Association Between Continuing Education and Job Satisfaction of Nurses Employed in Long-Term Care Facilities

The Role of Continuing Professional Training or Development in Maintaining Current Employment: A Systematic Review

The impact of continuing job education and professional development on early exit from the labor market is unclear. This systematic review examined how continuing job education or professional development influences the retention of current employment. We searched the PubMed and Embase databases from their start dates to January 2023. Two reviewers screened the full texts of relevant reports and assessed the methodological quality of the included studies using the adapted Effective Public Health Practice Project quality assessment. We qualitatively synthesized the results of the included studies. We screened 7338 publications and included 27 studies consisting of four cohort and 23 cross-sectional studies in the review. The participants of the selected studies were mostly from the health sector (24 studies). There were 19 studies on staying or leaving a current job, six on employee turnover intention, two on job change, one on return to work, one on early retirement, and one on employment. Continuing employee development or training opportunities were associated with increased intention to stay in a current job, decreased intention to leave a current job, decreased employee turnover intention, job change, or early retirement and with faster return to work. One of the two studies that examined the role of age showed that continuing employee development is a more important factor for retaining current employment among younger than older employees. A few studies found that job satisfaction and commitment fully mediated the relationship between employee development and employee intention to leave current employment. This study suggests that participating in professional training/development is related to a lower risk of leaving current employment.

Application of a Hybrid Multi-Criterion Decision-Making Model for Evaluation and Improvement of Nurses' Job Satisfaction

Background

The global shortage and turnover of nurses is a current challenge. Past studies have shown that nurse job satisfaction may ameliorate nurse shortage. Although there are many studies on the criteria influencing nurses' job satisfaction, few have examined the causal relationships and weight of each criterion from a systematic perspective.

Objective

Identify the key criteria and causal relationships that affect nurses' job satisfaction, and help nurse leaders identify high-weight, high-impact dimensions and contextualize them for improvement.

Methods

The study developed a hybrid multi-criterion decision-making model, which incorporated the McCloskey/Mueller satisfaction 13-item scale (MMSS-13), and the Decision-Making Trial and Evaluation Laboratory and the Importance-Performance Analysis methods the model was used to analyze key factors of nurse satisfaction and their interrelationships based on the experience of 15 clinical nurse specialists.

Results

In MMSS-13's dimension level, “satisfaction with work conditions and supervisor support” (C₅) had the highest impact, and “satisfaction with salary and benefits” (C₁) had the highest weight. In criteria level, “salary” (C₁₁), “flexibility in scheduling time off” (C₂₄), “maternity leave time” (C₃₁), “opportunities for social contact after work” (C₄₁), and “your head nurse or facility manager” (C₅₁) had high influence under their corresponding dimensions. The “benefits package” (C₁₃) was the top criterion with the highest impact on MMSS-13.

Conclusions

This study assessed nurses' job satisfaction from a multidimensional perspective and revealed the causal relationships between the dimensions. It refined the assessment of nurse job satisfaction to help nurse leaders better assess nurse job satisfaction and make strategic improvements. The study found that compensation and benefits had the highest weight in nurses' job satisfaction. Meanwhile, support for family responsibilities and working conditions, and support from supervisors were the cause dimensions of job satisfaction. Among the more detailed criteria, salary, benefits package, maternity leave time, and leadership had a greater impact on nurses' job satisfaction. Nurse leaders should start with these dimensions to achieve efficient improvement of nurses' job satisfaction.

