Allison P Squires

Abstract

Background: An optimal work environment for nurses is characterized primarily by appropriate staffing, good team relations, and support from the management staff. These factors are consistently associated with a positive assessment of patient safety by a hospital’s employees and a reduction in hospital mortality rates. Aim: To understand the relationships between the work environment as perceived by nurses on the 30-day mortality of patients treated in Polish hospitals. Background: An optimal work environment for nurses is characterized primarily by appropriate staffing, good team relations, and support from the management staff. These factors are consistently associated with a positive assessment of patient safety by a hospital’s employees and a reduction in hospital mortality rates. Material and methods: The analysis used discharge data from 108,284 patients hospitalized in internal medicine and surgery departments in 21 hospitals (with 24/7 operations) in Poland. Administrative data included coded data to estimate 30-day mortality. A Nurses’ satisfaction questionnaire, including the PES-NWI scale and the SAQ questionnaire, was used to assess the work environment of nurses (n = 1,929). Correlations between variables were assessed using the Pearson coefficient. The analysis used a Poisson regression model, which belongs to the class of generalized linear models. Results: A lower 30-day mortality rate amongst patients was found among those treated in hospitals where the personnel feel that they may question the decisions or actions of their superiors regarding the care provided (r = − 0.50); nurses are informed about changes introduced on the basis of reports about negligence and mistakes (r = − 0.50); the ward nurse is a good manager (r = − 0.41); nurses receive timely information from the head of the department that may have an impact on their work (r = − 0.41). Conclusions: Factors related to care during hospital stay such as the organization of care at the ward level, analysis of care errors, the number of staff providing direct patient care, informing nurses about mistakes without punishment, and the possibility of nurses challenging the decisions or actions of superiors, which concerns care providing, affect the 30-day mortality of patients after the end of hospitalization in Polish hospitals.

Abstract

Background: The organizational studies' literature suggests that employees' expressions of voice and silence may be distinct concepts with different predictors. Organizational researchers also argue that both employees' voice and silence are related to burnout; however, these relationships have not been adequately examined in the healthcare context. Objective: This study aimed to investigate the relationships among nurses' perceived impact, psychological safety, voice behaviors, and burnout using a theoretical model. Voice behaviors were conceptualized as voice and silence. Design: A cross-sectional, correlational study design was employed. Settings: Study data were collected in 34 general hospitals in South Korea. Participants: A total of 1255 registered nurses providing direct care to patients were included in this study. Methods: Using a convenience sampling method, a web-based survey was conducted to obtain data. All variables were measured using standardized instruments. A structural equation modeling analysis was employed to test a hypothesized model positing that perceived impact and psychological safety have both direct and indirect effects on nurse burnout through voice and silence. The response rate was 72.8 %. Results: The findings supported the hypothesized model. Both perceived impact and psychological safety were positively related to expressions of voice, but both were negatively associated with silence. We also found that perceived impact was more strongly associated with voice than with silence, while psychological safety had a stronger impact on silence than on voice. Furthermore, voice reduced burnout, while silence increased it. Finally, perceived impact reduced burnout through voice (β = − 0.10, 95 % confidence interval [− 0.143, − 0.059]) and silence (β = − 0.04, 95 % confidence interval [− 0.058, − 0.014]), and psychological safety also decreased burnout through voice (β = − 0.04, 95 % confidence interval [− 0.057, − 0.016]) and silence (β = − 0.07, 95 % confidence interval [− 0.101, − 0.033]). Additional analyses revealed that prohibitive voice and silence significantly mediated the associations between psychological safety and burnout and perceived impact and burnout, but the mediating role of promotive voice was not statistically significant. Conclusions: It is important to recognize that voice and silence are distinct concepts. Moreover, to reduce nurse burnout, nurse managers and hospital administrators should develop separate strategies for promoting nurses' perceived impact and psychological safety, as their influences on voice and silence differ. Registration: Not applicable. Tweetable abstract: Voice and silence both influence nurse burnout. Separate strategies should be applied to voice and silence, as they are different concepts.

