Showing papers in "Journal of Advanced Nursing in 2017"

Factors influencing new graduate nurse burnout development, job satisfaction and patient care quality: a time-lagged study.

Abstract: Aim To test a hypothesized model linking new graduate nurses’ perceptions of their manager's authentic leadership behaviours to structural empowerment, short-staffing and work–life interference and subsequent burnout, job satisfaction and patient care quality. Background Authentic leadership and structural empowerment have been shown to reduce early career burnout among nurses. Short-staffing and work–life interference are also linked to burnout and may help explain the impact of positive, empowering leadership on burnout, which in turn influences job satisfaction and patient care quality. Design A time-lagged study of Canadian new graduate nurses was conducted. Methods At Time 1, surveys were sent to 3,743 nurses (November 2012–March 2013) and 1,020 were returned (27·3% response rate). At Time 2 (May–July 2014), 406 nurses who responded at Time 1 completed surveys (39·8% response rate). Descriptive analysis was conducted in SPSS. Structural equation modelling in Mplus was used to test the hypothesized model. Results The hypothesized model was supported. Authentic leadership had a significant positive effect on structural empowerment, which in turn decreased both short-staffing and work–life interference. Short-staffing and work–life imbalance subsequently resulted in nurse burnout, lower job satisfaction and lower patient care quality 1 year later. Conclusion The findings suggest that short-staffing and work–life interference are important factors influencing new graduate nurse burnout. Developing nurse managers’ authentic leadership behaviours and working with them to create and sustain empowering work environments may help reduce burnout, increase nurse job satisfaction and improve patient care quality.

Nurse Competence Scale: a systematic and psychometric review

Abstract: Aim The aim of this study was to report a systematic and psychometric review. Background The Nurse Competence Scale is currently the most widely used generic instrument to measure Registered Nurses’ competence in different phases of their careers. Based on a decade of research, this review provides a summary of the existing evidence. Design A systematic literature review of research evidence and psychometric properties. Data sources Nine databases from 2004 - October 2015. Review methods We retrieved scientific publications in English and Finnish. Two researchers performed data selection and appraised the methodological quality using the COnsensus-based Standards for the selection of health status Measurement INstruments checklist. Results A total of 30 studies reported in 43 publications were included. These consisted of over 11,000 competence assessments. Twenty studies were from Europe and 10 from outside Europe. In addition to experienced nurses, the Nurse Competence Scale has been used for the competence assessment of newly graduated nurses and nursing students, mainly in hospital settings. Length of work experience, age, higher education, permanent employment and participation in educational programmes correlated positively with competence. Variables including empowerment, commitment, practice environment, quality of care and critical thinking were also associated with higher competence. The Nurse Competence Scale has demonstrated good content validity and appropriate internal consistency. Conclusion The value of Nurse Competence Scale has been confirmed in determining relationships between background variables and competence. The instrument has been widely used with experienced and newly graduated nurses and their managers. Cross-cultural validation must be continued using rigorous methods.

A mixed‐methods systematic review of the effects of mindfulness on nurses

Abstract: Aim To review the effects of mindfulness-based interventions on Registered Nurses and nursing students. Background Work-related stress among nurses is estimated to be the biggest occupational health problem after musculoskeletal disorders. Design A mixed-method systematic review incorporating quantitative and qualitative data was conducted. Data sources Studies on the effects of mindfulness-based interventions for nurses and nursing students published between 1980 and 2014 were identified through a systematic search in electronic databases: Medline, Embase, PsycINFO, Cochrane Library and Cinahl. Review methods Data analysis was conducted based on the framework of Thomas and Harden (2004). Results A total of 32 studies, including 17 controlled designs, 11 pre–post designs and four qualitative designs were reviewed. Meta-analysis suggests that mindfulness-based interventions may be effective in significantly reducing state anxiety and depression at posttreatment and state anxiety and trait anxiety at follow-up. Qualitative studies and uncontrolled studies shed light on benefits overlooked in RCTs, including improvements in the well-being of individuals (e.g. inner state of calmness, awareness and enthusiasm) and improved performance at work (better communication with colleagues and patients, higher sensitivity to patients’ experiences, clearer analysis of complex situations and emotional regulation in stressful contexts). Conclusions Mindfulness appeared to improve nurses’ mental health significantly. It could be used in worksite health promotion programmes. Only a few studies have explored the impact of mindfulness on nurses’ professional behaviours and their relationships with patients and colleagues. Future research should further explore the long-term impacts of mindfulness on performance and well-being at work using sound methodological designs.

Patient experiences of caring and person-centredness are associated with perceived nursing care quality

Abstract: Aims: To explore the extent to which patient ratings of perceived caring and person-centredness are associated with perceived nursing care quality in an acute hospital sample of inpatients. Backgro ...

Predictors of physical activity and barriers to exercise in nursing and medical students.

