The Influence of Supportive and Ethical Work Environments on Work-Related Accidents, Injuries, and Serious Psychological Distress among Hospital Nurses

Workplace ethical climate and its relationship with depression, anxiety and stress

BACKGROUND

Ethical climate in the workplace has been highlighted to have an important impact on workers' mental health; the evaluation of workplace ethics and its impact on workers' health should be considered an occupational health issue.

AIMS

The present study aims to investigate ethical climate as perceived by workers, and its correlation with mental health outcomes, in particular, symptoms of depression, anxiety and stress.

METHODS

A cross-sectional study was performed by administering an online survey, investigating socio-demographic variables, workplace ethics (through the Italian short version of the Corporate Ethical Virtues questionnaire) and mental health outcomes (using the short version of the Depression, Anxiety and Stress Scale). Descriptive analyses, analyses of variance and regression models were performed; P-values were considered significant for values ≤0.05.

RESULTS

The sample included 176 workers; the mean age of participants was 46.22 years and 44% were males. The most represented job sector was health care (37%), and 42% of participants had college-level education. Ethical climate was significantly correlated with all mental health outcomes investigated in the study: anxiety (P ≤ 0.001), depression (P ≤ 0.05) and stress (P ≤ 0.05).

CONCLUSIONS

Results from this study highlighted a significant correlation between workplace ethical climate and depression, anxiety and stress. This study underlines the importance of evaluating and improving ethical climate to prevent the onset of psychological distress in workers. Furthermore, results from this study should be a starting point for future research investigating the role of ethics and mental health in employees' turnover intention and job satisfaction.

The Commitment to Excellence: Understanding Nurses' Perspectives on Continuous Professional Development

Continuous Professional Development (CPD) is essential for nurses to maintain up-to-date knowledge and skills in the evolving healthcare sector. This study explores nurses' attitudes toward CPD, its necessity, and the challenges encountered. The aim is to examine nurses' perspectives on CPD, focusing on their participation and motivation, in relation to their workplace, workplace function, and form of work. A cross-sectional study design was employed with 151 nurses from University Hospital Centre Split, Croatia. Data were collected using the "Professional Development of Nurses questionnaire (Q-PDN)" and analyzed using descriptive statistical methods, the Kolmogorov-Smirnov test, Pearson's correlation, ANOVA test, and t-test. The average level of participation in CPD activities was 4.27 (±0.63), indicating a positive inclination towards CPD. The study identified a statistically significant difference in activities related to CPD (t = 2.12; p = 0.036) among employees of surgical and intensive care units compared to other departments, where a higher level of engagement was present among employees of other departments. Notably, nurses without managerial roles showed 0.16 points higher participation in CPD activities compared to their managerial counterparts, though this was not statistically significant (t = 0.92; p = 0.357). Nurses in managerial roles valued CPD for professional development more highly, with a significant difference (t = 2.77; p = 0.006). Full-time nurses demonstrated a higher perception of the importance of personal professional development compared to part-time nurses, with a significant difference (F = 2.88; p = 0.038). The study reveals a strong commitment to CPD among nurses, with variations based on workplace roles and schedules. It underscores the need for role-specific and adaptable CPD programs to meet diverse needs and enhance professional competence in the nursing workforce.

The relationship between psychological capital, patient's contempt, and professional identity among general practitioners during COVID-19 in Chongqing, China

General practitioners are crucial in the primary healthcare system as well as for epidemic prevention and control. However, few researchers have examined their professional identity. This study investigated the current status of the professional identity of general practitioners in Chongqing, China and explored the effects of psychological capital and patient's contempt on their professional identity. From December 2021 to January 2022, randomized cluster sampling was used to conduct a cross-sectional online self-assessment questionnaire survey among general practitioners in Chongqing. In total, 2,180 general practitioners working for more than one year were selected. General practitioners' sense of professional identity, mental health, and sense of patients' disrespect were measured using the Professional Identity Scale, Psychological Capital Questionnaire, and Patient's Contempt Questionnaire. Sociodemographic characteristics were also collected. A multiple linear regression model was used to analyze the association between professional identity, psychological capital, and patient's contempt. The average score for professional identity among general practitioners was 53.59 (SD = 6.42). The scores for self-efficacy, hope, resilience, and optimism (subscales of psychological capital) were 26.87 (SD = 5.70), 26.47 (SD = 5.74), 26.97 (SD = 5.55), and 26.86 (SD = 5.59), respectively. The score for perceived contempt was 34.19 (SD = 7.59). An average monthly income greater than CNY 8,000 (β = 1.018, p < 0.001), work tenure of more than 15 years (β = 0.440, p = 0.001), hope (β = 0.249, p < 0.001) and a higher optimism score (β = 0.333, p < 0.001) were positively correlated with professional identity. Having a bachelor's degree and above (β = -0.720, p = 0.014), an administrative role (β = -1.456, p < 0.001), self-efficacy (β = -0.122, p < 0.001), and higher patient's contempt (β = -0.103, p < 0.001) were negatively associated with professional identity. General practitioners in Chongqing demonstrated high professional identity and a strong psychological status during the COVID-19 pandemic. Psychological capital and patient's contempt were associated with professional identity. To improve general practitioners' professional identity, stakeholders should promote practitioners' mental health and physician-patient relationships in China.