From NAFLD to MAFLD: Nurse and allied health perspective

Fatty liver disease associated with metabolic dysfunction is the most prevalent liver disease worldwide, though both patient and health professional still lack awareness of it. An international consensus panel has produced what is sure to be an influential report renaming the disease from non-alcoholic fatty liver disease (NAFLD) to metabolic (dysfunction) associated fatty liver disease (MAFLD) and suggesting how the disease should be diagnosed. This viewpoint explores the call from the perspective of nurse and allied health practitioners. This group have raised serious concerns on the existing nomenclature, which labels the disease as NAFLD, and its diagnostic criteria, including provoking nurse role confusion and representing a major barrier to various key aspects; patient-nurse communications, patient awareness, partnership working, motivation of patients to undertake lifestyle changes and multiple health behaviour change promotion and nurse-led clinics. Therefore, they are enthusiastically supportive of this call to reframe the disease that we believe will ultimately have a positive impact on nurse-patient communication, and through this, improve patient care and quality of life and reduce burden on health system.

Continuing Education for Haitian Nurses: Evidence from Qualitative and Quantitative Inquiry

Background:

There is increasing evidence that to improve nursing practice, nurses must embrace lifelong learning. Research indicates that engagement in lifelong learning positively affects the quality of nursing care, improves patient outcomes, and increases nurses’ job satisfaction. Both lack of standardized initial education and nurses’ limited opportunities for lifelong learning are challenges in Haiti. It is crucial to ensure adequate continuing education in order to support the professional growth and development of Haiti’s existing nursing workforce.

Objectives:

The objectives of this study were to: 1) assess the continuing education nursing needs and desires of practicing Haitian nurses and 2) contribute to the body of knowledge about nursing in Haiti to help inform practice and policy.

Methods:

A multimodal needs assessment approach was used, with semi-structured focus groups and written surveys. The results were analyzed, and common themes were identified.

Findings:

The results were analyzed from 100 surveys and four focus groups (n = 33). Overwhelmingly, Haitian nurses desire continuing nursing education. Major themes include: recognition that continuing education is necessary to provide high quality patient care, continuing education saves lives, and more consistent and standardized initial nursing education is needed. Barriers to participation in continuing education opportunities were also identified.

Conclusions:

This study was one of the first formal studies that addressed continuing education needs of Haitian nurses. By identifying the barriers to important resources, we hope to continue to collaborate with our Haitian nursing colleagues to build curriculum and improve education programs. We also hope that this research will ensure that Haitian nurses voices are heard and will serve to foster change within the Haitian nursing education system. These results were shared with our nurse colleagues in Haiti.

Development of a Palliative Care Education Program in Rural Long-Term Care Facilities

In North America, people 85 years and older are the fastest growing age cohort and long-term care homes are increasingly becoming the place of end-of-life care. This is especially true in rural communities where services are lacking. Staff in long-term care homes lack education about palliative care, but in rural areas, accessing education and the lack of relevant curricula are barriers. The focus of this paper is to describe an approach to developing and delivering a research-based palliative care education curriculum in rural long-term care homes. The approach included conducting a detailed assessment of staffs’ educational needs and preferred educational formats; developing a 15-hour interprofessional curriculum tailored to the identified needs; and delivering the curriculum on site in rural long-term care homes. Staff confidence and participation in delivering palliative care increased. Based on work in northwestern Ontario, Canada, this approach can serve as a model for palliative care education in other rural areas.

Protocol for a Case Study to Explore the Transition to Practice of New Graduate Nurses in Long-Term Care

A qualitative case study protocol for an exploration of the transition to practice of new graduate nurses in long-term care is presented. For the new graduated nurse, the transition to professional practice is neither simple nor easy. This time of transition has been examined within the hospital setting, but little work has been done from the perspective and context of long-term care. As the global population continues to age and the acuity of persons accessing services outside of hospital continues to increase, there is a need to better understand the transition experience of new graduate nurses in alternative, tertiary settings such as long-term care. Therefore, the purpose of this report is to situate a study and describe a protocol that explored the transition to practice experience of seven new graduate nurses in long-term care using Yin’s case study methodology. The case or phenomenon being explored is new graduate nurse transition to practice. This report presents an overview of the literature in order to situate and describe the case under study, a thorough description of the binding of the case as well as the data sources utilized, and ultimately reflects upon the lessons learned using this methodology. The lessons learned include challenges related to precise case binding, the role and importance of context in conducting case study research, and difficulties in disseminating study findings. Overall, this report provides a detailed example of the application of the case study design through description of a study protocol in order to facilitate learning about this complex and often improperly utilized study design.