Abstract: Aims To investigate physical activity levels of nursing and medicine students; examine predictors of physical activity level; and examine the most influential benefits and barriers to exercise. Background Healthcare professionals have low levels of physical activity, which increases their health risk and may influence their health promotion practices with patients. Design We surveyed 361 nursing (n=193) and medicine (n=168) students studying at a UK medical school. Methods Questionnaire survey, active over 12 months in 2014-2015. Measures included physical activity level, benefits and barriers to exercise, social support, perceived stress and self-efficacy for exercise. Results Many nursing and medicine students did not achieve recommended levels of physical activity (nursing: 48%; medicine: 38%). Perceived benefits of exercise were health-related, with medicine students identifying additional benefits for stress-relief. Most notable barriers to exercise were: lack of time, facilities having inconvenient schedules and exercise not fitting around study or placement schedules. Nursing students were less active than medicine students; they perceived fewer benefits and more barriers to exercise and reported lower social support for exercise. Physical activity of nursing and medicine students was best predicted by self-efficacy and social support, explaining 35% of the variance. Conclusion Physical activity should be promoted in nursing and medicine students. Interventions should aim to build self-efficacy for exercise and increase social support. Interventions should be developed that are targeted specifically to shift-working frontline care staff, to reduce schedule-related barriers to exercise and increase accessibility to workplace health and wellbeing initiatives.

A longitudinal, mixed methods investigation of newly qualified nurses' workplace stressors and stress experiences during transition.

Abstract: Aim To investigate transition in newly qualified nurses through an exploration of their stressors and stress experiences during their first 12 months post-qualifying Background Globally, thousands of new nurses qualify annually They are crucial for the profession and healthcare service delivery Work-related stress has multiple serious consequences, yet there is a lack of robust, empirical evidence that directly analyses newly qualified nurses and the stress they feel and experience in the workplace Understanding what causes newly qualified nurses’ stress is vital to retaining and nurturing this vital component of the workforce Design Longitudinal, explanatory sequential mixed methods, cohort study Methods At the point of qualification (n= 288), 6 months post-qualifying (n= 107) and 12 months post-qualifying (n= 86), newly qualified nurses completed the Nursing Stress Scale, with n= 14 completing a one-to-one interview at 12 months post-qualifying Data were collected from 2010-2012 Inferential statistics, ‘thematic analysis’ and ‘side-by-side comparisons in a discussion’ were used for analysis Results/Findings Workload was consistently the highest reported stressor with inadequate staffing and managing multiple role demands given as explanations Incivility within the workplace was a noted stressor Conversely, being part of ‘a good team’ provided a civil, supportive, facilitative work environment Entering nurse education with previous healthcare experience had a mediating effect on the reported frequency of stressors Conclusions Newly qualified nurses encounter multiple work-related stressors over their first 12 months post-qualifying, which are intrinsically entwined with their transition Employing organisations need to be more proactive in managing their workload and addressing workplace incivility

Work climate and the mediating role of workplace bullying related to job performance, job satisfaction, and work ability: A study among hospital nurses

Abstract: Aim To increase understanding of workplace bullying and its relation to work climate and different outcomes among nurses Examine a proposed bullying model including both job resource and job demands, as well as nurse outcomes reflected in job performance, job satisfaction, and work ability Background Workplace bullying has been identified as some of the most damaging mechanisms in workplace settings It is important to increase understanding of workplace bullying in relation to work climate and different outcomes among nurses Design This study adopted a cross-sectional web based survey design Method A sample of 2946 registered nurses from four public Norwegian hospitals were collected during October 2014 We analysed data using descriptive statistics, correlations Cronbach's alpa, confirmatory factor analyses and structural equation modelling Results The majority of work climate characteristics confirmed to influence workplace bullying, and additionally had direct influence on nurse outcomes; job performance, job satisfaction, and work ability Bullying had a mediational role between most of the work climate dimensions and nurse outcomes Conclusion This study increases our understanding of organisational antecedent of bullying among nurses Workplace bullying among nurses functions as a mediator between the majority of work climate dimensions and outcomes related to job satisfaction and work ability Strategies to reduce bullying should look at the study finding and specifically job resources and job demands that influence bullying and nurse outcomes This article is protected by copyright All rights reserved

Theory-based self-management educational interventions on patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials.

Abstract: Aim To synthesize the effects of theory-based self-management educational interventions on patients with type 2 diabetes (T2DM) in randomized controlled trials. Background Type 2 diabetes is a common chronic disease causing complications that put a heavy burden on society and reduce the quality of life of patients. Good self-management of diabetes can prevent complications and improve the quality of life of T2DM patients. Design Systematic review with meta-analysis of randomized controlled trials following Cochrane methods. Data resources A literature search was carried out in the MEDLINE, EMBASE, CINAHL, PSYCINFO and Web of Science databases (1980-April 2015). Review methods The risk of bias of these eligible studies was assessed independently by two authors using the Cochrane Collaboration's tool. The Publication bias of the main outcomes was examined. Statistical heterogeneity and random-effects model were used for meta-analysis. Results Twenty studies with 5,802 participants met the inclusion criteria. The interventions in the studies were based on one or more theories which mostly belong to mid-range theories. The pooled main outcomes by random-effects model showed significant improvements in HbA1c, self-efficacy and diabetes knowledge, but not in BMI. As for quality of life, no conclusions can be drawn as the pooled outcome became the opposite with reduced heterogeneity after one study was excluded. No significant publication bias was found in the main outcomes. Conclusion To get theory-based interventions to produce more effects, the role of patients should be more involved and stronger and the education team should be trained beyond the primary preparation for the self-management education program. This article is protected by copyright. All rights reserved.