Shift work organization on nurse injuries: A scoping review

BACKGROUND

Extended work hours and shift work can result in mistimed sleep, excessive sleepiness, and fatigue, which affects concentration and cognition. Impaired concentration and cognition negatively affect employee safety.

OBJECTIVE

To examine the evidence of the impact of shift work organization, specifically work hours and scheduling, on nurse injuries including needlestick and sharps injuries, drowsy driving and motor vehicle crashes, and work-related accidents causing a near miss or actual injury to the nurse.

METHODS

A scoping review was conducted using search results from five bibliographic databases.

RESULTS

Through database searching, 7788 articles were identified. During the title and abstract screening, 5475 articles were excluded. Full text screening eliminated 1971 articles. During the data extraction phase, 206 articles were excluded leaving 34 articles from 14 countries in the scoping review. The results of the review suggest a strong association in nurses between long work hours and overtime and an increased risk for needlestick and sharps injuries, drowsy driving and motor vehicle crashes, and other work-related accidents. Rotating shifts increase the risk for needlestick and sharps injuries and other work-related accidents while night and rotating shifts increase the risk for drowsy driving and motor vehicle crashes.

CONCLUSIONS

Proper management of work hours and scheduling is essential to maximize recovery time and reduce or prevent nurse injuries. Nurse leaders, administrators, and managers, have a responsibility to create a culture of safety. This begins with safe scheduling practices, closely monitoring for near miss and actual nurse injuries, and implementing evidence-based practice strategies to reduce these occurrences.

Relationship between turnover intention and workplace personal relations among care workers employed by elder care facilities

BACKGROUND

This study focuses on care workers at elder care facilities to examine what factors (including workplace personal relations) influence turnover intention and to what extent. Based on this analysis, the study discusses the content of workplace personal relations problems in qualitative terms.

METHODS

The study targeted care workers at elder care facilities. There were 406 participants with no missing data who were analyzed. The survey period ranged from September to November 2021. Questions consisted of basic attributes, turnover intention, problems with workplace personal relations, content of personal relation problems, and psychological distress.

RESULTS

Female care workers were 2.25 times more likely than male care workers to have turnover intention. Care workers with workplace personal relation problems were 1.97 times more likely than those without these problems to have high turnover intention. Moreover, with regard to psychological distress, the ratio increased to 4.99 times. The following six categories were extracted from the text data on workplace personal relation problems: insufficient communication, bullying, sense of unfair workload, different attitudes to care work, difficulty in guidance for subordinates/new staff, and labelling.

CONCLUSIONS

Gender, workplace personal relation problems, and psychological distress have shown to affect care workers' turnover intentions. To prevent care worker turnover, future studies should focus on the development and impact of strategies to improve workplace personal relations specific to care workers, targeting the six factors identified in this study.

Do Leadership, Organizational Communication, and Work Environment Impact Employees' Psychosocial Hazards in the Oil and Gas Industry?

Workplace hazards can have a significant influence on a worker's physical and mental health, reducing an organization's effectiveness in terms of safety. However, psychosocial hazards are being recognized as a crucial component that must be addressed for the individual's and organization's safety. The purpose of this research was to propose and statistically evaluate a brief theoretical framework based on leadership, organizational communication, work environment, and psychosocial hazards in Malaysia's upstream oil and gas sector. The framework was tested on 380 Malaysian upstream oil and gas workers. The collected data were analyzed using partial least squares and structural equation modelling (PLS-SEM). The study's findings revealed that in the Malaysian oil and gas industry, leadership, communication, and work environment negatively influenced the psychosocial hazards. This negative association between predictors and psychosocial hazards, particularly job expectations, control, role, and relationships, indicates new grounds for research. It is discussed how the findings could be used to track employees' well-being over time and generate focused treatments.