Individual and organizational predictors of health care aide job satisfaction in long term care

Background

Unregulated health care aides provide the majority of direct health care to residents in long term care homes. Lower job satisfaction as reported by care aides is associated with increased turnover of staff. Turnover leads to inferior job performance and negatively impacts quality of care for residents. This study aimed to determine the individual and organizational variables associated with job satisfaction in care aides.

Methods

We surveyed a sample of 1224 care aides from 30 long term care homes in three Western Canadian provinces. The care aides reported their job satisfaction and their perception of the work environment. We used a hierarchical, mixed-effects ordered logistic regression to model the relative odds of care aide job satisfaction for individual, care unit, and facility factors.

Results

Care aide exhaustion, professional efficacy, and cynicism were associated with job satisfaction. Factors in the organizational context that are associated with increased care aide job satisfaction include: leadership, culture, social capital, organizational slack—staff, organizational slack—space, and organizational slack—time.

Conclusions

Our findings suggest that organizational factors account for a greater increase in care aide job satisfaction than do individual factors. These features of the work environment are modifiable and predict care aide job satisfaction. Efforts to improve care aide work environment and quality of care should focus on organizational context.

Job satisfaction of nurses in Jimma University Specialized Teaching Hospital, Ethiopia

BACKGROUND

In Ethiopia nurses have played a very important role in providing timely and quality health service in healthcare organizations. However, there is a limited literature in the area of nurses' job satisfaction in Ethiopian public hospitals. The objective of this research is to measure job satisfaction of nurses in Jimma University Specialized Teaching Hospital and to determine the influencing factors.

PARTICIPANTS AND METHODS

A cross-sectional survey was conducted from January 2012 to June 2012 in Jimma University Specialized Teaching Hospital. All full-time nurses with nonsupervisory management position and more than 1 year of work experience were invited to participate in the study. Minnesota Satisfaction Questionnaire was used to collect the data.

RESULTS

A total of 175 copies of the questionnaires were returned out of 186 copies distributed to the respondents. The results indicated that nurses were not satisfied by their job (mean=2.21, SD=0.52). Remuneration (r=0.71, P<0.01) and job advancement (r=0.69, P<0.01) were statically significant and strongly correlated with nurses' job satisfaction. Job security was associated with highest satisfaction (r=0.41, P<0.05) CONCLUSION AND RECOMMENDATIONS: Remuneration and job advancement were the most important factors for nurses' job satisfaction. Hospital administrators as well as health policy makers need to address the two major identified sources of nurses' job dissatisfaction in the study (i.e. remuneration and narrow opportunity of job advancement) and take appropriate measures to overcome their consequences.

Access to and support for continuing professional education amongst Queensland nurses: 2004 and 2007

This paper reports on the findings of a prospective exploratory study related to nurses' self-reports of continuing professional education access and support. The data were gathered by two postal surveys undertaken in 2004 and 2007 each which sampled 3000 nurses of the 30,000 nurse members of the industrial body - Queensland Nurses' Union. The response rates were 44.9% and 39.7% for 2004 and 2007, respectively. Over 85% of the nurses reported they had access to continuing professional education activities. However, it is apparent that the majority of these activities are either partially or completely self-funded. Further, between 2004 and 2007 the amount of financial support provided by employers for continuing education and training activities has decreased significantly. While there were differences between 2004 and 2007, the major barrier to be able to attend continuing professional education were financial (could not afford the fee involved; could not afford to take unpaid leave to attend). Another major barrier in both 2004 and 2007 was having the time to undertake the activity. Analysis for differences between nurses in different geographical locations indicated that distance remains a major barrier for nurses in rural and remote areas. These quantitative findings were supported by the qualitative findings on nurses' work where 'education and training' was, overall, the fifth highest ranked issue requiring further attention.