A bibliometric analysis of the Journal of Advanced Nursing, 1976-2015.

Abstract: Aim The aim of this study was to examine the publication characteristics and development of Journal of Advanced Nursing during its 40-year history. Background Bibliometric studies of single journals have been performed, but to the best of our knowledge, bibliometric analysis and bibliometric mapping have not yet been used to analyse the literature production of the Journal of Advanced Nursing. Design/Method Using descriptive bibliometrics, we studied the dynamics and trend patterns of literature production and identified document types and the most prolific authors, papers, institutions and countries. Bibliometric mapping was used to visualize the content of published articles and determine the most prolific research terms and themes published in Journal of Advanced Nursing and their evolution through time. We were also interested in determining whether there were any ‘Sleeping Beauties’ among the articles published in the journal. Results The study revealed a positive trend in literature production, although recently, the number of articles published in Journal of Advanced Nursing has slightly decreased. The most productive institutions are from the United Kingdom, which ranks in the highest place in terms of successful publishing in the journal. Thematic analysis showed that the most prolific themes corresponded to the basic aims and scope of the journal. Conclusion Journal of Advanced Nursing contributes to advances in nursing research, practice and education as well as the quality of health care, teamwork and family care, with an emphasis on knowledge transfer and partnership between various healthcare professionals.

Barriers and facilitators to healthy eating for nurses in the workplace: an integrative review.

Abstract: Background There is growing recognition of the influence of the workplace environment on the eating habits of the workforce, which in turn may contribute to increased overweight and obesity. Overweight and obesity exact enormous costs in terms of reduced well-being, worker productivity and increased risk of non-communicable diseases. The workplace is an ideal place to intervene and support healthy behaviours. This review aimed to identify barriers and facilitators to nurses’ healthy eating in the workplace. Design Integrative mixed method review Data sources Five electronic databases were searched: CINAHL, MEDLINE, PROQUEST Health and Medicine, ScienceDirect and PsycINFO. Reference lists were searched. Included papers were published in English between 2000-2016. Of 26 included papers, 21 were qualitative and 5 quantitative. Review methods An integrative literature review was undertaken. Quality appraisal of included studies used standardised checklists. A social-ecological framework was used to examine workplace facilitators and constraints to healthy eating, derived from the literature. Emergent themes were identified by thematic analysis. Results Review participants were Registered, Enrolled and/or Nurse Assistants primarily working in hospitals in middle or high income countries. The majority of studies reported barriers to healthy eating related to adverse work schedules, individual barriers, aspects of the physical workplace environment and social eating practices at work. Few facilitators were reported. Overall, studies found the workplace exerts a considerable negative influence on nurses’ dietary intake. Conclusion Reorientation of the workplace to promote healthy eating among nurses is required. This article is protected by copyright. All rights reserved.

Understanding interprofessional collaboration in the context of chronic disease management for older adults living in communities: a concept analysis.

Abstract: Aim To report a concept analysis of interprofessional collaboration in the context of chronic disease management, for older adults living in communities. Background Increasing prevalence of chronic disease among older adults is creating significant burden for patients, families and healthcare systems. Managing chronic disease for older adults living in the community requires interprofessional collaboration across different health and other care providers, organizations and sectors. However, there is a lack of consensus about the definition and use of interprofessional collaboration for community-based chronic disease management. Design Concept analysis. Data sources Electronic databases CINAHL, Medline, HealthStar, EMBASE, PsychINFO, Ageline and Cochrane Database were searched from 2000 - 2013. Methods Rodgers' evolutionary method for concept analysis. Results The most common surrogate term was interdisciplinary collaboration. Related terms were interprofessional team, multidisciplinary team and teamwork. Attributes included: an evolving interpersonal process; shared goals, decision-making and care planning; interdependence; effective and frequent communication; evaluation of team processes; involving older adults and family members in the team; and diverse and flexible team membership. Antecedents comprised: role awareness; interprofessional education; trust between team members; belief that interprofessional collaboration improves care; and organizational support. Consequences included impacts on team composition and function, care planning processes and providers' knowledge, confidence and job satisfaction. Conclusion Interprofessional collaboration is a complex evolving concept. Key components of interprofessional collaboration in chronic disease management for community-living older adults are identified. Implications for nursing practice, education and research are proposed.

