a growing problem among healthcare workers. Whereas there are numerous predictors of burnout, this article explores the compounding effects of job and family demands among nurses and Patient Care Associates (PCA). This study used the 2018 survey data of the Boston Hospital Health Workers Study (BHWHS) to assess the relationship of job and family demands, workplace flexibility, and burnout (N = 874). In addition, it aimed to evaluate the moderating effect of workplace flexibility and job and family demands on burnout. Results of the study demonstrate that active and high strained healthcare workers are associated with higher odds of experiencing burnout as well as workers who reported perceived low workplace flexibility. In addition, workplace flexibility is associated with reduced odds of experiencing burnout. Workplace flexibility moderated the relationship of childless married healthcare workers and burnout. The study shows that workplace flexibility plays a critical role in potentially reducing odds of burnout in the healthcare worker population. Assessing the perception and accessibility to workplace flexibility among workers is imperative to improve worker well-being and the quality of care provided to patients especially the current effects to worker's health during a pandemic. Burnout is an increasing concern among healthcare workers. We examined the buffering effects of workplace flexibility on the compounding effects of job and family demands on burnout. Workplace flexibility is associated with lower odds of burnout. Healthcare workers who are categorized as active and high-strained are associated with higher odds of burnout. Workplace flexibility moderated the relationship of married healthcare workers without children and burnout.
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Variations in Workplace Safety Climate Perceptions and Outcomes Across Healthcare Provider Positions. J Healthc Manag 2021; 65:202-215. [PMID: 32398531 DOI: 10.1097/jhm-d-19-00112] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
EXECUTIVE SUMMARY Injury rates reported among healthcare practitioners tend to vary depending on position. Nurses and healthcare aides report different rates of injury, which suggests that position and job duties may be key injury antecedents. The outcomes related to workplace safety climate perceptions (e.g., injury rates, job satisfaction, turnover) require reflection to identify antecedents of safety perception. The purpose of this study was to examine workplace safety perceptions and well-being (e.g., stress, job satisfaction) of healthcare practitioners by position. A cross-sectional survey of care teams (e.g., nurses, healthcare aides, allied health professionals) was conducted across three inpatient units. Data (N = 144) were analyzed using hierarchical linear regression and binomial logistic regression to examine the relationship between safety climate and self-reported injuries and ANOVA to determine variations in safety climate perceptions by position. Results indicated that nurses, healthcare aides, and allied health professionals report differing levels of workplace safety climate perceptions. Nurses reported the poorest safety perceptions, lowest job satisfaction, and highest stress, while allied health professionals reported the highest safety perceptions and job satisfaction and the lowest stress. Safety climate perceptions were found to be significantly related to care practitioner reported stress, turnover intent, and job satisfaction. Considering the importance of safety climate perceptions for the well-being of care practitioners, healthcare organizations need to prioritize workplace safety to optimize practitioners' perceptions. This study makes a unique contribution to the safety climate literature by identifying the variation in safety climate perceptions by care practitioner position. Practical implications are offered for enhancing workplace safety perceptions.
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Tu J, Mei X, Fang C. Indispensable outsiders: A qualitative study of the working experiences of hospital care workers in China. J Nurs Manag 2020; 29:268-276. [PMID: 32888383 DOI: 10.1111/jonm.13149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 12/13/2022]
Abstract
AIMS To explore the working experiences of Chinese hospital care workers from their own perspectives. BACKGROUND Many countries face an increasing demand for nursing care and an acute shortage of registered nurses. As a result, much of the care work at hospitals is delegated to assistant staff, such as care workers. METHODS Data were collected by semi-structured interviews with 22 hospital care workers in three hospitals of Guangzhou City, China. Thematic analysis was used to analyse the data. RESULTS Hospital care workers are mainly rural-to-urban migrant women, partaking in caregiver jobs to make a living. They play a significant role in the hospital to aid patients as well as nurses. Hospital care workers experience a sense of ambiguity towards their job, viewing it as "low" and "isolated", yet at the same time, "acceptable" and "helping". CONCLUSION Hospital care workers are a workforce that is not well supported, trained or regulated. Their working experiences suggest that attention needs to be given to protecting this vulnerable group. IMPLICATIONS FOR NURSING MANAGEMENT The working conditions of hospital care workers should be improved. Hospital care workers need improved status, increased rewards, and channels for further training and opportunities for continued career advancement.