Caregivers' attitudes to education and supervision in work with the older people in a nursing home

Community-based care in Sweden has problems recruiting and keeping staff with formal competence and education. Both the caregiver's well-being and the receiver's care improve when the personnel receive support in the form of continuing supervision and education. Yet the caregivers in this study did not participate in a training and supervision programme during working hours. The aim of this study was to describe the attitudes towards education, support and supervision in the care of older people in municipal care in Sweden. The study used a qualitative approach with a descriptive design. Twelve caregivers, nine enrolled nurses and three nurses' aides from four wards in a nursing home were interviewed. The interviews were analysed with qualitative content analysis. The main findings showed that all of the caregivers were positive towards the idea of participating in training and asked for education and supervision but felt that the management did not create conditions that made it possible to participate during working hours. According to the findings there is a need for developing new forms and methods for learning that can be integrated into working life.

Caring in residential aged-care. Qualitative findings from an e-cohort sub-study

AIM

The aim of this e-cohort sub-study was to explore and describe nurses' understandings of 'caring' in residential aged-care.

BACKGROUND

The quality of the work environment is an important issue for recruitment, retention and workforce planning. Knowledge about the people in and the place that is the residential aged-care facility may assist with the problems surrounding the recruitment and retention of nurses in the workforce.

DESIGN

Qualitative electronic cohort sub-study.

METHODS

This paper presents the qualitative research findings from an electronic cohort sub-study of 58 registered and enrolled nurses working in the residential aged-care sector in 2007. Data were collected through an open ended question and a qualitative content analysis was used to generate the core categories.

RESULTS

The concept of caring was grounded in and constrained by, the everyday reality of the nurses in the study. Organisational imperatives for the completion of documentation necessary for accreditation and funding combined with under-staffing restricted the time available for caring practices. Some nurses represented residential care faculties as devoid of care, others as a place where the resident was central to their work and care. The staff perceived of themselves as an ageing workforce in need of rejuvenation and resourcing.

CONCLUSION

The concept of caring is manifest in nurses' language as they describe their workplace, the residents, themselves and the structures that impact on what they do. Good caring manifests itself when the residents are central to the business of the aged care facility. However, nurses in this study describe a range of restrictive factors impeding caring practices and diminishing workforce morale and motivation to create environments that can truly be called a 'home-away-from-home' and one that all people would find acceptable.

RELEVANCE TO CLINICAL PRACTICE

These findings have implications for aged-care sector recruitment, retention and workforce planning within residential aged-care facilities.

Barriers to Participation in Continuing Education Activities Among Rural and Remote Nurses

BACKGROUND

This article examines the barriers to participation in continuing education activities that are perceived by rural and remote registered nurses in Canada.

METHODS

The data are drawn from a national survey that was part of a larger national project, "The Nature of Nursing Practice in Rural and Remote Canada."

RESULTS

Perceived barriers to participation in continuing education activities include the isolation of rural nurses and time and financial constraints. Nurses who perceived barriers to participation were more likely to be middle-aged, unmarried, and working full-time than nurses who did not perceive barriers. They were also more likely to possess higher levels of nursing education and have children or dependents. The perception of barriers to participation was also associated with lower job and scheduling satisfaction.

CONCLUSIONS

Rural and remote registered nurses have moderately high levels of participation in continuing education; however, participation and job satisfaction can be improved if some of the barriers identified are addressed.

Registered nurses’ education and their views on competence development in municipal elderly care in Sweden: A questionnaire survey

BACKGROUND

Recent changes of municipal elderly care in Sweden have resulted in that persons 65 years and older, previously nursed in hospital facilities, are now being cared for in the municipality. This change has had a significant impact on the work situation of registered nurses (RNs) and calls for appropriate educational preparation to enable RNs to undertake their new roles effectively.