Readiness for hospital discharge: A concept analysis

Abstract: Aim To report on an analysis on the concept of ‘readiness for hospital discharge’. Background No uniform operational definition of ‘readiness for hospital discharge’ exists in the literature, therefore a concept analysis is required to clarify the concept and identify an up to date understanding of readiness for hospital discharge. Clarity of the concept will identify all uses of the concept; provide conceptual clarity, an operational definition and direction for further research. Design Literature Review and Concept Analysis. Method A review of literature conducted in 2016 involved databases searched were: Academic Search Complete, CINAHL Plus with Full Text, PsycARTICLES, Psychology and Behavioural Sciences Collection, PsycINFO, Social Sciences Full Text (H.W. Wilson) and SocINDEX with Full Text. No date limits were applied. Results Identification of the attributes, antecedents and consequences of readiness for hospital discharge led to an operational definition of the concept. The following attributes belonging to ‘readiness for hospital discharge’; were extracted from the literature; physical stability, adequate support, psychological ability and adequate information and knowledge. Conclusion This analysis contributes to the advancement of knowledge in the area of hospital discharge, by proposing an operational definition of readiness for hospital discharge, derived from the literature. A better understanding of the phenomenon will assist health care professionals to recognise, measure and implement interventions where necessary, to ensure patients are ready for hospital discharge and assist in the advancement of knowledge for all professionals involved in patient discharge from hospital. This article is protected by copyright. All rights reserved.

The effects of nursing preceptorship on new nurses' competence, professional socialization, job satisfaction and retention: A systematic review.

Abstract: Aims The aim of this study was to determine the effects of nursing preceptorship on the competence, job satisfaction, professional socialization and retention of new nurses. Background Although studies have focused on the effects of nursing preceptorship on new nurses’ competence and retention, a systematic review of the overall effects is lacking. Design A quantitative systematic review. Data sources Five English/Chinese databases were searched for original articles published before June 2015 and only six articles published between 2001–2014 were included in the final analysis. Review methods Joanna Briggs Methodology was used to process one randomization control trial, one quasi-experimental study and four observational studies. Two appraisers independently reviewed each study using the standardized critical appraisal tools from the Joanna Briggs Institute. Results The most adopted preceptorship was a fixed preceptor/preceptee model and one-on-one for 1–3-month duration. It showed that new nurses’ overall competence increased significantly due to preceptorship. Only a few studies explored the effects of preceptorship on the job satisfaction and professional socialization of new nurses. Clear conclusions regarding the effect of preceptorship on nurses’ retention rate could not be made because of inconsistent time points for calculation and a lack of control groups in the study design. Conclusions Preceptorship can improve new nurses’ nursing competence; however, more studies are needed to ascertain its effects on new nurses’ retention rates, job satisfaction and professional socialization to promote nursing care quality and resolve nursing shortages.

Early warning systems and rapid response to the deteriorating patient in hospital: a systematic realist review.

Abstract: Aim To determine the Rapid Response System programme theory and investigate how the mechanisms of implementation and the characteristics of context combine to enable or constrain the implementation of Rapid Response Systems and the achievement of desired outcomes. Background Rapid Response Systems have been implemented internationally to improve the recognition and management of patient deterioration, reduce the need for cardiopulmonary resuscitation and improve patient outcomes. Design Realist review. Data sources We searched DARE, CENTRAL, NHSEED, MEDLINE, Medline In Process, EMBASE, CINAHL, PubMed, Scopus, The Web of Science and PychInfo databases from 1997 - 2017 in addition to purposively searching the grey literature looking for articles supporting, refuting or explaining Rapid Response System programme theories. Review methods Included studies were critically appraised and graded using the Critical Appraisal Skills Programme tool. Data extraction and synthesis investigated the Rapid Response System theoretical propositions against the empirical evidence to refine Rapid Response System programme theories. Results The review found that the Rapid Response System programme theory achieved desired outcomes when there were sufficient skills mix of experienced staff, EWS protocols were used flexibly alongside clinical judgement and staff had access to ongoing, multiprofessional, competency-based education. However, ward cultures, hierarchical referral systems, workload and staffing resources had a negative impact on the implementation of the Rapid Response System. Conclusion To improve the recognition and management of patient deterioration, policymakers need to address those cultural, educational and organizational factors that have an impact on the successful implementation of Rapid Response Systems in practice.

A randomized-controlled trial to examine the effectiveness of the 'Home-but not Alone' mobile-health application educational programme on parental outcomes.

Abstract: Aim To examine the effectiveness of Home-but not Alone, a postnatal psychoeducational programme delivered via a mobile-health application for parents during the early postpartum period to improve parenting outcomes. Background The early postpartum period is often a challenging but crucial period for new parents. Supportive educational programmes delivered via mobile-health applications are needed to improve parenting outcomes. Design A randomized-controlled two-group pre-test and post-test design was adopted. Methods Data were collected over 6 months (December 2015–May 2016) from 250 participants in a tertiary teaching hospital. They were randomly assigned to the intervention (n = 126) or control (n = 124) groups. Parental self-efficacy, social support, postnatal depression and parenting satisfaction were measured using reliable and valid instruments. A linear mixed method analysis was used to compare the percentage change of all outcome variables. Results The intervention group had statistically significant improvements for parental self-efficacy, social support and parenting satisfaction at 4 weeks postpartum compared with the control group. Postnatal depression scores did not show any significant improvement compared with the control group. Conclusion The mobile-health application was effective in improving parental self-efficacy, social support and parenting satisfaction. Hence, it should be introduced and carried out in routine care by nurses. Further studies should focus on evaluating the effects of this programme in reducing postnatal depression amongst parents. Trial Registration Number ISRCTN99092313.