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Affiliation(s)
- Jiong Tu
- School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou, China.,Center for Medical Humanities, Sun Yat-sen University, Guangzhou, China
| | - Xiao Mei
- Institute of Sociology, Chinese Academy of Social Sciences, Beijing, China
| | - Chan Fang
- Center for Medical Humanities, Sun Yat-sen University, Guangzhou, China.,Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
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29
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Rai R, Fritschi L, Carey RN, Lewkowski K, Glass DC, Dorji N, El‐Zaemey S. The estimated prevalence of exposure to carcinogens, asthmagens, and ototoxic agents among healthcare workers in Australia. Am J Ind Med 2020; 63:624-633. [PMID: 32236973 DOI: 10.1002/ajim.23108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/07/2020] [Accepted: 03/17/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Healthcare workers are occupationally exposed to various hazardous chemicals and agents that can potentially result in long-term adverse health effects. These exposures have not been comprehensively examined at a population level. The aim of this study was to examine occupational exposures to a wide range of asthmagens, carcinogens, and ototoxic agents among healthcare workers in Australia. METHODS Data were collected as part of the Australian Work Exposures Studies, which were computer-assisted telephone surveys conducted in 2011, 2014, and 2016 to assess the prevalence of occupational exposures to carcinogens, asthmagens, and ototoxic agents, respectively, among Australian workers. Using data on healthcare workers, the prevalence of exposures to these agents was calculated and associations of demographic variables and occupation groups with exposure status were examined. RESULTS The prevalence of exposure to at least one asthmagen, carcinogen, and ototoxic agent was 92.3%, 50.7%, and 44.6%, respectively. The most common exposures were to (a) cleaning and sterilizing agents in the asthmagen group; (b) shift work in the carcinogen group; and (c) toluene and p-xylene among ototoxic agents. Exposure varied by occupation, with exposure to carcinogens and ototoxic agents highest among personal carers and exposure to carcinogens most likely among nursing professionals and health and welfare support workers. CONCLUSION The results demonstrate that a substantial proportion of Australian healthcare workers are occupationally exposed to asthmagens, carcinogens, and ototoxic agents. These exposures are more common among certain occupational groups. The information provided by this study will be useful in prioritizing and implementing control strategies.
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Affiliation(s)
- Rajni Rai
- School of Public HealthCurtin University Bentley Western Australia Australia
| | - Lin Fritschi
- School of Public HealthCurtin University Bentley Western Australia Australia
| | - Renee N. Carey
- School of Public HealthCurtin University Bentley Western Australia Australia
| | - Kate Lewkowski
- School of Public HealthCurtin University Bentley Western Australia Australia
| | - Deborah C. Glass
- School of Public Health and Preventive MedicineMonash University Melbourne Victoria Australia
| | - Nidup Dorji
- Faculty of Nursing and Public HealthKhesar Gyalpo University of Medical Sciences of Bhutan Thimphu Bhutan
| | - Sonia El‐Zaemey
- School of Public HealthCurtin University Bentley Western Australia Australia
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Shippee TP, Akosionu O, Ng W, Woodhouse M, Duan Y, Thao MS, Bowblis JR. COVID-19 Pandemic: Exacerbating Racial/Ethnic Disparities in Long-Term Services and Supports. J Aging Soc Policy 2020; 32:323-333. [DOI: 10.1080/08959420.2020.1772004] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Tetyana P. Shippee
- Associate Professor, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Odichinma Akosionu
- Research Assistant, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Weiwen Ng
- Research Assistant, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mark Woodhouse
- Database Manager, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Yinfei Duan
- Research Assistant, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mai See Thao
- Postdoctoral Fellow in Primary Care Research, Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - John R. Bowblis
- Professor of Economics, Farmer School of Business, Miami University, Oxford, Ohio, USA
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31
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Ghanayem M, Srulovici E, Zlotnick C. Occupational strain and job satisfaction: The job demand–resource moderation–mediation model in haemodialysis units. J Nurs Manag 2020; 28:664-672. [DOI: 10.1111/jonm.12973] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/14/2019] [Accepted: 02/06/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Mohamad Ghanayem
- The Cheryl Spencer Department of Nursing University of Haifa Haifa Israel
- Hemodialysis Unit The Baruch Padeh Medical Center Tiberias Israel
| | - Einav Srulovici
- The Cheryl Spencer Department of Nursing University of Haifa Haifa Israel
| | - Cheryl Zlotnick
- The Cheryl Spencer Department of Nursing University of Haifa Haifa Israel
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32
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Travers JL, Teitelman AM, Jenkins KA, Castle NG. Exploring social-based discrimination among nursing home certified nursing assistants. Nurs Inq 2019; 27:e12315. [PMID: 31398775 DOI: 10.1111/nin.12315] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 07/04/2019] [Accepted: 07/04/2019] [Indexed: 12/11/2022]
Abstract
Certified nursing assistants (CNAs) provide the majority of direct care to nursing home residents in the United States and, therefore, are keys to ensuring optimal health outcomes for this frail older adult population. These diverse direct care workers, however, are often not recognized for their important contributions to older adult care and are subjected to poor working conditions. It is probable that social-based discrimination lies at the core of poor treatment toward CNAs. This review uses perspectives from critical social theory to explore the phenomenon of social-based discrimination toward CNAs that may originate from social order, power, and culture. Understanding manifestations of social-based discrimination in nursing homes is critical to creating solutions for severe disparity problems among perceived lower-class workers and subsequently improving resident care delivery.