AIM

The main focus was to describe RNs' education and their view of competence development in municipal elderly care. Another aim was to compare RNs working solely in dementia care (DC) with those working in general elder care (GC) of older persons with diverse diagnoses.

DESIGN

A non-experimental, descriptive design with a survey research approach was used.

SETTINGS

Sixty special housing with subunits including those offering daytime activities in a large city in the middle of Sweden.

PARTICIPANTS

The number of participating RNs was a total of 213, with a response rate of 62.3%. Of the 213 RNs, 95 (44.6%) worked in DC, and 118 (55.4%) in GC.

METHOD

A questionnaire survey.

RESULTS

The findings showed that RNs possessed a broad range of competence. The majority lacked a bachelor's degree in nursing. Few had adequate specialist competence. RNs' in DC wanted to invest more in competence development whereas RNs in GC were more motivated to attain greater authority in the making of important decisions and to seek another position.

CONCLUSION

An important future prospect is to develop the competence of RNs in elderly care. In order to ensure high quality and security in elderly care, it is also essential to increase the number of RNs with specialist competence.

A comparative analysis of contemporary nurses' discontents

AIM

This paper reports a study to evaluate and increase understanding of contemporary Registered Nurses' discontents, and to compare these discontents and their effects with those of nurses 20 years ago.

BACKGROUND

In 1986, Turner argued that nurses' discontents were reflected in a discourse or 'vocabulary of complaint' that provided a sense of solidarity amongst practising nurses, and defused their frustrations rather than channelling them into demands for workplace reform. In this paper, we revisit Turner's notion of a vocabulary of complaint in the context of a study of nurse retention in the contemporary Australian healthcare workplace.

METHODS

This paper draws on the qualitative data from a larger project (completed in 2001) exploring the relationship between job satisfaction and self-concept in both recently graduated and experienced nurses. Here, we elaborate on thematic analyses of the comments of 146 Australian Registered Nurses with more than 5 years' nursing experience.

FINDINGS

There is still a high level of discontent amongst contemporary practising nurses, although the focus of their complaints and their responses to them have changed since Turner's study. Conflicting expectations of nurses and managers and lack of opportunity to provide comprehensive care emerged as the most important issues for experienced nurses today. Rather than contributing to a sense of solidarity as in Turner's study, contemporary nurses' discontents reflect intense personal frustration and underpin individual nurses' decisions to leave, or plan to leave, the workforce.

CONCLUSION

There is an urgent need for increasing health service management and community awareness about the relationship between providing comprehensive nursing care and nurses' job satisfaction. Addressing nurses' discontents, wider nursing involvement in the international policy arena, and the politicization of nurses worldwide may contribute to alleviating the current global nursing shortage.

Factors influencing nursing staff members' participation in continuing education

The purpose was to determine the effect of personal and professional factors, as well as motivational orientations, on the participation of nursing staff in continuing education at two health institutions, one public and another private. Descriptive, comparative, correlational design. Probabilistic sampling, random estimation, error limit 0.05, confidence level 95%. Participants were 105 subjects from the private institution and 200 subjects from the public institution. Two instruments were applied: Scale of Reasons for Participation (SRP) and instrument of Participation in Continuing Education (PCE). The internal consistency of the instruments was acceptable. Among personal factors, the income demonstrated effect on the participation (p=.007) in continuing education. Academic level (p=.004) and staff position (p=.005) are professional factors that predict participation in continuing education, as well as the development factor and professional enhancement among motivational orientations (p=.005). The labor institution, whether private or public, did not show any significant effect.

Factors influencing rural health care professionals' access to continuing professional education

OBJECTIVES

The purposes of this study were to explore the perceived barriers and challenges to continuing professional education (CPE) access for Canadian health care professionals and to identify best practices for improving access to CPE.