The development of professional practice standards for Australian general practice nurses

Abstract: Aims To explore the current role of general practice nurses and the scope of Australian nursing practice to inform the development of national professional practice standards for Australian general practice nurses. Background Increasing numbers of nurses have been employed in Australian general practice to meet the growing demand for primary care services. This has brought significant changes to the nursing role. Competency standards for nurses working in general practice were first developed in Australia in 2005, but limited attention has been placed on articulating the contemporary scope of practice for nurses in this setting. Design Concurrent mixed methods design. Methods Data collection was conducted during 2013-2014 and involved two online surveys of registered and enrolled nurses currently working in general practice, a series of 14 focus groups across Australia and a series of consultations with key experts. Findings Data collection enabled the development of 22 Practice Standards separated into four domains: 1) Professional Practice; 2) Nursing Care; 3) General Practice Environment; and 4) Collaborative Practice. To differentiate the variations in enacting these standards, performance indicators for the enrolled nurse, registered nurse and registered nurse advanced practice are provided under each standard. Conclusion The development of national professional practice standards for nurses working in Australian general practice will support ongoing workforce development. These standards are also an important means of articulating the role and scope of the nurses’ practice for both consumers and other health professionals, as well as being a guide for curriculum development and measurement of performance. This article is protected by copyright. All rights reserved.

Conservation of resources theory in nurse burnout and patient safety

Abstract: Aims To examine how the Conservation of Resources theory explains burnout in the nursing profession. Background Burnout, which is an accumulation of work-related mental stress in people-oriented occupations, has been an issue of concern for decades for healthcare workers, especially nurses. Yet, few studies have examined a unified theory that explains the etiology, progression and consequences of nurse burnout. Design This discussion article integrates current knowledge on nurse burnout using Conservation of Resources theory, which focuses on four resources (i.e., objects, conditions, personal characteristics and energy). Data sources The databases that were used in this study included CINAHL, PubMed and PsycINFO. All reviewed articles were published between January 2006 - June 2016. Findings The Conservation of Resources theory explains that burnout will occur as a result of perceived or actual loss of these four resources. Furthermore, nurse burnout could affect work performance, leading to lower alertness and overall quality of care. Implications for nursing Healthcare organizations and nursing administration should develop strategies to protect nurses from the threat of resource loss to decrease nurse burnout, which may improve nurse and patient safety. The Conservation of Resources theory can guide interventions to decrease burnout and future research that examines the relationship between professional nurse burnout and patient safety. Conclusion The Conservation of Resources theory explains the etiology, progression and consequences of nurse burnout. Future studies must explore whether nurse performance is a mediating factor between nurse burnout and patient safety. This article is protected by copyright. All rights reserved.

Hermeneutic phenomenological analysis: the 'possibility' beyond 'actuality' in thematic analysis.

Abstract: Aims This article discusses the ways researchers may become open to manifold interpretations of lived experience through thematic analysis that follows the tradition of hermeneutic phenomenology. Background Martin Heidegger's thinking about historical contexts of understandings and the notions of ‘alētheia’ and ‘techne’ disclose what he called meaning of lived experience, as the ‘unchanging Being of changing beings’. While these notions remain central to hermeneutic phenomenological research, novice phenomenologists usually face the problem of how to incorporate these philosophical tenets into thematic analysis. Design Discussion paper. Data sources This discussion paper is based on our experiences of hermeneutic analysis supported by the writings of Heidegger. Literature reviewed for this paper ranges from 1927 – 2014. We draw on data from a study of foreign domestic helpers in Hong Kong to demonstrate how ‘dwelling’ in the language of participants’ ‘ek-sistence’ supported us in a process of thematic analysis. Data were collected from December 2013 – February 2016. Implications for Nursing Nurses doing hermeneutic phenomenology have to develop self-awareness of one's own ‘taken-for-granted’ thinking to disclose the unspoken meanings hidden in the language of participants. Understanding the philosophical tenets of hermeneutic phenomenology allows nurses to preserve possibilities of interpretations in thinking. In so doing, methods of thematic analysis can uncover and present the structure of the meaning of lived experience. Conclusion We provide our readers with vicarious experience of how to begin cultivating thinking that is aligned with hermeneutic phenomenological philosophical tenets to conduct thematic analysis.

Burnout mediates the association between depression and patient safety perceptions: a cross‐sectional study in hospital nurses