Changes in Psychological Distress in Five Groups of Welfare State Service Workers over a Nine-Year Period

Health and social care workers are exposed to varying degrees of stress in their work, which may be reflected in their trajectories of psychological distress during the education program and the first years in the job. The aim of this study was to add to the knowledge concerned with the long-term development of psychological distress in five groups of welfare state service workers in Norway. The study included 1612 individuals. Psychological distress was measured with General Health Questionnaire-12 at four occasions from the start of the education program to 6 years post-graduation (nine year follow-up period). Results of linear mixed models (LMM) for repeated measures showed that psychological distress changed significantly over time in the social work professional groups. At the start of the education program, the lowest and highest levels of psychological distress were found among the child welfare and social workers, respectively. Six years post-graduation, social workers had become less distressed and child welfare workers had become more distressed. No significant change pattern for psychological distress was found among any of the health care professional groups.

A conceptual model of nurses' workplace social capital: a theory synthesis

BACKGROUND

Research has confirmed the importance of workplace social capital in the nursing workforce. Integration of the empirical evidence about nurses' workplace social capital into a scientific collection can provide a comprehensive presentation of this concept. This scientific collection can be a conduit for further research and advancement of nursing management and leadership. The purpose of this paper, therefore, is to discuss the process of developing a conceptual model of nurses' workplace social capital, an effective and concise approach to illustrate a scientific phenomenon.

METHODS

The model of nurses' workplace social capital was developed following Walker and Avant's strategy of theory synthesis. Empirical evidence relevant to nurses' workplace social capital was synthesized by systematically examining the existing literature. PubMed, CINAHL, Web of Science and Google Scholar were searched periodically from October 2017 to July 2020.

RESULTS

Our proposed conceptual model lays out the determinants and outcomes of nurses' workplace social capital and specifies the relational statements among these concepts. Nurses' workplace social capital is influenced by the organizational and individual determinants shaped by multiple layers of sub-concepts. The development and implementation of nurses' workplace social capital has three themes of consequences: 1) nurses' outcomes; 2) patients' outcomes; and 3) organizational outcomes. All the concepts and statements have been organized and aligned with the principles of "inventory of determinants or results" and "theoretical blocks".

CONCLUSION

Our theoretical synthesis offers a comprehensive picture of the current knowledge of nurses' workplace social capital. Efforts should be dedicated to evaluating, revising, and revamping this newly developed model based on future empirical evidence. Our synthesized conceptual model is the segue to more comprehensive studies about nurses' workplace social capital. Interventional programs for the development of social capital can be structured based on the identified determinants.

Factors of feelings of happiness at work among staff in geriatric care facilities

Aim

To examine the factors influencing feelings of happiness at work among caregivers in geriatric care facilities.

Methods

Self‐reported questionnaires were distributed to caregivers (n = 1396) at 26 geriatric care facilities. The response rate was 68%. The questionnaire had items regarding feelings of happiness at work, professionalism in dementia care (i.e. intrinsic motivation), wage adequacy, and subscales of The Social Capital and Ethical Climate in the Workplace scale (extrinsic motivations), basic attributes, and work and organizational characteristics. Data pertaining to 632 staff members were used in the multivariable logistic regression for the group with high scores on feelings of happiness at work, by sex and occupation.

Results

Higher professionalism in dementia caregiving was more likely to occur in the high‐score groups among all staff (OR 1.21–1.55, P < 0.01). Female nurses and male professional caregivers with higher scores for social capital in the workplace (OR 3.11, P < 0.01; OR = 2.33, P < 0.05) and female professional caregivers with higher scores for ethical leadership (OR 1.78, P < 0.01) were more likely to be in the high‐score group for feelings of happiness at work, whereas male professional caregivers with perceived inadequacy of wages (OR 0.33, P < 0.05) were less likely to be in the high‐score group for feelings of happiness at work.