DESIGN

Key informant interviews and Web-based online surveys were conducted.

PARTICIPANTS

Key informant interviews were conducted with national CPE accreditation bodies and health professional associations. An online survey was distributed to health professional education programs, as well as provincial professional associations, licensing and professional regulatory bodies.

MAIN OUTCOME MEASURES

The perceived barriers and challenges to CPE access for Canadian health care professionals and best practices for improving access to CPE.

RESULTS AND CONCLUSIONS

Geographic isolation and poor technological and telecommunications infrastructure were identified as key barriers to CPE delivery and access. Financial factors, such as funding to support travel or cost of attendance, were also identified as major challenges. Tele-education programming was identified as a best practice approach to improve CPE access, as were regional CPE activities and self-directed learning programs. Employer-sponsored initiatives, including staff coverage or locum support, remuneration for time off and paid travel expenses for CPE participation were also identified as best practice approaches.

Evaluation of an educational "toolbox" for improving nursing staff competence and psychosocial work environment in elderly care: results of a prospective, non-randomized controlled intervention

BACKGROUND

Lack of professional development opportunities among nursing staff is a major concern in elderly care and has been associated with work dissatisfaction and staff turnover. There is a lack of prospective, controlled studies evaluating the effects of educational interventions on nursing competence and work satisfaction.

OBJECTIVES

The aim of this study was to evaluate the possible effects of an educational "toolbox" intervention on nursing staff ratings of their competence, psychosocial work environment and overall work satisfaction.

DESIGN

The study was a prospective, non-randomized, controlled intervention.

PARTICIPANTS AND SETTINGS

Nursing staff in two municipal elderly care organizations in western Sweden.

METHODS

In an initial questionnaire survey, nursing staff in the intervention municipality described several areas in which they felt a need for competence development. Measurement instruments and educational materials for improving staff knowledge and work practices were then collated by researchers and managers in a "toolbox." Nursing staff ratings of their competence and work were measured pre and post-intervention by questionnaire. Staff ratings in the intervention municipality were compared to staff ratings in the reference municipality, where no toolbox was introduced.

RESULTS

Nursing staff ratings of their competence and psychosocial work environment, including overall work satisfaction, improved significantly over time in the intervention municipality, compared to the reference group. Both competence and work environment ratings were largely unchanged among reference municipality staff. Multivariate analysis revealed a significant interaction effect between municipalities over time for nursing staff ratings of participation, leadership, performance feedback and skills' development. Staff ratings for these four scales improved significantly in the intervention municipality as compared to the reference municipality.

CONCLUSIONS

Compared to a reference municipality, nursing staff ratings of their competence and the psychosocial work environment improved in the municipality where the toolbox was introduced.

Measurement of Nurse Job Satisfaction Using the McCloskey/Mueller Satisfaction Scale

BACKGROUND

Originally developed to rank rewards that nurses value and that encourage them to remain in their jobs, the McCloskey/Mueller Satisfaction Scale (MMSS) is being used extensively in research and practice to measure nurse job satisfaction. Since its original development in 1990, limited evidence of psychometric properties of the MMSS has been reported.

OBJECTIVE

To investigate and report the psychometric properties of the MMSS when used in 2003 to measure hospital nurse job satisfaction.

METHODS

Data from a survey of 8,456 nurses were used to establish psychometric properties of the MMSS. Dimensionality was tested using confirmatory and exploratory factor analyses. Validity of new MMSS factors was tested by investigating relationships of the new factors with theoretically related concepts and by testing ability of the new factors to predict nurses' intentions to remain employed in their hospitals. Reliability coefficients of the new factors are reported.

RESULTS

The original eight factors could not be replicated satisfactorily using confirmatory factor analysis. Exploratory factor analysis found a seven-factor model rather than the original eight factors previously reported. Validity of this new model was supported. However, similar to the original instrument, weak internal consistency reliability coefficients were found for three of the new MMSS factors.