Abstract: Aims: The aim of this study was to investigate the relationships between depressive symptoms, burnout and perceptions of patient safety. A mediation model was proposed whereby the association between symptoms of depression and patient safety perceptions was mediated by burnout. BACKGROUND: There is growing interest in the relationships between depressive symptoms and burnout in healthcare staff and the safety of patient care. Depressive symptoms are higher in healthcare staff than the general population and overlap conceptually with burnout. However, minimal research has investigated these variables in nurses. Given the conceptual overlap between depressive symptoms and burnout, there is also a need for an explanatory model outlining the relative contributions of these factors to patient safety. AIMS: To investigate the relationships between depressive symptoms, burnout and perceptions of patient safety. A mediation model was proposed whereby the association between symptoms of depression and patient safety perceptions was mediated by burnout. DESIGN: A cross-sectional questionnaire was distributed at three acute NHS Trusts. METHOD: Three-hundred and twenty-three hospital nursing staff completed measures of depressive symptoms, burnout and patient safety perceptions (including measures at the level of the individual and the work area/unit) between December 2015 - February 2016. RESULTS: When tested in separate analyses, depressive symptoms and burnout facets were each associated with both patient safety measures. Furthermore, the proposed mediation model was supported, with associations between depressive symptoms and patient safety perceptions fully mediated by burnout. CONCLUSION: These results suggest that symptoms of depression and burnout in hospital nurses may have implications for patient safety. However, interventions to improve patient safety may be best targeted at improving burnout in particular, with burnout interventions known to be most effective when focused at both the individual and the organisational level.

What is the impact of shift work on the psychological functioning and resilience of nurses? An integrative review.

Abstract: Aim To synthesize existing research to determine if nurses who work shifts have poorer psychological functioning and resilience than nurses who do not work shifts. Background Research exploring the impact of shift work on the psychological functioning and resilience of nurses is limited compared with research investigating the impact of shifts on physical outcomes. Design Integrative literature review. Data Sources Relevant databases were searched from January 1995–August 2016 using the combination of keywords: nurse, shift work; rotating roster; night shift; resilient; hardiness; coping; well-being; burnout; mental health; occupational stress; compassion fatigue; compassion satisfaction; stress; anxiety; depression. Review Methods Two authors independently performed the integrative review processes proposed by Whittemore and Knafl and a quality assessment using the mixed-methods appraisal tool by Pluye et al. Results A total of 37 articles were included in the review (32 quantitative, 4 qualitative and 1 mixed-methods). Approximately half of the studies directly compared nurse shift workers with non-shift workers. Findings were grouped according to the following main outcomes: (1) general psychological well-being/quality of life; (2) Job satisfaction/burnout; (3) Depression, anxiety and stress; and (4) Resilience/coping. We did not find definitive evidence that shift work is associated with poorer psychological functioning in nurses. Overall, the findings suggest that the impact of shift work on nurse psychological functioning is dependent on several contextual and individual factors. Conclusion More studies are required which directly compare the psychological outcomes and resilience of nurse shift workers with non-shift workers.

A realist review: what do nurse led self-management interventions achieve for outpatients with a chronic condition?

Abstract: Aim To examine how nurse-led interventions that support self-management of outpatients with chronic conditions work and in what contexts they work successfully. Background Self-management could be directed at goals such as quality of life, adherence, or patients’ empowerment. Self-management support is an increasingly important task of nurses. Many nurse-led interventions have been developed but it is not clear how these actually help improve patients’ self-management capabilities. Design Realist review. Data Sources Primary research studies on self-management support interventions conducted by nurses from January 2000 until March 2015 were retrieved from all relevant databases. The studies had a before/after design and used qualitative and quantitative methods. Review Methods For each study we described how the intervention was supposed to improve self-management and compared this with the empirical evidence. Next, we described the Context-Mechanism-Outcome strings for each separate study, explored patterns and integrated the findings. Results Thirty-eight papers were included, evaluating 35 interventions concerning a diversity of conditions. Seven different context-mechanism-outcome strings were identified. Interventions focusing on patients’ intrinsic processes were most successful. Least successful were interventions only providing education aimed at patient behaviour change. Various contexts can influence the success of the interventions: involvement of relatives, target group (i.e. chronic condition, motivation, being recently diagnosed or not), involvement of fellow patients and intervention group homogeneity or heterogeneity. Conclusion Successful interventions focus on patients’ intrinsic processes (i.e. motivation or self-efficacy). This would guide nurses to decide what self-management support intervention they can best use in their specific setting and patient group. This article is protected by copyright. All rights reserved.

Service user involvement enhanced the research quality in a study using interpretative phenomenological analysis - the power of multiple perspectives.

Abstract: Aim The aim of this study was to examine how service user involvement can contribute to the development of interpretative phenomenological analysis methodology and enhance research quality. Background Interpretative phenomenological analysis is a qualitative methodology used in nursing research internationally to understand human experiences that are essential to the participants. Service user involvement is requested in nursing research. Design We share experiences from 4 years of collaboration (2012–2015) on a mental health promotion project, which involved an advisory team. Methods Five research advisors either with a diagnosis or related to a person with severe mental illness constituted the team. They collaborated with the research fellow throughout the entire research process and have co-authored this article. We examined the joint process of analysing the empirical data from interviews. Our analytical discussions were audiotaped, transcribed and subsequently interpreted following the guidelines for good qualitative analysis in interpretative phenomenological analysis studies. Results The advisory team became ‘the researcher's helping hand’. Multiple perspectives influenced the qualitative analysis, which gave more insightful interpretations of nuances, complexity, richness or ambiguity in the interviewed participants’ accounts. The outcome of the service user involvement was increased breadth and depth in findings. Conclusion Service user involvement improved the research quality in a nursing research project on mental health promotion. The interpretative element of interpretative phenomenological analysis was enhanced by the emergence of multiple perspectives in the qualitative analysis of the empirical data. We argue that service user involvement and interpretative phenomenological analysis methodology can mutually reinforce each other and strengthen qualitative methodology.