Abstract

BACKGROUND: As the quality of cancer care improves, oncology patients face a rapidly increasing number of treatment options. Thus, it is vital that they are full and active partners in the treatment decision-making process. Awareness of disease status has been investigated in the literature; it has been inconsistently conceptualized and operationalized.OBJECTIVE: The aim of this integrative review was to develop a conceptual definition and model of the awareness of disease status among patients with cancer.METHODS: Whittemore and Knafl's integrative review methodology guided this article. We obtained data through a systematic search of 8 databases. Key terms utilized were awareness, perception, truth disclosure, diagnosis, prognosis, terminal illness, status, neoplasm, and metastasis. Dates through January 2020 were searched to capture all relevant articles. Sixty-nine articles met inclusion criteria.RESULTS: The integrative review methodology guided the development of a conceptual definition and model. The concept of "awareness of disease status" was defined as the individual patient's understanding of being diagnosed and treated for cancer based on the multifactorial components of individual patient characteristics and contextually driven communication practices of healthcare providers. This understanding is dynamic and changes throughout the disease trajectory.CONCLUSION: These findings will inform consistency in the literature. Such consistency may improve person-centered clinical communication, care planning practices, and, ultimately, cancer-related outcomes.IMPLICATIONS FOR PRACTICE: With a greater understanding of the complexity of patients' awareness of disease status, nurses will be able to guide their patients to make informed decisions throughout their disease trajectory.

Abstract

Background Cardiovascular disease (CVD) prevalence is high in Ghana-but awareness, prevention, and treatment is sparse, particularly in rural regions. The nurse-led Community-based Health Planning and Services program offers general preventive and primary care in these areas, but overlooks CVD and its risk factors. Methods We conducted in-depth interviews with 30 community members (CM) in rural Navrongo, Ghana to understand their knowledge and beliefs regarding the causes and treatment of CVD and the potential role of community nurses in rendering CVD care. We transcribed audio records, coded these data for content, and qualitatively analyzed these codes for key themes. Results CMs described CVD as an acute, aggressive disease rather than a chronic asymptomatic condition, believing that CVD patients often die suddenly. Yet CMs identified causal risk factors for CVD: not only tobacco smoking and poor diet, but also emotional burdens and stressors, which cause and exacerbate CVD symptoms. Many CMs expressed interest in counseling on these risk factors, particularly diet. However, they felt that nurses could provide comprehensive CVD care only if key barriers (such as medication access and training) are addressed. In the interim, many saw nurses' main CVD care role as referring to the hospital. Conclusions CMs would like CVD behavioral education from community nurses at local clinics, but feel the local health system is now too fragile to offer other CVD interventions. CMs believe that a more comprehensive CVD care model would require accessible medication, along with training for nurses to screen for hypertension and other cardiovascular risk factors-in addition to counseling on CVD prevention. Such counseling should build upon existing community beliefs and concerns regarding CVD-including its behavioral and mental health causes-in addition to usual measures to prevent CVD mortality such as diet changes and physical exercise.

Abstract

Background: Nurses’ work environment influences nursing practice. Inappropriate working conditions are the result of underdeveloped workplace infrastructure, poor work organisation, inadequate education, and inappropriate staffing norms. The aim of this study was to describe and examine the predictors that affect nurses’ work environment using the Practice Environment Scale of the Nursing Work Index (PES-NWI). Methods: The validation of the PES-NWI was made. Nurse-reported job characteristics were used as independent variables. The sample included 1,010 nurses from adult surgical and medical units at 10 Slovenian hospitals. The Nurse Forecasting (RN4CAST) protocol was used. Permission to conduct the study was obtained from the National Medical Ethics Committee. Results: The PES-NWI mean (2.64) was low, as were job and career satisfaction at 2.96 and 2.89, respectively. The PES-NWI can be explained in 48% with ‘Opportunities for advancement’, ‘Educational opportunities’, ‘Satisfaction with current job’, ‘Professional status’, ‘Study leave’, and ‘Level of education’. A three-factor solution of PES-NWI yielded eight distinct variables. Conclusions: The obtained average on the Nursing Work Index was one of the lowest among previously conducted surveys. Nurses should be recognized as equals in the healthcare workforce who need to be empowered to develop the profession and have career development opportunities. Inter-professional relations and equal involvement of nurses in hospital affairs are also very important. Trial registration: This is a non-intervention study – retrospectively registered.

Abstract

This manuscript guides school nurses in addressing the unique needs of U.S. school-aged students and families with limited English proficiency (LEP). Owing to the increasing ethnic and racial diversity in U.S. K–12 schools, school nurses will likely encounter children and families with LEP. Students with LEP may be part of a family which immigrated to this country as permanent residents, are refugees, or asylum seekers. Some may be from migrant families who move throughout the region or country for work. School health services, including nursing services, may be the first and only health resource to which these children have consistent access. The availability and importance of language access services are highlighted, as well as tips for school nurses to advocate for language access resources, training for effective communication, understanding the legal landscape, and addressing cultural beliefs that influence health behaviors. Advocacy toward identifying the distinctive needs of families with LEP aims to help school nurses target equitable health outcomes.