DISCUSSION

From a research perspective, using an instrument with 23 items that measure 7 aspects of nurse job satisfaction is more desirable than an instrument with 31 items. However, MMSS items must be redeveloped to improve internal consistency of factors.

Staff Perceptions of Job Satisfaction and Life Situation before and 6 and 12 Months after Increased Information Technology Support in Dementia Care

We measured staff members’ satisfaction with their work before and after increased information technology (IT) support in dementia care. Comparisons were also performed of perceived life satisfaction and sense of coherence. Data were collected before, and 6 and 12 months after implementation of the first part of an IT support project. Instruments used were the Satisfaction with Work Questionnaires, the Life Satisfaction Questionnaire (LSQ) and the Sense of Coherence (SOC) scale. The study was performed in a residential home for persons with dementia. The participants were 33 staff members. The IT technology included general and individualized passage alarms, sensor-activated night-time illumination, fall detectors and Internet communication. Results showed that staff members’ job satisfaction and perceived quality of care improved in comparison with the control group. Personal development, workload, expectations and demands, internal motivation and documentation, as well as the total scores for ‘psychosocial aspects of job satisfaction’ and ‘quality of care aspects’, increased in the experimental group. There were significant interaction effects for the factors family relation, close friend relation (LSQ), the total SOC scale and the meaningfulness subscale. The study showed that IT support in dementia care increased staff members’ satisfaction with their work in several ways.

The Effectiveness of Empowering In-Service Training Programs for Foreign Nurse Aides in Community-Based Long-Term Care Facilities

The objective of the study was to examine the effectiveness of empowering in-service training programs for foreign nurse aides working in community-based long-term care (LTC) facilities. The design was a pretest and post-test design with experiment and control groups. The sample consisted of purposeful sampling from 10 LTC facilities in the Shihlin and Peitou areas of Taipei. A total of 35 foreign nurse aides participated in this study; 16 in the experimental group and 19 in the control group. The experimental group attended the training program for a 3-month period, whereas the control group did not receive any training. The research findings reveal that the training program was effective in increasing the work stress of workload/scheduling (Z = 2.01, p </= 0.05), meaning that the training program has raised the awareness of work stress for foreign nurse aides. The results could be used as a reference when considering the development of in-service training programs in LTC facilities.

Long-term-care residents: concerns identified by population and care trends

OBJECTIVE

Despite rising concern over population aging, few descriptions exist of long-term-care (LTC) residents, the people who are normally the oldest and the most dependent persons. This study sought to describe a LTC resident population and trends in this population.

METHODS

A descriptive-comparative quantitative analysis of all data (1988-1999) from a provincial (Alberta) LTC resident database was undertaken.

FINDINGS

Over the 10-year period, there was a significant increase in care needs. In the 1988, the mean Requirement Score was a "C" (indicating low to medium level care was required); by the 1999, the mean score was "E" (medium to high level care). There were both a substantial reduction in residents with low care needs and an increase in residents with high care needs. Although the mean age of LTC residents increased from 80.5 to 82.5, residents under age 65 had higher care needs. General linear modelling also revealed younger age was a significant influence in regard to higher care needs, along with larger (versus smaller) LTC admission to death also declined significantly from 6.9 to 3.4 years. Although this study may only confirm what is suspected about LTC residents, it should raise discussion over the impact of limited LTC beds on families, community-based health services, and acute care hospitals; and the implications of more dependent residents on LTC facility and personnel planning [corrected]

To feel betrayed and to feel that you are betraying the older residents: caregivers' experiences at a newly opened nursing home

BACKGROUND

In Sweden and internationally, little research has focused on the working situation of Enrolled Nurses and Nurses' Aides who form the majority of workers in geriatric care today. With this in mind, it is important to focus on how these occupational groups experience their working situation with older residents in municipal care.