Conclusions

The findings underlined the important contributory factors of feelings of happiness at work, which could motivate stakeholders to enhance social capital, ethical leadership, and remuneration and other extrinsic rewards to improve staff well‐being. Geriatr Gerontol Int 2021; 21: 818–824.

Ethical Climate as Social Norm: Impact on Judgements and Behavioral Intentions in the Workplace

We present a study that looks at the relationship between the ethical climate, considered as a set of social norms, and judgments and behaviors in the workplace. In this case we think that an ethical rule reflecting the climate is only actualized in conduct and/or decisions if the rule is applicable, is shared, and is the subject of social expectations. A total of 277 professionals responded to a questionnaire measuring the normativity of three ethical rules, socio-moral judgment, trust in supervisors, turnover intention, and discrimination as well as abusive supervision. The results confirm our hypothesis. This leads to a different view of how the ethical climate is measured and constructed in the workplace.

Ethical climate in contemporary paediatric intensive care

Ethical climate (EC) has been broadly described as how well institutions respond to ethical issues. Developing a tool to study and evaluate EC that aims to achieve sustained improvements requires a contemporary framework with identified relevant drivers. An extensive literature review was performed, reviewing existing EC definitions, tools and areas where EC has been studied; ethical challenges and relevance of EC in contemporary paediatric intensive care (PIC); and relevant ethical theories. We surmised that existing EC definitions and tools designed to measure it fail to capture nuances of the PIC environment, and sought to address existing gaps by developing an EC framework for PIC founded on ethical theory. In this article, we propose a Paediatric Intensive Care Ethical Climate (PICEC) conceptual framework and four measurable domains to be captured by an assessment tool. We define PICEC as the collective felt experience of interdisciplinary team members arising from those factors that enable or constrain their ability to navigate ethical aspects of their work. PICEC both results from and is influenced by how well ethical issues are understood, identified, explored, reflected on, responded to and addressed in the workplace. PICEC encompasses four, core inter-related domains representing drivers of EC including: (1) organisational culture and leadership; (2) interdisciplinary team relationships and dynamics; (3) integrated child and family-centred care; and (4) ethics literacy. Future directions involve developing a PICEC measurement tool, with implications for benchmarking as well as guidance for, and evaluation of, targeted interventions to foster a healthy EC.

Development of a relational workplace social capital scale for Japanese nurses

BACKGROUND

Although nurses' workplace social capital for a healthy work environment has received considerable attention, few scales about nurses' workplace social capital are based on the attributes of clinical settings in Japan. This study aims to develop a Relational Workplace Social Capital Scale for Japanese Nurses (RWSCS-JN), which includes bonding, linking, and bridging social capital and assessing its reliability and validity.

METHODS

We assessed its reliability and validity using questionnaire survey data collected from 309 nurses in the first survey and 105 nurses in the second survey in four hospitals in Japan. First, we determined the number of factors and items for the RWSCS-JN through the parallel and factor analyses after conducting the item analysis. Then, we confirmed the omega coefficients and intraclass correlation coefficients (ICC) of the RWSCS-JN. Finally, we examined the Pearson product-moment correlation coefficient between the RWSCS-JN score and other variables, including an existing measurement of workplace social capital, work engagement, and turnover intention.

RESULTS

The newly developed RWSCS-JN contained 15 items, comprising three factors as follows: bonding social capital, linking social capital, and bridging social capital. The omega coefficient and the ICC of the RWSCS-JN were 0.90 and 0.85, respectively. The Pearson product-moment correlation coefficient between the RWSCS-JN and the existing scale of the workplace social capital was 0.88 (p < 0.01). Furthermore, the Pearson product-moment correlation coefficient between the RWSCS-JN and work engagement was 0.36 (p < 0.01) and that of the RWSCS-JN and turnover intention was - 0.40 (p < 0.01).

CONCLUSIONS

This study suggests that the RWSCS-JN could be sufficiently useful for a healthy work environment in a clinical setting.

Workplace Ostracism in Nurses and Its Determining Factors

AIM AND OBJECTIVES

This study attempted to identify workplace ostracism in nurses and its determining factors.

BACKGROUND

Ostracism, which is a form of mistreatment in the nursing workplace, is neglected in the nursing profession although it can affect the quality of healthcare services.

DESIGN

The present study was a descriptive correlational study.