Resilience as a moderator of the indirect effects of conflict and workload on job outcomes among nurses

Abstract: Aim To examine the relative effects of interpersonal conflict and workload on job outcomes (turnover intentions, burnout, injuries) and examine if resilience moderates the indirect effects of conflict and workload on job outcomes via job-related negative affect. Background There is interest in understanding resilience in the nursing profession. Placing resilience in the context of the Emotion-Centered Model of Occupational Stress (Spector, 1998) is a novel approach to understanding how resilience ameliorates the negative effects of workplace stressors. Design This study used a two-wave survey design to collect data from 97 nurses across medical units. Methods Nurses working in the United States were recruited in June 2014 using Qualtrics Panels, an online survey platform service that secures participants for research. Nurses were contacted via email at two time points, two weeks apart and provided a link to an online survey. SPSS v. 23 and PROCESS v2.15 were used to analyze regressions and moderated mediation. Results/Findings Interpersonal conflict predicted turnover intentions and burnout; workload predicted injuries. Job-related negative affect mediated the relationships between stressors and job outcomes except for the direct effect of workload on injuries. Low resilience increased the magnitude of the indirect effects of conflict on job outcomes. Conclusion Job characteristics like workload predicted unique variability in self-reported physical injuries. Conflict at work, a social stressor, predicted well-being and job attitudes. Highly resilient nurses bounced back after experiencing conflict in the workplace. Resilience should be explored for its potential as a method to reduce the negative effects of social stressors. This article is protected by copyright. All rights reserved.

Effects of substituting nurse practitioners, physician assistants or nurses for physicians concerning healthcare for the ageing population: a systematic literature review

Abstract: Aims To evaluate the effects of substituting nurse practitioners, physician assistants or nurses for physicians in long-term care facilities and primary healthcare for the ageing population (primary aim) and to describe what influences the implementation (secondary aim). Background Healthcare for the ageing population is undergoing major changes and physicians face heavy workloads. A solution to guarantee quality and contain costs might be to substitute nurse practitioners, physician assistants or nurses for physicians. Design A systematic literature review. Data sources PubMed, EMBASE, CINAHL, PsycINFO, CENTRAL, Web of Science; searched January 1995–August 2015. Review methods Study selection, data extraction and quality appraisal were conducted independently by two reviewers. Outcomes collected: patient outcomes, care provider outcomes, process of care outcomes, resource use outcomes, costs and descriptions of the implementation. Data synthesis consisted of a narrative summary. Results Two studies used a randomized design and eight studies used other comparative designs. The evidence of the two randomized controlled trials showed no effect on approximately half of the outcomes and a positive effect on the other half of the outcomes. Results of eight other comparative study designs point towards the same direction. The implementation was influenced by factors on a social, organizational and individual level. Conclusion Physician substitution in healthcare for the ageing population may achieve at least as good patient outcomes and process of care outcomes compared with care provided by physicians. Evidence about resource use and costs is too limited to draw conclusions.

A systematic review of the psychometric properties of instruments for assessing the quality of the physical environment in healthcare.

Abstract: Aim: To identify instruments measuring the quality of the physical healthcare environment, describe their psychometric properties. Background: The physical healthcare environment is regarded as a quality factor for health care. To facilitate evidence-based design there is a need for valid and usable instruments that can evaluate the design of the healthcare environment. Design: Systematic psychometric review. Data sources: A systematic literature search in Medline, CINAHL, Psychinfo, Avery index and reference lists of eligible papers (1990–2016). Review method: Consensus based standards for selection of health measurement instruments guidelines were used to evaluate psychometric data reported. Results: Twenty-three instruments were included. Most of the instruments are intended for healthcare environments related to the care of older people. Many of the instruments were old, lacked strong, contemporary theoretical foundations, varied in the extent to which they had been used in empirical studies and in the degree to which their validity and reliability had been evaluated. Conclusions: Although we found many instruments for measuring the quality of the physical healthcare environment, none met all of our criteria for robustness. Of the instruments, The Multiphasic environmental assessment procedure, The Professional environment assessment protocol and The therapeutic environment screening have been used and tested most frequently. The Perceived hospital quality indicators are user centred and combine aspects of the physical and social environment. The Sheffield care environment assessment matrix has potential as it is comprehensive developed using a theoretical framework that has the needs of older people at the centre. However, further psychometric and user-evaluation of the instrument is required.

The diagnosis and lived experience of polycystic ovary syndrome: A qualitative study.

Abstract: Publisher policy: author can archive post-print on institutional repository after 12 months embargo. Publisher's version/PDF cannot be used. Publisher source must be acknowledged with citation. Must link to publisher version.