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Affiliation(s)
- Jasmine L Travers
- National Clinician Scholars Program, Yale University Schools of Medicine and Nursing, New Haven, CT, USA
| | - Anne M Teitelman
- Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Kevin A Jenkins
- Perelman School of Medicine, University of Pennsylvania School of Social Policy and Practice, Philadelphia, PA, USA
| | - Nicholas G Castle
- Department of Health Policy, Management and Leadership, West Virginia University, Morgantown, WV, USA
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Ginsburg L, Easterbrook A, Berta W, Norton P, Doupe M, Knopp-Sihota J, Anderson RA, Wagg A. Implementing Frontline Worker-Led Quality Improvement in Nursing Homes: Getting to "How". Jt Comm J Qual Patient Saf 2018; 44:526-535. [PMID: 30166036 DOI: 10.1016/j.jcjq.2018.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 04/17/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite emerging frameworks for quality improvement (QI) implementation, little is known about how the implementation process works, particularly in nursing home settings. A study was conducted to describe "how"' a complex frontline worker-led QI program was implemented in nursing homes. METHODS Six focus groups were conducted in February 2017 with participants of a year-long, multicomponent, unit-level QI intervention in seven nursing homes in the Canadian province of Manitoba. Constant comparative analysis was used to examine perspectives of different groups of QI program participants-35 health care aides, health professionals, and managers. RESULTS Five themes important to the implementation process were identified: (1) "supportive elements of the QI program structure," (2) "navigating the workplace," (3) "negotiating relationships," (4) "developing individual skills," and (5) "observable program impact." Data on theme integration suggest that "supportive elements of the QI program structure" (Theme 1), "developing individual skills" (Theme 4), and "observable program impact" (on residents, health care aides, and leaders; Theme 5) operated as part of a reinforcing feedback loop that boosted team members' ability to navigate the workplace, negotiate relationships, and implement the QI program. CONCLUSION Health care aide-led QI teams are feasible. However, a leadership paradox exists whereby worker-led QI programs also must incorporate concrete mechanisms to promote strong leadership and sponsor support to teams. The findings also point to the underexplored impact of interpersonal relationships between health care aides and professional staff on QI implementation.
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Wang Y, Yuan H. What is behind high turnover: a questionnaire survey of hospital nursing care workers in Shanghai, China. BMC Health Serv Res 2018; 18:485. [PMID: 29929520 PMCID: PMC6013857 DOI: 10.1186/s12913-018-3281-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 06/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Currently, hospital nursing care workers (hereafter referred to as HNCWs) have become an important part of the healthcare system in China. They exist in nearly all of the public hospitals and in some private hospitals, making up 20 to 30% of the total nursing staff and providing 30 to 40% of basic nursing care for patients. However, many studies have shown that the turnover rate of HNCWs is very high, with average annual rates of 20 to 45%. We conducted this survey to explore their turnover intentions and related factors and present some suggestions to improve their retention rate. METHODS A total of 514 HNCWs employed at 11 hospitals in Shanghai participated in this study. The inclusion criteria were as follows: (1) being a certified HNCW, (2) having worked as an HNCW for more than 1 year, and (3) volunteering to take part in the survey. RESULTS The overall turnover intention of the HNCWs was 41.3%. Influencing factors include education (βeta = 0.201, P = 0.000), wages (βeta = - 0.920, P = 0.000), management satisfaction, (βeta = - 0.213, P = 0.000), satisfaction with wages (βeta = - 0.612, P = 0.000), satisfaction with working hours (βeta = - 0.270, P = 0.000), satisfaction with their own work (βeta = - 0.066, P = 0.027), work stress (βeta = 0.726, P = 0.000), enjoyment of the job (βeta = - 0.141, P = 0.000) and hours of sleep (βeta = - 0.046, P = 0.037). CONCLUSIONS Decreasing HNCWs' turnover intentions and the overall turnover rate is important for improving the quality of healthcare. More attention should be paid to this issue in the enactment of health policy.