METHODS

Nurses in healthcare centers (n = 340) that had at least 12 months of clinical care experience were selected through proportionate stratified random sampling for the period from 2018 to 2019. The study instruments were a modified questionnaire based on the workplace ostracism scale and a questionnaire that assessed personal-social factors. To analyze the data, descriptive and inferential statistics were used.

RESULTS

Participants' average ostracism score was 9.03 ± 36.63, and there were statistically significant relationships between ostracism and employment status, university of education, a record of getting an incentive, nurses' current physical disorders, and feelings of colleagues' envy and managers' discrimination.

CONCLUSIONS

Applying some approaches to educate nurses about interpersonal relationships and clearly communicating mutual expectations between the staff and nursing management could help solve this problem.

IMPLICATIONS FOR PRACTICE

The study results will serve to guide legislators and managers in developing interventions to create supportive and safe work environments, both for nurses and patients.

Factors related to turnover intentions and work-related injuries and accidents among professional caregivers: a cross-sectional questionnaire study

Background

The Japanese health and welfare industry has a shortage of professional caregivers, and work-related accidents and injuries among this group are therefore especially critical issues. This study aimed to examine the factors associated with turnover intentions and work-related injuries and accidents among professional caregivers in Japan.

Methods

Self-report questionnaires were distributed to care workers (N = 1396) at 26 geriatric-care facilities. The questionnaire addressed basic attributes, work and organizational characteristics, wage adequacy, and intrinsic motivations for work (e.g., “being suited to caring work”). Social-relational aspects of the work environment were assessed via three subscales of the Social Capital and Ethical Climate in the Workplace instrument (i.e., “Social Capital in the Workplace,” “Exclusive Workplace Climate,” and “Ethical Leadership”). Dependent variables were the experience of work-related accidents or injuries in the prior year and organizational and occupational turnover intentions. We used datasets of professional caregivers for analyses.

Results

The response rate was 68% (N = 949). Among the 667 professional caregivers, 63% were female. On multivariable logistic regression analysis for work-related accidents and injuries for each sex, those with higher scores for “being suited to caring work” were found to experience significantly fewer work-related accidents and injuries (odds ratio [OR] = 0.78, p < 0.01) among female caregivers. Male caregivers who perceived an exclusive workplace climate experienced more work-related accidents and injuries (OR = 1.61, p < 0.01). However, experience of work-related accidents and injuries did not show significant relationships with organizational and occupational turnover intentions. Additionally, “being suited to caring work” (OR = 0.73, p < 0.01) and ethical leadership (OR = 0.76, p < 0.05) were found to be negatively associated with organizational turnover intentions. “Being suited to caring work” (OR = 0.61, p < 0.01), inadequacy of wage (OR = 2.22, p < 0.05), and marital status (OR = 2.69, p < 0.01) were also associated with occupational turnover intentions of professional caregivers.

Conclusions

These findings highlight the need to foster intrinsic motivations for work as well as providing a supportive and ethical work environment to reduce high turnover rates and work-related injuries and accidents among professional caregivers.

THE DIRECT EFFECT OF CLIMATE EMERGENCY AND SAFETY CLIMATE ON INTENTION TO SAFETY BEHAVIOR: A STUDY

Purpose of the study: The main objective of this study was to examine the effect of climate emergence (i.e., work ownership, Islamic work ethic, and employee safety climate) on the intention of safety behavior. Methodology: The research framework was developed based on the Theory of Planned Behavior and Social Exchange Theory. Stratified random sampling was used to collect data from 400 first-line operators and supervisors within the Small Medium Enterprise. A total of 250 useable questionnaires with a response rate of 75% were used for data analysis. The five proposed hypotheses were tested using Structural Equation Modeling (SEM) in IBM-SPSS-AMOS. Main Findings: The results indicate that climate emergence factors have a positive and significant effect on employee intention to safety behavior. Furthermore, employee safety climate found to be the strongest predictor of employee intention to safety behavior, while other climate emergence factors do not have a direct effect on the intention of safety behavior. The model accounted for 76% of the variance in climate emergence in the context of intention to safety behavior. Applications of this study: The results obtained from this study contribute to the improvement of proactive safety performance measures in the small-medium enterprise. However, further efforts are required to achieve the enhanced safety performance level Novelty/Originality of this study: This study adds to the existing psychological literature on climate and employee safety behavior. This present study enhanced the climate-based construct by improving the safety performance measurement for small-medium enterprises.