Interventions for nurses’ well-being at work: a quantitative systematic review

Abstract: Aim To gather, assess and synthesize current research knowledge on the interventions aiming to improve nurses’ well-being at work. Background Previous reviews describe health care professionals’ well-being at work from the perspective of burnout. Research on the interventions for and their effectiveness on nurses’ well-being at work is sporadic. Design A quantitative systematic review based on the procedure of the Centre for Reviews and Dissemination. Methods CINAHL, Cochrane, EBSCO, PubMed, PsycInfo, Scopus databases were sought from 2009–March 2015. The final data consisted of eight studies described in 10 articles. The study design was RCT in three studies, CBA in three and ITS in two studies. The studies were assessed with the Cochrane risk of bias tool. Data were summarised narratively and displayed in a harvest plot. Results Two of the six interventions were person-directed, two combined person- and organisation-directed and two organisation-directed interventions. Half of them were mainly targeted at stress management while the others aimed at improving interaction with colleagues, work methods and conditions or at supervision of professional skills. Conclusions There was a lot variation in the conceptual bases and the use of evaluation measurements in the studies and the interventions were carried out in a heterogeneous way. Moderate evidence was found to support the use of interventions among nurses employed at in-patient and out-patient units in four out of the six interventions. The review pointed out a need for research on standardised interventions on nurses’ well-being at work and their effectiveness with long-term follow-ups.

Randomized controlled trial of family-based education for patients with heart failure and their carers.

Abstract: Aim The aim of this study was to evaluate a heart failure education programme developed for patients and carers in Thailand. Background Heart failure is major health problem. This is the first trial of a family-based education programme for heart failure patients and carers residing in rural Thailand. Design Randomized controlled trial. Methods One hundred patient-carer dyads attending cardiac clinics in southern Thailand from April 2014 - March 2015 were randomized to usual care (n = 50) or a family-based education programme (n = 50) comprising face-to-face counselling, a heart failure manual and DVD and telephone support. Assessments of heart failure knowledge, health-related quality of life, self-care behaviours and perceived control were conducted at baseline, three and six months. Results Linear mixed-effects model revealed that patients and carers who received the education programme had higher knowledge scores at three and six months than those who received usual care. Among those who received the education programme, when compared with those who received usual care, patients had better self-care maintenance and confidence, and health-related quality of life scores at three and six months, and better self-care management scores at six months, whereas carers had higher perceived control scores at three months. Conclusion Addressing a significant service gap in rural Thailand, this family-based heart failure programme improved patient knowledge, self-care behaviours and health-related quality of life and carer knowledge and perceived control.

Recruiting nurses through social media: Effects on employer brand and attractiveness

Abstract: Aim To investigate whether and how nurses’ exposure to a hospital's profile on social media affects their perceptions of the hospital's brand and attractiveness as an employer. Background Since in many places across the globe hospitals are struggling with nursing shortages, competition is rising to be perceived as an attractive employer by this target group. Organizations are increasingly using social media for recruitment, however, little is known about its effects on potential applicants’ perceptions of the organization as an employer. We thus examine whether these effects occur and rely on the media richness theory to explain the mechanisms at play. Design A between-subjects experimental design was applied. Three conditions were used: a control group, one condition that required visiting the Facebook page of a hospital and one condition that required visiting the LinkedIn page. Method The focal organization was an existing Belgian hospital which had a LinkedIn and a Facebook page. An online questionnaire was sent to nursing students and employed nurses over 5 months in 2015-2016. Results Nurses’ exposure to the hospital's Facebook or LinkedIn page had a significant positive effect on a majority of the employer brand dimensions, both instrumental and symbolic. In addition, nurses who visited the Facebook page felt more attracted to working at the hospital. Most of these effects were mediated by social presence. Conclusion Nurses’ perceptions of employers can be positively influenced by seeing a hospital's social media page. Hospitals can thus employ social media to improve their employer brand image and attractiveness. This article is protected by copyright. All rights reserved.

A systematic review of evidence relating to clinical supervision for nurses, midwives and allied health professionals.

Abstract: Aim The aim of this study was to systematically review evidence relating to clinical supervision for nurses, midwives and allied health professionals. Background Since 1902 statutory supervision has been a requirement for UK midwives, but this is due to change. Evidence relating to clinical supervision for nurses and allied health professions could inform a new model of clinical supervision for midwives. Design A systematic review with a contingent design, comprising a broad map of research relating to clinical supervision and two focussed syntheses answering specific review questions. Data sources Electronic databases were searched from 2005 - September 2015, limited to English-language peer-reviewed publications. Review methods Systematic reviews evaluating the effectiveness of clinical supervision were included in Synthesis 1. Primary research studies including a description of a clinical supervision intervention were included in Synthesis 2. Quality of reviews were judged using a risk of bias tool and review results summarized in tables. Data describing the key components of clinical supervision interventions were extracted from studies included in Synthesis 2, categorized using a reporting framework and a narrative account provided. Results Ten reviews were included in Synthesis 1; these demonstrated an absence of convincing empirical evidence and lack of agreement over the nature of clinical supervision. Nineteen primary studies were included in Synthesis 2; these highlighted a lack of consistency and large variations between delivered interventions. Conclusion Despite insufficient evidence to directly inform the selection and implementation of a framework, the limited available evidence can inform the design of a new model of clinical supervision for UK-based midwives.