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Affiliation(s)
- Yan Wang
- Renji Hospital Shanghai Jiao Tong University School of Medicine, NO.160 Pujian Road, ShangHai, 200127 China
| | - Huiyun Yuan
- Renji Hospital Shanghai Jiao Tong University School of Medicine, NO.160 Pujian Road, ShangHai, 200127 China
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35
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Wu Y, Zheng J, Liu K, Baggs JG, Liu J, Liu X, You L. The associations of occupational hazards and injuries with work environments and overtime for nurses in China. Res Nurs Health 2018; 41:346-354. [PMID: 29862524 DOI: 10.1002/nur.21882] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 04/27/2018] [Indexed: 12/13/2022]
Abstract
Occupational hazards (OHs) and occupational injuries (OIs) may contribute to nurses needing sick time and to a high financial burden for hospitals. There is little published literature about nurse-reported OHs/OIs and their relationships with work environments and working overtime in China. This study was designed to describe Chinese hospital registered nurses' OHs/OIs and to explore the associations between work environments, working overtime, and nurse-reported OHs/OIs. This cross-sectional study was conducted in Guangdong province in China in 2014. The sample included 1,517 nurses from 111 medical/surgical units in 23 hospitals. The Practice Environment Scale of the Nursing Work Index was used to measure work environment. Overtime was calculated by subtracting scheduled work hours from actual work hours. Six items were used to measure nurse-reported OHs/OIs. Descriptive statistics, Chi-square tests, and two-level logistic regression models were used to analyze the data. The percentages of nurses reporting OHs/OIs occurred in the year before the survey ranged from 47% to 80%. Nurses who worked in good (vs. poor) unit work environments were less likely to experience OHs/OIs (Odds ratio [OR] = 0.65-0.68, p < .05). Nurses who worked overtime (OR = 1.19-1.33, p < .05) and in Level 3 (largest) hospitals (OR = 1.45-1.80, p < .05) were more likely to experience OHs/OIs. We found that OHs/OIs were prevalent among hospital nurses in China. Better work environment and less nurse overtime were associated with fewer nurse OHs/OIs.
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Affiliation(s)
- Yan Wu
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Jing Zheng
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Ke Liu
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Judith G Baggs
- School of Nursing, Oregon Health & Science University, Portland, Oregon
| | - Jiali Liu
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Xu Liu
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Liming You
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
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36
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Halifax E, Miaskowski C, Wallhagen M. Certified Nursing Assistants' Understanding of Nursing Home Residents' Pain. J Gerontol Nurs 2018; 44:29-36. [PMID: 29437185 DOI: 10.3928/00989134-20180131-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 12/19/2017] [Indexed: 01/12/2023]
Abstract
Pain is a significant problem for nursing home residents, yet its assessment is complex. Certified nursing assistants (CNAs) spend significant time with residents, but their role in understanding residents' pain is largely unexplored. The current qualitative grounded theory study analyzed interviews with 16 CNAs who described their experiences caring for residents in pain. Findings revealed how CNAs understood, recognized, interpreted, and responded to residents' pain. CNAs were found to differentiate between pain that they considered normal (everyday pain) and new pain judged significant enough to report to licensed nurses. CNAs exhibited a holistic understanding of pain, knowledge of strategies to identify and interpret pain, and actions to independently mitigate and report pain. Although additional confirmatory data are needed, the differentiation made between everyday and reportable pain may have important clinical implications suggesting that CNAs should always report to a licensed nurse when they perceive or suspect that residents have pain. [Journal of Gerontological Nursing, 44(4), 29-36.].
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Sanagoo A, Abdi Zarrini K, Jouybari L, Vakili M, Kavosi A. Evaluation of occupational hazards for nurses in intensive care units of tertiary care centers. JOURNAL OF NURSING AND MIDWIFERY SCIENCES 2018. [DOI: 10.4103/jnms.jnms_52_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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