AIMS AND OBJECTIVES

The aim of the study was to investigate the deeper meaning of work satisfaction and work dissatisfaction at a newly opened nursing home for older residents. The study focused on the narratives supplied by the caregivers at the nursing home. The participants included: one Registered Nurse, sixteen Enrolled Nurses, and three Nurses' Aides. All were directly involved in patient care.

DESIGN

The present study is part of a larger longitudinal study within the municipal geriatric care system in Sweden, with a quasi-experimental design.

METHOD

The interviews were analysed with a phenomenological-hermeneutic method inspired by the philosophy of Ricoeur.

RESULT

The caregivers experiences of work satisfaction and work dissatisfaction was expressed in four themes: (i) 'Experience of betrayal' describes how the staff felt let down in several ways; (ii) 'Experience of failing others' describes how the staff felt that they did not pay enough attention to older people, in several different ways; (iii) 'Experience of insufficiency' describes how the staff encountered overwhelming demands from several directions; (iv) 'Experience of work satisfaction' describes how the staff felt that they were given support in various ways. Each theme emerged from several subthemes that originated from the caregivers' narratives.

CONCLUSIONS

The study shows that the caregivers' experience of work dissatisfaction overshadows their experience of work satisfaction. It also suggests that their feelings of failing the older residents are connected to their own experiences of feeling betrayed.

RELEVANCE TO CLINICAL PRACTICE

The findings can be used when other nursing homes in municipal care are opened, as a means of preventing work dissatisfaction and increasing work satisfaction among future employees.

Older people living in nursing homes or other community care facilities: Registered Nurses' views of their working situation and co-operation with family members

BACKGROUND

Little attention has been paid to Registered Nurses' working conditions and how they experience their working situation in community health care. The nurses' vocational background is of interest, as well as their apprehension about communicating and co-operating with the older persons' family members.

AIMS AND OBJECTIVES

The aim of the study was to describe Registered Nurses' views of their working situation in community health care and of co-operation with family members of older people living in nursing homes or similar facilities.

DESIGN

The study was carried out in a geographically defined area in the south of Sweden. A questionnaire was sent to all the Registered Nurses (n = 314) working within community health care of whom 210 Registered Nurses replied to the questionnaires.

METHODS

Latent content analysis was used on the comments to six questions, in order to illuminate the statistical findings from the statements of the questions measured by the Likert scale.

RESULTS

The results showed that almost half of the Registered Nurses working in care of older people are not satisfied with their working situation. The nurses with less than 5 years working experience find their working situation most stimulating. All of them expressed that it is important that there is co-operation between themselves and the family members and it was also considered important to develop models that could improve co-operation. Male nurses believed, to a lesser extent, that family members were a resource in caring, compared with female nurses; however, all male nurses stressed the importance of facilitating informal caregivers. Nurses with more than 5 years of working experience expressed that it was important that family members show engagement in caring for older people. Furthermore, they expressed that it was necessary that the family members took care of the older persons' interests.

RELEVANCE TO CLINICAL PRACTICE

The findings that half of the Registered Nurses are dissatisfied with their working situation have relevance in clinical practice because of the risk of losing competent nurses in this area.

Nursing informatics. Applications for long-term care

Long-term care (LTC) settings, specifically nursing homes, have found it difficult to manage the regulatory process and provide quality resident care without computerization. Clinical information systems in the current health care environment, including LTC, need to provide five functions. These five functions are providing the legal record of care; supporting clinical decision-making; capturing costs for financial purposes; accumulating a database for administrative queries, quality assurance, and research; and supporting data exchange between systems. While computerization may have occurred in LTC, the application of the informatics concepts with nursing standardized languages and financial and database usage may not have occurred. To succeed in the current health care environment, nursing informatics concepts need to be implemented in LTC. As a result, the quality of care for older adults in nursing homes will be improved. The purpose of this article is to identify application for nursing informatics use in the LTC setting.