Prevention of occupational injuries and accidents: A social capital perspective

Prior research has consistently established the pragmatic nature of literature regarding occupational injuries and accidental happenings faced by nursing professionals. However, current realities require a subjective approach to identify preventative measures that could influence occupational health and safety in healthcare sectors. A qualitative design followed a descriptive approach to assess unbiased opinions towards occupational obstructions that lead to accidental happenings. This study used the social capital framework in particular as a support resource to eliminate its detrimental effects on nurse's capacity to serve their patients. The findings extended the fundamental understanding of social capital from social ties to workplace and personal ties as potential mechanisms of support. Healthcare organizations need to redefine their control policies to provide the ultimate support to their care agents. A social capital model offers nursing practitioners and nursing managers an approach for building evidence-based policies with implications for nurse's safety, education and training.

A contemporary understanding of nurses' workplace social capital: A response to the rapid changes in the nursing workforce

AIM

To provide an updated definition of the concept of nurses' workplace social capital that addresses changes in the contemporary nursing workforce.

BACKGROUND

Social capital explains the components of a constructive work environment. Advancements in psychology of workplace and changes in the demographic structure of nursing workforce call for a revised version of nurses' workplace social capital.

METHOD

Walker and Avant's approach was implemented. Data were compiled from 'Medline' and 'CINAHL', 'Google' search engine, book chapters and expertise of nursing academicians.

RESULTS

Nurses' workplace social capital is a relational network that is configured by interactions among healthcare professionals. Although, various attributes influence these interactions, Relational Network, Trust, Shared Understanding, Reciprocity and Social Cohesion are considered as the major attributes. A healthy relational network creates a healthy workplace which can be further fortified by effective communication, active group engagements and a supportive leadership.

CONCLUSIONS

Results of our concept analysis should establish a theoretical groundwork for nurse leaders to better build and more effectively lead the contemporary nursing workforce.

IMPLICATION FOR NURSING MANAGEMENT

Leaders' dedication to workplace social capital is the tenet of a constructive workplace, which in return can support nurses to flourish in their clinical and the other professional responsibilities.

Recognizing the risks in the work of Street Medical Consultations: a participative process

OBJECTIVE

To describe the work environment and recognize the occupational hazards to which Street Medical Consultation teams are exposed, as well as the applicable preventive measures according to the perception of the professionals who are part of the team.

METHOD

A qualitative, exploratory and descriptive study carried out with professionals representing the six Street Medical Consultation teams existing in a Northeast Brazilian state. The information was collected from the focus group technique, and the data were analyzed by the thematic analysis technique.

RESULTS

Fourteen (14) professionals participated. The work environment was described as stressful, with difficulties and vulnerabilities, but also enabling personal growth. Occupational risks caused by physical, biological, chemical, accident and psychosocial factors were recognized. Implemented preventive measures were predominantly light technologies. New personal protective equipment was suggested to be included/used.

CONCLUSION

The group reflection on the environment and work process enabled recognizing its risks, difficulties and challenges, demonstrating the need to implement measures to address the identified factors.

The Association between Quality Improvement Initiatives in Dementia Care and Supportive Psychosocial Work Environments in Nursing Homes

Background: Quality improvement initiatives can help nursing homes strengthen psychosocial work environments. The aim of the present study was to examine the association between supportive psychosocial work environment, and professional and organizational characteristics regarding quality improvement initiatives in dementia care. Methods: A paper questionnaire survey was administered to a convenience sample of 365 professional caregivers in 12 special nursing homes in Japan. Psychosocial work environment was assessed using the Social Capital and Ethical Climate at the Workplace Scale to calculate a score of social capital in the workplace, ethical leadership, and exclusive workplace climate. Variables for quality improvement initiatives included type of home (unit-type or traditional), presence of additional benefit for dementia care, and professionalism in dementia care among caregivers evaluated using the Japanese version of the Sense of Competence in Dementia Care Staff Scale. Results: Elevated professionalism and unit-type home were significantly associated with high social capital, strong ethical leadership, and low exclusive workplace climate. The presence of dementia care benefit was not associated with any subscale of psychosocial work environment. Conclusions: Quality improvement initiatives to foster supportive psychosocial work environment should enhance professionalism in dementia care with unit-based team building of professional caregivers in special nursing homes.